Internal Medicine board questions

INTERNAL MEDCINE

1. The treatment of choice for anemia of chronic renal disease:a. Ferrous sulfateb. Folic acid c. Erythropoetind. blood transfusion

Answer: C P. 1658

2. A patient was brought to the ER in a comatose state. Serum electrolytes drawn on admission showed the following: Na+ 133 meq/L, K + 8.0 meq?l, Cl 98 meq/L, HCO3 13 meq?L. ECG showed absent P waves, widend QRS and peaked T waves. Which would b the mot appropriate initial step:

a. Repeat electrolyte measurement and observe b. Attempt cardioversion c. Administer intravenous calcium gluconate d. Administer sodium polystyrene sulfonate (Kayexelate)

Answer: C P. 262

3. Low serum complement level would be seen in patients with hematuria, proteinuria and hypertension resulting from all of the following, EXCEPT:

a. Mixed essential cryoglobulinemia b. Hepatitis C associated membranoproliferative

glomerulonephritis c. Diffuse proliferative lupus nephritis d. Henoch-Schonlein purpura

Answer: D P. 1680

4. A 37 y.o. man is admitted with confusion. PE showed a BP of 140/70 with no orthostatic changes, normal jugular venous pressure and no edma. Serum chemistries are notable for Na+ 120 meq/L, K + 4.2 meq/L, HCO3 24 meq/L and a uric acid of 2 mg/L. The most likely diagnosis is:

a. Hepatic cirrhosis b. SIADH c. Addison’s disease d. Severe vomiting and diarrhes

Answer: B p. 256

5. TRUE statement/s about acute poststreptococcal glomerulonephritis (PSGN) EXCEPT:

a. The latent period appears to be longer when PSGN is associated with cutaneous rather than pharyngeal infection

b. Serologic tests for a streptococcal infection may be negative if antimicrobial therapy is begun early

c. PSGN leads to permanent and progressive renal insufficiency more often in adults than in children

d. Long-term antistreptococcal prophylaxis is indicated after documented cases of PSGN.Answer: D p. 1680-1681

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6. The a wave of the jugular venous pulse (JVP) represents:a. right ventricular contractionb. right atrial contraction c. ventricular septal defectd. atrial septal defect

7. One of the following is not true in the assessment of acute GI Bleeding:a. The presence of large quantities of bright red blood per

rectum rules out the source before the ligament of Treitzb. Melena almost always represents UGIBc. Black stools can be caused by lesions in the colond. A bilous NGT return flow in a patient who just had hematochezia

rules out an upper GI source of hemorrhage

8. Which of the following is true regarding gastric ulcer?a. presence of gastric acid excludes malignancyb. weight loss is distinctively unusual in benign ulcerc. ulcers along the greater curve favor malignancyd. coexisting duodenal ulcers favor benign nature of gastric

ulcer

9. A 55-year-old diabetic patient presents with heartburn and acidic eructation for 2 years. Endoscopic biopsy of a patch of hyperemic mucosa 3 cm. above the gastroesophageal junction showed squamous epithelium with inflammatory cells. The patient most likely has:

a. Barrett’s esophagusb. Gastroesophageal reflux disease c. Candidal esophagitisd. Herpes simplex esophagitis

10. Which of the following statements does NOT describe secretory diarrhea?

a. Diarrhea continues during fastingb. Stools are scanty and mucoid c. Fecal fat is lowd. Cholera can cause it

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

(+) HBsAG (-) Anti-HBe (+) HBeAG(+) Anti-HAVIgm (+) Anti HBclgM (-) AntiHBclgGThe patient most likely has

a. Acute Hepatitis A and Acute Hepatitis B simultaneous infection

b. Acute Hepatitis A superimposed on Chronic Hepatitis B in the replicative phases

c. Acute Hepatitis A superimposed on Chronic Hepatitis B in the non-replicative phase

d. Acute Hepatitis A; a previous immunization to Hepatitis B12. 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

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13. True of Ascaris infestation:a. may cause ground itchb. Loeffler’s pneumonitis results from allergy to ascaris eggsc. adult worms reside mostly in the small intestinesd. the drug of choice in biliary ascariasis is Mebendazole because

it paralyzes the worms and prevents their further migration

14. Which of the following risk factors has been directly associated with Bronchogenic Carcinoma?

a. Asbestos exposureb. Aflatoxin ingestion c. Cigarette smokingd. Chronic Bronchitis

15. This group of drugs reduce airway inflammation in bronchial asthma:a. Catecholaminesb. Methylxanthines c. Clucocorticoidsd. Anticholinergics

16. The American Thoracic Society defines chronic bronchitis as persistence of cough and excessive mucus production for most days out of 3 months for ________ successive years:

a. 2b. 3c. 4d. 5

17. A patient with CAP requires hospitalization when one of the following is present:

a. age < 65 years oldb. COPD in exacerbation c. temperature of 38.5Cd. unilobar CXR infiltrate

18. One of the following is NOT a useful clue to the microbial etiology of CAP (Community Acquired Pneumonia)

a. edentulous persons likely to develop pneumonia due to anaerobes

b. susceptible people exposed to an infectious aerosol in Legionellosis

c. patients with severe hypogammaglobulinemia at risk of infection with S. pneumoniae

d. anaerobic lung abscess occuring in patients prone to aspiration

19. In a patient suspected of PTE, presence of this symptom heralds the occurence of pulmonary infarction:

a. unexplained dyspneab. hemptysis c. sudden onset of coughd. syncope

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20. Gold standard in the diagnosis of PTE:a. ventilation-perfusion scanb. pulmonary angiography c. Helical/Spiral CT Scand. transesophageal echocardiography

21. One of the disorders below does NOT have vesicles or bulla as presenting lesions:

a. Impetigob. Chicken poxc. Herpes Simplex d. Psoriasis

22. Annular lesions with raised erythematous border and clear centers, distributed over the trunk area:

a. Tinea unglumb. Psoriasis c. Tinea versicolord. Tinea corporis

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

a. Herpes Simplexb. Chicken pox c. Verruca vulgarisd. Herpes Zoster

24. A pregnant woman with brown macules with irregular borders, symmetric pattern on her cheeks, forehead, upper lips, nose and chin most likely has:

a. SLEb. melasma c. Addison’s diseased. Psoriasis

25. One of the following statements is NOT true of typhoid fever:a. Salmonella typhi has no known hosts other than humans.b. Most cases result from ingestion of contaminated food or water.c. Incubation period ranges from 3 to 21 days.d. Stool culture is best done during the first week of fever.

26. In typhoid fever, which of the following specimen will have the best sensitivity for culture if a patient has been given antibiotics?

a. bloodb. bone marrow c. stoold. urine

27. Drug of choice for Schistosomiasis:a. Albendazoleb. Ivermectin c. Diethylcarbamazined. Praziquantel

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28. The fungus which is a normal inhabitant of the human mucocutaneous body surfaces and is a frequent cause of fungemia is:

a. Aspergillusb. Candidac. Cryptococcus d. Histoplasma

29. An 18-year-old boy had sex with an HIV+ prostitute a week ago. He is frightened and wants assurance he has not been infected. You should:

a. tell him you regret that there is no way at this time to tell if he has been infected or not

b. ask for an immediate AIDS ELISA testc. ask for an immediate Western Blot testd. assure him that if it was a one night affair he probably did not

get infected

30. The most likely organism/s causing secondary bacteremia following manipulation of a furuncle is/are:

a. anaerobes and gm (-) bacillib. anaerobes and Staph aureus c. Staph aureus and gm (-) bacillid. Staph aureus

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

a. pneumococcalb. hepatitis B c. tetanusd. polio

32. A patient with Bell’s Palsy has a pathology involving which cranial nerve?

a. IIIb. V c. VIId. III and VII

33. A patient suspected to have meningitis undergoes spinal tap. Upon insertion of the spinal needle, the opening pressure is recorded to be markedly elevated. You should:

a. continue draining the CSF to decrease the pressureb. withdraw the needle and run IV mannitolc. continue draining the CSF while running IV mannitold. withdraw the needle and reinsert at a lower site

34. The first drug of choice in a patient presenting with frank seizures is:a. Diphenylhydantoin IVb. Phenobarbital IV c. Carbamazepine p.o.d. Diazepam IV

35. Lower motor neuron type of paralysis is characterized by:a. hypotoniab. spasticity c. pathologic reflexesd. involuntary movement of the affected extremities

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36. A Cavernous sinus lesion could involve several cranial nerves. Which of the following is least likely to be affected?

a. oculomotor nerveb. Trochlear nerve c. Abducens nerved. facial nerve

37. Bitemporal hemianopsia means involvement of thea. optic nerve ipsilateral to the lesionb. optic chiasm c. optic tractd. optic radiation

38. Elevated urea in patients with chronic renal disease occurs because ofa. an increased reabsorption of urea by the proximal tubulesb. decreased secretion of urea by the distal tubulesc. decreased urea excretiond. an increased renal blood flow

39. Asymptomatic bacteriuria should always be treated in:a. pregnant womenb. catheterized elderly patients c. sexually active patientd. post CVD patients

40. What is the most conservative management for chronic renal failure?a. dietary proteins of 0.6 g/kg/dayb. allopurinol 300 mg ODc. dialysis d. kidney transplant

41. One of the following is NOT a pathophysiologic mechanism of DM nephropathy:

a. injury of the glomerular filtration barrier manifested by microalbuminuria

b. Ig G deposits along GBM resulting in immune complex mediated glomerulonephritis

c. mesangial matrix expansion resulting to enlarged kidneysd. atherosclerosis of the renal vascular bed due to hypertensive

arteriosclerosis

42. Not a characteristic laboratory feature of hepatorenal syndrome:a. elevated BUNb. Fractional excretion of NA+ < 1%c. Proteinuria d. Urinary Na+ > 40 mmol/L

43. The single most important parameter of renal function is:a. edemab. Creatinine clearance c. Serum Creatinined. Serum BUN

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44. A 50-year-old male with ESRD 20 diabetic nephropathy was brought to the emergency room because of weakness and light headedness. He has just completed his first dialysis, and was observed to be somewhat confused. BP = 90/40, CR = 80/min., RR = 20/min. The most likely explanation for his condition is:

a. Dialysis disequilibrium syndromeb. Dialysis dementia c. Poor dietary intake during dialysisd. Reduced dialysate temperature

45. In the presence of anemia, the ability to produce adequate circulating red cells is best measured by:

a. WBC countb. Serum iron binding capacity c. Reticulocyte countd. Total eosinophil count

46. Reticulocytosis is NOT seen in:a. aplastic anemiab. acute blood loss c. hemolytic anemiad. treatment of iron deficiency

47. All of the following anemias except one are chronic developing over weeks. Which anemia may develop acutely?

a. aplasticb. pernicious c. hemolyticd. iron deficiency

48. In the tumor cell cycle, the cells refractory to chemotherapy are the:a. Cells in the G2 phase

b. Cells in the M phase c. Cells in the G0 phase

d. Cells in the active S phase

49. Multiple osteolytic lesions, hypercalcemia and neurologic abnormalities are most often seen in:

a. Prostatic CAb. Non-Hodgkin’s lymphoma c. Plasma cell myelomad. CNS tumors

50. Thrombocytopenia is not expected in:a. SLE b. G6PD deficiency

c. Acute Leukemia d. Disseminated intravascular Coagulation (DIC)

51. This finding in Chronic Myelogenous Leukemia can differentiate it from leukemoid reaction:

a. decreased leukocyte alkaline phosphataseb. increased WBC countc. anemiad. hypercellular marrow with increased granulocyte precursor

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52. Lung cancer that is associated with significant progressive dyspnea and increasing hypoxemia

a. Squamous cell carcinomab. Oat cell CA c. Adenocarcinomad. Bronchoalveolar CA

53. The most common form of arthritis characterized by progressive deterioration and loss of articular cartilage:

a. Rheumatoid arthritisb. Osteoarthritisc. Gouty arthritis d. Septic arthritis

54. The characteristic feature of Rheumatoid arthritis is:a. fibrotic changes of the skinb. osteoporosisc. persistent inflammatory synovitisd. asymmetric involvement of large weight-bearing joints

55. Heberden’s nodes are found ina. Systemic lupus erythematous (SLE)b. Gouty arthritis c. Osteoarthritisd. Rheumatoid arthritis (RA)

56. Loss of hair at the lateral part of eyebrows, thickening of speech, coarse hair and dry skin, dulling of intellect, sluggish movements. Most likely diagnosis is:

a. Cushing’s syndromeb. Adrenal insufficiency c. Hypothyroidismd. Acromegaly

57. Psamomma bodies are characteristic of:a. Follicular Thyroid CAb. Papillary Thyroid CA c. Parathyroid Adenomad. Parathyroid CA

58. Jodbasedow phenomenon is:a. iodide-induced hyperthyroidismb. blocking of organic binding of iodine with large doses of the

substancec. hyperthyroidism due to hyperfunctioning thyroid adenomad. due to a thyroxine-producing ovarian tumor

59. A 50-year-old obese woman with hypertriglyceridemia without hypercholesterolemia. The most appropriate first management step would be

a. weight reductionb. gemfibrozil c. clofibrate therapyd. liposuction

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60. The diagnosis of diabetes mellitus is certain in which of the following situations?

a. persistently elevated nonfasting serum glucose levelsb. successive fasting plasma glucose of 147, 165, 152 mg/dL

in an otherwise healthy 40-year-old femalec. A serum glucose level of 140 mg/dL in a pregnant woman in her

26th week AOGd. glycosuria in a 30/F

61. Which of the following medications can cause hyperprolactinemia?a. Propranololb. glucocorticoids c. metoclopramided. levothyroxine

62. Obese persons are at increased risk fora. hypothyroidismb. Type I diabetes mellitusc. Cholelithiasis d. elevated LDL cholesterol

