XxxProject R-1000 - Beta Release

Project R-1000
Ultimate Revalida Reviewer

Preface
• This project is a compilation of revalida
questions, comprehensive exams, shifting
exams, long exams, and quizzes
• I have used standard textbooks and credible
internet sources in order to rationalize the
answers but I still cannot guarantee that
everything here is 100% correct.
• USE AT YOUR OWN RISK!
• Disclaimer: I do not own any pictures in this
project
Biochemistry
1. Which of the following will keep the bile salts adequately
ionized to be good emulsifier of dietary fat?
•HCl
– Will keep bile salts unionized
•Bicarbonate
– Will make bile salts ionized because bile salts are acidic so they will
donate their protons or hydrogen ions upon contact with a alkaline
substance or an alkaline environment
•Phospholipids
– Have no effect on bile salt ionization
•Colipase
– This is a coenzyme required for the optimal activity of pancreatic
lipase
Biochemistry
2. Which of the following is
incorporated into
chylomicrons formed inside
the intestinal epithelial cells?
•Palmitic acid
•2-monoacylglycerol
•Triacylglycerol – packaged
together with cholesterol and
proteins into chylomicrons
•Free fatty acids Chylomicron
Biochemistry
3. Which of the following will NOT be

incorporated into micelles?
•Palmitic acid
•2-monoacylglycerol
•Triacylglycerol
– must be broken down first into 2-monoacylglycerol
and 2 free fatty acids
•Free fatty acids
Biochemistry
4. Which of the following statements is TRUE regarding
the enzymatic action of pancreatic lipase on dietary
lipids?
•Release 2 FFA from the carbon 1 and 2 of TAG

– carbon 1 and 3
•Products: 1 saturated fatty acid, 1 unsaturated fatty
acid, 1 monoacylglycerol
•Produces diacylglycerol and 2 FFA
– monoacylglycerol
•Yields 2-monoacylglycerol and 1 FFA
– 2 FFA
Rehab Medicine
5. Leading cause of mortality in SCI patients

both during the first post injury year and during
subsequent years?
•Myocardial infarction
•Neoplasms
•UTI
•Pneumonia
7
Rehab Medicine
6. An injury of the spinal cord that results in
ipsilateral weakness and position sense loss
but contralateral pain and temperature sense
loss:
•Anterior cord syndrome

– complete motor paralysis below lesion and
retained proprioception
•Central cord syndrome
– UE > LE weakness, variable degree of sensory
loss, bladder dysfunction
•Brown-Sequard syndrome
•Posterior cord syndrome
– loss of proprioception and vibration sense only
Rehab Medicine
7. ASIA category where sensation is preserved in the
sacral segments S4-S5, but more than half the key
muscles below the neurological level of injury (NLI) have
a muscle grade less than 3/5
•A – complete SCI, sensory (-), motor (-)

•B – incomplete SCI, sensory (+), motor (-)
•C – incomplete SCI, sensory (+), motor (+), key muscles
have grades of < 3/5
•D – incomplete SCI, key muscles have grades of 3/5 or
more
•E – normal sensory and motor
Medical Nutrition
8. The diet is designed for an adult patient not requiring any
dietary modification.
•Full bland diet

– For hyperacidity, and PUD
•Low carbohydrate diet
– For DM, dumping syndrome, fat and carbohydrate-induced
hyperlipoproteinemia
•Regular full diet
•Clear liquid diet
– For immediate pre-op and post-op with normal GIT function, acute
diarrhea, intestinal obstruction
Medical nutrition
9. One of the following characterizes a high-fiber diet:
•Generally contains about 25-30 grams of dietary fiber

per day
•Decreases the intake of fiber on a daily basis
•Contains a minimal amount of indigestible carbohydrates
or dietary fiber to avoid large fecal volume
– liberal amounts fiber but a person should also increase fluid
intake
•Includes a low content of fruits and vegetables with the
skin and seeds removed
Medical Nutrition
10. Which of the following MUST NOT be

included in the diet of a patient with
hyperacidity
•“Hot” spices
•Caffeine containing beverages
•Alcoholic drinks
•All of the above
– these foods stimulate gastric acid secretion
Neurology
11. Which of the following neurotransmitters

have been implicated in the etiopathophysiology
of migrane?
•Serotonin
•Glutamate
•GABA
Neurology
12. Aneurysm causes headaches thru which of

these mechanisms?
•Inflammation
•Distention
•Traction
•Displacement of pain-sensitive structures
Neurology
13. The following are pain-sensitive structures

EXCEPT:
Pain-sensitive Pain-insensitive
Cranial venous sinuses Brain parenchyma
•Dural arteries Arteries at base of brain Ependyma
•Dural sinuses Arteries of the dura Choroid

Dura near base of brain and Pia
•Brain parenchyma large arteries
All extra-cranial structures: Arachnoid
•Bony periosteum • Periosteum Dura over convexity
• Muscles
• Eyes, ears Skull
Pediatrics
14. Give the reason why infants are prone to

wheezing.
•Small peripheral airway caliber

•Very compliant chest wall
•Higher level of lymphocytes, neutrophils in BAL
•Variety of inflammatory mediators
Pediatrics
15. In very young infants with bronchiolitis,

which of the following clinical manifestations
may be more prominent than wheezing early in
the course of the disease?
•Irritability
•Diarrhea and vomiting
•Apnea
•Tachypnea
Pediatrics
16. The mainstay of treatment in infants with acute
bronchiolitis.
•Ribavirin
– adjunct therapy only
•Supportive
– bronchiolitis is predominantly viral (usually RSV) so
supportive
•Steroids
– adjunct therapy only
•Vitamin C
– No proven therapeutic effect
ENT
17. The fibers of the olfactory nerve pass through this structure
to enter the nasal cavity.
•Nasolacrimal duct
– for tears
•Choanae
– An opening in the internal nose through which the nasal cavity
communicates with the nasopharnyx
•Cribriform plate of ethmoid
•Hiatus semilunaris
– Groove where openings of the frontal sinus, maxillary sinus, and
anterior ethmoidal sinus are located
19
ENT
18. One of the characteristic of a nasal polyp:
•Pinkish
– grayish
•Fixed
– movable
•Does not shrink when decongestant is applied
– needs steroids or surgery
•Hard
– soft
20
ENT
19. An opening in the internal nose through

which the nasal cavity communicates with the
nasopharnyx:
•Anterior nares
•Hiatus semilunaris
•Nasolacrimal duct
•Choanae
Gynecology
20. Breast palpation is performed using the:
•Tip of the index finger

•Pads of the middle 3 fingers
•Palmar aspect of both hands
•Tips of index and middle fingers
Gynecology
21. On inspection of the external genitalia, patient was
found to have moderate amount of coarse pubic hair
with a diamond-shaped distribution, extending towards
the umbilicus. This suggests:
•Normal finding
•Androgenized
– her pubic hair is of male type
•Peri-menopausal pattern
•Chromosomal defect
Gynecology
22. Patient was found to have a cystic, movable, non-tender
painless, 1.5 cm diameter mass on the posterior aspect of the
left labium majus. The mass most likely is related to this
structure:
•Gartner’s duct
– internal, lateral vaginal wall
•Bartholin’s gland
•Skene’s gland
– anterior, near urethra
•Urethrocele
– anterior
Gynecology
23. On pelvic exam, the cervix was directed
anteriorly, the normal-sized uterus was n the
same axis as the cervix. The uterine fundus
could not be felt on the anterior abdominal wall
when the cervix was pushed anteriorly. Theses
suggests the uterus to be in this position:
•Ante-versoflexed
•Anteflexed
•Retroflexed
•Retroverted
Anatomy
24. This Layer of the scalp is also known as the
dangerous area in the scalp.
•Skin
•Subcutaneous layer
•Galea aponeurotica
•Loose areolar tissue
– There’s a direct route from this space to the CSF via the
emissary veins. (high risk for brain infection)
Anatomy
25. Origin of the blood supply to the scalp:
•External carotid artery – superior temporal

•Ophthalmic artery – supratrochlear,
supraorbital)
Anatomy
26. Innervation of the muscles of facial

expression:
•Mandibular
•Maxillary
•Ophthalmic
•Facial
Surgery
27. Etiologies of breast cancer includes the following
EXCEPT:
•High dietary fat intake

– Lipid peroxidation creating free radicals
•Infertility
– Always in hyperestrogenic state
•History of primary breast cancer
– Risk factor
•Early menopause
– Rest in estrogenic state
Surgery
28. Features of ductal carcinoma in situ (DCIS):
•More than 90% are premenopausal

– menopausal 54-58 yrs, LCIS is premenopausal 44-
47
•Microcalcification on mammography
– LCIS is not associated with calcification
•Axillary node metastasis
– rarely metastasizes in the axilla (1-2%), and it’s
supposed to be in situ!
•Total mastectomy is the gold standard of
treatment
Surgery
29. What are the treatment options for lobular

carcinoma in situ (LCIS):
•Quadrantectomy
•Bilateral mastectomy
– LCIS is usually bilateral
•Modified radical mastectomy
•Conservation and tamoxifen
Internal Medicine
30. The dominant mechanism in the

pathogenesis of GERD is:
•Transient lower esophageal sphincter relaxation

•LES hypotension
•Refluxed gastric acid and pepsin
•Anatomic distortion of gastroesophageal
junction as seen in hiatal hernia
Internal Medicine
31. A 54 y/o male heavy smoker with a long history of
heartburn and regurgitation, is poorly compliant with
his medications (PPI). He undergoes periodic
gastroscopy because of the possible development of:
•Esophageal ulcers
•Stricture formation
– occurs in 10% of untreated GERD
•Barrett’s esophagus
– squamous metaplasia
•Esophagitis
Internal Medicine
32. The most common location of esophageal

carcinoma is in the:
•Proximal third – 10%

•Middle third – 35%
•Distal third – 55%, but GE junction is more
dominant
•Gastroesophageal junction
Internal Medicine
33. The simplest and non-invasive test to establish
eradication of H. pylori infection is:
•Rapid urease test

– needs gastroscopy and biopsy of mucosa
•Stool antigen test
– non-invasive but not convenient
•Serology
– invasive and takes time
•Urea breath test
– very practical and non-invasive
Obstetrics
34. What is the major site of blood formation
during the mesoblastic period?
• Yolk sac – embryonic period to 3
months
• Liver – from 2 months up to
near term
• Bone marrow – starts at 4
months then continues to
adulthood
• Kidneys – generally not a site for
hematopoiesis
Obstetrics
35. Which of the following has more
affinity to oxygen?
•Hgb F – for better access to oxygen

from mother’s bloodstream
•Hgb A
•Hgb A2 – found at low levels (1-3%),
increased in beta thalassemia and
sickle-cell disease
•All of the above
Obstetrics
36. What immunoglobulin is
produced by the fetus in response to
congenital infections?
•IgA
•IgM – produced by the fetus in
response to rubella, CMV, and
toxoplasmosis
•IgG – produced by the mother
•IgM and IgG
38
Behavioral Medicine
37. Which of the following is true of Oppositional Defiant

Disorder (ODD)?
•Boys are more affected than girls with a ratio of 4-12:1

– 11% in males, 9% in females
•Treatment includes family intervention
– Parent behavior therapy (positive/negative reinforcement)
•Often lies to avoid obligation
– conduct disorder
•All of the above
Behavioral Medicine
38. Treatment/s of choice of children with

Autistic Disorder:
•Behavioral interventions
•Language interventions – autistic children have
no problem in language itself
•Educational interventions
Behavioral Medicine
39. Parents of children with ADHD show an
increase incidence of:
•Alcohol use disorder

•Conversion disorder
– numbness, blindness, paralysis, etc. without an
organic cause that arise in response to stressful
situations
•Hyperkinesis
•All of the above
Histology
40. Which of the following cartilages is

characterized by the absence of the
perichondrium?
•Adult hyaline cartilage

•Fetal hyaline cartilage
•Fibrocartilage
•Articular cartilage
Histology
41. What type of cartilage is found in the epiglottis?
•Elastic cartilage
•Fetal hyaline cartilage
– found in entire skeletal system of embryo
•Fibrocartilage
– found in symphysis pubis, TMJ, menisci, and intervertebral
discs
•Hyaline cartilage
– found in respiratory system and articular surfaces of bones
Histology
42. What is the type of cartilagenous growth

that occurs only in young cartilage?
•Exogenous growth
•Appositional growth
•Endosteal growth
•Interstitial growth
Pathology
43. Which of the following adaptive responses

would the cell remain in the G0 phase of the cell
cycle during the entire process?
•Metaplasia
•Atrophy
•Hypertrophy
•Hyperplasia
Pathology
44. A cell adapts to a stressful environment to achieve

which of the following?
•Higher level of physiologic function to achieve survival

•New steady state to prolong survival
•Preparation for cell death
– apoptosis
•Autonomy of cell function
– neoplasia
Pathology
45. Metaplasia of an epithelium is achieved
through which of the following?
•Direct transformation of the original matured

cells to another type of cell
•Matured cells become immature and then
transform to another type of cell
•Stem cells divide and mature directly to
another type of cell different from the original
type of cell
•Stem cells divide and do not mature
Pharmacology
46. Patients with adrenal insuffiency presenting

with persistent hyponatremia will benefit
from:
• Flucortisone – highest Na (125) retaining

potency
• Hydrocortisone – 0.8
• Dexamethasone - 0
• Triamcinolone - 0
Pharmacology
47. Drug A has 100% receptor occupancy but

produces less than the expected maximal
pharmacologic response, Drug A is a:
•Partial agonist
•Full agonist – maximal response
•Antagonist – bind to receptors but do not
activate them
Pharmacology
48. This can block cardiac effects of Isoproterenol:
– Isoproterenol is a non-selective beta agonist used in the
treatment of bradycardia, heartblock, and rarely for asthma
• Esmolol – Beta 1 selective blocker

• Terbutaline – Beta 2 agonist that can be used for short-
term asthma treatment or as a tocolytic for preterm
labor
• Atropine – Antimuscarinic
• Prazosin – Alpha blocker that can control the
constriction of prostate (BPH) and ureters
Ophthalmology
49. Which of the following statements regarding

congenital esotropia is incorrect?
• There is poor abduction in one eye

• Crossing is present during the first 6 months of
life
• There is no significant hyperopia
• The eyes do not straighten with eyeglasses
Ophthalmology
50. What is the most common intraocular

malignancy in childhood?
• Retinoblastoma
– Characterized by leukocoria or amaurotic cat’s eye
reflex and strabismus
Ophthalmology
51. A patient with right 4th nerve palsy (trochlear) will
present which of the following?
• Medially deviated eye

– medial rectus, CN III
• Vertical deviation
– superior oblique muscle
• Exotropia
– lateral rectus, CNIII
• Incycolotorsion
– CN III palsy
Clinical Epidemiology
52. A screenable disease must have:
•Effective treatment after the disease becomes

apparent
•Rare occurrence
•Accurate test in the preclinical stage of the
disease
•All of the above
54
53. A study is looking at whether the addition of high
dose steroids can reduce deaths from severe sepsis.
The data shows 101 subjects randomized to steroids,
20 died; while of the 100 who did not, 25 died. The
relative risk of death when steroids are given is:
Solution:
RR = Rt/Rc
Rt = 20/101 = 0.20
Rc = 25/100 = 0.25
RR = 0.20/0.25 = 0.8
54. A study is looking at whether the addition of high dose
steroids can reduce deaths from severe sepsis. The data shows
101 subjects randomized to steroids, 20 died; while of the 100
who did not, 25 died. To prevent one death with steroids, you
have to treat:
Solution:
NNT = 1/ARR
ARR = Rc – Rt
Rt = 20/101 = 0.20
Rc = 25/100 = 0.25
ARR = 0.25 – 0.20 = 0.05
NNT = 1/0.05 = 20
Preventive Medicine
55. Which of the following is a correct

recommendation among 75 y/o patients?
•Yearly visual screening

•Pap smear every 2 years – until 50-60 years only
•Monthly FBS
•Pneumococcal vaccine every 5 years
Preventive Medicine
56. Which of the following is an appropriate

primary prevention for elderlies?
•Routine varicella immunization - secondary

•Aspirin 325 mg is given to prevent stroke -
secondary
•Physical therapy for stroke - tertiary
•Wearing seatbelts should be advised
Preventive Medicine
57. In BATHE technique, this gives an assessment of

functioning and provides direction for intervention:
•Background – “What’s going on in your life”?

•Affect – “How do you feel about it”?
•Trouble – “What troubles you most about the
situation”?
•Handling – “What helps you handle the situation”?
•Empathy – “Anybody would feel as you do”
Anesthesiology
58. Decreased sensitivity to a painful stimulus:
•Analgesia
– Absence of pain
•Paresthesia
– Abnormal sensation
•Hyposthesia
•Allodynia
– Pain due to a stimulus that does not normally provoke pain
60
Anesthesiology
59. Small diameter fibers transmit impulses associated
with sharp, burning first pain:
•A beta Big Abet is fastest
– largest, fastest, myelinated

•A delta
Small Adel is 1st honor
– 1st pain, small diameter, myelinated
•E fibers - ?
•C fibers
– 2nd pain, very small diameter, slow pain, unmyelinated
Anesthesiology
60. Gate’s Theory of pain modulation occurs

mostly in the:
•Peripheral nerve endings

•Dorsal horn of the spinal cord
•Thalamus
•Cerebral cortex
Radiology
61. A pulmonary nodule with popcorn-like

calcifications is most probably:
•Malignant
•Infectious
•Hamartoma
•Hemangioma
Radiology
62. The following may produce resorption atelectasis
•Pneumonic consolidation
– compression atelectasis
•Solid foreign bodies
•Asbestos particles
– contraction atelectasis
•Air trapping
– airway obstruction causes subsequent resorption
atelectasis
Radiology
63. Most common imaging test for evaluating the heart and
great vessels in the chest radiograph which consists of an upright
postero-anterior (PA) chest and a/an:
•Right lateral
– heart will be magnified or enlarged
•Left lateral
•Right anterior oblique
– not common
•AP chest
– heart will be magnified or enlarged
Anatomy
64. In which triangle of the neck will a surgeon
make an incision to gain access to the thyroid
gland?
•Muscular
•Submandibular
•Carotid
•Subclavian
66
Anatomy
65. Weakness in dorsiflexion and inversion of the foot
points to injury of which muscle?
•Peroneus longus
– plantar flexion, foot eversion at the ankle
•Tibialis anterior
•Extensor digitorgum longus
– extensor of toes and dorsiflexion of ankle
•Flexor digitorum longus
– flexor of toes
Anatomy
66. Aneurysm of the abdominal aorta at the aortic hiatus of the
diaphragm will most likely compress the following structures:
•Azygous vein and thoracic duct

•Thoracic duct and vagus nerve
– thoracic duct at aortic hiatus and vagus nerve at esophageal hiatus
•Vagus nerve and azygos vein
– vagus nerve at esophageal hiatus and azygos vein at aortic hiatus
•Inferior vena cava and phrenic nerve
– vena caval hiatus
Physiology
67. During a cardiac cycle, which of the following
events occur?
•AV valves open during diastole

•Closure of the aortic valve during systole
– diastole
•Pulmonary valve opens during diastole
– systole
•Aortic valve closes at the same time as AV valve
– impossible
Pharmacology
68. A patient was presecibed with a cholesterol lowering agent
which belongs to the “statin” family. This drug inhibits HMG-CoA
reductase. This agent decreses serum cholesterol by?
•Inhibiting absorption of cholesterol in the intestine

– Ezetemibe inhibits intestinal absorption while bile acid sequestrants
(Cholestyramine, Colestipol) prevents reabsorption into the intestine
by binding to bile acids
•Decreasing formation of mevalonic acid, the product of the
rate-limiting step in cholesterol synthesis
•Promoting the excretion of cholesterol and fecal sterols
•Increasing catabolism of cholesterol into bile acids
Biochemistry
69. As an enzyme, HMGCoA reductase utilizes what
coenzyme as cofactor?
•Thiamine pyrophosphate
– pyruvate dehydrogenase complex, alpha-ketoglutarate
dehydrogenase complex, etc.
•NADPH + H+
•Coenzyme Q
– or cytochrome c-oxidoreductase is the third complex in
electron transport chain
•Pyridoxal phosphate
– acts on all transamination reactions; plays a role in
conversion of levodopa to dopamine, conversion of
glutamate to GABA
Biochemistry
70. Further genetic studies have shown that the patient
suffers from familial hypercholesterolemia IIa. This
defect is brought about by what mechanism?
•Lipoprotein lipase deficiency

– familial hypercholesterolemia type I
•Defect in LDL receptor-mediated endocytosis
•Decreased synthesis of apoprotein B receptors
•LCAT deficiency and inefficient reverse cholesterol
transport
– Familial LCAT deficiency
Biochemistry
71. Patient decided to enroll in a gym and hired an instructor to help
him burn excess fats. This include aerobic exercises and some
muscles strengthening exercises. During intense aerobic physical
activity, all of the following are expected except?
•Glucose, fatty acids, and ketone bodies are used as fuels by

exercising muscle
•Blood glucose levels are maintained by hepatic gluconeogenesis
from lactate and glucogenic amino acids
•Anaerobic glycolysis provides greatest amount of ATP thru
oxidative phosphorylation
– Least amount of ATP; oxidative phosphorylation is aerobic
•Hormones epinephrine and glucagon are released to promote
muscle and liver glycogenolysis through 3’5’ cAMP formation
Biochemistry
72. Which transport process in biological membranes
allows the passage of substances against the
concentration gradient coupled with the expenditure of
energy as ATP?
•Facilitated diffusion
– no ATP, needs transmembrane protein channels
•Simple diffusion
– no ATP, along concentration gradient
•Primary active transport
•Primary osmosis
– no ATP, along concentration gradient
Physiology
73. During anaerobic glycolysis, the accumulation of lactate can
produce muscle fatigue and pain. This can also produce one of the
following effects on hemoglobin.
•Shift of the oxygen-dissociation curve of Hgb to the left

– decreased pH (acidosis) will shift the curve to the right (decreased affinity)
so oxygen is easily released [Bohr effect]
•Decrease in the affinity of oxygen to Hgb
•Stabilization of the R state of Hgb
•Decrease in the p50 value of Hgb
– Lactic acidosis will cause shift of curve to the right (decreased affinity).
Therefore, higher p50 (partial pressure at which Hgb is 50% saturated) is
needed. Affinity is inversely proportional to p50.
Physiology
74. A 50 y/o male underwent craniotomy. At the
recovery room, he was noted to have
voluminous urine. With this condition you may
assume that he has deficiency of which of the
following?
•Oxytocin
•ACTH
•TSH
•ADH
Physiology
75. Which of the following is true of the pressure
changes during the expiratory phase?
•Alveolar pressure exceeds atmospheric pressure

•Intrapleural pressure becomes more negative
– Less negative
•Transpulmonary pressure is increased
– Decreased; it is the difference between intra-alveolar
and intrapleural pressures
•End-expiratory pleural and alveolar pressures are
the same as end-inspiratory pressures
– End-expiratory pleural pressure less negative than its
end-inspiratory pressure
Medical Ethics
76. A friend of yours is requesting you to make a
medical certificate that she was sick but she was not
because she did not appear in a court hearing and she
will be charged with contempt of court. What will you
do?
•Accede to her request

•Reprimand her for her dishonesty
•Will refer her to somebody who is willing to do it for
her
•Explain clearly to her why you cannot accede to her
request
78
Medical Ethics
77. In a patient suffering from intractable pain no
longer responding to the usual dose of morphine, a
higher dose may be given if there will be a foreseeable
effect that it may hasten his death. This could be
justified by which principle?
•Non-maleficence
– do no harm
•Stewardship
– steward/caretaker of the self, others, and environment
•Double effect
•Subsidiarity
– a larger and greater body should not exercise functions
which can be carried out efficiently by one smaller and
lesser body
Pharmacology
78. An 11-month old baby was brought to the OPD for a well-baby
check-up. On PE, e was observed to have oral moniliasis. Which of the
following would you prescribe?
•Acyclovir
– predominantly against HSV and to a lesser extent, VZV.
•Flucytosine (5-FC)
– Restricted to Cryptococcus neoformans and some candida
species
•Lamivudine
– Reverse transcriptase inhibitor for chronic Hepatitis B and HIV
•Nystatin
– Active against most Candida species and used for local candidal
infections
Parasitology
79. Which is the mismatched pair of parasite and its infective stage?
•Fasciola hepatica: metacercaria

•Entamoeba hystolytica: trophozoite
– Entamoeba hystolytica: mature tetranucleated cyst
– Mature cysts are seen with ring and dot nucleus chromatoidal
bodies (cigar-shaped bodies)
– The active trophozoite stage is the pathogenic or invasive stage
•Trichuris trichiura: Embryonated ovum
•Leishmania donovani: promastigote
Obstetrics
80. Which of the following definitions is TRUE of
engagement?
•Biparietal diameter is at the level of the ischial spines

– Pelvic inlet
•Biparietal diameter has passed the pelvic inlet
– Biparietal diameter is the widest diameter of
the presenting part
•Lower most portion of the fetal head has passed the
pelvic inlet
– Maternal ischial spines
•Lower most portion of the fetal head is at the level of
the pelvic inlet
– Maternal ischial spines
Clinical Pathology
81. Which serum Hepatitis B marker is the only one detectable during
the so called “window period”?
•HBsAg (Hepa B surface antigen)

– indicates current acute or chronic Hepa B infection that is not
detectable during the window period
•Anti-HBs (Hepa B surface antibody)
– not detectable until the end of the window period
•Anti-HBc – (antibody for Hepa B core antigen)
– the only detectable marker during the gap between the
disappearance of HBsAg and appearance of anti-HBs or the
“window period”
•Anti-Hbe – (antibody for Hepa B e antigen)
– HBeAg indicates high viral replication and infectivity 83
Pediatrics
82. Which of the following is a major criteria for

persistence of childhood asthma?
•Allergic rhinitis – minor

•Food allergen sensitization – minor
•Parent asthma – major
•Wheezing apart from colds – minor
84
Pediatrics
83. The diagnosis of vascular ring is established

by:
•CT scan
•Chest x-ray
•Barium esophagogram
•MRI
85
Behavioral Medicine
84. Which of the following objective tests can determine the possibility of
an organic problem among behaviourally disturbed patients with cognitive
symptoms?
•Wisconsin card sorting test

– assesses executive or frontal lobe function (strategic planning,
organized searching, etc.)
•Minnesota multiphasic personality inventory
– identifies personality structure and psychopathology (paranoia,
hypochondriasis, schizophrenia, etc.)
•Wechsler adult intelligence scale
– measures intelligence in adults and adolescents
•Mini-mental state examination
– Screens for cognitive impairment (orientation, recall, language,
attention and calculation, etc.)
Pharmacology
85. A newborn was noted to have grade 3/6 hear murmur. Which of
the following drugs will close the ductus arteriosus?
When you’re indoors, the door should be closed
•Indomethacin
– blocks prostaglandin E2
•Alprostadil
– a prostaglandin E1 analog, that can keep the ductus
arteriosus open
•Aspirin
– an alternative but no clinical trials yet
•Naproxen
– inhibits both COX1 and COX2
87
Microbiology
86. Which of the following organism principally infects the
liver and kidneys?
•Staphylococcus aureus
– Skin infections
•Escherichia coli
– Gastroenteritis and UTI
•Leptospira interrogans
•Treponema pallidum
– Syphilis (skin, genital)
Microbiology
87. Which of the following is true regarding antigenic drift
in influenza virus? Antigenic SHIT! It’s a
major antigenic change
and new subtype results
•It results in major antigenic change
– Antigenic shift
•It is exhibited only by Influenza A virus
– Antigenic drift occurs in all types of influenza
– Antigenic shift occurs only in influenza A
•It is due to frame shift mutation in viral genes
•It results in new subtype over time
– Antigenic shift
Internal Medicine
88. Which clinical feature is seen in the intestinal type of
gastric adenocarcinoma?
•Presents as “ulcerative type”

