MEDICINE 2 | SHIFT 1
First Shifting Exam
DATE: 11/11/2025
FIRST SHIFTING EXAM
Questions Correct Answer
1. What is the leading cause of peripheral arterial disease (PAD) A. ATHEROSCLEROSIS
in patients >40 years
a. Atherosclerosis
b. Hypertension
c. Smoking
d. Diabetes Mellitus
2. This typical symptom is defined as a pain, ache, cramp, B. PARESTHESIA
numbness and sense of fatigue in the muscles, that occurs
during exercise and relieved by rest
a. Pallor
b. Paresthesia
c. Pulselessness
d. Intermittent claudication
3. What is an important physical finding in PAD? B. DECREASED PULSES DISTAL TO THE OBSTRUCTION
a. Rough skin
b. Decreased pulses distal to the obstruction
c. Warm skin
d. Presence of bruits over the normal artery
4. Which of the following is the best treatment for Peripheral D. BETA BLOCKER
arterial disease?
a. Foot rest
b. Cilostazol
c. Smoking cessation
d. Beta blocker
5. One of the most common sources of arterial emboli is D. HEART
a. Lung
b. Kidney
c. Brain
d. Heart
6. What is this condition that is characterized by episodic digital B. RAYNAUD’S PHENOMENON
ischemia and manifested clinically by the sequential
development of digital blanching, cyanosis, and rubor of the
fingers or toes after cold exposure and subsequent rewarming.
a. Atheroembolism
b. Raynaud's phenomenon
c. Frostbite
d. Livedo Reticularis
7. What is the condition below? D. RAYNAUD’S PHENOMENON
Explanation:
a. Livedo Reticularis
b. Pernio
c. Acrocyanosis
d. Raynaud’s Phenomenon
Notes:
MED 2 Quiz 1: Title Page 1 of
Samplex Committee
27
, ● Livedo Reticularis
● Pernio
● Acrocyanosis
Reference:
PPT: Arterial Diseases of Extremities - Dr. Sevilla (Slide 48, 59, 61,
55)
8. What is the hyperplastic disorder that affects medium-size and D. FIBROMUSCULAR DYSPLASIA
small arteries and identified angiographically by a “string of Explanation:
beads” multifocal appearance ● Fibromuscular Dysplasia
a. Thromboangiitis Obliterans ○ A hyperplastic disorder that typically affects
b. Vasculitis medium-size and small arteries, but it can also
c. Acute Limb ischemia affect larger arteries.
d. Fibromuscular Dysplasia ○ Occurs predominantly in females.
○ Involves the renal and carotid/vertebral arteries
but can involve coronary and mesenteric arteries,
as well as extremity vessels such as the iliac and
subclavian arteries.
○ May cause stenosis, dissection, aneurysm, or
thrombosis in affected arteries.
Reference:
PPT: Arterial Diseases of Extremities - Dr. Sevilla (Slide 18)
9. Which among the following is the clinical features of acute limb B. LOSS OF SENSATION
ischemia? Explanation:
a. Edema ● Acute limb ischemia clinical features:
b. Loss of sensation ○ Physical findings include loss of pulses distal to
c. Warm to touch the occlusion, cyanosis or pallor, mottling,
d. Hyperreflexia decreased skin temperature, muscle stiffening,
loss of sensation, weakness, and/or absent deep
tendon reflexes.
Reference:
Harrison’s Principles of Internal Medicine 21th Ed. - p. 2111
10. This is an inflammatory occlusive vascular disorder involving A. THROMBOANGIITIS OBLITERANS
small and medium-size arteries and veins in the distal upper Explanation:
and lower extremities with a definite relationship to cigarette ● Thromboangiitis obliterans
smoking. ○ An inflammatory occlusive vascular disorder
a. Thromboangiitis Obliterans involving small and medium size arteries and veins
b. Fibromuscular Dysplasia in the distal upper and lower extremities.
c. Acute Limb ischemia ○ Prevalence is higher in Asians and individuals of
d. Pernio Eastern European descent.
○ The cause is not known, but there is a definite
relationship to cigarette smoking.
Reference:
PPT: Arterial Diseases of Extremities - Dr. Sevilla (Slide 21)
11. Where is the most common location of peripheral artery B. POPLITEAL ARTERY
aneurysm? Explanation:
a. Femoral artery ● Popliteal artery aneurysm
b. Popliteal artery ○ Most common peripheral artery aneurysms.
c. Brachial artery ○ Approximately 50% are bilateral.
MED 2 SAMPLEX Page 2 of 27
, d. Radial artery ○ The most common clinical presentation is limb
ischemia secondary to thrombosis or embolism.
○ Popliteal artery aneurysm can be detected by
palpation and confirmed by duplex
ultrasonography. Repair is indicated for
symptomatic aneurysms or when
○ Diameter exceeds 2–3 cm, owing to the risk of
thrombosis, embolism, or rupture.
Reference:
PPT: Arterial Diseases of Extremities - Dr. Sevilla (Slide 41)
12. What is this inflammatory and stenotic disease of medium and B. TAKAYASU ARTERITIS
large sized arteries that is characterized by a strong Explanation:
predilection for the aortic arch and its branches.. ● Takayasu’s arteritis
a. Polymyalgia rheumatica ○ Inflammatory disease often affects the ascending
b. Henoch Schonlein aorta and aortic arch, causing obstruction of the
c. Takayasu arteritis aorta and its major arteries.
d. Polyarteritis nodosa ○ Also termed pulseless disease because of the
frequent occlusion of the large arteries originating
from the aorta. It also may involve the descending
thoracic and abdominal aorta and occlude large
branches such as the renal arteries
Reference:
Harrison’s Principles of Internal Medicine 21th Ed. - p. 2106
13. What is Nicoladoni-Branham sign? A. COMPRESSION OF A LARGE ARTERIOVENOUS FISTULA
a. Compression of a large arteriovenous fistula may cause MAY CAUSE SLOWING IN HEART RATE
reflex slowing of the heart rate. Explanation:
b. Compression of a large arteriovenous fistula may cause ● Compression of a large arteriovenous fistula may cause
reflex increase in heart rate. reflex slowing of the heart rate
c. Compression of a small arteriovenous fistula may cause
reflex increase in heart rate Reference:
d. Compression of a small arteriovenous fistula may cause Book: Harrison’s Principle of Internal Medicine - p. 2112
reflex slowing of the heart rate.
14. Which of the following is a secondary cause of Raynaud's B. ELECTRIC SHOCK
phenomenon? Explanation:
a. Hypertension.
b. Electric Shock
c. Diabetes mellitus
d. Swimming
Reference:
PPT: Arterial Diseases of Extremities by Dr. Sevilla - slide 51
15. What is the normal ankle: brachial index? A. 1.00-1.40
a. 1.00 - 1.40 Explanation:
b. less than 0.90 ● Normal ABI: 1.00-1.40
c. more than 1.40
d. 0.91 - 0.99 Notes:
● <0.80 - Elevated blood pressure, particularly systolic blood
pressure
● <0.90 - diagnostic of PAD and >50% stenosis in at least one
major lower limb vessel
MED 2 SAMPLEX Page 3 of 27
, Reference:
Harrison’s Principles of Internal Medicine 21st e. - p. 1895
16. Which of the following diseases will manifest as Peripheral D. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
cyanosis? Explanation:
a. Patent ductus arteriosus ● Peripheral Arterial Occlusive Disease - Peripheral Cyanosis
b. Ventricular Septal Defect
c. Coarctation of the aorta Notes:
d. Peripheral Arterial Occlusive Disease ● Central Cyanosis
○ Ventricular Septal Defect
○ Atrial Septal Defect
● Differential Cyanosis
○ Coarctation of Aorta, Patent Ductus Arteriosus
(PDA)
Reference:
Book: Harrison’s Principles of Internal Medicine 21e - pp. 1815-1816
PPT and Lecture by Dr. Cabus. Slide 15
17. Which of the following is a feature of Loeys-Dietz syndrome? D. BIFID UVULA
a. Blue sclerae Explanation:
b. High arched palate ● Bifid uvula - feature Loeys-Dietz syndrome
c. Orange tonsils
d. Bifid Uvula Notes:
● Blue sclerae - feature of Osteogenesis imperfecta
● High arched palate - feature of Marfan Syndrome
● Orange tonsils - Tangier Disease
Reference:
Book: Harrison’s Principles of Internal Medicine 20e - p. 1667
PPT and Lecture by Dr. Cabus. Slide 15
18. Which of the following is a feature of Marfan Syndrome? A. ARACHNODACTYLY
a. Arachnodactyly Explanation:
b. Clubbing ● Arachnodactyly - patients with Marfan Syndrome
c. Unopposable "fingerized" Thumb
d. Osler’s Nodes Notes:
● Clubbing - implies the presence of central right-to-left
shunting. Found in COPD. Also found in endocarditis but not
the main feature
● Unopposable “fingerized” thumb - seen in patients with Holt-
Oram syndrome
● Osler’s nodes, Splinter hemorrhages, Janeway lesions,
Petechiae - Infective endocarditis
Reference:
Book: Harrison’s Principles of Internal Medicine 21e - p. 1816 and
table 19-1 p. 137
Book: Bate’s Guide to PE and History taking - Table 6-10 p. 207
PPT and Lecture by Dr. Cabus. Slides 16-17
19. Which of the following is a characteristic of a Carotid artery B. NO RESPIRATORY CHANGE IN CONTOUR
pulse? Explanation:
a. The appearance is Biphasic ● Cannot be obliterated, no respiratory change in contour, and
b. No respiratory change in contour monophasic appearance are characteristics of carotid
c. Generally not palpable artery pulse.
d. Can be obliterated
Reference:
MED 2 SAMPLEX Page 4 of 27
First Shifting Exam
DATE: 11/11/2025
FIRST SHIFTING EXAM
Questions Correct Answer
1. What is the leading cause of peripheral arterial disease (PAD) A. ATHEROSCLEROSIS
in patients >40 years
a. Atherosclerosis
b. Hypertension
c. Smoking
d. Diabetes Mellitus
2. This typical symptom is defined as a pain, ache, cramp, B. PARESTHESIA
numbness and sense of fatigue in the muscles, that occurs
during exercise and relieved by rest
a. Pallor
b. Paresthesia
c. Pulselessness
d. Intermittent claudication
3. What is an important physical finding in PAD? B. DECREASED PULSES DISTAL TO THE OBSTRUCTION
a. Rough skin
b. Decreased pulses distal to the obstruction
c. Warm skin
d. Presence of bruits over the normal artery
4. Which of the following is the best treatment for Peripheral D. BETA BLOCKER
arterial disease?
a. Foot rest
b. Cilostazol
c. Smoking cessation
d. Beta blocker
5. One of the most common sources of arterial emboli is D. HEART
a. Lung
b. Kidney
c. Brain
d. Heart
6. What is this condition that is characterized by episodic digital B. RAYNAUD’S PHENOMENON
ischemia and manifested clinically by the sequential
development of digital blanching, cyanosis, and rubor of the
fingers or toes after cold exposure and subsequent rewarming.
a. Atheroembolism
b. Raynaud's phenomenon
c. Frostbite
d. Livedo Reticularis
7. What is the condition below? D. RAYNAUD’S PHENOMENON
Explanation:
a. Livedo Reticularis
b. Pernio
c. Acrocyanosis
d. Raynaud’s Phenomenon
Notes:
MED 2 Quiz 1: Title Page 1 of
Samplex Committee
27
, ● Livedo Reticularis
● Pernio
● Acrocyanosis
Reference:
PPT: Arterial Diseases of Extremities - Dr. Sevilla (Slide 48, 59, 61,
55)
8. What is the hyperplastic disorder that affects medium-size and D. FIBROMUSCULAR DYSPLASIA
small arteries and identified angiographically by a “string of Explanation:
beads” multifocal appearance ● Fibromuscular Dysplasia
a. Thromboangiitis Obliterans ○ A hyperplastic disorder that typically affects
b. Vasculitis medium-size and small arteries, but it can also
c. Acute Limb ischemia affect larger arteries.
d. Fibromuscular Dysplasia ○ Occurs predominantly in females.
