Board Questions As Recalled

Transcript

SEPTEMBER 2017 QUESTIONS, AS RECALLED DISCLAIMER OF LIABILITY: THE AUTHOR/S DISCLAIM LIABILITY FOR INCIDENTAL OR CONSEQUENTIAL DAMAGES and assumes no responsibility or liability for any loss or damage suffered by any person as a result of the use or misuse of any of the information or content found herein. The author/s assumes or undertakes NO LIABILITY for any loss or damage suffered as a result of the use, misuse or reliance on the information and content found herein. BIOCHEMISTRY • ALL PATHWAYS THWAYS • FED vs. FASTING FASTING STA STATE • Diabetes Mellitus Mellitus and the enzymes involved involved (glycolysis, gluconeoge gluconeogenesis, nesis, Beta Oxidation) Oxidation) • Substrate phosphorylation phosphorylation vs oxidative • Michaelis-Menten Michaelis-Menten & Lineweaver-Burk Lineweaver-Burk plot plot (Definition) (Definition) • Pathw Pathway ay Sites Sites • Purine and Pyrimidine Pyrimidine pathway pathway (IMP, (IMP, salvage pathway) pathway) • Catecholamines Catecholamines pathway pathway (precursor and enzymes) enzymes) • enzyme inhibited by aspirin and ibuprofen: ibuprofen: COX • Vit B6 (caboxyl (caboxylase) ase) • Most abundant abundant fibrous protein protein in the human human body: body: COLLAGEN COLLAGEN • Most variable component component of daily energy energy expenditure: expenditure: PHYSICAL ACTIVITY • A young young girl with a history of severe abdominal abdominal pain was take taken n to Emergency Room Room at 5 a.m. in severe distress. Blood was drawn, and the plasma appeared milky, with the triacylglycerol level in excess of 2,000 mg/dl (normal = 4–150 mg/ dl). The patient was placed on a diet extremely limited in fat but supplemented with medium-chain triglycerides. Which of the following lipoprotein particles are most likely responsible for the appearance of the patient’s plasma?  A. Chylomicrons Chylomicrons B. High-density lipoproteins C. Immediate-density Immediate-densi ty lipoproteins D. Low-density lipoproteins Recommended material: TOPNOTCH LECTURE + TOPNOTCH MAIN HANDOUT + TOPNOTCH PEARLS Recommended Samplex: UST Mock boards (2016, 2017) + UST Post Test (2017) + Lippincott’s End-ofChapter questions Note: One of the easiest subjects you will encounter. DO NOT MISS the topnotch lecture in biochemistry at all cost. Master the diseases with enzyme deficiencies involved, they were not asked in the biochemistry exam itself, but was asked on the other subjects. Only a few BRS Biochem questions were lifted. More than 20% of the questions were lifted from UST. Topnotch superexams for additional learnings. Hindi pa nagmumutate ang Biochemistry sa board exam. Super high-yield ng lecture/handout ni Dr. Baticulon so less likely na irevise ang Biochem handouts. Read the Topnotch Topnotch handout during internship. Dagdagan nyo na lang ng notes from Lippincott. For me, this is the EASIEST SUBJECT SUBJECT in the board exam. Your goal is to have a 90+ grade in this subject. ANATOMY AND HISTOLOGY • • • • • • • • • • • • • • • • Macrophage of lungs and heart (Definition) Few Upper and Lower Extremity questions Leg inversion/eversion, what muscles and nerve supply are involved. Adrenal blood supply Ureter (Blood Supplies, Water under the bridge, and other anatomical structures in relation to the ureter) Everything about the Prostate Prostate Volume in mL Brachial Plexus Dermatome Levels Hesselbach’s Triangle Hernias macrophage of placenta: hofbauer cell lining of small intestine and testes Floor of the orbit Epithelial lining of hollow organs that contract and distend Right bronchial artery is a branch of (basta know about the major arteries (subclavian, brachiocephalic, etc) and lung branches nila and yung mag sub branches) • Deep perineal space Recommended Material: TOPNOTCH MAIN HANDOUT + NETTER