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Internal Medicine > Internal Medicine > Flashcards

Internal Medicine Flashcards

1
Q

The treatment of choice for anemia of chronic renal disease:

A

Erythropoetin

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2
Q

A patient was brought to the ER in a comatose state. Serum electrolytes drawn on admission showed the following: Na+ 133 meq/L, K + 8.0 meq?l, Cl 98 meq/L, HCO3 13 meq?L. ECG showed absent P waves, widend QRS and peaked T waves. Which would b the mot appropriate initial step:

A

Administer intravenous calcium gluconate

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3
Q

Low serum complement level would be seen in patients with hematuria, proteinuria and hypertension resulting from all of the following, EXCEPT:

A

a. Mixed essential cryoglobulinemia / b. Hepatitis C associated membranoproliferative glomerulonephritis / c. Diffuse proliferative lupus nephritis / D.Henoch-Schonlein purpura*

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4
Q

A 37 y.o. man is admitted with confusion. PE showed a BP of 140/70 with no orthostatic changes, normal jugular venous pressure and no edma. Serum chemistries are notable for Na+ 120 meq/L, K + 4.2 meq/L, HCO3 24 meq/L and a uric acid of 2 mg/L. The most likely diagnosis is:

A

SIADH

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5
Q

TRUE statement/s about acute poststreptococcal glomerulonephritis (PSGN) EXCEPT:

A

a. The latent period appears to be longer when PSGN is associated with cutaneous rather than pharyngeal infection / b. Serologic tests for a streptococcal infection may be negative if antimicrobial therapy is begun early/ c. PSGN leads to permanent and progressive renal insufficiency more often in adults than in children/ d.Long-term antistreptococcal prophylaxis is indicated after documented cases of PSGN.*

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6
Q

The a wave of the jugular venous pulse (JVP) represents:

A

right atrial contraction

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7
Q

One of the following is not true in the assessment of acute GI Bleeding:

A

a. The presence of large quantities of bright red blood per rectum rules out the source before the ligament of Treitz* / b. Melena almost always represents UGIB / c. Black stools can be caused by lesions in the colon/ d. A bilous NGT return flow in a patient who just had hematochezia rules out an upper GI source of hemorrhage

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8
Q

Which of the following is true regarding gastric ulcer?

A

coexisting duodenal ulcers favor benign nature of gastric ulcer

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9
Q

A 55-year-old diabetic patient presents with heartburn and acidic eructation for 2 years. Endoscopic biopsy of a patch of hyperemic mucosa 3 cm. above the gastroesophageal junction showed squamous epithelium with inflammatory cells. The patient most likely has:

A

Gastroesophageal reflux disease

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10
Q

Which of the following statements does NOT describe secretory diarrhea?

A

Stools are scanty and mucoid

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11
Q

A 16-year-old male patient presenting with hepatitis syndrome has the following serologic exam findings: (+) HBsAG, (-) Anti-Hbe, (+) HBeAG, (+) Anti-HAVIgm , (-) AntiHBclgG. The patient most likely has

A

Acute Hepatitis A and Acute Hepatitis B simultaneous infection

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12
Q

The most common organism isolated from the ascitic fluid of patients with spontaneous bacterial peritonitis is:

A

Escherichia coli

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13
Q

True of Ascaris infestation:

A

adult worms reside mostly in the small intestines

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14
Q

Which of the following risk factors has been directly associated with Bronchogenic Carcinoma?

A

Cigarette smoking

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15
Q

This group of drugs reduce airway inflammation in bronchial asthma:

A

Clucocorticoids

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16
Q

The American Thoracic Society defines chronic bronchitis as persistence of cough and excessive mucus production for most days out of 3 months for ________ successive years:

A

2

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17
Q

A patient with CAP requires hospitalization when one of the following is present:

A

COPD in exacerbation

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18
Q

One of the following is NOT a useful clue to the microbial etiology of CAP (Community Acquired Pneumonia)

A

edentulous persons likely to develop pneumonia due to anaerobes

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19
Q

In a patient suspected of PTE, presence of this symptom heralds the occurence of pulmonary infarction:

A

hemptysis

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20
Q

Gold standard in the diagnosis of PTE:

A

pulmonary angiography

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21
Q

One of the disorders below does NOT have vesicles or bulla as presenting lesions:

A

Psoriasis

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22
Q

Annular lesions with raised erythematous border and clear centers, distributed over the trunk area:

A

Tinea corporis

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23
Q

Grouped vesicles arranged in a segmental pattern over the right side of the trunk, T7-8 level:

A

Herpes Zoster

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24
Q

A pregnant woman with brown macules with irregular borders, symmetric pattern on her cheeks, forehead, upper lips, nose and chin most likely has:

A

melasma

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25
Q

One of the following statements is NOT true of typhoid fever:

A

Stool culture is best done during the first week of fever.

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26
Q

In typhoid fever, which of the following specimen will have the best sensitivity for culture if a patient has been given antibiotics?

A

bone marrow

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27
Q

Drug of choice for Schistosomiasis:

A

Praziquantel

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28
Q

The fungus which is a normal inhabitant of the human mucocutaneous body surfaces and is a frequent cause of fungemia is:

A

Candida

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29
Q

An 18-year-old boy had sex with an HIV+ prostitute a week ago. He is frightened and wants assurance he has not been infected. You should:

A

tell him you regret that there is no way at this time to tell if he has been infected or not

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30
Q

The most likely organism/s causing secondary bacteremia following manipulation of a furuncle is/are:

A

Staph aureus

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31
Q

Which of the following vaccines is especially indicated in a splenectomized patient:

A

pneumococcal

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32
Q

A patient with Bell’s Palsy has a pathology involving which cranial nerve?

A

VII

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33
Q

A patient suspected to have meningitis undergoes spinal tap. Upon insertion of the spinal needle, the opening pressure is recorded to be markedly elevated. You should:

A

withdraw the needle and run IV mannitol

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34
Q

The first drug of choice in a patient presenting with frank seizures is:

A

Diazepam IV

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35
Q

Lower motor neuron type of paralysis is characterized by:

A

hypotonia

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36
Q

A Cavernous sinus lesion could involve several cranial nerves. Which of the following is least likely to be affected?

A

facial nerve

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37
Q

Bitemporal hemianopsia means involvement of the

A

optic chiasm

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38
Q

Elevated urea in patients with chronic renal disease occurs because of

A

decreased urea excretion

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39
Q

Asymptomatic bacteriuria should always be treated in:

A

pregnant women

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40
Q

What is the most conservative management for chronic renal failure?

A

dietary proteins of 0.6 g/kg/day

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41
Q

One of the following is NOT a pathophysiologic mechanism of DM nephropathy:

A

Ig G deposits along GBM resulting in immune complex mediated glomerulonephritis

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42
Q

Not a characteristic laboratory feature of hepatorenal syndrome:

A

Proteinuria

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43
Q

The single most important parameter of renal function is:

A

Creatinine clearance

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44
Q

A 50-year-old male with ESRD 20 diabetic nephropathy was brought to the emergency room because of weakness and light headedness. He has just completed his first dialysis, and was observed to be somewhat confused. BP = 90/40, CR = 80/min., RR = 20/min. The most likely explanation for his condition is:

A

Dialysis disequilibrium syndrome

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45
Q

In the presence of anemia, the ability to produce adequate circulating red cells is best measured by:

A

Reticulocyte count

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46
Q

Reticulocytosis is NOT seen in:

A

aplastic anemia

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47
Q

All of the following anemias except one are chronic developing over weeks. Which anemia may develop acutely?

A

hemolytic

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48
Q

In the tumor cell cycle, the cells refractory to chemotherapy are the:

A

Cells in the G0 phase

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49
Q

Multiple osteolytic lesions, hypercalcemia and neurologic abnormalities are most often seen in:

A

Plasma cell myeloma

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50
Q

Thrombocytopenia is not expected in:

A

G6PD deficiency

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51
Q

This finding in Chronic Myelogenous Leukemia can differentiate it from leukemoid reaction:

A

decreased leukocyte alkaline phosphatase

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52
Q

Lung cancer that is associated with significant progressive dyspnea and increasing hypoxemia

A

Bronchoalveolar CA

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53
Q

The most common form of arthritis characterized by progressive deterioration and loss of articular cartilage:

A

Osteoarthritis

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54
Q

The characteristic feature of Rheumatoid arthritis is:

A

persistent inflammatory synovitis

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55
Q

Heberden’s nodes are found in

A

Osteoarthritis

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56
Q

Loss of hair at the lateral part of eyebrows, thickening of speech, coarse hair and dry skin, dulling of intellect, sluggish movements. Most likely diagnosis is:

A

Hypothyroidism

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57
Q

Psamomma bodies are characteristic of:

A

Papillary Thyroid CA

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58
Q

Jodbasedow phenomenon is:

A

iodide-induced hyperthyroidism

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59
Q

A 50-year-old obese woman with hypertriglyceridemia without hypercholesterolemia. The most appropriate first management step would be

A

weight reduction

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60
Q

The diagnosis of diabetes mellitus is certain in which of the following situations?