63. Dietary deficiency of thiamine produces which of the following clinical syndromes?

a. color blindnessb. osteoporosisc. bruising d. peripheral neuropathy

64. A 24/M who took megadoses of vitamins develops severe headache and papilledema. The cause for this is intoxication of

a. Vitamin B6b. Vitamin Dc. Vitamin A d. Vitamin E

65. In using Serum albumin as gauge for malnutrition, which statement is correct?

a. a low serum albumin always indicates malnutritionb. the half-life of albumin in 21 days, so it cannot be used to

assess acute malnutritionc. albumin levels are unaffected by changes in extracellular

volumed. the bone marrow synthesizes albumin

66. Prolonged fasting causes the intestinal villi toa. hypertrophyb. atrophy c. necrosed. proliferate

67. A person with known allergy to penicillins should not be givena. cotrimoxazoleb. tetracyclinec. erythromycin d. cefalexin

68. Lymphokines are secreted by

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a. polymorphonuclear cellsb. monocytesc. lymphocytes d. lymphoma cells

69. A 30-year-old female has severe perennial allergic rhinitis. Her house is frequently flooded. She has a dog and sleeps on kepok pillow. As part of management of her allergy, you should advice her to

a. get a new kapok pillow and launder it frequentlyb. try to scoop out the flooded water as soon as the rain poursc. keep the dog out or get a cat insteadd. replace the kapok pillow with foam rubber, cover the pillow

and mattress with allergen proof encasings

70. IgE has high affinity for which type of cells?a. eosinophilsb. mast cellsc. platelets d. macrophages

71. A 65/M is brought to the ER due to chest pain. He suddenly becomes unresponsive and pulseless and cardiac monitor reveals ventricular fibrillation. You should immediately:

a. begin CPR, followed by intubation, then defibrillation with 100 J 200 J 360 J

b. begin CPR, followed by intubation, then defibrillation starting at 200J

c. begin CPR, then defibrillation at 200 J, 300 J then 360 Jd. begin CPR, defibrillate at 200 J, then intubate

72. If despite defibrillation, a pulseless patient has persistent ventricular fibrillation, the use of which drug would be most appropriate?

a. lidocaineb. procainamide c. amiodaroned. epinephrine

73. If only one person is present to provide basic life support, chest compressions should be performed at a rate of ______ per minute, and breaths twice in succession every 15 seconds

a. 50b. 80c. 60d. 40

74. One of the following is associated with an increased risk of sudden cardiac death:

a. frequent PVC’s (>30/min)b. hyponatremiac. smoking d. hyperlipidemia

75. Elevation of Serum Potassium is toxic to the:

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a. kidneysb. brainc. heartd. liver

76. Anti – Tuberculosis drug that can cause hyperuricemia:

a. Isoniazidb. Pyrazinamidec. Rifampicind. StreptomycinMPL: 0.25 p:964

77. Which of the following tests is required to diagnose Chronic Obstructive Pulmonary Disease:

a. Arterial blood gasb. Chest X-rayc. Chest CT scand. SpirometryMPL: 0.25 p:1551

78. Marantic endocarditis is commonly associated with this lung cancer:a. Squamous cellb. Large cellc. Adenocarcinomad. Small cell MPL: 0.25 p: 509

79. This is considered as the most frequent cause of Acute Respiratory Distress Syndrome

a. Smoke inhalationb. Severe sepsisc. Pulmonary contusiond. Acute pancreatitisMPL: 0.50 p:1592

80. The most common form of Lung cancer arising in lifetime of a non smoker young women

a. Small cell carcinomab. Adenocarcinomac. Squamous cell carcinomad. Large cell carcinomaMPL: 0.50 p: 507

81. The most common cause of acute renal failure a. Pre renal acute renal failureb. Renal acute renal failurec. Post renal acute renal failured. Pre renal with renal acute renal failureMPL: 0.50 p: 1644

82. The most significant risk factor for cancer is:a. Sexb. Agec. Nationalityd. Dietary factorsMPL: 0.50 p: 435

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83. DNA synthesis phasea. G1b. G2c. G0d. SMPL: 0.333 p: 469

84. This is the most common local manifestation of lung cancer at presentation

a. Dyspneab. Coughc. Hemoptysisd. Chest painMPL: 0.50 p: 508

85. Painless myocardial infarction is greater in patients witha. hypertensionb. diabetes mellitusc. homocystinemiad. dyslipidemiaMPL: 0.50 p: 955

86. In typoid fever this diagnostic exam is not affected by prior antibiotic use:

a. Bone marrow cultureb. Blood culturec. Urine cultured. Stool cultureMPL: 0.25 p: 899

87. British Thoracic Society major category for diagnosis of severe pneumonia

a. P/F ratio of <250b. Multilobar pneumoniac. Systolic pressure of less than 90 mmHgd. Need for mechanical ventilationMPL: 0.50 p: 1532

88. This anti-TB drug may cause “barrel vision”a. Rifampicinb. Isoniazidc. Pyrazinamided. StreptomycinMPL: 0.25 p: 961

89. Most common cause of pneumonia in ambulatory patients:a. Streptococcus pneumoniaeb. Mycoplasma pneumoniae c. influenza virusesd. Chlamydia pneumoniaeMPL: 0.25 p: 1531

90. Most common etiologic agent in uncomplicated cystitis:

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a. Pseudomonas aeruginosab. Staphylococcus aureusc. Escherichia colid. Proteus vulgarisMPL: 0.50 p: 1715

91. The best parameter to differentiate chronic bronchitis from emphysema a. Simple spirometryb. Lung volume studiesc. DLCOd. Arterial blood gasMPL: 0.333 p: 1503

92. The duration of treatment for acute cystitis in pregnant patient :a. single doseb. 3 daysc. 5 daysd. 7 daysMPL: 0.25 p: 1520

93. Diagnosis of Diabetes Mellitus is defined as:a. Random is defined as with regard to time since the last meal.b. Fasting is defined as no caloric intake for at least 12 h.c. The test should be performed using a glucose load containing

the equivalent of 50 g anhydrous glucose dissolved in water; not recommended for routine clinical use.

d. A random plasma glucose concentration =11.1 mmol/L (200 mg/dL) accompanied by classic symptoms of DM (polyuria, polydipsia, weight loss) is sufficient for the diagnosis of DM

MPL: 0.333 p: 2153

94. Type 2 DM is characterized by one of the pathophysiologic abnormalities:

a. impaired insulin absorptionb. peripheral insulin resistancec. decrease hepatic glucose productiond. increase gluconeogenesis

MPL: 0.333 p: 2157

95. Acute complication of Type 2 Diabetes Mellitus :a. Hyperosmolar Hyperglycemic Stateb. Coronary artery diseasec. DM neuropathyd. GastroparesisMPL: 0.25 p: 2161

96. Target blood pressure in Diabetes Mellitusa. 140/90b. 150/80c. 130/80d. 120/80MPL: 0.25 p: 2170

97. Risk factor for adverse prognosis in hypertension:

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A. elderlyB. female sexC. smokingD. pregnancyMPL: 0.25 p: 1466

98. The most common form of suppurative intracranial infection:A. viral meningitisB. bacterial meningitisC. fungal meningitisD. parasitic meningitisMPL: 0.50 p: 2472

99. Precipitating cause of heart failure:A. smokingB. exerciseC. infectionD. strokeMPL: 0.50 p: 1368

100. Underlying cause of heart failure:A. cardiomyopathyB. cardiac tamponadeC. respiratory diseasesD. anemiaMPL: 0.333 p: 1368

101. Minor criteria of congestive heart failure:A. S3 gallopB. cardiomegalyC. ralesD. tachycardiaMPL: 0.25 p: 1371

102. Levine’s sign:a. tenderness on palpationb. slowly progressive dyspneac. clenching of the fist in front of the sternumd. difficulty of breathingMPL: 0.25 p: 1435

103. An important factor predisposing to bacteriuria in men is urethral obstruction due to:

A. prostatic hypertrophyB. catheter insertionC. infectionD. ureteric stonesMPL: 0.25 p: 1716

104. The most common finding on physical examination in leptospirosis aside from fever:

A. calf tendernessB. conjunctival suffusionC. jaundiceD. rashMPL: 0.50 p: 990

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105. The most common cause of partial or generalized epilepsy in the elderly is :

A. strokeB. brain tumorC. infectionD. traumaMPL: 0.50 p: 2537

106. Definition of severe pneumonia by American Thoracic Society: A. need for mechanical ventilationB. systolic BP of >90 mmHgC. single lobe involvementD. PaO2/FiO2 < 200MPL: 0.333 p: 1532

107. Cause of transudative pleural effusion:A. mesotheliomaB. sarcoidosisC. cirrhosisD. meigs syndromeMPL: 0.25 p: 1567

108. Hallmark of COPD:A. airflow obstructionB. clubbing of digitsC. flail chestD. hoover’s signMPL: 0.25 p: 1551

109. Most commonly involved in extrapulmonary TB:A. meningesB. peritoneumC. pericardiumD. lymph nodesMPL: 0.25 p: 957

110. Primary Pulmonary TB frequently involved the:A. middle lobeB. lower lobeC. middle and lower lung zonesD. upper lobeMPL: 0.333 p: 956

111. The most common complication of measles:A. subacute sclerosing panencephalitisB. chronic encephalitisC. otitis externaD. hepatitisMPL: 0.50 p: 1150

112. The drug of choice for primary generalized seizures is:A. phenytoinB. carbamazepineC. valproic acidD. gabapentinMPL: 0.50 p: 2374

113. Type of anemia in Malaria:

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A. normochromic normocyticB. hypochromic normocyticC. hypochromic microcytic D. normochromic microcyticMPL: 0.333 p: 1226

114. Cerebral Malaria is caused by:A. P. falciparumB. P. malariaeC. P. ovaleD. P. vivaxMPL: 0.25 p: 1222

115. The most common presentation of amoebic infection is:A. asymptomatic cyst passageB. amoebic colitisC. liver abscessD. central nervous system infectionMPL: 0.25 p: 1640

116. Duodenal ulcer occur 90% located within: A. 3cm of the pylorusB. 4cm of the pylorusC. 5 cm of the pylorusD. 10 cm of the pylorusMPL: 0.333 p: 1749

117. The most common type of gallstone:A. cholesterolB. black pigment stoneC. brown pigment stoneD. green pigment stoneMPL: 0.25 p: 1881

118. Gold standard in diagnosing gallstone:A. abdominal xrayB. ultrasoundC. CT ScanD. CholescintigraphyMPL: 0.25 p: 1883

119. The most common risk factor of stroke :A. infectionB. hypertensionC. diabetes mellitusD. traumaMPL: 0.25 p: 2372

120. The most specific and characteristic symptom of gallstone disease:A. biliary colicB. vomitingC. constipationD. jaundiceMPL: 0.25 p: 1883

121. Local complication of acute pancreatitis:

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A. pancreatic abscessB. pleural effusionC. pericardial effusionD. peptic ulcer diseaseMPL: 0.50 p.1898

122. 85% of Pancreatic pseudocyst are located at the :A. tailB. bodyC. body and tailD. headMPL: 0.50 p: 1901

123. The most common serious complication of chicken pox:A. pneumoniaB. hepatitisC. meningitisD. pericarditisMPL: 0.50 p: 1043

124. Incubation period of chicken pox:a. 10-21 daysb. 7-10 daysc. 5-10 daysd. 21-30days

MPL: 0.333 p: 1043

125. The person recommended to receive influenza vaccine:A. person > 65 years of ageB. women in first trimester of pregnancyC. hypertensive patientsD. with prodromal phase of upper respiratory infection

MPL: 0.333 p: 1042

126. Most serious complication of influenza B virus:A. pneumoniaB. carditisC. reye’s syndromeD. encephalitisMPL: 0.5 p: 1067

127. Metabolic complication of nephritic syndromeA. hypercalcemiaB. bleeding C. normocytic normochromicD. hypoalbuminemiaMPL: 0.5 p: 1684

128. Primary Glomerulopathy which is highly steroid responsive:A. membranoproliferativeB. membranousC. focal segmental glomerolosclerosisD. minimal change diseaseMPL: 0.333 p: 1683

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

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A. membranoproliferativeB. membranousC. focal segmental glomerulosclerosisD. minimal change diseaseMPL: 0.5 p: 1687

130. Hallmark of nephrotic syndrome:A. dysmorphic red blood cellB. numerous red blood cell castC. heavy protenuriaD. waxy castMPL: 0.5 p: 1684

131. Most common glomerulopathy worldwide:A. minimal changeB. lupus nephritisC. membranousD. IgA nephropathyMPL: 0.5 p: 1690

132. Most common cause of Iron deficiency in adult:A. chronic blood lossB. hemolysisC. dietary deficiencyD. chronic inflammatory diseaseMPL: 0.5 p: 586

133. Virus serotype associated greatest risk for DHF:A. DEN-1B. DEN-2C. DEN-3D. DEN-4MPL: 0.5 p: 1161

134. Most important laboratory test for DHF monitoring:A. HemoglobinB. hematocritC. plateletD. liver function testMPL: 0.25 p: 1161

135. Which of the following is the earliest rabies specific clinical manifestation:

A. hydrophobiaB. aerophobiaC. tingling sensation at the bite siteD. deliriumMPL: 0.333 p: 1115

136. The diagnostic laboratory method of choice for typhoid fever in the first week

of illness:A. bone marrow cultureB. blood cultureC. urine cultureD. stool cultureMPL: 0.25 p: 991

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137. The most important predictor of multi-drug resistant M. tuberculosis organism

in all studies is:A. history of treatment tuberculosisB. HIVC. noncomplianceD. diabetes mellitus

MPL: 0.5 p: 958

138. Most discriminating symptom of duodenal ulcer:A. nausea and vomitingB. pain occur 90 min to 3 hours after a mealC. relieved by food intakeD. pain awakens patient at nightMPL: 0.5 p: 1751

139. Liver cirrhosis is best diagnosed by:A. UltrasoundB. Liver biopsyC. CT scanD. liver function testsMPL: 0.25 p: 1859

140. Drug of choice for Schistosomiasis:A. mebendazoleB. praziquantelC. tinidazoleD. metronidazoleMPL: 0.5 p: 1271

141. Spasm that is observed first in Tetanus: A. risus sardonicusB. abdominal rigidity only upon stimulationC. trismusD. opisthotonusMPL: 0.5 p: 1115

142. Gold standard in the treatment of typhoid fever:A. chloramphenicolB. penicillinC. tetracyclineD. ceftriaxoneMPL: 0.25 p: 991

143. The most common opportunistic fungal infection:A. candidaB. aspergillosisC. pneumocistis jeroverciD. fusariumMPL: 0.25 p: 1185

144. Source of cholera infection:

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A. contaminated water supplyB. food exposed to flies and cockroachesC. food utensils not properly disinfectedD. ingestion of live oral cholera vaccineMPL: 0.25 p: 909

145. Classical malarial paroxysms suggest infection with:A. P. malariae B. P. falciparum C. B. microtiD. P. vivaxMPL: 0.25 p: 1221

146. Most common cause of pneumonia in ambulatory patients:A. S. pneumoniaeB. M. pneumoniae C. influenza virusesD. C. pneumoniaeMPL: 0.25 p: 1531

147. The single most useful clinical sign of the severity of pneumonia:A. BP of 120/80B. Respiratory rate of > 30/minC. Cardiac rate of 76D. Temperature of 37CMPL: 0.333 p: 1532

148. The most common route for bacterial pneumonia :A. gross aspirationB. aerosolizationC. microaspiration of oropharyngeal secretionsD. hematogenous spread from a distant infected site.MPL: 0.5 p: 1529

149. Most common site of spinal tuberculosis in adult:A. upper thoracic spineB. lower thoracic spineC. lumbar spineD. cervical spineMPL: 0.5 p: 958

150. The most common site of gastrointestinal TB:A. appendixB. proximal ileumC. pancreasD. terminal ileumMPL: 0.5 p: 958

151. Most common site of pancreatic cancer:A. headB. bodyC. tailD. uncusMPL: 0.25 p: 537

152. Most consistent risk factor in pancreatic cancer:

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A. hypertensionB. alcoholismC. cigarette smokingD. obesityMPL: 0.5 p: 537

153. Hereditable gastrointestinal syndromes that has least malignant potential:

A. gardner’s syndromeB. turcot’s syndromeC. lynch syndromeD. juvenile polyposisMPL: 0.333 p: 528

154. The most common infectious complication of varicella isA. bacterial superinfection of the skinB. seizure C. sepsisD. meningitisMPL: 0.333 p: 1043

155. The most common extracutaneous site of involvement in childrenA. respiratory systemB. CVS C. CNSD. GITMPL: 0.5 p: 1043

156. A deficiency of this protease inhibitor is a proven genetic risk factor for COPD

A. alpha 1 anti trypsinB. alpha 2 anti trypsin C. M proteinD. piZZ alpha 2 anti trypsinMPL: 0.5 p: 1548

157. Glucose goal in patients with DKA: A. 70 - 100 mg/dlB. 100 -150 mg/dlC. 150 – 250 mg/dlD. 250-300 mg/dlMPL: 0.5 p: 2160

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

A. Class IB. Class IIC. Class IIID. Class IVMPL: 0.25 p: 1302

159. Heart failure with warm and flushed extremities and with widened pulse pressure

A. Low outputB. High outputC. Diastolic heart failureD. Systolic heart failure

21

MPL: 0.5 p: 1369

160. Cardiomyopathy with primary myocardial involvement A. InfectiveB. MetabolicC. ConnectiveD. IdiopathicMPL: 0.5 p: 1408

161. Reversible form of dilated cardiomyopathy A. Alcohol abuseB. Right ventricular dysplasiaC. AmyloidosisD. HemochromatosisMPL: 0.5 p: 1409

162. Systolic Hypertension with wide pulse pressure A. ArteriosclerosisB. Chronic PyelonephritisC. Oral contraceptivesD. PsychogenicMPL: 0.5 p: 1463

163. Framingham major criteria for Diagnosis of CHF : Night coughPleural effusionTachycardiaPositive hepatojugular refluxMPL: 0.25 p: 1371

164. Characteristic appearance of stools in patients with cholera: A. non-mucoid, non-bilious stoolsB. mucoid and watery stoolsC. sour and offensive odor which is non-bilious and non-bloodyD. non-bilious,non-bloody, gray, sl. cloudy with flecks of

mucusMPL: 0.25 p: 911

165. Primary pulmonary TB is characterized as:A. typically involves the apices of the lungsB. causes rupture of Rasmussen’s aneurysmC. involves the middle and lower lobes in most casesD. reactivation type of infectionMPL: 0.5 p: 956

166. Class I recommendations for use of an Early invasive strategy in Myocardial Infarction:

A. EF < 0.60B. Recurrent angina at rest/ low level activity despite RxC. PCI < 8 months, prior CABGD. Negative stress testMPL: 0.333 p: 1477

22

167. The most common presenting complaint in patients with ST elevation MI:

A. DysneaB. WeaknessC. PainD. VomitingMPL: 0.5 1449

168. De bakey classification of Aortic dissection in which dissection is limited to the ascending aorta:

A. Type IB. Type IIC. Type IIID. Type IVMPL: 0.5 p: 1483

169. Cardiomyopathy with primary myocardial involvement A. InfectiveB. MetabolicC. ConnectiveD. IdiopathicMPL: 0.25 p: 1408

170. This form of respiratory failure occurs when alveolar flooding and subsequent

intrapulmonary shunt physiology occur:A. Type 1 respiratory failureB. Type 2 respiratory failureC. Type 3 respiratory failureD. Type 4 respiratory failureMPL: 0.25 p: 1583

171. Heavy drinkers (i.e., those consuming 100 g of ethanol per day for the preceding 2 years) have a higher incidence of acquiring what type of organism in Community acquired Pneumonia?

