, SECTION I fr
QUESTIONS
DIRECTIONS:frChoosefrthefronefrbestfrresponsefrtofreachfrquestion.
I-
1.frAllfroffrthefrfollowingfrstatementsfrregardingfrpracticefrguidelinesfrsetfrforthfrbyfrgoverningfragenciesfrandfrpr
ofessionalfrorganizationsfrarefrtruefrEXCEPT:
A. Clinicalf r practicef r guidelinesf r protectf r caregiversf r againstf r inappropriatef r chargesf r off r malpractice
,f r yetfrdofrnotfrprovidefrprotectionfrforfrpatientsfrfromfrreceivingfrsubstandardfrcare.
B. Practicefrguidelinesfrhavefrlargelyfrreachedfrafrstagefroffrnuancefrallowingfrthemfrtofraddressfreveryfruniquefr
illnessfrandfrpatientfrpresentedfrtofrthefrmodernfrphysician.
C. Practicefrguidelinesfrprovidefrafrlegalfrconstraintfrtofrphysicians,frandfrdeviationfrfromfrguideline-
basedf r carefrinvariablyfrleavesfrphysiciansfrvulnerablefrtofrlegalfraction.
D. Wherefrdifferentfrorganizationsfrdisagreefrregardingfrpracticefrguidelines,frafrthird-
partyfragencyfrhasf r beenfrappointedfrtofrmitigatefrthesefrdisagreementsfrsuchfrthatfrnowfrallfrmajorfrorgan
izations’frguidelinesf r arefrconsistent.
E. Allf r off r thef r abovef r statementsf r aref r notf r true.
I-
2.f r Regardingf r molecularf r medicine,f r whichf r off r thef r followingf r statementsf r representsf r anf r INAC
CURATEfrexamplefroffrthefrlistedfrareafroffrstudy:
A. Exposomics:f r Anf r endocrinologistf r studiesf r sunlightf r exposuref r andf r populationf r riskf r off r hipf r fracture.
B. Metabolomics:f r Af r biochemistf r studiesf r thef r ratef r offrfluxf r throughf r thef r creatinef r kinasef r pathwayf r
duringfrthefrcardiacfrcycle.
C. Metagenomics:f r Af r biologistf r studiesf r thef r genomicf r alterationsf r inf r moldsf r commonlyf r foundf r inf r
humanfrdwellings.
D. Microbiomics:f r Af r microbiologistf r studiesf r thef r genomicf r variationf r inf r thermophiles,f r bacteriaf r tha
tf r canfrsurvivefrextremefrheatfrnearfrdeepfroceanfrvents.
E. Proteomics:f r Afrcardiologistfrstudiesfrdesmosomalfrproteinsfrandfrtheirfrposttranslationalfrmodifications
f r infrstudyingfrarrhythmogenicfrrightfrventricularfrdysplasia.
I-3.f r Whichf r off r thef r followingf r isf r thef r bestf r definitionf r off r evidence-basedf r medicine?
A. Af r summaryf r off r existingf r dataf r fromf r existingf r clinicalf r trialsf r withf r af r criticalf r methodologicf r revi
ewf r andfrstatisticalfranalysisfroffrsummativefrdata
B. Af r typef r off r researchf r thatf r comparesf r thef r resultsf r off r onef r approachf r tof r treatingf r diseasef r withf
r anotherfrapproachfrtofrtreatingfrthefrsamefrdisease
C. Clinicalf r decision-
makingf r supportf r toolsf r developedf r byf r professionalf r organizationsf r thatf r includefrexpertfropin
ionsfrandfrdatafrfromfrclinicalfrtrials
D. Clinicalf r decisionf r makingf r supportedf r byf r data,f r preferablyf r randomizedf r controlledf r clinicalf r trials
E. Onef r physician’sf r clinicalf r experiencef r inf r caringf r forf r multiplef r patientsf r withf r af r specificf r disord
erf r overfrmanyfryears
,I-
4.f r Whichf r off r thef r followingf r isf r thef r standardf r measuref r forf r determiningf r thef r impactf r off r af r healthf r con
ditionf r onfrafrpopulation?
