Internal Medicine

1. INTERNAL MEDICINE
DIRECTION: Each question below is followed by four possible answers. Select the one best
response and mark the appropriate spaces on the answer sheet provided for.
1. The most important risk factor for COPD is:
A. Tobacco smoke
B. Outdoor air pollution
C. Occupational exposure to fumes
D. Severe persistent bronchial asthma
2. The symptom of COPD that often precedes the development of airflow limitation by many
years is:
A. Cough
B. Cyanosis
C. Chest pain
D. Dyspnea
3. The airflow limitation characteristic of COPD is:
A. Recurrent
B. Irreversible
C. Non progressive
D. Not measurable
4. The gold standard for the diagnosis and assessment of COPD is:
A. CT scan
B. Chest PAL
C. ABG studies
D. Standardized spirometry
5. The only intervention proven to improve survival in severe COPD patients is:
A. Oxygen therapy
B. Cyclic antibiotics
C. Pulmonary rehabilitation
D. Smoking cessation
6. The strongest risk factor in the development of asthma is:
A. Atopy
B. Gender
C. Ethnicity
D. Smoking
7. The key effector cells in the late phase response of airway inflammation in asthma are:
A. Basophils
B. Eosinophils
C. Neutrophils
D. Lymphocytes
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2. 8. The most effective and practical test to objectively monitor bronchial asthma is:
A. Spirometry
B. Peak flow meter
C. Dyspnea visual analog scale
D. Structured serial questionnaire
9. Confusion, bradycardia and paradoxical breathing during asthma attack indicate:
A. Impending stroke
B. Moderate exacerbation
C. Imminent respiratory arrest
D. Co existing myocardial infarction
10. The radiologic feature of community acquired pneumonia which predicts increased mortality
and morbidity is:
A. Cavitary lesion
B. Hyperinflated lung
C. Unilobar involvement
D. Slowly spreading lung infiltrate
11. The most likely etiologic agent of a pneumonia in an elderly diabetic with a non healing
wound in the right big toe and bilateral cavitary lesions on chest x-ray is:
A. Klebsiella pneumoniae
B. Staphylococcus aureus
C. Pseudomonas aeruginosa
D. Streptococcus pneumoniae
12. The most likely etiologic agent of a pneumonia in a young patient developing 4 days post-
caesarian section under general anesthesia presenting with putrid blood streaked sputum
and x-ray finding of infiltrates on the right upper lung field posterior aspect is:
A. Anaerobic bacteria
B. Staphylococcus aureus
C. Pseudomonas aeruginosa
D. Streptococcus pneumoniae
13. The treatment most appropriate for a non small cell bronchogenic carcinoma (NSC) stage I
in a patient without co morbidity is:
A. Surgery
B. Radiotherapy
C. Chemotherapy
D. Immunotherapy
14. The recommended duration of a 4-drug regimen for a newly diagnosed sputum smear or
culture positive PTB patient without co morbidity is:
A. 4 months
B. 6 months
C. 9 months
D. 12 months
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3. 15. The characteristic clinical and serologic features in classic polyarteritis nodosa (PAN)
include the following, EXCEPT:
A. Hypertension
B. Slowly progressive renal insufficiency
C. Bland urine sediment with subnephrotic proteinuria
D. Presence of the characteristic anti neutrophilic cytoplasmic antibodies (ANCA)
16. Which of the following drugs is NOT associated with lupus or lupus-like conditions?
A. Isoniazid
B. Procainamide
C. D-penicillamine
D. Hydralazine
17. Which of the following immunosuppressive drugs is NOT used in the treatment of
rheumatoid arthritis?
A. Azathioprine
B. Cyclosporine
C. Chlorambucil
D. Cyclophosphamide
18. The Disease Modifying Anti rheumatic Drugs used in the treatment of rheumatoid arthritis
include the following, EXCEPT:
