CLINICAL PEARLS EXAM
SET IV
100-Item Post-Clerkship Review (Philippine-Based)
Examination Blueprint (Set IV - Endemic & Trending Case
Focus):
• 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 trending local cases (COVID-19, Mpox), endemic
diseases (Dengue, Typhoid, Malaria, Leptospirosis,
Schistosomiasis, TB, Rabies), strict Philippine DOH guidelines,
and the highest-yield clinical pearls tested in local medical board
exams.
Philippine Clinical Pearls Exam | Set IV Page 1 of 36
, PART I: EXAMINATION QUESTIONS
Surgery
1. A 50-year-old female presents with a locally advanced breast mass. Physical examination
reveals 'peau d'orange' (orange peel) appearance of the overlying skin. What is the
pathophysiological mechanism behind this clinical sign?
A. Direct tumor invasion of the epidermis
B. Subcutaneous lymphatic obstruction by tumor cells
C. Ischemic necrosis of the dermal vasculature
D. Inflammatory reaction to tumor necrosis factor
2. A 35-year-old female with a family history of endocrine tumors is diagnosed with Medullary
Thyroid Carcinoma. Which specific genetic mutation must be screened for in this patient and
her first-degree relatives?
A. BRCA1 mutation
B. RET proto-oncogene mutation
C. APC gene mutation
D. p53 mutation
3. A 60-year-old male presents with recurrent bouts of right upper quadrant pain and jaundice.
ERCP reveals an impacted gallstone in the cystic duct that is externally compressing the
common hepatic duct. What is the eponym for this condition?
A. Bouveret syndrome
B. Mirizzi syndrome
C. Zollinger-Ellison syndrome
D. Lemmel syndrome
4. During an operation for an incarcerated hernia, the surgeon notes that only the anti-
mesenteric border of the small bowel is trapped within the hernia sac, while the bowel lumen
remains patent. What type of hernia is this?
A. Pantaloon hernia
B. Littre's hernia
C. Amyand's hernia
D. Richter's hernia
Philippine Clinical Pearls Exam | Set IV Page 2 of 36
,5. A 25-year-old male sustains a gunshot wound to the right anterior chest, in the 5th intercostal
space at the mid-clavicular line (below the nipple). He is hemodynamically stable. Why is an
exploratory laparotomy strongly considered for this patient?
A. The bullet likely bounced off the ribs into the pelvis
B. Any penetrating injury below the level of the nipples (4th ICS) can involve intra-abdominal
organs due to the dome of the diaphragm
C. It is protocol to remove the spleen in all gunshot wounds
D. Gunshots to the chest always cause bowel perforation
6. A 30-year-old male requires a tube thoracostomy (chest tube) for a massive right-sided
hemothorax. What is the standard anatomical landmark for the safe insertion of a chest tube?
A. 2nd intercostal space, mid-clavicular line
B. 5th intercostal space, anterior or mid-axillary line
C. 7th intercostal space, posterior axillary line
D. Just below the clavicle, parasternal line
7. A 28-year-old female in her third trimester of pregnancy presents with acute abdominal pain.
She is diagnosed with acute appendicitis. How does the anatomical location of her pain typically
differ from a non-pregnant patient?
A. Pain is localized strictly to the left lower quadrant
B. Pain is shifted superiorly and laterally toward the right upper quadrant
C. Pain remains perfectly localized at McBurney's point
D. Pain is felt exclusively in the epigastric region
8. During an emergency appendectomy, the surgeon discovers a ruptured appendix with gross,
purulent spillage into the peritoneal cavity. According to the surgical wound classification, how
is this case classified?
A. Class I (Clean)
B. Class II (Clean-Contaminated)
C. Class III (Contaminated)
D. Class IV (Dirty/Infected)
9. A 40-year-old male presents with excruciating anal pain, especially when sitting or
defecating. Physical exam reveals a firm, bluish, exquisitely tender nodule at the anal verge.
The condition involves external hemorrhoids. Why are external hemorrhoids so much more
painful than internal hemorrhoids?
