ENDO - INTERNAL 2021
Congenital Heart Disease and Clinical Examination Quiz
Welcome to the Congenital Heart Disease and Clinical Examination Quiz! This comprehensive quiz consists of 50 questions designed to test your knowledge in cardiology and internal medicine.
Participants will benefit from:
- In-depth questions focused on congenital heart defects
- Clinical examination techniques and findings
- Pathophysiology and management of heart conditions
Which one of the following is the congenital heart disease?
Infective endocarditis
Aortic stenosis
Tetralogy of Fallot
Heart failure
Which of the following pathologies is characterized by pulse deficit?
Myocardial infarction
Pulmonary oedema
Extra systolic arrhythmia
Atrial fibrillation
Put components of head examination in correct order 1. eyes, 2. nose, 3. ears, 4. mouth&throat, 5. head
5, 1, 3, 2, 4
1, 2, 3, 4, 5
5, 3, 1, 2, 4
5, 1, 2, 4, 3
5, 1, 2, 3, 4
A 25-year-old man with complains of sudden, sharp pain in the chest & trouble breathing. On examination – cyanosis, tachypnoea, decreased tactile fremitus on the right, hyperresonance on the right and decreased breath sounds on the right. This is consistent with (choose one answer)
Tracheal deviation to the left
Tracheal deviation to the right
Coarse crackles or/with ronchi or/with wheezes
Bronchial breath sounds
Choose the true sentences **
Costovertebral angle tenderness is the typical sign of appendicitis
Increased bowel sounds can indicate early intestinal obstruction or adynamic ileus
A palpable fluid wave suggests, but does not prove ascites
A positive psoas sign is when the patient feels pain during flexion of right leg at the hip
McBurney’s point is localized in the right lower quadrant
Choose the true sentences
Palpation of an irregularly irregular rhythm reliably indicates atrial fibrillation
Periumbilical mass with expansile pulsation > 3cm in diameter can indicate abdominal aortic aneurysm
Grade 4 in Levine scale of heart murmurs means loud murmur with palpable thrill
Diastolic decrescendo murmur is characterized for aortic stenosis
Pan-systolic murmur, which radiates to the axilla is characteristic for mitral stenosis
Tetralogy of Fallot consist of?
Pulmonary stenosis, atrial septal defect, left ventricular hypertrophy & overriding aorta
Pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy & overriding aorta
Aortic stenosis, ventricular septal defect, left ventricular hypertrophy & overriding aorta
Aortic stenosis, ventricular septal defect, right ventricular hypertrophy & overriding aorta
79-year-old patient, with diagnosed Vater´s papilla cancer, complains of jaundice. During abdominal palpation, there is palpable non-tender gallbladder. How is this sign called?
Courvoisier´s sign
Murphy´s sign
Blumberg´s sign
Rovsing´s sign
Which of the following is NOT a part of Charcot´s cholangitis triad?
Haematemesis
Jaundice
Abdominal pain
Fever
While auscultating the lungs of a patient with exacerbation of chronic obstructive pulmonary disease (COPD), you would expect the adventitious breath sounds to be:
Stridor
Fine crackles
Absent
Coarse crackles or/with ronchi or/with wheezes
Choose the true sentence
Crackles (rales) are continuous breath sounds
Characteristic for vesicular breath sound is the same duration of inspiratory & respiratory phase
Wheezes usually disappear or decrease after coughing
Wheezes & ronchi are musical, prolonged breath sounds
Crackles can be described like whistling through a narrow tube
Which of the following is NOT typical for Cushing syndrome?
Plethroa
Moon face
Prominent forehead
Thin limbs
Which of the following murmurs is characteristic of ventricular septal defect?
Holosystolic, located over the apex, radiating to the left axilla
Diastolic, located over the apex
Diastolic, located in the 2nd to 4th interspaces
Holosystolic, located in the 3rd to 5th left interspaces
Point out all signs related to aortic regurgitation listed below
Moussets sign
Janeway sign
Corrigan’s pulse
Traube sign
Rovsings sign
Which of the following can be diagnosed by a per rectum examination?
