E3 Flashcards
1) The primary reason why breast conservation surgery is an acceptable alternative to modified radical mastectomy in the treatment of primary operable cancer
A. Better cosmetic outcomes
B. Decreased recurrence rate
C. Increased overall survival rate
D. Lesser cost because of no need for radiotherapy
Answer: A
2) The main treatment modality that is designed to alleviate persistent cough from breast CA metastasizing to the lung parenchyma is: A. Closed tube thoracotomy B. Best supportive care C. Palliative radiotherapy D. Palliative chemotherapy
Answer: D
3) The imaging test of choice to confirm clinical finding of possible bone metastasis from breast CA A. Bone xray B. Bone scan C. Bone mineral density scan D. Bone CT scan
Answer: B
4) Biopsy technique that requires a gauge 14-16 caliber needle that provides a core of tissue for histopathologic evaluation is A. Fine needle aspiration biopsy B. Frozen section biopsy C. Excision biopsy D. Core needle biopsy
Answer: D
5) 50/F asymptomatic consulted because of a 2.5 x 1.5 cm hard movable mass without overlying skin ulceration nor palpable axillary or supraclavicular lymph nodes. Core needle biopsy revealed invasive ductal carcinoma. The clinical stage is: A. IA B. IIA C. IIIA D. IVA
Answer: B
6) The therapeutic strategy for stage IIIC breast CA to downstage the disease prior to treatment with modified radical mastectomy is: A. Adjuvant chemotherapy B. Adjuvant radiotherapy C. Neoadjuvant chemotherapy D. Induction radiotherapy
Answer: C
7) Type of staging used to determine/guide primary therapy A. Clinical staging B. Pathognomonic C. Retreatment staging D. Autopsy staging
Answer: A
8) Management of occult metastases A. Adjuvant chemotherapy B. Adjuvant radiotherapy C. Neoadjuvant chemotherapy D. Ionizing (?) radiation
Answer: A
9) The pathologic basis in the diagnosis of peau d’orange skin is A. Dermal neovascularization B. Proliferation of inflammatory cells C. Tumor blockage of dermal lymphatics D. Invasion of Cooper’s ligament
Answer: C
10) A chromosomal 17 mutation among females that predisposes to about 60-80% lifetime risk of developing breast cancer A. Cyp D6 B. K-ras C. BRCA 1 D. BRCA 2
Answer: C
11) Histopathologic feature of fibroadenoma that differentiates it from phyllodes tumor
A. Epithelial and stromal proliferation
B. Hypocellular stroma without cellular atypia
C. Mitotic activity >10 per HPF
D. Infiltrative tumor margin
Answer: B
12) Best timing for breast self-examination
A. 7-10 days after 1st day of menstruation
B. 10-14 days before menstruation
C. Day before menstruation
D. Any day
Answer: A
13) Breast abscess is usually caused by what organisms? A. S. aureus B. M. tuberculosis C. S. pyogenes D. P. aeruginosa
Answer: A
14) A patient has sanguinous nipple discharge with NO palpable mass. The most likely diagnosis is A. Intraductal carcinoma B. Intraductal papilloma C. Paget’s disease of the nipple D. Ductal ectasia
Answer: B
15) A female patient presents with mastalgia and nodular breast tissue with no dominant mass. There is no axillary node. The primary clinical diagnosis A. Breast abscess B. Breast CA C. Fibroadenoma D. Fibrocystic changes
Answer: D
16) A lactating female patient palpated a mass on her breast. The mass is about 3 cm in its greatest diameter. There is no erythema. There is no axillary node. Most likely clinical diagnosis A. Fibroadenoma B. Breast CA C. Galactocoele D. Macrocyst
Answer: C
17) In a 50/F patient with no palpable breast mass but who needs a screening procedure because of a strong family history of breast CA, what is the recommended diagnostic procedure? A. Needle biopsy B. Open biopsy C. Mammography D. Ultrasound
Answer: C
18) Histologic examination of a fungating mass on the glans penis of a 50 year old man will most likely show A. Adenocarcinoma B. Transitional cell carcinoma C. Squamous cell carcinoma D. Balanitis xerotica obliterans
Answer: C
19) Most significant risk factor in development of erythroplasia of Queyrat A. Smoking B. HPV infection C. History of hepatic infection D. Multiple sexual partners
Answer: B
20) Painless, solid, testicular mass in a 30 year old will most probably yield the following histologic diagnosis A. Embryonal carcinoma B. Choriocarcinoma C. Seminoma D. Leydig cell tumor
Answer: C
21) Based on its pattern of drainage, metastasis from testicular cancer will first spread to the: A. Spermatic nodes B. Superficial inguinal nodes C. Deep pelvic nodes D. Paracaval and paraaortic nodes