•Poorer prognosis than diffuse type –
– diffuse type carcinoma has poorer prognosis
•Presents as “linitis plastica”
– Linitis plastica or “leather bottle” appearance is seen in
diffuse type carcinoma
•Common in younger age group
– diffuse type carcinoma is more common in younger age
group
Internal Medicine
89. In gastroesophageal reflux disease, the presence of
esophagitis is best diagnosed by:
•24-hour pH monitoring
– helpful only in the evaluation of acid reflux
•Endoscopic ultrasound
– can show esophageal wall thickness but is not the
best test
•Barium swallow
– reveals ulcers or strictures
•Upper GI endoscopy
Internal Medicine
90. In what stage of the disease is a patient with a
histopathologic diagnosis of colonic adenocarcinoma
involving the muscularis layer with 2 out of 12 lymph nods
(+) for metastasis?
•I – T1 (invasion of submucosa) or T2 (invasion of

muscularis propria), N0, M0
•II – T3 (invasion of subserosa or nonperitonealized pericolic
or perirectal tissues) or T4 (invasion of other organs or
perforation of visceral peritoneum), N0, M0
•III – Tany, N1-3, M0
•IV – Tany, Nany, M1
Anatomy
91. To avoid injury to the intercostal neurovascular

structures during thoracentesis, the needle should be
inserted in which of the following location?
“Choose heaven than hell”
•Beneath the lower border of the ribs

•Above the upper border of the ribs
•Between the external and internal intercostals
•Through the transversus thoracis muscle
93
Anatomy
92. In doing pericardiocentesis, the needle is to be
inserted thru which intercostal space adjacent to the
sternum
•Left 4th ICS

– too high
•Left 5th ICS
•Right 4th ICS
– should be left
•Left 6th ICS
– too low
Anatomy
93. Which of the following areas would
undergo infarction if there is occlusion in the
circumflex branch of the left coronary artery?
•Apex of the heart

– Left anterior descending artery (LAD)
•Right and left atria
– right atrium is supplied by right
coronary artery
– left atrium by circumflex branch of left
coronary artery
•Interventricular septum
– left anterior descending
(interventricular) artery
•Left atrium and left ventricle
Histology
94. The exocrine pancreas and the parotid gland are
purely made up of which of these glandular
subclassification?
•Compound branched acinar

•Compound tubulo-acinar
•Compound acinar
•Compound branched tubular
Histology
95. What is the specialized type of adipose tissue
found in newborn human and hibernating mammals?
Brown adipose
•Yellow adipose tissue
– A.K.A. white adipose but white adipose is
preferred
•Multilocular adipose tissue
– A.K.A. brown adipose tissue
•Unilocular adipose tissue
– A.K.A. white adipose tissue
•White adipose tissue
– Comprises 20% of total body weight in males White adipose
and 25% in females, acts as insulator, shock-
absorber, and energy store
Internal Medicine
96. Ehler’s Danlos syndrome, Osteogenesis imperfecta, Alport’s syndrome and
Epidermolysis bullosa are disease characterized by a genetic defect incapable of
producing which of these connective tissue fiber?
•Elastin
– William’s syndrome rare neurodevelopmental disorder characterized by:
• “Elfin” facial apperance, low nasal bridge.
• Developmental delay coupled with strong language skills.
• Supravalvular aortic stenosis
•Reticulin
•Collagen
•Laminin
– Pierson syndrome (novel cause of congenital nephrotic syndrome)
Neurology
97. Preganglionic sympathetic efferent fibers
course through which pathway?
•Dorsal and ventral roots

– Dorsal root is afferent
– Ventral root is efferent
•White and gray rami
– White rami contains efferent
sympathetic preganglionic fibers
– Gray rami contains sympathetic
postganglionic fibers
•Dorsal root and gray rami
– dorsal root is afferent
•Ventral roots and white rami
Neurology
98. A lesion that affects occulomotor nerve (CN- Occulomotor nerve
III) will result in which of the following? palsy
• Ptosis
• Downward deviation
•Ptosis of eyeball (paralyzed
superior rectus and
– Due to the paralysis of levator palpebrae inferior oblique)
superioris • Outward deviation of
eye ball
•Constricted pupil • Pupillary dilation
– Paralysis of iris sphincter muscle leads to
pupillary dilation
•Medially deviated eyeball
– Paralyzed medial rectus leads to laterally
deviated eyeball
•All of the above
100
Neurology
99. What is the hypothalamic nucleus that is specifically

associated with the circadian rhythm?
•Supraoptic nucleus – synthesizes ADH

•Suprachiasmatic nucleus
•Ventromedial nucleus – satiety (decreased feeding)
•Lateral hypothalamic nucleus – feeding center
(increased feeding)
•Dorsomedial nucleus – emotional behavior, sham rage
101
Anatomy
100. Which of the following is a branch of
the internal carotid artery?
•Anterior cerebral artery

•Anterior inferior cerebellar artery
– Branch of basilar artery (confluence of
vertebral arteries)
•Posterior inferior cerebellar artery
– Branch of vertebral artery
•Posterior cerebral artery
– Usually a branch of the basilar artery
Gynecology
101. A 24 y/o G1P1 (1001) wants to have a gynecologic check-up. She is
generally asymptomatic and pelvic examination is normal. Which of the
following should be done or requested?
•Mammography
– For women ages 40 and above
•Breast ultrasound
– ultrasound is not a screening tool in asymptomatic women
•Pap smear – should begin at age 21 or 3 years after the individual becomes
sexually active
•Transvaginal ultrasound
– Can detect presence of pelvic mass but does not establish tissue
diagnosis
– Can measure endometrial thickness
– ultrasound is not a screening tool in asymptomatic women
Gynecology
102. How is endometrial cancer diagnosed?
•Pap smear – screening for cervical cancer

•Colposcopy – diagnostic method of choice for
the evaluation of pap test abnormalities
• Transvaginal ultrasound - can detect presence of
pelvic mass but does not establish tissue
diagnosis
•Endometrial biopsy
Gynecology
103. Which of the following options can be offered to women with
complex atypical hyperplasia who is desirous of childbearing function?
•OCPs
– For simple or complex hyperplasia without atypia
•High-dose progestin
– Megestrol acetate 40 mg TID, QID
•Endometrial ablation
– Sometimes undertaken to control severe uterine bleeding
because abnormal vaginal bleeding is the most frequent
symptom of endometrial hyperplasia
•Immunotherapy
– HPV vaccine is promising but more studies needed
Gynecology
104. Which condition will result in a foul smell upon addition of 10%
KOH to a sample of vaginal discharge?
•Candidiasis
– KOH aids in the diagnosis of fungal infections by dissolving
cellular debris, mucus, and keratinized materials leaving fungal
elements intact in microscopy
•Herpes vaginitis
•Trichomoniasis
– KOH test (Whiff test) will produce a strong amine “fishy” odor
indicative of trichominiasis or bacterial vaginosis
•Atrophic vaginitis
– Generally odorless; otherwise, its infected.
Legal Medicine
105. What is the condition wherein blood merely

gravitates into the most dependent portion of the body
but still fluid in form?
•Diffusion lividity
– Blood has already clotted or coagulated
•Hypostatic lividity
– Blood is still fluid in form
•All of the above
•None of the above
Legal Medicine
106. What type of crime is virginity an essential element?
•Rape
– The age is less than 12; or if 12 but less than 18, there is force or
intimidation, or the girl may or may not be a virgin
•Qualified seduction
– The offended party is a virgin which is presumed if she is
unmarried and of good reputation
•Simple seduction
– The girl must be more than 12 but less than 18 and the crime is
by means of cajolery
•Statutory rape
– Generally refers to sex between an adult and a sexually mature
minor past the age of puberty
Dermatology
107. What are the cells that
form the epidermis?
•Melanocytes
– Pigmentation
•Keratinocytes
•Adipocytes
– Fat
•Langerhan cells
– Dendritic cells of the
skin and mucosa
Dermatology
108. What is a circumscribed, solid elevation with no visible
fluid varying in size from a pinhead to 1 cm?
•Macule
– Flat, 0.5 to 1 cm in diameter
•Papule
•Plaque
– Broad papule or confluence of papules greater than 1
cm
•Patch
– flat, larger than macule, greater than 1 cm
Rehab Medicine
109. What is the nerve affected in a carpal

tunnel syndrome?
Ulnar Median Radial
Guyon’s canal Carpal tunnel Saturday night
syndrome syndrome palsy
Cubital tunnel Wrist drop
•Ulnar syndrome
Claw hand
•Radial deformity
Ape hand
•Median
•Musculocutaneous
Rehab Medicine
Spurling’s
110. What maneuver is done to test
check for lumbar nerve root
impingement? Straight leg raise test
•Spurling’s test – for cervical

radiculopathy
•Straight leg raise test Gaenslen’s
test
•Gaenslen’s test – sacroiliac joint
inflammation
•Patrick’s test – evaluates the hip
joint or the sacroiliac joint Patrick’s test 112
Pathology
111. A 65 y/o man has several episodes of hematuria in the past week. On PE,
there are ano abnormal findings. A urinalysis shows (+4) hematuria and
cytologic examination of the urine shows that atypical cells are present. A
urologist performs a cytoscopy and observes a 4 cm mass with nodular,
ulcerated surface in the dome of the bladder. Which term best describes the
lesion?
•Sarcoma
– Malignant tumor that arises from bone, fat, cartilage, muscle, vascular,
or hematopoietic cells
•Papilloma
– Benign tumor growing exophytically in finger-like projections
•Fibroma
– Benign tumor composed of fibrous or connective tissue
•Carcinoma
Surgery
112. Which shock is characterized by decreased cardiac index,
decreased venous capacitance, increased vascular resistance, and
decreased CVP?
•Neurogenic shock
– disruption of the autonomic pathways leading to bradycardia,
hypotension, decreased systemic vascular resistance
•Hypovolemic shock
•Septic shock
– result of severe infection and sepsis ultimately leading to
refractory hypotension
•Cardiovascular shock
– failure of the heart to pump effectively leading to hypoperfusion
Obstetrics
113. In a primigravida, at what age of gestation

is the first fetal movement (quickening) usually
perceived?
•16-18 weeks - multigravida

•18-20 weeks
•20-22 weeks
•24-26 weeks
Internal Medicine
114. What is the initial diagnostic of choice for

carcinoma of the ampulla of Vater
•Pancreatectomy – not a diagnostic test

•CT scan
•MRI
•MRCP
Surgery
115. What is the treatment of choice for operable pancreatic
cancer?
•Pancreatectomy – total removal of pancreas, very poor

prognosis
•Whipple’s procedure
– pancreaticoduodenectomy; only the head of the
pancreas, gallbladder, common bile duct, gastric antrum,
and adjacent duodenum are removed
•Billroth I – not applicable; pylorus is removed so proximal
stomach is anastomosed to the duodenum
•Gastrojejunostomy – not applicable
Pediatrics
116. Which component of Tetralogy of Fallot

determines the severity of cyanosis?
•Overriding aorta
•VSD
•RVH
•Pulmonic stenosis
– Less blood will go to the lungs for oxygenation
ENT
117. In performing anterior rhinoscopy, what

structure will you appreciate in the nasal cavity?
•Superior meatus, turbinate only

•Middle turbinates, meatus only
•Inferior, middle turbinates and meati
•Superior, middle, inferior meati and turbinates
119
ENT
118. You notice a mass in the right nasal cavity. How will
you differentiate a polyp from a turbinate?
•Soft, grayish movable smooth

– turbinate is hard, pink, and non-movable
•Shrink with a decongestant
– Polyp does not shrink by using decongestant
•Firm, pinkish, smooth
– Polyp is movable, grayish, and smooth
•Cauliflower-like, bleeds easily
– This is nasal papilloma
Physiology
119. An increase in one of the following factors will

increase diffusion of gas across the alveolo-capillary (AC)
membrane:
•Diffusion coefficient of the gas

•Oxygen content of the blood
– Decreased diffusion
•Molecular size of the gas
•Thickness of AC membrane
Physiology
120. Mr. Garcia, an asthmatic, has been on beta
adrenergic agonist for quite some time. Currently, he
claims that his difficulty of breathing is hardly
relieved by intake of the said drug. The most likely
explanation related to the receptor involve is?
•Down regulation
•Competition
•Saturation
•Altered affinity
122
Internal Medicine
121. Which is true of orthopnea?
•Due to increased pulmonary capillary hydrostatic pressure

•Dyspnea that awakens the patient after sleeping
– paroxysmal nocturnal dyspnea
•An earlier manifestation of heart failure than exertional
dyspnea
– later than exertional dyspnea
•Dyspnea relieved by assuming a lateral decubitus position
– Upright position
Microbiology
122. Nasopharyngeal carcinoma is associated

with which virus?
•EBV infection
•HPV 16 – cervical cancer
•H. pylori – gastric cancer
•Herpesvirus – HHV8 (Kaposi’s sarcoma)
Microbiology
123. Which of the following normal genital flora is greatly
decreased in bacterial vaginosis?
•Staphylococcus epidermidis
•Prevotella sp.
•Candida albicans
•Lactobacillus sp.
– Greatly decreased in number causing increase in
vaginal pH thereby promoting the growth of other
bacteria like Gardnerella vaginalis, an etiologic agent
of bacterial vaginosis
Surgery
124. What is the long-term complication following excision
hemorrhoidectomy resulting from excessive loss of rectal
mucosa?
•White head deformity

– A.K.A. Ectropion
•Anal stenosis
•Ectropion (anal soiling)
– abnormal position of anal mucosa into the anodermal
junction or more distal into the perianal skin, mild rectal
prolapse
•Incontinence
Surgery
125. What is the best way to treat a patient with

symptomatic gallstones?
•Laparoscopic cholecystectomy
•Percutaneous cholecystecotmy
•Open cholecystectomy
•Any of the above
– Any of the above can be done to treat the patient
but laparoscopic cholecystectom is the best
127
Pediatrics
126. What is the most common childhood malignancy?
•Neuroblastoma
– 4th most common malignancy of childhood
– most common intra-abdominal malignancy of infancy
– most common extracranial solid tumor of childhood
•Wilm’s tumor
– Most common childhood abdominal malignancy
•Hepatoblastoma
– Most common liver cancer in children
•Acute lymphocytic leukemia
Pathology
127. Which of the following actively participates in

acute inflammatory process and contains
myeloperoxidase within its primary (azurophilic)
granules and alkaline phosphatases in its secondary
specific granules?
•Eosinophils – granules contain histamine

•Lymphocytes – agranulocyte
•Monocytes – agranulocyte
•Neutrophils 129
Internal Medicine
128. Which is an endocrine disorder most

commonly associated with palpitation?
•Diabetes mellitus type I

•Hyperthyroidism
•Diabetes mellitus type II
•Hypothyroidism
Radiology
129. What is the basis for the different densities

noted in a CT scan image?
•Electrical charge of atoms

•Electron density of the structures
•Velocity of the x-ray photons that interacts with
the patients
•Thickness of the CT slice
Radiology
130. What is the primary imaging modality to

visualize microcalcifications in breast cancer?
•Positron-emission tomogrophy
•Mammogram
•Ultrasound
•MRI
131. The following table summarizes results of a study to
evaluate the dexamethasone suppression test (DST) as a
diagnostic test for major depression. The study compared
results on the DST to those using the gold standard procedure,
routine psychiatric assessment and structured interview in368
patients. What is the sensitivity of the test?
Solution:
Dpression No depression Totals
•Sn = a / a + c (D+) (D-)
•Sn = 84 / 215 DST result (T+) 84 (a) 5 (b) 89
DST result (T-) 131 (c) 148 (d) 279
•Sn = 39%
Totals 215 153 368
results on the DST to those using the gold standard
procedure, routine psychiatric assessment and structured
interview in368 patients. What is the specificity of the test?
Solution: Dpression No depression Totals

•Sp = d / b + d (D+) (D-)
DST result (T+) 84 (a) 5 (b) 89
•Sp = 148 / 153 DST result (T-) 131 (c) 148 (d) 279
•Sp = 96.7% Totals 215 153 368
patients. What is the positive predictive value of the DST test?
Solution:
•ppv = a / a + b (D+) (D-)
•ppv = 84 / 89 DST result (T+) 84 (a) 5 (b) 89
DST result (T-) 131 (c) 148 (d) 279
•ppv = 94.4%
Totals 215 153 368
patients. What is the negative predictive value of the DST
test?

Solution: (D+) (D-)
•npv = d / c + d DST result (T+) 84 (a) 5 (b) 89
•npv = 148 / 279 DST result (T-) 131 (c) 148 (d) 279
Totals 215 153 368
•npv = 53%
Medical Nutrition
135. Aside from the hypercholesterolemia, patient was also found to have
NIDDM. Assuming that the rest of the other blood chemistries were normal,
which of the following dietary advices would benefit this newly diagnosed
diabetic?
•Restrict protein intake to 0.8 g/kg body weight daily –

– There is insufficient evidence to suggest that usual protein intake (15-
20%) should be modified in diabetics with normal renal function.
– 0.8 g protein is recommended for early CKD .
•Favour food with high glycemic index but low glycemic load
•Limit saturated fat to 7% of total calories
•Chromium and vitamin supplementation should be started
– There is no clear evidence of benefit from vitamin or mineral
supplementation
Microbiology
136. If Streptococcus pyogenes is the suspected etiologic agent, what cultural
characteristic will be present?
•Alpha hemolysis
– A.K.A incomplete hemolysis or green hemolysis
– Streptococcus pneumoniae and Streptococcus viridans display alpha
hemolysis
•Beta hemolysis – complete hemolysis due to exotoxin, streptolysin
•Optochin sensitive
– Streptococcus pneumoniae is sensitive while Streptococcus viridans is
resistant
•Bacitracin sensitive
– Bacitracin is added in the culture to show beta hemolysis
– Used to distinguish Streptococcus pyogenes from other beta-
hemolytic streptococci
Histology
137. Which of the following cell of the gastric carcinoma
elaborates HCl?
•Chief cell – pepsinogen

•Parietal cell – HCl and intrinsic factor
•Argentaffin cell
– A.K.A. enteroendocrine cells
– G cells produce gastrin
– Enterochromaffin-like cells produce histamine
•Mucous neck cell – secretes mucus
Clinical Pathology
138. Patient’s vital signs are within normal limits but hemoglobin is 7
g/dL. He complains of dizziness and dyspnea. Which blood component
would you give?
•Whole blood
•Packed RBC
•Washed red cells
– washed in sterile saline to remove WBCs, lytic mediators, non-self
antigens
– most useful in IgA-deficient patients who have circulating anti-IgA
antibodies,
– used to decrease febrile, urticarial and anaphylactic reactions.
•Fresh frozen plasma
Dermatology
139. If a patient presents with erythematous patches initially predilected
to the periorificial surfaces then developing generalized exfoliation
associated with fever, what is the most probable diagnosis?
•Slapped cheek syndrome

– A.K.A. erythema infectiosum or fifth disease
– Caused by parvovirus B19
– Rash is more pronounced in the cheeks
•Erythema marginatum
– The face is generally sparred
– (+) pink rings on the trunk and inner surface of limbs
– Associated with RHF
•Staphylococcal scalded skin syndrome
•Scarlet fever
Behavioral Medicine
140. In schizophrenia, what is the dopaminergic pathway that is
responsible for the negative symptoms?
Positive limbs
•Mesolimbic
– positive symptoms (delusion, hallucination, thought disorder)
•Mesocortical
– negative symptoms (akathisia, dystonia, dyskinesia,
andhedonia, alogia)
•Tuberoinfundibular
– related to hyperprolactinemia
•Nigrostriatal
– related to Parkinson’s disease
Physiology
141. What happens during sarcomere
shortening?
•M line is pulled to one end of the sarcomere

– remains at the center
•A band decreases in width
– remains the same
•Z lines move toward the center of the
sarcomere Myosin Actin
•M bands remain the same distance apart A band (+) (+)
– Get closer I band (-) (+)

H zone (+) (-)
Physiology
142. Vagal stimulation causes decreased heart rate. Which receptor
should be blocked in order to increase heart rate?
•Cholinergic muscarinic receptor

– stimulation of M2 receptors would decrease heart rate
•Cholinergic nicotinic receptor
– Found in neuromuscular junction, autonomic ganglion, and
brain, leads to muscle contraction or synaptic excitation
•Alpha adrenergic receptor
– No effect in heart rate
•Beta adrenergic receptor
– blocking beta-1 adrenergic receptors would decrease heart
rate
Preventive Medicine
143. Administration of measles vaccine to a baby will render
what type of immunity?
•Active
– baby will produce his own antibodies
•Passive
– giving preformed immunoglobulin or transplacental
transfer of antibodies
•Latent
– Immunity developed due to the giving of small doses for
a long period of time
•Both active and latent
Pathology
144. A patient presents with a large wound on the left leg as a result of
a vehicular accident. Initially his wound is filled with granulation tissue,
which is composed of proliferating fibroblasts and new blood vessels
(angiogenesis). Which of the following is a growth factor that is
capable of inducing all the steps necessary for angiogenesis?
•Epidermal growth factor

– stimulates cell growth, proliferation, and differentiation
•Platelet derived growth factor
– can contribute to angiogenesis
•Transforming growth factor
– has the capacity to induce oncogenic transformation
•Vascular endothelial growth factor
– major contributor to angiogenesis
Anatomy
145. A penetrating wound in the abdomen that injures the superior
mesenteric artery will result in ischemia of which of the following:
•Ascending and descending

– descending colon is supplied by the inferior mesenteric artery via
left colic artery
•Transverse and sigmoid
– Sigmoid colon is supplied by the sigmoid branches of the inferior
mesenteric artery
•Ascending and transverse
– Branches of superior mesenteric artery:
• Right colic artery supplies ascending colon
• Middle colic artery supplies transverse colon
•Transverse and descending
Internal Medicine
146. Fine, palpable rushing vibration is called?
•Apex beat
•Heave
•Lift
•Thrill
Pharmacology
147. A 50 year old patient was admitted because of severe chest pains 6 hours earlier.
ECG showed acute anterior wall myocardial infarction. BP=120/76, PR=104/min,
crackles over both lungs. Which of the following drugs will improve myocardial
performance by decreasing the afterload?
•Furosemide
– This will decrease preload by decreasing the blood volume through diuresis.
Preload is decreased when venous blood pressure and the rate of venous
return are decreased.
•Metoprolol
– It will decrease myocardial oxygen demand by decreasing heart rate.
•Enalapril
– Will decrease afterload by decreasing the systemic vascular pressure or
resistance
•Digoxin
– Has no effect in afterload. It will increase myocardial oxygen supply by
increasing contractility strength.
149
Anesthesiology
148. A 15 year old male patient is to undergo cardiac surgery under general
anesthesia, which anesthetic agent should be avoided because of its direct
myocardial depressant effect?
•Fentanyl
– A strong opioid agonist
•Isoflurane
– Increases heart rate but can cause coronary artery steal syndrome
•Ketamine
– Intravenous anesthetic that also stimulates the central sympathetic
pathways causing increased cerebral blood flow, IOP, cardiac output,
heart rate, central venous pressure
•Halothane
– Negative inotropic effect on the myocardium
Parasitology
149. Which of the following statements regarding the life cycle of
parasites is TRUE?
•Ascaris larvae bypass the lungs and molt in the gastrointestinal tract
– Ascaris undergoes lung phase, 6-15 days after initial exposure
then goes to the GI tract (intestinal phase)
•The mode of transmission of most hookworms is through ingestion of
the ova
– Skin penetration
•Capillaria philippinensis is a soil-transmitted nematode
– Fish-transmitted (via eating raw fish)
•The infective stage of Schistosoma is the cercaria
151
Neurology
150. Which is TRUE of the sympathetic nervous system?
•Preganglionic neurons are located in the intermediolateral cell

column of the spinal cord at all levels
•Preganglionic fibers are adrenergic
– Cholinergic, both SNS and PNS preganglionic neurons use
acetylcholine
•Postganglionic fibers maybe either adrenergic or cholinergic
– SNS postganglionic fibers are adrenergic
•All of the above are correct
151. You would like to find out whether adding a

diuretic to an ACE inhibitor versus beta blocker
alone would confer better control of hypertension.
The best study design that will answer your
question is which of these?
•Cross sectional survey

•Randomized clinical trial
•Cohort study
•Case control study
Radiology
152. What is the significance

of layering on lateral
decubitus film?
•The fluid is an exudate

•There are no loculations
•There is more than 1 liter of
fluid
•The effusion is non- Layering on lateral
decubitus film
complicated
Internal Medicine
153. What is the major prognostic determinant

in severe aplastic anemia?
•Absolute neutrophil count

•Age ANC = WBC x [(Segmenters + bands)/100]
•Degree of radiation exposure

•Severity of anemia
155
Surgery
154. A 38 y/o female developed a nodular enlargement of the thyroid gland
accompanied by dysphagia and weight loss. BP is 140/90, PR is 100/min. Her
skin is warm and moist. Thyroid scan shows a hot nodule on the right lobe,
and the left lobe is not demonstrated. What is the most likely diagnosis?
•Toxic adenoma
– solitary nodule with signs of hyperthyroidism
•Hashimoto’s disease
– usually presents as hypothyroidism; thyroid enlargement is due to
lymphocytic infiltration and fibrosis rather than hypertrophy
•Grave’s disease
– Enlarged gland with homogeneous uptake of tracer
•Toxic and Multinodular goiter
– patient has a single node only
Pharmacology
155. A male patient was brought to the emergency room because of
BLURRING OF VISION. He was diagnosed to have a glaucoma. Which of
the following is TRUE regarding the different drugs used in reducing
intraocular pressure?
•α1-agonist decreases the outflow of aqueous humor from the eye

– Increases outflow of aqueous humor (e.g. Phenylephrine)
•α-antagonist reduces aqueous humor secretion
– β-antagonist (e.g. Timolol)
•β-antagonist decreases aqueous humor secretion from the ciliary
body
•PGF2α analog decreases aqueous humor outflow
– Increases aqueous humor outflow (e.g. Latanoprost)
Internal Medicine
156. A 50 y/o teacher was noted to have a 5-cm

solid liver mass, alpha fetoprotein 5x normal.
What background liver disease is more likely to
be present in this patient?
•Acute viral hepatitis

•Liver abscess
•Liver cirrhosis
•Steatosis
Pediatrics
157. Which can result in false negative Mantoux test?
•Rubeola 2 weeks ago

– Can give false negative results because the immune system needs to be functional
to mount a response to the protein derivative injected under the skin
– Other conditions that can give false negative results are immunosuppression,
malnutrition, recent live virus vaccine, and other infections
•BCG vaccine
– Can give a false positive result due to the previous encounter with the antigen
•Infection with non-tuberculous mycobacteria
– Can give a false positive result because of the similarity of antigen among
mycobacteria
•Hypersensitivity reaction to PPD
– Can give a false positive result due to the patient’s hypersensitivity to the protein
component of PPD
Obstetrics
158. When screening for GDM with a 50-g GCT,

what minimum threshold value is used to
identify women needing to undergo further
testing?
•120 mg/dL
•130 mg/dL
•140 mg/dL
•150 mg/dL 160
Microbiology
159. Gram stain of the sputum revealed gram positive cocci in pairs
and plenty of pus cells. What is the most likely bacterial causative
agent?
•Streptococcus agalactiae
– gram positive cocci that occurs in pairs also
•Streptococcus pneumonia – most likely
•Streptococcus pyogenes
– gram positive cocci that usually grows in pairs or chains
•Enterococci
– gram positive cocci that usually grows in pairs or chains
Biochemistry
160. Which of the following is TRUE regarding thyroid hormones?
•They are derivatives of the amino acid tryptophan bound covalently to

iodine T.E.N.D.
– tyrosine ( as well as epinephrine, norepinephrine, and dopamine)
•The chief stimulator for their synthesis is the TSH secreted by the posterior
pituitary
– Anterior pituitary
•They inhibit fat mobilization leading to decreased concentrations of fatty
acids in plasma
– Promote fat mobilization leading to increased fatty acids in plasma
•They stimulate insulin-dependent entry of glucose into cells and increased
gluconeogenesis and glycogenolysis to generate free glucose
Behavioral Medicine
161. He has “the unusual belief that his blurred vision is due to poisons
secretly placed in his food by his neighbors.” The past month, he was
observed by the relatives to be exhibiting insomnia, suspicious behaviour
and hallucinatory experience. What is your diagnosis?
•Major depression with psychotic features – unlikely

