PDR 2ND BMEX Flashcards by Abby David

This group of muscle found in the elbow is responsible for extension:

a. Pronator teres
b. Brachioradialis
c. Biceps
d. Triceps

d. Triceps

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This condition refers to an excessive or thickened stratum corneum often but not always scaly.

a. Hyperkeratosis
b. Horn
c. Thick scaling
d. Lichenification

a. Hyperkeratosis

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This skin lesion is formed when multiple furuncles coalesced.

a. Abscess
b. Big pus
c. Carbuncle
d. Folliculitis

c. Carbuncle

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What is the most active joint in the human body?

a. Temporomandibular joint
b. Knee joint
c. Wrist joint
d. Elbow joint

a. Temporomandibular joint

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This skin abnormality will produce accentuated skin markings and may resemble a bark of the tree.

a. Lichen planus
b. Horn
c. Hyperkeratosis
d. Lichen simplex chronicus

d. Lichen simplex chronicus

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Which of these tests assesses the shoulder range of motion?

a. Empty can test
b. Hawkin’s test
c. Neer’s sign
d. Apley scratch test

d. Apley scratch test

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Identify the type of joint in which the bones are almost in direct contact with each other, which allows no appreciable movement.

a. Synovial joints
b. Cartilaginous joints
c. Fibrous joints
d. Spheroidal joints

c. Fibrous joints

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This is a configuration that is formed due to incomplete formation of an annular lesion.

a. Serpinginous
b. Arcuate
c. Whorled
d. Circular

b. Arcuate

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The turbid yellowish-green crust is formed due to

a. Purulent secretion
b. Hemorrhagic secretion
c. Hardening of calcium deposits
d. Dried serous secretion

a. Purulent secretion

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How is the patient best instructed if the examiner wants the patient to do an external rotation of the shoulder?

a. “Raise your arms behind you.”
b. “Raise your arms out to the side and overhead.”
c. “Place one hand behind your back as if brushing your hair.”
d. “Cross your arms in front of you.

c. “Place one hand behind your back as if brushing your hair.”

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Which of the following statements is True about Osteoporosis?

a. Osteoporosis typically arises from bone growth during aging.
b. Osteoporosis is a T score less than -2.5
c. Postmenopausal women have a lower risk of developing osteoporosis.
d. a low body weight (less than 70 kg) reduces the risk of developing osteoporosis.

b. Osteoporosis is a T score less than -2.5

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Which of these statements is true of Ballottement test?

a. Increased motion upon patellar oscillation denotes
intra-articular knee swelling.
b. Pressure is exerted along the medial and lateral collateral ligaments.
c. It tests the strength of the knees.
d. Orthopnea

a. Increased motion upon patellar oscillation denotes
intra-articular knee swelling.

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Which statement is true of angioedema?

a. Always painful
b. Occur in thicker tissue
c. Pruritic
d. Deeper edematous reaction

d. Deeper edematous reaction

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Which of the following describes erosions of the skin?

a. No infection
b. Does not bleed
c. Always very painful
d. Do not scar

d. Do not scar

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Identify the skin lesion described as elevated, circumscribed, more than 2 cm in diameter, involves the dermis and may extend to the subcutis layer. Its greatest mass may be beneath the skin surface.

a. Pustule
b. Bulla
c. Vesicle
d. Nodule

d. Nodule

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Which is a classic example of erythroderma?

a. Sezary syndrome
b. Lichen planus
c. Psoriasis
d. Toxic epidermal necrolysis

a. Sezary syndrome

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Identify the type of joint in which the bones do not touch each other, and the joint articulations are freely movable.

a. Spheroidal joints
b. Fibrous joints
c. Synovial joints
d. Cartilaginous joints

c. Synovial joints

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Which of these lesions is described as evanescent?

a. Wheal
b. Papule
c. Patch
d. Plaque

a. Wheal

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Papules surmounted with scale is a

a. Papulosquamous lesion
b. Scaly plaque
c. Silvery scale
d. Big papule

a. Papulosquamous lesion

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Which of the following statements is true of a pustule?

a. It is always a raised lesion containing bacteria.
b. Purulent exudate may contain multiple eosinophils.
c. The purulent exudate is hemorrhagic.
d. The purulent exudate may contain acellular debris.

d. The purulent exudate may contain acellular debris.

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The horn is usually involved in this layer.

a. Papillary
b. Subcutaneous fat
c. Reticular
d. Epidermis

d. Epidermis

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Spheroidal joints are capable of which type of movement?

a. Eversion
b. Circumduction
c. Motion in one plane
d. Internal rotation

b. Circumduction

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Which is an example of a cartilaginous joint?

a. Vertebral bodies of spine
b. Knee
c. Skull suture
d. Shoulder

a. Vertebral bodies of spine

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Which of the following is true of abscesses?

a. It is composed of multiple folliculitis.
b. The pus is usually not visible on the surface of the skin.
c. It is occasionally tender.
d. It will always produce fever.

b. The pus is usually not visible on the surface of the skin.

