1. A 15 year old African-American girl with pale conjunctivae, Hb level of 7.

1 g/dL, complains of
recurrent bilateral thigh and hip pain. This disease disrupts protein structure at which level? *
A. Protein primary structure

B. Protein secondary structure

C. Protein tertiary structure

D. Protein quaternary structure

E. None of the above

2. A 1 month old baby with recent history of upper respiratory symptoms with absent thymic
shadow is diagnosed as a case of Severe Combined Immunodeficiency due to a deficiency of
adenosine deaminase. The accumulation of which substance leads to the lymphotoxic effects of
the disease? *
A. Adenosine

B. Deoxyadenosine

C. Hypoxanthine

D. Inosine

E. Uric acid

3. Muscular 30 year old man presents with dermatitis and inflamed tongue. On history, he
reveals that he has been consuming raw eggs as part of his training for the past 6 months.
Which vitamin is likely deficient? *
A. Ascorbic acid

B. Biotin

C. Folic acid

D. Pantothenic acid

E. Riboflavin

4. A young man goes to the dentist complaining of loosening teeth. His gums are swollen,
spongy and purplish. His fingers have multiple splinter hemorrhages along distal end of the nail.
Which vitamin is likely deficient? *
A. Ascorbic acid

B. Biotin
C. Folic acid

D. Pantothenic acid

E. Riboflavin

5. A neonate is found to have a small spina bifida affecting her bladder and lower limb function.
Which vitamin is likely deficient? *
A. Ascorbic acid

B. Biotin

C. Folic acid

D. Pantothenic acid

E. Riboflavin

6. Restriction enzymes are used to cleave genomic DNA into smaller fragments. Which of the
following single strand DNA sequences has best potential to be site of action for a restriction
endonuclease? *
A. T A G C T T

B. C T G C A G

C. A A C C A A

D. G T G T G T

E. A A A C C C

7. The thyroid hormones T3 and T4 bind to THR in the target cells. Which describes the function
of THR? *
A. Activates adenyl cylclase to produce cAMP

B. Activates the phosphoinositide cascade

C. Is a soluble guanylyl cyclase

D. Is a tyrosine kinase

E. Is a transcription factor

8. A postop patient on parenteral diet, develops angular stomatitis. Urine studies showed
excretion of 15 ug riboflavin/mg creatitine (abnormally low). Which of he following TCA cycle
enzymes is likely to be affected? *
A. Citrate synthase
B. Isocitrate dehydrogenase

C. Fumarase

D. Malate dehydrogenase

E. Succinate dehydrogenase

9. After a drinking spree, a 30/ man is admitted to the hospital with "high-output" heart failure.
Which of the following enzymes is most likely inhibited? *
A. Aconitase

B. Citrate synthase

C. Isocitrate dehydrogenase

D. Alpha-ketoglutarate dehydrogenase

E. Succinate thiokinase

10. A 6 month infant was brought to you for hypotonia, severe head lag and failure to thrive.
Labs showed metabolic acidosis, with elevated blood lactic acid, puruvate and alanine. Which of
the enzymes is probably deficient in this patient? *
A. Alanine aminotransferase

B. Phosphoenolpyruvate caroxykinase

C. Pyruvate carboxylase

D. Pyruvate dehydrogenase

E. Pyruvate kinase

11. Deficiency in thymine will lead to which clinical manifestations? *

A. Decrease in carboxylase enzyme activity

B. Decrease in serum lactate

C. Decrease in RBC transketolase activity

D. Increase in urinary methylmalonate

E. Increase in prothrombin time

12. Which of the following is inhibited by Antimycin A? *

A. NADH: CoQ reductase

B. Cytochrome oxidase
C. Cytochrome c reductase

D. ATP synthase

E. ATP translocase

13. A young high school student underwent induction for a simple surgical procedure, but was
noted to have elevating temperature, tachypnea, muscle rigidity following anesthesia, What of
the ff best explains for the pyretic effect? *
A. Hypothalamic set point increased in response to cold ambient temperature

B. Muscle produce heat from exertion of contraction

C. Uncoupling proteins allow dissipation of the mitochondrial hydrogen ion gradient releasing energy as heat

D. Metabolism of fattty acids from lipid storage depots releasing heat

E. Elevated consumption of ATP to suport muscle contraction releasing heat

14. 3 month old infant presents with hepatosplenomegaly and failure to thrive. Liver biopsy
reveals glycogen with abnormal amylopectin structure with long outer chains. Which enzymes
would most likely by deficient? *
A. Alpha-amylase

B. Branching enzyme

C. Debranching enzyme

D. Glycogen phosphorylase

E. Glycogen synthase

15. Table sugar is hydrolyzed into _ and _? *

A. Glucose and maltose

B. Glucose and galactose

C. Glucose and fructose

D. Glucose and maltose

E. Maltose and isomaltose

16. A 17/M experiences painful muscle cramps and weakness on exercise. But he has no
symptoms during mild exercise. On ischemic exercise test, his serum lactic acid levels did not
significantly increase. What is most likely the deficient enzyme? *
A. CPT II
B. Glucose -6 - phosphatase

C. Glycogen phosphorylase

D. Glycogen synthase

E. Very long chain acyl CoA dehydrogenase

17. Which of the following can be expected in a patient with pyruvate kinase deficiency ? *
A. ADP to ATP ratios elevated above normal

B. NADP+ increase relative to NADPH

C. Ribulose 5 phosphate levels decrease

D. NADH to NAD+ ratios would decrease

E. Methemoglobin levels would increase

18. Cellulose is indigestible because it contains which glycosidic bonds? *

A. Galactose (beta 1-> 4) glucose

B. Galactose (beta 1-> 6) galactose

C. Glucose (alpha 1-> 4) glucose

D. Glucose (beta 1-> 2) fructose

E. Glucose (beta 1-> 4) glucose

19. Which of the following results from mutation in the gene coding for the enzyme
hexosaminidase? *
A. Huntington

B. Lesch-Nyhan

C. Tay-Sachs

D. Amyotrophic lateral sclerosis

E. Neurofibromatosis

20. In lipid transport via lipoproteins, which of the following Apoproteins binds to and activates
lipoprotein lipase? *
A. A

B. A-II

C. B-100
D. C-II

E. E

21. Which of these strap muscles elevates the larynx? *

A. Geniohyoid

B. Omohyoid

C. Sternohyoid

D. Sternothyroid

E. Thyrohyoid

22. A 48/F underwent total thyroidectomy for a papillary thyroid carcinoma. After the surgery,
the patient noted new-onset hoarseness characterized as a change in vocal pitch. On direct
laryngoscopy, decreased vocal fold mobility was noted on the right side. Patient denied any
respiratory distress. What else might also be present in the patient? *
A. inability to`elevate the larynx

B. decreased sensation above the vocal cords on the right

C. inability to depress the larynx

D. decreased sensation below the vocal cord on the right

E. Inability to tense the vocal cord

23. An 84/M had sudden onset severe chest pain, diaphoresis, fatigue and light-headedness.
Patient had a heart rate of 37 beats per minute. ECG showed 2:1 AV block. Coronary
angiography showed 80% stenosis in the right coronary artery. Which leads would most likely
reveal ST elevation? *
A. V2 - V4

B. V4 - V6

C. II, III, avF

D. V1 - V6, I, avL

E. V3R - V6R

24. Which of the following is not contained in the spermatic cord? *

A. Vas deferens
B. Testicular artery

C. Cremasteric artery

D. Genital branch of the genitofermoral nerve

E. Deep artery of corpus cavernosa

25. A 27/M with symptoms of gastroesophageal reflux over the past year complaints of
dyspepsia. On fluoroscopy of the distal esophagus, the gastroesophageal junction was
visualized more than 2 cm above the diaphragm. The gastric fundus was seen positioned
normally below the diaphragm. What is the diagnosis? *
A. Sliding hiatal hernia

B. Paraesophageal hernia

C. Achalasia

D. Esophageal diverticulum

E. Esophegeal varices

26. The blood supply of the stomach is rich, with overlap among the vessels. This allows the
surgeon to ligate the arterial supply without risk of ischemia. Which of the the following vessels
supplies the fundus, and is usually ligated during fundoplication? *
A. Left gastric artery

B. Right gastric artery

C. Left gastroepiploic artery

D. Gastroduodenal artery

E. Short gastric artery

27. An 83/M came in for constipation and problems defecating with 2 months of evolution. A
colonoscopy was carried out, revealing a vegetated ulcerated lesion 45 cm from the anal
margin. Pathology revealed adenocarcinoma. Where was the tumor found? *
A. Descending colon

B. Sigmoid

C. Rectosigmoid

D. Rectum

E. Anus
28. A 41/M fell from his bike, causing extreme hyperextension of the right extremity at the hip
joint. He complained of pain and instability of the right hip. On MRI, it was noted that there was
a tear in an extracapsular ligament that stabilizes the hip joint. Which ligament was most likely
torn? *
A. Iliofemoral ligament

B. Pubofemoral ligament

C. Ischofemoral ligament

D. Ligamentum teres

E. Ligament of the head of the femur

29. Which of the following are NOT functions served by the pudendal nerve and its branches? *
A. Carries motor fibers to the external anal sphincter