A. Disability-adjustedf r life-years
B. Infantfrmortality
C. Lifefrexpectancy
D. Standardizedf r mortalityf r ratio
E. Yearsf r off r lifef r lost
I-5.f r Whichf r off r thef r followingf r statementsf r regardingf r diseasef r patternsf r worldwidef r isf r true?
A. Childhoodf r undernutritionf r isf r thef r leadingf r riskf r factorf r forf r globalf r diseasef r burden.
B. Inf r af r 2006f r publication,f r thef r Worldf r Healthf r Organizationf r (WHO)f r estimatedf r thatf r 10%f r off r t
hef r totalfrglobalfrburdenfroffrdiseasefrwasfrduefrtofrmodifiablefrenvironmentalfrriskfrfactors.
C. Inf r 2010,f r ischemicf r heartf r diseasef r wasf r thef r leadingf r causef r off r deathf r amongf r adults.
D. Infrthefrlastfrtwofrdecades,frmortalityfrattributedfrtofrcommunicablefrdiseases,frmaternalfrandfrperinatalfrc
onditions,frandfrnutritionalfrdeficienciesfrhasfrremainedfrfairlyfrstable,frwithfrthefrmajorityfr(76%)froffrmort
alityfrfromfrthesefrcausesfroccurringfrinfrsub-SaharanfrAfricafrandfrsouthernfrAsia.
E. Whilef r povertyf r statusf r hasf r beenf r shownf r tof r bef r linkedf r tof r healthf r statusf r onf r thef r individualf r l
evel,f r thefrsamef r relationshipf r doesf r notf r holdf r truef r whenf r studyingf r thef r linkf r betweenf r nationalf r
healthf r indicatorsfrandfrgrossfrdomesticfrproductfrperfrcapitaframongfrnations.
I-
6.frYoufrarefrappointedfrtofrafrgovernmentalfrhealthcarefradvisoryfrsubcommitteefrconcernedfrwithfraddressingf
rproblemsf r facingf r thef r globalf r healthf r community.f r Yourf r taskf r isf r tof r drawf r generalf r conclusionsf r fro
mf r thefrglobalfrfightfragainstfrtuberculosisfr(TB)frandfrhumanfrimmunodeficiencyfrvirusfr(HIV)/acquiredfrim
munodeficiencyfrsyndromefr(AIDS)frthatfrmayfrbefrappliedfrinfrcombattingfrotherfrdiseases,frincludingfrnonco
mmunicablefrdiseases.frWhichfroffrthefrfollowingfrconclusionsfrisfrreasonablefrwhenfrconsideringfrHIV/AIDSfr
andfrTBfrasfrchronicfrdiseases?
A. Barriersfrtofradequatefrhealthcarefrandfrpatientfradherencefrimposedfrbyfrextremefrpovertyfrmustfrbefrcon
comitantlyf r addressedf r tof r adequatelyf r treatf r andf r preventf r chronicf r diseasef r inf r developingf r natio
ns.
B. Chargingf r smallf r feesf r forf r healthf r servicesf r (e.g.,f r AIDSf r preventionf r andf r care)f r suppliesf r thef r patien
tf r withfraf r sensef r off r thef r treatment’sf r valuef r andf r increasesf r compliancef r andf r overallf r publicf r health
.
C. Despitefradequatefravailablefrtoolsfrtofrpracticefrtheirfrtradefrlocallyfrinfrdevelopingfrnations,frmanyfrphysi
ciansfrandfrnursesfremigratefrtofrdevelopedfrnationsfrtofrpracticefrtheirfrrespectivefrtrades,frafrphenomenonf
rcalledfr“brainfrdrain.”
D. Inf r developedf r nationsf r wheref r physiciansf r aref r abundant,f r communityf r healthf r workerf r supervisi
onf r offrthefrcarefroffrchronicallyfrillfrpatientsfrisfrnotfreffective.
E. Inf r thef r casef r off r chronicf r infectiousf r diseases,f r switchingf r fromf r onef r drugf r tof r anotherf r throug
hf r afrprolongedfrcoursefroffrtreatmentfrprovidesfrthefrhighestfrcurefrratefrbyfrobviatingfrthefrinfectiousfragen
t’sfrabilityfrtofrdevelopfrresistancefrtofranyfrsinglefrdrug.
I-7.frMrs.frJones,frafr22-year-
oldfrAfricanfrAmericanfrwoman,frpresentsfrtofrDr.frSmith,franfrinternalfrmedicinefrspecialist,f r withf r af r facialf r r
ash.f r Mrs.f r Jonesf r statesf r thatf r thef r rashf r beganf r afterf r spendingf r af r dayf r atf r thef r beachfrwithf r herf r family
.f r Shef r alsof r notesf r thatf r herf r metacarpophalangealf r andf r proximalf r interphalangealf r jointsfrhavefrbeenfr
painfulfrandfrswollenfrforfrthefrprecedingfr2frweeks.frOnfrexamination,frthefrjointsfrarefrswollenfrandfrtender.f r La
boratoryf r analysisf r disclosesf r reducedf r creatininef r clearance,f r proteinuria,f r andf r hemolyticfranemia.frAn
tinuclearfrantibodiesfr(afrtestfrwithfrafrhighfrnegativefrpredictivefrvaluefrforfrsystemicfrlupusfrerythematosus)frar
efrdetectedfratfrsignificantfrtiter,frandfrultimately,frthefrdiagnosisfroffrsystemicfrlupusfrerythematosusfrisfrmade.
Twofrweeksfrlater,frMrs.frJohnson,frafr24-year-
oldfrAfricanfrAmericanfrwoman,frpresentsfrwithfrafrfacialfrrashfrandf r elbowf r painf r tof r Dr.f r Smith.f r Afterf r af r
cursoryf r interviewf r andf r brieff r physicalf r exam,f r Dr.f r Smithf r sendsfrbloodfrworkfronlyfrtestingfrforfrantinuc
learfrantibodies.frWhenfrthefrtestfrreturnsfrnegativefr(nofrantibodiesfrdetected),frDr.frSmithfrpresumesfrthisfrtofrb
efrafrfalse-
, negativefrresultfrandfrstartsfrMrs.frJohnsonfronfrhydroxychloroquinef r andf r prednisonef r forf r treatmentf r off r
systemicf r lupusf r erythematosus.f r Whichfrheuristic(s)frdidfrDr.frSmithfrlikelyfremployfrinfrdiagnosingfrMrs.frJ
ohnsonfrwithfrsystemicfrlupusf r erythematosus?
QUESTIONS
DIRECTIONS:frChoosefrthefronefrbestfrresponsefrtofreachfrquestion.
I-
1.frAllfroffrthefrfollowingfrstatementsfrregardingfrpracticefrguidelinesfrsetfrforthfrbyfrgoverningfragenciesfrandfrpr
ofessionalfrorganizationsfrarefrtruefrEXCEPT:
A. Clinicalf r practicef r guidelinesf r protectf r caregiversf r againstf r inappropriatef r chargesf r off r malpractice
,f r yetfrdofrnotfrprovidefrprotectionfrforfrpatientsfrfromfrreceivingfrsubstandardfrcare.
B. Practicefrguidelinesfrhavefrlargelyfrreachedfrafrstagefroffrnuancefrallowingfrthemfrtofraddressfreveryfruniquefr
illnessfrandfrpatientfrpresentedfrtofrthefrmodernfrphysician.
C. Practicefrguidelinesfrprovidefrafrlegalfrconstraintfrtofrphysicians,frandfrdeviationfrfromfrguideline-
basedf r carefrinvariablyfrleavesfrphysiciansfrvulnerablefrtofrlegalfraction.
D. Wherefrdifferentfrorganizationsfrdisagreefrregardingfrpracticefrguidelines,frafrthird-
partyfragencyfrhasf r beenfrappointedfrtofrmitigatefrthesefrdisagreementsfrsuchfrthatfrnowfrallfrmajorfrorgan
izations’frguidelinesf r arefrconsistent.
E. Allf r off r thef r abovef r statementsf r aref r notf r true.
I-
2.f r Regardingf r molecularf r medicine,f r whichf r off r thef r followingf r statementsf r representsf r anf r INAC
CURATEfrexamplefroffrthefrlistedfrareafroffrstudy:
A. Exposomics:f r Anf r endocrinologistf r studiesf r sunlightf r exposuref r andf r populationf r riskf r off r hipf r fracture.
B. Metabolomics:f r Af r biochemistf r studiesf r thef r ratef r offrfluxf r throughf r thef r creatinef r kinasef r pathwayf r
duringfrthefrcardiacfrcycle.
C. Metagenomics:f r Af r biologistf r studiesf r thef r genomicf r alterationsf r inf r moldsf r commonlyf r foundf r inf r
humanfrdwellings.
D. Microbiomics:f r Af r microbiologistf r studiesf r thef r genomicf r variationf r inf r thermophiles,f r bacteriaf r tha
tf r canfrsurvivefrextremefrheatfrnearfrdeepfroceanfrvents.
E. Proteomics:f r Afrcardiologistfrstudiesfrdesmosomalfrproteinsfrandfrtheirfrposttranslationalfrmodifications
f r infrstudyingfrarrhythmogenicfrrightfrventricularfrdysplasia.
I-3.f r Whichf r off r thef r followingf r isf r thef r bestf r definitionf r off r evidence-basedf r medicine?
A. Af r summaryf r off r existingf r dataf r fromf r existingf r clinicalf r trialsf r withf r af r criticalf r methodologicf r revi
ewf r andfrstatisticalfranalysisfroffrsummativefrdata
B. Af r typef r off r researchf r thatf r comparesf r thef r resultsf r off r onef r approachf r tof r treatingf r diseasef r withf
r anotherfrapproachfrtofrtreatingfrthefrsamefrdisease
C. Clinicalf r decision-
makingf r supportf r toolsf r developedf r byf r professionalf r organizationsf r thatf r includefrexpertfropin
ionsfrandfrdatafrfromfrclinicalfrtrials
D. Clinicalf r decisionf r makingf r supportedf r byf r data,f r preferablyf r randomizedf r controlledf r clinicalf r trials
E. Onef r physician’sf r clinicalf r experiencef r inf r caringf r forf r multiplef r patientsf r withf r af r specificf r disord
erf r overfrmanyfryears
,I-
4.f r Whichf r off r thef r followingf r isf r thef r standardf r measuref r forf r determiningf r thef r impactf r off r af r healthf r con
ditionf r onfrafrpopulation?
A. Disability-adjustedf r life-years
B. Infantfrmortality
C. Lifefrexpectancy
D. Standardizedf r mortalityf r ratio
E. Yearsf r off r lifef r lost
I-5.f r Whichf r off r thef r followingf r statementsf r regardingf r diseasef r patternsf r worldwidef r isf r true?
A. Childhoodf r undernutritionf r isf r thef r leadingf r riskf r factorf r forf r globalf r diseasef r burden.
B. Inf r af r 2006f r publication,f r thef r Worldf r Healthf r Organizationf r (WHO)f r estimatedf r thatf r 10%f r off r t
hef r totalfrglobalfrburdenfroffrdiseasefrwasfrduefrtofrmodifiablefrenvironmentalfrriskfrfactors.
C. Inf r 2010,f r ischemicf r heartf r diseasef r wasf r thef r leadingf r causef r off r deathf r amongf r adults.
D. Infrthefrlastfrtwofrdecades,frmortalityfrattributedfrtofrcommunicablefrdiseases,frmaternalfrandfrperinatalfrc
onditions,frandfrnutritionalfrdeficienciesfrhasfrremainedfrfairlyfrstable,frwithfrthefrmajorityfr(76%)froffrmort
alityfrfromfrthesefrcausesfroccurringfrinfrsub-SaharanfrAfricafrandfrsouthernfrAsia.
E. Whilef r povertyf r statusf r hasf r beenf r shownf r tof r bef r linkedf r tof r healthf r statusf r onf r thef r individualf r l
evel,f r thefrsamef r relationshipf r doesf r notf r holdf r truef r whenf r studyingf r thef r linkf r betweenf r nationalf r
healthf r indicatorsfrandfrgrossfrdomesticfrproductfrperfrcapitaframongfrnations.
I-
6.frYoufrarefrappointedfrtofrafrgovernmentalfrhealthcarefradvisoryfrsubcommitteefrconcernedfrwithfraddressingf
rproblemsf r facingf r thef r globalf r healthf r community.f r Yourf r taskf r isf r tof r drawf r generalf r conclusionsf r fro
mf r thefrglobalfrfightfragainstfrtuberculosisfr(TB)frandfrhumanfrimmunodeficiencyfrvirusfr(HIV)/acquiredfrim
munodeficiencyfrsyndromefr(AIDS)frthatfrmayfrbefrappliedfrinfrcombattingfrotherfrdiseases,frincludingfrnonco
mmunicablefrdiseases.frWhichfroffrthefrfollowingfrconclusionsfrisfrreasonablefrwhenfrconsideringfrHIV/AIDSfr
andfrTBfrasfrchronicfrdiseases?
