FACULTY OF MEDICINE AND SURGERY) DEPARTMENT OF MEDICAL EDUCATION WRITTEN REVALIDA December 15, 2012 (8:00-10:00n) PART 4 (SET B) Name: Student No: ‘SIGNATURE. GENERAL INSTRUCTIONS: This questionnaire is composed of 100 items. On the box provided in the front page of the Examination Answer Sheet, kindly write your student number, name, year, section. All final answers should be made on the back page of the EXAMINATION ANSWER SHEET that is provided for, SHADE SET B. Only Mongol 1 may be used. Do not leave any blanks as this will be considered incorrect. Do NOT detach the name stub. Submit this questionnaire together with your answer sheet. Please be guided accordingly. B____1. Which ofthe following characterizes a Mecke!'s diverticulum? ‘A. Abnormal persistence of the urachus B. Site of ectopic pancreatic tissue C. Caused by a failure ofthe midgut oop to return to the abdominal cavity 1D. Abnormal connection of the midgut o the duodenum ‘D___2. During the surgical repair ofa hiatal hemia, the celiac branch of the posterior vagal trunk is accidentally severed . Which segment is LEAST LIKELY to be affected by the nerve damage? ‘A. Ascending colon 8 Cecum ©. Jejunum D. Sigmoid colon D__3. Whats the inferior border of the posterior rectus sheath called? A Falx inguinais B. Inguinal ligament . intemal inguinal ring D. Arcuate tine ‘©___4. Whatis the artery involved when there is @ complete heart block? "A. Acute marginal branch 8 Circumfiex Anterior interventricular (Left anterior descending) i Posoror isomeric poser oncond ing) cal fascia blends with the great vessels of the heart?:D. Thicker walt B___10, What artery may be injured in fracture ofthe surgical neck of the humerus? ‘A Subscapular B. Posterior humeral circumflex ©, Radial recurrent D, Circumflex scapular 14, During thoracentesis, where would you insert the aspiration needle to avoid neurovascular bundle c ‘A. Superior border ofthe 8th intercostal space in the midelavicular Ine 2 B. Inferior border of he 8th intercostal space inthe midlavculr ine . Superior border of the Sth intercostal space in the midazilary line D Inferior border ofthe Sth intercostal space in the midaxilary ine ‘A___12. What fascial condensation provides supporto tho uterus? AA Transverse cervical igament B. Broad ligament . Round ligament ofthe uterus D infundbulopelvc igament C__13.Which of the following is TRUE ofthe lungs? ‘A Apex projects upward 25 cm above the vrtabral end ofthe 1st ib 8, Each lung contains 3 lobes C. Mediastinal surface contains the hilus . Lower border ofthe lung crosses the 10th nib in the mid axlay ine B___14. What movement ofthe lower mb is alected when thee is fracture ofthe ischial tuberosity? . Flexion of the thigh D___15. What visceral injury is involved if there i ui inthe Morson’s pouch during FAST examination of a ‘trauma patient?See ae 8, Reduced titrable cid excretion . Hypercapnia . Reduced renal HC0S reabsorption D___22:Ina normally hydrated person, which of the folowing is expected to increase ater 2 ters of ld intake’? ‘A. Tubular Na & water reabsorption B. ADH secretion C. Renin-angiotensin-aldosterone system D. Atrial natnuretic peptide secretion ‘A___23. The heart rat is 100/min while the end diastolic and end systolic volume are 110 and 60 ml. respectively What the ejection fraction? AM 8.50 €.55 D.60 ‘A___24, Which ofthe following congitions promotes laminar flow? ‘A. Small blood vessel diameter B. Low biood viscosity C. High flow velocity 1D. Numerous branching ofthe blood vessels ©___25. $2 occurs at what phase ofthe cardiac cycle? A Diastasis B. Rapid filling C. lsovolumic relaxation D. Atrial contraction ‘A___26, Which of the following is true about CSF formation? ‘A. Continuous tight junctions contribute to the blood-CSF bamier preventing ingress of all other molecules. B. The mode of CSF secretion involves passive secretion of sodium ions of choroid endothe Celis into the CSF C. There is active movement of water from local