OCTOBER 2023 FINAL COACHING & and relaxin and decreased systemic

FINAL EXAM – DAY 4 vascular

OB-GYN, PEDIA, PREVENTIVE resistance via AT II and norepinephrine
MEDICINE D. Due to increased cardiac output
OBSTETRICS AND GYNECOLOGY E. None of these
1. Which of the following is not true 3. Which of the following characteristics
regarding the of uterine
diagnosis of pregnancy? contractions signify true labor rather
A. Gestational sac is seen at 5 weeks on than a false labor?
transvaginal A. Painful, Frequent contractions
ultrasound or at a beta-hCG of occurring
1,500-2,000 irregularly, with Cervical effacement
mIU/mL B. Painless, Frequent contractions
B. FH motion seen at 6 weeks or at occurring
beta-hCG of irregularly, with Cervical effacement
5,000-6,000 mIU/mL C. Painful, infrequent contractions
C. Beta-hCG will rise to a peak of occurring
100,000 mIU/mL irregularly, with possible rupture of
by 10 weeks of gestation, decrease BOW
throughout the D. Painful, Frequent contractions
second trimester, and then level off at occurring regularly,
approximately 20,000 to 30,000 with cervical dilatation
mIU/mL in the 4. Which of the following is not a
third trimester. function of Human
D. Pregancy POCT will turn POSITIVE Chorionic Somatomammotropin (hCS)?
around the A. Increases circulating free fatty acids
time of missed menses B. Gluconeogenesis
E. None of these C. Peripheral uptake of glucose
2. Which of the following explains the D. Protein catabolism
increase in uterin E. All of these
blood flow to 500-750mL/min during 5. Which of the following is not a
pregnancy? parameter being tested
A. Due to decreased systemic vascular during the second trimester as part of
resistance via prenatal care?
increase in progesterone,and relaxin, A. hCG
and B. PAPP-A
increased refractoriness to AT II and C. AFP
norepinephrine D. E3
B. Due to increased systemic vascular E. None of these
resistance via 6. Which of the following is not a typical
increase in progesterone, relaxin, and characteristic of
decreased Ectopic Pregnancy?
refractoriness to AT II and A. Low Hematocrit
norepinephrine B. Bilateral pelvic or lower abdominal
C. Due to increased refractoriness to pain and
progesterone, vaginal bleeding
C. Small uterus for gestational age C. one or both hips not flexed, foot or
D. Tachycardia knee lies below
E. None of these breech in birth
7. Risk of a subsequent ectopic D. Extended hips, flexed knees, feet near
pregnancy is how many fetal head
percent after one prior ectopic 11. The Obstetrical conjugate is the
pregnancy? shortest distance
A. 5% between sacral promontory and
B. 10% symphysis pubis
C. 15% (typically ≥10 cm, but cannot be
D. 20% measured directly). It
E. 25% is shorter than Diagonal conjugate by:
8. 15% of Recurrent Pregnancy Loss A. 25 mm
(RPL) is due to: B. 2 cm
A. APAS C. 1 in
B. Luteal phase defect D. Depends on the pelvic contour
C. Insufficient progesterone E. Immeasurable unless true conjugate
D. After 3 consecutive Spontaneous is measured
abortions (SABs) 12. The required amount of calcium to
E. STIs consume per day a
9. Which of the following does not pregnant mother with high risk for
describe Complete hypertension
Molar Pregnancy? disorders is:
A. Results from the fertilization of an A. 1 000mg
enucleate B. 1 000-1 500mg
ovum/empty egg, one whose nucleus is C. 1 500-2 000mg
missing or D. 2 000-2 500mg
nonfunctional, by one normal sperm E. 1 000-2 500mg
that then 13. This drug, when taken during
replicates itself pregnancy may lead to
B. All chromosomes are paternally fetal lung and kidney hypoplasia
derived A. Captopril
C. Most common karyotype: diploid B. Ibupfrofen
46,XX C. Streptomycin
D. Placental abnormality: noninvasive D. Warfarin
trophoblastic E. DES
proliferation grape-like vesicles 14. What is your diagnosis if a 28-year
E. None of these old G2P1(1001)
10. Which of the following describes rushed to the ER with a complaint of
Frank Breech? vaginal spotting,
A. flexed hips, extended knees, feet near on history, LMP was 12 weeks ago; PT
fetal head was positive; on
B. flexed hips, one or both knees flexed, bimannual examination, her cervix was
at least one closed, corpus
foot near the breech was enlarged to 10-12 weeks, with no
adnexal mass or
tenderness; lastly, ultrasound showed variability, with accelerations, no
an embryo with decelerations, and
no cardiac activity? with mild contractions occurring every
A. Threatened abortion 5 minutes. What
B. Missed abortion is the next best step?
C. Incomplete abortion A. Observe
D. Inevitable abortion B. Augment labor
15. With the following bimannual C. Resuscitate
examination findings: D. Bed Rest
cervix 4 cm dilated, 60% effaced, soft, in E. Deliver
midposition, 19. A vaginal delivery is being done to a
head at station -2, with intact 28 year old G1P0
membranes. What is the woman. The EFW is 3.5kg. Shoulder
Bishop score? dystocia was
A. 4 encountered during delivery.
B. 5 McRobert’s maneuver
C. 6 was initiated, however, unsuccessful.
D. 7 What other
E. 8 maneuver can be done?
16. A buttonhole rectal laceration A. Mauriceau-Smellie-Veit maneuver
during NSD with B. Lovset Maneuver
mediolateral episiotomy is classified as C. Modified Prague Maneuver
what degree of D. Dürssen incision
perineal laceration? E. Rubin Maneuver
A. II 20. Which of the following increases
B. IIIa success of Vaginal
C. IIIb Birth after Cesarean Delivery (VBAC) or
D. IIIc Trial of Labor
E. IV after Cesarean Delivery (TOLAC)?
17. The purpose of this cardinal A. Induction of Labor
movement of labor is to B. Time from last cesarean < 18 mos
allow the smallest diameter to present C. Prior C/S for cephalopelvic
to the pelvis disproportion
A. Engagement D. Presentation in labor at: > 3 cm
B. Descent dilated and > 75%
C. Flexion effaced
D. Internal Rotation E. Use of Prostaglandins
E. Extension 21. What is the mechanism behind
18. Bimannual examination of a patient hydration causing
in labor reveals tocolysis?
