1.

The gold standard for the diagnosis of malaria is:

a. Antigen detection (rapid Diagnostic Tests)
b. Blood smears- Thick and thin
c. PCR
d. Serology
2. A 58 year old diabetic female was brought to the ER due to progressive headache for 3 weeks.
Disorientation was noted in some occasions on the second week, Low grade fever was seen on
the third week, and she became more disoriented. Her neighbour has lots of pigeons. She
probably has__.
a. Bacterial meningitis
b. Candida meningitis
c. Cryptococcal meningitis
d. Viral meningoencephalitis
3. A 34 year old gay, call center agent, was admitted for the 3rd time due to cough, fever and
progressive shortness of breath. He responded poorly with broad spectrum antibiotics this time.
He improved when he was given steroids and co-trimoxazole. He probably has___.
a. Pulmonary malignancy
b. Pneumocystis carinii pneumonia
c. Pulmonary aspergillosis
d. Pulmonary cryptococcosis
4. According to the Center for Disease Control and Prevention (CDC), a person with HIV infection
has AIDS if his CD4-T cell count is below what level?
a. 50
b. 100
c. 200
d. 350
>500 Acute HIV syndrome Persistent generalized
Vulvovaginal candidiasis lymphadenopathy, Guillan
barre syndrome
200-499 Pulmonary tuberculosis,
oropharyngeal thrush,
cryptosporidiosis self-limited
<200 Toxoplasmois of th brain, Burkitts lymphoma, HIV
recurrent pneumonia dementia
<50 CMV retinitis, disseminated
M. avium complex

5. A 27 year old male with a positive screening test for HIV was referred with the confirmatory test
done at DOH-SACCl, demonstrating antibodies in 3 HIV proteins, namely p24, gp41, and gp
120/60. Which confirmatory test is this?
a. ELISA – standard screening 99.5 sensitivity
b. IFA – alternative HIV serologic test
c. Western Blot
d. Viral load
6. A patient with leptospirosis was admitted and started on Ceftriaxone 1g IV q 24. The result of
Lepto MAT was negative. What will be the best diagnostic plan?
a. Request for CSF Leptospira PCR
b. Request for Urine Leptospira culture
c. Request for aerobic blood culture
d. Request for a repeat Lepto MAT or convalescent-phase serum sample
Weill’s disease = jaundice, renal failure, bleeding

1
 Pulmonary haemorrhage syndrome = MCC of Death
1st week – septicemic – Blood diagnostic sample of choice
7. AM a 23 year old male diagnosed to have AMl, was confined due to cough, fever and dyspnea.
He’s in his 9th day of 3rd cycle of chemotherapy. Broad spectrum antibiotics were given but he
further deteriorated. Bronchoalveolar lavage was done and histopathology revealed septated
hyphae, branching at 45 degrees. He has___.
a. Invasive Aspergillosis
b. Invasive Candidiasis
c. Pulmonary Cryptococcosis
d. Pneumocystis pneumonia
8. Aside from Vancomycin, the following antibiotics have MRSA coverage except:
a. Clindamycin
b. Trimethoprim-Sulfamethoxazole
c. Cefuroxime
d. Linezolid
9. A 55 year old male smoker complained of angina after climbing the stairs and reaching the third
floor of an apartment building. What is his functional class?
a. New York Heart Association Class 1
b. Canadian Cardiovascular Society Class II
c. New York Heart Association Class III
d. Canadian Cardiovascular Society Class IV
10. Optimal medical therapy for STEMI of 4 hours duration should include:
a. aspirin, isosorbide dinitrate, enoxaparine, streptokinase
b. Oxygen, isosorbide mononitrate, fondaparinuax, clopidogrel
c. Clopidogrel, morphine, diltiazem, nitroglycerin
d. Verapamil, oxygen, dopamine, enoxaparine, aspirin
11. The most common mechanism for STEMI is?
a. Coronary vasospasm
b. Progressive coronary artery stenosis
c. Coronary embolization
d. Plaque rupture
12. A 68 year old male hypertensive consulted at the ER due to chest pain of 2 hours duration. ECG
showed ST elevation at lead V1-V4. Torponin was negative. What will you do to arrive at a
definitive diagnosis?
a. Request for CPK-MB immediately
b. Perform 2D echocardiography
c. Repeat Troponin after 3-6 hours, released after 2-4 hrs
d. Request for a Chest X ray, PA and lateral view
13. Anginal equivalent should be suspected in which type of patient?
a. 50 year old male smoker
b. 38 year old hypertensive female
c. 75 yaer old diabetic female
d. 60 years old dyslipidemic male
14. Na 65 year old male comes in for difficulty of breathing developing over 2 weeks becoming
progressive. PE shows tachypnea and tachycardia with bilateral rales from mid to base areas. The
diagnosis is:
a. Community acquired pneumonia
b. Emphysema – chronic more than 8 weeks
c. Chronic bronchitis - chronic more than 8 weeks
d. Congestive heart failure
15. NA 65 years old. The patient’s chest x ray findings are expected to be as follows:

2
 a. Patchy infiltrates on the middle lobes - CAP
b. Hazziness in the middle to lower lobes of both lungs with obliteration of the costo-
phrenic sulci – Pulmonary congestion and pleural effusion
c. Cephalization and prominent bronchovascular markings – chronic lung disease
d. Flattened diaphragm with hyperaerated lungs – Asthma??
16. Which of the following medications is indicated for NA?
a. Aminophylline- for acute bronchospasm, congestive heart failure relaxes smooth muscle
b. Hydrocortisone- suppression of inflammation usually in asthma
c. Ceftriaxone – antibiotic for CAP
d. Furosemide- diuretic since there is pulmonary congestion and pleural effusion
17. PA 55 male comesin with chest pain started 30 mins before admission accompanied by sweating
and tachycardia. The ECG would probably show?
a. Deep q waves
b. ST segment elevation
c. U waves
d. Wide R-S-R pattern
18. A 23 year old male patient presents with excoriated scaly patches on the lateral neck and extensor
upper extremities. His mother has asthma. The diagnosis is:
a. aTopic dermatitis
b. Seborrheic dermatitis
c. Contact dermatitis
d. Stasis dermatitis
e. Numular dermatitis
19. A 30 year old female consults for erythematous patches on the eyebrow and nasolabial areas.
Employed in a call center, she complaints of stressful nature of work and the cold environement.
Her diagnosis is:
a. Erythroderma
b. Numular dermatitis
c. Contact dermatitis
d. Stasis dermatitis
e. Seborrheic dermatitis
20. A 53 year old cashier complaints of erythematous hyperpigmented patches on the medial ankle
areas. She experiences numbling pricking pain and itch. By late afternoon., she has bipedal
edema. Her diagnosis is:
a. Pompholyx
b. Erythroderma
c. Contact dermatitis
d. Stasis dermatitis
e. Numular dermatitis
21. A 45 year old housewife complaints of erythematous,s caling, fissured plaques on her dorsal
hands. She cooks, cleans, and does loaundry. Her diagnosis is:
a. Pompholyx
b. Seborrheic dermatitis
c. Numular dermatitis
d. Erythroderma
e. Contact dermatitis
22. Two days after eating out, a patient developed crampy abdominal pain with musht water diarrhea.
Stool exam showed Giardiasis. The most likely mechanism is:
a. Cytotoxin production
b. Enteroadherence
c. Enterotoxin

3
 d. Preformed tocin
23. The most likely offending agent in a patient with initially watery diarrhea which shortly became
bloody accompanied by marked abdominal pain is:
a. Rotavirus
b. Hemorrhagic E. Coli
c. Entamoeba hystolitica
d. Vibrio cholera
24. Four hours after eating re-heated fried rice, a group of friends developed several vomiting
episodes associated with frequent watery diarrhea. The most likely mechanism is:
a. Preformed toxin
b. Cytotoxin
c. Enterotoxin
d. Enteroadherence
25. A patient in the ICU on NGT feeding was referred because of diarrhea. Feeding was temporarily
stopped for 24 hours. With persistence of the diarhea. The most likely mechanism of the diarrhea
is:
a. Inflammatory – bleeding
b. Steatorrheal – fat, foul smelling, greasy
c. Secretory – doesn’t stop
d. Osmotic – stop after fasting
Matching Type: Match the hepatitis test result in column A with its interpretation in Column B

