Cardio.

Hema (Definitive) 1st sem 2013

Dr. Payawal Midterm Exam Sept. 3, 2013

1. Sinus Bradycardia

2. Atrial Flutter

3. Premature Atrial
Contraction

4. Normal ECG

5. Premature Junction
Contraction

Regularly occurring PQRST

Rate < 60 / min

Atrial rate = 220-300/min

( P as flutter waves )
Variable degree of AV block
( irregular RR interval )

Prematurely occurring PQRTS

complex
P wave different in configuration
from the sinus beat
PR interval often long
QRS narrow

Look at the p waves:

rate is 60-100/min
cycle length does not vary by 10%
PR interval is 0.12 sec. or more

Prematurely occurring PQRST.

Inverted P wave that may precede,
be incorporated within, or may
follow the QRS complex.
QRS narrow.

Cardio. Hema (Definitive) 1st sem 2013

Progressive lengthening of PR
interval w/ intermittent drop beats
.

7. Atrial Fibrillation

No discernible P waves
Irregular RR interval

8. Asystole

hmmmm

At least 3 consecutive PVCs

Rapid, bizarre, wide QRS
complexes
(> 0.10 sec)
No P wave (ventricular impulse
origin)
Within period of observation, one
P wave is not followed by a QRS
complex.
No change in P-R interval before
the transient failure of atrioventricular conduction.
n P waves to (n-1) QRS
complexes for each example of
transient type II block. (n will be
3 or more*)
Fixed PR interval
w/ intermittent
drop beats .

6. Mobitz I

9. Ventricular tachycardia,
monomorphic

10. Mobitz II

Cardio. Hema (Definitive) 1st sem 2013

11. Torsades de pointes

12. First degree heart block

13. Premature Ventricular

complex

14. Third degree heart block

P waves present
QRS complexes present
P waves morphology and axis usual
for the subject
QRS complexes morphology and
axis usual for the subject
One P wave to each QRS complex
P-R interval constant
P-R interval must be prolonged
( i.e. > 0.21 sec )
Prematurely occurring complex.
Wide, bizarre looking QRS
complex.
Usually no preceding P wave.
T wave opposite in deflection to
the QRS complex.
Complete compensatory pause
following every premature beat.
No recognizable consistent or
meaningful relationship between
atrial and ventricular activity
QRS complexes often abnormal in
shape, duration and axis
(occasionally normal)
QRS morphology constant
QRS rate constant ( 15-60
beats/min )
Any form of atrial activity seen
(most commonly sinus initiated)

Cardio. Hema (Definitive) 1st sem 2013

15. Sinus Tachycardia

Regularly occurring PQRST

Rate > 100 / min

16. Lateral walllead I

NOTE:
Lateral wall Lead I, AVL, V5, V6
Inferior wall Lead II & 3, AVF
Anterior wall V3, V4
Anterior septal wall V1, V2
No specific view AVR
17. Placement of V5 5th ICS anterior axillary line
NOTE:
V1 4th ICS right sternal margin
V2 4th ICS left sternal margin
V3 midway between V2 & V4
V4 5th ICS MCL
V5 5th ICS AAL
V6 5th ICS midaxillary line (MAL)
18. The cell membrane is impermeable to entry of
sodium ions during which phase of the action
potential?

phase 4 (a.k.a. RMP)

phase 0
phase 2
phase 1
NOTE:
Phase 0 aka Rapid depolarization
Na moves rapidly into the cell
Ca moves slowly into the cell
Phase 1 Early repolarization
Na channels close
Transient K efflux
Phase 2 Plateau phase
Ca cont. to flow in
K cont. to flow out
Phase 3 Rapid repolarization
Large amt. of K diffuse out as the K channels
open
Inactivation of Ca channels
19. ?
A 35 y/o F, came in at the ER complaining of
progressive SOB and DOB for the past month. She is non
diabetic and non smoker, non alcoholic. On PE she had
a BP of 130/95, HR 110/min and RR of 30/min. Her apex
beat is displaced at 6th ICS LAAL with a loud S3, no
murmurs were appreciated. She had crackles mid to
base in both lung fields with a +1 bipedal edema. Her
ECG showed:

(sorry no images but PE correlates well with DCMP &

Heart Failure)
Basis: S3 (indicative of fluid overload)
Crackles, peripheral edema, displaced apex beat
point to DCMP
20. The electrical axis on her 12 lead ECG is
A. Right Axis Deviation
B. Left Axis Deviation (?)
C. Normal
D. Extreme right axis deviation
NOTE:
Lead I (+), AVF (-) = left axis deviation
Lead I (-), AVF (+) = right axis deviation
Lead I (-), AVF (-) = right axis deviation
21. Her 12 ECG shows
A. Right BBB
B. Right Ventricular hypertrophy
C. Left Ventricular hypertrophy (?)
D. Left posterior hemiblock
E. None of the above
21. Her clinical findings are compatible with a diagnosis
of?
A. dilated cardiomyopathy
B. rheumatic mitral stenosis
C. inferior wall myocardial infarction
D. TOF
E. Atrial septal defect
22. To confirm your clinical impression you will request:
A. TPCK MB
B. ASO TITER
C. Serum cholesterol
D. ECG
E. ABG
23. Management would consist of the following except
A. Streptokinase
B. Captopril
C. PTCA (?)
D. Digoxin
E. A and C
F.
24. You would advise the patient to:
A. Avoid excessive salt intake
B. Undergo open mitral commissurotomy
C. Undergo patch closure
D. Undergo PTCA
E. NOTA
25. What is the prognosis for this type of heart disease?

Cardio. Hema (Definitive) 1st sem 2013

A. 75% mortality in 5 years
B. No improvement if PMC is not done
C. Coronary artery bypass grafting should be
performed to prolong life
D. Patch closure cannot be done because of
Eisenmenger syndrome
E. NOTA
26. What are the expected chest x-ray findings in this
patient?
A.
B.
C.
D.

normal sided heart

Interstitial edema
Boot shaped heart
Cut off sign of the pulmonary artery

27. ECG monitoring shows

31: Most common location of PAD:

A. Abd. aorta and iliac arteries
B. Femoral and Popliteal Arteries
C. Tibial and Peroneal
D. Radial and Brachial

32. Case: 57 year old female, hypertensive, with

diabetes, felt claudication with walking of a
distance of >200m, relieved with rest. Based on
history alone, what is the probable location?
A. Abd. aorta and iliac arteries
B. Femoral and Popliteal Arteries
C. Tibial and Peroneal
D. Radial and Brachial
33. ABI result: Right Tibial 1.4
Right Dorsalis Pedis = 1.3
Left Tibial = 1.1
Left Dorsalis Pedis = 1.0
Interpretation:
ANS = Incompressible right lower Ext & Normal
Left Lower Ext

NOTE:
ABI Classification system
A.
B.
C.
D.

