September 2016 PLE

Biochemistry

MSUD (amino acids deficient) - Leucine, Isoleucine, Valine - asked twice

Which is an essential amino acid PVT TIM HALL, Always Arg, Never Tyrs
Many questions on the Urea Cycle
Not much on the Nucleic Acids, but they asked about the mechanisms of actions of Tetracycline
(aminoacyl-tRNA), and Erythromycin (bind to 50S, inhibits translocation)
Actions of Insulin
Feed and Fast State
Vitamins as cofactors in different metabolic pathways (B1, B6)
Not really a Vitamin - B3 (Niacin)
Bond between glucose and galactose - glycosidic bond
Requires oxygen - oxidative phosphorylation
Location of glycolysis - cytoplasm
Precursor of prostaglandins - arachidonic acid
Precursor of Arachidonic acid - linoleic acid
3 Ketone bodies - Acetone, Acetoacetate, B-hydroxybutyrate
Primary bile acids - Cholic, chenodeoxycholic
Precursor of Nitric Oxide - Arginine
Hemoglobin VS Myoglobin
HBA1c - used to check level of glucose control
Vit B1 - co-factor in Transketolase reactions
Biotin - Carboxylase reactions
Diarrhea, demetia, dermatitis - deficiency of B3 (Niacin)
Mental retardation - Phenylketonuria if not treated will lead to
Gaucher disease - accumulation of glucosylceramide

Anatomy and Histology

Many questions on the Male reproductive system (homologues, function of seminiferous tubules,
etc.)
Many questions on the Kidneys and renal transplant (comparisons of the L and R kidneys, L and R
renal vein, drainage, blood supply)
Klumpke’s - C8 - T1
Contents of carpal tunnel - except Radial nerve
Rotator cuff muscles - SITS - except Teres Major
Common peroneal nerve - foot drop
Radial nerve (Saturday night palsy) - wrist drop
Skull fracture at the pterion - Middle meningeal artery - epidural bleed, with lucid interval
Makes up the Circle of Willis - Internal Carotid and Vertebral arteries
Histo questions were easy (special function of epithelium-absorption, lining of respiratory tract,
Hassl’s corpuscles - Thymus)
Chronic smoking - transforms to Stratified Squamous epithelium
Lymphoid tissue in the intestines - Peyer’s patches
Many questions on PTH, Calcitonin, Vit D., Parafollicular cells secrete Calcitonin, Chief cells
secrete PTH
Capillaries of skeletal muscles - continuous
Occipital lobe - visual cortex
Broca’s area - frontal lobe
Wernicke’s area - temporal lobe
Location of substantia nigra - Midbrain (Mesencephalon) (but choices were Telencephalon,
diencephalon, mesencephalon, myelencephalon)
IgG - crosses the placenta asked 2x
SA Node - pacemaker of the heart
Interatrial septum - location of AV node
Right coronary artery - SA and AV Node are supplied by
Testicular artery - found inside the spermatic cord
Appendicular artery - branch of Ileocolic
Which is a retroperitoneal organ (PUKIDADA) - Descending colon
Boundaries of the Triangle of Calot - Liver, cystic duct, common hepatic duct
Pylorus - gastric CA most commonly found in the
Most anterior - Renal vein (VAP- Vein, artery, pelvis)
Ureteric Constrictions - renal pelvis joins ureter, crosses the pelvic brim and external iliac artery,
enters the bladder wall
Male VS Female Pelvis
Common structure in the Greater and lesser sciatic foramen - Pudendal nerve (Also nerve to
obturator internus, internal pudendal vessels)
Hypospadia - failure of urethral folds to fuse
Innervation of little toe - S1
Innervation of big toe - L5
Patellar tendon reflex - L4

Microbiology and Parasitology

A lot of Derma cases (skin lesions of syphilis, Herpes, Varicella, tinea pedis, tinea corporis)
Primary stain in Gram staining - Crystal Violet
Facultative anaerobe - Corynebacterium
Grows on charcoal yeast extract - Legionella
Staph epidermidis - produces biofilms for attachment to prosthetic implants
Anchovy paste-like aspirate - found in Amebic liver abscess, caused by Entamoeba histolytica
Cause of Chagas’ disease - Trypanosoma cruzi
Treatment of neurocysticercosis - Albendazole
Farmer in Samar developed itching and dermatitis after wading in the fields - Schistosoma
japonicum (swimmer’s itch)
New World hookworm - Necator americanus Old World - Ancylostoma duodenale
Family of HIV - Lentivirus
Morphology of Male VS Female adult Ascaris worms
Description of an adult Trichuris
IgG - crosses the placenta again