HBsAg (+) Anti HBcIgM (+) HBeAG (+) = Acute HBV infection, High infectivity
HBsAg (+) Anti HBcIgG (+) Anti-HBe(+) = Late acute/chronic Hep B infection, Low infectivity
HBsAg (-) Anti HBcIgM (+) HBeAg (-) = Anti HBc window
HBsAg (-) Anti HBcIgG (+) Anti HBe (+) = Remote past infection
Anti HBs (+) Anti HBcIgG(+) Anti HBe (+) = Recovery from HBV infection

26. Which of the following condition is the precursor of gallstone disease?

a. Cholesterolosis
b. Bile sludge
c. Gallbladder adenomysosis
d. GB polyp
27. A 63 yearold male consulted to painless jaundice with significant weight loss. What is ht emost
likely diagnosis?
a. Ampullary CA
b. Chronic pancreatitis
c. Gastric Ca
d. Choledocholithiasis
28. The drug of choice for anaphylaxis is:
a. Intramuscular antihistamine
b. Intravenous corticosteroid
c. Intramuscular epinephrine
d. Subcutaneous H2 blocker

29. This pharmacologic action is true of epinephrine:

a. It acts as Beta 2 adrenergic agonist that blocks further release of mediators from mast cells
b. It antagonizes alpha 2 adrenergic receptros resulting in decreased peripheral resistance and
increase in mucosal edema
c. It blocks B1 adrenergic receptors promoting bronchodilation and vasoconstriction

4
 d. It acts as an alpha 1 agonist adrenergic receptor that promotes inotropy and
chronotropy of the heart
30. A 21 year old female had recurrence of anaphylaxis 8 hours after receiving treatment for
anaphylaxis at the ER. She is probably suffering from:
a. acute anaphylaxis
b. Biphasic anaphylaxis
c. Protracted anaphylaxis
d. Chronic anaphylaxis
31. One of the following statements is true about the epidemiology and cause of anaphylaxis:
a. Most common cause is drug allergy by tyooe 3 hypersensitivity reaction
b. Anaphylaxis from exercise is an IgE mediated cause of anapjhylaxis
c. Majority of fatalities from anaphylaxis is due to delay in the administration of epinephrine
d. The prevalence of anaphylaxis maybe lower than the reported prevalence bacuse of over
reporting and/or over diagnosis of cases.
32. A 25 year old female present with cough, wheezing and dyspne, one day prior to consultation.
She took one tablet of salbutamol which afforded no relief. Past hisoty also revealed frequent
coughing episodes during the cooler months of the year with associated mild dyspnea and
relieved by the use of SABA. Family history was unremarkable. The rpesenting manifestation
which makes asthma the most likely diagnosis is:
a. Seasonal variability
b. Nocturnal episodes
c. Positive family history of asthma
d. Unresponsiveness to bronchodilator
33. A 30 year ild male asthmatic underwent spirometry. His pre-bronchodilator FEV1 is 2.50L after
15 mins, he was given inhaled bronchodilator and on repeat spirometry his FEVE1 increased to
2,8 L. the computed % change confirming the diagnosis of asthma is:
a. 10%
b. 12%
c. 14%
d. 16%
34. A 20 year old female asthmatic has been stable for the past year with only every two months
daytime symptoms and nocturnal awakening. She uses her rescue medications only one or less
per month. Her FEV1 is 80% predicted. The treatment needed to control her asthma is:
a. Occasional PRN beta 2 agonist
b. Regular low dose ICS LABA combination
c. Regular medium dose ICS LABA combination
d. Regular ICS LABA plus oral corticosteroid

35. A 35 year old male asthmatic on maintenance of ICS LABA presents with a cough and dyspnea
with daily nocturnal awakenings. He uses his rescue medications almost three times a day. He
underwent spirometry with pre and post bronchodilator. The expected FEV1 is
a. > 80% predicted
b. 70% predicted
c. 60% predicted
d. <60% predicted

36. A 27 year old female asthmatic on maintenance of ICS LABA presents with cough and dyspnea
with daily nocturnal awakenings. He uses his rescue drug almost three times a day. He underwent
spirometrywith pre and post bronchodilator. What is the level of severity of this patient?
a. Intermittent
b. Mild intermittent

5
 c. Moderate persistent
d. Severe persistent

37. A 40 year old male patient presents with once a week daily symptoms of cough with nocturnal
awakenings. He uses his recue beta 2 agonist once to three times a week. He underwent
spirometry with FEV1 70% predicted. The treatment needed to control his asthma is:
a. ICE + LABA combination + OCS
b. ICS + LABA combination
c. ICS only
d. Occasional beta 2 agonist p.r.n.

