PHYSICAL DIAGNOSIS

MID-MODULE EXAM
SEPTEMBER 4, 2021

MID MODULE EXAM 1

QUESTION CHOICES ANSWER/RATIONALE

a. Transient neonatal pustular

Rash found in intertriginous area that appears melanosis Answer: B? (tho sa trans it says Candida Albicans)
erythematous plaques with sharply b. Candidiasis Krek. Infection caused by C. albicans ~ candidiasis
demarcated edges is most likely: c. Cavernous Hemangioma K tenks!
d. Erythema toxicum

Greasy white substance that normally covers

Answer: Vernix Caseosa
the skin until 38th week of gestation

Answer: B

a. Average Rationale:
A female patient’s waist circumference is 34.5 b. High Waist:Hip ratio = 34.5/40 = 0.86
inches and her hip circumference is 40 inches. c. Excellent
This is regarded as _____. d. good
e. Extreme

In the study of Tao Ai et. al. where they

investigated the accuracy of Chest CT scan in
diagnosing COVID-19, the following data were
gathered:

Answer: B
a. 83%
b. 25%
Rationale:
c. 65%
● Specificity: TN/(TN + FP)
d. 97%
● 105/413 = 0.25 x 100 = 25%

Compute for the specificity of Chest CT scan in

diagnosing COVID-19.

Answer: B

Rationale:

An uncontrolled increase in body temperature

that exceeds the body’s ability to lose heat a. True
without change in hypothalamic set point is b. False
called Hyperpyrexia

According to Marcial’s, tympanic membrane

temperature is higher than oral reading by
Answer: 0.8°C
_____ °C

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MID-MODULE EXAM 1 MICRO

In the study of Tao Ai et. al. where they

investigated the accuracy of Chest CT scan in
diagnosing COVID-19, the following data were
gathered:

Answer: B
a. 25%
b. 97% Rationale:
c. 65% ● Sensitivity: TP/(TP + FN)
d. 83% ● 580/601 = 0.965 x 100 = 96.5 → 97%

Based on this study, what is the sensitivity of

the Chest CT Scan in diagnosing COVID-19?

a. Why have you come to see the

Answer: D
doctor today?
Which of the following does not belong to the
b. What kind of pain was it?
group? Rationale:
c. Tell me about your problem
● Acc. to prev. samplex, not open-ended qs si D
d. Did you fall when you were dizzy?

a. Miliary Tuberculosis Answer: D

b. Community Acquired Pneumonia
Hyperpyrexia is most commonly encountered
c. Acquired Immunodeficiency Rationale:
in which of the following scenarios?
Syndrome ● Hyperpyrexia is common with CNS hemorrhages
d. Hypothalamic hemorrhagic stroke and patients with severe infections
Answer: D
a. Diagnostic testing
The most precise way of estimating the pretest
b. Epidemiological studies
probability of a disease in a given patient is via Rationale:
c. Clinician’s expertise
_____. ● CDRs are infrequently available but are the most
d. Clinical decision rule
precise way of estimating pretest probability
Answer: B
This type of fever is considered when a. Fagets sign
temperature readings are varying at different b. Drug-induced fever Rationale:
sites, and there is dissociation between c. Fraudulent fever ● Temperature-pulse dissociation occurs in typhoid
temperature and pulse rate. d. Remittent fever fever, brucellosis, leptospirosis, some drug-induced
fevers, and factitious fever
Answer: D

Rationale:

a. Obese I
A BMI of 23 in a 26 y/o male Filipino is best
b. Underweight
classified according to the Asia Pacific
c. Normal
classification as?
d. Overweight

Answer: A?

Rationale:

a. Shivering
Which of the following mechanisms help raise b. Decreased hepatic thermogenesis
the body temperature to the new set point? c. Peripheral vasoconstriction
d. Blood shunting

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MID-MODULE EXAM 1 MICRO

Which of the following cytokines is considered a. Prostaglandin E2 Answer: A

to be central in the humoral pathway of fever b. Heat Shock Protein Rationale:
due to its direct action on the hypothalamic c. Prostaglandin I2 ● PEG2 activates the thermal neurons in the anterior
thermoregulatory center? d. Interleukin-10 hypothalamus to a higher thermal balance point.

