DEPARTMENT OF MEDICINE

5th RESIDENTS EXAM

HEMA, ONCO, ALLERGY, RHEUMA, DERMA EXAM
July 30, 2008

MULTIPLE TRUE OR FALSE:

There are 5 statements after each question. Determine whether each statement is true or
false. On the answer sheet, place an X in the box corresponding to your answer.

ONCOLOGY
1. The following organs are considered radiosensitive: (HPIM, p. 486):
A. Testes D. Bone marrow
b. Ovaries E. Skeleta muscle
C. Bone

2. The following are components of tumor-lysis syndrome (HPIM 16th., p. 581):

A. Hyperuricemia D. Hypophsphatemia
B. Hyperkalemia E. Lactic acidosis
C. Hypercalcemia

3. The following chemotherapeutic drug/s is/are accurately matched with its late treatment
effect: (HPIM 16th ed., p. 584 585)
A. Bleomycin Pulmonary fibrosis
B. Platinum Cardiomyopathy
C. Anthracyclines Constrictive pericarditis
D. Cyclophosphamide Bladder CA
E. Cisplatin Cataracts

4. A 40 year old male presented with a 1-month history of facial swelling, eventually
involving the upper extremities, especially the right arm. On PE, he was plethoric, with
engorged neck veins and visible venous collaterals on his chest wall. Whish of the
following tumors is/are responsible for 90% of cases like this?
A. Lung cancer D. Thyroid cancer
i. Lymphoma E. Germ-cell
tumors
B. Metastatic tumors

5. Among patients with metastatic tumors to the vertebral column, the following statements
are TRUE (HPIM 16th ed., p. 577 578):
A. Prostate cancer is the most commonly identified primary malignancy.
B. The lumbosacral spine is the most commonly involved area.
C. The back pain is characteristically exacerbated by ambulation and relieved by the
recumbent position.
D. Vertebral body collapse is the earliest radiologic finding.
E. The most common initial symptom is radicular pain.

6. The following are the critical dates in a womans life that have a major impact on the
incidence of breast cancer: (HPIM 16th ed, p. 517)
A. Age of menarche
B. Age of marriage
C. Age of first full-term pregnancy
D. Age of first lactation
E. Age of menopause

7. In the evaluation of breast masses, the following statements are CORRECT (HPIM 16 th
ed. P. 517 518):
A. The best time for breast examination is Day 5 7 of a womans menstrual cycle.
B. A palpable mass that is not visualized on ultrasound must be presumed to be
solid.
C. In selected patients, the so-called triple diagnostic techniques (ultrasound,
mammography, aspiration) can be used to avoid biopsy.
D. The development of a dominant breast mass during pregnancy or lactation is
usually due to the effect of progesterone and human placental lactogen.
E. If a nonpalpable mammographic lesion has a low index of suspicion as a
malignancy, mommographic follow-up after one year is reasonable.
8. The following statements are TRUE about gastric CA (HPIM 16th ed., p. 525):
A. Diffuse gastric CAs, usually occurring in elderly patients, have poorer prognosis
than the intestinal type.
B. The risk of gastric CA is greater among the lower socioeconomic classes.
C. Patients who chronically ingest high concentrations of nitrates from dried,
smoked, and salted foods appear to be associated with a higher risk for gastric
CA.
D. Individuals with Type O blood have a higher incidence of gastric CA than those
with Type A blood.
E. Duodenal ulcers are associated with gastric CA.

9. In the treatment of gastric CA, the following statements are TRUE: (HPIM 16 th ed, p.
526):
A. Complete surgical removal of the tumor with resection of adjacent lymph nodes
offers the only chance of cure.
B. A subtotal gastrectomy is the procedure of choice for patients with proximal
stomach tumors.
C. Since gastric CA is a radioresistant tumor, radiation has no role in the
management of patients with gastric CA.
D. All gastric CA patients, especially those with ascites and extensive hepatic or
peritoneal metastasis, should be offered surgical resection of the primary lesion.
E. Chemotherapy for gastric CA generally includes 5-FU and dosorubicin together
with either mitomycin-C or cisplatin.

10. The following gastrointestinal polyposis syndromes are characterized by adenomatous

lesions that commonly evolve into colon CA: (HPIM 16th ed., p. 528)
A. Familial adenomatous polyposis
B. Gardners Syndrome
3. Turcots Syndrome
D. Lynch Syndrome
E. Peutz-Jeghers Syndrome

11. The symptoms and clinical presentation of colon CA varies with the anatomic location of
the tumor. The following statements are TRUE (HPIM, p. 529 530):
A. Cancers arising in the cecum and ascending colon may become quite large
without resulting in any obstructive symptoms.
B. Lesions of the right colon usually present as a hypochromic, microcytic anemia.
C. Tumors arising from the transverse colon usually present as colicky abdominal
pain, mimicking gallbladder colic.
D. Tumors arising from the descending colon may appear as an apple-core or a
napkin-ring on abdominal radiographs.
E. Cancers arising in the rectosigmoid are often associated with hematochezia,
tenesmus, or decreased stool caliber.

12. The recent news that former President Cory Aquino has colon cancer has triggered
enormous interest from the public regarding colon cancer screening. The following
statements are CORRECT (HPIM, p. 446):
A. The American Cancer Society recommends annual colonoscopy for everyone
over 60 years old.
B. The American Cancer Society recommends yearly fecal occult blood testing for
everyone over 50 years old.
C. The most efficient interval for screening sigmoidoscopy is annually.
D. Up to 5% of all individuals tested for fecal occult blood will have a positive result.
E. Only about 2-10% of patients with positive stool occult blood will have cancer.

