Module I

1. Which of the following types of rash will be observed in drug B Explanation: dahil demonstrate capillary
fragility?
reactions, leptospirosis and other disease conditions that
demonstrate capillary fragility?
a. Maculopapular
b. Petechial
c. Pustular
d. Polymorphic

2. Which of the following is consistent with myocardial infarction? C Explanation:

a. Ripping chest pain in between the scapula A = aortic dissection
B = Pericarditis or something
b. Episodic pleuritic chest pain graded 10/10 D = Pero stable angina pa lang ata?
c. Retrosternal pain radiating to the jaw SO baka di pa MI, ischemia pa lang?
d. Chest heaviness precipitated by exertion

3. Which statement is not included in the three-delays model of B Explanation:

morbidity and mortality?
a. Delay in seeking care
b. Delay in purchasing the prescribed medicine
c. Delay in the provision of care by the health facility
d. Delay in recognition of illness

4. Which of the following parameters is normally increased in the D Explanation: In Western societies,
systolic blood pressure tends to rise
elderly patient?
with aging (Fig. 20-2). The aorta and
a. Cardiac output large arteries stiffen and become
b. Resting heart rate athero- sclerotic. As the aorta becomes
c. Stroke volume less distensible, a given stroke volume
causes a greater rise in systolic blood
d. All three are increased
pressure

CO formula = SV x CO
● So increased na SV = ↑ CO
● So dapat all 3 are ↑

5. Which of the following statements is true regarding sensitivity of C Explanation:

Sensitivity: the ability of a test to
a test?
correctly identify patients with a
a. The ability to rule out the disease if the test is positive disease.
b. The ability to rule out the disease if the test is negative Specificity: the ability of a test to
c. The ability to rule in the disease if the test is positive correctly identify people without the
disease.
d. The ability to rule in the disease if the test is negative

6. Match the options below regarding back pain Radicular - a. Radicular pain -typically sharp
Electric and radiates from the low
a. Radicular pain
quality pain back to a leg within the
b. Pain referred to the back territory of a nerve root
c. Pain of spine origin b. Pain referred to the back -
Referred to
d. Local pain may arise from abdominal or
the back - pelvic viscera. The pain is
e. Pain associated with muscle spasm abdomen usually described as primarily
 i. Associated with abnormal posture or pelvis abdominal or pelvic,
accompanied by back pain
ii. Arise from other areas like abdomen or pelvis
Pain of and usually unaffected by
iii. Electric quality pain to the leg posture. The patient may
spine
iv. Site of the pain is near the affected part occasionally complain of back
origin -
v. More associated with multiple dermatomes pain only.
multiple c. Pain of spine origin may be
dermatome located in the back or referred
s to the buttocks or legs.
d. Local pain is caused by injury
Local pain - to pain-sensitive structures
site of pain that compress or irritate
sensory nerve endings. The
is near the
site of the pain is near the
affected
affected part of the back
part e. Pain associated with muscle
spasm is commonly
Pain associated with many spine
associated disorders. The spasms may
with be accompanied by an
muscle abnormal posture, tense
paraspinal muscles, and dull
spasm -
or achy pain in the paraspinal
abnormal
region.
posture

7. Which of the following statements is/are true regarding the B Statement 2 is true, not sure for
statement 1
hypothalamic body temperature?
False yung obesity
STATEMENT 1: obesity lowers the set point
STATEMENT 2: PGE2 raises the set point

a. Statement 1 is true
b. Statement 2 is true
c. Both statements are true
d. Both statements are false

8. Which of the following best describes representativeness bias? B Confirmation bias - seeking data to
confirm rather than refute the initial
a. Seeking data to confirm rather than refute the initial
hypothesis
hypothesis
b. Ignoring atypical features that are inconsistent with the Premature closure - Stopping the
favored diagnosis diagnostic process too soon
c. Stopping the diagnostic process too soon
Availability - Considering easily
d. Considering easily remembered diagnoses more likely remembered diagnoses more likely
irrespective prevalence irrespective to prevalence

9. A 25 yo male was brought to the ER because of severe A?

abdominal pain and fever. PE showed T=39, RR= 28, HR= 110.
The abdomen was rigid, with direct and rebound tenderness.
Psoas sign was positive. What is the most likely cause of the
fever?
a. Sepsis
b. Hepatic failure
c. Hypoxia
d. hypoglycemia

10. Match the finding with the corresponding nerve root C5- elbow
a. C5 extends
b. C7 backward
 c. C6 C6 -
d. C8 pronator
e. T1 teres
i. Abduction of little fingers is affected
C7- dorsal
ii. Pronator teres
forearm
iii. Pain in the fourth and fifth fingers and hand
iv. Pain in the dorsal forearm and hand
v. Elbow extends backward with hand on hip C8 -
abduction
of little
fingers and
III

T1 -
abduction
of little
finger

11. Characteristic of Substance P, EXCEPT C It is a potent vasodilator, causes mast

cell degranulation, is a chemoattractant
a. Chemoattractant
for leukocytes, and increases the
b. Pro-inflammatory production and release of inflammatory
c. Vasoconstrictor mediators.
d. Mast cell degranulator

12. What is the fever pattern in which febrile episodes lasting for B
3-10 days is followed by an afebrile period of 3-10 days and is
associated with hodgkin’s lymphoma?
a. Quadrant
b. Pel-ebstein fever
c. Intermittent
d. Remittent

13. As a generality, if you have to guess, without knowing the exact A If the cause is viral, the incubation
period from exposure to
virus that caused the fever and rash of a particular patient, how
prodrome is between 7 to 21 days
many days is the estimated incubation period from exposure to
prodrome?
a. 7-21 days
b. 1-3 days
c. 21-30 days
d. 3-5 days

14. A 6-mo old boy is rushed to the health center with a cc of jerky B Since fever and seizure yung CC, baka
bacterial/virus in origin yung problem →
movements. It is the 2nd day of fever. The infant appears
so dapat alamin kung ano yung vaccines
unresponsive, but is not in cardiorespiratory distress. During
history-taking, you sense that his yaya is having difficulty
describing what happened. The patient’s vital signs are within
normal limits except for his fever of 40 C. How will you improve
the quality of HPI?
a. Try to wait until the next episode of jerky movement and
observe for yourself
b. Try to obtain the vaccine records or baby book of the
patient
 c. Try to get the phone number of the parents to ask them
instead
d. Try to gesture to yaya how chills appear versus how
febrile seizures appear

15. A 5 yo patient with 10 days of fever, cherry red lips, strawberry A Symptoms of Kawasaki Disease
A rash on the main part of the body or in
tongue, conjunctivitis with perilimbal sparing, perianal and
the genital area (may be morbilliform
periungual desquamation and swelling of both hands and both (measles-like), maculopapular (red
feet will also manifest with patches and bumps), erythematous (red
a. Polymorphic rash skin) or target-like )
An enlarged lymph node in the neck
b. Petechial rash
Extremely red eyes without a thick
c. Maculopapular rash discharge
d. Pustular rash Red, dry, cracked lips and an extremely
red, swollen tongue
Swollen, red skin on the palms of the
hands and the soles of the feet, with
later peeling of skin on fingers and toes

16. The innervation of the large intracranial vessels and dura mater C
which is responsible for autonomic NS like lacrimation,
rhinorrhea, aural fullness and ptosis is brought by
a. Trochlear nerve
b. Facial nerve
c. Trigeminal nerve
d. Olfactory nerve

17. A 70 yo old patient has been diagnosed with COPD presents to B Dahil difficulty of breathing yung CC and
may COPD si patient
the ER due to difficulty of breathing. The patient has a 30-pack
year smoking history. This information should be best included
in which part of the adult medical record?
a. PMH
b. HPI
c. personal/ social
d. ROS

18. Standing height is measured in a well-child starting at what age? C For children older than 2 years, measure
standing height, optimally using
a. 4 yo
wall-mounted stadiometers. - Bates
b. 1
c. 3
d. 2

19. A technique of a skilled interviewer which involves C Validation. Another way to affirm the
patient is to validate the legitimacy of
acknowledging the legitimacy of the patient’s emotional exp
his or her emotional experience.
a. Empathy
b. Partnering
c. Validation
d. Reassurance

20. The most common type of primary headache is C

a. Idiopathic
b. Cluster
c. Tension-type
d. migraine

21. The least common type of secondary headache is D

a. Systemic infection
 b. Vascular injury
c. Head injury
d. Brain tumor

22. This is a cystic swelling in the floor of the mouth of a newborn C

and disappears spontaneously
a. Natal teeth
b. Mucocele
c. Ranula
d. Epstein pearl

23. This pertains to the secondary history that expands on the A Tertiary history = past medical
Secondary history = ROS
primary history and provides associated symptoms and other
Primary history = CC and HPI
comorbidities which may be present
a. ROS
b. CC
c. PMH
d. HPI

24. The symptomatic treatment of fever offers which advantage? D Treatment of fever in some patients is
highly recommended. Fever increases
a. The use of antipyretics generally shortens the duration
the demand for oxygen (i.e., for every
of bacterial and viral infections increase of 1°C over 37°C, there is a 13%
b. Lysing the fever will lead to higher oxygen consumption increase in oxygen consumption) and
c. There is no advantage in treating fever as it will prevent can aggravate the condition of patients
with preexisting impairment of cardiac,
the physician from reaching a definite diagnosis
pulmonary, or CNS function.
d. Lysing the fever confers neuroprotection in patients
being treated for acute stroke

25. Which of the following types of rash will be suspected as S. D

aureus (impetigo)?
a. Polymorphic rash
b. Petechial rash
c. Maculopapular rash
d. Pustular rash

26. Tim was about to have his blood drawn during a routine medical A The suggestion that pain will worsen
following administration of an inert
examination and suddenly experienced excruciating pain,
substance can increase its perceived
sweating, and near syncope when the needle of the syringe was intensity (the nocebo effect).
just about to enter the skin. This is called
a. Nocebo effect
b. Sensitization
c. Placebo effect
d. Hyperalgesia

27. A 50 yo male diabetic with uncontrolled sugar control presents B RULE-BASED/CATEGORICAL/DETERMIN

ISTIC REASONING
with cough, dyspnea, and fever of 3 days duration. His vital signs
upon presentation at the clinic is BP of 120/80 mmHg, CR of 125
bpm, RR of 24 rpm, temp 39C and rales on right basal lung field.
The physician immediately advised the patient for immediate
admission and requested for chest radiograph, complete blood
count, and blood culture in compliance with the 2010 philippine
clinical practice guidelines for pneumonia in immunocompetent
adults. This approach to the patient is a type of
a. Probabilistic reasoning
b. Categorical reasoning
 c. Causal reasoning
d. Inductive reasoning

28. In long haul, COVID-19, one or more digits of the hands or feet A
swells and turns pink reddish or purplish. The usual duration is _
days but is may last for months
a. 10-14
b. 5-7
c. 7-10
d. 3-5

29. This is described as salt and pepper speckling of the iris and is A
often seen in patients with down’s syndrome
a. Brushfield spots
b. Retinopathy of the newborn
c. Congenital cataract
d. Subconjunctival hemorrhage

30. If the medical history states that “the patient is unresponsive”, Level of
this phase is describing the patient’s _ conscious
ness

31. Drastic decrease in blood sugar in diabetic patients can cause D?

which change in skin?
a. Cyanosis
b. Hyperpigmentation
c. Jaundice
d. Pallor

32. Which is an expected response of our body to fever? A

a. Vasodilation of the arterioles in the hands and feet to
facilitate shunting of blood to the visceral organs
b. Increase in metabolism in organs like the liver
c. Heat conservation but not heat production
d. A behavioral response would include wearing thin and
cool clothing

33. The arm span is usually taken with the child C

a. Standing straight, arms at the sides and palms facing
inward
b. Seated and resting for 3-5 mins
c. Standing straight and arms outstretched to the sides
d. Supine and arms stretched upwards

34. This anthropometric parameter is measured around a joint just Head

above the supraorbital ridge anteriorly, and over the occipital Circumfer
protuberance posteriorly ence

35. In a patient with neurogenic abdominal pain, which of the A The demonstration of irregularly spaced
cutaneous “pain spots” may be the only
following manifestations signifies old nerve injury?
indication that an old nerve injury exists
a. Demonstration of pain spots
b. Distention of the abdomen
c. Non painful stimuli are painful
d. Rigidity of the abdominal wall
36. True of COX inhibitors D COX inhibitors are by far the most
commonly used analgesics. They are
a. COX-1 inhibitors are associated with increased
absorbed well from the gastrointestinal
cardiovascular risk tract and, with occasional use, have only
b. COX-2 selective drugs have lower risk of nephrotoxicity minimal side effects.
c. Nonselective COX inhibitors are the analgesics of choice
post operatively
d. COX inhibitors are absorbed well in the GI tract with
minimal side effects

37. Which technique can be used to determine the state of nutrition C Overall indicator of undernutrition
of a child, if weighing devices are not available?
a. Waist-to-hip ratio
b. Mid-thigh circumference test
c. Mid-arm circumference test
d. Height-to-wrist circumference ratio

38. PC, 37/M came in to ER because of bluish discoloration noted in D Since peripheral, baka wala siyang
kinalaman sa central cyanosis
the mouth. All of the following are possible differentials for the
patient’s condition, EXCEPT
a. Hemoglobinopathy
b. Respiratory problem
c. Cardiac disorder
d. Peripheral vasoconstriction

39. Which nerve fiber does not belong to the group? C Primary afferents include those with
large-diameter myelinated (Aβ),
a. A-beta
small-diameter myelinated (Aδ), and
b. C fibers unmyelinated (C) axons. All sympathetic
c. A-alpha postganglionic fibers are unmyelinated.
d. a-delta

40. Which of the following does not typically accompany fever? B

a. Malaise
b. Myalgia
c. Headache
d. Shivering

41. A 70/M came in for an annual physical check up. During the Family
course of the interview, the patient mentioned that he recently history
had a new granddaughter who was diagnosed with a congenital
heart disease. In which part of the adult medical record should
this be best included?

42. In patients with chronic heart failure, which symptoms is C Platypnea : Upright position yung
nakakalunod
described as shortness of breath when patient bends forward?
Orthopnea: supine position yung
a. Platypnea nakakalunod
b. Trepopnea Trepopnea: lateral decubitus (down with
c. Bendopnea the gud lung)
Benjopnea: di makahinga pag nakita si _
d. Orthopnea

43. CF, 58/F case to your clinic because of generalized, multiple B

erythematous, raised lesions (0.4 cm in diameter) containing
translucent fluid. She also had fever and myalgia 2 days prior to
occurrence of lesions. What are these lesions called?
a. Papule
 b. Vesicle
c. Plaque
d. Pustule

44. Skin fold thickness of a pediatric patient is measured with D

specialized calipers. What measure is about 20% fat?
a. 20 mm
b. 5.5 mm
c. 3 mm
d. 2.5 mm

45. Which level of consciousness is described as only being A Lethargic: drowsy but can be easily
aroused by minimal stimuli (voice or
responsive to repeated and vigorous stimuli only, mostly painful, touch) and can sustain arousal without
with grimacing and (+) deep tendon reflexes constant stimulation
Somnolence: more drowsy, needs
a. Stuporous constant stimulation to maintain arousal
b. Comatose Obtunded: sleeps more than usual,
c. Obtunded responds slowly to verbal or painful
stimuli, incomprehensible verbal
d. Lethargic response
Stuporous: only responsive to repeated
and vigorous stimuli, mostly painful, by
grimacing or drawing away from painful
stimuli. GCS 6-10
Comatose: no response to any stimuli,
no gag, corneal and deep tendon reflex
with GCS of 3

46. The dark purple rash over the extremities in a patient with late B Neisseria meningitidis
(meningococcemia) damages the blood
stage N. meningitidis is due to
vessels and shows a dark purple rash
a. Hermann’s effect over the extremities in the late stages of
b. Damage to blood vessels the disease
c. Post-inflammatory hyperpigmentation
d. High grade fever

47. Pain in the distribution of a nerve or nerves like that present in C

herpes zoster is
a. Neuritis
b. Hyperpathia
c. Neuralgia
d. Hyperalgesia

48. The general survey in pediatric medical history states that “the Ambulator
patient is carried by the parent.” This is a description of a patient y status
_.

49. This anthropometric parameter is best measured at the end of C Mid Inspiration si chest
normal expiration
a. Chest circumference
b. Head circumference
c. Abdominal circumference
d. Fontanelle size
e. U/L ratio

50. The expected ratio of breaths per minute to beats per minute in D
a pediatric patient is
a. 1:3
b. 1:1
c. 1:2
 d. 1:4

51. All of the following may exhibit hypothermia except B

a. Post-operative patient
b. Lymphoma patient with B-symptoms
c. Elderly
d. Patient who fell on an icy water

52. Why is it important to review the immunization record of a pedia D

patient with fever and rash?
a. It’s not important, the patient’s geographic location and
travel history are more important
b. The patient might be in a communicable phase of the
rash
c. Unimmunized children are predisposed to febrile seizure
episodes
d. Childhood exanthems are often traced back to
infectious etiology

53. Objective measurement of a person's essential body functions Vital

signs

54. Tietze’s syndrome is also known as A

a. Costochondritis
b. Tendonitis
c. Cervical radiculitis
d. Pericarditis

55. A 75/F with metabolic syndrome maintained on medications D/A Prognostic = Consider the most serious
diagnoses first
presents at the ER with sudden onset of chest pain. The ER
resident immediately requested the patient to be placed on O2
support, check for the vital signs and that a 12-lead ECG be
done. You asked the resident what his consideration is and he
told you that he is considering a heart attack. Which approach
did the resident demonstrate in approaching this case?
a. Prognostic
b. Pragmatic
c. Possibilistic
d. Probabilistic

56. Which of the following statements is true regarding likelihood D? LR + between 5 and 10 causes moderate
shift in probability (useful tests)
ratio? LR >10: Large shift in disease probability
a. A LR close to 1 necessitates further testing as it is more (useful RULE IN the disease)
LR <1 = FALSE or NEGATIVE = pushing
useful below threshold
b. +LR >10 shifts the disease probability and cause one to LR <0.1: large shift in disease probability
rule out the disease (useful in RULING OUT disease)
LR between 0.1 and 5: moderate shift
c. A +LR between 5-10% pushes the probability below the (useful test)
test threshold Closer the LR to 1: less useful test

d. A LR=1 do not change the probability and test is useless

57. A 16/M was brought to the ER due to sudden difficulty of A?

breathing associated with bouts of sneezing and coughing. He
was cleaning their attic hours prior to the episode. On PE, he
presented with wheezing bilaterally. The resident doctor
 immediately placed the patient on oxygen support and ordered
for hydrocortisone to be given IV and nebulization with albuterol.
Which approach was applied in approaching this case?
a. Probabilistic
b. Possibilistic
c. Prognostic
d. Pragmatic

58. Cephalhematoma is a temporary asymmetry of the skull B Molding dapat

resulting from the birth process most often seen with prolonged
Cephalohematoma:
labor and vaginal deliver ● Subperiosteal hemorrhage
a. True that never extends across the
b. False suture line
● It can be secondary to
traumatic delivery or forceps
delivery

59. In the milieu of COVID-19, immunocompromised persons are C

advised to remain at home. This is part of the
a. Procedure for isolation of the sick and the possibly
infected contacts
b. Discrimination against children, the pregnant and the
elderly
c. Standard transmission precaution
d. Supportive management of COVID-19

60. This refers to pain due to a stimulus that does not normally Allodynia
provoke pain

61. If a set of differential diagnosis is to made based on the location A

of the presentation of the patient’s abdominal pain, which of the
following should be considered in a patient with periumbilical
pain
a. Early appendicitis
b. Typhlitis
c. Peptic ulcer disease
d. Diverticulitis D

Typhlitis: RLQ
PUD: Epigastric
Diverticulitis: LLQ

62. Routine measurement of BP in the well child starts at what age? A

a. 3 yrs
b. Birth
c. 2 yrs
d. 4 yrs
e. 1 yrs

63. Which of the following drugs is a member of the family of the D Opioids are the most potent
pain-relieving drugs currently available
most potent pain-relieving drugs currently available?
a. Ketorolac
b. Indomethacin
c. Fenoprofen
d. Meperidine
64. What should be the complete OB score of a patient who carried G3P2
one pregnancy up to 38 wks with a surviving boy, carried 1 (1113)
pregnancy for 9 wks as an ectopic pregnancy, carried 1
pregnancy to 35 wks with surviving twin girls, and currently has 3
living children?

65. When recording a person’s sexual hx which one of the ff best C

described the information that you should aim to collect?
a. Details of contacts that involved penetrative sex of any
type only
b. Details of contacts which involved higher risk activities
only
c. Details surrounding all of the patient’s sexual contacts
including, the sex of the contact, the type of sex that
occured and if condoms were used, always, sometimes
or not at all
d. Details regarding the patient last sexual contact

66. Compute for the total smoking pack year of a 70/M diagnosed 17 pack from 14yo-30yo
30-14=16
of COPD who sought consult at the ER due to difficulty of years
(5/20) x 16 = 4
breathing. He started smoking at the age of 14 and consumes 5
sticks of cigarette until the age of 30. He stopped for a period of from 40yo-66yo
10 yrs due to work protocols but resumed smoking thereafter 66-40=26
(10/20) x 26 = 13
consuming half pack of cigarettes. He was diagnosed of COPD 4
yrs ago which prompted him to give up smoking. He has never 13+4=17 pack years
smoked since then.

67. Quantitative measurements of growth parameters than can B Anthropometrics: Quantitative

measurements of growth parameters
indicate when a child’s heart is at risk
that can indicate when a child’s health is
a. Z-score at risk
b. Anthropometrics ● Mali ata yung type ni doc
c. Growth chart (dapat health)
d. General survey

68. LJ, 33/F reportedly has a height of 160 cm and weight of 55 kg. B 21.48 BMI = normal
>22.9 = overweight
What is her BMI classification, based on asia pacific
classification?
a. Obese 1
b. Normal
c. Overweight
d. Underweight

69. Which disease is matched correctly with its classic fever A

pattern?
a. Pel ebstein fever: hodgkin lymphoma
b. Picket fence fever: typhoid
c. Quartan fever: P.vivax
d. Step-ladder fever: borrelia

70. This pertains to that step laying out the differentials into A
subcategories or problem specific
a. Frame the differential diagnosis
b. Limit the differential diagnosis
c. Rank the differential diagnosis
d. Organize the ddx
71. Which of the following statements is true? C C: Baka kasi referred pain lang from MI
or something
a. Pain is due to intra abdominal vascular disturbances is
sudden and catastrophic in nature A: A frequent misconception is that pain
b. Patients with peritonitis are characteristically restless due to intraabdominal vascular
and thrashing in discomfort disturbances is sudden and catastrophic
in nature
c. An intrathoracic disease must be considered in every
patient with upper abdominal pain B:The patient with peritonitis
d. Sudden distention of the biliary tree produced colicky characteristically lies quietly in bed,
type of pain preferring to avoid motion, in contrast to
the patient with colic, who may be
thrashing in discomfort

D: Sudden distention of the biliary tree

produces a steady rather than colicky
type of pain

72. 3 primary skin lesions that are less than 1 cm in size Macule
Papule
Vesicle

73. Which of the ff statements is true regarding treatment B

threshold?
a. When the probability of the diagnosis is below which
one would treat the patient without further testing
b. When the probability of the diagnosis is above which
one would treat the patient without further testing
c. When the probability of the diagnosis is below which
one would not treat the patient after further testing
d. When the probability of the diagnosis is above which
one would treat the patient after further testing

74. Which of the following is true of pyrogens? D

a. Pyrogens are only produced in infections, hence
antimicrobials should be initiated empirically in all
febrile patient
b. Toll-like receptors recognize endogenous pyrogens
c. Viruses are not capable of triggering a febrile response
as they do not produce toxins
d. Macrophages, monocytes and endothelial cells produce
endogenous pyrogens in response to infections

75. Hyperthermia is defined as an uncontrolled increase in body C It is important to distinguish between

fever and hyperthermia since
temperature that exceeds the body’s capacity to lose heat, while
hyperthermia can be rapidly fatal and
the thermoregulatory set point remains unchanged. Which of the characteristically does not respond to
following is true about hyperthermia? antipyretics
a. It is commonly triggered by pyrogens and responds to
antipyretics
b. Hyperthermia shares the same pathophysiology as
hyperpyrexia and are treated the same way
c. It is commonly manifests as heat stroke and can be
fatal
d. It only happens in young patients, since they exercise for
prolonged periods of time. Elderly with multiple
comorbids, never develop hyperthermia

76. Which of the following describes abductive reasoning? C

 a. Starting with a general rule and moving towards a more
specific conclusion
b. Coming up with a hypothesis from specific observations
to explain what is observed
c. Working backwards from the manifestations to the
cause
d. Conclusions generated are probable but not guaranteed

77. Comprises the tertiary history that imparts additional data that D
may be relevant to the patient’s present medical problem?
a. HPI
b. CC
c. ROS
d. PMH

78. Which of the following is the fever pattern seen in patients with D
malaria?
a. Relapsing
b. Continuous
c. Remittent
d. Intermittent

79. Due to the overlapping sensory supply of the central diaphragm D Shoulder and neck: overlapping sensory
supply of central diaphragm via phrenic
via the phrenic nerve with somatic sensory fibers originating in
nerve
the 3rd and 5th cervical segments, the pain of pleural pericarditis
is often referred to the Epigastric (Angina), stomach, pancreas,
a. Epigastric area colon
b. Back
Arm: radiation, referred pain or angina
c. Arm equivalent also merges in the heart
d. Shoulder which is on the same level
Back: descending aortic syndromes,

80. A small anterior fontanelle may be associated with which of the A A small anterior fontanelle may be
associated with hyperthyroidism,
following conditions?
microcephaly, or craniosynostosis
a. Hyperthyroidism
b. Hydrocephaly Sunken fontanelle: dehydration
c. Macrocephaly
d. Dehydration

81. A 17/F is on telemedicine consult with cc of acne. You notice on A Butterfly-shaped over both cheeks?
the video call that the acne she is complaining about appears
butterfly-shaped over both cheeks, as well as over the bridge of
the nose. During ROS, when asked about fever, she reports 37.8
C to 38.8C fever on and off for the last 15 days. This confirms
your initial impression of
a. SLE
b. Dengue
c. Brucellosis
d. Chickenpox

82. The gold standard of body temperature measurement is taken C

rectally using a thermometer. However, this is no longer
standard practice because
a. Most antipyretics can only be given at least 4 hrs apart
b. Gold standard is already established by different means
 c. Measurement of body temperature doesn’t need to be
very accurate
d. Most modern digital devices are accurate to within 0.5 C

83. Patients with sepsis secondary to typhoid fever have a B? Typhoid facies: thin, flushed face with a
staring, apathetic expression
characteristic facies. Which of the following best describes it?
a. Patient has a fixed sarcastic grimace and anxious A: Tetanus
expression with raised eyebrows and corners of the
mouth D: Acromegaly
b. Patient seems to be staring blankly, with tongue
protruded
c. Patient has loss of lateral eyebrows, with puffy face, dry
skin and brittle hair
d. Patient has protruded lower jaw/ mandible

84. When a physician considers a rare disease or condition ahead of A My favorite pursuing zebra
the most common and life-threatening conditions that can
explain a patient’s disease, he is committing
a. Base rate neglect
b. Confirmation bias
c. Availability
d. Premature closure

85. DT, 39/M, who was diagnosed with stroke syndrome in the C? Spastic gait:
● Ischemic stroke ay isa sa
young, came in to OPD with poor control of flexor muscles
causes
during swing phase, while the extensor muscles are hard to ● Characterized by stiffness in
move. Which is the most possible type of gait the patient has? the legs, an imbalance of
a. Steppage gait muscle tone, and a tendency
to circumduct and scuff the
b. Cerebellar ataxia
feet
c. Spastic hemiparesis Steppage gait:
d. Scissors gait ● the step height is increased to
compensate for foot drop, and
the sole of the foot may slap
on the floor during weight
acceptance
Scissors gait:
● The legs cross due to
increased tone in the
adductors

Cerebellar gait ataxia

● Characterized by a wide base
of support, lateral instability of
the trunk, erratic foot
placement, and
decompensation of balance
when attempting to walk on a
narrow base.

