nes Republic of the Philippi | PROPEESTONAL REGULATION CONMISSION Manila BOARD OF MEDICINE I PHYSICIANS Licensure Examination Monday, November 1, 2021 0 p.m. MEDICINE sora | ‘ ZMSTRUCTION: Select the correct answer fo= each’ of the following = Shading the box WuesFions. Wark only one enswer for each item by shading the Staspeponding to the letter of your choice on the answer sheet provid d. STRICTLY NO ERASURES ALLOWED MULTIPLE CHOICE 1.|mnat 3 the pathology Most commonly associated with adult respir tory | distress_syndrome? | As Extensive microembolization |. B: Partial collapse of lungs (atelectasis) | @ Dittuse alveolar damage | D. Edema in the microscopic air sacs Pt Jolt-accentuation maneuver 3 [ine $7 year old healthy man, what is the average dlomerular £i1{ zation Kate in ml/min/1.73 m2? A. 93 80 BL ilo 65 4, What 18 FALSE of seguental vititigo? R. Differs in cause and, frequency of associated illnesses B. It's mostly unilateral in characteristic : Grte's much more stable/static in esuree D. Ite treatment is the same as that of non-segmental vitiligc 5. Which class of drugs is associated Most with depression? ‘A. anti-hypertensive 2 Blood-sugar lowering | 8. Anti-migraine D. Lipid-lowering + . | 6. Yhat do you call the bleeding/henorrhace in the delicate innernos ayers of the meninges? t A. Subarachnoid C, Subdura: B. Epidural Du Intracerebral 7+ Yn dengue fever, the virel genone is translated in which part of he ely? 8) cert membrane Gp Bigopdanic retichiun | B. Nucleus cytoplasm 8. X semi-conscious 75-year old. man gczoke. His serum sodium is like: & 128 + 140 | Continued on Page 2PRYSIPIANS Licensure Examination 100. pom. ease | Monday, November 1, 292] — 02100 p.m. ~ OF i MEDrcENE : 10. an. 12 13 14. 16. 7. 1a. 19. hat is FALSE of the epidermis? A. Nourishment in mainly provided by diffusion | B. Eevsesdate ene. Tnnsnd Eyecems ia. warding off pathogen S: Sells are continually shred from the stzacun ou Dr It's nourished directly by its own s aracterized | ee Petechial rash in meningococcal meningitis ie ch i ollewing, EXCEPT ss red spots | A: rapidiy spreading ___€- purple or red spote | at blanching” : De eee y the : jelicobacter p lori? fihich is Nor a test for detecting the presence of Helicobacter p "urea breath | BE Meesuremant of sorum antibody &: Stoer"eneiboay D. Detection of urease activity Which of the following is the LEAST LIKELY complication of meningo-encephalitis? | 2X Disseminated intravascular coagulation | B. Sepsis Myocarditis . Systemic inflammatory résponse syndrone stance test i What distance in meters accomplished in the walk dist tes patients with chronic lung problems is associated with fair to giod brognosis? "pe 100 c. 200 B. 380 D. 520, The species of Plasmodium that causes serious or severe malaria /3 ky falciparum ——— c, malarias BY vivax D. ovale Lipiduria C. Albaminuria eS is NOY expected in Nephrotic syndrome? ~ Hyperglycemia D. dyperlipidemia A male adolescent was found to have glomexulonephritis with heariag and Yisual impairment, noted to be due to abnormal collagen deposicic vin he eyes and middle ears. He has likely syndrome A. Stickler c. Bhlers=Danlos B. Loeys-Dietz & Alpert, Besides Neisseria meningitidis, which is the NEXT Host frequent - use of bacterial meningitis? | © Peeudomonas aeruginosa —_C. Listeria monocytogenes | B+ Streptococcus pneumoniae B Staphylococcus’ qureus : ¢ ‘fs patients with HIV-AIDS, neyative for menin: jococdemia, what is :h Sext MOST likely cause of meningitis? : 1 - ' | A. Protozoal Pungal | B. Amebic D. Tuberculous =} positive Murphy sign in acute cholecystitis has ar Hegpent positive and negative predictive versent) “wound — 65°70 c. so |B. 80 D. 90 i Continued on Page 3 oes: | PUVSTCIANS Licengu: ae Censure Examination Monday, November 1, 2021. - 02:00 p.m, - MEDICINE SET A 04:00 p.m. Page| 3 20. The