A. gram positive organismB. gram negative organisms C. anaerobesD. enterococciMPL: 0.5 p: 1530

172. Associated with pandemics and are restricted to influenza A virusesA. antigenic shiftB. antigenic drift C. antigenic transformationD. antigenic rotationMPL: 0.25 p: 1066

173. Most common pathogen in intensive care unit:A. S. pneumoniaeB. C. pneumoniaeC. M. pneumoniaeD. H. influnzaeMPL: 0.25 p: 1531

174. The only known reservoir for Varicella zoster virus isA. humans

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B. cats C. mosquitoD. rodentsMPL: 0.25 p: 1042

175. The most common infectious complication of varicella isA. bacterial superinfection of the skinB. seizure C. sepsisD. meningitisMPL: 0.25 p:1043

1. The most common site of hypertensive intraparenchymal hemorrhage is:A. Deep Cerebellum B. PonsC. ThalamusD. PutamenPage 2390

2. The most common cause of ischemic stroke isA. Small vessel thrombosis (Lacunar)B. Large vessel thrombosisC. Cardio embolism due to mural thrombusD. Artery to artery embolism from carotid bifurcation atherosclerosisPage 2376

3. Currently considered the best initial treatment for primarily generalized tonic clonic seizures is:A. Phenytoin B. Valproic acidC. CarbamazepineD. PhenobarbitalPage 2367

4. Adverse effects such as gum hyperplasia, hirsutism and coarsening of facies is associated with long term use of:A. CarbamazepineB. Valproic acidC. PhenytoinD. TopiramatePage 2368

5. The pathognomonic sign of meningitis is:A. Presence of fever and cranial nerve deficitB. Presence of hemiparesis, headache and feverC. Presence of fever, headache and nuchal rigidityD. Presence of nuchal rigidity and hemiparesisPage 2473

6. The most common cause of community acquired bacterial meningitis in adults >20 years of ageA. N. meningitides B. Strep. PneumoniaeC. Listeria monocytogenesD. Group B streptococciPage 2471

7. Which of the following systemic disease is NOT associated with polyneuropathy:A. HIV infection B. Diabetes mellitusC. CarcinomaD. Carpal Tunnel SyndromePage 2501, 2504

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8. Compressive Metastatic Myelopathies most commonly involve which level of the spinal cordA. Cervical B. ThoracicC. LumbarD. SacralPage 2441

9. Which of the following is true of Trigeminal NeuralgiaA. More common in malesB. Objective sign of sensory loss in the face cannot be demonstrated on examinationC. Usually involve the ophthalmic division of the trigeminal nerveD. Affects most adolescents and young adultsPage 2434

10. Which of the following disorders causes irreversable dementia?A. Hypothyroidism B. Thiamine DeficiencyC. Multi-infarctD. Alzheimer’s diseasePage 2396

11. The most powerful risk factor for osteoarthritis is:A. Female sexB. ObesityC. AgeD. Prior inflammatory joint diseasePage 2037

12. Disabilility of patient with knee osteoarthritis is strongly associated with:A. Radiographic severity of joint damage B. Joint painC. Quadriceps muscle weaknessD. ObesityPage 2037

13. Which of the following is the characteristic physical examination finding of patient with osteoarthritis?A. Localized tenderness B. Swelling of bony and soft tissueC. Periarticular muscle atrophyD. Bony Crepitus Page – 2039

14. Which of the following is considered as the most common form of idiopathic osteoarthritisA. Bouchard’s nodes B. Heberden’s nodesC. Gelatinous dorsal cystD. Osler nodesPage 2040

15. A 30 y/o female with SLE is noted to have a prolonged partial thromboplastin time. This abnormality is associated with:A. Leukopenia B. Central nervous system vasculitisC. Central nervous system hemorrhageD. Deep venous thrombosisPage 1964

16. The best screening test for the detection of SLE is:A. Anti-SmB. Anti- dsDNAC. Antinuclear antibodiesD. Anti-RoPage 1961

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17. Diagnosis of gouty arthritis is base on the finding of crystals in the synovial fluid and which of the following crystals is diagnostic of gout?A. Apatite crystals B. Birefringent needle-shaped crystalsC. Rod-shaped weakly birefringent crystalsD. Rhomboid strongly birefrintent crystalsPage 2046-2049

18. The preferred treatment of acute gouty attack in elderly patient is:A. ColchicineB. NSAIDC. Intraarticular steroid infectionD. Oral steroidPage 2046

19. Joint pain among patient with Rheumatoid arthritis is cause mainly by which of the following mechanism?A. Muscle spasmB. Stretching of periostal nerve endingsC. Stretching of the joint’s ligamentsD. Distention of joint capsulePage 1971

20. Axial (vertebra) joints involvement in Rheumatoid arthritis is usually limited to the:A. Cervical vertebraeB. Thoracic vertebraeC. Lumbar vertebraD. Sacral vertebraePage 1971

21. Evidence suggests that early aggressive treatment of rheumatoid arthritic patient with Disease-Modifying Antirheumatic Drugs (DMARD) maybe effective at slowing the appearance of bone erosions. Which of the DMARD is currently considered the best initial choice?A. D-penicillamineB. Gold compoundC. MethotrexateD. SulfasalazinePage 1975

22. Which of the following Vitamins is capable of eliciting systemic anaphylactic reaction?A. CobalamineB. PyridoxineC. RiboflavinD. ThiaminePage 1949

23. Which of the following medicine or drug is NOT effective in the treatment of the acute event of systemic anaphylactic reaction?A. SC EpinephrineB. IV DopamineC. IV DiphenlydramineD. IV GlucocorticoidsPage 1950

24. Majority of acute diarrheas are due toA. toxic ingestion B. medicationsC. infectious agentsD. ischemiaPage 225

25. Clostridium deficile causes acute diarrhea byA. mucosal invasion B. cytotoxin productionC. pre-formed toxin production

26

D. enteroadherencePage 226

26. Majority (>50%) of all esophageal cancers are of which cell type?A. adenocarcinomaB. squamous cell carcinomaC. lymphomaD. sarcomaPage 542

27. Not considered as risk factor for the development of Pancreatic cancer?A. smoking B. cholelithiasisC. long standing DMD. obesityPage 537

28. Which of the following is a protective antibody against Hepatitis B infection?A. Anti-HBeB. Anti HBsC. HBsAgD. Anti HBcPage 1825

29. Drug that is contraindicated in the treatment of chronic Hepatitis B infection with decompensated liver is:diseaseA. InterferonB. LamivudineC. AdefovirD. EnterocavirPage 1847

30. Minimum amount of ascetic fluid which can be detected by shifting dullness is:A. 100 ccB. 300 ccC. 500 ccD. 700 ccPage 1866

31. Secretion of water and bicarbonate rich solution from the pancreas is stimulated by:A. secretinB. cholecystokininC. gastrinD. somatostatinPage 1895

32. Most common complication of Peptic Ulcer Disease is:A. perforationB. penetrationC. bleedingD. obstructionPage 1752

33. Which of the following isconnsidered as a non-pharmacologic management of Gastroesophageal Reflux Disease?A. wearing tight belts B. Proton pump inhibitorsC. SmokingD. Decreased amount of fluids at nightPage 1743

34. Who among the following is considered to be diabetic?A. a 34 y/o male who complained of excessive thirst, weight loss and casual blood sugar of

120mg%B. asymptomatic 40y/o female with Fasting Blood sugar of 120mg%C. a 45 y/o female with polyuria and +4 sugar in the urineD. a 40 y/o male executive with HbAiC of 8%

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Page 2153

35. The best way to assess blood sugar control is to monitor the:A. Fasting blood sugarB. Post prandial blood sugarC. Glycosalated HemoglobinD. Urine sugarPage 2172

36. A patient who is Hypertensive and Hypokalemic, should make one consider which of the ff. as the most likely cause of the hypertension?A. Pheochromocytoma B. Conn’s SyndromeC. Cushing’s diseaseD. Addison’s diseasePage 2138

