FORBIDDEN NOTES JUTSU

HEENT – NOTES 7. Fixed defects (scotomas) suggests defects in the:

 lens
1. All but one is associated with aging:  extraocular muscles
 Pinguecula  cornea
 Cataract  visual pathway
 Xanthelasma
 Ectropion 8. The following causes of eye pain is an ocular emergency requiring immediate
intervention:
2. You are examining a 20-year-old complaining of a “lump” in her neck. Which  astigmatism
of the following characteristic is indicative of an abnormal node?  acute angle-closure glaucoma
 non-tender  allergic conjunctivitis
 2 cm size  thyrotoxicosis
 mobile
 fleshy consistency 9. Lid lag is demonstrated by the following:
 when both lids close slowly and incompletely with jerky movements
3. There is poor convergence in:  the converging eyes follow the object to within 5-8cm of the nose
 diabetes mellitus  when a rim of sclera appears between the upper lid margin and the iris
 hyperthyroidism when the patient lowers his eyes
 hypertension  the pupils constrict when a person shifts gaze from a far object to a near
 hypothyroidism one

4. Absence of red-orange reflex suggests: 10. When examining the nasal cavity, which structure should you avoid touching
 hyperthyroidism with nasal otoscope speculum?
 a normal eye  ala nasia
 an opacity of the lens  lateral nasal wall
 papilledema  vestibule
 nasal septum
5. The external auditory canal is often swollen, narrowed, moist, pale, and
tender. It may be reddened. This is: 11. A positive “tug test” means:
 Acute otitis externa  an inflammation of the inner ear
 chronic otitis externa  an inflammation of the ear canal
 acute purulent otitis media  an inflammation of the middle ear
 acute otitis media  it is normal

6. In the examination of the pharynx, press a tongue blade firmly down upon 12. Family history may be positive in patients with:
the:  migraine
 midpoint of the arched tongue  astigmatism
 beyond midpoint of the arched tongue  subarachnoid hemorrhage
 before midpoint of the arched tongue  meningitis

まっすぐ自分の言葉は曲げねえ…オレの忍道だ！ Huwag niyo ikalat ‘to, mga gago. dattebayo!

 FORBIDDEN NOTES JUTSU
13. Which of the following is not a “red flag” in a headache history? 20. A neck mass in the midline of the upper half of the neck that slides upward
 markedly elevated blood pressure when the tongue is protruded is most likely:
 reversible sensory symptoms  brachial cleft cyst
 acute onset  thyroglossal duct cyst
 recent onset  carotid body tumor
 thyroid mass
14. Flashing lights or new vitreous floaters suggest:
 lesions in the anterior chamber 21. If a tonsillar node pulsates, what should you suspect?
 detachment of vitreous from retina  bruit
 lesions in the visual pathway  external jugular vein
 lesions in the retina  lymphadenopathy
 carotid artery
15. The most common site of bleeding in the anterior nose:
 inferior meatus 22. This benign condition follows antibiotic therapy:
 middle meatus  geographic tongue
 kiesselbach plexus  fissured tongue
 nasal septum  hairy tongue
 smooth tongue
16. Highly infectious, firm, button-like lesion that ulcerates and may become
crusted: 23. Opacities of the lenses visible through the pupil and is most common in
 angular cheilitis elderly:
 cold sore  cataract
 chancre of syphilis  pterygium
 carcinoma of the lips  corneal scars
 corneal arcus
17. A presbyopic person:
 has impaired far vision 24. Tiny disc vessels absent, disc margin is sharp. This is:
 is common among adolescent aptients  papilledema
 often sees better when the card is farther away  glaucomatous cupping
 can read print at 20 feet  optic atrophy
 normal optic disc
18. Lateral sparseness of the eyebrow is noted in:
 seborrheic dermatitis 25. May be due to chemotherapy treatment:
 hypothyroidism  geographic tongue
 renal disease  hairy tongue
 hyperthyroidism  smooth tongue
 fissured tongue
19. Which of the following would cause suspicion of lip carcinoma?
 Peutz-Jeghers syndrome
 actinic cheilitis
 angular cheilitis
 angioedema

まっすぐ自分の言葉は曲げねえ…オレの忍道だ！ Huwag niyo ikalat ‘to, mga gago. dattebayo!

