Final and midterms Physical Diagnosis-Orginal

Midterm Physical Diagnosis (04.12.2020) 1. During the assessment of the patient with left ventricular failure you check the radial pulse, which has the force changing from beat to beat. Which one from the following pulses is described? A. Irregularly irregular pulse B. Pulsus alternans C. Paradoxical pulse D. Regularly irregular pulse E. Large bounding pulse F. Weak pulse 2. Left lateral decubitus position helps to identify which one from the following? A. Murmur of pulmonic stenosis B. Murmur of aortic regurgitation C. Murmur of aortic stenosis D. Murmur of mitral stenosis E. Physiologic split of S2 3. How should you position the patient in order to accentuate the aortic sthenosis murmur? P.392 A. Standing upright B. Supine with head positioned in 0 degrees C. Sitting upright D. Left lateral decubitus E. Sitting upright, but leaning forward 4. Which of the following is right about a grade 5-intensity murmur? P.396 A. It can be heard with the stethoscope partially off the chest B. It can be heard with the stethoscope off the chest C. It is moderately loud D. It can be heard only by expert E. It is associated with a "thrill" 5. You have a patient who complains about diplopia, which is present with one eye covered, what can be a reason of the following problem? P.218 A. A problem in the cornea or lens B. A lesion of the brainstem C. Acute open angled glaucoma D. Disorder of CN III E. Disorder of CN IV F. Disorder of CN VI 6. A 68-year-old male presents to ER with malaise and few days history of dry cough. Last night he noticed sudden onset of chills, sharp left-sided chest pain after long bout of coughing and his sputum changed into rusty colour and he was feeling feverish. He thought to get a cold during fishing with his friends, but symptoms had worsened and he called to ambulance. He noticed that was breathing a bit faster then usual and now had a mild shortness of breath. He denied any gastrointestinal symptoms. On the physical examination his vital signs were as follows: temperature (C): 38.5, BP (mmHg): 128/76, HR (bpm) 102, RR (bpm): 24, SpO2 (%): 94. There was no orthopnea, peripheral oedema. On palpation chest was not tender, but increased tactile fremitus was revealed on the left lower part of the chest. In the same area dullness on percussion and crackles on auscultation were revealed too. The most likely diagnose is: A. Pericarditis B. Left sided pneumothorax C. Left lower lobe atelectasis D. Pulmonary embolus E. Left lower lobe pneumonia 7. Patient presents with the voice hoarseness that started 4 days ago. Which of the following cannot be the reason for this complain? P.221 □ Voice overuse □ Thyroid mass □ Acute viral laryngitis □ Head and neck cancers □ Hypothyroidism □ Lung cancer 8. Which one form the following cannot affect the blood pressure? P.353 A. Peripheral vascular resistance at the arteriolar level B. Left ventricular stroke volume C. Distensibility of the aorta and the large arteries D. Volume of blood in the arterial system E. Right ventricular stroke volume 9. S1 sound can be auscultated better with the use of one of the following techniques, which one of them? A. Right 2nd intercostal space sternal border with the patient in the left decubitus position using bell of the stethoscope B. Right 2nd intercostal space sternal border with the patient leaning forward using the bell of the stethoscope C. Left 2nd intercostal space sternal border with the patient supine using the diaphragm of the stethoscope D. Cardiac apex with the patient supine using the diaphragm of the stethoscope E. Cardiac apex with the patient supine position at end of inspiration using bell of the stethoscope 10. Causes of weight loss are the following, except P.113 □ GI diseases = Gastrointestinal diseases □ Diabetes mellitus □ Hypothyroidism □ Adrenal insufficiency □ Depression □ Glucocorticoids 11. Which on from the following can be auscultated with the bell of the stethoscope in the left decubitus position? (!!!) □ Pulmonary sthenosis □ Mitral regurgitation □ Atrial gallop □ Pulmonary regurgitation □ Mitral sthenosis □ Ventricular gallop = S3 12. Which of the following waves of the jugular venous pulsations is an atrial relaxation phenomenon? P.378 A. The "y" descent wave B. The downstroke of the "v" wave C. The upstroke of the "a" wave D. The "x" decent wave 13. Everything is true about characteristic for the normal air-filled lung, except: P.337 □ Spoken “ee” heard as “ee” □ Normal Tactile Fremitus □ Transmitted Sound is loud □ Spoken “ee” heard as “aa” □ Mainly vesicular breath sound □ Resonant sound on percussion 14. Which of the following statement is NOT true about consolidation? □ During consolidation alveoli are fille with fluid or blood cells. Crackles are on auscultation □ Percussion sound is resonant and auscultation sound is vesicular during consolidation and transmitted voice is muffled □ Consolidation occurs when there is a mucus of foreign object plug in a mainstream bronchus; rhonchi are heard on auscultation □ During consolidation tactile fremitus is increased, dullness is on auscultation and whispered words are loud □ The causes of consolidation include pneumonia, pulmonary edema, pulmonary hemorrhage 15. A 46 year old male, businessman, heavy smoke and mild alcohol consumer without personal of familial history of cardiovascular disease, presented to the emergency department complaining for worsening shortness of breath in the last week. He said that did not sleep last night, because of sudden episode of dispnoea that woke him up. He was not able to lie flat, that worsened his shortness of breath and he had to sit all night. He denied chest pain, palpitations, lihgtheadedness or fainting. On physical examination: HR 110 bpm regular, BP 120/90 mmHg, RR 25 br/min, SpO2 90% in room air. Jugular vein distension, crackles over the lower third of both lung fields, S3 gallop and an apical murmur of grade III were present; no peripheral oedema was appreciable. The most likely diagnosis is: A. Anxiety with hyperventilation B. Acute heart failure C. Bronchial asthma D. Pulmonary embolism E. Spontaneous pneumothorax 16. All of the can be a reason for vertigo, except: P.220 A. Labyrinthitis B. Vestibular neuritis C. Ménière disease D. Cerebral vascular disease E. Posterior fossa tumor F. Orthostatic hypotension 17. Increased JVP correlates with: P.377 A. Superior vena cava obstruction B. Cardiac tamponade C. Acute and chronic heart failure D. Chronic pulmonary hypertension E. Constrictive pericarditis F. All of the above 18. During the ear examination of 53 year-old male there are the following findings: positive whispered test on the right side, Rinne test – BCAC on the right side, ACBC on the left side. Weber test shows lateralization on the right side. There is: P.289 A. Right sided conductive hearing loss B. Right sided sensory neural hearing loss C. Mixed hearing loss D. Left sided conductive hearing loss E. Left sided sensory neural hearing loss 19. Which of the following valve disorders does produce a holosystolic murmur? P.410 A. Mitral sthenosis B. Aortic stenosis C. Incompetent mitral valve D. Incompetent aortic valve E. Pulmonic stenosis 20. Which one of the following best describes the role of history taking in patient assessment? A. Clinical history can be misleading and physical examination is the primary importance B. Clinical history provides a primary guiding foundation when making clinical decisions C. Clinical history always need to be confirmed by clinical examination D. Clinical history is of secondary importance to clinical examination E. All of the above 21. A 28-year-old male presents with the complain of a headache which is throbbing by his description and located in the right part of his head with intensity 8 on a scale of 1 to 10. It usually continues few hours, he notes nausea and sensitivity to light; the frequency of headache is usually once pre month. He cannot note factors. When he has this headache he cannot work and stays at home, trying to sleep. There has been no change in the frequency of the headaches. He usually takes an over-the -counter pain killers, but it does not help much with headache. What is the most likely diagnosis of the type of headache? A. Trigeminal headache B. Cluster headache C. Migraine D. Tension headache E. Analgesic rebound 22. All from the following are true about data in patient's history, except: (!!!) □ Information about medication □ Information about adulthood illnesses □ Information about substance use □ Information about tobacco use □ Information about risk factors □ Information about onset and settings of the problem 23. The 17-year-old active female patient presents with the gradual onset of bilateral knee, ankle, and wrist pain more than a year prior to visit. She enjoyed outdoor activities such as hiking, walking, and rollerblading, and danced on a competitive team. Her medical history included anxiety and depression, sleep disturbances, and scoliosis treated with braces and physical therapy. Her anxiety and depression were treated with psychotropic medications and counseling. Her family history was significant for fibromyalgia in a second-order relative, diabetes. And one sibling on the autism spectrum. She had a good interpersonal relation with family. She enjoyed learning and had no learning disabilities. Some social anxieties were reported, though she denied being bullied. 29 year old male, having years of insidious chronic low back pain, no structural fault identifiable. Pain distribution was not anatomically plausible. She could not note any particular aggravating / easing factor. NSAID medication did not help. Which type of the pain does the patient have? (!!!) A. Central sensitization B. Psychogenic pain C. Idiopathic pain D. Nociceptive pain E. Neuropathic pain 24. Which from the listed below is true about wheezes? □ Wheezes occur because of the rapid air flow through the narrowed airways, can be heard only on expiration, the quality of wheezes corresponds to the severity of asthma □ Wheezes occur because of the rapid air flow through the narrowed airways, they can be audible during bronchial asthma and COPD □ Wheezes are produced in the alveoli during consolidation, they can heard as on inspiration as well on expiration and cannot be audible at the mouth □ Wheezes are produced in the alveoli during consolidation, can be heard only on expiration and can be audible only with stethoscope □ Wheezes are continuouse musical respiratory sounds that may be audible to the patient and to others without auscultation 25. Which of the following is NOT true about fatigue? P.112 □ Fatigue cannot be associated with depression □ Fatigue is a nonspecific symptom with many causes □ Fatigue is a specific symptom suggesting possible myopathy □ Fatigue as a response to hard work and sustained stress is pathological □ Fatigue can be associated symptom of endocrine disorders 26. Which from the following are true about a focused assessment? P.5 □ Addresses certain concerns or symptoms □ Assesses symptoms related to the specific system of the body □ Applies examination methods relevant to the complaint or concern of patient □ Provides fundamental and personalized knowledge about patient □ Is appropriate for new patients in the office or hospital 27. Which one from the following statements is true about rhinorrhea? P.220 □ Rhinorrhea with purulent drainage with facial pain is characteristic for the acute viral URT infection □ Rhinorrhea refers to drainage from the nose and is always associated with nasal congestion □ Excessive use of topical decongestants can become a cause of the rhinorrhea □ Seasonal rhinorrhea suggests allergic rhinitis □ Rhinorrhea refers to drainage from the nose and is often associated with nasal congestion 28. For which one from the following conditions clubbing nails are NOT characteristic? P.211 & P.318 A. Left sided heart failure B. Interstitial lung disease C. Congenital heart disease D. Pulmonary fibrosis E. Lung malignancy 29. A 38-year-old female with no history of disease was admitted to the hospital after she suddenly collapsed while standing and lost consciousness fir approximately five minutes. She recovered spontaneously but was extremely weak and dyspneic. On admission patient had sharp chest pain worsening with inhalation and cough. On the physical examination she looked acutely ill, diaphoretic and dyspneic. No focal neurologic signs were revealed. HR 130 b/min regular. BP 125/70 mmHg without orthostatic changes, RR 32 breaths/minute. The room air oxygen saturation was 90%. Examination of the head and neck lymph modes was normal. The results of chest wall examination revealed reduced breath sounds bilaterally at the lung bases. Diaphragm excursion of the left hemithorax was reduced. The findings of heart and abdominal examinations were unremarkable. Examination of her legs revealed left leg oedema with the left calf measured 3 cm more than the right one. Patient said that she was taking birth control pills. The most likely diagnosis is: A. Myocardial infraction B. Bronchial asthma C. Pulmonary embolism D. Pneumonia E. Acute heart failure 30. The rapid gain of the weight (within last few days) can be caused by the following, except: □ Tricyclic antidepressants □ Heart failure □ Venous stasis □ Liver failure □ Caloric intake exceeds caloric expenditure □ Nephrotic syndrome Midterm Physical Diagnosis (11.06.2020) 1. Which of the following are the signs of peritonitis? P.475 A. Percussion tenderness B. Rebound tenderness C. Positive cough reflex D. Rigidity E. All of the above 2. 51-year-old woman employed as an administrator was present with chief complain in the right groin area, radiating into the right anterior thigh and sometimes knee. She also complained of right posterior low back pain. The pain of a variable, intermittent-type ache, aggravated by walking and eased by rest in the supine position. During the day, the patient's job involved standing, walking, and sitting. As the day progressed, the patient's symptoms worsened. The patient reported sleeping well. There were no complaints of paraesthesias or anaesthesias. The patient denied any neurological symptoms related to cauda equina or spinal cord involvement. On observation, the patient walked with Trendelenburg gait. Inspection revealed a slight shift in the lumber spine toward the left. There appeared to be a flattening of the tight gluteal musculature. Objectively, strength of musculus gluteus minimus and medius both graded 4. On palpation of the pelvic levels in standing, the right posterior inferior iliac spine was lower than the left. The right anterior superior iliac spine was higher than the left and the pelvis appeared to be in a right posterior ilial rotation. The levels of the greater trochanters, gluteal folds, and posterior knee creases appeared symmetrical. The most likely diagnosis is (!!!) C. Right knee joint osteoarthritis D. Chronic back pain 3. Which of the following is NOT characteristic for the ascetic fluid in abdomen? A. Produces a hyper-resonante note on percussion B. Abdomen has a protuberant contour C. Umbilicus can be everted D. Produces a dullness E. In supine position fluid accumulates in flanks 4. 22 year old female presents to hospital with lower abdominal pain, fever 38.2 C, nausea, urinary frequency and urgency. She said first symptoms appeared one week ago with pressure like discomfort in the suprapubic area and burning sencation during urination. On the examination costovertebral angle tenderness is present. The most ikely diagnosis is A. Pelvic inflammatory disease B. Acute pyelonephritis C. Chronic pyelonephritis D. Urethritis 5. Intermittent claudication means P.517 A. Cramping in the legs after long term standing and radiating to buttocks B. Cramping in the legs during exertion C. Cramping in the legs upon standing up D. Cramping in the legs when they are elevated 6. Parietal pain originates from inflammation in the parietal peritoneum. It varies in quality and may be gnawing, burning or cramping. When it becomes severe, it may be associated with sweating, pallor, nausea, vomiting, and restlessness A. True B. False 7. Tenderness and spasm of paravertebral muscles can be caused by P.671 A. Herniated disc B. Scoliosis C. Depression D. Prolonged contraction from abnormal posture E. All of the above 8. 