Med 1 1st Sft 2005
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racuHy
OTMe,,'Jlcme ana ~urge
Department of Medicine Medicine 1- lit Shifting Exam 110008-1000 I'riday, 12 August 2005
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accurately measure the blood pr~~sur~, .. A Center the inflatable bladder over the radial artery ~'G\C1;1'\~\\.,Jllfi. '1
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k1<~r(llkolr :mllnds arc iUlludiblo (hw to
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K Erroneous placement of stethoscope ' B. Full skin contact with the bell C. Raised jugular venous pulse D. Very.•...__t~b-blood pressure , --.
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the heart rate, ,." ' ~\(.1WY1()." ' '. after compression of the r~dial artery to a mimmiU pulsation: .':~~~i-'> . B.'·Count it for 15 seconds and multiply by 4 ifit is too slow R,((IlH.(;I(' .. :.,y /_ C .. Count it forGO seconds wtien it becomes unusually fast. . , ,: ;,>~I.;':: D. Count it/b§cardiac auscultation when the rhythm remains regular., '
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Rest the seatei~£.atient's arm on a table .atheart level./ ' .. ', " C. Secure the u_p_p_er,,-b_o_rde( of the cuff 2. 5 Inches above the antecubJtal foss~~. D. Use t~~d-i1lphragm of a stethoscope over the artery, )?('}..\"
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ann length
D." 80~
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cuff should be about .
D. 6Q% ofupp~r arm circumference"
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~ .-5:"When using a glass thermometer to measure oral temperatures, ' Insert it und~r the tongue" ., . B. Place it inside the.m()uth with pursed lips. ·;I05C fti~~, !if) ·C. Shake it down to at least 37°C. l?CjbC.) . D Wait~.atmost 60 seconds before reading ('J._r. 'J "'" Y"'ll1v!-fCc,. I' t:./\ ,/" l' (,,,,'1, ", . "1 /, .••.1, .
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'I tf~fJ..)J, 'is ' temperature of 37°C, the tympanic,membr~ne tempereturc
'~stimatedtobe 372••• , D. 37.4
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~. 24 , \11.1))) f.j , ,,~, j)(J' minute docs" 0' an 30 adult ,1_, , .' take ': nci~rmall . ,'.~ (,G(\~\ r .. ~\\\\J~t
r../'18·lllan~breathsper " /6:How O. "/t,t'] ~~Ij.'l •.
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C 376, D. 37.8
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.::;};>;.:;.~ ' 8. When ~ pa,tient can.on~y read the 40 line. ofSnell~~'s chart at' a'distance ~f20' , ~,\-e'\1 ,r--t O\SlU\\\~~ ft.'tlV Lli ~',~::;" feet, hiS Visual aCUItyIS reported as .. .:::..::~:::.,. A. ,,20/20 . C. 40/20 ~, ' !),"f., @ ~(I~. '.
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Y20/40.
~D.40/40
)
40
~
':<::i~:r:'~':'G 9. Visual field of an ind~vidual can be tested by this method:
: ::::;:,:, ",-,--.
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"
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A. Accommodation :a. Blinking'
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e
.e: Confrontation
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D. Divergence
1
. " (~\ AfO\SllAV\t.'\;.
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to. The normal blintl spot ca ' 159lemporallo the line of gaze 0 ' D. 30 nasal to the l/lle of gaze C. 60olcmporal to the line of gaze D. 90° from the Jine of gaz~
..... K ..
... ..... "
open~ng is normal whene-:it4 measures mm I D. 6 mOl
II. A. A1 pupillary mOl
:..';'?.;i .... J.:.;. ~
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B. 2 mm
-1,;:.~~
With intacG~cranial
12.
ne~e
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A. to the extreme left B. left and downward
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I J. \Vhc.~ll a patiellt is askcdh}
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.
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individual canpeiform th"fOliowiD88=::
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liJllow the tinger ...
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his~ycs
14, ~1ydriatic drops are used to dilate the pupils A(evaluatc the'macula well ' ...
ill order
cOllverge ' .
"
B.
usually
red
orange
111color
V\(\}Jv \
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How many times docs tl~e ophthalmoscope 6. C, 12 9 . D, 15
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magnify the.norn~~1 ~~tin~.? .~ , IYI S";:; "hr);.~ .
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] L
.·'·;f':;; ;
uninvolyw retina
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The sUrrlr()Tdiopters retina.
~' ••.
diopters of the two lenses used to rocuson
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D. The s~lm ofdiopters uninvolved retina'
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of the two lenses used ~o focus on the disc and the involved of the two lenses used to focus clearly on the disc and the.
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B. Dark red color - L\la~n
:\"\,~
for Iaterali~t~on,
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jY'in
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B. on the left side
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~he midline
" ~D.Visible \
pulsations'
,
should normally
hear the so~nd
C. on the right side .
D. over the occiput
20. The rise of the soft palat~ is a test of this cranial nerve: . C",AiI'.\.f)' ~/ A. VI[ lG\ C. X \v··1\,.) }l/'' 1X ,
;1'.) !':e ,.'.,),I': IJI~" \ I.1J'{1,: I ...( II ... J
features: .