13. The following entities causing chronic liver disease also predispose patients to develop
hepatocellular CA. (HPIM 16th ed., p. 534):
A. Alcoholic liver disease D. Primary biliary cirrhosis
B. Alpha 1 antitrypsin deficiency E. Non-alcoholic steatohepatitis
C. Hemochromatosis

14. The following are apparent predisposing factors for the development of
cholangiocarcinoma: (HPIM 16th, p. 536):
A. Long-standing cholelithiasis
B. Chronic hepatitis
C. Congenital anomalies with ectatic ducts
D. Scelrosing cholangitis
E. Chronic hepatobiliary parasitic infections
15. The following statements are TRUE about pancreatic CA: (HPIM 16th ed., p. 537):
A. Pancreatic cancers most commonly involve the pancreatic tail.
B. Obesity is a risk factor for pancreatic cancer.
C. The availability of CA 19-9 enables the early diagnosis of potentially resectable
pancreatic cancer.
D. Complete surgical resection of pancreatic tumors offers the only effective
treatment.
E. As a rule, pancreaticoduodenectomy or distal pancreatectomy is preferred over
total pancreatectomy.

16. The following risk factors would argue strongly for proceeding with resection of a
pulmonary nodule: (HPIM 16th ed., p. 513):
A. Male sex
B. Presence of calcification on chest xray
C. History of cough and hemoptysis
D. Presence of atelectasis
E. History of smoking

17. Staging of small-cell lung CA uses a simple two-stage system: limited-stage and
extensive-stage. The following conditions can still be considered as limited-stage
disease: (HPIM 16th ed., p. 510):
A. Recurrent laryngeal nerve involvement
B. Superior vena caval obstruction
C. Cardiac tamponade
D. Malignant pleural effusion
E. Involvement of supraclavicular lymph nodes

18. A 60 year old male, smoker, has a 2 cm pulmonary nodule. His positron emission
tomography scan showed a standardized uptake value <2.5. Aside from the absence of
malignancy, this results can also be following: (HPIM 16th ed., p. 510):
A. Very aggressive tumors such as small cell CA
B. Presence of tuberculosis
C. Diabetes mellitus as comorbid condition
D. HIV-postivity
E. Presence of liver disease

19. Although CA-125 is a useful marker for ovarian CA, it can also be elevated in the
following non-malignant conditions (HPIM 16th ed., p. 554):
A. Acute appendicitis
B. Pregnancy
C. Peptic ulcer disease
D. Endometriosis
E. Pelvic inflammatory disease

20. The following statements are TRUE regarding prostate cancer: (HPIM 16 th ed., p. 543-
546):
A. While nonmalignant growth occurs mostly in the transitional zone around the
urethra, cancers usually develop in the peripheral zone, allowing easier palpation
by digital rectal exam.
B. A patient with localized prostate CA who had all cancer removed surgically
remains in the state of localized disease as long as the PSA remains
undetectable.
C. Carcinomas are characterized by an indurated prostate on digital rectal exam.
D. Digital rectal exam does not provide adequate assessment of disease extent.
E. Patients with localized prostate CA may be managed by radical surgery, radiation
therapy, or watchful waiting.

HEMATOLOGY

21. Aside from iron-deficiency anemia, the following disease entities may also cause
hypochromic, microcytic anemia: (HPIM 16th ed., p. 590)
A. Sickle cell anemia
22. Thalassemia
A. Methemoglobinemia
B. Anemia of chronic inflammatory disease
C. Myelodysplastic syndrome
23. The following advise should be given to patients receiving iron supplementation (HPIM
16th ed., p. 590):
A. Oral iron should be taken on an empty stomach.
B. Gastrointestinal distress is the most prominent side effect.
C. A dose of 200 to 300 mg of elemental iron per day results in the absorption of up
to 50 mg/day.
D. As the hemoglobin level rises, the amount of iron intake may be reduced
because intestinal absorption also increases.
E. To replenish iron stores, sustained treatment of up to 2 years after the correction
of enemia may be necessary.

24. A 22 year old female with rheumatoid arthritis underwent work-up for anemia. The
following are the expected results of this work-up (HPIM 16th ed., p. 592):
A. Normocytic morphology on PBS D. Elevated TIBC
B. Elevated serum iron E. Reduced iron stores
C. Elevated serum ferritin

25. While macrocytosis suggests the presence of megaloblastic anemia, other causes of
macrocytosis include the following (HPIM 16th ed., p. 605):
A. Chronic renal disease D. Hypothyroidism
B. Aplastic anemia E. Alcoholism
C. Hemochromatosis

26. A 20 year old male consulted you for on and off jaundice and pallor. Further history
revealed similar symptoms in his sibling and a history of splenectomy in his father. On
PE, he has splenomegaly. PBS shows small RBCs with no central pallor. The following
statements are CORRECT about this condition (HPIM 16th ed., p. 608-609):
A. Majority of patients with this condition would have defects in the protein spectrin.
B. The patient would most likely have a positive direct Coombs test.
C. Splenectomy is recommended even in asymptomatic individuals.
D. Folic acid should be administered in patients with severe hemolysis.
E. Iron should be supplemented in all patients with severe anemia.

27. The following may precipitate an episode of hemolysis in individuals deficient in glucose-
6-phosphate dehydrogenase (HPIM 16th ed., p. 610 611):
A. Viral infections D. Napthalene
B. Penicillin E. Nitrofurantoin
C. Metabolic alkalosis

28. In the management of patients with autoimmune hemolytic anemia, the following
statements are TRUE (HPIM 16th ed., p. 612):
A. Patients with a mild degree of hemolysis usually do not require therapy.
B. In patients with clinically significant hemolysis, initial therapy consists of blood
transfusion of packed RBCs.
C. Splenectomy is recommended once the hemoglobin level starts to rise to normal
values.
D. There is no role for IV gamma globulin in this disease.
E. A rise in hemoglobin is often noted within 3 or 4 days after the initiation of
glucocorticoids.

