MEDICINE I 15.

Retrosternal pain which lasts 10-20 mins perceived as heaviness,

pressure or squeezing over the chest, often associated with
1. Patient presents with critical ischemia, rest pain and tissue loss on the diaphoresis, dyspnea and nausea, which occurs even at rest and is
lower extremities because of arterial occlusion. What is the most unrelieved by nitroglycerin?
probable ankle-brachial index of the patient? a. Stable angina c. esophageal spasm
a. > 1 c. < 0.9 b. Unstable angina d. pulmonary embolism
b. < 0.6 d. < 0.3 16. Sharp, knifelike pain, aggravated by inspiration or coughing which
2. The following are true in examining the Jugular venous pulse except: result from lung disease that damage and cause inflammation of the
a. Right Jugular vein is used best pleura of the lungs?
b. Simultaneous palpation of the left carotid artery aids in relating a. Pneumonia c. pericarditis
the venous pulsation to their timing in cardiac cycle b. Pneumothorax d.pulmonary embolism
c. In decreased venous pressure, it may be necessary to elevate 17. Sudden onset of pleuritic chest pain and respiratory distress which may
trunk further to as much as 90 degrees occur without a precipitating event in persons without lung disease or
d. Tangential lighting is used to expose the pulsations as a consequence of underlying lung disorder?
3. Positive wave produced by the bulging of the tricuspid valve into the RA a. Pneumonia c. pericarditis
during RV isovolumetric systole and by the impact of the carotid artery b. Pneumothorax d.pulmonary embolism
adjacent to the jugular vein? 18. Abrupt onset of unrelenting, tearing or ripping sensation, sometimes
a. A wave c. v wave knifelike, often radiating to the back?
b. C wave d. x descent a. Pericarditis c. aortic dissection
4. Results from the increasing volume of blood in the RA during b. Herpes zoster d. pulmonary embolism
ventricular systole when the tricuspid valve is closed? 19. Sharp or burning chest pain that has a dermatomal distribution?
a. A wave c. v wave a. Pericarditis c. chicken pox
b. C wave d. x descent b. Herpes zoster d. syphilis
5. Positive presystolic wave produced by venous distention due to RA 20. Retrosternal pain lasting more than 30 mins perceived as heaviness or
contraction? pressure over the cheast and unrelieved by nitroglycerin?
a. A wave c. v wave a. Stable angina c. acute MI
C wave d. x descent b. Aortic stenosis d. pulmonary embolism
6. All are true in estimating CVP except: 21. Type of syncope occurring during cough, micturition, deglutition and
a. Right internal jugular vein is the best vein used defecation?
b. Right external jugular vein is the best vein used a. Glossopharyngeal neuralgia c. neurocardiogenic syncope
c. Sternal angle is used as reference point b. Reflex syncope d. situational syncope
d. Normally it measures less than 3 cm 22. Associated with both sympathetic withdrawal (vasodilatation) and
7. Most common cause of positive abdominojugular reflux test? increased parasympathetic activity (bradycardia)?
a. Right sided HF c. Left side HF a. Vasovagal syncope c. pure autonomic syncope
b. Cardiac tamponade d. pulmonary edema b. Vasodepressor syncope d. orthostatic syncope
8. The following produce accentuated S1 except: 23. Syncope that is gradual in onset, precipitated by hot environment,
a. Tachycardia c. short PR interval extreme fatigue, pain, hunger or stress where sphincter control is
b. High cardiac output d. long PR interval maintained and relieved by lying down?
9. S2 normally splits into audibly distinct A2 and P2 components during: a. Neurocardiogenic c. carotid sinus hypersensitivity
a. Inspiration c. left decubitus position b. Psychogenic d. situational syncope
b. Expiration d. valsalva maneuver 24. Syncope that is not accompanied by facial pallor and not relieved by
10. Best heard with bell of the stethoscope: recumbency but can be reproduced by hyperventilation?
a. S1 & S2 c. S3 & S4 a. Hysterical fainting c. Anxiety attacks
b. Mitral regurgitation d. friction rubs b. Stokes-Adams Syndrome d. Wolff-Parkinson-White syndrome
11. What is the effect of Valsalva maneuver in the length and intensity of 25. The following results from ventilatory pump dysfunction except:
heart murmurs of patients with HCM or MVP? a. Kyphoscoliosis c. anemia
a. Increase c. no effect b. GBS d. asthma
b. Decrease d. variable 26. The following results from controller dysfunction except:
12. What is the effect of squatting in the intensity of heart murmurs of a. Pregnancy c. high altitude
patients with HCM or MVP? b. Pneumonia d. drug induced
a. Increase c. no effect 27. The following are low cardiac output dyspnea except:
b. Decrease d. variable a. Anemia c. nonischemic cardiomyopathies
13. In valvular aortic stenosis, the murmur may disappear over the sternum b. Coronary artery dse d. myocardial ischemia
and reappear at the apex leaving a false impression that mitral 28. Which of the following results in normal cardiac output dyspnea?
regurgitation is present. What is this phenomenon? a. CAD c. cardiovascular deconditioning
a. Mammary soufflé c. Gallavardin effect b. LR intracardiac shunt d. systolic dysfunction
b. Carvallo Sign d. Still’s murmur 29. A type of pulmonary edema with normal hydrostatic pressures, and
14. Which of the following will produce a continuous murmur? results from damage to pulmonary capillary lining?
a. PDA c. ventricular septal defect a. Cardiogenic c. physiologic
b. Mitral stenosis d. left atrial myxoma b. Noncardiogenic d. hydropericardium
30. In a non-smoker who has normal chest readiograph and is not taking 46. Which of the following is closed during diastole?
ACE inhibitor, the most common causes of chronic cough are the a. Mitral valve c. semilunar valve
following except: b. Tricuspid valve d. fossa ovale
a. Infection c. postnasal drip 47. Borders of Precordium
b. Asthma d. GERD a. 2nd to 5th ICS from right border of sternum to left midclavicular line
31. Acute cough lasts for about: 5th to 6th ICS
a. <4 weeks c. <2 weeks b. 2nd to 5th ICS from right border of sternum to left midclavicular line
b. <3 weeks d. <1 week 6th to 7th ICS
32. Chronic cough lasts for about: c. 3rd to 5th ICS from right border of sternum to left midclavicular line
a. >5 weeks c. >7 weeks 5th to 6th ICS
b. >6 weeks d. >8 weeks d. 3rd to 5th ICS from right border of sternum to left midclavicular line
33. Massive hemoptysis involves expectoration of how much blood over a 6th to 7th ICS
24 hour period? 48. At HR < 100 bpm, what is the relationship of diastole with regards to
a. > 25 mL c. >75 mL systole?
b. > 50 mL d. >100 mL a. Greater c. equal
34. Most common cause of respiratory hypoxia? b. Lesser d. no relationship
a. V/Q mismatch c. LR shunting 49. At HR > 100 bpm, what is the relationship of diastole with regards to
b. anemia d. asthma systole?
35. For cyanosis to occur, reduced Hb should be elevated to how much? a. Greater c. equal
a. > 2 g/dL c. > 8 g/dL b. Lesser d. no relationship
b. >5 g/dL d. >10 g/dL 50. Occurs at the onset of systole, during which a contraction is occurring
36. Results from arterial desaturation? in the ventricles but there is no emptying?
a. Central cyanosis c. clubbing a. rapid filling c. ejection
b. Peripheral cyanosis d. hypoxia b. isovolumetric contraction d. isovolumetric relaxation
37. Selective bulbous enlargement of the distal segments of the fingers due 51. At the end of systole, ventricular relaxation begins suddenly and the
to proliferation of connective tissues, particularly on the dorsal surface? elevated pressures in the large arteries snaps the semilunar closed.
a. Callous formation c. Reynaud’s phenomenon The ventricular muscles continues to relax even though ventricular
b. Clubbing d. arthritis volume does not change?
38. Unusual awareness of heartbeat that may be intermittent thumping, a. Rapid filling c. ejection
pounding or fluttering sensation? b. Isovolumetric contraction d. isovolumetric relaxation
a. Palpitation c. skip beats 52. The following increases the preload except:
b. Angina d. panic attack a. Inspiration c. exercise
39. Most common cause of palpitation? b. Exhalation d. increase venous return
a. Cardiac c. miscellaneous 53. Blood pressure is the product of?
b. Psychiatric d. unknown a. CO & TPR c. SV & TPR
40. Gross or generalized edema? b. CO & SV d. CO, SV & TPR
a. Ascites c. myxedema 54. The following are true except:
b. Hydrothorax d. anasarca a. Internal jugular pulsation is rarely palpable
41. Which of the following promotes movement of fluid from the vascular to b. Height of carotid pulsation is not affected by inspiration
the extravascular space? c. Internal jugular pulsation is eliminated by light pressure
a. Capillary hydrostatic pressure d. Carotid pulsation are soft, biphasic, undulating quality with 2
b. Capillary colloid oncotic pressure elevations and 2 troughs per heart beat
c. Interstitial hydrostatic pressure 55. Increased arterial pulse with a double systolic peak
d. B & C a. Bisferiens pulse c. bigeminal pulse
42. Multiple peripheral arteriovenous fistulae result in reduced effective b. Pulsus alternans d. paradoxical pulse
systemic perfusion and effective arterial blood volume thereby 56. Palpable decrease in the pulse amplitude on quiet respiration, SBP
enhancing edema formation? decreases by >10 mmHg during inspiration
a. Beri beri heart disease c. Edema of Nephrotic syndrome a. Bisferiens pulse c. bigeminal pulse
b. Refeeding edema d. Edema of Cirrhosis b. Pulsus alternans d. paradoxical pulse
43. Apical impulse is normally found where? 57. Humming vibration that feel like the throat of a purring cat
a. 5th RICS, 7-9cm lateral to midaxillary line a. Bruit c. heaves
b. 5th LICS, 7-9cm lateral to midsternal line b. Lift d. thrill
c. 6th LICS, midclavicular line 58. Soft decreascendo diastolic murmurs of aortic insufficiency is
d. 6th LICS, anterior axillary line accentuated in which of the following maneuver?
44. LV hypertrophy has a PMI measuring: a. Supine c. standing
a. > 1.5 cm c. > 2.5 cm b. Left lateral decubitus d. leaning forward after exhalation
b. > 2.0 cm d. > 3.0 cm 59. Opening snap, S3 and diastolic rumble of mitral stenosis are
45. Most prominent palpable impulse at xiphoid or epigastric area? accentuated in which of the following maneuver?
a. LV hypertrophy c. pulmonary HPN a. Supine c. standing
b. RV hypertrophy d. cardiac tamponade b. Left lateral decubitus d. leaning forward after exhalation
60. Decreased P2 intensity 77. Place hand above patient’s knes and raise his thigh to elicit pain
a. Pulmonary hypertension c. calcific aortic stenosis a. Rebound tenderness c. psoas sign
b. Pulmonic stenosis d. systemic hypertension b. Jar tenderness d. obturator sign
61. Increase A2 intensity 78. Inspiratory arrest seen in acute cholecystitis upon placing right hand on
a. Pulmonary hypertension c. calcific aortic stenosis liver border
b. Pulmonic stenosis d. systemic hypertension a. Middleton maneuver c. ballotment
62. Occur shortly after S1 coincident with opening of the aortic and b. Murphy’s sign d. markle’s sign
pulmonic valves. Usually high pitch, sharp and with clicking quality 79. Normal liver span (mid clavicular line)
a. Early systolic ejection sound c. systolic clicks a. 4-8 cm c. 6 – 10 cm
b. Opening snap d. Atrial Gallop b. 6-12 cm d. 8 -12 cm
63. Very early diastolic sound produced by opening of stenotic mitral valve 80. Meatus of penis on ventral surface
a. Early systolic ejection sound c. systolic clicks a. Hypospadias c. phimosis
b. Opening snap d. atrial gallop b. Epispadias d. hydrocele
64. Occurs just before S1, dull and low in pitch which is due to increased 81. Enlargement of spermatic cord that feels like a bag of worms
resistance to ventricular filling following atrial contraction a. Hypospadias c. phimosis
a. Ventricular gallop c. summation gallop b. Epispadias d. varicocele
b. Opening snap d. atrial gallop 82. Steady and aching abdominal pain accentuated by pressure changes
65. Holosystolic murmur at the apex, medium to high pitch that is soft to in the peritoneum
loud in intensity with apical thrill. a. Peritonitis c. cholangitis
a. Mitral regurgitation c. ventricular septal defect b. Pancreatitis d. colonic obstruction
b. Tricuspid regurgitation d. aortic regugitation 83. Dull suprapubic pain usually low in intensity associated with restless of
66. Pansystolic murmur heard over the 3rd, 4th and 5th LICS, that is often no specific complain
loud and high pitch. a. Urinary bladder obstruction c. pacreatitis
a. Mitral regurgitation c. ventricular septal defect b. Bilary tree obstruction d. peritonitis
b. Tricuspid regurgitation d. aortic regugitation 84. Occur in dieases that injure sensory nerves which is burning in
67. Turbulent blood flow generated by ventricular ejection of blood into the character, limited to the distribution of the peripheral nerve and
aorta with no underlying cardiovascular disease demonstration of irregularly spaced cutaneous pain spots
a. Innocent mumur c. aortic stenosis a. Causalgic pain c. functional cause
b. Physiologic murmur d. aortic regugitation b. Spinal nerve pain d. metabolic abdominal crisis
68. Midsystolic Murmur heard over the right ICS, medium to high pitch, 85. Sensation of lump lodged in the throat with no difficulty encountered
crescendo decrescendo type. whens swallowing
a. Innocent mumur c. aortic stenosis a. Aphagia c. phagophobia
b. Mitral regurgitation d. aortic regurgitation b. Globus pharyngeus d. odynophagia
69. Diastolic murmur heard over the 2nd to 4th ICS, high pitch that is blowing 86. Inhibitory innervation of both esophageal body and LES is impaired
decrescendo type. a. Aphagia c. achalasia
a. Innocent murmur c. aortic stenosis b. Globus pharyngeus d. diffuse esophageal spasm
b. Mitral regurgitation d. aortic regurgitation 87. Inhibitory innervation only to the esophageal body is impaired
70. Paradoxical Angina occurring during rest but usually not during a. Aphagia c. achalasia
exervise caused by coronary artery spasm. b. Globus pharyngeus d. diffuse esophageal spasm
a. Stable Angina c. Pritzmetal Angina 88. Rare disorder of unknown etiology that produces periodic discrete
b. Atypical angina d. Unstable Angina episodes of relentless nausea and vomiting, common in children.
71. Abdomen with General distented contour with inverted umbilicus a. Intestinal pseudoobstruction c. functional vomiting
a. Chronic ascites c. obesity b. Chronic idiophatic nausea d. cyclic vomiting syndrome
b. Umbilical hernia d. malnutrition 89. Severe form of nausea of pregnancy
72. Normoactive bowel sound a. Hyperemesis gravidarum c. hyperemesis neonatarum
a. <5/min c. <5 / 5 min b. Functional vomiting d. idiopathic nausea
b. 5 – 34 / min d. 5-34 / 5 min 90. Cyclical event which characterizes motility of SI during fasting
73. Decreased bowel sound a. MMC c. HAPC
a. Diarrhea c. ileus b. Phasic contraction d. colonic tone
b. Early pyloric obstruction d. early intestinal obstruction 91. Average transit time of the ascending and transverse colon
74. Frequent bowel sound due to early intestinal obstruction a. 10 h c. 20 h
a. Tinkles c. succusion splash b. 15 h c. 25 h
b. Rushes d. peritoneal friction rub 92. Average transit time of descending colon
75. Pain occurring at the site of pressure a. 1 h c. 3 h
a. Blumberg’s sign c. markles’ sign b. 2 h d. 4h
b. Rovsing’s sign d. cullen’s sign 93. Causes diarrhea after eating chicken except
76. Stand on toes and suddenly relax causing heels to hit the floor and a. Salmonella c. campylobacter
eliciting pain b. Shigella d. citrobacter
a. Blumberg’s sign c. markles’ sign 94. Causes diarrhea from eating mayonnaise
b. Rovsing’s sign d. cullen’s sign a. Gardia c. rotavirus
 b. S. aureus d. bacillus cereus 113. Mean hematocrit value for adult males
95. Most common cause of infectious diarrhea in institutionalized people a. 42% c. 52%
a. C. difficile c. shigella b. 47% d. 57%
b. Giardia d. ETEC 114. Signs of hypovolemic shock occurs with how much blood loss
96. Diarrhea associated with marked vomiting and minimal or no fever a. 10-15% c. >30%
a. Preformed bacterial toxin c. yersina b. 25% d. >40%
b. Entamoeba histolytica d. Giardia 115. Common cause of hypoproliferative anemia
97. Metastatic gastrointestinal carcinoid tumors a. Inadequate EPO stimulation c. blood loss
a. Secretory diarrhea c. steatorrheal diarrhea b. Folic acid deficiency d. heme synthesis abnormalities
b. Osmotic diarrhea d. dysmotility diarrhea 116. Common cause of maturation disorder
98. Carbohydrate malabsorption a. Marrow damage c. folic acid deficiency
a. Secretory diarrhea c. steatorrheal diarrhea b. Inadequate EPO stimulation d. blood loss
b. Osmotic diarrhea d. dysmotility diarrhea 117. Hematocrit levels of ___ in men and ___ in women may be abnormal
99. Tropical Sprue a. >45%, >50% c. >60%, >55%
a. Secretory diarrhea c. steatorrheal diarrhea b. >50%, >45% d. >55%, >60%
b. Osmotic diarrhea d.inflammatory diarrhea 118. Borders of Traube’s Space except
100. Eosinophilic gastroenteritis a. 6th rib superiorly c. left costal margin inferiorly
a. Secretory diarrhea c. steatorrheal diarrhea b. Left midaxillary line laterally d. diaphragm superiorly
b. Osmotic diarrhea d. inflammatory diarrhea 119. Azotemia >3 months, with prolonged symptoms of signs of eremia.
101. Hyperthryoidism and cardinod syndrome Renal osteodystrophy and bilateral reduction in kidney size
a. Secretory diarrhea c. inflammatory diarrhea a. Rapid progressive renal failure
b. Osmotic diarrhea d. dysmotility diarrhea b. Acute nephritis
102. Black tarry foul smelling stool c. Chronic renal failure
a. Hematemesis c. hematochezia d. Nephrotic syndrome
b. Melena d. occult GI bleeding 120. Proteinuria, Hypoalbuminemia, edema and hyperlipidemia
103. Most common cause of of lower gastrointestinal bleeding a. Nephrotic syndrome c. nephrolithiasis
a. Haemorrhoids c. neoplasm b. Acute nephritis d. acute renal failure
b. Meckel’s diverticulum d. vascular ectasia 121. < 500 ml in 24 hrs urine output
104. Presence of scleral icterus indicates a serum bilirubin of at least: a. Oliguia c. anuria
a. 2.5 mg/dl c. 3.5 mg/dl b. Azotemia d. nonoliguria
b. 3.0 mg/dl d. 4.0 mg/dl
105. Reacts after the addition of alcohol in van der bergh reaction
a. Direct bilirubin c. indirect bilirubin
b. Total bilirubin d. urine bilirubin
106. Unconjugated Hyperbilirubinemia where Patients live into adulthood
with serum bilirubin levels from 6-25 mg/dl
a. Criggler najjar I c. Gilbert syndrome
b. Criggler Najjar II d. dubin Johnson syndrome
107. Unconjugated hyperbilirubinemia due to reduced bilirubin UDPGT
activity with levels almost always 6 mg/dl
a. Criggler najjar I c. gilbert syndrome
b. Criggler najjar II d. dubin Johnson syndrome
108. AST:ALT ratio of 2:1 with AST rarely exceeding 300 U/L
a. Wislons disease c. acute viral hepatitis
b. Alcoholic hepatitis d. autoimmune hepatitis
109. Aminotransferases >500 U/L with ALT greater than or equal to AST
a. Wilson disease c. acute viral hepatitis
b. Alcoholic hepatitis d. autoimmune hepatitis
110. Succussion splash is present in
a. Dilated hollow viscus c. ulcer
b. Ascites d. pancreatitis
111. Prominent abdominal venous patter with direction of flow downward
toward umbilicus
a. Portal HPN c. SVC obstruction
b. IVC obstruction d. carotid obstruction
112. Prominent abdominal venous pattern with direction of flow away from
umbilicus
a. Portal HPN c. SVC obstruction
b. IVS obstruction d. carotid obstruction