IM Samplex

• The recorded history of an illness should: a. Include all the facts of medical significance to the patient B. Oldest events should be given the most attention C. Patients should have the opportunity to tell their own story of the illness with frequent interruption and when appropriate should receive expressions of disinterest, discouragement and sympathy from the physician D. Any event related by a patient, however trivial or seemingly irrelevant, may not provide the key to solving the medical problem

  Answer:A
• The review of system is A. Similar to the past medical history B. Not important and can be omitted from history taking at anytime C. To be asked first before the chief complaint D. Important to elicit features of an underlying disease that might not be mentioned in the patient’s narrative

  Answer: D
• The family history: A. Contains only the demographic information of the relatives of the patient B. Is only limited to the immediate family members C. Not only identifies rare genetic disorders or common exposures but often reveals risk factors for common disorders such as coronary heart disease, hypertension, autoimmunity and asthma D. Only pertains to the records of hospital confinement of family members

  Answer: C
• In the conduct of physical examination: A. Its purpose is to identify physical signs of disease B. The significance of these subjective indications of disease is lessened when they confirm a functional or structural change already suggested by the patient’s history C. It should be done according to the physician’s comfort and modesty D. The examination of a new patient must extend from head to toe in a subjective search for abnormalities Answer: A
• The results of the examination, like the details of the history, should be recorded: A. Hours later B. At the time they are elicited C. The following day D. After one week Answer: B
• Because physical findings can change with time the physical examination: A. is to be repeated once only B. Can always be done in a disorderly manner C. Should be repeated as frequently as the clinical situation warrants D. Is never to be recorded Answer: C
• A 31-year-old female comes to you complaining of low back pain, fever, vomiting, and painful urination for the past two days. She has on and off UTI in the past five years with diabetes but non-compliant to medications. She tested negative in the pregnancy test and only took Paracetamol 500 mg/tablet, 1 tablet every 4 hours. You are considering a complicated urinary tract infection. What diagnostic test/s are you going to request? A. Urinalysis (mid-stream clean catch) B. CBC with platelet count C. KUB ultrasound D. CBC, Urinalysis, KUB Ultrasound Answer: D
• In the proper practice of medicine, physicians must weigh the expense involved in laboratory procedures against the value of the information these procedures are likely to provide. Thus, A. Physicians generally request “batteries” of multiple tests, which often prove useful and can be performed with a single specimen at relatively low cost B. Single laboratory test is often offered C. The tests to be ordered should not be parallel to the diagnosis D. Diagnostic test/s should not be done because it is expensive Answer: A
• The Team-Based Care approach in the management of patient care is exemplified thru: A. In important setting, care may involve multiple consultants along with the primary admitting physician B. Physicians should not optimize any forms of communication (face-to-face or by phone) and thoughtful planning C. Management plans and treatment options should not be outlined succinctly for the patient D. Another dimension of team-based care involves non-allied health professions Answer: A
• The primary care physician: A. Should not explain the role of other specialists in the management team to reassure patients that they are in the hands of physicians best trained to manage their current illness B. It is the duty of the patient’s principal or primary physician to provide cohesive guidance through an illness C. Primary care physician must not be familiar with the techniques, skills, and objectives of specialist physicians and allied health professionals D. Should not be aware of the patient’s medical history at all times Answer: B
• The clinical practice guidelines: A. Should be strictly followed and is appropriate to all patients B. It cannot provide a useful framework for managing patients with particular diagnoses or symptoms C. Aid physicians and other caregivers in making diagnostic and therapeutic decisions that are evidence-based, cost-effective, and most appropriate to a particular patient and clinical situation D. It is expected to account for the uniqueness of each individual and his or her illness Answer: C
• The components of a patient’s health status or quality of life can include: A. Smoking cessation capacity B. Food preferences C. Cognitive function D. Sleeping habits Answer: C
• In which of the following is informed consent executed: A. Patients need not sign consent forms for most diagnostic or therapeutic procedures B. Discouraging patients to ask questions regarding the risks and benefits of a particular procedure or set of medications C. To go over certain issues with the patient only once D. Communicating in a clear and understandable manner; fully discussing the alternatives for care Answer: D
• In which of the following is medicine on the internet disadvantageous: A. Virtually anything can be published on the Internet, with easy circumvention of the peer-reviewed process that is an essential feature of academic publications B. Patients often arrive at a clinic visit with sophisticated information about their illness, hence physicians are challenged in a positive way to keep abreast of the latest relevant information while serving as an “editor” as patients navigate this seemingly endless source of information, the accuracy and validity of which are not uniform Answer: A
• The word doctor is derived from the Latin docere which means a. Heal b. Feed c. Give d. Teach

  Answer: D
• Dr. Aniceto is a 64-year-old male physician, an expert in his field, and can confidently say that he can assess and formulate judgment effortlessly with rules of thumb. This form of clinical decision is based on which type of reasoning? a. Analytic b. Objective c. Intuitive d. Logical Answer: C
• Ms. Ceylon is a postgraduate intern in a tertiary hospital. If she sees herself assessing patients in the future using a deliberative and effortful pattern, which type of reasoning she must pursue? a. automatic b. analytic c. instinctive d. intuitive Answer: B
• TRUE regarding premature closure, EXCEPT: a. mistake in diagnosis b. undisciplined recognition c. jumping to conclusion d. based on all relevant data Answer: D
• Diagnostic hypotheses that are based on memorized patterns is termed as __________ a. availability heuristics b. anchoring heuristics c. representativeness d. reconsideration Answer: C
• TRUE regarding diagnostic testing, EXCEPT: a. test facilitates diagnosis and appropriate treatment b. performing tests reduce the uncertainty of diagnosis c. expedites treatment without patient history d. diagnostic results help in giving patient prognosis Answer: C
• Which of the following is TRUE regarding false negative rate? a. a proportion of patients with the disease who have negative test b. reflects how well the new test identifies patients with disease c. proportion of patients with disease as defined by gold standards d. reflects how well the new test correctly identifies those without disease Answer: A
• Which of the following is TRUE regarding the false positive rate? a. proportion of patients without the disease who have positive test b. reflects how well the new test identifies patients without disease c. proportion of patients with the disease who have negative test d. proportion of patients without disease as defined by gold standard Answer A
• Patients >64 years old are at risk for having fractures, thus a preventive intervention recommended for this population is ______ a. vitamin E b. vitamin C c. vitamin D d. None of the above Answer: C
• According to US Preventive Services Task Force, ALL adults are recommended to be screened for the following conditions, EXCEPT: a. depression b. alcohol misuse c. hypertension d. aortic aneurysm Answer: D
• Principles of screening, EXCEPT: a. made for diseases that are poorly understood at present b. tests should be available and acceptable to the population c. there should be a latent stage of the disease d. facilitates and treatment should be available Answer A
• Dr. Helena Solaire has been a cardiologist for 15 years. She sees more than 20 patients per day. In the waiting area, her assistant heard from a patient’s relative saying that Dr. Solaire spends time discussing the patient's condition in simplest terms and explanations. Which type of cognitive shortcut applies here? a. representation b. Occam’s razor c. availability d. anchoring Answer: b
• TRUE about simplicity heuristics, EXCEPT: a. may adequately account patient’s symptoms b. errors can be made using this leading to neglect c. biological basis exists using this principle d. unexplained significant findings may occur Answer: C
• This principle involves judgment based on how easily prior similar cases or outcomes can be brought to mind a. anchoring b. simplicity c. stickiness d. availability Answer D
• A 31-year-old, male, alcoholic beverage drinker, came to the clinic due to joint pain involving the big toe and ankle. The general practitioner assumed it was gouty arthritis in flare without asking about pertinent history relating to other types of arthritis such as viral or bacterial arthritis. What kind of process was used in the scenario? a. complex judgment b. pattern recognition c. effortful pattern d. slow methodical Answer B
• The first patient she handled was a case of an elderly presented with sudden dyspnea. She recalled having a similar case which she handled as pneumonia during internship. Therefore, she also did a similar evaluation for a pulmonary disease. However, the patient eventually found to have acute myocardial infarction that might contribute to developing ischemic cardiomyopathy. What kind of cognitive shortcut was demonstrated in the case scenario? A. Representativeness B. Memorized pattern C. Availability D. Anchoring Answer C
• Dr. Santos was visited by a 65-year-old female who is anxious about having Osteoporosis. Which of the following is the preferred test to request according to the US Preventive Services Task Force? A. CT Scan B. DXA Scan C. Ultrasound D. Spine MRI Answer B
• A 23-year-old female, married, came to the clinic with husband to ask about preventive measures to avoid occurrence of neural tube defects in their future baby. Which preventive intervention would you recommend? A. Ferrous Sulfate B. Vitamin D C. Folic Acid D. Calcium Answer: C
• What type of pain is observed to be persistent to patients who suffered from thalamic infarction? A. Central neuropathic B. Peripheral neuropathic C. Somatic nociceptive D. Visceral nociceptive Answer: A
• Abnormal perception of pain from a normally non-painful stimulus can be explained by what mechanism? A. Enhanced excitability of dorsal horn cells during inflammation B. Decrease in production of ion channels of peripheral nerves C. Increase in opioid receptors D. Increased activity of type B nerve fibers from neuronal inflammation Answer: A
• Pain modulation via endogenous opioids involves which of the following structures? A. Pontine tegmentum B. Anterior insular cortex C. Periaqueductal gray matter D. Ventromedial medulla Answer: C
• Pain modulation via endogenous opioids involves which of the following structures? A. Pontine tegmentum B. Anterior insular cortex C. Periaqueductal gray matter D. Ventromedial medulla answer: C
• A 70 years old female had shingles 10 weeks prior. She consulted due to persistent pain from the area affected (right T12 level) despite trial intake of the following medications: Acetaminophen, Naproxen, Ketorolac, Pregabalin and Gabapentin. A tricyclic antidepressant (duloxetine) was prescribed. How could this medication be able to help with the patient's pain? A. It potentiates the descending pain modulation pathway B. It inhibits the inflammation process which prevents peripheral and central sensitization Answer A
• A 72 years old male diagnosed with prostate cancer 2 years ago, now complains of low back pain, described as sharp and worsens with movement. Magnetic resonance imaging showed metastasis to the lumbar spine. What type of pain is most likely observed in the patient? A. Central neuropathic B. Peripheral neuropathic C. Somatic nociceptive D. Visceral nociceptive Answer: C
• A 59 years old male complains of 3 days of history chest pain, described as sharp, worsened by deep breathing (both during inhalation and exhalation), localized in the retrosternal area, radiating to left shoulder and arm. The pain would improve whenever he sits up and upon leaning forward. There are no signs of dyspnea. What is the most likely consideration given these clinical features? A. Myocardial infarction B. Pulmonary embolism C. Pericarditis D. Acute aortic syndrome Answer: C
• A 34-year-old male was brought to ER due to severe abdominal pain localized in the right lower quadrant. Vital signs were as follows: BP 140/90mmHg, HR 90bpm, RR 21cpm, T 37°C. He underwent an appendectomy 5 years ago. Which of the following conditions can be considered? A. Appendicitis B. Salpingitis C. Nephrolithiasis D. Splenic abscess Answer: C