Beruflich Dokumente
Kultur Dokumente
ST
1
LONG
EXAMINATIONS
1.
Mr.
Roxas,
a
65-year
old
diabetic,
noted
pus
oozing
from
a
wound
on
his
pedicured
big
toe.
After
2
days
he
was
noted
to
have
temperature
of
39C.
Despite
antibiotics
he
remained
rd
highly
febrile.
On
the
3
day
of
fever
he
was
brought
to
the
ER
because
of
lethargy.
BP
was
70
systolic,
HR
of
130/min
and
RR
of
34/min.
What
cytokine
is
responsible
for
the
manifestations?
A. Tumor
necrosis
factor
B. Interleukin-2
C. Interleukin-4
D. GM-CSF
TNF
is
resonsible
for
the
inflammatory
response
to
infection
up
to
the
point
of
symptoms
of
septic
shock.
IL-2,
a
T
cell
cytokine
signals
other
lymphocytes
to
initiate
an
immune
response.
IL-4,
a
Th2
cytokine,
signals
B
cells
to
produce
antibodies
also
for
proliferation
of
mast
cells.
GM-CSF
tells
granulocytes
and
macrophages
to
proliferate.
2.
Ms.
Sanchez,
25
years
old,
has
been
experiencing
daily
bouts
of
sneezing
and
excessive
rhinorrhea
since
she
was
9
years
old.
Likewise
she
has
sneezing
and
nasal
itching
whenever
she
sweeps
the
floor.
What
is
one
cytokine
that
is
responsible
for
the
development
of
the
condition
described?
A. Interleukin-1
B. Interleukin-4*
C. Interferon-gamma
D. TGF-beta
IL-4
(B)
is
a
product
of
T
helper
ceIls
that
signals
B
cells
to
produce
especially
IgE
antibodies
is
response
to
allergen
exposure;
also
signals
for
proliferation
of
mast
cells.
IL-1
is
a
macrophage
cytokine
that
tells
Th
cells
to
initiate
an
immune
response.
IFN-
Th1
cytokine
that
helps
mediate
cell-mediated
immunity.
TGF-
usually
downregulates
YH1
or
Th2
immune
responses.
3.
A
virus
encountered
by
T/B
cells
results
in
an
immune
response
that
rids
the
agent
within
5-7
days.
After
2
weeks
the
same
virus
is
re-encountered.
The
host
does
not
manifest
symptoms
of
the
disease.
This
property
of
the
adaptive
immune
response
is:
A. Memory
*
B. Specificity
C. Diversity
D. Synergy
(A)
Memory
-
non-infection
during
the
2nd
encounter
is
because
of
the
anamnestic
response
triggered
by
the
memory
cells.
4.
Adhesion
molecules
are
necessary
for
the
following
step
involved
in
the
immune
response:
A. MHC-antigen
interaction
with
TCR
B. C3
attaching
to
cell
targeted
for
destruction
C. Phagocytosis
of
microorganisms
D. Entrance
of
inflammatory
cells
into
affected
tissue
*
(D)
adhesion
molecules
attract
and
mediates
adhesion
of
inflammatory
cells
onto
the
vascular
wall
and
the
entrance
between
cell
junctions
into
the
site
that
needs
help
to
fight
of
pathogens.
Others
-
no
connection
to
adhesion
molecules.
10.
Aside
from
male-male
sex,
another
mode
of
transmission
is
showing
an
increasing
trend:
A. Heterosexual
sex
B. Mother
to
Child
C. Needle
prick
D. Intravenous
drug
use
*
Self
explanatory
11.
You
are
formulating
a
new
antiretroviral
drug
that
will
prevent
viral
RNA
from
insinuating
itself
onto
the
host
DNA.
Your
target
molecule/enzyme
is:
A. Chemokine
receptor
acting
as
coreceptor
for
the
HIV
B. Reverse
transcriptase
C. Integrase
*
D. Protease
(C)
Target
integrase
to
prevent
viral
DNA
becoming
integrated
into
host
DNA.
The
rest
act
on
other
stages
of
the
life
cycle/
enzymes
of
the
virus.
12.
Mr.
Feliciano
experienced
fever,
fatigue,
myalgia,
and
headaches
for
a
week.
Two
weeks
after
the
illness,
he
is
worried
that
he
may
be
contracting
HIV
infection
because
he
had
unprotected
sex
with
a
casual
male
acquaintance.
You
recommend
the
following
examination
to
confirm
or
reassure
him:
A. HIV
ELISA
B. HIV
ELISA
then
Western
Blot
if
positive
C. HIV
DNA
PCR
*
D. Phenotyping
of
HIV
At
2
weeks
after
assumed
exposure,
the
anti-HIV
immune
response
has
not
occurred,
therefore
no
antibodes
will
be
detected
yet.
The
virus
itself
or
its
components,
however
will
be
detectable
(C).
Phenotyping
measures
inhibitory
action
of
anti-HIV
drugs
on
the
isolated
HIV
strain.
13.
Granuloma
formation
in
response
to
mycobacteria
is
an
example
of:
A. Type
I
hypersensitivity
B. Type
II
hypersensitivity
C. Type
III
hypersensitivity
D. Type
IV
hypersensitivity*
Granuloma
formation
around
the
tuberculosis
pathogen
is
cell
mediated
-
Type
IV
reaction
(D).
14.
A
43
year
old
male
consulted
for
hematuria,
edema
and
was
found
to
be
hypertensive
several
months
PTC.
Anti-hypertensives
were
given
and
he
was
lost
to
follow
up
until
he
began
developing
shortness
of
breath
then
a
few
hours
ago,
hemoptysis.
Immunoglobulins
were
identified
lining
basement
membranes
of
the
lungs
and
kidneys.
This
disease
is
an
example
of:
A. Type
I
hypersensitivity
B. Type
II
hypersensitivity
*
C. Type
III
hypersensitivity
D. Type
IV
hypersensitivity
The
disease
described
is
Goodpasture's
Syndrome
with
Igs
attacking
thecells
of
the
basement
membrane
in
the
lungs
and
glomeruli
-
Type
II
reaction.
15.
