Sample Of Exam Questions-1

exam of Diagnosis

Part one: multiple choice (60’) Directions: Each of the numbered items is followed by 5 answers. Select the one lettered answer that is best in each case. Then mark the corresponding letter on the Answer Sheet with a single line through the centre. 1. Which of the following is the most important first step in the diagnostic and treatment process? A. A thorough history and physical examination B. Blood work C. Urinalysis D. Electrocardiogram E. Radiographic imaging A 2. A 55-year-old man with emphysema will have which kind of respiratory pattern of breathing? A. Biot respiration B. Apneustic breathing C. Cheyne-Stokes respiration D. Rapid and shallow breathing E. Kussmaul breathing D 3. A loud S1 (increased intensity) is heard in which of the following conditions? A. Mitral stenosis (MS) B. Mitral regurgitation (MR) C. Left bundle branch block (LBBB) D. Aortic insufficiency (AL) E. Tricuspid regurgitation (TR) A 4. Which of the following statements is true regarding grading of heart murmurs? A. Grade 1 murmurs are never audible B. Grade 2 murmurs are never audible C. Grade 3 murmurs are loud D. Grade 4 murmurs are loud obvious murmurs with a palpable thrill E. Grade 5 murmurs may be heard with the stethoscope completely off the chest D 5. Which of the following is true regarding the second heart sound (S2)? A. It is best heard at the apex B. It is louder than S1 at the apex C. It is normally made up of P2 followed by A2 D. When split, it is always abnormal E. When it is split, the split may be increased by inspiration E

6. Which of the following is true regarding the third heart sound (S3)? A. It is a high-pitched sound B. It is a normal finding in the elderly C. It is heard in early systole D. It is associated with atrial dysfunction E. It is best heard at the apex of the heart E 7. Which of the following is the proper sequence for examination of the abdomen? A. Auscultation, percussion, inspection, palpation B. Auscultation, inspection, palpation, percussion C. Inspection, percussion, auscultation, palpation D. Inspection, auscultation, percussion, palpation E. Inspection, percussion, palpation, auscultation D 8. Patients with tracheal tumour have: A Inspiratory dyspnea B Expiratory dyspnea C Mixed dyspnea D Toxic dyspnea E Dyspneoneurosis A 9． What can be found in patients with pulmonary tuberculosis? A Low-grad fever B Moderate fever C Hyperpyrexia D Ultrahyperpyrexia E Normal temperature A 10 Which breath sound can be heard at the two sides of sternum in the first and second intercostal space, and at the level of the 3rd and 4th thoracic vertebrae of interscapular area? A Bronchovesicular breath sound B Pleural friction rub C Prolonged expiratory breath sound D Enhanced vesicular breath sound E Decreased vesicular breath sound A 11. Which of the following has a hyperresonance percussion sound, decreasing of low margin of lungs and has a reduced diaphragmatic movement? A A Obstructive emphysema B Left heart failure C Spontaneous pneumothorax D Pleural effusion

E Bronchial asthma 12. When respiratory center is inhibited, and the respiratory movement get slowly, we can found:A A Cheyne-Stokes respiratory or Biots repiratory B Nocturnal paroxysmal dyspnea C Kussmaul respiratory D Sigh respiratory E Blood disease 13. Which of the following signs we can’t find in patients with massive pleural effusion? A full of thorax on trouble side B weakens or disappears of the chest expansion on trouble side C trachea in the middle D weakens or disappears of the tactile fremitus E flatness in percussion C 14. The occurrence of abnormal percussion sound means: A left heart failure B emphysema C pulmonary consolidation D pathological changes with lungs, pleura, diaphragm or chest wall E massive pleural effusion in right side D 15. In which situations we can’t find the shift of trachea? A massive pleural effusion B pneumothorax C pulmonary atelectasis D pulmonary consolidation E thicken of pleural D 16. We can find the increase of the tactile fremitus in patient with: A Emphysema B Right heart failure C Cirrhosis ascites D Pleura effusion E Consolidation stage of lobar pneumonia E 17. Which one is not the common cause of decreasement of abdominal guarding? A. chronic consumptive disease; B. gestated women; C. older-aged weak person; D. profound extraction of ascite; E. postcholecystectomy. E 18. Which one is wrong about abdominal tenderness?

