DEPARTMENT OF INTERNAL MEDICINE

_B____1. All of the following are emergencies and require immediate attention and
treatment, EXCEPT:
a. acute left ventricular failure c. ventricular fibrillation
b. acute rheumatic carditis d. status asthmaticus
Priciples of internal Medicine
Harisson15th edition p1295

_A_____2. A 16 years old woman came to you with complaint of chest pain. After work-
up you diagnose her to have mitral valve prolapse. You explain to her that MVP tends
to be benign but the following may occur, EXCEPT:
a. angiodysplasia c. sudden cardiac death
b. endocarditis infective d. embolic phenomena
Priciples of internal Medicine
Harisson15th edition p1395

_D_____3. A patient has a suspicious myocardial infarction 4 hours ago. The most
reliable test is:
a. SGPT c. SLDH
b. WBC d. CK-MB
Harisson15th edition
p1495

_C_____4. The microorganisms associated with coronary heart disease are:

a. Chlamydia pneumoniae and Streptococcus pneumoniae
b. Chlamydia pneumoniae, Streptococcus pneumoniae and Helicobacter pylori
c. Chlamydia pneumoniae and Helicobacter pylori
d. Streptococcus pneumoniae and Helicobacter pylori
Harisson15th edition
p1349
_B_____5. A poverty related heart disease:
a. congenital heart disease c. coronary artery disease
b. rheumatic heart disease d. cor pulmonale
Harisson15th edition
p1369
_A_____6. Cardiac rehabilitation post-MI can be started
a. within 24 hours after admission c. not necessary
b. after discharge from the ICU d. after discharge from the hospital
Harisson15th edition
p1458

_A_____7. The single biggest risk factor in the causation of stroke:

a. hypertension c. obesity
b. cardiac disease d. none of these
Harisson15th edition
P 2372

_B_____8. Enlargement of the heart on plain PA view of a chest x ray is evidenced by a

minimal cardiothoracic index of:
a. less than 0.3 c. greater than 1.0
b. greater than 0.5 d. greater than 1.2
Harisson15th edition
p1253
_A_____9. Elevation of serum K is most toxic to the:
a. myocardium c. liver
b. kidney d. brain
Harisson15th edition
P282
_A_____10. Ventricular gallop or third heart sound is characteristic of:
a. mitral regurgita c. tricuspid regugita
b. aortic stenosi d. mitral stenosis
Harisson15th edition
P 1308

_C_____11. A 36 year old female is hypertensive and diabetic. She came in because
of an erythematous rash across the bridge of the nose. Her BP was 180/119. Which of
her medicines should be withdrawn?
a. propranolol c. hydrazine
b. nifedipine d. euglucon
Harisson15th edition
P 24

_A_____12. The most effective way to demonstrate the area of blood clot in deep
venous
thrombosis is by:
a. Doppler ultrasonography c. plain x ray
b. contrast venography d. impedance plethysmography
Harisson15th edition
P 1492

_B_____13. The usual cause of macrocytic anemia is:

a. chronic liver disease c. chronic renal disease
b. malabsorption d. iron deficiency
Harisson15th edition
P 603

_A_____14. Steppage gait is caused by:

a. bilateral pyramidal tract disease c. exaggerated lumbar lord
b. double athetosis d. bilateral foot drop
Bates 6th ed p. 616

_D_____15. Bell’s palsy is caused by damage to:

a.vagus nerve c. oculomotor nerve
b. trigeminal nerve d. facial nerve
Harisson15th edition
P 1307-1309

_C_____16. Antiplatelet agent used in preventing further TIA are the following,
EXCEPT:
a. dipyridamole c. etodolac
b. sulfinpyrazone d. aspirin
Harisson15th edition
P 2380

_C______17. The diagnosis of epilepsy is is best established by:

a. EEG c. history
b.CT scan d. physical examination
Harisson15th edition
P 2363

_A______18. The following are the cardinal signs of Parkinsonism, EXCEPT:

a. brisk reflexes c. tremor at rest, impaired postural instability
b. bradykinesia d. rigidity

Harisson15th edition
P 2406
_A_____19. The neurotransmitter deficient in Parkinsonism is
a. dopamine c. melatonin
b. serotonin d. norepinephrIne
Harisson15th edition
P 2409