Match the options below:
I. Part of the history that states previous
admissions in the hospital, summary of
each admission and condition of the child
from time of readmission
II. Part of pediatric history that states the
duration and circumstances of labor, if
home or hospital deliver, manner of
delivery, analgesia used, complications,
birth weight and age of gestation
III. This part of the history will give a clear,
detailed and unified picture and begins
with the nature and date of onset
IV. Part of the history where the patient’s
general state of health is described
including the height build, sexual
development, posture, motor activity, gait
and odor.
Answer:
● Part of the history that states previous admissions
in the hospital, summary of each admission and
condition of the child from time of readmission (H.
Interval History)
a. History of Present Illness
b. Physical Examination
c. Gestational History
d. Review of Systems
e. Natal History
● Part of pediatric history that states the duration
f. General Data and circumstances of labor, if home or hospital
g. General Survey
deliver, manner of delivery, analgesia used,
h. Interval history complications, birth weight and age of gestation
i. Past Medical history
(C. Gestational History)
● This part of the history will give a clear, detailed
and unified picture and begins with the nature and
date of onset (A. History of Present Illness)
● Part of the history where the patient’s general state
of health is described including the height build,
sexual development, posture, motor activity, gait
and odor (G. General Survey).

Answer: Triangle

Rationale:

According to Marcial’s, what shape is used in

the genogram to denote spontaneous
abortion?

a. 12-16 months Answer: A?

Children typically begin walking at what age?
b. 8-10 months

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MID-MODULE EXAM 1 MICRO
c. 14-18 months Rationale:
d. 10-12 months ● From trans it says, toddlers start walking but with
support from 1-3 years
In the study of Tao Ai et. al. where they
investigated the accuracy of Chest CT scan in
diagnosing COVID-19, the following data were
gathered: a. A patient has a decreased
probability of having COVID. Answer: D?
b. The patient has a probability
estimate between 1 and 5% Rationale:
c. The test has no utility in
estimating the probability of
having COVID.
d. The patient as a probability
estimate of having COVID at
>+15%
Based on this study, the computed positive
likelihood ratio (LR+) is +1.29. What can be
inferred from this information?
a. The number of packs that a
person smokes per day
b. A calculation used to quantify
Answer: C
exposure to tobacco smoke in a
In discussions surrounding smoking, which standard manner
Rationale:
one of the following best describes “pack c. The total number of years that an
● Pack years is defined as the clinical quantification of
years”? individual has smoked for
cigarette smoking to measure a person’s exposure
d. The number of years that a
to tobacco.
person has smoked for before
developing symptoms of a
smoking related disorder
a. symptoms related to the patient’s
current condition should be
recorded in the HPI
b. provides associated symptoms
and other comorbidities which
The following are true statements regarding may be present
Answer: C?
Review of Systems, EXCEPT c. may reveal symptoms that may
have altered the typical
presentation of the disease
d. inquire about signs and symptoms
associated with each
system/anatomic region
A 53-year old male was brought to the
emergency room. When you asked the patient
why he is there for consult, he said
“nanghihina kasi ako”. The condition started 2
hours prior to consult when the patient, after
standing up from the breakfast table, felt
a. Dizziness
dizziness described as a feeling of the
b. Right-sided weakness Answer: C
surrounding rotating around him. He sat down
c. “nanghihina kasi ako”
and after a few minutes had 1 episode of
d. Body weakness Rationale:
non-projectile vomiting of about half-glass of
e. Headache ● As much as possible, quote patient’s own words
clear translucent fluid. He also then started
f. Vomiting
having a throbbing frontotemporal headache,
non-radiating, graded as 7/10. He called for his
wife and she noted drooling on the right side
and weakness of the right side of the body.
She then brought the patient to the ER. What is
the chief complaint of this patient?
a. chest pain
Which of the following presentation of disease
b. edema
can be considered as sign and symptom at the Answer: A
c. headache
same time?
d. retching

Answer: Mali ata tanong char

a. Hypovolemia
All of the following can produce pulseless b. Decreased hydrogen ion
electrical activity (PEA), EXCEPT c. Hyperglycemia
d. Hyperthermia
Rationale:
Causes are:
Hypovolemia, hypoxia, hydrogen ion (acidosis),
hyper/hypokalemia, Hypoglycemia, Hypothermia,
Toxins, Cardiac tamponade, Tension pneumothorax,
Thrombosis, Trauma

