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Department of Medicine 1. In the pathogenesis of fever, which of the following statements is NOT true? A. Shunting of blood from periphery to internal organs occur to conserve heat B. Presence of PGE2 in the brain elevates set point of body temperature C. Exogenous and endogenous pyrogens are destroyed by phagocytes D. Elevated cAMP induces the release of monoamine neurotransmitters 2. The sympathetic nervous system can increase heat conservation through: A. Increased heart rate B. Vasoconstriction C. Increased skeletal muscle contraction D. Resetting of thermostat level at hypothalamus 3. Patients with fever may also complain of myalgia and/or arthralgia. These can be due to: A. Increased muscular tone C. Effect of interferon B. Effect of peripheral PGE2 D. Effect of endotoxins 4. A 20 y/o male was brought to the ER due to muscle rigidity. He also manifest with hallucination, pupil dilation and increased temperature with dry skin. The above findings can be due to: A. Amphetamine abuse C. Heat stroke B. Extrapyramidal symptoms D. Tetany 5. Increased heat production in cases of thyrotoxicosis can be secondary to: A. Chemical reaction of basal metabolism C. Chemical thermogenesis B. Increased skeletal muscle tone D. Vasodilation 6. What component of the lipid profile is anti-atherogenic? A. High density lipoprotein C. Total cholesterol B. Low density lipoprote.in D. Triglycerides 7. Which of the following manifestation is not a major criterion for rheumatic fever? A. Erythema multiforme C. Subcutaneous nodules B. Migratory polyarthritis D. Sydenham’s chorea 8. A run of 3 consecutive premature ventricular depolarizations is known as: A. Asystole C. Ventricular fibrillation B. Supraventricular tachycardia D. Ventricular tachycardia 9. What is the most common type of atrial septal defect? A. Membranous type C. Ostium secundum B. Ostium primum D. Sinus venosus 10. What is the most common cause of secondary hypertension in the general population? A. Cushing’s syndrome C. Primary aldosteronism B. Pheochromocytoma D. Renal diseases 11. Which of the following statements regarding cardiac symptoms is false? A. Chest discomfort and/or dyspnea that appear only during activity are characteristic of heart disease B. Many patients with heart disease may be asymptomatic C. Patients with valvular stenosis may manifest heart failure symptoms D. It is rare for asymptomatic cardiac patients to develop sudden death, acute myocardial infarction or stroke (p. 1301) 12. Which of the following best characterize the second heart sound? A. During inspiration, there’s and increase blood flow to the left ventricle casing a delay in aortic valve closure B. Wide splitting of the second heart sound may be due to right bundle branch block C. In pulmonary hypertension the second heart sound is soft D. P2 is normally louder than A2 in the second left intercostal space (p. 1307-1308) 13. Valvular abnormalities and chamber dilatation are best diagnosed by: A. Electrocardiogram C. Echocardiography B. Treadmill exercise testing D. Nuclear imaging techniques (p. 1320) 14. The electrocardiogram of a patient who is hypertensive for almost 5 years would show which of the following? A. Tall left precordial R waves and deep right precordial S waves B. Diminished voltages in the limb leads (aVL or aVR) C. Right atrial abnormality absence of repolarization abnormalities (ST depression and T-wave inversions) (p. 1314) 15. Which is not a component of the metabolic syndrome? A. Waist circumference of >40 inches in men B. Triglycerides >150 mg/dL C. LDL > 40 mg/dL D. Blood pressure >130/>85 mmHg (p. 1432) 16. A patient who shows on auscultation with an accentuated first heart sound, opening snap and a mid-diastolic rumbling murmur at the apex is suffering from: A. Mitral regurgitation C. Aortic regurgitation B. Mitral stenosis D. Aortic stenosis (p. 1390-1391) 17. The most common etiology for secondary hypertension is: A. Renal parenchymal hypertension C. Primary aldosteronism B. Renovascular hypertension D. Pheochromocytoma (p. 1464) 18. Liebman-Sacks lesion which is a small verrucous vegetation usually found in the ventricular surface of the mitral valve is associated with this disease: A. Rheumatoid arthritis C. Rheumatic Heart Disease B. SLE D. Rheumatomyositis 19. Spironolactone is the drug of choice in the medical treatment of hypertension o which of the following diseases? A. Essential hypertension C. Phrochromocytone B. Renal artery stenosis D. Hyperaldosteronism 20. Saw tooth appearance of EKG tracing is diagnostic of: A. Ventricular tachycardia C. Atrial flutter B. Ventricular fibrillation D. Atrial fibrillation 21. MVP has the following features EXCEPT: A. More common in males B. Most common course of isolated severe MR in North America C. May cause syncope D. Mid to late systolic click is the most important finding Reference: Harrison’s Principles of Internal Medicine 15th ed. pp. 1348 22. Which of the following is a major criterion in the Framingham Criteria for the diagnosis of CHF? A. Tachycardia C. Cardiomegaly B. Dyspnea or exertion D. Extremity edema Reference: Harrison’s Principles of Internal Medicine 15th ed. pp. 1323 23. The most common primary cardiac tumor is: A. Rhabdomyoma C. Lymphoma B. Myxoma D. Sarcoma 24. An effective drug for meningococcal chemoprophylaxis: A. Cefotaxime C. Chloramphenicol B. Ceftriaxone D. Ceftizoxime (See p.854, 16th ed. of Harrison’s) 25. The etiologic agent of chancroid is: A. Treponema pallidum C. Haemophilus ducreyl B. Calymmatobacterium granulomatis D. Neisseria gonorrhea (See p.771 Ulcerative Genital Lesions, 16th ed. Harrison’s) 26. Pyomyositis is usually due to: A. Group A Streptococcus C. Staphylococcus aureus B. Streptococcus pyogenes D. Clostridium perfringens (See p.744 Myositis/Myonecrosis, 16th ed. Harrison’s) 27. Cytoplasmic inclusion bodies found in certain neurons in the brain, and are diagnostic of rabies: A. Negri bodies C. Schuffner’s dots B. Owl’s eye bodies D. James stipplings th (See p.1157 Pathogenesis of Rabies, 16 ed. Harrison’s) 28. Most vaccine for adults can be given also to pregnant women EXCEPT: A. Tetanus, diphtheria C. MMR, Varicelia B. Pneumococcal, influenza D. Rabies, Hepatitis B (See p.720 Use of Vaccines in Special Circumstances, 16th ed. Harrison’s) 29. The single most important diagnostic test to request for a patient with clinical signs and symptoms suggestive of PTB is: A. CXR C. TB culture B. PCR D. Direct microscopy th (Sep.960 AFB microscopy, 16 ed. Harrison’s) 30. Urethritis can be documented on the basis of: A. Mucopurulent or purulent discharge B. Gram stain or urethral secretion > 5 wbcs/hpf C. First void urine demonstrating > 10 wbcs/hpf D. Either A or C (See p.764 Approach to patient with suspected urethritis, 16th ed. Harrison’s. Letter B may be correct but remember that the gram stain is read per oil immersion field) 31. Among the available test for Leptospirosis, the most sensitive and specific is: A. Culture with EMJH B. ELISA for antibodies C. MAT using genus specific antigen for Leptospira patoc D. Dipstick assay (See p.990 Diagnosis of Leptospirosis, 16th ed. Harrison’s) 32. The following are true of malaria EXCEPT: A. Hypoglycemia in falciparum malaria is associated with poor prognosis B. Splenic enlargement in endemic areas reflects repeated infection C. In severe malaria, one predicter of poor prognosis is the predominance of immature P. falciparum parasites D. The thick malarial smear has the advantage over the thin smear of concentrating parasites, thus increasing diagnostic sensitivity (See Table 195-3 p.1222, 16th ed. Harrison’s) 33. True of Staphylococcal infections EXCEPT: A. Toxic Shock Syndrome is a life threatening condition caused by toxins elaborated by S-aureus B. Nikolsky’s sign is a feature of TSS C. In Ritter’s disease, the skin often has a sandpaper-like texture and is tender D. Staphylococcal pneumonia most commonly follows tracheal intubation of a hospitalized patient or vital infection of the respiratory tract. (See p.819 Staphylococcal Scalded Skin Syndrome, 16th ed. Harrison’s) 34. The following are infection control measures EXCEPT: A. Irrigation of urinary catheters, with or without antimicrobials, may actually increase infection risk B. Replacing tubing circuits at intervals > 48 hours is one effective measure in the aseptic care of respirator equipment C. A control measure for surgical wound infection, aside from OR asepsis, antimicrobial prophylaxis for high risk procedures D. The recommended frequency of rotation of central venous catheter sites is 5 days (See p.778 every 72 to 96 hours, infections related to vascular access and monitoring, 16th ed. Harrison’s) 35. Characteristics of the itch mite include the following: A. It is an oval, ventrally flattened mite B. It can live on beddings for 7 days C. The female dies after copulation D. The female lays 20 eggs per day Andrews’ Diseases of the skin, 9th ed. p. 564-565 36. Infantile atopic dermatitis is characterized by the following: A. Lesions are less exudative, drier and more papular B. The buttocks and diaper area are often involved C. Lesions are lichenified plaques D. The face and scalp are more often involved Andrews’ Diseases of the skin, 9th ed. p. 70 37. The main substance causing vasodilation in urticaria is: A. Serotonin C. Bradykinin B. Histamine D. Prostaglandins th Andrews’ Diseases of the skin, 9 ed. p. 163 38. Gutate psoriasis is usually preceded by: A. Trauma C. Streptococcal pharyngitis B. Hepatitis D. Viral exanthem th Andrews’ Diseases of the skin, 9 ed. p. 221 39. An infectious disease transmitted by the body louse is: A. Trench fever C. Tsutsugamushi fever B. Dengue fever D. Scrub typhus Andrews’ Diseases of the skin, 9th ed. p. 552-553 40. Hormone implicated in the pathogenesis of androgenetic alopecia. A. Estrogen C. Testosterone B. Cortisol D. Growth hormone th Andrews’ Diseases of the skin, 9 ed. p. 947-948 41. The 4 cutaneous findings of 11 criteria for diagnosis of SLE are: A. Malar erythema, urticaria, photosensitivity and discoid LE B. Malar erythema, photosensitivity, discoid LE, oral ulcers C. Malar erythema, photosensitivity, skin erosion, oral ulcers D. None of the above Andrews’ Diseases of the skin, 9th ed. p. 180-181 42. The prothrombotic effect of coumarin (warfarin) during the early phases of its administration is due to a rapid drop in the plasma concentration of: A. Antithrombin C. Factor VII B. Protein C D. Plasminogen 43. A 55-year old woman with Grave’s disease developed pallor and scleral jaundice. Her peripheral blood showed pancytopenia, presence of macro-ovalocytes and hypersegmented neutrophils. What is the most likely diagnosis? A. Megaloblastic anemia C. Aplastic anemia B. Myelodysplastic syndrome D. Paroxysmal nocturnal hemoglobinuria 44. A 55-year old man previously diagnosed to have stage 0 CLL developed anemia and unconjugated hyperbilirubinemia. What is the single most important laboratory test required to diagnose the cause of the anemia? A. A repeat bone marrow examination C. Serum ferritin determination B. Coomb’s test D. Serum folate and vitamin B12 determination 45. A 24-year old female suddenly developed jaundice, confusion, petechiae, and fever. Peripheral blood examination showed anemia and thrombocytopenia. Fragmented red cells were seen with nucleated red blood cells. Prothrombin and partial thromboplastin time were normal. What is the treatment of choice for this patient? A. Plasmapharesis C. Pulse therapy with cyclophosphamide B. High dose glucocorticoids D. Splenectomy 46. The treatment of choice in patients with acute promyelocytic leukemia. A. Anthracycline + cytosine arabinoside B. Vincristine + prednisone C. All-transretinoic acid (ATRA) + anthracycline D. Melphalan + prednisone 47. A 36-year old male was refereed to an internist after a routine blood examination showed a low mean cell volume (MCV) but with no evidence of anemia. Stool is negative for occult blood nor was there exposure to lead. Serum ferritin is normal. What is the most likely diagnosis? A. Early iron deficiency anemia C. Thalassemia minor B. Anemia of chronic disease D. Sideroblastic anemia 48. A 32-year old male had excessive bleeding after a dental extraction. He has no other medical problems and physical examination is unremarkable. His mother has history of excessive bleeding. Bleeding time and PTT was prolong twice the normal range but the prothrombin time is normal. What is the most likely diagnosis? A. Hemophilia A C. Factor XII deficiency B. Hemophilia B D. von Willebrand’s disease 49. A 64-year old woman for preoperative evaluation was noted to have a markedly prolong PTT. Her prothrombin time, platelet count, and bleeding time were normal. She required blood transfusion blood transfusion after a dental extraction 2 years ago. Two siblings male and female has history of bleeding. The most likely diagnosis is a deficiency of: A. Factor VII C. Factor XI B. Factor VIII D. Factor XII 50. An 18-year old male develops massive bleeding after removal of a large sebaceous cysts. Prothrombin time, PTT, platelet count, and bleeding time were normal. There is no family history of bleeding time. Which of the following tests should be ordered? A. Factor XI level C. Urea clot lysis test B. Factor XII level D. Platelet aggregation study 51. A 59 year old, female, known hypertensive for 5 years, with poor compliance to anti-hypertensive medications, now complains of pallor, easy fatigue, anorexia, and itchiness. The kidneys on ultrasound appear contracted. Which casts will you find in the urinalysis in this condition? A. RBC casts C. Broad casts B. WBC casts D. Hyaline casts th Harrison 16 ed. pp. 251 52. The leading cause of end stage kidney disease is: A. Chronic glomerulonephritis C. Polycystic kidney disease B. Diabetic nephropathy D. Chronic pyelonephritis Harrison 16th ed. pp. 1688 53. A 40 year old, male, known diabetic for 8 years is noted to have +1 proteinuria. The best medication at this time is: A. Glibenclamide C. Rosiglitazone B. Insulin D. Captopril th Harrison 16 ed. pp. 1689 54. A 25 year old, female, developed anasarca over 2 months period. Her urinalysis showed RBC and RBC casts. Kidney biopsy revealed membranous glomerulonephritis. This condition is most likely to be associated with: A. Hepatitis B infection C. Diabetes mellitus B. Hypertension D. Periarteritis nodosa th Harrison 16 ed. pp. 1687 55. A 44 year old, male, operated twice for kidney stones has an estimated creatinine clearance of 40 ml/min. At what stage of renal failure is he in now? A. Stage 1 C. Stage 3 B. Stage 2 D. Stage 4 th Harrison 16 ed. pp. 1653 56. Dietary protein is restricted in which of these kidney conditions: A. Acute Pyelonephritis C. Renal failure B. Polycystic kidney disease D. Chronic glomerulonephritis th Harrison 16 ed. pp. 1652 57. A 25 year old, male, was admitted because of multiple gunshot wounds. On admission, he was hypotensive and tachycardic. He was immediately scheduled for exploratory laparotomy which lasted for about 4 hours. A total of 6 units of blood were transfused. He was oliguric and acidotic, for the next 7 days. At what phase of acute renal failure is he in? A. Initiation phase C. Diuretic phase B. Maintenance phase D. Recovery phase th Harrison 16 ed. pp. 1645 58. A 10 year old, boy, has puffy eyelids, tea-colored urine, and BP of 130 / 100, noted after 2 weeks bout of sore throat and fever. The clinical diagnosis is nephrotic syndrome. The condition that would initiate all the subsequent components of the syndrome is: A. Hypoproteinemia C. Lipiduria B. Glomerular proteinuria D. Edema th Harrisson 16 ed. pp. 1684 59. A 44 year old, male, was admitted to Philippine Hear Center because of severe chest pain. Initial findings indicate acute myocardial infarction. Within few minutes after admission, he developed transient arrhythmia and drop in BP. The serum creatinine went up from 0.9 mg% on admission to 1.3 mg% after 2 days. The urine output was about 250-300 /day. These findings can be explained on the basis of: A. Intratubular block by debris C. Back leak of glomerular filtrate B. Renal hypoperfusion D. Nephrotoxicity from drugs Harrison 16th ed. pp. 1645 60. A 33 year old, female, is suffering from SLE for the last 5 years. A year ago, proteinuria and hematuria were noted in her urinalysis. And subsequently her serum creatinine slowly deteriorated. The progression of her renal failure is due to: A. Nephrotoxicity C. Renal hypoperfusion B. Reduction in renal mass D. Interstitial nephritis Harrison 16th ed. pp. 1653 61. One of the following is not a classification criteria in the diagnosis of Rheumatoid arthritis: A. Morning stiffness less than 1 hour B. Radiographic change like erosion or decalcification of wrist bone C. Serum rheumatoid factor positivity D. Symmetric arthritis Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1885 62. One of the following statements is not true with regards to the epidemiology of SLE: A. Common in women of child bearing age B. Males are spared C. More common in blacks than in white D. Prevalence is form 15 to 50/100,000 population Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1874 Aling Nena, 75-years old, female, 5’2 ft tall, 100 lbs. Consulted because of pain in the (R) knee for a year; which is worst in the afternoon and after a long walk and improves with rest. On P.E. as bony hypertrophy and worse crepitation. 