•Delusional disorder - unlikely
•Paranoid schizophrenia
– schizophrenia demands greater than 6 months of signs and
symptoms
•Schizophreniform disorder
– Symptoms of schizophrenia of 2-6 months duration
Anesthesiology
162. Where is the puncture site during the

anesthetic technique for pelvic laparotomy?
•L1-L2 interspace
•L3-L4 interspace
•Sacral cornu
•Sacral hiatus
Dermatology
163. If a patient presents with widespread erythema and

few minute papules giving the skin a rough sandpaper
quality associated with fever, pharyngitis, and strawberry
tongue, what is the most probable diagnosis?
Strawberry tongue
•Slapped-cheek syndrome
•Staphylococcal scalded skin syndrome
•Scarlet fever
Widespread erythema
Surgery
164. When should interventions to relieve mitral

stenosis be considered?
•A patient is in NYHA Class III

•The mitral valve area is 2.5 cm
•Pulmonary artery pressure is 50/20
•Left atrium is enlarged
Histology
165. What lines the excretory passages of the urinary system?
•Stratified squamous, non-keratinizing epithelium

– Vagina, esophagus, tongue
•Stratified squamous, keratinizing epithelium
– Skin
•Simple cuboidal epithelium
– Thyroid, kidney tubules
•Transitional epithelium
– Renal pelvis, ureter, urinary bladder, and proximal 1/3
of urethra
Internal Medicine
166. To diagnose her as having metabolicRisk Factor Defining Level
syndrome, what other clinical features Abdominal obesity (male) > 102 cm
should be present? Abdominal obesity (female) > 88 cm
Triglycerides > 150 mg/dL
•Waist circumference >88 cm, HDL (male) <40 mg/dL
BP>130/85, HDL <50 mg/dL HDL (female) < 50 mg/dL
•Waist circumference >88 cm, FBS>110 Blood pressure ≥ 130/85 mmHg
Fasting glucose > 110 mg/dL

mg/dL, HDL>50 mg/dL
•Waist circumference <88 cm,
BP=140/80, triglycerides>150 mg/dL
•Waist circumference <88 cm, cholesterol
250 mg/dL, microalbuminuria
Rehab Medicine
167. Which of the following test is positive when there is
inflammation of the common tendon sheath of abductor
pollicis longus and extensor pollicis brevis?
Apollo Expobre
•Finkelstein test Finkelstein’s test
•Tenderness at the radial styloid area

•Pain on wrist ulnar deviation
•All of the above – these are signs of De Quervain’s
Tenosynovitis
Radiology
168. How will tendons in its

long axis appear in ultrasound?
•Honeycomb appearance
•Fascicular pattern Tissue Echogenecity Transverse Longitudinal
axis axis
•Fibrillar pattern Tendon Hyperechoic Broom end Fibrillar
•Pennate pattern Ligament Hyperechoic Broom end Fibrillar
Muscle Mixed Starry night Pennate
Nerve Mixed Honeycomb Fascicular
Clinical
Pathology
169. Smaller in diameter
than normal RBC with
concentrated Hgb
content:
•Spherocyte
•Schistocyte
•Echinocyte
•Dacryocyte 171
Microbiology
170. After use of broad spectrum antibiotic, this bacteria can
proliferate and cause diarrhea:
•Pseudomonas aeruginosa
•Staphylococcus epidermidis Clostridium difficile is
sensitive to vancomycin
•Clostridium difficile
– causes pseudomembranous colitis after use of broad-
spectrum antibiotics like clindamycin, cephalosporins,
carbapenems, and fluoroquinolones eradicates other
bacteria
•Bacteroides fragilis
Parasitology
171. What tapeworm is associated with eating raw fish?
•Diphyllobothrium latum (fish tapeworm)

•Dipylidium caninum (flea tapeworm)
– ingestion of infected flea
•Hymenolepis nana
– Ingestion of embryonated egg from contaminated food, water, or
hands or ingestion of cysticercoid-infected arthropods
•Echinococcus granulosus (dog tapeworm)
– Humans are accidental intermediate hosts that become infected by
handling soil, dirt or animal hair that contains eggs
Gynecology
172. Which of the following anomalies will cause
cryptomenorrhea (hematocolpos)?
•Unicornuate uterus
– Only one of the paired mullerian ducts developed; can
still menstruate normally
•Transverse vaginal septum
•Vertical vaginal septum
– Wall of tissue running vertically up and down the length
of a girl’s vagina, dividing it into two separate cavities
“double vagina”; can still menstruate normally
•Arcuate uterus
– uterine fundus displays a concave contour towards the
uterine cavity; can still menstruate normally
174
Pharmacology
173. All of the following carbapenems can be used for
Pseudomonas aeruginosa infection EXCEPT:
•Doripenem
Remember: D.I.M.E.
– for complex abdominal infection
•Imipenem
– for enterobacters
•Meropenem
– for febrile neutropenia
•Ertapenem
– least active against pseudomonas
Carbapenems are active against both
gram positive and gram negative bacteria
174. A study involving 200 subjects post excision of breast
masses comparing the efficacy of an antibiotic in reducing
postoperative infection gives the following result: Drug A
(control N=105) = 10 cases of post-op infection, Drug B
(experimental N=95) = 5 cases of post-op infection. What is
the risk of infection among those given drug A?
Solution:
•Rc = death in control/total number of control
•Rc = 10/105
•Rc = 9.5%
176
175. A study involving 200 subjects post excision of breast masses
comparing the efficacy of an antibiotic in reducing postoperative
infection gives the following result: Drug A (control N=105) = 10
cases of post-op infection, Drug B (experimental N=95) = 5 cases of
post-op infection. What is the absolute risk reduction?
Solution:
•ARR = Rc – Rt
•Rc = 10/105 = 0.0952
•Rt = 5/95 = 0.0526
•ARR = 0.095 – 0.052
•ARR = 0.43 or 43%
Physiology
176. Which of the following
occurs during isovolumic
contraction phase?
•AV valves open, semilunar

valves close
– isovolumic relaxation
•AV valves close, semilunar
valves open
•AV valves open, semilunar
valves open
•AV valves close, semilunar
valves close
Internal Medicine
177. Which is NOT TRUE of angina pectoris?
•Crescendo-decresendo in nature
– Typically lasts for 2-5 mins
•Described as squeezing, heaviness and pressure
•Levine’s sign is usually present
– Clenched fist held over the chest
•Usually radiates to the trapezius muscles
– Radiates to shoulder or both arms especially the
ulnar surfaces of the forearm and hand
Pediatrics
178. What is the most reliable sign of

pneumonia?
•Tachypnea
•Tachycardia
•Cough
•Sputum production
180
Neurology
179. A 60 y/o male, known hypertensive and diabetic comes in due to sudden onset of
slurring of speech, and right upper extremity weakness. What is the site of the vascular
territory involved?
•Left anterior communicating artery

– Visual field defects (bitemporal hemianopsia), psychopathology, frontal lobe
pathology
•Left middle cerebral artery MCA Stroke:
•Left anterior cerebral artery • Contralateral sensory
– Contralateral weakness of one leg and motor (face and
extremities) deficits
– Change in affect; impaired judgment and insight • Language deficits
– (+) primitive grasp and suck reflexes • Contralateral
•Left posterior cerebral artery homonymous
– Crossed motor/sensory syndrome: hemianopsia
• Ipsilateral cranial nerve deficits • Agraphia, acalculia,
apraxia of the
• Contralateral hemiparesis ipsilateral limbs
– Ipsilateral limb ataxia
– Internuclear opthalmoplegia
Obstetrics
180. What portion of the decidua is directly beneath the site of
implantation?
•Basalis
•Capsularis
– overlies the enlarging blastocyst
•Vera
– formed by union of capsularis and parietalis
•Parietalis
– lines the main cavity of the pregnant uterus elsewhere than at the
site of attachment of the chorionic vesicle.
Pathology
181. Denaturation of intracellular proteins

would result in which of the following
manifestations of cell death?
•Apoptosis
•Coagulative necrosis
•Liquefactive necrosis
•Caseous necrosis
Medical Nutrition
182. Which of the following is NOT TRUE regarding Polyunsaturated fatty
acids?
•Involved with the low blood cholesterol/CHD incidence among people

in the Mediterranean countries
– Monounsaturated fatty acids
•Omega-3 fatty acids have cardio-protective effects in primary and
secondary prevention of CHD
– Lowers TAG levels by inhibiting VLDL and apo B-100 synthesis
•When SFAs are replaced with omega-6 PUFAs, LDL and HDL cholesterol
levels are lowered
•Include fish and vegetable oils
– Fish (omega-3) and vegetable (omega-6)
ENT
183. A patient presents with salivary gland enlargement, dry
eyes, dry mouth, dry skin, and tooth decay. This condition is
seen in other patients with lupus, rheumatoid arthritis,
polymyositis and scleroderma:
•Sjogren’s syndrome
•Waardenburg’s syndrome
– Rare genetic disorder characterized by varying
degrees of deafness and pigmentation anomalies
•Cushing syndrome
– Central obesity, moon face, hyperhidrosis
•Sialadenosis
– noninflammatory swelling of the salivary glands
Ophthalmology
184. A patient’s visual acuity is 20/20 in each eye.
His fundoscopic findings revealed c/d 0.3 A:V 2:3 no
Dot hemorrhages
A:V crossing changes, few scattered dot
hemorrhages, and hard exudates. What is the
probable diagnosis?
•Hypertension retinopathy
•Central retinal artery occlusion
– Symptoms of sudden, acute, painless loss of
vision in one eye, decreased visual acuity;
fundoscopic findings of edematous retina
with attenuated arterioles and a cherry-red
macula
Hard exudates
•Branch retinal artery occlusion
•Diabetic retinopathy
Clinical Pathology
185. If you are suspecting a deficiency in the

extrinsic coagulation factors, which of these
tests would you request for?
•Platelet count
•Clotting time
•Prothrombin time
•Partial thromboplastin time
Biochemistry
186. A patient stands 5’6”, what is his desirable body

weight by using modified Tannhauser’s formula in kg?
Solution:
•Height = 66 inches = 167.64 cm
•DBW = [height in cm – 100] – [10% (height in cm –
100)
•DBW = [167.64 – 100] – [10%(167.64 – 100)]
•DBW = 60.876 kg or 61 kg
Radiology
187. Upper abdominal sonogram of the patient revealed multiple echogenic
structures within the gallbladder lumen exhibiting strong posterior acoustic
shadowing. The gallbladder wall measure 1.0 cm. What is the diagnosis?
•Acute cholecystitis
– gallbladder wall thickness > 3mm
•Emphysematous cholecystitis
– presence of gas in the gallbladder wall, lumen, or both
•Cholelithiases
– echogenic, strong posterior acoustic shadowing
•Calculous cholecystitis
– cholecystitis (gallbladder wall thickness > 3mm) + gallstones
(echogenic, strong posterior acoustic shadowing)
Medical Nutrition
188. A male patient sought consultation of joint swelling

and pain. It was revealed that the patient ate a plateful of
peanuts during a drinking spree the night before. An
impression of an acute attack of gout was then given.
Which food should be avoided by the patient at all times?
•Mussels
•Dried peas
•Mushrooms
•Eggs
Preventive Medicine
189. Which of the following is an important

primary preventive measure for a 60 y/o
female?
•Influenza vaccine
•Hormone replacement therapy – secondary
•Mini mental status examination – secondary;
for 60 y/o and above
•Depression screening – secondary
Internal Medicine
190. If you are suspecting mitral valve prolapse as the cause of
murmur, what maneuver will decrease the murmur due to the
prolapse?
•Hand grip
– Will increase MVP murmur by increasing systemic vascular
resistance
•Standing
– will increase MVP murmur due to decreased venous return
•Squatting
– will decrease MVP murmur due to increased venous return,
increased preload, and eventually the afterload
•Valsalva strain
– will increase MVP murmur due to decreased venous return
Pediatrics
191. A 2 y/o girl presents with 8 hours fever, pharyngitis,
vomiting and limb pain. At the ER, she has weak pulses, was
hypotensive, and has cold hands ad feet. Upon undressing
the child, the petecchial-purpuric rashes were noted over
her trunk. If this is meningococcal infection, what antibiotic
would be the drug of choice?
•Penicillin G
•Cefotaxime
•Ampicillin
•Ceftriaxone
Clinical Pathology
192. If the patient also complains of bilateral

flank pains and the urinalysis reveals 70-80
RBCs/HPF (2% dysmorphic) instead, which of the
clinical conditions is compatible?
•Schistosomiasis hematobium
•Acute glomerulonephritis
•Urolithiasis, bilateral
•Polycystic kidney
Behavioral Medicine
193. A 35 y/o male came in with delusion. If there is rapid
progression of these symptoms, which typical (first
generation) antipyschotic can be given?
•Olanzapine
– Atypical, 1st generation
•Aripiprazole
– Atypical, 2nd generation
•Haloperidol
•Quetiapine
– Atypical, 1st generation
Anatomy
194. Which of the following
features describe the ileum?
•Fewer mesenteric arterial arcades

•Longer vasa recta
•More fat in its mesentery
– Jejunum has lesser fat Jejunum Ileum
between the mesenteric Mesenteric Lesser More
folds than the ileum arterial arcades
Fat in mesentery Lesser More
•Thicker wall
Thicker wall Thicker Thinner
Plica circulares More Lesser
Vasa recta Longer Shorter
Physiology
195. Decreasing the radius of the artery by half

will decrease blood flow by how much?
•One half
•One fourth
•One eighth
•One sixteenth
Pharmacology
196. A male patient consulted because of blood in

the sputum. If he has active PTB and you prescribed
quaruple short-course chemotherapy, which of the
following drugs need pre-treatment liver function
tests?
•Isoniazid
•Streptomycin
•Ethambutol
•Ciprofloxacin
Surgery
197. The goal of primary survey in trauma is to:
•Identify and treat conditions that constitute an

immediate threat to life
•Determine the topography of the site where trauma
incident occurred
– secondary survey
•Determine other co-morbidities
•Detect missed injuries
Pediatrics
198. A 10 y/o developed persistent high grade fever for 4 days.
After fever defervescence, he was noted to have markedly
Erythema “Sea of red”
erythematous skin with islands of normal skin. What is the most
likely diagnosis?
•Kawasaki disease
•Scarlet fever
•Dengue fever
– The skin lesion is compatible with Herman’s rash which
appears as a maculopapular erythematous rash with
islands of normal skin sparing
– Classically described as “Islands of white in a sea of red”
– The erythematous rash (red appearance) is due to an
Islands of normal skin
increase in capillary permeability while the islands of
white are areas where there is more edema than the
surrounding area as a result of a greater increase in
fluid leakage
•Erythema multiforme
Neurology
199. A 30 y/o female is brought in the USTH

emergency room due to sudden onset of upward
rolling of the eyeballs with stiffening of the
extremities lasting for 10 minutes. What is the first
line of treatment for this patient?
•Phenobarbital
•Diazepam
•Phenytoin
•Leviteracetam
Internal Medicine
200. What laboratory finding is decreased in

prerenal acute renal failure?
•BUN to creatinine ratio – increased

•Urine specific gravity – increased
•Urine osmolality – increased
•Urine sodium
Obstetrics
201. What is the management of a 32 y/o, G4P3 (3003), 7-8 weeks with
unruptured tubal pregnancy?
•Salpingectomy
•Salpingostomy
– Removing the conceptus then incision is left to heal by itself. This is
conservative treatment for women who desires future fertility and is
hemodynamically stable
•Salpingotomy
– Removing the conceptus then suturing the incision afterwards. This is a
conservative treatment for women who desires future fertility and is
hemodynamically stable
•Methotrexate
– for treatment of unruptured tubal pregnancy but pregnancy should be < 6
weeks, the fetus is non-viable, tubal mass is < 3.5 cm, and HCG is < 15,000
mIU/mL
Dermatology
202. If a patient presents with generalized macules and papules
associated with high grade fever of 4 days duration, coryza, and brassy
cough, what is the most probable diagnosis?
•Rubella
– similar to rubeola but there’s no cough; (+) Forchheimer spots
•Rubeola
– Rash appears 3-4 days after onset of fever, conjunctivitis, Forchheimer spots
cough, coryza; Koplik’s spots usually develop 2 days before the
rash
•Roseola infantum
– 3-day fever followed by rash at defervescence of fever; (+)
Nagayama spots
•Scarlet fever
– Rash that appears within 24 hours after onset of fever and sore Koplik’s spots
throat
Microbiology
203. If you are entertaining Dengue fever, what laboratory test
would you request aside from CBC and platelet count?
•NS1 antigen in the serum

•ASO (antistreptolysin-O) titer in the serum
– Streptococcal infections (rheumatic fever, scarlet fever)
•IgG and IgM antibody against Salmonella
– Typhoid fever
•Thick and thin blood smear
– Malaria
Rehab Medicine
204. The most common injured
structure in a simple ankle
sprain is:
•Anterior talo-fibular ligament

•Deltoid ligament
•Posterior talo-fibular ligament
•Calcaneo-fibular ligament
Ophthalmology
205. Which is a common manifestation of

congenital glaucoma?
•Leukocoria - retinoblastoma
•Buphathalmos – increased IOP expands corneal
and scleral tissue producing an eye that is larger
than normal
•Esoptropia
•Exophthalmos 207
Buphathalmos
Pediatrics
206. A 7 y/o boy with tea-colored urine has a BP of 130/90
(p>95). Urinalysis revealed RBC casts dysmorphic red cells,
(++) protein. His serum C3 is low. What should you work
him up for?
•IgA nephropathy
•Alport’s syndrome
– (+) gross or microscopic hematuria, (+) hearing
impairment, proteinuria is usually absent in
childhood, anterior lenticonus is pathognomonic
•Henoch schonlein purpura nephritis
•Post-streptococcal glomerulonephritis
Surgery
207. What is the best treatment for a displaced

intra-articular fracture more than 2 mm?
•Open reduction
•Traction
•Closed reduction
209
ENT
208. This can cause saddle nose deformity:
•Allergic rhinitis
•Leprosy
•TB
•AIDS
Septal hematoma can also

cause saddle nose
deformity
Clinical Pathology
209. The D-dimer assay shows that:
•Tissue thromboplastin has increased

•Vitamin K dependent factors are decreased
•Platelet count is markedly low
•Both thrombin and plasmin have been formed
– D-dimer is a product of fibrinolysis by plasmin
Internal Medicine
210. What is the best way to document reversibility in

an asthmatic patient in exacerbation?
•Spirometry – could have been done if the patient is

not in exacerbation
•Peak flow
•Arterial blood gas – not applicable to this case
•Chest x-ray – not applicable to this case
212
Parasitology
211. Plasmodium falciparum infection will give this type of
malaria:
•Benign tertian
– Plasmodium vivax and Plasmodium ovale cause fevers
that recur at two-day interval
•Malignant tertian
•Quartan malaria
– Plasmodium malariae causes fevers that recur at
approximately three-day intervals
Radiology
212. The following roentgen finding is
NOT seen in transient tachypnea of the
newborn:
•Hyperaeration of both lungs

•Pathologic air bronchogram
– Hyaline membrane disease
•Depression and flattening of both
hemidiaphragm
•Clearing of the roentgen findings after
48 hours
Pathology
213. The patient has noted increasing abdominal enlargement for the past year. An
abdominal ultrasound reveals bilateral 10 and 7 cm adnexal masses. At surgery there
are bilateral mass lesions of the ovaries. Pathologic examination of the ovarian masses
reveal that they are unilocular, filled with watery fluid, and covered with papillary
excresences on all surfaces. Which of the following neoplasms is this woman most
likely to have?
•Clear cell carcinoma

– Exceedingly rare aggressive tumors characterized by large epithelial cells with
abundant clear cytoplasm similar to hypersecretory gestational endometrium.
Can be solid or cystic.
•Mature cystic teratoma
– A.K.A Dermoid Cyst. These are unilocular cysts containing hair and cheesy
sebaceous material. Within the all, it common to find tooth structures.
•Fibrosarcoma
•Serous cystadenocarcinoma
215
Anesthesiology
214. The tube for the general anesthesia must

be at which level?
•Above the carina – roughly 2 cm above the

carina
•Below the glottis
•Below the epiglottis
•Above the larynx
Histology
215. The parafollicular cells of the thyroid
elaborate which of the following?
•Triiodothyronine (T3)
– produced by thyroid follicular cells
•Calcitonin
– produced by parafollicular cells or C-
cells of the thyroid which reduces blood
calcium levels
•Tetraiodothyronine (T4)
– produced by thyroid follicular cells
•Parathormone (PTH)
– Produced by the chief cells of the
parathyroid gland that increases blood
calcium levels
Pharmacology
216. Laboratory results showed elevated T3, T4, FT3, FT4, low-TSH and
negative pregnancy test. You plan to give her methimazole. Which of
the following drugs should NOT be given prior to administration of
methimazole as it will delay the onset of effect?
•Propranolol
•Diltiazem
•Prednisone
•Potassium iodide
– inhibits thyroid hormone release through inhibition of
thyroglobulin proteolysis so it increases the intraglandular
stores of iodine, which may delay the onset of thioamide
therapy
Gynecology
217. A 21 y/o, single, nulligravida consulted because of irregular menses
occurring every 2-4 months, consuming 2-3 pads per day moderately soaked for
the past year. How would you characterize the bleeding of the patient?
•Hypomenorrhea
•Hypermenorrhea
– A.K.A. menorrhagia is uterine bleeding which is prolonged (more than 7
days) or excessive (> 80 mL) occurring at regular intervals
•Oligomenorrhea
– Infrequent uterine bleeding which has intervals that vary from 35 days to
6 months
•Polymenorrhea
– uterine bleeding occurring at regular intervals of less than 21 days
Obstetrics
218. A 19 y/o G1P0 on her 8th week of pregnancy came
for prenatal care. What is the location of the uterine
fundus at this age of gestation?
•At the pelvis

•Level of symphysis pubis
– 12 weeks
•Midway between symphysis pubis and umbicus
– 16 weeks
•At the umbilicus
– 20 weeks
Microbiology
219. The pathogenesis of Streptococcus
pneumoniae causing infection includes
•Invasion of cells lining the alveoli

•Resistance to phagocytosis by M proteins
– Streptococcus pyogenes
•Migration to mediastinal lymph nodes
•Inhibition of phagocytosis by a
polysaccharide capsule
Internal Medicine
220. How do we assess

the severity of COPD
Stage FEV1 range
according to GOLD?
Mild ≥ 80% predicted
Moderate 50% to <80% predicted
•Length of symptoms Severe 30% to <50% predicted

Very severe < 30% predicted
•FEV1
•Number of exacerbations
per year
•Hypoxemia
Pediatrics
221. Which of the following endocrinologic

features is seen in DiGeorge syndrome?
•Gonadal dysgenesis
•Growth hormone deficiency
•Hypoparathyroidism CATCH-22
C – Cardiac abnormalities (CHD)
•Hypothyroidism A – Abnormal facies
T – Thymic hypoplasia
C – Cleft palate
H – Hypocalcemia / Hypoparathyroidism
22 – Chromosome 22q11.2 deletion
Dermatology
222. Staphylococcal scalded skin syndrome is caused by
•Staphylococcal enterotoxin
– food poisoning
•Staphylococcal pyrogenic exotoxin
– Staphylococcal scarlet fever
•Staphylococcal superantigen
– Toxic shock syndrome (via TSST-1 or toxic shock
syndrome toxin-1)
•Staphylococcal exfoliatin toxins
Medical Ethics
223. A 10 year old child has to undergo bone marrow biopsy.
Although the parents have agreed, you would want her to
agree as well and secure her cooperation. What principle is in
line with this?
•Dissent
•Assent
– developmentally appropriate child’s willingness or
preference to participate in a proposed therapy or
procedure.
•Justice
•Autonomy
Rehab Medicine
224. On further examination, it was noted that the boy
sustained multiple hematoma not only on the lateral ankle
but also on the lateral knee. To ascertain if the meniscus is
damaged or not, this special test can be performed:
•Drawer’s test
– For anterior cruciate ligament
•Mc Murray’s test
•Ober’s test
•Patrick’s test
Preventive Medicine
225. Non-ionizing radiation emitted by cellular

phones:
•Radiofrequencies and microwaves

•Infrared
•Bright light
•Very low frequency radiation
Surgery
226. True statement regarding primary common

bile duct stone:
•Usually multifaceted
•Cholesterol is a significant component
•Shape conforms with the biliary duct
•Can be associated with biliary ascariasis
Neurology
227. A patient is drowsy but he has
eye opening to name calling. He
can follow simple commands and
is severely dysarthric with
appropriate responses. What is
the GCS score of the patient?
•12
•13
•14 – E3, V5, M6
•15
Ophthalmology
228. This is not a common feature of optic

neuritis:
• Blurred disc margin

• Central scotoma
• Bilateral
– usually unilateral
• Multiple sclerosis
Radiology
229. MRI was done and it shows an infarct in the left middle
cerebral artery territory with hemorrhagic conversion. If the
signal correlate of the hemorrhage is bright/hyperintense
on T1W1 and dark/hypointense on T2W1, what is the age
of the hemorrhage?
Stage T1 T2
Hyperacute (< 24 hrs) Isointense Hyperintense
•Hyperacute Acute (1-3 days) Isointense to Hypointense
Hypointense
•Acute
Early subacute (4-7 days) Hyperintense Hypointense
•Early subacute Late subacute (8-14 days) Hyperintense Hyperintense
•Late subacute Chronic (> 14 days) Hypointense Hypointense
231
Pathology
230. A patient has been experiencing cough and fever since two days prior to consult and
on admission, he was noted to have dyspnea and PE reveals increased respiratory rate with
bibasilar crackles on both lungs. What is the most likely pathology?
•Lower lobe consolidation with red boggy lung and increased RBCs within alveolar sacs
– This is lobar pneumonia in congestion stage
•Lower lobe distended alveolar sacs and bronchial dilatation
– This is probably bronchiectasis
•Multiple basal consolidated areas and foci of neutrophilic infiltrates of alveolar sacs
– This is bronchopneumonia
– It is more often multilobar and frequently bilateral and basal because of the
tendency of the secretitons to gravitate into the lower lobes
– Foci are consolidated areas of acute suppurative inflammation with neutrophil-
rich exudates
•Multiple lung sections with invading nests and sheets of atypical epithelial cells
– Lung cancer (probably small cell carcinoma)
Physiology
231. What are the expected thyroid function

test results after total thyroidectomy?
•High T3, T4, TSH, TRH

•Low T3, T4, and high TSH, TRH
•Low T3, T4, TSH, and high TRH
•High T3, T4, TRH, and low TSH
Anatomy
232. In thyroidectomy, the blood supplies to
the thyroid gland are ligated. From which of
the following vessels will the vascular supply
originate?
•Common carotid and thyrocervical trunk

•External carotid and thyrocervical trunk
– Superior thyroid artery is a branch of
external carotid artery
– Inferior thyroid artery is a branch of Sometimes a thyroid ima artery,
thyrocervical trunk a branch of brachiocephalic
artery ,is present which supplies
•Common carotid and arch of aorta the isthmus and base of the
thyroid
•Internal and external carotid arteries
ENT
233. Triad of Menniere’s

Disease:
•Hearing loss, otalgia,

vertigo
•Hearing loss, tinnitus,
vertigo
•Otalgia, vertigo, tinnitus
•Otalgia, facial paralysis,
hearing loss
Biochemistry
234. The patient was advised several dietary and behavioral modifications
by her physician in order to increase her HDL-cholesterol levels. Which of
the following is true of HDL lipoprotein?
•Derived from the metabolism of LDL-cholesterol

•Transports cholesterol from the peripheral tissues to the liver (reverse
cholesterol transport) promoting decrease in plasma cholesterol levels
– Via SR-B1 (scavenger receptor B1) and ATP Binding Cassette
Transporter A1 (ABCA1)
•Primarily transports triacylglycerols obtained from the diet
– chylomicrons
•Hydrolyzed by lipoprotein lipase in the capillary endothelial lining.
– Triacylglycerols of LDL and chylomicrons are the ones hydrolyzed by
lipoprotein lipase
Clinical Pathology
235. A 30 y/o house wife was brought to the E.R.

because of dizzines. She was noted to be pale. What
is the MCH (mean corpuscular hemoglobin)?
•HgB = 9.0 g Normal value: 27-31 pg

