Subject Pearl Sim

8/2/2019 Subject Pearl Sim

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a

• a

Internal MedicineTopnotch Board Prep

July 2011

Subject Pearls



a

• a

Which of the following are part of preload?

Cardiology

a. Atrial contractionb. Venous tonec. Elasticity of the arterial tree

d. Resistance of systemic vasculaturee. Pumping of the skeletal muscles



a

• a

Preload: Atrium PrOVideS Blood

Cardiology

Atrial contractionDistribution of Blood VolumeIntrathoracic/Intrapericardial pressureOrthostasis

Venous ToneSkeletal muscle pumping

Amount of Blood Volume



a

• a

Afterload: VenTRicles ReSeiVE Blood

Cardiology

Ventricular Wall TensionVentricular radius



a

• a

Which of the following is a state of High-Output failure?

Cardiology

a. Selenium deficiencyb. Orthostasisc. Anemia

d. Diabetes Mellitus



a

• aWhat is the initiating event in heart failure?

Cardiology

a. LV dysfunctionb. Decreased outputc. Activation of RAAS

d. Release of Anti-Diuretic Hormone



a

• aWhat is the initiating event in heart failure?

Cardiology

a. LV dysfunction – sine qua nonb. Decreased outputc. Activation of RAAS

d. Release of Anti-Diuretic Hormone



a

• aHeart failure patients who are warm and wetshould receive what treatment?

Cardiology

a. Diuretics and vasodilatorsb. Inotropes and vasodilatorsc. Cautious fluid repletion

d. None, search for causes other than heartfailure



a

• a The following are part of the non-pharmacologic management of heart failure

EXCEPT?

Cardiology

a. Exercise up to functional class IIIb. Sodium restriction < 2-3 grams daily

c. Fluid restriction in hyponatremic patients(Na < 130)

d. Vitamin supplementation



a

• a 3 Rules of 3 in Heart Failure

Cardiology

1st rule of 3s: LV DySfunction2nd rule of 3s: Retics, RAAS blockers, Rate

controllers

3rd rule of 3s: Excess Salty Fluid



a

• aA regurgitant aortic valve would producewhich of the following murmurs?

Cardiology

a. Systolic murmur, 2nd ICS Right PSBb. Diastolic murmur, 2nd ICS Right PSB

c. Systolic murmur, 2nd ICS Left PSBd. Diastolic murmur, 2nd ICS Left PSB



a

• aWhich of the following patients should receiveprophylaxis against infective endocarditis?

Cardiology

a. Patients with Cyanotic Congenital HeartDisease

b. Patients with Prosthetic Heart Valvesc. Patients with prior Endocarditisd. All of the above



a

• aHypertrophic cardiomyopathy is present inwhich of the following?

Cardiology

a. Keshan’s Disease

b. Fabry disease

c. Carcinoid Diseased. Sarcoidosis



a

• aHypertrophic cardiomyopathy is present inwhich of the following?

Cardiology

a. Keshan’s Disease – Dilated CMPb. Fabry disease

c. Carcinoid Disease – Restrictive CMPd. Sarcoidosis – Restrictive CMP



a

• aA 54 year-old male diabetic presents to theemergency room with chest tightness. What isthe first diagnostic test that should be done?

Cardiology

a. Treadmill exercise Testb. 2D-Echo

c. 12-L ECGd. Coronary angiography



a

• aA 54 year-old male diabetic presents to theemergency room with chest tightness. What isthe first diagnostic test that should be done?

Cardiology

a. Treadmill exercise Testb. 2D-Echo

c. 12-L ECG (followed by Cardiac Enzymes)d. Coronary angiography



a

• aThe previous patient’s chest pain may be

classified as “unstable” if it has following

characteristics EXCEPT

Cardiology

a. The pain occurs at restb. The pain lasts for > 10 minutes

c. The pain occurred for the first time 5months ago

d. The pain is more prolonged and frequent



a

• aThe previous patient’s chest pain may be

classified as “unstable” if it has following

characteristics EXCEPT

Cardiology

a. The pain occurs at restb. The pain lasts for > 10 minutes

c. The pain occurred for the first time 5months ago – within 4 to 6 weeks

d. The pain is more prolonged and frequent



a

• aObstructive respiratory disease will have whatparticular lung volume pattern?

Pulmonology

a. Decreased Vital Capacityb. Same residual volume

c. Decreased vital capacity and residualvolume

d. Increased vital capacity and residual

volume



a

• aObstructive respiratory disease will have whatparticular lung volume pattern?

Pulmonology

a. Decreased Vital Capacityb. Same residual volume

c. Decreased both vital capacity and residualvolume

d. Increased both vital capacity and residual

volume



a

• a What is the mechanism of hypoxia inAtelectasis?

