ANASURG

Cracking D’ Boards © Board Review Series ANATOMY & SURGERY EXAMINATION

INSTRUCTIONS: Select The Letter Of The Best Correct Answer For Each Of The Following Questions. Mark Only One Answer For Each Item By Shading The Box Corresponding To The Letter Of Your Choice On The Answer Sheet. Strictly No Erasures Allowed. Use Pencil No. 1 Only. 1.

The part of the inner ear responsible for balance a. vestibular portion b. pars superior c. cochlear portion d. pars inferior e. A and B

2.

Herpes Zoster Oticus is characterized by the following except: a. Also known as Ramsay Hunt disease b. Viral infection involving the geniculate ganglion c. Facial paralysis d. Otalgia e. Herpetic eruption of the internal ear

3.

A 18 year old female came to the emergency room for complaints of vomiting, anorexia, epigastric and right lower quadrant pain noted 12 hours prior to admission. Digital rectal exam revealed right pararectal wall tenderness. Differential diagnosis would include the following except: a. Acute appendicitis b. Urinary tract infection c. Twisted ovarian cyst d. Ectopic pregnancy e. None of the above

8. A 40 year old man who was an unrestrained passenger in a motor vehicle accident was brought to the emergency room. He was thrown from the car at impact. The patient is unconscious and, on evaluation becomes apneic. Ventilation should be achieved by a. endotracheal intubation b. nasotracheal intubation c. face mask d. tracheostomy e. cricothyroidotomy 9. A patient has lost cutaneous sensation over the tip of the nose. Which nerve is most likely damaged? a. facial nerve b. ophthalmic division of the trigeminal nerve c. greater auricular nerve d. mandibular division of the trigeminal nerve e. maxillary division of the trigeminal nerve 10. Emergency room thoracotomy for cardiac resuscitation would be most commonly indicated for a major blunt trauma with cardiac arrest a. failed closed chest massage lasting 15 minutes b. cardiac arrest after a stab wound to the left parasternal area c. cardiac arrest accompanying a major central nervous system injury d. hypovolemic cardiac arrest e. none of the above 11. Injury to the common peroneal nerve would result in an a. inability to evert the foot b. inability to invert the foot c. inability to plantar flex the ankle d. inability to plantar flex the big toe e. inability to feel sensation on the medial side of the leg

12. A 55 year old man is involved in a motor vehicular accident. Initial resuscitation is carried out. Cervical spine films are normal. A supine anteroposterior (AP) chest film suggests a distorted upper mediastinum. The next study should be a. aortogram b. CT scan of the chest c. MRI of the chest d. upright posteroanterior (PA) chest radiograph e. electrocardiogram 13. To test trapezius muscle paralysis, you would ask the patient to a. flex the arm fully b. adduct the arm against resistance c. push against a wall with both hands d. shrug the shoulder e. abduct the arm fully 14. A 14 year old boy fell off a wall and fractured his right humerus at midshaft. The wrist joint immediately assumed a flexed position that the patient was unable to correct. Extension and supination of the forearm was weakened but not abolished. Select the peripheral nerve damaged that could cause the symptoms. a. radial nerve b. ulnar nerve c. median nerve d. axillary nerve e. musculocutaneous nerve 15. In a 23 y.o, male coming in with anorexia, right lower quadrant pain and vomiting, peritoneal irritation is indicated by: a. Dunphy’s sign b. Hamburger Sign c. Rovsing’s sign d. Obturator sign e. Psoas sign 16. Blood supply ligated during an appendectomy a. Colonic artery b. branch of celiac artery c. branch of ileocolic artery d. branch of cecal artery e. superior mesenteric artery 17. Most common organisms causing acute appendicitis, except: a. e. coli b. peptostreptococcus sp. c. bacteroides fragilis d. enterobacter aeroginosa 18. Allelic loss at the site of this tumor suppressor gene is responsible for developing 100% risk of colon cancer: a. BRCA 1 b. BRCA 2 c. myc-trans gene d. APC e. fibrillin 19. The following are true of familial adenomatous polyposis except: a. colon becomes covered with polyps after puberty b. autosomal recessive inheritance c. 100% risk of developing colon CA d. May present with weight loss and hematochezia e. common in middle-aged Caucasians 20. Tumor marker for Papillary thyroid Carcinoma: a. free T3 b. free T4 c. Free T3 & T4 d. thyroglobulin e. calcitonin 21. A 67 y.o, female underwent total thyroidectomy. Biopsy findings revealed abundance of parafollicular cells or C cells. She will most likely manifest with increased levels of the following hormone: a. thyroglobulin b. calcitonin

c. parathyroid hormone d. tyrosine e. tryptophan 22. The same patient in the previous number had sudden onset of dyspnea and hoarseness of the voice. Serum Calcium revealed: 7.4 mg/dl. The following are expected, except: a. intraop injury to the recurrent laryngeal nerve b. presence of hematoma at post-op site c. presence of Trousseau’s sign d. carpopedal spasm e. low levels of thyroglobulin 23. Amino acid precursor of thyroid hormone a. tryptophan b. tyrosine c. thyroxine d. hyrdoxylysine e. hydroxyproline 24. The following contribute to the blood supply of the thyroid gland except: a. superior thyroid artery b. inferior thyroid artery c. brachiocephalic artery d. left common carotid artery e. right common carotid artery 25. Gene on chromosome 13 that is associated with early onset breast CA a. fibrillin b. CA-19 c. BRCA1 d. APC e. BRCA 2 26. The following are risk factors for developing breast CA, except: a. having an aunt with breast CA b. presence of BRCA 1 gene on chromosome 17 c. being 35% above ideal body weight d. Primigravida at the age of 18 e. menarche at 12 years old and menopause at 60 years old 27. Most common benign condition of the breast: a. fibrocystic breast disease b. peau d’ orange c. papillary CA d. invasive ductal e. phylloides tumor 28. Most common site of breast CA: a. Lower outer quadrant b. Upper outer quadrant c. Upper inner quadrant d. Lower inner quadrant 29. A 38 y.o, female noted “Winging of the scapula” after undergoing MRM. The most likely injured structure would be: a. axillary artery b. axillary nerve c. pectoralis minor muscle d. long thoracic nerve e. Batson’s plexus 30. The landmark structure used to divide Level I,II, and III in breast surgery a. axillary nerve b. long thoracic nerve c. pectoralis major mm. d. pectoralis minor mm. e. Rotter’s nodes 31. A 56 y.o, woman was diagnosed to have Invasive Ductal CA of the left breast. The following would be the most important factor in prognosis:

a. Involvement of the Batson’s plexus b. atypia and proliferative changes on biopsy c. axillary lymph node status d. winging of the scapula e. (+) BRCA 1 gene 32. The following drugs are contraindicated in a managing a 42, y.o, obese, female coming in for fever, chills and RUQ pain: a. tramadol b. morphine sulfate c. famotidine d. omeprazole e. cefuroxome 33. Hormone responsible for causing colicky abdominal pain after intake of a fatty meal: a. cholecystoglobulin b. cholecystokinin c. secretin d. pancreatin e. motilin 34. The following are characteristics of Carpal Tunnel Syndrome, except: a. common in secretaries and computer programmers & dressmakers b. May be confirmed by performing Tinel’s sign c. Entrapment of the median nerve by the flexor retinaculum d. Numbness and pain over the index finger and hypothenar area e. May be confirmed by performing Phalen’s sign 37. The following are Intracranial complications of chronic or recurrent otitis media, except: a. Extradural abscess b. Lateral sinus thrombosis c. Meningitis d. Brain abscess e. Gradenigo’s syndrome or petrositis 38. The following characteristics about skin are true except: a. Largest organ of the body b. Average weight = 4 Kg c. thickest at the palms/soles d. thinnest at the eyelids and genitals e. none of the above 39. The epithelial layers from Surface to base are the following a. Corneum, Lucidum, Granulosum, Spinosum, Basalis b. Corneum, Lucidum, Spinosum, Basalis, Granulosum c. Granulosum, Corneum, Lucidum, Spinosum, Basalis d. Lucidum, Spinosum, Basalis, granulosum, corneum e. Basalis, corneum, lucidum, spinosum, granulosum 40. Sweat is characterized by the following except: a. about 10 L/day (1% Solid, 99% Liquid) b. pH = 4.5-5.5 c. Colorless, odorless, hypertonic d. 1L – removes 540 Calories of heat from the body e. none of the above 41. The dangerous area of the scalp a. skin b. subcutaneous tissue c. loose areolar layer d. periosteum e. galea aponeurotica 42. Muscles of Mastication except: a. temporalis m. b. masseter m. c. medial pterygoid m. d. lateral pterygoid m. e. buccinator m.

43. The following statements are true except: a. Parotid gland is the largest salivary gland b. Wharton's duct opens opposite the 2nd upper molar c. Parotideo - massenteric fascia is a fibrous unyielding fascia d. Submandibular is predominantly mucous secreting e. Parotid gland is predominantly serous secreting 44. The following structures arise from the foregut except: a. Pharynx b. Thyroid c. Esophagus d. Lung Alveoli e. none of the above 45. The Anterior Pituitary gland arises from : a. foregut b. midgut c. hindgut d. Rathke’s pouch e. A and D 46. Waldeyer’s Ring is an imaginary ring composed of tonsils namely a. unpaired nasopharyngeal/adenoids b. paired tubal/tonsils of Gerlach c. paired palatine/faucial tonsils d. lingual e. none of the above 47. A 63 year old male is referred for urologic consult after a large prostate gland was found on routine rectal examination. The next diagnostic test of choice should be a. digital rectal examination (DRE) b. prostate specific antigen (PSA) level c. MRI d. transrectal ultrasound e. Computed tomography (CT) 48. A male trauma patient is brought in for profound shock can be resuscitated with all of the following except: a. type AB negative blood b. type O negative blood c. type-specific but not crossmatched blood d. type-specific crossmatched blood e. none of the above 51. Sustained tension of the vocal cords (folds) is best achieved through the action of which one of the following muscles a. cricopharyngeus b. cricothyroid c. aryepiglottic d. salpingopharygeus e. posterior cricoarytenoiD 55. With a patient in the standing position, fluid in the left pleural cavity tends to gravitate down to the a. oblique fissure b. cardiac notch c. costomediastinal recess d. costodiaphragmatic recess e. horizontal fissure 56. A 3 month old child has a soft, irregular, compressible, enlarging, posterior neck mass. The most likely diagnosis a. thyroglossal duct cyst d. teratoma b. abscess e. cystic hygroma c. paraganglioma 57. A muscle that protrudes the tongue is the a. styloglossus b. palatoglossus c. mylohyoid

d. hyoglossus e. genioglossus

58. Amebic pericarditis is an extension of amebic A. colitis C. splenitis E. none of the choices B. pneumonia D. hepatic abscess 59. If the foot is permanently dorsiflexed and everted, which nerve might be injured? a. Tibial nerve b. deep peroneal nerve c. superficial peroneal nerve d. obturator nerve e. common peroneal nerve 60. Portal hypertension hypersplenism is seen in late stage A. ascariasis B. giardiasis C. schistosomiasis D. enterobiasis

E. paragonimiasis

61. Tissue graft within the same individual is known as A. allograft B. isograft C. autograft D. xenograft 62. The portal vein is formed by the following vein(s) a. splenic vein b. superior mesenteric vein c. inferior mesenteric vein d. A and B e. A and C 63. Glandular metaplasia in the distal esophagus occurs in the following condition(s): a. chronic GERD d. achalasia b. Barrett’s esophagus e. none of the above c. esophagitis 64. Bowel thickening or “String Sign” on abdominal xray is indicative of this disease entity: a. Crohn’s disease b. Ulcerative colitis c. Irritable bowel syndrome d. Toxic megacolon e. Hirschsprung’s disesase 65. Characteristics of pancreatic carcinoma are the following except: a. Diabetes and smoking are strong risk factors b. a palpable gallbladder is present in 25% of patients c. Should undergo total pancreatectomy d. Whipple’s triad is a feature e. pain and jaundice is a prominent feature 66. Caroli’s disease and clonorchiasis is strongly associated with the following: a. cholangiocarcinoma b. gallbladder CA c. pancreatic CA d. hepatocellular CA e. Bladder outlet obstruction 67. Urinary metabolite found in patients with pheochromocytoma a. 5-hydroxytryptamine b. vanillymandelic acid c. organs of Zuckerkandl d. urinary metamphetamines e. valine, leucine, isoleucine metabolites 68.Most common type of gastric cancer a. leiomyosarcoma b. adenocarcinoma c. lymphoma d. signet ring adenocarcinoma e. papillary carcinoma 69. The following are absolute indications for tonsillectomy except: a. abscess (peritonsillar, recurrent) b. biopsy for suspected malignancy c. dysphagia

