What is the cornerstone of treatment in patient with Heart Failure with reduced ejection fraction which has been shown to be associated with decreased mortality? (HPIM 20^th ed p.1772)

A 60/M diagnosed with COPD consulted for follw-up, he has productive cough with whitish phlegm and exterional dyspnea. FEV1/FVC is < 0.7 with FEV1 > 30% but < 50% of predicted. Based on the GOLD classification how severe is the patients COPD? (HPIM 20^th ed p.1991)

What is your interpretation of the CXR?

Which of the following is the recommended dose for the Triple therapy in the eradication of H.pylori? (HPIM 20^th ed p. 2232)

What is the pathophysiology of Shock in dengue? WHO Dengue guidelines 2009 p.26

A 30/F, married, consulted due to hypogastric pain, dysuria and frequency, she denies history of vaginal discharge. According to the 2013 Phil. Clinical Practice Guidelines in the Diagnosis and Management of UTI, what is the recommended Primary antibiotic for this patient?

A 50/M with a fasting plasma glucose of 6.9mmol/L . The patient has

(HPIM 20^th ed p. 2850)

What is the estimated Glomerular Filtration Rate (GFR) of a 40 year old female, weighing 55kg with serum creatinine of 128 umol/L using the Cockroft and Gault formula?

A 55/M male consulted due of joint pain and swelling of the Distal Interphalangeal joint and 1^st Carpometacarpal joint. What is the cause of the joint swelling?

1. This is a trait of 5-star physician, who considers the patient as an integral part of a family and the community and provides high-standard clinical care and personalizes preventive care within a long-term trusting relationship.

This type of family is linked together by virtue of kinship bond between parents and children and/or between siblings.

FAMILY PROCESSES: this occurs when a third person is drawn into a two-pair system so as to diffuse anxiety or conflict.

PARENTING STYLES: In this parenting, parents let the child’s preferences take priority over their ideals and rarely are in control of the family rather than the parents.

FAMILY APGAR: the data you obtained from the patient had a total of 6, which means?

Among these patients, who should not undergo screening for anemia?

Which of the following is the probable vector that transmits Dengue virus to human?

Which of the following pair of primary pathogens associated with urethritis?

A 51-year old male came into your clinic complaining of 3 weeks cough. This was accompanied by loosening of his clothes, low grade fever which usually occur in the afternoon, and occasional blood tinged sputum. Patient is a known smoker and hypertensive allegedly compliant with his medications. He denies any previous PTB treatment. Physical examination revealed a BP 140/70, HR 92, RR 20, T 37.1c and clear breath sounds upon ausculatation. Chest xray was done showing linear opacities on the right upper lung field, and sputum afb showed 2 negative results.

What is your diagnosis?

Which of the following are the most common sign and symptoms to find in a patient diagnosed with COVID 19 based on several studies in Chinese population?

Corneal transparency is maintained by the following, except:

Which of the following are elevators of eye?

Which orbital wall is most commonly involved in orbital wall fractures?

Which type of lens is used to correct a purely myopic eye

The hallmark finding seen in Proliferative diabetic retinopathy

The eye structure with the highest refractive power is the

Ophthalmia neonatorum is

1. Normal A:V ratio of retinal blood vessels:

All of the following are causes of sudden painless loss of vision except:

1. Flashes of light before eyes (photopsia) is a feature of:

What are the layers of the epidermis (in correct order)?

This is a circumscribed change in color, without elevation or depression, >1cm.

Which of the following is a secondary lesion?

Which of the following is NOT a major diagnostic criteria for Atopic dermatitis?

What is the causative agent of a common wart?

A 7-year old male presented to you with skin-colored pearly papules with central umbilication on the right chest. What is your initial diagnosis?

A 2-month old baby girl presented to you with reddish white macerated plaques with satellite papules in the diaper area. What is the most likely etiologic agent?

The diagnosis of Toxic epidermal necrolysis is made when the body surface area (BSA) involved is:

These are linear, urticarial lesions occurring after stroking or scratching the skin.

Six signs of malignant melanoma (ABCDE Rule):

The spine consist of how many vertebra?

The Pia mater ends as?

It carries all the fibres of the brachial plexus

True of Restrictive Lung disease.

Drug Interaction between local anesthetics and sedatives?

Which of the following is an anticholinesterase?

Which drug reverses the effects of Opioids

Marks the beginning of the cardiac cycle

The most important buffering system in the body.