rollowing kinds or species of malaria cause mild disease, B} JEPT | Riva —— © oars BL faleiparun malariae 21! “Retinal whitening’ ie associated with what severe condition? | + Acute embolic occlusion of retinal arteries | & covrp-i9 Cerebral malaria with encephalopathy Intense ultraviolet, rays exposure 22 | ups of the following 1s true about the genetic variation in <¢ igue | viruses? A. The major determinant is temperatuze in area By Te Le generally. endemic in nultiple regions, with establishment into additional te=ritories | €. Tt is region specitic, suggesting that establishment into | new territories 1s relatively infrequent | > Regional specificity is based on denographics 23.| Which is TRUE of rabies? | A, wot transmitted thru te mouth, nose or eyes | WL Frequently w/ thirst and polydipsia due to dehydration~ (2 Involves the peripheral but not central nervous system D. Caused by a lyssavirus-thru animal bite 24.| the polyarthritis of Rheumatic fever ig usually starting in the RK. Iegs and migrating upwards : B. cervico-thoracic area going downvards CL shoulders and arms going downvards DE wrists and elbows going to shoulders and cervical area | 25.| tn epilepsy, non-consciously-generated activities and mostly, sin|zle | repetitive movements are called Rov amacking oy anromatTene B. tics D. aura 26.'X brainstem stroke is GENERALLY characterized by the following, |IKCEPT | apmasta |B, Altered breathing and heart rate | @% Altered smell sensation B. Brosping of eyelids 27,|Aside from mosquito-bite transmission of the dengup fever virus, the |following modes of transmission have also been repprted in recer - literatures, EXCEPT : ‘A. vertical transmission C. aicborne | BL infected blood products Dr organ donation 28. What skin lesion do you expect to see in children With scabies? A, Burrow Ex Scale | o Grae BY Lichen:fication 29.|which of these is the most appropriate initial pharmacotherapy { )x [symptomatic patients with osteoarthritis vho are bothered by ths |pein? er Chondroitin ©. Glucosamine $B. Acetaminophen D. Topical hot Liniments | | \ Continued on Page 4 1.9 iPHYSIQIANS Licensure Examination Monday, November 1, 2021 - 02:00 p.m. - 04:00 p.m. Page 4 NMeDrcmNe SETA EDICINE | 30. Whick of the following is an underlying cause of Type 2 respirator failure? : A, Neuromuscular problems B. Bronchial hypersensitivity Gy Increased breathing effort Decreased airway resistance 31. Heberden's nodes in osteoarthritis are seen in the — dpints. A. wrist/carpal c. shoulder Pv distal interphalangeal Dr proximal phalangeal 32. Which is Nor true of wheal as a skin lesion? (A) Usually disappears within 24 to 48 hours Y usually rounded or flat-topped | C. Characteristically evanescent D. Represents an enlargement of superziciel blood vessel 33. Water moves from places with lower sodium concentration to places ith higher sodium concentration through a process called permeation Eo Gomes B. diffusion D. saturation 34. Histologically, one notes a loss of cohesion between keratinocytes in which of the following? Atopic dermatitis C. Third-degree burns . Varicella zoster D. Germen measles 35. Which is FALSE during and immediately after an epiljeptic seizure? A. Patients may become unconscious Bl there may be trangient confusion. ef Affected patients feel exhausted. D. There is hyper-reflexia 36. Which PaO2/Pi02 ratio (PFR) in mmig is suggestive of moderate adul rgspiratory distress syndrome? ' a. 50 c. 200 Be 100 D. 250 37. FHaction of inspired oxygen (Fi02) at 1 liter 02 by! nasal cathete: is agproximately A. 0.24 M& 0.21 IB. 0.27 D. 0.29 38. h is the MOST common presenting symptom of menihgitis in adult: Headache High fever IB. Disorientation DY Nuchel rigidity 39. wiich BEST describes the typical presentation of patients with ¢hre ic olfstructive pulmonary disease? 