Student name: ------------------------------------ Student ID: ----------------------------
1- A 52-year-old man presents with a 3-week history of rectal discomfort and a persistent, urgent sensation of needing to pass
stool, even after defecation. He reports small-volume, frequent bowel movements and occasional blood mixed with the stool.
What symptom is he most likely experiencing?
A. Tenesmus B. Steatorrhea C. Melena D. Fecal incontinence E. Constipation
2- Pain in RLQ upon palpation of the LLQ:
A. Rovsing's sign B. Murphy's sign C. Valnitino's sign D. Boa's sign E. Kehr’s sign
3- All of the following statements regarding Buerger’s angle are true except:
A. In a normal limb, the toes stay pink even when the leg is raised to 90°.
B. Elevating the leg to 30° for 30-60 seconds and seeing pallor is a sign of arterial insufficiency.
C. An angle of less than 20° during the Buerger’s angle test indicates mild to moderate ischemia in lower limb.
D. After lowering the leg, the foot should turn from white to pink and then to purple-red in cases of reactive hyperemia.
E. The Buerger’s angle test can be useful for comparing both limbs to assess for asymmetry in arterial blood flow.
4- A groin swelling appears when the patient stands. With your finger on the midpoint of the inguinal ligament, you feel a sudden
impulse on coughing just above your fingertip. Which hernia is this?
A. Femoral hernia B. Direct inguinal hernia C. Indirect inguinal hernia D. Spigelian hernia
E. Not a hernia, just femoral artery pulsation
5- A 68-year-old woman presents to the emergency department with acute right groin pain that started 12 hours ago. She has
associated nausea and has vomited once. On examination, there is a tender, firm, and irreducible mass located below and lateral to
the pubic tubercle. Bowel sounds are diminished. What is the most likely type of hernia?
A. Femoral hernia B. Direct inguinal hernia C. Indirect inguinal hernia D. Obturator hernia E. Spigelian hernia
6- The scar following a standard open appendectomy procedure is called:
A. Paramedian scar B. Midline abdominal scar C. Pfannenstiel's scar D. Kocher's scar E. McBurney's scar.
7- All of the following can cause constipation EXCEPT:
A. Excess of fiber in diet B. Irritable bowel syndrome C. Intestinal obstruction
D. Hypothyroidism E. Hypercalcaemia
8- Which of the following causes abdominal distention?
A. Organomegaly B. Ascites C. Malignancy D. Intestinal obstruction E. All answers are true
9- Which of the following is true regarding auscultation during abdominal examination in a surgical patient?
A. In paralytic ileus, bowel sounds initially increase before becoming completely absent.
B. Renal artery bruits are best heard 2 cm below and 2 cm lateral to the umbilicus on both sides.
C. Iliac artery bruits are best heard 5 cm below and 2 cm lateral to the umbilicus on both sides.
D. In intestinal obstruction, bowel sounds increase in frequency and have a high-pitched, tinkling character.
E. Bowel sounds are typically loudest in the epigastric region regardless of pathology.
10. Which of the following forms the most common cause of bloody nipple discharge:
A. Duct ectasia B. Carcinoma of breast C. Lactational mastitis D. Intraductal papilloma E. Fibrocystic disease
11. All of the following are signs and symptoms of thyrotoxicosis, EXCEPT:
A. Chemosis B. Lid retraction C. Exophthalmos D. Asterixis E. Fine tremor
12. Which of the following is the most appropriate technique to assess for hepatomegaly during physical examination?
A. Begin palpation at the right hypochondrium and move upward toward the costal margin during deep inspiration.
B. Start palpation just below the costal margin and move downward while the patient exhales deeply.
C. Begin palpation in the right iliac fossa and move upward toward the costal margin while the patient takes deep breaths.
D. Percuss only over the left lower ribs to identify dullness associated with liver enlargement.
E. Position the patient upright and palpate the right lower quadrant for liver edge movement during expiration.
13. Which of the following statements about the physical examination for splenomegaly is correct?
A. Palpation for splenomegaly begins in the right iliac fossa and moves toward the right costal margin.
B. Castell’s sign is elicited by percussing the left midclavicular line during inspiration and is positive when the note remains
resonant.