A. Barriersfrtofradequatefrhealthcarefrandfrpatientfradherencefrimposedfrbyfrextremefrpovertyfrmustfrbefrcon
comitantlyf r addressedf r tof r adequatelyf r treatf r andf r preventf r chronicf r diseasef r inf r developingf r natio
ns.
B. Chargingf r smallf r feesf r forf r healthf r servicesf r (e.g.,f r AIDSf r preventionf r andf r care)f r suppliesf r thef r patien
tf r withfraf r sensef r off r thef r treatment’sf r valuef r andf r increasesf r compliancef r andf r overallf r publicf r health
.
C. Despitefradequatefravailablefrtoolsfrtofrpracticefrtheirfrtradefrlocallyfrinfrdevelopingfrnations,frmanyfrphysi
ciansfrandfrnursesfremigratefrtofrdevelopedfrnationsfrtofrpracticefrtheirfrrespectivefrtrades,frafrphenomenonf
rcalledfr“brainfrdrain.”
D. Inf r developedf r nationsf r wheref r physiciansf r aref r abundant,f r communityf r healthf r workerf r supervisi
onf r offrthefrcarefroffrchronicallyfrillfrpatientsfrisfrnotfreffective.
E. Inf r thef r casef r off r chronicf r infectiousf r diseases,f r switchingf r fromf r onef r drugf r tof r anotherf r throug
hf r afrprolongedfrcoursefroffrtreatmentfrprovidesfrthefrhighestfrcurefrratefrbyfrobviatingfrthefrinfectiousfragen
t’sfrabilityfrtofrdevelopfrresistancefrtofranyfrsinglefrdrug.
I-7.frMrs.frJones,frafr22-year-
oldfrAfricanfrAmericanfrwoman,frpresentsfrtofrDr.frSmith,franfrinternalfrmedicinefrspecialist,f r withf r af r facialf r r
ash.f r Mrs.f r Jonesf r statesf r thatf r thef r rashf r beganf r afterf r spendingf r af r dayf r atf r thef r beachfrwithf r herf r family
.f r Shef r alsof r notesf r thatf r herf r metacarpophalangealf r andf r proximalf r interphalangealf r jointsfrhavefrbeenfr
painfulfrandfrswollenfrforfrthefrprecedingfr2frweeks.frOnfrexamination,frthefrjointsfrarefrswollenfrandfrtender.f r La
boratoryf r analysisf r disclosesf r reducedf r creatininef r clearance,f r proteinuria,f r andf r hemolyticfranemia.frAn
tinuclearfrantibodiesfr(afrtestfrwithfrafrhighfrnegativefrpredictivefrvaluefrforfrsystemicfrlupusfrerythematosus)frar
efrdetectedfratfrsignificantfrtiter,frandfrultimately,frthefrdiagnosisfroffrsystemicfrlupusfrerythematosusfrisfrmade.
Twofrweeksfrlater,frMrs.frJohnson,frafr24-year-
oldfrAfricanfrAmericanfrwoman,frpresentsfrwithfrafrfacialfrrashfrandf r elbowf r painf r tof r Dr.f r Smith.f r Afterf r af r
cursoryf r interviewf r andf r brieff r physicalf r exam,f r Dr.f r Smithf r sendsfrbloodfrworkfronlyfrtestingfrforfrantinuc
learfrantibodies.frWhenfrthefrtestfrreturnsfrnegativefr(nofrantibodiesfrdetected),frDr.frSmithfrpresumesfrthisfrtofrb
efrafrfalse-
, negativefrresultfrandfrstartsfrMrs.frJohnsonfronfrhydroxychloroquinef r andf r prednisonef r forf r treatmentf r off r
systemicf r lupusf r erythematosus.f r Whichfrheuristic(s)frdidfrDr.frSmithfrlikelyfremployfrinfrdiagnosingfrMrs.frJ
ohnsonfrwithfrsystemicfrlupusf r erythematosus?
