CLINICAL PEARLS COMPREHENSIVE EXAM
100-Item Post-Clerkship Review (Philippine-Based Edition)
Examination Blueprint:
• Surgery (20 Items)
• Obstetrics & Gynecology (20 Items)
• Internal Medicine (20 Items)
• Pediatrics (20 Items)
• Specialties: ENT, Ophtha, Anesthesia, Rehab, Ortho (20
Items)
Prepared strictly in accordance with local guidelines (DOH,
POGS, PPS, NTP DOTS, IMCI, Unang Yakap) and standard
international medical references. Features major endemic
diseases including Dengue, TB, Leptospirosis, and
Schistosomiasis.
High-Yield Clinical Pearls | Philippine Post-Clerkship Review Page 1 of 31
, PART I: EXAMINATION QUESTIONS
Surgery
1. A 25-year-old male presents with right lower quadrant pain, anorexia, and nausea. Which of the following
parameters in the Alvarado score (MANTRELS) is given a value of 2 points?
A. Anorexia
B. Elevated temperature
C. Tenderness in the right lower quadrant
D. Rebound tenderness
2. According to the Tokyo Guidelines for acute cholecystitis, which of the following is considered a 'local sign of
inflammation'?
A. Fever > 38.0°C
B. Elevated WBC count
C. Murphy's sign
D. Elevated CRP
3. A 40-year-old female presents with a painless, hard anterior neck mass. Fine needle aspiration biopsy reveals
'Orphan Annie eye' nuclei and psammoma bodies. What is the most likely diagnosis?
A. Follicular thyroid carcinoma
B. Medullary thyroid carcinoma
C. Papillary thyroid carcinoma
D. Anaplastic thyroid carcinoma
4. A 65-year-old farmer from a rural barangay presents with a reducible bulge in his groin. During surgery, the
hernia sac is found protruding medial to the inferior epigastric vessels. Which anatomical space is the defect
located in?
A. Triangle of Doom
B. Hesselbach's triangle
C. Triangle of Pain
D. Petit's triangle
5. During a trauma assessment in a local provincial hospital, an Extended Focused Assessment with Sonography
for Trauma (eFAST) is performed. Which of the following evaluates the hepatorenal recess?
A. Subxiphoid view
B. Morison's pouch view
C. Perisplenic view
D. Suprapubic view
High-Yield Clinical Pearls | Philippine Post-Clerkship Review Page 2 of 31
,6. A 35-year-old tricycle driver presents with bright red rectal bleeding and a mass that prolapses during
defecation but reduces spontaneously. What grade of internal hemorrhoid is this?
A. First-degree
B. Second-degree
C. Third-degree
D. Fourth-degree
7. In the management of acute mechanical small bowel obstruction most commonly caused by postoperative
adhesions, what is the most appropriate initial conservative intervention?
A. Immediate exploratory laparotomy
B. Barium enema
C. Nasogastric tube decompression and IV fluid resuscitation
D. High-dose oral prokinetics
8. A 28-year-old male is rescued from a house fire in Manila with deep partial-thickness burns over his entire
anterior torso (18%) and both anterior arms (4.5% each). His weight is 70 kg. Using the Parkland formula (4mL/
kg/%TBSA), how much Lactated Ringer's should be given in the first 8 hours?
A. 3,780 mL
B. 7,560 mL
C. 5,040 mL
D. 10,080 mL
9. A 19-year-old male falls from a motorcycle in EDSA without a helmet. He has a brief loss of consciousness,
wakes up completely lucid, but 2 hours later rapidly deteriorates into a coma. CT scan shows a biconvex
hyperdensity. Which vessel is most likely injured?
A. Bridging veins
B. Middle meningeal artery
C. Superior sagittal sinus
D. Anterior cerebral artery
10. An elderly patient with cerebral atrophy presents with gradual cognitive decline and headaches 3 weeks after
a minor head bump. CT scan reveals a crescent-shaped extra-axial hemorrhage crossing suture lines. What is the
source of bleeding?
A. Middle meningeal artery
B. Bridging cortical veins
C. Berry aneurysm
D. Dural venous sinuses
11. A 21-year-old male is stabbed in the right chest. He presents with severe respiratory distress, absent breath
sounds on the right, distended neck veins, and tracheal deviation to the left. What is the immediate life-saving
intervention?