vessels of the choroid plexus into the ventricle The capilanes and vessels ofthe chorod plexus are large discontinuous endothe els, C___27, Relering o the chemical structure ofthe sugar shown below, whats the type of bond present inthis molecule?8. Glucose-alanine cycle ©. Krebs cycle D. Cori cycle . Embden-Meyethof pathway ¢__32. Which hormone inhibits hepatic gluconeogenesis synthesis? ‘A. Glucagon B Epinephrine . Insulin D. Cortisol 'B___33. Whats the main function of proteins and amino acidsin the body ? ‘A Serve as source of energy when completely oxidized B. Replace tissue proteins broken down as part of normal issue metabolism . Act as precursors to histamine . Synthesize neurotransmitter ‘A___34. Which of the following is an alternative fuel utlizd by the bain during prolonged periods of starvation? A Ketone boses B. Glycogen C. Amino acids D Fatty acids | __35. Which o the following isan inhibitory neurotransmitter synthesized from glutamate? A Ghtamine B Glycine Gamma aminobutyric acid Alpha ketogltaric acid ‘A___26, During periods of fasting, Acetyi CoA produced from fatty acid degradations diverted tothe formaton of which ofthe folowing substances? 'K Ketone bodies in the brain Protein in the muscle C. Thac\ylycerlin he adipose Glycogen in the muscle 8__37. Which ofthe folowing statements is TRUE regarding the altered metaboksm of cancer patents? ‘A Tumor exerts a consistent demand for essential amino acids B High rate of anaerobic aycolysis toyed lactate that can be converted fo glucase ©. Decreased proten tumaver as an adaptive reduced to reduced intake D Immunologie funtion preserved despite the presence of cancer cachexia ©_38. Why's Lactose NOT used as a carbohydrate source n most enteral formulas? 'A Lactose isnot enriched with essental fatty acids. 8 Lactoge afc he paatabity of enteral fod Lactase deficiency is common arnong the acutely i patients 1D Proten component of ube feedings interfere with lactose absorption >___39, What is prevented from entry into the thymic parenchyma by the biood-thymus baer? ‘A Hormones. 8 Hymphacyes © Anigenc materia D Narse cots __40, Which tonoflament ~type of cot matchup is comer? ‘A Cytokeratin - Mesoermal cal 8 Vimentn- Epineia cet C Gil tiny de pot Nene ot ce Se eee eee iP pects Fact non ony ne Somat?‘A. The lipidladen macrophages are initially deposited at the endothelial cel ayer. £8 Myointimal cls and fbroblasts are responsible for forming the fibrous wal ofthe plaque The tunica media isthe primary layer inital affected the atherosclerotic deposition. 1D Atherosclerosis never involves the advenita layer ofthe blood vessel C_44, Ad-yoar-old male had upper respiratory tract infection (URTI) 2 weeks ago, The patient now thas tea coloted urine, perorttal edema, end high blood pressure. What isthe most likely efcogi agent ofthe URTI? ‘A Staphyloconcus B Ecol C, Streplococcus 1D. Herophius intuenza ¢__45, A2-yrld female singer complains ofan enlarged “lymph node" inthe lateral neck. FNAB reveals a ‘celados aepete forming papiize with cytologic features of nuclear inclusions and nuclear grooves. What isthe mast tkely agnosis? ‘AMetastatic anaplastic carcinoma B. Benign thyrod tissue in cervical lymph node C Papltary thyroid carcinoma D Serotula ‘D___46. Which ofthe folowing 1S NOT associated with the step-wise causative relatonship between cigarete ‘snaking ard bronchogenic caronoma? ‘ACarcinoma-in-sity 8 Squamous metaplasia Lomso-igh grade dysplasia 1D, Glandular yperpiasia (C__A7 Wat's the expected microscope finding in osteosarcoma? ‘A. Benign osseous protruding from the metaphyseal medial area with cartiaginous cap Benign fibrous dysplasia occupying the area of the lesion [C Maligrant osteoid producing cells in a haphazard pattem wih prominent osteod material D. Atypical chondrosd cols admixed with basophilic myxod matenal B__46 What heart decane causes thickened leaits/papllry muscles and fused commissures in the 'B. Rheumatic Heart Disease C. Miral