UNIVERSITY OF THE PHILIPPINES MANILA

PHILIPPINE GENERAL HOSPITAL

DEPARTMENT OF MEDICINE

RESIDENTS EXAM
HEMATOLOGY, MEDICAL ONCOLOGY, ALLERGOLOGY AND IMMUNOLOGY,
RHEUMATOLOGY, AND DERMATOLOGY (HOARDS)
August 3, 2009

MULTIPLE TRUE OR FALSE. There are 5 statements after each question. Determine
whether each statement is true or false. On the answer sheet, place an x in the box
corresponding to your answer.

HEMATOLOGY:

1. Which of the following are diseases associated with massive splenomegaly? (Harrisons
17th ed., p 374, Table 60-3)
A. Acute myelogenous leukemia
B. Autoimmune hemolytic anemia
C. Chronic lymphocytic leukemia
D. Chronic myelogenous leukemia
E. Polycythemia vera

2. What clinical presentations when combined, may refer to febrile neutropenia?

(Harrisons 17th ed., p 529)
A. One temperature > or = 38.5 degrees Celsius
B. 2 readings of > or = 38 but < or = 38.5 per 24 hours
C. Neutropenic patient
D. Uncontrolled neoplasm involving the bone marrow
E. Patient undergoing treatment with cytotoxic agents

3. Which of the following is/are TRUE regarding signs and symptoms of aplastic anemia?
(Harrisons 17th ed., p 663-667)
A. Aplastic anemia incidence increases with age.
B. It appears to result from defective stroma or growth factor production
C. Bleeding is the most common early symptom
D. Mean corpuscular volume is commonly decreased
E. Very severe disease is defined as an absolute neutrophil count < 200/uL

4. Which of the following is/are TRUE regarding the management of aplastic anemia?
(Harrisons 17th ed., p 667)
A. Cyslosporine plus ATG (antithymocyte globulin) is the standard of treatment
for patients with severe disease
B. Menstruation should be suppressed either by oral estrogens or nasal follicle-
stimulating hormone/luteinizing hormone.
C. Aspirin and NSAIDs can be used for pain.
D. Red blood cells should be transfused to maintain a normal level of activity, usually at
a hemoglobin value of 80 g/L (100 g/L if there is underlying cardiac or pulmonary
disease).
 E. In chronic anemia, the iron chelator deferoxamine should be added at around
the fiftieth transfusion in order to avoid secondary hemochromatosis.

5. Which of the following is/are TRUE of myelodysplastic syndrome (MDS)? (Harrisons 17th
ed., p 668-671)
A. Idiopathic MDS is a disease of the elderly.
B. Fever and weight loss are the most common early symptom.
C. Peripheral blood smear shows macrocytosis, large platelets, hypogranulated
and hyposegmented neutrophils
D. Most patients die as a result of complications of pancytopenia and not due to
leukemic transformation
E. The therapy has been unsatisfactory

6. Which of the following is/are TRUE of hemolytic anemias? (Harrisons 17th ed., p 652-
662)
A. Hereditary spherocytosis is confirmed on the basis of red cell morphology and
a test for osmotic fragility, a modified version of which is called the pink test
B. The diagnostic test for paroxysmal nocturnal hemoglobinuria (PNH) is the Coombs
test, while that for autoimmune hemolytic anemia (AIHA) are surface proteins (CD55
and CD59)
C. When autoimmune hemolytic anemia (AIHA) is diagnosed, a full screen for
autoimmune disease is imperative
D. PNH may evolve into aplastic anemia, and PNH may manifest itself in patients
who previously had aplastic anemia.
E. Use of chloramphenicol carries a definitive risk of clinical hemolysis in persons with
G6PD deficiency.

7. Which of the following is/are TRUE of Immune thrombocytopenic purpura (ITP),

thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS)?
(Harrisons 17th ed., p 721-723)
A. ITP is characterized by mucocutaneous bleeding and low platelet count, with
otherwise normal peripheral blood cells and smear.
B. For patients with severe ITP (platelet count <5,000/uL) and/or symptoms of
bleeding, high dose glucocorticoids with IVIg or anti-RhoD therapy should be
given.
C. The mainstay of treatment for TTP and HUS is plasma exchange.
D. HUS is a syndrome characterized by acute renal failure, microangiopathic
hemolytic anemia, and thrombocytopenia.
E. PT/PTT are characteristically abnormal in HUS.

8. Which of the following is/are TRUE about acute myeloid leukemia (AML)? (Harrisons
17th ed., p 677-683)
A. The age distribution is biphasic, with the major peak in the teens and twenties and a
second rise in the elderly.
B. The WHO schemia is the first leukemia classification system to consider
genetic along with morphologic features to define different subsets of AML.
C. Infiltration of the gingivae, skin, soft tissues, or the meninges with leukemic blasts at
diagnosis is characteristic of the promyelocytic subtype.
D. Abnormal rod-shaped granules called Auer rods are not uniformly present, but
when they are, myeloid lineage is virtually certain.
E. Advancing age is associated with a poor prognosis.
9. Which of the following is/are TRUE about the management of AML? (Harrisons 17th ed.,
p 680-683)
A. The most commonly used induction regimen for all types of AML consist of
combination chemotherapy with cytarabine and an anthracycline.
B. The use of growth factors as supportive care for AML is proven.
C. Multilumen right atrial catheters should be inserted as soon as patients with
newly diagnosed AML have been stabilized.
D. RBC transfusions should be administered to keep the hemoglobin level >
80g/L in the absence of active bleeding, DIC, or congestive heart failure.
E. Blood products should be irradiated to prevent transfusion associated graft-
versus-host disease (GVHD).

