Test Questions Internal Medicine

DEPARTMENT OF INTERNAL MEDICINE _B____1. All of the following are emergencies and require immediate attention and treatment, EXCEPT: a. acute left ventricular failure c. ventricular fibrillation b. acute rheumatic carditis d. status asthmaticus Priciples of internal Medicine Harisson15th edition p1295 _A_____2. A 16 years old woman came to you with complaint of chest pain. After workup you diagnose her to have mitral valve prolapse. You explain to her that MVP tends to be benign but the following may occur, EXCEPT: a. angiodysplasia c. sudden cardiac death b. endocarditis infective d. embolic phenomena Priciples of internal Medicine Harisson15th edition p1395 _D_____3. A patient has a suspicious myocardial infarction 4 hours ago. The most reliable test is: a. SGPT c. SLDH b. WBC d. CK-MB Harisson15th edition p1495 _C_____4. The microorganisms associated with coronary heart disease are: a. Chlamydia pneumoniae and Streptococcus pneumoniae b. Chlamydia pneumoniae, Streptococcus pneumoniae and Helicobacter pylori c. Chlamydia pneumoniae and Helicobacter pylori d. Streptococcus pneumoniae and Helicobacter pylori Harisson15th edition p1349 _B_____5. A poverty related heart disease: a. congenital heart disease c. coronary artery disease b. rheumatic heart disease d. cor pulmonale Harisson15th edition p1369 _A_____6. Cardiac rehabilitation post-MI can be started a. within 24 hours after admission c. not necessary b. after discharge from the ICU d. after discharge from the hospital Harisson15th edition p1458 _A_____7. The single biggest risk factor in the causation of stroke: a. hypertension c. obesity b. cardiac disease d. none of these Harisson15th edition P 2372 _B_____8. Enlargement of the heart on plain PA view of a chest x ray is evidenced by a minimal cardiothoracic index of: a. less than 0.3 c. greater than 1.0 b. greater than 0.5 d. greater than 1.2 Harisson15th edition p1253 _A_____9. Elevation of serum K is most toxic to the: a. myocardium c. liver b. kidney d. brain Harisson15th edition P282

_A_____10. Ventricular gallop or third heart sound is characteristic of: a. mitral regurgita c. tricuspid regugita b. aortic stenosi d. mitral stenosis Harisson15th edition P 1308 _C_____11. A 36 year old female is hypertensive and diabetic. She came in because of an erythematous rash across the bridge of the nose. Her BP was 180/119. Which of her medicines should be withdrawn? a. propranolol c. hydrazine b. nifedipine d. euglucon Harisson15th edition P 24 _A_____12. The most effective way to demonstrate the area of blood clot in deep venous thrombosis is by: a. Doppler ultrasonography c. plain x ray b. contrast venography d. impedance plethysmography Harisson15th edition P 1492 _B_____13. The usual cause of macrocytic anemia is: a. chronic liver disease c. chronic renal disease b. malabsorption d. iron deficiency Harisson15th edition P 603 _A_____14. Steppage gait is caused by: a. bilateral pyramidal tract disease b. double athetosis

c. exaggerated lumbar lord d. bilateral foot drop Bates 6th ed p. 616

_D_____15. Bell’s palsy is caused by damage to: a.vagus nerve c. oculomotor nerve b. trigeminal nerve d. facial nerve Harisson15th edition P 1307-1309 _C_____16. Antiplatelet agent used in preventing further TIA are the following, EXCEPT: a. dipyridamole c. etodolac b. sulfinpyrazone d. aspirin Harisson15th edition P 2380 _C______17. The diagnosis of epilepsy is is best established by: a. EEG c. history b.CT scan d. physical examination Harisson15th edition P 2363 _A______18. The following are the cardinal signs of Parkinsonism, EXCEPT: a. brisk reflexes c. tremor at rest, impaired postural instability b. bradykinesia d. rigidity Harisson15th edition P 2406