Pulmonology

a. Hypoventilationb. Low inspired FiO2

c. Shuntd. V/Q mismatch



a

• aWhat is the most common allergen that cantrigger an asthma exacerbation?

Pulmonology

a. Viral Upper respiratory tract infectionb. Dermatophagoides spp

c. Aspirind. Food additives



a

• aWhat is the most common allergen that cantrigger an asthma exacerbation?

Pulmonology

a. Viral Upper respiratory tract infectionb. Dermatophagoides spp – dust mite

c. Aspirind. Food additives



a

• aTap water lung is caused by which agent?

Pulmonology

a. Thermophilic actinomycetesb. Mycobacteria sppc. Aspergillus sppd. Penicillium casei



a

• a A 32 year-old male alcoholic developspneumonia. What is the most likely etiology?

Pulmonology

a. Legionellab. Pseudomonas aeruginosac. Streptococcus pneumoniaed. Oral anaerobes



a

• a Risk factors for Pseudomonas in thePhilippine CAP 2010 guidelines EXCEPT

Pulmonology

a. COPDb. Malnutritionc. Chronic steroid use of at least 5 mg/dayd. Previous antibiotic use for 7 days in the

past month



a

• aWhich imaging study provides the bestassessment of extent and distribution of

interstitial lung disease?

Pulmonology

a. Biopsyb. Chest X-rayc. Chest CT Scand. Spirometry



a

• aAmong the following interstitial lung diseases,which one has the worst prognosis?

Pulmonology

a. Idiopathic Pulmonary Fibrosisb. Non-specific Interstitial Pneumoniac. Acute Interstitial Pneumoniad. Desquamative Interstitial Lung Disease



a

• aAmong the following interstitial lung diseases,which one has the worst prognosis?

Pulmonology

a. Idiopathic Pulmonary Fibrosisb. Non-specific Interstitial Pneumoniac. Acute Interstitial Pneumonia – Hamman-Rich Syndrome

d. Desquamative Interstitial Lung Disease



a

• aThe following are mainly caused by trauma,EXCEPT

Pulmonology

a. Chylothoraxb. Hemothoraxc. Subcutaneous emphysemad. Primary spontaneous Pneumothorax



a

• aWhat is the most common ECG abnormality inpatients with pulmonary embolism?

Pulmonology

a. Right axis deviationb. S1Q3T3c. T-wave inversion V1-4d. Sinus tachycardia



a

• aThe presence of a Graham-Steell murmur in apatient with Cor Pulmonale indicates a defect

in which valve?

Pulmonology

a. Tricuspidb. Pulmonaryc. Mitrald. Aortic



a

• aThe presence of a Graham-Steell murmur in apatient with Cor Pulmonale indicates a defect

in which valve?

Pulmonology

a. Tricuspid – Carvallo’s signb. Pulmonaryc. Mitrald. Aortic – Austin-Flint murmur



a

• aWhat is the only grade A recommendation inthe management of Acute Respiratory

Distress Syndrome?

Pulmonology

a. Low Tidal Volumeb. Minimization of LA Filling Pressurec. Prone Positioningd. Aspiration Precautions



a

• aWhat is the only grade A recommendation inthe management of Acute Respiratory

Distress Syndrome?

Pulmonology

a. Low Tidal Volumeb. Minimization of LA Filling Pressure (B)c. Prone Positioningd. Aspiration Precautions



a

• aIn patients with Acute Respiratory DistressSyndrome, weaning from ventilation is

expected earliest by when?

Pulmonology

a. After 1 weekb. After 2 weeksc. After 3 weeksd. After 4 weeks



a

• aA patient consults at the Emergency Room forwheals, swelling of the face and difficulty

breathing. What is the hallmark of the patient’s

condition?

Allergy, Immunology and

Rheumatology

a. Urticaria

b. Angioedemac. Response to Epinephrined. Onset of symptoms within seconds to

minutes of exposure



a

• aA patient consults at the Emergency Room forwheals, swelling of the face and difficulty

breathing. What is the hallmark of the patient’s

condition?


Rheumatology

a. Urticaria

b. Angioedemac. Response to Epinephrined. Onset of symptoms within seconds to

minutes of exposure (History is gold std)



a

• aWhich of the following is the LEAST priority intreating urticaria?


Rheumatology

a. Loratadineb. Ranitidinec. Mometasoned. Diphenhydramine



a

• aWhich of the following is the LEAST priority intreating urticaria?


Rheumatology

a. Loratadineb. Ranitidine – adjunct to H1-blockersc. Mometasoned. Diphenhydramine



a

• aWhich is NOT a criterion of Systemic LupusErythematosus?