Which of the following drugs has anxiolytic and amnesic effect?

The following are features of necrosis except:

This pattern of tissue necrosis is characterized by digestion of the dead cells, resulting in transformation of the tissue into a viscous mass

What is the hallmark of tissue repair?

A few minutes after being bittenby a mosquito, swelling and erythema were noted. What causes the erythema?

A housewife while cooking came in contact with her frying pan. A blister with clear fluid developed at the area of contact. What is the nature of the lesion?

A suppurative exudate contains necrotic debris in addition to neutrophils. Which of the following is most likely responsible for necrosis?

A 24 y.o laborer is found to have bilateral adenopathy on routing chest X-ray. Histology show Langhan’s type of giant cells with central caseation necrosis, which of the following is the best diagnosis?

Which of the ff result from the action of the product of the cyclooxygenase pathway:

Blocking the cyclooxygenase pathway by aspirin would best help alleviate:

Lymphatics is the 2nd line of defense in acute inflammation performing all of the ff functions EXCEPT:

The initial step in hemostasis is:

A 21/M suffered from a stab wound at the left chest, 4th ICS, left MCL. She was rushed to the ER and was found to have the following vital signs 80/50mmHg, 120bpm, 26cpm, afebrile. You are considering cardiac tamponade, what are the components of Beck’s Triad?

A 32-year old male presents after being hit by a truck. He opens his eyes to sternal rub, localizes to pain and is only making groaning sounds. What is his GCS?

Which of the following is a non-proliferative disorder of the breast:

A 25 year old female medical intern failed her PGMI examination and ingested 100 cc of household bleach. Appropriate treatment strategy include:

A 65-year old male, known COPD case was chronically taking NSAIDs, suddenly experienced severe epigastric pain. 24 hours later, fever was noted, thus consult. Chest x-ray upright revealed a crescent shape lucency beneath the diaphragm which can be attributed to:

A 30-year old male patient came in the ER due to ruptured appendicitis. His vitals were 80/50mmHg, 56 beats per minute, 21 breaths per minute, temperature of 36.1’C. his WBC count is 12000/uL. The following are part of the Systemic Inflammatory Response Syndrome (SIRS) except:

The statement about the anatomy of the gallbladder

A 16/M came in due reducible IIH. The hernial sac of an indirect inguinal hernia is located:

A 4 years old boy has an indirect inguinal hernia which is reducible. The surgery of choice is:

What nerves could possibly be severed during low transverse incision during caesarean section which could lead to loss of sensation of the skin over the suprapubic area, mons pubis and upper labia majora.

The perineal body is found at the junction between the anterior and posterior triangles and it provides significant perineal support. What muscles converge in the central tendon which is incised during episiotomy?

During vaginal birth, there is significant risk for damage to the levator ani muscle which could predispose women for POP. What muscle of the levator anii is more commonly damaged?

It is the part of the uterus which forms the lower uterine segment

In early pregnancy, softening of the isthmus is called

A branch of the uterine artery that runs within the round ligament

A G1P0 is on her 14 weeks age of gestation underwent exploratory. Intraoperative finding revealed that there was hemorrhagic corpus luteum. You have to remove the corpus luteum. Your consultant asked you if there is a need to give progesterone to maintain the pregnancy. You tell her that there is no need to give progesterone because Corpus Luteum found in pregnant women functions maximally during the first:

A patient comes in for prenatal check-up. She is on her third trimester and complains of swelling of the ankle. Her vital signs were normal and PE was unremarkable. You tell her that:

LH secretion peaks how m any hours before ovulations?

First histologic evidence of ovulation is:

An unconscious 30/M was brought to the emergency room after being involved in a vehicular crash (motorcycle vs motorcycle), with noted gross deformity of his R thigh. Which of the following should be the first course of action?

For the patient in Question 81, what would be the most appropriate imaging modality during the time of examination at the emergency room?

For the patient in Question 81, diagnostic imaging revealed a femoral shaft fracture R. What would be the most appropriate immobilization for the patient?

Deforming forces in a femoral shaft fracture include the following structures EXCEPT

The femoral artery becomes the popliteal artery as is courses through which of the following structures?

The carpal bones include the following EXCEPT

A 45/F teacher consulted at the outpatient clinic with a chief complaint of persistent pain on her R hand, with associated numbness of the thumb, index and middle finger. Primary consideration for this case would be which of the following conditions?