63. The pain she is experiencing maybe due to any of the following EXCEPT: A. Ligament insertion strain C. Muscle pain B. Cartilage destruction D. Capsular stretching Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1936-1937 64. One of the following statement about TB arthritis is true: A. Culture of M. tuberculosis from the synovial biopsy is positive in 90% of cases B. Joint destruction is rapid C. Polyarticular involvement is more common D. Treatment includes administration of Nafcillin and gentamycin Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1947 65. A 23-years old female patient consulted because of on and off pains, malar rash, oral ulcers and increasing hairloss. A probable diagnosis of SLE was made confirmed by: A. High ESR and (+) CRP B. High titer dsDNA and hypocomplementemia C. Leucopenia and anemia D. Thrombocytosis Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1877 Carla, 18-years old student is being treated for pneumonia. On the 4th day of hospitalization she noted swelling, redness and severe pain of the (L) knee. Aspiration of the knee revealed whitish, purulent fluid consistent with septic arthritis. 66. The laboratory test you would request for the condition is: A. Liver function test C. Culture and sensitivity of fluid B. Urinalysis D. ANA Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1945 67. The probability of a CPPD disease will reveal crystals appearing as: A. Highly birefringent, large flat B. Negatively birefringent, needle shape C. Positively birefringent, rod shaped D. Spheroidal aggregation Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1942 68. The pain in osteoarthritis arise from the following structure EXCEPT: A. Articular cartilage B. Stretching of joint capsule C. Stretching of periosteum covering osteophytes D. Synovitis Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1937 69. One of the following is not a classification criteria in the diagnosis of Rheumatoid arthritis: A. Morning stiffness less than 1 hour B. Radiographic change like erosion or decalcification of wrist bone C. Serum rheumatoid factor positivity D. Symmetric arthritis Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1885 70. One of the following statements is not true with regards to the epidemiology of SLE: A. Common in women of child bearing age B. Males are spared C. More common in blacks than in white D. Prevalence is form 15 to 50/100,000 population Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1874 Aling Nena, 75-years old, female, 5’2 ft tall, 100 lbs. Consulted because of pain in the (R) knee for a year; which is worst in the afternoon and after a long walk and improves with rest. On P.E. as bony hypertrophy and worse crepitation. 71. The pain she is experiencing maybe due to any of the following EXCEPT: A. Ligament insertion strain C. Muscle pain B. Cartilage destruction D. Capsular stretching Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1936-1937 72. One of the following statement about TB arthritis is true: A. Culture of M. tuberculosis from the synovial biopsy is positive in 90% of cases B. Joint destruction is rapid C. Polyarticular involvement is more common D. Treatment includes administration of Nafcillin and gentamycin Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1947 73. A 23-years old female patient consulted because of on and off pains, malar rash, oral ulcers and increasing hairloss. A probable diagnosis of SLE was made confirmed by: A. High ESR and (+) CRP B. High titer dsDNA and hypocomplementemia C. Leucopenia and anemia D. Thrombocytosis Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1877 74. The recommended screening test for DM is: A. FPC C. RBS B. 2-hr OGTT D. HbAic Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2154 75. All of the following symptoms are consistent with hypothyroidism EXCEPT: A. Constipation C. Heat intolerance B. Menorrhagia D. Hoarse voice Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2109 76. The most specific feature of cushings syndrome is: A. Centripetal obesity C. Hirsutism B. Weight gain D. Hypertension Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2139 77. All of the following chronic diabetic complications are microvascular in nature EXCEPT: A. Retinopathy C. Nephropathy B. Neuropathy D. Peripheral vascular disease Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2161 78. The following statements are true regarding the pathophysiologic abnormalities of type 2 DM EXCEPT: A. It is characterized by autoimmune destruction of the beta cells B. There is impaired insulin secretion C. Peripheral insulin resistance may be present D. There is excessive hepatic glucose production Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2157 79. The combination of insulin deficiency and hyperglycemia would result to the following biochemical abnormalities EXCEPT: A. Reduces the hepatic level of fructose 2-6 phosphate B. Decreases the activity of pyruvate kinase C. Promotes the process of glycogenolysis D. Increases the levels of the GLUT4 glucose transporter Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2159 80. The major effects of cortisol on body water are as follows EXCEPT: A. Retards the migration of water into cells B. Promotes renal water excretion C. Stimulates vasopression secretions D. Increases urine potassium excretion at high doses Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2131 81. Choose the correct pair of tumor marker and cancer implicated: A. Alphafetoprotein – colon cancer B. CA-125 - ovarian cancer C. Lactate dehydrogenase – myeloma D. Carcinoembryonic antigen – hepatocellular carcinoma Harrison’s Internal of Medicine, 16th ed. 439 82. The leading cause of cancer death in both men and women. A. Lymphoma C. Lung CA B. Nasopharyngeal CA D. Large cell CA Harrison’s Internal of Medicine, 16th ed. 436, 506 83. The most common histologic subtype of lung cancer for the past 25 years. A. Squamous or Epidermoid C. Small cell CA B. Adenocarcinoma D. Large cell CA th Harrison’s Internal of Medicine, 16 ed. 506 84. Usually, these types of lung cancer have already spread at the time of presentation and diagnosis, hence, surgery is unlikely to be curative. They are managed primarily by chemotherapy with or without radiotherapy. A. Squamous or Epidermoid C. Small cell CA B. Adenocarcinoma D. Large cell CA th Harrison’s Internal of Medicine, 16 ed. 506 CASE: Leo Garcia, 68-year old male came in to your clinic because of urgency, hesitancy and bloody urine: (Questions 167-169). 85. Prostate cancer is highly entertained, and the first screening modality that you will perform is: A. Digital rectal exam B. Assay for serum PSA (prostate specific antigen) C. Ultrasound of bladder/prostate D. Transrectal ultrasound guided biopsy Harrison’s Internal of Medicine, 16th ed. 446 86. Examinations revealed prostate cancer. The most common site for its metastasis: A. Lungs C. Colon B. Liver D. Bone Harrison’s Internal of Medicine, 16th ed. 87. Deregulation of molecular mechanics controlling cell cycle progression is a hallmark of cancer. Which phase of the cell cycle is critical in the regulation of cell proliferation. A. M C. S B. G1 D. G2 Harrison’s Internal of Medicine, 16th ed. 453 88. Certain human malignancies are associated with viruses. Correct examples are the following, EXCEPT: A. Burkitt’s Lymphoma – Epstein Barr virus B. Cervical cancer – Human Papilloma virus C. Hepatocellular carcinoma – Hepatitis B virus D. Colon cancer – Helicobacter pylori Harrison’s Internal of Medicine, 16th ed. 442 89. A woman with the following characteristics, has a greater risk of developing breast cancer: A. Menarche at 12 y/o, Primigravida at 18, menopause at 45 B. Menarche at 12 y/o, Nulligravida, menopause at 52 C. Menarche at 12 y/o, Multigravida, menopause at 45 D. Menarche at 16 y/o, Primigravida at 25, surgical menopause at 40 because of TAHBSO Harrison’s Internal of Medicine, 16th ed. 517 90. Tumor lysis syndrome is an oncologic emergency which may present as acute renal failure. This is due to destruction of a large number of neoplastic cells during chemotherapy. It is characterized by the following, EXCEPT: A. Hyperuricemia C. Hypercalcemia B. Hyperphosphatemia D. Hyperkalemia Harrison’s Internal of Medicine, 16th ed. 581 CASE A 55-year old male, farmer from Pampanga came to the ER because of difficulty of breathing. Present condition started 2 weeks prior to consult as cough productive of opious grayish yellow sputum accompanied by moderate grade fever body malaise and lost of apetite. Condition progressed despite over the counter antitussive medication, until 1 day PTC he started to have difficulty of breathing. PH-smoker 1 pack of cigarette/day since age of 25 … no other serious illness in the past. Pertinent P. E. Findings: RR – 28/min. Chest: Symmetrical expansion: resonance of percussion, crackles on the left midlung to base posteriorly with bilateral forced on expiration. 91. What disease conditions would you entertain? A. Chronic bronchitis (COPD) C. Pneumonia B. Mycosis D. All of the above 92. What diagnostic laboratory examination would you request for? A. Chest x-ray C. CBC B. Sputum gram stain, culture and sensitivity D. All of the above 93. How would you start your management? A. O2 inhalation B. IV antibiotic C. Nebulization D. All of the above 94. If arterial blood gas examination showed – ph7.33, pCO2-50 mmHg, pCO2 of 75 mmHg and HCO3 of 28 mEq/L. What would be your interpretation? A. Respiratory acidosis with hypoxemia B. Respiratory alkalosis with hypoxemia C. Respirator and metabolic acidosis D. Adequate Oxygenation 95. What further laboratory examination would you add aside from above examinations? A. PFT C. ECG B. Sputum for fungus D. A and B 96 - 100. A 60-year old male, 30-pack year smoker came in due to chronic cough and mild exertional dyspnea for 3 years. He self medicated with mucolytic but afforded no relief. On PE occasional wheezes and rhonchi were noted. 96. What is the most likely diagnosis: A. Pulmonary Tuberculosis B. Bronchial Asthma C. Chronic Obstructive Pulmonary Disease D. Pneumonia 97. What laboratory examination will you request to confirm the diagnosis: A. Chest x-ray C. Chest CT scan B. Sputum examination D. Spirometry 98. The mainstay in the treatment of this patient: A. Inhaled bronchodilator C. Methylxanthines B. Inhaled corticosteroids D. Antibiotics 99. A feature that best characterize chronic bronchitis. A. Elastic recoil is severely decreased B. Airway resistance is normal C. Pulmonary hypertension moderate to severe at rest D. Diffusing capacity is decreased 100. The most common mechanism of hypoxemia: A. Decrease in inspired PO2 C. Shunt B. Hypoventilation D. V/Q mismatching 101. A 40 year old male complains of chest pain, characterized by burning retrosternal discomfort that radiates to the neck and angles of the jaw. It is aggravated by bending forward, straining and lying recumbent and is worse after meals.This classic symptom is called: A. Heartburn C. Regurgitation B. Angina D. Water Brash p.1588 102. Your clinical impression for this Patient is: A. Acute myocardial infarction C. Gastric Ulcer B. Gastroeophageal Reflux Disease D. Esophageal Carcinoma p. 1592 103. The pathophysiology of this disease is: A. Spasm of the coronary artery B. Increase acid secretion in the stomach C. Decrease in the tone of the lower esophageal sphincter due to muscle weakness D. Exposure to carcinogens p. 1592 104. The drug of choice for this patient is: A. Nitrates B. Antacids p. 1593 C. Calcium channel blockers D. Protom pump inhibitors 105. A 70 year old male with chronic constipation presented with sudden onset left lower quadrant abdominal pain and high grade fever. Physical examination showed direct and rebound tenderness at the left lower quadrant. Your clinical diagnosis is: A. Sigmoid Diverticulits C. Irritable Bowel Syndrome B. Acute Appendicitis D. Colon Cancer p. 1649 106. Mark, a 7 yr old boy was passing by McDonald’s and smelled the aroma of hamburgers. At this instant, acid secretion took place in his stomach. Which phase of acid secretion was responsible for the acid secretion? A. Cephalic C. Intestinal B. Gastric D. Interdigestive 107. While Mark was eating his hamburger, the food in his stomach stimulated further acid secretion. Which of the following substances is responsible for the increased acid secretion? A. Histamine C. Somatostatin B. Gastrin D. Acetylcholine C. 108. Mark grew up to become an executive of a leading company. Because of the stresses of his job, he developed Duodenal Ulcers. The ulcers of Mark will be found: A. 3cm from the pyloric opening C. 2nd portion of the duodenum B. 10cm from the duodenal bulb D. 3rd potion of the duodenum 109. Mark consulted his physician at MCU because of his Duodenal ulcer. The physician examined Mark and found that Mark had a succussion splash. This finding indicates that Mark had this DU complication. A. Perforation C. Gastric outlet obstruction B. Penetration D. Hemorrhage 110. Which of the following items below is a function of the pre-epithelial level of defense to prevent mucosal damage? A. The mucus gel functions as a unstirred water layer impeding diffusion of ions and molecules including pepsin. B. The surface epithelial cells act as ionic transporters that maintain intracellular pH and bicarbonate production C. Gastric epithelial cells bordering an injury migrate to restore a damage region D. Epithelial cell renewal occurs and together with angiogenesis preserve integrity of the gastric tissues DEPARTMENT OF INTERNAL MEDICINE 1. Generally accepted indicator of the immunologic competence of the patient with HIV infection A. level of plasma viremia B. CD4+ T lymphocyte count C. immunoglobulin level D. PPD 2. The hallmark of HIV disease is A. Kaposi’s sarcoma B. opportunistic infections C. cell-mediated immunodeficiency D. humoral immunodeficiency 3. A 30 years old male job applicant consulted because of a hepatitis screening tests which showed HBsAg(+), IgG anti-HBc(+), HBeAg(+), anti-HBs(-), anti-HBe(-). He has A. Acute Hepatitis V viral infection B. Chronic HBV infection, low infectivity C. Chronic HBV infection high replication state D. Cirrhosis 4. A medical technologist had accidental needlestick while at work. His chances of getting infected is higher if the patient he handled is positive to HBeAg. What do you recommend? A. Gamma globulin B. Hepatitis B immune globulin C. first dose of Hepatitis vaccine D. interferon 5. A first year vet-med student was bitten by a dog he was examining, he claims to have had anti-rabies immunization 1 year ago. What do you recommend? A. Rabies vaccine booster on days 0 & 3 B. Give rabies immune globulin C. wound treatment D. all of the above 6. The earliest manifestation of Tetanus A. opisthotonus B. dysphagia C. lock jaw D. muscle spasms 7. Which of the following is a sign of severe (stage III) tetanus? A. spasms lasting for less than 10 seconds B. lock jaw C. risus sardonicus D. localized muscle stiffness 8. The most frequent manifestation of typhoid fever is A. Rose-spots B. pulse-fever disproportion C. prolonged persistent fever D. splenomegaly 9. A social worker frequently assigned to areas of calamity consulted for prophylaxis against Typhoid. She claims to have immunization with one injection of Vi polysaccharide vaccine 5 years ago. What do you recommend? A. live attenuated vaccine 1 capsule as a booster B. 3 doses of live attenuated oral typhoid vaccine C. gamma globulin D. none of the above 10. The following contribute to the renal failure in leptospirosis except A. hypovolemia B. acute tubular necrosis C. acute cortical necrosis D. direct renal tissue injury by the leptospires 11.A 40 y/o woman presented with 2 days diarrhea with fever and headache. The stools were mucoid with blood, small volume but very frequent accompanied by tenesmus. Fecalysis showed plenty of pus and red blood cells. The following may manifest with the above type of diarrhea except A. Shigella B. E. coli C. V. parahemolyticus D. V. cholera 12. An OFW on vacation from his work in Africa had high fever and chills for 5 days. Stained thick blood smears were reported to be positive to malaria. Which of the following is the preferred treatment? A. Chloroquine B. Quinine C. Mefloquine D. Sulfadoxine/Pyrimethamine 13. The earliest physical manifestation of sepsis is A. tachypnea B. tachycardia C. hypotension D. altered mental status 14. The ff. plays a major role in the severe vasodilatation in septic shock A. TNFa B. nitric oxide C. thromboxanes D. Interleukin-1 15. Effect/s of activated Protein C that may counteract some of the mechanisms in sepsis A. inhibits the coagulation cascade B. increase fibrinolysis C. inhibit leucocyte adherence to endothelium D. all of the above 16. A 38y/o male who has had chemotherapy for lymphoma sought admission because of fever & marked leukopenia. No focus of infection can be found. He was on Cefepime for several days. What do you recommend? A. Anti-anaerobic antibiotic B. anti-fungal treatment C. anti-pseudomonal antibiotic D. vancomycin 17. A 30y/o male was admitted because of progressively severe abdominal pain. On laparotomy, he was found to have ruptured appendix. Which of the following is appropriate? A. Ticarcillin/Clavulanic B. Piperacillin/Tazobactam C. Imipenem D. any of the above 18. The most common respiratory symptom of post primary tuberculosis A. hemoptysis B. chest pain C. chronic cough D. dyspnea 19. Impact of HIV infection on tuberculosis A. more atypical cases of tuberculosis B. more frequent occurrence of extrapulmonary TB C. more difficult to identify because of similarities of symptoms D. all of the above 20. Decreased alveolar ventilation results from the ff. condition, except A. Decreased CNS drive B. Decreased physiologic dead space C. Neuromuscular diseases E. Increased work of breathing with inadequate ventilation 21. The use of PEEP (positive end expiratory pressure) in mechanical ventilation is helpful because it can A. Limit venous return B. Increase airway pressure C. Decrease the cardiac output D. Increase FRC and prevents alveolar collapse 22. Which of the ff. pathologic changes is NOT a characteristic of ARDS A. Diffuse alveolar damage B. Hyaline membrane formation C. Hyperplasia of mucus gland and smooth muscle D. Increased alveolar-capillary permeability 23. Superior vena cava syndrome is characterized by the following A. Phrenic nerve paralysis and elevation of hemidiaphragm B. Shoulder pain radiating to ulnar distribution of the arm C. Edema and rubor of the face, neck and upper chest D. Anhidrosis, miosis, ptosis of affected side 24. One of the following is not a characteristic of the dyspnea of patients with COPD A. variable, frequent at night B. progressive & worsening over time C. present daily D. worse on exercise 25. A prominent cardiac silhouette on chest x-ray of a COPD with cor pulmonale patient is due to A. Right ventricle B. aorta C. left atrium D. left ventricle 26. The most common risk factor for development of ARDS is A. pneumonia B. sepsis C. aspiration D. severe trauma 27. Necrotizing pneumonia A. cavities > 2 cm diameter B. cavities < 2 cm diameter C. process confined to alveoli contiguous to bronchi D. interstitial involvement only 28. Pneumonia with erythema multiforme, hemolytic anemia, bullous myringitis A. Streptococcus pneumoniae B. Moraxella catarrhalis C. Mycoplasma pneumoniae D. Legionella pneumophilia 29. Risk factor for lung abscess A. inhalation of bacteria B. seizure C. spinal anesthesia D. amphetamine intake 30. Surgical indication for bronchiectasis A. Cosmetic B. severe dyspnea C. massive hemoptysis D. bilateral lung involvement 31. Usual source of pleural fluid in normal states A. parietal pleura B. visceral pleura C. interstitium D. peritoneal cavity 32. Most frequent cause of malignant pleural effusion A. Lymphoma B. breast Ca C. bronchogenic Ca D. mesothelioma 33. The most serious complication of hyperkalemia A. seizure B. cardiac toxicity C. respiratory failure D. muscle paralysis 34. Bence Jones Proteinuria is associated with A. myeloma B. hypertension C. lymphoma D. diabetes 35. The most common extrarenal system to develop cystic changes in ADPKD A. liver B. thyroid C. pancreas D. ovary 36. Urinary findings of patient with Tubulointerstitial Disease A. Protein > 3 grams B. hematuria C. pyuria D. RBC casts 37. Examination of the synovial fluid of the knee of a patient with osteoarthritis will reveal the following except A. Clear viscous fluid B. Negative culture C. WBC count of 200/hpf D. (+) CPPD crystals 38. Inflammation of the 1st metatarsal joint due to MSU crystal is called A. Bursitis B. Podagra C. Enthesitis D. Tophi 39. The structure in the joint that is affected in osteoarthritis A. Synovium B. Capsule C. Cartilage D. Subchondral bone 40. One of the following is NOT a classification criteria in the diagnosis of Rheumatoid arthritis A. Symmetric arthritis B. Serum rheumatoid factor positivity C. Radiographic change like erosion D. Morning stiffness less than an hour 41. The earliest and consistent finding on x-ray of patient with ankylosing spondylitis: A. Osteopenia B. Osteophytes C. Sacroilitis D. Subchondral bone erosion 42. Crystal associated with pseudo gout A. Monosodium urate B. Calcium pyrophosphate dihydrate C. Calcium oxalate D. Uric acid 43. The most specific test in the diagnosis of SLE A. ANA B. ds DNA C. Anti histone D. Anti-sm 44. The major risk factor in the development of osteoarthritis A. obesity B. Aging C. Trauma D. Endocrine disorder 45. Bony hypertrophy of the distal interphalangeal joint is known as A. Bouchard’s node B. Boutonnieres deformity C. Swan neck deformity D. Heberden’s node 46. Which of the following anemias is most likely to respond to the administration of erythropoietin? A. Iron deficiency anemia B. Pernicious anemia C. Pure red cell aplasia D. Anemia of renal disease 47. Pancytopenia with an “empty” marrow is seen in A. Aplastic anemia B. Myelodysplastic syndrome C. Paroxysmal nocturnal hemoglobinuria D. Acute leukemia 48. The patient with intravascular hemolysis can present with all of the following clinical and laboratory findings except A. Low levels of serum haptoglobin B. Increased indirect bilirubin and serum lactic dehydrogenase (LDH) E. Splenomegaly C. Hemoglobinuria and hemosiderinuria 49. The diagnosis of chronic ITP is established by A. Marrow examination that shows increase megakaryocytes B. Presence of anti-platelet-autobodies C. Presence of giant platelets in the peripheral blood smear D. Exclusion of other causes of thrombocytopenia 50. Which of the following is a strategy for primary prevention of cancer? A. Paps smear B. Digital rectal exam C. Hepatitis B vaccination D. Self-breast examination 51. Desired response to treatment if the goal of treatment is TO PALLIATE A. Complete response B. Partial response C. Stable disease D. Progressive disease 52. HER-2 neu is commonly expressed in which of the following malignancies? A. Colonic Ca B. Breast Ca C. Bronchogenic Ca D. Endometrial CA 53. The most common malignant cause of mortality in both sexes is A. Cervical Ca B. Bronchogenic Ca C. Breast Ca D. Colonic Ca 54. A 20 y/o male was noted to be oliguria 2 days after hazing in fraternity. Urine was described as reddish in color. Extreme tenderness noted all over the body. The cause of reddish urine is A. Hematuria B. hemoglobinuria C. myoglobinemia D. porphyria 55. A 23y/o female complaining of 1 day duration of dysuria, with urgency & hesitancy, afebrile with mild hypogastric tenderness. What is the most common uropathogen A. E. coli B. Staph saprophyticus C. Proteus C. Candida 56. A 35y/o F, w/ Type 1 DM since 11y/o had a consultation for generalized edema. Had hypertension for 2 years & had laser therapy of both eyes for retinopathy. Screa is 3.8 mg% Hgb=80. The stage of diabetic glomerulopathy is A. Initial Hyperfunctioning stage B. Incipient Glomerulopathy C. Overt Glomerulopathy D. Azotemia Glomerulopathy E. End Stage Glomerulopathy 57. 60 y/o male, smoker, had consultation for gross hematuria on & off for 3 months & weight loss. There is a palpable mass on (L) flank. The laboratory examination which will be very helpful to clinically stage this disease is A. renal UTZ B. IVP C. CT scan with contrast D. Renal scan 58. The most common glomerulopathy worldwide A. Acute post strep GN B. Lupus Nephritis C. IgA Nephropathy D. Thin Basement Membrane Disease 59. The most common functioning pituitary adenoma A. Prolactinoma B. ACTH-secreting adenoma C. TSH-secreting adenoma D. Acromegaly 60. A 67 year old woman has just undergone near total thyroidectomy for follicular thyroid carcinoma. Next step is A. Chemotherapy with adriamycin B. Radioactive iodine therapy C. Levothyroxine replacement therapy D. Observe and follow-up 61. Which of the following can differentiate a patient with Graves disease from a patient with transient thyrotoxic phase of subacute thyroiditis A. CTscan B. Ultrasound C. serum thyroid hormones level D. I 131 scan of thyroid 62. Which of the ff. laboratory findings is consistent with Graves disease E. High T4 with low TSH A. High T4 with high TSH B. low T4 with high TSH C. low T4 with low TSH 63. Diabetes is characterized by the following A. Hyperglycemia B. Disturbances in carbohydrate, fat and protein metabolism C. Associated with absolute or relative deficiency of insulin secretion and/ impaired action D. All of the above 64. Dietary management of diabetic patient should include which of the ff. A. Total caloric intake to achieve & maintain ideal body weight B. Reduced intake of saturated fats and cholesterol D. Avoidance of simple sugars E. All of the above 65. Which of the following is diagnostic of diabetes A. a single determination of FBS > 126 mg% B. blood sugar of > 200mg% after an OGTT C. RBS of > 200mg% D. positive glucosuria 66. Which of the following is most diagnostic of hypercorticolism A. overnight dexamethhasone test B. low dose dexamethasone test C. Random serum cortisol determination D. urinary cortisol determination 67. Which of the following will you consider in a young patient with hypertension with and hypokalemia A. Cushing’s disease B. Conn’s disease C. Pheochromocytoma D. Essential hypertension 68. Cause of dysmotility type of chronic diarrhea A. Hyperthyroidism B. VIPoma C. Radiation colitis D. Lactase deficiency 69. True regarding Crohns disease A. More common among non-smokers B. Rectal bleeding is common C. Surgery offers permanent cure D. Peri-rectal fistulas are common 70. A surgically resected colon revealed tumor cells invading the muscularis with 4 lymph nodes also (+)for tumor. Patient belongs to Dukes stage: A. A B. B1 C. B2 D. C 71. Tenesmus is A. Excessive passage of flatus B. Indicative of sigmoid pathology C. A symptom of inflammation of the anus D. Painful straining & sensation of incomplete emptying during defecation 72. Best modality to determine the presence and level of intestinal obstruction: A. Colonoscopy B. Plain film of the abdomen C. Angiography D. Gastroscopy 73. A 43/M had several episodes of bloody mucoid stools during the past 8 months. He had received 2 courses of Metronidazole & 3 courses of quinolones. Next most logical step is to A. Do lower gut endoscopy B. Repeat routine stool exam C. Request for Sudan II staining D. Request for fecal occult blood testing 74. Most common cause of acute pancreatitis A. drugs and genetics B. alcohol and gallstone C. ERCP and hypercalcemia D. Insect toxins and ischemia 75. Treatment for gallbladder stones seen incidentally by ultrasound on a normal individual A. emergency cholecystectomy B. elective cholecystectomy C. ERCP D. None of the above 76. Most common benign tumor of the esophagus A. Polyps B. Leimyoma C. Hemangiomas D. Squamous cell papilloma 77. Which of the following test for H. pylori cannot be used to monitor response to treatment A. Rapid urease test B. Serological test C. Urea breath test D. Culture 78. Which of the following food stuff is the most potent stimulant gastric acid secretion: A. Carbohydrates B. Protein C. Fats D. Alcohol 79. The most common cause of obscure GI bleeding A. Small bowel tumor B. Dieulafoy’s lesion C. Angiodysplasia D. Arteriovenous malformation 80. The epithelial lining of the esophagus is A. Cornified stratified squamous B. Non cornified stratified squamous C. Non cornified non stratified squamous D. Cornified non stratified squamous 81. During the gap or window period, this is the only serologic evidence Of hepatitis B A. HBsAg B. HBeAg C. Anti-HBc D. Anti-HBs 82. Despite persistence of virus in the liver, viral shedding in feces, viremia and infectivity diminish rapidly once jaundice becomes apparent: A. Viral hepatitis A B. Viral hepatitis B C. Viral Hepatitis C D. Viral Hepatitis D 83. Which of the following drugs can relieve dyspnea in CHF? A. Salbutamol by inhalation B. Furosemide IV C. Nitrates sublingual D. Beta blocker per orem E. Digitalis by IV route 84. Which of the drugs can dissolve the thrombus in acute coronary A. Low