Physiology

For communicaton in cardiac muscles - Gap junctions

A case of Charcot-Marie-Tooth - deficiency in Connexin 32 - disease of Gap junction
Visual lobe - occipital
11-cis retinal converted by light photons to 11-trans
Movement of the eyes of a ballerina after spinning - nystagmus (from BRS)
A dog conditioned to see Green with the right eye. Optic chiasm transected, what is the expected
result something (from Ganong)
Neurotransmitter for umami - Glutamate
Patient had a parotid surgery after which was unable to taste a candy, what cranial nerve was
injured (also from BRS)
IgG - crosses the placenta, secondary response
IgA - found in body secretions
S2 is heard during - isovolumic relaxation
Incisura is found during - isovolumic relaxation
Dicrotic notch (incisura) is due to closure of - aortic valve
Mitral valve mumur best heard - 5th ICS L MCL
Fatty acids - main energy source of the heart
Lung volumes and capacities - memorize
Chloride shift - buffer in the RBCs
A case of carbon monoxide poisoning
Secretes HCl - Parietal cell/Oxyntic cell
Trypsin - enzyme capable of activating most enzymes in the GI tract
Hormone for milk production - Prolactin
Cortisol - Increases gluconeogenesis, insulin sensitivity, lipolysis
Beta cells - most numerous in the pancreas, secretes Insulin
Final activation of Vitamin D in what organ - Kidney

Legal Medicine and Jurisprudence

Police power of the state - regulate the practice of medicine

Factors influencing the amount of medical fees
IQ of 30 and below - Profound MR asked twice
Physician’s fees (Retainer, Simple contractual fee, etc.)
Rights of Patients - memorize
Corporate liabilities
Medical records - belongs to the hospital
Ordinary vs expert witness
Reciprocity - foreign doctors can practice provided Fiipino doctors can also practice in their country
Subjects in the Pre lim exam - Ana, Physio, Biochem, Micro
Rights of Physicians (Differentiate Inherent form Incidental) - memorize
Different types of children (legitimate, natural, incestuous, sacrilegious, manceres)
Types of prostitutes
Cases on Qualified seduction, rape, acts of lasciviousness
Legal medicine - branch of medicine, medicine applied to law and justice
Autoptic evidence - perceived by senses
Sodium pentothal - used in narcoanalysis; inadmissible in court
Compound laceration - includes the cervix and anal canal
Definition of Concubinage VS Adultery
Transvestism - male individual derives pleasure from wearing female clothes
Dactylography - art and study of fingerprints
Post-morten caloricity - rise in temperature of the body after death
Icard’s test - injection of a solution of flourescein subcutaneously
Antemortem clot VS postmortem clot
Bright pink appearance - carbon monoxide poisoning
Post-mortem lividity/cadaveric lividity/postmortem suggilation/Postmortem hypostasis/Livor mortis -
blood accumulates in the most dependent portions of the body
Doctor overdosed patient with KCl without patient’s consent, what crime committed? Murder.
Epidural VS Subdural bleed
Entrance VS Exit wounds - memorize
Stagnant Anoxic death - brought about by failure of circulation
Marijuana - classified as Psychomimetic drug/Hallucinogen

