IM COMPREHENSIVE EXAM

1. You are seeing a patient with the chief complaint of relatively sudden onset of shortness
of breath and weakness but no chest pain. ECG shows nonspecific ST-T wave changes.
You would be particularly attuned to the possibility of painless or silent myocardial
Infarction in the
a. Advanced coronary artery disease patient with unstable angina on multiple
medications
b. Elderly diabetic
c. Premenopausal female
d. Inferior myocardial infarction patient

Source: PreTest Self Assessment and Review Medicine (10th ed)

2. While at the grocery store, you see an elderly lady slump to the floor. Going to her aid,
your first step in Adult Basic Life Support should be the following
a. Assess breathing
b. Establish an airway
c. Determine responsiveness
d. Institute chest compression

Source: PreTest Self Assessment and Review Medicine (10th ed)

3. A 72 years old male presents to the ER with the chief complaint of shortness of breath
that awakens him at night and also night cough. Further questioning confirms recent
dyspnea on exertion. As you pursue the diagnosis of congestive heart failure using the
Framingham criteria, you note the PE findings below. Which of the findings is
considered among the LESS specific minor criteria?
a. Neck vein distention - major criteria
 b. Rales - major criteria
c. Positive hepatojugular reflux - major criteria
d. Bipedal edema

Source: PreTest Self Assessment and Review Medicine (10th ed)

4. A 72 years old male comes to your clinic with intermittent symptoms of dyspnea on
exertion, palpitations, and cough occasionally producing blood. On cardiac auscultation,
a low-pitched diastolic rumbling murmur is faintly heard toward the apex. The origin of
the patient's problem probably relates to
a. Rheumatic fever as a youth
b. Long-standing hypertension
c. Silent MI within the past year
d. Congenital origin

Source: PreTest Self Assessment and Review Medicine (10th ed)

5. A 35 years old male complains of substernal chest pain aggravated by inspiration and
relieved by sitting up. He has a history of tuberculosis. Lung fields are clear to
auscultation and heart sounds are somewhat distant. Chest x-ray shows an enlarged
cardiac silhouette. The next step in evaluation is
a. Right lateral decubitus film
b. Echocardiogram
c. Serial ECGS
d. Cardiac catheterization

Source: PreTest Self Assessment and Review Medicine (10th ed)

6. A 30/M diagnosed with HIV has CD4 T-cell count of 150 cells/uL. Aside from starting
anti-retroviral therapy, prophylactic antibiotic for which opportunistic infection should be
given?
a. Disseminated Mycobacterium avium complex
b. Cryptococcal meningitis
c. Pneumocystis jiroveci pneumonia
d. Cytomegalovirus retinitis

7. A 28/M, presents with fever and chills for 2 weeks. He came from a 4-week vacation in
Palawan, where he did water sports and ate exotic foods. BP 120/70; PR 120/ min; RR
23/min; Temp 40°C. Pale palpebral conjunctiva; slightly icteric sclera. Heart and lungs
normal. Soft abdomen; no tenderness; liver span 12cm; obiit erated Traube's space. Hgb
8 gm/dL; Het 23%; Platelet 175,000 cells/mcL; WBC 10.2 ^3 /mm3; ALT 42u/L; AST
35u/L. What is the most likely diagnosis?
a. Enteric Fever
b. Hepatitis B
c. Leptospirosis
d. Malaria

8. You are a physician in charge of the patients who reside in a nursing home. Several
patients have developed influenza-like symptoms and the community In the midst of an
influenza A outbreak. None of nursing home residents have received the Influenza
vaccine. What course of action is most appropriate?
 a. Give the influenza vaccine to all residents who do not have a contraindication to
the vaccine (ie. allergy to eggs)
b. Give the influenza vaccine to all residents who do not have contraindication to
the vaccine; also give Amantadine for 2 weeks - from the source po
c. Give Amantadine to all residents
d. Do not give prophylactic regimen

9. Rabies, an acute viral disease of the mammalian central nervous system is transmitted
by Infected secretions, usually saliva. Which of the following statements about this
disease is correct?
a. The disease is caused by a reovirus that elicits both complement-fixing and
hemagglutinating antibodies useful in the diagnosis of the disease - rhabdovirus
b. The incubation period is variable and some cases remain asymptomatic for 30
days
c. Only 30% of infected patients will survive - High mortality rate
d. In the Philippines, dogs have been important recent sources of human disease

10. A 25 years old patient presents to the clinic with fever, chills, malaise and myalgia.
Upon examination, the patient was found to have a heart murmur. When asked about
this, patient blatantly denies any history of heart disease and said that he was perfectly
healthy before. There were needle marks over both his arms. What is the most likely
etiologic cause of this patient's
a. Streptococcus viridans
b. HACEK group
c. Staphylococcus aureus
d. Coagulase negative Staphylococci - Staph epidermidis

11. A 50/M, presents with pallor. Denies history of bleeding. Hemoglobin is 100mg/dL;
normal WBC, differential count and platelet count. His reticulocyte index is 1.8% and
peripheral blood smear shows macrocytic RBC. What is the most likely diagnosis?
a. Mild to moderate iron deficiency - Microcytic
b. Anemia of chronic kidney disease -Normocytic or Microcytic
c. Vitamin B12 deficiency - Macrocytic
 d. Intravascular hemolysis - there should be an increase RBC but reticulocyte index
are normal

12. Which of the following bone marrow failure states typically presents with pancytopenia
and a hypocellular bone marrow with replacement of marrow cells with adipose
tissue?
a. Myelodysplastic Syndrome
b. Myelofibrosis
c. Aplastic Anemia
d. Tuberculosis

● Aplastic anemia- pancytopenia with bone marrow hypocellularity.

● Primary myelofibrosis- characterized by marrow fibrosis, extramedullary
hematopoiesis, and splenomegaly.
● Myelodysplasia- cytopenias due to BM failure and high risk for development of AML;
anemia occurs with dysmorphic and usually cellular bone marrow.

13. A 60 year old female was brought to the emergency room because of a fall. X-ray
showed fracture in her right hip. Incidentally, they noticed that there are multiple lytic
lesions throughout the bones. Work-up done showed: “M spike” in serum protein
electrophoresis, elevated calcium and multiple plasma cells in her bone marrow biopsy,
what is the most likely diagnosis?
a. Burkitt lymphoma
b. Langerhans histicytosis
c. Diffuse large cell lymphoma
d. Multiple myeloma

14. A 50 years old women complains of pain and swelling in her proximal Interphalangeal
joints, both wrists and knees. She complains of morning stiffness. She had
hysterectomy 10 years ago. PE shows swelling and thickening of the PIP joints. Hub le
10.3 g/dL, MCV is 80 fL, serum iron is 8 umol/ L, TIBC is 200 ug/dL (N 250 to 370 ug/dL)
and saturation is 10%. The most likely explanation for this case is:
a. Occult blood loss
b. Vitamin deficiency
c. Anemia of chronic disease - sabi sa source
d. Sideroblastic anemia
15. A 35 years old female who is recovering from Mycoplasma pneumoniae develops
Increasing weakness. Her Hgb is 9 g/dL and her MCV is 110. The best test to determine
whether the patient has a haemolytic anaemia is
a. Serum bilirubin
b. Reticulocyte count and blood smear - sabi s pretest
c. Mycoplasma antigen
d. Serum LDH

16. A 55 year old male, a known alcoholic beverage drinker consulted at our institution
and was diagnosed with liver cirrhosis. Three days after, patient had labored breathing,
ABG was requested and revealed metabolic acidosis. Most likely diagnosis?
a. Hepatic encephalopathy* - eto sagot ng lower batch
b. Diabetic coma
c. Septic encephalopathy
d. Alcohol intoxication

17. A 40 years old, male presents with fever, jaundice and right upper quadrant pain.
Hepatitis profile reveals: (+) HBsAg, (+) Anti-HAV IgM, (+) Anti-HBc IgM, (-) Anti-HBC.
What is the diagnosis?
a. Acute Hepatitis B - (+) HBsAg, (+) Anti-HBC IgM
b. Acute Hepatitis A superimposed on chronic Hepatitis B - (+) HBsAg, (+) Anti-HAV
IgM, (-) Anti-HBC IgM
c. Acute Hepatitis A and B - (+) HBsAg, (+) Anti-HAV IgM, (+) Anti-HBC IgM, (-)
Anti-HBC
d. Acute Hepatitis C - (+) Anti-HCV

18. A 45 years old man comes to the clinic for a general check up. You note that he was
diagnosed with ulcerative colitis at age 25. He reports that he hasn’t had many
problems with the colitis over the years, He denies melena, hematochezia, or change in
stool pattern. The most appropriate recommendation for colorectal cancer screening in
this patient is:
 a. Annual digital rectal exam - all px with LGIB or melena, hematochezia, etc
b. Annual stool occult blood testing - used for screening but for UGIB (PUD)
c. Flexible sigmoidoscopy -with scanty intermittent hematochezia and all of the
following features
d. Colonoscopy - gold standard every 10 years if no polyps are detected

