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Internal Medicine Sample Questions

Internal Medicine

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Internal Medicine Sample Questions

  1. 1. INTERNAL MEDICINE DIRECTION: Each question below is followed by four possible answers. Select the one best response and mark the appropriate spaces on the answer sheet provided for. 1. The most important risk factor for COPD is: A. Tobacco smoke B. Outdoor air pollution C. Occupational exposure to fumes D. Severe persistent bronchial asthma 2. The symptom of COPD that often precedes the development of airflow limitation by many years is: A. Cough B. Cyanosis C. Chest pain D. Dyspnea 3. The airflow limitation characteristic of COPD is: A. Recurrent B. Irreversible C. Non progressive D. Not measurable 4. The gold standard for the diagnosis and assessment of COPD is: A. CT scan B. Chest PAL C. ABG studies D. Standardized spirometry 5. The only intervention proven to improve survival in severe COPD patients is: A. Oxygen therapy B. Cyclic antibiotics C. Pulmonary rehabilitation D. Smoking cessation 6. The strongest risk factor in the development of asthma is: A. Atopy B. Gender C. Ethnicity D. Smoking 7. The key effector cells in the late phase response of airway inflammation in asthma are: A. Basophils B. Eosinophils C. Neutrophils D. Lymphocytes Page 1 / 13 1/30/15
  2. 2. 8. The most effective and practical test to objectively monitor bronchial asthma is: A. Spirometry B. Peak flow meter C. Dyspnea visual analog scale D. Structured serial questionnaire 9. Confusion, bradycardia and paradoxical breathing during asthma attack indicate: A. Impending stroke B. Moderate exacerbation C. Imminent respiratory arrest D. Co existing myocardial infarction 10. The radiologic feature of community acquired pneumonia which predicts increased mortality and morbidity is: A. Cavitary lesion B. Hyperinflated lung C. Unilobar involvement D. Slowly spreading lung infiltrate 11. The most likely etiologic agent of a pneumonia in an elderly diabetic with a non healing wound in the right big toe and bilateral cavitary lesions on chest x-ray is: A. Klebsiella pneumoniae B. Staphylococcus aureus C. Pseudomonas aeruginosa D. Streptococcus pneumoniae 12. The most likely etiologic agent of a pneumonia in a young patient developing 4 days post- caesarian section under general anesthesia presenting with putrid blood streaked sputum and x-ray finding of infiltrates on the right upper lung field posterior aspect is: A. Anaerobic bacteria B. Staphylococcus aureus C. Pseudomonas aeruginosa D. Streptococcus pneumoniae 13. The treatment most appropriate for a non small cell bronchogenic carcinoma (NSC) stage I in a patient without co morbidity is: A. Surgery B. Radiotherapy C. Chemotherapy D. Immunotherapy 14. The recommended duration of a 4-drug regimen for a newly diagnosed sputum smear or culture positive PTB patient without co morbidity is: A. 4 months B. 6 months C. 9 months D. 12 months Page 2 / 13 1/30/15
  3. 3. 15. The characteristic clinical and serologic features in classic polyarteritis nodosa (PAN) include the following, EXCEPT: A. Hypertension B. Slowly progressive renal insufficiency C. Bland urine sediment with subnephrotic proteinuria D. Presence of the characteristic anti neutrophilic cytoplasmic antibodies (ANCA) 16. Which of the following drugs is NOT associated with lupus or lupus-like conditions? A. Isoniazid B. Procainamide C. D-penicillamine D. Hydralazine 17. Which of the following immunosuppressive drugs is NOT used in the treatment of rheumatoid arthritis? A. Azathioprine B. Cyclosporine C. Chlorambucil D. Cyclophosphamide 18. The Disease Modifying Anti rheumatic Drugs used in the treatment of rheumatoid arthritis include the following, EXCEPT: A. Cyclosporine B. Methotrexate C. D-penicillamine D. Gold compounds 19. The 1982 Clinical Criteria for the diagnosis of SLE include the following, EXCEPT: A. ANA B. Malar rash C. Leukopenia D. ++ Proteinuria 20. The Clinical Criteria for the diagnosis of polymyositis include the following, EXCEPT: A. + EMG B. Elevated ESR C. + Muscle biopsy D. Symmetrical weakness 21. Which of the following is NOT associated with SLE? A. Malar rash over the bridge of the nose B. Leukopenia with lymphopenia <1 500 C. Erosive arthritis usually involving the hands and elbows D. Proteinuria of > 300 grams per day or +3 per routine urinalysis 22. The drug most appropriate to lower serum urate in over producers, stone formers and patients with advanced renal failure is: A. Probenecid B. Allopurinol C. Benzbromarone D. Low dose aspirin 23. The disease associated with an episodic inflammation of the joints is: A. Fungal arthritis B. Syphilitic arthritis C. Tuberculous arthritis D. Gonococcal arthritis 24. Opportunistic CNS infections in patients with HIV include the following, EXCEPT: A. Toxoplasmosis B. Cryptococcosis C. Aseptic meningitis D. Syphilis 25. The most serious complication of chickenpox especially in adults is: Page 3 / 13 1/30/15
