IM Flashcards
For the past 2 weeks, your 55 year old uncle had BP in the range of 130-138 mmHg systolic /
82-86 mmHg diastolic. His height is 160 cm and weight is 55 kg. His waist circumference is 32
inches.
His blood chemistry is as follows: FBS 114 mg/dl, cholesterol 190 mg/dl, HDL 32 mg/dl, LDL 99
mg/dl, triglycerides 130 mg/dl.
What advice will you give him?
A. Undergo aerobic exercises 150 minutes per week
B. Increase his weight since he has a low BMI
C. Limit salt intake to less than 2 g/day
D. Drink a maximum of 2 bottles of beer per week
A
Which of the following health interventions has the greatest impact on reducing morbidity and
mortality?
A. Control of blood pressure to less than 140/90 mmHg
B. Achieving HbA1c less than 7%
C. Maintaining BMI less than 24
D. Targeting LDL below 70 mg/dl
A
Which of the following, when clustered with Type 2 diabetes, increases an individual’s risk for
cardiovascular disease?
A. Fasting triglcerides of 140 mg/dl
B. BP of 130/90
C. HDL cholesterol of 55 mg/dl in a female patient
D. Waist circumference of 70 cm in a male patient
B
Mang Tonio, a 60 year old tricycle driver, consults for sudden onset shortness of breath
associated with severe epigastric pain and cold swears. He has been having intermittent attacks
of mild chest discomfort especially when climbing stairs and after eating since 2 weeks ago. He is
a diabetic with poor compliance to medications. He is also a smoker, but does not drink alcohol.
On PE, BP is 110/80, HR 86/min, 18 RR, BMI 28. The rest of the PE is normal.
What test would you order to confirm your diagnosis? A. EGD B. Chest x-ray C. Exercise stress test D. 12-L ECG
D
Mang Tonio’s ECG shows: Acute STEMI ECG What is your diagnosis? A. Acute myocardial infarction B. Costochondritis C. Acute pericarditis D. Atrial fibrillation
A
Mang Tonio says that the physician at the health center gave him a table that relieved his
chest pain. He cannot recall the name of the drug but remembers that he developed a headache
after taking this medication. What best describes the mode of action of this drug?
A. It decreases myocardial oxygen demand
B. It dilates the coronary arteries
C. It inhibits the conversion of angiotensin I to angiotensin II
D. It inhibits thromboxane synthesis by platelets
B
The medication is probably sublingual nitrates, a potent vasodilator.
After 1 month of taking his medications, Mang Tonio reports that although he noted
improvement in his symptoms, he still occasionally experiences chest pain. On PE, BP 140/90,
HR 80/min regular. You review his medications and increase the dosage of which of the following:
A. Metoprolol
B. Simvastatin
C. Ramipril
D. Clopidogrel
A
Ben, a 55 year old jeepney driver, complains of easy fatigue and dyspnea on exertion. He is a
chronic smoker and a heavy alcohol drinker. Which of the following would make you consider a
right-sided heart failure in this patient?
A. Crackles
B. Displaced apex beat
C. Fluid wave
D. S3 gallop
C
Left-sided heart failure involves signs of pulmonary congestion such as crackles, rales, and
wheezing, as well as left ventricular dysfunction or remodeling, as in a displaced apex beat or S3
gallop. Right-sided heart failure signs include a heightened JVP, ascites, edema, and other signs
of portal hypertension, among others.
Which of the following drugs belongs to the class of medication that has been shown to relieve
symptoms of heart failure in a patient with depressed ejection fraction, reverse cardiac
remodeling, prevent hospitalization, and prolong life?
A. Atorvastatin
B. Digoxin
C. Captopril
D. Furosemide
C – ACE inhibitors is the drug class the question is talking about
Chest pain that presents as a severe “ripping” and “tearing” pain or a sudden severe sharp
pain in the front of the chest that extends into the back, between the shoulder blades, can be
correctly diagnosed by what test?
A. Electrocardiogram
B. Chest computed tomography
C. Esophageal manometry
D. Creatine kinase MB isoform
B
The described chest pain pertains to aortic dissection, which can be correctly diagnosed by CT
scan.
Aling Sonia, 74/F, consults at the OPD for swelling in her legs and feet. She says that this is
absent when she wakes up in the morning and is most noticeable late in the day. She uses 3
pillows behind her head when she sleeps and would often wake up at night with a sense of
drowning. Which of the following signs would you expected to find on PE?
A. Elevated JVP
B. Weak dorsalis pedis pulses
C. Pallor
D. Pursed lip breathing
A
The edema, 3-pillow orthopnea, and paroxysmal nocturnal dyspnea all point to CHF. B can be
expected in peripheral arterial occlusive disease, although severe pedal edema can also make it
difficult to appreciate dorsalis pedis pulses. Pallor may be seen in CKD and other chronic
diseases. Pursed lip breathing is usually associated with COPD.
This is Aling Sonia’s chest x-ray. Which cardiac chamber is enlarged?