B. Carries sensation from the anal canal inferior to the pectinate line

C. Carries sensation from the structures of the male/female superficial perineal space

D. Carries motor fibers to the muscles of the gluteal region

E. Carries sensation from the shaft of penis in males, and glans of the clitoris in females

30. A 31/F underwent a modified radical mastectomy of the right, with axillary lymph node
dissection. After the operation, there were no physical deformities, but she noted weakness of
abduction of the right arm compared to the left. What was possibly injured? *
A. Long thoracic nerve

B. Axillary nerve

C. Dorsal scapular nerve

D. Thoracodorsal nerve

E. Musculocutaneous nerve

31. 35/F office lady has carpal tunnel syndrome. The ff are features of carpal tunnel syndrome
EXCEPT? *
A. Difficulty opposing thumb

B. Tingling over lateral three and a half digits

C. Decreased sensation over the palm

D. Thenar atrophy
E. Reproduction of symptoms on tapping the middle of the wrist

32. Patient came in with foreshortened upper arm, pain and swelling. On X-ray, you noted
midshaft humeral fracture. Knowing the most commonly associated nerve injury, you
immediately check for this in your patient. *
A. Hand of benediction

B. Wrist drop

C. Claw hand

D. Tinel sign

E. Thenar atrophy

33. A soccer player had an accident in the field. On examination, you note that there is forward
sliding of the tibia over the femur. Which of the following ligaments is most likely damaged? *
A. Anterior cruciate

B. Fibular collateral

C. Patellar

D. Posterior cruciate

E. Tibial collateral

34. An athlete came in with a lower extremity injury. On examination, he has impaired
dorsiflexion of the foot, as well as loss of sensation over the first and second toe. Which is the
most likely injured nerve? *
A. Sural

B. Tibial

C. Deep peroneal

D. Superficial peroneal

E. Lateral plantar

35. Among the tarsal bones, which of the following transmits weights of the body from the tibia
to the foot and has no muscle attachments? *
A. Talus

B. Calcaneus

C. Navicular
D. Cuboid

E. Medial cuneiform

36. The sternal angle of Louis is an important clinical landmark for identifying several
anatomical points. Which of the following is NOT FOUND at the plane of the sternal angle? *
A. At the level of the manubriosternal junction

B. At the level of transverse thoracic plane that divides mediastinum into superior and inferior mediastinum

C. At the level of the carina and tracheal bifurcation

D. At the level of the 2nd costal cartilages

E. At the level of the T4 intervertebral disc

37. In a drunken brawl, a 19/M took the hit of a baseball bat on the side of his head. He had a
momentary loss of consciousness, after which he awoke and brought himself into the ER. But
minutes after speaking with the doctor, he complained of severe headache and vomiting and
lost consciousness. A lenticular density on the side was noted on CT scan. What is your
diagnosis? *
A. Subdural hemorrhage

B. Intracerebral hemorrhage

C. Subarachnoid hemorrhage

D. Epidural hemorrhage

E. Intraventricular hemorrhage

38. The human body has several exocrine glands, which secrete substances to the surface by
way of a duct. They can be classified according to the method of secretion. What method of
secretion is utilized by sebaceous glands? *
A. Merocrine

B. Apocrine

C. Holocrine

D. Mixed

E. Serous
39. These are antigen-presenting cells or dendritic cells of the skin. Histologically, they are
present in all layers of the epidermis and are most prominent in the stratum spinosum. They
contain tennis-racket shaped cytoplasmic organelles. What are they? *
A. Keratinocytes

B. Langhans cells

C. Paneth cells

D. Langerhans cells

E. Kupffer cells

40. Which of the following are widely scattered in islets of Langerhans, and secretes pancreatic
polypeptide? *
A. A cell

B. B cell

C. PP cell

D. D cell

E. None of the above

41. Patient complaining of dysuria and frequency. Urinalysis taken revealed positive Leukocyte
esterase. Urine culture was done. The bacterium isolated grows profusely on MacConkey's
agar. Positive for lactose fermentation. Which attribute determines the virulence of the
organism? *
A. Beta-lactamase

B. Fimbriae

C. Flagella

D. Glycocalyx

E. Urease

42. Patient complaining of dysuria and frequency. Urinalysis taken revealed positive Leukocyte
esterase. Urine culture was done. The bacterium isolated grows profusely on MacConkey's
agar. Positive for lactose fermentation. What is most likely source and mode of transmission for
this urinary bacterial isolate? *
A. Contamination with perianal flora

B. Hematogenous spread from kidney

C. Inadvertent inoculation with commensals on the skin

D. Transmission from uncircumcised sexual partner

E. Waterborne spread

43. A 78/M with indwelling catheter develops fever. Urine sample had alkaline pH. The
bacterium isolated has urease producing, highly motile, Gram negative bacillus. What is the
most likely complication of this bacteria? *
A. Antigen-antibody complex deposits in the glomeruli

B. Development of epididymiitis

C. Development of prostatitis

D. Formation of struvite kidney stones

E. Rapid dissemination throughout body

44. A 78/M with indwelling catheter develops fever. Urine sample had alkaline pH. The
bacterium isolated has urease producing, highly motile, Gram negative bacillus. What pathogen
is most likely involved? *
A. E. coli

B. P. mirabilis

C. P. aeruginosa

D. S. saprophyticus

E. U. urealyticum

45. 28/M with urethral purulent discharge, on Gram stained smear showed Gram negative
diplococci within PMNs. What is the diagnosis? *
A. Chancroid

B. Gonorrhea

C. LGV

D. Nongonococcal urethritis

E. Primary syphilis
46. 28/M with urethral purulent discharge, on Gram stained smear showed Gram negative rods
within PMNs. What is the appropriate therapy? *
A. Ceftriaxone

B. Ceftriaxone plus Azithromycin

C. Ciprofloxacin

D. Penicillin

E. Tetracycline

47. A pregnant mother diagnosed with erythema infectiosum is concerned for the health of her
fetus. What is the most likely outcome of fetal infection with virus causing disease? *
A. Hydrocephalus

B. Hydrops fetalis

C. Mental retardation

D. Microcephaly

E. Patent ductus arteriosis

48. A pregnant mother diagnosed with erythema infectiosum is concerned for the health of her
fetus. The effect on the fetus is caused by viral replication in which fetal cells or tissues? *
A. Cells of the aortic arch

B. Endothelial cells of the CNS

C. meninges

D. Neurons

E. Pre-erythrocytes

49. 55/M develops a rash along T6 dermatome on right side. On history, he has been taking
immunosuppressive drug therapy for a transplant. What is the etiologic agent? *
A. HSV

B. Measles

C. Molluscum contagiosum

D. Rubella

E. VZV
50. 55/M develops a rash along T6 dermatome on right side. On history, he has been taking
immunosuppressive drug therapy for a transplant. They have him acyclovir therapy to prevent
severity of which complication? *
A. postherpetic neuralgia

B. scarring from lesions

C. re-establishment of latency

D. halt spread of lesions

E. spread to CNS

51. A high school student has hepatitis panel: HBsAg negative, anti-HBsAg positive, anti-HBcAg
IgM negative, anti-HBcAg total negative, anti-HAV IgG positive, anti-HCV negative.
Interpretation is:____? *
A. Acute infection with HAV

B. Acute infection with HBV

C. Chronic infection with HBV

D. Past infection with HBV

E. Vaccinated against HBV and HAV

52. Which of the ff AIDS medicines blocks entry of HIV into cells? *
A. Efavirenz

B. Enfuvirtide

C. Fosamprenavir

D. Lamivudine

E. Ritonavir

53. A 20/M has adenopathy and maculopapular rash of the soles and palms. On history, he had
a painless sore that spontaneously resolved. What is the causative organism? *
A. Chlamydia trachomatis

B. Neisseria gonorrhea

C. Treponema pallidum

D. Borrelia burgdorferi

E. Rickettsia rickettsii
54. A patient with known case of sarcoidosis has severe hemoptysis. Imaging studies show
bronchiectasis and cavitation, with several movable masses within the cavitations. What is the
likely etiology? *
A. Rhizopus

B. Pneumocystis

C. Cryptococcus

D. Candida

E. Aspergillus

55. A patient being treated for SCCA develops pneumonia, sputum smear grows cream colored
colonies, which on microscopy has germ tubes. What is the etiology? *
A. Aspergillus flavus

B. Candida albicans

C. Coccidioides immitis

D. Cryptococcus neoformans

E. Pneumocystis jiroveci

56. A greenhouse worker has 1 month history of ulcerative nodule on her right pinky, where
she received scratches from the garden plants. She was treated with empirical antibiotics to no
avail. What is the likely etiologic organism? *
A. Acremonium spp.