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MID-MODULE EXAM 1 MICRO
a. False Negative/(True Positive +
False Negative)
b. False Positive/(True Negative + Answer: C
False Positive) Rationale:
Which of the following describe specificity?
c. Tue Negative/(True Negative + ● Specificity = d/(d+b)
False Positive) ● Specificity: TN/(TN + FP)
d. True Positive/(True Positive +
False Negative)
In the elderly patient, what is the term used for
a multifactorial condition that involves the
interaction between identifiable
situation-specific stressors and underlying Answer: Geriatric syndrome??
age-related risk factors that result in damage
across multiple organ systems?
In the study of Tao Ai et. al. where they
investigated the accuracy of Chest CT scan in
diagnosing COVID-19, the following data were
gathered:
Answer: A
a. 75%
Rationale:
b. 35%
● False positive: patients without the disease but
c. 47%
tested positive
d. 40
● FP = FP/(TN+FP)
● 308/413 = 0.745 x 100 = 74.5 → 75%
How many percent of the patients who had
positive Chest CT scans were actually free of
COVID?

a. Hypothermia
Which of the following vital sign findings
b. Tachypnea
predicts subsequent cardiopulmonary arrest in Answer: B
c. Hypotension
hospitalized patients?
d. Tachycardia
a. (height in cm - 100) - 10% of
(height in cm - 100)
b. 100 lbs for the first 5 feet + 5 lbs
for each additional inch + 10% for
Which of the following is the Hamwi’s equation
frame size Answer: B.
for the computation of the ideal body weight?
c. 50 + [0.91 x (height in cm -
152.4)]
d. 45.5 kg for 60 inches + 2.3 kg x
(height in inches - 60)
In the study of Tao Ai et. al. where they
investigated the accuracy of Chest CT scan in
diagnosing COVID-19, the following data were
gathered:

a. 1014
b. 888 Answer: A. Hindi ba 601 lang? hahaha. since RT-PCR
c. 601 yung Gold std’.
d. 580

The total number of COVID-19 patients used in

the study is

Answer: D?
SH, 78/M, known case of CHF sec. to CAD,
came to the clinic because of progressive Rationale:
enlargement of the legs for 2 weeks with
a. (+3)
dyspnea on exertion and occasional chest
b. (+4)
pain. On PE, you noted the swelling to be
c. (+1)
non-tender, not warm to touch, and involves
d. (+2)
the thighs, hands, and lower arms as well.
What is the grading of the edema of the
patient?

Answer: EP3
Among the four receptors for Prostaglandin
E2, which is essential for fever
Rationale:
● Vasoconstriction = Heat Production

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MID-MODULE EXAM 1 MICRO

a. Does the considered test improve

the clinical outcome of the
patient’s condition?
b. Is my pretest probability low
The following questions should be asked in
enough that a test is warranted for
determining the need for diagnostic test, Answer: A
more information?
EXCEPT
c. How certain am I that the
generated hypothesis is correct?
d. How much more certainty do I
need before I can start treatment?

Answer: B

Rationale:
● Elements of Decision-Making:
a. Communication skills
○ Clinical skills (communication skills)
The following are elements of clinical b. Outcome of treatment
○ Uses and Interpretation of diagnostic tests
reasoning, EXCEPT c. Shared decision making
○ Understanding cognitive biases and human
d. Metacognition
factors
○ Critical thinking / metacognition
○ Patient-centered EBM
○ Shared Decision making

Term used for a cutaneous condition where

there is a clear line of demarcation between an
area of redness and an area of normal
Answer: Harlequin Coloration
coloration. Cause is usually idiopathic or may
be a sign of blood shunt.
Answer: D

Rationale:
● Sustained fever - does not fluctuate >1C in 24
hrs and at no time it touches normal
LA, 33/M, consulted because of 1-week history
● Remitted fever - fluctuations >1.5 to 2°C but at no
of fever, described as exacerbations every 48
a. Sustained time it touches normal
hours. Tmax = 39.3C, with associated chills. In
b. Remittent ● Intermittent fever - present only several hours a
between, patient’s temperature is noted to be <
c. Intermittent day
37.6C. He went to Palawan 1-month prior for
d. Relapsing ● Relapsing fever - recurring fever separated with
field work in the forest. What is the fever
periods of low grade or no fever; depending on
pattern of the patient?
parasite, fever may change from in 24 (Quotidian to
48 hours (Tertian) to 72 hours (Quartant)
● Pel-Ebstein Fever - intermittent low-grade fever
characterized by 3-10 days of fever with subsequent
afebrile periods of 3-10 days

Answer: [(Diastole x 2) + Systole]/3 = [(110*2) + 170]/3 = 130

Grade 2 Hypertension

Rationale:

What is the mean arterial pressure of a patient

whose BP is 170/110 mmHg?