10. Which of the following is/are TRUE about CML in blastic crisis? (Harrisons 17th ed., p
684, 686)
A. Blast crisis is defined as blood or bone marrow blasts > 30%.
B. Treatment for primary blast crisis with imatinib is highly effective.
C. Patients who achieve complete hematologic remission or whose disease
returns to a second chronic phase should be considered for allogeneic stem
cell transplantation.
D. Occurrence of de novo blast crisis or following imatinib therapy is rare.
E. Hyposegmented neutrophils may appear (Pelger-Huet anomaly) in blast crisis.

11. Which of the following is/are TRUE about lymphomas? (Harrisons 17th ed., p 687-700)
A. Evaluation of patients with Hodgkin lymphoma will typically include CBC, BMA, LDH.
Beta-2-microglobuiln and CT scan of chest, abdomen, and pelvis.
B. MALT lymphoma is associated with H. pylori infection.
C. In mantle cell lymphoma, patients who present with gastrointestinal tract
involvement often have Waldeyers ring involvement, and vice versa.
D. Patients with MALT lymphoma have a high rate of histologic transformation to diffuse
large B cell lymphoma.
E. Cytogenetic and molecular genetic studies are not necessary for diagnosis of
diffuse large B cell lymphoma.

12. Which of the following is/are TRUE about transfusion medicine? (Harrisons 17th ed., p
707-713)
A. Apharesis technology is used for the collection of multiple units of platelets
from a single donor.
B. Adequate oxygenation can be maintained with a hemoglobin content of 70g/L
in the normovolemic patients without cardiac disease.
C. The threshold for prophylactic platelet transfusion is 10,000/ uL.
D. FFP is an acellular component and does not transmit CMV.
E. Cryoprecipitate is a source of Factor VIII, Factor IX and von Willebrand factor.

13. Which of the following chemotherapeutic agents is/are correctly matched with their
toxicities? (Harrisons 17th ed., p 518-527)
A. Docetaxel: vascular leak syndrome
B. Vincristine: glove-and-stocking neuropathy
C. 5-fluorouracil (5FU): second malignancy
D. Doxorubicin: cardiotoxicity
E. Cisplatin: hypercalcemia
 14. Which of the following is/are TRUE about nutritional anemias? (Harrisons 17th ed., p
630-633; p 643-651)
A. The appearance of iron deficiency in an adult male means gastrointestinal
blood loss until proven otherwise.
B. The total iron binding capacity (TIBC) in iron deficiency anemia is normal or low.
C. Usually, the anemia of chronic inflammation, in contrast to iron deficiency anemia, is
megaloblastic.
D. The incidence of cleft palate and harelip can be reduced by prophylactic folic
acid.
E. Folic acid deficiency may cause a bilateral peripheral neuropathy or degeneration of
the posterior and pyramidal tracts of the spinal cord.

DERMATOLOGY:
15. Which of the following is/are TRUE regarding contact dermatitis? (Harrisons 17th ed., p
313-314)
A. An example of allergic contact dermatitis would be dermatitis induced by a
concentrated acid or base.
B. The most common cause of allergic contact dermatitis is exposure to plants
like poison ivy.
C. Usually, treatment with high-potency topical glucocorticoids is enough to
relieve symptoms.
D. The most common area of involvement in irritant dermatitis is the intertriginous
areas.
E. Patch testing is helpful in identifying sensitizers among patients with widespread
active dermatitis.

16. Which of the following is/are TRUE regarding dermatophytosis? (Harrisons 17th ed., p
318)
A. Dermatophytes are fungi of the genera Trichophyton, Microsporum, and
Epidermophyton.
B. Distal subungal onychomycosis can be a marker for HIV infection or other
immunocompromised states.
C. Azoles, nystatin and terbinafine are active against dermatophytes.
D. Fingernails require 2 months of continuous therapy or two pulses, while
toenails require 3 months of continuous therapy or three pulses
E. All of the oral antifungal agents may cause hepatotoxicity and should not be
used in women who are pregnant or breast-feeding.

17. Which of the following is/are TRUE about seborrheic dermatitis? (Harrisons 17th ed., p
315)
A. The most common location is the scalp.
B. On the face, seborrheic dermatitis affects the eyebrows and eyelids. It rarely affects
the hairless areas such as the glabella and nasolabial folds.
C. The overwhelming majority of individuals with seborrheic dermatitis have no
underlying disorder.
D. Treatment of high-potency glucocorticoids should be used on severe facial
involvement of seborrheic dermatitis.
E. The scalp and beard areas may benefit form anti-dandruff shampoos, which
should be left in place 3-5 mins before rinsing.
18. Which of the following is/are clinical criteria used in the diagnosis of toxic shock
syndrome? (Harrisons 17th ed., p 764)
A. Fever
B. Hypotension
C. Multiorgan involvement
D. Pruritus
E. Rash

19. Which of the following is/are drugs the most commonly cause Stevens-Johnson
syndrome (SJS) and toxic epidermal necrolysis (TEN)? (Harrisons 17th ed., p 346)
A. Allopurinol
B. Anti-infectious sulfonamides
C. Lamotrigine
D. Non-aromatic anti-convulsants
E. Propylthiouracil

20. Which of the following is/are TRUE of psoriasis? (Harrisons 17th ed., p 315-316)
A. The most common variety of psoriasis is called the plaque-type.
B. Arthralgias are most often found in psoriatic patients with fingernail
involvement.
C. Traumatized areas often develop lesions of psoriasis (Koebner or isomorphic
phenomenon).
D. Patients with pustular psoriasis present with many small erythematous, scaling
pustules, frequently after upper respiratory tract infection with beta-hemolytic
streptococci.
E. UV light therapy in combination with cyclosporine is an effective therapy for many
patients with widespread psoriasis.