  4. 4. A. Myocarditis B. Hepatitis C. Nephritis D. Pneumonia 26. Among the infections, the most common cause of fever of unknown origin is: A. Malaria B. Salmonellosis C. Extrapulmonary tuberculosis D. Infective endocarditis 27. Nosocomial infections of medical personnel are most effectively prevented by: A. Handwashing by medical personnel B. Isolation of contagious patients C. Prophylactic antibiotics for compromised patients D. Sterilization of contaminated articles 28. Jaundice is more commonly seen in which of the following causes of Gram negative sepsis? A. E. coli B. E. aerogenes C. Acinetobacter D. P. aeruginosa 29. Induction of vascular permeability, hemorrhage and shock in dengue virus infection depends on the following factors, EXCEPT: A. Presence of enhancing antibodies B. Children less than 12 years of age C. Infecting Dengue virus serotype 2 D. Malnutrition 30. Which of the following is NOT a feature of severe Falciparum malaria? A. Coma B. Severe hypertension C. Hypoglycemia D. Lactic acidosis Page 4 / 13 1/30/15
  5. 5. 31. Which of the following sexually transmitted infections (STI) can be prevented through vaccination? A. Hepatitis B B. Hepatitis C C. Syphilis D. Gonorrhea 32. What is responsible for the persistent fever of clinical typhoid? A. Invasion of the gall bladder B. Invasion of Peyer’s patches C. Sustained bacteremia D. Intermittent bacteremia 33. What is the definitive diagnostic test of typhoid fever? A. Widal test B. Typhidot C. Latex agglutination test D. Isolation of the organism in culture 34. Diagnosis of tetanus is based entirely on: A. Clinical findings B. Isolation of C. tetani from wounds C. History of injury D. Serum anti toxin levels of 0.01 unit/mL 35. Which of the following Schistosoma species is closely associated with urinary bladder granuloma and squamous cell carcinoma? A. S. japonicum B. S. mansoni C. S. haematobium D. S. intercalatum 36. Which of the following is NOT true for hepatosplenic Schistosomiasis? A. Presence of Schistosome eggs in the feces considered diagnostic B. Ultrasonography as method choice for diagnosis C. Periportal fibrosis seen on histopathology D. Pathognomonic in S. mansoni, S. japonicum and S. mekongi 37. An acute diarrheal disease acquired through ingestion of contaminated water in a matter of hours resulting in profound rapidly progressive dehydration and death is: A. Salmonellosis B. Shigellosis C. Campylobacter jejuni D. Cholera Page 5 / 13 1/30/15
  6. 6. For next 3 questions, please refer to the case below: A 40-year old female complained of sudden onset of persistent epigastric pain for 2 hours noted few minutes after attending a party. Patient took antacid with temporary relief. 38. One of the following information would tell us that the source of pain is biliary in origin: A. Pain is most severe after food intake. B. Pain is most severe before food intake. C. Pain is most severe during food intake. D. Food intake has no effect on the occurrence of pain. 39. If this is biliary colic, the reason for the pain may be due to: A. Entry of food into the stomach stimulating entry of bile into duodenum B. Contraction of the small intestine against an obstructing gallstone C. Contraction of the diseased or inflamed gall bladder D. Spasm of the colon 40. In as much as epigastric pain may be produced by a cardiac event, what part of the heart may be involved if this is cardiogenic in origin? A. Antero-septal wall B. Antero-lateral wall C. Inferior wall D. Global involvement For next 2 questions: A patient was admitted for abdominal pain and restlessness. On PE, you found that the patient had tender epigastrium. BP was 140/80 mm Hg, RR 28/min, HR 110/min. 41. What diagnostic tests will you order first and consider most