CLINICAL PEARLS EXAM
SET II
100-Item Post-Clerkship Review (Philippine-Based)
Examination Blueprint (Alternative Set):
• Surgery (20 Items)
• Obstetrics & Gynecology (20 Items)
• Internal Medicine (20 Items)
• Pediatrics (20 Items)
• Specialties: ENT, Ophtha, Anesthesia, Rehab, Ortho (20
Items)
This document contains an entirely new set of 100
questions. It integrates local DOH/clinical practice
guidelines, endemic diseases (Dengue, Typhoid, Malaria,
Leptospirosis, Schistosomiasis, TB, Rabies), and the
highest-yield pearls tested in Philippine board exams.
Philippine Clinical Pearls Exam | Set 2 Page 1 of 35
, PART I: EXAMINATION QUESTIONS
Surgery
1. A 55-year-old female presents with a self-palpated breast mass. According to local and
international guidelines, at what age is baseline screening mammography typically
recommended for women of average risk?
A. 30 years old
B. 40 years old
C. 50 years old
D. 60 years old
2. A 35-year-old female with Graves' disease undergoes a total thyroidectomy. Intraoperatively,
she develops a high fever (40°C), tachycardia (150 bpm), and severe agitation. What is the most
appropriate initial management for this thyroid storm?
A. Administer Levothyroxine
B. Administer Propylthiouracil (PTU), Beta-blockers, and Lugol's iodine
C. Administer Calcium gluconate
D. Perform an emergency tracheostomy
3. A 65-year-old female presents with a 3-day history of right upper quadrant pain, fever, and
jaundice. Her blood pressure suddenly drops to 85/50 mmHg, and she becomes confused. What
is the diagnosis?
A. Acute cholecystitis
B. Choledocholithiasis
C. Reynolds' pentad (Acute suppurative cholangitis)
D. Mirizzi syndrome
4. A 60-year-old chronic Hepatitis B carrier from the Philippines presents with weight loss and a
right upper quadrant mass. Which serum tumor marker is most helpful in screening for
Hepatocellular Carcinoma (HCC)?
A. Carcinoembryonic antigen (CEA)
B. CA 19-9
C. CA 125
D. Alpha-fetoprotein (AFP)
Philippine Clinical Pearls Exam | Set 2 Page 2 of 35
,5. A 24-year-old male is brought to the ER after a motorcycle accident. He sustained blunt
trauma to the abdomen. He is hemodynamically unstable. What is the most commonly injured
intra-abdominal organ in blunt trauma?
A. Liver
B. Spleen
C. Small intestines
D. Kidneys
6. A 30-year-old male sustains a stab wound to the periumbilical area. He is tachycardic and has
generalized abdominal tenderness. What is the most commonly injured organ in penetrating
abdominal trauma (stab wounds)?
A. Spleen
B. Liver
C. Small bowel
D. Colon
7. A patient is evaluated using the Glasgow Coma Scale (GCS). He opens his eyes to pain, utters
inappropriate words, and withdraws his arm from a painful stimulus. What is his GCS score?
A. E2 V3 M4 = 9
B. E2 V4 M5 = 11
C. E3 V3 M4 = 10
D. E2 V2 M4 = 8
8. A 45-year-old male presents to the ER after a severe assault. He has ecchymosis behind his ear
(Battle sign), periorbital ecchymosis (Raccoon eyes), and clear fluid leaking from his nose. What
is the most likely diagnosis?
A. Le Fort III fracture
B. Basilar skull fracture
C. Orbital floor blowout fracture
D. Epidural hematoma
9. A 22-year-old female presents with a firm, painless, rubbery, freely mobile 2-cm mass in her
right breast. What is the most common benign breast tumor in this age group?
A. Intraductal papilloma
B. Phyllodes tumor
C. Fibroadenoma
D. Fibrocystic change
Philippine Clinical Pearls Exam | Set 2 Page 3 of 35
, 10. An 8-month-old infant presents with 'currant jelly' stools and episodic colicky abdominal
pain. On physical examination, there is a palpable sausage-shaped mass in the right upper
quadrant and an empty right lower quadrant. What is the name of this empty RLQ sign?
A. Dance sign
B. Rovsing sign
C. Kehr sign
D. Psoas sign
11. A 4-week-old male infant presents with non-bilious projectile vomiting. Laboratory tests
reveal a specific metabolic derangement. What is the classic acid-base imbalance in
hypertrophic pyloric stenosis?
A. Hyperkalemic hyperchloremic metabolic acidosis
B. Hypokalemic hypochloremic metabolic alkalosis
C. Normal anion gap metabolic acidosis
D. Uncompensated respiratory alkalosis
12. During a hernia surgery on a 5-year-old boy, the surgeon notes that the hernia sac passes
through the deep inguinal ring and travels alongside the spermatic cord. This hernia is due to
the failure of obliteration of which structure?
A. Umbilical vein
B. Urachus
C. Processus vaginalis
D. Vitelline duct
13. A surgical wound is healing by secondary intention. During which phase of wound healing
does the formation of granulation tissue, angiogenesis, and wound contraction primarily
occur?
A. Hemostasis phase
B. Inflammatory phase
C. Proliferative phase
D. Remodeling/Maturation phase
14. A patient spills boiling water on her arm. The burn is extremely painful, erythematous,
blanches with pressure, and has formed several large, weeping blisters. How is this burn
classified?
A. Superficial (First-degree) burn
B. Superficial partial-thickness (Second-degree) burn
C. Full-thickness (Third-degree) burn
D. Fourth-degree burn
Philippine Clinical Pearls Exam | Set 2 Page 4 of 35
SET II
100-Item Post-Clerkship Review (Philippine-Based)
Examination Blueprint (Alternative Set):
• Surgery (20 Items)
• Obstetrics & Gynecology (20 Items)
• Internal Medicine (20 Items)
• Pediatrics (20 Items)
• Specialties: ENT, Ophtha, Anesthesia, Rehab, Ortho (20
Items)
This document contains an entirely new set of 100
questions. It integrates local DOH/clinical practice
guidelines, endemic diseases (Dengue, Typhoid, Malaria,
Leptospirosis, Schistosomiasis, TB, Rabies), and the
highest-yield pearls tested in Philippine board exams.
Philippine Clinical Pearls Exam | Set 2 Page 1 of 35
, PART I: EXAMINATION QUESTIONS
Surgery
1. A 55-year-old female presents with a self-palpated breast mass. According to local and
international guidelines, at what age is baseline screening mammography typically
recommended for women of average risk?
A. 30 years old
B. 40 years old
C. 50 years old
D. 60 years old
2. A 35-year-old female with Graves' disease undergoes a total thyroidectomy. Intraoperatively,
she develops a high fever (40°C), tachycardia (150 bpm), and severe agitation. What is the most
appropriate initial management for this thyroid storm?
A. Administer Levothyroxine
B. Administer Propylthiouracil (PTU), Beta-blockers, and Lugol's iodine
C. Administer Calcium gluconate
D. Perform an emergency tracheostomy
3. A 65-year-old female presents with a 3-day history of right upper quadrant pain, fever, and
jaundice. Her blood pressure suddenly drops to 85/50 mmHg, and she becomes confused. What
is the diagnosis?
A. Acute cholecystitis
B. Choledocholithiasis
C. Reynolds' pentad (Acute suppurative cholangitis)
D. Mirizzi syndrome
4. A 60-year-old chronic Hepatitis B carrier from the Philippines presents with weight loss and a
right upper quadrant mass. Which serum tumor marker is most helpful in screening for
Hepatocellular Carcinoma (HCC)?
A. Carcinoembryonic antigen (CEA)
B. CA 19-9
C. CA 125
D. Alpha-fetoprotein (AFP)
Philippine Clinical Pearls Exam | Set 2 Page 2 of 35
,5. A 24-year-old male is brought to the ER after a motorcycle accident. He sustained blunt
trauma to the abdomen. He is hemodynamically unstable. What is the most commonly injured
intra-abdominal organ in blunt trauma?
A. Liver
B. Spleen
C. Small intestines
D. Kidneys
6. A 30-year-old male sustains a stab wound to the periumbilical area. He is tachycardic and has
generalized abdominal tenderness. What is the most commonly injured organ in penetrating
abdominal trauma (stab wounds)?
A. Spleen
B. Liver
C. Small bowel
D. Colon
7. A patient is evaluated using the Glasgow Coma Scale (GCS). He opens his eyes to pain, utters
inappropriate words, and withdraws his arm from a painful stimulus. What is his GCS score?
A. E2 V3 M4 = 9
B. E2 V4 M5 = 11
C. E3 V3 M4 = 10
D. E2 V2 M4 = 8
8. A 45-year-old male presents to the ER after a severe assault. He has ecchymosis behind his ear
(Battle sign), periorbital ecchymosis (Raccoon eyes), and clear fluid leaking from his nose. What
is the most likely diagnosis?
A. Le Fort III fracture
B. Basilar skull fracture
C. Orbital floor blowout fracture
D. Epidural hematoma
9. A 22-year-old female presents with a firm, painless, rubbery, freely mobile 2-cm mass in her
right breast. What is the most common benign breast tumor in this age group?
A. Intraductal papilloma
B. Phyllodes tumor
C. Fibroadenoma
D. Fibrocystic change
Philippine Clinical Pearls Exam | Set 2 Page 3 of 35
, 10. An 8-month-old infant presents with 'currant jelly' stools and episodic colicky abdominal
pain. On physical examination, there is a palpable sausage-shaped mass in the right upper
quadrant and an empty right lower quadrant. What is the name of this empty RLQ sign?
A. Dance sign
B. Rovsing sign
C. Kehr sign
D. Psoas sign
11. A 4-week-old male infant presents with non-bilious projectile vomiting. Laboratory tests
reveal a specific metabolic derangement. What is the classic acid-base imbalance in
hypertrophic pyloric stenosis?
A. Hyperkalemic hyperchloremic metabolic acidosis
B. Hypokalemic hypochloremic metabolic alkalosis
C. Normal anion gap metabolic acidosis
D. Uncompensated respiratory alkalosis
12. During a hernia surgery on a 5-year-old boy, the surgeon notes that the hernia sac passes
through the deep inguinal ring and travels alongside the spermatic cord. This hernia is due to
the failure of obliteration of which structure?
A. Umbilical vein
B. Urachus
C. Processus vaginalis
D. Vitelline duct
13. A surgical wound is healing by secondary intention. During which phase of wound healing
does the formation of granulation tissue, angiogenesis, and wound contraction primarily
occur?
A. Hemostasis phase
B. Inflammatory phase
C. Proliferative phase
D. Remodeling/Maturation phase
14. A patient spills boiling water on her arm. The burn is extremely painful, erythematous,
blanches with pressure, and has formed several large, weeping blisters. How is this burn
classified?
A. Superficial (First-degree) burn
B. Superficial partial-thickness (Second-degree) burn
C. Full-thickness (Third-degree) burn
D. Fourth-degree burn
Philippine Clinical Pearls Exam | Set 2 Page 4 of 35