86. Floppiness and head lag are seen in newborns with hypotonia A
a. True
b. False

87. The following is a pain-producing cranial structure D

a. Ventricular ependyma Pain-producing cranial structures:
Scalp, Meningeal arteries, Dural sinuses,
b. Choroid plexus Falx cerebri, Proximal segments of large
c. Pial veins pial arteries
d. Dural sinuses
 ● Non-producing pain structures:
Choroid plexus, Plial veins, Ventricular
ependyma

88. True regarding the approach to diagnosis of patients with B?

abdominal pain
a. Plain and upraight radiographs are necessary in patients
with unclear indication for surgery
b. Rectal examination is mandatory in every patient with
abdominal pain
c. Peritoneal lavage has replaced laparoscopy as a
diagnostic tool in nontrauma patient
d. Elevation of serum amylase can rule in or out the need
for operation

89. According to the 21st edition of nelson’s textbook of pediatrics, A

the most common cc at a sick child consults is
a. Fever
b. Cough
c. Colds
d. Rash

90. Which of the following is being described by abdominal pain D The pain of parietal peritoneal
inflammation is steady and aching in
which is steady and aching in character with direct localization
character and is located directly over
over the inflamed area the inflamed area, its exact reference
a. Vascular disturbances being possible because it is transmitted
b. Metabolic abdominal crises by somatic nerves supplying the parietal
peritoneum
c. Referred pain
d. Inflammation of the parietal peritoneum

91. What is the most common definition of fever? B In light of this study, a temperature of
>37.7°C (>99.9°F), which represents the
a. A core temp of 38.3 C
99th percentile for healthy individuals,
b. An oral temp of 37.8 C defines a fever.
c. A rectal temp of 38 C
d. An axillary temp of 38.3C

92. Secondary spontaneous pneumothorax may occur in patients B Explanation:

Primary spontaneous pneumothorax:
with the ff conditions except
● Risk factors include male sex,
a. PTB smoking, family history, and
b. Marfan Marfan syndrome.
c. Cystic fibrosis
Secondary spontaneous pneumothorax
d. COPD
may occur in patients with underlying
lung disorders, such as chronic
obstructive pulmonary disease, asthma,
or cystic fibrosis, and usually produces
symptoms that are more severe

MID-MODULE I

1. The following are true statements regarding Review of Systems, A/C? Explanation:
EXCEPT:
a. May reveal symptoms that may have altered the typical
presentation of the disease
b. Provides associated symptoms and other comorbidities
 which may be present
c. Symptoms related to the patient’s current condition
should be recorded in the HPI
d. Inquire about signs and symptoms associated with each
system/anatomic region

2. A patient presents at the Out-Patient Department complaining of HPI? Explanation:

fever of 3 days duration. During further questioning, patient
claims he did not have a cough. In which part of the adult
medical record should this information be placed?

3. Which of the following does not belong to the group? A/B Explanation: CC yung A but the rest
a. Why have you come to see the doctor today? is asked during HPI
b. Did you fall when you felt dizzy?
Yung B specific, the rest ay
c. Tell me about your problem.
open-ended question
d. What kind of pain was it?

4. Which of the following presentations of disease can be C? Explanation:

considered as a sign and a symptom at the same time?
a. Edema
b. Retching
c. Chest pain
d. Headache

5. According to Marcial’s, what shape is used in the genogram to Triangle Explanation:

denote spontaneous abortion?

6. In discussions surrounding smoking, which one of the following B Explanation:

best describes “pack years”?
a. The total number of years that an individual has smoked
for
b. A calculation used to quantify exposure to tobacco
smoke in a standardized manner
c. The number of packs that a person smokes per day
d. The number of years that a person has smoked before
developing symptoms of a smoking-related disorder

B. APPROACH TO ADULT PE AND APPROACH TO THE ELDERLY PATIENT

1. SH, 78/M, known case of CHF secondary to CAD, came to the Explanation:
clinic because of progressive enlargement of the legs for 2 B
weeks, with dyspnea on exertion and occasional chest pain. On
PE, you noted the swelling to be non-tender, not warm to touch,
 and involves the thighs, hands and lower arms as well. What is
the grading of the edema of the patient?
a. +1
b. +2
c. +3
d. +4

2. In the elderly patient, what is the term used for a multifactorial Geriatric Explanation:
condition that involves the interaction between identifiable syndrome
situation-specific stressors and underlying age-related risk
factors that result in damage across multiple organ systems?

3. In checking the vital signs of an elderly patient, which of the C/D Explanation:
following statements is true? Resting heart rate is the same
a. Basal body temperature is usually low making them
n older adults, resting heart rate
susceptible to the cold
remains
b. Resting heart rate is usually lower as compared to
unchanged, but there are declines in
young adults the pacemaker cells of the
c. Systolic hypertension with a widened pulse pressure is sinoatrial node and
normally seen the maximal heart rate, which affect
d. All given statements are true the response to exercise and
physiologic stress

Respiratory rate and temperature

are unchanged, but changes in
temperature regulation lead to a
susceptibility to
hypothermia.

C. INTRODUCTION TO CLINICAL MEDICINE; DECISION-MAKING IN CLINICAL MEDICINE (Dr. Cabarles)

In a study of Tao Ai et al. where they investigated the accuracy of Chest

CT scan in diagnosing COVID-19, the following data were gathered:
COVID-19 confirmed COVID-19 negative (by
(by RT-PCR) RT-PCR)
Positive Chest CT-Scan 580 308
Negative Chest
21 105
CT-Scan

1. The total number of COVID-19 patients used in the study is… D Explanation: Add only COVID-19
a. 888 confirmed (by RT-PCR)
b. 580
c. 1014
d. 601

2. How many percent of the patients who had positive Chest CT A Explanation: False positive
Scan were actually free of COVID? 308
580+308
× 100
a. 35%
b. 75%
c. 40%
d. 47%

3. Compute for the specificity of the Chest CT-Scan in diagnosing A Explanation: Specificity (True
 COVID-19. Negative) = TN/(TN+FP)
a. 25% 105
105+308
× 100
b. 97%
c. 65%
d. 83%

4. Based on this study, what is the sensitivity of Chest CT Scan in A Explanation: Sensitivity (True
diagnosing COVID-19? Positive) = TP/ (TP + FN)
a. 97% 580
580+21
× 100
b. 25%
c. 83%
d. 65%

5. Based on this study, the computed positive Likelihood Ratio C? D? Explanation:

(+LR) is +1.29. What can be inferred from this information?
a. The patient has a probability estimate between 1 and 5%
b. A patient has a decreased probability of having COVID
c. The test has no utility in estimating the probability of
having COVID
d. The patient has a probability estimate of having COVID
at > +15%

6. Which one of the following best describes the role that history B Explanation:
plays in patient assessment?
a. Clinical history always needs to be confirmed by clinical
examination
b. Clinical history provides a primary guiding foundation
when making clinical decisions
c. Clinical history is of secondary importance to clinical
examination
d. The best presenting clinical history is only available from
the patient’s notes

7. Which of the following describe specificity? C Explanation:

a. False positive / (true negative + false positive)
b. False negative / (true positive + false negative)
c. True negative / (true negative + false positive)
d. True positive / (true positive + false negative)

8. The most precise way of estimating the pretest probability of a A Explanation: CDRs are infrequently
disease in a given patient is via… available but are the MOST
a. Clinical decision rule PRECISE way of estimating pretest
probability
b. Epidemiological studies
c. Clinician’s expertise
d. Diagnostic testing

9. The following are elements of clinical reasoning, EXCEPT: B Explanation:

a. Metacognition
b. Outcome of treatment
c. Communication skills
d. Shared decision making
 10. The following questions should be asked in determining the A Explanation:
need for diagnostic testing, EXCEPT:
a. Does the considered test improve the clinical outcome
of the patient’s condition?
b. Is my pretest probability low enough that a test is
warranted for more information?
c. How certain am I that the generated hypothesis is
correct?
d. How much more certainty do I need before I can start
the treatment?

11. Arrange in the right order the following steps in constructing a 3, 6, 5, 4, Explanation:
differential diagnosis: 1, 2
1 - rank the differential diagnosis
2 - test the differential diagnosis
3 - frame the differential diagnosis
4 - explore other diagnosis using history and physical
exam findings
5 - limit the differential diagnosis
6 - organize the differential diagnosis

D. APPROACH TO ACUTELY-ILL FEBRILE PATIENT; FEVER AND HYPERTHERMIA (Dr. Conde)

1. Among the four receptors for Prostaglandin E2, which is EP-3 Explanation:
essential for fever?

2. An uncontrolled increase in body temperature that exceeds the B Explanation: Hyperthermia

body’s ability to lose heat without change in hypothalamic set
point is called hyperpyrexia. A fever of >41.5°C (>106.7°F) is
called hyperpyrexia
a. True
b. False

3. Hyperpyrexia is most commonly encountered in which of the B Explanation:

following scenarios? This extraordinarily high fever can
a. Commonly-acquired pneumonia develop in patients with severe
infections but most commonly
b. Hypothalamic hemorrhagic stroke
occurs in patients with central
c. Acquired immunodeficiency syndrome
nervous system (CNS)
d. Miliary tuberculosis hemorrhages

4. Which of the following diseases is matched correctly with its B Explanation:

classic fever pattern? A - Borrelia → relapsing fever
a. Step-ladder fever: Borrelia C - typhoid → sustained/
remittent/relapsing
b. Pel-Ebstein fever: Hodgkin's Lymphoma
D - P. vivax → quatertian
c. Picket-fence fever: Typhoid
d. Quartan fever: P. vivax malaria

5. Which of the following cytokines is considered to be central in A Explanation:

the humoral pathway of fever due to its direct action on the
hypothalamic thermoregulatory center?
a. Prostaglandin E2
b. Heat shock protein
c. Prostaglandin I2
d. Interleukin-10
 6. Which of the following mechanisms help raise the body C Explanation:
temperature to the new set point?
a. Decreased hepatic thermogenesis
b. Peripheral vasoconstriction
c. Shivering
d. Blood shunting

E. GENERAL SURVEY, VITAL SIGNS, AND ANTHROPOMETRIC MEASUREMENTS (Dr. Dela Torre)

1. Which breathing pattern is described as deep and rapid, and is Explanation:

seen in patients with metabolic acidosis? B Cheyne-stokes: Periods of deep
a. Cheyne-Stokes Breathing breathing alternate with periods of
apnea
b. Kussmaul respirations
c. Grunting respirations
Bendopnea: B occurs when the
d. Bendopnea heart can't compensate for fluid
shifts and pressure placed on the
abdomen that result when you bend
over.

2. Which Korotkoff sound is described as clear, well-heard tapping C Explanation:

sound that is loud and high pitched?
a. First
b. Second
c. Third
d. Fourth

3. Which of the following vital sign findings predict subsequent D Explanation:

cardiopulmonary arrest in hospitalized patients?
a. Tachycardia
b. Hypothermia
c. Hypotension
d. Tachypnea

4. Eating or drinking just before taking your temperature doesn’t B Explanation:

affect the reading of an oral thermometer.
a. True
b. False

5. All of the following diseases are associated with worse dyspnea C Explanation:
when upright, and relief after lying down, EXCEPT:
a. Hepato-pulmonary disease
b. Pulmonary arteriovenous malformation
c. Coronary artery disease
d. Patent foramen ovale

6. This type of fever is considered when temperature readings are D Explanation:

varying at different sites, and there is dissociation between In fraudulent fever, the patient is
temperature and pulse rate. normothermic but manipulates the
thermometer.
a. Fraudulent fever
b. Remittent fever
(Faget’s sign), where patients have
c. Fagets sign
 d. Drug-induced fever a lower heart rate than might be
expected for a given body
temperature.

Temperature-pulse dissociation occurs

in typhoid fever, brucellosis,
leptospirosis, some drug-induced fevers,
and factitious fever

7. What is the mean arterial pressure of the patient whose BP is 130 Explanation:
170/110 mmHg? mmHg MAP = (S + 2D)/3

8. All of the following can produce pulseless electrical activity D and C Explanation:
(PEA), EXCEPT: and B
a. Hypovolemia
b. Decreased hydrogen ion
c. Hyperglycemia
d. Hyperthermia

9. Which of the following is the Hamwi's equation for the D Explanation:

computation of the Ideal Body Weight?
a. 50 + [0.91 x (height in cm - 152.4)]
b. (height in cm - 100) - 10% of (height in cm - 100)
c. 45.5 kg for 60 inches + 2.3 kg x (height in inches - 60)
d. 100 lbs for the first 5 feet + 5 lbs for each additional inch
+ 10% for frame size

10. A BMI of 23 in 26/Male Filipino is best classified according to C Explanation:

the Asia Pacific classification as?
a. Underweight
b. Obese I
c. Overweight
d. Normal

11. According to Marcial’s, tympanic membrane temperature is 0.8 oC Explanation:

higher than the oral reading by ____ oC.

12. LA, 33/M, consulted because of 1-week history of fever, D Explanation:

described as exacerbations every 48 hours, Tmax = 39.3 oC, with Specifically, tertian if exacerbations
associated chills. In between, patient’s temperature is noted to occur every 48 hours
be <37.6 oC. He went to Palawan 1-month prior for field work in
the forest. What is the fever pattern of the patient?
a. Remittent
b. Relapsing
c. Sustained
d. Intermittent

13. A female patient’s waist circumference is 34.5 inches and her D Explanation:
hip circumference is 40 inches. This is regarded as…
a. Extreme
b. Good .86
c. Average
d. High
 e. Excellent

F. PEDIATRIC MEDICAL HISTORY, APPROACH TO PEDIATRIC PATIENT, PE OF THE NEWBORN (Dr. Repollo)

1. Greasy white substance that normally covered the skin until 38th Vernix Explanation:
week of gestation. caseosa

2. Part of the pediatric history that states the duration and Birth Explanation:
circumstances of labor, if home or hospital delivery, manner of history
delivery, analgesia used, complications, birth weight, and age of
gestation
3. Part of the history where the patient’s general state of health is General
described including the height, build, sexual development, Survey
posture, motor activity, gait and odor
4. Part of the history that states previous admissions in the Interval
hospital, summary of each admissions, and the condition of the history
child from the time of readmission
5. This part of the history will give a clear, detailed and unified Present
picture, and begins with the nature and date of onset illness

6. Eliciting the rooting reflex causes the infant to turn the head and A Explanation:
allows for easier examination of the neck. Rooting reflex: stroke the lip and the
a. True corner of the cheek with a finger
and the infant will turn in that
b. False
direction and open the mouth ○

Glabellar reflex (blink reflex): tap

gently over the forehead and the
eyes will blind

Neck-righting reflex: turn the

infant’s head to the right or left and
movement of the contralateral
shoulder should be obtained in the
same direction

Moro reflex: support the infant

behind the upper back 1cm or more
but not on the mattress

7. Term used for a cutaneous condition where there is a clear line Harlequin Explanation:
of demarcation between an area of redness and an area of coloration
normal coloration. Cause is usually idiopathic or may be a sign
of blood shunt.

8. Children typically begin walking at what age? B Explanation:

a. 8-10 months C? Sabi sa bates, 1 year daw
b. 10-12 months
c. 12-16 months
d. 14-18 months

9. Rash found in intertriginous area that appears as erythematous B Explanation:

plaques with sharply demarcated edges is most likely Transient: Characterized by three
a. Transient neonatal pustular melanosis stages of lesions, which may
appear over the entire body:
b. Candidiasis
● Pustules
c. Erythema toxicum
● Rupture vesiculopustules
d. Cavernous hemangioma with scaling/typical halo
 appearance
● Hyperpigmented macules
Erythema toxicum
● Numerous small areas of
red skin with a
yellow-white papule in the
center are evident
Cavernous hemangioma
● Usually appears as a large,
red cyst-like firm ill defined
mass

10. Reflex that causes abduction of both arms and extension of the Moro Explanation:
fingers reflex

EXTRAS

1. The maximum normal oral temp at 6AM is _ degree celsius and 37.2 C at
_ degree celsius at 4pm. These defines the 99th percentile of 6am
healthy individuals
37.7C at
4pm

2. Which secondary lesion is described as a product of dried A Ulcer: A deeper loss of epidermis
exudate of fluids? and dermis; may bleed and scar
a. Crust
Lichenification: Visible and palpable
b. Ulcer
thickening of the epidermis and
c. Lichenification
roughening of the skin with
d. Vesicle increased visibility of the normal
skin furrows (often from chronic
rubbing)

Vesicle: Up to 1.0 cm; filled with

serous fluid

3. A 10 day old infant was brought to the ER, with alar flaring, B
suprasternal, subcostal and intercostal retractions. In panic, the
caregiver hands the crying baby to you. You are immediately
able to examine
a. Skin: inspect, palpate
b. Chest: IPPA
c. Heart: IPPA
d. Abdomen: IAPP

4. A rash in which tiny sebaceous retention cysts are seen. It is Milia

also whitish, pinhead-sized and is usually found in the chin, nose
and cheeks

5. A 10 day old infant was brought to the ER, with alar flaring, B Alar flaring and chest retractions =
suprasternal, subcostal and intercostal retractions. RR is 60/min, cardiorespiratory distress
HR is 160/min. You record this in the chart as
 a. Asleep, comfortable, in mild cardiac distress
b. Awake, irritable, in cardiorespiratory distress
c. Asleep, comfortable, in mild respiratory distress
d. Awake, alert, not in cardiorespiratory distress

MID-MODULE II

1. A 28/M was brought to the ER after a motor vehicle accident. He C Chest tube thoraCOSTOMY is the
had a blunt injury to the left chest with extreme tenderness to emergency care for pneumothorax in
the left side. The patient is dyspneic with respiratory rate this case (note tracheal deviation
AND hyperresonance.
28/min, BP 100/60 mmHg, temp 37C. On examination, you
ThoraCENTESIS is to remove fluid
found the neck veins are prominent, the patient is having labored
from the pleural space and is done in
breathing with limited movement on the right side, palpation pleural effusion.
showed shifting of the trachea and apical impulse on the right
side, percussion on the right side is hyperresonant and
auscultation shows the absence of breath sound on the right
side. Your next best step should be to
a. Do a thoracentesis
b. Give him high oxygen support
c. Put a chest tube
d. Do lateral decubitus CXR

2. A 55 yo lawyer crashed his bicycle during a spirited sprint for the A Pneumothorax develops when air
city limits sign. He fractures his right clavicle in the fall. Four enters the pleural space as a result
days later, while in his clavicle strap and an arm sling, he notes of disease or injury which leads to a
loss of negative pressure between
that his right hand is extremely swollen, which he thinks is
two pleural membranes. Patients
probably normal. The next days he suddenly becomes very short
with pneumothorax usually present
of breath and has his wife take him to the ER. while performing with sudden-onset dyspnea,
your respiratory examination, which of the following are you ipsilateral chest pain, diminished
most likely to find? breath sounds, and hyperresonant
a. Unilateral hyperresonance on chest percussion percussion on the affected side.
b. Tracheal deviation
c. Crackles over the right mid-axillary line
d. Pleural friction rub

3. What pattern is suggested by this flow-volume loop? D

a. Fixed upper airway obstruction

b. Obstructive disease
c. Variable intrathoracic obstruction
d. Restrictive disease

4. ABG is one of the initial laboratory tests you can order in C an elevated bicarbonate might point
investigating possible etiologies of dyspnea. What ABG result toward the possibility of carbon
might point toward the possibility of carbon dioxide retention dioxide retention that might be seen
in chronic respiratory failure—in such
such as seen in a chronic respiratory patient?
a setting, an arterial blood gas may
a. Low arterial pH
provide useful additional information
b. Low arterial oxygen
 c. High bicarbonate
d. Low bicarbonate

5. In radiology, the difference between a nodule and a mass is the C <3 cm nodule
>3cm mass
a. Shape
b. Density
c. Size
d. Border

6. You are working ont he geriatric ward and are asked to review a A FEV1, FVC are all decreased = restrictive
lung disease
75/F patient admitted with progrssive shortness of breath over
the past five years. Her background medical history includes
hypertension, severe osteoporosis with multiple previous
compression fractures, and a 40 pack year history of smoking.
What do the findings suggest as a major contributor to her
dyspnea?

a. Severe kyphosis
b. Chronic bronchitis
c. Emphysema
d. Pulmonary hypertension

7. Which of the ff is associated with pleural effusion? D

a. Meniscus sign
b. CHF
c. Pleural thickening
d. A and B only
e. All

8. Compared to predicted normals, a patient has a reduced FVC, RV A

and TLC and a reduced FEV1, and FEV1/FVC ratio. Which of the
ff is most likely the problem?
a. Combined restrictive and obstructive disorder
b. A restrictive disorder is present
c. An obstructive disorder is present
d. Small airways obstruction is present

9. Which of the following is a cause of normal anion gap metabolic A

acidosis?
Ethylene glycol, lactic acidosis and
a. Diarrhea
diabetic ketoacidosis are causes of high
b. Ethylene glycol anion gap metabolic acidosis
c. Lactic acidosis
d. Diabetic ketoacidosis

10. Which of the ff physical examination findings indicates a partial A A wheeze that is entirely or
obstruction of the larynx or trachea and demands immediate predominantly inspiratory is called
attention? stridor. It is often louder in the neck
than over the chest wall. It indicates
a. Stridor
a partial obstruction of the larynx or
b. Mediastinal crunch
trachea, and demands immediate
c. Pleural rub attention.
d. Rhonchi
11. This is seen as chest falling on inspiration and rising on D Pulsus paradoxus
expiration and usually indicates respiratory failure
a. Kussmaul’s breathing
b. Biot’s breathing
c. Cheyne stokes
d. Paradoxic respiration

12. Radiologic sign for alveolar edema B Angel wing’s sign/spinnaker sign =
pneumomediastinum
a. Spinnaker sign
b. Bat wing sign
c. Sail sign
d. Angel wing sign

13. Method used to quickly assess the health of a newborn and may D
assess the newborn’s risk for infant mortality
a. Newborn PE
b. Ballard scoring
c. Any
d. APGAR

14. Which of the ff would not result in respiratory alkalosis? A Causes of respiratory alkalosis
A. Central nervous system stimulation
a. Opioids
1. Pain
b. Hypoxia 2. Anxiety, psychosis
c. Anxiety 3. Fever
d. Pain 4. Cerebrovascular accident 5. Meningitis,
encephalitis 6. Tumor
7. Trauma
B. Hypoxemia or tissue hypoxia
1. High altitude
2. Pneumonia, pulmonary edema 3.
Aspiration
4. Severe anemia
C. Drugs or hormones
1. Pregnancy, progesterone 2. Salicylates
3. Cardiac failure
D. Stimulation of chest receptors 1.
Hemothorax
2. Flail chest
3. Cardiac failure
4. Pulmonary embolism
E. Miscellaneous
1. Septicemia
2. Hepatic failure
3. Mechanical hyperventilation
4. Heat exposure
5. Recovery from metabolic acidosis

15. A 60 yo man has had cough and sputum production for over 15 A
yrs. Now, he complains that his sputum is blood tinged,
particularly when he first awakens in the morning. His CXR show D?
tram-lines at both lung bases. These findings suggest
a. Interstitial lung disease
b. Heart failure
c. Carcinoma of the lungs
d. Bronchiectasis

16. MMRC dyspnea scale is an example of a clinical method of A B: grade 0

rating dyspnea. MMRC grade 2 is equivalent to which of the C: grade 1
D: grade 3
 descriptions below
a. Walks slower than people of similar age on level ground
due to breathlessness or has to stop at rest when
walking at own pace on level ground
b. Not troubled by breathlessness, except with strenuous
exercise
c. SOB while walking on level ground or with walking up a
slight hill
d. Stops to rest after walking 100 m or after walking a few
minutes on level ground

17. Which of these is not a phase of coughing? A Phases of cough:

a. Expressive
b. Expiratory Irritation
Inspiration
c. Compressive
Compression
d. Inspiratory
Expulsion

18. Which of the following is characteristic of consolidation? A

a. Air bronchogram is present
b. Bilateral and asymmetrical
c. Both
d. Neither

19. Which of the ff is a common cause of cicatrisation atelectasis? E? Cicatrization atelectasis results from
diminution of volume as a sequela of
a. Granulomatous lung disease
severe parenchymal scarring and is
b. Radiation fibrosis usually caused by granulomatous disease
c. Necrotizing pneumonia or necrotizing pneumonia.
d. A and B only (Medscape)
e. A, B, C

20. Which of the following would you expect to find over the involved A PE findings: PRESENCE of crackles and
DECREASED bronchial breath sounds on
area in a patient with lobar pneumonia?
auscultation; ENHANCED bronchophony,
a. Egophony egophony, and tactile fremitus;
b. Muffled and indistinct transmitted voice sounds DULLNESS on percussion.
c. Decreased tactile fremitus
d. Vesicular breath sounds

21. Form of pulmonary edema manifesting as septal lines is called A Alveolar edema: airspace shadowing (bat
sign)
a. Interstitial edema
Consolidation: loss of silhouette sign or
b. Alveolar edema loss of outline sign
c. Consolidation
d. A and B
e. A, B, C

22. If a purring, vibratory sensation is felt when the palm is placed Thrills As you palpate the carotid artery, you
over the pericardium, this will be reported as a may detect humming vibrations, or
thrills, like the throat vibrations in a
cat when it purrs.

23. When crackles, wheezes, or rhonchi clear with a cough, which of B Adventitious sounds that clear with
cough are usually consistent with
the following conditions is the likely etiology?
bronchitis or atelectasis. The other
a. Cystic fibrosis conditions are not associated with
b. Bronchitis findings that clears with cough.
c. HF
d. asthma
24. Match the following coloured top to their appropriate use or Choices:
description
a. Blue VII
b. Red II
c. Black IV
d. Dark green V
e. Lavender IX
i. Contains potassium oxalate as anticoagulant
(Gray)
ii. For tests requiring clotted blood
iii. Contains gel separator (gold)
iv. For ESR
v. For lithium level
vi. For ammonia level (light green)
vii. Coagulation studies
viii. For DNA studies (yellow)
ix. For routine hematology procedures

25. This is the abnormal forward curvature of the spine D Kyphosis - abnormal forward
a. Lordosis curvature of the spine
b. Apicolordotic
c. Scoliosis
d. Kyphosis

26. Which is correct about normal breath sounds heard over most of B Vesicular - Inspiratory sounds last
both lungs? longer than expiratory sounds. Heard
a. Exp > ins Over most of both lungs - Bates
b. Ins > exp
c. Ins = exp
d. Ins and exp are indistinguishable

27. A form of lung atelectasis which occurs as a result to scarring or B Cicatrization atelectasis - Form of
fibrosis that reduces lung expansion lung atelectasis which occurs as a
a. Compression atelectasis result of scarring or fibrosis that
reduces lung expansion
b. Cicatrization
c. Passive
d. Obstructive

28. Which one of the ff conditions is characterized by tympany on C? Tympanic sounds heard over the
chest percussion? chest indicate excessive air in the
a. Pulmonary embolism chest, such as may occur with
pneumothorax.
b. Diaphragmatic hernia
c. Emphysema
Tympany on chest percussion:
d. Bronchial asthma Pleural effusion - dullness
Bronchial asthma - hyperresonant

29. Heart sound that is best heard at the apex in mid diastole D Heart sound that is best heard at the
a. S1 apex in mid diastole - trans
b. S4
S1 -closure of the AV (tricuspid and
c. S2
mitral); best heart at the apex
d. S3
S2 - closure of the semilunar (aortic and
pulmonic); best heard at the upper left
and right sternal borders
 S3 - best heard at the apex in the mid
diastole; heard as a gallop rhythm in the
setting of HF due to poor compliance;
normal in a young patient w/ tachycardia;
termed as S3 gallop in adults

S4 - not often heard in normal adults;

atrial contraction; immediately precedes
S1 of the next beat; reflect pathologic
change in ventricular compliance

30. Which percussion note would you hear over the airless area in D
atelectasis?
a. Resonant
b. Hyperresonant
c. Flat
d. Dull Airless area in atelectasis
(https://journals.lww.com/nursing/Ci
tation/2008/10000/Respiratory_syst
em_challenge__Test_your_knowledg
e.42.aspx)

31. A pneumothorax is considered under tension when E Pneumothorax is under tension when
a. A patient becomes hypotensive - tracheal or mediastinal shift
b. Patient becomes dyspneic away from the
pneumothorax
c. Patient’s mediastinal structures are displaced
- hypotension, in respiratory
d. A and b
distress, massive
e. All pneumothorax

32. Genuine widening of the mediastinum is usually due to a C Genuine widening of the
a. Mass mediastinum
b. Vascular abnormality - Widened mediastinum is
often due to technical
c. Both
factors
d. Neither
- Genuine widening is usually
due to a vascular
abnormality or a
mediastinal mass

33. Which one of the following patients has central cyanosis? A Central Cyanosis
a. A patient with bluish discoloration of nail beds, pale - bluish or purplish
mucous membranes and PaO2 of 40 mmHg discoloration in the mucous
membranes of the mouth
b. Patient with bluish discoloration of nail beds, lips,
- Mostly arterial PO2 is below
frenulum of the tongue and helix of the ear, and SaO2 75
normal
mmHg - SaO2 is reduced or an
c. Patient with bluish discoloration of nail beds, normal abnormal hemoglobin
mucous membranes andSaO2 90 mmHg derivative is present
d. Patient with bluish discoloration of nail beds and helix of Normal PaO2 = 80-100 mmHg
the ear and PaO2 60 mmHg Normal SaO2 = 95-100%

34. Match the options below Choices:

a. MCV
b. RDW
c. Hematocrit
d. MCH
e. MCHC
i. Content of hemoglobin in the average red cell D
 ii. Measurement of the range in the volume and B
size of RBCs
iii. Average volume of RBS A
iv. Average concentration of hemoglobin in given E
volume of pRBC
v. Packed cell volume C

35. A friend of yours, who is living in Baguio came to you for a visit. D? Living in Baguio + Erythrocytosis -
She had an annual check up and got her CBC result and handed
it to you. Erythrocytosis is one prominent finding. Which of the ff In persons with chronic hypoxemia
secondary to prolonged residence at
is a true statement?
a high altitude (>13,000 ft, 4200 m), a
a. It is a compensatory mechanism for acute hypoxemia
condition termed chronic mountain
b. It is expected because she is residing at a high altitude sickness develops. This disorder is
of 2,500 m characterized by a blunted
c. It is expected because she is residing at a high altitude respiratory drive, reduced ventilation,
of >8000 ft erythrocytosis, cyanosis, weakness,
d. It is a compensatory mechanism for chronic hypoxemia right ventricular enlargement
secondary to pulmonary
hypertension, and even stupor.

36. What is the cause of late inspiratory crackles? D Cause of late inspiratory crackles:
a. Air flows rapidly through secretions in large airways They result from a series of tiny
b. Air bubbles flow through secretions or slightly closed explosions when small airways,
deflated during expiration, pop open
small airways respiration
during inspiration. This mechanism
c. Air flows rapidly through bronchi narrowed nearly to
probably explains the late inspiratory
closure crackles of interstitial lung disease
d. Small airways, deflated during expiration, pop open and early heart failure
during inspiration (https://quizlet.com/160737388/ha-
quiz-4-study-guide-flash-cards/)

37. A 53/F presented with SOB. CXR shows multiple tiny pulmonary A Presentation
nodules scattered in both lungs and absent left breast shadow. - Shortness of breath
Which of the following is most likely diagnosis? - Chest x-ray shows multiple
tiny pulmonary nodules
a. Metastasis
scattered in both lungs
b. Lymphoma
- Absent left breast shadow
c. Tuberculosis
d. Pneumonia Breast cancer?

38. Which of the ff is a cause of metabolic alkalosis? A Cause of metabolic alkalosis

a. Vomiting
b. Diarrhea chronic respiratory alkalosis may
accompany liver disease, and
c. Cyanide toxicity
metabolic alkalosis can result from
d. Addison’s disease
vomiting

39. Cyanide poisoning is what type of hypoxia? D Cyanide and several other similarly
a. Anemic acting poisons cause cellular
b. Respiratory hypoxia. The tissues are unable to
use O2, and, as a consequence, the
c. Circulatory
venous blood tends to have a high
d. Histotoxic
O2 tension. This condition has been
termed histotoxic hypoxia.

40. A 50 yo patient was brought to the ER due to massive D Because most massive hemoptysis
hemoptysis. Most commonly, bleeding arises from the arises from the bronchial circulation,
a. Bronchial vein bronchial artery embolization is the
procedure of choice for control of
 b. Pulmonary vein massive hemoptysis - Hari
c. Pulmonary artery
d. Bronchial artery

41. As an effect in the CVS, acute hypoxia stimulates the A acute hypoxia stimulates the
chemoreceptor reflex arc leading to the following, except chemoreceptor reflex arc to induce
a. Arterial constriction venoconstriction and systemic
arterial vasodilation. These acute
b. Venoconstriction
changes are accompanied by
c. Arterial vasodilation
transiently increased myocardial
d. Transient increased myocardial contractility contractility, which is followed by
depressed myocardial contractility
with prolonged hypoxia

42. Patients who fail to respond to treatment targeting the common C Patients who fail to respond to
causes of cough or who have had causes excluded by treatment targeting the common
appropriate diagnostic testing should undergo this procedure/ cause of cough / who have had
causes excluded by appropriate
test
diagnostic testing -> Chest CT scan
a. Gastroscopy
ata
b. Bronchoscopy
c. Chest CT scan
d. Bronchoprovocation challenge

MODULE III

1. An isolated elevation of unconjugated bilirubin can be seen in A An isolated elevation of unconjugated

bilirubin is seen primarily in hemolytic
Crigler-Najjar syndrome
disorders and in a number of genetic
a. True conditions such as Crigler-Najjar and
b. False Gilbert’s syndromes

2. Dermographism is evident in which lesion? C

a. Plaque
b. Patch
c. Wheal
d. Vesicle

3. Which of the following statements is true? D C kasi antigen pa rin yung inactivated
SARS-COV2 COVID vaccine so katawan
Statement 1: inactivated SARS-COV2 COVID vaccine is an example of
mo pa rin yung gumawa nung antibodies,
passive immunity C? di galing sa vaccine
Statement 2: infection with a variant of SARS-COV2 is an example of
active immunity
a. Only statement 1 is true
b. Both statements are false
c. Only statement 2 is true
d. Both statements are true

4. The following are the most common causes of oropharyngeal C Iatrogenic, neurologic, and structural
pathologies are most common
dysphagia except
a. A structural Iatrogenic causes include surgery and
b. Iatrogenic radiation, often in the setting of head and
c. Metabolic neck cancer. Neurogenic dysphagia
resulting from cerebrovascular acci-
d. Neurologic
dents, Parkinson’s disease, and
amyotrophic lateral sclerosis is a major
source of morbidity related to aspiration
and malnutrition. Oropharyngeal
structural lesions causing dysphagia
 include Zenker’s diverticulum,
cricopharyngeal bar, and neoplasia.

5. This plasma protein can be used to measure the degree of fibrin D? D-dimer is a protein fragment (small
piece) that's made when a blood clot
degradation
dissolves in your body
a. Tissue factor
b. Thrombin
c. Prothrombin
d. D-dimer

6. Which of the following present/s with a predominantly D biliary obstruction, gallstone disease,
malignancy, autoimmune cholestatic
cholestatic pattern of liver injury?
syndromes (primary biliary cirrhosis,
a. A and B sclerosing cholangitis), and rare inherited
b. A, B, C forms of intrahepatic cholestasis.
c. Viral hepatitis
d. Acute cholangitis
e. Liver mass

7. A 21/F came to the emergency room complaining of tachycardia B? Pang STD ba yan? Discrimination naman
yung gender preference if di related sa
and dizziness. On general inspection, the patient was pale. In the
CC
diagnosis of the patient, the following should be part of your
assessment except:
a. Ethnic origin
b. Gender preference
c. History of alcohol intake
d. Geographic background

8. Which of the following statements is true regarding B Eosinopenia occurs with stress, such as
acute bacterial infection, and after
eosinopenia?
treatment with glucocorticoids. The
Statement 1: eosinopenia occurs with acute bacterial infection mechanism of eosinopenia of acute
Statement 2: eosinopenia can cause severe adverse effects bacterial infection is unknown but is
a. Both are true independent of endogenous
glucocorticoids, because it occurs in
b. Only 1 is true
animals after total adrenalectomy. There
c. Only 2 is true is no known adverse effect of
d. Both are false eosinopenia.

9. Which of the following protein in the classic pathway of the C C3a is an effector of the complement
system with a range of functions
complement system is responsible for initiating chemotaxis of
including T cell activation and survival,[2]
neutrophils and macrophages? angiogenesis stimulation,[3] chemotaxis,
a. C4a mast cell degranulation, and
b. C3b macrophage activation (gugel)
c. C5a
The C3b is said to be acting as an
d. C5b6789 opsonin in this case because it enhances
the ability of an entity to be
phagocytosed

10. PA, 45/F, came in to your clinic due to recurrent episodes of B? The rest are anticoagulants????
bipedal edema. Patient is a known hypertensive or diabetic,
however, she had 2 previous cerebrovascular accident last 3 yrs.
You are suspecting a possible coagulation disorder. Which
protein could be possibly deficient in this patient?
a. Plasmin
b. Fibrinogen
c. Thrombomodulin
d. Antithrombin III
11. 25/M came in due to genital pain. HPI revealed that the patient A Crescent = sickle cell
Pernicious = vitamin B12 (megaloblastic
had a penile erection for 6 hrs. PMH is significant for episodes
anemia)
of chest pain, lightheadedness, and easy fatigability. Pertinent
PE include pale palpebral conjunctiva, absence of traube’s space, Priapism - complication with sickle cell
hepatomegaly and skin pallor. CBC revealed Hb of 9.5 and PBS
showed crescent shaped RBC. What is the most probable
diagnosis of the patient?
a. Sickle cell anemia
b. Pernicious anemia
c. Thalassemia
d. G6PD deficiency

12. A laundry woman came into the OPD and complained of linear C
clefts throughout her heels. What kind of lesions are these?
a. Plaques
b. Erosions
c. Fissures
d. Any

13. A 27/M came in due to a stab wound over the abdomen. Surgery D?
was done and corrected the condition. Hb was noted at 6.5 and
3 units of pRBC was ordered for blood transfusion. During the
first bag of pRBC, the patient developed a fever with a temp of
37.8. Patient was also noted to be slightly jaundiced. Upon
investigation, it was noted that the patient was blood type O+
and was given B+ blood group. What is the underlying
mechanism for developing jaundice?
a. Binding of donor antigens to the recipient rbc leading to
intravascular hemolysis
b. Binding of recipient antigens to the donor rbc leading to
intravascular hemolysis
c. Binding of donor antibodies to the recipient rbc leading
to intravascular hemolysis
d. Binding of recipient antibodies to the donor rbc leading
to intravascular hemolysis

14. JR, 39/M was brought in because of sudden onset of D

hematochezia. When is surgery warranted as a diagnostic
procedure in patients presenting with hematochezia
a. When minimal bleeding is found after flexible
sigmoidoscopy
b. When a polyp is found after colonoscopy
c. When adherent clot is found after endoscopy
d. When bleeding persists despite doing angiography

15. Which statement is true about a nodule? D

a. It is chronic
b. It is usually non persistent
c. It is recurrent
d. It often indicates systemic disease

16. Match the description to the radiologic sign

 a. Falciform ligament sign
b. Football sign
c. Chilaiditi
d. Rigler’s sign
e. Coffee bean sign
f. Cupola sign
i. Large volume of free gas has risen to the front B
of the peritoneal cavity
ii. Accumulation of air underneath the central F
tendon of the diaphragm
iii. Visible inner and outer bowel wall due to D
pneumoperitoneum

17. A 60/M patient complains of solitary erythematous plaque with B?

raised irregular borders on the right cheek. Which of the
following tests should be done to the patient?
a. Dark field examination
b. Excision biopsy
c. KOH test
d. Tzanck smear

18. This is a palpable, solic, round, ellipsoidal lesion that is deeper A

than a papule
a. Nodule
b. Tumor
c. Plaque
d. Patch

19. A 12/M is at the OPD. HPI: 1 month of increasing intolerance for B or C?

exercise, which has worsened to daily fatigue. ROS: 2-pillow
orthopnea for half the month. PE: BMI is 20, bulging flanks when
standing upright, distended when supine, with hyperactive bowel
sounds, fluctuant and doughy to palpation, non-tender, no mass.
Which of the following PE is present in the patient?
a. Obesity
b. Ascites
c. Anasarca
d. Heart failure

20. Cholelithiasis are only visible in CT scans when calcified A

a. True
b. False

21. These lesions are linear clefts throughout the epidermis and A
rarely seen in the dermis.
a. Fissures
b. Lichenification
c. Scars
d. Atrophy

22. Getting a supine and lateral abdominal x-ray can help B The abdominal radiograph (AXR) is
performed almost exclusively in the
differentiate whether an object is internal or external
supine position and in the AP
a. True (anteroposterior) projection
 b. False

23. Which of the following is true regarding pernicious anemia? A With neurologic manifestations ata
Statement 1: it is due to vit B12 deficiency
Symptoms include dizziness, easy fatigability without any neurologic
manifestations/ deficit
a. 1 is true
b. Both are false
c. 2 is true
d. Both are true

24. KD, 36/F, went to the ER because of 2-wk hx of jaundice C 3 mg/dL

associated with icteric sclerae and blunt abdominal pain. What
is the expected level of bilirubin in this patient?
a. 4 mg/dL
b. 1 mg/dL
c. 3 mg/dL
d. 2 mg/dL

25. Which of the following measure/s the synthetic function of the C Inflammation yung ALT and AST
liver?
a. B and C
b. ALT
c. Albumin
d. A and B
e. A, B, C
f. AST

26. Which of the following categories best characterize the C Iron deficiency?
pathophysiology of the most common cause of anemia
The most common causes of anemia
worldwide? include nutritional deficiencies,
a. RBC maturation defects particularly iron deficiency, though
b. Excessive RBC destruction deficiencies in folate, vitamins B12 and A
are also important causes;
c. Inadequate RBC production
haemoglobinopathies; and infectious
d. Acute blood loss diseases, such as malaria, tuberculosis,
HIV and parasitic infections.

27. This is described as circumscribed elevation of the skin that A

contains clear fluid
a. Vesicle
b. Bulla
c. Wheal
d. Pustule

28. Best initial diagnostic for ascites A

a. Ultrasound
b. Xray
c. CT scan
d. MRI

29. Which of the following enzymes is responsible for the formation D

of direct bilirubin?
a. Biliverdin reductase
b. Heme oxygenase
c. Beta glucuronidase
 d. Glucuronosyltransferase

30. Which of the following populations is at risk to develop both C

hepatitis b and c infections?
a. Infants from disease endemic areas
b. People who received clotting factors before 1987
c. Patients underground hemodialysis sessions
d. Travelers to developing countries in asia and africa

31. Wheals are caused by shifting of the edema in the skin A

a. True
b. False

32. A chronic liver disease is defined as any hepatic disorder lasting B

for at least _
a. 2 mo
b. 6 mo
c. 3 mo
d. 1 mo

33. If the direct-acting fraction is >15% of the total, the bilirubin can B <15%
be considered to all be indirect
a. True
b. False

34. According to WHO guidelines on management of diarrhea, C Diarrhea is the passage of 3 or more
loose or liquid stools per day, or more
passing of how many unusual loose or watery stools in 24 hrs
frequently than is normal for the
defines diarrhea? individual.
a. 4
b. 1
c. 3
d. 2

35. These are thin, circular, folds of mucosa seen on an xray as a D

thin linear density that pass across the full width of the lumen
a. Haustrations
b. Intestinal band
c. Intestinal villi
d. Plicae circulares

36. A 30 yo complains of a solitary hyperpigmented flat lesions on C

the arm which measures greater than 1 cm. This primary lesion
is most probably a
a. Plaque
b. Papule
c. Patch
d. Macule

37. A 65/F went to the OPD complaining of inability to swallow. She D Aphagia (inability to swallow) typically
denotes complete esophageal
described her symptoms as having a foreign body impacted as
obstruction, most commonly
she tries to swallow but cannot make food pass through her encountered in the acute setting of a
throat. The patient is having food bolus or foreign body impaction.
a. Phagophobia
Odynophagia refers to painful
b. Globus pharyngeus
swallowing, typically resulting from
c. Odynophagia
 d. Aphagia mucosal ulceration within the oropharynx
or esophagus.

Globus pharyngeus is a foreign body

sensation localized in the neck that does
not interfere with swallowing and
sometimes is relieved by swallowing.

Transfer dysphagia frequently results in

nasal regurgitation and pulmonary
aspiration during swallowing and is
characteristic of oropharyngeal
dysphagia.

Phagophobia (fear of swallowing)

38. This lesion is described as circumscribed elevation of the skin C

that contains a yellowish purulent substance
a. Vesicle
b. Wheal
c. Pustule
d. Bulla

39. If a lesion is described as circumscribed elevation of the skin D

that contains a clear fluid measuring 1 cm, this is a
a. Pustule
b. Wheal
c. Vesicle
d. Bulla

40. A 20/F patient complains of pruritic multiple hyperpigmented D?

well-demarcated plaques topped with scales on both thighs,
which of the following laboratory tests should be done to the
patient?
a. Excision biopsy
b. Tzanck smear
c. Wood’s lamp
d. KOH test

41. Causative agents of acute infectious diarrhea

a. C. difficile
b. G. lamblia
c. S. aureus
d. Enterotoxigenic E. coli
e. S. typhi
i. Cytotoxic producer A
ii. Variable inflammation E
iii. Enteroadherent B
iv. Enterotoxin D
v. Preformed toxin C

42. Which of the following proteins serve as the molecular glue to B

 hold the platelets during adhesion
a. Gp Ib-IX-V
b. VWF
c. ADAMTS13
d. Gp IIb/IIIa

43. A 60 yo comes to your clinic for jaundice. He is known to have C HCC screening and HCC surveillance are
defined as a one-time test and repeated
chronic hepatitis B. which will you order if you suspect
tests over time for detecting HCC,
hepatocellular cancer? respectively[6]. Abdominal
a. Albumin ultrasonography (AUS) and serum
b. Antinuclear antibodies alpha-fetoprotein (AFP) measurement
are widely accepted as routine HCC
c. Alpha fetoprotein
screening and surveillance tests in
d. ALT chronic hepatitis B (CHB) patients

44. During a laboratory test of a weak-looking patient, the combined D? Bacterial infection?
amount of band forms and mature neutrophils were 150/uL. At
this level, which of the following is expected?
a. Excessive peripheral pooling of neutrophils
b. Absent local inflammatory response
c. Depressed production of neutrophils
d. Impaired control of endogenous microbial flora in the
gut

45. A patient complains of a solitary palpable, solid, movable lesion D

on the left arm. This lesion is most probably located at the
a. Reticular dermis
b. Papillary dermis
c. Subcutaneous tissue
d. All

46. A 25/M medical student was rushed to the ER of MMC due to A Indications for evaluation include
profuse diarrhea with dehydration,
watery stools. Which of the following clinical findings would
grossly bloody stools, fever ≥38.5°C
serve as indication for further evaluation? (≥101°F), duration >48 h without
a. Recent antibiotic use improvement, recent antibiotic use, new
b. Severe abdominal pain community outbreaks, associated severe
abdominal pain in patients aged >50
c. 24 hrs without improvement of symptoms
years, and elderly (≥70 years) or
d. Temp of 37C immunocompromised patients.

47. Which of the ff can cause increased production, increased C

marrow release and decreased or detective margination of
neutrophils?
a. Thermal injury
b. Leukocyte adhesion deficiency type 2
c. Glucocorticoids
d. Acute infection

48. What clotting factor is associated with the tissue factor and is A Intrinsic: factor XII and XI
important in initiating the extrinsic pathway?
a. VII
b. IX
c. XII
d. X

49. There is no elevation or depression of the surrounding skin and B

measures less than 10 mm
 a. Papule
b. Macule
c. Patch
d. plaque

50. In a patient with suspected GI bleeding but no apparent melena, B Hematochezia will be positive in FOBT
hematochezia or hematemesis, which of the following tests can
be requested to confirm such?
a. Clotting time and bleeding time
b. Fecal occult blood test
c. PT and PTT
d. CBC with platelet count

51. Which is the hepatitis profile for someone who acquired A Vaccination: only anti-Hbs yung positive
immunity due to vaccination?
a. hbsAg neg, antiHbc neg, antiHbs pos
b. HbsAg pos, antiHbc pos, antiHbs pos
c. HbsAg pos, antiHbc neg, antiHbs pos
d. HbsAg neg, antiHbc pos, antiHbs pos

52. Which of the following conditions best described crust? D

a. Base may be dry or red
b. Usually heals without scarring
c. May be thin, friable or thick and adherent
d. All

53. Which abdominal PE finding is observed on inspection? C Fluid wave: palpation/ percussion (di
kosure)
a. Fluid wave
Murphy: palpation
b. Murphy’s sign Borborygmi: auscultation
c. Caput medusa
d. Borborygmi

54. You suspect a hepatocellular pattern of liver injury on one of D

your patients who has paracetamol overdose. What would you
expect?
a. Markedly decreased serum albumin
b. Markedly elevated ALT
c. Markedly elevated direct bilirubin
d. Markedly elevated ALP

55. According to HPIM, what is the normal range of blood leukocyte 4.3–10.8
counts (in 10^9/L)? × 109/L

56. A 25 yo cook got first degree burns. Which of the following A

statements would be used to describe the lesions?
a. There would be loss of all or portions of the epidermis
b. It may become crusted
c. It heals without scarring
d. All

57. Which of the following conditions best describe ulcer? D Loss of dermis and epidermis
a. May be pedunculate
b. Involves the dermis
c. Base may be dry or red
d. Usually heals with scarring
58. A 3 yo child presented with multiple round blisters containing A Vesicle: elevated lesion containing fluid
Papule: solid elevation with no visible
seropurulent discharge. Lesions measured 12 mm. Primary
fluid
lesion of the skin condition is most probably a Pustule: containing purulent exudate
a. Bullae
b. Vesicle
c. Papule
d. Pustule

59. Most appropriate diagnostic for cholelithiasis C

a. CT
b. Xray
c. Ultrasound
d. MRI

60. RD, 35/Fwas brought to the ER due to lightheadedness. She has B? Common din yung C and D
a history of 5 episodes of melena per day for the last 3 days.
There was also noted epigastric pain, burning in quality. VAS
5/10, noted after eating and 2 episodes of hematemesis, ~½ cup
per episode. What is the most common etiology that could
cause the patient’s condition?
a. Colon cancer
b. Peptic ulcer disease
c. GERD
d. Mallory-weiss tear

61. Which of the ff information should be sought in a patient with D Odynophagia or dysphagia
Unexplained weight loss
GERD as it is considered an alarm symptom?
Recurrent vomiting
a. Pallor Occult or gross gastrointestinal bleeding
b. Retching Jaundice
c. Diarrhea Palpable mass or adenopathy
Family history of gastroesophageal
d. Odynophagia
malignancy

62. Which is the most common antibody during the primary E

response?
a. IgD
b. IgG
c. IgE
d. IgA
e. IgM

63. An 18/F is in the OPD. She is apparently healthy but she needs D? Baka lymph nodes lang
medical clearance prior to enrollment in college. The junior
intern palpated non-tender soft, flat nodes less than 1 cm in the
submandibular area bilaterally. What should be the next best
step?
a. Biopsy
b. CT
c. Ultrasound
d. None

64. In the absence of hemolysis, an isolated, unconjugated B Can be crigler or gilbert = further eval
hyperbilirubinemia in an otherwise healthy patient can be
attributed to Gilbert’s syndrome and no further evaluation is
required.
a. True
 b. False

65. MW, 35/F, came to the ER because of abdominal pain and C See fig 4 of trans 3.03
jaundice. Her ALP is elevated out of proportion to her AST and
ALT. Which of the ff systems should also be investigated aside
from hepatobiliary tract?
a. Hematologic
b. Nervous
c. Musculoskeletal
d. CVS

66. Which of the ff statements is true? B

An accurate reticulocyte count is key to initial classification of anemia
Howell jolly bodies are seen in post splenectomy patients
a. Both are false
b. Both are true
c. 2 is true
d. 1 is true

67. Which lesion is secondary to confluence of papules? D

a. Nodule
b. Tumor
c. Patch
d. Plaque

68. Which of the following statements is true about a nodule? C Generally persistent
Indicates systemic diseases
a. It is not usually persistent
b. It often indicates localized disease
c. It is a result of metabolic deposits
d. All are true

69. 21/M came in due to fever and dizziness. Vital signs: BP 100/70, D It is believed that certain immune system
cells (T-lymphocytes) target and destroy
HR 102, RR 21, temp 38.3. CBC shows Hb 10.2, WBC 4.2, Seg
the most primitive cells capable of
2.1, Lym 0.03. Bone marrow examination revealed replacement developing into blood cells,
of marrow with fats. What is the most probable diagnosis of the hematopoietic stem cells. Individuals
patient? with aplastic anemia do not have enough
stem cells to produce mature blood cells.
a. Cooley's anemia
The bone marrow appears to be replaced
b. Pernicious anemia by fat.
c. Sickle cell anemia (rarediseases.org)
d. Aplastic anemia
e. Hemolytic anemia

70. The ischial spines can be used as a landmark for which invisible B
structure?
a. Ureteropelvic junction
b. Ureterovesical junction
c. Ureter
d. Psoas muscle

71. HbeAg is a marker of infectivity A Hepatitis B e antigen (HBeAg) is a

secretory protein processed from the
a. True
precore protein. It is a marker of HBV
b. False replication and infectivity.
(science direct)

72. Clotting factors is the single best acute measure of hepatic A

 synthetic function
a. True
b. False

73. Upper normal dilatational limit of the large bowel? B 3, 6, 9 rule

3: small bowel
a. 2.5 cm
6: large bowel
b. 6 cm 9: cecum
c. 3 cm
d. 3.5 cm

74. A 34/F was brought to the ER due to loss of consciousness. On B <80 g/L (<8 g/dL)
PE, patient had pale palpebral conjunctivae, pail nail beds and
palmar creases are paler than surrounding skin. What is the
expected hemoglobin level of this patient?
a. Any of the three
b. <80g/L
c. <100 g/L
d. <120 g/L

75. GB, 30/M, had a 1-month history of cough, weight loss and D Drug toxicity
Predictable, dose-dependent (e.g.,
anorexia. His sputum Mtb Rif Xpert had a positive result, and
acetaminophen)
was started on anti-koch’s regimen. However, after 2 wks of Unpredictable, idiosyncratic (e.g.,
treatment, he developed jaundice and abdominal pain. On isoniazid)
workup, the patient had elevated AST and ALT, out of proportion
to ALP. Which of the following drugs could have caused the
patient’s condition?
a. Ribavirin
b. Rifampicin
c. Probenecid
d. Isoniazid

76. JR, 39/M was brought in because of sudden onset of D? Any patient who presents with chronic
diarrhea and hematochezia should be
hematochezia. At the ER, patient was noted to be pale, weak
evaluated with stool microbiologic
looking and stretcher bound. BP = 80/40, HR = 126, RR=24, temp studies and colonoscopy
36.8. Which of the ff is the next best step to do?
a. CT angiography
b. Upper endoscopy
c. Ultrasound
d. Colonoscopy

77. A 5-day old newborn is at the OPD for his first well baby check B Umbilical cord takes 7 days before it falls
off
up after delivery. Parents report that baby seems well, sleeps
comfortably, with good suck and good activity when awake. In a
newborn, what are the special considerations in abdominal PE?
a. Direct and rebound tenderness should be soft
b. Umbilical cord stump is present
c. Stethoscope must be small
d. Flat contour is physiologic

