Dignity Integrated Flashcards by Giselle Celine Cerrillo

A 65 year old male consulted to the clinic with complaints of painful grouped vesicles noted on his right forehead progressing to the right scalp area. He had slight fever the third day the vesicles appeared, and a posterior lymphadenopathy on his right nuchal area. Your initial impression of the case is

a. Herpes simplex
b. Herpes zoster
c. Multiple furunculosis
d. Contact dermatitis to hair dye

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A 5 month old baby boy presented with a diaper rash. In your examination, you noted the presence of blisters and yellow crusting. What would you advise the mother?

a. Rash is caused by a fungal infection
b. Rash is due to diaper allergy
c. Change diaper more frequently
d. Prompt antibiotic therapy is necessary

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A 42 year old male consulted the clinic with complaints of erythematous greasy scales in between his eyebrows, nasolabial folds and back of both ears. His scalp was also filled with scales which started to develop after losing his job prior to the appearance of the lesions. Your most likely initial impression is

a. Psoriasis
b. Contact dermatitis
c. Seborrheic dermatitis
d. Dermatophytosis

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The most effective oral antifungal agent for dermatophytes is

a. Ketoconazole
b. Itraconazole
c. Griseofulvin
d. Fluconazole
e. Terbinafine

No answer

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Mang July, a 62 year old male, consulted the clinic because of a rough, black itchy nodule “stuck-on” his lower back for almost 5 years. He would try reaching for the lesion, carefully scraping the surface with his fingernails, but only able to succeed superficially in some portions. Nodule is now growing in size. Mang July probably has

a. Seborrheic keratosis
b. Squamous cell carcinoma
c. Melanoma
d. Dermatofibroma

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Which of the following cytokines promote follicular hyperkeratinization?

a. IL-1
b. IL-10
c. IL-17
d. EGF

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Systemic treatment of acne is indicated in which of the following?

a. Cystic acne on the face of a 18 year old female
b. Comedones on the forehead in a 10 year old male
c. Papules on the face of a 14 year old female allergic to tretinoin
d. Pustules, comedones and papules on the face of a 29 year old male

No answer

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An infant presented with an erythematous patch on the right half of the body. What do you think the infant has?

a. Millaria rubra
b. Arteriovenous malformation
c. Harlequin color change
d. Infantile hemangioma

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Mycobacterium leprae will grow best in the following EXCEPT

a. Scalp
b. Testes
c. Peripheral nerves
d. Upper respiratory tract

No answer

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Epithelialization proceeds sequentially in the following manner

a. Migration, cellular detachment, proliferation, differentiation
b. Proliferation, differentiation, migration, cellular detachment
c. Migration, differentiation, proliferation, cellular detachment
d. Cellular detachment, migration, proliferation, differentiation

No answer

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Which of the following sets of drugs may induce acneiform eruption?

a. Iodides, Rifampicin, Aspirin
b. Isoniazid, Rifampicin, Corticosteroids
c. Vitamin D, Theophylline, Penicillin
d. High dose Vitamin B3, Streptomycin, Mefenamic acid

No answer

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A rapid and (???) type of abdominal pain progression would most likely be exhibited by a patient with

a. Acute appendicitis
b. Biliary pain
c. Acute necrotizing pancreatitis
d. Acute gastroenteritis

No answer

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The most common etiology of mechanical intestinal obstruction in a 25 year old male with no previous abdominal operation is

a. Intestinal adhesions
b. Intussusception
c. Groin hernia
d. Intestinal tumor

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The most important prognostic determinant among patients with colorectal cancer is

a. Histologic grade of the tumor
b. CEA levels
c. Histologic type of the tumor
d. Stage of the disease

No answer

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A 70 year old male, previously diagnosed to have essential hypertension, came into the ER for a sudden episode of syncope. History revealed passage of maroon-colored stools a few hours prior to admission. PE showed BP of 90/60, HR 135/min, RR 25/min, pale palpebral conjunctivae, soft abdomen with hyperactive bowel sounds, and blood on examining rectum on rectal exam. The most important thing that should be done is to insert which of the following?

a. Nasogastric tube
b. Large bore needle and infuse plasma expander
c. Foley catheter
d. Endotracheal tube

No answer

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Which kind of colonic polyp is believed to have the highest incidence of harboring carcinoma?

a. Villous
b. Tubular
c. Tubulovillous
d. They all have the same incidence

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Properties which make proton-pump inhibitors ideal drugs from the pharmacokinetic perspective include which of the following?

a. Long serum half-life
b. Concentrated near the site of action
c. Short duration of action
d. All of the above

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Apple core appearance of the rectum is seen in

a. Hemorrhoids
b. Intestinal obstruction
c. Rectal cancer
d. Diverticulitis

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What is the correct association between causative agent and the gastrointestinal manifestation?