cervix dilated at 6cm, and fetal head A. Decreases ADH
station at -3 for 4 B. Increases ADH
hours long. Bag of water has already C. Decreases Oxytocin
ruptured. CTG D. Increases Oxytocin
was done showing FHR of 150s with E. Increases Oxytocin receptors
moderate
22. Which of the following is not true (>5L in a 70kg adult)
regarding Preterm B. >50% of total blood volume lost in 3
Rupture of Membranes? hours
A. Gestational age at ROM rates are C. Bleeding in excess of 150mL/min
inversely D. Transfusion of 10 or more units of
correlated PRBC within 24
B. < 34 weeks: expectant management; hours
give E. None of these
antibiotics to prolonger latency period 26. Preferred modality for the
before evaluation of appendicitis in
onset of labor pregnancy
C. The most significant risk for PROM is A. UTZ
the B. MRI
development of chorioamnionitis C. CT Scan
D. 20 hours is the usual cut off for D. Alvarado Score
PROM E. History and PE
E. None of these 27. Not true about hyperemesis
23. All of the following characterize gravidarum
symmetric growth A. Mild to moderate nausea and
restriction except: vomiting until
A. Likely due to intrinsic growth approximately 16 weeks’ gestation
problems B. May lead to weight loss (≥% of
(aneuploidy, syndromes, congenital pre-pregnancy
infections) weight), dehydration, ketosis, alkalosis,
B. Likely represents normal, genetically electrolyte
determined imbalance, and transient hepatic
small stature dysfunction
C. Comprises 2/3 of IUGR C. Cause include elevated hCG,
D. Occurs early in pregnancy progesterone
E. Length, weight, and head (decreases gastric motility, relaxes
circumference at < 10th esophageal
percentile sphincter), and thyroid hormone
24. What is the first line in the medical D. Management of Mild hyperemesis
management of gravidarum
GDM? include Doxylamine + Vitamin B6 plus
A. Insulin diphenhydramine or dimenhydrinate,
B. Insulin + Biguanide ginger
C. Metformin + Gliburide supplementation with Vitamin B12
D. Gliburide E. None of these
E. Insulin + 2 other oral hypoglycemic 28. A 34-weeker primigravid came in
agents for consultation. BP
25. Which of the following is incorrect taken was consistently 140/90 after
regarding Critical being taken 4
bleeding? hours apart. Chemical analysis of urine
A. Loss of greater than one blood revealed 1+
volume in 24 hours protein. Whichh of the following is true?
