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FEB 2020 YEAR II Flashcards

1
Q
  1. Which is the central mechanism of disseminated intravascular coagulation?

A. Uncontrolled generation of thrombin by exposure of the blood to pathologic levels of tissue factor

B. Platelet thrombi deposition in the microvasculature

C. Decrease production and increase clearance of clotting factors

D. Immune-mediated thrombin formation

A

A. Uncontrolled generation of thrombin by exposure of the blood to pathologic levels of tissue factor

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2
Q
  1. A 50/F, with Stage IV Breast Cancer, presents with 3 days vomiting. Ionized serum calcium is 5 mmol/L. Which emergency treatment is LEAST useful in this case?

A. Bisphosphonates

B. Corticosteroids

C. IV Furosemide

D. PNSS

A

B. Corticosteroids

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3
Q
  1. Which cause of acute kidney injury presents with eosinophiluria?

A. Scleroderma crisis

B. Allograft rejection

C. Atheroembolic Disease

D. Ethylene glycol intoxication

A

C. Atheroembolic Disease

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4
Q
  1. Which novel biomarker for AKI can be detected in the plasma and urine within 2 hours of cardiopulmonary bypass-associated AKI?

A. NGAL (Neutrophil Gelatinase Associated Lipocalin)

B. IGFBP7 (Insulin Like Growth Factor Binding Protien 7)

C. KIM 1 (Kidney Injury Molecule 1)

D. TIMP-2 (Tissue Inhibitor of Metalloproteinase-2)

A

A. NGAL (Neutrophil Gelatinase Associated Lipocalin)

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5
Q
  1. A 60/M, diagnosed with alcoholic liver cirrhosis, has stopped alcohol intake 5 months ago, presents with new onset behavioral changes with asterixis. What is the drug of choice for this patient’s acute problem?

A. High dose B complex

B. Lactulose

C. Branched chain amino acids

D. Diuretics

A

B. Lactulose

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6
Q
  1. What is the best specimen for culture during the convalescent stage of Leptospirosis?

A. Blood

B. Urine

C. CSF

D. Stool

A

B. Urine

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7
Q
  1. A 25/F, G1P0, 30 weeks AOG, presents with 3 days fever. Able to tolerate oral fluids. No abdominal pain nor bleeding. VS stable with adequate urine output. CBC: Hct. 0.38, WBC 4 X 103/uL, lymphocytes 60%, platelet 155,000/uL. What will you decide on now?

A. Send home; follow-up CBC and platelet count

B. Admit to ward; oral hydration; do serial CBC

C. Admit to ward; IV hydration; do serial CBC

D. Admit to ICU for close monitoring

A

B. Admit to ward; oral hydration; do serial CBC

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8
Q
  1. Which is NOT a feature of Tumor Lysis Syndrome?

A. Hyperuricemia

B. Hyperkalemia

C. Hyperphosphatemia

D. Hypercalcemia

A

D. Hypercalcemia

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9
Q
  1. A 28/M, presents with left-sided pleuritic chest pain associated with progressive dyspnea, weight loss and fever. Pleural fluid studies yielded adenosine deaminase of 45 IU/L. What is the expected characteristic of the pleural fluid in this patient?

A. Dark red in color

B. Neutrophilic predominance

C. Pleural fluid LDH >1/3 for normal

D. Pleural fluid protein/serum protein ratio of 0.7

A

D. Pleural fluid protein/serum protein ratio of 0.7

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10
Q
  1. A 58/M, presents with severe, acute, non-remitting abdominal pain accompanied by diarrhea. PE: BP 90/60 mmHg, HR 120 bpm, RR 30 cpm, and afebrile. Cardiac exam (+) irregular heart rate with a mid-systolic, crescendo-decrescendo murmur heard best at the apex and abdomen, (+) hypoactive bowel sounds but no tenderness. What is the preferred diagnostic test for this patient?

A. Plain abdominal radiographs

B. CT scan of the whole abdomen

C. Duplex imaging

D. CT angiography

A

D. CT angiography

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11
Q
  1. A 50/M, while playing tennis suddenly lost consciousness. One co-player trained in BLS immediately did chest compressions while waiting for the EMS. When the EMS arrived, patient is attached quickly to defibrillator and a shock is delivered. What is the most likely initial rhythm noted upon hooking to the defibrillator?

A. Asystole

B. Pulseless electrical activity

C. Ventricular fibrillation

D. Ventricular tachycardia with pulse

A

C. Ventricular fibrillation

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12
Q
  1. Membranous glomerulonephritis is closely associated with the following infections, EXCEPT:

A. Malaria

B. Hepatitis B

C. Dengue fever

D. Leprosy

A

C. Dengue fever

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13
Q
  1. What complication do you expect when you do MRI with contrast in a patient with GFR of <30ml/min?

A. Calciphylaxis

B. Nephrogenic fibrosing dermopathy

C. Contrast-induced nephropathy

D. Osteitis fibrosa cystica

A

B. Nephrogenic fibrosing dermopathy

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14
Q
  1. What lesion differentiates pseudomonas infection in markedly neutropenic patients from other gram-negative infection?

A. Ecthyma gangrenosum

B. Erysipelas

C. Erythema multiforme

D. Erythroderma

A

A. Ecthyma gangrenosum

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15
Q
  1. A 45/F, with hyperthyroidism on Methimazole, presents with 10 days fever. PE: unremarkable. Work-ups for infection are normal except for neutropenia of 250/uL What is your initial empiric antibiotic therapy?

A. Ciprofloxacin

B. Levofloaxacin

C. Meropenem

D. Ceftriaxone

A

C. Meropenem

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16
Q
  1. Which condition is an absolute contraindication to the use of fibrinolytic agents in patients with ST elevation myocardial infarction?

A. Current use of anti-coagulant

B. Prolonged cardiopulmonary resuscitation

C. Cerebrovascular hemorrhage

D. Active peptic ulcer disease

A

C. Cerebrovascular hemorrhage

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17
Q
  1. Which pathogen for community-acquired pneumonia is associated with exposure to sheep, goats, and parturient cats?

A. Community-acquired MRSA

B. Francisella tularensis

C. Histoplasma capsulatum

D. Coxiella burnetii

A

D. Coxiella burnetii

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18
Q
  1. What subset of patients may undergo kidney biopsy?

A. Bilateral hydronephrosis

B. Four cm cyst right upper pole

C. Uncontrolled hypertension

D. Rapidly progressive azotemia

A

D. Rapidly progressive azotemia

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19
Q
  1. A 65/M, smoker, presents with shortness of breath, productive cough, low grade fever, body malaise and anorexia. Has decrease breath sounds, right hemithorax. UTZ-guided thoracentesis drained serosanguinous non-foul smelling fluid and analysis shows: LDH 1400 u/L, protein 74.3 gm/dL, glucose 58.4 mg/dL, Gram stain: no organisms, differential count is lymphocytic predominance, cytology shows atypical cells and mesothelial cells. What is the likely diagnosis?

A. TB pleurisy

B. Parapneumonic effusion

C. Malignant pleural effusion

D. Malignant mesothelioma

A

C. Malignant pleural effusion

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20
Q
  1. Which is NOT considered an immunologic manifestation of SLE?
  2. Anti-Sm
  3. Anti-RNP1
  4. Positive Direct Coombs Test
  5. Antiphospholipid
A

B. Anti-RNP1

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21
Q
  1. A 45/F, suffering from end stage kidney disease, on peritoneal dialysis, complains of severe abdominal pain and fever. PE: diffuse abdominal tenderness and cloudy dialysate. What is the cause of the secondary bacterial peritonitis?

A. Bowel perforation

B. Loss of peritoneal integrity

C. Perforation or leakage of other organs

D. Manipulation

A

B. Loss of peritoneal integrity

22
Q
  1. A 24/M, presents with abdominal pain, continuous, initially in the epigastric area then localizes at the right lower quadrant, aggravated by coughing, accompanied by nausea, vomiting and low grade fever. PE reveals tenderness at the right lower quadrant. What is the initial management?

A. Parenteral analgesic

B. Antibiotic for aerobic gram-negative bacilli and anaerobes

C. Antifungal drug

D. Hydration

A

B. Antibiotic for aerobic gram-negative bacilli and anaerobes

23
Q
  1. Which urinary sediments give us clue for glomerular origin of hematuria?

A. Fine granular casts

B. Broad Casts

C. RBC Casts

D. WBC casts

A

C. RBC Casts

24
Q
  1. A 68/M, diabetic, CKD on dialysis, presents with high-grade fever, extensive cellulitis of the left leg and melena. Labs: prolonged protime with decreased activity at 43% and platelet count of 87 x 109 / L. D-dimer 2x the normal. What is the 1st step that you will do?
  2. Transfuse FFP
  3. Control underlying cause
  4. Give Tranexamic Acid
  5. Give IV vitamin K
A

B. Control underlying cause

25
Q
  1. A 34/F, presents with 1- day fever, headache, malaise, and chills. Urinalysis shows bacteriuria and hematuria. Treated for UTI. Two days later, she comes back with worsening headache, retro-orbital pain exacerbated by eye movement, and feeling light-headed. Fever has resolved. PE: alert and oriented but has discomfort from headache, with loss of balance with eyes closed. Normal VS. Chest x-ray: minimal bilateral pleural effusion. What is the most likely diagnosis?
  2. Typhoid fever
  3. Complicated UTI
  4. Dengue Hemorrhagic Fever
  5. Viral meningitis
A

C. Dengue Hemorrhagic Fever

26
Q
  1. A 40/M, presents with 1-day fever, headache, malaise and chills followed by worsening headache, retro-orbital pain and light-headedness. Afebrile after 2 days. PE: alert and oriented. Normal vital signs and neuro exam. CBC: WBC of 3,900/μL, Hct of 43%, and platelet count of 115,000/μL. Went home but came back after 6 days with nausea. Now with grade 1 bipedal edema and small (1-2mm) red spots on her lower extremities. Repeat CBC: WBC of 3,800/μL, Hct of 45%, and platelet count of 90,000/μL. How will you manage the patient?
  2. Parenteral broad-spectrum antibiotic
  3. PLRS 100-120mL/hour
  4. IV Dextran 70 6% in 5% dextrose at 500ml/hour
  5. Transfuse 3 ’u’ platelet concentrate
A

B. PLRS 100-120mL/hour

27
Q
  1. A 38/M, “PLHIV”, presents with whitish-yellow creamy confluent plaque overlying his tongue. His most recent CD4 count was 120 cells/mL. What is your treatment?
  2. Trimethoprim Sulfamethoxazole
  3. Rifampicin
  4. Oseltamivir
  5. Doxycycline
A

A. Trimethoprim Sulfamethoxazole

28
Q
  1. A 62/M, with history of right upper lobe pulmonary adenocarcinoma, presents with progressive dyspnea. PE: edematous face, neck and right arm. (+) varicosities on his chest. What is the value of a chest CT scan for this patient?
  2. A guide for pericardiotomy
  3. Localization for aneurysmectomy
  4. Preparation for bone marrow transplant
  5. Ensure airway patency prior to radiation
A

D. Ensure airway patency prior to radiation

29
Q
  1. A 65/M, suffering from metastatic pancreatic cancer, presents with petechiae, ecchymoses and oozing of blood at venipuncture site. Hgb 10.6 g/dL , platelet count is 50,000/µL, and prothrombin time is > 1.9 times the normal. Elevated D- dimer and FDP. With schistocytes in his blood smear. Which blood products will you transfuse?
  2. Factor VIII concentrates
  3. Fresh Frozen Plasma
  4. Packed RBC
  5. Platelet concentrates
A

B. Fresh Frozen Plasma

30
Q
  1. A 60/F, presents with bipedal edema and ascites. Serum Na+ is 129 meq/L and urine Na+ is 25mM. Which is the likely etiology for his hyponatremia?
  2. Heart Failure
  3. Cirrhosis of the Liver
  4. Nephrotic Syndrome
  5. Renal Failure
A

D. Renal Failure

31
Q
  1. A 70/M, presents with 3 days severe watery diarrhea and body weakness. Labs: Serum creatinine 2.6mg/dL, serum Na+ 128 meq/L, and serum K+ 5.5 meq/L. ABG: pH 7.32, serum bicarbonate 18mmol/L. How much caloric intake will you prescribe?
  2. 10-15 kcal/kg/day
  3. 16-19 kcal/kg/day
  4. 20-30kcal/kg/day
  5. 35 kcal/kg/day
A

C. 20-30kcal/kg/day

32
Q
  1. Which supplement is found to be beneficial and relatively harmless to patients with hepatic encephalopathy?
  2. Selenium
  3. Thiamine
  4. Iron
  5. Zinc
33
Q
  1. What is the initiating event in the development of ascites in patients with cirrhosis?
  2. Increased splanchnic pressure
  3. Arterial underfilling
  4. Portal hypertension
  5. Sodium retention
A

C. Portal hypertension

34
Q
  1. During a typhoon, a 32 weeks pregnant woman was forced to wade through flood waters. She lived in an area endemic for leptospirosis. Which chemoprophylaxis is recommended?
  2. Amoxicillin
  3. Azithromycin
  4. Cefixime
  5. Doxycycline
A

B. Azithromycin

35
Q
  1. Based on the DOH Revised Dengue Clinical Case Management Guidelines 2011, which statement describes the Critical phase of Dengue Fever?
  2. Plasma leakage lasts for 72hours
  3. Hypervolemia develops
  4. Total WBC increases in patients with bleeding
  5. Develops multi-organ failure
A

C. Total WBC increases in patients with bleeding

36
Q
  1. A 34/M patient living with AIDS presents with 1month non-bloody diarrhea, abdominal pain, weight loss and anorexia. Colonoscopy shows multiple mucosal ulcerations. Biopsy reveals intranuclear and cytoplasmic inclusion bodies. What is the diagnosis?
  2. AIDS Enteropathy
  3. CMV Colitis
  4. Inflammatory Bowel Disease
  5. Tuberculous Colitis
A

B. CMV Colitis

37
Q
  1. Which laboratory result is prominently low in diabetic ketoacidosis compared with hyperglycemic hyperosmolar state?
  2. Arterial PCO2
  3. Anion gap
  4. Plasma ketones
  5. Serum bicarbonate
A

D. Serum bicarbonate

38
Q
  1. What is the LEAST common PUD - related complication?
  2. Perforation
  3. Gastrointestinal bleeding
  4. Gastric outlet obstruction
  5. Multiorgan failure
A

C. Gastric outlet obstruction

39
Q
  1. A 50/M, presents with an incidental finding of elevated hematocrit. Unremarkable past medical history. PE: palpable spleen. Hematocrit 57% with hemoglobin 18 g/dL, WBC count 12.5/μL, with normal differential and platelet count 400,000/μL. What is the next diagnostic step?
  2. Arterial blood gas
  3. Erythropoietin (EPO) level
  4. Red blood cell (RBC) mass
  5. Pulmonary function tests
A

C. Red blood cell (RBC) mass

40
Q
  1. A 58/M, develops sudden onset of right facial weakness and right hemiplegia 1 hour PTC. Anxious, with slurred speech. BP 150/90 mmHg, HR 106/min with irregular rhythm. Cranial CT scan shows no hemorrhage. What is the next best approach?
  2. Lower BP and heart rate
  3. IV recombinant tissue plasminogen activator (rtPA)
  4. Endovascular revascularization
  5. Warfarin
A

B. IV recombinant tissue plasminogen activator (rtPA)

FDA approval followed rapidly for treatment of patients within 3 hours after onset of acute ischemic stroke.

