TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
DEAR TOPNOTCH FRIENDS:
PLEASE FOLLOW THESE INSTRUCTIONS:
1.
2.
These questions are previous diagnostic, midterm, and finals exams of Topnotch, almost all of them made by Topnotch Board Exam Topnotchers.
Answer this Topnotch Superexam seriously 100-items at a time. Cover the “Explanations” Column. Do not immediately look at the answers from the
answer key. That’s not the correct way of answering sample exams. You need to treat these MCQs as exercises and not as handouts.
Time yourself. 1.5 hours per 100-item block.
After answering each 100-item block, refer to the Topnotch Answer Key for the correct answers. Please be careful of “frameshift mutations” when
checking your answers – check every 10 items. (the format of the answer key was designed for you to practice against “frameshift mutations”)
The Topnotch Superexams are EXERCISES for the actual med boards. They will not appear verbatim in your future exams. More than knowing what’s
the correct answer, it’s more important for you to:
a.
Know why the other choices are wrong
b. Know why the other choices were included in the first place
c.
Know the explanation to the correct answer
Sharpen your mind by answering the Topnotch Superexams. Most of these questions based on past feedback are more difficult than the actual questions
in the med boards. In these exams made by Board Exam Topnotchers, if you’re getting a score of 60/100 , that’s already a good score. More than 80/100
is outstanding.
3.
4.
5.
6.
Item
#
1
QUESTION
EXPLANATION
The most common cause of familial predisposition to
thrombosis is:
A. Hemophilia antibodies
B. Protein C deficiency
C. Protein S deficiency
D. Factor V Leiden mutation
E. None of the above
Approximately 3% of the worlds population is
heterozygous for this mutation.
A patient presents with neck stiffness and positive
kernig’s and brudzinski’s sign. The spinal tap results
were suggestive of TB meningitis. Which of the
following is the most likely CT scan finding?
A. Ring enhancing lesion
B. Hydrocephalus and abnormal enhancement of the
basal cisterns
C. Periventricular enhancement
D. Predisposition for the temporal lobes
E. Diffuse enhancement
Meningeal involvement of tuberculous meningitis
is most pronounced at the base of the brain.
3
Which of the following is best for monitoring
therapeutic response in liver cancer?
A. AFP
B. CEA
C. CA 19-9
D. CA 125
E. Chromogranin a
4
Which of the following is a marker for lupus
nephritis and is such most useful for assessing
prognosis in SLE?
A. Anti-histone
B. Anti-Sm
C. Anti-Ro
D. ANA
E. Anti-dsDNA
2
5
In patients with COPD with expiratory airflow
limitation, the residual volume is:
A. Increased
B. Decreased
C. Same
D. Normalizes
E. Initially increased then becomes decreased
Source: Harrison’s Principles of Internal Medicine
18th edition p525
AUTHOR
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
Source: Harrison’s Principles of Internal Medicine
18th edition p779
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
Antinuclear antibodies – Best screening test
Anti-dsDNA – High titers are SLE specific and in
some patients correlate with disease activity,
nephritis, vasculitis
Anti-Sm – Specific for SLE; no definite clinical
correlations; most patients also have anti-RNP;
more common in blacks and Asians than whites
Anti-Ro – neonatal lupus with congenital heart
block
Anti-histone – drug induced lupus
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
TB Meningitis – base of brain… TB meningitis –
base of brain… TB meningitis – base of brain
Source: Harrison’s Principles of Internal Medicine
18th edition p1348
Source: Harrison’s Principles of Internal Medicine
18th edition p2726
In COPD, there is airway wall thickening of the
small airways. Also, there is alveolar wall
destruction which leads to airway collapse and
decrease in elastic recoil. Airway wall thickening
with airway collapse leads to airway obstruction.
Airway obstruction with decrease elastic recoil
leads to airflow limitation causing air trapping and
hyperinflation. So, the patient experiences
difficulty in exhalation due to the obstruction.
In COPD, the lungs are hyperinflated thus the
diaphragm becomes depressed. This is because of
air trapping.
Notice that in COPD patients, there is a decrease in
the inspiratory capacity (IC) and an increase in the
residual volume (RV). The decrease in IC causes
dynamic hyperinflation.
Source: Harrison’s Principles of Internal Medicine
18th edition p2153
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 1 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
6
QUESTION
A 30 year old obese patient presents with
Hypertension. His roommate says he snores and
chokes during his sleep. During the day, the patient
would complain of headache and excessive daytime
sleepiness. The best ventilator management for this
patient is:
A. CPAP
B. BIPAP
C. Assist control mechanical ventilation
D. SIMV (Synchronized intermittent mandatory
ventilation)
E. None. Patient does not need ventilatory support
EXPLANATION
This is a case of obstructive sleep apnea.
CPAP continuous positive airway pressure –
obstructive sleep apnea
AUTHOR
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM MARCH 2016
BIPAP Bilevel positive airway pressure – COPD
AC mode – commonly used for initiation of
mechanical ventilation (unloads or rests the
respiratory muscles), absence of intact respiratory
drive, completely unloads the patient’s respi
muscles requiring no work from the patient
SIMV – weaning, allows patients with intact
respiratory drive to exercise inspiratory muscles
between assisted breaths
7
This describes acute decompensation after initiation
of therapy for infection due to spirochetes such as in
leptospirosis:
A. Drug resistance
B. Genetic variation
C. Jarische Herxheimer reaction
D. Acute drug reaction
E. All of the above
8
Migratory necrolytic erythema, glucose intolerance
and thromboembolism are features of:
A. VIPoma
B. Somatostatinoma
C. Gastrinoma
D. Glucagonoma
E. Insulinoma
Source: Harrison’s Principles of Internal Medicine
18th edition p2188, 2212
Source: Harrison’s Principles of Internal Medicine
18th edition p 1396
VIPoma/Verner Morrison syndrome– WDHA
Syndrome (watery diarrhea, Hypokalemia,
Achlorydia)
Somatostatinoma (3d’s) – Diabetes, diarrhea,
Disease of the gallbladder (gallstone)
Gastrinoma – multiple peptic ulcers
Insulinoma - hypoglycemia
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
Source: Harrison’s Principles of Internal Medicine
18th edition p3067
9
10
Occlusion of which of the following vessels results to
signs and symptoms of hemiplegia, homonymous
hemianopsia, hemianesthesia and gaze preference?
A. Anterior cerebral artery
B. Middle cerebral artery
C. Posterior cerebral artery
D. Basilar artery
E. Vertebral artery
Which of the following is not a part of the Bedside
Index of Severity in Acute Pancreatitis?
A. BUN
B. Mental Status
C. Amylase
D. SIRS
E. Effusion in the pleural cavity
Entire MCA occlusion at its origin (blocking both
its penetrating and cortical branches) and the
distal collaterals are limited: contralateral
hemiplegia, hemianesthesia, homonymous
hemianopia, and a day or two of gaze preference
to the ipsilateral side. Dysarthria is common
because of facial weakness. When the dominant
hemisphere is involved, global aphasia is present
also, and when the nondominant hemisphere is
affected, anosognosia, constructional apraxia, and
neglect are found
Source: Harrison’s Principles of Internal Medicine
18th edition p3284
BISAP = BUN, Impaired mental status, SIRS, Age
>60, Pleural effusion on radiography
The criteria for the severity of acute pancreatitis
was defined as organ failure of at least one organ
system and the presence of a local complication
such as necrosis, pseudocyst and abscess.
Source: Harrison’s Principles of Internal Medicine
18th edition p2639
11
Which of the following is the strongest predictor of
pneumonia?
A. Tachycardia
B. Tachypnea
C. Fever
D. Chills
E. Rhonchi
Remember that tachypnea is the single most
useful clinical sign for identifying pneumonia.
Source: Philippines CAP guidelines
Palafox et al (2000). Diagnostic Value of
Tachypnea in pneumonia defined radiologically.
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 2 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
12
13
14
QUESTION
EXPLANATION
A 57 year old alcoholic with chronic liver disease
presents with dyspnea that worsens on moving from
supine to upright position. This was supported by
the finding of decreased O2 saturation on pulse
oximetry when moving from supine to upright
position. What is treatment of choice for this
condition?
A. Liver transplantation
B. Continuous O2 support
C. Long acting Beta 2 agonist
D. Tiotropium
E. Portocaval shunt
2 complications of hepatic failure can only be
treated with liver transplantation –
hepatopulmonary and hepatorenal syndrome.
A 31-year-old male with hemophilia A is admitted
with persistent gross hematuria. He denies recent
trauma or any history of genitourinary pathology.
The examination is unremarkable. Hematocrit is
28%. All the following are treatments for hemophilia
A except:
A. Desmopressin
B. Fresh frozen plasma
C. Cryoprecipitate
D. Recombinant Factor VIII
E. Plasmapheresis
DDAVP causes the release of a number of factors
and von Willebrand factor
from the liver and endothelial cells. This may be
useful for patients with mild hemophilia. FFP,
Cryoprecipitate and Recombinant Factor VIII can
replace the lacking coagulation factor.
Plasmapheresis has no role in treatment of
Hemophilia A.
A patient who was diagnosed with acute MI develops
dyspnea. On PE, vitals were HR 96, RR 22 and bp
120/70 and an S3 gallop is appreciated. Chest xray
was done which revealed pulmonary edema.What is
the Killip classification for the patient?
A. Killip I
B. Killip II
C. Killip III
D. Killip IV
E. Killip V
Killip I – No signs of pulmonary edema
Killip II – Moderate heart failure as evidenced by
rales at the lung bases, S3 gallop, tachypnea, signs
of right sided heart failure including venous and
hepatic congestion
Killip III – Pulmonary edema, severe heart failure
Killip IV – Shock
Source: Harrison’s Principles of Internal Medicine
18th edition p 2601
AUTHOR
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
Source: Harrison’s Principles of Internal Medicine
18th edition p975
**There’s no killip V
Source: Harrison’s Principles of Internal Medicine
18th edition p2031
15
16
17
A 45 year old male with HIV sought consult for
edema. PE revealed normal blood pressure and
grade II bilateral edema. Auscultation was normal. A
urinalysis was requested which revealed +4
proteinuria and negative RBC/WBC findings. Blood
chemistry revealed serum albumin of 1.2g/dl and
elevated triglycerides. What is the most likely
finding in light microscopy?
A. Focal and segmental sclerosis and hyalinosis
B. GBM splitting
C. Subepithelial spike and dome
D. Diffuse capillary wall thickening
E. Tram tracking
We had cases that asked for patho like stuff in IM
like this.
A patient was recently diagnosed with carcinoid
syndrome and seeks consult for diarrhea and
photosensitive dermatitis. On physical examination,
an erythematous, pigmented skin rash in the
distribution of a broad collar (Casal necklace) was
noted. Patient is probably suffering from a deficiency
of which of the following?
A. Vitamin A
B. Vitamin B1
C. Vitamin B3
D. Vitamin B6
E. Vitamin E
This is a case of pellagra, which is a deficiency of
Vitamin B3 or niacin. Pellagra presents with the
classic D’s – diarrhea, dermatitis, dementia and
death.
A 30-year-old male patient who recently underwent
chemotherapy for a leukemia, presented at the ER
with signs and symptoms of acute renal failure and
seizures. Labs revealed hypocalcemia,
hyperuricemia, hyperphosphatemia and
hyperkalemia. Which of the following may be given
to prevent this condition?
A. Dexrazoxane
B. Leucovorin
C. Amifostine
D. Allopurinol
E. Aspirin
This is a case of Focal segmental
Glomerulosclerosis.
We are presented here with nephrotic syndrome.
The most common causes of nephrotic syndrome
in adults are either membranous glomerulopathy
and FSGS. However, FSGS is associated with
HIV/AIDS, Heroin use, morbid obesity.
Source: Robbins and Cotran Pathologic Basis of
Disease 8th ed p.918
NAD (niacin) is synthesized from the amino acid
tryptophan. In carcinoid syndrome, a serotonin
producing tumor diverts as much as 60% of the
body’s tryptophan metabolism away from the
synthesis NAD.
(in other words, serotonin and NAD are both
synthesized from tryptophan)
Source: Harper 27th ed p. 498
This is a case of tumor lysis syndrome which may
be precipitated by chemotherapy usually of
leukemias and lymphomas. The rapid death of
massive amounts of cancer cells causes release of
intracellular ions most significantly Calcium,
phosphates, potassium as well as uric acid. This
causes derangement of electrolytes precipitating
seizures and arrhythmias. The elevated uric acid
levels can cause urate nephropathy and acute
renal failure. Allopurinol may given
prophylactically.
Source: Harrison’s Principles of Internal Medicine
18th edition p2274
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 3 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
18
QUESTION
EXPLANATION
A 65 year old diabetic male with a 15 year history of
poorly controlled DM seeks consult for constantly
feeling fullness even after only a few bites. This is
occassionaly accompanied by nausea or abdominal
pain. He otherwise feels fine. An ultrasound was
done which reveals normal findings. He was finally
diagnosis with diabetic gastroparesis. What is the
drug of choice for this condition?
A. Metoclopromide
B. Ranitidine
C. Omeprazole
D. Lactulose
E. Senna concentrate
The drug of choice for DM gastroparesis is
Metoclopromide.
Which of the following is used in the diagnosis of an
anaphylactic reaction?
A. Epinephrine assays
B. Tryptase assay
C. Fibrinogen assay
D. Serotonin assay
E. Nitrous oxide (NO) assay
The diagnosis of anaphylactic reaction depends on
a history revealing the onset of symptoms and
signs within minutes after the responsible
material is encountered.
Which blood type is associated with gastric
adenocarcinoma?
A. Type A
B. Type B
C. Type AB
D. Type O
E. Blood type is not associated with gastric adenoCA
PUD – Blood type O
Gastric CA – Blood type A
21
Acne-form like rash can occur with treatment of
which anti-Koch's medication?
A. Rifampicin
B. Pyrazinamide
C. Isoniazid
D. Streptomycin
E. Ethambutol
22
A 60-year-old man, a heavy smoker, presents for
advice to stop smoking. On physical examination, he
is thin and has a ruddy complexion. He has a
productive cough and a barrel-shaped chest. He sits
leaning forward with his lips pursed to facilitate his
breathing. Which of the following is the most likely
histologic finding in the lungs?
A. Bronchial smooth muscle hypertrophy with
proliferation of eosinophils
B. Diffuse alveolar damage with leakage of proteinrich fluid into alveolar spaces
C. Dilation of air spaces with destruction of alveolar
walls
D. Hyperplasia of bronchial mucus-secreting
submucosal glands
E. Permanent bronchial dilation caused by chronic
infection, with bronchi filled with mucus and
neutrophils
A 62-year-old man has had an elevated hematocrit
for at least 3 years. His past medical history and
review of systems are negative, except for mild, wellcontrolled hypertension. His latest complete blood
count reveals the following: hemoglobin 18 mg/dL;
hematocrit 56%; and WBC count 17,500/mm3 with
platelets 800,000/mm3. On further investigation,
which of the following findings is the most typical
and expected?
A. Ringed sideroblasts on bone marrow examination
B. Arterial blood oxygen saturation less than 88%
C. Presence of a Philadelphia chromosome on
cytogenetic testing
D. Very low to absent erythropoietin titer
E. Many Pelger–Huet cells on peripheral blood smear
19
20
23
Source: Topnotch handout on Pharmacology
AUTHOR
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
KRISTEL TANHUI
(TOP 3 - AUG 2015
MED BOARDS;
TOPNOTCH MD
FROM LA SALLE)
DIAGNOSTIC
EXAM MARCH 2016
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. There were more than a
fair share of Dermatology questions in our IM
Exam, and some of them are nigh unanswerable
like in this case.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
Emphysema is an example of COPD. Due to the
destruction of alveolar walls, a lack of elastic recoil
causes air to become trapped in alveoli, and, thus,
airflow obstruction occurs on expiration. In COPD,
FEV1 is decreased, whereas FVC is normal or
increased; therefore, patients with COPD have a
decreased FEV1:FVC ratio.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
The very elevated hemoglobin and hematocrit,
which strongly correlate with true elevations in
RBC mass rather than plasma contraction, are
consistent with polycythemia. Polycythemia then
is broken down into autonomous or primary
polycythemia vera, a stem cell disease, in which
the marrow is autonomously creating too many
cells, versus reactive or secondary forms, in which
the marrow is responding to increased
erythropoietin from some alteration of normal
physiology. The elevations of the other cell lines
suggest polycythemia vera because this stem cell
disease involves all marrow cell lines. Ringed
sideroblasts and Pelger–Huet cells are seen in
myelodysplasia, which is another condition
resulting from abnormal marrow clonal stem cells.
However, in this condition, cytopenias rather than
increases in counts are expected. On occasion,
CML,
another marrow stem cell clonal proliferative
disease, may manifest with elevated counts—
specifically the WBC count and, to a lesser extent,
platelets. In CML, a hemoglobin and hematocrit
elevated to this degree would be unusual and are
much more typical of polycythemia vera.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
Source: Harrison’s Principles of Internal Medicine
18th edition p2710
Source: Harrison’s Principles of Internal Medicine
18th edition p766
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 4 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
24
QUESTION
EXPLANATION
AUTHOR
A 42-year-old woman presents to clinic for a routine
visit. Her father and brother were diagnosed with
colon cancer at ages 49 and 43, respectively. She
denies abdominal pain, weight loss, melena,
hematochezia, or changes in stool caliber. The best
option for colorectal cancer screening in this patient
is:
A. Colonoscopy beginning at age 50 years
B. CEA and CA 19-9 testing now
C. Screening for Helicobacter pylori infection and
treatment, if positive
D. Barium enema with CEA and CA 19-9 testing
beginning at age 50 years
E. Colonoscopy now
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. Screening for colon cancer
in average-risk patients should begin at age 50
years; however, this patient has two fi rst-degree
relatives with colorectal cancer, making her high
risk for developing the disease. Patients with a
family history of early colon cancer should begin
receiving screening at age 40 years or 10 years
before the age at which cancer was diagnosed in
the family member, whichever is first. CEA and CA
19-9 levels may be elevated in patients with
colorectal neoplasms, but this is not specific and is
not used for screening. H. pylori is a risk factor for
gastric cancer, but there is no evidence of
increased risk of colorectal cancers.
With the exception of the LDH findings, all of the
pleural fluid fi ndings listed indicate the presence
of an exudate. Exudates are caused by
inflammation or disease of the pleural surface or
by lymphatic obstruction (e.g., due to tuberculosis,
lung cancer, or pneumonia). Transudates are
caused by elevated systemic or pulmonary venous
pressure or by decreased plasma oncotic pressure
(e.g., due to CHF or nephrotic syndrome).
Therefore, in establishing the etiology of a pleural
effusion, it is useful to determine whether the fl
uid is a transudate or an exudate. This
determination often can be made on the basis of a
chemical analysis of the pleural fluid. A pleural
fluid-to-serum protein ratio of more than 0.5, an
LDH content of more than two-thirds the upper
limit for serum, or a pleural fluid-to-serum LDH
ratio of greater than 0.6 usually indicates the
presence of an exudate. Pleural fluid pH values of
less than 7.2 and a pleural fluid glucose content of
less than 20 mg/dL also are associated with
inflammatory effusions (exudates).
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. Adult polycystic kidney
disease is the most common inherited disorder of
the kidney and is characterized by autosomal
dominant inheritance. The disease is characterized
by partial replacement of the renal parenchyma
with cysts. An important association of adult
polycystic kidney disease is berry aneurysm of the
circle of Willis.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
An epidural hematoma is an arterial hemorrhage
between the dura and the skull, most often
resulting from skull fracture and laceration of the
middle meningeal artery. Epidural hematomas are
characterized clinically by a short period of
consciousness (lucid interval) followed by loss of
consciousness and signs of cerebral compression.
A subdural hematoma is venous hemorrhage
underneath the dura, resulting from laceration of
the bridging veins. Subdural hematomas are
characterized clinically by gradual signs of
cerebral compression occurring hours, days, or
weeks after injury. Subarachnoid hemorrhage is
commonly associated with rupture of a berry
aneurysm in the circle of
Willis. A transient ischemic attack is a brief
episode of impaired neurologic function caused by
a brief disturbance in cerebral circulation.
25
A 62-year-old woman with congestive heart failure
develops pneumonia and a large pleural effusion.
Thoracentesis is performed in an effort to establish
whether the pleural effusion is due to CHF or
pneumonia. Which of the following fi ndings would
indicate that the pleural effusion is due to CHF?
A. A protein content of 6 g/dL with a serum protein
level of 8 g/dL
B. A pH of 7.13
C. A glucose content of 20 mg/dL
D. A lactate dehydrogenase content of 100 mg/dL
(with a serum LDH level of 420 mg/dL)
E. A pleural fluid to serum protein ratio of 0.7
26
A 30-year-old man presents with hypertension,
hematuria, palpable renal masses, and flank pain. He
states that a kidney disease runs in his family, and
his mother and maternal grandfather have it.
Laboratory abnormalities confirm renal failure.
Which of the following is associated with the
disorder described here?
A. Autosomal recessive inheritance
B. Berry aneurysm of the circle of Willis
C. Clinical manifestation most commonly at birth
D. Multiple small medullary cysts in both kidneys
E. Presence of uric acid stones
27
Following a bar fight, a 22-year-old man is brought
unconscious to the emergency department. Several
minutes earlier, he had been hit on the head with a
heavy iron club and had been briefly unconscious,
but had then apparently recovered. One or two
minutes later, he had again lost consciousness.
Which of the following is the most likely diagnosis?
A. Epidural hematoma
B. Subarachnoid hemorrhage
C. Subdural hematoma
D. Transient ischemic attack
E. Stroke
TOPNOTCH
EXAM
MIDTERM 1
EXAM MARCH 2016
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 5 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
28
29
30
31
QUESTION
EXPLANATION
AUTHOR
A 64-year-old man enters the hospital because of
renal insuffi ciency. Until 6 months earlier, when he
developed persistent back pain, he was in good
health. At that time, he was found to be severely
anemic, and his BUN and creatinine levels were
elevated (42 and 4.6 mg/dL, respectively). He now
undergoes further evaluation. He denies the use of
any medications, any past history of renal injury, and
any diffi culty in voiding. He does complain of
persistent weakness and easy fatigability, and his
back pain has become more severe over the last 2
weeks. On physical examination, blood pressure is
120/80 mm Hg, pulse is 70 bpm, respiratory rate is
15 breaths per minute, and temperature is 37.0°C.
Major physical fi ndings include severe pallor, as
well as clear evidence of muscle wasting. Urinalysis
reveals 1 protein on dipstick testing and 4 on
sulfosalicylic acid testing. Microscopic examination
of the urine reveals an occasional broad cast and an
occasional granular cast. Laboratory studies give the
following results: BUN=61 mg/dL, creatinine = 5.1
mg/dL, serum sodium = 141 mEq/L, serum
potassium = 5.6 mEq/L, serum chloride = 101
mEq/L, serum bicarbonate = 14 mEq/L, serum
calcium = 11.7 mg/dL, and serum phosphorus = 6.0
mg/dL. Which of the following is the most likely
cause of this condition?
A. Renovascular disease
B. Thrombotic renal disease
C. Multiple myeloma
D. Systemic lupus erythematosus
E. Analgesic nephropathy
A 34-year-old woman presents in the emergency
department with tachypnea and shortness of breath
of acute onset. The history reveals that she has been
taking oral ontraceptives for 9 years. A lung scan
demonstrates a perfusion defect in the left lower
lobe. Which of the following occurs if the blood flow
to alveolar units is totally obstructed by a pulmonary
thromboembolism?
a. The V/Q ratio of the alveolus equals zero.
b. The PO2 of the alveolus will be equal to that in the
inspired air.
c. The PO2 of the alveolus will be equal to the mixed
venous PO2.
d. There will be an increase in shunting in the lung.
e. There will be a decrease in alveolar dead space.
A sexually active 24-year-old woman known to be
HIV-1 infected has had a fever for 2 days and has a
productive cough. Chest radiographs show an
infiltrate in the right lung. Two weeks earlier, her
helper T cell count was 510/mm3. Testing for
nontreponemal antigen (rapid plasma reagin) is
positive at two dilutions, and treponemal antigen
testing is also positive. Which of the following is the
most likely cause of the pneumonia?
A. Streptococcus pneumoniae
B. Pneumocystis carinii
C. Cytomegalovirus (CMV)
D. Mycobacterium avium-intracellulare
E. Syphilis
A 75-year-old man complains of chest pain while
climbing stairs. On physical examination, there is a
II/VI systolic ejection murmur that radiates to the
neck. The carotid upstrokes are delayed and
diminished in volume. The likely diagnosis is:
A. Hypertrophic cardiomyopathy
B. Aortic stenosis
C. Mitral stenosis
D. Pulmonary stenosis
E. Pulmonic regurgitation
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. Questions in our IM exam
tended to be long and focused on obscure
diseases, so manage your time wisely. Multiple
myeloma is the most likely etiology. The
combination of hypercalcemia and acute kidney
injury raises the possibility of multiple myeloma
as the bone breakdown secondary to tumor
involvement releases large amounts of calcium to
the extracellular fluid and hypercalcemia ensues.
The renal failure in myeloma is primarily related
to hypercalcemia combined with proteinaceous
cast formation within the renal tubules, producing
a form of intratubular obstruction as well as a
tubular infl ammatory lesion. The major diagnostic
clue is the finding of a urinary dipstick that is
mildly positive for protein in the urine but a
sulfosalicylic acid test that is strongly positive.
Dipstick testing does not detect the negatively
charged light-chain proteins, only the albumin.
The sulfosalicylic acid test detects all forms of
proteins. Renovascular lesions and thrombotic
renal disease could present with this picture,
although they should not be associated with
hypercalcemia and severe back pain, and findings
on examination of the urine would not include
proteins. SLE can be associated with severe
anemia and joint manifestations, but
hypercalcemia is not part of the picture.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
A pulmonary thromboembolism results in areas of
the lung that are ventilated, but not perfused,
yielding ratios of infinity and an increase in
alveolar dead space. When the ratio equals ∞, the
PAO2 of the affected alveoli will be the same as
that in the humidified inspired air because
atmospheric air enters the alveoli via the process
of ventilation, but no gas exchange takes place
because the alveoli are not perfused. Areas of the
lung that are perfused but not ventilated
constitute areas of shunting (venous admixture),
characterized as a ratio equal to 0, and having
PAO2 values that equilibrate with the mixed
venous blood.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
The most likely cause of the pneumonia is
Streptococcus pneumoniae. Although P. carinii is
the most common serious opportunistic infection
in patients with HIV-1 infection, the productive
cough, localized infi ltrate, and brief duration
argue against P. carinii pneumonia. In addition, the
CD4 count of more than 500 cells/mm3 suggests
that serious
opportunistic infections such as PCP,
cytomegalovirus, or Mycobacterium aviumintracellulare are unlikely for some time. Syphilis,
which may have been present, almost never
involves the lungs.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
The murmur and delayed carotid upstrokes are
typical of the fixed LV outflow obstruction of aortic
stenosis. Pulmonary stenosis also can cause chest
pain and a systolic ejection murmur but would not
cause carotid delay. Hypertrophic cardiomyopathy
causes a spike and dome of the carotid upstrokes,
that is, a sharp upstroke followed by fall and a
flatter secondary rise. The murmur of mitral
stenosis is diastolic.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 6 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
MIDTERM 1
EXAM MARCH 2016
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
32
33
34
35
QUESTION
EXPLANATION
AUTHOR
A 65-year-old woman with a significant smoking
history presents with cough and shortness of breath.
Computed tomography of the chest reveals a central
mass near the left mainstem bronchus. Biopsy of the
mass is performed. Histologic examination reveals
small round blue cells, and a diagnosis of small cell
carcinoma is made. Which of the
following is a frequent characteristic of this form of
lung cancer?
A. Generally amenable to surgical cure at time of
diagnosis
B. More common in women, and a less clear relation
to smoking than other forms of lung cancer
C. Secretes a parathyroid-like hormone
D. Secretes either corticotrophin or antidiuretic
hormone
E. Usually in a peripheral rather than in a central
location
A 21-year-old woman presents to the emergency
department complaining of abdominal pain. She
states that she has been having increased urination,
increased thirst, and a 10-lb weight loss. On exam
she has a blood pressure of 80/60 mm Hg, rapid
deep breaths, and dry mucous membranes. Which
lab abnormality fit with the patient’s clinical
presentation?
A. Low potassium
B. Low hematocrit
C. Normal Anion gap acidosis
D. Low serum osmolality
E. Low sodium
Small cell carcinoma of the lung is the most
aggressive type of bronchogenic carcinoma. The
location of this cancer is usually central. This is an
undifferentiated tumor with small round blue cells
and is least likely to be cured by surgery because it
is usually already metastatic at diagnosis.
Associated paraneoplastic syndromes include
secretion of adrenocorticotropic hormone and
antidiuretic hormone.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
The patient most likely had diabetic ketoacidosis,
in a setting of newly-diagnosed type 1 diabetes
characterized by a lack of insulin that led to
hyperglycemia and other metabolic derangements.
DKA results in high anion gap metabolic acidosis.
The liver produces more ketone bodies than the
body can metabolize. The anion gap reflects an
elevation of the acetoacetate and hydroxybutyrate
in the plasma. Serum potassium levels may be
elevated initially, but often patients have a low
body store and require repletion. As the acidosis
corrects, potassium will shift into cells in response
to insulin. Patients may appear to have an elevated
hematocrit secondary to hemoconcentration.
Serum osmolality is often elevated and serum
sodium is diluted secondary to osmotic pull of the
glucose that shifts fluid into the intravascular
space.
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. A papulosquamous
eruption in a bathing trunk distribution can be
seen with mycosis fungoides (cutaneous T cell
lymphoma), tinea corporis, or ossibly psoriasis.
The skin biopsy shows diagnostic changes with
atypical lymphocytes infi ltrating the epidermis
(epidermotropism) and forming clusters within
the epidermis (Pautrier microabscess). Impetigo
typically has golden crusts as a predominant
feature. Atopic dermatitis predominantly affects
flexor areas.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
The clinical situation strongly suggests pulmonary
embolism. In greater than 80% of cases,
pulmonary emboli arise from thrombosis in the
deep venous circulation (DVT ) of the lower
extremities, but a normal lower extremity Doppler
does not exclude the diagnosis. DVTs often begin
in the calf, where they rarely if ever cause
clinically significant pulmonary embolic disease.
However, thromboses that begin below the knee
frequently “grow,” or propagate, above the knee;
clots that dislodge from above the knee cause
clinically significant pulmonary emboli. Untreated
pulmonary embolism is associated with a 30%
mortality rate. Interestingly, only about 50% of
patients with DVT of the lower extremities have
clinical findings of swelling, warmth, erythema,
pain, or palpable “cord.” When a clot does dislodge
from the deep venous system and travels into the
pulmonary vasculature, the most common clinical
findings are tachypnea and tachycardia; chest pain
is less likely and usually indicates pulmonary
infarction. T he ABG is usually abnormal, and a
high percentage of patients exhibit low P CO2 with
respiratory alkalosis, and a widening of the
alveolar-arterial oxygen gradient. The ECG usually
shows sinus tachycardia, but atrial fibrillation,
pseudoinfarction in the inferior leads, and acute
right heart strain are also seen. Initial treatment
for suspected pulmonary embolic disease includes
prompt hospitalization and institution of
intravenous heparin or therapeutic dose
subcutaneous low molecular-weight heparin. It is
particularly important to make an early diagnosis
of pulmonary embolus, as intervention can
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
A 55-year-old man presents with a chronic rash over
the buttocks and hips that has been unresponsive to
topical steroids. It has recently started to itch.
Examination shows 6- to 12-cm erythematous,
scaling plaques in a “bathing trunk” distribution.
Potassium hydroxide preparation is negative for
evidence of a fungal infection. A skin biopsy
indicates an atypical lymphocytic infi ltrate with
evidence of epidermotropism and Pautrier
microabscess formation. What is the most likely
diagnosis?
A. Impetigo
B. Psoriasis
C. Mycosis fungoides
D. Tinea corporis
E. Atopic dermatitis
A 57-year-old man is admitted to the hospital
because of acute shortness of breath shortly after a
12-hour automobile ride. Findings on physical
examination are normal except for tachypnea and
tachycardia. He does not have edema or popliteal
tenderness. An electrocardiogram reveals sinus
tachycardia but is otherwise normal. Which of the
following statements is correct?
A. A normal D-dimer level excludes pulmonary
embolus.
B. If there is no contraindication to anticoagulation,
full-dose heparin or enoxaparin should be started
pending further testing.
C. Normal findings on examination of the lower
extremities make pulmonary embolism unlikely.
D. Early treatment of pulmonary embolism has little
effect on overall mortality.
E. A normal lower extremity venous Doppler study
will rule out a pulmonary embolus.
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 7 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
MIDTERM 1
EXAM MARCH 2016
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
decrease the mortality rate from 30% down to 5%.
A normal D-dimer level helps exclude pulmonary
embolus in the low-risk setting. T his patient,
however, has a high pretest probability of PE;
further testing (CT pulmonary angiogram, V/Q
lung scan) must be done to exclude this important
diagnosis.
36
37
38
A 62-year-old woman presents to her primary care
physician with a 2-month history of stiffness and
aching in her neck, shoulders, and hips. She is
referred to a rheumatologist. After doing a battery of
tests, he diagnoses the woman with polymyalgia
rheumatica and not fibromyalgia. Which of the
following findings is characteristic of polymyalgia
rheumatica?
A. Absence of response to prednisone
B. Antibodies to vascular smooth muscle
C. Increased serum creatine kinase levels
D. Increased erythrocyte sedimentation rate
E. Persistent muscle weakness
A 56-year-old patient with advanced alcoholic
cirrhosis and known ascites is found to have
abdominal pain, fever to 102 F, and a peripheral
white blood cell count of 17,000 with a shift to the
left. Which of the following statements regarding the
primary diagnosis is correct?
A. It is more likely when ascitic fluid total protein
exceeds 1 mg/dL.
B. It develops in the setting of preexisting ascites.
C. The ascitic polymorphonuclear count is less than
100 cells/mm3.
D. It is often associated with aspergillosis.
E. It is associated with a perforated viscus.
A 50-year-old woman complains of a 2-month
history of her hands becoming painful and turning
white or blue in the cold; progressive skin tightness
and thickening of fingers, hands, and forearms;
shortness of breath on exertion; and a sensation of
lower chest burning and food sticking on
swallowing. Antibody testing shows the presence of
ANA and elevated titers of antibody to antitopoisomerase I. Which of the following
pathogenetic explanations best fits this patient’s
illness?
A. Infiltration of
mucopolysaccharides into underlying subepithelial
tissues
B. Unregulated fibroblastic collagen synthesis
C. Raynaud’s phenomenon leading first to ischemia
and later to tissue fibrosis
D. Vascular endothelial damage and immunologically
mediated tissue fibrosis
E. Carcinomatous paraneoplastic process
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. Polymyalgia rheumatica is
almost always seen in patients older than 50 years
and can be seen in isolation or in patients with
giant cell arteritis. CK levels are not increased with
the disease, and while patients may have stiffness
and pain, muscle weakness is not seen and
electromyography and muscle biopsy are normal.
The characteristic laboratory finding in
polymyalgia rheumatica is an elevated ESR. There
is generally a prompt therapeutic response to lowdose prednisone.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
The clinical features of spontaneous bacterial
peritonitis, which develops in a setting of
preexisting ascites, include abdominal pain, fever,
leukocytosis, and paralytic ileus. The initial ascitic
fluid total protein count is usually less than 1
mm3/dL. The absolute polymorphonuclear count
in the ascitic fluid is generally greater than 250
cells/dL. Bacterial peritonitis associated with a
perforated viscus is secondary bacterial
peritonitis.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
This patient presents with characteristic features
of scleroderma, a chronic illness in which
unregulated immunologic processes (perhaps
triggered by unknown environmental antigens)
cause small-vessel endothelial damage and
widespread dermal and internal organ fi brosis.
The small-vessel endothelial damage leads to
secondary vascular reactivity (Raynaud’s
phenomenon) and, possibly, ischemic tissue
damage. The increased collagen synthesis by
tissue fibroblasts, which leads to widespread fi
brosis, is not unregulated; rather, it is caused by
cytokine and growth factor secretion from
lymphocytes, mast cells, and platelets. There is no
evidence that patients with scleroderma have
tissue mucopolysaccharide infi ltration or that
there are tumors responsible for paraneoplastic
dermal fibrosis. Immunologic clues include
elevated titers of antitbodies to antitopoisomerase I (Scl-70).
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 8 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
39
40
41
QUESTION
EXPLANATION
AUTHOR
A 78-year-old man enters the hospital because of
abnormalities of urination. Today he is passing large
amounts of urine; however, some days he passes no
urine at all. He now has a blood pressure of 180/90
mm Hg, and otherwise his physical examination is
normal. Laboratory studies show a BUN of 120
mg/dL and a serum creatinine of 4.2 mg/dL.
Urinalysis reveals a specific gravity of 1.010; urine
that is negative for protein, glucose, ketone bodies,
and blood; and an occasional WBC per high-power
field on microscopic examination. Which of the
following is the most likely cause of the renal
insufficiency?
A. Obstructive uropathy
B. Acute glomerulonephritis
C. Acute interstitial nephritis
D. Acute tubular necrosis
E. Chronic renal failure of unspecifi ed nature
The incidence of prostatism in elderly men is so
great that it must be considered the primary cause
of renal insuffi ciency until proven otherwise. This
patient’s history is classic, in that he had 1 or 2
days on which he seemed to pass no urine,
followed by days of high urine flow, a pattern that
is caused by the gradual accumulation of large
amounts of urine in the collecting system under
pressure, which eventually may overcome some
degree of obstruction. The high pressure is
transmitted back to the kidneys and results in
renal insuffi ciency. Acute glomerulonephritis and
acute interstitial nephritis are ruled out by the
normal results of urinalysis. The possibility of
acute tubular necrosis (ATN) should be
considered, but no information in the history
suggests recent surgery or nephrotoxic drug
intake that would have produced ATN. The best
way to screen for obstructive uropathy is renal
ultrasonography, which would demonstrate
dilated upper tract calyces.
Congestive heart failure is a syndrome, and its
cause should be sought and treated directly
whenever possible. It is usually helpful to establish
whether the root cause is systolic or diastolic
dysfunction, a distinction made easily with
echocardiography. Diuretics form the mainstay of
therapy, but adding both ACE inhibitors and betablockers prolongs life.
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
LESTER BRYAN CO
(TOP 10 - AUG
2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 1
EXAM MARCH 2016
The murmur and delayed carotid upstrokes are
typical of the fixed LV outflow obstruction of aortic
stenosis. Echocardiography with Doppler
interrogation of the valve will show the aortic
stenosis, quantify its severity, and assess left
ventricular function.
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
A 56-year-old man enters the emergency
department complaining of dyspnea that began
about 3 weeks ago and has progressed so that he
now has diffi culty walking across a room. He has
begun sleeping on three pillows. On physical
examination: temperature is 99 F, pulse is 102 bpm,
blood pressure is 130/90 mm Hg, and respiratory
rate is 24. There is jugular venous distention, and
estimated central venous pressure is 10 cm H2O.
Other findings include bibasilar rales and an S3
gallop. Which of the following is true about the
treatment of the condition of the patient?
A. The cause of the condition should be treated
whenever possible.
B. Systolic versus diastolic dysfunction usually
cannot be established.
C. ACE inhibitors improve symptoms but do not
prolong life.
D. Diuretics are the drugs of last resort.
E. Beta Blockers are dangerous and should be
avoided.
A 75-year-old man complains of chest pain while
climbing stairs. On physical examination, there is a
II/VI systolic ejection murmur that radiates to the
neck. The carotid upstrokes are delayed and
diminished in volume. The best test to confi rm the
diagnosis is:
A An ECG
B An exercise stress test
C An echocardiogram
D A radionuclide ventriculogram
E A chest x-ray
TOPNOTCH
EXAM
MIDTERM 1
EXAM MARCH 2016
42
A person who has been vaccinated against Hepatitis
B will have a reactive serologic test to
A. HBsAg
B. Anti-HBs
C. HBeAg
D. Anti-HBe
E. Anti-HBc
Vaccinated individuals will only seroconvert to
positive anti-HBs.
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
43
Which of the anti-TB medications has the potential
to cause pyridoxine deiciency
A. Isoniazid
B. Rifampin
C. Pyrazinamide
D. Ethambutol
E. Streptomycin
Isoniazid causes dose-related pyridoxine
deficiency.
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
44
E. coli infection causing hemolytic uremic syndrome
(HUS) produces this toxin
A. Tetratoxin
B. Saxotoxin
C. Verotoxin
D. Beta-toxin
E. Lecitoxin
Shiga-like toxin, also known as verotoxin, is a toxin
generated by some strains of Escherichia coli
causing hemolytic uremic syndrome.
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 9 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
45
QUESTION
EXPLANATION
AUTHOR
What agar can be use to differentiate the strain of E.
coli producing HUS from other strains?
A. OH157:H7 Agar
B. Sorbitol MacConkey Agar
C. Xylose Lysine Agar
D. Lysine Iron Agar
E. Lactose E. coli Agar
Sorbitol MacConkey Agar is a variant of traditional
MacConkey Agar used in the detection of E. coli
O157:H7. This strain differs from most other
strans of E. coli in being unable to ferment
sorbitol.
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
A 65 y/o M has had an elevated hematocrit for at
least 3 years. CBC reveals the following: hematocrit
56%; and WBC count 17,500/mm3 with platelets
800,000/mm3. On further investigation, which of
the following findings is the most typical and
expected?
A. Bone marrow hypoplasia
B O2 saturation less than 85%
C Presence of a Philadelphia chromosome on
cytogenetic testing
D Very low to absent erythropoietin titer
E Many Pelger–Huet cells on peripheral blood
smear
Drug that targets CD2- antigen on surface of mature
B ceslls used to treat Non-Hodgkin's lymphoma
A. Bevacizumab
B. Rituximab
C. Trastuzumab
D. Alemtuzumab
E. Cetuximab
The very elevated hematocrit, which strongly
correlate with true elevations in red blood cell
(RBC) mass rather than plasma contraction, are
consistent with primary polycythemia. No
secondary causes such as tissue hypoxia (as with
certain cardiac and pulmonary diseases) result
from physiologic increases in erythropoietin can
be seen in this case.
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
Trastuzumab - HER2/neu extracellular doman;
Bevacizumab - VEGF; Alemtuzumab - CD52
antigen on the surface of lymphocytes, monocytes
and macrophages; Cetuximab - EGFR
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
48
Most common type of head and neck cancer
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Adenosquamous carcinoma
D. Lymphoma
E. Lipoma
95% of head and neck cancers are squamous cell
carcinoma.
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
49
What would be the best way to screen an SLE patient
for possible renal involvement?
A. Kidney biopsy
B. Ultrasound
C. Urinalysis
D. ANA
E. Anti-dsDNA
anti-DsDNA is the best wasy to screen for possible
SLE nephritis.
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
50
Cerebral blood vessel vasoconstriction is caused by
which of the following?
A. Hypercarbia
B. Hyperoxygenation
C. Hypoxia
D. Hypocarbia
E. NOTA
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
51
Which of the following is not a sign of advanced
COPD?
A. Clubbing
B. Right heart failure
C. Systemic wasting
D. Weight loss
E. Paradoxical inward movement of ribcage on
inspiration
Risk factors for testicular cancer include, except
A. Hypospadias
B. Cryptorchid testicle
C. Abnormal testicular development
D. Klinefelter's syndrome
E. NOTA
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
46
47
52
53
Most common presentation of Renal Cell Carcinoma
A. Hematuria
B. Abdominal mass with flank pain
C. Weight loss
D. Fever and malasise
E. Paraneoplastic syndromes
Risk factors include hypospadias, a cryptorchid
testicle, abnormal testicular development,
Klinefelter’s syndrome, and a prior history of
testicular cancer. Familial testicular germ cell
tumors have an autosomal recessive inheritance,
with 4- to 10-fold increased risk in first-degree
relatives. There may be an association between
testicular germ cell tumors and organochlorine
compounds.
Clinical features
a. Hematuria (40%–70% of patients)
b. Abdominal mass with fl ank pain (20%–40% of
patients)
c. Weight loss (30% of patients)
d. Fever, malaise, night sweats, or anemia (15%–
30% of patients)
e. Paraneoplastic syndromes, including
hypercalcemia, polycythemia, hyponatremia, or
hypertension
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 10 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
MIDTERM 2
EXAM MARCH 2016
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
54
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 2
EXAM MARCH 2016
Most common etiologic agent of bacterial infection
in burned patients.
A. Steptococcus pneumoniae
B. Klebsiella pneumoniae
C. Mycoplasma pneumoniae
D. Pseudomonas aeruginosa
E. AOTA
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
55
Incubation period of Dengue virus
A. 1-5 days
B. 2-7 days
C. 5-8 days
D. 7-10 days
E. NOTA
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
56
DOC for pulmonary Cryptococcus in
immunocompetent individual
A. Fluconazole
B. Ketoconazole
C. Itraconazole
D. Voriconazole
E. NOTA
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
57
Mechanism of autoimmunity exhibited by antibodies
to M protein of Streptococcus crossreacting with
myosin
A. Sequestered antigen
B. Immune complex deposition
C. Molecular mimicry
D. Both A and C
E. AOTA
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
58
Treatment period of osteomyelitis
A. 1-2 weeks
B. 2-4 weeks
C. 4-6 weeks
D. 6-8 weeks
E. NOTA
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
59
Part of spine most commonyly involved in
rheumatoid arthritis
A. Atlanto-axial
B. Thoracic
C. Lumbar
D. Sacral
E. AOTA
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
60
The normal anti-reflux mechanism of the esophagus
includes the following
A. Lower esophageal sphincte
B. Crural diaphragm
C. Anatomical location of gastroesophageal
junction below the diaphragmatic hiatus
D. Both A and C
E. AOTA
Three normal antireflux mechanisms of the
esophagus
1. Lower esophageal sphincter
2. Crural diaphragm
3. Anatomical location of gastroesophageal
junction below the diaphragmatic hiatus
GEORGE MICHAEL
SOSUAN (TOP 5 AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 2
EXAM MARCH 2016
61
What is the definition of clinically important weight
loss?