Rheumatology

a. Fixed malar erythema with nasolabial foldsparing, and does not cross the nasalbridge

b. Arthritis in the presence of a normal joint X-ray

c. Leukopenia < 4,000

d. Proteinuria of 0.5 g/d




a

• aWhich is NOT a criterion of Systemic LupusErythematosus?

Rheumatology

a. Fixed malar erythema with nasolabial foldsparing, and does not cross the nasalbridge

b. Arthritis in the presence of a normal joint X-ray

c. Leukopenia < 4,000

d. Proteinuria of 0.5 g/d




a

• aWhich of the following must be present for atleast 6 weeks to qualify as a criterion for

Rheumatoid Arthritis?

Rheumatology

a. Rheumatoid nodulesb. Rheumatoid factorc. Radiologic changes

d. Arthritis of the hand joints




a

• aWhich of the following is a major criterion forAcute Rheumatic Fever?

Rheumatology

a. Polyarthritisb. Feverc. Prolonged PR interval

d. Positive ASO




a

• aSystemic sclerosis affects all parts of thebody. Involvement of which organ system isthe leading cause of death in this disease?

Rheumatology

a. Lungsb. Heart

c. Kidneysd. Brain




a

• aWhat is the sine qua non of ankylosingspondylitis?

Rheumatology

a. Sacroiliitisb. Bamboo spine

c. Positive Schober testd. Limitation of chest expansion




a

• aA 24 year-old male was diagnosed to haveReactive Arthritis. Which of the following is not

among its common causative agents?

Rheumatology

a. Shigellab. Campylobacter

c. Chlamydiad. Gonorrhea




a

• aA 32 year-old sales lady complains of footpain. On examination and biopsy, several

arteries, veins and venules have inflammation.

Which condition has been ruled out?

Rheumatology

a. Churg-Strauss Syndrome

b. Polyarteritis Nodosac. Behcet’s Syndrome

d. Wegener’s Granulomatosis




a

• aWhich organ is spared in amyloidosis?

Rheumatology

a. Skinb. Kidneyc. Heart

d. Brain




a

• a Blue sclerae is associated with whichdisease?

Rheumatology

a. Amyloidosisb. Osteogenesis Imperfectac. Ehler-Danlos Disease

d. Marfan Syndrome




a

• a Blue sclerae is associated with whichdisease?

Rheumatology

a. Amyloidosisb. Osteogenesis Imperfecta – Sillence classification

c. Ehler-Danlos Disease

d. Marfan Syndrome – Ghent criteria




a

• a What is the most potent risk factor forOsteoarthritis?

Rheumatology

a. Ageb. Injuryc. Estrogen Loss

d. Family History




a

• aA 44 year-old male presents at the outpatientdepartment complaining of pain, erythema, and

swelling of the knee but no fever. Aspiration revealed

the abundance of envelope-shaped crystals. What isthe diagnosis?

Rheumatology

a. Goutb. CPPD Deposition Diseasec. Calcium Apatite Deposition Diseased. Calcium Oxalate Deposition Disease




a

• aA 44 year-old male presents at the outpatientdepartment complaining of pain, erythema, and

swelling of the knee but no fever. Aspiration revealed

the abundance of envelope-shaped crystals. What isthe diagnosis?

Rheumatology

a. Gout – needleb. CPPD Deposition Disease – rhomboid/rodc. Calcium Apatite Deposition Diseased. Calcium Oxalate Deposition Disease




a

• aWhat is the most common causative agent foracute infectious arthritis?

Rheumatology

a. Gonorrheab. Chlamydiac. Streptococcusd. Staphylococcus




a

• aWhat is the most common causative agent foracute infectious arthritis?

Rheumatology

a. Gonorrheab. Chlamydiac. Streptococcusd. Staphylococcus – 2nd most common




a

• aWhich structure is affected among patientswith Tennis Elbow?

Rheumatology

a. Lateral epicondyleb. Medial epicondylec. Rotator cuffd. Knee




a

• aWhich structure is affected among patientswith Tennis Elbow?

Rheumatology

a. Lateral epicondyleb. Medial epicondyle – golfer’s/pitcher’s

c. Rotator cuffd. Knee – jumper’s



a

• aWhich of the following does not present withmicrocytic hypochromic anemia?

Hematology

a. Anemia of Iron deficiencyb. Anemia of Inflammationc. Thalassemiad. Anemia of Hypometabolic States



a

• a True about Sickle Cell Anemia

Hematology

a. It is a change in the 6th

amino acidb. There is a shift from valine to glutamic acidc. Sticky cells cause arterial occlusiond. Hemolytic anemia is the most common

manifestation



a

• aWhat is the treatment for alpha-thalassemia?

