Rationale Pa More

Written Revalida 2017 part 1

D12018
1. A 30 year old male has a cavitary lesion in the right upper lobe of the
lung showing clusters of epithelloid histiocytes surrounded by
Tuberculosis
lymphocytes with areas of caseation necrosis. What type of
hypersensitivity reaction is seen?
2. A 5 yr-old boy presents with gum bleeding. Family history is
significant for blood dyscrasias among his uncles (maternal
side). What is the most likely mode of inheritance of this
disorder?
A. Autosomal dominant
- at least one parent of an index case is usually
affected; both males and females are affected, and
both can transmit the condition; many generations
B. Autosomal recessive
- Usually seen in only 1 generation; often due to
enzyme deficiencies
C. X-linked dominant
- Transmitted through both parents; mothers transmit
to 50% of daughters and sons; fathers transmit to all
daughters but no sons
D. X-linked recessive
- sons of heterozygous mothers have a 50% chance of
being affected. Skips generation. Commonly more
severe in males
3. Histopathologic diagnosis of Barrett esophagus
requires the presence of which following cells?
A. Fundic type mucosa
B. Goblet cells Barrett esophagus
- columnar metaplasia of
C. Pancreatic heterotopia esophageal squamous
D. Neutrophil infiltrates epithelium
- the columnar epithelium is
often of the intestinal
(specialized) type with
prominent goblet cells
4. A 55 year old male show a malignant neoplasm
composed of atypical cells forming glands. What is
the histologic type of malignancy seen?

A. Adenocarcinoma
- carcinoma of glandular epithelium
B. Squamous cell carcinoma
- originates from stratified squamous epithelium
C. Lyphoma
- begins in lymphocytes
D. Neuroendocrine carcinoma
- usually involves increased secretions of hormones. Hormones are
detected via diagnostics
5. What is the pathognomonic microscopic
finding seen in the CNS in rabies infection?
A. Negri bodies
B. Langerhans cells
- Immature dendritic cells within the
epidermis; Langerhans cell histiocytosis
C. Lewy bodies
- abnormal aggregates of protein that develop
inside nerve cells; Lewy Body Dementia
D. Microgial nodules
- small aggregates around foci of necrosis;
Viral Meningoencephalitis
Histologic characteristics include
neuronal degeneration,
perivascular accumulations
of mononuclear cells in the
brain stem and spinal cord, and
characteristic
eosinophilic intracytoplasmic
inclusions (Negri bodies) in the
hippocampus and
Purkinje cells of the cerebellum.
6. Virchow’s triad in thrombosis includes all,
EXCEPT:
Three primary abnormalities that
A. Endothelial injury lead to thrombus formation (called
- in order to activate platelet plugs, platelet Virchow’s triad):
aggregation and signal more platelets to an (1) endothelial
active site injury,
(2) stasis or turbulent blood flow,
B. Inflammation and
(3) hypercoagulability
C. Abnormal blood flow of the blood
- stasis contributes to increased formation
of a thrombus
D. Hypercoagulability
- increased state of thrombus formation
 7. Which is the best measure of hypertrophy
in dilated hearts?
A. Ventricular wall thickness
B. Septal wall thickness
C. Heart weight
D. Intraluminal cardiac diameter
As a result, in dilation due to
volume overload the wall
thickness may be increased,
normal, or less than normal;
thus, heart weight, rather than
wall thickness, is the best
measure of hypertrophy in
volume overloaded hearts.
8. A patient died from acute respiratory failure. On histopathologic
examination of the airways, there is a submucosal glands hypertrophy
and goblet cell hyperplasia accompanied by hyperplasia of the bronchial
wall smooth muscle cells. What is the underlying cause of death of this
patient?
A. Acute Respiratory Distress Syndrome
- Some of the alveoli are collapsed; others are distended, and many are lined by hyaline membranes
B. Chronic bronchitis
- hyperplasia of mucus-secreting submucosal glands
C. Status asthmaticus
- bronchial smooth muscle hypertrophy, hyperplasia of goblet cells, thickening and hyalinization
of basement membranes, proliferation of eosinophils, and intrabronchial mucous plugs containing whorl-
like accumulations of epithelial cells (Curschmann spirals) and crystalloids of eosinophil derived proteins
(Charcot-Leyden crystals)

D. Bronchiectasis
- inflammation and necrosis of the bronchial wall.
9. Histopathology of the thyroid gland show an ill-defined
lesion composed of fetal type follicles and fronds supported by
thin fibrovascular cores. These are lined by cells with optically-
cleared out nuclei with nuclear grooves and nuclear inclusions.
What is the diagnosis?
A. Follicular adenoma
- the constituent cells often form uniform-appearing follicles that contain colloid; Hallmark: presence of an
intact,well-formed capsule encircling the tumor

B. Papillary thyroid carcinoma

- papillary projections into gland-like spaces; lined by cells with characteristic empty-appearing nuclei,
sometimes called “Orphan Annie eye” nuclei; invaginations of the cytoplasm may in cross-sections give the
appearance of intranuclear inclusions (“pseudo-inclusions”) or intranuclear grooves; calcified spheres (psammoma
bodies) may be present.