Pathology

Autophagy - sequestration of cellular organelles into cytoplasmic autophagic vacuoles that fuse
with lysosomes and digest the enclosed materials
Histamine - produced by Mast Cells, for vasodilation, increased vascular permeability
Mechanism for edema in acute inflammation - increases inter-endothelial spaces
IgG - crosses the placenta, again.
Hodgkin’s lymphoma - Reed-Sternberg cells
Morphology of Bronchial Asthma, Bronchiectasis, Emphysema
Kernigs and Brudzinsky - due to irritation of the meninges
Gottron’s papules - Dark, red, scaly patches over the knuckles, elbows, and knees seen in
dermatomyositis
Mousy odor, MR, blue eyes - Phenylketonuria
Cholesterolosis - strawberry gallbladder, accumulation of cholesterol, asked twice
Heinz bodies - membrane-bound precipitates of denatured globin chains (diffentiate from Howell
Jolly bodies - dark NUCLEAR remnants in RBCs of asplenic patients)
A case of TB meningitis - Cranial nerve deficits, LP with very high protein, CT scan with
hydrocephalus, basal enhancement
TB and Schistosomiasis are similar because - Cause granulomatous inflammation
Gaucher disease - lack glucocerebrosidase, crumpled tissue paper appearance
Post-Strep GN - Type 3 Hypersensitivity
Goodpasture syndrome - Type 2 Hypersensitivity
Proto-oncogenes - NORMAL cellular genes promote cell proliferation
Oncogenes - MUTATED or overexpressed versions of proto-oncogenes, autonomous
Anaplasia - hallmark of malignant transformation
Schistosoma haematobium can cause - bladder CA
RDS of the newborn - retrolental fibroplasia, bronchopulmonary dysplasia, deficiency of pulmonary
surfactant
Anitschow/Caterpillar cells - macrophages/histiocytes containing abundant cytoplasm, wavy ribbon
of chromatin in RHEUMATIC FEVER
MacCallum plaques - irregular thickenings of subendocardium in RHEUMATIC HEART DISEASE
Hirschprung disease - absence of ganglion cells in the submucosal and myenteric plexuses and
hypertrophic extrinsic nerve fibers, abnormal segment is DILATED
Family with deaths due to a “pulmonary cause” most likely has - Alpha-1 antitrypsin deficiency
Anorexia nervosa - has manifestations of LOW THYROID Hormone levels
Multiple Myeloma - presents with lytic bone lesions, fractures, hypercalcemia, and renal failure
Bence-Jones proteins - excess light or heavy chains along with complete Igs synthesized by
neoplastic plasma cells in Multiple myeloma
Teratomas - complex tumors containing hair, tooth, etc.
Complete VS Partial Mole
Fibrocystic change - blue-dome cyst lined by milk of calcium calcifications
Fibroadenoma - most common breast mass in younger than 35 years old
Cushing syndrome - hypercortisolism due to exogenous steroids
Diabetes insipidus—Central VS nephrogenic
Graves’ disease - hyperthyroidism, ophthalmopathy, dermopathy
A stroke may lead to - liquefactive necrosis
Negri bodies - cytoplasmic, round to oval, eosinophilic inclusions seen in rabies
Basal cell CA - rodent ulcer, frequent exposure to sunlight
An elderly with severe osteoarthritis - look for history of TB
Situational case of Breast Cancer
Situational case of VSD (most common is membranous, treatment, prognosis)

Pharmacology and Therapeutics

Cases with Cytochrome P450 inducers (Rifampicin, Carbamazepine, Barbiturates)

Cases with Cytochrome p450 inhibitors (INH, grapefruit juice)
Side effects of anti-cancer drugs (Vincristine, bleomycin, cyclophosphamide)
Topical - does not undergo first pass effect
Pilocarpine - treatment for glaucoma
Terbutaline - for a pregnant patient with asthma and on preterm labor
Clonidine - sudden withdrawal of the drug can cause hypertensive emergency
Hydralazine - may be used in a pregnant woman
Vit K - antidote to warfarin toxicity
Abciximab - glycoprotein IIb-IIIa inhibitor, prevents platelet aggregation
Ezetimibe - cholesterol absorption blocker, lowers LDL
Niacin - Increases HDL
Ondansetron - treatment of post-op and post-chemo vomiting
Glucocorticoids - for asthma maintenance
Theophylline - for asthma that does not respond to SABAs
Aminoglycosides - bactericidal
Chloramphenicol - causes gray baby syndrome
Ethambutol - test visual acuity
Mefloquine - malaria chemoprophylaxis for pregnant patients
Diloxanide furoate - for asymptomatic cyst carriers of Entamoeba histolytica
Metronidazole - for amebic dysentery
Phenobarbital - side effect is personality/neuro changes (porphyria)
Fluoxetine - drug for medical student who develeped depression after failing a test
Fluoxetine - binds to serotonin receptor
An epileptic woman maintained on Valproate wants to get pregnant - shift to Lamotrigine
Methylnaltrexone - treatment for constipation for a patient maintained in opiod
PTU - drug of choice for pregnant hyperthyroid patients
SSKI - reduces size and vascularity of thyroid gland
Progestin only pills - OCP of choice for lactating women
Tamoxifen - for hormone sensitive breast CA
Clomiphene - For ovulation induction
2nd Gen sulfonylurea - Gliclazide
Metformin - for obese diabetics, side effect is lactic acidosis in CKD patients
Glargine - ultra long acting insulin, basal insulin
Alendronate - side effect is esophagitis
Cimetidine - suppresses nocturnal acid secretion, H2 blocker
PPI - DOC for peptic ulcer disease
Peripheral neuropathy - side effect of Vincristine
Halothane + Succinylcholine - can cause malignant hyperthermia
Dantrolene - treatment for malignant hyperthemia
Lithium - excreted in the body unchanged

Surgery and EENT

Blood transfusion indications

Tamoxifen - ER/PR+ Breast Ca
Trastuzumab Her2/Neu
Worst prognosis - Triple negative breast CA
Cases on Thyroid Papillary, medullary, and Follicular CA
Cases on GCS Scoring - memorize
Epidural vs Subdural bleed
Hidradenitis suppurativa - apocrine gland blockage, infection and abscess formation
Bowen disease - in situ squamous cell carcinoma
Mucinous (Colloid) breast CA - 2% of all invasive breast CA, extracellular pools of mucin
Mammographic features of breast cancer: solid mass with or without stellate features, asymmetric
thickening of tissues, clustered microcalcifications
Modified radical neck dissection - preserves spinal accessory nerve, IJV, SCM, except CAROTID
ARTERY (not involved)
Lugol’s iodine - decreases vascularity of thyroid and lessens risk of thyroid storm
Psammoma bodies - Papillary thyroid CA
A lot of questions on GERD (diagnosis, treatment)
Esophageal SCC - most common type worldwide, most common in middle 3rd of the thoracic
esophagus
Duodenal ulcer - secondary to acid output, awakens the patient at night
Bleeding - most common complication of PUD
Perforation - Presents as acute abdomen
Type 3 gastric ulcer - pre-pyloric ulcer (near the pylorus)
Esophageal varices - manifestation of portal hypertension
Hepatic adenoma - benign solid neoplasm among young females on OCPs
Cholangitis - ascending bacterial infection due to blockage of the bile duct, usually due to GRAM
NEGATIVE AEROBES
Fecalith - most common cause of obstruction in acute appendicitis
Ulcerative colitis VS Chron’s disease
A case of retinal detachment in a diabetic elderly with sudden loss of vision

Internal Medicine

Purely stem cases and mostly Derma Cases

Psoriasis - treatment modalities
Atopic dermatitis
A CKD patient but they asked about the skin lesions on the head (Folliculitis) Haha
Tuberculoid VS Borderline VS Lepromatous Leprosy - Treatment, classification, skin biopsy result
A case of a model with molluscum contagiosum on the thigh- transmission, causative agent
A case of genital herpes - transmission, causative agent, treatment
Another case on breast CA - most important risk factor (Estrogen exposure), when to give
Tamoxifen, Trastuzumab, most common location of a breast mass - Upper outer quadrant
A bipolar patient overdosed with Lithium - treatment emergency hemodialysis, activated charcoal
lavage

OB-GYN

Histology on Day 17 of the menstrual cycle - Straight tubular glands

Last to disappear in the biophysical profile - fetal tone
Latent phase - begins during the onset of regular uterine contractions with progressive cervical
dilatation
Dilatational division ends at Full cervical DILATATION
Outlet forceps - Stn +4
Septic - type of abortion in a woman with IUD
Atony - indication for CS Hysterectomy
Chronic hypertension - BP of 150/90 at 18 weeks AOG
Seizures - eclampsia (many cases on pre-eclampsia and eclampsia)
Painless vaginal bleeding - placenta previa (differentiate with Abruptio placenta)
Trauma - most common cause of abruptio placenta
Bacterial vaginosis - Grayish-white, amine-like odor, with clue cells
Genital warts - indication for CS to prevent transmission of infection to baby
Androgen insensitivity - 46XY, Testosterone level of a normal male
A 15 yr old girl with amenorrhea but with breast enlargement, and pubic hair - May be a variant of
normal (cut - off is 16 yrs)
Endometriosis - fixed, tender uterus with scarring and tenderness posterior to the uterus
Pathognomonic sign of menopause - hot flushes
Initial endocrinologic change in menopause - Increased FSH
Most common cause of central precocious puberty - Idiopathic
CAH, late onset - Gradual-onset hirsutism, normal PE, increased 17-OH progesterone
Diagnosis of cervical CA - mainly clinical
Suggests a benign ovarian cyst - mobility (Malignant - solid, bilateral, multilocular)
“Tobacco pouch” fallopian tube - TB
Significance of delayed cord clamping - prevents anemia of the baby

Pediatrics and Nutrition

Cephalhematoma - does not cross the suture lines

Meconium aspiration syndrome - Coarse streaking granular pattern of both lung fields
A case on esophageal atresia (excessive salivation of the newborn, inability to pass an NGT/OGT,
significant maternal history - polyhydramnios, most common type - EA with distal TEF Type C)
Physiolgic jaundice - visible on the 2-3 day
Most common cause of jaundice in newborns - Physiologic
Toxoplasmosis - IUGR baby with hepatosplenomegaly, microcephaly, and INTRACEREBRAL
calcifications
Zinc - a deficiency of this trace element is associated with skin ulcers, reduced immune response
and hypogonadal dwarfism
Rabies Post exposure prophylaxis - Categories I, II, III
A case of severe dehydration, what to do first? Hydrate by bolus IV fluid
Why is there bleeding in diarrhea caused by Shigella - invasion of the intestinal epithelium
Most common cause of Nephrotic syndrome - Idiopathic
Nephrotic range proteinuria in children - 40mg/m2/hr
A case of neuroblastoma (crosses the midline) VS Wilm’s tumor/Nephroblastoma (does not cross)
A case of TB meningitis - significantly increased CSF protein, CT scan with basal enhancement
A case of meningococcemia - Treatment - Penicillin, Prophylaxis to contacts - Rifampicin
A case of epiglotittis (Child with cough, drooling, and the neck is slightly held hyperextended) Initial
management - secure airway with intubation, diagnostic procedure to request - Xray, soft-tissue
lateral (thumb print sign/leaf sign)
A case of bronchial asthma (drug of choice for an acute attack - inhaled salbutamol)
A child presents with a barking cough - Croup, treatment - racemic epinephrine
A child with fever for a week, developed rash, conjunctivitis, strawberry tongue, and
lymphadenopathy - Kawasaki Disease, this affects what arteries? Medium-sized arteries,
Treatment for subacute phase? Aspirin.
A child with muscle weakness was noted to have a periorbital violaceous erythema that may cross
over the bridge of the nose - Juvenile Dermatomyositis
Pathophysiology of tet spells in TOF? Decreased pulmonary blood flow
Initial management for a child having a tet spell? Place in knee-chest position
Closure of PDA - due to high O2
Transition of the cardiorespiratory system at birth - Increased Systemic vascular resistance
Differentiate Measles VS Rubella VS Roseola in terms of patterns of fever and rash
First sign of puberty in girls - thelarche
First sign of puberty in both girls and boys - adrenarche
Deficiency of adenoside deaminase - Severe Combined Immunodeficiency

Preventive Medicine and Public Health

Most difficult exam, in all levels!

2015 Theme of the WHO on Antibiotic Resistance: Antibiotics: Handle with care
CDC guideline for traveller’s diarrhea
Definition of Epidemiology
Levels of prevention (Primary, Secondary, Tertiary, Primordial)
Area under the normal curve (68-95-99.7%)
Epidemiological studies (Case report, case series, cross-sectional, case-control, cohort, Clinical
trials)
Computation on Number Needed to Treat, Number Needed to Harm
Identify the Impairment VS Disability VS Handicap
Earliest age when measles can be given - 6 months
Prevalence VS Incidence