A. Right ventricle
B. Right atrium
C. Left atrium
D. Left ventricle
D
Who among the following has a risk factor for diabetes that warrants early screening?
A. Carla, 32, with a waist circumference of 70 cm
B. Alan, 40, with a BMI of 28
C. Mark, 38, with an HDL cholesterol of 55
D. Donna, 29, whose first cousin has diabetes
B
Cut-off for DM screening is a waist circumference of >102 cm in males and >80 cm in females,
BMI > 25, HDL
Linda, a 45 year old executive, consults you for a random blood sugar of 230 mg/dl. A
diagnostic center near her office offered discounted rates for lab tests so she had her blood sugar
tested. You will diagnose Linda with diabetes if she also presents with which of the following
symptoms?
A. Polyuria, polydipsia, and weight loss
B. Polyuria, polydipsia, and blurring of vision
C. Polyuria, polydipsia, and polyphagia
D. Polyuria, polydipsia, and parasthesia
A – blurring of vision and parasthesia are signs of end-organ damage and are late
complications of DM. According to our resident monitor, polyphagia is no longer strongly
associated with DM, at least compared to weight loss
On review of systems, you elicit that Linda complains of tingling sensation on her hands and
feet. What is the most common pattern for diabetic neuropathy?
A. Distal sensorimotor polyneuropathy
B. Segmental sensorimotor polyneuropathy
C. Proximal motor polyneuropathy
D. Multifocal neuropathy with autonomic involvement
A – the so-called “glove and stocking” distribution of diabetic neuropathy
You diagnose Linda with type 2 DM. She is overweight and has mild to moderate hyperglycemia. The drug of choice is A. Insulin B. Metformin C. Sitagliptin D. Acarbose
B
Treatment goals for Linda include the following EXCEPT
A. HbA1c 50 mg/dl
B
A 54/F consults your clinic for depression, constipation, memory loss, and fatigue. She
reports having received treatment for hyperthyroidism in the past but she could not recall the
details. There was no goiter and there was no neck scar. She had a rounded face. Her speech was slow and her voice was low-pitched. You noted a slow return phase of her deep tendon
reflexes. What results do you expect to find on her thyroid function tests?
A. Elevated FT4, elevated TSH
B. Low FT4, low TSH
C. Elevated FT4, low TSH
D. Low FT4, elevated TSH
D – she now has hypothyroidism
Ana, a 32 year old housewife, consults at the OPD for palpitations. She claims to have lost
weight over the past few months despite an increased appetite. PE revealed HR of 110/min,
irregularly irregular rhythm. Her thyroid scan show this:
How will you manage this patient? A. Refer to ENT for FNAB B. Start glucocorticoid therapy C. Start anti-thyroid medication D. Start thyroid hormone replacement therapy
C
The scan shows a diffusely “hot” or active thyroid, pointing to a hyperthyroid condition, probably
Grave’s disease
You prescribe Ana with medications and advice follow-up in 4 weeks. Which lab test would
you request to monitor her response to treatment?
A. Free T3
B. Repeat thyroid scan
C. TSH
D. Free T4
D
Ana returns to the OPD complaining of epigastric pain. She reports improvement in her
symptoms after 1 month intake of propylthiouracil and propranolol. She also admits to selfmedicating
with multivitamins and ferrous sulfate upon the advice of her neighbor. You tell Ana
that her new symptoms may possible be from an adverse effect of which medication?
A. Ferrous sulfate
B. Propranolol
C. Multivitamins
D. PTU
A
Ariel, 50/M, consults at the OPD for parasthesias 1 week after undergoing thyroidectomy for
thyroid CA. You lightly tapped on the right side of his face and note this:
What is the explanation for this finding?
A. Beginning hypothyroidism
B. Low parathyroid hormone level
C. Persistent hyperthyroidism
D. Recurrent laryngeal nerve injury
B
This is the Chvostek sign, indicative of hypocalcemia. This may be secondary to inadvertent
removal of the parathyroids during thyroidectomy.
Amy, a 19 year old college student, consults the OPD for chest tightness. She was diagnosed
with bronchial asthma when she was 8 years old but was lost to follow-up because her symptoms
occurred only a few times a year. In the last 3 months, she began to experience more frequent
attacks of shortness of breath and cough. She now notes chest tightness and wheezing at least
once a day, relieved by salbutamol inhaler, but denies any night symptoms. What would be your
next step in management?
A. Leukotriene antagonists
B. Inhaled glucocorticoids
C. Long-acting beta-agonists
D. Oral corticosteroids
B – we need to give her controller meds in addition to her reliever meds
Which of the following is an effect of beta-adrenergic agonists on airways?
A. Control of inflammation over time
B. Contraction of airway smooth muscle
C. Decreased mucociliary clearance
D. Inhibition of mast cell mediator release
D
65/M consults for a 1 month history of persistent productive cough, occasionally with bloodtinged
sputum, but no fever. He has lost his appetite and noticed his pants becoming loose
around the waist. He also complains of exertional dyspnea. He has been smoking 1-2 packs of
cigarettes a day for the last 40 years. On PE, patient is cachectic with note of decreased breath
sounds on all lung fields and occasional wheezes. Which of the following is the LEAST likely
diagnosis?
