THIRD THEORETICAL EVALUATION

Histology: Respiratory and Cardiovascular

Gross: Intro to Gross, Back, Thorax, Pleura, Lungs, Heart and Mediastinum
1.

2.

3.

4.

5.

6.

7.

Alveoli and alveolar sacs can arise directly from:

a. Lobular bronchiole
c. Respiratory bronchioles
b. Terminal bronchiole
d. None of the above

8.

Olfactory cilia are modifications on the surface of which cell in

olfactory epithelium?
a. Granule cell
b. Olfactory cell
c. Sustentacular cell
d. Basal cell
TRUE of the dust cells in the lung alveoli:
a. They use the alveolar pores as migration routes.
b. They are macrophages.
c. They differentiate from monocytes.
d. All of the above

TRUE of bronchioles:
a. Hyaline cartilage form part of the wall of big bronchioles.
b. Lymph nodules may be present in their wall.
c. In small bronchioles, the lining epithelium contains Clara
cells.
d. All of the above.

9.

The following structures form part of the blood-air barrier in the

lungs, EXCEPT:
a. Type II alveolar cells
b. Type I alveolar cells I
c. Endothelial cells of the pulmonary capillaries
d. Basal lamina of the endothelium of the pulmonary
capillaries

10. Laryngeal cartilage/s that is/are elastic:

a. Epiglottic
c. Arytenoid
b. Cricoid
d. a & c above

In the lungs, venous blood circulate in the branches and/or

tributaries of the:
a. Pulmonary artery
b. Pulmonary vein
c. Bronchial artery
d. a & c above
Cell in respiratory epithelium that is a neuroendocrine cell:
a. Granule cell
c. Goblet cell
b. Serous cell
d. Ciliated columnar cell
Lined by respiratory epithelium, EXCEPT:
a. Paranasal sinuses
b. Laryngopharynx

c. Main bronchus
d. Trachea

Clara cells, which are cuboidal cells that secrete surface active
lipoproteins that reduce surface tension, form part of the epithelial
lining of:
a. Terminal bronchi
c. Respiratory bronchioles
b. Terminal bronchioles
d. b & c above

11. Cells in the interalveolar septa that secrete pulmonary surfactant:

a. Type I alveolar cells
c. Clara cells
b. Type II alveolar cells
d. b & c above
12. Segment of the bronchial tree that supplies a bronchopulmonary
segment:
a. Lobular bronchiole
c. Terminal bronchiole
b. Tertiary bronchus
d. Respiratory bronchiole
13. TRUE of the capillaries in the interalveolar septa of the lungs:
a. They arise from the terminal branches of the pulmonary
artery.
b. They are continuous capillaries.
c. They drain into the initial tributaries of the pulmonary
veins.
d. All of the above
14. Which is lined on its free surface by mesothelium?
a. Parietal pleura
c. Visceral pericardium
b. Parietal pericardium
d. All of the above

15. TRUE of the trachea:

a. It is lined by respiratory epithelium. Incorrect
b. Smooth muscle fibers and fibroelastic ligament bridge the
open ends of its C-shaped cartilages.
c. Its glands (i.e., tracheal glands) are embedded in the
submucosa.
d. All of the above

a.
b.
c.
d.

16. TRUE of pericytes:

a. They are contractile cells.
b. They are not present in lymph capillaries
c. Both
d. Neither
17. TRUE of lymphatic capillaries:
a. They start as blind tubes.
b. They are not present in the central nervous system.
c. Like blood capillaries, they have associated pericytes.
d. A and B above.
18. TRUE of a portal vessel:
a. It can be an artery that is interposed between two sets of
capillaries.
b. It can be a vein that is interposed between two sets of
capillaries.
c. It is a blood vessel that connects a small artery directly to
a small vein.
d. A & B above

They are bigger and paler-staining than the typical cardiac

muscle cells.
Those that make up the SA node are bigger than those in
the other components of the impulse conducting system of
the heart.
Their cell-to-cell attachments are similar to those present
in the intercalated discs.
A & C above