Valve Protapee D. Congenital Bicuspid Aorta Wat causes ineveruble damage 1 a cell's normal requlatoy genes and their products Jeading proto-oncogenes 'of genes that promote growth and division of cells female was exposed to a vial infection when she was age. thinner and shorter. What isthe cause of her condition? muscles 3 and developed ping oft'A____55. Which laboratory test confirms the diagnosis of bacterial endocarditis? ‘A Thee blood cultures on ciflerent sites 8 Grams stain of blood CBC D Chest Xray ‘0__56 In bacterial endocarits, which species DOES NOT belong tothe wridans step grou? ‘A Sanguis B Savers Mtns 1D Preumoniae B___57. Which best supports the diagnosis of Dengue fever? Dengue: ‘B___58. Which of the folowing is TRUE of Dengue Shock Syndrome? ‘A. The pathogenesis othe severe syndrome involves dengue antodees which develop dat the curent infection B tis accompanied by release ofcyokines, vasoactive mediators, and procoagulant . The fatality rate with dengue hemoragicfevar i around 20% 1D Nis not ated to DIC 'D___59. Wich one ofthe following tests is LEAST helpful in the agnosis of PTB? ‘A AFB sputum smear ‘8 Sputum cute on Lowenstein Jensen macium ©. Fhuorochrome staining of sputum D._Seroiogy ‘D__60, Which ofthe folowing IS NOT included in tho management of PTB n a Diabet: patent?” ‘A. Gring quadruple ant Kochs therapy 8 Control ot diabotes (C._Proper mutton 0. Give BCG vaccine 'A7 year old undemourished boy rom San Mato Rizal brought, Bismuth compounds A _65 Which anetiote generates the blood bran barner poorly the pce of «tammaton Therapeutic benefit i the treatment of bacterial meningts neonates? ‘A Amhacin B. Amphotericin B © Clndamycin D Chloramphenicol D___66 Which of the folowing a treatment of chore fo 48 year cd permenopautal woman wih progres csteoporosis? A. Teriparatise 8. Vitamin 03 © Raloxtene ©. Alendronate ‘D____67 Which blood glucose lowering agent requires an adequate pancreatic co function”? ‘A. Rosigitazone D_68 Which of he folowing antibiotics i eflecive agains! bh arabes and anaerobes? ‘A Metronidazole 8 Gentamicin © Ateeonam 1D. Chloramphenicol ‘C__69 Which agect when added io the at+-TB regimen. delays mene of drug reitance? ‘A sonia 8 Ramee C Etambutol 0 Pyaznamde ‘A__70 tn gorare pater, which ant ychot dug i prefered becaute cf lesser icience of orate ‘A Halogen 8 Cozapiee © Chiorpromacine 0 Respendone ‘Meftoqane f '8__71,42 yor dra ae peers wt igh oer ri cite. Tick ad pore ; ‘acing ten Insuone boat ste wa low Ons sD er A 18 Prmaqune Ge Quine ‘A__72. aia to best way 0 present ne top fv cases of moat? PachaAA Bel-shaped and symmetrical about the mean Total area under the cures equal 01 or 100% , The mean s greater than the median 1. Completely determined by two parameters, wand 0 a ¢___76 Whatis he best measure ofthe heath status ofa community engaged ina heath development e progam? 'A. Avalabilty of heath cae services 'B. Avalabity of pubbe vies . Statisal indices of morbidity and mortality 1. Utization of heal care services 77 Measures of heal status traditionally have been based on motalty data. What LONGER be satstacory inthe coming yeas? 'A. Changes in dlagnostc technology permit ea delecton of disease B_ The infant moray rate has decined so much that tn longer serves is usefulness ._ The population's growing oder ands more subject othe burden of chron Bnesses than inthe pest 1. There is ess sk of fata infecton than inthe past. ‘¢__78.Whch stlements TRUE regartng prevalence rate of diseases? ‘A. Reflected inthe numberof acute infectous diseases Denominator s the populaton at sk of disease development © Decreased by improved cure rate D. Decreased by beter reporting of cases ‘A__79. Wich communty heath actly is a form of secondary prevention? A. PTB ease finding DOTS (Drecty Observed Treatment Staten) Expanded program on immunizaton 1. Garanisadong Pamala ‘A___20.Avetm of a vehiular acters brought othe cmergeny room by 2 bystander No eaves can contacted. He needs emergency suger tat vl opetuly save hse, Whats the best thing 0.40? ‘A Do the surgery and ask somebody to continue searching forthe family B, Wat unl a relate comes to sign the formed consent dust ive supportive treatment 1D Transerto a goverment hospital €_B1 Apitenrequesistor a medica cericat tating tat she was Sick, because she id ol appear 2 ‘outheatng and wil cher be charged wih contempt of court. What wil you do? ‘A. Accede to her request 8 Repriand he forher dahonesty _Explanceary oer why you cant accede oer request D._ Refer hero someone wos wing to doit is NOT a feature ofthe Reproductive Heath Ba? Is inctded asa bith conrl mathod pls, condoms, IUDs are clasied as essential made nd must get the permission of his wile to have a vasectomy access contraceptives without he pemsion of thee parents isthe reason why his8. Heat stftening C Muscular contraction Rigor mors ‘A... Death due to extensive brain laceration as a result of vehicular accident is an example of folowing? A. Immediate cause of death 8 Proximate cause of death C. Secondary cause of death 0. Manner of death 0__7 Which ofthe folowing isthe principal higher center fr co A Thalamus 8 Hypothalamus © Brainstem D. Spinal cord C___, Which ofthe folowing is the most primitive segment ofthe adut brani? ‘A. Covebrum 8 Corebelium ‘ D. Medula 89. What isthe principal pathway for horizontal conjugate gaze? ‘A Dorsal ongittinal fasciculus 8 Medial longitudinal fasciculus ©. Fasciculs gracits D.Fascicuus cuneatus '8___90, Wich of the following wil result from a lesion of the facial nerve? rol of autonome: function? ©. Logs ofthe jaw jerk refiex 1D. Lous of tasto sensation, posterior 1/3 of the tongue ‘B___91. A pation who develops expressive aphasia has a lesion at whch ofthe following areas of the ‘cerebral cortex? A Areas 44, 45 Right 8 Armas 44, 45 Leh Ano 2 a 39) the following laboratory findings in cerebrospinal fuid analysis is consistent with meningitis? ‘Pressure of 220 mmH20A S2 year ot architect presented wth a month long hairy of exteme Sedna loss of sll worm and vel esteem, severe sol py, and hopelessness Sgnicant weight ost his appette and seep grossly datubed. He has been witdrawn and Shane sang wh pecete and rumaates everyday on hacen Mensa tom thet apartment cing Vhich of the folowing cincal presentations should always be inchuded inthe S-aymptom OSM: NTR crtena 38 requremect for he dagross of mayor dep A. Depressed mood asin sad B_Vegetatve symptoms of weet C. Suicidal deations D. Social wehdrawal D___98 Which of he fotowng presentations serves as the compeling indication for mmedatehoxptakraton? ‘A The month long depcessive symptoms 8 Ageof te patent C._Sieep deprvation 1D. Clear and persistent intention to hang himself Fors 9 and 100. CASE A 45 year od acttect seeks consut due to severe sadness, teeings of gl and wortiossness. He & witdrawn fo te past 4 weeks dun tothe weght of proessionalconfcts. icles wh Nis toss. He is frequent absent at work. unable o ater! fo ts personal hygiene, unable to sleep or eat. He frequent harbors sucdal deations. B___ 99 Which of me folowing DSM IV. TR mood duorterdhagnostc posites i consistent wih abowe cea decreased appette ad detteUNIVERSITY OF SANTO TOMAS) FACULTY OF MEDICINE AND SURGERY! DEPARTMENT OF MEDICAL EDUCATION WRITTEN REVALIDA December 15, 2012 (10:00-12:00n) PART Il (SET B) Name: ‘Student No: SIGNATURE. GENERAL INSTRUCTIONS: This questionnaire Is composed of 100 items. On the box provided in the front page of the Examination Answer Sheet, kindly write your student number, name, year, section. All final answers should be made on the back page of the EXAMINATION ANSWER SHEETthat is provided for. ‘SHADE SET B.Only Mongol 1 may be used. Do not leave any blanks, as this will be considered incorrect. Do NOT detach the name stub. Submit this questionnaire together with your answer sheet. Please be guided ‘accordingly. B___1. Which ofthe following statements is TRUE ina validation