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RITE > FEB 2020 YEAR I > Flashcards

FEB 2020 YEAR I Flashcards

1
Q
  1. Which organism causes “atypical” pneumonia?

A. Pseudomonas aeruginosa

B. Mycoplasma pneumoniae

C. Haemophilus influenza

D. Klebsiella pneumonia

A

B. Mycoplasma pneumoniae

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2
Q
  1. A 38/M, on chronic hemodialysis, develops cough associated with high-grade fever and dyspnea with crackles on his right lower lobe. Chest X-ray shows infiltrates on the right lower lobe. Which is the most likely pathogen causing his healthcare-associated pneumonia?

A. Methicillin-resistant Staphylococcus aureus

B. Pseudomonas aeuroginosa

C. Acinetobacter baumanii

D. Enterococcus

A

A. Methicillin-resistant Staphylococcus aureus

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3
Q
  1. A 42/F, G3P2 (3002), 32 weeks 4 days, presents with fetal demised. She complains of headache, blurring of vision, and occasional palpitation for the past 2 weeks. She is referred for BP 180/110 mmHg, (+) periorbital edema, (-) AV nicking by fundoscopy, clear breath sounds, (-) murmur, (-) S3/ S4 gallop, (+) Grade 3 pitting edema. What is the preferred medication for her?

A. Loop diuretics

B. Nitroprusside

C. Hydralazine

D. Esmolol

A

C. Hydralazine

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4
Q
  1. An 85/F, is suffering from hypertension, diabetes mellitus, Alzheimer’s disease and stroke. She’s on PEG tube feeding. Primarily bedbound with no verbal output. Stable vital signs. (+) contractures of all extremities. What is the target HBA1c level for her?

A. 5.5%

B. 6.5%

C. 7.5%

D. 8.5%

A

D. 8.5%

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5
Q
  1. A 52/M, hypertensive, presents with loose watery, non-bloody, non-mucoid stools > 11 bouts/day for 3 days accompanied by fever, crampy abdomen relieved after defecation, nausea, vomiting, and anorexia. PE: BP 90/60 mmHg, CAR 119/min, T 39 degC, dry lips and mucosa, sunken eyeballs, hyperactive bowel sounds, and poor skin turgor. What is the BEST initial approach?

A. IV Metronidazole

B. Dopamine drip

C. IV Paracetamol

D. Fluid replacement

A

D. Fluid replacement

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6
Q
  1. A 92/F, diabetic and hypertensive, develops shortness of breath and orthopnea. PE: BP 120/60 mmHg, CAR 98 beats/min, RR 22 cycle/min. (+) neck vein engorgement, crackles on mid-base, S3/ S4 gallop, grade 2 bipedal edema. SpO2 88% at room air. What is the most appropriate initial treatment?

A. IV Nitroglycerine

B. IV Furosemide

C. Dobutamine

D. IV labetalol

A

B. IV Furosemide

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7
Q
  1. A 45/F, with plaque psoriasis is noted to have insomnia accompanied by lack of interest to previous activities and depression after starting her anti-psoriatic medication. Which drug maybe causing her depression?

A. Methotrexate

B. Cyclosporine

C. Apremilast

D. Acitretin

A

C. Apremilast

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8
Q
  1. A 35/F seeks consult due to severe episodic, recurrent, throbbing, unilateral headache noted usually after exposure to bright lights and during her menstruation associated with nausea and photophobia. What drug will you prescribe?

A. Propranolol

B. Dihydroergotamine

C. Sumatriptan

D. Ibuprofen

A

C. Sumatriptan

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9
Q
  1. Which drug is LEAST likely associated with osteoporosis?

A. Tacrolimus

B. Steroids

C. Aspirin

D. Proton pump inhibitors

A

C. Aspirin

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10
Q
  1. A 31/M, suffering from PTB is (+) as well for HIV. CD4+ T cell count is 100/uL. Started on quadruple-antiTB medications. No previous severe infections. ( - ) serology for toxoplasma IgG. No CMV retinitis. What is your recommended prophylaxis to prevent opportunistic infection?

A. Azithromycin

B. TMP-SMX

C. Valgancyclovir

D. Fluconazole

A

B. TMP-SMX

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11
Q
  1. A 34/F, smoker, presents with 2 months bilateral hand stiffness upon waking up that lasts for >1 hour and relieved when doing daily chores. Denies other systemic symptoms. PE: swollen wrists, proximal interphalangeal and metacarpophalangeal joints. Labs: (+) serum anti-cyclic citrullinated peptide (anti-CCP) antibodies, (+) rheumatoid factor (RF), elevated CRP and ESR. What is the best treatment option?