 FORBIDDEN NOTES JUTSU

26. The teeth may be eroded by chemical reaction and is associated with 32. Headache from eye disorder:
bulimia. This is:  diplopia
 Hutchinson’s teeth  nearsightedness
 erosion of teeth  astigmatism
 attrition of teeth  exophthalmos
 abrasion of teeth with notching
33. A pituitary gland tumor may give rise to lesion in the:
27. Excessive tearing due to impaired drainage of tears is associated with:  optic radiation
 ectropion  optic chiasm
 pinguecula  optic nerve
 conjunctival inflammation  visual cortex
 corneal irritation
34. The retinal arteries in hypertension:
28. Cancer of the tongue occurs most often on:  the arteries show areas of focal or generalized narrowing
 the side of the tongue  a vein crossing beneath the artery can be seen right up to the column of
 the tip of the tongue blood on either side
 the base of the tongue  the light reflex is about ¼ the diameter of the blood column
 under the tongue  retinal wall is transparent

29. Improper posture is one of the precipitating factor: 35. The dilated pupil is fixed to light and near effort. Ptosis of the upper eyelid
 cluster headache and lateral deviation of the eyes are almost always present. This is:
 migraine  tonic pupil
 brain tumor  Argyll Robertson pupil
 tension headache  oculomotor nerve paralysis
 Horner’s syndrome
30. Metastasis of a thoracic abdominal malignancy may be noticeable in the:
 posterior cervical nodes 36. The throat is dull red and a gray exudate is present on the uvula, tongue,
 supraclavicular nodes and pharynx. Airway may become obstructed. This is most likely:
 submental nodes  exudative tonsillitis
 occipital nodes  diphtheria
 pharyngitis
31. Which can be caused by trauma?  candidiasis
 subconjunctival hemorrhage
 glaucoma 37. A painful, tender red infection in a gland at the margin of the eyelid:
 conjunctivitis  pinguecula
 acute iritis  xanthelasma
 chalazion
 stye

まっすぐ自分の言葉は曲げねえ…オレの忍道だ！ Huwag niyo ikalat ‘to, mga gago. dattebayo!

 FORBIDDEN NOTES JUTSU
38. A thin, grayish, white arc or circle not quite at the edge of the cornea. It
accompanies normal aging but is also seen in younger people: 46. This remains to be the best means in evaluating sinus disease:
 cataract  transillumination test
 pterygium  palpation
 corneal scar  percussion
 corneal arcus  radiograph examination

39. The optic disc is swollen with blurred margins. Disc vessels are more visible, 47. Examination of the lymph nodes is primarily by:
more numerous, and often with loss of venous pulsation.  X-ray & palpation
 this is optic atrophy  palpation
 this is papilledema  inspection
 there is glaucomatous cupping  X-ray
40. All but one inner ear disorder: 48. A smooth and often sore tongue has lost its papillae that is due to a
 perforated eardrum deficiency in riboflavin, niacin, folic acid, and Vit. B12, pyrodixine, or
 loud noise exposure iron, or treatment with chemotherapy:
 cochlear nerve and neurological impulse transmission to the brain  geographic tongue
 aging  hairy tongue
 fissured tongue
42. This red throat has a white exudate on the tonsils accompanied by fever and  atrophic glossitis
enlarged anterior cervical nodes. This is:
 diphtheria 49. It appears as hard nodules in the helix or antihelix and may discharge
 candidiasis chalky, white crystals through the skin. It also may appear near the
 Group A streptococcal infection joints, hands, feet, and other areas. This is:
 infectious mononucleosis  chronic gout
 basal cell carcinoma
43. In the WHO epidemiologic classification of cervical goiter, Grade 2 means:  cutaneous cyst
 no palpable or visible goiter  rheumatoid nodules
 a goiter that is palpable but not visible with the head in the normal
position 50. Nausea and vomiting are common with migraine headache but could
 a goiter that is clearly visible when the neck is in a normal position also indicate:
 chronic sinusitis
44. Any difference in pupillary size is called:  subarachnoid hemorrhage
 consensual  cluster headache
 anisocoria  acute sinusitis
 accommodation
 convergence

45. Anisocoria is significant if the difference between the pupillary size is:
 1 mm
 more than 1 mm
 0.3 mm
 0.5 mm

まっすぐ自分の言葉は曲げねえ…オレの忍道だ！ Huwag niyo ikalat ‘to, mga gago. dattebayo!

CLINICAL MEDICINE QUICK NOTES – CVS, CHEST & LUNGS revealed concentric LVH. Which abnormality in heart sounds will you expect
to hear on auscultation?
CVS PART 1 & 2 a. Loud S1
1. Which of the following murmur can be heard at the back below the left b. Soft S1
scapula?
c. S3
a. Ejection systolic murmur of aortic stenosis
d. S4
b. Diastolic murmur of mitral stenosis

c. Holosystolic murmur of mitral regurgitation

5. What other heart sounds will expect to hear on a patient with heart failure?
d. Diastolic blowing murmur of aortic regurgitation
a. Loud S2

b. S4
2. A 50-year old female from Japan consulted in cardiology clinic complaining
of easy fatigability, shortness of breath and dyspnea. On physical examination c. S3
a holosystolic murmur was appreciated transmitted to the axilla. An ejection
systolic murmur was also heard and transmitted to the neck. What is the d. Soft S1
valvular disease of the patient?

a. Mitral regurgitation and aortic stenosis 6. Which of the following physical examination finding is consistent in patient
b. Pulmonic regurgitation and mitral regurgitation with chronic mitral regurgitation?

c. Aortic regurgitation and mitral regurgitation a. Soft S1

d. Aortic regurgitation and mitral stenosis b. Persistent splitting of S2

c. Loud S1

3. A 65-year old male known to be hypertensive for the last 10 years. The d. Paradoxical splitting of S2
apical beat is at the 6th ICS left anterior axillary line with an apical lift. A loud
high pitch blowing murmur at the 3rd ICS left sternal border. What is the
valvular disease of the patient? 7. On examination of the heart of patient with hypertensive urgency will
reveal:
a. Tricuspid regurgitation
a. Loud A2/S2
b. Mitral regurgitation
b. Loud S1
c. Pulmonic regurgitation
c. Soft S1
d. Aortic regurgitation
d. Persistent splitting of S2

e. Paradoxical splitting of S2
4. A patient who is known to hypertensive was admitted his BP is 160/110
mmHg. Apical beat is palpable at the 5th LMCL which is forceful 2D echo

1|CHEEMS • GINTOKI Use at your own risk. 😊

8. Mitral stenosis will usually cause this abnormal finding on auscultation of the d. Ebstein anomaly
heart:

a. Soft S1
12. A 60-year old male was admitted because of syncope. Brain CT scan
b. Loud S1 revealed ejection systolic murmur grade 4/6 with paradoxical splitting of S2.
What is your diagnosis?
c. Paradoxical splitting of S2
a. Tricuspid stenosis
d. Persistent splitting of S2
b. Atrial septal defect
e. Loud A2/S2
c. Aortic stenosis

d. Pulmonic stenosis
9. Aortic stenosis can present with which of the following cardiac finding?

a. Soft S1
13. A paradoxical rise on jugular venous pressure in inspiration is called which
b. Loud S1 of the following:
c. Loud A2/S2 a. Levine’s sign
d. Persistent splitting of S2 b. Kussmaul’s sign
e. Paradoxical splitting of S2 c. Sail sound

d. Caravallo’s sign
10. Which of the following auscultation finding of the heart is present in
individual with pulmonic stenosis?
14. If the jugular vein becomes distended after applying pressure on the right
a. Loud S1 hypochondriae region. This maneuver is called which of the following?
b. Persistent splitting of S2 a. Sail sounds
c. Loud A2/S2 b. Kussmaul sign
d. Soft S1 c. Hepatojugular reflux
e. Paradoxical splitting of S2 d. Caravallo’s sign

11. A 28-year old female was referred to a cardiology clinic because of a 15. The high pitch blowing murmur at the apex is called:
murmur. The murmur is described to be early to mid-systolic murmur with
persistent splitting of S2. What is your diagnosis? a. Gallavardin’s murmur

a. Pulmonic stenosis b. Austin Flint murmur

b. Ventricular septal defect c. Carey Coombs murmur

c. Atrial septal defect d. Graham Steele murmur

2|CHEEMS • GINTOKI Use at your own risk. 😊
16. A patient diagnosed with heart failure complaining of dyspnea and d. Gallavardin’s murmur
orthopnea. The best position for this patient to be comfortable in her
breathing will be which of the following:

a. Left lateral decubitus position 20. Persistent splitting of S2 of pulmonic stenosis is heard:

b. Flat on bed a. 3rd ICS left sternal border

c. Semi recumbent at 60º b. 5th ICS LMCL

d. Semi recumbent at 45º c. 4th ICS left parasternal border

d. 2nd ICS left sternal border

17. Male patient 60 years old post coronary artery bypass graft surgery 10 e. 2nd ICS right sternal border
years ago now symptomatic with chest pain, shortness of breath and easy
fatigability. The apical beat could hardly be appreciated at the 5 th ICS LMCL.
His 2D echo findings revealed dilated ischemic cardiomyopathy. The best 21. Where can you hear the Austin flint murmur?
position to appreciate the apical beat is which of the following:
a. 3rd ICS left sternal border
a. Left lateral decubitus position
b. 5th ICS left midclavicular line
b. Semi recumbent 45º
c. 4th ICS left parasternal border
c. Supine
d. 2nd ICS left sternal border
d. Semi recumbent 30º
e. 2nd ICS right sternal border

18. A 65-year old male known to be hypertensive for the last 10 years. The
apical beat is the 6 th ICS left anterior axillary line with an apical lift. The loud 22. Graham Steele murmur is heard over:
diastolic blowing murmur was heard at the Erb’s point and loud high pitch a. 3rd ICS left sternal border
blowing murmur at the apex. What is the valvular disease of the patient?
b. 5th ICS LMCL
a. Tricuspid regurgitation
c. 4th ICS left parasternal border
b. Aortic regurgitation
d. 2nd ICS left sternal border
c. Mitral regurgitation
e. 2nd ICS right sternal border
d. Pulmonic regurgitation

23. Mitral regurgitation is heard over:

19. The high pitch Cooing murmur at the apex of aortic stenosis is called?
a. 3rd ICS left sternal border
a. Austin flint murmur
b. 5th ICS left midclavicular line
b. Graham Steele murmur
c. 4th ICS left parasternal border
c. Carey Coombs murmur
3|CHEEMS • GINTOKI Use at your own risk. 😊
d. 2nd ICS left sternal border 27. A paradoxical rise on jugular venous pressure in inspiration is called which
of the following:
e. 2nd ICS right sternal border
a. Levine’s sign

b. Caravallo’s sign
24. Aortic regurgitation is heard over:
c. Sail sound
a. 3rd ICS left sternal border
d. Kussmaul sound
b. 5th ICS LMCL

c. 4th ICS left parasternal border

28. A 48-year old male, sought consultation because of weakness and fatigue.
d. 2nd ICS left sternal border On PE his BP is within normal range and there is globular abdomen with (+)
e. 2nd ICS right sternal border Kussmaul’s sign and early S3. Based on these findings, which of the following
disease entity do you think the patient have?

a. Mild pericardial effusion

25. A 28-year old female was referred to a cardiology clinic because of a
murmur is described to be early to mid-systolic with persistent splitting of s2. b. Right heart failure
What is your diagnosis? c. Pulmonary congestion of CHF
a. Atrial septal defect d. Constrictive pericarditis
b. Pulmonic stenosis

c. Ebstein anomaly 29. If the jugular vein becomes distended, the maneuver is called which of the
d. Ventricular septal defect following?

a. Hepatojugular reflux

26. A 60-year old male was admitted because of syncope. Brain CT scan b. Sail sounds
revealed normal. On examination, the patient is hypertensive with a BP of c. Kussmaul sign
160/100 mmHg. Auscultation revealed ejection systolic murmur grade 4/6 with
a paradoxical splitting of S2. What is your diagnosis? d. Caravallo’s sign

a. Atrial septal defect

b. Pulmonic stenosis 30. Halosystolic murmur at the left parastructural area transmitted to the right:

c. Tricuspid stenosis a. Austin Flint murmur

d. Aortic stenosis b. Patent ductus arteriosus

c. De Musset’s sign

d. Atrial septal defect

e. Ventricular septal defect

4|CHEEMS • GINTOKI Use at your own risk. 😊

31. Mid-systolic murmur at the 2nd ICS with persistent splitting of S2: e. Atrial septal defect

a. Ventricular septal defect

b. Duroziez sign 35. Wide pulse pressure in patients with aortic insufficiency

c. Patent ductus arteriosus a. Patent ductus arteriosus (Machinery like murmur)

d. Austin Flint murmur b. Ventricular septal defect

e. Atrial septal defect c. De Musset’s sign

d. Corrigan’s sign

32. Hypertension in the upper extremity only: e. Atrial septal defect

a. Patent ductus arteriosus

b. Ventricular septal defect 36. If the jugular vein becomes distended after applying pressure on the right
hypochondriac region. The maneuver is called which of the following?
c. Austin Flint murmur
a. Kussmaul sign
d. Duroziez sign
b. Sail sounds
e. Atrial septal defect
c. Caravallo’s sign

d. Hepatojugular reflux
33. Continuous machinery like murmur

a. Patent ductus arteriosus

37. A patient was diagnosed with hypertrophic obstructive cardiomyopathy,
b. Ventricular septal defect what is the abnormality in heart sound will you expect to hear?
c. De Musset’s sign a. Loud S2
d. Duroziez sign b. Splitting of S2
e. Atrial septal defect c. Loud S1

d. S4
34. Rhythmic nodding of the head synchronous with the heart beat in patients
with aortic regurgitate
38. A patient diagnosed with rheumatic heart disease with valvular stenosis.
a. Patent ductus arteriosus Which abnormality in heart sound will you expect to hear at the 2nd ICS rib?
b. Ventricular septal defect a. Opening snap
c. De Musset’s sign b. S4
d. Duroziez sign c. Soft S1

5|CHEEMS • GINTOKI Use at your own risk. 😊

d. S3 c. Sitting but leaning forward

d. Supine

39. Which of the following valvular heart disease can give rise to holosystolic
murmur which becomes louder during inspiration?
43. A 65-year old male known to be hypertensive for the last 10 years. The
a. Mitral regurgitation apical beat is at the 6th ICS left anterior axillary line with an apical lift. A loud
high pitch blowing murmur at the Erb’s point and loud high pitch blowing
b. Pulmonic regurgitation murmur at the apex. What is the valvular disease of the patient?
c. Tricuspid regurgitation a. Aortic regurgitation
d. Aortic regurgitation b. Tricuspid regurgitation

c. Mitral regurgitation
40. To differentiate right sided murmur from left murmur you must ask your d. Pulmonic regurgitation
patient to do what?

a. Deep inspiration
44. The high pitch cooing murmur is called?
b. Valsalvas maneuver
a. Austin Flint murmur
c. Deep expiration
b. Gallavardin’s murmur
d. Pulmonic regurgitation
c. Carey Coombs murmur

d. Graham Steele murmur

41. A patient with coronary artery disease who is complaining of chest
discomfort everytime he experiences the chest heaviness. Everytime he
experiences these symptoms he usually make a fist and point to into his
anterior chest. This gesture is called which of the following: 45. A patient who is known hypertensive was admitted his BP is 160/100 mmHg.
Apical heart is palpable at the 6th ICS which is forceful 2D echo revealed LV
a. Levine’s sign dilation. Which abnormality in the heart sounds will you expect to hear on
auscultation?
b. Caravallo’s sign
a. Loud S1
c. Sail Sound
b. S3
d. Ewart’s sign
c. Soft S1

d. S4
42. The murmur of aortic stenosis is appreciated better when the patient is in
which position?

a. Sitting upright

b. Left Lateral decubitus

6|CHEEMS • GINTOKI Use at your own risk. 😊

46. A patient 60-year old was admitted because of SOB dyspnea and 50. A 60-year old male was admitted because of syncope. Brain CT scan
orthopnea. Apical beat at 5th ICS LAAL with regular rhythm. He is in heart revealed normal. On examination, the patient is hypertensive with a BP of
failure. 160/100 mmHg. Auscultation revealed systolic murmur grade 4/6 at the Erb’s
point.
a. S4
a. AS
b. S3
b. AR
c. Loud S2
c. MR
d. Soft S1
d. MS

CHEST & LUNGS (PART 1 & 2)

47. The murmur of pulmonic regurgitation is heard in which of the following
auscultatory area? 1. Which of the following causes acute as well as chronic cough:
a. 4th ICS parasternal area a. Aspiration of foreign bodies
b. 2nd ICS LSB b. Pneumoconiosis
c. 2nd ICS RSB c. Asthma
d. 3rd ICS left stenosis border d. Fibrothorax

48. Which of the following valvular disease gives rise to holosystolic murmur 2. The most likely mechanism of cough among patients with mediastinal mass
which becomes louder on deep inspiration?
a. Pressure on the airway
a. Mitral regurgitation
b. Inflammation of the airway
b. Pulmonic regurgitation
c. Changes in temperature
c. Aortic regurgitation
d. Decrease lung compliance
d. Tricuspid regurgitation

3. Patient with pleural effusion usually present with dry cough and the
49. A 28-year old was referred to a cardiology clinic because of a murmur. The mechanism of the cough is most likely:
murmur is described to be early to mid-systolic murmur with persistent splitting
of S2. What is your diagnosis? a. Pressure on the airway

a. Pulmonic stenosis b. Decrease lung compliance

b. Ebstein anomaly c. Inflammatory reaction

c. Ventricular septal defect d. Irritation of the airway

d. Atrial septal defect

7|CHEEMS • GINTOKI Use at your own risk. 😊

4. A 52-year old female, consult a doctor’s clinic because of cough for more d. Interstitial fibrosis
than 5 months now, she claims that her cough is more bothersome at night
when she lays down to sleep, and she frequently tries to clear her throat.
Cough is productive of watery whitish secretion. The most likely cause of the 7. A 55-year old, male have been coughing for more than a year and it is
cough is: usually in the morning with minimal sputum and he is found to have injected
a. Post nasal drip (chronic cough; sputum: mucoid or mucopurulent; pharynx. The most likely cause is
associated with: allergic rhinitis with or without sinusitis) a. Post nasal drip
b. Chronic Bronchitis (chronic cough; sputum: mucoid to purulent, may be b. Smoking
blood streaked or even bloody)
c. Chronic bronchitis
c. Gastroesophageal regurgitation (chronic cough especially at night or early
in the morning. Associated with: wheezing especially at night, early morning d. Asthma
hoarseness, repeated attempts to clear the throat. Often with heartburn and
regurgitation)

d. Bronchiectasis (chronic cough; sputum purulent, often copious and foul 8. A 17-year old female student consulted at the ER because of high grade
smelling, maybe blood streaked or bloody. Associated with: Recurrent fever without other symptoms. She is observed to have abnormal respiration.
pulmonary infections, sinusitis may coexist) The abnormal respiration is expected to be:

a. Tachypnea (rapid shallow breathing has numerous causes including

salicylate intoxication, restrictive lung disease, pleuritic chest pain, and
5. A 45-year old male, smoke at 3 sticks of cigarette a day for the past 3 years, elevated diaphragm)
have been coughing for more than 3 months now and he claims that he have
itchiness of the throat and have to constantly clear his throat especially in the b. Cheyne-Stoke Respiration (periods of deep breathing alternate with periods
morning. The problem is likely due to: of apnea. Normal in children and adults during sleep. Causes includes heart
failure uremia, drug induces respiratory depression, and brain injury (typically
a. Smoking bihemispheric)

b. Post nasal drip c. Hyperpnea (rapid deep breathing in response to metabolic demand from
causes such as exercise, high altitude, sepsis, and anemia)
c. Gastroesophageal reflux (chronic cough especially at night or early in the
morning. Associated with: wheezing especially at night, early morning d. Kussmaul’s breathing (compensatory over breathing due to systemic
hoarseness, repeated attempts to clear the throat. Often with heartburn and acidosis)
regurgitation)

d. PTB
9. A 62-year old female was found unconscious and at the ER she was noted
to have very fast and deep breathing with fruity breath. The pattern breathing
observed:
6. The following conditions causes both acute onset as well as chronic
progressive difficulty of breathing a. Kussmaul’s respiration (compensatory over breathing due to systemic
acidosis)
a. Bronchiectasis
b. Hyperpnea
b. Pleural effusion
c. Tachypnea
c. Pleural thickening

8|CHEEMS • GINTOKI Use at your own risk. 😊

d. Biot’s respiration (Causes: meningitis, respiratory depression, brain injury b. Dissecting aneurysm
typically at the medullary level)
c. Pericarditis

d. Esophageal Spasm
10. An IV drug user consulted at the ER because of hemoptysis and DOB but
denies any fever and cough. The most likely cause of hemoptysis is

a. Bronchitis 14. A 52-year old male, while hurrying to catch a bus, suddenly experience
difficulty of breathing which persisted even after resting for an hour.
b. Pneumonia
a. Pulmonary edema
c. PTB
b. Asthmatic attack
d. Vasculitis
c. Exacerbation of COPD

d. Pneumothorax
11. A 70-year old male was admitted to the hospital because of pneumonia.
Several medicines were given and he improved, however, on the 5th hospital
day, he suddenly developed shallow breathing and drowsiness. Drug reaction 15. Orthopnea is common among patients with:
was suspected to be the cause of sudden change. Which of the following
medicine may cause this problem? a. Pulmonary congestion

a. Amikin b. Pneumonia

b. Nitrofurantoin c. Acute bronchitis

c. Cyclophosphamide d. Pulmonary infarction

d. Metaprolol

16. Patient with chronic cough and unilateral effusion will usually complain

12. Kussmaul’s Respiration is usually observed in patient with: a. Platypnea

a. Aortic Stenosis b. Orthopnea

b. CVD c. Trepopnea

c. Bulbar Meningitis d. Hyperpnea

d. Severe Hemorrhage

17. Pneumoconiosis is due to exposure to:

13. A 13-year old female was rushed in the ER with severe retrosternal pain. a. Coal
Nitroglycerine must be given to the patient to relieve chest pain. She claimed
that the pain occurs when she ate something cold. The patient is suffering b. Asbestos
from: c. Silica
a. Myocardial infarction
9|CHEEMS • GINTOKI Use at your own risk. 😊
d. Silver 22. The normal resting level of the diaphragm is located at:

a. 10th thoracic vertebrae spinous process

18. Occupational asthma is more commonly seen in workers with exposure to: b. 10th vertebral body

a. Cotton dust c. 10th posterior rib

b. Hay d. 10th posterior ICS

c. Silica

d. Sugar cane 23. Reference used to identify the posterior rib (?)

a. Spinous process of C7

19. Primary malignancy of the pleura is associated with close and prolong b. Spinous process of T3
exposure to:
c. Superior scapular spin
a. Asbestos
d. Inferior scapular spin
b. Ozone
e. Sternal angle
c. Silica

d. Coal
24. Tactile fremitus is usually decreased in patients with:

a. Bronchiectasis
20. Psittacosis is due to exposure to sick:
b. Pneumonia
a. Cats
c. Atelectasis
b. Sheep
e. Emphysema
c. Dogs

d. Birds
25. Bilateral hyper-resonance on percussion of the chest is an expected
finding among patients with:

21. Lagging of one side of chest is best identify by: a. Asthma (resonant to diffusely resonant: eto din hyper resonant pero pag
severe lang)
a. Auscultation
b. Chronic bronchitis (resonant)
b. Palpation
c. Tension pneumothorax (hyperresonant but unilateral)
c. Percussion
c. Emphysema
d. Inspection

10 | C H E E M S • G I N T O K I Use at your own risk. 😊

26. Stridor is usually heard among patients with: (Large airway obstructions 30. Localized wheezes maybe heard in patient with: (wheezing: COPD,
kasi; L/R main stem bronchus and trachea) asthma, chronic bronchitis, heart failure)

a. Bronchogenic CA a. Chronic bronchitis

b. Pharyngitis b. Asthma (viral wheezing)

c. Epiglottis c. Aspiration pneumonia

d. Asthma d. Bronchogenic CA

27. Dullness on percussion of the chest with decrease to absent breath sounds 31. I:E ratio decreased in patient with:
would suggest:
a. Pleuritis
a. Pneumothorax (decreased breath sounds but hyper resonant)
b. Bronchitis
b. Fibrothorax (dullness but with crackles)
c. Asthma
c. Pneumonia (dullness but with crackles)
d. Emphysema
d. Lung mass (dullness with +/- breath sound)

32. Pattern of breathing observed in patient with heart failure:

28. Movement of secretions in the large airways would produce:
a. Cheyne-Stokes
a. Rales
b. Apneustic
b. Stridor
c. Kussmaul’s
c. Wheezes
d. Biot’s
d. Rhonchi

33. Fremitus is decreased in patient with:

29. Bronchial breath sounds with shifting of the mediastinum to the same side
implies: a. Pulmonary emboli

a. Pneumothorax (absent breath sound and shift on ‘opposite’ side) b. Bronchopneumonia

b. Pneumonia (w/ breath sound but no shifting) c. Pneumonia

c. Atelectasis (+/- breath sound with deviation on the same side) d. Emphysema

d. Lung mass (+/- breath sound and no shifting)

11 | C H E E M S • G I N T O K I Use at your own risk. 😊

34. Bronchial breath sounds maybe heard in patients with: b. Subscapular

a. COPD c. Central

b. Lung mass d. Pectoral

c. Mediastinal mass

d. Pleural effusion 39. Which of the following lymph node if palpable indicates late stage breast
CA:

a. Infraclavicular
35. Which of the following condition may cause distention of neck vein?
b. Supraclavicular
A. COPD
c. Central
b. Fibrothorax
d. Pectoral
c. Pneumonia

d. Bronchiectasis
40. Breast is usually divided in 4 quadrants to facilitate:

a. Staging of breast cancer

36. Elevated hemidiaphragm is suspected based on findings on:
b. Description of clinical findings
a. Auscultation
c. Description of developmental stage
b. Inspection
d. Differentiate benign from malignant lesion
c. Palpation

d. Percussion
41. A 55-year old female single who is 5’2 tall and weighs 160 lbs is afraid that
she may have breast cancer, since her young sister passed away because of
37. Early inspiratory crackles is usually heard in patient with: breast cancer at the age of 37, and her brother died of colonic cancer at the
age of 50. What should you advise the patient?
a. Chronic bronchitis (and asthma)
a. She have to undergo MRI study of the breast
b. CHF (late inspirational crackles)
b. Undergo annual mammography screening
c. bronchiectasis (mid ins/expiratory crackles)
c. Undergo annual mammography and ultrasound of the breast
d. interstitial fibrosis (late inspirational crackles)
d. Undergo preventive mastectomy

38. Most frequent palpable lymph node among patients with spread of breast
cancer is:

a. Lateral

12 | C H E E M S • G I N T O K I Use at your own risk. 😊

42. Orange peel skin of the breast is due to: c. Rounded

a. Venous obstruction d. >2cm (3cm - increased “risk” of malignancy)

b. Increase blood flow to the breast

c. Lymphatic obstruction

d. Spread of CA to the skin

43. Which of the following is associated with higher risk of breast CA?

a. Early pregnancy

b. Breast feeding

c. Late menopause

d. Early menopause

44. MRI of the breast is indicated if the patient have:

a. Past history CA of the uterus

b. Family history of lung CA

c. Family history of BRCA mutation

d. Past history CA bladder

45. Sign of advanced breast CA:

a. Orange peel skin

b. Nipple retraction

c. Nipple discharge

d. Dimpling

46. Malignant breast mass tend to be:

a. Tender

b. Hard (soft → cystic = non-malignant)

13 | C H E E M S • G I N T O K I Use at your own risk. 😊