d. Sleep apnea e. none of the above 70. Most common type of thyroid carcinoma a. papillary thyroid carcinoma b. medullary thyroid carcinoma c. anaplastic carcinoma d. poorly differentiated carcinoma e. Hurthle cell carcinoma 71. Most common post thyroidectomy complication a. Wound hemorrhage b. Recurrent laryngeal nerve injury c. Hypoparathyroidism d. Thyroid storm e. Winging of the scapula 72. The following are contents of Cubital Fossa except: a. Termination of Brachial Artery b. Radial and ulnar arteries c. Biceps tendon d. Median nerve e. none of the above 73. The superficial membranous fascia which continues as the Colle’s fascia in the perineum a. Camper’s fascia b. Scarpa’s fascia c. Gimbernat’s fascia d. Cooper’s Fascia e. External oblique fascia 74. Internal oblique muscle runs upward and medially and inserts to the public crest, tubercle and pectineal line giving rise to the following except: a. conjoined tendon b. cremasteric muscle c. cremasteric fascia d. all of the above e. none of the above 75. Branches of the Coelic Artery except: a. Left. Gastric artery b. Splenic artery c. Hepatic artery d. Renal artery e. none of the above 76. The following are signs of advanced disease in gastric carcinoma, except a. Virchow’s node b. Left supraclavicular lymphadenopathy c. Sr. Mary Joseph’s node d. Blumer’s shelf e. none of the above 77. Collection of para-aortic & paraganglionic cells that may serve as extra adrenal site for chromaffin cell tumor a. Klatskin tumor b. Organs of Zuckerkandl c. Organs of Zuckermann d. Pheochromocytoma e. none of the above 78. Characteristic of barium swallow showing dilated esophagus with area of distal stenosis à ‘BIRD’S BEAK” a. esophagitis b. barrett’s esophagus c. esophageal carcinoma d. tracheo-esophageal fistula e. achalasia 79. The best screening procedure for colon carcinoma is the general population is:

A. CEA assay B. Colonoscopy C. Barium enema D. Sigmoidoscopy E. Stool Occult Blood Test. 80. The following is/are indication/s for diagnostic peritoneal lavage: A. Kitchen knife wound across the belly, eviscerating small intestines B. Gunshot wound to the lower abdomen, non-penetrating C. Ice-pick wound at periumbilical area, 8 cm hematoma at left parieto-occipital area, GCS-4 D. Blunt and abdominal trauma, BP 80/40, RR 36, 2 L lactated Ringer’s already given E. none of the above 81. Which of the following is considered pre-malignant A. Pseudopolyp B. Hamartoma C. Villous adenoma D. Pedunculated polyp. E. Tubular polyp 82. The following statements are true except: a. Ext. spermatic fascia comes from ext. oblique muscle b. Cremasteric fascia comes from int. oblique muscle c. Int spermatic fascia comes from transversalis muscle d. pampiniform plexus of veins is contained in spermatic fascia e. nerves to spermatic cord are derived from renal and pelvic plexus 83. What presenting complaint is most common in a patient with carcinoma of the bladder? a. suprapubic pain b. palpable lower abdominal mass c. painless hematuria d. unexplained fever e. weight loss 84. A major cause of nosocomial infection in extensive burns is A. pseudomonas C. bacteroides B. branhamella D. aspergillus

E. enterobacter

85. During operations on the thyroid gland, the following nerve may be injured when tying the inferior thyroid artery a. sympathetic trunk b. internal laryngeal nerve c. descendens cervicalis d. recurrent laryngeal nerve e. superior laryngeal nerve 86. A 65 year old female sought consult due to hematochezia and weight loss. Colonoscopy revealed an ill-defined fungating mass 15 cm from the anal verge causing obstruction. The treatment of choice is: a. Biopsy b. Low Anterior Resection c. Mile’s procedure d. Insertion of Sump tube attached to low pressure gomco e. Radiation therapy 87. A 45 year old male executive is seen because he is vomiting bright red blood. There are no previous symptoms. The man admits to one drink a week with no other significant history. In the hospital, he bleeds 5 units of blood before endoscopy. The most likely diagnosis is a. gastritis b. duodenal ulcer c. esophagitis d. Mallory-Weiss tear e. esophageal varices 88. The diaphragm is derived from the following except: a. Septum transversum b. Pleuroperitoneal fold c. Body wall d. Dorsal mesentery of esophagus e. C3C4C5 (Phrenic Nerve)

89. Work-up reveals an inflammatory process within the colon with skip areas. The rectum is spared. The most likely diagnosis is a. ischemic colitis d. ulcerative colitis b. amebic dysentery e. Crohn’s Disease c. toxic megacolon 90. An elderly woman is admitted for weakness, weight loss, anemia and a palpable abdominal mass. She has colon carcinoma. The most likely anatomic site is a. rectum d. sigmoid colon b. left colon e. cecum c. transverse colon 91. The following statements are true, except: a. Nearly 30% of all patients with colorectal Carcinoma have a synchronous polyp b. 100% of patients with Familial Adenomatous Polyposis will develop colon carcinoma if the colon is not resected c.familial polyposis coli and Gardner’s syndrome are risk factors for carcinoma d. Most common manifestation of rectal CA is change in caliber of stools e. none of the above 92. Bone metastasis occurs from the following primary carcinomas, except: a. breast b. lung c. thyroid d. prostate e. none of the above 93. Meckel’s diverticulum is characterized by the following except: a. 2 % of population b. commonly presents during 1st 2 years of life c. 2 inches long d. 2 feet from the ileocecal valve e. 2 ectopic tissues: duodenal mucosa and pancreatic tissue 94. Acute hematogenous osteomyelitis is often diagnosed by isolation of the organism from the blood and is caused most often by A. Proteus mirabilis C. Escherichia coli E. pseudomonas aeruginosa B. Streptococcus epidermidis D. Staphylococcus aureus 95. Common pathogen in surgical implants: A. Klebsiella B. E. coli C. S. epidermidis