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When a patient is instructed to “Raise your arms behind you,” what is the principal muscle affected in this movement? a. Middle deltoid b. Pectoralis major c. Triceps brachialis d. Coracobrachialis

c. Triceps brachialis

Shoulder abduction is not a function of this muscle. a. Serratus major b. Pectoralis major c. Deltoid d. Supraspinatus

b. Pectoralis major

The radial nerve is responsible for the sensation in this area of the hand. a. Medial side of the 4th finger b. Pulp of the 5th finger c. Dorsal web space of the thumb and index finger d. Pulp of thumb

c. Dorsal web space of the thumb and index finger

Which of the following tests is performed to detect irritation of the median nerve by lightly percussing over the nerve? a. Finkelstein’s test b. Phalen’s test c. Digital Allen’s test d. Tinel’s test

d. Tinel’s test

A cyst is an encapsulated lesion that is lined with a. Dermis b. Epithelium c. Hypodermis d. Papillary layer

b. Epithelium

What is the muscle affected in the internal rotation of the hip? a. Iliopsoas b. Internal obturator c. Quadratus femoris d. Gluteus maximus

a. Iliopsoas (RATIO) b. Internal obturator eLearn Answer

How will the patient be instructed when an examiner wants the patient to perform hip adduction? a. “Lying flat, bend your knee and move your lower leg towards the midline.” b. “Lie face down, then bend knee and lift it up.” c. “Lying flat, bend knee and turn lower leg and foot across the midline.” d. “Bend knee to chest and pull it against the abdomen.

a. “Lying flat, bend your knee and move your lower leg towards the midline.”

A comedo is a hair follicle infundibulum that is dilated and plugged by a. Lipid b. Proteoglycan c. Dirt d. Protein

a. Lipid

Which of these is a feature of poikiloderma? a. Swollen blood vessel b. Generalized lesions c. Pruritic d. Varied pigmentary changes

d. Varied pigmentary changes

Identify the skin lesion that is described as elevated, circumscribed, less than 1 cm in diameter, seen in conditions such as Seborrheic keratosis, Lichen nitidus and Verruca contagiosum. a. Papule b. Plaque c. Patch d. Macule

a. Papule

Forward elevation to 90 degrees and active adduction of the should joint is done in this particular test. a. Supraspinatus strength test b. Infraspinatus strength test c. Crossover test d. Drop arm test

c. Crossover test

Which of the following techniques tests the rotator cuff? a. Supraspinatus strength test b. Apley scratch test c. Neer’s impingement sign d. Drop arm sign

c. Neer’s impingement sign

Scars are formed due to a breach in a. Papillary dermis b. Full thickness of hypodermis c. Reticular dermis d. Full thickness of the epidermis

c. Reticular dermis

In an ulcer, the breach of the dermis and destruction of adnexal structures can result in a. hyperpigmentation b. impedance of the blood flow c. impedance of the reepithelialization d. obstruction of the small blood vessel

c. impedance of the reepithelialization

Identify the skin lesion that is described as flat, circumscribed, more than 1 cm in diameter and seen in conditions such as vitiligo, melasma and solar purpura. a. patch b. papule c. plaque d. macule

a. patch

Identify the skin lesion that is described as elevated, circumscribed, more than 1 cm in diameter, and primarily filled with clear fluid. a. Nodule b. Pustule c. Bulla d. Vesicle

c. Bulla

Which part of the nail functions as a seal protecting it from external moisture? a. Lateral nail folds b. Cuticle c. Nail plate d. Lunula

b. Cuticle

Which of the following structures is involved when doing the Lachman test in knee examination? a. Medial collateral ligament b. Anterior cruciate ligament c. Medial meniscus d. Lateral collateral ligament

b. Anterior cruciate ligament

A 5 year-old child came in for consult with multiple very pruritic burrows. What is your diagnosis? a. Scabies b. Pyoderma gangrenosum c. Folliculitis d. Contact dermatitis

a. Scabies

Which of the following statements is true when inspecting the patient’s gait? a. A wide base may suggest abductor weakness b. Stance involves foot moving forward and does not bear weight c. First phase of the gait bears approximately 60% weight of the walking cycle d. The width of the base should be 3-5 inches from heel to heel

c. First phase of the gait bears approximately 60% weight of the walking cycle

Which of the bony structures are located on the anterior surface of the hip? a. Ischial tuberosity b. Pubic tubercle c. Posterior superior iliac spine d. Sacroiliac joint

b. Pubic tubercle

The involvement of the papillary and reticular connective tissue in atrophy will produce a. Paper thin appearance b. Glossy appearance c. Wrinkled appearance d. Depression of the skin

d. Depression of the skin

Identify the type of joint in which the articulating bony surfaces are separated by fibrocartilaginous discs and are slightly movable. a. Spheroidal joints b. Synovial joints c. Fibrous joints d. Cartilaginous joints

d. Cartilaginous joints

This particular neck motion occurs primarily in the axis of the spine. a. Lateral bending b. Flexion c. Extension d. Rotation

d. Rotation

This test examines the thumb function by asking the patient to grasp thumb against the palm and move wrist towards the midline. a. Thumb adduction test b. Tinel’s test c. Finkelstein test d. Hand grip test

c. Finkelstein test

Which of these conditions is hypothenar atrophy most commonly seen? a. Rheumatoid arthritis b. Ulnar nerve compression c. Dupuytren’s contracture d. DeQuervain’s tenosynovitis

b. Ulnar nerve compression

Identify the skin lesion that is described as flat, circumscribed, < 1 cm in diameter, often hypo or hyperpigmented that is seen in conditions such as impetigo, ephelid and petechiae. A. Patch B. Macule C. Plaque D. Papule

B. Macule

Identify the skin lesion that is described as flat, circumscribed, > 1 cm in diameter and seen in conditions such as vitiligo, melisma and solar purpura. A. Macule B. Plaque C. Patch D. Papule

C. Patch

Identify the skin lesion that is described as elevated, circumscribed, < 1 cm in diameter, and primarily filled with clear fluid. A. Pustule B. Vesicle C. Bulla D. Nodule

B. Vesicle

Identify the skin lesion that is described as elevated, circumscribed, usually < 1 cm in diameter, and filled with purulent fluid. A. Vesicle B. Bulla C. Nodule D. Pustule