_A_____19. The neurotransmitter deficient in Parkinsonism is a. dopamine c. melatonin b. serotonin d. norepinephrIne Harisson15th edition P 2409 _B_____20. Which is NOT a feature of Parkinson’s disease? a. expressionless facies c. festinating gait b. athetosis d. cogwheel rigidity Harisson15th edition P 2407 _D_____21. Basal skull fracture commonly involved in head injury: a. temporal lobe c. frontal lobe b. parietal lobe d. occipital lobe Harisson15th edition P 2364 _B_____22. The initial drug of choice in trigeminal neuralgia (tic doloreux) is a. morphine c. digitalis b. carbamazepine d. aspirin Harisson15th edition P 2935 _D_____23. Very small pupils that improve with Maloxone are characteristics of a. transtentorial hemiation c. marked increased intracranial pressure b. severe anoxia d. narcotic overdose Harisson15th edition P 2567 _B_____24. The following features are seen in delirium tremens, EXCEPT: a. hallucination c. fver b. alkalosis d. hypotension Harisson15th edition P 2565 _A_____25. Cognitive effect of stress: a. all of these c. difficulty in concentration b. short attention span d. tired of thinking Harisson15th edition P75 _A_____26. NOT a characteristic of infantile autism: a. thought and perceptual c. occurs before 36 months disturbances predominate d. abnormal non-verbal communication b. subnormal level of intelligence Harisson15th edition P249 _A_____27. One of the following is NOT feature of psychogenic depression: a. flat effect c. anorexia b. diarrhea d. lack of libido Harisson15th edition P 2553 _D_____28. The diagnosis of endogenous depression is bolstered by one of the following laboratory tests: a. serum cholinesterase c. electroencephalography b. serum serotonin d. dexamethasone suppression Harisson15th edition P 2853

_B_____29. Lithium carbonate is the drug of choice for a. hysteria c. depression b. mania d. schizophrenia Harisson15th edition P 2557 _C_____30. Which goal is most important to develop a sense of intimacy? a. finding a sexual partner c. finding a peer group b. resolution of identity d. resolving moral issues Synopsis of Psychiatry Kaplan 9th ed p.71 _D_____31. NOT a mature defense: a. humor c. sublimation b. ascetism d. suppression Kaplan 9th ed p.71 _C_____32. Type of schizophrenia which shows less regression of mental faculties, emotional response and behavior: a. disorganized c. catatonic b. undifferentiated d. residual Harisson15th edition P 2539 _B_____33. Fear of death at this age is because of the fear of abandonment: a. 10-14 years c. 1-1/2 years b. 2-1/2 to 5 years d. 1-1/2 to 2-1/2 years Kaplan 9th ed p.102 _C_____34. Suicide is most commonly seen in a. petit mal epilepsy c. affective disorders b. schizophrenic reaction d. character disorder Kaplan 9th ed p 861 _A_____35. A definitive contraindication to electroconvulsive therapy (ECT) is a. brain tumor c. aortic aneurysm b. threatened retinal detachment d. myocardial disease Harisson15th edition P 2558 _A_____36. The most common form of dementia in the elderly is a. Alzheimer’s disease c. brain tumores b. atherosclerosis d. cretinism Harisson15th edition P 2398 _B_____37. Definitive therapy of sleep apnea: a. electrophrenic stimulation c. respiratory stimulants b. tracheostomy d. nocturnal oxygen inhalation Harisson15th edition P 1376 _B_____38. A secretion is TENACIOUS if it a. is not clear c. smells like decaying matter b. is sticky and not easily pulled d. has salty taste apart Harisson15th edition P 1443 _D_____39. Pathognomonic radiologic sign of pneumothorax: a. tram line c. hyperinflation b. hyperluscency d. visceral pleural line Harisson15th edition P 1376