a. EHEC : traveler’s diarrhea
b. Clostridium difficile : pseudomembranous colitis
c. Bacillus cereus : dysentery
d. Shigella : enteric fever

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Diarrhea that stops with fasting is a form of

a. Osmotic diarrhea
b. Secretory diarrhea
c. Exudative diarrhea
d. Diarrhea secondary to altered motility

No answer

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In the Philippines and Asia, the development of chronic hepatocellular carcinoma is usually in a background of

a. Alcoholic liver disease
b. Viral hepatitis B infection
c. Biliary dysfunction
d. Clonorchis sinensis infection

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A 2 month old female from Quezon is brought in because of stool coming out of the umbilicus which has been present since birth. This is due to persistence of which structure?

a. Umbilical cord
b. Chorionic duct
c. Allantois
d. Vitelline duct

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Choledocholithiasis is a common cause of obstructive jaundice. It is associated with which of the following?

a. Elevation of conjugated bilirubin
b. Elevation of unconjugated bilirubin
c. Decrease in alkaline phosphatase
d. Increase in lymphocyte count

No answer

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COLUMN A. Level of consciousness

Level 7 (Service)
Level 5 (Internal Cohesion)
Level 2 (Relationship)
Level 6 (Making a difference)
Level 4 (Transformation)
COLUMN B. Skill

a. Need to be loved and secured
b. Letting go of fears
c. Meaning in existence
d. Selfless service
e. Actualizing one’s sense of meaning

D-C-A-E-B

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The child views hospital admission as a. An adventure b. A separation from home c. Shared time with the mother d. A break from school

When ill, a child may display all of the following EXCEPT a. Eagerness to learn b. Mood swings c. More maturity d. Loss of self-confidence

No answer

The following may be a good approach to a sick child a. Ignore the child, deal with the parents b. Inform the child of his illness, from pathology to prognosis c. Humor the child, joke about the illness d. Listen to the child first

No answer

Aside from hearing loss, retinitis pigmentosa is a prominent feature of which disease entity? a. Albinism b. Usher’s syndrome c. Jervell and Lange-Nielsen disease d. Apert’s syndrome

No answer

Which of the following ototoxic medications causes a predominantly reversible form of hearing loss? a. Gentamycin b. Salicylic acid c. Dihydrostreptomycin d. Cisplatinum

No answer

A patient with temporal arteritis is most likely to have the associated symptom of a. Nasal congestion b. Rhinorrhea c. Blurring of vision d. Ear fullness

No answer

The following statements are TRUE about cataract formation EXCEPT a. The senile type of cataract is usually associated with diabetes mellitus type 2 b. Cataract in children can be caused by congenital rubella, trauma and use of toxic drugs c. Diabetes can cause early cataract formation in adults d. Cataract can form in the subcapsular, posterior subcapsular, or nuclear area

No answer

The following are signs seen in the fundus of a patient with glaucoma EXCEPT a. Progressive enlargement of the cup b. Notching of the neuroretinal rim c. Splinter hemorrhage d. Narrowing of the arteriovenous ratio

No answer

The following statements are TRUE about extraocular muscles EXCEPT a. The secondary action of the lateral rectus is elevation b. Sherrington’s law states that an increased innervation and contraction of a given extraocular muscle is accompanied by a reciprocal decrease in innervation and contraction of its antagonist c. Right inferior oblique and left superior rectus are yoke muscles d. Hering’s law states that equal and simultaneous innervations flow to yoke muscles

No answer

# Choose the correct statement about metastatic cancers of the bone a. Metastatic bone cancers are less common that primary bone malignancies b. Metastatic bone tumors are more common in the young than in the older population c. Cancers that more commonly metastasize to bone include breast cancer, prostate cancer, thyroid cancer, renal cancer and lung cancer d. There is little need to treat patients with metastatic bone cancers since they will not survive more than a few months

You read in the radiology report of an X-ray of a patient with osteomyelitis that there were areas in the affected bone that were dense and sclerotic. These are most likely a. Sequestrum formation b. Involucrum formation c. Cloaca formation d. Normal bone findings

Which bone will most likely have a fracture if the patient falls on an outstretched hand? a. Scaphoid b. Lunate c. Olecranon d. Radial tuberosity

Two tests to determine congenital hip dislocations a. Ortolani and Barlow tests b. Adams and Allens tests c. Speed and Yergason tests d. Anterior and Posterior drawers tests

In a patient who presents with very painful swelling of a single joint of less than one week duration, which of the following tests will be most important to do? a. Serum uric acid determination b. CBC with differential count c. Synovial fluid analysis d. X-ray of the joint