A. The case is a Preeclampasia with patients with unknown GBS status:
severe features A. Preterm labor
B. Deliver at 37 weeks B. ROM >18hours
C. Administer magnesium sulfate C. Temperature of >100.4F
D. Induce labor D. NAAT + for GBS
E. Schedule for CS delivery E. All of these
29. Which of the following skin lesions 34. Triple I can be diagnosed as a
may improve during combination of fever
pregnancy? ≥9°C based on oral maternal
A. PUPPP temperature with
B. AEP another clinical sign except:
C. Psoriasis A. WBC >15,000/mL
D. Pemphigoid Gestationis B. FHT >100
E. Cholestasis of pregnancy C. Purulent fluid from cervix
30. Which of the following decreases D. Amniocentesis shows microbial
levels of circulating invasion
antiepileptic drugs in the blood? E. None of these
A. Estrogen 35. Regarding management of mothers
B. Sleep deprivation with HSV infection,
C. Stress which of the following is true:
D. Hyperventilation A. Routine screening for HSV is NOT
E. Pain recommended
31. Which of the following is not true B. Acyclovir is safe for use in pregnancy
about Postpartum C. Cesarean delivery is indicated for
blues? women with
A. Rapid mood swings and appetite, active genital lesions or prodromal
concentration, symptoms
and sleep changes D. Women with HSV may BREASTFEED,
B. Onset: 2-3days postpartum if there are
C. Peaks at the fifth day and resolves no active HSV breast lesions
within 2 months E. All of these
D. Self-limited 36. Regarding management of
E. None of these HIV-infected mothers,
32. Which of the following is strictly, not which of the following is true?
part of the Amsel’s A. Vaginal delivery is suggested for
criteria in the diagnosis of Bacterial women on cART
Vaginosis? + viral load < 1,000 copies/mL near
A. Presence of thin, white or gray, delivery
homogenous B. Zidovudine (ZDV) is recommended 3
discharge coating the vaginal walls hours prior
B. Positive whiff test to CS delivery
C. pH of greater than 4.5 C. ZDV therapy should be initiated to
D. Presence of epithelial cells the neonate
E. None of these within 12 hours, until 4-6 weeks
33. Treatment criteria/on on the D. Postnatal HIV transmission from
treatment of gravid breast milk at 2
years is as high as 25% the broad ligament and is the strongest
E. All of these ligament
37. Confirmatory test for Syphilis supporting both the uterus and cervix:
except: A. Cardinal
A. Quantitative VDRL B. Transverse
OCTOBER 2023 FINAL COACHING & C. Mackenrodt
RAPID REVIEW | TIER III HANDOUT | D. All of these
FINAL EXAM E. None of these
FOCUS REVIEW CENTER | Focus Review 42. Nerve that is injured or damaged
Center | focusreviewcenter@gmail.com due to improper
4 placement of legs in the stirrups or
B. FTA-ABS prolonged dorsal
C. MHA TP lithotomy position:
D. TPI A. Femoral
E. None of these B. Peroneal
38. Which of the following glands are C. Obturator
located near the D. Genitofemoral
female urethra? E. Pudendal
A. Skenes 43. Which of the following arises from
B. Bartholin abnormally high
C. Urethral levels of b-hCG?
D. Vulvovagina A. Theca Lutein Cyst
E. Cowper B. Follicular Cyst
39. Which of the following C. Corpus Luteum Cyst
characteristics is common to D. Endometrioma
both labia minora and majora? 44. Which of the following is not true
A. KSSE about estrogen?
B. Hair follicles A. Secretion is regulated by
C. Sweat glands follicle-stimulating
D. Sebaceous glands hormone (FSH)
E. None of these B. For development of secondary sex
40. True about blood supply, venous characteristics
and lymphatic in females at puberty
drainage of ovaries: C. Proliferative hormone
A. Ovarian arteries arise directly from D. Prepares endometrium for
the aorta implantation (during
B. Left ovarian vein drains into the left pregnancy)
renal vein E. Increases risk of endometrial cance
C. Right ovarian vein drains into the 45. Which of the following differentiates
inferior vena Primary from
cava secondary dysmenorrhea?
D. Lymph drained by aortic nodes A. Onset: >20 years old
E. All of these B. Secondary to abdominal surgery
41. Ligament that originated from the C. Management includes cervical
densest portion of dilatation
D. NSAIDs are the first line treatment
E. Gold standard in the diagnosis is a component in Oral Contraceptive
Pelvic ultrasound Pills?
46. Characteristic/s of McCune Albright A. Suppresses LH secretion thus
Syndrome: inhibiting ovulation
A. Mutation in G3 protein activating B. Thickens cervical mucus making it
adenylate cyclase less permeable
B. Constant stimulation of FSH, LH, TSH to sperm
& GH C. Inhibits FSH secretion thereby
C. Vaginal bleeding – first sign inhibiting formation
D. Triad: café-au-lait spots, polyostotic of the dominant follicle
fibrous D. Thins out the endometrium that is
dysplasia, cysts of skull and long bones not receptive to
E. All of these implantation
47. Also known as Ovarian Resistance E. All of these
Sysndrome PEDIATRICS:
A. Savage Syndrome 1. Which of the following steps in
B. Swyer Syndrome essential newborn
C. Mayer- Rokitanshy-Hauser Syndrome care prevents hypothermia, increases
D. Turner Syndrome colonization
E. Wedge Syndrome with protective family bacteria and
48. In cases of hyperandrogenism, improves
which of the following breastfeeding initiation and exclusivity?
markers is used to determine if the A. Immediate drying
source of androgen B. Uninterrupted skin-to-skin contact
in peripheral in nature? C. Delayed cord clamping after 1 to 3
A. Testosterone minutes
B. DHEAS D. Non-separation of mother and baby
C. 3a-diol-G OCTOBER 2023 FINAL COACHING &
D. SHBG RAPID REVIEW | TIER III HANDOUT |
E. Estradiol FINAL EXAM
49. MOA of metformin in the FOCUS REVIEW CENTER | Focus Review
management of PCOS: Center | focusreviewcenter@gmail.com
A. Decreases Estrogen and increases 5
FSH E. Thermoregulation
B. Antagonizes Estrogen on the 2. Regarding APGAR Score, which of the
receptors in the following is
hypothalamus a bluff?
C. Significant increase in insulin A. It rapidly assesses the need to
resistance resuscitate
D. Inhibits ovarian androgen B. it has a poor positive predictive value
steroidogenesis e in
E. Prevents conversion of Testosterone predicting neonatal mortality
to E3 C. Most children with cerebral palsy
50. Which of the following is an action have normal
of the estrogen as APGAR scores
D. A low 5-minute score does not base around the chin, neck, back, and
correlate with soles, which
outcome. However, the 1-minute score contains neutrophils:
is a A. Erythema toxicum
valid predictor of neonatal mortality. B. Pustular melanosis
E. There is NO consistent data on the C. Milia
significance of APGAR score on preterm D. Nevus simplex
infants E. Cutis marmorata
3. Which is not true about the Newborn 7. Which of the following is not true
Screening about
Test? surfactant?
A. Done at 24-48 hours of life A. Present in high concentrations in
B. Capillary blood is the specimen of fetal lung
choice homogenates by 20 wk of gestation
C. If blood was collected <24 hours, B. Appears in amniotic fluid between 28
repeat at 2 and 32
weeks old wk of gestation
D. For post term, ideal time for NBS is at C. Mature levels of are present usually
5-7days after 35
old wk of gestation
E. Cystic fibrosis is included D. Phosphatidylcholine comprise about
4. Which of the following are the half of its
expected laboratory total composition
findings of a 14 day old neonate with E. It is produced by Type II cells
21- 8. Primary cause of a newborn, whom
hydroxylase deficiency? several
A. Hyponatremia, hyperkalemia, minutes after birth, developed
hypoglycemia tachypnea,
B. Hypernatremia, hyperkalemia, retractions, expiratory grunting with
hypoglycemia clear breath
C. Hyponatremia, hypokalemia, sounds.
hypoglycemia A. Slow absorption of fetal lung fluid
D. Hyponatremia, hyperkalemia, B. Surfactant deficiency
hyperglycemia C. Persistence of the fetal circulatory
E. Hypernatremia, hyperkalemia, pattern of
hyperglycemia right-to-left shunting through the PDA
5. Albinism is associated with which and
metabolic foramen ovale after birth
disorder? D. Aspiration
A. PKU E. All of these
B. CAH 9. Management for ABO incompatibility:
C. MSUD A. Phototherapy
D. G6PD Deficiency B. Exchange transfusion
E. Cretinism C. RHOGAM
6. Vesiculopustular eruption over a dark D. Neocyte infusion
macular E. Panel testing
10. Full breastfeeding (BF) is defined is lethargic but irritable to touch. He
as: gulps
A. BF per demand vigorously the oral rehydration solution
B. Daytime in between BF not longer offered to
than 6 him. Dehydration falls under what
hours category?