21. TRUE of the right lymphatic duct:

a. It is shorter and smaller than the thoracic duct.
b. It collects lymph from all tissues that are on the right side
of the body and above the diaphragm.
c. It empties its lymph into the venous system at the junction
of the left jugular and subclavian veins.
d. A & B above.
22. Parts of the cardiac skeleton that are in between the AV and
semilunar orifices?
a. Septum membranaceum
c. Trigona fibrosa
b. Annuli fibrosi
d. None of the above
23. The pericardial cavity is the space between the:
a. Parietal pericardium and epicardium c. Fibrous and visceral
pericardia
b. Fibrous and parietal pericardia
d. None of the above
24. The thickest histologic layer of large veins:
a. Tunica adventitia b. Tunica serosa
d. Tunica intima

c. Tunica media

19. In which blood vessels is the tunica media (of their initial segment)
made up of an inner layer of circularly arranged smooth muscle
fibers and an outer layer that is made up of elastic lamellae?
a. Arteries such as the celiac artery that represent sudden
transition from elastic to muscular types.
b. Coronary arteries.
c. Arteries such as the axillary and common iliac that
represent gradual transition from elastic to muscular types.
d. Arteries within the skull.

25. TRUE of aortic bodies:

a. They are embedded in the tunica media of the common
carotid arteries.
b. Their
sensory
innervation
comes
from
the
glossopharyngeal nerve (CN IX)
c. They are made up of glomus and sheath cells that are
embedded in a connective tissue stroma.
d. All of the above

20. TRUE of the Purkinje fibers in the heart:

26. TRUE of endothelial cells:

a.
b.
c.
d.

They line the luminal surface of the heart and blood

vessels but not of the lymph vessels.
Those in arteries store von Willebrand factor.
They are not capable of mitosis.
All of the above

27. TRUE of fenestrated capillaries:

a. Their wall have no associated pericytes. Incorrect
b. The cytoplasm of their endothelial cells are pierced by
pores.
c. They are found in muscle tissue, central nervous system
and skin.
d. b & c above
28. Compared to the arteries that they accompany, veins have:
a. Bigger calibers
b. Thicker walls
c. More smooth muscle cells in their walls
d. All of the above
29. The internal elastic lamina that is present in bigger arteries is part
of which histologic layer?
a. Tunica intima
c. Tunica adventitia
b. Tunica media
d. None of the above
30. TRUE of the endocardium.
a. Its luminal lining consists of an endothelium.
b. It is mainly made up of connective tissue.
c. It is the histologic layer where the AV node is embedded.
d. A & B above
31. Student XR is studying all the anatomical structures from the
shoulder joint up to the tip of the fingers. Which anatomical
approach is being applied by the student?
a. Regional
c. Clinical and Systemic
b. Regional and Clinical
d. Systemic and Regional
32. Which of the following best describe the patient in the image?

a.

b.
c.
d.

Both
are

shoulders
adducted,
elbows are
flexed, wrist
and
fingers
are
extended, hips are adducted, knees are flexed, feet are
plantarflexed
Both shoulders are abducted, elbows and wrist are
extended, fingers are flexed, hips are adducted, knees are
flexed, feet are dorsiflexed
Both shoulders are adducted elbows, wrist, fingers are
flexed, hips are adducted, knees are extended, feet are
plantarflexed
Both shoulders are flexed, elbow, writs and fingers are
flexed, hips are flexed, knees are extended, feet are
dorsiflexed

33. The Z axis is utilized by what plane?

a. Horizontal
b. Transverse

c. Sagittal
d. Coronal

34. Wrist flexion and extension occurs on what plane and axis?
a. Horizontal plane and X-axis c. Sagittal plane and Y-axis
b. Sagittal plane and X-axis d. Horizontal plane and Y-axis
35. Forearm supination occurs on what plane and axis?
a. Frontal Plane and Y-Axis c. Transverse Plane and Y-Axis
b. Horizontal Plane and Z-Axis d. Sagittal Plane and X-Axis
36. The X-Y Plane produces what movements?
a. Internal-External Rotation
c. Circumductiion
b. Abduction-Adduction
d. Flexion-Extension
37. A structure located outside the body is termed as:
a. Intermediate
c. External
b. Superficial
d. Internal
38. When doing elbow flexion, the elbow flexors are performing what
kind of contraction?
a. Concentric
b. Isometric
c. Eccentric

39. This term is used to describe structures found in front of the

Coronal Plane?
a. Ventral or Cephalad
c. Anterior or Ventral
b. Ventral or Posterior
d. Anterior or Caudal
40. Foot eversion and inversion occurs on what plane and axis?
a. Horizontal plane and Z-axis c. Frontal plane and Y-axis
b. Sagittal plane and X-axis d. Transverse plane and Y-axis
41. Which of the following best fits the Anatomical Position?
a. Standing erect with hands at the sides and feet widely
apart
b. The neck is slightly flexed
c. Hands are fully extended, head is facing in front
d. The palmar and plantar surface are located anteriorly
42. This image is created by what plane?

a.
b.

Frontal
Sagittal

43. Which of the following is the innermost layer?

a.

Endoc
ardiu
m
c.

b.

Epicardium
Fibrous Pericardium

d. Myocardium

44. Biceps Brachii muscle can flex the elbow so as the Brachialis and
Brachioradialis muscles. On the other hand, Triceps Brachii is the
main extensor of the elbow. Moreover, Biceps Brachii can supinate
the forearm together with the Supinator Muscle. When the forearm
is in full pronation, only the Brachialis muscle can flex the elbow.
Which of the following statement is correct?
a. Biceps Brachii is the Antagonist in elbow flexion when the
forearm is in full pronation.
b. Brachialis is the main agonist in elbow flexion.
c. Biceps Brachii is the main agonist in elbow flexion.
Incorrect
d. Biceps Brachii and Triceps Brachii act in Synergy in
moving the elbow.
c. Coronal
d. Horizontal

45. Soft tissue connecting to adjacent bones is called:

a. Muscle
c. Cartilage
b. Ligaments
d. Tendon
46. Bending your hips forward occurs on what plane and axis?
a. Horizontal Plane and Y Axis c. Sagittal Plane and X-Axis
b. Sagittal Plane and Y-Axis d. Frontal Plane and X-Axis
47. Anatomical structures located below the horizontal plane is termed:
a. Superior or Cephalad
c. Superior or Caudal
b. Inferior or Cephalad
d. Inferior or Caudal

53. What structure is being pointed on by the black arrow?

48. The joint between the rib and the sternum is classified as:
a. Fibrous and Diarthrosis c. Cartilaginous &Synchondrosis
b. Synovial and Synchondrosis d. Cartilaginous and Synarthrosis
49. A muscle located in the deepest layer will usually bear the
word________?
a. Profundus
b. Superficialis
c.Minimi
d.
Intermedius
50. Which of the following statement is correct:
a. All cartilaginous joints are immobile
b. All synovial joints are capsulated
c. All cartilaginous joints are capsulated Incorrect
d. All cartilaginous joints are highly movable
51. Which muscle is pointed on the black arrow?

a.
b.

Supraspinous fossa
Coracoid process

c. Glenoid fossa
d. Acromion process

54. During palpation of the lower spinal segments, the imaginary line
which transects the spine at L4 level and is on top of the ilium is
called the:
a. Intercostal line
c. Inter-iliac crest line
b. Interlumbar line
d. Intercervical line
55. In the lumbar region of the back, some of the blood is supplied by
this/these branches:
a. Subcostal arteries
c. Lateral sacral arteries
b. Posterior intercostals arteries d. Internal iliac arteries

a.
b.

Rhomboid minor
Trapezius

c. Latissimus dorsi
d. Rhomboid major

52. Which muscle is pointed on the black arrow?

a.

57. From outside to inside, during a midline spinal needle insertion

while doing a spinal tap, the first ligament to be encountered is the:
a. Subcutaneous fats
c. Ligamentum flavum
b. Interspinous ligament
d. Supraspinous ligament
Rhomboid

minor
c.
b.

Trapezius
Latissimus dorsi

56. The odontoid procces is the structure found in the:

a. 7th cervicsl vertebrae
c. Atlas
b. Axis
d. 12th thoracic vertebrae

d. Rhomboid major

58. The major supporting ligament/s supporting the back include the
following:
a. Anterior longitudinal ligament
b. Posterior longitudinal ligament
c. Ligamentum nuchae
d. All of the choices are correct
e. A and B only

59. In the thoracic region, which is MOST responsible for limiting

vertebral rotation?
a. Intervertebral discs
d. Rib cage
b. Zygapophyseal joints
e. Spinous processes
c. Transverse processes
60. The term for the pathologic condition in which the neural arch does
not close posteriorly is?
a. Uncus
d. Hangmans fracture
b. Sacral hiatus
e. Spina bifida
c. Kyphosis
61. Another term for the primary spinal nerve is?
a. Kyphosis/kyphotic
c. Idiophatic
b. Scoliosis
d. Lordosis/lordotic
62. When the inner _____ ruptures through the outer layer, a herniated
intervertebral disc is said to have occurred:
a. Annulus fibrosis
c. Nucleus pulposus
b. Mucosa
d. Serosa
63. Which of the following best describes the thoracolumbar fascia?
a. Encloses the trapezius, rhomboids, and serratus anterior
muscles. Incorrect
b. It is also known as lumbo-ventral fascia.
c. It is defined as a single layer of fascia that covers the
intrinsic back muscles superficially.
d. Encloses all the intrinsic back muscles.
64. Which muscle group is innvervated by branches of the ventral
rami?
a. Splenius
c. Transversospinalis
b. Erector spinae
d. Trapezius
65. Which of these Transversospinalis muscles group spans the
shortest distance?
a. Semispinalis
d. Multifidus
b. Spinalis
e. Rotatores
c. Splenius