C. Traube’s space is bounded superiorly by the sixth rib, laterally by the left midaxillary line, and inferiorly by the left
costal margin.
D. A dull percussion note over Traube’s space is a normal finding and rules out splenomegaly.
E. In splenomegaly, the spleen can be felt just beneath the left costal margin on deep inspiration.
14. Which of the following about thyroid examination is FALSE?
A. Percussion can be helpful in swelling that extends below the suprasternal notch.
B. We do thyroid examination while the patient is supine at 20 degrees.
C. Palpation should be done from behind the patient with the head slightly flexed.
D. Swelling of the thyroid can be confirmed by asking the patient to swallow.
E. Thyroid auscultation should be performed to check for any systolic bruits.
15- You were asked to examine a patient with hypothyroidism, which of the following features are mostly likely to find?
A. Bradycardia B. Tachycardia C. Weight loss D. Exophthalmos E. Facial Palsy
16- Most notable feature on inspection of limb ischemia?
A. Vascular angle B. Ankle brachial index C. Vascular refilling time D. Color E. Capillary refilling time
17- Which of the following is NOT typically included in a social history assessment?
A. Patient's living home status B) Patient's occupation and exposure to hazards
C) Patient's history of smoking and alcohol use D) Patient's allergy history E) Patient's travel history
18- A fluid thrill during percussion can be caused by which of the following?
A. Gastric distension B. Hepatomegaly C. Intestinal obstruction D. Ascites E. Pregnancy
19- As a doctor, which of the following is the least appropriate attitude during patient interaction?
A. Demonstrating empathy and compassion toward the patient.
B. Starting with open-ended questions to explore the patient's concerns.
C. Respecting the patient’s privacy and maintaining confidentiality.
D. Using active listening to understand and respond appropriately.
E. Allowing the patient to guide the history-taking process according to their own priorities.
20- Which of the followings are abnormal nodules around umbilicus?
A. Blummer shelf nodules B. Irish nodules C. Campell de Morgan
D. Sister Mary Joseph nodules E. Osler nodules
1- A 24-year-old female pa琀椀ent presented to the emergency department with acute, sudden-
onset severe right pelvic pain. The pain was associated with nausea and vomi琀椀ng. She has a
known history of an ovarian mass. Which of the following statements regarding pain
sensa琀椀on is true?
A) Radia琀椀ng pain is the extension of pain to another site while the original site becomes
pain-free.
B) Referred pain is felt at a site distant from its source and occurs due to the central nervous
system’s inability to dis琀椀nguish between visceral and soma琀椀c sensory input.
C) Tenderness refers to pain that is always present and becomes worse only when the area is
touched.
D) Soma琀椀c pain is typically poorly localized.
E) Soma琀椀c pain is transmi琀琀ed through the autonomic nervous system.
Answer: B.
2- You were asked to examine a pa琀椀ent in the outpa琀椀ent clinic who is complaining of
jaundice. Which of the following statements about jaundice is false?
A) It can be caused by obstruc琀椀on in the bile ducts.
B) It can be caused by excessive hemolysis.
C) It usually appears 昀椀rst in the skin and urine, then later in the white sclera.
D) It can be caused by liver malfunc琀椀on.
E) Jaundice is a yellow discolora琀椀on caused by an abnormally increased blood level of
bilirubin.
Answer: C
3- A pa琀椀ent presents with a reducible swelling in the right groin. On examina琀椀on, a昀琀er
reducing the hernia, you apply pressure over the deep (internal) inguinal ring. The hernia
does not reappear. Which of the following 昀椀ndings is most consistent with an indirect
inguinal hernia?
A) The hernia bulge reappears directly forward a昀琀er reduc琀椀on.
B) The hernia descends straight backwards and is not controlled by pressure over the
internal inguinal ring.
C) The hernia reappears in the middle of the inguinal region and 昀氀ows medially and obliquely
toward the scrotum.
D) The hernia does not descend into the scrotum and is more common in older adults.
E) The hernia is not present in children and is never controlled by ring pressure.
Answer: C
4- While examining a pa琀椀ent for suspected splenomegaly, percussion over Traube’s space is
performed. Which of the following statements is correct?
A) Traube’s space is bounded superiorly by the le昀琀 sixth rib, laterally by the midaxillary line,
and inferiorly by the le昀琀 costal margin.
B) Dullness over Traube’s space always con昀椀rms the presence of splenomegaly.
C) Traube’s space is the le昀琀 inferior costal space at the level of the anterior axillary line.
D) Percussion of Traube’s space is best done during expira琀椀on to minimize diaphragma琀椀c
movement.
E) Tympany over Traube’s space is an abnormal 昀椀nding and indicates splenic enlargement.
Answer: A
5- While performing a physical examina琀椀on to assess for hepatomegaly, which of the
following techniques or 昀椀ndings is correct?
A) Start palpa琀椀on just below the right costal margin, as this is where the liver edge is
normally felt.
B) Palpate during expira琀椀on to allow the liver to rise and be more easily felt.
C) The liver edge is normally palpable in all healthy adults, especially during deep inspira琀椀on.
D) A normal liver edge is irregular and may be tender on deep palpa琀椀on.
E) To es琀椀mate the liver span, percussion should be performed over the chest along the
midclavicular line to iden琀椀fy the upper border of the liver.
Answer: E
6- A pa琀椀ent presents to the outpa琀椀ent clinic. He is a known case of hepa琀椀c encephalopathy.
You are asked to examine for asterixis. Which of the following is true about asterixis?
A) Asterixis is a sudden, brief, and irregular 昀氀apping tremor of the hands when held in an
outstretched posi琀椀on
B) Asterixis is a rhythmic, 昀椀ne tremor of the 昀椀ngers observed in pa琀椀ents with Parkinson’s
disease.
C) Asterixis is seen in the lower limbs when the pa琀椀ent a琀琀empts to walk or stand.
D) Asterixis occurs in the hands only when the pa琀椀ent is at rest.
E) Asterixis occurs in the hands and is always accompanied by signi昀椀cant motor weakness.
Answer: A
7- Which of the following ulcer edges denotes malignancy?
A) Punched out edge
B) Undermined edge
C) Sloping edge
D) Rolled edge
E) Smooth edge
Answer: D
8- What is the correct order for performing an abdominal examina琀椀on?
A) Inspec琀椀on, palpa琀椀on, percussion, ausculta琀椀on
B) Palpa琀椀on, ausculta琀椀on, inspec琀椀on, percussion
C) Inspec琀椀on, ausculta琀椀on, percussion, palpa琀椀on
D) Percussion, inspec琀椀on, ausculta琀椀on, palpa琀椀on
E) Ausculta琀椀on, inspec琀椀on, percussion, palpa琀椀on
Answer: C
9- All of the following are symptoms and signs of acute limb ischemia EXCEPT:
A) Pulseless
B) Painless
C) Paresthesia
D) Paralysis
E) Pallor
Answer: B
10- A 45-year-old woman presents with a palpable lump in her right breast. During the
clinical examina琀椀on, which of the following characteris琀椀cs of the lump would most likely
raise suspicion for malignancy?
A) The lump is smooth, mobile, and tender to touch.
B) The lump is hard, irregular in shape, and non-tender.
C) The lump is located in the upper outer quadrant and is freely mobile.
D) The lump is so昀琀, well-de昀椀ned, and moves with palpa琀椀on.
E) The lump has clear borders, is painless, and is tender on palpa琀椀on.
Answer: B
11- The scar following a standard open cholecystectomy procedure is called:
A) McBurney's scar
B) Midline abdominal scar
C) Pfannens琀椀el's scar
D) Kocher's scar
E) Lanz's scar
Answer: D
12- Hyperthyroidism usually causes all of the following symptoms except:
A) Weight loss
B) Nervousness
C) Increased bowel movements
D) Tachycardia
E) Weight gain
Answer: E
13- A 57-year-old female presents to the hospital with abdominal swelling. She has a history
of a midline laparotomy due to trauma. The a琀琀ending physician diagnoses an incisional
hernia. Which of the following statements regarding hernia terminology is correct?
A) Irreducible means that the contents of the hernia sac can be returned to the abdominal
cavity, but with di昀케culty.
B) Incarcerated means that the contents are trapped within the hernia sac; most of the 琀椀ssue
remains viable but is not func琀椀oning properly.
C) Obstructed means that a loop of bowel is kinked or trapped in the hernia sac,
compromising both its lumen and blood supply.
D) Strangulated means that compression or twis琀椀ng has compromised the blood supply to
the hernia contents, leading to ischemia or infarc琀椀on, with or without lumen obstruc琀椀on.
E) Bilateral direct inguinal hernias are referred to as a pantaloon hernia.
Answer: D.
14- Which of the following is not typically included in the History of Present Illness (HPI)?
A) A detailed 琀椀meline and descrip琀椀on of the chief complaint
B) Associated symptoms and relevant nega琀椀ves
C) Family history of similar condi琀椀ons
D) Cons琀椀tu琀椀onal symptoms like fever, fa琀椀gue, or weight loss
E) A chronic medical condi琀椀on that directly contributes to the current complaint
Answer: C
15- Which of the following statements about rebound tenderness is true?
A) Rebound tenderness refers to pain that radiates to the shoulder due to diaphragma琀椀c
irrita琀椀on.
B) Rebound tenderness is elicited by deep palpa琀椀on without any removal of pressure.
C) Rebound tenderness is more speci昀椀c than guarding for detec琀椀ng appendici琀椀s.
D) The sudden withdrawal of manual pressure may cause a sharp exacerba琀椀on of the pain,
which is known as rebound or release tenderness.
E) Rebound tenderness is the hal琀椀ng of inspira琀椀on because of the abdominal pain.
Answer: D
16- Shi昀琀ing dullness on abdominal percussion is most useful for detec琀椀ng:
A) Gastric distension
B) Hepatomegaly
C) Pancrea琀椀琀椀s
D) Ascites
E) Splenomegaly
Answer :D
17- Which of the following combina琀椀ons most strongly suggests a malignant cause for
abdominal symptoms?
A) Bloa琀椀ng and episodic diarrhea
B) Sudden onset right lower quadrant (RLQ) pain in a 21-year-old male
C) Weight loss, anorexia, night sweats, early sa琀椀ety
D) Acute cons琀椀pa琀椀on relieved a昀琀er 1 week
E) Colicky pain relieved by defeca琀椀on
Answer: C
18- Which of the following is typically not recorded during drug history taking?
A) The generic (scien琀椀昀椀c) name of each medica琀椀on
B) Previous blood transfusions
C) The brand (trade) name of each medica琀椀on
D) History of drug allergy sensi琀椀vity
E) History of drug side e昀昀ects/complica琀椀ons.
Answer: C
19- As a doctor, which of the following is the least appropriate a琀�tude during pa琀椀ent
interac琀椀on?
A) Demonstra琀椀ng empathy and compassion toward the pa琀椀ent.
B) Star琀椀ng with open-ended ques琀椀ons to explore the pa琀椀ent's concerns.
C) Respec琀椀ng the pa琀椀ent’s privacy and maintaining con昀椀den琀椀ality.
D) Using ac琀椀ve listening to understand and respond appropriately.
E) Allowing the pa琀椀ent to guide the history-taking process according to their own priori琀椀es.
Answer: E
20- While examining a female pa琀椀ent in the ED, you no琀椀ced her nail plate to have spoon
shape. What is the name of this physical 昀椀nding:
A) Beau’s lines nail
B) Leuconychia
C) Lindsay’s nails
D) Koilonychia
E) Onycholysis
Answer: D