41
Q
  1. A 62/M, presents with severe chest pain, hypotension, jugular venous (JV) distention, Kussmaul’s sign, hepatomegaly, clear lung fields. CXR is normal. ECG shows ST-segment elevation in lead V4 R. What is your diagnosis?
  2. Anteroseptal wall MI
  3. Inferior wall MI
  4. Inferoposterior wall MI
  5. Right ventricular MI
A

D. Right ventricular MI

42
Q
  1. A 64/M, diagnosed with ischemic cardiomyopathy, ejection fraction 35%, and NYHA Class III heart failure, complains of incessant coughing. His current regimen include Lisinopril, Furosemide, Aspirin, and Atorvastatin. If intolerant to Lisinopril, what drug can you prescribe instead?
  2. Aldosterone antagonist
  3. Angiotensin receptor blocker
  4. Beta-blocker
  5. Calcium channel blocker
A

B. Angiotensin receptor blocker

43
Q
  1. A 68/F, develops intra-abdominal abscess post cholecystectomy. Despite antibiotic therapy, fever persists and develops hematemesis, melena, and purpuric skin rash. Platelet count 60,000/microliter, prolonged prothrombin time (PT), and decreased fibrinogen. What is the appropriate treatment?
  2. Transfuse platelet concentrate
  3. Change antibiotics
  4. Drain the abscess
  5. Transfuse cryoprecipitate
A

C. Drain the abscess

44
Q
  1. A 36/F, chronic NSAID user for rheumatoid arthritis, presents with 3 days diarrhea. Now with high BUN and serum creatinine. Which test results suggest pre-renal azotemia vs acute tubular necrosis?
  2. BUN 90mg/dL and serum creatinine 3 mg/dL
  3. Urine osmolality < 350 mOsmol/L H2O
  4. Fractional sodium excretion > 2 %
  5. Urine sodium > 40 meq/L
A

A. BUN 90mg/dL and serum creatinine 3 mg/dL

45
Q
  1. A 30/M, presents with wading in the flood 10 days ago followed by 5 days fever, chills, generalized malaise, joint and muscle pains. (+) maculopapular rashes. What is the confirmatory test?
  2. Isolation of spirochetes in blood with PCR test
  3. Isolation of spirochetes in the urine
  4. Elevated WBC with left shift, CRP and ESR
  5. Detection of anti-leptospira antibody in the blood
A

A. Isolation of spirochetes in blood with PCR test

46
Q
  1. A 55/F, presents with 4 days fever, productive cough and easy fatigability after arriving from a cruise ship tour. Which antibiotic is best for her?

A. Amoxicillin-clavulanate

B. Cefuroxime

C. Azithromycin

D. Ciprofloxacin

A

C. Azithromycin

47
Q
  1. A 40/F, post splenectomy a year ago, presents with productive cough, fever and chills. PE: BP 90/60mmHg, CR 114/min, T: 39oC. Which antibiotic is most appropriate for her?

A. Piperacillin-tazobactam

B. Meropenem

C. Ceftriaxone

D. Co-Amoxyclav

A

C. Ceftriaxone

48
Q
  1. A 60/M, on Alprazolam for anxiety, presents with 18 hours of altered sensorium. (+) for cirrhosis due to hepatitis C, no signs of decompensation. Has psychomotor slowing with asterixis. No focal neurologic deficits. Normal CBC, serum electrolytes, creatinine, and blood glucose. After starting on lactulose, what is the next step in your management?

A. Hydration

B. Protein-restricted diet

C. Rifaximin

D. Withdraw alprazolam

A

D. Withdraw alprazolam

49
Q
  1. A 20/M, presents with fever, headache and anorexia. No vomiting nor mucosal bleeding. PE: T 38.8 °C, BP 100/70 mm Hg, PR 102/min, RR 19/min. Reddish posterior pharynx but no exudates. Legs show macupapular, erythematous rashes. Liver span 12 cm midsternal line. No palpable lymphadenopathies. What is the classification of the patient’s disease?
  2. Dengue without warning signs
  3. Dengue with warning signs
  4. Severe dengue
  5. Dengue shock syndrome
A

B. Dengue with warning signs

50
Q
  1. A 35/M, recently diagnosed with HIV infection. Asymptomatic. Has not yet started antiretroviral therapy. Complete childhood immunizations. PE: (+) cervical lymphadenopathies. Labs: (-) HBSAg; (+) Anti-Hbs; (-) Hepatitis A IgG; CD4 cell count 480/µL. Which vaccine must he received?
  2. Hepatitis A vaccine
  3. Hepatitis B vaccine
  4. Pneumococcal conjugate vaccine
  5. Pneumococcal polysaccharide vaccine
A

C. Pneumococcal conjugate vaccine

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