A. Portable chest X-ray
B. Immediate needle decompression
C. Endotracheal intubation
D. Pericardiocentesis
High-Yield Clinical Pearls | Philippine Post-Clerkship Review Page 3 of 31
, 12. A 72-year-old male presents with massive abdominal distention, abdominal pain, and obstipation. Plain
abdominal X-ray reveals a massively dilated colon pointing towards the right upper quadrant, resembling a
'coffee bean'. What is the most likely diagnosis?
A. Cecal volvulus
B. Sigmoid volvulus
C. Intussusception
D. Small bowel obstruction
13. A 2-day-old infant has not passed meconium. Digital rectal examination results in an explosive release of gas
and liquid stool (squirt sign). What is considered the diagnostic gold standard for this condition?
A. Serial abdominal radiographs
B. Anorectal manometry
C. Rectal suction biopsy
D. Barium enema
14. An 8-month-old infant is brought to the emergency room with episodic, severe abdominal colic where the legs
are drawn up, alternating with lethargy. The mother reports a 'currant jelly' stool. Ultrasound shows a 'target
sign'. What is the definitive initial management if no peritonitis is present?
A. Immediate exploratory laparotomy
B. Air or contrast hydrostatic enema reduction
C. High-dose osmotic laxatives
D. Empiric IV antibiotic therapy
15. A surgical pathology report confirms a malignant epithelial tumor localized precisely at the bifurcation of the
common hepatic duct. What is the specific eponym designated for this unique tumor?
A. Wilms tumor
B. Krukenberg tumor
C. Klatskin tumor
D. Brenner tumor
16. A 64-year-old male presents with progressive, painless jaundice, dark urine, and pale stools. On physical
examination, a smooth, non-tender, distended gallbladder is easily palpable. What is this sign, and what does it
indicate?
A. Murphy's sign; Acute cholecystitis
B. Courvoisier's sign; Pancreatic head or biliary malignancy
C. Cullen's sign; Hemorrhagic pancreatitis
D. Boas's sign; Acute cholelithiasis
17. A 45-year-old male presents to the ER with sudden-onset, excruciating epigastric pain. He has a long history of
NSAID abuse. Upright chest X-ray reveals free air under the right hemidiaphragm (pneumoperitoneum). What is
the most likely diagnosis?
A. Acute pancreatitis
B. Ruptured appendicitis
C. Perforated peptic ulcer
D. Acute cholecystitis
High-Yield Clinical Pearls | Philippine Post-Clerkship Review Page 4 of 31
100-Item Post-Clerkship Review (Philippine-Based Edition)
Examination Blueprint:
• Surgery (20 Items)
• Obstetrics & Gynecology (20 Items)
• Internal Medicine (20 Items)
• Pediatrics (20 Items)
• Specialties: ENT, Ophtha, Anesthesia, Rehab, Ortho (20
Items)
Prepared strictly in accordance with local guidelines (DOH,
POGS, PPS, NTP DOTS, IMCI, Unang Yakap) and standard
international medical references. Features major endemic
diseases including Dengue, TB, Leptospirosis, and
Schistosomiasis.
High-Yield Clinical Pearls | Philippine Post-Clerkship Review Page 1 of 31
, PART I: EXAMINATION QUESTIONS
Surgery
1. A 25-year-old male presents with right lower quadrant pain, anorexia, and nausea. Which of the following
parameters in the Alvarado score (MANTRELS) is given a value of 2 points?
A. Anorexia
B. Elevated temperature
C. Tenderness in the right lower quadrant
D. Rebound tenderness
2. According to the Tokyo Guidelines for acute cholecystitis, which of the following is considered a 'local sign of
inflammation'?
A. Fever > 38.0°C
B. Elevated WBC count
C. Murphy's sign
D. Elevated CRP
3. A 40-year-old female presents with a painless, hard anterior neck mass. Fine needle aspiration biopsy reveals
'Orphan Annie eye' nuclei and psammoma bodies. What is the most likely diagnosis?
A. Follicular thyroid carcinoma
B. Medullary thyroid carcinoma
C. Papillary thyroid carcinoma
D. Anaplastic thyroid carcinoma
4. A 65-year-old farmer from a rural barangay presents with a reducible bulge in his groin. During surgery, the
hernia sac is found protruding medial to the inferior epigastric vessels. Which anatomical space is the defect
located in?
A. Triangle of Doom
B. Hesselbach's triangle
C. Triangle of Pain
D. Petit's triangle
5. During a trauma assessment in a local provincial hospital, an Extended Focused Assessment with Sonography
for Trauma (eFAST) is performed. Which of the following evaluates the hepatorenal recess?