A. Cyclosporine
B. Methotrexate
C. D-penicillamine
D. Gold compounds
19. The 1982 Clinical Criteria for the diagnosis of SLE include the following, EXCEPT:
A. ANA
B. Malar rash
C. Leukopenia
D. ++ Proteinuria
20. The Clinical Criteria for the diagnosis of polymyositis include the following, EXCEPT:
A. + EMG
B. Elevated ESR
C. + Muscle biopsy
D. Symmetrical weakness
21. Which of the following is NOT associated with SLE?
A. Malar rash over the bridge of the nose
B. Leukopenia with lymphopenia <1 500
C. Erosive arthritis usually involving the hands and elbows
D. Proteinuria of > 300 grams per day or +3 per routine urinalysis
22. The drug most appropriate to lower serum urate in over producers, stone formers and
patients with advanced renal failure is:
A. Probenecid
B. Allopurinol
C. Benzbromarone
D. Low dose aspirin
23. The disease associated with an episodic inflammation of the joints is:
A. Fungal arthritis
B. Syphilitic arthritis
C. Tuberculous arthritis
D. Gonococcal arthritis
24. Opportunistic CNS infections in patients with HIV include the following, EXCEPT:
A. Toxoplasmosis
B. Cryptococcosis
C. Aseptic meningitis
D. Syphilis
25. The most serious complication of chickenpox especially in adults is:
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4. A. Myocarditis
B. Hepatitis
C. Nephritis
D. Pneumonia
26. Among the infections, the most common cause of fever of unknown origin is:
A. Malaria
B. Salmonellosis
C. Extrapulmonary tuberculosis
D. Infective endocarditis
27. Nosocomial infections of medical personnel are most effectively prevented by:
A. Handwashing by medical personnel
B. Isolation of contagious patients
C. Prophylactic antibiotics for compromised patients
D. Sterilization of contaminated articles
28. Jaundice is more commonly seen in which of the following causes of Gram negative
sepsis?
A. E. coli
B. E. aerogenes
C. Acinetobacter
D. P. aeruginosa
29. Induction of vascular permeability, hemorrhage and shock in dengue virus infection
depends on the following factors, EXCEPT:
A. Presence of enhancing antibodies
B. Children less than 12 years of age
C. Infecting Dengue virus serotype 2
D. Malnutrition
30. Which of the following is NOT a feature of severe Falciparum malaria?
A. Coma
B. Severe hypertension
C. Hypoglycemia
D. Lactic acidosis
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5. 31. Which of the following sexually transmitted infections (STI) can be prevented through
vaccination?
A. Hepatitis B
B. Hepatitis C
C. Syphilis
D. Gonorrhea
32. What is responsible for the persistent fever of clinical typhoid?
A. Invasion of the gall bladder
B. Invasion of Peyer’s patches
C. Sustained bacteremia
D. Intermittent bacteremia
33. What is the definitive diagnostic test of typhoid fever?
A. Widal test
B. Typhidot
C. Latex agglutination test
D. Isolation of the organism in culture
34. Diagnosis of tetanus is based entirely on:
A. Clinical findings
B. Isolation of C. tetani from wounds
C. History of injury
D. Serum anti toxin levels of 0.01 unit/mL
35. Which of the following Schistosoma species is closely associated with urinary bladder
granuloma and squamous cell carcinoma?
A. S. japonicum
B. S. mansoni
C. S. haematobium
D. S. intercalatum
36. Which of the following is NOT true for hepatosplenic Schistosomiasis?
A. Presence of Schistosome eggs in the feces considered diagnostic
B. Ultrasonography as method choice for diagnosis
C. Periportal fibrosis seen on histopathology
D. Pathognomonic in S. mansoni, S. japonicum and S. mekongi
37. An acute diarrheal disease acquired through ingestion of contaminated water in a matter of
hours resulting in profound rapidly progressive dehydration and death is:
A. Salmonellosis
B. Shigellosis
C. Campylobacter jejuni
D. Cholera
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6. For next 3 questions, please refer to the case below:
A 40-year old female complained of sudden onset of persistent epigastric pain for 2 hours
noted few minutes after attending a party. Patient took antacid with temporary relief.
38. One of the following information would tell us that the source of pain is biliary in origin:
A. Pain is most severe after food intake.
B. Pain is most severe before food intake.
C. Pain is most severe during food intake.
D. Food intake has no effect on the occurrence of pain.
39. If this is biliary colic, the reason for the pain may be due to:
A. Entry of food into the stomach stimulating entry of bile into duodenum
B. Contraction of the small intestine against an obstructing gallstone
C. Contraction of the diseased or inflamed gall bladder
D. Spasm of the colon
40. In as much as epigastric pain may be produced by a cardiac event, what part of the heart
may be involved if this is cardiogenic in origin?
A. Antero-septal wall
B. Antero-lateral wall
C. Inferior wall
D. Global involvement
For next 2 questions: A patient was admitted for abdominal pain and restlessness. On PE,
you found that the patient had tender epigastrium. BP was 140/80 mm Hg, RR 28/min, HR
110/min.
