physical diagnosis selective ques

Question 1

During the assessment of the patient with left ventricular failure you
chek 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

Answer 1

B. Pulsus alternans

Question 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

Answer 2

Murmur of mitral stenosis

Question 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

Answer 3

E. Sitting upright, but leaning forward

Question 4

. 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

Answer 4

A. A problem in the cornea or lens ( if he tell me both eyes I would tell him cranial nerve 3

Question 5

Aortic regurgitation

Answer 5

Immediate high-pitched diastolic murmur. Wide pulse pressure when
chronic. Can present with bounding pulses and head bobbing

Question 6

bruit

Answer 6

hearing in cartoid , whoosing murmur like sound of vascular orgin + suggests artheloscorlic narrowing

Question 7

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

Answer 7

A. Late systolic murmur

Question 8

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

Answer 8

D. T7-T8 intercostal space

Question 9

Generalized hyperresonance is common over the over the
hyperinflated lungs P.322
A. ILD
B. COPD or asthma
C. Sarcoidosis
D. Pneumonia

Answer 9

copd and asthma

ild (interstatial lung disease fibrosis
scardosis ( swallen and granullas if organ

Question 10

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

Answer 10

C. Around the trunk, lower quadrant, upper thigh and testicle or labium

Question 11

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

Answer 11

A. Pulmonary blood flow is greater than systemic blood flow

Question 12

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

Answer 12

B. 2nd intercostal space

Question 13

● 4th intercostal space for chest tube
insertion.

Answer 13

● T4 for the lower margin of an endotracheal tube on a chest x-ray

Question 14

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.

Answer 14

A. From abnormalities of the lung parenchyma (pneumonia, interstitial
lung disease, pulmonary fibrosis, atelectasis, heart failure) or of the
airways (bronchitis, bronchiectasis).
D. In the narrowed air-way of asthma, COPD, and bronchitis. ( wheezing

Question 15

Which of the following does not cause a holosystolic murmur?
A. Ventricular Septal Defect
B. Mitral stenosis
C. Mitral regurgitation
D. Tricuspid regurgitation

Answer 15

B. Mitral stenosis

Question 16

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

Answer 16

A. Pain felt in the right lower abdomen upon palpation of the left
side of the abdomen

Question 17

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

Answer 17

A. The frequent passage of large volumes of urine – more than 3 liters a da

Question 18

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

Answer 18

A. Yellow coloration of the skin and mucous layers.*

Question 19

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

Answer 19

E. An S4

Question 20

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. Onexamination, 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?
A. Handgrip exercise
B. Squatting
C. Standing
D. Valsalva maneuver
E. A and B
F. C and D

Answer 20

F. C and D The Valsalva maneuver is a breathing method that may slow your heart when it’s beating too fast

Question 21

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

Answer 21

B. The patient has to wake at night one or more times for voiding

Question 22

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

Answer 22

A. Fluid or solid tissue replaces air-containing lung or occupies the
pleural space beneath your percussing fingers.

Question 23

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

Answer 23

C. “Ronchi”

Question 24

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

Answer 24

The Austin Flint murmur is a rumbling diastolic murmur best heard at the apex of the heart that is associated with severe aortic regurgitation and is usually heard best in the fifth intercostal space at the midclavicular line

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

Question 25

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.

Answer 25

D. Test to detect a potential health problem or disease in
someone that doesn’t yet have signs or symptoms.

Question 26

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?
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

Answer 26

D. it is diminished

Question 27

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

Answer 27

A. Aortic stenosis

Question 28

. Types of the jaundice are all of the following EXCEPT:
A. Prehepatic
B. Posthepatic
C. Postprandial
D. Hepatic

Answer 28

C. Postprandial*

Question 29

Unilateral hyperresonance suggests:
A. A large pneumothorax or an air-filled bulla
B. Asthma
C. Alpha one antitrypsin deficiency
D. Pneumonia

Answer 29

A. A large pneumothorax or an air-filled bulla

Question 30

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

Answer 30

A. “Triple ripple” apical impulse

Triple apical impulse results from a late systolic bulge that occurs when the heart is almost empty and is performing near-isometric contraction.

