Professional Documents
Culture Documents
REVIEW
Class 2010
TIPS
Which of the following vaccines are
composed of inactivated bacterial or
viral components?
a. Tetanus – toxoid
b. Varicella – live attenuated
c. Influenza – inactivated virus
d. Measles – live attenuated
Question 1
Live Inactivated Toxoids Component
attenuated
MMR Inactivated Diphtheria Hib
polio
Oral polio Influenza tetanus Hep B
Varicella Hep A
Pneumococcal
Types of Vaccines
Which of the following vaccine/s is/are
contraindicated in a pregnant woman?
a. Varicella
b. Measles
c. Mumps
d. All of the above
Question 2
A 50 year old man with COPD was rushed to the ER for dyspnea. History
revealed a 1 week history of decreased sensorium associated with
high grade fever and decreased urine output. Initial PE: BP 80/60
becoming 90/60 after fluid challenge. HR: 100, RR: 40 T: 39C. Sputum
GS showed Gram negative bacilli. What is the most likely diagnosis?
Question 3
c. SIRS - Two or more of the following conditions:
(1) fever (oral temperature >38°C) or hypothermia
(<36°C);
(2) tachypnea (>24 breaths/min);
(3) tachycardia (heart rate >90 beats/min);
(4) leukocytosis (>12,000/L), leukopenia (<4,000/L), or
>10% bands; may have a noninfectious etiology
Question 3
Which of the following organisms comprise are HACEK organisms ?
a. Haemophilus
b. Acinetobacter
c. Clostridium
d. Klebsiella
e. All of the above
Question 4
What is the most common presenting
symptom of infective endocarditis?
a. fever – 80-90%
b. heart murmur – 80-85%
c. arthralgia – 15-30%
d. anorexia – 20-50%
Question 5
Definitive Endocarditis
• 2 major criteria (microbiologic,
endocardial involvement)
• 1 major + 3 minor
• 5 minor
Possible endocarditis
• 1 major + 1 minor
• 3 minor
Duke’s Criteria
Which of the following clinical scenario will
increase the risk of MDR-TB except?
Question 6
Which of the following extrapulmonary TB will
benefit from oral steroids?
Question 7
Which of the following infections are
associated with Streptoccocus pyogenes?
a. Impetigo contagiosa
b. Bullous impetigo – Staph
c. Hot Tub Folliculitis – Pseudomonas
d. None of the above
Question 8
Which of the following viruses are
associated with the common cold
EXCEPT?
a. Rhinovirus
b. coronavirus
c. adenovirus
d. Influenza virus
Question 9
True statements regarding the diagnosis of typhoid
fever EXCEPT?
Question 10
Which of the following statements regarding Dengue
Fever is/are TRUE except?
Question 11
A 21 year old sexually active woman presents with
fever, pleuritic pain of the RUQ and lower abdominal
pain. Pelvic examination reveals mucopurulent
cervicitis and tenderness after production of cervical
motion. The RUQ, uterine fundus and adnexae are
slightly tender. Lab exam revealed a high WBC count
and elevated ESR, rest of the lab exams including
liver function tests are normal. Which of the following
agents are the most likely cause of this clinical
syndrome?
Question 12
Which of the following regarding leptospirosis is/are TRUE?
Question 13
Which of the following disease confer
protection against death in malaria?
Question 14
A 20 year old female consults your clinic for chronic
cough for 1 month. She is 2 months pregnant. On
PE, there were no crackles. CXR showed apical
infiltrates on the R upper lung field, Sputum AFB
done thrice was +1. What is the most appropriate
treatment?
Question 15
Physical examination of a cardiac patient
reveals large, bounding peripheral pulses.
This finding is consistent with? – Hyperkinetic
pulse is usually associated with an increased
left ventricular stroke volume, a wide pulse
pressure, and a decrease in peripheral vascular
resistance
a. Mitral Regurgitation
b. Patent Ductus Arteriosus
c. Ventricular Septal Defect
d. All of the above
Question 16
Which of the following statements is/are true
regarding the a wave of the jugular venous pulse? -
positive presystolic a wave is produced by
venous distention due to right atrial contraction
and is the dominant wave in the JVP, particularly
during inspiration
Question 17
Jugular Venous Pulse
Which of the following heart murmur/s
decrease in length and intensity during
valsalva maneuver?