19. A 33 years old woman reports intermittent loose stools for the past year. She had
cramps, abdominal pain and a bloating sensation. Defecation seems to relieve the
discomfort. She sometimes has 3-5 bowel movements a day to control the discomfort.
She is not waking up at night with pain or having bowel movements at night. Between
episodes, however, she is often constipated. The most likely cause of this patient’s
diarrhea is:
a. Inflammatory bowel disease
b. Irritable bowel syndrome
c. Lactose intolerance
d. Celiac sprue
● Irritable Bowel Syndrome- usually affects individuals younger than 45
○ Women are 2-3 times more likely to have IBS (80%)
○ Main findings: abdominal pain during morning hours, defecation straining, feeling
of incomplete bowel movement, bloating, passing of mucus

20. A 59 years old woman reports nausea and achy epigastric pain for the last 12 months.
She does not drink alcohol or take any medications and has not had any vomiting or
diarrhea. A serum H.pylori serology is positive. Which of the following causes of
dyspepsia would respond to H.pylori eradication?
a. A. GERD
b. Peptic ulcer disease
c. Irritable bowel syndrome
d. Chronic pancreatitis

21. A 62 year-old retired secretary came to your clinic complaining of pain on the hands of
joints. The pain started about 3 years ago, and is noted most days of the week. The
hand aching is usually worse in the afternoons, though she reports a stiffness or
"gelling" sensation upon waking in the morning that last about 15 to 20 minutes. On
examination, you note hard tissue enlargement of the distal Interphalangeal joints of
both hands. What is your diagnosis?
a. Gout
b. Rheumatoid Arthritis
c. Osteoarthritis - Intermittent stiffness (gel phenomenon), shorter duration (<60
mins), exacerbated by activity
d. SLE
22. A 40 year old female consulted due to difficulty in sleeping with chronic widespread
musculoskeletal pain and tenderness with fatigue, anxiety and depression. What is your
diagnosis?
a. Inflammatory myositis
b. Rheumatoid arthritis
c. Polymyalgia rheumatic
d. Fibromyalgia -

23. A 50 year old male complained of left elbow pain after pulling grasses in his backyard.
The pain is worse with repeated extension and supination of his wrist. What is your
diagnosis?
a. Lateral epicondylitis - Tennis elbow
b. Medial epicondylitis
c. Olecranon bursts
d. Bicipital tendon rupture

24. A 28 year old female with multiple joint pains, weakness, body malaise, fever, and
rashes on sun exposed areas of the body. Your most likely clinical impression is:
a. Systemic lupus erythematosus
b. Rheumatoid arthritis
c. Polymyositis
d. Scleroderma

25. A 23 y.o. Otherwise healthy male had his first acute gouty arthritis. His uric acid is 13
mg/dl. He should be treated with:
a. Colchicine and NSAID followed by low dose allopurinol 100 mg OD once the
arthritis resolves
b. Colchicine alone followed by low dose allopurinol 100 mg OD once the arthritis
resolves
c. NSAID alone followed by low dose allopurinol 300 mg OD once the arthritis
resolves
d. Colchicine alone followed by low dose allopurinol 300 mg 00 once the arthritis
resolves

26. Patient X was 5 years old when she was initially diagnosed with acute rheumatic fever
with carditis causing moderate to severe mitral regurgitation. How long should patient X
receive antibiotic prophylaxis?
a. Up to 10 years old
b. Up to 15 years old
c. Up to 21 years old
d. Up to 40 years old* -basically minimum of 5 years for compliance lang pero
optimally binibigay daw for the whole lifetime ng patient until age 40-45
27. A 60 y/o male caucasian visiting his Filipina girlfriend developed severe diarrhea. He
came in hypotensive and anuric. Hydration, electrolyte replacement and antibiotics
given. His hydration status, creatinine and urine output Improved after 12 hours. What is
the most likely diagnosis?
a. Pre-Renal Azotemia
b. Post-Renal Azotemia
c. Intrinsic Renal Azotemia
d. Acute Tubular Necrosis

28. A 68 years old female ls found confused and hypotensive. She has the following
laboratory results in the ER: Na-130 meq/L, K-2.6 meq/L, CI-70 meq/L, HCO3-50 meq/L,
BUN-40 mg/dL, Creatinine-1.7 mg/dL, ABG- pH 7.63 (NV: 7.35-7.45), pO2 62, pCO2 47
(NV: 35-45), HCO3 30 (NV: 22-26). Which acid-base disorder is present?
a. Metabolic alkalosis
b. Respiratory acidosis
c. Metabolic alkalosis plus respiratory acidosis
d. Respiratory alkalosis
29. A 50y/o male was admitted for severe Right Flank pain that radiates anteriorly toward
the umbilicus. He claims he have passed sandy white materials in the urine in the
past. (+) kidney punch test, Right. Urinalysis revealed cloudy urine, WBC 1-5/hpf, RBC
20-30/hpt and bacteria
a. Urinary Tract Infection
b. Acute Renal Failure
c. Chronic Renal Failure
d. Nephrolithiasis

30. What is the commonly accepted criteria for Initiating patients on maintenance dialysis?
a. GFR of < 15ml/min
b. Hyperkalemia
c. Metabolic acidosis
d. Uremic symptoms

Accepted criteria on maintenance of dialysis: uremic symptoms, intractable

hyperkalemia unresponsive to conservative measures, persistent extracellular
volume expansion despite diuretic therapy, acidosis refractory to medical therapy,
bleeding diathesis, creatinine clearance or estimated GFR <10 mL/min per 1.73
m^2

31. A 43 years old female presents with hypertension, edema, hyperlipidemia, and deep
venous thrombosis in her left leg. Which of the following is NOT necessary to diagnose
nephrotic syndrome?
a. Edema
b. Hypertension (nephritic)
c. Albuminuria
d. Hyperlipidemia
32. A patient with low-grade fever and weight loss has poor excursion on the right side of the
chest with decreased remits, flatness to percussion and decreased breath sounds all on
the right. The trachea is deviated to the left. The most likely diagnosis is?
a. Pneumothorax
b. Pleural effusion - book
c. Consolidated pneumonia
d. Atelectasis

33. A 50 year old male with emphysema and a chest x-ray that has shown apical blebs
develops sudden onset of shortness of breath and left-sided pleuritic chest pain.
Pneumothorax is suspected. Physical examination finding that would confirm the
diagnosis are
a. Localized wheezes at the left base
b. Hyperresonance of the left chest with decreased breath sounds -
c. Increased tactile fremitus on the left side
d. Decreased breath sounds on the left side with deviation of the trachea to the left

34. A 65 years old, male consulted you at the OPD for 3 weeks duration of cough, dyspnea,
low grade fever, night sweats, weight loss and occasional hemoptysis. He was not
previously treated for any pulmonary illness. His wife had been previously treated for any
pulmonary illness. His wife had been previously treated for PTB. He is a 20 pack year
smoker. The sputum AFB turned out to be positive and you decided to request for
sputum GeneXpert. This test detects the gene for resistance to which agent?
a. Isoniazid
b. Rifampicin -
c. Pyrazinamide
d. Ethambutol
35. A 27 year old female, an office worker, visited a local clinic due to a productive cough for
3 days, with yellowish sputum production. It is associated with colds, fever, body
malaise, and loss of appetite. Upon physical examination, chest and lung findings reveal
rales on both lower lung fields. She is most likely having:
a. Systemic Viral infection
b. Pulmonary tuberculosis
c. Community Acquired Pneumonia
d. Bronchial Asthma

36. A 65/M and a chain smoker for 40 pack years smoker came into the hospital
complaining of exertional dyspnea associated with chronic cough and sputum
production. On physical examination, there is note of prolonged expiratory wheezes.
His condition is most likely:
a. Bronchiectasis
b. Pneumonia
c. Chronic Obstructive Pulmonary Disease (COPD)
d. Bronchial Asthma

37. A 35/M Patient came to you due to a sellar mass. Investigation revealed that the patient
had been having problems in temperature regulation, sleep disorders and appetite
problems. Given these, the patients sellar mass most probably is encroaching which of
the following structures?
a. Cavernous sinus
b. Frontal lobe
c. Hypothalamus
d. Optic chiasm

38. A 30 years old female complains of palpitations, fatigue and insomnia. On PE, her
extremities are warm and she is tachycardic. There is diffuse thyroid gland enlargement
and proptosis. There is a thickening of the skin in the pretibial area. Which of the
following laboratory values would you expect in this patient?
a. Increased TSH, Total thyroxine, Total T3
b. Decreased TSH, Increased total thyroxine
c. Increased T3 uptake, decreased T3
d. Decreased TSH, Normal T4