A. Loss of 5 lbs over a pd of 6-12 mos
B. Loss of 10 lbs over a pd of 6-12 mos
C. Loss of >5% of BW over a pd of 3 mos
D. Loss of >10% of BW over a pd of 3 mos
E. Both B and C
Clinically important weight loss is defined as the
loss of
10 pounds (4.5 kg) or >5% of one’s body weight
over a period of 6–12
months. All are lifted verbatim from Harrison's
Princieple of 19th edition same as the board
exams.
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
62
All of the ff statements regarding principles of
cancer diagnosis is true EXCEPT?
A. The diagnosis of cancer relies most heavily on
invasive tissue biopsy and should never be made
without obtaining tissues
B. No noninvasive diagnostic test is sufficient to
define a disease process as cancer
C. The first priority in patient management after the
diagnosis of cancer is established and shared with
the patient is to determine the extent of disease.
D. The curability of a tumor usually is inversely
proportional to the tumor burden
E. The most widely used system of staging for
cancers such as Lung Cancer, Breast Cancer,
Hodgkin's disease and Colorectal cancer is the TNM
(tumor, node, metastasis) system
As stated vebatim in Harrison's 19th ed, pg 468470, The most widely used system of staging is the
TNM (tumor, node, metastasis) system for most
cancers. Other anatomic staging systems are used
for some tumors, e.g., the Dukes classification for
colorectal cancers, the International Federation of
Gynecologists and Obstetricians classification for
gynecologic cancers, and the Ann Arbor
classification for Hodgkin’s disease.
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
DOC for pulmonary Cryptococcus in
immunocompetent individual – fluconazole (200400 mg/d for 3-6 months)
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 11 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
63
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 3
EXAM MARCH 2016
What is the most common cause of right sided heart
failure?
A. Left sided heart failure
B. COPD
C. Pulmonary hypertension
D. Coronary artery disease
E. Portal hypertension
The most common cause of right sided HF is a
concomitant left sided HF.
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
64
A 75 year old male went to you complaining of
bipedal edema, paroxysmal nocturnal dyspnea and
exertional dyspnea. Physical exam showed grade 2
bipedal edema, tachycardia and hepatomegaly.
Based on the Framingham criteria, which salient
feature is a major criterion for the diagnosis of heart
failure?
A. Bipedal edema
B. Paroxysmal nocturnal dyspnea
C. Tachycardia
D. Hepatomegaly
E. Exertional dyspnea
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
65
In evaluaitng a patient with thrombocytopenia, a key
step is to review the peripheral blood smear and to
first rule out what entity?
A. Schistocytes
B. Hypocalcemia
C. Pseudothrombocytopenia
D. Coagulation defects
E. Von Willebrand's disease
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
66
Which of the ff is an atypical organism that causes
pneumonia?
A. Haemophilus influenzae
B. Anaerobes
C. Legionella pneumophilia
D. Klebsiella pneumoniae
E. Pseudomonas aeruginosa
The Framingham criteria for the diagnosis of heart
failure consists of the concurrent presence of
either 2 major criteria or 1 major and 2 minor
criteria. Major criteria include the
following:Paroxysmal nocturnal dyspne, Neck vein
distention, Rales. Cardiomegaly, Acute pulmonary
edema, Hepatojugular reflux, S3 gallop, Central
venous pressure greater than 16 cm water. Minor
criteria are as follows: Nocturnal cough, Dyspnea
on ordinary exertion, A decrease in vital capacity
by one third the maximal value recorded, Pleural
effusion, Hepatomegaly, Tachycardia (rate of 120
bpm), Bilateral ankle edema. Weight loss of 4.5 kg
in 5 days in response to treatment is both a major
and minor criteria
key step is to review the peripheral blood smear
and to first rule out “pseudothrombocytopenia,”
particularly in a patient without an apparent cause
for the thrombocytopenia.
Pseudothrombocytopenia is an in vitro artifact
resulting
from platelet agglutination via antibodies (usually
IgG, but also IgM and IgA) when the calcium
content is decreased by blood collection in
ethylenediamine tetraacetic (EDTA) (the
anticoagulant present in tubes [purple top] used
to collect blood for complete blood counts.
Atypical organism that cause pneumoniae include
Mycoplasma pneumoniae, Chlamydia pneumoniae
and Legionella pneumophilia
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
67
Which of the ff statements regarding urinary tract
infection is correct?
A. The most common manifestation of UTI is
asymptmatic bacteriuria
B. Asymptomatic bacteruria is pyuria that occurs in
the absence of symptoms and usually requires
treatment.
C. Generally all women will acquire atleast one UTI
during their lifetime- uncomplicated cystitis in msot
cases
D. During the neonatal period, incidence of UTI is
higher in males than females.
E. None of the above
All of the ff factors are criteria to classify a patient as
having health care associated penumonia EXCEPT?
A. Hospitalization for 2 or more days
B. Hospitalization within the prior 4 months
C. Antibiotic therapy in the preceding 3 mos
D. Chronic dialysis
E. Home wound care
The most common manifestation of UTI is acute
cystitis. Asymptomatic bacteruria is pyuria that
occurs in the absence of symptoms and usually
does not require treatment. During the neonatal
period, the incidence of UTI is slightly higher in
males than in females bec males infants more
commonly have congenital urinary tract
anomalies. Only 50-80% of women will acquire
atleast one UTI during their lifetime
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
As stated vebatim in Harrison's 19th ed, pg 803,
the clinical conditions assoc with HCAP include
Hospitalization for 2 or more days within the
prior 3 months, Antibiotic therapy in the
preceding 3 mos, Chronic dialysis, Home wound
care, Nursing home residence, Home infusion
therapy and a family member with MDR infection
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
69
A newly diagnosed diabetic patient came to the
emergency room because of a a 1 week history of
freuqnt light headedness, cold sweats and
palpitations occuring 2 hours after taking an
unknown medication given to him by his neghbor
for diabetes. Which is the most likely medication
given to the patient?
A. Sulfonylurea
B. Biguanide
C. Alpha glucosidase inhibitor
D. Thiazolidinedione
E. PPD4 inhibitor
The px is suffering from hypoglycemic episode. Of
the all class of antidiabetic drugs mentioned, only
sulfonoylureas, being an insulin secretagouge, can
cause hypoglycemia
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
70
The only absolute contraindication to the use of
nitrates in patients with UA/NSTEMI?
A. Use of sildenafil for the prior 3-5 days
B. Bradycardia
C. Intractable headaches
D. Concomitant pulmonary edema
E. Hypotension
The only absolute contraindication to the use of
nitrates in patients with UA/NSTEMI is use of
sildenafil for the prior 24-48 hrs and hypotension.
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
68
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 12 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
71
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 3
EXAM MARCH 2016
Several stimuli trigger airway narrowing, wheezing,
and dyspnea in asthmatic patients. What is the most
common asthma trigger?
A. Atopy
B. Dermatophagoides species
C. Viral infections
D. Air pollution
E. Pollen
As stated vebatim in Harrison's 19th ed, pg 1671,
the most common allergen to trigger asthma is
Dermatophagoides commonly known as house
dust mites.
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
72
One of the following is NOT a diagnostic crtieria for
acute respiratory distress syndrome.
A. Acute in onset
B. Clinical respiratory distress
C. PaO2/FiO2 ratio of less than 300
D. Bilatreral alveolar or interstitial infiltrates in
CXR
E. Absence of left atrial hypertension
Clinical manifestions or resp. distress is not part of
the criteria. All others mentioned are the 4 criteria
of ARDS. Take not the new Berlin crtieria classifies
ARDS into mild (P/F ratio of less than 300)
moderate (P/F ratio of less than 200) and severe
(P/F ratio of less than 100)
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
73
This mode of mechanical ventilation wherein the
operator sets the number of mandatory breaths of
fixed volume to be delivered by the ventilator but
between those breaths the patient can breath
spontaneously?
A. Assist control ventilation
B. Pressure support ventilation
C. Intermitent mandatory ventilation
D. Continuous positive airway pressure
E. Pressure control ventilation
Intermitent mandatory ventilation, wherein most
frequently used is SIMV, operator sets the number
of mandatory breaths of fixed volume to be
delivered by the ventilator but between those
breaths the patient can breath. In this mode
mandatory breaths are deivered in synchrony
with the patient's inspiratory efforts at a
frequency determined by the operator.
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
74
All of the ff clinical entities leads primarily to
prerenal kidney injury EXCEPT?
A. Sepsis
B. Hypovolemia
C. Cirrhosis
D. Use of NSAIDS
E. Use of cyclosporine
Sepsis although theretically can lead to decreased
effective circulating volume is more commonly
associated with intrinsic kindey injury. Spesis
leads to endothelial damage which results in
microvascular thrombosis, activation of reactive
oxygen species and leukocyte adhesions and
migration all of which may injure renal tubular
cells.
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
75
A normocytic normochromic anemia is almost
universal in what stage of chronic kidney disease?
A. Stage 1
B. Stage 2
C. Stage 3
D. Stage 4
E. Stage 5
A normocytic normochromic anemia is observed
as early as stage 3 CKD and is almost universal by
stage 4.
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
76
What is the strongest risk factor for cardiovascular
morbidity and mortality in a CKD patient?
A. Heart failure
B. Hypertension
C. Ischemic heart disease
D. Left ventricular hypertophy
E. coronary artery disease
As stated vebatim in Harrison's 19th ed, pg 1817,
left ventricular hypertrophy and dilated
cardiomyopathy are among the strongest risk
factors for cardiovascular mortality and morbidity
in patients with CKD and are thought to be related
rpimariliy but not xclusively to prolonged
hypertension and ECFV overload.
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
77
All of the statements regarding peptic ulcer disease
is correct EXCEPT?
A. Ulcers are defined as breaks in the mucosal
surface >5mm in size with depth to the submucosal
layer
B. Helicobacter pylori and smoking are the most
common risk factors for PUD
C. Coronary heart diease is a stronger risk factor for
PUD than diabetes
D. Gastric ulcers tend to occur later in life than
duodenal ulcers
E. Duodenal ulcers occurs most often in the first
portion of the duodenum with 90% located within
3cm of the pylorus.
When patients present with ascities for the first
time, it is recommended that a diagnostic
paracentesis be perfromed to characterize the fluid.
What is the most useful constituent of ascitic fluid to
aid in determining etiology of fluid?
A. Cytology
B. Fluid LDH
C. Fluid albumin
D. Gram stain and culture
E. Cell count and differential count
Helicobacter pylori (Odds ratio of 3.7) and NSAID
abuse (OR=3.3) are the most common risk factors
for PUD not smoking (OR 0f 1.55). All other
statements are correct.
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
The most important criteria in determining the
etiology of the asictic fluid is through the use of
the SAAG ratio (Serum ascites to albumin
gradient).
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
78
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 13 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
79
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 3
EXAM MARCH 2016
This autoantibody in SLE best correlates with
disease activity, nephritis and vasculits?
A. ANA
B. Anti-Smith
C. Anti Ro and Anti La
D. Anti histone
E. Anti dsDNA
High titers of AntoidsDNA are specfic for SLE and
in some patients correlate well with disease
activity, nephritis and vasculitis
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
80
A patient with cushinoid features who tested
negative with a low dose dexametheasone
suppresion test but tested positive with a high DSM
test most likey has what form of Cushing's
syndrome?
A. Cushing's disease
B. Exogenous steroid use
C. Ectopic ACTH syndrome
D. Adrenal hyperplasia
E. MEN syndrome
A person who tested positive for a low dose DSM
but tested postive for a high dose DSM has
Cushing's disease/pituiatry adenoma. A person
with ectopic ACTH syndrome and adrenal sources
of cortisol will test negative in a high dose DSM
test.
JAN CHRISTIAN
FELICIANO (TOP 2
- AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
MIDTERM 3
EXAM MARCH 2016
81
Bruce Wayne’s parents were shot outside the
theater by a thief. His dad lost a lot of blood in the
crime scene. His HR = 120, RR = 32, and orthostatic
hypotension. How much of the blood volume is lost
by Bruce Wayne’s father?
a. 5 - 10%
b. 10 - 15%
c. 15 - 30%
d. 30 - 40%
e. 40 - 50%
2. Bruce Wayne saw his dad to have pale palmar
creases. If CBC was taken, what would be the most
likely hemoglobin level?
a. 11g/dl
b. 10g/dl
c. 9g/dl
d. 8g/dl
e. 7g/dl
3. Which of the following is true of the malaria
transmission cycle?
a. sporozoites from salivary gland of mosquito
invade the hepatocytes and begin sexual
reproduction
b. merogony produces 1,000-2,000 merozoites
c. Gametocytes are taken by the mosquito and then
form into a ookinete then a zygote
d. after entry into the bloodstream, merozoites
rapidly invade erythrocytes and become sporozoites
e. none of the above
4. Which of the following does an S3 signify?
a. aortic stenosis
b. aortic regurgitation
c. mitral stenosis
d. heart failure
e. pulmonic stenosis
when more than 30% of the blood volume is lost
suddenly, patients are unable to compensate with
the usual mechanisms of vascular contraction and
changes in regional blood flow. The patient prefers
to remain supine and will show postural
hypotension and tachycardia. If >40%, signs of
hypovolemic shock appear. If 10 - 15%, signs of
vascular instability appear.
Harrison’s Internal Medicine 18th edition p.449
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
Harrison’s Internal Medicine 18th edition p.449
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
B - 10 - 30,000 merozoites
C - gametocyte - zygote - ookinete
D - they become trophozoites in the RBC
Harrison’s Internal Medicine 18th edition p.1688
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
Harrison’s Internal Medicine 18th edition p.1827
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
5. MJP, a 25 year old female, diagnosed with Crohn’s
Disease came in for complaints of pallor, easy
fatigability, and carpopedal spasm. Upon physical
examination, (+) Chvostek’s sign and Trousseau’s
sign. Which of the following organs is most likely
involved?
a. duodenum
b. jejunum
c. ileum
d. cecum
e. rectum
6. Which of the following would present with an
elevated AFP?
a. prostate cancer
b. cirrhosis
c. ovarian germ cell tumor
d. both A and B
e. both B and C
patient showed signs of iron deficiency anemia
and hypocalcemia in which both are absorbed in
the duodenum
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
hepatocellular CA and hepatitis also presents with
elevated AFP.
Harrison’s Internal Medicine 18th edition p.652
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
7. Which of the following forms of shock would
present with an increase in cardiac output and
venous oxygen saturation?
a. hypovolemic
b. cardiogenic
c. septic
d. neurogenic
e. hypoadrenal
Harrison’s Internal Medicine 18th edition p.2219
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
82
83
84
85
86
87
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 14 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
88
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
FINAL EXAM MARCH 2016
8. Which of the following is not a clinical feature of
atopic dermatitis?
a. lesions resemble eczematous dermatitis
b. course usually lasts more than 6 weeks
c. Dennie- Morgan folds refer to hyperpigmentation
on flexural sites
d. lichenification of skin
e. exacerbations and remissions
9. Which of the following factors would increase the
clearance of theophylline?
a. liver disease
b. barbecued meat
c. high carbohydrate diet
d. old age
e. coadministration of zafirlukast
This refers to an extra fold of skin beneath the
lower eyelid.
Harrison’s Internal Medicine 18th edition p.395
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
other factors include enzyme induction, smoking,
high protein, low carbohydrate diet, and
childhood.
Harrison’s Internal Medicine 18th edition p.2111
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
10. Patient presented to the emergency room with
dyspnea. On physical examination, dullness over left
lung field with decreased tactile fremitus was noted.
Thoracentesis was done over the site and contents
were found to be exudative. Glucose was 40mg/dl.
Which of the following is likely a differential?
a. esophageal rupture
b. bacterial infection
c. rheumatoid pleuritis
d. both a and b
e. both b and c
11. Which of the following is the appropriate
screening strategies for average risk patients?
a. FOBT every 3 years
b. colonoscopy every 10 years
c. flexible sigmoidoscopy every 10 years
d. colonoscopy every 5 years
e. fecal DNA testing every 5 years
Harrison’s Internal Medicine 18th edition p.2178
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
A - every year; C - every 5 years; E - every 3 years
Harrison’s Internal Medicine 18th edition p.2423
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
92
12. which of the following are absolute
contraindications of liver transplantation except?
a. untreated sepsis
b. alcohol abuse
c. 72 years old
d. congestive heart failure
e. breast cancer stage IV
age >70 years old is a relative contraindication
Harrison’s Internal Medicine 18th edition p.2608
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
93
13. Which of the following initial tests must be
performed prior to starting etanercept in patients
with rheumatoid arthritis?
a. CBC
b. AST/ALT
c. eye examination
d. PPD skin test
e.creatinine
14. Which of the following clinical characteristics
would most likely point to Sjogren’s syndrome?
a. joint deformities such as ulnar deviation and
boutoniere deformity
b. HLA - DR5
c. positive serologic test for HIV
d. granulomas in salivary glands
e. predominant in young males
15. Which of the following conditions are not
associated with calcium pyrophosphate dihydrate
disease?
a. gout
b. hypermagnesemia
c. aging
d. hemochromatosis
e. hyperparathyroidism
16. Which of the following is not a risk factor for
papillary thyroid carcinoma in patients presenting
with a thyroid nodule?
a. male
b. 50 years old
c. hoarse voice
d. iodine deficiency
e. suspected lymph node involvement
17. Which of the following medications would have a
decrease effect of renin, increase effect of
aldosterone and increase net effect of aldosteronerenin-ration (ARR)?
a. beta blockers
b. alpha blockers
c. ACE inhibitors
d. ARBs
e. CCB
TST is done with TNF alpha inhibitors, abatacept,
anakinra, and tocilizumab
Harrison’s Internal Medicine 18th edition p.2748
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
B - HLA - DR3 and DRw52; C - negative serologic
test for HIV; D - lymphoid infiltrates of salivary
glands by CD4; E - predominant in middle aged
women
Harrison’s Internal Medicine 18th edition p.2772
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
hypomagnesemia; others include
hypophosphatasia, postmeniscectomy, gitelman’s
syndrome
Harrison’s Internal Medicine 18th edition p.2839
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
this is a risk factor for follicular thyroid carcinoma
Harrison’s Internal Medicine 18th edition p.2934
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
B&E - have no effects on renin, aldosterone, and
ARR; C&D - have opposite effects from beta
blockers
Harrison’s Internal Medicine 18th edition p.2951
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
89
90
91
94
95
96
97
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 15 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
98
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
FINAL EXAM MARCH 2016
18. Which of the following drugs are NOT associated
with an increased risk of generalized osteoporosis in
adults?
a. aluminum
b. lithium
c. alcohol
d. levothyroxine
e. none of the above
19. Patient presented with pain in the lips, gums,
cheek for a few seconds which recurs frequently at
day and night. Pain occurs usually when chewing
food. On neurologic examination, there is no sensory
loss. Which of the following is the drug of choice for
this condition?
a. phenytoin
b. carbamazepine
c. lamotrigine
d. valproic acid
e. baclofen
20. Among the inflammatory myopathies, which of
the following is associated with visceral malignancy?
a. polymyositis
b. dermatomyositis
c. inclusion body myositis
d. myofasciitis
e. polymyalgia rheumatica
others include steroids, cyclosporine, cytotoxic
drugs, anticonvulsants, aromatase inhibitors,
GnRH agonists, and heparin
Harrison’s Internal Medicine 18th edition p.3124
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
Harrison’s Internal Medicine 18th edition p.3361
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
Harrison’s Internal Medicine 18th edition p.3510
ANDREW TIU (TOP
1 - AUG 2015 MED
BOARDS;
TOPNOTCH MD
FROM CIM)
FINAL EXAM MARCH 2016
101
35 yr old woman with chronic renal failure and
undergoing hemodialysis 2-3x a day develops
tumoral calcinosis. Her PTH is markedly elevated
while her ionized Ca is normal. The most probable
diagnosis is:
A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Tertiary hyperparathyroidism
D. Parathyroid carcinoma
E. Pseudohyperparathyroidism
Page 213 of IM Platinum. Elevated PTH occuring in
CKD patients is secondary hyperparahyroidism.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
102
Clinical features present in both MEN 2A and
MEN2B syndromes:
A. Pituitary adenoma
B. Parathyroid hyperplasia
C. Pheochromocytoma
D. Marfanoid habitus
E. Pancreatic islet cell hyperplasia
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
103
A 55 y/o male presents at the OPD with cough, mild
dyspnea, and fever of 37.8OC. Symptoms have been
present for the past 3 days, and when over-thecounter cold medications were having no effect, he
decided to seek medical attention. On PE, BP
120/70, PR 96 and regular, and RR 23. Lung
examination revealed the presence of right lower
lung crackles with decreased breath sounds in the
RLLF. Laboratory studies revealed WBC of 15.6 with
a left shift, sodium of 140, potassium of 4.5, BUN of
22 and creatinine of 1.0. Chest x-ray revealed a right
lower lobe infiltrate. The patient is in which phase of
CAP if there is predominance of neurophils,
abundant fibrin deposition and cessation of
erythrocyte extravasation?
A. Edema
B. Red hepatization
C. Gray hepatization
D. Resolution
E. Consolidation
Page 208 of IM Platinum. Men 2A- Medullary
thyroid carcinoma, pheochromocytoma,
parathyroid hyperplasia. Men 2B- Medullary
thyroid carcinoma, Pheochromocytoma, mucosal
and gastrointestinal neuromas, marfanoid
features. Men1- Parathyroid
hyperplasia,pancreatic islet cell
hyperplasia/adenoma/carcinoma and pituitary
hyperplasia/adenoma.
Page 112 of IM Platinum. Pneumonia has four
stages, namely consolidation, red hepatization,
grey hepatization and resolution.
Consolidation/Edema-Occurs in the first 24
hours; Cellular exudates containing neutrophils,
lymphocytes and fibrin replaces the alveolar air.
Capillaries in the surrounding alveolar walls
become congested. The infections spreads to the
hilum and pleura fairly rapidly Pleurisy occurs.
Marked by coughing and deep breathing.
Red Hepatization- Occurs in the 2-3 days after
consolidation; At this point the consistency of the
lungs resembles that of the liver. The lungs
become hypeaemic. Alveolar capillaries are
engorged with blood. Fibrinous exudates fill the
alveoli. This stage is "characterized by the
presence of many erythrocytes, neutrophils,
desquamated epithelial cells, and fibrin within the
alveoli"
Grey
Hepatization- Occurs in the 2-3 days after Red
Hepatization. This is an avascular stage. The lung
appears "gray-brown to yellow because of
fibrinopurulent exudates, disintegration of red
cells, and hemosiderin"
The pressure of the exudates in the alveoli causes
compression of the capillaries. "Leukocytes
migrate into the congested alveoli"
Resolution- This stage is characterized by the
"resorption and restoration of the pulmonary
architecture". A large number of macrophages
enter the alveolar spaces. Phagocytosis of the
bacteria-laden leucocytes occurs. "Consolidation
tissue re-aerates and the fluid infiltrate causes
sputum". "Fibrinous inflammation may extend to
and across the pleural space, causing a rub heard
by auscultation, and it may lead to resolution or to
organization and pleural adhesions"
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
99
100
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 16 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
104
QUESTION
EXPLANATION
AUTHOR
GOLD COPD staging uses four categories of severity
for COPD, based on the value of FEV1. A patient
classified under Stage III, has a predicted FEV1 of:
A. >90 %
B. >80 %
C. 60 %
D. 30 %
E. <20 %
Page 109 of IM Platinum. 1: Mild COPDFEV1/FVC < 70%; FEV1 > or equal to 80%
predicted; With or without chronic symptoms
(cough, sputum production) 2: Moderate COPDFEV1/FVC < 70%; FEV1 between 50 and 80%
predicted; With or without chronic symptoms
(cough, sputum production) 3: Severe COPDFEV1/FVC < 70%; FEV1 between 30 and 50%
predicted; With or without chronic symptoms
(cough, sputum production) 4: Very Severe
COPD- FEV1/FVC < 70%; FEV1 < or equal to 30%
predicted or FEV1 < 50% predicted plus chronic
respiratory failure
Page 121 of IM Platinum. This patient is probably
having a massive PE.Dyspnea is the most common
symptom and tachypnea is the most frequent sign.
In massive PE like this case, on 2D echo there
would be RV hypokinesis.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
Page 176 of IM Platinum. These are characteristics
of Nephrotic syndrome. A-D are diseases which
present with nephrotic syndrome. Cresenteric GN
is a Nephritic syndrome, presenting with Oliguria,
Hematuria, Hypertension and Azotemia.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
Criteria used in the diagnosis of DM can be either of
the following, except:
A. HbA1C >/= 7.0%
B. FPG >/= 7.0 mmol/L
C. OGTT 2 hour plasma glucose >/= 11.1 mmol/L
D. Random plasma glucose >/= 11.1 mmol/L +
classic symptoms of hyperglycemia or
hyperglycemic crisis
E. None of the above
Which laboratory test is the most sensitive test for
pheochromocytoma?
A. Urinary VMA
B. Urinary Metanephrines
C. Urinary Catecholamines
D. Plasma Metanephrines
E. Plasma VMA
Page 186 of IM Platinum. Criteria for diagnosis
may either be one of the following HbA1C >/=
6.5% , FPG >/= 7.0 mmol/L, OGTT 2 hour plasma
glucose >/= 11.1 mmol/L and Random plasma
glucose >/= 11.1 mmol/L + classic symptoms of
hyperglycemia or hyperglycemic crisis
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
Page 221 of IM Platinum. The most sensitive and
less susceptible to false elevations from stress,
including venipuncture is the measurement of
plasma metanephrine.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
109
The following parameters are components of the
Child Pugh score, except:
A. Serum bilirubin
B. Serum albumin
C. Serum creatinine
D. Prothrombin time
E. Ascites
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
110
A 71 y/o male patient had complained of swallowing
difficulty after ingesting meat two days previously.
Endoscopy was done and a meat bolus was found 30
cm from the incisors, the bolus was removed and a
lower esophageal ring at the esophagogastric
junction is seen. Biopsy reported that the tissue has
normal esophageal squamous epithelium on one
side and gastric columnar epithelium on the distal
side of the membrane. What is the probable
diagnosis?
A. Esophageal webs
B. Schatzki ring
C. Zenker diverticulum
D. Nutcracker esophagus
E. Diffuse esophageal spasm
Page 233 of IM Platinum. Child Pugh is used to
assess the prognosis of chronic liver disease,
mainly cirrhosis. Although it was originally used to
predict mortality during surgery, it is now used to
determine the prognosis, as well as the required
strength of treatment and the necessity of liver
transplantation. Its components are Serum
bilirubin, serum albumin, prothrombin time,
Ascites and hepatic encephalopathy.
Page 261 of IM Platinum. This is a case of "steak
house syndrome" or schatzki ring. This is one of
the most common cause of intermittent food
impaction with meat as the typical instigator.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
105
106
107
108
A 75 y/o male who underwent left nephrectomy for
renal cell carcinoma 6 months ago is admitted to the
emergency department with acute severe dyspnea
and cyanosis. On PE, BP 100/60; PR 120, RR 25,
Oxygen saturation is 75% while breathing room air
and fails to rise under supplemental oxygen. The
patient is intubated and hooked to mechanically
ventilator with 100% oxygen, which results in
further drop of the arterial saturation to 65%
despite correct positioning of the tube. Chest X-ray
shows clear lungs without infiltrates. Based on the
patient's diagnosis, which of the following is a
possible finding in 2D echo?
A. RV hypokinesis
B. RV hyperkinesis
C. LV hypokinesis
D. LV hyperkinesis
E. No possible 2D echo findings
These kidney disorders are characterized by
proteinuria > 3.0 g/day, hypoalbuminemia,
hyperlipidemia and edema, except:
A.
Minimal change disease
B. Membranous GN
C. Focal-segment GN
D. DM nephropathy
E. Cresenteric GN
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 17 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - AUG
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
111
QUESTION
EXPLANATION
AUTHOR
Hemmorhoidal plexuses which traverse the anal
canal are commonly located in the following
positions, except:
A. Left lateral
B. Right lateral
C. Right anterior
D. Right posterior
E. None of the above
Page 265 of IM Platinum. The three positions of
the main hemmorhoidal cushions are, Left lateral,
right anterior and right posterior.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
112
A 35 y/o male withprogressing flank pain radiating
to R testicle and diagnosed to have urolithiasis. The
most common stone to expect is:
A. Calcium oxalate stone
B. Struvite stone
C. Cystine stone
D. Uric acid stone
E. Magnesium-ammonium-phosphate stone
Page 180 of IM Platinum. The most common stone
to expect are calcium stones.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
113
A 24 y/o female complains of palpitations. On
physical examination she has a midsystolic click
followed by a mid to late crescendo systolic murmur
at the apex. A 2-D echocardiogram was requested.
This will most likely reveal:
A. Doming and restriction of motion of the mitral
valve leaflets.
B. Marked superior displacement of mitral leaflets
w/ coaptation point at or superior to annular plane
C. Fluttering mitral valve leaflet
D. Mitral valve leaflets thickness <4mm
E. Chordae shortening
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
114
The auscultatory findings in patient w/ ASD will be:
A. Holosystolic murmur at the pulmonic area w/
loud pulmonic component of S2(P2)
B. Holosystolic murmur at the base w/ wide and
fixed split S2
C. Holosystolic murmur at the 4th ICS at the R
parasternal area w/ (+) Carvallo sign
D. Pansystolic murmur along lower left sternal
border
E. Crescendo-decrescendo murmur on the second
intercostal space along the left sternal border
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
115
A manifestation of severe aortic regurgitation
characterized as jarring of the body and bobbing of
the head with each systole:
A. Quincke's
pulse
B. Duroziez sign
C. De Musset sign
D. Traube sign
E. Austin Flint sign
Page 71 of IM Platinum. This is a case of Mitral
valve prolapse. Typical findings on
echocardiography are as follows:
Classic MVP: The parasternal long-axis view
shows > 2 mm superior displacement of the mitral
leaflets into the left atrium during systole, with a
leaflet thickness of at least 5 mm
Nonclassic MVP: Displacement is > 2 mm, with a
maximal leaflet thickness of < 5 mm
Other echocardiographic findings that should be
considered as criteria are leaflet thickening,
redundancy, annular dilatation, and chordal
elongation
Because the pressure in the left atria initially
exceeds that in the right, the blood flows in a left
to right shunt. This high volume of blood next
passes into the right ventricle, and the ejection of
the excess blood through a normal pulmonary
valve produces the prominent mid-systolic flow
murmur as heard in this sample. This murmur is
best heard over the “pulmonic area” of the chest,
and may radiate into the back. The most
characteristic feature of an atrial septal defect is
the fixed split S2. A split S2 is caused
physiologically during inspiration because the
increase in venous return overloads the right
ventricle and delays the closure of the pulmonary
valve. With an atrial septal defect, the right
ventricle can be thought of as continuously
overloaded because of the left to right shunt,
producing a widely split S2. Because the atria are
linked via the defect, inspiration produces no net
pressure change between them, and has no effect
on the splitting of S2. Thus, S2 is split to the same
degree during inspiration as expiration, and is said
to be “fixed.”
Page 72 of IM Platinum.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
116
A vascular phenomena included as a minor criteria
in the diagnosis of Infective Endocarditis:
A. Osler's nodes
B. Roth's spots
C. Subcutaneous nodules
D. Janeway lesions
E. Erythema marginatum
Page 65 of IM Platinum. Janeway lesions are nontender, painless, small hemorrhagic
macular/nodular lesions on the palms or soles.
Osler's nodes and Roth spots are immunologic and
not vascular. Erythema marginatum and
subcutaneous nodules are not included in the
Dukes criteria but in the Jones criteria for RF,
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
117
The most common arrythmia causing out of hospital
deaths from Myocardial Infarction is:
A. Atrial fibrillation
B. Asystole
C. Premature ventricular contractions
D. Junctional rhythms
E. Ventricular fibrillation
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPL Page 59 of IM Platinum. Most
out of hospital deaths are from ventricular
fibrillation.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 18 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - AUG
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
118
QUESTION
EXPLANATION
AUTHOR
A 23 y/o patient is undergoing surgery for a
zygomatic fracture. The surgeon inadvertently
applied too much pressure on the patient's eyeball.
The anesthesiologist then noted that the patient's
ECG tracing converted from sinus rhythm to sinus
bradycardia. The anesthesiologist knows that this
phenomenon is called:
A. Aschner reflex
B. Vasovagal reflex
C. Oculobradycardia phenomenon
D. Neurocardiogenic syncope
E. Oculovagal reflex
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. The oculocardiac reflex,
also known as Aschner phenomenon, Aschner
reflex, or Aschner-Dagnini reflex, is a decrease in
pulse rate associated with traction applied to
extraocular muscles and/or compression of the
eyeball. The reflex is mediated by nerve
connections between the ophthalmic branch of the
trigeminal cranial nerve via the ciliary ganglion,
and the vagus nerve of the parasympathetic
nervous system.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
119
The most useful indicator/index of LV function is
the ejection fraction, to compute for EF the following
parameter is needed:
A. Mean arterial
pressure in mmHg
B. Systemic vascular resistance in dynes
C. Cardiac output
D. End systolic volume
E. Stroke volume
Page 39 of IM Platinum. The formula for EF is EF=
SV/EDV.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
120
Dopamine has varying hemodynamic effects based
on the dose. The dose needed to activate the DA1
and DA2 receptors causing splanchnic and renal
vasodilation is:
A. 8 mcg/kg/min
B. 6 mcg/kg/min
C. 4 mcg/kg/min
D. 1 mcg/kg/min
E. 10 mcg/kg/min
Page 27 of IM Platinum. The renal dose of
dopamine is 1-2 mcg/kg/min. Inotropic dose is 24 mcg/kg/min, >5mcg/kg/min is a
vasoconstrictor dose.
ANGELA PAULINE
P. CALIMAGLOYOLA (TOP 8 FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM UST)
DIAGNOSTIC
EXAM - AUG
2015
121
Patient presents with a high-pitched, blowing,
diastolic murmur, heard best in the third intercostal
space along the left sternal border. This is most
likely a case of:
A. Ventricular septal defect
B. Mitral stenosis
C. Aortic regurgitation
D. Atrial septal defect
E. Pulmonic stenosis
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
122
Ventricular tachycardia lasting for more than 30
seconds and not terminated by therapy will lead to?
A. Hemodynamic collapse
B. Fatal arrythmia
C. Asynchronous rhythm
D. Recurrent arrythmia
E. VT storm
In patients with severe AR, the aortic valve closure
sound (A2) is usually absent. An S3 and systolic
ejection sound are frequently audible, and
occasionally an S4 also may be heard. The murmur
of chronic AR is typically a high-pitched, blowing,
decrescendo diastolic murmur, heard best in the
3rd intercostal space along the left sternal border.
In patients in whom the AR is caused by primary
valvular disease, the diastolic murmur is usually
louder along the left than the right sternal border.
However, when the murmur is heard best along
the right sternal border, it suggests that the AR is
caused by aneurysmal dilatation of the aortic root.
Note: At least 3 questions about heart murmurs
were asked in IM Feb 2015 boards, mentioning
only about the auscultation finding.
Sustained polymorphic VT, ventricular flutter, and
VF all lead to immediate hemodynamic collapse.
Emergency asynchronous defibrillation is
therefore required, with at least 200-J monophasic
or 100-J biphasic shock. (Harrison) SIMILAR TO
PREVIOUS BOARD EXAM CONCEPT.
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
123
Treatment for ischemic and nephrotoxic acute
kidney injury include:
A. None
B. Hydration
C. Antibiotics
D. Loop diuretics
E. Immunosuppressives
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
124
The most useful test for distinguishing prerenal
acute renal failure from intrinsic renal failure is:
A. BUN Creatinine Ratio
B. FENa
C. Serum Sodium
D. Creatinine clearance
E. Serum creatinine
Many different approaches to attenuate injury or
hasten recovery have been tested in ischemic and
nephrotoxic AKI. These include ANP, low-dose
dopamine, etc. Whereas many of these are
beneficial in experimental models of ischemic or
nephrotoxic ATN, they have either failed to confer
consistent benefit or proved ineffective in humans.
(Harrison's) SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT
The most useful test for distinguishing prerenal
ARF from ischemic or nephrotoxic intrinsic renal
ARF is the fractional excretion of sodium (FENa).
Prerenal ARF typically have a FENa of <1.0%
(frequently <0.1%). The FENa tends to be high in
ischemic ATN. (Harrison's) SIMILAR TO
PREVIOUS BOARD EXAM CONCEPT.
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
125
Which of the following drugs have been shown to
decrease mortality in patients with heart failure?
A. Digoxin
B. Loop diuretics
C. Nitroglycerine
D. Beta-blockers
E. All of the above
The following treatment modalities have been
shown to decrease mortality in patients with heart
failure: ACE-I/ARBS (EF<40), Beta blockers,
Spironolactone, AICD.
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 19 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - AUG
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
126
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 1
EXAM - AUG
2015
A 28-year-old female presented with headache and
cough. After a few days, her temperature rises
abruptly, now with body ache and petechial rash on
the trunk and legs. What is the drug of choice for her
condition?
A. Penicillin
B. Amikacin
C. Ciprofloxacin
D. Azithromycin
E. Ceftriaxone
This is a case of meningococcemia. The drug of
choice for this condition is IV penicillin. (Note:
SIMILAR TO PREVIOUS BOARD EXAM CONCEPT)
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
What is the role of iodides in the treatment of
hyperthyroidism?
A. It inhibits 5-deiodinase
B. It inhibits peripheral conversion of T4 to T3
C. It inhibits thyroid hormone synthesis
D. It blocks coupling of iodotyrosines.
E. Inhibit the thyroid peroxidase-catalyzed
reactions
Which of the following prophylactic antibiotics is
especially indicated in a splenectomized patient?
A. Penicillin
B. Ceftriaxone
C. Azithromycin
D. Chloramphenicol
E. Linezolid
Iodides inhibit thyroid hormone synthesis or
release with the induction of hypothyroidism.
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
Lifelong PROPHYLAXIS post-splenectomy include
Phenoxymethylpenicillin, Amoxicilliin or if allergic
to penicillin, give Clarithromycin. For EMPIRIC
treatment of hospitalized hyposplenic or asplenic
patients acute infection, Ceftriaxone 2g q24 hrs is
given. SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT.
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
129
A patient presents with the following serologic
pattern: HBsAG reactive, Anti-HAV IgM reactive,
anti-HBC IgG positive. The patient is most likely
suffering from?
A. Acute hepatits A and B
B. Acute hepatitis B
C. Acute Hepatitis A
D. Acute hepatitis A superimposed on Chronic
Hepatitis B
E. Acute Hepatitis B
HBsAG (+) & Anti-HBc IgG positive : Chronic Hepa
B carrier; Anti-HAV IgM reactive: Acute hepatitis
A infection
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
130
Which of the following drugs is the first line
treatment for acute uncomplicated cystitis in nonpregnant women?
A. Cefuroxime 250 mg BID x 3 days
B. Amoxicillin 500 mg TID x 7 days
C. Co-amoxiclav 625 mg BID x 7 days
D. Ciprofloxacin 250 mg BID x 3 days
E. Cefixime 400 mg OD x 3 days
Grade A antibiotic/first line drug for
uncomplicated cystitis: Ciprofloxacin, Ofloxacin,
Norfloxacin, Levofloxacin, Gatifloxacin,
Nitrofurantoin, Cotrimoxazole. Options A,C and E
are Grade B antibiotics. SIMILAR TO PREVIOUS
BOARD EXAM CONCEPT.
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
131
Which of the following is/are included in the
treatment for MDRTB?
A. Kanamycin
B. Erythromycin
C. Chloramphenicol
D. Pyrimethamine
E. Sulfamethoxazole
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
132
In the treatment of COPD patient with chronic
respiratory failure, which of the following
pharmacologic therapy improves survival?
A. Bronchodilators
B. Inhaled corticosteroids
C. Long-acting anticholinergic
D. Leukotriene inhibitors
E. Long-term O2 therapy
Treatment of MDRTB is based on drug
susceptibilities. The following are drugs given for
MRDTB: High dose INH, Pyrazinamide,
Ethambutol; Flouroquinolones (Levofloxacin,
Ciprofloxacin), Aminoglycosides (Amikacin,
Kanamycin, Capreomycin, Streptomycin);
Cycloserine, Terizidone, Para-aminosalicylic acid,
Bedaquiline. (SIMILAR TO PREVIOUS BOARD
EXAM CONCEPT)
Only 3 interventions influence the natural history
of COPD: smoking cessation, oxygen in chronic
hypoxemia, and lung volume reduction surgery for
emphysema.
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
133
A 48-year old male, hospitalized due to sepsis,
suddenly develops severe dyspnea at rest and
agitation. Physical findings showed hypoxemia, and
cold extremities. Chest radiograph done revealed
diffuse interstitial infiltrates wtih ground glass
changes. Which of the following treatment is
important in the management of his condition?
A. Glucocorticoids
B. Nitroglycerine
C. Morphine
D. Nitric oxide
E. Low-tidal volume ventilation
This is a case of Acute Respiratory Distress
Syndrome. It is a clinical syndrome of severe
dyspnea of rapid onset, hypoxemia, and diffuse
pulmonary infiltrates leading to respiratory
failure. The only grade A recommendation for the
management of ARDS is low tidal volume
mechanical ventilation. (6 ml/kg) Source:
Harrisons. (Note: SIMILAR TO PREVIOUS BOARD
EXAM CONCEPT)
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
127
128
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 20 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
134
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 1
EXAM - AUG
2015
A 32-year old female, presents to the clinic with
symptoms of fatigue, joint pains, and facial rash. On
examination she was noted to be thin with malar
skin changes. CBC with platelet count was requested
which will most likely reveal:
A. Thrombocytopenia
B. Leukocytosis
C. Anemia
D. Neutropenia
E. Lymphocytosis
This is a case of SLE. SLE may present with
anemia (hemolytic), thrombocytopenia,
leukopenia, or lymphopenia in the absence of
offending drugs. Among these, the most common
hematologic manifestaion of SLE is anemia,
usually normochromic normocytic, reflecting
chronic illness. (Harrison's) The best answer is
Anemia.
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
135
This finding in chronic myelogenous leukemia can
differentiate it from leukemoid reaction:
A. Increased WBC count
B. Anemia
C. Hypercellular marrow with increased
granulocyte precursor
D. Decrease leukocyte alkaline phosphatase
E. Increased CRP
Leukomoid reaction mimics CML, as both
condition wil reveal an elevated WBC. However, in
leukomoid reaction, neutrophil/leukocyte alkaline
phosphatase and CRP, as a result of inclease
inflammatory response will be elevated. These
parameters were low in CML. (Note: SIMILAR TO
PREVIOUS BOARD EXAM CONCEPT)
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
136
The most common organism isolated from the
ascitic fluid of patients with spontaneous bacterial
peritonitis is?
A. Streptococcus pneumoniae
B. Staphylococcu aureus
C. Escherichia coli
D. Bacteroides fragilis
E. Klebsiella pneumoniae
While enteric gram-negative bacilli such as
Escherichia coli are most commonly encountered,
gram-positive organisms such as streptococci,
enterococci, or even pneumococci are sometimes
found. Source: Harrison's
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
137
A 33-year old male was recently diagnosed to have
medullary thyroid carcinoma. On further work-up,
he was noted to have elevated levels of serum
calcium and decreased serum phosphate. His
abdominal CT scan showed a mass on the right
adrenal gland Which of the following is the most
likely diagnosis ?
A. MEN Type 1
B. MEN Type 2A
C. MENType 2B
D. Li Fraumeni Syndrome
E. von Hippel Lindau Syndrome
MEN 2A- medullary thyroid carcinoma,
pheochromocytoma, hyperparathyroidism; MEN
2B - Medullary thyroid carcinoma +
Pheochromocytoma + neuromas; MEN 1 pancreatic tumors, parathyroid glands neoplasia,
and pituitary tumors.
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
138
A 42-year-old female presented with hematuria,
edema, hypertension and scanty urine. She had a
history of the throat pain 2 weeks ago. Which of the
following is true regarding her condition?
A. This is an immune-mediated disease which
involves activation of complement in association
with cell-mediated injury.
B. Throat infections, but not skin infections
antedate glomerular disease.
C. In the first week of symptoms, most patient will
have elevated levels of C3.
D. The prognosis in adults is poor.
E. Complete resolution of hematuria in children
occurs within 3-6 months of the onset of nephritis.
Which of the following organism is implicated in bile
duct carcinoma?
A. Clonorchis sinensis
B. Schistosoma japonicum
C. Paragonimus westermani
D. Capillaria philippinensis
E. Fasciola hepatica
This is a case of PSGN. This is an immunemediated disease.Option B is incorrect, both skin
and throat infection antedate glomerular disease.