Mature
T
lymphocytes
that
emerge
from
the
thymus
have
survived
because:
A. They
have
no
affinity
for
self
antigens
*
B. They
have
no
affinity
for
self-MHC
C. They
have
escaped
cytotoxic
action
of
natural
killer
cells
D. They
have
non-functional
CD28
T
cells
that
have
undergone
positive
and
negative
selection
(A)
are
allowed
to
mature.
The
others
are
not
actual
events.
16.
This
autoimmune
disease
results
in
the
hyperactivity
of
the
affected
organs
physiologic
function:
A. Hashimotos
disease
B. Myasthenia
gravis
C. Type
I
diabetes
mellitus
D. Graves
disease*
All
except
Graves'
disease
(D)
result
in
hypofunctioning
organs.
17.
A
35-year
old
male
began
experiencing
easy
bruisability
with
hematomas
appearing
over
the
thighs
and
medial
surface
of
the
upper
extremities.
A
blood
exam
shows
a
hemoglobin
of
140,
hematocrit
of
40,
WBC
10
with
65%
neutrophils,
35%
lymphocytes
and
platelet
count
of
24,000.
You
suspect
this
autoimmune
disease:
A. Hemolytic
anemia
B. Idiopathic
thrombocytopenia*
C. Acute
myelogenous
leukemia
D. Aplastic
anemia
(B)
ITP
is
a
result
of
autoantibodies
against
platelets,
not
rbcs
(A).
The
others
are
not
autoimmune
diseases.
18.
A
49-year
old
female
has
been
experiencing
extreme
driness
of
the
eyes
and
mouth
as
well
as
swelling
of
the
parotid
glands
for
the
past
4
months.
There
were
no
signs
of
arthritis
nor
renal
involvement.
ANA
test
showed
increased
levels
of
the
autoantibody
SSa.
Your
diagnosis
is:
A. Systemic
lupus
erythematosus
B. Dermatomyositis
C. Scleroderma
D. Sjogrens
syndrome
*
(D)
is
the
disease
described.
SLE
-
multisystemic
with
arthritis
and
nephritis.
Dermatomyositis
has
a
rash
and
proximal
muscle
weakness.
Scleroderma
is
waxy
appearance
of
face
among
others.
19.
In
atopic
individuals,
B
lymphocytes
receives
signals
from
Th2
cells
to
produce
an
excessive
amount
of:
A. IgG
B. IgA
C. IgM
D. IgE
*
IgE
is
the
Ig
involved
in
atopy
(D),
not
the
others.
20.
The
following
statement
about
IgE-mediated
reactions
is
true:
A. An
allergen
is
capable
of
causing
mast
cell
degranulation
on
first
exposure
B.
C.
This
patient
has
the
typical
history
and
physical
examination
indicative
of
scabies.
30.
You
should
advise
the
patient
that
the
etiologic
agent
A. is
a
louse
that
causes
human
infestation
B. are
typically
present
in
thousands
in
infected
individuals
C. can
be
transmitted
by
fomites*
D. causes
a
characteristic
itching
both
day
and
night
Scabies
is
caused
by
a
mite.
It
is
only
present
in
thousands
in
immunocompromised
individuals.
Nocturnal
pruritus
is
characteristic.
31.
Upon
physical
examination
which
of
the
following
lesions
would
be
characteristic
of
the
disease?
A. nodule
B. burrow*
C. crust
D. ulcer
Burrows
are
the
characteristic
lesions
of
patients
with
scabies.
32.
The
patient
wants
to
be
further
educated
regarding
her
condition.
You
can
advise
that
A. sexual
transmission
of
the
disease
is
a
very
rare
occurrence
B. it
is
more
common
in
the
elderly
than
in
young
children
and
adults
C. males
are
more
commonly
affected
than
females
D. overcrowding
has
been
associated
with
this
condition*
The
disease
is
sexually
transmissible.
Its
occurrence
is
seen
both
in
young
children,
adults,
and
the
elderly.
Both
males
and
females
are
equally
affected.
Overcrowding
is
associated
with
this
condition.
33.
A
21-year
old
known
asthmatic
male
is
brought
to
the
emergency
room
because
of
dyspnea
and
generalized
appearance
of
wheals
of
30
minutes
duration.
History
revealed
that
he
took
Penicillin
V
tablets
for
sore
throat
as
recommended
by
a
classmate.
What
is
your
diagnosis?
A. Rubeola
B. Acute
Urticaria*
C. Erythema
Multiforme
Minor
D. Erythema
Multiforme
Major
34.
A
26-year
old
female
presents
with
erythematous
macules
and
patches
on
the
trunk
and
extremities
of
three
days
duration.
These
were
associated
with
fever,
painful
lips
and
eye
discharge.
The
patient
volunteered
that
she
self-medicated
with
cotrimoxazole
one
week
ago
because
of
dysuria
and
urinary
frequency.
The
resident
who
saw
the
patient
is
suspecting
Steven-Johnsons
Syndrome.
What
lesion
is
pathognomonic
for
this
condition?
A. vesicle
B. target*
C. wheal
D. purpura
35.
A
50-year
old
female
complains
of
yellowish
plaques
on
both
inner
upper
eyelids
of
2
years
duration.
What
is
the
underlying
genetic
defect?
A. Familial
hypertriglyceridemia
B.
C.
D.
Familial
hypercholesterolemia
Alpha-1
apolipoprotein
deficiency
Familial
lipoprotein
lipase
deficiency*
36.
An
85-year
old
female
is
diagnosed
with
Acrodermatitis
enteropathica.
Which
of
the
following
medications
will
lead
to
dramatic
improvement
of
her
skin
condition?
A. zinc
sulfate*
B. ascorbic
acid
C. copper
sulfate
D. beta-carotene
37.
A
35-year
old
male
diagnosed
with
ulcerative
colitis
is
referred
by
his
gastroenterologist
because
of
sudden
appearance
of
large,
extremely
painful
ulcers
and
boils
on
the
lower
extremities.
What
is
your
dermatologic
impression?
A. Decubitus
Ulcer
B. Multiple
Furuncolosis
C. Ecthyma
Gangrenosum
D. Pyoderma
Gangrenosum*
38.