78. A 26 yo patient had one yr history of progressively enlarging A Kasi 26 years old pa lang tapos 1 year na
yung duration? So baka infected kaya di
ulcer with poor demarcation the best way to confirm the
nag he-heal
diagnosis is to which of the ff procedures?
a. Bacterial culture
b. Punch biopsy
c. Tzanck smear
 d. KOH

79. Which of the following means that red cells are slightly larger B
than normal and grayish blue in color on Wright-Giemsa stain?
a. Poikilocytosis
b. Polychromasia
c. Anisocytosis
d. Anichromasia

80. The ff are evidence of RBC and Hb breakdown except A

a. Increased Hb binding protein haptoglobin
b. Increased stool stercobilin
c. Increased urinary urobilinogen
d. Increased unconjugated bilirubin

81. A patient presented with multiple depigmented flat lesions over A

the face and neck areas, lesions where described as measuring
5-8 mm. These primary lesions are most probably
a. Macules
b. Plaques
c. Patches
d. Papules

82. A medical student has on and off whitish to yellowish greasy D

laminated masses of keratin on the scalp. These lesion would be
a. Fissures
b. Scars
c. Erosions
d. Scales

83. A 20/M was diagnosed with spontaneous recurrent urticaria. D

Lesions of this condition is best described as
a. Rounded, pale, red plaques
b. Discrete, solid plaques
c. Evanescent wheals
d. All

84. In patients with unexplained dyspepsia, upper endoscopy is D

recommended in patients who are in the age of
a. >70
b. >45
c. >60
d. >55

85. Which of the following is true? B? True talaga yung 1, yung 2 not sure
The degree of anisocytosis correlates with increase in the RDW
Poikilocytosis suggest a defect in the maturation in the WBC precursor
a. Both are true
b. 1 is true
c. Both are false
d. 2 is true

86. This is a secondary lesion that lost all portions of the epidermis C Scales: dry or greasy laminated masses
Ulcer: loss of epidermis and dermis
and does not scar when it heals
Crust: dried serum, pus or blood
a. Scales
 b. Ulcer
c. Erosion
d. Crust

87. To identify stretching or inflammation over organ capsules in the A? Diba fist percussion sa kidney?
abdomen, which technique is used?
a. Fist percussion
b. Rocsing’s sign
c. Auscultation
d. Guarding

88. Platelet plug formation is amplified by which of the following B?

humeral mediators?
a. E-amino caproic acid
b. Epinephrine
c. Heparan proteoglycans
d. Nitric oxide

89. 20/F came in due to dizziness and exercise intolerance. Vital D? Underlying mechanism of patient’s signs
and symptoms?
signs: BP 90/60; HR 105; RR 19; temp 36.8. Pertinent history
includes episodes of palpitations, body weakness and easy Dahil sa heavy menstrual flow
fatigability. Patient also has irregular heavy menses consuming
5 pads per day with a duration of 5-10 days. Pertinent PE include
pale palpebral conjunctivae, skin pallor and tachycardia. What is
the underlying mechanism of a patient's signs and symptoms?
a. Increased blood loss secondary to an autoimmune
process resulting in decreased O2 carrying capacity of
the blood
b. Increased RBC production resulting in decreased oxygen
carrying capacity of the blood
c. Enzyme deficiency resulting in increased susceptibility
of RBC to hemolysis
d. Chronic blood loss with inadequate RBC production due
to insufficient supply of substrates needed for RBC
formation causing decreased O2 carrying capacity of
the blood

90. Causes of constipation in adults

a. Neoplasm
b. Drugs
c. Pregnancy
d. Anismus
e. Parkinsonism
B
i. Psychiatric disorders
D
ii. Disorder of rectal evacuation C
iii. Endocrinopathy A
iv. Colonic obstruction E
v. Neurologic disease Causes of constipation in adults

1. Mallory-Weiss tear refers to which of the following statements? A Explanation: usually on the gastric
a. Mucosal tear at the gastroesophageal junction due to side of the gastroesophageal
dry heaving junction- Hari
b. Rupture of the esophagus due to severe vomiting
c. Multiple lesions in the mucous lining
d. Multiple ulcers due to hormone-secreting small tumors
2. Costochondral calcification, calcified mesenteric lymph nodes A Explanation:
and phleboliths are rarely clinically significant when identified on
abdominal x-rays
a. True
b. False

3. Among patients with acute hepatic failure, which physical C/D? Explanation: Stigmata of chronic
finding, when present, portends to a poorer prognosis? liver disease, including spider nevi,
a. Ascites palmar erythema, gynecomastia,
caput medusae, Dupuytren’s
b. Hepatic encephalopathy
contractures, parotid gland
c. Caput medusae
enlargement, and testicular atrophy,
d. Palmar erythema are commonly seen in advanced
alcoholic (Laennec’s) cirrhosis and
occasionally in other types of
cirrhosis.

4. Liquid and frequent passage of stool weighing about >200 g/day C Explanation: For adults on a typical
for a week is considered to have Western diet, stool weight >200 g/d
a. Chronic diarrhea can generally be considered diar-
rheal. Diarrhea may be further
b. Subacute diarrhea
defined as acute if <2 weeks,
c. Acute diarrhea
persistent if 2–4 weeks, and chronic
d. Fecal incontinence if >4 weeks in duration

5. Which among the following etiologies of liver diseases will not D Explanation: Hepatitis A does not
lead to the eventual development of cirrhosis? lead to long-term complications,
a. Iron overload such as cirrhosis, because the
infection only lasts a short time. - Da
b. Hepatitis C virus
internet
c. Nonalcoholic steatohepatitis
d. Hepatitis A virus

6. The following are ALARM symptoms in GERD except A Obstructing Disorders

a. Pain and tenderness radiating to the back • Odonyphagia or dysphagia
b. Occult or gross GI bleeding • Unexplained weight loss
• Recurrent vomiting
c. Dysphagia
• Occult or gross gastrointestinal
d. Adenopathy
bleeding • Jaundice
• Palpable mass adenopathy
• Family history of gastroesophageal
malignancy

7. HbsAg is a marker of infection A

a. True
b. False

8. When delineating the nine abdominal regions, the horizontal C Huy sure ba to. Hahaha horizontal
plane used are the subcostal plane and the kase sabi
a. Midclavicular
C ata yan haha
b. Parasternal
c. Transtubercular
d. Mid-inguinal

9. The most dilatable part of the bowel is the B

a. Duodenum
b. Cecum
c. Ileum
d. Jejunum
10. Oral pharyngeal dysphagia can be caused by the following C The rest of the choices are part of
neurological diseases EXCEPT neurological causes of Oral
a. ALS Pharyngeal Dysphagia
b. Cerebrovascular disease
c. Achalasia
d. Parkinson’s disease

11. In patients with acute proximal intestinal obstruction, this A? Explanation: Symptoms include
symptom is pronounced cramping pain, vomiting,
a. Vomiting obstipation, and lack of flatus. - da
internet
b. Constipation
c. Abdominal discomfort
d. Abdominal distention

12. Which among the following causes of pediatric jaundice is C

non-obstructive?
a. Malrotation
b. Biliary atresia
c. Inborn error of metabolism
d. Intussusception

13. The length of the kidney spans which vertebral levels? C

a. T11- L2
b. T12-L2
c. T12- L3
d. T11- L3

14. Anti-Hbc IgM rises during acute and chronic infection A

a. True
b. False

15. AST is found primarily in the liver and therefore a more specific B Should be ALT
indicator of liver injury
a. True
b. False

16. The blood clotting factors are made exclusively in hepatocytes D Explanation: ​With the exception of
except which of the following? factor VIII, which is produced by
a. III vascular endothelial cells, the blood
clotting factors are made exclusively
b. IX
in hepatocytes - trans
c. VI
d. VIII

17. Jc, 67/M came in due to progressively enlarging abdomen, D

edema and jaundice, with associated anorexia and abdominal
pain. Which imaging can be used to detect ascites, as well as
detect possible liver disease in a cost-effective way?
a. Cholangiography
b. MRI
c. Fibroscan
d. Whole abdominal ultrasound

18. 40-year-old female comes to the emergency room for abdominal B Explanation: Viral hepatitis
pain and jaundice. ALT was 1,500 units. What are your ○ Ischemic liver injury
differentials? ○ Toxin- or drug-induced liver injury
Elevated aminotransferases (>500
 a. Isoniazid overdose units)
b. Viral hepatitis
c. Gilbert syndrome
d. Hepatic mass

19. Upper normal dilatational limit of small bowel B Rule of 3, 6, 9: the small bowel is
a. 2.5 cm normally <3cm in diameter. If it is
b. 3 cm >6cm, it is at high risk of rupture.
The large bowel is normally <6cm in
c. 3.5 cm
diameter. If it is >9 cm, it is at high
d. 4 cm
risk of rupture

20. SH, 38/M, who recently had 2 episodes of severe hematochezia, C

now has a systolic BP of < 100 mmHg. Upon upper endoscopy,
no source of bleeding was found at the upper GI. What will be
your immediate step if the patient still has decreasing BP and is
too unstable?
a. Surgery
b. Colonoscopy
c. Angiography
d. Flexible sigmoidoscopy

21. The stool excretion of fluid constitutes how much liters per day A Harrison’s: Average, 9L/day enter the
a. 0.2 L/d GIT, 1L to colon and 0.2L/day stool
b. 0.8 L/d excretion of fluid
c. 1.5 L/d
d. 2 L/d

22. A schizophrenic patient started recently on an anti-TB regimen D Explanation: considering they have
was referred due to development of the colored urine and icteric medium skin tone…
sclera. At what level of serum bilirubin will jaundice start to
3 mg/dL lang if fair skin tone
become evident by physical examination?
a. Above 1 mg/dL
b. Above 10 mg/dL
c. Above 2.5 mg/dL
d. Above 5 mg/dL

23. Hypoalbuminemia can be present in which of the following A Hypoalbuminemia is common in

conditions? CLD. In acute phases like acute viral
a. Cirrhosis hepatitis and acute or mild hepatic
dysfunction, albumin is not used
b. Acute viral hepatitis
c. Drug-induced hepatitis
d. criggler-Najar syndrome

24. A 2 yo male with acute onset of bloody stools, not associated D

with pain, which condition that follows the “rule of 2s” should be
included in the differential diagnosis?
a. Intussusception
b. Anal fissure
c. Hirschprung’s disease
d. Meckel’s diverticulum

25. Which of the following is TRUE in evaluating upper GI bleed? C? A: 80%

a. Upper GI barium radiography is 90% accurate in B: screening test
identifying a lesion, though does not confirm source of D: Done for gross blood;
meaningless for occult
bleeding
 b. Radioisotope scanning is a diagnostic test to establish
signs of bleeding
c. Upper endoscopy is the standard of care for initial
diagnostic evaluation
d. Nasogastric aspirate is routinely done

26. The most common source of normal abdominal bruit is the A

a. Celiac artery
b. Inguinal artery
c. Renal artery
d. Iliac artery

27. Which of the following terms is properly described? B

a. Indigestion is a non-specific term that encompasses a
variety of upper abdominal complaints
b. Odynophagia is a painful swallowing typically resulting
from mucosal ulceration within the upper GI that is
commonly accompanied by dysphagia
c. Visceral pain is steady kid of pain, most precisely
localised and brought about by inflammation of the
peritoneum
d. Regurgitation is the forceful expulsion of gastric
contents through the mouth

28. Example of secretory cause of diarrhea A

a. Post-ileal resection
b. Cholera infection
c. Hyperthyroidism
d. Lactose intolerance

29. True of GI symptoms D Explanation:

a. The classic history of vomiting, retching or coughing A. Mallory-Weiss tears
preceding hematemesis among alcoholic patients B. Rumination
C. Persistent diarrhea
describes GERD
b. Regurgitation is the repeated emesis of gastric contents
that exhibit non-volitional control
c. Acute diarrhea is the passage of abnormally liquid or
unformed stools lasting for 2-4 weeks
d. Clinical jaundice or icterus indicates serum bilirubin of
at least 3 mg/dL or 51 umol/L

30. AST/ALT ratio is typically >1 in patients with chronic viral B Explanation: AST:ALT ratio is
hepatitis and nonalcoholic fatty liver disease typically <1 in patients with chronic
a. True viral hepatitis and nonalcoholic fatty
liver disease - trans
b. False

31. Which is the hepatitis profile findings for someone with acute B
infection
a. HbsAg neg, anti-Hbc total pos, anti-Hbc pos, anti Hbs
neg
b. HbsAg pos, antiHbc total pos, anti-Hbc IgM pos, anti
Hbs neg
c. HbsAg pos, anti Hbc total neg, anti Hbc Igm pos, anti
Hbs neg
d. HbsAg pos, antiHbc total pos, anti Hbc Igm neg, antiHbs
 neg

32. Cholelithiases are always visible in CT scans B

a. True
b. False

33. Bowels are peripherally located in massive ascites B Ascites: gas-filled bowel rises in a
a. True central position in a supine patient..
b. False Bowel does not appear pushed to
the side as in organomegaly

34. The conjugated (direct) bilirubin fraction is water-soluble and A

can therefore be excreted by the kidney
a. True
b. False

35. Which isotype of serum globulin distinguishes autoimmune B

hepatitis from alcoholic liver disease?
a. IgD
b. IgG
c. IgM
d. IgA

36. Conjugated hyperbilirubinemia almost always implies liver or A Explanation: (+) presence of
biliary tract disease conjugated bilirubin – presence of
a. True hepatobiliary disease??
b. False

37. Which of the following statements pertains to true melena? C A: hematemesis

a. Indicates bleeding proximal to the ligament of Treitz B: pseudomelena
b. May be due to ingestion of iron D: described hematochezia; melena
is black na parang uling
c. More than 1000 mL blood per stool
d. Fresh, bright red blood per rectum

38. What is the cut off period to differentiate acute from chronic D
liver disease?
a. 1 month
b. 12 months
c. 3 months
d. 6 months

39. A formula fed 7 month-old infant at the OPD. CC: no stool A

output. HPI: strains at stool 1x every 3 days and passes formed
stool, the parents are requesting for medicine so that the infant
can pass stools 1x a day. PE: globular abdomen, non-distended,
no bowel sounds heard in 1 minute. What is the next step in the
complete abdominal PE in case of no bowel sounds heard in 1
full minute?
a. Listen to each quadrant for 5 minutes
b. Plain abdominal x-ray stat
c. Prescribe laxative medicine as required by the parents
d. Percussion and palpation to complete PE

40. The lumbar vertebral transverse process can be used as a A

landmark for which invisible structure?
a. Ureter
 b. Psoas muscle
c. Ureteropelvic junction
d. Ureterovesical junction

41. Patient lies down with his left fist beneath the left thorax. While B Castell's method involves first
standing on the left side facing the patient’s feet, you curled your placing the patient in the supine
fingers under the left costal margin. You asked the patient to position. With the patient in full
inspiration and then full expiration,
take a deep inspiration as you tried to feel for the splenic edge
percuss the area of the lowest
with your fingertips. The method described is called
intercostal space (eighth or ninth) in
a. Bimanual the left anterior axillary line.
b. Middleton
c. Castell’s Nixon’s method: The patient is first
d. Nixon’s placed in the right lateral decubitus
position. Percussion starts at the
midpoint of the left costal margin
and is continued upward
perpendicular to the left costal
margin.

42. If a patent has chronic abdominal pain of at least 8 weeks but D

there is no demonstrable anatomic, infectious, metabolic or
neoplastic condition, the abdominal pain is classified as
a. Congenital
b. Idiopathic
c. Organic
d. Functional

43. In acute liver failure, which of the following test is considered the C
most useful marker of prognosis
a. Serum globulin
b. Prothrombin time with INR
c. Serum bilirubin
d. Serum ALT level

44. Single most useful test for esophageal dysphagia D

a. Manometric study
b. CT scan of the chest
c. Esophageal pH study
d. Endoscopy

45. In hepatitis, albumin levels, <4 g/dL, should raise the possibility B Explanation: In hepatitis, albumin
of chronic liver disease levels <3 g/dL should raise the
a. True possibility of chronic liver disease
b. False

46. The following are indicators for an abdominal x-ray examination, B??
EXCEPT
a. Small bowel obstruction
b. Abdominal trauma
c. Large bowel obstruction
d. Small bowel perforation

47. The frequent passage of small volumes of stool that is often C

associated with rectal urgency, tenesmus or feeling of
incomplete evacuation
a. Fecal incontinence
 b. Overflow diarrhea
c. Pseudodiarrhea
d. All of the above

48. The mechanism for RUQ tenderness noted on the physical B?

examination of a patient with a liver pathology is due primarily to
a. Stretching or irritation of the Gisson’s capsule
b. Reactive cholecystitis
c. Obstruction of bile flow
d. Hepatocyte necrosis

49. Most common x-ray imaging position for the abdomen C

a. Oblique and upright
b. Upright and lateral decubitus
c. Upright and supine
d. Supine and lateral decubitus

50. Most sensitive imaging for the detection of pneumoperitoneum D Explanation:

a. Supine chest x ray
b. Upright abdominal x-ray
c. Supine abdominal x-ray
d. Upright chest x-ray

1. The best overall index of kidney function in health and disease is B Explanation:
the
a. Serum creatinine level
b. Glomerular filtration rate
c. Sonographic size of kidneys
d. Urine albumin excretion

2. Which of the following is the common UTI risk factor for all C Explanation:
women across ages? A/B: post menopausal and young
a. Incontinence healthy women
b. Diabetes D: not a risk factor

c. Sexual activity
d. Menstrual cycle

3. The gold standard measurement of the relative density of the A Explanation: As a measure of urine
urine concentration, it is more accurate
a. Osmolality than specific gravity (from trans)
b. Tonicity
c. Specific gravity
d. Osmolarity

4. In order for a child to be diagnosed with recurrent urinary tract C Explanation:

infection, how many times per year should the child have
symptoms, signs and laboratory confirmation of UTI?
a. Once every 2 years
b. Once a year
c. More than 2x a year
d. At least 5x a year

5. If urinalysis is requested in an infant, which method of specimen C Explanation:

collection is non-invasive, although it might be less accurate?
a. Catheterised specimen
 b. Suprapubic aspiration
c. Urine collection bag specimen
d. Wring the urine from the diaper

6. The presence of frequency, urgency, suprapubic pain with D Explanation:

perineal pain among men is consistent with…
a. Orchitis
b. Prostatitis
c. Pyelonephritis
d. Cystitis

7. The total urinary protein excretion in the normal adult should B Explanation:
be…
a. <30 mg/day
b. <150 mg/day
c. <500 mg/day
d. <1000 mg/day

8. Which of the following statements regarding pelvic imaging is A Explanation:

TRUE? B & D - MRI
a. MRI is the best imaging modality for evaluation of C - ultrasound
prostate cancer, rectal cancer and endometriosis
b. X-ray of the pelvis can accurately identify undescended
testes
c. CT scan is used as an initial evaluation of amenorrhea,
dysmenorrhea and abnormal uterine bleeding
d. Ultrasound is the best cross-sectional modality to
assess cryptorchidism

9. How much excreted RBC per high power field is needed to A Explanation:
consider the diagnosis of microscopic hematuria?
a. 3
b. 4
c. 5
d. 6

10. An infant is seen at the clinic due to fever. HPI: 1 day PTC, D? Explanation:
patient started to have intermittent fever with temperature of
38oC. No other signs and symptoms were noted. Few hours PTC,
the patient had another episode of fever 38oC hence consult.
ROS: includes foul-smelling urine. On PE, what specific finding
supports a diagnosis that is referable to the genitourinary tract
in this patient?
a. (+) urine culture
b. Generalized malaise
c. Percussion with the fist over the costovertebral angle
d. Percussion with 2 fingers over the costovertebral angle

11. Match the following signs and symptoms, or complications with Explanation:
the most likely disorder:
a. Nausea and vomiting A-II
b. Fever and shaking chills B-III
c. Costovertebral tenderness C-II
d. Gross hematuria D-III
e. Dysuria E-III
 i. Lower UTI (Cystitis)
ii. Upper UTI (Pyelonephritis)
iii. Both Upper and Lower UTI
iv. Neither Upper and Lower UTI

12. Which of the following is TRUE about the proximal convoluted D Explanation:
tubule? A - DCT
a. Chloride is poorly reabsorbed throughout the entire
segment of the proximal tubule
b. Water reabsorption through the cellular pathways is
enabled by aquaporin-2
c. Na+ concentration gradient is established by the activity
of the apical Na+/K- ATPase
d. Filtered bicarbonate is reclaimed by a carbonic
anhydrase-dependent mechanism

13. Which X-ray view provides a quick overview of the pelvis? C Explanation:
a. Oblique view
b. Frog leg view
c. AP view
d. Pelvic inlet view
e. Cross table lateral view

14. Which view is specific for the hip and gives a better evaluation of E Explanation:
the femoral neck?
a. Oblique view
b. Frog leg view
c. AP view
d. Pelvic inlet view
e. Cross table lateral view

15. Which view is the gold standard for slipped capital femoral B Explanation:
epiphysis
a. Oblique view
b. Frog leg view
c. AP view
d. Pelvic inlet view
e. Cross table lateral view

16. Which of the following is the correct order of the kidney’s blood B Explanation:
supply?
a. Renal artery → interlobar artery → arcuate artery →
interlobular artery → segmental artery
b. Renal artery → segmental artery → interlobar artery →
arcuate artery → interlobular artery
c. Renal artery → arcuate artery → interlobar artery →
interlobular artery → segmental artery
d. Renal artery → interlobular artery → segmental artery →
arcuate artery → interlobar artery

17. Urine specific gravity is an index of the ability of the kidneys to B Explanation:
a. Reabsorb sodium
b. Concentrate urine
c. Alter hydrogen ion concentration
d. Filter plasma
18. A patient recently has increased need for privacy, mostly has A Explanation:
friends of the same gender, is curious about pubertal changes, Middle adolescence: II, IV, V
and is at SMR (Tanner) Stage I or II on PE. At which stage of Late adolescence: V
adolescence is this patient?
a. Early adolescence
b. School age child
c. Middle adolescence
d. Late adolescence

19. In urine microscopy, which single parameter is increased in a Epithelial Explanation:

normal but poorly collected specimen? cells sabi ng aking MT friend -Cams
If prolonged processing =
increased bacteria

20. Red urine may be due to D Explanation:

a. Bilirubin
b. Homgentisic acid
c. Excess urobilin
d. Myoglobin

21. The primary component of most urinary calculi is B Explanation:

a. Cystine
b. Calcium
c. Leucine
d. Uric acid

22. Routine screening of urine samples for glycosuria is performed A Explanation:

primarily to detest
a. Glucose
b. Galactose
c. Fructose
d. All of the above

23. The recommended initial imaging exam for hematuria in C Explanation: Since does not involve
pregnancy is ionizing radiation
a. Retrograde pyelography
b. Magnetic resonance urography
c. KUB ultrasound
d. Plain helical CT scan

24. A newborn is delivered with ambiguous genitalia. Stat A? Explanation: Walang uterus and
ultrasound shows absence of a uterus and adnexae. Cheek adnexae so male (XY)? idk
swab is sent for karyotyping, waiting for results. Which of the
following pathophysiologic mechanisms has most likely
occurred in this patient?
a. XY whose developing genital tissues have low levels of
receptors to androgen
b. Ambiguous genitalia is a variant of normal and will
resolve by 9 months of age
c. XX whose adrenal glands are producing excess
androgens
d. XX whose mother has PCOS and an androgen-secreting
tumor

25. Which of the following has hyperchloremia? A Explanation:

a. Na - 117, Cl - 89 Divide Na/Cl, if below 1.4 =
 b. Na - 135, Cl - 90 hypochloremia
c. Na - 145, Cl - 100
d. Na - 129, Cl - 75

26. Hematuria is defined as the presence of… A Explanation:

a. 3-5 RBC per high power field
b. 1-2 RBC per scanning field
c. 1-3 RBC per low power field
d. 3-5 RBC per oil immersion field

27. This is a shallow depression seen at the medial surface of the C Explanation:
femoral head
a. Fovea femoris
b. Fovea medialis
c. Fovea capitis
d. Fovea centralis

28. Sine wave pattern in hyperkalemia is seen at serum potassium D Explanation:

level of
a. 4.5-5.5
b. 5.5-6.5
c. 6.8
d. >8

29. What is the most common type of renal stones? D Explanation:

a. Uric acid
b. Cholesterol
c. Struvite
d. Calcium oxalate

30. What is the nephrotic range proteinuria? D Explanation:

a. 500 mg/day
b. 1000 mg/day
c. 2000 mg/day
d. 3500 mg/day

31. While collecting the baby’s urine for analysis, you noticed the B Explanation:
specimen to have a “mousy” odor. Of the following substances Phenylpyruvate dapat
that may be excreted in the urine, the one that MOST
characteristically produces this oror is
a. Porphyrin
b. Phenylpyruvic acid
c. Coliform bacilli
d. Acetone

32. Which of the following decreases anion gap? A Explanation:

a. Hypoalbuminemia Decrease: acidosis, hyperviscosity,
b. Alkalosis bromism
c. Hypocalcemia
d. Uremia
33. Which of the following laboratory findings is commonly B Explanation:
associated with nephrotic syndrome?
a. Hypernatremia
b. Hypoalbuminemia
c. Hypolipidemia
d. Immunoglobulin-dominant proteinuria

34. Milky urine from a 24-year-old woman would most likely contain D Explanation:
a. RBCs
b. Bilirubin
c. Spermatozoa
d. Many WBCs

35. A 38-year-old male, brought to the emergency department by his Partially Explanation:
compensated
friend, complains of weakness, fatigue, poor appetite, and
metabolic
dizziness for 2 weeks. He has not seen any physician for 5 acidosis
years. Other than daily cocaine use, he has no significant
medical history. He is not on any prescription medications.
Physical examination reveals orthostatic blood pressure and
pulse changes. Except for anal condyloma acuminata, the
remaining examination is unremarkable. Rapid HIV test is
positive. Laboratory values on admission are:

Blood Chemistry:
Na - 126 mEq/L
K - 6.5 mEq/L
Cl - 110 mEq/L
HCO3 - 12 mEq/L
Creatinine - 2.1 mg/dL
BUN - 42 mg/dL
Glucose - 60 mg/dL

ABG:
pH - 7.29
pCO2 - 28 mmHg
pO2 - 94 mmHg
HCO3 - 12 mEq/L

What is the primary acid-base disorder of this patient?