Answer: D
22) Pain, swelling, tenderness of testes associated with scrotal erythema in teenage boy is best managed by A. Antibiotics B. Surgery C. Radiation D. Chemotherapy
Answer: A
25) Medical management of symptoms associated with benign prostatic hypertrophy aimed to relax smooth muscles of the bladder outlet include A. 5-alpha reductase inhibitors B. Androgen receptor inhibitors C. Calcium channel blockers D. Alpha-adrenergic receptor blockers
Answer: D
26) A 50 year old man presenting with an enlarged prostate on ultrasound but denies any voiding problem should be managed with A. Medical management B. Watchful waiting C. Prophylactic hormone therapy D. Herbal supplementation
Answer: B
27) In the early stages of obstruction from an enlarged prostate, the following symptoms may be expected because of changes in the bladder A. Frequency B. Urinary retention C. Hesitancy D. Weak urinary stream
Answer: A
28) 1 in 3 men would have the following type of sexual dysfunction A. ED B. Retrograde ejaculation C. Premature ejaculation D. Decreased libido
Answer: C
29) The recommended initial treatment for a 45 year old male complaining of inability to sustain erection with an estimated intravaginal ejaculation latency time (IELT) of less than 1 minute is/are
A. Dapoxetine only
B. PDE5 inhibitors only
D. Dapoxetine + PDE5 inhibitors
D. Dapoxetine + PDE5 inhibitors + psychotherapy
Answer: B
30) The drug of choice in the treatment of premature ejaculation is: A. Fluoxetine B. Sertraline C. Dapoxetine D. Paroxetine
Answer: C
31) Dapoxetine inhibits ejaculation by which of the following mechanisms
A. It increases the synaptic levels of serotonin
B. It produces significant penile hypoesthesia thus prolonging the latency time to ejaculation
C. It works by relaxing and dilating the blood vessels to the corpora cavernosa
D. It decrease sensorium to delay ejaculation
Answer: A
32) Occurs during normal erection A. NO exits cell membrane B. PDE converts GTP to cGMP C. Relaxation of penile smooth muscle D. Increased intracellular Ca2+ causes erection
Answer: C
33) Which of the following occurs in the flaccid state of the penis?
A. The penile smooth muscle is contracted
B. The helicine arteries are dilated
C. Sinusoidal spaces are filled up with blood
D. The subtunical venous plexuses are compressed
Answer: A
34) Which suggests an organic cause of ED
A. A patient is unable to sustain his erection in the middle of intercourse with his regular partner but is able to maintain good erections when he is with a different partner
B. Known diabetic with gradual loss of erection for the past 2 years
C. 28 year old who has good erections in 8 out of 10 times of sexual intercourse
D. 40 year old who immediately loses erection after ejaculating less than 1 minute of penetration
Answer: B
35) Which of the following is the best way of diagnosing premature ejaculation?
A. History alone
B. PE
C. PEDT
D. … measurement of IELT with the use of…
Answer: A
37) A 55/M with no known co-morbidities is complaining of decrease in libido and difficulty initiating erection for the past 6 months, accompanied by mood changes, irritability, and easy fatigability. His PE is essentially normal. What will be your next step? A. Request for serum testosterone B. Give a trial of tadalafil C. Administer testosterone undecanoate D. AOTA
Answer: A
38) Which of the following can be safely prescribed to a patient diagnosed with angina maintained on isosorbide mononitrate complaining of ED? A. Sildenafil B. Vardenafil C. Tadalafil D. Intraurethral alprostadil
Answer: D
39) Which of the following statements is true regarding priapism
A. It occurs due to excessive sexual stimulation
B. It spontaneously resolves without intervention
C. Penis is painful and tender
D. It can resolve once the patient ejaculates
Answer: C
40) 30/M construction worker is consulting due to prolonged painful erection of >4 hours duration when he slipped and hit his perineum against a wood slab. The patient most likely has
A. Overstimulation of the dorsal nerve
B. Fistula formation between the cavernous artery and cavernous corpora
C. Failure of venous blood to drain from
D. Normal erection prolonged secondary to trauma to the perineum
Answer: B
41) 75/M consulted at the ER due to bruising, swelling, and deformity of his penis sustained in the middle of sexual intercourse after taking sildenafil for erectile dysfunction. What would you advise the patient?
