Seat No .

: _ C/
. Repu b lic o f th e Philipp~ nes
PROFESS IONAL REGSLhTIOK COMMISS I ON
Mani l a

i BOARD OF ME DICI NE
PHY~IC ·
Mo~cil I .A.NS Licensure Exam :. na tJon
____ :ay, November 1, 2021 02:00 p , m. - 04: 10 p.m .
.r---------------------------------------------------------------- ·-----
~1E~ INE
,---..;;; SET A
IN i
--=-.STRUCTI ON: Select the correct answer fo~ each ' of the following
que
. s It-~ ions
·
,· Mark onl
o ne answe r for each item by shading the box
~orr ~ sponding to t h! l etter o f. y our choice on the answer sheet provid d.
STR'I f TLY NO ERASURES ALLOWED.
MULT;LPLE CHOICE
i
i
1
· Wl!at ~d the pathology .MOST commonly associated with adult resoi.r· tory
distre..§Ja_ayndrome? ---
.A.. Extensive microembolization
I ~- Pa~tial collapse of lungs (atelectasis)
....e. Diffuse alveolar damage .
D. Edema in the microscopic air sacs
I
jThe following sign or sympto;n may be seen in meningitis, EXCEPT
i

;·
/
•

A. Kernig' s
B. Brudzinki's
-
1 C. McCallum's
i ..J~ Jolt-accentuation maneuver

3. In a 57 year old healthy man, what is the average <jlomeruli::.r fi~ 1 :ation
rate in ml/min/1.73 m2?
A. 93 c. 80
B, 110 &) GS
I
4. ~ilhat is FALSE of segmental vitiligo? .
I A. Differs in cause and.frequency of associated ~lln~sses
B. It's mostly unilateral in characteristic
~ I t ' s much more stable/static in c::iurse
D. Its treatment is the same as that of non-segmental· vitiligc
I
5. ~hich class of drugs is associated MOST with d':f)re.ssJ.on?
1
1.:... Anti-hyperte·nsive .,Q< Blo·: :>d-sugar lowering
B. Anti-migraine D. Lipid-lowering ,
. I
6. hat do you call the bleecU:Eg/hemorrhaqe in ~he delp.oate innermos
ayers of the meninges? \
.Subarachno.id
1-\.. C. SUbdura::.. 1
B. Epidural Intracerebral

7. Jin dengue fever, the viri-,1 genome is translate·i:l in !Which part o:t; · l1e
el'¼?
@J Cell membrane <;;~ E.ndopla:mic retitlum
• B. Nucleus 'Q!.) Cytoplasm
8.
tfoke.
A
semi-conscious 75-year old - man was rushe~ to the ~linic for hea·
1
128
His serum sodium is likely - , - , . - - - - - - - mEq/L,
~D l3tl
. 140 (3/ 146
Continued on Fage 2
 PHYsr / r
Monda ANS Licens ure Examination
, November 1r 202 1 02 : 00 p . m . - 0 4: 00 p . m. Page
-MEDIC NE
SET A

9. 7
hat is Fl;>-LSE of the epidermi s ?
A. Nourishment is mainly provided by diffusion
j B. It assists the immune system in warding Qff pathogens
c f Cells are continually shred from the stratum oorneum
I P~ It's nourished directly by its own blood supply ·
10.
~he ~etechial rash in meningococcal meningitis 1s char~cterized the
r-Ollowing, EXCEPT
I
i
!:,
rapidl:y spreading
• blanching ·
c. purple or red spots
D. small and irregular
I7
J. l .
rhich is NCT a test fo;;. detecting the prese::ice of Helicobacter p ·lori?
Urea breath
I B. Measurement of serum antibody
: C · Stool antibody .
D. Detection of urease activity
L2.
tti/h i<?h
meningo-encephalitis? ·
of the following is the LEAS'l' LD<ELY complication of

