Correlation of National Medical Admission Test Scores, General

Correlation of NMAT and GWAG to PLE Scores of Medical Graduates. 69. VOL. 45 NO. 3 2011. ACTA MEDICA ... Schools are given the prerogative to set part...
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Heart Failuretoand Short Stature in a 43 year-old male Correlation of NMAT and GWAG PLE Scores of Medical Graduates ORIGINAL ARTICLE CASE REPORT

Correlation of National Medical Admission Test Scores, General Weighted and Short Stature in a 43Scores, year-old male Weighted Correlation of in National Medical Admission Test General Average Grade Pre-Medicine Courses, General Weighted Average Grade in CBC Blood chem. Urinalysis ABG 1Pre-Medicine Courses, General 1 2Average Grade 1 in Average Grade in Weighted Katerina T. Leyritana , Ma. Czarlota M. Acelajado-Valdenor , Amado O. Tandoc III and Agnes D. Mejia Medicine and the Physician Licensure amongpHMedical Reference Examination Result ColorScores straw 7.408 Reference Result Value Value and the Physician Licensure Examination Scores among Medical Medicine Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippinesof Manila Graduates of the University of the Philippines Manila College Medicine WBC RBS 3.9-6.1 6.3 Transp Clear pCO2 49.1 5-10 4.5 Department of Pathology, College of Medicine, University of the Philippines Manila Graduates of the University of the Philippines Manila College of Medicine RBC HGBA1C 4.27-6.07 6.4 Sp Gravity 1.010 pO2 70 4-6

Table 1. Initial Laboratory Results Heart Failure

1

2

HGB BUN 2.6-6.4 5.0 pH 8.0 HCO3 31.3 120-150 90 Marissa N. Teresita R. 53-115 Castillo, Pearl and Tita L.NEG DimaanoO2 sat HCT CREA 123 T. Villalon Sugar 93.6 0.38-0.48 0.27Valbuena, MCV ALBTeresita R. 34-50 32 T. Villalon Protein 21% 80-100 FL Marissa N. Valbuena, Castillo, Pearl and Tita L.NEG DimaanoFiO2 MCH TAG 0.34-1.7 0.82 RBC 0-1 Temp 36.9 27-31 PG College of Medicine, University of the Philippines Manila MCHC HDL 0.91-1.56 0.67 WBC 0-2 320-360 G/L College University of the RDW LDL of Medicine,1.1-3.8 4.21Philippines Manila Cast PBS 11.5-15.5% PLT TOTAL CHOL 4.2-5.2 5.25 regularEpith cell use. There Rare wasSlight 200-400Presentation Incof the case require laxative also poikilocytosis, a report of two RETIC AST 95 syncopal Bacteria Occ’l brought 0.005-0.015 more episodes. He was to another doctor This is a case of a 43-year-old male presenting with 15-37 short acanthocytes, ovalocytes, Introduction SEG ALT 30-65 91 Mucus th Rare 50-70% 48 slight toxic granulation, in a Student private hospital where the assessment was still a “heart stature and heart failure. The patient was admitted at the selection in a medical school which accepts a LYMPH Alk po4 184 Crystals Introduction Rare 20-44% 50 slight anisocytosis problem”. The patient was again prescribed unrecalled medicine ward of the Philippine General Hospital (PGH) large numberselection of in relation to the available slots Student school which accepts a MONO NA 140-148 136.9 Amapplicants uratesin a medical 2-9% 2 medications and again lost to follow-up. This time, for This paper will investigate several issues: EO dyspnea.0-4% K 3.6-5.2 3.35number seems to be easy, accept was theinbest applicants. reality, any 0 large of applicants relation to the In available slots BASO CL hypothyroidism, 100-108 86 to 0-2% 0 however, symptoms were persistent. He later at differentiating congenital from acquired mode of be assessment forthe student selection implicitly seems easy, accept best applicants. Inisconsulted reality, any BLAST CA++ 2.37 local hospital, where he was admitted and managed 0% another the relationship between 0 hypothyroidism and 2.12-2.52 the predicting future behavior of an applicant, is, the mode of assessment for student selection isthat implicitly P 2.27 as a case of anemia and bronchial asthma. He wasthat discharged cardiomyopathies, and the therapeutic options in patients selected applicants will be of “good students” and “good predicting future behavior an applicant, is, the MG++ 0.74-1 0.83

with cardiomyopathy secondary to hypothyroidism. The patient had been born full term to a then 31-yearold Gravida 4 Para 3 (G4P3), the 4th of 9 siblings, with an apparently unremarkable delivery at home facilitated by Table 2. Thyroid Function Tests a traditional birth attendant. He was noted to be normal Reference Value Result at birth. The patient was allegedly at par with age both Free T4 (0.8-2.0) 0.02 ng/dL physically and mentally until eight years old TSH (0.4-6.0) 24.75when Uiu/mlhe was said to have stopped growing in height. He was brought to a private doctor, whose diagnosis was undisclosed, and he was given medications to increase height, which the patient took for only one month with no improvement. Through the years, the patient was apparently well, although still of short stature, with thick lips, coarse facial features and dry skin. He was notably slow in ambulation. He was said to have bronchial asthma at age 15 years, and since then he had been taking salbutamol tablets occasionally for bouts of dyspnea occurring one to two times annually. The patient’s symptoms started in 2001 when he was reported to have sudden loss of consciousness. During this time, the patient did not have any symptoms of heart failure; no prior seizures, cyanotic episodes, chest pain, headache, or blurring of vision. He regained consciousness shortly after and was brought to a private physician, whose assessment was a “heart 1. problem”. He was prescribed unrecalled medications Figure Electrocardiogram upon admission taken for a few months and eventually discontinued when the syncopal episode did not recur. transferred to thefour intensive (ICU)would for ventilatory In the next years,care theunit patient develop support and closer monitoring. On bedside cardiacand ultrasound, intermittent, progressive exertional dyspnea bipedal ________________ there was a finding eccentric left ventricularbyhypertrophy, edema. Later on thisofwould be accompanied generalized Corresponding author: Marissa Valbuena, MD, MHPEd ________________ global hypokinesia with N. depressed overall systolicenough function body weakness, anorexia, and constipation, severe to College of Medicine spontaneous echo contrast on left ventricular with concomitant Corresponding author: Marissa N. Valbuena, MD, MHPEd University of the Philippines Manila College of Medicine (LV) cavity suggestive of rheologic the ejection fraction 547 Pedro Gil St., PO Box 593,Ermita, Manila stasis, 1000 Philippines University of the Philippines Manila Corresponding author: Ma. Czarlota Acelajado-Valdenor, M.D. was 25%, with moderate mitral regurgitation, moderate Telephone: +632 5361392 547 Pedro Gil St., PO Box 593,Ermita, Manila 1000 Philippines Department of Medicine Fax No: +632 5260371 aortic regurgitation with aortic sclerosis, severe tricuspid Telephone: +632 5361392 Philippine General Hospital Email: [email protected] Fax +632 5260371 regurgitation with mild pulmonary hypertension, pulmonary TaftNo: Avenue, Manila, 1000 Philippines Email: [email protected] Telephone: +632and 554-8488 regurgitation, minimal pericardial effusion or pericardial Email: [email protected]

VOL. 43 NO. N0. 432009 VOL. 45 2011 PHILIPPINA 12 ACTA MEDICA

slightly improved after fourbedays, onlystudents” to have recurrent heart doctors”. selected applicants will “good and “good failure symptoms, prompting admission at PGH. The University of the Philippines Manila College of doctors”. Upon admission thethe was inManila mild respiratory Medicine (UPCM) has 2 patient modes of entry to its 7 year The University of Philippines College of fat pad. Cardiac enzymes were not consistent with anFirst acute distress, with stable vital signs and no note of fever. Integrated Arts and has Medicine Program (Intarmed). is Medicine (UPCM) 2 modes of entry to itsPertinent 7 year coronary event (Table 3), however, intravenous (IV) heparin physical included short thick lips, nonby direct exam entry to its Learning Unit 1, stature, where 40 students are Integrated Artsfindings and Medicine Program (Intarmed). First is (overlapping withedema, oral warfarin) was still toscorers cover for pitting periorbital dry skin, a 1, displaced apical impulse, accepted from topLearning 50 male and top 50given female in by direct entry the to its Unit where 40 students are the presence ofoflung a the possible LV thrombus as demonstrated crackles on both fields, and bilateral bipedal the University Philippines College Admission Test accepted from the top 50 male and top 50non-pitting female scorers in by rheologic stasisalso on a cardiac ultrasound. Medications edema. There was 3 cm x 3 cm reducible umbilical (UPCAT). The second by lateral entry of 120 graduates of the University of the isPhilippines College Admission Test were shifted to IVthere diuretics and inotropes; oral digoxin was hernia. However, no pallor, noUnit neck distention, a(UPCAT). baccalaureate program to Learning 3.vein The second iswas byits lateral entry of 120 graduates of started. IV antibiotics were given for possible pulmonary no apparent congenital malformations, no cardiac murmurs The National Medical Test3.(NMAT) is a a baccalaureate program to itsAdmission Learning Unit infection. The patient later on showed improvement, and was and The no clubbing. no anote ofby an(NMAT) anterior medical admissions test was givenalso twice year the Centerneck NationalThere Medical Admission Test isfora eventually weaned off from ventilatory support, extubated, mass. Educational Measurement and is ataken bythe students or medical admissions test given twice year by Center for Laboratory workup showed cardiomegaly with pulmonary graduates who intend to apply toisa medical school. Schools Educational Measurement and taken by students or congestion, thoracic dextroscoliosis, atheromatous aorta by Table 3. Cardiac Enzymes are given the prerogative to set particular NMAT scores that graduates who intend to apply to aand medical school. Schools chestbe radiograph, left ventricular hypertrophy byto 12-lead will needed toand satisfy eligibility for admission their are given the prerogative toRange set particular NMAT scores that Reference (mmoL) Result electrocardiogram (12-L ECG) (Figures 1 and 2), normocytic 1 Only applicants with NMAT scores of 90 institution. will be needed to satisfy eligibility for admission to their Qualitative POSITIVE normochromic anemia (Hgb 90 mg/dL), for dyslipidemia, and Troponin I 1 orOnly percentile higher are considered lateral of entry applicants with NMAT scores 90 institution. pre-renal azotemia (serum creatinine 123 mmoL). Electrolytes CK-MB 0-6.0 1.14 admission to the UPCM. The requirement of NMAT scores percentile or higher are considered for lateral entry 21-232 543 onCK-TOTAL showed slight hyponatremia, hypokalemia, of 90admission percentile higher, however, does not to scores direct admission to theorUPCM. The requirement ofapply NMAT and hypochloremia (serum Na 136, K 3.35, Cl 86). Blood gases entrants. While they are required to take the examination, of 90 percentile or higher, however, does not apply to direct revealed partially compensated metabolic alkalosis with mild performance in the does chances for entrants. While theysaid are exam required to not takeaffect the examination, hypoxemia. The patient was noted to be hypothyroid based acceptance to LU 3. Enrollment (or promotion) to Learning performance in the said exam does not affect chances for on elevated serum thyroid-stimulating hormone (TSH) and Unit 3 (first year medicine proper) is assured provided acceptance to LU 3. Enrollment (or promotion) to Learning markedly decreased serum free thyroxine (FT4). The exact students satisfactorily completes all required for Unit 3 (first year medicine proper) is assuredcourses provided values are shown in Tables 1 and 2. Learning 1 and 2. completes all required courses for students Units satisfactorily Upon admission to the wards, the patient was managed A major Learning Units criterion 1 and 2. employed by the UPCM in the as having congestive heart failure from cardiomyopathy selection of lateral entrants is past by academic performance, A major criterion employed the UPCM in the secondary to acquired hypothyroidism. Oral loop diuretics, mainly general weighted average grade (Pre-Med selectiontheir of lateral entrants is past academic performance, angiotensin-converting enzyme (ACE) inhibitors, betaGWAG) in their undergraduate An interview is mainly their general weighted program. average grade (Pre-Med blockers, statins, and levothyroxine were started. Electrolyte also usedintotheir evaluate an applicant’s attitude, motivation, GWAG) undergraduate program. An interview is correction was instituted. The sections of Endocrinology study habits, leadership, high work standards and also used to evaluate an applicant’s attitude, motivation, and Cardiovascular Diseases were co-managing the patient communication among others. The comparable to study habits, skills, leadership, high work standardsdata and together with the General Medicine service. the baccalaureate or pre-Med GWAGThe of comparable the lateral entrants communication skills, among others. data to He soon developed respiratory failure, upon which the the baccalaureate or pre-Med GWAG of the lateral entrants considerations were acute pulmonary congestion, nosocomial Figure 2. Chest radiograph on admission pneumonia, to rule out an acute coronary event. He was later VOL. 43 N0. 4 2009 ACTA PHILIPPINA ACTA MEDICA MEDICA PHILIPPINA 13 69

Correlation of NMAT and GWAG to PLE Scores of Medical Graduates CASE REPORT

is the GWAG of the direct entrants in the first 2 years of the 7Stature the grades baccalaureate course (4 years) for the Heart Failure and Short in afor 43the year-old male year program. lateral entrants. 1 1 Medical graduates are required to takeM. and pass the Katerina T. Leyritana , Ma. Czarlota Acelajado-Valdenor , Amado O. Tandoc III2 and Agnes D. Mejia1 Physician Licensure Examinations (PLE) given by the Board Table 2. Number of students who graduated on time and of Medicine,Regulation College of Medicine and Philippinetook General Hospital, University of thegraduation Philippines Manila of Medicine of1Department the Professional Commission PLE immediately after 2 Department of Pathology, College Medicine, University of the Philippines Manila (PRC) after a one-year internship training to be ableof to Year Graduated Direct Lateral Total practice medicine as a profession in the Philippines. 2 The 2004 21 109 130 performance of the graduates of a medical school (passing 2005 34 104 138 rate) is often used as a yardstick of the quality of education 2006 29 96 125 provided by the school. 2007 26 111 137 2008 28 110 138 This study was undertaken to determine if NMAT 2009 38 114 152 scores correlate toPresentation general weighted average grade in the requireTotal regular laxative use. There was also a report of two of the case 176 644 820 more syncopal episodes. He was brought to another doctor This is a case of a 43-year-old male presenting short preparatory Medicine course (Pre-Med GWAG),with medical in a private hospital where the assessment was still a “heart stature general and heart failure. average The patient admitted at and the school weighted gradewas (Med GWAG) Table 3. NMAT scores problem”. The patient was again prescribed unrecalled medicine ward of thestudy Philippine General Hospital (PGH) the PLE scores. This also aimed to determine if the medications and again lost to follow-up. This time, for dyspnea. This paper will investigate several issues: Med GWAG correlates to Pre-Med GWAG and PLE scores. Directwas entrant Lateral entrant Year Graduated however, symptomsn were persistent. He later consulted differentiating congenital from acquired hypothyroidism, NMAT Mean n NMAT Mean at 2004 21 where 95.90 109 another local hospital, he was admitted and 94.03 managed the relationship between hypothyroidism and the Methods 2005 34 96.47 104 95.99 as a case of anemia and bronchial asthma. He was discharged cardiomyopathies, and the therapeutic options in patients Records of graduates of the UPCM from 2004 to 2009 2006 29 96.21 96 96.67 slightly2007 improved after days, only to have with cardiomyopathy to hypothyroidism. were retrieved and secondary data regarding the following entry 26 four 94.19 111 recurrent 95.12 heart failure symptoms, prompting admission at PGH. The patient had been born full term to a then 31-year2008 28 95.71 110 96.64 characteristics were collected: National Medical Admissions th 2009 38 95.95 114 96.40 Upon admission the patient was in mild respiratory old Gravida 4 Para 3 (G4P3), the 4 of 9 siblings, with an Test (NMAT) scores, pre-Medicine general weighted average Total 176 95.79 644 95.79 distress, with stable vital signs and no note of fever. Pertinent apparently unremarkable delivery at home facilitated by grade (Pre-Med GWAG), medical school general weighted p=0.8380 physical exam findings included short stature, thick lips, nona traditional birth attendant. He was noted to be normal average grade (MedGWAG). Average and individual subject pitting periorbital edema, dry skin, a displaced apical impulse, at birth. The patient was allegedly at par with age both scores in the PLE were also retrieved for this study. Included Table 4. Pre-Med GWAG crackles on both lung fields, and bilateral non-pitting bipedal physically and were mentally eight years when he who was for analyses datauntil obtained fromoldstudents edema. There was also a 3 cm x 3 cm reducible umbilical said to haveonstopped growing height. was brought to graduated time and took inthe PLE He immediately after Direct entrant Lateral entrant Year hernia. However, there was no pallor, no neck vein distention, a private doctor, whose diagnosis was undisclosed, and he Graduated n Pre-Med GWAG (LU1-2) n Pre-Med GWAG graduation. Statistical analysis using the Pearson correlation 2004 21 1.63 109cardiac murmurs 1.72 no apparent congenital malformations, no was given medications increase height, which the patient analysis was performed to using STATA. 34 There was1.64 1.70 neck and 2005 no clubbing. also no note 104 of an anterior took for only one month with no improvement. Through the 2006 29 1.62 96 1.65 mass. years, the patient was apparently well, although still of short Results 2007 26 1.86 111 1.74 Laboratory workup showed stature, with thick2 lips, coarse facial dry skin. 2008 28 1.70 cardiomegaly 110 with pulmonary 1.66 Tables 1 and list the number of features students and admitted, the 2009 38 1.70 114 1.64 congestion, thoracic dextroscoliosis, and atheromatous aorta by He was notably slow who in ambulation. saidand to have number of students graduatedHeonwas time who Total 176 and left ventricular 1.69 644 1.69 chest radiograph, hypertrophy by 12-lead bronchial asthma at age 15 years, and since then he had been immediately took the PLE. The NMAT scores of the electrocardiogram (12-L ECG) (Figures 1 and 2), normocytic taking salbutamol tablets occasionally for bouts of dyspnea graduates from 2004 to 2009 are summarized in Table 3. The Table 5 shows the average Med GWAG were 2.10 and normochromic anemia (Hgb 90 mg/dL), dyslipidemia, and occurring onescores to tworanged times annually. mean NMAT from 94-96.67. The average score 2.09 for the direct and lateral entrants, respectively. There is pre-renal azotemia (serum creatinine 123 mmoL). Electrolytes symptoms started in 2001 when was for The the 6patient’s classes was 95.53. Mean NMAT scores of thehedirect no statistical difference in the Med GWAG between the 2 on admission showed slight hyponatremia, hypokalemia, reported to have sudden loss of consciousness. During this entrant group (95.69) and the lateral entrant group (95.61) groups (p= 0.1732). (serum Na 136, K 3.35, Cl 86). Blood gases and hypochloremia time,not thediffer patient did not have any symptoms of heart failure; did significantly from each other (p=0.8380). revealed partially compensated metabolic alkalosis with mild no prior seizures, cyanotic episodes, chest pain, headache, or Table 5. Medical schoolwas general average based grade hypoxemia. The patient noted weighted to be hypothyroid blurring of vision. He regained consciousness shortly after and Table 1. Number of students by type of admission (Med GWAG) on elevated serum thyroid-stimulating hormone (TSH) and was brought to a private physician, whose assessment was a markedly decreased serum free thyroxine (FT4). The exact “heart problem”. He was prescribed unrecalled medications Class Direct entrant Lateral entrant Direct entry Lateral entry Year Graduated values are shown in Tables 1 and 2. taken when (Yearfor of a few months and eventually discontinuedTotal n Med GWAG n Med GWAG Number didPercent Number Percent graduation) Upon was 2.13 managed the syncopal episode not recur. 2004admission21to the wards, 2.17 the patient 109 17.72 82.28 158 2005 congestive 34 heart 2.17 104 cardiomyopathy 2.12 as having failure from In2004the next 28four years, the 130 patient would develop 2005 39 25.49 114 74.51 153 2006 to acquired 29 hypothyroidism. 2.12 96 loop 2.10 secondary Oral diuretics, intermittent, progressive exertional123dyspnea 2006 37 23.13 76.88and bipedal 160 2007 26 2.09 111 2.11 2007 Later on 34 21.12be accompanied 127 78.88 161 angiotensin-converting enzyme (ACE) inhibitors, betaedema. this would by generalized 2008 28 2.10 110 2.09 37 24.18 116 75.82 enough 153 to blockers, statins, and levothyroxine were started. Electrolyte body2008 weakness, anorexia, and constipation, severe 2009 38 2.00 114 2.01 2009 42 25.77 121 74.23 163 Total was instituted. 176 2.10 sections644 2.09 correction The of Endocrinology and Cardiovascular Diseases were co-managing the patient Corresponding author: the Ma. Czarlota M.D. and Table 4 shows Pre-MedAcelajado-Valdenor, GWAG of the direct Table 6 shows the average PLEservice. scores of the graduates. together with the General Medicine Department of Medicine lateral entrants. No comparison between the two groups was There was no statistical difference between the mean He soon developed respiratory failure, upon whichPLE the Philippine General Hospital made because the of the Pre-Med GWAG was Taft Avenue, Manila, 1000basis Philippines score of the direct (80.67) and the lateral entrants considerations wereentrants acute pulmonary congestion, nosocomial different; in LU 1 and LU 2 for the direct entrants and Telephone: grades +632 554-8488 (80.24) p=0.1732. pneumonia, to rule out an acute coronary event. He was later Email: [email protected]

70 ACTA 12 ACTA MEDICA MEDICA PHILIPPINA PHILIPPINA

VOL.45 43NO. N0. 43 2009 VOL. 2011

Heart Failuretoand Short Stature in a 43 year-old male Correlation of NMAT and GWAG PLE Scores of Medical Graduates

Table Laboratory Results Commission Board of Table 1.6.Initial Professional Regulation Medicine Physicians Licensure Examination (PLE) mean CBC Blood chem. scores

Reference Reference Result Value Value Direct entrant Lateral entrant Year Graduated WBC RBS 3.9-6.1 5-10 4.5 n PRC PLE n PRC PLE RBC HGBA1C 4.27-6.07 4-6 2004 21 78.88 109 78.58 HGB 2005 BUN 2.6-6.4 120-150 34 90 79.40 104 79.06 HCT 2006 CREA 0.38-0.4829 0.27 79.59 96 79.26 53-115 MCV 2007 ALB 80-100 FL 26 81.08 111 80.70 34-50 MCH 2008 TAG 27-31 PG28 81.70 110 81.52 0.34-1.7 MCHC2009 HDL 320-360 38 G/L 82.59 114 82.07 0.91-1.56 RDW Total 11.5-15.5% LDL 176 80.67 644 80.24 1.1-3.8 PLT TOTAL CHOL 4.2-5.2 200-400 Inc RETIC AST 15-37 0.005-0.015 The grading system of the university is that the highest SEG ALT 30-65 50-70% 48 grade is 1.0 and the lowest passing grade 3.0, conditional LYMPH Alkispo4 20-44% 50 failure and failure is 5.0. The correlation coefficient MONOis 4.0 2-9% NA 140-148 2 EO 3.6-5.2 between the 0-4% NMAT and the0 Pre-Med KGWAG is negative BASO CL 100-108 0-2% 0 because the lower the GWAG, the higher the grade. There BLAST CA++ 2.12-2.52 0% 0 was a significant weak linear correlation P between NMAT score and Pre-Med GWAG in classes The MG++2006-2009. 0.74-1

correlation in class 2004 and 2005 was not significant. There was moderate correlation between NMAT and Pre-Med GWAG among direct and lateral entrants in 2006, Table 2. Thyroid direct entrants in Function 2005 andTests lateral entrants in 2004 (Table 7). Reference Value

Result

Table Pre-Med Free T47. Correlation between (0.8-2.0) NMAT Score 0.02and ng/dL TSH (0.4-6.0) 24.75 Uiu/ml GWAG Year Graduated

n

2004 2005 2006 2007 2008 2009

21 34 29 26 28 38

Direct entrant correlation coefficient -0.3940 -0.5804 -0.6356 -0.3686 -0.3314 -0.1651

p value 0.0772 0.0003 0.0002 0.0639 0.0849 0.3220

n 109 104 96 111 110 114

Lateral entrant correlation p coefficient value -0.4288 < 0.0001 -0.3137 0.0012 -0.4191 < 0.0001 -0.3767 < 0.0001 -0.1673 0.0806 -0.2883 0.0019

Table 8 presents the correlation between NMAT scores and Medicine GWAG. Significance was noted for the 2006 and 2009 graduates of the direct entrant group and 2004, 2005, 2006 and 2009 for the lateral entrant group. Table 8. Correlation of NMAT Score and Medicine GWAG Figure 1. Electrocardiogram Direct entrant upon admission Lateral entrant Year Graduated

Correlation p Correlation p N N coefficient Value coefficient Value 2004 21 109 (ICU) -0.4288 < 0.0001 transferred to the-0.1916 intensive 0.4053 care unit for ventilatory 2005 and34 0.0812 104 -0.3737 ultrasound, 0.0012 support closer-0.3933 monitoring. On bedside cardiac 2006 29 -0.5490 0.0020 96 -0.4191 < 0.0001 there was a26finding of eccentric left ventricular hypertrophy, 2007 -0.1918 0.3480 111 -0.1918 0.3480 global with depressed overall systolic function 2008 hypokinesia 28 -0.2815 0.1467 110 -0.2815 0.1467 2009 38 -0.4885 0.0019 114 -0.4885 0.0019 with concomitant spontaneous echo contrast on left ventricular

(LV) cavity suggestive of rheologic stasis, the ejection fraction the Pre-Med Medicine moderate GWAGs was Correlation 25%, with of moderate mitral and regurgitation, revealed a significantwith positive all classes for aortic regurgitation aorticcorrelation sclerosis, in severe tricuspid both direct and entrants (Table 9). Note that this regurgitation withlateral mild pulmonary hypertension, pulmonary correlation for the direct with regurgitation,was and stronger minimal pericardial effusionentrants or pericardial VOL. 45 43 NO. N0. 432009 VOL. 2011

correlation coefficients ranging from 0.7438 (2005) to 0.8365 (2008). Urinalysis

ABG

Result Color pH 7.408 Table 9. Correlation between straw Pre-Med GWAG and Medicine GWAG 6.3 Transp Clear pCO2 49.1

6.4 Sp Gravity 1.010 pO2 70 Direct entrant Lateral entrant31.3 5.0 pH 8.0 HCO3 Year Correlation p Correlation 93.6p 123 Sugar NEG Graduated N N O2 sat coefficient Value coefficient 21% Value 32 Protein NEG FiO2 2004 21 0.7512 0.0001 109 Temp 0.6406 < 0.0001 0.82 RBC 0-1 36.9 2005 34 0.7438 0.0000 104 0.4846 < 0.0001 0.67 WBC 0-2 2006 29 0.7974 0.0000 96 0.5219PBS < 0.0001 4.21 Cast 2007 26 Epith 0.7262 0.0000 < 0.0001 5.25 cell Rare 111 Slight0.3867 poikilocytosis, 2008 28 0.8364 0.0000 110 0.4362 < 0.0001 95 Bacteria Occ’l 2009 38 -0.0349 0.8353 114 acanthocytes, 0.5212 ovalocytes, < 0.0001 91 Mucus th Rare slight toxic granulation, 184 Crystals Rare slight anisocytosis 136.9 Am and urates PLE scores had moderately strong The NMAT 3.35 correlation among lateral entrants of 2004 and 2006 and 86 direct 2.37 entrants of 2005. There was a strong correlation among 2.27 direct entrants of 2006. (Table 10) 0.83

Table 10. Correlation of NMAT and PLE Scores fat pad. Cardiac Direct enzymes were not consistent an acute entrant Lateralwith entrant Year Correlation p Correlation p coronary event (Table 3), however, intravenous (IV) heparin Graduated N N coefficient Value was stillcoefficient Valuefor (overlapping with oral warfarin) given to cover 2004 21 0.0167 0.9428 109 0.4501 < 0.0001 the 2005 presence of a0.5151 possible 0.0018 LV thrombus as demonstrated 34 104 0.3628 0.0002 by 2006 rheologic on cardiac 29 stasis 0.6494 0.0001 ultrasound. 96 0.4618Medications < 0.0001 2007 0.7055inotropes; 111 0.3467 0.0002 were shifted26to IV 0.0778 diuretics and oral digoxin was 2008 28 0.1826 0.3525 110 0.1154 0.2300 started. IV antibiotics were given for possible pulmonary 2009 38 0.1845 0.2675 114 0.1963 0.0363 infection. The patient later on showed improvement, and was eventually weaned off from ventilatory support, extubated, Table 11 shows very strong correlation between PreMed GWAG and PLE scores among direct entrants in 2005, Table 3. Cardiac Enzymes and strong correlation in 2004, 2006 and 2008. Among lateral entrants, moderately strong correlation between Reference Range (mmoL) Result Pre-Med GWAG and PLE scores in 2004, 2006 and 2009 was noted. Qualitative POSITIVE Troponin I CK-MB 0-6.0 1.14 Table 11. Correlation between Pre-Med GWAG CK-TOTAL 21-232 543 and PLE

scores

Year Graduated

N

2004 2005 2006 2007 2008 2009

21 34 29 26 28 38

Direct entrant Correlation p coefficient Value -0.6737 0.0008 -0.8333 0.0000 -0.7414 0.0000 -0.3301 0.0995 -0.7593 0.0000 -0.3809 0.0182

N 109 104 96 111 110 114

Lateral entrant Correlation p coefficient Value -0.4911 < 0.0001 -0.2878 0.0030 -0.4655 < 0.0001 -0.3232 0.0005 -0.2542 0.0074 -0.4712 < 0.0001

There is significant strong to very strong correlation between the Medicine GWAG and the PLE scores in all classes except for direct entrants in 2007 where the correlation is moderately strong. (Table 12) Figure 2. Chest radiograph on admission ACTA ACTA MEDICA MEDICA PHILIPPINA PHILIPPINA 71 13

Correlation of NMAT and GWAG to PLE Scores of Medical Graduates CASE REPORT

Table 12. Correlation of Med GWAG and PLE scores Heart Failure and Short

or content licensures male examinations Stature in a of43the year-old

would cover comparable areas of knowledge as that covered in medical entrant 1, Ma. Czarlota Lateral 1 school.1, Amado Aside from considering the D. UPCM imposes Katerina T.Direct Leyritana M.entrant Acelajado-Valdenor O. this, Tandoc III2 and that Agnes Mejia Year Correlation p Correlation p a high requirement on NMAT scores among its admitted Graduated N N coefficient Value coefficient Value 1 Department of Medicine, College of Medicine and Philippinestudents General Hospital, of the Manila percentile) it Philippines would be expected that the (>90 University 2004 21 -0.7229 0.0002 109 -0.7472 < 0.0001 2 Department of Pathology, College of Medicine, University of the Manilawould be homogenous, thus NMAT scores ofPhilippines its graduates 2005 34 -0.7747 0.0000 104 -0.7797 < 0.0001 2006 29 -0.8182 0.0000 96 -0.8569 < 0.0001 resulting in low correlations. Note that the weak correlation 2007 26 -0.4737 0.0145 111 -0.7523 < 0.0001 of NMAT scores to PLE scores observed in the present study 2008 28 -0.8222 0.0000 110 -0.7757 < 0.0001 differed from findings reported by Donnon et al in their 2009 38 -0.7229 0.0000 114 -0.8174 < 0.0001 study correlating the MCAT (Medical College Admission Test) which is widely used in the US and Canada as a Discussion screening tool, laxative to performance schoolof and require regular use. There in wasmedical also a report two Presentation of the case Previous studies had been conducted to determine if more syncopal episodes. He was brought to another doctor This is a case of a 43-year-old male presenting with short licensing examinations. In their study, Donnan et.al found admissions criteria utilized by the UPCM had any in where the assessment was still a “heart stature andtoheart failure. The patient was admitted at the thea private MCAT hospital to have a relatively consistent and good correlation performance in medical school. A study by problem”. The patient was again prescribed unrecalled medicine ward of the Philippine General Hospital (PGH) predictive validity for performance in both medical school Catbagan on lateral entrant graduates of UPCM in 19865 lost to follow-up. This time, medications again was for dyspnea. will GWAG investigate and licensing and examinations. 1994, reportedThis that paper Pre-Med and several NMAT issues: scores however, symptoms were persistent. later consulted in at differentiating congenital from acquired hypothyroidism, While there are other factors takenHe into consideration correlated well with the average grades in the basic science another local hospital, where he was admitted and managed the relationship between hypothyroidism and the 3 determining admission of students to the UPCM, the present subjects in medical school. Gonzales and Salonga also as a case of anemia bronchial asthma. He was cardiomyopathies, the therapeutic options study focused only and on NMAT scores and pre Meddischarged GWAG as conducted a study and to validate admissions criteriainofpatients UPCM slightly improved after four days, only to have recurrent with cardiomyopathy secondary to hypothyroidism. possible predictors of future performance. Other factorsheart that where delay in graduation was utilized as the outcome failure prompting admissioneven at PGH. The patient beenreported born fullthat termamong to a then 4 This had could symptoms, possibly affect and perhaps predict future study the31-yearlateral measure. Upon admission the patient in mild respiratory old Gravida Para 3 (G4P3), the 4th ofdelay 9 siblings, with an performance of applicants in was medical school include entrants who4 graduated in 1994-1995, in graduation distress, with stable vital signs and no note of fever. Pertinent apparently unremarkable delivery at home facilitated by students’ attitude, motivation, study habits, leadership, high correlated with NMAT scores < 85 percentile. physical exam findings included shortskills. stature,These thick are lips,taken nona traditional birth attendant. He towas noted to be normal work standards and communication The current study also aims determine if two of the pitting periorbital edema, dry skin, a displaced at birth.forThe patient to was par withnamely age both into consideration thru structured interviewapical and impulse, may be criteria admission UP allegedly College ofatMedicine, the crackles on both lung fields, and bilateral non-pitting bipedal physically and mentally until eight years old when he was subject of future investigations. NMAT score and Pre-Med GWAG could be predictive of edema. There was also a 3 cm x 3 cm reducible umbilical