Question 31

Costovertebral angle tenderness is one of the following symptoms: ✔
A. Abdominal distension
B. Murphy’s sing
C. Pasternack’s Sign
D. Caput meduse

Answer 31

C. Pasternack’s Sign

murphy sign . If pain occurs when the inflamed gallbladder comes into contact with the examiner’s hand

Caput medusae is the name for a cluster of swollen veins in your abdomen

Question 32

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

Answer 32

A. Diastolic rumble at apex of the heart

Question 33

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?
A. mitral stenosis
B. mitral insufficiency
C. aortic stenosis
D. aortic insufficiency
E. tricuspid stenosis

Answer 33

C. aortic stenosis

Question 34

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

Answer 34

B. Aortic regurgitation

Question 35

. 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

Answer 35

B. Shifting dullness

Question 36

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

Answer 36

1. History ????

Question 37

Pain as a symptoms can be is one of the following types EXCEPT: P.453
A. Visceral
B. Parietal
C. Toxic
D. Referred

Answer 37

C. Toxic

Question 38

. Melena or melaena is the sign of: P.460
A. Upper GI bleeding
B. Anal bleeding
C. Lung injury
D. Goiter

Answer 38

A. Upper GI bleeding

Question 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

Answer 39

RLQ

Question 40

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

Answer 40

C. A decrease in the systolic ejection murmur with inspiration

Question 41

. Hematochezia is one of the following: P.460 ✔
A. Black stool
B. Nasal bleeding
C. Bloody urine
D. Bloody stools

Answer 41

D. Bloody stools RECTAL BLEED

Question 42

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?
A. Aortic stenosis
B. HOCM
C. Mitral regurgitation (chronic)
D. Tricuspid regurgitation
E. Mitral valve prolapse

Answer 42

B. HOCM

Question 43

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)

Answer 43

B. Intermittent, nonmusical, and brief, Like dots in time

Question 44

When inspiratory and expiratory sounds are almost equal, it is: P.325
A. Vesicular
B. Bronchial
C. Tracheal
D. Wheezing

Answer 44

C. Tracheal

Question 45

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

Answer 45

A. The appearance of distended and engorged paraumbilical veins

Caput medusae is the name for a cluster of swollen veins in your abdomen

Question 46

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

Answer 46

c) Pulmonic regurgitation or tricuspid stenosis

Question 47

Describe location for the sternal angle or angle of Louis.
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

Answer 47

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

Question 48

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
A. Pulsus tardus
B. Pulsus paradoxus
C. Hyperkinetic pulse
D. Bisferiens pulse
E. Dicrotic pulse

Answer 48

D. Bisferiens pulse (hocm)

Question 49

. 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

Answer 49

B. HOCM hypertrophic cardiomyopathy

Question 50

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?
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

Answer 50

B. Upon standing, the click will occur earlier in systole

Question 51

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

Answer 51

E. Valsalva maneuver
The Valsalva maneuver is a breathing method that may slow your heart when it’s beating too fast

Question 52

The common subtype of selective neck dissection is:
A. Infraomohyoid
B. Supraomohyoid
C. Medial
D. Posterior
E. Inferior

Answer 52

B. Supraomohyoid

Question 53

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

Answer 53

A. Active filling into non-compliant ventricle

Question 54

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

Answer 54

D. Passive filling into compliant ventricle causing sudden tensing
of chordae tendinea

Question 55

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 noguarding 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

Answer 55

C. McMurphy sign

Psoas sign is elicited by having the patient lie on his or her left side while the right thigh is flexed backward

Obturator sign is a clinical sign of acute appendicitis, it is defined as discomfort felt by the subject/patient on the slow internal movement of the hip joint, while the right knee is flexed.