Ventricular fibrillation
Fragments of shivering
Atrial fibrillation
Ventricular tachycardia

28.
29. A 60 y/o male, bus driver, hypertensive, 45 pack
years of smoking complained of left caudal pain after
walking.
ANS: clopidogrel + B blocker + stop smoking
30. What antiarrhythmic agent would you give if the
patient is successfully resuscitated with BP of 120/90
mmHg?
A.
B.
C.
D.

Verapamil
Nifedipine
Diltiazem
Metoprolol

>1.3 incompressible
1.0 1.3 normal
0.90 0.99 equivocal/borderline
0.51 0.89 mild to mod
0.41 0.50 mod to severe
<0.40 severe

Cardio. Hema (Definitive) 1st sem 2013

Dra. Deduyo Prelims
1. Best antihypertensive with 30 year old patient with asthmatic and heart rate of 110-120 bpm
a. ND CCB
c. B Blocker
b. D CCB
d.ACEi
2. Female hypertensive, bilateral kidney palpable, abdominal bruit
a. Renal artery stenosis
c.Hyperaldosteronism
b. Polycystic kidney disease
d.Pheocromocytoma
3. The patient had ECG and Cardiac Bio Markers what other test the patient need immediately to detect
CAD?
a. 2D echo
c. CXR
b. Coronary angiography
d. ---4. A 28 year old female is hypertensive with a bp of 140/100-160/100. The hypertension had been
diagnosed since 4 years ago. which antihypertensive drug is best for a 28 year old fertile female?
a. CCB
c. ACEi
b. B blocker
d. ARBs
6. 36 y/o, male, non HPN, 5cm ST elevation at I, VL, (sorry dkomaalalamsyado.) troponin of 150 ug/L
a. Stable angina
c. NSTEMI
b. Unstable angina
d. STEMI
8. -----A 62y/o male was admitted due to severe progressive chest pain. He is hypertensive with COPD
because of chronic smoking. BP is 160/90 to 166/100. ECG revealed sinus tachycardia with Tall & Peaked T
wave. Troponin T is Negative.
a. Chronic stable angina pectoris
c. NSTEMI
b. Unstable angina pectoris
d. STEMI
9. A 60 y/o patient complained of severe progressive chest pain. Bp is 180/110mmhg. ECG revealed LBBB,
(+) Troponin T
a. Chronic stable angina
c. NSTEMI
b. Unstable angina
d. STEMI
10. 70 y/o, male, (+) DM and HPN, continuous(?) severe chest pain, ST depression at II, III, V3, V4, V5 , VL(?),
positive troponin after 6 hours
a. Stable Angina
c. NSTEMI
b. Unstable angina
d. STEMI
13. Which is a contraindication for a trhombolytic therapy in ACS?
a. CVA hemorrhage
c. ST elevation.
b. 180/100
d. ST elevation
15.This is the common cause of death in acute coronary syndrome.
a.Heart failure
c. Ventricular fibrillation
b. Pneumonia
d. Sinus tachycardia
16. A 40 year old male, athletic, hypertensive but can do regular gym activities without any cardiac
symptoms
a. Stage A
c. Stage C
b. Stage B
d. Stage D
20. 61 y/o male with orthopnea, fatigue and dyspnea - diabetic with insulin treatment. With dilated
ischemic Cardiomyopathy
a. Stage A
c. Stage C
b. Stage B
d. Stage D

Cardio. Hema (Definitive) 1st sem 2013

23. Gold standard for the diagnosis of heart failure?
a. ECG
c. 2D echo Doppler
b. CXR
d. pro BNP
26. NC 30y/o, call center agent, with no previous medical illness complained of daily bilateral leg heaviness
while at work. Elevating the legs or walking would temporarily relieve the symptoms. While playing
basketball, he tripped and fell landing on his left leg. He was brought to the hospital for treatment. The leg
x-ray is negative for fracture. He was sent home with NSAIDS. 3days later the patient noticed the entire left
leg is swollen. He was brought to ER for evaluation and treatment. On measurement the right ankle is 21cm,
calf is 38cm and thigh is 50cm. On the left lower ex, the ankle measures 25cm, calf is 44cm, thigh is 54cm.
Wells score is 4. Your working impression is DVT. What initial test will you do next?
a. Venograph
c. Venous duplex scan of LE
b. D-dimer
d. CT scan of LE
e. MRA
28. Non invasive procedure to rule in pulmonary embolism: ANS VQ scan
29. Confirmed pulmonary embolism on left lung, what is the best tx. of choice
a. Direct catheter thrombolytics
c. ----b. Systemic thrombolytics
d. LMW and Dabigatran

1. Endocarditis prophylaxis is indicated in the ff:

A. prosthetic heart valves
B. previous infective endocarditis
C. VSD
D. HOCM
E. all of the above

Dr. Bartolome Prelims B1

2) Most common site of cardiac metastasis
a. Pericardium
3.) DM in CVS
a. CAD leading cause of death in DM
b. MI tend to be larger
c. abnormal pain response to MI
d. all
e.b& c
5.) A holosystolic murmur in left sternal border radiating
to the right.
a. Tricuspid regurgitation
b. VSD
c. both
d. neither

2. Most common site of metastasis in the heart

a. pericardium (ans)
b. myocardium
c. endocardium
3. Tx of Choice for ACS CABG

7.) 68 y/o male patient was noted to have systolic

murmur at the apex of the heart which radiates to the
carotids. Which of the following is unusual in severe
aortic stenosis?
A. Dyspnea
B. Exertional syncope
C. Angina
D. Hypertension
8.) 28 year old female; bp of 140/40 (kulang ata itong
given sa Q)
a. pulsus parvus et tardus
b. head bobbing
9.) 35 year old, female, with dyspnea and orthopnea, RV
heave, diastolic rumbling murmur at 5th ICS MCL
A. Tricuspid Stenosis
B. Mitral Stenosis
C. Aortic regurgitation
D. Pulmonary Stenosis