informative? A. CK MB, Creatinine and ECG 12 leads B. Serum amylase, CK MB C. CBC, Creatinine, Flat plate of the abdominal D. CK MB, Amylase, Chest PA, ECG 12 leads 42. What test is the easiest way to check for perforated peptic ulcer disease in this patient? A. Upper gut endoscopy B. Barium contrast study C. Chest x-ray D. Upright film of the abdomen For next 3 questions: A 40-year old male homosexual came in for progressive pallor, LBM and melena for 3 months with easy fatigability. BP was 110/80 mm Hg and HR 110/min. PE showed pallor, palpable mass in the right upper quadrant, bipedal pitting edema. Rectal exam showed melena. Labs: CBC – Hgb 4 gms/dL, Hct 12 vol%, WBC 25 000/cu mm with 92% segmenters, platelet 850 000/cu mm; Serum albumin = 2.2 grams/L (Normal =–4-5 grams/L) 43. Which of the following is LEAST likely to cause melena? A. Bleeding esophageal varices B. Slowly bleeding gastric ulcer C. Colon cancer D. Bleeding duodenal ulcer Page 6 / 13 1/30/15
  7. 7. 44. The cause for the hematologic picture of the patient is due to: A. Bone marrow infiltration B. Primary bone marrow defect C. Severe anemia D. Leukemia 45. Colon biopsy revealed adenocarcinoma. How does this condition produce pedal edema? A. Congestive heart failure B. Protein loss C. Renal failure D. Compression of the vena cava 46. Which of the following does NOT predispose to colon cancer? A. Hyperplastic polyp B. Ulcerative colitis C. Polyposis coli D. Adenomatous polyp 47. Colonic polyps will most likely become malignant if it is: A. Sessile (flat-based) B. 1.5 cm in size C. Pedunculated (stalked) D. Multiple 48. A definitive diagnosis of cancer is only made through: A. Radiologic characteristics of the tumor B. Elevated levels of tumor markers C. Pathologic exam of tissue samples D. Clinical manifestations of the disease 49. What is the importance of estimating a tumor’s doubling time? A. It helps you choose the appropriate drug regimen for the case. B. It gives you an estimate of a patient’s performance ability. C. It determines how soon you need to initiate treatment. D. It gives you an idea how a patient will develop drug toxicity. 50. Which of the following conditions is a contraindication to systemic chemotherapy? A. Patients with age >60 years old B. Patients with good performance status C. White blood cell count of 5 000 cells/cu mm D. Overwhelming systemic infection present 51. The rationale of giving ACE inhibitor in diabetic patients with microalbuminuria is to: A. promote diuresis B. decrease glomerular hydrostatic pressure C. increase glomerular filtration rate D. decrease glomerular oncotic pressure Page 7 / 13 1/30/15
  8. 8. 52. The following are reasons why pregnant women are at risk in developing UTI, EXCEPT: A. Decreased ureteral tone B. Incomplete bladder emptying C. Decreased ureteral peristalsis D. Incompetent vesico-ureteral valve 53. Drug used to treat uric acid stone: A. Thiazide diuretic B. Sodium bicarbonate C. Cellulose phosphate D. Vitamin C 54. Anemia in nephritic syndrome is due to: A. Decreased erythropoietin factor B. Transferrin loss C. GI bleeding D. Iron deficiency 55. Radiocontrast-induced acute renal failure is due to: A. Direct toxicity to the tubular epithelial cells B. Intratubular obstruction C. Intrarenal vasoconstriction D. Rhabdomyolysis 56. The most specific test for lupus nephritis is: A. C3 B. ANA C. ESR D. Anti-DsDNA 57. The treatment of hyponatremia must be done gradually to prevent: A. Pulmonary edema B. Cerebral edema C. Central pontine myelinolysis D. Peripheral nerve disease 58. The drug used for the treatment of hyperkalemia to stabilize cellular membranes is: A. D50water + Regular Insulin B. NaHCO3 C. Calcium gluconate D. Furosemide 59. Hyponatremia in chronic renal failure is best treated with: A. NaCl tablet B. Normal saline infusion C. Water restriction D. Diuretics Page 8 / 13 1/30/15
  9. 9. 60. Because of the predilection of herpes encephalitis for the temporal lobes, common manifestations are seizures and: A. Hemiataxia B. Hemiparesis C. Aphasia D. Hemisensory loss 61. The most common modifiable risk factor for both ischemic and hemorrhagic strokes is: A. Age B. Smoking C. Hypertension D. Hyperlipidemia 62. What area is usually involved in a stroke manifested as sudden onset of diplopia and hemiparesis? A. Supratentorial B. Infratentorial C. Extra parenchymal (e.g. meningioma) D. Spinal cord 63. The most common cause of non traumatic subarachnoid hemorrhage is: A. Mycotic aneurysm B. Berry “congenital” aneurysm C. Dissecting aneurysm D. Fusiform, dolichoectatic aneurysm 64. Cell loss of the substantia nigra in Parkinson’s disease primarily leads to: A. Dopamine deficiency B. Cholinergic deficiency C. GABA deficiency D. Adrenergic deficiency 65. Dyskinesias (i.e. chorea and dystonia) in Parkinson’s disease are primarily due to: A. Continued cell degeneration B. Medication effect C. On and off phenomenon D. Natural course of disease 66. The most deadly complication due to too rapid infusion of intravenous phenytoin (>50 mg/min) is: A. Respiratory depression B. Cardiac arrhythmias and hypotension C. Intravenous burns and phlebitis D. Nystagmus 67. The Guillain Barre syndrome of subacute generalized (four-limb) weakness, areflexia, and at times plegic pupils can be mimicked by: A. Cervical lesion (i.e. disc herniation) B. Cervical lesion (i.e. disc herniation) with spinal shock C. Subacute combined degeneration (Vitamin B12 deficiency) D. Amyotrophic lateral sclerosis 68. The most common form of migraine is: A. Migraine with aura B. Migraine without aura C. Basilar migraine D. Familial hemiplegic migraine 69. In psychoanalytic theory, the major factor in producing depression is: A. Projection B. Sublimation C. Introjection D. Displacement 70. Diagnostic criteria for “major depressive episode” include all of the following, EXCEPT: Page 9 / 13 1/30/15
  10. 10. A. Significant change in appetite or weight B. Change in sleep pattern C. Increased energy D. Decreased concentration 71. Prodromal signs of schizophrenia commonly include all of the following, EXCEPT: A. Abnormal affect B. Peculiar behavior C. Strange perceptual experience D. Excessive spending 72. Negative symptoms of schizophrenia include all of the following, EXCEPT: A. Hallucination B. Flattening of affect C. Poverty of speech D. Blocking 73. Delusions of persecution are characteristic of this type of schizophrenia: A. Disorganized B. Catatonic C. Paranoid D. Undifferentiated 74. An overdose of narcotics causes all of the following, EXCEPT: A. Dilated pupils B. Hypotension C. Depressed reflexes D. Respiratory depression 75. The highest risk factor for developing alcoholism is: A. Being raised in a family with alcoholism B. Being male and having a biologic parent with alcoholism C. Having a mood disorder D. Alienation from society Page 10 / 13 1/30/15
  11. 11. 76. Standard chemotherapy regimen for newly diagnosed AML consists of: A. Melphalan + Prednisone B. Hydroxyurea + Interferon C. Cytarabine + Anthracycline D. Cyclophosphamide + Vincristine + Prednisone 77. The following finding is consistent with Polycythemia vera: A. O2 saturation of 80% B. Low LAP score C. Low serum erythropoietin D. Low serum vit. B12 78. Which of the following findings is consistent with CML: A. Auer rods B. Pelger Huet anomaly C. Philadelphia chromosome D. Howell Jolly bodies 79. The following findings are consistent with iron deficiency anemia, EXCEPT: A. Low serum ferritin level B. Low mean corpuscular volume C. Low total iron binding capacity D. Prussian blue staining (-) 80. Recombinant erythropoietin therapy is ABSOLUTELY indicated in: A. Anemia of chronic disease B. Anemia of renal disease C. Aplastic anemia D. Anemia from GI losses 81. Recommended management of patients with ITP includes the following, EXCEPT: A. Prednisone B. Splenectomy C. Immunosuppressives D. Whole blood transfusion 82. Which patient would benefit most from fresh frozen plasma transfusion? A. Patient with gum bleeding and thrombocytopenia B. Patient with liver cirrhosis and prolonged prothrombin time C. Patient with massive hematemesis and prolonged prothrombin time D. Patient for elective surgery with coumadin-induced prolonged prothrombin time 83. Which of the following is an unmistakable sign of inadequate control in a chronic hypertensive? A. Hypercalcemia B. (+) albuminuria C. Premature cataract formation D. Calcification of the aortic arch Page 11 / 13 1/30/15
  12. 12. 84. A 60-year old patient with usual BP of 120-130/70-80 mm Hg, on anti hypertensives, now presents with a BP range of 160-170/90-95 mm Hg. At first visit, all of the following modes of action are good choices, EXCEPT: A. Change the anti-hypertensive medication. B. Re evaluate the blood chemistries. C. Evaluate compliance and optimize the existing drug’s dose. D. Review drug history for possible source of secondary hypertension. 85. Which of the following statements is TRUE for the hypertensive patient with chronic renal failure? A. The “normal’ BP is now pegged higher at < 160/90 mm Hg. B. It will be necessary to monitor serum electrolytes more frequently. C. Any of the anti hypertensive drugs available in the market can be used. D. Beta blockers are contraindicated because they usually cause peripheral vascular disease. 86. In the hypertension clinic, A. Screening should be limited to patients above 21 years old. B. It is mandatory that BP be taken on all extremities at first visit. C. The pharmacologic history can be limited to what cardiovascular medications the patient is on. D. The complete examination includes urinalysis, eye examination with fundoscopy, and palpation-auscultation of all pulse points. 87. A 60-year old man comes to the E.R. with chest discomfort. What is the appropriate action to take? A. An ECG should be taken after the initial history. B. A dose of sublingual nitrates can be given as therapeutic trial. C. He should be admitted at once to the coronary care unit for observation. D. He can be sent to the out-patient department for proper assessment, as he is not in acute distress. 88. An obese diabetic 55-year old smoker has been admitted for acute myocardial infarction. Which of the following is true? A. The initial drugs should include aspirin, anti thrombins and beta blockers. B. It is reasonable to use NSAID’s as first line drugs to control pain. C. ICU or CCU admission is not necessary, unless he is in failure. D. Complete bed rest is mandatory for at least one week. 89. The following are common congenital heart defects with expected adult survival, EXCEPT: A. Atrial septal defect (secundum) B. Patent ductus arteriosus C. Coarctation of the aorta D. Ventricular septal defect 90. The following are relative contraindications to cardiac catheterization, EXCEPT: A. Uncontrolled ventricular irritability B. Uncorrected hypertension C. Decompensated heart failure D. Large ventricular septal defect 91. What arrhythmia is suggested by wide complex QRS tachycardia exceeding 100 beats/minute and is associated with syncope and sudden cardiac death? A. Ventricular tachycardia B. Ventricular parasystole C. AV junctional complexes D. Ventricular fibrillation 92. Sinus node dysfunction has the following characteristics, EXCEPT: A. It is most often found in the elderly as part of a syndrome. B. Marked sinus bradycardia (<50/min) may cause fatigue and other symptoms due to inadequate cardiac output. C. Most important step to diagnosis is to correlate symptoms with ECG. D. Symptoms may become manifest only in the presence of cardioactive drugs in some patients. Page 12 / 13 1/30/15
  13. 13. 93. A thyroid function test which shows elevated T4 and below normal TSH would be most consistent with: A. Graves’ disease B. Papillary carcinoma C. Colloid cystic goiter D. Chronic lymphocytic thyroiditis 94. One of the following thyroid disorders would present with clinical thyrotoxicosis but the RAIU would be below normal: A. Graves’ disease B. Thyrotoxicosis factitia C. Iodine deficiency goiter D. Anaplastic thyroid CA 95. Which type of thyroid malignancy has the best prognosis? A. Papillary CA B. Follicular CA C. Medullary CA D. Anaplastic CA 96. The treatment of choice for goitrous Hashimoto’s thyroiditis is: A. Thyroidectomy B. Propylthiouracil C. Radioactive iodine D. L-thyroxine 97. Hyperaldosteronism may present with all of the following metabolic derangements, EXCEPT: A. Hypertension B. Hyperkalemia C. Hypernatremia D. Metabolic alkalosis 98. Hypercortisolism is best diagnosed by: A. MRI of the pituitary gland B. CT scan of the adrenals C. Dexamethasone suppression test D. ACTH level determination 99. All of the following findings support the diagnosis of Addison’s disease, EXCEPT: A. Hyponatremia B. Hyperkalemia C. Hypertension D. Hyperpigmentation 100. A solid skin lesion wherein the diameter exceeds the thickness and measures more than 5 mm in diameter is: A. Papule B. Vesicle C. Nodule D. Plaque END OF EXAMINATION. REFERENCE (Unless otherwise specified) Kasper DL, Fauchi AS, Longo DL, Braunwald, Hauser SL, Jameson JL, Editors. Harrison’s Principles of Internal Medicine, 16th Edition. New York: McGraw Hill Companies, 2005. Page 13 / 13 1/30/15