37. What is the most common cell type of Thyroid Carcinoma?A. Follicular carcinoma B. Papillary carcinomaC. Medullary carcinomaD. Anaplastic carcinomaPage 2125

38. Which of the following physiologic condition can stimulate prolactin secretion by the pituitary gland?A. PhenothiazinesB. MenstruationC. StressD. Post mealPage 2085

39. Which of the following is NOT consistent with Diabetic Ketoacidosis?A. pH of 7.12B. HCO3

- of 14 mmol/LC. Blood sugar of 240mg%D. Urine ketone of +4Page 2159 table 323-4

40. What is the expected laboratory findings in Grave’s Hyperthyroidism?A. elevated thyroid hormones with low TSHB. elevated thyroid hormones & TSHC. low thyroid hormones & TSHD. elevated TSH with low thyroid hormonesPage 2115

41. Which of the following is NOT a feature of Hypocalcemia?A. short QT intervalB. increased urinationC. depressionD. diarrheaPage 2252

42. Which of the following test is recommended as the initial screening for Cushing’s Sydrome?A. overnight dexamethasone testB. low dose dexamethasone testC. high dose dexamethasone testD. plasma ACTH determinationPage 2135

43. Which of the following have the most potent glucocorticoid effect?A. TriamcinoloneB. BetamethasoneC. DexamethasoneD. ParamethasonePage 2147

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44. The most potent risk factor for development of active TB disease is:A. MalnutritionB. Old ageC. Late adolescenceD. HIV co-infectionPage 955

45. Tuberculosis treatment failure is suspected when appropriate regimen is prescribed but:A. sputum cultures remain positive after 3 monthsB. AFB sputum smears remain positive after 5 monthsC. EitherD. NeitherPage 963

46. The most important impediment to cure Tuberculosis is:A. Drug resistanceB. inappropriate assessment of its severityC. Cheap medicineD. non-compliancePage 962

Case: A 58 years old male presented with 4 days fever and lately weakness and dizziness whenever he sits or stands up; disorientation. Upon PE: BP=90/60mmHg, PR=112/min., RR=28/min., T=39.8ºC. The only remarkable finding is an ulcerated skin lesions in the lower leg with black discoloration. Lab tests: WBC=2,500cells/m3; gram negative bacilli from smears of the skin lesion.

47. This patient hasA. SIRSB. severe sepsisC. septic shockD. sepsisPage 1606

48. The most probable organism that has causes severe febrile illness with changes in sensorium and associated with ulceration and black discoloration of the skin is:A. S. aureusB. B. anthrasisC. Cl. PerfringensD. P. aeruginosaPage 310

49. The following anti microbial agent is effective for the treatment of Pseudomonas infection:A. NafcillinB. TetracyclineC. Ceftazidime D. Any of the abovePage 708

50. The major anatomic site for the establishment and propagation of HIV infection is:A. Genital organsB. Lymphoid organsC. Vascular systemD. LymphocytesPage 1080

51. Central to the pathogenesis of severe falciparum malaria is/are:A. cytoadherence in capillary and venular endotheliumB. rosette formation by non parasitized RBC’sC. agglutination of parasitized RBC’sD. all of the abovePage 1221

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52. Sequestration and microcirculatory arrest occur in which of the following Plasmodium?A. P. falciparumB. P. vivaxC. P. malariaeD. all of the abovePage 1221

53. Hypoglycemia in severe malaria is associated with poor prognosis and it may result fromA. failure of hepatic gluconeogenesisB. increased glucose consumption by host and parasiteC. increased insulin secretion in treatment with QuinineD. all of the abovePage 1222

54. The diagnostic test of malaria that is also used to monitor response to treatment is:A. SerologyB. Stained blood filmC. eitherD. neitherPage 1224

55. Dengue Hemorrhagic fever can occur following:A. Primary infection with a virulent serotypeB. Second infection with the same serotypeC. Second infection with a serotype different from that involved in primary infectionD. All of the abovePage 1164

56. Diagnosis of Dengue fever is made in a clinically Compatible disease manifestation byA. IgM ELISAB. HemoconcentrationC. LeucopeniaD. ThrombocytopeniaPage 1164

57. The main clinical manifestations of Chronic Schistosomiasis are dependent onA. SpeciesB. site of egg deposition in the host’s tissuesC. BothD. NeitherPage 1269

58. The following are effects of tetanospasmin EXCEPTA. blood release of inhibitory neurotransmittersB. increased circulating catecholamine levelsC. block neurotransmitter release at the neuromuscular junctionD. all of the abovePage 841

59. The following laboratory findings are suggestive of Iron Deficiency Anemia EXCEPTA. koilonychiasB. decreased serum ferritinC. decreased total iron binding capacityD. low reticulocyte responsePage 589

60. Which of the following statement regarding Polycythemia Vera is correct?A. anemia is commonB. transformation to acute leukemia is commonC. an elevated plasma erythropoietin level excludes the diagnosisD. phlebotomy is used only after hydroxyurea and interferon have been tired

30

E. thrombotic risk is mainly attributed to ThrombocytosisPage 627-628

61. Diagnosis of Acute Myeloid Leukemia is established by the presence of:A. ≥ 10% myeloblasts in the bone marrowB. ≥ 20% myeloblasts in the bone marrowC. ≥ 5% myeloblasts in the bone marrowD. < 5% myeloblasts in the bone marrowPage 632

62. Which of the following syndrome have autoimmune hemolytic anemia with immune thrombocytopenia?A. Raynaud’s syndromeB. Evans syndromeC. Hemolytic uremic syndromeD. Thrombotic thrombocytopenic purpuraPage 612

63. Which of the following is the cytogenetic hallmark of Chronic Myelogenous Leukemia?A. t(15:17)B. t(9;22)C. inv 16D. t(8;21)Page 638

64. What is the most common symptom of patient with Myeloma?A. FeverB. BleedingC. Bone painD. NumbnessPage 657

65. Cryoprecipitate is produced by centrifugation after thawing of this particular blood componentA. Packed RBCB. Single donor apheresis plateletC. Fresh frozen plasmaD. CryosupernatePage 664

66. Asthma is a disorder characterized by:A. Acute airway inflammation followed by bronchoconstrictionB. Persistent subacute airway inflammationC. Sensitivity to metacholine and histamineD. Hypertrophy and hyperplasia of bronchial mucus glandsPage 1508

67. Major infectious cause of asthma exacerbation in adults is:A. Respiratory syncitial virusB. Influenza virusC. StreptococcusD. MycoplasmaPage 1510

68. The hallmark of COPD is airflow obstruction as evidenced byA. Increased FEV1/FVCB. Increased FEV1C. Decreased FEV1/FVCD. Decreased residual volume (RV)Page 1551

69. Paradoxical inspiratory inward movement of the rib cage seen in patients with severe COPD is called the:A. Palla’s signB. Tripod postureC. Hamman’s signD. Hoover’s signPage 1551

70. The single most useful clinical sign of severe pneumonia among patient without underlying lung disease is:A. RR>30/minB. T>38ºCC. BP<110 systolicD. CR>100Page 1532