In the first week of symptoms, most patient will
have depressed level of C3. The overall prognosis
of PSGN is good in adults and children. Complete
resolution of the hematuria and proteinuria in
children occurs within 3–6 weeks of the onset of
nephritis. (Harrison's)
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
Infection of these three species is established by
ingestion of raw or inadequately cooked
freshwater fish harboring metacercariae. These
organisms excyst in the duodenum, releasing
larvae that travel through the ampulla of Vater and
mature into adult worms in bile canaliculi.
Cholangiocarcinoma is epidemiologically related
to C. sinensis infection in China and to O. viverrini
infection in northeastern Thailand. This
association has resulted in classification of these
infectious agents as human carcinogens.
(Harrison's)
Tetracycline, Nafcillin, and Ertapenem have no
coverage for Pseudomonas infection. SIMILAR TO
PREVIOUS BOARD EXAM CONCEPT.
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
LYNN DARYL
FELICIANO
VILLAMATER, MD
(TOP 5 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM EAC)
MIDTERM 1
EXAM - AUG
2015
This is the tremor controlling dose of propranolol
due to hyperthyroidism - Reference: IM Platinum
page199
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
139
140
Which of the following anti-microbial drug is
effective for the treatment of Pseudomonas
infection?
A. Tetracycline
B. Nafcillin
C. Ertapenem
D. Ceftazidime
E. All of the above
141
The suppressive dose of propranolol needed in
controlling the tremors from hyperthyroidism is:
A. 20-40 mg tab q6
B. 20-40 mg tab q4
C. 100mg tab q6
D. 100mg tab q4
E. None of the above
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 21 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
142
QUESTION
EXPLANATION
AUTHOR
You are treating a case of sepsis in which the culture
and sensitivity results are still unavailable, the
practice of giving antibiotics before C & S becomes
available is defined as
A. Giving an antibiotic which has a broad spectrum
of activity without knowing the specific organism
B. Withholding the treatment while awaiting C & S
results
C. Tailoring the antibiotic regimen guided by the
results from the culture and sensitivity
D. Both A and C
E. None of the above
Empiric therapy is giving the antibiotic treatment
with broad spectrum of activity for a suspected
organism/s without the benefit of knowing the
susceptibility patterns of such organism/s. Once
the results of the C &S become available, the
therapy can then be tailored depending on the
susceptibility results.
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
143
What is the empiric therapy for post-splenectomy
sepsis?
A. Ciprofloxacin
B. Penicillin
C. Erythromycin
D. Tetracycline
E. None of the above
Penicillin is used as empiric treatment in post
splenectomy sepsis as the organism most likely
involved is S. pneumoniae which is a Gram (+)
bacteria and is susceptible to the effects of
penicillin
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
144
An example of the triple drug regimen used in H.
pylori infection consists of:
A. PPI + Clarithromycin + Amoxicillin or
Metronidazole
B. PPI + Metronidazole + Tetracycline + Bismuth
C. PPI + Ciprofloxacin + Clindamycin
D. A and B
E. None of the above
This is the triple drug therapy used in H. pylori
infection while option B is the quadruple therapy
and is used when the triple therapy has failed.
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
145
The thyroid suppressive dose of metoprolol is
A. 50 mg
B. 200 mg
C. 300 mg
D. 400 mg
E. None of the above
Reference: IM Platinum page 202
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
146
Which of the following is not associated with
inflammation
A. Redness
B. Vasodilation
C. Decreased capillary permeability
D. Pain
E. Heat
Decreased capillary permeability is not associated
with inflammation
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
147
The IgM antibody exists as pentamer. This basically
means that it consists of 5 antibodies joined
together. Thus the IgM pentamer could bind to how
many antigens?
A. 5
B. 15
C. 8
D. 10
E. 9
The IgM pentamer is made up of 5 units of IgM
with each unit capable of binding 2 antigens on
each side.
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
148
Histamine increases blood flow and vascular
permeability. This would account for all of the
following changes that occur during inflammation
except
A. Redness of the inflamed tissue
B. Heat of the inflamed tissue
C. Increased number of phagocytes being attracted
to the tissue
D. Increased formation of interstitial fluid at the site
of injury
E. None of the above
A sample of blood from patient RR shows a high
concentration of IL-1. This would indicate that RR:
A. Is running a fever
B. Has a sore throat
C. Is producing T lymphocytes
D. Has hypotension
E. Has swollen lymph nodes
Increase number of phagocytes being attracted to
the site of injury is not a function of histamine
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
Elevated levels of IL-1 an endogenous pyrogen
would indicate that RR has fever.
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
149
150
A patient came in to your clinic for the interpretation
of his hepatitis profile you noted that Anti-Hbc IgM
is positive, what does it mean?
A. The patient is actively replicating Hepa B virus
B. The patient is at the window preiod following 6
months of acute infection
C. The patient has recovered from Hepa B
D. The patient was immunized before
E. It is insignificant
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 22 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
MIDTERM 2
EXAM - AUG
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
151
EXPLANATION
AUTHOR
JA, was suspected of having a hematologic
malignancy, analysis showed that he has a t(9:22)
translocation forming a fusion product called bcrabl, what is the treatment for this case?
A. Abciximab
B. Infliximab
C. Omalizumab
D. Imatinib
E. None of the above
Imatinib, a tyr kinase inhibitor is used for the
treatment of CML. Abciximab is a GPIIb/IIIa
inhibitor, infliximab is a TNF - alpha antibody used
in autoimmune diseases, omalizumab is an IgG
antibody for IgE used in the treatment of
moderate - severe asthma.
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
152
Which of the following would deal with an
extracellular pathogen in the lymph?
A. B cells and natural killer cells
B. B cells and antibodies
C. Killer T cells only
D. Macrophages only
E. Helper T cells only
B cells and the antibodies deal with extracellular
pathogens from the lymph fluid draining a
particular region of the body.
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
153
If a virus invaded a liver cell, that liver cell would
A. Display fragments of viral proteins on its MHC I
protein
B. Display fragments of viral proteins on its MHC II
protein
C. Begin making viral proteins and nucleic acids (e.g.,
DNA, RNA).
D. Both A and C
E. All of the above
Which of the following cells destroys body cells that
have been infected by a virus
A. Monocytes
B. B lymphocytes
C. Natural killer cells
D. T lymphocytes
E. None of the above
Both options would tell what a virally infected cell
would do.
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
NK cells are endowed with the ability to kill a
variety of infected and tumor cells, without prior
exposure to or activation by these microbes or
tumors. This ability makes NK cells an early line of
defense against viral infections and, perhaps, some
tumors. E is cytotoxic T cell or CD8 mediated
destruction of virally infected cells through the
recognition of virally infected class 1 MHC
molecule of that cell (Robbins, 9th ed.)
Plasma zinc levels are unaffected by fever. The rest
are actions of the body occuring during fever.
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
154
QUESTION
TOPNOTCH
EXAM
MIDTERM 2
EXAM - AUG
2015
155
Which of the following does not occur during a fever
A. WBC function is increased
B. Bacterial metabolism is impaired.
C. Plasma zinc levels rise
D. Plasma iron levels fall
E. There is release of cytokines
156
Which of the following is true of neutrophils?
A. They account for most of the dead cells in pus
B. They're usually the last immune cells to enter
infected tissues
C. They're considered part of the adaptive immune
system
D. Both A and C
E. All of the above
What is the most common presenting symptom of
Meckel's diverticulum among adults
A. Passage of currant jelly stools
B. Intestinal obstruction
C. Passage of blood painlessly in the stool
D. Abdominal pain
E. None of the above
Most of the dead cells in pus are neutrophils
together with killed pathogens.
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
The diverticulum may serve as a point for
intussussception. In children, it usually presents
with bleeding painlessly in the stools
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
158
AO, a 40 year old man came in due to anemia, PE was
unremarkable except there was weakness of legs,
arms, trunk, tingling and numbness that the patient
said progressively worsens, CBC shows anemia and
peripheral blood smear shows the presence of large
RBCs. What is the treatment for this case?
A. Iron supplement
B. Folate supplementation
C. Vit. B12 supplementation
D. Vit. C supplementation
E. None of the above
This is a case of Vit. B12 deficiency, the
differentiating features with folate deficiency is
the presence of neurologic manifestations and
folate improves only the anemia while the
neurologic symptoms would not improve.
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
159
It is a group of disorders characterized by insulin
resistance, impaired insulin secretion and excessive
hepatic glucose production
A. Type 1 DM
B. Type 2 DM
C. Central Diabetes Insipidus
D. Nephrogenic Diabetes Insipidus
E. None of the above
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
MIDTERM 2
EXAM - AUG
2015
157
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 23 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
160
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 2
EXAM - AUG
2015
MD, 35 year old male came in to your clinic due to
palpitations, you noted marfanoid features and
elicited a strong family history of the same condition
among his ascendants in which there is also
medullary thyroid carcinoma and
pheochromocytoma, what is the most likely
diagnosis
A. MEN I
B. MEN 2A
C. MEN 2B
D. Marfan syndrome
E. None of the above
This is characterized as head nodding which is found
in patients with Aortic regurgitation.
A. Corrigan's pulse
B. Durosier's sign
C. Traube's sign
D. De Mussets sign
E. Hill's sign
Both MEN 2A and 2B have marfanoid habitus,
pheochrmocytoma and medullary thyroid CA,
MEN 2A has parathyroid adenoma while MEN 2B
has mucosal neuromas.
EDWARD HARRY
VALLAJERA, MD
(TOP 8 - FEB 2015
MED BOARDS;
TOPNOTCH MD
FROM PERPETUAL
BINAN)
Corrigans pulse is bounding pulses. Durosier's
sign if femoral retrograde bruits. Traube's sign is
pistol shot femorals. Hills sign is pistol shot
femorals
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
162
Graham-Steel murmur is a murmur usually caused
by pulmonary hypertension. This murmur is usually
heard in what valve abnormality?
A. Pulmonary regurgitation
B. Pulmonary stenosis
C. Tricuspid Regurgitation
D. Tricuspid stenosis
E. Aortic Regurgitation
this murmur is usually caused by pulmonary
hypertension caused by the pulmonary valve
regurgitation
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
163
A patient came in at the ER with altered mental
status. According to his companion the patient was
just watching TV and suddenly fell on the ground. On
assessment, you noticed that the patient opens his
eyes through loud voice, confused and localizes pain.
What is the GCS score of the patient?
A. 10
B. 11
C. 12
D. 13
E. 14
E3V4M5
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
164
A patient came in at the ER complaining of body
malaise associated with polyuria. ECG shows
prominent U waves. Which of the following is most
likely the cause of the disease.
A. hyperkalemia
B. hypokalemia
C. hypocalcemia
D. hypercalcemia
E. hyponatremia
U waves are seen in hypokalemia
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
165
The contiguous ECG leads for the septal wall are:
A. II, III, aVF
B. I, aVL
C. V1, V2
D. V3, V4
E. V4, V5
A. inferior wall… B. high lateral wall…. D..anterior
wall. V5 V6 is lateral wall
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
166
A patient in the ward is diagnosed with Multiple
Endocrine Neoplasia 2A. You are aware that this
disease has the following components EXCEPT:
A. Medullary thyroid carcinoma
B. pheochromocytoma
C. hyperparathyroidism
D. Pituitary neoplasia
E. none of the above
Pituitary neoplasia is a component of MEN 1
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
167
Which among the following is the most common
toxin associated with Dilated Cardiac Myopathy?
A. Cigarette smoke
B. Alcohol
C. Shabu
D. Paracetamol
E. Nifedipine
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
161
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 24 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
168
QUESTION
The following are components of the classic triad for
Cardiac Tamponade EXCEPT:
A. Pulsus parodoxus
B. Decrease blood pressure
C. Neck vein engorgement
D. Muffled heart sound
E. B and C
EXPLANATION
B, C, D are the classic components of Becks triad.
Pulsus parodoxus can also be seen in Cardiac
tamponade but it is not a part of the triad.
AUTHOR
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
TOPNOTCH
EXAM
MIDTERM 3
EXAM - AUG
2015
169
Janeway lesions, Osler's nodes, and Roth's spots are
usually seen in what disease?
A. Rheumatic Fever
B. Kawasaki disease
C. Infective Endocarditis
D. SLE
E. Dermatomyosis
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
170
Prolonged QT interval is usually caused by what
abnormality?
A. hypokalemia
B. hyperkalemia
C. hypocalcemia
D. hypercalcemia
E. Hypernatremia
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
171
A patient is currently on his 4th month of anti TB
regimen suddenly developed tingling sensations of
his hands and feet. Which of the following drugs
might have caused the symptoms?
A. Rifampicin
B. Isoniazid
C. Ethambutol
D. Pyrazynamide
E. Streptomycin
Isoniazid can cause peripheral neuropathy
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
172
In relation to the above question, what should be
given to improve the symptom?
A. Vitamin B1
B. Vitamin B2
C. Vitamin B6
D. Vitamin B12
E. B Complex
only pyridoxine or B6 is given
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
173
which of the following drugs is LEAST likely to cause
hypoglycemia in a diabetic patient?
A. metformin
B. gliclazide
C. glibenclamide
D. repaglinide
E. Nateglinide
other choices are insulin secretagogue which can
cause hypoglycemia
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
174
This is a qualitative marker of HBV replication and
relative infectivity. Its disappearance may be a
harbinger of clinical improvement and resolution of
infection
A. HBsAg
B. Anti HBs
C. Anti HBc
D. HBV DNA
E. HBeAg
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
175
Which among the following is the most common
cause of acute pancreatitis
A. Trauma
B. Drugs
C. gallstone
D. alcohol
E. Smoking
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
176
what is the single most common risk factor for
hepatitis C?
A. Injection drug use
B. hemodialysis
C. Promiscuous activity
D. Maternal-fetal transmission
E. Unprotected sex
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 25 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
177
QUESTION
EXPLANATION
This is the single BEST acute measure of hepatic
synthetic function and helpful in both the diagnosis
and assessing prognosis of acute parenchymal liver
disease
A. Total albumin
B. LDH
C. AST
D. ALT
E. Coagulation factors
178
All of the following are criteria for Systemic
Inflammatory Response Syndrome or SIRS except
A. Fever of >38C
B. Hypothermia of <36C
C. Tachypnea of >24
D. Tachycardia of >90
E. Leukocytosis>10,000
179
This is the most active drug against M leprae and
inhibits Folate synthesis.
A. Dapsone
B. Rifampicin
C. Clofazimine
D. Isoniazid
E. Sulfamethoxazole
180
Which among the following findings is consistent for
Moderate Risk Community Acquired Pneumonia in a
Diabetic patient?
A. RR of 28
B. PR of 120
C. Temperature of 39C
D. BP of 100/60
E. RBS of 300
181
AUTHOR
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
CAP MR-- RR of 30 or above, PR of 125 or above,
Temp of equal or more than 40 or less than or
equal to 36, altered mental state of acute onset.
Suspected aspiration, decompensated
comorbidities. RBS of 300 means that there is
decompensation of the DM which poses more risk
to infection
HAROLD JAY S.
BAYTEC, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FEU)
MIDTERM 3
EXAM - AUG
2015
What is the drug of choice for post-splenectomy
sepsis?
A. Penicillin 20-30M units/day IV continuous
infusion
B. Ceftriaxone 1-2g/day IV/IM OD
C. Cefuroxime 1.5g IV/IM q8
D. Vancomycin 500mg IV q6
E. Clindamycin 2g/day IV/IM q6-q12
In pleural effusion, the following are factors
indicating the likely need for a procedure more
invasive than a thoracentesis except?
A. Loculated pleural fluid
B. Pleural fluid pH <7.20
C. Pleural fluid glucose >3.3 mmol/L (<60 mg/dL)
D. Positive Gram stain or culture of the pleural fluid
E. Presence of gross pus in the pleural space
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE.. Ceftriaxone is the drug of
choice for post-splenectomy sepsis
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
the following are factors indicating the likely need
for a procedure more invasive than a
thoracentesis: Loculated pleural fluid
Pleural fluid pH <7.20
Pleural fluid glucose <3.3 mmol/L (<60 mg/dL)
Positive Gram stain or culture of the pleural fluid
Presence of gross pus in the pleural space. There is
no typo in choice B.
the following are factors indicating the likely need
for a procedure more invasive than a
thoracentesis: Loculated pleural fluid
Pleural fluid pH <7.20
Pleural fluid glucose .3 mmol/L (<60 mg/dL)
Positive Gram stain or culture of the pleural fluid
Presence of gross pus in the pleural space
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
183
62 year old female presented with chronic cough
and sputum production. Chest x-ray revealed "tram
tracks" appearance. What diagnostic test will you
request to confirm the diagnosis?
A. Bronchoscopy
B. Sputum culture
C. Pulmonary angiography
D. Chest CT scan
E. No further tests necessary
Chest CT is more specific for bronchiectasis and is
the imaging modality of choice for confirming the
diagnosis. CT findings include airway dilation, lack
of bronchial tapering, bronchial wall thickening in
dilated airways, inspissated secretions (e.g., the
"tree-in-bud" pattern), or cysts emanating from
the bronchial wall (especially pronounced in cystic
bronchiectasis
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
184
The liver enzyme test of a 41 year old female patient
with jaundice revealed the following results: AST=
40 IU/L, ALT= 55 IU/L, alkaline phosphatase and
gamma-glutamyl transpeptidase are elevated. What
should you request next?
A. serum albumin
B. ultrasound
C. liver biopsy
D. prothrombin time
E. serum bilirubin
Alkaline phosphatase, 5'nucleotidase, gamma
glutamyl transpeptidase are enzymes that reflect
cholestasis. If these enzymes are found to be
elevated, the 1st thing to do is ultrasound to look
for dilated intra/extrahepatic biliary tree and to
identify gallstones
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
182
. Harrison’s 18th edition chapter 271 page 2223
table 271-1 and IM platinum page 297. according
to these sources tachypnea should be >24. I was
actually shocked as i crossed reference it with
other sources like Schwartz 9th ed and medscape
in which they considered tachypnea of >20. It is
odd that harrisons and medscape have the same
source which is the american college of chest
physicians but they have different values
TOPNOTCH
EXAM
MIDTERM 3
EXAM - AUG
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 26 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
185
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
FINAL EXAM AUG 2015
What is the most common manifestation of Neisseria
meningitides infection?
A. rash
B. headache
C. fever
D. bleeding
E. hypotension
A nonblanching rash (petechial or purpuric)
develops in >80% of cases of meningococcal
disease.
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
186
The following are expected laboratory findings in
tumor lysis syndrome except?
A. Hyperuricemia
B. Hyperphosphatemia
C. Hypocalcemia
D. Hyperkalemia
E. None of the above
Tumor lysis syndrome (TLS) is characterized by
hyperuricemia, hyperkalemia,
hyperphosphatemia, and hypocalcemia and is
caused by the destruction of a large number of
rapidly proliferating neoplastic cells. It is most
often associated with treatment of leukemia.
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
187
27 year old male patient presented with headache
and weakness. BP is elevated, other PE findings are
normal. CBC within normal limits, Na= 149, K= 2.5.
What is your primary consideration in this case?
A. Conn's Syndrome
B. Essential Hypertension
C. Cushing Syndrome
D. Cushing's Disease
E. Pheochromocytoma
Hypertension + hypokalemia = Conns disease
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
188
60 year old female patient, with no known
comorbities suddenly became lethargic and
progressed to coma. According to her relatives, they
noticed that the patient had long-standing fatigue,
cold intolerance and weight gain. Impression was
myxedema coma. What other findings would you
expect to see in this patient?
A. BP 140/90
B. Temp= 38 deg C
C. RR= 28
D. Na= 132
E. hyperglycemia
mnemonics for myxedema coma: 5Hhypoglycemia, hyponatremia, hypothermia,
hypoventilation, hypotension
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
189
Chikungunya virus belongs to what family?
A. Reoviridae
B. Flaviviridae
C. Togaviridae
D. Herpesviridae
E. Filoviridae
Chikungunya belongs to togaviridae family.
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
190
What is the most common location of
extrapulmonary TB?
A. Lymph node
B. Bones
C. Intestines
D. Ovary
E. Brain
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
191
Patient presented with pale palpebral conjunctiva
and skin pallor. Hgb Hct were decreased. PBS
showed decreased MCV, MCH. If you are suspecting
iron deficiency anemia, which of the following is an
unlikely finding?
A. Decreased serum iron
B. Decreased TIBC
C. Decreased ferritin
D. B and C
E. All of the above
TIBC is increased in iron deficiency anemia
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
192
A patient comes to you with the following laboratory
finding- Anti-HAV (-), Anti-HCV (-), HBsAg (-), AntiHBs (+), Anti-HBc (+), HBeAg (-), Anti-Hbe (+). What
is your interpretation?
A. Patient has hepatitis A
B. Recovery from hepatitis B
C. Vaccination with hepatitis B
D. Chronic hepatitis B with high infectivity
E. Acute hepatitis B with high infectivity
p.245 IM platinum 1st edition
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
193
What is the most common cause of systolic
dysfunction that leads to left-sided heart failure?
A. Valvular heart disease
B. Dilated cardiomyopathy
C. Coronary artery disease
D. Thyrotoxicosis
E. Aging
CAD is the the most common cause of systolic
dysfunction that leads to left-sided heart failure.
VHD and dilated cardiomyopathy are other causes
of systolic heart failure
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 27 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
194
QUESTION
EXPLANATION
Hypovolemic hyponatremia is seen in which of the
following condition?
A. Addison's Disease
B. Conn's Syndrome
C. SIADH
D. Diabetes insipidus
E. Diuretic therapy
AUTHOR
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
TOPNOTCH
EXAM
FINAL EXAM AUG 2015
195
A patient has easy fatigability, easy bruising,
hypertension, central obesity and moon facies. You
suspect Cushing Syndrome. After giving low dose
dexamethasone, cortisol levels were not suppressed.
After high dose dexamethasone test, cortisol levels
decreased. What should you request next?
A. Cranial MRI
B. Abdominal CT scan
C. Inferior petrosal sinus sampling
D. Abdominal ultrasound
E. Chest X-ray
Non-suppression in low dose dexamethasone test
confirms cushing syndrome. High dose
dexamethasone test is used to determine the cause
of elevated cortisol. If cortisol is suppressed in
High dose dexamethasone test, then a pituitary
cause is considered, so you should request for a
cranial MRI
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
196
What is the most important virulence factor of E.coli
in causing urinary tract infection?
A. capsule
B. endotoxin
C. P-fimbriae
D. enterotoxin
E. H-antigen
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
197
A 25 year old male complains of arthritis and eye
irritation. There was previous episodes of burning
sensation upon urination. PE revealed swelling of
the right knee and a lesion in the glans penis. Which
of the following is correct?
A. Culture from the glans penis lesion would yield
Neisseria gonorrhea
B. Rheumatoid factor is likely to be positive
C. Patient had a GI tract infection several weeks
ago
D. ANA is positive
E. None of the above
40 year old female develops severe pain and
swelling in the right elbow. She is not sexually active.
You suspect septic arthritis. What is the most likely
organism to cause septic arthritis in this case?
A. Neisseria gonorrhea
B. Escherichia coli
C. Streptococcus pneumoniae
D. Streptococcus pyogenes
E. Staphylococcus aureus
strains of E. coli that cause invasive symptomatic
infection of the urinary tract in otherwise normal
hosts often possess and express genetic virulence
factors, including surface adhesins that mediate
binding to specific receptors on the surface of
uroepithelial cells. The best-studied adhesins are
the P fimbriae, hairlike protein structures that
interact with a specific receptor on renal epithelial
cells.
Diagnosis is Reiter's syndrome. It usually develops
after a non-gonococcal urethritis infection or GI
tract infection with the following organisms,
Salmonella, Shigella, Campylobacter, Yersinia
enterocolitica.
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
S.aureus is the most common cause of septic
arthritis in adults. If the patient is sexually active,
then N.gonorrhea is the most likely cause.
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
198
199
30 year old male patient developed bipedal edema
and hypertension. Work-up revealed
hypoalbuminemia, proteinuria, hematuria and
hypercholesterolemia. Liver enzymes are normal.
Renal biopsy revealed uniform thickening of the
basement membrane along the peripheral capillary
loops seen by light microscopy. Subepithelial
deposits are seen in electron microscopy. This
condition is associated with which of the following?
A. Schistosomiasis
B. Gastric cancer
C. Hepatitis B
D. All of the above
E. B and C
Diagnosis is MGN. Secondary membranous
glomerulonephritis causes are the following:
Infection: Hepatitis B and C, syphilis, malaria,
schistosomiasis, leprosy, filariasis
Cancer: Breast, colon, lung, stomach, kidney,
esophagus, neuroblastoma
Drugs: gold, mercury, penicillamine,
nonsteroidal anti-inflammatory agents,
probenecid
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
200
Patient with pallor is evaluated for anemia. CBC
revealed decreased hemoglobin and hematocrit.
MCV and MCH are both normal. Reticulocyte index is
greater than 2.5. Which of the following is not
considered in the differential diagnosis?
A. Paroxysmal Nocturnal Hemoglobinuria
B. Hereditary spherocytosis
C. Autoimmune hemolytic anemia
D. Blood loss
E. None of the above
Anemia with elevated reticulocyte index is caused
by any hemolytic process or by hemorrhage.
JEAN PAOLO M.
DELFINO, MD (TOP
10 - FEB 2015 MED
BOARDS;
TOPNOTCH MD
FROM FATIMA)
FINAL EXAM AUG 2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 28 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
201
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - FEB
2015
The diagnosis of metabolic syndrome rests on
measurement of the following parameters EXCEPT:
A. Triglycerides
B. Waist circumference
C. Blood pressure
D. HDL
E. LDL
Instead of LDL, FBS is the fifth criterion in the
diagnosis of metabolic syndrome.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
202
When and how often is lipid screening among adults
recommended?
A. Start at 20 years old, then annually
B. Start at 20 years old, then every 5 years
C. Start at 30 years old, then annually
D. Start at 30 years old, then every 5 years
E. Start at 40 years old, then annually
Current ATP III guidelines recommend screening
in all adults >20 years of age. The screen should
include a fasting lipid profile repeated every 5
years.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
203
Auscultation of a patient with a known valvular
heart defect revealed a holosystolic murmur noted
at the left parasternal border. The murmur
characteristically increased in intensity during
inspiration. The valve affected is:
A. Aortic valve
B. Pulmonary valve
C. Mitral valve
D. Tricuspid valve
E. Both aortic and mitral valve
This is Carvallo sign of tricuspid regurgitation.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
204
Standard treatment of a patient with suspected
multidrug-resistant healthcare-associated
pneumonia consist of:
A. 1 Anti-pseudomonal + 1 MRSA-active antibiotics
B. 1 Anti-pseudomonal + 2 MRSA-active antibiotics
C. 2 Anti-pseudomonal + 1 MRSA-active antibiotics
D. 2 Anti-pseudomonal + 2 MRSA-active antibiotics
E. None of the above
The standard recommendation for patients with
risk factors for MDR infection is for three
antibiotics: two directed at P> aeruginosa and one
at MRSA.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
205
Adenosine deaminase is used in the diagnosis of:
A. TB pleural effusion
B. Lung adenocarcinoma
C. COPD
D. Asthma
E. Silicosis
Determination of the pleural concentration of
adenosine deaminase (ADA) is a useful screening
test: tuberculosis is virtually excluded if the value
is very low.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
206
A 56 year-old patient suffering from sudden onset of
dyspnea underwent 2D-echocardiography. Imaging
showed a hypokinetic right ventricular free wall
with a normal apex. This indirect sign is highly
suggestive of:
A. COPD exacerbation
B. Bronchial asthma
C. Pulmonary embolism
D. Congestive heart failure
E. Malignant pleural effusion
This is McConnell's sign of pulmonary embolism.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
207
In the computation of a patient's corrected plasma
sodium concentration, what other laboratory value
must be considered?
A. Albumin
B. Calcium ion concentration
C. Random blood sugar
D. Potassium
E. Blood pH
Plasma Na concentration falls by 1.6 to 2.4 mM for
every 100 mg/dL increase in glucose due to
glucose-induced water efflux from cells. This true
hyponatremia resolves after correction of
hyperglycemia.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
208
The anemia seen in chronic kidney disease is
usually:
A. Microcytic, hypochromic
B. Normocytic, normochromic
C. Macrocytic, hyperchromic
D. Normocytic, hypochromic
E. Microcytic, hyperchromic
A normocytic, normochromic anemia is observed
as early as CKD stage 3 and is almost universal by
stage 4.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
209
Which of the following conditions does NOT
predispose to urolithiasis?
A. Bacterial infection
B. Dehydration
C. Metabolic syndrome
D. Diet high in calcium
E. Gout
Studies have shown that low-calcium diets
increase the risk of incident stone formation,
perhaps by reducing the amount of calcium in the
intestine to bind oxalate, thereby incerasing urine
oxalate levels.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 29 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
210
QUESTION
EXPLANATION
AUTHOR
In the management of diabetic ketoacidosis, what
condition can potentially withold the administration
of insulin?
A. Hypernatremia
B. Hypokalemia
C. Metabolic acidosis
D. Impaired mental status
E. Severe hyperglycemia
If the initial serum potassium is <3.3 mEq/L, do
not administer insulin until the potassium is
corrected. Administering insulin in this setting will
aggravate the hypokalemia as insulin causes
intracellular shift of potassium.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
211
After instituting treatment, when do you expect the
TSH response to thyroid hormone replacement
therapy in cases of hypothyroidism to occur?
A. 2 weeks
B. 4 weeks
C. 2 months
D. 6 months
E. 1 year
The TSH response is gradual and should be
measured about two months after instituting
treatment or after any subsequent change in
levothyroxine dosage.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
212
Which laboratory finding is NOT consistent with
diabetes insipidus?
A. Urine output >50 mL/kg/day
B. Urine osmolarity <300 mOsm/L
C. Blood pressure of 90/60
D. Plasma osmolarity of 290 mOsm/L
E. Plasma sodium ion concentration of 160 mEq/L
If the defect is due to pituitary, gestational, or
nephrogenic DI, the polyuria results in a small (1–
2%) decrease in body water and a commensurate
increase in plasma osmolarity and sodium
concentration that stimulate thirst and a
compensatory increase in water intake. As a
result, hypernatremia and other overt physical or
laboratory signs of dehydration do not develop
unless the patient also has a defect in thirst or fails
to drink for some other reason.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
213
A duodenal ulcer is considered refractory if it is not
healed after how many weeks of therapy?
A. 4 weeks
B. 6 weeks
C. 8 weeks
D. 10 weeks
E. 12 weeks
A refractory gastric ulcer is one that fails to heal
after 12 weeks of therapy.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
214
The Rome II criteria is used to diagnose:
A. Crohn's disease
B. Exudative pleural effusion
C. Infective endocarditis
D. Acute kidney injury
E. Irritable bowel syndrome
Recurrent abdominal pain or discomfort at least 3
days per month in the last three months
associated with two or more of the following: 1]
improvement with defecation; 2] onset associated
with a change in frequency of stool; and 3] onset
associated with a change in form (appearance) of
stool
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
215
This is the antibiotic of choice in cases of
spontaneous bacterial peritonitis.
A. Metronidazole
B. Clindamycin
C. Amikacin
D. Cefotaxime
E. TMP-SMZ
Treatment is with a second-generation
cephalosporin, with cefotaxime being the most
commonly used.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
216
What is the standard test for CSF examination in
suspected cases of neurosyphilis?
A. RPR
B. VDRL
C. MHA-TP
D. FTA-ABS
E. Biopsy
The VDRL test remains the standard for examining
CSF. It is highly specific, and when reactive, is
considered diagnostic of neurosyphilis. However,
this test is insensitive and may be nonreactive
even in cases of symptomatic neurosyphilis.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
217
In an asymptomatic HIV-positive patient, at what
CD4 count is antiretroviral therapy warranted?
A. <500
B. <450
C. <400
D. <350
E. <300
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
218
Which form of arthritis carries the highest incidence
of infective arthritis?
A. Ankylosing spondylitis
B. Lupus arthritis
C. Rheumatoid arthritis
D. Gouty arthritis
E. Osteoarthritis
At present, a reasonable course of action is to
initiate antiretroviral therapy in anyone with the
acute HIV syndrome; all pregnant women; patients
with an AIDS-defining illness; patients with HIVassociated nephropathy; patients with hepatitis B
infection when treatment for hepatitis B is
indicated; and patients with asymptomatic disease
with CD4+ T-cell counts of <500 u/L. NOTE: in
Harrison's 17th edition, the cut-off value was <350
u/L.
Patients with RA have the highest incidence of
infective arthritis (most often secondary to S.
aureus) because of chronically inflamed joints,
glucocorticoid therapy, and frequent breakdown
of rheumatoid nodules, vasculitic ulcers, and skin
overlying deformed joints.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 30 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
219
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - FEB
2015
Falsely normal vitamin B12 levels are seen in:
A. Pregnancy
B. Folate deficiency
C. OCP use
D. Bacterial overgrowth
E. Phenytoin use
Bacterial overgrowth, liver disease, and
myeloproliferative disorders cause a falsely
normal vitamin B12 level. Folate deficiency,
pregnancy, and OCP use cause falsely low vitamin
B12 levels.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
220
Pure red cell aplasia is associated with what tumor?
A. Small cell carcinoma of the lung
B. Squamous cell carcinoma of the lung
C. Thymoma
D. Colon adenocarcinoma
E. Renal cell carcinoma
A small minority of pure red cell aplasia cases
occur with a thymoma. Resection of the thymoma
leads to hematologic improvement in about half of
the patients, possibly because the tumor is a
source of marrow suppressive cells.
GRACE ARVIOLA,
MD (TOP 3 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - FEB
2015
221
which of the following is a class I recommendation
for the use of aspirin and oral anticoagulants in
mitral valve prolapse?
A. Warfarin therapy after stroke
B. Aspirin therapy for patients in sinus rhythm
with echocardiographic evidence of high risk mitral
valve prolapse
C. overlap warfarin therapy along with aspirin for
patient with transient ischemic attack
D. aspirin therapy after stroke in patients with
contraindication to anticoagulants
E. all of the above
Class I indication for aspirin or warfarin therapy in
patients with MVP: ASA for cerebral TIA; warfarin
therapy for patients aged >65y/o in atrial
fibrillation with hypertension, mitral regurgitation
or hx of heart failure. ASA for patients <65 y/o
with atrial fibrillation, warfarin therapy after
stroke. SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
222
which of the following is a false correlation between
JVP waves and its indicated condition?
A. Large fused cv wave - tricuspid stenosis
B. Rapid x+y descent - constrictive pericarditis
C. Kussmaul sign - pericardial tamponade, RV
failure
D. Cannon a wave- complete heart block
E. large a wave - primary pulmonary hypertension
finding of a large fused cv wave indicates tricuspid
regurgitation. Tricuspid stenosis produces large a
wave in JVP
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
223
which of the following is true about chronic stable
angina ?
A. The most important predictor of prognosis is left
ventricular function
B. Myocardial ischemia is caused by increased
myocardial oxygen demand
C. Resting blood flow does not cause ischemia
unless stenosis is >95%
D. during ischemia, diastolic dysfunction precedes
ECG changes and regional wall motion abnormalities
E. all of the above
which of the following is an absolute
contraindication for fibrinolysis in STEMI?
A. Thalamic hemorrhage 10 years ago
B. Current use of anticoagulants
C. Active peptic ulcer
D. Traumatic or prolonged (>10mins) CPR or
major surgery (<3 weeks)
E. all of the above
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
absolute contraindication for fibrinolysis in
STEMI: any prior ICH, known structural
cerebrovascular lesion, known malignant
intracranial neoplasm, ischemic stroke within 3
months, suspected aortic dissection, active
bleeding or bleeding diatheses ( excluding
menses), significant closed head or facial trauma
within 3months.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
measuring the serum concentration of IGF-1 is the
best screening test for acromegaly. It is always
increased in patient with active acromegaly.
Physiologic increased is seen in the following
condition: pregnancy, adolescence, sleep apnea.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
psychogenic polydipsia does not present with
nocturia. This is the most distinguishing symptom
that separates it from a true structural or
physiologic abnormality.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
224
225
226
the following statement is true about acromegaly
except?
A. Increased risk of premalignant colon polyps and
colon cancer
B. A random serum level of GH is not helpful in
establishing the diagnosis
C. Surgical excision is the treatment of choice
D. serum concentration of IGF1 is increased in only
50% of patient with active acromegaly
E. none of the above
which of the following statement is true about
diabetes insipidus except?
A. The absence of response to water deprivation (
urine osmolality <300mosm/kg) is diagnostic of
diabetes insipidus
B. Cortisol is necessary hormone for kidney in
terms of excreting excess water load
C. the presence of nocturia cannot rule out
psychogenic polydipsia
D. central diabetes insipidus can be distinguished
from nephrogenic type by the response to
exogenous desmopressin
E. none of the above
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 31 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
227
QUESTION
EXPLANATION
AUTHOR
in severe hypercalcemia wherein the primary cause
cannot be detected, what is the most important
therapeutic intervention ?
A. dialysis
B. Calcitonin IV
C. Pamidronate plus loop diuretics
D. Saline diuresis
E. All of the above is important
in cases of sever hypercalcemia with unknown
primary, calcium concentration should be
decreased, aggressive rehydration with volume
espansion promotes calciuresis or saline diuresis
and is the most important therapeutic
intervention. Loop diuretics helps promote
calcium excretion only after rehydration is done.
pamidronate decreases calcium concentration by
inhibiting bone resorption and has a marked and
prolonged effect on calcium concentration,
however its effect is delayed. dialysis is reserved
for patients with renal failure while calcitonin is
used rarely because of its modest effect andthe
rapid onset of tachyphylaxis.
type A gastritis involves the fundus and/or body of
the stomach. It is associated with autoimmune,
atrophic gastritis and pernicious anemia. The
serum levels of gastrin since achlorydia develops
in this patient. Gastrin is potent growth factor for
the development of gastric carcinoid tumors and
gastric polyps. on the otherhand, type B gastritis
involves primarily the antrum and it is associated
with H pylori infection.
Ulcerative colitis is a continuous inflammatort
process that etends from the anal verge to the
more proximal colon. Crohns is a segmental type
of inflammation. UC does not form fistules and
perianal disease is uncommon. Stricture of the
intestine are common with Crohns but rate in UC.
presence of it mandates ruling out carcinoma.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
228
The following condition are associated with type A
gastritis except ?
A. Gastric carcinoids
B. Pernicious anemia
C. H pylori infection
D. Atrophic gastritis
E. Hypergastrinemia
229
True about inflammatory bowel disease except?
A. ulcerative colitis is a continuous process
B. Ulcerative colitis is associated with intestinal
fistula, strictures, and perianal disease
C. elevated levels of alkaline phosphatase in a
patient with UC suggest the presence of primary
schlerosing colangitis
D. the presence of strictures in patient with active
UC suggest colonic adenocarcinoma
E. none of the above
230
which of the following is a poor prognostic indicator
for alcoholic hepatitis?
A. Discriminant function of 28
B. Prolonged PT
C. Total bilirubin of 18mg/dl
D. AST > 400U/L
E. Severe jaundice
231
TOPNOTCH
EXAM
MIDTERM
EXAM 1 - FEB
2015
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
poor prognostic markers for alcoholic hepatitis:
Discriminant Function of >32, encephalopathy,
ascites, renal failure, prolonged PT, bilirubin
>20mg/dl.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
which of the folowing condition is associated with
SAAG >1.1g/dl?
A. Nephrotic syndrome
B. Colonic malignancy
C. Genitourinary TB
D. Right sided heart failure
E. All of the above
A SAAG value of >1.1g/dl is almost always
indicate portal hypertension.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
232
what is the primary treatment for thrombotic
thrombocytopenic purpura?
A. Aspirin plus dipyridamole
B. Platelet transfusion
C. plasmapharesis
D. Intravenous IVIG
E. Splenectomy
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
233
A 67 y/o male was worked up for persistent
proteinemia. The laboratory results showed the ff: M
protein 2.4 g/dl, BMA 8% plasma cells, serum
creatinine 0.9mg/dl, Hgb 145, bone radiograph
shows osteoporotic changes of the vertebra. what is
your primary diagnosis?
A. Multiple myeloma
B. waldenstrom macroglobulinemia
C. MGUS
D. plasmacytoma
E. none of the above
TTP is a type of microangiopathies wherein there
is a deficiency in the vWF cleaving protease
(ADAMTS13). This result to large vWF multimers
in the plasma promoting aggregant effect. The only
treatment for this case is plasma exchange (
plasmapheresis with infusion of FFP or
cryosupernatant infusion. platelet transfusion is
generally contraindicated unless invasive
procedures is required. other ancillary treatment
however with unknown benefit include:
dipyridamole, ASA, prednisone. IVIG is reserved
for refractory cases.
MGUS is the most common dysproproteinemia, M
protein is < 3g/dl and the plasma cell is < 10% (
MM >10% BMA plasma cell). Patient is
asymptomatic. Serum creatinine, hemoglobin and
bone radiographs are normal.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
234
A 47 y/o male asymptomatic presents in your clinic
with an incidental finding of WBC count 110x109 /L,
basophilia, eosinophilia and obliterated traube
space. Cytogenetic studies showed t(9,22). Which of
the following is true about his condition except?
A. the standard therapy for this condition is
Imatinib
B. leukocyte alkaline phosphatase score is low or
zero
C. increased serum Vitamin B12 level
D. philadelphia chromosome is the hallmark of this
condition
E. all of the above
this is a classic case of CML. Characterized by
increased WBC count, granulocytes in all stages of
maturation. Presence of philadelphia chromosome
is the hallmark for this condition. This is caused by
translocation of bcr -abl gene. Leukocyte alkaline
phosphatase ( marker of functional activity of
granulocytes) is low compared to reactive
leukocytosis. there is an increaesed Vitamin B12
level due to increased level of transcobalamin I.
Imatinib is the treatment of choice.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 32 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
235
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM
EXAM 1 - FEB
2015
68 y/o male with DM nephropathy with creatinine of
2.4 then suddenly came in creatinine of 9 mg/dl
without any other hx of blood loss or diarrhea. he
also have anemia and Low back pain in the past 6
mo, 24 hr urine protein showed proteinuria
iof10g/day, the urine dipstick is negative ?
A. Multiple Myeloma
B. FSGS
C. RPGN
D. Uremia
E. any of the above
proteinuria with negative urine dipstick
accompanied by low back pain and suddenc
increase in creatinine is a classic manifestation of
myeloma kidney.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
236
which laboratory finding will distinguish acute
tubular necrosis from pre renal azotemia?
A. Urine spgr 1.031
B. BUN/Creatinine 30:1
C. Urine osmolality of 300 mOsm/L
D. FeNa% 0.8%
E. Urine Na 20mEq/L
Acute tubular necrosis: Urine Osm - <350
mOsm/L; BUN/Crea ratio - <15; urine Na >30
mg/dl; FeNa >3%
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
237
which of the following will decrease in
glomerulonephritis presenting with nephrotic
syndrome?
A. Urinary excretion of antithrombin III
B. Atrial natriuretic peptide
C. vasopressin
D. VLDL
E. None of the above
urinary loss of antithrombin is main causative
factor why nephrotic syndrome is prone to
thrombotic states. Loss of albumin leads to
compensatory increase in the synthesis of
lipoprotein leading to increase in VLDL fraction.
ADH is increase as well as aldosterone to
compensate for sodium and water loss. ANP is
decreased at this state.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
238
which of the following is not a manifestation of
Fanconi Syndrome?
A. anemia
B. acidosis
C. aminoaciduria
D. glycosuria
E. Hyperuricosuria
fanconi syndrome is a renal disease affecting the
proximal renal tubule. Glucose, amino acid,
phosphate,uric acid,bicarbonate are completely
passes in urine instead of being reabsorbed.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
239
which of the following is true about acquired
Immunodeficiency syndrome except?
A. Diagnosis is attained if anyone with HIV
infection develop diseases associated with T cell
defect and CD4 count of <200 /ul.
B. Trimethoprim/sulfamethoxazole should be
started for primary prophylaxis if CD4 count reaches
<200/ul
C. leukopenia is the most common hematologic
abnormality in HIV
D. invasive cervical cancer and generalized wasting
>10% is an AIDS defining illness.
E. immune reconstitution syndrome is frequently
seen in the setting of mycobacterial infection
this type of respiratory failure results in alveolar
hypoventilation secondary to impaired respiratory
drive?
A. Type 1
B. Type 2
C. Type 3
D. Type 4
E. None of the above
anemia is the most common hematologic
abnormality in HIV patients and in the absence of
a specific treatable cause is independently
associated with poor prognosis.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
type 1, acute hypoxemic respiratory failure -d/t
alveolar flooding and subsequent intrapulmonary
shunt physiology. Type 3-d/t lung atelectasis.
Type 4 - hypoperfusion of respiratory muscles in
patient in shock. SIMILAR TO PREVIOUS BOARD
EXAM CONCEPT/PRINCIPLE
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
MIDTERM
EXAM 1 - FEB
2015
A 50 year old male 10 pack year smoker and
hypertensive consulted due to dyspnea. History
revealed multiple episodic attacks of dyspnea and
coughing over the past few years. He said that he has
had siblings with similar coughing episodes as well.
He has verbalized that the dyspnea and coughing
would frequently accompany colds and an episode of
flu would last a few weeks and would eventually
resolve only to return again after a few months.
Initial PE revealed symmetrical chest expansion,
occasional wheezes on both lung bases, no other
remarkable findings, most likely condition is
A. COPD - emphysema
B. bronchial asthma
C. congestive heart failure
D. anginal equivalent
E. post nasal drip syndrome
remissions and exacerbations, (+) family history,
PE and history point more to asthma
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
240
241
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 33 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
242
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 2
EXAM - FEB
2015
30 year old female patient diagnosed case of
rheumatic heart disease with mitral regurgitation
presented with new onset fever over the past 5 days,
dyspnea, easy fatigability, 2D echo revealed
vegetations on the mitral valve, however blood
cultures returned negative, which of the following
antibiotics would most likely be used for this
patient?
