San Lazaro Hospital Shifting Exam

Topics

A. Definition of nosocomial infection and the most common mode of transmission of nosocomial infection

B. What will you do if you will see a hyperlucency of the Right lung field in chest x-ray of an 18 year-old male patient who while

playing basketball, suddenly developed pleuritic chest pain?

a. Insert CTT

- know the steps in proper handwashing in correct sequence

- know the IMCI guidelines in dehydration (including calculation of

fluid resuscitation)

- Rabies category and post-exposure prophylaxis

o Rabies Immune Globulin (in pedia, 20 IU/Kg BW)

o Vaccine

Thai Red Cross (1-1-1-1-1) given ID

Day 0

Day 3

Day 7

Day 28/30

Day 90

Zagreb Protocol (2- 1 -1) given IM

Day 0

Day 7

Day 21

- The criteria of correct attachment of a breastfeeding babys mouth with the mothers breast

o Chin of the baby attached to the chin of the mothers breast

o Mouth of the baby is opened wide

o The lower lip of the baby is sucked inward

o There is more exposed areola above the babys upper lip.

Matching type

A. Diagnostic test of choice

Leptospirosis (blood culture)

Typhoid fever (blood culture)

Cryptosporidiosis (stool)

Tetanus (clinical)

Rabies (FAT)

Pneumonia (chest x-ray)

Pulmonary tuberculosis (Sputum culture)

Dengue hemorrhagic fever (if included in the choices, serum IgM)

Herpes (Tzanck smear)

Schistosomiasis (COPT, Kato-Kat)

Malaria (Thin and thick blood smear)

Diphtheria (culture of pharyngeal swab)

Cryptococcosis India ink stain of CSF ; CALAS

B. Drug of choice

A. Pregnant with complicated typhoid fever - ceftriaxone B. Pregnant with malaria - quinine C. Clinical leptospirosis Pen G D. Leptospirosis Pen G E. Severe pneumonia Imipenem, cabapenem F. Dengue Fever none G. Tetanus Metronidazole

C. Give the etiologic organism and the drug of choice

1. risus sardonicus Clostridium tetany Metronidazole

2. pertussis Bordetella pertussis Eryhtromycin

3. Acute parotitis Mumps virus (paramyxoviridae) supportive therapy

4. diphtheria Corynebacterium diphtheriae Pen G

5. Leptospirosis Leptospira interrogans Pen G

6. Schistosomiasis Schistosoma japonicum praziquantel

7. Measles Measles virus supportive treatment

8. Washerwomans hands Vibrio cholerae Fluoroquinolone (Ciprofloxacin)

9. complictated Typhoid fever Salmonella typhi Ciprofloxacin

10. Dystentery Shigella flexneri/sonnei/ boydii Ciprofloxacin

11. Amoebiasis Entamoeba histolytica - Metronidazole

Oral Medications:

Paracetamol 10-15 mkdose q4

Salbutamol 0.1 mkdose q6-q8

Amoxicillin 20-40 mkd (0 mkd for otitis media)

Ampicillin/Chloramp enicol/Cloxacill in 50-100 mkd (Ampicillin 100 mkd for

Haemophilus influenza, 200-400 for meningitis)

Cefalexin 25-50 mkd

Diphenhydramine: 3-5 mkd q6

Chlorphenamine maleate: 0.35 mkd

Metronidazole 10 mkd for amoebiasis, 5 mkd for giardiasis

Anti-TB meds:

INH 5-10 mkd

Rifampicin 10-15

Pyrazinamide 15-25

Ethambutol 15-25

Streptomycin 20-30

IV Penicillin G 200,000 Ukd q4-q6

Ampicillin 100-200 mkd q6

Gentamicin 4mkd

Diphenhydramine: 1 mkd

Computation of Fluids

1. Holiday Method

a. Maintenance: makes up for urine output and insensible water loss

b. TFR = 1600 mL/day + 24 h = 0.66mL/h x 4- any factor

66 ugtts/hr 16 gtts/min

insensible water loss = 400 x BSA

BSA = [ht (cm) x wt (Kg)]

3600

2. Lindaus Method

Mild

3-5%

Moderate

6-9%

Severe

>10%

15kg 30 60 90

3. Nelsons

Maintenance Holidays, deficit Lindaus

Revalida ata to...