B. Blastomyces dermatitidis

C. Candida tropicalis

D. Cladosporium carrionii

E. Sporothrix schenckii

57. A greenhouse worker has 1 month history of ulcerative nodule on her right pinky, where
she received scratches from the garden plants. She was treated with empirical antibiotics to no
avail. What is the appropriate treatment? *
A. AmphoB

B. Casofungin

C. Itraconazole
D. Nystatin

E. Topical bacitracin

58. A middle aged woman presents with macrocytic anemia. She loves eating pickled fish. A
stool sample reveals parasite ova. What is the likely etiologic agent? *
A. Diphyllobothrium latum

B. Echinococcus granulosus

C. Hymenolepis nana

D. Taenia saginata

E. Taenia solium

59. Brazilian man with progressively enlarging scrotum. Thick blood film with Giemsa was taken,
what organism is most likely to be found? *
A. Ancylostoma braziliense

B. Loa loa

C. Onchocerca volvulus

D. Trichinella spiralis

E. Wuchereria bancrofti

60. A 9 year old child repeatedly scratching perianal area at night. How would you diagnose the
etiologic agent? *
A. Gram stain

B. Cellophane tape technique

C. Wet smear

D. Direct visualization

E. NAAT

61. Solution A is 15 mM urea. Solution B is 10 mM urea. Both solutions are separated by a

membrane permeable to urea. If the concentration of urea in Solution B is halved, the flux
across membrane will: *
A. Not change
B. Double

C. Triple

D. Quadruple

E. Decrease to one-half

62. What is the correct sequence of events that occurs in the neuromuscular junction? (A)
Degradation of acetylcholine. (B) Depolarization of muscle membrane. ( C) Depolarization of
presynaptic membrane and calcium uptake. (D) Binding of acetylcholine to Nicotinic receptors.
(E) Release of acetylcholine into synaptic cleft. *
A. B > E > D > C > A

B. A > B > C > D > E

C. B > C > A > D > E

D. C > D > E > A > B

E. C > E > D > B > A

63. Which of the following features may be found in BOTH cardiac pacemaker and smooth
muscles? *
A. Organization into sarcomeres

B. Ca2+ influx during AP upstroke

C. Plateau during AP

D. Regulation using tropomyosin

E. Regulation using Myosin light chain kinase

64. Which receptor mediates its effect by opening Na-K channels? *

A. Alpha 1 receptor

B. Alpha 2 receptor

C. Beta 1 receptor

D. Muscarinic receptor

E. Nicotinic receptor

65. A 44/F presented with headaches and decreased visual acuity characterized as inability to
see the most lateral edges of the television screen. MRI showed suprasellar mass. What
structure was most likely encroached by the mass? *
A. Optic nerve

B. Optic chiasm

C. Optic tract

D. Geniculocalcarine tract

E. Occipital lobe

66. In the tonotopic organization of the inner ear, high frequency sounds are tranduced _? *
A. At the apex of the cochlea

B. Throughout the cochlea

C. At the base of the cochlea

D. In the Scala vestibuli

E. In the Scala tympani

67. During which phase of the cardiac cycle can S4 be heard? *

A. Atrial contraction

B. Isovolumic contraction

C. Rapid Ventricular ejection

D. Slow Ventricular ejection

E. Isovolumic relaxation

68. Which of the following demonstrates vasoconstriction in response to hypoxia? *

A. Coronary circulation

B. Cerebral circulation

C. Muscle circulation

D. Skin circulation

E. Pulmonary circulation

69. Turbulent blood flow is implicated in the pathogenesis of several aortic diseases. Which of
the following factors increases turbulence of blood flow? *
A. Increased viscosity of blood

B. Increased hematocrit

C. Increased velocity of blood flow

D. Decreased velocity of blood flow

E. A, B and C are true

70. Which of the following lung volumes is measurable by spirometry? *

A. Vital capacity

B. Functional residual volume

C. Total lung capacity

D. Physiologic dead space

E. None of the above

71. Which of the ff is NOT TRUE about Fetal hemoglobin? *

A. Beta chains are replaced by gamma chains

B. Higher O2 affinity compared to adult hemoglobin

C. Binds 2,3-diphosphoglycerate more avidly compared to adult hemoglobin

D. Has lower P50 than adult hemoglobin

E. Induces leftward shift in the Oxyhemoglobin dissociation curve

72. Knowing that barometric pressure decreases with altitude, which of the following
respiratory changes can be expected in a man who is up Mount Everest? *
A. Decreased PaO2, normal A-a gradient

B. Decreased PaO2, increased A-a gradient

C. Increased PaO2, increased A-a gradient

D. Normal PaO2, increased A-a gradient

E. Normal PaO2, decreased A-a gradient

73. A newborn presents with severe polyuria with >2L/m2 urine output, associated with
weakness, lethargy, failure to thrive and severe dehydration. Glucose levels were normal. On
measurement, there was notable urine HYPO-osmolarity, with plasma HYPER-osmolarity (>300
mOsm/L) . Serum ADH levels were normal to high. What is your diagnosis? *
A. Primary polydipsia

B. Nephrogenic diabetes insipidus

C. Central diabetes inspidus

D. Diabetes mellitus

E. Syndrome of inappropriate ADH secretion

74. A woman presents with weakness, weight loss, orthostatic hypotension, increased pulse
rate and increased skin pigmentation. On examination, she has serum hyponatremia,
hyperkalemia and serum hypoosmolarity. ABG will most likely show _. *
A. low pH, low [HCO3-], low PCO2

B. high pH, high [HCO3-], high PCO2

C. low pH, high [HCO3-], high pCO2

D. high pH, low [HCO3-], low pCO2

E. none of the above

75. Which of the following cells secretes cholecystokinin? *

A. G cells

B. S cells

C. K cells

D. M cells

E. I cells

76. Enterochromaffin-like cells secrete which of the following? *

A. gastrin

B. Intrinsic factor

C. serotonin

D. histamine

E. pepsinogen

77. The surgical resection of the GI tract has consequences on nutrition. Which of the following
may be possible sequelae of ileal resection? *
A. Fat malabsorption

B. Deficient absorption of Vitamin A

C. Megaloblastic anemia

D. Tingling sensations and paresthesias

E. All of the above

78. Which step in steroid hormone biosynthesis is stimulated by ACTH? *

A. Cholesterol -> pregnenolone

B. Progesterone -> 11-deoxycorticosterone

C. 17-Hydroxypregnenolone -> dehydroepiandrosterone

D. Testosterone -> estradiol

E. Testosterone -> dihydrotestosterone

79. Which of the following hormones acts by increasing IP3 and Ca2+? *
A. 1,25 - Dihydroxycholecalciferol

B. Nitric oxide

C. Insulin

D. Thyrotropin-releasing hormone

E. Parathyroid hormone

80. LAM or Lactational amenorrhea is a family planning method used in postpartum mothers.
Which of the following is the physiological basis of its use in family planning? *
A. Decreased prolactin levels

B. Human placental lactogen levels are increased

C. Fetal adrenal gland does not produce sufficient estradiol

D. Increased levels of estrogen and progesterone

E. Suppression of maternal anterior pituitary

81. In which of the following is there a physician-patient relationship? *

A. Autopsy Exam

B. Pre-employment PE

C. Casual consultation in a party

D. PE conducted for insurance purposes with prescription

E. Appointed by trial court to examine insanity of accused

82. All of these are inherent rights of a physician EXCEPT_? *
A. Right to compensation

B. Right to choose patients

C. Right to limit practice

D. Right to determine appropriate management procedure

E. Right to avail of hospital services

83. Dr. A receives a 2% backpay from Laboratory X, for every patient he sends to the lab for
diagnostic services. This is an example of what kind of medical fee? *
A. Contractual

B. Retainer

C. Contingent

D. Dichotomous

E. Straight

84. What is the burden of evidence needed to convict a physician for criminal charges? *
A. Substantial evidence

B. Preponderance of evidence

C. Circumstantial evidence

D. Proof beyond reasonable doubt

E. Direct evidence

85. A lap pack was left inside the abdomen of a patient. The court deemed that there is no need
for an expert to enlighten the case. This is based on which doctrine? *
A. Contributory negligence

B. Res Ipsa Loquitur

C. Last clear chance

D. Assumption of Risk

E. Superior knowledge
86. Patient C was admitted in the Psych ward. The patient fell down from the bed and incurred
a hip fracture. It was found out that the bed handles had been malfunctioning. What is the
liability of the hospital? *
A. Civil liability

B. Corporate liability

C. Criminal liability

D. Vicarious liability

E. Administrative liability

87. The physician who saw the victim in the ER was called to the court, to describe the
documented lesions on the victim's body. What kind of witness is he acting as? *
A. Document Witness

B. Expert Witness

C. Ordinary Witness

D. Conditional Witness

E. Qualified Witness

88. The physician who saw the victim in the ER was called to court, to describe the documented
lesions on the victim's body, however the physician did not show up. All of the following are
valid reasons for which a medical witness need not comply with subpoena, EXCEPT: *
A. The court issuing subpoena has no jurisdiction over the subject matter

B. The place of residence is 50 km from the court issuing the subpoena

C. The MD is attending to an emergency and no one is available as a substitute

D. The MD suffers from an infirmity which may be aggravated if he complied with the subpoena

E. The transportation expenses were not given by the party requesting his presence, in a civil case

89. Which of the following bodies is responsible for administering and conducting the licensure
examination? *
A. Board of Medical Education

B. Professional Regulatory Commission

C. Board of Medicine

D. Philippine Medical Academy

E. Philippine Medical Colleges

90. A child was suffering from diarrhea. The neighbor told the mother to give Pedialyte. Which
describes her action? *
A. Illegal practice of medicine

B. Not considered an act constituting practice of medicine

C. Committing malpractice

D. Acting under false pretenses

E. Committing fraud

91. Which of the following is the liability of a school professor enticing his 16 year old student
who is a virgin into having sexual intercourse with him? *
A. Statutory rape