_B_____20. Which is NOT a feature of Parkinson’s disease?

a. expressionless facies c. festinating gait
b. athetosis d. cogwheel rigidity
Harisson15th edition
P 2407

_D_____21. Basal skull fracture commonly involved in head injury:

a. temporal lobe c. frontal lobe
b. parietal lobe d. occipital lobe

Harisson15th edition
P 2364
_B_____22. The initial drug of choice in trigeminal neuralgia (tic doloreux) is
a. morphine c. digitalis
b. carbamazepine d. aspirin
Harisson15th edition
P 2935

_D_____23. Very small pupils that improve with Maloxone are characteristics of
a. transtentorial hemiation c. marked increased intracranial pressure
b. severe anoxia d. narcotic overdose

Harisson15th edition
P 2567

_B_____24. The following features are seen in delirium tremens, EXCEPT:

a. hallucination
b. alkalosis
_A_____25. Cognitive effect of stress:
a. all of these
b. short attention span
_A_____26. NOT a characteristic of infantile autism:
a. thought and perceptual
disturbances predominate
b. subnormal level of intelligence
c. fver
d. hypotension
Harisson15th edition
P 2565
c. difficulty in concentration
d. tired of thinking
Harisson15th edition
P75
c. occurs before 36 months
d. abnormal non-verbal communication
Harisson15th edition
P249

_A_____27. One of the following is NOT feature of psychogenic depression:

a. flat effect c. anorexia
b. diarrhea d. lack of libido
Harisson15th edition
P 2553
_D_____28. The diagnosis of endogenous depression is bolstered by one of the
following laboratory tests:
a. serum cholinesterase c. electroencephalography
b. serum serotonin d. dexamethasone suppression

Harisson15th edition
P 2853
_B_____29. Lithium carbonate is the drug of choice for
a. hysteria c. depression
b. mania d. schizophrenia
Harisson15th edition
P 2557

_C_____30. Which goal is most important to develop a sense of intimacy?

a. finding a sexual partner
b. resolution of identity
_D_____31. NOT a mature defense:
a. humor
b. ascetism
c. finding a peer group
d. resolving moral issues
Synopsis of Psychiatry
Kaplan 9th ed p.71
c. sublimation
d. suppression
Kaplan 9th ed p.71

_C_____32. Type of schizophrenia which shows less regression of mental faculties,

emotional
response and behavior:
a. disorganized c. catatonic
b. undifferentiated d. residual
Harisson15th edition
P 2539

_B_____33. Fear of death at this age is because of the fear of abandonment:

a. 10-14 years c. 1-1/2 years
b. 2-1/2 to 5 years d. 1-1/2 to 2-1/2 years

Kaplan 9th ed p.102

_C_____34. Suicide is most commonly seen in
a. petit mal epilepsy c. affective disorders
b. schizophrenic reaction d. character disorder

Kaplan 9th ed p 861

_A_____35. A definitive contraindication to electroconvulsive therapy (ECT) is
a. brain tumor c. aortic aneurysm
b. threatened retinal detachment d. myocardial disease
Harisson15th edition
P 2558
_A_____36. The most common form of dementia in the elderly is
a. Alzheimer’s disease c. brain tumores
b. atherosclerosis d. cretinism
Harisson15th edition
P 2398
_B_____37. Definitive therapy of sleep apnea:
a. electrophrenic stimulation c. respiratory stimulants
b. tracheostomy d. nocturnal oxygen inhalation
Harisson15th edition
P 1376
_B_____38. A secretion is TENACIOUS if it
a. is not clear c. smells like decaying matter
b. is sticky and not easily pulled d. has salty taste
apart
Harisson15th edition
P 1443
_D_____39. Pathognomonic radiologic sign of pneumothorax:
a. tram line c. hyperinflation
b. hyperluscency d. visceral pleural line
Harisson15th edition
P 1376
_D_____40. In what condition is the lung ventilated but not perfused?
a. emphysema c. viral pneumonitis
b. atelectasis d. embolism
Harisson15th edition
P 1361

_A_____41. A respiratory consequence not found in pulmonary embolism:

a. fetor hepaticus c. pulmonary infarction
b. respiratory alkalosis and tachyp d. pneumoconstriction
Harisson15th edition
P 1361
_B_____42. Bronchiectasis is commonly a sequel to
a. carcinoma of the lung c. pulmonary embolism
b. infection d. heart failure
Harisson15th edition
P 1541
_C_____43. Total lung capacity is usually increased with
a. congestive failure c. emphysema
b. cystic fibrosis of pancreas d. hyaline membrane disease