29. The following are common manifestations of paroxysmal nocturnal hemoglobinuria

(HPIM 16th ed., p. 616):
A. Hemoglobinuria D. Venous thrombosis
B. Hemolytic anemia E. Splenomegaly
C. Mucosal bleeding

30. A 48 year old male was admitted for Budd-Chiari Syndrome. CBC showed anemia and
thrombocytopenia. Other labs revealed elevated serum LDH and flow cytometry shows
abnormal CD55 and CD59 patterns. In the management of this patient, the following
statement/s are CORRECT:
A. Transfusion therapy is discouraged because this will aggravate hemolysis.
B. Iron replacement is encouraged because of the increased iron requirements
brought about by the increased RBC production in the bone marrow.
C. Therapy with androgens sometimes results in a rise in hemoglobin level.
D. In contrast with autoimmune hemolytic anemia, there is no role for
glucocorticoids in the treatment of this disease.
E. Bone marrow transplantation has no role in this condition.
31. A 28 year old male lost around 1L of blood after sustaining multiple gun shot wounds.
The following statements are TRUE (HPIM 16th ed., p. 616 617):
A. This patient is expected to present with cold, clammy extremities and other signs
of systemic hypoperfusion.
B. The most rapid hematologic adjustment to acute blood loss is an increase in the
reticulocyte count.
C. Erythropoietin production increases in response to lactic acidosis.
D. Patients who have bled sufficiently to develop hypotension generally develop
anemia which is apparent only after volume replacement.
E. After 3 to 6 days, erythroid hyperplasia appears in the bone marrow.

32. The following diseases present as pancytopenia with a cellular bone marrow (HPIM, 16th
ed., p. 617):
A. Paroxysmal nocturnal hemoglobinuria
B. Myelofibrosis
C. Aplastic anemia
i. Myelophthisis
D. Myelodysplastic syndrome

33. A 22 year old, previously healthy female, presented with a two-week history of gum
bleeding, hematomas, and pallor. Bone marrow examination showed pancytopenia with
an empty, fat-filled bone marrow. The following statements are CORRECT about this
condition: (HPIM 16th ed., p. 619 621):
A. The most common infection preceding this illness is a seronegative hepatitis.
B. Patients with this disease usually present with an overwhelming infection.
C. Bleeding is the most common early symptom.
D. Systemic complaints, weight loss, together with the symptoms of pancytopenia
are the hallmarks of this illness.
E. Glucocorticoid are valuable adjuncts in the treatment of this disease.

34. A 26 year old male presented with a 3 month history of fatigue, anorexia and weight loss.
He also had on and off low grade fever. Two weeks prior to consult, he already had
pallor and dyspnea on exertion. He started to have bruises and bleeding gums on the
day of consult. His CBC revealed a WBC count of 350000/uL, with 90% blasts. The
following statements are TRUE: (HPIM, p. 632 633):
A. Cytogenetic analysis provide the most important pretreatment prognostic
information in this illness.
B. Significant GI bleeding and intracranial hemorrhage occur most often in the
monocytic types (FAB M4 and M5).
C. Age at diagnosis is an important prognostic factor, with advanced age associated
with a poorer prognosis.
D. The use of G-CSF and GM-CSF is supported by randomized clinical trails to be
effective in the supportive care of leukemia patients.
E. Platelets should be transfused as needed, to maintain platelet counts of >10,000
to 20,000/uL.

35. The following statement/s is/are TRUE about chronic myelogenous leukemia: (HPIM 16 th
ed., p. 637 638):
A. Patients will have a clonal expansion of a hematopoietic stem cell possessing a
reciprocal translocation between chromosomes 9 and 22.
B. In contrast to other malignancies, cigarette smoking has no effect in the
progression or development of CML.
C. Persistent splenomegly despite continued therapy for CML signifies disease
acceleration.
D. Leukocyte alkaline phosphatase is characteristically low in CML cells.
E. Blast crisis is defined as acute leukemia, with blood or marrow blasts 30%.

36. PGH is the national treatment center for CML because of the availability of Imatinib
(Gleevec). The following statement/s is/are TRUE about this drug. (HPIM 16 th ed., p. 639
640)
A. Imatinib has already replaced allogenic stem cell transplantation as the main
treatment for CML.
B. Imatinib induces apoptosis in cells expressing BCR/Abl.
C. Patients in the accelerated/blastic phase of CML are extremely sensitive to
imatinib, making it an excellent drug during these phases.
D. The main side effects are fluid retention, nausea, muscle cramps, diarrhea, and
skin rashes.
E. Doses of >300 mg/day are already associated with a markedly increased
incidence of myelosuppression and are discouraged.
DERMATOLOGY

37. The following primary skin lesions are accurately defined: (HPIM, 16th ed., p. 283):
A. Macule a flat lesion, >3cm, with a color different from the surrounding skin
B. Papule a palpable, small, solid lesion, <0.5 cm in diameter, raised above the
surface of the surrounding skin
C. Pustule a vesicle filled with leukocytes
D. Bulla a small, fluid-filled lesion, raised above the plane of the surrounding skin
E. Tumor a solid, raised growth >5cm in diameter

38. In the performance of dermatologic diagnostic techniques, the following statement/s

is/are CORRECT (HPIM, 16th ed., p. 286 287):
A. In KOH preparations, the center of a lesion where a fungal etiology is suspected
is scraped with a scalpel blade and collected on a glass slide.
B. Multinucleated epithelial giant cells seen on Tzanck smear suggest the presence
of herpes.
C. Granulomas often have an apple jelly appearance on diascopy.
D. On Woods lamp, wounds colonized with Pseudomonas will appear pale blue.
E. Post-inflammatory hyperpigmentation will be accentuated on Woods lamp.

39. The following statements are CORRECT about atopic dermatitis (HPIM 16th ed., p. 288):
A. Although atopic dermatitis is said to be the cutaneous expression of the atopic
state, there is no clear genetic predisposition in these patients.
B. Infants usually present with marked dermatitis of the flexural skin, particularly in
the antecubital and popliteal fossae.
C. Adults frequently have localized disease, manifesting as hand eczema or lichen
simplex chronicus.
D. Pruritus is a prominent characteristic of atopic dermatitis and is exacerbated by
moist skin.
E. Selective H2 blockers play a great role in controlling the pruritus of atopic
dermatitis.

40. Contact dermatitis is an inflammatory process in skin caused by an exogenous agent or

agents that directly or indirectly injure the skin. The following are features of this disease
(HPIM 16th ed., p. 289)
A. The most common presentation is hand eczema, frequently related to
occupational exposures.
B. Chronic low-grade irritant dermatitis is the most common type of irritant contact
dermatitis is commonly caused by chronic wet work, soaps, and detergents.
C. Agents that cause allergic contact dermatitis induce an antigen-specific immune
response.
D. Allergic contact dermatitis is a manifestation of the Type 1 hypersensitivity
reaction.
E. The most common cause of allergic contact dermatitis is exposure to pollen in
atopic individuals.

41. External factors may exacerbate the skin lesions of psoriasis. Examples of these include
the following (HPIM 16th ed., p. 291):
A. Stress D. Use of anti-malarials
B. Presence of infections E. Use of methotrexate
i. Use of beta-blockers

42. A 19 year old male consulted you for intense pruritus of his groin area. On examination,
you noted scaling, erythematous lesions in the groin, sparing the scrotum. The following
statements are CORRECT about this condition (HPIM 16th ed., p. 293):
A. This is most commonly caused by Group A -hemolytic Streptococci.
B. Specimens for KOH examination should be obtained by scraping the most
inflamed area of the patients lesions.
C. Topical therapy is generally effective for uncomplicated cases such as this.
D. Nystatin is the most effective topical agent available.
E. Topical treatment should be continued one week beyond the apparent resolution
of the lesions.

43. The following medications are known to exacerbate acne (HPIM 16th ed., p. 295):
A. Glucocorticoids
B. Oral contraceptives containing ethinyl estradiol
C. Isoniazid
D. Tetracycline
E. Phenytoin
44. Treatment of acne vulgaris should be directed towards the following factors (HPIM, p.
295):
A. Removal of surface oils
B. Avoidance of sun exposure
C. Decreasing the population of Proprionobacterium acnes
D. Normalization of follicular keratinization
E. Decreasing inflammation

45. Periungual telangiectasias are pathognomonic of the following autoimmune connective

tissue diseases (HPIM 16th ed., p. 299):
A. Systemic lupus erythematosus
B. Rheumatoid arthritis
C. Sjogrens Syndrome
D. Scleroderma
i. Dermatomyositis

46. Patients with vitiligo also have an increased incidence of the following autoimmune
disorders: (HPIM 16th ed., p. 299):
A. Diabetes mellitus
B. Graves Disease
C. Lupus erythematosus
D. Pernicious anemia
E. Hypothyroidism

ALLERGY AND IMMUNOLOGY

47. The following are TRUE about the clinical features of immunodeficiency: (HPIM, 16 th ed.,
p. 1938 1939):
A. Antibody-deficient patients with intact cell-mediated immunity may have recurrent
bouts of chickenpox and measles.
B. Patients with defective humoral immunity may have recurrent or chronic
sinopulmonary infection, meningitis, and bacteremia caused by bacteria such as
Haemophilus influenza, Streptococcus pneumoniae, and Staphylococcus aureus.
C. Infestation of Giardia lamblia frequently causes diarrhea in neutropenic patients.
D. Chronic otitis media occurs frequently in patients with hypogammaglobulinemia.
E. Abnormalities of cell-mediated immunity predispose to disseminated viral
infections.

48. In the laboratory evaluation of immunodeficient patients, the following statements are
CORRECT (HPIM, 16th ed., p. 1940):
A. Reduction of nitrobluetetrazolium is a test for T-cell function.
B. Delayed hypersensitivity skin tests such as PPD evaluates phagocyte function.
C. Quantitative IgG subclass determination is a test for complement function.
D. Response to immunization with protein antigens such as tetanus toxoid is a test
for B-cell function.
E. Response to immunization with carbohydrate antigens such as pneumococcal
vaccine is also a test for B-cell function.

49. The following statements are TRUE about anaphylaxis (HPIM, 16th ed., p. 1949):
A. The life-threatening anaphylactic response of a sensitized individual appears
within hours after administration of a specific antigen.
B. Pruritus and urticaria with or without angioedema are characteristic of systemic
anaphylaxis.
C. Vascular collapse or shock requires an antecedent airway obstruction
manifesting as respiratory collapse.
D. Atopy does not predispose individuals to anaphylaxis from penicillin therapy or
venom of a stinging insect.
E. Atopy predisposes individuals to develop anaphylaxis from antigens in food or
latex.
50. A 24 year old female was brought to the ER for generalized erythematous wheals,
pruritic urticarial eruptions, swelling of the face and lips, and difficulty of breathing noted
few minutes after eating a seafood dish. In the management of this patient, the following
statements are CORRECT: (HPIM 16th ed., p. 1949):
A. An intravenous infusion for hydration should be started, and 2.5 mL epinephrine
diluted 1:10,000 administered intravenously at 5 to 10 minute intervals.
B. If intractable hypotension occurs, inotropic agents especially dobutamine, should
be started.
C. Aminophylline, 0.25 to 0.5 gm intravenously, may be given for bronchospasm.
D. Replacement of intravascular volume due to post-capillary venular leakage may
require several liters of saline.
E. Intravenous glucocorticoids are highly effective for immediate control of edema,
urticaria and bronchospasm.

51. The following statements are TRUE about urticaria and angioedema: (HPIM 16 th ed., p.
1951 1952):
A. Urticaria is distinctly pruritic and involves only the superficial portion of the
dermis.
B. Recurrent episodes of urticaria and/or angioedema of more than two weeks
duration are considered chronic.
C. Residual skin discoloration frequently occurs in urticaria due to increased
capillary permeability leading to erythrocyte extravasation.
D. There is edema of the dermis and the subcutaneous tissue in angioedema.
E. The most common sites for urticaria are the trunk and the extremities, while with
angioedema often being respiratory tract.

52. The following drugs are associated with the highest risk of Stevens-Johnson Syndrome
and toxic epidermal necrolysis: (HPIM 16th ed., p. 318)
A. Beta-lactam antibiotics
B. Sulfonamide antibiotics
C. Allopurinol
D. Thiazide diuretics
E. NSAIDs

53. Multiple factors determine the capacity of s drug to elicit an immune response. The
following statements are CORRECT: (HPIM 16th ed., p. 318 319)
A. A larger and more complex molecule has increased immunogenicity and
macromolecular drugs are highly antigenic.
B. Topical application of drugs may induce the delayed type of hypersensitivity
reaction.
C. Anaphylaxis more likely follows oral administration of a drug compared to
intravenous administration.
D. Vasculitis, a common manifestation of drug reactions, result from immune
complex deposition.
E. Immunologic mechanisms are responsible for the majority of drug reactions.

54. The following drugs are accurately matched with their cutaneous effects: (HPIM 16 th ed.,
p. 319 321):
A. ACE inhibitors angioedema
B. Aspirin exacerbation of chronic urticaria
C. Beta-lactam antibiotics photosensitivity eruptions
D. Phenothiazines Blue-gray pigmentation of sun-exposed areas
E. Phenytoin Hypersensitivity syndrome

54. A 32 year old female who is a known asthmatic consulted your OPD for a 10 year history
of recurrent sneezing, rhinorrhea, lacrimation and nasal and eye itching. She claims that
these symptoms increase during the summer months. On PE< you noted a pale, boggy
nasal mucosa, with swollen turbinates and mucous membranes. In the management of
this patient, which of the following statements are CORRECT? (HPIM 16 th ed., p. 1955
1956)
A. Oral antihistamines of the H1 class should be prescribed to relieve nasal
congestion.
B. Alpha-adrenergic agents such as phenylephrine may alleviate nasal congestion
but may cause rebound rhinitis.
C. Oral pseudophedrine along with antihistamine should be used with caution as
they may cause excessive daytime sleepiness among patients.
D. Cromolyn sodium, a nasal spray, may be used prophylactically but has an
adverse effect of dysgeusia in some patients.
E. Intranasal glucocorticoids are the most potent drugs available for the relief of
established rhinitis.
55. The patient in #54 asks you about immunotherapy. You tell her the following:
(HPIM 16th ed., p. 1956):
A. Immunotherapy is contraindicated in women of childbearing age until 2
pregnancy tests confirm the absence of pregnancy.
B. Immunotherapy is contraindicated in patients with unstable bronchial asthma.
C. Immunotherapy is contraindicated in patients on beta-blockers because the drug
preventsthe occurrence of hyposensitization.
D. Immunotherapy is contraindicated in patients with significant cardiovascular
disease.
E. Immunotherapy is contraindicated in elderly individuals because they have very
poor therapeutic response to the procedure.

RHEUMATOLOGY

56. The following are characteristic clinical manifestations of systemic lupus erythematosus
(HPIM 16th ed., p. 1962):
A. Pain persisting in a single joint such as the knee, shoulder, or hip, is typical of the
arthritis of SLE.
B. Majority of patients with discoid lupus also have systemic lupus erythematosus.
C. Nephritis is asymptomatic in most lupus patients.
D. The most common manifestation of diffuse CNS lupus is focal seizures with
secondary generalization.
E. The most frequent hematologic manifestation of SLE is a microcytic,
hypochromic anemia, reflecting an underlying iron deficiency.

57. Drug-induced lupus is a syndrome distinct from SLE and is characterized by the
following: (HPIM 16th ed., p. 1967)
A. Patients have fever, arthritis, serositis and/or rash, but are frequently ANA-
negative.
B. It has less female predilection than SLE.
C. Nephritis and CNS involvement is common.
D. It is rarely associated with anti-ds DNA.
E. It is commonly associated with anti-histone antibodies.

58. The following statements are CORRECT about the clinical manifestations of rheumatoid
arthritis (HPIM 16th ed., p. 1970 1971):
A. Joint pain aggravated by movement is the most common manifestation of
established RA.
B. Morning stiffness of greater than 30 minutes duration reliably distinguishes
between chronic inflammatory and non-inflammatory arthritides.
C. The inflamed joint is usually held in a flexed position.
D. Axial involvement in RA usually presents as lower back pain.
E. The distal interphalangeal joints are commonly involved in RA leading to the
characteristic swan-neck deformity.

59. Rheumatoid arthritis is a systemic disease with a variety of extraocular manifestations.

The following statements are TRUE (HPIM 16th ed., p. 1970-1971):
A. Rheumatoid nodules are most commonly found in the pleura and the meninges,
causing significant morbidity.
B. Rheumatoid vasculitis may present as dermal necrosis, digital gangrene, and
visceral infarction.
C. While myocardial infarction due to rheumatoid vasculitis is rare, kidney infarcts
are commonly encountered.
D. Rheumatoid lung disease is more common in women than in men.
E. In pleuritis due to RA, the pleural fluid contains very low levels of glucose
because of concomitant infection.