•RBC = 3 x 10^12/L
•Solution:
•MCH = Hgb x 10/RBC
•MCH = 9.0 x 10/3.0 x 10^12
•MCH = 30 pg
Rehab Medicine
236. A 4 y/o girl was brought to your clinic because mother
noted that the child walks on tip toes and buckled knees.
When running, she has her arms high up like strap hanger.
In doing complete history, the most common prenatal
history that may bring about cerebral palsy is:
•Weight of <2500 g
•3rd trimester bleeding
•<32 weeks AOG
•Prolonged labor
237. A study involving 200 subjects post rhinoplasty
comparing the efficacy of a drug in reducing postoperative
infection gives the following result: Drug A (control N=110)
= 11 cases of post-op infection, Drug B (experimental
N=105) = 5 cases of post-op infection. What is the relative
risk reduction?
Solution:
•Rt = 5/105 = 0.05
•Rc = 11/110 = 0.1
•RR = Rt/Rc
•RR = 0.05/0.1= 0.48 239
Pharmacology
238. The preferred drug if you’re considering Ancylostoma, Ascaris, Trichiuris:
•Pyrantel pamoate
– Effective in enterobiasis, ascariasis, hookworm
– Not effective in trichuriasis and stronglyloidiasis
•Albendazole
– Efffective in ascariasis, trichuriasis, strongyloidiasis, enterobiasis, and hookworm
•Metronidazole
– Anti-protozoan: (Trichomonas vaginalis, Entamoeba hystolitica, Giardia lamblia)
– Anti-bacterial: (Clostridium difficile, Helicobacter pylori, Gardnerella species,
Anaerobes)
•Praziquantel
– Effective in schistosomiasis, trematodes, and cestodes
Parasitology
239. One of the following WILL NOT be a possible
complication of falciparum malaria:
•Blackwater fever
– due to hemolysis
•Acute pulmonary edema
•Steroid-resistant nephrotic syndrome
– Nephrotic syndrome is more associated with
Plasmodium malariae
•DIC
241
Internal Medicine
240. Which of the following data is most compatible with
the diagnosis of gout?
•Additional involvement of the right knee and both wrists

with early morning stiffness
– Rheumatoid arthritis
•Left knee swelling of 1 month duration
•Pain on both knees especially on weight-bearing
– Osteoarthritis
•Prior recurrent episodes of mono-arthritis, each episode
lasting for 3 to 5 days
Medical Nutrition
241. Which of the following is true of the nutritional therapy for patients
with gout?
•In severe cases, purines must be restricted to about 500 mg/day

– Restricted to 100 to 150 mg/day
•Water intake should be restricted since water retention is common in this
disease
– Water intake of 3 L/day should be encouraged to assist the
excretion of uric acid and minimize renal calculi formation
•Total restriction of cheese, chocolates, eggs, and milk from his diet even
in it times of remission
– These foods have negligible purine content
•Anchovies, brains, kidney, mackarel, mussels, scallops should be
omitted from his diet
– High purine content (100 to 1000 mg per 100 g of food)
Obstetrics
242. What is the management of a 21 y/o G2P0 (0010), 12-13
weeks, with threatened abortion?
•Bed rest
•Tocolytics
•Progesterone
•Cerclage
– used in habitual abortion (3 or more losses in a row) to
reinforce the incompetent cervix
Behavioral Medicine
243. A patient had violent behavior aside from delusions. The past year, she has been
experiencing religious preoccupations, claiming to her the voice of Jesus and the
Virgin Mary. She remained isolated, had deteriorating personal hygiene, and preferred
to lock herself inside her room. What is your diagnosis?
•Schizophreniform psychosis
– 2-6 months duration of symptoms
•Paranoid schizophrenia
– Preoccupations with one or more delusions, or frequent auditory
hallucinations
•Catatonic schizophrenia
– Motoric immobility, waxy flexibility, stupor, excessive motor activity that is
purposeless, rigid or bizarre postures, mutism, prominent mannerisms,
stereotyped movements
•Disorganized schizophrenia
– Poor grooming, dishevelled personal appearance, inappropriate emotional
responses, onset before 25 years of age
Clinical Pathology
244. Which of the following cerebrospinal fluid values is
normal?
•WBC of 50 cells
– N.V. (0-5 cells/µL)
•Glucose of 65 mg/dL
– N.V. (50-80 mg/dL)
•Proteins of 70 mg/dL
– N.V. (15-45 mg/dL)
•Xanthochromic appearance
– Should be clear and colorless
Neurology
245. What is the most common location of
intracerebral bleed?
•Pons
•Occipital lobe
•Basal ganglia
•Midbrain
Pediatrics
246. CBC reveals Hgb of 10 g/dL, Hct of 30%, RBC of 4.5 M, RDW is normal, MCV is 66
µm3, MCH is 22 pg/cell, reticulocyte count is 5%, reticulocyte production index (RPI) is
0.2%. What is the most likely cause of anemia?
•Iron deficiency anemia

– Low Hgb, low RBC, low MCV, low ferritin, high RDW, high TIBC, high transferrin
•Thalassemia trait
– Normal to mild anemia, low MCV, normal RDW, normal TIBC, normal ferritin
•Diamond-blackfan anemia
– Congenital hypoplastic anemia: low RBC, macrocytosis, low reticulocyte, high
serum Fe, high RBC adenosine deaminase activity
•Transient erythroblastopenia of childhood
– Acquired pure RBC anemia: Low RBC, low reticulocyte, normal MCV, normal
RBC adenosine deaminase activity
Patient has: Low Hgb, low Hct, normal RBC, normal

RDW, low MCV, low MCH, high reticulocyte count, low
RPI
Surgery
247. A patient with a gunshot wound to his right chest has
severe dyspnea. His apex beat in the left anterior axillary line
and there is hyper-resonance and decreased breath sounds
over the right chest. What is the most probable diagnosis?
•Pneumothorax
– contralateral shifting of mediastinum, hyper-resonance,
decreased breath sounds
•Atelectasis
– dullness, ipsilateral shifting of mediastinum
•Hemothorax
– dullness, decreased breath sounds
•Pyothorax (empyema)
– dullness, decreased breath sounds
248. What should our clinical decision be when the post-
test probability of disease is above the upper testing limit
(treatment threshold)?
•Do another test Lower testing

threshold
Upper testing
threshold
– within the testing zone Testing zone
•Entertain another disease

– below the lower testing threshold
•Institute the needed treatment for the disease
•Search for the best possible treatment
Internal Medicine
249. A patient with elevated creatinine apparently had 5 days of acute
gastroenteritis. He has not taken any medications nor had any imaging procedures.
You think he has pre-renal acute renal failure. Which of the following would be
high?
•BUN/serum creatinine ratio

– (>20:1) Urea increases disproportionately to creatinine due to enhanced
proximal tubular reabsorption that follows the enhanced transport of
sodium and water
•Fractional excretion of sodium (FeNa)
– (<1%) Decreased because sodium reabsorption is increased
•Urine sodium concentration
– (<10 mmol/L) Decreased because sodium reabsorption is increased
•Urine volume
– Decreased because water reabsorption is increased
Sassone’s score Feature Finding Points
Gynecology Inner wall

structure
smooth
irregularities ≤ 3
1
2
mm
papillarities > 3 3
mm
250. Which feature will favor a
lesion mostly solid 4
malignant nature of an ovarian new (not applicable)
growth? Wall thickness in thin (≤ 3 mm) 1
(mm)
thick (> 3 mm) 2
lesion mostly solid 3
•Cystic, well defined borders (not applicable)
– probably benign Septa in (mm) no septa 1

thin (≤ 3 mm) 2
•Sassone’s score of 6 thick (> 3 mm) 3
– Sassone’s score ≥ 9 is malignant Echogenecity sonolucent 1

low echogenicity 2
•Positive color flow low echogenicity 3
•Absence of ascites with echogenic
core
– probably benign mixed 4
echogenicity
high echogenicity 5
Pathology
251. A 20 y/o female singer complains of an enlarged

lymph node in the lateral neck. FNAB reveals a
cellular aspirate forming papillae with cytologic
features of nuclear inclusions and nuclear grooves.
What is the most likely diagnosis?
•Metastatic anaplastic carcinoma

•Benign thyroid tissue in cervical lymph node
•Papillary thyroid carcinoma
•Scrofula 253
Anesthesiology
252. The following are muscle relaxants that compete with the acetylcholine released
at the neuromuscular junction, preventing depolarization EXCEPT:
•Pancuronium Only the non-

depolarizing muscle
– long-acting non-depolarizing muscle relaxant relaxants can be
•Atracurium reversed by
– short-acting non-depolarizing muscle relaxant anticholinesterases
(e.g. Neostigmine).
•Mivacurium
– intermediate-acting non-depolarizing muscle relaxant
•Succinylcholine
– Mimics the effect of acetylcholine by depolarizing the postsynaptic
membrane at the neuromuscular junction thus prolonging or making
persistent depolarization. It causes initial muscle twitching then followed by
desensitization of the receptor.
Succinylcholine is metabolized
by pseudocholinesterases.
ENT
253. What disease occurs because of long-term

use of nasal decongestant?
•Rhinitis medicamentosa
•Atrophic
•Acute rhinits
•Hormonal rhinitis
Ophthalmology
254. What is a sympathetic response in the eye?
•Pupillary constriction – parasympathetic

•Convergence
– Inward movement of eyes toward each other mediated by
medial rectus which is innervated by occulomotor nerve;
not autonomic
•Lid retraction
– Due to stimulation of Muller's muscle, a sympathetic muscle
in the upper lid.
•Divergence
Lid retraction (R)
– Outward movement of eyes away from each other; not
autonomic
Normal
Histology
255. Which of the following pulmonary alveolar cells
elaborate surfactant to prevent alveolar collapse?
•Small alveolar cells

– A.K.A Type I pneumocyte covers 97% of alveolar
surface and provides a barrier of minimal
thickness that is readily permeable to gasses
•Clara cells
– Non-ciliated, secretory bronchiolar epithelial cells
that act as a stem cell and multiply and
differentiate into ciliated cells to regenerate the
bronchiolar epithelium
•Alveolar macrophages
•Great alveolar cells
– A.K.A. Type II pneumocyte
Microbiology
256. Three blood cultures were all positive for gram positive cocci in
chains. Which of the following organisms, which causes about 70%
of endocarditis cases, is probably involved?
•Streptococcus pneumoniae
•Enterococcus spp.
•Staphylococcus epidermidis
•Viridans streptococci
– Viridans streptococci have the unique ability to synthesize
dextrans from glucose, which allows them to adhere to fibrin-
platelet aggregates at damaged heart valves once introduced
into the bloodstream (e.g. through dental extraction) because
they are commonly found in the oral cavity
Dermatology
257. Skin lesions were slightly scaly, pinkish papules and plaques
that erupted in crops over the trunk, following the line of
cleavage. There was a history of solitary annular scaly plaque on Lepromatous leprosy
abdomen one week prior to the appearance of the present
lesions. What is the most likely diagnosis?
•Lepromatous leprosy
– symmetric skin lesions, nodules, plaques, thickened
dermis, and frequent involvement of the nasal mucosa Pityriasis rosea
•Pityriasis rosea
– begins with a single "herald patch" lesion, followed in 1
or 2 weeks by a generalized body rash
•Tinea corporis
– enlarging raised red rings with a central area of healing Tinea corporis
•Urticaria
– Skin rash that are pale red, raised, itchy wheals due to an
allergic reaction
Urticaria
Parasitology
258. A 15 y/o female student from Baguio has

abdominal cramps, flatulence, and diarrhea. The
water source is chlorinated. Fecalysis shows flagellate
with falling leaf motility and bilateral symmetry. What
is the most likely cause?
•Entamoeba histolytica
•Giardia lamblia
•Trichomonas vaginalis
•Balantidium coli
Legal Medicine
259. What is the condition wherein the body becomes rigid
three to six hours after death due to the contraction of the
muscles?
•Cadaveric spasm
•Heat stiffening
– When a body is exposed to temperatures above 65°C,
heat causes stiffening of the muscles, because the tissue
proteins are denatured and coagulated.
•Muscular contraction
•Rigor mortis
Internal Medicine
260. What is the best treatment for a patient

with gastric ulcer and positive rapid urease test?
•Colloidal bismuth + tetracycline +

metronidazole
•Famotidine + metronidazole + amoxicillin
•Omeprazole + clarithromycin + amoxicillin
•Sucralfate + clarithromycin + tetracycline
Behavioral Medicine
261. A 32 y/o female nurse was brought to the ER because of RLQ pain. She also claims to have mixed
symptoms of dizziness, paresthesias, vague multiple pains in various parts of her body, and
intermittent nausea. It is discovered that the patient has been having these symptoms since she was
25 years of age. What is the most likely diagnosis?
•Body dysmorphic disorder

– Preoccupation with an imagined defect or exaggerated distortion of a minimal or minor
defect in physical appearance
– Presence of one or more neurological symptoms (paralysis, blindness, paresthesia, etc.) that
cannot be explained by a known neurological or medical disorder
•Somatization
– A history of somatic complaints over several years, starting prior to the age of 30.
– There are at least four different sites of pain on the body, and at least two gastrointestinal
problems, and one sexual dysfunction, and one pseudoneurological symptom.
•Generalized anxiety disorder
– Excessive anxiety and worry about several events or activities for a majority of day during at
least 6 month period
Anatomy
262. What is the inferior border of the posterior rectus
sheath?
•Falx inguinalis
•Inguinal ligament
•Internal inguinal ring
•Arcuate line
– horizontal line that demarcates the lower limit of the
posterior layer of the rectus sheath
– located about 1/3 of the distance from the umbilicus to
the pubic crest
Preventive Medicine
263. What is the best measure of the health

status of a community engaged in a health
development program?
•Availability of health care services

•Availability of public utilities
•Statistical indices of morbidity and mortality
•Utilization of health care services
Neurology
264. A patient who develops expressive aphasia has a lesion at which of
the following areas of the cerebral cortex?
•Areas 44, 45 right

– Broca’s area is in the left hemisphere
•Areas 44, 45 left Broca L4445
– Broca’s/expressive aphasia
•Areas 22, 39 left
– Receptive aphasia Wernicke L22
– Wernicke’s area is situated at area 22 but areas 37, 39, and 40 are
considered to be part of it
•Areas 22, 39 right
– Wernicke’s area is in the left hemisphere
Obstetrics
265. What is the most likely cause of

postpartum brisk bleeding in a patient with a
firm, contracted, uterus?
•Lacerations
•Retained placenta
•Coagulopathy
•Uterine atony
Biochemistry
266. Which metabolic pathway yields the greatest amount of energy from the
metabolism of glucose?
•Cori cycle
– To recycle lactic acid, the “glycolysis part” of the cycle produces 2 ATP
molecules at a cost of 6 ATP molecules consumed in the
“gluconeogenesis part” to produce glucose back (4 ATP deficit)
•Glucose-alanine cycle
– The alanine cycle is similar to the Cori cycle but is less productive
because a byproduct of this cycle is urea. Removal of the urea is
energy-dependent, requiring 4 ATP. (8 ATP deficit)
•Krebs cycle
– Assuming that there’s subsequent entry to electron transport chain, a
total of 32 ATP will be produced
•Embden-Meyerhof pathway
– 2 net ATP
Physiology
267. S2 occurs at what phase of the
cardiac cycle?
•Isovolumic contraction
– S1, due to closure of AV valves
•Rapid filling
– S3, due to increased blood within
the ventricle (e.g. athletes,
pregnancy, CHF)
•Isovolumic relaxation
– S2, due to closure of semilunar
valves
•Atrial contraction
– No heart sound
Clinical Pathology
268. What serum CK isoenzyme is abnormally elevated in a
patient with recent cerebral infarction?
•CK-BB
– brain
•CK-BM
– this does not exist because there are only 3 creatine kinase
isoenzymes
•CK-MB
– cardiac muscle
•CK-MM
– skeletal muscle
Pharmacology
269. Which antibiotic penetrates the blood brain barrier poorly in the presence
of inflammation but produces therapeutic benefit in the treatment of bacterial
meningitis in neonates?
•Amikacin
– penetrates blood-brain barrier when meninges are inflamed
•Amphotericin B
– This is a systemic antifungal but only 2-3% reach the CSF in fungal
meningitis so intrathecal therapy is needed
•Clindamycin
– Penetrates the brain and CSF poorly. It is indicated for skin and soft
tissue infections caused by streptococci and staphylococci
•Chloramphenicol
– Although it is widely distributed throughout the body including the CNS,
it is an alternative only to a β-lactam antibiotic for treatment of
meningococcal meningitis
Internal Medicine
270. A 55 y/o, 65 kg, diabetic male for the past 16 years consults due to anorexia and nausea.
He is lethargic with bipedal edema, bibasal crackles, and asterixis. His serum creatinine is 5.5
mg/dL (N.V. 0.5-1.2 mg/dL), arterial pH 7.3. How should you treat him?
•Observe response to furosemide

– This would relieve the edema and congestion but this is not the main concern for the
time being
•Give IV sodium bicarbonate and serial monitoring of ABG
– The blood pH is not that acidotic for this kind of therapy
•Emergency hemodialysis
– Because the patient most probably suffers from renal failure due to long-standing
diabetes as evidenced by the rise in creatinine
– The acid-base imbalance may be due to the renal failure because of the inability to
excrete hydrogen ions
– Signs of hyperammonemia like asterixis and lethargy may be due to renal failure as
well. This may be lethal so dialysis is needed.
•Emergency kidney transplantation
– This is not necessary for now because its too radical
Pathology
271. What is the expected finding in osteosarcoma?
•Benign osseous protruding from the metaphyseal medial area

with cartilaginous cap
– Osteochondroma
•Benign fibrous dysplasia occupying the area of the lesion
– Osteofibrous dysplasia
•Malignant osteoid producing cells in a haphazard pattern with
prominent osteoid material
•Atypical chondroid cells admixed with basophilic myxoid
material
– Myxoid chondrosarcoma
Gynecology
272. A 55 y/o G2P1 (1011) menopausic for 2 years
consulted for bothersome hot flashes. What is the
hormonal treatment of choice?
•Estrogen
•Progesterone
•Tibolone
•Bisphosphonates
– Prevents osteoporosis by retarding formation and
dissolution of hydroxyapatite crystals of bones
Pediatrics
273. A 10 y/o girl develops moderate to high grade fever for 3 days. On the 4 th day of illness,
she is weak-looking but afebrile. CBC reveals: Hgb 130, Hct 50, WBC 2000, and platelet
150,000. On the 2nd hospital day, she develops narrow pulse pressure requiring fluid
resuscitation. Platelet drops to 60,000. Thereafter her vital signs stay stable. On the 4 th
hospital day, she is discharged improved with platelet count of 200,000. What is the final
diagnosis?
•Dengue hemorrhagic fever grade I

– Fever and nonspecific constitutional symptoms.
– Positive tourniquet test
•Dengue hemorrhagic fever grade II
– Grade I manifestations plus spontaneous bleeding
•Dengue hemorrhagic fever grade III (Dengue shock syndrome)
– Signs of circulatory failure (rapid/weak pulse, hypotension, narrow pulse pressure,
cold clammy skin)
•Dengue hemorrhagic fever grade IV
– Profound shock, undetectable pulse and BP
Medical Ethics
274. Which of the following principles justifies

the amputation of a cancerous leg?
•Non-maleficence
•Solidarity
•Subsidiarity
•Totality
Radiology
275. The chest x-ray of the patient shows a homogeneous density in one
hemithorax with contralateral shift of mediastinal structures. What is the
probable diagnosis?
•Lobar consolidation
– This presents as homogeneous density of the affected lobe and it
almost always produce a silhouette sign and air bronchograms
•Massive atelectasis
– Ipsilateral shift of mediastinum
•Pulmonary mass
– This is unlikely because it must be very very big to have occupied an
entire hemithorax although it can present with contralateral shifting of
mediastinum if it is significantly big
•Massive pleural effusion
ENT
276. Otoscopy showed impacted

cerumen. Where is cerumen
produced?
•Entire external auditory canal

•Cartilaginous part of external
auditory canal
•Osseous part part of external
auditory canal
•Temporomandibular joint
Histology
Early proliferative
277. Which of the following characterizes
the endometrium during the menstrual
phase?
•Few and small endometrial glands Early secretory

– Early proliferative phase
•Presence of subnuclear vacuoles
– Early secretory phase
•Partial or complete destruction of Late secretory
endometrial glands
•Edematous stroma with “cork-screw
glands”
– Late secretory phase Menstrual
Dermatology
278. A 48 y/o female complained of profuse vaginal bleeding and
claims to have irregular menstruation. Examination of the skin showed
numerous erythematous papules, pustules, and nodules with open
and closed comedones on the forehead, nose, cheeks and chin. Which
skin appendage is probably affected?
•Hair follicle
– In the pilosebaceous unit, it is the sebaceous gland that is
problematic and not the hair follicle itself
•Eccrine sweat glands
– distributed almost all over the body for cooling purposes
•Apocrine sweat glands
– Larger sweat glands and are mostly limited to the axilla and
perianal areas
•Pilosebaceous gland
– The patient must be suffering from acne due to increased
sebum production secondary to increased androgen levels as
evidenced by irregular menstruation.
Obstetrics
279. A 30 y/o female consults because of abdominal enlargement. Her menses are delayed for 12 weeks
already and she complains of nausea and vomiting and breast fullness. PPE: VS within normal limits; Breasts:
tender, hyperpigmentation of areola; Pelvic exam: Speculum: Cervix violaceous with whitish, cottage cheese-
like discharge. IE: Cervix soft, closed, long. Uterus: fundus palpated up to the level of the symphysis pubus,
isthmus compressible. Adnexae: negative. If pregnancy is considered, what type of evidence does she
present?
•Presumptive
– Nausea, vomiting, disturbance in urination, fatigue, perception of fetal movement, breast
heaviness/tenderness/changes, cessation of menstruation, changes in vaginal mucosa, skin
pigmentation (chloasma, striae), increased body temperature
•Probable
– Abdominal enlargement, changes in the size, shape and consitency of the uterus, anatomical
changes in the cervix, braxton-hicks contractions, ballottement, physical outlining of the feuts,
positive endocrine tests (HCG)
•Positive
– Fetal heart action, active fetal movement as perceived by the doctor, recognition of embyro or fetus
by ultrasound
•Equivocal
Internal Medicine
280. What grade is a murmur if a thrill is

palpated on the precordium
•3/6
•4/6
•5/6
•6/6
Neurology
281. What is the principal pathway for
horizontal conjugate gaze?
•Dorsal longitudinal fasciculus

•Medial Longitudinal fasciculus
Graceful legs
•Fasciculus gracilis
– Proprioception of the trunk and lower extremities
•Fasciculus cuneatus
– Transmits fine touch, fine pressure, vibration, and
proprioception information from the upper
extremities
Legal Medicine
282. A young man who was stabbed in the abdomen died of general
peritonitis. How do we define peritonitis in relation to his death?
The stab wound is the proximate cause of death
while the peritonitis is the immediate cause
•Manner of death
– explains how the cause of death arose and is classified as
natural, accident, suicide, homicide or undetermined
•Proximate/underlying cause of death
– the disease or injury that initiated the train of morbid events
leading directly to death
•Immediate cause of death
– The disease, injury, or complication that directly results in death
•Secondary cause of death
283. What would be your decision when the p-

value of the computed test statistics is greater
than the alpha?
•Accept the alternative hypothesis

•Accept the null hypothesis
•Reject the alternative hypothesis
•Reject the null hypothesis
285
Rehab Medicine
284. The patient’s low back pain radiates to the right lower extremity.
He was diagnosed to have L4 lumbar radiculopathy on the right. Which
muscle is most likely to be weak on physical examination?
•Iliopsoas
– L2, hip flexion
•Anterior tibialis
– L4, dorsiflexion of foot
•Extensor hallucis longus
– L5, toe extensor
•Gastrocnemius
– S1, plantar flexor
Physiology
285. Which type of Type 1 Type 2A Type 2B
muscle fibers possess (avian)
high glycolytic capacity, Contractio Slow Fast Fast
n velocity
low oxidative capacity,
easily fatigable and with Main Oxidative Both Glycolysis
fast contraction source of phosphorylatio
ATP n
velocity?
Fatigability No No Yes
•Type I Glycolytic Moderate High High

capacity
•Type 2A
Oxidative High High Low
•Type 2B capacity
•Type 3 Diameter Moderate Small Large
Microbiology
286. A patient had 3 episodes of UTI this year. Plain film of the
abdomen showed struvite calculi. Which among the following
organisms may predispose to this condition?
Urease enzyme splits urea into
•Escherichia coli ammonia and carbon dioxide.
– E. coli is the most common cause of UTI (80-85%) Ammonia causes the
alkalinization of the urine
– Does not produce urease
•Proteus mirabilis
– Can produce urease
– Most common cause of infection-induced urinary
stones
•Klebsiella pneumoniae
– Can also produce urease but Proteus mirablis is more
common in causing struvite stones
•Enterobacter sp. Struvite stone (MgNH4PO4)
– Not a very common cause of UTI precipitates in increased or
– Does not produce urease alkaline pH
Pediatrics
287. If a patient were due to receive his 3rd primary dose of DTP,
what is the usual site and route of giving this vaccine?
Theoretically, the patient is at least
•Deltoid, intradermal 14 weeks old to be receiving his
DTP3
– BCG
•Anterolateral thigh, intramuscular
– DTP, Hepa B, Hib
•Deltoid, subcutaneous
– Not applicable for newborn and infants
•Anterolateral thigh subcutaneous
– Measles (9 mos), MMR (12 mos), Varicella (12 mos)
Preventive Medicine
288. After continuously exploring the issues, as part of your counseling, you asked the
daughter, “despite what is happening to your father, what are your strengths in order to
cope with this crisis?” What stage of counselling is this?
•Catharsis
– Clarifying or defining the problem of the patient. The patient “Tells the problem”
to someone else.
•Insight
– The patient should achieve a shift in thinking or perspective. There is challenge
or confrontation from the physician-counselor leading to a redefinition of the
problem. In the end, the patient will finally know where he is going.
•Action
– Patient makes his own plan for himself, with the doctor-counselor’s assistence to
resolve his difficulties
•Education
– Phases of counselling only involves “CIA” paradigm which stands for Catharsis,
Insight, and Action.
Parasitology
289. A male patient consulted because of blood in the sputum. If a
parasite is the etiology of the bleeding, which of the following is the most
likely cause?
•Paragonimus westermani
•Schistosoma mansoni
– Lodged eggs in the liver or intestinal wall can cause esophageal
varices and dilatations that can tear and bleed
•Ancylostoma duodenale
– Causes chronic blood loss that leads to iron deficiency anemia and
protein malnutrition
•Angiostrongylus cantonensis
– This is a rat lungworm which causes eosinophilic meningitis in
humans being an incidental host
Internal Medicine
290. A holosystolic murmur becomes more pronounced with deep
inspiration. What is this called?
•Pulsus deficit
– Difference between simultaneous pulse rate and heart rate
•Austin-flint murmur
– Best heard at the cardiac apex as a mid-diastolic or presystolic
murmur which is associated with severe aortic regurgitation
•Carvallo’s sign
•Pre-systolic accentuation
– A presystolic murmur, also called presystolic accentuation, is a
type of diastolic heart murmur typically associated with the
opening snap in mitral valve stenosis
Anatomy
291. Which of the following is true of the lungs?
•Apex projects upward 2.5 cm above the vertebral

end of the 1st rib
– Apex of each lung protrudes about 3-4 cm
above the anterior or sternal end of the 1st rib
•Each lung contains 3 lobes
– Right lung has 3 lobes while left lung has 2
•Mediastinal surface contains the hilus
•Lower border of the lung crosses the 10th rib in the
mid axillary line
– Inferior borders of each lung are similarly
sharp, thin and slanted from the 6th rib level
down to the 8th rib level at the midaxillary line
293
Pharmacology
292. Which blood glucose-lowering agent

requires an adequate pancreatic cell function?
•Rosiglitazone
•Acarbose
•Metformin
•Glibenclamide
Surgery
293. When is the best time for repair of cleft

palate?
•Before speech development

•Upon birth
•Before school age
•Any time
Radiology
294. What radiologic findings in a scout film of the
abdomen (SFA) most likely supports the diagnosis of
mechanical intestinal obstruction?
•Free peritoneal fluid