A. The tenderness point of acute appendicitis is located on lateral one-third of the line between umbilicus and anterior superior iliac spine. B. The tenderness of acute pancreatitis is most prominent on median part of epigastrium. C. The tenderness point of acute appendicitis is usually located on epigastrium in early stage and metastasis to right lower quadrant later. D. Tenderness of left lumbar region can be seen in acute pancreatitis. E. Sometimes tenderness of epigastrium can be found in thoracic diseases for example pleuritis. B 19. Which one is wrong about the texture of liver on palpation? A. Usually the texture of liver is divided into soft and hard; B. In cirrhotic patient the liver usually harder than that in chronic hepatitis on palpation; C. The texture of liver in hepatic carcinoma is harder than that in hepatic cirrhosis; D. Fluctuation sometimes can be found in the patient with hepatic abscess or liquefaction of hepatic cyst; E. Fluctuation sometimes can be felt in the patient with large and superficial hepatic cyst. A 20. A 28-year old man occured abrupt abdominal pain on below the xiphoid process after having meal with his friends and the pain turned to right lower quadrant several hours later. Physical examination: T 38℃, significant tenderness on epigastrium, abdominal rigidity, disappearance of relative hepatic dullness, decreasement of borborgmi. The most possible diagnosis is: A. perforation of acute cholecystitis; B. perforation of acute appendicitis; C. perforation of peptic ulcer; D. acute pancreatitis; E. acute dilatation of somach. C 21. Which one is the most valuable item for the diagnosis of urine retention? A. mass located in the median of hypogastrium; B. mass with cystic texture; C. mass with tenderness or feeling of discomfort; D. mass with dullness on percussion; E. mass located in the median of hypogastrium disappeared after catheterization of urine. E 22. Which type of signs will be surely not standing for acute pancreatitis? A. disappearance of abdominal respiration; B. rigidity of abdominal muscle; C. abdominal bulge; D. intestinal pattern; E. tenderness and rebound tenderness. D 23. Beside which part is the most common sites of spider angioma? A. face;

B. C. D. E.

neck; dorsum of hands; anterior chest; abdomen.

E 24. A large mass was found on left epigastrium in one patient when given physical examination. Which one would be most valuable when diagnosed splenomegaly? A. superficially located mass; B. upward and downward movement of mass with respiration; C. smooth surface; D. incisure notch palpated on right side of mass; E. large width of movement. D 25. In which kind of disease is pyrexia accompanying chills most uncommon seen? A. lobar pneumonia; B. septicemia; C. acute cholecystitis; D. acute pyelonephritis; E. viral hepatitis. E 26. Which one is wrong about the mechanisms causing abdominal pain? A. spasm or tension of empty cavity viscus; B. cutting or puncturing of abdominal wall; C. inflammation of parietal peritoneum; D. stretch of capsule of parenchymal organs. E. Vascular spasm of visceral organs. B 27. The temperature is above 39℃, wide range, temperature difference is above 2℃ in one day, the lower body temperature is also above normal. The fever type of it is: A. continus fever; B. remittent fever; C. intermittent fever; D. recurrent fever; E. undulant fever; B 28. From the view point of pathogenesis; vomiting caused by different gastrointestinal diseases attributes to: A. neurosal vomiting, B.central vomiting; C.dysfunction of vestibule; D.reflex vomiting; E.spurting vomiting. D 29. The vomitus will be, when examining a patient with haematemesis?