Cardio. Hema.Gastro (Definitive) 1st sem 2013

D. Dilated left atrium, normal sized ventricle
10) Graham Steell murmur high pitch decrescendo
diastolic blowing murmur noted @ Left upper sternal
border due to:
a. Aortic Regurgitation
b. Aortic Stenosis
c. Pulmonic Stenosis
d. Pulmonic Regurgitation
14) Definition of pulsus paradoxus is
a. inspiratory decline in systolic arterial pressure
b. patch of dullness above the left scapular space
c. delayed carotid upstroke
15.) A 45 y/o female patient was brought to the ER due
to dyspnea. She is known to be diagnosed with breast
malignancy. Cardiac Tamponade is suspected. Which is
not a manifestation of Cardiac Tamponade?
A. Increased arterial pressure
B. Neck vein engorgement
C. Faint heart sounds
D. Pulsus paradoxus
18.) PDA except?
A. Loud S1 & S2
B. Differential Cyanosis
C. Machinery Murmur
D. AOTA
19.) A 35 year old male - pleuritic chest pain radiating to
the trapezius ridge on auscultation, grating sound. What
is the ECG finding?
A. Widespread ST elevation with concavity
B. (something about sa QRS)
C. (something about sa Q wave)
21.) A 53 year old male in the ER presented with neck
vein distention, ascites, bipedal edema. No S3 no
murmur with Kussmaul's sign. The patient most likely
has:
a. cardiac tamponade
b. acute pericarditis
c. constrictive pericarditis
d. tricuspid regurgitation
23) Radiologic finding of mitral stenosis (MS)?
A. water bottle shaped (pericardial effusion)
B. "3 sign" (COA)
C. boot shaped, normal sized heart (TOF)

26.) What is the most common location of syphilitic

aneurysm?
ANS: ascending aorta

1. Most common site of acute aortic dissection

A. ascending aorta
B. aortic arch
C. infra abdominal aorta
D. descending aorta
E. supra abdominal aorta
5. Clinical criteria Takayasu arteritis
A. age < 40
B. systolic BP? >40
C. Brachial artery...
D. Carotid pulse....
8. Dynamic maneuver to make MVP murmur click sound
earlier?
A. Standing (early)
B. Squatting (late)
C. Isometric (late)
D. Valsalva's (late)
9. Valvular murmur that increases during inspiration?
A. Standing (early)
B. Squatting (late)
C. Isometric (late)
D. Valsalva's (late)
15. Routine antimicrobial prophylaxis needed, EXCEPT
A. AR
B. MVP
C. PDA
D. VSD
18. True of PDA
A. murmur s1 to after s2 upper sternal border
B. machinery like murmur
C. differential cyanosis may be present
D. AOTA
E. B&C
ECG in acute pericarditis widespread
ST-segment elevation
20. Radiologic finding in mitral stenosis
A. water bottle

Cardio. Hema.Gastro (Definitive) 1st sem 2013

B. 3 sign
C. boot shaped
D. Large atrium and normal ventricle
26. 45 yo F, hx of breast ca w/ cardiac tamponade.
Features of cardiac tamponade EXCEPT:
A. Increased arterial pressure
B. Neck vein distention
C. Faint heart sounds
D. Pulsus paradoxus
30. Relationship of DM and cardiovascular disease
A. Most common cause of death in DM is coronary
artery disease
B. In DM, MI is larger in size
C. Abnormal pain response to myocardial ischemia
D. All of the above
1.Most common site of acute aortic dissection
a. ascending aorta
b. aortic arch
c. infra abdominal aorta
d. descending aorta
e. supra abdominal aorta
2. Clinical criteria Takayasu arteritis
a. age <40
b. systolic BP ?>40
c. Brachial artery
d. Carotid pulse....
3. Dynamic maneuver to make MVP murmur click sound
earlier?
A. Standing (early)
b. Squatting (late)
C. Isometric (late)
D. Valsalva's (late)
4. Valvular murmur that increases during inspiration?
A. Standing (early)
B. Squatting (late)
C. Isometric (late)
D. Valsalva's (late)
5. Routine antimicrobial prophylaxis needed, except
A. AR
B. MVP
C. PDA
D. VSD

7. ECG in acute pericarditis

ANS widespread ST segment elevation
11. Loud S1, diastolic rumbling:
A. AS
B. MS
C. MR
D. AR
12. Systolic murmur radiating to axilla:
A. AS
B. MS
C. MR
D. AR
13. Normal LV, dilated LA:
A. AS
B. MS
C. MR
D. AR
14. Most common organism found in the blood culture
after dental procedure
A. S. viridans
B. S. pneumonia
C. Chlamydia
D. S. aureus
15. Common sign to LV diastolic dysfunction
a. Dyspnea on exertion
b. Chest pain on exertion
c. Easy fatigability
d. Palpitation

1. Key in the classification of anemia

a. Coombs test
c.Reticulocyte count
b. BMA
d.all
2. Principal site of hematopoiesis at birth
a. yolk sac (embryo)
b. liver (embryo)
c. spleen (fetus)
d. bone marrow (at birth)
3. Most common infection preceding aplastic
anemia

Cardio. Hema.Gastro (Definitive) 1st sem 2013

a. Infectious mononucleosis
b. Hepatitis
c. Parvovirus B19
d. EBV
4. Characterized by anemia, reticulocytopenia and
absent or rare erythro precursor cells in the bone
marrow
a. pure red cell aplasia
b. aplastic anemia
c. myelodysplastic syndrome
d. megaloblastic anemia
5. A clonal hematopoietic stem cell disorder
characterized by cytopenia associated with
dysmorphic usually cellular bone marrow and
ineffective erythropoiesis
a. pure red cell aplasia
b. aplastic anemia
c. myelodysplastic syndrome
d. paroxysmal nocturnal hemoglobinuria
6. The presence of the ff. cells is suggestive of
leukoerythroblastic anemia EXEPT
a. nucleated red cell c. target cells
b. tear drop shaped cell
d. immature white
cell
7. Earliest least developed stem cells
a. Pluripotent stem cell
b. multipotent stem cell
c. erythroid progenitor cell
d. granulocyte progenitor cell
8. Earliest precursor of RBC that is recognizable
morphologically
a. promegakaryoblast
b. proerythroblast a.k.ka. pronormoblast
c. promyelocyte
d. myeloblast (earliest for granulocyte)
9. Treatment for anemia of endocrine disorder
a. bone marrow transplant
b. glucocorticoid
c. androgen

d. correction of underlying endocrine disorder

10. Pancytopenia with hypocellular bone marrow
a. pure red cell aplasia
b. aplastic anemia
c. myelodysplastic syndrome
d. megaloblastic anemia
11. Anucleated hematopoietic stem cell
a. RBC
c. both
b. platelet
d. neither
12. Red cell morphology of anemia of renal origin
a. Normocytic, normochromic
b. microcytic, hypochromic
c. macrocytic, hypochromic
d. normocytic, hyperchromic
13. Treatment of choice for anemia of renal origin
a. Erythropoietin
c. androgen
b. Glucocorticoids
d. G-CSF
14. Cell membrane defect in PNH (Paroxysmal
Nocturnal Hemoglobinuria)
a. depletion of CD 55 c. both
b. depletion of CD 59 d. neither
15. Major physiologic regulator of RBC production
a. erythropoietin
c. granulopoietin
b. thrombopoietin
d. all
16. RBC morphology of severe iron deficiency
anemia
a. normocytic, normochromic
b. microcytic, hypochromic
c. macrocytic, hypochromic
d. normocytic, hyperchromic
17. Most common cause of cobalamin deficiency
caused by absence of intrinsic factor from
autoimmune dysfunction
a. post gastrectomy
b. pernicious anemia
c. hypothyroidism
d. alcoholism

Cardio. Hema.Gastro (Definitive) 1st sem 2013

d. all
18. Main site for folate absorption
a. duodenum
c. jejunum
b. ileum
d. cecum
19. Main site for iron absorption
a. duodenum
c. jejunum
b. ileum
d. cecum
remember: IFB DJI (Im on Facebook, Do Join It)
I iron D duodenum
F folate J jejunum
B B12 and bile acids I ileum
20. Main iron transport protein
a. transferrin
c. both
b. ferritin
d. neither
21. Major source of iron utilized for erythropoiesis
a. senescent RBC
c. both
b. iron from fat
d. neither
22. The following conditions may result to
increased iron loss
a. Phlebotomy as treatment for polycythemia vera
b. pregnancy
c. infancy
d. chronic inflammation
23. Definitive treatment for aplastic anemia
a. bone marrow transplant
b. splenectomy
c. chemotherapy
d. radiation therapy
24. The major convenient lab test to estimate iron
storage
a. serum iron
c. iron stains
b. serum ferritin
d. TIBC
25. A reticulocyte index of < 2.5 indicates
a. hemolytic anemia
b. anemia from acute bloos loss
c. hypoproliferative anemia

26. Microcytosis is reflected by a

a. lower MCV
c. lower RDW
b. lower MCHC
d. lower MCH
27. Most common form of hypoproliferative
anemia
a. anemia of renal disease
b. anemia of acute and chronic inflammation
c. anemia of endocrine disorder
d. aplastic anemia
28. Presence of significant MACROcytosis is
suggestive of:
a. iron deficiency anemia
b.. b thalassemia
c. MEGAloblastic anemia
d. all
29. A cell directed carrier protein for cobalamin
a. transferrin
b. intrinsic factor
c. ferritin
d. ceruloplasmin
30. Deficiency of this vitamin is almost always due
to malabsorption
a. cobalamin
c. iron
b. folate
d. all

1. Diagnosis of AML is established by the presence

of:
a. >10% myeloblast in the bone marrow
b. >20% myeloblast in the bone marrow
c. >5% myeloblast in the bone marrow
d. <5% myeloblast in the bone marrow
2. FAB classification of erythroleukemia
a. M3
c. M5
b. M4
d. M6
3. Leukemia with the high risk to develop DIC

Cardio. Hema.Gastro (Definitive) 1st sem 2013

a. AML M2
b. AML M3

c. AML M4
d. AML M5

4. Immunophenotypic feature of AML cells

a. expression of CD 13 and 33
b. expression of CD 3
c. CD 19 and 20
d. CD 7 & CD 10
5. Treatment of AML M3
a. Hydroxyurea
b. 7+3 chemotherapy
c. ATRA
d. high dose cytarabine
6. Cytochemical stain that favors AML and ALL
a. (+) myeloperoxidase
b. (-) myeloperoxidase
c. (+) Periodic Acid Schiff (PAS)
d. (-) Periodic Acid Schiff (PAS)
7. Immunophenotypic feature of AML 7
a. expression of CD 13
b. expression of CD 41
c. expression of CD 19
d. expression of CD 7
8. Earliest precursor of granulocyte recognizable by
light microscopy
a. promyelocyte
c. myelocyte
b. myeloblast
d. proerythrocyte
9. Treatment of choice for relapse cases of AML
a. Doxorubicin & cytarabine c. Splenectomy
b. Glucocorticoids
d. stem cell transplant
10. NOT a feature of retinoic acid syndrome
a. occur during the first three weeks of treatment
b. (+) fever, dyspnea, chest pain
c. related to adhesion of differentiated neoplastic
cell to pulmonary vasculature
d. glucocorticoids not usually effective
11. Causes of absolute lymphocytosis, EXCEPT:
a. COPD

b. Polycythemia vera
c. diuretic use (a relative cause, not absolute)
d. hepatoma
12. Treatment of essential thrombocytopenia that
is selective to platelet and platelet precursor
a. Anagrelide
c. Salicylates
b. Hydroxyurea
d. Interferon
13. Erythropoietin level of patient with
Polycythemia vera
a. high
c. normal
b. low
d. all
14. Neoplastic expansion of hematopoietic cell in
blood and bone marrow.
a. lymphoma
c. sarcoma
b. leukemia
d. hemangioma
15. Most common presenting sign of Polycythemia
vera
a. splenomegaly
c. digital gangrene
b. vertigo
d. pallor
16. NOT a criteria of clinical diagnosis of essential
thrombocytosis
a. platelet count <500,000/uL
b. (-) Ph chromosome
c. (-) myelofibrosis
d. (-) known cause of selective thrombocytosis
17. Philadelphia chromosome (+)
a. ALL
c. both
b. CML
d. neither
18. Cytogenic hallmark of CML
a. 15:17
c. 16
b. 9:22
d. Ba:22
19. NOT a hematologic finding onf CML
a. elevated WBC leftward shift
b. Low Lap score
c. Neutropenia
d. normal to elevated platelet count