36. This is the Y-shaped epiphyseal plate that occurs at the junction B Explanation:
where the ischium, ilium and pubis meet in the skeletally
immature skeleton.
a. Acetabular triangle
b. Triradiate cartilage
c. Capital femoral epiphysis
d. None of the above

37. When this line becomes abnormal, suspicion for posterior E Explanation: E ata to
column fracture is raised A - anterior column fracture
a. Iliopubic line B - slipped capital femoral
epiphysis in adolescence
b. Line of klein
C - reference for perkins line and
c. Hilgenreiner’s line
measure acetabular angle
d. Shenton’s line D - adult: femoral neck fracture;
e. Ilioischial line
 f. Perkin’s line pedia: developmental dysplasia of
g. Intertrochanteric line hip
F - developmental dysplasia of the
hip
G - intracapsular fracture

38. What is the most common etiologic agent of UTI? D Explanation:

a. Staphylococcus saprophyticus
b. Klebsiella pneumoniae
c. Enterococcus faecalis
d. Escherichia coli

39. Which of the ff statements is/are TRUE regarding the clinical D The percutaneous renal biopsy
correlation of the kidney’s anatomy? (PRB) is the standard of care. It is
most commonly performed by
radiologists and nephrologists. The
[STATEMENT 1] Ultrasound-guided percutaneous biopsy of the
patient is placed in the prone
kidney is usually done at the upper pole of the kidney
position, and the biopsy is typically
taken from the lower pole of the
[STATEMENT 2] Due to the location of the ureters, kidney if there are no specific
ultrasonography is no longer the diagnostic test of choice in the locations of interest.
evaluation of nephrolithiasis
Ultrasonography should be
a. Only statement 1 is TRUE considered the standard-of-care,
b. Only statement 2 is TRUE first- line imaging modality for
patients <14 years of age and
c. Both statements are TRUE
those who are pregnant. This
d. Both statements are FALSE
modality should be considered for
all patients with potential
nephrolithiasis when a strong
suspicion of stones exists and in
thin (BMI <30) patients

40. Match the location of these pelvic fat pad A-II Explanation: Ito yung parang mali
a. Iliopsoas fat stripe B-I ni doc wee, feel ko napagbaliktad
b. Gluteus minimus fat stripe C-III niya yung description ng Iliopsoas
and gluteus.
c. Obturator fat stripe
i. Superior aspect of the femoral neck
ii. Inferior to iliopsoas tendon
iii. Medial to the iliopectineal line

41. In interpreting the ABG, what is the relationship between the pH B Explanation:
and the PaCO2 when we evaluate the primary acid base Increase in PaCO2= acidic (low pH)
disorder?
a. Directly proportional
b. Inversely proportional
c. Independent of one another
d. Undetermined

42. Glomerulonephritis can present with the ff abnormal urinary B Explanation:

sediments EXCEPT
a. WBC cast
b. Crystal cast
c. RBC cast
d. Granular cast

43. Which of the ff casts is most likely to be found in healthy people C Explanation:
 a. Waxy
b. WBC
c. Hyaline
d. RBC

44. Which of the ff organisms is the most common cause of B Explanation:

complicated UTI?
a. Staphylococcus aureus IT’S ALWAYS E COLI PEKPEK
b. E. coli
c. Pseudomonas aeruginosa
d. Enterococci

PELVIC IMAGING (DR. WEE)

1. What is the best imaging modality for the evaluation of prostate MRI
cancer, rectal cancer, and endometriosis?

2. Which of the following is true regarding the Judet view? D

a. Otherwise known as cross-table lateral view
b. Patient is in lateral decubitus position
c. Beam is perpendicular to inlet bones
d. The unaffected side is rotated roughly 45 degrees
anterior

3. Which of the following statements is FALSE regarding the D

shallow depression at the medial surface of the femoral head?
a. It lacks hyaline cartilage
b. It contains vascular canals
c. It is identified for structural soundness
d. It is the attachment for teres minor muscle

4. Which of the following is FALSE regarding Fovea Capitis? D Fovea capitis is the site of attachment of
ligamentum teres
a. Lacks hyaline cartilage
b. Contains vascular canals
c. Identified for structural soundness
d. Attachment for teres minor muscle

5. Match the options below:

a. Shenton’s line
b. Hilgenreiner’s line
c. Iliopubic line
d. Perkin’s line
e. Ilioischial line
f. Intertrochanteric line/crest
g. Line of Klein
I. Landmark used to delineate intracapsular from F
extracapsular femoral pathology
II. Mainly used as reference line and to calculate B
acetabular angle
III. When this line is interrupted, femoral neck A
fracture or developmental dysplasia of the hip
may be correlated.
URINALYSIS (DR. WEE)

6. Osmolality is a measure of A The solute or particle concentration of a

fluid is known as its osmolality,
a. Total concentration
expressed as milliosmoles per kilogram
b. Dissolved particles of water (mOsm/kg).
c. Molecule size
d. Undissociated molecules only

7. Isosthenuria is associated with specific gravity of B ● Normal range: 1.003-1.035

● Hyposthenuric: low specific gravity,
a. Variable between 1.001 to 1.008
“diluted urine”
b. Fixed at 1.010 ● Hyposthenuric: high specific gravity,
c. Variable between 1.015 to 1.022 “concentrated urine”
d. Fixed at 1.020 8. Isosthenuric: fixed at 1.010
poor tubular reabsorption

9. All casts typically contain… A Urinary casts are cylindrical structures

that are formed from coagulated protein
a. Tamm-Horsfall glycoprotein
(Tamm-Horsfall protein) secreted by
b. Globulin tubular cells.
c. IgG and IgM (science direct)
d. Albumin

10. Which of the following casts is most indicative of end-stage A ● Advanced/chronic tubular
inflammation and degeneration reflect
renal disease?
end-stage renal disease
a. Waxy ● AKA = Renal failure casts
b. Granular
c. Cellular
d. Hemoglobin

11. Match the options below

a. Cystine
b. Uric acid
c. Calcium oxalate
d. Oxalic acid
e. Calcium phosphate
f. Cholesterol
g. Citrate
h. Struvite

I. Transparent thin plates F

II. Coffin lid crystals H
III. Lozenges with varying shape B
IV. Hexagonal plates with irregular sides A
V. Dumbbell-shaped C

PEDIATRIC PE: RENAL & EXTERNAL GENITALIA (DR. QUI)

12. When getting the vital signs, which of the top 3 major clinical Hyperten The 3 major symptoms of renal
manifestations of renal disease can be checked? sion disease are proteinuria, hematuria
and hypertension. The key word sa
question is WHICH and VITAL SIGNS

13. What is the prognosis for retractile testes? D Retractile testes can be outgrown at
puberty
a. Treat with 0.01% estradiol cream 2-3x a day for several
weeks
b. Can observe until the 9th month of life
c. Refer for surgical correction immediately
 d. Can observe until puberty

14. At which age of gestation can prenatal ultrasound begin to B? The fetal bladder should be visualized
from 13 weeks on. Its identification is
screen for possible congenital abnormalities of the urinary tract?
easy because of its pelvic location
a. 6th to 8th week between the umbilical arteries. Fetal
b. 12th to 16th week urinary production starts at 9 weeks of
c. 24th to 28th week pregnancy and increases significantly
beyond 16 weeks.
d. 32nd to 36th week

ALTERATIONS IN RENAL AND URINARY TRACT FUNCTIONS (DR. CABARLES)

15. Which of the following is considered a primary metric for kidney B

function?
a. Serum creatinine
b. Glomerular filtration rate
c. Blood urea nitrogen
d. Cystatin C

16. Statement 1 – There is an increase in the level of ANP when the A ANP decreases sodium reabsorption
concentration of sodium in the ECF decreases
Statement 2 – When the concentration of sodium in the ECF
decreases, there is an increase in the level of aldosterone
a. Only statement 1 is TRUE
b. Only statement 2 is TRUE
c. Both statements are TRUE
d. Both statements are FALSE

17. One of the most common serious manifestations of D Most serious manifestations:
○ muscle weakness or paralysis
hyperkalemia is…
■ mus. weakness begins w/ the legs and
a. Dyspnea progresses to the
b. Seizures trunk and arms
c. Palpitations ○ cardiac conduction abnormalities
○ cardiac arrhythmias
d. Muscle weakness

18. Neurologic symptoms manifested in acute hyponatremia is… D

a. Inverse related to the chronicity of development and
level of sodium
b. Associated with increased solute concentration in the
intravascular space
c. Subclinical in nature and without any symptoms
d. Related to the rapid osmotic water movement into the
brain

19. Which of the following medications should be sought as a cause A

of hyponatremia?
a. Thiazides
b. NSAIDs
c. Aspirin
d. Metformin
20. In the evaluation of azotemia, a patient was found to have B
hydronephrosis. Which of the following is the next best thing to
do?
a. Measure urine electrolytes
b. Refer for urologic evaluation
c. Do kidney biopsy
d. Check for the urinalysis

21. A patient with acute respiratory alkalosis would have an A B = for chronic respiratory alkalosis
expected compensatory response described by the following D = for chronic respiratory acidosis
relationship
a. Decrease in HCO3 by 0.2 mmol/L per mmHg decrease in
PaCO2
b. Decrease in HCO3 by 0.5 mmol/L per mmHg decrease in
PaCO2
c. Increase in HCO3 by 0.2 mmol/L per mmHg decrease in
PaCO2
d. Increase in HCO3 by 0.4 mmol/L per mmHg decrease in
PaCO2

22. A 2-year-old boy with fever had positive urine ketones. This D Causes of Ketonuria:
would most likely be caused by Starvation.
a. Anemia Digestive disturbances.
Dietary imbalance (high fat/low
b. Biliary tract obstruction
carbohydrate diet)
c. Hypoglycemia
Eclampsia.
d. Vomiting Prolonged vomiting and diarrhea.
Glycogen storage diseases.
Severe, sustained exercise.
Fever.

23. If a urinary tract infection is considered, which finding will A

support it?
a. WBC = 5-10/hpf
b. RBC = 0-3/hpf
c. Specific gravity = 1.010
d. Ketone = +2

24. Which of the following symptoms is indicative of invasive C

infection?
a. Flank pain
b. Hematuria
c. Fever
d. Proteinuria

25. A 5-year-old boy is seen at the ER for abdominal pain. He D Lupus nephritis - The kidneys are often
affected by the systemic autoimmune
describes it as vague, and draws a large circle over the
process of systemic lupus
periumbilical area when asked for the location. It is around 8/10 erythematosus (SLE).
on the Wong-Baker scale “It hurts a lot.” His ankles appear
swollen, and he complains of 4/10 pain on both knees. Which
additional PE finding will confirm the diagnosis of a systemic
 disease with renal involvement?
a. Gray-Cullin sign
b. Sister Mary Joseph’s nodule
c. Rash over the buttocks, back of the thighs and
dependent parts of the legs
d. Rash over the malar aspect of the face and the bridge of
the nose, sparing the nasolabial folds

26. Which of the following statements is true regarding urinary tract A UTI is a collective term that describes
any infection, involving any part of the
infection?
urinary tract
a. UTI is defined as the presence of bacteria in the urine,
with associated pyuria, regardless if symptoms are
present or not
b. Recurrent UTI is considered a type of complicated UTI
c. At the age group 1-50 years old, UTI is more common
among women than men
d. Infection involving the urethra is known as cystitis

27. The following are conditions that define a complicated UTI, D

EXCEPT:
a. Renal transplantation
b. Use of indwelling catheters
c. Vesicoureteral reflux
d. Elderly

28. M.L., 24/M, came in to your clinic because of 2-week history of A

urethral discharge, with associated dysuria. No fever, vomiting
and abdominal pain. Patient has BP=120/80, HR=90, RR=19,
Temp=37.6C, (-) Costovertebral angle tenderness, (+) yellowish
discharge at urethral meatus. What is the probable diagnosis in
this patient?
a. Uncomplicated UTI - urethritis
b. Uncomplicated UTI - cystitis
c. Complicated UTI - prostatitis
d. Complicated UTI - pyelonephritis

29. The probability of bacterial cystitis in women increases from A women presenting with at least one
symptom of UTI (dysuria, frequency,
50% to 90% when the following symptoms are present:
hematuria, or back pain) and without
a. Dysuria, frequency, urgency, without fever complicating factors, the probability of
b. Dysuria, frequency, no vaginal discharge, no irritation acute cystitis or pyelonephritis is 50%.
c. Dysuria, frequency, dribbling, irritation
d. Dysuria, hematuria, frequency, and vaginal discharge

30. Which of the following is a risk factor to develop UTI among C Other risk factors in pre menopausal:
- Frequent sexual intercourse
pre-menopausal women?
- Use of spermicide
a. Presence of cystoceles - First UTI before 15 yo
b. Use of foley catheters - Maternal hx of UTI
c. New sexual partner
d. Diabetes mellitus

31. A patient is said to have polyuria if he/she has a total urine >3L/ 24
output of at least _________ (include unit) hrs

32. What type of proteinuria is being described below:

Overflow
a. Increased excretion of low-molecular-weight proteins
proteinuria
 can occur with marked overproduction of a particular
protein, leading to increased glomerular filtration and
excretion Glomerular
b. Due to increased filtration of macromolecule across the proteinuria
glomerular capillary wall
Tubular
c. Low-molecular-weight proteins with molecular weights
proteinuria
that are generally under 25,000 Daltons
d. Due to immunoglobulin light chains in multiple myeloma Overflow
but may also be due to lysozyme, myoglobin or free proteinuria
hemoglobin that is not bound to haptoglobin
Post-renal
e. Inflammation in the urinary tract, which can occur with proteinuria
urinary tract infection, can give rise to increases in
urinary protein excretion

THYROID HORMONES (DR. DELA CRUZ)

33. Which type of epithelium is found in thyroid follicles? C Simple cuboidal

a. Squamous
b. Columnar
c. Cuboidal
d. Transitional

34. Which of the following amino acids is the precursor for the D
synthesis of thyroid hormones?
a. Proline
b. Tryptophan
c. Alanine
d. Tyrosine

35. Which of the following is the active form of thyroid hormone? A

a. T3
b. rT3
c. T4
d. None of the above

36. Which of the following is the most common cause of B ● iodine deficiency remains common
cause of hypothyroidism
hypothyroidism worldwide?
worldwide
a. Radiation exposure ● in areas of iodine sufficiency,
b. Iodine deficiency autoimmune disease (Hashimoto’s
c. Hashimoto’s thyroiditis thyroiditis) and iatrogenic causes
(treatment of hyperthyroidism) are
d. Graves’ disease
most common.

37. Iodine deficiency can cause… B

a. Thyroid cancer
b. Goiter
c. Thyroiditis
d. Solitary thyroid nodules

38. Which of the following cellular processes increase in response C?D?

to thyroid-stimulating hormones?
a. Uptake of iodide into the follicular cells
b. Incorporation of iodide ions into tyrosine molecules of
thyroglobulin
c. Synthesis of thyroglobulin proteins
d. All of the above
39. In peripheral tissues, T4 is converted to T3 by which enzyme Deiodinas
a. 3-iodinase e ??
b. 3’-iodinase
c. 5-iodinase
d. 5’-iodinase

40. Thyroperoxidase is an enzyme involved in the production of D?

thyroid hormone. This enzyme catalyzes the following reaction,
EXCEPT?
a. Cleavage and release of thyroid hormone
b. Incorporation of iodine to a tyrosine residue of
thyroglobulin
c. Condensation of monoiodotyrosine and diiodotyrosine
d. Conversion of iodide to iodine-free radical

41. Which of the following transporters is responsible for the uptake B

of iodine into thyroid cells in the presence of a concentration
gradient?
a. I-/Cl- antiport
b. Na+ I- symport
c. K+ I- symport
d. None of the above

42. Thyroid-stimulating hormone (TSH) is a hormone produced by B/C?

the anterior pituitary gland that regulates thyroid hormone
production. The enhanced thyroid hormone production is
mediated by the following mechanisms:
a. Increased cGMP production in follicular cells
b. Increased cAMP production in follicular cells
c. Increased diacylglycerol production in follicular cells
d. Increased Ca2+ ions in the follicular cells

43. The bulk of thyroid hormones seen in the blood are C

protein-bound. Which of the following is not a plasma thyroid
hormone-binding protein?
a. Albumin
b. Thyroid binding globulin
c. Thyroglobulin
d. None of the above

44. Which of the following proteins serves as a precursor to thyroid B

hormone and also serves as a sign for thyroid cancer?
a. Thyroalbumin
b. Thyroglobulin
c. Thyroid binding globulin
d. All of the above

45. A condition marked by low TSH levels is called B

a. Hyperthyroidism
b. Hypothyroidism
c. Goiter
d. Thyroid cancer
46. Sign of hypothyroidism D
a. Constipation
b. Paresthesia
c. Hoarse voice
d. Carpal tunnel syndrome

47. Symptom of hypothyroidism D A-C are signs

a. Serous cavity effusion
b. Bradycardia
c. Diffuse alopecia
d. Dry skin

48. Signs of thyrotoxicosis B A, C, D are symptoms

a. Palpitation
b. Gynecomastia
c. Loss of libido
d. Oligomenorrhea

49. Symptom of thyrotoxicosis C

a. Warm skin
b. Tremor
c. Diarrhea
d. Gynecomastia

50. Primary cause of hypothyroidism A

a. Overexpression of T3 deiodinase
b. Bexarotene treatment
c. Subacute thyroiditis
d. Radioactive ablation

51. Secondary cause of hypothyroidism A

a. Sheehan's syndrome
b. Hashimoto’s thyroiditis
c. Scleroderma
d. Hemochromatosis
52. Secondary hyperthyroidism C
a. Infarction of adenoma
b. Thyroid carcinoma metastasis
c. Thyroid hormone resistance syndrome
d. Radiation

53. TBG levels rise during pregnancy, resulting in an increase in total A B = low free T4, normal/low T3
thyroid hormone but no change in free thyroid hormone levels. C = Normal both
This is referred to as: D = High both
a. Euthyroid state
b. Hypothyroid state
c. Subclinical hypothyroid state
d. Hyperthyroid state

54. Low serum TSH, normal FT4 and T3 B A = Normal TSH, normal/high FT4 &
a. Euthyroid hyperthyroxinemia T3
b. Subclinical hyperthyroidism C = Low serum TSH, high FT4 & T3
D = Normal TSH, low FT4,
c. Hyperthyroidism
normal/high T3
d. Euthyroid: T3 therapy

55. All of the following are associated with increased levels of total D?
T4 in the plasma with a normal free T4, EXCEPT:
a. Familial dysalbuminemic hyperthyroxinemia
b. Sick-euthryoid syndrome
c. Pregnancy
d. Cirrhosis

56. A 26-year-old medical student is being treated at the student C

health clinic for panhypopituitarism after childhood
craniopharyngioma excision. She reports moderate adherence to
her meds but is otherwise healthy. A TSH level is determined to
be below the assay’s detection limits. Which of the following
actions is the most suitable next step?
a. Do nothing
b. Order MRI of her brain
c. Order free T4 level
d. Decrease levothyroxine dose to half of current dose

57. In chronically deficient people, this anomaly is closely connected C The decrease of thyroid hormone levels
from baseline increases TSH secretion
to the growth of the thyroid gland
from the pituitary gland. Increased
a. An antibody that binds to the TSH receptor in the thyroid demand for thyroid hormones due to
gland physiological requirements like
b. Impaired conversion of T3 and T4 adolescence or pregnancy also leads to
pituitary stimulation and increased TSH
c. Elevated levels of TSH
secretion. The increased TSH causes
d. Reduced activity of thyroperoxidase increased cellularity and hyperplasia of
the thyroid gland.

58. Which of the following statements best described Graves’ C? The proptosis is often asymmetric and
can even appear to be unilateral. Orbital
ophthalmopathy?
inflammation and engorgement of the
 a. It is never found without concomitant hyperthyroidism extraocular muscles, particularly the
medial rectus and the inferior rectus,
b. Although a cosmetic problem, Graves’ ophthalmopathy
account for the protrusion of the globe.
is rarely associated with major ocular complications Corneal exposure, lid retraction, lid lag on
c. Diplopia may occur from periorbital muscle swelling downgaze, conjunctival injection,
d. The most serious complication is corneal abrasion restriction of gaze, diplopia, and visual
loss from optic nerve compression are
cardinal symptoms

59. Graves disease patients have elevated thyroid hormone levels in B

their blood. Graves disease is defined by the following, EXCEPT?
a. Presence of TSH receptor antibodies causing receptor
activation
b. Excess release of TSH from the anterior pituitary
c. Hyperactivation of TSH receptor in thyroid glands
d. Decreased TSH levels

60. A patient with tachycardia and sensitivity to heat is suspected of B Because all other choices are
having Graves disease. Which of the following is not a characteristic of Grave’s
distinguishing trait of Graves disease?
a. Increased total and free T4
b. Decreased thyroid radioactive iodine uptake
c. Suppressed plasma TSH
d. Exophthalmos

61. Following the commencement of therapy for her newly A Graves’ ophthalmopathy can be treated
with oral prednisone (60 mg/d) for 1
diagnosed Graves’ disease, a 27-year-old girl has eye discomfort
month, followed by a taper over several
and decreased visual acuity. Which of the following therapies months. Worsening of symptoms upon
was most likely not initiated? glucocorticoid withdrawal is common.
a. Radioiodine treatment Topical lubricants, taping the eyelids
closed at night, moisture chambers, and
b. Carbimazole and thyroxine
eyelid surgery are helpful to limit
c. Thyroidectomy exposure of ocular tissues. Radiation
d. Propylthiouracil therapy is not effective. Orbital
decompression should be performed for
severe, symptomatic exophthalmos or if
visual function is reduced by optic nerve
compression. In patients with diplopia,
prisms or eye muscle surgery can be
used to restore ocular alignment in
primary gaze.

62. Which of the following is not a function of thyroid hormones in D

the metabolic process?
a. Glycogenesis
b. Glycogenolysis
c. Gluconeogenesis
d. Glucose oxidation

63. The metabolic function of thyroid hormones include C

a. Increased lipogenesis
b. Decreased oxygen consumption
c. Increased lipolysis
d. Protein anabolism

64. The primary principle behind radioactive thyroid scan and uptake A The test uses a radioactive tracer, which
is a protein or a molecule attached to
a. Thyroid gland pulling large amounts of iodine from the
radioactive material. The radioactive
bloodstream tracer is administered into the patient,
b. Thyroid gland being especially vulnerable to radioactive and a probe measures the amount of
 decay iodine uptake by the thyroid gland
c. Thyroid gland releasing electromagnetic radiation
d. A and B are correct
e. All of the above

65. Which of the following is the screening test for the diagnosis of D
thyroid disease?
a. Total T4
b. Total T3
c. Free T3
d. Thyroid stimulating hormone

DIABETES MELLITUS (DR. DELA CRUZ)

66. Abnormal and unpleasant sensations in the skin that are felt as D Paresthesias: sensations of tingling or
“pins and needles” around the lips or in
intense tingling, or pins and needles
the extremities
a. Allodynia Hyperesthesia: pain or increased
b. Hyperalgesia sensitivity in response to touch
c. Hyperpathy Allodynia: a nonpainful stimulus, once
perceived, is experienced as painful, even
d. Paresthesia
excruciating. An example is elicitation of
a painful sensation by application of a
67. An excessive painful reaction to being in contact with everyday B vibrating tuning fork
objects such as clothes or sheets/ Hyperalgesia: severe pain in response to
a. Allodynia a mildly noxious stimulus
Hyperpathia: a broad term,
b. Hyperesthesia
encompasses all the phenomena
c. Hyperalgesia described by hyperesthesia, allodynia,
d. Hyperpathy and hyperalgesia

68. Test to determine mechanical allodynia B Since mechanical?

a. Vibration test
b. Brush test
c. Monofilament test
d. Pinprick test

69. Test to determine hyperalgesia D

a. Brush test
b. Hot/cold test
c. Vibration test
d. Pinprick test

70. Which of the following is NOT a characteristic of nociceptive B It can be acute or chronic.
pain?
a. Responds to analgesics
b. Almost always chronic
c. Time-limited
d. Aching throbbing and well-localized

71. Retinopathy is a complication of diabetes. Which of the D

following is not a retinopathy finding?
a. Yellow exudates
b. Scattered hemorrhages
c. Neovascularization
d. Arteriovenous nicking
72. Which of the following is not a consequence of diabetic A -
peripheral neuropathy?
a. Uncontrolled sugars
b. Amputation
c. Fractures
d. Disability

73. All of the following are consistent with nonproliferative diabetic None Aneurysm, hard exudates, hemorrhages,
dapat abnormal growth of blood vessels and
retinopathy, EXCEPT:
cotton wool spots
a. Neovascularization
b. Blot hemorrhages
c. Retinal vascular microaneurysms
d. Cotton-wool spots

74. Which of the following results establishes a diagnosis of A

diabetes mellitus?
a. Symptomatic patient with random glucose 12.0 mmol/L
on one occasion
b. Symptomatic patient with fasting glucose 6.8 mmol/L
on two occasions
c. Glycosuria +++
d. Asymptomatic patient with fasting glucose 7.9 mmol/L
on one occasions

75. Which of the following laboratory measurements best indicates B HbA1c reflects average glycemic control
over the previous 2–3 months
blood glucose control over a period of weeks?
a. Measurement of insulin
b. Measurement of HbA1C
c. Measurement of urinary ketone bodies
d. Measurement of blood glucose

76. Which of the following measures of serum concentration is not A

used to rule out diabetes?
a. Insulin
b. Glycated hemoglobin HbA1c
c. Fasting blood glucose
d. Postprandial blood glucose

77. Lethargy and polydipsia are observed in a 48-year-old obese guy. B

What HbA1c level is required to diagnose type 2 diabetes
mellitus?
a. 6.0% (42 mmol/mol)
b. 6.5% (58 mmol/mol)
c. 6.3% (45 mmol/mol)
d. Cannot use HbA1c for diagnosis
78. Prediabetes is a term used to describe people whose blood A
sugar levels are not high enough to be diagnosed as diabetic but
are also not normal either. Pre-diabetes is best described by
which of the statements below?
a. Fasting blood glucose from 100-125 mg/dL
b. Fasting blood glucose from 126-140 mg/dL
c. Fasting blood glucose from 120-180 mg/dL
d. All of the given choices are correct

79. Diabetes may be diagnosed based on the following factors, A 2 hr postprandial glucose of >11.1
mmol/L or 200 mg/dL
except?
a. 2-hour postprandial glucose >140 mg/dL
b. Random blood glucose >200 mg/dL with classical
symptoms
c. HbA1C > 6.5%
d. Fasting blood glucose >126 mg/dL

80. An 18-year-old female patient presents to the Emergency C? Kasi mababa glucose pero mataas
insulin
Department complaining of excessive perspiration and
dizziness. Her father, who has type 2 diabetes mellitus, brings
her in out of concern that she may be diabetic. He recounts a
series of similar incidents over the last two weeks her BM is 1.9
mmol/L at admission, and the following blood tests are
performed:
Plasma glucose 1.8 mmol/l
Insulin 15mg/ml (NV: 6-10 mg/ml)
Proinsulin 22% (NV: 22-24%)
C peptide 0.15 nmol/l (NV: 0.2-0.4 nmol/l)

What is the most likely diagnosis?

a. DM type 1
b. Diabetes mellitus 2
c. Insulinoma
d. Insulin abuse

81. Lethargy and polyuria are evident in a 71-year-old lady with a C

history of type 2 diabetes mellitus. The possibility of
hyperosmolar hyperglycemia is discussed. Which of the
following observations is most compatible with this diagnosis?
a. Ketones 1+ in urine
b. pH of 7.38
c. Serum osmolality of 310 mosmol/kg
d. Serum bicarbonate of 19 mmol/l

82. Type 1 diabetes is characterized by which of the following? D

a. Type 1 diabetes is caused by an absolute deficiency of
insulin
b. Type 1 diabetes is associated with the autoimmune
destruction of beta cells
c. Patients with type 1 diabetes present with diabetic
ketoacidosis
d. All of the given choices
 83. Which of the following is not an autoantibody marker of type 1 A islet cell antibodies (ICA, against
cytoplasmic proteins in the beta cell),
DM?
antibodies to glutamic acid
a. Zinc transporter 8 decarboxylase (GAD-65), insulin
b. Antibodies to GAD65 autoantibodies (IAA), and IA-2A, to
c. Antibodies to tyrosine phosphatase IA-2 and IA-2 beta protein tyrosine phosphatase
d. None of the above

84. In diabetic ketoacidosis, a shortage of insulin results in an B

increase in ketone body synthesis. Which of the following test
findings is most likely to occur with diabetic ketoacidosis?
a. Decreased arterial blood pH, increase blood glucose,
decreased anion gap
b. Decreased arterial blood pH, increased blood glucose,
decreased bicarbonate ion concentration
c. Increased arterial blood pH, increased blood glucose,
decreased bicarbonate ion concentration
d. All of the given choices are correct

85. Hyperglycemia is one of the signs of diabetes mellitus. In type 2 B

diabetes, which of the following is not a common characteristic
of DM type 2?
a. Impaired insulin secretion
b. Excessive hepatic glucose production
c. Increased insulin resistance
d. Diabetic ketoacidosis

86. Hyperosmolar coma, diabetic ketoacidosis, and other acute C Polyuria, weight loss and diminished oral
intake = mental confusion, lethargy or
consequences of diabetes mellitus may occur if the disease is
coma
not well-treated. The hyperglycemia hyperosmolar coma is
associated with which of the following?
a. Severe hyperglycemia shifts fluid from the intracellular
to the extracellular space
b. Increased serum osmolality
c. Polyuria increases the volume of extracellular space and
decreased renal blood flow
d. The severe loss of intracellular fluid from the brain
causes the coma

87. Baselow’s disease is due to? B

a. Insulin resistance
b. Hyperactivity of thyroid gland
c. Hypoactivity of thyroid gland
d. Autoimmune destruction of pancreas

88. Which of the following conditions promote increased potassium D Diabetes only
release from the cells? Milk-Alkali syndrome: hypercalcemia
a. Insulin deficiency in Type 1 DM Adrenal insufficiency
b. Milk-Alkali syndrome
c. Primary hyperaldosteronism
d. Chronic kidney disease

A.
1. Stages of bone healing are inflammatory, osteoblastic phase, B Explanation:
and osteolytic phase
a. TRUE Inflammatory, reparative, remodeling
b. FALSE

2. A large hypodensity in the brain denotes irreversible tissue A Explanation:

damage
a. TRUE
b. FALSE

3. Leaving fixation material in the fractured for extended period A Mainstay treatment for fracture is
ensures fracture immobilization and faster healing immobilization. There are times na
a. TRUE tumatagal ang healing because
nagagalaw yung bones (Doc Wee)
b. FALSE

4. Depending on the plane of deformity, it can be defined as away A

from the midline
a. Valgus
b. Abduction
c. Recurvatum or flexion
d. Varus

5. Chronic, progressive immune-mediated inflammatory disorder A

that results in radiographic finding of bamboo spine and
sacroiliitis
a. Ankylosing spondylitis
b. Osteoarthritis of the spine
c. Lumbar spondylosis
d. Rheumatoid arthritis

6. Which of the following drug combinations is the first choice to C? the proven superiority of
retard progression of bone erosion in rheumatoid arthritis? combination DMARD regimens over
a. NSAIDs and methotrexate methotrexate alone
b. NSAIDs and corticosteroids
c. Methotrexate and azathioprine
d. Methotrexate and hydroxychloroquine

7. Insular ribbon sign is one of the early signs of infarction A

a. TRUE
b. FALSE

8. Rheumatoid arthritis is more common in B Like many other autoimmune

a. Males diseases, RA occurs more
b. Females commonly in females than in males,
with a 2–3:1 ratio
c. Equal preference

9. High intensity on DWI indicates the ability of water protons to B High intensity on DWI indicates
freely diffuse extracellularly restriction of the ability of water
a. TRUE protons to diffuse extracellularly
b. FALSE

10. The sutures are found in typical anatomical locations and are B
characteristically smooth and linear in appearance
a. TRUE
b. FALSE
11. Which finding in your history and physical examination of an C
injured worker with low back pain would require immediate
intervention
a. Pain that awakens the worker at night
b. Pain radiating to the posterior thigh
c. Paresthesia in the great toe
d. Ankle weakness only with long distance walking

12. In the correct clinical scenario, interruption of the shenton line C

can indicate:
a. Developmental dysplasia of the hip
b. Femoral neck fracture
c. Both
d. neither

13. The most commonly injured rotator cuff tendon is C

a. Infraspinatus
b. Teres minor
c. Supraspinatus
d. Teres major

14. Children typically begin walking at what age range? C

a. 14 to 18 months
b. 10 to 16 months
c. 10 to 12 months
d. 12 to 16 months

15. CT Perfusion study can accurately identify the occluded vessel A

causing ischemic infarct
a. True
b. False

16. Medical term for forward slippage of the vertebrae SPONDYLOL

ISTHESIS

17. Skull fractures are usually corticated in appearance on CT B

a. True
b. False

18. Obesity can cause B Secondary osteoarthritis happens when

your cartilage is damaged by another
a. Primary osteoarthritis
disease or medical condition. Things that
b. Secondary osteoarthritis can cause it or make it more likely
c. Both include: Obesity , which puts more stress
d. Neither on your joints, especially your knees.