_D_____40. In what condition is the lung ventilated but not perfused? a. emphysema c. viral pneumonitis b. atelectasis d. embolism Harisson15th edition P 1361 _A_____41. A respiratory consequence not found in pulmonary embolism: a. fetor hepaticus c. pulmonary infarction b. respiratory alkalosis and tachyp d. pneumoconstriction Harisson15th edition P 1361 _B_____42. Bronchiectasis is commonly a sequel to a. carcinoma of the lung c. pulmonary embolism b. infection d. heart failure Harisson15th edition P 1541 _C_____43. Total lung capacity is usually increased with a. congestive failure c. emphysema b. cystic fibrosis of pancreas d. hyaline membrane disease Harisson15th edition P 1498 _A_____44. The honeycombed density seen on chest x-ray is characteristics of a. bronchiectasis c. acute pulmonary edema b. cardiac asthma d. pulmonary TB in a diabetic Harisson15th edition P 1541 _A_____45. Which most closely simulate military TB? a. histoplasmosis c. chlamydia b. candidiasis d. mycoplasma Harisson15th edition P 959 _D_____46. Lung abscess is a complicating factor in comatose patients. This is due to a. decubitus ulcers c. thrombophlebitis b. repeated convulsions d. aspirations Harisson15th edition P 1536 _D_____47. The term “coin lesion” is diagnosed because of a. hemoptysis c. aspirated foreign body b. bronchoscopy d. chest x-ray finding -B_____48. The best screening tool available for peripherally located lung cancer is the a. sputum cytology c. chest radiograph b. bronchoscopy d. CT scan Harisson15th edition P 1307 _D_____49. In respiratory acidosis, one of the following is retained: a. HCI c. oxyhemoglob b. sulfates d. carbon dioxide Harisson15th edition P263

_A_____50. A chronic smoker who develops primary lung malignancy is apt to have a. small cell carcinoma c. epidermoid carcinoma b. adenocarcinoma d. large cell carcinoma Harisson15th edition P306 _C_____51. Type of bronchogenic carcinoma which commonly produces endocrine manifestations: a. epidermoid Ca c. small cell carcinoma b. squamos Ca d. Adenocarcinoma Harisson15th edition P508 _C_____52. The risk of a non-smoker married to a smoker is a. increased for ischemic heart disease only b. not increased in any significant amount c. increased by approximately 25% for lung cancer and ischemic heart disease d. increased for lung cancer only Harisson15th edition P808 _B_____53. The highly acidic gastric content is neutralized in the duodenum largely by the a. bile acids c. hydroxyl groups from the ileum b. bicarbonate from the pancreas d. residual secretion of the esophageal goblet cell Harisson15th edition P1746 _C_____54. Which specific electrolyte disturbance in the body fluid leads to clinical disorders? a. iron c. hydrogen b. zinc d. potassium Harisson15th edition P1796 _C_____55. Fat absorption in the intestines is facillated by a. amylase c. bile salts b. mucopolysaccharides d. mucin Harisson15th edition P1765 _D_____56. There may be extra-gastric sources of gastrin, excessive secretion of which may lead to peptic ulcer. The most common nongastric source of this gastrin is a. gall bladder c. uterus b. lung d. pancreas Harisson15th edition P1739 _C_____57. Spasms of abdominal pain that are colicky are most likely due to a. peritonitis c. obstructed hollow viscus b. referred pain from the chest d. paralytic ileus Harisson15th edition P1803 _C_____58. Which of the following is present in the large bowel? a. intrinsic nerves of the intestines c. absorption of water b. extrinsic nerves of the intestines d. succus entericus Harisson15th edition P1763