said to have stopped growing in height. He was brought to performance in medical school. The Pre-Med GWAG hernia. However, there was no pallor, no neck vein distention, a private doctor, whoseacademic diagnosis was undisclosed, and he __________________ represents a student’s performance for 4 years of no apparent congenital malformations, no cardiac murmurs was given medications to increase height, which the patient study for the lateral entrants and 2 years for the direct Acknowledgment and no clubbing. There was also no note of an anterior neck took for only one month with no improvement. Through the entrants while the NMAT is a reflective of academic The authors thank Ms. Katherine Salazar for her assistance in the mass. years, the patient was apparently well, although still of short performance for a single examination. The current study statistical analysis. Laboratory workup showed cardiomegaly with pulmonary stature, with thick lips, coarse facial features and dry skin. showed that the NMAT score and the pre-Med GWAG had congestion, thoracic dextroscoliosis, and atheromatous aorta by He was notably slow in ambulation. He was said to have weak correlation to each other. In terms of the ability for __________ chest radiograph, and left ventricular hypertrophy by 12-lead bronchial asthma at age 15 years, and since then he had been these 2 criteria to predict good academic performance in electrocardiogram (12-L ECG) (Figures 1 and 2), normocytic taking salbutamol tablets occasionally for bouts of dyspnea References Medicine, the Pre-Med GWAG had moderate to strong normochromic anemia (Hgb03,90Series mg/dL), occurring one to two times annually. 1. CHED Memorandum Order of 2003.dyslipidemia, Determination ofand the correlation to the Medicine GWAG while the NMAT score national medical admission test (NMAT)123 cut-off score and opening of pre-renal azotemia (serum creatinine mmoL). Electrolytes The patient’s symptoms started in 2001 when he was had weak to moderate correlation. The findings would new medical program. on admission showed slight hyponatremia, hypokalemia, reported to have sudden loss of consciousness. During this 2. Bellosillo JN, Castro BC, Mapili EL, Rebosa AD, Rebosa AD. Basics of therefore imply that Pre-Med GWAG was better able to and hypochloremia (serum Na 136, K 3.35, Cl 86). Blood gases time, the patient did not have any symptoms of heart failure; Philippine Medical Jurisprudence and Ethics. Quezon City:Central Book predict student performance in medicine. Note that the revealed partially metabolic alkalosis with mild no prior seizures, cyanotic episodes, chest pain, headache, or Supply, Inc; 2010.compensated pp.650-668. present study excluded graduates who were delayed in 3. Catbagan The AB. patient Predictivewas validity of the admissions criteria based of the hypoxemia. noted to be hypothyroid blurring of vision. He regained consciousness shortly after and graduation. University of the Philippines College of Medicine on academic on elevated serum thyroid-stimulating hormone (TSH) and was brought to a private physician, whose assessment was a performance. 2000 (unpublished) In terms of correlation with PLE scores, the Medicine markedly decreased thyroxine exact “heart problem”. He was prescribed unrecalled medications 4. Gonzales JL, Salongaserum AM. Afree preliminary study(FT4). on theThe admissions GWAG had the highest correlation followed by Pre-Med criteria of the College of Medicine values are shown in Tables 1 andof2.the University of the Philippines. taken for a few months and eventually discontinued when GWAG, then NMAT scores. This implies that among the 2000 (unpublished) Upon admission to the wards, the patient was managed the syncopal episode did not recur. 5. Donnon T, Paolucci EO, Violato C. The predictive validity of the MCAT three variables, the Medicine GWAG would be the best as having congestive heart failure from cardiomyopathy In the next four years, the patient would develop for medical school performance and medical board licensing predictor of success in the Physicians Licensure secondary to acquired hypothyroidism. Oral loop diuretics, intermittent, progressive exertional dyspnea and bipedal examinations: a meta-analysis of the published research. Acad Med. Examinations. One would expect the Medicine GWAG to 2007; 82(1):100-6. angiotensin-converting enzyme (ACE) inhibitors, betaedema. Later on this would be accompanied by generalized have stronger correlation to the PLE scores in comparison to blockers, statins, and levothyroxine were started. Electrolyte body weakness, anorexia, and constipation, severe enough to Pre-Med GWAG and NMAT scores in as much as the subject correction was instituted. The sections of Endocrinology and Cardiovascular Diseases were co-managing the patient Corresponding author: Ma. Czarlota Acelajado-Valdenor, M.D. together with the General Medicine service. Department of Medicine He soon developed respiratory failure, upon which the Philippine General Hospital Taft Avenue, Manila, 1000 Philippines considerations were acute pulmonary congestion, nosocomial Telephone: +632 554-8488 pneumonia, to rule out an acute coronary event. He was later Email: [email protected]

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