C. Follicular carcinoma
- relatively uniform follicles with capsular and/or vascular invasion
D. Anaplastic carcinoma
- composed of highly anaplastic cells, with variable morphology, including: (1) large, pleomorphic giant cells,
including occasional osteoclast-like multinucleate giant cells; (2) spindle cells with a sarcomatous appearance; and
(3) mixed spindle and giant cells
10. Which skin lesion exhibits hyperplasia of the
stratified squamous epithelium, with
hyperkeratosis, parakeratosis and koilocytosis?
Hyperkeratosis Increased thickness of the stratum corneum
A. Molluscum contagiosum Parakeratosis Hyperkeratosis with retention of nuclei of keratinocytes
- cuplike verrucous epidermal hyperplasia; molluscum body, which occurs as a large (up
to 35 μm), ellipsoid, homogeneous, cytoplasmic inclusion in cells of the stratum
granulosum and the stratum corneum
B. Verruca vulgaris
- epidermal hyperplasia that is often undulant; Vacuolated cells (koilocytes) in the
granular cell layer of the epidermis are characteristic
C. Seborrheic keratosis
-Exuberant keratin production (hyperkeratosis) occurs at the surface, and small keratin-
filled cysts (horn cysts) and invaginations of keratin into the main mass (invagination
cysts)
D. Squamous pailloma
- multiple slender, finger-like projections supported by central fibrovascular cores and
covered by an orderly stratified squamous epithelium
11. This level of disease prevention is applied if 0-1
year old infants are vaccinated in the community?
A. Primary
- Prevent disease before it occurs (e.g vaccination)
B. Secondary
- Screen early for and manage existing but aymptomatic disease (pap smear for
Cervical CA)
C. Tertiary
- Treatment to reduce complications from disease that is ongoing or has long-
term effects (chemotherapy, rehab)
D. Both Primary and Secondary
12. A study involves tracking a condition that can
recur in individuals over time. Which of the
following measures would allow the authors of the
study to make full use of their collected date?
A. Attributable risk
- Difference in rate of a condition between an exposed population and an unexposed
population
B. Incidence density
- Incidence is the number of new cases arising in a given period in a specified population
- The most accurate way of calculating incidence rate is to calculate the person-time incidence
rate (Incidence density)

C. Period prevalence
- The proportion of a population that has the condition at some time during a given period
D. Point prevalence
Prevalence is the number of cases in a defined population at a specified point in time
13. A periodic health examination is done for
the purpose of:
A. Determining whether the transfer to another jobs is medically
advisable –Transfer examination
B. Identifying whether patient needs special rehabilitation –Return to
work examination
C. Making a final evaluation of workers’ health –Separation from
employment examination
D. Detecting the possible onset of acceptable disease
14. Error in the design, organization, training and
maintenance which leads to operator errors and whose
effects lie dormant in the system for lengthy periods of
time is called:
A. Active error
• Error which occurs or is noticed first, committed by the person
closest to the patient
B. Accident
C. Latent error
• Error which occurs or is noticed later, committed by a series
of errors in management done beforehand
D. Adverse event
15. A 75 year old retired lawyer has lapses of memory.
Montreal Cognitive Assessment (MOCA) was done and
his score is 24. This means he has which of these?
MOCA assesses for mild cognitive
A. Normal cognition impairment. Scores below 26 are
considered abnormal. MMSE, on the other
B. Mild cognitive impairment hand, can also assess for cognition and
C. Mild dementia dementia. For MMSE, 24 is the cut-off for
D. Moderate dementia normal cognition.
16. Under the Expanded Senior Citizens Act of 2010
(R.A. 9994) where should the fund for the mandatory
coverage of all senior citizens come from?
A. Department of Social Welfare and Development
B. Department of Health
C. Local Government Unit
D. Private sponsors

“All indigent senior citizens shall be covered by the national health insurance
program of PhilHealth. The LGUs where the indigent senior citizens resides
shall allocate the necessary funds to ensure the enrollment of their indigent
senior citizens in accordance with the pertinent laws and regulations.” (RA
9994, Sec. 5, Subsection H, under “Mandatory PhilHealth Coverage”)
17. Which of the following is an instrumental
activity of living?
Activities of Daily Living Instrumental Activities of Daily
A. Toileting Living
B. Feeding Feeding Using the phone
Continence Shopping
C. Handling medications Transferring Preparing food
Toileting Housekeeping
D. Dressing Dressing Doing laundry
Bathing Using transportation
Handling medications
Handling finances

ADLs are essentials in daily living

IADLs are NOT essential in daily living
18. To determine if the chosen study about a
diagnostic test is valid, what should you look for?
A. Institution responsible for conducting the study
B. Journal where it was published
C. Proper randomization of subjects
D. Comparison of diagnostic findings with a reference standard
A. To determine whether a diagnostic test is effective, a reference standard is
needed for comparison.If a reference standard is not used in the study,
the benefit of the diagnostic test cannot be ascertained
19. What is the relative risk for cardiovascular
event among subjects who were on Drug X?
A. 0.25 Cardiovascular No cardiovascular Total
event event
B. 0.50 Placebo 50 50 100

C. 0.75 Drug X 25 75 100

Total 75 125 200
D. 0.9
RR= Rt/Rc
Rt = 25/100 = 0.25
Rc = 50/100 = 0.50
RR = 0.25/0.50 = 0.50
20. What is the relative risk reduction for
cardiovascular event among subjects who were on
Drug X?
A. 0.25 Cardiovascular No cardiovascular Total
event event
B. 0.50 Placebo 50 50 100
C. 0.75 Drug X 25 75 100
D. 0.9 Total 75 125 200

RR= Rt/Rc
Rt = 25/100 = 0.25
Rc = 50/100 = 0.50
RR = 0.25/0.50 = 0.50
RRR = 1 – RR = 1 – 0.50 = 0.50
21. Why is blinding important in a randomized
controlled trial?
A. It will assure the equal distribution of confounding variables in both
groups
B. It allows prospective collection of data
C. It would help eliminate bias which could affect study results
D. It helps the investigator be truthful
22. What is the first step in the Evidence-
based Medicine cycle?
A. Appraising the validity of the methods of the article
- After searching for an article, its validity is appraised to see if it can be used to
answer the clinical question
B. Asking the clinical question
- EBM always begins with the generation of a clinical question
C. Searching the literature for the best answer
- Searching for literature follows a clinical question as the clinical question
provides the keywords needed in searching for the articles
D. Summarizing the results of the article
- The last step in EBM
23. Which of the following is the error
committed in the 2x2 table above?
A. Switched row and column headings
B. Switched column headings
C. Switched row headings
D. NO error can be found
Nephropathy NO Nephropathy
Usual treatment
Empagliflozin
24. Which of the following measures of association is
the most intuitive and is used to discuss the effect of
treatment to patients?