Gastric ulcer perforation
Gastrointestinal bleeding
Diverticulitis
Colon polyps
Haemoptysis **
Refers to blood coughed up from the lower respiratory tract
May vary from blood-streaked sputum to frank blood
Is common in infants, children and adolescents
Causes include bronchitis, malignancy and CF, and less commonly bronchiectasis, mitral stenosis, Goodpasture syndrome and Wegener granulomatosis
Massive haemoptysis (wider than 200 cm3) may be life threatening
FALSE statement about breathing sounds
In vesicular breathing sounds, expiration lasts longer than inspiration
Bronchial breathing sounds can be heard over fluid filled or solid lung tissue
Vesicular breathing sounds are heard over most of both lungs
In bronchovesicular breathing sounds the duration of inspiration and expiration are about equal
Bronchovesicular breathing sounds are often heard in the 1st and 2nd ICS
The area of auscultation of the mitral valve
2nd ICS, left sternal border (2ICS-LSB)
2nd ICS, right sternal border (2ICS-RSB)
3rd left ICS (3ICS)
Cardiac apex (5ICS-MCL)
Features of typical angina chest pain
Retrosternal location, provoked by deep breathing, relived by rest or nitroglycerine
Retrosternal location, provoked by exertion, without any relieving factors
Retrosternal location, provoked by exertion, relived by rest or nitroglycerine
Only retrosternal location
When auscultating normal lungs, expected breathing sounds would be
Flatness
Bronchovesicular
Bronchial
Vesicular
Painless haemorrhagic cutaneous lesions on the palms and soles, observed in infective endocarditis
Moussets sign
Osler’s nodules
Janeway sign
Blumberg sign
Roth’s spots
Which CANNOT be the cause of pain located in the lower left quadrant of the abdomen
Cholecystitis
Kidney stones
Diverticulitis
UTI
65 y.o. patient, with chronic cardiac insufficiency, complains of progressing dyspnoea during light physical effort, physical examination reveals that tactile fremitus is decreased over the lower part of the right lung, percussion note is dull over the lower part of the right lung, breathing sound is decreased over the lower part of the right lung, the most likely diagnosis is
Bronchial asthma
Hydrothorax
Chronic bronchitis
Pneumothorax
In the 6-point murmur grading scale “very loud, audible when stethoscope is removed from chest, with a thrill” corresponds to
Grade 6
Grade 5
Grade 1
Grade 3
Which statement about haematochezia is correct?
Is commonly associated with lower gastrointestinal bleeding
It can be caused by iron supplements
Refers to back, tarry faeces
Is commonly associated with upper gastrointestinal bleeding
Asymmetric increased tactile fremitus occur in:
Unilateral pleural effusion
Unilateral pneumonia
Pneumothorax
Haemothorax
Among the mentioned conditions, the cause of pitting oedema is:
Lymphoedema
Heart failure
Myxoedema
Allergy
Choose the true sentence about funnel chest (Pectus Extravatum):
Depression in lower portion of the sternum
Increased AP diameter
Seen often in COPD
Related compression of the heart and great vessels may cause murmurs
Anteriorly displaced sternum
Periods of deep breathing alternate with periods of apnoea. This pattern is normal in children and older adults during sleep. Causes include heart failure, uraemia, drug-induced respiratory depression, and brain injury. The description above matches best:
Kussmaul breathing
Cheyenne-Stokes Breathing
Slow breathing (Bradypnea)
Obstructive breathing
Signs of Respiratory Distress:
Contraction of accessory muscles SMC and scalene muscles
Supraclavicular retraction
Respiratory rate faster than 25 breaths per minute
Cyanosis on lips, tongue, and oral mucosa
Orthopnoea
Melena:
Refers to passage of black tarry stool
Causes include gastritis, GERD, peptic ulcer, esophageal or gastric varices
Originated usually from the esophagus, stomach, or duodenum, less commonly the jejunum, ilium, or ascending colon
Usually associated with epigastric discomfort caused by heartburn, dysmotility or pain after meals
Typically, it appears only in very short transit time through gastrointestinal tract
Which term has WRONG definition?