A. Complete bed rest until the condition spontaneously resolves
B. Emergency penile surgery
C. Prescribe tranexamic acid to prevent further bleeding
D. Cold compress to prevent further swelling of the penis
Answer: B
42) Which of the following statements is TRUE regarding male sexual dysfunction?
A. Majority of men with ED are properly diagnosed and treated
B. The prevalence of ED is expected to decrease 10 years from now due to new diagnostic and treatment modalities
C. Age itself is the only identifiable cause of ED in the elderly
D. Metabolic syndrome contributes to the development of ED
Answer: D
43) What is the accepted diagnosis for the condition with displacement of lower genitourinary and lower GI tract from their normal anatomical location, which results in a bulge in the female introitus? A. Pelvic organ protrusion B. Pelvic organ relaxation C. Pelvic organ prolapse D. Pelvic organ mass
Answer: C
44) What is the most common risk factor for the development of such (43)? A. Parity B. Age C. Menopause D. Obesity
Answer: A and B
45) It is a device placed in the vagina to hold the uterus in place to prevent it from prolapsing? A. Vaginal cone B. Uterine dilator C. Hegar’s dilator D. Pessary
Answer: D
46) What is the test to determine the pressure/volume relationship of the urinary bladder? A. Cystometrogram B. Urinalysis C. Intravenous pyelography D. Biodfeedback
Answer: A
47) A condition where there is immediate involuntary loss of urine synchronous with \_\_\_\_ on sneezing and coughing A. Mixed urinary incontinence B. Urge urinary incontinence C. Overflow incontinence D. Stress urinary incontinence
Answer: D
48) Hormonal changes in perimenopausal women A. Decreased inhibin B. Decreased FSH C. Decreased LH D. Decreased estradiol
Answer: A
49) Correct statement regarding principles of HRT use
A. HRT effective in perimenopause to regulate menstrual cycle
B. HRT is still the most effective therapy for vasomotor and estrogen-deficiency related urogenital symptoms
C. Risk and benefits are the same for women around time of menopause and those who are older
D. AOTA
Answer: B
50) Indication of HRT use as recommended by FDA
A. Prevention of osteoporosis
B. Treatment of mild vasomotor symptoms
C. Treatment of mild LVD
D. Prevention of moderate vaginal dryness
Answer: A
51) Absolute contraindication/s to the use of HRT include/s A. Undiagnosed vaginal bleeding B. Recent myocardial infarction C. Suspected breast CA D. AOTA
Answer: D
52) 68/F underwent DEXA screening test showing T-scores of -1.8 at the spine and -2.9 at the hip. The following statements are correct:
A. Since patient is hypoestrogenic, bone remodeling decreases, leading to increased bone resportion
B. Patient has severe osteoporosis
C. Reduction in trabecular bone is greater than in cortical bone at first 20 years of menopause
D. AOTA
Answer: D
53) The use of estrogen replacement therapy A. Protects against endometrial cancer B. Protects against cervical cancer C. Protects against colorectal cancer D. Protects against ovarian cancer
Answer: C
54) Which is correct?
