1

IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

IM-B Midterms 2012-2014
Cardiology

Risk factors for atherosclerosis
1. atherogenic diet- modifiable
2. male- unmodifiable
3. father with CAD- unmodifiable
4. sedentary lifestyle- modifiable
5. hypertension- modifiable
6. obesity- modifiable
*unmodifiable includes: AGE, MALE GENDER, GENETICS

Case
36y/o with chest heaviness, 15 pack year smoker and alcoholic with a family hx of DM
and CAD. His father died of massive MI at age of 45.

7. WHO criteria for the dx of MI:
a. hx of chest pain dx is based on Hx, ECG and Cardiac biomarkers/enzymes
b. hx of DM
c. LDH determination
d. 2D echo

8. At the ED, ECG should be requested within how many minutes upon the patients
arrival?
a. 60 min
b. 15 min
c. 10min
d. 45min

9. ECG shows *with ST elevation
a. NSTEMI
b. STEMI
c. Normal
d. Ischemia

10. The door to needle time (Fibrinolytic tx) is
a. 30min
b. 45min
c. 60min
d. 90min

11. The door to balloon time (PCI) is
a. 30min
b. 45min
c. 60min
d. 90min
2
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)


12. The type of atheromatous plaque that can possibly lead to STEMI is
a. Stable plaque
b. Unstable plaque
c. Both
d. None of the above

13. The following is an EKG manifestation of ischemia
a. T wave inversion- earliest ECG/EKG changes
b. ST segment depression
c. ST segment elevation
d. QT prolongation

14. The following is an advanced PE finding in myocardial ischemia
a. Friction rub
b. Pulmonary rales
c. Accentuated P2
d. Apical diastolic murmur- apical SYSTOLIC murmur if not yet advanced

15. The following is true regarding treadmill exercise test
a. Lesser false positive ST depression is > or = 2mm- dapat positive
b. Development of acute AF means positive strain test
c. Up sloping ST segment is positive unsloping or junctional ST segment changes do
not constitute a positive test
d. Increase in BP 10mmHg higher than the predicted BP is positive- wrong

16. The following is not contraindication to the use of beta blocker
a. Nightmares and bad dreams
b. AV mode dysfunction
c. Reynauds phenomenon
d. COPD
-also included: severe bradycaria, hx of depression

17. The ff is a CCB that can be used concomitant with beta blocker or digitalis
a. dihydropyridine- Dihydropyridine= Di heart, actions is on BV only
b. diltiazem- CCB with actions on both BV and Heart
c. verapamil- CCB with actions on both BV and Heart actions
d. captopril- ACEi

18. What antiplatelet acts on the cyclooxygenase activity
a. clopidogrel
b. aspirin
c. ticlopidine
d. cilostazol

19. What is the reperfusion of choice for patients with multi-vessel CAD and DM
3
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

a. Plain old balloon angiography (POBA)
b. Multiple angioplasty with multiple stenting
c. Coronary artery bypass graft surgery
d. Thrombolysis and triple antiplatelet

20. What is the leading prognostic indicator for IHD
a. Presence of left main CAD
b. State of LV function
c. Complex arrhythmia
d. Presence of DM as co-morbidity
*others included: location and severity of coronary artery narrowing, severity and
activity of myocardial ischemia

21. Which combinations are true, except
a. coronary arteries- angina pectoris
b. CNS- TIA
c. Peripheral circulation-venous insufficiency if you noticed, others pertains to
ischemia..so ito dapat aterial insufficiency not venous
d. Splanchnic circulation- mesenteric ischemia

22. Plaque features which makes them vulnerable to rupture, except
a. Thin fibrous caps
b. Relatively large lipid cores
c. High content of macrophages
d. None of the above
*others include: few smooth muscle cells, eroded endothelium

23. ATP III lipid screening starts at this age, repeated every 5 years
a. >20
b. >30
c. >40
d. >50

24. The major determinant of coronary resistance is found in
a. Large epicardial arteries (R1)
b. Prearteriolar vessels (R2)
c. Arteriolar and intrmyocardial capillary vessels (R3)
d. R2 and R3
*review anatomy!! reistance vessel= arterioles

25. The ff are true about the effects of ischemia, except
a. Failure of normal muscle contraction and then relaxation
b. Subendocardium affected more than the subepicardial region
c. Transient left ventricular failure
d. Mitral regurgitation
4
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

*A ang sagot sa pinost na ans key pero lahat nasa handout ng ischemic heart disease
except for letter B.

