TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

BIOCHEMISTRY (1-20) A. Methylmalonyl CoA

1. Which of the following reactions requires N5,N10 methylene B. Succinyl CoA
THF as the co-factor? * C. A-ketoglutarate
A. UDP to dUDP D. Succinate
B. Orotic acid to UMP E. Isocitrate
C. dUMP to dTMP 10. Arachidonic acid is the precursor of prostaglandins which
D. UDP to CTP plays a role in different body processes. Which fatty acid is the
E. dUDP to dUMP precursor of Arachidonic acid? *
2. Which of the following reactions is affected in the absence of A. Palmitic acid
the enzyme Adenosine phosphoribosyl transferase? * B. Linoleic acid
A. Adenine to AMP C. Linolenic acid
B. Adenine to Inosine D. Oleic acid
C. Adenosine to Inosine E. Lauric acid
D. Adenosine to AMP 11. Antimycin A is a known inhibitor of electron transport chain.
E. Adenine to Adenosine Which of the following ETC component is inhibited in the
3. Which of the following are product/s of pyrimidine presence of Antimycin A? *
degradation? * A. Ubiquinone-cytochrome C reductase
A. Uric acid B. NADH coenzyme Q reductase
B. B-Hydroxybutyric acid and alanine C. Succinate dehydrogenase
C. Uric acid and glutamine D. Cytochrome oxidase
D. Aspartic acid and glutamine E. none of the above
E. B-alanine and aminoisobutyrate 12. Deficiency and excess of vitamins will cause different signs
4. Which of the following mechanism converts Uracil to and symptoms. Which of the following vitamin in
Thymine? * excess/deficiency will lead to podagra? *
A. Deamination A. Deficiency of Vitamin B2
B. Dehydration B. Excess of vitamin B3
C. Methylation C. Deficiency of vitamin B5
D. Acetylation D. Excess of vitamin B1
E. Deacetylation E. Deficiency of vitamin B7
5. Which of the following part of the tRNA detects the tRNA by 13. . A 1-month old patient, purely breastfed came into your clinic
aminoacyl-tRNA synthetase? * presenting with failure to thrive and jaundice. Upon PE, patient
A. T-arm noted to have hepatomegaly and infantile cataracts. The
B. D-arm patient is most likely to have: *
C. Acceptor stem A. Essential fructosuria
D. Variable arm B. Hereditary fructose intolerance
E. None of the above C. Galactokinase deficiency
6. Problems with Merosin will affect the production which D. Classic galactosemia
substance? * E. lactase deficiency
A. Laminin 14. Cystinuria is a hereditary defect of renal PCT and intestinal
B. Collagen amino acid transporter that prevents reabsorption of the
C. Elastic fibers following amino acids, except: *
D. Glycogen A. Cystine
E. Enamel B. Ornithine
7. Amino acid metabolism leads to formation of different C. Leucine
products. Which is not a product of tryptophan metabolism? * D. Arginine
A. Niacin E. None of the above
B. Serotonin 15. During prolonged fasting, the body produces ketone bodies.
C. Melanin Which of the following is involved only in ketone body
D. Melatonin production? *
E. None of the above A. HMG-CoA reductase
8. Acetyl-CoA from inside the mitochondria is not readily utilized B. HMG-CoA synthase
for fatty acid synthesis and needs to be transported through C. HMG-CoA lyase
the mitochondrial membrane and passes through which D. HMG-CoA transferase
shuttle? * E. All the above
A. Carnitine shuttle 16. Fragile X syndrome is the most common cause of inherited
B. Glycerophosphate shuttle intellectual disability. Which trinucleotide repeat expansion is
C. Citrate shuttle related to Fragile X syndrome? *
D. Malate aspartate shuttle A. CAG
E. Oxaloacetate shuttle B. CGG
9. Beta oxidation of Odd-Chain fatty acids produces Acetyl-CoA C. CTG
and Propionyl CoA. Propionyl CoA is utilized and enters the D. GAA
TCA cycle at which entry point? * E. UAA
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

17. This is an Autosomal recessive disorder of peroxisome

biogenesis due to mutated PEX genes. *
A. Zellweger syndrome
B. Refsum disease
C. Keshan disease
D. Adrenoleukodystrophy
E. Menkes disease
18. DNA replication consists of different enzymes and proteins
which plays a crucial role. Which of the following prevents
strands from reannealing? *
A. DNA topoisomerase
B. Single-stranded binding proteins
C. Primase
D. Okazaki fragments
E. DNA polymerase
19. Which of the following are donors of atoms in the nucleotide
synthesis that is exclusive in the purine synthesis? *
A. Glycine
B. Aspartate
C. Carbon dioxide
D. Glutamine
E. None of the above
20. Which statement is not true about the altered metabolic
pathways in chronic alcoholics? *
A. There is accumulation of pyruvate and lactate which
may lead to fatal acidosis
B. Anaerobic glycolysis predominates as the pyruvate is
shunted away from the formation of acetyl CoA
C. There is a high NAD+/NADH ratio seen in alcoholics
D. Alcohol dehydrogenase and acetaldehyde
dehydrogenase produce a high amount of NADH
E. Can lead to thiamine deficiency
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

28. Internal iliac artery is divided into anterior and posterior division.
ANATOMY (21-40) Which of the following belongs to the posterior division? *
21. Which of the following aortic sinus gives rise to the right 1 point
coronary artery? * A. Superior gluteal artery
1 point B. Inferior gluteal artery
A. Anterior aortic sinus C. Internal pudendal artery
B. Right posterior aortic sinus D. Obturator artery
C. Left posterior aortic sinus E. Middle rectal artery
D. Posterior aortic sinus 29. The ovary usually lies near the lateral wall of the pelvis in a
E. Medial aortic sinus depression called the ovarian fossa. It is bounded by the following,
22. During an emergency department thoracotomy, the surgeon except: *
made a left anterolateral incision to reach the pericardium in order 1 point
to relieve the patient from cardiac tamponade. During the A. External iliac vessel
operation, the surgeon encountered a structure coursing behind the B. Internal iliac vessel
left lung root. This structure is most likely to be * C. Ureter
1 point D. Broad ligament of the uterus
A. Phrenic nerve E. obturator nerve
B. Vagus nerve 30. It is considered as the largest muscle in the upper body. *
C. Azygos vein 1 point
D. Thoracic duct A. Trapezius
E. Superior vena cava B. Pectoralis major
23. Which of the following is part of the Tricuspid valve except? * C. Deltoids
1 point D. Latissimus dorsi
A. Anterior cusp E. Subscapularis
B. Septal cusp 31. The quadrangular space is located immediately below the
C. Lateral cusp shoulder joint and is bounded by subscapularis muscle, teres major
D. Inferior cusp and surgical neck of the humerus. Damage to the quadrangular
E. Posterior cusp space may damage which of the following structures: *
24. Conjoint tendon strengthens the medial half of the posterior wall 1 point
of the inguinal canal and is the combination of which of the A. Axillary artery
following? * B. Axillary nerve
1 point C. Musculocutaneous nerve
A. External oblique and internal oblique D. Axillary vein
B. External oblique and transversus abdominis E. thoracodorsal nerve
C. Internal oblique and transversus abdominis 32. Which of the following is not part of the proximal row of carpal
D. transversus abdominis and transversalis fascia bones? *
E. internal oblique and transversalis fascia 1 point
25. The spermatic cord is a collection of structures that pass A. Scaphoid
through the inguinal canal. Which of the following is not part of the B. Lunate
spermatic cord? * C. Trapezium
1 point D. Pisiform
A. Testicular veins E. None of the above
B. Testicular lymph nodes 33. The talus articulates above with the tibia and fibula and below
C. Cremasteric artery with the calcaneum. Which of the following muscle is attached to
D. Ilioinguinal nerve the talus? *
E. Genitofemoral nerve 1 point
26. The parietal peritoneum is innervated and is sensitive for pain, A. Gastrocnemius
temperature, touch and pressure. Which of the following mainly B. Soleus
innervates the parietal peritoneum of the pelvis? * C. Tibialis anterior
1 point D. Peroneous longus
A. Greater splanchnic nerve E. None of the above
B. Lesser splanchnic nerve 34. Which of the following suprahyoid muscles is innervated by the
C. Obturator nerve C1 nerve? *
D. Genitofemoral nerve 1 point
E. Superior gluteal nerve A. Geniohyoid
27. Which of the following is most anteriorly located? * B. Posterior belly of the digastric
1 point C. Anterior belly of the digastric
A. Renal vein D. Stylohyoid
B. Renal artery E. Mylohyoid
C. Ureter 35. Multiple structures courses through the cavernous sinus. Which
D. Ureteropelvic junction of the following does not course through the cavernous sinus? *
E. Renal papilla 1 point
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