41. What diagnostic tests will you order first and consider most informative?
A. CK MB, Creatinine and ECG 12 leads
B. Serum amylase, CK MB
C. CBC, Creatinine, Flat plate of the abdominal
D. CK MB, Amylase, Chest PA, ECG 12 leads
42. What test is the easiest way to check for perforated peptic ulcer disease in this patient?
A. Upper gut endoscopy
B. Barium contrast study
C. Chest x-ray
D. Upright film of the abdomen
For next 3 questions: A 40-year old male homosexual came in for progressive pallor, LBM
and melena for 3 months with easy fatigability. BP was 110/80 mm Hg and HR 110/min. PE
showed pallor, palpable mass in the right upper quadrant, bipedal pitting edema. Rectal exam
showed melena.
Labs: CBC – Hgb 4 gms/dL, Hct 12 vol%, WBC 25 000/cu mm with 92% segmenters,
platelet 850 000/cu mm; Serum albumin = 2.2 grams/L (Normal =–4-5 grams/L)
43. Which of the following is LEAST likely to cause melena?
A. Bleeding esophageal varices
B. Slowly bleeding gastric ulcer
C. Colon cancer
D. Bleeding duodenal ulcer
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7. 44. The cause for the hematologic picture of the patient is due to:
A. Bone marrow infiltration
B. Primary bone marrow defect
C. Severe anemia
D. Leukemia
45. Colon biopsy revealed adenocarcinoma. How does this condition produce pedal edema?
A. Congestive heart failure
B. Protein loss
C. Renal failure
D. Compression of the vena cava
46. Which of the following does NOT predispose to colon cancer?
A. Hyperplastic polyp
B. Ulcerative colitis
C. Polyposis coli
D. Adenomatous polyp
47. Colonic polyps will most likely become malignant if it is:
A. Sessile (flat-based)
B. 1.5 cm in size
C. Pedunculated (stalked)
D. Multiple
48. A definitive diagnosis of cancer is only made through:
A. Radiologic characteristics of the tumor
B. Elevated levels of tumor markers
C. Pathologic exam of tissue samples
D. Clinical manifestations of the disease
49. What is the importance of estimating a tumor’s doubling time?
A. It helps you choose the appropriate drug regimen for the case.
B. It gives you an estimate of a patient’s performance ability.
C. It determines how soon you need to initiate treatment.
D. It gives you an idea how a patient will develop drug toxicity.
50. Which of the following conditions is a contraindication to systemic chemotherapy?
A. Patients with age >60 years old
B. Patients with good performance status
C. White blood cell count of 5 000 cells/cu mm
D. Overwhelming systemic infection present
51. The rationale of giving ACE inhibitor in diabetic patients with microalbuminuria is to:
A. promote diuresis
B. decrease glomerular hydrostatic pressure
C. increase glomerular filtration rate
D. decrease glomerular oncotic pressure
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8. 52. The following are reasons why pregnant women are at risk in developing UTI, EXCEPT:
A. Decreased ureteral tone
B. Incomplete bladder emptying
C. Decreased ureteral peristalsis
D. Incompetent vesico-ureteral valve
53. Drug used to treat uric acid stone:
A. Thiazide diuretic
B. Sodium bicarbonate
C. Cellulose phosphate
D. Vitamin C
54. Anemia in nephritic syndrome is due to:
A. Decreased erythropoietin factor
B. Transferrin loss
C. GI bleeding
D. Iron deficiency
55. Radiocontrast-induced acute renal failure is due to:
A. Direct toxicity to the tubular epithelial cells
B. Intratubular obstruction
C. Intrarenal vasoconstriction
D. Rhabdomyolysis
56. The most specific test for lupus nephritis is:
A. C3
B. ANA
C. ESR
D. Anti-DsDNA
57. The treatment of hyponatremia must be done gradually to prevent:
A. Pulmonary edema
B. Cerebral edema
C. Central pontine myelinolysis
D. Peripheral nerve disease
58. The drug used for the treatment of hyperkalemia to stabilize cellular membranes is:
A. D50water + Regular Insulin
B. NaHCO3
C. Calcium gluconate
D. Furosemide
59. Hyponatremia in chronic renal failure is best treated with:
A. NaCl tablet
B. Normal saline infusion
C. Water restriction
D. Diuretics
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9. 60. Because of the predilection of herpes encephalitis for the temporal lobes, common
manifestations are seizures and:
A. Hemiataxia
B. Hemiparesis
C. Aphasia
D. Hemisensory loss
61. The most common modifiable risk factor for both ischemic and hemorrhagic strokes is:
A. Age
B. Smoking
C. Hypertension
D. Hyperlipidemia
62. What area is usually involved in a stroke manifested as sudden onset of diplopia and
hemiparesis?
