Internal Medicine - Introduction

Select the correct findings in lung consolidation :

• reduced TVF

• crackles

• hyperresonant percussion

• mediastinal shift to the same side

• whispering pectoriloquy

Answer explanation

in lung consolidation, the following features are,

1) increased TVF

2) added sound - crackles

3) central mediastinal shift

4) dull percussion

5) whispering pectoriloquy on vocal resonance

Select the triad for left ventricular failure ( LVF )

• basal crepitations

• tender hepatomegaly

• bilateral pedal edema

• pulsus alternans

• gallop rhythm

Answer explanation

LVF triad is,

1) pulsus alternans

2) gallop rhythm

3) basal crepitations

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RVF triad is,

1) raised JVP

2) pedal edema

3) tender hepatomegaly

Absent breath sounds can occur due to,

• partial lung collapse

• total lung collapse

• empyema

• pneumothorax

• hydropneumothorax

Answer explanation

absent breath sounds is present in,

1) total collapse

2) pleural effusion

3) emphysema

4) pneumothorax

5) hydropneumothorax

Select the WRONG description about murmur grading :

• Grade I, faint murmur but clearly audible

• Grade II, moderately loud murmur without thrill

• Grade III, moderately loud murmur with thrill

• Grade IV, loud murmur with thrill and stethoscope half lifted from chest

• Grade VI, loud murmur with thrill even with stethoscope lifted from chest

Answer explanation

murmur grading is,

grade I, very faint and audible with effort

grade II, faint but clearly audible

grade III, moderately loud but no thrill

grade IV, louder murmur with thrill

grade V, louder murmur with thrill and audible with half-lifted stethoscope

grade VI, louder murmur with thrill and audible even without stethoscope

Which of the following is NOT a cause of chest pain,

• GERD

• psychological

• myocardial infarction

• pancreatitis

• seizure

Answer explanation

chest pain causes include,

1) cardiovascular causes

2) pulmonary causes

3) gastrointestinal causes

4) musculoskeletal causes

5) neurological causes

6) psychological causes

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among neurological causes, the one that commonly cause chest pain is only,

• - cervical disc disease

• - herpes zoster infection

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• although seizure is a neurological cause, seizure is NOT known to cause chest pain

Select the correct descriptions for mMRC grading for dyspnea :

• grade 0, breathlessness only with strenuous exercise

• grade 1, breathless when walking uphill

• grade 2, walks slower than person of different age

• grade 3, stops after walking for few minutes uphill

• grade 4, too breathless to leave house or breathless when dressing or undressing

Answer explanation

mMRC grading for dyspnea include,

grade 0, breathless with strenous exercise

grade 1, breathless when walking uphill

grade 2, walks slower than person of same age

grade 3, stops after few minutes on level ground

grade 4, too breathless to leave house or undress

soft S1 is present in,

• emphysema

• thin chest wall

• atrial fibrillation

• mitral stenosis

• mitral regurgitation

Answer explanation

soft S1 is present in these conditions,

1) emphysema

2) regurgitation

3) mitral regurgitation

4) tricuspid regurgitation

5) thick chest wall

6) poor conduction from chest

7) pericardial effusion

8) prolonged PR interval

9) acute MI

10) LV aneurysm

11) cardiomyopathy

12) calcified valve

Which of the following cranial nerves are correct :

• CN VI, trochlear nerve

• CN V, facial nerve

• CN VIII, vestibulocochlear nerve

• CN IX, hypoglossal nerve

• CN XI, accessory nerve

Answer explanation

CN I, olfactory

CN II, optic

CN III, oculomotor

CN IV, trochlear

CN V, trigeminal

CN VI, abducens

CN VII, facial

CN VIII, vestibulocochlear

CN IX, glossopharyngeal

CN X, vagus

CN XI, accessory

CN XII, hypoglossal

Which of these murmurs occur between S2 and S1 ?

• mid-systolic murmur

• mid-diastolic murmur

• pansystolic murmur

• early systolic murmur

• early diastolic murmur

Answer explanation

• - all systolic murmur occurs between S1 and S2

• - all diastolic murmur occurs between S2 and S1

Which of these are false,

• Liver dullness is noted at 5th ICS

• Hooking is one of the ways for liver palpation

• Grade III ascites is confirmed if horseshoe dullness is positive

• Grade IV ascites is confirmed if puddle sign is positive

• Rigidity is voluntary muscle contraction, which is reversible

Answer explanation

1) hooking is a way for SPLEEN palpation

2) guarding is voluntary reversible contraction

3) rigidity is involuntary irreversible contraction

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ascites grading is as follows,

grade I, puddle sign positive

grade II, shifting dullness positive

grade III, horseshoe dullness positive

grade IV, fluid thrill positive