26. False positive stress test can be seen in the following, except
a. Pre-menopausal women with no risk factors for premature atherosclerosis
b. Patients taking cardioactive drugs- digitalis and antiarrhythmic agents
c. Those with intraventricular conduction disturbances, resting ST segment and
Twave abnormalities
d. Obstructive disease limited to the circumflex coronary artery
-also included: abnormal serum potassium levels




































5
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

SECOND PRELIM EXAM SY 2013-2014
PULMONOLOGY 3B

A= A correct; B= B correct; C= C correct; D= all correct; E= all incorrect


E 1. Berlin definition of ARDS, following are diagnostic criteria for ARDS
a. The onset is within 5 days of a known clinical insult within 1 week
b. The PCWP should be less than 18 mm Hg PCWP not included in Berlin
criteria. This is American-European Consensus criteria for ACUTE LUNG
INJURY
c. The respiratory failure can be explained by fluid overload * not fully
explained by fluid overload

Timing Within 1 week of a known clinical insult
OR new OR worsening respiratory
symptoms
Chest Imaging Bilateral opacities not fully explained by
effusions, lobar/lung collapse, or nodules
Origin of Edema Respiratory failure not fully explained by
cardiac failure or fluid overload; needs
objective assessment (eg.: 2DEcho)
Oxygenation
Mild
200 mm Hg < PaO2/FiO2 300 mm Hg
with PEEP or CPAP 5 cm H2O
Moderate 100 mm Hg < PaO2/FiO2 200 mm Hg
with PEEP 5 cm H2O
Severe PaO2/FiO2 100 mm Hg with PEEP 5 cm
H2O

B 2. Which of the following test/s for pleural fluid is/are diagnostic of ARDS
a. Pleural fluid/serum LDH ratio >0.6
b. Pleural fluid/serum albumin ratio >0.7 finding in ARDS
c. Pleural fluid/serum albumin ration <0.6 and pleural fluid/serum LDH ration >0.6
This indicates
transudate in cardiogenic edema

C 3. Which of the following is/are the recommended therapies for ARDS based on strong
evidence from randomized controlled trials?
a. Glucocorticoids indeterminate
b. Mechanical ventilation with high PEEP indeterminate
c. Mechanical ventilation with low tidal volume This is the only therapy with strong
evidence
6
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)



4- 6 REFER TO CASE IN TEST PAPER

E 4. What is the paO2/FiO2 ratio of patient?
a. 60
b. 65
c. 80

paO2= in ABG; FiO2= amt. of oxygen you give to patient
paO2/FiO2= 65/0.6= 108 should be the answer

D 5. What should be the goal for adequacy of oxygenation based on ARDS network
protocol?
a. PaO2/FiO2 >250 (??? Wala sa handout pero pwede cguro itong iderive n lng from
other values
b. PaO2 60-80 mmHG 55-80
c. SaO2 >95% 88-95%

Other goals for adequate ventilation: PEEP <= 10 cm H2O; FiO2 <= 60

D 6. Based on above patient, which of the following is/are the ventilator strategy/ies to
adequately manage the patient
a. Tidal volume of 6 ml/kg predicted body weight <=6 ml/kg
b. Maintain inspiratory plateau pressure <30 cm H2O <= 30 cm H2O
c. Maintain paO2 55-80 mmHG
Other: RR<= 35 cpm
C 7. Beneficial effects of PEEP except:
a. Increased end expiratory lung volume
b. Decreased intrapulmonary shunt
c. Increased perfusion of unventilated alveoli Decreased dapat

Other effects: Improve V/Q mismatching; Decrease intrapulmonary shunt
7
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)



B 8. The open lungmethod for ventilating ARDS patients indicate
a. High tidal volume with high PEEP above the lower inflection point
b. Low tidal volume with PEEP above the lower inflection point
c. Low tidal volume with PEEP at the upper inflection point

C 9. Complication/s of low tidal volume with ZEEP (zero PEEP) (??)
a. Volutrauma
b. Barotrauma
c. Atelectrauma