..•
tile examinee
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TIl~i~;Ca~~ri;;J1re distinguished tfom vei~s ~ased on the following prt
"'~~~~~·:~:·~A ]9. In Webertest
the
the'dlscand
~'.:~~:t-~.·;::.0 18, :.'.:.\!,.;';', A. Absent light reflex " :';;\.; i.:i. , : II".' :.:
I I
.
Thc,diIferencein
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7' The elevation of the optic disc can be measured by this es~hnat.on: . The difference in dioptcrs of the two lenses used to focus on the disc ., and the. . involved retina ... '
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~(('slllalJerthanthephysiologiccup fh::". located atthe temporal side NC\sm'
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15, Norma!l);, the optic disc is A. somewhat bluned in the nasal portion'lC~,\'nC',.·~
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of al1cxamincr,
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l.l.cxamine the fund~is ora con;atcisc,patient Y. PO \1vi bI\..&11 v C illvestigalt: visual hISS follo\Villgltc'ild illjury j. (Ie hr,! l>\\.cnr~/ D, see peripheral structures in Ilarrow-migle glaucoma
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C. 10 em.
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~down D. to the on leftthe andlenupward
.uon-ually within ." ;(:..-A em ..
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21, Tll.tcst chest cxpans'
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22. Fremitus is .' ~ A. absent in the supraclavicular fossa .pre<,e..\'\l diuf~ B .. more intense in the left side 1\~r\1 rz: more prominent in the interscapular area
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24. The extent of diaphragmatic ~x~ursion is estimated riorn~l1~'~b~ut' .' A 4 rY" 8 ' ..
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n. BrOl1Ch~vesiculaf {} CIll, D. 10best em. over 25. breath sound is heard second mterspace anlenody' .. ·:iU ..... ..B. manubrium, if heard at all BIOno': -
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~ spoken "ee" is transmitted as &lay". ecOY\I?\ \~J ..t;. words are muffled and IndIstinct· D .. tactile fremitus is increased YlDt\\ 'fo.l..- '.
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.;i':': -: D D. Pulsat ions not eliminated by light pressure ~\ II',.,\\ \" lC 'lJ . ~:}\':.'.__. __ 31. In all positions, the sternal angle usually, remains above the right atrium by · :I~ '.:. A. 2 em.· C. 4 enl.
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B. deep as iris wide . LYwider than it is deep .. :, '. .' " . fi1II e d Iung, t,' .. .' 28. In norma 1 alr" A. breath sounds are predominantly bronchovesicular . ~'(,;.\CV\("
.,,:vn,:~\)\LX Il)r. I 1''1','. ')" , pulsations? A. A more vigorous thrust with a single I component .[(,1\11\' :;.\1 f.1"\ \ ,) B. Level ofthe pulsations unchanged by position C\\(\V\({{'V·. .fC. Level of the pulsatio.ns descends with inspiration .
. .'.....
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C. depressed in the lower sternum.
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'30. Which of the foliowing features helps to distingui f;~om
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is" "
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;
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Wluclt adventitiOus sOllnd IS~~llchcd and musIcal? A. Crackle'i... C. Rhonchus ,.. J . B: Rale . rD. Wheeze in the no~al A. deeper than it i's wide
'II
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.' sound~ ~r~ called 29. Louder,
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Co most of both lungs '(£'i;C·\\·!i1'i D. trachea in the neck 1\ (\(0C/\l
1.~{f:.L.f_ .': ~":., J"') .. 27. Thethora~ .;.;·i:;:.~> · '., ." •••.
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23. Which of the following percussion notes is distinguished ~:~ihl'yhy i~s:~~~i~;aj:' ': '.'::\:~~:~~~h, , ... I ;.\ ,I' ~ . A..timbre? Dullness C, ,Hyperresonanc~ . ,:,:' ,: '~:: . ".: . :1·~.~~L:~~~11 H ~i\:l.1~ B .. Flatness If.' Tympany ,; i :;\,}.j;
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D. palpable below the diaphragm
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rift
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B. Second
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D. Fourth)
A. Early tiI11ing.•
C. Louder intensity
n.
1Y.'Shorter duration
Higher pitch
.
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34. Loud murmur with a palp~ble tJ~iIl is graded
.:, ,', " .. •. '
A.3 ¥4
,.>.'i ..~~:·:.
ii
~
33. Heart sounds are differentiated from murmurs by their
.;:-":~;::' ...
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3~. "Yhlch heart soulld IS heard ~est at the ape~ .,!L.lnr.~?: A First rY\nVUL' \...:..e':' fhird '
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using. the bell of sound a stethoscope? 35. Which heart is heard• A First
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B. Second
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I • ; , ; ~,.;,/: 'notch ":' Ii. ·J·'i :1" in. the supras~ema'l i ':! !':i1i I ""'. " i. '1111 ,,;: 'I~ I:
e:'Thlrd
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36/Which oftl!dollo~in~
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~tep'enhanee~ ~xa.mi~aliL,n ?f the abdomen?