B. Simple seduction

C. Qualified seduction

D. Acts of lasciviousness

E. Not a crime due to presence of consent

92. A dead fetus was discovered inside a waste bin. On examination, the fetus was 3 kg, 50 cm
long, with no lanugo hair, nails beyond fingertips and testicles in scrotum. What is the probable
age of the fetus? *
A. 3 months

B. 4 months

C. 5 months

D. 7 months

E. 9 months

93. The body of a child was unearthed from a dump site. The soft tissues were degraded, what
was left were skeletal remains. They noted the presence of 12 permanent teeth only. What is
the probable age of the body? *
A. 6-7 months

B. 6-7 years

C. 8-9 years
D. 12-13 years

E. 25 years

94. These describe the entrance of a gunshot wound EXCEPT? *

A. Smaller than bullet

B. Contact ring

C. Inverted

D. Stellate shape

E. (+) Paraffin test

95. From what distance did the assailant fire the gun, if the victim had a circular wound with
abrasion collar, and muzzle imprint? *
A. Near fire

B. Short range

C. Medium range

D. >60 cm

E. Cannot be assumed

96. A mentally defective person with mentality of a 2-7 year old and an IQ of 21-40 is classified
as which? *
A. Moron

B. Bobo

C. Imbecile

D. Mongoloid

E. Idiot

97. When a physician with an S2 license prescribes a dangerous drug, how many copies of the
prescription must be filled out and signed? *
A. One

B. Two

C. Three

D. Four
E. Five

98. According to the Dangerous Drugs Act of 2002 (RA 9165), who are required to maintain and
keep original records of the transactions on dangerous drugs? (A) practitioner, (B)
manufacturer, ( C) distributor, (D) dealer, (E) retailer *
A. A

B. A, B

C. A, E

D. A, B, C, E

E. A, B, C, D, E

99. The victim of a vehicular crash was rushed to the emergency room unconscious. The ER
doctor quickly does his physical examination and treatment as he sees fit. The consent of the
patient in this scenario is what type? *
A. Written

B. Oral

C. Implied

D. Explicit

E. No consent was given

100. A 76/M was diagnosed to have Advanced Colorectal Cancer, for which extensive surgery is
an option. Upon extensive discussion of the risks and benefits of the procedure with the
patient, he, of sound mind and good judgment, opted against surgery. What principle is being
upheld by the doctor? *
A. Beneficence

B. Non-maleficence

C. Justice

D. Autonomy

E. Truth
101. A 70/F suddenly lost consciousness and on awakening, she could not speak or move her
right arm. After a few months, Cranial CT scan showed a cystic area in the L parietal lobe. Which
pathologic process has most likely occurred in the brain? *
A. Coagulative necrosis

B. Liquefactive necrosis

C. Gangrenous necrosis

D. Caseous necrosis

E. Fat necrosis

102. A patient with joint pain is taking Aspirin. The aspirin therapy alleviates pain by reducing
which mediators? *
A. Complement C1q

B. Histamine

C. Leukotriene E4

D. Nitric oxide

E. Prostaglandins

103. 75/M had emergency operation for accidental fracture of the left femoral trochanter. 2
weeks later, he complains of sudden onset dyspnea and desaturation. On PE, the left leg is
swollen, with pain on movement of the leg. What complication has occurred? *
A. DIC

B. Fat embolism syndrome

C. Gangrenous necrosis of the foot

D. Hematoma of the thigh

E. Pulmonary thromboembolism

104. A 12 year old boy presents with chronically productive cough associated with shortness of
breath and wheeze. He also reported of lethargy, night sweats and weight loss. Sweat test
revealed a high chloride level of 81 mmol/L (high). Subsequent genetic testing confirmed
1040G>C p mutation and Exon 14b deletion present. How is this inherited? *
A. Autosomal dominant

B. Autosomal recessive
C. X-linked recessive

D. Trinucleotide repeat disorders

E. Mitochondrial inherirance

105. A 16/F presents with primary amenorrhea.On physical exam, you take note of short
stature, cystic hygroma over the neck, positive cardiac murmur and absence of breasts and
pubic hair over the mons. What is her most probable chromosomal set? *
A. 47XXY

B. 46XX

C. 45XO

D. 46 XY

E. 46 XY

106. A 30/F has an erythematous rash over her cheeks, pleuritic chest pain and peripheral
edema. Labs show increasing serum creatinine, and urinalysis shows proteinuria with RBC casts
Which autoantibody is specific for the patient's condition? *
A. Centromere

B. Cyclic citrullinated polypeptide

C. DNA topoisomerase I

D. Smith

E. U1-RNP

107. A 2 yo boy with Meckel diverticulum underwent surgical management. Ectopic gastric
tissue was found in the histopath specimens of the diverticulum. What describes the gastric
tissue? *
A. Carcinoma

B. Sarcoma

C. Metaplasia

D. Hamartoma

E. Choristoma

108. A college student developed fever and lymphadenopathy. CBC showed atypical
lymphocytes. Monospot test was negative. What is the etiologic agent? *
A. measles

B. Herpes

C. Varicella

D. CMV

E. EBV

109. 4/M, cyanotic with failure to thrive. Noted decreased pulmonary vascular markings and
RVH with a characteristic boot-shaped heart. What is the diagnosis? *
A. ASD

B. VSD

C. PDA

D. TOF

E. TGA

110. Among the different causes of pneumonia, which of these often complicates viral illness
and has high rate of empyema and abscess formation? *
A. Streptococcus pneumoniae

B. Haemophilus influenzae

C. Moraxella catarrhalis

D. Staphylococcus aureus

E. Klebsiella pneumoniae

111. 22/F, with a parotid mass. Excision biopsy was done, and showed nests of benign looking
epithelial cells, occasionally forming duct-like structures, embedded in a myxoid stroma. *
A. Pleomorphic adenoma

B. Mucoepidermoid carcinoma

C. Warthin tumor

D. Adenoid cystic carcinoma

E. None of the above

112. Crohn's Disease is characterized by which of the following? *

A. Noncaseating granulomas
B. Superficial mucosal ulceration

C. Commonly affects only rectum and descending colon

D. Absence of fibrosis

E. All of the following

113. An adolescent girl with history of sore throat 3 weeks prior to onset of symptoms, with an
increased ASO titer, and decreased C3. What will come out on IF of her kidney? *
A. Granular IgG and Complement in capillary walls and mesangium

B. Linear IgG and C3 along GBM

C. negative for IgG and complement

D. mesangial IgA

E. None of the above

114. Schiller Duval bodies can be found in _? *

A. Seminoma

B. Embryonal carcinoma

C. Endodermal sinus tumor

D. choriocarcinoma

E. Teratoma

115. A reproductive age woman with breast tenderness has a biopsy showing fibrosis, increase
in the number of acini per lobule, and cystic dilatation of the acini; some which show apocrine
metaplasia. What is the diagnosis? *
A. Fibrocystic change

B. Epithelial hyperplasia

C. Sclerosing adenosis

D. Intraductal papilloma

E. Complex sclerosing lesion

116. Which of the following has Orphan Annie nuclei and Psammoma bodies? *
A. Papillary carcinoma

B. Follicular adenoma
C. Follicular carcinoma

D. Anaplastic carcinoma

E. Medullary carcinoma

117. A young adolescent with inability to flex his back, notes bamboo stick appearance on Xray.
What marker may be positive? *
A. HLA-B1

B. HLA-B2

C. HLA-B27

D. HLA-B28

E. HLA-DR1

118. What are the findings in ALS? *

A. Thinned out anterior horn neurons

B. Atrophy of the cranial nerve motor nuclei

C. Corticospinal tract degeneration

D. A and B only

E. All of the above

119. A teenager with recurring headaches had a CT angiography done showing bag of worms
appearance in cranium. What is the diagnosis? *
A. MS

B. Subarachnoid hemorrhage

C. AVM

D. Parkinsons

E. AD

120. Where can Flexner-Wintersteiner rosettes be found? *

A. Medulloblastoma

B. Glioblastoma

C. Oligodendroglioma

D. Retinoblastoma
E. Meningioma

121. Phase 4 clinical trials involve which of the following? *

A. Collection of data regarding late-appearing toxicities from patients previously studied in phase 1 trials

B. Double-blind, closely monitored evaluation of new drug in hundreds of patients with the target disease

C. Evaluation of the new drug under conditions of actual use in 1000-5000 patients with the target disease

D. Measurement of pharmacokinetics of the new drug in normal volunteers

E. Postmarketing surveillance of drug toxicities

122. Which of the following when used in combination with other drugs of similar structure,
requires INCREASE in dosage of administration of drug to achieve the same effect? *
A. Cimetidine

B. Fluoroquinolone

C. Grapefruit juice

D. Phenobarbital

E. Erythromycin

123. Which of the following describes the mechanism of action of Botulinum toxin on
autonomic transmission? *
A. Inhibits action potential propagation

B. Inhibits transmitter synthesis

C. Inhibits transmitter storage

D. Inhibits transmitter release

E. Receptor blockade

124. A 29/M self-administered a drug with the intention of suicide, in the hospital. Within
minutes, the patient was brought to the ER. Patient had fever T 39.8 C, maximally dilated
pupils, HR of 140s, BP of 170/110. Mucus membranes were very dry. After stabilization of the
breathing and circulation of the patient, which of the ff drugs must be administered? *
A. Atropine