10. Which statement on pleural fluid protein physiology is correct?
a. Pleural membrane is resistant to protein movement FALSE Pleural membrane is
considered to
be leaky meaning protein and liquid may pass thru
b. Protein concentration of normal pleural fluid is low
c. Proteins are filtered across a low pressure gradient across a high pressure
gradient
c. Entry of proteins into the pleural space is at the rate of 0.5 ml/hr pleural liquid
entry not
proteins

11. Which of the following factors is operational in the reduction of lymphatic exit rate in
pulmonary congestion seen in congestive heart failure?
a. Obstruction of parietal pleural stomas
b. Inhibition of lymphatic contractility
c. Infilitration of draining parasternal lymph nodes
d. Elevation of systemic venous pressure Notice that all the other choices, hndi siya
mechanism
seen in CHF. All of the choices are mechanisms that result to pleural effusion
(that is,
decreased lymphatic exit rate)..pero ung SA CHF nga, there is elevated
venous pressure

12. What is the threshold value for serum-pleural fluid protein gradient above which a fluid
may be considered a transudate? TRICKY!!!!
a. >3.1 g/L
b. >13 g/L
c. >31 g/L Sa handout, nklgay is >3.1 g/dL.Take note of the UNIT..so if icconvert mo
siya sa g/L,
>31 g/L ung answer
d. >60 g/L

13. Which of the following is expected to have an elevated NT- proBNP level >150 pg/ml?
a. Hepatic hydrothorax
8
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

b. Congestive heart failure Never ko nabasa ung NT etc..pero based from the choices,
all the
others are exudative, ito lng ung transudate..nanghula lang ako thru
elimination
c. Empyema thoracis
d. Pulmonary embolism

14. 51 year old male with pnueumonia have massive left-sided pleural effusion. What is the
most compelling indication for tube thoracostomy after thoracentesis?
a. loculated effusion
b. pleural fluid pH less than 7.2
c. gross pus aspirated
d. pleural fluid glucose lower than 60 mg/dL
15. previously health 45 year old male in a VA sustaining multiple chest wall injuries. An
emergency thoracotomy was done to suture lung parenchymal lacerations. Effusion was
noted to be milky white and odorless. Persistenly cloudy after centrifugation
a. Chylothorax Wala pong sagot sa answer key but I think this is the answer..it is
acute (from VA trauma, emergency, milky white)
b. Pseudochylothorax
c. Empyema thoracis
d. Hemothorax

Chylothorax ; Acute disease process; Pleural surfaces not thickened; No cholesterol
crystals; Pleural fluid triglyceride >110 mg/dL

Pseudochylothorax Chronic disease process; Thickened pleural surfaces; (+) cholesterol
crystals; Pleural fluid triglyceride level not elevated

16. 52 year old male with cough of 1 year duration, minimal sputum, shortness of breath,
fibrohazed densities on both lung apices and pleural effusion. Pleural fluid protein was at
>6 g/dL. What is mechanism of effusion?
a. hypersensitivity reaction to TB protein in pleural space Remember that >5 g/dL
indicates tuberculous pleurisy.. And there are clues in the cases that this is TB (highlighted
in red)
b. direct movement of peritoneal fluid through small openings in the diaphragm into
pleural space
c. inc. amount of fluids in the lung interstitial spaces exit across the visceral pleura
d. Pleural inflammation secondary to metastatic disease

17. ???

18. Which of the following maybe associated with secondary spontaneous pneumothorax?
Secondary spontaneous pneumothorax decrease the pulmonary function of a patient with
already compromised function
a. Marfan Syndrome
9
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

b. Pulmonary Tuberculosis has already compromised pulm function
beforehandMost common cause of secondary etc..is COPD..pero pwede rin TB,
sarcoidosis, cystic fibrosis, tumor,
c. Disturbance of collateral ventilation
d. Homocysteinuria


A= A correct B= B correct C= both correct D= both incorrect

19. Superior boundary of mediastinum
a. Base of brain (obviously hindi) b. Thoracic Inlet

Borders of mediastinum- lateral- parietal pleura
Anterior-sternum
Posterior- vertebral column and paravertebral gutters
Superior- thoracic inlet
Inferior- diaphragm

20. Superior vena cava, heart, pericardium, and trachea- Middle mediastinum

21. Which of the following are located in the posterior mediastinum?
a. Lower vagus nerve posterior b. upper vagus nerve middle