Among patients with rheumatoid arthritis and seronegative spondyloarthropathy, the use of the available biologic agents is anchored in which of the following mechanisms of disease? a. Action of inflammatory cytokines b. Central pain receptors c. Reversal of pannus formation d. Increasing anti-inflammatory cytokines

No answer

Involvement of the wrist joints is most often seen in which of the following conditions? a. Gout b. Rheumatoid arthritis c. Osteoarthritis d. Systemic lupus erythematosus

Among patients with lupus, which of the following interventions is required for all patients? a. Sunlight avoidance b. Calcium supplements c. Corticosteroids d. Anti-malarials

Which of the following refers to disability? a. Patient has boutonniere deformities of the proximal interphalangeal joints of the second to fourth digits secondary to osteoarthritis of his right hand b. Patient has good compliance with medications and rehabilitation sessions c. Patient has poor grip because finger flexion is painful (VAS = 8/10) and so takes longer time to perform self-care activities d. Patient has gone on leave from her job as a secretary

A patient with orthostatic hypotension may present with the following EXCEPT a. Increased pulse rate b. Burning sensation in the lower extremity c. Lightheadedness d. Tremors

No answer

The body’s center of gravity is lowest during a. Midstance b. Float phase c. Single limb support d. Double limb support

Which of the following hormones is decreased during exercise? a. Adrenocorticotropic hormone b. Catecholamines c. Growth hormone d. Insulin

Which statement is false in factitious disorder? a. The intentional production of false or grossly exaggerated symptoms b. There is a need to assume the sick role and to receive care c. The gain itself is often very apparent and conscious d. Patients often receive multiple hospitalizations

The DSM-IV-TR criteria for somatization disorder include the following EXCEPT a. 4 pain symptoms b. 1 sexual symptom c. 1 neurologic symptom d. 2 GIT symptoms

In an inpatient setting a patient may idealize some staff members and disparage others. What is the defense used by the patient who is ambivalent and divides the staff members as good or bad? a. Fantasy b. Passive aggressive c. Acting out d. Splitting

Paranoid personality disorder can usually be differentiated from delusional disorder by the absence of which of the following? a. Fixed delusions b. Ideas of reference c. Odd behavior d. Relationships

Baby Michel (9 days old) is brought to PGH because of lethargy and poor feeding. As the LU4 student observer at the ER, you will consider all of the following conditions EXCEPT a. Urea cycle enzyme defect b. Maple syrup urine disease c. Fatty acid oxidation defect d. Mucopolysaccaridosis e. Sepsis neonatorum

Which of the following patients has epilepsy? a. A 13 year old girl who has episodes of loss of consciousness in school after standing for a prolonged period of time b. A 6 month old baby who developed cyanosis and some flickering of the fingers during vaccination c. A 7 year old boy with clonic movements associated with fever d. A 9 year old boy with left facial twitching during sleep

Given a 7 year old child with global developmental delay whose mother developed mumps during her first trimester of pregnancy, your most likely working diagnosis would be a. Mental retardation b. Learning disorder c. Pervasive developmental disorder d. Asperger’s disorder

Which is a highly significant psychosocial risk factor for optimal development? a. Domestic violence b. A nuclear family c. An extended family d. Many languages being spoken at home e. Busy parents

A 50 year old female notes that she finds it painful to hear loud sounds on the left ear. This symptom develops with damage to which cranial nerve? a. V b. VII c. VIII d. IX e. X

A 70 year old male with non-valvular atrial fibrillation presents with sudden onset weakness of the right face, arm and leg with aphasia. Symptoms fully resolved within 40 minutes. Cranial CT scan done within the hour was normal. The diagnosis is a. TIA, left MCA territory b. Stroke, left MCA territory c. TIA, right MCA territory d. Stroke, left vertebral artery territory e. Stroke mimicker

A or C

Most common area affected by rheumatoid arthropathy a. Sacroiliac joints b. Lumbar c. Craniocervical d. Thoracic

Cost-effective goal-directed management of dizziness by the 5-star physician a. Giving betahistine for 2 weeks for as long as there is dizziness b. Demonstrating the Epley maneuver for a patient with canalithiasis c. Giving betahistine in a patient who is currently having vertigo d. Performing the caloric testing in a patient with cerebellar tumor

No answer

Which of the following is TRUE of the concept of negative feedback for hormonal regulation? a. The hormone that acts on the target cell or organ also causes an increase in the secretion of its trophic hormone (or hormone from the pituitary gland or hypothalamus) b. The presence of an excess amount of exogenous hormone causes a decrease in the secretion of both the endogenous hormone as well as its trophic hormone c. A decrease in trophic hormone secretion from the pituitary causes an increase in free target hormone d. A decreased free target hormone level in the peripheral circulation causes a decrease in secretion of trophic hormone from the pituitary

