R1 Written Exam 2020

1. All are true about HIV cholangiopathy,

EXCEPT
A. Parvum is the most common cause
B. Papillary stenosis is the common type
C. Laboratory results can be normal
D. Medical treatment can resolve the problem
2. Which is NOT true about the Dengue Fever?
A. Aedes. egypti is the commonest vector
B. Prophylactic platelet transfusion is
recommended to prevent bleeding
3. Which is NOT true about Chikungunya Fever?
A. Steroid has a mortality Benefit
B. Joint pain can last longer and usually
debilitating
C. Aedus aegyptus is common vector
D. No specific treatment or vaccine is available
4. Which does NOT affect phosphate level
A. Klotho
B. PTH
C. ACTH
D. FGF-23
5. A 75 yr old man with hypertension and a history of
CAD scheduled for elective knee replacement, he had PCI
2 yrs back. He is on ASA, clopidogrel, Amlodipine,
Lisinopril, and atorvastatin. Which of the following
intervention isn't recommended to reduce the risk of
major perioperative cardiac complications
A. Continue Atorvastatin
B. Initiate beta blocker prior to surgery
C. Continue ASA in the perioperative period
D. start class III anti arrhythmic drug like amiodarone
6. Which of the following isn't a feature of spa
according to ASAS
A. Crohns and ulcerative colitis
B. Anterior Uveitis
C. Back pain that improve with movement
D. Arthritis
7. A 60 yr old women known HTN and Type II DM pt hospitalized
b/c of progressive dyspnea and orthopnea. On P/E she has a
raised JVP, peripheral edema and normal BP, after 4 days of
treatment she becomes Euvolemic, but the serum Cr risen from
1.6 mg/dl to 2.3 mg/dl. which of the following is incorrect
A. DM and HTN predispose to the development of cardiorenal
syndrome
B. Decrease renal venous pressure contribute to the development
of cardiorenal syndrome
C. Worsening of renal function in acute heart failure is a predictor
of early hospital readmission and mortality
D. High dose diuretics contribute to cardiorenal syndrome
8. A 70 yr old brought by her daughter with the
complaint of forgetfulness, disinterest in social
activities, sleeps most of the day, unsteady gait and
difficulty in climbing stairs. She also has constipation
and weight gain. Which laboratory test should be
ordered for this patient?
A. ANA
B. Vitamin D level
C. Serum growth hormone
D. TSH
9. Hypocomplementemia is a feature of all
except
A. Lupus nephritis
B. Hepatitis B associated membranous
nephropathy
C. SBE associated GN
D. Cryoglobulinemic GN
10. About nutritional assessment of a patient
A. SGA ass’t incorporates serum albumin
B. SGA rating A should be initiated on
intervention immediately
C. Mineral depletion can occur during refeeding
D. TPN is preferred in all not be able to take PO
11. About migraine headache duration
A. 4-72 hrs
B. 3 months
C. > 3 minutes
12. Not considered as a contaminant if reported
from a blood culture
A. Candida
B. CONS
C. Corynebaccterium
D. Micrococcus
13. Not correct about BCS
A. Angioplasty is therapeutic
B. Local risk factor plays a role
C. MPD has less role than PV
14. Which of the following isn't a presentation of
serotonin syndrome
A. HTN
B. Diarrhea
C. Clonus
D. Miosis
15. Which of the following isn't a poor
prognostic marker of CLL
A. P53 mutation
B. ZAP 70
C. CD38 positivity
D. Mutated IG heavy chain gene
16. Preferred treatment of prolactinoma
A. Medical treatment
B. Surgical resection
C. Radiation
17. Incorrect about typhoid fever
A. Bone marrow culture is a gold standard
B. Widal test detects agglutinating antibodies
C. Animal reservoir for the etiologic bacteria
18. False regarding COVID – 19
A. Endothelial injury is the hallmark of severe
disease
B. Reinfection is possible
C. Chloroquine isn't an effective prophylaxis
D. Remdesevir is effective in reducing mortality
in severe COVID
19. Which of the following isnt considered for
ALL
A. Hyperdiploid karyotype
B. T(4;11)
C. Ph+ ALL with persistent positivity
20. Which of the following condition benefit
most from ACEI
A. Anterior MI with EF 60%
B. Inferior MI with EF 55 %
C. Stable angina
21. Not true about Eosinophilic esophagitis
A. Common in males
B. Diagnosis require 10 Eosinophil/HPF
C. Familial predisposition has a minor role
D. Food allergens are common precipitating
factors
22. You have attended a farmer with rheumatic valvular heart disease
for many years. 2 yrs later he had an elective replacement of the
mitral valve with st. Jude prosthetic valve and tricuspid annuloplasty.
His dentist calls for you for advise regarding endocarditis prophylaxis
prior to dental extraction. The patient never had IE. 1 yr ago, he
developed a marked urticarial rash associated with bronchospasm
following ampicillin administration prior to dental extraction. How
would you now advise the patient and his dentist?
A. Clindamycin 600mg orally or IV 1hr before the procedure
B. Ceftriaxone 1g IV 1 hr before the procedure
C. Erythromycin stearate 1g orally before the procedure
D. Naficilline sodium 2g IV 1hr before the procedure
23. A patient has unexplained CLD, how can you
make the diagnosis of non- alcoholic liver
disease?
A. Alcohol intake<20g/day
B. Metformin should be initiated
C. Weight loss doesn’t affect the management
D. Diagnosis requires abnormal hip-waist ratio
24. A cirrhotic bleeding patient on warfarin with
elevated PT and PTT. Which factor is expected to
be normal if there is no underlying DIC?
A. Factor XI
B. vWAg
C. Factor VIII
D. Factor II
25. A patient with massive UGIB who is tachycardic and
BP 90/60 with orthostatic drop, Hgb result is pending.
Regarding the transfusion strategy for these patient to
follow
A. Packed RBC is better than whole blood
B. Knowing the underlying cause doesn’t have an
impact
C. In Comorbidities: IHD liberal transfusion should be
followed
D. Liberal transfusion is required for variceal bleeding
26. Which TKI is effective in CML with T315I
mutation?
A. Nilotinib
B. Ponatinib
C. Dasatinib
D. Bosatinib
27. Which of the following is wrong regarding
hepatorenal syndrome?
A. Plasma renin activity is usually high
B. It can occur with or with out ascites
C. Infection often trigger the situation
D. It can occur in patients with Subacute or
chronic liver failure and portal hypertension
28. Which of the following isn't a complication
of DKA?
A. Metabolic acidosis
B. Cerebral edema
C. Hypokalemia
D. Respiratory acidosis
29. Which of the following is contraindicated in
primary cardiac amyloidosis?
A. ACEI
B. Beta blocker
C. Loop diuretics
30. Which of the following is wrong about
Pancoast tumor?
A. MRI is better than CT for the diagnosis
B. Horner syndrome can be a manifestation
C. Shoulder pain is the most common symptom
D. Small cell lung Ca is the leading cause
31. Which of the following doesn’t occur in
normal pregnancy?
A. Elevated GFR
B. Low serum osmolality
C. Glycosuria
D. Hypernatremia
32. Which of the following is contraindicated for
intrathecal administration?
A. Hydrocortisone
B. Vincristine
C. Methotrexate
D. Cytarabine
33. Which subtype of Hodgkin lymphoma is
associated with HIV?
A. Mixed cellularity
B. Lymphocyte rich
C. Lymphocyte depleted
D. Nodular sclerosis
34. Which investigation help to distinguish
between type 2A an 2B von willebrand disease?
A. VWF:Rco/vWF:Ag ratio
B. Low dose RIPA
C. Multimer gel analysis
D. CBC
35. Which of the following focal neurologic gefici
simulate stroke?
A. Hypoglycemia
B. Hyponatremia
C. Hypocalcemia
D. Hypercalcemia
36. What is the maximum dose of vincristine in
RCHOP regimen??
37. What is the most common histologic lesion
in patient with AKI and MM?
A. Cast nephropathy
B. Urate nephropathy
C. Amyloidosis
D. Light chain deposition disease
38. Which of the following is false regarding
COVID-19?
A. Chloroquine is proved to be effective as a
treatment and prophylaxis
B. Reinfection with SARS- Cov-2 is possible
C. Endothelial injury is the hallmark of severe
disease
D. Remdesevir is effective in reducing mortality in
severe disease
39. Which component of language often left as a
residual abnormality?
A. Comprehension
B. Repetition
C. Agraphia
D. Anomia
40. SGLT-2 inhibitors are associated with which
of the following
A. Pancreatitis
B. DKA
C. Hypoglycemia risk
D. Bladder malignancies
41. Sustained metabolic alkalosis is due to
A. Impaired bicarbonate excretion
B. Depletion of body potassium stores
C. Increased production of mineralocorticoid
D. Depletion of body chloride stores
42. The hemorrhagic diathesis in CKD patients is
typically mirrored by which of the following?
A. Prolongation of prothrombin time
B. Severe thrombocytopenia
C. Prolongation of bleeding time
D. Prolongation of aPTT
43. The beta lactamase inhibitors clavulunate,
sulbactam and tazobactam effectively inhibit
many of the beta lactamases except
A. P.aerugiosa
B. Bacteroid fragilis
C. Staph aureus
D. H.Influenza
44. Which factor deficiency isn't associated with
bleeding diathesis
A. Factor XII
B. Factor VII
C. Factor V
D. Fibrinogen
45. What is the mechanism of ibrutininb
A. Bruton’s tyrosine kinase inhibitor
B. Inhibitor of delta isoform of P13K
C. BCR/ABL TKI
D. Bispecific T-cell engager
46. Not true statement about the use of adenosine in the
management of cardiac arrhythmias
A. Slow peripheral IV administration of 6-12mg of
adenosine is useful in terminating supraventricular
tachycardia involving the AV node
B. Adenosine may be ineffective in patients who have
consumed caffeine
C. Flushing, dyspnea, and chest pressure are all common
side effects of adenosine therapy
D. Adenosine administration may aid in the diagnosis of
wide QRS complex tachycardia
47.How do you make the diagnosis of AML
regardless of the blast percentage?
A. Inv 3
B. T (8;24)
C. Inv 16
D. T (16;16)