Question 18
A 40 year old male suddenly collapsed on the golf
course is brought to the ER. At the ER, patient has no
spontaneous pulse or respiration. CPR was
performed, a line was inserted and the patient was
intubated. On the cardiac monitor, you see the strip
below, you order defibrillatory shocks: 200 joules, the
300 joules, then 360 joules. CPR is continued. Which
of the following is the most appropriate drug to
administer at this time?
Question 19
Vaughan Williams Classification
Factors accounting for bipedal edema
associated with congestive heart failure
include all of the following except?
Question 20
Aspirin has been shown to reduce the risk of
myocardial infarction in all of the following
groups EXCEPT?
Question 21
A 63 year old woman with is brought to the ER by relatives
because she has become incoherent in the past 24 hours. At
the ER, PE revealed a disoriented woman with BP: 240/160
HR: 110, RR: 20, afebrile. The chest reveals bibasilar rales.
Rest of the findings was normal. Relatives revealed that the
patient has not been taking her antihypertives meds in the
past several weeks. Emergent CT scan showed no
hemorrhage or mass lesion. The most appropriate next step
would be to?
Question 22
A 70 year old retired businessman with no past medical
history presents to the ER 4 hours after the onset of
severe substernal crushing chest pain with radiation to
the left arm and neck. ECG revealed ST elevation in
leads V1 to V6. The patient has no clear cut medical
contraindications to anticoagulation. Which of the
following would be the optimal management at this
time?
Question 23
A 52 year old male with significant COPD presents
with dyspnea for 2 days and palpitations for the
past hour. On PE, there is diffuse expiratory
wheezing and an irregular heart rate. ECG
demonstrates rapid atrial fibrillation at HR of 170
and on specific ST- and T wave changes. All of the
following should be used to treat the patient’s AF
except?
a. Digoxin
b. Metoprolol
c. Verapamil
d. Cardioversion
Question 24
All of the following regarding the vascular biology of the
atherosclerotic process are true EXCEPT?
Question 25
A 72 year old male smoker with COPD was admitted 2 days
ago with a patchy right lower lobe pneumonia
accompanied by fever, cough and dyspnea. He was started
on IV Cefuroxime. On the 3rd hospital day, he is afebrile, has
good oral intake, no cough or sputum and is not short of
breath. O2 sat on room air is 92%. Repeat CXR shows a
slight decrease in his R lower lobe infiltrate compared to
his initial CXR. What is the next best clinical approach in
the management of this patient?
Question 26
A 65 year old man was hospitalized for an
exacerbation of newly diagnosed COPD. You
discharged him 4 weeks ago and now presents at
the OPD for follow up. He has never received any
adult vaccinations. Which of the following
preventive approach for pneumonia will you
recommend to your patient?
a. Pneumococcal vaccine
b. Pseudomonal vaccine
c. Haemophilus influenzae type B vaccine
d. Influenza vaccine
Question 27
A 25 year old woman presents at the ER with a 2 day history of fever,
chills, cough productive of greenish sputum and shortness of breath.
At the ER, she is in severe respiratory distress HR: 125, RR: 36, BP:
80/50, O2 sat at room air 82%. CXR shows bilateral diffuse infiltrates
with consolidation in the right middle lobe. Sputum GS shows
numerous neutrophils and scattered gram positive cocci and gram
negative bacilli. What is/are the appropriate antibiotic/s on which to
start this patient?