Harisson15th edition
P 1498
_A_____44. The honeycombed density seen on chest x-ray is characteristics of
a. bronchiectasis c. acute pulmonary edema
b. cardiac asthma d. pulmonary TB in a diabetic
Harisson15th edition
P 1541

_A_____45. Which most closely simulate military TB?

a. histoplasmosis c. chlamydia
b. candidiasis d. mycoplasma
Harisson15th edition
P 959

_D_____46. Lung abscess is a complicating factor in comatose patients. This is due to

a. decubitus ulcers c. thrombophlebitis
b. repeated convulsions d. aspirations

Harisson15th edition
P 1536
_D_____47. The term “coin lesion” is diagnosed because of
a. hemoptysis c. aspirated foreign body
b. bronchoscopy d. chest x-ray finding

-B_____48. The best screening tool available for peripherally located lung cancer is the
a. sputum cytology c. chest radiograph
b. bronchoscopy d. CT scan
Harisson15th edition
P 1307

_D_____49. In respiratory acidosis, one of the following is retained:

a. HCI c. oxyhemoglob
b. sulfates d. carbon dioxide
Harisson15th edition
P263
_A_____50. A chronic smoker who develops primary lung malignancy is apt to have
a. small cell carcinoma c. epidermoid carcinoma
b. adenocarcinoma d. large cell carcinoma
Harisson15th edition
P306

_C_____51. Type of bronchogenic carcinoma which commonly produces endocrine

manifestations:
a. epidermoid Ca c. small cell carcinoma
b. squamos Ca d. Adenocarcinoma
Harisson15th edition
P508
_C_____52. The risk of a non-smoker married to a smoker is
a. increased for ischemic heart disease only
b. not increased in any significant amount
c. increased by approximately 25% for lung cancer and ischemic heart disease
d. increased for lung cancer only
Harisson15th edition
P808
_B_____53. The highly acidic gastric content is neutralized in the duodenum largely by
the
a. bile acids c. hydroxyl groups from the ileum
b. bicarbonate from the pancreas d. residual secretion of the esophageal goblet
cell
Harisson15th edition
P1746

_C_____54. Which specific electrolyte disturbance in the body fluid leads to clinical
disorders?
a. iron c. hydrogen
b. zinc d. potassium
Harisson15th edition
P1796
_C_____55. Fat absorption in the intestines is facillated by
a. amylase c. bile salts
b. mucopolysaccharides d. mucin
Harisson15th edition
P1765

_D_____56. There may be extra-gastric sources of gastrin, excessive secretion of

which may lead to peptic ulcer. The most common nongastric source of this
gastrin is
a. gall bladder c. uterus
b. lung d. pancreas
Harisson15th edition
P1739

_C_____57. Spasms of abdominal pain that are colicky are most likely due to
a. peritonitis c. obstructed hollow viscus
b. referred pain from the chest d. paralytic ileus
Harisson15th edition
P1803
_C_____58. Which of the following is present in the large bowel?
a. intrinsic nerves of the intestines c. absorption of water
b. extrinsic nerves of the intestines d. succus entericus

Harisson15th edition
P1763
_D_____59. Pneumoperitoneum is present when there is
a. duodenal ulcer c. salpingitis
b. gall bladder empyema d. ruptured bowel
Harisson15th edition
P1807

_A_____60. The following pathogens are causative agents of enteric infections. Which
of the following has basent fecal leucocytes?
a. Vibrio cholera c. Campylobacter jejuni
b. diarrheogenic d. Shigella
Harisson15th edition
P909

_B_____61. Paralytic ileus is NOT pathologic in one of the following:

a. ruptured appendicitis c. bile peritonitis
b. soon after abdominal surgery d. hypokalemia
Harisson15th edition
P1803

_D_____62. A rise in BUN without renal disease, renal ischemia, obstruction is most
likely to be due to
a. severe liver disease c. hemolytic anemia
b. eclampisa d. massive GI bleeding

Harisson15th edition
P1650
_B_____63. After major abdominal surgery there is
a. gastric hyperacidity c. volvulus
b. transient ileus d. reflux esophagitis
Harisson15th edition
P1495

_A_____64. For disorders in the GIT such as ulcers, diverticula, strictures, new growths
and motility disorders the test that is most useful is
a. x-ray c. MRI
b. CT scan d. ultrasound
Harisson15th edition
P1752

_B_____65. Ascitic fluid in cirrhosis of the liver would be expected to show

a. more than 1000 white cells/cubic c. hemorrhage
mm. d. positive malignant cytology
b. protein less than 2.5%
Harisson15th edition
P1838

_C_____66. Ruptured peptic ulcer with pneumoperitoneum is most easily and safely
diagnosed by
a. barium swallow c. plain x-ray of abdomen
b. ultrasound d. paracentecis of the abdomen
Harisson15th edition
P1732

_A_____67. An upright firm of the abdomen shows free air in the peritoneum. This
means
a. perforated viscus c. volvulus
b. diabetic acidosis d. hyperkalemia
Harisson15th edition
P1752
_B_____68. Colonoscopy compared to Ba enema as a diagnostic procedure for
colorectal cancer has
a. less cost c. greater chance of misdiagnosis
b. greater chance of perforation d. less chance of hemorrhage
Harisson15th edition
P1737,529

_D_____69. In an upright scout film of the abdomen, a step-ladder appearance of the

bowel indicates
a. enterocolitis c. peritonitis
b. volvulus d. bowel obstruction
Harisson15th edition
P1809

_B_____70. Which of the following esophageal disorders is best characterized by

dysphagia for both solids and liquids?
a. Schatzki’s rings c. benign esophageal stricture
b. achalasia d. esophageal carcinoma
Harisson15th edition
P1791

_D_____71. The fungus that frequently invades the upper GIT and causes esophagitis
is the
a. Blastomyces c. Cryptococcus
b. Aspergillus d. Candida
Harisson15th edition
P1186

_D_____72. Lower esophageal sphincter (LCS) dysfunction is not uncommon. Which of

the following is useful in evaluation LES pressure?
a. endoscopy c. Ba swallow
b. acid reflex test d. esophageal manometry
Harisson15th edition
P223

_A_____73. Repeated severe epigastric pain 1 hour after heavy meals in a 40-year old
obese female is usually due to
a. gall stones c. peptic ulcer
b. pancreatitis d. meteorism
Harisson15th edition
P1883

_B_____74. Stress ulcer that occurs with burns, brain tumors and shock present
commonly as
a. hematochezia c. severe abdominal pain
b. melena d. intestinal obstruction
Harisson15th edition
P1760
_B_____75. In the classification of polyps of the colon, what is/are considered
precancerous?
a. lymphosarcomatous c. Peutz-Jegners syndrome
b. all of these are correct d. adenomatous
Harisson15th edition
P1732
_D_____76. Most of the ammonia is formed in the
a. small intestines c. kidneys
b. lungs d. liver
Harisson15th edition
P1867
_B_____77. Albumin is a protein that is synthesized in the
a. pancreas c. nephron
b. liver d. lymphoid tissue
Harisson15th edition
P1813

_C_____78. The urea cycle converts a potentially toxic substance to a more innocuous
substance. The toxic material is
a. urea c. ammonia
b. uric acid d. ornithine
Harisson15th edition
P2302
_D_____79. Ammonia is highly toxic. It is detoxified by its transformation in the liver into
a. alpha-ketoglutarate c. methionine
b. uric acid d. none of the above
Harisson15th edition
P1540
_D_____80. Ammonia is most toxic when
a. the gut is sterile c. low serum Na+
b. serum K is high d. blood pH is high
Harisson15th edition
P2602
_C_____81. Which constitutes a major portion of the bile?
a. cholesterol c. water
b. bile salts d. bile acid
Harisson15th edition
P1880

_D_____82. The synthesis of bile salts takes place in the

a. common bile duct c. pancreas
b. duodenum d. none of the above
Harisson15th edition
P1880

_C_____83. Pruntus is most severe in jaundice due to

a. portal dirrhosis c. biliary cirrhosis
b. hepatic schistosomiasis d. amebis liver abscess
Harisson15th edition
P1860
_C_____84. A large liver is least expected in
a. acute malaria c. chronic portal cirrhosis
b. typhoid fever d. chronic heart failure
Harisson15th edition
P1858
_B_____85. Long-lasting marker of hepatitis B:
a. anti-HBo c. anti-H
b. HbsAg d. anti-HBe
Harisson15th edition
P1829

_B_____86. A patient with complete biliary obstruction developed bleeding tendencies.

The
diagnostic test of choice is
a. fibrinogen blood level c. platelet count
b. prothrombin time d. BUN
Harisson15th edition
P1816
_C_____87. An elevated serum SPGT is probably due to
a. jaundice c. liver necrosis
b. cholestasis d. bleeding varices
Harisson15th edition
P1815
_B_____88. Delta viral hepatitis can only occur together with
a. hepatitis A c. leptospirosis
b. hepatitis B d. hepatitis
Harisson15th edition
P1830

_A_____89. Which of the following drugs will be less potent in the presence of severe
liver disease?
a. phenytoin c. tetracycline
b. imipramine d. lidocaine
Harisson15th edition
P1814
_D_____90. The most common benign neoplasm of the liver
a. sarcoma c. adenoma
b. focal nodular hyperplasia d. hemangioma
Harisson15th edition
P533

_B_____91. Most common primary tumor that spread/s to the liver is/are
a. prostate c. melanoma
b. gastrointestinal tumor d. bone
Harisson15th edition
P535

_D_____92. Pancreatic lipase preferentially splits triglycerides to form free fatty acids
and
a. delta-monoglycerides c. glycerol
b. alpha-monoglycerides d. beta-monoglycerides
Harisson15th edition
P1792

_A_____93. The least symptomatic stones in the billiary tree are located in
a. gallbladder c. cystic duct
b. neck of the gall bladder d. common bile duct
Harisson15th edition
P1881

_B_____94. The following pancreatic enzymes are potentially harmful, EXCEPT:

a. lipase c. lysolecithinase
b. none of these d. elastase
Harisson15th edition
P1891

_C_____95. Blood level that does NOT rise in acute renal failure:
a. creatinine c. sodium
b. potassium d. uric acid
Harisson15th edition
P1650

_B_____96. Pain described as “renal colic” usually indicates

a. kidney stone c. bladder stone
b. ureteral stone d. pyelonephritis
Harisson15th edition
P1722
_A_____97. Which is acquired from infected water vapor or moist air inhaled?
a. legionella c. pseudomonas
b. mononucleosis d. typhus
Harisson15th edition
P871

_C_____98. Amylase is NOT elevated in one of the following diseases:

a. choledocholithiasis c. penetrating peptic ulcer
b. acute gastritis d. mumps
Harisson15th edition
P89,1817

_D_____99. Urobilinogen is produced in the

a. renal tubules c. red blood cell
b. liver d. intestinal mucosa
Harisson15th edition
P1871

_D_____100. Conjugation of bilirubin is a function of the

a. Kupfer cells c. intestinal mucosa
b. erythrocytes d. none of the above
Harisson15th edition
P1817

@@@END OF EXAM@@@
REFERENCES:

1. Harrison’s: Principles of Internal Medicine Edition 2002

2. Braunwald, Fauci Edition 2002
3. National Medical Study in Medicine, 8th Edition
4. Board Review Series in Medicine; 4th edition

ANSWERS: 7. a 15. d
8. b 16. c
1. b 9. a 17. c
2. a 10. d 18. a
3. d 11. c 19. b
4. c 12. a 20. d
5. b 13. b 21. b
6. a 14. a 22. d
23. b 83. c
24. a 84. b
25. a 85. b
26. a 86. c
27. d 87. b
28. b 88. a
29. c 89. b
30. d 90. b
31. c 91. d
32. b 92. a
33. c 93. b
34. a 94. c
35. a 95. b
36. b 96. a
37. b 97. c
38. d 98. d
39. d 100. d
40. a
41. b
42. c
43. a
44. a
45. d
46. d
47. b
48. d
49. a
50. a
51. c
52. b
53. c
54. c
55. d
56. c
57. c
58. d
59. a
60. b
61. d
62. b
63. a
64. b
65. c
66. a
67. b
68. d
69. b
70. d
71. d
72. a
73. b
74. b
75. d
76. b
77. c
78. d
79. d
80. c
81. d
82. c