A. vancomycin
B. ampicillin
C. ceftriaxone
D. gentamicin
E. penicillin G
Dilated cardiomyopathy is most commonly brought
about by which of the following?
A. infectious etiology
B. genetic factors
C. hypertensive heart disease
D. autoimmune destruction
E. immunologic dysfunction
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, no culture isolated
organism, give broad spectrum IV antibiotic that
covers for the most common organisms
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, hypertensive heart disease
still most common cause
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
244
Which of the following hepatitis virus causes the
most cases of chronic liver disease in humans?
A. hepatitis A
B. hepatitis B
C. hepatitis C
D. hepatitis D
E. hepatitis E
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, only about 1% of cases of
Hep B go on to become chronic and cause CLD
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
245
Which of the following drugs are classified to have a
narrow therapeutic index, is both nephrotoxic and
ototoxic at the same time?
A. vancomycin
B. imipinem cilastatin
C. furosemide
D. cyclophosphamide
E. cisplatin
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, only vancomycin reflects
all characteristics, (aminoglycosides also have the
same characteristics)
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
246
Nitroglycerin is usually given to relieve chest pain
during an acute anginal attack, which of the
following is its predominant mechanism of action?
A. acts as a venodilator
B. negative inotropic
C. negative chronotropic
D. decreases peripheral vascular resistance
E. prevents platelet aggregation
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, venodilator, decrease
preload
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
247
A 32 year old female patient was noted to have
rheumatic heart disease. Patient comes in for follow
up check up since she was referred back by her
cardiologist to her primary care physician, after
routine vital signs checking,BP130/60 heart rate of
96 RR of 20, the patient told her primary care
physician that she was told by her cardiologist that
she had a valvular problem developed as
complication of her condition, the primary care
physician most likely thinks this is?
A. mitral stenosis
B. mitral regurgitation
C. aortic stenosis
D. aortic regurgitation
E. none of the above
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, AR = wide pulse pressure
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
248
32 year old female patient treated for SLE went into
remission a few weeks ago and discontinued her
medications when she got well, 5 days prior, she
started having cough and colds and body malaise,
she reported recent episodes of light headedness,
muscle weakness, weight loss. BP was 120/80 at
sitting but on standing dropped to 80/60, there was
some noted hyperpigmentation of the skin on the
dorsum of the arms, which of the following
conditions is most likely?
A. SLE flare
B. sepsis secondary to pneumonia
C. dehydration
D. medication side effects
E. adrenal insufficiency
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, skin changes and
hypotensive episodes = primary adrenal
insufficiency
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
243
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 34 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
249
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 2
EXAM - FEB
2015
60 year old male patient came in due to easy
fatigability, no other symptoms noted on ROS. On
examination, patient was noted to be pale, no oral
lesions, no palpable cervical lympadenopathies,
chest, abdominal PE findings were unremarkable,
DRE revealed smooth rectal vault, (-) blood on
tactating finger, CBC revealed hgb 9.5g/dL which of
the following is the most likely pathology?
A. chronic renal failure
B. lymphoma
C. occult GI malignancy
D. Pulmonary TB
E. HIV
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, unexplaine anemia in
elderly rule out occult GI malignancy
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
250
40 year old female patient come in with neck mass of
3 years duration, noted gradual increase in size, she
also complained of occasional difficulty swallowing
and complained of the cosmetic disturbance due to
the mass in her neck. The patient was worked up
and evaluated to be euthyroid, ultrasound revealed
multinodular goiter, which of the following
treatments is most applicable?
A. subtotal thyroidectomy
B. radioactive iodine I131
C. thyroid hormone levothyroxine supplementation
D. PTU antithyroid medication
E. SSKI (saturated solution of potassium iodide)
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, multinodular goiter,
subtotal thyroidectomy is the best treatment of
choice for this condition
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
251
A 55 year old male patient admitted for severe
pneumonia went into septic shock, which of the
following is a possible effect on the patient's kidney?
A. increase GFR decrease sodium and water
retention
B. decrease GFR increase sodium and water
retention
C. no change in GFR decrease in sodium and water
retention
D. no change in GFR increase in sodium and water
retention
E. none of the aove
A 56 year old male marathon runner collapsed on
track, when he was brought in for medical
assistance, he was found to be very dehydrated and
hypotensive, assessment was heat exhaustion and
severe dehydration, which type of renal failure will
this patient most likely develop if the condition is
allowed to progress?
A. pre renal
B. intra renal
C. post renal
D. all of the above
E. none of the above
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, about 2 similar question in
this form of a physio question, personally I did not
study for IM as a board subject, study your
pharma, patho, micro, physio and you will be ok
plus your internship clerkship experiences as well,
one of the easiest subjects on the boards IM
platinum would do ok as well which I read during
internship
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, pre renal due to shock
dehydration
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
253
A 40 year old female patient came into the clinic
complaining of epigastric pain 2-3 hours after eating,
this was accompanied by burning sensation going
upward into the chest, which of the following
treatments is most suitable for this patient?
A. AlMgOH take 1 tablet as needed
B. omeprazole 20mg/tablet 1 tablet OD
C. omeprazole 40mg/tablet 1 tablet OD
D. prednisone 10mg/tab 1 tab OD
E. ISDN 5mg/tab 1 tab sublingual
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, for GERD need to be high
dose proton pump inhibitors
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
254
50 year old female patient known diabetic and
hypertensive for 10 years recently complained of
episodes of exertional dyspnea, bipedal edema,
nocturnal cough and 2 pillow orthopnea, which of
the following oral hypoglycemic medications are
contraindicated for this patient?
A. metformin
B. glimepiride
C. sitagliptin
D. acarbose
E. pioglitazone
thiazolidinediones can cause excess water
retention which may exacerbate patient's
beginning heart failure thus is contraindicated
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
252
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 35 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
255
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 2
EXAM - FEB
2015
24 year old military recruit residing with his platoon
developed high fever, nuchal rigidity, altered
consciousness and rapid onset of purpuric rashes
over the trunk and lower extremities, the drug of
choice for this condition is?
A. penicillin G
B. ceftriaxone
C. ampicillin sulbactam
D. azithromycin
E. clindamycin
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, drug of choice is still PenG
for meningo
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
A 65 year old male 20 pack year smoking history
presents with a history of increasing dyspnea,
weight loss, occasional intermittent coughing. Chest
xray was requested by his primary physician which
revealed a hilar mass on the right hemithorax
causing collapse of the right upper lung lobe, which
of the following was the most likely PE findings in
this patient?
A. bilateral crackles over lung bases occasional
wheezing bilateral lung bases
B. decreased breath sounds over right upper lung
field, occasional wheezing right hemithorax
C. dullness on right lung base, increased tactile and
vocal fremiti
D. tracheal shifted to the left, decreased breath
sounds over the right hemithorax
E. (+) bronchophony and egophony right lung base,
occasional crackles right lung
In relation to the question above, which of the
following diagnostic procedures is most appropriate
for patient's condition?
A. CT guided aspiration biopsy
B. transbronchial biopsy
C. resection biopsy via thoracotomy incision
D. VATS guided lung biopsy
E. none of the above
A more on asthma, C pneumonia, D trachea should
be on the same side with atelectasis, E more on
pneumonia
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, accessible hilar lung mass
can be accessed through bronchoscopy
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
258
Which of the following conditions below could
potentially produce hypovolemic hyponatremia?
A. SIADH
B. water intoxication
C. diuretic therapy
D. Conn's syndrome
E. none of the above
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, A and B, D are
hypervolemic
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
259
Which of the following is the test of choice to
document H. Pylori eradication following treatment?
A. rapid urease test
B. urea breath test
C. gastric mucosal biopsy
D. H.pylori serological test
E. all of the above
urea breath test to document cure
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
260
50 year old male patient smoker and alcoholic with
history of chronic epigastric pain passed black tarry
stools, the physician knows that the stool was
probably in the GI tract for at least how long?
A. 14 hours
B. 16 hours
C. 20 hours
D. 24 hours
E. 72 hours
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE, 14 hours for melena
KEVIN BRYAN LO,
MD (TOP 7 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2015
261
A 54 year old male who has been hospitalized for
severe acute pancreatitis complained of onset of
dyspnea and tachypnea. Chest X-ray reveals diffuse
bilateral infiltrates and stat ABG revealed severe
hypoxemia. Pulmonary capillary wedge pressure
was measured and was unremarkable. What is the
most likely pathophysiologic mechanism of this
condition?
A. Bronchial mucous plugging
B. Alveolar wall destruction
C. Left ventricular infarction
D. Endothelial damage
E. Interstitial fibrosis
This is a case of ARDS which results from
endothelial damage and leakage of protein-rich
material into the alveolar spaces. There are many
causes, one of which is severe pancreatitis.
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
256
257
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 36 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
262
QUESTION
EXPLANATION
AUTHOR
A patient with known coronary artery disease is
prescribed with a maintenance dose of aspirin.
Which of the following is the mode of action of this
drug in preventing future ischemic events?
A. Inhibition of cyclooxygenase 2-mediated synthesis
of prostaglandins
B. Irreversible acetylation of prostacyclin
C. Inhibition of prostaglandin synthase 1
D. Direct blockade of thromboxane action on
platelets
E. Reversible acetylation of cyclooxygenase
Given the following clicical picture: (+) HbsAg, ()anti-Hbs, (+) anti-Hbc IgG, (-) HbeAg, (+) anti-Hbe,
(+) anti-HbA IgG, (+) anti-HbC, what is the
diagnosis?
A. Past Hepatitis A infection, Chronic Hepatitis B
carrier, Hepatitis C infection
B. Acute Hepatitis A infection, Chronic Hepatitis B
carrier, Hepatitis C infection
C. Past Hepatitis A infection, Chronic Active Hepatitis
B, Hepatitis C infection
D. Acute Hepatitis A infection, Chronic Hepatitis B
carrier, Resolved Hepatitis C infection
E. Past Hepatitis A infection, Past Hepatitis B
vaccination, Hepatitis C infection
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. Prostaglandin synthase I or
COX1 - irreversibly acetylated by aspirin to
decrease synthesis of thromboxane. Prostaglandin
synthase II or COX2 is selectively expressed in
inflammatory cells and mediate inflammation.
Aspirin inhibits both but its action on
prostaglandin synthase I or COX1 is what helps
prevent platelet aggregation.
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
Review hepatitis laboratory profile
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
264
A 63 year old male patient comes to your clinic
complaining of redness and painful swelling of the
right knee. Synovial fluid analysis revealed an
inflammatory picture and analysis under polarized
microscopy shows negative birefringerence. What is
the most likely etiology?
A. Autoimmune pathology
B. Crystal arthropathy
C. Dissemininated gonococcal infection
D. Wear and tear
E. None of the above
Urate appears as needle like crystals with negative
birefringerence under polarized light
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
265
A chronic alcoholic was hospitalized for lethargy and
confusion. Physical examination findings include
icteric sclerae, positive fluid wave and shifting
dullness, bilateral pedal edema, and flapping
tremors of the hand. Which of the following will help
improve that patient's current reason for admission?
A. Alkalinization of urine
B. Colonic acidification
C. Large-volume paracentesis
D. Adequate intravenous hydration
E. TIPS
This is a case of hepatic encephalopathy. Lactulose
is converted by colonic bacteria into organic acids,
which traps ammonia and prevents diffusion back
into the circulation
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
266
A patient presents with anemia and enlarged spleen
upon palpation. Peripheral smear reveals RBC's with
lack of central pallor. Family history is also
significant for the condition. If a splenectomy is
performed on this patient, which of the following
may be prevented?
A. Portal vein hypertension
B. Neoplastic transformation
C. Gallstone formation
D. Thrombocytosis
E. Invasive bacterial infection
Hereditary spherocytosis is an extravascular type
pf hemolytic anemia which may cause gallstone
formation due to accumulation of unconjugated
bilirubin. Splenectomy will prevent this.
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
267
In a patient who recently had myocardial infarction,
when do you expect the possibility of an
autoimmune-mediated type of pericarditis after MI?
A. 12-24 hours
B. 1-3 days
C. 4-7 days
D. 7-14 days
E. >2 weeks
Fibrinous pericarditis may 1-3 days after MI as a
response to the necrotic tissue. But the
autoimmune type of pericarditis called Dressler's
syndrome occurs weeks to months after MI
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
268
An elderly hospitalized patient who has been
confined to bed complained of acute onset dypnea,
tachypnea and shortness of breath. Further
examination revealed left calf pain and tenderness.
What will be the expected ABG findings?
A. pH=7.31, pCO2=50, pO2=98
B. pH=7.29, pCO2=29, pO2=76
C. pH=7.39, pCO2=39, pO2=88
D. pH=7.52, pCO2=49, pO2=54
E. pH=7.49, pCO2=29, pO2=72
Symptomatic pulmonary embolism will cause
tachypnea, hypoxemia, and respiratory alkalosis
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
263
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 37 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
MIDTERM 3
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
269
QUESTION
EXPLANATION
AUTHOR
A 5 year old patient is brought to the ER by her
mother due to complaints of polyuria, nausea and
vomiting, and abdominal pain. Respiration is noted
to be deep and rapid and urine ketones is positive. If
serum chemistry levels are measured, which of the
following will be expected?
A. Increased K, Deacresed Na, Increased Glucose
B. Increased K, Increased Na, Increased Glucose
C. Decreased K, Decreased Na, Increased Glucose
D. Increased K, Increased Na, Normal Glucose
E. Decreased K, Decreased Na, Decreased Glucose
DKA will cause shift of potassium from intacellular
to extracellular causing hyperkalemia. The
increase in osmotic pressure will cause brisk
diuresis and loss of Na causing hyponatremia
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
270
What is the drug of choice in a patient with
Addison's disease presenting with acute adrenal
crisis?
A. Prednisone
B. Prednisolone
C. Hydrocortisone
D. Betamethasone
E. Dexamethasone
Hydrocortisone IV is the drug of choice in acute
adrenal crisis
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
271
A 23 year old female patient complaining of
epigastric pain underwent endoscopy which
revealed a duodenal ulcer. She was started on
Proton pump inhibitor therapy. The addition of
antibiotics to the treament regimen will help:
A. Decrease recurrence risk
B. Relieve symptoms
C. Facilitate ulcer healing
D. Prevent disease transmission
E. Prevent malignant transformation
Antibiotic therapy helps eradicate H. pylori and
primarily decreases recurrence risk
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
272
What is the most common cause of acute kidney
injury?
A. Intrinsic AKI
B. Postrenal AKI
C. Acute Tubular Necrosis
D. Prerenal AKI
E. Obstructive uropathy
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
273
A 23 year old female patient who was diagnosed
with Grave's disease is being maintained on a
thionamide medication. In order to rapidly detect a
rare idiosyncratic adverse reaction that is associated
with this drug, which laboratory tests should be
monitored?
A. Liver function test
B. Alkaline phosphatase
C. CBC
D. Serum potassium
E. Serum creatinine
Agranulocytosis is a rare idiosyncratic reaction of
thionamides (ex. Methimazole)
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
274
A 72 year old male patient who is a native of Baguio
City is complaining of knee pain that is worse in the
afternoon and during exertion. He lives a sedentary
lifestyle and is overweight. Family history reveals
that this runs in the family. There are no other
associated symptoms. Which of the following is the
most important risk factor for causing this disease in
this patient?
A. Cold climate
B. Gender
C. Obesity
D. Family history
E. Age
Age is the primary predisposing factor for
osteoarthritis
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
275
A 25 year old patient who is being treated for a
urinary tract infection develops conjunctival redness
and difficulty in ambulation due to a swollen knee.
Which of the following is true about this condition?
A. Reactive arthritis
B. Associated with HLA-B27
C. Seronegative type of arthritis
D. A and B
E. All of the above
Reiter's syndrome/Reactive arthritis seronegative, associated with HLA B27, triad of
urethritis, conjunctivitis, and arthritis
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 38 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
MIDTERM 3
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
276
277
278
279
280
281
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 3
EXAM - FEB
2015
A elderly female patient who recently suffered from
left-sided hemiparesis is able to comprehend speech
but is unable to repeat words and has difficulty
using words and sentences. Which of the following
areas of the cortex is most likely affected?
A. Inferior frontal gyrus
B. Superior frontal gyrus
C. Superior temporal gyrus
D. Posterior parietal gyrus
E. None of the above
Broca's area - expressive aphasia
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
A 72 year old patient presents at the ER with
complaints of dypnea and chest discomfort. P.E.
findings include decreased dullness upon percussion
and decreased breath sounds and vocal fremitus.
She has a history of chronic hypertension. Chest xray reveals cardiomegaly and blunting of the
costophrenic angle. Which of the following findings
is most consistent with the patient's most likely
diagnosis upon thoracentesis?
A. Pleural fluid LDH of >200 U/L
B. Pleural fluid protein of >3 g
C. Pleural fluid and serum protein gradient of
>31g/L
D. Pleural -serum LDH ratio >0.6
E. All of the above
In the recovery phase of acute renal failure, one
should be most concerned of which of the following
possible complications?
A. Volume overload
B. Hypokalemia
C. Hypernatremia
D. Hyperuricemia
E. Hyperkalemia
transudative (ex. CHF, nephrotic): PF LDH<200, PF
protein <3, PF-serum protein ratio <0.5, PR-serum
LDH ratio of <0.6, PF-serum protein gradient of
>31g/L
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
Recovery phase is the diuretic phase placing
patient at risk for hypokalemia
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
A 54 year old anxious and diaphoretic male patient
presents at the ER complaining of severe substernal
chest pain that is unrelieved by rest. Physical
examination reveals bradycardia and ECG shows ST
segment elevation of II, III, aVF. BP is 130/90, HR is
52, and RR is 23. Which of the following is the most
consistent with the patient's scenario?
A. Cardiogenic shock secondary to massive
infarction
B. Blockage of the vessel supplying the SA and AV
node
C. Compensatory parasympathetic response
D. Pericardial tamponade
E. Coronary atherosclerosis affecting the left
anterior descending artery
A patient who was diagnosed with bacterial
pharyngitis is treated with amoxicillin and develops
a pruritic maculopapular rash. Patient claims that he
was treated with amoxicillin several years ago
without any reaction. What is your primary etiologic
consideration?
A. RNA virus
B. Catalase positive cocci
C. DNA virus
D. Fungal infection
E. Drug-induced hypersensitivity reaction
Inferior infarct - blockage of right coronary artery
which supplies SA and AV node
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
Infectious mononucleosis (EBV) - Almost all
patients with mononucleosis that are treated with
amoxicillin/ampicillin develops a generalized
pruritic maculopapular rash
RAYMUND
MARTIN LI, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 3
EXAM - FEB
2015
A 58 year old male was brough to the ER due to a
one week history of progressive headache and fever.
He has been diagnosed with Pulmonary
Tuberculosis but has been unable to start his
medications due to financial difficulties. On
examination, he was drowsy but arousable with note
of nuchal rigidity and a positive Brudzinski sign.
Lumbar puncture was done which showed an
elevated WBC count of lymphocytic predominance,
an elevated protein level and a decreased glucose
level. Which of the following statements is true
regarding the most probable condition of the
patient?
A. Polymerase chain reaction (PCR) is the gold
standard for diagnosis
B. The disease often presents abruptly with a acute
onset of severe headache and vomiting
C. Adjunctive treatment with dexamethasone
promotes significantly reduces the frequency of
neurologic sequelae
D. It is more common in elderly than in young
children
E. Involvement is more pronounced at the base of
the brain, with paresis of cranial nerves being a
Dx: TB meningitis. TB of the central nervous
system is seen most often in young children but
also develops in adults, especially those infected
with HIV. The disease often presents subtly as
headache and slight mental changes after a
prodrome of weeks of low-grade fever, malaise,
anorexia, and irritability. Since meningeal
involvement is pronounced at the base of the
brain, paresis of cranial nerves (ocular nerves in
particular) is a frequent finding, and the
involvement of cerebral arteries may produce
focal ischemia. Lumbar puncture is the
cornerstone of diagnosis. Adjunctive
dexamethasone significantly enhanced the
chances of survival among persons >14 years of
age but did not reduce the frequency of neurologic
sequelae.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 39 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
frequent finding
282
Which of the following joints is spared in
Osteoarthritis?
A. Knee
B. Ankle
C. Cervical Vertebrae
D. Proximal interphalangeal joint
E. Hip
OA affects certain joints, yet spares others. Usually
spared are the wrist, elbow, and ankle. Some
joints, like the ankles, may be spared because their
articular cartilage may be uniquely resistant to
loading stresses
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
283
A 40 year old female presented with progressive
weight gain and marked swelling of her lower
extremities. She has no known co-morbids. PE is
normal except for the presence of a grade 2 bipedal
edema. CBC, BUN, Electrolytes and Creatinine were
all normal. Her urinalysis showed a 4+ albumin, oval
fat bodies and free fat droplets. Her 24 hour urine
albumin excretion was elevated at 8.6 grams. Which
of the following findings would also be expected in
this patient?
A. Elevated bilirubin levels
B. Elevated serum cholesterol
C. Elevated serum albumin
D. Elevated blood uric acid
E. None of the above
Dx: Nephrotic syndrome Nephrotic syndrome
classically presents with heavy proteinuria,
minimal hematuria, hypoalbuminemia,
hypercholesterolemia, edema, and hypertension. If
left undiagnosed or untreated, some of these
syndromes will progressively damage enough
glomeruli to cause a fall in GFR, producing renal
failure.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
284
Which of the following clinical features argues
against the diagnosis of Irritable Bowel Syndrome
(IBS)?
A. Bloody diarrhea
B. Alteration in bowel habits
C. Exacerbation of abdominal pain by stress
D. Resolution of abdomina pain on passage of stool
E. Increased belching or flatulence
Alteration in bowel habits is the most consistent
clinical feature in IBS. Abdominal Pain is often
exacerbated by eating or emotional stress and
improved by passage of flatus or stools. Patients
with IBS frequently complain of abdominal
distention and increased belching or flatulence.
Bleeding is not a feature of IBS unless
hemorrhoids are present.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
285
A 40 year old female was referred for hematologic
evaluation because of findings of splenomegaly and
a markedly elevated WBC count of 180,000/uL with
the following differential count: Blasts 2%,
Promyelocyte 15%, Metamyelocyte 20%, Myelocyte
10%, Bands 8%, Segmenters 30%, Lymphocytes
10% and Basophils 5%. A primary diagnosis of CML
was made by the hematologist. Which of the
following treatment options for this case induces
rapid disease control by lowering the WBC count?
A. Imatinib
B. Cytarabine
C. Doxorubicin
D. Hydroxyurea
E. Stem cell transplantation
Dx: CML. Initial management of patients with
chemotherapy is currently reserved for rapid
lowering of WBCs, reduction of symptoms, and
reversal of symptomatic splenomegaly.
Hydroxyurea, a ribonucleotide reductase inhibitor,
induces rapid disease control.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
286
Which of the following statements concerning
Pheochromocytoma is false?
A. Hypertension is the dominant sign
B. Catecholamine crises can lead to heart failure,
pulmonary edema, arrhythmias, and intracranial
hemorrhage
C. Elevated plasma and urinary levels of
catecholamines and metanephrines are the
cornerstone for the diagnosis
D. Complete tumor removal is the ultimate
therapeutic goal
E. Restriction of salt intake is a necessary preoperative preparation
Because patients are volume-constricted, liberal
salt intake and hydration are necessary to avoid
orthostasis. Among the presenting symptoms,
episodes of palpitations, headaches, and profuse
sweating are typical and constitute a classic triad.
The dominant sign is hypertension. Classically,
patients have episodic hypertension, but sustained
hypertension is also common. Catecholamine
crises can lead to heart failure, pulmonary edema,
arrhythmias, and intracranial hemorrhage.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 40 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
287
QUESTION
EXPLANATION
AUTHOR
A 60 year old male sought consult due to muscle
weakness. His BP was elevated at 180/110 with an
abdominal bruit noted. Blood tests revealed
hypokalemia. An arterial duplex scan was done
which showed a decreased blood flow through the
right renal artery. What are the expected plasma
renin activity (PRA) and aldosterone level for this
case?
A. Low PRA and low aldosterone
B. High PRA and low aldosterone
C. High PRA and high aldosterone
D. Low PRA and high aldosterone
E. Normal PRA and low aldosterone
The murmur of mitral regurgitation most commonly
radiates to what location?
A. Axilla
B. Right parasternal area
C. Neck
D. Epigastric area
E. Left parasternal area
Dx: Secondary Hyperaldosteronism (secondary to
Renal Artery Stenosis). Decreased RBF will
stimulate renin release which will stimulate
aldosterone release. Aldosterone promotes
sodium absorption (hence an elevated BP) and K
excretion (hence hypokalemia which presented as
muscle weakness)
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
systolic murmur of at least grade III/VI intensity
is the most characteristic auscultatory finding in
chronic severe MR. It is usually holosystolic (see
Fig. 227-5A), but as previously noted it is
decrescendo and ceases in mid- to late systole in
patients with acute severe MR. The systolic
murmur of chronic MR is usually most prominent
at the apex and radiates to the axilla.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
A 29 year old female presented with weigh loss,
palpitation, tremors and heat intolerance. She is
tachycardic at 115/bpm with the presence of
moderate to severe proptosis. The thyroid gland is
diffusely enlarged and non tender. Reflexes are
hyperactive. The rest of the examination is normal.
Which of the following treatment options may
worsen her proptosis?
A. PTU
B. Methimazole
C. Propranolol
D. RAI
E. Prednisone
A "locked-in" state of preseved consciousness with
quadriplegia and cranial nerve signs suggests
complete infarction of what area in the central
nervous system?
A. Thalamus and Basal Ganglia
B. Cerebellum and Medulla
C. Hypothalamus and Pituitary
D. Pons and Lower Midbrain
E. Occipital lobe of the cerebral hemisphere
The presence of severe ophthalmopathy requires
caution, and some authorities advocate the use of
prednisone, 40 mg/d, at the time of radioiodine
treatment, tapered over 2–3 months to prevent
exacerbation of ophthalmopathy.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
The picture of complete basilar occlusion,
however, is easy to recognize as a constellation of
bilateral long tract signs (sensory and motor) with
signs of cranial nerve and cerebellar dysfunction.
A "locked-in" state of preserved consciousness
with quadriplegia and cranial nerve signs suggests
complete pontine and lower midbrain infarction.
The therapeutic goal is to identify impending
basilar occlusion before devastating infarction
occurs.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
291
A 56 year old female developed dysphagia to both
solids and liquids from the onset. Which of the
following disorders would be most compatible with
this case?
A. Schatzki ring
B. Peptic Stricture
C. Achalasia
D. Esophageal carcinoma
E. Eosinophilic esophagitis
Intermittent dysphagia that occurs only with solid
food implies structural dysphagia, whereas
constant dysphagia with both liquids and solids
strongly suggests a motor abnormality such as in
achalasia
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
292
What is the only pharmacologic therapy
demonstrated to unequivocally decrease mortality
rates in patients with COPD ?
A. LABA
B. Corticosteroids
C. Supplemental Oxygen
D. Theophylline
E. Ipratropium
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
293
A 25 year old male, known case of Hemophilia A
with a history of multiple Factor VIII concentrate
transfusion, was admitted due to bilateral knee
swelling. Despite transfusion with adequate levels of
Factor VIII concentrate, levels of the said factor
remain to be decreased. Which of the following
statements regarding the patient's current
predicament is true?
A. It is an uncommon complication of hemophilia
treatment
B. It is a transient condition which will
spontaneously resolve
C. The laboratory test required to confirm its
presence is an aPTT mixed with a normal plasma
D. Intensive replacement therapy such as for major
surgery, intracranial bleeding, or trauma are risk
factors for the development of this phenomenon
E. Both C and D are correct
Supplemental O2 is the only pharmacologic
therapy demonstrated to unequivocally decrease
mortality rates in patients with COPD. For patients
with resting hypoxemia the use of O2 has been
demonstrated to have a significant impact on
mortality rate. Patients meeting these criteria
should be on continual oxygen supplementation,
as the mortality benefit is proportional to the
number of hours/day oxygen is used
The formation of alloantibodies to FVIII or FIX is
currently the major complication of hemophilia
treatment. The prevalence of inhibitors to FVIII is
estimated to be between 5 and 10% of all cases
and 20% of severe hemophilia A patients.
Inhibitors usually appear early in life, at a median
of 2 years of age, and after 10 cumulative days of
exposure. However, intensive replacement
therapy such as for major surgery, intracranial
bleeding, or trauma increases the risk of inhibitor
formation for patients of all ages. The clinical
diagnosis of an inhibitor is suspected when
patients do not respond to factor replacement at
therapeutic doses. .
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
288
289
290
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 41 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
FINAL EXAM FEB 2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
294
EXPLANATION
AUTHOR
Which of the following is a clinical manifestation of
secondary syphilis?
A. Condylomata lata
B. Gumma
C. Tabes dorsalis
D. Argyll Robertson Pupil
E. Chancre
In warm, moist, intertriginous areas (commonly
the perianal region, vulva, and scrotum), papules
can enlarge to produce broad, moist, pink or graywhite, highly infectious lesions [condylomata lata
(see Fig. e7-20)] in 10% of patients with
secondary syphilis.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
A 56 year old male, with no known co-morbids
presented with gradual abdominal enlargement. On
PE, the abdomen was tense with a positive fluid
wave and shifting dullness. The rest of the
examination was essentially unremarkable. A
diagnostic paracentesis was done which showed a
serum ascites albumin gradient (SAAG) of > 1.1
g/dL. Which of the following clincial conditions are
compatible with such finding?
A. TB peritonitis
B. Pancreatic ascites
C. Peritoneal carcinomatosis
D. Portal Hypertension
E. None of the above
What is the target blood pressure in chronic kidney
disease (CKD) patients with diabetes or proteinuria
of > 1g/24hr?
A. 130/85 mmHg
B. 125/75 mmHg
C. 120/80 mmHg
D. 130/80 mmHg
E. 140/90 mmHg
If SAAG <1.1: think of infection, malignancy and
nephrotic syndrome. SAAG >1.1 almost always
secondary to portal HTN
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
CKD patients with diabetes or proteinuria >1 g per
24 h, blood pressure should be reduced to 125/75,
if achievable without prohibitive adverse effects.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
A 66 year old female, known hypertensive and
diabetic, was brough to the ER due to a sudden onset
of left sided weakness. Vital signs are as follows: BP
is 120/70, PR 97, RR 20, T 36.5. Neurologic
examination showed preferential gaze to the right,
shallow left nasolabial fold, MMT of 2/5 on both left
upper and lower extremites and a positive Babinski
on the left. A plain cranial CT scan was done which
ruled out the presence of intracerebral hemorrhage.
To be considered a candidate for thrombolytic
therapy, the onset of symptoms to time of drug
administration should be less than or equal to how
many hours ?
A. 8 hours
B. 2 hours
C. 3 hours
D. 10 hours
E. 14 hours
What is the most common manifestation of diffuse
CNS lupus?
A. Headache
B. Cognitive dysfunction
C. Psychosis
D. Seizures
E. Myelopathy
The National Institute of Neurological Disorders
and Stroke (NINDS) recombinant tPA (rtPA)
Stroke Study showed a clear benefit for IV rtPA in
selected patients with acute stroke. The NINDS
study used IV rtPA (0.9 mg/kg to a 90-mg max;
10% as a bolus, then the remainder over 60
minutes) versus placebo in patients with ischemic
stroke within 3 hours of onset.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
The most common manifestation of diffuse CNS
lupus is cognitive dysfunction, including
difficulties with memory and reasoning.
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
299
A 23 year old male sought consult due to polyuria.
PE was essentially normal. Blood tests showed a
normal FBS and HBA1C. Plasma osmolality and
serum sodium were both elevated. Urinalysis was
done which showed a decreased specific gravity.
Water deprivation test was done which did not
concentrate the urine. Vasopressin was then
administered however it also failed to concentrate
the urine. What is the most likely diagnosis for this
case?
A. SIADH
B. Central diabetes insipidus
C. Psychogenic polydipsia
D. Nephrogenic diabetes insipidus
E. None of the above
If water deprivation test resulted in concentration
of urine: think of primary polydipsia. If
administration of vasopressin resulted in
concentration of urine: think of central DI
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
300
Which of the following tests can be done to
distinguish IgA nephropathy with acute post
streptococcal glomerulonephritis (APSGN)?
A. KUB ultrasound
B. Serum Creatinine
C. Lipid profile
D. CBC
E. Serum C3 level
ASPGN will present with a low C3 level while it is
normal in IgA nephropathy
ERIC ROYD
TALAVERA, MD
(TOP 1 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2015
295
296
297
298
QUESTION
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 42 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
FINAL EXAM FEB 2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
301
QUESTION
EXPLANATION
AUTHOR
the presence of rapid x+y descent in jugular venous
waveform is correlated in what cardiac condition?
A. Atrioventricular dissociation
B. Tricuspid stenosis
C. Tricuspid regurgitation
D. Constrictive pericarditis
E. Pericardial tamponade
the following are JVP abnormalities and its
correlated cardiac conditions: increase JVPCongestive heart failure; large a wave- tricuspid
stenosis, RVH, pulmonary hypertension, cannon a
wave - atrioventricular dissociation, rapid x+y
descent - constrictive pericarditis, kussmaul signpericardial tamponade, RVH, and constrictive
pericarditis; large fused cv wave - tricuspid
regurgitation. Mayo clinic IM concise textbook 1st
ed p 37
absolute contraindication for fibrinolysis in
STEMI: any prior ICH, known strucutral
cerebrovascular lesion, known malignant
intracranial neoplasm, ischemic stroke within 3
months EXCEPT acute ischemic stroke in evolution
(<3hrs), suspected aortic dissection, active
bleeding or bleeding diathesis ( excluding
menses), and significant closed head or facial
trauma.Mayo clinic IM concise textbook 1st ed p
106
thymoma is associated with the following
condition: myasthenia gravis, pure red cell aplasia,
hypogammaglobulinemia, polymyositis,SLE,
sjogren, ulcerative colitis , pernicious anemia,
scleroderma, and panhypopituitarism.
Erythrocytosis secondary to increase production
of erythropoeitin is a paraneoplastic syndrome
associated with hepatocellular carcinoma and
renal cell neoplasm.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
302
which of the following is not an absolute
contraindication for fibrinolysis in STEMI?
A. Presence of malignant intracranial neoplasm
B. Active peptic ulcer disease
C. Suspected aortic dissection
D. Concomittant ischemic stroke in evolution ( <
1hr)
E. bleeding diathesis
303
A 42 y/o female complaining of dry nonproductive
cough of 3 weeks duration. This is accompanied by
weight loss and fatigue. She is a chronic smoker with
20 pack years and an alcoholic beverage drinker. CT
scan was requested showed absence of any
suspicious lung lesion but an incidental finding of
thymoma was seen. the latter may be associated
with the following except?
A. pure red cell aplasia
B. erythrocytosis
C. hypogammaglobulinemia
D. polymyositis
E. none of the above
304
what is a recommended therapy for patients
diagnosed with metastatic renal cell carcinoma?
A. Gemcitabine containing chemotherapy
B. Radical nephrectomy with adjuvant
chemotherapy
C. Interferon gamma based therapy
D. Sorafenib
E. palliative managment.
305
An asymptomatic 64 y/o female went for consult
secondary to incidental finding of one 1.8cm sessille
villous adenoma on her transverse colon during
routine colonoscopy. What is the next step in
managing this case?
A. repeat colonoscopy after 10 years
B. abdominal CT scan with contrast
C. transverse colectomy
D. colonoscopy after 3 years
E. Reassurance
306
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM - FEB
2015
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
renal cell carcinoma is known to be resistant to
traditional chemotherapeutic agents. Cytokine
therapy with interleukin 2 or interferon gamma
produces regression only in about 10-20% of
patient with metastatic disease. recently, sunitinib
or sorafenib were proved to be superior to other
biologic based therapy and now the first line
therapy for metastatic RCC. Harrison 18th ed.
chapter 94
patients with high risk adenomatous polyp (
villous, and/or >2.5cm) should have a follow up
colonoscopy or radiographic study in 3 years. CT
scan is only done for staging once colon cancer is
diagnosed and not just by presence of polyps
alone. Routine colonoscopy after 10 years is
recommended if the initial screening is negative.
surgery is recommended if the diagnosis is colonic
malignancy.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
A 49 y/o (+) htn, (+) T2DM male was admitted at the
ICU secondary to MVA. After 5 days of
hospitalization. Patient experienced nonproductive
cough and fever. Supine CXR revealed new bibasilar
pulmonary infiltrates. urine antigen is positive for
legionella infection. which of the following
medication is not effective in this present case?
A. Levofloxacin
B. Aztreonam
C. Cotrimoxazole
D. Doxycycline
E. Clindamycin
aztreonam, beta lactams and cephalosporin are
generally ineffective in Legionella infection since
the latter is an intracellular bacteria.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
307
Which of the following is an indication for adjunct
glucocorticoids in a patient diagnosed with
Pneumocystics Jiroveci infection?
A. Aa gradient of 42mmHg
B. Acute Respiratory distress syndrome
C. pneumothorax
D. Lack of improvement after 3 days of treatment
E. all of the above
Initial antibiotic management of PCP is
characterized by worsening of condition due to
lysis of organism and immune mounted response
to the intracellular contents. adjunct
glucocorticoid administration is recommended in
moderate or severe cases of PCP infection as
determined by room air PaO2 < 70mmHg and Aa
gradient of >35mmHg.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
308
which of the following manuevers would be
expected to increase the intensity of murmur in
hypertrophic obstructive cardiomyopathy?
A. Squatting
B. Valsalva
C. handgrip
D. A and C
E. B and C
In hypertrophic cardiomyopathy, there is an
assymetric hypertrophy of the interventricular
septum, creating a dynamic outflow tract
obstruction. Maneuvers that will decrease the left
ventricular volume will increase the intensity of
the murmur. In the choices, only valsalva
maneuver will decrease the left ventricular
preload.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 43 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
309
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM - FEB
2015
Which of the following is not a potential
complication of patient who underwent massive
resection of small bowel due to superior mesenteric
artery occlusion?
A. Calcium oxalate renal stones
B. Cholesterol gallstones
C. Progressive coronary atherosclerosis
D. gastric ulcers
E. none of the above
this patient may develop short bowel syndrome
following resection of larger portion of the small
and large intestine. Multiple factors contribute to
diarrhea and steatorrhea including gastric acid
hypersecretion, increased bile acids in the small
bowel due to decreased absorption in the
remaining bowel. and lactose intolerance due to
gastric acid hypersecretion. the propensity to
develop oxalate renal stones is because of the
binding of free fatty acids in the colon to the
calcium. thus the calcium is not free to bind to
oxalate and the latter is easily absorbed in the
large intestine. The increase bile acid pool size will
yield to supersaturation of gallbladder contents
leading to cholesterol gallstones. loss of inhibitory
transmitters coming from the small intestine will
make the gastric acid secretion unchecked. there is
no relation between atherosclerosis and
shortbowel syndrome.
( SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE). Harrisons 18 th chapter
321
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
310
what is the earliest radiographic finding in
rheumatoid arthritis ?
A. Periarticular soft tissue swelling
B. joint space loss
C. Periarticular osteopenia
D. Capsular thickening
E. Subchondral erosions
311
the following statement is true about acromegaly
except?
A. Increased risk of premalignant colon polyps and
colon cancer
B. A random serum level of GH is not helpful in
establishing the diagnosis
C. Surgical excision is the treatment of choice
D. serum concentration of IGF1 is increased in only
50% of patient with active acromegaly
E. none of the above
measuring the serum concentration of IGF-1 is the
best screening test for acromegaly. It is always
increased in patient with active acromegaly.
Physiologic increased is seen in the following
condition: pregnancy, adolescence, sleep apnea.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
312
The following condition are associated with type A
gastritis except ?
A. Gastric carcinoids
B. Pernicious anemia
C. H pylori infection
D. Atrophic gastritis
E. Hypergastrinemia
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
313
which of the following is not part of the treatment
goals in diabetes mellitus according ADA?
A. HBA1c <6.5%
B. TAG <130mg/dl
C. BP <120/80mmHg
D. HDL >60mg/dl. E. All of the above
type A gastritis involves the fundus and/or body of
the stomach. It is associated with autoimmune,
atrophic gastritis and pernicious anemia. The
serum levels of gastrin since achlorydia develops
in this patient. Gastrin is potent growth factor for
the development of gastric carcinoid tumors and
gastric polyps. on the otherhand, type B gastritis
involves primarily the antrum and it is associated
with H pylori infection.
ADA treatment goals for DM: Hba1c <7.0%,
Preprandial glucose of 70-130mg/dl, postprandial
glucose <180mg/dl. BP <130/80mmHg, LDL
<100mg/dl, HDL >40mg/dl (men), >50mg/dl
(women), TAG <150mg/dl. Harrison 18th ed p
2990
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
314
Which of the following is not part of Bedside Index
of Severity in Acute Pancreatitis?
A. Confusion
B. Age >60years old
C. Prsence of pleural effusion
D. BMI > 30
E. BUN > 22mg%
BISAP scoring is predictive of hospital mortality
secondary to acute pancreatitis. The presence of 3
or more is donates a higher risk. BUN> 22mg%,
impaired mental status, SIRS 2/4, Age >60 y/o,
Pleural effusion. Harrison 18th d page 2640
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
315
which of the following drugs have a direct toxic
effect on hepatocytes ?
A. halothane
B. simvastatin
C. Acetaminophen
D. isoniazid
E. All of the above
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
316
which in the following condition is not associated
with digital clubbing?
A. hyperthryroidism
B. Hepatocellular carcinoma
C. Idiopathic pulmonary fibrosis
D. Chronic obstructive pulmonary disease
E. None of the above
drug induced liver injury can be categorized into
two types: direct toxic effect and idiosyncratic
effect. The former is predictable, dose related
pattern of injury and short time to effect duration.
The most common example is acetaminophen (
NAPQI) others are Carbon tetrachloride,
trichloroethylene,tetracycline, and amanitin.
examples of drugs that causes idiosyncratic liver
injury are the following: halothane, isothane,
isoniazid, statins and chlorpromazine.
digital clubbing is most commonly associated with
advanced lung diseases such as bronchiectasis,
cystic fibrosis, sarcoidosis, idiopathic pulmonary
fibrosis, tuberculosis, empyema , and lung abscess.
extrapulmonary causes include cyanotic
congenital heart disease, subacute bacterial
endocarditis, crohns disease, ulcerative colitis, and
untreated hyperthyroidism. COPD does not cause
clubbing.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 44 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
317
QUESTION
EXPLANATION
AUTHOR
A 47 y/o male asymptomatic presents in your clinic
with an incidental finding of WBC count 110x109 /L,
basophilia, eosinophilia and obliterated traube
space. Cytogenetic studies showed t(9,22). Which of
the following is true about his condition except?
A. the standard therapy for this condition is
Imatinib
B. leukocyte alkaline phosphatase score is low or
zero
C. increased serum Vitamin B12 level
D. philadelphia chromosome is the hallmark of this
condition
E. all of the above
the most common genetic cause of End stage Renal
disease in children and adolesence?
A. ARPKD
B. ADPKD
C. Nephronopthisis
D. Medullary cystic kidney disease
E. Medullary sponge kidney
this is a classic case of CML. Characterized by
increased WBC count, granulocytes in all stages of
maturation. Presence of philadelphia chromosome
is the hallmark for this condition. This is caused by
translocation of bcr -abl gene. Leukocyte alkaline
phosphatase ( marker of functional activity of
granulocytes) is low compared to reactive
leukocytosis. there is an increaesed Vitamin B12
level due to increased level of transcobalamin I.
Imatinib is the treatment of choice
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
Harrisons 18th ed p 2359
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
319
which of the following is not an recommended
empiric antibiotic treatment for patients diagnosed
with Healthcare associated Pneumonia and without
risk factors for MDR pathogens?
A. ceftriaxone
B. meropenem
C. moxifloxacin
D. ampicillin/sulbactam
E. none of the above
recommended empiric antibiotics for HCAP
without risk factors for MDR Pathogen ( pls see
table 257-1 Harrison 18th ed page 2130) are the
following: ceftriaxone, moxifloxacin,levofloxacin,
ciprofloxacin, ampicillin sulbactam, and
ertapenem. Harrison 18th ed p 2139 ( SIMILAR TO
PREVIOUS BOARD EXAM CONCEPT/PRINCIPLE)
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
320
minimum definition of clinically important
involuntary weight loss is?
A. >5% loss of body weight in 6-12 months
B. >10% loss of body weight in 5 months
C. >5% loss of body weight in 1 month
D. >10% loss of body weight in 6-12 months
E. none of the above
Harrison 18th ed pag 641.
LEAN ANGELO
SILVERIO, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD),
MD
BACK-UP
MIDTERM
EXAM - FEB
2015
321
What is the major symptom of acute pancreatitis?
A. abdominal pain
B. dyspnea
C. hypotension
D. abdominal tenderness
Pain is characteristically steady and boring in
character, located in the epigastrium and
periumbilical region and often radiates to the
back, chest, flank, and lower abdomen. C & D are
not symptoms, but are signs. Harrison's Principles
of Internal Medicine 18th edition, p. 2636
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
322
Supportive care measure/s that form the hallmark in
the treatment in acute pancreatitis, except:
A. bowel rest
B. hydration with crystalloid
C. analgesia
D. pancreatic enzyme supplementation
E. none of the above
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
323
The most common valvular abnormality in
rheumatoid arthritis?