D. Pustule

Identify the type of scale that is described as thick, greasy or waxy, yellow to brown in color and flaky. A. Pityriasiform B. Lamellar C. Exfoliative D. Seborrheic

D. Seborrheic

What are the four muscles of the rotator cuff? A. Supraspinatus, Infraspinatus, Teres major, Subscapularis B. Supraspinatus, Infraspinatus, Levator scapulae, Subscapularis C. Supraspinatus, Infraspinatus, Trapezius, Subscapularis D. Supraspinatus, Infraspinatus, Teres minor, Subscapularis

D. Supraspinatus, Infraspinatus, Teres minor, Subscapularis

What is the name of the test where you press on the scapula to prevent scapular motion with one hand, and raise the patient’s arm with the other. Pain elicited during this maneuver is indicative of a possible rotator cuff tear. A. Drop arm sign B. Hawkin’s impingement sign C. Neer’s impingement sign D. Apley scratch test

C. Neer’s impingement sign

Upon palpation of the elbow, you noted tenderness distal to the epicondyle. This is indicative of what disease entity? A. Pitcher’s elbow B. Tennis elbow C. Golfer’s elbow D. Bursitis

B. Tennis elbow

What do you call the special maneuver for examining the knee wherein you let the patient lie in supine position, hips flexed and knees flexed to 90⁰ and feet flat on the table. Both your hands are cupped around the knee with your thumbs on the medial and lateral joint line and the fingers on the medial and lateral insertions of the hamstrings. You then draw the tibia forward from under the femur. A forward jerk showing the contours of the upper tibia is a positive sign, making an anterior cruciate ligament tear more likely. A. Valgus stress test B. Varus stress test C. Lachman test D. Anterior Drawer sign

D. Anterior Drawer sign

NEXUS criteria is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging and includes the following except A. no evidence of intoxication B. obtunded C. no focal neurologic deficits D. no posterior midline cervical spine tenderness

B. obtunded

In the setting of neck pain secondary to trauma, the following are considered high risk of having an injury requiring radiographic investigation: A. 50-year-old car passenger with neck pain 3 days after collision B. 50-year-old motorcycle rider, GCS 15 C. 55-year-old jeepney passenger with no cervical midline tenderness D. 50-year-old jeepney passenger, ambulatory in the ER

B. 50-year-old motorcycle rider, GCS 15

Which of the following activities present with the greatest lumbar disc pressure? A. Sitting and leaning forward B. Supine lying C. Sitting without back support D. Standing and bending forward

D. Standing and bending forward

The following are examples of mechanical causes of low back pain except A. severe scoliosis B. spinal cord tumor C. herniated disk D. lumbar strain

B. spinal cord tumor

Straight leg test is a test for A. neurologic dysfunction B. lumbar instability C. foraminal stenosis D. lumbar ligament laxity

A. neurologic dysfunction

Muscle strength grade described as movement against gravity only A. Grade 1 B. Grade 2 C. Grade 3 D. Grade 4

C. Grade 3

In performing the Shoulder External Rotation Lag test, patient is unable to maintain arm in full external rotation. You suspected patient has A. supraspinatus and/or infraspinatus tear B. bicipital tendinitis C. deltoid weakness D. anxiety

A. supraspinatus and/or infraspinatus tear

24-year-old male complains of localized pain and tenderness on the left anterior chest after being involved in a 2- wheel non-collision motor vehicle accident, passenger. What special technique would you employ to rule out rib fracture? A. Observe contour of anterior chest for possible deformities B. Palpate the affected area for localized tenderness to pinpoint possible fracture C. Apply anteroposterior compression of the chest to illicit tenderness of the affected part D. Percuss affected area to identify the fractured rib

C. Apply anteroposterior compression of the chest to illicit tenderness of the affected part

A 45-year-old male came into the emergency room complaining of chest pain. Upon investigation, he pointed with his finger the area in his chest where he felt the pain. What could probably be the origin of his complaint according to Bates? A. Respiratory pathology B. Gastrointestinal pathology C. Musculoskeletal pathology D. Cardiac pathology

C. Musculoskeletal pathology

A 30-year-old female was rushed into the emergency department for severe dyspnea. History revealed that she has a condition known as PICA. Initial radiographic findings noted a collapsed right lung. What would be the expected physical examination finding of the involved site of the chest upon percussion? A. Resonant on the right lung B. Dull on the right lung C. Dull on the left lung D. Resonant on the left lung

B. Dull on the right lung

A 30-year-old female was rushed into the emergency department for severe dyspnea. History revealed that she has a condition known as PICA. Initial radiographic findings noted a collapsed right lung. What would be the expected physical examination finding of the chest? A. Stridor heard upon auscultation B. Tactile fremitus increased C. Contralateral displacement of the trachea D. Resonant lung fields upon percussion

B. Tactile fremitus increased

A 45-year-old male complains of cough and fever of one-week duration. You noted dullness over the right lung field on percussion. As a review, how is dullness in percussion defined according to Bates? A. Soft intensity, high pitch, short duration Flat B. Medium intensity, medium pitch, medium duration C. Very loud intensity, lower pitch, longer duration Hyperresonant D. Loud intensity, low pitch, long duration

B. Medium intensity, medium pitch, medium duration

What do you call an auscultatory chest finding that is heard as a series of precordial crackles that is synchronous with the heart beat and not with respiration? A. Mediastinal crunch B. Pleural rub C. Rhonchi D. Late inspiratory crackles

