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exam of Diagnosis E. Superior rectus muscle-depression

5.A 48-year-old man presents with the
inability to move the right side of his mouth.
Part one: multiple choice (60’) On physical examination, the patient has
Directions: Each of the numbered items is difficulty raising his right eyebrow, puffing
followed by answers. Select the one lettered out his right cheek, and smiling using the right
answer that is best in each case. Then mark the side of his mouth. His nasolabial fold on the
corresponding letter on the Answer Sheet with right is absent. Blinking is sparse on the right
a single line through the centre. compared to the left, but extraocular muscles
1. A loud S1 (increased intensity) is heard in are intact and pupils are equal and reactive.
which of the following conditions? The patient’s tongue is midline. Which of the
A. Mitral stenosis(MS) following is the most likely diagnosis?
B. Mitral regurgitation (MR) A. Paralysis of cranial nerve V
C. Left bundle branch block(LBBB) B. Paralysis of cranial nerve VII
D. Aortic insufficiency(AI) C. Paralysis of cranial nerve XII
E. Tricuspid regurgitation(TR) D. Horner syndrome
A E. Pancoast tumor
2 . Which of the following diseases manefest B
pyrexia accompanying chills in common 6. The most likely cause of large amount
Except: proteinuria, casts and decreased SG(specific
A. lobar pneumonia; gravity) is:
B. septicemia; A. acute glomerulonephritis
C. acute cholecystitis; B. rapidly progressive glomerulonephritis
D. acute pyelonephritis; C. chronic glomerulonephritis
E. viral hepatitis. D. chronic pyelonephritis
E E. diabetic nephropathy
3 . Which is necessary for sinus rhythm in C
ECG: 7. If a patient has significant right-side lung
A. heart rate 60-100beats per minute disease, his of her preferred recumbent
B. erectile P wave in lead V1-V6 position would be which of the following?
C. inverse P wave in lead avR A. Right lateral decubitus position
D. duration of P wave <0.12s B. Left lateral decubitus position
E. P-R interval 0.12-0.20s C. Prone position
C D. Supine position
4. According to the cardinal positions of gaze, E. No preferred position
which of the following pairings of ocular B
muscles and actions is correct? 8. Which of the following is the most common
A. Inferior oblique muscle-abduction and site of spider angioma Except?
elevation A. face
B. Lateral rectus muscle-adduction B. neck
C. Medial rectus-abduction and depression C. dorsum of hands
D. Superior oblique muscle-adduction and D. anterior chest
E. abdomen. Except?
E A. chronic consumptive disease;
9. A man is stabbed and arrives to the B. gestated women;
emergency room within 30min. You notice C. older-aged weak person;
that the trachea is deviated away from the side D. patient with ascites after being drained off
of the chest with the puncture. The most likely excess fluid
lung finding on physical examination of the E. postcholecystectomy.
traumatized side is which of the following? E
A. Increased fremitus 14. Which of the following is true regarding
B. Incrersed breath sounds auscultation of breath sounds?
C. Dullness to percussion A. Vesicular breath sounds are high-pitched
D. Hyperresonant percussion sounds
E. Wheezing B. Bronchial breath sounds are normally
D heard over the trachea
10. Which of the following statements is true C. Bronchovesicular breath sounds are
regarding normal tracheal anatomy and normally heard over the lung periphery
structure? D. Bronchial breath sounds are low-pitched
A. The trachea is posterior to the esophagus sounds
B. The trachea is 4cm long E. Maximal intensity of the breath sounds is
C. The trachea is 4cm in diameter heard normally at the lung bases
D. The trachea divides into right and left B
main stem bronchi below the sternal 15. A Which of the following is the most
angle important first step in the diagnostic and
E. The trachea is to the right of the midline treatment process?
D A. A thorough history and physical
11. A 55-year-old man with emphysema will examination
have which kind of repiratory pattern of B. Blood work
breathing? C. Urinalysis
A. Biot respiration D. Electrocardiogram
B. Apneustic breathing E. Radiographic
C. Cheyne-Stokes respiration A
D. Rapid and shallow breathing 16. Which of the following statements is true
E. Kussmaul breathing regarding grading of heart murmurs?
D A. Grade 1 murmurs are never audible
12. Clubbing of the fingers is associated with B. Grade 2 murmurs are never audible
which of the following? C. Grade 3 murmurs are loud
A. Asthma D. Grade 4 murmurs are loud obvious
B. Emphysema murmurs with a palpable thrill
C. Bronchitis E. Grade 5 murmurs may be heard with the
D. Tuberculosis stethoscope completely off the chest
E. Cystic fibrosis D
E 17. Which of the following statements best
13. Which of the following is the common describes a precordial thrill?
cause of decreasement of abdominal rigidity A. It is a normal finding
B. It accompanies most heart murmurs palpation
C. It only exists during systole E. Inspection, percussion, palpation,
D. It is a palpable murmur auscultation
E. It is always a sign of congestive heart D
failure 22. Which of the following statements is true
D regarding the term “scaphoid” abdomen?
18. Which of the following is NOT the A. An unremarkable abdomen should be
characteristics of renal edema? called scaphoid
A. orthostatic edema B. It is a convex abdomen
B. pitting edema C. It is seen in patients who have ascites.
C. edema most pronounced in the morning D. It is absent in obese patients
D. proteinuria may be found E. It implies guarding
E. renal function may be normal D
A 23. Which of the following best describes the
19. Which of the following statement refers to location of McBurney’s point?
inspiratory dyspnea? A. In the midclavicular line just under the
A. Difficulty in the expiratory phase of right costal margin
breathing with prolonged expiratory time B. At the midpoint of a line connecting the
B. Three depression sign symphysis pubis and the anterior superior
C. Often associated with rhonchi iliac spine
D. Due to reduced alveolar elasticity and/or C. Midway along the right inguinal ligament
bronchiole obstruction D. One-third of the way along a line drawn
E. Cannot caused by airway obstruction in from the right anterior superior iliac
the larynx or large bronchi spine to the umbilicus
B E. One centimeter to the right of the
20. Which of the following is true regarding umbilicus
the second heart sound(S2)? D
A. It is best heard at the apex 24. Patients with tracheal tumour have:
B. It is louder than S1 at the apex A. Inspiratory dyspnea
C. It is normally made up of P2 followed by B. Expiratory dyspnea
A2 C. Mixed dyspnea
D. When split, it is always abnormal D. Toxic dyspnea
E. When it is split, the split may be E. Dyspneoneurosis
increased by inspiration A
E 25. In which situation we can’t find the
21.Which of the following is the proper weaken of the tactile fremitus and vocal
sequence for examination of the abdomen? resonance?
A. Auscultation, percussion, inspection, A emphysema
palpation B pulmonary consolidation
B. Auscultation, inspection, palpation, C pulmonary atelectasis
percussion D pleural effusion
C. Inspection,percussion, auscultation, E spontaneous pneumothorax
palpation B
D. Inspection, auscultation, percussion, 26. Which of the following statements is true
regarding palpation of the thyroid gland? following?
A. The left lobe of the thyroid is 25% larger A. Inspiratory dyspnea
than the right lobe B. Expiratory dyspnea
B. The consistency of the thyroid gland C. Mixed dyspnea
should be gritty and coarse D. Three depression sign
C. The patient should never be examined E. None of above
from the front B
D. The thyroid gland should remain 31. Massive hemoptysis means
immobile with swallowing A. Less than 100ml of blood lost in a 24
E. The patient should be positioned with the hour period
neck flexed slightly forward and laterally B. More than 100ml to 500ml of blood lost
toward the side being examined in a 24 hour period
E C. More than 100ml of blood lost in a 24
27. Patients with a left hypoglossal nerve hour period
palsy will have which of the following? D. More than 300-500ml of blood lost for
A. Deviation of the tongue to the left the whole episode
B. Deviation of the tongue to the right E. None of above
C. Loss of taste on the left D
D. Deviation of the jaw to the left 32. The color of hematochezia is major
E. Deviation of the jaw to the right determined by:
A A. bleeding volume
28. Which of the following stantements B. stagnation time of blood in gastrointestinal
regarding lymphadenopathy is true? tract
A. The harder the node, the more likely it is C. volume of stool in colon
to be benign D. with or without hematemesis
B. The more discrete the node , the more E. location of hemorrhage of gastrointestinal
likely it is to be benign tract
C. The more tender the node, the more E
likely it is to be inflammation 33. Which of following is the most typical
D. Lymph nodes may occasionally be image of cholelithiasis?
pulsatile A. The gallbladder with increased size and
E. A palpable left supraclavicular node is dilated biliary ducts..
often benign B. There is a echogenic movable mass in the
C gallbladder with posterior acoustic
29. Which of the following characteristics shadowing.
NOT refers to blood from the lower C. There are multiple ,fixed polyps found in
respiratory tract? the gallbladder wall.
A. Bright red
B. Foamy, runny
D. The gallbladder with an irregular outline