38. An approach to treatment to reduce exacerbation and improvements in asthma control is a single
inhaler maintenance and relief therapy strategy. This can be achieved by what inhaler
combination?
a. Fomoterol+Budesonide
b. Salmeterol+Fluticasone
c. Salmeterol+Budesonide
d. Ipratropium+Salbutamol

39. A 60 year old female, smoker, was diagnosed to have right upper lobe mass noted to have ptosis,
miosis and anhydrosis of the right eye. This means that the patient has:
a. Horner’s syndrome
b. Pancoast syndrome
c. Superior vena cava syndrome
d. Paraneoplastic syndrome

40. In a patient whom you subject to have pulmonary embolism, chest X-ray showed focal oligemia
in the right upper lung. This is referred to as:
a. Palla’s sign
b. Westermark’s sign
c. Hampton’s sign
d. Atelectasis

41. A 40 year old female on oral contraceptive pills with known deep venous thrombosis complained
of dyspnea which was progressive, to confirm your diagnosis the gold standard is:
a. Venous ultrasonography
b. Esopahgeal 2D-Echocardiogram
c. Chest Spiral CT scan/CTPA
d. VQ lung scan

42. An asthmatic patient developed fever, malaise, snorexia, weight loss, sinusitis, and purpura. On
bronchial biopsy, granulomatous reaction was noted in a small and medium vessel sassociated
with eosinophils. The pulmonary vasculitis is most likely due to:
a. Behcet’s Syndrome
b. Aortic arch Syndrome
c. Churgs-Strauss Syndrome
d. Wegener’s granulomatosis

6
 43. In the Light’s Criteria. When one of the exudative pleural effusions criteria are met yet the patient
is clinically assessed to have an effusion due to congestive heart failure, what should be measured
to confirm the type of effusion?
a. Difference in protein levels in the serum and pleural fluid
b. Difference in the glucose levels in the serum and pleural fluid
c. Difference in the amylase levels in the serum and pleural fluid
d. Difference in LDH levels in the serum and pleural fluids
44. What is the treatment of choice for chronic kidney disease
a. renal transplant
b. Hemodialysis
c. Peritoneal dialysis
d. Sodium bicarbonate
45. Asymptomatic bacteriuria is defined as:
a. 100 CFU/ml of urine
b. 1,000 CFU/ml of urine
c. 10,000 CFU.ml of urine
d. 100,000CFU/ml of urine
Match the diuretic with its site of action
46. Furosemide A. Distal tubule
47. Thiazide B. Proximal tubule
48. Acetazolamide C. Loop Henle
49. Bumetanide D. CCD
50. mannitol

51. the most common etiology of acute pancreatitis (2635)

a. Gallstone disease
b. Alcohol
c. Hypertriglyceridemia
d. Sphincter of Oddi dysfunction
52. The intial phase in the pathogenesis of acute pancreatitis is (2636)
a. Pancreatic acinar cell injury
b. Sequestration of inflammatory cells into the pancreas
c. Pancreatic release of cytokine
d. Activation of phospholipase A2
53. Hallmark treatment of acute pancreatitis EXCEPT: (2640)
a. Bowel rest
b. Immediate administration of antibiotics
c. Hydration using crystalloid
d. Analgesia
54. Most common cause of chronic pancreatitis in adult is (2643)
a. Autoimmune disease
b. Alcohol
c. Sjogren’s syndrome
d. Cystic fibrosis
55. The most common etiology of upper GI bleeding are
a. Ulcers
b. Varices
c. Mallory Weiss tear
d. Neoplasm

