MED - Post Review Exam

UNIVERSITY OF SANTO TOMAS FACULTY OF MEDICINE AND SURGERY DEPARTMENT OF MEDICAL EDUCATION MEDICAL BOARD REVIEW 2017

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POST TEST: INTERNAL MEDICINE SATURDAY, JULY 22, 2017

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I '3 U ' Name: ” J J " ' GENERAL INSTRUCTIONS: This questionnaire is composed of 100 items On the box prowded in the front page of the Examination Answer Sheet, kindly write your student code & name All final answers should be made On the back page of the EXAMINATION ANSWER SHEET prowded for SHADE SET A. Only Mongol 1 may be used Do not leave any blanks as this Will be conSidered incorrect Do NOT detach the name stub Submit your EAS only Please be guided accordingly TEST I: CHOOSE THE BEST ANSWER: J],

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Which vaccine should be administered in splenectomized patients receiving intensive chemotherapy7 A. 4-Valent meni‘ngococcal vaccine C. Hepatitis B D. Measles/mumps/rubella B. 23-Valent pneumococcal polysacchari‘de Diagnosis of tetanus is usually based on: A. Positive tissue culture growmg C tetani B. Serum antitoxin levels > 0.01 unit/ml C. EMG showing continuous discharge of motor units D. Clinical findings The drug of ch0ice for a 25 year old woman on herLt'drimester of pregnancy suffering from typhoid fever is: 9‘ ‘7 A. Chlorampheni'col C. Co-tri’moxazole , ‘it. Aw“ D. Ampicillin B. Ciprofloxacin ,..1 The pathophysiologic mechanism causmg the clinical manifestations in Leptospirosis is A. Antibody production C. Leptospiremia B. Ischemia D. Vasculitis CC and her friends ate fried rice, nido soup, fried chicken and potato salad. Four hours after, most of them experienced vomiting, abdominal pain and diarrhea. The etiologic agent causing the above symptoms is: A. Bacillus cereus C. E coli B. Cholera vibrio D. Clostridium perfringens The single most important preventive measure to prevent health care associated Infections is: C. Use of personal protective equipment A. Hand hygicne D. Proper waste disposal 8. Isolation of patients Appropriate interventions for secondary syphills in pregnant patients allergic to penicillin A. Ceftn'axone 1 gm IM q weekly for 3 doses B. oxycycline 100 mg BID for 2 weeks C. Azithromycin 500 mg OD for 1 week D. Benzathine penicillin G 2.4 M units IM after desensitization Regarding the clinical course of HIV infection: \. A. Death is often due to the WHIVinfection itself ,. _ B. Opportunistic infections usually appear when CD4 counts are S 500 cells/UL C. Acute retroviral syndrome occurs w/in 3-6 weeks after primary infection. *0. Viral load is low during the clinical latency/“period. F‘ ‘ 9‘42 Among febrile neutropenic patients, what is the most important laboratory parameter in monitoring treatment reSponse? A. Serum creatinine C. Prothrombin time 8. Quantitative platelet count D. Absolute neutrophil count i

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10. The hallmark of f“.p$l.‘i is: A. dCCTEd‘SCSVJ in peripheral reSistance and increased in cardiac output B. increased in peripheral resnstance and decreased in cardiac output

