Comprehensive Internal Medicine Exam 2019 PDF

INTERNAL MEDICINE COMPREHENSIVE EXAMINATION 2019 1 DR. CORDERO...

INTERNAL MEDICINE COMPREHENSIVE EXAMINATION 2019 1 DR. CORDERO b. Hydroxyzine c. Prednisone 1. Which drug is helpful in severe cases of d. Cyclosporine amphetamine abuse? a. Lidocaine 6. A 67/M, diabetic, presents with a 4-day b. Cyproheptadine history of productive cough with greenish c. Barbiturates phlegm, fever, and back pain. PE: BP of d. Pyridoxine 100/70, RR of 27/min, HR of 126/min, temp of 38.5 C, CBG of 267 mg/dL, and crackles 2. What is the most reliable prognosticator of from mid-to-base at the right posterior poor outcome in poisoning or drug hemithorax. What is the patient’s withdrawal? pneumonia risk stratification? a. Core temperature a. Low risk b. CNS manifestations b. Moderate risk c. Cyanosis c. High risk d. Respiratory rate d. Severe risk 3. After 4 days of therapy with amoxicillin 500 7. A 22/F, is a clinically diagnosed case of PTB. mg PO TD, a patient with a non-purulent Her baseline and end of 2nd month direct cellulitis on the left foot reports progression sputum smear microscopy (DSSM) results of swelling and episodes of low-grade fever. are negative. When should you request for The patient has allergy to Cotrimoxazole. another sputum examination as part of Which treatment is appropriate? monitoring treatment response? a. Empirical treatment with a. No further sputum examination Clindamycin b. End of 3rd month b. Reassure patient and continue c. End of 5th month current therapy d. End of 6th month c. Increase dose of Amoxicillin to 1 gram PO TID 8. Based on the Philippine Clinical Practice d. Amoxicillin-clavulanic acid 1 gram Guideline on Community Acquired PO BID Pneumonia in Immunocompetent Adults 2016 Updates, what is the drug of choice 4. A 30/F, with no known co-morbid condition, for low risk pneumonia without comorbid compliance of pain and swelling on the illness? dorsum of the right hand a day after a. Amoxicillin sustaining a scratch wound. You note b. Azithromycin erythema, non-fluctuant swelling, and c. Cefuroxime tenderness on the area with some scanty d. Sultamicillin purulent discharge. What antibiotic would you prescribe? 9. A 31/M, asthmatic complains of difficulty of a. Cephalexin 500 mg PO QID sleeping due to pruritis of eczema. Which b. Amoxicillin 500 mg PO TID drug can benefit this patient? c. Topical Mupirocin BID a. Diphenhydramine d. Clindamycin 450 mg PO TID b. Loratadine c. Cetirizine 5. Which antihistamine is a standard d. Prednisone treatment of acute spontaneous uritcaria? a. Levocetirizine P a g e 1 | 15  INTERNAL MEDICINE COMPREHENSIVE EXAMINATION 2019 2 DR. CORDERO 10. A 23/F, asthmatic, presents with pruritus 14. What are the most common causes of and scaling over both hands. She hand irritant contact dermatitis? washed her laundry with a new brand of a. Rubbing alcohol solutions detergent a week ago and she also tried on b. Bleach solutions a new hand cream recently. What test c. Water procedure will you recommend to identify d. Soaps and Detergents the culprit? a. Eosinophil % on CBC b. Patch testing 15. What is the triceps skinfold in marasmus? c. Skin biopsy A. 8mm d. Prick testing B. 6-7 mm 11. Which treatment is appropriate in order to avoid overuse of topical corticosteroids and C. 4-5 mm minimize likelihood of flares in atopic D. 10mm decubitus Xray in the evaluation of suspected 24. How often should periodic contrasted chest CT pleural effusions and as a guide to thoracentesis? scan be done in patients with resected non-small A. Chest CT scan cell lung carcinoma? B. Chest ultrasound A. Every 3 months C. Chest MRI B. Every 6 months D.thoracoscopy C. Every 9 months D. Once a year 21. A 61 year old female presents with a 4-day 25. A 44-year old male comes to ER because of an history of fever, cough and right-sided pleuritic acute exacerbation of severe asthma attack. He chest pain. Chest Xray shows right lower and middle becomes agitated, confused and develop lobe infiltrate with effusion. Which pleural fluid progressive respiratory distress and cyanosis. What result would indicate a complicated effusion that would be his expected ABG? may require chest tube thoracostomy? A. pH 7.45, pCO2 30 mmHg, pO2 88mmHg A. Ph >7.20 B. pH 7.28, pCO2 55mmHg, pO2 60mmHg B. Glucose >60mg/dL C. pH 7.40, pCO2 33mmHg, pO2 80mmHg C. (+) gram stain / culture D. pH 7.35, pCO2 40mmHg, pO2 75mmHg D. Protein 1gm P a g e 3 | 15  INTERNAL MEDICINE COMPREHENSIVE EXAMINATION 2019 4 DR. CORDERO 26. A 25- year old male consulted due to morning stiffness and pain from the neck down to the lumbar area. And Xray of the lumbosacral spine showed “body fusions”. What is the most likely 30. Which condition commonly occurs in women diagnosis? described as tickle or sensitivity in the throat and is typically “dry” or at most productive of scanty amount of A. Osteoarthritis mucoid sputum? B. Ankylosing spondylitis - Cough variant asthma - Cough hypersensitivity variant C. Rheumatoid arthritis - Chronic eosinophilic bronchitis - Gerd D. Gouty arthritis Chronic idiopathic cough, also called cough hypersensitivity syndrome, is distressingly common. It is often experienced as a 27. A 61-year old male diabetic, presents with tickle or sensitivity in the throat, occurs more often in women, voluminous watery diarrhea occurring for > and is typically “dry” or at most productive of scant amounts of 10episodes accompanied by vomiting. He is mucoid sputum. clinically dry with brownish urine on foley catheter. What is the expected urinary sediments? 31. A 28/M with a 3-day history of productive cough and A. RBC casts fever is brought to the ER due to difficulty of breathing. PE: BP 110/70, HR 108/min, RR 25/min. Chest: decreased B. WBC casts costophrenic angle with shifting of radiodensity on right C. Granular casts decubitus film. What is your next appropriate diagnostic procedure? D. Crystalluria A. Chest ct scan B. Bronchoscopy C. Pleural tap 28. What is the consequence of alveolar D. Fluoroscopy hypoventilation syndrome regardless of cause? A. Respiratory alkalosis 32. Which feature readily distinguishes syncope from seizure? B. Compensatory decrease in serum bicarbonate A. Variable posture B. Cyanosis and frothing of mouth C. Hypoxemia C. Immediate transition to unconsciousness D. Facial pallor D. Primary erythrocytosis Symptoms of orthostatic intolerance such as dizziness, lightheadedness, and fatigue, premonitory features of 29. What is the most compatible gram stain finding autonomic activation may be present in patients with neurally in gonococcal urethritis? mediated syncope, also diaphoresis, pallor, palpitations, nausea, hyperventilation, and yawning. A. Gram +, extracellular, coccobacilli Generalized and partial seizures may be confused with syncope. th B. Gram +, intracellular, diplococci (page 147. Harrison’s 19 ed) C. Gram -, intracellular, diplococci D. Gram -, extracellular, coccobacilli P a g e 4 | 15  INTERNAL MEDICINE COMPREHENSIVE EXAMINATION 2019 5 DR. CORDERO 33. What is the most common sign/symptom accompanying severe migraine attacks? 36. A 50-year old female presents with a unilateral, A. Photophobia throbbing frontal headache of moderate intensity and B. Lightheadedness aggravated by movement, associated with nausea and C. Vomiting vomiting. The headache is being felt repeatedly and D. Nausea lasting for almost the entire day. PE: normal. What is the most likely diagnosis? A. Tension headache B. Migraine C. Hypnic headache D. Cluster headache 34. A 25-year old man living with HIV, who was recently diagnosed with Kaposi’s sarcoma presents with numbness over the hands and feet. What is the most likely diagnosis? A. Multiple mononeuropathy 37. What would a chest x-ray finding of a 6-cm solitary B. Distal symmetric polyneuropathy nodule with spiculations at the right upper lobe in a C. Progressive polyradiculopathy chronic smoker means? D. Demyelinating polyradiculopathy A. Pulmonary tuberculosis B. Lung ca The most common peripheral neuropathy in patients with HIV C. Pneumonia infection is a distal sensory polyneuropathy (DSPN) also D. Sarcoidosis referred to as painful sensory neuropathy (HIV-SN), predominantly sensory neuropathy, or distal symmetric peripheral neuropathy. 35. What is the leading cause of cancer-related death worldwide? A. Prostate ca B. Breast ca C. Colon ca D. Lung ca 38. A 66-year old male presents with pallor, 20% weight Lung cancer is the most common cause of cancer death. Lung loss in 6 months and hypochromic, microcytic anemia. cancer is rare below age 40, with rates increasing until age 80, Which malignancy would you consider in this patient? after which the rate tapers off. The incidence of lung cancer varies by racial and ethnic group, with the highest age-adjusted A. Lung ca incidence rates among African Americans. B. Colon ca C. Gastric ca Cigarette smokers have a 10-fold or greater increased risk of D. Pancreatic ca developing lung cancer compared to those who have never smoked. A deep sequencing study suggested that one genetic mutation is induced for every 15 cigarettes smoked. P a g e 5 | 15  INTERNAL MEDICINE COMPREHENSIVE EXAMINATION 2019 6 DR. CORDERO Patients with tumors of the ascending colon often present with Cl– and water transport; in contrast, patients with hypovolemic symptoms such as fatigue, palpitations, and even angina hyponatremia will often be hyperuricemic, due to a shared pectoris and are found to have a hypochromic, microcytic activation of proximal tubular Na+-Cl– and urate transport. anemia indicative of iron deficiency. 42. Which antibiotic can be used for the treatment of 39. A 49-year old male case of CKD secondary to patients with aspiration pneumonia? hypertensive nephrosclerosis not on dialysis, complains A. Azithromycin of dyspnea and body weakness maintained on ACEi and B. Cefuroxime Spironolactone for his CHF. 12L ECG shows loss of P wave C. Gentamycin and widened QRS complex. Serum K is 8.5mmol/L; Na D. Moxifloxacin 138meq/L, creatinine 2.5mg/dl. What is your immediate intervention? A. Insulin B. 50% dextrose C. Calcium gluconate D. Bicarbonate 43. A 75/F with severe CAP is admitted at the ICU with pleural effusion on the right lung. CTT insertion is done revealing empyema. Which organism needs to be covered in our empirical therapy pending sputum and/or blood culture results? A. Hemophilus B. Legionella 40. A 35-year old male complained of a severe pain and st C. MRSA swelling on the 1 metatarsophalangeal joint. This is called… D. Pseudomonas A. Podagra Harrison’s 19th Edition B. Osteoarthritis C. Tophi D. Septic arthritis 41. What diagnostic test would differentiate SIADH from other causes of Euvolemic hyponatremia? A. Urine Na >20 B. Urine Na 4mg/dl prolongation of QT interval? D. Serum Uric Acid 75 fL; the hematocrit is rarely 25 and SQUAMOUS CELLS > 25 D. Conjugated bilirubin B. PMNs < 25 and SQUAMOUS CELLS < 25 C. PMNs < 25 and SQUAMOUS CELLS > 25 D. PMNs > 25 and SQUAMOUS CELLS < 25 63. Which thyroid function test will tell you that your patient has excess iodine induced hyperthyroidism? 68. A 51/F presents with stool exam showing (+) A. Normal tsh, high unbound t4, high t3 Entamoeba histolytica cysts. She also tested (+) for B. Low tsh, high total and unbound t4 high t3 heme. Which coexisting condition does the patient have C. Low tsh, normal unbound t4, high t3 secondary to the primary infectious agent? D. Low tsh, high total and unbound t4, normal t3 A. Enteritis B. Colitis 64. What is your diagnosis if the TSH is elevated and an C. Hepatitis unbound T4 is low? D. Pancreatitis A. Secondary hypothyroidism B. Sick euthyroid syndrome Fecal findings suggestive of amebic colitis include a positive C. Mild hypothyroidism test for heme, a paucity of neutrophils, and amebic cysts or D. Primary hypothyroidism trophozoites. The definitive diagnosis of amebic colitis is made by the demonstration of hematophagous trophozoites of E. 65. Which among the following conditions will give a low histolytica. TSH, normal unbound T4 and normal unbound T3? A. Graves disease 69. A 42/M presents with chest pain and being managed B. T3 toxicosis as ACS. Which ECG reading is consistent in STEMI? C. Thyroid hormone resistance syndrome D. Subclinical hyperthyroidism A. A NEW HORIZONTAL ST DEPRESSION MEASURING >0.5mm IN TWO AUTOMATICALLY CONTIGUOUS LEADS A low TSH with a normal free T3 and free T4, particularly in B. A NEW ST ELEVATION AT THE J POINT IN TWO older patients, suggests the possibility of thyroid