7
56. A 19 year old came at the ER due to hematemesis. He came from drinking spree and had several
episodes of retching. No abdominal pain. Examination showed BP: 120/80 HR 70, No pallor nor
jaundice. Abdomen was flat. What is the most likely cause of UGIB?
a. Peptic ulcer diseas
b. Esophageal Varices
c. Mallory Weiss tear
d. Gastric malignancy
57. A 55 year old female came in due to hematochezia. EGD and colonoscopy did not localized the
source of bleeding persists. The next best step to do in this case is:
a. Do a repeat colonoscopy
b. RBC tagging
c. Mesenteric angiography
d. CT scan of the abdomen
58. A 24 year old, female non smoker was diagnosed with asthma 9 months ago and has been on
budesonide formeterol 160mcg 2 puffs twice a day as reliever and maintenance therapy. She is
asymptomatic for the past 3 months. Her FEV1 is 97% predicted. Which of the following should
you advise
a. Continue the same treatment
b. Reduce the treatment to one puff twice a day
c. Discontinue formoterol
d. Discontinue medication
59. A 50 year old male diabetic presents with productive cough, fever and dyspnea. his chest x ray
revealed hazy infiltrates at the right lower lung field. Sputum examination gram stain showed
gram positive diplococci in chains. The most likely pathogen is:
a. Streptococcus pneumonia
b. Staphylococcus aureus
c. E. coli
d. Hemophilus influenza
60. A 60 year old male smoker present with cough and weight loss. His chest x ray showed a 5 cm
mass on the right lower lung filed abutting the pleura. The most appropriate diagnostic procedure
to arrive at a diagnosis is:
a. Fiberoptic bronchoscopy
b. Transthoracic needle biopsy
c. MRI
d. Pleural biopsy
61. Oliguria is defined as urine output:
a. <100ml/24 hrs
b. <400ml/ 24 hrs
c. <500ml/ 24 hrs
d. <1000ml/24 hrs
62. What is the most common cause of Chronic Kidney disease among adults:
a. Glomerulonephritis
b. Diabetic nephropathy
c. Hypertensive nephrosclerosis
d. ADPKD
63. What is the most common cause of nephrotic syndrome in adults?
a. Minimal change disease
b. Membranoproliferative GN
c. Membranous GN
d. Post streptococcal GN
64. What is the most common cause of nephrotic syndrome in children?

8
 a. minimal change disease
b. membranoproliferative GN
c. membranouse GN
d. Post streptococcal GN
65. Write the cocroft gault formula:
66. What is the most common form of acute kidney injury:
a. Acute tubular necrosis
b. Pre renal
c. Intrinsic renal
d. Post renal

67. What is the most common cause of post renal AKI?

a. Bladder neck obstruction
b. Ureterolithiasis
c. Cervical CA
d. Urethral stricture
68. What is the gold standard diagnostic examination for kidney/ureteral stone disease?
a. KUB UTZ
b. Plain CT scan
c. CT scan with contrast
d. CT Stonogram
69. A patient diagnosed with catheter associated UTI has the following urine culture result:
Organism: 100,000CFU/ml. E. coli

Sensitive to: Amikacin, Piperacillin-Tazobactam, Ciprofloxacin, Chloramphenicol, Ertapenem,

Meropenem, Imipenem

Resistant to: Amoxicillin- clavulanic acid, ceftazidime, Ceftriaxone, Ampicillin-sulabctam,

Cefuroxime, Gentamicin

What antibiotic will you give to treat the infection?

a. Piperacillin-tazobatam
b. Ciprofloxacin
c. Ertapenem
d. Chloramphenicol
70. A 50 year old female asthmatic had pulmonary function test showing reduced FEV1, reduced
FEV1/FVC and normal FVC. After 25 mins she was given an inhaled salbutamol and a repeat
PFT was done. The expected PFT result is:
a. No change in FEV1
b. More than 12% increase in FEV1
c. Increase in FVC
d. No change in FEV1.FVC
71. A 45 year old male was discharged from the hospital 6 weeks ago after an asthma attack that had
required an intubation and mechanical ventilation. He is now in your clinic for a follow up check
up. He reports being asymptomatic except for occasional cough and colds. He is maintained on
ICS LABA but stopped 5 days ago. On PE occasional bilateral wheezing heard. Spiromerty
showed FEV1 of 75% predicted. On hospital discharge his FEV1 was 96% predicted. Which of
the following suggest that the patient is at risk for a near fatal asthma attack?
a. Presence of cough
b. Presence of wheezing
c. Discontinuation of ICS LABA

