Alport

B. abnormalities in RBC spectrin and ankyrin –

Hereditary Spherocytosis
In the process of DNA replication, which among C. accumulation of alpha-amyloid
the following enzymes prevents premature D. abnormal collagen types I, III and V
reannealing of double-stranded DNA? E. defective fibrillin proteins
1 A. DNA polymerase Simvastatin is a potent antihyperlipidemic drug
B. Helicase that disrupts the rate-limiting step in cholesterol
C. DNA ligase biosynthesis. Which among the following enzymes
D. Single-strand binding proteins 10 is inhibited by this drug?
E. Topoisomerases A. HMG-CoA synthase
Which among the following glucose transporters is B. HMG-CoA reductase
found in the small intestines? C. PRPP synthetase
A. GLUT1 D. Glucose-6-phosphate dehydrogenase
2 B. GLUT2 E. Mevalonate kinase
C. GLUT3 Which among the following is the predominant
D. GLUT4 form of estrogen that is produced during
E. All of the above pregnancy?
Oxidative phosphorylation relies on ATP 11 A. estrone
generation via the electron transport chain. In B. estradiol
human cells, where is the electron transport C. estriol
3 chain located? D. norgestrel
A. cristae mitochondriales E. diethylstilbestrol
B. outer mitochondrial membrane Excess of which of the following vitamins is
C. inner mitochondrial membrane considered teratogenic?
D. mitochondrial matrix A. Vitamin A
E. cytosol 12 B. Vitamin B
Anaerobic glycolysis is the transformation of C. Vitamin C
glucose to pyruvate when limited amounts of D. Vitamin D
oxygen are available. How much is the net ATP E. Vitamin E
4 yield of anaerobic glycolysis? Adenosine triphosphate (ATP) can be produced
A. 0 ATP from which of the following?
B. 1 ATP A. bisphosphate
C. 2 ATP 13 B. phosphoenolpyruvate
D. 4 ATP C. creatine phosphate
E. 6 ATP D. all of the above
Which among the following biochemical processes E. B and C only
involves a thiophorase enzyme? Glucose and galactose are both 6 carbon
A. ketogenesis sugars, which differ only at the position of the
5 B. tricarboxylic acid cycle hydroxyl group in their 4th carbon atom. Which
C. hexose monophosphate shunt 14 among the following best describes their structural
D. beta oxidation relationship with each other?
E. ketone body metabolism A. Isomers
Other than the liver, which among the following B. Epimers
represents an anatomic site where cholesterol C. Diastereomer
synthesis occurs? D. Enantiomers
6 A. lungs E. These compounds are not structurally related.
B. thyroid gland A 2/M has familial deficiency of lipoprotein
C. kidneys lipase. Which among the following will most likely
D. adrenal glands be observed in this boy?
E. spleen 15 A. increased HDL cholesterol
In the settings of a developing country, which B. increased LDL cholesterol
among the following represents a plausible but C. increased VLDL cholesterol
less reliable screening test for phenylketonuria? D. increased chylomicrons
7 A. serum levels of phenylalanine E. decreased triglycerides
B. tandem mass spectrometry for Which among the following differentiates
phenylalanine hydroxylase marasmus and kwashiorkor based on plasma
C. urinary phenylpyruvate detection with FeCl3 insulin levels?
D. high performance liquid chromatography 16 A. Plasma insulin is normal in marasmus.
E. demonstration of characteristic EEG findings B. Plasma insulin is normal in kwashiorkor.
Which among the following complexes of the C. Plasma insulin is equal in marasmus and
electron transport chain will be severely affected kwashiorkor.
upon exposure to barbiturates? D. Plasma insulin is low in both marasmus and
8 A. NADH dehydrogenase kwashiorkor.
B. succinate dehydrogenase E. All of the above are correct.
C. cytochrome b/c1 Arachidonic acid is not one of the essential fatty
D. cytochrome a3 acids. However, it becomes essential if there is a
E. none of the above deficiency of which of the following?
A 10/M is brought for evaluation of bloody 17 A. palmitic acid
stools. The boy’s maternal grandfather suffered B. stearic acid
deafness and died of renal failure. Which C. linoleic acid
9 among the following abnormalities are most likely D. myristic acid
present in this child? E. linolenic acid
A. defective subunits of collagen type IV - Which among the amino acids is considered an
 imino acid? B. C5
A. alanine 27 C. C6
18 B. histidine D. C7
C. proline E. T1
D. valine A newborn female is born with a malformed
E. threonine uterus. This is most likely due to embryologic
A newborn female manifests with hypoglycemia abnormalities in which of the following structures?
and muscle weakness. Beta-oxidation was 28 A. metanephros
noted to be impaired in this baby. Which among B. mesonephros
19 the following deficiencies will most likely explain C. Bartholin’s ducts
her clinical presentation? D. wolffian ducts
A. creatine E. paramesonephric ducts
B. phosphatidylcholine Overinversion of the foot places great strain on
C. propionyl-CoA which of the following anatomic structures in the
D. mevalonate ankle?
E. carnitine 29 A. anterior cruciate ligaments
The genome of a human subject contains 10% B. medial collateral ligaments
adenine. How much in percentage will be the C. medial ligaments
amount of cytosine in his genome? D. lateral ligaments
20 A. 10% E. deltoid ligaments
B. 20% From which branchial cleft is the external auditory
C. 30% meatus derived from?
D. 40% A. first
E. 80% 30 B. second
C. third
D. fourth
ANATOMY and HISTOLOGY E. fifth
Which among the following represents the most Which among the following best describes a
common location of ectopic parathyroid tissue? bipolar neuron?
A. floor of the mouth A. neuron with one process, with different
21 B. posterior mediastinum 31 segments serving as receptive surfaces and
C. superior mediastinum releasing terminals
D. root of the neck B. neuron with separate dendrite and axon
E. posterior cervical triangle C. neuron with a single process splits into two,
A 34/F with parathyroid hyperplasia is scheduled both of which function as axons
to undergo subtotal parathyroidectomy. How many D. neuron with two dendrites only
lobes will be removed? E. neuron with three or more processes
22 A. one Which among the following blood vessels is most
B. two and one half commonly used in coronary artery bypass graft
C. three (CABG)?
D. three and one half 32 A. internal thoracic artery
E. four B. radial artery
Which parathyroid glands are frequently severed C. azygos vein
during total thyroidectomy? D. superficial femoral vein
A. inferior parathyroids E. saphenous vein
23 B. superior parathyroids ??? Which among the following is the largest nerve in
C. ectopic parathyroids the human body?
D. A and B only A. vagus nerve
E. all of the above 33 B. abduscens nerve
A 22/F undergoes esophagoscopy to determine C. femoral nerve
extent of caustic injuries. How far will the D. sciatic nerve
endoscope travel from the incisors until the level of E. peroneal nerve
24 the carina? Right thyroid lobe carcinoma will most like
A. 15 cm metastasize first to which among the following
B. 17 cm groups of lymph nodes?
C. 20 cm 34 A. paratracheal nodes
D. 25 cm B. mediastinal nodes
E. 30 cm C. deep cervical nodes
Which part of the pancreas is related to the D. superficial cervical nodes
superior mesenteric artery? E. para-aortic nodes
A. head A 32/F opera singer underwent thyroid surgery.
25 B. neck Post-surgery, she can no longer reach the high
C. body notes that she could reach previously. Which
D. tail 35 among the following structures was most likely
E. uncinate process damaged during her operation?
The flexor retinaculum is attached medially to A. recurrent laryngeal nerve
which of the following bony structures? B. internal laryngeal nerve
A. pisiform C. external laryngeal nerve
26 B. scaphoid D. criminal nerve of Grassi
C. trapezium E. vagus nerve
D. capitate The median nerve supplies these muscles,
E. lunate EXCEPT?
At which vertebral level does the esophagus start? A. First and second lumbricals
A. C4 36 B. Flexor pollicis brevis
 C. Opponens pollicis hours. He denies using any intravenous drugs. On
D. Abductor pollicis brevis questioning you learn that he had his impacted
E. Adductor pollicis 45 wisdom teeth removed 5 weeks prior. On physical
A 55/F develops pericardial effusion and requires examination you hear a murmur which starts low
pericardiocentesis. Which among the following and rises between S2 and S1. Which among the
areas is NOT a safe area to perform this following is the most likely causative organism?
37 procedure because of risk of causing pleural A. viridans streptococci
injury? B. Streptococcus bovis
A. left fifth intercostal space, parasternal border C. Straphylococcus aureus
B. left sixth intercostal space, parasternal border D. Streptococcus pneumoniae
C. infrasternal angle E. HACEK
D. right 4th intercostal space, parasternal border A 27-year-old heterosexual male presents with a
E. cardiac notch on left lung 2-week history of progressively enlarging masses
A 34/M develops signs of meningitis. At which in his right groin. He just came back from a trip to
vertebral level is it most appropriate to perform 46 Amsterdam. The masses are inflamed and he
lumbar puncture for examination of his CSF? reports fever, arthralgias, and malaise. The
38 A. L1-L2 overlying skin is thick and indurated. If these
B. L2-L3 masses undergo suppuration, which among the
C. L3-L4 following techniques will aid best in identifying the
D. L5-S1 causative organism?
E. S1-S2 A. Silver stain
Which among the following coronary arteries is B. Acid fast stain
involved primarily in cases of acute myocardial C. Giemsa stain
infarction of the lateral wall of the left ventricle? D. Sudan IV stain
39 A. left circumflex artery E. Congo red stain
B. left anterior descending artery A 54-year-old smoker with multiple comorbidities
C. right posterior descending artery presents with a 2-day history of a productive
D. right marginal artery cough with rust-colored sputum, chest tightness,
E. AV nodal artery and fever. CXR reveals a left lower lobe infiltrate.
Which connective tissue structure attaches the 47 Which among the following is the most likely
liver anteriorly? causative organism of this patient’s infection?
A. coronary ligament A. Staphylococcus aureus
40 B. triangular ligament B. Streptococcus pneumoniae
C. round ligament C. Klebsiella pneumoniae
D. cardinal ligament D. Proteus mirabilis
E. falciform ligament E. Escherichia coli
A 22/F G1P0 24 weeks AOG delivers a baby boy
MICROBIOLOGY following premature rupture of membranes. 12
An 18/F develops a fluctuant axillary nodule that hours after delivery, the baby shows signs of
developed into an abscess. A few days later, it lethargy and becomes tachypneic. His BP drops
ruptured externally and drained purulent material. 48 and his hands and feet begin to feel cold. Which
41 Which among the following is best and most among the following is the most likely causative
rational medication to administer to this patient? organism in this baby’s infection?
A. penicillin V A. Streptococcus pneumoniae
B. benzathine penicillin G B. Escherichia coli
C. dicloxacillin C. Listeria monocytogenes
D. ampicillin D. Streptococcus agalactiae
E. imipenem-cilastatin E. Staphylococcus aureus
A 22/F develops night sweats and chronic cough. A 3-year-old boy is brought to the health clinic for
He now presents with cachexia and hemoptysis. diarrhea that began 20 hours ago. The volume has
Which among the following is the primary increased rapidly, so that now there is almost a
42 virulence factor of the causative organism of this 49 continuous passage of rice water-like stools into
infection? the bed. The toxin produced by the causative
A. sulfatides organism has which of the following molecular
B. tuberculin effects?
C. cord factor A. Inhibition of acetylcholine release
D. lecithinase B. Disruption of rRNA interaction with EF-1 and
E. hyaluronidase EF-2
Which among the following microbes is the major C. Activation of Gs
cause of nosocomial infection in patients with D. Inactivation of Gs
extensive burn injuries? E. ADP ribosylation of EF-2
43 A. Legionella pneumophila A 23/M presents with facial erythema, edema and
B. Pseudomonas aeruginosa warmth. The facial lesions are raised above the
C. Staphylococcus aureus level of surrounding skin and well-delineated. The
D. Streptococcus pyogenes 50 area of involvement is “butterfly” shaped. Which
E. Clostridium perfringens among the following organisms most likely caused
Which among the following descriptions best this infection?
characterizes Helicobacter pylori? A. Streptococcus pyogenes
A. obligate aerobe B. Propionibacterium acnes
44 B. non-motile C. Actinomyces israelii
C. shooting star motility D. Staphylococcus epidermidis
D. urease-positive E. Staphylococcus aureus
E. catalase-negative A 20-year-old college student presents to the
A 27/M consults for fever and chills for the past 24 emergency room with fever and confusion. The
 previous night he felt unwell and complained of a E. Staphylococcus epidermidis
51 headache. This morning he was difficult to arouse, A 12-month-old female infant presents with
seemed confused, and felt warm to touch. On spasmodic cough with whooping, cyanosis and
physical exam he is acutely ill with fever, posttussive vomiting. The infant’s mother reports
tachycardia, and mild hypotension. He opens his that she herself has been coughing for 6 weeks.
eyes and withdraws in response to painful stimuli. 58 The child’s vaccination records are incomplete.
Nuchal rigidity and a few truncal petechiae are What is the drug of choice for the infant’s
present. Which among the following drugs must be condition?
administered to this patient? A. Ceftriaxone
A. Ciprofloxacin B. Penicillin G
B. Rifampicin C. Erythromycin
C. Doxycycline D. Ciprofloxacin
D. Ceftriaxone E. Chloramphenicol
E. Penicillin G A 4/M presents with pallor and easy fatigability.
A previously healthy 9-month-old infant presents The boy was previously healthy and enjoyed
with a 4-day history of sudden-onset high fever of playing with friends barefoot by the sandy beach
104˚F (40˚C) that has since been intermittent, near their house. stool examination revealed
peaking in the early evening. Today, his fever is 59 Ancylostoma duodenale. Which among the
52 resolved but he has developed an eruption following is expected to be found on further
consisting of rose-red macules 2 to 5 mm in examination?
diameter on his trunk and proximal extremities. A. visceral larva migrans
Which among the following is the most likely B. worms swimming in the vitreous humor
causative organism? C. multiple space-occupying lesions in the brain
A. Measles virus D. microcytic hypochromic anemia
B. Rubella virus E. macrocytic anemia
C. HSV-1 A 25/M from Mindanao comes in with paroxysmal
D. HHV-6 bouts of fever and chills. Blood smears revealed
E. VZV ring forms inside parasites with characteristic
Where does the antigenic stimulation of T cells in Schuffner’s dots. What drugs must be given to this
infectious mononucleosis occur? 60 patient to achieve radical cure of her infection?
A. paracortex A. Primaquine only
53 B. hilum B. Chloroquine only
C. cords of Billroth C. Mefloquine only
D. medullar cords D. Primaquine and Chloroquine
E. subcapsular sinus E. Chloroquine and Doxycycline
Which important parts of bacteria confer the ability
to resist extremes of heat? PHYSIOLOGY
A. glycocalyx The sciatic nerve is the largest nerve in the human
54 B. spores body. It is involved in conveying motor and
C. plasmids sensory stimuli from the lower extremities.
D. pili Myelination of this nerve is made possible by
E. nucleoid 61 which of the following neuroglial cells?
A 2-mo-old baby is diagnosed to have a specific T- A. oligodendrocytes
cell deficiency. The child is presently febrile. B. Schwann cells
Examination of the oropharynx revealed whitish C. astrocytes
55 plaques. Blood cultures revealed pseudohyphae. D. satellite cells
What is the most likely causative organism of this E. ependymal cells
baby’s infection? Which among the following generalizations
A. Candida albicans regarding adrenergic and cholinergic nerves is
B. Blastomyces dermatidis MOST accurate?
C. Nocardia asteroides 62 A. All somatic nerves are adrenergic.
D. Malasezzia furfur B. All preganglionic sympathetic and
E. Aspergillum fumigatus parasympathetic nerves are cholinergic.
A 25/F presents to the office with malodorous C. All postganglionic sympathetic nerves are
vaginal discharge and pruritus for the last 15 days. adrenergic.
She reports the smell is worse after intercourse D. All parasympathetic postganglionic nerves are
56 and the discharge is white. Microscopy revealed adrenergic.
clue cells. What is the drug of choice for her E. None of the above are accurate.
condition A 22/M medical student is running late for his
A. clindamycin exam. The grace period of 15 minutes for his
B. nystatin exam is running out. While he is racing towards
C. acyclovir his examination room, which among the following
D. fluconazole autonomic responses will MOST LIKELY be
E. metronidazole 63 observed in his urinary bladder?
Two weeks after undergoing colonic resection A. Sympathetic relaxation of the bladder trigone
surgery, a 55/M develops fever and chills. B. Sympathetic relaxation of the detrusor
Abdominal CT revealed air fluid levels in a muscle
57 localized portion of his abdominal cavity. Which C. Parasympathetic contraction of the bladder
among the following microbes will most likely be trigone
isolated from the site of infection? D. Parasympathetic contraction of the detrusor
A. Escherichia coli muscle
B. Listeria monocytogenes E. A and B are correct
C. Staphylococcus aureus Which among the following best characterizes
D. Bacteroides fragilis emmetropia?
 A. bulging eyeball the following mechanisms?
64 B. flattened eyeball A. Bainbridge reflex
C. well-proportioned eyeball B. Baroreceptor reflex
D. eye is contracted and focused on an object C. Bohr effect
more than 6 meters away D. Haldane effect
E. nearsightedness E. Frank-Starling mechanism
A 56/F was noted to drink 4 cups of coffee per day. Which among the following levels of nervous
Which among the following best characterizes the control is responsible for precision and accurate
effect of coffee on gastrointestinal function? timing of body movements?
A. increased cholecystokinin A. midbrain
65 B. decreased gastric acid production 74 B. basal ganglia
C. increased salivation C. pons
D. increased pepsin D. cerebellum
E. increased gastrin E. cerebrum
Which among the following best characterizes The evening dose of intermediate insulin is high in
diabetes insipidus? a 44/F diabetic. Consequently, she developed
A. production of dilute urine hypoglycemia at around 3:00 AM. When she
B. production of concentrated urine checked her pre-breakfast CBG, she was
66 C. production of isotonic urine 75 hyperglycemic. Which among the following best
D. production of urine with ketones explains this occurrence?
E. production of urine with red blood cells A. waning of insulin dose
A 44/F is diagnosed to have Addison’s disease. B. Dawn phenomenon
What is the expected effect on her serum sodium C. Somogyi effect
levels? D. Wolf-Chaikoff effect
67 A. increased E. Honeymoon period
B. decreased Cycloplegia is observed when they eye is exposed
C. no change to muscarinic blockers. Which among the following
D. initially increased, then decreased is primarily involved in this physiologic
E. initially decreased, then normal occurrence?
The following conditions result in increased 76 A. radial muscle
cardiac output EXCEPT? B. circular muscle
A. beri-beri C. ciliary body
B. arteriovenous fistula D. ciliary muscle
68 C. anemia E. superior oblique
D. hyperthyroidism Which among the following are associated with
E. myocardial infarction hypercalcemia?
What is the major postganglionic sympathetic A. widened QRS complex
neurotransmitter in sweat glands? B. spastic paralysis
A. acetylcholine 77 C. tetany ??
B. norepinephrine D. prolonged QT interval
69 C. epinephrine E. prominent U waves
D. dopamine Breast development and fat deposition is caused
E. A and B by what hormone/s?
Which among the following represents the only A. progesterone
type of immunoglobulin that can across the B. estrogen
placenta? 78 C. inhibin
A. IgA D. all of the above
70 B. IgD E. A and B only
C. IgE Continuous touch and pressure sensations are
D. IgG conveyed by which among the following
E. IgM receptors?
Which among the following divisions of the A. Pacinian corpuscles
autonomic nervous system functions for GIT 79 B. Ruffini endings
motility and is mainly excitatory? C. Merkel disks
A. sympathetic nervous system D. Meissner corpuscles
71 B. parasympathetic nervous system E. Golgi tendon organ
C. Auerbach’s plexus Considering the pattern of inheritance of the ABO
D. Meissner’s plexus blood groups, which is TRUE?
E. C and D are correct A. a child with blood type O may have parents
Migrating myoelectric complexes (MMCs) are 80 who both have blood types not O
waves of activity that sweep through the intestines B. a man with blood type AB and a woman with
in a regular cycle during fasting state. Which blood type O may have a child with blood type O
among the following substances primarily C. all the children of a man with blood type B and
regulates MMCs? a woman with blood type B will have blood type B
72 A. secretin D. all the children of a man with blood type A and a
B. motilin woman with blood type B will have blood type AB
C. gastrin E. none of the above
D. VIP A 25/M was observed to have been enjoying
E. ghrelin sexual gratification associated with the act of
Increased blood volume is detected by stretch defecation. He is most likely suffering from:
receptors located in both atria at the venoatrial A. Urolagnia
junctions. Consequently, an increase in heart rate 81 B. Algolagnia
occurs due to an increase in central venous C. Coprophagia
73 pressure. This is best characterized by which of D. Coprophilia
 E. Don Juanism false, extravagant and unethical advertisement is
An 18/M has received multiple disciplinary liable to:
sanctions due to indecent behavior. He has been A. Criminal malpractice
caught multiple times masturbating while peeping 90 B. Civil malpractice
82 at the ladies dressing room. He most likely has: C. Administrative malpractice
A. Pluralism D. Constitutional malpractice
B. Troilism E. Media malpractice
C. Voyeurism A physician receives a subpoena to appear in
D. Mixoscopia court. The technical and descriptive term for the
E. Fetishism subpoena issued to him is:
Which among the following tests will determine A. Subpoena duces tecum - evidence
whether respiration took place in a newborn before 91 B. Subpoena ad testificandum
death? C. Subpoena of medical records
83 A. Biological test of Farnum - semen D. Subpoena of welfare documents
B. Breslau test E. Writ of mandamus
C. Fodere test – blood in lung Who among the following individuals is qualified to
D. Wredin test be a part of the Philippine Board of Medical
E. Hydrophobic test examiners?
The pregnancy of a 24/F is demonstrated by A. Dr. Reyes, graduated and licensed 1992, born
injection of her urine to a female African tadpole. It in Indonesia to a Filipino mother, eminent
was observed that the tadpole rapidly ovulated. physician, published in New England Journal of
84 This test for pregnancy is called the: Medicine
A. Mayor’s test - facebook B. Dr. Cruz, graduated and licensed 1964, eminent
B. Ascheim-Zandek test - mice physician, born in Manila, former dean of UP
C. Friedman test - statistics 92 College of Medicine, presently Professor emeritus
D. Goodell sign C. Dr. Santos, graduated and licensed 2001,
E. Hogben test - frog eminent physician, born in Davao, noble prize
IQ tests for a 21/F revealed that she had the laureate in medicine
intelligence equivalent to that of a 1-year-old. D. Dr. Lee, graduated and licensed 1985,
Therefore, we may consider her a/an: previously convicted for medical malpractice,
A. Idiot president and owner of Lee Medical College and
85 B. Imbecile Training Hospital
C. Intellectually-challenged E. Dr. Solis, graduated and licensed 1975,
D. Feeble-minded eminent physician, born in Alaminos, retired
E. Morally defective professor of FEU
A 25/M who suffered a concussion 1 year ago is Which among the following differentiates rigor
noted to be completely drunk after intake of 1 cup mortis from cadaveric spasm?
of beer. His drunkenness may be characterized A. Rigor mortis appears immediately after death.
as: B. Cadaveric spasm involves all muscles of the
86 A. Normal drunkenness body.
B. Pathological drunkenness ?? 93 C. Rigor mortis may be used to determine the time
C. Consumption tolerance of death.
D. Constitutional tolerance D. Cadaveric spasm is a constant natural
E. Punch drunkenness phenomena.
A 32/M sustained a 2-cm superficial wound on his E. Cadaveric spasm is characterized by symmetric
left arm but complains of severe unbearable and muscle involvement.
cannot move the affected arm. It is likely that this Post-mortem stoppage of blood flow causes it to
is a case of: deposit in gravity dependent areas, producing the
87 A. Conversion disorder phenomenon called:
B. Feigned malingering A. Livedo reticularis
C. Acute delirium 94 B. Rigor mortis
D. Fictitious malingering C. Ultimen mariens
E. Factitious malingering D. Suggilation
A 21/M who sustained traumatic brain injury to the E. Death struggle
anterior cranium was found to have cerebral A 12/F drowned in a swimming pool. On autopsy,
hemorrhage at the temporoparietal area. In legal the lungs had doughy consistency and exuded
parlance, the mechanism of injury for this water and froth on suction. This observation is
88 particular case is called: designated as:
A. Coup injury 95 A. Agua d’ pulmones
B. Contrecoup injury B. Emphysema aquosum
C. Coup contrecoup injury C. Edema aquosum
D. Locus minoris resistencia D. Champignon d’ ocume
E. Basilar skull fracture E. Tete de negri
A 42/F undergoes emergency surgery. However, Failure of a physician to perform his duty, with
due to the difficulty of operation, the primary resultant injury to the patient constitutes:
surgeon calls another surgeon to do it for him. If A. Medical malpractice
the original surgeon charges the patient for the B. Civil malpractice
89 surgery, he is guilty of: 96 C. Administrative malpractice
A. Phantom surgery D. Illegal practice of medicine
B. Implied surgery E. Contributory negligence
C. Quasi-surgery A child conceived by the sexual union of a
D. Ghost surgery prostitute and a seminarian is considered
E. Blanket surgery A. Sacrilegious child
A physician who engages in false, who engages in B. Manceras child
97 C. Incestuous child D. type IV
D. Adulterous child E. type V
E. Spurious child A 45/M presents with hematuria. Further
A physician provides written documents composed questioning revealed unintentional weight loss and
of physician notes and laboratory finding easy fatigability. Examination revealed a left-sided
concerning the death of a patient in court. This 106 varicocoele. CBC revealed a Hgb of 23. Which
98 type of evidence is classified as: among the following are expected histopathologic
A. Autoptic evidence changes associated with this condition?
B. Testimonial evidence A. Homer-Wright pseudorosettes - neuroblastoma
C. Documentary evidence B. triphasic combination of cells
D. Circumstantial evidence C. clear cells – renal cell CA
E. Corpus delicti D. coffee-bean nuclei – Brenner tumor
A 41/F widow enticed a 12/M to sexual intercourse E. Orphan Annie cells – papillary thyroid
and succeeded. What crime was committed? A 28/F presents with subacute onset of cloudy
A. Statutory rape vision in 1 eye, with pain on movement of that eye.
99 B. Qualified seduction She has occasional parethesias and difficulty of
C. Consent seduction ambulation. The tone of her voice continually
D. Act of lasciviousness 107 changes while you interview her. Which among the
E. No crime was committed following best explains her condition?
An innocent bystander is killed by a bullet that A. multiple sclerosis
ricocheted from the ground after being fired by a B. amyotrophic lateral sclerosis
policeman pacifying a nearby riot. The policeman C. Guillain-Barre syndrome
100 is guilty of: D. normal pressure hydrocephalus
A. Impossible crime E. parasagittal meningioma
B. Violent death A 25/M presents with a slowly enlarging,
C. Serious physical injury nonpainful right neck mass. Biopsy done revealed
D. Simple imprudence lymphocytes with bilobed nucleus and prominent
E. Reckless imprudence 108 eosinophilic inclusion-like nuclei. Which among the
following best explains this patient’s condition?
PATHOLOGY A. Burkitt’s lymphoma
A 46-year-old woman presents with a 6-week B. Hodgkin’s disease
history of progressive weakness in her thighs and C. CMV infection
upper arms. On examination she has a periorbital D. Infectious mononucleosis
101 heliotrope rash, violaceous papules on the E. Langerhans histiocytosis
metacarpophalangeal joints, and capillary nail-fold Nests and tongues of malignant squames that are
dilation. Which among the following best accounts seen in squamous cell cancers are best described
for her present condition? pathologically as?
A. systemic lupus erythematosus A. actinic keratosis
B. dermatomyositis 109 B. cutaneous horns
C. mixed connective tissue disease C. acrochordons
D. rheumatoid arjthritis D. keratoacanthomas
E. polymyositis E. keratin pearls
Gastric cancer is most related to which among the Which among the following is abnormal in
following risk factors? Hemoglobin Barts disease?
A. Diet A. alpha globin
B. Ethanol 110 B. beta globin
102 C. Smoking C. gamma globin
D. Antacid D. delta globin
E. Infections E. tetra globin
A 50/M presents with a history of chronic cough, A patient dies of community-acquired pneumonia
weight loss and decreased appetite. CXR showed due to Streptococcus pneumoniae. Sections of his
peripheral mass. Which among the following best lungs revealed numerous red blood cells and
accounts for this patient’s condition? 111 neutrophils. At which phase of illness did the
103 A. Small cell carcinoma patient succumb?
B. Squamous carcinoma A. congestion
C. Adenocarcinoma B. red hepatization
D. Large cell carcinoma C. gray hepatization
E. Bronchioalveolar carcinoma D. resolution
A 10/F presents with a 2-day history of fever and E. complication
sore joints. Further questioning reveals that she A 30/F African American woman has a chest x-ray
had a sore throat 3 weeks ago but did not seek that shows bilateral hilar lymphadenopathy and
any medical help at this time. Which among the diffuse abnormalities of the lung parenchyma.
104 following histopathologic findings best characterize 112 Biopsy reveals non-caseating granulomas. All
her condition? culture studies are negative. Which of the
A. Janeway lesions following is the most likely diagnosis?
B. verrucous endocarditis A. Coccidioidomycosis
C. tigered myocardium B. Histoplasmosis
D. Aschoff bodies C. Leprosy
E. MacCallum plaques D. Sarcoidosis
Which type of hypersensitivity best characterizes E. Tuberculosis
Hashimoto thyroiditis? Which of the following types of hepatitis is
A. type I associated with polyarteritis nodosa?
105 B. type II A. Hepatitis A
C. type III 113 B. Hepatitis B
 C. Hepatitis C C. Clostridium difficile
D. Hepatitis D D. Shigella dysenteria
E. Hepatitis E E. Salmonella typhi
A 59/F woman presents with complaints of
frequent headaches, which occur on one side and PHARMACOLOGY
are throbbing. Physical examination is remarkable A 57/F with dyslipidemia is treated with sitosterol.
for tenderness over both temples. Laboratory tests What is the primary mechanism of action of this
114 reveal a slightly decreased hematocrit and an drug?
elevated erythrocyte sedimentation rate. This 121 A. Inhibits intestinal cholesterol absorption
patient should be treated aggressively to prevent B. Inhibition of hepatic VLDL secretion
the development of: C. Inhibition of HMG-CoA reductase
A. blindness D. Stimulation of HDL production
B. deafness E. Stimulation of lipoprotein lipase
C. stroke Which among the following is the antidote for
D. arthritis acute lead poisoning?
E. paralysis 122 A. EDTA
Which among the following is seen in alcoholic B. dimercaprol – iron
hepatitis? C. penicillamine
A. Hirano bodies - Alzheimer D. succimer
115 B. Bunina bodies – motor neuron disease E. protamine
C. Mallory bodies Which among the following is the antidote for
D. Councilman bodies – viral HEP acute arsenic poisoning?
E. Negri bodies - rabies A. EDTA
A 4/M presents with recurrent bacterial infections. 123 B. dimercaprol
His stools are greasy and foul smelling. The child C. penicillamine
is growing poorly since birth. Which among the D. succimer
116 following best accounts for this child’s condition? E. protamine
A. Chronic granulomatous disease The primary chemotherapeutic drug for testicular
B. Chediak-Higashi syndrome cancer is?
C. Selective IgA deficiency A. doxorubicin
D. Bruton’s agammaglobulinemia 124 B. methothrexate
E. Severe combined immunodeficiency ???? C. cyclophosphamide
A 6 mo/F presents with a history of restlessness, D. actinomycin D
vomiting and sweating. Symptoms occur between E. bleomycin
meals and subside after feeding. She is small for Which among the following is the analgesic of
117 her age, with protuberant abdomen and choice for biliary colic?
xanthomas on her buttocks. UTZ revealed A. morphine
hepatomegaly. Which among the following 125 B. fentanyl
enzymes are deficient in this patient? C. meperidine
A. hexosaminidase – Tay Sach D. ibuprofen
B. glucocerebrosidase – Gaucher E. tramadol
C. muscle phosphorylase – McArdle V Which among the following best differentiates
D. acid maltase – Pompe II serotonin syndrome from neuroleptic malignant
E. glucose-6-phosphatase – Von Gierke’s I syndrome?
An 18/M is noted to have systolic murmur 126 A. presence of hyperthermia
preceded by a distinct click on auscultation. The B. association with anesthetics
patient has unique body features, with unusually C. treatment with cyproheptadine
118 long legs and long, tapering fingers. An ocular D. unstable vital signs
examination reveals dislocation of the lens. An E. presence of tremors
abnormality of which of the following gene A 32/F presents with a history of progressively
products is thought to underlie this condition. worsening menstrual pain and dyspareunia, that is
A. Collagen type 3 now causing her distress for most of the month.
B. Dystrophin - DMD 127 Rectovaginal exam reveals uterosacral nodularity
C. Elastin and exquisite tenderness. Which among the
D. Fibrillin - Marfan following is the drug of choice for her condition?
E. Myosin A. finasteride
Which of the following types of glomerular injury is B. flutamide
associated with worst prognosis in systemic lupus C. pentoxifylline
erythematosus (SLE) patients? D. megestrol
119 A. Membranous type E. danazol
B. Mesangial type What is the most appropriate pharmacologic
C. Sclerosing type intervention for a patient with postoperative ileus?
D. Diffuse proliferative 128 A. pilocarpine
E. Focal proliferative B. betanechol
A 25/M experiences the gradual onset of C. pralidoxime
intermittent diarrhea, which over years, progresses D. diphenoxylate
120 to severe diarrhea, alternating with constipation, E. loperamide
rectal bleeding, and passage of mucus. Which anti-migraine drug is associated with
Colonoscopy demonstrates inflammation limited to retroperitoneal fibrosis?
the rectum. Flare-ups of his disease condition may 129 A. sumatriptan
be associated with infection with which of the B. ergonovine
following? C. ergometrine
A. Escherichia coli D. methysergide
B. Campylobacter jejuni E. ondansetron
 A 65/M presents with complaints of ringing in his An 18/M with a history of epilepsy complains of
ears, blurred vision and upset stomach. His wife double vision, thickened gums, and growth of
tells you that he has been displaying crazy facial hair since starting a new medication. Which
130 behavior. Which of the following agents might be 139 of the following anticonvulsant medications is most
responsible for this man’s symptoms? likely responsible for his symptoms?
A. Allopurinol A. Carbamazepine
B. Quinidine B. Topiramate
C. Hydralazine C. Phenobarbital
D. Niacin D. Phenytoin
E. Spironolactone E. Lamotrigine
A 42/M with chronic tophaceous gout develops Which among the following drugs is used in the
gradual onset of blurring of vision. On management of myxedema coma?
opthalmoscopy, only a peripheral red-orange reflex A. propylthiouracil
131 was detected. Which among his anti- 140 B. ipodate
hyperuricemic medications could have led to his C. liothyronine
present condition? D. salcatonin
A. Colchicine E. corticosteroids
B. Indomethacin
C. Probenecid INTERNAL MEDICINE
D. Allopurinol What is the most proper route of administration of
E. Naproxen nutrition on a patient who has been comatose for a
Which among the following drugs must be long time?
administered preoperatively to reduce thyroid 141 A. Nasogastric tube feeding
vascularity before a contemplated thyroidectomy? B. Gastrostomy tube feeding
132 A. Lugol’s solution C. Jejunostomy tube feeding
B. propylthiouracil D. Peripheral hyperalimentation
C. methimazole E. Central venous hyperalimentation
D. radioactive iodine A 24/F is brought to the ER after a vehicular crash.
E. pertechnate She has a cervical spine injury. You note that her
Which among the following laxatives causes tongue is swollen and she has difficulty of
pigment deposition in the colon? 142 breathing. Which among the following will you
A. cascara immediately perform to ensure an adequate
133 B. castor oil airway?
C. psyllium A. endotracheal intubation
D. lactulose B. nasotracheal intubation
E. microlax C. tracheotomy
Why hypoglycemia not frequently observed with D. cricothyroidotomy
metformin use? E. rapid sequence intubation
A. It increased hepatic gluconeogenesis. A 4/M admitted at the pediatric SICU develops
B. It decreases hepatic glucose metabolism. continuous bleeding, you have ruled out almost all
134 C. It impairs glucose absorption. possible causes of bleeding. The only abnormal
D. It sensitizes muscles to the effects of 143 parameter you find is a decreased level of gp IB
insulin. from a platelet assay. This should alert you that
E. It mimicks the action of endogenous insulin. the boy has which of the following conditions?
Which anti-TB drug should be used with caution in A. Glanzmann thrombasthenia – IIb IIIa
patients taking anti-arrhythmic drugs due to B. Bernard-Soulier syndrome - Ib
danger of precipitating new arrhythmias as a result C. idiopathic thrombocytopenic purpura
of drug interactions? D. quantitative platelet defect
135 A. ethionamide E. medication overdose with abciximab
B. isoniazid A surgical patient develops metabolic acidosis.
C. ethambutol Which among the following represents the most
D. pyrazinamide important of management for the correction of this
E. streptomycin 144 acid-base abnormality?
Which among the following anti-psychotic drugs A. restoration of perfusion
possess anti-emetic properties? B. administration of bicarbonate
A. Chlorpromazine C. immediate surgical intervention
136 B. Olanzapine D. alkalinization of urine
C. Fluoxetine E. acidification of urine
D. Haloperidol Which of the following represents the most
E. Risperidone common type of malignant melanoma?
Which anti-Parkinsonism drug may also be used in A. acral lentiginous melanoma
the treatment of prolactinomas? B. nodular melanoma
A. levodopa 145 C. amelanotic melanoma
137 B. carbidopa D. superficial spreading melanoma
C. entacapone E. lentigo maligna melanoma
D. amantadine A 55/M was involved in a vehicular crash and
E. bromocriptine presented to the ER unable to void. On
Which among the following is a relative examination he has blood at urethral meatus and
contraindication to the use of corticosteroids? 146 scrotal hematoma. Rectal exam revealed high
138 A. Malignant exophthalmos riding prostaee. What would be the next step in
B. Osteoporosis management of this patient?
C. Peptic ulcer A. Do an immediate surgical repair of urethra
D. Psychosis B. Insert a Foley catheterization
E. Cerebrovascular disease C. Do a retrograde urethrogram
 D. Give a diuretic to increase the urine output
E. Do a retrograde cystogram with post void films
A 35/M is shot in the abdomen with a large caliber
gun. He walks to the ER, alert and awake. On
physical, he has BP of 135/75 mm of Hg, pulse of
147 90/min and respiration rate of 16/min. There is an
entry wound just lateral to the right of the
umbilicus but no exit wound is seen. There is no
rebound or guarding. His blood work up is normal.
The most appropriate management is:
A. Diagnostic peritoneal lavage
B. Ultrasound
C. CT scan
D. Local wound exploration
E. Exploratory laparotomy
A 41/M presents acute onset of breathlessness,
and right-sided chest pain. On examination he is in
severe distress with absent breath sounds on the
148 right and jugular venous distention. What would be
next best step in the management of this patient?
A. chest x-ray
B. arterial blood gas analysis
C. pericardiocentesis
D. needle thoracotomy
E. endotracheal intubation
A 25/M is brought to the ER after a vehicular
crash. You note that he has possible head injuries.
He opens his eyes only to sternal pressure. He
149 utters incomprehensible words and withdraws to
painful stimuli. What is his GCS?
A. 7
B. 8
C. 9
D. 10
E. 11
A 29/M comes in to the ER for scald burns. Using
the rule of nines, he has 36% TBSA of scald
burns. Which among the following represents the
150 most appropriate initial fluid resuscitation to give
him?
A. 5L lactated Ringer’s over 8 hours
B. 6L lactated Ringer’s over 8 hours
C. 10L lactated Ringer’s over 16 hours
D. 10L lactated Ringer’s over 24 hours
E. 5L lactated Ringer’s over 12 hours
Which among the following represents the most
important indicator of organ perfusion
postoperatively?
151 A. mean arterial blood pressure
B. passage of stools
C. urine output
D. acid-base profile
E. serum albumin
Which malignant liver cancer has the best
prognosis?
A. pseudoglandular
152 B. giant cell
C. pleomorphic
D. clear cell
E. fibrolamellar
The most common cause of unilateral bloody
153 nipple discharge in women below 50 years of age
is?
A. fibroadenoma
B. fibrocystic disease
C. invasive ductal carcinoma
D. intraductal papilloma
E. lobular carcinoma in situ
A 68/M with 2 week jaundice consults for lethargy.
He is markedly febrile and hypotensive with RUQ
pain. What is underlying principle for management
154 for this patient?
A. Broad spectrum antimicrobial therapy
B. Aggressive fluid resuscitation
C. Relief of elevated biliary pressure
D. Surgery to remove the gallbladder
E. Wide resection of tumor margins
A 75/M who cannot feed himself is set to undergo
percutaneous gastrostomy. In which area of the
stomach will you place the internal end of the
155 gastrostomy tube?
A. cardia
B. fundus
C. body
D. antrum
E. pylorus
Which among the following represents the most
common type of tracheoesophageal fistula (TEF)?
A. Esophageal atresia with distal TEF
156 B. Isolated esophageal atresia without TEF
C. Isolated TEF
D. Esophageal atresia with proximal TEF
E. Esophageal atresia with proximal and distal
TEF
A 41/M presents at the ER with dyspnea and VAS
10/10 epigastric pain that radiates to the back of 1
hour duration. He also complains of vomiting and
157 watery diarrhea, for the last 4 hours. Palpable
crepitus is noted in the suprasternal notch. The
most probable diagnosis is:
A. Pneumothorax
B. Pancreatitis
C. Perforated peptic ulcer
D. Boerhaave’s syndrome
E. Mallory-Weiss tear
Which of the following is the most appropriate next
step to diagnose Meckel’s diverticulum?
A. Explorative laparotomy
158 B. Angiography
C. Contrast enema
D. Technetium pertechnetate scintigraphy
E. Gastrography
A 52/M trauma patient’s neurological examination
shows paraplegia, with loss of pain and
temperature in both the legs but normal
159 proprioception. Upper extremities do not show any
neurological deficits. Passive straight leg raising
test is negative. A CT scan of spine shows burst
fracture at level of fourth thoracic vertebra. What is
the most likely diagnosis in this patient?
A. Central cord syndrome.
B. Anterior cord syndrome.
C. Brown Séquard syndrome.
D. Acute disk prolapse.
E. Cauda equine syndrome.
After the initial resuscitation, what would be the
next best step in management of a patient with
acute subdural hematoma without CT scan signs
160 of midline shift?
A. Do a craniotomy.
B. Give heparin.
C. Do a MRI.
D. Do a spinal tap to rule out subarachnoid
hemorrhage.
E. Conservative treatment.
SURGERY
A 46/M presents with fever and dyspnea. He has
cough productive of rust-colored sputum. Chest x-
ray reveals lobar consolidation. What is the most
161 common pathologic mechanism for the
development of his condition?
A. Microaspiration of oropharyngeal contents
B. Inhalation on infected droplets
C. Hematogenous spread from another focus of
infection
D. Primary mycobacterial infection
 E. Contiguous spread of infectious particles
A 42/F is brought to the emergency room with
severe respiratory distress. Her husband gives a
history of a bee sting one hour ago. On
162 examination she is in severe respiratory distress
with audible wheezing. What is the most
appropriate next step in management?
A. Give her intravenous steroids.
B. Give her intramuscular epinephrine
C. Give her subcutaneous epinephrine
D. Give her intravenous anti histamines
E. Look for the sting and carefully remove it.
Which among the following represents the
threshold for platelet transfusion?
A. Platelet count < 10,000
163 B. Platelet count < 20,000
C. Platelet count < 30,000
D. Platelet count < 40,000
E. Platelet count < 50,000
Which among the following represents the usual
cause of death in cases of pulmonary embolism?
A. acute respiratory distress syndrome
164 B. pulmonary edema
C. progressive right heart failure
D. shunting of pulmonary blood flow
E. severe ventilation-perfusion mismatch
Which among the following represents the most
appropriate treatment for agammaglobulinemia?
A. bone marrow transplantation
165 B. broad-spectrum antibiotics
C. strict isolation
D. intravenous immunoglobulins
E. plasmapheresis
Which among the following cells are involved in
bronchial asthma?
A. CD8+ T cells
166 B. NK cells
C. monocytes
D. TH2 cells
E. TH1 cells
Which among the following is the single leading
indication for lung transplantation?
A. pulmonary arterial hypertension
167 B. chronic obstructive pulmonary disease
C. pulmonary fibrosis
D. alpha-1 antityrpsin deficiency
E. cystic fibrosis
Which among the following is the leading cause of
morbidity and mortality in patients at every stage
of CKD?
168 A. fluid and electrolyte abnormalities
B. gastrointestinal and nutritional abnormalities
C. cardiovascular abnormalities
D. hematologic abnormalities
E. overt uremia
Suppression of which of the following hormones is
most likely responsible for biliary stones?
A. Secretin
169 B. Cholecystokinin
C. Glucagon
D. insulin
E. Gastrin
Which of the following should be checked next
after obtaining an increased alkaline phosphatase
170 level of unclear etiology?
A. Unconjugated bilirubin level
B. Lactate dehydrogenase level
C. Serum ammonia levels
D. Prothrombin time
E. y-glutamyl transpeptidase
Which of the following is the most likely cause of
gigantism?
171 A. Increased release of insulin from pancreas
B. Increased release of IGF-1 from liver
C. Increased release of IGF-1 from hypothalamus
D. Defective growth hormone receptors
E. Excessive free thyroxine (T4) levels
A 34/M with chronic leprosy is noted to be
cyanotic. However, his lungs are clear and well-
ventilated. His p02 is normal. Which treatment will
172 be of greatest benefit?
A. 100% oxygen by facemask
B. IV methylene blue
C. Megadoses of ascorbic acid
D. Inhaled amyl nitrite
E. Endotracheal intubation
A 51/F complains pain, itching and red streaks in
her left arm. She had a similar episode in her
chest almost 2 weeks ago, but it went away on its
173 own. Her vitals are stable and there is mild
epigastric tenderness. What is the next best step
in this patient?
A. Upper GI endoscopy with barium swallow
B. Chest x-ray
C. Antibiotics and reassurance
D. CT scan abdomen
E. Spiral CT chest
A 51/F obese housewife has chronic bilateral knee
pain. X-ray shows narrow joint space, subchondral
bone cysts, with bony spur. What would be the
single best step in the management of this
174 patient?
A. Muscle strengthening exercise.
B. NSAIDS.
C. Weight loss
D. Chondroitin sulfate.
E. Acetaminophen.
A 62/M with hyperparathyroidism presents with
complaints of pain in his left knee for 2 days.
Examination of the knee joint reveals tenderness,
erythema, and swelling. Which of the following
175 joint fluid aspirate findings best correlates with his
condition?
A. Needle shaped crystals white negative
birefringence
B. Coffin lid shaped crystals
C. Rhomboid shaped crystals with positive
birefringence
D. Needle shaped crystals with positive
birefringence
E. Rhomboid shaped crystals with negative
birefringence
Some patients with tetralogy of Fallot (TOF) are
cyanotic at birth. Others have relatively mild
symptoms and experience only episodic cyanosis
and dyspnea. The severity of symptoms in patients
176 with this disorder largely depends on the severity
of:
A. Right ventricular hypertrophy
B. Ventricular septal defect
C. Pulmonic stenosis
D. Aortic insufficiency
E. Atrial septal defect
A 45/F smoker consults for chest pain. He
describes it to be burning retrosternal pain
radiating to the neck, occurring 30-60 minutes
177 post-meals. What is the most likely mechanism to
account for her disease condition?
A. drug-induced hypotension of the LES
B. transient lower esophageal sphincter
relaxation
C. anatomic disruption of the gastroesophageal
junction
D. hypotensive lower esophageal sphincter
E. coronary artery vasospasm
Which of the following types of myocardial
infraction (MI) is associated with an increased risk
of arterial embolism?
178 A. Anterior wall MI
B. Inferior wall MI
C. Lateral wall MI
D. Posterior wall MI
E. Right ventricular infarct
What is the mechanism of action of
hyperventilation in patients with increased
intracranial pressure?
179 A. acts as stimuli to brain and helps to arouse the
patient.
B. corrects hypoxia.
C. helps to wash out the carbon dioxide.
D. causes vasoconstriction and helps to reduce
intracranial bleeding.
E. causes vasoconstriction and decreases the
cerebral blood flow.
Patients with tetralogy of Fallot (TOE) may
assume a squatting position during episodes of
severe cyanosis and dyspnea (“tet spells”). The
180 posture helps to:
A. Improve respiratory muscle work
B. Decrease pulmonary vascular resistance
C. Increase systemic vascular resistance
D. Decrease pulmonary flow
E. Decrease left ventricular work load
OBSTETRICS & GYNECOLOGY
What is the most common complication of
untreated severe hematocolpos?
A. endometritis
181 B. endometriosis
C. endometrial hyperplasia
D. complex hyperplasia with atypia
E. endometrioid carcinoma
Which among the following best explains why
macrosomic infants are predisposed to dystocia or
cesarean delivery?
182 A. excessive fat deposition on the shoulders
and trunk
B. incoordinate uterine activity
C. abnormal fetal lie or presentation
D. disproportionate increase in size of the fetal
head
E. absence of receptive relaxation in uterine
smooth muscle
Which among the following characterizes the
management of appendicitis during pregnancy?
A. immediate delivery of the baby and removal of
183 appendix
B. supportive management with antibiotics
C. delay surgery until definitive diagnosis is made
D. laparoscopic surgery before peritonitis
occurs
E. induction and augmentation of labor
Which among the following will be detectable at 8
weeks AOG?
A. fetal heart tones by ultrasound
184 B. fetal movement can be appreciated by the
mother
C. uterus is palpable at hypogastric area
D. uterus becomes globular and firmer
E. fetal heart tones by stethoscope
Sugar control before pregnancy in overt diabetics
is important to prevent which among the following
185 fetal outcomes?
A. macrosomia
B. congenital heart disease
C. cephalopelvic disproportion
D. intrauterine fetal demise
E. intrauterine growth retardation
Which among the following is almost always the
predisposing condition to acute pancreatitis in a
pregnant patient?
186 A. alcohol abuse
B. hypertriglyceridemia
C. viral infections
D. hyperparathyroidism
E. cholelithiasis
The obstetrical conjugate cannot be measured
directly with the examining fingers. Anatomically, it
pertains to the distance between the sacral
promontory and which portion of the symphysis
187 pubis?
A. superior end
B. inferior end
C. middle
D. anterior end
E. anterosuperior end
Chorioamnionitis leads to preterm labor by which
among the following mechanisms?
A. activation of the adaptive immune system
188 B. irritation of the amniotic membrane
C. release of anti-inflammatory cytokines
D. production of prostaglandins
E. IL-12-mediated cervical ripening
Which among the following best characterizes the
Arias-Stella reaction that is associated with both
intrauterine and ectopic pregnancies?
189 A. displacement of the squamocolumnar junction
B. endocervical gland hyperplasia and
hypersecretion
C. atypical glandular hyperplasia
D. crystallization and beading of the cervical
mucus
E. eversion of the proliferating columnar glands
A 22/F G1P0 12 weeks AOG presents with vaginal
bleeding and lower abdominal pain. She describes
passage of meaty tissues with the bleeding. On
190 speculum examination, the cervix is closed. Based
on these findings, what is the most likely
diagnosis?
A. Incomplete abortion
B. Completed abortion
C. Hydatidiform mole
D. Inevitable abortion
E. Ectopic pregnancy
A 17/F presents with 1 day history of lower
abdominal pain. Her LMP was two weeks ago.
She is afebrile and her vital signs are stable. On
191 examination, both the left and right lower
quadrants are tender to deep palpation without
guarding. CBC and HCG are within normal. She
most likely has:
A. Ectopic pregnancy
B. Ovarian torsion
C. Mittelschmerz
D. Appendicitis
E. Pelvic inflammatory disease
In the immediate postpartum period, 20/F G1P1
(1001) consults for bloody vaginal discharge. On
examination you notice a sweetish odor, and
bloody discharge along with some small blood
192 clots on the introitus and vaginal walls. Initial labs
reveal WBC of 10,000 with predominant
granulocytes. What is the most appropriate next
step in management?
A. Reassurance
B. Curettage
C. Give oral antibiotics
D. Order urinalysis
E. Culture of discharge
A 26/F consults for recurrent 2nd trimester
spontaneous abortions. Review of systems
reveals photosensitivity and occasional hematuria.
193 On examination, you observe a bilateral malar
rash. What is the most likely responsible for her
abortions?
A. Lupus anticoagulant
 B. Vasospasm
C. Chromosomal abnormalities
D. Infection
E. Cervical incompetence
While performing IE on a 27/F G1P0, you note
cervix is 50% effaced and 2cm dilated. You also
note a pooling of clear fluid in the posterior fornix,
which reacts with Nitrazine paper by turning it from
194 yellow to blue. What is the most likely diagnosis?
A. Placenta previa
B. Congenital fetal tachycardia
C. Chorioamnionitis
D. Placental abruption with concealed hemorrhage
E. Maternal pyelonephritis
After placing fetal heart monitoring and external
tocometer, you note repetitive decreases in fetal
heart rate which exactly coincide with the uterine
195 contraction. Which of the following corresponds to
the mechanism by which the noted fetal heart
pattern occurs?
A. Period of fetal sleep
B. Fetal cord compression
C. Fetal head compression
D. Uteroplacental insufficiency
E. Intrauterine infection
Suction curettage for hydatidiform mole is
performed on a 27/F primigravida. 1 week post-op
her beta hCG levels were normal. From that point,
how should you monitor her beta hCG levels?
196 A. every 2 weeks until the titers become
normal for 3 consecutive determinations
B. every 2 months until the titers become normal
for 3 consecutive determinations
C. monthly for 6 months, then discontinue
D. every 2 months for the next 6 months, then
discontinue
E. every 3 weeks until the titers become normal for
3 consecutive determinations
Histological examination of an ovarian new growth
revealed Walthard cell nests with coffee bean
nuclei and cords of transitional cells. This is most
consistent with a diagnosis of:
197 A. Serous cystadenoma
B. Krukenberg tumor
C. Metastatic transitional cell bladder CA
D. Brenner tumor
E. Mucinous cystadenoma
A 24/F undergoes exploratory laparotomy and
right ovarian cystectomy. Microscopically the cyst
has cartilage, adipose tissue, intestinal glands,
198 hair, and a calcification that appears to be a tooth.
There is also a large amount of thyroid tissue.
Which of the following is the most likely diagnosis?
A. Benign cystic teratoma
B. Ectopic pregnancy
C. Gastric carcinoma
D. Struma ovarii
E. Metastatic thyroid carcinoma
To prevent successive pregnancies in a sexually-
active female who has just given birth, when
should you give contraceptives?
199 A. immediately postpartum
B. after 1 month
C. after 3 months
D. after 6 months
E. after resumption of her menses
Which among the following best explains
hypothalamic amenorrhea?
A. decreased prolactin
200 B. decreased dopamine
C. increased GnRH pulsatility
D. increased estrogen
E. increased inhibin
PEDIATRICS
A 12/M has been having serial convulsions without
return of consciousness for the past 30 minutes.
He is given Lorazepam but convulsive activity
201 persists. Which among the following anti-seizure
drugs should be administered next?
A. Phenytoin
B. Phenobarbital
C. Propofol
D. Midazolam
E. Valproic acid
Which among the following does NOT warrant a
search to determine the cause of jaundice?
A. appears in the 1st 24-36 hr of life
202 B. serum bilirubin is rising at a rate faster than 5
mg/dL/24 hr
C. serum bilirubin is >12mg/dL in full-term infants
D. jaundice persists after 10-14 days of life
E. indirect-reacting bilirubin is >2 mg/dL at any
time
A 4/M is brought by her mother to your clinic. On
examination, you note a nontender, firm, irregular
abdominal mass that crosses the midline. Which
203 among the following is the most likely etiology of
this mass?
A. Wilms tumor
B. chloroma
C. neuroblastoma
D. hepatoblastoma
E. paraganglioma
Which among the following tests proves
occurrence of transplacental hemorrhage by
demonstrating significant amounts of fetal
204 hemoglobin and red blood cells (RBCs) in
maternal blood on the day of delivery?
A. Mentzer index
B. Apt-Downey test
C. flow cytometry
D. Kleihauer-Betke test
E. dilute Russell viper venom time
A 13/M previously diagnosed with juvenile
rheumatoid arthritis develops profound anemia
associated with thrombocytopenia or leukopenia
205 with a high, spiking fever, lymphadenopathy, and
hepatosplenomegaly. Which complication has
most likely occurred?
A. macrophage activation syndrome
B. immune reconstitution syndrome
C. hemophagocytic lymphohistiocytosis
D. Pel-Ebstein syndrome
E. cytokine storm syndrome
A 4-day-old baby presents with bilious vomiting
and significant abdominal distension. Explosive
passage of stools occurs after a doctor inserts a
206 finger into the rectum. Which among the following
represents the most appropriate diagnostic test for
condition?
A. barium enema
B. anorectal manometry
C. rectal biopsy
D. anorected ultrasound
E. plain abdominal CT scan
A previously healthy 9-month-old infant presents
with a 4-day history of sudden-onset high fever of
104˚F (40˚C) that has since been intermittent,
peaking in the early evening. Today his, fever is
207 resolved but he has developed an eruption
consisting of rose-red macules 2 to 5mm in
diameter on his trunk and proximal extremities.
Which among the following best explains his
condition?
A. rubeola 1
B. rubella 3
 C. exanthema subitum 5 D. Pseudomonas aeruginosa
D. erythema infectiosum 6 E. Mycoplasma pneumonia
E. Duke’s disease 4 An 8-hour-old newborn is found to have a swelling
In an air-conditioned room not warmer than 25 C, in the scalp. On examination, the swelling is
how long can you store breast milk? limited to the surface of one cranial bone; there
A. 30 minutes are no visible pulsations, indentations of the skull,
208 B. 1 hour 216 or discoloration of the overlying scalp. Which of
C. 2 hours the following is the most likely diagnosis?
D. 3 hours A. Cephalhematoma
E. 4 hours B. Caput succedaneum
A premature newborn demonstrates forced C. Cranial meningocele
expiration against a partially closed glottis. Which D. Intracranial hemorrhage
among the following best explains why this E. Depressed skull fracture
209 occurs? On examination, you note that an infant walks
A. to increase inspiratory pressure alone, knows two words, throw objects, and
B. to increase gas exchange time comes when called. What is the most likely age of
C. to increase chest wall compliance this infant?
D. to decrease lung compliance 217 A. 6 months
E. to improve the ventilation-perfusion ratio B. 9 months
Which among the following is an absolute C. 12 months
contraindication for phototherapy? D. 15 months
A. bronze baby syndrome E. 18 months
210 B. dehydration You are examining a term newborn infant from an
C. hypothermia uncomplicated pregnancy. He is pink, except the
D. porphyria extremities which are blue. He has a HR of
E. overheating 218 150/min, and his respiration is irregular and slow
A 2/F is brought to the ER. The child is irritable but at a rate of 40/min. He coughs on nasal
thirsty and eager to drink. She has slightly sunken stimulation and is noted to have some flexion of
eyeballs and decreased urine output. Her the extremities. What is the Apgar score for this
211 extremities are cool to touch. How will you classify newborn?
her level dehydration? A. 6/10
A. no dehydration B. 7/10
B. minimal dehydration C. 8/10
C. mild to moderate dehydration D. 9/10
D. severe dehydration E. 10/10
E. none of the above A 12/M with nephrotic syndrome develops scrotal
An 18/M with known sickle cell disease presents edema. Which among the following represents the
with sudden onset of dyspnea, weakness, pallor most effective treatment strategy for this
and fatigue. Labs show a sudden fall in 219 complication?
212 hemoglobin concentration and virtual absence of A. corticosteroids
reticulocytes on peripheral blood smear. Which of B. sodium restriction
the following is the most likely diagnosis? C. fluid restriction
A. Hemolytic crisis D. combined diuretic and albumin therapy
B. Splenic sequestration crisis E. hemodialysis
C. Acute chest syndrome Which among the following represents the most
D. Aplastic crisis common major complication of nephrotic
E. Hemolytic uremic syndrome syndrome in children?
A preterm neonate, who is being monitored in the 220 A. hyperlipidemia
neonatal intensive care unit, is beginning to have B. thromboembolic events
increased gastric residues. Pneumatosis C. spontaneous bacterial peritonitis
213 intestinalis is seen on babygram. What is the most D. acute renal failure
likely cause for this child’s present condition? E. rapidly progressive glomerulonephritis
A. Tracheo-esophageal fistula
B. Necrotizing enterocolitis PREVENTIVE MEDICINE
C. Duodenal atresia A 65/M with COPD presents with chronic
D. Meconium aspiration syndrome symptoms of shortness of breath and productive
E. Pyloric stenosis cough. Which of the following vaccination should
A 2/M is referred for white eye-reflex. The mother 221 be given to him annually?
says that she suspects her child to have a hearing A. influenza vaccine
problem. On examination you notice a continuous B. H. Influenza B vaccine
214 machinery murmur over the right 2nd intercostal C. Meningococcal vaccine
space. What is the most likely diagnosis? D. Pneumococcal vaccine
A. Sturge Weber syndrome E. Td vaccine
B. Retinoblastoma A 23/F medical student got a needle stick-injury
C. Congenital rubella syndrome while drawing blood from a patient who is suffering
D. Congenital CMV infection from acute HBV infection and he is HBsAg
E. Congenital Toxoplasma infection positive. She received HBV vaccination 5 years
A 6/M is hospitalized for pneumonia. Chest x-ray 222 ago and had a documented response to the
reveals consolidation with pneumatocoele vaccine. What will be the most appropriate next
formation. Which of the following is the most likely step in management?
causative agent for his disease condition? A. Administeration of HBIG
215 A. Esherichia coli B. Vaccination against HBV
B. Staphylococcus aureus C. Give both HBIG and HBV vaccine
C. Streptococcus pneumoniae D. Testing for anti-HBsAg
 E. Reassurance
Which of the following smokers has the highest
risk of developing lung cancer?
A. An asbestos worker
223 B. A uranium miner
C. A coal worker
D. A textile worker
E. A sandblaster
Which of the following findings is most consistent
among offenders in cases of child sexual abuse?
A. Alcohol abuse
224 B. Psychiatric illness
C. Prior sexual abuse
D. Relative or known to the child
E. Stranger to the child
Which of the following patients is at highest risk of
adverse effects from iron deficiency anemia?
A. A postmenopausal woman
225 B. An elderly widow living alone
C. A breast-fed one-month-old infant
D. A 10-month-old with a diet of cows milk
E. A 14-year-old with heavy periods
A 35/M executive is angry about lack of space in
the parking lot of your clinic. He angrily told you
that he is a wealthy businessman and works 18-
226 hours a day. His speech was pressured. This
patient’s attitude makes him at risk for?
A. Cancer
B. Stroke
C. Coronary artery disease
D. Migraine
E. Pancreatitis
Which of the following can be potentially used as a
screening test for ovarian cancer?
A. Annual bimanual examination
227 B. Pap smear
C. CA 19-9
D. CA 125
E. Prophylactic oophorectomy
Which of the following is the most appropriate next
step in management of a patient newly diagnosed
to have hypercholesterolemia without coronary
228 artery disease?
A. No further intervention is needed in this patient
B. Start the patient on lifestyle modification to
reduce blood lipids
C. Start the patient on lipid lowering drug therapy
D. Start the patient on lifestyle changes and drug
therapy to decrease blood lipids
E. Start the patient on lifestyle changes, aspirin
and statins
Which of the following is the gold standard
investigation for osteoporosis?
A. X-ray pelvis and spine
229 B. Dual energy X-ray
C. Quantitative computerized tomography
D. Densinometry
E. Dual photon absorptiometry
A study was conducted to assess the relationship
between a particular 5-lipoxygenase genotype and
atherosclerosis. The study population was
230 randomly selected. The investigators took blood
samples for leukocyte genotyping and performed
ultrasonography to assess carotid intima-media
thickness. Which of the following choices identifies
the study design used by the investigators?
A. Prospective cohort study
B. Retrospective cohort study
C. Case-control study
D. Cross-sectional study
E. Randomized clinical trial
Which of the following factors is associated with
decreased drug use among young adults?
A. Low socioeconomic status
231 B. Early drug use
C. Marriage
D. Parental drug use
E. Depression
A new multidrug chemotherapy regimen
significantly prolongs the survival in patients with
lung cancer. If this new regimen is widely
232 implemented, what changes in prevalence and
incidence of lung cancer would you expect?
A. Incidence will decrease, prevalence will
decrease
B. Incidence will increase, prevalence will increase
C. Incidence will not change, prevalence will
increase
D. Incidence will not change, prevalence will not
change
E. Incidence will decrease, prevalence will
increase
A cohort study was conducted to evaluate the
relationship between multivitamin use and colon
cancer among middle-aged women. The
233 investigators reported that the women who
consumed multivitamins for two years or longer
had decreased risk of colon cancer (RR = 0.75, p
= 0.02), but the women who took multivitamins for
a period of less than two years, had no change in
the risk of colon cancer (RR = 1.03, p = 0.80). The
phenomenon described above is an example of:
A. Selection bias
B. Confounding
C. Latent period
D. Measurement bias
E. Lead time bias
Photokeratoconjunctivitis is most likely caused by:
A. Infrared radiation
B. Visible radiation
234 C. Ultraviolet radiation A
D. Magnetic radiation
E. Ultraviolet radiation B
Which of the following physical characteristics of
water is the most important impediment to
disinfection?
235 A. Color
B. Viscosity
C. Turbidity
D. Density
E. Temperature
The Coronary Drug Project was a randomized trial
to evaluate the efficacy of several lipid-lowering
drugs. The five-year mortality of the men who
236 adhered to the regimen of clofibrate (i.e., took 80%
of their medicine or more) was 15%; among those
assigned to the clofibrate group who were less
compliant, it was 24.6%. The result was highly
statistically significant (p<0.0001). From this one
can conclude
A. Clofibrate was very beneficial to the patients
who took it reliably
B. Clofibrate is not effective unless patients take at
least 80% of the recommended doses
C. Either clofibrate or something associated with
taking it reliably is strongly associated with
reduced total mortality
D. There was a problem with blinding in this study
E. Only those who were compliant should be
included in the data
HIV-infected persons are at highest risk of having
an active TB infection resistant to:
A. Izoniazid
237 B. Rifampin
C. Streptomycin
D. Ethambutol
E. Pyrazinamide
Which is the most appropriate intervention for
 malaria prophylaxis for a patient planning a trip to
Palawan?
A. No prophylaxis
238 B. Chloroquine
C. Doxycycline
D. Artemsinin
E. Primaquine
Which of the following is the best statistical
method to compare the average cholesterol level
for males and females?
239 A. Two-sample t test
B. Two-sample z test
C. Analysis of variance (ANOVA)
D. Chi-square test
E. Meta-analysis
Ten measurements of systolic blood pressure
were obtained from a patient in ICU using intra-
arterial canula over several hours. The maximal
value recorded is 120mmHg and the minimal
240 value is 100 mmHg. If the next measurement
shows the value of 240 mmHg, which of the
following is most likely to happen?
A. Mean would increase significantly
B. Median would increase significantly
C. Mode would increase significantly
D. Standard deviation would not change
E. Range would not change