57-year-old man who reports to the clinic complaining of frequent cramping pain in his left leg induced by walking. Because of this he cannot accomplish his daily walking plan. On his visit to a physician, resting ankle-brachial index (ABI) test was performed and showed result 0.90. Patient has a past medical history of hypertension, which is well managed. He does not take any other prescription medication. Smokes 1 pack per day. The most likely diagnosis is A. Chronic compartment syndrome B. Muscle strain C. Left knee arthritis D. Peripheral arterial disease 9. To examine the patient's abdomen the requirements are following □ Empty bladder □ Full bladder □ Patient's arms being at the sides or folded across the chest □ Warm stethoscope and warm hands □ Warm stethoscope and cold hands 10. A 22-year-old male presents to the emergency department with abdominal pain, anorexia, nausea, and feverish. Pain started in the mid-abdominal region 6 hours ago and is now in the right lower quadrant of the abdomen. The pain was steady in nature and aggravated by coughing. Physical examination reveals fever 38°C; HR 100 b/min, RR 20, BP 110/70, Sp02 98 on room air. Pain on palpation at right lower quadrant, rebound tenderness, positive Rovsing's sign. The most likely diagnosis is A. Reffered pain form aute cholecystitis B. Acute appedicltis C. Crohn's disease D. Acute diverticulitits 11. A 54 year male patient got admitted in a private hospital with a chief complaint of swelling of the both legs and bulging of veins. He had started noticing lower extremity swelling about 5 years ago and then for 1 year progressive leg pain. He is not aware of any family history of similar problem. Personal history states that he is a smoker and occasionally alcoholic, his sleep and appetite are normal. On further inquiry he also describes restlessness, occasional cramping bilaterally, feeling tired and heavy at the end of day. As a pharmacist the patient works full time standing for extended periods of time in his practice. On physical examination, his lower extremity symptoms include a bulging viscosity on his left and right lower legs associated with achiness and bilaeral oedema. A. Chronic venous insufficiency* B. Deep venous thrombosis C. Heart failure D. Liver cirrhosis E. PAD 12. Which of the following are the risk factors for abdominal aortic aneurism? □ Hypertension □ Hyperglucosmia □ Aortic diameter more than 2 cm □ Age more than 65 years □ Hyperlidemia □ Coronary artery disease 13. 63 old female complains of shoulder pain and limited ROM due to it. Assessing patient you ask her to scratch her neck and touch the opposite shoulder. She shows difficulties producing this motion. Patient might have □ Rotator cuff disorder* □ Anterior dislocation of the shoulder □ Adhesive capsulitis* □ Biceps tendinitis □ Acromioclavicular joint arthritis 14. A 55-year-old man presents because of chest pain, breathlessness and headache. This patient had uncontrolled systemic arterial hypertension for 15 years and had been treated with B-blockers, diuretic and angiotensin receptor-blocker and calcium channel blockers. Despite this therapy, on physical examination, his blood pressure was 185/120 mm Hg with no difference between the two arms and arm and leg. He had no history of diabetes, but he is a smoker. The most likely diagnosis is A. Renal artery stenosis* B. Renal artery dissection C. Essential hypertension D. Coarctation of aorta 15. 47-year-old male construction foreman who has noticed worsening medial and posterior knee pain, joint stiffness, weakness, and the feeling of instability in his right knee over the last 10 days beginning after playing in a soccer game. The patient has not seen a physician regarding the pain until 1 day ago. On the examination he expresses that the worse pain (8/10) is felt during squatting motions, getting up from a chair, ambulating, and descending stairs. ROM was limited and presented decreased strength muscles. There were signs of inflammation in the joint line and moderate swelling in the medial joint line. The patient also claims a locking sensation during deeper flexion. MCL stress testing has not reveal laxity and/or pain. McMurey test revealed tenderness in the medial joint line. The most likely diagnosis is A. Anterior crucial ligament tear B. Knee osteoarthritis C. Medial meniscus tear* D. Medial collateral ligament tear 16. A 38 year old white woman, she prsents to the physician experiencing intermittent low back and right sided hip joint pain with difficulty bending over when picking up her kids or cleaning around the house. Patient notes the pain began about six months ago without injury and comes and goes without any obvious trigger, although the pain seems be worse when she gets up in the morning. She says she needs about 30-40 min to "unlock" her joints. On the examination physician notes piited nails. The most likely diagnosis is A. Systemic lupus erythematosus B. Reiter's syndrome C. Psoritic arthritis D. Reumatoid arthritis 17. Bladder distention can be caused by the following except A. Acute cystitis B. Multiple sclerosis* C. Urethral stricture D. Prostatic hyperplasia 18. A 74-year-old retired man, with history of smoking one pack within 40 years and hypertension, overweight, consulted a doctor of chiropractic for chronic low back pain. The history and physical examination confirmed chronic sacroiliac and a lumbar facet dysfunction. After 5 weeks, the patient stated he had stomach cramps. Physical examination revealed pulsatile mass in the abdomen. The most likely diagnosis is A. Intestinal obstruction B. Acute pancreatitis C. Ruptured viscus D. Mesenteric ischemia E. Aorta aneurism* 19. You are having a patient male, 50 years old, with history of diabetes type 2, smoking 10 cigarettes per day. He says that 4-5 days per week he intensively exercises in gym. Which of the above listed parameters is not a risk factor for peripheral artery disease? A. Diabetes B. Age of 50 C. Smoking D. Gender E. High physical activity levels for his age* 20. Positive Tinel's sign helps in diagnosis of A. Wrist joint arthritis B. Rheumatoid arthritis C. Carpal tunnel syndrome* D. Test is not relevant to any of the above listed 21. You palpate anatomical snuff box what elicit the tenderness. Patient might have A. Osteoarthritis B. Gonococcal tenosynovitis C. Scaphoid bone fracture* D. De Quervain's tenosynovitis E. All of the above 22. Which of the following statements is true? □ Early guarding is voluntary process □ Rigidity is an involuntary response of muscle suggesting peritoneal inflammation □ Rigidity decreases with relaxing methods □ Guarding presens only in case appendicitis □ Guarding cannot be eliminated with relaxing methods 23. Which of the listed below statements is NOT true about dorsalis pedis pulse? P.528 A. Dorsalis pedis pulse is felt lateral to the extensor tendon of the big toe B. Dorsalis pedis pulse is felt medial to the extensor tendon of the big toe C. Dorsalis pedis pulse can be felt more laterally if it branches higher in the ankle D. Dorsalis pedis artery may be congenitally absent 24. In patients above 50 year old normally diameter of the abdominal aorta must not exceed: P.483 A. 2 cm B. 2.5 cm C. 3 cm D. 3.5 cm 25. Unusually intense and immediate desire to void is called P.462 A. Polyuria B. Nocturia C. Dysuria D. Urgency E. Frequency 26. From the following tests which can you use to check possible rotator cuff disorder? A. Forearm supination B. Hawkins impingement sign C. Empty can test D. "Drop-arm" test* E. Neer impingement sign F. All of the above 27. Traube's space is P.479 A. Space from the 6th intercostal space on midclavicular line to the anterior axillar line and down to the costal margin B. Space from the 6th intercostal space on midclavicular line to the middle axillar line and down to the costal margin C. Space from the 5th intercostal space on midclavicular line to the anterior axillar line and down to the costal margin D. Space from the 5th intercostal space on midclavicular line to the middle axillar line and down to the E. 6th intercostal space from midclavicular line to the anterior axillar line 28. Decreased strength during hand grip tests helps to identify which of the following? A. From pain of degenerative joint changes B. Weakness of intrinsic muscles of the hand C. Weakness of the finger flexors D. All of the above P.663 29. Heberden's nodes are inspected in which of the following joints P.660 A. Radiocarpal joint B. DIP joint C. MCP joint D. PIP joint 30. You are having a female patient who presents with jaundice, telangiectasia, dilated veins on the abdominal wall and palmar erythema. What could be the possible disorder? P.208 A. B12 anemia B. Pregnancy C. Lymphoma D. Liver disease E. Iron deficient anemia Midterm Physical Diagnosis (09.06.2021) 1. The echocardiogram of a 22-year-old woman reveals mitral valve prolapse. Which of the following is the most common physical finding in this condition? (Lang internal medicine) A. Late systolic murmur B. Absent first heart sound C. Aortic regurgitation D. Diastolic click E. Diastolic rumble 2. Landmark for thoracentesis with needle is? P.305 A. T2-T4 intercostal space B. T5-T6 intercostal space C. T6-T7 intercostal space D. T7-T8 intercostal space 3. Generalized hyperresonance is common over the over the hyperinflated lungs P.322 A. ILD B. COPD or asthma C. Sarcoidosis D. Pneumonia 4. Ureteral pain usually radiates in the following areas: P.463 A. Right upper quadrant B. Epigastrium C. Around the trunk, lower quadrant, upper thigh and testicle or labium D. In the mesogastrium 5. A 17-year-old girl develops exertional dyspnea, but has no cough, sputum, or wheezing symptoms. On examination, she has a fixed splitting of her second heart sound and a 3/6 systolic ejection murmur heard best over the left sternal border. An echocardiogram confirms the condition. Which of the following is the best physiologic explanation for her condition? (Lang internal medicine) A. Pulmonary blood flow is greater than systemic blood flow B. Pulmonary blood flow is less than systemic blood flow C. Pulmonary blood flow is equal to systemic blood flow D. The left ventricle is enlarged E. The systemic blood pressure is elevated 6. Describe location for needle insertion for tension pneumothorax. P.304 A. First intercostal space B. 2nd intercostal space C. 4th intercostal space D. 5th intercostal space 7. Crackles can arise from: P.325 A. From abnormalities of the lung parenchyma (pneumonia, interstitial lung disease, pulmonary fibrosis, atelectasis, heart failure) or of the airways (bronchitis, bronchiectasis). B. Pneumonia, pneumothorax C. In the widened airways of bronchitis. D. In the narrowed air-way of asthma, COPD, and bronchitis. 8. Which of the following does not cause a holosystolic murmur? A. Ventricular Septal Defect B. Mitral stenosis C. Mitral regurgitation D. Tricuspid regurgitation 9. Rowsing sign is one of the following: A. Pain felt in the right lower abdomen upon palpation of the left side of the abdomen B. There is pain upon removal of pressure rather the application of pressure to the abdmen. C. Tenderness and guarding in the right hypochondrium exacerbated by inspiration D. Right low quadrant pain with extension of the right hip or with flexion of the right hip against resistance 10. In the usual preparation for general surgery, the patient may be: (internet) A. Given specifically ordered oral medications with couple glasses of water B. NPO for 12 to 14 hours before C. Given ice chips D. Allowed to brush teeth and swallow water 11. Polyuria is one of the following: A. The frequent passage of large volumes of urine – more than 3 liters a day B. The patient has to wake at night one or more times for voiding C. Painful urination D. Urinary incontinence 12. Jaundice is one of the following: A. Yellow coloration of the skin and mucous layers.* B. Loss of the appetite C. Increased frequency of the urination D. Alteration of the constipation and diarrhea 13. When inspiratory sounds last longer than expiratory sounds, it is: P.324 A. Vesicular B. Bronchial C. Tracheal D. Wheezing 14. A 76-year-old woman with severe aortic stenosis presents with dyspnea and worsening functional class in the setting of new-onset atrial fibrillation. Which of the following auscultatory findings would not be expected? HURST'S THE HEART A. A late-peaking crescendo-decrescendo systolic murmur B. A soft S2 C. An apical systolic murmur D. Delayed and weak carotid upstroke E. An S4 15. A 24-year-old man is referred to cardiology after an episode of syncope while playing basketball. He has no recollection of the event, but he was told that he collapsed while running. He awakened lying on the ground and suffered multiple contusions as a result of the fall. He has always been an active individual but recently has developed some chest pain with exertion that has caused him to restrict his activity. His father died at age 44 while rock climbing. He believes his father’s cause of death was sudden cardiac death and recalls being told his father had an enlarged heart. On examination, the patient has a III/VI midsystolic crescendo-decrescendo murmur. His electrocardiogram shows evidence of left ventricular hypertrophy. You suspect hypertrophic cardiomyopathy as the cause of the patient’s heart disease. Which of the following maneuvers would be expected to cause an increase in the loudness of the murmur? Harrison's A. Handgrip exercise B. Squatting C. Standing D. Valsalva maneuver E. A and B F. C and D 16. Nocturia is one of the following: A. The frequent passage of large volumes of urine – more than 3 liters a day B. The patient has to wake at night one or more times for voiding C. Painful urination D. Urinary incontinence 17. Dullness replaces resonance when: P.322 A. Fluid or solid tissue replaces air-containing lung or occupies the pleural space beneath your percussing fingers. B. Aircontaining lung replaces fluid or solid tissue C. Healthy lung D. Asthma 18. Many clinicians use this term to describe sounds from secretions in large airways that may change with coughing. It is: P.325 A. "Wheezes" B. "Crackles" C. "Ronchi" D. "Acute bronchitis 19. What is the Austin-Flint murmur? A. The systolic ejection murmur from the high flow across the aortic valve in a person with severe aortic insufficiency B. The short, early diastolic murmur caused by severe aortic regurgitation* C. The murmur created by severe aortic stenosis heard at the cardiac apex sounding holosystolic and mimicking mitral regurgitation D. The diastolic murmur at the cardiac apex in the presence of severe aortic regurgitation caused by the regurgitant jet striking the anterior leaflet of the mitral valve mimicking mitral stenosis 20. Screening is one of the following: A. Test after surgery B. Test before surgery C. Test for deadly infectious disease D. Test to detect a potential health problem or disease in someone that doesn't yet have signs or symptoms. 21. A patient with new-onset syncope has a blood pressure of 110/95 mm Hg and a harsh systolic ejection murmur at the base, radiating to both carotids. Auscultation of the second heart sound at the base might reveal which of the following findings? (Lang internal medicine) A. it shows fixed splitting B. it is accentuated C. it is normal in character D. it is diminished E. it is widely split due to delayed ventricular ejection 22. Crescendo-decrescendo systolic ejection murmur following ejection click. Radiates to carotids. Pulses are weak compared to heart sounds A. Aortic stenosis B. Aortic regurgitation C. Ventricular septal defect D. Mitral stenosis 23. Types of the jaundice are all of the following EXCEPT: A. Prehepatic B. Posthepatic C. Postprandial* D. Hepatic 24. Unilateral hyperresonance suggests: A. A large pneumothorax or an air-filled bulla B. Asthma C. Alpha one antitrypsin deficiency D. Pneumonia 25. All of the following findings would suggest a diagnosis of hypertrophic cardiomyopathy except: HURST'S THE HEART A. "Triple ripple" apical impulse B. Bifid pulse C. Fixed split S2 D. S4 E. Paradoxically split S2 26. Costovertebral angle tenderness is one of the following symptoms: A. Abdominal distension B. Murphy's sing C. Pasternack's Sign D. Caput meduse 27. A 28-year-old woman has been told she has rheumatic heart disease, specifically mitral stenosis. Which of the following murmurs is most likely present? Case file -internal A. Diastolic rumble at apex of the heart B. Early diastolic decrescendo at right-upper sternal border C. Holosystolic murmur at apex D. Late-peaking systolic murmur at right-upper sternal border 28. A 63-year-old woman develops exertional angina and has had two episodes of syncope. Examination shows a systolic ejection murmur with radiation to the carotids and a soft S2. Which of the following is the most likely diagnosis? (Lang internal medicine) A. mitral stenosis B. mitral insufficiency C. aortic stenosis D. aortic insufficiency E. tricuspid stenosis 29. Immediate high-pitched diastolic murmur. Wide pulse pressure when chronic. can present with bounding pulses and head bobbing A. Aortic stenosis B. Aortic regurgitation C. Mitral regurgitation D. Tricuspid regurgitation 30. In case of ascites the percussion reveals one of the following: A. Absence of the tympani B. Shifting dullness* C. Fixed dullness D. Absence of the dullness 31. For most elective (nonemergency) cases the correct sequence of patient management is: 1. History 2. Physical examination 3. Laboratory & instrumental examination 4. Treatment & follow-up 32. Wheezes arise: P.325 A. from abnormalities of the lung parenchyma (pneumonia, interstitial lung disease, pulmonary fibrosis, atelectasis, heart failure) or of the airways (bronchitis, bronchiectasis). B. Pneumonia, pneumothorax C. In the widened airways of bronchitis. D. In the narrowed air-way of asthma, COPD, and bronchitis. 33. Adventitious sounds are: P.325 A. Added sounds that are superimposed on the usual breath sounds. B. Wheezings and vesicular sounds C. Normal breath sounds D. Tracheal sounds 34. When expiratory sounds last longer than inspiratory ones, it is: P.324 A. Vesicular B. Bronchial C. Tracheal D. Wheezing 35. Rebound tenderness is one of the following: A. Tenderness and guarding in the right hypochondrium exacerbated by inspiration B. There is pain upon removal of pressure rather than application of pressure to the abdomen. C. Right low quadrant pain with extension of the right hip or with flexion of the right hip against resistance D. Pain felt in the right lower abdomen upon palpation of the left side of the abdomen 36. Physical examination of the patient is the part of the: P.7 A. Subjective examination B. Objective examination 37. Pain as a symptoms can be is one of the following types EXCEPT: P.453 A. Visceral B. Parietal C. Toxic D. Referred 38. Melena or melaena is the sign of: P.460 A. Upper GI bleeding B. Anal bleeding C. Lung injury D. Goiter 39. Pain during the acute appendicitis commonly is located in one of the following areas: A. Right lower quadrant B. Left lower quadrant C. Left lumber region D. Epigastrium 40. Describe location for the lower margin of an endotracheal tube on a chest x-ray. P.304 A. T4 B. T6 C. T6-T7 intercostal space D. T7-T8 intercostal space 41. Anorexia is one of the following: P.458 A. Yellow skin B. Lack of appetite C. Black stool D. Lack of water 42. Melena or melaena means: P.460 A. Black stool B. Nasal bleeding C. Bloody urine D. Bloody vomitus 43. A 45-year-old woman is referred for a murmur. Which finding on physical examination would be suggestive of a diagnosis of hypertropic obstructive cardiomyopathy? HURST'S THE HEART A. A decrease in the intensity of the systolic murmur upon standing B. A midsystolic click C. A decrease in the systolic ejection murmur with inspiration D. A palpable P2 E. An apical holosystolic murmur 44. Hematochezia is one of the following: P.460 A. Black stool B. Nasal bleeding C. Bloody urine D. Bloody stools 45. A 45-year-old woman has developed increasing SOB on exertion and fatigue. She has a loud systolic ejection murmur heard best at the left sternal border, and the murmur increases with standing. A double apical impulse is also felt what could be the underlying disease? (Lang internal medicine) A. Aortic stenosis B. HOCM C. Mitral regurgitation (chronic) D. Tricuspid regurgitation E. Mitral valve prolapse 46. Crackles are: P.325 A. Sinusoidal, musical, prolonged (but not necessarily persisting throughout the respiratory cycle) B. Intermittent, nonmusical, and brief, Like dots in time C. Like dashes in time D. Relatively high-pitched (≥400 Hz) with hissing or shrill quality (80 ms) 47. Percussion is resonant in: P.322 A. Diagnostic tool for liver B. "Acute bronchitis" C. Asthma D. Healthy lung 48. When inspiratory and expiratory sounds are almost equal, it is: P.325 A. Vesicular B. Bronchial C. Tracheal D. Wheezing 49. Caput meduse is one of the following: A. The appearance of distended and engorged paraumbilical veins B. Scull fracture C. Scull tumor D. Head wound 50. An elderly patient presents with a diastolic murmur that gets louder during inspiration. Which of the following are the most likely? a) Aortic regurgitation or mitral stenosis b) Aortic stenosis or mitral regurgitation c) Pulmonic regurgitation or tricuspid stenosis d) Pulmonic stenosis or tricuspid regurgitation 51. Describe location for the sternal angle or angle of Louis. P.304 A. T1-T7 intercostal space B. T5-T6 intercostal space C. In the hollow curve of the suprasternal notch D. In the hollow curve of the suprasternal notch, then move it down approximately 5 cm to the horizontal bony ridge where the manubrium joins the body of the sternum 52. Normal breath sound in the base of the lung is: P.325 A. Vesicular B. Bronchial C. Tracheal D. Wheezing 53. Wheezies are: P.325 A. Intermittent, nonmusical, and Brief, Like dots in time B. Normal breath sounds C. Somewhat louder, lower in pitch (∼350 Hz), brief (15–30 ms) D. Relatively high-pitched (≥400 Hz) with hissing or shrill quality (80 ms), Like dashes in time 54. A 18-year-old man notices occasional lightheadedness when standing up quickly. He also has difficulty playing sports because of easy fatigue and SOB. Examination shows normal heart sounds, but a loud systolic ejection murmur at the right sternal border. The murmur decreases with elevating the legs and increases in the standing position. Your clinical diagnosis is hypertrophic cardiomyopathy (HOCM). SELECT ANSWER regarding to HOCM (Lang internal medicine) A. Pulsus tardus B. Pulsus paradoxus C. Hyperkinetic pulse D. Bisferiens pulse E. Dicrotic pulse 55. A 22-year-old woman with no past medical history is found to have a systolic ejection murmur on routine physical examination. She has no symptoms and feels well. The murmur is heard along the right and left sternal borders and it decreases after rapid squating. What could be the underlying disease? (Lang internal medicine) A. Aortic stenosis B. HOCM hypertrophic cardiomyopathy C. Mitral regurgitation (chronic) D. Tricuspid regurgitation E. Mitral valve prolapse 56. A 25-year-old woman is referred for a murmur. Transthoracic echocardiography demonstrates mitral valve prolapse. Which of the following is true about the click accompanying mitral valve prolapse? HURST'S THE HEART A. This usually occurs in early systole B. Upon standing, the click will occur earlier in systole C. It decreases in intensity with inspiration and moves closer to S1 D. This is a lough, high-pitched sound E. Upon Valsalva maneuver, the click will occur later in systole 57. A 20-year-old basketball player is seen for evaluation prior to beginning another season of competitive sports. A harsh systolic murmur is heard at the left lower sternal border. Which of the following maneuvers will enhance this murmur if A. Hand grip B. Leaning forward while sitting C. Lying left side down D. Squatting E. Valsalva maneuver 58. Each lung is divided roughly in half by: A. T6-T7 intercostal space B. In the hollow curve of the suprasternal notch C. An minor fissure. D. An oblique (major) fissure 59. Follows opening snap rumbling late diastolic murmur A. Aortic stenosis B. Mitral stenosis C. Mitral prolapse D. Mitral regurgitation 60. 60. FINAL Physical Diagnosis (01.07.2019) 1. What is the origin of S4 sound? A. Active filling into non-compliant ventricle B. Active filling into compliant ventricle causing sudden tensing of chordae tendinea C. Passive filling into non-compliant ventricle D. Passive filling into compliant ventricle causing sudden tensing of chordae tendinea 2. What is the origin of S3 sound? A. Active filling into non-compliant ventricle B. Active filling into compliant ventricle causing sudden tensing of chordae tendinea C. Passive filling into non-compliant ventricle D. Passive filling into compliant ventricle causing sudden tensing of chordae tendinea 3. 16 year old male presents to the hospital with abdominal pain, which he describes as generalized the previous day, but localaized in the lower right quadrant at the moment. He also complains about nausea and anorexia. Examining the patient you palpate his left quadrant and he admits that pain when you remove your hand in comparison with when you press on the area. What is the name of the test? A. Rovsing's sign B. Obturator sign C. Rebound tenderness D. Psoas sign 4. A 3-year-old boy is brought into your office by his parents after 4 days of abdominal pain. His parents state that it appeared their son had some pain in his abdomen, and they assumed he had a simple “stomach virus” with some associated vomiting and malaise. They decided to bring him to the office because he was not completely better. They noted he “felt warm” during the past few days and had not been eating much. According to the parents, the pain seems to be improved today but he is still not himself. On examination, the temperature is 38° C and the pulse is 105 beats per minute. The boy appears ill but is not lethargic or in any distress. Abdominal examination reveals tenderness in the right lower quadrant with deep palpation. The abdomen is otherwise soft, and there is no guarding or rebound tenderness. You suspect the patient has appendicitis. All except which of the following may be positive physical examination signs in acute appendicitis? A. Rovsing sign B. pain at McBurney point C. McMurphy sign D. psoas sign E. obturator sign 5. A 30-year-old woman presents for a routine checkup. She has no complaints and denies previous medical problems. On heart examination, the patient has a loud S1. She has a grade 2 low-pitched mid- to late diastolic murmur that is heard best at the apex. Immediately preceding the murmur is a loud extra sound. Which of the following is the most likely diagnosis? A. Mitral valve prolapse (MVP) C. Ventricular septal defect D. Aortic insufficiency E. Atrial septal defect 6. A 50-year-old construction worker presents with a slow growing eroded papule on his lower lip. He has a history of leukoplakia and was a heavy smoker. He has a small, tender supraclavicular node. A. Superficial spreading melanoma B. Basal cell carcinoma C. Squamous cell carcinoma D. Bowen’s disease 7. Louder, clearer voice sounds during auscultation of the lungs are called A. adventitious sounds, B. egophony. C. bronchophony. D. fremitus. 8. A 30 year old male presents with a single sudden shaking chill with a rapid rise in temperature. Within a few hours agonizing left pleuritic pain and cough with rust coloured sputum supervene. On examination the man appears acutely ill with rapid shallow respiration. With no treatment he continues to run a temperature up to 40.5 deg C for a week at which time he experiences a dramatic improvement. Physical examination on day 2 of the illness would probably show all of the following over the left chest EXCEPT A. restricted hemithorax movement B. flat percussion sound C. bronchial breathing D. decreased fremitus E. whispering pectoriloquy Diagnosis: pneumonia 9. Which of the following do require mental health screening? P.151 A. Symptoms for more than weeks B. Medically unexplained physical symptoms C. Substance abuse D. All of the above 10. A 61-year-old man comes to your office complaining of a “popping” sensation in his left ear for nearly 2 wk. He also complains of decreased hearing. Recently, another physician treated him for an acute otitis media with antibiotics. Physical examination reveals a normal right ear canal and tympanic membrane. The left tympanic membrane is gray, retracted, and immobile. Which of the following is the most likely diagnosis? A. Otitis media with effusion B. Acute otitis media C. Mastoiditis D. Otitis externa E. Malignant otitis externa 11. A 34-year-old firefighter presents to the emergency room complaining of the sudden onset of severe right-sided flank pain that radiates to the right groin and genitalia. He is unable to lie still on the stretcher of the emergency room. He denies any history of trauma. He denies any dysuria, frequency, nocturia, or fever. Examination of the genitalia is normal. Abdominal and rectal examinations are normal. There is positive right costovertebral angle (CVA) tenderness. Urinalysis reveals blood. Which of the following is the most likely diagnosis? A. Pyelonephritis B. Renal calculi C. Testicular torsion D. Strangulated hernia E. Acute prostatitis 12. Adduction (or varus) stress test caused pain in knee during patient's examination. The reason is A. Partial tear of the lateral collateral ligament B. Partial tear of the medial collateral ligament C. Partial tear of the lateral meniscus D. Partial tear of medial meniscus 13. A 22-year-old man is brought to the emergency department 8 hours after twisting his right knee while playing in a soccer match. At the time of injury, he felt a sharp pain on the “inner” part of his right knee. He has been unable to straighten his knee fully and had to be carried off the field by his teammates. On examination, there is a moderate joint effusion, tenderness at the medial joint line, and limitation of the last 20 degrees of extension by a springy resistance. There is sharp anteromedial knee pain when passive extension is forced. Lachman test is negative. What is the most likely diagnosis in this patient? A. medial meniscus tear B. lateral meniscus tear C. post collateral ligament sprain D. anterior cruciate ligament sprain E. fractured patella 14. Which of the following is correct about jugular venous pressure? A. Pulsations cannot be eliminated by light pressure on the jugular vein B. Venue pressure measured more than 9 cm in total distance above the right atrium is considered elevated C. The JVP best estimates from the right external jugular vein D. Atrial contraction produces V wave 15. By the following description grade the heart murmur: very faint, not necessarily heard in all positions A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4 E. Grade 5 F. Grade 6 16. By the following description grade the heart murmur: quiet, heard immediately after placing the stethoscope on the chest A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4 E. Grade 5 F. Grade 6 17. By the following description