A. Mediastinal crunch

What is the most frequent cause of chest pain in children? A. Angina pectoris B. Heartburn C. Rib fracture D. Anxiety

D. Anxiety

Which among these muscle groups when noted to be involved in breathing denotes a certain disease process? A. Diaphragm during respiration B. Parasternals during inspiration C. Sternomastoids during expiration D. Abdominal muscles during expiration

D. Abdominal muscles during expiration

A 48-year-old male presents with a chest deformity identified by the consultant on duty as PECTUS CARINATUM. As a medical student, what is the clinical definition of the said condition? A. The thorax is wider than it is deep B. The lower portion of the sternum is depressed C. The sternum is displaced anteriorly D. Uniformity increased anteroposterior diameter of the chest

C. The sternum is displaced anteriorly

A 30-year-old female was rushed into the emergency department for severe dyspnea. History revealed that she has a condition known as PICA. Initial radiographic findings noted a collapsed right lung. What would be the possible cause of her symptoms? A. Alveoli is filled with fluid or blood cells B. Fluid accumulates in the pleural space C. Air leaks into the pleural space D. Lobar obstruction due to foreign object

D. Lobar obstruction due to foreign object

As a second year medical student, practicing percussion on your own self, which area of your body would give you TYMPANY? A. On a puffed-out cheek B. Over the anterior chest C. On both extended thighs D. Over the right upper quadrant of the abdomen

A. On a puffed-out cheek

A 21-year-old male was involved in a 2-wheel collision motor vehicle accident and sustained multiple rib fractures resulting in a traumatic flail chest. What can be observed in this condition? A. The injured area remains motionless during the expiration and inspiration efforts B. The injured area moves outward on expiration and caves inward during inspiration C. The pain felt on the injured area increases with expiration and inspiration efforts D. Soft tissue injuries will be apparent over the injured site

B. The injured area moves outward on expiration and caves inward during inspiration

Which breath sound upon chest auscultation can the examiner observe a “silent gap” between the inspiratory and expiratory phase? A. Tracheal breath sounds B. Bronchovesicular breath sounds C. Vesicular breath sounds D. Bronchial breath sounds

D. Bronchial breath sounds

According to the US Preventive Services Task Force, you should ask the 5A’s in assessing the patient’s readiness to quit smoking. Which of the following is correct? A. Assess tobacco use B. Arrange follow up C. Ask about the willingness to quit D. Advise to quit

B. Arrange follow up

A 28-year-old female complains of occasional, non-productive cough associated with dyspnea. Upon auscultation of the anterior and posterior chest you noted a breath sound that is continuous, relatively high-pitched with hissing or shrill quality. What do you call this breath sound? A. Stridor B. Rhonchi C. Wheeze D. Crackles

C. Wheeze

Upon inspection of the respiratory system, the physician noted that the trachea of the patient is displaced laterally. What could be the cause of this physical examination finding? A. A large pleural effusion B. The trachea is displaced to the ipsilateral side in cases of pneumothorax C. The trachea is displaced to the contralateral side in cases of atelectasis D. Normal variant, not all tracheas are midline in position

A. A large pleural effusion

According to the Centers of Disease Control and Prevention a tobacco cigarette smoker is at risk for developing pathologic conditions compared to non-smokers. Which of the following is correct? A. A male smoker is 13 times more at risk to die from lung cancer compared to non-smokers B. A smoker is 23 times more at risk to die from COPD compared to non-smokers C. A smoker is 10 times more at risk to develop peripheral vascular disease compared to non-smokers D. A smoker is 10 times more at risk for developing coronary artery disease compared to non-smokers

C. A smoker is 10 times more at risk to develop peripheral vascular disease compared to non-smokers

Which adventitious breath sound is heard on auscultation of the anterior and posterior chest in patients with early onset congestive heart failure? A. Crackles B. Wheeze C. Rhonchi D. Stridor

D. Stridor

A 15-year-old male was noted to have chest deformity. Upon complete physical examination of the chest, you also noted the presence of murmurs. Which chest deformity is associated with cardiac murmurs? A. Funnel chest B. Barrel chest C. Pigeon chest D. Traumatic flail chest

A. Funnel chest

This landmark in the anterior chest is used to identify the area for thoracentesis A. Thoracic four level B. Fourth intercostal space C. Second intercostal space D. Thoracic four to thoracic 8 interspace

D. Thoracic four to thoracic 8 interspace

Which normal breath sound is heard in the first and second interspaces anteriorly and in the intrascapular area on auscultation? A. Vesicular breath sounds B. Tracheal breath sounds C. Bronchial breath sounds D. Bronchovesicular breath sounds

D. Bronchovesicular breath sounds

What is the characteristic of a vesicular breath sound on auscultation according to Bates? A. Equal inspiratory and expiratory sound duration, soft intensity of expiratory sound, relatively low pitch of expiratory sound B. Inspiratory sound is longer than expiratory sound, soft intensity of expiratory sound, intermediate pitch of expiratory sound C. Inspiratory sound is longer than expiratory sound, soft intensity of expiratory sound, relatively low pitch of expiratory sound D. Equal inspiratory and expiratory sound duration, intermediate intensity of expiratory sound, intermediate pitch of expiratory sound

C. Inspiratory sound is longer than expiratory sound, soft intensity of expiratory sound, relatively low pitch of expiratory sound

This anatomical term is used to locate the area between the scapulae A. Infrascapular B. Suprascapular C. Interscapular D. Scapular line

C. Interscapular

What is the type of cardiac murmur that starts with S1 and stops at S2, without a gap between murmur and heart sounds? A. Early diastolic murmur B. Pansystolic murmur C. Late systolic murmur D. Midsystolic murmur

B. Pansystolic murmur

What is the term that refers to the difference between systolic and diastolic pressures? A. Systolic pressure B. Pulse pressure C. Diastolic pressure D. Blood pressure

B. Pulse pressure

What type of murmur can be heard when the mitral valve fails to close fully in systole, causing blood to regurgitate from the left ventricle to the left atrium? A. Early diastolic murmur B. Midsystolic murmur C. Late systolic murmur D. Pansystolic murmur

D. Pansystolic murmur

What is the type of murmur that can be heard when the tricuspid valve fails to close fully in systole, causing blood to regurgitate from the right ventricle to the right atrium? A. Pansystolic murmur B. Midsystolic murmur C. Early diastolic murmur D. Late systolic murmur

A. Pansystolic murmur

What is the term given to the volume of blood ejected from each ventricle during one minute? A. Stroke volume B. Cardiac output C. Heart rate D. Preload

B. Cardiac output

What is the term that refers to the unpleasant awareness of the heartbeat? A. Orthopnea B. Chest pain C. Palpitations D. Paroxysmal nocturnal dyspnea

C. Palpitations

What is the type of murmur that can be heard in a congenital abnormality in which blood flows from the relatively high-pressure ventricle into the low-pressure right ventricle through a hole? A. Early diastolic murmur B. Late systolic murmur C. Midsystolic murmur D. Pansystolic murmur

D. Pansystolic murmur

What is the anatomic location of the point of maximal impulse in a normal person? A. 6th interspace, 7cm to 9cm lateral to the midsternal line B. 6th interspace, 10cm to 12cm lateral to the midsternal line C. 5th interspace, 10cm to 12cm lateral to the midsternal line D. 5th interspace, 7cm to 9cm lateral to the midsternal line

D. 5th interspace, 7cm to 9cm lateral to the midsternal line

What is the term of the arterial pulse with a double systolic peak? A. Pulsus alterans B. Bigemini pulse C. Paradoxical pulse D. Bisferiens pulse

D. Bisferiens pulse

What is the term that refers to the ability of the cardiac muscle, when given a load, to shorten? A. Myocardial contractility B. Stroke volume C. Preload D. Afterload

A. Myocardial contractility

What is the estimated blood pressure reading from the right internal jugular vein, that reflects right atrial pressure? A. Central venous pressure B. Pulse pressure C. Jugular venous pressure D. Blood pressure

C. Jugular venous pressure

Which of the following are called semilunar valves? A. Aortic and pulmonic valves B. Aortic and atrioventricular valves C. Aortic and mitral valves D. Aortic and tricuspid valves

A. Aortic and pulmonic valves

A 46-year-old female has the following physical examination of the lungs: dull over the affected area on percussion, trachea is midline, bronchial breath sounds over the affected area, late inspiratory crackles over the affected area, increased tactile fremitus with bronchophony, egophony, and whispered pectoriloquy. What possible consolidation does the patient have? A. Lobar pneumonia B. Atelectasis C. Pneumothorax D. Pleural effusion

A. Lobar pneumonia

In measuring JVP, what is the starting angle to raise the head of bed? A. 30 degrees B. 45 degrees C. 60 degrees D. 90 degrees

A. 30 degrees

A 36-year-old female with a history of lobar pneumonia came back to your clinic. All her symptoms were resolved after antibiotic therapy. Which of the following statements is correct about a normal air-filled lung? A. Whispered words are faint and indistinct B. EE heard as AY C. Breath sounds are bronchial D. Spoken words are louder and clearer

A. Whispered words are faint and indistinct

A 24-year-old came in to your clinic for acute onset of cough. You diagnose the patient with viral upper respiratory tract infection and were managed as such. It came to your knowledge as you probed to the personal and social history of the patient that he just recently started smoking because of peer pressure. As a holistic approach in managing your patient, which fact would you tell him to convince him to consider smoking cessation as early as possible? A. A smoker is 10x more likely to die from lung cancer B. A smoker is 23x more at risk for having stroke compared to non-smoker C. A smoker is 2x more likely to develop COPD compared to non-smoker D. A smoker is 10x more at risk to develop peripheral vascular disease compared to non-smoker

D. A smoker is 10x more at risk to develop peripheral vascular disease compared to non-smoker

What is the term that refers to the ability of the cardiac muscle, when given a load, to shorten? A. Myocardial contractility B. Stroke volume C. Preload D. Afterload

A. Myocardial contractility

What is the origin of a murmur that is medium pitched, grade 2/6, blowing decrescendo diastolic murmur, heard best in the 4th interspace, with radiation to the apex? A. Mitral stenosis B. Aortic regurgitation C. Mitral regurgitation D. Aortic stenosis

B. Aortic regurgitation

What is the clinical term that refers to the superior aspect of the heart of the right and left 2nd interspaces next to the sternum? A. Cardiac apex B. Base of the heart C. Inferior border D. Superior border

B. Base of the heart

What is the respiratory sound that is described as musical and may be audible to the patient and to others? A. Rhonchi B. Rales C. Stridor D. Wheezes

D. Wheezes

It refers to the degree of vascular resistance to ventricular contraction A. Preload B. Afterload C. Myocardial contractility D. Cardiac output

B. Afterload

The location on the chest wall when you hear heart sounds and murmurs help identify the valve or chamber where they originate. Which of the following statements is correct? A. Sounds and murmurs arising from tricuspid valve are usually heard best at around cardiac apex B. Murmurs originating in aortic valve may be heard anywhere from the left second interspace to the apex C. Sounds and murmurs originating in mitral valve are heard best at or near the lower left sternal border D. Murmurs arising from pulmonic valve are usually heard best in second and third interspaces close to the sternum

D. Murmurs arising from pulmonic valve are usually heard best in second and third interspaces close to the sternum

The following statements are about adventitious lung sounds. Which is correct? A. Pleural rubs is a series of precordial crackles that is synchronous with heartbeats. not respiration B. Mediastinal crunch is a creaking sound when surface of a roughened pleural surfaces rub against each other C. Wheezes occur when air flows slowly through a narrowed bronchus nearly to the point of closure D. Wheezes that is entirely predominantly inspiratory is called stridor

D. Wheezes that is entirely predominantly inspiratory is called stridor

Which of the following statements regarding the production of heart sounds is correct? ' A. Closure of pulmonic valve produces S2 B. Closure of aortic valve produces S1 C. Closure of tricuspid valve produces S2 D. Closure of mitral valve produces S1

D. Closure of mitral valve produces S1

Which of the following chest and lung PE findings can be observed in a patient with tension pneumothorax? A. Increased fremitus B. Dull percussion C. Tracheal deviation away from the side of lesion D. Increased breath sounds

C. Tracheal deviation away from the side of lesion

Which of the following statements about the electrocardiogram is correct? A. When positive and negative vectors balance, they are isoelectric appearing as a straight line B. The ECG consists of 4 limb leads in the frontal plane and 8 chest or precordial leads in the transverse plane C. Electrical vectors moving away from the lead causes a positive, or downward, deflection D. Electrical vectors approaching a lead cause a negative, or upward, deflection

A. When positive and negative vectors balance, they are isoelectric appearing as a straight line

Initiation of antihypertensive therapy is warranted at what stage of hypertension, according to JNC7? A. 140/90 mmHg B. 160/100 mmHg C. 130/80 mmHg D. 120/80 mmHg

C. 130/80 mmHg

The CDC recommends pneumococcal vaccinations for which groups of patients? A. People living with HIV B. Americans with African ancestry C. Healthy population between ages 2 to 64 years old D. 1-year-old patient

A. People living with HIV

In graduation of cardiac murmurs. what is the grade of a murmur that is very loud, with thrill, may be heard when the stethoscope is partly off the chest? A. Grade 1/6 B. Grade 6/6 C. Grade 5/6 D. Grade 3/6

C. Grade 5/6

It is a dyspnea that occurs when a patient is lying down and improves when the patient sits up? A. Orthopnea B. Chest pain C. Palpitation D. Paroxysmal nocturnal dyspnea

A. Orthopnea

What is probably the cause of chronic cough among the following disease entities? A. Gastroesophageal reflux B. Left ventricular heart failure C. Bacterial sinusitis D. Viral upper respiratory infection

A. Gastroesophageal reflux

A 38-year-old male presented with acute onset of chest pain and dyspnea. What is the expected chest examination findings to diagnose tension pneumothorax? A. Asymmetric increased fremitus B. Increased breath sounds on auscultation C. Tympany on percussion D. Trachea deviate to the ipsilateral side

C. Tympany on percussion

A 60-year-old male with a history of 20-pack-year cigarette smoking, presents at your clinic with complaints of chronic cough and occasional dyspnea. Which statement is correct regarding the shape of his chest? A. There is increased anteroposterior diameter B. The sternum is displaced anteriorly C. The lower portion of the sternum is depressed D. The thorax is wider than it is deep

A. There is increased anteroposterior diameter

A 60-year-old male, a known hypertensive stage 2 for more than 10 years, with a highest blood pressure reading of 200/110 mmHg, and a usual BP of 160/100 mmHg, non-complaint to medication and was lost to follow-up, came to your clinic for noted breathlessness rousing him from sleep. He also noted that he needs to use more pillows so that he can breathe comfortably while lying supine. He also reported that he was out of breath halfway through the stairs going up to the clinic this morning. However, there was no chest pain and his dyspnea was relieved by sitting down in the waiting area while waiting for his turn. What would be the expected physical finding of the PMI of this patient? A. 4th to 5th interspace gives the vertical location of the PMI B. PMI felt on the xiphoid process C. 15 cm lateral to the midsternal line gives the horizontal location of the PMI D. 2.5 cm diameter of the impulse

B. PMI felt on the xiphoid process

The same patient was then again lost to follow-up. He came back a year after, now complaining of dyspnea at rest. You checked the BP yourself and noted an alternating loud and soft Korotkoff sound as the cuff pressure declines. What is the term of the said auscultation? A. Hypertensive urgency B. Hypertensive emergency C. Pulsus paradoxus D. Pulsus alernans

D. Pulsus alernans

According to ATP III, this is a coronary heart disease risk equivalent A. Stable angina pectoris B. History of myocardial infraction C. History of angioplasty D. Peripheral arterial disease

D. Peripheral arterial disease

Target BP for a patient with diabetes mellitus and chronic kidney disease according to JNC7 A. <130/80 mmHg B. <140/80 mmHg C. <120/80 mmHg D. <160/100 mmHg

B. <140/80 mmHg

A 25-year-old female has the following PE findings: resonant lung fields on percussion, trachea is midline, vesicular breath sounds, no adventitious breath sounds, normal tactile fremitus. What condition does she have? A. Normal B. Chronic bronchitis C. Left-sided heart failure D. Consolidation

B. Chronic bronchitis

A 36-year-old female with a 7-day history of productive cough associated with fever came in to your clinic for consultation. Which of the following statements is consistent with your primary impression of an airless lung? A. Spoken words are muffled and indistinct B. Normal tactile fremitus C. Bronchial or bronchovesicular breath sounds over the involved areas D. Spoken as EE heard as EE

C. Bronchial or bronchovesicular breath sounds over the involved areas

A 45-year-old male complains of cough and fever of one-week duration. You noted dullness over the right lung field on percussion. As a review, How is dullness in percussion defined according to Bates? A. Percussion is very loud in intensity, lower pitch, longer duration B. Percussion is loud intensity, low pitch, and long duration C. Percussion is soft intensity, high pitch, and short duration D. Percussion is medium intensity, medium pitch, and medium duration

D. Percussion is medium intensity, medium pitch, and medium duration

What structure of the heart occupied most of anterior cardiac surface? A. Left ventricle B. Right ventricle C. Left atrium D. Right atrium

B. Right ventricle

Which of these statements about the use of stethoscope in cardiac auscultation is correct? A. The diaphragm is better for picking up relatively highpitched sounds of S3 and S4 B. The bell is better for listening to pericardial friction rubs C. The diaphragm is better for listening to the murmurs of aortic and mitral regurgitation D. The bell is more sensitive to low-pitched sounds of S1 and S2

C. The diaphragm is better for listening to the murmurs of aortic and mitral regurgitation

Which of the following is a risk factor for hypertension, according to Bates? A. Insufficient intake of calcium B. Excess consumption of ethanol C. GFR > 60 D. Excess intake of dietary potassium

B. Excess consumption of ethanol

In breathing, what is the most important accessory muscle for respiration? A. Parasternal B. Scalene C. Sternocleidomastoid muscle D. Abdominal muscles

C. Sternocleidomastoid muscle

A 40-year-old male has the following physical examination findings of the lungs: dull over the affected area on percussion, trachea deviated on contralateral side, decreased to absent breath sounds on affected side, no adventitious breath sounds, decreased to absence fremitus. What is the possible finding that the patient has? A. Pulmonary embolism B. Atelectasis C. Consolidation D. Pneumothorax

B. Atelectasis

What is the term given to the volume of blood ejected from each ventricle during one minute? A. Cardiac output B. Stroke volume C. Heart rate D. Preload

A. Cardiac output

Rogasiano is a 65-year-old male from Lapasan, Cagayan de Oro. He complained of 7 days’ history of cough, productive with yellowish, non-bloody sputum. It was associated with fever and chills, and chest pain described as persistent and sharp in character with 5 to 6/10 in severity. The pain is aggravated by coughing. The patient denies any comorbidities, denies exposure to COVID-19, PTB, and significant travel history recently. Patient also denies history of first-hand smoke exposure and alcohol beverage consumption. He had history of bronchial asthma on the maternal side. Blood pressure of 120/80 mmHg, heart rate of 110 bpm, respiratory rate of 20/min, temperature of 38.5⁰C and O2 saturation of 98% at room air. His BMI is 23 kg/m2. Based on the history alone, what is the most feasible primary impression of the patient? A. Asthma B. Lung abscess C. Bacterial pneumonia D. Postnasal drip

C. Bacterial pneumonia

According to JNC7, what is the definition of hypertension stage 1? A. Blood pressure of 160/100 mmHg B. Blood pressure of 140/90 mmHg C. Blood pressure of 130/80 mmHg D. Blood pressure of 120/80 mmHg

B. Blood pressure of 140/90 mmHg

A 24-year-old male complains of localized pain and tenderness on the left anterior chest after being involved in a 2- wheel non-collision motor vehicle accident, passenger. What special technique would you employ to rule out rib fracture? A. Observe contour of anterior chest for possible deformities B. Palpate the affected area for localized tenderness to pinpoint possible fracture C. Apply anteroposterior compression of the chest to illicit tenderness of the affected part D. Percuss affected area to identify the fractured rib

C. Apply anteroposterior compression of the chest to illicit tenderness of the affected part

Which of the following statements about the events of the cardiac cycle is correct? A. In diastole, the aortic valve is open, mitral valve is closed B. Systole is the period of ventricular relaxation C. In systole, the aortic valve is open, mitral valve is closed D. Diastole is the period of ventricular contraction

C. In systole, the aortic valve is open, mitral valve is closed

What is the characteristic of sputum in patients with cystic fibrosis? A. Mucoid sputum B. Tenacious sputum C. Foul-smelling sputum D. Purulent sputum

A. Mucoid sputum

It is a group of specialized cardiac cells localized on the right atrium near the junction of the ventricular cava where each normal electrical impulse is initiated A. Purkinje fibers B. Bundle of His C. Atrioventricular node D. Sinus node

D. Sinus node

It refers to the load that stretches the cardiac muscle before contraction A. Stroke volume B. Afterload C. Cardiac output D. Preload

D. Preload

The 4th interspace in the anterior chest wall is an important landmark for which medical procedure? A. Chest tube insertion B. Lower margin of endotracheal tube on chest x-ray C. Thoracentesis D. Needle insertion for tension pneumothorax

A. Chest tube insertion

According to AHA, if a patient has smoking and alcohol intake as a risk factor for the development of cardiovascular disease and stroke, what is the frequency of screening for this patient? A. Regularly B. Every routine visit C. Every 5 years D. Every 2 years

B. Every routine visit

NEXUS Criteria is a set of validated criteria used to decide which trauma patients do not require cervical spine imaging includes the following except A. obtunded B. no posterior midline cervical spine tenderness C. no focal neurologic deficits D. no evidence of intoxication

A. obtunded

In the setting of neck pain secondary to trauma, the following are considered high risk of having an injury requiring radiographic investigation? A. 50-yeaar-old motorcycle rider, GCS 15 B. 55-year-old jeepney passenger with no cervical tenderness C. 50-year-old jeepney passenger, ambulatory in the ER D. 50-year-old car passenger with neck pain 3 days after collision

A. 50-yeaar-old motorcycle rider, GCS 15

Which of the following activities present with the greatest lumbar disc pressure? A. Standing and bending forward B. Supine lying C. Sitting without back support D. Sitting and leaning forward

A. Standing and bending forward

The following are examples of mechanical causes of low back pain except A. lumbar strain B. herniated disk C. severe scoliosis D. spinal cord tumor

D. spinal cord tumor

A special landmark in the anterior chest for needle insertion for tension pneumothorax.