B. Physostigmine
C. Phenothiazine

D. Pralidoxime

E. N-acetylcysteine

125. A 32/F hypertensive wishes to become pregnant. Which of the following is absolutely
contraindicated for her? *
A. Losartan

B. Methyldopa

C. Atenolol

D. Nifedipine

E. Propanolol

126. Which of the following anti-arrhythmics has a very broad spectrum of action: blocking
sodium, calcium, potassium channels and Beta adrenoreceptors? Some notable side effects of
this drug include thyroid abnormalities and pulmonary fibrosis. *
A. Verapamil

B. Lidocaine

C. Procainamide

D. Flecainide

E. Amiodarone

127. A 20/M is taking diphenhydramine for severe hay fever. Which of the following adverse
effects is he most likely to report? *
A. Increased bladder tone

B. Nausea

C. Nervousness, anxiety

D. Sedation

E. Vertigo

128. Your patient complains that he develops wheezing and severe shortness of breath
whenever he takes aspirin for headache. Your are suspecting Aspirin Hypersensitivity. Increased
levels of which of the following may be responsible for this effect? *
A. PGE2
B. Leukotriene LTC4

C. Thromboxane

D. Prostacyclin

E. Cyclooxygenase

129. In patients with Parkinsons Disease whose symptoms are not sufficiently controlled by
levodopa-carbidopa, Entecapone can be given. The action of Tolcapone is which of the ff? *
A. Activates COMT

B. Decreases formation of 3-O-methyldopa

C. Inhibits monoamine oxidase A

D. Inhibits neuronal reuptake of dopamine

E. Releases dopamine from nerve endings

130. Patients on Lithium treatment are monitored for their plasma levels, because overdosages
can contribute to severe toxicity. Which of the following, if found in your patient, can increase
lithium levels in the blood? *
A. Dehydration

B. Thiazides

C. ACE inhibitors

D. Loop diuretics

E. All of the above

131. A woman was found to have macrocytic anemia on CBC. On workup, she had increased
serum transferrin, normal Vitamin B12. Which of the following is likely deficient? *
A. Cobalamin

B. Erythropoietin

C. Folic acid

D. Intrinsic factor

E. Iron

132. A 57/M presented with intense pain, warmth, redness of the first toe of left foot after an
"inuman". Joint fluid was shown to have uric acid crystals. High doses of colchicine were used to
reduce pain and inflammation. Which of the following side effects are most likely to occur? *
A. Psychosis

B. High blood pressure

C. Rash

D. Severe diarrhea

E. Sudden GI Bleed

133. A 24/F with Graves disease is started on thionamides. Which is a rare, serious toxicity that
should be watched out for? *
A. Agranulocytosis

B. Lupus erythematosus-like syndrome

C. Myopathy

D. Torsades de pointes arrhythmia

E. Thrombotic thrombocytic purpura

134. A patient with Chronic Heart Failure NHYA III, is diagnosed to have Diabetes mellitus on
admission. Which of the following drugs are contraindicated? *
A. Insulin

B. Metformin

C. Glipizide

D. Rosiglitazone

E. Exenatide

135. A 33/M complains of dysuria and urethral discharge of pus. He noted a painless ulcer on
the penis, which spontaneously resolved. Gram stain of the urethral exudate showed gram
negative diplococci within WBCs. The most appropriate treatment should be: *
A. Single IM dose of Ceftriaxone

B. Amoxicillin orally for 7 days

C. Procaine penicllin G IM single dose plus oral probenicid

D. Meropenem orally for 5 days

E. Vancomycin IM single dose

136. Your patient needs antibiotic treatment for an infective enterococcal endocarditis. He
recalls that he has a medical history of severe anaphylactic shock to Penicillin G. The best
approach is to treat with? *
A. Ticarcillin

B. Ceftriaxone

C. Aztreonam

D. Amoxicillin-Clavulanate

E. Vancomycin

137. Which of the following antihelminthics acts by increasing membrane permeability to

calcium, causing marked contraction and then paralysis of trematode and cestode muscles,
followed by vacuolization and parasite death? *
A. Albendazole

B. Diethylcarbamazine

C. Praziquantel

D. Ivermectin

E. Mebendazole

138. A patient arrived at the ER with methanol poisoning. Which of the following is an ideal
antidote? *
A. Deferoxamine

B. Fomepizole

C. Naloxone

D. Physostigmine

E. Pralidoxime

139. Ondansetron is commonly given for chemotherapy-related nausea and vomiting. What
class of drug is Ondansetron? *
A. 5-HT3 antagonist

B. 5-HT2 blocker

C. 5-HT3 blocker

D. 5-HT4 agonist
E. 5-HT1B/D agonist

140. Which of the following herbal products can have significant interactions causing
sympathomimetic effects (hypertension, stroke)? *
A. Dong qual

B. Garlic

C. Ginseng

D. Kava

E. Ma huang (ephedra)

141. 50/M came in for a growing pigmented lesion of the forearm. On biopsy, it was noted to
be malignant melanoma Which is the most common type of melanoma? *
A. Superficial spreading

B. Nodular sclerosis

C. Acral lentiginous

D. Lentigo maligna

E. Ulcerative

142. 50/M came in for a growing pigmented lesion of the forearm. On biopsy, it was noted to
be malignant melanoma. Which is the most accurate predictor of clinical prognosis ? *
A. Age

B. T cell infiltration

C. Diameter of primary tumor

D. Clark level of invasion

E. Breslow depth of invasion

143. 26/M with acute nausea and vomiting and abdominal pain radiating to the back following
a binge drinking session. On PE, T 38.8, HR 110, Bp 110/60, RR 28. The abdomen is distended
and tender. WBC 18, LDH 300. Amylase is markedly elevated at 6800. CXR shows a little pleural
effusion. What is the most probable diagnosis? *
A. Acute cholecystitis
B. Alcoholic intoxication

C. Malingering

D. Acute pancreatitis

E. Acute appendictis

144. 26/M with acute nausea and vomiting and abdominal pain radiating to the back following
a binge drinking session. On PE, T 38.8, HR 110, Bp 110/60, RR 28. The abdomen is distended
and tender. WBC 18, LDH 300. Amylase is markedly elevated at 6800. CXR shows a little pleural
effusion. What is the most crucial management step ? *
A. Antibiotic therapy

B. Fluid resuscitation

C. CT of the pancreas

D. Cholecystectomy

E. Measuring Lipase

145. 26/M with acute nausea and vomiting and abdominal pain radiating to the back following
a binge drinking session. On PE, T 38.8, HR 110, Bp 110/60, RR 28. The abdomen is distended
and tender. WBC 18, LDH 300. Amylase is markedly elevated at 6800. CXR shows a little pleural
effusion. Which of the following are indications for surgery? *
A. Intractable pain

B. Bowel obstruction

C. Biliary obstruction

D. Persistent symptomatic psudocysts

E. All of the above

146. An otherwise healthy 33 year old man presents with a large primary spontaneous
pneumothorax. What is the immediate management? *
A. Tube thoracostomy or needle aspiration

B. Immediate CXR

C. Intubation

D. Packing with 3 way valve

E. Surgical excision
147. An otherwise healthy 33 year old man presents with a large primary spontaneous
pneumothorax. Which of these findings support pleural effusion and not pneumothorax? *
A. RR>33

B. Agitation

C. Somnolence

D. Dullness to percussion over chest wall on affected side

E. Cough

148. An otherwise healthy 33 year old man presents with a large primary spontaneous
pneumothorax. Which of these findings are consistent with left tension pneumothorax? *
A. Hypotension, distended neck veins, midline trachea, muffled heart sounds

B. Hypotension, open wound in left lateral chest

C. Hypotension, diminished breath sounds on left, tracheal deviation to the right, CXR showing opacification
of left hemithorax

D. Diminished left breath sounds, tracheal deviation to the right

E. Diminished left breath sounds, tracheal deviation to the left

149. Which of the ff are NOT part of ERAS? *

A. Early mobilization

B. No prolonged fasting

C. Non-opioid oral analgesia

D. Low thoracic epidural anesthesia/analgesia

E. Avoidance of salt and water overload

150. What is the Infection Rate of a traumatic stab wound to the chest, according to its
Operative Wound Class? *
A. 1-2%

B. 8-11%

C. 15%

D. >28-40%

E. <1%
151. Which of the following are NOT criteria for positive Diagnostic Peritoneal Lavage in
anterior abdominal stab wounds? *
A. RBC >100,000/mL

B. WBC >500 /mL

C. Amylase >19 IU/L

D. ALP > 2 IU/L

E. Bilirubin >1 mg/dL

152. Penetrating injuries to the neck above the angle of the mandible are part of which Zone? *
A. Zone I

B. Zone II

C. Zone III

D. Zone IV

E. Zone V

153. Which of the following warrants referral to a burn center? *

A. PTB> 10% TBSA

B. Burn involving hands

C. Electrical burn

D. Chemical burn

E. All of the above

154. Which of the ff is marker used for medullary thyroid cancer? *

A. TRH

B. Thyroid antibody

C. Thyroid thyroglobulin

D. Calcitonin

E. Total T4

155. Which of the following is an indication for Parathyroidectomy? *

A. Serum Ca > 1mg/dL over ULN

B. Hypercalcemic crisis
C. Kidney stone

D. Age <50

E. None of the above

156. Which of the following provides route for spread of metastasis from breast cancer to the
vertebrae? *
A. Batson's vertebral plexus