study? ‘A. Half of the study subjects wi have the gold standard test while the other half wil have the diagnostic test under study B._Allof the study subjects wil have the gold standard test and diagnostic test C. All subjects entered in the study are diseased . The patients are all bnded to both tests ‘A___2. When sa diagnostic test considered to be accurate? A Itidentifies the disease when present and identfis those wihout disease when realy ‘ot sick B.Itidentfis the disease when present . identifies the disease when absent D. The sensitivity is 100% For #'s 3 and 4A new diagnostic test for salmoneta is developed. You perform the test on 100 patients with ‘salmonella and 100 patients without salmonella, The results are With Saimonelia Without Salmonella (Typhidot) ‘iyptidot) Wewtest a @ tenes 8 8 TAL 100 A 3. Which of the following is correct? 5 ’A. The predictive values cannot be determined fram the given data 8 The specify ofthe testis 88%. C The false negative rae is 12%, D. The sensitivity of the testis 81%. From the above scenano, what's the "Gol standard tst?. Reject the nut hypothesis 7. What i the bos study design to determine f giving neo-achuvant chemotherapy i Stage 38 breast cancer wil result in beter suv? ‘A Cross sectional survey B. Cohort study ©. Randomized controled th D. Case-coniol study 8. Whats the best way to report the benefcal and harmiletfects of a comparative treatment study? ‘A Relative risk reduction B. Relative nk ©. Abyolute risk reduction 1. Numbers needed to treat 9. How do you manage the wound ater incision and drainage ofa breast abscess? ‘A. Close with 4-0 absorbable sutures B Close 40 non absorbable sutures . Leave the wound open 1 Pack te wound with tere gauze 10.55 yo male pation has been on spn or the past two yoars fs sotto undergo laparoscople cholecystectomy for calculus cholecytits. How should you handle the potential bleeding problem? ‘A Transfuse fresh whole blood during the operation B Discontinue aspinn use for 5 o 7 days prot the operation Go on wth schedule and disregard the asprin use D. Transtuse platelets 3 days prior to schedule operation 11. What wil you use to replace insensible fui losses from the body? A Lactated Ringers sluton 8. Pure water ©. Gatorade 1, Normal saline soliton 12. The pre-op serum sodiam of 45 yo males 115 mEq/L. Wha the estimated socium defi i patent? ‘A 1500 meq 81200 meq ©. 600mEq D.200™meq 13, Whats the fota caloric requirement of 70 kg man (r Keal) sing the "Rule of Thom 1B Can be fed earter ‘C. Presents with a smaller abominl wal dofect Needs more ud resuscitation $5. Which ofthe folowing causes the damage ofthe crtaginous18, What causes the early onset of hydrocephalus in tubercus meningiis? A Basal arachnadits 8 Vasculitis © Cerebral atertis Obstruction of CSF flow due to granuloma formation 19, Whatis the inital kagnostic procedure of choice in a previously wel patent who develops sudden onset of headache, nausea and vomiting wih severe neck ng? ‘Lumbar puncture 8 CT scan © MRI scan Four vessel angiography 20. Whats he most ikely diagnosis in a 70 year ld female smoker who complains of ntermitent gross Danless hematuria wth frequency and ugency? ‘AUT! 8, Renal neoplasm C, Bader tumor Urethral stricture __21. Which ofthe folowing statements is comec regarding a 53 year ld asymptomatic male with normal ORE ‘nd ats in serial PSA values trom 316 gin over 3 yeas? A. Rise in PSAs de oprostoptts and warantsno futher investigation 8. Risein PSA characters of noma! gig He does not need a biopsy based on he age specie PSA atria Rate of sen PSA warrants a bopsy D___22.A2 month ld infant has a progressively enaging x2 cm hemangioma onthe let owe evel, Whats the commended management? ‘8 Excision 8 Scleotherophy Compson teraphy 1, Observation and reassurance {©___23 Which of the olowing is associated wih absence of sensation fhe palmar aspect of he thumb, dx ‘and mda ngers? ‘A Uner nerve def 8 Radial neve damage Median nerve injury , Muscuocutaneous nerve laceraton D__24, What stuctres ae inoed in DeQuervas Tenosynovts? ‘A Median a unas nerves 8. Abductor polis bes ad abductor di minim muscle Fes cigorum supericiasand ponds tendons Abdctrpolicislongus and etensorplics bes endons ©.‘A. Deficient lymph nodes and lymphatic channels 8. Absence of serosal ayer C. Rich capilry network nthe submucosa . Non segmental ymphatis drainage 2.47 ylo male, on H-eoeplr antagonist forthe past 2 years presans wih ramp Vomiting. PPE: afebrile, abdomen: distended, nor tender with intemitent hyperactive BO What s the most ikely agnosis? ‘A Small bow! obstructon om adhesions 8 Perforated PUD C. Gastric outlet obstruction from PUD D-Acute erosive gastnts \___30. Whats the most important atbute of radonucide scan asa dlagnoste ool in upper i beet A Can detect ven very minimal bleed 8 Can accurately localize bleeding ste C. Provides opportunity for contol of bleeding highly specific fr bleeding gastric mucosa __31. What's the TNM staging fa 56 yo male who has @25 cm mass in he buccal mucosa wth palpable Iymph node on the ipsilateral side ifthe biopsy result tums out o be malignant? Al Bl) cul ow ‘A___32.What's a major cisadvantage of ratioactive iatine asa teatment modality for Grave's disease? ‘A. High incdence of permanent hypothyroxism B. Short ime to conte disease © Notcost efectve . Recurrent neve paralysis €___33. Whatis the most cast etectve hagnostic screening procedure to diferente benign from malignant thytod nodules? ‘A Utrasonography B. Thyroid scintigraphy C. Fine-neede aspiration topsy (FNAB) ©. Thyroid homane suppression C3. Which of he folowing scenarios represents the most urgent indication for suger in duodenal uicer patent? ‘A. Epigasine pain not rebeved wih h2recepor antagonist andlor proton pump inhibitors B, Melena on two occasions during the past week Sudden severe abdominal pan wih tenderness and muscle quaning 1. Vomiting with hyperactive bowel sounds ___5 doctor asks a patent about pain, "What do you foo” What ype of question this? ‘A Direct B indirect © Leading 1 Open-ended ‘A___6 Whats the BMI of 2 man who is 2 meters tal ard woighs 80 kas? Am Ba Dao ‘D___37, What examination technique is uitiized o determine the tissue density of the quadriceps femods? ‘8 Auscutation B InspectonA forte steoss 8 Aor equrptaton & Putnone oos ‘unonic regurptaten D__40.Inthe 2010 Ameren Heat Associaton BLS Guvlnes, wht ’ ‘providing cardiopulmonary resusitaion? ESE Nts some oot ‘A inay, Breathing, Crelaton 8 Creulaton, reaing. Ay © Breathing, Creation, Away © Cevltin, Away, Beating C__41. What condition is probably presenti we hear bronchial breath sounds inthe 8 ICS posterior aary line? ‘A Hyperion 8. Pleural eftusion ©. Consolidation D Atelectasis 42, Whats NORMAL finding? ‘A. Vesicular breath sounds atthe 8 ICS anterior anlar ne 8. Bronchial breath sounds atthe interscapular area (©. Bronchovesiclar breath sounds over the manubrum stem 1. Tractea breath sounds below the suprastemal notch C_43. Whats contraindicated in patnts taking sdenafl (phosphodiesteras ior)? ‘A Metoproiot B Feledpine Isosorbide mononirate D Prazosin ‘A__44, Whats he drug of choice in patents with variant angina? ‘A Nifedipine B.Bisoprobl (C. Methydopa D Clonidine 'B_45,What clinical manestatin is a contraindication to morphine SOM administra n patents wih Acute Mi ‘A Tachycardia BB Respratoy depression Severe chest pan 1D Pulmonary congestion >___46, Whatis tre about he vascular mechanism of Hypertension? ‘A Resistance to flow in the artery vanes drecy wi the fourth power of ras 'B Thromboxane isa vasa peptide produced by the endothe {G Increased Nat enty leads to increased vascular toe by increasing ntaceltiar Cat 1B Eutrophic vascular remodeling increases lumen se via neeased deposit fierce matric B__47 What. drug causes bloatedness and loose stools? A—— a a ae eet ee oS area esos eaten eaceases a eines ramus oe a eae ‘A__56. ASO year old asymptomatc Gatyss nurse consulted because of elevated rarsomnase ieee wercenrae Ss Ps cco Se ‘8__7, Wat compscason can cocurin bot: Non Atobolc Fatty Liver Osease and chen hepa 67 ag te As mae nas he srancund ol be woper setomen sewed SAS rere hse te ance toe eat as©. Metoproto! D. Ramipni |A65 year old diabetic female consuts due to @ swollen and tender lft leg. On examination there is a \wound on her let dorsal foot wth purulent discharge. Her laboratory examinations show the following values Normal Values Arterial p= 7.24 pCO2 = 28 mmHg (35-45 mmHg) HCO3= 13 mEqh. (22.26 mEqh) ‘Serum potassium = 6 2 mE ql. (355 mEgi) Serum chiorde = 100 mEqi. (102-109 meg) Serum sodium = 137 mEq/L (136-146 mEgt) B___60 Whats her acid base disturbance? ‘A. Normal anion gap metabolic acidosis High anion gap metabolic acidosis, Respiratory acidosis D. Combined metabolic and respiratory acidosis €__51. 5 year od 65 kilogram mate diabetc forthe past 16 years consuls due to anorexia and nausea. He is lethargic wih bipedal edema, bibasal cracls and asters His serum creatine 5 5 mpl (NV: 07-4.2mgi), aerial ph 73. How should you treat hin? ‘A Obser response to fuosemide 8, Give Vsodum bicarbonate ad seal monitoring of ABG C. Emergency hemodialysis Emergency kidney transplantation )___62.A20 year olf ale consuts due to te-colored urine and bipedal edema. Ten days ago he had fever and ‘ore oat. His BP is 150/90 and serum creatrine fs 1 mgd. He has numerous dysmorphi RBC and 410-45 pus oes on uinalyss. His C3 levels 40 mg/l (NV= 83177 mal). What the most ikely agnoss? ‘Acute post streptococcal glomerlonephis 8 Immunogibuln A nephropathy © Lupus nepheis .Unnary tact nfecton )__63. 4.38 year ld street vendor presents with 4 days fever, myaia and headache. On physical exeminaon, BP 100160 She s also tactycarde, ebro, wih epigastnctendemess. Which statements the regarding the diagnosis ofthis patient? ‘A Appearance of vesicular rashes ar ypcal ofthe Herman's rash of dengue infection 8 Hemoconcentraon and thrombocytopenia are characters ndings in leptospross © Loucooytosis feature of typhoid fever 1 Onset of aundce folowing fever ysis s characters of eal hepatitis __64 35 year ol prevously heathy male sustansmutile wounds oloving vicar accident. He renee ra pacimy Ore wos stp, e dvs lew sone et ier skit spel ke gauze Which aneg he long mercrgansms ost aly be ‘R Candids abicans srandmather consis because of painful knees and occasional back pins. Co-moriles 0 ad tabetic nephropathy win renal insufficiency Which statements tre regarding eet nnanto radiographs. a eshanta: reece! swelling eft knee. Which of the following Berane le can ding cite gout fom sept ats the synovial fd cules out septic artis ct septic artis immediately afer obtaining synovial id forber a tupsties 24 yea old medial students dagrosed vith temic lupus enh best dicates active opus disease? Tene ke yeni Wr A Elevated C-reactive protein 8. Elevated serum complement levels .Posive ant-nuciearantbody (ANA) test D. Utnary protein 3, djsmonphic red blood cos >100npt 68, Whatis the MOST imporiant parameter ol the APGAR Sour? A Color 8 Ativy © Respiration Heart rato D__69, Whatis he best ancitar procedure to A Clinical ndings B Chest MR ©. Chest ulrasound D. Chest Xray ‘A__70, Whats the most common pathogen of neonatal pneumeniain developing countries? A Ecol 8._K. pneumoniae C. L monocytogenes D._ Streptococcus agalactiae ‘A__171.Whats the drug of choice for a7 year old mae patent presenting wih anasarca & preter suspected to be due to minimal change nephobe syndrome? ‘A Prednisone 8 Furosemide . Cyclophosphamide .Coptopn ©__72.85 wk old purely breasted infant present wih persistent jaundice om 2 wks of ge, a wel a8 erssientachok stools & darkly colored une, PE reveals hepaosplenomegaly. Neonatal sore is "ormal Whal should you suspect? ‘A. Breasiik jaundice B._iopattic neonatal epats ©. Exrahepae biary atresia D._Hypotyroidism B___73 Aone yeaa 10g child presenting wi acute watery canes & voting i assessed to have ‘moterte dehydration. Over the next hous, how much ORS (nm) should be gen fo comet is ‘eter? ‘A. 300-500 500-900 ©. §,000-1,500 D> 1500 ‘6-74 nthe treatment of iron deficiency anomia in pdt paint, how many weoks afr the ial Temaleaon of ood count should ion therapy be continued, inorder replenish he tssue 0. aniose Respiratory Distress Syndrome (ROS)? Presents wit ecuring URTIs and ow to moderate grade ever over the at 2 moni ‘and mphadenopathy, What condton shoud you storeyee D___77. A 10 year old gir develops moderate to high grade fever for 3 days. On the 4” day ofillness, she is ‘weak-looking but afebrile. CBC reveals: Hgb 130 Hct 50 WBC 2,000 & platelet 150,000, On the 2 hospital day (HO), she develops nartow puse pressure requiring fd resuscitation. Platelet drops to 60,000, Thereaterher vil sigs stay stable. On the 4” hospital day, she is discharged improved with platelet count 0f200,000, What is the final diagnosis? A Acute viral illness . B. Dengue hemorrhagic fever (OHF) gr! C. DHF grade 1! D. DHF grade itl D___78. 1 year old male presents with persistent high grade fever of 5 days, with development of non-purulent erythematous conjunctival injection, strawbeny tongue, cm left posterior cervical lymph node, ‘generalized erythematous macules. What is the most likely condition? A. Acute rheumatic fever B, Stevens-Johnson syndrome C. Scarlet fever D. Kawasaki's disease B___79. In what age group do we see a peak in the incidence of Streptococcal pharyngitis? AS 3 years old B early school years C. early adolescence D. late adolescence ‘D___80. What condition is a frequent co-morbid condition of asthma, and may contribute to poor asthma control? A achalasia B diaphragmatic hemia ©. peptic uler disease ‘D. GERD. For#'s Btand 82CASE: 29y/0, G1, 38-39 weeks, Gestational Diabetes, presents with hypogastric pain ‘BP-110/70mmHg PR-76/min RR-20/min T-36.6C ; ‘Abd. FH-34om EFW-3.3kg_LM1- breech, LM2-FBL, LM3- cephalic and LM4- cephalic prominence at the ‘ight Usene coniractions: every 45 minutes, 50-60 seconds duration, moderate in intensity IE- crv 3em diated, 60% effaced, cephalic, nict membranes and station -1 ‘A_A1, Atha stage of tors the pant in? e B 2s co 8s 8 time to monitor the fetal heart rate? a” Beene rea Immediately©. Complete bed rest D. Corclage D___87. What s the management for primary antiphospholipid antibody syndrome with prior recuTent pregnancy koss? A. Heparin B. Prednisone and heparin C. Aspirin and prednisone D. Heparin and aspirin 'A___88.A 85 year old G2P1 (1011) menopausic for 2 years consulted fr bothersome hot flashes, What the hormonal treatment of choice? A. Estrogen B. Progesterone ©. Tibolone D._Biphosphonates '89.A young couple married for 4 years consult because they want fo have a child. The woman is @ 28 year ‘cl nuligravid with regular monthy cycles, and an unremarkable past medical history. What isthe inal step to be performed on this couple? A. Hysterosalphingography B._ Sperm analysis ©. Serum FSH on day 3 D. Hysteroscopy D___90.A42 year old G5P5(5005), consults because of bleeding after coitus. PPE: cervix is smooth with a 11¢m Whitsh discoloration atthe posterior ectocervix. E: fm, long and closed, Uterus and adnexa, are ‘unremarkable. What s the management? A. Wet smear B, Repeat the Pap smear after a month & Endocervical curettage Coed j quided cervical biopsy B__91.A M4: (0010) had a pelvic laparotomy for an ovarian newgrowth. If, intra-operatively, the left localized cancer with intact capsule, which of the following should be the minimum consults due to profuse and prolonged menses with progressive dysmenontes. rus fs enlarged symmetrically to 4 months sie, tender, adnexa- with her TVS results which 'X 2 ems attached to the)_§7. nan Silo ea eon os ne what area wil require closer examination? AL Oral cavity B. Oropharynx D. Divergence ophthalmopathy, what is an indication for removing the lateral, medial and inferior walls of the Pa present on extraocular movement