22. Most valuable imaging technique for mediastinal masses- Chest CT scan
a. MRI b. CXR

23. Mediastinal regions of Heitzman?
a. Thoracic inlet b. Anterior mediastinum

- Thoracic inlet
- Anterior mediastinum
- Supra-aortic area
- Infra-aortic area
- Supra-azygos area
- Infra-azygos area
- Hila
24. Anterior mediastinal mass, Myasthenia gravis, red cell aplasia, myocarditis,
hypogammaglobulinemia
a. Neuroblastoma b. Thymoma

25. Anterior mediastinal mass, gynecomastia, elevated AFP, beta hcg
a. Germ cell tumors b. Ganglioneuroma Posterior
26. Teardrop-shaped mass in middle mediastinum
a. Pericardial cyst b. Bronchogenic cyst

10
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

SECOND PRELIMS EXAMINATION
IM B ONCOLOGY


1. True of Gompertizian tumor growth
a. The growth rate of a tumor peaks the moment it is clinically detectable the growth
rate of tumor peaks BEFORE IT IS CLINICALLY DETECTABLE
b. Tumor becomes detectable at a burden of about 10^3 cm3 and kills the patient at a
tumor burden about 1kg tumor becomes detectable at burden of 10^9 (1cm3) and can
kill at 10^12 (1kg)
c. Efforts to treat the tumor and reduce its size can result in an increase in the growth
fraction and an increase in growth rate

2. Benefits of neoadjuvant chemotherapy neoadjuvant therapy is given after an initial
diagnostic biopsy to reduce the size of tumor and clinically control undectected metastatic
disease, followed by surgical procedure to remove the residual mass. It is NOT FOR
DOWNGRADING TUMORS
a. Downgrade the tumor
b. Clinically control undetected metastatic disease
c. Both A and B

3. Surgery may be curative in the following
a. Patients with lung metastases from breast cancer may be cured by resection of the lung
lesions -- lung mets from osteosarcoma may be cured by resection of lung lesion
b. Patients with an ulcerating breast mass with bone metastases undergoes mastectomy
c. Patients with colon cancer who have fewer than five liver metastases restricted to one
lobe and no extrahepatic metastases

4. True regarding use of surgery and its systemic effect antitumor effects
a. If resection of the primary lesion takes place in the presence of metastases, acceleration
of metastatic growth may occur --d/t the removal of the source of angiogenesis
inhibitors and mass related growth regulators in the tumor
b. Removal of both breasts may prevent breast cancer spread to other organs
c. Orchiectomy in male ER (+) breast cancer can prevent recurrence

5. Surgery as palliation can be applied to the following cause/s
a. Limb-sparing surgery followed by adjuvant radiation in therapy and chemotherapy for
osteosarcoma
b. Axillary lymph dissection in breast cancer
c. Inferior vena cava filter for recurrent pulmonary emboli, insertion of central venous
catheter, control of pleural and pericardial effusions and ascites, stabilization of cancer
weakend weight bearing bones, control of hemorrhage

6. Correct about core needle biopsy
a. Usually obtains considerably less tissue, but this procedure often provides enough
information to plan a definitive surgical procedure
b. Wedge of tissue is removed and an effort is made to include the majority of the cross
sectional diameter of the tumor in the biopsy to minimize sampling error Incisional
Biopsy
c. Both A and B
11
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)


7. The following statements describes the sentinel node approach
a. Useful for all malignancies
b. The first draining lymph node a spreading tumor would encounter is defined by
injecting a dye into the tumor site at operation and then dissecting the first node to turn
blue
c. Provides reliable information regarding stage of breast cancer but risk of lymphedema
lymphangioedema is increased

8. Correct about radioactive therapy
a. Is selectivity for cancer cells may be due to defects in a cancer cells ability to repair
sublethal DNA and other damage
b. Radiation damage is dependent on oxygen, hypoxemic cells are more sensitive --
Radiation damage is dependent on oxygen, hypoxemic cells are more RESISTANT
c. Augmentation of oxygen is the basis for radiation resistance - - HYPOXEMIC CELLS
RELATIVELY RESISTANT TO RADIATION , augmenting oxygen makes it relatively
sensitive