grade the heart murmur: moderately loud, no thrill A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4 E. Grade 5 F. Grade 6 18. By the following description grade the heart murmur: loud, with palpable thrill A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4 E. Grade 5 F. Grade 6 19. By the following description grade the heart murmur: very loud, palpable thrill that can be heard with stethoscope partially off the chest A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4 E. Grade 5 F. Grade 6 20. By the following description grade the heart murmur: very loud, palpable thrill that can be heard without a stethoscope A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4 E. Grade 5 F. Grade 6 21. A 34-year-old nursing student is referred to your office because of the onset of a recent cough productive of dark-colored sputum. She is febrile but does not appear ill. She has been able to continue working with her symptoms. Examination of the posterior thorax is normal but there is dullness at the anterior right hemithorax below the fifth rib. Crackles, as well as localized pectoriloquy, are audible over the same area. Which of the following is the most likely diagnosis? A. Right lower lobe pneumonia B. Left lower lobe pneumonia C. Right lower lobe atelectasis D. Right middle lobe pneumonia E. Right upper lobe pneumonia 22. Which continuous breath sounds are relatively high pitched with a hissing or shrill quality? A. Wheezes B. Fine crackles C. Ronchi D. Corse crackles 23. Wheezies are: P.325 A. Intermittent, nonmusical, and Brief, Like dots in time B. Normal breath sounds C. Somewhat louder, lower in pitch (∼350 Hz), brief (15–30 ms) D. Relatively high-pitched (≥400 Hz) with hissing or shrill quality (80 ms), Like dashes in time 24. Patient with hematemesis. This means A. Blood in sputum B. Blood in stool C. Blood in urine D. Blood in vomit 25. Skin cancer is definitively diagnosed by A. X-ray B. Dermoscopy C. Skin biopsy D. All of them are valid for definite diagnosis 26. Affection of the cerebellar may produce any of the following except A. Positive Romberg’s test B. Positive finger to nose test C. Positive legs-heel-to-shin test D. Positive Rinner test E. Dysdiadochokinesis 27. A 45-year-old obese man presents to the emergency department in the middle of the night screaming and holding his left foot. He tells you that he thinks he has an “acute blood vessel blockage” in his left toe. He wakes up the entire emergency department observation unit with his screams. His past history is significant for essential hypertension, for which he has been treated with a thiazide diuretic for the past 5 years. He categorically relates to you that he has never had the symptoms that he is experiencing now, and he further adds that instead of all these questions he would prefer if you just got on with treatment. On examination, the patient’s temperature is 39.1° C and his blood pressure is 170/110 mm Hg. He has an inflamed, tender, swollen left great toe at the metatarsophalangeal (MTP) joint. There is extensive swelling and erythema of the left foot, and his whole foot is tender. No other joints are swollen. No other abnormalities are found on physical examination. What is the most likely diagnosis? A. acute cellulitis B. acute gouty arthritis C. acute rheumatoid arthritis D. acute septic arthritis E. acute vasculitis 28. Which of the following cannot be heard with the bell of stethoscope? P.390 A. Mitral stenosis murmur B. Mitral regurgitation C. S3 D. S4 29. Left ventricle hypertrophy is related to which of the following findings? A. The presence of the S4 sound B. The presence of systolic ejection click C. Accentuated S1 sound D. Widened split of S2 sound 30. 29 year old male come to the office with complains of almost persistent increased BP, ACE-inhibitors do not work and worsen his condition. You should think about A. Screening for PAD B. Screening for Abdominal Aortic Aneurism C. Screening for renal artery disease D. Non of the above 31. Which of the following is correct about musculo-skeletal disease? A. Age more than 60 years consider rheumatoid arthritis B. Articular structures includes tendons and bursae C. Age more than 60 years considers osteoporosis fracture D. Extra articular disease always leads to reduced AROM and PROM 32. A 27-year-old woman comes to your office for assessment of symptoms including weakness, visual loss, bladder incontinence, sharp shooting pain in the lower back, clumsiness when walking, and sensory loss. These symptoms have occurred during three episodes (different combinations of symptoms each time) approximately 3 months apart, and each episode lasted approximately 3 days. The first episode consisted of weakness, bladder incontinence, and sharp shooting pains in the lower back (in both hip girdles). The second episode consisted of visual loss, clumsiness when walking, and sensory loss. The third episode (last week) consisted of sharp shooting pains in the lower back and sensory loss (bilateral) in the upper extremities. Given this information, what is the most likely diagnosis in this patient? A. amyotrophic lateral sclerosis B. multiple sclerosis (MS) C. vitamin B12 deficiency D. hysterical conversion reaction E. tertiary syphilis 33. A 16-year-old girl, the star on her high-school basketball team, sustains a knee injury after pivoting on her right knee during a game. She collapses to the floor in severe pain and is immediately taken to the hospital. She arrives at the emergency department approximately 45 minutes after the injury, and her right knee is already very swollen. Laxity is noted with the anterior drawer test and Lachman test. What three structures are involved in the “unhappy triad”? A. anterior cruciate ligament, posterior cruciate ligament, medial meniscus B. posterior cruciate ligament C. lateral collateral ligament, medial meniscus D. medial collateral ligament, medial meniscus 34. Abduction (or Valgus) stress test caused pain in knee during patient's examination. The reason is A. Partial tear of the lateral collateral ligament* B. Partial tear of the medial collateral ligament C. Partial tear of the lateral meniscus D. Partial tear of medial meniscus 35. A 30-year-old man comes to the emergency department with acute onset of examination, the patient is in acute distress. The patient has a low-grade fever at a temperature of 37.2° C, pulse is 96 beats per minute, respirations are 20 breaths per minute, and blood pressure is 140/90 mm Hg. He has significant right costovertebral angle tenderness. The rest of the examination is normal. There is 2+ blood on the urine dipstick test; no casts are seen on microscopic examination. What is the most likely diagnosis in this patient? A. renal colic B. acute pyelonephritis C. acute pyelitis D. atypical appendicitis E. none of the above 36. 45 year old patient with history of COPD presents to clinic with suspected pneumonia. He is struggling, talking in sentences Clinical findings support right-sided pneumonia. On physical examination would probably show? A. Dullness on percussion and decreased tactile fremitus B. Expiatory wheezes and resonance on percussion C. Fine inspiratory crackles and increased tactile fremitus D. Dullness on percussion and increased tactile fremitus 37. Soft and low-pitched breath sounds normally heard over most of both lungs through inspiration and without pause expiration are A. Tracheal B. Vesicular C. Bronchovesicular D. Bronchial 38. Which of the following does not require mental health screening? P.151 A. Back pain continuing 4 weeks B. Difficult encounter C. Substnace abuse D. Chronic pain 39. Which of them is not risk factor for melanoma? A. Male gender B. Age over 50 C. History of previous melanoma D. Age over 40 40. A 29-year-old woman comes to your office with a 1-day history of nausea, mild vomiting, and vague central abdominal pain. The pain has begun to move down and to the right. She also describes mild dysuria. Anorexia began 24 hours ago, and the patient has “felt warm.” Her last menstrual period was 2 weeks ago. Her past health has been excellent. She has no drug allergies and is not taking any medications. On physical examination, she appears ill. Her temperature is 38.1° C. She has tenderness in both the right lower quadrant and the left lower quadrant, but tenderness is greatest in the right lower quadrant. Rebound tenderness is present. The rectal examination discloses tenderness on the right side. There is no costovertebral angle tenderness. What is the most likely diagnosis in this patient? A. pelvic inflammatory disease (PID) B. ovarian torsion C. acute appendicitis D. acute cholecystitis E. acute pyelonephritis 41. Which of the following maneuvers of examining the shoulder is pain provocation test for rotator cuff disorder? A. Neer impigement test B. Apley scratch test C. Hawkings test D. All of the above 42. An 80-year-old woman presents with a 6-month history of pain accompanied by a short period of morning stiffness. She also notices mild pain in her lower back, hips, and knees. On examination, the patient is obese. She has significant swelling in both the proximal interphalangeal (PIP) joints and the distal interphalangeal (DIP) joints. There is also deformity of both knees on examination. The rest of her physical examination is normal. Which of the following statements regarding this patient’s condition is true? A. the swelling present at the DIP joints may represent Bouchard nodes B. the swelling present at the PIP joints may represent Herberden nodes C. this patient will most likely have a normal erythrocyte sedimentation rate D. this patient will most likely have a positive rheumatoid factor E. synovial fluid analysis will probably demonstrate low viscosity 43. The Rinne test indicates equal or better bone conduction in which of the following? A. Labyrinthine disorders B. Conductive hearing loss C. None of the above D. Sensorineural hearing loss 44. You are asking patient about his/her full name, date and place of birth and the place of their being at the moment. You are assessing A. Short term memory B. Confusion C. Awareness D. Long term memory E. Orientation 45. A 71-year-old woman presents to your office complaining of unilateral hearing loss. She denies vertigo and tinnitus. A Weber test lateralizes to the deaf ear, and bone conduction is greater than air conduction on the Rinne test. The tympanic membranes are bilaterally normal. Which of the following best explains her hearing loss? A. Conductive hearing loss B. Sensorineural hearing loss C. Electrical hearing loss D. Hysterical hearing loss E. Mixed hearing loss 46. A 57-year-old man comes to the ED with “a headache like I’ve never had before.” He is brought to the ED by his wife. The patient had been completely well, healthy, and active before this episode (which began last night). Nausea and vomiting began soon after the headache onset. The patient and his family report no history of trauma. There is no family history of migraine or cluster headache. On examination, there is significant neck stiffness. The patient is unable to move his neck without extreme pain. You are just about to continue with the neurologic examination when a patient with a cardiac arrest is wheeled through the ED doors. At this time, with the information you have to this point, what is the most likely diagnosis? A. acute subdural hematoma B. cluster headache C. subarachnoid hemorrhage D. migraine headache without aura E. glioblastoma multiforme 47. A thin 35-year-old woman presents with a 2-day history of cough. She complains of some mild dyspnea and left-sided pleuritic chest pain. On physical examination, her temperature is 38.5°C (101.4°F) and her respiratory rate is 26 breaths per minute. Her blood pressure is 110/65 mm Hg and her heart rate is 125 beats per minute. Which of the following physical examination findings would most likely be found if she has an uncomplicated left-sided pneumonia? A. Inspiratory stridor B. Vesicular breath sounds on the left C. Absence of egophony on the left D. Decreased tactile fremitus on the left E. Increased tactile fremitus on the left 48. A man is stabbed and arrives at the emergency room within 30 minutes. You notice that the trachea is deviated away from the side of the chest with the puncture. The most likely lung finding on physical examination of the traumatized side is which of the following? A. Increased fremitus B. Increased breath sounds C. Dullness to percussion D. Hyperresonant percussion E. Wheezing F. Stridor 49. Which of the following cannot be heard with the diaphragm of stethoscope? A. S1 B. S2 C. Murmur of mitral regurgitation D. Mitral stenosis E. Murmur of aortic regurgitation 50. Examiner's hand is placed on the patient's right anterior thigh and the patient is asked to raise higher right leg against the examiners hand This testis called A. Rosvsign's sign B. Oburatory sign C. Rebound tenderness D. Psoas sign 51. You are called to evaluate a 57-year-old man with pressure-like chest pain that occurred while he was shoveling the snow. The pain radiates to the jaw and medial aspect of the left arm. The patient denies dizziness, nausea, vomiting, or palpitations. He has a past medical history of hypertension and he smokes 2 packs of cigarettes per day. He has a brother who had a myocardial infarction that required balloon angioplasty when he was in his forties. The patient has recently been told to modify his diet because of a recently discovered high glucose and cholesterol level. On physical examination the patient appears pale and diaphoretic. Blood pressure is 160/100 mm Hg and pulse is 108/min. His extremities are cool. Heart examination reveals an S4 gallop. Lungs are normal. Peripheral pulses are palpable and bilaterally equal. He has no peripheral edema. Which of the following is the most likely diagnosis? A. Right ventricular infarction B. Cardiogenic shock C. Acute myocardial infarction D. Congestive heart failure (CHF) E. Prinzmetal’s angina 52. A 23-year-old medical student presents with the chief complaint of palpitations while playing basketball. The episode lasted 15 minutes. He denies dizziness, syncope, chest pain, and shortness of breath. He admits to a sedentary lifestyle but tries to eat three healthy meals per day. He is adopted, and a family history of heart disease is unknown. Physical examination is remarkable for a triple apical precordial impulse. Which of the following is the most likely diagnosis? A. Hypertrophic cardiomyopathy B. Pulmonary embolism C. Aortic regurgitation D. Right ventricular infarction E. Atrial septal defect 53. 53. 54. 54. Q-Bank 1 1. Skin cancer is definitively diagnosed by? A. Dermoscopy B. X-ray C. MRI D. SKIN BIOPSY E. All of the above 2. Where jaundice can not appear? A. Lips B. Tympanie membrane C. Skin D. Undersurface of the tounge E. Nails 3. Dryness, Sweating, and oiliness are signs of? A. Moisture of the skin B. Texture of the skin C. Mobility of the skin D. Turgor of the skin E. Temprature of skin 4. 48-Year old man complains about pain in the spinal area afater long time walking and standing. Which radiates to buttocks and thighs, he has the... A. Intermittent claudication B. Neurogenic Claudication C. No any of them 5. Which of the following is not the warning sign of PAD? A. Erectile dysfunction B. Fatigue, aching,numbness, or pain that limita walking or exertion in the legs C. Poorly healing or nonhealing woundsof the legs or feet D. All of them are warning signs of PAD 6. Carpal tunnel syndrome cannot be caused by which of the following? A. Repetitive motion with flexed wrists B. Pregnancy C. Repetitive motion with extended hand D. Diabetes E. Hypothyrodism 7. Joint pain and a butterfly rash on the cheeks suggests A. Psoriatic arthritis B. Systemic lupus erythematous C. Acute rheumatic fever D. Arthritis of rubell 8. Drop-arm test