A. Supratentorial
B. Infratentorial
C. Extra parenchymal (e.g. meningioma)
D. Spinal cord
63. The most common cause of non traumatic subarachnoid hemorrhage is:
A. Mycotic aneurysm
B. Berry “congenital” aneurysm
C. Dissecting aneurysm
D. Fusiform, dolichoectatic aneurysm
64. Cell loss of the substantia nigra in Parkinson’s disease primarily leads to:
A. Dopamine deficiency
B. Cholinergic deficiency
C. GABA deficiency
D. Adrenergic deficiency
65. Dyskinesias (i.e. chorea and dystonia) in Parkinson’s disease are primarily due to:
A. Continued cell degeneration
B. Medication effect
C. On and off phenomenon
D. Natural course of disease
66. The most deadly complication due to too rapid infusion of intravenous phenytoin (>50
mg/min) is:
A. Respiratory depression
B. Cardiac arrhythmias and hypotension
C. Intravenous burns and phlebitis
D. Nystagmus
67. The Guillain Barre syndrome of subacute generalized (four-limb) weakness, areflexia, and
at times plegic pupils can be mimicked by:
A. Cervical lesion (i.e. disc herniation)
B. Cervical lesion (i.e. disc herniation) with spinal shock
C. Subacute combined degeneration (Vitamin B12 deficiency)
D. Amyotrophic lateral sclerosis
68. The most common form of migraine is:
A. Migraine with aura
B. Migraine without aura
C. Basilar migraine
D. Familial hemiplegic migraine
69. In psychoanalytic theory, the major factor in producing depression is:
A. Projection
B. Sublimation
C. Introjection
D. Displacement
70. Diagnostic criteria for “major depressive episode” include all of the following, EXCEPT:
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10. A. Significant change in appetite or weight
B. Change in sleep pattern
C. Increased energy
D. Decreased concentration
71. Prodromal signs of schizophrenia commonly include all of the following, EXCEPT:
A. Abnormal affect
B. Peculiar behavior
C. Strange perceptual experience
D. Excessive spending
72. Negative symptoms of schizophrenia include all of the following, EXCEPT:
A. Hallucination
B. Flattening of affect
C. Poverty of speech
D. Blocking
73. Delusions of persecution are characteristic of this type of schizophrenia:
A. Disorganized
B. Catatonic
C. Paranoid
D. Undifferentiated
74. An overdose of narcotics causes all of the following, EXCEPT:
A. Dilated pupils
B. Hypotension
C. Depressed reflexes
D. Respiratory depression
75. The highest risk factor for developing alcoholism is:
A. Being raised in a family with alcoholism
B. Being male and having a biologic parent with alcoholism
C. Having a mood disorder
D. Alienation from society
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11. 76. Standard chemotherapy regimen for newly diagnosed AML consists of:
A. Melphalan + Prednisone
B. Hydroxyurea + Interferon
C. Cytarabine + Anthracycline
D. Cyclophosphamide + Vincristine + Prednisone
77. The following finding is consistent with Polycythemia vera:
A. O2 saturation of 80%
B. Low LAP score
C. Low serum erythropoietin
D. Low serum vit. B12
78. Which of the following findings is consistent with CML:
A. Auer rods
B. Pelger Huet anomaly
C. Philadelphia chromosome
D. Howell Jolly bodies
79. The following findings are consistent with iron deficiency anemia, EXCEPT:
A. Low serum ferritin level
B. Low mean corpuscular volume
C. Low total iron binding capacity
D. Prussian blue staining (-)
80. Recombinant erythropoietin therapy is ABSOLUTELY indicated in:
A. Anemia of chronic disease
B. Anemia of renal disease
C. Aplastic anemia
D. Anemia from GI losses
81. Recommended management of patients with ITP includes the following, EXCEPT:
A. Prednisone
B. Splenectomy
C. Immunosuppressives
D. Whole blood transfusion
82. Which patient would benefit most from fresh frozen plasma transfusion?
A. Patient with gum bleeding and thrombocytopenia
B. Patient with liver cirrhosis and prolonged prothrombin time
C. Patient with massive hematemesis and prolonged prothrombin time
D. Patient for elective surgery with coumadin-induced prolonged prothrombin time
83. Which of the following is an unmistakable sign of inadequate control in a chronic
hypertensive?
A. Hypercalcemia
B. (+) albuminuria
C. Premature cataract formation
D. Calcification of the aortic arch
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12. 84. A 60-year old patient with usual BP of 120-130/70-80 mm Hg, on anti hypertensives, now
presents with a BP range of 160-170/90-95 mm Hg. At first visit, all of the following modes
of action are good choices, EXCEPT:
A. Change the anti-hypertensive medication.
B. Re evaluate the blood chemistries.
C. Evaluate compliance and optimize the existing drug’s dose.
D. Review drug history for possible source of secondary hypertension.
85. Which of the following statements is TRUE for the hypertensive patient with chronic renal
failure?