A. Ocolumotor nerve
B. Trochlear nerve
C. Abducens nerve
D. Optic nerve
E. None of the above
36. Which of the following muscles is responsible for the protruding
of the tongue? *
1 point
A. Genioglossus
B. Hyoglossus
C. Styloglossus
D. Palatoglossus
E. Mylohyoid
37. The auscultatory triangle is the site on the back where breath
sounds may be most easily heard with a stethoscope. Which is not
a part of the boundaries of the triangle? *
1 point
A. Latissimus dorsi
B. Trapezius
C. Medial border of the scapula
D. Rhomboid major
E. None of the above
38. Jefferson fracture is caused by the compression of the spinal
column and places the spinal cord at risk. Which of the following
vertebra is fractured in this type of pathology? *
1 point
A. C1
B. C2
C. T4
D. C7
E. T1
39. Which layer of the abdominal wall is not correctly paired with
the layers of the testes and spermatic cord? *
1 point
A. Superficial fascia: Colles and dartos fascia
B. External oblique muscle: External spermatic fascia
C. Internal oblique muscle: cremasteric muscle
D. Transversalis fascia: Internal spermatic fascia
E. None of the above
40. The internal/medial surface of the tympanic membrane is
innervated by which of the following? *
1 point
A. CN V
B. CN VII
C. CN IX
D. CN X
E. All of the above
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 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

47. This infection is associated commonly with this serotype of

TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS) salmonella that usually manifests with early invasion of the
* Required bloodstream with possible focal lesions in the meninges. But
MICROBIOLOGY (41-60) intestinal manifestations are often absent. *
41. Neisseria gonorrhoeae is able to avoid host defenses and able 1 point
to multiply and produce its symptoms. The reason for this ability to A. S. typhi
avoid host defenses is: * B. S. paratyphi
1 point C. S. choleraesuis
A. Intracellularly located D. S. typhimurium
B. Antigenic variation E. S. salamae
C. Too small to be detected by the host immune system 48. This antigenic structure is located on the most external part of
D. The presence of pili the cell wall lipopolysaccharide and consists of repeating units of
E. The presence of Opa proteins polysaccharide. *
42. Which of the following is true regarding Neisseria 1 point
gonorrhoeae? * A. H antigen
1 point B. O antigen
A. Gonococci oxidize glucose and galactose C. K antigen
B. Gonococci usually produce larger colonies that those of the D. Capsular antigen
other Neisseria E. Flagellar antigen
C. Opaque colonies are associated with surface-exposed protein 49. The following are true regarding Pseudomonas, except: *
D. Gonococci isolated from symptomatic urethritis are transparent 1 point
colonies A. Grows well at 37 to 42 degrees Celsius
E. Gonococcal ophthalmia neonatorum, an infection of the eye in B. Oxidase positive
the newborns, is acquired transplacental C. Pathogenic when present regardless of location in the body
43. In the event of antimicrobial resistance, many mechanisms is D. Gram negative, motile, rod-shaped bacteria
involved in the development of resistance. Resistance to nafcillin by E. None of the above
Staphylococci is mainly due to: * 50. Yersinia pestis is a zoonotic pathogens that cause disease
1 point ranging from mild to high mortality diseases as plague. Which of
A. B-lactamase production the following is true regarding Y. pestis? *
B. Conjugation 1 point
C. Antibiotic efflux pump A. Transmitted to humans usually through the bite of an infected
D. Bacteriophage transfer rat
E. Staphylococcal cassette chromosome mec B. Gram negative rod, motile organism
44. S. aureus produces multiple virulence factors. In CA-MRSA C. Is an obligate aerobic bacteria
infections, the important virulence factor that can kill white blood D. Virulence factors are V and W antigens
cells is: * E. All of the above
1 point 51. Sporothrix schenckii is a thermally dimorphic fungus that lives
A. Toxic shock syndrome toxin on vegetation. Which of the following is false regarding S.
B. Catalase shenckii? *
C. Clumping factor 1 point
D. Hemolysins A. Causes a chronic granulomatous infection
E. Panton-Valentine Leukocidin B. Asteroid body is often seen in tissue samples that contains a
45. Streptococcus pneumoniae is an important cause of pneumonia central basophilic yeasts cell
in humans. Which of the following is false regarding S. C. Most reliable method of diagnosis is culture
pneumoniae? * D. Can mimic chronic cavitary tuberculosis in cases of primary
1 point pulmonary sporotrichosis
A. Gram-positive diplococci, often lancet shaped or arranged in E. Treatment of choice is saturated solution of potassium iodide in
chains milk
B. Possess a capsule of polysaccharide that permits typing with 52. This systemic mycoses is characterized by the presence of
antisera multiple skin lesions known as desert bumps and can cause desert
C. Not readily lysed by surface-active agents rheumatism: *
D. Growth is enhanced by 5-10% Carbon dioxide 1 point
E. None of the above A. Histoplasmosis
46. Which of the following is false regarding Enterococci? * B. Blastomycosis
1 point C. Coccidioidomycosis
A. The group D cell wall-specific antigen is a teichoic acid and is D. Paracoccidioidomycosis
not an antigenically good marker E. All of the above
B. They are usually nonhemolytic but are occasionally alpha- 53. A 9-year old male presents with multiple seizure episodes in
hemolytic span of 1 month. Brain CT scan was done which showed a lesion
C. PYR positive that is densely calcified and was diagnosed with
D. Grows in the presence of bile and hydrolyze esculin neurocysticercosis. All of the following are true regarding the case,
E. intrinsically susceptible to monobactams except *
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

1 point 60. In relation to question no. 59, Survivors of this neonatal herpes
A. Caused by T. solium infection will have the following sequelae: *
B. Is acquired by eating cysticerci encysted in undercooked pork 1 point
C. Corticosteroids are given for management A. Multiple cutaneous scarring that leads to gross deformities
D. The intestinal infections are usually asymptomatic, with mild B. Cerebral palsy with formation of multiple cystic lesions in the
intestinal symptoms that includes diarrhea and abdominal pain brain
E. Compared to T. saginata, T. saginata does not cause C. Permanent neurologic deficit
neurocysticercosis D. Chronic lung failure that requires mechanical ventilator
54. Infection of this parasite causes Vitamin B12 deficiency: * dependence
1 point E. None of the above
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different cells. Lymphocyte-tropic strains of HIV utilizes which
coreceptor? *  Forms
1 point
A. CD4
B. CXCR5
C. CCR4
D. CCR5
E. CXCR4
56. Generally, enveloped viruses acquire their envelopes from
plasma membrane when they exit from cell, Exceptions include
which of the following viruses: *
1 point
A. Herpesvirus
B. Papillomavirus
C. Adenovirus
D. Parvovirus
E. Polyomavirus
57. A newborn male was delivered via normal spontaneous vaginal
delivery at a lying-in clinic. The mother was noted to have multiple
painful vesicular lesions in the perineum and was diagnosed to
have active herpes infection. Which of the following is true
regarding Herpes simplex viruses? *
1 point
A. Have 8 types
B. Infections ranges from gingivostomatitis to encephalitis
C. Usually does not establish latent infections
D. Can enter unbroken skin or mucosal surface
E. None of the above
58. In the case above, The newborn male is susceptible to neonatal
herpes infection which has three categories of disease, except: *
1 point
A. Lesions localized to the skin, eye and mouth
B. Encephalitis with or without localized skin involvement
C. Disseminated disease involving multiple organs including the
central nervous system
D. Acute respiratory distress syndrome causing acute lung failure
E. None of the above
59. In the case above, which of the following category of neonatal
herpes infection has the worst prognosis? *
1 point
A. Lesions localized to the skin, eye and mouth
B. Encephalitis with or without localized skin involvement
C. Disseminated disease involving multiple organs including the
central nervous system
D. Acute respiratory distress syndrome causing acute lung failure
E. None of the above
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