19. A 12-year old boy had an accident while playing basketball. D

Imaging revealed a fracture in the distal tibia. Which of the
following descriptions has the worst prognosis?
a. Fracture involving the physis and metaphysis; epiphysis
is not involved
b. Increased width of the physis
c. Compression injury of the epiphyseal plate with no
associated epiphyseal or metaphyseal fracture
d. Fracture involving the epiphysis, physis, and metaphysis

20. A 20-year old morbidly obese male with narrowing of the medial B
 compartment of the knees due to secondary osteoarthritis will
most likely present with
a. Stiffness that lasts for hours and improves with activity
b. Genu varum
c. Genu valgum
d. Cellulitis

21. Which of the following inhibits osteoclastic activity A

a. Calcitonin
b. Growth hormone
c. Estrogen
d. Thyroxine

22. Osteomyelitis symptoms include the following EXCEPT B half of patients develop fever >38°C
severe localized back pain and
a. Elevated temperature
progresses to radicular pain, reflex
b. Affectation on the non-weight bearing limb changes, sensory abnormalities, motor
c. Pallor weakness, bowel and bladder
d. Irritability dysfunction, and paralysis.

23. 15% of MCA infarcts are initially hemorrhagic A?

a. True
b. False

24. A 25-year old male was involved in a motorcycle accident and D

sustained an open comminuted fracture. This means that he has
a fracture with
a. Fracture line oblique to the long axis of the bone and a
broken skin
b. Fragments overlapping at the end and a broken skin
c. The distal fragment off-set relative to the proximal
fragment and a broken skin
d. More than 2 fragments and a broken skin

25. What do you call the deformity wherein there’s subluxation of Z-line Hyperextension of the PIP joint with
flexion of the DIP joint (“swan-neck
the 1st metacarpophalangeal joint with hyperextension of the deformity
deformity”),
1st interphalangeal joint?
flexion of the PIP joint with
hyperextension of the DIP joint
(“boutonnière deformity”), and

subluxation of the first MCP joint with

hyperextension of the first
interphalangeal (IP) joint (“Z-line
deformity”) also may result from
damage to the tendons, joint capsule,
and other soft tissues in these small
joints.

Inflammation about the ulnar styloid and

tenosynovitis of the extensor carpi
ulnaris may cause subluxation of the
distal ulna, resulting in a “piano-key
movement” of the ulnar styloid.

26. Mainstay of fracture treatment is fixation and immobilization A?

a. True
b. False
27. Characterized by an initial resistance to passive movement, Spasticity
followed by a sudden release

28. Which of the following data strengthen the diagnosis of B

rheumatoid arthritis in a 48 year old female who has bilateral
symmetrical arthritis of the hands, elbows, and ankles of 4
months duration?
a. Iron-deficiency anemia
b. Subcutaneous nodules
c. ESR <20 mmHg in the 1st hour
d. Morning stiffness of < 30 minutes duration

29. Lupus arthropathy are generally C

a. Asymmetric and non-erosive
b. Asymmetric and erosive
c. Symmetric and non-erosive
d. Symmetric and erosive

30. Angiography should be requested after detecting subarachnoid B?

hemorrhage on CT
a. True
b. False

31. Tested by assessing the degree of resistance when an individual Range of

joint is moved passively Motion

32. Most common joint affected in hand osteoarthritis D distal and proximal interphalangeal
a. 1st CMC joints and the base of the thumb
b. 2nd PIP
c. 2nd CMC
d. 1st DIP

33. The examiner in the image is palpating for the A?

a. Sacroiliac joint
b. Coccyx
c. Posterior superior iliac spine
d. Iliac crest

34. Characterized by constant resistance to passive movement of rigidity

 both extensor and flexor muscles. May be a result of a lesion in
the basal ganglia

35. A disruption in all or part of the cortex of a bone A

36. What is the medical term for osteoarthritis of the spine? spondylo
sis

37. Which of the following describes senile osteoporosis A

a. It is associated with hip fracture
b. It is commonly observed in the female population
c. It has predominantly trabecular bone loss
d. It has reduced parathyroid function

38. Cranial nerve VII has both sensory and motor functions. How do Test the anterior 2/3's of the tongue
you test the sensory function of cranial nerve VII (CN VII) by alternately placing two to
three familiar liquids on each side of
the anterior 2/3's of the tongue

39. Torus fracture is also called buckling fracture and is a type of B incomplete
complete fracture
a. True
b. False

40. The arthropathy in persons with systemic lupus erythematosus B

generally is in the wrists, knees, and small joints of the hands. It
is also
a. Asymmetric and non-erosive
b. Symmetric and non-erosive
c. Symmetric and erosive
d. Asymmetric and erosive

41. Kellgren Lawrence score of doubtful narrowing of joint space B 2: Mild; Definite osteophytes and
and possible osteophytic lipping possible narrowing of joint space
a. 2
3: Moderate; Moderate multiple
b. 1
osteophytes, definite narrowing of
c. 3
joint space, some sclerosis, and
d. 4 possible deformity of bone ends

4: Severe; Large osteophytes,

marked narrowing of joint space,
severe sclerosis, and definite
deformity of bone ends

42. Chronic infarct is a stroke that occurred more than a week B At least 6 months
a. True
b. False

43. Spine involvement in rheumatoid arthritis A

a. Cervical
b. Sacral
c. Thoracic
d. Lumbar
 44. On which specific joint is podagra seen? 1st
metatars
ophalang
eal joint

45. Which of the following best differentiates inflammatory from A

non-inflammatory type of arthritis
a. Presence and duration of morning stiffness
b. Presence of decreased range of motion
c. Pain upon initiation of motion
d. Pain on maximal range of motion

46. Fracture of this structure is mandatory to diagnose le fort B

fractures
a. Nasal bone
b. Pterygoid plates
c. Maxillary bone
d. Zygomatic bone

47. Hyperacute means infarction occurred less than 24 hours A? Within the first 3 hrs
a. True
b. False

48. A lesion in cranial nerve XII will result in C

a. Any of the given choices
b. Impaired gag reflex
c. Deviation of the tongue away from the side of lesion
d. Dysarthria

49. MRI is the most cost effective modality for fracture evaluation in A
trauma
a. True
b. False

A.

1. Common causes of brief dizziness (seconds) include Meniers B Explanation:

diseases while that which lasts for hours include BPPV. BPPV is a common cause of
Vestibular migraine or Meniere’s disease last for hours. recurrent vertigo. Episodes are brief
(<1 min and typically 15–20 s)
a. TRUE
b. FALSE

2. An elderly female was brought for consult because she had a A Explanation: upper motor ata
stroke affecting her right side a 6 years ago. Which among the affected
following findings would you expect on neuro exam?
a. Hyperreflexia and babinski
b. Fasciculations
c. Cogwheel rigidity
d. Muscle hypertrophy

3. Reissers index is used to check for A

a. Skeletal maturity
b. Malignancy
c. Brittle bone
 d. Severity of scoliosis

4. Which of the following data strengthen the diagnosis of D Patients often complain of early morning
joint stiffness lasting more than 1 h that
Rheumatoid arthritis in a 48 year old female who has a bilateral
eases with physical activity.
symmetric arthritis of the hands, elbows and ankles of 4 months
duration? Subcutaneous nodules have been
a. Morning stiffness of <30 minutes duration reported to occur in 30–40% of patients
b. Iron deficiency anemia
c. ESR <20 mmHg in the first hour
d. Subcutaneous nodules

5. Which structure marks the start of lower motor neuron lesions? D

a. Internal capsule
b. Cerebral peduncle
c. Dorsal root ganglion
d. Anterior horn cell

6. NREM sleep is characterized by a low-amplitude, B REM sleep is characterized by a

mixed-frequency, EEG similar to that of REM stage N1 sleep low-amplitude, mixed-frequency
a. TRUE EEG, similar to NREM stage N1
sleep (harrisons)
b. FALSE

7. In dementia, short-term memory is the cognitive function most B Explanation: Episodic memory, the
commonly lost ability to recall events specific in
a. TRUE time and place, is the cognitive
function most commonly lost; 10%
b. FALSE
of persons age >70 years and
20–40% of individuals age >85 years
have clinically identifiable memory
loss

8. 90% of ankylosing spondylitis is associated with which antigen? A

a. HLA-B27
b. HLA-B24
c. HLA-DR4
d. HLA-B57

9. As the rotating intern at the ICU, you noted an elderly male A The two most consistently identified
presenting with a diagnosis of delirium. Which of the following risk factors are older age and
factors is associated with a higher risk of delirium? baseline cognitive dysfunction.
a. Older age
b. Intake of beta blockers
c. Presence of diabetes
d. Presence of depression

10. In the Kellgren-Lawrence Radiographic Grading Scale for B

osteoarthritis of the tibiofemoral joint, in what grade are definite
osteophytes with unimpaired joint space seen?
a. 1
b. 2 DOMS
c. 3
d. 4

11. When do you say that a patient has tactile extinction up double C Patients with tactile extinction are
simultaneous stimulation? aware of being touched on a
a. The patient is able to identify that he is being touched on contralesional limb, but seem
unaware of similar contralesional
both sides with his eyes closed
 b. The patient is able to identify that he is being touched on touch if touched simultaneously on
both sides with his eyes open their ipsilesional limb (wiki lang to
c. The patient is able to identify that he is being touched hirap hanapan source)
only on one side with his eyes closed
d. The patient is able to identify he is being touched only
on one side with his eyes open

12. Complete disruption of a joint refers to: D

a. Compound fracture
b. Subluxation
c. Diastatic fracture
d. Dislocation

13. Where is the origin of the corticospinal tract? D Upper motor neurons have their cell
a. Postcentral sulcus bodies in layer V of the primary
b. Central sulcus motor cortex (the precentral gyrus,
or Brodmann area 4) and in the
c. Postcentral gyrus
premotor and supplemental motor
d. Precentral gyrus
cortex (area 6).

14. A young female complains of progressive weakness over 2 D Myasthenia gravis

weeks duration. She claims that fatigue catches up with her as
the day progresses. She can barely raise her arms to comb her
hair and she notices that her eyelids tend to droop. Where is the
lesion?
a. Spine
b. Brain
c. Muscle
d. Neuromuscular junction

15. Which of the following is due to excess fluid (endolymph) in the C Ménière’s disease is associated with
inner ear; hence the term endolymphatic hydrops? excess endolymph fluid in the inner
a. Vestibular migraine ear; hence the term endolymphatic
hydrops
b. BPPV
c. Meniere's disease
d. Vestibular neuritis

16. Chronic, progressive immune-mediated inflammatory disorder D

that results in ankylosis of the vertebral column and sacroiliac
joints
a. Rheumatoid arthritis
b. Gouty arthritis
c. Septic arthritis
d. Ankylosing spondylitis

17. Which of the ff symptoms best differentiates between E Soft tissue swelling, puffy fingers,
inflammatory from non-inflammatory type of arthritis and pruritus are signs of the early
a. Pain on maximal range of motion inflammatory “edematous” phase
b. Presence and duration of morning stiffness
c. Pain upon initiation of motion
d. All of the given choices are correct
e. Presence of edema

18. A 25-year-old male presents to MMC OPD with medial knee pain. A
He was playing football yesterday when he collided with another
player and was unable to continue playing because of pain in his
 knee. The knee was swollen this morning. He is able to walk but
with pain, and he also has locking sensation when he attempts
to bend his knee. On examination there is medial joint line
tenderness and a positive McMurray. What is the most possible
problem?
a. Medial meniscus injury
b. Medial collateral injury
c. Patellar tendinitis
d. Plica syndrome

19. Which of the ff is the most common cause of cervical spine A Myelopathy from cervical
dysfunction in the elderly leading to upper motor neuron deficit spondylosis is a common cause of
a. Cervical spondylotic myelopathy spastic or spastic-ataxic gait in the
elderly
b. Cervical radiculopathy
c. Cervical scoliosis
d. Cervical strain

20. The steppage gait where the patient must lift the leg up to clear B? Steppage gait is the inability to lift
the foot off the floor is caused by? the foot while walking due to the
a. Foot drop weakness of muscles that cause
dorsiflexion of the ankle joint
b. Proximal muscle weakness
c. Cerebellar ataxia
d. Spasticity

21. This modality can easily detect acute intracranial hemorrhage A Hemorrhage is most easily detected
a. CT with CT, but it can also be visualized
b. X-ray with gradient echo MR-sequences
c. Ultrasound
d. MR

22. Presence of this particular deformity of the hand wherein the PIP A Swan-neck deformity is a bending in
joints are hyperextended and the DIP joints are fixed in flexion is (flexion) of the base of the finger, a
noted in this clinical condition. straightening out (extension) of the
middle joint, and a bending in
a. Rheumatoid arthritis
(flexion) of the outermost joint.
b. Osteoarthritis
The most common cause of
c. Scleroderma swan-neck deformity is rheumatoid
d. Dermatomyositis arthritis. Galing msd gugel

23. A patient complains of pins and needles sensation, while seated A ANESTHESIA
or lying on the bed, without any triggers. What sensory ● Complete absence of skin
disturbance is being described? sensation to the same
stimuli plus pinprick
a. Paresthesia
HYPERESTHESIA
b. Anesthesia
● Pain or increased
c. Hyperesthesia sensitivity in response to
d. Dysesthesia touch
DYSESTHESIAS
● All types of abnormal
sensations, including
painful ones
● Regardless of whether a
stimulus is evident
24. Identify: A subperiosteal hemorrhage that never extends across Cephaloh
the suture line. It can be secondary to traumatic delivery or ematoma
forceps delivery. Hemoglobin should be monitored in these
patients and resolved in 2 to 3 weeks.

25. The arthropathy in patients with Rheumatoid Arthritis generally D Osteoporosis

can be found in the wrists, knees, and small joints of the hands. ● Asymmetric
It is also…
SLE
a. Symmetric and non-erosive
● Non-erosive
b. Asymmetric and erosive
c. Symmetric and erosive
d. Asymmetric and non-erosive

26. A 4 year old patient is brought to the ER after a motor vehicle E4V2M4?
accident. He has spontaneous eye opening, cries to pain,
withdraws to pain. Using the pediatric Glasgow Coma scale, the
patient’s score is (answer using the only the format: E_V_M_)

27. What do you call the deformity wherein there’s subluxation of the Z-line subluxation of the first MCP joint with
hyperextension of the first
first metacarpophalangeal joint with hyperextension of the first deformity
interphalangeal (IP) joint (“Z-line
interphalangeal joint? deformity”) also may result from
damage to the tendons, joint capsule,
and other soft tissues in these small
joints.

28. the posterior fontanelle usually closes at _______ 2-4

months

29. A 79 year old man noted right foot drop after peroneal nerve C
compression. Which of the following is characteristic of lower
motor neuron damage?
a. Hyperreflexia
b. Spasticity
c. Hyporeflexia
d. Increased tone

30. A gait that involves circumduction of one leg? B

a. Cerebellar gait
b. Hemiplegic gait
c. Myopathic gait
d. Sensory ataxic gait

31. Common CT artifact between 2 dense artifacts C

a. T2 shine through
b. Movement artifact
c. Beam hardening
d. Reflective artifact

32. The common adverse effect of Methotrexate in pregnant women A

a. Teratogenic - neural tube defect
b. Gestational diabetes
c. Teratogenic - phocomelia
 d. Induced abortion

33. Non-compressible component involved in pressure-volume C?

relationship in the cranium except
a. Cerebrum
b. Blood
c. Brainstem
d. Meninges
e. CSF

34. A 50 year old male consulted at the ER for personality loss, D Personality change, disinhibition,
disinhibition, and weight gain. What is your primary differential? and weight gain or compulsive
a. Dementia with Lewy bodies eating suggest FTD, not AD
b. Alzheimer’s disease
c. Drug-induced delirium
d. Fronto-temporal dementia

35. Difficulty in initiating to walk is seen in these conditions, A

EXCEPT:
a. Tabes dorsalis
b. Parkinson’s disease
c. Normal pressure hydrocephalus
d. Frontal lobe tumor

36. Which of the following is not included in the description of B

fracture in an x-ray film?
a. Shortening
b. Active bleeding
c. Displacement
d. Angulation

37. This finding is a result of a lesion in the basal ganglia Rigidity

characterized by constant resistance to passive movement of
both extensor and flexor muscles

38. A diabetic patient complains of numbness of both hands and B? Since both hands and feet, tapos sa
feet, where is the probably site of the lesion? thalamus nag tratravel yung
a. Parietal lobe pathway bago pa mag decussate sa
pons and medulla
b. Thalamus
c. Dorsal root
d. Peripheral nerve

39. Which of the following is not a component of Boutonniere A Hyperextension of the PIP joint with
flexion of the DIP joint (“swan-neck
deformity caused by tearing of the extensor hood?
deformity”),
a. Hyperflexion at the MCP joint
b. Flexion at the PIP joint flexion of the PIP joint with
c. Hyperextension of the DIP joint hyperextension of the DIP joint
(“boutonnière deformity”), and
d. Hyperextension at the MCP joint
subluxation of the first MCP joint with
hyperextension of the first
interphalangeal (IP) joint (“Z-line
deformity”) also may result from
damage to the tendons, joint capsule,
and other soft tissues in these small
joints.

Inflammation about the ulnar styloid and

 tenosynovitis of the extensor carpi
ulnaris may cause subluxation of the
distal ulna, resulting in a “piano-key
move- ment” of the ulnar styloid.

40. A 14 year old female came in for low back pain usually noted C Scoliosis ata ito
after prolonged sitting. On physical examination, there was
noted shoulder asymmetry and pelvic obliquity. There was noted
of right rib hump on Adam’s test. What diagnostic examination
will be done to help evaluate the patient’s condition?
a. Plain radiographs of the thoracolumbar spine
b. Single photon emission computer tomography
c. Magnetic resonance imaging of the thoracolumbar
spine
d. Bone scan

41. This type of intracranial hemorrhage is commonly associated D Subarachnoid hemorrhage is

with trauma or spontaneous bleeding from a ruptured commonly associated with trauma
intracranial aneurysm or spontaneous bleeding from an
intracranial aneurysm
a. Subdural
b. Periosteal
c. Intracerebral
d. Subarachnoid
e. Epidural
f. subgaleal

42. What is a positive romberg’s sign A

a. The patient sways much more when the eyes are closed
b. The patient sways as he starts walking following a
straight line
c. The patient sways even when the eyes are open
d. The patient’s arm start to drop after a few moments of
standing feet together and eyes closing

43. Which of the following provides objective evidence of sleepiness D MSLT provides essential, objective
+ REM sleep dysregulation evidence of sleepiness plus REM
a. Electroencephalogram sleep dysregulation.
b. Polysomnography
c. Sleep log
d. Multiple sleep latency test

44. Management of delirium involves addressing the underlying A

factor (ie infection or electrolyte imbalance)
a. True
b. False

45. A type of incomplete fracture D

a. Greenstick fracture
b. Buckling fracture
c. Torus fracture
d. All of the above

46. An elderly man consults due to progressive weakness on both B?

legs and severe muscle cramps. On neuro exam, his
 gastrocnemius muscles are tender. He is able to stand and walk
with assistance, but only for short distances as he tires easily.
Where is the lesion?
a. Brain
b. Nerve
c. Muscle
d. Spine

47. Clarito, a 60 year old male with prostatic hyperplasia, consulted A Incontinence of urine may occur
at the telemedicine for syncope after urination. No other with both seizures and syncope
symptoms such as chest pain were noted. What is the most
Multiple triggers of the afferent limb
likely etiology
of the reflex arc can result in
a. Neurally-mediated
neurally mediated syncope. In some
b. Cardiac situations, these can be clearly
c. Psychogenic defined, e.g., the carotid sinus, the
d. Orthostatic hypotension gastrointestinal tract, or the bladder.

48. A 30 year old female came in to the clinic for confusion, hair A Dry,cool skin,hair loss,and
loss, dry skin, and constipation. Her vitals were unremarkable bradycardia
except for bradycardia. What is your primary differential? ○ Suggest hypothyroidism
a. Thyroid abnormality
b. Vitamin deficient
c. Vascular dementia
d. Drug-induced delirium

49. At what age will a child have similar gait characteristics as that 7
of an adult?

50. A patient experiences severe pain on light application of pin B Severe pain in response to a mildly
prick. What sensory disturbance is being described? noxious stimulus
a. Neuralgia
b. Hyperalgesia
c. Allodynia
d. Causalgia

51. Medical term for osteoarthritis of the spine A

a. Spondylosis
b. Ankylosing spondylitis
c. Spondylolisthesis
d. Spondylolysis

52. Salvageable area surrounding an ischemic event such as C

thrombotic or embolic stroke
a. Edema
b. Glioma
c. Penumbra
d. Penemue

53. A person with severe osteoporosis would present with which of C, D A T-score <–2.5 in the lumbar spine,
the following? (check all that apply or none) femoral neck, or total hip has been
a. T score of -3.0 with associated back pain defined as osteoporosis.
b. Presence of dowager’s hump
c. T score of -2.5 with L1 compression deformity
d. Decreased weight and height
54. A hitchhiker thumb is more common in C
a. Osteoarthritis
b. Gout
c. Rheumatoid arthritis
d. Ankylosing spondylitis

55. A 64 year old female was brought to your clinic because of gait A In ataxia from dorsal column
problem. During the examination, you noticed that she is able to disease and loss of position sense,
stand upright with both feet together but unable to do so with vision compensates for the sensory
loss. The patient stands fairly well
eyes closed. Which of the following statements is true for this
with eyes open but loses balance
case?
when they are closed, a positive
Romberg sign

56. Heberden nodes are found at the D

57. When the examiner asks patient to walk normally, the main B
purpose of this is to:
58. anti-CCP in RA indicates … D?
C?

59. A 58/F consulted at the rehab clinic because of progressive B Few minutes stiffness upon
bilateral hand pain of 6 months duration, usually after prolonged awakening
activity such as food preparation and cooking. There is also
stiffness of the fingers upon awakening lasting for a few
minutes. On physical examination, there were no swelling,
erythema nor tenderness over the hand and wrist joints. There
was no atrophy observed in both hands. There were deformities
over the finger joints on both hands. There was a good grip
bilaterally. What is the most likely diagnosis.

60. Which of the following is the most common cause of syncope D

61. The first line option for the pharmacologic treatment of A

osteoporosis

62. A 50 year old male diagnosed with osteoarthritis came to the C

clinic complaining of a node at the PIP joint. What should you
do?
63. A young female consults for pain on her right wrist. She D
complains of weak grip and numbness of the first 3 digits. There
is severe pain also when bending at the wrist. Which of the
following likely involves the localization of her symptoms

64. Which of the following underlies the pathophysiology of B A decrease in cardiac output and/or
syncope? systemic vascular resistance—the
determinants of blood
pressure—thus underlies the
pathophysiology of syncope. (HPIM)

65. Upright posture results in increased venous return to the heart B

and reduced ventricular filling that result in diminished cardiac
output and blood pressure
a. True
b. False

A
66. Which of the following is a reflex found in normal infants, but
may indicate an upper motor neuron lesion in an adult?

67. A 50 year old man presented with weakness. He said that he A? For planning, initiating and directing
noticed trouble climbing stairs the previous year, but this voluntary movements
progressed to him having trouble standing up from a chair and
lifting heavy objects over his head. Where is the likely lesion?
68. A 45/M alcoholic came for pain on the foot. He noted sudden D
onset of the pain of 5 days duration after he had attended his
boss’ cocktail party. Pain was severe, especially at the medial
foot causing difficulty to step on it. On PE, there was warmth,
erythema, and tenderness at the forefoot, particularly at the area
of the big toe and the MTP. what is the most likely diagnosis

69. Which of the following usually causes and is associated with B

drunkenness?

70. A fracture is said to be comminuted if A

71. Which of the following maneuvers assesses the anterolateral D

system?

72. During this phase, sleep is most intense and prominent during D
 childhood, decreasing with puberty and across the second and
third decades of life/
a. N1
b. N4
c. N2
d. N3

73. Peripheral lesions causing vertigo typically cause unidirectional A

horizontal nystagmus
a. True
b. False

74. Acetylcholine inhibitors such as donepezil, rivastigmine, A

galantamine are used to treat alzheimer’s disease
a. True
b. False

75. Reisser’s index is used to check for C

76. Most common joint affected in hand osteoarthritis C

77. Which of the following is the most useful bedside test to assess B The most useful bedside test of
peripheral vestibular function peripheral vestibular function is the
head impulse test, in which the
vestibulo ocular reflex (VOR) is
assessed with small-amplitude (~20
degrees) rapid head rotations.

