MCU-FDT MEDICAL FOUNDATION

College of Medicine
Department of Medicine

1. In the pathogenesis of fever, which of the following statements is NOT true?

A. Shunting of blood from periphery to internal organs occur to conserve heat
B. Presence of PGE2 in the brain elevates set point of body temperature
C. Exogenous and endogenous pyrogens are destroyed by phagocytes
D. Elevated cAMP induces the release of monoamine neurotransmitters
2. The sympathetic nervous system can increase heat conservation through:
A. Increased heart rate
B. Vasoconstriction
C. Increased skeletal muscle contraction
D. Resetting of thermostat level at hypothalamus
3. Patients with fever may also complain of myalgia and/or arthralgia. These can be
due to:
A. Increased muscular tone C. Effect of interferon
B. Effect of peripheral PGE2 D. Effect of endotoxins

4. A 20 y/o male was brought to the ER due to muscle rigidity. He also manifest with
hallucination, pupil dilation and increased temperature with dry skin. The above
findings can be due to:
A. Amphetamine abuse C. Heat stroke
B. Extrapyramidal symptoms D. Tetany

5. Increased heat production in cases of thyrotoxicosis can be secondary to:

A. Chemical reaction of basal metabolism C. Chemical thermogenesis
B. Increased skeletal muscle tone D. Vasodilation

6. What component of the lipid profile is anti-atherogenic?

A. High density lipoprotein C. Total cholesterol
B. Low density lipoprote.in D. Triglycerides

7. Which of the following manifestation is not a major criterion for rheumatic fever?
A. Erythema multiforme C. Subcutaneous nodules
B. Migratory polyarthritis D. Sydenham’s chorea

8. A run of 3 consecutive premature ventricular depolarizations is known as:

A. Asystole C. Ventricular fibrillation
B. Supraventricular tachycardia D. Ventricular tachycardia

9. What is the most common type of atrial septal defect?

A. Membranous type C. Ostium secundum
B. Ostium primum D. Sinus venosus

10. What is the most common cause of secondary hypertension in the general
population?
A. Cushing’s syndrome C. Primary aldosteronism
B. Pheochromocytoma D. Renal diseases

11. Which of the following statements regarding cardiac symptoms is false?

A. Chest discomfort and/or dyspnea that appear only during activity are
characteristic of heart disease
B. Many patients with heart disease may be asymptomatic
C. Patients with valvular stenosis may manifest heart failure symptoms
D. It is rare for asymptomatic cardiac patients to develop sudden death, acute
myocardial infarction or stroke
(p. 1301)
12. Which of the following best characterize the second heart sound?
A. During inspiration, there’s and increase blood flow to the left ventricle
casing a delay in aortic valve closure
B. Wide splitting of the second heart sound may be due to right bundle branch
block
C. In pulmonary hypertension the second heart sound is soft
D. P2 is normally louder than A2 in the second left intercostal space
(p. 1307-1308)

13. Valvular abnormalities and chamber dilatation are best diagnosed by:
A. Electrocardiogram C. Echocardiography
B. Treadmill exercise testing D. Nuclear imaging techniques
(p. 1320)

14. The electrocardiogram of a patient who is hypertensive for almost 5 years would
show which of the following?
A. Tall left precordial R waves and deep right precordial S waves
B. Diminished voltages in the limb leads (aVL or aVR)
C. Right atrial abnormality absence of repolarization abnormalities (ST
depression and T-wave inversions)
(p. 1314)

15. Which is not a component of the metabolic syndrome?

A. Waist circumference of >40 inches in men
B. Triglycerides >150 mg/dL
C. LDL > 40 mg/dL
D. Blood pressure >130/>85 mmHg
(p. 1432)

16. A patient who shows on auscultation with an accentuated first heart sound,
opening snap and a mid-diastolic rumbling murmur at the apex is suffering from:
A. Mitral regurgitation C. Aortic regurgitation
B. Mitral stenosis D. Aortic stenosis
(p. 1390-1391)