A

successive fasting plasma glucose of 147, 165, 152 mg/dL in an otherwise healthy 40-year-old female

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61
Q

Which of the following medications can cause hyperprolactinemia?

A

metoclopramide

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62
Q

Obese persons are at increased risk for

A

Cholelithiasis

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63
Q

Dietary deficiency of thiamine produces which of the following clinical syndromes?

A

peripheral neuropathy

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64
Q

A 24/M who took megadoses of vitamins develops severe headache and papilledema. The cause for this is intoxication of

A

Vitamin A

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65
Q

In using Serum albumin as gauge for malnutrition, which statement is correct?

A

the half-life of albumin in 21 days, so it cannot be used to assess acute malnutrition

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66
Q

Prolonged fasting causes the intestinal villi to

A

atrophy

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67
Q

A person with known allergy to penicillins should not be given

A

cefalexin

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68
Q

Lymphokines are secreted by

A

lymphocytes

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69
Q

A 30-year-old female has severe perennial allergic rhinitis. Her house is frequently flooded. She has a dog and sleeps on kepok pillow. As part of management of her allergy, you should advice her to

A

replace the kapok pillow with foam rubber, cover the pillow and mattress with allergen proof encasings

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70
Q

IgE has high affinity for which type of cells?

A

mast cells

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71
Q

A 65/M is brought to the ER due to chest pain. He suddenly becomes unresponsive and pulseless and cardiac monitor reveals ventricular fibrillation. You should immediately:

A

begin CPR, then defibrillation at 200 J, 300 J then 360 J

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72
Q

If despite defibrillation, a pulseless patient has persistent ventricular fibrillation, the use of which drug would be most appropriate?

A

epinephrine

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73
Q

If only one person is present to provide basic life support, chest compressions should be performed at a rate of ______ per minute, and breaths twice in succession every 15 seconds

A

80

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74
Q

One of the following is associated with an increased risk of sudden cardiac death:

A

frequent PVC’s (>30/min)

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75
Q

Elevation of Serum Potassium is toxic to the:

A

heart

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76
Q

Anti – Tuberculosis drug that can cause hyperuricemia:

A

Pyrazinamide

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77
Q

Which of the following tests is required to diagnose Chronic Obstructive Pulmonary Disease:

A

Spirometry

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78
Q

Marantic endocarditis is commonly associated with this lung cancer:

A

Small cell

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79
Q

This is considered as the most frequent cause of Acute Respiratory Distress Syndrome

A

Severe sepsis

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80
Q

The most common form of Lung cancer arising in lifetime of a non smoker young women

A

Adenocarcinoma

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81
Q

The most common cause of acute renal failure

A

Pre renal acute renal failure

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82
Q

The most significant risk factor for cancer is:

A

Sex

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83
Q

DNA synthesis phase

A

S

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84
Q

This is the most common local manifestation of lung cancer at presentation

A

Cough

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85
Q

Painless myocardial infarction is greater in patients with

A

hypertension

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86
Q

In typoid fever this diagnostic exam is not affected by prior antibiotic use:

A

Bone marrow culture

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87
Q

British Thoracic Society major category for diagnosis of severe pneumonia

A

Need for mechanical ventilation

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88
Q

This anti-TB drug may cause “barrel vision”

A

a. Rifampicin / b. Isoniazid/ c. Pyrazinamide / d. Streptomycin

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89
Q

Most common cause of pneumonia in ambulatory patients:

A

Streptococcus pneumoniae

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90
Q

Most common etiologic agent in uncomplicated cystitis:

A

Escherichia coli

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91
Q

The best parameter to differentiate chronic bronchitis from emphysema

A

DLCO

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92
Q

The duration of treatment for acute cystitis in pregnant patient :

A

7 days

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93
Q

Diagnosis of Diabetes Mellitus is defined as:

A

A random plasma glucose concentration =11.1 mmol/L (200 mg/dL) accompanied by classic symptoms of DM (polyuria, polydipsia, weight loss) is sufficient for the diagnosis of DM

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94
Q

Type 2 DM is characterized by one of the pathophysiologic abnormalities:

A

peripheral insulin resistance

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95
Q

Acute complication of Type 2 Diabetes Mellitus :

A

Hyperosmolar Hyperglycemic State

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96
Q

Target blood pressure in Diabetes Mellitus

A

130/80

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97
Q

Risk factor for adverse prognosis in hypertension:

A

smoking

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98
Q

The most common form of suppurative intracranial infection:

A

bacterial meningitis

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99
Q

Precipitating cause of heart failure:

A

infection

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100
Q

Underlying cause of heart failure:

A

cardiomyopathy

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101
Q

Minor criteria of congestive heart failure:

A

tachycardia

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102
Q

Levine’s sign:

A

clenching of the fist in front of the sternum

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103
Q

An important factor predisposing to bacteriuria in men is urethral obstruction due to:

A

prostatic hypertrophy

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104
Q

The most common finding on physical examination in leptospirosis aside from fever:

A

conjunctival suffusion

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105
Q

The most common cause of partial or generalized epilepsy in the elderly is :

A

stroke

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106
Q

Definition of severe pneumonia by American Thoracic Society:

A

need for mechanical ventilation

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107
Q

Cause of transudative pleural effusion:

A

cirrhosis

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108
Q

Hallmark of COPD:

A

airflow obstruction

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109
Q

Most commonly involved in extrapulmonary TB:

A

lymph nodes

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110
Q

Primary Pulmonary TB frequently involved the:

A

middle and lower lung zones

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111
Q

The most common complication of measles:

A

subacute sclerosing panencephalitis

112
Q

The drug of choice for primary generalized seizures is:

A

phenytoin

113
Q

Type of anemia in Malaria:

A

normochromic normocytic

114
Q

Cerebral Malaria is caused by:

A

P. falciparum

115
Q

The most common presentation of amoebic infection is:

A

asymptomatic cyst passage

116
Q

Duodenal ulcer occur 90% located within:

A

3cm of the pylorus

117
Q

The most common type of gallstone:

A

cholesterol

118
Q

Gold standard in diagnosing gallstone:

A

ultrasound

119
Q

The most common risk factor of stroke :

A

hypertension

120
Q

The most specific and characteristic symptom of gallstone disease:

A

biliary colic

121
Q

Local complication of acute pancreatitis:

A

pancreatic abscess

122
Q

85% of Pancreatic pseudocyst are located at the :

A

body and tail

123
Q

The most common serious complication of chicken pox:

A

pneumonia

124
Q

Incubation period of chicken pox:

A

7-10 days

125
Q

The person recommended to receive influenza vaccine:

A

person > 65 years of age

126
Q

Most serious complication of influenza B virus:

A

reye’s syndrome

127
Q

Metabolic complication of nephritic syndrome

A

hypoalbuminemia

128
Q

Primary Glomerulopathy which is highly steroid responsive:

A

minimal change disease

129
Q

Most common cause of idiopathic nephrotic syndrome in adult:

A

membranous

130
Q

Hallmark of nephrotic syndrome:

A

heavy protenuria

131
Q

Most common glomerulopathy worldwide:

A

IgA nephropathy

132
Q

Most common cause of Iron deficiency in adult:

A

chronic blood loss

133
Q

Virus serotype associated greatest risk for DHF:

A

DEN-2

134
Q

Most important laboratory test for DHF monitoring:

A

Hemoglobin

135
Q

Which of the following is the earliest rabies specific clinical manifestation:

A

tingling sensation at the bite site

136
Q

The diagnostic laboratory method of choice for typhoid fever in the first week of illness:

A

blood culture

137
Q

The most important predictor of multi-drug resistant M. tuberculosis organism in all studies is:

A

history of treatment tuberculosis

138
Q

Most discriminating symptom of duodenal ulcer:

A

pain occur 90 min to 3 hours after a meal

139
Q

Liver cirrhosis is best diagnosed by:

A

Liver biopsy

140
Q

Drug of choice for Schistosomiasis:

A

praziquantel

141
Q

Spasm that is observed first in Tetanus:

A

risus sardonicus

142
Q

Gold standard in the treatment of typhoid fever:

A

chloramphenicol

143
Q

The most common opportunistic fungal infection:

A

candida

144
Q

Source of cholera infection:

A

contaminated water supply

145
Q

Classical malarial paroxysms suggest infection with:

A

P. vivax

146
Q

Most common cause of pneumonia in ambulatory patients:

A

S. pneumoniae

147
Q

The single most useful clinical sign of the severity of pneumonia:

A

Respiratory rate of > 30/min

148
Q

The most common route for bacterial pneumonia :

A

microaspiration of oropharyngeal secretions

149
Q

Most common site of spinal tuberculosis in adult:

A

lower thoracic spine

150
Q

The most common site of gastrointestinal TB:

A

terminal ileum

151
Q

Most common site of pancreatic cancer:

A

tail

152
Q

Most consistent risk factor in pancreatic cancer:

A

cigarette smoking

153
Q

Hereditable gastrointestinal syndromes that has least malignant potential:

A

juvenile polyposis

154
Q

The most common infectious complication of varicella is

A

bacterial superinfection of the skin

155
Q

The most common extracutaneous site of involvement in children

A

CNS

156
Q

A deficiency of this protease inhibitor is a proven genetic risk factor for COPD

A

alpha 1 anti trypsin

157
Q

Glucose goal in patients with DKA:

A

150 – 250 mg/dl

158
Q

Heart failure with development of symptoms in less than an ordinary activity:

A

Class III

159
Q

Heart failure with warm and flushed extremities and with widened pulse pressure

A

High output

160
Q

Cardiomyopathy with primary myocardial involvement

A

Idiopathic

161
Q

Reversible form of dilated cardiomyopathy

A

Alcohol abuse

162
Q

Systolic Hypertension with wide pulse pressure

A

Arteriosclerosis

163
Q

Framingham major criteria for Diagnosis of CHF :

A

Positive hepatojugular reflux

164
Q

Characteristic appearance of stools in patients with cholera:

A

non-bilious,non-bloody, gray, sl. cloudy with flecks of mucus

165
Q

Primary pulmonary TB is characterized as:

A

involves the middle and lower lobes in most cases

166
Q

Class I recommendations for use of an Early invasive strategy in Myocardial Infarction:

A

Recurrent angina at rest/ low level activity despite Rx

167
Q

The most common presenting complaint in patients with ST elevation MI:

A

Pain

168
Q

De bakey classification of Aortic dissection in which dissection is limited to the ascending aorta:

A

Type II

169
Q

Cardiomyopathy with primary myocardial involvement

A

Idiopathic

170
Q

This form of respiratory failure occurs when alveolar flooding and subsequent intrapulmonary shunt physiology occur:

A

Type 1 respiratory failure

171
Q

Heavy drinkers (i.e., those consuming 100 g of ethanol per day for the preceding 2 years) have a higher incidence of acquiring what type of organism in Community acquired Pneumonia?

A

gram negative organisms

172
Q

Associated with pandemics and are restricted to influenza A viruses

A

antigenic shift

173
Q

Most common pathogen in intensive care unit:

A

S. pneumoniae

174
Q

The only known reservoir for Varicella zoster virus is

A

humans

175
Q

The most common infectious complication of varicella is

A

bacterial superinfection of the skin

176
Q

The most common site of hypertensive intraparenchymal hemorrhage is:

A

Putamen

177
Q

The most common cause of ischemic stroke is

A

Artery to artery embolism from carotid bifurcation atherosclerosis

178
Q

Currently considered the best initial treatment for primarily generalized tonic clonic seizures is:

A

Valproic acid

179
Q

Adverse effects such as gum hyperplasia, hirsutism and coarsening of facies is associated with long term use of:

A

Phenytoin

180
Q

The pathognomonic sign of meningitis is:

A

Presence of fever, headache and nuchal rigidity

181
Q

The most common cause of community acquired bacterial meningitis in adults >20 years of age

A

Strep. Pneumoniae

182
Q

Which of the following systemic disease is NOT associated with polyneuropathy:

A

Carpal Tunnel Syndrome

183
Q

Compressive Metastatic Myelopathies most commonly involve which level of the spinal cord

A

Thoracic

184
Q

Which of the following is true of Trigeminal Neuralgia

A

Objective sign of sensory loss in the face cannot be demonstrated on examination

185
Q

Which of the following disorders causes irreversable dementia?

A

Alzheimer’s disease

186
Q

The most powerful risk factor for osteoarthritis is:

A

Age

187
Q

Disabilility of patient with knee osteoarthritis is strongly associated with:

A

Obesity

188
Q

Which of the following is the characteristic physical examination finding of patient with osteoarthritis?

A

Bony Crepitus

189
Q

Which of the following is considered as the most common form of idiopathic osteoarthritis

A

Heberden’s nodes

190
Q

A 30 y/o female with SLE is noted to have a prolonged partial thromboplastin time. This abnormality is associated with:

A

Deep venous thrombosis

191
Q

The best screening test for the detection of SLE is:

A

Antinuclear antibodies

192
Q

Diagnosis of gouty arthritis is base on the finding of crystals in the synovial fluid and which of the following crystals is diagnostic of gout?

A

Birefringent needle-shaped crystals

193
Q

The preferred treatment of acute gouty attack in elderly patient is:

A

Intraarticular steroid infection

194
Q

Joint pain among patient with Rheumatoid arthritis is cause mainly by which of the following mechanism?

A

Distention of joint capsule

195
Q

Axial (vertebra) joints involvement in Rheumatoid arthritis is usually limited to the:

A

Cervical vertebrae

196
Q

Evidence suggests that early aggressive treatment of rheumatoid arthritic patient with Disease-Modifying Antirheumatic Drugs (DMARD) maybe effective at slowing the appearance of bone erosions. Which of the DMARD is currently considered the best initial choice?

A

Methotrexate

197
Q

Which of the following Vitamins is capable of eliciting systemic anaphylactic reaction?

A

Thiamine

198
Q

Which of the following medicine or drug is NOT effective in the treatment of the acute event of systemic anaphylactic reaction?

A

IV Glucocorticoids

199
Q

Majority of acute diarrheas are due to

A

infectious agents

200
Q

Clostridium deficile causes acute diarrhea by

A

cytotoxin production

201
Q

Majority (>50%) of all esophageal cancers are of which cell type?

A

adenocarcinoma

202
Q

Not considered as risk factor for the development of Pancreatic cancer?

A

cholelithiasis

203
Q

Which of the following is a protective antibody against Hepatitis B infection?

A

Anti HBs

204
Q

Drug that is contraindicated in the treatment of chronic Hepatitis B infection with decompensated liver is: disease

A

Interferon

205
Q

Minimum amount of ascetic fluid which can be detected by shifting dullness is:

A

500 cc

206
Q

Secretion of water and bicarbonate rich solution from the pancreas is stimulated by:

A

secretin

207
Q

Most common complication of Peptic Ulcer Disease is:

A

bleeding

208
Q

Which of the following isconnsidered as a non-pharmacologic management of Gastroesophageal Reflux Disease?

A

Decreased amount of fluids at night

209
Q

Who among the following is considered to be diabetic?

A

a 34 y/o male who complained of excessive thirst, weight loss and casual blood sugar of 120mg%

210
Q

The best way to assess blood sugar control is to monitor the:

A

Glycosalated Hemoglobin

211
Q

A patient who is Hypertensive and Hypokalemic, should make one consider which of the ff. as the most likely cause of the hypertension?

A

Conn’s Syndrome

212
Q

What is the most common cell type of Thyroid Carcinoma?

A

Papillary carcinoma

213
Q

Which of the following physiologic condition can stimulate prolactin secretion by the pituitary gland?

A

Stress

214
Q

Which of the following is NOT consistent with Diabetic Ketoacidosis?

A

Blood sugar of 240mg%

215
Q

What is the expected laboratory findings in Grave’s Hyperthyroidism?

A

elevated thyroid hormones with low TSH

216
Q

Which of the following is NOT a feature of Hypocalcemia?

A

diarrhea

217
Q

Which of the following test is recommended as the initial screening for Cushing’s Sydrome?

A

overnight dexamethasone test

218
Q

Which of the following have the most potent glucocorticoid effect?

A

Triamcinolone

219
Q

The most potent risk factor for development of active TB disease is:

A

HIV co-infection

220
Q

Tuberculosis treatment failure is suspected when appropriate regimen is prescribed but:

A

A. sputum cultures remain positive after 3 months / B. AFB sputum smears remain positive after 5 months / C. Either* / D. Neither

221
Q

The most important impediment to cure Tuberculosis is:

A

non-compliance

222
Q

A 58 years old male presented with 4 days fever and lately weakness and dizziness whenever he sits or stands up; disorientation. Upon PE: BP=90/60mmHg, PR=112/min., RR=28/min., T=39.8ºC. The only remarkable finding is an ulcerated skin lesions in the lower leg with black discoloration. Lab tests: WBC=2,500cells/m3; gram negative bacilli from smears of the skin lesion. This patient has

A

severe sepsis

223
Q

The most probable organism that has causes severe febrile illness with changes in sensorium and associated with ulceration and black discoloration of the skin is:

A

P. aeruginosa

224
Q

The following anti microbial agent is effective for the treatment of Pseudomonas infection:

A

Ceftazidime

225
Q

The major anatomic site for the establishment and propagation of HIV infection is:

A

Lymphoid organs

226
Q

Central to the pathogenesis of severe falciparum malaria is/are:

A

A. cytoadherence in capillary and venular endothelium / B. rosette formation by non parasitized RBC’s / C. agglutination of parasitized RBC’s / D. all of the above*

227
Q

Sequestration and microcirculatory arrest occur in which of the following Plasmodium?

A

P. falciparum

228
Q

Hypoglycemia in severe malaria is associated with poor prognosis and it may result from

A

A. failure of hepatic gluconeogenesis / B. increased glucose consumption by host and parasite / C. increased insulin secretion in treatment with Quinine / D. all of the above*

229
Q

The diagnostic test of malaria that is also used to monitor response to treatment is:

A

Stained blood film

230
Q

Dengue Hemorrhagic fever can occur following:

A

Second infection with a serotype different from that involved in primary infection

231
Q

Diagnosis of Dengue fever is made in a clinically Compatible disease manifestation by

A

IgM ELISA

232
Q

The main clinical manifestations of Chronic Schistosomiasis are dependent on

A

A. Species / B. site of egg deposition in the host’s tissues / C. Both*

233
Q

The following are effects of tetanospasmin EXCEPT

A

A. blood release of inhibitory neurotransmitters / B. increased circulating catecholamine levels / C. block neurotransmitter release at the neuromuscular junction / D. all of the above*

234
Q

The following laboratory findings are suggestive of Iron Deficiency Anemia EXCEPT

A

A. koilonychias / B. decreased serum ferritin* / C. decreased total iron binding capacity / D. low reticulocyte response

235
Q

Which of the following statement regarding Polycythemia Vera is correct?

A

an elevated plasma erythropoietin level excludes the diagnosis

236
Q

Diagnosis of Acute Myeloid Leukemia is established by the presence of:

A

≥ 20% myeloblasts in the bone marrow

237
Q

Which of the following syndrome have autoimmune hemolytic anemia with immune thrombocytopenia?

A

Evans syndrome

238
Q

Which of the following is the cytogenetic hallmark of Chronic Myelogenous Leukemia?

A

t(8;21)

239
Q

What is the most common symptom of patient with Myeloma?

A

Bone pain

240
Q

Cryoprecipitate is produced by centrifugation after thawing of this particular blood component

A

Fresh frozen plasma

241
Q

Asthma is a disorder characterized by:

A

Persistent subacute airway inflammation

242
Q

Major infectious cause of asthma exacerbation in adults is:

A

Influenza virus

243
Q

The hallmark of COPD is airflow obstruction as evidenced by

A

Decreased FEV1/FVC

244
Q

Paradoxical inspiratory inward movement of the rib cage seen in patients with severe COPD is called the:

A

Hoover’s sign

245
Q

The single most useful clinical sign of severe pneumonia among patient without underlying lung disease is:

A

RR>30/min

246
Q

Recurrent pneumonia in the same location is most likely due to the presence of:

A

Bronchial obstruction

247
Q

The presence of pus in the pleural space is termed as:

A

Empyema

248
Q

Sudden severe dyspnea, and P.E. finding of unilateral absent breath sounds and hypertesonance in a COPD patient without antecedent injury should make one suspect:

A

Secondary spontaneous pneumothorax

249
Q

Subcutaneous emphysema and Hamman’s sign is seen in:

A

Pneumomediastinum

250
Q

Hospital acquired pneumonia (HAP) is consider if pneumonia occur:

A

Occurs 48 hours after hospital admission

251
Q

A 56 y/o female admitted for Acute Pyelonephritis was started on Amikacin 500 mg IV every 6 hours. After 7 days repeat serum creatinine=5.7 mg/dL (Initial was 1.3 mg/dL). Urinalysis at this time will reveal:

A

muddy brown granular casts

252
Q

A 65 y/o male with poorly controlled diabetes had renal colic and underwent an IVP. He develop oliguria 1 day after the procedure. Repeat serum creatinine=6.9 mg/dL (Initial=2.9 mg/dL). The risks factors on this patient that predispose him to develop contrast dye nephropathy are the following, EXCEPT:

A

A. Diabetes / B. Renal Insufficiency / C. Infection* / D. Elderly

253
Q

The findings of eosinophiluria in patient with acute Renal Failure is suggestive of:

A

Acute Allergic Insterstitial Nepritis

254
Q

Which of the following statement is true regarding the measurement of GFR?

A

Serum creatinine is ⇑ after ingestion of cooked meat

255
Q

A patient with Chronic Renal Disease and GFR of 40 ml/min has serum K of 6.2 meq/L. the elevated K is due to the following, EXCEPT:

A

A.⇓ urinary K+ excretion* / B. constipation / C. ⇑ dietary K+ intake / D. drugs that ⇓ K+ secretion in tubules

256
Q

A 36 y/o female with Chronic Renal Disease complains of restless leg syndrome. Screatinine=5.2 mg/dL. You should advice the patient to:

A

initiation of Dialysis

257
Q

A 46 y/o hypertensive patient serum creatinine=9.8 mg/dL and with marked pallor. The anemia is primarily due to:

A

⇓ EPO synthesis

258
Q

The most prominent findings in patient with nephritic syndrome is:

A

proteinuria > 3.5 gm/1.73m2

259
Q

A 20 y/o male, smoker was admitted because of oliguria and hemoptysis. Initial lab: revel serum creatinine=8.6mg/dL. Urinalysis shows rbc casts and dysmorphic rbc. (+) anti GBM Ab’s. The expected histopathologic findings is

A

crescents formation

260
Q

Duration of treatment of acute uncomplicated cystitis in non pregnant woman is:

A

3 days

261
Q

Which of the following is a chronic clinical manifestation of Atherosclerosis?

A

Stable effort induced angina pectoris

262
Q

Atherosclerotic plaque that ate vulnerable to rupture is characterized by which of the ff.?

A

A. Thick fibrous cap / B. Large lipid cores / C. A high content of lymphocytes / D. Abundance of smooth muscle cells

263
Q

Which of the following risk factors is a coronary heart disease risk equivalent?

A

Diabetes Mellitus

264
Q

The abnormal lipoprotein profile associated with insulin resistance known as Diabetic dyslipidemia?

A

High Triglyceride, Low HDL

265
Q

Microvascular angina is a condition caused by:

A

Abnormal constriction or failure of normal dilatation of the coronary resistance vessels

266
Q

The major sites of atherosclerotic disease are the:

A

Epicardial arteries

267
Q

CAD manifested as symptoms of dyspnea, fatigue and faintness is known as

A

Angina equivalent

268
Q

The typical physical examination findings of patients with Stable Angina Pectoris is:

A

Normal

269
Q

Which of the following is typical of hypertensive crises?

A

Diastolic blood pressure is > 140 mm Hg

270
Q

Class I drug used in the treatment of symptoms of patients with Chronic stable Angina pectoris include which of the following?

A

ASA, beta blockers and NTG

271
Q

Stenosis of the left main coronary artery on three vessel disease in patients with Diabetes Mellitus or severe LV dysfunction are best treated with:

A

CABGS

272
Q

To achieve revascularization of the ischemic myocardium in patients with asymptomatic IHD and suitable stenoses of the epicardial coronary arteries, the best treatment option is:

A

PCI

273
Q

The most common presenting symptom of patients with STERMI is:

A

Deep and visceral pain

274
Q

The initial ECG changes in STEMI is:

A

A. ST segment depression / B. ST segment elevation / C. Deep Q / D. Tall T wave

275
Q

In which of the following pattern of MI will the use of morphine be restricted because of its vagotonic effect?

A

Postero inferior MI

Internal Medicine (1 decks)

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