A. Lung cancer
B. Pneumonia
C. Emphysema
D. Tuberculosis
B
TB and lung cancer can explain the symptoms, especially weight loss. Smoking is also a risk
factor for lung cancer. Emphysema can occur secondary to COPD, which the patient possibly has
because of the symptoms and the history of smoking.
Which of the following interventions is proven to reduce mortality in patients with COPD?
A. Leukotriene receptor antagonists
B. Inhaled LABA + corticosteroid combination
C. Systemic corticosteroids
D. Oxygen
D
What diagnosis should you consider when you see the following PE finding in patients with COPD? A. Cor pulmonale B. Lung cancer C. TB D. Reactive erythrocytosis
B
A 75/F with diabetes has had cough and fever for the past 3 years. On PE: HR 84, RR 22, BP
120/70, T 38.1 C. You hear crackles on the right lower lung field. What would be your choice of
antibiotic treatment based on the 2010 Philippine Guidelines on the Management of Community-
Acquired Pneumonia in Immunocompetent Adults?
A. Claithromycin
B. Cefuroxime
C. Levofloxacin
D. Amoxicllin
B
Actually given her age and concomitant DM, she may be considered immunocompromised,
necessitating the use of a cephalosporin.
Which of the following would you expect to find in sputum microscopy? A. Legionella pneumophilia B. S. aureus C. Pseudomonas aeruginosa D. Enteric gram-negative bacilli
D
Identify the organism in the sputum gram stain below: A. H. influenza B. M. tuberculosis C. P. aeruginosa D. S. pneumonia
D – these are gram-positive diplococci
Which of the following statements is TRUE about the treatment of pulmonary TB?
A. It is important that the patient is compliant with all his medications during the first 2 months in
order to prevent relapse
B. The treatment regimen of choice for PTB consists of a 4 month intensive phase and 2 month
continuation phase
C. Cough that persists until 5 months of treatment in a patient adherent to medications is
indicative of treatment failure
D. Fixed dose combinations of anti-TB drugs improves compliance
D
A 35/M being treated for PTB develops cute pain on the 1st metatarsophalangeal joint. You
noted erythema, swelling, and tenderness. Which of the following drugs is responsible for this
event?
A. Isoniazid
B. Pyrazinamide
C. Rifampicin
D. Ethambutol
B
Which of the following drug and adverse effect pairs are CORRECTLY matched? A. Pyrazinamide: jaundice B. Isoniazid: Vitamin B1 depletion C. Rifampicin: color blindness D. Streptomycin: arthritis
A
A 25/F consults at the OPD for a 3 month history of non-productive cough, with weight loss,
night sweats, and fatigue. She does not smoke. Chest examination is normal. What would be
your first step in the management of this patient?
A. Start treatment with a 1 week course of antibiotic
B. Refer for bronchoscopy
C. Send sputum for microscopy
D. Therapeutic trial with antihistamine-decongestant combination
C
In what phase of pneumonia is there predominance of neutrophils and deposition of fibrin? A. Resolution B. Red hepatization C. Edema D. Grey hepatization
D
Which of the following is TRUE regarding atypical pathogens in pneumonia?
A. They are difficult to grow on standard culture media
B. They are generally susceptible to beta-lactam antibiotics
C. They are generally resistant to macrolides
D. They are easily visualized on gram stain
A
The following are criteria of a good screening test in healthy adults EXCEPT
A. The burden of illness is high
B. The screening strategy is safe and cost-effective
C. Early treatment is more effective than late treatment
D. Prognosis of the disease being screened, if missed, is poor
D
This 55 year old laundrywoman consults you for weight gain. She says that her pants have gotten tighter around the waist. What is your primary diagnosis? A. Hypothyroidism B. Cushing’s syndrome C. Nephrotic syndrome D. Polycystic ovary syndrome
B – the classic moon facies of Cushing’s is evident here
20/M known to have asthma since childhood, consults for recent weight gain. He is taking
various oral and inhaled medications to control his asthma. On PE, his abdomen appeared like
this:
Which one of his medications most likely caused this finding?
A. Oral montelukast
B. Inhaled salmeterol
C. Oral prednisone
D. Inhaled budesonide
C – These violaceous striae are indicative of Cushing’s, most likely due to his intake of
steroids.
A 24/F consults at the OPD for left-sided chest pain, which is more apparent when she
inhaled deeply. She has no other illnesses, is a non-smoker, and has no family history of heart
disease. PE reveals an area of point tenderness on the 4th rib along the LMCL. There was no
erythema or warmth of the overlying skin. What is the most likely diagnosis?
A. Costochondritis
B. Herpes zoster
C. Myofascial pain syndrome
D. Angina pectoris
A
