ENDOCRINOLOGY

1. Which is true of autoimmune polyendocrine syndrome (APS)?

A. APS I presents during infancy
B. APS I is more predominant in females
C. Mucocutaneous candidiasis is a feature of APS II
D. Myasthenia Gravis is a nonendocrine immunologic condition in APS I

2. Which is true of multiple endocrine neoplasia II?

A. Pheochromocytoma is found in virtually all cases
B. Locations of RET mutation correlate with severity of the disease
C. Nearly all pheochromocytoma are malignant
D. Prophylactic parathyroidectomy is recommended in RET mutation carriers

The best-known pheochromocytoma-associated syndrome is the autosomal dominant disorder MEN 2. Both types of MEN 2 (2A and 2B) are
caused by mutations in RET, which encodes a tyrosine kinase. The locations of RET mutations correlate with the severity of disease and the type
of MEN 2. MEN 2A is characterized by medullary thyroid carcinoma (MTC), pheochromocytoma, and hyperparathyroidism; MEN 2B also includes
MTC and pheochromocytoma as well as multiple mucosal neuromas, marfanoid habitus, and other developmental disorders, though it typically
lacks hyperparathyroidism. MTC is found in virtually all patients with MEN 2, but pheochromocytoma occurs in only ~50% of these patients. Nearly
all pheochromocytomas in MEN 2 are benign and located in the adrenals, often bilaterally. Pheochromocytoma may be symptomatic before MTC.
Prophylactic thyroidectomy is being performed in many carriers of RET mutations; pheochromocytomas should be excluded before any surgery in
these patients. HPIM 20th ed, page 2744

3. Based on the 2015 Philippine Clinical Practice Guidelines for the management of Dyslipidemia, which lipid
abnormality has the highest prevalence of 71.3% among Filipinos?
A. High Total Cholesterol
B. High LDL
C. Low HDL
D. High Triglycerides

4. Which genetic cause of dyslipidemia is associated with eruptive xanthomas?

A. Familial defective apoB100
B. Familial apoC II deficiency
C. Familial hypercholesterolemia
D. Sitosterolemia
 5. Which drug for the treatment of osteoporosis carries a warning of increased risk for cardiovascular disease?
A. Bisphosphonates
B. Denosumab
C. Teriparatide
D. Strontium

Strontium ranelate has never been approved for osteoporosis in the United States but is approved in Europe and other exUS countries. It increases
bone mass throughout the skeleton, but some of the increase is related to strontium incorporation into hydroxyapatite. In clinical trials, the drug
reduced the risk of vertebral fractures by 37% and that of nonvertebral fractures by 14%. It appears to be modestly antiresorptive while at the
same time not causing as much of a decrease in bone formation (measured biochemically). In 2014, the use of strontium was restricted because of
an increased risk of cardiovascular disease and severe skin reactions. Small increased risks of venous thrombosis also occur. HPIM 20th ed, page
2958

6. Which of the following is diagnosed by an elevated level of urinary uroporphyrins?

A. Bullous dermatosis of hemodialysis
B. Drug-induced pseudoporphyria
C. Porphyria cutanea tarda
D. Porphyria variagata
 7. Which antihypertensive agent may be an alternative to estrogen to control menopausal symptoms?
A. Clonidine
B. Prazosine
C. Metoprolol
D. Diltiazem

Compelling evidence, including data from randomized clinical trials, indicates that estrogen therapy is highly effective for controlling vasomotor
and genitourinary symptoms. Alternative approaches, including the use of antidepressants (such as paroxetine, 7.5 mg/d; or venlafaxine, 75–150
mg/d), gamma-aminobutyric acid analogues (such as gabapentin, 900– 2400 mg/d [dose divided 3 times per day]; or pregabalin, 150–300 mg/d
[dose divided twice per day]), or clonidine (0.1 mg/d), may also alleviate vasomotor symptoms, although they are less effective than HT. Paroxetine
is the only nonhormonal drug approved by the U.S. Food and Drug Administration for treatment of vasomotor symptoms. Bazedoxifene, an
estrogen agonist/antagonist, in combination with conjugated estrogens has also received approval for this use. Cognitive behavioral therapy and
clinical hypnosis have been shown in randomized trials to help with vasomotor symptom management. Weight loss, mindfulness-based stress
reduction, stellate ganglion block, and the consumption of S-equol soy derivatives are also promising strategies, although more trials are needed.
For genitourinary syndrome of menopause, the efficacy of low-dose vaginal estrogen is similar to that of oral or transdermal estrogen; oral
ospemifene or vaginal prasterone are additional options. HPIM 20th ed, page 2806