39. A 50 years old obese female is taking oral hypoglycaemic agents. While being treated
for an upper respiratory tract infection, she develops lethargy and is brought to the
emergency room. On PE, there is no focal neurologic finding or neck rigidity. Laboratory
results are as follow: Na- 134 meq/L. K- 4 meq/L, HCO3- 25 meq/L, Glucose 900 mg/dL,
BUN- 84 mg/dL, Creatinine- 3 mg/ dL BP 120/80 sitting, 105/55 lying down. The most
likely cause of this patient's coma is
a. Diabetic ketoacidosis
b. Hyperosmolar coma
 c. Inappropriate ADH
d. Hypoglycemia

40. A 30 years old nursing student presents with confusion, sweating, hunger and
fatigue. Blood sugar is noted to be 40 mg/dL. The patient has no history of diabetes
mellitus, although her sister is an Insulin-dependent diabetic. The patient has had
several similar episodes over the past year, all occurring just prior to reporting for work in
the early morning. On this evaluation, the patient is found to have high insulin levels and
low C peptide level. The most likely diagnosis is
a. Reactive hypoglycaemia
b. Factitious hypoglycaemia
c. Early diabetes mellitus
d. Insulinoma- high C peptide
Factitious hypoglycemia should be suspected in healthcare workers, patients or family members
with diabetes, and others who have a history of malingering. Patients present with
● Symptoms of hypoglycemia
● HIGH insulin WITHOUT concomitant rise in C peptide

41. A 37 year old female presents with severe acute left flank pain radiating to the left groin,
gross hematuria, and dysuria. She recalls passing a "kidney stone" 3 years prior, and
was diagnosed with acid-peptic disease at that time. Initial diagnostic evaluation reveals
an obstructing calculus in the left ureterovesical junction, bilateral nephrocalcinosis, and
multiple stones in the right kidney. Urinalysis: pH 5.5.(-) for protein, 20-30 RBC; 0-2
WBC; serum creatinine 2.3 mg/dL; serum calcium 13.0 mg/dL (normal 8.7-10.2); serum
phosphorus 1.9 mg/dL (normal 2.5 4.3); normal blood uric acid. Repeat serum calcium
levels are persistently elevated. The overall clinical picture is most consistent with:
a. Idiopathic hypercalciuria
b. Secondary hyperparathyroidism
c. Primary hyperparathyroidism
d. Hypercalcemia of malignancy

42. What is the basis of Tc99m sulfur colloid uptake in liver imaging studies?
a. Taken up by catecholamine producing cells
b. Taken up by Kupffer cells
c. Taken up by the hepatocytes
d. Visualized on flow images due to portal vein superiorly

Because the colloidal particles are accumulated mainly in the Kupffer cells of the liver, Tc-99m
sulfur colloid is widely used in the evaluation of liver disease. It is clear that hepatocellular
damage might produce different degrees of Kupffer cell dysfunction.

43. The gold standard for measuring bone density?

a. Central DXA
b. FDG PET
c. Peripheral Quantitative CT scanning
 d. Tc99 Bone Scan

44. Which of the following is a common cause of V/Q (hyperperfusion?) mismatch:

a. Chronic Obstructive Pulmonary Disease
b. Pulmonary Embolism
c. Congestive Heart Failure
d. ??

45. ____ diagnosed with Non-small cell lung ____ stage IV, was rushed to the emergency
room for dyspnea. On physical examination, he was noted to have facial and neck, arm
edema, dilated neck veins and Increased collateral veins covering the anterior chest
wall. Plain CT scan of the chest showed a 5x8 cm central mass, minimal pleural effusion
on the right and opacified central venous structures. What is your working clinical
impression?
a. Pericardial tamponade
b. Superior vena cava syndrome
c. Pulmonary leukostasis
d. Tumor lysis syndrome

When blood flow to the heart is restricted, the increased pressure in the veins of the face and
arms causes edema, or fluid buildup, in these areas. Signs and symptoms of superior vena
cava syndrome include, face and neck swelling, distended neck veins, shortness of breath, and
upper extremity swelling, distended chest veins. Superior Vena Cava Syndrome

46. An 18-year old single female sought opinion regarding cervical cancer prevention. This
was brought about by her mother's recent demise due to cervical cancer. She denies
ever engaging in sexual intercourse. Which of the following cancer prevention strategies
is effective and more appropriate for her?
a. Acetic acid wash
b. HPV vaccination
c. Pap smear
d. Transvaginal ultrasound

47. CA 85/F is a diagnosed case of breast cancer at IV (bone and lung metastasis). She
presents in the emergency room dyspneic and in respiratory distress. Chest x-ray done
showed massive pleural effusion on the left. What is the best way to palilate her
symptoms?
a. Diuretics
b. Drainage
c. Opioids
d. Intubation

48. CA's relative signed a DNI (Do not Intubate) walver and refuses any other invasive
procedures. She has been taking codeine (weak opioid) at home for pain. What can you
still offer her?
 a. Continue codeine and give supplemental oxygen.
b. Discontinue codeine and give supplemental oxygen.
c. Shift codeine to a stronger opioid like morphine.
d. Continue codeine and add morphine

49. A 67 years old male presents with hemoptysis 1 week In duration. He has smoked 15
sticks per day for 50 years and has been unable to quit smoking despite nicotine
replacement therapy. He has mild COPD for which he uses an Tiotropium Inhaler. Chest
x-ray reveals a 3 cm perihilar mass. The most likely cause of patient's hemoptysis is
a. Adenocarcinoma of the lung
b. Squamous cell carcinoma of the lung
c. Bronchoalveolar cell carcinoma
d. Bronchial adenoma

50. A 53 year old man develops dusky red lesions after intake of Allopurinol. Lesions can
be found over the trunk and face with involvement of the eyes and lips but the skin
involvement is <10%. You also notice that there is (+) Nikolsky sign. What is the most
likely __ for this patient?
a. AGEP
b. Erythema multiforme
c. Steven-Johnson syndrome -
d. Vasculitis

51. A 28 year-old woman suddenly develops wheals all over the body with lip angioedema
and difficulty breathing minutes after intake of Amoxicillin. What is the most likely
diagnosis for this patient?
a. Anaphylaxis*****
b. DRESS
c. Maculopapular rash
d. Fixed drug eruption

52. In the previous patient (28/F) in #50, what can we advise her regarding future use of
Amoxicillin?
a. After a month, it will be ok to take Amoxicillin if she needs it since the antibodies
will be cleared.
b. If she will require Amoxicillin, we can give it via intravenous route to avoid an
allergic reaction.
c. It is best to avoid Amoxicillin and other structurally related drugs.
d. She can take Cephalexin instead since they do not cross-react with Amoxicillin

53. While working as a Doctor to the barrio, an 18 years old female patient came to you for
an erythematous slightly painful papule and plaques located at her scalp. She noted the
evolution of these lesions 24 hours after applying a sachet of L’oreal hair color. She had
 previously applied the same product with no untoward incidents. What is your primary
working impression for the case?
a. Allergic Contact Dermatitis
b. Atopic Dermatitis
c. Irritant Contact Dermatitis (irritable si doc kasi loreal lang meron sa barrio)
d. Nummular Eczema

54. What is the initial treatment of anaphylaxis once diagnosis is suspected?

a. Diphenhydramine 50 mg/ intravenously
b. Epinephrine 1:1000 0.1mL/Kg intravenously
c. Epinephrine 1:1000 0.1mL/Kg intramuscularly
d. Hydrocortisone 100mg/ intravenously

55. A 23 year old male 3rd yr medical student presented with pruritic, erythematous plaques
topped with silvery __ scales over the scalp, back, elbows, and knees. He __ the
appearance of lesions on the 2nd day of his final exams. What is the diagnosis?
a. Seborrheic Dermatitis
b. Pityriasis Rosea
c. Pityriasis Rubra Pilaris
d. Psoriasis -

56. A 27-year-old came to see you due to the presence of painful lesions on her left upper
lip. Physical examination shows grouped vesicles on an erythematous base. Your
diagnosis is?
a. Varicella
b. Herpes Simplex Infection
c. Herpes Zoster
d. Chicken Pox

57. A 70 year old male was brought to your clinic due to unilateral involvement of the trunk
with lesions consisting of multiple, well defined, vesicles on an erythematous base.
The patient also complains of sharp and tingling sensations that make it hard for him
to sleep at night. You diagnosed his condition as
a. Varicella
b. Herpes Simplex Infection
c. Herpes Zoster
d. Chicken Pox

58. This parasitic Infection is transmitted through sharing of hats, caps, brushes or combe
and head to head contact
a. Pediculosis capitis
b. Pediculosis corporis
c. Pediculosis pubis
d. Pediculosis palpebrarum
59. A 70 year old farmer noted hyperpigmented, pearly nodule over the tip of the nose
which was reported to bleed easily on slight trauma. The lesion started as a
hyperpigmented macule 5 months ago which eventually grew in size. On physical
examination, telangiectasias and minute erosion over the lesion. What is diagnosis?
a. Squamous cell carcinoma
b. Basal Cell Carcinoma -
c. Melanoma
d. Actinic keratosis

60. An anxious 80-year-old woman presents with multiple complaints. You perform a
thorough evaluation of this patient. Including laboratory work, stress testing with
echocardiography, and pulmonary function testing. When evaluating this woman and her
test results, which of the following is considered a normal finding for her age?
a. A Decrease in creatinine clearance
b. Blood pressure of 160/80
c. Elevated FEV1 value on pulmonary function tests
d. Low-frequency hearing loss

61. Which of the following is TRUE regarding normal aging?

a. All individuals age and lose function at the same rate.
b. Reaction times are unaffected by aging
c. Reasoning and learning are adversely affected by normal aging
d. Personalities remain stable over time with normal aging

62. Routine vaccination of a 65-year-old would include which of the following?

a. Pneumococcal vaccine
b. Meningococcal vaccine
c. Haemophilus influenza B vaccine
d. Hepatitis B vaccine

63. A 65-year old male had a cerebral stroke 3 days ago. He presented with left sided
weakness (⅘ motor score). The caregiver consulted with you because he noticed that the
patient would only respond to things presented to him on the right side but not on the
left. What seems to be the problem?
a. Patient has hemi-neglect.
b. Patient is not able to respond because of the weakness.
c. Patient is just irritable and has a selective response to things.
d. All of the above contributes to the patient’s behavior.

64. A 60 -year old male, who had a right hemispheric stroke complains of difficulty
swallowing. He is fully awake with good cognitive function. Hat maneuver can help him
with his swallowing
a. Flex his head and bend to the right
 b. Flex his head and bend to the left
c. Flex his head and bend forward
d. Flex his head and bend backward

65. In motor recovery in stroke, the first to recover is the:

a. Tone
b. Motor
c. Distal Muscle
d. Upper Extremity

66. A stroke patient is able to drink from a cup but is not able to do it when you ask him to
mimic the task without the cup. What does this patient has?
a. Aphasia
b. Apraxia
c. Agnosia
d. Amnesia

67. Dermatomes and myotomes caudal to the neurological level that remain partially
innervated
a. Incomplete cord injury
b. Zone of partial innervation
c. Conus medullaris syndrome
d. Caudal regression

68. The expected finding of a Chest X-ray of an 85 year old patient with hypertension.
A. Left ventricular enlargement
B. Left atrial enlargement
C. Bi-ventricular cardiomegaly
D. Right ventricular cardiomegaly

69. A 50 year old with fever and cough for one week, chest x-ray showed consolidation with
air bronchogram in the right middle lobe indicates what pathology.
A. Pulmonary edema
B. Pneumonia -
C. Pleural effusion
D. Pneumothorax

70. 45 year old female, overweight presented at the Emergency room of abdominal pain and
(+) sonographic Murphy sign, what imaging modality would you request?
A. CT Stonogram
B. Upper Gastro-intesinal series
C. Ultrasound - RUQ
D. T-Tube cholangiogram
 71. "Meniscus" forming density in the right hemithorax obscuring the diaphragm,
costophrenic sulcus and paracardiac border. What disease entity would you think of?
A. Pneumothorax
B. Pleural effusion
C. Pneumonia
D. Pulmonary congestion

72. A 30 years old male complains of unilateral headaches with rhinorrhea and tearing of the
eye on the side of the headache. Episodes are precipitated by alcohol. Headaches may
become a problem for weeks to months, after which a headache-free period occurs. The
most likely diagnosis is:
A. Migraine
B. Cluster headache
C. Sinusitis
D. Tension headache
Cluster headaches differ from migraines in that they are nonthrobbing and are more common in men.

73. A 36 years old previously healthy woman complains of severe, excruciating headache
and then has a transient loss of consciousness. There are no focal neurologic findings.
The next step in evaluation is:
A. CT scan without contrast

Since mukhang Subarachnoid Hemorrhage to, the probable answer is CT

Angiography with contrast
(Na-cut yung ibang choices huhu)

74. A 58 years old complains of slowly progressive weakness over several months. Walking
has become more difficult, as has using his hands. There are no sensory bowel or
bladder complaints or any problems in thinking, speech or vision. Examination shows
distal muscle weakness with muscle wasting and fasciculations. There are also upper
motor neuron signs, including extensor plantar reflexes and hyperreflexia in wasted
muscle groups. The most likely diagnosis is
a. Polymyositis- also primarily a muscle weakness
b. Duchenne muscular dystrophy- occurs in younger age and involves proximal
muscle weakness.
c. Amyotrophic lateral sclerosis
d. Myasthenia gravis- would not cause hyperreflexia or babinski reflex; it is a
disease of muscle weakness characterized by fatigability
The disease described involves motor neurons exclusively. Amyotrophic lateral sclerosis affects both
upper and lower motor neurons. In this patient, there is upper and lower motor neuron involvement
without sensory deficit.

75. An 18 years old male with resting tremor, bradykinesia, rigidity, drooling, deposits in
cornea and abnormal liver function tests. What is the most likely disease process?
a. Parkinson's disease
 b. Wilson's disease
c. Huntington's disease
d. Dystonia
A movement disorder in itself in a young person suggests Wilson’s disease. This is an autosomal recessive disorder in
which a deficiency in the copper-binding protein ceruloplasmin results in copper deposition in tissue. Copper deposition in
the basal ganglia causes tremor and rigidity. Copper deposition in the eye produces the Kayser-Fleischer ring. Deposition in
the liver causes cirrhosis and hepatitis.

76. An elderly patient with bradykinesia, micrographia and resting tremor. What is the most
likely disease process?
a. Parkinson's disease (PARKinson = resting,brady,micrographia)
b. Wilson's disease
c. Huntington's disease
d. Dystonia
The diagnosis of Parkinson’s is based on resting tremor, cogwheel rigidity, and bradykinesia. Tremor is
low-frequency, occurs at rest, and is pill rolling, with abduction-adduction of the thumb. Bradykinesia is
usually a most striking feature. Micrographia (small handwriting) is also characteristic. Posture is often
stooped with a shuffling gait and easy loss of balance.

77. Rapid, writhing movements in a 40 years old associated with dementia. What is the most
likely disease process?
a. Parkinson's disease
b. Wilson's disease
c. Huntington's disease
d. Dystonia
Huntington’s chorea is suspected in association with dementia and rapid, nonrhythmic movements. The
disease is autosomal dominant and presents in the third or fourth decade of life. There are often slow,
writhing movements called athetosis

78. 3 weeks after an upper respiratory illness, a 25 years old male develops weakness of his
arms and legs over several days. On PE, he is tachypneic with shallow respirations and
symmetric muscle weakness in both arms and legs. There is no obvious sensory deficit,
but motor reflexes cannot be elicited. The most likely diagnosis is:
a. Myasthenia gravis
b. Multiple sclerosis
c. Guillain - Barre syndrome
d. Dermatomyositis
This patient presents with an acute symmetrical polyneuropathy characteristic of Guillain-Barré syndrome.
This is a demyelinating polyneuropathy that is often preceded by a viral illness. Characteristically, there is
little sensory and about 30% of patients require ventilatory assistance.

79. An 80 years old develops steady, progressive memory and cognitive deficit over 2
years. He has normal blood pressure and no focal neurologic findings and workup for
dementia is negative. What is the most likely diagnosis?
a. Senile dementia of the Alzheimher’s type
b. Multi-infarct dementia
 c. Vitamin B12 deficiency
d. Delirium
The 80-year-old patient with progressive, steady memory loss and cognitive dysfunction over 2 years has
not been found to have a reversible cause of dementia by standard workup. The great majority of such
patients have senile dementia of the Alzheimer type.

80. A 60 years old woman admitted for urinary retention develops acute confusion and
disorientation. What is the most likely diagnosis?
a. Senile dementia of the Alzheimher’s type
b. Multi-infarct dementia
c. Vitamin B12 deficiency
d. Delirium
The 60-year-old woman has developed an acute clouding of consciousness and an acute confusional
state described as delirium. This may occur in association with infection, drug effect, acute illness, or
change in environment.

81. A 70 years old male with history of hypertension and previous history of stroke presents
with new focal findings and acute worsening of cognitive function. What is the most likely
diagnosis?
a. Senile dementia of the Alzheimher’s type
b. Multi-infarct dementia
c. Vitamin B12 deficiency
d. Delirium
The 70-year-old with hypertension and previous stroke is most likely to have multi-infarct dementia. This
is a progressive stepwise deterioration, usually the result of recurrent bilateral cerebral infarcts. Focal
findings are common, including hemiparesis, extensor plantar responses, and pseudobulbar palsy.

82. CS, 56 years old female, presents with fever, stiff neck and CSF has positive quellung
reaction. What is the correct diagnosis?
a. Pneumococcal meningitis
b. Cryptococcal meningitis
c. Viral meningitis
d. Brain abscess
Fever and stiff neck with a positive quellung reaction on CSF prove the diagnosis of pneumococcal
meningitis. The CSF of a patient with bacterial meningitis will show thousands of white blood cells, with
more than 90% being polymorphonuclear leukocytes. The protein is always elevated, and glucose is
usually lower than normal. The patient on high-dose corticosteroids with a CSF with a positive india ink
stain has cryptococcal meningitis. Cryptococcal meningitis patients usually have a lymphocytic meningitis
also, with an elevated CSF protein and low CSF sugar. The patient with focal findings and a history of
dental abscess has a brain abscess. Lumbar puncture is contraindicated in the disease, but would usually
show only a small number of white blood cells, if any, and a high protein and elevated CSF pressure.

83. A patient had a history of dental abscess, has focal neurologic findings and low grade
fever. What is the correct diagnosis?
a. Pneumococcal meningitis
b. Cryptococcal meningitis
 c. Viral meningitis
d. Brain abscess
The patient with focal findings and a history of dental abscess has a brain abscess. Lumbar puncture is
contraindicated in the disease, but would usually show only a small number of white blood cells, if any,
and a high protein and elevated CSF pressure

84. A 55 years old diabetic woman suddenly develops weakness of the left side of her face
as well her right arm and leg. She also has diplopia on left lateral gaze. The responsible
lesion is probably located in the
a. Right cerebral hemisphere
b. Left cerebral hemisphere
c. Right side of the brainstem
d. Left side of the brainstem
This patient has weakness of the left face and the contralateral (right) arm and leg, commonly called a
crossed hemiplegia. Such crossed syndromes are characteristic of brainstem lesions. In this case, the
lesion is an infarct localized to the left inferior pons caused by occlusion of a branch of the basilar artery.
The infarct has damaged the left sixth and seventh cranial nerves or nuclei in the left pons with resultant
diplopia on left lateral gaze and left facial weakness. Also damaged in the left pons is the left corticospinal
tract, proximal to its decussation in the medulla; this damage causes weakness in the right arm and leg.
This classic presentation is called the Millard-Gubler syndrome.

85. What type of seizure presents with postictal confusion and deja vu experience?
a. Absence (petit mal) seizure - no post ictal
b. Complex partial seizure
c. Simplex partial seizure
d. Atonic seizure

86. A 55 years old hypertensive presents with contralateral weakness and sensory loss,
worse in face and arm, homonymous hemianopsia, aphasia or neglect syndrome. Where
is the lesion?
a. Internal Carotid artery
b. Middle Cerebral artery
c. Mid Basilar artery
d. Anterior Cerebral artery
Occlusion of the entire middle cerebral artery results in contralateral hemiplegia, hemianesthesia, and homonymous hemianopsia. When the dominant
hemisphere is involved, aphasia is present. When the nondominant hemisphere is involved, apraxia and neglect are produced. When only a
penetrating branch of the middle cerebral artery is affected, the syndrome of pure motor hemiplegia is produced, as the infarct involves only the
posterior limb of the internal capsule, involving only motor fibers to the face, arm, and leg (lacunar infarct).

87. Jane, a 3rd year physical student, was influenced by her peers to use
methamphetamine (MAP). This eventually caused Jane to develop behavioral changes.
Which psychiatric condition is likely to be similar in presentation to this MAP induced
behavioral change?
a. Bipolar I disorder
b. Panic disorder
c. Major depressive disorder
d. Schizophrenia, paranoid type
88. A 21 year old male college student is brought to the ER by his roommate for increasingly
odd behavior. The patient has grown increasingly isolated over the past 3 months with
little interest in socializing. 4 weeks ago, he began accusing his roommate of trying to
“steal thoughts” from his head (delusion). His schoolwork has become increasingly
disorganized and he has missed several deadlines for papers (avolition). On the day of
admission, the roommate heard the patient talking to himself. His PE is unremarkable
and urine toxicology is negative for substances. He is noted to have blunted affect
(negative symptom) and reports hearing voices (auditory hallucinations). Which of the ff
is most likely the diagnosis?
a. Brief psychotic disorder (1 day to 1 month)
b. Schizophrenia (> 6 months)
c. Delusional disorder
d. Schizophreniform disorder (1-6 months)

89. For a manic episode, the symptoms of mania should last for not less than.
a. 4 days (hypomania)
b. 7 days (mania)
c. 14 days
d. 30 days

90. A 31 year old woman has refused to leave her home for the past 4 months. She had
been on a crowded train when she felt lightheaded and nervous, had a headache, and
felt like she could not breathe. She felt a tingling in her left arm & left side of her head.
Since then, she has been afraid of going out on her own, worried that another attack
 would happen and no one would help her. She has no prior medical history, and the
attack does not occur at home. Which of the following is the most likely diagnosis?
a. Agoraphobia
b. Major depressive disorder
c. Generalized anxiety disorder
d. Panic disorder

91. A 27 year old woman, after undergoing selective cosmetic breast augmentation
surgery, presents to her surgeon dissatisfied with the results and requesting more
surgery, even though she has received compliments from both her friends and her
husband regarding her new appearance. She has had no medical complications from
the procedure. The patient, who weighs 115 pounds, tells her surgeon that she has
been preoccupied with her breast size since she was a teenager and that she has
difficulties in relationships with previous boyfriends because she felt that they viewed her
as inadequately feminine. She describes that she also had difficulties in the past
because of the excessive amount of time she spends working out at the gym and
jogging to maintain her figure. Which of the following is the most likely diagnosis?
a. Body dysmorphic disorder
b. Functional neurological disorder
c. Delusional disorder
d. Somatic symptom disorder

92. A 15 year old boy is brought in by his mother to see a psychiatrist for “strange behavior”.
She reports that her son is often late for school because he spends more than an hour in
the shower every morning. When asked about this, he says that he takes a long time
because he feels compelled to wash himself in a certain manner and he has to repeat
the whole process if he makes a mistake. He knows it sounds ridiculous, and that it
makes him late for school & other activities, but he cannot seem to stop himself. In
addition, he has found it difficult to fall asleep at night because he needs to constantly
check that he has set his alarm for the morning. Which of the following is the most likely
diagnosis?
a. Bipolar 1 disorder
b. Schizophrenia
c. Generalized anxiety disorder
d. Obsessive-Compulsive disorder

93. Which of the following statements is true regarding psychotropic agents?

a. Decisions on drug selection are made on a case to case basis, relying on
individual judgment by the physician
b. Psychotropics have varying effectiveness for the indicated disorder, and differ
considerably in pharmacology & adverse effects on patients
c. Psychotropics help cure the disorder
d. The risk for life threatening side effects with psychotropics is high
 94. This type of receptor interaction refers to a … that produces an effect identical to that
usually induced by a neurotransmitter affecting that receptor
a. Antagonist
b. Inverse agonist
c. Full agonist
d. Partial agonist

95. A 39 year old male was brought to the outpatient clinic accompanied by his wife. 6
months ago, he complained that his neighbors were spying on him and devising ways to
kill him. He states that the neighbors have inserted cameras in several rooms of his
house to monitor his activities. He claims to hear them through the walls saying they are
going to kill him. The wife called the police when he bought a gun stating that he was
going to kill the neighbors “in self defense”. What is the most likely diagnosis?
a. Bipolar 1 disorder most recent episode manic
b. Schizophrenia
c. Delusional disorder - (Persecutory type)
d. Schizophreniform disorder

96. This patient was prescribed an atypical antipsychotic. After 2 months of treatment, the
patient's auditory hallucinations resolved. However, the paranoid delusions persisted.
What is the treatment outcome for this patient?
a. Relapse
b. Remission - (partial remission)
c. Response
d. Treatment failure

Remission - is a term that refers to the absence of disease.

Relapse - means the disease has reappeared after a period of remission.

97. A 43 year old man with a 20 year history of schizophrenia presents to his psychiatrist for
follow up. He is currently taking chlorpromazine at bedtime. The psychiatrist noted
abnormal, involuntary, Irregular choreoathetoid movements of the limbs. He likewise
 noted perioral movements of the tongue, lip puckering and facial grimacing. What
neuroleptic induced side effect is this patient likely experiencing?
a. Akathisia
b. Movement disorder
c. Parkinsonism
d. Tardive dyskinesia

The presence and severity of tardive dyskinesia were determined in 66 patients with chronic
psychiatric disorders treated with chlorpromazine. - pubmed CNS side effects of
Chlorpromazine: include dystonias, motor restlessness, pseudo-parkinsonism and tardive
dyskinesia, and appear to be dose-related.

98. The family of a 42 year old pianist brings her to a psychiatrist for evaluation. She tells the
psychiatrist that a famous conductor is in love with her and is planning to leave his
wife so they can be married. She had met him once at a reception while on tour in the
United States with the philharmonic orchestra. She tells the psychiatrist that, during his
concerts, he gives her signals that he loves her. In addition, the family reports that she
somehow got his e-mail address and has been sending him messages. She denies
having perceptual disturbances. Which of the following subtype of delusion does this
patient most likely have?
a. Erotomanic
b. Somatic
c. Grandiose
d. Paranoid

A person with erotomania has a delusional belief that another person is in love with him or her
despite clear evidence against it. The object of the person’s delusions is often a celebrity or a
person of a higher social status. An individual may believe that this person is communicating
with them and affirming their love, using secret messages.

99. A 45 year old man is admitted to the intensive care unit for trauma-related Injuries
sustained in a car accident. Thirty-six hours after admission, he becomes agitated. He is
pulling at his IV lines and is disoriented to place and time. His blood pressure is 190/110
mmHg, his pulse is 114/min, and with tremors on both hands. A reliable history from the
patient's son reveals that the patient is alcohol dependent. What is the most likely
diagnosis?
a. Alcohol withdrawal
b. Delirium
c. Bipolar I disorder
d. Schizophrenia

100. A 57 year old female accompanied by her husband was been by a psychiatrist. The
patient has no significant past medical or psychiatric history. She admits to depressed
mood, decreased appetite, a 10 pound weight loss, Initial insomnia, decreased
ability to concentrate and mild memory problem for the past three weeks. On
 further questioning, she feels hopeless & helpless. On mental status examination, the
patient appears calm and is cooperative. Affect is appropriate. There is no evidence of a
thought disorder. What is the most likely diagnosis?
a. Alzheimer's dementia
b. Major depressive disorder
c. Bipolar I disorder
d. Schizophrenia

Major Depressive Disorder DSM criteria

101. Allan and Charm have been married for 10 years. One day, Allan made a statement
in a family gathering that he enjoyed wearing female clothing and that it has been years
since he recalled that he is a woman trapped in a man's body. He claimed that his wife
is aware of such thoughts and behavior. He,
however, admits that he still prefers to have
sexual intercourse with his wife. What is
Allan's Gender Identity?
a. Female
b. Heterosexual* feel ko itu sagot kasi
cross-dresser siya under ng
transgender (yung gender expression
niya) then prefers pa rin kay wifey niya
makipag boom boom pow so
heterosexual parin siya ¯\_(ツ)_/¯ (i
think C, kasi gender identity tanong not
sexual orientation?) [joke gender
identity pala so female dapat]
c. Homosexual - (kasi naniniwala siyang
babae siya, and attracted din siya sa
babae. Tama vuh) okianjfbakjdi rainbow
d. Male
 1. Target BP for DM
a. 130/90 A. Squamous cell
2. The treatment of choice for anemia B. Large cell
of chronic renal disease C. Adenocarcinoma
a. Erythropoietin D. Small cell
3. A 55-year-old diabetic patient
presents with heartburn and acidic 8.If despite defibrillation, a pulseless patient
eructation for 2 years. Endoscopic has persistent ventricular fibrillation, the use
biopsy of a patch of hyperemic of which drug would be most appropriate?
mucosa 3 cm. above the
gastroesophageal junction showed A. Lidocaine
squamous epithelium with B. Procainamide
inflammatory cells. The patient most C. Amiodarone
likely has: D. Epinephrine
a. Barrett's esophagus
b. Gastroesophageal reflux 9.Autosomal dominant polycystic kidney
disease disease (ADPKD) is an inherited monogenic
c. Candidal esophagitis kidney disorder characterized by the
d. Herpes simplex esophagitis development of cysts within the kidneys.
4. The most common organism Although it is a rare disorder, occurring in
isolated from the ascitic fluid of approximately 1 in every 1000 people,
patients with spontaneous bacterial ADPKD is the fourth-leading cause of
peritonitis is: end-stage renal disease, and more than half
a. Streptococcus pneumoniae of patients with ADPKD develop kidney
b. Staphylococcus aureus failure by 60 years of age. Patients
c. Escherichia coli experience diminished quality of life owing
d. Bacteroides fragilis to substantial symptom burden, including
flank and abdominal pain, urinary tract and
5. A person with known allergy to cyst infections, kidney stones, hematuria,
penicillins should not be given and hypertension, and they are at increased
a. Cotrimoxazole risk for cardiovascular events, intracranial
b. Tetracycline aneurysms, and mortality. In recent years,
c. Erythromycin improved understanding of the molecular
d. Cefalexin pathogenesis and treatment of ADPKD has
led to novel treatment options and improved
6. Psamomma bodies are characteristic of: management. Which statement regarding
dietary interventions in ADPKD is accurate?
A. Follicular Thyroid CA
B. Papillary Thyroid CA A. A low-protein diet has been shown
C. Parathyroid Adenoma to improve outcomes in ADPKD
D. Parathyroid CA B. A low-salt diet is not recommended
for patients with ADPKD who
7.Marantic endocarditis is commonly develop hypertension or renal failure
associated with this lung cancer:
 C. A low-salt diet is recommended for 13. An 18-year-old boy had sex with an
all patients with ADPKD, even those HIV+ prostitute a week ago. He is
with preserved kidney function
D. Increased water and fluid intake frightened and wants assurance he has not
have been shown to reduce cystic been infected. You should:
fibrosis. A. Tell him you regret that there is no
way at this time to tell if he has been
10. In using Serum albumin as gauge for infected or not
malnutrition, which statement is correct? B. Ask for an immediate AIDS ELISA
test
A. A low serum albumin always C. Ask for an immediate Western Blot
indicates malnutrition test
B. The half-life of albumin in 21 days, D. Assure him that if it was a one night
so it cannot be used to assess acute affair he probably did not get
malnutrition infected
C. Albumin levels are unaffected by
changes in extracellular volume 14.Precipitating cause of heart failure:
D. The bone marrow synthesizes
albumin A. Smoking
B. Exercise
11. A patient with Bell's palsy has a C. Infection
pathology involving which cranial nerve? D. Stroke

A. III 15. A 30-year-old female has severe

B. V perennial allergic rhinitis. Her house is
C. VII frequently flooded. She has a dog and
D. III and VII sleeps on kepok pillow. As part of
management of her allergy, you should
12. One of the following is NOT a advice her to
pathophysiologic mechanism of DM A. Get a new kapok pillow and launder
nephropathy: it frequently
B. Try to scoop out the flooded water
A. Injury of the glomerular filtration as soon as the rain pours
barrier manifested by C. Keep the dog out or get a cat
microalbuminuria instead
B. lg G deposits along GBM resulting in D. Replace the kapok pillow with foam
immune complex mediated rubber, cover the pillow and mattress
glomerulonephritis with allergen proof encasings
C. Mesangial matrix expansion
resulting to enlarged kidneys 16. Most guidelines agree that regular
D. Atherosclerosis of the renal vascular breast cancer screening with
bed due to hypertensive mammography should be recommended for
arteriosclerosis which population?
 A. Women aged 39 years or younger D. Work at home is an alternative work
with average risk schedule
B. Women aged 40-49 years with
average risk 20. The fungus which is a normal inhabitant
C. Women aged 50-74 years with of the human mucocutaneous body
average risk surfaces and is a frequent cause of
D. Women aged 75 years or older with fungemia is:
average risk
A. Aspergillus
17. In typhoid fever, which of the following B. Candida
specimen will have the best sensitivity for C. Cryptococcus
culture if a patient has been given D. Histoplasma
antibiotics?
21. The most common form of Lung cancer
A. Blood arising in lifetime of a non-smoker young
B. Bone marrow women.
C. Stool
D. Urine A. Small cell carcinoma
B. Adenocarcinoma
18. One of the disorders below does NOT C. Squamous cell carcinoma
have vesicles or bulla as presenting lesions: D. Large cell carcinoma

A. Impetigo 22. This group of drugs reduce airway

B. Chicken pox inflammation in bronchial asthma:
C. Herpes Simplex
D. Psoriasis A. Catecholamines
B. Methylxanthines
19. Advice for pregnant employees on risk C. Clucocorticoids
assessments in the workplace and D. Anticholinergics
occupational health during the coronavirus
(COVID-19) pandemic: 23. Multiple osteolytic lesions,
hypercalcemia and neurologic abnormalities
A. Pregnant women of any gestation are
should not be required to continue most often seen in:
working if this is not supported by
the risk assessment. Pregnant A. Prostatic CA
women require special consideration B. Non-Hodgkin's lymphoma
as contained in government guides C. Plasma cell myeloma
B. Pregnant women have an increased D. CNS tumors
risk of becoming severely ill and of
pre-term birth if COVID-19 infected 24. A patient with CAP requires
C. Pregnant women have to stop hospitalization when one of the following is
working and take a leave of absence
until the pandemic ends present:
 A. Right ventricular contraction
A. Age 65 years old B. Right atrial contraction
B. COPD in exacerbation C. Ventricular septal defect
C. Temperature of 38.5C D. Atrial septal defect
D. Unilobar CXR infiltrate
30. This anti-TB drug may cause "barrel
25. Painless myocardial infarction is greater vision"
in patients with
A. Rifampicin
A. Hypertension B. Ethambutol
B. Diabetes mellitus C. Pyrazinamide
C. Homocystinemia D. Streptomycin
D. Dyslipidemia
31. Loss of hair at the lateral part of
26. Not a characteristic laboratory feature of eyebrows, thickening of speech, coarse hair
hepatorenal syndrome: and dry skin, dulling of intellect, sluggish
movements. Most likely diagnosis is:
A. Elevated BUN
B. Fractional excretion of NA+ < 1% A. Cushing's syndrome
C. Proteinuria B. Adrenal insufficiency
D. Urinary Na+ 40 mmol/L C. Hypothyroidism
D. Acromegaly
27. Lymphokines are secreted by
32. Prolonged fasting causes the intestinal
A. Polymorphonuclear cells villi to
B. Monocytes
C. Lymphocytes A. Hypertrophy
D. Lymphoma cells B. Atrophy
C. Necrose
28. Which of the following is true regarding D. Proliferate
gastric ulcer?
33. Acute complication of Type 2 Diabetes
A. Presence of gastric acid excludes Mellitus :
malignancy
B. Weight loss is distinctively unusual A. Hyperosmolar Hyperglycemic State
in benign ulcer B. Coronary artery disease
C. Ulcers along the greater curve favor C. DM neuropathy
malignancy D. Gastroparesis
D. Coexisting duodenal ulcers favor
benign nature of gastric ulcer 34. Obese persons are at increased risk for

29. The a wave of the jugular venous pulse A. Hypothyroidism

(JVP) represents: B. Type I diabetes mellitus
C. Cholelithiasis
 D. Elevated LDL cholesterol A. Acute Hepatitis A and Acute
Hepatitis B simultaneous infection
35. The most common cause of acute renal B. Acute Hepatitis A superimposed on
failure Chronic Hepatitis B in the replicative
phases
A. Pre renal acute renal failure C. Acute Hepatitis A superimposed on
B. Renal acute renal failure Chronic Hepatitis B in the
C. Post renal acute renal failure non-replicative phase
D. Pre renal with renal acute renal D. Acute Hepatitis A; a previous
failure immunization to Hepatitis B

36. Anti - Tuberculosis drug that can cause 40. A 24/M who took megadoses of vitamins
hyperuricemia: develops severe headache and

A. Isoniazid papilledema. The cause for this is

B. Pyrazinamide intoxication of
C. Rifampicin
D. Streptomycin A. Vitamin B6
B. Vitamin D
37. Which of the following medications can C. Vitamin A
cause hyperprolactinemia? D. Vitamin E

A. Propranolol 41. Grouped vesicles arranged in a

B. Glucocorticoids segmental pattern over the right side of the
C. Metoclopramide
D. Levothyroxine A. trunk, T7-8 level:
B. Herpes Simplex
38. This finding in Chronic Myelogenous C. Chicken pox Verruca vulgaris
Leukemia can differentiate it from leukemoid D. Herpes Zoster
reaction:
A. Decreased leukocyte alkaline 42. In the tumor cell cycle, the cells
phosphatase refractory to chemotherapy are the:
B. Increased WBC count
C. Anemia A. Cells in the G2 phase
D. Hypercellular marrow with increased B. Cells in the M phase
granulocyte precursor C. Cells in the GO phase
D. Cells in the active S phase
39. A 16-year-old male patient presenting
with hepatitis syndrome has the following 43. Which of the following tests is required
serologic exam findings: (+) HBSAG (-) to diagnose Chronic Obstructive
Anti-HBe (+) HBeAG (+) Anti-HAVIgm (+) Pulmonary Disease:
Anti HBclgM (-) AntiHBclgG The patient A. Arterial blood gas
most likely has B. Chest X-ray
C. Chest CT scan
 D. Spirometry 49. The American Thoracic Society defines
chronic bronchitis as persistence of cough
44. Asymptomatic bacteriuria should always and excessive mucus production for most
be treated in: days out of 3 months for successive years:

A. Pregnant women A. 2
B. Catheterized elderly patients B. 3
C. Sexually active patient C. 4
D. Post CVD patients D. 5

45. What is the most conservative 50.The single most important parameter of
management for chronic renal failure? renal function is:

A. Dietary proteins of 0.6 g/kg/day A. Edema

B. Allopurinol 300 mg OD B. Creatinine clearance
C. Dialysis C. Serum Creatinine
D. Kidney transplant D. Serum BUN

46. Most common cause of pneumonia in 51. The most significant risk factor for
ambulatory patients: cancer is:

A. Streptococcus pneumoniae A. Sex

B. Mycoplasma pneumoniae B. Age
C. Influenza viruses C. Nationality
D. Chlamydia pneumoniae D. Dietary factors

47. The best parameter to differentiate 52. True of Ascaris infestation:

chronic bronchitis from emphysema
A. May cause ground itch
A. DLCO B. Loeffler's pneumonitis results from
B. Simple spirometry allergy to ascaris eggs
C. Lung volume studies C. Adult worms reside mostly in the
D. Arterial blood gas small intestines
D. The drug of choice in biliary
48. Lung cancer that is associated with ascariasis is Mebendazole because
significant progressive dyspnea and it paralyzes the worms and prevents
increasing hypoxemia their further migration

A. Squamous cell carcinoma 53. All of the following anemias except one
B. Oat cell CA are chronic developing over weeks. Which
C. Adenocarcinoma anemia may develop acutely?
D. Bronchoalveolar CA
A. Aplastic
B. Pernicious
 C. Hemolytic 58. The characteristic feature of
D. Iron deficiency Rheumatoid arthritis is:

54. Which statement about breast cancer is A. Fibrotic changes of the skin
the most accurate? B. Osteoporosis
A. C. Persistent inflammatory synovitis
B. Breast cancer is typically first D. Asymmetric involvement of large
detected during a clinical breast weight-bearing joints
examination
C. Very few patients with breast cancer 59. Most common etiologic agent in
present with breast pain uncomplicated cystitis:
D. All patients with breast cancer have
a lump in the breast A. Pseudomonas aeruginosa
E. Malignant masses in the breast are B. Staphylococcus aureus
usually tender, soft, or round to the C. Escherichia coli
touch D. Proteus vulgaris

55. Which of the following risk factors has 60. A 37 y.o. man is admitted with
been directly associated with Bronchogenic confusion. PE showed a BP of 140/70 with
Carcinoma? no orthostatic changes, normal jugular
venous pressure and no edema. Serum
A. Asbestos exposure chemistries are notable for Na+ 120 meq/L,
B. Aflatoxin ingestion K+ 4.2 meq/L, HCO3 24 meq/L and a uric
C. Cigarette smoking acid of 2 mg/L. The most likely diagnosis is:
D. Chronic Bronchitis
A. Hepatic cirrhosis
56. In the presence of anemia, the ability to B. SIADH
produce adequate circulating red cells is C. Addison's disease
best measured by: D. Severe vomiting and diarrhea

A. WBC count 61. Heberden's nodes are found in

B. Serum iron binding capacity
C. Reticulocyte count A. Systemic lupus erythematous (SLE)
D. Total eosinophil count B. Gouty arthritis
C. Osteoarthritis
57. The most common form of arthritis D. Rheumatoid arthritis (RA)
characterized by progressive deterioration
and loss of articular cartilage: 62. Type 2 DM is characterized by one of
the pathophysiologic abnormalities:
A. Rheumatoid arthritis
B. Osteoarthritis A. Impaired insulin absorption
C. Gouty arthritis B. Peripheral insulin resistance
D. Septic arthritis C. Decrease hepatic glucose
production
 D. Increase gluconeogenesis C. Staph aureus and gm (-) bacilli
D. Staph aureus
63. Those who are at most likely to acquire
COVID 19 infection are the following except: 66. One of the following is NOT a useful
clue to the microbial etiology of CAP
A. Persons who have had prolonged, (Community Acquired Pneumonia)
unprotected close contact with a
patient with confirmed SARS-CoV-2 A. Edentulous persons likely to develop
infection, regardless of whether the pneumonia due to anaerobes
patient has symptoms. B. Susceptible people exposed to an
B. Persons frequently in assisted living infectious aerosol in Legionellosis
facilities C. Patients with severe
C. Those who live in or have recently hypogammaglobulinemia at risk of
been to areas with sustained infection with S. pneumoniae
transmission may also be at higher D. Anaerobic lung abscess occuring in
risk of infection patients prone to aspiration
D. Young children with co-morbidities
67. One of the following is not true in the
64. Diagnosis of Diabetes Mellitus is defined assessment of acute GI Bleeding:
as:
A. The presence of large quantities of
A. Random is defined as with regard to bright red blood per rectum rules out
time since the last meal. the source before the ligament of
B. Fasting is defined as no caloric Treitz
intake for at least 12 h. B. Melena almost always represents
C. The test should be performed using UGIB
a glucose load containing the C. Black stools can be caused by
equivalent of 50 g anhydrous lesions in the colon
glucose dissolved in water; not D. A bilous NGT return flow in a patient
recommended for routine clinical who just had hematochezia
use. E. rules out an upper Gl source of
D. A random plasma glucose hemorrhage
concentration =11.1 mmol/L (200
mg/dL) accompanied by classic 68. Underlying cause of heart failure:
symptoms of DM (polyuria,
polydipsia, weight loss) is sufficient A. Cardiomyopathy
for the diagnosis of DM B. Cardiac tamponade
C. Respiratory diseases.
65. The most likely organism/s causing D. Anemia
secondary bacteremia following
manipulation of a furuncle is/are: 69. Elevation of Serum Potassium is toxic to
the:
A. Anaerobes and gm (-) bacilli
B. Anaerobes and Staph aureus A. Kidneys
 B. Brain B. Successive fasting plasma glucose
C. Heart of 147, 165, 152 mg/dL in an
D. Liver otherwise healthy 40-year-old
female
70. If only one person is present to provide C. A serum glucose level of 140 mg/dL
basic life support, chest compressions in a pregnant woman in her 26th
should be performed at a rate of ------ per week AOG
minute, and breaths twice in succession D. Glycosuria in a 30/F
every 15 seconds
75. A patient was brought to the ER in a
A. 50 comatose state. Serum electrolytes drawn
B. 80 on admission showed the following: Na+
C. 60 133 meq/L, K + 8.0 meq?L, CL 98 meq/L.
D. 4 HCO3 13 meq?L. ECG showed absent P
waves, widend QRS and peaked T waves.
71. Bitemporal hemianopsia means Which would be the most appropriate initial
involvement of the step:

A. Optic nerve ipsilateral to the lesion A. Repeat electrolyte measurement

B. Optic chiasm and observe
C. Optic tract B. Attempt cardioversion
D. Optic radiation C. Administer intravenous calcium
gluconate
72. This is the most common local D. Administer sodium polystyrene
manifestation of lung cancer at presentation sulfonate (Kayexelate)

A. Dyspnea 76. Jodbasedow phenomenon is:

B. Cough
C. Hemoptysis A. lodide-induced hyperthyroidism
D. Chest pain B. Blocking of organic binding of iodine
with large doses of the substance
73. The most common form of suppurative C. Hyperthyroidism due to
intracranial infection: hyperfunctioning thyroid adenoma
D. Due to a thyroxine-producing
A. Viral meningitis ovarian tumor
B. Bacterial meningitis
C. Fungal meningitis 77. Drug of choice for Schistosomiasis:
D. Parasitic meningitis
A. Albendazole
74. The diagnosis of diabetes mellitus is B. Ivermectin
certain in which of the following situations? C. Diethylcarbamazine
A. Persistently elevated non fasting D. Praziquantel
serum glucose levels
78. Gold standard in the diagnosis of PTE:
 A. Ventilation-perfusion scan 84. This is considered as the most frequent
B. Pulmonary angiography cause of Acute Respiratory Distress
C. Helical/Spiral CT Scan Syndrome
D. Transesophageal echocardiography
A. Smoke inhalation
79. Dietary deficiency of thiamine produces B. Severe sepsis
which of the following clinical syndromes? C. Pulmonary contusion
D. Acute pancreatitis
A. Color blindness
B. Osteoporosis 85. The first drug of choice in a patient
C. Bruising presenting with frank seizures is:
D. Peripheral neuropathy
A. Diphenylhydantoin IV
80. Reticulocytosis is NOT seen in: B. Phenobarbital IV
C. Carbamazepine p.o
A. Aplastic anemia D. Diazepam IV
B. Acute blood loss
C. Hemolytic anemia 86. TRUE statement/s about acute
D. Treatment of iron deficiency poststreptococcal glomerulonephritis
(PSGN) EXCEPT:
81. DNA synthesis phase
A. The latent period appears to be
A. G1 longer when PSGN is associated
B. G2 with cutaneous rather than
C. GO pharyngeal infection
D. S B. Serologic tests for a streptococcal
infection may be negative if
82. British Thoracic Society major category antimicrobial therapy is begun early
for diagnosis of severe pneumonia C. PSGN leads to permanent and
progressive renal insufficiency more
A. P/F ratio of <250 often in adults than in children
B. Multilobar pneumonia D. Long-term antistreptococcal
C. Systolic pressure of less than 90 prophylaxis is indicated after
mmHg documented cases of PSGN.
D. Need for mechanical ventilation
87. Lower motor neuron type of paralysis is
83. Which of the following statements does characterized by:
NOT describe secretory diarrhea?
A. Hypotonia
A. Diarrhea continues during fasting B. Spasticity
B. Stools are scanty and mucoid C. Pathologic reflexes
C. Fecal fat is low D. Involuntary movement of the
D. Cholera can cause it affected extremities
 C. Tetanus
88. In typhoid fever this diagnostic exam is D. Polio
not affected by prior antibiotic use:
93. One of the following is associated with
A. Bone marrow culture an increased risk of sudden cardiac death:
B. Blood culture
C. Urine culture A. Frequent PVC's (>30/min)
D. Stool culture B. Hyponatremia
C. Smoking
89. In a patient suspected of PTE, presence D. Hyperlipidemia
of this symptom heralds the occurence of
pulmonary infarction: 94. A 65/M is brought to the ER due to
chest pain. He suddenly becomes
A. Unexplained dyspnea. unresponsive and pulseless and cardiac
B. Hemptysis monitor reveals ventricular fibrillation. You
C. Sudden onset of cough should immediately:
D. Syncope
A. Begin CPR, followed by intubation,
90. One of the following statements is NOT then defibrillation with 100 J 2001
true of typhoid fever: 360 1
B. Begin CPR, followed by intubation,
A. Salmonella typhi has no known then defibrillation starting at 2001
hosts other than humans. C. Begin CPR, then defibrillation at 200
B. Most cases result from ingestion of J, 300 I then 360 J
contaminated food or water. D. Begin CPR, defibrillate at 200 J,
C. Incubation period ranges from 3 to then intubate
21 days.
D. Stool culture is best done during the 95. Annular lesions with raised
first week of fever. erythematous border and clear centers,
distributed over the trunk area:
91. IgE has high affinity for which type of
cells? A. Tinea unglum
B. Psoriasis
A. Eosinophils C. Tinea versicolor
B. Mast cells D. Tinea corporis
C. Platelets
D. Macrophages 96. A 50-year-old male with ESRD 20
diabetic nephropathy was brought to the
92. Which of the following vaccines is emergency room because of weakness and
especially indicated in a splenectomized light headedness. He has just completed his
patient: first dialysis, and was observed to be
somewhat confused. BP = 90/40, CR =
A. Pneumococcal 80/min., RR = 20/min. The most likely
B. Hepatitis B. explanation for his condition is:
 100. A Cavernous sinus lesion could involve
A. Dialysis disequilibrium syndrome several cranial nerves. Which of the
B. Dialysis dementia following is least likely to be affected?
C. Poor dietary intake during dialysis
D. Reduced dialysate temperature A. Oculomotor nerve
B. Trochlear nerve
97. A patient suspected to have meningitis C. Abducens nerve
undergoes spinal tap. Upon insertion of the D. Facial nerve
spinal needle, the opening pressure is
recorded to be markedly elevated. You
should:

A. Continue draining the CSF to

decrease the pressure
B. Withdraw the needle and run IV
mannitol
C. Continue draining the CSF while
running IV mannitol
D. Withdraw the needle and reinsert at
a lower site

98. Low serum complement level would be

seen in patients with hematuria, proteinuria
and hypertension resulting from all of the
following, EXCEPT:

A. Mixed essential cryoglobulinemia

B. Hepatitis C associated
membranoproliferative
glomerulonephritis
C. Diffuse proliferative lupus nephritis
D. Henoch-Schonlein purpura

99. A 50-year-old obese woman with

hypertriglyceridemia without
hypercholesterolemia. The most appropriate
first management step would be

A. Weight reduction
B. Gemfibrozil
C. Clofibrate therapy
D. Liposuction