21. Which of the following is/are TRUE of impetigo? (Harrisons 17th ed., p 317)
A. The primary lesion is a superficial pustule that ruptures and forms a
characteristic yellow-brown honey colored crust.
B. It is a common superficial bacterial infection of skin caused most often by group A
beta-hemolytic streptococci, and in some cases by Staphylococcus aureus.
C. Pyoderma gangrenosum is a variant of impetigo that causes punched-out ulcerative
lesions.
D. Current recommendations for methicillin-sensitive infections are beta-lactam
antibiotics
E. Bullous impetigo is caused by the production of exfoliative toxin by
Staphylococcu aureus phage type II.

22. Which of the following is/are TRUE of cutaneous drug reactions? (Harrisons 17th ed., p
343-349)
A. Morbilliform rash is the most frequent skin reaction.
B. NSAIDs, lithium, ACE inhibitors, beta blockers and antimalarials can exacerbate
plaque psoriasis.
C. Pretreatment with prednisone and diphenhydramine reduces reaction rates
from high-osmolality radiocontrast media.
D. Alopecia is a common complication of IFN-alpha.
E. Any severe reaction to drugs should be notified to a regulatory agency or to
pharmaceutical companies.
23. Which of the following drug/s may exacerbate subacute systemic lupus erythematosus?
(Harrisons 17th ed., p 344)
A. Captopril
B. D-penicillamine
C. Lithium
D. Minocycline
E. Thiazide diuretics

24. Staphylococcal scalded-skin syndrome (SSSS) can be distinguished from toxic

epidermal necrolysis (TEN) by the following features: (Harrisons 17th ed., p 328)
A. Younger age group
B. Deeper site of blister formation
C. No oral lesions
D. Longer course
E. Lesser morbidity and mortality

25. Which of the following skin manifestations of internal disease is/are correctly paired?
(Harrisons 17th ed., p 324)
A. Erythema gyratum repens: malignancy
B. Erythema marginatum: rheumatic disease
C. Dermatophytes: Majocchis granuloma
D. Dermatomyositis: mat telangiectasis
E. Mastocytosis: periungal telangiectasia

26. Which of the following is/are required in the diagnosis of toxic shock syndrome?
(Harrisons 17th ed., p 329)
A. Diffuse erythema of the skin
B. Desquamtion of palms and soles 1-2 weeks after onset of illness
C. No involvement of mucous membranes
D. Presence of cervical lymphadenopathies
E. Thrombocytosis

27. The location, consistency, and color of papulonodular skin lesions are the keys to their
diagnosis. Which of the following diseases is/are correctly matched with their colors?
(Harrisons 17th ed., p 330-334)
A. Necrobiosis lipoidica: black
B. Bacillary angiomatosis: red
C. Sweet syndrome: red-brown
D. Lupus pernio: yellow
E. Kaposi sarcoma: purple

28. Which of the following is/are TRUE of scabies? (Harrisons 17th ed., p 2748-2749)
A. Intense itching worsens at day especially during a hot shower.
B. Except in infants, the face, scalp, neck, palms and soles are spared.
C. Permethrin cream is applied thinly but thoroughly behind the ears and from
the neck down after bathing and are removed 8 hours later with soap and
water
D. To prevent reinfestations, bedding and clothing should be washed and/or dried
on high heat or heat-pressed.
E. Close contacts should only be treated if symptomatic.
 29. Which of the following is/are TRUE of the clinical and histologic spectrum of lepromatous
and tuberculoid leprosy? (Harrisons 17th ed., p 1022-1023)
A. The polar tuberculoid type of leprosy is frequent in Southeast Asia
B. Invasion and destruction of nerves in the dermis by T cells are pathognomonic
for leprosy.
C. The skin lesions of tuberculoid leprosy consist of symmetrically distributed skin
nodules, raised plaques, or diffuse dermal infiltration.
D. Lepromin skin test is negative in patients with untreated lepromatous leprosy.
E. In lepromatous leprosy, there is a 2:1 predominance of helper CD4+ over CD8+ T
lymphocytes.

ALLERGOLOGY AND IMMUNOLOGY:

30. Which of the following is/are TRUE of atopic dermatitis? (Harrisons 17th ed., p 312-313)
A. The childhood and adolescent pattern is marked by dermatitis of extensor surfaces.
B. There is direct role of dietary allergies in atopic dermatitis.
C. An extra fold of skin beneath the lower eyelid is called Dennies line.
D. Tacrolimus ointment and pimecrolius cream can suppress the hypothalamic-pituitary-
adrenal axis.
E. When secondary infection is suspected, topical mupirocin should be given.

31. Which of the following is/are TRUE of allergic rhinitis? (Harrisons 17th ed., p 2068-2070)
A. Episodic rhinorrhea, sneezing, obstruction of the nasal passages with
lacrimation, and pruritus of the conjunctiva, nasal mucosa, and oropharynx are
the hallmarks of allergic rhinitis.
B. Nasal polyps may occur independent of allergic rhinitis in patients with
aspirin-intolerant triad of rhinosinusitis and asthma.
C. Vasomotor rhinitis resembles perennial allergic rhinitis occurring with specific stimuli.
D. A positive intradermal test has a high positive predictive value.
E. ELISA employing anti-IgE provides rapid and cost-effective determinations.

32. Which of the following is/are TRUE regarding treatment of allergic rhinitis? (Harrisons
17th ed., p 2069-2070)
A. Phenylephrine or oximetazoline are effective for nasopharyngeal itching, tearing, and
erythema.
B. Intranasal high-potency glucocorticoids are the most potent drugs for the
relief of seasonal and perennial rhinitis, and are effective in relieving nasal
congestion.
C. The duration of the efficacy of alpha-adrenergic agents is limited because of
rebound rhinitis and hypertension
D. Immunotherapy is contraindicated in patients with significant cardiovascular disease
or stable and unstable asthma.
E. Topical ipatropium can be additionally efficacious when combined with
intranasal steroids.

