HERO LICENSURE EXAM
100 High-Yield Clinical Pearls | Post-Clerkship Edition | PLUS
ULTRA!
Class 1-A: SURGERY
Q1
A 32-year-old male from Manila is rushed to the ER after a motorcycle crash.
He is hypotensive (80/50), with distended neck veins and muffled heart
sounds. Lungs are clear. What is the most appropriate immediate step?
A. Tube thoracostomy
B. Pericardiocentesis
C. Emergency thoracotomy
D. Massive transfuion
Q2
A 25-year-old male presents with sudden shortness of breath after a stab
wound to the right chest. He has absent breath sounds on the right,
hyperresonance, and tracheal deviation to the left. What is the immediate
treatment?
A. Chest tube at 5th ICS
, B. Needle decompression at 2nd ICS MCL
C. Intubation
D. Pericardiocentesis
Q3
A 45-year-old female presents with a painless, hard mass in the right breast.
Core needle biopsy shows infiltrating ductal carcinoma. The skin overlying
the breast resembles an orange peel (peau d'orange). What causes this skin
change?
A. Dermal lymphatic invasion
B. Suspensory ligament shortening
C. Direct skin infiltration
D. Infection
Q4
A 60-year-old male alcoholic presents with a severe head injury. He
gradually becomes comatose over 3 weeks. CT scan shows a crescent-
shaped hyperdensity crossing suture lines. What vessel is injured?
A. Middle meningeal artery
B. Bridging veins
C. Berry aneurysm
D. Anterior cerebral artery
,Q5
A 22-year-old male is hit by a baseball bat on the temple. He loses
consciousness, wakes up and seems fine, but 2 hours later becomes
comatose. CT shows a lens-shaped bleed. What is the diagnosis?
A. Epidural hematoma
B. Subarachnoid hemorrhage
C. Subdural hematoma
D. Diffuse axonal injury
Q6
A 28-year-old pregnant woman at 24 weeks AOG presents with right lower
quadrant pain, nausea, and leukocytosis. Ultrasound shows a dilated, non-
compressible tubular structure. What is the most likely diagnosis?
A. Ectopic pregnancy
B. Ovarian torsion
C. Acute appendicitis
D. Pyelonephritis
Q7
A 70-year-old male presents with painless jaundice, weight loss, and a
palpable, non-tender gallbladder. What is the most likely diagnosis?
A. Choledocholithiasis
B. Pancreatic head cancer
, C. Acute cholecystitis
D. Gallstone ileus
Q8
A 55-year-old male complains of severe epigastric pain radiating to the back
after a heavy alcohol binge. Serum amylase and lipase are elevated 4x
normal. Which of the following is NOT part of Ranson's criteria at
admission?
A. Age > 55
B. WBC > 16,000
C. Blood glucose > 200
D. Serum calcium < 8
Q9
A 65-year-old male with chronic constipation presents with massive
abdominal distention. X-ray shows a 'coffee bean' sign arising from the
pelvis. What is the initial treatment?
A. Emergency laparotomy
B. Rigid sigmoidoscopy and detorsion
C. Barium enema
D. IV Neostigmine
100 High-Yield Clinical Pearls | Post-Clerkship Edition | PLUS
ULTRA!
Class 1-A: SURGERY
Q1
A 32-year-old male from Manila is rushed to the ER after a motorcycle crash.
He is hypotensive (80/50), with distended neck veins and muffled heart
sounds. Lungs are clear. What is the most appropriate immediate step?
A. Tube thoracostomy
B. Pericardiocentesis
C. Emergency thoracotomy
D. Massive transfuion
Q2
A 25-year-old male presents with sudden shortness of breath after a stab
wound to the right chest. He has absent breath sounds on the right,
hyperresonance, and tracheal deviation to the left. What is the immediate
treatment?
A. Chest tube at 5th ICS
, B. Needle decompression at 2nd ICS MCL
C. Intubation
D. Pericardiocentesis
Q3
A 45-year-old female presents with a painless, hard mass in the right breast.
Core needle biopsy shows infiltrating ductal carcinoma. The skin overlying
the breast resembles an orange peel (peau d'orange). What causes this skin
change?
A. Dermal lymphatic invasion
B. Suspensory ligament shortening
C. Direct skin infiltration
D. Infection
Q4
A 60-year-old male alcoholic presents with a severe head injury. He
gradually becomes comatose over 3 weeks. CT scan shows a crescent-
shaped hyperdensity crossing suture lines. What vessel is injured?
A. Middle meningeal artery
B. Bridging veins
C. Berry aneurysm
D. Anterior cerebral artery
,Q5
A 22-year-old male is hit by a baseball bat on the temple. He loses
consciousness, wakes up and seems fine, but 2 hours later becomes
comatose. CT shows a lens-shaped bleed. What is the diagnosis?
A. Epidural hematoma
B. Subarachnoid hemorrhage
C. Subdural hematoma
D. Diffuse axonal injury
Q6
A 28-year-old pregnant woman at 24 weeks AOG presents with right lower
quadrant pain, nausea, and leukocytosis. Ultrasound shows a dilated, non-
compressible tubular structure. What is the most likely diagnosis?
A. Ectopic pregnancy
B. Ovarian torsion
C. Acute appendicitis
D. Pyelonephritis
Q7
A 70-year-old male presents with painless jaundice, weight loss, and a
palpable, non-tender gallbladder. What is the most likely diagnosis?
A. Choledocholithiasis
B. Pancreatic head cancer
, C. Acute cholecystitis
D. Gallstone ileus
Q8
A 55-year-old male complains of severe epigastric pain radiating to the back
after a heavy alcohol binge. Serum amylase and lipase are elevated 4x
normal. Which of the following is NOT part of Ranson's criteria at
admission?
A. Age > 55
B. WBC > 16,000
C. Blood glucose > 200
D. Serum calcium < 8
Q9
A 65-year-old male with chronic constipation presents with massive
abdominal distention. X-ray shows a 'coffee bean' sign arising from the
pelvis. What is the initial treatment?
A. Emergency laparotomy
B. Rigid sigmoidoscopy and detorsion
C. Barium enema
D. IV Neostigmine