7 Easy fatigability, orthopnea, wheezing Ib. Dry cough, rhonchi and coarse crackles on auschitation fe. Dyspnea, cyanosis, cold clammy pereoiration ] shortness of breath, cough, sputum production 40. In Wernicke-Korsakoff psychosis, the associated pathology in the ki sin is} due to damage of which ‘part? In. Medulle oblongata C. Frontal locke pL Parietal lobe D. Thalamus Continued on Page 5PRusrc re Examination Monday, November Ts SASTIMRCC g om. — 24:09 pom ase 5 mebrex SETA webrexine 41. th eysonte's disease, unat type of tissue afows sbnormally in)th male Styatd A. Vascular c. coblagen | |B. muscular Be Cavernous | 42. Treatment after exposure (dog bite) can prevent rabies if given within : days" RTs c. 20 Bie BS 43. Wheure new dengue viruses are released into the circulation by the Process of 5 A. exocytosis fer c, cellular transfer Bo viral migration Di expulaion | SITUATIONAL, situation 1 46 A 31-year old female with a pale ashen appearance segs y .u, and ybu suspect chronic glomerulonephritis (GN). . Which of the following urinalysis findings is NOT expected as part of the Gu? - A. 3+ proteinuria c. WEC of >100/hpt 'B Red cell casts @) Rec of > 100/hpE Which serum findings may be associated with this cdndition? ‘A. Sorum K of 3.2 mEq/L Serum uric acid of 5 mgs/al Serum LDL cholesterol of 150 mgs/dl. Sexum random blood sugar of 140 mgs/dl Which type of GN usually result in nephrotic syndrdme? |A- Nonproliferative C. Post-infectious IB. Rapidly progressive De Menbrano-proliferative situat{on 2 - A single 30-year old male consults you for painful urina ion and 47. 48. 49. piis-1ike secretion coming out of his urethra, He had unprotected sdx recently. Wijat is generally the incubation period in days of |sexually transn tted Aiffections like gonorrhea and chlamydia? ! 2-5 c. 6-9 10-12 D. 0.5-2 you're suspecting gonorrhea or chlamydia in eitier males or fem: les, tie following specimen may be reliably used as speqimen for the ednfirmatory test, EXCEPT _ | IA, urine for both males and m————-| cervical swab in women ¢ vaginal swab in women jp: anal swab for both males and females For gonorrhea and chlemydia infection, the recommended method of cdnfiemetory diagnosis is through tests. oulture eee a ee eee » nucleic acid amplification 2 gram stein polymerase chain reaction Continued on page 6 ' 71g B i | | | || PRYSICHANS Licensure pexarey Examination | November “1, 2021 = 62:00 p.m. - 4:00 p.m. Page 6 Sitvation 3 - A a8-year old healthcare front liner is admitted to the oVvrD-19 Nard with fever, anosmia, and anorexia. He claims to be . cqmfortable with his breathing at rest. RT-PCR swab done outside wds positive, 50. wor nding 4n the complete blood count (C3C); in microliter (ut of bhegd, is WoT expected for his condition? Homatoceit of 40 percent JE: white blood cell Count of 3,500 D: Platere: count of 243,000 52. Chest x-ray done is unremarkable, Requestine for a chest cr scan = SEITI advisable to Tule out COVID infiltration of lungs“ gptional in cases when there's no cough or dyspnea indicated only if patient develope cough or dyspnea B no longer necessary since chest x-ray is normal 52. I patients with covrp-19 who are not dyspneic, such as in this ca e, a stonidicanciy low oxrgen acrorecion tao {babs JA highly ntikely"and 4s Just most likely due to @ defective oxineter B. expected in the early stage of even asymptomatic CovID L~ patients : ©. Gxplained by the sense of denial of patients who fear $ eeeeteetras auc 20 +a phenerencn of “havey breonaniar | Situation 4 - A 45-year old woman with multi, lergies, for which v rious dications are prescribed, comes to you for high blood pressure of 160/100 mmg. She also complains of easy fatigabiity, hgadaches, irregular menstruation. On PE, you note, her vound face wijth acnes, a fat lump between the shoulders, reddish stretch marks and weak motor tone in both upper and lower extremities. 53. Al excess of which substance or hormone would you consider MOST? Aldosterone C. Catecholamine B. Glucocorticoids D. Progesterone 54. Yqu inguire about her medication history. Which of| the following nddieives she's. been taking without regvler followLup with her phy ician mst likely contributed to her condition? : ‘A. Monteleukast. Levocetirizine B. Diphenhydramine Methylprednisolpne 55. Wijich hormone may be checked in the blood ta confikm the diagnosis la. Growth hormone Thyxoid stimulating hormone Adrenocorticotropie hozmone Follicle-stimulating hormone Situation 5 - You're following up @ 50-year old known pase of Rheumato 4 arthritis (RA). She seams to be doing well cn her burrent tyeatment regimen. You repeated some of her laboratory tests, | 5 ich is consistent with RA in her coy e ount? : “Ine platelet count of 450,000/ men" *t® Pood count B. hematocrit of 41 percent IX white blood cell count of 16,500 ceils/meL ‘ID. red blood cell count of 3,600 celis/neL, | : Continued on pege 7 - : !bsg FCTANS Licensure rxamination 57-]¥he= do‘you Nor expect to £ind on 2D echocardiogram with Dopple} study [in this Ratiene? | A; Mild left ventricular compliance abnormality | @ ejection fraction of 70 percent | C. minimal pericardial effusion | “| P. outflow tract dyskinesia 58-|the following may be seen on x-rays of the hands and feet, EXCEP ' “Re subluxations C. osteopenia | BT csteophye Br bony ezosions | Situftton, 6 = commonly uséd calcium channel blockers in clinical prp tice are: I. nifedipine, II, diltiazem atid, III. Verapamil. 59-iWhyan may be used in patients with hypertension? x, in, 111 @ 1 only |B None of them D. In only 60. 'Which can potentially increase heart rate? joe mar oe IT ets B. None of chem Si. Which is. best given in patients with supraventricular tachycardi ? | A. None of them cir j eae wr Situation 7 - Aa young female, who has a history of recurrent short £ inting spells usually preceded by palpitations, wuddeniy collapsed whil: waiting for a ride at the bus stop. she'was ruched’ toe nearby hospital ER, and hooked to a cardiac monitor, she das ancoectou leith no palpable pulse: 62. Hex rhythm in the cardiac monitor is most likely | #0 sinus bradycardia with frequent 2-second pauses | B. ventricular fibrillation ¢. chaotic atrial rhythm j P+ atrio-ventricular tachycardia with reentry 63, After intervention, regular sinus rhythm was restofed. 12 -lead } vould likely show right bundle branch block (RSBB) lwith X, tall peaked T waves B. ST elevation in I, AVL, II, 111, avF C! inverted tT wave in V1, v2 } D. ST elevation in V1, v2 \ i $4. fin this patient, which of the following drugs should be always eusided? A. Sodium channel blockers By. Beta-blockers 2” ACE inhibitors D. Mineralocorticoid receptor antagonists Situation @ - Atrial septal defect (ASD) is a songenitdi heart diseat: (CHD) a physioien may diagnose in unsuspecting adults’ who [did not Feallze they had such CHD. 65. What is the MOST common type of ASD? | A. Patent foramen ovale C. Ostium srimum B. Sinus venosus D_Ostium secundum | ‘ Continued on Page 8PHYSIGIANS Licensure Examination Monday, November 1, 2021 = 02:00 p.m. - 04:00 B.m. Page 3 Merce SETA 66. fn stients with relatively small shunts, what is a PRACTICAL maa uver jo gecentuace the shunt during diagnostic study? | acrValsalve cc. Coughing B. Deep inspiration D. sitting up 67. Reversal of the shunt in asp occurs in : — JE intactive endocarditis C. Bisenmengez™s syndrone | \B. paradoxical embolization D. decompression syndrome Situadion 9 ~ vou requested for the serum level of adrenocorticotropi hormone vie, in a suspected case of Cushing's syndrome, and the following are the possible results you may obtain: I, Indatectable or low level, if..Normal to mildly elevated; or IIz. larkedly elevated. Which of these results are HOST related to or associated with the following interpretation? 6B pic ACTH syndrome is Likely? Ole C. wone of these nr BF 69. dushing's may be considered? 70. Hrimary hypercortisolism is likely. Ja. rr . Wone of these j [Bog D. IT Situation 10 \- A 35-year old housewife sees you for a Siday history of roductive cough with yellowish sputum, accompanied by fever, and some pain in the chest when breathing deeply. na. isch of the following is Gomen expected finding in her complete blood lount? : “A. White blood cell count of 14,500/uL ! |B! Hematocrit of 48 percent | Gi Neutrophile count of 12,000/uL 6 Lymphocyte count of 7,500/uL 72. dram staining shows a Grem positive (+), lancet-shkped pathogen, 1 0st ikery, the causative organism is ; Klebsiella pneumonia G.j Beaphylecoccus hureus |B. Pseudomonas asruginosa (5) Strertococcua pheumoniae 73. what is your antibiotic of choice for this patient! 6 Fluoroquinolone + doxyoycline Beta-lactam + doxycycline Macrolide + fluoroquinolone D. Beta-lactam + macrolide Situation 11 — A 40-year old male, previously healthy, fs rushed to th ER with spvere difficulty of breathing, He has fever and'dky cough for ys. You hear crackles at both bases, and right ml lung ficids 14. 6 LEAST expected in this patient on PE? ‘Apical 83 or 3rd heart sound Heart rate of 120/ minute | ¢: apicel 84 or ath heart sound |B: RBapiratory rate of 3a/ninnce t | Continued on Page 9 | aed 1 ' |PAYSICIANS Licensure Examination Monday, November 1, 2021 ~- 02:00 p.m. ~ 04:00 p.m. rood meprdrne sera | deci, arterial blood gas finding at room air will surprise you (unexpected finding)? ; Oxygen saturation of 60 percent Gi pakefa,Ceturstlon of oo er stonice (FCO2) of 48 nly C. pi of 7.45 D. Bartial pressure of oxygen (p02) of 55 mug 76. you computed for the Pa02/Fi02 ratio (PFR). Which of the followirj PFR Necwost’ compacibie with his condition? GP ize C30 2 8 5: 300 Situgtion 12 ~ A 52-year old male smoker, with hypertension and diabei ss, was rushed'to the emergency room for severe, crushing chest peins, cold sweats and shortness of breath of 1-hour duration. 77. Which of the following will you Nat. ccnsicer immediately? A. Acute pulmonary embolism B. Acute massive myocardial infarction & Severe aortic valvular stenosis D. Acute aortic diasecting aneurysm | 78. jWhich is the LEAST likely t6 find in his 12-lead ECG causing his symptoms? A. Biphasic T-wave in Vi-vS, I, AVL, and TT, TIT, AVE i & Diffusely low QRS voltages with pathclogic Q waves 3-4 mm ST elevation in V1-VS 3-4 mm ST depression in V1-V6 79. groponin 1 wae 0.40 ng/ml. BP was 80/€0 mrHg; heant rate of 120/ ninute. Mwhat is the Mos? appropriate intervention in this jscenario? | Az Massive dose of low molecular weight heparin | | 47 Percutaneous coronary intervention ! | °C. Trans-catheter pulmonary enbolectomy ! pl trans-catheter aortic valve replecement ' Situgtion 13 — A 60-year old with a 25-year history of jancontrolled ¢:abetes Jconsvits you in the clinic for weakness and easy jatigability. lyou note crackles on lung auscultation, with hepatomegaly and lpilateral pedal edema. His random blood suger is 456 mgs/dl., loreatinine of 3-5 mg/dl A. Potassium of 5.4 mEq/L B. Sodium of 145 mEq/1 | fy HDAlc of 9.5 percent | @ triglycerides of 350 mgs/di wb la 0. ae other lab value (serum) is not expected? stimated glomerular filtration rate (GFR) is 29 nti-diabetic drug should you NoT prescriie? A, Metformin ©, Linagliptin i. /min/1,73/m2, which | @ Papagiiflozin D. Thsuiin 82. You would recommend renal replacement the 8 iehan a ryenal feplacement therapy once GFR i les ce . c. 1a i 19 D. as | Situation 14 - Diarrhea due to cholera can be life-threatening if noy adequately managed. Continued on 2age 10 |PHYSICIANS Licensure Examination ‘9di00 Bim: oa 10 Monday, November 1s 208) 93:00 pene - meprérnk — 93. Thy siarchea in cholera is MAINLY due to cause 84. What ion is lost Most significantly in cholera? : Potassium : "ae soditun Chloride * Magnesium 85. In| cholera, the intestinal fluid secreted is _ “hypertonic ¢. isotonic T B. hypotonic D! variable situation 15 - You see a 55-year old.male, on polypharmacy, complaining onrand-off diarrhea. Two major causes of diarrhea you're cchsidering are: T. Secretosy, and TT. Osmotic 56. Which is/are associated with bowel movement of 6 or more per day? ape rr . Both > D. Neither 87. Select which type(s) is/are associated with inhibition of absorptic1 in gut. + Neither - mn + Both D.T 88. Which may be caused by ingestion of excessive sugar or salt? Neither Saecer bY Both D. Ir Situatibn 16 ~ An elderly patient was rushed to the ER in the middle of -he night due to sudden onset dyspnea and orthopyea preceded a few holirs ago by chest discomfort which he just dismissed to be due tol indigestion. on PE, he had an apical S3, a highzpitched blowing systolic murmir, and bilateral crackles. | rr Acute mitral regurgitation Pericarditis ¢: Severe heartburn b. Acute aortic regurgitation valvular vegetation ischemic papillary muscle inflamed pericardial lining + Severe gastro-esophageal reflux, 90. “4 MOST likely cause in this patient is __ 91. Th¢ following may help this patient, EXCEPT _ beta agonist Y angiotensin receptor blocker $. nitrates : ACE inhibitor Situatidn 17 ~ You were called to see a 55-year old patfent brougnt to = «x foy severe abdominal pain. History and PE suggeste|ecute et 7 BR perjoreatitis. You requested for serim amylase ani {ents 1 92. whgt should you remember when you request for these teste? + Bven with severe abdominal pain® . Pain, diegnosis is still Continued on Page 11 : ie 219Monday, November 1, 2021 - 02:00 p.m. ~ \ wepren seta : ‘ set of DyBeruri Lipane rises within 30 minutes from che onset | t symptoms avitis 83. geru. amylase may be normal in acute OF chronic panore pon : A. Read OF pancreas is oriented inferiorly < acinar cell mass is deplete & acinar cell mags 18 deCtoh in all regions of pancreas Y , 43? Suppression of pancreatic zymogens of Proenzymes | 2 94. tay ds Wor a seagon for ® falsely elevated serum amylase? Portal hypertension B. Salivary gland désease | C. Bowel obstruction, infarction D. Perforated ulcer Situation 18 — A 42-year old housewife sees you for 4 palpable mass on hex neck. sor ncte on PEL LS x 2 em firm nodule on the right side of the eck. 95. To conficm the presence of a nodule and assess the status of the thole fland, what exam on the thyroid gland would you request? Pox. Fine needie aspiration | po Radioactive iodine uptake Thyroid function test D, Ultrasound 96. hich test will help you evaluate the ohysiclogic func thyroid disease? : 7 Thy-oid ultrasound I". Fine needle aspiration | Bl Calcitonin test Z pntithyroid antibodies (7 tion of pat .ent’s 97. hetection of any metastases of thyZoid cancer can be performed wiih a full-body os n using iodine-191. inagnetie ¥esonance (© conptterized cohogrepny scintigraphy bone t Situation 19 ~ A Si-year old peri-menopsusal yonan, whol was lost to fc (low-up deh her endocrinologist, but still erratically taking the ‘ethimazole she was prescribed,” was brought to you, with an acute neet of symptoms of restlessness and agitation, cbnfusion, omiting and diarrhea starting just 3 hours before} consultation). 98. fhat would be your primary consideration? i a/ Thyroid storm C. Acute ischemic [stroke BY Myxidema D. Methimazole toxicity 99. What is NOT an expected finding in-this case? pen. Temperature of 36.5 degrees Centigrade | Bl systolic BP of 160 nimig ; ¢iYPulse pressure of 80 mmnag | pe peart rete of 115/min 100. Which of the following will you NOT give this patient? A, Anti-thyroid drags C. Inorganic iodine B. Beta-blockers X” Alpha blockers