D. S. pyogenes

E. Pseudomonas

96. The following are risk factors for developing gastric carcinoma except: a. High consumption of smoked fish b. Blood type “A” c. post-gastrectomy patients d. chronic hypochlorhdia e. Virchow’s node 97. Most common congenital anomaly of the GI tract characterized by persistence of the vitelline duct or yolk stalk a. Cystic hygroma b. Inguinal hernia c. Meckel’s diverticulum d. omphalocoele e. Vitelloma 98. Wrist bone with greatest incidence of aseptic necrosis a. navicular bone b. cuneiform c. lunate d. sesamoid bone e. none of the above

99. Condition where pupils accommodates when patient follows finger moving towards the nose but does not react to direct light a. Neurosyphilis b. Horner’s syndrome c. Adies pupil d. Argyll-Robertson pupil e. Weber’s syndrome 100. A 24 year old male was in a vehicular accident. He arrived at the ER with raccoon eyes and otorrhea. On the 3 rd hospital day he developed high grade fever and nuchal rigidity. The most common meningeal isolate in this patient would be a. Streptococcus pneumoniae b. H. influenzae c. N. meningitides d. S. aureus e. Listeria monocytogenes

1. In cerebrospinal fluid, the presence of encapsulated yeasts is indicative of A. coccidioidomycosis B. candidiasis C. blastomycosis D. cryptococcus 2. Which one of the following pairs of drugs has been known to cause lupus syndrome? a. Propranolol and disopyramide b. Guanethidine and reserpine c. Lidocaine and phenytoin d. Procainamide and hydralazine 3. The etiologic agent of leprosy: A. appears on smears biopsy from the lesion as acid-fast bacilli arranged like pockets of cigars B. has a special predilection to the skin and peripheral nerve C. has been successfully cultured in artificial media D. A and B 4. The superior orbital fissure transmits the fo9llowing structures, except a. optic nerve b. frontal nerve c. abducens nerve d. trochlear nerve e. ophthalmic veins 5. The presence of pneumatocoeles on chest radiograph suggest this pathogen a. Klebsiella pneumoniae b. Staphylococcus aureus c. Peudomonas aeruginosa d. Streptococcus pneumoniae 6. A 40 year old man who was an unrestrained passenger in a motor vehicle accident was brought to the emergency room. He was thrown from the car at impact. The patient is unconscious and, on evaluation becomes apneic. Ventilation should be achieved by a. endotracheal intubation b. nasotracheal intubation c. face mask d. tracheostomy e. cricothyroidotomy 7. A syndrome characterized by galactorrhea-amenorrhea not associated with pregnancy a. Albright’s Syndrome b. Ahumada-del Castillo syndrome c. Sheehan’s syndrome d. Asherman’s syndrome e. eclampsia

8.A 32 year old male hypertensive smoker complains of chest oppression provoked by effort and relieved by rest. The drug to recommend to relieve his oppression is a. Diltiazem b. Aspirin c. Nifedipine d. A nitrate 9. Which one of the following medical fees is considered as unethical: A. dichotomous fees C. retainer’s fees B. contingent fees D. contractual fees 10. A resident in the Department of OB-Gyne saw a patient in the ER complaining of left-sided abdominal pain. She was given mefenamic acid and sent home only to come back in shock for ruptured ectopic pregnancy. The hospital is liable in this case under the doctrine of: A. Vicarious liability B. Borrowed servant C. Independent contractor theory D. Corporate liability 11. One of the following is a United Nation Millenium Development Goal: A. Family Planning B. Fight Against Child and Maternal Mortality C. Control of Diarrheal Diseases D. Control of Acute Respiratory Infection 12. A patient has lost cutaneous sensation over the tip of the nose. Which nerve is most likely damaged? a. facial nerve b. ophthalmic division of the trigeminal nerve c. greater auricular nerve d. mandibular division of the trigeminal nerve e. maxillary division of the trigeminal nerve 13. Bacteria that grows at temperatures as high as 50º C to 55º C are known as A. mesophiles B. halophiles C. thermophiles D. psychrophiles 14. Delayed speech/language of a child may be caused by the following except a. child neglect d. child abuse b. inborn e. none of the above c. mental retardation 15.The standard for diagnosis of pneumonia a. Sputum culture b. Chest radiograph c. CBC d. CT scan 16. Emergency room thoracotomy for cardiac resuscitation would be most commonly indicated for a major blunt trauma with cardiac arrest a. failed closed chest massage lasting 15 minutes b. cardiac arrest after a stab wound to the left parasternal area c. cardiac arrest accompanying a major central nervous system injury d. hypovolemic cardiac arrest 18. Which collaborating agency in the world helps erase Polio in children? a. UNICEF b. Rotary International c. W.H.O d. Canadian International Development Agency 18. Sporulation is the feature of all these microorganisms, EXCEPT: A. Corynebacterium diphtheriae D. Clostridium perfringens B. Bacillus anthracis E. Aspergillus flavus C. Coxiella burnetti

19.Which of the following is not a major goal in the management of bronchiectasis a. Elimination of underlying cause b. Control of infection c. Reversal of airflow obstruction d. Reversal of bronchiectasis 20. The greatest risk of death from home accidents occurs in children: A. between 5 to 6 years old C. between 12 to 16 years old B. less than 5 years old D. between 9 to 12 years old 21. The target group of immunization program is: A. infants ages 1 to 3 years old B. infants and children C. infants, children and pregnant mothers D. all age groups 22. A child on consultation was observed to have dementia, diarrhea and dermatitis. This is found in what vitamin deficiency a. biotin d. niacin b. folic acid e. riboflavin c. ascorbic acid 23. Injury to the common peroneal nerve would result in an a. inability to evert the foot b. inability to invert the foot c. inability to plantar flex the ankle d. inability to plantar flex the big toe e. inability to feel sensation on the medial side of the leg 24. Bacteremia shock is triggered by A. exotoxins B. endotoxins C. hyaluronidase

