WRITTEN REVALIDA

Topic: Clinical Part

S.Y.: 2021-2022

PART 1 – Original Score was 63/100 5. The MOST common precipitating event for cardiac instability in infants and
1. What artery/ies supply the female bladder? children is:
 Vaginal Artery  Myocarditis
 Inferior gluteal artery  Poisoning
 Superior vesical artery  Respiratory Insufficiency - this is also the answer in Nelson MCQ
 Superior vesical, vaginal and inferior gluteal artery  Electrolyte Imbalance
 Superior vesical and vaginal artery  Trauma

2. What should be a part of the delivery plan due to asthma?

 Avoid oxygen use
 Prophylactic antibiotics 6. Regarding Glasgow coma scale in
 Avoid carboprost use – this is a PGF2a drug pediatrics, all the following are true EXCEPT:
 Avoid pushing  Score <8 require aggressive
management
 It has 3 components
 Valid as a prognostic scoring
system
3. Which among the following is NOT a vector-borne disease?  In modified type it uses 15 score
 Pneumonia points
 Leishmaniasis – sandfly  Verbal response Component has 5
possible points
 Dengue fever – female aedes aegypti
 Malaria – female anopheles
According to Nelson:
4. These facts are true regarding the developmental stage of preschool children
EXCEPT:
 Egocentric Thinking
 Handedness is achieved by 3 years of age
 Boys are usually later than girls in achieving bladder control
 Masturbation
7. A 3-year old girl presented with recurrent attacks of chest infection and
 Knowing gender by 4 years frequent episodes of chronic diarrhea, stool examination revealed Giardia
lamblia and serum IgA level was very low. Regarding this condition, all the
following are true EXCEPT:
 Phenotypically normal blood B cells
 Autosomal dominant inheritance
 It is associated with a celiac-like syndrome with dramatic response to
gluten-free diet
 Environmental factors may trigger the disease
 Administration of IVIG is not indicated

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8. Childhood psychosis may include all the following EXCEPT: 13. Sudden increase in proteinuria and blood pressure in a previously well-
 Disorganized speech controlled hypertensive pregnant patient:
 Loss of reality testing  Preeclampsia-eclampsia
 Catatonic behavior  Preeclampsia superimposed on chronic hypertension
 Delusions  Chronic hypertension
 Acute phobic hallucinations – this is the answer also in Nelson MCQ  Gestational hypertension

14. A 24-year old G2P1001 is status post spontaneous vaginal delivery 5 min ago.
The placenta has delivered without issue. The patient begins to have heavy
vaginal bleeding. What FIRST steps should be taken to evaluate the patient?
 The vagina should be packed immediately
9. Gestational DM risk assessment: High risk  Ultrasound should be performed to assess for retained placenta
EXCEPT:  Lacerations should be ruled out with thorough visual assessment of
 Weight normal before pregnancy vaginal area
 Severe obesity  The bladder should be emptied and a bimanual pelvic exam should
 Previous history glucosuria be performed
 Previous history of impaired glucose
Based on Obstetric Essentials: A question-based review
metabolism

10. For women at Higher risk of having a fetus affected with a neural tube defect,
what is the daily recommended folic acid intake?
 4 grams
 40 milligrams
 400 micrograms
 4 milligrams
15. Which among the following items can be considered as indirect mode of
transmission of an infectious agent? – answer is obvious since there is a vector
 Repeated and long-term contact with a person who has leprosy
11. What is the plasma half-life of intact hCG?  Aedes aegypti that has bitten a patient with dengue fever, then bites
 12 hours another person
 48 hours  Sexual intercourse with someone known to have HIV infection
 8 hours  Exposure and close contact to a coughing person who unknowingly
 24 hours has COVID-19

16. Which of the following is TRUE in regard to neural tube defects?

 Neural tube is normally complete by the onset of the second week
12. What is the most common cause of primary postpartum hemorrhage? after conception (4 weeks after the last period)
 Defects in coagulation  Affect the ventral column and urogenital diaphragm
 Retained placenta  Most common congenital anomaly worldwide
 Vaginal laceration  Can be isolated or occur as part of a genetic syndrome
 Uterine Atony

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17. Ingestion of large doses of vitamin C can cause: 21. A highly educated young couple has their first baby with Down syndrome;
 Musculoskeletal pain they are asking you about his development. Of the following, the MOST
appropriate answer is:
 Severe headache
 Respiratory symptoms
 Programs of stimulation will achieve eventual normal development

 Osmotic diarrhea
 Motor development is the mostly affected domain with fair cognitive
delay
 Hematemesis
 Developmental delay is universal, all domains of development almost
equally affected
18. Patients with sickle cell anemia are at increased risk for:  Developmental delay will be in the initial first few years, but it will
normalize later on
 Multifetal gestations
 Gestational diabetes
 Developmental delay is universal, social development is relatively
spared but he will have problems with expressive language
 Preterm labor
 Macrosomia From Nelson:

19. A pregnant patient has heard about the hepatitis A vaccine and asks if she
should receive it. She is an IV drug user and has fatty liver disease. You counsel
her:
 Yes, it is recommended because of her drug use
 Yes, it is recommended for all pregnant women 22. What factors are assessed regularly in prenatal care in a pregnant asthmatic?
 No, because it is contraindicated in patients who have chronic liver  Maternal weight
disease  Maternal O2 saturation
 No, it is contraindicated during pregnancy. She may receive it at her  Fetal growth
postpartum visit.  Placental grade

Based on Obstetric Essentials: A question-based review

23. DiGeorge syndrome is an example of:
 Numeric chromosomal disorder
 Single gene disorder
 Contiguous gene disorder
 Mitochondrial inheritance disorder
 Imprinting disorders

20. Of all races, which group has the highest prevalence of anemia in pregnancy?
 Multiparous mothers
 Mothers of low income 24. What are the two most common causes of anemia in pregnancy and the
 Teenaged mothers puerperium period?
 Mothers of advanced age  Acute blood loss and sickle cell anemia
 Iron deficiency and acute blood loss
Based on Obstetric Essentials: A question-based review  Hemoglobinopathies and iron
deficiency
 Iron deficiency and hemolysis

25. Comparisons of affected and unaffected persons lead to the identification

of: - unsure of this one
 Sensitivity
 Case fatalities
 Prognosis
 Risk factors

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26. Which among the following doesn’t characterize non-communicable 29. What is the difference between primary and secondary postpartum
diseases? hemorrhage?
 With long term treatment  Primary postpartum hemorrhage occurs within the first 12 h of
 Usually of single cause delivery and secondary hemorrhage occurs between 12 h and 6-12
weeks postpartum
 With insidious onset
 Involves multispecialty care
 Primary postpartum hemorrhage occurs within the first 24 h of
delivery and secondary hemorrhage occurs between 24 h and 6-12
weeks postpartum
 Primary postpartum hemorrhage occurs within the first 48 h of
delivery and secondary hemorrhage occurs between 48 h and 6-12
weeks postpartum
 Primary postpartum hemorrhage occurs within the first 72 h of
delivery and secondary hemorrhage occurs between 72 h and 6-12
weeks postpartum

27. A person’s intact skin protects against invading microorganisms:

 First line of defense, reflexes
 Second line of defense: cellular action
 First line of defense, natural barrier
 Second line of defense, humoral action

30. Which of the following increases the risk for shoulder dystocia?
 Labor induction
 Labor induction, operative vaginal delivery and obesity
 Obesity
 Operative vaginal delivery
 Labor induction and operative vaginal delivery

28. In males, the first visible sign of puberty is testicular enlargement, beginning
as early as:
 9.5 year
 10.5 year
 12.5 year 31. The diagnosis of allergic rhinitis is established by the time the child reaches
 8.5 year age of:
 11.5 year  6 yr
 2 yr
 4 yr
 8 yr
 10 yr

32. This can provide us an objective evidence of the presence of disease:

 Diagnostic testing
 Searching for prognostic factors
 Testing of new treatment
 Determining natural history of disease

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33. What are the two common indications for post partum hysterectomy? 37. The MOST appropriate treatment of homocystinuria is:
 Uterine atony and uterine inversion  Methionine
 Placenta accreta and uterine atony restriction
 Coagulation abnormalities and placenta accreta  Vitamin C
 Coagulation abnormalities and uterine atony  Vitamin B6
 Betaine

38. Probiotics are oral supplement or a food product that contains a sufficient
number of viable microorganisms (live microorganisms that are most often
referred to as “friendly” or “good” bacteria). Probiotics are indicated in all the
following EXCEPT:
 Inflammatory bowel disorders
 Constipation
 Protein losing enteropathy
34. In the ecologic triad, which among the following does NOT characterize an  Antibiotic associated diarrhea
agent?  Irritable bowel syndrome
 Cannot directly cause a disease process – they can directly cause disease
(e.g. virus, bacteria)
 Can be animate or inanimate
 Serves as stimulus for disease development
 May be an element, substance or force

Agent originally referred to an infectious microorganism or pathogen: a virus, bacterium,

parasite, or other microbe. Generally, the agent must be present for disease to occur; however,
presence of that agent alone is not always sufficient to cause disease. A variety of factors influence
whether exposure to an organism will result in disease, including the organism’s pathogenicity 39. A 6 year old girl that looks tall and thin with light skin. On examination she
(ability to cause disease) and dose. has a peculiar malar flush, subluxation of the ocular lens, developmental delay,
Over time, the concept of agent has been broadened to include chemical and physical causes of
and severe hypertension. Of the following, the MOST likely cause of
disease or injury. These include chemical contaminants (such as the L-tryptophan contaminant
responsible for eosinophilia-myalgia syndrome), as well as physical forces (such as repetitive hypertension is:
mechanical forces associated with carpal tunnel syndrome). While the epidemiologic triad serves  Coarctation of aorta
as a useful model for many diseases, it has proven inadequate for cardiovascular disease, cancer,
and other diseases that appear to have multiple contributing causes without a single necessary  Thromboembolism
one.  Renal artery stenosis
 Atherosclerosis
35. A 6- year old tall and thin boy who had failed preparatory exam for school
entry found to have myopia and subluxation of the ocular lens. Of the following,  Hyperthyroidism
the MOST important challenge is to know whether he is responsive to:
 Vitamin B12 – Cobalamin
 Vitamin E
 Vitamin B6 - Pyrodixine
 Vitamin C
 Folic acid - B9

40. Inborn errors of metabolism (IEM) are hereditary biochemical disorders

caused by single- gene mutations that result in alteration of:
 Chromosomal number or structure
 Primary protein structure or the amount of protein synthesized
36. The following are indications for genetic counseling EXCEPT:
 Primary fat structure or the amount of fat synthesized
 Family history of intellectual disability
 Mitochondrial synthesis or function
 Maternal age >45 years
 Primary carbohydrate structure or the amount of carbohydrate
 Paternal age >50 years synthesized
 Infertility
 Consanguinity

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41. Ms. Montoya II admitted to the hospital. On admission, her temperature is 45. A 2 year old toddler was playing with candles and sweets in playroom, he
38.3 C. Her serum creatinine is 0.7 mg/dL, her hemoglobin is 12g/dL and her developed an attack of wheezing and shortness of breath, the parents brought
white blood cell count is 18,000/mm3. A catheterized urine specimen is the child to emergency room, RR was 68/min with subcostal retractions, and O2
obtained, and aggressive intravenous hydration is initiated. Cefazolin is selected saturation was 92%. Of the following, the MOST proper next action is to:
as the treatment regimen. After 48 hours, the patient remains febrile with a  Arrange for bedside CXR
maximum temperature of 38.6 C and continues to complain of significant flank
pain. The costovertebral angle tenderness elicited on initial presentation has not
 Arrange for CT chest
improved.  Arrange for urgent bronchoscopy
 Encourage coughing
What is the next step when the patient fails to respond to intravenous  Reassure parents
antibiotics?
 Consider a renal ultrasound and check antibiotic sensitivities
 Order an intravenous urogram
 Consider a renal US, check antibiotic sensitivities and order an
intravenous urogram
 Consider a renal ultrasound

42. Hypertensive condition that may exist in pregnancy:

 Chronic hypertension, preeclampsia-eclampsia and gestational
hypertension
 Gestational hypertension
 Chronic hypertension
 Chronic hypertension and preeclampsia-eclampsia 46. A patient who had telemedicine consult due to on and off fever was
 Preeclampsia-eclampsia diagnosed with dengue fever. The clinical manifestations of the disease can be
attributed to the etiologic agents’s:
43. Prenatal exposure to cigarette smoke is associated with:  Infectivity – ability to cause infection
 Neonatal diabetes  Pathogenicity – ability to cause disease
 Learning problems  Virulence
 Lower birth weight  Antigenicity – ability to react with antibodies
 Shorter length
47. You are a newly employee pediatrician to foster care children (children
 Changes in neonatal
removed from their original families and put in suitable institutes for protection).
neurodevelopmental
Those children have many significant problems, but the MOST common one is:
status
 Abuse and neglect
 Mental health concerns
 Chronic medical problems
44. All the following are widely used modalities for treatment of inborn errors of
 Developmental problems
metabolism (IEM) EXCEPT:
 Family relationship problems
 Liver transplantation
 Gene therapy
 Peritoneal dialysis
 Administration of the deficient metabolite
 Special diets

48. The MOST devastating consequence of untreated hypernatremia is:

 Seizures
 Central pontine myelinolysis
 Extra pontine myelinolysis
 Brain edema
 Brain hemorrhage

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49. The age at which the infant can reach an object, grasp it and bring it to mouth 53. This is NOT associated with the natural history of disease?
and seems excited when the infant see the food is:  Survival time
 4 months  Clinical course of illness
 8 months  Comparison of patient outcomes
 6 months  Case fatality
 5 months
 7 months

50. Dietary supplements (as herbs) are commonly used and may be helpful
54. Which of the following is FALSE regarding pain associated with labor and
adjunctive treatments for common childhood problems. All the following
delivery?
matching are true EXCEPT:
 Aloe vera --- lice
 The pudendal nerve is responsible for transmitting the pain felt in the
pelvic floor and perineum.
 Ginger --- nausea
 Pain experienced with uterine contractions is mediated by T-10
 Tea tree oil --- acne remedies through the L-1 portions of the spinal cord.
 Chamomile --- dyspepsia  Cervical dilation and descent of the fetal head generate somatic pain.
 Peppermint --- irritable bowel syndrome  A medical indication is not necessary to provide maternal pain relief.