B. Axillary artery branches

C. Posterior intercostal artery branches

D. Internal mammary artery branches

E. None of the above

157. Among breast cancer signs and symptoms, which is the most important prognostic
correlate of survival? *
A. Size of mass

B. Axillary lymph node status

C. Distant metastasis

D. Pain associated with the mass

E. Skin changes associated with the mass

158. What antibiotics are given to Open fractures longer than 10 cm according to the Anderson-
Gustilo Classification? *
A. Cefazolin 1g every 8 hours for 48 hours after each debridement

B. Cefazolin 1g every 8 hours and Aminoglycoside, 3-5 mg/kg/day for 72 hours after each debridement

C. Penicillin 2 Million units every 4 hours or Metronidazole, 500 mg every 6 hours for 72 hours after each
debridement

D. Cefazolin 1g every 8 hours and Aminoglycoside, 3-5 mg/kg/day and Penicillin 2 Million units every 4 hours

E. None of the above

159. What is the management of imperforate anus, with rectal pouch below the levator ani
muscle? *
A. Anoplasty in neonatal period

B. Colostomy then PSARP at a later date

C. Medical management

D. Expectant management

E. None of the above

160. What is the origin of the midbrain? *

A. Telencephalon

B. Diencephalon

C. Metencephalon

D. Mesencephalon

E. Myelencephalon

INTERNAL MEDICINE (161-180)

161. An 18/F comes in for health maintenance check-up. She has not had a Pap smear
previously. She takes OCPs. She began being sexually active 6 months ago. Which of the ff
statements is true? *
A. A pap smear should not be performed in this patient at this time.

B. HPV vaccine should be administered only if she has high risk for genital warts.

C. The most common cause of mortality for this patient would be suicide.

D. Hepatitis C vaccine should be offered.

162. A 63/M comes in for health maintenance check-up. He is asking about varicella zoster
vaccine. Which of the ff is true? *
A. This vaccine is recommended for patients 65 and older.

B. This vaccine is not recommended for patients who have already developed shingles.

C. This vaccine is a live attenuated virus.

D. This vaccine has some cross-reactviity with HSV and offers some protectiin against HSV.

E. None of the above.

163. 56/M, 40 py-smoker, dyslipidemic, has chest pain characterized as severe retrosternal
pressure >30 mins long. On PE, you note hypertension, tachycardia, diaphoresis. On cardiac
exam, he has an S4 gallop. What critical diagnostic should be ordered? *
A. Coagulation profile

B. 12L ECG

C. 2d Echo

D. Treadmill stress test

E. Angiography

164. 56/M, 40 py-smoker, dyslipidemic, has chest pain characterized as severe retrosternal
pressure >30 mins long. On PE, you note hypertension, tachycardia, diaphoresis. On cardiac
exam, he has an S4 gallop. On ECG, he is noted to have ST elevation in leads V2-V4. If you are
considering Fibrinolysis, which of the following is NOT a CONTRAINDICATION to fibrinolysis? *
A. Prior intracranial hemorrhage

B. Ischemic stroke within 3 months

C. Suspected aortic dissection

D. Active heavy bleeding including menses

E. Known structural cerebral vascular lesion

165. 56/M, 40 py-smoker, dyslipidemic, has chest pain characterized as severe retrosternal
pressure >30 mins long. On PE, you note hypertension, tachycardia, diaphoresis. On cardiac
exam, he has an S4 gallop. On ECG, he is noted to have ST elevation in leads V2-V4. Which of
the following vessels were likely occluded? *
A. RCA

B. LCX

C. LAD

D. marginal artery

E. none of the above

166. 56/M, 40 py-smoker, dyslipidemic, has chest pain characterized as severe retrosternal
pressure >30 mins long. On PE, you note hypertension, tachycardia, diaphoresis. On cardiac
exam, he has an S4 gallop. On ECG, he is noted to have ST elevation in leads V2-V4. He
undergoes PCI and is discharged home well. Several weeks after, he returns complaining of
fever, pleural chest pain. On PE, you note of pericardial friction rub. What complication has
occurred? *
A. Papillary muscle dysfunction
B. Papillary muscle rupture

C. Ventricular septal rupture

D. Ventricular aneurysm

E. Dressler syndrome

167. A 26/F has chronic cough associated with unintentional weight loss with diminished
appetite. On PE, he has a low grade fever with few scattered crackles in the left mid lung fields.
His CXR shows right upper lobe reticulonodular and left lower lobe alveolar opacities with
cavitation. What is the appropriate management? *
A. Meropenem 2g IV OD until lysis of fever

B. HRZE for 2 months then HR for 4 months

C. Cessation of cigarette smoking

D. Chemotherapy

E. Bronchodilator PRN

168. The 26/F has been given the appropriate therapy. After 3 months, he complains of
numbness and tingling of both feet but no back pain. What is the most appropriate next step? *
A. CT of lumbar spine

B. Initiate pyridoxine

C. Continue agents and monitor for neurologic workup

D. Initiate workup for TB adenopathy compression on the femoral nerve

E. Cessation of TB drugs

169. On workup, sputum smear turns out AFB positive. What medication can be given if the 26
year old patient is pregnant? *
A. No medication until pregnancy is done

B. HRZE2/HR4 in half dose

C. HR9/ES2

D. HRE6

E. HRZE2/HR4

170. A 23/M has a firm nontender ulcer on his penis with small nontender inguinal lymph nodes
bilaterally. What is the appropriate management? *
A. Single dose intramuscular penicillin G 2.4 mU

B. Single dose intramuscular Ceftriaxone 250 mg

C. Azithromycin 1g per orem

D. Doxycycline 100 mg BID x 14 days

E. He does not need any treatment

171. A 23/M has a firm nontender ulcer on his penis with small nontender inguinal lymph nodes
bilaterally. After appropriate management has been given, which serologic marker will indicate
successful treatment? *
A. FTA-ABS becomes negative

B. RPR drop in titers

C. RPR increase in titers

D. Resolution of the lesion

E. MHA-TP becomes negative

172. A 32/F with 5 year history of HIV has CD4 count of 100 cells/mm3. She is admitted to the
hospital with 2 week history of fever, dyspnea and dry cough. What will confirm diagnosis? *
A. Silver stain or Direct Fluorescence antibody of sputum

B. Gram stain of sputum showing gram positive diplococci

C. Acid fast smear of sputum

D. Serum cryptococcal antigen

E. ABG

173. A 44/F coinfected with HIV is noted to have CD4 count of 180 cells/mm3. Which of the
following is recommended as useful prophylactic agent? *
A. Fluconazole

B. Azithromycin

C. TMP-SMX

D. Ganciclovir

E. None of the above

174. A patient comes in for fasting plasma glucose test. On two separate tests, noted FBS 115
mg/dL and 120 mg/dL. Which of the following is the most appropriate next step? *
A. Reassurance that these are normal blood sugar

B. Recommend weight loss, ADA diet and exercise

C. Diagnose diabetes mellitus and start on sulfonylurea

D. Recommend cardiac stress testing

E. Obtain stat ABG and serum ketone levels

175. Which of the following oral drugs for diabetes mellitus is contraindicated in patients with
congestive heart failure? *
A. Sulfonylurea

B. Metformin

C. Thiazolidinedione

D. GLP-1 agonist

E. DPP-4 inhibitor

176. Which of the following have demonstrated benefit for preventing progression of
proteinuria and kidney disease in patients diagnosed with T2DM? *
A. Beta blocker

B. Calcium channel blocker

C. ACE or ARBs

D. Diuretics

E. Ampalaya capsules

177. A 72/M develops severe pain and swelling in both knees. PE shows warmth and swelling of
both knees with large effusions. Arthrocentesis of the R knee reveals weakly positive
birefringent crystals in the synovial fluid. gram stain is negative. What is the diagnosis? *
A. Gout

B. Septic arthritis

C. Calcium oxalate deposition disease

D. Reactive arthritis

E. Pseudogout

178. The combination of Rheumatoid arthritis, splenomegaly, leukopenia, lymphadenopathy

and thrombocytopenia is called _? *
A. Sly syndrome

B. Felty syndrome

C. Fanconi syndrome

D. Caplan's syndrome

E. Reiter's syndrome

179. 22/M with low back pain for 5 months and stiffness of the lumbar area which worsens
with inactivity. He reports difficulty getting out of bed in the morning, needing to roll out
sideways. Lumbosacral Xray will likely show? *
A. Degenerative joint disease with spur formation

B. Sacroilitis with increased sclerosis around the sacroiliac joints

C. Vertebral body destruction with wedge fractures

D. Osteoporosis with compression fractures of L3-L5

E. Diffuse osteonecrosis of LS spine

180. 36/F with pain in hands, wrists and knees is diagnosed with rheumatoid arthritis. Which of
the ff treatments reduces joint inflammation and slows progression of the disease? *
A. NSAID

B. Joint aspiration

C. Methotrexate

D. Intraarticular steroid

E. Systemic corticosteroid

OB-GYN (181-200)

181. The following physiologic changes in the respiratory system occur during pregnancy
EXCEPT? *
A. Functional residual capacity decreases

B. Residual lung volume decreases

C. Respiratory rate increases

D. Tidal volume increases

E. Peak expiratory flow rate increases

182. To maximize passive antibody transfer to the fetus, a dose of Tdap is ideally given to
gravidas: *
A. before 20 wks AOG

B. 14 – 28 wks AOG

C. 24 – 28 wks AOG

D. 27 – 36 wks AOG

E. Anytime during the pregnancy

183. Case: On assessing a gravid female in labor: A large nodular mass, with uneven surface was
palpated with the fundal grip.A flat hard convex structure was palpated on the maternal left
side, while small nodular structures were palpated on the maternal right side. A hard ballotable
mass was palpated on the Pawlik’s grip. On the pelvic grip, the cephalic prominence was
palpated on the maternal lower right side. // Which of the following is true? *
A. longitudinal, cephalic, flexed

B. longitudinal, cephalic, extended

C. longitudinal, breech, complete

D. longitudinal, breech, footling

184. Case: On assessing a gravid female in labor: A large nodular mass, with uneven surface was
palpated with the fundal grip.A flat hard convex structure was palpated on the maternal left
side, while small nodular structures were palpated on the maternal right side. A hard ballotable
mass was palpated on the Pawlik’s grip. On the pelvic grip, the cephalic prominence was
palpated on the maternal lower right side. / /If the sagittal suture aligns in the transverse plane
of the maternal pelvis, what is the fetal position? *
A. Right occiput transverse

B. Left occiput transverse

C. Right occiput anterior

D. Left occiput anterior

185. You receive a primigravida at the ER. She is having moderate to strong uterine contractions
every 5 minutes. Her cervix is 5 cm dilated at 6 am. Three hours later, the cervix is 6 cm dilated.
At 10 am, her cervix is 7 cm dilated. What is your assessment? *
A. Normal progress of labor

B. Arrest in cervical dilatation

C. Protracted active phase dilatation

D. Prolonged deceleration

E. Secondary arrest of dilatation

186. A G2P1 with 7 weeks missed period presents with one week diagnosis of vaginal bleeding
and hypogastric pain. Cervix is 1 cm open with intact membranes. What is the diagnosis? *
A. Recurrent abortion

B. Imminent abortion

C. Inevitable abortion

D. Threatened abortion

E. Missed abortion

187. Which of the following is utilized for the medical treatment of ectopic pregnancy? *
A. Dexamethasone

B. Vincristine

C. Methotrexate

D. Adriamycin

E. Progesterone

188. A 29/ G3P2 patient is s/p evacuation of H mole 6 weeks ago. On monitoring, there was
noted elevation of hCG titers for 3 consecutive intervals. What intervention is warranted? *
A. Continue observation of titers

B. Repeat suction curettage

C. Start systemic chemotherapy

D. Start brachytherapy

E. Hysterectomy for Persistent Disease

189. A 38/ G4P3 at 32 wks AOG consulted for sudden-onset severe headache with loss of vision
on one eye. She has a family history of hypertension. She was never hypertensive during her
pregnancies. She was first seen today with a BP of 160/100 mmHg. Urine protein is +1. The
diagnosis is: *
A. Pre-eclampsia

B. Pre-eclampsia with Severe Features

C. Chronic hypertension with Superimprosed Preeclampsia

D. Gestational hypertension

E. Eclampsia

190. In pregnancy, epilepsy itself is not associated with an elevated fetal malformation rate.
Rather, it is the anticonvulsant therapy which is associated with fetal malformations, especially
in polytherapy. Which of the ff. anticonvulsant medication is associated with increased risk of
clefts? *
A. Valproate

B. Phenytoin

C. Phenobarbital

D. Lamotrigine

E. All of the above

191. Which of the following is NOT a derivative of the urogenital sinus? *

A. Skene’s glands

B. Bartholin’s glands

C. Cowper’s gland

D. Prostate gland

E. Vestibular bulb

192. Which of the following warrants an investigation for Primary Amenorrhea? *

A. 13 y/o female gymnast who has never menstruated

B. 14 y/o female cellist without any breast development

C. 12 y/o female student who has not yet menstruated, breast development occurred a year ago

D. 11 y/o female who has never menstruated

193. Which is the present drug of choice for GnRH dependent precocious puberty? *
A. Selective estrogen receptor modulator

B. Aromatase inhibitor
C. Pure estrogen receptor antagonist

D. GnRH agonist

194. A 29 y/o woman was being worked up for failure to conceive despite 3 years of regular
unprotected coitus. She is regularly menstruating. IE is normal. Her serum FSH and estradiol
levels are normal. HSG showed normal outline of the uterus without spillage of dye into the
abdomen. What is the probable cause of infertility? *
A. Ovulatory factor

B. Tubal factor

C. Uterine factor

D. Cervical factor

E. Male factor

195. An 84/ G10P10 was brought in by her daughter, for a palpable vaginal mass extending
beyond her introitus on straining. She noted difficulty urinating and defecating. She has poorly
controlled hypertension and a history of MI s/p revascularization. Which of the following
present the best option for her condition? *
A. Cerclage

B. Pessary

C. Uterosacral fixation with McCall’s culdoplasty

D. Vaginal estrogen cream

E. Oral Hormone replacement therapy

196. A 45 y/o comes in for intermenstrual spotting. On speculum exam, there was a reddish
pink, glistening 2 x 2 cm mass with stalk, protruding from the cervix. What is the management?
*
A. Observation

B. Office polypectomy

C. Hysteroscopic polypectomy

D. Curettage

E. Endometrial biopsy
197. A 25/G1P1 s/p Cesarean section, was noted to have ectopic endometrial glands and
stroma in the abdominal wall. What is the most likely pathogenesis? *
A. Retrograde menstruation

B. Lymphatic and vascular menstruation

C. Metaplasia

D. Iatrogenic dissemination

E. Inflammation

198. A 28/G0 presented with oligomenorrhea, hirsutism, acne, deep voice and dull abdominal
pain. Serum testosterone levels were 520 ng/dL (normal 15-70 ng/dL). Ultrasound revealed an
echogenic mass 7 cm x 6 cm in the right ovary. What is the most appropriate management? *
A. Observation

B. GnRH agonist

C. Metformin and diet modification

D. Unilateral salpingo-oophorectomy

E. Total hysterectomy and bilateral salpingo-oophorectomy

199. Which of the following tumor markers associated is used in epithelial ovarian cancers, for
demonstrating therapy response and detecting tumor progression? *
A. CA-125

B. Inhibin

C. CEA

D. AFP

E. LDH

200. Pap smear is a routine screening method used to detect for abnormal cells of cervical
cancer. Which area is the most common place on the cervix for abnormal cells to develop? *
A. Transition zone

B. Transformation zone

C. Transversion zone

D. Squamo-columnar junction
PEDIATRICS (201-220)

201. A 6 year old boy presents with fever, petechiae, hepatosplenomegaly and 1 week history
of leg pain and limping. Which is the most appropriate FIRST step in the diagnosis? *
A. Karyotype

B. CBC with platelets and differential

C. Bone marrow biopsy

D. Flow cytology

E. Blood culture

202. A 6 year old boy presents with fever, petechiae, hepatosplenomegaly and 1 week history
of leg pain and limping. Which markers suggest good prognosis for his disease? *
A. 1- 9 years old

B. WBC > 500,000

C. T(4;11)

D. CNS leukemia

E. Mediastinal mass

203. 10 year old boy presents with wheezing, dry cough worse at night, bouts of chest
tightness, especially during the PE classes, where he jogs in the cold. What is the confirmatory
test? *
A. Chest Xray

B. Bronchioalveolar lavage

C. Spirometry

D. CBC with eosinophils

E. Auscultation of wheeze

204. Which of the ff is NOT an essential medication for acute asthma exacerbation? *
A. Montelukast

B. Albuterol

C. Prednisone

D. Ipatropium
E. Levalbuterol

205. Increased pulmonary flow from large left to right shunts can cause pulmonary
hypertension resulting in conversion to right to left shunt of blood. What is the DEFINITIVE
treatment for this phenomenon? *
A. Bronchodilator

B. Beta blocker

C. Steroids

D. Transplant

E. Nitrates

206. Which congenital heart disease has physical finding of fixed splitting of 2nd heart sound? *
A. VSD

B. ASD

C. PDA

D. Coarctation of the aorta

E. None of the above

207. A previously healthy term infant suddenly develops respiratory distress on day 3 of life.
Echo reveals Coarctation of the aorta. Which is the most appropriate immediate treatment? *
A. Digoxin

B. Furosemide

C. Albuterol

D. Racemic epinephrine

E. Prostaglandin

208. Which of the following is NOT an important part of the initial evaluation of a heart
murmur? *
A. CXR

B. ABG

C. Echocardiogram

D. Pulse oximetry
E. ECG

209. An otherwise normal 2 year old boy has prolonged focal seizure associated with fever,
lasting <15 minutes, with no recurrence. What is the diagnosis? *
A. Simple febrile seizure

B. Complex febrile seizure

C. Bacterial meningitis

D. Epilepsy

E. Status epilepticus

210. 8 month old boy has refractory eczema that was first noticed at 2 months of age. His past
medical history reveals multiple episodes of otitis media and pneumonia. He has now
developed severe nose bleeds. You suspect a primary immunodeficiency. Which is the next best
test in your evaluation? *
A. Sweat chloride test