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71. Recurrent pneumonia in the same location is most likely due to the presence of:A. ImmunodeficiencyB. Bronchial obstructionC. Lung hypoplasiaD. Interstitial lung diseasePage 1537

72. The presence of pus in the pleural space is termed as:A. Parapneumonic effusionB. ChylothoraxC. EmpyemaD. Exudative effusionPage 1566

73. Sudden severe dyspnea, and P.E. finding of unilateral absent breath sounds and hypertesonance in a COPD patient without antecedent injury should make one suspect:A. Primary spontaneous pneumothoraxB. Secondary spontaneous pneumothoraxC. Traumatic pneumothoraxD. Tension pneumothoraxPage 1568

74. Subcutaneous emphysema and Hamman’s sign is seen in:A. COPDB. PneumomediastinumC. Pleural effusionD. HemothoraxPage 1569

75. Hospital acquired pneumonia (HAP) is consider if pneumonia occur: A. Occurs 24 hours after being placed on a respiratorB. Occurs 48 hours after hospital admissionC. Occurs 72 hours after ICU admissionD. Occurs rarely in large, variegated-patient medical centersPage 1538

76. A 56 y/o female admitted for Acute Pyelonephritis was started on Amikacin 500 mg IV every 6 hours. After 7 days repeat serum creatinine=5.7 mg/dL (Initial was 1.3 mg/dL). Urinalysis at this time will reveal:A. RBC castsB. Pus cell castsC. fine granular castsD. muddy brown granular castsPage 1649

77. A 65 y/o male with poorly controlled diabetes had renal colic and underwent an IVP. He develop oliguria 1 day after the procedure. Repeat serum creatinine=6.9 mg/dL (Initial=2.9 mg/dL). The risks factors on this patient that predispose him to develop contrast dye nephropathy are the following, EXCEPT:A. DiabetesB. Renal InsufficiencyC. InfectionD. ElderlyPage 1647

78. The findings of eosinophiluria in patient with acute Renal Failure is suggestive of:A. Acute Allergic Insterstitial NepritisB. Acute GlomerulonephritisC. Acute Tubular NecrosisD. Acute Uric Acid NephropathyPage 1649

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

32

B. Serum creatinine is ⇑ after ingestion of cooked meatC. Cockcroft-Gault equation is similar for both male and femaleD. Insulin clearance is affected by both tubular absorption and secretionPage 246-247

80. A patient with Chronic Renal Disease and GFR of 40 ml/min has serum K of 6.2 meq/L. the elevated K is due to the following, EXCEPT:A. ⇓ urinary K + excretion B. constipationC. ⇑ dietary K+ intakeD. drugs that ⇓ K+ secretion in tubulesPage 1655

81. A 36 y/o female with Chronic Renal Disease complains of restless leg syndrome. Screatinine=5.2 mg/dL. You should advice the patient to:A. consult neurologistB. therapeutic trial of high dose B6 & B12

C. therapeutic trial of phenytoinD. initiation of DialysisPage 1659

82. A 46 y/o hypertensive patient serum creatinine=9.8 mg/dL and with marked pallor. The anemia is primarily due to:A. hemolysisB. ⇓ EPO synthesisC. bone marrow suppressionD. Iron deficiencyPage 1658

83. The most prominent findings in patient with nephritic syndrome is:A. hypoalbuminemiaB. edemaC. proteinuria > 3.5 gm/1.73m 2 D. hyperlipidemiaPage 1684

84. A 20 y/o male, smoker was admitted because of oliguria and hemoptysis. Initial lab: revel serum creatinine=8.6mg/dL. Urinalysis shows rbc casts and dysmorphic rbc. (+) anti GBM Ab’s. The expected histopathologic findings isA. thickened glomerular basement membraneB. prominent mesangial deposits of IgAC. crescents formationD. glomerulosclerosisPage 1683

85. Duration of treatment of acute uncomplicated cystitis in non pregnant woman is:A. single doseB. 3 daysC. 7 daysD. 14 daysPage 1718-1719

86. Which of the following is a chronic clinical manifestation of Atherosclerosis?A. Myocardial infarctionB. Cerebrovascular accidentC. Sudden cardiac deathD. Stable effort induced angina pectorisPage 1425

87. Atherosclerotic plaque that ate vulnerable to rupture is characterized by which of the ff.?A. Thick fibrous capB. Large lipid coresC. A high content of lymphocytes

33

D. Abundance of smooth muscle cellsPage 1429

88. Which of the following risk factors is a coronary heart disease risk equivalent?A. HypertensionB. Diabetes MellitusC. DyslipidemiaD. ObesityPage 1431

89. The abnormal lipoprotein profile associated with insulin resistance known as Diabetic dyslipidemia?A. High LDL low HDLB. High Triglyceride, High LDLC. High Triglyceride, Low HDLD. Low HDL, Low LDLPage 1431

90. Microvascular angina is a condition caused by:A. Abnormal constriction or failure of normal dilatation of the coronary conductance

vesselsB. Normal constriction the coronary resistance vessels C. Abnormal constriction or failure of normal dilatation of the coronary resistance vesselsD. Abnormal dilatation of the coronary resistance vesselsPage 1434

91. The major sites of atherosclerotic disease are the:A. Conductance vesselsB. Resistance vesselsC. Epicardial arteriesD. Endocardial arteriesPage 1434

92. CAD manifested as symptoms of dyspnea, fatigue and faintness is known asA. Unstable angina pectorisB. Angina equivalentC. Stable angina pectorisD. Angina decubitusPage 1435

93. The typical physical examination findings of patients with Stable Angina Pectoris is:A. (+) atrial gallopB. (+) ventricular gallopC. Mitral systolic murmurD. NormalPage 1436

94. Which of the following is typical of hypertensive crises?A. Diastolic blood pressure is > 140 mm HgB. Normal mental statusC. Iron deficiency anemiaD. Grade I fundusPage 1480

95. Class I drug used in the treatment of symptoms of patients with Chronic stable Angina pectoris include which of the following?A. Dipyridamole and chelation therapyB. Clopidogrel and long acting dihydropiridine CCBC. ASA, beta blockers and NTGD. Long acting nitrates and beta blockersPage1439

96. Stenosis of the left main coronary artery on three vessel disease in patients with Diabetes Mellitus or severe LV dysfunction are best treated with:A. Traditional medical managementB. PCI

34

C. CABGSD. ThrombolysisPage 1442

97. To achieve revascularization of the ischemic myocardium in patients with asymptomatic IHD and suitable stenoses of the epicardial coronary arteries, the best treatment option is:A. CABGSB. PCIC. ThrombolysisD. Low molecular weight heparinPage 1442

98. The most common presenting symptom of patients with STERMI is:A. DyspneaB. ChockingC. Deep and visceral painD. Nape painPage 1449

99. The initial ECG changes in STEMI is:A. ST segment depressionB. ST segment elevationC. Deep QD. Tall T wavePage 1450

100. In which of the following pattern of MI will the use of morphine be restricted because of its

vagotonic effect?A. anterior MIB. antero lateral MIC. Postero inferior MI D. Massive MIPage 1452

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