51. Late in the first trimester:

 Estrogen increases insulin sensitivity
 Progesterone decreases insulin sensitivity
 Estrogen decreases insulin sensitivity
 Progesterone increases insulin sensitivity 55. What percentage of Rh alloimmunization occurs due to antepartum feto-
maternal hemorrhage?
 5%
 15%
 10%
 1%

52. The three major anatomic parts of the ovary are the outer cortex, the
medulla and the:
 Hilum
 Middle muscle layer
 Body
 Fundus
56. The critical site for the renal regulation of sodium balance is the:
 Nephron
 Loop of Henle
 Collecting duct
 Distal tube
 Proximal tubule

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57. The major chemical modulator of attention is: 61. Regarding nutritional requirement during childhood, all of the following are
 Non-epinephrine true EXCEPT:
 Epinephrine  Estimated average requirement (EAR) is the average daily nutrient
intake level estimated to meet the requirements for 50% of the
 Dopamine
population.
 Troponin
 Recommended dietary allowance (RDA) is an estimate of the daily
 Serotonin average nutrient intake to meet the nutritional needs of >97% of the
individuals in a population.
 Major risk period for growth stunting is between 4 and 24 months of
age.
 Nutrition and growth during 3-6 years of life predict adult stature and
some health outcomes
 The 3 components of energy expenditure are the basal metabolic
rate, thermal effect of food and energy for physical activity.

58. A pregnant patient is positive for HBsAg. What is most likely regarding her
symptoms?
 She may not have clinical symptoms yet
 She may be chronic carrier
 She may have currently acute symptoms or may not have clinical
symptoms yet 62. Untreated depression during pregnancy is associated with:
 She may have currently acute symptoms or may not have clinical  Premature birth, low birthweight and fetal growth restriction
symptoms yet or she may be a chronic carrier  Low birthweight
 She may have acute symptoms currently  Fetal growth restriction
 Low birthweight and fetal growth restriction
 Premature birth

59. The following conditions can cause eosinophilia EXCEPT:

 Amebiasis
 Ascariasis 63. Antidotes are available for relatively few toxins, but early and appropriate
 Giardiasis use of an antidote is a key element in managing the poisoned patient. The
 Malaria following matching are true EXCEPT:
 Filariasis  Lead - BAL (dimercaprol)
 Opioids - naloxone
 Isoniazid - thiamine
60. What is the best measure to estimate the probability of developing diabetes
mellitus within a population of morbidly obese patients?  Iron - deferoxamine
 Specificity  B blockers – glucagon
 Incidence
 Risk
 sensitivity

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64. The disease burden related to diabetes is rising in every country fueled by 69. What is the best way to administer naloxone to a neonate?
the global rise in the prevalence of:  Intramuscularly
 Venous insufficiency  Intravenously
 Cardiovascular disease  Subcutaneously
 Obesity  Orally
 Thyroid disorders
70. Atopic dermatitis typically begins in:
65. Of the following, the MOST common presenting behavior in girls with  Infancy
attention-deficit/hyperactivity disorder (ADHD) is:
 Toddlerhood
 Disruptive
 School age
 Impulsive
 Adolescence
 Combined
 Preschooler age
 Hyperactive
 Inattentive 71. Which among the following can be employed to identify subgroup of patients
with unusually favorable clinical outcomes?
 Natural history
 Diagnostic testing
 Survival analysis
 Surveillance

66. All of the following are recognizable teratogens EXCEPT:

 Antiepileptic medications
 Mercury
 Toxoplasmosis
 Hypothermia
 Ethanol

72. Your pregnant patient only requires albuterol as needed to control

symptoms:
 Mild persistent (not well controlled)
 Severe persistent (very poorly controlled)
67. Which is measured in terms of fatality?
 Intermittent (well controlled)
 Infectivity
 Moderate persistent (not well controlled)
 Antigenicity
 Virulence
 Pathogenicity

73. What is the recurrence risk of postpartum hemorrhage in a subsequent

pregnancy?
 20%
 15%
68. A confirmatory test should have:
 5%
 High false positives
 10%
 Low false positives
 1%
 Low false negatives
 High false negatives

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74. A person who accurately touched a hot pan then withdraws his hand shows 80. The first factor to be affected by deficiency of vitamin K is:
an example of:  Factor II
 Second line of defense, cellular  Factor VII
action
 Factor X
 First line of defense, reflexes
 Factor IX
 Second line of defense, humoral
 Factor I
action
 First line of defense, natural barrier

75. What is the most common side effect of regional analgesia

 Hypotension
 Transient neurologic symptoms
 Postdural puncture headache
 Pruritus
81. The age at which the infant achieve early head control with bobbing motion
when pulled to sit is:
 5 months
 4 months
 2 months
 3 months
 6 months
76. All of the following are known risk factors for stillbirth, EXCEPT:
 Nulliparity
 Multiple gestation
 Hispanic race
 Advanced maternal age

82. Where are Bartholin glands located?

 9 and 3 o’ clock at the vaginal introitus
 4 and 8 o’ clock at the vaginal introitus
 6 and 12 o’ clock at the vaginal introitus
 7 and 5 o’ clock at the vaginal introitus

77. What is the best measure to estimate the rapidity with which new cases of
hypertension can develop in a community? 83. Smoking during pregnancy is associated with an average decrease in fetal
weight by:
 Specificity
 Risk
 300g

 Incidence
 200g

 Sensitivity
78. Which among the following questions can BEST be answered by
epidemiology?
 Who is likely to develop a particular condition and under what
circumstances?
 Where can we find the treatment for the most common disorders?
 Where is the exact location of the outbreak?
 What is the type of disease man has and its pathophysiology?
 100g
 400g
 500g
84. COVID-19 pandemic is caused by the which of the following?
 Virus with positive-sense stranded RNA
 Sars Cov2 with membrane spikes s1 subunit for fusion – S2 for fusion
 Virus with single stranded negative sense RNA - positive
 Sars Cov2 which belongs to alpha type of virus - beta

79. A test with high sensitivity has:

 High false positives
 Low false positives
 High false negatives
 Low false negatives

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85. A pregnant patient has recently been diagnosed with hepatitis B, she asks 88. The MOST common reason for a sick child visit is:
about long-term consequence. You inform her:  Fever
 HBeAg decreases the risk for vertical transmission  Vomiting
 Perinatal infection carries a decrease risk for chronic disease of  Respiratory distress
approximately 5%
 Altered mental status
 Vertical transmission risk is greatest if the mother is acutely infected
 Abdominal pain
in the first trimester
 The risk for chronic disease in adults is 30%
 Perinatal infection carries an increased risk for chronic disease of
approximately 90%

89. What percent of daily caloric intake should come from protein during
pregnancy?
 50%
 20%
 40%
 30%
86. Criteria for the diagnosis of severe preeclampsia:
 Fetal growth restriction
 Blood pressure 160 mmHg systolic or higher and fetal growth
restriction
 Blood pressure 160 mmHg systolic or higher and fetal growth
restriction and thrombocytopenia
 Blood pressure 160 mmHg systolic or higher
 Thrombocytopenia
90. What is the male homologue of the clitoris?
 Penis
 Epididymis
 Testes
 Scrotum