A
5-year
old
male
is
brought
to
the
Dermatology
OPD
clinic
because
of
dry
skin,
brittle
hair
and
edema
of
the
abdomen.
What
is
your
diagnosis?
A. Pellagra
B. Kwashiorkor*
C. Vitamin
A
deficiency
D. Acrodermatitis
enteropathica
39.
A
63-year
old
male,
known
diabetic,
consults
because
of
shiny
yellow
plaques
on
both
shins
of
2
years
duration.
Physical
examination
revealed
telangiectasia
on
the
surface
of
the
lesions.
What
is
your
diagnosis?
A. Pyoderma
gangrenosum
B. Granuloma
annulare
C. Necrobiosis
lipoidica*
D. Stasis
dermatitis
40.
An
indigent
30
year-old
pregnant
patient
consults
you
with
physical
findings
and
history
indicative
of
scabies.
Which
scabicide
would
you
opt
to
give
her
and
her
six
other
children?
A. lindane
B. sulfur*
C. permethrin
D. crotamiton
Sulfur
is
cheap
and
effective
in
treating
9
patients,
including
this
pregnant
patient.
Lindane
is
not
safe
for
the
patient.
Permethrin
is
expensive,
considering
that
this
is
an
indigent
patient
with
6
other
children
to
be
treated.
Crotamiton
has
very
low
cure
rate.
41.
A
20-year
old
male
presents
with
skin-colored
umbilicated
papules
on
the
suprapubic
and
pubic
area.
He
claims
to
have
noted
these
lesions
a
month
ago.
Which
is
true
about
his
condition?
A. It
may
have
been
acquired
through
sexual
contact
with
another
partner.*
B. Asymptomatic
viral
shedding
is
a
feature
of
his
condition.
46.
An
infant
was
brought
in
to
your
clinic
due
to
erythematous
thin
plaques
on
her
cheeks
and
on
her
elbows.
Similar
lesions
are
seen
on
her
knees.
What
is
your
clinical
impression?
A. psoriais
vulgaris
B. seborrheic
dermatitis
C. measles
D. atopic
dermatitis*
The
predilection
sites
of
infantile
phase
of
atopic
dermatitis
are
the
face
(cheeks,
forehead)
&
extensor
surfaces
(knees
and
elbows)
47.
A
30
y/o
man
presented
with
erythematous
plaques
and
papules
in
the
shape
of
a
dragon
on
his
left
deltoid
area.
Ten
days
prior
to
consultation,
he
had
henna
tattoo
done
on
the
exact
area.
He
wondered
why
he
had
this
reaction
to
the
tattoo,
when
he
had
tattoos
done
several
times
in
the
past,
with
no
untoward
reactions.
Which
of
the
following
does
not
describe
the
condition
that
he
has?
A. The
dermatitis
will
initially
be
sharply
confined
to
site
of
contact,
later
spreading
beyond
area.
B. It
is
associated
with
intense
pruritus.
C. It
is
dependent
on
the
concentration
of
agent*
D. It
occurs
only
in
sensitized
individuals.
This
is
an
allergic
contact
dermatitis,
secondary
to
paraphenyldiamine
found
in
henna
tattoos.
ACD
is
not
dependent
on
the
concentration
of
the
agent
for
a
dermatitis
to
occur,
in
contrast
to
irritant
contact
dermatitis
wherein
it
is
dependent
on
the
concentration
of
the
acid
or
base.
In
ACD,
the
lesions
or
the
rash
develops
after
several
exposures
to
the
allergen
has
happened
(not
during
the
first
time
it
was
introduced,
ie,
not
the
first
time
the
patient
had
a
henna
tattoo).
48.
A
75
y/o
man
was
diagnosed
with
bullous
pemphigoid.
Which
of
the
following
do
you
expect
to
find
on
physical
examination?
A. Flaccid
bullae
B. Tense
bullae*
C. Positive
Nikolsky
sign
D. A
&
C
only
The
pemphigoid
group
of
diseases
present
clinically
with
tense
bullae.
Both
Asboe-Hansen
and
Nikolsky
sign
will
be
elicited
in
the
pemphigus
vulgaris,
and
will
be
negative
in
bullous
pemphigoid.
49.
A
35
woman
was
referred
to
the
Dermatology
service
due
to
well-defined
areas
of
eroded
skin
on
the
chest
and
back,
affecting
about
5%
of
the
total
body
surface
area.
She
also
had
erosions
on
her
oral
mucosa
and
genitalia.
The
cutaneous
lesions
started
to
appear
th
on
her
5
day
on
antibiotic
therapy
(co-trimoxazole)
given
for
urinary
tract
infection.
What
is
your
diagnosis?
A. Steven
Johnson
syndrome*
B. Erythema
multiforme
C. Toxic
epidermal
necrolysis
D. None
of
the
above
In
SJS
the
affected
area
is
less
than
10%,
in
Stevens-Johnson
syndrome-Toxic
epidermal
necrolysis
overlap,
epidermal
detachment
is
10-30%
while
in
Toxic
epidermal
necrolysis
it
is
>30%.
50.
A
50
y/o
American
man
came
in
due
to
a
large
ulcer
with
a
rolled
border
filled
with
black
necrotic
debris
on
his
right
nasolabial
fold.
Histopathologic
findings
were
consistent
with
basal
cell
carcinoma
(BCC).
Which
of
the
following
statements
is/are
true
of
BCC?
A. It
is
the
most
common
skin
cancer
B. >90%
occur
on
the
face
C. Rarely
occurs
in
dark-skinned
individuals
D. All
of
the
statements
are
true*
Basal
cell
carcinoma
is
the
most
common
type
of
skin
cancer.
It
is
locally
invasive
but
with
limited
capacity
to
metastasize.
More
than
90%
occur
on
the
face.
It
is
more
common
in
Caucasians
or
those
with
Fitzpatrick
skin
types
1
&
2.
For
questions
51-53,
refer
to
the
following
case:
A
41
y.o.
laundry
woman
presents
with
5-10
mm
lesions
with
overlying
honey
colored
crust
on
her
lower
legs
of
about
1
week
duration,
with
increasing
number
of
lesions.
51.
Primary
diagnosis
would
be:
A. Hansens
disease
B. Scabies
C. Impetigo*
D. Herpes
zoster
Lesions
are
descriptive
of
impetigo.