A. tricupid regurgitation
B. mitral stenosis
C. mitral regurgitation
D. aortic regurgitation
Harrison's Principles of Internal Medicine 18th
edition, p. 2739
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
324
In the treatment of nongonococcal bacterial arthritis,
the following may be done, except:
A. needle aspiration
B. weight bearing
C. intravenous bactericidal agents
D. arthrotomy
Weight bearing should be avoided until signs of
inflammation have subsided, but frequent passive
motion of joint is indicated to maintain full
mobility. Arthrotomy best manages septic arthritis
of the hip in young children. Harrison's Principles
of Internal Medicine 18th edition, p. 2845
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
325
True regarding diabetic ketoacidosis, except:
A. fluid deficit is often 3-5 L
B. Insulin deficiency and glucagon excess are
necessary for its development
C. Inadequate fluid intake is the underlying cause
D. initial intravenous fluid replacement: 0.9% NSS
E. Bicarbonate replacement is not necessary.
Relative insulin deficiency and inadequate fluid
intake are underlying causes of HHS. HHS free
water deficit: 9 - 10 L. Bicarbonate replacement
often impairs heart function, decreases tissue
oxygenation, and promotes hypokalemia.
Harrison's Principles of Internal Medicine 18th
edition, p. 2977-2979
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
326
This is the single best measure of hepatic synthetic
function:
A. serum globulins
B. serum albumin
C. clotting factors
D. alkaline phosphatase
E. liver span
Serum albumin is not a good indicator of acute
hepatic dysfunction because of its slow turnover
(T1/2: 18-20 days). Alkaline phosphatase (the
liver isoenzyme) is increased in cholestasis.
Harrison's Principles of Internal Medicine 18th
edition, p. 2529-2530
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
318
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 45 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
327
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM - FEB
2015
True of Crohn disease but not true of ulcerative
colitis:
A. gross blood and mucus in stool
B. systemic symptoms
C. pain
D. recurrence after surgery
E. ANCA (+)
ANCA is more frequently associated with
ulcerative colitis. Crohn - ASCA (+) Harrison's
Principles of Internal Medicine 18th edition, p.
2486 table 295-5
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
328
True in the treatment of uric acid lithiasis, except:
A. raise urine pH above 6.5
B. lower excessive uric acid secretion
C. give supplemental alkali
D. low purine diet
E. allopurinol
Raising the urine pH above 6.5 won't provide
additional benefit but increases the risk of calcium
phosphate stone formation. Harrison's Principles
of Internal Medicine 18th edition, p. 2386
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
329
The most common hematologic abnormality in
rheumatoid arthritis is:
A. thrombocytopenia
B. neutropenia
C. thrombocytosis
D. microcytic, hypochromic anemia
E. normocytic, normochromic anemia
Harrison's Principles of Internal Medicine 18th
edition, p. 2740
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
330
Usually the earliest manifestation of
ophthalmopathy in Grave's Disease:
A. periorbital edema
B. chemosis
C. proptosis
D. excess tearing
E. diplopia
The earliest manifestations of ophthalmopathy in
Grave's Disease are usually a sensation of
grittiness, eye discomfort, and excess tearing.
Harrison's Principles of Internal Medicine 18th
edition, p. 2924
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
331
In the diagnosis of pheochromocytoma, the
measurement of this is the most sensitive and is less
susceptible to false (+) increase from stress:
A. 24hour urine VMA
B. 24hour urine metanephrines
C. plasma metanephrine
D. 24hour urine catecholamine
E. plasma catecholamine
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
332
One of the following is not a contraindication to the
administration of IV rtPA for acute ischemic stroke:
A. coma
B. GI bleed in the preceeding 21 days
C. prior stroke in 3 months
D. onset to adminstration in </= 3 hours
E. recent MI
Harrison's Principles of Internal Medicine 18th
edition, p. 3273 table 370-1
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
333
The most common cause of cerebral embolism
overall:
A. MI
B. prosthetic valve
C. rheumatic heart disease
D. nonrheumatic atrial fibrillation
E. ischemic cardiomyopathy
Harrison's Principles of Internal Medicine 18th
edition, p. 3274
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
334
The initial treatment of cirrhotic ascites is:
A. furosemide
B. restriction of salt intake
C. spironolactone and furosemide
D. transjugular intrahepatic peritoneal shunt
E. restriction of water intake
Harrison's Principles of Internal Medicine 18th
edition, p. 332
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
335
The presence of scleral icterus indicates a serum
bilirubin of at least:
A. 1 mg/dL
B. 1.5 mg/dL
C. 2 mg/dL
D. 2.5 mg/dL
E. 3 mg/dL
Harrison's Principles of Internal Medicine 18th
edition, p. 324
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
336
The hemoglobin level in patient with palmar crease
pallor is at most:
A. <11 g/dL
B. <10 g/dL
C. <9 g/dL
D. <8 g/dL
Harrison's Principles of Internal Medicine 18th
edition, p. 449
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
337
The clinical hallmark of acne vulgaris:
A. comedones
B. scarring
C. pustules
D. telangiectasias
E. papules
Harrison's Principles of Internal Medicine 18th
edition, p.404
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 46 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
338
EXPLANATION
AUTHOR
Which of the following strictly defines a fever?
A. > 41.5C
B. > 106.7F
C. AM temperature of >37.2C
D. PM temperature of >37.5C
E. none of the above
A & B pertain to hyperpyrexia. A PM temperature
of 37.7C also defines a fever. Harrison's Principles
of Internal Medicine 18th edition, p. 143
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
339
Causes of hypovolemic hyponatremia include the
following, except:
A. primary hypoaldosteronism
B. diarrhea
C. burns
D. nephrotic syndrome
E. none of the above
Nephrotic syndrome is a cause of hypervolemic
hyponatremia.
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
340
A true statement regarding potassium level
derangements:
A. Oral replacement with KCl is the mainstay of
therapy for hypokalemia.
B. Reduced tissue uptake is the most common cause
of hyperkalemia.
C. Intravenous bicarbonate is routinely used in the
treatment of hyperkalemia.
D. none of the above
What is the significance of (+) PPD?
A. Exposure to TB
B. Infection with TB
C. Active TB
D. Highly infectious TB
The use of intravenous administration should be
limited to patients unable to utilize the enteral
route or in the setting of severe complications. A
decrease in renal K excretion is the most common
underlying cause of hyperkalemia. Intravenous
bicarbonate should be reserved for patients with
hyperkalemia concomitant metabolic acidosis.
DEBBIE ROSE
TANENGSY, MD
(TOP 5 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
Sulfonylureas, especially those of the 1st
generation, are notorious for causing
hypoglycaemia.
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
C3 levels are decreased in acute PSGN
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
This is a case of hypertensive emergency for which
IV antihypertensives are indicated.
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
341
342
343
344
345
346
347
QUESTION
Why is monotherapy with isoniazid highly
discouraged in treatment of active TB?
A. Increases the risk for drug resistance
B. Has not been proven effective as
chemoprophylaxis
C. Due to hepatotoxicity
D. Increased occurrence of peripheral neuropathy if
not combined with other medications
Which autoantibody is highly specific for SLE?
A. Anti-histone
B. Anti-RNP
C. Anti-Ro/SSA
D. Anti-Sm
A newly diagnosed diabetic patient was brought to
the ER because of loss of consciousness. His CBG is
35 mg/dL. He was recently started on a medication
for diabetes by their family physician. Which is the
most likely medication given to him?
A. Thiazolidinedione
B. Sulfonylurea
C. Alpha glucosidase inhibitor
D. Metformin
A 20 year old female consults due to tea-colored
urine and bipedal edema. She had recent fever and
sore throat. Her BP is 150/90 and serum creatinine
is 1 mg/dL. C3 level is 130 mg/dL (NV = 83-177
mg/dL). What feature would suggest IgA
nephropathy over acute post-streptococcal
glomerulonephritis?
A. C3 levels
B. Bipedal
C. If the fever and cough occurred 16 days ago
D. Her blood pressure
A 45 year old lawyer came to the ER because of
headache and right sided weakness. BP was noted to
be 220/120, HR 110/bpm. Which antihypertensive
agent is recommended?
A. Clonidine sublingual
B. Esmolol IV
C. Nicardipine IV
D. Nifedipine sublingual
Which of the following is an absolute
contraindication to fibrinolytic therapy?
A. Suspected aortic dissection
B. Hypertension with SBP > 160 mmHg and/or DBP
>90 mmHg
C. Recent invasive surgical procedure (<2 weeks)
D. Prolonged CPR
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 47 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
348
349
350
QUESTION
A 20 year old female student complains of
palpitations. On PE, she has a mid systolic click
followed by a mid to late crescendo murmur at the
apex. The diagnosis is most probably:
A. Tricuspid regurgitation
B. Mitral valve prolapse
C. Mitral stenosis
D. Atrial septal defect
A 20 year old female student complains of
palpitations. On PE, she has a mid systolic click
followed by a mid to late crescendo murmur at the
apex. If she was instructed to squat, this will result
to:
A. Increase in venous return and delay in the
occurrence of the systolic click
B. Decrease in venous return and delay in the
occurrence of the systolic click
C. Increase in venous return and early occurrence of
the systolic click
D. Decrease in venous return and early occurrence of
the systolic click
What is the cardinal symptom of heart failure?
A. Fatigue
B. Orthopnea
C. Paroxysmal noctural dyspnea
D. Edema
EXPLANATION
AUTHOR
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
In MVP:
Squatting - increases venous return = delayed
systolic click = shorter murmur
Standing or Valsalva maneuver - decreases venous
return = earlier systolic click = prolonged murmur
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM - FEB
2015
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
351
What is the most useful index of LV function?
A. Stroke volume
B. End diastolic volume
C. Ejection fraction
D. End systolic volume
352
A 55 year old male, both diabetic and hypertensive,
has chronic renal failure due to diabetic
nephropathy. Which of the following findings will
most likely also be present in the patient?
A. Absence of proteinuria
B. Contracted small kidneys on ultrasound
C. Diabetic retinopathy
D. Red cell casts in the urine sediment
A 55 year old man is found to have a serum calcium
of 13 mg/dL after complaining of fatigue and thirst
for the past month. A CXR revealed a 4 cm mass in
the right lower lobe of the lung. Which of the
following is the most likely cause of his
hypercalcemia?
A. ACTH
B. ADH
C. PTH
D. PTH related protein
A 57 year old man is evaluated through endoscopy
after an episode of hematemesis. Findings showed a
3 cm duodenal ulcer. Which of the following
statements is correct regarding this finding?
A. The lesion should be biopsied because duodenal
ulcers have increased risk of carcinoma
B. Poor socioeconomic status is a risk factor for the
development of this condition
C.The patient is not at risk for any associated
cancers
D. Antral gastritis is rarely found with this condition
Which of the following is the most common
symptom or sign of liver disease?
A. Fatigue
B. Itching
C. Jaundice
D. Nausea
Diabetic nephropathy present with normal size to
enlarged kidneys on ultrasound. A patient who has
developed diabetic nephropathy most likely also
has diabetic retinopathy as well.
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
The patient’s hypercalcemia was most likely
caused by elevated levels of PTHrp, a
paraneoplastic syndrome associated with
squamous cell carcinoma.
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
Majority of ulcers are caused by Helicobacter
pylori, which is associated with poor
socioeconomic status.
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
356
In women, what is the average amount of reported
daily alcohol intake that is associated with the
development of chronic liver disease?
A. 1 drink
B. 2 drinks
C. 3 drinks
D. 6 drinks
For women, drinking more than 1 alcoholic drink
daily (so at least 2 drinks), is associated with
development of chronic liver disease. For men,
more than 2 drinks (or at least 3 drinks) is the cut
off.
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
357
A 24 year old is newly diagnosed with SLE. Which of
the following organ system complications is she
most likely to have over the course of her lifetime?
A. Cardiopulmonary
B. Renal
C. Hematologic
D. Musculoskeletal
The system most commonly involved is the
musculoskeletal system, with 95% of patients
having involvement, usually as arthralgias or
myalgias.
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
353
354
355
Reference: Harrison’s Principles of Internal
Medicine, Self-Assessment and Board Review,
18th ed.
Reference: Harrison’s Principles of Internal
Medicine, Self-Assessment and Board Review,
18th ed.
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 48 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
358
QUESTION
EXPLANATION
AUTHOR
A 32 year old woman with known SLE was noted to
have a new cardiac murmur on routine follow-up
with her rheumatologist. She is asymptomatic,
without any fever, weight loss, nor history of
previous cardiac disease. On 2D echo, a vegetation
on the mitral valve is demonstrated. Which of the
following statements is true?
A. Blood cultures are unlikely to be positive
B. Steroid therapy has been proven to improve this
condition
C. Pericarditis is frequently present concomitantly
D. The lesion has a low risk of embolisation
A 45 year old man reports to his physician that his
wife noted coarsening of his facial features over
several years. In addition, he also reports low libido
and energy. PE shows frontal bossing and enlarged
hands. An MRI confirms that he has a pituitary mass.
Which of the following screening tests should be
ordered to diagnose the cause of the mass?
A. 24 hour urinary free cortisol
B. ACTH assay
C. Growth hormone level
D. Serum IGF-1 level
Which of the following proteins is the primary
source of bound T4 in the plasma?
A. Albumin
B. Gamma globulin
C. Thyroid peroxidase
D. Thyroxine-binding globulin
Diagnosis is Libman-Sacks endocarditis, known for
having sterile vegetations because it’s not thought
to be due to microbial infection.
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
GH is secreted in a highly pulsatile fashion,
therefore obtaining a random sample is not
reliable. IGF-1, the downstream mediator of GH, is
used as a marker instead.
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
JESSICA MAE
SANCHEZ, MD
(TOP 4 - AUG 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
361
The classic lesion of a secondary
hyperparathyroidism in patients with CKD which is
associated with high bone turnover
A. Calciphylaxis
B. Osteitis fibrosa cystica
C. Adynamic bone disease
D. Osteomalacia
E. None of the above
The major disorders of bone disease can be
classified into those associated with high bone
turnover with increased PTH levels (including
osteitis fibrosa cystica, the classic lesion of
secondary hyperparathyroidism) and low bone
turnover with low or normal PTH levels
(adynamic bone disease and osteomalacia). HPIM
18th pg 2313
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
362
Which of the following is/are TRUE regarding
pulmonry embolism?
A. About half of patietns with pelvic vein thrombosis
or distal leg deep venous thrombosis develop
pulmonary embolism
B. Isolated calf vein thrombi pose a much lower risk
of pulmonary embolism but are the most common
source of paradoxical embolism
C. The msot common gas exchange abnormalities are
hypercarbia and an increased alveolar oxygen
gradient
D. Progressive left sided heart failure is the usual
cause of death in PE
E. All are TRUE
The extrapulmonary site LEAST commonly involved
in TB is/are the
A. Lymph nodes
B. Peritoneum
C. Bones and joints
D. Meninges
E. Pericardium
A: proximal leg DVT; C: hypoxemia (decreased
arterial PO2) and an increased alveolar-arterial O2
tension gradient, which represents the inefficiency
of O2 transfer across the lungs; D: right sided
heart failure HPIM 18th pg 2171
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
In order of frequency, the extrapulmonary sites
most commonly involved in TB are the lymph
nodes, pleura, genitourinary tract, bones and
joints, meninges, peritoneum, and pericardium.
HPIM 18th pg 1346
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
364
In a patient with paroxysmal nocturnal
hemoglobinuria, their RBCs are deficient in which of
the following surface proteins?
A. CD4 and CD8
B. CD55 and CD59
C. CD51 and CD55
D. CD19 and CD21
E. All of the above
The definitive diagnosis of PNH must be based on
the demonstration that a substantial proportion of
the patient's red cells have an increased
susceptibility to complement (C), due to the
deficiency on their surface of proteins
(particularly CD59 and CD55) that normally
protect the red cells from activated C. HPIM 18th
pg 884
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
365
Most common complication of PUD?
A. Gatric outlet obstruction
B. Perforation
C. Bleeding
D. B and C
E. All of the above
Perforation - 2nd most common; outlet
obstruction - least common HPIM 18th pg 2445
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
366
The following are used in the management of
bronchiectasis EXCEPT?
A. Antibiotics
B. Mucolytic agents
C. Bronchodilators
D. Surgery
E. No exception
Treatment of infectious bronchiectasis is directed
at the control of active infection and
improvements in secretion clearance and
bronchial hygiene so as to decrease the microbial
load within the airways and minimize the risk of
repeated infection. For refractory cases surgery
can be considered, with resection of a focal area of
suppuration. In advanced cases, lung
transplantation can be considered. HPIM 18th pg
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
359
360
363
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 49 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
2143-2144
367
A 55-year old male smoker came to you for chronic
cough with associated sputum production and
exertional dyspnea. He experienced these symptoms
for years but appeared to be worsening. On PE, you
noted a prolonged expiratory phase and wheezing.
Physical findings of advanced disease include the
following EXCEPT?
A. Systemic wasting
B. Bitemporal wasting
C. Hoover’s sign
D. Clubbing of digits
E. No exception
Advanced disease may be accompanied by
systemic wasting, with significant weight loss,
bitemporal wasting, and diffuse loss of
subcutaneous adipose tissue. Some patients with
advanced disease have paradoxical inward
movement of the rib cage with inspiration
(Hoover's sign), the result of alteration of the
vector of diaphragmatic contraction on the rib
cage as a result of chronic hyperinflation. HPIM
18th pg 2156
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
368
The most discriminating symptom of duodenal
ulcers is?
A. Epigastric pain awakening patient from sleep
B. Burning gnawing epigastric pain
C. Epigastric pain 90 minutes to 3 hours after a meal
D. Epigastric pain relieved by antacids or food
E. Nausea and vomiting
Pain that awakes the patient from sleep (between
midnight and 3 a.m.) is the most discriminating
symptom, with two-thirds of DU patients
describing this complaint HPIM 18th pg 2445
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
369
What is the most common form of diabetic
neuropathy?
A. Proximal symmetric polyneuropathy
B. Proximal asymmetric polyneuropathy
C. Distal symmetric polyneuropathy
D. Distal asymmetric polyneuropathy
E. None of the above
The most common form of diabetic neuropathy is
distal symmetric polyneuropathy. It most
frequently presents with distal sensory loss, but
up to 50% of patients do not have symptoms of
neuropathy. HPIM 18th pg 2984
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
370
Amiodarone can have which of the following effect/s
on thyroid function?
A. Chronic suppression of thyroid function
B. Suppression of autoimmune Grave’s disease
C. Thyrotoxicosis caused by a Jod-Basedow effect
D. Hypothyroidism in patients susceptible to the
stimulatory effects of a high iodine load
E. None of the above
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
371
A 45/F presented to you with a two week history of
fever, jaw pain and sore throat. Further history
revealed that, she had a flu-like illness a few weeks
prior to the onset of sore throat. On PE, patient is
febrile, with an apparent neck mass. Upon palpation,
there was tenderness on the anterior neck area.
Which of the following is/are TRUE?
A. The most common cause of acute thyroiditis is
due to the presence of a piriform sinus, a remnant of
the third branchial pouch.
B. A long standing goiter and degeneration in a
thyroid malignancy are risk factors in the young
C. Patient’s condition is also termed as de Quervain’s
thyroiditis, granulomatous thyroiditis or viral
thyroiditis
D. A specific viral etiology is usualy identifiable
E. None of the above
Hyperuricemia is a common adverse effect of which
anti-TB medication?
A. Isoniazid
B. Rifampicin
C. Pyrazinamide
D. Ethambutol
E. Streptomycin
Amiodarone has the following effects on thyroid
function: (1) acute, transient suppression of
thyroid function; (2) hypothyroidism in patients
susceptible to the inhibitory effects of a high
iodine load; and (3) thyrotoxicosis that may be
caused by either a Jod-Basedow effect from the
iodine load, in the setting of MNG or incipient
Graves’ disease, or a thyroiditis-like condition.
HPIM 18th pg 2930
Acute thyroiditis is rare and due to suppurative
infection of the thyroid. In children and young
adults, the most common cause is the presence of
a piriform sinus, a remnant of the fourth branchial
pouch. Subacute thyroiditis is also termed de
Quervain’s thyroiditis, granulomatous thyroiditis,
or viral thyroiditis. Many viruses have been
implicated, including mumps, coxsackie, influenza,
adenoviruses, and echoviruses, but attempts to
identify the virus in an individual patient are often
unsuccessful and do not influence management.
HPIM 18th ed pg 2927-2928
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
Hyperuricemia is a common adverse effect of
pyrazinamide therapy that usually can be
managed conservatively. Clinical gout is rare.
HPIM 18th ed pg 1376
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
Idiopathic TTP is related to a deficiency of, or
antibodies to the metalloprotease ADAMTS13, that
cleaves VWF. VWF is normally secreted as ultralarge multimers, which are then cleaved by
ADAMTS13. The persistence of ultra-large VWF
molecules is thought to contribute to pathogenic
platelet adhesion and aggregation HPIM 18th pg
969
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
372
373
The pathogenesis of idiopathic TTP is related to a
deficiency of, or antibodies to:
A. ADAMTS13
B. von Willebrand factor
C. GpIb-IX-V
D. Gp IIb-IIIa
E. Platelets
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 50 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
374
EXPLANATION
AUTHOR
What is the signature tachycardia of patients with
significant pulmonary disease?
A. Atrial flutter
B. Multifocal atrial tachycardia
C. Ventricular premature complexes
D. Atrial premature complexes
E. Atrioventricular Junctional Tachycardias
Multifocal AT (MAT) is the signature tachycardia
of patients with significant pulmonary disease.
The atrial rhythm is characterized by at least three
distinct P-wave morphologies and often at least
three different PR intervals, and the associated
atrial and ventricular rates are typically between
100 and 150 beats per minute. HPIM 18th pg 1886
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
375
Metabolic syndrome can be diagnosed by fulfilling 3
or more of the criteria defined by the NCEP:ATPIII in
2001. Which of the following parameters can
following can satisfy the criteria?
A. TG level of 120 on fenofibrate
B. HDL < 40 mg/dL for males
C. BP reading of 120/90
D. B and C
E. All of the above
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
376
An obese 34/M presents with crushing chest pain
after having a fight with his partner. He was
immediately brought to the ER and an ECG was done
which showed ST-segment depression on V1-V6.
After 30 minutes, the pain eventually subsided. A
coronary angiogram was subsequently done which
showed no abnormalities. What is your diagnosis?
A. Prinzmetal variant angina
B. Cardiac syndrome X
C. Unstable angina
D. NSTEMI
E. None of the above
Central obesity: Waist circumference >102 cm
(M), >88 cm (F)
Hypertriglyceridemia: Triglycerides ≥150 mg/dL
OR specific medication
Low HDL cholesterol: <40 mg/dL and <50 mg/dL,
respectively, OR specific medication
Hypertension: Blood pressure ≥130 mm systolic
OR ≥85 mm diastolic OR specific medication
Fasting plasma glucose ≥100 mg/dL or specific
medication OR previously diagnosed Type 2
diabetes
Cardiac syndrome X is used to describe patients
with angina-like chest pain and ischemicappearing ST-segment depression during stress
despite normal coronary arteriograms. Some data
indicate that many such patients have limited
changes in coronary flow in response to pacing
stress or coronary vasodilators. Prinzmetal angina
would show ST-segment elevation during an
episode HPIM 18th pg 102 & 2020
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
377
Absolute contraindications to fibrinolytic therapy in
STEMI include which of the following?
A. Elevated BP of >220 mmHg systolic and/or >110
mmHg diastolic at any time during the acute
presentation
B. History of a nonhemorrhagic stroke within the
last two years
C. Active internal bleeding including menses
D. A and B
E. None of the above
BP >180mmHg/ > 110mmHg at any time during
acute presentation; history of hemorrhagic CVD at
any time of nonhemorrhagic CVD within the past
year; active internal bleeding excluding menses;
suspicion of aortic dissection HPIM 18th 2028
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
378
Hemoptysis from tuberculosis results from:
A. erosion of a blood vessel in the wall of a cavity
B. rupture of a dilated vessel in a cavity
C. aspergilloma formation
D. A and B
E. All of the above
Hemoptysis develops in 20–30% of cases, and
massive hemoptysis may ensue as a consequence
of the erosion of a blood vessel in the wall of a
cavity. Hemoptysis, however, may also result from
rupture of a dilated vessel in a cavity
(Rasmussen’s aneurysm) or from aspergilloma
formation in an old cavity. HPIM 18th 1345
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
379
Tthe following can precipitate acute
decompensation in patients with CHF EXCEPT?
A. Liver failure
B. NSAID use
C. Infection
D. Pregnancy
E. No exception
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
380
Which of the following is/are TRUE regarding
ankylosing spondylitis (AS)?
A. Associated with HLA-B25
B. Outer annular fibers are eroded and eventually
replaced by bone ultimately bridging the adjacent
vertebral bodies
C. NSAIDs are the first line of pharmacologic therapy
for AS.
D. B and C
E. All of the above
What is the recommended duration of treatment for
extrapulmonary tuberculosis?
A. 6-9 months
B. 9-12 months
C. 12-15 months
D. 15-18 months
E. 2 years
Factors That May Precipitate Acute
Decompensation in Patients With
Chronic Heart Failure include dietary indiscretion,
myocardial ischemia/infarction, arrhythmias
(tachycardia or bradycardia), discontinuation of
HF therapy, infection, anemia, initiation of
medications that worsen HF: {Calcium antagonists
(verapamil, diltiazem), Beta blockers,
Nonsteroidal anti-inflammatory drugs,
antiarrhythmic agents [all class I agents, sotalol
(class III)] Anti-TNF antibodies}, alcohol
consumption, pregnancy, worsening hypertension
and acute valvular insufficiency HPIM 18th pg
1907
Associated with HLA B27; B - The outer annular
fibers are eroded and eventually replaced by bone,
forming the beginning of a syndesmophyte, which
then grows by continued endochon- dral
ossification, ultimately bridging the adjacent
vertebral bodies. Ascending progression of this
process leads to the “bamboo spine.” HPIM 18th
pg 2774 and 2777
MAIRRE JAMES
GADDI, MD (TOP 4
- AUG 2013 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. Extrapulmonary
tuberculosis is generally treated with anti-Koch's
regimen for 6-9 months, except for CNS
tuberculosis, which is treated for 9-12 months.
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
381
QUESTION
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 51 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
382
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM - FEB
2015
Which of the following ECG findings is consistent
with hyperkalemia?
A. Tall, peaked T wave
B. Widened QRS complex
C. Prolonged PR interval
D. Appearance of sine waves
E. All of the above
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
383
Which of the following acid-base abnormalities
would you expect to see in a patient sufferring from
aspirin toxicity?
A. High anion gap acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
E. Both A and D
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
384
Which of the following drugs constitute the
cornerstone of treatment for congestive heart
failure?
A. ACEI and digoxin
B. Furosemide and ACEI
C. ACEI and beta blocker
D. aspirin and digoxin
E. beta blocker and thiazide
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
385
Which of the following CNS diseases are
characterized by a pathologic triad of demyelination,
inflammation and gliosis?
A. Ischemic stroke
B. Parkinson's disease
C. Multiple sclerosis
D. Guillain-Barre syndrome
E. Progressive multifocal leukoencephalopathy
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE.
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
386
A 56-year old obese male was admitted for STelevation myocardial infarction. On his 7th hospital
day, he was referred for sudden decrease in
sensorium, hypotension and irregular pulses. You
suspected a reinfarction. Which of the following
cardiac enzyme would confirm your diagnosis?
A. CK-MB
B. Troponin I
C. Lactate dehydrogenase
D. AST
E. Myoglobin
CK-MB returns to normal in 2-3 days following a
myocardial infarction. New-onset elevation may
indicate reinfarction.
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
387
Among patients with prosthetic valves, which of the
following organisms is the most common cause of
infective endocarditis
A. Staphylococcus aureus
B. viridans streptococci
C. enterococci
D. Staphylococcus epidermidis
E. beta-hemolytic streptococci
IV drug user and right-sided acute IE: S. aureus.
Native valves and left-sided subacute IE: viridans
streptococci. Prosthetic valves: S. epidermidis. GI
malignancy: enterococci.
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
388
Which of the following is the most commonly
involved organ in sarcoidosis?
A. Skin
B. Heart
C. Lung
D. Kidney
E. Liver
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE.
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
389
Which of the following imaging findings would be
most consistent with sarcoidosis?
A. Enlarged mass of confluent lymph nodes in the
anterior mediastinum
B. Bilateral symmetric hilar and mediastinal
lymphadenopathy with discrete node enlargement
C. Bilateral asymmetric hilar lymph node
enlargement, usually more pronounced on the right
D. A conglomerate mass of lymph nodes in the
bilateral hila
E. Any of the above can suggest sarcoidosis
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE.
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
390
Graham-Steel murmur is characteristically heard in
which of the following conditions?
A. Pulmonic regurgitation
B. Tricuspid regurgitation
C. Aortic regurgitation
D. Mitral stenosis
E. Ventricular septal defect
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 52 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
391
QUESTION
EXPLANATION
AUTHOR
Among elderly patients, which of the following is the
most common cause of lower GI bleeding?
A. Diverticulosis
B. Colorectal cancer
C. Anal fissure
D. Ulcerative colitis
E. Amoebic colitis
However, colorectal cancer is the most worrisome
cause of lower GI bleeding and must first be ruled
out in any elderly patient with such complaint.
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
392
A 26-year old patient presented with 1-month
history of productive cough with associated weight
loss and night sweats. Chest radiograph showed
minimal reticulonodular infiltrates in the right lung
apex. Sputum examinations were all negative
despite adequate sputum collection. You began the
patient on a 7-day regimen of amoxicillin therapy
However, symptoms persisted despite good
compliance. You then decided to start him on antiKoch's treatment. Under WHO guidelines, the patient
is classified as:
A. Category I
B. Category II
C. Category III
D. You should have ordered TB culture first.
E. You should have started the patient on another 7day trial with azithromycin.
Category III: new smear (-) without extensive
parenchymal disease
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
393
Which of the following clinical features would
warrant a classifcation of moderate-risk communityacquired pneumonia?
A. RR 24 breaths/min
B. HR 100 beats/min
C. Temperature 38.0oC
D. Bilateral lung infiltrates on chest radiograph
E. All of the above
Criteria for moderate-risk CAP: RR > 30, HR >125,
BP < 90/60, T <36 or >40, altered mental state,
decompensated comorbidity, suspected
aspiration, multilobar infiltrate, pleurall effusion,
abscess formation
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
394
Which of the following laboratory parameters would
suggest pre-renal etiology for azotemia?
A. BUN:creatinine ratio > 20
B. FeNa > 2%
C. Urine osmolarity < 350 mOsm/kg
D. Urine:plasma creatinine ratio < 20
E. All of the above
The other parameters suggest an intrinsic renal
etiology.
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
395
Which of the following laboratory findings are
consistent with tumor lysis syndrome?
A. Hyperkalemia
B. Hyperphosphatemia
C. Hyperuricemia
D. Hypocalcemia
E. All of the above
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
396
At what stage of chronic kidney disease will you
expect to fiirst see normocytic, normochromic
anemia?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
E. Stage V
Normocytic, normochomic anemia can be seen as
early as stage III CKD and is universal by stage IV.
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
397
Which of the following bacteria is known as the most
common etiologic agent in spontaneous bacterial
peritonitis?
A. Bacteroides fragilis
B. Enterococcus faecalis
C. Escherichia coli
D. viridans streptococci
E. Enterobacter spp.
Empiric drug of choice for SBP: cefotaxime
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
398
The presence of bifid pulse is associated with which
of the following conditions?
A. Cardiac tamponade
B. Aortic regurgitation
C. Aortic stenosis
D. Pericarditis
E. Hypertrophic obstructive cardiomyopathy
Cardiac tamponade: pulsus paradoxus, pulsus
alternans. Aortic stenosis: pulsus parvus et tardus.
Aortic regurgitation: wide pulse pressure.
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 53 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
399
QUESTION
EXPLANATION
AUTHOR
In a patient who has recently recovered from an
episode of rheumatic fever without any sequelae,
prophylactic treatment with benzathin penicillin 1.2
units IM every 2-4 weeks is recommended until
when?
A. For 3 years after attack or until 21 years old
B. For 5 years after attack or until 21 years old
C. For 10 years after attack or until 21 years old
D. For 10 years after attack or until 40 years old
E. For 15 years after attack or until 40 years old
RF without carditis: 5 years after attack or until 21
years old. RF with mild carditis: 10 years after
attack or until 21 years old. RF with moderate to
severe carditis: 10 years after attack or until 40
years old, or even lifetime
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
400
Which of the following is a posthepatic etiology for
portal hypertension?
A. Congenital hepatic fibrosis
B. Alcoholic liver cirrhosis
C. Schistosomiasis
D. Budd-Chiari syndrome
E. Portal vein thrombosis
Options A-C are intrahepatic causes. Option E is a
prehepatic cause.
SCOTT RILEY ONG,
MD (TOP 5 - AUG
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM - FEB
2015
401
A patient came to you with recurrent anal fistula,
you noted on her radiologic studies that there are
noticeable "skip lesions". Which of the following
medications may be given to the patient?
A. Sulfadiazine
B. Sulfasalazine
C. Sulfamethoxazole
D. Salicylic Acid
E. Mycophenolate mofetil
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
402
A 40 year old asymptomatic patient has just
completed 1 week treatment for CAP-moderate risk,
Upon follow-up you requested a Chest Xray still with
noted lobar infiltrates. What would be your next step
of management?
A. Extend antimicrobial therapy
B. Change antimicrobial therapy to a broader
spectrum
C. Consider PTB
D. Re-admit, do sputum culture and sensitivity and
do re-treatment
E. None of the above
You encountered an ECG tracing with ST elevations
in all leads. What will be your primary
consideration?
A. Inferior wall MI
B. High lateral wall MI
C. Anterior Wall MI
D. Pancardiac MI
E. None of the above
Patient is already asymptomatic, CXR findings in a
CAP treated patient takes 4-12 weeks to clear.
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
Diffuse ST elevation is seen in Pericarditis.
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
404
A chest Xray was done in a patient with severe
dyspnea, the radiologic report stated a noticed
Hampton's Hump above the diaphragm. What would
be your next step of management?
A. Antibiotic therapy
B. Further investigation for a primary malignancy
C. Refer to surgery for immediate removal
D. Fibrinolytic therapy
E. Give a bronchodilator with Corticosteroids
Hampton's Hump is a peripheral wedge shaped
density on CXR, usually above the diaphragm seen
in Pulmonary embolism
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
405
Metabolic Syndrome is defined using the following
criteria, EXCEPT:
A. Waist line more than 40 in in Males
B. TG> 200 mg/dL
C. HDL less than 40mg/dl in Males
D. BP >/= 130/ >/= 85
E. FBS >100 mg/dL
TG >150 mg/dL is more proper.
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
406
A patient with a history of RHD came in with a 2d
Echocardiography result revealing an Aortic
Regurgitation, upon your physical examination you
noticed that the patient's Upper extremity BP was
140/100 while his Lower extremity BP was 100/70.
This sign is termed as a:
A. Hill's Sign
B. Demusset's Sign
C. Quincke's Sign
D. Corrigan's Sign
E. Duroziez's Sign
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
407
Transfusion-associated Viral Hepatitis is due to:
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
E. Hepatitis E
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
403
Although both Hepatitis B and C can be
transmitted thru blood transfusion, Hepatitis C is
more associated with blood transfusions.
(SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE)
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 54 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM - FEB
2015
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
408
QUESTION
An elderly female patient is suffering from
occasional arthralgias on her right knee, the
Rheumatologist performed arthrocentesis with
microscopic findings of rhomboid and rod-like
crystals with weak positive birefringence, which of
the following would be the Rheumatologist's
primary consideration?
A. Gout
B. Pseudogout
C. Rheumatoid Arthritis
D. Acute Bacterial Arthritis
E. Osteoarthritis
409
Which of the following is NOT a risk factor for
OSTEOPOROSIS?
A. Family History
B. s/p TAHBSO
C. Injury
D. Obesity
E. Age
410
A patient undergoing therapy for Crohn's Disease,
had a reactivation of his Latent TB, what Drug may
have been responsible?
A. Rituximab
B. Sulfasalazine
C. 5-ASA
D. Infliximab
E. Alosetron
411
EXPLANATION
The description is compatible with CPPD crystals
of Pseudogout.
AUTHOR
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - AUG
2014
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
A patient with manifestations of Cushing's
Syndrome, to determine the source of his disease a
Dexamethasone Suppression Test was done: Cortisol
Levels were not suppressed by Low dose
Dexamethasone meanwhile High Dose
Dexamethasone suppressed Cortisol levels. What is
the probable primary disease?
A. Pituitary CS
B. Adrenal CS
C. Ectopic CS
D. Exogenous Steroid Use
E. Addison's Disease
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
412
This heart sound, coincides with early diastole or
rapid ventricular filling, commonly seen in a dilated
cardiomyopathy:
A. S1
B. S2
C. S3
D. S4
E. C and D
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
413
Among which of the following thyroid function tests
is most accurate in diagnosing Hyperthyroidism?
A. TSH
B. TRH
C. Total T3
D. Free T4
E. Calcitonin
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. The free fraction of
Thyroid hormines is the "true" Thyroid level.
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
414
To prevent Nitroglycerin tolerance which of the
following should be done?
A. Increase dose of NTG
B. Stop NTG for 6-8 hours a day
C. Decrease Dose of NTG
D. Replace NTG with Sodium Nitroprusside
E. Do Nitroglycerin desensitization
a 6-8-hour NTG free period every 24 hours will
prevent NTG tolerance.
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
415
Which of the following is not seen in Diabetes
insipidus?
A. Increased Urine osmolality after water
deprivation test
B. Random Urine Specific gravity of 1.005
C. Serum osmolality of 390 mOsm/L
D. No response to desmopressin
E. Specific Gravity of 1.030 after HCTZ
administration
The following are characteristics of a Type I Diabetes
mellitus, EXCEPT:
A. Islet Amyloid Deposit on histology
B. Associated with HLA system
C. Severe Glucose intolerance
D. Decreased C-peptide levels
E. Weak genetic predisposition
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. A: urine osmolality should
not increase after water deprivation test; B and C
are both seen in DI; D and E are seen in a
nephrogenic type of Diabetes insipidus.
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
Based on USMLE step 1.
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
416
a TNF-alpha inhibitor prevents granulation
formation hence reactivation of TB occurs.
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 55 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
417
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - AUG
2014
SIADH presents with the following, EXCEPT:
A. Excessive water retention
B. Maybe seen in Lung Cancer
C. Hyponatremia
D. Serum osmolarity more than the urine
osmolarity
E. Treated with Demeclocycline
Serum osmolarity should be less than the urine.
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
418
A patient presenting with a Parathyroid adenoma,
Prolactinoma, and Insulinoma, with several stomach
ulcers and a history of Urolithiasis is presenting with
what syndrome?
A. MEN 1
B. MEN 2A
C. MEN 2B
D. Sipple's Syndrome
E. Simmond's Syndrome
PPP(parathyroid, Pituitary and Pancreatic tumors)
are seen in MEN 1 or Wermer's Syndrome.
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
419
A woman on maintenance for Hyperthyroidism
unknowingly became pregnant. After giving birth,
the Pediatrician told her that her child has Aplasia
cutis congenita. What drug was responsible?
A. PTU
B. Methimazole
C. Propranolol
D. I 131
E. Lugol's Iodine
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
420
What stage of Pneumonia corresponds with a
predominance of macrophages?
A. Edema
B. Red hepatization
C. Gray hepatization
D. Resolution
E. None of the above
the resolution phase is described with a
predominance of macrophages and cessation of
inflammatory response.
JOSE CARLO
MASANGKAY III,
MD (TOP 8 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2014
421
A chest radiograph showing "water bottle" sign,
suggesting a multichambered heart enlargement is
most consistent with:
A. Cardiac tamponade
B. Myocardial infarction
C. Endocarditis
D. Congestive heart failure
*IM is much like an "anything under the sun" type
of exam. It will test your ability to integrate the
basic subjects (biochem, physio, ana, patho,
pharma) into clinical perspective. But again, just
similar with the other subjects, it has many
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLEs (not really of IM, but of
physio, pharma, etc) and very few case analysis.
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
422
The anti-TB drug which is found to be more active
against slowly replicating bacilli and is known to
cause hyperuricemia in some TB patients is:
A. Isoniazid
B. Rifampicin
C. Pyrazinamide
D. Ethambutol
Must know some notable side effects of anti-TB
drugs: Hepatotoxicity (H>R>Z); GI upset, orange
urine, flu-like, anemia, thrombocytopenia
(Rifampicin); Ototoxicity, vestibular impairment,
local irritation due to injection (Streptomycin);
Peripheral neuropathy, psychosis, convulsion
(Isoniazid); Optic neuritis (Ethambutol)
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
423
The recognized primary mediator of bronchial
asthma:
A. Histamine
B. Acetylcholine
C. Dust mites
D. Slow reacting substances of anaphylaxis
SRSA are leukotrienes C4, D4, E4. Histamine,
although associated with hypersensitivity states, is
not a mediator of asthma, and hence antihistamines are not used as reliever or controller
for asthma. Dust mites are not mediators, but
triggers.
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
424
Of the following clinical findings, which will
differentiate diffuse systemic scleroderma from the
CREST variant?
A. Hands turning painful and white or blue in the
cold
B. Distal skin thickening
C. Renal involvement
D. Esophageal dysmotility
E. All of the above
This urinalysis finding is pathognomonic of an endstage renal disease; a very poor prognostic sign:
A. Hyaline casts
B. "Coffin lid" crystals
C. Broad waxy casts
D. Oil droplets
The CREST syndrome includes subcutaneous
calcinosis, Reynaud's phenomenon (choice A),
esophageal dysmotility, sclerodactyly and
telangiectasia (also present in the systemic type
but less common). Another defining finding in
systemic sclerosis is that its pulmonary
involvement is most likely to be severe than in
CREST.
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
Broad waxy casts suggest presence of significant
tubular degeneration and implies a poor
prognosis. Hyaline casts are composed almost
entirely of Tamm-Horsfall protein and a 0-2/lpf
count is considered normal; increased amounts
are found during exercise, fever, dehydration, and
heart failure. Coffin lid crystals are typical of triple
phosphate. Oil droplets on the other hand, may
only be artefactual during urinalysis.
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
425
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 56 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
426
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 1
EXAM - AUG
2014
The Chinese restaurant syndrome, a condition
characterized by burning and tightness in the upper
body accompanied by diaphoresis, nausea, flushing
and cramps is attributed to:
A. Monosodium glutamate intoxication
B. Puffer fish poisoning
C. Fried rice (Yangchow) contaminated with
enteric bacteria
D. Rancid cooking oil poisoning
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
427
A 26 year-old male came in for consult due to painful
urethral discharge. He admits sexual promiscuity
and practice of unsafe sex. Which of the following
infectious agents most likely accounts for his
condition?
A. Treponema
B. Chlamydia
C. Trichomonas
D. Granuloma inguinale
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
428
Which of the following statements about insulin
synthesis and secretion is not true?
A. Blood glucose level of >70 mg/dl stimulates
insulin synthesis.
B. Glucose phosphorylation by glucokinase is the
rate-limiting step in glucose-regulated insulin
secretion.
C. Glucose is transported to the pancreatic beta
cells by an active glucose transport.
D. All of the above
E. None of the above
Glucose stimulation of insulin secretion starts with
entry of glucose molecules into pancreatic beta
cells by means of a facilitative glucose transporter
(GLUT 2). Options A and B are true. (HPIM, DM
Chapter 18th edition)
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
429
A 32 year-old man was found to have chronic fatigue
and AST elevations 4x the upper limit. He had a
series of blood transfusions 4 years ago in a
secondary hospital in a remote island due to
vehicular trauma. Vascular biopsy was done and
showed polyarteritis. Which of the following is the
most likely cause of his condition?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis D
Hepatitis B is associated with polyarteritis (PAN).
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
430
A 63 year-old previous MI male patient was seen at
the emergency room after experiencing severe
abdominal pain that is out of proportion from
physical findings. On exam he has soft abdomen with
hypoactive bowels. An abdominal radiograph
reveals 'thumbprinting" or bowel loops. Which of
the following is consistent with the most likely
diagnosis?
A. Metabolic alkalosis is also present.
B. CBC will show leukopenia but with relative
increase in bands.
C. There is involvement of the superior mesenteric
artery.
D. Barium enema can be used to reverse the
condition.
E. None of the above.
Which of the following drugs can cause acute
pericarditis?
A. Isoniazid
B. Hydralazine
C. Procainamide
D. All of the above
This is a case of acute mesenteric ischemia which
is more common in patients with history or
evidence of arterial vascular compromise
including MI and peripheral arterial diseases. The
superior mesenteric artery is usually affected.
"Thumbrpinting" or bowel looping is a common
finding in Xrays. Patients will often have
abdominal PE findings that are relatively benign
compared with the patient's symptoms. Metabolic
acidosis will usually be present as well.
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
The best way to confirm the diagnosis of aortic
stenosis is by performing:
A. An electrocardiogram
B. An echocardiogram
C. An exercise stress test
D. A radionuclide ventriculogram
Echo study with Doppler can detect the valvular
problem, quantify its severity and assess left
ventricular function. Although a ventriculogram
can tell about ventricular function, it cannot assess
disease severity. ECG is non-specific whereas a
stress test is contraindicated in symptomatic
patients.
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
431
432
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 57 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
433
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 1
EXAM - AUG
2014
A 60 year-old hypertensive male patient came in for
regular follow-up. He has no new complaints except
for easy fatigability and weakness. On examination,
there is no hepatomegaly or jaundice but there is
pallor. CBC was ordered showing a hemoglobin of 9
g/dl with MCV less than 80 fl. Liver function tests
and iron studies were all normal. The next
procedure that should be performed is:
A. Colonoscopy
B. Bone marrow aspirate
C. Bone scan
D. Liver biopsy
Any elderly male patient, who has anemia
especially if its microcytic, and does not have a
demonstrable source of anemia warrants
investigation for a colonic mass or tumor (for
occult blood loss). And in this case, the best test
will be a colonoscopy.
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
434
A liver function panel shows: NORMAL AST, ALT,
and LDH; LOW total protein and albumin; HIGH
bilirubin and ammonia. The most likely hepatic
condition based on these lab results pattern is:
A. Hepatitis
B. Biliary obstruction
C. Passive hepatic congestion
D. Cirrhosis
E. None of the above
Cirrhosis is the most consistent. There is
considerable destruction of hepatocytes in
cirrhosis which can lead to "normal" hepatic
enzymes (AST, ALT) in the blood, in contrast to
elevated levels as seen when there is on going
destruction of liver cells (hepatitis). The
destruction of hepatocytes also leads to
diminished synthesizing functions of the liver (low
proteins/albumin, low coagulation factors);
similarly, its ability to detoxify and excrete wastes
is also compromised (high bilirubin and
ammonia).
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
435
Evidence of pulmonary embolism may also be seen
through a chest radiograph. A sign where there is a
peripheral wedge-shaped density above the
diaphragm is known as:
A. Westermark's
B. Palla's sign
C. Humpton's
D. McConnell's
E.
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
436
Which of the following pleural fluid analysis findings
is consistent with a transudative effusion?
A. PF pro-BNP of >1500 pg/ml
B. Loculated PF
C. PF pH <7.2
D. Positive culture
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
437
Chvostek's sign is seen in:
A. Hypocalcemia
B. Hypercalcemia
C. Hypermagnesemia
D. Hyperkalemia
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
438
In which conditions is a thyroid bruit may be
present?
A. Ectopic thyroid gland
B. Thyroglossal duct cyst
C. Infectious thyroiditis
D. Grave's disease
Grave's disease renders the thyroid gland
hypervascular, which is responsible for the
turbulent blood flow producing the bruit. It is best
heard on the lateral lobes of the thyroid.
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
439
The stigmata of liver cirrhosis include all of the
following except:
A. Testicular atrophy
B. Spider angiomata
C. Gynecomastia
D. Esophageal varices
E. None of the above
Choosing the best answer, presence of esophageal
varices is a pathognomonic finding in portal
hypertension rather than cirrhosis. The two are
different and separate entities.
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
440
Idiopathic pancreatic beta cell destruction which
leads to absolute insulin deficiency is classified as:
A. DM type 1a
B. DM type 1b
C. DM type 2
D. MODY type 2
Type 1a = autoimmune beta cell destruction; 1b =
non-autoimmune/idiopathic destruction. MODY
means maturity-onset diabetes of the young and is
characterized by impaired insulin secretion
secondary to defective factors or enzymes
involved in normal beta cell functions. MODY 2, in
particular, is characterized by problem in
glucokinase.
WEBSTER
ALINDOG, MD
(TOP 3 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - AUG
2014
441
Uremic fetor is caused by:
A. Breakdown of urea to ammonia in saliva
B. Bacterial conversion of ammonia in the
intestines
C. Accumulation of ammonia in the blood due to
decreased clearance by the kidneys
D. A and C
E. All of the above
Uremic fetor is a urine-like odor on the breath;
derives from the breakdown of urea to ammonia
in saliva and is often associated with an
unpleasant metallic taste (dysgeusia).
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 58 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
442
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 2
EXAM - AUG
2014
A 42 year-old male patient, nonhypertensive,
nondiabetic visits in the out-patient department. On
auscultation, an accentuation of first heart sound,
opening snap and mid-diastolic rumbling murmur at
the apex were heard. The above findings pertain that
the patient is suffering from:
A. Mitral regurgitation
B. Mitral stenosis
C. Pulmonary stenosis
D. Aortic regurgitation
E. Aortic stenosis
Mitral stenosis findings are loud S1, accentuated
P2, apical diastolic rumble and murmur and
opening snap. These are secondary to Rheumatic
Heart Disease.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
443
The main substance/s causing vasodilation in
urticaria is/are:
A. Serotonin
B. Bradykinin
C. Histamine
D. Prostaglandins
E. All of the above
Histamine is the main substance causing
vasodilation in urticaria also in Type I
hypersensitivity. Wheal is a classic demonstration
of histamine effect.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
444
A 35 year-old female, hypertensive and diabetic
came into your clinis because of erythematous rash
across the bridge of her nose. Her BP was 180/100.
Among her maintenance medications, this medicine
should be withdrawn:
A. Propranolol
B. Hydralazine
C. Nifedipine
D. Losartan
E. Captopril
Hydralazine causes drug-induced lupus thus
should be withdrawn.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
445
A 55 year-old male, nonhypertensive, nodiabetic was
brought to the Emergency Room confused and
disoriented with fluctuating consciousness and
perception. If the diagnosis is alcohol delirium, what
is the blood alcohol level of this patient?
A. 50-100
B. 100-200
C. 200-300
D. 300-400
E. >500
Blood alcohol level: 50-100=sedation, high, slower
reaction times, 100-200=impaired motor function,
slurred speech, ataxia, 200-300=emesis, stupor,
300-400=coma, >500=respiratory depression,
death
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
446
Bone marrow biopsy was done to a 20 year-old
female with recurrent infections. Pancytopenia with
an empty marrow is seen. Diagnosis for the above
findings:
A. Acute leukemia
B. Myelodysplastic syndrome
C. Aplastic anemia
D. Pure red cell aplasia
E. Paroxysmal nocturnal hemoglobinuria
Pancytopenia is a syndrome of chronic primary
hematopoietic failure. Bone marrow biopsy
reveals an empty marrow.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
447
Examination of the synovial fluid of the knee of a
patient with osteoarthritis will reveal the following
except:
A. Clear viscous fluid
B. Negative culture
C. Low levels of WBC count
D. (+) CPPD crystals
E. None of the above
In osteoarthritis, the findings of the synovial fluid
are are clear viscous fluid, negative culture, low
WBC. CPPD crystals are found in pseudogout.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
448
Superior vena cava syndrome is characterized by the
following:
A. Anhidrosis, miosis, ptosis of affected side
B. Edema and rubor of face, neck and upper chest
C. Prenic nerve paralysis and elevation of
hemidiaphragm
D. Shoulder pain radiating to ulnar distribution of
the arm
E. All of the above
In patients with HIV infection, the generally
accepted indicator of the immunologic competence
is:
A. Immunoglobulin level
B. Plasma viremia level
C. CD4 T lymphocyte count
D. A and C
E. B and C
Superior vena cava syndrome is a severe
reduction invenous retirn from the head, neck and
upper extremities due to obstruction of SVC blood
flow. Most common etiologies are lung cancer,
lymphoma, and metastatic tumors.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
For prognostication, CD4 count value tells the
immune status of patients infected with HIV.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
449
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 59 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
450
QUESTION
EXPLANATION
AUTHOR
Which of the following drugs can dissolve the
thrombus in acute coronary syndrome?
A. Low molecular weight heparin
B. Unfractionated heparin
C. Aspirin
D. Streptokinase
E. Abciximab
Streptokinase is a thrombolytic, a tissue
plasminogen activator analog, which converts
plasminogen to plasmin, which degrades the fibrin
and fibrinogen, causing thrombolysis.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
451
In large retrosternal goiter, when the arms are
raised above the head, this cause the thyroid mass to
impinge on the blood vessels causing flushing of the
face and syncope. This is also known as:
A. Basedow sign
B. Reidel's sign
C. Pemberton sign
D. McConnell's sign
E. Cullen's sign
Pemberton sign is venous distention over the neck
and difficulty breathing especially when the arms
are raised in large retrosternal goiters.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
452
a 48 year-old man with a history of alcohol abuse
presents to the emergency room vomiting bright red
blood. All the following should be included in the
differential diagnosis except:
A. Ruptured esophageal varices
B. Esophageal reflux secondary to hiatal hernia
C. Boerhaave's syndrome
D. Mallory weiss syndrome
E. None of the above
Esophageal reflux secondary to hiatal hernia will
not present with bright red blood vomitus and is
not related to alcohol abuse.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
453
The differentiating agent that do not produce DIC
and promotes maturation of promyelocytes in AML
M3 is:
A. Vitamin A
B. Tretinoin
C. All cis-retinoic acid
D. All trans-retinoic acid
E. Retinol
All trans-retinoic acid allows DNA transcription
and differentiation of immature leukemic
promyelocytes into mature granulocytes. It is
useful in patients with Acute Myelogenous
Leukemia M3.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
454
A transient, pruritic linear wheal with a flare at a site
in which the skin is briskly stroked with a firm
object is known as:
A. Dermatosis
B. Dermographics
C. Dermatography
D. Dermographism
E. Dermoid
Dermographism is a transient, pruritic linear
wheal with a flare at a site in which the skin is
briskly stroked with a firm object.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
455
In a patient presenting with upper respiratory tract
infection, the sudden onset of chest pain with
pericardial friction rub and heart failure is usually
due to:
A. Hepatitis B virus
B. Herpesviruses
C. Coxsackievirus
D. Measles virus
E. Adenovirus
Coxsackievirus B is the most common cause of
myocarditis and pericarditis manifested as fever,
chest pain and signs of congestive heart failure.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
456
Patients who are undergoing dialysis for the first
time will experience this condition due to rapid
removal of toxic metabolites:
A. Dumping syndrome
B. First use syndrome
C. Anaphylactic shock
D. Recirculation
E. Disequilibrium syndrome
The dialysis disequilibrium syndrome is a rare but
serious complication of hemodialysis. Despite the
fact that maintenance hemodialysis has been a
routine procedure for over years, this syndrome
remains poorly understood. The signs and
symptoms vary widely from restlessness and
headache to coma and death.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
457
A 58 year-old male was diagnosed with
membranous GN. Kidney biopsy of this patient will
show:
A. Effacement of foot processes
B. Subendothelial deposits
C. Subepithelial deposits
D. IgG linear antibodies
E. Kimmelsteil-Wilson bodies
Membranous GN is the most common adult cause
of nephrotic syndrome. It is characterized by
diffuse capillary and BM thickening, spike and
dome appearance, subepithelial IgG and C3
deposits.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
458
Pulmonary infections is common among patients
with cystic fibrosis. Therapy should be directed
against which of the following organism:
A. Pseudomonas aeruginosa
B. Streptococcus penumoniae
C. Chlamydia pneumoniae
D. Klebsiella pneumoniae
E. All of the above
Pseudomonas aeruginosa is the most common
cause of nosocomial pneumonia in patients with
cystic fibrosis patients. Renal colic typically begins
in the abdomen and often radiates to the
hypochondrium or the groin. It is typically colicky
due to the presence of a stone in the ureter or at
the pelviureteric junction.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 60 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
MIDTERM 2
EXAM - AUG
2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
459
QUESTION
EXPLANATION
AUTHOR
A 25 year-old man came to Emergency Room due to
severe intermittent flank pain radiating to groin.
Pain was described as "renal colic" usually indicates:
A. Kidney stone
B. Ureteral stone
C. Bladder stone
D. Pyelonephritis
E. Cystitis
Renal colic typically begins in the abdomen and
often radiates to the hypochondrium or the groin.
It is typically colicky due to the presence of a stone
in the ureter or at the pelviureteric junction.
Perforation is the second most common
complication of peptic ulcer disease. Initial
procedure of choice which is safe and easy to
document pneumoperitoneum is Plain xray of the
abdomen. Barium swallow is contraindicated in
the presence of perforation.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
460
Ruptured peptic ulcer with pneumoperitoneum is
most easily and safely diagnosed by:
A. Barium swallow
B. Ultrasound
C. Plain xray of the abdomen
D. CT scan
E. A and C
Perforation is the second most common
complication of peptic ulcer disease. Initial
procedure of choice which is safe and easy to
document pneumoperitoneum is Plain xray of the
abdomen. Barium swallow is contraindicated in
the presence of perforation.
JULIET KRISTINE
EVANGELISTA, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - AUG
2014
461
In tumor lysis syndrome, the following are the
electrolyte abnormalities except:
A. hypekalemia
B. hyperphosphatemia
C. hyperuricemia
D. hypocalcemia
E. Hypercalcemia
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
462
A 50 year old female presented with acute cough,
fever and tachypnea. On chest x-ray, there was
bilateral infiltrates and pneumatoceles. What is the
most likely etiologic agent?
A. Staphylococcus aureus
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Mycoplasma pneumoniae
E. Klebsiella pneumoniae
Pneumatocele formation is consistent with S.
aureus.
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
463
One of the following is not consistent with the
criteria for metabolic syndrome.
A. Triglyceride level of 200
B. Patient on metformin
C. Blood pressure of 135/90
D. Female waist circumference of >102 cm
E. HDL level of <40 mg/dl in males
waist circumference of >102cm is for males, while
for females it is >88cm
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
464
The following echocardiographic findings are
considered positive for infective endocarditis:
A. Intracardiac mass
B. abscess
C. New dehiscence of prosthetic valve
D. New valvular regurgitation
E. All of the choices
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
465
What is the causative agent of malignant tertian
malaria?
A. Plasmodium falciparum
B. Plasmodium vivax
C. Plasmodium ovale
D. Plasmodium malariae
E. B and C
P. falciparum - malignant tertian malaria: P. vivax
and ovale - benign tertian malaria; P. malariae quartan malaria.
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
466
A 30 year old male construction worker was
admitted due to fever of 3 days, associated with
abdominal pain, diarrhea, myalgia, and headache. On
Physical examination, there was conjuctival
suffusion and calf tenderness. History revealed that
he waded in flood water. Vital signs were normal,
good urine output, no jaundice, and no signs of
meningeal irritation. What is the first line drug?
A. Amoxicillin 500mg q6hrs PO
B. Ampicillin 1g q6h IV
C. Penicillin G 1.5MU q6h IV
D. Doxycycline 100mg BID PO
E. Azithromycin 500mg OD PO
This is a mild case of leptospirosis. The first line
drug is Doxycycline 100 mg BID PO, while
amoxicillin is the alternative drug. For severe
cases, Penicillin G 1.5MU q6-8h IV is the first line
drug. The rest of the choices are alternative drugs
for severe cases.
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
467
Components of multiple endocrine neoplasia 2B
except:
A. Medullary thyroid carcinoma
B. pheochromocytoma
C. Parathyroid adenoma
D. Mucosal and Gastrointestinal neuroma
E. Marfanoid features
components of MEN 2B are: medullary thyroid
carcinoma, pheochromocytoma, mucosal and GI
neuroma, and marfanoid features. Parathyroid
adenoma is a component of MEN 2A
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 61 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
MIDTERM 2
EXAM - AUG
2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
468
QUESTION
Coronary artery disease is the most common cause
of:
A. Systolic dyfunction
B. Diastolic dysfunction
C. cardiomyopathy
D. Left ventricular hypertrophy
E. All of the choices
469
Patient came in complaining of dysuria, hematuria,
and oliguria. How will you define oliguria?
A. No urine output for 6 hours
B. No urine output for 12 hours
C. Urine output of <400ml/24 hours
D. Urine output of < 600ml/24 hours
E. None of the choices
470
In spirometry, patients with Chronic Obstructive
Pulmonary Disease have:
A. Increased FEV1
B. Increased Residual volume
C. Decreased total lung capacity
D. Decreased functional residual capacity
E. Increased FEV1/FVC ratio
471
EXPLANATION
CAD is the most common cause of systolic
dysfunction, while concentric LVH is the most
common cause of diastolic dysfunction.
AUTHOR
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
In COPD: FEV1 and FEV1/FVC ratio are reduced,
while residual volume, total lung capacity, and
functional residual capacity are increased.
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
In the natural history of ARDS, in what pahase will
most patients recover or wean from mechanical
support?
A. Exudative phase
B. Proliferative phase
C. Fibrotic phase
D. Resolution phase
E. None of the choices
There are 3 phases in ARDS: exudative,
proliferative, and fibrotic phase. Most patients will
recover during the proliferative phase.
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
472
A 36 year old female had vomiting and profuse
diarrhea for 3 days at home without any medications
taken. She was brought to the emergency
department severely dehydrated without urine
output for 15 hours. Her serum creatinine was
5mg/dl. Using the RIFLE criteria for acute kidney
injury, the patient is in what stage?
A. risk
B. injury
C. failure
D. loss
E. end stage renal disease
RIFLE criteria for AKI: risk - urine output
<0.5ml/kg/h for 6 hrs; injury - urine output of
<0.5ml/kg/h for 12 hrs; failure - urine output of
<0.3ml/kg/h for 24 hours or anuria for 12 hours;
Loss - complete loss of kidney function for
>4weeks; ESRD - complete loss of kidney function
for >3 months.
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
473
A 40 year old female came in for consultation due to
menorrhagia for 6 months. She complained of
dizziness upon standing and changing positions. She
was pale, with heart rate of 120bpm, respiratory
rate of 24cpm. Hemoglobin level was 8g/dl. What is
the best management?
A. surgery
B. ferrous sulfate tablet TID
C. IV iron
D. transfuse with packed RBC
E. transfuse with Packed RBC together with
platelet concentrate
Patient presents with polyuria, polydipsia, and
weight loss. If you are suspecting diabetes mellitus,
which of the following will confirm your diagnosis.
A. HBA1C of 6%
B. FBS of 6.9mmol/L
C. 2-hour plasma glucose during an OGTT is
220mg/dl
D. random blood sugar of 11mmol/L
E. any of the choices
this is a case of anemia due to bleeding.
Transfusion is done when Hemoglobin is <7g/dl,
or hemoglobin of <10g/dl in symptomatic anemic
patient - presence of tachycardia, dyspnea,
postural hypotension, chest pain, and syncope.
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
The criteria for the diagnosis of DM are the
following: HBA1C ≥6.5%; FBS ≥ 126mg/dl
(7mmol/L); 2hr plasma glucose during OGTT ≥
200mg/dl (11.1mmol/L); RBS ≥ 200mg/dl
(11.1mmol/L) + classic symptoms of
hyperglycemia.
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
A 28 year old male presented with acute abdominal
pain. He can't find position of comfort, and keeps on
moving in the bed rolling up himself trying to ease
the pain. He also had hematuria and dysuria. What is
the standard diagnostic procedure to confirm your
diagnosis?
A. helical CT scan with contrast
B. helical CT scan without contrast
C. urinalysis
D. ultrasound
E. TURP
This is a case of nephrolithiasis, and the standard
diagnostic procedure is helical CT scan without
contrast
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
474
475
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 62 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
476
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
A 54 year old female patient presents with an
anterior neck mass. She had sleepless nights and
profuse sweating. She had palpitations and tremors.
She had weight loss of about 5kg despite eating
more than her regular meal. She asked you, what
management will give the quickest resolution of her
symptoms?
A. propylthiouracil
B. methimazole
C. surgery
D. radioactive iodine therapy
E. propranolol
RAI therapy provides the quickest resolution of
hyperthyroidism
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
477
A 28 year old male alcoholic came in due to vomiting
and abdominal pain around the periumbilical region
boring in character radiating to the back, which
intensifies when lying supine. On examination you
noticed a blue discoloration around the umbilicus
which is called:
A. turner's sign
B. cullen's sign
C. Dunphy's sign
D. courvoisier's sign
E. murphy's sign
this is a case of pancreatitis, in which there are
two distinctive signs: cullen's sign - blue
discoloration around the umbilicus; turner's sign green brown discoloration of the flanks.
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
478
What is the best screening test for systemic lupus
erythematosus?
A. Anti-DsDNA
B. Anti-Sm
C. ANA
D. C3
E. Any of the choices
For SLE, ANA is the best screening test. AntiDsDNA is highly specific and correlates with the
disease activity, and Anti-Sm is specific for SLE.
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
479
The following are the indications for dialysis except:
A. Intractable volume overload
B. Intractable hyperkalemia
C. Intractable acidosis
D. Uremic encephalopathy
E. None of the choices
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
480
A 45 year old farmer smoker, and alcoholic had a
one month productive cough, associated with
intermittent fever, chest pain, anorexia and fatigue.
If this is a new case with a smear-positive, what
drugs are given during the maintenance phase of
treatment?
A. isoniazid and rifampicin
B. pyrazinamide and isoniazid
C. ethambutol and isoniazid
D. rifampicin, ethambutol, and isoniazid
E. isoniazid, rifampicin, pyrazinamide, and
ethambutol
DJ had just been administered an injection of pollen
extract as prescribed by her allergologist. She
started to complain about nausea and you note that
her face is flushed and her voice sounds muffled and
strained. Which of the following is the first priority
in managing this episode of anaphylaxis?
A. intravenous injection of 1:10,000 epinephrine
B. subcutaneous injection of 1:1,000 epinephrine
C. intravenous corticosteroid
D. intramuscular injection of diphenhydramine
this is a new smear positive PTB. The treatment is
divided into 2 phases: the intensive phase
wherein, isoniazid, rifampicin, ethambutol, and
pyrazinamide are given for 4 months; and the
maintenace phase wherein isoniazid and
rifampicin are given for 2 months.
LUISA SARANILLO,
MD (TOP 6 - FEB
2014 MED
BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014 - FOR
INCLUSION IN
THE SAMPLEX
Subcutaneous epinephrine would be the first
medication used. Additional treatment can include
plasma expanders, diphenhydramine and
cimetidine, as indicated. Corticosteroids should be
started early but the effect is delayed.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
482
A 40-year-old female receiving a drug from
supraventricular tachycardia shows prolongation of
the QT interval on ECG. An antiarrhytmic drug which
causes QT prolongation include:
A. lidocaine
B. propranolol
C. flecainide
D. quinidine
In contrast, propranolol causes an increase in the
PR interval.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
483
A 20-year-old man presents with recurrent upper
respiratory tract infections. What immunodeficiency
does he have if through further studies he was
shown to have normal number of B cells but very
low to absent plasma cells?
A. Bruton's agammaglobulinemia
B. Severe combined immunodeficiency
C. Common variable immunodeficiency
D. Wiskott Aldrich Syndrome
CVID is due to a defect in B-cell mutation and has
various causes. It can be acquired during the 20s
to 30s.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
481
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 63 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
484
QUESTION
Benzene causes:
A. leukemia
B. lymphoma
C. aplastic anemia
D. polycythemia vera
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
FINAL EXAM AUG 2014
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. Benzene is a risk factor for
BOTH aplastic anemia and leukemia (some
reference include lymphoma also). Some
questions in the boards actually have 2 best
answers so you just answer one and pray that
your choice is what the board of medicine has in
mind. :)
Hemophilia A is the most common type of
hemophilia. It is an X-linked disorder. Most
patients present with major bleeding like
hemarthrosis, and internal bleeding. Factor VIII is
the treatment of choice in managing these
patients. Other alternatives would be
cryoprecipitate then fresh frozen plasma. SIMILAR
TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
485
A boy presents with hemarthrosis and gross
hematuria. He has an uncle with the same condition.
On further examination, his partial thromboplastin
time (PTT) is increased. Considering the most likely
diagnosis, which of the following should be
administered to the patient?
A. Factor VIII concentrate
B. cryoprecipitate
C. cryosupernatant
D. fresh frozen plasma
486
Multiple endocrine neoplasia (MEN) 2A and 2B have
these features in common, EXCEPT:
A. Medullary thyroid carcinoma
B. Pheochromocytoma
C. Parathyroid adenoma
D. There is no exception
Parathyroid adenoma is a feature of MEN2A only.
Know the features of the MEN syndromes.
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
487
What is the average GFR per day under normal
conditions in the healthy adult?
A. 80 liters
B. 200 liters
C. 180 liters
D. 120 liters
The average GFR per day is 180 (some references,
185) liters per day.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
488
A patient was diagnosed to have idiopathic
pulmonary fibrosis. What is the hallmark
spirometric finding for this disease?
A. Decreased vital capacity
B. Decreased functonal residual capacity
C. Decreased inspiratory reserve volume
D. Decreased total lung capacity
Idiopathic pulmonary fibrosis is a type of
restrictive lung disease, the hallmark of which is
decreased total lung capacity. This is verbatim
from Harrisons. SIMILAR TO PREVIOUS BOARD
EXAM CONCEPT/PRINCIPLE.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
489
Dihydropiridines reduce the blood pressure of a
hypertensive patient by:
A. Decreasing peripheral vascular resistance
B. Increasing cardiac output
C. Decreasing calcium influx into cardiac muscles
D. Decreasing renal blood flow
Dihydropiridines like amlodipine and nifedipine
act on the blood vessels. Nondihydropiridines like
verapamil act on the cardiac muscles.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
490
A lethargic 23-year-old female was brought to the
ER who intentionally took an unknown number of
sedatives. The appropriate antidote would be:
A. naloxone
B. flumazenil
C. N-acetylcysteine
D. 100% oxygen
Naloxone is the antidote for opioid overdose, NAC
for paracetamol overdose, and 100% oxygen for
carbon monoxide poisoning.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
491
Ataxia, confusion and ophthalmophlegia are clinical
features of a syndrome that result from severe
deprivation of:
A. Ethyl alcohol
B. Methanol
C. Thiamine
D. Riboflavin
Vitamin B1 or Thiamine deficiency causes
Wernicke-Korsakoff's syndrome.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
492
A negative HBSAg, positive anti-HBC and positive
anti-HbS is interpreted as:
A. Immune due to natural infection
B. Immune due to hepatitis B vaccination
C. Acutely infected
D. Chronically infected
A negative HBSAg, negative anti-HBC and positive
anti-HbS, on the other hand, is interpreted as
immune due to Hep B immunization.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
493
A patient from Palawan complains of paroxysms of
chills, fever, and profuse sweating. What additional
physical finding is consistent with the most likely
diagnosis?
A. petechiae
B. jaundice
C. hepatomegaly
D. Splenomegaly
Splenomegaly is a characteristic finding in patients
with malaria.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
494
The most common site of TB in pregnancy:
A. Pulmonary
B. GIT
C. GUT
D. Placenta
In general, the most common site in all age groups
for tuberculosis infection is still pulmonary.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 64 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
495
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
FINAL EXAM AUG 2014
The hallmark of dengue hemorrhagic fever is:
A. thrombocytopenia
B. hemoconcentration
C. plasma leakage
D. Bleeding
The other choices can also be seen in dengue
hemorrhagic fever/severe dengue.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
496
According to the CDC, which among the following is
NOT an AIDS-defining condition?
A. oral candidiasis
B. cytomegalovirus retinitis
C. pneumocystic jirovecci pneumonia
D. progressive multifocal leukoencephalopathy
Bronchi, trachea, lungs or esophageal candidiasis
are considered as aids-defining illnesses, but not
oral candidiasis.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
497
A patient presents with recurrent febrile episodes
and migratory joint pains. On physical examination,
there is a systolic murmur over the 4th ICS left midclavicular area. To confirm your diagnosis, you
should order which of the following diagnostics?
A. ASO titers
B. throat swab culture
C. anti-Dnase A titers
D. ESR
A similar question was asked recurrently during
our exam. Acute rheumatic fever can be diagnosed
if the patient fulfills 2 major or 1 major and 2
minor manifestations plus evidence of a preceding
GAS infection through ASO or anti-Dnase B titers.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
498
This condition presents with crypt abscesses and
friable mucosal pseudopolyps. There is also leadpipe appearance on imaging. What disease is this?
A. Crohn's disease
B. Ulcerative colitis
C. Irritable bowel syndrome
D. Peutz-Jeghers syndrome
This should be differentiated from Crohn's
disease, the features of which are: cobblestone
mucosa, transmural inflammation, skip lesions,
strictures and fistulas.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
499
All of the following can cause hemorrhagic cystitis,
EXCEPT:
A. cyclophosphamide
B. adenovirus
C. radiation
D. kanamycin
Kanamycin, an aminoglycoside, is nephrotoxic but
does not affect the bladder. Other causes of
hemorrhagic cystitis include E. coli, papovavirus,
influenza A, methicillin, piperacillin etc.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
500
A female patient presents with charcot's classic triad
of scanning speech, intention tremor and nystagmus.
Which of the following may be of benefit to this
patient?
A. natalizumab
B. IVIG
C. valproic acid
D. Memantine
Natalizumab is a humanized monoclonal antibody
that belongs to a class known as alpha-4 integrin
inhibitors. It binds to the cell surface receptors
known as alpha-4-beta-1 and alpha-4-beta-7. It
has been shown to reduce the rates of relapse and
disease progression in multiple sclerosis.
ANGELIS ANDREA
COCOS, MD (TOP 1
- FEB 2014 MED
BOARDS;
TOPNOTCH MD)
FINAL EXAM AUG 2014
501
Which of the following statements regarding pulsus
paradoxus is true?
A. It is the fall in systolic blood pressure by
>10mmHg with inspiration.
B. It is the beat to beat variability of pulse
amplitude seen in severe LV systolic heart failure.
C. It refers to posterior calf pain on active
dorsiflexion of the foot againsts resistance
suggestive of DVT.
D. all of the above
E. none of the above
Imelda, a 76 year old vendor went to visit your clinic
complaining of dizziness. Vital signs revealed
BP=150/110mmHg, HR=78bpm; RR=20rpm; and
Temperature=36.8C. Classify hypertension of
patient:
A. Normal
B. Pre-hypertension
C. Stage 1 hypertension
D. Stage 2 hypertension
E. Isolated Systolic hypertension
B. Pulsus alternans; C. Homan's sign
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
Normal <120/<80mmHg; Pre-hypertension=120139/80-89mmHg; Stage 1= 140-159/90-99mmHg;
Stage 2=>160/>100mmHg; Isolated Systolic
hypertension=>140/<90mmHg
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
Metabolic syndrome refers to metabolic
abnormalities that confer an increased risk of
cardiovascular disease and diabetes mellitus. Which
of the following does not meet the criteria for
metabolic syndrome?
A. Waist circumference of >88cm in a female
B. Triglyceride >100mg/dL
C. HDL <40mg/dL and <50mg/dL in a male and
female, respectively
D. BP of 140/90mmHg
E. Fasting blood glucose of 150 mg/dL
Waist circumference >102cm in males;
TAG>150mg/dL or use of specific med; low HDL;
BP >130/85mmHg; FBS>100mg/dL or previously
diagnosed T2DM
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
502
503
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 65 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
504
QUESTION
EXPLANATION
A 59 year old man was rushed to the emergency
room because of severe chest pain described as
heaviness . Pain radiates to left shoulders and arm.
What ancillary procedure should you request?
A. Stress testing
B. 2D Echo
C. 12- lead ECG
D. CBC with platelet
E. CT scan of the chest
AUTHOR
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM AUG
2014
505
This drug acts as an HMG-CoA reductase inhibitor
which results to plaque stabilization, lowering of
LDL cholesterol and TAG and raising HDL
cholesterol:
A. Fenofibrate
B. Clopidogrel
C. Metoprolol
D. Nifedipine
E. Atorvastatin
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
506
In which of the following patients is Coronary artery
bypass grafting indicated?
A. Elena, 53 years old, with 3-vessel coronary artery
disease
B. Mario, 47 years old with 70% occlusion of the left
anterior descending and left circumflex artery
C. Inang, 61 years old with stenosis of the left main
coronary artery
D. All of the above
E. None of the above
IM platinum 55
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
507
The following patients cannot be given streptokinase
and tissue plasminogen activators, except:
A. Riza, 49 years old, complaining of severe chest
heaviness, with ST elevation in leads II, III, AVF, day
2 of menses
B. Minda, 67 years old, suspected aortic dissection
C. Roel, 52 year old with blood pressure of
190/120mmHg at the ER
D. Rommel, 74 years old with history of
hemorrhagic stroke in the basal ganglia 20 years ago
E. Sanse, 67 years old, with history of ischemic
stroke in the thalamus 8 months ago
Absolute contraindications to thrombolysis: any
prior intracranial hemorrhage, non-hemorrhagic
stroke or other CV event withn the past year,
marked hypertension (SBP>180 or DBP>110) at
any time during the acute presentation, suspected
aortic dissection, and active bleeding or bleeding
diathesis (excluding menses)
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
508
The following clinical findings can be appreciated in
a patient with aortic regurgitation, except:
A. De Musset sign
B. Gallavardin effect
C. Corrigan's pulse
D. Duroziez sign
E. Austin Flint murmur
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
509
Jemima is a 23 year old sales clerk who developed
fever days prior to consult with associated cough,
colds and difficulty of breathing. The impression was
Moderate Risk Pneumonia, what is the expected
chest exam findings?
A. Resonant to percussion, normal fremitus, no
adventitious sounds noted
B. Hyperresonant to percussion, decreased
fremitus, with occassional wheezing
C. Dull to percussion, Increased fremitus, with
bibasal crackles
D. Dull to percussion, decreased fremitus, with
pleural friction rub
E. Resonant to percussion, normal fremitus, with
wheezes
This refers to a previously treated pulmonary
tuberculosis patient who has been declared cured
and is now diagnosed with culture positive
tuberculosis:
A. New
B. Relapse
C. Failure
D. Return after default
E. Transfer in
A. De Musset sign - jarring of the body and
bobbing of the head with each systole in severe AR
B. Gallavardin effect - in AS, low-pitched
midsystolic ejection murmur at 2nd R ICS that may
be transmitted to the apex resembling murmur of
MR
C. Corrigan's pulse - water hammer pulse
D. Duroziez sign - To and fro murmur when
femoral artery is compressed
E. Austin Flint murmur- soft low-pitched
rumbling mid to late diastolic murmur
A. Resonant to percussion, normal fremitus, no
adventitious sounds noted - Normal
B. Hyperresonant to percussion, decreased
fremitus, with occassional wheezing-COPD
C. Dull to percussion, Increased fremitus, with
bibasal crackles -Pneumonia
D. Dull to percussion, decreased fremitus, with
pleural friction rub-Pleural effusion
E. Resonant to percussion, normal fremitus, with
wheezes-Asthma
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
(IM platinum 99) Failure- a patient, who while on
treatment, is sputum smear positive at 5 months
or later during the course of treatment; Return
after default- a patient who returns to treatment
with positive bacteriology following interruption
of treatment for 2 months or more; Transfer in patient who was transferred from another facility
with proper referral slip to continue treatment -IM
99
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
510
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 66 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
511
QUESTION
The presence of this antigen determines Rh
positivity:
A. D antigen
B. d antigen
C. C antigen
D. c antigen
E. H antigen
512
What is the single best test to request in a patient
suspected of hyperthyroidism?
A. T3, T4
B. TSH
C. FT3
D. Thyroglobulin
E. TSI
513
Arterial blood gas result of a patient at the ER reads
pH of 7.10, pCO2=68mmHg and plasma
bicarbonate=32mmol/L. Interpret:
A. Respiratory acidosis with renal compensation
B. Metabolic acidosis with respiratory
compensaton
C. Respiratory alkalosis with renal compensation
D. Metabolic alkalosis with respiratory
compensaton
E. None of the above
This management yields the quickest resolution of
the hyperthyroid state, however, it leads to
hypothyroidism requiring lifelong thyroid
replacement therapy:
A. Propylthiouracil
B. Methimazole
C. Radioactive Iodine therapy
D. Propranolol
E. None of the above
514
EXPLANATION
AUTHOR
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
TSH is supressed. IM platinum 198
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM AUG
2014
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
RAI damages gland thru cytotoxic effect. Absolute
contraindications: pregnancy and breast feeding
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
515
The following are chronic macrovascular
complications of diabetes mellitus, except:
A. Diabetic ketoacidosis
B. Retinopathy
C. Neuropathy
D. Nephropathy
E. All of the above
*Acute complications of DM- DKA, HHS; *Chronic
microvascular complications-Retinopathy,
Neuropathy, Nephropathy; *Chronic
macrovascular complications- CAD, PAD,
Cerebrovascular disease
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
516
Minda, 36 year old G2P1 25 weeks AOG, come to
your clinic for follow up check up. You diagnosed her
to have gestational diabetes last month for which
you prescribed Metformin 500mg tab once a day.
You want to know the glycemic status over the prior
2 weeks. What test should you request?
A. FBS
B. 2 hour OGTT
C. Random blood sugar
D. HbA1C
E. Fructosamine assay
HbA1C- reflects the glycemic status over the prior
3 months; Fructosamine assay- reflects the
glycemic status over the prior 2 weeks
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
517
These antacids can cause diarrhea and constipation
respectively:
A. Magnesium hydroxide and aluminum hydroxide
B. Aluminum hydroxide and magnesium hydroxide
C. Cimetidine and ranitidine
D. Ranitidine and cimetidine
E. None of the above
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
518
What is the gold standard in the diagnosis of
Typhoid fever?
A. Blood culture
B. Stool culture
C. Urine culture
D. Serology
E. Bone marrow culture
Blood culture is the gold standard for the
diagnosis of typhoid fever
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
519
What is the level of dopamine in Parkinson's Disease
and in Schizophrenia, respectively?
A. Increased, Decreased
B. Decreased, Increased
C. Increased, Increased
D. Decreased,Decreased
E. None of the above
Im platinum 353
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
BACK-UP
MIDTERM
EXAM AUG
2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 67 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
520
QUESTION
What is the hallmark sign of liver disease and is the
most reliable marker of severity?
A. Fatigue
B. Abdominal distention
C. Elevated ALT
D. Jaundice
E. Right upper quadrant tenderness
EXPLANATION
Jaundice is hallmark of liver disease and the most
reliable marker of severity
Fatigue- most common and most characteristic
symptom of liver disease -IM platinum 267
AUTHOR
JAN CHARMAINE
PALOMAR, MD
(TOP 9 - FEB 2014
MED BOARDS;
TOPNOTCH MD)
TOPNOTCH
EXAM
BACK-UP
MIDTERM
EXAM AUG
2014
521
A 43 year old hypertensive man comes to the
physician because of headache, blurred vision, and
confusion for 2 days. He has not had weakness or
numbness, difficulty ambulating, chest pain or
discomfort, diplopia, or vertigo. Blood pressure is
190/120 mmHg on presentation. The neck is supple.
Fundoscopic examination shows enlargement of
optic discs with indistinct border. Blood vessels near
the discs are indistinct. The lungs are clear to
auscultation. There is an S4 with no murmur.
Neurologic examination shows no abnormalities.
Which of the following is the most likely diagnosis?
A) Cerebral infarction
B) Malignant hypertension
C) Subarachnoid hemorrhage
D) Transient ischemic attack
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
522
A 27 year old woman is brought to the physician
because of a 3 days history of visual loss and aching
discomfort of her right eye. Examination shows
markedly reduced visual acuity on the right; the
peripheral visual fields are full to confrontation.
Color vision is decreased in the right eye. The right
eye does not react to direct light but has a normal
consensual response. Fundoscopic examination
shows no abnormalities. She has an ataxic gait.
Babinski sign is present bilaterally. Which of the
following is the most appropriate next step in
diagnosis?
A) Carotid ultrasonography
B) Visual evoked potentials
C) CT scan of the head with contrast
D) MRI of the brain with contrast
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
523
A 52 year old man comes to the physician because
he has had a 14kg weight loss during the past 6
months. He has noticed oily, floating stools during
the past 2 months. He received the diagnosis of acute
pancreatitis 2 years ago and has had 1 to 3 hour
episodes of severe abdominal pain since ten. The
patient is a 30 year pack smoker. He is an alcoholic
but has been abstinent for the past 2 years. The
abdomen is scaphoid with mild diffuse tenderness.
The liver edge is firm and is palpated 2 cm below the
right costal margin. Laboratories show Amylase 90
(slightly increased), Lipase 43 (normal), alkaline
phosphatase 120 (normal), AST 23, ALT 29. Which of
the following is the most appropriate step in
management?
A) Dietary supplementation with multivitamins and
iron
B) Insulin therapy
C) Pancreatic enzyme replacement therapy
D) Parenteral nutrition
A 42 year old woman comes to the physician
because of progressive shortness of breath during
the past 6 months. She now has to rest three or four
times when climbing one flight of stairs. She is a 30
pack year smoker. She has a chronic nonproductive
cough and has wheezing controlled with an albuterol
inhaler two to three times weekly. Arterial blood gas
analysis reveals pH 7.37 pCO2 48 pO2 62 O2 sat
92%. Her FEV1 is 75% of predicted, and total lung
capacity is 50% of predicted. Which of the following
is the most likely diagnosis?
A) Chronic obstructive pulmonary disease
B) Congestive heart failure
C) Interstitial pneumonia
D) Restrictive lung disease
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
524
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 68 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
525
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 1
EXAM - FEB
2013
An asymptomatic 47 year old woman comes to the
physician for a routine health maintenance
examination. She has no history of rheumatic fever.
She takes no medications. Her pulse is 70 bpm, and
blood pressure is 150/60 mmHg. A grade 2/6
decrescendo murmur that begins after S2 is heard at
the sternal border. Which of the following is the
most likely diagnosis?
A) Aortic valve insufficiency
B) Aortic valve stenosis
C) Mitral valve regurgitation
D) Mitral valve stenosis
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
526
A 37 year old woman comes to the physician
because of a 3 week history of discomfort in both
knees. She is an avid runner, 15 pack year smoker,
with a BMI of 31. Her parents both have mild
osteoarthritis. The patient asks how she can
decrease her risk for osteoarthritis in the future.
Which of the following is the most appropriate
recommendation?
A) Avoidance of high-impact physical activities
B) Smoking cessation
C) Weight loss
D) Daily use of calcium supplement
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
527
A 24 year old man is brought to the emergency
department comatose after he sustained severe head
trauma in a head on motor vehicle collision. His
medical history is unknown. Over the next hour, he
receives 80 mL of 0.45% saline and has a urine
output of 900 mL. Laboratory studies show Na 147,
glucose 124, osmolality 294, urine specific gravity
1.001. A CT scan of the head shows scattered
contusions and a subarachnoid hemorrhage. Which
of the following is the most likely cause of this
patient’s increased urinary output?
A) Syndrome of inappropriate secretion of ADH
B) Traumatic nephropathy
C) Hypernatremia
D) Diabetes insipidus
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
528
A 21-year-old African American college student has
had increasing fatigue over the past 3 weeks. Since
an episode of cystitis treated with trimethoprimsulfamethoxazole 3 weeks ago, he has been unable
to keep up with his physical education classes. For 6
months, he has been following a vegetarian diet that
has been supervised by student health services.
Examination shows no abnormalities. His
hemoglobin level is 10 g/dL, mean corpuscular
volume is 85 μm3, and reticulocyte count is 15%.
Which of the following is the most likely cause of
anemia in this patient?
A) Anemia secondary to infection
B) Antibiotic therapy
C) Gastrointestinal blood loss
D) Sickle cell disease
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
529
A 28-year-old woman at 28 weeks' gestation reports
excessive fatigability and dyspnea. Her blood
pressure is 118/74 mm Hg, pulse is 110/min and
regular, and lungs are clear to auscultation. The
cardiac apex is not palpable. S1 is loud, and there is a
sharp sound after S2. A low-frequency diastolic
murmur is heard at the apex that increases in
intensity before S1. Which of the following is the
most likely diagnosis?
A) Aortic regurgitation
B) Ebstein's anomaly
C) Mitral regurgitation
D) Mitral stenosis
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 69 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
530
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 1
EXAM - FEB
2013
A 42-year-old woman comes to the physician for
evaluation of persistently increased blood pressures.
At her last two office visits during the past 3 months,
her blood pressure has ranged between 150–
170/105–115 mm Hg. During this period, she has
had occasional headaches. In addition, she has had
an increased urine output over the past 6 weeks that
she attributes to a diet high in sodium. She is
otherwise healthy and takes no medications. Her
blood pressure today is 168/115 mm Hg, pulse is
68/min, and respirations are 14/min. Funduscopic
examination shows mild arteriovenous nicking. The
point of maximal impulse is not displaced. There is
no edema, abdominal bruits, or masses. Serum
studies show Na 144, Cl 90, K 2.9, HCO3 32, BUN 20,
Creatinine 1.2. Which of the following is the most
likely underlying cause of this patient's
hypertension?
A) Autonomous production of aldosterone
B) Catecholamine-producing tumor
C) Decreased arterial distensibility caused by
atherosclerosis
D) Excess production of atrial natriuretic peptide
A previously healthy 16-year-old high school
wrestler comes to the physician because of a rash on
his forearms and the back of his legs for 1 week. He
is allergic to pollen and dust. Examination shows
patches of erythema with mild lichenification over
the antecubital and popliteal fossae. There are
clusters of painful umbilicated vesicles at sites of
active skin inflammation. Which of the following is
the most likely diagnosis?
A) Eczema herpeticum
B) Herpes zoster
C) Keratosis pilaris
D) Lichen planus
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
532
A 20-year-old man is brought to the emergency
department on a summer day 20 minutes after
developing headache, nausea, and unsteady gait
while running the last 2 miles of a marathon. On
arrival, he is confused and disoriented. His
temperature is 40 C (104 F), blood pressure is
100/60 mm Hg, and pulse is 155/min. His skin is
warm and dry. Neurologic examination shows no
focal findings. Which of the following is the most
likely mechanism of this patient's condition?
A) Depletion of total body potassium
B) Depletion of total body sodium
C) Release of creatine kinase from muscle cells
D) Inadequate dissipation of body heat
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
533
A 72-year-old man with hypertension has had
increasingly severe back pain over the past 2
months. He had a myocardial infarction 4 years ago.
He has marked tenderness over T11, T12, L1, and
L2. An x-ray film of the lumbosacral spine shows
osteoblastic lesions in these vertebrae. Which of the
following is the most likely diagnosis?
A) Abdominal aneurysm
B) Fibrosarcoma
C) Metastatic prostate carcinoma
D) Multiple myeloma
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
531
Osteoblastic lesions >> prostate mets
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 70 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
534
535
QUESTION
A 50-year-old woman has had progressive dyspnea
over the past 2 weeks and constant, sharp chest pain
for 4 days. The pain is localized to the center of the
chest and is worse while supine. She underwent a
right, modified radical mastectomy and adjuvant
chemotherapy for breast cancer 3 years ago. She has
a history of hypothyroidism treated with thyroid
replacement therapy. She has smoked one pack of
cigarettes daily for 30 years and drinks two ounces
of alcohol daily. She is dyspneic and diaphoretic. Her
temperature is 37.2 C (99 F), blood pressure is
90/70 mm Hg with a pulsus paradoxus of 20 mm Hg,
pulse is 110/min, and respirations are 28/min.
Examination shows jugular venous distention to the
angle of the mandible. The liver span is 14 cm with 4
cm of shifting abdominal dullness. Arterial blood gas
analysis on room air shows a pH of 7.50, PCO2 of 30
mm Hg, and PO2 of 70 mm Hg. An x-ray film of the
chest shows an enlarged cardiac silhouette with a
globular configuration. An ECG shows sinus
tachycardia with nonspecific ST-segment changes
diffusely. Which of the following is the most
appropriate next step in management?
A ) Echocardiography
B ) CT scan of the abdomen
C ) Ventilation-perfusion lung scans
D ) Bronchoscopy
A 52-year-old woman with alcoholism comes to the
physician after a serum cholesterol level of 290
mg/dL was found on a routine screening. She drinks
a pint of vodka daily. She takes captopril for
hypertension and glyburide for type 2 diabetes
mellitus. She also has intermittent episodes of gout.
Fasting serum studies show:
EXPLANATION
Echo to diagnose cardiac tamponade
AUTHOR
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
TOPNOTCH
EXAM
MIDTERM 1
EXAM - FEB
2013
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
Total cholesterol 252 mg/dL
HDL-cholesterol 80 mg/dL
Triglycerides 300 mg/dL
Glucose 118 mg/dL
Thyroid-stimulating hormone 4.5 μU/mL
Which of the following is the most appropriate next
step in management?
A) Alcohol cessation
B) Thyroid replacement therapy
C) Switch from captopril to calcium-channel
blocking agent therapy
D) Gemfibrozil therapy
536
A 67-year-old man is brought to the emergency
department 4 hours after the onset of severe
midlumbar back pain. He is anxious, pale, and
diaphoretic. His temperature is 37.1 C (98.8 F),
blood pressure is 105/65 mm Hg, and pulse is
120/min. Examination shows no other
abnormalities. X-ray films of the lumbar spine show
degenerative disc disease with calcifications anterior
to the vertebral bodies. Which of the following is the
most likely diagnosis?
A) Aortoiliac occlusion
B) Herniated nucleus pulposus
C) Lumbar discitis
D) Ruptured aortic aneurysm
hints >> calcifications anterior to the vertebral
bodies+ BP 105/65 mm Hg
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
537
A 24-year-old woman comes to the physician
because of constant, severe pain in her neck,
shoulders, and back for 3 months. She has been
unable to enjoy her usual activities because of the
pain. Use of over-the-counter ibuprofen and aspirin
has not relieved her symptoms. She has a history of
irritable bowel syndrome. Examination shows
multiple tender spots over the neck, shoulders, and
lumbar spine. Range of motion of all joints is full.
There is no evidence of synovitis. Fluorescent serum
antinuclear antibody and rheumatoid factor assays
are negative. Which of the following is the most
likely diagnosis?
A) Ankylosing spondylitis
B) Fibromyalgia
C) Polymyalgia rheumatica
D) Polymyositis
hint >> multiple tender spots over the neck,
shoulders, and lumbar spine
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2013
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 71 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
538
539
QUESTION
EXPLANATION
AUTHOR
A 72-year-old man comes to the physician because
of a 6-month history of mild to moderate shortness
of breath when climbing stairs. He had a myocardial
infarction 2 years ago and has had an ejection
fraction of 35% since then. His only medication is a
β-adrenergic blocking agent. The lungs are clear to
auscultation. Cardiac examination shows an S4
gallop. There is no peripheral edema. Laboratory
studies are within normal limits. An ECG shows no
acute changes. Which of the following is the most
appropriate pharmacotherapy?
A) α-Adrenergic blocking agent
B) Angiotensin-converting enzyme (ACE) inhibitor
C) Angiotensin2-receptor blocking agent
D) Nitrates
ACEI show mortality benefit, ARBs do no
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
A 57-year-old man is brought to the emergency
department 30 minutes after he was found on the
floor of his house. He has renal failure but has
missed his last two dialysis treatments. His renal
failure was caused by inadvertent ingestion of
ethylene glycol. Medications include amlodipine and
doxazosin. On arrival, his temperature is 37.5 C
(99.5 F), blood pressure is 150/100 mm Hg, pulse is
95/min and regular, and respirations are 24/min.
His breathing is rapid and deep. Crackles are heard
in the lung bases. Laboratory studies show:
ECG changes with hyperkalemia >> immediate IV
calcium gluconate
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
Na+ 135 mEq/L
Cl– 102 mEq/L
K+ 7.1 mEq/L
HCO3– 12 mEq/L
pH 7.22
PCO2 31 mm Hg
PO2 61 mm Hg
An ECG shows peaked T-waves. It will be at least 45
minutes before dialysis can be started. Which of the
following is the most appropriate next step in
management?
A) Intravenous sodium bicarbonate
B) Intravenous calcium gluconate
C) Intravenous glucose and insulin
D) Intravenous 0.9% saline
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 72 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
MIDTERM 1
EXAM - FEB
2013
MIDTERM 1
EXAM - FEB
2013
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
540
QUESTION
A 26-year-old woman is brought to the emergency
department because of marked confusion for 2
hours; she also has had a flu-like illness for 3 days.
Over the past 6 weeks, she has had increased fatigue,
weakness, and nausea. She recently started thyroid
hormone replacement therapy for autoimmune
thyroiditis; 1 week ago, her serum thyroidstimulating hormone level was 3 μU/mL. Her
temperature is 38 C (100.4 F), blood pressure is
80/40 mm Hg, and pulse is 140/min. She appears
confused and lethargic. Examination shows cool,
mottled skin. There is generalized
hyperpigmentation, especially involving the palmar
creases. The lungs are clear to auscultation.
Abdominal examination shows diffuse mild
tenderness and no rebound. Laboratory studies
show:
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 1
EXAM - FEB
2013
Addison'a Disease
MIGUEL RAFAEL
RAMOS, MD (TOP 3
- FEB 2012 MED
BOARDS;
TOPNOTCH MD)
The rest are actions of nitrates.
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
In heart failure, fluid restriction is generally
unnecessary unless with hyponatremia and
volume overload. Caloric supplementation is
warranted for those with cardiac cachexia.
Diuretics are only used to restore normovolemic
status; while digoxin is used only for symptomatic
LV dysfunction with concomitant AF as add on to
standard therapy.
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
Weight reduction = 5 - 20 mmHg/10 kg
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
Hemoglobin 10 g/dL
Leukocyte count 9000/mm3
Segmented neutrophils 55%
Eosinophils 20%
Lymphocytes 25%
Serum
Na+ 124 mEq/L
Cl– 92 mEq/L
K+ 6.4 mEq/L
HCO3– 16 mEq/L
541
542
543
An x-ray film of the chest and urinalysis show
normal findings. An ECG shows sinus tachycardia
with peaked T waves. Which of the following is most
likely to confirm the primary cause of this patient's
condition?
A) Measurement of serum antithyroglobulin
antibody level
B) Dexamethasone suppression test
C) Measurement of serum thyroid-stimulating
hormone level
D) ACTH stimulation test
A 45/M comes in with severe, prolonged substernal
chest pain associated with diaphoresis and nausea.
ECG reveals ST segment elevation in the anterior
leads. Among other medications, you start him on
Metoprolol. What is the mechanism of action of this
drug in the treatment of ischemia in myocardial
infarction?
A. Systemic venodilation with reduction in LV enddiastolic volume
B. Dilation of epicardial coronary vessels
C. Increased blood flow in collateral vessels
D. Reduction of myocardial O2 demand by inhibiting
increases in HR, BP and myocardial contractility
E. All of the above
Four months after an MI, a 45/M starts experiencing
gradually worsening exertional dyspnea associated
with 3-pillow orthopnea and paroxysmal nocturnal
dyspnea. On PE, you note bibasilar rales on
auscultation and Grade 2 bipedal edema. Which of
the following are cornerstones of treatment?
A. Fluid restriction
B. Caloric supplementation
C. ACE inhibitors and beta blockers
D. Diuretics and digoxin
E. All of the above
According to JNC7, which of the following lifestyle
modification recommendations leads to the greatest
reduction in average systolic blood pressure?
A. DASH eating plan
B. Dietary sodium restriction
C. Moderation of alcohol consumption
D. Weight reduction (10 kg)
E. Aerobic physical activity
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 73 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
544
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
FINAL EXAM FEB 2014
You are performing the chest PE on a patient who
came in for dyspnea. The left lung fields were dull on
percussion while vocal fremitus was increased. This
is consistent with:
A. Emphysema
B. Pneumothorax
C. Pleural effusion
D. Asthma
E. Consolidation
Emphysema and pneumothorax: hyperresonant,
decreased. Pleural effusion: dull, decreased.
Asthma: hyper-resonant, normal
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
545
A 55/M heavy smoker comes in for cough
productive of sputum and progressive and
persistent exertional dyspnea. On PE, you note
hyperresonant lung fields and poor diagphragmatic
excursion on percussion. Which of the following
interventions have been demonstrated to influence
the natural history of his condition?
A. Smoking cessation
B. Treatment with inhaled corticosteroids
C. Treatment with long acting beta agonists
D. Treatment with anticholinergics
E. All of the above
In COPD, only 3 interventions influence the natural
history: smoking cessation, lung volume reduction
surgery and oxygen therapy in the chronically
hypoxemic patients.
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
546
High levels of adenosine deaminase (>40 IU/L) in
pleural fluid is virtually diagnostic of:
A. Parapneumonic effusion
B. Malignant pleural effusion
C. Effusion secondary to congestive heart failure
D. Tuberculous pleural effusion
E. Cirrhosis
FINAL EXAM FEB 2014
547
A 35/F, diagnosed case of SLE, comes in for a follow
up. Routine labs done revealed the following results:
ABG: pH 7.35, pCO2 34, pO2 of 98; Na 132; K 3.2; Cl
108; and HCO3 12. The patient's metabolic disorder
is likely due to:
A. Uremia
B. Diarrhea
C. Diabetic ketoacidosis
D. Lactic acidosis
E. Renal tubular acidosis
Lab data consistent with NORMAL ANION GAP
METABOLIC ACIDOSIS. Only E causes NAGMA
among choices. Lupus is a known cause of type 1
RTA.
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
548
The presence of ECG changes in hyperkalemia
should be considered as an emergency and thus
should be managed immediately. Which of the
following ECG abnormalities is characteristic of
hyperkalemia?
A. Prolonged PR interval
B. Presence of U waves
C. ST segment depression
D. Loss of P waves
E. Shortened QT interval
Classic ECG findings: peaked T waves (5.5 - 6.5
mM); loss of P waves (6.5 - 7.5); widened QRS (7 8 mM); and sinusoidal pattern (>8 mM).
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
549
A 25/M, recently diagnosed case of type 1 DM,
comes in for routine follow up after he noted passing
foamy urine. You order a urinalysis which reveals 3+
proteinuria. You refer the patient to an
Ophthalmologist who found no evidence of
retinopathy. The most likely cause of proteinuria in
the patient is:
A. Diabetic nephropathy
B. Hypertensive kidney disease
C. Minimal change disease
D. Membranous glomerulonephritis
E. Focal segmental glomerulosclerosis
Usually, DM nephropathy develops after 10 years
duration; occurring in the presence of other
microvascular complications, e.g. retinopathy.
PEARL: Presence of nephropathy in diabetic in the
absence of eye disease should warrant
investigation for other causes of nephropathy. The
most common cause of nephrotic syndrome in
adults is MGN; the most common cause in kids is
MCD.
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
550
You are assessing glycemic control in a diabetic
patient who does self monitoring of blood glucose.
You note that the patient's post-prandial glucose
levels are elevated. Which of the following
hypoglycemic agents target post-prandial glucose in
particular?
A. Metformin
B. Glibenclamide
C. Pioglitazone
D. Miglitol
E. All of the above
Agents which target PPG in particular include
meglitinides, incretin-related drugs (sitagliptin,
saxagliptin) and a-glucosidase inhibitors
(acarbose and miglitol.)
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
551
What is the MOST COMMON sign of
hyperthyroidism?
A. Tremor
B. Goiter
C. Warm, moist skin
D. Tachycardia
E. Lid lag
SIMILAR TO PREVIOUS BOARD EXAM
CONCEPT/PRINCIPLE. The most common
SYMPTOM is hyperactivity, irritability and
dysphoria.
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
FINAL EXAM FEB 2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 74 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
FINAL EXAM FEB 2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
TIONGSON, MD (40
QUESTIONS)
552
553
A 28/F with Cushingoid features complained of
blurring of vision. Formal visual field testing
revealed bitemporal hemianopsia. You suspect a
functioning pituitary adenoma. Which of the
following laboratory findings is NOT consistent with
your primary impression?
A. Elevated serum cortisol
B. Elevated urine free cortisol
C. Cortisol level not suppressed with low-dose
dexamethasone
D. Cortisol level not suppressed with high-dose
dexamethasone
E. None of the above
After a night of binge-drinking, a 53/M comes in to
the ER complaining of sudden onset severe mid
epigastric abdominal pain radiating to the back;
associated with nausea, vomiting and anorexia. Vital
signs are as follows: BP 90/50, HR 114, RR 24, T
39C. Cornerstones for the management of this
condition include the following except:
A. Analgesivs
B. IV hydration
C. No oral alimentation (NPO)
D. Prophylactic antibiotics
E. None of the above
554
A 28/M who presents with fever and jaundice has
the following hepatitis profile: IgM Anti-HAV (+);
HBsAg (+); IgM Anti-HBc (-); and Anti-HCV (-). He
has:
A. Acute hepatitis A
B. Acute hepatitis B
C. Acute hepatitis A and B
D. Acute hepatitis A superimposed on chronic
hepatitis B
E. Acute hepatitis C
555
The following are recommendations of the Surviving
Sepsis Guidelines in the management of sepsis,
EXCEPT:
A. Start IV fluids to maintain CVP > 12 mmHg in
mechanically ventilated patients.
B. Maintain MAP above 65 mmHg.
C. Epinephrine and dopamine are the initial
vasopressors of choice.
D. Start with broad-spectrum IV antibiotics with
adequate penetration.
E. Hydrocortisone may be indicated for adult septic
shock when hypotension responds poorly to
sufficient fluid resuscitation and vasopressors.
A 12/M was attacked by a stray dog and sustained
minor abrasions without bleeding. The patient has
had no rabies vaccination. Which of the following is
MOST appropriate?
A. Wash exposed skin with immediately with soap
and water. No vaccine or RIG is needed.
B. Administer rabies immunoglobulin immediately.
C. Start rabies vaccination and rabies
immunoglobulin.
D. Start rabies vaccination without rabies
immunoglobulin.
E. Start rabies vaccination, rabies immunoglobulin,
and oral antibiotics.
A 40/M complains of excruciating pain and swelling
in his left big toe that developed suddenly. He is
obese and is a heavy beer drinker. On PE, you note
marked swelling, redness, and warmth of the left big
toe. You may give all of the following for acute
attacks except:
A. NSAIDs
B. Glucocorticoids
C. Colchicine
D. Allopurinol
E. Ice compress
556
557
A high-dose dexamethasone suppression test can
differentiate pituitary Cushing's syndrome
(cortisol is suppressed) from adrenal/ectopic
Cushing's syndrome (cortisol is NOT suppressed).
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
Classic pancreatitis. Prophylactic antibiotics have
NO role in either interstitial or necrotizing
pancreatitis
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
Start with norepinephrine and dopamine.
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
Patient had a Category II exposure (minor
abrasions without bleeding). Start vaccine only.
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
Do NOT start hypouricemic therapy during acute
attacks of gout.
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
FINAL EXAM FEB 2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 75 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
558
QUESTION
EXPLANATION
Which of the following autoantibodies is SLE-specific
and correlates with disease activity, nephritis and
vasculitis?
A. ANA
B. Anti-dsDNA
C. Anti-Sm
D. Anti-Ro
E. Antihistone
C is highly specific but has NO definite clinical
correlations. A is the best screening test. D is
nonspecific for SLE and associated with sicca
syndrome, and neonatal lupus. E is associated
more with drug-induced lupus.
559
Anemia with a reticulocyte index > 2.5 is consistent
with:
A. Iron deficiency anemia
B. Thalassemia
C. Hereditary spherocytosis
D. Anemia of chronic disease
E. Bone marrow infiltration
RI > 2.5 suggests hemolysis or hemorrhage.
560
Platelet count and bleeding time within normal
limits, associated with prolonged PT and PTT, is
classically seen in:
A. Immune thrombocytopenic pupura
B. Bernard-Soulier syndrome
C. von Willebrand disease
D. Hemophilia
E. Vitamin K deficiency
561
Obesity is the driving force behind the metabolic
syndrome, thus, the primary approach to this
disorder is/are
A. Treatment of dyslipidemia
B. ACE-inhibitors
C. Smoking cessation
D. Weight reduction
562
The drug of choice for lowering fasting triglycerides
A. Gemfibrozil
B. Atorvastatin
C. Nicotinic Acid
D. Ezetimibe
563
Indications for coronary arteriography EXCEPT:
(HPIM 18, p2005)
A. Patients with known or possible angina pectoris
who have survived cardiac arrest
B. Patients with chronic stable angina pectoris who
are severely symptomatic despite medical therapy
and who are being considered for revascularization
C. Patients with troublesome symptoms that present
diagnostic difficulties in whom there is a need to
confirm or rule out IHD
D. Patients with no evidence of ischemia on noninvasive testing and no clinical or laboratory
evidence of ventricular dysfunction
564
At least how many hours each day must a patient be
kept nitrate-free to minimize tolerance and restore
any useful response (HPIM 18, p2010)
A. 4 hours
B. 6 hours
C. 8 hours
D.12 hours
565
Mechanism of action of thienopyridines (HPIM 18,
p2011, 2017)
A. Inhibition of thromboxane synthesis
B. Inhibition of the IIB/IIIA receptor
C. Inhibition of clotting factor Xa
D. Inhibition of P2Y12 ADP receptor
Obesity is the driving force behind the metabolic
syndrome. Thus, weight reduction is the primary
approach to the disorder.
With weight reduction, the improvement in insulin
sensitivity is often accompanied by favorable
modifications in many components of the
metabolic syndrome.
In general, recommendations for weight loss
include a combination of caloric restriction,
increased physical activity, and behavior
modification
A fibrate (gemfibrozil or fenofibrate) is the drug of
choice to lower fasting triglycerides and typically
achieve a 35–50% reduction
AUTHOR
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
ABDELSIMAR
OMAR II, MD (TOP
2 - AUG 2013 MED
BOARDS;
TOPNOTCH MD 200 QUESTIONS)
AND MARC
DENVER
TIONGSON, MD (40
QUESTIONS)
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
TOPNOTCH
EXAM
FINAL EXAM FEB 2014
FINAL EXAM FEB 2014
FINAL EXAM FEB 2014
MIDTERM 2
EXAM - FEB
2014
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
Answer: Coronary arteriography is indicated in:
(1) patients with chronic stable angina pectoris
who are severely symptomatic despite medical
therapy and are being considered for
revascularization, i.e., a percutaneous coronary
intervention (PCI) or coronary artery bypass
grafting (CABG),
(2) patients with troublesome symptoms that
present diagnostic difficulties in whom there is a
need to confirm or rule out the diagnosis of IHD,
(3) patients with known or possible angina
pectoris who have survived cardiac arrest,
(4) patients with angina or evidence of ischemia
on noninvasive testing with clinical or laboratory
evidence of ventricular dysfunction, and
(5) patients judged to be at high risk of sustaining
coronary events based on signs of severe ischemia
on noninvasive testing, regardless of the presence
or severity of symptoms
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
Different preparations and/or administration
during the daytime should be tried only to prevent
discomfort while avoiding side effects such as
headache and dizziness. Individual dose titration
is important to prevent side effects. To minimize
the effects of tolerance, the minimum effective
dose should be used and a minimum of 8 h each
day kept free of the drug to restore any useful
response(s).
Inhibition of P2Y12 ADP Receptor
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 76 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
566
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 2
EXAM - FEB
2014
NOT an indication for discontinuation of stress
testing:
A. Chest discomfort
B. Ventricular tachyarrhythmia
C. Fall in systolic blood pressure <10 mmHg
D. Dizziness
Answer: Exercise duration is usually symptomlimited, and the test is discontinued upon evidence
of chest discomfort, severe shortness of breath,
dizziness, severe fatigue, ST-segment depression
>0.2 mV (2 mm), a fall in systolic blood pressure
>10 mmHg, or the development of a ventricular
tachyarrhythmia.
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
567
NOT a contraindication to exercise stress testing:
(HPIM 18, p2004)
A. Severe pulmonary hypertension
B. Severe aortic regurgitation
C. Uncontrolled heart failure
D. Active infective endocarditis
Contraindications to exercise stress testing
include rest angina within 48 h, unstable rhythm,
severe aortic stenosis, acute myocarditis,
uncontrolled heart failure, severe pulmonary
hypertension, and active infective endocarditis.
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
568
The most common clinical indication for
Percutaneous Coronary Intervention
a. Decompensated Heart Failure
b. Ventricular Tachyarrythmias
c. Symptom – limiting Angina Pectoris
d. Cardiogenic shock
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
569
After verification of precocious pubertal
development, which of the following lab tests should
first be measured?
A. Serum LH and FSH
B. Serum testosterone
C. Serum DHEA S
D. Serum B-HCG
The most common clinical indication for PCI is
symptom-limiting angina pectoris, despite medical
therapy, accompanied by evidence of ischemia
during a stress test. PCI is more effective than
medical therapy for the relief of angina. PCI
improves outcomes in patients with unstable
angina or when used early in the course of
myocardial infarction with and without
cardiogenic shock.
Answer: To determine if it is gonadotropin
dependent or independent
• Gonadotropin Dependent
Gonadotropins increased in relation to
chronologic age
CNS lesions, idiopathic central precocity
• Gonadotropin Indenpendent
High testosterone/suppressed LH
CAH, adrenal neoplasms, testicular neoplasms
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
570
Most important step in the evaluation of male
infertility
A. Serum testosterone
B. HCG stimulation test
C. Semen Analysis
D. Testicular biopsy
Answer: Most important step in the evaluation of
male infertility
• Normal ejaculate
Volume 2-6 mL
Sperm count of >20million/mL
Motility >50%
>15% normal morphology
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
571
What malignancy is associated with a mutated RET
proto-oncogene?
A. Follicular carcinoma
B. Medullary carcinoma
C. Parathyroid carcinoma
D. Papillary carcinoma
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
572
Agents proven to reduce the risk of fractures in
patients being treated with glucocorticoids
Answer: Only bisphosphonates have been
demonstrated in large clinical trials to reduce the
risk of fractures in patients being treated with
glucocorticoids. Risedronate prevents bone loss
and reduces vertebral fracture risk by ~70%.
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
a. Bisphosphonates
b. Selective estrogen response modulators (SERMs)
c. Calcium supplements
d. Hormone replacement therapy
573
Substance that is produced by macrophages in
chronic granulomatous diseases (tuberculosis,
sarcoidosis) that causes hypercalcemia
a. PTHrP
b. 1,25(OH)2D
c. PTH
d. 25(OH)D
Answer: In patients with sarcoidosis and other
granulomatous diseases, such as tuberculosis and
fungal infections, excess 1,25(OH)2D is
synthesized in macrophages or other cells in the
granulomas.
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
574
First line anti-epileptic drug for petit mal and grand
mal seizures (HPIM p2507 table 363-8)
A. Phenytoin
B. Phenobarbital
C. Levetiracetam
D. Valproic acid
ANSWER: first line drugs are as follows
• Primary Generalized Tonic-Clonic
Valproic Acid
Lamotrigine
Topiramate
• Absence Seizures
Valproic Acid
Ethosuximide
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 77 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
575
QUESTION
Acute nephrotic syndrome associated with hepatitis
B and C infections:
A. Mesangioproliferative GN
B. Membranoproliferative GN
C. IgA Nephropathy
D. MCD
576
The most common cause of nephrotic syndrome in
the elderly
A. Focal segmental glomerulosclerosis
B. Membranous glomerulonephritis
C. Diabetic nephropathy
D. Minimal change disease
577
Kimmelstiel-Wilson nodules are seen in:
A. Fabry’s disease
B. Focal segmental glmerulosclerosis
C. Diabetic Nephropathy
D. Membranous Glomerulonephritis
578
Hematuria, thinning and splitting of the GBMs, mild
proteinuria, chronic glomerulosclerosis leading to
renal failure and Sensorineural deafness is seen in:
A. Anti-GBM disease
B. Alport’s Syndrome
C. Thin Basement Membrane disease
D. Nail-Patella Syndrome
579
Sclerotherapy is a treatment option for which stage
of hemorrhoidal disease?
a. Stage I – enlargement with bleeding
b. Stage II – protrusion with spontaneous reduction
c. Stage III – protrusion requiring manual reduction
d. Stage IV – irreducible protrusion
580
After a person is infected with HBV, the first
virologic marker detectable in serum within 1-12
weeks is (H-18, C-304, P-2540):
a) HBeAg
b) HBsAg
c) HBcAg
d) Anti-HBc IgM
581
Finkelstein's test is used to diagnose what
condition?
A. De Quervain tenosynovitis
B. Ulnar nerve palsy
C. Compartment syndrome
D. Carpal tunnel syndrome
E. Osteoarthritis of the hands
582
EXPLANATION
MGN and MPGN are causes of NEPHROTIC
SYNDROME. IgA Neph causes SSx of both.
Mesangioproliferative GN is type II lupus
nephritis. MGN and MPGN are both associated
with hep B and C.
AUTHOR
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
TOPNOTCH
EXAM
MIDTERM 2
EXAM - FEB
2014
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
BLAKE WARREN
ANG, MD (TOP 1 AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2
EXAM - FEB
2014
Prayer test and Tinel test is for carpal tunnel
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
A patient with meningitis suddenly went to coma.
The cause is?
A. Sepsis
B. Increased ICP
C. Pulmonary embolism
D. Hyperthermia
E. Subarachnoid hemorrhage
One of the treatment for ICP increase is inducing a
state of coma. The most likely cause for a patient
with meningitis is sepsis or bacterial seeding
resulting in a depressed brain.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
583
Risk factors associated with the development of
osteoporosis include all the following EXCEPT?
A. Excessive alcohol intake
B. Obesity
C. Genetics
D. Poor calcium intake during adolescence
E. Postmenopausal state
Obesity prevents osteoporosis. (Pre test questions
may appear in IM, no. 270, Pretest 7th ed)
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
584
Which antibodies are associated with
neuropsychiatric lupus?
A. Anti-Sm
B. Anti-Ro and Anti-La
C. Anti-nRNP
D. Anti-ribosomal
E. Anti-centromere
Anti-Sm - specific for SLE
Ro and La - neonatal lupus
nRNP - mixed connective tissue disease
anti-centromere - scleroderma
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
585
What is the standard immunization schedule for
primary Hepatitis B vaccination among adults?
A. 0, 1 and 6 months from initial vaccination
B. 0, 1 and 2 months (4 weeks interval)
C. 0, 6 and 12 months (6 months interval)
D. 0, 1 and 2 months plus a booster dose after 1
year of the last dose
E. 0, 2 months (2 doses 6-8 weeks apart)
The schedule for initial vaccination in adults is
similar to children. 0, 1 (or 2) and 6 months.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
Answer: Some patients (with Diabetic
nephropathy) also develop eosinophilic, PAS+
nodules called nodular glomerulosclerosis or
Kimmelstiel-Wilson nodules.
III
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 78 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
586
QUESTION
EXPLANATION
AUTHOR
An 18 year old male complains of polyuria. What is
the most likely diagnosis?
A. Diabetes Milletus
B. Diabetes Insipidus
C. Primary polydipsia
D. Renal tubular necrosis
E. Idiopathic polyuria
The most common cause of polyuria in both adults
and children is uncontrolled diabetes mellitus,
causing an osmotic diuresis. In the absence of
diabetes mellitus, the most common causes are
primary polydipsia (excessive fluid drinking),
central diabetes insipidus and nephrogenic
diabetes insipidus.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
587
Uncontrolled hypertension not amenable to lifestyle
modifications is treated with?
A. Calcium channel blocker
B. Thiazide diuretic
C. ACE Inhibitor
D. β-blocker
E. Central acting adrenergic agents
The first line for hypertension withour compelling
indications after lifestyle modification is a thiazide
diuretic based on JNC 7.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
588
In the setting of myocardial infarction, what is the
first cardiac biomarker to be detected?
A. Troponin I
B. CK-MB
C. Total CK
D. LDH
E. Myoglobin
The first biomarker to be elevated is myoglobin.
The most specific for MI is troponin I or T.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
589
A systolic murmur is detected upon ausculatation of
a heart failure patient. Prominent findings include an
enlarged and pulsatile liver. What is the heart valve
defect?
A. Aortic stenosis
B. Ventral septal defect
C. Tricuspid insufficiecny
D. Mitral regurgitation
E. Pulmonary stenosis
An enlarged and pulsatile liver is virtually
diagnostic of Tricuspid Insufficiency.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
590
The goal of BP reduction in a diabetic patient is?
A. <140/90
B. <130/90
C. <130/80
D. <120/80
E. <110/80
<130/80 is the goal of aggressive BP lowering for
patients with diabetes or chronic kidney disease
based on the ACCF.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
591
Which tissue in the body is LEAST affected by
radiation?
A. Intestinal lining
B. Lymphocytes
C. Bone
D. CNS
E. Skin
The CNS is made up of permanet neural cells and
labile glial cells and they need 50 Gy of radiation
before they are damaged. Lymphocytes need 1 Gy.
Skin, about 10 Gy. Bone is also damaged by
absorption of radiation and myelosuppression.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
592
Which of the following interventions increase
survival in COPD patients?
A. Smoking cessation
B. Corticosteroids
C. β adrenergic agonist
D. Pneumococcal vaccination
E. All of the above
Smoking cessation, oxygen therapy and limited
lung resection have been proven to increase
survival in COPD patients.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
593
A 20 year old previously healthy female suddenly
have blurring of vision and hemiplegia of the right
arms and legs that lasted for 3 hours. What is the
likely diagnosis?
A. TIA
B. Mild stroke
C. Migraine
D. Partial seizure
E. Intracranial aneurysm
Hemiplegic migraine and not atherosclerotic
lesions (TIA, stroke) are responsible for
temporaray hemiparesis in a normal individual
esp females. Seizures do not give rise to weakness
that last for hours.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
594
What is the initial imaging modality of choice for
patients suspected of having pulmonary embolism?
A. Ventillation-perfusion scan (V/Q scan)
B. Computed tomography angiography (CTA)
C. Pulmonary angiography
D. Magnetic resonance angiography (MRA)
E. Chest radiograph (PA and Lateral)
Computed tomography angiography (CTA) is the
initial imaging modality of choice for stable
patients with suspected pulmonary embolism. The
American College of Radiology (ACR) considers
chest CTA to be the current standard of care for
the detection of pulmonary embolism. Pulmonary
angiography is the gold standard.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 79 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
MIDTERM 1
EXAM - FEB
2014
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
595
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 1
EXAM - FEB
2014
A 65 year old male, non-smoker, with a chronic
history of gastric esophageal reflux disease consults
your clinic for dysphagia. The diagnosis is?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. MALT Lymphoma
D. Linitis plastica
E. Hypertrophic pyloric stenosis
A patient with a chronic history of GERD can be a
risk factor for development of esophageal
adenocarcinoma esp if Barrett esophagus is
diagnosed.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
596
In the chest radiograph of a 22 year old male patient
shows multiple infilttrates inconsisitent with the
normal PE findings and the only complain of
occasional cough. What antibiotic will you AVOID
giving this patient?
A. Azithromycin
B. Amoxicillin
C. Erythromycin
D. Ciprofloxacin
E. Doxycycline
You do not give amoxicillin for Mycoplasma
pneumoniae or atypical pneumonis since they are
not effective because Mycoplasma does not have
cell walls.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
597
Which of the following is a risk factor for breast
cancer?
A. Fibrocystic disease
B. First-degree relative with breast cancer
C. Late menarche
D. Multiple pregnancies
E. Early menopause
Nulliparity, early menarche, late menopause and
history of a first degree relative with breast cancer
are all risk factors for breast cancer. Fibrocystic
disease is not a risk factor.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
598
Magnetic resonance imaging is more sensitive than
computed tomography in the diagnosis of which of
the following?
A. Intracranial hemorrhage
B. Transient ischemic attack
C. Generalized tonic-clonic seizures
D. Early cerebral infarction
E. Skull fracture
Diagnosing hemorrhage and bony fractures are
better in CT. TIA and Seizure disorders cannot be
diagnose by imaging. Early cerebral infarction is
detectable in MRI but not CT.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
599
What is the most common trigger in an asthmatic
attack?
A. Failure of intake of medications
B. Excitement
C. Upper respiratory tract infection
D. Air pollution
E. Strenuous activities
The presence of URTI is the most common cause of
exacerbations for Asthmatic and COPD patients.
All of the choices can possibly trigger an asthma
attack.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
600
The pathophysiology of which disease CANNOT be
explain by the Hygiene Hypothesis?
A. AIDS
B. Allergy
C. Asthma
D. Autoimmunde disease
E. ALL
AIDS is an infection and cannot be explain by the
hygiene hypothesis. The hygiene hypothesis states
that a lack of early childhood exposure to
infectious agents, symbiotic microorganisms, and
parasites increases susceptibility to allergic
diseases by suppressing natural development of
the immune system.
TIMOTHY TANG
LEE SAY, MD (TOP
4 - AUG 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 1
EXAM - FEB
2014
601
A 27-year old male is brought to the ER due to
severe chest pain radiating to his left arm, with
associated body weakness and diaphoresis. PE
revealed small, raised yellowish lesions around the
eye and on volar surfaces of both arms. ECG
revealed ST elevations. His brother died at the age of
24 due to a heart problem. What is the underlying
genetic condition of this patient?
A. Li-Fraumeni syndrome
B. Autosomal dominant polycystic kidney disease
C. Neurofibromatosis type 1
D. Familial hypercholesterolemia
E. Factor V Leiden Mutation
The small, raised yellowish leions around the eyes
and volar surfaces of his arms are xanthomas.
Biopsy of these will show lipid-laden macrophages
(foam cells). In this condition, there is a low
number of functioning LDL receptors, hence LDL
accumulates within the blood strean and gets
deposited on different tissues, such as
endothelium (may ccause blockage, in this case
MI) and subcutaneous tissue.
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
602
A 45 year old male, a chronic alcoholic, is brought to
the ER for agitation, confusion and bizarre behavior.
The patient is cachectic, jaundiced with ascites. ON
PE, you further note spider angiomas, palmar
erythema and flipping hand tremors and ankle
clonus. Which of the following is correct regarding
treatment of this condition?
A. Lactulose should be given for acute
encephalopathy 30-80 ml every hour until diarrhea
occurs.
B. Neomycin is administered to decrease ammonia
production in the gut
C. Metronidazole and Neomycin have comparable
benefits.
D. All of the above
E. A and B
Treatment for hepatic enceph include: aminoleban
for nutrition, neomycin orally or metronidazole to
decrease gut bacteria and thereby decrease
production of ammonia, which is responsible for
encephalopathy. Lactulose is given to neutralize
existing ammonia.
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 80 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
603
QUESTION
According to recent studies, microorganisms
associated with coronary heart disease are:
A. Chlamydia pneumoniae and Streptococcus
pneumoniae
B. Chlamydia pneumoniae, Streptococcus
pneumoniae and Helicobacter pylori
C. Chlamydia pneumoniae and Helicobacter pylori
D. Streptococcus pneumoniae and Helicobacter
pylori
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
FINAL EXAM FEB 2013
Epidemiologic studies have demonstrated an
association between serologic evidence of C.
pneumoniae infection and atherosclerotic disease
of the coronary and other arteries. In addition, C.
pneumoniae has been identified in atherosclerotic
plaques by electron microscopy, DNA
hybridization, and immunocytochemistry. A
potentially important but even more controversial
association is the association of H. pylori with
ischemic heart disease and cerebrovascular
disease.
The given patient has SLE. Antinuclear antibodies
(ANA) are positive in >98% of patients during the
course of disease; repeated negative tests suggest
that the diagnosis is not SLE, unless other
autoantibodies are present. High-titer IgG
antibodies to double-stranded DNA and antibodies
to the Sm antigen are both specific for SLE and,
therefore, favor the diagnosis in the presence of
compatible clinical manifestations.
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
604
A 24-year old female started to note fatigue,
occasional fever, muscle and joint pains over the
past 3 months. At the clinic, she was observed to
have fixed raised erythema over the malar
eminences, along with several oral ulcers.
Auscultation revealed pericardial friction rub. What
is the most specific test for this condition?
A. ANA
B. anti-dsDNA
C. anti-Smith
D. A and B
E. B and C
605
A 45-year old patient suddenly developed diffuse
blisters and eventual skin detachment after injection
of a certain drug. Upon evaluation, the physician
documented that the 25% of the total body surface
area of the patient is affected. The most likely
diagnosis is:
A. Stevens-Johnson Syndrome (SJS)
B. Toxic Epidermal Necrolysis (TEN)
C. SJS/TEN
D. Serum sickness
E. Acute generalized exanthematous pustulosis
The term SJS is now used to describe cases with
blisters developing on dusky or purpuric macules
in which total body surface area blistering and
eventual detachment is <10%. The term SJS/TEN
is used to describe cases with 10–30%
detachment, and TEN is used to describe cases
with >30% detachment. (Harrison's, 17th ed)
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
606
Which of the following is TRUE in anaphylaxis?
A. Anaphylactic urticarial eruptions are intensely
pruritic and frequently persist beyond 48 h
B. Atopy predisposes individuals to anaphylaxis
from penicillin therapy
C. The diagnosis of an anaphylactic reaction depends
largely on an accurate history
D. NSAIDS may produce IgE related acute airway
obstruction
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
607
What part of the immune system does the nitroblue
tetrazolium test (NBT) evaluate?
A. B cell
B. T cell
C. Phagocytic
D. Complement system
E. All of the above
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
608
Dementia with Lewy bodies is associated with the
following syndromes/symptoms, EXCEPT?
A. Capgras' syndrome
B. Parkinsonism
C. Visual hallucinations
D. Memory loss
E. Major depression
A characteristic feature is the eruption of wellcircumscribed, discrete cutaneous wheals with
erythematous, raised, serpiginous borders and
blanched centers. These urticarial eruptions are
intensely pruritic and may be localized or
disseminated. They may coalesce to form giant
hives, and they seldom persist beyond 48 h. The
diagnosis of an anaphylactic reaction depends on a
history revealing the onset of the symptoms and
signs within minutes after the responsible
material is encountered. Aspirin and other NSAIDs
such as indomethacin, aminopyrine, and
mefenamic acid may precipitate a life-threatening
episode of obstruction of upper or lower airways,
especially in patients with asthma, that is clinically
indistinguishable from anaphylaxis but is not
associated with the presence of specific IgE or
elevation of blood tryptase. According to most
studies, atopy does not predispose individuals to
anaphylaxis from penicillin therapy or venom of a
stinging insect but is a risk factor for allergens in
food or latex. (Harrison's, 17th ed)
Deficiencies of oxidative metabolism are detected
with either the nitroblue tetrazolium (NBT) dye
test or the dihydrorhodamine (DHR) oxidation
test. These tests are based on the ability of
products of oxidative metabolism to alter the
oxidation states of reporter molecules so that they
can be detected microscopically (NBT) or by flow
cytometry (DHR). Qualitative studies of
superoxide and hydrogen peroxide production
may further define neutrophil oxidative function.
(Harrison's 17th ed)
in DLB, the first symptoms include: Visual
hallucinations, REM sleep disorder, delirium,
Capgras' syndrome, parkinsonism. The mental
status affected is the drawing and
frontal/executive part. It spares memory, but is
delirium prone. Patients with DLB also complain
of visual hallucinations, depression, sleep
disorder, delusions.
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 81 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
609
EXPLANATION
AUTHOR
A 44 year old renal transplant patient consulted at
the OPD for painful blisters located along his right
breast. Tzanck smear was done, revealing which of
the follwoing results?
A. Hyphae and budding yeast
B. Multinucleated giant cells
C. Granules
D. Sea-blue histiocytes
E. Hirano bodies
The patient has herpes zoster along a dermatomal
distribution. Tzanck smear is done to confirm
diagnosis. Pathognomonic of herpes zoster is the
presence of multinucleated giant cells.
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
610
Urobilinogen is produced in the:
A. Renal tubules
B. Red blood cell
C. Liver
D. Intestinal mucosa
E. Spleen
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
611
A 62-year old male was observed to be moving more
slowly than usual. He has not been sleeping well and
was always anxious. He was brought to your clinic
and you observed wide-based, shuffling gait, with
cogwheel rigidity and resting, pill-rolling tremors.
What is the mechanism of action of the most
appropriate treatment for this condition?
A. Dopamine precursor with peripheral carboxylase
inhbitor
B. Catechol-O-methyltransferase (COMT) inhibitor
C. Dopamine agonist that acts directly on
postsynaptic dopamine receptors (D2)
D. A or B
E. A or C
Which of the following statements is/are correct
regarding the pathogenesis of Type 2 DM?
A. There is a strong genetic component for the
development of the disease.
B. The presence of islet cell autoantibodies
characterizes the initial stage of the disease
C. Exposure to nitrosureas, coxsackie and rubella
viruses has been identified as putative triggers of the
disease.
D. All of the above
Following secretion into bile, conjugated bilirubin
reaches the duodenum and passes down the
gastrointestinal tract without reabsorption by the
intestinal mucosa. An appreciable fraction is
converted by bacterial metabolism in the gut to
the water-soluble colorless compound,
urobilinogen. Urobilinogen undergoes
enterohepatic cycling. Urobilinogen not taken up
by the liver reaches the systemic circulation, from
which some is cleared by the kidneys.
Either a dopamine agonist or levodopa/carbidopa
can be used as initial treatment for parkinson's
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
All the others describe Type 1 DM
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
612
QUESTION
TOPNOTCH
EXAM
FINAL EXAM FEB 2013
613
A patient with complete biliary obstruction
developed bleeding tendencies. Which of the
following parameters may be prolonged?
A. Partial thromboplastin time
B. Prothrombin time
C. Bleeding time
D. All of the above
E. A and B
Patients with complete biliary obstruction will
have impaired absorption of fat-soluble vitamins,
one of which is vitamin K. It is expected in this
patient that his PTT and PT may be prolonged, due
to inadequate amounts of factors 10, 9, 7 and 2.
Factor 10 and 2 is part of both intrnsic and
extrinsic coagulation pathway (common pathway),
such that both PTT and PT may be affected.
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
614
A 21-year old male developed fever and sore throat.
On PE, there was a note of lymphadenopathy. Blood
exam revealed leukocytosis, with predominance of
atypical lymphocytes. Which of the following may
be a complication of this condition?
A. Splenic rupture
B. Guillain-Barré syndrome
C. Autoimmune hemolytic anemia
D. All of the above
E. A and B
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
615
For disorders along the wall of the gastrointestinal
tract, such as ulcers, diverticula, strictures, new
growths and motility disorders, the most useful
diagnostic test to order is:
A. Radiograph
B. MRI
C. CT scan
D. Ultrasound
E. Scintigraphy
The patient is diagnosed with infectious
mononucleosis. Most cases are self-limited.
Deaths are very rare and most often are due to
central nervous system (CNS) complications,
splenic rupture, upper airway obstruction, or
bacterial superinfection. Acute EBV infection has
also been associated with cranial nerve palsies
(especially those involving cranial nerve VII),
Guillain-Barré syndrome, acute transverse
myelitis, and peripheral neuritis. Autoimmune
hemolytic anemia occurs in ~2% of cases during
the first 2 weeks. Hypertrophy of lymphoid tissue
in the tonsils or adenoids can result in upper
airway obstruction, as can inflammation and
edema of the epiglottis, pharynx, or uvula. About
10% of patients with IM develop streptococcal
pharyngitis after their initial sore throat resolves.
Radiograph studies, such as barium swallow and
barium enema, can provide an actual picture of
motility, filling defects and mucosal defects when
taken in series. Intetsinal obstruction is also
preferred to be viewed in upright and supine
radiographic studies.