9. Determinants of radiation dose
a. Type of malignancy
b. Type of machine
c. Total rad, time and number of fractions

10. Drugs used in cancer treatment that may also act as radiation sensitizers
a. Compounds that incorporate into DNA and alter stereochemistry
I cant read the other choices due to poor quality of picture :l

11. I cant read the question due to poor quality of picture :l
12. Development of second solid tumors in or adjacent to the radiation fields
a. Acute toxicity of radiation development of second solid malignancy is a serious LATE
toxicity of radiation
b. Development is dependent on dose of radiation received
c. Occur at a ratio of about 1 per year beginning in the second decade after treatment

A for TRUE OR B for FALSE

13. X-rays are generated by linear accelerations, gamma rays are generated from decay of
atomic nuclei in radioisotopes such as cobalt and radium
14. In treating mycosis fungoides, electron beam are used because of its high tissue penetrance
-- In treating mycosis fungoides, electron beam are used because of its LOW TISSUE
PENETRANCE
15. The maximum dose in the target volume is often the cause of complications to tissues in the
transit volume
16. Radiation is quantitated is based on the amount of radiation generated by the linear
acceleration -- Quantitated on the basis of the AMOUNT OF RADIATION ABSORBED IN THE
PATIENT; NOT based on the amount of radiation generated by the machine
17. Patients with colon cancer who have lung metastases restricted to one lung and no
extrapulmonary metastases may have long term disease-free survival in 25% if they
undergo pneumonectomy - Patients with colon cancer who have <5 LIVER MEATSTASES
12
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

restricted to ONE LOBE and no extrapulmonary metastases may have long term disease-
free survival in 25% if they undergo HEPATIC LOBECTOMY
18. Immunologic detection of proteins is more effective in fresh frozen tissue rather than in
formaldehyde fixed tissue










































13
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

SECOND PRELIM EXAM
IM- NEPHROLOGY

1. Etiologic mechanism underlying glomerular diseases
a. Autoimmune
b. Infectious agents
c. Drug reaction
d. All of the above including inherited disorders and environmental agents

2. Sympharyngitic nephritis is associated with
a. Lupus nephritis
b. Poststrep GN
c. IgA GN or Bergers disease
d. Membranoproliferative GN

3. In untreated lupus nephritis, worst renal outcome is expected in
a. Mesanglial proliferation lupus nephritis minimal or mild clinical renal
findings, normal SCr and GFR, inactive urinary sediment
b. Membranous lupus nephritis high risk of thrombotic complications,
proteinuria 40%
c. Diffuse proliferative lupus nephritis impaired renal function, all patients
have proteinuria (>50%), most active and severe clinical features
d. Focal proliferative lupus nephritis lesser glomeruli involved, fewer
necrotizing features and less crescents

4. A 24 year old male presented with hemoptysis, anemia, fever, dyspnea and
hematuria recurring over 4 days. Creatinine on admission was 3.6 mg/dL. Serologic
markers are awaited. What is the most likely diagnosis?
a. Microscopic polyangitis clinically similar to Wegeners but rarely have
significant lung disease or destructive sinusitis
b. Goodpastures syndrome males in their 20s present with hemoptysis,
anemia, fever, dyspnea and hematuria
c. Churg-Strauss syndrome hemoptysis not part of lung manifestations
d. Wegeners granulomatosis - -fever, SOB, hemoptysis, nasal ulcer, purulent
rhinorrhea, sinus pain, microscopic hematuria, subnephrotic proteinuria,
polyarthralgia/arthritis,

5. A patient presented with fever, purulent rhinorrhea, nasal ulcers, sinus pain,
arthritis, microscopic hematuria and 1.0gm/24hour of proteinuria. Serial chest xray
revealed persistent infiltrates and pulmonary nodule. Renal biopsy was done
showing non caseating granuloma. What is the most likely diagnosis?
a. Microscopic polyangitis clinically similar to Wegeners but rarely have
significant lung disease or destructive sinusitis
b. Goodpastures syndrome males in their 20s present with hemoptysis,
anemia, fever, dyspnea and hematuria
c. Churg-Strauss syndrome hemoptysis not part of lung manifestations
14
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

d. Wegeners granulomatosis - -fever, SOB, hemoptysis, nasal ulcer, purulent
rhinorrhea, sinus pain, microscopic hematuria, subnephrotic proteinuria,
polyarthralgia/arthritis, CXR: pulmonary nodules and persistent infiltrates
with cavitation, Tissue biopsy: small vessel vasculitis and adjacent non-
caseating granuloma