A. They are innervated by somatic pain fibers from the inferior rectal nerve
B. They are innervated by autonomic visceral nerve fibers
C. They contain arterial blood rather than venous blood
D. They are highly prone to malignant transformation
Philippine Clinical Pearls Exam | Set IV Page 3 of 36
, 10. In the Philippines, upper gastrointestinal bleeding is a common medical emergency. What is
statistically the most common etiology of massive upper GI bleeding?
A. Esophageal varices
B. Mallory-Weiss tears
C. Peptic Ulcer Disease (PUD)
D. Gastric adenocarcinoma
11. A 22-year-old female presents with a raised, thick, hyperpigmented scar on her chest
following a minor laceration 6 months ago. The scar tissue extends significantly beyond the
boundaries of the original wound. What is the diagnosis?
A. Hypertrophic scar
B. Keloid
C. Dermatofibroma
D. Squamous cell carcinoma
12. A 35-year-old male is rescued from a closed-space house fire. He has singed nasal hairs,
facial burns, carbonaceous sputum, and a hoarse voice. What is the most critical, immediate
intervention for this patient?
A. Broad-spectrum prophylactic antibiotics
B. Early endotracheal intubation
C. Application of topical silver sulfadiazine to the face
D. Administration of hyperbaric oxygen
13. A 60-year-old male with a history of prior abdominal surgeries presents with obstipation,
vomiting, and abdominal distension. A supine abdominal X-ray reveals dilated loops of bowel
with visible folds that extend completely across the lumen (valvulae conniventes) and a 'string
of pearls' sign. What is the diagnosis?
A. Large bowel obstruction
B. Small bowel obstruction
C. Paralytic ileus
D. Pneumoperitoneum
14. A 55-year-old male with severe acute hemorrhagic pancreatitis develops bluish
discoloration around his umbilicus. What is this clinical sign called?
A. Grey Turner's sign
B. Cullen's sign
C. Kehr's sign
D. Fox's sign
Philippine Clinical Pearls Exam | Set IV Page 4 of 36
SET IV
100-Item Post-Clerkship Review (Philippine-Based)
Examination Blueprint (Set IV - Endemic & Trending Case
Focus):
• 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 trending local cases (COVID-19, Mpox), endemic
diseases (Dengue, Typhoid, Malaria, Leptospirosis,
Schistosomiasis, TB, Rabies), strict Philippine DOH guidelines,
and the highest-yield clinical pearls tested in local medical board
exams.
Philippine Clinical Pearls Exam | Set IV Page 1 of 36
, PART I: EXAMINATION QUESTIONS
Surgery
1. A 50-year-old female presents with a locally advanced breast mass. Physical examination
reveals 'peau d'orange' (orange peel) appearance of the overlying skin. What is the
pathophysiological mechanism behind this clinical sign?
A. Direct tumor invasion of the epidermis
B. Subcutaneous lymphatic obstruction by tumor cells
C. Ischemic necrosis of the dermal vasculature
D. Inflammatory reaction to tumor necrosis factor
2. A 35-year-old female with a family history of endocrine tumors is diagnosed with Medullary
Thyroid Carcinoma. Which specific genetic mutation must be screened for in this patient and
her first-degree relatives?
A. BRCA1 mutation
B. RET proto-oncogene mutation
C. APC gene mutation
D. p53 mutation
3. A 60-year-old male presents with recurrent bouts of right upper quadrant pain and jaundice.
ERCP reveals an impacted gallstone in the cystic duct that is externally compressing the
common hepatic duct. What is the eponym for this condition?
A. Bouveret syndrome
B. Mirizzi syndrome
C. Zollinger-Ellison syndrome
D. Lemmel syndrome
4. During an operation for an incarcerated hernia, the surgeon notes that only the anti-
mesenteric border of the small bowel is trapped within the hernia sac, while the bowel lumen
remains patent. What type of hernia is this?