NUTRITION/IMMUNIZAT ION:

______ 1. A type of anemia that shows macrocytic RBCs is seen in deficiency of:

a. Vitamin A c. Vitamin B6

b. Iron d. Vitamin B12

_______ 2. Hemorrhagic disease of the newborn is seen in:

a. Breastfed babies c. Vitamin K deficiency e. A and C

only

b. Babies born in a hospital d. all of the above

_______ 3. When the head circumference is greater than the chest

circumference at 1 year old, it is an indication of:

a. Cerebral palsy c. Seizure disorder

b. Malnutrition

_______ 4. The most common clinical manifestation of Kwashiorkor is:

a. old mans facies c. brittle hair

b. edema d. weight loss

_______ 5. Anthropometry involves:

a. computing for daily caloric requirements

b. measuring physical dimensions of the human body at different ages

c. monitoring growth and development

_______ 6. The EPI targets children:

a. 0-12 years old c. 0-12 months old

b. 1-6 years old

_______ 7. To ensure the potency of a vaccine from time of manufacture to

the time it is given, one should implement the:

a. preservation chain c. cold chain

b. refrigeration chain

_______ 8. A completely immunized child in a health center setting means:

a. vaccines under the EPI were given c. MMR was given at 15 months

b. BCG, DPT and Polio only were given d. all of the above

_______ 9. Measles vaccine:

a. is given at 0.5 ml e. A and C only

b. is injected IM (subcu) d. all of the above

c. may cause fever and rashes after f. none of the above

few days

_______ 10. Live vaccines can be given to:

a. patients on chemotherapy c. hemophilia patients?

b. AIDS patients d. patients on steroids

Write check () for the true statement or zero (0) for the false statement.

_____t__ 11. A 2year old infants height should be measured standing up.

_____t__ 12. The head and chest circumference should also be included in the

anthropometric

data.

______t_ 13. Minimal clothing is required in weighing the child.

_____t__ 14. Multivitamins should be routinely given.

_____t__ 15. Breastfeeding is best up to 6 months of age.

PRIMARY OBSTETRICS/GYNECOLO GY

28 years old patient consulted because of vaginal spotting accompanied by

hypo gastric pain since 2 days PTC. LMP: _________ OB Hx: 1998TERM, NSD; 1993, 94, 95abortions incomplete, completed by curretage; 1998 TERM, NSD, live girl; PH: March 2002 myomectomy; January 2000 Dx Hyperthyroid; PPPE: BP 130/90; PR: 102/min RR: 30/min; HHENT: pink

palpable conjunctivae with anterior neck mass; Speculum exam ex. bluish with minimal blood coming from the OS; whitish curd like discharge on the

lateral vaginal walls. IE Cx soft, long closed; uterus slightly enlarged; adnexae (-) for mass/tenderness.

______ 16. The bleeding in this case may be:

a. normal findings c. incomplete abortion

b. ectopic pregnancy d) threatened abortion

______ 17. The bleeding in this case may be managed by:

a. traditional birth attendant at home c. doctor at the district hospital

b. midwife in the rural health unit d. referral to tertiary hospital

______ 18. The complete age of gestation is:

a) 910 weeks b) 1112 weeks c) 1011 weeks d) 1213 weeks

19,20,21. Patient is high risk because: a. ____________ _________

_________ _____

b.__________ _________ _________ __ c. ____________ _________ __

______ 22. Whitish curd like discharge is most probably:

a) bacterial vaginitis b) gonorrhea c) candidiasis

d) trichomoniasis

______ 23. Yellowish frothy vaginal discharge accompanied by vulvar

prunitis is:

a) gardnerella b) moniliasis c) trichomoniasis d) bacterial

vaginitis

______ 24. Trichomoniasis is caused by:

a) virus b) bacteria c) fungus d) protozoa

______ 25. Treatment for threatened abortion is:

a) curettage b) syntocinon c) multivitamins d) tocolytic agents

______ 26. To estimate the date of ovulation in a patient with regular 28-32

days cycle, it is important to observe the fertile cervical mucus that is usually

felt:

a. 14 days after the last period c. anytime before the next period

b. 14 days before the next period d. near the midcycle

______ 27. The LMP of Mrs. Anita Garcia, 40, G6P4 (4014) is May 25-29,

2005. Her estimated date of confinement is:

a. March 15, 2006 c. Feb. 29, 2006

b. March 1, 2006 d. April 1, 2006

______ 28. The most common site of breast malignancy is at which quadrant?

a. right upper inner c. left upper outer

b. left lower inner d. right lower outer

______ 29. During the rainy season the most common infection consulting at

the outpatient is:

a. Bacterial c. Parasitic

b. Viral d. Protozoal

______ 30. At the rural community, the most important preventive measure

against Pulmonary Kochs infection is:

a. Prophylactic anti-B c. environmental sanitation

b. immunization d. health education

______ 31. Poisoning among farmers using fertilizer may best be prevented

by:

a. proper hygiene c. use of goggles and gloves

b. using cap and mask d. organic farming instead

______ 32. To monitor if patients with serious illnesses are compliant with

medical advise, it is the responsibility of the doctor to:

a. advise weekly visit to Center c. send to UST hospital

b. track patients to see their status d. refer to district hospital

______ 33. Since patients rarely consult at SMPCSMC for natural family

planning (NFP), we must:

a. do house to house campaign

b. give brochures to all our patients

c. create the opportunity to facilitate the NFP

d. lecture to all the women in the Barangay

______ 34. The most common co-morbid condition why some children at the

nutrition program are slow to thrive is:

a. Primary complex c. Scabies

b. Parasitism d. Upper Respiratory Tract Infection

______ 35. The Schistosomiasis discovered in a patient who consulted at the

SMPCSMC had a chief complaint of:

a. loss of weight c. fever

b. pruritus d. edema

______ 36. The most widely used screening for MTB is:

a. Chest X-ray, PA & Lateral c. PPD

b. Sputum microscopy d. history and physical exam

______ 37. The final diagnosis of Julius Macawile, 37 years old, male, single,

was Pulmonary

Tuberculosis, Relapse, Return after Default, Treatment Category II. The

treatment regimen of which consist of:

a. 2 HRZE / 4 HR c. 2 HRZ / 4 HR

b. 2 HRZES / 1 HRZE / 5 HRE d. 2 HRZ / 1 HRZE / 5 HRE

______ 38. The most cost effective intervention for TB control is

a. INH c. BCG vaccine

b. DOTS d. lifestyle improvement/ proper nutrition

______ 39. Most common route of pneumonia infection is through:

a. direct inoculation of the organism from an open wound in the chest

b. blood contamination/ transfusion

c. inhalation

d. aspiration of organisms from the oropharynx

______ 40. Atypical pneumonia:

a. is a viral infection

b. presents with sudden onset of fever, cold, cough

c. has prominent pleuritic pains

d. has malaise and other extra pulmonary symptoms

FAMILY MEDICINE

______ 41. Separation anxiety a. nuclear family

______ 42. Consists of one generation b. family tree

______ 43. Determines family resources available c. APGAR

______ 44. Shows dynamic interaction between family d. functional

relationship members

______ 45. Brought about by remarriage e. blended

family

______ 46. Comprehensive medical management for patient f. family

health care plan and his family

______ 47. Denotes hereditary illness in the family g. medical

history

______ 48. Determines family function/dysfunctio n h. family

lifeline

______ 49. Index patient is indicated with an arrow i. family with

young children

______ 50. Parents and children living in one household j. SCREEM

k. 1st order change

l. none of the above

RESEARCH METHODOLOGY

Scenario: As a medical student you were tasked to do a research on the

relationship between nutritional status and IQ levels among grade 2 students.

I. Write check () for true statement or zero (0) for false statement.

A. The appropriate research design for the above scenario to determine the

magnitude of malnutrition and low IQ is:

_______51. case series

_______52. experimental study

_______53. cohort study

_______54. cross-sectional study

_______55. case-control study

B. The research question is the most important part of your research proposal

and

should contain the following:

_______56. biologic rationale

_______57. population

_______58. exposure/cause/ independent variable

_______59. outcome/effect/ dependent variable

_______60. study design

MULTIPLE CHOICE:

______ 61. It is calculated in a case-control study:

a. incidence rate b. relative risk c. prevalence d. odds ratio

______ 62. This term determines which started first, the cause or the effect:

a. matching b. temporal sequence c. blinding d.

randomization

______ 63. This timing or approach is preferred for making causal inferences:

a. retrospective b. ambispective c. prospective

d. none of the

above

______ 64. This is done in a case-control study wherein subjects are in two

groups to minimize variability:

a. matching b. temporal sequence c. blinding d.

randomization

______ 65. The purpose of BLINDING is to achieve:

a. validity b. objectivity c. precision d.

accuracy

______ 66. A variable that distorts the apparent relationship between exposure

and outcome:

a. independent var b. dependent var c. confounder var d.

