IPD PART RATIO

#111-150
SECTION 3F
SY 2018-2019

111. To palpate for S1, feel for the upstroke by placing your left index and middle finger on the:
A. Carotid artery C. Jugular vein
B. Chest wall D. Radial artery

Answer: A. Carotid artery. As you listen to the heart sounds, you can identify which one is S1 or
S2 by palpating the carotid artery. The upstroke is corresponds to S1 while the other is S2.

112. If you cannot identify the apical impulse at the supine position, the NEXT step you can do is
ask the patient to:
A. Elevate head to 30 degree angle
B. Exhale fully and stop breathing for a few seconds
C. Right lateral decubitus
D. Roll partly to the left

Answer: D. Roll partly to the left. 1st step is to inspect the apex beat if visible. If not, palpate by
laying the palmar aspect of the right hand within the vicinity of the usual location. If not
palpable in supine, palpate in the left lateral decubitus position or sitting and leaning forward.
Apex beat is palpable only in 50% of normal adults.

113. Apical impulse location can be accurately assessed if the patient is in this position:
A. Left lateral decubitus C. Sitting and leaning forward
B. Moderate high back (30 deg) D. Supine

Answer: D. Supine. Inspection and palpation of the precordium as well as auscultation are all
done beginning in the supine position.

114. Assessment of apical impulse include/s:

A. Amplitude C. Location
B. Duration D. All of the above

Answer: D. All of the above.

115. Normal amplitude is described as small and feels brisk.

A. TRUE B. FALSE

Answer: A. TRUE. Another description aside from small and brisk is ‘gentle tap’.
116. True about apical impulse.
A. ALWAYS corresponds to the point of maximal impulse (PMI)
B. Normally palpated along the anterior axillary line
C. Palpable in 50% of individuals in the supine position
D. Represents the brief early pulsation of the left ventricle.

Answer: D. Represents the brief early pulsation of the left ventricle. The apical impulse or apex
beat may not be the PMI which is why we need to describe its location. It is normally palpated
along the 5th ICS, LMCL; 1x2cm; palpable in 50% of normal adults (not necessarily in the supine
position since there are other maneuvers after supine to try to feel the apical impulse).

117. Which of the following questions is/are most appropriate in eliciting the chief complaint?
A. Do you feel pain?
B. What brings you here?
C. What is your problem?
D. What is your chief complaint?
E. All of the above

Answer: B. What brings you here? (We know this by heart- in Filipino, Ano pong dahilan at
kumonsulta po kayo dito ospital?- open-ended, unassuming)

118. In a 25 year-old female with chief complaint of abdominal pain, which of the following
question/s is/are relevant in the history of present illness?
A. When did you first notice the pain?
B. When was your last menstrual period?
C. Do you have any previous operations?
D. Do you have allergy to any medicine?
E. All of the above

Answer: A. When did you first notice the pain?- Timing under PQRST. LMP is part of menstrual
and obstetric history; previous surgeries and allergies are under past medical history along with
medical, gynecologic illnesses, medications, blood transfusion, accidents and injuries,
psychiatric history.

119. Which of the following should be included in the Personal and Social History?
A. Living conditions C. Sexual history
B. Dietary preferences D. All of the above

Answer: D. All of the above. All are included under personal and social history including
occupation, relationships, smoking history, education, etc.
120. Which of the following statement/s regarding the History of present illness is/are TRUE:
A. Current symptoms are reported in their chronologic or temporal context.
B. It includes childhood illnesses
C. It states the immediate reason for seeking medical condition
D. It includes maintenance medications which the patient has been taking
E. All of the above

Answer: A. Current symptoms are reported in their chronologic or temporal context.

B and D are under Past Medical History while C refers to Chief complaint.

121. It details the course of the illness from the date of last discharge or from the time the
patient was last seen to the present admission.
A. Interval History C. History of present illness
B. Summary Case D. None of the above

Answer: A. Interval history. This replaces the HPI for chronic conditions with numerous previous
admissions related to the current admission.

122. True of Respiratory Rate:

A. Normal rate is 12 cycles per minute
B. Instruct patient to inhale then exhale while counting the respiratory rate
C. Patient should not be aware that you are counting his/her respiratory rate
D. A and C

Answer: D. A and C. Normal RR is 12-20 cpm and patient should not be aware to avoid
conscious control of breathing so no instruction on breathing should be given.

123. In getting the blood pressure of a patient, which area should be palpated in order to check
for a viable pulse and after which the bell of the stethoscope must also be placed?
A. Brachial artery B. Femoral artery
C. Radial artery D. Ulnar artery

Answer: A. Brachial artery. We use the brachial artery to get the BP.

124. What data should be obtained first in order to know how high the cuff pressure should be?
A. Heart rate C. Systolic pressure
B. Diastolic pressure D. Radial artery pressure

Answer: C. Systolic pressure. The systolic pressure is estimated by palpation of the radial artery
by inflating the cuff until the radial pulse disappear then gradually deflate the cuff until the first
pulsation is felt.
125. Instructions given to patient before taking the blood pressure, EXCEPT:
A. Rest for 5 minutes
B. No smoking for at least 30 minutes before
C. At least 8-10 hours of sleep the day before the consult
D. No food intake at least 30 minutes prior
E. No caffeinated beverages immediately prior.