Pl\~ Disserr.inatecl intravascular coagul:1.tion

~- Sepsis •
~;> Myocarditis ·
., • Systemic inflammatory r;sponse sy,..:i.dro:ne
i
13. fhat distance in meters accornpli~hed i~ the walk distapce test i ;
patients with chronic lung problems is ass•:)Ciated with fair to 91 od
prognosis?
! 100 c. 240
! ·a. 380 D • .s20
I
14. 'fhe species of Plasmodium that causes serious or severe malaria::;
'. A. falciparum c. mal:1.riae
! !ii-:" vivax D. ovale

tA
15. hich is NOT expected in ~ephrotic syndrome?
IA\. Lipiduria c. Alb·:.1minuria j
'i?.- Hyperglycemia D. Hyperlipidemia I
16. male adolescent ,..,as found to have glome:i;-ulonephr.itis w.ith !+~ad 1g and
yisual impairm~nt _, noted to be due . to abnormal collagen qepos;i.t.;i.c 1 in
'rhe eyes and middle ears. He has li_k ely _________ synd~ome.
i A. Stickle~ C. Ehlers-Danlos .
i B. Loeys-Dietz .2':" Alpc-rt · )

1 7 . Jesides Neisseria meningitidis, which is the NEXT ~ost frequent: ruse of

~acterial meningitis?
I A< Pseudomonas . aerttginosa C. Listeria monocyt;ogenes
i B. Streptococcus pnernmoniae E'f:' Staphylococcus ~ureus

.1.8. 1 n patients with HIV~AIDS, negative for meningococ,temia, what is ~he

1 ext MOST likely cause of meningitis?
A, Protozoal ~Fungal

19.
1 B. Arnebic D. Tubercul:n.1s

positive Murphy sign in acute cholecystitis has around

1

1,1. e;:.fent positive and negative predictive value.

(b) 70 C. 60
l B. 80 D. 90
· 2. 1-9
Cont i nued pn Fags 3
 ;

PHYSITCIA
M dla '
NS Licensure Examination
on :ay, November 1 , 2021 04:00 p.m. Page
02 : 00 p . m. -
I
t!,EDrlcnm SET A
Ii -
2 O· Th1:::: ·r o 11 owing kinds or species o.f ma 1 ar .1a
· cause mi· ld d isease,
' B}• 'EP'r
•
·A. vivax ,0) ovale ·
_
1
B • falciparum 't(. malar iae
·i l i
'• • • I
'Retinal whitening' is associated with what severe condition?
A. Acute embolic occlusion o f . retinal arteries
B. COVID-19
I
I f) Cerebral malaria with encephalopathy
! D. Intense ultraviolet
; .
rays exposure
22 .I Wl:ic~ of the following is true .about the genetic variation in c.e 1gue
v.1.ruses?
I A. 'I'he, major determinant is temperature in area
B. It i s generally . endemic in multiple regions, with
I establishment into additional te:::ritories
C. It is region specific, suggesting that establiehmen:t into
new territories is relatively infrequent
D • Regional specificity is based on demographics,{/
23. Which is TRUE of rabies?
A. Not transmitted thru tne mouth, nose or eyes ·-J.
03'. Frequently w/ thirst and polydipsia due to dehydration/
.rr. Involves the peripheral but not central nervous system
D • Caused by a lyssavirus • thru a·nim-:11 bite

24. The polyarthritis of Rheumatic fever~~ usually starting in the

A. legs and migrating upwards

B. cervico-thoracic area going downwards
C. shoulders and arms going downwarqs ;

D~wrists and elbows going to shoulders and cervkcal area

I

25. In epilepsy, non-consciously-generated activities and mostly sin >le

repetitive movements are called ·
'. A. smacking C. au~o1M.tisms
B. tics D. au~a

26. : A brainstem stroke is GENERALLY chara-::terized by following, ~XCEPT

A. Aphasia
B. Altered breathing and heart rate
.e"'. Altered smell sensation
D. Drooping of eyelids ~- ·

27. Aside from mosquito-bite transmission of the dengu fever virus, the
following modes of transmission have also been rep rted in recer
literatures, EXCEPT~~-------·
A. vertical transmission c. ai=borne
B. infected blood products .V. organ donation,
28. what skin lesion do you expect to s·e.e in c~ildren
A. Burrow ..C:--:-- Sc ale
·Lith
I
scabies?