A. Subxiphoid view
B. Morison's pouch view
C. Perisplenic view
D. Suprapubic view
High-Yield Clinical Pearls | Philippine Post-Clerkship Review Page 2 of 31
,6. A 35-year-old tricycle driver presents with bright red rectal bleeding and a mass that prolapses during
defecation but reduces spontaneously. What grade of internal hemorrhoid is this?
A. First-degree
B. Second-degree
C. Third-degree
D. Fourth-degree
7. In the management of acute mechanical small bowel obstruction most commonly caused by postoperative
adhesions, what is the most appropriate initial conservative intervention?
A. Immediate exploratory laparotomy
B. Barium enema
C. Nasogastric tube decompression and IV fluid resuscitation
D. High-dose oral prokinetics
8. A 28-year-old male is rescued from a house fire in Manila with deep partial-thickness burns over his entire
anterior torso (18%) and both anterior arms (4.5% each). His weight is 70 kg. Using the Parkland formula (4mL/
kg/%TBSA), how much Lactated Ringer's should be given in the first 8 hours?
A. 3,780 mL
B. 7,560 mL
C. 5,040 mL
D. 10,080 mL
9. A 19-year-old male falls from a motorcycle in EDSA without a helmet. He has a brief loss of consciousness,
wakes up completely lucid, but 2 hours later rapidly deteriorates into a coma. CT scan shows a biconvex
hyperdensity. Which vessel is most likely injured?
A. Bridging veins
B. Middle meningeal artery
C. Superior sagittal sinus
D. Anterior cerebral artery
10. An elderly patient with cerebral atrophy presents with gradual cognitive decline and headaches 3 weeks after
a minor head bump. CT scan reveals a crescent-shaped extra-axial hemorrhage crossing suture lines. What is the
source of bleeding?
A. Middle meningeal artery
B. Bridging cortical veins
C. Berry aneurysm
D. Dural venous sinuses
11. A 21-year-old male is stabbed in the right chest. He presents with severe respiratory distress, absent breath
sounds on the right, distended neck veins, and tracheal deviation to the left. What is the immediate life-saving
intervention?
A. Portable chest X-ray
B. Immediate needle decompression
C. Endotracheal intubation
D. Pericardiocentesis
High-Yield Clinical Pearls | Philippine Post-Clerkship Review Page 3 of 31
, 12. A 72-year-old male presents with massive abdominal distention, abdominal pain, and obstipation. Plain
abdominal X-ray reveals a massively dilated colon pointing towards the right upper quadrant, resembling a
'coffee bean'. What is the most likely diagnosis?
A. Cecal volvulus
B. Sigmoid volvulus
C. Intussusception
D. Small bowel obstruction
13. A 2-day-old infant has not passed meconium. Digital rectal examination results in an explosive release of gas
and liquid stool (squirt sign). What is considered the diagnostic gold standard for this condition?
A. Serial abdominal radiographs
B. Anorectal manometry
C. Rectal suction biopsy
D. Barium enema
14. An 8-month-old infant is brought to the emergency room with episodic, severe abdominal colic where the legs
are drawn up, alternating with lethargy. The mother reports a 'currant jelly' stool. Ultrasound shows a 'target
sign'. What is the definitive initial management if no peritonitis is present?
A. Immediate exploratory laparotomy
B. Air or contrast hydrostatic enema reduction
C. High-dose osmotic laxatives
D. Empiric IV antibiotic therapy
15. A surgical pathology report confirms a malignant epithelial tumor localized precisely at the bifurcation of the
common hepatic duct. What is the specific eponym designated for this unique tumor?
A. Wilms tumor
B. Krukenberg tumor
C. Klatskin tumor
D. Brenner tumor
16. A 64-year-old male presents with progressive, painless jaundice, dark urine, and pale stools. On physical
examination, a smooth, non-tender, distended gallbladder is easily palpable. What is this sign, and what does it
indicate?
A. Murphy's sign; Acute cholecystitis
B. Courvoisier's sign; Pancreatic head or biliary malignancy
C. Cullen's sign; Hemorrhagic pancreatitis
D. Boas's sign; Acute cholelithiasis
17. A 45-year-old male presents to the ER with sudden-onset, excruciating epigastric pain. He has a long history of
NSAID abuse. Upright chest X-ray reveals free air under the right hemidiaphragm (pneumoperitoneum). What is
the most likely diagnosis?
A. Acute pancreatitis
B. Ruptured appendicitis
C. Perforated peptic ulcer
D. Acute cholecystitis
High-Yield Clinical Pearls | Philippine Post-Clerkship Review Page 4 of 31