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MID-MODULE EXAM 1 MICRO
Eating or drinking just before taking your
a. True
temperature doesn’t affect the reading of an Answer: B
b. False
oral thermometer.
a. Resting heart rate is usually lower
as compared to young adults
b. All given statements are true
c. Basal body temperature is usually
In checking the vital signs of an elderly patient,
low making them susceptible to Answer: B?
which of the following statements is true?
the cold
d. Systolic hypertension with a
widened pulse pressure is
normally seen
Arrange in the right order the following steps
in constructing a differential diagnosis
Answer: 3, 6, 5, 4, 1, 2:
1 - rank the differential diagnosis ● 1. Frame the differential Diagnosis
2 - test the differential diagnosis ● 2. Organize the differential diagnosis
3 - frame the differential diagnosis ● 3. Limit the differential diagnosis
4 - explore other diagnosis using history and ● 4. Explore other diagnosis using history and Physical findings
physical exam findings ● 5. Rank the differential diagnosis
5 - limit the differential diagnosis ● 6. Test the differential diagnosis
6 - organize the differential diagnosis
A patient presents at the out-patient
department complaining of fever of 3 days
duration. During further questioning, patient
claims he did not have a cough. In which part Answer: History of Present Illness
of the adult medical record should this
information be placed?
Eliciting the rooting reflex causes the infant to
a. True
turn the head and allows for easier Answer: A
b. False
examination of the neck
Reflex that causes abduction of both arms and
Answer: Moro Reflex
extension of the fingers
a. Step-ladder fever: Borrelia
b. Picket-fence fever: Typhoid
Which of the following diseases is matched
c. Quartan fever: P. vivax malaria Answer: D
correctly with its classical fever pattern?
d. Pel-Ebstein fever: Hodgkins
lymphoma
Answer: A

Rationale:
● Type of Dyspnea: Platypnea
○ Dyspnea when in upright position and relief after
a. Coronary artery disease lying down
All of the following diseases are associated b. Hepato-pulmonary disease ○ Occurs in:
with worse dyspnea when upright, and relief c. Patent foramen ovale ■ Intracardiac shunts (Patent Foramen Ovale,
after lying down, EXCEPT: d. Pulmonary arteriovenous Atrial Septal Defect and Atrial Septal
malformation Aneurysm)
■ Extra-cardiac Shunts (Pulmonary
Arteriovenous Malformation (AVM), Lung
Parenchymal Diseases, Hepato-pulmonary
syndrome, Fat Embolism & Parkinson’s
Disease)
Answer: D

Rationale:

a. Bendopnea
Which breathing pattern is described as deep
b. Cheyne-Stokes breathing
and rapid, and is seen in patients with
c. Grunting respirations
metabolic acidosis?
d. Kussmaul respirations

a. Clinical history is of secondary

importance to clinical examination
Which one of the following best describes the
b. Clinical history provides a primary Answer: B or C?
role that history plays in patient assessment?
guiding foundation when making
clinical decisions
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MID-MODULE EXAM 1 MICRO
c. Clinical history always need to be
confirmed by clinical examination
d. The best presenting clinical
history is only available from the
patient’s notes.

Answer: C
Rationale:

a. Fourth
Which korotkoff sound is best described as
b. Second
clear, well-heard tapping sound that is loud
c. Third
and high pitched?
d. First

MID MODULE EXAM 2

QUESTION CHOICES ANSWER/RATIONALE

QUESTION a. Answer:

MODULE EXAM 3

QUESTION CHOICES ANSWER/RATIONALE

QUESTION b. Answer:

MID MODULE EXAM 4

QUESTION CHOICES ANSWER/RATIONALE

QUESTION c. Answer:

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MID-MODULE EXAM 1 MICRO

MID MODULE EXAM 5

QUESTION CHOICES ANSWER/RATIONALE

QUESTION d. Answer:

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