87. Shoulder dystocia increases maternal risk for which of the following?
 Postpartum endometritis
 Postpartum hemorrhage
 Postpartum hemorrhage and fourth degree laceration
 Postpartum endometritis and fourth degree laceration
 Fourth degree laceration

91. A significant risk factor in the development of allergic rhinitis in children is:
 Serum IgA higher than 100iu/mL
 Alcoholic mother
 Diabetic mother
 Positive family history
 Father with renal disease

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92. What is the leading cause of perinatal mortality in pregnancies complicated 95. The following are ocular manifestation of albinism EXCEPT:
by pregestational diabetes?  Strabismus
 Congenital anomalies  Refractive errors
 Diabetic lactoacidosis  Red reflex
 Spontaneous preterm delivery  Lack of binocular
 Iatrogenic preterm deliveries vision
 Foveal hyperplasia

96. The diagnosis of homocystinuria is usually made after 3 yr of age when the
ophthalmologist found:
 Retinal detachment
 Ectopia lentis
 Cataracts
 Glaucoma
 Astigmatism
93. A 33-year old G1P0 presents for her new obstetrical visit at 6 weeks
gestation. She has a history of moderate persistent asthma and is currently on
two different medications to control her symptoms. She is concerned about how
the medications will interfere with the development of her fetus. You counsel 97. Major cause of neonatal mortality in full-term newborn is:
her:  Necrotizing enterocolitis
 She should stop taking all medications due to known fetal risks and  Bronchopulmonary dysplasia
that her symptoms will be treated as they arise.  Respiratory distress syndrome
 She should continue her current medication regimen as the benefits  Congenital anomalies
of well-controlled asthma symptoms clearly outweigh the potential
teratogenic risks to her fetus.
 Intraventricular hemorrhage

 She should continue her current medication because there is no
known fetal risk associated with them.
 She should discontinue her medications because the teratogenic
risks far outweigh the risks of an asthma exacerbation.
98. In pica disorder, the MOST appropriate statement is:
 It need a period of more than a month to be stated
 It is only related to eating clay and earth
 Not present with other eating disorders
 It resulted in high fatalities
 Usually in children below 2 years

99. What is the preferred inhaled corticosteroid for use during pregnancy?
 Fulticasone
 Theophylline
 Budesonide
94. Expansion of the intravascular volume and increased intravascular pressure
 Salmeterol
are the main causes of edema in:
 Sepsis
 Nephrotic syndrome
 Lymphatic syndrome 100. A patient who sustained injuries due to an accident recovered but retained
some disability. He underwent training in order to get back to his office work.
 Protein-losing enteropathy
This falls under what level of prevention?
 Heart failure
 Primary
 Primordial
 Tertiary
 Secondary

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PART 2 – Original Score was 67/100 3. A 53-year old woman presents for evaluation of a murmur suggestive of mitral
1. This disorder will NOT cause acute non-infectious diarrhea: stenosis and is noted on echocardiography to have a lesion attached to the fossa
 Partial bowel obstruction ovalis of the left atrial septum. The mass is causing obstruction of the mitral
valve. Which of the following is the most likely diagnosis?
 Inflammatory bowel disease
 Cardiac Sarcoma
 Diverticulitis
 Cardiac myxoma
 Ischemic colitis
 Endocarditis
 Lymphoma

2. Which among the following is included in the criteria for the diagnosis of DM? 4. What is the most common cardiovascular manifestation of Grave’s disease?
 FPG =/> 126mg /Dl in one occasion without typical symptoms  Atrial fibrillation
 HbA1c =/> 6  Atrial flutter
 FBS > 100 mg/dL with typical symptoms  Sinus tachycardia
 FBS =/> 126 in two or more occasions  Supraventricular tachycardia

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5. A 50-year-old male presented with pancytopenia, reticulocytopenia, 10. A 38-year-old housewife had her annual laboratory check-up which showed
hypocellular bone marrow and with noted fatty infiltration. Which is the MOST FBS at 110 mg/dl. She was asymptomatic with family history of type 2 diabetes
probable etiologic cause of his hematologic condition? – case of aplastic anemia? mellitus (paternal aunt). What is your advice to the patient? - prediabetes
 Mycobacteria  Disclose to her that she is diabetic
 Hepatitis virus  Lifestyle intervention including proper diet and exercise
 Plasmodium falciparum  With normal glucose level, she can eat everything
 Tapeworm  She will be referred to an endocrinologist

6. An 18-year-old senior high student presents with testicular mass. After

treatment he returns for regular follow-up visits. What is the most useful serum
marker for detecting recurrent disease after treatment of nonseminomatous
testicular cancer?
 Human chorionic gonadotropin (hCG)
 Carcinoembryonic antigen (CEA)
 Prostate-specific antigen (PSA)
 CA125
11. Which among the following antiarryhtmic agents can cause hypo or
hyperthyroidism?
 Lidocaine
 Amiodarone

7. A 60-year-old male patient who had been experiencing low-grade fever and
 Digoxin
weight loss few months prior to consultation was noted with pancytopenia and  Quinidine
leukoerythroblastosis. Which is the MOST probable cause of his hematologic
condition?
 Plasmodium falciparum
 Fish tapeworm
 Hepatitis virus
 Mycobacteria 12. Exemplified by parents perceiving their child to have low self-esteem. That
they repeatedly affirm the child, thus the child’s self-esteem grows dependent
8. The development of chronic complication among diabetic patients is NOT on their affirmation.
influenced by:
 Family projection
 Duration of diabetes
 Nuclear family emotional process
 Level of glucose control
 Triangulation
 Hypertension
 Self-differentiation
 Gender

9. Which of the following has the lowest risk factor for breast cancer?
 Dietary fat intake
 Excessive estrogen exposure-early menarche, late menopause,
nulliparity
 Paternal relative with breast cancer 1 (BRCA1) mutation
 Previous biopsy with atypical hyperplasia

13. Which among the following does NOT characterize an apical beat?
 Due to left ventricular movement
 Displacement could mean LV enlargement
 Normally greater than 2.5cm in diameter
 Normally at the 5th ICS LMCL

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14. A 35-year-old man with a 3-year history of ulcerative colitis (UC) presents for 18. This variable is often manipulated in order to affect the outcome of an
discussion for surgical intervention. The patient is otherwise healthy and does experiment.
not have evidence of rectal dysplasia. Which of the following is the most  CONFOUNDING
appropriate elective operation for this patient?
 INDEPENDENT
 Total abdominal colectomy with ileal-rectal anastomosis
 CONTROL
 Total proctocolectomy with ileal pouch-anal anastomosis and
 DEPENDENT
diverting ileostomy
 Total proctocolectomy with ileal pouch-anal anastomosis anal
mucosectomy, and diverting ileostomy
 Total proctocolectomy with end ileostomy