_D_____59. Pneumoperitoneum is present when there is a. duodenal ulcer c. salpingitis b. gall bladder empyema d. ruptured bowel Harisson15th edition P1807 _A_____60. The following pathogens are causative agents of enteric infections. Which of the following has basent fecal leucocytes? a. Vibrio cholera c. Campylobacter jejuni b. diarrheogenic d. Shigella Harisson15th edition P909 _B_____61. Paralytic ileus is NOT pathologic in one of the following: a. ruptured appendicitis c. bile peritonitis b. soon after abdominal surgery d. hypokalemia Harisson15th edition P1803 _D_____62. A rise in BUN without renal disease, renal ischemia, obstruction is most likely to be due to a. severe liver disease c. hemolytic anemia b. eclampisa d. massive GI bleeding Harisson15th edition P1650 _B_____63. After major abdominal surgery there is a. gastric hyperacidity c. volvulus b. transient ileus d. reflux esophagitis Harisson15th edition P1495 _A_____64. For disorders in the GIT such as ulcers, diverticula, strictures, new growths and motility disorders the test that is most useful is a. x-ray c. MRI b. CT scan d. ultrasound Harisson15th edition P1752 _B_____65. Ascitic fluid in cirrhosis of the liver would be expected to show a. more than 1000 white cells/cubic c. hemorrhage mm. d. positive malignant cytology b. protein less than 2.5% Harisson15th edition P1838 _C_____66. Ruptured peptic ulcer with pneumoperitoneum is most easily and safely diagnosed by a. barium swallow c. plain x-ray of abdomen b. ultrasound d. paracentecis of the abdomen Harisson15th edition P1732 _A_____67. An upright firm of the abdomen shows free air in the peritoneum. This means a. perforated viscus c. volvulus b. diabetic acidosis d. hyperkalemia Harisson15th edition P1752

_B_____68. Colonoscopy compared to Ba enema as a diagnostic procedure for colorectal cancer has a. less cost c. greater chance of misdiagnosis b. greater chance of perforation d. less chance of hemorrhage Harisson15th edition P1737,529 _D_____69. In an upright scout film of the abdomen, a step-ladder appearance of the bowel indicates a. enterocolitis c. peritonitis b. volvulus d. bowel obstruction Harisson15th edition P1809 _B_____70. Which of the following esophageal disorders is best characterized by dysphagia for both solids and liquids? a. Schatzki’s rings c. benign esophageal stricture b. achalasia d. esophageal carcinoma Harisson15th edition P1791 _D_____71. The fungus that frequently invades the upper GIT and causes esophagitis is the a. Blastomyces c. Cryptococcus b. Aspergillus d. Candida Harisson15th edition P1186 _D_____72. Lower esophageal sphincter (LCS) dysfunction is not uncommon. Which of the following is useful in evaluation LES pressure? a. endoscopy c. Ba swallow b. acid reflex test d. esophageal manometry Harisson15th edition P223 _A_____73. Repeated severe epigastric pain 1 hour after heavy meals in a 40-year old obese female is usually due to a. gall stones c. peptic ulcer b. pancreatitis d. meteorism Harisson15th edition P1883 _B_____74. Stress ulcer that occurs with burns, brain tumors and shock present commonly as a. hematochezia c. severe abdominal pain b. melena d. intestinal obstruction Harisson15th edition P1760 _B_____75. In the classification of polyps of the colon, what is/are considered precancerous? a. lymphosarcomatous c. Peutz-Jegners syndrome b. all of these are correct d. adenomatous Harisson15th edition P1732 _D_____76. Most of the ammonia is formed in the a. small intestines c. kidneys b. lungs d. liver Harisson15th edition P1867

_B_____77. Albumin is a protein that is synthesized in the a. pancreas c. nephron b. liver d. lymphoid tissue Harisson15th edition P1813 _C_____78. The urea cycle converts a potentially toxic substance to a more innocuous substance. The toxic material is a. urea c. ammonia b. uric acid d. ornithine Harisson15th edition P2302 _D_____79. Ammonia is highly toxic. It is detoxified by its transformation in the liver into a. alpha-ketoglutarate c. methionine b. uric acid d. none of the above Harisson15th edition P1540 _D_____80. Ammonia is most toxic when a. the gut is sterile c. low serum Na+ b. serum K is high d. blood pH is high Harisson15th edition P2602 _C_____81. Which constitutes a major portion of the bile? a. cholesterol c. water b. bile salts d. bile acid Harisson15th edition P1880 _D_____82. The synthesis of bile salts takes place in the a. common bile duct c. pancreas b. duodenum d. none of the above Harisson15th edition P1880 _C_____83. Pruntus is most severe in jaundice due to a. portal dirrhosis c. biliary cirrhosis b. hepatic schistosomiasis d. amebis liver abscess Harisson15th edition P1860 _C_____84. A large liver is least expected in a. acute malaria c. chronic portal cirrhosis b. typhoid fever d. chronic heart failure Harisson15th edition P1858 _B_____85. Long-lasting marker of hepatitis B: a. anti-HBo c. anti-H b. HbsAg d. anti-HBe Harisson15th edition P1829 _B_____86. A patient with complete biliary obstruction developed bleeding tendencies. The diagnostic test of choice is a. fibrinogen blood level c. platelet count b. prothrombin time d. BUN Harisson15th edition P1816