A. NNH
B. NNT
C. Odds Ratio
D. RRR
25. Which of the ff. principle allows organ
donation from a living donor?
A. Totality -all decisions in medical ethics must prioritize the good of the entire person,
including physical, psychological and spiritual factors
B. Beneficence -duty to be of a benefit to the patient, as well as to take positive steps to
prevent and to remove harm from the patient
C. Non maleficence -requires of us that we not intentionally create a harm or injury to
the patient, either through acts of commission or omission
D. Fraternal love/Charity
26. Which of the ff. determines the moral
acceptability of new reproductive technology?
A. Good benefit/risk ratio
B. Acceptability of the special society
C. If the procedure assists the conjugal act
D. Informed consent from the husband and wife about the procedure
27. A 60 y/o male known diabetic, hypertensive was admitted because
of pneumonia. On day 2 of hospitalization the patient was noted to be
more tachypneic. On PE, BP was 80/60, RR 32, HR 110 regular, T 38.5C,
GCS 10 (E3 M6 V1). Lung findings showed resonance on both lungs with
crackles on right mid lung field. He was noted to speak in phrases and
has abdominal paradox. The medical resident was called and ordered for
emergency intubation. What is the indication for intubation?

A. Abdominal paradox Source: Harrison’s 19E, p 1740

-one of the signs of respiratory failure The most common reason for
B. Decreased GCS instituting mechanical
C. Hypotension ventilation is acute respiratory
failure with hypoxemia (65% of
D. Tachypnea all ventilated cases).
28. After intubation, the medical resident A. Atelectasis
examined the chest. There was dullness B. Pneumonia
on percussion and absence of breath
sounds on the left. What condition C. Pleural effusion
explains these findings on the left lung? D. Pneumothorax
Condition Percussion Fremitus Breath Sounds Voice Transmission Adventitious BS
Normal Resonant Normal Vesicular Normal Absent

Consolidation or Dull Increased Bronchial Bronchopony,Egophony Crackles

Atelectasis (with
patent airway)
Consolidation or Dull Decreased Decreased Decreased Absent
Atelectasis (with
blocked airway)
Asthma Resonant Normal Vesicular Normal Wheezing

Emphysema Hyperresonant Decreased Decreased Decreased Absent or wheezing

Pneumothorax Hyperresonant Decreased Decreased Decreased Absent

Pleural effusion Dull Decreased Decreased Decreased Absent or pleural friction rub

Pulmonary mass Dull (over the mass) Normal Normal Normal Decreased (over the mass)
Source: IM Platinum, 2nd Ed. Page 93
 29. Splitting of the S2 is due to delay in which
component of the heart sound?
A. Delay in the pulmonic component
B. Delay in the aortic component
C. Delay in the mitral component
D. Delay in the tricuspic component
Heart Sounds
S1 Mitral and tricuspid valve closure. Loudest at mitral area
S2 Aortic and pulmonary valve closure. Loudest at left upper sternal border
S3 In early diastole during rapid ventricular filling phase. Associated with increased filling pressures (eg, mitral
regurgicationm HF) and more common in dilated ventricles (but can be normal in children and young adults)
S4 In late diastile (‘’atrial kick’’). Best heard at apex with patient in left lateral decubitus position. High atrial
pressure. Associated with ventricular noncompliance (eg, hyperthrophy). Left atrium must push against stiff LV
wall. Considered abnormal, regardless of patient age.
30. A 23 y/o male athlete who recently joined the yearly A. Obstructive coronary artery disease
ironman competition complains of chest pain. On PE, he B. Hypertrophic cardiomyopathy
has left ventricular heave and an S4 gallop. Which of the C. Pericarditis
following explains the PE findings? D. Vasospastic coronary artery disease
Dilated Cardiomyopathy Restrictive Cardiomyopathy Hypertrophic Cardiomyopathy
Pathophysiology Cardiac enlargement resulting in Endomyocardial scarring or Disproportionate hypertrophy,
impaired systolic function, heart myocardial infiltration resulting in typically involving the
failure, arrhythmia, emboli restriction of ventricular filling interventricular septum more than
the free wall
Ejection fraction Usually <30% 25-50% >60%
LV dimension Dilated >60mm >60mm (may be decreased) Often decreased
LV wall thickness Decreased Normal or increased Markedly increased
Atrial size Increased increased,; may be massive Increased
Valvular regurgitation Related to annular dilation Related to endocardial involvement Related to valve-septum interaction
Common first sx Exertional intolerance Exertional intolerance; fluid Exertional intolerance; may develop
retention early late
Congestive sx Left before right Right often predominates Left-sided congestion may develop
late
Common examples Viral, parasitic Amyloidosis Most common abnormality found at
Peripartum Loeffler’s autopsy in young competitive
Alcohol, MAP, cocaine Endomyocardial athletes who die suddenly
Chemotherapy
 31. After his check-up, the athlete went to the gym for work out. At the
parking lot, he was found unconscious. Your immediate response is…
A. Survey the scene
B. Call for help
C. Activate EMS
D. Do CPR
32. Which of the following physiologic
functions is performed by astrocytes?
A. Produce CSF
B. Create blood brain barrier
C. Sheath the CNS axons
D. Process sensory information

