Internal Medicine

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MCU-FDT MEDICAL FOUNDATION College of Medicine

Department of Medicine

1. In the pathogenesis of fever, which of the following statements is NOT true? A. Shunting of blood from periphery to internal organs occur to conserve heat B. Presence of PGE2 in the brain elevates set point of body temperature C. Exogenous and endogenous pyrogens are destroyed by phagocytes D. Elevated cAMP induces the release of monoamine neurotransmitters 2. The sympathetic nervous system can increase heat conservation through:

A. Increased heart rate B. Vasoconstriction

C. Increased skeletal muscle contraction

D. Resetting of thermostat level at hypothalamus

3. Patients with fever may also complain of myalgia and/or arthralgia. These can be due to:

A. Increased muscular tone C. Effect of interferon B. Effect of peripheral PGE2 D. Effect of endotoxins

4. A 20 y/o male was brought to the ER due to muscle rigidity. He also manifest with hallucination, pupil dilation and increased temperature with dry skin. The above findings can be due to:

A. Amphetamine abuse C. Heat stroke B. Extrapyramidal symptoms D. Tetany

5. Increased heat production in cases of thyrotoxicosis can be secondary to:

A. Chemical reaction of basal metabolism C. Chemical thermogenesis B. Increased skeletal muscle tone D. Vasodilation

6. What component of the lipid profile is anti-atherogenic?

A. High density lipoprotein C. Total cholesterol B. Low density lipoprote.in D. Triglycerides

7. Which of the following manifestation is not a major criterion for rheumatic fever? A. Erythema multiforme C. Subcutaneous nodules

B. Migratory polyarthritis D. Sydenham’s chorea 8. A run of 3 consecutive premature ventricular depolarizations is known as:

A. Asystole C. Ventricular fibrillation

B. Supraventricular tachycardia D. Ventricular tachycardia 9. What is the most common type of atrial septal defect?

A. Membranous type C. Ostium secundum

B. Ostium primum D. Sinus venosus

10. What is the most common cause of secondary hypertension in the general population?

A. Cushing’s syndrome C. Primary aldosteronism B. Pheochromocytoma D. Renal diseases

11. Which of the following statements regarding cardiac symptoms is false? A. Chest discomfort and/or dyspnea that appear only during activity are characteristic of heart disease

B. Many patients with heart disease may be asymptomatic

C. Patients with valvular stenosis may manifest heart failure symptoms

D. It is rare for asymptomatic cardiac patients to develop sudden death, acute myocardial infarction or stroke

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12. Which of the following best characterize the second heart sound?

A. During inspiration, there’s and increase blood flow to the left ventricle casing a delay in aortic valve closure

B. Wide splitting of the second heart sound may be due to right bundle branch block

C. In pulmonary hypertension the second heart sound is soft

D. P2 is normally louder than A2 in the second left intercostal space (p. 1307-1308)

13. Valvular abnormalities and chamber dilatation are best diagnosed by: A. Electrocardiogram C. Echocardiography

B. Treadmill exercise testing D. Nuclear imaging techniques (p. 1320)

14. The electrocardiogram of a patient who is hypertensive for almost 5 years would show which of the following?

A. Tall left precordial R waves and deep right precordial S waves B. Diminished voltages in the limb leads (aVL or aVR)

C. Right atrial abnormality absence of repolarization abnormalities (ST depression and T-wave inversions)

(p. 1314)

15. Which is not a component of the metabolic syndrome? A. Waist circumference of >40 inches in men

B. Triglycerides >150 mg/dL C. LDL > 40 mg/dL

D. Blood pressure >130/>85 mmHg (p. 1432)

16. A patient who shows on auscultation with an accentuated first heart sound, opening snap and a mid-diastolic rumbling murmur at the apex is suffering from:

A. Mitral regurgitation C. Aortic regurgitation B. Mitral stenosis D. Aortic stenosis (p. 1390-1391)

17. The most common etiology for secondary hypertension is:

A. Renal parenchymal hypertension C. Primary aldosteronism B. Renovascular hypertension D. Pheochromocytoma (p. 1464)

18. Liebman-Sacks lesion which is a small verrucous vegetation usually found in the ventricular surface of the mitral valve is associated with this disease:

A. Rheumatoid arthritis C. Rheumatic Heart Disease

B. SLE D. Rheumatomyositis

19. Spironolactone is the drug of choice in the medical treatment of hypertension o which of the following diseases?

A. Essential hypertension C. Phrochromocytone B. Renal artery stenosis D. Hyperaldosteronism 20. Saw tooth appearance of EKG tracing is diagnostic of:

A. Ventricular tachycardia C. Atrial flutter B. Ventricular fibrillation D. Atrial fibrillation 21. MVP has the following features EXCEPT:

A. More common in males

B. Most common course of isolated severe MR in North America C. May cause syncope

D. Mid to late systolic click is the most important finding

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22. Which of the following is a major criterion in the Framingham Criteria for the diagnosis of CHF?

A. Tachycardia C. Cardiomegaly

B. Dyspnea or exertion D. Extremity edema

Reference: Harrison’s Principles of Internal Medicine 15th_{ed. pp. 1323}

23. The most common primary cardiac tumor is:

A. Rhabdomyoma C. Lymphoma

B. Myxoma D. Sarcoma

24. An effective drug for meningococcal chemoprophylaxis:

A. Cefotaxime C. Chloramphenicol

B. Ceftriaxone D. Ceftizoxime

(See p.854, 16th_{ed. of Harrison’s)}

25. The etiologic agent of chancroid is:

A. Treponema pallidum C. Haemophilus ducreyl B. Calymmatobacterium granulomatis D. Neisseria gonorrhea (See p.771 Ulcerative Genital Lesions, 16th ed. Harrison’s) 26. Pyomyositis is usually due to:

A. Group A Streptococcus C. Staphylococcus aureus B. Streptococcus pyogenes D. Clostridium perfringens (See p.744 Myositis/Myonecrosis, 16th_{ed. Harrison’s)}

27. Cytoplasmic inclusion bodies found in certain neurons in the brain, and are diagnostic of rabies:

A. Negri bodies C. Schuffner’s dots

B. Owl’s eye bodies D. James stipplings (See p.1157 Pathogenesis of Rabies, 16th_{ed. Harrison’s)}

28. Most vaccine for adults can be given also to pregnant women EXCEPT: A. Tetanus, diphtheria C. MMR, Varicelia

B. Pneumococcal, influenza D. Rabies, Hepatitis B

(See p.720 Use of Vaccines in Special Circumstances, 16th_{ed. Harrison’s)}

29. The single most important diagnostic test to request for a patient with clinical signs and symptoms suggestive of PTB is:

A. CXR C. TB culture

B. PCR D. Direct microscopy

(Sep.960 AFB microscopy, 16th_{ed. Harrison’s)}

30. Urethritis can be documented on the basis of: A. Mucopurulent or purulent discharge

B. Gram stain or urethral secretion > 5 wbcs/hpf C. First void urine demonstrating > 10 wbcs/hpf D. Either A or C

(See p.764 Approach to patient with suspected urethritis, 16th_{ed. Harrison’s.}

Letter B may be correct but remember that the gram stain is read per oil immersion field)

31. Among the available test for Leptospirosis, the most sensitive and specific is: A. Culture with EMJH

B. ELISA for antibodies

C. MAT using genus specific antigen for Leptospira patoc D. Dipstick assay

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32. The following are true of malaria EXCEPT:

A. Hypoglycemia in falciparum malaria is associated with poor prognosis B. Splenic enlargement in endemic areas reflects repeated infection

C. In severe malaria, one predicter of poor prognosis is the predominanceof immature P. falciparum parasites

D. The thick malarial smear has the advantage over the thin smear of concentrating parasites, thus increasing diagnostic sensitivity (See Table 195-3 p.1222, 16th_{ed. Harrison’s)}

33. True of Staphylococcal infections EXCEPT:

A. Toxic Shock Syndrome is a life threatening condition caused by toxins elaborated by S-aureus

B. Nikolsky’s sign is a feature of TSS

C. In Ritter’s disease, the skin often has a sandpaper-like texture and is tender D. Staphylococcal pneumonia most commonly follows tracheal intubation of a hospitalized patient or vital infection of the respiratory tract.

(See p.819 Staphylococcal Scalded Skin Syndrome, 16th_{ed. Harrison’s)}

34. The following are infection control measures EXCEPT:

A. Irrigation of urinary catheters, with or without antimicrobials, may actually increase infection risk

B. Replacing tubing circuits at intervals > 48 hours is one effective measure in the aseptic care of respirator equipment

C. A control measure for surgical wound infection, aside from OR asepsis, antimicrobial prophylaxis for high risk procedures

D. The recommended frequency of rotation of central venous catheter sites is 5 days

(See p.778 every 72 to 96 hours, infections related to vascular access and monitoring, 16th_{ed. Harrison’s)}

35. Characteristics of the itch mite include the following: A. It is an oval, ventrally flattened mite

B. It can live on beddings for 7 days C. The female dies after copulation D. The female lays 20 eggs per day

Andrews’ Diseases of the skin, 9th_{ed. p. 564-565}

36. Infantile atopic dermatitis is characterized by the following: A. Lesions are less exudative, drier and more papular B. The buttocks and diaper area are often involved C. Lesions are lichenified plaques

D. The face and scalp are more often involved Andrews’ Diseases of the skin, 9th_{ed. p. 70}

37. The main substance causing vasodilation in urticaria is:

A. Serotonin C. Bradykinin

B. Histamine D. Prostaglandins

Andrews’ Diseases of the skin, 9th_{ed. p. 163}

38. Gutate psoriasis is usually preceded by:

A. Trauma C. Streptococcal pharyngitis

B. Hepatitis D. Viral exanthem

Andrews’ Diseases of the skin, 9th_{ed. p. 221}

39. An infectious disease transmitted by the body louse is:

A. Trench fever C. Tsutsugamushi fever

B. Dengue fever D. Scrub typhus

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40. Hormone implicated in the pathogenesis of androgenetic alopecia.

A. Estrogen C. Testosterone

B. Cortisol D. Growth hormone

41. The 4 cutaneous findings of 11 criteria for diagnosis of SLE are: A. Malar erythema, urticaria, photosensitivity and discoid LE B. Malar erythema, photosensitivity, discoid LE, oral ulcers C. Malar erythema, photosensitivity, skin erosion, oral ulcers D. None of the above

42. The prothrombotic effect of coumarin (warfarin) during the early phases of its administration is due to a rapid drop in the plasma concentration of:

A. Antithrombin C. Factor VII

B. Protein C D. Plasminogen

43. A 55-year old woman with Grave’s disease developed pallor and scleral jaundice. Her peripheral blood showed pancytopenia, presence of macro-ovalocytes and hypersegmented neutrophils. What is the most likely diagnosis?

A. Megaloblastic anemia C. Aplastic anemia

B. Myelodysplastic syndrome D. Paroxysmal nocturnal hemoglobinuria 44. A 55-year old man previously diagnosed to have stage 0 CLL developed anemia and unconjugated hyperbilirubinemia. What is the single most important

laboratory test required to diagnose the cause of the anemia?

A. A repeat bone marrow examination C. Serum ferritin determination B. Coomb’s test D. Serum folate and vitamin B12

determination

45. A 24-year old female suddenly developed jaundice, confusion, petechiae, and fever. Peripheral blood examination showed anemia and thrombocytopenia. Fragmented red cells were seen with nucleated red blood cells. Prothrombin and partial thromboplastin time were normal. What is the treatment of choice for this patient?

A. Plasmapharesis C. Pulse therapy with cyclophosphamide B. High dose glucocorticoids D. Splenectomy

46. The treatment of choice in patients with acute promyelocytic leukemia. A. Anthracycline + cytosine arabinoside

B. Vincristine + prednisone

C. All-transretinoic acid (ATRA) + anthracycline D. Melphalan + prednisone

47. A 36-year old male was refereed to an internist after a routine blood examination showed a low mean cell volume (MCV) but with no evidence of anemia. Stool is negative for occult blood nor was there exposure to lead. Serum ferritin is normal. What is the most likely diagnosis?

A. Early iron deficiency anemia C. Thalassemia minor B. Anemia of chronic disease D. Sideroblastic anemia

48. A 32-year old male had excessive bleeding after a dental extraction. He has no other medical problems and physical examination is unremarkable. His mother has history of excessive bleeding. Bleeding time and PTT was prolong twice the normal range but the prothrombin time is normal. What is the most likely

diagnosis?

A. Hemophilia A C. Factor XII deficiency B. Hemophilia B D. von Willebrand’s disease

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49. A 64-year old woman for preoperative evaluation was noted to have a markedly prolong PTT. Her prothrombin time, platelet count, and bleeding time were

normal. She required blood transfusion blood transfusion after a dental extraction 2 years ago. Two siblings male and female has history of bleeding. The most likely diagnosis is a deficiency of:

A. Factor VII C. Factor XI

B. Factor VIII D. Factor XII

50. An 18-year old male develops massive bleeding after removal of a large

sebaceous cysts. Prothrombin time, PTT, platelet count, and bleeding time were normal. There is no family history of bleeding time. Which of the following tests should be ordered?

A. Factor XI level C. Urea clot lysis test

B. Factor XII level D. Platelet aggregation study

51. A 59 year old, female, known hypertensive for 5 years, with poor compliance to anti-hypertensive medications, now complains of pallor, easy fatigue, anorexia, and itchiness. The kidneys on ultrasound appear contracted. Which casts will you find in the urinalysis in this condition?

A. RBC casts C. Broad casts

B. WBC casts D. Hyaline casts

Harrison 16th_{ed. pp. 251}

52. The leading cause of end stage kidney disease is:

A. Chronic glomerulonephritis C. Polycystic kidney disease B. Diabetic nephropathy D. Chronic pyelonephritis Harrison 16th_{ed. pp. 1688}

53. A 40 year old, male, known diabetic for 8 years is noted to have +1 proteinuria. The best medication at this time is:

A. Glibenclamide C. Rosiglitazone

B. Insulin D. Captopril

54. A 25 year old, female, developed anasarca over 2 months period. Her urinalysis showed RBC and RBC casts. Kidney biopsy revealed membranous

glomerulonephritis. This condition is most likely to be associated with: A. Hepatitis B infection C. Diabetes mellitus B. Hypertension D. Periarteritis nodosa Harrison 16th_{ed. pp. 1687}

55. A 44 year old, male, operated twice for kidney stones has an estimated creatinine clearance of 40 ml/min. At what stage of renal failure is he in now?

A. Stage 1 C. Stage 3

B. Stage 2 D. Stage 4

56. Dietary protein is restricted in which of these kidney conditions: A. Acute Pyelonephritis C. Renal failure

B. Polycystic kidney disease D. Chronic glomerulonephritis Harrison 16th_{ed. pp. 1652}

57. A 25 year old, male, was admitted because of multiple gunshot wounds. On admission, he was hypotensive and tachycardic. He was immediately scheduled for exploratory laparotomy which lasted for about 4 hours. A total of 6 units of blood were transfused. He was oliguric and acidotic, for the next 7 days. At what phase of acute renal failure is he in?

A. Initiation phase C. Diuretic phase B. Maintenance phase D. Recovery phase Harrison 16th_{ed. pp. 1645}

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58. A 10 year old, boy, has puffy eyelids, tea-colored urine, and BP of 130 / 100, noted after 2 weeks bout of sore throat and fever. The clinical diagnosis is nephrotic syndrome. The condition that would initiate all the subsequent components of the syndrome is:

A. Hypoproteinemia C. Lipiduria

B. Glomerular proteinuria D. Edema Harrisson 16th_{ed. pp. 1684}

59. A 44 year old, male, was admitted to Philippine Hear Center because of severe chest pain. Initial findings indicate acute myocardial infarction. Within few minutes after admission, he developed transient arrhythmia and drop in BP. The serum creatinine went up from 0.9 mg% on admission to 1.3 mg% after 2 days. The urine output was about 250-300 /day. These findings can be explained on the basis of:

A. Intratubular block by debris C. Back leak of glomerular filtrate B. Renal hypoperfusion D. Nephrotoxicity from drugs Harrison 16th_{ed. pp. 1645}

60. A 33 year old, female, is suffering from SLE for the last 5 years. A year ago, proteinuria and hematuria were noted in her urinalysis. And subsequently her serum creatinine slowly deteriorated. The progression of her renal failure is due to:

A. Nephrotoxicity C. Renal hypoperfusion B. Reduction in renal mass D. Interstitial nephritis Harrison 16th_{ed. pp. 1653}

61. One of the following is not a classification criteria in the diagnosis of Rheumatoid arthritis:

A. Morning stiffness less than 1 hour

B. Radiographic change like erosion or decalcification of wrist bone C. Serum rheumatoid factor positivity

D. Symmetric arthritis

62. One of the following statements is not true with regards to the epidemiology of SLE:

A. Common in women of child bearing age B. Males are spared

C. More common in blacks than in white

D. Prevalence is form 15 to 50/100,000 population

Aling Nena, 75-years old, female, 5’2 ft tall, 100 lbs. Consulted because of pain in the (R) knee for a year; which is worst in the afternoon and after a long walk and improves with rest. On P.E. as bony hypertrophy and worse crepitation.

63. The pain she is experiencing maybe due to any of the following EXCEPT: A. Ligament insertion strain C. Muscle pain

B. Cartilage destruction D. Capsular stretching

Reference: Harrison’s Principles of Internal Medicine 14th_{ed. pp. 1936-1937}

64. One of the following statement about TB arthritis is true:

A. Culture of M. tuberculosis from the synovial biopsy is positive in 90% of cases B. Joint destruction is rapid

C. Polyarticular involvement is more common

D. Treatment includes administration of Nafcillin and gentamycin Reference: Harrison’s Principles of Internal Medicine 14th_{ed. pp. 1947}

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65. A 23-years old female patient consulted because of on and off pains, malar rash, oral ulcers and increasing hairloss. A probable diagnosis of SLE was made confirmed by:

A. High ESR and (+) CRP

B. High titer dsDNA and hypocomplementemia C. Leucopenia and anemia

D. Thrombocytosis

Carla, 18-years old student is being treated for pneumonia. On the 4th_{day of}

hospitalization she noted swelling, redness and severe pain of the (L) knee. Aspiration of the knee revealed whitish, purulent fluid consistent with septic arthritis.

66. The laboratory test you would request for the condition is:

A. Liver function test C. Culture and sensitivity of fluid

B. Urinalysis D. ANA

67. The probability of a CPPD disease will reveal crystals appearing as: A. Highly birefringent, large flat

B. Negatively birefringent, needle shape C. Positively birefringent, rod shaped D. Spheroidal aggregation

68. The pain in osteoarthritis arise from the following structure EXCEPT: A. Articular cartilage

B. Stretching of joint capsule

C. Stretching of periosteum covering osteophytes D. Synovitis

69. One of the following is not a classification criteria in the diagnosis of Rheumatoid arthritis:

A. Morning stiffness less than 1 hour

B. Radiographic change like erosion or decalcification of wrist bone C. Serum rheumatoid factor positivity

D. Symmetric arthritis

70. One of the following statements is not true with regards to the epidemiology of SLE:

A. Common in women of child bearing age B. Males are spared

C. More common in blacks than in white

D. Prevalence is form 15 to 50/100,000 population

Aling Nena, 75-years old, female, 5’2 ft tall, 100 lbs. Consulted because of pain in the (R) knee for a year; which is worst in the afternoon and after a long walk and improves with rest. On P.E. as bony hypertrophy and worse crepitation.

71. The pain she is experiencing maybe due to any of the following EXCEPT: A. Ligament insertion strain C. Muscle pain

B. Cartilage destruction D. Capsular stretching

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72. One of the following statement about TB arthritis is true:

A. Culture of M. tuberculosis from the synovial biopsy is positive in 90% of cases B. Joint destruction is rapid

C. Polyarticular involvement is more common

D. Treatment includes administration of Nafcillin and gentamycin Reference: Harrison’s Principles of Internal Medicine 14th_{ed. pp. 1947}

73. A 23-years old female patient consulted because of on and off pains, malar rash, oral ulcers and increasing hairloss. A probable diagnosis of SLE was made confirmed by:

A. High ESR and (+) CRP

B. High titer dsDNA and hypocomplementemia C. Leucopenia and anemia

D. Thrombocytosis

74. The recommended screening test for DM is:

A. FPC C. RBS

B. 2-hr OGTT D. HbAic

75. All of the following symptoms are consistent with hypothyroidism EXCEPT:

A. Constipation C. Heat intolerance

B. Menorrhagia D. Hoarse voice

76. The most specific feature of cushings syndrome is: A. Centripetal obesity C. Hirsutism

B. Weight gain D. Hypertension

77. All of the following chronic diabetic complications are microvascular in nature EXCEPT:

A. Retinopathy C. Nephropathy

B. Neuropathy D. Peripheral vascular disease

78. The following statements are true regarding the pathophysiologic abnormalities of type 2 DM EXCEPT:

A. It is characterized by autoimmune destruction of the beta cells B. There is impaired insulin secretion

C. Peripheral insulin resistance may be present D. There is excessive hepatic glucose production

79. The combination of insulin deficiency and hyperglycemia would result to the following biochemical abnormalities EXCEPT:

A. Reduces the hepatic level of fructose 2-6 phosphate B. Decreases the activity of pyruvate kinase

C. Promotes the process of glycogenolysis

D. Increases the levels of the GLUT4 glucose transporter

80. The major effects of cortisol on body water are as follows EXCEPT: A. Retards the migration of water into cells

B. Promotes renal water excretion C. Stimulates vasopression secretions

D. Increases urine potassium excretion at high doses

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81. Choose the correct pair of tumor marker and cancer implicated: A. Alphafetoprotein – colon cancer

B. CA-125 - ovarian cancer

C. Lactate dehydrogenase – myeloma

D. Carcinoembryonic antigen – hepatocellular carcinoma Harrison’s Internal of Medicine, 16th_{ed. 439}

82. The leading cause of cancer death in both men and women.

A. Lymphoma C. Lung CA

B. Nasopharyngeal CA D. Large cell CA Harrison’s Internal of Medicine, 16th_{ed. 436, 506}

83. The most common histologic subtype of lung cancer for the past 25 years. A. Squamous or Epidermoid C. Small cell CA

B. Adenocarcinoma D. Large cell CA

Harrison’s Internal of Medicine, 16th_{ed. 506}

84. Usually, these types of lung cancer have already spread at the time of

presentation and diagnosis, hence, surgery is unlikely to be curative. They are managed primarily by chemotherapy with or without radiotherapy.

A. Squamous or Epidermoid C. Small cell CA

B. Adenocarcinoma D. Large cell CA

CASE: Leo Garcia, 68-year old male came in to your clinic because of urgency, hesitancy and bloody urine: (Questions 167-169).

85. Prostate cancer is highly entertained, and the first screening modality that you will perform is:

A. Digital rectal exam

B. Assay for serum PSA (prostate specific antigen) C. Ultrasound of bladder/prostate

D. Transrectal ultrasound guided biopsy Harrison’s Internal of Medicine, 16th_{ed. 446}

86. Examinations revealed prostate cancer. The most common site for its metastasis:

A. Lungs C. Colon

B. Liver D. Bone

Harrison’s Internal of Medicine, 16th_ed.

87. Deregulation of molecular mechanics controlling cell cycle progression is a

hallmark of cancer. Which phase of the cell cycle is critical in the regulation of cell proliferation.

A. M C. S

B. G1 D. G2

88. Certain human malignancies are associated with viruses. Correct examples are the following, EXCEPT:

A. Burkitt’s Lymphoma – Epstein Barr virus B. Cervical cancer – Human Papilloma virus C. Hepatocellular carcinoma – Hepatitis B virus D. Colon cancer – Helicobacter pylori

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89. A woman with the following characteristics, has a greater risk of developing breast cancer:

A. Menarche at 12 y/o, Primigravida at 18, menopause at 45 B. Menarche at 12 y/o, Nulligravida, menopause at 52

C. Menarche at 12 y/o, Multigravida, menopause at 45

D. Menarche at 16 y/o, Primigravida at 25, surgical menopause at 40 because of TAHBSO

90. Tumor lysis syndrome is an oncologic emergency which may present as acute renal failure. This is due to destruction of a large number of neoplastic cells during chemotherapy. It is characterized by the following, EXCEPT:

A. Hyperuricemia C. Hypercalcemia

B. Hyperphosphatemia D. Hyperkalemia Harrison’s Internal of Medicine, 16th_{ed. 581}

CASE

A 55-year old male, farmer from Pampanga came to the ER because of difficulty of breathing. Present condition started 2 weeks prior to consult as cough productive of opious grayish yellow sputum accompanied by moderate grade fever body malaise and lost of apetite. Condition progressed despite over the counter antitussive medication, until 1 day PTC he started to have difficulty of breathing.

PH-smoker 1 pack of cigarette/day since age of 25 … no other serious illness in the past. Pertinent P. E. Findings: RR – 28/min.

Chest: Symmetrical expansion: resonance of percussion, crackles on the left midlung to base posteriorly with bilateral forced on expiration.

91. What disease conditions would you entertain?

A. Chronic bronchitis (COPD) C. Pneumonia

B. Mycosis D. All of the above

92. What diagnostic laboratory examination would you request for?

A. Chest x-ray C. CBC

B. Sputum gram stain, culture and sensitivity D. All of the above 93. How would you start your management?

A. O2 inhalation C. Nebulization

B. IV antibiotic D. All of the above

94. If arterial blood gas examination showed – ph7.33, pCO2-50 mmHg, pCO2 of 75

mmHg and HCO3 of 28 mEq/L. What would be your interpretation?

A. Respiratory acidosis with hypoxemia B. Respiratory alkalosis with hypoxemia C. Respirator and metabolic acidosis D. Adequate Oxygenation

95. What further laboratory examination would you add aside from above examinations?

A. PFT C. ECG

B. Sputum for fungus D. A and B

96 - 100. A 60-year old male, 30-pack year smoker came in due to chronic cough and mild exertional dyspnea for 3 years. He self medicated with mucolytic but afforded no relief. On PE occasional wheezes and rhonchi were noted. 96. What is the most likely diagnosis:

A. Pulmonary Tuberculosis C. Chronic Obstructive Pulmonary Disease B. Bronchial Asthma D. Pneumonia

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97. What laboratory examination will you request to confirm the diagnosis:

A. Chest x-ray C. Chest CT scan

B. Sputum examination D. Spirometry 98. The mainstay in the treatment of this patient:

A. Inhaled bronchodilator C. Methylxanthines B. Inhaled corticosteroids D. Antibiotics 99. A feature that best characterize chronic bronchitis.

A. Elastic recoil is severely decreased B. Airway resistance is normal

C. Pulmonary hypertension moderate to severe at rest D. Diffusing capacity is decreased

100. The most common mechanism of hypoxemia: A. Decrease in inspired PO2 C. Shunt

B. Hypoventilation D. V/Q mismatching

101. A 40 year old male complains of chest pain, characterized by burning retrosternal discomfort that radiates to the neck and angles of the jaw. It is aggravated by bending forward, straining and lying recumbent and is worse after meals.This classic symptom is called:

A. Heartburn C. Regurgitation

B. Angina D. Water Brash

p.1588

102. Your clinical impression for this Patient is:

A. Acute myocardial infarction C. Gastric Ulcer

B. Gastroeophageal Reflux Disease D. Esophageal Carcinoma p. 1592

103. The pathophysiology of this disease is: A. Spasm of the coronary artery

B. Increase acid secretion in the stomach

C. Decrease in the tone of the lower esophageal sphincter due to muscle weakness

D. Exposure to carcinogens p. 1592

104. The drug of choice for this patient is:

A. Nitrates C. Calcium channel blockers

B. Antacids D. Protom pump inhibitors

p. 1593

105. A 70 year old male with chronic constipation presented with sudden onset left lower quadrant abdominal pain and high grade fever. Physical examination showed direct and rebound tenderness at the left lower quadrant. Your clinical diagnosis is:

A. Sigmoid Diverticulits C. Irritable Bowel Syndrome

B. Acute Appendicitis D. Colon Cancer

p. 1649

106. Mark, a 7 yr old boy was passing by McDonald’s and smelled the aroma of

hamburgers. At this instant, acid secretion took place in his stomach. Which phase of acid secretion was responsible for the acid secretion?

A. Cephalic C. Intestinal

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107. While Mark was eating his hamburger, the food in his stomach stimulated further acid secretion. Which of the following substances is responsible for the increased acid secretion?

A. Histamine C. Somatostatin

B. Gastrin D. Acetylcholine

C.

108. Mark grew up to become an executive of a leading company. Because of the stresses of his job, he developed Duodenal Ulcers. The ulcers of Mark will be found:

A. 3cm from the pyloric opening C. 2nd_{portion of the duodenum}

B. 10cm from the duodenal bulb D. 3rd_{potion of the duodenum}

109. Mark consulted his physician at MCU because of his Duodenal ulcer. The physician examined Mark and found that Mark had a succussion splash. This finding indicates that Mark had this DU complication.

A. Perforation C. Gastric outlet obstruction

B. Penetration D. Hemorrhage

110. Which of the following items below is a function of the pre-epithelial level of defense to prevent mucosal damage?

A. The mucus gel functions as a unstirred water layer impeding diffusion of ions and molecules including pepsin.

B. The surface epithelial cells act as ionic transporters that maintain intracellular pH and bicarbonate production

C. Gastric epithelial cells bordering an injury migrate to restore a damage region

D. Epithelial cell renewal occurs and together with angiogenesis preserve integrity of the gastric tissues