molecular weight heparin B. Unfractionated heparin C. Aspirin D. Streptokinase E. Abciximab 85. Inspiration increases the intensity of loudness the murmur of A. tricuspid regurgitation B. atrial septal defect C. MVP D. Aortic stenosis 86. The most common primary malignant tumor of the heart is A. atrial myxoma B. sarcoma C. malignant D. fibroma 87. All of the following are major Jones criteria for the diagnosis of rheumatic fever except A. chorea B. erythema marginatum C. fever D. carditis 88. True of Coarctation of Aorta A. femoral pulse is weak and delayed B. blood pressure in the leg is greater than the arm C. primary cause of hypertension D. presence of boot shaped heart on chest x-ray 89. Chest pain is present in patient with A. aortic dissection B. myocardial infarction C. both D. neither 90. Type of congenital heart disease that is acyanotic without a shunt A. atrial septal defect B. ventricular septal defect C. coarctation of aorta D. tetralogy of Fallot 91. Second heart sound is widely split and relatively fixed A. atrial septal defect B. ventricular septal defect C. patent ductus arteriosus D. tetralogy of Fallot 92. Standing increases the intensity of the murmur of A. tricuspid regurgitation B. mitral stenosis C. mitral valve prolapse D. pulmonic stenosis 93. Chose the correct statement regarding aortic insufficiency A. high pitched, blowing diastolic murmur B. best heard with the bell of the stethoscope C. decrease pulse pressure D. best heard at the apex 94. A 28 y/o female patient came in with dyspnea. On auscultation the first heart sound is loud and a low pitched diastolic murmur was noted at the apex. No LV heave was also noted. The most likely condition is A. aortic regurgitation B. mitral valve prolapse C. mitral stenosis D. patent ductus arteriosus 95. The severity of this component of tetralogy of Fallot determines the cyanotic manifestation of this congenital anomaly A. ventricular septal defect B. obstruction to RV outflow C. overriding aorta D. RV hypetrophy 96. Infective endocarditis prophylaxis is indicated except A. mitral stenosis B. PDA C. ASD, venosus type D. MVP without MR 97. The most important physical sign of acute pericarditis A. chest pain B. pericaridal friction rub C. paradoxical pulse D. Kussmaul’s sign 98. Aspirin is indicated A. acute myocardial infarction B. acute pericarditis C. both D. neither 99. Most common cause of death in adults with diabetes A. pericardial disease B. coronary artery disease C. valvular heart disease D. renal failure 100. A 62 y/o man was admitted for evaluation of syncopal attack. He denied symptoms of chest pain nor dyspnea on exertion. On P.E., a harsh grade IV/VI systolic ejection murmur was heard at the right sternal border with radiation to the carotids. Carotid upstroke was delayed. What is the most likely diagnosis? A. pulmonic stenosis B. mitral regurgitation C. aortic stenosis D. aortic regurgitation DAVAO MEDICAL SCHOOL FOUNDATION College of Medicine INTERNAL MEDICINE I. CHOOSE THE BEST ANSWER: 1. A 50 year old female presented with multiple erythematous scaly papules on trunk and extremities. The following differential diagnosis may be considered: A. Pityriasis rosea B. Psoriasis E C. Pityriasis lichenoides chronica D. Small plaque parapsoriasis E. All of the above 2. On further examination, similar lesions appear on sites of even trivial injuries give one diagnosis. B A. Pityriasis rosea B. Psoriasis C. Pityriasis lichenoides chronica D. Small plaque parapsoriasis E. All of the above 3. The patient was treated with oral steroids with resolution of lesions. The steroid was discontinued. Three days later, the patient became febrile followed by appearance of erythematous patches on trunk and extremities with pinpoint pustules on the patches. What is your diagnosis? A. Mycosis Fungoides C B. Drug reaction C. Von Zumbusch D. Folliculitis 4. The following drugs may be given in this patient except: A. Retinoids B. Methotrexate C C. Steroids D. Dapsone 5. Clinical clues to look for in patients with exfoliative dermatitis secondary to stasis dermatitis: A. Varicosities, edema,ulcers at the ankle A B. Persistence of islands of normal skin within diffusely involved areas C. Prominent white dermographism D. Onycholysis and pterygium of the nails 6. Characteristic lesion of Mucha-Habermann disease: A. Lichenoid papules B. Macules with collarette scales C. Papulonecrotic papules D. Silvery white scales E. Purplish polygonal papules C 7. One of the following is due to suprapapillary thinning of the epidermis: A. Koebner phenomenon B. Woronoff ring D C. Wickham’s striae D. Auspitz sign 8. One of the following is due to focal epidermal thickening: A. Koebner phenomenon B. Woronoff ring C C. Wickham’s striae D. Button holing sign 9 The following diseases have unknown etiology except: A. Psoriasis B. Pityriasis rosea C. Lichen planus D. Parapsoriasis E. None of the above E 10. Unusual distribution of lesions in patients with pityriasis rosea include the following sites except: A. Trunk B. Face and head A C. Scalp D. Distal extremities Reference: Andrews’ Diseases of the Skin 9th edition 11. The mechanism of hypoxemia in patients with an increased carbon dioxide and a normal alveolar to arterial oxygen gradient is: a. hypoventilation b. diffusion impairment c. ventilation perfusion mismatch d. shunt Harrison’s Principles of Internal Medicine, 15th Edition, p.1452 12. According to the Philippine Clinical Practice Guidelines on CAP, the basis for the diagnosis of pneumonia is established by: a. when cough has been present for two weeks b. clinical findings alone c. radiologic diagnosis to confirm the diagnosis d. by sputum G/S and C/S done routinely Philippine Consensus Guidelines on Diagnosis and Management of Pneumonia 13. In the Gina (Global Initiative Against Asthma) Guidelines the addition of a long acting beta agonist as controller medication is recommended in which category: a. mild intermittent b. mild persistent c. moderate persistent d. status asthmaticus Global Initiative Against Asthma 14. A physiologic feature most suggestive of chronic bronchitis: a. decreased DLCo b. increased residual volume c. increased airway resistance d. decreased compliance Harrison’s Principles of Internal Medicine, 15th Edition 15. A clinical feature typical of emphysema: a. cyanosis b. bipedal edema c. cachexia d. recurrent exacerbations Harrison’s Principles of Internal Medicine, 15th Edition 16. Localized bronchiectasis is a feature of: a. panhypogammaglobulinemia b. primary ciliary dyskinesia c. endobronchial obstruction d. cystic fibrosis Harrison’s Principles of Internal Medicine, 15th Edition, p. 1486 17. Modality which has largely replaced bronchography for the diagnosis of bronchiectasis: a. PET (positron emission tomography) b. fiberoptic bronchoscopy c. HRCT (high-resolution computed tomography) d. gallium Scan Harrison’s Principles of Internal Medicine, 15th Edition, p. 1486 18. The initial recommended procedure for the diagnosis of pulmonary thromboembolism: a. ventilation perfusion scan b. leg ultrasound c. d-dimer assay d. pulmonary angiogram Harrison’s Principles of Internal Medicine, 15th Edition, p.1511 19. Antimicrobials for suspected atypical pathogens causing pneumonia EXCEPT: a. macrolide or azalide b. antipneumococcal fluroquinolone c. tetracycline d. beta lactam Harrison’s Principles of Internal Medicine, 15th Edition 20. The most common etiologic agent of pneumonia in HIV-infected patients with CD4+ counts of <200/µL: a. Mycobacterium avium-intracellulare b. Cytomegalovirus c. Pneumocystis carinii d. Nocardia Harrison’s Principles of Internal Medicine, 15th Edition, p.1477 21. The single useful measurement for thyroid function in a suspect hypothyroid patient is: A. T3 B. T4 C. TSH D. Thyroglobulin Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2068 22. In large retrosternal goiter, when the arms are raised above the head, this cause the thyroid mass to impinge on the blood vessels causing suffusion of the face, giddiness and syncope. This is known as: a. Basedow sign b. Pembertons sign c. Curtis sign d. Reidel’s sign Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2064 23. One of the following is a long glucocorticoid preparation. a. Hydrocortisone b. Prednisone c. Bethamethasone d. Triamcinolone Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2104 24. The first to rise up among the lipoproteins in diabetes mellitus is: a. Total cholesterol b. LDL c. HDL d. Triglycerides Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2124 25. The principal undesirable side effect of anti-thyroid drugs: a. Wolf-Chaikoff effect b. Agranulocytosis c. Thyroid acropatchy d. Fulminant hepatitis Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2072 26. The single-thyroid drug which can be safely use in pregnant women: a. Neomercazole b. Thiamazole c. Propylthiouracil d. Tapazole Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2073 27. The shortest acting oral hypoglycemics: a. Glipizide b. Glibenclamide c. Gliclazide d. Glimeperide Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2133 28. Secondary hyperaldosterone has all of the following, EXCEPT: a. Acidosis b. Hypokalemia c. Hypertension d. Edema Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2097 29. The other name of Multiple Neoplasia Type I is: a. Lub syndrome b. Stenon’s disease c. Parry’s disease d. Wermer’s syndrome Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2184 30. The other term for Subacute thyroiditis are the following, EXCEPT: a. Painless thyroiditis b. Granulomatous thyroiditis c. Giant cell thyroiditis d. De Quervan’s thyroiditis Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2074 31. One of these cardiac anti-arrythmic drugs contains 37% iodine and can induce thyrotoxicosis: a. Flecainide b. Verapamil c. Amiodarone d. Propranolol Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2076 32. Conns’ syndrome commonly present with the following signs and symptoms, EXCEPT: a. Hyperkalemia b. Hypernatremia c. Alkalosis d. hypertension Harrison’s Principle of Internal Medicine Vol. 2 15th Edition page 2096 33. The effort less appearance of gastric or esophageal contents in the mouth is called: a. Heartburn b. Pyrosis c. Vomiting d. Regurgitation Harrison’s Principle of Internal Medicine Vol. 2 13th Edition page 1356 Chap 251 34. Nutcracker esophagus is associated with: a. Achalasia b. Scleroderma c. Diffuse esophageal spasm d. Esophageal CA Harrison’s Principle of Internal Medicine Vol. 2 13th Edition page 1358 Chap 251 35. The most common complication of Gastric Ulcer is: a. Perforation b. Penetration c. Obstruction d. Hemorrhage Harrison’s Principle of Internal Medicine Vol. 2 13th Edition page 1371 Chap 252 36. A 40 year old patient with a history of peptic ulcer surgery due to massive upper GI bleeding came in because of lightheadedness, diaphoresis confusion 90 min after eating. Your diagnosis is: a. Dumping syndrome b. Bile reflux gastritis c. Afferent loop syndrome d. Postvagomtomy diarrhea Harrison’s Principle of Internal Medicine Vol. 2 13th Edition page 1374 Chap 252 37. A 39 year old seaman showed you the following hepatitis serologic profile: HbsAg (+), IgM anti-HAV (+), IgM anti-HBc (+), anti-HCV (-). Your diagnostic interpretations is: a. Acute Hep A superimposed on Chronic Hep B b. Acute Hep A and B c. Acute Hep A d. Acute Hep B Harrison’s Principle of Internal Medicine Vol. 2 13th Edition page 1470 Chap 266 38. Stage II hepatic Encephalopathy is characterized by: a. Coma b. Marked confusion, incoherent speech c. Lethargy d. Euphoria or depression Harrison’s Principle of Internal Medicine Vol. 2 13th Edition page 1494 Chap 269 39. A collection of tissue, fluid, debris, pancreatic enzymes and blood which develop over a period of 1-4 weeks after the onset of acute pancreatitis is: a. b. c. d. Phlegmon Pseudocyst Abscess Pseudoaneurysm Harrison’s Principle of Internal Medicine Vol. 2 13th Edition page 1525 Chap 274 40. A sudden and severe loss of vision in patient with acute pancreatitis is: a. Diabetic retinopathy b. Glaucoma c. Purstcher’s retinopathy d. Retinal detachment Harrison’s Principle of Internal Medicine Vol. 2 13th Edition page 1356 Chap 274 41. The most consistently observed risk factor for development of pancreatic cancer is: a. Chronic alcoholism b. Diabetes mellitus c. Cigarette smoking d. Acute pancreatitis Harrison’s Principle of Internal Medicine Vol. 2 13th Edition page 1352 Chap 275 42. The following frequent signs and symptoms of pancreatic cancer, EXCEPT: a. Abdominal pain b. Weight loss c. Jaundice d. Splenomegaly Harrison’s Principle of Internal Medicine Vol. 2 13th Edition page 1532 Chap 275 43. A serum creatinine level starts to increase when the glomerular filtration rate is: a. 75ml/min b. 50ml/min c. 25ml/min d. 10mml/min Harrison’s Textbook of Internal Medicine, 15th edition 44. Metabolic acidosis in moderate to severe renal failure is due to: a. Increase acid production b. Decreased acid excretion c. Increase serum potassium d. Nephron loss Harrison’s Textbook of Internal Medicine, 15th edition 45. A source of endogenous toxin which can cause acute renal failure is: a. Rhabdomyolysis b. Sepsis c. Radiocontrast agents d. Antibiotics Harrison’s Textbook of Internal Medicine, 15th edition 46. The most common complication of end stage renal disease is: a. Congestive health failure b. Hypertension c. Recurrent infections d. Gastrointestinal bleeding Harrison’s Textbook of Internal Medicine, 15th edition 47. An absolute contraindications of kidney transplantation is: a. Active glomerulonephritis b. Presence of vesical or urethral abnormality c. Iliofemoral occlusive disease d. Psychiatric problem Harrison’s Textbook of Internal Medicine, 15th edition 48. The major cause of death in end stage disease patients receiving dialysis is: a. Bleeding b. Infection c. Uremia d. Cardiovascular disease Harrison’s Textbook of Internal Medicine, 15th edition For nos. 49 – 52: A 68 year old female was admitted because of LBM. Her condition started 3 days PTA as abdominal pain, followed by LBM characterized as watery, nonbloody, and occurring 4-5 times per day. LBM became more persistent and profuse, hence, the admission. Her past history included mild hypertension of 2 years, which was treated irregularly, and joint pains of 10 years. On admission, vital signs were the following: BP = 90/60; HR = 100/min; RR = 24/min; T = 38.5 C. She was weak-looking but conscious. He r skin and tongue were dry. The heart had a gr 2/6 systolic aortic murmur. The abdomen was soft, tympanitic, and slightly tender all over, with hyperactive bowel sounds. Lab result revealed the following: CBC: Hb = 132g/l, WBC ct = 10.2, Seq. = 0.85, Ly = 0.15. Urinalysis: pH = 5.0, SG = 1.030, protein = +, sugar = trace, pus cells = 13/hpf, rbc = 5-10/hpf, hyaline cast = 5-10/hpf. FBS = 6.4 m mol/I; serum creatinine = 330 mmol/l; serum Na+ = 136 mmol/l; serum K+ = 3.4 mmol/l. Stool exam: pus cell = 510/hpf; rbc = 3-5/hpf. ECG = sinus tachycardia. 