Frequent
exposure
to
water
may
compromise
barrier
function
of
skin
52.
What
would
be
a
simple
laboratory
procedure
to
help
confirm
the
diagnosis:
A. KOH
stain
B. Tzanck
smear
C. AFB
stain
D. Gm
stain*
Gm
stain
is
a
simple
procedure
that
will
help
determine
presence
of
Gm
+
bacteria
53.
What
would
be
the
findings
in
the
test:
A. Multinucleated
giant
cells
B. Gm
(+)
cocci
in
clusters*
C. hyphae
D. Gm
(-)
bacilli
Most
probable
finding
would
be
Gm+
cocci
in
clusters
(S
aureus)
or
Gm+
in
chain
(Strep)
(not
included
in
choice)
54.
A
40
y.o.
female,
obese,
consults
for
fluctuant,
erythematous,
tender
mass
(about
10
mm)
on
her
groin.
The
most
probable
diagnosis
is:
A. Erythrasma
B. Tinea
Cruris
C. Folliculitis
D. Furuncle*
Obesity
and
site
predisposed
to
friction
and
clinical
description
supports
probable
diagnosis
of
furuncle
For
questions
55-56,
refer
to
the
following
case:
A
24
y.o.
male
consults
for
very
itchy
papules
and
vesicles
on
ball
of
plantar
area
of
L
foot,
with
involvement
of
2nd
and
3rd
digital
webs
which
are
also
slightly
macerated.
The
lesions
are
of
4weeks
duration
and
slowly
increasing
in
area
of
involvement.
55.
The
most
probable
etiologic
agent
involved
is:
A. Candidia
albicans
B. Trichophyton
rubrum*
C. Corynebacterium
mi
nitissumum
D. Pityrosporum
ovale
Clinical
description
suggests
Tinea
pedis
especially
involvement
of
interdigital
webs.
Trichophyton
rubrum
is
one
of
the
more
common
dermatophytes
involved
56.
Recommended
treatment
would
be:
A. Griseofulvin
B. Azoles*
C. Erythromycin
D. Selenium
sulfide
Azoles
are
effective
for
dermatophytes.
Griseofulvin
,
erythromycin,
Selenium
sulfide
and
are
not.
57.
Discrete
flaccid
bullae
with
some
lesions
having
crusting
on
the
surface
are
noted
on
lower
legs,
bilateral
of
a
22
yo
female.
She
also
has
some
inguinal
lymphadenopathy
and
low
grade
fever.
The
most
probable
diagnosis
is:
A. Epidermolysis
bullosa
B. Herpes
zoster
C. pemphigus
D. Bullous
impetigo*
Clinical
description
is
suggestive
of
infectious
nature
of
disease
and
bilaterality
excludes
Herpes
Zoster;
Bullous
Impetigo
is
most
probable
diagnosis.
58.
Testicular
pain
or
tenderness
is
one
of
the
criteria
in:
A. Polyarteritis
Nodosa
*
B. Hypersensitivity
vasculitis
C. Wegeners
Granulomatosis
D. Kawasaki
Arteritis
59.
Mrs.
Delos
Reyes,
an
over
weight
65
years
old
and
a
previous
patient
of
yours
in
the
OPD
has
been
known
to
have
mild
osteoarthritis
of
the
knees.
She
came
in
today
due
to
increasing
pain
on
her
knees
especially
when
she
stands
up
coming
from
a
prolonged
sitting
position.
She
has
gained
more
weight
in
the
last
2
months.
The
major
risk
factor
for
the
progression
of
her
knee
osteoarthritis
is:
A. her
age
B. her
weight
*
C. her
gender
D. she
has
developed
Diabetes
Age
is
the
most
potent
risk
factor
for
OA.
OA
occurs
in
>50%
of
persons
over
age
70,
and
aging
increases
joint
vulnerability,
however,
obesity
is
a
major
risk
factor
in
increasing
its
prevalence
and
obesity
is
the
cause
of
its
high
rate
of
disability.
60.
Joint
injuries,
such
as
what
happens
in
athletes
are
another
risk
factor
for
early
OA.
Malalignment
is
another
anatomic
abnormality
that
can
make
one
at
risk
for
OA.
Among
these
patients,
who
has
the
highest
risk
of
early
cartilage
loss?
A. a
patient
with
varus
deformity*
B. a
patient
with
valgus
deformity
C. a
normal
patient
D. a
patient
with
polymyositis
Varus
(bowlegged)
knees
w/
OA
are
exceedingly
high
risk
of
cartilage
loss
in
the
medial
or
inner
compartment
of
the
knee.
This
is
the
usual.
Whereas
valgus
(knock-kneed)
malalignment
predisposes
to
rapid
cartilage
loss
in
the
lateral
compartment.
Patients
with
polymyositis
have
proximal
muscle
weakness,
hence
would
have
difficulty
standing
and
would
not
be
able
to
put
weight
on
their
knees.
61.
A
57
year
old
slightly
over
weight
teacher
came
to
you
complaining
of
mechanical
pains
on
her
knees.
You
suspect
early
stage
of
knee
osteoarthritis.
PE
of
the
knees
is
unremarkable
except
for
some
crepitations.
You
requested
XRAY
of
both
knees,
upon
looking
at
the
film,
you
see
that
the
joint
spaces
are
still
intact,
however
you
already
see
the
Radiologic
Hallmark
of
OA,
which
is:
A. juxta-articular
osteopenia
B. Osteophytes
C. Bone
sclerosis*
D. Decreased
medial
compartment
Juxta-articular
osteopenia
is
the
earliest
radiographic
manifestation
of
RA.
Osteophytes
are
an
important
radiographic
hallmark
of
OA,
they
form
near
areas
of
cartilage
loss
and
start
as
outgrowths
of
new
cartilage.
Bone
sclerosis
is
seen
in
more
advanced
OA,
so
as
diminution
in
the
space
of
the
medial
compartment.
62.
Nonpharmacotheraphy
has
been
the
mainstay
in
the
management
of
OA.
If
you
were
to
provide
an
exercise
program
to
your
patient
with
knee
OA,
what
would
be
the
most
effective
exercise
regimen?
A. aerobic
and/or
resistance
training*
B. range
of
motion
exercises
C. running
D. all
of
the
above
Aerobics
will
build
endurance
and
resistance
training
focuses
on
strengthening
muscles
across
the
joint.
ROM
exercises
alone
will
not
strengthen
muscles
and
running
is
impact
loading
w/c
you
do
not
want
in
a
joint
w/
OA.
63.
You
have
a
patient
with
mild
to
moderate
OA
of
the
Hands
and
Knees.
She
would
only
have
occasional
pains
with
VAS
(Visual
Analog
Scale)
pain
score
of
4/10.
Your
initial
analgesic
of
choice
is:
A. a
COX-2
inhibitor
B. Paracetamol*
C. Ibuprofen
D. Prednisone
Acetaminophen
or
Paracetamol
is
the
initial
analgesic
of
choice
for
patients
with
OA
in
knee,
hip
or
hands.
Systemic
steroids
have
no
role
in
OA
64.
Your
42
year
old
easy
go
lucky,
bachelor
uncle
who
lives
with
you
and
your
family
awakened
you
one
night
because
he
was
in
severe
pain.
He
said
that
the
pain
and
swelling
was
so
dramatic
that
everything
just
happened
that
night,
you
saw
his
left
big
toe
very
warm,
red,
swollen
and
very
tender.
You
thought
it
was
cellulitis
and
immediately
brought
him
to
the
ER.
At
the
ER,
you
realized
that
your
first
impression
was
wrong
when
you
heard
the
Medical
Resident
asked
this
question?
A. Are
you
a
drug
addict?
B. Did
you
have
excessive
alcohol
ingestion?*
C. Do
you
have
fever?
D. Have
you
had
this
before?
This
is
obviously
gout.
And
trigger
factors
are
very
important
to
ask,
commonly
in
young
males,
it
is
alcohol/ethanol
ingestion.
Fever
is
common
in
acute
gout
and
it
doesnt
always
mean
there
is
infection.
It
is
also
important
to
ask
if
the
patient
had
a
similar
episode
already
in
the
past
because
that
would
increase
the
probability
that
this
is
really
gout.
However,
in
this
case,
the
trigger
factor
is
the
most
important
question.
This
patient
probably
had
a
drinking
spree
prior
to
the
attack.
65.
For
question
number
64,
the
Medical
residents
impression
is
gout.
He
ordered
serum
Uric
acid
level
but
turned
out
to
be
normal.
You
want
to
document
that
this
is
really
gout.
The
patients
left
first
MTP
is
still
swollen.
What
will
you
suggest?
A. Repeat
the
serum
Uric
Acid
after
2
weeks
on
your
uncles
follow-up
in
the
OPD
B. Get
an
XRAY
of
his
big
toe
C. Aspirate
the
First
MTP
and
examine
the
fluid
for
MSU
crystals*
D. Wait
for
the
next
attack,
because
if
this
is
gout
he
will
certainly
have
another
attack
Even
if
the
clinical
appearance
strongly
suggests
gout,
the
presumptive
diagnosis
ideally
should
be
confirmed
by
needle
aspiration.
Needle-shaped
MSU
crystals
are
seen
both
intracellularly
and
extracellularly.
w/
polarized
light,
these
crystals
are
brightly
birefringent
w/
negative
elongation.
Serum
Uric
acid
levels
are
not
diagnostic
of
gout.
66.
L.T.,
a
21
year
old
female,
now
diagnosed
to
have
SLE,
was
just
in
Boracay
last
April
for
her
summer
vacation
with
her
friends.
Among
the
pathogenesis
of
SLE,
which
do
you
think
was
triggered
by
her
vacation
in
Boracay?
A. genes
B. abnormal
immune
response*
C. autoantibodies
and
immune
complexes
D. Inflammation
This
patients
vacation
in
Boracay
exposed
her
to
sunlight
for
quite
a
long
period
of
time.
Exposure
to
UV
light
causes
flares
of
SLE
in
approximately
70%
of
patients,
possibly
by
increasing
apoptosis
in
skin
cells
or
by
altering
DNA
and
intracellular
proteins
to
make
them
antigenic.
Because
this
patient
is
genetically
predisposed,
that
abnormal
response
to
the
UV
light
made
her
produce
autoantibodies
and
immune
complexes
and
the
subsequent
inflammation
in
SLE.
67.
A
30
year
old
female
with
SLE
comes
to
you
with
her
urinalysis
result
that
showed:
Sp
gravity
1.002,
(+++)
proteins,
(-)
sugar,
RBC
30-40,
WBC
25-30,
(++)
RBC
casts,
(++)
hyaline,
coarse
and
granular
casts.
You
know
there
is
definite
nephritis,
what
will
be
the
next
most
valuable
examination
that
you
will
perform
to
confirm
nephritis?
A. kidney
Biopsy*
B. Renal
Ultrasound
C. RBC
morphology
D. 24
hour
urine
collection
to
measure
the
patients
total
protein
excretion
Nephritis
is
already
evident
with
presence
of
+++
proteinuria
and
casts,
we
dont
need
ultrasound,
rbc
morphology
anymore.
We
do
24
hour
urine
for
protein
measurement
if
the
proteinuria
in
the
urinalysis
is
not
very
conclusive.
At
this
stage
we
should
determine
the
classification
of
her
nephritis,
this
will
help
us
in
the
choice
of
treatment
and
prognosis
of
the
patient.
68.
The
earliest
lesions
in
rheumatoid
arthritis
is:
A. Pannus
formation
B. Sequestration
and
destruction
of
Ig-coated
circulating
cells
C. Microvascular
injury
and
an
increase
in
the
number
of
synovial
lining
cells
*
D. Bone
erosions
69.
A
22
year
old
female
presents
with
a
facial
rash
on
the
malar
area
sparing
the
naso
labial
fold.
She
also
has
arthritis
of
the
hand
joints
and
hair
loss
of
3
months
duration.
Her
laboratory
work
ups
revealed
a
urinalysis
with
+++
protein,
CBC
with
hemoglobin
of
90.
Other
indications
of
disease
activity
of
her
SLE
may
be:
A. high
C3
B. low
C3*
C. thrombocytosis
D. Lymphocytosis
In
active
SLE,
we
usually
encounter
decrease
levels
of
blood
elements
such
as
thrombocytopenia,
lymphopenia,
anemia
and
leukopenia.
Complement
levels
are
low
especially
in
cases
with
nephritis,
hence
you
expect
C3
to
be
low.
70.
An
18
year
old
female
college
student
was
brought
to
the
ER
after
a
grand
mal
seizure.
She
was
diagnosed
to
have
SLE
2
years
ago.
At
that
time,
she
presented
with
arthralgia,
fatigue,
alopecia,
a
butterfly
rash,
and
a
positive
ANA
(titer
1:640).
She
was
started
on
Hydroxychloroquine
200mg
twice
a
day
and
was
given
steroid
creams
for
her
facial
rash.
She
seemed
to
respond
well
to
treatment.
2
months
ago,
she
developed
tender
black
spots
on
the
skin
at
the
base
of
her
fingernails.
Her
facial
rah
worsened,
and
more
hair
had
fallen
out.
She
began
to
have
episodes
of
throbbing
frontal
headache,
and
on
the
day
of
admission,
she
suffered
a
generalized
tonic-clonic
seizure
during
a
lecture
at
school
and
was
brought
to
the
ER.
Remembering
the
criteria
for
SLE,
her
manifestation
now
is:
A. idiopathic
epilepsy
B. CNS
infection
C. Intracerebral
thrombosis
D. CNS
lupus
*
Neurologic
manifestations
of
SLE
may
vary
from
just
a
simple
headache
to
a
frank
seizure.
This
is
CNS
manifestation
of
lupus
71.
A
40
year
old
patient
with
SLE
for
10
years
has
received
cyclophosphamide
and
rituximab
for
her
lupus
nephritis
class
IV
in
the
last
4
years.
This
patient
was
rushed
to
the
ER
due
to
difficulty
of
breathing.
On
auscultation,
there
were
coarse
and
wet
crackles
all
over
the
chest
wall.
Immediate
intubation
was
done
due
to
impending
respiratory
arrest.
Pulmonary
edema
and
possible
pulmonary
hemorrhage
was
the
initial
reading
of
the
Chest
Xray.
You
know
that
this
is
a
life-threatening
condition
in
SLE.
What
must
be
given
to
this
patient?
A. pulse
Methylprednisolone*
B. blood
transfusion
C. pulse
Cyclophosphamide
D. IVIG
For
life-threatening
conditions
in
SLE
due
to
disease
activity,
we
give
pulse
methylprednisolone.
This
is
given
at
a
dose
of
1
gm
OD
for
3
days
in
the
hope
of
arresting
the
disease
activity.
72.
In
osteoarthritis,
nodes
in
the
distal
interphalangeal
joints
are
called:
A. Heberdens
nodes
*
B. Bouchards
nodes
C. Oslers
nodes
D. Erythema
nodosum
73.
A
32
year
old
mother
presented
with
an
8
week
history
of
pain
and
swelling
of
the
small
joints
of
her
hands,
followed
additively
by
swelling
of
her
knees,
shoulders,
and
ankles.
She
was
experiencing
4
hours
of
morning
stiffness
and
fatigue
during
the
day.
She
recalled
experiencing
a
mild
sorethroat,
low-grade
fever,
and
myalgias
during
the
start
of
her
symptoms.
Pertinent
physical
examinations
are:
tenderness
on
both
shoulders,
MCPs,
PIPs,
knees
and
ankles.
Swelling
is
noted
on
the
MCPs,
PIPs,
knees
and
ankles.
What
will
be
of
use
for
you
to
document
your
diagnosis?
A. ANA
B. ASO
titer
and
ECG
C. ESR
and
anti-CCP*
D. Xray
of
the
joints
The
diagnosis
here
is
Rheumatoid
arthritis,
therefore
increase
ESR
and
positive
anti-CCP
will
be
of
benefit
for
us
to
document
the
diagnosis.
These
2
are
part
of
the
criteria/scoring
system
for
RA
74.
A
58
year
old
female
presented
to
you
with
a
history
of
left
knee
pain
and
swelling
of
6
weeks
duration.
This
was
followed
about
a
week
later
by
pain
and
swelling
of
3
of
her
MCPs
and
3
PIPs
on
both
of
her
hands.
You
are
thinking
of
RA
but
is
uncertain,
hence,
you
requested
for
a
CBC,
ESR,
Rheumatoid
Factor
(RF),
and
anti-CCP.
CBC
turned
out
to
be
normal,
RF
was
negative,
but
the
ESR
was
70mm,
and
the
anti-CCP
was
3x
the
upper
limit
of
normal.
What
is
your
score
now
based
on
the
new
classification
criteria
for
RA?
A. 5
B. 8
C. 10*
D. 12
Knee=1;
3MCPs=2;
3PIPs=2;
6
wks
duration=1;
elevated
ESR=1;
high
positive
anti-CCP=3
total
score:
10;
A
score
of
6
or
more
is
needed
for
a
diagnosis
of
definite
RA
75.
A
45
year
old
patient
with
RA,
considered
Methotrexate-nave
who
has
now
sustained
multiple
joint
deformities.
Her
DAS-28
score
is
still
high.
You
worked
up
the
patient
for
possible
initiation
of
Biologic
treatment.
Her
HBsAg
was
+,
her
XCR
showed
old
PTB
scar.
The
patient
could
not
tolerate
NSAIDS
due
to
epigastric
discomfort.
What
do
you
think
will
be
the
best
combination
treatment
for
this
patient?
A. high
dose
Prednisone,
Hydroxychloroquine,
and
Etanercept
B. low
dose
Prednisone,
Hydroxychloroquine,
and
Rituximab
C. low
dose
Prednisone,
Hydroxychloroquine,
and
Tocilizumab*
who
initially
present
w/
polymyalgia
rheumatica
may
later
go
on
to
develop
giant
cell
arteritis.
Temporal
arteritis
is
another
name
for
giant
cell
arteritis.
Takayasu
arteritis
is
another
type
of
large
vessel
vasculitis,
its
also
called
the
pulseless
disease.
80.
A
23
year
old
male
was
admitted
in
the
ward
due
to
palpable
purpura
on
his
lower
extremities.
Your
differential
diagnoses
are
Hypersensitivity
Vasculitis,
Henoch-Schonlein
Purpura,
and
Churge-Strauss
Syndrome
because
all
of
these
are
small
vessel
vasculitis
and
may
present
as
palpable
purpura
on
the
lower
extremities.
For
small
vessel
vasculitis,
common
histopathological
finding
on
skin
biopsy
is:
A. fibrinoid
necrosis
B. aneurysm
formation
C. leucocytoclasis*
D. Thrombosis
Leucocytoclasis,
a
term
that
refers
to
the
nuclear
debris
remaining
from
the
neutrophilsthat
have
infiltrated
in
and
around
the
vessels
during
the
acute
stages.
This
is
typical
feature
of
cutaneous
vasculitis
of
small
vessels.
81.
A
30
year
old
male
is
being
seen
by
a
Rheumatologist
due
to
an
axial
arthritis.
His
history
started
as
a
dull
pain,
insidious
in
onset,
felt
deep
in
his
lumbar
and
gluteal
area,
accompanied
by
low-back
morning
stiffness
that
improves
with
activity.
The
hallmark
in
this
patient
is:
A. muscular
spasm
B. sacroilitis*
C. syndesmophyte
D. bamboo
spine
This
patient
has
Ankylosing
spondylitis.
Sacroilitis
is
usually
the
earliest
manifestation,
and
this
is
the
explanation
for
the
initial
low
back
pain
and
stiffness.
The
muscular
spasm
may
be
just
secondary,
syndesmophytes
are
the
bony
excrescences
that
are
formed
when
the
outer
annular
fibers
are
already
eroded,
then
youll
see
bamboo
spine
because
the
spine
has
already
ankylosed.
82.
A
25-year-old
graduate
student
presents
with
a
10-day
history
of
arthritis.
She
developed
a
fever
of
39
degrees
Celcius
with
chills,
followed
by
pain
and
swelling
in
the
2nd
and
3rd
MCP
and
PIP
joints
of
her
left
hand
and
the
2nd,
3rd,
and
4th
MCP
joints
of
her
right
hand,
which
lasted
3
days.
As
the
small
joint
swelling
disappeared,
her
left
wrist
became
slightly
red,
warm,
swollen,
and
very
painful
to
flex
or
extend
for
2
to
3
days.
As
the
wrist
became
normal,
her
left
knee
became
red,
swollen,
tender,
and
warm,
and
has
remained
so
now
for
4
days.
She
has
a
mild
sore
throat
and
has
also
noticed
small
skin
lesions
on
her
arms.
Which
characterization
best
describes
the
presentation
and
evolution
of
this
patients
illness?
A.
Chronic
Polyarthritis
B.
Acute
migratory
Polyarthritis
*
C.
Acute
Intermittent
Monoarthritis
D.
Nonarticular
Pain
Syndrome
83.
A
32-year-old
mother
presented
with
an
8
week
history
of
pain
and
swelling
of
the
small
joints
of
her
hands,
followed
additively
by
similar
involvement
of
her
knees,
shoulders,
and
ankles.
She
was
experiencing
2
hours
of
morning
stiffness
and
fatigue
during
the
day.
She
recalled
experiencing
a
mild
sore
throat,
moderate-grade
fever,
and
myalgias
a
week
before.
Pertinent
physical
examinations
are:
tenderness
on
both
shoulders,
MCPs,
PIPs,
knees
and
ankles.
Swelling
is
noted
on
the
MCPs,
PIPs,
knees
and
ankles.
Most
likely
diagnosis
is:
A. Rheumatic
fever
B. Rheumatoid
Arthritis
*
C. Reactive
Arthritis
D. Viral
Arthritis
84.
Which
of
the
following
is
most
specific
for
the
diagnosis
of
gout?
A. elevated
serum
uric
acid
B. monosodium
urate
crystals
in
the
synovial
aspirate
*
C. calcium
dihydrophosphate
crystals
in
the
synovial
aspirate
D. radioluscent
bone
erosions
on
the
sites
of
tophi
85.
A
30
year
old
female
diagnosed
with
SLE
came
to
you
for
follow-up.
You
diagnosed
her
with
nephritis
based
on
her
urinalysis
which
showed:
+++
proteins,
5-10
RBC,
and
RBC
casts.
To
monitor
the
activity
of
the
nephritis,
the
marker
antigen
that
you
will
use
is:
A. Anti-histone
B. Anti-Sm
C. Anti-DsDNA
*
D. ANA
86.
As
a
measure
of
toxicity,
the
LD50
of
a
substance
is
defined
as:
A. The
maximum
dose
at
which
50%
of
the
known
adverse
effects
are
expressed.
B. The
dose
expected
to
cause
50%
mortality
among
test
animals.*
C. The
ability
of
the
substance
to
kill
test
animals
at
50%
the
specified
dose.
D. The
probability
that
50%
of
the
maximum
recommended
dose
will
cause
death
on
a
test
animal.
87.
A
class
of
insecticide
sprays
is
being
evaluated
for
its
safety
for
use
in
homes.
However
toxicity
of
inhaled
microscopic
droplets
to
humans
becomes
an
issue
for
all
of
them.
Which
of
the
ff.
statements
is
true?
A. The
one
with
the
highest
LC50
is
the
least
potent,
but
safest
to
humans.*
B. The
one
with
the
highest
LC50
is
the
most
toxic
to
both
insects
and
humans.
C. The
one
with
the
lowest
LC50
is
the
least
potent
insecticide
but
safest
for
humans.
D. The
one
with
the
lowest
LC50
is
the
most
toxic
to
insects
but
safest
for
humans.
88.
Miosis
is
an
expected
finding
among
patients
with
toxic
exposures
to:
A. Amphetamines
B. Beta
blockers*
C. Ethanol
D. carbamate
89.
In
which
of
the
following
poisoning
by
ingestion
is
gastric
lavage
CONTRAINDICATED?
A. Paracetamol
overdose
B. Malathion
ingestion
C. NaOH
(lye)
ingestion*
D. Isoniazid
overdose
90.
