MEDICINE

1. How can iodine deficiency cause enlargement of the thyroid gland?

A. Enough iodine in the community / diet will cause enlargement of the thyroid gland.
B. An acquired defect in hormone synthesis leads to elevated levels of TSH
C. Deficiency will cause an increase in TSH, stimulates growth of the thyroid gland
D. There is a familial tendency to cause a growth in the thyroid gland.
2. Main drugs for asthma includes bronchodilators which give rapid relief from bronchoconstriction. However, they
have little or no effect on the following areas:
A. Chronic inflammation
B. Increased mucociliary clearance
C. Inhibition of plasma exudates and airway edema
D. Inhibition of mast cell mediator release
3. Which of the following tests can be used to determine presence of myocardial demand ischemia?
A. Exercise electrocardiography
B. Cardiac imaging
C. Magnetic resonance imaging
D. Signal – averaged electrocardiography
4. The MOST common extra pulmonary presentation of tuberculosis in which one of the following ?
A. Lymph node
B. Skeletal
C. Manigeal
D. Gastroistestinal
5. Which of the following spirometry results would point to a diagnosis of astma?
A. Increased FEV1 immediately after Methacholine
B. Increased FEV1 immediately after Salbutamol
C. Increased after 4 weeks of ipratropium
D. Increased FEV1 after 4 weeks of Fluticasone.
6. A previously healthy 23 year old patient admitted for a closed, complete , displace fracture of his femur. He
suffered the injury while recklessly driving his motorcycle after a drinking spree, also complained of sudden
development of petechial rash and dyspnea. His vitals are: BP of 110/60,. HR OF 110, RR of 10, temp of 37.4 and
02 sats of 89% despite oxygen support. What is the working diagnosis of this case at this point?
A. Meningococcemia
B. Hospital- acquired Pneumonia
C. Myocardial Infarction
D. Pulmonary Embolism
7. In the OCW’s clinic , Jerry was found to have a fasting plasma Glucose (FPC) of 123 mg/dl. In the WHO category,
Which is he in one of the following?
A. Cleared for work
B. Prediabetic
C. Diabetic
 D. Normal
8. For moderate to severe Rheumatoid Arthritis, the first choice for initial treatment would be one of the following :
A. Biologicals
B. NSAIDs
C. Glucocorticoids
D. Methotrexate
9. Which of the following factors does NOT exacerbate reflux regardless of its mechanism?
A. Gastric hypersecretory State
B. Pregnancy
C. Early Gastric emptying
D. Abdominal Obesity
10. One of the following changes is NOT a late sign of melanoma, Which one?
A. Bleeding
B. Ulceration
C. Changes in color
D. Pain
11. A 35 year – old woman presents with excruciating Pain on her left cheek which would occur spontaneously or
whenever she would brush her teeth on that side. On examination she is otherwise normal except for severe pain on
touching her cheek with a wisp of cotton. There are no sensory deficits. Which of the following options should be
initially offered?
A. Valacyclovir
B. Carbamazepine
C. Microvascular decompression
D. Prednisone
12. Nephrotic syndrome classically presents with heavy proteinuria, minimal hematuria, edema and _____.
A. Hypotension
B. Hypocholesterolemia
C. Hypoalbuminemia
D. Hyperalbuminemia
13. The best method of choice to determine accuracy of the size of the thyroid gland is to do which one of the
following ?
A. Physical examination
B. X- ray
C. Thyroid scan
D. Ultrasound
14. Which of the following statements maybe TRUE epithelial lung cancer?
A. Small cell lung cancer responds favorably to cytotoxic chemotherapy.
B. Non-small cell lung cancer maybe potentially cured by resection
C. Small cell lung cancer is curable by surgery
D. Small cell lung cancer is typically widely disseminated.
15. For females, What is 1 in the incidence of cancer?
A. Endometrial
B. Breast
C. Thyroid
D. Lungs
16. A patient presents with fever and confusion. On examination, he also has a stiff neck. Which of the following
describes the Kernig’s Sign, Which is a supplementary test for nuchal rigidity?
