AGO GENERAL HOSPITAL

MARK JOSEPH CERVANTES, MD

NAME: ____________________________________________________ DATE: __________________________

INTERNAL MEDICINE

1. A 69 yo man with a history of coronary artery disease and hypertension presents with acute onset of right facial weakness
and numbness. On examination, his speech and extremity strength are normal, but he has significant weakness of the right
side of the face, including the orbicularis oculi. In addition, he complains of roaring in the right ear, and his taste sensation is
absent on the right side of the anterior tongue. Sensation is normal to prinprick. Which of the following would best explain
these findings?

A. Lacunar stroke of the left internal capsule

B. Brainstem glioma
C. Bell’s palsy
D. A stroke due to occlusion of the left middle cerebral artery

Bell’s palsy is idiopathic and nearly always

acute. All of the patient’s deficits are referable to
the peripheral nervous system, including the loss
of taste (chorda tympani branch of the facial
nerve) and hyperacusis (branch of the stapedius
muscle of the ear).

2. A 60 yo known diabetic patient was rushed to the ER for unresponsiveness. On physical examination, she was noted to have
dry skin and oral mucosa with BP 100/70mmHg, HR 100 bpm, RR 28 cpm. RBS = 600mg/dL, urine – negative for ketones.
What is the initial step in the management of this patient?

A. Give IV insulin as soon as possible

B. Insert a line and administer plain NSS
C. Give IV bolus of sodium bicarbonate
D. Intubate the patient

3. The ECG of a 66 yr-old male with a history of atherosclerotic heart disease reveals an irregular
but rapid heart rate. The QRS complexes are normal but no P waves can be seen. The most likely reason
for this finding is:

A. Atrial fibrillation
B. Paroxysmal ventricular tachycardia
C. Right bundle branch block
D. Sinus tachycardia
E. Wolf-Parkinson-White syndrome

A-fib is a continuous chaotic re-entry of electrical impulses within the atrial myocardium that arises
in a diseased or stretched L atrium. The chaotic patterns of atrial excitation prevents P-waves from being seen in the ECG.
He ventricular response is rapid and irregular. In all other choices, p wave should be distinguishable.

4. A 67 yr-old woman complains of gradually increasing fatigue. On physical examination, she is found to be anemic and has
peripheral neuropathy characterized by loss of position and vibratory sense. Labs show macrocytic anemia and low WBC
and platelet counts. Your impression is:

A. Folate defiency anemia

B. Pernicious anemia
C. Chronic blood loss
D. Diabetes mellitus
E. Myelodysplastic sideroblastic anemia

The inability to absorb Vit.B12 leads to a

 macrocytic pancytopenia and peripheral
neuropathy

5. Calcium and aluminium-containing antacids should not be given to patients taking which of the following?

A. amoxicillin
B. erythromycin
C. isoniazid
D. minocycline
E. rifampin

Tetracyclines such as minocycline chelates cations (Ca & Al).

6. Most common cause of bacterial meningitis in adults >20 y/o?

A. H. influenzae
B. N. meningitidis
C. S. pneumoniae
D. L. monocytogenes
E. None

The most common causes per age group are as follows: a - infants, b - adolescents, c - adults >20, d - immunosuppressed
and elderly

7. The following are causes of high anion gap metabolic acidosis, except?

A. Methanol
B. Ethylene glycol
C. Paraldehyde
D. Acetazolamide
E. Aspirin

All of the examples cause HAGMA, except acetazolamide which causes NAGMA.

8. Class of anti-arrythmic that blocks Na channels?

A. I
B. II
C. III
D. IV

I - Na channel blockers, II - B - blockers, III – K channel blockers, IV - Ca channel blockers

9. A 24 year old male consulted you due to purulent penile discharge. Gram stain showed garm(-) intracellular diplococci.
What is/are the best treatment?

A. Ceftriaxone 250mg IM
B. Metronodazole 500mg tablet, 4 tablets single dose
C. Azithromycin 1 gram single dose
D. A and B
E. A and C

Ceftriaxone should definitely be given. However, gonorrhea is almost always accompanied by Chlamydial infection, hence
Azithromycin or Doxycycline should be given too.

10. Which of the following is associated with development of primary central nervous system
lymphoma in patients with HIV?

A. EBV
 B. JC virus
C. Mycobacterium avium complex
D. Previous radiation exposure
E. Toxoplasma gondii

Virtually all cases of primary CNS lymphoma in patients with HIV are associated with EBV

PEDIATRICS

11. An 8 month old manifests with fussiness and emesis and refuses to eat. 1 week ago, he was brought for consult and was
diagnosed with URTI. On the morning of consult, his mother noted currant jelly like material on his diaper. On PE, a sausage
shaped mass was palpable in the abdomen. There is likewise abdominal distention and rectal exam reveals blood in the
stool. The most likely diagnosis is:

A. Viral diarrhea
B. Duodenal atresia
C. Intussusception
D. Hypertrophic pyloric stenosis
E. Intestinal adenoma

Aside from that, intussusception may present with lethargy out of proportion to the intestinal signs and
symptoms. Intussusception in children is usually due to lymphoid hyperplasia in the intestines. This becomes the lead point.
The most common location is ileocolic.

12. A 3 year old is brought to the ER. On PE, inspiratory stridor and a barking cough were noted. There is mild respiratory
distress, tachypnea, and fever. The signs and symptoms are aggravated by agitation and crying. The most likely diagnosis is

A. Laryngotracheobronchitis
B. Epiglotittis
C. Bacterial tracheitis
D. Peritonsillar abscess

This is a case of croup and is common in this age group. Barking cough = croup
Epiglotitis and bacterial tracheitis patients are more toxic appearing and not in merely mild respi distress

13. A newborn was noted to be cyanotic. Unfortunately the imaging facilities are unavailable for the day. A hyperoxia test was
thus done which showed no improvement of PaO2 after administration of 100% O2. The next step in the management of
this neonate is:

A. Low tidal volume mechanical ventilation

B. Positive pressure ventilation
C. Digoxin
D. Emergency laparotomy
E. Prostaglandin E

The hyperoxia test is used to differentiate whether the etiology of cyanosis is cardiac or not. PaO2 does not
improve in cardiac etiologies. In the absence of imaging for definitive diagnosis of the congenital heart disease, the clinician
should not hesistate to administer prostaglandin in case the patient has a ductus dependent congenital heart
disease. Prostaglandin prevents the ductus from closing. (indomethacin promotes closure)

14. Parahemophilia is deficiency of what coagulation factor?

A. Factor 5
B. Factor 8
C. Factor 9
D. Factor 11
E. NOTA

Factor 5 - Parahemophilia
 Factor 8 - Hemophilia A
Factor 9 - Hemophilia B
Factor 11 - Hemophilia C

15. Major criteria for diagnosis of acute rheumatic fever includes the following, except

A. Polyarthritis
B. Erythema nodosum
C. Subcutaneous nodules
D. Carditis
E. NOTA

It should erythema marginatum

16. What is the ideal dose to give a 10 kg child with iron deficiency anemia?

A. Elemenal iron, 3-6 mg/day

B. Elemenal iron, 30-60 mg/day
C. Elemenal iron, 300-600 mg/day
D. Elemenal iron, 33-66 mg/day
E. Elemenal iron, 0.3-0.6 mg/day

The ideal dose for iron supplemention is 3-6 mg/kg/day. For ths child, it should be 30-60 mg/day
of elemental iron.

17. Which pf the following Plasmodium species causes the most severe form of malaria

A. P. falciparum
B. P. malariae
C. P. knowlesi
D. P. ovale
E. P. vivax

Plasmodium falciparum is the most severe form and has the highest fatality rate. FALCIPARUM = FUCK YOU UP

18. An 8 year old male was brought to the pediatrician by his mother because he developed low grade fevers several days ago,
and now has red cheeks and a new rash on his body? What is the most lilkely diagnosis?

A. Exanthem subitum
B. Rubella
C. Rubeola
D. Erythema infectiosum
E. Infectious mononucleosis

The initial stage of erythema infectiosum is an erythematouus facial flushing often described as a slapped cheek
appearance. The causative agent is Parvovirus B19. AKA 5th Disease

19. What is the most common cause of death of pediatric patients afflicted with measles?

A. Otitis media
B. Meningitis
C. Encephalitis
D. Dehydration due to diarrhea and vomiting
E. Pneumonia

Pneumonia is the most common cause of death in measles. It may manifest as giant cell pneumonia
caused directly by the viral infection or as superimposed bacterial infection.
 20. A 14 year old boy has 3+ protein and 4+ blood with RBC casts on urinalysis. Further questioning revelaed 2 prior episodes of
tea coloured urine concurrent with upper respiratory tract infection during the last 3 years. Which of the ff is the most likely
diagnosis?

A. Membranous nephropathy
B. SLE nephritis
C. IgA nephropathy
D. Membranoproliferatifve GN
E. Post streptococcal GN

This patient's clinical presentation are consistent with IgA nephropathy. They usually present with recurrent
bouts of gross hematuria assoc with respiratory infections.

OB-GYNE

21. A 25 year old primipara gives birth to a neonate with IUGR, microcephaly, craniofacial dysmorphism, hypopastic nails and
distal phalanges. Which of the following teratogen may be responsible for this?

A. Ethanol
B. Lithium
C. Phenytoin
D. Thalidomide
E. Methimazole

This case describes fetal hydantoin syndrome. It is due to ingestion of the antiseizure drug phenytoin.
Ethanol – Fetal alcohol syndrome
Lithium – Ebstein anomaly
Phenytoin – Fetal hydantoin syndrome
Thalidomide – phocomelia
Methimazole – aplasia cutis congenita

22. A 19 yr-old primigravida at 32 weeks’ gestation comes to the office for a routine prenatal visit. Her BP is 150/95 mmHg. Her
previous BPs have been 120/7- mmHg range. 2 hours later: While receiving IV MgSO4 therapy, her RR have decreased from
20-5 rpm. Findings are consistent with

A. Gestational HTN
B. Mild preeclampsia
C. Severe preeclampsia
D. Eclampsia
E. Magnesium toxicity

Antidote for magnesium toxicity is IV calcium gluconate.

23. A 4 yo girl was brought to the clinic for slight enlargement of the left breast with no other associated signs and symptoms
since two years ago. You will tell the parents that premature thelarche is:

A. A condition that needs surgical removal of the ovaries

B. A benign self-limiting condition that does not require treatment
C. A serious condition leading to central precocious puberty
D. A condition that requires treatment with hypothalamic suppressive therapy

Thelarche – breastbudding

24. Definition of a reactive NST:

A. 2 or more accelerations
B. Peak at 15 bpm above baseline
C. Each acceleration lasts more than 30 seconds
D. A and b
 E. All of the above

Reactive NST - presence of two or more fetal heart rate accelerations within a 20-minute period, with
or without fetal movement discernible by the woman. Accelerations are defined as 15 bpm above
baselines for at least 15 seconds if beyond 32 weeks gestation, or 10 bpm for at least 10 seconds if at or
below 32 weeks.

25. The most common cause of secondary amenorrhea is?

A. Ovarian tumor
B. PCOS
C. Imperforated hymen
D. A or B
E. None of the above

SPERM is the MC cause of secondary amenorrhea

26. This is an abnormal uterine bleeding characterized by scanty menstruation.

A. Menorrhagia
B. Hypomenorrhea
C. Oligomenorrhea
D. Polymenorrhea
E. Metrorrhagia

Hypomenorrhea refers to scanty menstruation.

Oligomenorrhea refers to prolonged intervals of menstruation.

27. The minimum criteria for diagnosing Pelvic Inflammatory Disease includes

A. Cervical tenderness
B. Uterine tenderness
C. Adnexal tenderness
D. A and C only
E. All of the above

28. A 27 year-old nulligravid have undergone explore laparotomy due to ovarian tumor. Grossly, the
tumor contains teeth, hair and bone. What is your impression?

A. Dermoid cyst
B. Seminoma
C. Teratoma
D. A and C only
E. All of the above

Dermoid cyst is the most common ovarian tumor in patients less than 30 years old. Since it is derived
from all germ layers, it can differentiate into any other tissues like bones, teeth, or cartilage.

t/c dermoid cyst r/o teratoma

29. Which of the following is/are criteria for using Oxytocin?

A. Cervix should atleast 4cms opened

B. CPD is ruled out
C. Cephalic presentation
D. B and C only
E. All of the above

The judicial use of Oxytocin should start when thelabor is already at the active phase (4cms cervical
 dilatation), no CPD and the child is on cephalic presentation.