Hematology

a. Chronic hypertransfusionsb. Splenectomyc. Pneumococcal vaccinesd. Genetic counseling



a

• aWhat is the only hematologic condition with anincreased MCHC?

Hematology

a. Methemoglobinemiab. Megaloblastic anemiac. Hereditary Spherocytosisd. G6PD Deficiency



a

• a A patient presents with sudden-onset jaundice, tea-colored urine and anemia. Onperipheral blood smear, you would expect to

see the following EXCEPT

Hematology

a. Pyknocyte

b. Bite cellsc. Heinz bodiesd. Auer rods



a

• aWhat is the gold standard for the diagnosis ofParoxysmal Nocturnal Hemoglobinuria?

Hematology

a. Peripheral Blood Smearb. Urine Hemoglobinc. Flow Cytometryd. Karyotyping

a



a

• aWhat is the gold standard for the diagnosis ofParoxysmal Nocturnal Hemoglobinuria?

Hematology

a. Peripheral Blood Smearb. Urine Hemoglobinc. Flow Cytometry – CD 55-, CD 59- cellsd. Karyotyping

a



a

• a What is the most common presentingsymptom in a patient with aplastic anemia?

Hematology

a. Easy fatigabilityb. Dizzinessc. Bleedingd. Infection

a



a

• a What is the most common presentingsymptom in a patient with aplastic anemia?

Hematology

a. Easy fatigabilityb. Dizzinessc. Bleeding – thrombocytopeniad. Infection

a



a

• a In a 29 year-old male with anemia, thepresence of Auer rods and elevated WBC, you

also note high amounts of platelets. What is

his FAB classification?

Hematology

a. M4b. M5

c. M6d. M7

a



a

• aStarry sky appearanceFlower-shaped NucleusEpstein-Barr virus

HIVSkin involvementReed-Sternberg Cell

Hematology

Burkitt’s Lymphoma

Adult T-cell lymphomaBurkitt’s Lymphoma

Burkitt’s LymphomaMycosis FungoidesHodgkin’s Lymphoma

a



a

• aWhich of the following diseases is treated withDDAVP?

Hematology

a. Hemophilia Ab. Hemophilia B

c. Factor XI deficiencyd. Von Willebrand Disease

a



a

• aWhich of the following diseases is treated withDDAVP?

Hematology

a. Hemophilia A – Factor VIIIb. Hemophilia B – Factor IX

c. Factor XI deficiencyd. Von Willebrand Disease

a



a

• aWhich genera of influenza is responsible formost major flu pandemics?

Infectious Disease

a. Ab. B

c. Cd. D

a



a

• aWhich genera of influenza is responsible formost major flu pandemics?

Infectious Disease

a. A (e.g H1N1 swine flu, H5N1 avian flu)b. B

c. Cd. D

a



a

• aWhat is the maximum length of quarantine forinfluenza-infected patients starting from the

day of first symptoms?

Infectious Disease

a. 4 daysb. 5 days

c. 6 daysd. 7 days

a



a

• aWhat is NOT part of the treatment of tetanus?

Infectious Disease

a. Penicillinb. Metronidazolec. Anti-toxind. Brain biopsy

a



a

• aWhich illness has the highest case-fatalityrate?

Which causes the most rapidly lethal form of

shock in humans?

Infectious Disease

a. Meningococcemia

b. Leptospirosisc. Malariad. Rabies

a



a

• aWhich illness has the highest case-fatalityrate?

Which causes the most rapidly lethal form of

shock in humans?

Infectious Disease

a. Meningococcemia

b. Leptospirosisc. Malariad. Rabies

a

Infectious Disease



a

• aWhat is the hepatic stage of falciparummalaria?

a. Sporozoitesb. Schizogonyc. Merozoitesd. Hypnozoites

a

Infectious Disease



a

• aWhat is the hepatic stage of falciparummalaria?

a. Sporozoites – infective stageb. Schizogonyc. Merozoitesd. Hypnozoites – vivax and ovale

a

Infectious Disease



a

• aWhich test is unreliable in diagnosing cases ofTyphoid Fever?

a. Blood cultureb. Urine culturec. Stool cultured. Typhidot

a

Infectious Disease



a

• aWhich test is unreliable in diagnosing cases ofTyphoid Fever?

a. Blood cultureb. Urine culturec. Stool cultured. Typhidot

Headache is the most common presenting signRose spots are pathognomonic

a

Infectious Disease



a

• aWhat is the component of the cell wall ofMycobacterium Tuberculosis that is

responsible for most of its antibiotic-resisting

and tissue-damaging effects?

a. Mycolic Acid

b. Lipoarabinomannanc. Arabinoglycand. Surface glycolipids

a

Infectious Disease



a

• aWhich of the following is a bacteriostatic anti-TB medication?