33. Which of the following is/are TRUE of anaphylaxis? (Harrisons 17th ed., p 2063-2065)
A. Atopy predisposes individuals to anaphylaxis from penicillin therapy or venom of a
stinging insect.
B. The hallmark of the anaphylactic reaction is the onset of some manifestation within
minutes to hours after introduction of the antigen.
 C. Elevations of tryptase levels in serum implicate mast cell activation in an
adverse systemic reaction and are particularly informative with episodes of
hypotension during general anesthesia.
D. Skin testing is of no value for non-IgE-mediated eruptions.
E. Mild symptoms such as pruritus and urticaria can be controlled by
administration of 0.3 to 0.5 ml of 1:1000 epinephrine SC or IM.

34. Which of the following is/are IgE-dependent cause/s of urticaria and/or angioedema?
(Harrisons 17th ed., p 2065, Table 311-1)
A. Autoimmunity
B. Food allergy
C. NSAIDs
D. Radiocontrast media
E. Serum sickness

35. The classic target lesions of erythema multiforme appear symmetrically on what part/s of
the body? (Harrisons 17th ed., p 129)
A. Back
B. Elbows
C. Lips
D. Palms and soles
E. Shin

36. What is/are drug/s that most often cause induction of erythema multiforme (EM) major?
(Harrisons 17th ed., p 328)
A. Baribiturates
B. Carbamazepine
C. Penicillin
D. Phenytoin
E. Sulfonamides

37. What can often cause erythema multiforme? (Harrisons 17th ed., p 328)
A. Exposure to environmental toxins
B. Herpes simplex virus
C. Radiation therapy
D. Upper respiratory tract infections
E. Vaccinations

RHEUMATOLOGY:
38. Which of the following is/are TRUE of rheumatoid arthritis (RA)? (Harrisons 17th ed., p
2083-2092)
A. The characteristic feature is persistently inflamed synovitis usually involving
peripheral joints in an asymmetric distribution
B. Morning stiffness of > 30 min duration is an almost invariable feature
C. Microvascular injury and an increase in the number of synovial lining cells
appear to be the earliest lesions.
D. The distal interphalangeal joints are rarely involved.
E. DMARD therapy should be begun as soon as the diagnosis of RA is
established, especially those with any evidence of aggressive disease with a
poor prognosis.
39. What consists of Feltys syndrome? (Harrisons 17th ed., p 2087)
A. Neutropenia
B. Acute rheumatoid arthritis
C. Splenomegaly
D. Thrombocytosis
E. Anemia

40. Which of the following is/are the disease modifying anti-rheumatic drugs (DMARDs)
used in the treatment of rheumatoid arthritis? (Harrisons 17th ed., p 2090)
A. Antimalarials
B. Azathioprine
C. Cyclophosphamide
D. D-penicillamine
E. Methotrexate

41. Which of the following biologics used in the treatment of rheumatoid arthritis is/are
correctly paired? (Harrisons 17th ed., p 2090)
A. Adalimumab: fully human antibody to TNF
B. Anakinra: recombinant IL-1 receptor antagonist
C. NSAIDs: cyclooxygenase-1 and-2 inhibitor
D. Etanercept: chimeric mouse/human monoclonal antibody to TNF
E. Infliximab: TNF type II receptor fused to IgG1

42. Which of the following is/are TRUE of osteoarthritis (OA)? (Harrisons 17th ed., p 2158-
2165)
A. Because of the aging of western populations and because obesity are
increasing in prevalence, the occurrence of osteoarthritis is on the rise.
B. The pathologic sine qua non of disease is reticular articular cartilage loss.
C. MRI is indicated as part of the diagnostic work-up because it reveals the extent of
pathology in an osteoarthritic joint.
D. Isometric strengthening has been shown consistently to be efficacious.
E. Chondrocyte transplantation is a promising modality in the treatment of OA.

43. Which of the following is/are TRUE of systemic sclerosis? (Harrisons 17th ed., p 2100-
2101)
A. The term scleroderma is used to describe a group of localized fibrosing skin
disorders that primarily affect children
B. Morphea presents as streaks of thickened skin, typically in one or both upper
extremities
C. Linear scleroderma presents as solitary or multiple circular patches of thickened skin
D. Raynauds phenomenon is defined as episodic vasoconstriction in the fingers
and toes.
E. The initial 4 years of the disease is the period of rapidly evolving systemic
involvement.

44. Which of the following is/are cardinal feature/s of systemic sclerosis? (Harrisons 17th
ed., p 2097)
A. Cellular immunity
B. Humoral immunity
C. Vasculopathy
 D. Progressive visceral fibrosis
E. Progressive vascular fibrosis on multiple organs

45. Which of the following is/are skin manifestation/s of systemic sclerosis? (Harrisons 17th
ed., p 2101)
A. Digital pits
B. Mauskopf face
C. More pronounced transverse creases in the palms
D. Radial furrowing
E. Salt and pepper appearance

46. Which of the following is/are TRUE of polymyositis (PM) and dermatomyositis (DM)?
(Harrisons 17th ed., p 2696-2703)
A. Facial muscles as well as ocular muscles are involved in advanced stage.
B. The incidence of malignant conditions appears to be specifically increased only in
patients with PM and not in those with DM.
C. In DM, humoral immune mechanisms are implicated. By contrast, in PM a
mechanism of T cell-mediated cytotoxicity is likely.
D. The clinically suspected diagnosis of DM and PM is confirmed by examining
the serum muscle enzymes, EMG findings and muscle biopsy.
E. The presence of perifascicular atrophy is diagnostic of DM, even in the
absence of inflammation

47. Which of the following is/are TRUE of polyarteritis nodosa (PAN)? (Harrisons 17th ed., p
2124-2125)
A. PAN is a multisystem necrotizing vasculitis of small and medium-sized arteries and
veins.
B. PAN does not involve pulmonary arteries, although bronchial vessels may be
involved.
C. The pathology in the kidney in classic PAN is that of arteritis and glomerulonephritis.
D. Death usually results from cardiovascular and pulmonary causes.
E. Favorable therapeutic results have been reported in PAN with the combination
of prednisone and cyclophosphamide.

48. Which of the following is/are TRUE of periarticular disorders of the extremities?
(Harrisons 17th ed., p 2184-2186)
A. Of the tendons forming the rotator cuff, the subscapularis tendon is the most often
affected, probably because of its repeated impingement.
B. Bicipital tendinitis is produced by friction on the tendon of the long head of the
biceps as it passes through the bicipital groove.
C. Adhesive capsulitis occurs more commonly in men after age 40.
D. Plantar fasciitis is seen frequently in younger population consisting of
runners, aerobic exercise dancers and ballet dancers.
E. Lateral epicondylitis occurs with recreational activities such as swinging a golf club or
throwing a baseball.

49. Which of the following is/are TRUE of gout? (Harrisons 17th ed., p 2166)
A. Gout is a metabolic disease most often affecting middle-aged to elderly men and
women.
 B. Even if the clinical appearance strongly suggests gout, the diagnosis should
be confirmed by needle aspiration of acutely or chronically involved joints or
tophaceous deposits.
C. Synovial fluid cell counts are elevated to 100,000/uL. Large amounts of crystals
occasionally produce a thick pasty or chalky joint fluid.
D. The mainstay of treatment is the administration of NSAIDs, cochicine, steroids and
allopurinol.
E. Urate-lowering therapy should be initiated in any patient who already has tophi
or chronic gouty arthrtitis.

50. Which of the following is/are TRUE of systemic lupus erythematosus (SLE)? (Harrisons
17th ed., p 2075-2083)
A. A new classification of lupus nephritis was published by the American Rheumatologic
Association. It added a for active and c for chronic changes, giving the physician
information regarding the potential reversibility of disease.
B. Anti-ds DNA correlate with nephritis, while anti-Ro and anti-La are associated
with decreased risk of nephritis.
C. Tests for following disease course include: blood count, urinalysis and serum
levels of creatinine and albumin.
D. Maternal SLE should be controlled with dexamethasone.
E. Prevention of complications of SLE includes vaccination, giving agents that
prevent osteoporosis, control of hypertension, and treatment of dyslipidemia,
hyperglycemia and obesity.

51. Which of the following is/are part of the classification criteria for the diagnosis of SLE?
(Harrisons 17th ed., p 2077, Table 313-3)
A. Hemolytic anemia or leukocytosis
B. Erosive arthritis of 2 or more peripheral joint with tenderness and swelling
C. Proteinuria > 0.5 g/d or >/= 3 +, or cellular casts
D. Exposure to UV light causes rash
E. Pleuritis or pericarditis

MEDICAL ONCOLOGY:
52. The management of lung cancer is guided by a correct histologic diagnosis. Which of
the following is/are TRUE regarding the histologic types of lung cancers? (Harrisons 17th
ed., p 552)
A. Non-small cell lung cancer is chemosensitive and is managed primarily by
chemotherapy with or without radiotherapy.
B. Small cell lung cancers (SCLC) are initially very responsive to combination
chemotherapy and to radiotherapy; however, most SCLCs ultimately relapse.
C. Stage for stage, the histology of NSCLC is not an important prognostic factor.
D. Squamous and small cell cancers usually present as central masses with
endobronchial growth.
E. Lung adenocarcinomas may be responsive to therapy aimed at the epidermal
growth factor receptor.

53. Bronchoalveolar carcinoma can present radiographically as: (Harrisons 17th ed., p 552)
A. Diffuse, multinodular lesions
B. Fluffy infiltrate
C. Ground glass opacity
D. Lymphangitic spread
 E. Single mass

54. Which of the following types of calcification/s on chest radiography is/are highly
suggestive of a benign lesions? (Harrisons 17th ed., p 558)
A. Bulls eye
B. Dense central nidus
C. Multiple punctuate foci
D. Popcorn ball
E. Spiculated lesions

55. PET scan is sensitive in assessing the mediastinum and solitary nodules. However,
false negatives may be seen in which of the following disorders? (Harrisons 17th ed., p
555)
A. Concurrent infections such as tuberculosis
B. Diabetes mellitus
C. Slow-growing tumors such as bronchoalveolar carcinoma
D. Thyroid disease
E. Tumors < 8mm

56. Which of the following statements regarding the primary treatment of breast cancer
is/are TRUE? (Harrisons 17th ed., p 566)
A. Lumpectomy with radiation has equivalent survival to mastectomy with
radiation
B. Lumpectomy without radiation has equivalent survival to mastectomy without
radiation
C. Most women with primary breast cancer should receive a mastectomy
D. Postlumpectomy nodal radiation improves 10-year survival
E. Postlumpectomy radiation reduces the risk of local recurrence

57. Which of the following tumor characteristics confers a poor prognosis in patients with
breast cancer? (Harrisons 17th ed., p 567)
A. Estrogen receptor positive
B. Good nuclear grade
C. Low proportion of cells in S-phase
D. Overexpression of erbB2 (HER-2/neu)
E. Progesterone receptor-positive

58. The following is/are risk factors for the development of colorectal cancer: (Harrisons 17th
ed., p 574-575)
A. Animal fat
B. Inflammatory bowel disease
C. NSAID use
D. Polyposis coli
E. Streptococcus bovis bacteremia

59. Which of the following is/are TRUE of prostatic cancer? (Harrisons 17th ed., p 593-600)
A. PSA is prostate cancer specific.
B. The major histologic subtype of prostate cancer is transitional cell
C. The Gleason score is a measure of histologic aggressiveness of the disease
D. After surgery, serum PSA should become undetectable within 4 weeks.
E. Cytotoxic chemotherapy is the main treatment for patients with advanced disease
 60. Which of the following is/are TRUE of the screening for cancer? (Harrisons 17th ed., p
490-491, 576, 595, 604)
A. Breast self-examination, clinical breast examination by a care-giver, and
mammography have been advocated as a useful screening tools.
B. Most screening guidelines recommend regular Pap testing for all women who
are or have been sexually active for 3 years or have reached the age of 21.
C. Fecal hemoccult screening annually and flexible sigmoidoscopy every 5 years
beginning at age 60 is recommended for asymptomatic individuals with no colorectal
cancer risk factors.
D. For men with a family history of prostate cancer, digital rectal examination (DRE) and
PSA testing is advised to begin at age of 50.
E. Pelvic examination and yearly CA-125 determination are recommended among
females > 60 years old for early screening of ovarian cancer.