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C. stimulation of the coagulation pathway 0. down regulation of the inflammatory mediators 11. The most likely etiologic agent in a patient presenting With generalized erythroderma and sepsis lS.’ A. Acmebacter baumanil C. Streptococcus pneumonia 8. StaphyIOcoccus aureus D. Streptococcus pyogenes 12. An 80-year~old male wrth prosta‘tic enlargement developed oliguria. On PE, the hypogastnc area was noted to be distended and dull on percussion. His serum creatinine lS progressrvely elevating Which of the followrng is the possible mechanism for the patient’s acute kidney injury? A. Extra—renal C. Pre-renal B. Intra-rena'l D. Post-renal 13. 1nf patients wrth advanced cirrchosis, systemic vascular resistance is markedly reduced because 0 .' A. a primary arterial vasodilatron in the splanchnic Circulation 8. volume depletion and dehydration C. infections like spontaneous bacterial peritonitis D. concomitant right heart failure seen in these patients 14. An example or an endogenous toxin that can lead to acute kidney injury is: A. pentamidine C. uric acrd B. ethylene glycol D. Tamm~Horsfal| protein 15 What histopathologic finding is an ominous sign of irreversibility and progression to renal failure among patients with glomerular disease? A. Glomerular crescents ‘ ' "*1 B. Interstitial fibrosis C. Mesangial hypercellulan'ty ~ “““e D. Splitting of the glomerular basement membrane ' 1' t « » «I. "W 16. Post-streptococcal glomerulonephritis after an episode of impetigo usually develops after: A. 1-3 weeks B. 2-6 weeks C. 6-8 weeks D. 8—12 weeks 17. What is the most cause of hypothyroidism worldwide" A. Hashimoto’s thyroiditis C. Radioactive loadine B. Iodine deficiency D. Thyroidectorny 18. What is the Single best screening test for thyroid dysfunction? A. T4 C. TSH B. PM D. TRH 19. What is the marker for recurrent well-differentiated thyroid cancer?’ A. Thyroid binding globulin C. Thyroglobulin D. Calcitonin B. Anti-TPO antibody 20. What are the expected laboratory results in Graves disease? C. High TSH and Low FT4 A. Low TSH and low FT TSH and high FT4 D. High TSH and High FM B. Low 21. Which oral antidiabetic agent has the most potential to cause hypoglycemia? A. Biguanides C. Sulfonylureas B. Thiazolidinediones D. Dipeptidyl peptidase-IV inhibitor 22. Which counterregulatory hormone drives most of the clinical signs and symptoms of hypoglycemia? A. Epinephrine C. Growth hormone B. Glucagon D. Cortisol the appropriate test 23. What is screening for a patient with prognatism, macroglossia, coarsening of facial features and carpal tunnel syndrome? A. Growth hormone level C. Insulin tolerance test B. IGF-l level D. ACTH stimulation test 24. What is the preferred definitive treatment for most prolactinomas? A. Dopamine agonist C. External beam irradiation B. Transcranial surgery D. Transsphenoidal surgery Page 2 of 8

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8. Opening of aortic and pulmonic valves D. Isovolumetric relaxation ‘ . 7‘26. Which among the following would have a negative Carvallo’s sign — \'- r a). i ‘ ’i‘) i' "’ K A. Tricuspid stenosrs murmur '“ - '"C. Aortic stenosis murmur a” B. Pulmonic stenosis murmur D. Tricuspid regurgitation murmur 27. A 58 year old female corporate lawyer known hypertensive but poorly compliant to her medications, came to the ER because of right sided weakness, accompanied by slurring of ‘\__ . speech and facial asymmetry. Her initial BP was 210/ 110. She belongs to what stage of hyperten5ion? ‘ ‘ A. Pre-hypertension C. Stage 2 B. Stage 1 D. Isolated systolic hypertension 28. One of the following physical examination findings signifies a hypertensive emergency: C. Sustained apical impulse 7‘ A. Papilledema on fundoscopy B. Blot hemorrhages on fundoscopy D. Apical holosytolic murmur L 29. The ideal maintenance anti-hypertensive drug to start for diabetic patients with nephropathy is: C. ACE inhibitor L A. Centrally acting drugs D. Calcium channel blocker B. Thiazrde diuretics 30. Which of the following would most likely suggest an Acute Myocardial Infarction? V." bf, \ i A. CKMB 2x elevated, cardiomegaly by CXR, T-wave inversion by ECG, leukocytosis on CBC 5 ‘ j B. Troponin 0.03, normal CXR, 0.5mm ST segment depression leads V1-V3, leukocytosis on CBC C. Troponin 2x elevated, cardiomegaly by CXR, 2.5 mm ST segment depression; leukocytosis on CBC _

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‘ 25. Which one of the following happens during ventricular diastole? i. I A. lsovolumetric contraction C. Atrial diastole

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D. Troponin 0.03, cardiomegaly by CXR, 1.5 mm ST segment elevation leads V4oV6 leukocytosis on CBC

31. Primary mechanism involved in acute coronarysyndrome: A. Chronic progressive narrowing of the epicardial coronary arteries 8. Leucocyte recruitment and foam cell formation C. Plaque rupture and resultant thrombus formation A D. Acute embolic occlusion of an epicardial coronary artery ‘; 32. What is the definitive treatment of choice for ST elevation MI? " " A. Unfractionated heparin administration C. IV Beta-blockers B. IV nitroglycerine D. Timely reperfusion using fibrinolytics or PCI 33. True regarding use of beta-blockers in Acute Myocardial Infarction: A" A. Improves ischemia but has no role in symptomatic relief of chest pain ’ .c B. Improve myocardial supplyvdemand mismatch by reducing heart rate C. By reducing heart rate, may potentially increase serious ventricular arrhythmias D. Significantly reduce mortality and morbidity, hence must be given to all patients even those

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34. If chest pain occur while doing ordinary physical activity, what is the functional classification? C. Class III A. Class I B. Class II D. Class IV 35. Which one of the following is preferred for chronic treatment of congestive heart failure due to left ventricular systolic dysfunction? a“ A. Diuretics l B. Digoxin C. ACE inhibitors \. D. Hydralazine (Apresoline) plus isosorbidedinitrate (Isordil, Sorbitrate) I)", 36. Which among the following is part of the major Framingham criteria for heart failure? r’ C. Norturnal Cough / A. Positive hepatojugular reflux B. Ankle edema D. Dyspnea on ordinary exertion A 37. Most common rhythm in sudden cardiac death: %’ C A. Ventricular fibrillation C. Idioventricular rhythm D. Atrial fibrillation B. Junctional rhythm 38. A 21 year old male consulted at the outpatient department because of fever and joint swelling, . involving the knees, elbows and his wrists. He had history of sore throat 2 weeks ago. What is the most likely diagnosis? ¢\ , “x A. Post-streptococcal reactive arthritis (PSRA) B. Post-viral Reactive arthritis C. Rheumatic Fever D. Acute Viral Illness .\1

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39. TRUE regarding manifestation of ACUTE Rheumatic Fever (ARF) A. Sydenham's churea commonly occurs in the absence of other manifestations and IS found, mainly in males B. Valvular damage is the hallmark of rheumatic carditis. C. The typical ARE ]ornt involvement is migratory, moving from one Jomt to another over a period of hours, it almost always affects the smaller JOIDIS and it is symmetric. D. Subcutaneous nodules occur as painful, smal’le—OS2cm), mobile lumps beneath the skin overlying bony prominences, particulary of the hands, feet, elbows, occiput and occasronally the vertebrae. They are early manifestations that disappear 2-3 weeks after onset of disease. 40. What PE finding points to impending respiratory failure? A. Alar flaring C. Abdominal paradox B. Pulsus paradoxus D. Tripod position 41. An anxious patient had a respiratory rate of 26. The rest of the Physrcal Exam was unremarkable. What do we expect on ABG’ A. High pH, high PaCOZ C. High pH, low PaCOZ B. Low pH, low PaC02 D. low pH, h:gh PaC02 42. A 58 year old patient was diagnosed to have “Asthma”. She uses her ICS once daily. She has _ nightawakening twice a week, and has had to stop Ballroom because of frequent episodes of shortness of breath. What is expected in the sprrometry of this Asthma patient? A. Low FVC C. Low FEVl/FVC B. High FEVl D. High FEVl/FVC 43. What spirometry result best pornts to a COPD? A. Pre-bronchodilator FEVl < 70 C. Resrdual volume < 140% B. Post bronchodilator FEVl/FVC < 70 D. Reversrbility > 12% 44. What pathology is expected in a Lung Cancer patient manifesting With the following PE findings on the right hemrthorax: lagging, decreased tactile fremiti, dullness, decreased breath sounds, apex beat at 5” LICS parasternal line? A. Consolidation C. Obstructive atelecta5is B. Pleural effusion D. Pneumothorax 45. A trauma patient manifests With a Tension Pneumothorax. What PE finding is most diagnostic? A. HR 110/min C. Altered sensorium B. BP 80/40 D. Subcutaneous emphysema 46. A 46 year old patient consults for fever, mugh and dyspnea. His daughter says he also seems a bit confused. BP 110/80, CR 110, RR 31, T40. What is the srte of care for his pneumoniaj A. Out patient C. In patient ICU B. In patient non ICU D. We need to see the chest x-ray first 47. A patient with 3 weeks cough is suspected to have PTB He has never had previous TB treatment. What test should we request for according to the NTP guidelines? C. Sputum AFB A. TST D. Sputum MTB culture B. Chest x—ray 48. A patient presenting 4 weeks cough is confirmed to have TB. What regimen should be given? A. RHEZ4/RH2 C. RHEZSZ/RHEZl/RHES D. RH9 B. RHEZZ/RH4 tor 49. A 43 year old obese patient is assessed OSAS. He also has hypoxemia while awake. What does he most likely have7 A. Primary snoring C. Obstructive sleep apnea D. Obesity hypoventilation syndrome B. Sleep hypopnea syndrome 50. A female post op patient suspected to have Pulmonary Embolism. What finding is most diagnostic7 A. Loud 82 B. Pedal edema C. Bibasal rales D. RVH 51. Which statement best describes basic structure of immunoglobulin7 A. All immunoglobulins have basic structure 2 heavy and 2 light chains B. The f0ur chains are covalently linked by 2 molecules of »-OH bonds C. The variable regions are respons‘ble for the biologic functions of immu.ioglobu|ins D. The constant regions constitute the antibody binding (Fab) region of the molecule. 52. A 75 year old retired busiriesswoman consulted because of 7 days history of knee 10int pains and diffi'Culty in walking. On examination, r.ght knee was slightly warm, minimally effused with pain limited range of motion. A diagnostic arthrocentesrs was done What is the most plausible cause of knee effusion? A. Septic arthritis C. Rheurriatoid arthritis 8. Crystal arthropathy D. Reiter's syndrome Page 4 of 8