6. Poor prognostic factor in patient with Goodpastures syndrome
a. Creatinine of 5.5mg/dl at time of diagnosis -- Screat >5-6 mg/dL, >50%
crescent on renal biopsy with advanced fibrosis, (+) oliguria, need for acute
dialysis
b. Hemoglobin of 7.5 gm/dL
c. Presence of anti-mpo ANCA
d. High titer of anti-GBM antibody

7. Etiologic factor implicated in Type II membranoproliferative GN
a. Subacute bacterial endocarditis an antigen source in Type 1
b. SLE an antigen source in Type 1
c. C3 nephritic factor-associated nephritis involved in the pathogenesis of
Type 2
d. Cyroglobulinemia nephropathy an antigen source in Type 1

8. The development of renal vein thrombosis is highest in
a. Minimal change disease
b. Membranous glomerulopathy Although thrombotic complications are a
feature of all nephrotic syndromes, MGN has the highest reported incidences
of renal vein thrombosis, pulmonary embolism, and deep vein thrombosis
(Harrisons)
c. Focal segmental glomerulosclerosis
d. Henoch-Schonlein purpura

9. Recommendation for detection of microalbuminemia in Type 2 DM
a. At the time of diagnosis - because the time of onset of type 2 diabetes is often
unknown, to test type 2 patients at the time of diagnosis of diabetes and
yearly thereafter (Harrisons)
b. When creatinine starts to get abnormal
c. Five years after diagnosis - It is currently recommended to test patients with
type 1 disease for microalbuminuria 5 years after diagnosis of diabetes and
yearly thereafter (Harrisons)
d. Only when nephropathy is evident

15
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

10. Which of the following genetically-linked glomerular diseases present with
hematuria, proteinuria, lens abnormality and sensorineural hearing loss?
a. Fabrys disease - Classically, Fabry's disease presents in childhood in males
with acroparesthesias, angiokeratoma, and hypohidrosis. Over time male
patients develop cardiomyopathy, cerebrovascular disease, and renal injury,
with an average age of death around 50 years of age
b. Alports syndrome - Classically, patients with Alport's syndrome develop
hematuria, thinning and splitting of the GBMs, mild proteinuria (<12 g/24
h), which appears late in the course, followed by chronic glomerulosclerosis
leading to renal failure in association with sensorineural deafness
c. Nail-Patella Syndrome - Patients with nail-patella syndrome develop iliac
horns on the pelvis and dysplasia of the dorsal limbs involving the patella,
elbows, and nails, variably associated with neural-sensory hearing
impairment, glaucoma, and abnormalities of the GBM and podocytes, leading
to hematuria, proteinuria, and FSGS
d. Thin basement membrane syndrome - Thin basement membrane ndisease
(TBMD) characterized by persistent or recurrent hematuria is not typically
associated with proteinuria, hypertension, or loss of renal function or
extrarenal disease. Although not all cases are familial (perhaps a founder
effect), it usually presents in childhood in multiple family members and is
also called benign familial hematuria




11. In patients with interstitial nephritis, provision of glucocorticoid therapy to
accelerate renal recovery is relative indication in:
a. Sarcoidosis
b. Sjogrens syndrome
c. Lupus nephritis
d. Infection-associated AIN
Table 285-2 Indications for Corticosteroids and Immunosuppressives in Interstitial Nephritis

Absolute Indications
Sjgren's syndrome
Sarcoidosis
SLE interstitial nephritis
Adults with TINU
Idiopathic and other granulomatous interstitial nephritis
Relative Indications
16
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

Drug-induced or idiopathic AIN with:
Rapid progression of renal failure
emsp; Diffuse infiltrates on biopsy
emsp; Impending need for dialysis
emsp; Delayed recovery
Children with TINU
Postinfectious AIN with delayed recovery (?)