C. Night time in between BF not longer A. No dehydration
than 8 B. Some dehydration
hours C. Severe dehydration
D. BF 6-12x a day D. Dehydration with danger signs
E. BF until 6 months E. Profound dehydration
11. Not True about familial short 15. A child prefers to use his right hand
stature: to pick up
A. Stay parallel to the growth curve objects, runs stiffly, and is beginning to
B. Growth curves at or below the 5th climb
percentile steps with 1 hand held, says about 15
by 2 years of age words, and
C. Normal bone age values can feed himself with a spoon. The
D. Puberty occurs at the expected time developmental
E. Over time, it starts falling off the age of this child is most consistent with:
height curve A. 9 months old
12. Which of the following vitamin B. 10 months old
deficiency is C. 15 months old
associated with long term usage of high D. 18 months old
estrogencontaining E. 24 months old
contraceptive pills? 16. After watching a tiktok video of a
A. B1 healthy
B. B2 combination of oats, almond nuts, chia
C. B3 seeds,
D. B6 yogurt and fresh milk, a 12 year old
E. B7 female who’s
13. Hallmark of Refeeding syndrome: already conscious with her appearance
A. Hypophosphatemia started this
B. Hypernatremia regimen. However, she started having
C. Hypokalemia foul
D. Hypomagnesemia smelling watery soft stools She says
E. Hypercalcemia that she
14. A 3-year old boy was brought to usually drinks coffee in the mornings
your clinic for and is not
multiple bouts of watery diarrhea, not accustomed to drinking milk. What is
associated the most
with vomiting. PE shows tachycardia, likely mechanism of diarrhea in this
with weak case?
pulses, reduced skin turgor, and sunken A. Decreased absorption, increased
eyes. He secretion
B. Maldigestion, transport defects B. Decreased C3
ingestion of C. Increased C3
unabsorbable substances D. Decreased to Normal C3
C. Decreased transit time and functional E. Normal to decreased C3
capacity 19. During an annual medical check up
D. Defect in neuromuscular unit(s) in a private
stasis school, a child was discovered to have
E. Inflammation, decreased colonic asymptomatic microscopic hematuria.
reabsorption The child
17. An 18 year-old beauty queen sought wears very thick glasses and wears
an online hearing aid.
consult with you due to history of fever, On further consultation, he has aunts
chills and with the
right upper quadrant abdominal pain. same condition. Diagnosis?
The patient A. Goodpasteur
claims she noticed yellowing of her ice B. Alport
and skin. C. IgA Nephropathy
She also shared, she can feel a mass on D. PKU
the right E. HSP
side of her abdomen. You suspect an 20. An 8-year-old female presented
acute with puffy eyelids,
hepatitis B infection. What test would swelling of face, arms and legs. A
you expect 24-hour
to find? collection of urine yielded 5 grams of
A. HBsAg (+), Anti-HBc (+), IgM protein, rare
Anti-HBc (+), red cells, and no red cell casts. The child
Anti-HBs (– was given
B. HBsAg (+), Anti-HBc (+), IgM corticosteroids. All symptoms and
Anti-HBc (-), findings
Anti-HBs (– vanished. Even without biopsy, you can
C. HBsAg (-), Anti-HBc (+), Anti-HBs (+) conclude
D. HBsAg (-), anti-HBc (-), Anti-HBs (+) that the child most likely has:
18. A mother sought consult for his 13 A. Acute post-streptococcal
year old child glomerulonephritis
who had sore throat a week ago, but B. IgA nephropathy of Berger
now presents C. Nephritic syndrome
with headache and blurring of vision. D. Minimal change disease
Initial E. FSGS
examination revealed bipedal edema 21. Which of the following is not true
but no about HUS?
symptoms of dysuria, no abdominal A. Microvascular injury with endothelial
pain. BP is cell
150/90, HR 106, RR 20 T 36.9°C, which damage is characteristic of all forms of
among HUS
the ff. is an expected laboratory finding? B. Most common in <4 years old
A. Normal C3 C. Platelets NOT generally administered
regardless of platelet count A. 30 minutes
D. Antibiotics directed against most B. 1 hour
common C. 6 hours
etiologic agent D. 12 hours
E. TTP has the same triad but can E. 18 hours
include CNS 25. This is a case of a 3-year old child
involvement and fever and has a more who presented
gradual onset with occasional jerky movements of
22. The mother of a one-month old legs. On PE,
infant was an abdominal mass was palpated,
concerned that her baby’s CBC showed crossing the
a Hgb level midline. There were also some bluish
of 10g/dl (NV: 12-14). Physical subcutaneous nodules palpated. What
examination is is the most
unremarkable. The following are true likely diagnosis?
regarding A. Wilms Tumor
this condition EXCEPT? B. Neuroblastoma
A. This condition is expected in the first C. Hodgkins Lymphoma
8-12 D. Non-Hodgkins Lymphoma
weeks of life E. Rhabdomyosarcoma
B. This is explained by the down 26. Which of the following is a major
regulation of risk factor for
EPO production recurrence of Febrile Seizures?
C. No therapy is indicated for both term A. Family history of febrile seizures
and preterm B. Complex febrile seizure
infants C. Male gender
D. Nadir Hgb levels rarely falls between D. Family history of epilepsy
100mg/dL E. Duration of fever <24 hours
E. None of these 27. Which of the following is an
23. VWD is the most common absolute
congenital bleeding contraindication for performing lumbar
disorder. Which of the following is not a tap?
typical A. GCS <8
finding? B. Signs of shock, sepsis or hypotension
A. Prolonged APTT C. DIC
B. Prolonged PT D. Epileptic seizure
C. Prolonged Bleeding Time E. Local infection at desired puncture
D. Defective Platelet Aggregation site
E. Decreased Factor VIII 28. Which of the following is not typical
24. C Normal clot retraction requires for GBS?
normal level of A. An autoimmune reaction that
fibrinogen, calcium, ATP, and intact and develops in
functional response to a previous infection leading
platelets. Complete clot retraction time to
is usually aberrant demyelination of peripheral
achieved at: nerves &
ventral motor nerve roots fever of 38.5°C. The child points to the
B. Ascending paralysis neck area
C. Tendon reflexes usually the last that seems to bother him, and his voice
function to was a little
recover & lower extremity weakness muffled. PE revealed HR 108, RR 33, T
last to 38.7 C with
resolve minimal movement and refusal to move
D. Dissociation between high CSF the neck,
protein and a (+) neck stiffness. On oral examination.
lack of cellular response is diagnostic there is
(albuminocytologic dissociation) mild erythematous posterior pharynx
E. None of these and bulging
29. A 4-year-old male child is brought to of the posterior pharyngeal wall; chest
the PE revealed
emergency room due to difficulty no crackles, occasional rhonchi. What is
breathing. He the most
has high fever of 39°C. 12 hours ago, he likely diagnosis?
started A. Retropharyngeal abscess
having sore throat and a mild fever B. Peritonsillar abscess
which C. Bacterial tracheitis
progressed and prompted consult. D. Epiglottitis
Patient is seen E. Laryngotracheobronchitis
drooling and the neck is slightly held 32. This is seen in children aged 3-10
hyperextended. CXR was requested years with a
which most history of episodic pain that occurs at
likely reveals: night after
A. Consolidation increased daytime physical activity and
B. Steeple sign is relieved
C. Thumb sign by rubbing; no limp or complaints in
D. Ragged air column sign the morning
E. Any of these A. Pain syndrome
30. At what stage of Wilms Tumor is B. Growing pains
hematogenous C. Patellofemoral syndrome
metastasis seen which is typically in the D. Benign hypermobility syndrome
lungs, E. Fibromyalgia
liver and distant lymph nodes? 33. A 4-year-old female patient presents
A. II to the clinic
B. IIIa with 5-day history of fever with
C. IIIb temperatures
D. IV between 38-39°C. There was bilateral
E. V redness of
31. A 3 y/o male patient presents with a the eyes with no discharge, decreased
2-day history appetite
of gradual decreased oral intake, and intake, physical exam reveals dry
irritability, and cracked lips,
erythematous oral and pharyngeal 35. Which is not a hematologic
mucosal areas, manifestation of SLE?
(+) cervical lymphadenopathy, A. Hemolytic Anemia
maculopapular and B. Leukopenia
scarlatiniform rashes most prominent C. Lymphopenia
at the groin D. Thrombocytopenia
areas, there was also noted mild E. None of these
swelling and 36. Which of the following is not true
erythema of the hands and feet, HR 108, about changes
RR 28 T in circulation after birth?
> 38.8°C what is the most likely A. The primary change after birth is a
diagnosis? shift of
A. Rubeola blood flow for gas exchange from the
B. Kawasaki disease placenta
C. Steven Johnson syndrome to the lungs
D. Scarlet fever B. There is an increase in systemic
E. Ritter disease vascular
34. A 7-year-old male child presents to resistance due to removal of the
the clinic with lowresistance
a rash extending from the buttocks to placenta, hence there is closure of
the lower the ductus venosus as a result of lack of
extremities. The rash is characterized as blood
raised return from the placenta
pinkish to erythematous purpuric C. Lung expansion results in the
lesions. The reduction of the
mother recalled that he had just gotten PVR → an increase in pulmonary blood
well from flow
the flu 1 week ago. He also has right → a fall in PA pressure
knee pain D. Anatomic closure of the FOoccurs
with slight swelling but not warm and due to
nonerythematous. increased pressure in the LA
He is presently afebrile. Urinalysis E. Closure of PDA as a result of
reveals 6-8 RBC, protein +2, WBC 0-2, increased arterial
glucose O2 saturation
(-), bacteria +1. What is the pathologic 37. Which of the following murmurs is
mechanism behind this case? considered
A. Deposition of IgA and immune pathologic?
complexes A. Diastolic
B. Microvascular thrombi leading to B. Musical
hemolysis C. Grade III
C. Immune reaction against platelet D. Soft
with E. Short
increased vascular permeability 38. A newborn boy was discharged from
D. Endotoxin release resulting to DIC the nursery
and shock at 2 days old. His mother notes that
E. None of these over the past
day, he had “heavy breathing”. HR to blistering and peeling off of the skin
170/min, RR easily with
65. On PE, he had a strong pulse in the accompanying pain. Examination
right revealed
brachial but very weak pulses at both conjunctival erythema with fissuring
femoral and crusting
arteries. You ordered CXR. Which of the around the nose and mouth with some
following superficial
would most likely appear in the imaging erosions on the lips, slightly
plate? erythematous
A. Inverted E posterior pharynx, diffuse erythema of
B. Snowman the skin
C. Figure of 8 with denuded areas over the axillae,
D. Egg on string antecubital
E. Boot area, and groin. HR 110, RR 30, T 39°C.
39. Not part of the Jones Major Criteria What is
in diagnosing the most likely diagnosis?
ARF: A. Rubeola
A. Arthritis B. Steven Johnson Syndrome
B. Chorea C. Ritter Disease
C. Carditis D. Kawasaki
D. Eythema migrans E. Scarlet Fever
E. Subcutaneous nodule 42. Recommended post exposure
40. Which of the following does not prophylaxis for a 6
satisfy the clinical year old child who had a sister with
criteria for the definitive diagnosis of varicella:
infective A. Immunoglobulin within 96 hours
endocarditis? B. Live vaccine + immunoglobulin
A. 2 major criteria within 96
B. 1 major + 3 minor hours
C. 5 minor C. Live vaccine within 3-5 days
D. 1 major + 2 minor D. Live vaccine + immunoglobulin
E. 5 minor within 96
41. A 1-year-old male patient presents hours
to the clinic E. Live vaccine + immunoglobulin
with 2-day history of fever and rash. within 3-5
Patient was days
noted to be irritable, weak, with poor 43. This is a case of a 10-year old male
appetite, and who came in
fever of 38°C. One day PTC, an due to fever and rash. History reveals
erythematous rash documented
appeared which started in the face and fever of 38°C, malaise, anorexia,
around the headache, and
oral mucosa, axilla, and groin areas. It mild abdominal pain. One day PTC,
proceeded pruritic
erythematous macules started eye with tearing. Then 3 days prior, the
appearing over the mother
face and trunk. These rashes eventually noted flat red spots starting on the
became hairline, behind
vesicles some of which started to erupt, the ears and upper neck spreading to
then new the entire
lesions started to appear over the face, neck, upper arms, and chest. Today,
extremities. the rash
Persistence of symptoms prompted spread over the back, abdomen, and
consult. PE thighs which
reveals some vesicles on a red base over prompted them to seek consult. PE: HR
the 110, RR
extremities, some crusted lesions over 32 T 39.5°C, generalized maculopapular
the face rash with
and trunk. What is the most likely areas of confluence. Which among the ff
diagnosis? interventions is said to decrease
A. Varicella mortality in the
B. Steven Johnson Syndrome above condition?
C. Ritter Disease A. Antibiotic therapy (Penicillin)
D. Measles B. Ribavirin therapy
E. Kawasaki C. Vitamin A supplementation
44. A 5-year-old male child presents D. IV Ig
with a 2-day E. Acyclovir
history of sore throat progressively 46. A 3-year-old male patient presents
getting worse, to the ER with
and fever of 38-39°C. PE revealed HR fever 40°C and sore throat. Upon
108, RR 28, inspection, there
T 39°C. There is erythematous posterior are multiple vesicles and ulcers over the
pharyngeal wall, bilateral tonsils are tonsillar
enlarged and pillars and posterior pharyngeal wall,
with yellow exudates, and with (+) no rashes on
tender the body or extremities. What is the
enlarged anterior cervical lymph nodes. most likely
What is causative agent?
the most likely diagnosis? A. Human Herpes Virus
A. Retropharyngeal abscess B. Coxsackie A Virus
B. Peritonsillar abscess C. GABHS
C. Diphtheria D. Adenovirus
D. Epiglottitis E. Staph aureus
E. Streptococcal tonsillopharyngitis 47. This is a case of a 10-year old male
45. A 5-year-old male presents with with chronic
fever and rashes. sneezing and cough that is more
6 days prior, he was noted to have a prominent
fever of around 5-8am. Both parents are
37.9°C, dry cough, runny nose and asthmatics. PE
redness of the
shows watery nasal discharge with 2. Which of the following vectors can
boggy carry Ascaris,
turbinates and (+) allergic shiners. For causing diarrhea?
the past 2 A. Cockroach
months, patient has been having almost B. Sand Fly
daily C. Reduviid bug
attacks with difficulty sleeping. What is D. Mites
the E. Fleas
classification of this patient’s disease? 3. Type of host that is similar to an
A. Mild Persistent intermediate host,
B. Moderate-Severe Persistent only that it is not needed for the
C. Mild Intermittent parasite's
D. Moderate-Severe Intermittent development cycle to progress; serves
48. Which of the following is not as "dumps" for
associated with non-mature stages of a parasite in
Digeorge syndrome? which they can
A. Cleft Palate accumulate in high numbers
B. TOF A. Reservoir
C. Decreased CD4/CD8 ratio B. Paratenic
D. Hypocalcemia C. Incidental
E. Chromosome 22 deletion D. Amplifying
49. Features of Wiskott Aldrich E. Dead end
Syndrome except: 4. One of the important provisions of
A. Bacterial infection the UHC act of 2019
B. Eczema is the creation of province or city-wide
C. WASP mutation health care
D. Autosomal Recessive provider networks (HCPN) where both
E. T and B cell defect public and
50. What step in phagocytosis is private health facilities are integrated to
defective among provide
patients with Chronic Granulomatous? coordinated and comprehensive
A. Margination healthcare. Which of
B. Rolling the following is not true?
C. Adhesion A. The HCPN is linked to an apex
D. Diapedesis hospital, a
E. Killing Level 3 single-specialty or a
PREVENTIVE MEDICINE multi-specialty
1. It is defined as the capacity of an general hospital, which serves as the
agent to induce endreferral
disease which is clinically apparent in center.
an infected host B. The primary care facility shall serve
A. Pathogenecity as the first
B. Virulence point of contact of patients, families,
C. Immunogenecity and
D. Antigenecity communities with the healthcare
E. Infectivity system to
access basic and comprehensive 7. DOH developed Resource Stratified
primary Frameworks (RSF) for
care. sixteen (16) medical specialties. RSFs
C. Primary care provider includes delineate roles, minimum
Barangay service capabilities, resource
Health Station requirements, and accountabilities
D. Those needing complex specialty for facilities in each level of care in the
care will be HCPN. Which type or
referred to an apex or end-referral level of care involves management of
hospital at complex, specialized
the regional, subnational, or national conditions, and strategic equitable
level. distribution of facilities to
subnational, or national level. address needs that will require
E. None of these additional specialized training
5. Select among the following lists are and equipment for higher level care?
examples of apex A. Primary Care
hospitals B. Secondary Care
A. Regional Hospital, Medical Center, C. Intermediate Care
Specialty D. Tertiary Care
Center E. Specialty Care
B. District Hospital, Provincial Hospital, 8. Prior deployment to GIDA areas of
Regional Ilocos Norte for a medical
Hospital mission after the typhoon Egay incident,
C. Provincial Hospital, Regional Hospital, the members of the
Medical team took 100mg doxycycline tablet as
Center pre-exposure
D. RHU, Health Center, Infirmary prophylaxis against leptospirosis. This
E. General Hospital, Specialized Health is PrEP is under what level
Facility, of protection?
Diagnostic Facility A. Primary
6. Universal Health Care addresses the B. Secondary
problem of health C. Primordial
inequity by improving access to D. Tertiary
services and financial E. Health Promotion
protection. The current government is 9. This type of population pyramid is
committed to reducing used to describe
these inequities through a universal populations that are elderly and
healthcare scheme shrinking:
called Kalusugan Pangkalahatan. Are A. Constrictive
there how many building B. Stationary
blocks identified to achieve UHC? C. Expansive
A. 3 D. Mixed Stationary + Expansive
B. 6 10. In the pyramid of Evidence Based
C. 10 Medicine, which of the
D. 12 following occupies the highest level?
E. 15 A. RCTs
B. Case-Controlled Studies
C. Meta-analysis
D. Cohort Studies
E. Expert Opinion
11. Which of the following active
listening skills involves setting
aside our biases, prejudices, and
pre-conceived notions to make
way for what the patient is really
saying?
A. Attending
B. Bracketing
C. Leading
D. Probing
E. Reflecting
12. Parents do not pay attention to their
children needs and
seldom have expectations regarding
how the child should
behave, as a result, child is immature,
psychologically troubled
child
A. Democratic Parenting
B. Authoritarian Parenting
C. Permissive Parenting
D. Rejecting Parenting
E. Uninvolved Parenting
13. The family APGAR is a 5-item
questionnaire that has the
adequate reliability and validity to
measure one’s level of
satisfaction with family relationship. It
is a rapid screening
instrument for family dysfunction and
has adequate reliability
and validity to measure one’s level of
satisfaction with family
relationship.Which parameter
measures members satisfaction
with the commitment made by the
members of the family, how
time, space, money are shared?
A. Adaptation
B. Partnership
C. Growth
D. Affection
E. Resolve
14. At which stage of dying typically
manifests as patients seek
some measure of control over their
illness. Guilt is the primary
emotion at this stage.
A. Denial
B. Anger
C. Bargaining
D. Depression
E. Acceptance
15. Differentiate Palliative care from
Hospice care:
A. Offered and provided for patients
during their last phase of
an incurable illness or near the end of
life
B. Provided while the patient is
receiving active treatment, thus,
can be given at the same time as chemo,
radiation, or
immunotherapy for cancer
C. Provided when there is no active or
curative treatment
being given for the serious illness
D. Involves managing symptoms and
side effects
E. None of these
16. Which of the following differentiates
Traditional from
Primary Healthcare?
A. Doctor dominated
B. Focus of care: The well and early sick
C. Structure: Health is an integral part of
socioeconomic
development
D. Goal: Development of preventive
health care
E. None of these
17. Community Organizing
Participatory Action Research
(COPAR) facilitates the education of the
people in part with
capability enhancement activities. It
nurtures the ability of the
society to organize themselves and to
emphasize people
involvement in the resolution of issues
and concerns in the
community. Which of the following is
the most crucial stage
since it is during this time that the
people are mobilized through
the creation of the community health
organization.
A. Pre-entry phase
B. Entry phase
C. Formation phase
D. Organization- building phase
E. Sustenance and strengthening phase
18. Geographically Isolated and
Disadvantaged Areas (GIDAs)
refer to barangays which are specifically
disadvantaged due to
the presence of both physical and
socio-economic factors.
Physical factors refer to characteristics
that limit the delivery of
and/or access to basic health services
to communities that are
difficult to reach due to distance,
weather conditions, and
transportation difficulties.
Socio-Economic factors refer to social,
cultural, and economic characteristics
of the community that
limit access to and utilization of health
services. Which of the
following is not a socio-economic
factor?
A. Atleast 10% of its population are Ips
B. Atleast 10% of its population are
affected by Armed Conflict
or Internally Displaced or the
barangayis identified as a
Communist Terrorist Group
(CTG)/Local Extremist Group
(LEG)area by the National Intelligence
Coordinating Agency
(NICA)
C. At least 50% of its population are
enrolled in Pantawid
Pamilyang Pilipino
Program/Conditional Cash Transfer
(4Ps/CCT);
D. At least 25% of sitios/puroks should
have no access to a Rural
Health Unit (RHU) nor a hospital within
60 minutes of travel in
any form of transport, including
walking
E. The performance of the barangay, in
infant mortality rate,
contraceptive prevalence rate, fully
immunized child, and
Adolescent (Age 10-19) Birth Rate is
less than their provincial
data.
19. Which of the following results from
deficiency of water/salt
leading to circulatory insufficiency?
A. Heat Stroke
B. Heat Exhaustion
C. Heat Cramps
D. Heat Syncope
E. Hyperpyrexia
20. Controlling exposures to hazards in
the workplace is vital to
protecting workers. The hierarchy of
controls is a way of
determining which actions will best
control exposures. The
hierarchy of controls has five levels of
actions to reduce or
remove hazards. Which of the following
is the lowest in the
hierarchy and hence least effective?
A. Elimination
B. Substitution
C. Engineering Controls
D. Administrative Controls
E. PPE
21. According to the Research Institute
for Tropical Medicine,
based on risk assessment during
COVID-19 pandemic, which of
the following is the last to be donned 25. The “Happy Birthday” song can be
during PPE donning for hum while scrubbing
NPS/OPS collection? hands during handwashing. This is
A. Head Cover equivalent to how many
B. Face shield/Googles seconds?
C. Foot cover A. 15
D. Disposable gown/Cover all B. 20
E. Outer gloves C. 25
22. 5TH S strategy kontra dengue: D. 30
A. Search and destroy mosquito E. It depends on the arrangement or
breeding sites rendition of the singer
B. Self-protection like using of insect 26. All sick children aged 2 months up
repellents to 5 years are examined
C. Seek early consultation at the neatest for general danger signs and all sick
health care facility young infants from birth up
D. Support fogging, spraying, and to 2 months are examined for very
misting in hot spot areas severe and local bacterial
E. Sustain hydration infection. These signs indicate
23. PD 856 is also known as Code on immediate referral or admission
Sanitation of the to hospital except:
Philippines. The latter does not specify A. Lethargy
a minimum distance B. Vomiting
between a cemetery and a dwelling C. Convulsions
house. However, it states D. Inability to drink or breastfeed
that np burial ground shall be located E. None of these
withing how many meters 27. Disposition when a positive ELISA
from either side of a river or any source test for HIV has been
of water? released by a Medical Technologist:
A. 25 A. Request for Western Blot
B. 50 B. Send a sample to RITM for
C. 75 confirmatory testing
D. 100 C. Repeat the test
E. 150 D. Counsel the patient and start ART
24. According to CDC, Handwashing is E. A or B
the best way to get rid 28. Particulate matter (PM) refers to
of germs in most situations. If soap and inhalable particles,
water are not readily composed of sulphate, nitrates,
available, one can use an alcohol-based ammonia, sodium chloride,
hand sanitizer that black carbon, mineral dust or water. PM
contains at least how many percent of can be of different size
alcohol? and is generally defined by their
A. 50 aerodynamic diameter. Pollen,
B. 55 sea spray and wind-blown dust from
C. 60 erosion, agricultural
D. 65 spaces, roadways and mining
E. 70 operations range at what size?
A. <2.5u stipulation by the parties and are fixed
B. 2.5-5u by law
C. 2.5-10u D. Breach of the marital contract gives
D. 10-20u rise to an action for
E. >20u damages
29. A 65-year-old male with history of E. All are facts
uncontrolled DM had a 33. According to data privacy act of the
CVD which led to his confinement. Philippines, a person
During the course of who provides access of
hospitalization patient developed personal/sensitive information due to
pneumonia and subsequently negligence shall be liable to how many
died. Which of these is the antecedent years of imprisonment?
cause? A. 6 months- 3 years
A. Respiratory Failure B. 1-6 years
B. Pneumonia C. 1 year and 6 months – 5 years
C. DM D. 1 year and 6 months – 7 years
D. CVD 34. Which of the following data privacy
E. Unhealthy lifestyle principle describes that
30. Which of the following is classified the processing of information shall be
as a garbage code? compatible with declared
A. Cardiac Arrest and specified purpose which must not
B. Asystole be contrary to law,
C. Electromechanical dissociation morals, or public policy?
D. DIC A. Transparency
E. V-Fib B. Legitimate Purpose
31. Which of the following Philippine C. Proportionality
herbal medicinal plant is D. Processing of personal data
approved by DOH for the prevention of 35. Prophylaxis for an expected single
urolithiasis? exposure to L. interrogans
A. Sambong after wading in flooded water with
B. Tsaang gubat intact skin and mucosa:
C. Ulasimang bato A. Doxycycline 100m/cap; 2 caps single
D. Yerba Buena dose within 24-72 hours
E. Niyog-niyogan B. Doxycycline 100m/cap; 2 caps once a
32. Referring to the family code of the day for 3-5 days
Philippines, which of the C. Doxycycline 100m/cap; 2 caps once a
following is a bluff? week until the end of
A. There are 3 parties in a marriage exposure
contract, the man, the D. Doxycycline 100m/cap; 1 cap within
woman, and the state 24-72 hours
B. The marital bonds can only be served E. Doxycycline 100m/cap; 1 cap once a
by death, or upon a day for 3-5 days
court declaration of nullity or 36. According to NVBSP, estimates for
annulment annual blood needs per
C. The rights and obligation of the region shall be based on how many
parties are not subject to percent of their total
population? B. Orange
A. 1% C. Green
B. 5% D. Yellow
C. 10% 42. Which of the following is a
D. 15% non-modifiable risk factor in the
E. 20% acquisition of NCDs?
37. All blood units must be tested for A. Diet
transfusion-transmissible B. Smoking
diseases which include the following C. Type A personality
except: D. Birth weight
A. Syphilis E. Body weight
B. Hepa B 43. What household method of water
C. Hepa C treatment involves
D. Malaria transfer of water from one container to
E. Gonorrhea another?
38. Effective means of preventing A. Aeration
trichinosis in humans include: B. Boiling
A. Cooking pork and pork products to C. Flocculation
ensure that all parts of the D. Filtration
meat reach a temperature of at least E. Sedimentation
40°C 44. Not a parameter in Metabolic
B. Prohibiting the marketing of Syndrome:
garbage-fed hogs A. Total Cholesterol
C. Attention to proper disposal of hog B. TAG
feces C. BP
D. Skin testing of hogs with Trichinella D. FBS
antigen prior to slaughter E. Waist circumference
39. Aedes mosquito can transmit which 45. Which is not part of the microcytic
of the following disease? hypochromic anemia
A. Dengue umbrella?
B. Chikungunya A. ACD
C. Zika B. Thalassemia
D. Filariasis C. IDA
E. All of these D. Lead poisoning
40. Which of the following herbal plant E. D. Latum infection
can be prescribed to an 46. Bacterial quality of coliform/100
adult patient with asthma? mL warrants an
A. Lagundi alternative water source:
B. Bayabas A. 5,000-10,000
C. Ampalaya B. 10, 000- 20,000
D. Yerba Buena C. 20,000-30,000
E. Tsaang gubat D. 30,000-50,000
41. Sharps like used needles should be E. >50,000
disposed in which type 47. Most important single test to find
of container? out if water is potentially
A. Red dangerous:
A. Physical
B. Chemical
C. Biological
D. Radiological
48. Antimicrobial Stewardship (AMS)
program is the program of
the DOH tasked with concerted
implementation of systematic,
multi-disciplinary, multi-pronged
interventions in both public and
private hospitals in the Philippines to
improve appropriate use of
antimicrobials, which is essential for
preventing the emergence
and spread of AMR. Which of the
following does not require
preauthorization
by IDS or AMS clinician?
A. Linezolid
B. Amphotericin B
C. Cefuroxime
D. Vancomycin
E. Cefepime
49. Are there how many core elements
in the national AMS
program that form its foundation for its
success?
A. 4
B. 5
C. 6
D. 7
50. What type of water-related disease
is associated with poor
hygiene and domestic cleaning?
A. Water-based disease
B. Water-washed disease
C. Water-borne disease
D. Water-related disease