53. The following best describes morning stiffness associated with inflammatory disorders. A. Precipitated by exposure to cold C. Improves With activity 8. Lasts for lSminutes at most D. Exacerbated by activity 54. Which of the following poses a greater likelihood of deveIOping joint abnormalities and disabilities

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in a patient with rheumatoid arthritis?

A. Markedly elevated sedimentation rate

8. Pattern of disease onset C. Radiographic eVIdence of periarticular osteopenia D. Symmetric polyarthritis 55. What is the preferred muscle enzyme in myopathies? ‘ A. Gamma-glutamyl transferase C. Aspartate aminotransferase D. Creatine kinase B. Lactic dehydrogenase 56. What is the optimal goal of drug therapy in osteoarthritis? I A. Reverse pathologic changes 8. Delay progression C. Offer palliative treatment D. Prevent progression 57. Which is the major component of the antrlreflux barrier? C ‘C. Lower esophageal sphincter A. Acute angle of His B. Diaphragmatic crura D. Phrenoesophageal ligaments 58. What is the gold standard for the diagnosis of erosive gastroesophageal reflux disease (GERD) A. Barium swallow 8. Continuous intraesophageal pH monitoring D C. Proton pump inhibitor pH monitoring D. UGI endoscopy .i ' 59. What of the following symptoms is more typical of duodenal than gastric ulcer? ) A. Nausea C. Vomiting \ B. Night distress D. Weight loss _._\ 60. What is the most common cause of lower GI bleeding? ‘ A. Hemorrhoids C. Neoplasms B. Inflammatory, bowel disease/juvenile polyps D. Vascular ectasia _ 61. What is the most common cause of acute pancreatitis? K" A. Alcohol C. Gallstone ‘ 8. Drugs D. Hypertriglyceridemia ,3“. 62. What is the best test for hepatocyte injury: ” A. Alanine aminotransferase C. Bilirubin B. Albumin/Globulin ratio D. Gamma glutamyl transferase ._ 63. What is the inherited tubular disorder due to mutations in the thiazide-sensitive Na-Cl co( transporter (NCC) in the dilstalLQllectlng'tubule characterized by hypocalciuria, severe ” hypomagnesemia, and prominent muscular signs and symptoms? A. Bartter's syndrome 8. Gitelman’s syndrome C. Gordon syndrome D. Liddle’s syndrome .. 64. True regarding glomerular diseases: A. Lupus nephritis is an example of an idiopathic glomerular disease because of its autoimmune pathophysiology B. A crescent is a half-moon-shaped collection of mostly visceral epithelial cells in the Bowman’s space C. Diffuse lesions signify involvement of almost all of the glomerular tuft as opposed to " ' segmental lesions D. Fibrosis is commonly a consequence of healing of crescents or tubulointerstitial disease 65. Which is an example of a secondary from of glomerular disease? A. Crescentic GN C. Diabetic nephropathy 8. Minimal change disease D. Membranoproliferative Gn type II Post-strep GN: 66. there is a role for immunosuppressive therapy has the clinical picture occurring a day after the infection can spontaneously recover hematuria does not last for a week after the infection ‘

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67. What is the basement membrane syndrome associated with h’emajuria, thinning and spiltting ol the GEMS, mild proteinu‘na, chronic glomerulosclerosrs and sensgnneurdl hearing deafness7 ” A. Alpo'rt s syndrome 8. AntiGBM disease C. Fabry‘s disease D. Thin Basement syndrome

DB _ Which of the lollowmg is an absolute indication for hemodialysis7 C. Respiratory acidosis \ A. Hypervolemia D. Uremic pencarditrs B. Hyperkalemia 69. Pathognomonic clinical feature of vQco_u\re_teral reflux: @ Q

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’ flu“ Asymptomatic Flank pain that occurs only with micturition Pain wrth variable intensity that occurs continuously Pain radiating to the testes or labia

r). 70. What IS the most appropriate therapy f0r a 20 year-old non-pregnant female presenting wrth “ dysuria and suprapubic tenderness?