Exophthalmos – eyeball protrudes forward
Miosis – constriction of the pupil
Ptosis – drooping of the lower lid
Xanthelasma – slightly raised, yellowish, well-circumscribed plaques in the skin which appear along the nasal portions of one or both eyelids
By definition, diarrhoea is when:
The patient passes more or 3 liquid or semiliquid stools a day
The patient passes < 3 liquid or semiliquid stools a day
The patient passes > 3 liquid or semi-liquid stools a day
The patient returns > 3 formed stools per day
Which of the following results in physical examination will present when a plug in a mainstem bronchus (as from mucus or foreign object) obstructs airflow, affected lung tissue collapses into an airless state?
Increased chest movement
Bronchial sound
Pleural rub
Dull percussion note
Systolic murmur heard over the apex radiating to left axillary line. The most probable explanation is:
Mitral regurgitation
Aortic stenosis
Tricuspid regurgitation
Pulmonary stenosis
Mitral stenosis
Aortic regurgitation
Tympanic sound during lung percussion is specific to:
Pneumothorax
Lobar pneumonia
Hydrothorax
Acute bronchitis
Lung oedema
A patient complains of shortness of breath and productive cough. Pneumonia is present in the lungs if you find:
Bronchial breath sounds
Increased tactile fremitus
Inspiratory and expiratory wheezes
Dullness to percussion
Absent adventitious sounds
Which of the following findings in clinical examination speaks against the presence of ascites (select one)?
Presence of shifting dullness
Positive fluid wave test
Flank tympany
Bulging flanks
What pressure values determine the diagnosis of hypertension in this patient, choose one answer:
Arterial pressure ≥ 130/80 mmHg, measured on the left arm
Arterial pressure ≥ 150/90 mmHg, measured on the left arm
Arterial pressure ≥ 130/85 mmHg, in two different measurements, regardless of arm
Arterial pressure ≥ 140/90 mmHg, in two different measurements, regardless of arm
In which valvular heart disease systolic murmur may be present
Aortic stenosis and mitral regurgitation
Aortic stenosis and mitral stenosis
Tricuspid stenosis and aortic regurgitation
Aortic stenosis and tricuspid stenosis
68-years old patient reported to the GP due to the peripheral oedema. He noticed that his left leg swells 2 days ago and erythema appeared after one day.In physical examination the doctor also found that the affected leg is warmer. The symptoms are limited only to one leg. Which of the following is the least probable cause of patient’s complaints?
Heart failure
Deep vein thrombosis
Erysipelas
Lymphangitis
Which of the following is NOT an eye sign of hyperthyroidism
Möbius's sign
Graefe's sign
Rovsing's sign
Kocher's sign
Globe’s lag behind the eyelid’s movement at looking upwards observed in hyperthyroidism is called (select one):
Duroziez’s sign
Stellwag’s sign
Kocher’s sign
Graefe sign
Mobius’ sign
Which statement about spleen examination is FALSE?
An enlarged spleen may be missed if the examiner starts too high in the abdomen to feel the lower edge
A positive splenic percussion sign exclude splenomegaly
Fluid or solids in the stomach or colon may also cause dullness in Traube’s space
A change in percussion note in the lowest interspace in the left anterior axillary line, from tympany to dullness on inspiration suggests splenic enlargement
Movement of the auricle and tragus (the “tug test”) is painful in
Otitis media
Otitis interna
Otitis externa and otitis media
Otitis externa
A 75-year-old woman with history of cardiac heart failure presents with several weeks of gradually progressive dyspnoea on exertion. In the heart auscultation you find mid-systolic diamond-shaped murmur in the right 2nd interspace radiating to the neck, best heard with the patient sitting and leaning forward.What valvular pathology do you suspect?
Aortic incompetence
Pulmonic stenosis
Mitral regurgitation
Aortic stenosis
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