78. Goals of cranial imaging, EXCEPT E? Exclude hemorrhage/tumors

● Differentiate between irreversibly
affected brain tissue and
reversibly impaired tissue (dead
tissue versus tissue at risk)
 ● Identify stenosis or occlusion of
major extra and intracranial
arteries
● In this way we can select patients
who are candidates for
thrombolytic therapy.

79. Which of the following is somehow similar to the gait of a blind A Sensory Ataxia (SA) is a form of
Ataxia caused by the impairment of
the somatosensory nerve, leading to
the interruption of sensory feedback
signals. It is characterized by
postural instability and
incoordination that diminish due to
visual input contributing to
functional deficits and gait
impairments.

patient?

80. An intern assisted in aspiration of the knee of a 55 year old male B Rhomboid = pseudogout
with acute arthritis of 2 days duration. Patient has been having
similar episodes involving his big toe and ankles in the past.
Which of the following synovial fluid test will be helpful in
clinching the diagnosis?

81. The particular shape of this intracranial hemorrhage is limited by E

the dura mater that is strongly adherent to the skull in the region
of the sutures
82. Which of the following causes of dementia is properly matched A
with its course?

83. Lillian, a geriatric patient consulted for occasional dizziness. C

How will you diagnose orthostatic hypotension?

84. The midline is assumed to be coplanar with ________, and is best D

represented as a line drawn between the anterior and posterior
attachments of the falx to the inner table of the skull

Xray

Densitometry

CT scan

MRI

MRI
85.

86. Ideally, hydroxychloroquine treatment should have baseline B

87. General category of syncope, except: E The causes of syncope can be
divided into three general
categories: (1) neurally mediated
syncope (also called reflex or
vasovagal syncope), (2) orthostatic
hypotension, and (3) cardiac
syncope.

88. Narcolepsy results from the loss of the hypothalamic neurons A

that produce the orexin neuropeptides also known as
hypocretins
a. True
b. false

89. Abnormal separation of a joint that is slightly or non-movable: B

90. An upper motor neuron lesion would likely produce which of the B
following changes in the muscle tone?

91. Paresis or paralysis can be seen in the lesions of the following , C? Pang sensory
EXCEPT
92. Which of the following is the hallmark of delirium? A

93. Pressure-volume relationship that aims to keep a dynamic B

equilibrium among the essential non-compressible components
inside the rigid compartment of the skull

94. A patient complains of feeling “extra cold” whenever she B

showers with cold water. What is the sensory disturbance is
being described?

95. Although the timing, duration, and internal structure of sleep vary A Adults need at least 7 h of sleep per
among individuals, adults need at least 7 h of sleep per night to night to promote optimal health,
promote optimal health although the timing, duration, and
internal structure of sleep vary
a. True
among individuals.
b. False

96. The particular shape of this intracranial hemorrhage is due to D?

fragile cerebral vessels that predisposed to bleeding in elderly
and those on thrombolytic therapy
 97. Most common foot joint affected in gout B

98. Suvorexant (orexin receptor antagonist) is a medication which A The orexin receptor antagonists
can be used for insomnia suvorexant (10–20 mg) and
a. True lemborexant (5–10 mg) can also
improve insomnia by blocking the
b. fal
wake-promoting effects of the
orexin neuropeptides

Quizzes compilation

1. What is the very 1st part of the patient history? C

2. You may ask a relative/ companion if patient seems unsure of A

his answer
a. True
b. false

3. In a patient presenting with hypertensive urgency, his history of A

hypertension and diabetes should be best included in which part
of his medical record?
a. History of present illness
b. Past medical history
c. Family medical history
d. General data

4. Physical examination is part of the adult and paediatric medical A Pero pwede din false
 history
a. True
b. False

5. If things are unclear to you, you may repeatedly ask the patient A
until it becomes clear
a. True
b. False

6. In which part of the history do you include the intake of C

paracetamol in a patient presenting with fever?

7. Which of the following is the LEAST important to ask if a patient C

mentions a medication?

8. Which of the following is part of a patient’s genogram? C

a. Relatives living with the patient
b. Medical history of a grandchild
c. Both
d. Neither

9. Asking what brand of alcoholic beverage is an important B Only the type of alcohol
question to ask
a. True
b. False
c. Only if you want to drink with the patient
d. Only if you’re curious

10. Which of the following DOES NOT typically accompany fever? A

a. Myalgia
b. Headache
c. Malaise
d. Shivering
 Correct WHO classification
nasa pic

11.

12. The dorsalis pedis pulse is palpated in which part of the body B

13. Which of the following is the least accurate in the measurement B

of body temperature

14. What do you call the slight tapping sounds produced by blood Korotkoff
escaping the occluding pressure of a sphygmomanometer cuff? sound

15. The sensitivity of a thorough history and physical examination in B

detecting serious illness in a child is approximately
a. 99%
b. 90%
c. 8-%
d. 75%

16. To mount a fever, _______ attaches to hypothalamic receptors to B

determine the new temperature set point
a. Viral RNA
b. Prostaglandin E2
c. IGF-1
d. IFN-a

17. A 2 year old with a chief complaint of colds is alert, playful, and C?
has no significant abnormal PE findings. It is the 2nd day of
fever
18. Which of the following is a self-limiting infection A

19. A patient with a digital aural temperature of 38 C and up (100.4 F

and up) is experiencing which symptom

20. Which fever pattern varies by 1-2 C or more during the day (24 C
hours), but doesn’t lyse to normal range?

21. Fever with temperatures < 39 C in healthy children B

 A

22. This rash is

a. Maculopapular
b. Vesicular
c. Pustular
d. Not a rash

23. This rash is B

a. Maculopapular
b. Vesicular
c. Pustular
d. Not a rash

24. This rash is C

a. Maculopapular
b. Vesicular
c. Pustular
d. Not a rash

25. 2 weeks prior to consult, a 6 year old female had a low grade A
fever and on and off mild, vague, abdominal pain. The
 pediatrician prescribed paracetamol, and soft diet. 1 week prior
to consult, fever lysed, but patient now had joint pain over both
ankles. 3 days prior to consult, joint pain over both knees
started, and a rash with non-blanching macules and papules
over the curve of both elbows, both buttocks, thighs, calves, and
feet developed, hence follow-up. The most likely cause of the
fever is -

26. A 12 year old with atopic dermatitis since he was 2 years old is B
non-compliant with the prescribed medications. If he just
scratches at the affected areas of his skin all the time, instead of
applying ointments, he might develop

27. What is the etiologic agent of MIS-C? B

28. Basic steps of PE of the chest A

29. Grading of intensity of murmur in grave V D

30. The lowest and outermost part of the cardiac impulse is usually A
located at

40. The 3C’s - coryza, cough, & conjunctivitis - are seen in which measles
childhood febrile viral exanthem?

41. Abnormal breathing pattern with cessation of breathing Cheyne-s

stokes

42. An abnormal disorder of the respiratory depth with an increase of Hyperven

respiratory rate and depth tilation

43. Pathologic respiration characterized as gasping and laboured Kussmaul

respiration usually seen in diabetic ketoacidosis or other states breathing
of respiratory acidosis

44. During palpation, this is felt as coarse, cracking sensation as the Tactile
examiner presses over the affected area; escape of air from the fremitus
lungs.

45. The meaning of PMI when used in reporting cardio PE Point of

maximal
impulse

46. Clinical condition that manifests with chest findings when the Dextrocar
apex beat is displaced to the right dia

47. The ‘purring’ vibratory sensation felt by the palm over the Thrills
pericardium; they are palpable equivalent of murmur

48. The pulse palpated on the inner aspect of the wrist, just below Radial
the thumb pulse

49. This condition would result in an increased tactile fremitus B Fremitus is decreased or absent
when the voice is higher pitched or
soft or when the transmission of
vibrations from the larynx to the
surface of the chest is impeded by a
thick chest wall, an obstructed
bronchus, COPD, or pleural changes
from effusion, fibrosis, air
(pneumothorax), or an infiltrating
tumor.

50. Which is correct about normal breath sounds heard over most of A
both lungs?
51. True regarding anatomic landmark of the chest D?

52. When testing for respiratory expansion, the hands of the A Test chest expansion. Place your
examiner should be at what level of the rib? thumbs at about the level of the
10th ribs, with your fingers loosely
grasping and parallel to the lateral
rib cage

53. Match the following adventitious breath sounds

a. Loud bubbly noise heard during inspiration; not cleared
by cough
b. Musical noise sounding like a squeak; usually louder
during expiration
c. Dry, grating sound usually caused by inflammation of
pleura; loudest over lower lateral anterior surface
d. Loud, low, course sounds like a snore most often heard
continuously during inspiration or expiration; coughing
may clear sound
e. High-pitched, discrete, discontinuous crackling sound at
the end of inspiration

54. A 56 year old male, known COPD, has a marked increase in B

antero-posterior diameter of the chest wall. What is the
deformity called.
55. The proper sequence of the pulmonary examination is C

56. A palpable impulse that lifts an examiner’s hand D Heaves and lifts are sustained
impulses that rhythmically lift your
fingers, usually produced by an
enlarged right or left ventricle or
atrium and occasionally by
ventricular aneurysms.

57. This is the most reliable landmark in the anterior chest A?

58. What Is true regarding diaphragmatic excursion B

An abnormally high level suggests a

pleural effusion or an elevated
hemidi- aphragm from atelectasis or
phrenic nerve paralysis - bates

59. Which of the following is a normal heart sound? B?

60. Characteristic of S1 - High pitch
-

61. Which of the following is the technique to best appreciate a

carotid bruit?
C

C
1. These are high pitched grating sounds heard over the diaphragm
and spleen using the diaphragm of the stethoscope which may
indicate inflammation of the peritoneal surface
a. friction rub
b. succussion splash
c. borborygmi
d. venous hum
 e. bruit

2. What is the name of the exact area where renal tenderness is Costovert
assessed? ebral
angle

3. Which of the following is true regarding the borders of the

abdomen?
a. It is limited by the pubis and symphysis pubis inferiorly.
b. It is limited by the iliac crests superiorly.
c. It is limited by the ASIS inferiorly.
d. It is limited by the costal margins and xiphoid process
superiorly

4. A distended urinary bladder can become palpable when it Symphysi

reaches beyond which abdominal landmark? s pubis

5. What is the correct sequence in doing the abdominal IAPP Inspection → auscultation →
examination? percussion → palpation

6. What is the specific name of the maneuver shown in the image? Bimanual
palpation
of liver?

7. Pain induced or increased by quick withdrawal of examining Tenderne

hand is called ss

8. The following are physical examinations for ascites, EXCEPT A For gallbladder inflammation
 a. Murphy sign
b. Fluid wave
c. Puddle sign
d. All given options are correct.
e. Shifting dullness

9. Abdominal pain on raising the patient's right thigh against Obturator

resistance is called. sign
(cope
sign)

10. Flexing the patient's right thigh at the hip with the knee bent and Psoas
rotating the leg internally at the hip is called sign

11. KC, 32/F, was brought in to the ER because of generalized body

weakness, with 1-year history of repetitive binge-eating and
vomiting, later with anorexia. Her height is 170 cm, while her
weight is 40 kg. Using Tannhauser’s equation, what is the current
state of nutrition of the patient?

12. KC, 32/F, was brought in to the ER because of generalized body

weakness, with 1-year history of repetitive binge-eating and
vomiting, later with anorexia. Her height is 170 cm, while her
weight is 40 kg. Using Tannhauser’s equation, what is her ideal
body weight?

13. A 50-year-old male came to the clinic to have his BP checked.

You took the BP from the right arm and it read 120/80 mmHg.
The patient asked you the interpretation of his BP reading.
According to the JNC 7, the patient has __________?

14. AD, 36/F, came to your wellness clinic for consult. She claims to
be on intermittent fasting for 4 months. Her previous weight was
at 80 kg, while her height is at 60 cm. The circumference
between her rib cage and iliac crest measures 34 inches, while
the widest part of her buttocks measures 40 inches. What is her
waist-hip ratio?

15. A BMI of 23 in a 26 - year - old Filipino is best classified

according to the Asia Pacific classifications as?

16. Which of the following statements is TRUE about BP

measurement?
a. BP can be measured in an arm with arteriovenous
fistula.
b. If the cuff is too small, the blood pressure will read low
in a large arm.
c. Instruct the patient to avoid smoking or drinking coffee
for ~ 30 minutes before measuring blood pressure.
d. If the brachial artery is 7-8 cm below the heart level, the
blood pressure will read ~ 5 cm lower.

17. Tympanic membrane temperatures are approximately higher

than oral temperature by how many degrees?
a. 1.5 degree Celsius
b. 0.4 degree Celsius
 c. 0.8 degree Celsius
d. 2.0 degree Celsius

18. Clinically palpable pulses include the following EXCEPT? B

a. Anterior tibial
b. Brachial
c. Popliteal
d. Dorsalis pedis

19. The following are components of the general survey EXCEPT A

a. Anamnesis
b. Level of consciousness
c. Grooming and personal hygiene
d. Posture, gait, and motor activity

20. The Body Mass Index (BMI) is represented by what unit? C

a. lb/(ft)2
b. kg/(ft)2
c. kg/(m)2
d. lb/(m)2

21. In patients taking antihypertensive medications or patients with

a history of fainting or postural dizziness, BP is taken in the
supine, sitting, and standing positions to detect which of the
following situations?
a. Postprandial hypotension
b. Orthostatic hypertension
c. Postprandial hypertension
d. Orthostatic hypotension

22. Estimating the systolic pressure by palpation prior to

auscultation prevents inaccuracies due to which of the following
phenomenon?
a. Auscultatory dip
b. Auscultatory gap
c. Palpatory gap
d. Palpatory dip

23. The following are situations wherein a patient’s arm should not
be selected for BP measurement EXCEPT:
a. Presence of scarring from prior brachial artery cutdowns
b. Presence of focal weakness
c. Presence of an arteriovenous fistula for dialysis
d. Presence of lymphedema

24. Fatigue, Malaise, Fever, Weakness and Weight Changes are also
known as which of the following?
a. Convention symptoms
b. Conditional symptoms
c. Constitutional symptoms
d. Configurational symptoms

25. Which of the following is described as markedly increased

respiratory rate?
a. Tachypnea
 b. Tachyphylaxis
c. Tachycardia
d. Tachyarrhythmia

26. Korotkoff sounds heard during BP measurement may never

disappear in which condition?
a. Right sided heart failure
b. Subclavian Steal Syndrome
c. Aortic Regurgitation
d. Dilated Cardiomyopathy

27. Taste in the anterior 2/3 of the tongue tests for which CN?

28. Asking a patient to repeat three items the examiner just

mentioned checks for the patient's...
a. attention.
b. registration.
c. intermediate memory.
d. short-term memory.

29. Which of the following is a phrase used to test abstract C

reasoning?
a. If a stone quits rolling, moss will grow on it.
b. Work hard, play hard.
c. Any of the 3.
d. People in glass houses shouldn't throw stones.

30. Facial sensation tests for which CN?

31. Patient is unable to actively or passively flex his neck without

pain. This is called

32. Upon stroking the bottom of the foot, the big toe plantar flexes, B Common in babies yung babinski
this is. Trousseau’s sign = characterized by
a. Normal Plantar Reflex the appearance of a carpopedal
spasm which involves flexion of the
b. Babinski Sign
wrist, thumb, and MCP joints along
c. Trousseau's sign
with hyperextension of the IP joints
d. Hoffman sign
Hoffman sign = If your thumb or
forefinger move after the doctor's
flick
33. A Babinski sign plus spastic paralysis indicates a possible.. D
a. Ipsilateral Peripheral Nerve Lesion
b. ipsilateral Corticospinal Tract Lesion
c. Contralateral Peripheral Nerve Lesion
d. Contralateral Corticospinal Tract Lesion

34. Patient, with his eyes closed, is asked to identify the site where a
wisp of cotton is lightly brushed. This is called...

35. Which of the following materials is used to test the dorsal

columns?
a. pin
b. warm and cold water in test tubes
c. cotton wisp
d. 256 Hz tuning fork
e. 512 Hz tuning fork
f. no material needed

36. Involuntary eye movements, which may cause vertigo, are Nystagm
called.. us

37. Weber and Rinne tests for which CN?

38. Ability of the patient to recognize, with eyes closed, letters or Graphest
numbers drawn on the palm of the hand. hesia

39. Check which of the following CNs can usually be tested together
a. XI
b. I
c. III
d. IX
e. XII
f. VI
g. VII
h. VIII
i. IV

40. Asking the patient to look to the right tests for which CN of the Abducens
right eye?

41. Asking a patient about self, place, and time tests for B
a. Memory
b. Orientation
c. Function
d. Awareness

42. A patient with dementia usually

a. confabulates answers.
b. gives concrete answers.
c. has abstract thoughts.
d. has disarrayed thoughts

43. Asking the patient to shrug his shoulders tests for which CN? Spinal
 accessor
y nerve

Finals

1. On echocardiogram, what does hypokinesis of the inferior and

inferoseptal segments of the left ventricle mean?
a. Obstruction of the Left Anterior Descending Artery
b. Obstruction of the Left Main Coronary Artery
c. Obstruction of the Right Coronary Artery
d. Obstruction of the Left Circumflex Artery

2. Humming vibrations A
a. Thrill
b. Contour
c. Bruits
d. Amplitude

3. In a healthy child who is 5 years old and above, a temperature

between 37.8 and 39C
a. High risk for increased cardiac workload, Rx: antipyretic
b. Must be treated with an antipyretic to prevent febrile
seizure
c. Not a fever, no need to threat
d. Is permissible as an adaptive response, no need to treat

4. If a patient has an active medical, surgical, or psychiatric B

problem which has an impact on the present problem, in which
part of the medical history should this be initially included?
a. Review of systems
b. Chief complaint
c. Past medical history
d. History of Present illness

5. Which of the following is TRUE regarding acute anemia due to D?

blood loss?
a. Vascular instability ensues with blood volume loss of 5%
b. 02 delivery is decreased brought by Bohr effect
c. Hematocrit and hemoglobin reflects the volume of blood
lost
d. Hypovolemia dominates the clinical picture

6. ECG tracing characterized by atrio ventricular dissociation B Complete heart block (third-degree
a. 2nd degree AV block type 2 block) involves complete AV
b. 3rd degree AV block dissociation with a ventricular rate
that is slower than the atrial rate
c. 1st degree AV block
1st degree = prolonged PR intervals
d. 2nd degree AV block type 1
2nd degree
● Type I
○ PR intervals gets
progressively
longer then drops
● Type II
○ If the PR interval
is <160 ms prior
to the AV
 conduction and
QRS is wider than
normal, infranodal
(type II) block is
most likely.

7. A positive Stork test indicates B

a. Scoliosis
b. Sacroiliac joint restriction
c. True leg length inequality
d. Kyphosis

8. Generates impulse at 60-100 bpm A

a. SA node
b. AV node
c. Purkinje fibers
d. Bundle of His

9. What is the most frequent cause of primary immunodeficiency

a. Complement deficiency
b. B lymphocyte deficiency
c. T lymphocyte deficiency
d. Phagocyte deficiency

10. Painful and has short stance phase of gait B? The antalgic gait results from
a. Waddling avoidance of pain associated with
b. Antalgic weight bearing and is commonly
seen in osteoarthritis.
c. Trendelenburg
d. Steppage

11. This refers to an occluded artery or direct visualization of a A

thromboembolic artery
a. Dense MCA sign
b. Tram track sign
c. Dural tail sign
d. Insular ribbon sign

12. Festinating D
a. Cautious gait
b. Hemiplegic gait
c. Cerebellar gait ataxia
d. Parkinson’s
e. Frontal gait disorder

13. A 30-year old female complains of tiredness, weakness, hair B?

loss, and menorrhagia. Pregnancy test is negative. On PE, there
is a suspicious albeit small anterior neck mass that moves with
deglutition. There were no palpable nodules. If the patient has
limited funds, which of the following tests is the first one that
you are going to request?
a. FT3
b. TSH
c. FT4
d. RAIU
e. Thyroid Ultrasound
14. Ability of the cardiac muscle to shorten when given a load A
a. Myocardial contractility
b. Afterload
c. Volume overload
d. Preload

15. A patient presents with signs of hypothyroidism. To investigate A May positive feedback so mag
the matter, you measure the levels of T4 and TSH. If the patient sesend ng signal sa pituitary na mag
suffers from iodine deficiency, you can expect the following release ng TSH para ma stimulate
yung production ng T4?
results
a. T4 reduced, TSH elevated
b. T4 elevated, TSH elevated
c. T4 elevated, TSH reduced
d. T4 reduced, TSH reduced

16. Thyroid disorders are often mistaken for this condition C?

a. Crohn’s disease
b. Posttraumatic stress disease
c. Pregnancy
d. Menopause

17. The ff are clinical signs of fractures: EXCEPT

a. Impaired neurovascular status
b. Guarding the site
c. Edema
d. Proximal limb weakness

18. Which of the ff is a measure of biosynthetic function of the liver? A

a. Albumin
b. ALT
c. AST
d. ALP

19. This is usually present in diastolic dysfunction

a. S4 gallop
b. Mitral regurgitation
c. S3 gallop
d. Elevation of JVP

20. Patients with chronic bilateral ureteral obstruction will produce B

all of the following clinical features, EXCEPT
a. Azotemia
b. Polyuria
c. Pain
d. Elevated Blood Pressure

21. Which of the ff will produce volume overload in the left ventricle D
a. Mitral regurgitation
b. Pulmonic stenosis
c. Hyperthyroidism
d. Aortic stenosis
22. What is the most freqwuent symptom of pulmonary embolism A
a. Dyspnea
b. Cyanosis
c. Tachypnea
d. Pleuritic pain

23. Most common primary headache C

a. Idiopathic
b. Cluster
c. Tension-type
d. Vascular
e. Migraine

24. For men with cystitis, what is the gold standard to diagnose UTI? B
a. CT urogram
b. Urine culture
c. Urine dipstick
d. Urinalysis

25. Which of the ff findings suggest a non-glomerular cause of B Wtf is initiation hematuria
gross hematuria?
a. Brown, cola-colored urine
b. Initiation hematuria
c. Dysmorphic hematuria
d. RBC casts

26. Which of the ff statements regarding spider angiomata is/are D

correct?
a. Hard to detect in dark-skinned individuals
b. Only seen in the arms, face and upper torso
c. Typically fill from the center outwards
d. All of the above

27. Stiffness of the legs, imbalance of the muscle tone, and a E Basta circumduct = hemiplegic
tendency to circumduct and scuff the feet.
a. Frontal gait disorder Cautious
Walks with an abbreviated stride,
b. Cautious gait
widened base, and lowered center of
c. Cerebellar gait ataxia
mass, as if walking on a slippery
d. Parkinson’s surface
e. Hemiplegic gait
Cerebellar
wide base of support, lateral
instability of the trunk, erratic foot
placement, and decompensation of
balance when attempting to walk on
a narrow base

Parkinson’s
Stooped posture, shuffling gait, and
decreased arm swing
Patients sometimes accelerate
(festinate) with walking, display
retropulsion, or exhibit a tendency to
turn en bloc. May also have freezing
gait
 Frontal gait
Typical features include a wide base
of support, a short stride, shuffling
along the floor, and difficulty with
starts and turns.
Exhibit a difficulty with gait initiation
that is descriptively characterized as
the “slipping clutch” syndrome or
gait ignition failure

28. Greatly exaggerated pain sensation to innocuous or mild A

nociceptive stimuli
a. Allodynia
b. Hyperpathia
c. Desensitization
d. Radiation

29. According to the 20th edition of Harrison’s Principles of Internal

medicine, diarrhea lasting for 2-4 weeks is commonly due to
a. Campylobacter
b. C. difficile
c. E. histolytica
d. Giardia

30. A 55-year old lawyer crashes his bicycle during a sprint for the B Pneumothorax = unilateral
city limits sign. He fractured his right clavicle in the fall. Four hyperresonance
days later, while in his clavicle strap and an arm sling, he notes
Tracheal deviation = baka pag
that his right hand is extremely swollen, which if thinsk is
chronic lang? IDK acute ata yung kay
probably normal. The next day he suddenly becomes very short
patient since “next day”
of breath and has his wife take him to the Emergency
Department. While performing your respiratory examination, Pleural friction rub = inflammation
which of the ff are you most likely to find? nung pleura
a. Tracheal deviation
b. Unilateral hyperresonance on chest percussion
c. Pleural friction rub
d. Crackles over the right mid-axillary line

31. Using pivotal points, create a patient-specific differential B

diagnosis to narrow the list. Extracting pivotal points from the
history and physical examination will
a. Consider all common causes of the disease
b. Limit a large differential to a focused set of differentials
c. Identify the most serious diagnosis first
d. Focus more on the pertinent positives

32. PG, 15/M, went to the school clinic for annual PE. his current D Hamwi method
height is 5’2’’. What is his ideal weight M = 106 lb for the first 5 ft
a. 106 Add 6 lb for each additional inch
b. 118
c. 110
d. 112

33. The most common reason for patient to visit the emergency D? Chest discomfort is among the
department (HPIM 20th edition) most common reasons for which
a. Gastrointestinal causes patients present for medical
 b. Pleuritis attention at either an emergency
c. Ischemic heart disease department (ED) or an outpatient
d. Chest wall syndrome clinic.

34. Incomplete development of teeth, bones, and ligaments is the A

result of
a. Osteogenesis imperfecta
b. Congenital hip dysplasia
c. Hypopituitarism
d. Duchenne’s

Facebook docs : ))))

35. Which of the following statement is CORRECT regarding acne? D?

a. Severity of acne in persons developing the disease is
related to the severity of acne in their parents
b. Carbohydrate rich foods causing acne has no scientific
basis and is therefore a myth
c. Closed comedones are noninflammatory acne lesions
and are usually symptomatic
d. Pustules are common in inflammatory acne

36. Patient came in due to elevated blood sugar of 500 mg/dL with C? Since may acidosis si patient, tapos
slightly elevated creatinine and ketones of ____. ABG result mababa yung HCO3 so metabolic
showed pH of 7 and HCO3 of 8 meq/L. What would be the most acidosis diba thus magkakaroon ng
kussmaul breathing (Deep rapid
prominent physical finding of this patient?
labored breathing)
a. Loss of consciousness
b. Non, since most of this conditions are asymptomatic
and diagnosed only by laboratory exams
c. Deep rapid labored breathing
d. vomiting

37. The following are findings suggestive of appendicitis on CT, B should be greater than 6
except
a. Wall thickening and enhancement
b. Lumen of < 6 cm in diameter
c. Periappendiceal fat stranding
d. Periappendiceal fluid collection or abscess formation

38. Which of the following is true about bilirubins D

a. The unconjugated bilirubin is soluble in water and is
bound to albumin in the blood
b. Bilirubin is found in the blood in 3 fractions - conjugated,
unconjugated, and indirect
c. The direct bilirubin is lipid-soluble and is excreted by the
kidney
d. Presence of bilirubin in the urine signifies liver disease
39. The minimum duration of disease that is necessary in order to D
classify patients as having chronic liver disease
a. 12 months
b. 1 month
c. 3 monts
d. 6 months

40. A 60 year old female was brought to the emergency room due to C
dizziness. The following findings point to a cerebellar
dysfunction, EXCEPT
a. A wide-based gait
b. Truncal ataxia
c. A patient, who is standing with feet together, sways
while eyes are closed but doesn’t sway when eyes are C ata kasi puwedeng absent?
open
d. Dysdiadochokinesia
e. Tremors that increase in intensity as the patient’s finger
approaches the examiner’s fingers
Sabi ni marcial

E yung test para sa D

41. Volume of blood ejected from ventricle in 1 minute A

a. Cardiac output
b. Afterload
c. Preload
d. Stroke volume

42. What does the Sister Mary Joseph’s nodule signify? C Occasionally, one can palpate
a. Melanocytic nevi subcutaneous metastases in the
b. Foreign body granuloma periumbilical area referred to as a
Sister Mary Joseph’s node - Harrison
c. Umbilical metastasis
d. Primary malignant tumor of the umbilicus

43. A 20 year old complains of a solitary hypopigmented flat lesion D

on the leg which measures greater than 10 mm, this primary
lesion is most probably a
a. Plaque
b. Macule
c. Papule
d. Patch
44. Which of the following is not true for Hashimoto thyroiditis? A? Emergency surgery is generally safe
a. Surgery is required in almost all cases in patients with untreated
b. It is an autoimmune disease caused by CF4 cells hypothyroidism, although routine
surgery in a hypothyroid patient
specificity with to thyroid antigens
should be deferred until
c. Hashimoto thyroiditis can progress to lymphoma of
euthyroidism is achieved - Harrison
thyroid
d. Commonly presents as hypothyroidism

Gugel (so parang A nga)

Hindi ata D
● Iodine deficiency remains a
common cause of
hypothyroidism worldwide. In
areas of iodine sufficiency,
autoimmune disease
(Hashimoto’s thyroiditis) and
iatrogenic causes (treatment of
hyperthyroidism) are most
common
● De alam ko form talaga ng
hypothy ang hashimoto’s so not
D

45. This radiographic sign when seen on a plain upright abdominal E Bird beak - Achalasia
radiograph may suggest small bowel obstruction Coffee Bean - Sigmoid volvulus -
a. Bird beak sign large bowel
RIgler - supine
b. Coffee bean sign
Step ladder
c. Rigler sign
d. Foot ball sign
e. Step ladder sign

46. What is the nephrotic range proteinuria? B Proteinuria > 3.5 g/day (trans)
a. 2000 mg.day
b. 3500 mg/day
c. 500 mg/day
d. 1000 mg/day

47. Which pattern of intracranial hemorrhage likely suggests a A Subarachnoid hemorrhage is

ruptured aneurysm commonly associated with trauma
a. Subarachnoid hemorrhage or
spontaneous bleeding from an
b. Subdural hematoma
intracranial aneurysm (trans)
c. Epidural hematoma
d. Intraparenchymal hemorrhage

48. A patient complains of shortness of breath for the past few D COPD - obstructive
days. On examination, you wrote late inspiratory crackles in the Asthma obstructive
lower 3rd of the chest that were not present a week ago. What is Bronchiectasis - obstructive
the most likely explanation for these?
a. COPD
b. Asthma
c. Bronchiectasis
d. Heart failure
49. A 55 year old male came into the ER due to drooling of saliva. D
Upon examination, patient has flattened left nasolabial folds and
is unable to whistle. Patient is also unable to wrinkle his
forehead, close his eye, raise his eyebrow and puff his cheeks on
the left side. Where is the lesion?
a. Right cerebral hemisphere
b. Right facial nerve
c. Left cerebral hemisphere
d. Left facial nerve
e. Any of the above
f. None of the above

50. A 57 year old weak looking male was brought to the Emergency D? Signs and Symptoms
room due to difficulty of breathing. Vital signs were BP of Sudden onset of chest pain - sharp
110/70, HR was 105, RR was 30, O2 sat was 95%. Chest C? pain worse on inspiration[6]
Dyspnoea - shortness of breath
expansion was asymmetrical. Patient had absent tactile
Tachycardia - increased heart rate
fremitus, dullness, and absent breath sounds on the right lower
Tachypnoea - increased respiration
lung field. Which of the following conditions should be rate
considered? Dry cough
a. Consolidation Fatigue
b. Emphysema Signs of respiratory distress -nasal
c. Atelectasis with plugged bronchi flaring, anxiety, use of accessory
d. pneumothorax muscles
Hypotension
Subcutaneous emphysema

On examination of the chest with a

stethoscope, it will be noted that
there is either decreased or absent
breath sounds over the area of the
affected lung, which may indicate
that the lung is not inflated in that
particular area

51. A 63/F consulted at your clinic because of progressive bilateral C? Since walang inflammation sa
hand pain of 6 months duration, usually after prolonged activity kamay and wrist joints?
such as food preparation and cooking. There is also stiffness of
Wala ring fever so di septic?
the fingers upon awakening lasting for a few minutes. On
physical examination, there were no swelling, erythema nor
tenderness over the hand and wrist joints. There was no atrophy
observed in both hands. There were deformities over the finger
joints on both hands. There was good grip bilaterally
 a. Osteoarthritis
b. Septic arthritis
c. Polymyositis
d. Gouty arthritis

52. All of the following are risk factors for type 2 diabetes mellitus, C
EXCEPT
a. BMI above 25 kg/m2
b. Hemoglobin A1C 5.7-6.4%
c. Delivery of a baby more than 3.5 kg
d. HDL level below 35 mg/dL

53. When auscultating the abdomen of a 7 year old patient, if you do C Kahit adults, alam ko same lang
not hear bowel sounds or the abdomen has hypoactive bowel
sounds in 1 full minute, you…
a. Consider intestinal ileus and come back after an hour to
auscultate the abdomen
b. Listen with the bell of the stethoscope at the midline
c. Listen to each quadrant for 5 minutes
d. Listen with the diaphragm over the right lower quadrant

54. Which one of the following has central cyanosis A

a. A patient with bluish discoloration of nail beds, pale
mucous membranes and PaO2 of 40 mmHg
b. A patient with bluish discoloration of nail beds, lips,
frenulum of the tongue and helix of the ear and SaO2 75
mmHg
c. A patient with bluish discoloration of nail beds, normal
mucous membranes and SaO2 of 90 mmHg
d. A patient with bluish discoloration of nail beds and helix
of the ear, and PaO2 of 60 mmHg

55. When you abduct the hips and feel a clunk of the dislocated D The examiner's hands are placed
femoral head, this is a positive over the child's knees with his/her
a. Lawsuit thumbs on the medial thigh and the
fingers placing a gentle upward
b. Bryant’s
stress on the lateral thigh and
c. Barlow’s sign
greater trochanter area. With slow
d. Ortolani test abduction, a dislocated and
reducible hip will reduce with a
described palpable “clunk.”

Google:
The blue scrotum sign of Bryant is
an ecchymosis of the scrotum. It is
a medical sign associated with
ruptured abdominal aortic aneurysm
(AAA) that is leaking relatively slow

The Barlow Maneuver is done by

guiding the hips into mild adduction
and applying a slight forward
 pressure with the thumb. If the hip is
unstable, the femoral head will slip
over the posterior rim of the
acetabulum, again producing a
palpable sensation of subluxation or
dislocation.

56. What is the cause of late inspiratory crackles B

a. Air flows rapidly through secretions in large airways
b. Small airways, deflated during expiration, pop open
during inspiration
c. Air bubbles flow through secretions or slightly closed
small airways during respiration
d. Air flows rapidly through bronchi narrowed nearly to
closure

57. A 60 year old male came to the OPD due to numbness in his C? Posterior column–lemniscal system
right leg. Patient has uncontrolled diabetes and a 15-pack year (touch, pressure, joint position)
smoking history. Physical examination revealed loss of pain, hot,
Afferent peripheral nerve fibers
cold, vibration, and position senses. Where is the most probable
conveying somatosensory
location of the lesion?
information from the limbs and
a. Right lumbar ventrolateral spinal cord trunk traverse the dorsal roots and
b. Left medial postcentral gyrus enter the dorsal horn of the spinal
c. Left medial lemniscus cord (Fig. 25-1); the cell bodies of
d. VPM of the right thalamus first-order neurons are located in the
e. Any of the above dorsal root ganglia (DRG). In an
analogous fashion, sensations from
the face and head are conveyed
through the trigeminal system (Fig.
441-2). Once fiber tracts enter the
spinal cord, the polysynaptic
projections of the smaller fibers
(unmyelinated and small
myelinated), which subserve mainly
nociception, itch, temperature
sensibility, and touch, cross and
ascend in the opposite anterior and
lateral columns of the spinal cord,
through the brainstem, to the ventral
posterolateral (VPL) nucleus of the
thalamus and ultimately project to
the postcentral gyrus of the parietal
cortex and other cortical areas
(Chap. 13). This is the spinothalamic
pathway or anterolateral system.

58. The following instances may mimic cardiomegaly in a chest B

x-ray except
a. Prominent pericardial fat pad
b. Hyperaerated lungs
c. Pericardial cyst
d. Patient taken in a supine position

59. in the determination of acid base disturbances in the arterial

blood, which of the following parameters is usually calculated
instead of measured?
a. PaO2
 b. HCO3
c. PaCO2
d. pH

60. Which of the following is the most common cause of A “Transudate” is fluid buildup caused
transudative pleural effusion? by systemic conditions that alter the
a. Congestive heart failure pressure in blood vessels, causing
fluid to leave the vascular system.
b. Lung cancer
“Exudate” is fluid buildup caused by
c. Pneumonia
tissue leakage due to inflammation
d. Trauma or local cellular damage.

61. Physical examination findings that can be seen in both acute D Typical physical findings in liver
and chronic liver disease disease are icterus, hepatomegaly,
a. Gynecomastia hepatic tenderness, splenomegaly,
spider angiomata, palmar erythema,
b. Sarcopenia
and skin excoriations. Signs of
c. Dupuytren’s contracture
advanced disease include muscle
d. Palmar erythema wasting, ascites, edema, dilated
abdominal veins, hepatic fetor,
asterixis, mental confusion, stupor,
and coma. In male patients with
cirrhosis, particularly that related to
alcohol use, signs of
hyperestrogenemia such as
gynecomastia, testicular atrophy,
and loss of male-pattern hair
distribution may be found

Spider angiomata and palmar

erythema occur in both acute and
chronic liver disease - harrisons

62. ECG tracing with regularly occurring PQRST and a rate of less A? Sinus Bradycardia is an arrhythmia
than 60 bpm defined as a rate below 60 BPM with
a. Sinus bradycardia all beats remaining normal (pacheck
hihi)
b. Sinus arrhythmia
c. Sinus rhythm
d. Sinus tachycardia D
63. A 25 year old male with a reticulocyte index of < 2.5, Anemias associated with
normochromic, normocytic anemia probably have which of the normocytic and normochromic red
following cells and an inappropriately low
a. Nuclear defects reticulocyte response (reticulocyte
index <2–2.5) are hypoproliferative
 b. Cytoplasmic defect anemias. This category includes
c. Fragmentation hemolysis early iron deficiency (before
d. Marrow damage hypochromic microcytic red cells
develop), acute and chronic
inflammation (including many
malignancies), renal disease,
hypometabolic states such as
protein malnutrition and endocrine
deficiencies, and anemias from
marrow damage.

Thymic wave sign refers to the

64. This sign representing a normal thymus where its characteristic indentation of the normal thymus in
appearance is due to indentation of overlying ribs B young children by the ribs, resulting
a. Sail sign in a wavy border on chest
b. Wave sign radiograph.
c. Figure 3 sign
d. Reverse “E” sign
e. Spinnaker sign

65. Which of the following describes an uncompensated state? D Uncompensated Respiratory

a. Increased pH, increased pCO2, increased HCO3 Acidosis: This occurs when there is
b. Decreased pH, decreased pCO2, decreased HCO3 an increase in the PaCO2 level
without a resultant alteration
c. Increased pH, decreased pCO2, decreased HCO3
(increase) of the HCO3 value.
d. Decreased pH, increased pCO2, normal HCO3

66. All of the following cause hypokalemia, EXCEPT C

a. Elevated beta adrenergic activity
b. Metabolic alkalosis
c. Hyperthermia
d. Increased availability of insulin
67. What compartment of the knee is most commonly affected in D
osteoarthritis
a. Infrapatellar
b. Lateral
c. Suprapatellar
d. Medial
68. What is the most likely diagnosis
E
Pleural effusion ata since nasa
dependent part siya

Puwede rin siguro atelectasis, IDK

Pneumonia usually cavitation ang

meron like tuberculosis sa upper
right lung

Consolidation usually may air

bronchogram

Pneumothorax and emphysema

dapat increased yung air so dapat
hypodense yung aira, hindi
hyperdense

a. Pneumonia
b. Consolidation
c. Pneumothorax
d. Atelectasis
e. Pleural effusion
f. Emphysema

69. Which of the following statements is true regarding headache? B D - trigeminal

a. In new-onset and severe headache, the probability of
finding a potentially serious cause is lesser than in
recurrent headache
b. Lacrimation, conjunctival injection, nasal congestion,
aural fullness, and ptosis are prominent in the trigeminal
The first step in the management of
autonomic cephalgias
patients with CDH is to diagnose
c. Brain imaging is the essential first step in the evaluation
any secondary headache and treat
of patients with headache that problem (Table 16-3).
d. The innervation of the large intracranial vessels and dura
is via the facial nerve

70. The 3 Cs of measles are Cough

a. Spots Coryza
b. Cough Conjuncti
c. Congestion vitis
d. Clubbing
e. Coryza
f. Crepitation
g. Conjunctivitis
h. Constipation

71. Most common site of osteoporosis-related fracture C? Spine and hip daw
a. Knee
 b. Leg
c. Hip
d. Ankle

72. Which of the following is the most common cause of C Tuberculosis had long been the
hemoptysis in industrialized countries worldwide? most common cause of hemoptysis
a. Tuberculosis worldwide, but it is now surpassed
in industrialized countries by
b. Pulmonary metastases
bronchitis and bronchiectasis
c. Bronchitis
d. Pulmonary embolism

73. HM, 20/F, came in to your clinic and presented with icteric C?
sclerae and tenderness on RUQ. serum liver tests were found to
be elevated and ALP was out of proportion to ALT/AST. What will
you do next?
a. CT/MRCP/ERCP
b. Viral serologies
c. Ultrasound
d. ANA, SMA, SPEP

74. A 48 year old man with diabetes mellitus and hyperlipidemia D

presents to the emergency department for evaluation of right
flank pain and groin pain that has been severe and presents for
approximately 3 hours. He is clinically diagnosed of having
kidney stone. Which of the following modality will you request to
Abdominal ultrasound offers the
prove your diagnosis of renal stones? advantage of avoiding radiation and
a. MRI with gadolinium contrast provides information on
b. Renal ultrasonography hydronephrosis, but it is not as
c. Voiding cystourethrogram sensitive as CT and images only the
d. Plain helical CT scan kidney and possibly the proximal
segment of the ureter; thus, most
ureteral stones are not detectable by
ultrasound - harrisons pa rin

75. Which one of the following conditions is characterized by C

tympany on chest percussion?
a. Pulmonary embolism
b. Emphysema
c. Diaphragmatic hernia
d. Bronchial asthma

76. Which component of S1 causes louder sounds reflecting the C The M1 sound is much louder than
high pressure of the left side of the heart? the T1 sound due to higher
a. Pulmonic pressures in the left side of the heart
b. Aortic
c. Mitral
d. tricuspid

77. A relatively acute decline in cognition that fluctuates over hours B

or days
a. Confusion
b. Delirium
 c. Drowsiness
d. A and B only
e. All of the above
f. None of the above

78. How can fever be differentiated from hyperthermia? B

a. Hyperthermia follows a circadian rhythm while such
diumal variation is not seen with fever
b. The hypothalamic set point is elevated with fever and is
unchanged in hypothermia
c. Pyrogen synthesis occurs with hyperthermia while it is
absent with fever
d. All of the above statements are true and correct

79. Modified medical research council (MMRC) dyspnea scale is an C

example of a clinical method of rating dyspnea. MMRC grade 2
is equivalent to which of the descriptions below
a. Stops to rest after walking 100 m or after walking a few
minutes on level ground
b. Shortness of breath while walking on level ground or
with walking up a slight hill
c. Walks slower than people of similar age on level ground
due to breathlessness or has to stop at rest when
walking at own pace on level ground
d. Not troubled by breathlessness, except with strenuous
exercise

80. Which of the following is a CORRECT description of the clinical A

presentation of impetigo
a. Golden honey colored crust over an erythematous base
b. Flesh colored papule with a rough surface
c. Salmon colored plaque with silvery scale
d. Comedones, pustules and nodules

81. Milky urine from a 24 year old woman would most likely contain A
which of the following?
a. Many WBCs
b. Bilirubin
c. RBCs
d. spermatozoa

82. At which level of serum potassium does a patient with B? Hypokalemia is more prevalent than
hypokalemia become more symptomatic? hyperkalemia, and most cases are
a. <2.0 mild. Severity is categorized as mild
when the serum potassium level is 3
b. <2.5
to 3.4 mmol/L, moderate when the
c. <3.0
serum potassium level is 2.5 to 3
d. < 3.5 mmol/L, and severe when the serum
potassium level is less than 2.5
mmol/L (ncbi)

83. Which of the following statements is true? D A D-dimer test is used to find out if
a. A prior history of bleeding, especially if isolated, is a you have a blood clotting disorder.
negative predictor of future bleeding These disorders include: Deep vein
thrombosis (DVT), a blood clot that's
b. Abnormality in blood vessels may result in easy bruising
deep inside a vein
or ecchymoses, hence the latter do not always suggest
 presence of bleeding disorder
c. Symptoms of bleeding or thrombosis that present at a
young age are usually due to acquired disorders of
hemostasis
d. D-dimers are products of degradation of fibrinogen and
are used to confirm the diagnosis of deep vein
thrombosis

84. A 45/ M alcoholic came for pain on the foot. He noted sudden A? Since may podagra?
onset of the pain of 5 days' duration after he had attended his
boss’ cocktail party. Pain was severe, especially at the medial
foot causing difficulty to step on it. On your PE, you noted
warmth, erythema, and tenderness at the forefoot, particularly at
the area of the big toe and the MTP. what is your primary
impression?
a. Gout
b. Osteoarthritis
c. Tendinitis
d. Rheumatoid arthritis

85. A 20 year old female patient complains of pruritic multiple D? Excision =

hyperpigmented well-demarcated plaques topped with scales on Wood’s = evaluation of certain skin
both thighs. Which of the following laboratory tests should be disorders
Tzanck = used in the diagnosis of
done to the patient?
herpesvirus infections (herpes
a. Excision biopsy
simplex virus [HSV] or
b. Wood’s lamp varicella-zoster virus [VZV])
c. Tzanck smear KOH = for fungal
d. KOH test Since may scale, baka fungal yung
meron si patient?

86. A patient presents with signs of hyperthyroidism C? Since mag fe-feedback na mataas
(thyrotoxicosis). To investigate the matter, you measure the na yung t4 sa pituitary = bababa
levels of T4 and TSH. if the patient has a benign thyroid yung TSH?
adenoma (toxic nodule), you can expect the following results
a. T4 elevated, TSH elevated
b. T4 reduced, TSH normal
c. T4 elevated, TSH reduced
d. T4 reduced, TSH reduced

87. Which of the following is the most common symptom of liver C Fatigue is the most common and
disease? most characteristic symptom of
a. RUQ pain liver disease. It is variously
described as lethargy, weakness,
b. Jaundice
listlessness, malaise, increased
c. Fatigue
need for sleep, lack of stamina, and
d. Itching poor energy.

88. A 62 year old male complained of numbness of the left arm. A? This large-fiber system is referred to
Neurologic examination only revealed loss of position sense. as the posterior column–medial
Damage to which of the following would result in this clinical lemniscal pathway (lemniscal, for
short). Although the fiber types and
picture?
functions that make up the
a. Medial lemniscus
spinothalamic and lemniscal
b. Spinothalamic tract systems are relatively well known,
c. Lissauer’s tract many other fibers, particularly those
d. Fasciculus cuneatus associated with touch, pressure, and
e. Fasciculus gracilis position sense, ascend in a diffusely
 distributed pattern both ipsilaterally
and contralaterally in the
anterolateral quadrants of the spinal
cord

89. Urinary tract infection in younger children can present with D?

vomiting, with or without fever. Urinalysis was requested in a 2
year old patient, with the following result: specific gravity 1.010,
negative for ketones, negative for sugar, rbc 0-2/hpf, wbc 0-2, no
nitrites, no casts, no crystals. You -
a. Refer to pediatric surgeon
b. Prescribe cefuroxime
c. Request KUB ultrasound
d. Reassure the parents

90. Which of the following is TRUE regarding the pathogenesis of A Initiating event may be peripheral
cirrhotic ascites arterial vasodilation triggered by
a. It is triggered by endotoxin and cytokines and mediated endotoxin and cytokines and
mediated by nitric oxide - trans
by nitric oxide
b. Initiating event may be peripheral venous vasodilation
c. Contributing factors include portal hypertension,
hyperalbuminemia, hepatic lymph, and renal sodium
retention
d. Renal sodium retention is secondary to decreased
renin-angiotensin production

91. Which of the following is the most common cause of B

hypothyroidism worldwide?
a. Hashimoto's thyroiditis
b. Iodine deficiency
c. Iatrogenic hypothyroidism
d. Grave’s disease

92. Which of the following is not a part of the routine tests in D

evaluating a patient with dementia?
a. Vitamin B12
b. Cranial MRI
c. TSH
d. Chest x-ray

93. True of erythropoietin (EPO), except B For red cell production,

a. Regulation is linked to tissue oxygenation erythropoietin (EPO) is the primary
b. Fundamental stimulus for production is CO2 increase in regulatory hormone. EPO is required
for the maintenance of committed
the blood
erythroid progenitor cells that, in the
c. Prevent the apoptosis of committed erythroid progenitor
absence of the hormone, undergo
cells programmed cell death (apoptosis)
d. Primary regulator of red cell production

94. This is an example of secretory cause of diarrhea A? Hyperthyroidism = dysmotile cause

a. Post-ileal resection Lactose intolerance = osmotic
b. Hyperthyroidism cause
Cholera = inflammatory cause?
c. Lactose intolerance
 d. Cholera infection

95. Of the following locations, which reflects the core body B?

temperature most accurately
a. Axillary
b. Rectal
c. Oral
d. Temple

96. Which of the following risk factors in developing UTI is seen in D?

post-monopausal women
a. Cystocele
b. First UTI before 15 years of age
c. Maternal history of UTI
d. New sexual partner

97. Given the following likelihood ratio, the following physical D?

findings increases the probability of Cushing syndrome

a. Central obesity
b. Plethora
c. Ecchymoses
d. Thin skin fold

98. REM sleep is similar in EEG pattern to which stage of NREM B

sleep?
a. N2
b. N1
c. N3
d. N4

99. Which of the following is most suggestive of a restrictive pattern C?

on spirometry
a. FEV1/FVC ratio > 0.70
b. FEV1 < 80% of predicted
c. FVC < 80% of predicted
d. FEV1/FVC ratio <0.70

100. A skin condition characterized by areas of dark, velvety A

discoloration in body folds and creases
a. Acanthosis nigricans
b. Necrosis lipoidica
 c. Diabetic dermopathy
d. Xerosis

101. Patient is born to a 23 year old G1P1 (1001) mother by NSD B?

at a tertiary hospital, assisted by OB. mother had regular
prenatal check-up, complete vaccinations, took the
recommended prenatal iron and folic acid supplements, and had
a healthy pregnancy without experiencing any illnesses. Apgar
score 8.9. Birth weight 2.5 kg, birth length 45 cm, head
circumference 33 cm. Which piece of information is missing
from this patient’s gestational history?
a. Marital status
b. Age of gestation
c. Age of the father
d. Birth order

102. An obese female had 2 yeast infections for the past 6 D?

months. She usually feels thirsty. She does report waking up at
night to urinate. Which of the following studies is the most
appropriate first test in evaluating the patient for diabetes
mellitus
a. Random plasma glucose level
b. Oral glucose tolerance test
c. Plasma insulin level
d. Hemoglobin A1C

103. What is the most cost effective modality in diagnosis B?

cholecystitis?
a. Fluoroscopy
b. Ultrasound
c. MRI
d. CT scan

104. A type of fracture that is common in children 10 years of age B

and younger is known as greenstick fracture. Which statement
best describes a greenstick fracture?
a. The bone is crushed
b. The bone bends and cracks
c. The break spirals around the bone
d. The bone completely breaks

105. Average naturally-occurring background radiation a person C

may receive in a span of 1 year
a. 5 msv
b. 4 msv
c. 3 msv
d. 2 msv

106. Which artery is commonly used to measure BP in a sthenic, C

apparently well patient
a. Dorsalis pedis
b. Radial
c. Brachial
d. ulnar
107. Which finding in your history and physical examination of an
injured worked with low back pain would require immediate
intervention?
a. Paresthesia in the great toe
b. Pain radiating to the posterior thigh
c. Pain that awakens the worker at night
d. Ankle weakness only with long distance walking

108. A 30 year old female is started on Carbimazole 20 mg bid

following a diagnosis of Grave’s disease. What is the best
biochemical marker to assess her response to treatment
a. Total T4
b. TSH
c. Free T4
d. Free T3

109. What is the meaning of grade 2 in the evaluation of graves C

ophthalmopathy
a. Sight loss
b. Proptosis
c. Soft tissue involvement
d. Only signs no symptoms

110. You were assigned at the heart station during one of your
duties as a post-graduate intern. While the resident went out on
a break, 4 stat ECG requests came in. which of the following will
you prioritize in doing ECG
a. Patient with irregular heart rate
b. Patient with mitral regurgitation
c. Asymptomatic patient diagnosed with blocked coronary
arteries
d. Patient with infective endocarditis

111. Characteristic sign of consolidation D Tram-track sign may be used in

a. Tram track sign chest radiography or CT to denote
b. Air lucency sign the thickened non-tapering (parallel)
walls of cylindrical bronchiectasis
c. Bronchial airway sign
d. Air bronchogram sign

112. The most common cause of scoliosis is B

a. Trauma
b. Idiopathic
c. Mesenchymal
d. Neuromuscular

113. A lesion was described to be multiple, elevated, with rough

edges measuring less than 8 mm. This lesion may be located in
the
a. Papillary dermis
b. Epidermis
c. Hair follicle
d. Subcutaneous tissue
114. Which of the following test use fludeoxyglucose 18? D? F-18 2-fluoro 2-deoxy-D glucose
a. Cardiac MRI (FDG) is an analogue of glucose and
b. Exercise stress test like glucose it is taken up by
activated inflammatory cells that
c. Myocardial viability test
accumulate at the site of infection.
d. Cardiac CT with calcium scoring
This has formed the basis of the use
of F-18 FDG PET/CT in the
non-invasive evaluation of human
inflammatory diseases.

115. A 2 year old patient with a chief complaint of vomiting is

seen at your clinic. HPI: he is apparently well until the day of
consult, when the patient had 1 episode of vomiting of
previously ingested food (pan de sal), about 1 cup in amount.
Patient was quickly brought to your clinic. No other signs and
symptoms were reported. The abdomen of the patient is
globular, with hyperactive bowel sounds, tympanitic, no
organomegaly. The 2 year old remains comfortable and attentive
throughout the entire examination of the abdomen, no
tenderness seems to be elicited by light and deep palpation.
Which one should be included in the top 3 differential
diagnoses?
a. Gastroesophageal reflux
b. Mickey’s diverticulum
c. Testicular torsion
d. Acute appendicitis

116. Which of the following stones is associated with the A

presence of proteus sp.
a. Triple stone
b. Cystine stone
c. Calcium oxalate stone
d. Uric acid stone

117. ABG is one of the initial laboratory tests you can order in C
investigating possible etiologies of dyspnea. What ABG result
might point toward the possibility of carbon dioxide retention
such as seen in chronic respiratory patient?
a. Low arterial oxygen
b. Low bicarbonate
c. High bicarbonate
d. Low arterial pH

118. In a patient who is 10 years old with the worst headache of A

his life, sudden onset, preceded by 3 days fever, still with good
appetite, the focused history inquires about
a. Immunizations received
b. Last urine output
c. School anxiety and tension
d. Last bowel movement

119. JJ, 24/ M has the following hepatitis profile results: HBsAG D
+, HBeAG +, HBV DNA -, antiHBC IgM -, AntiHBc total +, antiHBe -,
anti HBs -, what is the serologic diagnosis of the patient
a. Chronic infection
b. Incubation
 c. Vaccination
d. Acute infection

120. The finding of bilateral babinski reflex in infants up to 2 D

years old is normal. Beyond this, suspect
a. Hyperpyrexia
b. Autism
c. Pernicious anemia
d. Spinal cord injury