A. Pantaloon hernia
B. Littre's hernia
C. Amyand's hernia
D. Richter's hernia
Philippine Clinical Pearls Exam | Set IV Page 2 of 36
,5. A 25-year-old male sustains a gunshot wound to the right anterior chest, in the 5th intercostal
space at the mid-clavicular line (below the nipple). He is hemodynamically stable. Why is an
exploratory laparotomy strongly considered for this patient?
A. The bullet likely bounced off the ribs into the pelvis
B. Any penetrating injury below the level of the nipples (4th ICS) can involve intra-abdominal
organs due to the dome of the diaphragm
C. It is protocol to remove the spleen in all gunshot wounds
D. Gunshots to the chest always cause bowel perforation
6. A 30-year-old male requires a tube thoracostomy (chest tube) for a massive right-sided
hemothorax. What is the standard anatomical landmark for the safe insertion of a chest tube?
A. 2nd intercostal space, mid-clavicular line
B. 5th intercostal space, anterior or mid-axillary line
C. 7th intercostal space, posterior axillary line
D. Just below the clavicle, parasternal line
7. A 28-year-old female in her third trimester of pregnancy presents with acute abdominal pain.
She is diagnosed with acute appendicitis. How does the anatomical location of her pain typically
differ from a non-pregnant patient?
A. Pain is localized strictly to the left lower quadrant
B. Pain is shifted superiorly and laterally toward the right upper quadrant
C. Pain remains perfectly localized at McBurney's point
D. Pain is felt exclusively in the epigastric region
8. During an emergency appendectomy, the surgeon discovers a ruptured appendix with gross,
purulent spillage into the peritoneal cavity. According to the surgical wound classification, how
is this case classified?
A. Class I (Clean)
B. Class II (Clean-Contaminated)
C. Class III (Contaminated)
D. Class IV (Dirty/Infected)
9. A 40-year-old male presents with excruciating anal pain, especially when sitting or
defecating. Physical exam reveals a firm, bluish, exquisitely tender nodule at the anal verge.
The condition involves external hemorrhoids. Why are external hemorrhoids so much more
painful than internal hemorrhoids?
A. They are innervated by somatic pain fibers from the inferior rectal nerve
B. They are innervated by autonomic visceral nerve fibers
C. They contain arterial blood rather than venous blood
D. They are highly prone to malignant transformation
Philippine Clinical Pearls Exam | Set IV Page 3 of 36
, 10. In the Philippines, upper gastrointestinal bleeding is a common medical emergency. What is
statistically the most common etiology of massive upper GI bleeding?
A. Esophageal varices
B. Mallory-Weiss tears
C. Peptic Ulcer Disease (PUD)
D. Gastric adenocarcinoma
11. A 22-year-old female presents with a raised, thick, hyperpigmented scar on her chest
following a minor laceration 6 months ago. The scar tissue extends significantly beyond the
boundaries of the original wound. What is the diagnosis?
A. Hypertrophic scar
B. Keloid
C. Dermatofibroma
D. Squamous cell carcinoma
12. A 35-year-old male is rescued from a closed-space house fire. He has singed nasal hairs,
facial burns, carbonaceous sputum, and a hoarse voice. What is the most critical, immediate
intervention for this patient?
A. Broad-spectrum prophylactic antibiotics
B. Early endotracheal intubation
C. Application of topical silver sulfadiazine to the face
D. Administration of hyperbaric oxygen
13. A 60-year-old male with a history of prior abdominal surgeries presents with obstipation,
vomiting, and abdominal distension. A supine abdominal X-ray reveals dilated loops of bowel
with visible folds that extend completely across the lumen (valvulae conniventes) and a 'string
of pearls' sign. What is the diagnosis?
A. Large bowel obstruction
B. Small bowel obstruction
C. Paralytic ileus
D. Pneumoperitoneum
14. A 55-year-old male with severe acute hemorrhagic pancreatitis develops bluish
discoloration around his umbilicus. What is this clinical sign called?
A. Grey Turner's sign
B. Cullen's sign
C. Kehr's sign
D. Fox's sign
Philippine Clinical Pearls Exam | Set IV Page 4 of 36