Cardio. Hema.Gastro (Definitive) 1st sem 2013

20. Tyrosine kinase inhibitor that induce cytogenic
remission in CML patients
a. Hydroxyurea
c. Busulfan
b. Imatinib mesylate d. Anagrelide
21. Origin of majority of lymphoid leukemia and
lymphoma
a. T-cell
c. NK cell
b. B-cell
d. plasma cell
22. FAB class of ALL with small uniform
lymphoblast
a. L1
c. L3
b. L2
d. all
NOTE:
L1 small uniform lymphoblast
L2 lymphoblast size varies
L3 uniform large lymphoblast with vacuolation
23. Causes of anemia and thrombocytopenia in CLL
a. progression marrow infiltration
b. autoimmune phenomenon
c. hypersplenism
d. all
24. A potentially cardiotoxic chemotherapeutic
agent to acute leukemia
a. Anthracycline (Doxorubicin)
b. Prednisone
c. Imatinib
d. Vincristine
25. Recognition of diagnosis of Reed-Strenberg
(RS) cells is diagnostic of
a. Non-hodgkins
c. Myeloma
b. Hodgkins
d. Leukemia
26.Indication of CLL therapy
a. Thrombocytosis
b. Asymptomatic lymphositosis
c. Richter transformation
d. Autoimmune hemolytic anemia
27. NOT an indication for CLL therapy
a. Thrombocytopenia

b. Asymptomatic lymphocytosis
c. Richter transformation
d. Prolymphocytic transformation
NOTE: List of Indication for CLL treatment
Anemia
Thrombocytopenia
Disease related symptoms
Markedly enlarged or painful spleen
Symptomatic
lymphadenopathy/lymphocytosis
Blood lymphocyte count doubling time <6
months
Prolymphocytic transformation
Richter transformation
28. Neoplastic proliferation of mature lymphocytes
in blood, marrow, and lymphoid tissue
a. ALL (if immature)
c. AML
b. CML
d. CLL (mature)
29. Solid tumor of the immune system
a. Leukemia
b. Sarcoma (solid tumor of soft tissues)
c. Lymphoma (solid tumor of immune system)
d. Hemangioma
30. Most common malignancy of pediatric
population ALL (Acute Lymphoblastic
Leukemia)

1. Factor VIII deficiency:

a. Hemophilia A
b. Hemophilia B (factor 9 def.)
c. Hemophilia C (factor 11 def.)
d. all
2. Vit. K deficiency, EXCEPT:
a. Factor II
c. Factor XII
c. Protein C & S
d. Factor XI
NOTE:
Vitamin K dependent clotting factors are:

Cardio. Hema.Gastro (Definitive) 1st sem 2013

II, VII, IX, and X; protein C and S
Vit.K dependents are also the ones affected by
WARfarin
(9,10,7, and 2 1972; there was WAR in 1972)
whereas heparin and related compounds increase
the action of antithrombin on thrombin and factor
Xa
3. Vitamin K antagonist
a. Heparin
c. Streptokinase
b. Warfarin
d. Aspirin
4. Enzyme cyclooxygenase resulting to
thromboxane A2 inhibit synthesis
a. NSAID
c. Ticlopedine
b. Aspirin
d. Heparin
5. Plasma protein derivative that inactivates factor
V and VIII
a. Antithrombin III (AT III)
b. Plasmin
c. Protein C
d. Heparin
6. Safest replacement therapy for bleeding patients
with liver disease
a. cryoprecipitate
b. cryosupernate
c. platelet concentrate
d. FFP (fresh Frozen Plasma)
7. Critical events necessary for effective primary
hemostasis
a. platelet adhesion
b. granule release and secretion
c. platelet aggregation
d. all
8. Most common cause of isolate
thrombocytopenia that results from action of antiplatelet antibody coating the platelet
a. Megakaryocytic thrombocytopenic purpura
b. ITP (Idiopathic Thrombocytopenic Purpura
c. TTP

d. Vascular purpura
9. Test to distinguish Hemophilia A from
Hemophilia B:
a. Bleeding time
b. Urea clot lysis test (is a screening test for factor
13, if positive, it is diagnostic for factor 13
deficiency)
c. Mixing test (performed if screening test is
prolonged)
d. Specific factor assay (distinguishes Factor 8
from F9)
10. Treatment with curative intent in CML
a. Hydroxyurea
b. Interferon
c. Allogenic SCT (Stem Cell Transplant)
d. Prednisone
11. A non-alkylating, myelosuppresive
chemotherapeutic drug
a. Anagrelide
c. ASH
b. Hydroxyurea
d. Interferon
12. Clinical manifestation of Pancytopenia, EXCEPT:
a. pallor
c. sepsis
b. bleeding
d. thrombosis

Additional:
1.MCV 120 Macrocytic
2. Reticulocyte index of 4 means bone marrow is
responding to anemia
3. Low/absent iron stores Iron Deficiency
Anemia
4. End product of Secondary hemostasis
fibrin clot formation
5. Factor II aka Prothrombin
6. Definitive treatment for Chronic ITP
splenectomy

Cardio. Hema.Gastro (Definitive) 1st sem 2013

7. General signs and symptoms of anemia is due to
low affinity of hemoglobin to O2
8. Main treatment of choice for Anemia of Chronic
Renal disease/insufficiency
Erythropoietin (EPO)

1. Laboratory finding seen in anemia in chronic

disease, EXCEPT:
a. low serum protein
b. inc. red cell protophorpyrin
c. hypocellular marrow
d. dec. serum ferritin
2. Caf au lait spot, short stature, thumb
abnormality Fanconi Syndrome
3. First line treatment of AIHA:
a. Rituximab
b. Splenectomy
c. transfusion of RBC d.corticosteroids

MCHC amount of hemoglobin relative to the size

of the cell
RDW measures variation in red blood cell size or
red blood cell volume
8. A 40 year old male complained of anemia with a
history of 5 year post-gastrectomy due to BPUD.
What is the most likely cause of his anemia:
a. iron deficiency
b. folate deficiency
c. Vit.b12 deficiency/Megaloblastic anemia
d. anemia of chronic disease
9. True regarding Hemolytic anemia except:
a. premature destruction of RBC
b. Detected by decrease reticulocyte count
c. increase red cell production
d. usually presented with pallor or jaundice

Hematology Recalls Midterm Exam

Dr. Samson-Cruz
Sept. 3, 2013

4. Hereditary spherocytosis, EXCEPT:

a.jaundice
c. gallstones

b. splenomegaly
d. pancreatitis

5. Hereditary spherocytosis, EXCEPT:

a.jaundice
c. gallstones

b. splenomegaly
d. hemoglobinuria

6. True about hemolyticanemia,except:

Low reticulocyte index
7. Red blood cell index/indices for red cell size
a. MCV
b. MCH
c. MCHC
d. RDW
NOTE:
MCV average red blood cell size
MCH amount of hemoglobin per RBC

1. 60 y/o male with leukocytosis. WBS is marked....

A. melphalan
3. Ascites, svc obstruction, EXCEPT
a. Bulging flanks
b.
c. Everted umbilicus
d. Pulsatile liver
e. Venous hum
A,c,d,e are correct
4. Few weeks onset of easy bruising, pale,
hepatosplenomegaly,ecchymosis,
PBS
normochromic,normocytic
RBC,
dec
WBC
predominantly myeloblast, dec platelet
A. AML
B. ALL
C. CML
D. CLL

Cardio. Hema.Gastro (Definitive) 1st sem 2013

5. 60 years old, low back pain, cough, pale
conjunctiva, CXR- infiltrates
A. AA
B. BMA & Biopsy
C. SPEP
D. Serum B2 macroglobulin
6. The most common sign of Myeloproliferative
dse: ANS: Splenomegaly
8. Cytogenic hallmark of CML
Chromosome t(9:22)
A. Chromosome t(17:22)
B. Chromosome t(22:9)
9. Polycythemia vera
A. erythrocytosis
B. leukocytosis
C. BMA mandatory
D. red cell mass to differentiate absolute
versus relative
10. Intrathecal CNS treatment:
A. ALL
B. AML
C. CML
D. CLL

D. PAS
14. Treatment of asymptomatic essential
thrombocytosis
A. Aga
B. Aspirin
C. Hydroxylurea
D. None
15. true of chronic idiopathic myelofibrosis except:
1. clonal disorder of multipotent
hematopoietic progenitor cell of unknown
etiology characterized by marrow fibrosis,
myeloid metaplasia, with extramedullary
hematopoiesis and splenomegaly
2. same manifestation with PV and CML
3. Hydroxyurea is the only treatment for
children
16. True of PV except:
A. Clonal disorder involving a multipotent
hematopoietic progenitor cell in which
there is accumulation of phenotypically
normal red cells, granulocytes, and platelets
in the presence of a recognizable
physiologic stimulus

11. MC hepatotoxic drug

A. prescription
B. environmental toxin
C. metabolites of Cyp450
D. metabolites of glucuronidation

17. 53 y/o F CML for 3 years. Imatinib. Platelet

count 80,00 & BM Blast 12%:
A. MDS
B. CML Chronic
C. CML Accelerated
D. CML Blast

12. WHO cutoff for blast count for AML

A. 20%
B. 40%
C. 30%
D. 50%

18. absolute erythrocytosis except:

A. hepatoma
B. dehydration
C. R-L shunt
D. splenomegaly

13. Stain that do not react with lymphoblasts

except
A. Myeloperoxidase
B. Sudan Black
C. Non-specific esterase

19. Retinoic Syndrome except:

A. occur during the first three weeks of
treatment
B. (+) fever, dyspnea, chest pain

Cardio. Hema.Gastro (Definitive) 1st sem 2013

C. related to adhesion of differentiated
neoplastic cell to pulmonary vasculature
D. none
20. True about ALL except:
A. a standard remission induction
requirement 7,3 regimen
B. continuous treatment given for 2-3 years
C. Intrathecal chemoprophylaxis is mandatory
D. Higher centers command
21. Hema: test to differentiate primary to
secondary polycythemia
A. red cell mass determination
B. epo level
C. bma
D. pa score
22. Aim of Post Remission therapy except:
A. induce complete remission quickly
B. eliminate residual cells
C. prolong relapse
D. prolong survival
23. B Cell ALL marker:
A. CD 13, 33
B. CD 3, CD 4
C. CD 19, CD 20
D. CD 41, CD 61
24. Prognostic single factor for survival of multiple
myeloma:
A. LDH
B. Crea Level
C. SPEP
D. Serum B2 microglobulin
25. Best regimen for highly agressive HL- B. ABVD
26. Indication for chemotherapy in CML
A. Anemia
B. Thrombocytopenia
C. Richter formation
D. All

27. Most common sign of myeloma

A. Renal failure
B. Susceptibilty to bacterial infections
C. Bone pains
D. Hyperviscocity problems
28. aa
29. A ribonucleotide reductase inhibitor, non
selective myelosupression is mechanism of what
chemotherapeutic agent?
A. Anagrelide
B. Anthracycline
C. Imatinib
D. Hydroxyrurea
30. Lab features of CML except:
A. LAP score is zero
B. Normal platelet count
C. Decreased WBC
D. ABR

Cardio. Hema.Gastro (Definitive) 1st sem 2013

1. Levels of narrowing
Upper esophageal sphincter
Aortic arch
Left mainstem bronchi
Diaphragm
Lower esophageal sphincter
2. MC type of TEF EA with distal TEF
3.
Anomaly
Age at presentation
EA with distal TEF
New born
Isolated EA
Isolated TEF (H-type Infants to adult
TEF)
4. Hypopharyngeal web + iron def. anemia + dysphagia
= PLUMMER VINSON or PATTERSON KELLY SYNDROME
5. Diagnosis for Hypertensive motor disorder cork
screw esophagus on barium swallow
6. Adenocarcinoma MC upper GI Ca
7. Most common site affected in Squamous cell Ca
lower third (55%)
~least affected is the upper third
8.
Diffuse type
No cell cohesion
No mass formed
Leather
bottle
appearance
Affects whole stomach
(antrum and cardia)
Younger patients
Hereditary
Poorer prognosis

Intestinal type
Cohesion present
Tumor formed
Ulcerative
Distalstomach
affected

9. Gastric Ca MC metastasis to LIVER

10. Most common type of gastric lymphoma nonHodgkins (B-cell in origin)
11. Treatment for primary gastric lymphoma subtotal
gastrectomy followed by combination chemotherapy
(R-CHOP)

12. International Prognostic Index for NHL

Five clinical risk factors:
Age 60 yo
Serum lactate dehydrogenase (LHD) levels
elevated
Performance status 2 (ECOG) or 70 (Karnofsky)
= cares for self; unable to carry on normal
activity or do active work
Ann Arbor stage III or IV
>1 site of extranodal involvement
13. GIST non-epithelial (mesenchymal) tumors that
arise from the gastrointestinal pacemaker calls called
interstitial cells of Cajal (ICC)
14. Metastasis of stomach MC arise from primary
breast Ca
15. Oxyntic glands at the fundus and body of the
stomach
located in a gastric pit, the most numerous and
distinct gastric glands
secretes acid, pepsinogen, intrinsic factor, & the bulk
of gastric enzymes
16. Pyloric glands at the antrum and pylorus of the
stomach
composed of endocrine, mucous and gastrin (G) cells
17. Ketoprofen most harmful NSAID
18. H. Pylori treatment- 10 to 14 days of antibiotic
therapy
19. Gastric ulcer 6 to 8 weeks treatment
20. Duodenal ulcer 4 to 6 weeks treatment
21. Regulation of gastric acid secretion
Stimulants of gastric Inhibitors of gastric acid
acid secretion
secretion
Histamine
(ECL Somatostatin (D cell)
cells)
Secretin/Cholecystokinin
Gastrin (G cells)
(Hormonal)
Acetylcholine
Neural (CNS/PNS)
(Vagus)
22. Duodenal vs Gastric Ulcers

Cardio. Hema.Gastro (Definitive) 1st sem 2013

Duodenal
Gastric
Malignant DUs
can
represent
are extremely
malignancy
rare
most often found
most often in
distal
to
the
the
first
junction between
portion
of
the antrum and
duodenum
the acid secretory
(>95%), with
mucosa (body)
~90% located
within 3 cm of
the pylorus.
23. Most sensitive/specific INVASIVE test to detect H.
pylori infection rapid urease test
24. Most sensitive/specific NON-INVASIVE test to detect
H. pylori infection urea breath test
25. Guide to NSAID therapy in CV setting
No CV risk no aspirin
With C risk consider giving aspirin
DO NOT give COX 2 inhibitor for patients with CV risk
26. Naproxen safest NSAID
27. Classified according to predominant site of
involvement
Type A - Body predominant form (autoimmune)
Type B - Antral predominant form (H. pylori-related)
AB gastritis - mixed antral and body
28. ZOLLINGER-ELLISON SYNDROME (ZES)
- Gastric acid hypersecretion from Gastrinoma tumor
- associated with Multiple Endocrine Neoplasia (MEN)
type 1 syndrome
- Mostly malignant (>60%)
- MC tumor distribution: at duodenum (most common
non-pancreatic lesion)
- Peptic ulcer MC manifestation of ZES
- Diarrhea 2nd MC manifestation of ZES
29. Sensitivity of imaging in ZES
Primary gastrinoma

Metastatic
gastrinoma

Most - EUS (80-100%)

Least - UTZ

Most Ostreoscan
Least - UTZ

30. Lymphocytic gastritis

also called varioliform gastritis
primarily in the body of the stomach
presence of lymphocytes
have thickened folds
31. Eosinophilic gastritis
primarily in the antrum
edematous folds
presence of eosinophils
can lead to outlet obstruction
33. Mntrier's Disease
large, tortuous gastric mucosal folds mostly in
the fundus and body
34. Granulomatous gastritis
not associated with folds

GASTROENTEROLOGY 1st SEM 2013-2014

PRELIMS Dr. Lopez
12. Anemia, palpitation and weakness are signs and
symptoms of colorectal cancer found in:
A. cecum
B. transverse colon
C. descending colon
D. rectum
NOTE: obstruction of a tumor at the right side (cecum)
manifests as bleeding it will cause anemia
18. Least common cause of mechanical S.I obstruction
a. neoplastic common for Large intestine
b. adhesions
c. hernia
d. volvulus
16. Which is a purely diagnostic alone?
A. Colonoscopy
b. Barium enema
c. CT cholangiography
D. Enteroclysis

Cardio. Hema.Gastro (Definitive) 1st sem 2013

21, sign of ruptured appendicitis except:
a. mass
b. abdominal rigidity
c. absent bowel sound
d. (+) Rovsings sign
27. True regarding C. Difficile Infection
a. community acquired than hospital
b. An invasive organism
c. Secrete toxin leading to Pseudomembranous
Enterocolitis
d. An aerobic organism
28. Best acceptable risk factor for irritable bowel
syndrome
a. psychosis
b. genetic predisposition
c. old age
d. previous campylobacter infection
29. Mesenteric angiography. (not so sure of the exact
question)
A. Superior mesenteric artery
B. non-occlusive Mesenteric ischemia
C. Superior mesenteric artery embolus
D. Mesenteric venous thrombosis
30. Treatment for IBS-D
a. Lactulose
b. SSRI
c. Desipranozasine
d. Bisacodyl

B. ??
C. ??
D. ??
2. Hepatotoxic:
A. Prescription drugs
B. environmental toxin
C. metabolites of P450
D. metabolites of glucoridation
3. true of viral hepatitis:
A. Hepa A is dsDNA
B. Hepa B is ssDNA
C. Hepa D is dsDNA
D. Hepa C is ssRNA
NOTE:
Hepa B dsDNA
The rest are ssRNA
4. Parameters in differentiating Jaundice from
hyperbilirubinemia of other cause except
A. greenish discoloration of skin
B. nasolabial fold involvement
C. sparing of sclera
D. predominant involvement of palms and forehead
E. sparing of the non exposed skin to sun
5. Sequel of chronic HBV infection except:
A. HCC with or without cirrhosis
B. Polyarthritis Nodosa
C. GN
D. Lichen Planus

Additional Recalls:
Severe mucosal invasion - shigella, others EIEC,
E.histolytica
Ciprofloxacin except rotavirus
IBD- tgf-b and il-10
GI TB- distal ileum and cecum
Aminoglycoside - least/never used in
pseudomembranous colitis
Sigmoid - most common diverticula location

6. Bilirubin Metabolic process that most likely causing

bilirubinuria:
A. conjugation of bilirubin to glucoronic acid
B. Conversion of biliverdin to bilirubin
C. Transfer of unconjugated bilirubin
D. Transfer of conjugated bilirubin

MIDTERMS Dra. Payawal

7. Complication of Hepatitis C except:

A. Cryoglobinemia dermatitis
B. Lymph sialadenitis
C. B cell lymphoma
D. T cell lymphoma

1. unlikely cause of isolated hyperbilirubinemia:

A. Ca bilirubinate

8. Low Risk immunocompromised booster after primary

given

Cardio. Hema.Gastro (Definitive) 1st sem 2013

A. every year
B. every 5-7 years
C. every 10-15 years
D. not needed
9. Superior vena cava obstruction
A. bulging flanks
B. collateral venous
C. pulsatile liver
D. venous hum
10. (+) HbsAg, no need for therapy:
A. 35, female, alt 150, HbeAg (+), HBV DNA (+)
B. 35, female, alt 50, HBV DNA (+), HbeAg (-)
C. 35, female, alt 150, HBV DNA (-), HbeAg (-)
D. 35, female, Anti-HbSag (+), with liver cirrhosis
11. Basolateral iron transporter
A. Ferroportin
B. Transferrin
C. Ferritin
D. DMTI
12. Viral Hepatitis which causes a risk fatality among the
pregnant
A. Hepa B
B. Hepa C
C. Hepa D
D. Hepa E
E. Hepa A

17. Risk factor for development of drug induced liver

injury except:
A. AA
B. aa
C. dd
D. DD
NOTE: The risk factors are:
Toxic potential of drugs: Reactive Metabolite,
Acylglucoronide, Mitochondrial Effects
Genetic Factors: Drug metabolism, Detoxification,
Transport
Environmental Factors: Age, Sex, Underlying Disease
18. Fulminant: acetaminophen
19. OCP hepatotoxic effects:
A. macrovesicular steatosis
B. hepatic vein thrombosis
C. Hepatic adenoma
D. intrahepatic cholestasis
20. Cholestasis except:
A. Elevated serum bilirubin
B. elevated AP
C. can be caused by lymphoma
21. Pathophysiology of liver cirrhosis except:
A. irreversible liver damage

14. Which of the conditions does hepatic venous

pressure do not correlate with actual portal pressure?
A. Budd Chiari
B. Alcohol induced cirrhosis
C. Venoocclusive disease
D. Portal vein thrombosis

22. True about alcoholic liver disease except:

A. PPAR can induce FPA and transport genes
B. PPAR can induce synthesizing FPA
C. Down regulation of PPAR
D. Down regulation of SREB

15. True of Alcoholic liver injury:

A. increases peripheral transport of fatty acids
B. convert NAD to NADH
C. bridging fibrosis
D. microvesicular injury

23. Causes of liver cirrhosis except:

A. Wilsons disease
B. Glycogen Storage Dse
C. TB
D. Schistosomiasis

16. Best marker for liver injury:

A. Serum albumin
B. bilirubin
C. Factors 2, 7, 9, 10
D. EPO

24. Fibrolamellar HCC:

A. children, adult and elderly
B. common in OCP users
C. frequent in males
D. worse prognosis than other HCC
E. AOTA

Cardio. Hema.Gastro (Definitive) 1st sem 2013

25. True of chronic hepatitis EXCEPT:
A. Caused by DNA virus
B. Caused by RNA virus
C. Caused by??
26. For patient with HBsAg who does not need
treatment:
A. ALT 150, HBeAG (+)/ HBV DNA (+)
B. ALT 250 HBeAG (-)/ HBV DNA (+)
C. ALT 20 HBeAG (-)/ HBV DNA (-)
D. Anti-HbsAG
27. True of protocol for liver cancer screening except:
A. alpha feto protein measurement every 6 months
B. -C. CEA for high risk individuals
D. due to reactivation of chronic or acute hepatitis
28. Fulminant Hepatitis includes all of the following
except:
A. collapsed reticulin network
B. hepatic failure in 6 months
C. presence of massive necrosis with only portal tract
visible
D. may be due to reactivation of chronic or acute
hepatitis

FINALS Dr. Lapuz

1. 73 y/o male underwent surgery due to intestinal
ischemia and gangrene, later on develop malabsorption.
Why?
A. bacterial overgrowth
B. short bowel syndrome
C. destruction of intestinal mucosal function and
structure
D. intestinal obstruction
2. Bird beak appearance on esophagogram:
A. scleroderma B. esophageal ring
C. achalasia
D. hypertensive motor disorder
3. Oxyntic cells: Fundus and Body
20. H. Pylori seg??? MALT
25. Duodenal ulcer tx: Omeprazole 20mg BID +
Clarithromycin 500g BID + Amoxicillin 1g BID or
Metronidazole 500 mg BID for 10-14 days

49. Pathophysiology of liver cirrhosis, except

A. Irreversible chronic injury of hepatic
parenchyma
B. Extensive fibrosis
C. Regenerating nodule
D. Histopathological diagnosis
50. True of Hepa C virus except:
- caused by DNA

Gastric adenocarcinoma- linitis plastics or

leather bottle appearance
Esophageal cancer-chronic gastric reflux
(barretts esophagitis)
Gastric cancer-mc adenocarcinoma (85%)
Esophageal cancer- post radiation therapy
Non-hodgkins lymphoma-mc type of gastric
lymphoma;b cell in origin
Primary gastric lymphoma- B symptoms: unexplained weight loss of >10% body weight recurrent fever -night sweats
Gastric adenocarcinoma- mc route of spread is
hematogenous
GIST- arises from GU pacemaker cells
Breast-mc metastatic site of stomach cancer
Fundus&body- oxyntic cells are located
Duodenal ulcers- malignancy is rare
Somatostatin-inhibitor of gastric acid secretion
Duodenal ulcers- antral predominant gastritis
Gastric ulcer-6 to 8 weeks of treatment
Advanced age-established risk factor for pud
Ketoprofen- most harmful Ibuprofen-least
harmful
H. Pylori treatment- 10 to 14 days of antibiotic
therapy
Eradication of H. Pylori may result in complete
regression of tumor
Traditional NSAID + PPI if GI risk warrants
gastric protection
Other causes of elevated gastrin: H. Pylori
infection and used of anti secretory agents for
ulcers
Esophageal atresia with TEF distal - most
common
Crohn disease- not included in folded type of
gastritis

Cardio. Hema.Gastro (Definitive) 1st sem 2013

Congenital anomalies arises from Vertebral,

anal, cardiac, tracheal, esophageal, renal, limb
system
Endoscopic Ultrasound (EUS) - most commonly
used in primary gastrinoma
Scleroderma- decreases LES pressure
Achalasia- bird beak appearance
Bernstein test/ acid perfusion test- least
effective in diagnosing GERD
CREST syndrome - esophageal dysfunction