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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(+), antiHBs(-), anti-HBe(-). He has A. Acute Hepatitis V viral infection B. Chronic HBV infection, low infectivity 3. 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) C. Splenomegaly D. 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 3. 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 1. 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 A. High T4 with low TSH B. High T4 with high TSH C. low T4 with high TSH D. 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 4. 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 2. 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