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 82 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
616
QUESTION
This syndrome results from defective hypothalamic
gonadotropin-releasing hormone (GnRH) synthesis
and is associated with anosmia or hyposmia due to
olfactory bulb agenesis or hypoplasia:
A. Bardet-Biedl Syndrome
B. Prader-Willi Syndrome
C. Carney syndrome
D. McCune-Albright syndrome
E. Kallmann syndrome
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
FINAL EXAM FEB 2013
McCune-Albright syndrome consists of polyostotic
fibrous dysplasia, pigmented skin patches, and a
variety of endocrine disorders, including GHsecreting pituitary tumors, adrenal adenomas, and
autonomous ovarian function. Carney syndrome is
characterized by spotty skin pigmentation,
myxomas, and endocrine tumors including
testicular, adrenal, and pituitary adenomas.
Acromegaly occurs in about 20% of patients.
Prader-Willi Syndrome is associated with
hypogonadotropic hypogonadism, hyperphagiaobesity, chronic muscle hypotonia, mental
retardation, and adult-onset diabetes mellitus.
Bardet-Biedl Syndrome is a rare genetically
heterogeneous disorder characterized by mental
retardation, renal abnormalities, obesity, and
hexadactyly, brachydactyly, or syndactyly. Central
diabetes insipidus may or may not be associated.
Alkaptonuria is a rare disorder of tyrosine
catabolism in which deficiency of homogentisate
1,2-dioxygenase (also known as homogentisic acid
oxidase) leads to excretion of large amounts of
homogentisic acid in urine and accumulation of
oxidized homogentisic acid pigment in connective
tissues (ochronosis). Alkaptonuria may go
unrecognized until middle life, when degenerative
joint disease develops.
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
617
A 29-year old male complains of progressive attacks
of joint pains and stiffness (hip and knee joints),
back pain and darkening of urine. Physical exam
revealed generalized darkening of the ear, along
with limited range of motion for both lower
extremities due to pain. The underlying defect is:
A. Lack of homogentisic acid oxidase
B. Abnormal overproduction of melanin granules
C. Reduced activity of cystathionine synthase
D. Overactivity of tyrosinase
E. None of the above
618
Which of the following is NOT a major criterion
included in the Framingham criteria of congestive
heart failure?
A. Rales
B. Cardiomegaly
C. Dypnea on exertion
D. S3 gallop
E. Neck vein distention
Framingham Major Criteria include: paroxysmal
nocturnal dyspnea, rales, incresed CVP, neck vein
distention, cardiomegaly, acute pulmonary edema,
s3 gallop, hepatojugular reflux, weight loss.
Dyspnea on exertion is included in the minor
criteria.
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
619
A 63-year old congestive heart failure patient
frequently complains of worsening orthopnea,
requiring him to use 4 pillows when sleeping. The
most probable mechanism for this is:
A. Worsening interstitial pulmonary edema
B. Redistribution of fluid from the splanchnic
circulation and lower extremities into central
circulation
C. Increased pressure in the bronchial arteries
leading to airway compression
D. Transudation of fluid from the intravscular space
into the alveoli
E. Diminished sensitivity of the respiratory canter to
arterial PCO2
A 30-year old male sought consult due to presistent
headache and palpitations. He was pale, restless and
sweating profusely during the interview. BP was
220/120 mmHg, HR was 124 bpm, PE was otherwise
unremarkable. CT scan was requested revealing an
adrenal mass. Surgery was planned. What is the
most appropriate pre-oprative treatment for this
patient?
A. Nitroprusside drip 12 hours prior to surgery
B. Nicardipine IV infusion 12 hours prior to surgery
C. Propranolol 10mg TID-QID 10-14 days prior to
surgery
D. Phenoxybenzamine 20-30mg TID 10-14 days
prior to surgery
E. Captopril 25mg TID-QID 10-14 days prior to
surgery
Orthopnea is due to redistribution of fluid from
the splanchnic circulation and lower extremities
into the central circulation during recumbency.
PNH is due to increased pressure on bronchial
arteries leading to airway compression, along with
interstitial edema. Cheyne-Stokes respiration is
due to diminished sensitivty of respiratory center
to arterial PCO2. Crackles/rales is due to
transudation of fluid from the intravscular space
into the alveoli.
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
Complete tumor removal is the ultimate
therapeutic goal. Preoperative patient preparation
is essential for safe surgery. -Adrenergic blockers
(phenoxybenzamine) should be initiated at
relatively low doses (e.g., 5–10 mg orally three
times per day) and increased as tolerated every
few days. Because patients are volume constricted,
liberal salt intake and hydration are necessary to
avoid orthostasis. Adequate alpha blockade
generally requires 10–14 days, with a typical final
dose of 20–30 mg phenoxybenzamine three times
per day. Oral prazosin or intravenous
phentolamine can be used to manage paroxysms
while awaiting adequate alpha blockade. Before
surgery, the blood pressure should be consistently
below 160/90 mmHg, with moderate orthostasis.
Beta blockers (e.g., 10 mg propranolol three to
four times per day) can be added after starting
alpha blockers, and increased as needed, if
tachycardia persists. Because beta blockers can
induce a paradoxical increase in blood pressure in
the absence of alpha blockade, they should be
administered only after effective alpha blockade.
Other antihypertensives, such as calcium-channel
blockers or angiotensin-converting enzyme
inhibitors, have also been used when blood
pressure is difficult to control with
phenoxybenzamine alone.
RACHELLE
MENDOZA, MD
(TOP 9 - AUG 2012
MED BOARDS;
TOPNOTCH MD)
FINAL EXAM FEB 2013
620
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 83 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
621
622
623
624
625
QUESTION
EXPLANATION
AUTHOR
A 36 year old man presents to the clinic with
complaints of a genital sore. The patient is sexually
active, heterosexual involved with 3 partners and
practices unprotected intercourse. Four days ago he
noted, a painless sore on his penis. He is afebrile
with a HR of 80bpm, BP of 120/80 mmHg. PE reveals
a solitary ulcerated lesion located on the lateral
aspect of his penis. The lesion is non tender and is
associated with with bilateral inguinal
lymphadenopathy. PE is otherwise normal. If left
untreated, this man is at increased risk for which of
the following?
A. Ascending aortic aneurysm
B. Coronary artery aneurysm
C. Endocarditis
D. Mitral valve stenosis
E. Rupture of ventricular free wall
A 65 year old woman presents to the ER department
complaining of dizziness. She is disoriented to the
date and her location and it is difficult to gather an
accurate history. Her pulse is 48 bpm, BP of 80/60
mmHg, and RR of 12 cpm. On examination, her
extremities are cool and clammy. her capplary refill
time is 5 seconds. What is the most appropriate
therapy?
A. Adenosine
B. Amiodarone
C. Atropine
D. Isoproterenol
E. Metoprolol
A 25 year old man is recovering in the hospital froman open rapair of his broken femur, which he
suffered during an automobile accident. On
postoperative day 3, he develops sudden onset of
shortness of breath and vague chest pain. His
temperature is 37.6 C and HR of 108 bpm, BP of
90/60 mmHg, RR of 42 cpm and O2 sat of is 89 % on
room air. PE is significant for jugular venous
distention to 9 cm and an accentuated pulmonic
component of S2. Which of the following is most
likely DECREASED?
A. Airway resistance
B. Alveolar dead space
C. Alveolar ventilation
D. Pulmonary compliance
E. Pulmonary vascular resistance
A 48 year old man is brought to the emergency
department confused and disoriented. He is a
diagnosed case of DM type 1. He reports recent
onset of nausea and has had several episodes of
emesis in the past 4 days. On further questioning, he
also notes a metallic taste in his mouth, frequent
hiccups, and pruritus. On PE there is rough, velcrolike sound heard accross his precordium. Which of
the following is the most likely diagnosis?
A. Addisonian crisis
B. Fulminant hepatic failure
C. Heroin withdrawal
D. Renal insufficiency
E. Vit B 12 insufficiency
A 43 year old man develops fever, headache, and
altered mental status. His past medical history is
notable only for a motor vehicle accident 2 years
ago, during which he sustained a splenic laceration
requiring splenectomy. Which of the following is the
most likely causing this patient's syndrome?
A. Cryptococcus neoformans and Listeria
monocytogenes
B. Cryptococcus neoformans and Streptococcus
pneumonia
C. Haemophilus influenza and Staphylococcus
aureus
D. N. meningitides and S. Aureus
E. N. meningitides and Streptococcus pneumoniae
This case is a PRIMARY SYPHILIS. It may lead to
tertiary syphilis which can cause ascending aortic
aneurysm
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
patient has symptomatic bradycardia. Atropine is
the dug of choice.
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
This is a case of Pulmonary Embolism in which the
compliance of the lungs (volume change per unit
pressure change) decreases.
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
As uremic toxins increases, patients will complain
of pruritus, nausea and vomiting, hiccups, and a
metallic taste in her mouth. Pericardial friction rub
in cases of uremic pericarditis
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
encapsulated organism such as Neisseria, Strep
pneumoniae and H influenza may cause infection
in asplenic patients, as they are unable to
manufacture a new antibody immune response
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 84 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - AUG
2012
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
626
627
628
629
QUESTION
A 34 year old man presents with fever and night
sweats for 3 weeks and productive cough. A recent
HIV test was negative. A PPD test performed on
admission shows 15 mm induration. His ESR is 97
mm/hr. Past medical history is significant for
relapse of alcoholism. rebiew of systems reveal
generalized fatigue over the past month and a 3.2 kg
weight loss. His temperature is 39.6 C, RR is 25 cpm,
and O2 sat is 86 % on room air. Bilateral pulmonary
rales are noted on P.E and moderate sternal
retractions are present. X ray of the chest reveals
reticulonodular infiltrates spread evenly throughout
both lung fields. Which of the following is the most
likely diagnosis?
A. Latent tuberculosis
B. Miliary tuberculosis
C. Pneumocystus jiroveci pneumonia
D. Primary tuberculosis
E. Reactivation pulmonary tuberculosis
A 54 year old man presents to his physician
complaining of difficulty urinating. He urinates more
often during the day and often wakes at night to
urinate. He also has difficulty starting and
maintaining a stream of urine. DRE reveals a fusely,
large, rubbery prostate. Urinalysis and urine culture
reveal no hematuria or signs of infection. What is the
BEST next step in the diagnosis?
A. Cystoscopy
B. Measure creatinine levels
C. Measure PSA level
D. UTZ guided transrectal prostate biopsy
E. X ray of the chest and bone scan
A 29 year old type 1 diabetic presented to the ER
with clouded sensorium. He is febrile and
tachypneic, sweating profusely and pale. His BP is
90/60 mmHg, CR of 116 bpm and CBG of 300 mg/dL.
Relatives reported that he has cough and yellow
sputum for about a week now and has not sought
consult nor took antibiotics. he has decreased
appetite for the last 3 days. His breath has a
characteristic fruity odor. These statements are
TRUE regarding the pathophysiology of the case
EXCEPT:
A. Increase hepatic gluconeogenesis
B. Insulin deficiency
C. Low peripheral glucose utilization
D. Blunted counter-regulatory response
E. Insulin resistance
The MOST useful physiologic marker of thyroid
hormone synthesis is:
A. Triiodithyronine
B. TSH
C. TRH
D. Thyroxine
E. Thyroglobulin
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - AUG
2012
This is a case of Miliary TB. It refers to
hematogenous spread of the bacteria following
reactivation of a latent infection. The important
information here is is the classic MILIARY
PATTERN ON XRAY of the chest indicative of
hematogenous spread.
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
This is a cse of BPH. Urinary obstructive
symptoms (hesitancy, weak stream, intermittent
stream and etc). Serum creatinine is used to assess
for renal insufficiency caused by obstructive
uropathy 2ndary to BPH.
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
TSH is the most useful physiologic marker of
thyroid hormone synthesis
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
630
The gold standard in the diagnosis of
gastroesophageal reflux disease:
A. Esophagoscopy
B. 24 hr pH monitoring
C. Barium swallow
D. Berstein test
E. Breath test
24 hr pH monitoring
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
631
A 37 year old seaman came to your clinic for a
second opinion. In his pre-employment medical
examination, he turned (+) for HBs Ag. His industrial
physician requested for a complete hepatitis
serology. The following are the results: anti-HBs (-),
anti -HBc (-), HBeAg (+), anti-HBe (-), anti-HAV IgG
(+), anti-HCV (-). The CORRECT interpretation of the
results is:
A. Active Hepa B with high infectivity and active
Hepa A
B. Active Hepa B with high infectivity and previous
Hepa A
C. Active Hepa B in the window period and
previous Hepa A
D. Active Hepa B with low infectivity and previous
Hepa A
E. None of the above
Active Hepa B with high infectivity and previous
Hepa A
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 85 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
632
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - AUG
2012
A 42 year old female came in due to diarrhea for 6
months. She has stopped all dairy and milk products
for the past few months as advised by a physician
who told her that her symptoms were caused by
lactase deficiency. The diarrhea occurs throughout
the day and she has not noticed blood or pus in the
stools. Past medical history revealed PUD for many
years that has been relatively resistant to medical
treatment. She takes maximum doses of omeprazole
and famotidine and still has symptoms. Her PE is
unrevealing. her lab results are normal except for
mild hypercalcemia. What is the most likely
diagnosis?
A. H. pylori associated PUD
B. Zollinger-Ellison Syndrome
C. Irritable Bowel syndrome
D. Autoimmune atrophic gastritis
E. None of the above
What is the cornerstone of the treatment for NONALCOHOLIC fatty liver diasease?
A. Thiazolidinediones
B. Statins
C. Fibrates
D. Metformin
E. Weight Loss
Zollinger-Ellison Syndrome
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
weight loss
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
634
A 24 year old man is brought to the ER department
after suffering blunt trauma to his chest in a motor
vehicle accident. His RR is 32 cpm, CR of 125 bpm,
and BP is 80/40 mmHg, with a decrease to 60/40
mmHg on inspiration. PE reveals decreased heart
sounds and a pericardial friction rub. Which other
symptom would the physician expect to see as part
of the patient's presentation?
A. Bounding pulse
B. Bradycardia
C. Holosystolic murmur
D. Hypertension
E. Jugular venous distention
This is a cse of Cardiac tamponande. Beck's triad:
hypotension, muffled heart sounds and JUGULAR
VENOUS DISTENTION
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
635
A 47 year old man with hypertension is prescribed
with hydochlorothiazide by his primary care
physician. Which of the following is a potential effect
of this medication?
A. Hypokalemia
B. Dilutional Hyponatremia
C. Hyperuricemia
D. Hyperlipidemia
E. All of the above
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
636
An 85 year old man with hypertension and
cerebrovascular disease presents to his physician's
office for a routine check up. Review of systems is
positive only for "periodic ringing in the ears". PE
reveals left facial paralysis and poof hearing on the
left side. A stroke in which vascular territory is
MOST likely?
A. Anterior cerebral artery
B. Anterior inferior cerebellar artery
C. Middle cerebral artery
D. Posterior cerebral artery
E. Posterior inferior cerebellar artery
Anterior inferior cerebellar artery , distribution
typically present with gaze palsy, DEAFNESS,
TINNITUS and ipsilateral facial weakness.
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
637
Which of the following is associated with
development of primary central nervous system
lymphoma in ppatients with HIV?
A. EBV
B. JC virus
C. Mycobacterium avium complex
D. Previous radiation exposure
E. Toxoplasma gondii
Virtually all cases of primary CNS lymphoma in
patients with HIV are associated with EBV
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
638
What is the best treatment for anemia in patients
with chronic kidney disease?
A. Thrice weekly erythropoietin
B. Periodic blood transfusion
C. Daily intake of ferrous sulfate
D. Bone marrow transplantation
E. Any of the above choices
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
633
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 86 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
639
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - AUG
2012
What is the gold standard in the diagnosis of
pulmonary embolism?
A. V/Q scan
B. CT Scan with IV contrast
C. Pulmonary angiography
D. MRI contrast enhanced
E. Chest Xray
gold standard: pulmonary angiography; principal
imaging technique: CT scan with IV contrast
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
640
A 69 year old male was diagnosed to have COPD.
What is/are the only intervention/s proven to
improve survival in severe COPD patients?
A. Smoking cessation
B. Oxygen therapy
C. Cyclic antibiotics
D. Inhaled corticosteroids
E. A and B
smoking cessation and oxygen therapy
VON ANDRE
MEDINA, MD (TOP
4 - FEB 2012 MED
BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2012
641
Primary Syphilis is best treated with?
A. Ampicillin
B. Amikacin
C. Penicillin G
D. Spectinomycin
E. Ceftriaxone
The DOC for syphilis is still Pen G
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
642
The most common complication of Peptic Ulcer
disease is?
A. Perforation
B. Bleeding
C. Fistula formation
D. Hypertrophy of the pylorus
E. Peritonitis
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
643
A 24 year old male consulted you due to purulent
penile discharge. Gram stain showed garm(-)
intracellular diplococci. What is/are the best
treatment?
A. Ceftriaxone 250mg IM
B. Metronodazole 500mg tablet, 4 tablets single
dose
C. Azithromycin 1 gram single dose
D. A and B
E. A and C
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
644
A 32 year old cave explorer came to your clinic due
to a 3 week history of cough that became associated
with blood-streaked sputum. What is the best
differential for this case?
A. Community Acquired Pneumonia
B. Pulmonary tuberculosis
C. Paragonimus westermani infection
D. Histoplasma capsulatum infection
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
645
The lowest grade of murmur that you can observe
thrill is
A. Grade I
B. Grade II
C. Grade III
D. Grade IV
E. Grade V
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
646
A 42 year old teacher came to your clinic to consult
for lesions in her skin. Upon PE, you saw vesicular,
erythematous and crusted lesions on her
extremities, chest and back. Some lesions have the
characteristic dew-drop on a rose petal morphology.
You are sure this is
A. Scabies
B. Psoriasis
C. Impetigo
D. Varicella zoster
E. Herpes simplex
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
647
A 56 year year old alcoholic male came to ER due to
severe hematemesis. Bleeding is uncontrollable,
hence you considered rupture of distal esophagus
due to retching which is called
A. Mallory-Weiss Syndrome
B. Boerhaave Syndrome
C. Plummer-Vinson Syndrome
D. Zenker's Diverticulum
E. Traction Diverticulum
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
Ceftriaxone should definitely be given. However,
gonorrhea is almost always accompanied by
Chlamydial infection, hence Azithromycin or
Doxycycline should be given too.
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 87 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
648
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - AUG
2013
The most common presenting symptom of
Pulmonary Thromboembolism is
A. Syncope
B. Tachycardia
C. Dyspnea
D. Hemoptysis
E. "sense of impending doom"
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
649
A tumor in the descending colon commonly presents
as
A. Fatigue and palpitations
B. tenesmus
C. hematochezia
D. Hypochromic, microcytic anemia
E. Applecore lesion on radiograph
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
650
During your internship, you saw a patient with
psoriasis scraping off her lesions and punctate
hemorrhages appeared. This is called
A. Koebner phenomenon
B. Wickham striae
C. Auspitz sign
D. Forscheimer phenomenon
E. Nagayama spots
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
651
A 27 year old male was noted to have BP of 150/90
mmHg. Which drug should you prescribe the least?
A. Amlodipine
B. Losartan
C. Captopril
D. Propranolol
E. Hydrochlorothiazide
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
652
You are given a patient with thalassemia major who
had hemochromatosis. This is also known as
A. Bronze diabetes
B. Wilson's disease
C. Ondine's curse
D. Gustilo's syndrome
E. Beckmann's Disease
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
653
The Philippine CPG for Community Acquired
Pneumonia requires ______ as basis for its diagnosis.
A. History of cough of >2 weeks
B. Clinical findings alone
C. Routine sputum gram stain
D. Radiologic confirmation
E. Blood culture
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
654
the Global Initiative Against Asthma (GINA)
recommends addition of long acting beta-agonist as
controller medication for
A. Mild intermittent asthma
B. Mild persistent asthma
C. Moderate persistent asthma
D. Severe acute attacks
E. Status asthmaticus
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
655
In a patient with goiter on hyperthyroid state, this
medication is usually given to reduce vascularity and
size of the tumor
A. Lugol's iodine
B. Propanolol
C. PTU
D. Methimazole
E. Bromocriptine
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
656
A 45 year old patient presented with bone pain.
Radiographic findings showed lytic bone lesions and
serology showed monoclonal antibodies. This
patient would probably be suffering from?
A. Chronic Myelogenous Leukemia
B. Primary Myeloproliferative disease
C. Multiple Myeloma
D. Multiple Sclerosis
E. Reynaud's Disease
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
Beta blockers can cause impotence
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 88 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
657
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
DIAGNOSTIC
EXAM - AUG
2013
A 29 year old female came to ER due to severe flank
pain and decreased amount of urine. Urinalysis
showed gross hematuria with leukocytes, few
squamous cells and coffin-lid crystals. You know this
is caused be renal stones composed by
A. Magnesium Ammonium Phosphate
B. Calcium oxalate
C. Uric acid
D. Calcium carbonate
E. None of the above
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
658
This is the pathognomonic lesion for Rheumatic
Fever.
A. Anitschkow cells
B. Caterpillar cells
C. Aschoff bodies
D. McCullough Plaques
E. Vegetations
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
659
The following are Type III hypersensitivity
reactions, EXCEPT?
A. Systemic LupusErythematosus
B. Arthus Reaction
C. PSGN
D. Serum sickness
E. Goodpasteur's Syndrome
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
660
You are presented with a 34 year old call center
agent who developed severe coughing episodes
associated with high grade fever. Further history
revealed previous diagnosis of HIV. You requested
for CD4 count and revealed <200/µL. What is the
most likely etiologic agent?
A. Nocardia
B. Cytomegalovirus
C. Mycobacterium Avium-Intracellulare
D. Pneumocystis jirovecii
E. None of the above
LITO JAY
MACARAIG, MD
(TOP 8 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
DIAGNOSTIC
EXAM - AUG
2013
661
Patient presented with dizziness and dyspnea at the
ER. Physical examination showed a holosystolic
harsh sounding murmur loudest at the left lateral
sternal border. This describes?
A. Mitral stenosis
B. Mitral regurgitation
C. Ventricular septal defect
D. Mitral valve prolapse
E. Patent dusctus arteriosus
VSD is an acyanotic congenital heart defect, aka a
Left-to-right shunt, so there are no signs of
cyanosis.
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
662
On ECG, PR interval shows increased duration of
more than 5 small squares. What would be the
diagnosis?
A. Atrial flutter
B. Mobitz Type II
C. Wenckebach type AV block
D. 1st degree AV block
E. None
Atrial flutter is descbed to have a "sawtooth
pattern" on ECG. 2nd degree AV block is divided
into to subcategories, namely Mobitz I (
Wenckebach) with progressive lengthening od PR
interval and dropped beats, and Mobitz II with
dropped beats not preceeded by change in length
of PR interval.
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
663
Class of anti-arrythmic that blocks Na channels?
A. I
B. II
C. III
D. IV
E. None
I - Na channel blockers, II - B - blockers, III - K
channel blockers, IV - Ca channel blockers
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
664
This disease is characterized by acute adrenocortical
insufficiency and adrenal hemorrhage secondary to
infection with N. menigitidis?
A. Waterhouse - Friedrichsen Syndrome
B. Pheochromocytoma
C. Conn's disease
D. Addison's disease
E. None
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
665
Manifestation of MEN I except?
A. Pheochromocytoma
B. Kidney stones
C. Stomach ulcers
D. Pituitary tumors
E. Zollinger - Ellison Syndrome
The bacterial infection leads to
massive hemorrhage into one or (usually) both
adrenal glands. It is characterized by
overwhelming bacterial
infection meningococcemia leading to massive
blood invasion, organ failure, coma, low blood
pressure and shock,disseminated intravascular
coagulation (DIC) with widespread purpura,
rapidly developing adrenocortical
insufficiency and death.
Multiple endocrine neoplasia type 1 (MEN-1
syndrome) or Wermer's syndrome is part of a
group of disorders that affect theendocrine
system through development neoplastic lesions
in pituitary, parathyroid gland and pancreas.
Kidney stones are due to excess calcium
deposition due to PTH tumor, stomach ulcers are
secondary to ZES, a form of pancreatic tumor.
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 89 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
666
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 2 AUG 2013
The following are causes of high anion gap metabolic
acidosis, except?
A. Methanol
B. Ethylene glycol
C. Paraldehyde
D. Acetazolamide
E. Aspirin
All of the examples cause HAGMA, except
acetazolamide which causes NAGMA.
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
667
GFR of stage III CKD?
A. >90 ml/min/1.73m2
B. 60 - 89
C. 30 - 59
D. 15 - 29
E. < 15%
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
668
This is the most common cause of glomerular origin
hematuria.
A. PSGN
B. Goodpasture syndrome
C. SLE Nephritis
D. Minimal Change DIsease
E. Berger's Syndrome
Chronic kidney disease (CKD), also known
as chronic renal disease, is a progressive loss
in renal function over a period of months or
years.All individuals with a glomerular filtration
rate (GFR) <60 mL/min/1.73 m2 for 3 months are
classified as having chronic kidney disease,
irrespective of the presence or absence of kidney
damage.
IgA nephropathy (also known as IgA
nephritis, IgAN, Berger's disease, Berger's
syndrome and synpharyngitic glomerulonephritis)
is a form of glomerulonephritis (inflammation of
the glomeruli of the kidney). IgA nephropathy is
the most common glomerulonephritis throughout
the world
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
669
Most common cause of bacterial meningitis in adults
>20 y/o?
A. H. influenzae
B. N. meningitidis
C. S. pneumoniae
D. L. monocytogenes
E. None
The most common causes per age group are as
follows:
a - infants, b - adolescents, c adults >20, d - immunosuppressed and elderly
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
670
Used in diagnosis of diabetes insipidus?
A. Metyrapone test
B. Water deprivation test
C. Demeclocycline administration
D. 24 hr urine osmolality
E. None
Metyrapone test is used to diagnose excess
cortisol production in ACTH, demeclocycline is
used as treatment for SIADH/
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
671
A 65 year old female came in due to joint pain
invloving her knees and hip joints. Her symptoms
appeared gradually with morning stiffness lasting
less than 30 minutes. Pain worsens with activity. On
PE, there are nodes at the DIP and PIP joints of the
hands. what is the diagnosis?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Gouty arthritis
D. Septic arthritis
E. none
The case is a classic presentation of osteoarthritis
which is due to decreased synovial fluid and
leading to"wear and tear" of the joint. Treatment
includes lifestyle modification, exercise and
NSAIDS, and surgery id with severe debilitation.
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
672
True of hereditary spherocytosis?
A. A form of intravascular hemolysis
B. Presents during early adulthood
C. Cells have decreased surface - volume ratio
D. A and b
E. None
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
673
Mechanism of lead poisoning, except?
A. Inhibition of ferrochelatase
B. Decreased heme synthesis
C. Inhibition of ALA dehydrogenase
D. A and b only
E. None
Hereditary spherocytosis is an auto-hemolytic
anemia characterized by the production of red
blood cells that are sphere-shaped rather than biconcave disk shaped (donut-shaped), and
therefore more prone to hemolysis. It is an
example of extravascular hemolysis which can
lead to heppsplenomegaly and usually present
during childhood.
One of the main causes for the pathology of lead is
that it interferes with the activity of an essential
enzyme called ALA dehydratase, which is
important in the biosynthesis of heme, the
cofactor found in hemoglobin.Lead also inhibits
the enzyme ferrochelatase, another enzyme
involved in the formation of heme
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
674
Type of skin cancer associated with exposure to
sunlight. Lesions are described to have rolled edges
with central ulceration and "palisading nuclei" on
microscopy?
A. Squamous cell carcinoma
B. Melanoma
C. Basal Cell Carcinoma
D. Actinic Keratosis
E. Dysplastic Nevus
Basal cell carcinoma is the most common form of
skin cancer, it is locally invasive and rarely
metastasize. SCC is mainly caused by cumulative
UV exposure over the course of a lifetime
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
675
Disease characterized by decreased production of
neurotransmitters from the locus ceruleus, ventral
tegmentum and raphe nucleus?
A. Anxiety
B. Depression
C. Huntington's
D. Schizophrenia
E. None
Depression is due to a decreased production of
neurotransmitters, namely NE, dopamine and 5HT from locus ceruleus, tegmentum of septal
nucleus and raphe nucleus respectively.
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 90 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
676
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 2 AUG 2013
Lesion in this areal eads to development of fluent
aphasia?
A. BA 22
B. BA 44, 45
C. BA 3, 1, 2
D. BA 19
E. Arcuate fasciculus
Fluent aphasia, also known as sensory aphasia/
Wernicke's aphasia, wherein articulation is
normal, however, perception is impaired. This
involves BA 22 also known as the superior
temporal gyrus, or Wernicke's area.
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
677
Most common location of berry aneurysms in the
Circle of WIllis?
A. ICA
B. Junction between the posterior cerebral and
posterior communicating artery
C. Junction between anterior cerebral artery and
anterior communicating artery
D. basilar artery
E. none
he most common sites include the anterior
cerebral artery and anterior communicating
artery (30–35%), the bifurcation, division of two
branches, of the internal carotid and posterior
communicating artery (30–35%), the bifurcation
of the middle cerebral artery (20%), the
bifurcation of the basilar artery, and the remaining
posterior circulation arteries (5%).
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
678
Side effects of anti - TB medications, except?
A. INH : hepatotoxicity
B. Rifampicin : peripheral neuropathy
C. PZA : hyperuricemia
D. Ethambutol : optic neuropathy
E. Streptomycin : ototoxic
Rifampicin causes orange discoloration of body
fluids, hepatotoxicity, pruritus.
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
679
Drug of choice for the treatment of anaerobic
infections above the diaphragm?
A. Amoxicillin
B. Cloxacillin
C. Co - amoxiclav
D. Metronidazole
E. Clindamycin
The first three antibiotics are treatment for
penicillin - susceptible microorganisms.
Metronidazole is used for treatment of anaerobic
infections below the diaphragm.
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
680
Lumbar tap showed increased lymphocytes, protein
and decreased sugar in a patient with nuchal rigidity
and irritability. Cause?
A. Fungal
B. Bacterial
C. Viral
D. Protozoan
E. None of the above
Bacterial - inc pressure, predominance of PMN,
increased protein, decreased sugar
Viral - n/inc pressure, lymphocytes, n/inc protein,
normal sugar
HAZEL KAREN
RAZ, MD (TOP 6 FEB 2013 MED
BOARDS;
TOPNOTCH MD)
MIDTERM 2 AUG 2013
681
Component therapy is encouraged in transfusion
medicine to avoid volume overload most especially
in elderly patients. In a male patient with a current
hemoglobin level of 96 g/L, how many units of
packed red blood cell (PRBC) is needed to be
transfused to raise the hematocrit level to 0.38?
A. 2 units
B. 3 units
C. 4 units
D. 5 units
Answer: B. 3 units of PRBC
Notes: 1 unit of PRBC increases haemoglobin by 1
g/dL in adults (3 g/dL in children) and hematocrit
by 3% (0.03).
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
682
Which seronegative spondyloarthropathies
associated with Human Leukocyte Antigen B27 most
likely presents in a young man complaining of
chronic lower back pain with morning stiffness for
more than an hour which improves with exercise?
A. Rieter’s Syndrome
B. MCTD
C. Psoriatic Arthritis
D. Ankylosing Spondylitis
Answer: D. Ankylosing Spondylitis
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
683
The following miscellaneous cardiac
“pathognomonisms” are correctly matched; except,
A. Parvus et Tardus pulses: aortic stenosis
B. Continuous machinery murmur: patent ductus
arteriosus
C. Pulsus paradoxus: cardiac tamponade
D. Bifid pulse: atrial-septal defect
Answer: D. Bifid pulse: atrial-septal defect
Notes:
• Bifid pulse: hypertrophic cardiomyopathy (from
midsystolic obstruction)
• Fixed, split S2 heart sound: atrial-septal defect
• Opening snap: mitral stenosis
• Parvus only: low output cardiomyopathy
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
684
A 20 yo male complained of chest pains and
difficulty in breathing. He was seen in the ED, and his
vital signs were as follows: T = 37OC; PR = 88 bpm,
regular; BP = 110/70 mmHg, RR = 20 cpm; and O2
sat on room air = 94%. PE revealed a rather anxious
patient with no pallor, icterus, or cyanosis. JVP was
normal. The apical pulse was in the 5th ICS MCL, and
a murmur was heard that extended throughout the
cardiac cycle. The most likely cause for this murmur
is which of the following?
A. Aortic Stenosis
B. Mitral regurgitation
C. Pericarditis
D. Patent Ductus Arteriosus
Answer: D. Patent Ductus Arteriosus
Notes: This patient has a continuous murmur that
straddles the entire spectrum of the cardiac cycle.
Such murmur is called a “machinery murmur,” and
is observed in patients having PDA or an
arteriovenous fistula.
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 91 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
685
QUESTION
EXPLANATION
AUTHOR
A 69 yo man with a history of coronary artery
disease and hypertension presents with acute onset
of right facial weakness and numbness. On
examination, his speech and extremity strength are
normal, but he has significant weakness of the right
side of the face, including the orbicularis oculi. In
addition, he complains of roaring in the right ear,
and his taste sensation is absent on the right side of
the anterior tongue. Sensation is normal to
prinprick. Which of the following would best explain
these findings?
A. Lacunar stroke of the left internal capsule
B. Brainstem glioma
C. Bell’s palsy
D. A stroke due to occlusion of the left middle
cerebral artery
A 34 yo man comes to your clinic complaining of
“crushing” chest discomfort for 1 hour. He has no
siginifcant medical history. The ECG is normal but
you still give sublingual nitroglycerin which
immediately improves the pain. What is the next
step in the management?
A. Request for Troponin T
B. Repeat the ECG
C. Do a barium swallow
D. Do an endoscopy
Answer: C. Bell’s Palsy
Notes: Bell’s palsy is idiopathic and nearly always
acute. All of the patient’s deficits are referable to
the peripheral nervous system, including the loss
of taste (chorda tympani branch of the facial
nerve) and hyperacusis (branch of the stapedius
muscle of the ear).
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
Answer: C. Do a barium swallow
Notes: The most likely diagnosis for the patient in
this case is DES (Diffuse Esophageal Spasm).
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
687
A 60 yo known diabetic patient was rushed to the ER
for unresponsiveness. On physical examination, she
was noted to have dry skin and oral mucosa with BP
100/70mmHg, HR 100 bpm, RR 28 cpm. RBS =
600mg/dL, urine – negative for ketones. What is the
initial step in the management of this patient?
A. Give IV insulin as soon as possible
B. Insert a line and administer plain NSS
C. Give IV bolus of sodium bicarbonate
D. Intubate the patient
Answer: B. Insert a line and administer plain NSS
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
688
A 30 yo female is brought to the ER for lethargy. You
noted dry skin and hair, periorbital edema and
sparse hair on the armpit. Serum TSH and FT4 levels
are low. What is your most probable diagnosis?
A. Primary hyperthyroidism
B. Primary hypothyroidism
C. Secondary hyperthyroidism
D. Secondary hypothyroidism
Answer: D. Secondary Hypothyroidism
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
689
A 35 yo patient is brought for evaluation of
confusion for a day. You find that she has an elevated
BP, decreased air entry on right lung base with
dullness to percussion, and symmetrical joint
swelling of the wrists. Chemistry profile shows
elevated creatinine with proteinuria on urinalysis.
What is your diagnosis?
A. Rheumatoid arthritis
B. Systemic lupus erythematosus
C. Mixed connective tissue disease
D. Nephritic syndrome
Answer: B. Systemic lupus erythematosus
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
690
Characteristic of Obstructive Lung Disease:
A. Increased FEV/FVC, normal RV, increased VC
B. Decreased FEV/FVC, normal RV, increased VC
C. Decreased FEV/FVC, increased RV, decreased VC
D. Increased FEV/FVC, increased RV, decreased VC
Answer: C. Decreased FEV/FVC, increased RV,
decreased VC
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
691
Which of the following is characteristic of a transient
ischemic attack?
A. Weakness, paralysis or dysarthria in one side of
the face or extremity
B. Incontinence of bowel & bladder
C. Bilateral paresthesias, numbness or aphasia
D. Symptoms lasting longer than 24 hrs
An 80 yr-old male previously diagnosed to have
duodenal bulb ulcer was admitted because of
repeated bouts of vomiting previously ingested food
of 2 months duration associated with weight loss
and weakness. On PE, he was noted to have poor
skin turgor and succusion splash. What is the
probable diagnosis?
A. Achalasia
B. Peptic stricture
C. Gastric outlet obstruction
D. Perforated duodenal ulcer
Answer: B
TIA completely resolves within 24hrs, involves
unilateral sensory or motor deficit.
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
Answer: C
Achalasia is a motor disorder of the esophagus
characterized by dysphagia, nocturnal vomiting
and regurgitation but w/out succusion splash.
Peptic stricture occurs at CEJ brought about by
chronic reflux disease. It manifests w/ progressive
dysphagia but w/out succusion splash.Perforated
duodenal ulcer will present w/ sudden epigastric
pain, pallor, hypotension, and tachycardia but still
no succusion splash.
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
686
692
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 92 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH
EXAM
MIDTERM 1 AUG 2013
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item
#
693
QUESTION
EXPLANATION
AUTHOR
TOPNOTCH
EXAM
MIDTERM 1 AUG 2013
A significant amount of pleural effusion
accompanying pneumonia is an indication for:
A. CT Scan
B. Thoracentesis
C. Closed tube thoracostomy
D. Video-assisted thoracoscopy
Answer: B
Thoracentesis allows for analysis of pleural fluid
and microbiologic testing for etiologic diagnosis.
CTT is not indicated unless there is empyema of
complicated effusion. VATS and CT Scan are
usually not needed.
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
694
A 60 yr-old female with known coronary heart
disease was recently diagnosed to have
hyperthyroidism probably due to Grave’s. The best
treatment option for this patient is:
A. Anti-thyroid drugs for 3 years
B. RAI therapy
C. Subtotal thyroidectomy
D. Total thyroidectomy
Answer: B
In patients with coexisting medical conditions
particularly heart disease, best treatment is RAI.
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
695
An acute myocardial infarction that is transmural
produces dramatic and characteristic
electrocardiographic changes. The earliest change
on ECG with an acute transmural infarction is:
A. Peaking of T waves
B. ST segment elevation
C. Development of new Q waves
D. T wave inversion
Answer: A
Usually T wave peaking in the leads reflecting
electrical activity from the necrosing area of the
myocardial infarction is the first sign. These are
referred to as hyperacute T wave changes.
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
696
The patient is a 43 yr-old male. He is anemic with a
hemoglobin of 12.2 g/dl an MCV of 120 fL. Which of
the following is the least likely diagnosis?
A. Acute bleeding
B. Folate deficiency
C. Iron deficiency
D. Vit. B2 deficiency
E. Vit. K deficiency
Answer: C
Choice A,B & D will reveal macrocytic RBCS but
IDA will have microcytic RBC (Normal MVC = 80100femtoliters). Vit. K deficiency will have
problems w/ coagulation but not with RBC
morphology.
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
697
The ECG of a 66 yr-old male with a history of
atherosclerotic heart disease reveals an irregular
but rapid heart rate. The QRS complexes are normal
but no P waves can be seen. The most likely reason
for this finding is:
A. Atrial fibrillation
B. Paroxysmal ventricular tachycardia
C. Right bundle branch block
D. Sinus tachycardia
E. Wolf-Parkinson-White syndrome
Answer: A
A-fib is a continuous chaotic re-entry of electrical
impulses within the atrial myocardium that arises
in a diseased or stretched L atrium. The chaotic
patterns of atrial excitation prevents P-waves
from being seen in the ECG. He ventricular
response is rapid and irregular. In all other
choices, p wave should be distinguishable.
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
698
One of you diabetic patient has a blood glucose level
of 200 mg/dl. Surprisingly, a dipstick test is negative
for urinary glucose. How could this finding be
explained?
A. Dipstick tests are more sensitive for reducing
sugars other than glucose
B. Patient has defective tubular glucose transporters
C. Patient has diabetes insipidus
D. Patient has significant renal damage
E. Patient is in a state of antidiuresis
Answer: D
Glucose excretion by the kidneys depends
glomerular filtration and tubular reabsorption. \At
a renal threshold of 180 mg/dl, excess glucose is
spilled into the urine and is detected by dipstick in
as little as 100 mg/dl.
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
699
A 67 yr-old woman complains of gradually
increasing fatigue. On physical examination, she is
found to be anemic and has peripheral neuropathy
characterized by loss of position and vibratory
sense. Labs show macrocytic anemia and low WBC
and platelet counts. Your impression is:
A. Folate defiency anemia
B. Pernicious anemia
C. Chronic blood loss
D. Diabetes mellitus
E. Myelodysplastic sideroblastic anemia
Answer: B
The inability to absorb Vit.B12 leads to a
macrocytic pancytopenia and peripheral
neuropathy
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
700
Calcium and aluminium-containing antacids should
not be given to patients taking which of the
following?
A. amoxicillin
B. erythromycin
C. isoniazid
D. minocycline
E. rifampin
Answer: D
Tetracyclines such as minocycline chelates cations
(Ca & Al).
MICHELLE JAY
FRANCISCO, MD
(TOP 9 - FEB 2013
MED BOARDS;
TOPNOTCH MD)
MIDTERM 1 AUG 2013
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 93 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
Item #
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
ANSWER
D
B
A
E
A
A
C
D
B
C
B
A
E
C
A
C
D
A
B
A
A
C
D
E
D
B
A
C
B
A
B
D
E
C
B
D
B
D
A
A
C
B
A
C
B
D
B
A
E
D
A
A
A
D
B
A
C
C
A
E
B
E
A
B
C
C
D
B
A
E
B
B
C
A
D
D
B
C
E
A
D
E
A
D
A
E
C
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
C
B
E
B
C
D
A
B
D
A
E
B
B
B
C
C
D
A
E
A
D
C
B
B
A
B
B
C
D
E
A
E
D
C
A
A
B
D
A
C
A
D
D
A
E
E
C
D
C
B
A
A
D
A
A
B
A
B
C
D
C
A
B
D
B
D
C or E
C
A
B
C
B
BONUS
D
A
C
B
C
D
B
A
C
C
B
C
A
E
C
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
A
E
E, C
A
E
B
C
D
B
A
E
A
D
C
A
B
B
C
E
A
C
C
E
D
E
E
B
D
C
A
C
C
B
D
B
C
E
C
E
D
B
A
C
D
C
A
A
E
A
D
C
D
C
B
B
D
C
C
E
A
C
B
A
C
B
B
C
B
C
A
A
D
E
C
A
B
A
C
E
A
B
B
C
B
A
D
C
A
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
B
B
C
E
E
A
C
A
D
C
E
E
A
C
B
B
C
E
B
B
A
D
E
C
A
D
D
C
C
E
A
D
B
C
B
D
E
D
B
B
D
D
B
A
B
C
C
D
C
E
D
C
D
E
C
B
A
A
D
C
B
C
C
D
A
E
D
C
D
D
B
E
D
A
C
D
A
B
A
D
B
A
C
A
B
A
A
C
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 94 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
C
D
B
A
B
D
A
D
D
B
B
E
B
C
E
D
A
C
C
C
C
A
B
E
A
E
E
A
D
A
B
E
C
C
A
D
C
B
A
A
C
D
A
E
C
C
E
B
D
B
E
E
D
B
A
C
B
D
D
A
C
D
B
A
A
D
A
B
D
A
C
D
C
C
A
B
C
B
C
D
B
A
D
C
A
A
D
D
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500
501
502
503
504
505
506
507
508
509
510
511
512
513
514
515
516
517
518
519
520
521
522
523
524
525
526
527
528
B
A
B
C
B
B
C
D
B
C
D
C
B
D
D
C
E
C
A
B
C
E
A
D
E
A
D
C
A
C
B
B
C
D
C
B
D
B
C
E
A
B
D
C
C
A
C
C
D
A
B
C
A
D
A
C
A
A
B
D
A
A
D
B
C
E
D
A
B
C
B
A
B
A
C
E
E
A
A
B
D
B
D
C
D
A
C
D
B
529
530
531
532
533
534
535
536
537
538
539
540
541
542
543
544
545
546
547
548
549
550
551
552
553
554
555
556
557
558
559
560
561
562
563
564
565
566
567
568
569
570
571
572
573
574
575
576
577
578
579
580
581
582
583
584
585
586
587
588
589
590
591
592
593
594
595
596
597
598
599
600
601
602
603
604
605
606
607
608
609
610
611
612
613
614
615
616
617
D
A
A
D
C
A
A
D
B
B
B
D
D
C
D
E
A
D
E
D
D
D
D
D
D
D
C
D
D
B
C
D
D
A
D
C
D
C
B
C
A
C
B
A
B
D
B
A
C
B
A
B
A
A
B
D
A
A
B
E
C
C
D
A
C
B
B
B
B
D
C
A
D
D
C
E
C
C
C
D
B
D
E
A
E
D
A
E
A
618
619
620
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
637
638
639
640
641
642
643
644
645
646
647
648
649
650
651
652
653
654
655
656
657
658
659
660
661
662
663
664
665
666
667
668
669
670
671
672
673
674
675
676
677
678
679
680
681
682
683
684
685
686
687
688
689
690
691
692
693
694
695
696
697
698
699
700
C
B
D
A
C
D
D
E
B
B
E
B
B
B
B
E
E
E
B
A
A
C
E
C
B
E
D
D
D
B
C
E
C
D
A
D
C
A
C
A
C
E
D
C
D
A
A
A
D
C
E
C
B
B
C
C
C
B
A
C
B
E
A
B
D
D
D
C
C
B
D
B
C
B
C
B
B
A
C
A
D
B
D
TOPNOTCH MEDICAL BOARD PREP INTERNAL MEDICINE SUPEREXAM Page 95 of 95
For inquiries visit www.topnotchboardprep.com.ph or email us at topnotchmedicalboardprep@gmail.com