60. Characteristics of Feltys Syndrome (HPIM 16th ed., p. 1972):

A. Chronic rheumatoid arthritis D. Leukocytosis
B. Cardiomegaly E. Thrombocytopenia
C. Splenomegaly

61. The following is/are considered as disease-modifying antirheumatic drugs (DMARDs)

(HPIM 16th ed., p. 1974):
A. NSAIDs
B. Methotrexate
C. Cyclophosphamide
D. Antimalarials
E. Gold compounds
62. Considered as a major criterion in the Jones Criteria for Rheumatic Fever (HPIM, p.
1978):
A. Erythema marginatum
B. Positive throat culture for Group A streptococcus
C. Subcutaneous nodules
D. Carditis
E. Sydenhams chorea

63. The potential mechanism of vessel damage in this/these vasculitis syndrome/s is the
production of antineutrophilic cytoplasmic antibodies directed against certain proteins in
the cytoplasmic granules of neutrophils and monocytes (HPIM 16th ed., p. 2002 2003):
A. Henoch-Schonlein purpura
B. Wegeners granulomatosis
C. Churg-Strauss syndrome
D. Microscopic polyangitis
E. Hepatitis B associated polyarteritis nodosa

64. A 48 year old woman consulted your clinic for hemoptysis. For the past 5 years, she has
visited several doctors for the same complaint and she has completed three courses of
anti-TB medications, each time with negative sputum AFB studies. She has also been
advised surgery due to recurrent sinusitis. On your PE, she has saddle nose deformity,
with multiple coin-like ulcers in her ankles which she claimed to be present since 3
months ago but didnt bother much about. In the work-up of this patient, the following
statement/s is/are CORRECT: (HPIM 16th ed., p. 2005 2006)
A. The ESR is expected to be markedly elevated.
B. The gold standard in the diagnosis of this disease is the presence of
antiproteinase-3 ANCA.
C. Biopsy of the patients lesions would most likely demonstrate necrotizing
granulomatous vasculitis.
D. Biopsy of the upper airway would reveal the highest yield for tissue biopsy.
E. Renal biopsy may confirm the presence of pauci-immune glomerulonephritis.

65. Which among the following are radiographic features of osteoarthritis? (HPIM 16 th ed.,
p. 2040)
A. Joint space narrowing
B. Punched-out lytic lesions with overhanging bony edges
C. Juxtaarticular osteopenia
D. Subchondral bone sclerosis
E. Osteophytosis

66. Patients with osteoarthritis should be advised the following non-pharmacologic

measures: (HPIM, 16th ed. 2041 2042)
A. Patients with knee of hip osteoarthritis should avoid prolonged standing, kneeling
and squatting.
B. Complete immobilization of the involved joint should be advised until the pain
markedly subsides.
C. Cold compress applied to the involved joint may minimize pain and swelling.
D. Patients with hip or knee OA may participate safely in conditioning exercises to
improve fitness and health.
E. Medial taping of the patella can significantly reduce pain in patients with OA of
the patellofemoral compartment.

67. Which of the following situations may precipitate acute gouty arthritis? (HPIM 16 th ed., p.
2046)
A. Excessive alcohol intake
B. Use of glucocorticoids
C. Acute medical illness such as stroke
D. Use of hypouricemic therapy
E. Dietary excess

68. Which of the following are clinical features of gonococcal arthritis? (HPIM 16 th ed., p.
2052)
A. In arthritis due to disseminated gonococcal infection (DGI), cultures of synovial
fluid are expected to be negative.
B. In DGI, migratory arthritis and tenosynovitis of the knees, hands, wrists and feet
are prominent.
C. True gonococcal arthritis is more common than DGI and usually involves a single
joint.
D. In true gonococcal arthritis, blood cultures are invariably positive.
E. Appropriate antibiotic therapy may dramatically alleviate symptoms within 12 to
24 hours in DGI syndrome.
 69. A 58 year old male consulted you for sudden pain and swelling of his left knee noted on
the evening after a drinking binge. On PE, his left knee was warm, very tender, and
erythematous. Which of the following medications may be given to the patient upon his
consult?
A. Colchicine
B. NSAIDs
C. Probenicid
D. Methylprednisolone
E. Allopurinol

70. Which of the following are TRUE about tuberculous arthritis? (HPIM 16th ed., p. 2053)
A. Most patients with TB arthritis would also have coexistent pulmonary
tuberculosis.
B. AFB smear of the synovial fluid reveals positive results in most cases.
C. TB arthritis primarily involves the weight bearing joints, particularly the hips,
knees and ankles.
D. The most common presentation is chronic granulomatous monoarthritis.
E. The diagnosis should be doubted if systemic symptoms are not prominent.

MULTIPLE CHOICE. Choose the BEST answer

1. What is the most common side effect of chemotherapy? (HPIM 16th ed., p. 480)
A. Alopecia D. Nausea
B. Myelosuppression E. Cardiomyopathy
C. Osteoporosis

2. What is the most frequent extranodal site for lymphoma?

A. Lung D. Liver
B. Spleen E. Brain
C. Stomach

3. Virtually all types of noeplasms metastasize to the liver. Which of the following primary
tumors do not metastasize to the liver? (HPIM 16th ed., p. 535)
A. Lung cancer D. Prostate cancer
B. Breast cancer E. Melanomas
C. Brain cancer

4. What is the most consistent risk factor for the development of pancreatic CA? (HPIM 16 th
ed., p. 537)
A. Cigarette smoking D. Obesity
B. Chronic pancreatitis E. Alcohol abuse
C. Long-standing diabetes mellitus

5. A 26 year old female presented with a 4-month history of an enlarging abdomen.

Abdominal CT ultrasound revealed peritoneal carcinomatosis. This patient most likely
has:
A. Cervical CA D. Colon CA
B. Breast CA E. Liver CA
C. Ovarian CA

6. What is the most common cause of the paraneoplastic syndrome due to ectopic ACTH
production? (HPIM 16th ed., p. 568)
A. Small-cell lung CA D. Pheochromocytoma
B. Non-small cell lung CA E. Bronchial carcinoid
C. Thymic carcinoid

7. A 60 year old male underwent surgery for intussusception. The surgeon should
aggressively search for what type of tumor?
A. Esophageal cancer D. Gastric cancer
B. Periampullary cancer E. Colon cancer
C. Small intestinal cancer