30. A 25 year old at 32 weeks AOG is noted to have a BP of 160/100 mmHg with the presence of +2
proteinuria. The platelet count and liver function tests were abnormal. After few hours, patient went
into seizure. What is the best management plan in this case?

A. Induction of labor
B. Intelligent expectancy
C. Control the seizure then expectant management
D. Cesarian section
E. Forcep delivery

CS is the only cure for eclampsia.

SURGERY

31. Which of the following treatment used for the management of burn wounds can be absorbed
systemically and cause metabolic acidosis?

A. Silver nitrate
B. Silver sulfadiazine
C. Mafenide acetate
D. A and B
E. All of the above

Silver sulfadiazine – antimicrobial activity, soothing quality, inexpensive and easily applied,
neutropenia
Mafenide acetate – antimicrobial activity, painful, metabolic acidosis
Silver nitrate – antimicrobial activity, hyponatremia, methemoglobinemia, black staining

32. In which type of hiatal hernia does the fundus of the stomach herniate?

A. Type I
B. Type II
C. Type III
D. Type IV
E. Type V

Type I (sliding) – cardia

Type II (rolling) – fundus
Type III – cardia and fundus
Type IV – intestines

33. Which of the following infections have been correlated with nasopharyngeal carcinoma?

A. Herpes simplex virus

B. Epstein Barr virus
C. Cytomegalovirus
D. Human immunodeficiency virus
E. Human Papilloma Virus

strong correlation exists between nasopharyngeal cancer and the presence of EBV
infection, such that EBV titers may be used as a means to follow a patient’s response to treatment.
34. To confirm a diagnosis of achalasia, the following should be requested

A. EGD
B. Manometry
C. CT scan
D. Barium swallow
 E. 24 hours pH monitoring

35. What is the basal caloric requirement (kcal/Kg/day) of a normal healthy individual?

A. 20
B. 25
C. 30
D. 35
E. 40

basal requirement: 25; mild stress: 25-30;

moderate stress: 30; severe stress 35-40

36. Single most important test in the evaluation of thyroid nodules:

A. Core needle biopsy

B. Fine needle aspiration biopsy
C. Thyroid ultrasound
D. Excision biopsy
E. Incision biopsy

FNAB - single most important test in evaluation of thyroid nodules; Core needle biopsy – for breast nodules

37. A 65 y/o M, smoker, obese presented at the ER with sudden, severe abdominal pain. The PE of the abdomen was normal.
What is the most probable diagnosis?

A. Acute mesenteric ischemia

B. Acute perforated PUD
C. Acute appendicitis
D. Acute diverticulitis

Abdominal pain with severity out of proportion to PE findings is the hallmark of acute mesenteric ischemia.

38. What are the six P’s of acute limb ischemia?

A. Pain, purple, paralysis, paresthesias, pulselessness, poikilothermia

B. Pain, purple, pathologic, paresthesias, pulselessness, poikilothermia
C. Pain, pallor, paralysis, paresthesias, pulselessness, poikilothermia
D. Pain, pallor, pathologic, paresthesias, pulselessness, poikilothermia
E. Pain, pallor, paralysis, paretic, pulselessness, poikilothermia

39. What is the most common cause of fever in the first 48 hours post-operatively?

A. Atelectasis
B. Pneumonia
C. UTI
D. Wound infection
E. Seroma

40. Most common site of perforation of the colon

A. Cecum
B. Ascending colon
C. Transverse colon
D. Descending colon
E. Sigmoid colon

The cecum is the widest portion but has the thinnest wall; thus, it is the most common site of perforation.
The sigmoid is the narrowest portion; thus, it is the most common site of obstruction.
 41-44.List the first-line drugs to manage hypertension
41.
42.
43
44.

The Philippine Medicine Board exam is composed 12 subjects. Categorize each subject based on your own self-assessment.

Weak Strong

In bulleted format, state your game plan to turn the weak subjects (if there’s any) to a strong one.

List all review materials that you will use for each subject below.

Deadline of submission:
September 12, 2022 / Monday
Attach your answers to the attendance logbook.

Hello are you doing