D. kinase

E. hemolysin

25. A 55 year old man is involved in a motor vehicular accident. Initial resuscitation is carried out. Cervical spine films are normal. A supine anteroposterior (AP) chest film suggests a distorted upper mediastinum. The next study should be a. aortogram b. CT scan of the chest c. MRI of the chest d. upright posteroanterior (PA) chest radiograph e. electrocardiogram 26. In the child, the chief arterial supply to the head of the femur is derived from the: a. obturator artery b. internal pudendal artery c. branches from the medial and lateral circumflex femoral arteries d. deep circumflex iliac artery e. superficial circumflex iliac artery 27. The lymph from the medial quadrants of the breast drains mainly into: a. internal thoracic nodes b. posterior axillary (subscapular) nodes c. anterior axillary (pectoral) nodes d. lateral axillary (brachial) nodes e. infraclavicular (deltopectoral) nodes 28. In the absence of an attending doctor at death, the responsibility of signing the death certificate goes to: A. Closest kin C. Local Health Officer B. Nurses D. Midwife 29. Criterion/criteria in the selection of a community to be organized: A. all of these B. existence of a serious peace and order problem

C. D. E.

need for basic health services extreme economic depression strong resistance from the community

30. An infectious disease not considered communicable: A. scabies C. pneumonia B. tetanus D. mumps

31. Selection of drugs to be sold in the “botika sa barangay” is based on: A. most common morbidity and mortality of the barangay B. effectiveness of the drugs C. all of these D. essential drug list 32. The level of prevention employed when a serologic test is done to determine syphilis among suspects: A. rehabilitation C. health promotion B. early diagnosis D. disability limitation 33. A 12 year old boy is to be operated on for acute appendicitis. The following can give consent for operation in the absence of these and others, EXCEPT: A. grandparents C. teachers/professors B. parents D. the hospital director 34. What presenting complaint is most common in a patient with carcinoma of the bladder? a. suprapubic pain b. palpable lower abdominal mass c. painless hematuria d. unexplained fever e. weight loss 35. Intrauterine synechiae, typically occurring after curettage of the uterus, presenting as amenorrhea a. Asherman’s syndrome b. Ahumada-del Castillo syndrome c. Sheehan’s syndrome d. Alport’s syndrome e. None of the above 36. The Mental Health Program aims to reduce the number of mental illness in the country. The thrust of the program is to implement and expand: A. Hospital in-patient services B. Out-patient services C. Mental Hospitals D. None of these 37. The twin moves to promote rational drug use is the development of the Philippine National Drug Formulary and: A. Control Cost B. review and amend promotion and advertising of drugs C. Control manufacture of drugs D. Control importation of drugs 38. This is considered the most common congenital infection today and is known as the “child care virus” a. human immunodeficiency virus b. cytomegalovirus c. rubella d. herpes simplex e. rubeola 39. Which testicular cancer cell type is extremely radiosensitive a. embryonal carcinoma

b. yolk sac tumor c. seminoma d. choriocarcinoma e. teratocarcinoma 40. Syndrome characterized by postpartum pituitary necrosis resulting from sudden infarction of the anterior lobe precipitated by obstetric hemorrhage a. Albright’s syndrome d. Sheehan’s syndrome b. Sezary’s Syndrome e. Ahumada- del Castillo syndrome c. Adson’s syndrome 41. The mainstay in the treatment of alveolitis is ILD a.Tamoxifen b. Methotrexate c. Glucocorticoids d. Cyclophosphamide 42. A 2 year old child partially immunized was exposed to his brother with diphtheria. The prophylactic drug of choice is a. erythromycin d. penicillin b. cephalosporin e. rifampicin c. chloramphenicol 43. In order not to overlook coarctation of the aorta, the blood pressure should be measured over the following a. arms and the legs b. one arm c. both legs d. both arms e. none of the above 44.Which of the following is most associated with industrial exposure to naphthalenes and related products: A. carcinoma of the cervix B. carcinoma of the stomach C. carcinoma of the urinary bladder D. hepatocellular CA 45. In order to maintain the high quality and standard of the medical practice in the Philippines, the following administrative bodies were created for the purpose of licensing and regulation of the medical profession, EXCEPT: A. Professional Regulation Commission B. Board of Medicinal Education, Ministry of Education C. Board of Medicine D. Bureau of Licensing and Regulation, Department of Health 46. A person affixes his right thumb mark on his residence certificate. This is an example of a: A. real impression C. chance impression B. visible print D. latent print 47. An abnormal sexual behavior wherein sexual gratification is obtained by licking or sucking the female external genitalia: A. Cunnilingus C. Bestiality B. Tribadism D. Fellatio 48. A former hospital patient requested access to his clinical records but was refused by the hospital administration. He can file a court order of: A. Legal claim C. Injunction B. Mandamus D. Certiorari 49. Carbon monoxide may cause death by: A. poisoning all tissues directly B. breaking down hemoglobin C. causing hemolysis

D.

displacing O2 because of it’s stronger chemical affinity to hemoglobin

50. Antibiotic (e.g. clindamycin) associated diarrhea and the more serious pseudomembranous enterocolitis can be caused by A. Clostridium sordelli C. Staphylococcus B. Clostridium perfringens D. Clostridium difficile

51. To test trapezius muscle paralysis, you would ask the patient to f. flex the arm fully g. adduct the arm against resistance h. push against a wall with both hands i. shrug the shoulder j. abduct the arm fully 52. A 14 year old boy fell off a wall and fractured his right humerus at midshaft. The wrist joint immediately assumed a flexed position that the patient was unable to correct. Extension and supination of the forearm was weakened but not abolished. Select the peripheral nerve damaged that could cause the symptoms. a. radial nerve b. ulnar nerve c. median nerve d. axillary nerve e. musculocutaneous nerve 53. The most important laboratory procedure in the diagnosis of subacute bacterial endocarditis is a. ESR b. Blood culture c. Complete blood count d. Throat swab e. ASO titer 54. Bacterial meningitis in children between the ages of 6 months and 2 years most commonly is caused by A. haemophilus B. pneumococcus C. staphylococcus D. neisseria 55. Children conceived by prostitute: A. manceres C. sacrilegious children B. illegitimate children D. adulterous children 56. If the patient died and spouse is incapacitated, the claim for medical fee shall be made from the: A. ascendants from the nearest degree B. sister C. descendents from the nearest degree D. brother 57. A pathologist, connected and associated with a hospital on salary contract, reported after tissue biopsy that a patient had cancer when in fact he did not. The patient underwent hysterectomy as a result of the misdiagnosis. The hospital was held liable by the court under the doctrine of: A. ostensible agent C. borrowed servant B. fellow servant D. captain of the ship 58. A 63 year old male is referred for urologic consult after a large prostate gland was found on routine rectal examination. The diagnostic test should be a. digital rectal examination (DRE) b. prostate specific antigen (PSA) level c. digital rectal exam combined with PSA d. transrectal ultrasound e. Computed tomography (CT) 59. Pruritus ani is a common manifestation of patient with

A. oxyuriasis

B. uncinariasis

C. capillariasis

D. ascariasis

E. strongloidiasis

60. What is the maintenance therapy among infants with supraventricular tachycardia converted to a sinus rhythm? a. propanolol d. quinidine b. digoxin e. phenytoin c. verapamil

61. A major cause of nosocomial infection in extensive burns is A. pseudomonas C. bacteroides E. enterobacter B. branhamella D. aspergillus 62. Which of the following is NOT considered as a dangerous drug under the Dangerous Drug Act: A. Codeine C. Methamphetamine B. Atropine D. Phenobarbital 63. A 45 year old female had breast surgery for CA of the breast with metastasis. She consented in writing to undergo trial of a new chemotherapeutic modality. The patient continued to deteriorate and sued the physician. The physician was absolved under the doctrine of: A. Assumption of Risk C. Common Knowledge B. Continuing Negligence D. Contributory Negligence 64. An abnormal mental condition wherein a person is performing an act, like walking, while in the state of natural sleep? A. hallucination C. somnambulism B. somnolencia D. mesmerism 65. All of the following retroperitoneal hematomas should be explored a. central abdominal d. peripancreatic b. pelvic e. paraduodenal c. renal pedicle 66. The American Medical Association drafted 10 principles to serve as guidelines in the conduct of medical research. This serves as the cornerstone in the Allied cases against Nazi physicians. This is known as: A. Hippocratic Oath B. Declaration of Helsinski C. Medical Code of Ethics D. Nuremberg Code of Ethics in Medical Research 67. An obstetrician had to go out of town for a speaking engagement and duly informed his patients about this, with a qualified obstetrician taking over. A 25 year old, G3P2 (2-0-0-2), previous NSD, 40 weeks AOG, went into labor and had complications. The original obstetrician is: A. not liable for anything B. liable for gross negligent C. liable for breach of contract D. liable for dishonorable conduct 68. The following rights inherent in the privilege to practice medicine, EXCEPT: A. right for compensation on all cases B. right to determine the appropriate management procedure C. right to choose patients D. right to limit his practice of the profession 69. What is the primary objective of medical practice? A. to safeguard the best interest of our colleague B. serve mankind regardless of race, creed or political affiliation C. the tradition of “friend of man” should be maintained D. fulfillment of a physician’s civic duties

70. The body of the crime which points to the act of the criminal is: A. Real evidence C. Corpus delicti B. Circumstantial evidence D. En flagrante delicto 71. During physical examination, a physician fondled the breast of his female patient. He may be charged with: A. malpractice C. act of lasciviousness B. qualified seduction D. moral turpitude 72. The body vested by law to have general supervision and regulation over the practice of medicine is: B. Commission on Higher Education C. Department of Education D. Professional Regulatory Commission E. Board of Medical Education 73. The state of not knowing the nature of sexual life and not having experienced sexual relation is termed as: A. moral virginity C. false physical virginity B. demi-virginity D. true physical virginity 74. The following are true of Downs syndrome, EXCEPT: A. Mental retardation and prominent epicanthal folds B. Simian crease C. Development of Alzheimer’s disease in > 35 y.o D. Endocardial cushion defect E. Decreased risk of Acute Lymphoblastic Leukemia 75.Antistreptolysin test to diagnose A. strep fecalis B. peptostreptococcus

C. Strep pyogenes

D. strep pneumonia

76. During operations on the thyroid gland, the following nerve may be injured when tying the inferior thyroid artery a. sympathetic trunk b. internal laryngeal nerve c. descendens cervicalis d. recurrent laryngeal nerve e. superior laryngeal nerve 77. The most common cause of arterial hypertension in children a. chronic pyelonephritis b. coarctation of the aorta c. nephritic syndrome d. renal artery stenosis e. post-streptococcal GN 78. The most serious consequence of iodine deficiency is a. congenital goiter b. sporadic goiter c. endemic goiter/cretinism d. intratracheal goiter e. thyroiditis 79. The following are true about the Renin-Angiotensin-Aldosterone axis, EXCEPT: A. activated during states of hypovolemia B. activation of zona fasciculata for sodium retention C. Conversion of angiotensinogen to angiotensin I in the pulmonary circulation D. Vasoconstriction due to angiotensin II 80. Collateral circulation around the shoulder joint would involve all of the following except a. subscapular artery b. superficial cervical artery

c. suprascapular artery d. anterior circumflex humeral artery e. lateral thoracic artery 81. Malignant tumors of the trigone of the bladder spread /metastasize to the following lymph nodes a. external and internal iliac b. lumbar c. sacral d. external iliac e. superficial inguinal 82. A male trauma patient is brought in for profound shock can be resuscitated with all of the following except: a. type AB negative blood b. type O negative blood c. type-specific but not crossmatched blood d. type-specific crossmatched blood e. none of the above 83. Acute hematogenous osteomyelitis is often diagnosed by isolation of the organism from the blood and is caused most often by A. Proteus mirabilis C. Escherichia coli B. Streptococcus epidermidis D. Staphylococcus aureus 84. Mycobacterium leprae has been successfully grown in A. footpads of mice C. peritoneum of guinea pig medium B. testicles of rabbits D. Lowenstein-Jensen medium

E. all of the above

85. A 50 year old man has a right upper lobe cavitary lesion that is 4 cm in diameter and of unknown age. Which test is most likely to establish the diagnosis? a. bronchography b. computed tomography c. bronchoscopy with biopsy brushings and washings d. percutaneous needle aspiration of the cavity contents e. an immunologic skin test 86. The anti-TB drug utilized in the treatment of both pulmonary tuberculosis and leprosy: A. dapsone B. rifampicin C. streptomycin D. pyrazinamide 87. A 5 year old patient has a midline neck mass that moves with swallowing and is located just below the hyoid. The mass is most likely to be a a. branchial cleft cyst d. thyroglossal duct cyst b. cystic hygroma e. laryngeal papilloma c. teratoma 88. A 60 year old smoker complains of dyspnea, wheezing, and non productive cough. Chest radiograph appears normal, but computed tomography scan reveals an intraluminal mass located in the distal trachea. The most likely diagnosis is a. adenoid cystic carcinoma b. carcinoid tumor c. squamous cell carcinoma d. mucoepidermoid carcinoma e. squamous papilloma 89. Sustained tension of the vocal cords (folds) is best achieved through the action of which one of the following muscles a. cricopharyngeus b. cricothyroid c. aryepiglottic d. salpingopharygeus e. posterior cricoarytenoid 90. 96% of children with SLE presents with these manifestations/characteristics

a. b. c. d. e.