A. Celecoxib

B. Methotrexate

C. Sulfasalazine

D. Hydroxychloroquine

A

B. Methotrexate

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12
Q
  1. A 20/M, presents with fever, jaundice, body malaise, anorexia, vomiting and vague abdminal pain. PE: alert, BP 110/70, HR 94/min, RR 12/min, T 36.4 0C. Jaundiced; (+) tender, right upper quadrant. Labs: Hb 12.6 g/dL, Hct: 37.4, WBC 4.7 k/uL (PMN 54, Lymphocytes 46), Platelet 170 x109/L. Creatinine 0.7 mg/dL; ALT: 1700 u/L, AST: 1400 u/L. Total Bilirubin 5.7 mg/dL (B1: 3.4, B2: 2.3), Alkaline phosphatase: 312 iu/L. What is the most likely diagnosis?

A. Influenza

B. Acute viral hepatitis

C. Enteric fever

D. Leptospirosis

A

B. Acute viral hepatitis

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13
Q
  1. What tissue or secretion culture becomes (+) for typhoid fever on the 3rd week of illness?

A. Blood

B. Bone Marrow

C. Intestinal secretions

D. Stool

A

D. Stool

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14
Q
  1. The 2014 ACC/AHA Guidelines recommend the initiation of statin therapy for primary prevention in which patient group?

A. Individuals ≥ 21 years old with LDL-C < 190 mg/dL

B. All patients with diabetes mellitus

C. Patients with <7.5% risk for ASCVD

D. All patients with HDL-C level of <40 mg/dL

A

B. All patients with diabetes mellitus

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15
Q
  1. What is the confirmatory test for dengue fever?

A. Dengue NS1

B. Dengue IgM antibody

C. PCR

D. Platelet count

A

C. PCR

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16
Q
  1. A 65/M, admitted for CAP-HR, develops severe ARDS. What is the best management option for this patient?

A. Set tidal volume to 6 ml/kg

B. Increase PEEP to 18 mm Hg

C. Set airway pressure release ventilation

D. Set high frequency oscillation ventilation

A

A. Set tidal volume to 6 ml/kg

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17
Q
  1. What is the primary stimulus for renin secretion in the kidneys?

A. Stimulation of renin-secreting cells via beta-1 adrenoreceptors

B. Increased NaCl transport in the macula densa

C. Decreased pressure in the afferent arterioles

D. Increased NaCl in the afferent arterioles

A

C. Decreased pressure in the afferent arterioles

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18
Q
  1. A 66/F, DM, with home CBG 185-225 mg/dL and HbA1C 5.5%, admitted for CAP. Now presents with confusion and poor oral intake. Antibiotics, IVF and oxygen have been initiated. Aside from sliding short acting insulin, what else will you order to address the patient’s hyperglycemia?

A. Empagliflozin

B. Metformin

C. Scheduled basal insulin

D. Gliclazide

A

C. Scheduled basal insulin

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19
Q
  1. A 24/F, complains of diarrhea after drinking milk and dairy products. How will you explain her symptoms?

A. Carbohydrate malabsorption

B. Intraluminal malabsorption

C. Fatty acid malabsorption

D. Protein malabsorption

A

A. Carbohydrate malabsorption

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20
Q
  1. A 55/F, newly diagnosed with rheumatoid arthritis, on Methotrexate. However, after 6mos, still has the same symptoms and is considered non-responsive to treatment. What is the next step?

A. Prednisone and NSAID

B. Celecoxib

C. Hydroxylchloroqine

D. Hydroxychloroquine and sulfasalazine

A

D. Hydroxychloroquine and sulfasalazine

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21
Q
  1. A 32/M, (+) HIV, presents with 12 days low grade fever, non-productive cough, with progressive shortness of breath. PE: BP 100/70 mmHg, HR 105/min, RR 34/min, clear breath sound. O2 saturation 78% at room air. WBC and LDH are elevated. CXR: perihilar, diffuse bilateral interstitial infiltrates. ABG: moderate hypoxemia, PaO2 65 mmHg. The following management will benefit the patient, EXCEPT:

A. Bronchoalveolar lavage

B. Glucocorticoids

C. Trimethoprim + sulfamethoxazole

D. Clindamycin + Primaquine if TMP-SMX fails

A

A. Bronchoalveolar lavage

22
Q
  1. What is the mechanism of action of thiazides?

A. Inhibit the sodium-chloride transporter in the distal tubule

B. Aldosterone antagonist

C. Inhibit the luminal Na-K-Cl cotransporter in the thick ascending loop of Henle

D. Reduces the secretion of H+ ions by the proximal tubules

A

A. Inhibit the sodium-chloride transporter in the distal tubule

23
Q
  1. A 25 /M, newly diagnosed HIV, has a CD4 count of 100 cells/uL. He is due for vaccination. Which vaccine must be avoided for this patient?

A. Influenza

B. MMR

C. HPV

D. Hep B

A

B. MMR

24
Q
  1. A 35/F, known asthmatic, presents with shortness of breath that sometimes awaken her at night or exacerbated by household chores. She is taking Salbutamol MDI 2-3x a day. What is your assessment of her asthma control?

A. Controlled

B. Partly controlled

C. Uncontrolled

D. Cannot be assessed

A

C. Uncontrolled

25
Q
  1. The sources of pain in osteoarthritic knees include the following, EXCEPT:

A. Joint effusion

B. Bone marrow edema

C. Synovial inflammation

D. Cartilage loss

A

D. Cartilage loss

26
Q
  1. An 18/M, with same sex partner, presents with (+) screening test for HIV1/2 EIA taken twice. The Western blot for HIV 1 and 2 were indeterminate. What is the next step to establish the diagnosis of HIV?

A. HIV RNA PCR

B. HIV-1 p24 Ag

C. Repeat Western Blot after a month

D. Repeat Western Blot after 3-6 months if clinically warranted

A

C. Repeat Western Blot after a month

27
Q
  1. A 60/M, osteoporotic, presents with lab: low serum calcium, high urine calcium, and normal CBC. What is your recommended treatment?

A. Calcium supplement

B. Calcitonin

C. Thiazide Diuretic

D. Biphosphonates

A

C. Thiazide Diuretic

28
Q
  1. What is the treatment outcome of a clinically diagnosed PTB patient who completed 6 months of Category 1 treatment but is unable to repeat Direct Sputum Smear Microscopy?

A. Completed treatment

B. Cured

C. Failure

D. Relapse

A

A. Completed treatment

29
Q
  1. A 55/F, while being treated for pneumonia, is referred due to pallor, jaundice, and splenomegaly. Laboratory results: CBC Hemoglobin: 8.4 g/dL Hematocrit: 0.25 MCV 87 MCH 32 Reticulocyte count 5.6% LDH 564 U/L What is your diagnosis?

A. Gallstones

B. Acute Hepatitis

C. Hemolytic anemia

D. Iron deficiency anemia

A

C. Hemolytic anemia

30
Q
  1. In a patient who has fluid losses, how does the body maintain homeostasis?

A. Two thirds of filtered Na+-Cl- is reabsorbed by the distal tubule

B. Renal tubular absorption of Na+-Cl- is regulated by circulating and paracrine hormones

C. Renal Na+-Cl- excretion happens in the Loop of Henle

D. Sodium is reabsorbed while chloride is secreted along the tubules

A

B. Renal tubular absorption of Na+-Cl- is regulated by circulating and paracrine hormones

31
Q
  1. The pathophysiology of COPD include the following, EXCEPT:

A. Increases in residual volume

B. Reduction in forced expiratory flow rates

C. Decrease in the ratio of residual volume and total lung capacity

D. Ventilation-perfusion mismatch

A

C. Decrease in the ratio of residual volume and total lung capacity

32
Q
  1. Which drug has been proven to be the only one effective for the acute treatment of ischemic stroke?

A. Clopidogrel

B. Heparin

C. Dipyridamole

D. Aspirin

A

D. Aspirin

33
Q
  1. A 50/M, consults at your clinic for a wellness check-up. Which screening tests are recommended for his age?

A. Chest CT scan

B. Colonoscopy

C. Colonoscopy and PSA

D. Colonoscopy, Chest CT scan, PSA

A

B. Colonoscopy

34
Q
  1. Which vaccine combination is recommended for both immunocompetent and immunocompromised adults?

A. Polio, measles, mumps, rubella

B. Haemophilus influenza type B, Hepatitis A, Varicella

C. Tetanus, Diphtheria, Pertussis, Hepatitis B

D. Rotavirus, HPV, Influenza

A

C. Tetanus, Diphtheria, Pertussis, Hepatitis B

35
Q
  1. A 58/M, chronic smoker, suspected to have COPD, underwent spirometry with these results: FEV1/FVC 0.65, FEV1 45%. According to the GOLD criteria, how severe is his condition?

A. Mild

B. Moderate

C. Severe

D. Very severe

A

C. Severe

36
Q
  1. A 65/F, obese, presents with bilateral knee pain worsened with prolonged walking and relieved by rest. Which x-ray finding will convince you that she has osteoarthritis?

A. Erosions with sclerotic margins

B. Linear radio-dense deposits

C. Presence of osteophytes

D. Widened joint space

A

C. Presence of osteophytes

37
Q
  1. A 68/F, hypertensive, presents with right femoral neck fracture after slipping on the floor. Bone Mineral Densitometry done 2 years ago showed a T score of -2.4 and took Calcium twice daily. Her eGFR 68ml/min /1.73m2. What is the best drug for her?