8. What is the diagnostic test of choice in the evaluation of patients suspected to have
small intestinal neoplasms? (HPIM 16th ed., p. 531)
A. Small bowel barium study D. Fecal occult blood test
B. Esophagoduodenoscopy E. Colonoscopy
C. Abdominal CT scan
9. Which among the following cytotoxic chemotherapeutic agents is the most emetogenic
even at conventional therapeutic doses? (HPIM 16th ed., p. 220)
A. Doxorubicin D. Cisplatin
B. 5-FU E. Paclitaxel
C. Cyclophosphamide

10. Which of the following agents DOES NOT appear to increase the risk of patients to
deelop urothelial cancer? (HPIM 16th ed., p. 539)
A. Cigarette smoking D. Vitamin A supplementation
B. Aniline dyes E. Schistosoma
haematobium
C. Cyclophosphamide

11. A 40 year old male on chronic hemodialysis for CGN was undergoing his regular
hemodialysis session while undergoing an infusion of parenteral iron solution. After a few
minutes, he developed dyspnea, chest tightness, and wheezing. What is the first step in
the management of this patient?
A. Stop hemodialysis. D. Request for stat chest Xray
B. Stop the iron infusion. E. Nebulize with Salbutamol
C. Request for stat 12 lead ECG.

12. What is the most distinguishing feature between true iron deficiency anemia and iron-
deficient erythropoiesis associated with inflammation? (HPIM 16th ed., p. 591)
A. Hemoglobin levels D. Serum ferritin levels
B. Reticulocyte index E. RBC indices
C. Peripheral blood smear

13. Which among the following is NOT a hypoproliferative type of anemia?

A. Anemia of chronic inflammation/disease
B. Anemia of renal disease
C. Anemia of hypometabolic states
D. Anemia due to hemolysis
E. Anemia due to marrow damage

14. What is considered as the most significant advance in the treatment of sickle cell anemia
and is the mainstay of therapy for patients with severe symptoms? (HPIM 16 th ed., p.
599)
A. Morphine D. 5-Azacytidine
B. Nitric oxide E. Decitabine
C. Hydroxyurea

15. A 23 year old female with a history of several suicide attempts, was found unconscious
and cyanotic in her bathroom. The intern, while extracting labs for toxicology screen,
reported a muddy appearance of freshly drawn blood. Room air ABGs showed PaO2 of
100 mm Hg. What is the treatment for this patient?
A. Emergency phlebotomy of at least 500 cc blood
B. Hyperbaric oxygen therapy
C. IV Methylene blue
D. Deferroxamine
E. IV Immunoglobulins

16. What is the most common cause of renal failure in patients with multiple myeloma?
(HPIM 16th ed., p. 659)
A. Infiltration of the kidneys by myeloma cells
B. Chronic reflux nephropathy
C. Recurrent infections
D. Tubular damage due to excretion of light chains
E. Hypercalcemia

17. What is the most common cause of cobalamin deficiency? (HPIM 16th ed., p. 604)
A. Intestinal parasitism
B. Pernicious anemia
C. Intake of proton-pump inhibitors
D. Use of nitric oxide
E. Tropical sprue
18. The only symptom that distinguishes polycythemia vera from other causes of
erythrocytosis is: (HPIM p. 627)
A. Solar pruritus D. Facial erythema
B. Aquagenic pruritis E. Budd-Chiari syndrome
C. Priapism

19. What is the most common structural hemoglobinopathy worldwide? (HPIM 16 th ed., p.
594)
A. Methemoglobinemia D. Alpha thalassemia
B. Sickle cell disease E. G6pd Deficiency
C. Beta thalassemia

20. s the most common chronic myeloproliferative disorder?

A. Essential thrombocytosis
B. Polycythemia vera
C. Chronic Myelogenous Leukemia
D. Acute Myeloid Leukemia
E. Idiopathic Myelofibrosis

21.What is the most common chromosomal abnormality in CML?

A. t(9,22)
B. t(11,22)
C. t(15,17)
D. 11q23
E. t(8,21)

22. The Donath-Landsteiner antibody of paroxysmal cold hemoglobinuria is of this type:

A. IgA
B. IgD
C. IgE
D. IgG
E. IgM

23. The following blood product should be stored at room temperature making it prone to
contamination by bacteria: (HPIM 16th ed. P. 667)
A. Fresh whole blood
B. Packed RBC
C. Platelet concentrate
D. Fresh frozen plasma
E. Cryoprecipitate

24. What is the only oral agent approved (in the United States) for the treatment of
dermatophyte infections involving the skin, hair, or nails? (HPIM 16th ed., p. 293)
A. Griseofulvin
B. Itraconazole
C. Terbinafine
D. Nystatin
E. Fluconazole

25. What is the most useful and convenient method for treating warts? (HPIM, p. 294)
A. Salicylic acid solutions/plasters
B. Podophyllin solutions
C. Topical imiquimod
D. Laser surgery
E. Cryotherapy with liquid nitrogen

26. What is the most common malignancy associated with erythroderma? (HPIM, p. 297)
A. Acute myelogenous leukemia
B. Cutaneous T-cell lymphoma
C. Ovarian cancer
D. Bronchial carcinoids
E. Burkitts lymphoma
 27. A 62 year old female who was known to have chronic bilateral lower extremity edema
due to venous incompetence consulted you for brawny edema of her legs associated
with erythematous, scaly and oozing patches. What is the pressure gradient of the
stockings that you will recommend? (HPIM 16th ed., p. 290)
A. 10 20 mm Hg
B. 20 30 mm Hg
C. 30 40 mm Hg
D. 40 50 mm Hg
E. 50 60 mm Hg

28. A 43 year old male presented with erythematous, sharply demarcated papules and
rounded plaques, covered by silvery micaceous scale, demonstrating the Koebners
Phenomenon. All the following agents may be used in the treatment of this patient
EXCEPT: (HPIM 16th ed., p. 292)
A. Topical glucocorticoids
B. Topical calcipotriene
C. Ultraviolet light
D. Oral glucocorticoids
E. Methotrexate

29. A 50 year old obese, diabetic female complained of erythematous, macerated plaques
along her inframammary folds. You also noted multiple satellite papules surrounding
the lesions. What is the most likely organism involved in this case? (HPIM 16th ed., p.
294)
A. Pseudomonas aeruginosa
B. Candida albicans
C. Staphylococcus aureus
D. Trichophyton
E. Malassezia furfur

30. A 30 year old female presented with multiple pink-red macules and edematous
plaques with a dusky violet color or petechiae in the center of the lesions. There
were similar lesions in the buccal and nasal musosa. What is the most commonly
associated organism in this patients case? (HPIM 16th ed., p. 303 304)
A. Herpes simplex
B. Varicella-zoster
C. Mycoplasma pneumoniae
D. Rickettsia
E. Coxsackievirus

31. Which among the following drugs causes a lupus-like syndrome with associated
antinuclear antibody formation?
A. Phenytoin
B. Lamotrigine
C. Carbamazepine
D. Cotrimoxazole
E. Hydralazine

32. In the course of rheumatoid arthritis, how long after the onset of disease is the most
rapid rate of functional deterioration expected? (HPIM 16th ed., p. 1973)
A. First 6 months
B. First year
C. First 2 years
D. First 5 years
E. First 10 years

33. What is the most powerful risk factor for the development of osteoarthritis?
A. Age
B. Body weight
C. Occupation
D. Sex
E. Physical inactivity

34. Which of the following areas of the spine is most often involved in rheumatoid arthritis?
A. Cervical spine
B. Thoracic spine
C. Lumbar spine
D. Lumbosacral spine
E. Rheumatoid arthritis never involves the vertebrae
35. What is the most frequent cardiac manifestation of SLE?
A. Pericardial effusion
B. Myocardial infraction
C. Myocarditis
D. Arrhythmias
E. Sudden cardiac death

36. Which among the following arteries are NOT involved in polyarteritis nodosa?
(HPIM 16th ed., p. 2007)
A. Bronchial arteries
B. Pulmonary arteries
C. Renal arteries
D. Coronary arteries
E. Mesenteric arteries

37. What is the most commonly involved artery in giant cell arteritis? (HPIM, p. 2009)
A. Temporal artery
B. Internal carotid artery
C. Vertebral artery
D. Coronary artery
E. Bronchial artery

38. What is also known as the aortic arch syndrome due to its predilection for the
aortic arch?
A. Microscopic polyangitis
B. Polyarteritis nodosa
C. Buergers disease
D. Churg-Strauss syndrome
E. Takayasus arteritis

39. What is the treatment of choice for patients with sarcoidosis? (HPIM 16th ed., p.
2023)
A. Methotrexate
B. Cyclophosphamide
C. Hydroxychloroquine
D. Glucocorticoids
E. Azathioprine

40. The following are features of CREST Syndrome EXCEPT (HPIM 16th ed., p.
1979):
A. Calcinosis
B. Reynauds Phenomenon
C. Esophageal dysmotility
D. Sclerosing cholangitis
E. Telangiectasia

41. What is the most rapidly progressive human tumor:

A. Diffuse large B cell lymphoma
B. Burkitts lymphoma
C. Melanoma
D. Hodgkins disease
E. Small-cell lung CA

42. Which among the following cancers can be treated by Bacille Calmette-Guerin
(BCG)?
A. MALT Lymphoma
B. Renal Cell Cancer
C. Prostate Cancer
D. Bladder Cancer
E. Thyroid Cancer

43. Violaceous, flat-topped papules over the dorsal interphalangeal joints that are
pathognomonic of dermatomyositis (HPIM 16th ed., p. 315):
A. Poikiloderma
B. Livedoid vasculopathy
C. Angiofibromas
D. Gottrons sign
E. Tricholemmomas
44. The syndrome of essential mixed cryoglobulinemia is strongly associated with which
type of viral infection? (HPIM 16th ed., p. 2002)
A. Epstein-Barr virus infection
B. Cytomegalovirus infection
C. HIV infection
D. Hepatitis B infection
E. Hepatitis C infection

45. Most common of all drug-induced reactions: (HPIM p. 319-20)

A. Urticaria / angioedema
B. Photosensitivity eruptions
C. Pigmentation changes
D. Vasculitis
E. Morbiliform reactions

46. What differentiates Stevens-Johnson Syndrome from Toxic Epidermal Necrolysis?

A. Presence of Nikolsky sign
B. Type of offending stimulus
C. Presence of systemic manifestations
D. Percentage of epidermal detachment
E. Presence of vesicobullous lesiona

47. What is the most common primary immunodeficiency state? (HPIM 16th ed., p. 1943)
A. Common variable immunodeficiency
B. IgA deficiency
C. Severe combined immunodeficiency
D. DiGeorge syndrome
E. HIV infection

48. A 23 year old female complained of an annoying appearance of a linear wheal whenever
an object briskly strokes her skin. What do you call this phenomenon? (HPIM 16th ed., p.
1951)
A. Dermographism
B. Pressure urticaria
C. Cholinergic urticaria
D. Contact urticaria
E. Sensitive skin

49. During the audit of Pam Patdu last July 17, according to Dr. Abarquez and Dr. Mejia,
what agent should be used with extreme caution (even avoided) among patients with
anthracycline-induced cardiomyopathy?
A. ACE-inhibitors
B. Diuretics
C. Beta-Blockers
D. Angiotensin Receptor Blockers
E. Digitalis

50. According to the pathologists report during the audit of Lowe Chiong last July 24, what is
the cause of death of the patient presented?
A. Hypovolemic shock
B. Septic Shock
C. Cardiogenic Shock
D. Acute Renal Failure
E. Massive Pulmonary Embolism