– Seen via ultrasound which may indicate
ascites
•Serosal thickening of small intestine
– Seen in MRI which indicates benign or
malignant bowel obstruction
•Presence of air fluid levels
•Paucity of gas in the distal rectum
– There is absence of gas beyond the site of
obstruction, unlike in paralytic ileus where
gas can be seen in the rectum
Behavioral Medicine
295. The attending physician noted that the patient started
experiencing suspicious behavior claiming to hear “voices” of his
officemates: “Why do you hurt yourself?”, “Better not give up, or
else”. What is the best atypical antipsychotic drug we can
prescribe?
•Chlorpromazine
– typical antipsychotic, low potency
•Flupentixol
– typical antipsychotic, high potency
•Imipramine
– tricyclic antidepressant
•Olanzapine
Clinical Pathology
296. The patient complains of occasional difficulty in urination. Digital rectal
exam revealed an enlarged from to hard nodular prostate. What serum
marker would you request to rule out prostate cancer?
•CEA
– For colorectal cancer treatment monitoring, identify recurrence, for
staging, or localizing cancer spread
•AFP
– Increased in hepatocellular carcinoma, neural tube defects, germ cell
tumors
•PSA
– obviously, this is a case of a prostate pathology so Prostate Specific
Antigen is most applicable
•CA 125 PSA N.V.: < 4.0 ng/mL
– For ovarian cancer screening
Pathology
297. The patient has a 55-pack year history of smoking cigarettes
and recently experienced an episode of hemoptysis along with
his usual cough. On physical examination there are no abnormal
findings. He has sputum cytology examination performed which
shows atypical cells with hyperchromatic nuclei and orange-pink
cytoplasm. What is the most likely pathology in this case?
•Bacterial pneumonia
•Tuberculosis
•Bronchogenic carcinoma
•Malignant mesothelioma
299
Ophthalmology
298. A 60 y/o patient with headaches was examined. The visual acuity
was 20/200 on both eyes. Fundoscopic examination disclosed macular
star shaped exudates, flame-shaped hemorrhages, and blurred disc
margins. AV ratio was 1:3 and C/D ratio was 0.3 in both eyes. What is the
most likely diagnosis?
•Intracranial hypertension
– Main symptoms are headache, nausea, and vomiting, as well as pulsatile tinnitus, double Blue arrow:
vision, and other visual symptoms. If untreated, it may lead to swelling of the optic disc in Cotton wool
the eye, which can progress to vision loss spots
•Systemic arterial hypertension – stage IV
White arrow:
– This is a case of hypertensive retinopathy. Most commonly, the patient is middle age or
flame-shaped
older. Findings include cotton wool spots and flame shaped hemorrhages. Only rarely will
hemorrhages
there be retinal or macular edema. In advanced cases, there will be a macular star and disc
edema.
•Intraocular hypertension Green arrow:
Macular star
– Intraocular pressure higher than normal in the absence of optic nerve damage or visual field
loss
•Central retinal artery occlusion
– Symptoms of sudden, acute, painless loss of vision in one eye, decreased visual acuity;
fundoscopic findings of edematous retina with attenuated arterioles and a cherry-red
macula
Gynecology
299. In a pregnant patient with an ovarian mass, which is the most
common type?
•Serous cystadenoma
– Epithelial tumors are the most frequent ovarian neoplasm
•Benign cystic teratoma
– Most common germ cell tumor which occurs during reproductive
years; germ cell tumors are second most common ovarian
neoplasm
•Dysgerminoma
– Most common type of malignant germ cell tumors
•Granulosa cell tumor
– A type of sex cord-stromal tumors which are the third most
common ovarian neoplasm
Internal Medicine
300. Which of the following causes the damage of the
cartilaginous surfaces of a joint in rheumatoid
arthritis?
•Excessive stress on the joint

– Osteoarthritis
•Microfractures secondary to weakened bone
– Osteoarthritis
•Pannus
– It is a membrane of granulation tissue
composed of mesenchyme- and bone
marrow-derived cells. Formation of the
pannus stimulates inflammation which
ultimately cause cartilage destruction and
bone erosion
•Bacteria
– Septic arthritis
Neurology
301. Which of the following will result from a lesion of the facial nerve?
•Ipsilateral hemifacial anesthesia

– Ipsilateral hemifacial weakness/paralysis
•Loss of corneal reflex
– Perceived by ophthalmic branch of the trigeminal nerve (afferent)
– Motor response via facial nerve (efferent)
•Loss of the jaw jerk reflex
– This is mediated by the trigeminal nerve
– Ellicited by tapping the mandible at a downward angle just below the lips
at the chin while the mouth is held slightly open. In response, the masseter
muscles will jerk the mandible upwards
•Loss of taste sensation, posterior 1/3 of the tongue
– Loss of taste sensation, anterior 2/3 of the tongue
– Posterior 1/3 of the tongue taste is mediated by glossopharyngeal nerve
Anatomy
302. What is the best way to locate the
appendix inside the peritoneal cavity?
•Trace the descending colon

– This is too far away and it should be the
cecum
•Locate the appendicular artery
•Follow the tenia coli of the cecum
•Search for the mesoappendix
Obstetrics
303. A 29 y/o, G1, 38-39 weeks, gestational diabetes, presents with hypogastric pain. Fundus:
34 cm, EFW: 3.3 kg.
LM1: breech, LM2: FBL, LM3: cephalic, and LM4: cephalic prominence at the right.
Uterine contractions: every 4-5 minutes, 50-60 secs duration, moderate intensity.
IE: cervix is 3 cm dilated, 60% effaced, cephalic, intact membranes and station -1. At what
stage of labor is the patient in?
•1st stage
– Begins with regular uterine contractions and ends with full cervical dilatation at 10
cm
•2nd stage
– Commences from full cervical dilatation and ends with the delivery of the fetus
•3rd stage
– Begins after delivery of the fetus until the delivery of the placenta
•4th stage
– Begins after delivery of the placenta until 6 weeks postpartum
Medical Nutrition
304. The patient started using artificial sweetener

for all his beverages. He starts to have frequent
attacks of migraine and headaches. Which non-
nutritive sweetener should be discontinued?
•Sucralose
•Aspartame
•Sorbitol
•Saccharin
Surgery
305. The cellular component of
wound-healing is characterized by the
appearance of cells. What is the order
of their appearance in the wound?
•Neutrophils, macrophages,
lymphocyte, fibroblasts
•Neutrophils, lymphocytes,
fibroblasts, macrophages
lymphocytes, fibroblasts
fibroblasts, lymphocytes
Preventive Medicine
306. A patient was eventually diagnosed to have a stroke, and after appropriate
interventions were give, he was advised to have physical therapy weekly. The patient
feels anxious about his disease and what has happened to him. What stage of the
family illness trajectory is he in?
•Onset of illness
– Experienced prior to contact with health care providers
•Reaction to diagnosis
– This is the impact phase where disease and appropriate treatment can be
described according to the patient’s level of comprehension
•Early adjustment to outcome
– Return from the hospital or major therapy initiates a period of gradual
movement from the role of being sick to some form of recovery
•Adjustment to the permanency of outcome
– This is the “second crisis” which points to the family’s adjustment to the effect
of illness
Physiology
307. What is the proper
sequence of smooth muscle
cross bridge cycling? (arrange
the items correctly)
•Power stroke - 2
•Dephosphorylation of myosin
light chain - 1
•Disengagement - 3
•Return of head and arms to a
90° orientation - 4
Dermatology
308. Obstruction of the ostia of what structure will result in
milaria?
•Hair follicles
•Pilo-sebaceous unit
– Acne
•Sebaceous gland Milaria crystallina Milaria pustolosa
– Acne
•Sweat gland
Milaria rubra 310

Parasitology
309. A 26 y/o male tourist travelled to Leyte for 1 month. During the trip,
he swam in the river noted for its locally claimed therapeutic effects. Two
months after his return, he begun complaining of intermittent abdominal
pain, cramps, tenderness, and intermittent bloody mucoid stools with
weight loss, anemia, and occasional dependent edema. Stool examination
revealed parasitic ova with a minute subterminal spine. Which of the
following parasite is the cause of the patient’s symptoms?
•Schistosoma mansoni
– causes intestinal schistosomiasis; egg has lateral spine
•Schistosoma japonicum
– causes intestinal schistosomiasis; egg has a small knob, or small
subterminal spine, or no spine
•Toxoplasma gondii
– very unlikely etiologic agent; causes flu-like symptoms to
encephalitis and neurologic diseases when immunocompromised
•Schistosoma haematobium
– causes urinary schistosomiasis; egg is ellipsoid with a terminal
spine
Internal Medicine
310. An ABG was taken while the patient was on 3 L/min of oxygen per nasal
cannula. Results are as follows: pH 7.24, PCO2 70, PO2 90, HCO3 30, O2 sat 88.
What is the acid-base balance?
•Partially compensated metabolic acidosis

– This is respiratory and not metabolic acidosis because the PCO2
problem (N.V. 35-45) is more deranged than the HCO3
•Partially compensated metabolic alkalosis
– Alkalosis needs a pH greater than 7.45 (N.V. 7.35-7.45)
•Partially compensated respiratory acidosis
•Uncompensated respiratory alkalosis
– This is already a partially compensated case as evidenced by the rise
in HCO3 level (N.V. 22-26). Again, this is not alkalosis.
Pediatrics
311. What is the most common pathogen of

neonatal pneumonia in developing countries?
•E. coli
•K. pneumoniae
•L. monocytogenes
•Streptococcus agalactiae
Pharmacology
312. What is the mechanism of action of
allopurinol?
•Binds to intracellular protein tubulin thereby

preventing polymerization into microtubules and
leading to the inhibition of leukocyte and
phagocytosis
– Colchicine
•Interferes with the kidneys' organic anion
transporter (OAT), which reclaims uric acid from the
urine and returns it to the plasma
– Probenecid
•Non-purine selective inhibitor of xanthine oxidase
– Febuxostat
•Inhibits xanthine oxidase as a structural analog of
hypoxanthine
Pathology
313. What is the hallmark of chronic granulomatous
inflammation in pulmonary tuberculosis? Langhan’s giant cell
Epithelioid histocytes
•Casseation necrosis
– Often seen in tuberculosis but rare in other
granulomatous diseases
•Epithelioid histiocytes
– Activated macrophages that are elongated, finely
granular, with pale eosinophilic cytoplasm
•Lymphocytes
– Surrounds the epithelioid histiocytes in a
granuloma
•Langhan’s type multinucleated giant cell
– Formed by the fusion of epithelioid histiocytes
– Found in granulomatous conditions but not
specific for tuberculosis or any mycobacterial
disease Granuloma
Microbiology
314. If there is an ascending cholangitis, what

are the most common pathogens?
•Enterobacteriaceae
•Staphylococcus spp.
•Streptococcus spp.
•Bacillus spp.
Anesthesiology
315. If a patient has bronchial asthma, induction of general
anesthesia is ideally achieved by administering which agent?
•Midazolam
•Propofol
– It is a potent respiratory depressant that causes dose-related
depression of central ventilatory drive and transient apnea
•Ketamine
•Thiopental
– It is a potent respiratory depressant, producing transient
apnea and lowering the sensitivity of the medullary
respiratory center to CO2
Ophthalmology
316. A male patient consulted because of blurring of vision of 3 days duration and
accompanied by eye redness, OD. Which of the following is the most likely
diagnosis?
•Acute angle closure glaucoma

– Redness
– Severe pain
– Blurring of vision
– (+) halos
•Myopia
– This should be chronic and not associated with eye redness
•Retinal detachment
– Flashes of light (photopsia)
– Increase in floaters
– A dense shadow that starts in the peripheral vision and slowly
progresses towards the central vision
– A veil or curtain was drawn over the field of vision
– Straight lines that suddenly appear curved (positive Amsler grid test)
– Acute painless central visual loss
•Vitreous hemorrhage
– Blurring of vision
– (+) floaters
– Photopsia
Clinical Pathology
317. If a patient’s jaundice is due to an obstruction in

the bile flow along the common bile duct, what
laboratory (blood) test would hep you in the
diagnosis?
•Acid phosphatase
•Alkaline phosphatase
•ALT
•AST
Rehab Medicine
318. Phalen’s test is a maneuver to determine

the presence of:
•DeQuervain tenosynovitis
– Finkelstein’s test
•Trigger finger
•Carpal tunnel syndrome
•Felon Phalen’s test
Gynecology
319. A young couple married for 4 years consult

because they want to have a child. The woman is a 28
y/o nulligravid with regular monthly cycles and an
unremarkable past medical history. What is the initial
step to be performed on this couple?
•Hysterosalphingography
•Sperm analysis
•Serum FSH on day 3
•Hysteroscopy
Internal Medicine
Primary prophylaxis:
320. What is the prophylaxis for Penicillin V 500 mg, PO, BID for 10 days in
prevention of recurrence of adults
rheumatic fever? or
1.2 M units Benzathine penicillin G, single IM
•High-dose ASA for 6 weeks injection
– This is a prophylaxis for
Kawasaki disease To eliminate major
•IM long-acting Penicillin G every 4 risk factors
weeks
•IV Ampicillin and Gentamycin 1 To control disease
hour before dental/surgical or prevent
procedure recurrence
•Oral Penicillin V for 10 days
– Can be given twice daily but Secondary prophylaxis: For penicillin-allergic:
is less effective than 1.2 M units Benzathine Erythromycin 250 mg,
benzathine penicillin G penicillin G, IM, every 4 weeks BID
ENT
321. In an adult with unilateral chronic otitis media, what area
will require closer examination?
•Oral cavity
•Oropharynx
•Mastoids
– Since the middle ear is connected to the mastoid,
chronic otitis media is accompanied by chronic
mastoiditis
•Nasopharynx
Adams, Boies and Hilger. (2010). Boies Fundamentals of Otolaryngology. 6 th Ed. Pg. 110.
Physiology
322. What is the lung volume left after a
forceful exhalation?
•Residual volume
•Functional residual capacity
– volume in the lungs at the end-
expiratory position (RV +ERV)
•Expiratory reserve volume
– The maximal volume of air that can
be exhaled from the end-expiratory
position
•Vital capacity
– the volume of air breathed out after
the deepest inhalation. (TV + IRV
+ERV)
Surgery
323. A 65 y/o male has biliary colic, jaundice,

and fever. An ultrasound of the upper abdomen
showed dilated CBD and intrahepatic ducts. He
underwent cholecystectomy in 2004 for
cholelithiasis. On PE, he was coherent, febrile
with stable BP. What is the most likely cause of
the patient’s obstructive jaundice?
•Retained CBD stone

•Inadvertent CBD ligation
Pediatrics
324. A 1 y/o male presents with persistent high grade fever
of 5 days, with development of non-purulent, erythematous
conjunctival injection, strawberry tongue, 2 cm left
posterior cervical lymph node, and generalized
erythematous macules. What is the most likely condition?
•Acute rheumatic fever

•Steven-Johnson syndrome
•Scarlet fever
•Kawasaki’s disease
Obstetrics
325. What is the most accurate method to establish PROM in a 30-31
week AOG?
•Nitrazine test
– Can support the diagnosis of PROM
– While vaginal pH is normally acidic, a pH above 7.0 can
indicate that the amniotic sac has ruptured.
– However, elevated pH can also be associated with bacterial
vaginosis
•Direct visualization of fluid coming from the os
– Careful visual inspection via a speculum examination is the Nitrazine test
safest method
•Ferning test
– Can support the diagnosis of PROM
– Ferning permits positive identification of amniotic fluid by its
fern-type crystallization under microscopic examination
•Abdominal ultrasound
– If all fluid has leaked out as in early ROM, this test may then
show absence or very low amounts of amniotic fluid in the
uterine cavity
Ferning test
Medical Ethics
326. What is the most important ethical guideline in

determining the morality of new reproductive
technology techniques?
•Cost of the procedure

•Informed consent of the patient
•Whether the technology assists or replaces the
conjugal act
•Whether the technology has been approved by the
specialty society as cost-effective
Preventive Medicine
327. The patient works in a factory and oeprates a

steel-cutting machine. In the Philippines, what is the
permissible level of exposure for an 8-hour period in
terms of decibels (dB)?
•80 dB
•85 dB
•90 dB
•95 dB
Behavioral Medicine
328. A 40 y/o male business executive was seen with anxiety attacks
which occur practically daily, lasting 10-15 minutes. During the said
attacks, he would sweat profusely and experience palpitations. What is
the most possible diagnosis for this case?
•Agoraphobia
– Anxiety in situations where the sufferer perceives certain
environments as dangerous or uncomfortable, often due to the
environment's vast openness or crowdedness (e.g. airport,malls)
•Panic disorder without agoraphobia
•Hypochondriasis
Parasitology
Oral ingestion Skin penetration Insect bite
Ascaris lumbricoides Ancylostoma Brugia malayi
duodenale
329. If the patient has Capillaria Necator Leishmania
Paragonimus philippinensis americanus
westermani, how did he Entamoeba

histolytica
Schistosoma Loa Loa
became infected? Enterobius Strongyloides Onchocerca

vermicularis stercoralis volvulus
Giardia lamblia Plasmodium
•Oral ingestion Fasciola hepatica Trypanosoma
•Skin penetration Paragonimus Wuchereria

westermani bancrofti
•Insect bites Taenia saginata
•Airborne transmission Taenia solium

Toxoplasma gondii
Trichinella spiralis
Trichuris trichiura
Internal Medicine
330. A patient is given supplemental oxygen at 3 LPM. Her ABG
reveals the following: pH 7.36, PaCO2 48, PaO2 100, HCO3 29, O2
sat 97%. What is the actual P/F ratio of the patient?
Solution:
•FiO2 = (LPM x 4) + 20
•FiO2 = (3 LPM x 4) + 20
•FiO2 = 32%
•P/F ratio = PaO2/FiO2

•P/F ratio = 100/0.32
•P/F ratio = 312.5
Biochemistry
331. Which of the following is the principal function of the electron
transport chain?
•Traps energy as ATP via oxidative phosphorylation

•Acts as final common pathway for oxidation of metabolic fuels
– Kreb’s cycle
•Produces reducing equivalents for reductive biosynthesis of molecules
– Kreb’s cycle, HMP shunt, glycolysis
•Generates high energy compounds like creatine PO4 through substrate
level phosphorylation
– Creatine phosphate is synthesized through formation of
guanidinoacetate from Arginine and Glycine (in kidney) followed by
methylation to creatine (in liver), and phosphorylation by creatine
kinase to phosphocreatine (in muscle)
Anatomy
332. Which of the following characterizes a Meckel’s diverticulum?
•Abnormal persistence of urachus

– A patent urachus is a congenital anomaly in which the urachus
remains patent from the bladder to the umbilicus
•Site of ectopic pancreatic tissue
– There is failure of the vitelline duct which connects the yolk sac to
the midgut to obliterate
– As the vitelline duct is made up of pluripotent cell lining, Meckel’s
diverticulum may harbor abnormal tissues, containing embryonic
remnants of other tissue types (pancreatic, gastric)
•Caused by a failure of the midgut loop to return to the abdominal cavity
– Omphalocele
•Abnormal connection of the midgut to the duodenum
Radiology
333. The following urinary tract stones are
radiopaque in conventional radiograph EXCEPT:
Composition Conventional
•Calcium oxalate radiograph appearance
Calcium oxalate Radiopaque
•Calcium phosphate Calcium phosphate Radiopaque
•Struvite Brushite Radiopaque

Struvite Radiopaque
•Uric acid stone Cystine Mildly radiopaque
Uric acid Radiolucent
Indinavir calculus Radiolucent
Pharmacology
Gray Baby Syndrome
334. Which of the following antibiotics is effective against both aerobes and
anaerobes? Newborn infants lack
an effective glucoronic
•Metronidazole
acid conjugation
mechanism for the
– Effective against anaerobes and protozoa
degradation and
•Gentamicin
detoxification of
– Like all aminoglycosides, it has no activity against anaerobes chloramphenicol
– Inhibits many strains of staphylococci and coliforms and other gram-
negative bacteria. Bone marrow
•Aztreonam disturbances
– Unlike other beta-lactam antibiotics, they have no activity against • Chloramphenicol
gram-positive bacteria or anaerobes commonly causes a
– Its spectrum of activity is limited to aerobic gram-negative rods dose-related
•Chloramphenicol reversible
– It is a bacteriostatic broad-spectrum antibiotic that is active suppression of RBC
against both aerobic and anaerobic gram-positive and gram- production
negative organisms • Aplastic anemia
– H. influenzae, N. meningitidis, and some strains of Bacteroides are occurs more
highly susceptible so chloramphenicol may be bactericidal frequently with
prolonged use
Clinical Pathology
335. Which of the following Bacterial Viral TB
laboratory findings in Opening > 180 mmH2O 100 – 350 > 180 mmH2O
cerebrospinal fluid analysis pressure mmH2O
is consistent with
WBC 10 - 10,000/µL Lymphocytic Lymphocytic
meningitis? (neutrophil pleocytosis pleocytosis (10 -
predominance) (25 – 500 500 cells/µL)
cells/µL)
•Opening pressure of 220 Glucose < 40 mg/dL Normal 20 – 40 mg/dL
mmH2O
CSF/serum < 0.4 - -
•White blood cell count of glucose
12 Protein > 45 mg/dL Normal to 10 – 500 mg/dL
slightly
•CSF glucose to serum elevated
glucose ratio of 25%
•CSF protein of 60 mg/dL
336. What is the best way to report the

beneficial and harmful effects of a comparative
treatment study?
•Relative risk reduction

•Relative risk
•Absolute risk reduction
•Number needed to treat
Neurology
337. What cranial nerve exits the brainstem
between the posterior cerebral artery and the
superior cerebellar artery?
•CN VII
•CN III
•CN IV
•CN VI
Gynecology
338. A 48 y/o female complained of irregular menstruation. She subsequently became
anemic. PE revealed midline nodular palpable abdominal mass measuring about 8 x 8
x 7 cm which she palpated 6 months earlier. If myoma uteri was considered, what is
the most likely type?
•Intraligamentary (broad ligament myoma)

– Difficult to differentiate on pelvic exam from a solid ovarian tumor
– May produce a hydroureter as they enlarge
•Intramural
– Intramural fibroids are located within the wall of the uterus and are the
most common type
– Unless large, they may be asymptomatic
•Submucous
– Most troublesome clinically
– Associated with abnormal vaginal bleeding or distortion of the uterine
cavity that may produce infertility or abortion
– The uterus will try to expel this and the prolapsed myoma may protrude
through the external cervical os
•Subserous
– Gives the uterus its knobby contour
– Further growth may lead to a pedunculated myoma wandering into the
peritoneal cavity
– May obtain a secondary blood supply from another organ, and becomes a
parasitic myoma
Histology
339. Which type of capillaries allows rapid exchange of fluid in the glomerulus?
•Continuous or somatic
– endothelial cells provide an uninterrupted lining, and they only allow
small molecules, like water and ions to diffuse through tight junctions
– found in skeletal muscles, finger, gonads, and skin, central nervous
system (constituent of the blood brain barrier)
•Sinusoidal
– allow red and white blood cells and various serum proteins to pass
– located in the bone marrow, lymph nodes, and adrenal gland
•Fenestrated or visceral with diaphragm
– have pores in the endothelial cells that are spanned by a diaphragm of
radially oriented fibrils and allow small molecules and limited amounts of
protein to diffuse
– Found in endocrine glands, intestines, pancreas, and glomeruli of kidney
•Fenestrated or visceral without diaphragm
– there are cells with no diaphragms called podocyte foot processes or
"pedicels," which have slit pores with an analogous function to the
diaphragm of the capillaries.
– Found in endocrine glands, intestines, pancreas, and glomeruli of kidney
Internal Medicine
340. When is there accentuation of a right-sided murmur? It is Right to Increase
Inhalation
•Exhalation
– Left-sided murmurs generally increase in intensity with expiration
•Inhalation
– Right-sided murmurs generally increase in intensity with inspiration
– Inhalation pressure causes an increase in the venous blood return to the right side of the
heart by increasing intrathoracic negative pressure.
– Increased (more negative) intrathoracic pressure has an opposite effect on the left side of the
heart, making it harder for the blood to exit into circulation so left-sided murmurs decrease
with inspiration
•Left lateral decubitus
– The left lateral decubitus position increases murmur of mitral stenosis
•Sitting and leaning forward
– Sitting up and leaning forward accentuates the second heart sound and increases the aortic
insufficiency murmur
Pediatrics
341. Meningomyelocoele belongs to what type of birth defect?
•Malformation
– Morphological defect of an organ or a larger region of the body
resulting to intrinsically abnormal process (e.g. Meningomyelocoele,
ear tags)
•Deformation
– Caused by mechanical pressure (e.g. twins, talipes equinovarus)
•Disruption
– Initially normal development that get disrupted by external factors
(e.g. amniotic band, developmental dysplasia of the hip)
•Dysplasia
– Abnormal organization of cells (e.g. AV malformation, hemangioma,
nevi)
ENT
342. If otoscopy revealed a dry central perforation of
the eardrum, what will you expect?
•Normal hearing
•Conductive hearing loss
– Due to disorders of the external or middle ear
•Sensorineural hearing loss
– Due to disturbance of the cochlea, eighth
nerve, or central auditory channels
•Mixed hearing loss
– Involves both conductive and sensorineural
mechanisms
Obstetrics
343. What is the drug of choice in the management of eclampsia?
MgSO4 toxicity:
MgSO4 • (-) DTRs
•Diazepam
• Loading dose: 4 g/IV bolus • RR < 12
– Can be used slowly over 5 mins • Low urine output
• Maintenance: 1-2 g/hr IV
•Phenytoin < 100 mL/4 hrs
drip • Serum Mg
– Can be used (N.V. 1.5-2.5 mg/dL)
•MgSO4
– Anticonvulsant of choice. Latest RCTs have shown that MgSO4
is superior over diazepam or phenytoin
•Meperidine hydrochloride
– Has the potential for producing seizures secondary to
accumulation of its metabolite, normeperidine
Dermatology
344. A 30 y/o stewardess complained of skin rashes and pruritus.
If the rashes were wheals that would disappear within 24 hours
and reappear on other areas of the body for one week, what is
the most likely diagnosis?
•Urticaria
– A vascular reaction of the skin characterized by the
apperance of wheals, generally surrounded by a red
halo or flare and associated with severe itching,
stinging, or pricking sensation
– The wheals are caused by localized edema
– Acute urticaria evolves over days to weeks, producing
evanescent wheals that individually rarely last more
than 12 hours
– Drugs are the most frequent cause of acute urticaria
•Arthropod bites
•Pityriasis rosea
•Erythema multiforme Urticaria
Preventive Medicine
345. Which of the following strategies is DOH Health-Related

required in the Department of Health’s Millennium
Development Goals
goal of improving the general health (MDGs) 2011-2016
status of the population? • Eradicate extreme
poverty and hunger
• Reduce child
•Reduce infant and child mortality rate mortality
• Improve maternal
•Decrease life expectancy health
• Reverse the spread
•Increase total fertility rate of HIV/AIDS, Malaria
and other infectious
•Increase growth rate diseases
• Ensure
environmental
sustainability 347
Legal Medicine
346. A patient with dyspnea was found to have a stab

wound on the chest. The size and shape of stab wound
in the skin is dependent on the following statement
EXCEPT:
•Configuration of the weapon

•Direction of the thrust
•The movement of the blade in wound
•The wider area of the body involved
Physiology
347. A 35 y/o male was brought for consult Receptor Action
because of attempted suicide. Assuming that
he ingested an agent that stimulated the M3 M1 Increase salivary and gastric
type of muscarinic receptor, which of the acid secretion
following is expected? M2 Decrease heart rate and
contractility
•Constriction of the airways M3 Smooth muscle contraction,
•Decreased intestinal movement bronchoconstriction, eye
accomodation
– M3 stimulation increases intestinal
(constriction), vasodilation,
movement
increase exocrine and
•Dilation of the pupils endocrine gland secretion
– M3 stimulation constricts the pupils
M4 Decreased locomotion
•Increased heart rate
M5 Cerebral blood vessel
– β1 increases heart rate dilatation
– M2 decreases the heart rate
Pathology
348. A 60 y/o patient consulted at the emergency room for severe intermittent headache
for the past year. On CT scan, he was noted to have an irregular mass at the center of the
left parieto-occipital cerebral hemisphere measuring around 4 cm. What is the most likely
type of tumor? Gliomas are the most
common primary brain tumor
•Medulloblastoma
– Occurs predominantly in children and exclusively in the cerebellum
– Highly malignant but exquisitely radiosensitive
•Ependymoma
– Often manifest with hydrocephalus secondary to progressive obstruction of the 4th
ventricle
•Glioblastoma
– A.K.A glioblastoma multiforme is the most common and most aggressive primary
brain tumor in humans
•Metastatic lung carcinoma
– Usually produces multiple metastatic lesions to the brain. Patient so far does not
manifest pulmonary symptoms because secondary brain tumors indicate advanced
stages of the disease
Microbiology
349. In AFB stain, the part of the bacteria which
is responsible for taking the primary stain is:
•Lipopolysaccharide
•Mycolic acid
•Polysaccharide
•Lipid A
Mycobacteria and
Nocardia are acid- Acid-fast cell wall
fast
Internal Medicine
350. What is the first link in the chain of survival

concept?
•Early ACLS
•Early access
•Early CPR
•Early defibrillation
Gynecology
351. A 48 y/o G3P3 (3003) consults due to profuse and prolonged menses with progressive
dymenorrhea. PE: IE: cervix – firm, long, closed; Uterus is enlarged symmetrically to 4 months size,
tender; Adnexa – negative. What is the most likely diagnosis?
•Myoma uteri
•Adenomyosis
– Growth of endometrial glands and stroma into the uterine myometrium
– Classic symptoms are secondary dysmenorrhea and menorrhagia
– Uterine enlargement is most unusual to be greater than 14-week gestation
•Adenomyoma
– An isolated area of endometrial glands and stroma in the uterine musculature that can be
identified grossly
– Adenomyosis usually initiates adenomyoma
– Usually asymptomatic
•Pelvic endometriosis
– Presence and growth of the glands and stroma of the lining of the uterus in an aberrant or
heterotopic location
– Grows under the influence of ovarian hormones and is particularly estrogen dependent,
therefore, it is commonly found during the reproductive years
– Ovaries are the most common site of implantation which is often bilateral
Pharmacology Hypoglycemic agent Adverse effects
Alpha-glucosidase Flatulence, diarrhea,
inhibitor (Acarbose) abdominal pain
352. What hypoglycemic Amylin analog Hypoglycemia, nausea,
(Pramlintide) vomiting, anorexia
agent can aggravate Biguanide (Metformin) Nausea, vomiting, diarrhea,
edema and anemia? lactic acidosis
DPP-4 Inhibitor (Sitagliptin) Nasopharyngitis, URTI,
headaches
•Alpha-glucosidase GLP-1 analog (Exenatide) Nausea, vomiting, diarrhea,

anorexia, pancreatitis
inhibitor Glitinides (Repaglinide) Hypoglycemia
•Biguanides Insulin Hypoglycemia, weight gain
•Sulfonylurea Sulfonylurea (Glimepiride) Hypoglycemia, weight gain
•Thiazolidinedione Thiazolidinediones Fluid retention, edema,

(Rosiglitazone) anemia, weight gain
Anatomy
353. The following are components of
the inguinal or Hesselbach’s triangle
EXCEPT:
•Linea semilunaris
– This is also the lateral edge of the
rectus abdominis
•Inferior epigastric vessels
•Medial end of the inguinal ligament
•Arcuate line
– demarcates the lower limit of the
posterior layer of the rectus
sheath
Ophthalmology
354. A 60 y/o woman came in because of severe pain in the right eye. This was
accompanied by circumcorneal redness (ciliary injection), visual acuity of 20/800 and
nausea. On examination, there was slight tearing, the cornea was edematous with
poor view of the iris details and mid-dilated pupil unresponsive to light stimulation.
The next best test will be:
•Fundus fluorescein angiography

– This is very important in the diagnosis and evaluation of many retinal
conditions like ischemia, neovascularization, and vascular occlusion
•Applanation tonometry
– To measure the IOP which is markedly increased in angle-closure glaucoma
(N.V. 11-21 mmHg)
•Amsler grid testing
– detection of visual disturbances caused by changes in the retina, particularly
the macula like in macular degeneration
•Request for culture and sensitivity of the eye discharge
– The case is least likely to be infectious in nature
Rehab Medicine
355. If the patient has right L4
radiculopathy, where will he
have a sensory deficit?
•Lateral thigh
– L5
•Lateral foot
– S1
•Medial malleolar area
– L4
•Dorsum of the first web space
of foot
– L5
Behavioral Medicine
356. A 24 y/o college student came in with problems of “bizarre thoughts and hearing
voices of dead people”. Which of the following is a neuropsychological test that assesses
the “executive function” in the cognitive domains of psychiatric patients?
•Boston naming test

– Measures confrontational word retrieval in individuals with aphasia or other
language disturbance caused by stroke, Alzheimer's disease, or other dementing
disorder
•Thematic apperception test
– Person's responses reveal underlying motives, concerns, and the way they see the
social world through the stories they make up about ambiguous pictures of people
•Clock drawing test
•Benton visual retention test
– Test for people from eight years old to adulthood that measures visual perception
and visual memory by showing 10 designs, one at a time, and asked to reproduce
each one as exactly as possible on plain paper from memory
Parasitology
357. What is the most commonly affected
organ in congenital toxoplasmosis?
•Heart
– Can be affected
•Eye and brain
– Toxoplasmosis commonly causes
encephalitis and necrotizing Toxoplasmal Retinochoroiditis
retinochoroiditis
•Liver
– Can be affected
•Lymph nodes
– Can be affected
Surgery
358. Which of the following statements is correct regarding a 53
y/o asymptomatic male with normal DRE and a rise in serial PSA
values from 3 to 6 ng/mL over 3 years?
•Rise in PSA is due to prostoptitis and warrants no further

investigation
•Rise in PSA characteristic of normal aging
•He does not need a biopsy based on the age-specific PSA
criteria
•Rate of rise in PSA warrants a biopsy
Radiology
359. X-ray of the right arm showed fracture of the radius with
associated dislocation of the distal radio-ulnar joint. What kind
of fracture is this?
•Monteggia’s fracture
– Fracture of the proximal third of ulna with dislocation
of the head of the radius
– Caused by direct blow on the back of the upper
forearm or falling on an outstretched hand with the
forearm in excessive pronation
•Colle’s fracture
– Fracture of the distal radius with dorsal displacement
of the of the wrist and hand
– Caused by falling with outstretched arms
•Smith’s fracture
– Fracture of the distal radius
– Caused by direct blow to the dorsal forearm or falling
on flexed wrists
•Galeazzi’s fracture
Monteggia’s Galeazzi’s
Internal Medicine
360. The following are included in the 1992 Jones Criteria (major
Revised Jones criteria for the diagnosis of manifestations):
C - Carditis
Rheumatic fever and rheumatic heart A - Arthritis
disease EXCEPT: S – Subcutaneous nodules
E – Erythema marginatum
S – Sydenham’s chorea
•Polyarthritis
•Elevated ESR
– This is only a minor manifestation
•Sydenham’s chorea
Erythema marginatum
Physiology
361. In which part of the nephron
does majority of water absorption
occur?
•Collecting duct
– Reabsorbs ~8-17% of
filtered water
•Distal tubule
– Impermeable to water
•Loop of Henle
– Reabsorbs 15% of the
filtered water
•Proximal tubule
– Reabsorbs 67% of the
filtered water
363
Biochemistry
Glucose 6-phosphate
362. Natural deficiency of this enzyme
of the uronic acid pathway makes Phosphoglucomutase
vitamin C essential for man: Glucose 1-phosphate
UDPGlc Phosphorylase
•UDP glucose dehydrogenase UDP glucose
•Phosphogluconate dehydrogenase UDPGlc Dehydrogenase

– This is a part of the HMP shunt UDP glucoronate
that converts phosphogluconate
to ribulose 5-phosphate
Glucoronate
•Phosphoglucomutase Glucoronate reductase
•Gluconolactone oxidase Gulonate
– Humans, some primates, and Aldonolactonase
guinea pigs cannot synthesize
Gulonolactone
this enzyme because of genetic
mutation Gluconolactone oxidase
2-keto gulonolactone
Ascorbate
Obstetrics
363. A patient complained of hypogastric pain and bleeding amounting to 1 pad. Speculum: (+)
brownish discharges, (+) pooling; IE: cervix 1 cm dilated; TVS: Intrauterine pregnancy 9-10 weeks;
fetal heart rate is 167 beats per minute. Give the diagnosis.
•Incomplete abortion
– Part of the placenta or portions of the produces of conception is expelled in the
presence of an open cervix and bleeding
•Inevitable abortion
– Gross rupture of the bag of waters in the presence of cervical dilatation without
passage of products of conception or the fetus
•Threatened abortion
– Presence of bloody vaginal discharge, closed cervix, and uterine enlargement in the first
half of pregnancy with rhythmic, crampy, abdominal pain
•Missed abortion
– There is embryonal or fetal demise but there is no expulsion of the product of
conception and there is retention for 8 weeks or more
– Closed cervix and minimal or absent vaginal bleeding
364. Which statement is TRUE regarding prevalence rate of
diseases?
•Reflected in the number of acute infectious diseases

– This is incidence
•Denominator is the population at risk of disease development
– This is incidence because the denominator of prevalence is
the total population
•Decreased by improved cure rate
•Decreased by better reporting of cases
– Increased by better reporting of cases
Pediatrics
365. A 1 y/o 10 kg child presenting with acute watery

diarrhea and vomiting is assessed to have moderate
dehydration. Over the next 4 hours, how much ORS
(in mL) should be given to correct his deficit?
•300-500 mL Body weight Amount of fluid replacement

1st 10 kg 100 mL/kg
•500-900 mL 2nd 10 kg 50 mL/kg
•1000-1500 mL >20 kg 20 mL/kg
•> 1500 mL
Medical Nutrition
366. What is the general goal of nutritional therapy for any pulmonary
condition?
•Preserve lean body mass to prevent respiratory muscle dysfunction

•Meet nutrient requirements only
– Meet energy and nutrient requirements
•Maintenance of fluid and acid-base balance is not important
– Maintenance of fluid and acid-base is important
•Provide nutritional substrates that will increase CO2 production
– The goal is to minimize CO2 production
Neurology
367. A 60 y/o right-handed male consulted at the ER for
severe headache, later accompanied by sudden onset of
left-sided hemiplegia and dysarthria. Which of the following
has been shown by evidence to be the most effective in the
treatment of acute ischemic stroke?
•Streptokinase
•Recombinant tissue plasminogen activator
•Citicoline
•Aspirin
Preventive Medicine
368. A patient consulted because of pain and decreased hearing in his left ear.
He noted this after a gun was fired by his co-soldier beside him during a
recent encounter with Abu Sayyaf in Basilan. If he completely loses hearing in
the left ear, how long is he entitled to permanent partial disability benefits?
•10 months
– Loss of hearing of one ear, loss of one ear, and loss of a thumb
•20 months
– Loss of both ears
•25 months
– Loss of sight of one eye
•50 months
– Loss of one arm, loss of hearing of both ears
Anesthesiology
369. Which is a sign of Insufficient depth Sufficient depth Excessive depth
insufficient anesthetic depth? Breath holding; deep Minimal response No response
breathing
Insufficient muscle Adequate muscular Inability to
•Obtundation
relaxation relaxation reestablish normal
– Excessive depth ventilatory function
•Amnesia Delirium Amnesia; sleep Obtundation
– Sufficient depth Increased/decreased Absence of Decreased BP/PR
•Retching BP/PR troublesome reflexes
– Insufficient depth Arrythmias Stable CV Arrythmia
•Muscle relaxation Nausea Apnea

– Sufficient depth Retching GI atony, ileus
Salivation
Internal Medicine
370. What PE and radiologic examination findings

are characteristic of ankylosing spondyloarthritis?
•Acute synovitis
•Destruction of bony outgrowths
•Primary involves the axial joints
•Production of articular cartilage
Histology
371. Which of the following is a
mechanoreceptor which subserves 2-point
tactile discrimination? Receptory type Function
Free nerve endings Pain, temperature,
crude touch
•Vater-Pacinian Golgi tendon organs Muscle tension
Meissner’s 2-point tactile
•Meissner’s corpuscle corpuscle discrimination
Merkel’s disks Light touch and
•Ruffini’s corpuscle superficial pressure
•Muscle spindle Muscle spindle

Ruffini’s corpuscle
Muscle length
Stretching of skin
Vater-Pacinian Deep pressure,
vibration
Clinical Pathology
372. Microscopically, the urine sediment

revealed 50% dysmorphic red cells. What is the
most probable clinical diagnosis?
•Acute cystitis
•Acute tubular necrosis
•Acute glomerulonephritis
•Acute pyelonephritis
Gynecology
373. If the primary consideration is an endometrial polyp, what is the correct diagnostic procedure to
do?
•Colposcopy
– This is used to visualize cervical pathologies
•Saline-infusion sonography
– Polyps are often undetected on standard ultrasound, but are clearly visible when surrounded
by water.
– The saline distends the cavity, pushing the opposed walls of the endometrium apart giving
exquisite detail of the uterine lining
– Best performed as soon as possible after the cessation of menses where endometrium is
thinnest to better visualize lesions
– Difficult to interpret with (+) bleeding; CONTRAINDICATED IN PREGNANCY
•Hystero-salpingography
– A radiographic imaging technique in which the uterine cavity and the lumen of fallopian tubes
are visualized by injecting contrast material through the cervical canal
– Can also be done to visualize endometrial polyps but is not the best test
– It is important to examine histologically both the polyp and the associated endometrial lining
because of the frequent association of endometrial polyps and other endometrial pathology
Anatomy
374. Which of the following statements about the
cervical plexus is TRUE?
•Supplies motor innervation to platysma

– It supplies motor innervation to the SCM,
trapezius, levator scapula, scalene muscles,
and infrahyoid muscles
– Platysma is innervated by the cervical branch
of the CN-VII
•Comprises spinal segments C1-C3
– Formed by entwining anterior rami of C1-C4
•Carries only cutaneous fibers
– It carries cutaneous and motor fibers
•Consists solely of ventral rami of spinal nerves
Dermatology
375. What is the drug of choice to manage the problem of Adults:
one-week duration of evanescent wheals? Diphenhydramine 25-50 mg, PO, q4-q6
Children:
•Antihistamine 2-6 y/o: 6.25 mg, q4-q6
– This is a case of urticaria which is caused by the 6-12 y/o: 12.5 – 25 mg, q4-q6
release of histamine by the mast cells
– 1st generation antihistamines are sedating and
have anticholinergic activity while 2nd
generation have little or no sedating and 1st generation (sedating)
anticholinergic activity
•Corticosteroid
– This is anti-inflammatory and not an
Urticaria
antihistamine
•Epinephrine
– Is a physiologic antagonist of antihistamine
which causes smooth muscle relaxation 2nd generation (non-sedating)
– Useful in systemic anaphylaxis
•Ranitidine
– This is an Histamine-2 receptor antagonist to Adults:
decrease gastric acid secretion
Cetirizine 5-10 mg, PO, once daily
– Urticaria is secondary to activation of Histamine- Children:
1 receptor which affects
2-6 y/o: 2.5 mg, PO, once daily
Behavioral Medicine
376. A 70 y/o woman complains of sadness, insomnia, difficulty concentrating
and decreased interest for the last two months. She barely eats and has not
returned the phone calls of her family and friends. She states “life is just not
worth living.” What is the most likely diagnosis in this case?
Bipolar I
•Bipolar II Disorder
– Involves major depressive episodes and hypomanic episodes
– Bipolar I disorder presents with full manic episodes and major
depressive episodes
•Cyclothymic disorder Bipolar II
– Alternating hypomania and depressive episodes
– Never reaches full mania or major depression
•Dysthymic disorder
– Mild depression without any hypomanic episodes Cyclothymic
– Depressive symptoms last for at least two years without break
•Major depressive disorder
– Suffers from worst type of depression without any hypomanic
episodes Dysthymic
– May have a family history of bipolar disorder
– Characterized by depressed mood, diminished interest or pleasure in
activities, significant weight loss, insomina/hypersomnia, recurrent
thoughts of death, fatigue, feeling of worthlessness, diminished
ability to think, pyschomotor agitation or retardation MDD
Pharmacology
377. If the patient is to be given an anti-platelet agent, this anti-platelet works by
inhibiting ADP-mediated platelet aggregation:
•Aspirin
– Inhibits the synthesis of thromboxane A2 by irreversible acetylation of the
enzyme cyclooxygenase
•Abciximab
– A monoclonal antibody that inhibits the final common pathway in platelet
aggregation by binding to the glycoprotein IIb/IIIa receptor complex for
fibrinogen, vitronectin, fibronectin and von Willebrand factor
•Clopidogrel
•Dipyridamole
– Is a vasodilator that inhibits the platelet function by inhibiting adenosine
uptake and cGMP phospphodiesterase activity.
– It has little or no beneficial effect by itself; therefore it is primarily used in
combination with aspirin or warfarin
Pathology
378. Which of the following statements is true about
atherosclerosis?
•The lipid-laden macrophages are initially deposited at the

endothelial cell layer
– Lipid-laden macrophages are initially deposited at the
tunica intima
•Myointimal cells and fibroblasts are responsible for forming
the fibrous wall of the plaque
•The tunica media is the primary layer initially affected by the
atherosclerotic deposition
– The tunica intima is the primary layer initially affected
•Atherosclerosis never involves the adventitia layer of the blood
vessel
Surgery
379. A 2-month old infant has a progressively enlarging 2 x 2 cm hemangioma on the left
lower eyelid. What is the recommended management?
•Excision
•Sclerotherapy
•Compression therapy
•Observation and reassurance
– Around the 2nd month of life, they enter the proliferating phase in which rapid
growth is seen caused by plump, rapidly dividing endothelial cells
– Hemangioma growth frequently peeks before the first year, and then lesion enter
the involuting phase which continues until 5 to 10 years of age
– Approximately 90% involute over time
Internal Medicine
380. A 30 y/o street vendor presents with 4-day fever, myalgia, and headache. On
PE, BP= 100/60. She is also tachycardic, febrile, with epigastric tenderness. Which
statement is true regarding the diagnosis of this patient?
•Appearance of vesicular rashes are typical of Herman’s rash of dengue infection

– Herman’s rash appears on the upper and lower extremities, purplish or
violaceous red with blanched areas about 1 cm or less in size
•Hemoconcentration and thrombocytopenia are characteristic findings in
leptospirosis
– These are characteristic findings of dengue
•Leukocytosis is a feature of typhoid fever
– Leukopenia
•Onset of jaundice following fever lysis is characteristic of viral hepatitis
Obstetrics
381. If pregnancy is indeed 12 weeks, which of the following should be
demonstrable?
•HCG at its peak

– HCG is at its peak at around 8-10 weeks AOG
– HCG begins to decline at around 10-12 weeks AOG
•Fetal heart action by Doppler apparatus
– Fetal heart tone is detected at 10-12 weeks by Doppler
– FHT can be heard by an ordinary stethoscope at 18th week AOG
•Appreciation of fetal movement by examiner
– After the 20th week, fetal movement may be seen or felt by the examiner
– Perception of fetal movement by the mother is at 18-20 weeks for
primigravidas and 16-18 weeks for multigravidas.
•All of the above
Physiology
382. Which of the following conditions Factors that promote
promote laminar flow? turbulence:
• Large vessel
diameter
• High blood volume
•Small blood vessel diameter
• High velocity of
•Low blood viscosity blood flow
• More branching of
– turbulent Reynold’s number:
blood vessels
< 2000 – Laminar flow
•High flow velocity > 3000 – Turbulent
• Low viscosity of
blood
– turbulent flow
• Vessel obstruction
• Rough intimal
•Numerous branching of the blood surface of vessel
vessels
– turbulent
Biochemistry
383. Which of the following is an alternative fuel

utilized by the brain during prolonged periods of
starvation?
Organ Primary fuel Alternative fuel
Brain Glucose Ketone bodies
•Ketone bodies Muscle • Glucose Muscle protein
• Fatty acids (deleterious)
•Glycogen • Ketone bodies
•Amino acids Liver Keto acids (from

protein degradation)
Glucose
•Fatty acids Heart Fatty acids • Glucose (least

preferred)
• Ketone bodies and
lactate (when energy
demand is high)
Pediatrics
384. A new born was noted to be cyanotic. The heart rate was 110 beats per
minute. There were gasping respirations, grimaced on suctioning with slight
movement of extremities. What is the APGAR score?
•4
•5
– A-0
– P-2
– G-1
– A-1
– R-1
•6
•7 Scores
Severely depressed 0–3
Moderately depressed 4–6
Excellent condition 7 – 10
Neurology
385. Based on the homunculus of the brain, if you have lesion in
an area supplied by the anterior cerebral artery, what is the most
common manifestation?
•Weakness of the ipsilateral upper extremity

•Dysarthria
– Left middle cerebral artery
•Weakness of the contralateral lower extremity
•Central facial palsy
Microbiology
386. The patient admitted using paid sexual partners and complained of penile
secretions especially in the morning. What is the most probable causative bacterial
agent?
•Haemophilus ducreyi
– Causes chancroid or soft chancre characterized by ragged ulcer on the
genitalia, with marked swelling and tenderness.
– Regional lymph nodes are enlarged and painful
•HIV-2
– Symptoms of acute HIV are nonspecific and include fatigue, rash, headache,
nausea, and night sweats.
•Neisseria gonorrhea
•Treponema pallidum
– In 2-10 weeks after infection, a papule develops at the site of infection and
breaks down to form an ulcer with a clean, hard base “hard chancre”
Ophthalmology
387. A male patient consulted because of redness of the
eye. He noted it after much rubbing because of perceived
foreign body in his left eye while playing football. Which
do you think can best explain the mechanism of the eye
redness?
•Obstruction to the drainage of secretions of the

meibonian glands
– Chalazion Chalazion
•Acute supporation of the sebaceous glands of Zeis
– Hordeolum
•Exposure of the conjunctiva and cornea to various
agents making it prone to acute inflammation
•Ocular inflammation of the uveal tract which is the most
vascular tissue of the eye
– Uveitis
Hordeolum
Preventive Medicine
388. The patient would need tertiary prevention. This will
involve what aspect of management?
•Physical therapist will start him on passive exercises once

stabilized
•Do a lipid profile
– Secondary prevention
•Screen other family members for hypertension
– Secondary prevention
•Monitor blood pressure
– Primary prevention
ENT
389. If the difficulty of breathing were focused in the nasal
cavity, a common condition could be allergic rhinitis which may
be associated with:
•Increased thick mucus secretion by the glands of Bowman

•Increased edema and congestion of the turbinates secondary
to the engorgement of the venous plexuses in the Schneiderian
membrane
•Increased ciliary motion of the lining epithelium of the nasal
mucosa
•Accumulation of the dust particles on the vibrissae of the
vestibule of the nose
Internal Medicine
390. The pre-op serum sodium of a 45 y/o male

is 115 mEq/L. What is the estimated sodium
deficit in this patient?
Sodium deficit = Total body water x
(desired serum Na – actual serum Na)
•1500 mEq
•1200 mEq
•600 mEq
•200 mEq
Clinical Pathology
Onset Duration
391. Which blood test
Troponin 3 – 12 hours Up to 10 days
is the fastest to rise in CPK-MB 3 – 12 hours 36 – 48 hrs
a case of acute Myoglobin 1 – 4 hours 24 hours
myocardial infarction? LDH 6 – 12 hours 6 – 8 days
•Troponin
•CPK-MB
•Myoglobin
•LDH
Surgery
392. A 30 y/o female present with reducible mass at the right inguinal region. No
other symptoms were noted. The patient is probably suddering from:
•Indirect inguinal hernia

– Inguinal hernias that protrude lateral to the inferior epigestric vessels
through the deep inguinal ring
– result of the failure of embryonic closure of the internal inguinal ring
after the testicle passes through it
•Direct inguinal hernia
– Protrusions medial to the inferior epigastric vessels of the Hasselbach’s
triangle
•Femoral hernia
– Occur just below the inguinal ligament
– A reducible femoral hernia occurs when a femoral hernia can be pushed
back into the abdomen, either spontaneously or with manipulation. This
is usually painless.
– Can occur in both males and females
– Almost all of them develop in women because of the wider bone
structure of the female pelvis
•Pantaloon hernia
– Occurs when both a direct and an indirect hernia which are divided by
epigastric vessels develop on the same side of the groin
Anatomy
393. Narrowest portion of the urethra that can

be injured during catheterization:
•Prostatic
•Penile
•Membranous
•Fossa navicularis
Behavioral Medicine
394. What is a psychological theory that posits the symptoms as a response
learned from behavior or through classic conditioning?
•Psychoanalytic theory
– Human behavior is governed by irrational forces, and the unconscious, as
well instinctual and biological drives.
– There is psychic conflict between unconscious sexual or aggressive wishes
(Id) and corresponding threats from superego or external reality
•Cognitive behavioral
– Also known as the learning theory
•Existential theory
– Persons become aware of feelings of profound nothingness in their lives
•Developmental theory
Radiology
395. A chest x-ray (PA view) showed “canon ball”
pulmonary densities in both lungfields. What is this
roentgen finding indicative of?
•Miliary TB
– Presents as discrete, distinctive pin-point
opacities, which are well circumscribed
nodules in millet seed pattern
•Pulmonary metastases
•Radiation pneumonitis
– Vary from normal or subtle hazy ground glass
density to marked patchy or homogenous
consolidation. Canon ball metastasis of the
– Air bronchograms are commonly present and lungs from primary breast cancer
volume loss of the affected portion of the lung
may be observed
•Bronchogenic CA
– Typically presents as a solitary pulmonary
nodule in the periphery of the lung
Rehab Medicine
396. The patient manifests with
tingling sensation on the dorsum
of the right foot. What
dermatomal level is involved?
•L2
– anterior medial thigh
•L3
– medial epicondyle of the
femur
•L4
– medial maleolus
•L5
– dorsum of the foot
397. Urinalysis revealed glucosuria. You have recently learned
of a newly developed test that produced positive results in
138 of 150 known diabetics and 24 of 150 persons known not
to have diabetes. What is the sensitivity of the test (%)?
Gold standard (+) Gold standard (-)
Solution: New test (+) True positive (a) False positive (b)
•Sn = a/a+c New test (-) False negative (c) True negative (d)
•Sn = 138/150
Gold standard (+) Gold standard (-) Total
•Sn = 92% New test (+) 138 24 162
New test (-) 12 126 138
Total 150 150 300
Parasitology
398. A 25 y/o male student presents with high fever and chills. Thick and thin peripheral smear showed P.
vivax ring forms. In addition to blood schizonticide, which of the following drugs should be given to prevent
relapse?
•Mefloquine
– Chemoprophylaxis and treatment of infections with P. falciparum especially those which are
chloroquine-resistant
– Blood schizonticidal against P. falciparum and P. vivax but not active against hepatic stages
•Primaquine
– For radical cure (kills hypnozoites or the dormant stage) and terminal prophylaxis of infections
with P. vivax and P. ovale; alternative prophylaxis for all species
•Artesunate
– Artemisinin analogs (water-solube Artesunate and lipid-soluble Artemether) are blood
schizonticidal against all human malaria species but they have no effect on hepatic stages of parasite
– Effective in uncomplicated or complicated falciparum malaria
•Quinine
– First-line therapy for falciparum malaria especially severe disease
– Blood schizonticide against all four species of human malaria but not effective against the hepatic
stages
Gynecology
399. A 42 y/o G5P5(5005) consults because of bleeding
after coitus. PPE: cervix is smooth with a 1 cm whitish
discoloration of the posterior ectocervix. IE: firm, long, and
closed; uterus and adnexa are unremarkable. What is the
management?
•Wet smear
•Repeat the pap smear after a month
•Endocervical curettage
•Colposcopy guided cervical biopsy
Internal Medicine
Diastolic ARMS
400. Which of the
Systolic Diastolic Continuous
following produces a murmurs murmurs
diastolic murmur? Mitral Aortic Patent ductus
regurgitation regurgitation arteriosus
Tricuspid Mitral stenosis
•Aortic stenosis regurgitation
Ventricular
•Mitral valve prolapse septal defect
•Tricuspid regurgitation Aortic stenosis