INFECTIOUS DISEASES

8. Which botulinum toxin serotype is associated with rapid progression of quadriplegia and respiratory failure but
with rapid recovery?
A. Serotype A
B. Serotype B
C. Serotype E
D. Serotype F

All botulinum toxin serotypes have been demonstrated to cause bot-ulism in nonhuman primates. Human cases associated with serotypes A, B, E,
and F are reported each year. Serotype A produces the most severe syndrome, with the greatest proportion of patients requiring mechanical
ventilation. Serotype B causes milder disease. Serotype E, most often associated with foods of aquatic origin (e.g., uneviscerated fish and seal oil),
produces a syndrome of variable severity. Illnesses caused by toxin serotype F are infrequent and are characterized by rapid progression to
quadriplegia and respiratory failure but also by relatively rapid recovery. Studies have shown that at least some serotypes can be differentiated
into subtypes through neurotoxin gene sequencing; however, the impact of these subtype differences on clinical illness is not yet known. HPIM 20th
ed, page 1106

9. Which of the following risk factors is the primary determinant of HIV 1 transmission?
A. Mode of exposure
B. Type of HIV virus
C. Quantity of plasma HIV 1 virus
D. Sexual behavior

The quantity of HIV-1 in plasma (viral load) is a primary determinant of the risk of HIV-1 transmission. HPIM 20th ed, page 1400

10. What is the intermediate host of intestinal dwarf tapeworm?

A. Grain beetle
B. Snail
C. Rodents
D. Cow

v
 11. What is the recommended antimicrobial combination for Clostridial sepsis?
A. Penicillin + Clindamycin
B. Ampicillin + Clindamycin + Ciprofloxacin
C. Cefoxitin + Clindamycin
D. Vancomycin + Metronidazole + Ciprofloxacin

12. Based on the 2010 Philippine Clinical Practice Guidelines on Leptospirosis, at what level of platelet count will the
risk for bleeding and pulmonary hemorrhage start to increase in leptospirosis?
A. 20,000
B. 50,000
C. 100,000
D. 150,000

Complete blood count (CBC) with platelet count may show peripheral leukocytosis with neutrophilia. Thrombocytopenia is common. Platelet count of
< 100,000/cu mm is a risk factor for bleeding and pulmonary hemorrhage. Leptospirosis CPG 2010, page 25

13. According to the 2016 Philippine Clinical Practice Guidelines for the diagnosis, treatment, prevention and control
of TB, what is the anti-TB treatment recommendation for post-solid organ transplant patients without risk factor for
drug resistance?
A. INH, rifampicin, ethambutol, and pyrazinamide for 6 months
B. INH, rifampicin, pyrazinamide for 2 months then INH and rifampicin for 6 months
C. INH, ethambutol, pyrazinamide for 2 months then INH and ethambutol for 12-18 months
D. INH, rifampicin, ethambutol, pyrazinamide, streptomycin for 2 months then INH rifampicin for 4 months
 14. According to the 2016 updated Philippine Clinical Practice Guidelines on Community Acquired Pneumonia, which
of the following is a correctly matched symptom improvement over time?
A. 3 days – fever resolution
B. 2 weeks – chest pain and sputum production have reduced
C. 4 weeks – fatigue has resolved
D. 6 weeks – cough and breathlessness have reduced