-,/, Crust D. Lichen~ficationl

2 9, Which of these is the most appropriate in~tial pharmacothdsrbapythf >r , ,

symptomatic ~a-~iente with osteoarthritis who are bothere Y · = pain'
~..,, Chondroi tin c. Glucosamine
s. Ac•taminophen D. Topical hot liniments
. l.9
Continued on Page 4
 ~HYSidIANS Licensure Examination
fvtonda Yj, November i, 2021 0 2: 00 p. m. - 04:00 p.m. Page 4
-~~CliNE
--r-= SET A

30. I
W1hicl1 of the following is an underlying cause of Type 2 respiratc.1 /
f lailure?
' A. Neuromuscular problems
B. Bronchial hypersensitivity
Cyincreased breathing effort
Pr. Decreased airway resistance
31.
H~berden's nodes in osteoarthritis are seen in the
jpints.
.
A• wrist/carpal C. shoulder
I
,_y. distal interphalangeal D< proximal phalangeal
32.
W~~-~h is NO'J~ t _rue of wheal as· a skin lesion?
,
A. Usually disappears within 24 to 48 hours
I• Usually rounded or flat-topped
C • Characteristically evanescent
I
I
Di Represents an enlargement of super~icial blood vessel
.
I .
W~ter moves from places with lower sodium concentration to place~ 1ith
h~gher sodium concehtration through a process called
:
-,-;-.;:A:-.-p_e_r_n-,e-a-t-:-_-:-i_o_n_ _ _ _ _ _ ,,.
(2.)osmosis
i B. diffusion D. saturation
i
34. HjLstologically, one notes -a loss of cohesion betwe~n keratinocytes in
wtich of the following?
(1P
Atopic dermatitis C. Third-degree burns
i'l3. Varicella zoster D. Germen measles
I
35. W~~ich is FALSE . during and immediately after an
epilrptic seizure)
IA. Patients may become unconscious
B. There may be transient confusion.
e~ Affected patients feel exhausted .
.I There is hyper-ref~exia
i
36. Wlbich PaO2/Fi02 ratio (PFR) in mmHg is suggestive of rnoderat(;l adul
rj spiratory distres~·syndrome?
1

A. 50 C. 200
lw.-
100 D. 250

37. FJact-ion of inspired oxygen (Fi02) at 1 liter 02 by.nasal cathete::- ts

al;
proximately
f>.. Q.24 !Y. 0.21
.B. 0.27 D. 0.29

38. wtji9h is the MOST common pres-enti_l}g ~ymptom of meni gitis in adult: ?
/}(. Headache High fever
IB. Disorientation _p);' Nuchal rigidity
I
39. wdich BEST describes the typical presentation of patients with chrc 1ic
obstructive pulmonary _disease?
ii!-'<. Easy fatigability, ortnopnea, wheezing
t
~- Dry cough, rhon~hi and coarse crackl~s o~ ausc ltation
jC. Dyspnea, cyanosis, cold clammy pers!:>1rat1.on .
1D. Shortness of breath, cough, sputum production
!

40 . In Wernicke-Koreakoff psy~hosis, the associated pathology in the b1 !in

isi due to damage of which part?
1\ . Medulle oblongata < C. Frontal lobe
•:B. Pa.r.ie tl."IJ. lob e D. Thalamus V

Cont i nued on Page 5 2. 1. 9

 PHYS ICO: ANS Licens ur e Examin·at ion
Monday~ Novembe r 1 , 2021 0 2 : 0 0 p . m. - J4:08 p.m. Page 5
I
t!_EDICI)'lE SE'.l' A
I
I
i
11. : \1 _eyronie • ~
I -
disease, what t y pe of tissue grows abnormally int~ male
OJt"gan?
' l\. Vascular c. Collagen
] B. Muscular jY. cavernous
I
4 ·:2 · 'I' p eatment after exposure (dog bite) can pre~ant rabies if given WJ thin
days.
A. 15 c. 20
, B. 10 S-,-5
i
I
4 3. M~ture new dengue viruses are released into the circulation by th~
process of ;
}.\. e:x:ocy-tos is c. cellular transfer
, 11,..--- viral migration D. expulsion
! .,.
'
SITUATIONAL

Situati on l - A 31-year old female with a p~le ashen appearance seeij ju, and
Y~U suspect chronic glomerulonephritis (GN).

44. W~ich of the following urinalysis findi~gs .is NOT expected as part of
tpe GN? ·
. A. 3+ proteinuria C. WBC of >100/hpf
' B. Red cell casts @;) RBC of > 100/hpf
4-~.
r: r.rt
j• 1
n 1c1
[ , ,
serum :·indings may be• associ~ted with this cqndition?
' . .
A. Serum K of 3.2 mEg/L
!;§· Serum uric acid of 5 mqs/dl
l~\ Serum LDL cholesterol of
150 mgs/dl
1
I
·d. Serum random blood sugar of 140 mgs/dl
I ,
46. W1.i.ch type o~ GN u~ually result in nephr<;>tic Bfndrqrne?
:A. Nonproliferative C. Post~1nfect1ous[
: B. Rapidly pro~rress:Lve ,Jr;' Membrano-prolif~rative

Situatlon 2 - A single 30-year old male consults you for pain~ul urina ion and
pJs-like secretion coming out of his urethra. He hl'd unprotected
sJx recently.
I
·

47. w1at is generally the incubation period in days of _~exually transu tted
infections like gonorrhea and chlamydia?
& 2-5 C. 6-9
10-12 D. 0.5-2
I
4 8. I1 you're suspecting gonorrhea or chlamydia in eittler males or fem; les,
tl1e· following specimen rnay__b_e_r__ eq.'imen for the
el_i_a_b_l_Y_\:._·_s_e_d_a_s_s_p__
ctjnfirmatory test, EXCEPT
~- urine for both males and females l
J,£<- cervical swab in women
jc.-. vaglnal swab in women ,
1
o. ·anal swab for both males and females
4 9. F~r gonorrhea and chlamydia infection, the recomme ded method of
co:~n:eirmatory diagnosis is through - - - - - - - - - ~ - - - - - - . - - t£ ~ts.
culture
· , . 11ucleic acid amplification
C. gram st.?.in
~- pcilymerase chain reaction

Continued ·on Page 6 --.1.9

 PH}' c•rc -
-~,. ~ ANS, L.1.cens
.
u re Examina tion
Monday,: Novembe r 1, 2021 02 : 00 p . r:1. - C4:00 p.m. Page 6
I
~~)~~HiE SET A
' 9
Situat ~on _ .t\ 48-year old he a lth c are f1:ont liner is admitted to the OVID-cl
wqrd w1 th fever, anosmia, and anorexia. He claims to be •.
cqmf:ortable with his breat h ing at ~est. RT-PCR swab done outside

5 0. W~ .1.ct
wl~-
positive. _ . .
inding in the complete blood count (C3C), in m1crol1ter (uL of
b ffd, is NOT expected for his conditior.?
Lymphocyte count. of 2,800
a·. Hematocrit of 48 percent
C. White blood celL count of 3,500
D. Plntelet count of 245,000
51. C1est :x-ray done is tmrEIB)arkable. Requesting for a chest C'l' scan

;A. still advisable to--r~Ile out COVID infiltration of

iB. c,ptional in cases when there's no cough or dyspnea
indicated only .i.f 1_Jatient develops cour;h or dyspnea
no longer necessary since chest x-ray is normal
5 .2 . !1gn.i:Eicantly
p~t~ents with COVID-19 who are not dyspneicb ~uch
~,J low oxygen sa;turation is . J, :J.J:A.<t"
as in this ca e, a
1
IA. hi?hly unlik~ly and ~s just most likely due to a defective
1 ox.irneter
/B. expected in the ear. ly stage ·o f even asymptomar,ic COVID V
pat:Lents
C. explained by the sen s e of denial of patients ~ho f~ar
e'"')1 intubation
,Y :3till possible d1.1e to the phenomencn of "happy hypm~emia" K
Situat i on4 - A 45-year old woman with rnul~llergies, for - which v rious
_· m~dications are prescribed, comes to you for high ~load pressure
o~ 160/100 rnmr-Jg. She also complains of easy fatigapiity,
h~adaches, irregula~ menstruation. On PE, ycu note\ her round face
w:ii t.11 acn•~r::, c1 :Eat lump b~tween the shoulders, reddish stretch
m~rks
i
and weak motor tone in both upp~r 3nd lower ~xtrem~ties.
:
' .
5 3. Atlt-~xcess of wl"l.ich ·s ubstance or hormone 'A'OUld you
@) Aldosterone
:B. Glucocorticoids
C, Catecholamine
D. Progestero~e
I ,
tlonside:i:- . MOST?
.
I
54. Ydu inquire about her medication history. Which o~ the following
m~cHcines she's been taking without regt:lar follow~up with her phy icj_an
mdst likely contributed to her condition? '.
iA . .Monteleukast h" Levocetirizine 1
!B· Diphenhydramine V"Methylprednisolfne
55. Wljich hormone may be checked in the blooj to confi m the diagnosis
A. Growth hormone
A!:~· Thy;c-oid stimulating hormone .
Adrenocorticotropic hormone
ID. Follicle-stimulating hormone
situat~on , s - You're following up a SO-year old known cas~ of Rh~~~ato d
a~thritis (RA). She seerns to be doing well en her burrent
tueatment regimen. Y6u repeated some of her laboratory tests~
i
56. w~ ich i~ consistent with RA in .her complete blood count?
A . platelet count of 450,000/ mcL
I
a. hematocrit of 41 percent
l
ex whj_tc blood cell count of 16,500 cells/mcL
D• . red blood cell count of 3, 6 O·O celle /mcL

Continued on P~ge 7
.-
 P[·IY
Ivio;1 ~f i
'
CI _ANS Licensure Examinat io n
Y, November 1I 2021 0 2 :0 0 p . m. - 04: o·o p .. m. Page

57 ·
,-
t!_EDI INE

do you NOT expect to fi nd on 2 D echocardiogram with Doppler study

SET A

in this patient?
A. Mild left ventricula r compliance abnormality
.,)3"°:ejection fraction of 7 0 perce nt
C. minimal pericardial e ff usion
I D. outflow tract dyskinesia
58 - i The following may be seen on x-rays of the hands and feet, EXCEP'
I

. subluxations c. osteopenia
I B. osteophytes B~ bony e=osions
s{tuLtion
1
6 - Commonly used calcium channel blockera in clinical pra tice are:
: I . ni' f e d"l.pine,
' II, diltiazem artd, III. Verapamil.
;

S9. Wh~cf may be used ir: patients with hypertension?

A. I, II, III CY. I only
• None 8f them o. III only
GO. Which can potentially increase heart rate?
A. III
B. I 9/. II
D. None o:: -chem

61. Which is best given in patients with supraventricular tachycardi?

A. None of them . ~;.,, II
i
I
B. III V, I

Situction 7 - A young female, who has a history of recurrept short f. inting

spells usually preceded by palpitations, suddenly collapsed whil•
waiting for a ride at the bus stop. She was rushedlto a nearby
hospital ER, and hooJted to a cardiac monitor. She was unconsciou:
with no palpable pulse.
62 ~ Her rhythm in the cardiac monitor is most likely
..z<: sin.us bradycardia with frequent 2--,second paus~s
B. ventricular fibrillation

j
C. chaotic atrial rhythm
D. atria-ventricular tachycardia with reentry 1
I
1

63, A.fter intervention, ·regular sinus rhythm was resto{ed. 12 -lead l ::G
,,ould likely show right bundle branch plock (RBBB) with . --"'--
,?(. ·l:all peaked T wa·1.res 1
~
! B. ST elevation in I, AVL, II, III, AVF
I C. inverted T wave in Vl, V2
I
1

' D. ST elevation in Vl, V2 ·

shoT
i
64. ~n this patient, which of the follo0ing drugs be .always a, Jided?
• A. Sodium channel bl.oclrnrs
By Beta-blockers
e:. ACE inhibitors
D. Mineralocorticoid receptor antagonists

Situ~tion 8 - ktrial septal defect (ASD) is a =ongenitJl heart diseaE { CHD) a

~hysician may diagnose in unsuspecting adults, wholdid not
F~alize they had such CHD.
!
65. Wbi:,t. is the MOST common type of ASD? ·
A. Patent foramen ovale c. ostium ~rimum
B. Sinus venosus
--
D. ostium ;ecundum

Con t inued on Page 8 9

 PHYsr dIANS Lice nsu re Examinati on Page 3
Monctai ,November 1, 2021 02 : 0 0 p . m . - 0 4:0 0 p.m.

~!3:DIC:£ NE SET A
i
•tients w ith relative ly smal l sh unts, what is a po_ ACTii-:::AL ma:1 uv·er
1
GG • •
~ 11 -
, o accentua~e the shunt du r ing diagnostic study?
~Valsal7a c. Coughing
I
, B. Deep inspiration D. Sitting up
67. Re~ersal of the shunt in ASD occurs in
: ... ~i.nfectiva endoc~rdit is C _- Eisenmenger' s syndrome
D. paradoxical embolizat i on D. decompression syndrome
Situa~ ion 9 - You requested for the serum level of adrenocorticobropi hormone
GACTH) in a suspecterl case of Cushing"s syndrome, and the
~ollow~ng are the pos~ible results you may obtain: I.
Qndetectable or low level, II . . Normal to mildly elevated; or III.
~arkedly elevated. Which of these results are MOST related to or
~ssociatecl with the following interpretation?
I
I

68. 1c~pic ACTH syndrome is likely?

A II c. ,None of these
, III D. I
I
69. qushing's may be considered?
: J..\. II bl None of these
I B.
I
I III

70. ~rirnary hypercortisolism is like~,.

1
J\. II . (9 None of these
; H. I D. II
I
S :Ltua·~i_on 10 - A 3 5-year old housewife sees you for a 5;-day history of
grocluctive cough with yellowish sputum, accompanieti by fever, and
~ome pain in the chest when breathing deeply. .
i

7 J.. ~hich of the following is Q,an

expected finding ct.n her comple-t e blood
dount? ·
A. White blood cell count of 14,500/uL l
; B. Hematocrit of 48 percent I
j • Neutrophile count of 12, 000/uL !
i J; Lymphocyte count of 7, 500/uL \.

72. dram staining shows a Gre.m positive(+), lancet-shhped

1
pathogen. OST
~ikely, the causative organism is
·@. Klebsiella pneumonia ~) Staphylccocous tu:i;eus
I B. Pseudornonas aeruginosa (E/ Sti:-eptococcus p eumoniae
!
7 3 • ~hat is your antibiotic of choice for this patien~
. .. Fluoroquinol_o ne · + doxycycline ,
e_'
Beta-lactam + doxycycline •
Macrolide + fluoroquinolone
~
; D. Beta-lactam + macrolide
I
Sitt1at1'ion 11 - A 40-year old male, previously heaJ,:t;,ny, a ~us.tie!i tg t;h, ER with
severe difficulty of breathing. He has feve.r and d y qough, fo:i;-
cays. You hear crackles at both bases. and right m d lung field.
74. T at is LEAST expected in this patient on PE? I
b,..,/Apical S3 or 3rd heart sound
B. Heait rate of 120/ minute
· C. Apical S4 or 4th heart sound
o. Respir~tory rate of 32/minute

Continued on Page 9
MEDI INE SET A
75. Whicl. arterial blood gas f i nding at room air will surprise fou
(unexpected finding)?
.J\. Oxygen saturation of 8 0 percer~t
(~ Partial pressure of carbon dioxice (J;COZ) of 48 mmHg
C . pH of 7.45 .
D. Partial pressure of oxygen (p02) of 55 rnmHg
76 · you ~omputed for the PaO2/FiO2 ratio (PFR). Which of the followir 1 PFR
is~OST compatible wi-th his condition?
A 150 · · c. 30
. 450 D. 300
Situ~tion 12 - A 52-year old male smoker, with hyperten~iQn apd diabe1 ?s, was
!rushed to the emergency room for severe, crushing chest pains,
;cold sweats and shortness of breath of 1-hour duration.
77. i'1,,1Jhich of the following· will y o u JID.T. ccnsic:er immediately?
A. Acute pulmonary embolism
B. Acute massive myocardial i nfarction
.G-:" Severe aortic valvular stenosis
D. Acute aortic dissecting aneurysm
!
78. iWhich is the LEAST likely t~ find i n his 12-lead ECG causing his
symptoms?
1
A • B~phas ic T-wav~ in Vl-VS, I, AVL, anc. II, III, AVF
i cw;• Diffusely low QRS voltages with pathclogic Q waves
1
' Cl 3-4 mm ST elevation in Vl-V6
i • 3-4 mm ST depression in Vl-V6

79. 1Troponin I was 0.40 ng/ml. BP was 80/E0 mrr.Ha; hear:t rate of 120/ :ninute.
~hat is the MOST appropriate intervention ii this ~cenario?
A . Massive dose of low nrolecula.r wei-3ht heparin l
$ . Percutaneous coronary inter.vention i
C. Trans-catheter pulmonary ernbolectomy
D. Trans-catheter aortjc valve repla=ement
Situ~tion 13 - A 60-year old with a 25-ye~r his~ory of uncontrolled d: · abetes
cbnsblts you in the clinic for weakness and easy atigability.
You note crackles on lung auscultatio~, with hepa omegaly and
bilateral pedal edema. His random blood sugar is 56 mgs/dl.,
,creatlnine of 3. 5 mg/dl.

80. iw11ich other lab value ( serum) is not expected?

I A. Potassium of s:4 mEq/L
! B. Sodium of 145 mEq/1
A· HbAlc of 9. 5 percent
(EJ· Tr,iglircerides of 350 rngs/dl
I
81. !Estimated glomerular filtration rate ( GFR) is 29 11/min/l.73/rn2. Which
lanti-diabetic drug should you NOT preecribe?
. A -. Metformin C. Lir..agliptin
I @i Dapaglif lozin D. Insulin

82. I You would recommend renal replacement tterapy once the GFR i less
lthan __________ ml/rnin/l.73/m2.
(~). 12 c. 18
iI ':B'. 19 D. 15

·situ~tion 14 Diarrhea due to cholera can be life-thr~atening if not adequat~ly

ri anaged.

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t!-EDICINE
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83
· Th~ ,........ iarrhea in cholera is HA I NLY due to _ _ _ _ _ _ _ _ _ _ cause•

84
r•
.f'r'. secretory
inflammatory
~ ' exuda.-~ive
osmot::.c

· Wh~t ion is lost MOST significantly in cholera?

f,.. Potassium ~Sodiu;n
~- Chloride D. Magnesium
i.
8 5 · lnJ c_hol·era, the intestinal fluid secreted is
hypertor. ic c. isotonic
iB. hypotonic D. variable

S.i.tuati~n 15 - You see a s's-year old. male, on polypharmacy, complaining :if

ontand-off diarrhea. Two major · causes of diarrhea you're
considering are: ~. Secretor_y, and II. Osmotic.

86. Wh'ch is/are associated with bowel movement of 6 or more per day?
II C. Both
· I D. Neith~r
8 7. Se ect -which type(s) is/are associated with inhibition of absorptic
gut:. . 1 in
f>.·
I
Neither
•

~II
l3. Both D. !
i
8 8. Wh ~ch may be caused by ingestion of excessive sugar or salt?
· A. Neither . C. I
fa-<°' Both D. II
i'
Situatibn 16 - An elderly pati~nt was rushed to t~e ER in the m~ddle of :he
ni~ht due to sudden onset dyspnea and orthop~ea preceded a few
ho~rs ago by chest di~comfprt which he just dismissed to be due
to! indigestion . On PE, he had an apical S3, a highipitched
blf,4ing systolic murmur, and bilateral c.:::-ackles. i
i •
89. Whtt will you consider MOST?
¥,,., Acute mi tral regurgitation
B. Pericarditis
¢. Se~ere heartburn
~- Acuie aortic regurgitation

90. Th~ MOST likely cause in this patient is

A. valvular vegetation
~- ischemic papillary muscle

~r-
d!-.- inflamed pericardia]. lining
severe gastro~esophageal reflux.

91.. Th~ following ~ay help this patient, EXCEPT

A. beta ago!l.ist .
.JV. angiotensin receptor blocker
c±. nitrates
6. ACE inhibitor
Situatidn 17 - You were called to see a 55-year bld pat~ent brought to ·- .e ER
fo~ severe abdominal pain. History and PE suggestslacute
pa11creati tis. You requested for serum amylase and lipase•
92. Wh ~ t should you remember when vou request for these tests1
4. Ev~n with severe abdominal pain, d!agnosis is still
I nondiagnostic . ·
~- They have no ~ole in assessing disease severity
~S~rum amylase is more se11sitive and specific than serum
· I l.ipase !
Continued on Page 11 1 e 2 .1. 9
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· 1IANS Licensure Examination
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MJ~.Ql CJ) NE
~--·-·
D~e·:r\Jm lipas ,: rises within 30 minutes from the onset of
symptoms
I
9 3 · ~eru. ..:1.mylase may be normal :Ln acute or chronic pancrea"t!.i -t;:is
'rhen_.---~._..,.-.
j A• he~d of pancreas is oriented _i9feriorly
~,- acinar cell mass is depleted V ~J
there is vascular mismatch in all regions of pancreas
, • Suppression of pancreatic zymogens or proenzymes

94. ~rl~ j
is NOT a reason for a falsely elevated serum amylase?
Portal hypertension
B. Salivary gland d~sease
!I C. Bowel obstruction, inj:arction
i D. Perforated ulcer ·

Situalion 18 - A 42-year old housewife sees you for a p~ipabl~ mass on her neck.
fou note on PE a 1.5 x 2 cm firm nodule on the right side o! tbe
reek.
95. ')I'o confirm the presence o:f. a nodule and assess the st&tus of the hole
1

~land, what exam on the thyroid gland would you request?

i A. Fine ne~dle aspiration
! Radioactive _i odine upt;3.ke
j ~) Thyroid function test
! D. Ultr.a8ound
i
96. 0hich test will help you evaluate the physiologic function of pat .ent's
thyroid disease ? · ;
! A. Fine need le aspiration fE.:J Thy.::-oid ultrasound
B. Calcitonin test Y. Antithyroid antibodies V . 1
i
97. betection of any metastases of thyroid cancer can be performed wi :h a
tfucyl-body _,.--------···:___ scan using iodine-1~1 . .
/2) computerized to~ography
I A magnetic resonance
. 3. s ·cinti9raphy '!5. bone . I
. I
(.
situa~ion 19 - A 51-year old peri-menopausal woman, whofwas lost to fc Llow-up
1th her endocrinologist, but still errati=ally ta~ing the
1ethimazole she was prescribed,· was brought to you.with ah acute
nset of symptoms of restlessness and :1.gitation, c~nfusion,
~romiting and diarrhea starting just 3 hours befo~~ consultation.

9 8. ·1ll~t/would be your primary considerati-: m?

iv Thyroid storm C. Acute ischemic !st:i:-q~e
i
_liY."' Myxidema D. Methimazole tofci ty

9~- fhat is NOT an expected finding in·this case? '

: A. Temperature of 36. 5 d8g:rees Centiqrade
/ B •. 1 Systolic BP of J.60 mmf.-1g
· cY Pulse pressure of 80 mmHg
; Heart rate of 115 /min
I

100 . ~hich of the following will you NOT give this pat'ent?
I A. Anti-th~roid drugs c. Ino~ganic iodi e
l I:',. Beta-blockers )-;r." Alpha blockers
i