Mitral valve
•Mitral stenosis prolapse
Continuous public display of

affection (PDA)
Biochemistry
401. Which of the following reactions would be

impaired during folic acid deficiency?
•Transamination
•Carboxylation
•Transketolation
•Transmethylation
Histology
402. The histological feature of an ovary on day 18 of a 28-day
menstrual cycle:
•Corpus luteum
– After ovulation typically at day 14, the dominant follicle
reorganizes to become the corpus luteum
– Normally, the functional life span of the corpus luteum is 12-16
days
•Corpus albicans
•Cumulus oophorus
•Graafian follicle
– A single follicle is selected to be the dominant follicle between
days 5 and 7 of the normal 28-day cycle and is called the
Graafian follicle
Pediatrics
403. During the 2nd day of life, patient developed

jaundice. Work-up showed hyperbilirubinemia,
reticulocytes, and (+) Coomb’s test. Which of the
following would you entertain?
•Breastfeeding jaundice
•Physiologic jaundice
•Sepsis
•Hemolytic disease of the newborn
Obstetrics
404. A 20 y/o patient G1P0 38-39 weeks in labor, FH = 36 cm, LM1 – breech, LM2 -
fetal back left, LM3 – cephalic, LM4 (-). IE: cervix 5 cm dilated, 80% effaced, intact
membranes, station 0, LOA. In this patient, what pelvic plane would you consider
adequate?
•Inlet
– The fetal head is engaged because the lowest portion of the fetal skull is at the
level of the maternal ischial spines (station 0) and LM4 is negative
– Engagement is considered an important clinical parameter as it demonstrates
that, at least the pelvic inlet is sufficiently large to allow descent of the fetal
head
•Midpelvis
•Outlet
•Inlet and midpelvis
Physiology
405. Which of the following scenarios GFR Renal Glomerular
can cause anuria secondary to a low blood capillary
GFR?
flow hydrostatic
pressure
•Afferent arteriole dilation with
Constricted afferent,
constricted efferent arteriole
normal efferent
– Increased GFR
arteriole
•Afferent arteriole dilation with normal
efferent arteriole Normal afferent,
constricted efferent
– Increased GFR
arteriole
•Normal afferent arteriole with
constricted efferent arteriole Normal afferent,
– Increased GFR dilated efferent
arteriole
•Normal afferent arteriole with dilated
efferent arteriole Dilated afferent,
– Decreased GFR normal efferent
arteriole
Berne, Levy, et al (2004) . Physiology. 5th Ed. Chapter 34. pg. 369.
Legal Medicine
406. A 45 y/o male patient was unconscious

after a vehicular accident. He has 5 cm x 5 cm
lesion over his right forehead and his BP
continues to drop. He needs immediate head
surgery. Who among the following should give
consent?
•Patient himself
•His 34 y/o live-in partner for 3 months
•His 23 y/o son by the legal wife
Medical Nutrition
407. What should be included in the nutritional management for a cancer
patient ?
•Decrease the carbohydrate content of the diet to spare protein

– Carbohydrate should be increased in the diet to spare protein
•Exclude vitamin and mineral supplementation
– Use of multivitamin and mineral supplement that provides no more
than 100% of the RNI is generally considered safe
•Increase protein in the diet to promote tissue repair
– To rebuild tissues affected by cancer therapy and to maintain a
healthy immune system
•Maintain the basal energy expenditure even during stress
– Energy requirement should be increased by 1.3 to 1.5 times the
basal energy expenditure
Neurology
408. A 67 y/o male with a history of diabetes and hypertension
developed sudden onset of severe headache and blurred vision on
the left. Neurological exam demonstrated a left homonymous
hemianopia, normal response to threat, normal optokinetic
nystagmus, and normal drawing and copying. Imaging studies
showed an acute ischemic stroke. Where is the most likely
anatomical location of the lesion?
•Right occipitoparietal lesion

•Right temporoparietal lesion
•Bilateral occipital lesion
•Bilateral lesions of the banks of the calcarine fissure
Anesthesiology
409. Which of the following inhalational anesthetics is comparable to sevoflurane for rapid
elimination, but pungent and not recommended for inhalational induction of anesthesia?
Halo-en ang negative inotrophy at arrhythmias
•Halothane
–BP is lowered due to its negative inotropic effect
–Sensitizes the myocardium to cathecolamines causing ventricular arrhythmias
–Liver necrosis known as “halothane hepatitis” can occur especially in repeated use
•Desflurane
•Isoflurane Despungent
–Lowers the BP due to its effect on the systemic vascular resistance and peripheral
vasolidalation
I saw
–It can cause coronary vasodilatation that might lead him stealartery steal syndome
to coronary
•Enflurane
–Cause a dose-dependent myocardial depression
–Lowers BP due to its negative inotropy
–Sensitizes the myocardium to cathecolamines causing ventricular arrhythmias
Internal Medicine
410. Mr. Aguirre, a 45 y/o lawyer of a prominent politician came in because of palpitations. His BP is
130/85. According to JNC7 classification of his BP, what should be advised to the patient?
The patient is classified under
•DASH diet prehypertension (SBP 120-139 or DBP 80-
89) which is a diet rich in fruits,
– Dietary Approaches to Stop Hypertension (DASH) eating plan
vegetables, and low-fat dairy products with a reduced content of dietary cholesterol as
well as saturated and total fat
•Exercise for at least 1 hour daily
– Everyone who is able should engage in regular aerobic physical activity such as brisk walking
at least 30 minutes per day most days of the week
•Hydrochlorotiazide 25 mg/tab, 1 tab QD
– Lifestyle modification is the cornerstone of management in all patients with
prehypertension or with the metabolic syndrome, but if BP exceeds 140/90 mmHg,
pharmacological therapy is indicated
•Limit alcohol intake to 3 bottles of beer/day
– Alcohol intake should be limited to no more than 1 oz (30 mL) of ethanol, the equivalent of
two drinks per day in most men and no more than 0.5 oz of ethanol (one drink) per day in
women and lighter weight persons.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2004). pp. 25 and 41.
Ophthalmology
411. What does a visual acuity of 20/500 mean?
•What a normal person reads at 20 feet, the patient can read at

500 feet
•What a normal person can read at 20 feet, the patient can read
at 20 feet
•What a normal person can read at 500 feet, the patient can
read at 20 feet
•What the patient can read at 500 feet, the normal person can
read at 500 feet
1st number represents the 2nd number represents the smallest row
testing distance of letters that the patient can read
Pathology
412. Which of the following is a calcitonin-secreting tumor of the thyroid
gland?
•Papillary carcinoma
•Follicular carcinoma
•Medullary carcinoma
– This is a neuroendocrine neoplasm derived from the parafollicular
cells or C cells of the thyroid
– It accounts for 5% of thyroid neoplasms
– In some instances, the tumor cells elaborate other polypeptide
hormones such as serotonin, ACTH, and vasoactive intestinal peptide
(VIP)
•Hurtle cell carcinoma
Pharmacology
413. Which of the following antimicrobials kills an increasing proportion of
bacteria with increasing concentrations?
Time-dependent Concentration- dependent

•Gentamicin
– Concentration-dependent Beta-lactams Aminoglycosides
•Ampicillin Vancomycin Quinolones
– Time-dependent Time-dependent bactericidals continues as
•Chloramphenicol long as serum concentration is greater than
the minimal bactericidal concentration (MBC)
– It is only a bacteriostatic agent
and maintained above the minimal inhibitory
•Cefuroxime concentration (MIC) for the entire time
– Time-dependent
Concentration-dependent bactericidals rate and
extent of killing increase with increasing drug
concentration and they have a post-antibiotic
effect contributing to their less frequent dosing
Parasitology
414. Which of the following findings in a

malarial smear is consitent with Plasmodium
falciparum?
•Ring forms, trophozoites, schizonts, and

gametocytes
•Ring forms, trophozoites and schizonts
•Ring forms and schizonts
•Ring forms and gametocytes
Anatomy
415. Which structure that forms the Triangle of Calot is identified and
ligated during cholecystectomy?
•Cystic duct
– Lateral border of the triangle
•Common bile duct
– Not included in the triangle
•Cystic artery
– Superior border of the triangle
•Common hepatic duct
– Medial border of the triangle
Gynecology
416. What is the most likely etiology of the cheese-like vaginal discharge?
•Trichomonas vaginalis
– Profuse vaginal discharge which can be white, gray, yellow, or green and
classically frothy and often has an unpleasant odor
•Bacterial vaginosis
– Thin and gray-white homogeneous vaginal discharge with fishy or musty
odor
– pH equal to or greater than 4.5
– Has an amine-like odor when mixed with KOH (whiff test)
– A wet smear will demonstrate clue cells
•Candida albicans
•Gonorrhea
– Women are often asymptomatic
Behavioral Medicine
417. A 22 y/o female, college student presented with recent
episodes of difficulty sleeping, profound sadness, loss of appetite,
feelings of worthlessness and hopelessness. Personal hygiene was
poor and he has not been attending class the past 3 weeks. Parents
were compelled to seek consultation because of an attempted
suicide. Which of the following biological substances or
pathophysiologic mechanisms basically cause this clinical problem?
•Increase dopaminergic activity Decreased Serotonin

and Norepinephrine
•Excessive glutaminergic activity are associated with
•Gabaergic deficiency depression
•Decrease serotonergic signals

Surgery
418. Which of the following is responsible for the contraction of
a scar that could result in unwanted contracture deformities?
•Excessive collagen deposition in the scar

•Presence of foreign bodies in the wound that should have been
debrided
•Myofibroblasts
– This cell contains α-smooth muscle actin in thick bundles
called stress fibers, giving myofibroblasts contractile
capability
•Excessive epithelial migration from the center of the scar
Preventive Medicine
419. The best Family Assessment Tool that will hep Carlo’s doctor in the assessment of his family as to his
capacity to participate in health care provisions and crisis management is:
•Family genogram
– For quick overview of the interrelationships between family members
– Way of looking at the family medical and psychological problems
– Tool for understanding the multigenerational family systems
•Family APGAR
– 5-item questionnaire designed to elicit the patient’s perception of the current state of the family
relationships
– Serves as a rapid screening instrument for family dysfunction
– APGAR is the acronym for Adaptation, Partnership, Growth, Affection, and Resolve
•SCREEM
– Assesses the family as to its capacity to participate in the provision of health care or to cope with
crisis
– SCREEM is an acronym that stands for Social, Cultural, Religious, Economic, Educational, and
Medical factors
•DRAFT
– A.K.A. Draw-a-family test
– Provides clues on the individual members of the family with regarding their personality
Internal Medicine
420. Which of the following Major criteria Minor criteria
does not fulfil the Paroxysmal nocturnal dyspnea Bilateral ankle edema
Framingham criteria for Neck vein distention Nocturnal cough
heart failure? Rales Dyspnea on ordinary

exertion
Radiographic cardiomegaly Hepatomegaly
•Crackles on both lung Acute pulmonary edema Pleural effusion
fields S3 gallop Decreased vital capacity
by 1/3 from maximum
•JVP of 5 cm recorded
•Murmur heard on Increased CVP > 16 cm H2O Tachycardia > 120 bpm
auscultation Hepatojugular reflux

Weight loss > 4.5 kg in 5 days in
•(+) S3 response to treatment
Diagnosis of CHF requires at least:

• 2 major criteria or
• 1 major and 2 minor
Neurology
421. In examining a patient who is lying supine on bed

and complaining of right-sided weakness, the patient can
only bring his right arm near to his side. What is his best
motor response for his right upper extremity?
•1/5 Grade
5/5 Against maximal resistance
•2/5 4/5 Against moderate resistance
•3/5 3/5 Against Gravity
•4/5 2/5 Gravity eliminated

1/5 Palpable muscle contraction
0/5 No palpable or observable muscle contraction
Ophthalmology
422. A female patient had an executive check-up
which revealed an elevated FBS of 380 mg/dL.
Fundoscopy showed presence of hard exudates and
flame-shaped hemorrhages throughout the retina.
What is the earliest change in diabetic retinopathy?
•Microaneurysm
– Develops later
•Reduction of endothelial cells
– There will be reduction of pericytes
•Reduction of pericytes
•Thickening of tunica media
– One of the earliest signs of diabetic
retinopathy is thickening of the capillary
endothelial basement membrane
Pediatrics
423. An infant, by his first birthday, is expected to have the
following:
•Birth weight has doubled

– Birth weight doubles at 6 months
– Birth weight triples at 1 year of age
•Birth length has increased by 75%
•Head circumference has increased by 10 cm
•AP diameter of the chest is greater than transverse diameter
Obstetrics
424. Which of the following describes forceps that are applied in an
engaged head at station +1?
•Outlet forceps
– Scalp is visible at the introitus without separating the labia
– Fetal skull has reached the pelvic floor
•Low forceps
– Station +2 or below, but not on the pelvic floor
•Midforceps
– Station above +2 but head is engaged
•Inlet forceps
– Not included
Physiology
425. Which of the following factors could shift the oxygen-
hemoglobin dissociation curve to the right?
•Increased pH Factors that cause shift to

the right (decreased
– Shift to the left affinity):
•Low pCO2 • Decreased pH (acidosis)
• Increased 2,3 BPG
– Shift to the left • Increased temperature
• Increased pCO2
•Increased 2,3 BPG
•Decreased temperature
– Shift to the left
Biochemistry
426. Which is TRUE of the rate limiting step of the Urea Cycle?
•Uses glutamine as its substrate

– CO2, ammonia, and ATP are the substrates of Carbamoyl phosphate synthase I
– Glutamine is the substrate of Carbamoyl phosphate synthase II in pyrimidine
biosynthesis
•Allosterically activated by N-acetylglutamate
– Carbamoyl phosphate synthase I, the rate-limiting enzyme of the urea cycle,
is active only in the presence of its allosteric activator N-acetylglutamate
•Is inhibited by UTP
– ???
•Occurs in the cytosol
– Some reactions of the urea synthesis occur in the matrix of the
mitochondrion, other reactions in the cytosol
– The rate limiting step of the urea cycle occurs in the mitochondrial matrix
428
Medical Ethics
427. What is the ethical requirement that is

most essential in informed consent?
•Duly signed in the consent sheet

•Witnessed by an independent party
•Obtained without duress
•Written and not merely verbal
Dermatology
428. The etiologic agent of Impetigo is:
•Staphylococcus and/or Streptococcus

– Impetigo contagiosa can be caused by staphylococcus or
streptococcus or combined
– Impetigo bullosa generally caused by staphylococcus aureus
•Varicella zoster
– Etiologic agent of varicella (chickenpox) and zoster (shingles)
•Microsporum
– Fungi that cause tinea capitis, tinea corpus, ringworm, and other
dermatophytoses
•Mycobacteria
– Mycobacterium leprae is the etiologic agent of leprosy
ENT
429. What is the most common organism found in chronic
otitis media?
•Streptococcus pneumonia
– Most common cause of acute otitis media in all age
groups
•Hemophilus influenza
•Pseudomonas aeruginosa
Internal Medicine
430. Bony enlargement of the proximal interphalangeal
joint is called:
•Bouchard’s node
– Found on the proximal interphalangeal joint
•Heberden’s node
– Found on the distal interphalangeal joint
•Gottron’s node
– This does not exist. However, dermatomyositis can
present with Gottron’s papules which are
erythematous papules that overlie the matacarpal
and interphalangeal joints
•Node of Ranvier
– This is the gap between two schwann cells of
myelinated neurons Gottron’s papules
Microbiology
431. Which of the following statement is NOT true of Legionella pneumophilia?
•An intracellular parasite of macrophages

– Readily enters and grows within alveolar macrophages and monocytes
•Can be grown in culture from respiratory specimens
– The organisms can be recovered from bronchial washings, pleural fluid, lung biopsy
specimens, or blood.
– Isolation of legionella from sputum is more difficult because of the predominance of the
normal flora
– They are rarely recovered from other anatomic sites
•Can contaminate cooling towers of air-conditioning units
– Cooling towers and evaporative condensers can be heavily contaminated
•Hyperchlorination and superheating of water cannot eliminate Legionella contamination in
water
– Hyperchlorination and superheating of water can hep control the multiplication of
legionellae in water and in air-conditioning system
Brooks et al. (2010). Jawetz, Menick & Adelberg’s Medical Microbiology. 25th Ed. Pg. 281-284.
Histology
432. Which description of the connective tissue

fiber is correct?
•Elastic fibers – discontinuous sheets

•Reticulin – fine fibrils
•Collagen type 1 – delicate meshwork
•Collagen type 2 – strong bundles
Parasitology
433. Which of the following statements regarding Taeniasis is NOT true?
•Taeniasis solium occurs whenever people eat cured or undercooked pork

•The adult worms cause symptoms in the majority of patients
– Cysticercosis (tissue infection) causes more problems than taeniasis
(carriage of adult tapeworms) in the intestines
– Cysticerci can infect the eyes, brain, muscles, and subcutaneous
tissues
– Taeniasis is generally asymptomatic
•Cysticerci can develop in any voluntary muscle
•Human cysticercosis due to Taenia saginata apparently does not occur
– Human cysticercosis is caused by Taenia solium
Anatomy
434. In doing total pancreatectomy, ligation of
branches of which artery are NOT affected?
•Splenic
– Supplies the pancreas by branching into small
numerous pancreatic arteries
•Gastroduodenal
– Supplies the pancreas through its superior
pancreatico-duodenal artery
•Inferior mesenteric
– Its branches:
• superior left colic artery - supplies the
transverse and descending colon
• sigmoid artery - supplies the sigmoid
colon
•Superior mesenteric
– Supplies the pancreas through its inferior
pancreatico-duodenal artery
Pathology
435. The glomerular damage in post-streptococcal
glomerulonephritis is due to which of these?
•Formation of immune complexes in-situ and subsequent

complement activation
– Membranous glomerulopathy
•Direct damage by streptococcal organisms
•Mobilization of cytotoxic T cells as a result of presence of
streptococcal antigens within the nephron
•Immune complexes formed in circulation that are
preferentially implanted in certain organs or tissues due to
hemodynamic factors
Gynecology
436. A 44 y/o G2P2 (2002) consults because of vaginal bleeding. She brings her TVS
results which show that the endometrial lining has a hyperechoic elongated structure
2x2x2 cms attached to the fundal area. What is the BEST management for the patient?
– Because of the frequent association of endometrial polyps and other
endometrial pathology, it is important to examine histologically both the polyp
and the associated endometrial lining.
•Endometrial curettage
– Because of their mobility, polyps tend to elude the curette
•Fractional curettage
– Because of their mobility, polyps tend to elude the curette
•Hysteroscopy with resection
– The optimal management of endometrial polyps is removal by hysteroscopy
with D & C
Behavioral Medicine
437. Narcissistic personality disorder:
DSM-IV-TR criteria for Narcissistic
personality disorder
•Avoids occupational activities that
involve significant interpersonal contact • Expects to be recognized as
superior and special, without
because of hear criticism
superior accomplishments
– Avoidant personality disorder • Expects constant attention,
•Often envious with others admiration and positive
reinforcement from others
•Identifies with the feelings and needs
• Envies others and believes others
of others envy him/her
– Dependent personality disorder • Preoccupied with thoughts and
•Vulnerable to comment and fantasies of great success,
suggestions of others enormous attractiveness, power,
intelligence
– Histrionic personality disorder • Lacks the ability to empathize
• Arrogant in attitudes and behavior
• Has expectations of special
treatment that are unrealistic
Surgery
438. The risk of exsanguinating hemorrhage

intraoperatively is highest with injury at which
level?
•Zone 1
•Zone 2
•Zone 3
•Zone 4
– This does not exist
Pharmacology
439. Which of the following antihypertensive drug is
contraindicated during pregnancy?
PREGNANCY USE WARNING
•Methyldopa
• ACE inhibitors are
– Reduce sympathetic outflow from vasomotor contraindicated during the
centers in the brain stem second and third trimesters
– Used primarily for hypertension during of pregnancy because of the
pregnancy risk of fetal hypotension,
•Hydralazine anuria, and renal failure
– Dilates arterioles but not veins through release which are sometimes
of nitric oxide
associated with fetal
– Safe to use during pregnancy
malformations or death.
•Calcium channel blocker
• Recent evidence also
– Inhibits calcium influx into arterial smooth
muscle cells implicates first-trimester
– Safe to use during pregnancy exposure to ACE inhibitors
•ACE inhibitor in increased teratogenic risk
Internal Medicine
440. What serum electrolyte do you
have to monitor if the patient has
intractable vomiting?
Serum electrolyte Normal values
Sodium 135 – 145 mEq/L
•Calcium Potassium 3.5 – 5.0 mEq/L
•Chloride Total Calcium 8.6 – 10.2 mg/dL
•Potassium Ionized Calcium 4.6 – 5.3 mg/dL
– Hypokalemia can lead to Magnesium 1.5 – 2.5 mEq/L
arrythmias Chloride 95 – 105 mEq/L
•Sodium
Pediatrics
441. What vitamin must be given as supplement

to children afflicted of CGN with uremia?
•Thiamine
•Calcitriol
•Ascorbic acid
•Cobalamin
443
Obstetrics
442. A 24 y/o G1P0 28-29 weeks AOG whose blood pressure becomes
elevated for the 1st time. BP 140/90 mmHg, urine proteins is 340 mg/24 hrs.
What is the most likely diagnosis? Severe pre-eclampsia
• BP ≥ 160/110
•Gestational HPN • Proteinuria ≥ 4
g/day or at least
– Hypertension ≥140/90 without proteinuria occurring after 20
weeks AOG (2+) by dipstick
– Hypertension did
• Oliguria < 400
mL/day
•Chronic HPN
• IUGR
– BP ≥140/90 prior to pregnancy or before the 20th week of
pregnancy and persists long after delivery
• Pulmonary edema
or cyanosis
– Persistent hypertension after 12 weeks postpartum
• Severe headache
•Mild pre-eclampsia
or visual
– Presence of hypertension ≥140/90 with proteinuria ≥ 300 mg/24 disturbances
hrs occurring after the 20th week of gestation
• Hemolysis
•Superimposed preeclampsia hypertension and proteinuria
• Abdominal pain
– Pre-eclampsia on pre-existing chronic hypertension and is
• Elevated liver
acompanied by signs and symptoms of end-organ dysfunction
enzymes
• Thrombocytopenia
< 100,000
Neurology
443. Which of the following PE findings is a sign of a lower motor
neuron lesion? Upper motor Lower motor
neuron neuron
Atrophy None Severe
•Increased muscle tone
Fasciculations None Common
– Upper motor neuron
Tone Spastic Decreased
•Spastic muscles Distribution of Pyramidal/ Distal/
– Upper motor neuron weakness regional segmental
•Fasciculations Tendon Hyperactive Hypoactive/

reflexes absent
•(+) Babinski Babinski’s sign Present Absent
– Upper motor neuron
Fauci et al. Harrison’s Principles of Internal Medicine. 17th Ed. Pg 147.

Physiology
444. Which one of the
following binds to a G
Ligand-gated GPCRs Enzyme/kinase Nuclear receptor
protein coupled ion channel linked
receptor? receptors
Nicotinic Muscarinic Insulin Steroids
acetylcholine acetylcholine
•Steroid hormone receptor receptor
– Nuclear GABA-A Adrenoceptor Growth factors Thyroid hormone
receptor Neuropeptide
Histamine Cytokine Vitamin D
•Thyroid hormone receptors receptor
– Nuclear Glutamate Retinoic acid
receptor Fibrates
•Vitamin D Thiazolidinediones
– Nuclear
receptor
•Adrenergic hormone
Biochemistry
Side chain Essential amino Nonessential
445. Which of the following acids amino acids
group of amino acids is
classified as nutritionally With aliphatic side Leucine Alanine
chains Isoleucine Glycine
essential with branched side
Valine
chain (R group)?
Containing hydroxyl Threonine Serine
groups Tyrosine
•Aspartic acid, glutamic acid,
asparagine Containing sulfur Methionine Cysteine
atoms
– They are nonessential
•Phenylalanine, tyrosine, Containing acidic None Asparagine
tryptophan groups or amides Aspartic acid
Glutamic acid
– Contain aromatic rings Glutamine
•Isoleucine, valine, leucine
Containing basic Histidine None
•Histidine, lysine, arginine groups Arginine
– They contain basic Lysine
groups
Containing Phenylalanine Tyrosine
aromatic rings Tryptophan
Imino acid None Proline
Preventive Medicine
446. You have a 62 y/o male patient with colorectal cancer in
the advanced stage (stage 4). During the hospital stay, he
developed severe pneumonia necessitating intubation. The
course was downhill. You informed the eldest daughter about
this. The daughter of the patient told you that she would like
to seek a second opinion first. How would you categorize this
reaction?
•Denial
•Anger
•Bargaining
•Acceptance
Radiology
447. A 22 y/o female consults because of easy fatigability
and was found to have a cardiac murmur. A chest x-ray
shows uplifting of the left main stem bronchus,
restrosternal fullness, and a dilated main pulmonary artery.
Which cardiac chamber/s is/are most likely enlarged?
•LA only
•LV only
•RV and LA
•LV and LA
Legal Medicine
448. What is the condition of a woman who permits any sexual liberties as long as
they abstain from rupturing the hymen?
•Demi-virginity
•Virgo intacta
– A woman who had several sexual intercourse but had not born a child
•False physical virginity
– A woman who had not experienced sexual intercourse.
– Hymen is unruptured, elastic and distensible and admits 1 or 2 examining
fingers with least resistance
•True physical virginity
– The woman is sexually matured and had not experience sexual intercourse
– Hymen is still intact with distinct regular edges and the opening is small
barely admits the tip of the smallest finger
ENT
449. What is the best way to examine a nasal

bone fracture?
•Palpation
•Percussion
•Inspection
•Auscultation
Internal Medicine
450. JC, 40 y/o female was referred for hematologic

evaluation because of splenomegaly and CBC: Hgb 120
g/L, Hct 0.36, WBC 180x10^9/L, blastas 2%,
promyelocytes 15%, metamyelocytes 10%, bands 8%,
segmenters 30%, lymphocytes 10%, basophil 5%,
platelets 650,000. What is the treatment of choice?
•Cytarabine and anthracycline

•Hydroxyurea
•Stem cell transplantation
•Tyrosine kinase inhibitors
Anatomy
451. Which of the following pertains to the lumbar
plexus?
•Arises from anterior rami of spinal nerves L1-L5

– It arises from the anterior rami of spinal nerves
L1-L4
•Formed within the psoas muscle
•Innervates muscle of the gluteal region, perineum, and
lower extremities
– This is the function of the sacral plexus
– The lumbar plexus innervates muscles of the
abdominal wall, lumbar area, genitals, and lower
extremities
•Its lowest branch joins the 1st sacral nerve to form the
lumbosacral trunk
– L4 gives a descending branch that unites with L5
to form the lumbosacral trunk
Behavioral Medicine
452. For a seizure to be effective in the course of ECT, it should
last:
•At least 15 minutes