1 point
TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS) A. Hypotension
* Required B. Tachycardia
PHYSIOLOGY (61-80) C. Irregular respirations
61. Which of the following steps within the beta cell will bring about D. Seizures
insulin secretion? * E. Severe headache
1 point 69. Oxygen-Hemoglobin dissociation curve is affected by multiple
A. Opening of the K channels by sulfonylureas factors. Shift to the right of the hemoglobin dissociation curve
B. Closing of calcium channels to prevent influx of calcium associated with all the following except: *
C. Repolarization of the beta cell 1 point
D. Increase in intracellular calcium A. Decreased P50
E. None of the above B. Acidosis
62. This type of intracellular structures between cell membranes is C. Increase PC02
responsible for tight intercellular adhesions: * D. Increased temperature
1 point E. Increased 2,3-BPG
A. Gap junctions 70. Respiratory responses to high altitude include all of the
B. Tight junctions following, except: *
C. Zonula adherens 1 point
D. Macula adherens A. Decreased alveolar PO2
E. Zonula occludens B. Decreased Arterial PO2
63. In the cardiac action potential, phase 2 is characterized by C. Decreased Pulmonary vascular resistance
which of the following? * D. Increased arterial pH
1 point E. Increased respiratory rate
A. Sodium influx 71. Which of the following part of the nephron is most susceptible
B. Calcium influx to hypoxia and toxins and is considered as the workhorse of the
C. Repolarization nephron? *
D. Resting membrane potential 1 point
E. Increased Potassium efflux A. Glomerulus
64. This tactile receptor gives steady-state signal for continuous B. Proximal convoluted tubule
touch and determines texture: * C. Loop of Henle
1 point D. Distal convoluted tubule
A. Messner corpuscles E. Collecting duct
B. Merkel disc 72. The following are true regarding the mechanism of vomiting,
C. Hair-end organ except: *
D. Ruffini Corpuscles 1 point
E. Pacinian corpuscles A. Usually preceded by nausea
65. These cells are output cells of the retina in which axons form B. Vomiting center is located in the Medulla
the optic nerve: * C. Wave of peristalsis begins from the stomach
1 point D. Receives information from vestibular system, GI tract and
A. Mueller cells chemoreceptor trigger zone
B. Ganglion cells E. None of the above
C. Bipolar cells 73. Which gastrointestinal secretion is inhibited when the pH of the
D. Amacrine cells stomach contents is 1.0? *
E. Horizontal cells 1 point
66. Blood flow per grams of tissue is greatest in which organ? * A. Saliva
1 point B. Gastric secretion
A. Liver C. Pancreatic secretion
B. Brain D. Bile
C. Kidney E. All of the above
D. Intestines 74. This enzyme is responsible for peripheral conversion of T4 to
E. Spleen T3: *
67. In the atrial pressure curve, this is represented by venous blood 1 point
going to the atria: * A. D1 thyroid deiodinase
1 point B. D2 thyroid deiodinase
A. A wave C. D3 thyroid deiodinase
B. C wave D. Pendrin
C. V wave E. None of the above
D. X descent 75. This form of estrogen is the major form of estrogen seen in
E. Y descent post-menopausal period. *
68. Following head trauma, this occurs as a response to increased 1 point
intracranial pressure known as the Cushing reflex. Which of the A. Estrone
following is part of the triad: * B. Estradiol
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

C. Estriol
D. Estetrol
E. Estetriol
76. Which of the following serum proteins is a known protease that
inhibits serum endoproteases? *
1 point
A. Alpha fetoprotein
B. Alpha 2 macroglobulin
C. Transthyretin
D. Hemopexin
E. Orosomucoid
77. This type of antibody is known to have the greatest avidity. *
1 point
A. IgM
B. IgG
C. IgA
D. IgE
E. IgD
78. Blood type is determined by the presence or absence of
specific antigen in the red blood cells. The absence of H antigen in
the red blood cells is designated as which of the following? *
1 point
A. Type A
B. Type B
C. Type AB
D. Type O
E. None of the above
79. Among the Vitamin K dependent factors, which of the following
has the shortest half-life? *
1 point
A. Factor VII
B. Factor II
C. Factor IX
D. Factor X
E. Factor XIII
80. At which site is systolic blood pressure the highest? *
1 point
A. Aorta
B. Pulmonary artery
C. External carotid artery
D. Renal artery
E. Internal carotid artery
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 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

D. Death of middle age

TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS) E. Death from asphyxia
* Required 88. Aaron is a 25 y/o male, BMI of 40 and was riding is car and was
LEGAL MEDICINE (81-100) stopped at a check-point. Upon checking, a container was seen
81. All of the following are considered incidental rights of a with suspected marijuana resin. At least how many grams of this
physician, except: * substance is needed for Aaron to be convicted and punished with
1 point lifetime imprisonment? *
A. Right of way 1 point
B. Right of exemption from execution of instruments and library A. 1 gram
C. Right to compensation B. 10 grams
D. Avail of hospital services C. 50 grams
E. Right to hold certain public or private offices D. 500 grams
82. Condition of a woman who permits any form of sexual liberties E. none of the above
as long as they abstain from rupturing the hymen by sexual act: * 89. While Aaron is in prison, he had altercation with other prison
1 point inmates and obtained a blunt trauma on his thigh which resulted to
A. Virgo intacta effusion of blood into the tissues underneath the skin because of
B. Demi virginity the rupture of the blood vessels. This is known as: *
C. Physical virginity 1 point
D. Moral virginity A. Petechiae
E. All of the above B. Contusion
83. A form of hymenal laceration wherein the laceration reaches C. Hematoma
beyond the base of the hymen: * D. Subluxation
1 point E. Abrasion
A. Superficial 90. A few days later, Aaron consulted in your clinic because of pain
B. Deep laceration on his thigh, You saw the wound to have green discoloration. What
C. Complete laceration is the approximate age of his wound? *
D. Compound laceration 1 point
E. Complicated laceration A. 24-48 hours
84. Simple seduction is the seduction of a woman who is single or B. 48-72 hours
a widow of good reputation. Which of the following is not an C. 4-5 days
element of simple seduction? * D. 7-10 days
1 point E. 10-14 days
A. There is sexual intercourse 91. A few days after his consult, Aaron was seen lying in his cell
B. Sexual intercourse was committed by means of deceit with no pulse. An autopsy was done which showed a clot in his
C. Patient is over twelve but under 18 years of age arteries. You are suspecting an emboli formed that resulted in his
D. The offended party is a virgin death. Which of the following suggests that it is a post-mortem
E. None of the above clot? *
85. Type of sexual abnormality wherein there is sexual gratification 1 point
attained by fingering, fondling with breast, licking parts of the A. Firm
body. * B. Blood vessel surface is raw after the clots are removed
1 point C. Stripped off in layers
A. Sodomy D. Has uniform color
B. Uranism E. None of the above
C. Frottage 92. On the Autopsy report, it is noted that Aaron had a
D. Partialism characteristic dark brown blood and you suspect that he was
E. Coprolalia poisoned by the other inmates. Which of the following is more likely
86. The human skeleton of victims of foul play may help with the the cause of his death: *
identification of the body. Which of the following is not used to 1 point
measure the height? * A. Hydrocyanic acid
1 point B. Phosphorous
A. Femur C. Carbon Monoxide poisoning
B. Humerus D. Asphyxia
C. Tibia E. None of the above
D. Radius 93. Aaron M, married, and known ladies man is seen with his
E. None of the above mistress in his conjugal dwelling. You reported him to the police
87. The time of death can be approximated by measuring the and the police responded and was convicted with Concubinage.
temperature of the body. Which of the following factors delays the What is the punishment for Aaron M? *
cooling of the body EXCEPT? * 1 point
1 point A. Up to 6 years in prison
A. Acute pyrexial disease B. Destierro
B. Sudden death C. Lifetime imprisonment
C. Leanness of the body D. Death by hanging
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