A. The “normal’ BP is now pegged higher at < 160/90 mm Hg.
B. It will be necessary to monitor serum electrolytes more frequently.
C. Any of the anti hypertensive drugs available in the market can be used.
D. Beta blockers are contraindicated because they usually cause peripheral vascular
disease.
86. In the hypertension clinic,
A. Screening should be limited to patients above 21 years old.
B. It is mandatory that BP be taken on all extremities at first visit.
C. The pharmacologic history can be limited to what cardiovascular medications the
patient is on.
D. The complete examination includes urinalysis, eye examination with fundoscopy,
and palpation-auscultation of all pulse points.
87. A 60-year old man comes to the E.R. with chest discomfort. What is the appropriate action
to take?
A. An ECG should be taken after the initial history.
B. A dose of sublingual nitrates can be given as therapeutic trial.
C. He should be admitted at once to the coronary care unit for observation.
D. He can be sent to the out-patient department for proper assessment, as he is not in
acute distress.
88. An obese diabetic 55-year old smoker has been admitted for acute myocardial infarction.
Which of the following is true?
A. The initial drugs should include aspirin, anti thrombins and beta blockers.
B. It is reasonable to use NSAID’s as first line drugs to control pain.
C. ICU or CCU admission is not necessary, unless he is in failure.
D. Complete bed rest is mandatory for at least one week.
89. The following are common congenital heart defects with expected adult survival, EXCEPT:
A. Atrial septal defect (secundum)
B. Patent ductus arteriosus
C. Coarctation of the aorta
D. Ventricular septal defect
90. The following are relative contraindications to cardiac catheterization, EXCEPT:
A. Uncontrolled ventricular irritability
B. Uncorrected hypertension
C. Decompensated heart failure
D. Large ventricular septal defect
91. What arrhythmia is suggested by wide complex QRS tachycardia exceeding 100
beats/minute and is associated with syncope and sudden cardiac death?
A. Ventricular tachycardia
B. Ventricular parasystole
C. AV junctional complexes
D. Ventricular fibrillation
92. Sinus node dysfunction has the following characteristics, EXCEPT:
A. It is most often found in the elderly as part of a syndrome.
B. Marked sinus bradycardia (<50/min) may cause fatigue and other symptoms due to
inadequate cardiac output.
C. Most important step to diagnosis is to correlate symptoms with ECG.
D. Symptoms may become manifest only in the presence of cardioactive drugs in some
patients.
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13. 93. A thyroid function test which shows elevated T4 and below normal TSH would be most
consistent with:
A. Graves’ disease
B. Papillary carcinoma
C. Colloid cystic goiter
D. Chronic lymphocytic thyroiditis
94. One of the following thyroid disorders would present with clinical thyrotoxicosis but the RAIU
would be below normal:
A. Graves’ disease
B. Thyrotoxicosis factitia
C. Iodine deficiency goiter
D. Anaplastic thyroid CA
95. Which type of thyroid malignancy has the best prognosis?
A. Papillary CA
B. Follicular CA
C. Medullary CA
D. Anaplastic CA
96. The treatment of choice for goitrous Hashimoto’s thyroiditis is:
A. Thyroidectomy
B. Propylthiouracil
C. Radioactive iodine
D. L-thyroxine
97. Hyperaldosteronism may present with all of the following metabolic derangements,
EXCEPT:
A. Hypertension
B. Hyperkalemia
C. Hypernatremia
D. Metabolic alkalosis
98. Hypercortisolism is best diagnosed by:
A. MRI of the pituitary gland
B. CT scan of the adrenals
C. Dexamethasone suppression test
D. ACTH level determination
99. All of the following findings support the diagnosis of Addison’s disease, EXCEPT:
A. Hyponatremia
B. Hyperkalemia
C. Hypertension
D. Hyperpigmentation
100. A solid skin lesion wherein the diameter exceeds the thickness and measures more
than 5 mm in diameter is:
A. Papule
B. Vesicle
C. Nodule
D. Plaque
END OF EXAMINATION.
REFERENCE (Unless otherwise specified)
Kasper DL, Fauchi AS, Longo DL, Braunwald, Hauser SL, Jameson JL, Editors. Harrison’s
Principles of Internal Medicine, 16th
Edition. New York: McGraw Hill Companies, 2005.
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