Somatotroph adenoma occurring before closure of epiphysis results in a. Pituitary apoplexy b. Gigantism c. Acromegaly d. Bone malocclusions

Which of the following is the most common manifestation of Cushing’s syndrome? a. Fungal infection b. Skin atrophy and bruising c. Hypertension d. Truncal obesity

Hypertension associated with hypokalemia and low plasma renin activity a. Severe Cushing’s syndrome b. Hyperparathyroidism c. Primary aldosteronism d. Pheochromocytoma

Pathophysiologic abnormality in type 2 diabetes mellitus a. Abnormal insulin molecule synthesis b. Hypoproduction of insulin c. Hypercatabolism of insulin by target organs d. Target organ resistance to insulin

Which of the following is correct regarding waist circumference determination? a. The tape measure should be perpendicular to the floor b. The patient should inhale during measurement c. Waist circumference should be taken at the level of the umbilicus d. Waist circumference should be taken at the midpoint between the lowest ribs and the anterior superior iliac spine e. The patient should be in the fasting state

The cornerstone of therapy in an overweight 5 year old boy with new onset diabetes mellitus type 1 is a. Metformin twice a day before meals b. Daily insulin injections c. Combination of insulin and oral metformin d. Strict weight loss program and daily exercise

A or D

The most feared side effect of metformin use a. Bone marrow toxicity b. Hepatotoxicity c. Acute interstitial nephritis d. Lactic acidosis

No answer

Features of a follicular carcinoma a. Encapsulated b. Solitary c. Vascular invasion d. Nodal metastasis

No answer

The following is a specific or reliable sign for thyroid storm a. Jaundice b. Temperature dysregulation or fever poorly responsive to antipyretics c. Fine finger tremors and increased sweating d. Diffuse goiter with thyroid bruit

Treatment suitable for all types of hypothyroidism a. Levothyroxine b. Propylthiouracil c. Iodine d. Radioactive iodine

The following laboratory tests are consistent with hyperparathyroidism a. Low calcium, high PO4 b. High calcium, high PO4 c. High calcium, low PO4 d. Low calcium, low PO4

No answer

In 45X Turner syndrome with amenorrhea there is a. Absent breast development, uterus absent b. Breast development, uterus present c. Breast development, uterus absent d. Absent breast development, uterus present

No answer

Which of the following is a cause of secondary amenorrhea? a. 45, XO b. Agonadism c. Kallman syndrome d. Asherman syndrome

Based on the two-cell, two-gonadotropin theory, LH primary acts on _______ cells to produce androstenedione a. Granulosa b. Theca c. Arcuate nucleus d. Leydig

This is the most common anti-estrogenic drug used to stimulate ovulation a. Mestranol b. Tamoxifen c. Clomiphene d. Norgentrol

Mechanism of action of cyclosporine in aplastic anemia a. Reduces cytotoxic T cells b. Inhibits IL-2 production by T lymphocytes c. Modulates adverse reactions to ATG d. Stimulate production of erythropoietin

Most common cause of fatal transfusion reaction worldwide a. Clerical error b. Transfusion related acute lung injury c. Congestive heart failure secondary to volume overload d. Febrile non-hemolytic transfusion reaction

Site of maximum iron absorption a. Stomach b. Duodenum c. Distal ileum d. Colon

Anemia of inflammation a. Increased serum ferritin, low transferrin, high serum iron b. Increased red cell destruction from activation of host factors c. Increased TNF-α d. Decreased absolute reticulocyte count

Response following parenteral vitamin B12 administration to a deficient patient a. Increased plasma iron turnover b. Normal hemoglobin within 2 weeks c. Marrow begins to normalize within 72 hours d. Reticulocytosis within 1 week

The “B symptoms” of lymphomas include a. Pruritus b. Jaundice c. Weight loss d. Anorexia

The diagnosis of aplastic anemia should be questioned in the presence of a. Splenomegaly b. Increased mast cells in the marrow c. Normal marrow reticulin d. Macrocytosis

When a suspected hemolytic reaction occurs, the first thing to do is a. Slow the transfusion rate and call the physician b. Administer medication to stop the reaction c. Stop the transfusion but keep the intravenous line open d. First inform the laboratory to begin an investigation

A 4 year old boy presents with recurrent otitis media with effusion. He also had 3 episodes of pneumonia documented by X-rays. He had an elder brother who died early in childhood because of pneumonia. On physical examination, there is a lack of tonsillar tissue and there is no lymphadenopathy. What would be the best treatment option for this patient? a. Isolation to an aseptic environment b. Prophylactic antibiotics given at regular intervals c. Bone marrow transplantation d. IVIG administered every 21 days