C. Mixed with mucus of a thickened wall.

D. Acidic pH E. None of above.
E. Persistent cough B
D 34. In which situations we can’t find the shift
30. Asthma is characterized by which of the of trachea?
A. massive pleural effusion E
B. pneumothorax 40. Ultrosonography can Not be used to
C. pulmonary atelectasis detect:
D. pulmonary consolidation A. Heart
E. thicken of pleural B. Abdomen
D C. Lung
35 Which one of the followings can indicate D. Aortic artery
the renal failure? E. Thyroid gland
A. Increase of GFR and BUN C
B. Increase of Ccr and Scr
C. Increase of Scr and BUN Part two: essay question (40’)
D. Increase of GFR and Scr Directions: In this part there are four
E. Increase of Ccr and BUN questions. You should answer them in a
C concise statement.
36 Which one of the followings is abnormal in 1. Please bring out the three signs of
urinalysis? meningeal irritation by nervous
A. RBC 0-2/HP examination?
B. WBC 0-4/HP 2. What will be revealed in patients with the
C. Cast (-) right side pleural effusion by lung
D. Protein (+) examination?
E. Glucose (-) 3. Please describe the signs of Mitral
D Stenosis.
37. What’s the dagnosis of ECG1? 4. How should you describe the abdominal
A. atrial flutter mass?
B. sinus tachycardia
C. paroxysmal supraventricular tachycardia
D. atrial fibrillation
E. paroxysmal ventricular tachycardia
38.What’s the dagnosis of ECG2?
A. Premature ventricular contraction
B. Premature atrial contraction
C. Left anterior fascicular block
D. Preexcitation syndrome
E. Premature junctional contraction
39.What’s the dagnosis of ECG3?
A. Normal sinus rhythem
B. Sinus Tachycardia
C. Paroxysmal supraventricular tachycardia
D. Atrial fibrillation ECG 1:

E. Paroxysmal ventricular tachycardia

ECG 2:

ECG 3: