MEDICINE 1st LE
1. A positive Auspitz sign is pathognomonic for which of the following scaling disorders:
a. Psoriasis vulgaris b. Ichthyosis vulgaris c. Pityriasis rosea d. Tinea versicolor
2. A herald patch is the initial lesion seen in: a. Psoriasis vulgaris
b. Pityriasis rosea c. Ichthyosis vulgaris d. Tinea versicolor
3. Pemphigus vulgaris, an autoimmune blistering disease presents with flaccid bullae which easily ruptures. This level of split of the bullae is:
a. Subepidermal b. Intradermal c. Subcorneal d. Subcutaneous
4. A 35 year old female is diagnosed to have Stevens-Johnson Syndrome secondary to intake of anticonvulsant. What type of lesion should you look for?
a. Discoid lesion b. Purpura c. Target lesion
d. AOTA (all of the above) are correct
5. A 65 year old male consults because of a deep ulcer on the medial malleoli area. The diagnosis is:
a. Arterial ulcer b. Neurotropic ulcer c. Venous ulcer d. Decubitus ulcer
6. A scar which spreads beyond the initial injury is: a. Hypertropic scar
b. Keloid c. Both A and B d. Neither A nor B
7. Scarring alopecia may be one of the dermatologic presentation of
a. SLE b. Syphilis c. Both A and B d. Neither A nor B 8. Alopecia in SLE is caused by:
a. Telogen effluvium b. Anagen effluvium
c. Autoimmune damage to the hair follicle d. AOTA
9. A 25 year old male presents with multiple patches with fine scaling at the periphery on the trunk. Your diagnosis is Pityriasis rosea. Further PE revealed similar lesions on the palms and soles. You will now suspect that the patient has:
a. Scabies b. Follicultits
c. Secondary syphilis d. Psoriasis
10. The most common pattern in cutaneous drug eruption is a. Urticarial
b. Pustular c. Exanthematous d. Blistering
11. Acute eczema generally presents as a. Scales or crusting b. Hyperpigmentation c. Lichenification d. Vesicles
12. A 19 year old nursing student consults for recurrent very pruritic deep-seated tapioca-like vesicles on the sides of the fingers affecting both hands. Appropriate management include
a. Mupirocin ointment b. Ketoconnazole cream c. Zinc oxide cream d. Clobetasol ointment
13. Koebner’s phenomenon is seen in which of the following conditions?
a. Psoriasis vulgaris b. Seborrheic dermatitis c. Allergic contact dermatitis d. Stasis dermatitis
14. Seborrheic dermatitis characteristically occurs on the a. Flexural areas in children, extensor areas in adults b. Scalp, nasolabial sulci, eyebrows, chest, back c. Sides of fingers and toes
d. Elbows, knees, palms and soles
15. A 56 year old consulted because of multiple pruritic, closely grouped erythemaatous vesicles and papules that coalesce into coin-shaped plaques topped with crusts, on both lower extremeties. Your most likely diagnosis is:
a. Impetigo
b. Nummular eczema c. Folliculitis
d. Tinea corporis
16. Satellite lesions are seen in which of the following conditions? a. Tinea corporis
b. Pityriasis versicolor c. Onychomycosis d. Candidal intertrigo
17. Which of the following infections can be highly inflammatory and is very common in children?
a. Pityriasis versicolor b. Tinea pedis c. Kerion
d. Candidal intertrigo
18. A dull green fluorescence on Wood’s light examination can indicate infection with
a. Trichophyton schoenleinii b. Microsporum canis
c. Microsporum audouinii d. Malassezia furfur
19. The best area to obtain a high yield in KOH preparation of a tinea corporis lesion is in
a. The center of the lesion
b. The advancing border of the lesion c. A satellite lesion
d. The dermis of skin biopsy specimens 20. Dermatophytes are fungi that
a. Live in the superficial keratinized areas of the skin, hair and nails
b. Cause inapparent systemic infections c. Require complex media for growth d. Invariably invade the subcutaneous tissue 21. The characteristic lesion seen in scabies is the
a. Crust b. Burrow c. Nodule d. Excoriation 22. Scabies classically causes
a. Daytime itch
b. Itch anytime of the day
c. Itch on the extensor areas of the body d. Nocturnal itch
23. Cold sores are usually caused by a. Herpes simplex virus 1 b. Herpes simplex virus 2 c. Human papilloma virus d. Pox virus
24. Genital herpes is usually caused by a. Herpes simplex virus 1 b. Herpes simplex virus 2 c. Human papilloma virus d. Pox virus
25. Bullous impetigo is usually caused by a. Staph aureus
b. Group B Streptococcus c. Pseudomonas
d. Corynebacterium m. 26. Hot tub folliculitis is usually caused by
a. Staph aureus b. Grp B Streptococcus c. Pseudomonas
d. Corynebacterium m. 27. Erythrasma is usually caused by
a. Staph aureus b. Grp B Streptococcus c. Pseudomonas d. Corynebacterium m. 28. Molluscum contagiosum is caused by
a. Herpes simplex virus 1 b. Herpes simplex virus 2 c. Human papilloma virus d. Pox virus
29. Type wart with malignant potential a. Flat wart
b. Common wart c. Genital wart d. Subungal wart
30. A simple lab test to support the diagnosis of Herpes Simplex infection is
a. KOH stain
b. Polymerase reaction test c. Tzanck smear
d. Gram stain
31. Which of the following organism produces diarrhea by producing toxins?
a. Bacillus cereus b. Rotavirus c. Giardia
d. Clostridium difficile
32. Which of the following is an indicator for further work up in a patient with diarrhea?
a. Duration >24 hours with improvement of symptoms b. Elderly >70 years old
c. Patients with low grade fever d. Watery, mucoid stools
33. Antibiotic prophylaxis is recommended for the following patients travelling to high risk countries
a. Elderly
b. Patients with mechanical heart valves c. Patients with gastric achlorhydria d. Patients with recent vascular graft
34. A 55 year old male with diabetes was admitted because of respiratory tract infection. A few days after antibiotics was started, patient developed abdominal pain, with fever, vomiting and bloody diarrhea. Most probable cause of the patient’s bloody diarrhea is
a. Salmonella typhi b. Shigella sp
c. Clostridium difficile d. E. histolytica
35. Diagnostic test that would confirm the diagnosis of the above patient would be
a. Blood culture b. Stool exam
c. C. difficile toxin assay d. Colonoscopy
36. Treatment for the above patient would be a. Ciprofloxacin
b. Ceftriaxone c. Amoxicillin d. Metronidazole
37. A 35 year old missionary from Australia developed abdominal pain with 2-3 episodes of bloody diarrhea for 2 days after arrival to the Philippines. Patient has no signs of dehydration on examination. Most likely etiology of patient’s symptoms is
a. Rotavirus b. Escherichia coli c. Entamoebal coli d. Helminthes
38. Aside from hydration, management for the above patient would include
a. Viral culture b. Antibiotics
c. Admit patient for observation d. Urgent colonoscopy
39. A 20 year old male patient developed diarrhea occurring >10x per day amounting to >1L/episode. Stools were characterized as rice-water appearance. Most likely etiology of diarrhea is
a. Vibrio cholera b. Salmonella infection c. Entamoeba histolytica d. Bacillus cereus
40. A 30 year old businessman developed watery stools, <6x/day, with low grade fever and mild abdominal pain of 3 days duration. No signs of dehydration noted. Most likely etiology of diarrhea is
a. Rotavirus b. Shigella infection c. Entamoeba histolytica d. EHEC
41. This type of intraabdominal infection arises from the alimentary tract and contaminates the peritoneum is
a. Primary b. Secondary c. Tertiary d. Mixed
42. Organisms that may cause tertiary peritonitis a. Candida
b. Streptococci
c. Obligate anaerobic bacteria d. Coagulase positive staphylococci
43. By epidemiology, most common cause of community acquired intraabdominal infection is
a. Enterococci b. E. coli c. Enterobacter d. S. aureus
44. Diagnostic test of choice for secondary peritonitis a. History and PE
b. Blood cultures c. Radiologic tests d. Diagnostic laparotomy
45. The simple diagnostic test can assess the presence of free gas in the peritoneum and bowel obstruction
a. CT scan b. Ultrasound c. Abdomninal Xray d. MRI
46. The following risk factor increases the risk of patients in developing IAI
a. Low APACHE II score b. High albumin
c. Patients on immunosuppression d. Controlled hypertension
47. Antimicrobials that may be used for high risk patients a. Piperacillin/tazobactam alone
b. Ciprofloxacin alone c. 3rd gen cephalosporin alone d. Metronidazole alone
48. Patients with spontaneous bacterial peritonitis secondary to alcoholic cirrhosis is classified as
a. Primary peritonitis b. Secondary peritonitis c. Tertiary peritonitis d. Nosocomial infection
49. This affordable diagnostic test is useful for identifying abdominal fluid collections but is operator dependent
a. CT scan b. Ultrasound c. MRI
d. Abdominal Xray
50. Which of the following is true for hospital associated/acquired IAI?
a. Bacteria are more sensitive to antimicrobials b. Organisms seen are similar to community acquired
IAI
c. Gram stain is of no value
d. Treatment should be based on knowledge of local nosocomial flora
51. The safest and most cost-effective antibiotic in treating pregnant patients with acute cystitis is
a. Cotrimoxazole b. Nitrofurantoin c. Co-amoxyclav d. Doxycycline
52. For patients with beta-lactam allergy, which of the following antibiotics could be used as an alternative option in treating Listeria bacteremia
a. Clindamycin b. Aztreonam c. Cotrimoxazole d. Chloramphenicol
53. An important side effect of cotrimoxazole that limits its use a. Hypoprothrombinemia
b. Steven-Johnson syndrome c. Aplastic anemia
d. Hepatotoxicity
54. A good quality sputum specimen is documented by microscopy if
a. WBC > 25/hpf; EC < 10/hpf b. WBC > 25/lpf; EC < 10/lpf c. WBC > 25/lpf; EC < 25/hpf d. WBC > 25/lpf; EC < 10/hpf
55. Post influenza bacterial pneumonia is frequently caused by
a. Streptococcus pneumonia
b. Haemophilus influenza
c. Pseudomonas aeruginosa
d. Staphylococcus aureus
56. Pneumonia plus extra-pulmonary finding of serous myringitis on tympanoscopy is commonly seen in
a. Pneumocystis carinii pneumonia b. Chlamydia pneumoniae pneumonia c. Legionella pneumophila pneumonia
d. Mycoplasma pneumoniae pneumonia
57. Appropriate therapy for community-acquired purulent meningitis of unknown cause in a previously healthy 20 yo residing in the Phils is
a. Vancomycin + ceftriaxone b. Cefotaxime
c. Ampicillin+ chloramphenicol d. Aqueous penicillin G
58. The recommended initial therapy for suspected methicillin-resistant Staphylococcus aureus infection is
a. Ceftriaxone b. Clindamycin c. Cotrimoxazole d. Vancomycin
59. The combination of penicillin and streptomycin in recommended against what specific organism
a. Streptococcus pneumoniae
b. Enterococcus fecalis
c. Moraxella catarrhalis
d. Pseudomonas aeroginosa
60. For patients with complicated intraabdomnial infections, like ruptured appendicitis or pericholecystic abscess, the most appropriate empiric antibiotic therapy is
a. Cefazoline b. Cefuroxime c. Cefoxitin d. Ceftriaxone
61. The single most important risk factor for infection in patients with hematologic malignancy is
a. Anemia b. Leucopenia c. Granulocytopenia d. Thrombocytopenia
62. The recommended form of management of asymptomatic HIV-infected patients, with a CD4 count of more than 500/mm3 is
a. Anti-retroviral therapy (HAART) b. Prophylactic antivirals
c. Administration of isoniazid and cotrimoxazole d. Patient education
63. This drug is recommended for the prevention of Mycobacterium avium-intracellulare (MAI) infection in HIV patients with a CD4 count < 50/mm3
a. Cotrimoxazole
b. Fluconazole c. Rifampicin d. Clarithromycin
64. Recommended prophylactic antibiotic for high risk afebrile neutropenic patients
a. Levofloxacin b. Cotrimoxazole c. Cefixime d. Co-amoxyclav
65. Regarding CMV infections among post-transplant recipients a. Pharyngitis and lymphadenopathy are frequent
manifestations
b. Splenomegaly is often present
c. Fever and leucopenia are the usual findings d. Candidiasis is a common complication
66. In the evaluation of febrile neutropenic patients, the clinician’s most important task is to
a. Immediately start on empiric antibiotic therapy b. Identify the most likely source of the infection c. Administer granulocyte colony stimulating factor d. Give prophylactic antibiotic
67. Among febrile neutropenic patients, one of the following increases the risk of complications and mortality
a. Outpatient onset of fever b. Presence of solid tumor c. Female sex
d. Hypotension
68. The inclusion of vancomycin in the initial antimicrobial therapy for febrile neutropenic patients is necessary when the patient manifests with
a. Oral ulcers b. Loose stools c. Jaundice d. Oliguria
69. The recommended empiric antifungal drug for neutropenic patients, with persistent fever is
a. Itraconazole b. Fluconazole c. Amphotericin B d. Flucytosine
70. In community-acquired native valve endocarditis, the primary site of entry for Streptococcus bovis is the
a. Oral cavity b. Skin
c. Upper respiratory tract d. Gastrointestinal tract
71. Severe congestive heart failure to infective endocarditis is primarily due to the dysfunction of which valve
a. Mitral valve (eto daw sagot accdg to dr javelosa) b. Tricuspid valve
c. Aortic valve (answer key) d. Pulmonic valve
72. Which of the following is a vascular phenomenon in infective endocarditis?
a. Osler’s nodes b. Janeway lesions c. Roth spots d. Rheumatoid factor
73. Appropriate antibiotic for prophylaxis against infective endocarditis for high-risk adults with penicillin-allergy undergoing an oral cavity procedure
a. Cotrimoxazole b. Cephalexin c. Clindamycin d. Linezolid
74. The usual etiologic cause of acute bacterial endocarditis is a. Viridians Streptococci
b. Enterococcus spp c. Staphylococcus aureus
d. Coagulase-negative staphylococcus
75. To enhance its ability to adhere and invade intact endothelium, Staphylococcus aureus require this molecule, leading to infected vegetation
a. Catalase b. Lipotechoic acid c. Dextran
d. Clumping factor
76. Appropriate antimicrobial therapy for enterococcal endocarditis
a. Cefazolin + gentamicin b. Ceftriaxone + gentamicin c. Ampicillin + gentamicin d. Vancomycin only
77. Antibiotic prophylaxis before dental procedures is recommended in the following cardiac conditions to prevent infective endocarditis
a. Aortic stenosis
b. Previous coronary artery bypass graft c. Mitral valve prolapsed with mitral regurgitation d. Previous history of endocarditis
78. For culture-negative IE, the recommended antibiotic is a. Penicillin
b. Ampicillin
c. Ampicillin-sulbactam d. Vancomycin
79. The most frequent clinical manifestation of patients with IE is a. Fever
b. Heart murmur c. Joint pains d. Splenomegaly
80. Which of the following sites of intravascular lines poses the highest risk of IV catheter-related infection
a. Jugular vein b. Subclavian vein c. Femoral vein d. Antecubital vein
81. Effective measures in preventing ventilator-associated pneumonia include
a. Selective gut decontamination with non-absorbable antibiotics
b. Replacement of ventilator tubings every 48 hours c. Elevation of the patient’s head to 30-45o
d. Administration of sucralfate as stress ulcer prophylaxis
82. The mechanism of common cold transmission under conditions which results in a high percentage of cases is
a. Large particles of respiratory secretions transported in air
b. Hand contamination
c. Direct contact with infectious secretions or environmental surfaces
d. Infectious droplet nuclei suspended in the air 83. To prevent outbreaks of Varicella, aside from the usual
standard precautionary measures, this form of transmission-based precautions should be included in the management of patients with chicken pox in the hospital?
a. Airborne only b. Droplet only c. Contact only d. Airborne and contact
84. One of the following measures target the removal of sources of pathogenic organisms
a. Adequate immunization
b. Antibiotic prophylaxis for high risk procedures c. Appropriate antimicrobial treatment of patients
with infections
d. Isolation procedures, including appropriate barrier procedures in handling patients
85. What is the most likely organism involved in vascular devise infections?
a. Aspergillus b. Streptococci c. Haemophilus spp
d. Coagulase-negative staphylococci
86. After the administration of lipid-containing fluids intravenously, the fluid infusion set should be changed
a. 24 hours after completing the infusion b. 48 hours after completing the infusion c. Immediately once the infusion is completed d. No change of infusion aet is necessary
87. Nosocomial pneumonia frequently develops because of what mechanism
a. Inhalation b. Aspiration
c. Hematogenous dissemination d. Gastrointestinal translocation
88. The recommended prophylactic antibiotic for clean cardiac, orthopedic or neurologic surgery is
a. Cefazoline b. Cefuroxime c. Ceftriaxone
d. Ampicillin-sulbactam
89. The most common point of entry for infection related to intravascular devices
a. Contaminated infusate b. Insertion site c. Leaking connections d. Contaminated tubings
90. Hygienic hand rubbing, using alcohol-based gel, is necessary in which of the following situations
a. Before handling every patient in the ward b. Before any major surgical procedure c. During outbreaks of infection
d. When performing routine tasks in the general ward 91. Which of the following does correctly applies to the etiology of
sepsis?
a. Gram negative and gram positive including fungi accounts for the majority of cases
b. Microbiologic data is positive in the majority of cases with a clinical picture of severe sepsis and shock c. Microbial invasion of the bloodstream is not
essential for the development of severe sepsis d. Blood culture yield is higher in severe sepsis than
septic shock
92. Which of the following is considered a sign of organ dysfunction in sepsis?
a. Central venous pressure of <8mmHg b. Leukocyte count of >12,000/UL
c. Urine output 80cc in 1 hour of a 50kg individual d. Arterial systolic BP of <90mmHg
93. Which of the following is not true with septic shock?
a. Increase in PVR due to increased levels of catecholamines
b. Increase in CO to maintain blood flow to peripheral tissues
c. Impaired oxygen utilization by tissue due to maldistribution of blood flow
d. Diminished vasoconstrictor response to catecholamines
94. Which of the following abnormality is not common during the early part of sepsis?
a. Leucocytosis and thrombocytopenia b. Elevated lipid concentrations
c. Hyperventilation inducing respiratory alkalosis d. Hypoglycemia
95. Hypotension during the early phase of sepsis is most likely due to
a. Adrenal insufficiency b. Volume depletion
c. Decrease capillary permeability d. Autonomic dysfunction
96. The microcirculatory dysfunction in sepsis is a cascade of events that usually starts with
a. Complement activation b. Coagulopathy
c. Cytopathic hypoxia
d. Increase vascular permeability
97. A standard of care in sepsis that refers to volume replenishment therapy or the appropriate use of drugs in order to maintain blood pressure and organ perfusion
a. Mechanical ventilation b. Renal replacement therapy c. Antibiotic
d. Hemodynamic support
98. A skin manifestation secondary to P. aeruginosa infection characterized as hemorrhagic vesicles with central necrosis
usually associated with neutropenia and
hypogammaglobulinemia a. Toxic shock syndrome
b. Purpura fulminans c. Ecthyma gangrenosum d. Petechiae
99. A 48 year old male was admitted for fever and BP 80/60 mmHg. A day PTA, had trauma of right thigh secondary to a vehicular accident. On examination, right thigh was tender, severely gangrenous with bullae formation and multiple crepitations on palpation. Most likely diagnosis
a. Necrotizing fasciitis b. Purpura fulminans c. Clostridial myonecrosis d. Ecthyma gangrenosum
100. What provides the most reliable bacteriologic information in diabetic foot infections?
a. Culture and Gran stain of curettage material on the base of ulcer
b. Culture of aspirated purulent exudates c. Deep tissue culture
d. Culture of swab from purulent exudates
101. A more extensive skin infection located in the nape, back or thighs that extends into subcutaneous tissue can result to bloodstream invasion upon manipulation
a. Necrotizing infection b. Toxic epidermal necrolysis c. Carbuncle
d. Furuncle
102. A skin lesion among children characterized as painless, small vesicular lesion with a narrow halo which rapidly pustulates and readily rupture with a discharge that dries and forms a thick, golden yellow “stuck on” crusts
a. Impetigo b. Erysipelas c. Carbuncle d. Furuncle
103. Erysipelas can be differentiated from cellulitis based on this characteristic
a. Painful lesion
b. Lesions involve more than the lower extremities c. Portals of entry can be due to trauma or skin ulcers d. Border is raised, sharply demarcated from
adjacent normal skin
104. An etiologic agent of cellulitis resulting from traumatic wound sustained in saltwater or exposed to drippings of raw seafood
a. Group A streptococci b. Vibrio spp
c. Erysipelothrix rhusiopathiae d. E. coli
105. Which of the following is not a necrotizing type of skin and skin structure infection
a. Meleney’s synergistic gangrene b. Streptococcal cellulitis c. Gas gangrene
d. Non-clostridial anaerobic cellulitis
106. The most common etiologic agent of non-clostridial anaerobic cellulitis
a. Grp A beta hemolytic streptococci b. Staphylococcus aureus
c. Erysipelothrix rhusiopathiae d. Bacteriodes spp
107. Necrotizing fasciitis secondary to penetrating injury or burn is predominantly due to
a. Group A streptococci b. Enterococci
c. Mixed anaerobes d. Gram-negative aerobic
108. A longer treatment duration of antibiotic in complicated skin and skin structure infection is recommended except
a. Venous insufficiency
b. Accompanying tissue necrosis c. Presence of resistant organisms d. Severely immunocompromised host 109. The most common etiology of asymptomatic cervicitis
a. Trichomonas vaginalis b. Gardnerella vaginalis c. Chlamydia trachomatis d. Neiserria gonorrheae
110. Solitary, non-painful, indurated surface penile ulcer a. Treponema pallidum spp pallidum b. Herpes zoster
c. Haemophilus ducreyi d. Herpes simplex I
111. A highly specific sign of bacterial vaginosis a. Clue cells in Gram stain b. Vaginal pH >4.5
c. Homogenous vaginal discharge d. Strawberry-like appearance of the cervix
112. A 24 year old male with urethral discharge of 7 days onset after sexual contact with the infected partner associated with slight dysuria that reveal the following: Gram stain >5 pus cells/OIF and absence of gram negative diplococcic
a. Chlamydia trachomatis b. Ureaplasma urealyticum c. Neisseria gonorrheae d. Trichomonas vaginalis
113. The method of diagnosis for Neisseria gonorrheae that determines drug sensitivity
a. Antigen detection b. DNA hybridization c. Culture and isolation d. Nucleic acid amplification
114. Which of the following is a live attenuated vaccine a. Hepatitis B
b. Pneumococcal c. Influenza d. Oral polio
115. Which of the following is true regarding inactivated vaccine a. Minimal interference with antibody production b. Immune response is similar to natural infection c. Replicate within the recipient’s immune system to be
effective
d. Effective with just a single dose
116. A vaccine that is contraindicated to be given and administered simultaneously with other vaccines
a. Meningococcal vaccine b. Typhoid vaccine c. Yellow fever vaccine d. Influenza virus vaccine
117. The most common systemic adverse effect of a live attenuated vaccine
a. Pain and swelling at site of administration b. Redness and induration
c. Rash and angioedema d. Fever and malaise
118. Contraindicated to be given in severely immunocompromised individual
a. Oral polio vaccine b. Pneumococcal vaccine c. Influenza virus vaccine d. Hepatits B vaccine
Sorry kung ung iba walang sagot kasi di ko tlga maintindihan sa audio eh... mejo malabo kasi.. hehehe =)