Functions of astrocytes include physical and metabolic support for neurons,

detoxification, guidance during migration, regulation of energy metabolism,
electrical insulation (for unmyelinated axons), transport of blood-borne
material to the neuron, and reaction to injury.
Axonal end-feet that surround capillaries contribute to formation of the
blood-brain barrier.
 33. Lesion of the left
posterior spinal artery at the
lower 3rd of the medulla will
result in :
A. Loss of position and vibration sense, left
B. Loss of position and vibration sense, right
C. Weakness of arms and legs, left
D. Weakness of arms and legs, right

The posterior spinal arteries are a pair of arteries that supply the
respective ipsilateral grey and white posterior columns of the spinal
cord.
34. Which of these statements is true about
temperament?
A. It is biologically determined
B. It is unchangeable throughout life
C. It is always caused by poor parenting
D. It is a synonym for personality
35. A 25 mo old boy plays with a ball which rolls under a
couch. The boy promptly crawls under the couch to
retrieve the ball. According to Piaget, which thinking
process best describes this child’s behavior?
Stages of development
A. Object permanence 1. Sensorimotor stage (birth to 2 y/o)
- object permanence - knowing that an object still exists, even if it is
B. Basic trust hidden.
2. Pre-operational stage (2 to 7 y/o)
C. Object constancy - young children can think about things symbolically
D. Animistic thinking 3. Concrete operational stage (7 to 11 y/o)
- beginning of logical or operational thought
- Conservation- understanding that something stays the same in
quantity even though its appearance changes
4. Formal operational stage (11+ to adolescence and adulthood)
- develop the ability to think about abstract concepts, and logically test
hypotheses
36. One characteristic of this virus is gene
reassortment
Genetic shift
A. Parainfluenza virus - Causes pandemics
- Reassortment of viral genome
B. Respiratory Syncitial virus segments e.g segments of
C. Influenza virus human flu A virus reasserts with
swine flu A virus
D. Corona virus
Genetic drift
- Causes epidemics
- Minor changes based on random
mutation in hemagglutinin or
neuraminidase genes
37. Pseudomembranous colitis is attributed to
this organism:
A. Salmonella typhi – Typhoid fever
B. Shigella dysenteriae - Shigellosis
C. Clostridium difficile
D. Bacteroides fragilis
38. Fission bodies are dematiaceous Fission bodies – are

structures seen in this infection: spherical,

dematiaceous
structure which neither
A. Candidiasis bud nor produce
hyphae. Some prefer to
- Yeast cells, germ tube call these structures
“sclerotic bodies.”
B. Sporotrichosis (rose gardener’s disease)
- infection of the fungus Sporothrix
C. Coccidioidomycosis
- Spherule (much larger than RBC) filled with endospores of Coccidioides
D. Chromomycosis
- Sclerotic bodies
39. A 14 year old male complained of sore throat and fever.
Physical exam revealed “beefy red” posterior pharyngeal wall
with exudates, palpable cervical lymphadenopathies. Chest
exam was normal. Gram stain revealed gram (+) cocci in chains.
The isolate was inhibited by bacitracin. What is the most likely
causative organism?

A. Streptococcus agalactiae
B. Streptococcus pneumonia
C. Streptococcus pyogenes
D. Viridans streptococci
40. A middle aged visitor recently arrived from Palawan, her
family became alarmed when she had bout of chills and fever
and did not respond to aspirin or paracetamol. She was
brought to the emergency room were blood samples for
malaria was obtained. Which of the following stages is found in
the mosquito only.
A. Gamete – infective to mosquito
B. Schizont – diagnostic stage
found in exo-erythrocytic (liver)
and erythrocytic cycle
C. Ring form – found in thin and
thick smear
D. Ookinete
41. A 5 year old male with on and off abdominal pain sought
consult. Stool exam request revealed ova for Ascaris,
Enterobius and Trichuris. What is the mode of transmission of
Ascaris and Trichuris
A. Ingestion – Ascaris, Trichuris, Enterobius (ingestion of fertilized ovum)
B. Skin penetration – Hookworm, Strongyloides
C. Inhalation – Enterobius
D. Skin bite
42. 40 year old male, farmer, sought consult because of vague
abdominal pain. On CT scan there is a space occupying lesion
in the liver. CT scan confirmed the presence of a cyst. Upon
surgery a hydatid cyst was recovered. What parasite is
associated with this condition

A. Taenia solium – pork tapeworm

B. Taenia saginata – beef tapeworm
C. Hymenolepis nana – dwarf tapeworm
D. Echinococcus granulosa
43. This test measures the rate of hemolysis of red
cells when exposed to a hypotonic solution
A. Osmotic fragility test – used in thalassemia and hereditary spherocytosis
B. Mechanical fragility test – in vitro measurement of the extent of RBC
sublethal injury
C. Thorn test – used in diagnosis of adrenal insufficiency
D. Reticulocyte test – measures how rapid immature red cells are made
44. A positive FOBT is usually observed in
A. Biliary atresia
B. Gastric carcinoma – (FOBT Adults >50 y/o – screen annually)
C. Ascariasis
D. Malabsorption syndrome
45. Presence of this in the urine suggest active
bone resorption
A. Pyridinium crosslinks – marker of bone resorption in patients with
osteoporosis, 1°hyperPTH and Paget’s disease
B. Procollagen
C. Cross linked telopeptides
D. Osteocalcin
46. In a 9 year old child, an abnormal neutral fat
(Sudan) and fecal trypsin test would point to this
visceral organ as the site of pathology.
A. Liver – ALT (most specific)
B. Spleen
C. Pancreas – secretes trypsin and amylase
D. Large intestine
47. A 24 year old male came for consultation because of
purulent penile discharge. He has a live-in partner for 2 years.
You advised him to get an appropriate treatment. 2 days later
his partner came to your clinic asking about his partner’s
diagnosis. What will you do?

A. I will disclose that his partner has HIV because it is her

right to know
B. I will decline to disclose because it is a breach of
confidentiality
C. I will instruct her to ask another doctor instead
D. I will show her the results without explaining anything
48. How much information to give may be dependent of
the different standards of disclosure. One that focuses
on considering what the patient would need to know is
consistent with
A. Reasonable physician standard
B. Reasonable patient standard
C. Subjective standard
D. Clinical standard
49. A pharmaceutical company’s offer to fund the
training of a physician is ethically

A. Unacceptable
B. Allowable if the stipend is direct to trainee himself
C. Allowable if contributed to a general fund
D. Allowable if the company has products in the hospital
50. As a junior medical intern, you were tasked to
extract arterial blood from patient A, unfortunately you
extracted blood from patient B who does not have any
blood draw request. What would you do?
A. Inform the resident and conceal the error from the
patient
B. Proceed by drawing blood from patient A
C. Share the misadventure with your colleagues
D. Inform your resident and immediately tell the truth,
reimburse any charge it incurred the patient
51. You are called to perform thoracentesis to
remove fluid from the pleural cavity. To avoid
injuring lung or neurovascular elements, where
would you insert the aspiration needle?
A. above rib 8 in the midclavicular line
B. below rib 9 in the midaxillary line
C. above rib 9 in the midaxillary line
D. below rib 11 in the scapular line
 52. A 54 year old man suffered myocardial infarction at the apex of the heart. Occlusion
by atherosclerosis may be found in which of these arteries?

A. Marginal – Supplies the Right Atrium

B. Anterior Intraventricular – Supplies the Apex, Left
Ventricle
C. Posterior Interventricular – Supplies the Right
Ventricle
D. Circumflex branch of the Left Coronary Artery –
Supplies the Left Atrium
53. A patient with history of pulmonary tuberculosis presents with pus draining from the
superomedial part of the thigh. To which muscle did the TB most likely spread?

A. Illiacus - Superolateral
B. Vastus Medialis - Inferiomedial
C. Psoas Major - Superomedial
D. Quadratum Laborium – Lower Back
54. In performing lumbar puncture what landmark is used to locate the point of insertion
of the spinal needle between the 4th and the 5th lumbar vertebral spines?

A. Anterior Superior Illiac Spine – Located at the sacral level

B. Costal Margin – Anterior; below last rib
C. Illiac Crest – Located at L4
D. Transpyloric Plane – Located at L1
55. Prostate cancer is diagnosed in an 82 year old male. Thereafter a malignant brain
tumor of prostate origin is found. By what vascular pathway did the cancerous cells get to
the brain?

A. Anterior Spinal Artery

B. Vertebral Venous Plexus – “Batson’s Vertebral Venous
Plexus”
- Main route of cancer metastasis from genitals that
lead to the cranial area/ brain
- Drains deep pelvic veins and thoracic veins
C. Azygous Venous System – Thoracic vertebral column
to the Superior Vena Cava
D. Vertebral Artery
56. During herniorraphy, a surgeon finds a hernical sac with a small knuckle on the
intestine passing through the abdominal wall just above the inguinal ligament and lateral
to the inferior epigastric vessels. What type of hernia is this?

A. Direct inguinal hernia

B. Femoral Hernia
C. Incisional Hernia -
An incisional hernia is a type
of hernia caused by an
incompletely-healed surgical
wound.
D. Indirect inguinal hernia
57. During emergency surgery, it was found that a chronic gastric ulcer had perforated the
posterior wall of the stomach and eroded a large artery running immediately posterior
to the stomatch. What artery is this?

A. Gastroduodenal – anterior
wall perforation

B. Common Hepatic

C. Left Gastroepiploic

D. Splenic
58. A surgeon needs to construct a bypass between the veins of the portal and caval
systems to circumvent insufficient drainage through the natural portacaval anastomoses.
Which plan is highly to be successful?

A. Coronary Vain to right gastroepiploic vein

B. Inferior Mesenteric Vein to Splenic Vein
C. Left Colic Vein to Middle Colic Vein
D. Splenic Vein to Left Renal Vein
59. A patient with blood stained stools and inability to completely empty his rectum also
has pain along the back of his thigh an weakness of the posterior thigh muscles. DRE
reveals a tumor in the posterolateral wall of the rectum. Pressure on what nerve plexus
could cause the pain in his lower limb?

A. Inferior hypogastric
B. Inferior mesenteric
C. Lumbar
A. -(L1-L4) one of the main nervous pathways supplying the lower limb
D. Sacral
A. -(S1-S4) main branches innervate the anterior thigh
60. A 20 yo male falls on his outstretched right wrist. PE in the ER reveals severe pain
upon palpation of the anatomical snuffbox. Radiological studies confirm a fracture. Which
bone is most likely fractured?

A. Head of the 1st metacarpal

B. Scaphoid
A. -clinical importance of the anatomical snuffbox lies in the fact that scaphoid bone is most easily
palpated here as well as the pulsations of the radial artery
C. Styloid process of the ulna
D. Trapezoid
61. Which of the ff endocrine cells produce a hormone that suppresses the activity of the
osteoclastic resorption of bone?

A. Oxyphils
A. -found in Hurthle cell cancer or follicular cancer
B. Chief cells
A. -secrete PTH (stimulates bone resorption)
C. Follicular cells
A. -secrete thyroid hormones
D. Parafollicular cells
A. -secrete Calcitonin (inhibit bone resorption)
62. Which of the structures in the lymph node is responsible for filtration of lymph?

A. Cortex and medulla

B. Lymphatic cords
C. Germinal center of fleming
A. -site of maturation of antibodies
D. Lymph sinuses and lymphatic vessels
A. -aids CV system in the removal of tissue fluid from the tissue spaces of the body and returns it to
the blood
63. Which of the histological changes in the
endometrium is the earliest sign that ovulation
has taken place?
A. Subnuclear vacuoles –early secretory phase
B. Collapsed stroma –menstrual endometrium
C. Pseudostratification of glands –proliferative phase
D. Cork-screw pattern of the glands –gastric polyp
64. From what embryologic structure does the
primordium of the lower respiratory tract arise?
A. Ventral foregut
B. Dorsal foregut
C. Midgut
D. hindgut
65. Atrial Septal Defect results form incomplete
closure of these embryonic structures?
A. Sinus venorum
- The sinus venosus is a large quadrangular cavity which precedes the atrium on the
venous side of the chordate heart. It exists distinctly only in the embryonic heart
(where it is found between the two venae cavae); however, the sinus venosus persists
in the adult. In the adult, it is incorporated into the wall of the right atrium to form a
smooth part called the sinus venarum, also known as the venarum sinus,
B. Foramen ovale
C. Ductus arteriosus
- Connects the main pulmonary artery to the proximal descending aorta. Defect in PDA
D. Truncus arteriosus
- heart disease that in which a single blood vessel (truncus arteriosus) comes out of the
right and left ventricles, instead of the normal 2 vessels (pulmonary artery and aorta).
66. The metabolic pathway considered as the final
common pathway to completely metabolize major
energy fuels into CO2 water and energy
A. Embden meyerhoff pathway
- Glycolysis
B. Electron transport chain
- series of complexes that transfer electrons from electron donors to electron
acceptors via redox (both reduction and oxidation occurring simultaneously) reactions,
and couples this electron transfer with the transfer of protons (H+ ions) across a
membrane.
C. Citric acid cycle
- A.k.a. kreb’s cycle
D. Hexose monophosphate shunt
- Ak.a. pentose phosphate pathway. generates NADPH and pentoses (5-carbon sugars)
as well as ribose 5-phosphate (precursor for the synthesis of nucleotides)
67. The major end product of beta oxidation
of fatty acid is
A. Acetoacetate
B. acetylCoA
- beta-oxidation is the catabolic process by which fatty acid molecules are
broken down in the cytosol in prokaryotes and in the mitochondria in
eukaryotes to generate acetyl-CoA, which enters the citric acid cycle, and NADH
and FADH2, which are co-enzymes used in the electron transport chain
C. propionyCoA
D. Beta hydroxybutyric acid
68. During prolonged fasting and starvation,
glucose homeostasis is maintained by
A. Glycogenolysis
B. Gluconeogenesis
C. Ketogenesis
D. Anaplerosis
69. The krebs-henseleit Cycle in man
functions principally to
A. Generate carbons for amino acid synthesis and transport
- Carbon skeletons of amino acids come from intermediates of glycolysis, the
pentose phosphate pathway, or the citric acid cycle
B. Covert ammonia into nontoxic and excretable form
- A.k.a. urea cycle
- Explanation in next slide
C. Provide an alternate pathway for catabolism of essential amino acids
- The catabolic pathways for the 20 amino acids vary considerably, but all amino
acids are degraded to one of seven metabolites: pyruvate, a-ketoglutarate, succinyl-
CoA, fumarate, oxaloacetate, acetyl CoA, or acetoacetate.
D. Maintain acid base balance
- Work of the kidneys and lungs. Recall ABG values.
70. Chronic alcoholism leads to impaired metabolic
consequences due to which of the following initial
effect of increased alcohol ingestion?
A. Accumulation of acetylCoA and fatty acids
B. Increased NADH/NAD ratio
- Ethanol is a toxin, the majority of which is oxidised in the liver to acetaldehyde. The
alcohol dehydrogenase reaction is the principal oxidative pathway and involves the
reduction of NAD to NADH. Acetaldehyde is then further oxidised in hepatic
mitochondria to acetic acid, which then forms acetyl coenzyme A (acetyl CoA).
Mitochondrial NAD is reduced to NADH during this process. In liver tissue exposed to
alcohol, this mitochondrial NADH accumulates, increasing the NADH/NAD ratio, and
interfering with mitochondrial metabolic activity. This raised NADH/NAD ratio is
thought to be pivotal in the development of ketoacidosis and lactic acidosis
C. Decreased ATP synthesis
D. Impaired gluconeogenesis and lower blood glucose levels
71. Between HDL and LDL, the HDL is considered the ‘good’ lipoprotein because it:

A. Contains less free cholesterol and more cholesterol esters

B. Transports cholesterol to the liver thru reverse cholesterol transport
A. - LDL (‘bad’ lipoprotein) deposits excess cholesterol on walls of the artery
C. Is smaller in size and lower molecular weight
D. Derived from VLDL and LDL
72. Which statement is true based on the normal oxygen-dissociation curve of
hemoglobin and myoglobin?

A. Hemoglobin is a better oxygen transporter than

myoglobin because it has a higher oxygen affinity
B. The oxyhemoglobin dissociation curve shifts to the
right as a consequence of the Bohr effect and
increased 2,3-BPG
C. The p50 value increases when affinity of oxygen
to both hemoglobin and myoglobin increases
D. The hyperbolic shape of the oxygen-myoglobin
dissociation curve reflects the positive
cooperativity of oxygen binding of myoglobin
73. Which of these patients will benefit from primary prevention of diabetes using
medical nutrition therapy?

A. Obese 47 yo male with and HbA1c of

7.5%
B. 7 yo female with low C-peptide and
insulin assay
C. Bank executive with an FBS of 109mg/dL
on routine annual examination
A. -prevent Diabetes Mellitus
D. Hypertensive with normal BMI and a 2hr
75g post glucose load of 206mg/dL
74. Which of these increase HDL levels?

A. Saturated fatty acids

- Elevate both LDL and HDL MUFAs will also increase
B. W-3 PUFA in diet HDL levels and lowers LDL
levels. Best of both worlds.
- Lowers TAG
C. High TAG levels
- Lower HDL
D. W-6 PUFA in diet
- Lowers LDL and HDL
75. In patients with HIV/AIDS, weight
assessment is best evaluated in terms of:
A. Percentage of desirable body weight
B. Percentage of usual body weight
C. Present body mass index
D. Percentage of lean body mass
 76. An expected Starling’s force in the
peritubular capillaries is:
A. High capillary hydrostatic pressure
B. High capillary oncotic pressure
C. Low interstitial hydrostatic pressure
D. High interstitial oncotic pressure

Arteriolar end Favors filtration High capillary hydrostatic pressure

Venous end Favors absorption High capillary oncotic pressure
Glomerular capillaries Favors filtration High capillary hydrostatic pressure
Peritubular capillaries Favors absorption High capillary oncotic pressure
77. Secretion of creatinine occurs in this
segment:
A. Proximal tubule
B. Thick ascending
Loop of Henle
C. Distal tubule
D. Cortical collecting
duct
78. The kidneys of a 60 year old with heart failure,
pulmonary and bipedal edema will respond to:
A. Stimulation of Angitensin II and Aldosterone
B. Dilatation of both the afferent and efferent arteriole due to ANP
C. An increase in the GFR as a response to increase sympathetic
activity
D. An increase in the filtered load on Na reaching the distal segment
of the nephron
• renal tubule trans- port functions decrease with age. The kidneys do not
respond as effectively to changes in sodium load, do not dilute or concentrate
urine as effectively, and also have a somewhat impaired ability to excrete
potassium, phosphate, and acid. )
79. True of the topographic representation of the
different parts of the body in the sensory cortex:
A. The bigger the organ, the bigger
the space occupied in the cortex
B. The size of representation can
be modified by experience
C. Body parts on the right side are
represented on the right cortex
D. The size of representation is
directly proportional to the size
of the receptive field
80. This is an example of a steroid hormone:
A. Leptin – “hormone of energy expenditure”
B. Oxytocin – peptide hormone
C. Dehydroepiandrostenedione – steroid hormone
D. Corticotropin-releasing hormone – polypeptide hormone
81. In the cross bridge cycling of skeletal muscle,
this happens immediately before the power stroke
A. Calcium binding to
troponin C
B. Attachment of
myosin to actin
C. Hydrolysis of ATP to
ADP +P
D. Attachment of ATP
to the myosin head
82. This effect is due to atropine administered to a
patient prior to induction of general anesthesia:
A. Urinary frequency
B. Decreased salivation
C. Decreased in pupillary diameter
D. Bronchoconstriction
83. Duration of ventricular depolarization is
represented by
A. P wave amplitude
B. QRS net amplitude
C. QRS duration
D. QT interval
84. A 22yr old varsity basketball player suddenly experienced
palpitations and difficulty of breathing during a game. His heart
rate was 202 beats/min. the effect of increased heart rate
beyond physiological limit will:
A. Increase mycardial
tension
B. Be more than the effect of
decreased SV
C. Reduce diastolic filling
time
D. Increase duration of
systole
85. While walking barefooted, the right foot of a man steps on a piece of
broken glass. One of the following physiologic responses will protect him
from further injuries.

A. Elicit flexor reflex in the left limb & extensor

reflex in the right limb.
B. Maintain a prolonged after discharge in the
extended limb.
C. Supply more ATPs to the involved muscles to
prevent fatigue.
D. Lengthen the duration of application of the
stimulus.

The FLEXOR REFLEX - The noxious stimulus activates nociceptor afferents, which convey their information through
group Aδ axons. These axons synapse on both inhibitory and excitatory interneuron (Flexed limb – Inhibits extension,
excites flexion; Extended limb – inhibits flexion, excites extension)
86. TRUE of hematopoietic sites in fetus.
A. The yolk sac is the first site of
fetal hemoglobin (Hgb F)
synthesis
B. Blood cell formation is observed
in the spleen starting at second
month age of gestation
C. The liver is the main site of blood
formation from 2 to 4 months age
of gestation
D. During the last three months of
gestation, the bone marrow is
the chief site of blood cell
formation
87. Dangerous hemolytic transfusion reaction
can occur in
A. Rh- recipient receiving Rh+
blood for the first time
B. Rh+ recipient receiving Rh-
blood for the first time
C. Type B recipient receiving
Type O packed RBC
D. Type O recipient receiving
Type AB packed RBC
www.redcrossblood.org
88. Parameter in the complete blood count that is
expected to INCREASE in a healthy woman who
spent the last six months in Baguio:

A. White blood cell count

B. Mean cell volume
C. Mean cell hemoglobin concentration
D. Red blood cell count
• In high altitudes, increased red blood cell production occurs in order to
compensate for the low ambient oxygen levels and inadequate tissue
oxygenation.
89. Seen after the parasympathetic innervation of
the GI tract is cut
A. GI motility will be affected but not secretions
B. GI secretions and motility will not be affected
C. GI motility and secretions will be affected
D. GI secretions will be affected but not motility

REVIEW:
Sympathetic: Fight-or-Flight (ThoracoLumbar)
Parasympathetic: Rest and Digest (CranioSacral)

The vagus nerve (which is a Cranial nerve; remember

CranioSacral for Parasympathetic) is responsible for
the parasympathetic innervation of the GIT

The vagus nerve supplies both sensory (afferent

fibers) and motor (efferent fibers) functions to the
GIT
90. A 6-month old infant is diagnosed to have
congenitally absent biliary system causing building up of
bile and liver injury. Expected liver function in this
patient:
A. Able to remove urea from the body
• Ammonia is converted to urea in the liver via the urea/ornithine cycle. It then enters the bloodstream,
filtered by the kidneys, and is ultimately excreted in the urine.
B. Decreased vitamin K-dependent clotting factors (2,7,9,10)
C. Large glycogen stores
• Since there is liver injury, there may be depletion of stored glycogen
D. Intact first-pass metabolism
• This phenomenon of drug metabolism will be altered
91. Drug X was added to Drug Y leading to decreased
effect of drug Y. Increasing concentration of drug Y did
not lead to further increase in Drug Y’s effect.
A. Full agonist
B. Partial agonist
C. Competitive antagonist
• binds to the same site as the agonist but does not activate it, thus blocks the agonist’s action. May be displaced by
increasing the concentration of the agonist.
D. Non-competitive antagonist
• binds to an allosteric (non-agonist) site on the receptor to prevent activation of the receptor.
92. The parameter that promptly raises the plasma
concentration of the drug to its target concentration
A. Maintenance dose
• given to maintain the minimum effective concentration which may be in continuous infusion
or in regular dosing
B. Half-life
• This is the period of time required for the concentration or amount of drug in the body to be
reduced by one-half
C. Loading dose
• A loading dose rapidly achieves the peak concentration necessary to compete with
clearance, so that the desired effect is achieved and maintained sooner
D. Volume of distribution
• a theoretic concept that relates the amount of drug in the body (dose) to the concentration
(C) of drug that is measured (in blood, plasma, and unbound in tissue water).
93. Which of the following is a special concern for
indomethacin for inducing labor?
A. Fetal cardiac arrest
B. Fetal gastrointestinal
C. Fetal hematuria
D. Closure of the fetal ductus arteriosus
• Indomethacin, an NSAID, may cause premature closure of the ductus arteriosus
94. A 50 year old male, alcoholic, with duodenal ulcer
on endoscopy came to the ER due to black tarry stool
and dizziness. BP is 80/50, with weak peripheral pulses.
What drug should be given to him aside from blood
transfusion?
A. Antacid
B. H2 blocker
C. Proton pump inhibitor
• Proton pump in gastric parietal cells (H+/K+ ATPase) when inhibited, results in the
suppression of basal and stimulated acid secretion. Among the choices, this is the drug of
choice since it directly inhibits acid production, thus preventing aggravation of the
duodenal ulcer.
D. Mucosal protective barrier
95. A 50 year old male came to the clinic due to
palpitations. ECG showed atrial fibrillation with rapid
ventricular response. Which drug can be given for rate
control without cardioversion?
A. Amiodarone
B. Disopyramide
C. Quinidine
D. Digoxin
96. Bethanechol can be used for treating
urinary retention because of this action:
A. Contracts detrussor muscle
• This is the result of activation of the parasympathetic receptors by Bethanechol, a
parasympathomimetic agent
B. Contracts bladder sphincter muscle
• Symphatetic action
C. Relaxes detrussor muscle
• Sympathetic action
D. Relaxes urethral muscle
97. Aminoglycoside antibiotics are frequently used
in combination with the betalactam antibiotics.
Which of the following choices best explains the
rationale for this use?
A. The combination provides for much greater spectrum of activity
B. A synergistic effect is often seen when the combination is
employed
C. The beta-lactam antibiotics prevent toxic effects of the
aminoglycoside antibiotics
D. The combination decreases incidence of superinfections
98. A 26 year old G3P2 at 5 months AOG had fever and
chills for 3 days. Malarial smear showed positive for P.
falciparum ring form. What is the drug of choice?
A. Mefloquine
• Mefloquine should not be used for treatment of malaria in pregnancy unless there is no other
treatment option because of increased risk for stillbirth

B. Artesunate
C. Doxycycline
• Doxycycline and tetracycline are generally not indicated for use in pregnant women. It has been
associated with transient suppression of bone growth and with staining of teeth of the infant.
D. Chloroquine + Primaquine
• Primaquine should not be taken by pregnant women or by people who are deficient in G6PD (glucose-
6-phosphate dehydrogenase)
99. The rationale for using fixed dose combination
of inhaled corticosteroids and (ICS) and long acting
b2 agonist (LABA) is:
A. Synergism (LABA and ICS equally enhances each other’s
effect)
B. Additive bronchodilating effect
C. Potentiation of ICS effect by LABA
D. Diminish each other’s adverse effect
100. A 23 year-old college student is diagnosed with
Neisseria meningitides based on his clinical
representation and gram-negative diplococci on gram
stain. Which of the following drugs can be used as
prophylactic agent for roommates and other close
contacts?
A. Amoxicillin 2-day regimen of rifampin (600mg every 12h for 2 days
in adults and 10mg/kg every 12h for 2 days in children >
B. Isoniazid 1 year). Rifampin is not recommended in pregnant
women. Alternatively, adults can be treated with one
C. Dapsone dose of azithromycin (500 mg) or one intramuscular
dose of ceftriaxone (250 mg).
D. Rifampicin -Harrison’s p.889