B. Chest CT

C. CBC

D. CD4 cell count

E. referral to ENT for nasal endoscopy

211. A toddler with fatigue, decreased appetite, periorbital discoloration ("raccoon eyes") and
multiquadrant abdominal mass. What is the likely diagnosis? *
A. Functional cyst

B. Hepatoma

C. hepatoblastoma

D. Wilms tumor

E. Neuroblastoma

212. A toddler with smooth, well-defined, left sided mass that doesn’t cross the midline,
associated with hematuria and hypertension. What is the likely diagnosis? *
A. Functional cyst

B. Hepatoma

C. hepatoblastoma
D. Wilms tumor

E. Neuroblastoma

213. A teenager comes in with purpuric lesions on both shins, joint pain, blood in urine and
guiac-positive stool. What is the potential complication? *
A. Renal failure

B. GI bleeding

C. Intususception

D. Proteinuria

E. All of the above

214. A teenager comes in with purpuric lesions on both shins, joint pain, blood in urine and
guiac-positive stool. What is the best next step in management? *
A. Begin a course of systemic steroids

B. Begin empiric antimicrobial therapy for sepsis

C. Obtain a urinalysis and provide supportive care

D. Perform aspiration of the synovial fluid in his painful joint

E. Administer IVIG

215. A 6 week old male has projectile emesis after feeding. He has olive shaped abdominal
mass on PE. Which of the ff is true? *
A. He likely has hypochloremic metabolic alkalosis.

B. He likely has metabolic acidosis

C. This condition is more common in female infants

D. He should be restarted on feeds when vomiting resolves

E. He likely will develop diarrhea.

216. At 3 weeks of life, a former 33 week gestation infant develops poor feeding, abdominal
distention, vomiting and bloody stools. He has also had several apneic episodes and
temperature instability overnight. Which would you expect to see on imaging? *
A. Double bubble sign

B. Absence of colonic gas

C. Decreased or absent air in the rectum with dilated loops of bowel proximally
D. Air in the wall of the small intestine

E. Target sign

217. A 2/F comes in with petechiae on upper and lower extremities. 2 weeks prior, she had
fever and URTI symptoms which spontaneously resolved. Her platelet count is 25,000/mm3.
WBC is 9000/mm3, Hb is 11 mg/dL. What is the diagnosis? *
A. Henoch-Schonlein purpura

B. Thrombotic thrombocytopenic purpura

C. Immune thrombocytopenic purpura

D. Hemolytic uremic syndrome

E. Leukemia

218. A 2/F comes in with petechiae on upper and lower extremities. 2 weeks prior, she had
fever and URTI symptoms which spontaneously resolved. Her platelet count is 25,000/mm3.
WBC is 9000/mm3, Hb is 11 mg/dL. What is the next step in management? *
A. Review the peripheral blood smear

B. Administer IVIG

C. Send a blood culture and begin empiric antimicrobial therapy

D. Order a platelet transfusion

E. Arrange for bone marrow biopsy

219. The child sits unsupported, uses a raking grasp, transfers objects from one hand to
another, and babbles. He is most likely of what age? *
A. 1 mos

B. 3 mos

C. 6 mos

D. 9 mos

E. 12 mos

220. The child crawls well, pulls to stand and cruises, with immature pincer grasp, says mama
and dada indiscriminately, gestures and waves bye bye. He is most likely of what age? *
A. 1 mos

B. 3 mos
C. 6 mos

D. 9 mos

E. 12 mos

PREVENTIVE MEDICINE (221-240)

221. A new Salmonella test kit is being developed. In a study population of 300 people, 36
people who were culture positive, turned out positive by the test kit. 9 culture positive people
had negative results on the test kit. In the meantime, 25 people who had negative cultures
turned out positive for Salmonella on the test kit. 230 people were negative on both culture
and the test kit. What is the sensitivity? *
A. 0.80

B. 0.90

C. 0.59

D. 0.25

E. 0.85

222. A new Salmonella test kit is being developed. In a study population of 300 people, 36
people who were culture positive, turned out positive by the test kit. 9 culture positive people
had negative results on the test kit. In the meantime, 25 people who had negative cultures
turned out positive for Salmonella on the test kit. 230 people were negative on both culture
and the test kit. What is the specificity? *
A. 0.80

B. 0.90

C. 0.59

D. 0.25

E. 0.85

223. A new Salmonella test kit is being developed. In a study population of 300 people, 36
people who were culture positive, turned out positive by the test kit. 9 culture positive people
had negative results on the test kit. In the meantime, 25 people who had negative cultures
turned out positive for Salmonella on the test kit. 230 people were negative on both culture
and the test kit. What is the Positive predictive value? *
A. 0.80

B. 0.90

C. 0.59

D. 0.25

E. 0.85

224. A new Salmonella test kit is being developed. In a study population of 300 people, 36
people who were culture positive, turned out positive by the test kit. 9 culture positive people
had negative results on the test kit. In the meantime, 25 people who had negative cultures
turned out positive for Salmonella on the test kit. 230 people were negative on both culture
and the test kit. What is the prevalence? *
A. 0.80

B. 0.90

C. 0.35

D. 0.50

E. 0.15

225. A large pharmaceutical company released a press conference that they were developing a
vaccine for COVID. They declared that the drug had been tested on a moderate number of
patients with the disease and is now beginning an RCT to compare results vs. current standard
of care. Which stage of drug trial is the company currently in? *
A. Phase I

B. Phase II

C. Phase III

D. Phase IV

226. Your aunt recently took a rapid antigen test for a disease. Her results turned out to be
positive. You look up the brand of the antigen test and note that the disease has high sensitivity
and low specificity. Based on this, what can you tell your aunt: *
A. You tell your aunt that because the test is highly sensitive, it is probably a true positive

B. You tell your aunt that because the test has low specificity, there is a high chance that it is a false positive

C. You tell your aunt that the test is unreliable because a good test must have both high specificity and high
sensitivity to be valid
D. None of the above

227. During an RCT, one of the researchers happened to come across a scrap of paper with the
name of his patient listed as part of the group being given a drug. The doctor then noticed
sudden drastic improvement of the patient over the course of the treatment on par with the
patients who were improving the most. What phenomenon is being demonstrated here? *
A. Confirmation bias

B. Pygmalion effect (Observer-expectancy bias)

C. Hawthorne Effect (Observation bias)

D. A and B only

228. The number of dengue cases in a particular area has been on the rise. The local
government, as a result, has allocated more funds to offer free treatment to those that contract
the illness. What level of disease prevention is this? *
A. Primary disease prevention

B. Secondary disease prevention

C. Tertiary disease prevention

D. Quaternary disease prevention

229. Which of the following is a form of secondary prevention? *

A. Treating a pregnant person infected with syphilis

B. using condoms during sexual intercourse

C. Folic acid supplementation

D. Pap smear

230. A popular barangay official got into an accident on Christmas eve. In the emergency room,
his wife, his children, his parents, and the entire barangay apparently came to make sure that
he was being treated properly. While the entire group have different opinions on what should
be done, ultimately the person who is legally asked to give consent for anything done to the
patient would be: *
A. Parents of the patient

B. Wife of the patient

C. Children of the patient

D. The barangay captain as the financier of the treatment

231. A study compared 150 children with a particular disease with 300 disease free children to
examine past experience that may contribute to the development of illness. What type of study
is this? *
A. Cohort

B. RCT

C. Case series

D. Case control

E. Meta-analysis

232. A study followed babies with Hydrocephalus and babies without hydrocephalus for
neurologic sequelae as they grow older. What type of study is this? *
A. Cohort

B. RCT

C. Case series

D. Case control

E. Meta-analysis

233. The following procedures are covered by Philhealth except? *

A. Dialysis

B. Chemotherapy

C. Cancer treatment

D. Liposuction

E. None of the above

234. Which of the ff is not a qualified dependent who can avail of Philhealth benefits? *
A. Live in partner

B. Step parent

C. Illegitimate children

D. 21 y/o with disability

E. None of the above

235. Mr. X is a 45 y/o male applying for pre-employment examination for a job as a
construction worker. He is hypertensive being controlled on amlodipine. Assessment is: *
A. Class A

B. Class B

C. Class C

D. Class D

E. Class X

236. The exposure to this mineral dust may present with egg shell pattern on CXR *
A. Silica

B. Cotton dust

C. Coal dust

D. Asbestos

E. Gold

237. The exposure to this mineral dust may present with diaphragmatic or pericardial
calcifications and thickening on CXR *
A. Silica

B. Cotton dust

C. Coal dust

D. Asbestos

E. Gold

238. Retinopathy, nephropathy and diabetic foot complications fall under what stage of natural
history of disease? *
A. Stage of susceptibility

B. Pre-clinical

C. Clinical disease

D. Disease outcome

239. The member of the family is very satisfied with the way the rest of the members support
their aspirations and dreams in life. What aspect of family APGAR is this? *
A. Adaptation

B. Growth

C. Partnership

D. Resolve

E. Affection

240. What is a cost effective way and public health measure used today to prevent dental caries
*
A. Proper nutrition

B. Regular dental visits

C. Iodization of salt

D. Water fluoridation

E. Promotion of toothpaste