15. Which statement is true about echinocandins?

A. Considered fungistatic for Candida and fungicidal for Aspergillus
B. Its greatest use to date is against Aspergillus infection.
C. The minimal inhibitory concentrations (MIC) are highest against Candida tropicalis
D. Caspofungin has been at least as efficacious as Amphotericin B for the treatment of Candidemia

The echinocandins are considered fungicidal for Candida and fungistatic for Aspergillus. Their greatest use to date is against candidal infections.
They offer two advantages: broad-spectrum activity against all Candida species and relatively low toxicity. The minimal inhibitory concentrations
(MICs) of all the echinocandins are highest against Candida parapsilosis; it is not clear whether these higher MIC values represent less clinical
effectiveness against this species. The echinocandins are among the safest antifungal agents. In controlled trials, caspofungin has been at least as
efficacious as AmB for the treatment of candidemia and invasive candidiasis and as efficacious as fluconazole for the treatment of candidal
esophagitis. In addition, caspofungin has been efficacious as salvage therapy for aspergillosis. HPIM 20th ed, page 1517

ALLERGOLOGY / IMMUNOLOGY

16. Which of the following is a major diagnostic criterion for systemic mastocytosis?
A. Intestinal codon 816 mutation
B. Total serum tryptase of >20ng/mL
C. Multifocal dense infiltrates on mast cells in bone marrow
D. Aberrant mast cell surface phenotype
RHEUMATOLOGY

17. What is the most common non-pulmonary manifestation in patients with eosinophilic granulomatosis with
polyangiitis?
A. Migratory polyarthritis
B. Relapsing fever
C. Mononeuritis multiplex
D. Purpuric subcutaneous nodules

Patients with eosinophilic granulomatosis with polyangiitis (Churg Strauss) often exhibit nonspecific manifestations such as fever, malaise,
anorexia, and weight loss, which are characteristic of a multisystem disease. The pulmonary findings in eosinophilic granulomatosis with
polyangiitis (Churg-Strauss) clearly dominate the clinical picture with severe asthmatic attacks and the presence of pulmonary infiltrates.
Mononeuritis multiplex is the second most common manifestation and occurs in up to 72% of patients. Allergic rhinitis and sinusitis develop in up
to 61% of patients and are often observed early in the course of disease. Clinically recognizable heart disease occurs in ~14% of patients and is an
important cause of mortality. Skin lesions occur in ~51% of patients and include purpura in addition to cutaneous and subcutaneous nodules. The
renal disease in eosinophilic granulomatosis with polyangiitis (Churg-Strauss) is less common and generally less severe than that of granulomatosis
with polyangiitis and microscopic polyangiitis. HPIM 20th ed, page 2583

18. What joint is usually spared in osteoarthritis?

A. Metacarpophalangeal joint
B. Distal interphalangeal joint
C. First metatarsal phalangeal joint
D. Lower lumbar vertebrae

OA affects certain joints, yet spares others. Commonly affected joints include the hip, knee, and first metatarsal phalangeal joint (MTP) and cervical
and lumbosacral spine. In the hands, the distal and proximal interphalangeal joints and the base of the thumb are often affected. Usually spared
are the wrist, elbow, and ankle. HPIM 20th ed, page 2624
HEMATOLOGY

19. Which biologic agent is considered as second line treatment for autoimmune hemolytic anemia?
A. Etanercept
B. Adalimumab
C. Rituximab
D. Tocilizumab

20. What is the recommended dose of folic acid in a patient with paroxysmal nocturnal hemoglobinuria?
A. At least 0.5mg/day
B. At least 1mg/day
C. At least 2mg/day
D. At least 3mg/day

NEPHROLOGY

21. Among at risk patients aged 30-59 years old, at least how many cyst should be present on each kidney to
diagnose autosomal dominant polycystic kidney disease, with 100% sensitivity and specificity?
A. 1
B. 2
C. 3
D. 4

22. What is observed in patients with chronic bilateral ureteral obstruction?

A. Increased renal blood flow
B. Increased GFR
C. Increased vasoconstrictor prostaglandins
D. Increased renin-angiotensin production