No answer

The correct sequence of events in immediate hypersensitivity reactions is a. Introduction of an allergen, IgE production, sensitization of mast cells by binding to FcεRI, subsequent exposure to the antigen, stimulation of TH2 reactions, mast cell activation, release of mediators b. Introduction of an allergen, stimulation of TH2 reactions, sensitization of mast cells by binding to FcεRI, subsequent exposure to the antigen, mast cell activation, IgE production, release of mediators c. Introduction of an allergen, stimulation of TH2 reactions, IgE production, sensitization of mast cells by binding to FcεRI, subsequent exposure to the antigen, mast cell activation, release of mediators d. Introduction of an allergen, mast cell activation, stimulation of TH2 reactions, IgE production, sensitization of mast cells by binding to FcεRI, subsequent exposure to the antigen, release of mediators

No answer

A 45 year old woman has experienced progressive increasing muscular weakness, particularly toward the end of the day, over the past two months. She does not have any arthralgia or myalgia. On physical examination, her motor strength goes from 5/5 to 4/5 with repeated movement of extremities. A chest CT scan reveals an anterior mediastinal mass. Laboratory studies show that her antinuclear antibody test is negative. By which of the following immunologic mechanisms is her disease most likely produced? a. Local immune complex formation b. Interleukin release from macrophages c. Binding of anti-receptor antibody d. Cross-reactivity with tissue antigens myasthenia gravis

No answer

An influenza virus that was isolated from an outbreak was reported as A/HongKong/9/95(H5N1). This means that the isolate is identified as strain number a. 95 b. 9 c. H1N1 d. 1

A 2 year old child has been diagnosed to have atopic dermatitis. You decide to start steroids. Given that you would like to minimize the adverse drug reaction, which of the following should be the drug you would choose? a. Hydrocortisone 0.1% cream b. Oral prednisone c. Triamcinolone 5% cream d. Subcutaneous or intramuscular dexamethasone

Which of the following drugs used in the treatment of allergic rhinitis would cause hypotension? a. Oxymetalozine b. Phenylephrine c. Ephedrine d. Phenylpropanolamine

Who among these individuals positive for house dust mites is NOT a candidate for allergen specific immunotherapy? a. A 10 year old male with daily rhinorrhea, sneezing, nasal congestion, recurrent sinusitis and obstructive sleep apnea - Allergic Rhinitis b. A 4 year old female with severe persistent dry scaly maculopapular rashes on her elbow and popliteal creases - Atopic Dermatitis c. A 24 year old female with 3 episodes of angioedema, rashes and difficulty of breathing 10 minutes after being stung by a wasp - Allergy to wasp d. A 14 year old male with recurrent cough, dyspnea and wheezing occurring with nasal symptoms on chronic use of inhaled corticosteroids - Asthma

An 18 year old female came in to the ER with symptoms of dyspnea, inability to talk and with a sensation of choking after eating a sandwich. Her vitals showed hypotension with a BP of 90 palpatory. She has rashes all over her body. The most appropriate initial management for this patient is a. IV fluids b. Oxygen c. Epinephrine IM d. Epinephrine IV e. Endotracheal intubation

A 25 year old male consults at the OPD because of almost daily rhinorrhea for the past three weeks that interferes with his sleep. Based on the ARIA protocol, his rhinorrhea would be classified as a. Mild intermittent b. Mild persistent c. Moderate to severe intermittent d. Moderate to severe persistent

No answer

Marla has had asthma since childhood. Once a week, she has daytime shortness of breath, relieved by salbutamol inhaler, but she has no nocturnal symptoms. Her level of asthma control is a. Controlled b. Partly controlled c. Uncontrolled d. In exacerbation

In diagnosing a patient with atopic dermatitis, one should fulfill the folllwing Hanifin and Rajka criteria a. 2 major or ≥ 3 minor criteria b. 1 major and ≥ 3 minor criteria c. 3 major and 1 minor criteria d. 3 major and 3 minor criteria

Your patient develops Clostridium difficile colitis after a round of antibiotics. This is an example of a. Overdosage b. Secondary effect c. Side effect d. Drug interaction

Fremitus is decreased in all of the following conditions EXCEPT a. COPD b. Consolidation c. Pleural effusion d. Pneumothorax

The most common mechanism causing hypoxemia among pulmonary disorders is a. Ventilation abnormality b. Perfusion abnormality c. Diffusion abnormality d. Ventilation-perfusion mismatch e. Shunting

No answer

Which of the following is a negative symptom of schizophrenia? a. Patient was noted to be as if talking to someone even when there was nobody else around b. Patient does not find pleasure in leisure activities such as watching television and playing with children that he used to find pleasurable c. Patient did not feel comfortable at home because she felt as if someone was watching and was concerned that “they” are out to get her d. Patient would pick up trash from the streets and put it around her neck e. Patient was noted to have increased verbal output along with elated mood and grandiosity