The
resulting
phocomelia
from
intake
of
thalidomide
during
the
1st
trimester
of
pregnancy
is
the
result
of
the
expression
of
the
toxic
effect
of
the
drug
as
a:
A. Mutagen
B. Teratogen*
C. Carcinogen
D. Cytotoxin
91.
A
5
year
old
kid
ingested
kerosene
contained
in
a
bottle
of
Seven-up
which
he
mistook
for
the
soda
drink.
He
promptly
vomited
and
the
frantic
mother
brought
him
to
your
attention.
You
should:
A. Do
a
chest
x-ray
to
check
for
chemical
pneumonitis.*
B. Insert
an
NGT
and
do
gastric
lavage.
C. Give
activated
charcoal
to
get
rid
of
the
remaining
kerosene
ingested.
D. Give
the
child
a
cathartic
to
hasten
elimination
of
the
ingested
kerosene.
92.
This
morning
over
breakfast,
a
26
y/o
male
cousin
casually
told
you
his
migraine
headache
was
at
its
worst
the
day
before,
he
took
a
total
of
no
less
than
twenty
500
mg
tablets
of
acetaminophen
in
the
last
24
hours.
He
took
four
Mefenamic
Acid
500
mg
capsules
with
a
midazolam
(a
short
acting
benzodiazepine)
tablet
last
night
to
put
him
to
sleep.
He
claims
he
feels
fine
and
cursory
neurologic
examination
seems
normal.
Which
of
the
following
should
be
your
course
of
action
toxicology-wise?
A. Prudent
observation
should
be
enough,
he
is
asymptomatic.
B. He
should
undergo
gastric
lavage.
C. He
should
be
given
pyridoxine
as
antidote.
D. He
should
be
in
the
hospital
immediately
and
the
antidote
started.*
93.
After
discovering
that
her
husband
was
having
an
affair,
a
29
y/o
housewife
took
a
250
ml
bottle
of
muriatic
acid
and
drank
it
in
front
of
him.
The
husband
claims
she
was
able
to
take
three
gulps
before
screaming
in
pain
and
throwing
up.
She
is
now
in
your
care
at
the
ER.
Which
of
the
following
is
appropriate
for
this
patient?
A. Gastric
lavage
with
plain
water
B. Activated
charcoal
administration
C. Mg(OH)2-Al(OH)3
antacid
to
neutralize
the
ingested
acid.
D. Stabilize
patient
&
refer
the
patient
for
endoscopy.*
94.
A
36
year
old
known
drug
pusher
was
brought
to
jail
shortly
after
a
buy-bust
operation.
Three
hours
later
he
started
to
manifest
signs
of
amphetamine
toxicity.
Witnesses
claim
they
saw
the
suspect
swallow
several
plastic
packets
before
police
caught
up
with
him.
He
was
brought
to
the
hospital
for
two
reasons:
the
police
wanted
the
evidence
retrieved,
and
wanted
him
well
enough
so
he
could
pinpoint
his
source.
The
best
thing
to
do
is:
A. Obtain
gastric
aspirate
for
analysis,
start
lavage,
and
treat
the
toxicity.
B. Collect
urine
sample
for
assay,
do
whole
bowel
irrigation
and
start
treatment
of
toxicity.*
C. Extract
blood
samples
for
assay
and
start
your
treatment.
D. Collect
urine
sample
for
analysis
and
start
treating
the
toxicity.
95.
Poisoning
patients
who
go
into
protracted
episodes
of
seizures
may
go
into
rhabdomyolysis.
Expected
sequelae
in
these
patients
include:
A. Hypokalemia
with
cardiac
compromise
B.
C.
D.
96.
Patients
of
poisoning
often
have
temperature
homeostasis
problems
as
part
of
the
toxidrome.
Which
of
the
following
statements
is
true?
A. Hypothermic
patients
must
have
their
body
temperature
raised
rapidly
to
prevent
end
organ
damage.
B. Ice
baths
are
indicated
for
hyperthermic
patients.
*
C. Hypothermia
usually
persists
even
if
the
toxin
has
been
eliminated.
D. Hyperthermia
may
be
seen
in
oral
hypoglycemic
and
sedative
hypnotic
overdose.
97.
Activated
charcoal
is
sometimes
referred
to
as
the
universal
antidote
in
poisonings
by
ingestion.
This
is
because:
A. The
GIT
absorbs
it,
goes
into
enterohepatic
circulation
and
picks
up
toxins
on
its
way
out.
B. It
neutralizes
a
lot
of
toxic
substances
in
the
GIT.
C. It
is
inert
and
adsorbs
a
variety
of
poisons
in
the
GIT.*
D. It
is
a
cathartic
and
an
antidote
to
a
variety
of
poisons.
98.
Atropine
reverses
the
toxic
effects
of
anticholinesterases
like
carbamates
&
organophosphates
by:
A. Accelerating
their
urinary
excretion.
B. Competitive
inhibition
at
the
receptor
sites.*
C. Bypassing
the
physiologic
effects.
D. Forming
an
inert
complex
with
the
poison.
99.
A
depressed
post-partum
26
y/o
female
ingested
some
43
(potentially
fatal
number
of)
iron
fumarate
pills
and
was
brought
to
your
attention.
She
was
also
on
antidepressant
medications.
The
patient
claims
she
feels
fine.
Abdominal
x-ray
verified
the
presence
of
the
radio-opaque
tablets
and
has
entered
the
small
intestines.
Deferroxamine,
will
not
be
available
until
72
hours
later.
The
best
thing
to
do
is
to:
A. Induce
vomiting.
B. Insert
NGT
and
give
repeated
doses
of
activated
charcoal
slurry.
C. Wait
until
deferroxamine
is
available
D. Start
whole
bowel
irrigation*
100.
The
effect
of
a
potentially
fatal
ingested
poison
may
be
mitigated
by
forcing
the
poison
to
form
inert
complexes
with
the
antidote.
This
is
exemplified
by:
A. Administering
starch
slurry
in
Lugols
iodine
solution
ingestion.*
B. IV
ethanol
administration
in
methanol
poisoning
C. Use
of
atropine
in
carbamate
inhalation.
D. Use
of
flumazenil
in
benzodiazepine
overdose.