66. Which region(s) of the vertebral column retain(s) the primary spinal
curve(s) into adulthood?
a. Thoracic and Sacral
d. Thoracic
b. Sacral
e. Lumbar
c. Cervical
f.
Cervical
and Lumbar
67. In a hyperextension injury such as whiplash, which ligament is
most likely to be injured?
a. Supraspinous ligament
d. Alar ligament
b. Posterior longitudinal ligament e. Anterior longitudinal
ligament
c. Ligamentum flavum
68. Which is NOT part of the posterior element of a vertebra?
a. Lamina
d. Vertebral body
b. Pedicle
e. Transverse process
c. Spinous process
69. Which vertebral body/bodies will Rib 4 articulate with?
a. T3 and T4
c. T4 and T5
b. T3 only
d. T4 only
70. Which two vertebrae does not have an intervertebral disc inbetween?
a. T11 T12
d. C7 T1
b. L5 S1
e. T12 L1
c. C1 C2
71. In the hilum of the lung, the bronchus is usually situated ______ to
the vessels.
a. Posterior
c. Superior
b. Inferior
d. Anterior
72. The 7th thoracic spinal nerve maybe assessed by examining the
dermatome it supplies. This may be found at which of the following
areas?
a. Level of the nipple
c. Level of the xiphoid
b. Level of the umbilicus
d. Level of the sterna angle

73. The trachea begins at the level of which of the following cervical
vertebra?
a. C6
c. C7
b. C5
d. C4
74. The xiphisternal joint lies in the same horizontal plane of which of
the following vertebral bodies?
a. T8
c. T10
b. T7
d. T9
75. At mid-clavicular line the pleura is reflected at the level of the:
a. 8th rib
b. 10th rib
c. 4th rib
6th rib

d.

76. The esohageal opening of the diaphragm is found at the same

horizontal plane as the vetebral body of:
a. T10
b. T12
c. T8
d. T6
77. Aspiration pneumonias are usually seen affecting the right lung
because:
a. The right bronchus has a more vertical orientation.
b. The left bronchus is longer than the right.
c. The right lung has a larger volume. Incorrect
d. The left bronchus has a smaller diameter.
78. The costal groove of a typical rib is found in which of the following
borders?
a. Anterior
c. Superior
b. Inferior
d. Posterior
79. Incisions made through the intercostal space are kept close to the
upper border of the ribs to avoid damage to which of the following
structures?
a. Diaphragm
c. Pleura
b. Lungs
d. Neurovascular structures
80. The aortic opening of the diaphragm is found at the same horizontal
plane as the vertebral body of:

a.

T 12
T6

b. T 8
d. T 10

c.

81. The visceral pleura is sensitive to which of the following

sensations?
a. Stretch
b. Touch c. Temperature
d. Pain
82. The caval opening of the diaphragm is found at the horizontal plane
as the vertebral body of:
a. T6
b. T8
c. T10
d. T12
83. The vascular structure that descends one fingerbreadth lateral from
the lateral margin of the sternum is the:
a. Superior epigastric vessels c. Internal thoracic vessels
b. Posterior intercostal vessels d. Anterior intercostal vessels
84. At mid-inspiration, the lower border of the lung at the mid-axillary
line may be found at the level of which of the following structures?
a. 4th rib
b. 8th rib
c. 6th rib
d. 10th rib
85. At the mid-axillary line, the neurovascular bundle can be found in
which of the following planes of dissection?
a. Between the parietal pleura & internal intercostal
membrane
b. Between the external intercostal membrane & internal
intercostal muscles
c. Between the external intercostals & internal intercostal
muscles
d. Between the internal intercostals & innermost intercostal
muscles
86. At mid-inspiration, the lower border of the lung at the mid-clavicular
line may be found at the level of which of the following structures?
a. 10th rib
b. 6th rib
c. 8th rib
d. 4th rib
87. Which of the following statements describe the bronchopulmonary
segment?

a.
b.
c.
d.

It is a subdivision of a lung.
Each segment is drained independently by a segmental
vein.
Each segment shares adjacent segmental bronchi.
It is pyramidal in shape.

88. Ribs are classified as True, False or Floating depending on their

relationship with which of the following structures?
a. Sternum
c. Cartilage
b. Muscle
d. Vertebral body
89. The suprasternal notch lies in the same horizontal plane of which of
which of the following vertebral bodies?
a. T 2
b. T 3
c. T 4
d. T 1
90. The sterna angle lies in the same horizontal plane of which of the
following intervertebral discs?
a. T 4 T 5
c. T 3 T 4
b. T 1 T 2
d. T 2 T 3
91. A stethoscope placed over the right second intercostal space just
lateral to the sternum would be best positioned to detect sounds
associated with which heart valve?
a. Mitral
b. Pulmonic
c.
Tricuspid
d. Aortic
92. If your patient has an enlarged heart and the aorta is big on chest
x-ray, which of the following chambers of the heart will most likely
be enlarged?
a. Right Ventricle
c. Left Ventricle
b. Left Atrium
d. Right Atrium
93. A 30-year-old female is brought into the emergency room after
having been involved in an automobile accident. After examination,
you concluded that the most likely immediate danger is cardiac
tamponade. You prepare to draw off some of the blood from the sac
to relieve the pressure on the heart. The safest site at which to
insert the needle of the syringe in order to miss the pleura would
be:
a. Right of the sternal angle
b. Through the jugular notch

c.
d.

Left of the sternal angle

Just to the left of the xiphisternal junction

94. While attempting to suture the distal end of a coronary bypass onto
the anterior descending artery, the cardiothoracic surgeon
accidentally passed the needle through the adjacent vein. Which
cardiac vein was most likely damaged?
a. Middle
b. Anterior
c. Small
d. Great
95. During cardiothoracic surgery, ligatures can be passed into the
_______ sinus and around the _______ and ______ to control
hemorrhage.
a. Oblique, aorta, pulmonary trunk
b. Oblique, aorta, superior vena cava
c. Transverse, aorta, superior vena cava
d. Transverse, aorta, pulmonary trunk
96. Characteristics of the Trachea, EXCEPT:
a. Starts at the level of the 6th vertebrae
b. Descends posteriorly to the esophagus
c. Bifurcates into left and right main bronchus Incorrect
d. Ends at the level of the sternal angle
97. You are watching a surgeon remove a Thymoma on a 20 year old
patient. The surgeon points out an important plane used to divide
the superior and inferior mediastinum. You identify this plane as
the:
a. Inferior Thoracic
c. Glandular Plane
b. Superior Thoracic
d. Transverse Thoracic
98. All of the following are areas of Esophageal constrictions, EXCEPT:
a. Where it is crossed by aortic arch c. Where it is crossed by left
bronchus
b. Beginning of cervical part
d. At the aortic hiatus
99. Blockage of which of the following arteries of the heart would lead
to ischemia of the apex of the heart?
a. Left circumflex
c. Anterior interventricular
b. Posterior interventricular
d. Right marginal

100.Irritation of the Phrenic nerve may cause referred pain to the tip of
the left shoulder blade. This is often a symptom of a ________.
a. Teratoma
c. Cholecystitis
b. Ruptured Spleen
d. Thymoma

107.This is a potential space in the mediastinum where abnormal

enlargement of lymph nodes can be seen on a chest x-ray.
a. Oblique pericardial sinus c. Transverse pericardial sinus
b. Para-tracheal stripe
d. Aorto-pulmonary window

101.While listening to a patients heart sounds with a stethoscope, you

identify a clearly audible murmur in the 5th intercostal space just
to the left of the lower part of the sternum. You know it must be
associated with severe stenosis of which heart valve?
a. Mitral
b. Tricuspid
c.
Pulmonic
d. Aortic

108.A 19-year-old teenager is found to have a non-invasive Thymoma

that is impinging posteriorly on a blood vessel. The affected
vessel is most likely the:
a. Left brachiocephalic vein
c. Left pulmonary vein
b. Right pulmonary artery
d. Right subclavian artery

102.The descending
compartment?
a. a. Middle
Posterior

aorta

is

located

in

b. Superior
d. Anterior

which

mediastinal
c.

103.As the Vagus nerve descend through the neck and mediastinum,
they give off a recurrent laryngeal branch. On the right side, which
structure does this branch loop around?
a. Carotid artery
c. Subclavian artery
b. Ligamentum arteriosum
d.
Brachiocephalic
trunk
104.A patient involved in an automobile accident presents with a sharp
object puncture at the level of the 4th costal cartilage just to the
right of the sternum. If the object also penetrated the pericardium
and the heart wall, which heart chamber would most likely be
damaged?
a. Left ventricle
c. Right ventricle
b. Right atrium
d. Left atrium
105.A Neurofibroma of the posterior mediastinum is most likely to
compress which of the following structures?
a. Inferior vena cava
c. Esophagus
b. Superior vena cava
d. Trachea
106.Which valves would be open during ventricular diastole?
a. Mitral and Aortic
c. Mitral and Tricuspid
b. Aortic and Pulmonary
d. Tricuspid and Pulmonary

109.If your patient has an enlarged heart and the main pulmonary
artery is big on chest x-ray, which of the following chambers of the
heart will most likely be enlarged?
a. Right Ventricle
c. Left Ventricle
b. Left Atrium
d. Right Atrium
110. You are watching a surgical closure of Ductus Arteriosus in the
operating room. The surgeon points out an important structure
lateral to the duct. You identify the structure as the:
a. Thoracic duct
c. Sympathetic trunk
b. Left recurrent laryngeal nerve
d. Left phrenic nerve
111. This is a case of B.U. who died due to motorcycle vehicular
accident. History from bystanders reveals: Patient had not seen a
tow at the middle of the road middle of the night while driving fast.
A truck was being towed by a neck-height steal cable when
patients motorcycle happened at that time and accidentally,
snagged his neck. In the emergency room, patients helmet was
removed carefully and subjected his head and neck to serial
radiographs & imagings. But, patient start deteriorating and
inadvertently, led to patients demise while having cervical (neck)
x-rays & MRI. Imaging reveals a fractured dens (as shown below).
Categorize patients fracture based on Anderson-DAlonzos
Classification:

denotes Cardiac Tamponade. Which anatomical structure is most

likely punctured that incurs tamponade?

a.

Type 3

b. Type 1
d. Undefined

c. Type 2

112. The pulmonic valve is more likely to be found at which level?

a.

Point A

b. Point B
d. Point D

c.

Point

113. This is a case of R.K. a 51 year-old male who was rushed in the
emergency room due to mauling & stabbed wound. Impaled
object is found on the 3rd intercostal space 1.5cm away from the
left parasternal border (as presented below). Patient moans,
responds to pain & with noticeable eye movements when asked.
Upon fast-paced physical examination, remarkable findings reveal
(+) engorged neck veins, (+) distant & muffled heart sounds & (+)
lowering arterial blood pressure. Chest X-ray reveals (+) Situs
Inversus (+) Dextrocardia (+) Normal aeration of both lungs but
(+) Water-bottle Sign of the heart silhouette. Double intravenous
line were administered & prepares the patient for emergency
surgery due to accumulating blood inside pericardial sac which

a.
b.

Mittral Valve
Arch of the Aorta

c. Left Ventricle
d. Right Atriums right auricle

114. This is a case of Y.T., a 49 year-old female who was rushed in the
hospital due to fainting. Imperial & non-specific management &
treatment were given to the patient. Upon fast-paced complete
physical examination, remarkable findings were noted: (+) severe
pitting edema (swelling) extending to the abdomen (+) abdominal
swelling & (+) neck vein engorgement with (+) visible & strong
neck vein pulsations. After 25 minutes, patient becomes awake &
coherent. During history taking, she claims having (+) episodes of
general weakness [body malaise]; (+) unexplained fatigue & (+)
irregular episodes of palpitations since she decided to stop
Phentermine-Fenfluramine (a banned miraculous diet pills) at age
28. Repeated Vital Signs revealed normal except for irregular
heart beat recordings with irregularities on patients cardiac
rhythm. A remarkable diastolic murmurs (abnormal heart sounds)
were heard loudest on the pointed ICS (as shown below). What
would be your initial working diagnosis?

a.

Aortic Valve Regurgitation

Valve Prolapse

c.

Mitral

b.

Pulmonic Valve Stenosis

Valve Insufficiency

d.

Tricuspid
a.

115. What is your initial impression?

b.

Sprengels
Deformity
c.
Cleidocranial
Dystosis
WallisGoldblatt-Zieff Syndrome d. (+) Higoumenakis Sign