gastrointestinal symptoms malaise, weight loss, growth retardation nephritis photophobia fever and chills

91. Which is NOT the true statement concerning the Mycobacterium avium/intracellulare (MAI) complex: A. Prior to 1980 there were few cases of MAI disease observed. B. Acid-fast stain and culture of the stool are important diagnostic aids. C. MAI infection in AIDS patients is a result of direct contact with another person who is infected with acid-fast bacilli. D. Patients with reduced T-cell-mediated immunity are more susceptible to infection with MAI. 92. The type of necrosis seen predominantly in brain infarction: A. coagulative C. liquefactive B. enzymatic fat D. caseation 93. The following structures are closely related to the rectouterine pouch (pouch of Douglas) except a. anteriorly is situated the posterior surface of the upper part of the vagina b. posteriorly is situated the upper part of the rectum c. the trigone of the bladder is directly related to the anterior wall d. anteriorly is situated the posterior surface of the body of the uterus e. laterally is situated the sacrocervical ligaments passing forward to the cervix 94. The second law of thermodynamics states that in an isolated system: A. any spontaneous process increases the entropy of the universe B. enthalpy increases as the process proceeds C. the entropy tends to decrease with time D. the total entropy change in a spontaneous process is always negative 95. A 45 year old male executive is seen because he is vomiting bright red blood. There are no previous symptoms. The man admits to one drink a week with no other significant history. In the hospital, he bleeds 5 units of blood before endoscopy. The most likely diagnosis is a. gastritis b. duodenal ulcer c. esophagitis d. Mallory-Weiss tear e. esophageal varices 96. Most common cause of septic arthritis A. Acinetobacter B. Gonococcus C. Staphylococcus

D. Listeria

E. Streptococcus

97. First line agent for patients with congestive heart failure and pulmonary edema A. Furosemide B. Digoxin C. Nitroglycerine D. Nifedipine 98. Death from Weil’s disease is usually due to A. renal failure B. meningitis C. pneumonia D. encephalitis 99. Which of the following structures may be eroded by a perforating gastric ulcer on the posterior wall of the stomach? a. splenic artery b. inferior mesenteric artery c. right kidney d. quadrate lobe of liver e. second part of duodenum

100. Meningitis caused by Listeria monocytogenes in the pediatric age group is seen primarily in A. newborn infants C. patients receiving broad-spectrum antibiotics B. children with chronic otitis media D. children with ventriculoperitoneal shunts 101.This drug lowers plasma lipoprotein concentration by inhibition of HMG CoA Reductase A. Lovastatin B. Nicotinic Acid C. Clofibrate D. Cholestyramine 102. Most effective drug for AIDS A. zidovudine B. ribavirin C. isonoplex D. vidarabin E. acyclovir 103. A 3-year old child presents at the physician’s office with symptoms of coryza, conjunctivitis, lowgrade fever, and Koplik’s spots. The causative agent of this disease belongs to which group viruses? A. adenovirus B. orthomyxovirus C. picornavirus D. herpes virus E. paramyxovirus 104. The toxic property of endotoxin lies in the A. protein C C. O antigen B. polysaccharide core D. protein A

E. lipid A

105. The most common protozoa causing opportunistic infections in patients with AIDS: A. Toxoplasma gondii C. Cryptosporidium E. Sarcocystis hominis B. Pneumoncystis carinii D. Isospora belli 106.Most common cause of digitalis toxicity B. Hypomagnesemia C. Hypokalemia D. Hypocalcemia E. Hypochloremia 107. With a patient in the standing position, fluid in the left pleural cavity tends to gravitate down to the a. oblique fissure b. cardiac notch c. costomediastinal recess d. costodiaphragmatic recess e. horizontal fissure 108.Limited primarily to the testing of new bactericidal agents: A. Zephiran B. phenol C. benzylalkonium chloride

D. lime

109. A 3 month old child has a soft, irregular, compressible, enlarging, posterior neck mass. The most likely diagnosis a. thyroglossal duct cyst d. teratoma b. abscess e. cystic hygroma c. paraganglioma 110. All of the following areas in the Philippines are known endemic for Schistosoma japonicum, EXCEPT: A. Lake Nauhan in Mindoro C. Sorsogon (southern barrios) B. All of Leyte and Samar (coastal regions) D. Cebu City (southern barrios) 111.This antihypertensive agent, if given in the third trimester, may cause fetal bradycardia and hypoglycemia in the neonatal period a. ACE Inhibitor b. Propranolol c. Calcium channel blocker d. Hydrochlorothiazide 112. A muscle that protrudes the tongue is the a. styloglossus

d. hyoglossus

b. palatoglossus c. mylohyoid

e. genioglossus

113. Plasmid-mediated resistance to penicillins and cephalosporins is due to production of A. beta-lactamase C. adenylating enzyme E. protease B. phosphorylating enzyme D. gyrase 114. Amebic pericarditis is an extension of amebic A. colitis C. splenitis E. none of the choices B. pneumonia D. hepatic abscess 115. This agent does not pass through the placenta but causes osteoporosis and thrombocytopenia in the mother, leading to increased incidence of human fetal loss associated with hemorrhage A. Heparin B. Aspirin C. Dicoumarol D. Warfarin 116. If the foot is permanently dorsiflexed and everted, which nerve might be injured? f. Tibial nerve g. deep peroneal nerve h. superficial peroneal nerve i. obturator nerve j. common peroneal nerve 117. Portal hypertension hypersplenism is seen in late stage A. ascariasis B. giardiasis C. schistosomiasis D. enterobiasis 118.All aminoglycosides are useless against A. anaerobes B. pseudomonas

C. staphylococcus

E. paragonimiasis

D. TB

E.