E. None of the above B. 100 mg%

94. On the way to prison, Aaron M tried to escape and jumped on C. 150-300 mg%
the bridge and was able to escape. A few days later, the body of D. 300 mg%
Aaron M was seen floating with noted whitish foam on his mouth E. 400 mg%
and nostrils. This is known as: * 100. Adolfo M then became insane and on his way home, he saw
1 point his wife with Aaron M and was deeply hurt because he loves his
A. Emphysema aquosum wife so much. Because of this, he waited for an opportunity to kill
B. Edema aquosum Aaron M when he escaped the police. He was then being accused
C. Champignon d'ocume or murder. Which of the following rules utilized by the court that he
D. Tete de negri can use which states that the accused is not criminally responsible
E. None of the above if his act was the product of mental disease or defect? *
95. Upon inspection, you want to know if Aaron M died on salt 1 point
water or in fresh water. You may need to do which of the following A. Wild beast rule
test? * B. Delusion rule
1 point C. McNaghten Rule
A. Gettler test D. Durnham Rule
B. Serum osmolality test E. Currens Rule
C. Schaefer test Back
D. Walker test Next
E. Gilroy Test
96. After the test you requested, You note that there is discrepancy
and suggests that Aaron M's cause of death is not drowning in salt
water. A witness then appeared and in his statement, he saw
Adolfo M, the Husband of Aaron M's mistress, was seen kneeling
on Aaron M's chest and using his hands to close the nostrils and
mouth. This is known as: *
1 point
A. Overlaying
B. Smothering
C. Choking
D. Burking
E. None of the above
97. Adolfo, the husband of Aaron's mistress were happily married
for 1 year. On their first anniversary they knew that she was
pregnant and gave birth and eventually gave birth at 40 weeks
AOG. Which of the following is not a requisite for the child to be
called a legitimate children? *
1 point
A. There is a valid marriage
B. Birth took place after 180 days following marriage
C. Birth took place within 280 days following its dissolution
D. No physical impossibility of the husband having access to the
wife during the first 120 days of the 300 days preceding the birth
E. None of the above
98. Upon delivery, the baby was not breathing with no visible
movements. They tried to revive the baby but no spontaneous
breathing noted and was pronounced dead. Which of the following
test is not included to determine whether respiration took place on
a newborn child before death? *
1 point
A. Hydrostatic test
B. Fodere test
C. Static test
D. Wredin test
E. None of the above
99. Upon the death of Aldolfo M's son, He became drug dependent
and addicted to drugs and alcohol. He was seen disoriented,
confused, with sensory disturbances, slurred speech and
exaggerated emotions. What is the most likely blood alcohol level
of Adolfo M? *
1 point
A. 50 mg%
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

1 point
TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS) A. Lower motor neuron disease
* Required B. Upper motor neuron disease
PATHOLOGY (101-120) C. Disease of the skeletal muscle
101. Acute phase reactants are increased in cases of inflammation D. Both A and B only
and in infections. Which of the following is not positive/upregulated E. All of the above
acute phase reactant? * 108. Aaron M, a curious medical student then asked you if what
1 point would be the morphology of his disease. You will answer: *
A. Ferritin 1 point
B. Fibrinogen A. Degeneration of the upper motor neurons that result in loss of
C. Transferrin myelinated fibers in the corticospinal tract
D. Serum Amyloid A B. Hypertrophy of the precentral gyrus because of the loss of
E. Hepcidin myelinated fibers in the corticospinal tract
102. Which of the following diseases is associated with the loss of C. Hypertrophy of the myelinated fibers in the corticospinal tract
function of the tumor suppressor gene RB? * becuase of loss of cells in the precentral gyrus
1 point D. Hypertrophy of cells in the precentral gyrus and corticospinal
A. Retinopathy of prematurity tract
B. Osteosarcoma E. Any of the following is present in cases of ALS
C. Pancreatic cancer 109. You then asked Aaron M that if you were to do a biopsy in his
D. Retinitis pigmentosa affected neurons, you will see PAS-positive cytoplasmic inclusions
E. Colon cancer that are called: *
103. You are a rotating pathology intern when the pathology 1 point
resident called you and ask you to check the structure focused in A. Granule bodies
the microscope. You see a laminated, concentric spherules with B. Bunina bodies
dystrophic calcifications. The pathology resident then asked you, C. Chorea bodies
the following diseases are associated with these findings except: * D. Glial bodies
1 point E. Coiled bodies
A. Somatostinoma 110. Ulcerative colitis is an example of inflammatory bowel disease
B. Meningioma which mainly presents with gastrointestinal manifestations.
C. Malignant mesothelioma However, they often manifests with extraintestinal manifestations
D. papillary carcinoma of the thyroid which include the following, except: *
E. None of the above 1 point
104. These cells are present in areas of CNS damage and can be A. Polyarthritis
seen with enlarged vesicular nuclei and conspicuous eosinophilic B. Uveitis and episcleritis
cytoplasm. These type of cells hypertrophy and undergoes C. Primary biliary cirrhosis
hyperplasia and culminates in tissue gliosis? * D. Sacroilitis
1 point E. Pyoderma gangrenosum
A. Rosenthal astrocytes 111. Prostate diseases is associated with an increase in serum
B. Gemistocytic astrocytes prostate-specific antigen. An increased total PSA with a decreased
C. Alzheimer type II astrocytes fraction of free PSA suggest which of the following *
D. Oligodendroglial cells 1 point
E. Ependymal cells A. Benign prostatic hyperplasia
105. Smudge cells are present in: * B. Prostatic carcinoma
1 point C. Urinary tract infection
A. Acute lymphocytic leukemia D. Prostatitis
B. Chronic lymphocytic leukemia E. Any of the above
C. Acute myelogenous leukemia 112. It is the most common sexually transmitted disease *
D. Chronic myelogenous leukemia 1 point
E. Acute promyelocytic leukemia A. Chlamydia infection
106. Congenital heart diseases can be classified into cyanotic and B. Gonorrhea infection
noncyanotic heart disease. Which of the following is not a C. Herpes simplex virus infection
congenital heart disease with right to left shunt? * D. Syphilis
1 point E. Granuloma inguinale
A. Truncus arteriosus 113. Endometrial carcinoma has two main types. Which of the
B. Transposition of great arteries following does not describe type 1 endometrial carcinoma? *
C. Tricuspid atresia 1 point
D. Tetralogy of Fallot A. Prolonged estrogen stimulation
E. None of the above B. Resemble normal endometrium
107. Aaron M, An 26 year old male complaining of generalized C. Associated with obesity
weakness came in for visit. Basic work-ups was done which are D. Has a poor prognosis
normal. You consider amyotrophic lateral sclerosis as you one of E. None of the above
the differential diagnosis. ALS is characterized by: * 114. Meigs syndrome is associated with the following, except: *
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

1 point Next
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E. None of the above
115. While you are rotating in pathology, a pathology consultant  Forms
asked you to observed the slide on the microscope which he said,
answer this correct or you will repeat your rotation here in
pathology. "The organ is the pancreas and what you see are
inclusion bodies known as islet amyloid polypeptides. Which of the
following is associated with these pathologic findings?". *
1 point
A. Type I diabetes
B. Type II diabetes
C. Acute pancreatitis
D. Chronic pancreatitis
E. All of the above
116. Atherosclerosis is a very common disease of elastic arteries
and large and medium sized muscular arteries caused by a build-
up of cholesterol plaques. In which of the following vessels
atherosclerosis is most commonly present: *
1 point
A. Abdominal aorta
B. Coronary artery
C. Popliteal artery
D. Carotid artery
E. Middle meningeal artery
117. Plummer-Vinson syndrome is characterized by which of the
following, except: *
1 point
A. Dysphagia
B. Iron Deficiency anemia
C. Esophageal varices
D. Esophageal adenocarcinoma
E. None of the above
118. An increased in ratio of AST to ALT is a characteristic finding
in which of the following: *
1 point
A. Acute viral hepatitis
B. Ischemic hepatitis
C. Alcoholic liver disease
D. Cholestasis
E. Drug-induced liver disease
119. The presence of this antibody in pregnant women increases
the risk of newborn in developing neonatal lupus: *
1 point
A. Anti-Histone
B. Anti- dsDNA
C. Anti-SSA
D. Anti-SSB
E. Anti- U1 RNP
120. Alzheimer disease is the most common cause of dementia in
the elderly. Which of the following altered proteins is associated
with increased risk of sporadic forms? *
1 point
A. ApoE-2
B. ApoE-4
C. Presenilin-1
D. Presenilin-2
E. Amyloid polypeptide
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 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

1 point

TOPNOTCH GENESIS A. Atenolol

B. Hydralazine
C. Nifedipine
DIAGNOSTIC EXAMS D. Sildenafil
E. Terbutaline

(240 ITEMS) 125. A 58 year old male is known to take

* Required digitalis for his arrhythmia. Which of the
PHARMACOLOGY (121-140) following is associated with increased risk of
121. This is an antagonist drug which counters arrhythmogenesis? *
the effects of another by binding the agonist 1 point

drug and not the receptor * A. Hyperkalemia

B. Hypomagnesemia
1 point C. Hypocalcemia
A. Pharmacologic antagonist D. Only A and C
B. Irreversible antagonist E. None of the above
C. Physiologic antagonist
D. Chemical antagonist 126. Mannitol is the prototypical osmotic
E. Inverse antagonist diuretic given intravenously that is freely
122. Which of the following drugs used in filtered at the glomerulus but poorly
glaucoma acts to increase outflow via reabsorbed and they remain in the lumen and
uveoscleral veins? * "hold" water by virtue of their osmotic effect.
1 point
The major location for this actions is in the: *
1 point
A. Timolol
B. Latanoprost A. Proximal convoluted tubule
C. Epinephrine B. Loop of Henle
D. Pilocarpine C. Distal convoluted tubule
E. Mannitol D. Collecting ducts
E. All parts of the nephron
123. You are an internal medicine rotator
when a 25 year old female patient was 127. Which of the following is considered as
brought to the ER with severe tachycardia first-generation histamine antagonists? *
after a drug overdose. Which one of the 1 point

following drugs increases the heart rate in a A. Cetirizine

B. Fexofenadine
dose-dependent manner? *
C. Loratadine
1 point D. Promethazine
E. Desloratadine
A. Captopril
B. Hydrochlorothiazide 128. This group of drug inhibits the enzyme
C. Losartan
D. Minoxidil that converts arachidonic acid to leukotriene
E. Verapamil precursors: *
124. Which of the following interacts with 1 point

nitroglycerin by inhibiting the metabolism of A. Aspirin

B. Clopidogrel
cGMP? *
C. Zileuton
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

D. Zafirlukast
depressed and used cocaine until he is
E. NSAID
overdosed. Which of the following is the least
129. The mechanism of antiseizure activity of likely symptom to manifest: *
vigabatrin is: * 1 point
1 point
A. Agitation
A. Block of sodium ion channel B. Hyperthermia
B. Block of calcium ion channels C. Bradycardia
C. Facilitation of GABA actions on chloride channels D. Myocardial infarction
D. Glutamate receptor antagonism E. Seizures
E. Inhibition of GABA transaminase
134. This drug reversibly inhibits the binding
130. Which of the following is responsible for of fibrin and other ligands to the platelet
the metabolism of ester local anesthetics? * glycoprotein IIb/IIIa receptor. *
1 point 1 point
A. Pseudocholinesterase A. Abciximab
B. Cytochrome P450 enzymes B. Ticlopidine
C. Renal elimination C. Ticagrelor
D. Biliary elimination D. Cilostazol
E. All of the above E. Dipyridamole

131. Which of the following nondepolarizing 135. Adolfo M is 28 year old male with history
skeletal muscle relaxant is known to have the of podagra. Which of the following drugs is
ability to release histamine? * most likely to exacerbate his condition? *
1 point 1 point
A. Cisatracurium A. Cholestyramine
B. Succinylcholine B. Ezetimibe
C. Rocuronium C. Gemfibrozil
D. Pancuronium D. Niacin
E. Tubocurarine E. Simvastatin

132. Aaron M is 28 year old male who is 136. Which of the following is a known
depressed because his girlfriend broke up with estrogen receptor antagonist in all tissues? *
him on his birthday and after giving her 1 point
Swarovski as birthday gift. He then ingest
A. Anastrozole
several iron-containing supplements. What B. Exemestane
immediate treatment is necessary? * C. Fulvestrant
D. Danazole
1 point E. Abarelix
A. Activated charcoal
137. This drug is used in advanced prostate
B. Oral deferasirox
C. Parenteral deferoxamine cancer that acts as a competitive inhibitor of
D. Parenteral dantrolene
androgen receptor: *
E. Parenteral erythropoietin
1 point
133. Aaron M is a 28 year old male who knew
A. Flutamide
that her girlfriend was seen at a Christmas B. Ketoconazole
party kissing another man. He is very C. Finasteride
D. Ganirelix
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

E. Leuprolide

138. This drug is used in hyperparathyroidism

and its mechanism of action is to activate the
calcium-sensing receptor: *
1 point

A. Calcitonin
B. Raloxifene
C. Denosumab
D. Cinacalcet
E. Ibandronate

139. This protease inhibitor is associated with

the development of nephrolithiasis: *
1 point

A. Darunavir
B. Amprenavir
C. Indinavir
D. Ritonavir
E. Tipranavir

140. This drug acts as a centrally acting

antitussive agent: *
1 point

A. Butamirate
B. Bromhexine
C. Brompheniramine
D. Buprenorphine
E. All of the above

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 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

B. Absence of colon
C. Absence of ileocecal valve
TOPNOTCH GENESIS D. Absence of colon
E. None of the above

DIAGNOSTIC EXAMS 145. Primary cancer of which organ most

commonly metastasize to the thyroid? *
(240 ITEMS) 1 point
* Required A. Lung
B. Colon
SURGERY (141-160) C. Adrenals
141. Which of the following types of hernia is D. Kidney
E. Liver
described as Hernia that contains the
antimesenteric wall of the intestines? * 146. You are the surgery intern that was
1 point asked by the attending surgeon to check for
A. Richter hernia the initial reading of the thyroid specimen. The
B. Littre’s hernia resident pathologist then told you that there is
C. Spigelian Hernia
D. Amyand’s hernia
presence of amyloid in the thyroid tissue.
E. Pantaloon hernia Before he was able to tell you the diagnosis,
you were called by the attending to quickly
142. The Gail model is a validated breast
report to him. What thyroid disease will you
cancer risk assessment tool that is primarily
quickly study before you go back to the
based on breast cancer risk factors. Which of
attending surgeon? *
the following is not included in estimating the
1 point
Gail risk? *
A. Papillary thyroid carcinoma
1 point
B. Medullary thyroid carcinoma
A. Age C. Hurthle cell carcinoma
B. History of previous breast biopsy D. Follicular carcinoma
C. Prior history of radiation exposure E. Thyroid lymphoma
D. Age at menarche
E. Age at first live birth 147. A 45 y/o female came in for breast
ulceration. She said that it started as a breast
143. This is the most common type of anal
mass that grew in size and eventually became
fistula: *
bigger. There are no palpable axillary lymph
1 point
nodes. The patient’s breast cancer is at least
A. Perianal
B. Transphincteric
what stage based on your history and physical
C. Intersphincteric examination? *
D. Supralevator
E. Extrasphincteric 1 point

A. Stage IIIA
144. All of the following are considered risk B. Stage IIIB
factors for the development of short bowel C. Stage IIIC
D. Stage IIID
syndrome, except: * E. Stage IV
1 point

