MCU-FDT MEDICAL FOUNDATIONCollege of Medicine

Department of Medicine

1. In the pathogenesis of fever, which of the following statements is NOT true?A. Shunting of blood from periphery to internal organs occur to conserve heatB. Presence of PGE2 in the brain elevates set point of body temperatureC. Exogenous and endogenous pyrogens are destroyed by phagocytesD. Elevated cAMP induces the release of monoamine neurotransmitters

2. The sympathetic nervous system can increase heat conservation through:A. Increased heart rateB. VasoconstrictionC. Increased skeletal muscle contractionD. Resetting of thermostat level at hypothalamus

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

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

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

A. Amphetamine abuse C. Heat strokeB. Extrapyramidal symptoms D. Tetany

5. Increased heat production in cases of thyrotoxicosis can be secondary to:A. Chemical reaction of basal metabolism C. Chemical thermogenesisB. Increased skeletal muscle tone D. Vasodilation

6. What component of the lipid profile is anti-atherogenic?A. High density lipoprotein C. Total cholesterolB. Low density lipoprote.in D. Triglycerides

7. Which of the following manifestation is not a major criterion for rheumatic fever?A. Erythema multiforme C. Subcutaneous nodulesB. Migratory polyarthritis D. Sydenham’s chorea

8. A run of 3 consecutive premature ventricular depolarizations is known as:A. Asystole C. Ventricular fibrillationB. Supraventricular tachycardia D. Ventricular tachycardia

9. What is the most common type of atrial septal defect?A. Membranous type C. Ostium secundumB. Ostium primum D. Sinus venosus

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

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

11. Which of the following statements regarding cardiac symptoms is false?A. Chest discomfort and/or dyspnea that appear only during activity are characteristic of heart diseaseB. Many patients with heart disease may be asymptomaticC. Patients with valvular stenosis may manifest heart failure symptomsD. It is rare for asymptomatic cardiac patients to develop sudden death, acute myocardial infarction or stroke(p. 1301)

12. Which of the following best characterize the second heart sound?A. During inspiration, there’s and increase blood flow to the left ventriclecasing a delay in aortic valve closureB. Wide splitting of the second heart sound may be due to right bundle branch blockC. In pulmonary hypertension the second heart sound is softD. P2 is normally louder than A2 in the second left intercostal space

(p. 1307-1308)

13. Valvular abnormalities and chamber dilatation are best diagnosed by:A. Electrocardiogram C. EchocardiographyB. Treadmill exercise testing D. Nuclear imaging techniques (p. 1320)

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

A. Tall left precordial R waves and deep right precordial S wavesB. Diminished voltages in the limb leads (aVL or aVR) C. Right atrial abnormality absence of repolarization abnormalities (ST depression and T-wave inversions)(p. 1314)

15. Which is not a component of the metabolic syndrome?A. Waist circumference of >40 inches in menB. Triglycerides >150 mg/dLC. LDL > 40 mg/dLD. Blood pressure >130/>85 mmHg

(p. 1432)

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

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

17. The most common etiology for secondary hypertension is:A. Renal parenchymal hypertension C. Primary aldosteronismB. Renovascular hypertension D. Pheochromocytoma(p. 1464)

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

A. Rheumatoid arthritis C. Rheumatic Heart DiseaseB. SLE D. Rheumatomyositis

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

A. Essential hypertension C. PhrochromocytoneB. Renal artery stenosis D. Hyperaldosteronism

20. Saw tooth appearance of EKG tracing is diagnostic of:A. Ventricular tachycardia C. Atrial flutterB. Ventricular fibrillation D. Atrial fibrillation

21. MVP has the following features EXCEPT:A. More common in malesB. Most common course of isolated severe MR in North AmericaC. May cause syncopeD. Mid to late systolic click is the most important finding Reference: Harrison’s Principles of Internal Medicine 15th ed. pp. 1348

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

A. Tachycardia C. CardiomegalyB. Dyspnea or exertion D. Extremity edema Reference: Harrison’s Principles of Internal Medicine 15th ed. pp. 1323

23. The most common primary cardiac tumor is:A. Rhabdomyoma C. LymphomaB. Myxoma D. Sarcoma

24. An effective drug for meningococcal chemoprophylaxis:A. Cefotaxime C. ChloramphenicolB. Ceftriaxone D. Ceftizoxime(See p.854, 16th ed. of Harrison’s)

25. The etiologic agent of chancroid is:A. Treponema pallidum C. Haemophilus ducreylB. Calymmatobacterium granulomatis D. Neisseria gonorrhea(See p.771 Ulcerative Genital Lesions, 16th ed. Harrison’s)

26. Pyomyositis is usually due to:A. Group A Streptococcus C. Staphylococcus aureusB. Streptococcus pyogenes D. Clostridium perfringens(See p.744 Myositis/Myonecrosis, 16th ed. Harrison’s)

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

A. Negri bodies C. Schuffner’s dotsB. Owl’s eye bodies D. James stipplings(See p.1157 Pathogenesis of Rabies, 16th ed. Harrison’s)

28. Most vaccine for adults can be given also to pregnant women EXCEPT:A. Tetanus, diphtheria C. MMR, VariceliaB. Pneumococcal, influenza D. Rabies, Hepatitis B(See p.720 Use of Vaccines in Special Circumstances, 16th ed. Harrison’s)

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

A. CXR C. TB cultureB. PCR D. Direct microscopy(Sep.960 AFB microscopy, 16th ed. Harrison’s)

30. Urethritis can be documented on the basis of:A. Mucopurulent or purulent dischargeB. Gram stain or urethral secretion > 5 wbcs/hpfC. First void urine demonstrating > 10 wbcs/hpfD. Either A or C(See p.764 Approach to patient with suspected urethritis, 16th ed. Harrison’s.

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

31. Among the available test for Leptospirosis, the most sensitive and specific is:A. Culture with EMJHB. ELISA for antibodiesC. MAT using genus specific antigen for Leptospira patocD. Dipstick assay(See p.990 Diagnosis of Leptospirosis, 16th ed. Harrison’s)

32. The following are true of malaria EXCEPT:A. Hypoglycemia in falciparum malaria is associated with poor prognosisB. Splenic enlargement in endemic areas reflects repeated infectionC. In severe malaria, one predicter of poor prognosis is the predominanceof

immature P. falciparum parasitesD. The thick malarial smear has the advantage over the thin smear of concentrating parasites, thus increasing diagnostic sensitivity(See Table 195-3 p.1222, 16th ed. Harrison’s)

33. True of Staphylococcal infections EXCEPT:A. Toxic Shock Syndrome is a life threatening condition caused by toxins

elaborated by S-aureusB. Nikolsky’s sign is a feature of TSSC. In Ritter’s disease, the skin often has a sandpaper-like texture and is tenderD. Staphylococcal pneumonia most commonly follows tracheal intubation of a

hospitalized patient or vital infection of the respiratory tract.(See p.819 Staphylococcal Scalded Skin Syndrome, 16th ed. Harrison’s)

34. The following are infection control measures EXCEPT:A. Irrigation of urinary catheters, with or without antimicrobials, may

actually increase infection riskB. Replacing tubing circuits at intervals > 48 hours is one effective measure in

the aseptic care of respirator equipmentC. A control measure for surgical wound infection, aside from OR asepsis,

antimicrobial prophylaxis for high risk proceduresD. The recommended frequency of rotation of central venous catheter sites

is 5 days(See p.778 every 72 to 96 hours, infections related to vascular access and

monitoring, 16th ed. Harrison’s)

35. Characteristics of the itch mite include the following:A. It is an oval, ventrally flattened miteB. It can live on beddings for 7 daysC. The female dies after copulationD. The female lays 20 eggs per dayAndrews’ Diseases of the skin, 9th ed. p. 564-565

36. Infantile atopic dermatitis is characterized by the following:A. Lesions are less exudative, drier and more papularB. The buttocks and diaper area are often involvedC. Lesions are lichenified plaquesD. The face and scalp are more often involvedAndrews’ Diseases of the skin, 9th ed. p. 70

37. The main substance causing vasodilation in urticaria is:A. Serotonin C. BradykininB. Histamine D. ProstaglandinsAndrews’ Diseases of the skin, 9th ed. p. 163

38. Gutate psoriasis is usually preceded by:A. Trauma C. Streptococcal pharyngitisB. Hepatitis D. Viral exanthemAndrews’ Diseases of the skin, 9th ed. p. 221

39. An infectious disease transmitted by the body louse is:A. Trench fever C. Tsutsugamushi feverB. Dengue fever D. Scrub typhusAndrews’ Diseases of the skin, 9th ed. p. 552-553

40. Hormone implicated in the pathogenesis of androgenetic alopecia.A. Estrogen C. TestosteroneB. Cortisol D. Growth hormoneAndrews’ Diseases of the skin, 9th ed. p. 947-948

41. The 4 cutaneous findings of 11 criteria for diagnosis of SLE are:A. Malar erythema, urticaria, photosensitivity and discoid LEB. Malar erythema, photosensitivity, discoid LE, oral ulcersC. Malar erythema, photosensitivity, skin erosion, oral ulcersD. None of the aboveAndrews’ Diseases of the skin, 9th ed. p. 180-181

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

A. Antithrombin C. Factor VIIB. Protein C D. Plasminogen

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

A. Megaloblastic anemia C. Aplastic anemiaB. Myelodysplastic syndrome D. Paroxysmal nocturnal hemoglobinuria

44. A 55-year old man previously diagnosed to have stage 0 CLL developed anemia and unconjugated hyperbilirubinemia. What is the single most important laboratory test required to diagnose the cause of the anemia?

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

determination45. A 24-year old female suddenly developed jaundice, confusion, petechiae, and fever. Peripheral blood examination showed anemia and thrombocytopenia. Fragmented red cells were seen with nucleated red blood cells. Prothrombin and partial thromboplastin time were normal. What is the treatment of choice for this patient?

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

46. The treatment of choice in patients with acute promyelocytic leukemia.A. Anthracycline + cytosine arabinosideB. Vincristine + prednisoneC. All-transretinoic acid (ATRA) + anthracyclineD. Melphalan + prednisone

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

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

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

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

49. A 64-year old woman for preoperative evaluation was noted to have a markedly prolong PTT. Her prothrombin time, platelet count, and bleeding time were normal. She required blood transfusion blood transfusion after a dental extraction 2 years ago. Two siblings male and female has history of bleeding. The most likely diagnosis is a deficiency of:

A. Factor VII C. Factor XIB. Factor VIII D. Factor XII

50. An 18-year old male develops massive bleeding after removal of a large sebaceous cysts. Prothrombin time, PTT, platelet count, and bleeding time were normal. There is no family history of bleeding time. Which of the following tests should be ordered?

A. Factor XI level C. Urea clot lysis testB. Factor XII level D. Platelet aggregation study

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

A. RBC casts C. Broad castsB. WBC casts D. Hyaline castsHarrison 16th ed. pp. 251

52. The leading cause of end stage kidney disease is:A. Chronic glomerulonephritis C. Polycystic kidney diseaseB. Diabetic nephropathy D. Chronic pyelonephritisHarrison 16th ed. pp. 1688

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

A. Glibenclamide C. RosiglitazoneB. Insulin D. CaptoprilHarrison 16th ed. pp. 1689

54. A 25 year old, female, developed anasarca over 2 months period. Her urinalysis showed RBC and RBC casts. Kidney biopsy revealed membranous glomerulonephritis. This condition is most likely to be associated with:

A. Hepatitis B infection C. Diabetes mellitusB. Hypertension D. Periarteritis nodosaHarrison 16th ed. pp. 1687

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

A. Stage 1 C. Stage 3B. Stage 2 D. Stage 4Harrison 16th ed. pp. 1653

56. Dietary protein is restricted in which of these kidney conditions:A. Acute Pyelonephritis C. Renal failureB. Polycystic kidney disease D. Chronic glomerulonephritisHarrison 16th ed. pp. 1652

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

A. Initiation phase C. Diuretic phaseB. Maintenance phase D. Recovery phaseHarrison 16th ed. pp. 1645

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

A. Hypoproteinemia C. LipiduriaB. Glomerular proteinuria D. EdemaHarrisson 16th ed. pp. 1684

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

A. Intratubular block by debris C. Back leak of glomerular filtrateB. Renal hypoperfusion D. Nephrotoxicity from drugsHarrison 16th ed. pp. 1645

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

A. Nephrotoxicity C. Renal hypoperfusionB. Reduction in renal mass D. Interstitial nephritisHarrison 16th ed. pp. 1653

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

A. Morning stiffness less than 1 hourB. Radiographic change like erosion or decalcification of wrist boneC. Serum rheumatoid factor positivityD. Symmetric arthritisReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1885

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

A. Common in women of child bearing ageB. Males are sparedC. More common in blacks than in whiteD. Prevalence is form 15 to 50/100,000 populationReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1874

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

63. The pain she is experiencing maybe due to any of the following EXCEPT:A. Ligament insertion strain C. Muscle pain B. Cartilage destruction D. Capsular stretchingReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1936-1937

64. One of the following statement about TB arthritis is true:A. Culture of M. tuberculosis from the synovial biopsy is positive in 90% of casesB. Joint destruction is rapidC. Polyarticular involvement is more commonD. Treatment includes administration of Nafcillin and gentamycinReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1947

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

A. High ESR and (+) CRPB. High titer dsDNA and hypocomplementemia C. Leucopenia and anemiaD. ThrombocytosisReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1877

Carla, 18-years old student is being treated for pneumonia. On the 4th day of hospitalization she noted swelling, redness and severe pain of the (L) knee. Aspiration of the knee revealed whitish, purulent fluid consistent with septic arthritis.

66. The laboratory test you would request for the condition is:A. Liver function test C. Culture and sensitivity of fluidB. Urinalysis D. ANAReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1945

67. The probability of a CPPD disease will reveal crystals appearing as:A. Highly birefringent, large flatB. Negatively birefringent, needle shapeC. Positively birefringent, rod shapedD. Spheroidal aggregationReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1942

68. The pain in osteoarthritis arise from the following structure EXCEPT:A. Articular cartilageB. Stretching of joint capsuleC. Stretching of periosteum covering osteophytesD. SynovitisReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1937

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

A. Morning stiffness less than 1 hourB. Radiographic change like erosion or decalcification of wrist boneC. Serum rheumatoid factor positivityD. Symmetric arthritisReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1885

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

A. Common in women of child bearing ageB. Males are sparedC. More common in blacks than in whiteD. Prevalence is form 15 to 50/100,000 populationReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1874

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

71. The pain she is experiencing maybe due to any of the following EXCEPT:A. Ligament insertion strain C. Muscle pain B. Cartilage destruction D. Capsular stretchingReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1936-1937

72. One of the following statement about TB arthritis is true:A. Culture of M. tuberculosis from the synovial biopsy is positive in 90% of casesB. Joint destruction is rapidC. Polyarticular involvement is more commonD. Treatment includes administration of Nafcillin and gentamycinReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1947

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

A. High ESR and (+) CRPB. High titer dsDNA and hypocomplementemia C. Leucopenia and anemiaD. ThrombocytosisReference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1877

74. The recommended screening test for DM is:A. FPC C. RBSB. 2-hr OGTT D. HbAicReference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2154

75. All of the following symptoms are consistent with hypothyroidism EXCEPT:A. Constipation C. Heat intoleranceB. Menorrhagia D. Hoarse voiceReference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2109

76. The most specific feature of cushings syndrome is:A. Centripetal obesity C. HirsutismB. Weight gain D. Hypertension Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2139

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

A. Retinopathy C. NephropathyB. Neuropathy D. Peripheral vascular diseaseReference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2161

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

A. It is characterized by autoimmune destruction of the beta cellsB. There is impaired insulin secretionC. Peripheral insulin resistance may be presentD. There is excessive hepatic glucose productionReference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2157

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

A. Reduces the hepatic level of fructose 2-6 phosphateB. Decreases the activity of pyruvate kinaseC. Promotes the process of glycogenolysisD. Increases the levels of the GLUT4 glucose transporterReference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2159

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

Stimulates vasopression secretionsC. Increases urine potassium excretion at high dosesReference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2131

81. Choose the correct pair of tumor marker and cancer implicated:A. Alphafetoprotein – colon cancerB. CA-125 - ovarian cancerC. Lactate dehydrogenase – myelomaD. Carcinoembryonic antigen – hepatocellular carcinomaHarrison’s Internal of Medicine, 16th ed. 439

82. The leading cause of cancer death in both men and women.A. Lymphoma C. Lung CAB. Nasopharyngeal CA D. Large cell CAHarrison’s Internal of Medicine, 16th ed. 436, 506

83. The most common histologic subtype of lung cancer for the past 25 years.A. Squamous or Epidermoid C. Small cell CAB. Adenocarcinoma D. Large cell CAHarrison’s Internal of Medicine, 16th ed. 506

84. Usually, these types of lung cancer have already spread at the time of presentation and diagnosis, hence, surgery is unlikely to be curative. They are managed primarily by chemotherapy with or without radiotherapy.

A. Squamous or Epidermoid C. Small cell CAB. Adenocarcinoma D. Large cell CAHarrison’s Internal of Medicine, 16th ed. 506

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

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

A. Digital rectal examB. Assay for serum PSA (prostate specific antigen)C. Ultrasound of bladder/prostateD. Transrectal ultrasound guided biopsyHarrison’s Internal of Medicine, 16th ed. 446

86. Examinations revealed prostate cancer. The most common site for its metastasis:A. Lungs C. ColonB. Liver D. BoneHarrison’s Internal of Medicine, 16th ed.

87. Deregulation of molecular mechanics controlling cell cycle progression is a hallmark of cancer. Which phase of the cell cycle is critical in the regulation of cell proliferation.

A. M C. SB. G1 D. G2Harrison’s Internal of Medicine, 16th ed. 453

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

A. Burkitt’s Lymphoma – Epstein Barr virusB. Cervical cancer – Human Papilloma virusC. Hepatocellular carcinoma – Hepatitis B virusD. Colon cancer – Helicobacter pyloriHarrison’s Internal of Medicine, 16th ed. 442

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

A. Menarche at 12 y/o, Primigravida at 18, menopause at 45B. Menarche at 12 y/o, Nulligravida, menopause at 52C. Menarche at 12 y/o, Multigravida, menopause at 45D. Menarche at 16 y/o, Primigravida at 25, surgical menopause at 40 because of

TAHBSOHarrison’s Internal of Medicine, 16th ed. 517

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

A. Hyperuricemia C. HypercalcemiaB. Hyperphosphatemia D. HyperkalemiaHarrison’s Internal of Medicine, 16th ed. 581

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

PH-smoker 1 pack of cigarette/day since age of 25 … no other serious illness in the past. Pertinent P. E. Findings: RR – 28/min.Chest: Symmetrical expansion: resonance of percussion, crackles on the left midlung to base posteriorly with bilateral forced on expiration.

91. What disease conditions would you entertain? A. Chronic bronchitis (COPD) C. PneumoniaB. Mycosis D. All of the above

92. What diagnostic laboratory examination would you request for?A. Chest x-ray C. CBCB. Sputum gram stain, culture and sensitivity D. All of the above

93. How would you start your management?A. O2 inhalation C. NebulizationB. IV antibiotic D. All of the above

94. If arterial blood gas examination showed – ph7.33, pCO2-50 mmHg, pCO2 of 75 mmHg and HCO3 of 28 mEq/L. What would be your interpretation?

A. Respiratory acidosis with hypoxemiaB. Respiratory alkalosis with hypoxemiaC. Respirator and metabolic acidosisD. Adequate Oxygenation

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

A. PFT C. ECGB. Sputum for fungus D. A and B

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

96. What is the most likely diagnosis:A. Pulmonary Tuberculosis C. Chronic Obstructive Pulmonary DiseaseB. Bronchial Asthma D. Pneumonia

97. What laboratory examination will you request to confirm the diagnosis:A. Chest x-ray C. Chest CT scanB. Sputum examination D. Spirometry

98. The mainstay in the treatment of this patient:A. Inhaled bronchodilator C. MethylxanthinesB. Inhaled corticosteroids D. Antibiotics

99. A feature that best characterize chronic bronchitis.A. Elastic recoil is severely decreasedB. Airway resistance is normalC. Pulmonary hypertension moderate to severe at restD. Diffusing capacity is decreased

100. The most common mechanism of hypoxemia:A. Decrease in inspired PO2 C. ShuntB. Hypoventilation D. V/Q mismatching

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

A. Heartburn C. RegurgitationB. Angina D. Water Brashp.1588 

102. Your clinical impression for this Patient is:A. Acute myocardial infarction C. Gastric UlcerB. Gastroeophageal Reflux Disease D. Esophageal Carcinoma p. 1592 

103. The pathophysiology of this disease is:A. Spasm of the coronary arteryB. Increase acid secretion in the stomachC. Decrease in the tone of the lower esophageal sphincter due to muscle weaknessD. Exposure to carcinogens p. 1592 

104. The drug of choice for this patient is:A. Nitrates C. Calcium channel blockersB. Antacids D. Protom pump inhibitors p. 1593  

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

A. Sigmoid Diverticulits C. Irritable Bowel SyndromeB. Acute Appendicitis D. Colon Cancer p. 1649 

106. Mark, a 7 yr old boy was passing by McDonald’s and smelled the aroma of hamburgers. At this instant, acid secretion took place in his stomach. Which phase of acid secretion was responsible for the acid secretion?

A. Cephalic C. IntestinalB. Gastric D. Interdigestive

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

A. Histamine C. SomatostatinB. Gastrin D. AcetylcholineC.

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

A. 3cm from the pyloric opening C. 2nd portion of the duodenumB. 10cm from the duodenal bulb D. 3rd potion of the duodenum

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

A. Perforation C. Gastric outlet obstructionB. Penetration D. Hemorrhage

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

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

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

C. Gastric epithelial cells bordering an injury migrate to restore a damage regionD. Epithelial cell renewal occurs and together with angiogenesis preserve

integrity of the gastric tissues