Inpatients, ICU
A beta-lactame [cefotaxime (1–2 g IV q8h), ceftriaxone (2 g IV od),
ampicillin-sulbactam (2 g IV q8h)] plus
Azithromycin or a fluoroquinolone (as listed above for inpatients, non-
ICU)
Question 28
A 64 year old woman undergoes diuretic therapy for severe
CHF complicated by a right sided pleural effusion. Three
weeks later her symptoms are moderately improved and
her weight has decreased by 4.5 kg but the effusion
persists. She denies fever, chest pain, or leg swelling. PE
shows an S3 and a grade 3/6 holosystolic murmur. –
transudative
Question 29
A 42 year old man presents with right upper
lobe cavitary infiltrate and also right sided
pleural effusion. Sputum and pleural fluid
acid fast smears are positive. – exudative
Question 30
Which of the following are TRUE regarding
measurements in lung volume?
Question 31
Spirometry
Which of the following regarding features of asthma is TRUE?
Question 32
Which of the following regarding treatment of asthma is
TRUE?
Question 33
Which of the following statements regarding
pneumothorax is TRUE?
Question 34
Primary vs Secondary Pneumothorax
Which of the following are proven risk
factors for COPD?
a. cigarette smoking
b. respiratory infections
c. All of the above
e. None of the above
Question 35
Which of the following interventions have
been demonstrated to influence the
natural course of COPD?
a. Smoking cessation
b. Ipatropium bromide
c. Theophylline
d. All of the above
Question 36
Which of the following statements regarding
the diagnosis of pneumonia is TRUE?
Question 37
A 65 yr old man with a long history of
constipation presents with cramping LLQ
pain. PE showed low grade fever,
midabdominal distention and LLQ
tenderness. CBC showed: leukocytosis with
shift to the left. The patient most likely has?
a. colon CA
b. Inflammatory Bowel Disease
c. Ulcerative Colitis
d. Acute diverticulitis
Question 38
Diverticulitis
Most common site of bleeding in porto-
systemic collaterals:
a. rectum (hemorrhoids)
b. left falciform ligament
c. esophagogastric varices
d. retroperitoneal space.
Question 39
A 60 year old man was brought to the ER for
diffusely painful abdomen. He has not had any
BM or flatus for the past 3 days. Plain abdominal
upright x-ray reveals marked distention of bowel
loops, air fluid levels and absence of rectal gas.
How will you manage this patient?
Question 40
A 25 year old female comes to the ER for RLQ pain
associated with nausea and vomiting. Which of the
following is/are TRUE regarding making the diagnosis
of acute appendicitis in this patient?
Question 41
Release of this hormone from the duodenum
and jejunum is largely triggered by long chain
fatty acids, essential amino acids and gastric
acid itself and evokes and enzyme rich
secretion from the pancreas?
Question 42
A 45 year old businessman came to the ER for
vomiting of coffee ground material. PE was
normal except for poor skin turgor and
tachycardia. Which of the following is/are true
regarding the etiology of this patient’s upper GI
bleeding?
Question 43
Correct statement/s regarding Hepatitis B
serology?
Question 44
Schematic diagram of Acute Hep B Infection
Which of the following statements is/are true
regarding transmission of Hepatitis B?
Question 45
Which clinical and laboratory features
suggest progression of acute hepatitis to
chronic hepatitis?
Question 46
Which of the following causes of portal
circulatory obstruction is presinusoidal in
location?
a. Cirrhosis
b. Schistosomiasis
c. Budd-Chiari
d. Inferior Venal caval obstruction.
Question 47
Nos 48-49-. A 45 year old male with chronic alcoholism is
brought to the ER for agitation and bizarre behavior.
The patient is cachectic, jaundiced with ascites. ON PE,
you further note spider angiomas, palmar erythema
and flipping hand tremors and ankle clonus.
You know that this is most likely hepatic encephalopathy:
a. latent stage
b. stage I
c. stage II
d. stage III
e. stage IV
Question 48
Hepatic encephalopathy
The following are correct principles for management of
this patient?
Question 49
For nos 50-51. A 35 year old man complains of nausea
and vomiting and rapid onset of midepigastric pain
with radiation to the back after eating a large meal.
PE shows low grade fever, epigastric tenderness and
decreased bowel sounds. An abdominal film shows
localized dilatation of the upper duodenum. – infected
pancreatic necrosis
Question 50
How will you manage this patient?
Question 51
Which of the following medications for allergic
rhinitis is associated with rebound rhinitis?
Question 52