A. Perimenopause is marked by irregularity of the menstrual cycles
B. The administration of large amounts of estrogen will lower the FSH levels to premenopausal concentrations
C. A BMI of >30 is a risk factor for osteoporosis
D. AOTA
Answer: A
55) True of use of risedronate for the management of osteoporosis
A. Prevents vertebral fracture
B. Prevents hip fracture
C. Prevents vertebral and hip fracture
Answer: C
56) Choose the best route of administration for 60/F with fatty liver, and elevated liver enzymes A. Oral (tablet) B. Non-oral (patch) C. Vagifem (vaginal tablet) D. Any of the above
Answer: B
57) True of the effects of estrogen deficiency from perimenopause to advanced age A. Early – insomnia B. Intermediate – psychological symptoms C. Late – dyspareunia D. AOTA
Answer: A
58) The pathognomonic symptom of menopause A. Hot flush B. Menstrual irregularity C. Low back pain D. Mood swings
Answer: A
59) Age of menopause may be determined by
A. Age of menarche of the patient
B. Age of menarche of the patient’s mother
C. Age of menopause of the patient’s mother
D. AOTA
Answer: C
60) Which statement is correct?
A. HDL cholesterol is the strongest predictor of heart disease in women
B. The lifetime risk of death in postmenopausal women with coronary artery disease is higher compared to the lifetime risk of death in a postmenopausal woman with breast cancer
C. The most prevalent finding in the lipid profile of postmenopausal women is an accelerated rise in total cholesterol
D. AOTA
Answer: D
65) Usual imaging modality used to supplement UTZ by providing additional characterization of ascites A. CT scan B. KUB-IVP C. MRI D. X-ray
Answer: A
66) \_\_\_\_\_\_\_\_ combined with ultrasound CT scan and MRI is used to diagnose congenital malformations of the female genital tract and mechanical causes of infertility A. Ductogram B. Hysterosalpingogram C. Mammogram D. Stenogram
Answer: B
67) Imaging modality used for 1st trimester obstetric examinations? A. CT scan B. MRI C. Transabdominal UTZ D. Transvaginal UTZ
Answer: D
68) 60/M experiences urinary flow problems and pelvic pain. What test should be ordered? A. CT scan B. Endoluminal ultrasound C. MRI D. Transabdominal ultrasound
Answer: D
69) 16/F still has not experienced menarche and is experiencing pelvic pain, which imaging modality will be requested? A. Hysterosalpingogram B. Transabdominal UTZ C. Transrectal UTZ D. Transvaginal UTZ
Answer: B
70) A pregnant woman 28 weeks AoG complains of abdominal pain. Best modality to use? A. Xray B. KUB IVD C. Ultrasound D. MRI
Answer: C
71) 45/F complains of recurrent bouts of UTI. UTZ shows pelvocaliectasia, what is the cost effective imaging modality that should be requested? A. CT scan B. KUB-IVP C. Plain xray D. Stenogram
Answer: B
72) 55/M complains of urinary problem. UTZ shows complex right kidney mass. Modality to assess the lesion before surgery? A. CT scan B. KUB-IVP C. MRI D. Repeat UTZ
Answer: A
73) Recommended screening test for 53 year old women for annual check up EXCEPT A. Xray B. CT scan C. MRI D. Mammogram
Answer: C
74) Additional test for 53/F with small, circumscribed mass A. Xray B. CT scan C. Additional mammographic test D. MRI
Answer: C
75) 35/F exhibited clear nipple discharge. What is the best imaging modality to assess her? A. Breast MRI B. Ductogram C. Additional mammographic studies D. Breast UTZ
Answer: B
76) 45/F in her younger years had silicon breast injections. What is the cost effective imaging modality that could be ordered? A. Breast MRI B. Ductogram C. Additional mammographic studies D. Breast UTZ
Answer: C
77) What is the screening imaging modality used for infants and children suspected of having a pelvic mass on PE? A. CT scan B. MRI C. Ultrasound D. X-ray
Answer: C
78) What is a feature of primary apnea?