Pl. Approach and examIne the patient very qUick! y. '. q i" ;I! . L:. rl; ,..r. .J . '" B:' Don't talk to the patient during abdo~inal palpation: ,re~(.\r·; II,.j:'
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YLarge.·
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D. Small
39. An enlarged spleen is detected
..
by
.
/.
_-t.
i
this technique;'
..
P~rCUS8m~glll l.he .lon IO,wer nnterior costal .... chest wull hetween the
. )~
~
for. the patienfs . 11'{:i!.i! I:' :11il/"'1, ,;,':';h~ad 'and .,: ano'Lhe~'un'd'edhe lUl:'\.Ih .'. kh~es~I!!li; ': "!'.!"!I:' Ili/,f/;lli';; i1·';I'I:~!::!·t:i!':~';""H·'1 I. I,,! r'l ""'\.1\.1'lr'l~t'.I~1:IJII:!""ll~! :f'l' I f'Jl"I,.' :1 ·',IFI. ~ l' II
I",
W11~nthe v~rtjcalspan ~eas~rcs 14cm in right midcla~~~:I~di~~~'lr6~ Iive~is' A. Absent. C. Normal' N" W - I~ (U I l' (",t,+-
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C. Have'the patient keep arms over t'ho head. COV\l(u\Cl·. r((1~\~'lli,:';:: I :1,';:;:.,1' dJ, .. ": "'::'" : ..:i:t
'" ... ,..l!... _~7. A
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,l
.... '; j;!1',1 ':",. I'~·:',Ji,·;~. '::ll' 'II' I, :It ~!
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·D. Fourth
D. .' Use.. a pillow 11 .:
:
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. : bes~a'i1be~iRhoidlnd --
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I~n~ r~~lo~ance ': . , ~.~~v~ •.Ii' .
,,, t' ):·>i !hl;i~;i;:lj,l;I!iijr
an~.~!!I;:!!i.I.;.ir;rlllli 'hA'''!i If,I'
"/il
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.' lowest interspace rea: tl 1 the B. bPercuss
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40. N~rm(ll.l. I Trnube'sspnccls
..
A. Dull, -
·.:).Y.,:'/, """n 'I
B. HyperreSbnaut
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, •.~
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Resonant ' ';:!
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em
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D. Shifting dullness
I,.. ,
;
42. Which technique helps to confirm an o,-gatl tl1 au a~~ ~~tI. . A. Dallotement ' .• 12': Puddle sign .' . ':
j
;H~I!:llll!:; ,.
,J"!fl;;"I!i' +1,1! ,ll!,IJ
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em
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x( ~
. B. Fluid wave .., ..,:;:;\,:
,'
~cn,
B_ ~
..., .... - '.::::\ ,.: .,----
' .,. a. ~~er'
I'"
I"~ ','. ~~ line_befor~j
The width of a normal aorta is not more than
J.-.
h
midaxillary
~
4, vl'. tu-",&td; i- fl(/. .•.,
,;.';5.;:
«:.,~
lea
Percuss' from th~ 9th to 11th'int~rspaces along the mida~iIlarY i~nJ.·". .':~··it'11;,(l!Y ;,'! :::/:1 Percuss the. lowest interspace frc'm the midaxillary to the poste';or ~illary line;'''!;1
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in the
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43. Which sign is a test for referreJ reb~und tenderness of the abdomen? A' Markle's C. Psoas .
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13~ Rovsing' s
:.:?;/:)....~ ".:", ;' ,
44. When a patientstr~ins down, tlw abdominal mass r~mains palpable and is locat,~& . in the'
D. Obturator
.
.' :\.n
I\~Abdominal
· ;~.~:'-:..':
B. Abdominal cavily
., .
,l·r.;· .
wall
C. Pelvic ar~
D, Relropenloneal s
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, ...:~ . . '~ ..
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t.
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PlIIe glCII.LlI_I.UJ\I.~~~JUPLiull
iScJ.Lcj~~d by duing
,~~~.,.(':~t' t ,e
this ~chrUque:
'.:':. '.:/'.; ',:'):.;'
A. Pla~ bothJ~~d~_ behindthe neck, with elbows out Lothe side r ~;Ll'''('\\" . I '1, ~ Placeboth hanas behlnc.tthe-smaJl of th~ back ~L·c~\nl ~ 1 ~.>r. .. { !'1 i~. ~ j. hI ..(1••..• ~ 'C. Rnisethe arms to shoulder level with palms facing down ... '
",:..'.',,/:: .~",
D. Raise the arms \) \"'H'\ \ 'k--·~""L,d '.I , . to a vertical position above the head .. ~tYl '0 'A C.:t :","l,r1' "\)'V'.:w
::::;.~ median nerv~ , ~:.: L46/Test1(. porsull1 of the handfunction by ~hecking . sensation on the: ' ,,::')~}' ' ...B. Dorsa! web space of the thumbnlld index finger 'P\
\"
.