 A. Passive Flexion of the neck also produces knee flexion
B. Passive knee extension while neck is flexed produces pain
C. Passive knee extension while hips are flexed produces pain
D. Passive knee flexion decreases pain
17. Uncle Boy was recently diagnosed with COPD and was asking for advise regarding his treatment . Which of the
following interventions can influence the natural history of COPD?
A. Steroids
B. Anticholinergics
C. Smoking Cessation
D. Bronchodilators
18. Executive dysfunction, problems with memory and chorea are clinical features of this type of degenerative
dementia:
A. Huntington’s disease
B. Parkinson’s disease
C. Creutzfeldt- Jakob disease
D. Alzhelmer’s disease
19. The MOST common diseases of the respiratory system are which of the following lung disorders?
A. Malignancy
B. Disorders with restrictive pathophysiology
C. Obstructive lung diseases – ASTHMA
D. Pulmonary vascular diseases
20. Which of the following media tricks should be avoided among pregnants with Urinary Tract Infections ?
A. Fluroquinolones
B. Ampicillin
C. Cephalosporine
D. Nitrofurantoin
21. Which of the following physiologic changes among newborns reflect the influence of maternal androgens?
A. Milia
B. Epstein pearls
C. Vernix caseosa
D. Sebaceous gland hyperplasia
22. Which of the following statements may NOT be TRUE of atrial fibrillation (AF)?
A. Many patients with AF are asymptomatic.
B. AF is common in children with or without structured heart disease
C. AF has loss of atrial contractility
D. AF is common during acute and early recovery phase of surgical procedures.
23. Which of the following 12 lead ECG findings is NOT suggestive of ischemia?
A. S-T segment elevation
B. S-T segment depression
C. Atrial premature complexes
D. Transient T – wave inversion
24. Pathologic features of Alzheimer’s disease include which one of the following?
A. Lewy bodies – 1st BEST
B. Alpha- synuclein pathology – 3rd BEST
C. Neurofibrillary tangles – 2nd BEST
D. Trinucleotide repeat – 4th BEST
25. Which of the following is TRUE regarding the host response to malaria?
 A. Body temperature above 40º C damage mature parasites.
B. Splenic immunologic and filtrative clearance are poor in malaria patients.
C. Caseating necrosis occurs in the spleen and liver due to granulomatosis.
D. Patients with sickle cell disease have sixfold increase in the risk of dying from faleiparum malaria. –
homozygous SCA
26. Large majority of lung cancer is caused by which of the following factors?
A. Occupational exposure to asbestos
B. Ionizing radiation
C. Cigarette and tobacco smoking
D. Environmental tobacco smoke
27. ACTS follows a circadian rhythm under the control of the hypothalamus, what is this pattern of ACTS secretion?
A. Adrenal cortisol secretion levels peak is the morning and low in the evening
B. Adrenal cortisol secretion has plateau levels during noontime
C. Adrenal cortisol secretion levels peak in the evening and low in the morning.
D. Adrenal cortisol secretion levels are very minimal in the afternoons.
28. Which of the following effects of lschemia had caused MOST patients to die suddenly the lschemic heart
disease?
A. Ischemia associated with angina pectoris
B. Subendocardial lschemia
C. Mechanical disturbance in call metabolism, function and structure
D. Ischemia induced ventricular tachyarrhythmias
29. Among SLE patients with fatigue, pain and autoantibodies, the mainstay of management to suppress symptoms
to an acceptance level, is / are the following:
A. Corticosteroids , oral and topical
B. Photoprotection
C. Analgesics and antimalarials
D. Methotrexate
30. Which of the following is TRUE regarding brain tumors ?
A. The presence of calcifications is uncommon in oligodendrogliomas
B. Glioblastomas are benign brain tumors
C. Prophylactic anticonvulsants are indicated when a brain tumor is diagnosed
D. The majority of brain tumors are malignant
31. What is the MOST severe histologic consequence of Gastro- esophageal disease?
A. Multiple esophageal rings linear furrows or white punctuate saudales
B. Singular and deep ulcerations at point of narrowing
C. Findings of specialized columnar metaplasia
D. Diffuse inflammation that tends to involve the proximal esophagus
32. Which of the following is NOT part of the conventional management of acute pancreatitis?
A. No oral alimentation
B. Prophylactic antibiotics
C. Analgesics for pain
D. IV fluids and colloids
33. Autoimmune disease should demonstrate the following pathogenesis to be classified as autoimmune. One of
following is NOT a major requirement:
A. Presence of the autoantibodies or evidence of cellular reactivity to self
B. Demonstration of autoantibodies or lymphocytic infiltrates in the lesion
C. Evidence of trauma or infection in the pathologic tissue\
 D. Demonstration that autoantibodies or T cells can cause pathology
34. Martha is 7 months pregnant . Her Obstetrician said she has Gestational diabetes mellitus (D.M ). What advice /
precaution/ patients education would you give her?