A. Spontaneous breathing occurs after stimulation
B. Primary apnea is due to idiopathic cause
C. Aminophylline is the drug of choice in primary apnea
D. Hypotension is an early manifestation of primary apnea
Answer: A
79) The following are part of the criteria to diagnose perinatal asphyxia EXCEPT
A. Metabolic acidosis with pH
Answer: D
80) Transition from fetal to neonatal circulation includes the following EXCEPT
A. Closure of patent ductus arteriosus
B. 10x increase in pulmonary blood flow
C. Right to left shunt along foramen ovale
D. Removal of low resistance shunt
Answer: C
81) During asphyxia, the body is converted into a 3-organ organism. The organs preserved are the following EXCEPT A. Heart B. Kidneys C. Brain D. Adrenal gland
Answer: B
82) Which of the following features of hypoxic ischemic encephalopathy is associated with good prognosis? A. Hypotonia B. Incomplete Moro C. Dilated pupils D. Absent myoclonus
Answer: C
83) The following are mechanisms of action of therapeutic hypothermia EXCEPT A. Decrease intracellular acidosis B. Increase nitric oxide production C. Prevents protein kinase inhibition D. Inhibits apoptosis
Answer: A
84) With re-establishment of blood flow are hypoxia, injury occurs due to A. Generation of oxygen radicals B. Increase in intracellular calcium C. Activation of lytic enzymes D. Inhibition of apoptosis
Answer: A
85) What is the most important and effective action in a newborn requiring resuscitation A. Give epinephrine B. Do chest compression C. Ventilate the lungs D. Provide oxygen
Answer: C
86) What are the ABCs of resuscitation A. APGAR, bicarbonate, and chest compression B. Apnea, blood volume, and care C. Airway, breathing, circulation D. Assess, blame, and criticize
Answer: C
87) Evaluation and decision making during resuscitation are primarily based on which combination of signs? A. BP, HR, color B. Color, HR, RR C. RR, BP, HR D. Color, BP, RR
Answer: B
88) What needs to be attached to self-inflating bag to deliver 90-100% oxygen? A. Pressure valve B. Pop-off valve C. BOF feeding tube D. Reservoir bag
Answer: A
90) Which routes are used for administration of epinephrine for neonatal resuscitation? A. IV and subcutaneous B. Subcutaneous and endotracheal C. Endotracheal and IV D. Subcutaneous and IM
Answer: C
91) When is epinephrine indicated?
A. Persistent HR
Answer: D
92) You are resuscitating a newborn baby. Despite adequate ventilation, cardiac compressions, and administration of epinephrine, the baby is not improving. What are indications of volume expansion?
A. The baby has strong pulses, although HR is
Answer: D
93) Newborn baby with birth weight of 3.6 kg, responding poorly to resuscitative efforts. Maternal history of extensive vaginal bleeding. Baby is pale. How much volume expander should you give? A. 0.36 ml B. 3.6 ml C. 36 ml D. 360 ml
Answer: C
94) A newborn is being ventilated with a bag and mask, which are signs of effective ventilation?
A. Improvement in color and tone, spontaneous breathing, increased heart rate
B. Rapid decline in HR, chest movement, audible breath sounds
C. Spontaneous breathing, decreased oral secretions, decreased breath sounds
D. Chest movement, audible sounds over the stomach, improved color
Answer: A
95) Which medication should be used during first minute of resuscitation? A. Calcium B. Atropine C. Epinephrine D. Sodium bicarbonate
Answer: C
96) What are the appropriate doses of IV and endotracheal epinephrine using ____ concentration?
A. 0.3 to 1 ml/kg IV and 0.1 to 0.3 ml/kg endotracheal
B. 0.1 to 0.3 ml/kg IV and 0.5 to 1 ml/kg endotracheal
C. 1 to 3 ml/kg IV and 0.3 to 1 ml/kg endotracheal
D. 1 to 3 ml/kg IV and 0.5 to 1 ml/kg endotracheal
Answer: B
97) Acceptable solutions for volume expansion include which of the following?
A. 0.9, NSS, Ringer’s lactate, albumin
B. 0.9, NSS, Ringer’s lactate, pRBC
C. 0.9, NSS, Ringer’s lactate, fresh frozen plasma
D. 0.9, NSS, Ringer’s lactate, NaHCO3
Answer: B
98) During which time period should a newborn ideally be intubated? A. 20 sec B. 30 sec C. 40 sec D. 60 sec
Answer: B
99) In resuscitating a newborn, 1700 g, 32 weeks AoG. What size laryngoscope do you use? A. Number 0 B. Number 0.5 C. Number 1 D. Number 2
Answer: A
100) In resuscitating a newborn, 1200 g, 30 weeks. What size endotracheal tube do you use? A. 2.3 mm B. 3 mm C. 3.5 mm D. 4 mm
Answer: B