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IV ampicillin for 7 days 8. IV vancomycm for 3 days C. Oral ciprofloxacin for 3 days 0. Oral nitrofurantom for 7 days A 71. What is the most cause of hypo'thyror'dism in iodine sufficient countn‘es? A. Hashimoto‘s thyrorditis C. Radioactive iodine B. Iatrogenic D. Thyr0idectomy C 72. What ultrasound feature of a nodule indicates a risk for thyrord malignancy? A. Peripheral vascularity C. Microcalcification , , than tall D_ Hyperechoic B. P\ 73. What is the marker for recurrent m’edullary therId cancer? 1'” ' " ' z. i“ j A. Thyroid binding globulin C. Thyroglobulin B. Anti-TPO antibody D. Calcrtonin 74. What is the appropriate test for a patient with buffalo hump, wide purple abdominal istmria‘e, moon” ‘ face and easy brwsability7 A. ACTH level C. InSulin tolerance test B. 24«hur urine free cortisol D. ACl'H stimulation test 75. What are the expected laboratOry tests in postsmgical hypoparathyroidism7 A. High calcrum and low phosphate Cl’ow calcrum’and low phosphate 8. High calcium and high phosphate D. Low calcium and high phosphate 4‘ 76. What parameter in the GOLD gurdelines sh0uld make the physician prescribe an ICS to a patient y with Emphysema7 A. Frequent exacerbation C. Symptoms score airway 8. Severity of obstruction D. Oxygen saturation / /77. What PE finding wrll make the physicran prescribe home ___02 inhalation? L// A. Increased AP diameter of the chest C. NP” 4cm at 30° angle 8. Left parasternal heave D. Bipedal edema R 78. A patient had an arterial blood gas drawn while on 02 inhalation at 2 LPM. ) pH 7.33 PaCoZ 68 Pa02 105 HCO3 29. OZsat 98% —- What is the acrd base status? A. Partially compensated metabolic alkalosis .1 B. Uncompensated respiratory alkalosrs C. Uncompensated metabolic acidosis D. Partially compensated respiratory acidosis 3‘ 79. A patient was diagnosed to have “Community Acquired Pneumonia RML, moderate risk", What is 1’) the most probable organism involved" \\ A. Gram (-) coccobacilli C. Gram (+) cocci in clusters 8. Gram (v) diplocococ D. Gram (-) bacilli r 80. A 40 year old teacher was diagnosed to have “Asthma” in December 2013, and was maintained j on 1C5. She also undewvent Spirometry, but the results were "normal". How can we best confirm a diagnose of Bronchial Asthma? A. Wait for her to have symptoms and then do the spirometry B. Let her come to your clinic every week so you can measure her PEFR C. Request f0r an arten‘al blood gas D. Do methachoiine challenge test Page 6 of 8

81. What IS the first Wow utic step in all patients diagnosed to have Bronchial Asthma, regardless of classification7 & A. Envronmental control/education C. Inhaled certicosterOid 8. Short acting 8 agonist as rescue med D. Long acting 8 agonist 82. What is usually seen in the ultrasound of patients with deep venous Uiromboss" A. Non compressrble C. Vrsrble clot

8. Pulseless D. Smaller vessel 83. What PE finding IS most compatible with 3 Pulmonary embolism? A. Palpable pulse in 2"" [CS synchronous With the apex beat

B. Diffuse and sustained apex beat ‘ C. JVP 4 cm at 30 ° angle D. Loud 52 at base

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84. A 47 year old chef con5ults because of excessive daytime sleepiness. A sleep disorder is suspected. What is TRUE about Obstructive Sleep Apnea? A. His chest and abdomen are seen to move even if there is no airflow B. His snoring Suddenly stops when he goes to REM C. There is absence of chest and abdomen movement synchronous with hypoxemia D. Hypoxemla occurs even during the daytime 85. What IS the best test for Helicobacter pylori in a patient who IS on PPI" C. Stool antigen A. Histology urease test D. Urea breath test 8. Rapid 86. A 70 year old male, hypertensive, presents wrth muelena and later hematochezra. After stabilizing the patient, gagstroscopy and colonoscopy were done which showed [18935]):results. What is the