A. You are diabetic, so you would need antidiabetic predications
B. You have a substantial risk of developing D.M in the next 10- 20 years
C. Do not worry results will go back to normal postpartum
D. You might have a big baby thus prepare for a caesarean section
35. Which of the following medications for anaphylaxis are NOT effective for acute anaphylaxis but may allieviate
later recurrences?
A. Antihistamines
B. Glucocorticoids
C. Aminophyilline
D. Epinephrine
SITUATIONAL
Situation1 . A 50 year old OCW consulted the clinic because of very thick “dandfruff”. He also complained of thick
reddish brown plaques on his elbows ,knees , buttocks areas covered with silvery white scales. His grandfather and
younger brother had history of similar lesions

36. Of the following externalization factors , which of these can LEAST LIKELY exacerbate psoriatic plaques?
A. Infection
B. Stress
C. Medications
D. Ultraviolet lights
37. A clue to the diagnosis of psoriasis is the presence of clinical manifestations located on the non glabrous parts
of the body. Which ones?
A. Glands
B. Sebaceous glands
C. Nails
D. Hair
38. Which of the following oral medications is contraindicated ?

A. Oral Glucocorticoids
B. Cyclosporine
C. Systemic retinoids
D. Methotrexate
Situation 2 – Abigail a 36 years old grade school teacher consulted your clinic for cough lasting for a week . No code
taken aside from vitamin C. Cough notably worsened in the last few days with occasional bouts of dyspnea after
severe episodes. Physical examination revealed crackles on both sides. Chest radiography was done , interstitial
infiltrates was noted on both lung fields. Patient was diagnosed with community acquired pneumonia.
39. What is the LEAST LIKELY means by which microbes gain access of the lower respiratory tract system?
A. Aspiration from oropharynx
B. Inhalation of contaminated droplets
C. Hematogenous route
D. Small- volume aspiration during sleep
40. What specific mechanism triggers the clinical syndrome of pneumonia?
A. Alveolar macrophages initiate inflammatory response
B. Chemokines stimulate release of neutrophilia
 C. Macrophages ingest or kill microbes
D. Proliferation of microbes
41. What BEST explains the pathology of dyspnea is this patient with pneumonia?
A. Decreased secretion
B. Decreased respiratory drive
C. Decreased compliance due to capillary leak
D. Increased oxygenation
Situation 3 – A 28 year old female was confined in the hospital because of shortness of breath and labored breathing.
She had inability to stay flat in bed, had 3 pillow orthopnea. And most sit upright while sleeping. On physical
examinations, her neck vein was engorged, with rales on both lung fields and her liver was palpable.
42. Doing a cardiac examination of this patient with cardiomegaly, what would be the expected findings?
A. Point of maximum impulse directly at midclavicular line,5TH intercostal space, palpable over 1 interspace.
B. Point of maximum impulse would be right of midclavicular line, 3RD intercostal space , palpable over 1
interspace.
C. Point of maximum impulses would be below 5th intercostal space, lateral to midclavicular line palpable over
2 interspaces
D. There is a sustained point of maximum impulse.
43. Following the New York classification of heart failure which class of Heart Failure is the patient having?
A. Class III
B. Class I
C. Class II
D. Class IV
44. An early sign of heart failure will include which of the following?
A. Exertional dyspnea
B. Ascites
C. Jaundice
D. Orthopnea
Situation 4 – A 45 year old female was rescued after 7 Days . She drank rainwater and left over food from a nearby
house where she stayed. Upon rescue, she was having diarrhea and severe vomiting.