Answer: C. At least 8-10 hours of sleep the day before the consult. Patient should have rested
for 5 minutes and ideally should not have eaten or smoked for 30 minutes prior.

126. Choose the correct statement regarding blood pressure measurement using
sphygmomanometer?
A. Patient should have rested at least 10 minutes.
B. The bell of the stethoscope is placed over the radial artery.
C. The cuff is deflated slowly at a rate of 6-8 mmHg per second
D. The disappearance point of the korotkoff sounds corresponds to the diastolic
pressure.

Answer: D. The disappearance point of the korotkoff sounds corresponds to the diastolic
pressure. Patient should have rested for 5 mins. The bell is placed over the brachial artery. The
cuff is deflated slowly at a rate of 2-3 mmHg per second.

127. Which gives the highest temperature reading?

A. Axillary C. Oral
B. Forehead D. Rectal

Answer: D. Rectal. Rectal temperature is 0.4 to 0.5 degrees Celsius higher than oral readings.
Axillary and forehead readings are more superficial and lower.

128. A 29 year old male, who smokes 40 sticks per day for 5 years. Compute for the pack years.
A. 8 C. 12
B. 10 D. 14

Answer: B. 10 Pack years = (# of sticks/20 sticks per pack) x Years smoking

129. A 33 year old female, gave birth 4 times, 1 is spontaneous abortion. What is the Gravidity
and Parity?
A. G4P4 C. G3P3
B. G4P3 D. G4P2

Answer: B. G4P3. Gravidity refers to number of pregnancies. Parity refers to number of

pregnancies that reached or went beyond the threshold of viability (24 weeks). Spontaneous
abortion happens before 20 weeks; hence, is not included in parity.
130. Open ended question:
A. Narrative information
B. Limit rapport and leave interaction neutral
C. Specific details
D. Short or two-word answers

Answer: A. Narrative information. B, C, D describe closed or direct questions.

131. What visual field defect is usually involved with an enlarged pituitary gland?
A. Temporal C. Both
B. Nasal D. Neither

Answer: A. Temporal. Always remember that any lesion affecting the optic chiasm (yung
crossing) where an enlarged pituitary gland can encroach on, wil cause BITEMPORAL
HEMIANOPSIA.

132. Which of the following cranial nerves are tested when doing the pupillary light reflex?
A. Optic and oculomotor nerves C. Oculomotor and Trigeminal nerves
B. Optic and trigeminal nerves D. Oculomotor and facial nerves

Answer: A. Optic and oculomotor. The afferent arm is optic (yung magrereceive the light), and
the efferent arm is oculomotor (what will make the pupil constrict). Trigeminal and facial are
involved in corneal reflex.

133. Which of the following cranial nerves are tested when doing the corneal reflex.
A. Optic and oculomotor nerves C. Oculomotor and facial nerves
B. Oculomotor and trigeminal nerves D. Trigeminal and facial nerves

Answer: D. Trigeminal and facial nerves. Trigeminal is the afferent arm (yung sensation sa
cornea pag tinouch ng cotton) and facial is the afferent arm (what will cause you to blink).

134. Which of the following cranial nerves are tested when doing the doll’s eye reflex?
A. Optic and oculomotor C. Oculomotor and vestibulocochlear
B. Optic and vestibulocochlear D. Oculomotor and facial nerves

Answer: C. Oculomotor and vestibulocochlear. Doll’s eye or vestibule-ocular reflex is elicited

when the head is moved producing eye movement in the direction opposite to the head
movement. Head movement activates the vestibulocochlear (afferent), producing the eye
movement through the oculomotor (efferent). The purpose of this reflex is to stabilize images
on the retina during head movement.

135. Which of the following cranial nerves are tested when doing the gag reflex?
A. Glossopharyngeal and vagus C. Vagus and hypoglossal
B. Glossopharyngeal and hypoglossal D. Neither
Answer: A. Glossopharyngeal and vagus. CN IX and X are tested together in gag reflex, checking
for dysphonia and dysarthria, position of the uvula, equal elevation of the palate. Immediately
exclude hypoglossal because it is for tongue fasciculations, symmetry, atrophy, deviations and
movement.

136. Active movement against gravity with minimal to moderate resistance applied.
A. Grade 1 B. Grade 2
C. Grade 3 D. Grade 4
E. Grade 5

Answer: Grade 4. I always remember the Muscle strength grading by remembering

GRADE 3- Against gravity without resistance (meaning itinaas lang yung kamay)
…then go up or down
Grade 4 and 5: you will apply resistance, minimal to moderate for Grade 4 and full resistance
for Grade 5
Grade 1 and 2: Gravity eliminated (hindi na maitaas) but for Grade 2, still able to move (parang
ginagalaw lang arms habang nakapatong sa kama), and Grade 1, only slight contractility with no
evidence of joint motion
Grade 0- no evidence of muscle contractility
NORMAL MUSCLE STRENGTH IS 5/5.

137. Normal deep tendon reflex

A. + C. +++
B. ++ D. ++++

Answer: B.++.
0- Absent
+- Diminished
++- normal
+++- increased or hyperactive
++++- hyperactive with clonus

138. Failure to do rapid alternating movement is called

A. Dysdiadochokinesia C. Apraxia
B. Dysmetria D. Ataxia

Answer: A. Dysdiadochokinesia (failure to do rapid alternating movement- yung pinapagaya

natin sa patient na binabalikbaliktan many times yung hands sa lap; a cerebellar test)
Dysmetria – clue yung ‘metria’ meaning cannot accurately estimate distance, elicited when we
ask the patient to do finger-nose-finger test tapos lagpas lagpas yung turo niya
Apraxia- inability to perform purposeful actions, tested using 3-stage command; a test of
cortical motor integration under Cerebrum sa Neuro assessment
Ataxia – loss of muscle control and balance; observed when testing the gait of the patient (pag
pinapalakad natin); usually associated with cerebellar disease

139. The Romberg Test is mainly a test for:

A. Vibration C. Visual coordination
B. Proprioception D. Cerebellar function

Answer: B. Proprioception. If you know how Romberg’s is done (yung nakatayo tapos pipikit
kung magkakaroon siya ng imbalance), you can immediately eliminate A and C. It is mainly a
test of proprioception, but also used in testing cerebellar function, but to DIFFERENTIATE
cerebellar from proprioceptive abnormality. When imbalance is only present when eyes are
closed, proprioceptive lang yun, but if with imbalance whether eyes are open or closed,
cerebellar yun.

140. Peristaltic waves may be normal in thin individuals:

A. True B. False

Answer: A. True. Peristaltic waves may be normal in thin individuals. Another possible normal
finding na ‘sounds abnormal’ ay pulsations IN the epigastric region. But pulsations OUTSIDE the
epigastric region are always abnormal.

141. The umbilicus can be described by the following except:

A. everted C. scaphoid
B. inverted D. flat

Answer: C. Scaphoid. A, B and D are descriptions of the umbilicus. Scaphoid, flat, globular, and
protuberant can be used to describe the shape of the abdomen.

142. Visible pulsations in the abdomen

A. pulsation of the ascending aorta C. seen on the epigastric region
B. seen on individuals with protuberant abdomen D. seen on the iliac region

Answer: C. seen on the epigastric region. This can be a normal finding especially for thin
individuals due to the abdominal aorta.

143. This is a correct description of an abdominal scar

A. 2-inch linear scar at the right inguinal area from an appendectomy
B. scar at the periumbilical area
C. post Cesarean scar
D. 5 cm circumferential scar

Answer: A. 2-inch linear scar at the right inguinal area from an appendectomy. Description
should be complete- size, appearance, location, cause
144. Which of the following can be a normal inspection finding of the abdomen?
A. spider angiomata C. mass
B. pulsations ouside the epigastric region D. peristaltic wave

Answer: D. peristaltic wave. See ratio for No. 140. Spider angiomata is associated with liver
disease. Mass is abnormal

145. What is the standard format in examining the Abdomen.

A. Auscultation, Inspection, Palpation, Percussion
B. Inspection, Auscultation, Percussion, Palpation
C. Inspection, Palpation, Percussion, Auscultation
D. Inspection, Percussion, Palpation, Auscultation

Answer: B. Inspection, Auscultation, Percussion, Palpation. Remember IAPP for Abdomen, for
the rest, IPPA (Inspection, Palpation, Percussion, Auscultation)

146. What is the percussion sound over the small intestine?

A. Tympanitic C. Resonant
B. Dull D. Hyperresonant

Answer: A. Tympanitic. Dull is for solid organs like liver, spleen. Resonant and for hyperresonant
are for lungs.

147. In measuring for the liver span, it should start in percussing tympany from below the level
of:
A. Subcostal margin C. Inguinal
B. Umbilicus D. Nipple area

Answer: B. Umbilicus. You only have 2 landmarks for the liver span, the level of the umbilicus
(start with tympanitic going up until it becomes dull) and the right nipple (start with resonant
going gown until dull)

148. The normal liver span at the right mid-clavicular line is between:
A. 3 to 6 cm C. 6 to 12 cm
B. 12-15 cm D. 15 to 18 cm

Answer. C. 6 to 12 cm (memorize); 4-8cm in midsternal line

149. Normal result of percussing the spleen:

A. Splenic dullness over one intercostal space from 7th to 9th intercostal space
B. Tympanitic from 9th to 11th intercostal space mid clavicular to anterior axillary line
C. No resonance appreciated
D. No dullness appreciated
Answer: D. No dullness appreciated. Normal finding is NO DULLNESS appreciated or Splenic
dullness over ONE ICS from the 9th to 11th ICS.

150. What is the percussion sound over the liver:

A. Tympanitic C. Resonant
B. Dull D. Hyperresonant

Answer: B. Dull. Refer to ratio for #146.