MULTIPLE CHOICE: Choose the best answer. On the answer sheet, place an x in the box
corresponding to your answer.

HEMATOLOGY:
1. What is the most common genetic disorder in the world? (Harrisons 17th ed., p 636)
A. G6PD deficiency
B. Hemoglobin SC
C. Polycythemia vera
D. Sickle cell disease
E. Thalassemia

2. What is the single most powerful predictor of survival and can substitute for staging of
multiple myeloma? (Harrisons 17th ed., p 704)
A. Advanced lytic bone lesions
B. Hemoglobin
C. Serum beta-2-microglobulin
D. Serum calcium
E. Serum M protein

3. What is the first step in the approach to diagnosing patients with polycythemia?
(Harrisons 17th ed., p 362)
A. CT scan of the head
B. Determination of JAK-2 mutation
C. Measurement of carboxyhemoglobin
D. Measurement of erythropoietin level
E. Measurement of red cell mass

4. Chronic myelogenous leukemia is the consequence of t(9;22). In contrast, Polycythemia

vera, idiopathic myelofibrosis and essential thrombocytosis are characeterized by
expression of what mutation? (Harrisons 17th ed., p 672)
A. JAK-1
B. t(15:19)
C. PDGFR
D. V617F
5. The following cause microcytic erythrocytosis, EXCEPT: (Harrisons 17th ed., p 673)
A. Beta thalassemia trait
B. Hypoxic erythrocytosis
C. Myelodysplastic syndrome
D. Polycythemia vera

6. What is the most frequent infectious cause of hemolytic anemia in endemic areas?
(Harrisons 17th ed., p 659)
A. CMV
B. Malaria
C. Parvovirus
D. Hepatitis B

7. Idiopathic thrombotic thrombocytopenic purpura (TTP) is related to deficiency of, or

antibodies to, a metalloprotease that cleaves what molecule? (Harrisons 17th ed., p 722)
A. ADAMTS13
B. GPIb-IX-V
C. MYH9
D. Von willebrand factor

8. What is the most sensitive test for disseminated intravascular coagulation (DIC)?
(Harrisons 17th ed., p 729)
A. Fibrin degradation product (FDP) level
B. D dimer
C. Platelet count
D. Presence of schistocytes
E. Prolongation of PT/PTT

9. The following are associated with exposure to benzene, EXCEPT: (Harrisons 17th ed., p
664, 669, 677, 683)
A. Acute myeloid leukemia
B. Aplastic anemia
C. Chronic myelogenous leukemia
D. Myelodysplastic syndrome

10. Which of the following chromosome findings in AML is associated with a very good
prognosis? (Harrisons 17th ed., p 680)
A. inv(3)
B. inv(16)
C. t(6;9)
D. t(8,21)
E. t(15;17)

11. The initial goal in the treatment of Acute Myeloid Leukemia (AML) is to quickly induce
complete remission. Which of the following parameters is not included in the definition
of complete remission? (Harrisons 17th ed., p 680)
A. Blood neutrophil count >/= 1,000/uL
B. Bone marrow cellularity > 20% with trilineage maturation
C. Bone marrow contain < 5% blasts
D. Hemoglobin concentration > 100 g/L
E. Platelet count >/= 100,000/uL
 12. What is the most common type of non-Hodgkin lymphoma? (Harrisons 17th ed., p 695-
696)
A. Burkitt lymphoma
B. Diffuse large B cell lymphoma
C. Follicular lymphoma
D. Hairy cell leukemia
E. Mucosa-associated lymphoid tissue lymphoma

13. Characteristic pleomorphic abnormal CD4 positive cells with indented nuclei, called
flower cells are found in what type of malignancy? (Harrisons 17th ed., p 698)
A. Adult T cell leukemia/lymphoma
B. Burkitt lymphoma
C. Follicular lymphoma
D. Mantle cell lymphoma
E. Mycosis fungoides

14. A characteristic fever which persists for days to weeks, followed by afebrile intervals and
then recurrence of the fever, known as Pel-Ebstein fever, can be found in what
malignancy? (Harrisons 17th ed., p 699)
A. Acute myeloid leukemia
B. Anaplastic large T cell lymphoma
C. Diffuse large B cell lymphoma
D. Hodgkin disease
E. Multiple myeloma

15. What is the most common inherited bleeding disorder? (Harrisons 17th ed., p 723)
A. Ataxia-telangiectasia
B. G6PD deficiency
C. Hemophilia
D. Thalassemia
E. von Willebrand disease

16. Cryoprecipitate is enriched with Factor VIII protein. Each bag of cryoprecipitate contains
how many international units (IUs) of Factor VIII? (Harrisons 17th ed., p 727)
A. 80 IUs
B. 100 IUs
C. 120 IUs
D. 140 IUs
E. 160 IUs

17. What is the most frequent reaction associated with the transfusion of cellular blood
components? (Harrisons 17th ed., p 711)
A. Acute hemolytic transfusion reactions
B. Allergic reactions
C. Febrile nonhemolytic transfusion reaction
D. Fluid overload
E. Hypothermia