23. In NSAID-induced Acute Kidney Injury, what is the mechanism that causes reduction in the perfusion pressure in
the nephron and a decrease in GFR?
A. Increased afferent arteriolar resistance
B. Decreased efferent arteriolar resistance
C. Increased vasodilatory prostaglandins
D. Decreased angiotensin II

24. In the phenomenon of reverse causation seen in dialysis patients, which risk factor predicts poor prognosis?
A. Low hematocrit
B. Low blood pressure
C. Hyperlipidemia
D. Obesity

25. What classification of lupus nephritis will present with diffuse segmental sclerosis on kidney biopsy?
A. Class IV S active
B. Class IV G active
C. Class IV S chronic
D. Class IV G chronic

ONCOLOGY

26. Which gene is most commonly mutated or inactivated in pancreatic cancer?

A. ARAS
B. p16
C. p53
D. SMAD4

27. What condition will present with a radiographic finding of winking owl sign?
A. Malignant intestinal obstruction
B. Malignant biliary obstruction
C. Spinal cord compression
D. Neoplastic meningitis

28. When does anti-CTLA-4-associated hypophysitis symptoms occur after initiation of therapy?
A. Less than 3 weeks
B. 3-5 weeks
C. 6-12 weeks
D. More than 12 weeks

Ipilimumab, an anti-CTLA-4 antibody used for treatment of malignant melanoma, may cause autoimmunity including autoimmune-like
enterocolitis, hypophysitis, (leading to secondary adrenal insuffi-ciency), hepatitis, and, rarely, primary adrenal insufficiency. Autoim-mune
hypophysitis may present with headache, visual field defects, and pituitary hormone deficiencies manifesting as hypopituitarism, adrenal
insufficiency (including adrenal crisis), or hypothyroidism. Ipilimumab-associated hypophysitis symptoms occur at an average of 6–12 weeks after
initiation of therapy. An MRI usually shows homogenous enhancement of pituitary gland. Early glucocorticoid treatment and hormone
replacement are the initial treatment. The role of high-dose glucocorticoids in the treatment of hypophysitis is not clear. High-dose glucocorticoids
may not improve the frequency of pituitary function recovery. Autoimmune adrenalitis can also be observed with anti-CTLA-4 antibody. HPIM 20th
ed, page 519

NEUROLOGY

29. Which condition is characterized by the clinical triad of gait abnormality, dementia and urinary incontinence?
A. Korsakoff syndrome
B. Normal pressure hydrocephalus
C. Corticobasal syndrome
D. Progressive supranuclear palsy

30. What disease is characterized by retinitis pigmentosa, sensory ataxia, sensorineural deafness and demyelinating
____?
A. Joubert Syndrome
B. Kearns-Sayre Syndrome
C. Niemann Pick Disease Type C
D. Refsum Disease

Refsum’s disease can manifest in infancy to early adulthood with the classic tetrad of (1) peripheral neuropathy, (2) retinitis pigmentosa, (3)
cerebellar ataxia, and (4) elevated CSF protein concentration. HPIM 20th ed, page 3211
CARDIOLOGY

31. Based on the 2015 Philippine Clinical Practice Guidelines for the management of Dyslipidemia, which lipid
abnormality has the highest prevalence of 71.3% among Filipinos?
A. High Total Cholesterol
B. High LDL
C. Low HDL
D. High Triglycerides

32. According to 15th Philippine Clinical Practice Guidelines on the Management of Hypertension, what clinical
outcome is expected with pharmacologic treatment of uncomplicated hypertension?
A. Reduction in stroke by 35-40%
B. Reduction in MI by 11%
C. Reduction in nephropathy by 13%
D. Reduction in total mortality by 50%

33. In what condition does the jugular venous pressure fail to decline during inspiration?
A. Cardiac tamponade
B. Hypertrophic cardiomyopathy
C. Tricuspid stenosis
D. Atrial septal defect

34. Which of the following is a cause of aortic root to right heart shunt?
A. Patent ductus arteriosus
B. Coronary arteriovenous fistula
C. Aortopulmonary window
D. Transposition of the great arteries