A. neutral; B.acidosis; C.alkalosis; D.usually acidosis, but sometimes alkalosis; E. acidosis or alkalosis related to the retented duration in the stomach. B 30. The color of hematochezia is major determined by: A. bleeding volume; B. stagnation time of blood in gastrointestinal tract; C. volume of stool in colon; D. with or without hematemesis; E. location of hemorrhage of gastrointestinal tract. E 31. The cause of cardiogenic edema is mainly because: A. hypoalbuminemia; B. increased permeability of capillary; C. obstruction of lymph circulation; D. dysfunction of left heart; E. dysfunction of right heart. E 32. The body temperature is higher in the afternoon than that in the morning in normal person, but the difference is less than: A. 0.3℃ B. 0.5℃ C. 1℃ D. 1.5℃ E . 2℃ C 33. Beside which one in the following diseases are all the most common causes of hemorrhage of upper gastrointestinal tract: A. peptic ulcer; B. acute erosive gastritis; C. rupture of varices of esophagofundal veins; D. gastric carcinoma; E. chronic gastrititis. E 34. How much blood at least is lost when melena is appeared in hemorrhage of upper gastrointestinal tract in general ? A . 5 ml B . 50 ml C . 75 ml D . 100 ml E . 250 ml B

35. The characteristic of obstruction of biliary ascariasis: A. drilling pain on the region below the xiphoid process or right upper quadrant; B. shock-like pain below the xiphoid process; C. knife-like pain on middle epigastrium; D. girdle-like pain on epigastrium; E. colicky pain on right upper quadrant and radiated to right thigh. A 36. How much blood at least is lost when positive result is seen in stool occult test in hemorrhage of upper gastrointestinal tract in general ? A. 5 ml B. 50 ml C.75 ml D.100 ml E. 150 ml A 37．Which one of the followings is abnormal in urinalysis? A RBC 0-2/HP B WBC 0-4/HP C Cast (-) D Protein (+) E Glucose (-) D 38. The most likely cause of large amount proteinuria, casts and decreased specific gravity is: A. acute glomerulonephritis B. rapidly progressive glomerulonephritis C. chronic glomerulonephritis D. chronic pyelonephritis E. diabetic nephropathy D 39. Ultrosonography can Not be used to detect: A. Heart B. Abdomen C. Lung D. Aortic artery E. Thyroid gland C 40.What’s the dagnosis of ECG1? A. Premature ventricular contraction B. Premature atrial contraction C. Left anterior fascicular block D. Preexcitation syndrome E. Premature junctional contraction B ECG 1：

Part two: essay question (40’)

Directions: In this part there are four questions. You should answer them in a concise statement. 1．Please show the basic contents that compose a medical interview. Answer: A. Introduction 1’ B. Chief complaint 1’ C. History of the present illness 2’ D. Past medical history 1’ E. Review of systems 1’ F. Personal history 1’ G. Marriage history 1’ H. Family history 1’ I. Closure 1’ 2. Please describe the sequence and content of heart auscultation. Answer: Sequence: Pulmonic area→Aortic area→2nd Aortic area→Mitral area→Tricuspid area, OR Mitral area→Pulmonic area→Aortic area→2nd Aortic area→Tricuspid area. (5’/ contents and sequence, depending on the condition) Content: heart rate, rhythm, heart sound, murmur and friction rub. (1’/1 item) 3．How should you describe the abdominal mass?

Note their location (2’), size (1’), shape(1’), texture(1’), mobility(1’), tenderness(1’), pulsate(1’), hepatojugular reflux sign(1’), friction rub(1’). 4. What will be revealed in patients with the right side pleural effusion by lung examination? Inspection: decreased breathing motion and depth (affected side) (2’) Palpation: decreased breathing motion, decreased tactile fremitus (affected side) (2’); contralateral shift of the trachea(2’) and bulging of the intercostal spaces Percussion: dullness to percussion (affected side) (2’) Auscultation: diminution of breath sounds over the effusion; (A pleural friction rub indicates pleuritis.) (2’)