Recommended Samplex: UST Mock Boards (2016) + UST Post Test (2017) + Topnotch Pearls Note: Factor in the specialty of the board examiner when studying for this subject. One of the hard exams, specially the gross anatomy part. The histology part consists ~20% which was answerable. The histology part in the topnotch handout is already sufficient for your review. Study well. Tip: Read the question. DO NOT PANIC! Try to eliminate options. There are options that can be easily eliminated because they are obviously wrong. Again, do not panic! Attend Dr. Vibar’s lecture. He emphasizes the important points during the lecture. Mahirap aralin ang Anatomy, kasi memorization sha. Supplement it with Netter. Sa mga weakness ang Anatomy, tyagain sya. If kelangang magprint ng pictures at idikit sa pages ng Anatomy handout, do it. MICROBIOLOGY • VIRUS (everything about viruses); read about smallpox virus kahit eradicated na siya quasi it was asked both in the microbe and prev med exams • Bacteria (everything about bacteria) • Picornavirus (Viruses in this family) • Management of parasitic disease. • larval stage in the lungs or intestine • Malaria • Cholera • Schistosomiasis • Leptospirosis • Bubonic Plague Vector • Meningococcemia and prophylaxis • Situational questions on Anthrax vs meningitis, Dengue, Madura foot, LGV • mycobacteria can produce disease indistinguishable from tuberculosis • Most common mode of transmission of anthrax • Bacteria with synergistic effect with influenza virus • Confirmatory test – PID • Mobile genetic elements: TRANSPOSONS • Transcription, translation • Start/Stop codons • Herpes virus Recommended Material: SuperDuperUltraMega MicroPara Table (Familiarize and Master this!) Recommended Supplement Material: Sketchy Micro + Topnotch Superexam (First 200 items) Recommended Samplex: UST Mock Boards (2017) + UST Post Test (2017) Notes: One of the fair-hard subjects. Majority of the questions were clinical, know the signs & symptoms for the disease. No questions were asked regarding the descriptions of the agars/culture/tests. Know the description of the pathognomonic signs, they gave the definition but not the pathognomonic sign itself. Majority of the questions involved cases and were cascading questions in format. A few pathology concepts were asked, and many were clinical scenarios. SuperDuperUltraMega MicroPara Table is a combination of Topnotch main + supertable + FirstAid USMLE Step 1 + Micro MRS + other references. Therefore, it is the single best reviewer in Micro-Para! CHAROT! PHYSIOLOGY • Pulmonology Concepts (Restrictive vs Obstructive; Pulmonary embolism; VQ Shunting) • Physiology in OB (estrogen, progesterone etc) • Phospholamban • Filtration rate computation • Source of greatest percentage of the redistributed blood volume in case of hemorrhage • Hemophilia A • Effect of finasteride exposure on fetus • Thrombotic thrombocytopenic purpura: Decreased activity of the plasma metalloproteinase ADAMTS13 • Diet of patient with MHC class II antigen HLA-DQ2: GLUTEN-FREE DIET • circadian rhythm is controlled by which of the following nuclei: SUPRACHIASMATIC • Anxiety: GABA-A • Gastrocolic reflex Recommended Material: TOPNOTCH LECTURE + TOPNOTCH MAIN HANDOUT Recommended Supplement Material: TOPNOTCH Superexam (First 200 items) Recommended Samplex: End-of-chapter questions from BRS and Ganong, Pretest Physio Notes: The hardest subject on the first week. DO NOT MISS the topnotch lecture, it will give you clarity if you were having a hard time on this during your med school days. Equal number of questions on all concepts. Pray Pray Pray and repeat. Physiology questions are clinical. Walang lalabas sa inaral mo verbatim. Pero if naintindihan mo ang inaral mo, you will be able to answer the questions correctly. Hindi mo aaralin ang BRS Physio dahil may lalabas na tanong dun, aaralin mo sha  para para maintindihan ang Physio. Do not memorize Physio, you have to understand the concepts. LEGAL MEDICINE, ETHICS AND MEDICAL JURISPRUDENCE • Majority of questions from “Compilation of Questions in Legal Medicine and Jurisprudence for the Philippine Medical Boards (600 items)” so make sure to read this material. • CPD Units: 35 units required for MD • Administrative vs Civil vs Criminal • Damages • Licensee vs Trespasser vs Invitee • Personal disqualifications: Grounds for revocation of license • Different kinds of virginity • Concepts regarding captain of the ship doctrine, vicarious liability, ostensible agent and other related terms • Types of evidence • Rights of physicians • Indirect vs direct contempt Recommended Material: Dr. Rebosa Lecture Recommended Supplement Material: TOPNOTCH MAIN HANDOUT + Dr. Abet Rebosa’s powerpoint Recommended Samplex: Compilation of Questions in Legal Medicine and Jurisprudence for the Philippine Medical Boards (600 items) Notes: One of the easiest subjects. Familiarize yourself with the samplex and you are good to go, although some of the questions were rephrased. Secure a soft copy of the samplex entitled Legal Medicine Board Compilation (71 pages). “Pambawi” subject! Your goal is to have a 90+ grade in this subject. Read the handout during internship (first reading).  Answer the 600-item samplex with corrected answer key and explanation from Topnotch. Highlightan nyo na ang tamang sagot during internship, isulat nyo na ang rationale. PATHOLOGY • HIV • Lymphoma • microscopic characteristics of each types of hypersensitivity and examples of each (refer to topnotch handout) • Disease of the blood vessels (atherosclerosis formation) • TB (xray findings of primary and secondary TB) • Meningo • Site of hyperplasia in prostate • Hodgkin vs Non-hodgkin (everything about this, cascading question type) • Phases and Pathologic events of MI(ex. What is) • Normal PSA level based on age • BPH,Prostate cancer (know the difference in PE, appearance, etc) • Most common cause of immunodeficiency in children • Troponin elevation, how many hours post-MI? Recommended Material: Robbins & Cotran Pathologic Basis of Disease Recommended Supplement Material: TOPNOTCH Pathology Supertable + TOPNOTCH luminance lecture on pathology + TOPNOTCH Superexam (First 200 items) + Pathoma lecture videos (Dr. Sattar) Recommended Samplex: UST Mock boards (2016, 2017) + UST Post Test (2017) Notes: One of the hard subjects. 80% of the questions were cases and were cascading in format. Master the must know and general concepts in pathology. The questions were quite confusing because the examiner will add additional data and “ifs” on the previous questions. Do not rush and read the questions carefully. The reference of the examiner is the Papa Robbins, not the Mama Robbins, not the Baby Robbins!!! Wag na mag-BRS Patho. Makapal ang Topnotch Main Handout, pero tyagain. It is based from Papa Robbins. Invest time on Patho. Kapag namaster nyo ang patho, makakasagot kayo kahit papano sa clinical subjects. Pathology is the bridge between basic and clinical subjects. PHARMACOLOGY AND THERAPEUTICS • ANTI SEIZURE DRUGS (study all) • Forms of drug elimination • First order elimination • Warfarin & Heparin • Coagulation pathway • Anti arrhythmic drugs • Drug for SVT • Leuprolide given with Flutamide in prostate Ca to prevent disease flare • TB Drugs side effects and MOA (Cidal/Static) • Urology drugs • 5 a reductase inhibitor, aromatase inhibitor • can cause pulmo fibrosis (bleomycin, busulfan, nitrofurantoin, MTX to name a few) • can cause gingival hyperplasia (phenytoin) • Diuretics, diuretics, diuretics • Vasodilatory effect of furosemide is due to? • Furosemide is a high-ceiling diuretic because? • Definition of adverse