The rotator cuff muscles include the following structures EXCEPT

The risk for anterior shoulder dislocation of the glenohumeral joint is highest in which of the following shoulder positions?

A 25/F soccer player presented at the outpatient clinic with a 3 week history of twisting her L knee, with notably less pain on the L knee but with persistent instability especially when going down the stairs. A positive anterior drawer test/Lachmann test would be indicative of which of the following conditions?

What is the expected weight in kilograms of an 8 MONTH child?

A term well newborn is discharged before 48^th hour of life. This baby should be followed up within the next

Rotavirus is given at a minimum age of:

The visual acuity of a newborn permits recognition of an object held at:

The drug of choice for CAP in children 2-5 yo:

A 4 yo vehicular accident male patient remains hypoxic and dyspneic despite 100% FiO2 via ET. On PE, lungs are hyperresonant and breath sounds are diminished bilaterally. What is most likely the complication?

Lesion arising from other intrauterine disorders like oligohydramnios and presents with respiratory distress soon after birth

A 2 yo child awakens with a characteristic barking cough, noisy inspiratory sound with respiratory distress. Patient is afebrile and symptoms diminish within several hours

In the Philippines, the newborn screening test for congenital hypothyroidism consists of:

The most satisfactory stimulus to the production of human milk is:

What is the depression inside the pinna that leads to the external auditory meatus?

The following are the nerve supply of the Middle Ear, EXCEPT:

How does one straighten the external ear canal during physical examination in an adult patient?

Which of the following structures are properly paired with their source of sensory innervation?

In patients with velopharyngeal insufficiency what kind of voice if produced?

Damage to the external laryngeal nerve during thyroid surgery would cause inability to:

A patient is asked to smile and the right corner of the patient’s mouth does not move upward. There would be injury to what nerve?

Which of the following is not included in the Waldeyer’s Ring?

Which of the following statement/s is/ are TRUE regarding the physical examination of the Oral Cavity

What divides the oropharynx and the hypopharynx?

In order of most radiolucent to most radiopaque, which is correct?

Which is true?

On frontal view chest x-ray, which cardiac chamber corresponds with the right cardiac border?

Which is true with regards to normal anatomy of the diaphragm?

The following are retroperitoneal organs/structures, EXCEPT

Assessment of the major abdominal organs is made easier by the rim of ___ surrounding them.

Which of the following is suggestive of splenomegaly?

The “crescent sign”, or an area of lucency beneath the diaphragm on upright chest x-ray is a sign of:

65/M, with known history of CKD.

35/M, case of gunshot wound, with difficulty of breathing, and on PE, (+) distended neck veins.

The alteration in sensorium in most instances of metabolic encephalopathies is based on the following principle:

In Cranial CT scans, ischemic infarcts appear as:

A 21-year-old Nursing student was brought into your clinic for a 3-day history of fever, progressive headache and vomiting. In the past 24 hours, there has been note of deteriorating sensorium and seizures. You decide to do a lumbar puncture. What is the classic CSF picture you expect to obtain in this patient?

A 78-year-old lady consulted your clinic because of dizziness, which she described as spinning of the environment. While examining the patient, she tells you that she has recently observed decreased hearing on both ears and a vague feeling of fullness of the ears. What is the most likely diagnosis in this patient?

A 19-year-old engineering student complained of severe headache. Pertinent neuro exam showed right-left disorientation, acalculia and agraphia. The blood supply to the involved area is the:

A 50-year-old male gym instructor suddenly developed severe headache followed by vomiting after lifting weights. Pertinent neurologic examination showed a 5 mm fixed pupil on the right, medial rectus paralysis on the right, ptosis on the right and left hemiplegia at 1/5, and nuchal rigidity. You localize the lesion to be in:

A 45-year-old female came in because of easy fatigability noted after heavy exertion and usually in the afternoon. At times, her husband notices that by late afternoon, she already has a nasal quality to her voice. What is the main pathologic feature of this disease?

A 50 year old patient came in due to acute onset of right sided headache. The location of the headache is on the temporal area. There is tenderness over the right superficial temporal artery. The most likely diagnosis will be:

A 50-year old left handed male came in due to gradually progressive headache described as dull, worse in the morning with associated nausea and vomiting. He has been having the pain for the past 6 months. Neurologic examination also showed papilledema. What is the most likely diagnosis?

The presence of clonus automatically grades the ankle jerk as: