PRC PHYSICIANS LICENSURE EXAM | ALL
QUESTIONS AND ANSWERS | A+ GRADED |
COMPREHENSIVE EXAM GUIDE 2026/2027
1. A 56-year-old man presents with crushing substernal chest pain for 45 minutes. ECG
shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C
Rationale: Inferior-wall ST elevation in leads II, III, and aVF is most commonly caused by
right coronary artery occlusion.
2. A 24-year-old woman presents with fatigue, weight loss, heat intolerance, tremor, and
palpitations. Examination reveals diffuse goiter and ophthalmopathy. Which diagnosis is
most likely?
A. Graves disease
B. Hashimoto thyroiditis
C. Subacute thyroiditis
D. Toxic multinodular goiter
Answer: A
Rationale: Graves disease causes diffuse thyroid stimulation through TSH-receptor antibodies
and classically produces ophthalmopathy and hyperthyroidism.
3. A patient with diabetic ketoacidosis has a serum potassium of 5.8 mEq/L before
treatment. What best explains this finding?
A. Increased total body potassium
B. Shift of potassium from cells into extracellular fluid
C. Increased renal potassium retention caused by insulin
D. Increased gastrointestinal potassium absorption
Answer: B
Rationale: Despite total-body potassium depletion, insulin deficiency and acidosis shift
potassium extracellularly, causing an initially normal or elevated serum potassium.
,4. A 67-year-old man develops sudden right-sided weakness and expressive aphasia. CT of
the brain shows no hemorrhage. Which vascular territory is most likely affected?
A. Right posterior cerebral artery
B. Right middle cerebral artery
C. Left anterior cerebral artery
D. Left middle cerebral artery
Answer: D
Rationale: The left middle cerebral artery supplies the dominant frontal and temporal
language regions and motor areas controlling the contralateral face and upper extremity.
5. A woman develops profuse watery diarrhea after completing clindamycin therapy.
Which diagnostic test is most appropriate?
A. Stool culture for Salmonella
B. C. difficile toxin or molecular assay
C. Ova and parasite examination
D. Fecal occult blood testing
Answer: B
Rationale: Recent antibiotic exposure followed by significant watery diarrhea strongly
suggests Clostridioides difficile infection, which should be evaluated using appropriate stool
toxin or molecular testing.
6. A patient with asthma uses a short-acting beta-2 agonist several times each day despite
prescribed controller therapy. What is the most appropriate next step?
A. Discontinue all inhaled medications
B. Increase reliance on the rescue inhaler
C. Reassess adherence and inhaler technique and optimize controller therapy
D. Begin long-term oral antibiotics
Answer: C
Rationale: Frequent rescue-inhaler use indicates inadequate control. Adherence, technique,
triggers, and appropriate controller therapy should be reassessed before escalating treatment.
7. A 70-year-old patient with atrial fibrillation has an irregularly irregular pulse. Which
ECG finding is expected?
A. Absent distinct P waves with irregularly irregular R-R intervals
B. Regular sawtooth flutter waves
C. Wide QRS complexes with fixed conduction
D. Prolonged PR intervals before every QRS complex
Answer: A
,Rationale: Atrial fibrillation produces chaotic atrial electrical activity, absent organized P
waves, and an irregularly irregular ventricular response.
8. A 35-year-old woman presents with malar rash, photosensitivity, arthralgia, and
proteinuria. Which antibody is most specific for systemic lupus erythematosus?
A. Anti-centromere antibody
B. Anti-histone antibody
C. Anti-dsDNA antibody
D. Anti-mitochondrial antibody
Answer: C
Rationale: Anti-double-stranded DNA antibodies are highly specific for SLE and are also
associated with lupus nephritis.
9. A 63-year-old smoker presents with painless gross hematuria. Which diagnosis should be
strongly considered?
A. Renal colic
B. Bladder malignancy
C. Acute cystitis
D. Nephrotic syndrome
Answer: B
Rationale: Painless gross hematuria in an older smoker is a classic warning sign of urothelial
malignancy and requires appropriate evaluation.
10. A patient with chronic heart failure suddenly develops severe dyspnea, bilateral
crackles, and pink frothy sputum. Which condition is most likely?
A. Pulmonary embolism
B. Acute pulmonary edema
C. Pneumothorax
D. Pleural effusion
Answer: B
Rationale: Acute pulmonary edema commonly presents with severe respiratory distress,
diffuse crackles, and pink frothy sputum due to alveolar fluid accumulation.
11. A 45-year-old man has recurrent episodes of severe epigastric pain radiating to the
back, with elevated serum lipase. Which diagnosis is most likely?
A. Acute pancreatitis
B. Acute appendicitis
C. Cholecystitis
D. Mesenteric ischemia
, Answer: A
Rationale: Characteristic epigastric pain radiating to the back together with significant lipase
elevation strongly supports acute pancreatitis.
12. A patient with suspected bacterial meningitis is hypotensive and unstable. What should
be prioritized?
A. Delay treatment until lumbar puncture is completed
B. Stabilization and prompt empiric antimicrobial therapy
C. Observation until culture results are available
D. Oral hydration alone
Answer: B
Rationale: Suspected bacterial meningitis is a medical emergency. Treatment should not be
unnecessarily delayed when diagnostic procedures could compromise timely therapy.
13. A 58-year-old woman has osteoporosis and a vertebral compression fracture. Which
intervention is most important for long-term management?
A. Encourage prolonged bed rest
B. Eliminate all physical activity
C. Assess fracture risk and initiate appropriate osteoporosis management
D. Restrict calcium-containing foods
Answer: C
Rationale: A fragility fracture establishes high fracture risk and requires comprehensive
osteoporosis evaluation and treatment rather than immobilization alone.
14. A patient taking warfarin develops life-threatening bleeding with a markedly elevated
INR. Which therapy provides rapid reversal?
A. Protamine sulfate
B. Vitamin K alone in every circumstance
C. Idarucizumab
D. Four-factor prothrombin complex concentrate with vitamin K
Answer: D
Rationale: Life-threatening warfarin-associated bleeding requires rapid replacement of
vitamin K-dependent clotting factors, typically with four-factor PCC plus vitamin K.
15. A 30-year-old patient presents with fever, neck stiffness, and altered mental status.
Which finding most strongly supports bacterial meningitis?
A. CSF neutrophilic pleocytosis with low glucose
B. CSF lymphocytosis with normal glucose
QUESTIONS AND ANSWERS | A+ GRADED |
COMPREHENSIVE EXAM GUIDE 2026/2027
1. A 56-year-old man presents with crushing substernal chest pain for 45 minutes. ECG
shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely
occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Answer: C
Rationale: Inferior-wall ST elevation in leads II, III, and aVF is most commonly caused by
right coronary artery occlusion.
2. A 24-year-old woman presents with fatigue, weight loss, heat intolerance, tremor, and
palpitations. Examination reveals diffuse goiter and ophthalmopathy. Which diagnosis is
most likely?
A. Graves disease
B. Hashimoto thyroiditis
C. Subacute thyroiditis
D. Toxic multinodular goiter
Answer: A
Rationale: Graves disease causes diffuse thyroid stimulation through TSH-receptor antibodies
and classically produces ophthalmopathy and hyperthyroidism.
3. A patient with diabetic ketoacidosis has a serum potassium of 5.8 mEq/L before
treatment. What best explains this finding?
A. Increased total body potassium
B. Shift of potassium from cells into extracellular fluid
C. Increased renal potassium retention caused by insulin
D. Increased gastrointestinal potassium absorption
Answer: B
Rationale: Despite total-body potassium depletion, insulin deficiency and acidosis shift
potassium extracellularly, causing an initially normal or elevated serum potassium.
,4. A 67-year-old man develops sudden right-sided weakness and expressive aphasia. CT of
the brain shows no hemorrhage. Which vascular territory is most likely affected?
A. Right posterior cerebral artery
B. Right middle cerebral artery
C. Left anterior cerebral artery
D. Left middle cerebral artery
Answer: D
Rationale: The left middle cerebral artery supplies the dominant frontal and temporal
language regions and motor areas controlling the contralateral face and upper extremity.
5. A woman develops profuse watery diarrhea after completing clindamycin therapy.
Which diagnostic test is most appropriate?
A. Stool culture for Salmonella
B. C. difficile toxin or molecular assay
C. Ova and parasite examination
D. Fecal occult blood testing
Answer: B
Rationale: Recent antibiotic exposure followed by significant watery diarrhea strongly
suggests Clostridioides difficile infection, which should be evaluated using appropriate stool
toxin or molecular testing.
6. A patient with asthma uses a short-acting beta-2 agonist several times each day despite
prescribed controller therapy. What is the most appropriate next step?
A. Discontinue all inhaled medications
B. Increase reliance on the rescue inhaler
C. Reassess adherence and inhaler technique and optimize controller therapy
D. Begin long-term oral antibiotics
Answer: C
Rationale: Frequent rescue-inhaler use indicates inadequate control. Adherence, technique,
triggers, and appropriate controller therapy should be reassessed before escalating treatment.
7. A 70-year-old patient with atrial fibrillation has an irregularly irregular pulse. Which
ECG finding is expected?
A. Absent distinct P waves with irregularly irregular R-R intervals
B. Regular sawtooth flutter waves
C. Wide QRS complexes with fixed conduction
D. Prolonged PR intervals before every QRS complex
Answer: A
,Rationale: Atrial fibrillation produces chaotic atrial electrical activity, absent organized P
waves, and an irregularly irregular ventricular response.
8. A 35-year-old woman presents with malar rash, photosensitivity, arthralgia, and
proteinuria. Which antibody is most specific for systemic lupus erythematosus?
A. Anti-centromere antibody
B. Anti-histone antibody
C. Anti-dsDNA antibody
D. Anti-mitochondrial antibody
Answer: C
Rationale: Anti-double-stranded DNA antibodies are highly specific for SLE and are also
associated with lupus nephritis.
9. A 63-year-old smoker presents with painless gross hematuria. Which diagnosis should be
strongly considered?
A. Renal colic
B. Bladder malignancy
C. Acute cystitis
D. Nephrotic syndrome
Answer: B
Rationale: Painless gross hematuria in an older smoker is a classic warning sign of urothelial
malignancy and requires appropriate evaluation.
10. A patient with chronic heart failure suddenly develops severe dyspnea, bilateral
crackles, and pink frothy sputum. Which condition is most likely?
A. Pulmonary embolism
B. Acute pulmonary edema
C. Pneumothorax
D. Pleural effusion
Answer: B
Rationale: Acute pulmonary edema commonly presents with severe respiratory distress,
diffuse crackles, and pink frothy sputum due to alveolar fluid accumulation.
11. A 45-year-old man has recurrent episodes of severe epigastric pain radiating to the
back, with elevated serum lipase. Which diagnosis is most likely?
A. Acute pancreatitis
B. Acute appendicitis
C. Cholecystitis
D. Mesenteric ischemia
, Answer: A
Rationale: Characteristic epigastric pain radiating to the back together with significant lipase
elevation strongly supports acute pancreatitis.
12. A patient with suspected bacterial meningitis is hypotensive and unstable. What should
be prioritized?
A. Delay treatment until lumbar puncture is completed
B. Stabilization and prompt empiric antimicrobial therapy
C. Observation until culture results are available
D. Oral hydration alone
Answer: B
Rationale: Suspected bacterial meningitis is a medical emergency. Treatment should not be
unnecessarily delayed when diagnostic procedures could compromise timely therapy.
13. A 58-year-old woman has osteoporosis and a vertebral compression fracture. Which
intervention is most important for long-term management?
A. Encourage prolonged bed rest
B. Eliminate all physical activity
C. Assess fracture risk and initiate appropriate osteoporosis management
D. Restrict calcium-containing foods
Answer: C
Rationale: A fragility fracture establishes high fracture risk and requires comprehensive
osteoporosis evaluation and treatment rather than immobilization alone.
14. A patient taking warfarin develops life-threatening bleeding with a markedly elevated
INR. Which therapy provides rapid reversal?
A. Protamine sulfate
B. Vitamin K alone in every circumstance
C. Idarucizumab
D. Four-factor prothrombin complex concentrate with vitamin K
Answer: D
Rationale: Life-threatening warfarin-associated bleeding requires rapid replacement of
vitamin K-dependent clotting factors, typically with four-factor PCC plus vitamin K.
15. A 30-year-old patient presents with fever, neck stiffness, and altered mental status.
Which finding most strongly supports bacterial meningitis?
A. CSF neutrophilic pleocytosis with low glucose
B. CSF lymphocytosis with normal glucose