A. Small bowel length of <300cm

 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

148. Based on Nyhus classification of hernia, cm mass on the mid appendix. You requested
Type IIIA is what type of hernia: * for a histopathology which came back positive
1 point for appendiceal carcinoid. What is your next
A. Indirect hernia best step? *
B. Direct hernia 1 point
C. Femoral hernia
D. Recurrent hernia: Direct A. Right hemicolectomy
E. Combination of hernia B. Extended right hemicolectomy
C. Radiation therapy
149. Which of the following patient is not a D. Adjuvant chemotherapy
E. Appendectomy is enough
candidate for liver transplantation? *
1 point 154. Patient is a 35 year old female coming in
A. One nodule measuring 6 cm for anterior neck mass. You requested a a
B. 3 nodules measure 2.5cm, 1.6 cm and 2.8 cm neck ultrasound which revealed multiple
C. Without vascular invasion
D. Absence of metastasis enlarged lymph nodes. The patient reported
E. Child C that she has persistent cough hence you
requested for a chest X ray which revealed a
150. What is the best management for a
solitary nodule in which a final diagnosis of
patient with a type 3 choledochal cysts? *
metastatic Papillary thyroid carcinoma was
1 point
given. What is the stage of the disease? *
A. Segmental liver resection
B. Liver transplantation 1 point
C. Sphincterotomy
A. Stage I
D. Roux-en-Y hepaticojejunostomy
B. Stage II
E. Whipple’s procedure
C. Stage IIIA
D. Stage IIIB
151. It is the most common congenital E. Stage IV
anomaly of the pancreas *
155. The following are true regarding
1 point
ulcerative colitis, except? *
A. Annular pancreas
B. Wilkie’s syndrome 1 point
C. Pancreas divisum
A. There is equal distribution between male and
D. Pancreatic hypoplasia
female
E. Pseudocyst
B. Smoking can cause disease
C. Appendectomy is protective
152. Which of the following does not inhibit D. It involves the rectum and extends proximally to
spontaneous closure of a fistula? * involve all or part of colon
E. None of the above
1 point

A. Foreign body 156. Which of the following features suggests

B. Radiation malignancy in a thyroid nodule? *
C. Infection
D. Epithelization 1 point
E. Long tract
A. Microcalcifications
B. Irregular margins
153. Anthony O is a 28 year old male who is C. Increased nodular blood flow
admitted for acute appendicitis. He underwent D. Hyperechogenicity
E. None of the above
laparoscopic appendicitis which you note a 1.5
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

157. The following are factors predictive of

high risk for malignancy of the thyroid,
except: *
1 point

A. Bilateral disease
B. Extrathyroidal extension
C. Tumor >4cm in diameter
D. Female sex
E. None of the above

158. In which of the following cases does

prophylactic cholecystectomy not indicated. *
1 point

A. Sickle cell disease

B. Hereditary spherocystosis
C. Porcelain gall bladder
D. Cardiac transplant patients

159. Which of the following is not considered a

hard signs of vascular injury? *
1 point

A. Pulsatile bleeding
B. Palpable thrill or bruit
C. Expanding hematoma
D. Peripheral nerve deficit
E. None of the above

160. Depth of invasion in cases of malignant

melanoma is important in prognostication.
Invasion to the base of papillary dermis is
what Clark’s level? *
1 point

A. I
B. II
C. III
D. IV
E. V

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 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

history is unremarkable. No recent history of

TOPNOTCH GENESIS antibiotic use. What is your choice of antibiotic

for this patient? *
DIAGNOSTIC EXAMS 1 point

A. Amoxicillin
(240 ITEMS) B. Piperacillin- tazobactam
C. Levofloxacin
* Required D. Meropenem
E. Cefuroxime
INTERNAL MEDICINE (161-180)
161. Acute kidney injury can be classified into 165. Patient is a newly diagnosed case of
prerenal, intrinsic, and postrenal causes. extrapulmonary tuberculosis of the liver. What
Which of the following is considered as a is the best antibiotic regimen for this case? *
prerenal cause of acute kidney injury? * 1 point

1 point A. 2HRZE 4HR

B. 2HR 10 HR
A. ACE-I induced C. 2HRZES 1 HRZE 5HRE
B. Vasculitis D. 2HRES 1HRZE 9 HRE
C. Malignant hypertension E. 2HR 4HRZE
D. TTP-HUS
E. All of the above 166. All of the following are characteristic of
162. Which of the following is true regarding pleural fluid that will require you to do an
antibiotic-induced acute kidney injury? * invasive procedure, except: *
1 point 1 point

A. Aminoglycosides and amphotericin B both cause A. Loculated pleural fluid

glomerular injury B. Presence of gross pus
B. Typically manifests after 3-5 days of therapy C. Pleural fluid pH <7.20
C. Can present even after the drug has been D. Positive gram stain
discontinued E. None of the above
D. Hypermagnesemia is a common finding
E. None of the above 167. A 28 year old male comes in with
complaints of difficulty of breathing. PE
163. Which of the following chest pain
revealed a hyper resonant right hemithorax
characteristics has the highest likelihood of
with deviation of his larynx to the left. Which of
acute myocardial infarction? *
the following disease can lead to the patient’s
1 point
current status? *
A. Radiation to left arm
1 point
B. Associated with diaphoresis
C. Associated with nausea and vomiting A. Centriacinar emphysema
D. Described as pressure B. Panacinar emphysema
E. Radiation to right arm or shoulder C. Paraseptal emphysema
D. Irregular emphysema
164. You are an IM intern in the ER when a E. All of the above
45/F came in with 1 week history of cough.
168. Aaron M is a 28M consulted you at the
Awake, alert, oriented. RR 29, PR 120, Temp
OPD with presence of rash on his extensor
of 38, 100/70 mmHg. PE revealed a crackles
surface of elbow and his gluteal area. PE
on the right lower lung area. Past medical
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

revealed well circumscribed erythematous 172. The following are indications for
plaques with silvery scales. Which of the hemodialysis in tumor lysis syndrome
following is the most common type of this except? *
disease? * 1 point

1 point A. Serum uric acid of 11mg/dL

B. Serum creatinine of 12mg/dL
A. Plaque type
C. Increasing serum phosphate
B. Guttate Type
D. Asymptomatic hypercalcemia
C. Pustular type
E. All are indications for dialysis
D. Arthritic type
E. Eruptive type
173. According to KDIGO guideline in the
169. Guttate type psoriasis presents with management of chronic kidney disease. What
many small erythematous, scaling papules is the suggested protein intake of patients with
frequently appears after: * or without diabetes with a GFR of
1 point <30ml/min? *
A. Corticosteroid use 1 point
B. Ultraviolet exposure
A. 0.6 g/kg/day
C. Infection
B. 0.8 g/kg/day
D. Pregnancy
C. 1.2 g/kg/day
E. Trauma
D. 1.4 g/kg/day
E. 1.6 g/kg/day
170. Which among the following is not a
known treatment for hyperkalemia? * 174. The following are true regarding restless
1 point legs syndrome, except: *
A. Kayexelate 1 point
B. Diuretics
A. Patients report a creepy-crawly or unpleasant
C. Salbutamol
deep ache within the thighs or calves
D. Hemodialysis
B. Dysesthesias and restlessness are much worse
E. None of the above
in the evening and first half of the night
C. The nocturnal discomfort usually interferes with
171. Which of the following is true regarding sleep, and patients may report daytime sleepiness
bacterial vaginosis? I. Fishy odor with addition as a consequence
D. Treated by addressing the underlying cause such
of 10% KOH II. Microscopy findings include as iron deficiency if present, but otherwise
vaginal epithelial cells with paired gram symptomatic treatment
E. None of the above
negative cocci III. Caused by infection of
Gardnerella vaginalis IV. Treatment includes 175. Which of the following presents with ST
Metronidazole per orem * elevation?I. Pericarditis II. Myocardial
1 point infarction III. Left ventricular aneurysm *
A. I, II, III and IV 1 point
B. II, III, IV only
A. I, II, III
C. I,III,IV only
B. I, and II only
D. I, II, III only
C. II and III only
E. II, and IV only
D. I and III only
E. II only
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

B. Bacille-calmette guerin
176. Which of the following is/are a result of
C. Phenacetin
prolonged QT: I. Sudden death II. Ventricular D. MESNA
E. Warfarin
arrhythmia III. Stokes Adams syndrome *
1 point
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177. Aortic insufficiency is related to which of
the following: I. Rheumatic heart disease II.
 Forms
Ehlers Danlos syndrome III. Bi-aortic valve
disease *
1 point

A. I, II, III
B. I, and II only
C. II and III only
D. I and III only
E. II only

178. Asterixis is present in which of the

following conditions: I. Hepatic
encephalopathy II. Uremia III. Focal brain
lesions *
1 point

A. I, II, III
B. I, and II only
C. II and III only
D. I and III only
E. I only

179. Having a fractional excretion of sodium of

>2% is suggestive of which of the following
causes: *
1 point

A. Pre-renal cause
B. Intrinsic renal cause
C. Post-renal cause
D. Sodium overload
E. All of the above

180. Which of the following medications can

causes urogenital cancer? *
1 point

A. Mitomycin
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

B. Fetal skull has reached pelvic floor

C. Sagittal suture is in anteroposterior diameter
TOPNOTCH GENESIS D. Rotation does not exceed 45 degrees
E. Fetal head is at or on perineum