12. Most common cause of primary nephrotic syndrome among adult patients?
a. Minimal change disease most common primary nephrotic syndrome among
children
b. Diabetic nephropathy
c. Focal segmental glomerulosclerosis
d. Membranous nephropathy

13. A 24 y/p female presented with fever, rash, eosinophilia and oliguric renal failure
after 1 week of PTB treatment. Urinalysis showed pyuria, white blood cell casts and
microscopic hematuria. Creatinine was 2x elevated. What is the most likely
diagnosis?
a. Granulomatous interstitial nephritis
b. PTB related interstitial nephritis
c. Allergic interstitial nephritis diagnostic triad of fever, rash and eosinophilia
d. Acute urate nephropathy






14. Intersitial nephritis associated with papillary necrosis is most frequently seen in
a. Allergic interstitial nephritis
b. Sickle cell nephropathy
c. Analgesic nephropathy
d. Chinese herbal nephropathy

15. Reversal of renal injury in acute allergic interstitial nephritis is best achieved with:
a. Dialysis
17
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

b. Drug discontinuation since acute allergic interstitial nephritis is due to
allergic rezction to certain agents like drugs, the best way to reverse it is to
stop taking the drug.
c. Plasmapheresis
d. Immunoglobulin therapy

16. The primary defect in Type 2 renal tubular acidosis
a. Excessive back diffusion of hydrogen ion Type 1
b. Defective bicarbonate reabsorption
c. Impaired ammoniagenesis Type 4
d. Low titratable acid excretion Type 1

17. Gain of function mutation in the principal call apical transport protein that leads to
hypertension, hypokalemia and metabolic alkalosis
a. Gitelmans syndrome more common than Bartter's syndrome and has a
generally milder clinical course with a later age of presentation. It is
characterized by prominent neuromuscular symptoms and signs, including
fatigue, weakness, carpopedal spasm, cramps, and tetany
b. Bartters syndrome may result from mutations affecting any of five ion
transport proteins in the TAL, mimics the effects of chronic ingestion of a
loop diuretic
c. Liddle syndrome - mimics a state of aldosterone excess by the presence of
early and severe hypertension, often accompanied by hypokalemia and
metabolic alkalosis, but plasma aldosterone and renin levels are low
d. Gordons syndrome

18. Ultrasonograhic diagnosis of ADPKD in a 45 year old asymptomatic patient is
possible in the presence of (based on Harrisons)
a. 3 or more cysts in one kidney
b. 2 or more cysts in each kidney
c. 4 or ore cysts in each kidney
d. 2 or more cysts in one kidney

At least 2 cysts in 1 kidney or 1 cyst in each kidney in an at-risk patient younger than 30 years
At least 2 cysts in each kidney in an at-risk patient aged 30-59 years
At least 4 cysts in each kidney for an at-risk patient aged 60 years or older

19. Predictor if poor renal outcome in ADPKD
a. Diagnosis at age 60 years
b. Early development of hypertension -- Risk factors for progressive kidney
disease include younger age at diagnosis, black race, male sex, presence of
polycystin-1 mutation, and hypertension
c. At least one episode of cyst infection yearly
d. Presence of recurrent flank pain -- Dull, persistent flank andabdominal pain
and early satiety are common due to the mass effect of the enlarged kidneys
or liver
18
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)




20. Treatment of choice for Liddles syndrome
a. Amiloride -- Amiloride or triamterene blocks ENaC and, combined with salt
restriction, provides effective therapy for the hypertension and hypokalemia
b. Furosemide
c. Hydrochlorothiazide
d. Spironolactone





































19
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

Endo
1. Which of the following is a screening test for Cushings syndrome?
a. High dose dexa suppression test
b. ACTH
c. Midnight salivary cortisol
d. CT scan of adrenals
*others included: 24hr urine free cortisol, dexa overnight suppression test

2. This is a medical emergency condition, which is a result of rapid withdrawal of
steroid. This is usually precipitated by severe illness or infection
a. Cushings sundrome
b. hyperaldosteronism
c. Pheochromocytoma
d. Adrenal crisis

3. Which of the ff characteristic is suggestive of malignant adrenal mass
a. adrenal mass <3cm- >4cm
b. Housefield unit of >10
c. More than 50% washout after contrast CT scan -<50%
d. None of the above

4. Most common enzyme mutation causing congenital adrenal hyperplasia
a. 21 hydroxylase
b. 17 a-progesterone
c. 17,20 lyase
d. 11-hydroxylase

5. which of the ff is not correct regarding pheochromocytoma
a. caused by cathecolamine- producing tumors
b. 25% is inherited as gene mutations
c. majority are malignant- 90%benign
d. mostly unilateral

Case 1: a 36 y/o male sought consult at the ER because of body weakness. He is a known
hypertensive for 2 years. His BP is fluctuating inspite of 3 antihypertensive meds. At the ER,
BP was 170/100mmHg, K=3.0mmol/L. Initial tests showed elevated aldosterone/renin
ratio. (case of primary aldosteronism)
6. what is the most common cause of excess aldosterone
a. cushings
b. adrenal adenoma
c. bilateral adrenal hyperplasia
d. pituitary adenoma

7. after confirmatory testing, CT scan showed 2x3cm nodule at the left adrenal. What is
the best treatment approach for this patient
a. spitinolactone
20
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

b. laparoscopic adrenalectomy
c. observation since patient is young
d. none of the above

Case2: a 40y/o male came to the clinic for consult because of body weakness and easy
bruisability. Non hypertensive, was previously told to have borderline diabetes. On PE
Bp=140/90 CR=90 RR=2-. He was noted to be obsess but thin extremities, with rounded
face, looks flushed with buffalo hump and large reddish striae (case of Cushings)
8. what is the most common physical presentation in patients such as in case 2
a. buffalo hump
b. big purplish-reddish striae
c. central obesity
d. moon facie

9. in the above case, a low dose dexa suppression test showed elevated level of
cortisol, furthermore, ACTH test showed suppressed result. The attending physician
plan to do imaging. What should be requested (ACTH independent)
a. CT scan of abdomen/adrenals cause is adrenal is ACTH is elevated
b. CT scan of the pituitary
c. CT scan of the chest
d. PET scan

10. Best treatment option for above case
a. Surgery -TSS
b. Metyrapone
c. Hydrocortisone
d. None

11. Which of the following is/are true of infertility
a. Unexplained causes in up to17%
b. Inability to conceive after 12months
c. Ovulatory dysfunction in majority of females
d. All of the above

12. Treatment options for infertility are the following, except
a. Expectant for sperm count <10c10^6/mL, 10% motility normal sperm count
>20M/mL >50%motility
b. Gonadotropin therapy for secondary hypogonadism
c. Clomiphene citrate for PCOS
d. In vitro technique for primary testicular failure

13. 68 y/o male admits to have decreased physical function and muscle strength. Which
of the ff describe/s the age related changes in his reproductive function
a. Testosterone concentrations increase starting 3
rd
decade decrease!
b. Reduced LH response to GnRH
21
IM-B SY 2013-2014 2
nd
PRELIM EXAM WITH RATIONALE by Acad. Com. (MHS)

c. Lower sex hormone binding globulin- higher bec theres lack of hormone that will
bind
d. All of the above

14. 50 y/o postmenopausal woman wanted to take hormonal therapy. The ff should be
discussed prior to treatment
a. Definite benefit is improvement of genitourinary symptoms- highly effective for
controlling vasomotor and genitourinary symptoms
b. Unproven benefit is decreased risk of diabetes mellitus
c. Definite risk is increased ovarian cancer- uncertain risk!
d. Probable risk is gallbladder disease- definitive risk!

15. Management of disorders of sex development are the ff, except
a. Androgen benefit is improvement of genitourinary symptoms
b. Recombinant GH for short stature in 45x
c. Estrogen replacement with progesterone in Turner Syndrome
d. None of the above

Matching type
16. Pubertal failure, aortic root dilatation, hearing loss (turner)= High FSH, low
estradiol
17. Fertility wanes, mean duration is 4 yrs, hot flushes (Perimenopause)= FSH, Estradiol
not diagnostic
18. Gynecomastia, eunuchoid proportion, small testes (klinefelter) = high FSH, Estradiol
19. Symptoms begin after menarche, slowly progressive (PCOS)= normal FSH, low
estrdiol
20. Headache, galactorrhea, short stature, diabetes insipidus (hypothalamic or pituitary
cause)= low LH, FSH and estradiol

hypothalamic
or pituitary
cause
PCOS Perimenopause Premature
Ovarian
failure
(Turner)
Klinefelter
FSH Normal/low Normal/low not diagnostic High High
LH Normal/low High High
Estradiol Low Low not diagnostic Low High
Testosterone High low