35. Which betablocker enhances nitric oxide activity?

A. Metoprolol
B. Carvedilol
C. Nebivolol
D. Labetalol

36. Which antiarrhythmic drug for atrial fibrillation increases mortality in patients with heart failure?
A. Sotalol
B. Dronedarone
C. Bumetanide
D. Verapamil

37. Which clinical trial showed that the continuation of ACE inhibitor + calcium channel blocker is superior to the
continuation of ACE inhibitor + diuretic in reducing the risk of cardiovascular events and death in high risk
hypertensive patients?
A. ALLHAT
B. ONTARGET
C. SPRINT
D. ACCOMPLISH

38. Which clinical trial showed that Nesiritide did not significantly decrease death or hospitalization compared with
placebo in patients with Acute Decompensated Heart Failure?
A. ASCEND-HF
B. RELAPSE-HF
C. ATOMIC-HF
D. SURVIVE

39. Which antihypertensive agent may be an alternative to estrogen to control menopausal symptoms?
A. Clonidine
B. Prazosine
C. Metoprolol
D. Diltiazem

40. What percentage of patients with NSTEMI ACS have no apparent critical epicardial coronary stenosis on
angiogram?
A. 10%
B. 15%
C. 20%
D. 30%

PULMONOLOGY

41. Approximately what percentage of COPD cases are found to have severe alpha antitrypsin deficiency?
A. 1
B. 2-3
C. 4
D. 5
 42. According to the 2016 updated Philippine Clinical Practice Guidelines on Community Acquired Pneumonia, which
of the following is a correctly matched symptom improvement over time?
E. 3 days – fever resolution
F. 2 weeks – chest pain and sputum production have reduced
G. 4 weeks – fatigue has resolved
H. 6 weeks – cough and breathlessness have reduced

43. According to the 2016 Philippine Clinical Practice Guidelines for the diagnosis, treatment, prevention and control
of TB, what is the anti-TB treatment recommendation for post-solid organ transplant patients without risk factor for
drug resistance?
E. INH, rifampicin, ethambutol, and pyrazinamide for 6 months
F. INH, rifampicin, pyrazinamide for 2 months then INH and rifampicin for 6 months
G. INH, ethambutol, pyrazinamide for 2 months then INH and ethambutol for 12-18 months
H. INH, rifampicin, ethambutol, pyrazinamide, streptomycin for 2 months then INH rifampicin for 4 months

GASTROENTEROLOGY

44. Which of the following is not a complication of chronic pancreatitis?

A. Cobalamin deficiency
B. Niacin deficiency
C. Pancreatic carcinoma
D. Vitamin A deficiency

45. Which of the following viruses can most likely cause fulminant hepatitis in a pregnant patient?
A. Hepatitis A
B. Hepatitis B
C. Hepatitis C
D. Hepatitis E

46. Which gene is most commonly mutated or inactivated in pancreatic cancer?

A. ARAS
B. p16
C. p53
D. SMAD4

47. What are the two factors that predispose patients to high H. pylori colonization?
A. Age and less education
B. Race and poor socioeconomic
C. Race and age
D. Less education and poor socioeconomic

48. Which part of the stomach is Dieulafoy’s lesion most commonly seen?
A. Antrum
B. Cardia
C. Greater curvature, distal body
D. Lesser curvature, proximal body

DERMATOLOGY

49. What is the active ingredient of the sensitizing antigen common to the plants belonging to the family
Anacardiaceae which is a common cause of allergic contact dermatitis?
A. Alkyl ethoxy sulfate
B. Monoethanolamine
C. Pentadecyl catechol
D. Urushiol

50. Which of the following causes of figurate skin lesions is a primary cutaneous disorder?
A. Erythema annulare centrifugum
B. Erythema teleratum repens
C. Erythema marginatum
D. Erythema migrans

MISCELLANEOUS TOPICS

51. In amnesic shellfish poisoning, what is the regulatory limit for domoic acid in shellfish?
A. 5 parts per million
B. 10 parts per million
C. 15 parts per million
D. 20 parts per million