No answer

Jeffrey, a 31 year old male sought consult with his physician in a state of agitation. He complained of nonproductive cough and was convinced that he had lung cancer even though he had no history of smoking. After an extensive physical examination, reassurance and intake of anxiolytic medications, the patient was noted to calm down. On further interview, the patient’s mother and brother passed away due to cancer. His aunt also died of ovarian cancer. A month ago, he learned that his sister, whom he was very close with, would be migrating to the US. What could Jeffrey have? a. Somatization disorder b. Conversion disorder c. Schizophrenia d. Hypochondriasis

The DSM-IV-TR criteria for somatization disorders include the following EXCEPT a. 1 sexual intercourse b. 2 GIT symptoms c. 4 pain symptoms d. 1 neurologic symptom

This atypical antipsychotic is the only serotonin-dopamine partial agonist currently available a. Amisulpride b. Aripiprazole c. Clozapine d. Risperidone

The action of new generation or atypical antipsychotics on this tract improves negative symptoms of schizophrenia a. Tubuloinfundibular b. Nigrostriatal c. Mesolimbic d. Mesocortical

Which of the following is a possible psychodynamic understanding of depression? a. Repressed anger b. Re-experiencing of a traumatic event when patient felt helpless c. Loss of self-esteem because specific needs of the child for validation and rule-modeling were not met by parents d. Signal for conflicts between id and superego

A 70 year old, non-hypertensive, non-diabetic male consults at the Emergency Room for inability to void. He had been having intermittency, nocturia and terminal dribbling over the past two years. He has noted decreasing urine output in the past week. On the day of consult he had hypogastric pain and could not void urine. The most pertinent PE finding is a palpable hypogastric mass. Digital rectal exam reveals a rubbery enlarged mass anterior to the rectal vault. He weighs 60 kg. Your primary impression is acute urinary retention secondary to a. Benign prostatic hyperplasia b. Prostatic carcinoma c. Acute urethritis d. Acute cystitis

A 70 year old, non-hypertensive, non-diabetic male consults at the Emergency Room for inability to void. He had been having intermittency, nocturia and terminal dribbling over the past two years. He has noted decreasing urine output in the past week. On the day of consult he had hypogastric pain and could not void urine. The most pertinent PE finding is a palpable hypogastric mass. Digital rectal exam reveals a rubbery enlarged mass anterior to the rectal vault. He weighs 60 kg. What is the next best thing to do in the ER? a. Request for a holoabdominal ultrasound b. Request for BUN and creatinine c. Give intravenous furosemide d. Insert a Foley catheter

What kidney ultrasound finding would you expect to see? a. Hyperechogenic focus with posterior sonic shadowing b. Pelvocaliectasia with dilated proximal ureters c. Cystic masses on both kidneys d. Bilaterally small kidneys

His serum creatinine is 200 μmol/L. What is TRUE regarding his computed GFR? Assume a normal GFR of 100 mL/min. a. It is normal for his age b. It is 44 mL/min less than expected for his age c. It is 26 mL/min more than expected for his age d. It confirms a diagnosis of chronic renal failure

No answer

A 6 year old girl is brought to you by her mother because of progressive swelling of both legs. Her mother claims that she had a bout of flu a week before. Thereafter she noted facial puffiness on waking up in the morning. Over the past three days she has noted increasing swelling of her legs. There is no decrease in urine output. Patient is normotensive and anasarcous. Serum creatinine is 50 μmol/L. Urine protein/creatinine ratio of a random urine specimen is 6. 164. What do you expect to see on urinalysis? a. ++ glucose b. ++++ albumin c. Broad casts d. Dysmorphic RBCs

No answer

A 6 year old girl is brought to you by her mother because of progressive swelling of both legs. Her mother claims that she had a bout of flu a week before. Thereafter she noted facial puffiness on waking up in the morning. Over the past three days she has noted increasing swelling of her legs. There is no decrease in urine output. Patient is normotensive and anasarcous. Serum creatinine is 50 μmol/L. Urine protein/creatinine ratio of a random urine specimen is 6. Renal biopsy on light microscopy will likely reveal a. Normal findings b. Thickened basement membrane c. Diffuse effacement of the foot processes d. Mesangial proliferation and matrix expansion

No answer

A 6 year old girl is brought to you by her mother because of progressive swelling of both legs. Her mother claims that she had a bout of flu a week before. Thereafter she noted facial puffiness on waking up in the morning. Over the past three days she has noted increasing swelling of her legs. There is no decrease in urine output. Patient is normotensive and anasarcous. Serum creatinine is 50 μmol/L. Urine protein/creatinine ratio of a random urine specimen is 6. Which is TRUE regarding the management of this patient? a. Her disease is very responsive to oral steroids b. Intravenous pulse methylprednisolone is the drug of choice c. Aggressive diuresis with furosemide is ideal to relieve her anasarca d. Management is supportive since her disease will remit spontaneously