autonomy or ANATOMICALLY CONTIGUOUS LEADS OF ≥2mm undiagnosed Graves’ disease, and is termed subclinical IN ALL LEADS OTHER THAN V2 AND V3 thyrotoxicosis. C. T INVERSION ≥1mm IN TWO ANATOMICALLY CONTIGUOUS LEADS WITH PROMINENT R WAVE D. PRESENCE OF Q WAVES P a g e 10 | 15  INTERNAL MEDICINE COMPREHENSIVE EXAMINATION 2019 11 DR. CORDERO 70. A 54/M diabetic and hypertensive presents with A. Leukocytosis chest heaviness, substernal in location, lasting only for a B. Anemia few seconds, aggravated by eating. Which condition C. Thrombocytopenia would decrease the likelihood of a diagnosis of AMI? D. Neutropenia A. Quality of pain B. Location of pain 76. 40 yo male diabetic, presents with fever, and C. Provoking factor severe pain on the right thigh for the last 3 days. He D. Pattern of pain reports a history of a light scratch on painful area sustained while playing basketball 5 days ago. The 71. A 35 yo male consults for pre-employment right thigh is swollen, with blue gray patches and consultation. Included in his lab test done aree the severely tender on palpation. What is the most ffg: HBsAg (+), anti HBS (-), anti HBc IgG(+), HBeAg likely diagnosis? (+), and Anti-HBe (-). How would you interpret A. Cellulitis these serologic results? B. Sift tissue abscess A. Acute Hepatitis B C. Necrotizing fasciitis B. Chronic Hepatitis B, high infectivity D. Fracture C. Acute hepatitis B, high infectivity D. Chronic Hepatits B, low infectivity 77. 32 year old male presents with gradual onset of lower abdominal pain, bloody diarrhea, fever, and 72. How many percent of total volume blood loss weight loss for the past 3 weeks. Which findings in must be before signs of vascular instability appear? the stool exam will help you arrive at a definite A. 5% total blood volume diagnosis? B. B. 10% total blood volume A. Neutrophils C. 30% total blood volume B. Tropozoites D. 40% total blood volume C. Cysts D. RBC 73. How will you describe an uticaria? A. Maculo-papular rashes 78. Which cholestatic condition may produce B. Confluent desquamative eruptions jaundice? C. Circumscribed wheals involving the dermis A. TB D. Vesiculo-bullous rashes B. Wilson’s disease C. HSV D. Acretaminophen toxicity 74. A 51 yo male preseents with pallor. No history of bleeding, hemoglobin is 100md/dl, normal WBC, differential count and plt count. His reticulocyte 79. A 61 yo male hypertensive, presents index is 1.8% and peripheral blood smear shows withsignificant weight loss and progressive macrocytic RBC. What is the most likely diagnosis? dysphagia over 6 months period. He occassionally A. Mild to mod iron deficiency expreiences mild chest pain that radiates to the B. Vit. B12 deficiency back and experiences food regurgitation. A heavy C. Intravascular hemolysis alcoholic drinker and smoker. PE reveals BP D. Anemia of CKD 180/110, CR 110bpm, RR 18cpm, T 37.4, decreased breath sounds with expiratory wheezes. Liver size is normal. What is the most likley diagnosis? 75. What is the most hematologic abnormality in A. Esophageal stricture HIV-infected patients? B. Esophageal Carcinoma P a g e 11 | 15  INTERNAL MEDICINE COMPREHENSIVE EXAMINATION 2019 12 DR. CORDERO C. Ascending aortic aneurysm B. Needle prick from a diagnosed patient D. Gastric CA C. Medical technologist handling of fecal specimen D. Ingestion of water contaminated by asymptomatic carrier 80. A 30 yo female presents with amenorrheafor 8 months diastolichypertension, and impaired glucose tolerance. PE reveals central obesity and proximal myopathy. You are suspecting Cushing’s syndrome. Which test results will confirm the diagnosis? 85. A 45-yr-old married female presents with A. 24 hr urinary free cortisol is increased 2x above frequent UTI occurring >3x/year. What is the normal recommended treatment? B. Dexamethasone overnight test(plasma cortisol A. Fosfomycin 3 gms at bedtime (10 mmHg with inspiration B. Lack of fall of the jugular venous pressure with inspiration C. Late diastolic murmur with opening snap D. Pulsus parvus et tardus E. Rapid y-descent of jugular venous pressure tracing P a g e 14 | 15  INTERNAL MEDICINE COMPREHENSIVE EXAMINATION 2019 15 DR. CORDERO ` P a g e 15 | 15