A. Calcitonin

B. Ibandronic acid

C. Raloxifene

D. Zoledronic acid

A

D. Zoledronic acid

38
Q
  1. A 67/F, diabetic, and poorly compliant with her medications, is on her 3rd day of Ceftriaxone 2g IV OD and Azithromycin 500mg OD PO for CAP. At present: BP 110/70, HR 74/min, RR 20/min, Temp 36.4°C. (+) fine crackles from mid to base. What would you do by this time?

A. Repeat Chest x-ray and CBC

B. Complete IV antibiotics for 7 days

C. Await complete resolution of crackles

D. Shift Ceftriaxone to oral and discharge

A

D. Shift Ceftriaxone to oral and discharge

39
Q
  1. What is the dose of Allopurinol in patients on dialysis?

A. 300 mg/day

B. 200 mg/day

C. 150 mg/day

D. 100 mg/day

A

D. 100 mg/day

40
Q
  1. A 26/M, complains of severe nasal congestion, conjunctival itching and lacrimation. He has history of atopic dermatitis and allergy to seafood. PE: pale and boggy nasal mucosa, congested and edematous conjunctivae and normal pharynx. What will be your treatment of choice?

A. Intranasal glucocorticoids

B. Oral long-acting H1 antihistamines

C. Oral alpha-adrenergic agents

D. Intranasal mast cell stabilizer

A

A. Intranasal glucocorticoids

41
Q
  1. A 65/F, hypertensive, diabetic, and previous smoker complains of epigastric pain. PE: diaphoretic, BP 90/50 mmHg, HR 56/min, RR 22/min, O2 saturation 94%. (+) bibasal crackles, regular rhythm, (+) S3, no murmur. 12 lead ECG shows (see below):

Which test would you request?

A. CK-MB

B. 2D ECHO

C. Troponin I

D. Coronary angiogram

A

C. Troponin I

42
Q
  1. A 29/F, presents with pruritic plaques with whitish scales on her elbows, knees and scalp associated joint pains. What is the most appropriate management?

A. Prednisone

B. Salicylic acid

C. Methotrexate

D. Anthralin

A

C. Methotrexate

43
Q
  1. A 46/F, consults due to 2-3 months fatigue and generalized malaise with decreased in appetite; unintentional weight loss of 5.5kgs; pain and stiffness on both hands and fingers that is worst in the morning. ESR is 60 mm/hr. What is the most likely diagnosis?

A. Osteoarthritis

B. Rheumatoid Arthritis

C. Psoariatic Arthritis

D. Gouty Arthritis

A

B. Rheumatoid Arthritis

44
Q
  1. A 20/M, student, presents with 7 days high fever with headache, malaise, joint pain, sweating, loss of appetite, abdominal pain, vomiting, diarrhea and rose colored rash on the abdomen. What is the most likely diagnosis?

A. Hepatitis A

B. Dengue Fever

C. Malaria

D. Typhoid Fever

A

D. Typhoid Fever

45
Q
  1. Which mineral when depleted is uniquely associated with Leptospiral nephropathy?

A. Potassium

B. Sodium

C. Magnesium

D. Calcium

A

C. Magnesium

46
Q
  1. A 30/F, being treated for leptospirosis suddenly develops dyspnea, hemoptysis and oliguria. PE: BP 110/70 mmHg, HR 110/min, RR 32/min, O2 sat 90%; (+) bilateral coarse breath sounds. What is the most appropriate management?

A. IV Methylprednisolone

B. Oral prednisolone

C. Intubate and hook to mechanical ventilator

D. Initiate acute renal replacement therapy

A

D. Initiate acute renal replacement therapy

47
Q
  1. A 66/F, seeks treatment for osteoporosis. Had hip fracture 3 months ago. Menopause at 52; previous smoker; BMI 19.2kg/m2. Labs: Calcium 8.7mg/dl, Phosphorus 3mg/dl, Creatinine 0.8mg/dl and 25- hydroxy vitamin D 18mg/dl (normal >30mg/dl). Bone mineral densitometry (+) score of -3.0. What is the best therapy for her?

A. Denosumab + Calcium + Vit D

B. Raloxifene

C. Risedronate + Calcium

D. Ethinyl Estradiol medroxyprogesterone acetate

A

C. Risedronate + Calcium

48
Q
  1. Which type of headache presents as throbbing, generalized, intense in the morning, aggravated by noise, bright light with vomiting and visual loss; relieved by darkness, sleep and intake of NSAIDs?

A. Migraine with aura

B. Migraine without aura

C. Tension headache

D. Cluster headache

A

A. Migraine with aura

49
Q
  1. Which pathogen produces enterotoxin that causes watery diarrhea?

A. Shigella sp.

B. Vibrio cholera

C. Salmonella typhi

D. Entamoeba histolytica

A

B. Vibrio cholera

50
Q
  1. What is the daily dose of rifampicin in an adult patient?

A. 5 mg/kg

B. 10 mg/kg

C. 15 mg/kg

D. 20 mg/kg

A

B. 10 mg/kg

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