Klebsiella

119. Which is responsible for the biologic activity of cholera toxin? A. Subunit A-1 C. Subunit B B. All three D. Subunit A-2 120. Work-up reveals an inflammatory process within the colon with skip areas. The rectum is spared. The most likely diagnosis is a. ischemic colitis d. ulcerative colitis b. amebic dysentery e. Crohn’s Disease c. toxic megacolon 121. Causes chronic debilitating disease characterized by significant arthropathy and cardiovascular sequelae: A. Borrella burgodofori C. Chlamydia psittaci B. Pseudomonas pseudomallei D. none of the above 122. Aspiration pneumonia secondary to anaerobic bacteria is more often associated with A. Propionbacterium acne C. Bacteroides melaninogenicus B. Clostridium difficile D. Fusobacterium 123. A patient whose job involves worldwide travel presents with complaint of right upper quadrant pain. Examination reveals hepatomegaly and eosinophilia. The most likely diagnosis is a. hepatocellular carcinoma b. hepatitis B c. echinococcal cyst d. candida albicans of the liver e. schistosomiasis 124. Stippling produced in infected red cells by Plasmodium vivax: A. Garnham’s bodies C. cuneiform dots E. Zieman’s dots B. Schuffner’s dots D. Maurer’s dots

125. In a patient who presents with Cushing’s syndrome and has elevated plasma cortisol and low plasma adrenocorticotrophic hormone (ACTH) levels, the most likely diagnosis is a. an adrenocortical adenoma b. basophilic adenoma of the pituitary gland c. oat cell carcinoma of the lung d. bilateral adrenal hyperplasia e. malignant islet cell tumor of the pancreas 126. A 45 year old woman who has had a hysterectomy presents to the emergency room with abdominal pain and vomiting. A mechanical bowel obstruction is seen on the abdominal radiograph. The most likely cause of the obstruction is a. carcinoma of the colon d. small bowel cancer b. adhesions e. diverticulitis c. incarcerated inguinal hernia 127. Which of the following can NOT serve as a vector of rickettsiae? A. ticks B. lice C. mosquitoes D. fleas 128. Heterophile antibody test (Paul-Bunnel) is a diagnostic of A. herpes virus C. cytomegalovirus E. brucellosis B. infectious mononucleosis D. polio virus 129. Tissue graft within the same individual is known as A. allograft B. isograft C. autograft D. xenograft 130. Frank amoebic dysentery in entamoeba histolytica infection: A. sigmoid-rectal B. liver C. all of these D. cecum 131. An elderly woman is admitted for weakness, weight loss, anemia and a palpable abdominal mass. She has colon carcinoma. The most likely anatomic site is a. rectum d. sigmoid colon b. left colon e. cecum c. transverse colon 132. The inclusion body of smallpox virus is A. Miyagawa B. Guarnier-Paschen C. Lipschutz

D. Torres-Councilman

133. Type I allergic disease of the respiratory tract is exemplified by A. bronchial asthma C. Goodpasture’s syndrome B. farmer’s lung D. tuberculosis 134. Which of the following immunosuppressive agents is a fungal metabolite that has been used clinically? A. methotrexate B. cyclosporine A C. azathioprine D. cyclophosphamide 135. Blackwater fever results from A. anaphylaxis C. liver enlargement B. splenic enlargement D. melanosacroma

E. intravascular hemolysis

136. Chorioretinitis and cerebral calcification are manifestations of A. T. gondii B. all three C. Cryptosporidium sp. D. P. carinii 137. A 4-year old boy has a young puppy and a history of pica. He has had the recent onset of Wheezing, hepatomegay, and marked eosinophilia (80% eosinophils). The test most likely to produce a specific diagnosis is A. histoplasmin test C. tuberculin skin test B. ELISA for Toxocara D. silver stain of gastric aspirate 138. The following are prominent hypotensive molecules, except a. nitric oxide d. bradykinin b. beta endorphin e. none of the above

c. prostacyclin

139. A 15 year old girl has recurrent abdominal cramping and melena. Physical examination reveals increased pigmentation on her lips and buccal mucosa. Her sister has a similar history and similar findings. What is the most likely diagnosis a. pseudopolyposis b. Familial polyposis c. Villous adenoma d. Juvenile polyposis e. Peutz-Jegher’s syndrome 140. The following are principles of antimicrobial therapy in sepsis, except a. initiate empirical therapy effective against both gram (+) and gram (–) bacteria b. patterns of antimicrobial susceptibility among bacterial isolates from hospitals, the community and patient should be taken into account c. minimum recommended doses of antimicrobial drugs should be given intravenously d. should be initiated as soon as samples for blood culture from at least 2 different sites have been cultured e. none of the above 141. Enzyme responsible for hydrolyzing triacylglycerol-associated with VLDL in the blood: A. steapsin B. pancreatic lipase C. lipoprotein lipase D. hormone-sensitive lipase 142. Deficiency in availability of which of the following will result in ketosis? A. carbohydrates B. proteins C. lipids D. essential fatty acids 143. The prostanoid with the greatest vasodilatory effect is A. PGE2 B. PGF2 C. misoprostol D. prostacyclin

E. thromboxane

144. Direct synthesis of ATP from high energy compounds is known as A. substrate level phosphorylation C. adenylation B. high energy phosphorylation D. oxidative phosphorylation 145. Pancreatic digestion of fats require the action of bile salts to A. enhance peristalsis C. increase lipid surface area B. precipitate the lipids D. activate pancreatic enzyme 146. In electrophoresis, antibodies correspond to A. gamma globulin C. alpha-1-globulin B. beta globulin D. alpha-2-globulin 147. The platelets produce a potent vasoconstrictor called A. ADP B. phospholipids C. serotonin D. fibrin 148. The release of oxygen from oxyhemoglobin due to an increased CO2 is known as A. Pasteur effect C. Bohr effect B. Haldane effect D. Hamburger phenomena E. isohydric transport 149. Some antibiotics act as ionophores, which means that they A. interfere directly with bacterial cell wall synthesis B. have a detergent-like effect on cell membranes C. increase cell-membrane permeability to specific ions D. inhibit both transcription and translation E. inhibit only translation 150. The Megaloblastic macrocytic anemia with subacute degeneration of the spinal cord is due to a

deficiency of A. ascorbic acid B. folic acid

C. thiamin D. biotin

 AMDG…Ad Majorem Dei Gloriam

E. cyanocobalamin