45. The medical team who saved her said she had severe dehydration. Signs included the following:
A. Thirst dry mouth decreased axillary sweating
B. Decreased urine output and slight weight loss
C. Orthostatic fall in blood pressure skin testing and sunken eyes
D. Obtunded, feeble pulse hypotension
46. The first thing to do to manage this case of vomiting and dehydration, is to give which of the following?
A. Oral dehydration solution
B. Anti-metical bismuth subsalicylate
C. IV solution : Ringer’s lactate
D. Anti-diarrheal medications
47. The patient’s diarrhea showed mucoid and bloody stools. To check for presence of fecal lactoferrin, a marker of
fecal leucocytes, Which of the following diagnostic approach can be done?
A. Methylene blue examination
B. Stool exam smear with NSA
C. Enzyme – linked immunosorbent assay
D. Guiac’ s test
SITUATION 5.
Jess, a 25 year old student is centrally above, diabetic and hypertensive . He has purplish stria on his abdomen and
had a hard time standing up his chair.
48. What would be the MOST useful test to establish the diagnosis of this case?
A. Exclusion of exogenous glucocorticoids
B. Dexamethasone suppression test
C. Imaging/ surgery
D. 24 hour urinary free cortical excretion test
49. What is the diagnosis of this case?
A. Pituitary adenoma
B. Adrenal module
C. Acts producing
D. Cushing’s syndrome
50. What is the MOST common of this condition?
A. Carcinoid tumors
B. Pheochromomytemia
C. Medical use of glucerticoids
D. Ectopic ACTS syndrome
Situation 6 – Twenty five year old office secretary frequently complained and dizziness and fatigue every time she
want to work. She also had occasional tachycardia but ECG taken was normal. Complete blood count showed red
blood cells which were hypochromic with poikilocytosis and target cells.
51. What level of hemoglobin is this patient having?
A. >14g/dl
B. 7-8 g/dl
C. 9- 10 g/dl
D. 10 -11 g/d
52. One of the following is NOT an indication for blood transfusion. Which one?
A. Gastric disease
B. Severe anemia
C.
53. Why is there a difference between the levels of hemoglobin between men and women, with males being higher
than females?
A. Testosterone and anabolic steroids augment erythropoiesis
B. Estrogen increases erythropoiesis
C. Females have ongoing menstrual cycle
D. Males are heavier built than females.
Situation 10 Jess was tending his garden a day prior to consultations. Last night , he started to develop wheals and
hives all over his legs face and arms.
54. What could be the possible predisposing factors of his wheals/hives?
A. Pollen extracts (ragweed, grass,trees)
B. Hemoptera venom ( wasps, bees)
C. Drugs (NSAID”s)
D. Food (peanuts, milk, eggs)
55. Jesa also expressed lump in his throat. What could be the cause of this?
A. Bronchial constriction
B. Bronchial obstruction
C. Laryngeal edema
D. Bronchial asthma
56. The following statements may NOT be TRUE of urticarial symptoms
A. Eruptions persist even beyond 48 hours
B. A non pitting deeper edematous angioedema may be present
C. Eruptions are intensely pruritic
D. If scratched are rubbed, lesions tend to coalesce to giant hives.
Situation 11 Mr. Santos had been making daily rounds in his six – story ice plant building which stored craters of
fruits , chicken and meat products. He had been doing this for 18-20 years. Until one day his annual chest xray
revealed abnormalities.
57. What common chemical agent can produce toxic effects to his lungs?
A. Sulfur oxide
B. Ammonia
C. Formaldehyde
D. Nitrogen Dioxide
58. How does this toxic agent affect the lungs?
A. It causes bronchoconstriction and pulmonary edema
B. It affects lower airways and disrupts alveolar architecture
C. It causes phagocytosis of cells causing further injury
D. It acts as a mucous membrane irritant decreasing lung function
59. What chronic effects can be produced from continuous low exposure to this agent?
A. Epistaxis
B. Chronic obstructive lung disease
C. Chronic bronchitis
D. Upper respiratory lung infection
Situation 12 - Mrs. Santos , a 60 year old lady was found to have as early systolic murmur in a decrescendo manner.
His cardiologist diagnose her as having acute severe Mitral Regurgitation .
60. What are heart murmurs?
A. They are signs of leaflet prolapse radiating anteriorly
B. They are results of audible vibrations caused by increased turbulence timed within the cardiac cycle.
C. They are progressive attenuations of left ventricle to left atrial pressure gradient.
D. They are differences between two cardiac chambers
61. The MOST common cause of midsystolic murmur is an adult is which one of the following?
A. Thyrotoxicosis
B. Fever
C. Anemia
D. Aortic stenosis
62. What is the difference between systolic murmurs and diastolic heart murmurs?
A. Diastolic murmurs may increase in intensity after intake of vasodilators
B. Diastolic heart murmur always signify structural heart disease
C. Diastolic murmur involves a crescendo- decrescendo pattern
D. Diastolic murmurs are best heard in a decubitus position.
Situation 13. Mrs. Tes has SLE which involved a multiorgan system. What is the MOST common manifestation of
SLE in the following organ systems:
63. What is the MOST common manifestations of SLE in the musculoskeletal system?
A. Joint dysfunction
B. Inchonic occlusion
C. Myositis
D. Polyarthritis
64. What is the MOST common manifestation of SLE in the vascular system?
A. Accentuated athoroclerosis
B. Brain Ischemia
C. Vasculitis
D. Hypertension
65. What is the MOST common manifestation of SLE in the Pulmonary System?
A. Pleuritis
B. Pulmonary infiltration
C. Interstitial hemorrhage
D. Plural effusion
Situation 14- Olan a 25 year old male, was diagnosed with schizophrenia when he was 19. He has been exposed in
medications since and was recently able to find work as a construction company . Olan went to your clinic asking
help as he would experienced stiffening of the jaw robot movements occasionally with upward rolling of his eyes
which impeded with his work. This started when his medications were increased recently.
66. Olan’s symptoms are MOST probably due to _____.
A. Anticbolinergic drug toxicity
B. Neuroleptic malignant syndrome
C. Adult – chest seizure disorder
D. Extrapyramidal side effects.
67. Which of the following will help control his symptoms?
A. A beta – blocker
B. A berrodiarepine
C. An antiparkinsonian drug
D. An anticonvulsant
68. Olan asked if he can stop taking his medications. Which of the following will LEAST likely be the response?
A. Schimphremia is a chronic condition and medications to control symptoms
B. He can stop current medications but you need to shift to his another antipsychotic drug during the process.
C. He can stop current medications since symptoms of schizophrenia had already been controlled for 2 years.
D. Stopping antipsychotic medications will cause symptoms of schizophrenia to recur.
Situation 15
70 year old grandmother consulted the clinic because of painful right knee. This was initiated years ago when she
had to pick up her groceries which had spilled down the floor.
69. What is happening to patients knee?
A. There was rupture of right knee ligaments
B. She has osteoarthritis of her right knee.
C. Shae has undetected right knee dislocation
D. She developed Charoot’s arthropathy
70. Which of the following mechanism may NOT BE TRUE of patient’s condition?
A. Decrease on the lubrication function of her affected knee
B. Weakening of the bridging muscles and tendons that protected her right knee
C. On and off inflammation of her knee may be responsible for her condition
D. Loss of the compressive stiffness of her hyaline articular cartilage
71. Which one of the following risk factors MAY NOT BE TRUE in the development of this co0ndition?
A. Her aged cartilage was less responsible to cartilage matrix synthesis.
B. Her joint muscle and stretched ligaments responded less quickly to incoming impulses.
C. Her sensory nerve input slowed down retarding the feedback loop of mechanoceptois to her
muscles/tendons.
 D. Her hormonal loss with monopoles was a big contributory factor.
Situation 16 – a 19 year sick college student came to the OPD for painful urination. Fortinet findings of the review of
system are urinary frequency without increased fluid intake. She claim to have a fever in the past few days. On
physical examination, there was sets of slight suprapubic tenderness upon palpation.
72. What is the primary working impression of this case?
A. Pyelonephritis
B. Vaginitis
C. Cervicitis
D. Cystitis
73. As many as 50 – 60 of woman in the general population acquire at least one UTI during their lifetime ,
uncomplicated cystitis in most cases. What is NOT an independent risk factor for acute cystitis in this age group?
A. History of UTI
B. Incontinence
C. Recent use of a diaphragm with spermicide
D. Frequent sexual intercourse
74. Many factors predisposing women is cystitis also increase the risk of pyelonephritis in young healthy women?
A. Having only 1 sexual partner
B. Having childhood history of UTI
C. Having diabetes mellitus
D. Having UTI in the previous 2 years
Situation 17 – Jazel was documented to have infection with human immunodeficiency virus a few years prior to
consult. During the past month , he was noted to have problems with attention and concentration, and was also noted
to have severe mood swings. He does not have any previous history of mood of behavioral changes nor does he
have any recent substance or medication use. Your primary consideration is neurocognitive disorder due to HIV
infection.
75. Which of the following will most likely expect Jazel to have ?
A. Impairment in executive functioning and processing speed
B. Rapid progression to profound neurocognitive impairment
C. Marked difficulty with recall of learned information
D. Language difficulties such as conspicuous aphasias
76. Aside from the documented HIV infection and fulfilment of the criteria for a neurocognitive disorders, what other
requirement must Jazel have not to quality for his diagnosis?
A. Pattern of cognitive impairment characterized by early predominance of aphasia
B. Pattern of cognitive impairment characterized by early development of psychotic symptoms
C. Inability to attribute the neurocognitive disorder to other medical or psychiatric conditions
D. Presence of progressive multifocal leukoencephalopathy or Cryptococci meningitis
77. Which of the following is TRUE regarding neurocognitive disorder due to HIV infection?
A. Kayser- Fleisher rings are often observed on PE
B. Brain involvement shows a subcortical pattern
C. Clouding of consciousness is observed early in the course
D. It is more prevalent in individuals with low viral loads
Situation 18 – Jess sought consultation because of 2 week old circular ulcerated lesions on his lower lip and penis.
The lesions were nontender, fire with ulcerated centers.
78. The causative agent in this case is which one of the following?
A. Herpes simplex virus
B. Ducrei
C. Aureus
 D. Pallidum
79. The disease above may pressure and give which one of the following secondary presentation?
A. Condyloma vanetila
B. Condyloma acuminata
C. Chancroid
D. Condyloma lata
80. Unfortunately the lesions are dry. Which of the following test should be performed for fast diagnosis of this
disease?
A. Dark- field microscopy
B. Blood and car culture
C. Rapid plasma Reagin
D. Enzyme immunoassay
SITUATION 19 – A 75 year old peddler would collect all the leftover food of Jollibee and McDo at around 10pm in
the evening to bring home to his large family. They would recook the leftover food and eat them. After months of
doing this routine, the old man developed anorexia, dysphagia, nausea, vomiting gradual weight loss. Steady upper
epigastric abdominal pain and abdominal mass.

81. His doctor, upon palpation of an abdominal mass, says he has a fever. This would probably be _____ carcinoma.
A. Pancreatic
B. Lymphomatous
C. Metastatic
D. Gastric
82. Which organ is the MOST common site for the Hematogenous spread of the tumor
A. Colon
B. Pancreas
C. Lungs
D. Liver
83. What would be the SIMPLIEST diagnostic procedure which can be requested for this patient with epigastric
complaint?
A. Gastroscopy and brush cytology combined
B. Brush cytology alone
C. Biopsy of tissue
D. Double contrast radiographic examination
84. The life cycle of the organism is complete when it is reached which of the following g organs?
A. Intestines
B. Renal
C. Lungs
D. Heart
85. Which of the following medications can be given to mild leptospirosis?
A. Ceftriaxone 1 gram/ day IV
B. Penicillin 1.5 M units IV
C. Doxycycline 100 mg per oren HID
D. Amoxicillin 500 mg per oren QID
SITUATION 21 – A 35 year old female complained of development of a hyper pigmented , indian – ink stain like
patch, measuring the size of a five peso coin , located on her left liver leg area lesions had been there for months . It
was initially erythematous but after a few months became dark. She noticed that there were times when her lesions
would become reddish again.
86. What question should be asked from the history?
A. Intake of drugs
B. Trauma to the area
C. Use of socks/stockings
D. Use of anklets
87. What is the diagnosis of this case?
A. Hematoma
B. Statis dermatitis
C. Fixed drug eruption
D. Contact dermatitis
88. How do you document this case?
A. Skin biopsy
B. Complete blood count
C. Patch test
D. Drug challenge / rechallenge