_C_____87. An elevated serum SPGT is probably due to a. jaundice c. liver necrosis b. cholestasis d. bleeding varices Harisson15th edition P1815 _B_____88. Delta viral hepatitis can only occur together with a. hepatitis A c. leptospirosis b. hepatitis B d. hepatitis Harisson15th edition P1830 _A_____89. Which of the following drugs will be less potent in the presence of severe liver disease? a. phenytoin c. tetracycline b. imipramine d. lidocaine Harisson15th edition P1814 _D_____90. The most common benign neoplasm of the liver a. sarcoma c. adenoma b. focal nodular hyperplasia d. hemangioma Harisson15th edition P533 _B_____91. Most common primary tumor that spread/s to the liver is/are a. prostate c. melanoma b. gastrointestinal tumor d. bone Harisson15th edition P535 _D_____92. Pancreatic lipase preferentially splits triglycerides to form free fatty acids and a. delta-monoglycerides c. glycerol b. alpha-monoglycerides d. beta-monoglycerides Harisson15th edition P1792 _A_____93. The least symptomatic stones in the billiary tree are located in a. gallbladder c. cystic duct b. neck of the gall bladder d. common bile duct Harisson15th edition P1881 _B_____94. The following pancreatic enzymes are potentially harmful, EXCEPT: a. lipase c. lysolecithinase b. none of these d. elastase Harisson15th edition P1891 _C_____95. Blood level that does NOT rise in acute renal failure: a. creatinine c. sodium b. potassium d. uric acid Harisson15th edition P1650 _B_____96. Pain described as “renal colic” usually indicates a. kidney stone c. bladder stone b. ureteral stone d. pyelonephritis Harisson15th edition P1722

_A_____97. Which is acquired from infected water vapor or moist air inhaled? a. legionella c. pseudomonas b. mononucleosis d. typhus Harisson15th edition P871 _C_____98. Amylase is NOT elevated in one of the following diseases: a. choledocholithiasis c. penetrating peptic ulcer b. acute gastritis d. mumps Harisson15th edition P89,1817 _D_____99. Urobilinogen is produced in the a. renal tubules c. red blood cell b. liver d. intestinal mucosa Harisson15th edition P1871 _D_____100. Conjugation of bilirubin is a function of the a. Kupfer cells c. intestinal mucosa b. erythrocytes d. none of the above Harisson15th edition P1817

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REFERENCES: 1. 2. 3. 4.

Harrison’s: Principles of Internal Medicine Edition 2002 Braunwald, Fauci Edition 2002 National Medical Study in Medicine, 8th Edition Board Review Series in Medicine; 4th edition

ANSWERS: 1. 2. 3. 4. 5. 6.

b a d c b a

7. a 8. b 9. a 10. d 11. c 12. a 13. b 14. a

15. d 16. c 17. c 18. a 19. b 20. d 21. b 22. d

23. b 24. a 25. a 26. a 27. d 28. b 29. c 30. d 31. c 32. b 33. c 34. a 35. a 36. b 37. b 38. d 39. d 40. a 41. b 42. c 43. a 44. a 45. d 46. d 47. b 48. d 49. a 50. a 51. c 52. b 53. c 54. c 55. d 56. c 57. c 58. d 59. a 60. b 61. d 62. b 63. a 64. b 65. c 66. a 67. b 68. d 69. b 70. d 71. d 72. a 73. b 74. b 75. d 76. b 77. c 78. d 79. d 80. c 81. d 82. c

83. c 84. b 85. b 86. c 87. b 88. a 89. b 90. b 91. d 92. a 93. b 94. c 95. b 96. a 97. c 98. d 100. d