FINAL Physical Diagnosis

1. 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

2. When expiratory sounds last longer than inspiratory ones, it is: P.324
A. Vesicular
B. Bronchial
C. Tracheal
D. Wheezing

3. 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

4. A 63-year-old woman develops exertional angina and has had two

episodes of syncope. Examination shows a systolic ejection murmur
with radiation to the carotids and a soft S2. Which of the following is
the most likely diagnosis? (Lang internal medicine)
A. mitral stenosis
B. mitral insufficiency
C. aortic stenosis
D. aortic insufficiency
E. tricuspid stenosis

5. Costovertebral angle tenderness is one of the following symptoms: (!!!)

A. Abdominal distension
B. Murphy's sing
C. Pasternacki's Sign
D. Caput meduse

6. 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
7. 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

8. In the usual preparation for general surgery, the patient may be: (internet)
A. Given specifically ordered oral medications with couple glasses of water
B. NPO for 12 to 14 hours before
C. Given ice chips
D. Allowed to brush teeth and swallow water

9. Wheezies are: P.325

A. Intermittent, nonmusical, and Brief, Like dots in time
B. Normal breath sounds
C. Somewhat louder, lower in pitch (∼350 Hz), brief (15–30 ms)
D. Relatively high-pitched (≥400 Hz) with hissing or shrill quality
(>80 ms), Like dashes in time

10. Normal breath sound in the base of the lung is: P.325
A. Vesicular
B. Bronchial
C. Tracheal
D. Wheezing

11. Describe location for the sternal angle or angle of Louis. P.304
A. T1-T7 intercostal space
B. T5-T6 intercostal space
C. In the hollow curve of the suprasternal notch
D. In the hollow curve of the suprasternal notch, then move it
down approximately 5 cm to the horizontal bony ridge where
the manubrium joins the body of the sternum

12. 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

13. 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)
14. When inspiratory and expiratory sounds are almost equal, it is: P.325
 A. Vesicular
B. Bronchial
C. Tracheal
D. Wheezing

15. Hematochezia is one of the following: P.460

A. Black stool
B. Nasal bleeding
C. Bloody urine
D. Bloody stools

16. Melena or melaena means: P.460

A. Black stool
B. Nasal bleeding
C. Bloody urine
D. Bloody vomitus

17. 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

18. Describe location for the lower margin of an endotracheal tube on a

chest x-ray. P.304
A. T4
B. T6
C. T6-T7 intercostal space
D. T7-T8 intercostal space

19. Wheezes arise: P.325

A. from abnormalities of the lung parenchyma (pneumonia,
interstitial lung disease, pulmonary fibrosis, atelectasis, heart
failure) or of the airways (bronchitis, bronchiectasis).
B. Pneumonia, pneumothorax
C. In the widened airways of bronchitis.
D. In the narrowed air-way of asthma, COPD, and bronchitis.

20. Adventitious sounds are: P.325

A. Added sounds that are superimposed on the usual breath sounds.
B. Wheezings and vesicular sounds
C. Normal breath sounds
D. Tracheal sounds

21. When expiratory sounds last longer than inspiratory ones, it is: P.324
E. Vesicular
 F. Bronchial
G. Tracheal
H. Wheezing

22. 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

23. 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

24. 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.

25. 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

26. 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

27. A 45-year-old woman has developed increasing SOB on exertion and fatigue.
She has a loud systolic ejection murmur heard best at the left sternal border,
and the murmur increases with standing. A double apical impulse is also felt
what could be the underlying disease? (Lang internal medicine)
A. Aortic stenosis
B. HOCM
C. Mitral regurgitation (chronic)
D. Tricuspid regurgitation
E. Mitral valve prolapse
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