No answer

A 55 year old female consulted her physician because of nape pains and blurring of vision. BP is 160/90 for which she is given hydrochlorothiazide 12.5 mg/day. She returns to the clinic two weeks later with complaints of weakness and nausea. Her BP is now 90/60. HR is 110/min. 167. What electrolyte abnormalities do you expect as a result of her medications? a. Hyponatremia and hypokalemia b. Hypernatremia and hyperkalemia c. Hypocalcemia and hypomagnesemia d. Hyperphosphatemia and hypocalcemia

No answer

A 55 year old female consulted her physician because of nape pains and blurring of vision. BP is 160/90 for which she is given hydrochlorothiazide 12.5 mg/day. She returns to the clinic two weeks later with complaints of weakness and nausea. Her BP is now 90/60. HR is 110/min. What EKG findings would you expect to see as a result of her medications? a. Diffuse low voltage complexes b. Elevated ST segments c. Presence of U waves d. Peaked T waves

No answer

A 30 year old male, hypertensive for 3 years, consults because of vomiting. You notice that he is pale with a BP of 160/100, HR of 90/min, RR of 24/min. His usual weight is 60 kg. On physical examination, there are bibasal crackles, a pericardial friction rub and bipedal edema. Funduscopy is normal. Lab exams reveal the following: Hb = 50 g/L BUN = 100 mg/dL Creat = 8 mg/mL Na = 126 mEq/L K = 7.0 mEq/L Cl = 90 mEq/L Urine findings: +++ protein + glucose 5-6 RBCs/hpf 2-3 WBCs/hpf (+) broad granular casts/hpf ABG findings: pH = 7.28 pCO2 = 22 mmHg HCO3 = 10 mEq/L The patient is in CKD stage a. II b. III c. IV d. V

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A 30 year old male, hypertensive for 3 years, consults because of vomiting. You notice that he is pale with a BP of 160/100, HR of 90/min, RR of 24/min. His usual weight is 60 kg. On physical examination, there are bibasal crackles, a pericardial friction rub and bipedal edema. Funduscopy is normal. Lab exams reveal the following: Hb = 50 g/L BUN = 100 mg/dL Creat = 8 mg/mL Na = 126 mEq/L K = 7.0 mEq/L Cl = 90 mEq/L Urine findings: +++ protein + glucose 5-6 RBCs/hpf 2-3 WBCs/hpf (+) broad granular casts/hpf ABG findings: pH = 7.28 pCO2 = 22 mmHg HCO3 = 10 mEq/L What is the most likely diagnosis? a. Diabetic nephropathy b. Chronic glomerulonephritis c. Hypertensive nephrosclerosis d. Rapidly progressing glomerulonephritis

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A 30 year old male, hypertensive for 3 years, consults because of vomiting. You notice that he is pale with a BP of 160/100, HR of 90/min, RR of 24/min. His usual weight is 60 kg. On physical examination, there are bibasal crackles, a pericardial friction rub and bipedal edema. Funduscopy is normal. Lab exams reveal the following: Hb = 50 g/L BUN = 100 mg/dL Creat = 8 mg/mL Na = 126 mEq/L K = 7.0 mEq/L Cl = 90 mEq/L Urine findings: +++ protein + glucose 5-6 RBCs/hpf 2-3 WBCs/hpf (+) broad granular casts/hpf ABG findings: pH = 7.28 pCO2 = 22 mmHg HCO3 = 10 mEq/L What is the acid-base abnormality? a. Pure high anion gap metabolic acidosis b. Pure normal anion gap metabolic acidosis c. Mixed metabolic acidosis and respiratory alkalosis d. Mixed high anion gap and normal anion gap metabolic acidosis

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A 30 year old male, hypertensive for 3 years, consults because of vomiting. You notice that he is pale with a BP of 160/100, HR of 90/min, RR of 24/min. His usual weight is 60 kg. On physical examination, there are bibasal crackles, a pericardial friction rub and bipedal edema. Funduscopy is normal. Lab exams reveal the following: Hb = 50 g/L BUN = 100 mg/dL Creat = 8 mg/mL Na = 126 mEq/L K = 7.0 mEq/L Cl = 90 mEq/L Urine findings: +++ protein + glucose 5-6 RBCs/hpf 2-3 WBCs/hpf (+) broad granular casts/hpf ABG findings: pH = 7.28 pCO2 = 22 mmHg HCO3 = 10 mEq/L What is the main cause of his anemia? a. Platelet dysfunction b. Increased hemolysis c. Occult uremic GI bleeding d. Decreased erythropoietin production

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A 30 year old male, hypertensive for 3 years, consults because of vomiting. You notice that he is pale with a BP of 160/100, HR of 90/min, RR of 24/min. His usual weight is 60 kg. On physical examination, there are bibasal crackles, a pericardial friction rub and bipedal edema. Funduscopy is normal. Lab exams reveal the following: Hb = 50 g/L BUN = 100 mg/dL Creat = 8 mg/mL Na = 126 mEq/L K = 7.0 mEq/L Cl = 90 mEq/L Urine findings: +++ protein + glucose 5-6 RBCs/hpf 2-3 WBCs/hpf (+) broad granular casts/hpf ABG findings: pH = 7.28 pCO2 = 22 mmHg HCO3 = 10 mEq/L What is the diuretic of choice to relieve his pulmonary edema? a. Furosemide b. Spironolactone c. Triamterene d. Hydrochlorothiazide

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If his EKG shows widened QRS segments with peaked T waves, what drug should you give immediately to reverse these changes? a. Calcium gluconate b. Cation exchange resin c. Inhaled salbutamol d. Glucose-insulin solution

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What renal replacement therapy will offer the best quality of life for this patient? a. Hemodialysis b. Peritoneal dialysis c. Hemoperfusion d. Renal transplantation

You decide to initiate hemodialysis. What finding will prompt you to prescribe a daily hemodialysis for this patient? a. Hyperkalemia b. Pulmonary edema c. Acid-base status d. Uremic pericarditis

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A 16 year old male consults because of diarrhea and muscle weakness. He has a past history of recurrent episodes of muscle weakness usually precipitated by a heavy carbohydrate meal. For the past three days he has been complaining of loose watery stools. On waking up this morning, he had difficulty getting out of bed and complained of hip pain and thigh muscle weakness. On examination, he has a BP of 80/50 on sitting and BP of 70/40 on standing, HR of 95/min, RR of 28/min. Lung fields are clear, heart sounds are distinct, and bowel sounds are hypoactive. Neurologic exam shows proximal muscle weakness. Urinalysis showed pH of 7.0, trace protein and normomorphic RBCs. Serum Na = 140 mEq/L, K = 2.0 mEq/L, Cl = 117 mEq/L. ABG shows pH = 7.26, pCO2 = 26 mmHg, HCO3 = 12 mEq/L. Renal ultrasound shows a small lithaisis, measuring 0.4 cm, in the right kidney. What is the most likely diagnosis? a. Gitelman’s syndrome b. Bartter’s syndrome c. Proximal RTA d. DIstal RTA

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A 16 year old male consults because of diarrhea and muscle weakness. He has a past history of recurrent episodes of muscle weakness usually precipitated by a heavy carbohydrate meal. For the past three days he has been complaining of loose watery stools. On waking up this morning, he had difficulty getting out of bed and complained of hip pain and thigh muscle weakness. On examination, he has a BP of 80/50 on sitting and BP of 70/40 on standing, HR of 95/min, RR of 28/min. Lung fields are clear, heart sounds are distinct, and bowel sounds are hypoactive. Neurologic exam shows proximal muscle weakness. Urinalysis showed pH of 7.0, trace protein and normomorphic RBCs. Serum Na = 140 mEq/L, K = 2.0 mEq/L, Cl = 117 mEq/L. ABG shows pH = 7.26, pCO2 = 26 mmHg, HCO3 = 12 mEq/L. Renal ultrasound shows a small lithaisis, measuring 0.4 cm, in the right kidney. What diagnostic test will best elucidate the cause of this patient’s acid-base abnormality? a. Urine anion gap b. Serum anion gap c. Urine chloride level d. Serum potassium level

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A 16 year old male consults because of diarrhea and muscle weakness. He has a past history of recurrent episodes of muscle weakness usually precipitated by a heavy carbohydrate meal. For the past three days he has been complaining of loose watery stools. On waking up this morning, he had difficulty getting out of bed and complained of hip pain and thigh muscle weakness. On examination, he has a BP of 80/50 on sitting and BP of 70/40 on standing, HR of 95/min, RR of 28/min. Lung fields are clear, heart sounds are distinct, and bowel sounds are hypoactive. Neurologic exam shows proximal muscle weakness. Urinalysis showed pH of 7.0, trace protein and normomorphic RBCs. Serum Na = 140 mEq/L, K = 2.0 mEq/L, Cl = 117 mEq/L. ABG shows pH = 7.26, pCO2 = 26 mmHg, HCO3 = 12 mEq/L. Renal ultrasound shows a small lithaisis, measuring 0.4 cm, in the right kidney. a. Uric acid b. Calcium oxalate c. Calcium phosphate d. Magnesium ammonium phosphate

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