19. A 40-year-old woman presents with generalized malaise and

lymphadenopathy. Biopsy of a supraclavicular lymph node reveals non-Hodgkin
lymphoma. Forty-eight hours after initiation of chemotherapy, she develops a
high-grade fever and her laboratory studies demonstrate hyperkalemia,
15. The entry of SARS-CoV into cells was initially identified to be accomplished hyperphosphatemia, and hypocalcemia. Which of the following cells mediate
by direct membrane fusion between the virus and plasma membrane through this syndrome? – tumor lysis syndrome
the:  Cytotoxic T lymphocytes
 Nucleocapsid  Natural killer cells
 Endosomes  Macrophages
 Ss RNA  Polymorphonuclear leukocytes
 Spike protein

16. Purpose of this disaster preparedness measure is to detect, forecast, and

when necessary, issue alerts related to impending hazard events.
 Resource mobilization
 Early warning systems
 Information management
 Public education, training and rehearsal

17. A 26-year-old woman presents with epigastric abdominal pain and nausea.
She is afebrile with normal vital signs. On laboratory results she has no
leukocytosis with normal levels of bilirubin and alkaline phosphatase. The
amylase and lipase are elevated. Ultrasound demonstrates gallstones, normal
gallbladder thickness, no pericholecystic fluid, and a common bile duct of 3mm,
what is the diagnosis? 20. Which among the following is the receptor for SARSCov and SARSCov 2?
 Choledocholelithiasis  Ace2
 Acute cholecystitis  SGLT2
 Gallstone pancreatitis  DPP4
 Symptomatic cholelithiasis  SGPT

21. Most of researchers include socioeconomic characteristics of the subjects

expressed quantitatively. This can be helpful to readers to assess the
applicability of your study results to their own population. This include the
following, EXCEPT:
 Occupation
 Average size of a family
 Age and sex
 Education and income level

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22. An intoxicated 20-year-old man is involved in a vehicular accident. 25. A patient came for follow up to Dr. B after attending to her hospital
Examination reveals normal vital signs, but the rest of the examination is confinement for 1 week. As a token of gratitude she gave her doctor her
unreliable secondary to the patient’s intoxicated state due to alcohol. Which of signature bakes cookies every time she will follow up. What type of continuity of
the following sole findings on a CT scan of the abdomen and pelvis mandates an care was developed in this scenario?
exploratory laparotomy?  Interpersonal
 Free fluid in the pelvis  Informational
 Splenic hematoma  Longitudinal
 Liver hematoma  Management
 Pelvic fracture

23. One spouse will pressure another spouse to think or act a certain way,
exerting control over their partner and if any family tension arises.
 Triangulation
26. Which of the following items is NOT TRUE about cholera?
 Self differentiation
 A chronic diarrheal disease – acute diarrheal disease
 Family projection
 Unsuccessfully treated with oral rehydration solution
 Nuclear family emotional process
 Soil sanitation is critical to control the transmission
 Can kill within hours if left untreated

27. You were tasked to show graphically the family history of illness, health risk
behavior, members staying together in one house and the interrelationship.
What tool for family assessment will you use?
 Psychodynamics
 SCREEM
 Genogram
 Family Circle

24. A 23-year-old man with no known illness is admitted to the hospital with
acute onset of left-sided chest pain. ECG findings are normal, but CXR shows a 28. A 65-year-old man is concerned when upon looking in front of the mirror he
40% left pneumothorax. Appropriate treatment consists of which of the noticed a white patch on his oral mucosa upon a routine inspection of his mouth.
following procedures? He seeks consult and the physician’s proper management should include which
of the following?
 Observation
 Strict oral hygiene and avoidance of alcohol and tobacco
 Thoracotomy
 Excisional biopsy of all lesions
 Tube thoracostomy
 Low-dose radiation therapy
 Barium swallow
 Application of topical antibiotics

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29. More extensive evaluation of patients with acute diarrheal episodes is 33. A comatose 30-year old woman sustained a depressed skull fracture in an
indicated if this is present: automobile collision. She has been unconscious for 6 weeks. Her vital signs are
 Vomiting stable and she breathes room air. Following her initial decompressive
craniotomy, she has returned to the operating room twice due to intracranial
 Watery stools
bleeding. Which of the following monitoring is necessary for the patient?
 Fever >38.5 ℃
 Intracranial pressure monitoring
 Abdominal pain
 Central venous catheterization
30. Which is the test used to diagnose sleep apnea  Blood-gas monitoring
 EMG  Pulmonary artery catheterization
 Polysomnography
 ECG
 Electroencephalography

31. A 35 year old woman was rushed to the ER with severe rectal bleeding. She
has a history of ulcerative colitis. Her BP is 76/54 mmHg, her pulse is 146, and
she is pale and clammy. Which of the following responses is likely to occur after
administration of Ringer Lactate solution?
 Increase in metabolic acidosis
 Increase in serum lactate concentration
 Impairment of liver function
 Improvement in hemodynamics by alleviating the deficit in the
interstitial fluid compartment 34. Which of the following scenario will allow medical treatment without his/her
written informed consent.
 When the law makes it compulsory for everyone to submit a
procedure
 When the patient not minor and legally competent
 When the health of the population is dependent on the adoption of
a mass health program to control epidemic
 In emergency cases, when the patient is at imminent risk of physical
injury if treatment is withheld or postponed.

35. Which is TRUE regarding ulcerative colitis?

 Bleeding is due to common anal fistulas
 Incidence is greater than in Crohn’s Disease
 More common in males than in females
 Can affect the GI tract from mouth to anal region
32. Which among the following malabsorption syndromes is NOT characterized
by steatorrhea?
 Bacterial overgrowth
 Primary lactase deficiency
 Hepatic cirrhosis
 Chronic pancreatitis

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36. At this illness stage the physician should know that feeling of guilt is a natural 39. In an obese diabetic patient, what is the initial drug therapy recommended?
response to stress of grief and loss.  Sulfonylureas
 Onset of illness  DPP4 inhibitors
 Major therapeutic efforts  Biguanides
 Adjustment to the permanency of the outcome  Thiazolidinediones
 Reaction to diagnosis

40. An act prohibiting the demand of deposits or advance payments for the
confinement or treatment of patients in Hospitals and medical clinicals in certain
cases.
 Republic Act No. 11223
 Republic Act No. 10932
 Republic Act No. 10532
 Republic Act No. 10611

41. Known as the Philippine National Mental Health Research System act of 2013
 Republic Act No. 83531
 Republic Act No. 10532
 Republic Act No. 71721
37. This is a good predictor of poor prognosis after resection of colorectal CA:  Republic Act No. 20672
 Three lymph nodes positive for tumor cells
 Well- differentiated histology
 Microsatellite instability in tumor tissue
 Specific chromosomal allelic loss

42. A 45 year old man has a rocky course for 3 days following a bowel resection
for intestinal perforation due to inflammatory bowel disease. His CVP has been
12 to 14 but is now 6, in the face of diminished blood pressure and oliguria.
Which of the following is the most likely etiology of his hypotension?
 Positive-pressure ventilation
 Pulmonary embolism
 Hypervolemia
 Gram-negative sepsis

38. A 69 year old man undergoes a subtotal colectomy for a cecal perforation
due to a sigmoid colon obstruction. He has had a prolonged recovery and has
been on total parenteral nutrition for 2 weeks postoperatively. After regaining
bowel function, he experienced significant diarrhea. Examination of his
abdominal wound demonstrate minimal granulation tissue. He complains that
he has lost his taste for food. He also has increased hair loss and a new perioral
pustular rash. Which of the following deficiencies does he most likely have?
 Selenium
 Molybdenum
 Chromium
 Zinc

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43. A 55 year old man with gastric outlet obstruction secondary to a duodenal 46. A patient has received an injection of immunoglobulin: he will develop which
ulcer presents with hypochloremic, hypokalemic metabolic alkalosis. Which of of the following types of immunity?
the following is the most appropriate therapy for this patient?  Naturally acquired passive immunity
 Infusion of isotonic (0.15N) HCL via a central venous catheter  Naturally acquired active immunity
 Clamping the nasogastric tube to prevent further acid losses  Artificially acquired passive immunity
 Infusion of 0.9% NaCl with supplemental KCL until clinical signs of  Artificially acquired active immunity
volume depletion are eliminated
 Administration of acetazolamide to promote renal excretion of
bicarbonate

47. For the past 6 months the 48-year-old previously healthy female patient
44. A 60 year old woman with neck mass undergoes total thyroidectomy. Final complained of episodes of “fainting spells” which usually lasted for a few
pathologic findings reveal a 2 cm- Hurthle cell carcinoma. Which of the following minutes. There was no BP elevation noted and on PE, she had good carotid
is the most appropriate post-surgical management of this patient? pulses and no bruits. Which is the most LIKELY lesion present?
 Radioiodine ablation  Left atrial myxoma
 External beam radiotherapy  Pericardial effusion
 Chemotherapy  Mitral valve stenosis
 No further therapy is indicated  Bicuspid aortic valve ????

48. A 33-year-old man was rushed to the ER because of vehicular accident. On

examination, he is hypertensive with tenderness and bruising over his left lateral
chest below the nipple. An ultrasound examination is performed and reveals free
fluid in the abdomen. What is the most likely organ to have been injured in this
patient?
 Liver

45. A 9 year old girl not wearing a seatbelt was severely injured in a high-speed
 Spleen
motor vehicle collision. She is intubated in the field for unresponsiveness and on  Kidney
presentation to the ER, her heart rate is 155 beats per minute, and her blood  Intestine
pressure is 60/40 mmHg. She weighs 30 kg. Which of the following is the most
appropriate recommendation for her fluid resuscitation?
 Bolus 600cc of normal saline initially followed by a repeat bolus.
Transfuse if no response.
 Bolus 1L of 5% albumin initially
 Transfuse 300cc of packed RBC initially
 Bolus 1L of normal saline initially.

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49. In the management of obesity: 53. Which among the following is NOT considered high risk for infective
 Pharmacologic treatment is indicated if BMI > 27 or >25 with co- endocarditis and does not require antibiotic prophylaxis prior to abdominal
morbidities surgery?
 Bariatric surgery indicated if BMI >40 or <35 associated with diabetes  Patent ductus arteriosus
or family history of early heart attacks  Mitral valve prolapse
 There is an increased health risk if waist circumference is >105 cm in  Ventricular septal defect
females and >90 in males based on WHO criteria  Aortic regurgitation
 Diet and exercise is the only recommended management regardless
of the patient’s BMI

54. At this illness stage the physician should know that feeling of guilt is a natural
response to stress of grief and loss
 Adjustment to the permanency of the outcome
 Reaction to diagnosis
 Major therapeutic efforts
 Onset of illness

55. If a physician focused on examining the clinical and laboratory evidence of

the patients biological and psychophysiologic dysfunction. The center of
50. A 33 year-old woman presents with serum calcium level of 15.2mg/dL and attention is towards ____?
an elevated parathyroid hormone level. Following correction of the patient’s
hypercalcemia with hydration and furosemide, which of the following is the best
 Illness
therapeutic approach?  Suffering
 Administration of steroids  Sickness
 Radiation treatment of the neck  Disease
 Neck exploration and resection of all 4 parathyroid glands
 Neck exploration and resection of the parathyroid adenoma

56. A 49-year-old man presents with signs and symptoms of peritonitis in the
right lower quadrant. The clinical impression and supportive data suggest acute
appendicitis. At exploration, a 3.5-cm tumor encroaching onto the cecum is
found with extensive liver metastasis. Frozen section suggests carcinoid
51. In hyperglycemia emergencies, insulin is best given via which route? features. What is the most appropriate surgical procedure for this patient?
 Subcutaneous intermediate acting insulin  Cecectomy
 IV bolus  Hepatic wedge resection and appropriate bowel resection
 Subcutaneous regular insulin  Segmental ileal resection
 Intravenous insulin drip  Right hemicolectomy

52. Physician can use this tool to have a glimpse of health behaviors and practice
being utilized that can be a barrier to patient care.
 APGAR
 Genogram
 Family wellness
 SCREEM

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57. What is the method of choice in determining the size of the thyroid 62. A 60-year-old man has end stage heart failure due to atherosclerosis. His
accurately? cardiologist refers him for evaluation for heart transplantation. Which of the
 Thyroid scan following is an absolute contraindication for heart transplantation?
 Fluorescent scan  Reversible high pulmonary vascular resistance
 MRI  Age over 65
 Thyroid ultrasound  Cirrhosis
 Diabetes without end organ damage

58. The main mechanisms of prone position in improvement of ARDS patients

condition include:
 Increasing chest wall elastane
 Decreasing tidal volume
 Increasing alveolar shunt
 Decreasing end-expiratory lung volume

59. The last step in investigating outbreaks is to:

 Recommended control measures 63. If a physicians focused on the suffering and experience of the patient and on
 Prepare and distribute an epidemiologic report the broad range felt during the course of his condition. The center of attention
is towards?
 Test the hypothesis formulated
 Determine the existence of an epidemic
 Disease
 Suffering
 Sickness
 Illness

64. A 69-year-old man is admitted to the hospital for elective coronary artery
bypass grafting. On the day of his operation, an asymptomatic carotid bruit is
found. Which of the following is the most appropriate immediate next step in
diagnosis?
 PET scan of the brain
 Duplex scan of the neck
 CT scan of the head
 MRI of the brain

60. Sleep apnea is characterized:

 As a minor medical condition
 By pauses in breathing during sleep
 As to having 4 types
 By good oxygenation while asleep

61. A 40-year-old male patient had intermittent hematochezia and melena of 3

months duration. Gastroscopy and colonoscopy were done which revealed
normal findings. What diagnostic test will you request in order to identify the
source of bleeding?
65. Three hours after undergoing a right hepatic lobectomy, a 63-year-old
 Fecal occult blood testing woman has a distended abdomen. Her pulse is 120/min, and blood pressure is
 RBC tagging 100/60 mmHg. Which of the following is the most likely cause of these findings?
 CT scan of the abdomen with contrast  Poor mechanical hemostasis
 Mesenteric angiography  Deficiency of factor VII
 Deficiency of factor III
 Deficiency of factor XII

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66. Which profile does NOT require screening for DM Type 2? 70. A 45 year old trauma patient develops acute respiratory distress syndrome
 A 55 year old bank executive with hypertension (ARDS) and has difficulty oxygenating despite increased concentrations of
inspired O2. After the positive end expiratory pressure (PEEP) is increased the
 A 35 year old female with PCOS and BMI 0f 30
patient’s oxygenation improves. What is the mechanism by which this occurs?
 A 30 year old male with BMI of 23, without family history of diabetes
 Decreasing the minute ventilation requirement
 A 35 year old female with history of GDM on her previous
 Increasing tidal volume
pregnancies
 Increasing functional residual capacity
67. A 40 year old male with BMI of 30, waist circumference of 110cm is expected  Decreasing dead space ventilation
to have the following biochemical profile?
 Low leptin 71. A 70 year old man status post-coronary artery bypass graft 5 years ago
presents with hematochezia, abdominal pain, and fever. Colonoscopy reveals
 Low resistin levels
patches of dusky-appearing mucosa at the splenic flexure without active
 Elevated free fatty acids bleeding. Which of the following is the most appropriate management of this
 Elevated adiponectin patient?
 Angiography with administration of intra-arterial papaverine
68. A 65 year old woman undergoes a pancreaticoduodenectomy for pancreatic
head cancer. A jejunostomy is placed to facilitate nutritional repletion as she is
 Aortomesenteric bypass
expected to have a prolonged recovery. What is the best method for delivering  Expectant management
postoperative nutrition?  Emergent laparotomy with left hemicolectomy and transverse
 Institution of supplemental enteral feeding via the jejunostomy tube colostomy
only if oral intake is inadequate after return of bowel function
 Institution of a combination of immediate trophic (15mL/h) enteral
feeds via the jejunostomy tube and parenteral nutrition to provide
total nutritional support.
 Institution of enteral feeding via the jejunostomy tube after return of
bowel function as evidenced by passage of flatus or a bowel
movement.
 Institution of enteral feeding via jejunostomy tube within 24 hours
postoperatively.

72. A 30 year old man is resuscitated with packed red blood cells following a
motor vehicle collision complicated by a fractured pelvis and resultant
hemorrhage. A few hours later the patient becomes hypotensive with a normal
central venous pressure, oliguric, and febrile. Upon examination, the patient is
noted to have profuse oozing of blood from his intravenous sites. Which of the
following is the most likely diagnosis.
 Transfusion reaction
 Gram negative bacteremia
 Hypovolemic shock
 Acute adrenal insufficiency

69. A 40 year old male coastal resident presented with diarrhea and macrocytic
anemia. Which is the MOST probable etiologic cause of the patient’s
hematologic condition?
 Parvovirus
 Mycobacteria
 Hepatitis virus
 Fish tapeworm

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73. I find that my family “accepts my wishes to take on new activities or make 75. A 35 year old man with a history of crohn disease develops an
changes in my lifestyle”. Belong to what component of APGAR questionnaire enterocutaneous fistula and is placed on total parenteral nutrition through a
 Partnership right subclavian central venous catheter. After 7 days, the patient develops a
fever and leukocytosis. CT scan of the abdomen reveals no intra-abdominal
 Growth
abscess. The subclavian catheter insertion site is inspected and noted to be
 Resolve erythematous and painful. Blood cultures are positive. Which of the following
 Affection organisms is the most likely cause of his fever?
 Enterococcus
 Group A streptococcus
 Coagulase positive staphylococci
 Coagulase negative staphylococci

76. A 50-year-old woman sustains blunt abdominal trauma because of a

vehicular accident. Her blood pressure is 105/55 mm Hg and her pulse is 94. She
complains of abdominal pain. She undergoes CT scanning of the abdomen and
pelvis, which demonstrates a splenic injury. Which of the following would
preclude an attempt at nonoperative management of the patient?
 Presence of a subcapsular hematoma involving more than 50% of the
surface area of the spleen
 Evidence of a blush on CT scan
 Presence of a subcapsular hematoma involving more than 25% of the
surface area of the spleen
 Peritoneal signs on abdominal examination

74. A 65 year old man presents to his primary care physician with complaints of
intermittent constipation and is found to have microcytic anemia. Colonoscopy
reveals a fungating mass in the proximal sigmoid colon with no other
synchronous lesions. Biopsy of the mass confirms adenocarcinoma. What
appropriate procedure in indicated for the patient?
 Total colectomy
 Subtotal colectomy
 Right hemicolectomy
 Left hemicolectomy

77. An act instituting Universal Health Care for all Filipinos, prescribing reforms
in the health care system, and appropriating funds.
 REPUBLIC ACT No. 10932
 REPUBLIC ACT No. 10532
 REPUBLIC ACT No. 11223
 REPUBLIC ACT No. 10611

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78. This is a TRUE statement about typhoid: 82. Which medication can be beneficial in a patient with irritable bowel
 It is an illness always manifesting with diarrheal episodes. syndrome (IBS)?
 It has symptoms which are often specific and clinically distinguishable  Racecadotril
from other febrile illness  Tegaserod
 It is a systemic infection caused by ingestion of contaminated food or  Desipramine
water  Paroxetine
 It is a chronic illness characterized by prolonged fever and headache
83. Which is the most common primary thyroid carcinoma?
79. What clinical finding is associated with the score of 3 for Grave’s disease?  Medullary
 Proptosis  Papillary
 Diplopia  Follicular
 Lid lag  Anaplastic
 Corneal ulcer

84. Which among the following is TRUE regarding Irritable Bowel Syndrome or
IBS?
 CT scan finding may reveal subtle changes in bowel arrangement in
the peritoneal cavity
 Abdominal pain as prerequisite of diagnosis should be accompanied
by diarrhea or constipation
 Carries a low but significant mortality rate of 4%
 There is presence of bacteria hence the need for antibiotic treatment

80. A 30-year-old woman seek consult regarding pain and numbness in her right
arm and hand. She reports that is exacerbated by raising her arm over her head.
On examination, the right radial pulse disappears when the patient takes a deep
breath and turns her head to the left. A provisional diagnosis is made. Which of
the following is the most appropriate initial treatment for this patient?
 Physical rehabilitation
 Gabapentin to treat neuropathic pain
 Right first rib resection
 Thoracoscopic sympathectomy

Thoracic Outlet Obstruction

85. Which among the following is TRUE regarding diabetes mellitus?

81. A 47-year-old woman with history of being hooked in the use of painkillers
presents with acute abdominal pain. She undergoes exploratory laparotomy 30
hours after onset of symptoms and is found to have a perforated duodenal ulcer.
Which among the following procedure will treat her perforation?
 Highly selective vagotomy with omental patch
 Truncal vagotomy and antrectomy
 Truncal vagotomy and pyloroplasty
 Simple closure with omental patch
 Patients with DM Type 1 may develop diabetic ketoacidosis while
patients with DM type 2 do not.
 Patients with DM Type 1 present only with insulin deficiency while
patients with DM Type 2 can present with both insulin resistance.
 DM type 1 is more associated with familial transmission than DM
Type 2. – DM type 1 – more of genetic ; DM type 2 – more of lifestyle
 DM Type 2 is more common among young people.
86. Which factor is compatible with Irritable Bowel Syndrome (IBS)?
 Stool weight >200-300 cc/day
 Nocturnal pain
 Fecal occult blood- positive
 Dyspareunia

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87. A 66-year old man with a 35% body surface area (BSA) burn develops 89. A 17-year old woman is involved in a vehicular accident. She is hypotensive,
hyperkalemia after this drug induction: with tension pneumothorax and has distended neck veins. What appropriate
 Midazolam life-saving procedure should be done to the patient?
 Pancuronium  Tube thoracostomy
 Succinylcholine  Cricothyroidotomy
 Nitrous oxide (N2O)  Endotracheal intubation
 Subxiphoid window

88. Twelve years ago, a 63-year old woman underwent an aortic valve
replacement with a porcine heterograft. She now has shortness of breath with
exertion. Examination and x-ray of the chest show evidence of congestive heart
failure. Which of the following is the most likely explanation of these findings?
90. Which among the following is included in the criteria for the diagnosis of
 Degeneration of the valve
metabolic syndrome?
 Development of an ascending aortic aneurysms
 BP>130/90 mmHg
 Development of mitral stenosis
 Waist circumference >88cm in female and >102 cm in males
 Development of a ventricular septal defect
 Triglycerides > 130 mg/dL
 BMI > 21

91. An obese 45-year old woman undergoes a laparoscopic cholecystectomy in

the recovery room, she is found to be hypotensive and tachycardic. Her arterial
blood gases reveal a pH of 7.29, PaO2 of 60 mmHg and PaCO2 of 54 mmHg.
Which of the following is the most likely cause of this patient’s problem?
 Carbon dioxide absorption from induced pneumoperitoneum
 Pulmonary edema
 Alveolar hypoventilation
 Acute pulmonary embolism

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Topic: Clinical Part
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92. A 42-year old woman with a known history of Von Willebrand disease has a
ventral hernia after a previous cesarean section and desires to undergo elective
repair. Which of the following should be administered preoperatively?
 High- purity factor VIII concentrates
 Fresh-frozen plasma
 Cryoprecipitate
 Low molecular weight dextran
97. A 39-year-old man experienced intermittent crampy abdominal pain and
rectal bleeding. Colonoscopy is performed and demonstrates multiple
hamartomatous polyps. The patient is managed by removing as many polyps as
possible. Which of the following is the most likely diagnosis?
 Villous adenomas
 Peutz-Jeghers syndrome
 Familial polyposis
 Ulcerative colitis

93. A 50-year-old patient had the presence of systolic thrill at the apical region
on auscultation. The finding is a sign of which of the following?
 Aortic stenosis
 Mitral regurgitation
 Aortic regurgitation
 Mitral stenosis 98. Maritess a 23y/o patient keeps on coming back to you with the same chief
complaint of headache. She stated that the medication only works temporarily,
and now her bout of headache became frequent since her sister studied
medicine. Upon letting her answer the APGAR questionnaire, she had a result of
4. What is the reflective interpretation of her score?
 Her family is moderately dysfunctional
 Her family is mildly dysfunctional
 Her family is primarily dysfunctional
 Her family is severely dysfunctional

99. A 40-year old female patient was diagnosed with pure red cell aplasia. What
is the MOST probable cause of her hematologic condition?
 Fish tapeworm
 Plasmodium falciparum
94. Acute amoebiasis can present as diarrhea with this stool characteristic:  Mycobacteria
 Scanty – bacterial dysentery  Hepatitis virus
 Watery
100. What is the most common cause of chronic thyroiditis?
 Rice water - cholera
 Voluminous
 Hashimotos
 Riedel’s thyroiditis
95. The entry of SARS-CoV into cells was identified to be accomplished by direct  Granuloma
membrane fusion between the virus and plasma membrane through:  Postpartum thyroiditis
 S2 subunit
 S1 subunit
 M protein
 E protein

96. This tool gives a more dynamic image of the family, especially the
relationship of each member to other members. So that the physician may have
an idea of the family’s totality as a unit.
 Family wellness
 SCREEM
 APGAR
 Genogram

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Topic: Clinical Part
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ADDITIONAL QUESTIONS
1. A worried mother of a 4-year old boy describing attacks of inconsolable crying
episodes of her child, taking long time, she stated also that he prefers to play
alone. Of the following, the MOST appropriate action is to:
 Investigate social issues of the family
 Investigate for the child abuse
 Reassures her that this is a normal phenomenon
 Seek more history regarding other skills and developmental domains
 Refer her to pediatric psychiatry
4. The clinical diagnosis of preeclampsia requires elevated blood pressure
(>140/90 mmHg) and which of the following?
 Swelling of hands and face
 Proteinuria (>300 mg/d in a 24-hour collection or 1+ dipstick on two
separate samples 6 hours apart)
 Swelling of legs and ankle
 Maternal weight gain of >2 lb in 1 week

2. Which of the following therapies is recommended in pregnant patients with

sickle cell disease?
 Prophylactic cesarean section
 1 mg folate a day
 Hydroxyurea
 4 mg folate a day
 Avoidance of regional anesthesia 5. The MOST specific but late radiographic feature of scurvy is:
 Pencil outlining of the epiphysis and diaphysis
 The white line of fränkelat the metaphysis
 Ground-glass appearance of the shafts of the long bones
 Pelkan spur at cortical ends
 Trümmerfeld zone at the metaphysis

3. Iron deficiency anemia during pregnancy has been associated with all of the
following, EXCEPT:
 Increased risk of structural abnormalities
 Increased risk of low birth weight
 Increased risk of perinatal mortality
 Increased risk of preterm delivery
6. A symptomatic patient who tested positive for Covid-19 was immediately
managed in a facility. The scenario exemplifies which level of prevention?
 Primary
 Primordial
 Secondary
 Tertiary

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7. Breastfeeding is contraindicated in the following scenario: 11. Which is TRUE regarding the etiology and pathogenesis of Inflammatory
 Recurrent HSV genital lesions Bowel Disease?
 Active HSV breast lesions  A microorganism is a known etiology
 Mother is currently taking valacyclovir  The trait is transmitted by sex-linked recessive inheritance
 Active primary HSV genital lesions  The activity of IL-1, IL-6, and TNF are enhanced
 The normal flora helps in reducing the immune hyperactivity in the
gut

8. Ms. Dela Cruz continues prenatal visits with you. Her fundal height growth is
appropriate and her BP control remains adequate on her methyldopa. Her 24
hour urine protein is 147 mg/24 hours and her second trimester serum screen
predicts a low risk for fetal Down syndrome and trisomy 18. A fetal anatomy
survey performed at 20 weeks is normal. At her 22-week visit, you noticed that
her BP dropped significantly. Currently it is 110/70 mmHg.

What is the significance of a second trimester drop in BP?

 Reassuring- Hypertension may be resolving
 Reassuring- Mother’s vessel are more compliant
 Worrisome- Mother’s heart may be in failure
 Worrisome- Fetal oxygenation may suffer

9. More than 40% of total body sodium is in the:

 Gastrointestinal fluid
 Bone
 Interstitial spaces
 Intravascular spaces
 Intracellular fluid

10. The characteristics of agent and host with their interaction are directly
related to and depends largely on the nature of the environment:
 Prevalence of disease
 Health concept
 Ecologic concept of disease
 Etiology of disease defined

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