•At least 3 minutes
•At least 60 seconds
– When the current is passed between the electrodes, a
generalized seizure is produced in the brain.
– The seizure usually lasts for 30 to 60 seconds.
•At least 25 seconds
http://www.hopkinsmedicine.org
Gynecology
453. If a patient has withdrawal bleeding after a progesterone challenge
test, this signifies the presence of:
•Ovulation
– After ovulation, the corpus luteum produces progesterone which
will not promote bleeding
•Estrogen-primed endometrium
•Early pregnancy
– Normally, there shouldn’t be any bleeding during pregnancy
•Absence of estrogen
– Estrogen is responsible for the endometrial growth that will
slough after the progesterone levels fall
Katz et al. Comprehensive Gynecology. 5th Ed. Pg. 949.
Ophthalmology
454. Which of the following statements regarding Marcus-Gunn pupil
is correct?
•When each eye is stimulated by a rapid alternating light, each

constricts
•When both eyes are stimulated by rapid alternating light, the
normal eye constricts, whereas the affected eye dilates as the light
falls on it
•When both eyes are stimulated by a rapid alternating light, the
normal and the affected eye constrict as the light falls on each one
•When both eyes are stimulated by a rapid alternating light, the
normal eye dilates, whereas the affected eye constricts as the light
falls on each one.
Surgery
455. Hemodynamic compromise in cardiac tamponade is

attributed to what mechanism?
•Decreased ventricular filling secondary to reflex

tachycardia
•Decreased venous return (preload) secondary to
increased intrapericardial pressure
•Decreased peripheral resistance secondary to
hemorrhage
•Decreased peripheral resistance (afterload) secondary to
increased pericardial pressure
456. What is the smallest value of alpha for

which the null hypothesis can be rejected?
•Standard error
•Sampling distribution of statistic
•Sampling variation
•P-value
Anesthesiology
457. Which of the following drugs has no analgesic property but produces sedation and amnesia?
•Propofol
– Is used for both induction and maintenance of anesthesia as part of total intravenous or
balanced anesthesia techniques
– The agent of choice for ambulatory surgery
•Midazolam
– Benzodiazepines have no analgesic properties
– Benzodiazepines have sedative, anxiolytic, and amnestic properties, and their ability to
control acute agitation makes them the choice for preanesthetic medication
– Benzodiazepines potentiate the neural inhibition mediated by GABA
•Ketamine
– An intravenous NMDA receptor antagonist agent with analgesic, intoxicating, and
hallucinatory properties
– It produces dissociative anesthetic state characterized by catatonia, amnesia, and analgesia,
with or without loss of consicousness
•Morphine sulfate
– Is a strong agonist of the opioid receptor
Dermatology
458. This finding in an obese
child is strongly associated with
insulin resistance in Type 2 DM:
•Papular keratosis
•Pityriasis alba Acanthosis nigricans
– Common, self-limiting Pityriasis alba
hypopigmentation due to
reduced activity of
melanocytes
•Pityriasis rosea
•Acanthosis nigricans
Microbiology
459. A patient was brought to the hospital because of vomiting and abdominal pain. The patient had
just eaten macaroni salad at a party. What is the most probable infectious agent?
•Enterotoxigenic E. coli
– Common cause of traveller's diarrhea
– Produces heat-labile toxin that increase cAMP and results to intense and prolonged
hypersecretion of water and chloride
– Produces heat-stable toxin that activate guanylyl cyclase and stimulates fluid secretion
– Causes profuse watery diarrhea
•Salmonella spp.
– Can cause typhoid fever, bacteremia, or enterocolitis
– Can be contracted from incorrectly prepared pork, poultry, beef, eggs, and milk
•Shigella spp.
– Causes dysentery
– Enterotoxins are produced when S. aureus grows in carbohydrate and protein foods are
important causes of food poisoning
– The emetic effect of enterotoxin is probably the result of stimulation of the vomiting
center of the CNS
461
Internal Medicine
460. A 35 y/o mother presented with infertility, irregular menses, puffy
eyes and non-pitting edema. TSH 20 (N.V. 0.4 – 4.0), FT4 0.6 (N.V 0.8 –
2.0). What is the most possible etiology?
•Central hypothyroidism
– reduction in circulating thyroid hormone as a result of
inadequate stimulation of a normal thyroid gland by TSH and
may be secondary, due to pituitary disease, or tertiary, due to
hypothalamic dysfunction
– TSH should be low and thyroid hormones are low
•Iodine deficiency
•Jod-Basedow phenomenon
•Plummer’s disease
Obstetrics
461. Which of the following is the most common cause of
postpartum hemorrhage?
Postpartum Hemorrhage (PPH)
> 500 mL – vaginal delivery
> 1000 mL – cesarean delivery
•Vaginal lacerations • Occurs within 24 hours
– Second most common after delivery
• Late PPH occurs 24 hours
•Uterine atony to 6 weeks after delivery
•Placenta accreta
– Less common
Etiology of Postpartum
•Retained placenta hemorrhage: (4 T’s)
– Less common Tone – uterine atony
Trauma – lacerations
Tissue – retained placenta
Thrombin – coagulopathies
Pediatrics
462. Which of the following developmental milestones can be
considered a red flag for an 11-month old female infant?
•Cannot sit with support

– Expected at 4 months
– The baby can sit without support at 6 months
•Can speak “mama”
•Recognizes her name
•Can walk with one hand held
– Expected at 1 year of age
Neurology
463. A lesion of the right cerebellar hemisphere will result in which condition?
•Truncal ataxia
– Caused by lesions of the midline vermis of the cerebellum
– Lesions of the cerebellar hemisphere causes ataxia of the ipsilateral limb
•Right limb ataxia
•Left limb ataxia
– It should be ipsilateral
•Left hemibalismus
– This motor disorder consists of uncontrolled flinging (ballistic) movements of
the upper or lower extremity
– It is most commonly seen in patients with vascular lesions localized to the
contralateral subthalamic nucleus
– Usually involves the contralateral upper extremity
Physiology
464. The following, when stimulated, cause vomiting
EXCEPT:
Vomiting Center
Located in the nucleus of
•Chemoreceptor trigger zone the tractus solitarius at
– A.K.A. Area postrema the medulla oblongata
– Provides afferent input to the vomiting center
•Labyrinthine receptors
•Mechanoreceptors in the stomach
•Chemoreceptors in the throat
– There are touch receptors in the throat that sends
afferent input to the vomiting center
Biochemistry
465. If the patient were obese, all of the following peptides will
suppress appetite and stimulate energy expenditure EXCEPT:
•Insulin
– Decreases appetite Increase Decrease
– Stores energy in the form of fat or glycogen appetite appetite
•PYY (Peptide YY)
– A.K.A pancreatic peptide YY Neuropeptide Y Leptin
– Reduces appetite in humans
Ghrelin Insulin
– Released by the cells in the ileum and colon
•Leptin Peptide YY
– Inhibits the appetite Cholecystokinin
– Produced by the adipose
– Counteracts the effect of neuropeptide Y
•Ghrelin
– Increase food intake and increase fat mass “Y do gremlins love to eat”?
Rehab Medicine
466. X-ray of lumbar spine showed 25% slipping of L4

vertebral body over L5. This is consistent with what grade
of spondylolisthesis based on Myerding’s classification?
•Grade 1
Myerding’s Slipping of
•Grade 2 Classification vertebral body
•Grade 3 Grade 1 ≤25%

Grade 2 26-50%
•Grade 4 Grade 3 51-75%
Grade 4 76-100%
Clinical Pathology
467. A young boy was brought for consultation because of frequent passing out of
foul-smelling, greasy, or fatty stool. Diagnostic test useful to assess the condition:
•D-xylose absorption test

– Test for malabsorption due to defects in the integrity of the mucosa
– D-xylose is a monosaccharide that does not require enzymes for digestion
prior to absorption and requires intact mucosa
– Decreased urine value means decreased absorption like in cases of small
intestinal bacterial overgrowth and Whipple’s disease
•Trypsin activity
– For acute pancreatitis
•Sweat chloride test
– Screening test for cystic fibrosis
– Measures concentration of chloride in sweat because chloride channels are
defective in cystic fibrosis
•All of the above
Pharmacology
468. A patient who has cancer is now in constant pain. You put him on slow-
release form of morphine. To which of the following classes of opioid
receptors does morphine exert its full agonist effect?
•Mu
– Morphine is a full agonist at the µ (mu)-opioid receptor, the major
analgesic opioid receptor
– Codeine functions as a partial or weak µ-receptor agonist
•Delta
•Kappa
•Gamma
– Does not belong to the three major classes of opioid receptors
Medical Nutrition
469. Which of the following nutritional treatment is employed in the
Diet for ARF
management of acute renal failure?
• High calories
• High carbs
•Give low carbohydrates and high fats to spare proteins
• High fat
– To prevent use of protein, energy must come from high intake of • Limit protein
carbohydrates and fats
• Limit sodium
•Institute low calorie and low protein diet
• Limit fluid and
– A high level of 35-50 kcal/kg ABW to provide positive nitrogen balance electrolytes
– Protein intake should be adjusted to 0.5 to 0.6/kg ABW (but not less
than 40 g/day). Increase as GFR returns to normal.
– With dialysis, allow 1.0 – 1.5 g/kg ABW/day
– Non-dialyzed patients require a protein-free diet
•Sodium intake should not be restricted
– Anuric-oliguric phase: 500 - 1000 mg/day
– Diuretic phase: replace losses depending on urinary Na levels, edema
and frequency of dialysis
•Parenteral administration of glucose, lipids, and essential amino acids
Internal Medicine
Thyrotoxicosis Thyrotoxicosis Hypothyroidism Hypothyroidism
470. Which of symptoms signs symptoms signs
the following Hyperactivity,

irritability,
Tachycardia Tiredness, weakness Dry coarse skin
sign or symptom dysphoria Dry skin Cool peripheral

extremities
is compatible Heat intolerance
and sweating
Tremor
Feeling cold Puffy face, hands,
with Palpitations Goiter feet (myxedema)
thyrotoxicosis? Fatigue and Warm, moist skin

Hair loss Diffuse alopecia
weakness Difficulty Bradycardia
concentrating and
Weight loss with Muscle weakness,
poor memory
increased appetite proximal
•Hyperactive myopathy Constipation Peripheral edema
DTRs Diarrhea Lid retraction or Weight gain with Delayed tendon
lag poor appetite reflex relaxation
•Dry brittle hair Polyuria Gynecomastia Dyspnea Carpal tunnel
syndrome
•Bradycardia Oligomenorrhea,
Hoarse voice Serous cavity
loss of libido
•Constipation effusions
Menorrhagia (later
oligomenorrhea or
amenorrhea)
Anatomy
471. Which blood supply of the stomach is a direct branch of
the celiac trunk?
•Left gastric
•Short gastric
– Branch of the splenic artery
•Left gastroepiploic
– Branch of the splenic artery
•Right gastroepiploic
– Branch of gastroduodenal artery which is a branch of
common hepatic artery 473
Behavioral Medicine
472. Hyperprolactinemia is more commonly associated with:
Dopamine 2 receptor
•Haloperidol blockade results to
hyperprolactinemia
– Affinity: D2 > α1 > D4 > 5-HT2A > D1 > H1
•Quetiapine Atypical antipsychotics
– Affinity: H1 > α1 > M1,3 > D2 > 5-HT2A have lesser affinity to
block D2 receptors
•Chlorpromazine
– Affinity: α1 = 5-HT2A > D2 > D1 Dopamine agonists
•Clozapine Used as the standard medical
therapy for hyperprolactinemia due
– Affinity: D4 = α1 > 5-HT2A > D2 = D1 to their high affinity for D2 receptors.
(e.g. Bromocriptine and Cabergoline)
Gynecology
473. In a 65 y/o menopausic patient, which ovarian tumor will MOST likely cause uterine
bleeding?
•Serous cystadenocarcinoma
– Cystadenomas occur during reproductive years
– The carcinomas typically occur in women older than 40 years
•Mucinouscystadenocarcinoma
– Benign mucinous tumors are found during reproductive years
– Carcinomas usually occur during 30 to 60 years of age
•Immature teratoma
– Malignant ovarian tumors found in women younger than the age of 20
– They do not occur in women after menopause
•Granulosa cell tumor
– Occurs in women of all ages
– In postmenopausal women, these tumors can produce increased levels of blood
estrogens, uterine bleeding, and ocassionally endometrial carcinoma
– In menstruating women, the functional granulosa cell tumor can produce abnormal
menstrual patterns, menorrhagia, and even amenorrhea
Radiology
474. Small intestinal obstruction will
show this feature:
•Jejunal diameter of 20 mm
– Diameter should be > 2.5 to 3
cm
•Ileal diameter of 20 mm
– Diameter should be > 2.5 to 3
cm
•Rosary bead pattern of air fluid level
•Presence of presacral gas
– Absence of presacral gas
Rosary bead pattern or String-of-beads sign
Microbiology
475. Which of the following characteristics of Beta lactams Activity
Pseudomonas aeruginosa is correct?
Carbapenems Doripenem, imipenem
and meropenem are
•Usually sensitive to beta lactam antibiotics
active
– It is intrinsically resistant to most beta
lactams 1st gen Poor
cephalosporins
– It is naturally resistant to a large number of
antibiotics, therefore, it should not be treated 2nd gen Poor
with single-drug therapy cephalosporins
•Can be isolated in anaerobic culture 3rd gen Only ceftazidime and
– P. aeruginosa is an obligate aerobe cephalosporins cefoperazone are
•Is oxidase positive active
– This means that the bacteria produce certain 4th gen Cefepime has good
cytochrome c oxidases that catalyze the cephalosporins activity
transport of electrons from donor
compounds (NADH) to electron acceptors Extended- Piperacillin is active
(usually oxygen) spectrum beta
lactams
•Produces non-water-soluble pigment
– Pseudomonads produce water-soluble Monobactams Aztreonam is active
pigments (e.g. pyocyanin, pyoverdin,
pyorubin, pyomelanin)
Surgery
476. Which of the following is most compatible with

the clinical picture of appendicitis?
•Always manifests with both direct and rebound

tenderness in the RLQ
•Usually preceded by vague epigastric pain before
localization in RLQ
•Manifests with diarrhea
•Pain is relieved by sitting up and bending forward
Parasitology
477. Which of the following statements regarding Entamoeba histolytica is TRUE?
•Inhabits the small intestine of man

– It inhabits the large intestine
– Excystation occurs in the small intestine
•Infection with this organism is solely confined to the gastrointestinal tract
– It can also invade other organs such as the liver (causing liver abscess),
lungs, brain, etc.
•To compare with strains resembling the parasite, one can inoculate E.
histolytica at room temperature in which survival and multiplication of the
parasite is not expected
•The chromatoidal bars of the parasite can be used to differentiate it from E.
dispar
Preventive Medicine
478. A family has rigid
rules and very low in
cohesion. The family is
classified as what type
in the circumplex
model?
•Chaotically enmeshed
•Chaotically
disengaged
•Rigidly enmeshed
•Rigidly disengaged
Pathology
479. Gross specimen after thyroidectomy for a suspected neoplasm showed a 3 cm
mass in the right lower pole that on sectioning is cystic and has papillary excrescences.
Which of the following sets of microscopic pathologic findings is most typical for this
lesion?
•Amyloid stroma
– Medullary carcinoma
•Clear cell
– Papillary carcinoma
– The nuclei of papillary carcinoma contain finely dispersed chromatin, which
imparts an optically clear or empty appearance, giving rise to the designation
ground-glass or Orphan Annie eye nuclei
•Giant cell
– Anaplastic carcinoma
•Small thyroid follicle
– Follicular carcinoma
Internal Medicine
480. A 60 y/o housewife was brought to the hospital because of dyspnea. Her
sons says that his mother was diagnosed in 2008 to have an “airway disease”, but
she has not been taking her inhalers the past 6 months. She started noting cough
and fever around 10 days ago, and has also been having progressive dyspnea in
the past week. She has 12 pack years smoking, and still smokes occasionally.
PPE: anxious, upright position, abdominal paradox, refuses to talk, pursed lip
breathing, prominent SCM. BP 170/90, CR 119, RR 32, T 39.0. Suprasternal,
subcostal, and intercostal retractions, bronchial breath sounds and dullness on
right base, wheezes over both lung fields, Heart and abdomen unremarkable. No
cyanosis. What is the CRB 65 score of the patient?
•0
•1
•2
•3
Obstetrics
Estrogen Progesterone HCG HPL
481. What is Stretching and Cervical mucus Nausea and Decreased
hypertrophy of “beading pattern” vomiting glucose
the hormone myometrium tolerance
responsible for Gingivitis/ Hyperventilation Anti-insulin or
epulis diabetogenic
the nausea Decreased HCl Decreased LES Maternal
and vomiting secretion tone lipolysis
Spider Decreased
of the patient? angiomata stomach motility
Palmar Decreased
erythema motility and tone
of gallbladder
•HCG Elevation of body
•HPL temperature
•Estrogen
•Progesterone
Ophthalmology
482. Which is indicative of an optic nerve disease?
•Distortion on Amsler grid testing

– Amsler grid has vertical and horizontal lines used for
testing the central visual field where the patient looks
on the central dot to see if there all lines are straight
and there are no missing portions
– Wavy distortion of the lines (metamorphopsia) can
indicate macular edema or submacular fluid
– A scotoma or blank area can indicate disease of the
macula or optic nerve
•(+) Relative Afferent Pupillary Defect (RAPD)
•Diplopia
– Monocular diplopia is likely do be due to refractive
error, lens opacity, Diplopia
•Blurred near vision
Histology
483. Which is true about the cell cycle?
•Chromosomal duplication happens in the M phase

– Chromosomal duplication happens in the S phase
•All types of cells regularly undergo the M phase
– Labile tissues continuously divide (e.g. epithelia)
– Stable or quiescent tissues have low level of replication but can rapidly divide
in response to stimuli (e.g. liver, pancreas, kidney)
– Permanent tissues cannot undergo mitotic division in postnatal life (e.g.
neurons, skeletal and cardiac muscles)
•Cell differentiation and performance of specialized function is seen in the Gap phase
1
•Gap phase 2 is a prelude to the S phase
– Gap phase 2 happens after S phase
Neurology
484. The primary visual cortex (striate cortex) is located in the upper and
lower banks of which structure?
•Transverse gyrus of Heschl

– Found in the primary auditory cortex buried within the lateral
sulcus occupying Brodmann’s area 41
•Sylvian fissure
– A.K.A. Lateral sulcus
– It divides the frontal lobe and parietal lobe above from the
temporal lobe below
– The transverse gyrus of Heschl is buried within it
•Calcarine sulcus
– The calcarine sulcus is where the primary visual cortex is
concentrated
– The central visual field is located in the posterior portion of the
calcarine sulcus and the peripheral visual field in the anterior
portion
•Parieto-occipital notch
– considered a landmark because the occipital lobe is located just
behind the line that connects that notch with the parietoccipital
sulcus
485. What is the best way to present the top five causes of mortality?
•Pie chart
– Sometimes called a sector chart
– Best for illustrating the division of the whole into segments
•Histogram
– Used only for presenting frequency distribution of continuous
variable including age
– Has no space between the cells unlike the bar graph
•Line graph
– Shows trends or changes through time with respect to another
variable Histogram
•Pictogram
– Variation of the bar chart
– Uses a series of small identifying symbols to present the data
– A symbol will represent a fixed number of persons or units
– Figures are usually arranged horizontally
Pictogram
Biochemistry
486. Catecholamines and thyroid hormones are derived
from which amino acid?
•Tryptophan
– Serotonin, niacin
•Tyrosine
– Epinephrine, norepinephrine, dopamine,
triiodothyronine (T3), thyroxine (T4), melanin
•Glycine
– Collagen
•Glutamic acid
– GABA
488
Physiology
487. The hormone secreted by the G cells of the stomach that stimulates
parietal cells to secrete H+ is which of this?
•Cholecystokinin
– Synthesized by the I-cells of the duodenum
– Causes the release of digestive enzymes from the pancreas and bile from the gall
bladder
– Stimulates the contraction of the gall bladder and relaxation of the sphincter of
Oddi
•Gastrin
•Glucagon
– This is secreted by the alpha cells of the Islet of Langerhans of the pancreas that
increases blood sugar level
•Secretin
– Produced by the S-cells of the duodenum
– Increases watery bicarbonate secretion from the pancreas and from Brunner’s
gland of the duodenum
– Stimulates pepsin secretion from the chief cells
– Decreases gastric acid secretion by inhibiting gastrin
489
Pediatrics
488. What is the most likely presentation of a

young infant with acute pyelonephritis?
•Dysuria
•Polyuria
•Fever and chills
•Vomiting and abdominal pain
ENT
489. In children, a unilateral nasal obstruction and foul discharge is suggestive
of:
•Polyp
– The most common complains associated are nasal obstruction and rhinorrhea
– Nasal polyps are most commonly seen in the upper part of the lateral nasal
wall around the middle turbinate
•Foreign body
– As a cause of nasal obstruction, this is practically always encountered in
children
– Recently inserted objects give little or no discomfort unless they are sharp or
very large
– The majority of objects are found either in the anterior part of the vestibule
or in the inferior meatus along the floor of the nose
•Hypertrophied turbinates
•Deviated nasal septum
Adams et al. Boies Fundamentals of Otolaryngology. 6th Ed. Pg. 246-247

Internal Medicine
490. A 38 y/o obese man presented with RUQ pain, jaundice, and high-grade fever.
Ultrasound showed dilated extrahepatic and intrahepatic ducts. He is lethargic and
has a BP of 90/60, PR 112 and temp 39.8°C. What is the most plausible diagnosis for
the above patient?
•Sepsis
•Cholecystitis Murphy’s sign
– Unremitting biliary colic typically at the RUQ or epigastrium and may Inspiratory arrest with deep
radiate to the right upper part of the back or interscapular area palpation in the right
– Often febrile, complains of anorexia, nausea, and vomiting subcostal area
– Ultrasound will show stones, thickening of the gallbladder wall and
pericholecystic fluid
– (+) Murphy’s sign
Charcot’s Triad (“FPJ”)
•Miritzzi syndrome
– Rare complication in which a gallstone becomes impacted in the cystic duct
• Fever
or neck of the gallbladder causing compression of the common bile duct • Pain (epigastric/RUQ)
(CBD) or common hepatic duct, resulting in obstruction and jaundice • Jaundice
•Acute cholangitis
– Ascending bacterial infection in association with partial or complete
obstruction of the bile ducts Reynolds Pentad (“FPJ-
– The most common presentation is fever, epigastric or RUQ pain, and SM”)
jaundice (Charcot’s triad)
– May progress rapidly to Reynolds pentad (fever, jaundice, RUQ pain, • Fever
septic shock, and mental status changes) • Pain (epigastric/RUQ)
– Ultrasonography will demonstrate the presence of gallbladder stones, • Jaundice
dilated ducts, and pinpoint the site of obstruction
• Septic Shcok
• Mental status changes
Behavioral Medicine
491. DSM-IV-TR diagnostic Oppositional defiant Conduct Disorder
criteria for oppositional disorder
defiant disorder include/s: Argues often Often initiates physical fights
Performs actions deliberately Physically cruel to people and
•Often deliberately annoys to annoy others animals
people
Angry and resentful of others Forced someone into sexual
•Often lies to obtain favors activity
– Conduct disorder
Blames others for his or her Deliberately destroys other’s
•Often threatens or own mistakes property
intimidates others
– Conduct disorder Actively refuses to comply Often lies to obtain goods or
with majority's requests or favors or to avoid obligations
•Physically cruel to people and consensus-supported rules
animals
– Conduct disorder Often loses temper Has broken into someone
else’s house, building, car
Spiteful or seeks revenge Has stolen items of nontrivial
value
Touchy or easily annoyed Serious violation of rules
Anatomy
492. Pulsation felt just above the
zygomatic arch and in front of the ear
is from which vessel?
•Superficial temporal artery

•Internal jugular vein
– Veins do not pulsate
•Facial artery
– Crosses over the lower border of the
mandible about 3 cm in front of the
angle of the mandible where its
pulsations may be felt
•Retromandibular vein
– Veins do not pulsate
Surgery
493. Which of the following zones of the prostate gland
does cancer usually develop?
•Transitional
– Surrounds the proximal urethra
– Area responsible for BPH
– Accounts for 10-20% prostate cancers
•Peripheral
– Surrounds the distal urethra
– Accounts for 70-80% prostatic cancers
•Central
– Surrounds the ejaculatory ducts
– Accounts for roughly 2.5% prostate cancer
•Anterior
– Devoid of glandular components
– Composed of muscle and fibrous tissue
Pharmacology
494. A 19 y/o female student was diagnosed to have organophosphate intoxication. What drug will best
control the signs of muscarinic excess?
•Flumazenil
– Antagonist at benzodiazepine binding sites on the GABA-A receptor thus it used for benzodiazepine
overdose (e.g. alprazolam, diazepam)
•Pyridostigmine
– Inhibits acetylcholinesterase thus increasing availability of acetylcholine at the motor end plate
– Used in myasthenia gravis
•Atrophine
– Competitive antagonist at all muscarinic receptors
– Used in antichilinesterase, organophosphate, and carbamate toxicity
•Pralidoxime
– Can treat organophospate poisoning
– Capable of regenerating cholinesterase from the organophosphorus-cholinesterase complex
– It is ineffective in reversing the central effects of organophosphate poisoning because its positive
charge prevents entry into the CNS
– It is not recommnded for the reversal of inhibiton of acetylcholinesterase by carbamate inhibitors
Gynecology
495. What is the treatment of choice for a
symptomatic Bartholin’s duct cyst or abscess?
•Incision and drainage

– Simple incision and drainage of a
Bartholin’s gland abscess are
complicated by a tendency for the
abscess to recur
•Excision
– For recurrent Bartholin’s gland abscess
•Marsupialization
– Development of a fistulous tract from
the dilated duct to the vestibule
•Observation
– For asymptomatic cysts in women
younger than 40
Insertion of a Word catheter is an

alternative surgical approach
Medical Ethics
496. A patient with an elevated creatinine developed

seizure as the antimicrobial given was not reduced
according to renal function. He and his family were
informed of this. What virtue is shown by the
physician?
•Prudence
•Integrity
•Compassion
•Discernment
Anesthesiology
497. A patient who had myocardial infarction
last year and angina controlled medically is
scheduled for cholecystectomy. He is classified
as ASA Physical Status Class:
Class Definition
P1 A normal healthy patient
•II P2 With mild systemic disease with no functional limitation
•III P3 With severe systemic disease with some functional limitation (COPD,
DM, CHF, renal failure)
•IV P4 With severe systemic disease that is a constant threat to life with
functional incapacitation (e.g. unstable angina, burn with septic
•V shock)
P5 Patient not expected to survive without the operation
P6 Brain dead patient
E If the procedure is an emergency
Clinical Pathology
498. Thrombocytopenia is considered severe if

the count is below:
•150,000/cu. mm Platelet count Interpretation
– Normal 150,000 – 450,000 Normal

100,00 – 149,000 Mild
•100,000/cu. mm 50,000, - 99, 000 Moderate
< 50, 000 Severe
•50,000/cu. mm
•25,000/cu. mm
Pathology
499. A 20 y/o previously healthy man has been feeling tired for the past 5 days. He
consults after he notes dark-colored urine. His BP is 155/90. Serum creatinine is 4.4
mg/dL. A urinalysis revealed pH 6, SG 1.011, 3+ blood, 1+ protein, no glucose, and no
ketones. On urine microscopic examination, there are numerous RBC casts. Which of
the following pathologic findings on renal biopsy is most likely to be present in this
man?
This is a case of nephritic syndrome to
consider:
•Widened proximal tubules • PSGN
•Lipiduria • RPGN
– Present in nephrotic syndrome
•Glomerular crescents
– Crescents are formed by proliferation of parietal cells and by migration of
monocytes and macrophages into the urinary space
– This is the most common histologic picture in RPGN or crescentic
glomerulonephritis
– Severe cases of PSGN can present with crescents
•Polymorphonuclear infiltrates
– PSGN presents with both monocytic and neutrophilic infiltration
– RPGN presents with monocyte and macrophage infiltrates
– Polymorphonuclear infiltrates are seen in acute pyelonephritis
Internal Medicine
500. In which of the following condition can one elicit rebound
tenderness?
•Peritoneal irritation
•Organomegaly
– Can be elicited in some organs via percussion:
• Spleen (Traube’s space)
• Liver (liver span)
•Ascites
– Can be elicited through succusion splash, shifting dullness, fluid wave
test
•Muscle spasm

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3. Which of the following will NOT be

•Release 2 FFA from the carbon 1 and 2 of TAG

5. Leading cause of mortality in SCI patients

•Anterior cord syndrome

•A – complete SCI, sensory (-), motor (-)

•Full bland diet

9. One of the following characterizes a high-fiber diet:

•Generally contains about 25-30 grams of dietary fiber

10. Which of the following MUST NOT be

11. Which of the following neurotransmitters

12. Aneurysm causes headaches thru which of

13. The following are pain-sensitive structures

•Dural sinuses Arteries of the dura Choroid

14. Give the reason why infants are prone to

•Small peripheral airway caliber

15. In very young infants with bronchiolitis,

19. An opening in the internal nose through

20. Breast palpation is performed using the:

•Tip of the index finger

•External carotid artery – superior temporal

26. Innervation of the muscles of facial

•High dietary fat intake

•More than 90% are premenopausal

29. What are the treatment options for lobular

30. The dominant mechanism in the

•Transient lower esophageal sphincter relaxation

32. The most common location of esophageal

•Proximal third – 10%

•Rapid urease test

•Hgb F – for better access to oxygen

37. Which of the following is true of Oppositional Defiant

•Boys are more affected than girls with a ratio of 4-12:1

38. Treatment/s of choice of children with

•Alcohol use disorder

40. Which of the following cartilages is

•Adult hyaline cartilage

42. What is the type of cartilagenous growth

43. Which of the following adaptive responses

44. A cell adapts to a stressful environment to achieve

•Higher level of physiologic function to achieve survival

•Direct transformation of the original matured

46. Patients with adrenal insuffiency presenting

• Flucortisone – highest Na (125) retaining

47. Drug A has 100% receptor occupancy but

• Esmolol – Beta 1 selective blocker

49. Which of the following statements regarding

• There is poor abduction in one eye

50. What is the most common intraocular

• Medially deviated eye

52. A screenable disease must have:

•Effective treatment after the disease becomes

55. Which of the following is a correct

•Yearly visual screening

56. Which of the following is an appropriate

•Routine varicella immunization - secondary

57. In BATHE technique, this gives an assessment of

•Background – “What’s going on in your life”?