DERMATOLOGY:
18. What is the most common dermatophyte infection? (Harrisons 17th ed., p 318)
 A. Kerion
B. Tinea pedis
C. Tinea versicolor
D. Onychomycosis
E. Oral thrush

19. Demonstration of spaghetti and meatballs in KOH preparation is characteristic of:

(Harrisons 17th ed., p 318)
A. Candida albicans
B. Epidermophyton sp
C. Malassezia furfur
D. Microsporum sp.
E. Trichophyton tonsurans

20. What is the clinical hallmark of acne? (Harrisons 17th ed., p 319)
A. Comedone
B. Nodule
C. Pustule
D. Rhinophyma
E. Telangiectasia

21. The term toxic epidermal necrolysis (TEN) is used to describe cases with blisters
developing on dusky or purpuric macules in which total body surface area blistering and
eventual detachment is: (Harrisons 17th ed., p 346)
A. 1-10%
B. < 10%
C. 10-30%
D. > 30%

22. What is the most common malignancy associated with erythroderma? (Harrisons 17th
ed., p 321)
A. Cutaneous T cell lymphoma (CTCL)
B. Hairy cell leukemia
C. Malignant melanoma
D. Uterine cancer

23. What is the most common setting for eruptive xanthoma? (Harrisons 17th ed., p 331-
332)
A. Chronic tophaceous gout
B. Hyperlipidemia
C. Psuedoxanthoma elasticum
D. Uncontrolled diabetes mellitus
E. Von Recklinghausen disease

RHEUMATOLOGY:
24. What is the most common form of bursitis? (Harrisons 17th ed., p 2184)
A. Golfers elbow
B. Jumpers knees
C. Subacromial bursitis
D. Tennis elbow
25. What complication is the leading cause of death in systemic sclerosis? (Harrisons 17th
ed., p 2102)
A. Cardiac
B. Infectious
C. Gastrointestinal
D. Pulmonary
E. Renal

26. The best evidence of viral connection in polymyositis is: (Harrisons 17th ed., p 2698)
A. Arthropod-borne viruses
B. Enterovirus
C. Influenza
D. Retroviruses
E. Rheovirus

27. In terms of gastrointestinal toxicity, meta-analyses have suggested that non-acetylated

salicylates are among the safer NSAIDs. Which of the following is a non-acetylated
salicylate? (Harrisons 17th ed., p 2164)
A. Ibuprofen
B. Ketoprofen
C. Ketorolac
D. Piroxicam

28. Pleuropulmonary manifestations of rheumatoid arthritis are more commonly observed in

men. In pleural effusion, the pleural fluid typically has: (Harrisons 17th ed., p 2087)
A. Normal levels of glucose
B. Low complement
C. High protein
D. High eosinophil count

29. Life threatening colchicine toxicities have been described with the administration of:
(Harrisons 17th ed., p 2166)
A. >2 mg/d IV
B. >3 mg/d IV
C. >4 mg/d IV
D. >6 mg/d IV
E. >8 mg/d IV

30. Which of the following drugs have no uricosuric effects? (Harrisons 17th ed., p 2166)
A. Amlodipine
B. Fenofibrate
C. Losartan
D. Metoprolol

31. What is the mechanism of action of allopurinol? (Harrisons 17th ed., p 2166)
A. Anti-inflammatory
B. Recombinant uricase
C. Uricosuric agent
D. Xanthine oxidase inhibitor
32. What is the joint most frequently affected in CPPD (calcium pyrophosphate dihydrate)
arthropathy? (Harrisons 17th ed., p 2167)
A. Ankle
B. Elbow
C. Knee
D. Spine
E. Wrist

33. What is the typical appearance of crystals in CPPD? (Harrisons 17th ed., p 2167)
A. Bipyramidal crystals
B. Needle- and rod-shaped strongly negative birefringent crystals
C. Non-birefringent globules
D. Rhomboid weakly-positive birefringent crystals
E. Rod-shaped strongly negative birefringent crystals

34. What is the typical appearance of crystals in gout? (Harrisons 17th ed., p 2166)
A. Bipyramidal crystals
B. Needle- and rod-shaped strongly negative birefringent crystals
C. Non-birefringent globules
D. Rhomboid weakly-positive birefringent crystals
E. Rod-shaped strongly negative birefringent crystals

35. What is the most commonly involved joint in acute bacterial arthritis? (Harrisons 17th ed.,
p 2171)
A. Ankle
B. Elbow
C. Knee
D. Spine
E. Wrist

36. Which is a cause of chronic monoarticular arthritis? (Harrisons 17th ed., p 2172)
A. Beta-hemolytic streptococci
B. Gram-negative bacilli
C. Neisseria gonorrheae
D. Staphylococcus aureus
E. Treponema pallidum

37. Cystic changes, well defined erosions with sclerotic margins (often with overhanging
bony edges) are characteristic radiographic features of: (Harrisons 17th ed., p 2166)
A. Gout
B. Lyme disease
C. Psoriatic arthritis
D. Rheumatoid arthritis
E. Tuberculous arthritis

38. What is the most frequent hematologic manifestation of systemic lupus erythematosus
(SLE)? (Harrisons 17th ed., p 2079)
A. Anemia
B. Leucopenia
C. Neutropenia
D. Thrombocytopenia
 E. Thrombocytosis

39. What is the most serious manifestation of SLE in the first decade? (Harrisons 17th ed., p
2077)
A. Bleeding
B. Myocarditis
C. Nephritis
D. Seizure
E. Thromboembolic events

40. What autoantibody is associated with syndromes that have overlap features? (Harrisons
17th ed., p 2076)
A. ANA
B. Anti-histone
C. Anti-RNP
D. Anti-Ro
E. Anti-Sm