Answer: 2nd intercostal space

A special landmark in the anterior chest for chest tube insertion.

Answer: 4th intercostal space

A special landmark in the anterior chest used for the insertion of endotracheal tube on a chest x-ray?

Answer: T4

An anatomical landmark in the posterior chest for thoracentesis.

Answer: T7-T8 Intercostal space

Axillary line that drops from the apex of the axilla

Answer: Midaxillary line

Vertical line that overlies the spinous process

Answer: Vertebral line

This fissure runs close to the 4th rib and meets the oblique fissure in the midaxillary line near the 5th rib.

Answer: Horizontal/Minor fissure

General anatomical term that means above clavicle

Answer: Supraclavicular

General anatomical term that means between scapulae

Answer: Interscapular

General anatomic term that means below the clavicle

Answer: Infraclavicular

Potential space between visceral and parietal space

Answer: Pleural space

A clenched fist over sternum suggests

Answer: Angina pectoris

A painless but uncomfortable awareness of breathing that is inappropriate to the level of exertion.

Answer: SOB/ Dyspnea

A reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi.

Answer: Cough

Refers to blood coughed up from the lower respiratory tract; it may vary from blood-streaked sputum to frank blood.

Answer: Hemoptysis

Refers to the palpable vibrations that are transmitted through the bronchopulmonary tree to the chest wall as the patient is speaking and is normally symmetric.

Answer: Fremitus

In percussion, the hyperextended middle finger of the left hand is known as

Answer: Pleximeter finger

The percussion note with a loud intensity, low pitched and long duration.

Answer: Resonant

Sound that is heard on the hyperinflated lungs of COPD and Asthma

Answer: Hyperresonant sound

Upon auscultation, patient spoken “ee” heard as “ay” is called________

Answer: Egophony

In breath sound, it is a harsh sounds heard over the trachea in the neck.

Answer: Tracheal

An adventitious breath sound that may be heard in pneumonia, fibrosis, congestive heart failure.

Answer: Crackles

Exercise electrocardiography is important in determining ___________.

Answer: Arrhythmia

A thorax deformity in which sternum is displaced anteriorly increasing in anteroposterior diameter.

Answer: Pigeon chest

A point of maximal impulse diameter greater than 2.5 cm is evidence of ___________.

Answer: LVH

The ____________ and _____________ are called semilunar valves because the valve leaflets are shaped like half moons.

Answer: Aortic and pulmonic valve

It is the period of ventricular contraction

Answer: Systole

During systole the _________is open allowing ejection of blood from the left ventricle into the aorta while _________ is closed preventing blood from regurgitating back into the left atrium.

Answer: aortic valve, mitral valve

Its closure produces a second heart sound, S2.

Answer: Aortic valve

Acts as the cardiac pacemaker and automatically discharges an impulse about 60 to 90 times a minute.

Answer: SA node or sinus node

Refers to an ECG wave that corresponds to atrial depolarization

Answer: P-wave

Refers to the load that stretches the cardiac muscle before contraction

Answer: Preload

Refers to the degree of vascular resistance to ventricular contraction

Answer: Afterload

Reflects the right atrial pressure which in turn equals the central venous pressure and right ventricular end diastolic pressure

Answer: Jugular venous pressure

An unpleasant awareness of the heartbeat. Describe as skipping, racing, fluttering, pounding, or stopping of the heart.

Answer: Palpitations

A dyspnea that occurs when the patient is supine and improves when the patient sits up.

Answer: Orthopnea

Described as the sudden onset of dyspnea and orthopnea that awakens a patient from sleep, usually 1 or 2 hours after going to bed.

Answer: Paroxysmal Nocturnal Dyspnea

A continuous murmur that is harsh and machinery-like in quality

Answer: Patent Ductus Arteriosus

A cardiovascular sound that is due to the inflammation of the pericardial sac that is scratchy and scraping in quality

Answer: Pericardial Friction Rub

A benign sound produced by turbulence of blood in the jugular veins—common in children

Answer: Venous hum

The aortic valve leaflets fail to close completely during diastole, causing regurgitation from the aorta back into the left ventricle and left ventricular overload.

Answer: Aortic regurgitation

The stiffened mitral valve leaflets move into the left atrium in midsystole and narrow the valve opening, causing turbulence.

Answer: Mitral stenosis

The mitral valve fails to close fully in systole causing blood to regurgitate from the left ventricle to the left atrium.

Answer: Mitral Regurgitation

A very early diastolic sound caused by an abrupt deceleration during opening of a stenotic mitral valve.

Answer: Opening snap

A murmur that can be heard in a congenital abnormality in which blood flow from the relatively high-pressure ventricle into the low- pressure right ventricle through a hole.

Answer: Pansystolic Murmur

Is noted in cases of pericardial tamponade where pulse varies in amplitude with respiration

Answer: Paradoxical pulse

The rhythm of the pulse remains regular, but the force of the arterial pulse alternates because of alternating strong and weak ventricular contractions.

Answer: Pulsus Alternans