control var

______ 67. Characteristics of a cross-sectional study:

a. subjects have rare diseases c. incidence rate can be

measured

b. applicable for short duration diseases d. determines

magnitude of a disease

______ 68. A measure of the precision of an instrument/tool:

a. accuracy b. repeatability c. both d.

neither

______ 69. One criteria for choosing a research topic is the serenity/gravity of

the problem and persons affected. It means:

a. novelty b. relevance c. feasibility d.

ethical issues

______ 70. The statement of the research Problem means:

a. first step in the development of a research project

b. it is an integral part of selecting of a research project

c. focusing the investigators chosen topic

d. all of the above

______ 71. Elements of a research question is/are:

a. biological rationale c. exposure and outcome

are defined

b. study population d. all of the above

______ 72. Purpose of a comprehensive literature search is/are:

a. to elaborate on the significance of the study

b. to cite similar studies done on the subject of interest

c. to find

d. all of the above

______ 73. The term means unawareness of the true nature of treatment:

a. manipulation b. randomization c. masking d. matching

______ 74. True of case-control studies:

a. there should be a disease no disease groups at the start of the study

b. only the disease group should be included

c. very expensive

d. needs a large of sample population

______ 75. This characteristics is true of cohort studies:

a. subjects should have the outcome in generation

b. exposed and unexposed groups should be similar with regards

possible

confounding factors

c. there should be equal numbers of persons in both study groups

d. subjects to be chosen should have the outcome in question at the start of

the study

______ 76. An ideal diagnostic test/procedure should be able to transform

significantly the pre-test probability to the post-test probability. This is

achieved:

a. with high positive likelihood ratio c. both

b. with low negative likelihood ratio d. neither

______ 77. In a very sensitive test, it is more useful if the test result is

negative because:

a. the patient can be excluded as having the disease

b. the patient can be included as having the disease

c. it has high true positive rate

d. it has high false negative rate

______ 78. Positive predictive value of diagnostic test is affected by the

following:

a. sensitivity c. specificity

b. prevalence of a disease d. likelihood ratio

______ 79. The ideal diagnostic cut off value in a ROC curve with high

specificity and sensitivity is found near the:

a. upper left corner c. under the curve

b. upper right corner d. left lower corner

______ 80. This is used to convert pre-test probability to post-test probability:

a. positive predictive value c. sensitivity

b. prevalence of a disease d. likelihood ratio

______ 81. Odds ratio of 4 is equivalent to a probability of:

a. 80% b. 20% c. 75% d. 25%

______ 82. Probability of 50% is equivalent to odds of:

a. 4 b. 3 c. 2 d. 1

______ 83. Type II error is:

a. rejecting a false Ho c. accepting a true Ho

b. accepting a false Ho d. rejecting a true Ho

______ 84. P-value is compared with alpha, which of the following is true?

a. alpha should be greater than P-value to be significant

b. alpha should be lower than P-value to be significant

c. alpha is not related to P-value

d. alpha value is the size of type I error

______ 85. Relative risk value of more than one means:

a. treatment option A is the same as option B

b. treatment option A is better than option B

c. treatment option A is worst than option B

d. treatment option A and B are not related

______ 86. Source of indoor air pollution:

a. environmental tobacco smoke (ETS) c. hazardous pollutants

b. criteria pollutants d. ozone

______ 87. Biological sources of indoor air pollution:

a. households pets c. disinfectants e. glues

b. smoking (ETS) d. textile

______ 88. Primarily combustion-related products:

a. asbestos c. criteria pollutants e. waste products

b. carcinogens d. industries products

______ 89. Binds to hemoglobin to reduce capacity of the blood to deliver

oxygen in the tissues:

a. nitrogen oxide c. carbon monoxide

b. sulfur oxide d. hydrogen peroxide

______ 90. Populations susceptible to air pollution:

a. asthmatics c. elderly e. all of the above

b. cigarette smokers d. only A and C

______ 91. Food preservatives:

a. nitrates and nitrites c. metals e. all of the above

b. ethylene dibromide d. glass

______ 92. Addition of poisonous or other deleterious ingredient, which may

render such article injurious to health:

a. bacterial food poisoning c. adulteration of food

b. chemical food poisoning d. food decomposition

______ 93. Diseases spread in milk:

a. salmonella c. staphylococcus aureus e. only A

b. E coli d. all of the above

______ 94. Carcinogen found in tea:

a. caffeine c. tannins e. hydrazines

b. alcohol d. aflatoxins

______ 95. Particle size that can be carried by diffusion to the alveolar level:

a. 10 um c. 1-2 um e. 0.05 um

b.