41. What is the earliest manifestation of ankylosing spondylitis? (Harrisons 17th ed., p 2110)
A. Bamboo spine
B. Enthesitis
C. Limited chest expansion
D. Sacroilitis
E. Squaring of the vertebra

42. What is the most common extra-articular manifestation of ankylosing spondylitis?

(Harrisons 17th ed., p 2111)
A. Anterior uveitis
B. Aortic regurgitation
C. Cataracts
D. Inflammatory bowel disease
E. Third-degree heart block

43. About 90% of patients with active Wegener granulomatosis have a positive: (Harrisons
17th ed., p 2122)
A. Anti-myeloperoxidase
B. Antiproteinase-3 ANCA
C. HLA-B27
D. HLA-cw6

MEDICAL ONCOLOGY:

44. What is the most common side effect of chemotherapy: (Harrisons 17th ed., p 530)
A. Alopecia
B. Gonadal dysfunction
C. Myelosuppression
D. Nausea
E. Vomiting

45. What is the most common type of lung cancer? (Harrisons 17th ed., p 552)
A. Adenocarcinoma
 B. Bronchioavleolar carcinoma
C. Oat cell carcinoma
D. Small cell carcinoma
E. Squamous cell carcinoma

46. Whether the tumor can be entirely removed by a standard surgical procedure such as
lobectomy or pneumonectomy, is called: (Harrisons 17th ed., p 555)
A. Curability
B. Operability
C. Resectability
D. Screening

47. It results from local extension of a tumor growing in the apex of the lung with
involvement of the eighth cervical and first and second thoracic nerves, with shoulder
pain that characteristically radiates in the ulnar distribution of the arm, often with
radiologic destruction of the first and second ribs. (Harrisons 17th ed., p 554)
A. Horner syndrome
B. Ortner syndrome
C. Pancoast syndrome
D. Superior vena cava syndrome

48. Breast cancer screening with mammography has been shown to decrease mortality in
which of the following groups of women? (Harrisons 17th ed., p 565)
A. Under 40 years old with a positive family history
B. Between 40 and 50 years old
C. Over 50 years old
D. Over 75 years old
E. On hormone replacement therapy

49. A 73-year old male presents to your clinic with increasing low back pain. He states that
the pain is worst at night while he is lying in bed. Physical examination is normal.
Laboratory studies show an elevated alkaline phosphatase, and a lytic lesion in the L3
vertebrae on radiogram. Which of the following malignancy is most likely? (Harrisons
17th ed., p 613)
A. Gastric carcinoma
B. Non-small cell lung cancer
C. Osteosarcoma
D. Pancreatic carcinoma
E. Thyroid carcinoma

50. It is a familial cancer syndrome in which affected individuals have germ-line

abnormalities of the tumor-suppressor gene p53 and an increased incidence of soft
tissue sarcomas. (Harrisons 17th ed., p 610)
A. Fanconi syndrome
B. Gradner syndrome
C. Li Fraumeni syndrome
D. Lynch syndrome
E. Turcot syndrome

51. What is the term used to refer to bilateral ovarian masses from metastatic mucin-
secreting gastrointestinal cancers? (Harrisons 17th ed., p 605)
 A. Blummer shelf
B. Krukenberg tumor
C. Paterson-Kelly syndrome
D. Plummer-Vinson syndrome
E. Sister Mary Joseph node

52. What is the classic triad of renal cell cancer? (Harrisons 17th ed., p 592)
A. Hematuria, flank pain and flank mass
B. Erythrocytosis, hematuria and flank mass
C. Erythrocytosis, hypercalcemia and hematuria
D. Fever, pain and jaundice

53. Which of the following is the most common cause of paraneoplastic syndrome due to
ectopic ACTH production? (Harrisons 17th ed., p 618)
A. Lymphoma
B. Pheochromocytoma
C. Renal cell carcinoma
D. Small cell lung cancer
E. Thymic carcinoid

54. Epithelial carcinomas of the head and neck arise from the mucosal surfaces in the head
and neck area and typically are of what histologic type? (Harrisons 17th ed., p 548)
A. Adenocarcinoma
B. Mucoepidermoid carcinoma
C. Squamous cell cancer
D. Urothelial cancer

55. What is the primary treatment for superior vena cava (SVC) syndrome caused by non-
small cell lung cancer and other metastatic solid tumors? (Harrisons 17th ed., p 1730)
A. Chemotherapy
B. Glucocorticoids
C. Radiotherapy
D. Surgery

56. What is the most significant factor in the development of non-melanoma skin cancer?
(Harrisons 17th ed., p 546)
A. Exposure to UV-A
B. Exposure to UV-B
C. Fair complexion
D. Male sex
E. Older age

57. Acute toxicities of radiotherapy include all of the following, EXCEPT: (Harrisons 17th ed.,
p 517)
A. Bone marrow toxicity
B. Mucositis
C. Skin erythema
D. Thyroid failure

ALLERGY AND IMMUNOLOGY:

58. What is the most often used as treatment for the control of pruritus in atopic dermatitis?
(Harrisons 17th ed., p 313)
A. Mild sedating antihistamines
B. Non-sedating antihistamines
C. Oral glucocorticoids
D. Selective H2 blockers
E. Topical glucocorticoids

59. What is the most frequent side effect of intranasal high-potency glucocorticoids?
(Harrisons 17th ed., p 2069)
A. Candida overgrowth
B. Insomnia
C. Local irritation
D. Rebound rhinitis
E. Urinary retention

60. A 23-year old female complained of an annoying appearance of a linear wheal whenever
an object briskly strokes her skin. What do you call this phenomenon? (Harrisons 17th
ed., p 2065)
A. Cholinergic urticaria
B. Contact urticaria
C. Dermographism
D. Pressure urticaria
E. Sensitive skin

--END--