a. Isoniazidb. Rifampicinc. Streptomycin

d. Pyrazinamide

a

Infectious Disease



a

• aWhen the level of CD4+ cells drops below thisvalue, HIV-infected individuals have a steep

rise in opportunistic infections.

a. 100b. 200c. 300

d. 400

a

Infectious Disease



a

• aWhen the level of CD4+ cells drops below thisvalue, HIV-infected individuals have a steep

rise in opportunistic infections.

a. 100b. 200c. 300

d. 400

a



a

• a

End of Part 1

a



a

• a

Internal MedicineTopnotch Board Prep

July 2011

Subject Pearls

a

Nephrology



a

• aThiazides act on which part of the nephron?

a. Proximal convoluted tubuleb. Loop of Henlec. Distal convoluted tubule

d. Collecting duct



a

Nephrology



a

• aUremia develops during which phase of acutetubular necrosis?

a. Initiationb. Extensionc. Maintenance

d. Recovery

a

Nephrology



• aUremia develops during which phase of acutetubular necrosis?

a. Initiationb. Extensionc. Maintenance

d. Recovery

a

Nephrology



• aWhich of the following is NOT a correct goalfor patients with chronic kidney disease?

a. Protein restriction of 0.6-0.75 for CKDstage II

b. BP < 125/75

c. FBS 90-130 mg/dLd. Hemoglobin > 90 g/L

a

Nephrology



• a What is the stage of lupus nephritis ifmesangial proliferation is seen on kidney

biopsy?

a. Ib. IIc. III

d. IV

a

Nephrology



• aWhich of the following is NOT a pulmonary-renal syndrome?

a. Churg-Strauss Vasculitisb. Goodpasture’s Syndrome

c. Henoch-Schonlein Purpura

d. Polyarteritis Nodosa

a

Nephrology



• aWhat is the most common cause of chronicrenal insufficiency in adults?

a. Diabetic Nephropathyb. Hypertensive Nephrosclerosisc. Membranous glomerulonephritis

d. Minimal Change Disease

a

Nephrology



• aWhat is the most common cause of chronicrenal insufficiency in adults?

a. Diabetic Nephropathyb. Hypertensive Nephrosclerosisc. Membranous glomerulonephritis - elderly

d. Minimal Change Disease - children

a

Nephrology



• aHypertension, cysts, SAHNephrocystin and InversinHamartin and Tuberin

Paintbrush features on IVP

Polycystic KidneyNephronophthisisTuberous Sclerosis

Med Sponge Kidney

a

Nephrology



• aBartter’s SyndromeGitelman’s SyndromeLiddle’s Syndrome

Thick Ascending LimbDistal Convoluted Tub+MgCortical Collecting Duct

a

Nephrology



• aWhich is not a feature of Type II renal tubularacidosis?

a. Impaired bicarbonate reabsorptionb. Nephrolithiasisc. Hypercalciuria

d. Hyperaminoaciduria

a

Nephrology



• aWhat is an expected finding on biopsy of thekidney of a patient with essential

hypertension?

a. Hyaline depositsb. Fibrinoid necrosisc. Onion-skin lesionsd. Crescentic destruction

a

Nephrology



• aWhat is an expected finding on biopsy of thekidney of a patient with essential

hypertension?

a. Hyaline depositsb. Fibrinoid necrosis – malignant HPNc. Onion-skin lesions – malignant HPNd. Crescentic destruction – RPGN

a

Nephrology



• aWhat is the treatment for cystine stones?

a. Low Na diet

b. Allopurinolc. High fluid intaked. Antibiotics

a

Nephrology



• aWhat is the pathognomonic urinalysis findingof acute pyelonephritis?

a. Positive urine culture

b. Low specific gravityc. WBC castsd. Hyaline casts

a

Nephrology



• aWhen should candiduria NOT be treated?

a. Symptomatic patient

b. Immunocompromised patientc. Patient with positive culture for Candidad. None of the above

a

Nephrology



• aWhen should candiduria NOT be treated?

a. Symptomatic patient

b. Immunocompromised patientc. Patient with positive culture for Candidad. None of the above

a

Gastroenterology



• a Which anti-hypertensive medicationexacerbate gastroesophageal reflux disease?

a. Calcium channel blockersb. Beta-adrenergic blockersc. Alpha-adrenergic blockersd. Diuretics

a

Gastroenterology



• a Which anti-hypertensive medicationexacerbate gastroesophageal reflux disease?

a. Calcium channel blockersb. Beta-adrenergic blockersc. Alpha-adrenergic blockersd. Diuretics

a

Nephrology



• aIron deficiency, hypopharyngeal web, middleaged women

Diverticulum in the posterior hypopharyngeal

wall

Lower esophageal ring

Tear from retching/Rupture from retching

Plummer-Vinson Syndrome

Zenker’s Diverticulum

Schatzki’s Ring

Mallory-Weiss Tears/ Boerhaave’s Syndrome

a

Gastroenterology



• aWhich of the following is NOT a risk factor forH. pylori infection?

a. Unclean foodb. Exposure to the gastric contents of aninfected individual

c. Poor economic statusd. Increased meat intake

a

Gastroenterology



• aOf the disorders of malabsorption, which onewill require only dietary restriction?

a. Short Bowel Syndromeb. Celiac Spruec. Whipple’s Disease

d. Bacterial Overgrowth Syndrome

a

Gastroenterology



• aOf the disorders of malabsorption, which onewill require only dietary restriction?

a. Short Bowel Syndromeb. Celiac Spruec. Whipple’s Disease – T. whipplei, Cotrimoxazole

d. Bacterial Overgrowth Syndrome

a

Gastroenterology



• a Which of the following is a feature ofUlcerative Colitis?

a. Crypt abscessesb. Granulomasc. Segmental involvementd. Tendency to spare the rectum

a

Gastroenterology



• aWhat is the sine qua non of irritable bowelsyndrome?

a. Changes in the appearance of stoolb. Changes in the frequency of stoolc. Recurrent abdominal paind. CNS dysmodulation

a

Gastroenterology



• aWhich areas of the colon are predisposed tomesenteric vascular insufficiency?

a. Junction of the ileum and the cecumb. Junction of the cecum and the ascendingcolon

c. Junction of the ascending colon and thetransverse colon

d. Junction of the transverse colon and thedescending colon

a

Gastroenterology



• aWhich areas of the colon are predisposed tomesenteric vascular insufficiency?

a. Junction of the ileum and the cecumb. Junction of the cecum and the ascendingcolon

c. Junction of the ascending colon and thetransverse colon

d. Junction of the transverse colon and thedescending colon – Griffith’s point

Griffith’sPoint

Sudeck’s

Point

a

Gastroenterology



• aWhich of the following is lowest in Criggler-Najar I as compared to the rest of theunconjugated hyperbilirubinemias?

a. Levels of unconjugated bilirubinb. Incidence of kernicterusc. Pigmentation of the liver

d. Response to phenobarbital

a

Gastroenterology



• aIn patients with Chronic Hepatitis B, whatfinding will prompt you to start treatment?

a. Positive HBsAgb. Positive HBeAgc. HBV DNA level > 105

d. All of the above

a

Gastroenterology



• aIn patients with Chronic Hepatitis B, whatfinding will prompt you to start treatment?

a. Positive HBsAg – all cases are positiveb. Positive HBeAg – negative cases are txc. HBV DNA level > 105

d. All of the above

a

Gastroenterology



• aWhich of the following is a risk factor forAlcoholic Liver Disease?

a. Male sexb. Hepatitis B infectionc. Underweight

d. Alcohol Intake > 40-60 g/d

a

Gastroenterology



• aIn which of the following cases would you optfor immediate drainage of the hepatic

abscess?

a. 2 cm abscess in the right lobeb. 4 cm abscess in the right lobec. 5 cm abscess in the right lobe

d. 5 cm abscess in the left lobe

a

Gastroenterology



• aWhich of the following antibiotics is NOT usedas prophylaxis against spontaneous bacterial

peritonitis?

a. Azithromycinb. Ciprofloxacinc. Norfloxacin

d. Cotrimoxazole

a

Gastroenterology



• aWhat is the most important therapeuticmaneuver in Acute Pancreatitis?

a. NGT Insertionb. Meperidinec. Antibiotics

d. NPO

a

Gastroenterology



• aWhat is the most important therapeuticmaneuver in Acute Pancreatitis?

a. NGT Insertionb. Meperidinec. Antibiotics

d. NPO

a

Endocrinology



• a The following are functions of Follicle-Stimulating Hormone EXCEPT

a. Estrogen secretionb. Seminiferous tubule developmentc. Spermatogenesis

d. Testosterone secretion

a

Endocrinology



• a Which of the following peaks at night?

a. ACTH

b. GHc. TSHd. Prolactin

a

Endocrinology



• a Which of the following peaks at night?

a. ACTH

b. GHc. TSHd. Prolactin

Hormone Peak Secretion

ACTH 6 AM

GH Night (sleep)

TSH Pulsed

Prolactin 4-6 AM

a

Endocrinology



• aHypersecretion syndromes of the followinghormones are correctly matched with their

temporizing agents EXCEPT

a. ACTH – Ketoconazoleb. GH – Somatostatinc. TSH – Methimazole

d. Prolactin – Cabergoline

a

Endocrinology



• aHypersecretion syndromes of the followinghormones are correctly matched with their

temporizing agents EXCEPT

a. ACTH – Ketoconazoleb. GH – Somatostatinc. TSH – Methimazole

d. Prolactin – Cabergoline

aEndocrinology



• a Hypersecretion TemporizingAgent

ACTH

(Cushing’s Syndrome)

Ketoconazole,

MetyraponeGH

(Acromegaly)Somatostatin

TSH Somatostatin

ProlactinCabergoline,

Bromocriptine

a

Endocrinology



• aWhich of the following is the correct treatmentmodality for Pituitary Diabetes Insipidus?

a. Thiazidesb. Amiloridec. Low Na Diet

d. Desmopressin

a

Endocrinology



• aWhich of the following is the correct treatmentmodality for Pituitary Diabetes Insipidus?

a. Thiazides - Nephrogenicb. Amiloride - Nephrogenicc. Low Na Diet - Nephrogenic

d. Desmopressin

a

Endocrinology



• aWhat is the most important finding that wouldconfirm the presence of hyperthyroidism?

a. Low TSHb. High T4c. Positive anti-TPO

d. Clinical findings

a

Endocrinology



• aWhat is the most important finding that wouldconfirm the presence of hyperthyroidism?

a. Low TSHb. High T4 – confirms thyrotoxicosisc. Positive anti-TPO – for autoimmune thyroiditis

d. Clinical findings – there are cases of subclinical hyperthyroidism

a

Endocrinology



• aWhat is the most common cause of Cushing’sSyndrome?

a. ACTH secretionb. Exogenous steroid usec. Adrenal neoplasm

d. Bilateral adrenal hyperplasia

a

Endocrinology



• aWhich of the following is present in primaryadrenocortical deficiency as opposed to

secondary deficiency (ACTH deficiency)?

a. Weaknessb. Hypotensionc. Hyperkalemia

d. Hyperpigmentation

a

Endocrinology



• aWhich of the following is not a part of theclassic triad of Pheochromocytoma?

a. Sweatingb. Hypertensionc. Headaches

d. Palpitations

a

Endocrinology



• aWhich of the following does NOT qualify asDiabetes Mellitus?

a. FBS of 126 mg/dL aloneb. 2-hour PPBS of 200 mg/dL alonec. RBS of 200 mg/dL alone

d. HBa1c of 7% alone

a

Endocrinology



• aPatients in a hyperglycemic hyperosmolarstate have higher laboratory findings in the

following parameters compared to DKA,

EXCEPTa. Serum Sodiumb. Serum HCO3

c. Serum pCO2d. Anion Gap

a

Endocrinology



• aWhich of the following is a correct target for a45 year-old diabetic female with no signs of

chronic kidney disease?

a. HDL > 40 mg/dLb. LDL < 150 mg/dLc. Post-prandial glucose < 180 mg/dLd. BP < 130/80

a

Endocrinology



• a Which of the following is the correcttemporizing agent for Verner-Morrison

Syndrome?

a. Somatostatinb. Octreotidec. Diazoxided. Omeprazole

a

Endocrinology



• a Which of the following is the correcttemporizing agent for Verner-Morrison

Syndrome?

a. Somatostatinb. Octreotidec. Diazoxided. Omeprazole

aEndocrinology



• a Hypersecretion Temporizing Agent5-HT

(Carcinoid Syndrome)Somatostatin

Gastrin

(Zollinger-Ellison Syndrome)PPI, H2-Blockers

Insulin Diazoxide

Glucagon Somatostatin

Somatostatin OctreotideVIP

(Verner-Morrison syndrome, WDHA

syndrome, Pancreatic cholera)

Octreoride

a

Endocrinology



• aWhich of the following is NOT present inMultiple Endocrine Neoplasia Type I?

a. Prolactinomab. Hyperparathyroidismc. Gastrinomad. Medullary Thyroid CA

a

Endocrinology



• a What is the most common cause ofHypercalcemia?

a. Bone lysisb. Exogenous Vitamin D intakec. PTHrP secretiond. Calcitonin hypersecretion

a

Endocrinology



• a What is the most common cause ofHypercalcemia?

a. Bone lysis – 2nd most commonb. Exogenous Vitamin D intake – rarec. PTHrP secretion – by malignanciesd. Calcitonin hypersecretion – calcitonin has

little physiologic significance in humans

a

Endocrinology



• a What is the first-line management ofhypercalcemia?

a. Witholding of Vitamin Db. Diuresis

c. Dialysisd. Fluid repletion

a

Endocrinology



• aHexosaminidase deficiencyAlpha-galactosidaseBeta-galactosidase

Sphingomyelinase

Tay-Sachs DiseaseFabry DiseaseGaucher’s Disease

Niemann-Pick Dse

a

Endocrinology



• a Glycogen Storage Diseases

Type I

Type IIType IIIType IVType V

G6PD

Acid MaltaseGlycogen debranchingGlycogen branchingMuscle phosphorylase

a

Endocrinology



• a Glycogen Storage Diseases

Phenylalanine

Cystathionine β-synthaseHomogentisic acid oxidaseImpaired dibasic amino acid

reabsorptionDefective neutral amino acid

transporter

Phenylketonuria

HomocystinuriaAlkaptonuriaCystinuria

Hartnup disease

a

Oncology



• aWhat is the most significant risk factor forcancer?

a. Ageb. Smokingc. Increased BMId. Sun exposure

a

Oncology



• aWhat is the most common cause of death incancer?

a. Infectionb. Respiratory failurec. Heart failured. Renal insufficiency

a

Oncology



• aWhat is the most specific parameter todetermine whether a nevus is neoplastic?

a. Asymmetryb. Border irregularityc. Color variegationd. Diameter

a

Oncology



• aWhat is the most significant risk factor for thedevelopment of non-melanoma skin cancer?

a. Old ageb. Male sexc. Fair complexiond. UV light B

a

Oncology



• aWhat is the most important initial test in thework-up for Thyroid Cancer?

a. TSHb. Thyroid Ultrasoundc. CT scan of the neckd. Fine-needle aspiration biopsy

a

Oncology



• aWhat is the most important initial test in thework-up for Thyroid Cancer?

a. TSHb. Thyroid Ultrasoundc. CT scan of the neckd. Fine-needle aspiration biopsy

Frequency: Papillary > Follicular > Medullary > Anaplastic



a

Oncology



• aWhich of the following is NOT a correctdescription of Small Cell Lung Cancer?

a. It has neuroendocrine propertiesb. It is not responsive initiallyc. It is likely to relapsed. It presents as metastatic

a

Oncology



• aWhich is NOT a risk factor for Breast Cancer?

a. Radiationb. Earlier menarchec. Increased caloric intaked. Use of Oral contraceptive pills

a

Oncology



• aHot tea is a risk factor for malignancy of whichpart of the Gastrointestinal Tract?

a. Head and neck CAb. Esophageal CAc. Gastric CAd. Colon CA

a

Oncology



• aUpon doing a triphasic CT scan for a hepaticmass, a central hypovascular scar was

appreciated during the arterial phase. This is

most compatible with which of the following?

a. Focal Nodular Hyperplasiab. Hepatocellular CAc. Hemangiomad. Adenoma

a

Oncology



• aUpon doing a triphasic CT scan for a hepaticmass, a central hypovascular scar was

appreciated during the arterial phase. This is

most compatible with which of the following?

a. Focal Nodular Hyperplasiab. Hepatocellular CA – necrosis, heterogenous

c. Hemangioma – vascular lesiond. Adenoma – smooth, well defined,

enhances on portal venous phase

a

Oncology



• aCoffee is a risk factor for which neoplasm?

a. Pancreatic CA

b. Gallbladder CAc. Peritoneal CAd. Cholangiocarcinoma

a

Oncology



• aPolychronotropism is a characteristic of whichneoplasm?

a. Uterine CA

b. Endometerial CAc. Renal cell CAd. Bladder CA

a

Oncology



• aAFP and HCG are both elevated in whichmale germ cell tumor?

a. Choriocarcinomab. Endodermal sinus tumorc. Pure embryonal carcinomad. Teratoma

a

Oncology



• aWhat is the most common female pelvicmalignancy?

a. Vulvar CAb. Uterine CAc. Ovarian CAd. Cervical CA

a

Oncology



• aAn onion-peel periosteal reaction is seen inwhich osteogenic sarcoma?

a. Osteosarcomab. Chondrosarcomac. Ewing’s sarcoma

d. Histiocytoma

a

Oncology



• aAn onion-peel periosteal reaction is seen inwhich osteogenic sarcoma?

a. Osteosarcoma – Codman’s triangle, sunburst

b. Chondrosarcoma – Lobular/Cauliflowerc. Ewing’s sarcoma

d. Histiocytoma

a

Oncology



• aSurgery is required to stage the followingcancers EXCEPT

a. Colorectal CA

b. Prostate CAc. Ovarian CAd. Uterine CA

a

Oncology



• aSurgery is required to stage the followingcancers EXCEPT

a. Colorectal CA

b. Prostate CAc. Ovarian CAd Uterine CA

Subject Pearl Sim

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