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next most appropriate step to do7 ‘ A. Angiography B. CT scan C. Enteroscopy D. Tagged RBC scintigraphy s 87. Which eSOphageal lesion is the most common risk fact0r adenocarcinoma of the esophagus? A. Barrett's B. Web C. Papilloma D. Stricture 88. What is the Philadelphia chromosome? A. Translocation between chromosome 9 & 22 ." T B. Translocation between chromosome 11 & 22 C. Deletion of short arm of chromosome 9 D. Deletion of long arm of chromosome 9 8t 22 89. Which of the followmg is used to rapidly reduce the WBC count? C. Busulfan A. Hydroxyurea D. Cytarabine B. lmantinib ’\ .\ 90. Most common proceeding infection associated with the development of aplastic anemia is: I) A. Parvovirus B 19 C. Chlammydia D. Hepatitis B. Schistosoma 91. A 49 year old female presents with left Uppewr/Quagdrant discomfort. Physical examination showed the spleen to be enlarged measuring 20cm below the left subcostal margin. CBC: hgb 110 G/L \ .l Hct 0.36 WBC: 32x109/L promyelocytes 15% metamyelocytes 20% myelocytes 10% bands 8% segmenters 37% lymphocyte 10% platelets 650000. Peripheral smear showed presence of tearlg‘dro shaped cells and nucleated red blood cells. What is the most probable diagnosis of the

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above patien“'t.7‘ C. Chronic Idiopathic myelofibrosis A. Acute Myelogenous Leukemia D. Hairy Cell Leukemia 8. Chronic Myelogenous Leukemia 92. What is the blood smear picture of extramedullary hematopoiesis? A. Absence of myelocytes and promyelowtes B. Increased number of Howell Jolly bodies C. Presence of tear drop shaped cells D. Absence of nucleated RBC‘s 93. Which of the following is a cause of megaloblastic anernia from cobalamin deficiency? C. Pregnancy A. Acute Hemolysis

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L. 94. Tyrosine Kinase inhibitor used in Chronic Myelogenous Leukemia A. Cytarabine C. Imatinib B. Doxorubicin D. Tretinoin 95. A 55 year old male, hypertensive and diabetic, has been expereincing anginal pains for a year now. He was awakened an hour earlier by a constricting chest pain that lasted for 20 minutes, .« p accompanied by shortness of breath. Although it has disappeared, she decrded to go to the C ’9 emergency room. What is the most likely diagnosis?

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A. Costochondritis C. Acute Myocardial Infarction B. Unstable Angina D. Biliairy Tract Disease \ 96. A 26 year old female consulted because of passage of tea-colored urine and pedal edema. Her , 3 BP is 150/ 100.Which of the following urinalysis casts lS most likely to be present in the patient7 \ ,2 A. hyaline C. WBC ~ B. RBC 0. waxy r 97. A 40 year old female is complaining of pain on her fingers. PE revealed a bony enlargement on k the PIP joint. This is known as node. A. Heberden's node C. Bouchard’s node B. Virchow's node D. Bunyard's node 98. A 55 year old male, hypertensive and diabetic, came in due to chest pain and left—sided weakness. BP was 200/ 100, PR 90 bpm, regular, RR 20 cpm, regular, T 36.6C. MMT Left Upper & (Lower extremities: 2/5, Right Upper and Lower extremities 5/5. Which of the following neurologic findings would be compatible in this case7 A. Asterexis C. Hypoactive Deep tendon reflex B. Dorsiflexuon of the big toe D. Neck immobility I)" 99. A 23 year-old male medical student with diabetes mellitus has altered sensorium. At the ER, he ‘ was noted to be moaniingincohercntly. Upon painful stimulation, he withdrew his extremities but there was no eye opening. What is his Glasgow Coma Scale score7 A. 7 C. 11 B. 9 D. 13

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A 48 year old male presented with abdominal pain, jaundice. The patient has hepatomegaly

if the liver span is more than 12cm in the right A. midaxillary line C. midclavicular line B. anterior axlllary line D. midsternal

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