RITE Practice Questions

1.
A 33-year-old nonpregnant female consulted due to dysuria, urinary frequency and hematuria with no fever and
no vaginal discharge. What is the BEST management for this patient?
a. Do urinalysis and start empiric antibiotic
b. Start on Ciprofloxacin 500mg BID for 3 days
c. Start on Nitrofurantoin macrocrystals 100mg QID for 5 days
d. Start on Amoxicillin-clavulanate 625mg BID for 7 days
For questions 2-3, refer to the case below:

A 50-year-old male, who recently underwent bladder tumor resection, consulted at the OPD due to hematuria, fever,
chills, vomiting, loss of appetite and left flank pain. He denies dysuria and urinary frequency. You decided to admit
the patient. Upon admission, he has stable vital signs.
2. What will be the next best step?

a. Request for urinalysis and urine CS and start on empiric oral antibiotics while waiting for culture results
b. Request for urinalysis and urine CS and start on empiric IV antibiotics
c. Request for urine CS and blood CS and start on empiric IV antibiotics
d. Refer to a urologist, request for KUB imaging and start on empiric antibiotics
3. What is the cutoff for significant bacteriuria for this patient?

a. 105 CFU/mL
b. 104 CFU/mL
c. 103 CFU/mL
d. 102 CFU/mL
4. A 37-year-old pregnant patient on 28 weeks AOG came to ER due to fever Tmax 38.3C, chills, dysuria and right
flank pain. You decided to request for urinalysis and urine GS/CS. What laboratory findings will likely support your
diagnosis?
a. ≥5 WBC/LPF on urinalysis and 105 CFU/mL on urine culture
b. ≥5 WBC/HPF on urinalysis and 104 CFU/mL on urine culture
c. ≥5 WBC/LPF on urinalysis and 104 CFU/mL on urine culture
d. ≥5 WBC/HPF on urinalysis and 105 CFU/mL on urine culture
5. A 50-year-old female with type 2 diabetes underwent an executive check-up. She consulted you due to elevated
WBC and bacteria on urinalysis. She denies any symptoms. What will you advise her?
a. No treatment is needed and reassure her
b. Request for a urine culture
c. Start on Nitrofurantoin 100mg QID
d. Start on Ciprofloxacin 500mg BID

A 30-year-old garbage collector came to ER due to 8-day history of fever, chills, headache, myalgia, nausea, vomiting
and calf pain. On physical examination, he has stable vital signs, clear breath sounds, soft nontender abdomen, and
an open wound on his right hand.
6. How will you confirm your diagnosis?

a. Culture and isolation
b. Urine Polymerase Chain Reaction
c. Specific IgM Rapid Diagnostic Test
d. Microagglutination test
7. What laboratory finding may indicate that this patient has severe leptospirosis?
a. Serum creatinine 3 mg/dL
b. Serum potassium 2.5 mmol/L
c. Chest X-ray showing extensive alveolar infiltrates
d. Hemoglobin level of 10 g/dL on CBC
8. A 44/M known diabetic residing in Navotas City, had a small cut on his right foot, waded in flood during the recent
flood. He consulted regarding post exposure prophylaxis. What will you recommend?
a. Doxycycline 200mg one dose
b. Azithromycin 500mg single dose
c. Doxycycline 200mg once daily for 3-5 days
d. Doxycycline 200mg once weekly until end of exposure
9. A 39/F came to ER due to 10-day history of fever (TMax 39C), severe headache, fatigue, abdominal pain and
diarrhea. VS showed BP 100/60, HR 86bpm, T 38.9C. Which of the following is TRUE of this case?
a. Early findings include salmon-colored, non-blanching maculopapular rashes on the trunk and relative
bradycardia
b. Chronic carriers are at increased risk of urinary bladder cancer
c. Gastrointestinal bleeding and intestinal perforation usually occur on the second week of illness
d. Fluoroquinolones are the most effective class of agents for drug-susceptible pathogens
10. What is the optimal antibiotic therapy for the previous patient if the pathogen isolated turns out to be Multidrug-
Resistant?
a. Ceftriaxone 2gm IV OD
b. High dose Ciprofloxacin 400mg IV every 8 hours
c. Chloramphenicol 25mg/kg TID
d. Trimethoprim-sulfamethoxazole 160/800mg BID
11. A 29-year-old patient presented to ER due to 4-day history of fever, headache, myalgia and maculopapular rashes.
Upon PE, BP is 80/60, HR 108/min, with thready pulse, Temp 38.6C, with spontaneous gum and nose bleeding. She
was seen lethargic and slow to response. Both Dengue IgM and IgG were positive. What is the most immediate
clinical management for this patient?
a. Administration of platelet concentrate
b. Administration of fresh frozen plasma
c. Administration of crystalloid
d. Administration of colloid
12. A 20/F consulted due to fever, myalgia, headache, retro-orbital pain and rashes. Symptoms started 6 days ago.
Dengue IgM and IgG were positive. Which of the following BEST describes the epidemiologic and clinical features
of this viral illness?
a. Incubation period is 3-10 days
b. Rashes usually begins on the face and spreads to the trunk and extremities
c. Laboratory findings include leukopenia, thrombocytopenia, and, in many cases, elevations
of serum aminotransferase concentrations
d. The vector responsible for infection, A. aegypti mosquitoes, are night biters and typically
breed near human habitation, using relatively fresh water from sources such as water jars,
vases, discarded containers, coconut husks, and old tires
13. A 28-year-old female on her 2nd trimester of pregnancy consulted regarding tetanus vaccination during
pregnancy. What will you advise her?
a. Tetanus vaccination is contraindicated during pregnancy
b. 2 doses of tetanus toxoid 4 weeks apart
c. 2 doses of tetanus toxoid on third trimester, 6 weeks apart
d. 1 dose of tetanus vaccination now and another dose on or after giving birth
14. A 20/M, construction worker, with unrecalled vaccination history, was admitted due to fever, trismus, sweating
and difficulty swallowing. Your primary consideration is Tetanus infection. Which of the following is TRUE
regarding his case?
a. It is caused by aerobic, gram-positive, spore forming rod
b. The toxin enters the vascular system and is transported to the neuromuscular junctions
c. Infection can be seen in patients with no puncture entry wound
d. Clinical manifestations occur only after tetanus toxin reached the postsynaptic inhibitory nerves
15. A 35-year-old pregnant patient on 28 weeks AOG came to ER due to dog bite on her right foot. The wound was
deep and bled spontaneously. Based on DOH AO 2018-0013 on the Guidelines on the management of Rabies
Exposures, you should give the following intramuscularly as post-exposure prophylaxis.
a. Rabies vaccine and rabies Ig are contraindicated in pregnancy
b. Rabies vaccine until Day 28; Rabies Ig is contraindicated
c. 1 dose rabies Ig and post rabies vaccine until Day 7
d. 1 dose rabies Ig and post rabies vaccine until Day 28
16. A 45/M, who was bitten by a dog 2 weeks ago, presented at the ER due to hydrophobia and aerophobia. Primary
consideration was rabies infection. Which of the following best describes the pathogenesis of rabies virus in the
nervous system?
a. Rabies virus spreads centrifugally along the peripheral nerves via antegrade axonal transport
b. Rabies virus spreads centripetally along the autonomic nerves via antegrade axonal transport
c. Rabies virus spreads centripetally along the autonomic nerves via retrograde axonal transport
d. Rabies virus spreads centripetally along the peripheral nerves via retrograde axonal transport
17. A 65-year-old came to your clinic for executive check-up and is asking about vaccination against “pneumonia”.
He has no other co-morbid conditions. Based on the PSMID Adult Immunization Guidelines, what will you
recommend?
a. PCV-13 now then PPSV-23 a year later
b. PCV-13 now then PPSV-23 4 weeks later
c. PPSV-23 now then PCV-13 a year later
d. PPSV-23 now then PCV-13 4 weeks later
18. A 20-year-old male who received Rabies Ig and rabies vaccine one month ago went to your clinic inquiring on
timing of MMR vaccine. What will you advise regarding the interval of vaccination?
a. 4 weeks after rabies Ig
b. 4 months after rabies Ig
c. 6 weeks after rabies Ig
d. 6 months after rabies Ig

A 40-year-old male with history of travel from Samar one month ago where he engaged in swimming and recreational
activities consulted due to fever, body malaise, myalgia, headache, and abdominal pain. Physical examination showed
hepatosplenomegaly and inguinal lymphadenopathy. CBC was done, showing elevated eosinophils.
19. How will you confirm the diagnosis?

a. Stool PCR test
b. Serology
c. Blood culture
d. Detection of eggs in stool
20. What is the treatment of choice for this patient?

a. Albendazole
b. Praziquantel
c. Ivermectin
d. Diethylcarbamazine
21. The patient asks you on how he got infected. What will you tell him regarding its mode of transmission?
a. Ingestion of metacercariae in freshwater fish
b. Ingestion of metacercariae in crayfish or crabs
c. Skin penetration by cercariae released from snails
d. Ingestion of eggs from soil
A 45-year-old female with history of travel to Sudan consulted due to fever spikes, chills and rigors occurring every
2 days, associated with headache, fatigue and myalgia. Peripheral blood smear was done showing infected young
RBCs with black pigment.
22. What is the likely organism involved?

a. Plasmodium falciparum
b. Plasmodium vivax
c. Plasmodium ovale
d. Plasmodium malariae
23. What is the recommended treatment if her illness remains to be uncomplicated?

a. Mefloquine
b. Primaquine
c. Artemether-lumefantrine
d. Quinidine
24. A 77/M, smoker, known with Hypertension and Type 2 DM presented at the ER due to fever, cough, nasal
congestion, body malaise and anorexia. His latest HbA1c one month ago was at 6.8%. At the ER, oxygen saturation
is 95%, CBG of 120 mg/dL. Initial Chest X-ray done showed cleared lungs. RT-PCR for SARS-COV2 yielded
positive results. What will be the next management?
a. Send home and advise isolation
b. Admit to COVID-19 ward and give supportive care
c. Send to quarantine facility
d. Start empiric antibiotics
25. A 40/F with RHD was admitted due to fever, shortness of breath and easy fatigability. A TTE was done, showing
an oscillating mass on the mitral valve. Blood Culture showed growth of methicillin-sensitive S. aureus (MSSA).
What is the best course of treatment?
a. Cefazolin x 4 weeks
b. Ampicillin plus Gentamicin x 4 weeks
c. Vancomycin plus Gentamicin plus Rifampin x 4 weeks
d. Ceftriaxone x 4 weeks
26. A 20/M, injecting drug user was referred to you due to 2-week history of intermittent fever, palpitations, chest
pain and headache. On physical examination, he is febrile with temperature of 38.8C. You also noted conjunctival
hemorrhage and a grade 3/6 murmur on the parasternal area. Blood culture was done showing growth of MRSA. 2D
Echo was done showing vegetation on the tricuspid valve. Which of the following findings will give you a definite
diagnosis of infective endocarditis?
a. Fever, (+) Blood culture, conjunctival hemorrhage
b. Vegetation on 2D Echo, injecting drug user, (+) Blood culture
c. Fever, Injecting Drug user, vegetation on 2D Echo
d. Fever, conjunctival hemorrhage, injecting drug user
27. An 80/M known with severe aortic stenosis underwent valve replacement surgery. 8 months after, he developed
intermittent fever, shortness of breath, easy fatigability, bipedal edema and a new onset 3/6 systolic murmur. What
is the most likely etiologic agent?
a. viridans Strep
b. S. aureus
c. Cardiobacterium hominis
d. Coagulase-negative staphylococci
28. A 20/F with history of congenital heart disease underwent repair of ASD when she was a child, with no
complications. She consulted for prophylaxis prior to dental tooth extraction. What will you advise her?
a. No need for prophylaxis
b. Take Amoxicillin 2g 1 hour prior to dental procedure
c. Take Clindamycin 600mg 1 hour prior to dental procedure
d. Ceftriaxone 1gm IM prior to dental procedure
For questions 29-30, refer to the following case:
A 22/M developed high grade fever and body malaise, with dry persistent cough, coryza and conjunctivitis. On PE,
you noted bluish white lesions on the buccal mucosa; rashes apparently started on the ears, neck then back, spreading
to trunks and arms.
29. Most likely diagnosis is:

a. Measles
b. German Measles
c. Hand Foot and Mouth disease
d. Varicella Infection
30. Which of the following vitamin is an effective treatment shown to reduce morbidity and mortality in this case?
a. Vitamin E
b. Vitamin D
c. Vitamin C
d. Vitamin A
31. A 53/M consulted due to right trunk pain along the distribution of T6-T8 dermatome, with no other symptoms.
He has unrecalled history of varicella infection. You are still considering herpes-zoster infection. In how many days
are rashes expected to appear from onset of pain?
a. in 24 hours
b. in 1-2 days
c. in 2-3 days
d. in 3-5 days
32. A 40/M farmer admitted at the Orthopedic unit was referred to you due to fever, severe right leg pain and
hypotension. He sustained a right leg fracture due to vehicular accident and underwent ORIF. On physical
examination, he is in severe pain, and you noted a foul-smelling serosanguineous wound discharge. The right leg also
appeared mottled, with brawny color, edematous and with bullous lesions. What is the likely diagnosis?
a. Pyomyositis
b. Clostridial Myonecrosis
c. Acute Osteomyelitis
d. Necrotizing Fasciitis
33. A 58/M diabetic, construction worker presented at the ER due to fever, chills, left foot wound with swelling and
foul-smelling wound discharge. He accidentally stepped on a nail 1 week ago. On PE, you noted blackish
discoloration on the left foot. Blood CS was obtained, showing Gram positive cocci in chains. What is the most
appropriate antibiotic therapy for this patient?
a. Ampicillin-sulbactam 1.5gm every 6 hours
b. Vancomycin 1gm IV every 12 hours
c. Clindamycin 600mg IV every 6 hours plus Penicillin G 4 million units IV every 4 hours
d. Ampicillin 2g IV every 4 hours plus Clindamycin 600mg IV every 6 hours plus
Ciprofloxacin 400mg IV every 6 hours
34. An 83/F consulted due to sudden onset painful red swelling of the left nasolabial fold with well-defined margins;
with bullae formation on the 2nd day. What is the appropriate treatment?
a. IV Clindamycin
b. IV Oxacillin
c. IV Penicillin
d. IV Vancomycin
A 75/F was rushed to the ER due to 1 day history of severe right knee pain, swelling, with limited range of motion,
accompanied by fever and chills. She denies any history of trauma on the right knee. On physical examination, right
knee joint is swollen, warm to touch, with limited ROM. Arthrocentesis and synovial fluid analysis were done.
35. Which of the following is an expected finding?

a. Synovial fluid cell count of <180/uL with mononuclear predominance
b. Synovial fluid cell count of 20,000/uL, with 60% neutrophils, 40% lymphocytes
c. Synovial fluid cell count of 150,000/uL with neutrophilic predominance
d. Synovial fluid cell count 30,000/uL with lymphocytic predominance
36. What is the LEAST likely etiologic agent involved in this case?
a. Streptococcus pneumoniae
b. Staphylococcus aureus
c. Mycobacterium tuberculosis
d. Gram-negative bacilli
37. A 22-year-old commercial sex worker with history of untreated gonorrhea had 10-day history of intermittent
fever, chills, and joint pains involving her right elbow, right wrist, left knee and left ankle. Arthrocentesis and synovial
fluid aspirate gram stain were done revealing a gram negative intracellular monococci and diplococci. Which of the
following is TRUE of this case?
a. Men are at greater risk of acquiring gonococcal arthritis
b. True gonococcal septic arthritis is less common than disseminated gonococcal infection
(DGI) and always follows DGI
c. Gonococcal septic arthritis usually involves multiple joints such as hip, ankle, knee or wrist
d. Blood cultures are almost always positive in most cases of gonococcal septic arthritis

A 45/M, chronic alcoholic with cirrhosis consulted due to 2-day history of fever, generalized abdominal pain, body
malaise, fatigue and nausea. On physical examination, there is ascites and tenderness on all abdominal quadrants
38. Which of the following is TRUE of his case?

a. The most common manifestation is abdominal pain
b. It is most commonly associated with single organism
c. An abdominal CT scan can help in establishing diagnosis
d. Empiric treatment includes anaerobic coverage
39. What prophylactic regimen can you give in this patient given that he has normal renal function?
a. Metronidazole 500 mg 3x/day
b. Ciprofloxacin 250 mg 2x/day
c. Metronidazole 500 mg weekly
d. Ciprofloxacin 500 mg weekly
40. A 55/M diabetic with history of nephrolithiasis consulted due to progressive and worsening right flank pain of 3
months duration, now associated with fever, chills, nausea and vomiting. Diagnostics were done including urine CS,
blood CS and KUB imaging. Ultrasound showed subcapsular abscess in the right kidney. What is the most likely
organism involved?
a. E. coli
b. S. aureus
c. Anaerobes
d. Mixed flora
A 40/F consulted due to numbness of her fingers and toes. She also claimed that she has nonpruritic hypopigmented
lesions on her right arm which started 1 year ago. On physical examination, there is decreased sensation at the tips of
her fingers and toes. You also noted dry scaling skin with several symmetrically distributed skin nodules and plaques
on the extremities, back, face, with decreased sensation. There is also loss of the outer two-thirds of both eyebrows
and pendulous earlobes. Your primary consideration is Leprosy.
41. Which spectrum of leprosy is she presenting?

a. Tuberculoid leprosy
b. Lepromatous leprosy
c. Borderline tuberculoid
d. Mid borderline
42. What is the WHO recommended treatment regimen for her?

a. Dapsone 100 mg/day for 5 years
b. Dapsone 100 mg/day (unsupervised) plus Rifampin 600 mg/month (supervised) for 6
months
c. Dapsone 100 mg/day plus Clofazimine 50 mg/day (unsupervised); and Rifampin 600 mg
plus clofazimine 300 mg monthly (supervised) for 1–2 years
d. Rifampin 600 mg/day for 3 years plus Dapsone 100 mg/day indefinitely
43. After months of treatment, she complained of red-black skin discoloration. What drug is the most likely culprit?
a. Dapsone
b. Clofazimine
c. Rifampin
d. Look for other causes

A 51/M consulted due to 1-month history of fever with temperatures ranging from 38.4 to 38.6C on four occasions.
You plan to work-up the patient on FUO.
44. Which of the following is NOT part of obligatory tests in management of FUO?
a. Procalcitonin
b. IGRA
c. ESR
d. LDH
45. He had his obligatory tests done with normal results. What is your next best step?
a. Request for chest and abdominal CT scan
b. Request for autoimmune panel
c. Request for tumor markers
d. Review medication history
46. A 30/M volunteered to participate in a COVID-19 vaccine clinical trial. As part of the trial’s screening process,
he underwent HIV screening test, which turned out positive. He is inquiring which of the following modes of
transmission has the highest risk of acquiring HIV infection?
a. Needle sharing during injecting drug use
b. Receptive oral intercourse
c. Unprotected insertive penile-vaginal intercourse
d. Unprotected receptive anal intercourse
47. A 31/M, diagnosed with HIV, noncompliant with ART, was admitted due to 2-week history of anorexia, non-
bloody diarrhea and abdominal pain. Fecalysis and stool culture are negative. He underwent endoscopy, showing
multiple mucosal ulcerations; biopsy of the lesions revealed intranuclear and cytoplasmic inclusion bodies. What is
the best management for this case?
a. Start on Valacyclovir
b. Give Foscarnet for 7 days
c. Refer to Ophthalmology
d. Repeat stool culture
48. A 24-year-old, newly-diagnosed with HIV infection, inquired about prophylaxis for opportunistic infections. He
has unremarkable past medical history and denies any symptoms. Physical exam was also unremarkable. You
requested for chest x-ray, which showed normal results. CD4+ T cell count was 180/uL. You should give:
a. Azithromycin
b. Co-trimoxazole
c. Itraconazole
d. Valganciclovir
49. A 48-year-old male sought consult for his annual company check-up. He is asymptomatic. His mother is Diabetic
and his father is Hypertensive. His body mass index is 25.3kg/m2. Patient had blood examination as part of his
routine company check-up. Given his above clinical features, which of his laboratory findings can be considered as
an additional risk factor that predisposes him to develop Type 2 DM?
a. Triglycerides= 2.77 mmol/L
b. 2H PG= 7.6 mmol/L
c. HbA1c= 5.6%
d. HDL= 0.80 mmol/L
50. A 22-year-old Type 1 Diabetic patient plans to engage in physical activity and attend regular gym sessions. What
should you prescribe him?
a. Ingest carbohydrate before exercising if blood glucose is 6mmol/L.
b. Delay exercise if blood glucose is 12mmol/L and ketones are present.
c. Monitor glucose during exercise and ingest carbohydrate to prevent hypoglycemia.
d. Increase insulin doses (based on previous experience) before and after exercise and inject
insulin into a non-exercising area.
51. Which of the following anti-diabetic drugs may cause angioedema as well as urticarial and immune-mediated
dermatologic effects?
a. Linagliptin
b. Glimepiride
c. Repaglinide
d. Empagliflozin
52. A 19-year-old female, known Diabetic with poor compliance to medication was rushed to the ER due to
abdominal pain and vomiting. Upon assessment, the following findings were noted:
Vital Signs:
BP= 130/70, HR=105, RR=26
Temperature=37.6C
Drowsy, in respiratory distress.
Initial laboratory work-up showed:

CBG= high
ABG= uncompensated metabolic acidosis
Serum Ketone= positive.
Her condition can be explained by which mechanism?

a. Glucagon excess that increases the activity of pyruvate kinase.
b. Insulin deficiency which decreases the activity of phosphoenolpyruvate carboxykinase.
c. The combination of insulin deficiency and hyperglycemia reduces the hepatic level of
fructose-2,6-bisphosphate.
d. Insulin deficiency enhances the levels of the GLUT4 glucose transporter, which impairs
glucose uptake into skeletal muscle.
53. A 21-year-old male came to the ER due to nausea, vomiting, abdominal pain and generalized weakness.
Vital signs were as follows:

BP=110/70, HR=108 RR=28,
Temperature= 38.9.
Initial laboratory work-up showed:

CBG= high
ABG= uncompensated metabolic acidosis
Plasma Ketone= positive
Appropriate management of this case includes:

a. Replacement of potassium at 10meqs/hr if the potassium is <3.5mmol/L in the next 24 hours.
b. If the serum phosphate is <0.32mmol/L, then phosphate supplementation should be
considered.
c. In case of severe acidosis (pH< 7.0), compute for the bicarbonate deficit and replace it in 12
to 24 hours until pH is 7.0.
d. When the plasma glucose reaches 300mg/dL, glucose should be added to the 0.45% saline
infusion to maintain the plasma glucose in 250 mg/dL range, and the insulin infusion should
be continued at a lower rate.
54. A 55-year-old female, known Diabetic and Hypertensive for 8 years has been complaining of persistent distal
symmetrical lower extremity pain despite having a good glycemic, blood pressure and lipid control. He has no known
vices. Your recommendation is to initiate an FDA-approved drug for her condition which includes:
a. Tramadol
b. Duloxetine
c. Gabapentin
d. Amitriptyline
55. A 48-year-old male, known Diabetic sought consult with the following lipid profile:
Triglycerides= 568mg/dL
HDL=28mg/dL
LDL= 64mg/dL
The patient is already on lifestyle modification for the past 6 months. Which medication can be prescribed to him to
reduce his risk of pancreatitis?
a. Bile acid sequestrants
b. Nicotinic acid
c. Fenofibrate
d. Statin
56. A 34-year-old female consulted due to weight gain. Her waist circumference is 35 inches and her body mass
index is 30kg/m2. She has no other co-morbidities. Which of the following pulmonary abnormalities may be
associated with her condition?
a. decreased minute ventilation
b. increased chest wall compliance
c. decreased expiratory reserve volume
d. increased functional residual capacity
57. A 22-year-old female presented with hypogonadotropic hypogonadism, hyperphagia-obesity, chronic muscle
hypotonia, mental retardation, and diabetes mellitus. She also has multiple somatic defects that involves her skull,
eyes, ears, hands, and feet. What is the most likely diagnosis?
a. Turner syndrome
b. Kallmann Syndrome
c. Bardet-Biedl Syndrome
d. Prader-Willi Syndrome
58. A 32-year-old female sought consult due amenorrhea, galactorrhea and infertility. Her initial serum Prolactin
was 950 ng/mL (normal: 1.9-25ng/mL). The rest of pituitary hormone levels were normal. Pituitary MRI revealed a
2.3 x 1.9 x 1.5 cm mass in the anterior pituitary gland. Patient would want to conceive. She is taking titrated doses of
Bromocriptine for 12 months. Her latest Prolactin is 835 ng/mL. She also developed blurring of vision and
intermittent episodes of headache. Repeat MRI does not show tumor shrinkage. What will be the next step in
management?
a. Start Estrogen.
b. Add Octreotide to Bromocriptine
c. Continue titrating the dose of Bromocriptine until maximum dose is achieved.
d. Refer to Neurosurgery for transphenoidal resection of tumor
59. A 29-year-old male sought consult for coarse facial features and progressively enlarging hands and feet. He also
complained of hyperhidrosis and arthralgia. He has bitemporal hemianopsia on visual field exam. His vital signs are
stable.
His initial laboratory work-up showed:

Growth hormone: 56.9 ng/mL (normal: 0-5 ng/mL), taken when patient was fasting
IGF-1: elevated
Rest of pituitary hormone: normal
Fasting blood sugar: 117 mg/dL
Colonoscopy: no polyp or mass
ECG: regular sinus rhythm, normal axis with left ventricular hypertrophy
What should you do next?

a. Repeat IGF-1 on fasting and stimulated state
b. Request for pituitary, chest and abdominal CT-scan
c. Determine growth hormone level after 75 grams oral glucose load
d. No further work-up needed. Proceed with definitive treatment.
60. A 30-year-old male was diagnosed with Acromegaly. He had persistent headache and blurring of vision. Initial
evaluation showed that the likelihood of surgical cure is low. He still underwent debulking surgery. On his regular
follow-up for the past 6 months, his IGF is still elevated. What should be the next step in management?
a. Start Somatostatin analogue
b. Refer to Radiology for Radiotherapy
c. Refer to Neurosurgery and schedule for repeat debulking surgery
d. Reassure the patient that he needs to wait after 12 months to see improvement in his
condition.
61. A 32-year-old female consulted due to facial plethora, proximal muscle weakness, easy bruisability, menstrual
irregularity, and obesity. She had no known exposure to any medication that contains steroids. Her initial laboratory
features showed elevated 24-hour urinary cortisol, elevated salivary cortisol and elevated serum ACTH. High dose
dexamethasone suppression test was also done which revealed suppressed level of cortisol, less than 5ug/dL. What
should you do next?
a. Start Mitotane
b. Perform pituitary MRI
c. Request for chest, abdominal and pelvic CT-Scan
d. Refer to Neurosurgery and schedule for pituitary surgery as soon as possible
62. A 34-year-old male patient came in due to complaints of increase urinary frequency and volume, amounting to
90 mL/kg. He weighs 88 kilograms.
His laboratory results are as follows:
24 hour Urine volume: almost 8500 cc
Urine osmolarity: 230 mosm/Liter
Urine specific gravity: 1.001
Basal plasma arginine vasopressin: 5pg/mL
Pituitary MRI result showed presence of bright spot.
Based on the above findings, which is the most likely diagnosis?

a. Pituitary Diabetes Insipidus
b. Nephrogenic Diabetes Insipidus
c. Primary Poyldipsia- Dipsogenic Type
d. Primary Polydipsia- Psychogenic Type
63. A 65-year-old female being managed as a case of lung malignancy was referred due to persistent hyponatremia.
The patient does not have CHF, CKD, CLD, thyroid or adrenal disease. The patient does not experience increase
diuresis or bowel movement. Clinically, the patient is euvolemic. Which of the following findings will be consistent
with the possible cause of her hyponatremia?
a. low urate
b. low urinary sodium
c. elevated potassium
d. elevated plasma renin activity
64. Who among these patients are at increased risk for generalized osteoporosis?
a. L.Q., 38-year-old male with elevated TSH and low fT4
b. M.C., a 40-year-old female with low level of Prolactin
c. A.F, a 42-year-old male with low cortisol and ACTH
d. S.D., a 44-year-old female with HbA1c of 5.6% and FBS of 5.5mmol/L
65. Who among these patients will need a vertebral imaging test to screen for osteoporosis?
a. E.Z., a 48-year-old female who had low-trauma fracture at age 45
b. P.D., 52-year-old male with historical height loss of 1.6 inches
c. I.G., 59-year-old-female with prospective height loss of 0.6 inches.
d. R.V., 67-year-old male with BMD T-score at the spine, total hip, or femoral neck of 2.0
66. A 66-year-old female being treated for osteoporosis developed dermatitis, rash and eczema. After undergoing
dental procedure, she had Osteonecrosis of the Jaw. Her serum calcium was checked and it was low. What is the most
likely medication that the patient is taking and eventually predisposes her to this condition?
a. Calcitonin
b. Tamoxifen
c. Denosumab
d. Abaloparatide
67. A 59-year-old female consulted due to easy fatigability, weakness, constipation and weight gain. She also has
puffy face with edematous eyelids and nonpitting pretibial edema. Initial laboratory revealed elevated TSH and low
fT4. What should you order to establish her diagnosis?
a. fT3
b. TPO Ab
c. TSH-Receptor Ab
d. Thyroid Ultrasound
68. A 35-year-old female was referred by her Ob-Gynecologist due to easy fatigability, menstrual irregularity and
constipation. Part of her work-up revealed a normal TSH and low fT4 and fT3. Thyroid function tests were done
twice and yielded same results. She has no known co-morbidities. She is not taking any medications. What should be
the next step in managing this patient?
a. Evaluate pituitary function.
b. Facilitate a thyroid scan with uptake
c. Observe and repeat thyroid function tests after 3 months.
d. No further work-up needed. Start treatment with Levothyroxine.
69. A 38-year-old male, previously diagnosed with Graves’ Disease, underwent Radioactive Iodine Therapy
consulted with an elevated TSH and low fT4. He weighs 73kg. What is his computed dose of Levothyroxine?
a. 104.9 ug
b. 116.8 ug
c. 128.6 ug
d. 129.3 ug
70. A 35-year-old female was referred to you for co-management of her infertility. She is clinically euthyroid. She
has no known heart disease. For the past 3 months, her Ob-Gynecologist told you that her TSH is above 10 mIU/L.
Her current TSH is 15 mIU/L. Her ft4 and ft3 are both normal. What is the best management option for her condition?
a. Facilitate pituitary MRI as soon as possible.
b. Observe and repeat thyroid function test after 4 to 6 weeks.
c. You can tell her to start treatment with Levothyroxine.
d. Reassure the patient that there is no need to start treatment or do further work-up.
71. A 65-year-old female was rushed to the ER due to decreasing sensorium. She was previously diagnosed with
unrecalled thyroid disease, non-compliant to medication and was lost to follow-up. She is bradycardic and
hypothermic. She also has generalized edema. Work-up revealed elevated TSH and low fT4. Her Chest X-Ray
revealed pneumonia on right lower lung field. What should be part of her management?
a. Hypotonic IV fluids should be preferred if available.
b. Parenteral hydrocortisone (50mg every 6 h) should be administered.
c. An initial loading dose of 30-50 μg Liothyronine should be followed by 2.5–10 μg 8 hourly,
with lower doses for those at cardiovascular risk.
d. Levothyroxine can initially be administered as a single IV bolus of 200–400 μg, which
serves as a loading dose, followed by a daily oral dose of 1.6 μg/kg/d, increased by 25% if
administered IV.
72. A 29-year-old male consulted due to palpitations, tremors, hyperdefecation and weight loss.
Upon assessment, the following findings were noted:
Vital Signs: BP= 140/90, HR=108, RR=20 Temperature=36.8C

He is hyperreflexic.
There are no other significant physical examination findings.
Initial laboratory tests showed suppressed TSH and normal fT4.
What should be the next step in managing this case?

a. Do fT3
b. Do TPO Ab
c. Facilitate thyroid ultrasound.
d. Request for dedicated pituitary MRI.
73. A 32-year-old male consulted due to symptoms of thyrotoxicosis. There was no thyroid-related eye disease as
well as thyromegaly. Thyroid function tests which were done twice showed normal TSH and elevated fT4 and fT3.
What is his most likely diagnosis?
a. de Quervain’s thyroiditis
b. Sick Euthyroid Syndrome
c. Subclinical Hyperthyroidism
d. TSH-secreting Pituitary Adenoma
74. A 29-year-old female consulted due to symptoms of thyrotoxicosis. There was no thyroid-related eye disease as
well as thyromegaly. There was also no palpable nodule or mass. Thyroid function tests which were done twice
showed suppressed TSH and elevated fT4. Thyroid scan was also done which revealed low radioactive iodine uptake.
What is her most likely diagnosis?
a. Iodine Excess
b. Toxic Adenoma
c. TSH-secreting Pituitary Adenoma
d. Rule out other causes including stimulation by chorionic gonadotropin
75. A 34-year-old female consulted due to 4-week symptoms of palpitations, fever, hyperdefecation associated with
painful thyroid gland radiating to the jaw. Eye examination did not show exophthalmos, retraction or lid lag. Neck
examination did not reveal thyromegaly or mass or nodule. Thyroid function test results showed suppressed TSH
and elevated fT4. Thyroid scan showed low radioactive iodine uptake. Which of the following is part of the
appropriate management plan for this patient?
a. Aspirin 80mg/tablet may be given at a dose of 5-6 tablets every 4-6 hours.
b. Either PTU or Methimazole can be given during the thyrotoxic phase, but preferably
Methimazole.
c. Levothyroxine replacement may be needed if the hypothyroid phase is prolonged, but doses
should be 50–100 μg/day
d. If Aspirin or NSAID is not sufficient, Prednisone may be given at a dose of 3-4mg/kg/day
for 8 to 12 weeks and must be tapered based on patient’s symptoms.
76. A 27-year-old female was referred for evaluation of possible thyroid disease. She is clinically euthyroid. She has
no known co-morbidities. Upon assessment, the following findings were noted:
Vital Signs: BP= 120/70, HR=90, RR=16 Temperature=36.5C

There are no other significant physical examination findings.
Initial laboratory tests showed suppressed TSH and normal unbound thyroid hormones.
What should be the next step in managing this case?

a. Do thyroid ultrasound.
b. Request for dedicated pituitary MRI.
c. Follow up in 6-12 weeks with repeat thyroid function tests.
d. No further work-up needed and start treatment with Methimazole.
77. A 36-year-old female came in due to palpable nodule on her neck. She was clinically euthyroid. There were no
complaints of hoarseness, dysphagia or odynophagia. On neck palpation, an approximately 2.5 x 1.5 cm mass was
palpated on her left thyroid gland. There was no palpable lymph node. TSH was suppressed. What should be the
next best step in managing this patient?
a. Request for radionuclide scan
b. Start treatment with Methimazole
c. Refer to surgery and schedule for lobectomy
d. Do Fine Needle Aspiration Biopsy of the thyroid nodule
78. A 40-year-old-female came for palpable solitary thyroid nodule on the right lobe. Her previous physician
requested thyroid function test which revealed normal TSH. Thyroid ultrasound revealed the following results: Right
lobe: 5.7 x 3.6x 2.5 cm, with nodule described as hypoechoic, with calcifications, measuring 2.2 x 1.5 x 1.3 cm. Left
lobe: 4.1 x 3.9 x 2.4 cm. Isthmus: 1.5 x 1 x 0.5 cm
No cervical lymphadenopathy. She had fine needle aspiration biopsy that showed Suspicious for Papillary Thyroid
Cancer. She was advised by her previous physician to undergo immediate surgery. She consulted you for 2nd opinion.
What will you advise her?
a. Repeat fine needle aspiration biopsy, this time ultrasound guided.
b. Consider doing thyroid scan first to check if it is a hot or cold nodule
c. Immediately advise patient to undergo total thyroidectomy followed by radioactive iodine
therapy and levothyroxine suppression therapy.
d. Do thyroid peroxidase and thyroglobulin antibodies to rule out the possibility of
Hashimoto’s thyroiditis that may increase likelihood of co-existing thyroid lymphoma.
79. A 29-year-old female consulted due to progressive weight gain, easy bruisability, proximal myopathy, purplish
abdominal striae >1cm, diabetes mellitus, dyslipidemia and hypertension. There were no known co-morbidities.
Patient denies use of steroids. Initial work-up revealed elevated midnight salivary cortisol and suppressed ACTH.
How should you proceed with work-up?
a. Do pituitary gland MRI
b. Do adrenal gland CT-Scan
c. Perform High Dose Dexamethasone Suppression Test
d. Refer to Interventional Radiologist for Inferior Petrosal Sinus Sampling
80. A 31-year-old male suspicious of Cushing’s syndrome had a non-suppressible low dose dexamethasone
suppression test and an elevated 24-hour urine free cortisol levels. Serum ACTH was elevated. Pituitary Magnetic
Resonance Imaging showed a pituitary mass, 1.2 cm x 0.9 cm x 0.8 cm. High dose dexamethasone suppression test
was done and results showed non-suppressed level of cortisol. CRH test done showed non-stimulated levels of ACTH
and cortisol. What should be the next plan of management?
a. Start Mitotane followed by Radiotherapy
b. Transphenoidal excision of pituitary mass
c. Perform inferior petrosal sinus sampling
d. Subject patient to adrenal gland protocol then treat with Ketoconazole
81. A 32-year-old female consulted due to progressive weight gain, easy bruisability, proximal myopathy, purplish
abdominal striae >1cm, impaired glucose tolerance and hypertension. There were no known co-morbidities. Patient
denies use of steroids. Initial work-up revealed 4 times elevated urinary cortisol and elevated ACTH. Which of the
following is the most likely diagnosis?
a. Macronodular Adrenal Hyperplasia
b. McCune-Albright Syndrome
c. Adrenocortical adenoma
d. Ectopic ACTH Syndrome
82. A 44-year-old male was diagnosed with Primary Aldosteronism based on a positive Aldosterone-Renin Ratio and
an elevated aldosterone levels on confirmatory test. On history, he claimed that most of the time, his blood pressure
was 140-150/90mmHg and serum potassium was normal. There is no family history of early-onset hypertension or
Primary Aldosteronism. Imaging revealed bilateral micronodular hyperplasia. What will be your next plan of action?
a. Schedule for Adrenal Vein Sampling
b. Do Fludrocortisone Suppression Test
c. Start treatment with Spironolactone
d. Refer to Urologist for Bilateral Adrenalectomy
83. A 43-year-old female came in due to generalized weakness, nausea, dizziness, vomiting and abdominal pain.
Blood pressure was 90/60mmHg. Capillary blood glucose was 68mg/dL. She was suspected to have Adrenal
Insufficiency hence she had cosyntropin test that revealed low level of cortisol. Further diagnostic exam showed low
ACTH, normal renin and normal aldosterone. There was no history of previous steroid intake. How should you
proceed with the diagnostic work-up?
a. Screen for autoantibodies
b. Facilitate Insulin Tolerance Test
c. Do CT-Scan of chest and abdomen
d. Perform MRI of the pituitary gland
84. A 32-year-old male presented with intermittent episodes of headache with associated palpitation and sweating.
His blood pressure was documented to be 160-180/110-120mmHg. Further work-up revealed a 4-times elevated
plasma metanephrine and a 3x2 cm mass noted on the left adrenal gland. Given his condition, which of the following
anti-hypertensive medications should be initiated first to achieve adequate blood pressure control before doing his
surgery?
a. Verapamil
b. Propranolol
c. Spironolactone
d. Phenoxybenzamine
85. A 39-year-old male consulting due to eruption of pruritic papular lesions on his trunk. He has hypertension on
losartan + HCTZ 50/12.5mg OD. He claims that he noted a solitary oval patch with fine scales 2 weeks ago which
spontaneously resolved (see photo 1). On PE, VS were stable. Examination of the trunk shows Symmetric
erythematous papules and plaques with a collarette of scale (see photo 2). Which is true of his condition?
a. Expect the papules to quickly progress to vesicles, to pustules, then to crusted sites.
b. Treatment of choice is UVB phototherapy.
c. Reassure him that the condition is self-limiting.
d. Reassure him that the condition is self-limiting.
86. 66-year-old, female obese patient consulting for persistent, irritated, mildly painful erythematous scaly skin
lesions beneath both breasts for the past 5 months. She claims to have refrained from using bra but with no
improvement. Examination of affected area shows edematous, erythematous, and scaly papular lesions with scattered
“satellite pustules” (see photo). What is the expected finding on KOH smears?
a. Pseudohyphae
b. Hyphae and spores
c. Hyphae
d. Spores
87. 29-year-old male soldier consulting for persistent nonpruritic, nonpainful, hyperpigmented patches on the trunk
and back. KOH preparation demonstrates a confluence of “spaghetti and meatballs” configuration. What is the
treatment of choice?
a. Ketoconazole 200mg/tab OD PO
b. Topical hydrocortisone TID
c. Topical selenium sulfide OD
d. Topical clotrimazole TID
88. A 42-year-old diabetic female had high grade fever, night sweats and chills. On PE, she has a murmur at the
cardiac apex on left lateral position. She also has painful purplish nodular lesions on her finger tips. What do you call
these lesions?
a. Splinter hemorrhages
b. Janeway’s lesions
c. Actinic Keratosis
d. Osler’s nodes
89. 32-year-old female consulting for very slowly healing vesicles and bullae that rupture, producing moist erosions
with a hemorrhagic base with crusting and purplish discoloration over the dorsal hands, forearms and face especially
when exposed to sunlight. She is a smoker with a regular alcohol intake. She has no known comorbidities. She denies
illicit drug use and only takes self-prescribed ASA and OCPs. Initial test show negative ANA result. What is the next
best step?
a. Determine plasma porphyrin
b. Perform skin biopsy
c. Order phototest with UVB and UVA
d. Discontinue ASA
90. A 53-year-old male security guard consults for circular or oval “coinlike” lesions, beginning as small edematous
papules that become crusted and scaly. What is the most likely diagnosis?
a. Seborrheic dermatitis
b. Asteatotic eczema
c. Nummular eczema
d. Lichen simplex chronicus
91. A 65-year-old hypertensive male presents with a generalized urticarial rash with pruritus and hypotension after
undergoing whole abdominal CT Scan with contrast. He had been admitted for abdominal distension and is being
worked up for mechanical bowel obstruction, probably due to a colonic mass. He claims to have no food and drug
allergies and no prior exposure to diagnostic contrast media. Immediate allergic reactions which can occur on first
exposure are most likely caused by which of the following mechanisms:
a. Immune complex dependent reactions
b. Non-immune cutaneous reactions
c. Ige dependent reactions
d. Mast cell degranulation
92. 28-year-old female consults for urticarial serpiginous rashes over her lower extremities (see photo) associated
with fever and arthralgia. She has polycystic ovarian syndrome and is maintained on metformin and OCP with good
compliance. She was recently diagnosed with UTI on cefuroxime. What is the most likely diagnosis?
a. Drug-Induced Hypersensitivity Syndrome (DIHS)
b. Acute Generalized Exanthematous Pustulosis (AGEP)
c. Serum-sickness
d. Fixed drug eruptions
93. The clinical hallmark of acne vulgaris is the:

a. Inflammatory Papule
b. Painful pustule
c. Close or open comedone
d. Cystic or nodule
94. A 55-year-old female consults for erythematous pustular lesions in the face with noted flushing associated with
alcohol intake. Physical exam demonstrates erythematous papulopustular lesions with severe signs of inflammation
and telangiectasia. Which is the best therapy to prescribe?
a. Topical glucocorticoids
b. Topical ivermectin
c. Oral glucocorticoids
d. Oral Doxycycline
95. What is true about the causative agent of this condition?

a. It is caused by a human poxvirus.
b. HPV types 16 and 18 are major risk factors
for intraepithelial neoplasia.
c. Genital affectation usually involves HPV type 1
d. HPV vaccine effectively reduces incidence of
both the periungual and anogenital types.
96. A 25-year-old student was referred for scalp itchiness. He initially dismissed the condition as simple dandruff but
became anxious when the eyebrows, eyelashes and glabella were involved. He has central facial erythema with
overlying greasy, yellowish scale. What is your best advise?
a. He needs high-potency topical glucocorticoid (betamethasone or clobetasol) for control of severe scalp
involvement.
b. It does not spread to other areas of the body like the chest, groin, axilla and gluteal cleft.
c. Antidandruff shampoos are effective if left in place for 30 min before rinsing.
d. No treatment is necessary as it is self-limiting.
97. Portal areas of the liver consist of small veins, arteries, bile ducts and lymphatics. Secreted bile flows:
a. From the hepatocytes to the sinusoids
b. From the portal areas to the sinusoids to the terminal hepatic areas
c. In a counter-current pattern
d. From zone 1 to zone 3
98. A 68-year-old male is evaluated for hematemesis. He reports history of smoking, hypertension, weight loss for
the last 3 months, abdominal fullness, and fatigue. On PE BP 90/60, CR 120s, RR 24, T37.2C. He has pale palpebral
conjunctivae, icterisia, abdominal shifting dullness, tender right upper quadrant area, and grade 2 bipedal edema. His
intial serologies showed Hg 8.7g/dL, platelet 122, BUN 32mg/dL, creatinine 1.3mg/dL, PT INR 1.8, ALT 278, AST
322 and high biliribuin levels; with (+) HBsAg, (+) IgG anti-HBc. What is the ideal management along with upper
endoscopy:
a. CT angiography
b. CT enterography
c. Once daily PPI therapy
d. Vasoactive drug like octreotide
99. A 62-year-old female with no previous therapy for the liver came for follow up for fatigue and occasional
itchiness with her lab results: SGPT 74, SGOT 79, (+) HBsAg, (-) HBeAg, (+) anti-HBe, (-) anti-HBc and HBV DNA
< 20 IU/mL. What does she have:
a. Acute hepatitis B, replicative phase
b. Acute hepatitis B, non-replicative phase
c. Chronic hepatitis B, replicative phase
d. Chronic hepatitis B, non-replicative phase
100. A 28-year-old male complained of 2-month history of hematochezia with frequent soft to watery stools of about
4 episodes per day, accompanied by weight loss and anorexia. Distal colon biopsy showed diffuse mucosal disease
with no ulceration and no cobblestoning. Management for this condition:
a. Cyclophosphamide
b. Metronidazole
c. Rituximab
d. Sulfasalazine
101. 66-year-old diabetic male was admitted for debridement of cellulitis on the right foot. However on his 22nd
hospital day, he developed watery stools occurring 4 episodes per day for the last 2 days, fever Tmax 38.9C, with
CBC WBC 18,000, N88; The most sensitive and specific test for the isolation of this organism is:
a. Cell culture cytotoxin test on stool
b. Colonoscopy
c. Enzyme immunoassay for toxins A and B in stool
d. Nucleic acid amplification tests for toxins A and B in stool
102. A 26-year-old female with 8 days of flu-like symptoms with anorexia came in for evaluation. She is sexually
active with multiple partners. On PE BP 132/84, CR 98, RR 19, T 37.9C, icteric sclerae, clear breath sounds, no
active skin lesions, with palpable liver at mid clavicular line, measuring 17cm by percussion. Her serologies showed:
HbsAg (+), IgG anti-HBs (-), HBe Ag (+), IgM anti-HBc (+)
a. Active hepatitis B infection
b. Active protection against the hepatitis B virus
c. No active hepatitis B infection
d. Previous hepatitis B infection
103. A 42-year-old female seeking clearance for work came in with hepatitis panel results: anti-HAV IgG (+), anti-
HAV IgM (-), HBsAg (-), anti-HBs (+), anti-HBc (-), HBeAg (-), anti-HBe (-). What is the assessment:
a. Acute Hepatitis A infection with immunization from vaccination with Hepatitis B
b. Acute hepatitis A and B infection
c. Previous hepatitis A infection with immunization from vaccination with Hepatitis B
d. Previous hepatitis A infection with chronic hepatitis B infection
104. A 26-year-old male came in for occasional frequent bowel movement of about 3 episodes, with passage of small
volumes of stool amounting to about less than 1 cup, often associated with urgency, tenesmus and feeling of
incomplete evacuation. He remembers having the same episodes 3 years ago which lasted for a few weeks and
spontaneously improved. Most likely he has:
a. Chronic diarrhea
b. Irritable bowel syndrome
c. Malabsorption syndrome
d. Overflow diarrhea
105. A 43-year-old female came for evaluation of gradual abdominal enlargement for the last 3 weeks, accompanied
by bilateral leg swelling. On PE BP 160/100, CR 110, RR 22, T 36.8C. She has multiple cervical lymphadenopathy,
neck veins not distended, decreased breath sounds bibasal; abdominal enlargement, with normoactive bowel sounds,
negative hepatojugular reflux, non tender abdomen and grade 2 bipedal edema. Her SAAG was noted at <1.1g/dL.
Possible differential would include:
a. Budd-Chiari syndrome
b. Congestive heart failure
c. Nephrotic syndrome
d. Sinusoidal obstruction syndrome
106. A 35 year old female with no known comorbidities sought consult due to chronic epigastric pain accompanied
by diarrhea. EGD was done which showed hypertrophic gastric folds and prepyloric and duodenal scars, as well as
duodenitis. At the second portion of the duodenum a sessile hemispheric polyp was seen close to the papilla of Vater.
Biopsy of the polyp showed an abundance of cells immunoreactive for gastrin. What will be the next diagnostic test
for the patient?
a. Endoscopic ultrasound
b. Fasting gastrin level
c. Measurement of gastric fluid pH
d. Trial of high dose PPI 60 mg/24H
107. A 68-year-old male, chronic alcohol beverage drinker, was seen at the ER with complaints of abdominal
discomfort. On PE, the following were noted: BP120/74, CR 82, RR 20, T 36.9C, icteric sclerae, jaundice, liver
span 14cm, tender right upper quadrant, and flapping tremors. His ALT 47U/L, AST 158 U/L, albumin 2.3, PT INR
1.20, RBS 132. Which among the following treatment options would result to better survival for his condition:
a. Alcohol intake cessation
b. Anti-TNF like infliximab or etanercept
c. Penicillamine
d. Pentoxyfilline
108. A 40-year-old female came in for EGD due to 4 months of epigastric pain worst between meals, occasionally
relieved by Sodium alginate + Sodium bicarbonate + Calcium carbonate sachet, and now advised for EGD due to
melena. She has no comorbidity, with no intake of medications. Her PE is normal except for epigastric tenderness.
Her EGD which showed a well- circumscribed 2-cm duodenal ulcer that is positive for H.pylori. Which of the
following is the recommended initial therapy given these findings?
a. A. Esomeprazole plus bismuth subsalicylate plus tetracycline plus metronidazole for 5-7 days
b. Lansoprazole plus clarithromycin plus amoxicillin for 14 days
c. Omeprazole plus Clarithromycin plus Amoxicillin plus Metronidazole for 5-7 days
d. Omeprazole plus rifabutin plus amoxicillin for 10 days
109. 58-year-old alcoholic male, presented with 3-days of hematemesis. His BP 100/70, CR 108bpm, pale palpebral
conjunctivae with slight icterisia. He had tender epigastric and RUQ areas. Liver was firm with palpable nodular edge
at mid clavicular line. His BUN was 20mg/dL, Hgb 11g/dL, with no signs of heart failure. Aside from PPI infusion
at presentation, what will be the next management?
a. Antibiotic therapy with quinolone or ceftriaxone
b. Blood transfusion
c. Early endoscopy within 12 hours
d. Surgery
110. A 46-year-old male, came in due to 2 days hematochezia. He is hemodynamically stable. Upon colonoscopy,
there is active bleeding mass on the sigmoid area. Base on the findings, what is your next immediate management?
a. CT angiography
b. Flexible sigmoidoscopy
c. Intraoperative colonoscopy and surgery
d. Surgery alone
111. A 65 year old male with liver cirrhosis came in for follow up for his liver function tests: ALT 158U/L, AST
172U/L, INR 1.0, albumin 3.2; HBsAg (+), HBe Ag (-) , HBV DNA <2000 IU/mL. What will be the next step:
a. Consider liver biopsy
b. Consider liver transplant
c. Start chemotherapy
d. Start Lamivudine +/- adefovir
112. A 32-year-old female with 3 month history of fatigue was referred for hepatomegaly 17cm by ultrasound,
elevated ALT 198mg/dL and AST 221mg/dL, viral hepatitis tests negative, ANA 1:320 homogenous. IgG (+), and
anti-LKM1 (+). Liver biopsy showed: interface hepatitis. Management for this case would include:
a. Azathioprine
b. Glucocorticoid therapy + Azathioprine
c. Glucocorticoid + Hydroxychloroquine therapy
d. Hydroxychloroquine therapy
113. A unique form of hemolytic anemia with spurs and acanthocytes that occur among patients with severe alcoholic
liver disease.
a. Beck’s triad
b. Laennec’s syndrome
c. Wernicke’s syndrome
d. Zieve’s syndrome
114. 28/F, PU36 weeks AOG came to the ER due to RUQ pain with radiation to the scapula accompanied by vomiting.
PE was unremarkable. Ultrasound of the gall bladder showed bile sludge.
Factors that may contribute to gallstone formation during pregnancy:
a. Decrease in bile salt secretions
b. Gallbladder hypomotility
c. Decreased enterohepatic circulation of bile acids
d. Decreased size of bile acid pools
115. A 39-year-old male with no known co-morbidities sought consult for a 3-year history of recurrent epigastric
pains with nausea and vomiting. He took PPI for 1 month, but symptoms persisted. He underwent gastroscopy with
biopsy which showed: inflammatory infiltrate extending deeper into the mucosa with progressive distortion and
destruction of the glands. Based on these findings, what phase of chronic gastritis does he belong to?
a. Atrophic gastritis
b. Gastric atrophy
c. Gastric metaplasia
d. Superficial gastritis
116. A 65-year-old male admitted for syncope due to cardiomyopathy-associated ventricular tachycardia and had
been on amiodarone drip for 3 days then oral amiodarone for 10 days developed jaundice and vomiting and later
encephalopathy just when discharge was being planned. Which therapy provides a higher transplant-free survival?
a. Glucocorticoids
b. N-Acetylcysteine
c. Silymarin
d. Ursodeoxcholic acid
117. Congestive splenomegaly with hypersplenism is common in patients with portal hypertension and is usually the
first indication of portal hypertension in liver cirrhosis. They are characterized with the development of
a. Thrombocytosis and leukocytosis
b. Thrombocytosis and leukopenia
c. Thrombocytopenia and leukocytosis
d. Thrombocytopenia and leukopenia
118. A 52-year-old male diagnosed was diagnosed with gastric ulcer. What is true of its pathology:
a. Intake of Paracetamol increases the risk
b. NSAIDs induce increase in prostaglandin secretion
c. The organism associated is a gram-positive microaerophilic rod
d. The organism associated is S-shaped with multiple sheathed flagella
119. A 57 year old male with duodenal ulcer experienced transient improvement with H.pylori eradication. Three
months later, symptoms recur despite suppressing therapy. He has no NSAID intake. Stool test for H.pylori is
negative. EGD reveals prominent gastric folds together with persistent ulceration in the duodenal bulb previously
detected and the beginning of a new ulcer 4cm proximal to the initial ulcer. What is the likely diagnosis
a. H.pylori associated PUD
b. Malignancy
c. NSAID induced gastropathy
d. Zollinger Ellison Syndrome
120. A 67 year old male presenting with melena at the ward developed orthostatic hypotension. His current BP is
90/50, HR 128. His hemoglobin is 6.9g/dL, BUN of 20. What will be your next initial management?
a. Admit to ICU
b. Blood transfusion
c. PPI therapy
d. Urgent endoscopy
121. A 38-year old female who was previously well, developed a 3 month history of progressive body weakness,
body malaise, and fatigue. She has no history of illicit drug use, an occasional alcoholic drinker and a non-smoker.
She is married with only one sexual partner, her husband who admits to having multiple partners in the last 3 years,
prior to his marriage. The last 2 weeks patient has anorexia, nausea and occasional vomiting. Upon PE she has right
upper quadrant tenderness. Her lab results showed: CBC: 12/0.39/WBC 14/N50, L45, M3, E2/plt 250; RBC 88,
Creatinine 1.0, BUN 14, ALT 235, AST 100, TB 2.0 mg/dl, IgM anti HAV – Negative; IgM Anti-HBc-Positive; anti-
Hbs – Negative; HBsAg – Positive; HBeAg-Negative; anti HCV Negative; HBV DNA >2 x104 IU/mL How will
you manage this patient?
a. Anti-viral therapy is not recommended, suggest liver biopsy
b. Close monitoring of viral load every 3 months
c. Interferon therapy 5M units subcutaneously daily
d. Tenofovir 300mg OD PO
122. A 62-year-old female came in due to epigastric pain radiating to the back. PMH: s/p cholecystectomy a year
ago. Ultrasound showed absent gall bladder with dilated common bile duct. The present of choledocholithiasis should
be suspected if
a. Elevation of aminotransferases 2-10 fold
b. Intrahepatic biliary dilatation
c. Presence of pruritus and acholic stools
d. Serum bilirubin levels > 20mg/dL
123. A 53-year-old female with T2DM came in with epigastric fullness and eructation. Ultrasound showed a 7mm
gallstone. The best management advice would be:
a. Choleresis to increase biliary secretion
b. Expectant management
c. Gallstone dissolution with UDCA at 10-15 mg/kg/day.
d. Prophylactic cholecystectomy
124. A 20-year-old female consulted for itchiness of 2 weeks, bloatedness and periods of tiredness. Initial
aminotransferases are elevated. What diagnostic imaging study would be valuable in evaluation of the patient’s
condition?
a. CT scan of the abdomen
b. ERCP
c. MRCP
d. Ultrasound of the abdomen
125. A 39 year old male with history of 2 CVD infarcts when he was 19 years old and later when he was 25 years
old, is admitted for severe generalized abdominal pains since 2 days now. He has no nausea/vomiting but with last
bowel movement 4 days ago. On PE he has hypoactive bowel sounds, tender on light percussion on all quadrants, no
ascites, no organomegaly, tender on all quadrants. DRE was negative. Abdominal X-ray showed “thumbprinting” on
the bowel wall. The next diagnostic step for this condition:
a. Angiography with venous phase
b. Colonoscopy
c. Duplex scan
d. Ultrasound of the whole abdomen
126. A 38-year-old female comes in for recurrent bloody diarrhea. Fecalysis showed WBCs and RBCs, fecal
lactoferrin is elevated. ESR and CRP are elevated. Ultrasound of the whole abdomen was unremarkable. The
colonoscopy shows diffuse continuous inflammation of the bowel across the rectosigmoid. What key diagnostic test
can confirm her likely condition?
a. CT scan of the whole abdomen with triphasic contrast
b. Endoscopic ultrasound of the rectum
c. Immune markers such as ANA and AMA
d. There is no key / definitive test for her condition.
127. Which is the most commonly affected portion of the GI system in patients with Crohn’s disease?
a. The cecum
b. The rectum
c. The stomach
d. The terminal ileum
128. A 41-year-old female Crohn’s disease patient comes in for severe abdominal pain. She has been maintained on
sulfasalazine and azathioprine for the last 10 years but was lost to follow up for the last 3 years. She now has difficulty
defecating for over 1 week. Her Xray shows evidence of bowel obstruction and CT scan confirms multiple strictures.
Her ideal management would be:
a. Perform a colonoscopy to dilate the strictured segments
b. Refer for surgical intervention
c. Start bowel rest and steroids
d. Step up management to use infliximab
129. A 52 year old female, recently diagnosed with Rheumatoid arthritis was referred for clearance prior to Rituximab
infusion. She denies history of any liver disease, abdominal pains and problems in defecation. On work up she has:
IgM anti HAV (-); HBsAg (+),IgM anti-HBc (-),IgG anti HBc (+),HBeAg (-), anti-HBe(-), anti-HCV (-). What is the
patient’s hepatitis status?
a. Acute hepatitis B infection
b. Chronic hepatitis B infection
c. Process of seroconversion to antiHBs
d. No hepatitis infection
130. A 44-year-old male, smoker, alcoholic was rushed to the ER for progressive, severe abdominal pain for the last
8 days. Initially described as burning, epigastric pain radiating to the back. On PE BP 60/40, CR 130s, RR 24, T
38.7C, dry mucosa, decreased breath sounds bibasal, faint blue discoloration on the periumbilicus, hypoactive bowel
sounds, tender on all quadrants. The patient is currently in which phase of this condition?
a. First phase
b. Second phase
c. Third phase
d. Fourth phase
131. A 66-year-old female, previously alcoholic came in for work up for weight loss abdominal pains and chronic
diarrhea. She noticed that fecal matter is frothy and floats every bowel movement which occurs about 3-4 times daily.
Initial work up for this condition would include:
a. CT scan of the pancreas
b. Endoscopic ultrasound
c. Fecal elastase measurement
d. Pancreas function test with secretin
132. A 43-year-old female came in from India with 2-week fever, abdominal pains, anorexia, weight loss and nausea
and vomiting. She remembers having salmon colored rash that lasted for 3 days during the first week of fever. On PE
BP 130/90, CR 80s, T39C. She has tender abdomen and hepatosplenomegaly. If she will be left untreated and develop
chronic carriage, this will increase the risk for:
a. Coma vigil
b. Gallbladder cancer
c. Hemophagocytic syndrome
d. Osteomyelitis
133. In general, the serum cobalamin level below which megaloblastic anemia develops is:
a. 164 pmol/L
b. 148 pmol/L
c. 74 pmol/L
d. 58 pmol/L
134. A 25-year-old woman is seen at the outpatient clinic with jaundice and dark-colored urine. 3 days earlier, she
was diagnosed with UTI and was given Nitrofurantoin. 6 hours after her first dose of Nitrofurantoin, she complained
of body malaise, weakness, and lumbar pain. She looked pale and icteric. CBC done showed normocytic
normochromic anemia. PBS showed bizzare poikilocytes and Heinz bodies. What underlying condition can explain
the patient’s clinical course?
a. Beta thalassemia
b. G6PD deficiency
c. Atypical HUS
d. Pyruvate kinase deficiency
135. A 26/F was admitted due to jaundice since 3 weeks ago. Physical examination shows pallor, icteric sclerae, and
splenomegaly. Abdominal ultrasound confirmed the presence of splenomegaly with an incidental finding of
gallstones. Further workup showed normocytic anemia with elevated mean corpuscular hemoglobin concentration.
Her peripheral blood smear is shown below. What is the main diagnostic test to clinch the diagnosis for this case?
a. Electrophoresis
b. Osmotic fragility test
c. Reticulocyte count
d. Western blot
136. A 23-year-old female flight attendant with no known comorbidities came in for a feeling of lassitude, weakness,
shortness of breath and a pounding sensation in the ears. Yesterday, she noted a difficult-to-control bout of epistaxis.
On physical examination, she was visibly pale, with crops of petechiae on her arms. Complete blood counts were
taken which revealed pancytopenia, elevated MCV with very few reticulocytes. She was advised to have a bone
marrow biopsy. The bone marrow biopsy will likely reveal:
a. Dry tap
b. 10-30% cellularity
c. 10-20% blasts
d. Predominantly fat
137. Which of the following cytogenetic abnormalities confers a “good risk” feature in MDS?
a. del(20q)
b. -7
c. +8
d. +13/del(13q)
138. Which of the following genetic changes characterizes Primary Myelofibrosis (PMF)?
a. t(15;19) translocation
b. JAK2 activating mutation
c. PDGFRa deletion or translocation
d. t(9;22)(q34:11) translocation
139. Which of the following myeloproliferative neoplasms has high risk of leukemic transformation?
a. Polycythemia vera
b. Primary myelofibrosis
c. Chronic myelogenous leukemia
d. Essential thrombocytosis
140. DJ, 42/M was referred to you for a history of excessive bleeding after accidentally nicking himself during
shaving. The patient denies any other symptoms nor any other previous bleeding episodes or easy bruisability. He
denies intake of any medications nor any food supplements. Family history is unremarkable. PE is also unremarkable.
Review of laboratory results showed normal CBC, prolonged PT but normal aPTT. Which of the following is the
most likely differential for the patient’s case?
a. Factor VII deficiency
b. von Willebrand disease
c. Factor XI deficiency
d. Factor V
141. A 50-year-old man, otherwise asymptomatic, shows you a CBC with the following findings: Hb 140mg/dL, Hct
0.38, WBC 4,500/uL, Platelet count 100,000/uL. What will you do next?
a. Assure patient that the values are normal
b. Repeat CBC in 24 hours
c. Request for peripheral blood smear
d. Refer for bone marrow biopsy
142. Which treatment for ITP require monitoring for 8 hours post infusion due to the rare complication of severe
intravascular hemolysis?
a. Prednisone
b. Rho (D) immune globulin
c. IVIg
d. Rituximab
143. What is the central mechanism of DIC?

a. Increase in physiologic anticoagulant mechanism
b. Uncontrolled thrombin generation
c. Normal fibrinolysis
d. Systemic fibrin deposition in large vessels
144. A 45-year-old man has an enlarged non-tender left cervical lymph node. He has been having late afternoon fever,
night sweats, weight loss for the last 2 months. On PE, there we enlarged lymph nodes palpated post-auricular and
left axillary. Excision biopsy of the left cervical lymph node showed diffuse proliferation of large atypical
lymphocytes that are heterogenous with vesicular chromatin and prominent nucleoli, with no identified RS cells.
IHCs done showed: CD20 (+), CD19 (+), CD10 (+), CD30 (-), BCL2 (-) What is the most likely diagnosis of this
patient?
a. Hodgkin’s lymphoma
b. Follicular Lymphoma
c. Diffuse Large B-cell Lymphoma
d. Marginal Zone Lymphoma
145. A 58-year-old female was newly diagnosed with AML. She has no known comorbids and has an ECOG
performance score of 1. What is the best induction regimen for this patient?
a. Cytarabine and Anthracyclines
b. Hemopoietic Stem Cell Transplantation
c. Azacitidine and Decitabine
d. Investigational Therapy
146. A 48-year-old male diagnosed with ALL completed his induction therapy. He was advised to undergo
maintenance therapy which usually consists of 6-mercaptopurine and methotrexate. For this patient, how long would
you give the treatment?
a. 1 – 2 years
b. 1.5 – 2 years
c. 2 – 2.5 years
d. 2.5 – 3 years
147. A 34-year-old male underwent a pre-employment check-up. He is asymptomatic and has no known co-morbids.
However, his results showed absolute lymphocytosis with 6425 B-lymphocytes/µL. What would be the next best
diagnostic work-up?
a. Bone marrow aspiratory
b. Chest CT scan
c. Flow cytometry on the peripheral blood
d. Whole abdominal CT scan
148. A 24-year-old athlete was diagnosed with iron deficiency anemia. Although she has a hemoglobin of 9 g/dL,
she has no symptoms and can carry out her usual rigorous training. She asks you what is the best management for her
anemia. You would tell her:
a. Oral treatment with ferrous fumarate would be best.
b. IV iron is the treatment of choice for her condition.
c. She would need a blood transfusion immediately.
d. Weekly subcutaneous erythropoietin injections would be better for her anemia.
149. A 48-year-old male with anemia was noted with low serum iron, low percent transferrin saturation, normal
ferritin and low TIBC. Which key iron regulator is responsible for these distinctive iron values?
a. Gamma interferon
b. Interleukin-6
c. Hepcidin
d. Interleukin-1
150. A patient presented with the characteristic “chipmunk” facies, easy fatigability, dizziness, pale skin and requires
intensive blood transfusion support to survive. What is the possible diagnosis?
a. β Thalassemia Major
b. β Thalassemia Intermedia
c. β Thalassemia Trait
d. β Thalassemia Minor
151. A 26-year-old female was referred for gum bleeding accompanied by heavy menstrual bleeding for the last 6
days. CBC showed Hg 9.7g/dL, WBC 11,000, platelet 25,000 and peripheral blood smear showed large platelets,
normocytic hypochromic anemia. Initial management given was Prednisone at 1mg/kg/day however there was
persistence of bleeding and low platelet. The next management would be:
a. Belimumab therapy
b. Infliximab therapy
c. Intravenous immunoglobulin therapy
d. Methotrexate therapy
152. This is the major cause of morbidity and the second leading cause of death in hemophilia patients receiving
clotting factor concentrates:
a. Hepatitis B virus
b. Hepatitis C virus
c. HIV
d. Tuberculosis
153. This is an important co-factor for the y-carboxyglutamic acid residues on coagulation proteins:
a. Carboxylase
b. Epoxide reductase
c. Glutamic acid
d. Vitamin K
154. A 69-year-old male came in due to body pains for the last 3 weeks prompting patient for NSAID use. On further
examination he is febrile 38.9C, pale, clear breath sounds, tender hypogastric area; with tender upper and lower limbs,
no arthritis. His Hg 8.5, WBC 5.4, platelet 102,000; creatinine 2.1mg/dL, Total calcium 11.2 and urinalysis showed
proteinuria +2, WBC >50, RBC 0-2. The likely organism to cause his current infection associated with his condition
is:
a. Campylobacter sp
b. Eschericia coli
c. Pseudomonas sp
d. Streptococcus pneumoniae
155. Features responsible for high progression from smoldering multiple myeloma to multiple myeloma include bone
marrow plasmacytosis >10%, abnormal kappa/lamda free light chain ratio, and ___:
a. < 20 g/L hemoglobin, below the lower limit of normal
b. > 177umol/L serum creatinine
c. >30g/L (3g/dL) serum M protein
d. ≥ 200mg per 24h urinary monoclonal protein
156. Individuals with blood type O have:

a. A more severe malaria
b. Enhanced susceptibility to Helicobacter pylori
c. Higher procoagulation phenotype
d. Less susceptibility to cholera bacillus
157. A 65-year-old female came in due to non-productive cough, progressive shortness of breath, facial and right
upper extremity swelling, visible collateral veins on anterior chest wall. Chest X-ray revealed a large mediastinal
mass. Which of the following is correct about the case?
a. Symptoms decrease in severity when lying down
b. The presence of breast edema would point to the possibility of a breast primary
c. Right-sided pleural effusion is seen in majority of patients with effusions being mostly exudative and
occasionally chylous
d. The occurrence of seizure should point to the possibility of brain metastases rather than cerebral edema
from venous occlusion
158. A 54-year-old woman diagnosed with Stage IV breast cancer now complains of lower back pain with point
tenderness at the level of T12. She mentions that the pain developed 2 weeks ago and becomes worse when coughing
or sneezing, and when lying supine. What is your next step in the management of this patient?
a. Refer patient for radiotherapy and start patient on glucocorticoids
b. Request for a thoracolumbar MRI
c. Request for a plain spine X-ray
d. In the absence of neurologic signs and symptoms, continue to observe patient and give pain relievers
159. Which of the following biochemical findings is expected with Tumor Lysis Syndrome?
a. Hypophosphatemia
b. Hypokalemia
c. Hypocalcemia
d. Hypomagnesemia
160. A 54-year-old male, non-smoker, comes to your clinic asking about genetic predisposition to lung cancer as one
of his maternal cousins was recently diagnosed with lung cancer. What will you tell him about his genetic
predisposition for lung cancer?
a. He may be at two-fold increased risk of lung cancer
b. Suggest to him screening for established inherited gene mutations associated with lung cancer
c. Being a non-smoker, his susceptibility to lung cancer is increased presence of a germline mutation called
T790Ma
d. His risk of inherited lung cancer can be determined using established molecular criteria
161. A 50-year-old female, non-smoker patient diagnosed with NSCLC who underwent chemotherapy and radiation
therapy the previous year presented with disease progression. The patient turned out to be positive with anaplastic
lymphoma kinase translocation. Which of the following can be given to the patient?
a. Alectinib
b. Dabrafenib
c. Osimertinib
d. Erlotinib
162. A 56-year-old male presents to your clinic with abdominal CT scan showing a 3 cm contrast-enhancing right
liver lobe mass. The rest of the liver findings show homogenous echopattern with no evidence of cirrhosis. There are
no other abnormalities identified. He is non-alcoholic with the following serologic data: HBs Ag (-), AntiHBs (+),
AntiHCV (-). Your oncology consultant recommended biopsy of the liver mass. What could be the basis of this
recommendation?
a. Solitary nature of the lesion
b. Location of the liver mass
c. The absence of enlarged lymph nodes or intestinal wall thickening on CT scan
d. The absence of background cirrhosis on CT scan
163. A 62-year-old male has a long-standing history of Hepatitis B cirrhosis. He had been undergoing a screening
protocol with ultrasound and AFP every 6 months. However, a recent ultrasound reveals a 0.8 cm nodule in the left
hepatic lobe. What will you do next?
a. Repeat ultrasound in 4 months
b. Order a dynamic contrast-enhanced MRI
c. Change surveillance imaging to CT scan with IV contrast
d. Refer to an interventional radiologist for biopsy
164. A 56-year-old male has been recently diagnosed with HCC. The solitary liver mass is 2.5 cms . His Child Pugh
Score is A and ECOG PS is 0. What other information is necessary to plan out the patient’s treatment?
a. Serum bilirubin
b. Protime
c. Immunologic panel
d. Hepatitis serologic profile
165. A 70-year-old asymptomatic man has a recent PSA of 4.3 ng/mL. When evaluating the significance of this
elevated PSA in pursuing further diagnostic modalities, which of the following is considered the foremost
consideration?
a. Presence of comorbidities
b. Family history of malignancy
c. Abnormal finding on DRE
d. Estimated life expectancy
166. The diagnosis of a castrate-resistant metastatic prostate cancer is based on disease progression despite:
a. Serum testosterone not more than 50ng/mL
b. Docetaxel chemotherapy
c. Bicalutamide and Abiraterone therapy
d. Multiple lines of treatment
167. A 36-year-old man diagnosed with nasopharyngeal cancer will undergo daily radiotherapy concurrent with high
dose Cisplatin chemotherapy every 21 days. The most appropriate antiemetic regimen for this patient should include:
a. A neurokinin 1 inhibitor and dexamethasone
b. A neurokinin 1 inhibitor, dexamethasone, and antidopaminergic phenothiazine
c. A serotonin antagonist, neurokinin 1 inhibitor, and dexamethasone
d. A serotonin antagonist, dexamethasone, and antidopaminergic phenothiazine
168. A 22y/o female was diagnosed with mediastinal Hodgkin’s Lymphoma Stage II and completed 4 cycles of
ABVD regimen underwent radiotherapy. Her risk for secondary malignancy would warrant including this test as part
of her long-term surveillance.
a. Thyroid ultrasound
b. Breast MRI
c. Chest CT scan
d. Head and Neck CT scan
169. A 45-year-old male consults for advice on colorectal cancer prevention. His father was diagnosed with colorectal
CA at the age of 55. Patient is inquiring about dietary measures to prevent occurrence of colon CA. How will you
advise the patient?
a. Ketogenic diet has recently been found to prevent colorectal CA
b. It is best to minimize animal fat in diet as this has been associated with increased occurrence of colon CA
c. A diet rich in fibers have been definitely proven to decrease risk of colorectal CA
d. DASH diet also has benefit in decreasing risk for colorectal CA
170. A 40-year-old female banker is admitted for executive check-up. She is asymptomatic, with no comorbidities.
She underwent total hysterectomy for myoma 3 years ago. She is a nonsmoker and occasional alcoholic beverage
drinker. She has no personal or family history of cancer.
Which cancer screening test is recommended for her?
a. Colonoscopy
b. Mammography
c. Pap test with HPV test
d. Transvaginal ultrasound
171. Which of the following patients would require an MRI as part of breast cancer screening?
a. 30 y/o with BRCA 1 gene mutation
b. 50 y/o with previous history of breast cancer
c. 40 y/o with BMI >40
d. 60y/o with previous history of chest wall irradiation 5 years ago
172. Which of the following is associated with increased risk of breast cancer?
a. Late menarche
b. Late first full-term pregnancy
c. Early menopause
d. High fat diet
173. A 44-year-old premenopausal woman had a screening mammogram revealing an abnormality in the right breast
despite having no palpable mass on physical examination. Core needle biopsy revealed ductal carcinoma in situ.
What is the 5-year survival rate for this patient?
a. 65%
b. 82%
c. 92%
d. 99%
174. A 35-year-old female, premenopausal teacher has a 7 cm breast mass in the right upper inner quadrant. Core
needle biopsy revealed Invasive Ductal Carcinoma grade 3, ER+PR+ and HER2NEU +1. Baseline chest x-ray, bone
scan, and liver ultrasound showed no evidence of metastases. Which is an appropriate recommendation?
a. Neoadjuvant chemotherapy then MRM followed by adjuvant chemotherapy and radiotherapy, then
hormonal treatment.
b. Modified radical mastectomy (MRM), adjuvant chemotherapy with concurrent tamoxifen and
trastuzumab
c. MRM then adjuvant chemotherapy then Aromatase Inhibitor x 5 years.
d. Breast conserving surgery followed by radiotherapy and trastuzumab
175. Which of the following is not an endogenous factor favoring growth of nitrate-converting bacteria in the stomach
(as a factor in the causation of gastric carcinoma)?
a. Decreased gastric acidity
b. Prior gastric surgery (antrectomy) (15- 20-year latency period)
c. Atrophic gastritis and/or pernicious anemia
d. H. pylori infection
176. A 52-year-old male, chronic smoker is admitted due to dysphagia and dyspnea. He is cachectic with notable pale
palpebral conjunctivae. Pertinent results revealed FOBT positive and hemoglobin of 8g/dl. Neither
lymphadenopathies nor hepatomegaly are noted. What diagnostic work-up will you request next?
a. Barium swallow
b. CT scan of the abdomen
c. PET scan
d. Upper Endoscopy
177. Who among the following individuals need to undergo screening for colorectal cancer?
a. 40/M who has S.bovis endocarditis
b. 20/F, smoker of 5 pack years
c. 55/F with irritable bowel syndrome
d. 30/M, who is on a vegan diet
178. A patient underwent hemicolectomy due to mass in the descending colon associated with hematochezia. On
biopsy, the tumor was found to invade up to the muscularis propria with 2/12 lymph nodes found to have metastasis.
Further work-up of this patient did not reveal any metastases to the bone, liver, or brain. What is the stage of the
patient’s colon CA?
a. Stage I
b. Stage II
c. Stage III
d. Stage IV
179. A 55-year-old female complains of fatigue and palpitations when doing housework. On PE, she has pale
palpebral conjunctivae and palmar pallor. CBC shows microcytic, hypochromic anemia with increased red cell width.
She denies any overt bleeding or changes in bowel habits. Family history reveals some 1st and second-degree relatives
were diagnosed with different solid malignancies. Other than tests to confirm iron-deficiency as a cause of anemia,
which of the following should be your next step in the evaluation of this patient?
a. Whole abdomen CT scan with triple phase contrast
b. Fecal occult blood
c. Colonoscopy
d. Flexible proctosigmoidoscopy
180. After undergoing colonoscopy due to a positive FOBT, a 35/M was diagnosed with polyposis coli. Surgery was
strongly recommended; however, he was still hesitant due to cost and substantial morbidity. In the meantime, what
medication can we give as a temporizing strategy that may decrease polyp number and size?
a. Dexamethasone
b. Celecoxib
c. Rifaximin
d. Psyllium

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1.

For questions 2-3, refer to the case below:

2. What will be the next best step?

3. What is the cutoff for significant bacteriuria for this patient?

For questions 6-7, refer to the case below:

6. How will you confirm your diagnosis?

For questions 19-21, refer to the case below:

19. How will you confirm the diagnosis?

20. What is the treatment of choice for this patient?

22. What is the likely organism involved?

23. What is the recommended treatment if her illness remains to be uncomplicated?

29. Most likely diagnosis is:

35. Which of the following is an expected finding?

For questions 38-39, refer to the case below:

38. Which of the following is TRUE of his case?

41. Which spectrum of leprosy is she presenting?

42. What is the WHO recommended treatment regimen for her?

For questions 44-45, refer to the case below:

Initial laboratory work-up showed:

Her condition can be explained by which mechanism?

Vital signs were as follows:

Initial laboratory work-up showed:

Appropriate management of this case includes:

His initial laboratory work-up showed:

What should you do next?

Based on the above findings, which is the most likely diagnosis?

Vital Signs: BP= 140/90, HR=108, RR=20 Temperature=36.8C

What should be the next step in managing this case?

Vital Signs: BP= 120/70, HR=90, RR=16 Temperature=36.5C

What should be the next step in managing this case?

93. The clinical hallmark of acne vulgaris is the:

95. What is true about the causative agent of this condition?

143. What is the central mechanism of DIC?

156. Individuals with blood type O have:

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