17. The most common etiology for secondary hypertension is:

A. Renal parenchymal hypertension C. Primary aldosteronism
B. Renovascular hypertension D. Pheochromocytoma
(p. 1464)

18. Liebman-Sacks lesion which is a small verrucous vegetation usually found in the
ventricular surface of the mitral valve is associated with this disease:
A. Rheumatoid arthritis C. Rheumatic Heart Disease
B. SLE D. Rheumatomyositis

19. Spironolactone is the drug of choice in the medical treatment of hypertension o

which of the following diseases?
A. Essential hypertension C. Phrochromocytone
B. Renal artery stenosis D. Hyperaldosteronism

20. Saw tooth appearance of EKG tracing is diagnostic of:

A. Ventricular tachycardia C. Atrial flutter
B. Ventricular fibrillation D. Atrial fibrillation

21. MVP has the following features EXCEPT:

A. More common in males
B. Most common course of isolated severe MR in North America
C. May cause syncope
D. Mid to late systolic click is the most important finding
Reference: Harrison’s Principles of Internal Medicine 15th ed. pp. 1348
22. Which of the following is a major criterion in the Framingham Criteria for the
diagnosis of CHF?
A. Tachycardia C. Cardiomegaly
B. Dyspnea or exertion D. Extremity edema
Reference: Harrison’s Principles of Internal Medicine 15th ed. pp. 1323

23. The most common primary cardiac tumor is:

A. Rhabdomyoma C. Lymphoma
B. Myxoma D. Sarcoma

24. An effective drug for meningococcal chemoprophylaxis:

A. Cefotaxime C. Chloramphenicol
B. Ceftriaxone D. Ceftizoxime
(See p.854, 16th ed. of Harrison’s)

25. The etiologic agent of chancroid is:

A. Treponema pallidum C. Haemophilus ducreyl
B. Calymmatobacterium granulomatis D. Neisseria gonorrhea
(See p.771 Ulcerative Genital Lesions, 16th ed. Harrison’s)

26. Pyomyositis is usually due to:

A. Group A Streptococcus C. Staphylococcus aureus
B. Streptococcus pyogenes D. Clostridium perfringens
th
(See p.744 Myositis/Myonecrosis, 16 ed. Harrison’s)

27. Cytoplasmic inclusion bodies found in certain neurons in the brain, and are
diagnostic of rabies:
A. Negri bodies C. Schuffner’s dots
B. Owl’s eye bodies D. James stipplings
(See p.1157 Pathogenesis of Rabies, 16th ed. Harrison’s)

28. Most vaccine for adults can be given also to pregnant women EXCEPT:
A. Tetanus, diphtheria C. MMR, Varicelia
B. Pneumococcal, influenza D. Rabies, Hepatitis B
(See p.720 Use of Vaccines in Special Circumstances, 16th ed. Harrison’s)

29. The single most important diagnostic test to request for a patient with clinical signs
and symptoms suggestive of PTB is:
A. CXR C. TB culture
B. PCR D. Direct microscopy
(Sep.960 AFB microscopy, 16th ed. Harrison’s)

30. Urethritis can be documented on the basis of:

A. Mucopurulent or purulent discharge
B. Gram stain or urethral secretion > 5 wbcs/hpf
C. First void urine demonstrating > 10 wbcs/hpf
D. Either A or C
(See p.764 Approach to patient with suspected urethritis, 16th ed. Harrison’s.
Letter B may be correct but remember that the gram stain is read per oil
immersion field)

31. Among the available test for Leptospirosis, the most sensitive and specific is:
A. Culture with EMJH
B. ELISA for antibodies
C. MAT using genus specific antigen for Leptospira patoc
D. Dipstick assay
(See p.990 Diagnosis of Leptospirosis, 16th ed. Harrison’s)
32. The following are true of malaria EXCEPT:
A. Hypoglycemia in falciparum malaria is associated with poor prognosis
B. Splenic enlargement in endemic areas reflects repeated infection
C. In severe malaria, one predicter of poor prognosis is the predominanceof
immature P. falciparum parasites
D. The thick malarial smear has the advantage over the thin smear of
concentrating parasites, thus increasing diagnostic sensitivity
(See Table 195-3 p.1222, 16th ed. Harrison’s)

33. True of Staphylococcal infections EXCEPT:

A. Toxic Shock Syndrome is a life threatening condition caused by toxins
elaborated by S-aureus
B. Nikolsky’s sign is a feature of TSS
C. In Ritter’s disease, the skin often has a sandpaper-like texture and is tender
D. Staphylococcal pneumonia most commonly follows tracheal intubation of a
hospitalized patient or vital infection of the respiratory tract.
(See p.819 Staphylococcal Scalded Skin Syndrome, 16th ed. Harrison’s)

34. The following are infection control measures EXCEPT:

A. Irrigation of urinary catheters, with or without antimicrobials, may
actually increase infection risk
B. Replacing tubing circuits at intervals > 48 hours is one effective measure in
the aseptic care of respirator equipment
C. A control measure for surgical wound infection, aside from OR asepsis,
antimicrobial prophylaxis for high risk procedures
D. The recommended frequency of rotation of central venous catheter sites
is 5 days
(See p.778 every 72 to 96 hours, infections related to vascular access and
monitoring, 16th ed. Harrison’s)

35. Characteristics of the itch mite include the following:

A. It is an oval, ventrally flattened mite
B. It can live on beddings for 7 days
C. The female dies after copulation
D. The female lays 20 eggs per day
Andrews’ Diseases of the skin, 9th ed. p. 564-565

36. Infantile atopic dermatitis is characterized by the following:

A. Lesions are less exudative, drier and more papular
B. The buttocks and diaper area are often involved
C. Lesions are lichenified plaques
D. The face and scalp are more often involved
Andrews’ Diseases of the skin, 9th ed. p. 70

37. The main substance causing vasodilation in urticaria is:

A. Serotonin C. Bradykinin
B. Histamine D. Prostaglandins
Andrews’ Diseases of the skin, 9th ed. p. 163

38. Gutate psoriasis is usually preceded by:

A. Trauma C. Streptococcal pharyngitis
B. Hepatitis D. Viral exanthem
th
Andrews’ Diseases of the skin, 9 ed. p. 221

39. An infectious disease transmitted by the body louse is:

A. Trench fever C. Tsutsugamushi fever
B. Dengue fever D. Scrub typhus
Andrews’ Diseases of the skin, 9th ed. p. 552-553
40. Hormone implicated in the pathogenesis of androgenetic alopecia.
A. Estrogen C. Testosterone
B. Cortisol D. Growth hormone
th
Andrews’ Diseases of the skin, 9 ed. p. 947-948

41. The 4 cutaneous findings of 11 criteria for diagnosis of SLE are:

A. Malar erythema, urticaria, photosensitivity and discoid LE
B. Malar erythema, photosensitivity, discoid LE, oral ulcers
C. Malar erythema, photosensitivity, skin erosion, oral ulcers
D. None of the above
Andrews’ Diseases of the skin, 9th ed. p. 180-181

42. The prothrombotic effect of coumarin (warfarin) during the early phases of its
administration is due to a rapid drop in the plasma concentration of:
A. Antithrombin C. Factor VII
B. Protein C D. Plasminogen

43. A 55-year old woman with Grave’s disease developed pallor and scleral jaundice.
Her peripheral blood showed pancytopenia, presence of macro-ovalocytes and
hypersegmented neutrophils. What is the most likely diagnosis?
A. Megaloblastic anemia C. Aplastic anemia
B. Myelodysplastic syndrome D. Paroxysmal nocturnal hemoglobinuria

44. A 55-year old man previously diagnosed to have stage 0 CLL developed anemia
and unconjugated hyperbilirubinemia. What is the single most important
laboratory test required to diagnose the cause of the anemia?
A. A repeat bone marrow examination C. Serum ferritin determination
B. Coomb’s test D. Serum folate and vitamin B12
determination
45. A 24-year old female suddenly developed jaundice, confusion, petechiae, and
fever. Peripheral blood examination showed anemia and thrombocytopenia.
Fragmented red cells were seen with nucleated red blood cells. Prothrombin and
partial thromboplastin time were normal. What is the treatment of choice for this
patient?
A. Plasmapharesis C. Pulse therapy with cyclophosphamide
B. High dose glucocorticoids D. Splenectomy

46. The treatment of choice in patients with acute promyelocytic leukemia.

A. Anthracycline + cytosine arabinoside
B. Vincristine + prednisone
C. All-transretinoic acid (ATRA) + anthracycline
D. Melphalan + prednisone

47. A 36-year old male was refereed to an internist after a routine blood examination
showed a low mean cell volume (MCV) but with no evidence of anemia. Stool is
negative for occult blood nor was there exposure to lead. Serum ferritin is normal.
What is the most likely diagnosis?
A. Early iron deficiency anemia C. Thalassemia minor
B. Anemia of chronic disease D. Sideroblastic anemia

48. A 32-year old male had excessive bleeding after a dental extraction. He has no
other medical problems and physical examination is unremarkable. His mother
has history of excessive bleeding. Bleeding time and PTT was prolong twice the
normal range but the prothrombin time is normal. What is the most likely
diagnosis?
A. Hemophilia A C. Factor XII deficiency
B. Hemophilia B D. von Willebrand’s disease
49. A 64-year old woman for preoperative evaluation was noted to have a markedly
prolong PTT. Her prothrombin time, platelet count, and bleeding time were
normal. She required blood transfusion blood transfusion after a dental extraction
2 years ago. Two siblings male and female has history of bleeding. The most
likely diagnosis is a deficiency of:
A. Factor VII C. Factor XI
B. Factor VIII D. Factor XII

50. An 18-year old male develops massive bleeding after removal of a large
sebaceous cysts. Prothrombin time, PTT, platelet count, and bleeding time were
normal. There is no family history of bleeding time. Which of the following tests
should be ordered?
A. Factor XI level C. Urea clot lysis test
B. Factor XII level D. Platelet aggregation study

51. A 59 year old, female, known hypertensive for 5 years, with poor compliance to
anti-hypertensive medications, now complains of pallor, easy fatigue, anorexia,
and itchiness. The kidneys on ultrasound appear contracted. Which casts will you
find in the urinalysis in this condition?
A. RBC casts C. Broad casts
B. WBC casts D. Hyaline casts
th
Harrison 16 ed. pp. 251

52. The leading cause of end stage kidney disease is:

A. Chronic glomerulonephritis C. Polycystic kidney disease
B. Diabetic nephropathy D. Chronic pyelonephritis
Harrison 16th ed. pp. 1688

53. A 40 year old, male, known diabetic for 8 years is noted to have +1 proteinuria.
The best medication at this time is:
A. Glibenclamide C. Rosiglitazone
B. Insulin D. Captopril
th
Harrison 16 ed. pp. 1689

54. A 25 year old, female, developed anasarca over 2 months period. Her urinalysis
showed RBC and RBC casts. Kidney biopsy revealed membranous
glomerulonephritis. This condition is most likely to be associated with:
A. Hepatitis B infection C. Diabetes mellitus
B. Hypertension D. Periarteritis nodosa
th
Harrison 16 ed. pp. 1687

55. A 44 year old, male, operated twice for kidney stones has an estimated creatinine
clearance of 40 ml/min. At what stage of renal failure is he in now?
A. Stage 1 C. Stage 3
B. Stage 2 D. Stage 4
th
Harrison 16 ed. pp. 1653

56. Dietary protein is restricted in which of these kidney conditions:

A. Acute Pyelonephritis C. Renal failure
B. Polycystic kidney disease D. Chronic glomerulonephritis
th
Harrison 16 ed. pp. 1652

57. A 25 year old, male, was admitted because of multiple gunshot wounds. On
admission, he was hypotensive and tachycardic. He was immediately scheduled
for exploratory laparotomy which lasted for about 4 hours. A total of 6 units of
blood were transfused. He was oliguric and acidotic, for the next 7 days. At what
phase of acute renal failure is he in?
A. Initiation phase C. Diuretic phase
B. Maintenance phase D. Recovery phase
th
Harrison 16 ed. pp. 1645
58. A 10 year old, boy, has puffy eyelids, tea-colored urine, and BP of 130 / 100,
noted after 2 weeks bout of sore throat and fever. The clinical diagnosis is
nephrotic syndrome. The condition that would initiate all the subsequent
components of the syndrome is:
A. Hypoproteinemia C. Lipiduria
B. Glomerular proteinuria D. Edema
Harrisson 16th ed. pp. 1684

59. A 44 year old, male, was admitted to Philippine Hear Center because of severe
chest pain. Initial findings indicate acute myocardial infarction. Within few minutes
after admission, he developed transient arrhythmia and drop in BP. The serum
creatinine went up from 0.9 mg% on admission to 1.3 mg% after 2 days. The urine
output was about 250-300 /day. These findings can be explained on the basis of:
A. Intratubular block by debris C. Back leak of glomerular filtrate
B. Renal hypoperfusion D. Nephrotoxicity from drugs
Harrison 16th ed. pp. 1645

60. A 33 year old, female, is suffering from SLE for the last 5 years. A year ago,
proteinuria and hematuria were noted in her urinalysis. And subsequently her
serum creatinine slowly deteriorated. The progression of her renal failure is due to:
A. Nephrotoxicity C. Renal hypoperfusion
B. Reduction in renal mass D. Interstitial nephritis
Harrison 16th ed. pp. 1653

61. One of the following is not a classification criteria in the diagnosis of Rheumatoid
arthritis:
A. Morning stiffness less than 1 hour
B. Radiographic change like erosion or decalcification of wrist bone
C. Serum rheumatoid factor positivity
D. Symmetric arthritis
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1885

62. One of the following statements is not true with regards to the epidemiology of
SLE:
A. Common in women of child bearing age
B. Males are spared
C. More common in blacks than in white
D. Prevalence is form 15 to 50/100,000 population
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1874

Aling Nena, 75-years old, female, 5’2 ft tall, 100 lbs. Consulted because of pain
in the (R) knee for a year; which is worst in the afternoon and after a long walk and
improves with rest. On P.E. as bony hypertrophy and worse crepitation.

63. The pain she is experiencing maybe due to any of the following EXCEPT:
A. Ligament insertion strain C. Muscle pain
B. Cartilage destruction D. Capsular stretching
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1936-1937

64. One of the following statement about TB arthritis is true:

A. Culture of M. tuberculosis from the synovial biopsy is positive in 90% of cases
B. Joint destruction is rapid
C. Polyarticular involvement is more common
D. Treatment includes administration of Nafcillin and gentamycin
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1947
65. A 23-years old female patient consulted because of on and off pains, malar rash,
oral ulcers and increasing hairloss. A probable diagnosis of SLE was made
confirmed by:
A. High ESR and (+) CRP
B. High titer dsDNA and hypocomplementemia
C. Leucopenia and anemia
D. Thrombocytosis
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1877

Carla, 18-years old student is being treated for pneumonia. On the 4th day of
hospitalization she noted swelling, redness and severe pain of the (L) knee. Aspiration
of the knee revealed whitish, purulent fluid consistent with septic arthritis.

66. The laboratory test you would request for the condition is:
A. Liver function test C. Culture and sensitivity of fluid
B. Urinalysis D. ANA
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1945

67. The probability of a CPPD disease will reveal crystals appearing as:
A. Highly birefringent, large flat
B. Negatively birefringent, needle shape
C. Positively birefringent, rod shaped
D. Spheroidal aggregation
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1942

68. The pain in osteoarthritis arise from the following structure EXCEPT:
A. Articular cartilage
B. Stretching of joint capsule
C. Stretching of periosteum covering osteophytes
D. Synovitis
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1937

69. One of the following is not a classification criteria in the diagnosis of Rheumatoid
arthritis:
A. Morning stiffness less than 1 hour
B. Radiographic change like erosion or decalcification of wrist bone
C. Serum rheumatoid factor positivity
D. Symmetric arthritis
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1885

70. One of the following statements is not true with regards to the epidemiology of
SLE:
A. Common in women of child bearing age
B. Males are spared
C. More common in blacks than in white
D. Prevalence is form 15 to 50/100,000 population
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1874

Aling Nena, 75-years old, female, 5’2 ft tall, 100 lbs. Consulted because of pain
in the (R) knee for a year; which is worst in the afternoon and after a long walk and
improves with rest. On P.E. as bony hypertrophy and worse crepitation.

71. The pain she is experiencing maybe due to any of the following EXCEPT:
A. Ligament insertion strain C. Muscle pain
B. Cartilage destruction D. Capsular stretching
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1936-1937
72. One of the following statement about TB arthritis is true:
A. Culture of M. tuberculosis from the synovial biopsy is positive in 90% of cases
B. Joint destruction is rapid
C. Polyarticular involvement is more common
D. Treatment includes administration of Nafcillin and gentamycin
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1947

73. A 23-years old female patient consulted because of on and off pains, malar rash,
oral ulcers and increasing hairloss. A probable diagnosis of SLE was made
confirmed by:
A. High ESR and (+) CRP
B. High titer dsDNA and hypocomplementemia
C. Leucopenia and anemia
D. Thrombocytosis
Reference: Harrison’s Principles of Internal Medicine 14th ed. pp. 1877

74. The recommended screening test for DM is:

A. FPC C. RBS
B. 2-hr OGTT D. HbAic
Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2154

75. All of the following symptoms are consistent with hypothyroidism EXCEPT:
A. Constipation C. Heat intolerance
B. Menorrhagia D. Hoarse voice
Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2109

76. The most specific feature of cushings syndrome is:

A. Centripetal obesity C. Hirsutism
B. Weight gain D. Hypertension
Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2139

77. All of the following chronic diabetic complications are microvascular in nature
EXCEPT:
A. Retinopathy C. Nephropathy
B. Neuropathy D. Peripheral vascular disease
Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2161

78. The following statements are true regarding the pathophysiologic abnormalities of
type 2 DM EXCEPT:
A. It is characterized by autoimmune destruction of the beta cells
B. There is impaired insulin secretion
C. Peripheral insulin resistance may be present
D. There is excessive hepatic glucose production
Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2157

79. The combination of insulin deficiency and hyperglycemia would result to the
following biochemical abnormalities EXCEPT:
A. Reduces the hepatic level of fructose 2-6 phosphate
B. Decreases the activity of pyruvate kinase
C. Promotes the process of glycogenolysis
D. Increases the levels of the GLUT4 glucose transporter
Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2159

80. The major effects of cortisol on body water are as follows EXCEPT:
A. Retards the migration of water into cells
B. Promotes renal water excretion

C. Stimulates vasopression secretions

D. Increases urine potassium excretion at high doses
Reference: Harrison’s Principles of Internal Medicine 16th ed. pp. 2131
81. Choose the correct pair of tumor marker and cancer implicated:
A. Alphafetoprotein – colon cancer
B. CA-125 - ovarian cancer
C. Lactate dehydrogenase – myeloma
D. Carcinoembryonic antigen – hepatocellular carcinoma
Harrison’s Internal of Medicine, 16th ed. 439

82. The leading cause of cancer death in both men and women.
A. Lymphoma C. Lung CA
B. Nasopharyngeal CA D. Large cell CA
Harrison’s Internal of Medicine, 16th ed. 436, 506

83. The most common histologic subtype of lung cancer for the past 25 years.
A. Squamous or Epidermoid C. Small cell CA
B. Adenocarcinoma D. Large cell CA
th
Harrison’s Internal of Medicine, 16 ed. 506

84. Usually, these types of lung cancer have already spread at the time of
presentation and diagnosis, hence, surgery is unlikely to be curative. They are
managed primarily by chemotherapy with or without radiotherapy.
A. Squamous or Epidermoid C. Small cell CA
B. Adenocarcinoma D. Large cell CA
th
Harrison’s Internal of Medicine, 16 ed. 506

CASE: Leo Garcia, 68-year old male came in to your clinic because of urgency,
hesitancy and bloody urine: (Questions 167-169).

85. Prostate cancer is highly entertained, and the first screening modality that you will
perform is:
A. Digital rectal exam
B. Assay for serum PSA (prostate specific antigen)
C. Ultrasound of bladder/prostate
D. Transrectal ultrasound guided biopsy
Harrison’s Internal of Medicine, 16th ed. 446

86. Examinations revealed prostate cancer. The most common site for its metastasis:
A. Lungs C. Colon
B. Liver D. Bone
th
Harrison’s Internal of Medicine, 16 ed.

87. Deregulation of molecular mechanics controlling cell cycle progression is a

hallmark of cancer. Which phase of the cell cycle is critical in the regulation of cell
proliferation.
A. M C. S
B. G1 D. G2
Harrison’s Internal of Medicine, 16th ed. 453
88. Certain human malignancies are associated with viruses. Correct examples are
the following, EXCEPT:
A. Burkitt’s Lymphoma – Epstein Barr virus
B. Cervical cancer – Human Papilloma virus
C. Hepatocellular carcinoma – Hepatitis B virus
D. Colon cancer – Helicobacter pylori
Harrison’s Internal of Medicine, 16th ed. 442
89. A woman with the following characteristics, has a greater risk of developing breast
cancer:
A. Menarche at 12 y/o, Primigravida at 18, menopause at 45
B. Menarche at 12 y/o, Nulligravida, menopause at 52
C. Menarche at 12 y/o, Multigravida, menopause at 45
D. Menarche at 16 y/o, Primigravida at 25, surgical menopause at 40 because of
TAHBSO
Harrison’s Internal of Medicine, 16th ed. 517

90. Tumor lysis syndrome is an oncologic emergency which may present as acute
renal failure. This is due to destruction of a large number of neoplastic cells
during chemotherapy. It is characterized by the following, EXCEPT:
A. Hyperuricemia C. Hypercalcemia
B. Hyperphosphatemia D. Hyperkalemia
Harrison’s Internal of Medicine, 16th ed. 581

CASE
A 55-year old male, farmer from Pampanga came to the ER because of difficulty of
breathing. Present condition started 2 weeks prior to consult as cough productive of
opious grayish yellow sputum accompanied by moderate grade fever body malaise and
lost of apetite. Condition progressed despite over the counter antitussive medication,
until 1 day PTC he started to have difficulty of breathing.

PH-smoker 1 pack of cigarette/day since age of 25 … no other serious illness in the

past. Pertinent P. E. Findings: RR – 28/min.
Chest: Symmetrical expansion: resonance of percussion, crackles on the left midlung
to base posteriorly with bilateral forced on expiration.

91. What disease conditions would you entertain?

A. Chronic bronchitis (COPD) C. Pneumonia
B. Mycosis D. All of the above

92. What diagnostic laboratory examination would you request for?

A. Chest x-ray C. CBC
B. Sputum gram stain, culture and sensitivity D. All of the above

93. How would you start your management?

A. O2 inhalation C. Nebulization
B. IV antibiotic D. All of the above

94. If arterial blood gas examination showed – ph7.33, pCO2-50 mmHg, pCO2 of 75
mmHg and HCO3 of 28 mEq/L. What would be your interpretation?
A. Respiratory acidosis with hypoxemia
B. Respiratory alkalosis with hypoxemia
C. Respirator and metabolic acidosis
D. Adequate Oxygenation

95. What further laboratory examination would you add aside from above
examinations?
A. PFT C. ECG
B. Sputum for fungus D. A and B

96 - 100. A 60-year old male, 30-pack year smoker came in due to chronic cough and
mild exertional dyspnea for 3 years. He self medicated with mucolytic but
afforded no relief. On PE occasional wheezes and rhonchi were noted.

96. What is the most likely diagnosis:

A. Pulmonary Tuberculosis C. Chronic Obstructive Pulmonary Disease
B. Bronchial Asthma D. Pneumonia
97. What laboratory examination will you request to confirm the diagnosis:
A. Chest x-ray C. Chest CT scan
B. Sputum examination D. Spirometry

98. The mainstay in the treatment of this patient:

A. Inhaled bronchodilator C. Methylxanthines
B. Inhaled corticosteroids D. Antibiotics

99. A feature that best characterize chronic bronchitis.

A. Elastic recoil is severely decreased
B. Airway resistance is normal
C. Pulmonary hypertension moderate to severe at rest
D. Diffusing capacity is decreased

100. The most common mechanism of hypoxemia:

A. Decrease in inspired PO2 C. Shunt
B. Hypoventilation D. V/Q mismatching

101. A 40 year old male complains of chest pain, characterized by burning retrosternal
discomfort that radiates to the neck and angles of the jaw. It is aggravated by
bending forward, straining and lying recumbent and is worse after meals.This
classic symptom is called:
A. Heartburn C. Regurgitation
B. Angina D. Water Brash
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102. Your clinical impression for this Patient is:

A. Acute myocardial infarction C. Gastric Ulcer
B. Gastroeophageal Reflux Disease D. Esophageal Carcinoma
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103. The pathophysiology of this disease is:

A. Spasm of the coronary artery
B. Increase acid secretion in the stomach
C. Decrease in the tone of the lower esophageal sphincter due to muscle
weakness
D. Exposure to carcinogens
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104. The drug of choice for this patient is:

A. Nitrates C. Calcium channel blockers
B. Antacids D. Protom pump inhibitors
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105. A 70 year old male with chronic constipation presented with sudden onset left
lower quadrant abdominal pain and high grade fever. Physical examination
showed direct and rebound tenderness at the left lower quadrant. Your clinical
diagnosis is:
A. Sigmoid Diverticulits C. Irritable Bowel Syndrome
B. Acute Appendicitis D. Colon Cancer
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106. Mark, a 7 yr old boy was passing by McDonald’s and smelled the aroma of
hamburgers. At this instant, acid secretion took place in his stomach. Which phase
of acid secretion was responsible for the acid secretion?
A. Cephalic C. Intestinal
B. Gastric D. Interdigestive
107. While Mark was eating his hamburger, the food in his stomach stimulated further
acid secretion. Which of the following substances is responsible for the increased
acid secretion?
A. Histamine C. Somatostatin
B. Gastrin D. Acetylcholine
C.
108. Mark grew up to become an executive of a leading company. Because of the
stresses of his job, he developed Duodenal Ulcers. The ulcers of Mark will be
found:
A. 3cm from the pyloric opening C. 2nd portion of the duodenum
B. 10cm from the duodenal bulb D. 3rd potion of the duodenum

109. Mark consulted his physician at MCU because of his Duodenal ulcer. The
physician examined Mark and found that Mark had a succussion splash. This
finding indicates that Mark had this DU complication.
A. Perforation C. Gastric outlet obstruction
B. Penetration D. Hemorrhage

110. Which of the following items below is a function of the pre-epithelial level of
defense to prevent mucosal damage?
A. The mucus gel functions as a unstirred water layer impeding diffusion
of ions and molecules including pepsin.
B. The surface epithelial cells act as ionic transporters that maintain
intracellular pH and bicarbonate production
C. Gastric epithelial cells bordering an injury migrate to restore a damage
region
D. Epithelial cell renewal occurs and together with angiogenesis preserve
integrity of the gastric tissues