F
·~1·I,
.:
J
..
•
C
.';,"~21",
D. 'Pulp of the index finger
:')-J}.::;:'
47. To test extension of tile neck, ask the patient to perform th~ following maneuver: . '.Jv( Look up the cf':i1ing, ' '.' .' B, Tilt the head, touching each ear to the corresponding shoulder; 9'd€lk>e.\ ~'Jll)i.i C .. Touch the chin to the .chest. 'n..:.\~..) \1\
~
:-',\:;! :: :'~;;:i>
· -:';,:' · ,:\((1.'
:· .;... :i~;, ..:'
Pulp of the
fifth finger'
::."1\'"
L
,,'.~, ..
D, Turn the head tocach side, looking directly over the shoulder. :
48, exceeos atlea~.. A. Agait 2 Inchesis wide-based when the heel to heetC.dist~nce 6 Inches,
.i(' 4 inches'
'I .!
'D, 8 inches
,:'j\~:':',; ~
49, Awareness that disturbed behaviors are normal or not is used to evaluate
:7.1\'.;:,
A. Insight D. Judgmcllt
;':';~::~':~ l.,:t •
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:·· ...1:··/··
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L
, ' .., ..,:.\'y....
:~:d::'~;":
:.:-',('\ ..
::;:;:>:. .. .. \
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C. Orientation
.IJ Perception '.
cranial nerVe is .'tested by askingt.he. patiew· ' ~eventh ry 0 . C· N d 1\ Frown .. ~ . D, Sleep~.
:' :.,
.. 1;o~i.C~:~:,·:~S::·\}'i?~' ';j 0l v;, -(, '. ,. ,\!' .D ( '., , ,. '''I''''\S, t,!'l. -,\-'
51. Muscle strength ~~aded 4 wheu the individual can move A. ...Against 0:) some ,J.:.. resislanc,e Against gravity gravity and '.',. ·c, A~ainst f~1I rc~.ist~nc~without evidence of fatib'Ue-E) \.'.. D, With gravity ehnuilaled . -(~)
.
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,,"
'.
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l'\<\Ci\\\CW:-~ "·:--"1" :.'- ~C\I'(Ci\)'~'1~ 1_ C!C1\V'f., mOi-:.'. .;\ \1 '. ~ l q,.\.( • c;.•.•, ,:_. ~1,?"\1r: - h:h'\(,~ 4 -,jrC\.
52~re.st adduction anhe hips by asking the patient'.to do this: .. 5.-.~~\tV' rC1IS-:: It, Brmg both legs together .' .. C. Raise the leg - iltw,.H \ .. B. P~shtheposteriorthjghdown..:-t:Z-\{.f~,t\jD. Spread both legs -~(~\}~\C1l0"1
53. The Romberg test is mainly a test of . J1.Ulction . C: Position sense ,-.J
',::',\'::.:' .' K Cerebellar
B. Hearing acuity
: ::,r:'.~> I ~i" ~'\ ..
·:·:7Y~~:; 'A ',:,~"i·.·
·f
.
~ ,,'
D. Vestibular apparatlls .\ .," ~"
/v"
54. Which r~t1~x .x: Ankle .' tests primarily .' th
: '.t::::·i
D, Babinski ....L~)J '1'\
"'::J~~:(' ~
55. What level of consciousness is determined by shaking the patientgelltly as
. '»
l: .
/;J.\~<.~l /;1. : ii,qI0 ", ....
.
awakening n sleeper? .. Lethargy i}l,~' .••:rv~{}J; 1'1 : B. OblllllOll1 inn T:I\\ \'7~ ,\,1,' • r;.', •..
¢-' A.,
"
,
,,~ I ' A:~:':\:~,:
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D, Plantar
.
bet .. i\ ' ' ••
C/56.
l~l4, \ i'
e· Stupor D, «lIllll "
'L
DoWs eye movements are ob~~~ed in response to . A. COl1leal reflex ' Oculocephalic reue D. Gaze preference . D, S.••• :nging Oashl:g::, 'te.s·
'.c.
if . ..
OTMe,,'Jlcme ana ~urge
Department of Medicine Medicine 1- lit Shifting Exam 110008-1000 I'riday, 12 August 2005
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Sub.Sect..
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.
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,
C .. (ZO% of upper
- <·.if·,' ..
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accurately measure the blood pr~~sur~, .. A Center the inflatable bladder over the radial artery ~'G\C1;1'\~\\.,Jllfi. '1
i{
<·~tX· .... '."~..:~::
A
,. :>:"
k1<~r(llkolr :mllnds arc iUlludiblo (hw to
'.
K Erroneous placement of stethoscope ' B. Full skin contact with the bell C. Raised jugular venous pulse D. Very.•...__t~b-blood pressure , --.
.. ""--
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.t
.'~'i4~:~~f~;~ V 4"~ess ;:\iit:;; K Co~nt
the heart rate, ,." ' ~\(.1WY1()." ' '. after compression of the r~dial artery to a mimmiU pulsation: .':~~~i-'> . B.'·Count it for 15 seconds and multiply by 4 ifit is too slow R,((IlH.(;I(' .. :.,y /_ C .. Count it forGO seconds wtien it becomes unusually fast. . , ,: ;,>~I.;':: D. Count it/b§cardiac auscultation when the rhythm remains regular., '
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it
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Rest the seatei~£.atient's arm on a table .atheart level./ ' .. ', " C. Secure the u_p_p_er,,-b_o_rde( of the cuff 2. 5 Inches above the antecubJtal foss~~. D. Use t~~d-i1lphragm of a stethoscope over the artery, )?('}..\"
:: .:~:::<."
,')
.
ann length
D." 80~
.
I I 1r;X;;': }~~
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cuff should be about .
D. 6Q% ofupp~r arm circumference"
.:~.~:).. . . :.~~~/'
...
'.
.
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"
~ .-5:"When using a glass thermometer to measure oral temperatures, ' Insert it und~r the tongue" ., . B. Place it inside the.m()uth with pursed lips. ·;I05C fti~~, !if) ·C. Shake it down to at least 37°C. l?CjbC.) . D Wait~.atmost 60 seconds before reading ('J._r. 'J "'" Y"'ll1v!-fCc,. I' t:./\ ,/" l' (,,,,'1, ", . "1 /, .••.1, .
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rJo
'I tf~fJ..)J, 'is ' temperature of 37°C, the tympanic,membr~ne tempereturc
'~stimatedtobe 372••• , D. 37.4
. ./\--.t,_\:;';(::; ':· .''+:\'\:. I:••.· •
i'
'.
~. 24 , \11.1))) f.j , ,,~, j)(J' minute docs" 0' an 30 adult ,1_, , .' take ': nci~rmall . ,'.~ (,G(\~\ r .. ~\\\\J~t
r../'18·lllan~breathsper " /6:How O. "/t,t'] ~~Ij.'l •.
4 ~<·,K:.,,~~d .;_":_' _.
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-to. rOc..
C 376, D. 37.8
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.::;};>;.:;.~ ' 8. When ~ pa,tient can.on~y read the 40 line. ofSnell~~'s chart at' a'distance ~f20' , ~,\-e'\1 ,r--t O\SlU\\\~~ ft.'tlV Lli ~',~::;" feet, hiS Visual aCUItyIS reported as .. .:::..::~:::.,. A. ,,20/20 . C. 40/20 ~, ' !),"f., @ ~(I~. '.
;'//:.','. ': ;'!(,: .,
Y20/40.
~D.40/40
)
40
~
':<::i~:r:'~':'G 9. Visual field of an ind~vidual can be tested by this method:
: ::::;:,:, ",-,--.
>:'~:( .
:rr.-· 'I' /I(IIf. ,I"
"
"
.. ,'" "t'" "
. ,7
A. Accommodation :a. Blinking'
~L.-ltll-INI-1H1---1I
e
.e: Confrontation
' .,'
D. Divergence
1
. " (~\ AfO\SllAV\t.'\;.
. \l(o.~,
: i.
_JJ_
to. The normal blintl spot ca ' 159lemporallo the line of gaze 0 ' D. 30 nasal to the l/lle of gaze C. 60olcmporal to the line of gaze D. 90° from the Jine of gaz~
..... K ..
... ..... "
open~ng is normal whene-:it4 measures mm I D. 6 mOl
II. A. A1 pupillary mOl
:..';'?.;i .... J.:.;. ~
:';:::.' ">" ..
B. 2 mm
-1,;:.~~
With intacG~cranial
12.
ne~e
....:~,' :.,'.; .:;'. , ,.'},.,~ .'
A. to the extreme left B. left and downward
", ,.' ·.h
I J. \Vhc.~ll a patiellt is askcdh}
, n_
.
'::': .iL
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individual canpeiform th"fOliowiD88=::
I
liJllow the tinger ...
0
~.··.r';'·:.
":'~,:'::'; ':\ ····D. ~';'
his~ycs
14, ~1ydriatic drops are used to dilate the pupils A(evaluatc the'macula well ' ...
ill order
cOllverge ' .
"
B.
usually
red
orange
111color
V\(\}Jv \
0,;
I , .•
:1 ::1
How many times docs tl~e ophthalmoscope 6. C, 12 9 . D, 15
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magnify the.norn~~1 ~~tin~.? .~ , IYI S";:; "hr);.~ .
•
I
,
] L
.·'·;f':;; ;
uninvolyw retina
:;;
The sUrrlr()Tdiopters retina.
~' ••.
diopters of the two lenses used to rocuson
··",'X:'-':·':·,
.''-' "...
D. The s~lm ofdiopters uninvolved retina'
, ...~:;i:: ....
•• J.,."
.
'.
,
of the two lenses used ~o focus on the disc and the involved of the two lenses used to focus clearly on the disc and the.
rtl)
B. Dark red color - L\la~n
:\"\,~
for Iaterali~t~on,
:::;';tr:~·:, .
jY'in
:~;,:)}'') ~
B. on the left side
:. \.:. , ...'
_.)/.~·:.t,:~::C,.-. .
~he midline
" ~D.Visible \
pulsations'
,
should normally
hear the so~nd
C. on the right side .
D. over the occiput
20. The rise of the soft palat~ is a test of this cranial nerve: . C",AiI'.\.f)' ~/ A. VI[ lG\ C. X \v··1\,.) }l/'' 1X ,
;1'.) !':e ,.'.,),I': IJI~" \ I.1J'{1,: I ...( II ... J
features: .
..•
tile examinee
J) ,Xl I \:' f\' . I.'\'0'UI' iJ .){( .;.'
1
!
.
TIl~i~;Ca~~ri;;J1re distinguished tfom vei~s ~ased on the following prt
"'~~~~~·:~:·~A ]9. In Webertest
the
the'dlscand
~'.:~~:t-~.·;::.0 18, :.'.:.\!,.;';', A. Absent light reflex " :';;\.; i.:i. , : II".' :.:
I I
.
Thc,diIferencein
:>;;.~.:,:
I
7' The elevation of the optic disc can be measured by this es~hnat.on: . The difference in dioptcrs of the two lenses used to focus on the disc ., and the. . involved retina ... '
:'~',~:;:::: .·D.
f'!:,·'1~"",'--
~
(ctHCfl
!~YC.~·, ','.1:•...
~(('slllalJerthanthephysiologiccup fh::". located atthe temporal side NC\sm'
..·t:}A~ 16, :' J~;>":: X B. :';,'j..:
..:.... ,
i::J~:j~ .i~!J
to, .
,
•• :
.c it
1'/ ( .. ~ em.
15, Norma!l);, the optic disc is A. somewhat bluned in the nasal portion'lC~,\'nC',.·~
••~.:~:.:.
~
/i;':iJlli!l . "'.", q"\.fv~'V(\J,etl; t\'JV~:' f ,'):II::fh;lt
of al1cxamincr,
~v :~,::'fL '~':<:;
#
'
l.l.cxamine the fund~is ora con;atcisc,patient Y. PO \1vi bI\..&11 v C illvestigalt: visual hISS follo\Villgltc'ild illjury j. (Ie hr,! l>\\.cnr~/ D, see peripheral structures in Ilarrow-migle glaucoma
.
. .
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C. 10 em.
8' CIll ..
/).j:1o'
InY)']'
~down D. to the on leftthe andlenupward
.uon-ually within ." ;(:..-A em ..
.. '
. ~. !~.-.,..£) .
:1-5
":,
. '
I
__ Jt._
21, Tll.tcst chest cxpans'
Ic\d
- the
A. . ~:'·>~.1,:' ':.
.
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··'·r::
'.
,
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r.' "I, $r-
22. Fremitus is .' ~ A. absent in the supraclavicular fossa .pre<,e..\'\l diuf~ B .. more intense in the left side 1\~r\1 rz: more prominent in the interscapular area
I
.
'I"
.'!
.••
'
24. The extent of diaphragmatic ~x~ursion is estimated riorn~l1~'~b~ut' .' A 4 rY" 8 ' ..
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~.
em,'
,
,
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. ;::::.':'('~
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."<:':>:: ),: .•.... . ;~;{.r· ;~26. :: ,~>',
n. BrOl1Ch~vesiculaf {} CIll, D. 10best em. over 25. breath sound is heard second mterspace anlenody' .. ·:iU ..... ..B. manubrium, if heard at all BIOno': -
.. ' •. , .....
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,:.?~\': .(\ , :.:':'.;~'::;: ',,',. V
;.;
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adult
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.
,
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1"
.
~ spoken "ee" is transmitted as &lay". ecOY\I?\ \~J ..t;. words are muffled and IndIstinct· D .. tactile fremitus is increased YlDt\\ 'fo.l..- '.
j{
n. 3 (Ill.
.
r{
5 ern .
I ..
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.; I ',I· ".'
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.' lOI/.Del'
\lrl'::.lrt(·I·L~. carot~d artery ' ..
•.
'.\
:.
.,
.;i':': -: D D. Pulsat ions not eliminated by light pressure ~\ II',.,\\ \" lC 'lJ . ~:}\':.'.__. __ 31. In all positions, the sternal angle usually, remains above the right atrium by · :I~ '.:. A. 2 em.· C. 4 enl.
",
'I :..·•/T .~~.
.(.\,
B. deep as iris wide . LYwider than it is deep .. :, '. .' " . fi1II e d Iung, t,' .. .' 28. In norma 1 alr" A. breath sounds are predominantly bronchovesicular . ~'(,;.\CV\("
.,,:vn,:~\)\LX Il)r. I 1''1','. ')" , pulsations? A. A more vigorous thrust with a single I component .[(,1\11\' :;.\1 f.1"\ \ ,) B. Level ofthe pulsations unchanged by position C\\(\V\({{'V·. .fC. Level of the pulsatio.ns descends with inspiration .
. .'.....
i.~':"\'!:"11
").:';':
C. depressed in the lower sternum.
': ~.;:/::.. .':.\~ .•.. '.. ..
;:il
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.;
'30. Which of the foliowing features helps to distingui f;~om
. ' ·':'~,:;i"
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is" "
:..,:~Yi'~' ...':_~
... ··~;tf.'.
i:m~~~
;
,'.
~
Wluclt adventitiOus sOllnd IS~~llchcd and musIcal? A. Crackle'i... C. Rhonchus ,.. J . B: Rale . rD. Wheeze in the no~al A. deeper than it i's wide
'II
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l.qt\i}i
;:~:.~~:fr
"
\J::\~1f.{11:'\
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.' sound~ ~r~ called 29. Louder,
,
1
..'
Co most of both lungs '(£'i;C·\\·!i1'i D. trachea in the neck 1\ (\(0C/\l
1.~{f:.L.f_ .': ~":., J"') .. 27. Thethora~ .;.;·i:;:.~> · '., ." •••.
..' ". '"
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23. Which of the following percussion notes is distinguished ~:~ihl'yhy i~s:~~~i~;aj:' ': '.'::\:~~:~~~h, , ... I ;.\ ,I' ~ . A..timbre? Dullness C, ,Hyperresonanc~ . ,:,:' ,: '~:: . ".: . :1·~.~~L:~~~11 H ~i\:l.1~ B .. Flatness If.' Tympany ,; i :;\,}.j;
Yf. ';:':;, ~
'
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D. palpable below the diaphragm
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rift
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lib:
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B. Second
4 : .~?~:,.: _f') i
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D. Fourth)
A. Early tiI11ing.•
C. Louder intensity
n.
1Y.'Shorter duration
Higher pitch
.
v
i
34. Loud murmur with a palp~ble tJ~iIl is graded
.:, ,', " .. •. '
A.3 ¥4
,.>.'i ..~~:·:.
ii
~
33. Heart sounds are differentiated from murmurs by their
.;:-":~;::' ...
:
..
3~. "Yhlch heart soulld IS heard ~est at the ape~ .,!L.lnr.~?: A First rY\nVUL' \...:..e':' fhird '
.
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.
.'
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.
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using. the bell of sound a stethoscope? 35. Which heart is heard• A First
· ,,\l
;.:y .. .' •
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.. :,,:' ....
. ;,;:
"
B. Second
•••
JL
" .. /~',.>\
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.
.:~::::.'.' : .::.',
.
I • ; , ; ~,.;,/: 'notch ":' Ii. ·J·'i :1" in. the supras~ema'l i ':! !':i1i I ""'. " i. '1111 ,,;: 'I~ I:
e:'Thlrd
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36/Which oftl!dollo~in~
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~tep'enhanee~ ~xa.mi~aliL,n ?f the abdomen?
Pl. Approach and examIne the patient very qUick! y. '. q i" ;I! . L:. rl; ,..r. .J . '" B:' Don't talk to the patient during abdo~inal palpation: ,re~(.\r·; II,.j:'
", 't "i
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B' .,
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~~t 11
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YLarge.·
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.. :.L:~:.:.: \.::..
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D. Small
39. An enlarged spleen is detected
..
by
.
/.
_-t.
i
this technique;'
..
P~rCUS8m~glll l.he .lon IO,wer nnterior costal .... chest wull hetween the
. )~
~
for. the patienfs . 11'{:i!.i! I:' :11il/"'1, ,;,':';h~ad 'and .,: ano'Lhe~'un'd'edhe lUl:'\.Ih .'. kh~es~I!!li; ': "!'.!"!I:' Ili/,f/;lli';; i1·';I'I:~!::!·t:i!':~';""H·'1 I. I,,! r'l ""'\.1\.1'lr'l~t'.I~1:IJII:!""ll~! :f'l' I f'Jl"I,.' :1 ·',IFI.
I",
W11~nthe v~rtjcalspan ~eas~rcs 14cm in right midcla~~~:I~di~~~'lr6~ Iive~is' A. Absent. C. Normal' N" W - I~ (U I l' (",t,+-
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.
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C. Have'the patient keep arms over t'ho head. COV\l(u\Cl·. r((1~\~'lli,:';:: I :1,';:;:.,1' dJ, .. ": "'::'" : ..:i:t
'" ... ,..l!... _~7. A
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.... '; j;!1',1 ':",. I'~·:',Ji,·;~. '::ll' 'II' I, :It ~!
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·D. Fourth
D. .' Use.. a pillow 11 .:
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an~.~!!I;:!!i.I.;.ir;rlllli 'hA'''!i If,I'
"/il
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,
i
.' lowest interspace rea: tl 1 the B. bPercuss
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40. N~rm(ll.l. I Trnube'sspnccls
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A. Dull, -
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B. HyperreSbnaut
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D. Shifting dullness
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42. Which technique helps to confirm an o,-gatl tl1 au a~~ ~~tI. . A. Dallotement ' .• 12': Puddle sign .' . ':
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I"~ ','. ~~ line_befor~j
The width of a normal aorta is not more than
J.-.
h
midaxillary
~
4, vl'. tu-",&td; i- fl(/. .•.,
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lea
Percuss' from th~ 9th to 11th'int~rspaces along the mida~iIlarY i~nJ.·". .':~··it'11;,(l!Y ;,'! :::/:1 Percuss the. lowest interspace frc'm the midaxillary to the poste';or ~illary line;'''!;1
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in the
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43. Which sign is a test for referreJ reb~und tenderness of the abdomen? A' Markle's C. Psoas .
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13~ Rovsing' s
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44. When a patientstr~ins down, tlw abdominal mass r~mains palpable and is locat,~& . in the'
D. Obturator
.
.' :\.n
I\~Abdominal
· ;~.~:'-:..':
B. Abdominal cavily
., .
,l·r.;· .
wall
C. Pelvic ar~
D, Relropenloneal s
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, ...:~ . . '~ ..
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PlIIe glCII.LlI_I.UJ\I.~~~JUPLiull
iScJ.Lcj~~d by duing
,~~~.,.(':~t' t ,e
this ~chrUque:
'.:':. '.:/'.; ',:'):.;'
A. Pla~ bothJ~~d~_ behindthe neck, with elbows out Lothe side r ~;Ll'''('\\" . I '1, ~ Placeboth hanas behlnc.tthe-smaJl of th~ back ~L·c~\nl ~ 1 ~.>r. .. { !'1 i~. ~ j. hI ..(1••..• ~ 'C. Rnisethe arms to shoulder level with palms facing down ... '
",:..'.',,/:: .~",
D. Raise the arms \) \"'H'\ \ 'k--·~""L,d '.I , . to a vertical position above the head .. ~tYl '0 'A C.:t :","l,r1' "\)'V'.:w
::::;.~ median nerv~ , ~:.: L46/Test1(. porsull1 of the handfunction by ~hecking . sensation on the: ' ,,::')~}' ' ...B. Dorsa! web space of the thumbnlld index finger 'P\
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.
F
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C
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D. 'Pulp of the index finger
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47. To test extension of tile neck, ask the patient to perform th~ following maneuver: . '.Jv( Look up the cf':i1ing, ' '.' .' B, Tilt the head, touching each ear to the corresponding shoulder; 9'd€lk>e.\ ~'Jll)i.i C .. Touch the chin to the .chest. 'n..:.\~..) \1\
~
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· -:';,:' · ,:\((1.'
:· .;... :i~;, ..:'
Pulp of the
fifth finger'
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L
,,'.~, ..
D, Turn the head tocach side, looking directly over the shoulder. :
48, exceeos atlea~.. A. Agait 2 Inchesis wide-based when the heel to heetC.dist~nce 6 Inches,
.i(' 4 inches'
'I .!
'D, 8 inches
,:'j\~:':',; ~
49, Awareness that disturbed behaviors are normal or not is used to evaluate
:7.1\'.;:,
A. Insight D. Judgmcllt
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, ' .., ..,:.\'y....
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C. Orientation
.IJ Perception '.
cranial nerVe is .'tested by askingt.he. patiew· ' ~eventh ry 0 . C· N d 1\ Frown .. ~ . D, Sleep~.
:' :.,
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51. Muscle strength ~~aded 4 wheu the individual can move A. ...Against 0:) some ,J.:.. resislanc,e Against gravity gravity and '.',. ·c, A~ainst f~1I rc~.ist~nc~without evidence of fatib'Ue-E) \.'.. D, With gravity ehnuilaled . -(~)
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52~re.st adduction anhe hips by asking the patient'.to do this: .. 5.-.~~\tV' rC1IS-:: It, Brmg both legs together .' .. C. Raise the leg - iltw,.H \ .. B. P~shtheposteriorthjghdown..:-t:Z-\{.f~,t\jD. Spread both legs -~(~\}~\C1l0"1
53. The Romberg test is mainly a test of . J1.Ulction . C: Position sense ,-.J
',::',\'::.:' .' K Cerebellar
B. Hearing acuity
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·:·:7Y~~:; 'A ',:,~"i·.·
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D. Vestibular apparatlls .\ .," ~"
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54. Which r~t1~x .x: Ankle .' tests primarily .' th
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D, Babinski ....L~)J '1'\
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55. What level of consciousness is determined by shaking the patientgelltly as
. '»
l: .
/;J.\~<.~l /;1. : ii,qI0 ", ....
.
awakening n sleeper? .. Lethargy i}l,~' .••:rv~{}J; 1'1 : B. OblllllOll1 inn T:I\\ \'7~ ,\,1,' • r;.', •..
¢-' A.,
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,
,,~ I ' A:~:':\:~,:
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D, Plantar
.
bet .. i\ ' ' ••
C/56.
l~l4, \ i'
e· Stupor D, «lIllll "
'L
DoWs eye movements are ob~~~ed in response to . A. COl1leal reflex ' Oculocephalic reue D. Gaze preference . D, S.••• :nging Oashl:g::, 'te.s·
'.c.
if . ..
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