DEPARTMENT OF INTERNAL MEDICINE

1. Generally accepted indicator of the immunologic competence of the patient with HIV infectionA. level of plasma viremiaB. CD4

+ T lymphocyte countC. immunoglobulin levelD. PPD

2. The hallmark of HIV disease isA. Kaposi’s sarcomaB. opportunistic infectionsC. cell-mediated immunodeficiencyD. 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 hasA. Acute Hepatitis V viral infectionB. Chronic HBV infection, low infectivityC. Chronic HBV infection high replication stateD. 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 globulinB. Hepatitis B immune globulinC. first dose of Hepatitis vaccineD. 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 & 3B. Give rabies immune globulinC. wound treatmentD. all of the above

6. The earliest manifestation of TetanusA. opisthotonusB. dysphagiaC. lock jawD. muscle spasms

7. Which of the following is a sign of severe (stage III) tetanus?A. spasms lasting for less than 10 secondsB. lock jawC. risus sardonicusD. localized muscle stiffness

8. The most frequent manifestation of typhoid fever isA. Rose-spotsB. pulse-fever disproportionC. prolonged persistent feverD. 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 boosterB. 3 doses of live attenuated oral typhoid vaccineC. gamma globulinD. none of the above

10.The following contribute to the renal failure in leptospirosis exceptA. hypovolemiaB. acute tubular necrosisC. acute cortical necrosisD. 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 exceptA. ShigellaB. E. coliC. V. parahemolyticusD. 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. ChloroquineB. QuinineC. MefloquineD. Sulfadoxine/Pyrimethamine

13.The earliest physical manifestation of sepsis isA. tachypneaB. tachycardiaC. hypotensionD. altered mental status

14.The ff. plays a major role in the severe vasodilatation in septic shockA. TNFaB. nitric oxideC. thromboxanesD. Interleukin-1

15.Effect/s of activated Protein C that may counteract some of the mechanisms in sepsisA. inhibits the coagulation cascadeB. increase fibrinolysisC. inhibit leucocyte adherence to endotheliumD. 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 antibioticB. anti-fungal treatmentC. anti-pseudomonal antibioticD. 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/TazobactamC. ImipenemD. any of the above

18.The most common respiratory symptom of post primary tuberculosisA. hemoptysisB. chest painC. chronic coughD. dyspnea

19.Impact of HIV infection on tuberculosisA. more atypical cases of tuberculosisB. more frequent occurrence of extrapulmonary TBC. more difficult to identify because of similarities of symptomsD. all of the above

20.Decreased alveolar ventilation results from the ff. condition, exceptA. Decreased CNS drive B. Decreased physiologic dead spaceC. Neuromuscular diseasesE. Increased work of breathing with inadequate ventilation

21.The use of PEEP (positive end expiratory pressure) in mechanical

ventilation is helpful because it canA. Limit venous returnB. Increase airway pressureC. Decrease the cardiac outputD. Increase FRC and prevents alveolar collapse

22.Which of the ff. pathologic changes is NOT a characteristic of ARDSA. Diffuse alveolar damageB. Hyaline membrane formationC. Hyperplasia of mucus gland and smooth muscleD. Increased alveolar-capillary permeability

23.Superior vena cava syndrome is characterized by the followingA. Phrenic nerve paralysis and elevation of hemidiaphragmB. Shoulder pain radiating to ulnar distribution of the armC. Edema and rubor of the face, neck and upper chestD. Anhidrosis, miosis, ptosis of affected side

24.One of the following is not a characteristic of the dyspnea of patients with COPDA. variable, frequent at nightB. progressive & worsening over timeC. present dailyD. worse on exercise

25.A prominent cardiac silhouette on chest x-ray of a COPD with cor pulmonale patient is due toA. Right ventricleB. aortaC. left atriumD. left ventricle

26.The most common risk factor for development of ARDS isA. pneumoniaB. sepsisC. aspirationD. severe trauma

27.Necrotizing pneumoniaA. cavities > 2 cm diameterB. cavities < 2 cm diameterC. process confined to alveoli contiguous to bronchiD. interstitial involvement only

28.Pneumonia with erythema multiforme, hemolytic anemia, bullous myringitisA. Streptococcus pneumoniaeB. Moraxella catarrhalisC. Mycoplasma pneumoniaeD. Legionella pneumophilia

29.Risk factor for lung abscessA. inhalation of bacteriaB. seizureC. spinal anesthesiaD. amphetamine intake

30.Surgical indication for bronchiectasisA. CosmeticB. severe dyspneaC. massive hemoptysisD. bilateral lung involvement

31.Usual source of pleural fluid in normal statesA. parietal pleuraB. visceral pleuraC. interstitiumD. peritoneal cavity

32.Most frequent cause of malignant pleural effusionA. LymphomaB. breast CaC. bronchogenic Ca D. mesothelioma

33.The most serious complication of hyperkalemia

A. seizure B. cardiac toxicityC. respiratory failureD. muscle paralysis

34.Bence Jones Proteinuria is associated withA. myelomaB. hypertensionC. lymphomaD. diabetes

35.The most common extrarenal system to develop cystic changes in ADPKDA. liverB. thyroidC. pancreasD. ovary

36.Urinary findings of patient with Tubulointerstitial DiseaseA. Protein > 3 gramsB. hematuriaC. pyuriaD. RBC casts

37.Examination of the synovial fluid of the knee of a patient with osteoarthritis will reveal the following exceptA. Clear viscous fluidB. Negative cultureC. WBC count of 200/hpfD. (+) CPPD crystals

38.Inflammation of the 1st metatarsal joint due to MSU crystal is calledA. BursitisB. PodagraC. EnthesitisD. Tophi

39.The structure in the joint that is affected in osteoarthritisA. SynoviumB. CapsuleC. CartilageD. Subchondral bone

40.One of the following is NOT a classification criteria in the diagnosis of Rheumatoid arthritisA. Symmetric arthritisB. Serum rheumatoid factor positivityC. Radiographic change like erosionD. Morning stiffness less than an hour

41.The earliest and consistent finding on x-ray of patient with ankylosing spondylitis:A. OsteopeniaB. OsteophytesC. SacroilitisD. Subchondral bone erosion

42.Crystal associated with pseudo goutA. Monosodium urateB. Calcium pyrophosphate dihydrateC. Calcium oxalateD. Uric acid

43.The most specific test in the diagnosis of SLEA. ANAB. ds DNAC. Anti histoneD. Anti-sm

44.The major risk factor in the development of osteoarthritisA. obesityB. AgingC. TraumaD. Endocrine disorder

45.Bony hypertrophy of the distal interphalangeal joint is known as

A. Bouchard’s nodeB. Boutonnieres deformityC. Swan neck deformityD. Heberden’s node

46.Which of the following anemias is most likely to respond to the administration of erythropoietin?A. Iron deficiency anemiaB. Pernicious anemiaC. Pure red cell aplasiaD. Anemia of renal disease

47.Pancytopenia with an “empty” marrow is seen inA. Aplastic anemiaB. Myelodysplastic syndromeC. Paroxysmal nocturnal hemoglobinuriaD. Acute leukemia

48.The patient with intravascular hemolysis can present with all of the following clinical and laboratory findings exceptA. Low levels of serum haptoglobinB. Increased indirect bilirubin and serum lactic dehydrogenase (LDH)C. SplenomegalyD. Hemoglobinuria and hemosiderinuria

49.The diagnosis of chronic ITP is established byA. Marrow examination that shows increase megakaryocytesB. Presence of anti-platelet-autobodiesC. Presence of giant platelets in the peripheral blood smearD. Exclusion of other causes of thrombocytopenia

50.Which of the following is a strategy for primary prevention of cancer?A. Paps smearB. Digital rectal examC. Hepatitis B vaccinationD. Self-breast examination

51.Desired response to treatment if the goal of treatment is TO PALLIATEA. Complete responseB. Partial responseC. Stable diseaseD. Progressive disease

52.HER-2 neu is commonly expressed in which of the following malignancies?A. Colonic CaB. Breast CaC. Bronchogenic CaD. Endometrial CA

53.The most common malignant cause of mortality in both sexes isA. Cervical CaB. Bronchogenic CaC. Breast CaD. 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 isA. Hematuria B. hemoglobinuriaC. myoglobinemiaD. 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 uropathogenA. E. coliB. Staph saprophyticusC. ProteusC. 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 eyesfor retinopathy. Screa is 3.8 mg% Hgb=80. The stage of diabetic glomerulopathy isA. Initial Hyperfunctioning stageB. Incipient GlomerulopathyC. Overt GlomerulopathyD. Azotemia GlomerulopathyE. End Stage Glomerulopathy

57.60 y/o male, smoker, had consultation for gross hematuria on & off for3 months & weight loss. There is a palpable mass on (L) flank. The laboratory examination which will be very helpful to clinically stagethis disease isA. renal UTZB. IVPC. CT scan with contrastD. Renal scan

58.The most common glomerulopathy worldwideA. Acute post strep GNB. Lupus NephritisC. IgA NephropathyD. Thin Basement Membrane Disease

59.The most common functioning pituitary adenomaA. ProlactinomaB. ACTH-secreting adenomaC. TSH-secreting adenomaD. Acromegaly

60.A 67 year old woman has just undergone near total thyroidectomy for follicular thyroid carcinoma. Next step isA. Chemotherapy with adriamycinB. Radioactive iodine therapyC. Levothyroxine replacement therapyD. Observe and follow-up

61.Which of the following can differentiate a patient with Graves diseasefrom a patient with transient thyrotoxic phase of subacute thyroiditisA. CTscanB. UltrasoundC. serum thyroid hormones levelD. I 131 scan of thyroid

62.Which of the ff. laboratory findings is consistent with Graves diseaseA. High T4 with low TSHB. High T4 with high TSHC. low T4 with high TSHD. low T4 with low TSH

63.Diabetes is characterized by the followingA. HyperglycemiaB. Disturbances in carbohydrate, fat and protein metabolismC. Associated with absolute or relative deficiency of insulin

secretion and/ impaired actionD. 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 weightB. Reduced intake of saturated fats and cholesterolD. Avoidance of simple sugarsE. All of the above

65.Which of the following is diagnostic of diabetesA. a single determination of FBS > 126 mg%B. blood sugar of > 200mg% after an OGTTC. RBS of > 200mg%D. positive glucosuria

66.Which of the following is most diagnostic of hypercorticolismA. overnight dexamethhasone testB. low dose dexamethasone testC. Random serum cortisol determinationD. urinary cortisol determination

67.Which of the following will you consider in a young patient with hypertension with and hypokalemiaA. Cushing’s diseaseB. Conn’s diseaseC. PheochromocytomaD. Essential hypertension

68.Cause of dysmotility type of chronic diarrheaA. HyperthyroidismB. VIPomaC. Radiation colitisD. Lactase deficiency

69.True regarding Crohns diseaseA. More common among non-smokersB. Rectal bleeding is commonC. Surgery offers permanent cureD. 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 toDukes stage:A. AB. B1C. B2D. C

71.Tenesmus isA. Excessive passage of flatusB. Indicative of sigmoid pathologyC. A symptom of inflammation of the anusD. Painful straining & sensation of incomplete emptying during

defecation72.Best modality to determine the presence and level of intestinal

obstruction:A. ColonoscopyB. Plain film of the abdomenC. AngiographyD. 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 ofquinolones. Next most logical step is toA. Do lower gut endoscopyB. Repeat routine stool examC. Request for Sudan II stainingD. Request for fecal occult blood testing

74.Most common cause of acute pancreatitisA. drugs and geneticsB. alcohol and gallstoneC. ERCP and hypercalcemiaD. Insect toxins and ischemia

75.Treatment for gallbladder stones seen incidentally by ultrasound on a normal individualA. emergency cholecystectomyB. elective cholecystectomyC. ERCPD. None of the above

76.Most common benign tumor of the esophagusA. PolypsB. LeimyomaC. HemangiomasD. Squamous cell papilloma

77.Which of the following test for H. pylori cannot be used to monitor response to treatmentA. Rapid urease testB. Serological testC. Urea breath testD. Culture

78.Which of the following food stuff is the most potent stimulant gastricacid secretion:A. CarbohydratesB. ProteinC. FatsD. Alcohol

79.The most common cause of obscure GI bleedingA. Small bowel tumorB. Dieulafoy’s lesionC. AngiodysplasiaD. Arteriovenous malformation

80.The epithelial lining of the esophagus isA. Cornified stratified squamousB. Non cornified stratified squamousC. Non cornified non stratified squamousD. Cornified non stratified squamous

81.During the gap or window period, this is the only serologic evidenceOf hepatitis BA. HBsAgB. HBeAgC. Anti-HBcD. 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 AB. Viral hepatitis BC. Viral Hepatitis CD. Viral Hepatitis D

83.Which of the following drugs can relieve dyspnea in CHF?A. Salbutamol by inhalationB. Furosemide IVC. Nitrates sublingualD. Beta blocker per oremE. Digitalis by IV route

84.Which of the drugs can dissolve the thrombus in acute coronaryA. Low molecular weight heparinB. Unfractionated heparinC. AspirinD. StreptokinaseE. Abciximab

85.Inspiration increases the intensity of loudness the murmur ofA. tricuspid regurgitationB. atrial septal defectC. MVPD. Aortic stenosis

86.The most common primary malignant tumor of the heart isA. atrial myxomaB. sarcomaC. malignantD. fibroma

87.All of the following are major Jones criteria for the diagnosis of rheumatic fever exceptA. choreaB. erythema marginatumC. feverD. carditis

88.True of Coarctation of AortaA. femoral pulse is weak and delayedB. blood pressure in the leg is greater than the armC. primary cause of hypertensionD. presence of boot shaped heart on chest x-ray

89.Chest pain is present in patient withA. aortic dissectionB. myocardial infarctionC. bothD. neither

90.Type of congenital heart disease that is acyanotic without a shuntA. atrial septal defectB. ventricular septal defectC. coarctation of aortaD. tetralogy of Fallot

91.Second heart sound is widely split and relatively fixedA. atrial septal defectB. ventricular septal defectC. patent ductus arteriosusD. tetralogy of Fallot

92.Standing increases the intensity of the murmur ofA. tricuspid regurgitationB. mitral stenosisC. mitral valve prolapseD. pulmonic stenosis

93.Chose the correct statement regarding aortic insufficiencyA. high pitched, blowing diastolic murmurB. best heard with the bell of the stethoscopeC. decrease pulse pressureD. 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 isA. aortic regurgitationB. mitral valve prolapseC. mitral stenosisD. patent ductus arteriosus

95.The severity of this component of tetralogy of Fallot determines the cyanotic manifestation of this congenital anomalyA. ventricular septal defectB. obstruction to RV outflowC. overriding aortaD. RV hypetrophy

96.Infective endocarditis prophylaxis is indicated exceptA. mitral stenosisB. PDAC. ASD, venosus typeD. MVP without MR

97.The most important physical sign of acute pericarditis A. chest painB. pericaridal friction rubC. paradoxical pulseD. Kussmaul’s sign

98.Aspirin is indicatedA. acute myocardial infarctionB. acute pericarditisC. bothD. neither

99.Most common cause of death in adults with diabetesA. pericardial diseaseB. coronary artery diseaseC. valvular heart diseaseD. 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 stenosisB. mitral regurgitationC. aortic stenosisD. aortic regurgitation