DIAGNOSTIC EXAMS 185. Which of the following is not a risk factor

for uterine rupture? *
(240 ITEMS) 1 point
* Required A. Prior uterine surgery
B. Multiparity
OB-GYNE (181-200) C. Oligohydramnios
181. In cases of placenta percreta, it occurs D. External Version
E. None of the above
when the placenta invades the: *
1 point 186. This presentation is characterized by
A. Superficial myometrium flexed hips and extended knees, and thus the
B. Deep myometrium feet are near the fetal head: *
C. Endometrial basement membrane
D. Uterine serosa 1 point
E. Endometrium A. Complete breech
B. Frank breech
182. If a single ultrasound examination is C. Incomplete breech
planned for the purpose of evaluating fetal D. Extended breech
E. Compound breech
anatomy, ACOG recommends it to be
performed at? * 187. All of the following are true regarding
1 point malpresentation, except: *
A. 14 weeks 1 point
B. 18-20 weeks A. Common complication of compound presentation
C. 20-24 weeks is umbilical cord prolapse
D. 24-28 weeks B. Mentum posterior, vaginal delivery will often
E. 28-32 weeks ensue
C. Brow presentation must convert to vertex or face
183. This is a maneuver for delivering an to deliver vaginally
infant with a shoulder dystocia where it D. Shoulder presentations are delivered via CS
E. None of the above
involves hyperflexing the mother's legs tightly
to her abdomen. * 188. Which of the following is not a known
1 point outcome of precipitous labor and delivery? *
A. Rubin Maneuver 1 point
B. Wood’s corkscrew maneuver A. Amniotic fluid embolism
C. Zavanelli maneuver B. Uterine atony
D. McRobert’s maneuver C. Brachial palsy
E. Gaskin’s maneuver D. Newborn may fall to the floor if unattended
E. None of the above
184. Which of the following is not included in
the classification of outlet forceps delivery: * 189. Which of the following is true regarding
1 point contracted outlet, except: *
A. Scalp is visible at the introitus upon separating 1 point
the labia A. 8cm or less interischial tuberous diameter
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

B. The posterior border is limited by the tip of the

194. The most common route of spread of
coccyx
C. Outlet contraction without concomitant midplane endometrial carcinoma is: *
contraction is rare
1 point
D. Disproportion between fetal head and pelvic
outlet is not sufficiently great to give rise to severe A. Direct extension
dystocia B. Lymphatic system
E. None of the above C. Transtubally
D. Hematogenous spread
190. Which of the following is the typical E. Exfoliation
presentation of patients with Asherman
195. Early decelerations can be attributed to
syndrome? *
which of the following choices? *
1 point
1 point
A. Metromenorrhagia
B. Menorrhagia A. Head compression
C. Oligomenorrhea B. Uteroplacental insufficiency
D. Menometrorrhagia C. Cord compression
E. Hypomenorrhea D. Fetal movement
E. None of the above
191. What is the age cut-off for a patient to be
196. You are rotating in the OBGYNE
considered having primary amenorrhea? *
department and the Reproductive
1 point
endocrinology and infertility consultant opted
A. 14 year old
to prescribe clomiphene citrate to her patient.
B. 15.5 years old
C. 16.5 years old Your consultant asks you about the
D. 12 years old mechanism of this drug. Which of the following
E. 12.5 years old
will you tell her? *
192. What is the most common cause of 1 point
premature ovarian failure? *
A. Stimulates follicular development for ovulation
1 point induction
B. Triggers ovulation after follicle stimulation
A. Trauma C. Release of FSH/LH form pituitary
B. Chromosomal defect D. Increases granulosa cell maturation
C. Iatrogenic E. None of the above
D. Infection
E. Metabolic 197. Which of the following is not part of
193. A 41/F coming in for abnormal vaginal semenalysis? *
bleeding. You did an internal examination 1 point

which revealed a friable mass on the cervix A. Volume

with noted extension on pelvic sidewalls. B. Concentration
C. Morphology
Which of the following is the best D. Viscosity
management for this patient? * E. Acrosomal penetration

1 point 198. All of the following are CDC

A. Radical Hysterectomy recommended inpatient management of acute
B. Chemoradiation
pelvic inflammatory disease, except: *
C. Simple Hysterectomy
D. Radiation therapy alone 1 point
E. Pelvic exenteration
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

A. Cefotetan plus Doxycycline

B. Cefoxitin plus Doxycycline
C. Clindamycin plus Gentamycin
D. Ampicillin-sulbactam plus doxycycline
E. Ceftriaxone plus Doxycycline

199. Which of the following is used as a

monotherapy for pelvic inflammatory
disease? *
1 point

A. Ceftriaxone
B. Doxycycline
C. Cefotaxime
D. Azithromycin
E. Metronidazole

200. All of the following are indications for in-

patient management of PID, except: *
1 point

A. Surgical emergencies cannot be excluded

B. Pregnant patient
C. Does not respond clinically to oral antibiotics.
D. Has nausea, vomiting and high fever.
E. None of the above

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 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

204. Which of the following is usually the first

TOPNOTCH GENESIS sign of puberty in females? *

1 point

DIAGNOSTIC EXAMS A. Menstruation

B. Thelarche

(240 ITEMS) C. Growth spurt

D. Adrenarche
* Required E. Pubarche

PEDIATRICS (201-220) 205. Which of the following is true regarding

201. Some researchers believe that excess development of the cardiovascular system? *
crying may be an early manifestation of: * 1 point

1 point A. The 2 dorsal aortae will fuse to form the the

descending aorta
A. GERD B. The proximal aorta from the aortic valve to the
B. Migraine right carotid artery arises from the aortic sac.
C. Lactose intolerance C. The first aortic arch gives rise to the stapedial
D. Cow-milk allergy artery
E. All of the above D. The 2nd aortic arch gives rise to the maxillary
artery
202. The following is true regarding crying: I. E. The 5th arch persist as a major structure in the
Occurs as a response to stimuli II. Infants who mature circulation and gives rise to the pulmonary
arteries
are consistently picked up and held in
response to distress cry less at 1 year and 206. Which of the following is true regarding
show less-aggressive behavior at 2 years old evaluation of cardiovascular system in
III. Infants who are carried close to mother, pediatric patients? I. Cyanosis at rest is often
babies cry less in societies IV. Crying peaks at overlooked by parents and may be mistaken
about 4 weeks. * for a normal individual variation in color II.
1 point
Cyanosis during crying or exercise is often
noted as abnormal by observant parents III.
A. I and II only
B. I, II and III Blue around the lips when crying vigorously
C. II and III only must be carefully differentiated from cyanotic
D. I only
E. III only heart disease IV. Chest pain is an unusual
manifestation of cardiac disease *
203. Which of the following secretes excess
1 point
gonadotropin-releasing hormone and are
responsible for a significant proportion of A. I, II, III only
B. I, II and IV only
cases of precocious puberty? * C. II, III and IV only
D. I, II only
1 point
E. I, II, III and IV
A. Prolactinoma
B. Corticotropinoma 207. Which of the following is the most
C. Somatotropinoma common cardiac malformation and accounts
D. Hamartomas
E. Gonadotropinoma for 25% of congenital heart disease? *
1 point
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

A. ASD A. Ultrasound
B. VSD B. VCUG
C. AVSD C. DMSA scan
D. Endocardial cushion defect D. MRI
E. Ostium primum defect E. CT scan

208. Which of the following is true regarding 212. In the patient above, the test came back
Patent ductus arteriosus? I. Functional closure positive for scarring and acute pyelonephritis.
of the ductus normally occurs soon after birth Which of the following is the next best step to
II. Female outnumber males 2:1 III. PDA is check for reflux? *
associated with maternal rubella infection 1 point
early in pregnancy IV. PDA persisting beyond A. Ultrasound
the 1st week of life in a term infant rarely B. VCUG
C. DMSA scan
closes spontaneously * D. MRI
1 point E. CT scan

A. I, II and III only 213. In a patient with a first episode of

B. I, II and IV only
C. II, III and IV only pyelonephritis with normal anatomy and no
D. I, II only reflux. Which of the following is best for
E. I, II, III and IV
prophylaxis? *
209. Which of the following are considered 1 point
risk factors for urinary tract infection?I. Male A. Nitrofurantoin
gender II. Pinworm infestation III. Constipation B. Amoxicillin-clavulanic acid
C. TMP-SMX
IV. Tight clothing * D. Amoxicillin
1 point E. None of the above

A. I, II and III only 214. When the foreskin is retracted proximal

B. II, III and IV only
C. I, III and IV only to the coronal sulcus and the prepuce cannot
D. I and II only be pulled back over the glans. This condition
E. III and IV only
is known as: *
210. Which of the following imaging modalities 1 point
must be requested during a typical first- A. Phimosis
episode of UTI? * B. Chordee
C. Hypospadia
1 point D. Paraphimosis
E. Epispadia
A. Ultrasound
B. VCUG
C. DMSA scan 215. The average night time sleep for a 4 year
D. MRI old child is how many hours: *
E. CT scan
1 point
211. Which of the following is the preferred A. 13.5 hours
imaging modality to check for presence of B. 12 hours
C. 11.5 hours
renal scarring or acute pyelonephritis? * D. 11 hours
1 point E. 10.75 hours
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)
216. At what age in the child development
does the lower 1st molars erupt? *
1 point
A. 8-11 months
B. 16-20 months
C. 10-16 months
D. 20-30 months
E. 36 months
217. Which of the following are/is considered
true regarding parainfluenza infections? I.
Parainfluenza virus replicate in the respiratory
epithelium II. Viruses induce cell death
through the process of apoptosis III. In
children, the most severe illness coincides
with the time of maximal viral replication IV.
Disease severity is likely related to the host
immune response to infection as much as to
direct cytopathic effects of the virus *
1 point
A. I, II, III and IV
B. II, III, IV only
C. I, II, IV only
D. I, II, III only
E. II, and IV only
218. Which of the following is true regarding
innocent murmurs? I. Medium, pitched,
vibratory or musical II. Heard best along the
left lower and midsternal border III. No
significant radiationIV. Most frequent in
children between 3-7 years old *
1 point
A. I, II, III and IV
B. II, III, IV only
C. I, II, IV only
D. I, II, III only
E. II, and IV only
219. A 7 year old male coming in for acute
onset of nausea, vomiting and crampy
abdominal pain followed by severe watery
diarrhea with blood and mucus. Which of the
following is true regarding Salmonella
infection? I. The most common clinical
presentation is acute enteritis II. The peak
incidence of Salmonella meningitis is in
infancy III. Gastric acidity inhibits multiplication
of salmonella IV. Capable of penetrating
intestinal mucosa and leads to destruction of
epithelial cells and ulcers *
1 point
A. I, II, III and IV
B. II, III, IV only
C. I, II, IV only
D. I, II, III only
E. II, and IV only
220. Which of the following is true regarding
the treatment of the above case? I. In
gastroenteritis, rapid clinical assessment,
correction of dehydration and electrolytes are
key II. Antibiotics are generally not
recommended for isolated uncomplicated
gastroenteritis III. Use of antibiotics may
shorten the excretion and lowers the risk for
chronic carrier stateIV. Antibiotics are usually
indicated in bacteremia in < 3 months and with
high-risk groups with immune compromise *
1 point
A. I, II, III and IV
B. II, III, IV only
C. I, II, IV only
D. I, II, III only
E. II, and IV only
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 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

D. No vomiting, diarrhea or malabsorptive disorder

E. None of the above
TOPNOTCH GENESIS 225. Which of the following are considered

DIAGNOSTIC EXAMS indications that mandates prolonged IV

antimicrobial therapy? *

(240 ITEMS) 1 point

* Required A. Empyema
B. S. aureus bacteremia
PREVENTIVE MEDICINE (221-240) C. Septic arthritis
D. Endocarditis
221. Which of the following is not part of the E. All of the above
point-of-care interventions of the antimicrobial
226. Appearance of classical rash of “isles of
stewardship program? *
white in the sea of red” indicates that the
1 point
patient is in what phase of dengue infection: *
A. Dose optimization
B. Streamlining or de-escalation of antimicrobial 1 point
therapy A. Viremia
C. Intravenous to oral antimicrobial therapy switch B. Febrile phase
D. Automatic 7-day stop of antibiotic C. Critical phase
E. None of the above D. Recovery phase
E. Chronic phase
222. This group of drugs requires pre-
authorization by infectious disease consultant 227. Warning signs of dengue includes which
or by AMS clinician. * of the following, except: *
1 point 1 point

A. Monitored antimicrobials A. Persistent vomiting

B. Restricted antimicrobials B. Severe abdominal pain
C. Limited antimicrobials C. Melena
D. Reportable antimicrobials D. Liver enlargement
E. Narrow-spectrum antimicrobials E. Leukopenia

223. Which of the following is not considered 228. Which of the following is not monitored in
as restricted antimicrobials? * DHF patients during critical period? *
1 point 1 point

A. Aztreonam A. Appetite
B. Vancomycin B. Capillary refill time
C. Amphotericin B C. Blood pressure
D. Linezolid D. Complete blood count
E. Fluconazole E. None of the above

224. Which of the following is not included in 229. The following are signs and symptoms of
the criteria in switching IV to PO antibiotics patients with fluid overload in dengue
based on the DOH AMS program? * management *
1 point 1 point

A. Afebrile A. Puffy eyelids

B. Normalization of C-reactive protein B. Distended abdomen
C. Tolerates oral diet C. Tachypnea
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

D. Wheezing
234. This type of causal relationship describes
E. None of the above
the agent must be present for the disease to
230. Which of the following are included in the occur, although it does not always result in
OPD management of suspected dengue disease: *
cases, except: * 1 point
1 point
A. Sufficient cause
A. Avoid red, black or brown-colored food B. Risk factor
B. Anti-emetic and proton-pump inhibitors C. Necessary cause
C. NSAID for fever D. Confounding case
D. Follow-up CBC for monitoring E. Intervening case
E. None of the above
235. Which of the following is the formula for
231. The following factors increases the positive predictive value? *
prevalence rate: I. Longer duration of disease 1 point
II. In-migration of cases III. High case fatality
A. TP/TP+FP
rate * B. TP/TP+FN
C. TN/FN+TN
1 point
D. TN/TP+FN
A. I, II and III E. TP/TN+FP
B. I and III only
C. I and II only 236. Self-breast examination is an example of
D. II and III only
which of level of prevention: *
E. III only
1 point
232. This is utilized by screening tests to rule
A. Primordial
out disease: * B. Primary
C. Secondary
1 point
D. Tertiary
A. Specificity E. Pre-disease phase
B. Sensitivity
C. Positive predictive value 237. You developed a test which serves as an
D. Negative predictive value
early marker for pancreatic cancer. You
E. Likelihood ratio
performed a test on a patient and came back
233. This type of study starts with persons positive. He then underwent surgery for
with a given disease and persons without the removal and histopathology revealed negative
disease are selected. The proportion of cases for cancer. This is an example of: *
and controlled of being exposed to a probable 1 point
risk factor are determined using which
A. True positive test
inferential statistics: * B. True negative test
C. False positive test
1 point
D. False negative test
A. Odds ratio E. Positive predictive test
B. Relative risk
C. Relative risk reduction 238. Which of the following is part of health
D. Prevalence ratio
promotion strategy: I. Health education II.
E. Prevalence odds ratio
Health protection III. Disease prevention *
1 point
 TOPNOTCH GENESIS DIAGNOSTIC EXAMS (240 ITEMS)

A. I and II only
B. I and III only
C. I only
D. I, II and III
E. III only

239. Which of the following is part of the

national TB program: I. Giving of free BCG
vaccine at birth II. Case finding III. Diagnosis
of TB IV. TB DOTS for treatment *
1 point

A. II, III, IV only

B. I, III and IV only
C. I, II and III only
D. I, II, III and IV
E. III and IV only

240. Typhoid fever is an example of: *

1 point

A. Water borne disease

B. Water-washed disease
C. Water-based disease
D. Water related insect-vector disease
E. Water contaminated disease

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