9
 d. FEV1 of 75% predicted
72. Beta 2 adrenergic agonist are drugs used to reverse the bronchoconstrictor of asthma. The
primary bronchodilating effect of beta adrenergic agonist on the airways is by what mechanism:
a. Relaxation of smooth muscles
b. Inhibition of mast ce;; mediator release
c. Reduction in plasma exudation
d. Inhibition of sensory nerve activation
73. A 27 year old female in the 5ht month of pregnancy present ot her family physician due to recent
onset of dyspnea on moderate exertion and dry cough causing frequent nocturnal awakening. She
has been on maintenance with ICS and LABA but stopped during the first trimester for fear of
adverse effects on the fetus. PE showed slight bilateral wheezing. Spirometry showed FVC 90%
predicted. FEV1 50% predicted. FEV1/FVC 55%./ after inhalation of 2 puffs salbumatol FEV1
improved to 90% predicted, while FVC remained at 90%b predicted. Which of the following is
most appropriate for this patient?
a. Restart inhaled corticosteroids
b. Avoid systemic corticositeroids
c. Avoid SABA
d. Start leukotriene antagonist
74. A 45 year old male non smoker, asthmatic has been on daily oral theophylline as an add on
treatment to his inhaled corticosteroids for severe asthma. Three days before consultation, he
developed cough and sputum production with dyspnea. his chest x ray revealed hazy infiltrates on
the right base. He consulted and was prescribed erythromycin.
What is the recommended step regarding theophylline?
a. Increase the dose
b. Decrease the dose
c. Maintenance the dose
d. Discontinue its use
75. A 30 year old male asthmatic, no ton maintenance ICS, will join the 5km marathon in Tagaytay.
If this patient has exercise induced asthma. The exercise induced bronchoconstriction will
develop at which part of the marathon?
a. While undergoing marathon
b. 5-10minutes after completing the event
c. 1 hr after the event
d. 2 hrs after the event

76. A 35 year old mael asthmatic on maintenance ICS LABA, had daily symptoms of dyspnea, with
nightly nocturnal awakening due to episodes of dyspnea partially relieved by inhaled salbutamol.
She underwent PFT with FEV1 58% predicted. Based on the Philippines Consensus guidelines on
asthma. The level of severity is:
a. Intermittent
b. Mild persistent
c. Partly controlled
d. Uncontrolled
77. A 36 year old male, non smoker with daily use of ICS LABA was admitted for three times the
current yer due to acute exacerbations. During the past two weeks, he uses his reliever inhaler on
the average of three times per week on PFT his FEV1 is 60% predicted. Based on the Philippine
Asthma Consensus Guidelines the level of asthma control is:
a. Well controlled
b. Mildly controlled
c. Partly controlled
d. Uncontrolled

10
78. A 25 year old asthmatic present with sudden onset of chest tightness, cough, wheezing, dyspnea,
after cleaning the house and burning the garbage. SABA inhaler afforded no relief he was brought
to ER. On PE he was tachypneic and tachycardic. The initial ABG will likely show:
a. Normal oxygenation and normal PCO2
b. Hypoxemia with normal PCO2
c. Hypoxemia with Low PCO2
d. Hypoxemia with high PCO2

79. Multiple cytokines regulate chronic inflammation of asthma. The cytokines that are deficient in
asthmatic and has anti inflammatory properties are:
a. IL-4
b. TNF- Alpha
c. IL-10
d. Eotaxin

80. A 35 year old female asthmatic was admitted due to cough, colds, sneezing nasal congestion and
dyspnea. Viral infection that could have caused have caused the exacerbation of her asthma:
a. Adenovirus
b. Rhinovirus
c. Influenza virus
d. Coxsackievirus
 Viral infections are the most common triggers of severe asthma exacerbations but the
mechanism is not CLEAR! Common viruses area: RHINOVIRUS, RSV, CORONAVIRUS

11