drug reaction (choices were adverse drug event, side effect and adverse drug reaction) • Antibiotic that can be taken without regard to food intake (one choice in the question was Co-Amoxiclav) Recommended Material: TOPNOTCH LECTURE + TOPNOTCH MAIN HANDOUT Recommended Supplement Material: Sketchy Pharma Recommended Samplex: UST Mock boards (2016, 2017) + UST Pharma shifting exam (2016,2017) + UST Post Test (2017) Notes: One of the fair subjects. The questions were straight to the point. Familiarize yourself with the MOA and side effects of the drugs. Memorize Memorize Memorize and repeat. Nagfocus ang examiner sa secondary effects ng drugs, not on the primary effects. Like Furosemide, ang question is not about its diuretic effect, but its vasodilatory effect. SURGERY AND OPHTHALMOLOGY, OTOLARYNGOLOGY AND RHINOLOGY • Complications in parotid surgery when the facial nerve is damaged • Total thyroidectomy complications • Pancreatitis • Genital malformation • Anal abscess • Trigeminal neuralgia • Tic douloureux management • Long term management • Urology Topics • Ophthalmology topics • Scleritis • Froment sign • Ulnar nerve lesion • Neck nodes • Lesch Nyhan syndrom (wtf haha) • MTC vs papillary vs anaplastic thyroid CA surgical management (question in the boards mentioned total thyroidectomy with bilateral central neck node dissection which is usually for MTC) • PRAY!!! Recommended Material: Absite Recommended Supplement Material: TOPNOTCH SUPPLEMENT Handout + TOPNOTCH Superexam (First 200 items) Recommended Samplex: UST Mock boards (2017) + UST Post Test (2017) Notes: One of the Fair-Hard Subjects. The questions structure itself was confusing due to double negatives (e.g. all of the following except ! EXCEPT). In the past, one of the easy subjects ang Surgery. Aralin lang ang Supplement Handout ng Topnotch, OK ka na sa Surgery. Pero last September 2017 boards, isa ang Surgery sa mga subjects na nag-undergo ng mutation. Dumami ang questions on subspecialties (like ortho, etc). MEDICINE • MUST KNOWS AND MOST COMMONS • Myocardial infarction • Pericarditis • Pneumonia • COPD • Seizures • Arrhythmia • Diverticulosis/diverticulitis • Asthma Category and Management • SLE most common presentation (carditis,arthritis,vasculitis etc) • Psoriasis (from pearls) • Fixed drug eruption vs contact dermatitis • Patient with GDM. What advice will you give? She is at risk of developing overt DM. Yes, tinanong sha sa IM. • Occupational lung diseases eg exposure to refrigerant: acute effects, chronic exposure • Most common cause of midsystolic murmur • Independent risk factors for UTI Recommended Material: Harrison’s Principle of Internal Medicine + TOPNOTCH Pearls Lecture/Handout Recommended Supplement Material: TOPNOTCH MAIN HANDOUT + IM Platinum board correlates + BOARDS in a FLASH Recommended Samplex: UST Mock boards (2016, 2017) + UST Post Test (2017) Notes: One of the fair subjects. The questions were straight to the point, with a few cascading questions and cases. Few Dermatology questions were asked. Your experience during clerkship and internship will be a great help when answering the questions. Internal Medicine is a combination of Physio, Patho, Pharma, Micro, OB. The reference of the board of examiner for nonderma questions is Harrisons. Pero sino ang makakapagmemorize ng Harrisons? So kapit ka sa knowledge mo sa basic sciences + experience during clerkship and internship. Dapat mabasa mo na ang IM Platinum during internship. Mangangain sha ng time if sa actual review nyo pa lang sya ififirst read. Sabi, Dr. Aherrera (the main author of IM Platinum) will be the lecturer in IM for September 2018 boards!  ! OBSTETRICS AND GYNECOLOGY • Shoulder dystocia and management • GDM • Abruptio placenta • Placenta previa • BPS • Phases of labor • Arrest of dilation and other related concepts • Cervical cancer • Endometriosis vs adenomyosis • Teratoma • Choriocarcinoma • Ectopic pregnancy • Ovarian cancer • Menstrual cycle physiology • Ligaments • HCG peak at 8-10 weeks • Elevated HCG in 2nd trimester: Down Syndrome • Safe to fly up to 36 weeks AOG • Best time to perform congenital anomaly scan • Management for transverse lie • Staging of cervical cancer and its management • Woods corkscrew maneuver • Partial vs complete breech extraction • PCOS • Molar pregnancy: Complete vs Partial Recommended Material: FEU OB-GYNE REVIEW or DLSHSI Lectures or TOPNOTCH MAIN HANDOUT Recommended Supplement Material: BOARDS in a FLASH + TOPNOTCH Superexam (First 200 items) Recommended Samplex: UST Mock boards (2016, 2017) + UST Post Test (2017) Notes: One of the fair subjects. The questions were mainly cases and clinical scenarios. The questions were straight to the point. Clinical experience on clerkship and internship will greatly help you in this subject matter. PEDIATRICS AND NUTRITION • • • • • • • • Neonatology (RDS, TTN; know the Sign and Symptoms, Onset, Xray Findings) HIV (neuro complications, criteria, sign and symptoms) Immunodeficiency disorders (scid, agammaglobunimenia, di george syndrome) TB ALL Isoniazid Prophylaxis Murmurs viral exanthems (must now!!!) Recommended Material: TOPNOTCH LECTURE + MAIN HANDOUT or UST Pedia Board Review Recommended Supplement Material: BOARDS in a FLASH Recommended Samplex: UST Mock boards (2017) + UST Post Test (2017) Notes: One of the hard subjects. Majority of the questions were clinical scenarios and cascading in format. Many Pathology topics involved. No Growth and Development Questions asked. No EPI questions asked. No IMCI questions asked. Cascading ang questions. Manlilito ang examiner. Yung tipong may sagot ka na sa number 1, pag nabasa mo next question, magdududa ka sa sagot mo sa number 1, to the point na papalitan mo ang sagot mo sa number 1. Same format ng sa Patho (same examiner - Dr. Noche). Kaya wag magpapalito. Example of cascading questions (10 questions on immunodeficiency disorders): 1. Patient with recurrent infection... PE: absent tonsils, what is the diagnosis? a. Bruton b. DiGeorge c. Common variable immunodeficiency d. SCID 2. If the patient has recurrent infection but with enlarged tonsils and lymph nodes, what is the diagnosis? (same choices) 3. If the diagnosis is bruton, which of the following is correct? 4. If the diagnosis is CVID, which of the following is correct? 5. What will confirm your diagnosis? Master the 80+-page Topnotch handout. Memorize all the important tables. PREVENTIVE MEDICINE AND PUBLIC HEALTH • Edward Jenner • Blood donor program privileges and requirements • Medical act (R.A. 2382) • Blood donation act (R.A. 7719) • Formative vs summative evaluation • Impact evaluation • Risk factor for asthma (uncommon choices like aspirin, coffee) • Variance computation • Sensitivity vs specificity • PPV • p value interpretation • Correlation of p value with types of error (type 1 and 2) • Definition of Epidemiology • Definition of public health • Definition of bias and types of bias • Types of variables (control, confounding, etc) • Different types of studies (cohort, case control and their use) • Definition of alpha • Generation time, incubation period • Coefficient of variance; mean, median, mode • Levels of prevention (primordial, primary, secondary, tertiary) • Definition of outbreak • Antigenic drift vs shift • vaccines for pregnant patient • Tetanus Vaccine Booster dose Recommended Material: TOPNOTCH MAIN HANDOUT (BIOSTAT and EPIDEMIOLOGY part) + TOPNOTCH PEARLS Recommended Supplement Material: TOPNOTCH Superexam Recommended Samplex: UST Mock boards (2017) + UST Post Test (2017) Notes: One of the over exaggerated subjects that was said to be problematic. Few questions requiring computation. Pre Test Family Medicine and Preventive Medicine questions were low yield. Read the questions carefully, some of the answers can be found in the question itself. Your Test taking abilities will be highly required in this subject. Only around 3-5 out of the 500 questions were lifted from Pretest Family Medicine, 3-5 out of the 500 questions from Pretest Preventive Medicine, 5 questions from Jekel Epidemiology, Biostatistics, and Preventive Medicine, 3-5 questions from NMS Family Medicine. In short, the examiner uses a lot of references as sources of questions. You cannot read them all. But you can answer the questions correctly by using some test-taking strategies. SUMMARY OF RECOMMENDED REVIEW MATERIALS SUBJECT BIOCHEMISTRY MAIN (MUST-MASTER) • • • ANATOMY • • • Dr. Baticulon’s lecture Topnotch Main Handout Topnotch Pearls Handout • Dr. Vibar’s lecture Topnotch Main Handout Topnotch Pearls Handout • Netter  • Micro MRS MICROBIOLOGY • SuperDuperUltraMega Micro-Para Table PHYSIOLOGY • Dr. Banzuela’s lecture BRS Physiology • SUPPLEMENTAL Lippincott MUST-HAVE SAMPLE EXAMS • • • • • LEGAL MEDICINE • • • Dr. Rebosa’s lecture Topnotch Main Handout Dr. Abet Rebosa’s powerpoint PATHOLOGY • Topnotch Main Handout (Robbinsbased) PHARMACOLOGY • Dra. Yns Pereyra’s lecture Topnotch Main Handout Topnotch Pearls Handout • • SURGERY • Topnotch Supplement Handout MEDICINE • IM Platinum + Board Correlates OB-GYNE • PEDIATRICS • • PREVENTIVE MEDICINE • Topnotch Main Handout FEU Board Review OR Topnotch Main Handout • Med School Lectures Topnotch 80+ page handout (Memorize the tables) • Topnotch 127-page handout UST Pedia Review • Topnotch Main Handout (Biostat and Epid part) Topnotch Pearls • Ganong End-of-Chapter questions BRS End-of-Chapter questions Pretest Physiology • Compilation of Questions in Legal Medicine and Jurisprudence for the Philippine Medical Boards (600 items) • UST Mockboards, Post-test • UST Mockboards Topnotch Supertable by Dr. Elomina • • UST Mockboards / Post-test Lippincott’s End-of-chapter questions CDC website lectures on Epidemiology OPTIONAL: Pretest Family Medicine Pretest Preventive Medicine NMS Family Medicine End-of-Chapter questions Jekel Epidemiology, Biostatistics, Preventive Medicine End-of-Chapter questions • • • • TIPS: • • • • • • • • • • Two months of review is NOT enough! Nakakalula ang kapal ng mga handouts. Start reviewing during internship. Basahin na ang kayang basahin habang maaga pa Sa mga hindi kayang magpuyat at hindi kaya ang maikling tulog, magsimula nang magbasa during internship. Para may K kang matulog nang mahaba during actual review. Masarap makinig sa lecture kung kumpleto ka sa tulog. Kung hindi ka kagalingan nung medschool, internship is your bawi/catch-up time. Bawasan ang lakwatsa. For interns, seryosohin ang interns review. Wag maniniwala sa mga upper batch na magsasabi na “Wag na kayong mag-aral, hindi naman ganyan magtanong sa boards.” Bad influence sila! Allot two weeks per subject. Kasi sa actual review, magiging two days na lang yan per subject. Kung kaya mong imemorize ang 80-page handout in two days, sige, kahit hindi ka na magbasa during internship. Use only one material per subject during actual review and master it. Wag maniniwala sa “sabi ng ganitong school, ito daw ang sabi ng examiner na lalabas!” “Sa patho, tinupi raw ng examiner yung topics na kukunan nya ng tanong!” etc, etc ! WALA NI ISA MANG NAGKATOTOO! Wag maniniwala sa mga patok.  " During your mastery period, make your own pearls handout na andun na lahat ng must-knows. Yung magagamit nyo one week before the board exam. Kasi hindi nyo na kayang balikan pa ang main handouts. Wag maniniwala sa “Hindi ako nag-aral for boards. Pero nakapasa naman ako.” It’s either mayabang sya or tsumamba lang sya! Pray. Pray. Pray.