○ Involves the renal and carotid/vertebral arteries
but can involve coronary and mesenteric arteries,
as well as extremity vessels such as the iliac and
subclavian arteries.
○ May cause stenosis, dissection, aneurysm, or
thrombosis in affected arteries.
Reference:
PPT: Arterial Diseases of Extremities - Dr. Sevilla (Slide 18)
9. Which among the following is the clinical features of acute limb B. LOSS OF SENSATION
ischemia? Explanation:
a. Edema ● Acute limb ischemia clinical features:
b. Loss of sensation ○ Physical findings include loss of pulses distal to
c. Warm to touch the occlusion, cyanosis or pallor, mottling,
d. Hyperreflexia decreased skin temperature, muscle stiffening,
loss of sensation, weakness, and/or absent deep
tendon reflexes.
Reference:
Harrison’s Principles of Internal Medicine 21th Ed. - p. 2111
10. This is an inflammatory occlusive vascular disorder involving A. THROMBOANGIITIS OBLITERANS
small and medium-size arteries and veins in the distal upper Explanation:
and lower extremities with a definite relationship to cigarette ● Thromboangiitis obliterans
smoking. ○ An inflammatory occlusive vascular disorder
a. Thromboangiitis Obliterans involving small and medium size arteries and veins
b. Fibromuscular Dysplasia in the distal upper and lower extremities.
c. Acute Limb ischemia ○ Prevalence is higher in Asians and individuals of
d. Pernio Eastern European descent.
○ The cause is not known, but there is a definite
relationship to cigarette smoking.
Reference:
PPT: Arterial Diseases of Extremities - Dr. Sevilla (Slide 21)
11. Where is the most common location of peripheral artery B. POPLITEAL ARTERY
aneurysm? Explanation:
a. Femoral artery ● Popliteal artery aneurysm
b. Popliteal artery ○ Most common peripheral artery aneurysms.
c. Brachial artery ○ Approximately 50% are bilateral.
MED 2 SAMPLEX Page 2 of 27
, d. Radial artery ○ The most common clinical presentation is limb
ischemia secondary to thrombosis or embolism.
○ Popliteal artery aneurysm can be detected by
palpation and confirmed by duplex
ultrasonography. Repair is indicated for
symptomatic aneurysms or when
○ Diameter exceeds 2–3 cm, owing to the risk of
thrombosis, embolism, or rupture.
Reference:
PPT: Arterial Diseases of Extremities - Dr. Sevilla (Slide 41)
12. What is this inflammatory and stenotic disease of medium and B. TAKAYASU ARTERITIS
large sized arteries that is characterized by a strong Explanation:
predilection for the aortic arch and its branches.. ● Takayasu’s arteritis
a. Polymyalgia rheumatica ○ Inflammatory disease often affects the ascending
b. Henoch Schonlein aorta and aortic arch, causing obstruction of the
c. Takayasu arteritis aorta and its major arteries.
d. Polyarteritis nodosa ○ Also termed pulseless disease because of the
frequent occlusion of the large arteries originating
from the aorta. It also may involve the descending
thoracic and abdominal aorta and occlude large
branches such as the renal arteries
Reference:
Harrison’s Principles of Internal Medicine 21th Ed. - p. 2106
13. What is Nicoladoni-Branham sign? A. COMPRESSION OF A LARGE ARTERIOVENOUS FISTULA
a. Compression of a large arteriovenous fistula may cause MAY CAUSE SLOWING IN HEART RATE
reflex slowing of the heart rate. Explanation:
b. Compression of a large arteriovenous fistula may cause ● Compression of a large arteriovenous fistula may cause
reflex increase in heart rate. reflex slowing of the heart rate
c. Compression of a small arteriovenous fistula may cause
reflex increase in heart rate Reference:
d. Compression of a small arteriovenous fistula may cause Book: Harrison’s Principle of Internal Medicine - p. 2112
reflex slowing of the heart rate.
14. Which of the following is a secondary cause of Raynaud's B. ELECTRIC SHOCK
phenomenon? Explanation:
a. Hypertension.
b. Electric Shock
c. Diabetes mellitus
d. Swimming
Reference:
PPT: Arterial Diseases of Extremities by Dr. Sevilla - slide 51
15. What is the normal ankle: brachial index? A. 1.00-1.40
a. 1.00 - 1.40 Explanation:
b. less than 0.90 ● Normal ABI: 1.00-1.40
c. more than 1.40
d. 0.91 - 0.99 Notes:
● <0.80 - Elevated blood pressure, particularly systolic blood
pressure
● <0.90 - diagnostic of PAD and >50% stenosis in at least one
major lower limb vessel
MED 2 SAMPLEX Page 3 of 27
, Reference:
Harrison’s Principles of Internal Medicine 21st e. - p. 1895
16. Which of the following diseases will manifest as Peripheral D. PERIPHERAL ARTERIAL OCCLUSIVE DISEASE
cyanosis? Explanation:
a. Patent ductus arteriosus ● Peripheral Arterial Occlusive Disease - Peripheral Cyanosis
b. Ventricular Septal Defect
c. Coarctation of the aorta Notes:
d. Peripheral Arterial Occlusive Disease ● Central Cyanosis
○ Ventricular Septal Defect
○ Atrial Septal Defect
● Differential Cyanosis
○ Coarctation of Aorta, Patent Ductus Arteriosus
(PDA)
Reference:
Book: Harrison’s Principles of Internal Medicine 21e - pp. 1815-1816
PPT and Lecture by Dr. Cabus. Slide 15
17. Which of the following is a feature of Loeys-Dietz syndrome? D. BIFID UVULA
a. Blue sclerae Explanation:
b. High arched palate ● Bifid uvula - feature Loeys-Dietz syndrome
c. Orange tonsils
d. Bifid Uvula Notes:
● Blue sclerae - feature of Osteogenesis imperfecta
● High arched palate - feature of Marfan Syndrome
● Orange tonsils - Tangier Disease
Reference:
Book: Harrison’s Principles of Internal Medicine 20e - p. 1667
PPT and Lecture by Dr. Cabus. Slide 15
18. Which of the following is a feature of Marfan Syndrome? A. ARACHNODACTYLY
a. Arachnodactyly Explanation:
b. Clubbing ● Arachnodactyly - patients with Marfan Syndrome
c. Unopposable "fingerized" Thumb
d. Osler’s Nodes Notes:
● Clubbing - implies the presence of central right-to-left
shunting. Found in COPD. Also found in endocarditis but not
the main feature
● Unopposable “fingerized” thumb - seen in patients with Holt-
Oram syndrome
● Osler’s nodes, Splinter hemorrhages, Janeway lesions,
Petechiae - Infective endocarditis
Reference:
Book: Harrison’s Principles of Internal Medicine 21e - p. 1816 and
table 19-1 p. 137
Book: Bate’s Guide to PE and History taking - Table 6-10 p. 207
PPT and Lecture by Dr. Cabus. Slides 16-17
19. Which of the following is a characteristic of a Carotid artery B. NO RESPIRATORY CHANGE IN CONTOUR
pulse? Explanation:
a. The appearance is Biphasic ● Cannot be obliterated, no respiratory change in contour, and
b. No respiratory change in contour monophasic appearance are characteristics of carotid
c. Generally not palpable artery pulse.
d. Can be obliterated
Reference:
MED 2 SAMPLEX Page 4 of 27