49. What is the cause of the abnormal serum creatinine? a. Acute renal failure b. Chronic renal failure c. Nephrosclerosis d. Rapidly progressive renal failure Harrison’s Textbook of Internal Medicine, 15th edition 50. What is the possible etiology? a. Hypertension b. Dehydration c. Nephrotoxicity d. Diabetic nephropathy Harrison’s Textbook of Internal Medicine, 15th edition 51. If this is an uncomplicated acute renal failure, when would you expect the kidneys to recover? a. 1-2 weeks b. 2-3 weeks c. 3-4 weeks d. 2-3 months Harrison’s Textbook of Internal Medicine, 15th edition 52. If this patient had chronic renal failure secondary to diabetic nephropathy when would you expect end stage renal disease to set in? a. 3-5 years b. 5-10 years c. 10-15 years d. 15-20 years Harrison’s Textbook of Internal Medicine, 15th edition 53. The primary factor that regulates erythropoietic activity is: a. The kidney b. Erythropoietin c. Bone marrow d. Oxygen Harrison’s Textbook of Internal Medicine, 15th edition 54. Maximal iron absorption occurs in the: a. Stomach b. Duodenum and upper jejunum c. Terminal ileum d. Colon Harrison’s Textbook of Internal Medicine, 15th edition 55. Phagocytosis is a primary function of: a. Lymphocytes b. Eosinophils c. Neutrophils d. Basophils Harrison’s Textbook of Internal Medicine, 15th edition 56. The like hood that a daughter of a patient with severe hemophilia A will be a carried of hemophilia is: a. 0% b. 25% c. 50% d. 100% Harrison’s Textbook of Internal Medicine, 15th edition 57. Aspirin affects the platelets by: a. Shortens platelets life span b. Promotes platelets aggregation c. Decreases platelet production d. Prolongs the bleeding Harrison’s Textbook of Internal Medicine, 15th edition 58. Which of the following hematopoietic growth factors is non-lineage specific and would induce formation of progenitor cells. a. Granulocyte colony stimulating factors b. Macrophage colony stimulating factor c. Granulocyte-macrophage colony stimulating factor d. Erythropoietin Harrison’s Textbook of Internal Medicine, 15th edition 59. One of the following is true in patients with New York Heart Association functional class IV: a. Symptoms occur with ordinary activity b. Asymptomatic at rest c. Symptoms occur even at rest d. None of the above Harrison’s Textbook of Internal Medicine, 15th edition 60. Pulsus paradoxus may be seen in: a. Pericardial tamponade b. COPD c. Superior vena cava obstruction d. All of the above Harrison’s Textbook of Internal Medicine, 15th edition 61. One or some of the following is/are true regarding jugular venous pulse (JVP), EXCEPT: a. The left internal jugular vein is the best to use in JVP measurement b. Cannon a waves may be seen in complete heart block c. It reflects phasic pressure changes in the left atrium d. A and C Harrison’s Textbook of Internal Medicine, 15th edition 62. Prominent a waves of the JVP waves are seen in the following, EXCEPT: a. Severe mitral stenosis with atrial fibrillation b. Severe tricuspid stenosis in sinus rhythm c. Ventricular tachycardia d. A and B only Harrison’s Textbook of Internal Medicine, 15th edition 63. The following are true regarding cardiac activation, EXCEPT: a. At the rest the cardiac cell are polarized b. The polarized state is brought about by the Na+-K-+ inhibiting pump c. During phase 2 of the action potential there is slow inward current through the L-type calcium channel d. A and C only Harrison’s Textbook of Internal Medicine, 15th edition 64. The following are components of Wolf-Parkinsons-White syndrome, EXCEPT: a. Short PR interval b. Delta wave c. Paroxysmal ventricular tachycardia d. All of the above Harrison’s Textbook of Internal Medicine, 15th edition 65. The following are true regarding digitalis in heart failure, EXCEPT: a. It is now obsolete since the discovery of ACE inhibitors which block the RAA axis b. It is particularly effective4 in patient with sustolic heart failure by stimulating myocardial contraction c. It improves ventricular emptying by improving myocardial contractility d. It has little or no value in heart failure patients in sinus rhythm and diastolic dysfunction Harrison’s Textbook of Internal Medicine, 15th edition 66. The following are true regarding murmurs, EXCEPT: a. Tricuspid regurgitation murmurs are louder during expiration b. With valsalva maneuver, the murmur of hypertrophic obstructive cardiomyopathy increases. c. With standing mitral regurgitation murmur decreases d. A and C Harrison’s Textbook of Internal Medicine, 15th edition 67. The following are true regarding contractile process of the cardiac muscle, EXCEPT: a. During activation, the A band remains constant in length, whereas the I band shortens and the Z lines move towards one another b. The interactions between the actin and myosin is inhibited by the tropomyosin during relaxed stage c. Troponic I, accelerates cardiac contraction d. A and B Harrison’s Textbook of Internal Medicine, 15th edition 68. Continuous murmurs are heard in the following, EXCEPT: a. Coarctation of the aorta b. Ruptured coronary sinus of valsalva into the left ventricle c. PDA with normal PA d. Pregnant woman with mammary soufflé Harrison’s Textbook of Internal Medicine, 15th edition 69. Which of the following exposures is most likely to result in transmission of HIV to an uninfected person? a. One use of injected drugs with a needle previously used by an HIV infected person b. Once instance unprotected sexual intercourse with an HIV infected partner c. being born to a woman with symptomatic HIV disease d. sustaining a needle stick injury with a needle used to draw blood from a patient with AIDS Harrison’s Textbook of Internal Medicine, 15th edition 70. An HIV man presents with Pneumocystic pneumonia, oral hairy leukoplakia, oral candidiasis. Select the stage of HIV disease. a. Acute retroviral syndrome b. Early disease (CD4 count greater than 500/ul) c. Intermediate disease (CD4 count 200 to 500/ul) d. Late disease (CD4 count 50 to 200/ul) Harrison’s Textbook of Internal Medicine, 15th edition 71. A 26 year old female prostitute with recently diagnosed HIV infection has odynophagia and vaginal discharge without fever. Select the most likely pathogen. a. Candida b. Cytomegalovirus c. Hepatitis C d. Microsporidia Harrison’s Textbook of Internal Medicine, 15th edition 72. True statements about MDR (multidrug-resistant) tuberculosis: a. It is more likely to cause extra pulmonary disease than is drug-susceptible TB b. It is likely to present with cavitary pulmonary disease than is drugsusceptible TB c. HIV-infected injection drug users have the highest risk of MDR-TB of all HIV (+) patient d. Noncompliance with treatment for drug-susceptible TB is the most important cause of this disease Harrison’s Textbook of Internal Medicine, 15th edition 73. Which of the following statements is true about the bactericidal activity of antibiotics? a. B lactam antibiotics are bactericidal in vivo at all concentrations b. Only bactericidal antibiotics are effective in sterilizing abscesses c. Relapse rates of endocarditis are higher when bacteriostatic antibiotics are used in place of bactericidal drugs d. The MIC of the antibiotic predicts its bactericidal activity Harrison’s Textbook of Internal Medicine, 15th edition 74. Antibiotics prophylaxis is advised for prevention of endocarditis in all of the following conditions, EXCEPT: a. Previous episode of infectious endocarditis b. Mitral valve prolapse with an audible murmur c. Hypertrophiccardiomyopathy d. Coronary artery disease after coronary bypass graft Harrison’s Textbook of Internal Medicine, 15th edition 75. All of the following STD facilitate transmission of HIV, EXCEPT: a. Human papilloma virus b. Chancroid c. Syphillic ulcers d. Herpes simplex virus Harrison’s Textbook of Internal Medicine, 15th edition 76. All of the following statements are true about human papilloma virus, EXCEPT: a. An abnormal Pap test requires consideration of human papilloma virus b. Women with some serotypes of human papilloma virus should be routinely screened for cervical neoplasia c. Cervical neoplasia in a 23 year old woman suggest HIV disease d. Interferon alfa eliminates human papilloma infection Harrison’s Textbook of Internal Medicine, 15th edition 77. No clinical evidence for “true” bacteremia. Select the most likely blood culture. a. b. c. d. E.coli Epidermidis Clostridium welchi S. Aureus Harrison’s Textbook of Internal Medicine, 15th edition 78. Rheumatic heart disease. Select the organism most likely to cause endocarditis. a. A. aureus b. S. bovis c. E.faecalis d. Viridans streptococci Harrison’s Textbook of Internal Medicine, 15th edition 79. A 63 year old man with diabetes and peripheral vascular disease. Select the most appropriate prophylaxis. a. Rabies vaccine b. Pneumococcal vaccine c. Hepatitis B vaccine d. Meningococcal vaccine Harrison’s Textbook of Internal Medicine, 15th edition 80. Approximately one third of patient infected with this virus may respond to treatment with interferon alfa. a. Norwalk virus b. Rotavirus c. Human herpesvirus 6 d. Hepatitis C virus Harrison’s Textbook of Internal Medicine, 15th edition 81. The following are risk factor for the increasing prevalence of drug resistant TB, EXCEPT: a. HIV-1 infection b. Addition of a single new drug to a failing anti-TB regimen c. Failure to complete treatment of active TB d. Increased age Harrison’s Textbook of Internal Medicine, 15th edition 82. True about granulocyte-colony stimulating factor, EXCEPT: a. It reduces the number of febrile days and the frequency of infection in patients receiving cytotoxic therapy for lung carcinoma b. It stimulates the proliferation of neutrophils in the bone marrow c. Its principal side effects is bone pain d. Its use should be avoided in patient receiving treatment for myeloid leukemia Harrison’s Textbook of Internal Medicine, 15th edition 83. True about coagulase-negative staphylococci (CNS), EXCEPT: a. Most CNS are resistant to B lactam and therefore require a glycopeptide antibiotic in initial, empiric, or definitive antibiotic regimens b. CNS often cause true bacteremias, even in the absence of a foreign body c. CNS strains frequently cause foreign body infections d. Definitive therapy of CNS central nervous system shunt infections usually requires shunt removal. Harrison’s Textbook of Internal Medicine, 15th edition 84. This is characterized by an inability to recall important personal information, usually of a traumatic or stressful nature: a. Dissociative Amnesia b. Dissociative Fugue c. Depersonalization Disorder d. Dissociative Identity Disorder Kaplan & Saddock’s Synopsis of Psychiatry - page 678 85. Characterized by the presence of two or more distinct personality states: a. Depersonalization Disorder b. Dissociative Identity Disorder c. Dissociative Amnesia d. Dissociative Fugue Kaplan & Saddock’s Synopsis of Psychiatry - page 681 86. The following are features seen in Kleptomania, except: a. Increasing sense of tension immediately before committing the theft b. Pleasure or relief at the time of committing the theft c. Stealing is committed to express anger d. Recurrent failure to resist impulses to steal objects Kaplan & Saddock’s Synopsis of Psychiatry - page 786 87. Trichotillomania is associated with: a. Fire setting b. Gambling c. Stealing d. Pulling of hair Kaplan & Saddock’s Synopsis of Psychiatry - page 790 88. The following are impulses control disorders, except: a. Generalized anxiety disorder b. Pathological gambling c. Kleptomania d. Intermittent explosive disorder Kaplan & Saddock’s Synopsis of Psychiatry - page 783 89. The following are features of Anorexia Nervosa, except: a. Refusal to maintain body weight at or above a minimally weight for age b. Intense fear of gaining weight c. Awareness of the seriousness of the current low body weight d. Amenorrhea Kaplan & Saddock’s Synopsis of Psychiatry - page 741 90. Features of Bulimia Nervosa, except: a. Normal weight to slightly overweight or underweight b. Poor sexual adjustments c. Increased frequency of depressive symptoms d. Binge eating Kaplan & Saddock’s Synopsis of Psychiatry - page 748 91. A 60 year old male was brought to the emergency room when he was found to be wandering in the vicinity, apparently lost and distressed. He was able to state his name, his daughter’s name, but could not recall how he came to be lost. When his daughter arrived, she provided information that his father has been increasingly forgetful for the last 12 months. Initially, he would forget where he placed his keys, glasses. He would ask questions repeatedly, would forget names of friends and relatives. This has progressed to difficulty finding his way even in familiar places. Neurologic exam shows an awake, alert, elderly male who insists that he was just on his way to the mall. There were no moto-sensory deficits. These manifestations are consistent with A. Dementia B. Delirium C. Either dementia or delirium D. None of the above Kaplan 9th ed page 334-335 92. Which component of the neurologic exam would be most important in the diagnosis of this case A. mental status exam B. cranial nerve exam C. motor exam D. sensory exam Kaplan 9th ed page 334-335 93. On further exam the patient was noted to be rigid with tremors and bradykinesia. What is your consideration? A. Cortical dementia B. Subcortical dementia C. Binswanger’s disease D. Normal pressure hydrocephalus Kaplan 9th ed page 334 94. What is the most common type of dementia A. Alzheimer’s disease B. Pick’s disease C. Huntington’s disease D. Vascular dementia Kaplan 9th ed page 330 95. A 54 year old alcoholic was brought to the ER confused and disoriented with fluctuating consciousness and perception. What is your diagnosis? A. Alzheimer’s disease B. Alcohol intoxication C. Alcohol delirium D. none of the above Kaplan 9th ed page 405 - 406 96. A few months later the patient mentioned above came back because of memory impairment and confabulation. What is your diagnosis? A. Alzheimer’s disease B. Korsakoff’s syndrome C. Wernicke’s encephalopathy D. None of the above Kaplan 9th ed page 347 97. The following are reversible causes of dementia EXCEPT A. hypothyroidism B. vit b deficiency C. normal presuure hydrocephalus D. Creuztdfeldt-Jakob disease Kaplan 9th ed page 364 98. Triad of Normal Pressure Hydrocephalus A. gait disturbance,aphasia, memory disturbance B. cerebellar signs, sensory signs, ocular signs C. gait disturbance, urinary incontinence and dementia D. memory impairment, ataxia and urinary incontinence Kaplan 9th ed page 254 99. A 50 year old man was brought to the ER because of worsening confusion and distractibility. The wife can’t pinpoint the exact onset of symptoms but remembers her husband to be acting different some 2 months ago. Lately the patient has been complaining of headache.What’s the least likely possibility? A. Dementia B. Delirium C. Mood disorder D. Primary psychotic disorder Kaplan 9th ed page 360 - 361 100. On further exam the patient has lapses in memory and mild right facial weakness. What diagnostic tool will you employ? A. lumbar puncture B. electroencephalograph C. Ct scan of the head with contrast D. None of the above Kaplan 9th ed page 360 - 361 DEPARTMENT OF INTERNAL MEDICINE _B____1. All of the following are emergencies and require immediate attention and treatment, EXCEPT: a. acute left ventricular failure c. ventricular fibrillation b. acute rheumatic carditis d. status asthmaticus Priciples of internal Medicine Harisson15th edition p1295 _A_____2. A 16 years old woman came to you with complaint of chest pain. After workup you diagnose her to have mitral valve prolapse. You explain to her that MVP tends to be benign but the following may occur, EXCEPT: a. angiodysplasia c. sudden cardiac death b. endocarditis infective d. embolic phenomena Priciples of internal Medicine Harisson15th edition p1395 _D_____3. A patient has a suspicious myocardial infarction 4 hours ago. The most reliable test is: a. SGPT c. SLDH b. WBC d. CK-MB Harisson15th edition p1495 _C_____4. The microorganisms associated with coronary heart disease are: a. Chlamydia pneumoniae and Streptococcus pneumoniae b. Chlamydia pneumoniae, Streptococcus pneumoniae and Helicobacter pylori c. Chlamydia pneumoniae and Helicobacter pylori d. Streptococcus pneumoniae and Helicobacter pylori Harisson15th edition p1349 _B_____5. A poverty related heart disease: a. congenital heart disease c. coronary artery disease b. rheumatic heart disease d. cor pulmonale Harisson15th edition p1369 _A_____6. Cardiac rehabilitation post-MI can be started a. within 24 hours after admission c. not necessary b. after discharge from the ICU d. after discharge from the hospital Harisson15th edition p1458 _A_____7. The single biggest risk factor in the causation of stroke: a. hypertension c. obesity b. cardiac disease d. none of these Harisson15th edition P 2372 _B_____8. Enlargement of the heart on plain PA view of a chest x ray is evidenced by a minimal cardiothoracic index of: a. less than 0.3 c. greater than 1.0 b. greater than 0.5 d. greater than 1.2 Harisson15th edition p1253 _A_____9. Elevation of serum K is most toxic to the: a. myocardium c. liver b. kidney d. brain Harisson15th edition P282 _A_____10. Ventricular gallop or third heart sound is characteristic of: a. mitral regurgita c. tricuspid regugita b. aortic stenosi d. mitral stenosis Harisson15th edition P 1308 _C_____11. A 36 year old female is hypertensive and diabetic. She came in because of an erythematous rash across the bridge of the nose. Her BP was 180/119. Which of her medicines should be withdrawn? a. propranolol c. hydrazine b. nifedipine d. euglucon Harisson15th edition P 24 _A_____12. The most effective way to demonstrate the area of blood clot in deep venous thrombosis is by: a. Doppler ultrasonography b. contrast venography c. plain x ray d. impedance plethysmography Harisson15th edition P 1492 _B_____13. The usual cause of macrocytic anemia is: a. chronic liver disease c. chronic renal disease b. malabsorption d. iron deficiency Harisson15th edition P 603 _A_____14. Steppage gait is caused by: a. bilateral pyramidal tract disease b. double athetosis c. exaggerated lumbar lord d. bilateral foot drop Bates 6th ed p. 616 _D_____15. Bell’s palsy is caused by damage to: a.vagus nerve c. oculomotor nerve b. trigeminal nerve d. facial nerve Harisson15th edition P 1307-1309 _C_____16. Antiplatelet agent used in preventing further TIA are the following, EXCEPT: a. dipyridamole c. etodolac b. sulfinpyrazone d. aspirin Harisson15th edition P 2380 _C______17. The diagnosis of epilepsy is is best established by: a. EEG c. history b.CT scan d. physical examination Harisson15th edition P 2363 _A______18. The following are the cardinal signs of Parkinsonism, EXCEPT: a. brisk reflexes c. tremor at rest, impaired postural instability b. bradykinesia d. rigidity Harisson15th edition P 2406 _A_____19. The neurotransmitter deficient in Parkinsonism is a. dopamine c. melatonin b. serotonin d. norepinephrIne Harisson15th edition P 2409 _B_____20. Which is NOT a feature of Parkinson’s disease? a. expressionless facies c. festinating gait b. athetosis d. cogwheel rigidity Harisson15th edition P 2407 _D_____21. Basal skull fracture commonly involved in head injury: a. temporal lobe c. frontal lobe b. parietal lobe d. occipital lobe Harisson15th edition P 2364 _B_____22. The initial drug of choice in trigeminal neuralgia (tic doloreux) is a. morphine c. digitalis b. carbamazepine d. aspirin Harisson15th edition P 2935 _D_____23. Very small pupils that improve with Maloxone are characteristics of a. transtentorial hemiation c. marked increased intracranial pressure b. severe anoxia d. narcotic overdose Harisson15th edition P 2567 _B_____24. The following features are seen in delirium tremens, EXCEPT: a. hallucination c. fver b. alkalosis d. hypotension Harisson15th edition P 2565 _A_____25. Cognitive effect of stress: a. all of these c. difficulty in concentration b. short attention span d. tired of thinking Harisson15th edition P75 _A_____26. NOT a characteristic of infantile autism: a. thought and perceptual c. occurs before 36 months disturbances predominate d. abnormal non-verbal communication b. subnormal level of intelligence Harisson15th edition P249 _A_____27. One of the following is NOT feature of psychogenic depression: a. flat effect c. anorexia b. diarrhea d. lack of libido Harisson15th edition P 2553 _D_____28. The diagnosis of endogenous depression is bolstered by one of the following laboratory tests: a. serum cholinesterase c. electroencephalography b. serum serotonin d. dexamethasone suppression Harisson15th edition P 2853 _B_____29. Lithium carbonate is the drug of choice for a. hysteria c. depression b. mania d. schizophrenia Harisson15th edition P 2557 _C_____30. Which goal is most important to develop a sense of intimacy? a. finding a sexual partner c. finding a peer group b. resolution of identity d. resolving moral issues Synopsis of Psychiatry Kaplan 9th ed p.71 _D_____31. NOT a mature defense: a. humor c. sublimation b. ascetism d. suppression Kaplan 9th ed p.71 _C_____32. Type of schizophrenia which shows less regression of mental faculties, emotional response and behavior: a. disorganized c. catatonic b. undifferentiated d. residual Harisson15th edition P 2539 _B_____33. Fear of death at this age is because of the fear of abandonment: a. 10-14 years c. 1-1/2 years b. 2-1/2 to 5 years d. 1-1/2 to 2-1/2 years Kaplan 9th ed p.102 _C_____34. Suicide is most commonly seen in a. petit mal epilepsy c. affective disorders b. schizophrenic reaction d. character disorder Kaplan 9th ed p 861 _A_____35. A definitive contraindication to electroconvulsive therapy (ECT) is a. brain tumor c. aortic aneurysm b. threatened retinal detachment d. myocardial disease Harisson15th edition P 2558 _A_____36. The most common form of dementia in the elderly is a. Alzheimer’s disease c. brain tumores b. atherosclerosis d. cretinism Harisson15th edition P 2398 _B_____37. Definitive therapy of sleep apnea: a. electrophrenic stimulation c. respiratory stimulants b. tracheostomy d. nocturnal oxygen inhalation Harisson15th edition P 1376 _B_____38. A secretion is TENACIOUS if it a. is not clear c. smells like decaying matter b. is sticky and not easily pulled d. has salty taste apart Harisson15th edition P 1443 _D_____39. Pathognomonic radiologic sign of pneumothorax: a. tram line c. hyperinflation b. hyperluscency d. visceral pleural line Harisson15th edition P 1376 _D_____40. In what condition is the lung ventilated but not perfused? a. emphysema c. viral pneumonitis b. atelectasis d. embolism Harisson15th edition P 1361 _A_____41. A respiratory consequence not found in pulmonary embolism: a. fetor hepaticus c. pulmonary infarction b. respiratory alkalosis and tachyp d. pneumoconstriction Harisson15th edition P 1361 _B_____42. Bronchiectasis is commonly a sequel to a. carcinoma of the lung c. pulmonary embolism b. infection d. heart failure Harisson15th edition P 1541 _C_____43. Total lung capacity is usually increased with a. congestive failure c. emphysema b. cystic fibrosis of pancreas d. hyaline membrane disease Harisson15th edition P 1498 _A_____44. The honeycombed density seen on chest x-ray is characteristics of a. bronchiectasis c. acute pulmonary edema b. cardiac asthma d. pulmonary TB in a diabetic Harisson15th edition P 1541 _A_____45. Which most closely simulate military TB? a. histoplasmosis c. chlamydia b. candidiasis d. mycoplasma Harisson15th edition P 959 _D_____46. Lung abscess is a complicating factor in comatose patients. This is due to a. decubitus ulcers c. thrombophlebitis b. repeated convulsions d. aspirations Harisson15th edition P 1536 _D_____47. The term “coin lesion” is diagnosed because of a. hemoptysis c. aspirated foreign body b. bronchoscopy d. chest x-ray finding -B_____48. The best screening tool available for peripherally located lung cancer is the a. sputum cytology c. chest radiograph b. bronchoscopy d. CT scan Harisson15th edition P 1307 _D_____49. In respiratory acidosis, one of the following is retained: a. HCI c. oxyhemoglob b. sulfates d. carbon dioxide Harisson15th edition P263 _A_____50. A chronic smoker who develops primary lung malignancy is apt to have a. small cell carcinoma c. epidermoid carcinoma b. adenocarcinoma d. large cell carcinoma Harisson15th edition P306 _C_____51. Type of bronchogenic carcinoma which commonly produces endocrine manifestations: a. epidermoid Ca c. small cell carcinoma b. squamos Ca d. Adenocarcinoma Harisson15th edition P508 _C_____52. The risk of a non-smoker married to a smoker is a. increased for ischemic heart disease only b. not increased in any significant amount c. increased by approximately 25% for lung cancer and ischemic heart disease d. increased for lung cancer only Harisson15th edition P808 _B_____53. The highly acidic gastric content is neutralized in the duodenum largely by the a. bile acids c. hydroxyl groups from the ileum b. bicarbonate from the pancreas d. residual secretion of the esophageal goblet cell Harisson15th edition P1746 _C_____54. Which specific electrolyte disturbance in the body fluid leads to clinical disorders? a. iron c. hydrogen b. zinc d. potassium Harisson15th edition P1796 _C_____55. Fat absorption in the intestines is facillated by a. amylase c. bile salts b. mucopolysaccharides d. mucin Harisson15th edition P1765 _D_____56. There may be extra-gastric sources of gastrin, excessive secretion of which may lead to peptic ulcer. The most common nongastric source of this gastrin is a. gall bladder c. uterus b. lung d. pancreas Harisson15th edition P1739 _C_____57. Spasms of abdominal pain that are colicky are most likely due to a. peritonitis c. obstructed hollow viscus b. referred pain from the chest d. paralytic ileus Harisson15th edition P1803 _C_____58. Which of the following is present in the large bowel? a. intrinsic nerves of the intestines c. absorption of water b. extrinsic nerves of the intestines d. succus entericus Harisson15th edition P1763 _D_____59. Pneumoperitoneum is present when there is a. duodenal ulcer c. salpingitis b. gall bladder empyema d. ruptured bowel Harisson15th edition P1807 _A_____60. The following pathogens are causative agents of enteric infections. Which of the following has basent fecal leucocytes? a. Vibrio cholera c. Campylobacter jejuni b. diarrheogenic d. Shigella Harisson15th edition P909 _B_____61. Paralytic ileus is NOT pathologic in one of the following: a. ruptured appendicitis c. bile peritonitis b. soon after abdominal surgery d. hypokalemia Harisson15th edition P1803 _D_____62. A rise in BUN without renal disease, renal ischemia, obstruction is most likely to be due to a. severe liver disease c. hemolytic anemia b. eclampisa d. massive GI bleeding Harisson15th edition P1650 _B_____63. After major abdominal surgery there is a. gastric hyperacidity c. volvulus b. transient ileus d. reflux esophagitis Harisson15th edition P1495 _A_____64. For disorders in the GIT such as ulcers, diverticula, strictures, new growths and motility disorders the test that is most useful is a. x-ray c. MRI b. CT scan d. ultrasound Harisson15th edition P1752 _B_____65. Ascitic fluid in cirrhosis of the liver would be expected to show a. more than 1000 white cells/cubic c. hemorrhage mm. d. positive malignant cytology b. protein less than 2.5% Harisson15th edition P1838 _C_____66. Ruptured peptic ulcer with pneumoperitoneum is most easily and safely diagnosed by a. barium swallow c. plain x-ray of abdomen b. ultrasound d. paracentecis of the abdomen Harisson15th edition P1732 _A_____67. An upright firm of the abdomen shows free air in the peritoneum. This means a. perforated viscus c. volvulus b. diabetic acidosis d. hyperkalemia Harisson15th edition P1752 _B_____68. Colonoscopy compared to Ba enema as a diagnostic procedure for colorectal cancer has a. less cost c. greater chance of misdiagnosis b. greater chance of perforation d. less chance of hemorrhage Harisson15th edition P1737,529 _D_____69. In an upright scout film of the abdomen, a step-ladder appearance of the bowel indicates a. enterocolitis c. peritonitis b. volvulus d. bowel obstruction Harisson15th edition P1809 _B_____70. Which of the following esophageal disorders is best characterized by dysphagia for both solids and liquids? a. Schatzki’s rings c. benign esophageal stricture b. achalasia d. esophageal carcinoma Harisson15th edition P1791 _D_____71. The fungus that frequently invades the upper GIT and causes esophagitis is the a. Blastomyces c. Cryptococcus b. Aspergillus d. Candida Harisson15th edition P1186 _D_____72. Lower esophageal sphincter (LCS) dysfunction is not uncommon. Which of the following is useful in evaluation LES pressure? a. endoscopy c. Ba swallow b. acid reflex test d. esophageal manometry Harisson15th edition P223 _A_____73. Repeated severe epigastric pain 1 hour after heavy meals in a 40-year old obese female is usually due to a. gall stones c. peptic ulcer b. pancreatitis d. meteorism Harisson15th edition P1883 _B_____74. Stress ulcer that occurs with burns, brain tumors and shock present commonly as a. hematochezia c. severe abdominal pain b. melena d. intestinal obstruction Harisson15th edition P1760 _B_____75. In the classification of polyps of the colon, what is/are considered precancerous? a. lymphosarcomatous c. Peutz-Jegners syndrome b. all of these are correct d. adenomatous Harisson15th edition P1732 _D_____76. Most of the ammonia is formed in the a. small intestines c. kidneys b. lungs d. liver Harisson15th edition P1867 _B_____77. Albumin is a protein that is synthesized in the a. pancreas c. nephron b. liver d. lymphoid tissue Harisson15th edition P1813 _C_____78. The urea cycle converts a potentially toxic substance to a more innocuous substance. The toxic material is a. urea c. ammonia b. uric acid d. ornithine Harisson15th edition P2302 _D_____79. Ammonia is highly toxic. It is detoxified by its transformation in the liver into a. alpha-ketoglutarate c. methionine b. uric acid d. none of the above Harisson15th edition P1540 _D_____80. Ammonia is most toxic when a. the gut is sterile c. low serum Na+ b. serum K is high d. blood pH is high Harisson15th edition P2602 _C_____81. Which constitutes a major portion of the bile? a. cholesterol c. water b. bile salts d. bile acid Harisson15th edition P1880 _D_____82. The synthesis of bile salts takes place in the a. common bile duct c. pancreas b. duodenum d. none of the above Harisson15th edition P1880 _C_____83. Pruntus is most severe in jaundice due to a. portal dirrhosis c. biliary cirrhosis b. hepatic schistosomiasis d. amebis liver abscess Harisson15th edition P1860 _C_____84. A large liver is least expected in a. acute malaria c. chronic portal cirrhosis b. typhoid fever d. chronic heart failure Harisson15th edition P1858 _B_____85. Long-lasting marker of hepatitis B: a. anti-HBo c. anti-H b. HbsAg d. anti-HBe Harisson15th edition P1829 _B_____86. A patient with complete biliary obstruction developed bleeding tendencies. The diagnostic test of choice is a. fibrinogen blood level c. platelet count b. prothrombin time d. BUN Harisson15th edition P1816 _C_____87. An elevated serum SPGT is probably due to a. jaundice c. liver necrosis b. cholestasis d. bleeding varices Harisson15th edition P1815 _B_____88. Delta viral hepatitis can only occur together with a. hepatitis A c. leptospirosis b. hepatitis B d. hepatitis Harisson15th edition P1830 _A_____89. Which of the following drugs will be less potent in the presence of severe liver disease? a. phenytoin c. tetracycline b. imipramine d. lidocaine Harisson15th edition P1814 _D_____90. The most common benign neoplasm of the liver a. sarcoma c. adenoma b. focal nodular hyperplasia d. hemangioma Harisson15th edition P533 _B_____91. Most common primary tumor that spread/s to the liver is/are a. prostate c. melanoma b. gastrointestinal tumor d. bone Harisson15th edition P535 _D_____92. Pancreatic lipase preferentially splits triglycerides to form free fatty acids and a. delta-monoglycerides c. glycerol b. alpha-monoglycerides d. beta-monoglycerides Harisson15th edition P1792 _A_____93. The least symptomatic stones in the billiary tree are located in a. gallbladder c. cystic duct b. neck of the gall bladder d. common bile duct Harisson15th edition P1881 _B_____94. The following pancreatic enzymes are potentially harmful, EXCEPT: a. lipase c. lysolecithinase b. none of these d. elastase Harisson15th edition P1891 _C_____95. Blood level that does NOT rise in acute renal failure: a. creatinine c. sodium b. potassium d. uric acid Harisson15th edition P1650 _B_____96. Pain described as “renal colic” usually indicates a. kidney stone c. bladder stone b. ureteral stone d. pyelonephritis Harisson15th edition P1722 _A_____97. Which is acquired from infected water vapor or moist air inhaled? a. legionella c. pseudomonas b. mononucleosis d. typhus Harisson15th edition P871 _C_____98. Amylase is NOT elevated in one of the following diseases: a. choledocholithiasis c. penetrating peptic ulcer b. acute gastritis d. mumps Harisson15th edition P89,1817 _D_____99. Urobilinogen is produced in the a. renal tubules b. liver c. red blood cell d. intestinal mucosa Harisson15th edition P1871 _D_____100. Conjugation of bilirubin is a function of the a. Kupfer cells c. intestinal mucosa b. erythrocytes d. none of the above Harisson15th edition P1817 @@@END OF EXAM@@@ REFERENCES: 1. 2. 3. 4. Harrison’s: Principles of Internal Medicine Edition 2002 Braunwald, Fauci Edition 2002 National Medical Study in Medicine, 8th Edition Board Review Series in Medicine; 4th edition ANSWERS: 1. b 2. a 3. d 4. c 5. b 6. a 7. a 8. b 9. a 10. d 11. c 12. a 13. b 14. a 15. d 16. c 17. c 18. a 19. b 20. d 21. b 22. d 23. b 24. a 25. a 26. a 27. d 28. b 29. c 30. d 31. c 32. b 33. c 34. a 35. a 36. b 37. b 38. d 39. d 40. a 41. b 42. c 43. a 44. a 45. d 46. d 47. b 48. d 49. a 50. a 51. c 52. b 53. c 54. c 55. d 56. c 57. c 58. d 59. a 60. b 61. d 62. b 63. a 64. b 65. c 66. a 67. b 68. d 69. b 70. d 71. d 72. a 73. b 74. b 75. d 76. b 77. c 78. d 79. d 80. c 81. d 82. c 83. c 84. b 85. b 86. c 87. b 88. a 89. b 90. b 91. d 92. a 93. b 94. c 95. b 96. a 97. c 98. d 100. d APMC BOARD EXAM INTERNAL MEDICINE 2005 Name________________________________________ Score__________ A. Write the best answer in the space provided before each number. _____1. Among the viruses associated with causing bronchiectasis, choose the main ones: A. Coxsackie virus B. Arena virus C. Influenza Virus D. Parvo virus _____2. In patients with hospital acquired pneumonia, the following organisms are commonly found in the ICU except: A. Pseudomonas aeruginosa B. Staphylococcus aureus C. Acinetobacter spp. D. Hemophilus influenzae _____3. In patients with asbestosis, smoking greatly increases the incidence of A. Lung Cancer B. Mesothelioma C. Pulmonary fibrosis D. A and C _____4. In the treatment of asthma, the following are classified as leukotriene modifiers except: A. Montelukast B. Nedocromil C. Zileuton D. Zafirlukast _____5. In evaluating a possible lesion on chest xray, which of the following radiologic procedure will give the best information. A. Magnetic resonance imaging B. CT scan with contrast C. Ultrasound of the thoracic area D. Radionuclide scanning APMC Board exam Internal Medicine 2005 page 2 _____6. Pulmonary infections is common among patients with cystic fibrosis, therapy should be directed against which of the following organisms: A. Pseudomonas aeruginosa B. Streptococcus pneumoniae C. Chlamydia pneumoniae D. None of the above _____7. The following are radiologic signs which are found in patients with pulmonary embolism: A. Westermark’s sign B. Hampton’s sign C. Palla’s sign D. All of the above _____8. Aside from lung cancer, the other malignancy (cies) most commonly associated with pleural effusion are: A. Breast carcinoma B. Hepatoma C. Renal cell cancer D. Colon cancer _____9. Key features to describe primary alveolar hypoventilation includes: A. Chronic Respiratory Acidosis B. Frequent episodes of central hypopnea C. Development of daytime somnolence, disturbed sleep and morning headaches D. All of the above _____10. What is the most common disease condition in patients waiting for a lung transplant? A. COPD B. Idiopathic pulmonary fibrosis C. Cystic fibrosis D. Primary Pulmonary hypertension _____11. In an alcoholic who comes in the emergency room complaining of ophthalmoplegia, lateral rectus palsy and ataxia, the differential diagnosis should include: A. cerebrovascular accident B. Korsakoff’s psychosis C. Wernicke’s disease D. A and B APMC Board exam Internal Medicine 2005 -page 3 _____12. In patients with atheroembolic stroke, the treatment most shown to have benefits included: A. Heparin B. Aspirin C. Dipyridamole D. A and B _____13. Current accepted treatment of asymptomatic carotid disease includes: A. Carotid endarterectomy B. Conservative management with statins and aspirin C. Balloon angioplasty with stenting D. All of the above _____14. Asking a patient what they ate for breakfast this morning is testing his: A. Working memory B. Episodic memory C. Long term memory D. Procedural memory _____15. Alzheimer’s disease is characterized by the following except: A. reduction of acetylcholine in the nucleus basalis of Meynert B. formation of neuritic plaques composed of AL amyloid, proteoglycans C. Maybe genetic in origin, involving the APP gene mutation in chromosome 21 D. May involve presenilin-1 and presenilin-2 in chromosome 14 and 1 respectively _____16. Patients with post infectious GN have the following findings: A. Depressed C3 level B. Depressed C4 level C. Elevated ASO titer D. A and B _____17. Patients with acute renal failure secondary to gentamicin has the following findings: A. oliguric renal failure B. elevated eosinophil count in the urine C. presence of dirty brown coarse granular cast in the urine sediments D. presence of red blood cell cast in the urine _____18. The correction of hyperkalemia which involves actual excretion of potassium is achieved by what method? A. administration of calcium gluconate B. administration of sodium bicarbonate C. administration of d50 water plus insulin D. administration of kayaxelate APMC Board Internal Medicine –page 4 _____19. Kidney biopsy of a patient with membranous glomerulopathy will show: A. Mesangial deposits B. Subendothelial deposits C. Subepithelial deposits D. IgG linear antibodies _____20. Patients with kidney transplantation who have received anti-lymphocyte antibodies (OKT3) are prone to developing what type of infection in the immediate post transplant period? A. B. C. D. Hepatitis B infection Hepatitis C infection Cytomegalovirus infection None of the above _____21. Patients who are undergoing dialysis for the 1st time will experience this condition due to rapid removal of toxic metabolites: A. First use syndrome B. Disequilibrium syndrome C. Anaphylactic shock D. Recirculation _____22. Which of the following substances below are potent inhibitors of stone formation? A. Uric acid B. Inorganic pyrophosphate C. Oxalate D. None of the above _____23. A 5 year old male presenting with multiple cysts in the 2 kidneys associated with hepatic fibrosis is most likely to have: A. autosomal dominant polycystic kidney disease B. medullary cystic kidney disease C. autosomal recessive polycystic kidney disease D. medullary sponge kidney _____24. Patient was complaining of reducing urine output after he started taking rifampicin and isoniazid for pulmonary tuberculosis. The lab test shows normal sgpt but creatinine is 3.5mg/dl (baseline of 1.0mg/dl at start of treatment). Urinalysis shows eosinophilia with WBC cast. What is the expected etiology of the renal failure? A. Acute tubular necrosis B. Acute Glomerulonephritis C. Acute Interstitial nephritis D. Acute Vascular thromobosis APMC Board Exam Internal Medicine 2005 page 5 _____25. Which of the following post transplant malignancy is/are common? A. Lung cancer B. Breast Cancer C. Colon cancer D. Non-Hodgkins lymphoma _____26. Which of the following physical findings suggest left ventricular heart failure? A. Pulsus paradoxus B. Pulsus alternans C. Bisferiens pulse D. Pulsus tardus _____27. Which of the following statement is true of right bundle bunch block? A. Only occur in pathologic conditions, that is in coronary artery disease. B. May occur in subjects without structural heart conditions C. May occur in patients with atrial septal defect D. B and C _____28. Which of the following imaging procedures is best to detect “hibernating myocardium” A. Thallium 201 stress testing B. Adenosine stress echo C. Positron emission tomography with flurodeoxyglucose D. Technetium 99m nuclear imaging _____29. In patients with severe knee osteoarthritis and chronic obstructive lung disease, the best way to test for myocardial ischemia is to do: A. Adenosine stress echo B. Dipyridamole stress echo C. Dobutamine stress echo D. None of the above _____30.Which of the following conditions can cause AV nodal dysfunction? A. Lyme’s disease B. Sarcoidosis C. Digitalis intoxication D. All of the above APMC Board Exam Internal Medicine 2005 page 6 ____31. A Cardiac Pacemaker is absolutely indicated in the following condition: A. 3rd degree AV block B. 2nd degree AV block Mobitz type I C. 2nd degree AV block Mobitz type II following anteroseptal wall infarction D. A and C _____32. The method with the best chance to terminate Wolf-Parkinson-White syndrome is: A. Digitalis B. Verapamil C. Beta-blocker D. Catheter ablation _____33. In a patient with abdominal aortic aneurysm, what diameter of the aortic aneurysm is surgery absolutely indicated? A. 4 cm B. 4.5 cm C. 5 cm D. 5.5 cm _____34. In treating deep vein thrombosis, the following statements are true: A. Anticoagulation should be continued for 1 to 3 months B. INR should be maintained between 2.5 to 3.5 C. Low molecular weight heparin should be started first then overlapped with warfarin D. all of the above _____35. In patients about to receive fibrinolytic therapy, what conditions are contraindicated to its use: A. Previous administration of streptokinase B. Recent history of surgical procedure within the last 2 weeks C. Patient taking anticoagulant with INR >2.0 D. All of the above _____ 36. In a patient presenting with upper respiratory tract infection, the sudden onset of chest pain with pericardial friction rub and heart failure is usually due to: A. Hepatitis B virus B. Herpesviruses C. Coxsackievirus D. Measles virus APMC Board Exam –Internal Medicine 2005 page 7 _____37. In patients with suspected dengue hemorrhagic fever, the following should be done: A. Infusion of crystalloid or colloid to prevent hemoconcentration B. Administer steroid to prevent hypotension C. Blood transfusion if the hematocrit goes below 36% D. Prophylactic platelet transfusion if platelet count goes below 100,000 _____38. Which of the following viral agent does not cause hemorrhagic fever: A. Dengue virus B. Ebola virus C. Hantavirus D. HTLV I _____39. Deeply Invasive Candidiasis is treated best with: A. IV amphotericin B B. Oral Fluconazole C. Itraconazole D. IV Caspofungin _____40. The following are zoonotic infections, EXCEPT: A. Brucellosis B. Leptospirosis C. Filariasis D. Toxoplasmosis _____41. The following are human infections caused by bacteria located intracellularly, EXCEPT: A. Legionella infections B. Chlamydia infections C. Salmonella infections D. Streptococcal infections _____42. The drug of choice for methicillin-resistant Staphylococcus aureus is: A. Carbapenems B. Oxacillin C. Fluoroquinolones D. Vancomycin _____43. Which of the following antibacterial agents does not penetrate cells well A. Ampicillin B. Macrolide C. Metronidazole D. Quinolones APMC Board Exam- Internal Medicine 2005 page 8 _____44. Which antimycobacterial agent should be stopped if the patient develops gouty arthritis A. Rifampicin B. Isoniazid C. Ethambutol D. Pyrazinamide _____45. Which vaccine is safe for use in pregnant women: A. Hepatitis B B. Measles C. Mumps D. Varicella _____46. Very distinctive, pruritic small wheals that are surrounded by large areas of erythema sometimes precipitated by fever or hot baths, are seen in: A. Cholinergic Urticaria B. Light urticaria C. Vibratory angioedema D. Aquagenic pruritus _____47. Differential diagnosis of localized hypomelanosis includes: A. Tinea Versicolor B. Vitiligo C. Nevus Depigmentosus D. All of the above _____48. Nikolsky’s sign which is separation of the epidermis is seen in: A. Pemphigus Vulgaris B. Toxic Epidermal Necrolysis C. Stevens-Johnson Syndrome D. All of the above _____49. Tissue and blood eosinophilia are prominent features of: A. Wegeners Granulomatosis B. Allergic Granulomatosis C. Polyarteritis Nodosa D. Lymphomatoid Granulomatosis APMC Board Exam –Internal Medicine 2005 page 9 _____50. A transient, pruritic linear wheal with a flare at a site in which the skin is briskly stroked with a firm object is known as: A. Dermatosis B. Dermographics C. Dermatography D. Dermographism _____51. The following are included in the criteria for the classification of Systemic Lupus Erythematosus except: A. Butterfly rash B. Alopecia C. Photosensitivity D. Serositis _____52. The following are true of systemic sclerosis: A. Acquired Disease B. Non-contagious multisystem disease C. Raynaud’s phenomenon is the most common symptoms D. All of the above _____53. The following are features of Behcet’s disease except: A. Multiple oral aphthous ulcers B. Uveitis C. Malar rash D. None of the above _____54. The following are true of Takayasu’s arteritis: A. Chronic vasculitis of the aorta and its branches B. Most common in young women of Asian descent C. Biopsy is rarely done because of the vessel size involved D. All of the above _____55. Antiphospholipid syndrome: A. Recurrent arterial or venous thrombosis B. 2nd & 3rd trimester fetal death C. (+) lupus anticoagulant D. all of the above _____56. Sjogren’s syndrome is characterized by the following except: A. Dry eyes B . Dry mouth C. Dry hair D. none of the above APMC Board Exam- Internal Medicine 2005 page 10 _____57. The following are tumors commonly associated with dermatomyositis: A. Melanoma B. Lung cancer C. Chronic lymphocytic leukemia D. Pancreatic cancer _____58. What is true of Rheumatoid Factor? A. Can be found in patients with SLE and Sjogrens syndrome B. Presence of Rheumatoid factor establishes the diagnosis of Rheumatoid arthritis C. High titers and low titers of Rheumatoid factor has the same significance D. All of the above _____59. Which of the following patients is the LEAST suspicious of SLE: A. 60 y.o female with fatigue, anorexia, cough, fever, increased ESR B. 40 y.o female with oral ulcers, rash over cheeks, anemia, thrombocytopenia increased ESR, arthritis C. 30 y.o male with anemia, leucopenia, casts in the urine, decreased C3, headache, pleural effusion D. 42 y.o female with skin rash, photosensitivity, anemia, fatigue _____60. HLA B-27 is associated with what condition? A. Ankylosing Spondylitis B. Systemic Lupus Erythematosus C. Sjogren’s syndrome D. Scleroderma _____61. The most life threatening side effect of cytotoxic chemotherapy is A. Nausea and vomiting B. Leucopenia C. Alopecia D. Mucositis _____62. The following are goals of cancer treatment except: A. To cure or control the disease whenever possible B. To palliate symptoms in advanced disease C. To increase over-all survival in terminally ill patients D. To ensure that minimal functional impairment results from treatment APMC Board Internal Medicine 2005 page 11 _____63. Telomerase, a protein found at the distal ends of DNA strands, normally fall off. However, if it does not fall off, one of the following occurs: A. B. C. D. Production of Immortal cells Diseases of aging Point mutation Spontaneous regression _____64. What is true of apoptosis A. Programmed death of cells that lose normal growth regulations B. Extrinsic pathway is activated by cross-linking members of the tumor necrosis receptor superfamily C. Intrinsic pathway is initiated by the release of cytochrome C and second mitochondrial activator of caspases in response to a variety of noxious stimuli D. All of the above _____65. Current principles in antiangiogenic therapy depend on the following mechanism to halt formation of new blood vessels in tumor growths: A. Necrosis B. Apoptosis C. Anoikis D. None of the above _____66. Which of the following treatment may reverse the cytopenia in patients with advanced Idiopathic myelofibrosis? A. Hydroxyurea B. Interferon C. Splenectomy D. Plateletpheresis _____67. The enzyme that promotes myeloid proliferation in chronic myelogenous leukemia is: A. thymidine kinase B. tyrosine kinase C. leucocyte alkaline phosphatase D. none of the above _____68. Fever in neutropenic patients is treated with empiric antibiotics against: A. Staphylococcus B. Gram positive aerobes C. Gram negative aerobes D. All APMC Board Exam – Internal Medicine 2005 page 12 _____69. The differentiating agent that do not produce DIC and promotes promyelocytic maturation in AML M3: A. All-cis retinoic acid B. All-trans retinoic acid C. Tretinoin D. Vitamin A _____70.Which biochemical abnormality is associated with multiple myeloma? A. Hypercalcemia B. Hypocalcemia C. Hypophosphatemia D. None of the above _____71. In a patient with hepatic cirrhosis, hepatic encephalopathy can be precipitated by all of the following except: A. Gastrointestinal bleeding B. Metabolic Acidosis C. Infection D. Vomiting _____72. Which of the following drug used for treating peptic ulcer disease should be avoided in patients with renal failure A. Sucralfate B. Famotidine C. Aluminum Hydroxide-Magnesium Hydroxide antacid D. A and C _____73. What can be said of type A gastric ulcer? A. Also called autoimmune gastritis B. Associated with Helicobacter Pylori infection C. Associated with pernicious anemia D. A and C _____74. 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 APMC Board Internal Medicine 2005 page 13 _____75. The most serious pulmonary complication of pancreatitis is: A. Pleural effusion B. Acute respiratory distress syndrome C. Pneumonia D. Pulmonary embolism _____76. The following is true of Hepatitis B infection: A. Accounts for >50% of fulminant hepatitis, a sizable proportion of which is associated with Hepatitis D infection B. DNA virus C. Risk of chronic infection is much greater in adults than in infants D. A and B _____77. A 71 y.o. woman with a history of coronary artery disease presents to her family physician for a routine check up. The physician notices that she has lost 20 lbs since her last visit 6 months ago. When questioned, she gives a history of intermittent periumbilical pain that always begins about 30min. after eating and lasts for about 2 hours. She claims that the pain is more after a large meal so she began to eat less out of fear of the pain. The most likely diagnosis is: A. Pancreatitis B. Cholecystitis C. Small bowel obstruction D. Intestinal Ischemia _____78. A 48 y.o. man with a history of alcohol abuse presents to the emergency room vomiting bright red blood. All of the following should be included in the differential diagnosis except: A. Ruptured Esophageal varices B. Esophageal Reflux secondary to a hiatal hernia C. Boerhaave’s syndrome D. Mallory Weiss Syndrome _____79. The most common site for ischemic colitis to occur is: A. Splenic Flexure B. Cecum C. Rectum D. Sigmoid Colon _____80. All of the factors listed below may play a role in the development of duodenal ulcer disease except: A. Tobacco smoking B. Helicobacter Pylori infection C. Spicy Food ingestion D. Genetic Factors APMC Board Exam Internal Medicine 2005 – page 14 _____81. The cell mediated type of response is characterized by: A. T cell involvement B. Usually responsible for host defense against virus and fungus C. Type IV hypersensitivity type of reaction D. All of the above _____82. The smallest concentration of antibody in the serum is: A. IgA B. IgM C. IgE D. IgM _____83. The complement system can do all the following except: A. Activate phagocytes B. Lyze the target cells C. Activates chemotaxis D. inhibits opsonization _____84. Mast cell degranulation is due to: A. Crosslinking of 2 IgE antibodies B. Primary response to antigen C. antibody production D. T cell activation _____85.What is true of systemic mastocytosis: A. Result of a point mutation B. +Dariers sign C. Presence of hepatosplenomegaly D. all of the above _____86. The following are true of hyperosmolar nonketotic coma except: A. serum osmolality more than 320 B. ph 7.4 C. Hyperglycemia D. serum ketones more than 2:1 _____87. A 28 year old male with mild hypertension had controlled blood pressure, he suddenly developed hypertensive crisis with an elevated 24 hr urine metanephrines, what is the most likely cause of his condition A. Renal Artery Stenosis B. Cushings syndrome C. Pheochromocytoma D. none of the above APMC Board Exam – Internal Medicine 2005 -page 15 _____88. The most reliable thyroid function test for diagnosing primary hypothyroidism: A. Thyrotropin B. Thyroid Stimulating Hormone C. Free T4 D. Thyroid Scan _____89. Clinical Feature of Conn’s disease: A. Hyperkalemia B. Metabolic Alkalosis C. Hyponatremia D. Alternating Hypotension-Hypertension _____90. If a young female patient is amerorrheic with galactorrhea, complaining of slight visual problems, the blood test to check is: A. LH, FSH B. Prolactin C. Dopamine D. Estradiol _____91. You suspect a patient to have acromegaly. To screen for this problem you check: A. IGF 1 level B. Random Growth Hormone C. TSH and T4 levels D. serum ACTH level _____92. A patient presents with polyuria and polydipsia. Serum sodium is 145 meq/l with a dilute urine with specific gravity of 1.005. Patient has normal response to water deprivation without any response to exogenous AVP (vasopressin). The condition is consistent with: A. Dipsogenic diabetes insipidus B. Central diabetes insipidus C. Nephrogenic diabetes insipidus D. SIADH _____93. A 45 y.o. male presents with infertility. On examination he was noted to have small firm testes and gynecomastia. The following statements is true of the above condition: A. Most likely due to a secondary cause like pituitary gland trauma B. Rule out possibility of exogenous estrogen intake C. basic defect is a chromosomal abnormality= 47 XXY D. Biochemical tests will reveal: low testosterone and low LH/FSH levels APMC Board Exam – Internal Medicine 2005 page 16 _____94. Clinical manifestations of Growth Hormone Excess includes the following except: A. Prognatism B. Anhydrosis C. Hypertension D. Glucose Intolerance _____95. 32 y.o. female with high blood sugar was examined to have “moon facies”, truncal obesity with thin extremities, easy bruisibility and abdominal striae. She has an excess of which hormone A. ACTH B. Growth Hormone C. Cortisol D. A and C _____96. This syndrome is described as “an imposter has replaced your relative”: A. Munchausen’s syndrome B. Capgras syndrome C. Delirium Tremens D. Rogers Syndrome _____97. The following drugs are used in the treatment of bipolar disorders: A. Lithium carbonate B. Valproic Acid C. Carbamezepine D. All of the above _____98. The following is true of schizophrenia: A. Affected by both genetic and environmental events B. Drugs which activate dopaminergic activities are used to treat it. C. There is gradual increase in cortical volume over time D. None of the above _____99. In the treatment of general anxiety disorders, what is true: A. Benzodiazepines can be given for more than 4 weeks without problems B. Buspirone takes more than 1 week to act but has no abuse potential C. Over 80% of patients with general anxiety disorders have depression D. B and C _____100. Criteria for major depression includes: A. Loss of energy every day B. depressed mood daily for at least 1 week C. Hypersomnia nearly every day D. A and C Answer Key: 1. C 2. D 3. D 4. B 5. B 6. A 7. D 8. A 9. D 10. A 11. D 12. B 13. B 14. B 15. B 16. C 17. D 18. C 19. C 20. B 21. B 22. C 23. C 24. C 25. D 26. B 27. D 28. C 29. C 30. D 31. D 32. D 33. D 34. C 35. D 36. C 37. A 38. D 39. A 40. C Harrisons 16th edition, chapter 240 page 1542 Harrisons 16th edition, chapter 239 page 1539 Harrisons 16th Edition, chapter 238 page 1522-23 Harrisons 16th edition, chapter 236 page 1513 Harrisons 16th edition, chapter 235 page 1505 Harrisons 16th edition, chapter 241 page 1545 Harrisons 16th edition, chapter 244 page 1562 Harrisons 16th edition, chapter 245 page 1567 Harrisons 16th edition, chapter 246 page 1571 Harrisons 16th edition, chapter 248 page 1577 Harrisons 16th edition, chapter 372 page 2563 Harrisons 16th edition, chapter 349 page 2375 Harrisons 16th edition, chapter 349 page 2377 Harrisons 16th edition, chapter 350 page 2394 Harrisons 16th edition, chapter 350 page 2398-2399 Harrisons 16th edition, chapter 264 page 1681 Harrisons 16th edition, chapter 260 page 1645-1647 Washington Manual of Medical Therapeutics 30th Chap. 3 page 58-59 Harrisons 16th edition, chapter 264 page 1687 Harrisons 16th edition, chapter 263 page 1673 Washington Manual of Medical Therapeutics 30th Chap. 12 page 271 Harrisons 16th edition, chapter 268 page 1712 Harrisons 16th edition, chapter 265 page 1696 Harrisons 16th edition, chapter 260 page 1648 Harrisons 16th edition, chapter 263 page 1673 Harrisons 16th edition, chapter 209 page 1305 Harrisons 16th edition, chapter 210 page 1315 Harrisons 16th edition, chapter 211 page 1325 Harrisons 16th edition, chapter 211 page 1324 Harrisons 16th edition, chapter 213 page 1336 Harrisons 16th edition, chapter 213 page 1337 Harrisons 16th edition, chapter 214 page 1350-1351 Harrisons 16th edition, chapter 231 page 1483 Harrisons 16th edition, chapter 232 page 1492 Harrisons 16th edition, chapter 228 page 1453-1454 Harrisons 16th edition, chapter 175 page 1145 Harrisons 16th edition, chapter 180 page 1173 Harrisons 16th edition, chapter 180 page 1170 Harrisons 16th edition, chapter 187 page 1187 Harrisons 16th edition, chapter 155 p988, chap 198 p1243 chap 202 p1260 41. D 42. D 43. A 44. D 45. A 46. A 47. D 48. D 49. B 50. D 51. B 52. D 53. C 54. D 55. D 56. C 57. A 58. A 59. A 60. A 61. B 62. B 63. A 64. D 65. B 66. C 67. B 68. D 69. C 70. A 71. B 72. D 73. D 74. C 75. B 76. D 77. D 78. B 79. A 80. C 81. D 82. C 83. D 84. A 85. D 86. D 87. D 88. B 89. B 90. B 91. A 92. A 93. C 94. B 95. D 96. B 97. D 98. A 99. D 100. D Harrisons 16th edition, chapter 132 p871, chap 160 p1011 chap 121 p824 Harrisons 16th edition, chapter 120 page 821 Harrisons 16th edition, chapter 118 page 790 Harrisons 16th edition, chapter 150 page 963 Harrisons 16th edition, chapter 107 page 720 Harrisons 16th edition, chapter 298 page 1951 Harrisons 16th edition, chapter 48 page 299 Harrisons 16th edition, chapter 49 page 311 Harrisons 16th edition, chapter 306 page 2007 Harrisons 16th edition, chapter 298 page 1951 Harrisons 16th edition, chapter 300 page 1962 Harrisons 16th edition, chapter 303 pages 1979-1981 Harrisons 16th edition, chapter 307 page 2014 Harrisons 16th edition, chapter 306 page 2009-2010 Harrisons 16th edition, chapter 300 page 1964 Harrisons 16th edition, chapter 304 pages 1990-1991 Harrisons 16th edition, chapter 369 page 2541 Harrisons 16th edition, chapter 301 page 1972 Harrisons 16th edition, chapter 300 pages 1962-1963 Harrisons 16th edition, chapter 296 page 1937 Harrisons 16th edition, chapter 70 pages 479-481 Harrisons 16th edition, chapter 70 page 467 Harrisons 16th edition, chapter 69 page 454 Harrisons 16th edition, chapter 69 page 458-459 Harrisons 16th edition, chapter 69 page 462-463 Harrisons 16th edition, chapter 95 page 629 Harrisons 16th edition, chapter 96 page 637 Harrisons 16th edition, chapter 254 page 1611 Harrisons 16th edition, chapter 96 page 636 Harrisons 16th edition, chapter 98 page 658 Harrisons 16th edition, chapter 289 page 1868 Harrisons 16th edition, chapter 274 page 1753-1754 Harrisons 16th edition, chapter 274 page 1761 Harrisons 16th edition, chapter 112 page 750 Harrisons 16th edition, chapter 294 page 1898 Harrisons 16th edition, chapter 285 pages 1822-1825, 1834 Harrisons 16th edition, chapter 279 page 1799 Harrisons 16th edition, chapter 273 pages 1745-1746 Harrisons 16th edition, chapter 279 pages 1797-1798 Harrisons 16th edition, chapter 274 pages 1750-1753 Harrisons 16th edition, chapter 297 page 1940, 1946-7 Harrisons 16th edition, chapter 295 page 1922 Harrisons 16th edition, chapter 295 page 1907, 1913-1915 Harrisons 16th edition, chapter 298 page 1947-1949 Harrisons 16th edition, chapter 298 page 1953 Harrisons 16th edition, chapter 323 page 2161 Harrisons 16th edition, chapter 322 page 2151 Harrisons 16th edition, chapter 320 page 2111 Harrisons 16th edition, chapter 321 page 2139 Harrisons 16th edition, chapter 318 page 2086 Harrisons 16th edition, chapter 318 page 2090 Harrisons 16th edition, chapter 319 page 2098-2099 Harrisons 16th edition, chapter 328 page 2215 Harrisons 16th edition, chapter 318 page 2090 Harrisons 16th edition, chapter 321 page 2134 Harrisons 16th edition, chapter 350 page 2398 Harrisons 16th edition, chapter 371 page 2556-2557 Harrisons 16th edition, chapter 371 page 2559-2560 Harrisons 16th edition, chapter 371 page 2549-2550 Harrisons 16th edition, chapter 371 page 2553 MPL: 1. 65% 2. 70% 3. 80% 4. 90% 5. 75% 6. 90% 7. 70% 8. 75% 9. 70% 10. 80% 11. 80% 12. 90% 13. 85% 14. 80% 15. 60% 16. 85% 17. 75% 18. 95% 19. 60% 20. 70% 21. 65% 22. 75% 23. 75% 24. 65% 25. 60% 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 80% 60% 65% 60% 60% 50% 50% 50% 55% 75% 70% 95% 85% 90% 65% 60% 100% 80% 65% 85% 70% 70% 65% 70% 70% Blueprint: A. Percentage by subject: 1. Pulmonary - 10% 2. Neurology - 5% 3. Nephrology - 10% 4. Cardiology - 10% 5. Infectious Diseases – 10% 6. Dermatology - 5% 7. Rheumatology – 10% 8. Oncology – 5% 9. Hematology – 5% 10. Gastroenterology – 10% 11. Allergy/Immunology – 5% 12. Endocrinology – 10% 13. Psychiatry – 5% B. Types of Questions: 1. Recall - 52 % 2. Analysis - 42 % 3. Case/Problem Solving - 6 % 51. 52, 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75. 85% 65% 75% 75% 90% 65% 60% 60% 85% 85% 80% 70% 60% 40% 40% 50% 65% 90% 60% 65% 75% 45% 70% 85% 60% 76. 60% 77. 40% 78. 65% 79. 70% 80. 75% 81. 40% 82. 50% 83. 60% 84. 50% 85. 40% 86. 55% 87. 60% 88. 75% 89. 70% 90. 65% 91. 65% 92. 50% 93. 75% 94. 65% 95. 80% 96. 65% 97. 80% 98. 60% 99. 65% 100. 65%