University of Bamenda Medicine Exam PDF, 2022

## UNIVERSITY OF BAMENDA ### FACULTY OF HEALTH SCIENCES Department of Biomedical Sciences ### FIRST SEMESTER EXAMINATION Programme: **MEDICINE** YEAR 3 Credit Value: 4 Course Code/Title: CLSH 4101 Clinical Semiology 1 Time Allowed: 2 hours Date: 04/02/2022 Hall: Hall 1 Course Instructors: Dr Tanygie...

## UNIVERSITY OF BAMENDA ### FACULTY OF HEALTH SCIENCES Department of Biomedical Sciences ### FIRST SEMESTER EXAMINATION Programme: **MEDICINE** YEAR 3 Credit Value: 4 Course Code/Title: CLSH 4101 Clinical Semiology 1 Time Allowed: 2 hours Date: 04/02/2022 Hall: Hall 1 Course Instructors: Dr Tanygie/Dr Kuaban/Dr Jingi/Prof Ashuntantang. Instructions: Write down in your answer sheet the letter that corresponds to the correct answer. Return your exam questions paper. ### SECTION A: CARDIOVASCULAR SYSTEM Only one answer is correct. 1. A 54-year-old man with a 20-year history of hypertension has a point of maximal impulse that is palpable at the left 6th intercostal space lateral to the mid-clavicular line spaces. Which of the following best explains the location of the point of maximal impulse? * A) It means that the patient has left ventricular enlargement (cardiomegaly) * B) It means the patient has congestive heart failure * C) It means that the patient has aortic stenosis * D) It means the patient has mitral stenosis * E) It means the patient has a pericardial effusion 2. How would you describe the intensity of a systolic murmur that is easily audible, associated with a thrill, however, the stethoscope must remain on the chest to hear the murmur? * A) Grade I * B) Grade II * C) Grade III * D) Grade IV * E) Grade V * F) Grade VI 3. What could a pericardial friction rub indicate? * A) Acute pericarditis * B) Pericardial effusion * C) Constrictive pericarditis * D) Cardiac tamponade * E) None of the above 4. Which of the below describes stable angina? * A) Angina occurring at rest with a fixed duration * B) Recent onset angina occurring with a fixed amount of exertion relieved with rest * C) Chronic angina occurring with a fixed amount of exertion relieved with rest * D) Angina occurring with a fixed amount of exertion that has recently required less exertion to bring about symptoms * E) Symptoms of angina with a consistent amount of physical exertion that is relieved with rest that has been present for a long duration 5. Which of the following is not a sign of heart failure on the chest x-ray? * A) Cardiomegaly * B) Kerley B lines * C) Pleural effusion * D) Enlarged mediastinum * E) None of the above 6. Which of the following is not a cause of edema? * A) Cardiac failure * B) Nephrotic syndrome * C) Liver failure * D) Chronic venous insufficiency * E) Alcohol 7. An 80-year-old woman on a ward has syncope when getting up from bed to wash in the morning. The doctor performs a lying-standing blood pressure measurement. A drop of BP by how much within the first 3 min indicates orthostatic hypotension? * A) 20/10 * B) 30/15 * C) 40/20 * D) 50/25 * E) None of the above 8. Which of the following can present with a weak or hypokinetic pulse? * A) Hypovolemia * B) Anemia * C) Fever * D) Aortic regurgitation * E) None of the above 9. The Kussmaul sign is seen in which of the following disorders? * A) Cardiomyopathy * B) Left ventricular infarction * C) Right ventricular infarction * D) Septal wall dysfunction * E) Constrictive pericarditis 10. The arrow in the figure below shows which physical examination finding? ## UNIVERSITY OF BAMENDA (CONTINUED) ### FACULTY OF HEALTH SCIENCES Department of Biomedical Sciences ### FIRST SEMESTER EXAMINATION Programme: **MEDICINE** YEAR 3 Credit Value: 4 Course Code/Title: CLSH 4101 Clinical Semiology 1 Time Allowed: 2 hours Date: 04/02/2022 Hall: Hall 1 Course Instructors: Dr Tanygie/Dr Kuaban/Dr Jingi/Prof Ashuntantang. Instructions: Write down in your answer sheet the letter that corresponds to the correct answer. Return your exam questions paper. ### SECTION A: CARDIOVASCULAR SYSTEM Only one answer is correct. 11. Which of the following is not a characteristic of the pulse? * A) Rate * B) Regularity * C) Amplitude * D) Velocity * E) None of the above 12. An electrocardiogram can be used in the diagnosis of which of the following? * A) Arrhythmias * B) Infective endocarditis * C) Peripheral arterial disease * D) Pneumonia * E) None of the above 13. Which of the following is true regarding the third heart sound (S3)? * A) It is a high-pitched sound * B) It is a normal finding in the elderly * C) It is heard in early systole * D) It is associated with atrial dysfunction * E) It is best heard at the apex of the heart 14. Which of the following heart sounds is produced by closure of the semilunar (aortic and pulmonic) valves? * A) S3 * B) Opening snap * C) S1 * D) S2 * E) S4 15. Which of the following statements best describes a precordial thrill? * A) It is a normal finding * B) It accompanies most heart murmurs * C) It only exists during systole * D) It is a palpable murmur * E) It is always a sign of congestive heart failure 16. A patient present's with dyspnoea on mild exertion. According to the New York Heart Association, she is suffering from: * A) Grade 2 dyspnoea * B) Grade 3 dyspnoea * C) Grade 4 dyspnoea * D) Grade 5 dyspnoea * E) None of the above 17. A patient suffering from edema of the legs and abdomen and raised jugular venous pressure most likely has: * A) Hypertension * B) Hypotension * C) Left-sided heart failure * D) Right-sided heart failure * E) None of the above 18. A pulse that fluctuates between strong and weak is often present in patients with very advanced heart failure. This type of pulse is known as: * A) Pulsus alternans * B) Pulsus paradoxus * C) Pulsus pulmonalis * D) Pulsus voivulus * E) None of the above 19. Which of the following heart sounds is produced by closure of the AV valves? * A) S3 * B) Opening snap * C) S1 * D) S2 * E) S4 20. The term bradycardia means * A) A grossly irregular heartbeat * B) A heartbeat of over 100 per minute * C) A heartbeat of under 60 per minute * D) A heartbeat that has irregular skipped beats * E) None of the above 21. A 16-year-old boy is referred to your practice for leg claudication. His right arm blood pressure is 150/110 mm Hg while his left leg blood pressure is 80/60 mm Hg. You also find that the patient's femoral pulses are diminished when compared to his brachial pulses. Which of the following is the most likely diagnosis? * A) Patent ductus arteriosus * B) Ventricular septal defect * C) Coarctation of the aorta * D) Atrial septal defect * E) Tetralogy of Fallot 22. A pericardial knock is heard in which of the following disorders? * A) Pericardial effusion * B) Pericardial tamponade * C) Pericarditis(infection of the pericardium) * D) Constrictive pericarditis * E) Restrictive cardiomyopathy 23. Which of the following is the best systematic method of heart auscultation? * A) Over the aortic valve, tricuspid valve, mitral valve, and pulmonic valve * B) Over the tricuspid valve, aortic valve, mitral valve, and pulmonic valve * C) Over the mitral valve, aortic valve, tricuspid valve, and pulmonic valve * D) Over the aortic valve, pulmonic valve, tricuspid valve, and mitral valve * E) Over the aortic valve, mitral valve, pulmonic valve, and tricuspid valve 24. Which of the following cardiovascular risk factors is modifiable? * A) Hypertension * B) Diabetes mellitus * C) Age * D) A and B * E) None of the above 25. Which of the following is not a differential diagnosis of life-threatening chest pain? * A) Myocardial infarction * B) Pulmonary embolism * C) Aortic dissection * D) Costochondritis * E) Acute pericarditis with tamponade 26. The following are signs of cardiovascular disease except * A) Edema * B) Hepatojugular reflux * C) Jugular venous distension * D) Murmur * E) Vertigo 27. Which of the following arteriole pulse waveforms is consistent with aortic stenosis? * A) Pulsus alternans * B) Pulsus tardus * C) Bisferiens pulse * D) Dicrotic pulses * E) Parvus et tardus pulse 28. By smoking 10 cigarettes a day for 30 years, Mr. X has consumed (only one answer): * A) 4 pack-years * B) 7 pack-years * C) 13 pack-years * D) 15 pack-years * E) 16 pack-years 29. Which classification system do we use to grade chest pain? * A. New York Heart Association * B. Canadian Heart Association * C. European Heart Association * D. WHO chest pain grade * E. None of the above 30. How do you grade the intensity of chest pain (scale)? * A. Three grades * B. Four grades * C. Five grades * D. Six grades * E. None of the above 31. Which classification system do we use to grade shortness of breath? * A. New York Heart Association * B. Canadian Heart Association * C. European Heart Association * D. WHO chest pain grade * E. None of the above 32. Which of the following statements is true regarding the grading of heart murmurs? * A. Grade 1 murmurs are never audible * B. Grade 2 murmurs are never audible * C. Grade 3 murmurs are loud * D. Grade 4 murmurs are loud obvious murmurs with a palpable thrill * E. Grade 5 murmurs may be heard with the stethoscope completely off the chest * * Mr. AN is a 60-year-old man. His medical history was remarkable for diabetes, hypertension, and intermittent epigastric pains immediately after meals, relieved with anti-acids. He is a known smoker, 25 sticks of cigarettes daily for about 30 years. He drinks alcohol occasionally. He admits that taking his medicines regularly. He was not regularly followed up by a physician. He denies any allergies. His presenting complaints were: Chest pain with exertion and one episode of spontaneous vomiting. The symptoms occurred after climbing a flight of stairs. The nurse assistant took his parameters while waiting to see you for consultation. His blood pressure was 122/66 mmHg with a heart rate of 109 beats per minute. His weight was 105.5 kg for a height of 185 cm. His respiratory rate was 22 per minute and his oxygen saturation was 92% on ambient air. 33. How do you grade that of Mr. AN? * A. Grade 3 * B. Grade 4 * C. Grade 5 * D. Grade 6 * E. None of the above 34. What is the clinical significance of the systolic murmurs in Mr. AN? * A. Aortic stenosis * B. Pulmonary Stenosis * C. Mitral insufficiency * D. Tricuspid insufficiency * E. All of the above * On further inquiry, Mr. AN admitted exertional shortness of breath with normal daily activities, associated with frequent palpitation. 35. How do you grade the shortness of breath of Mr. AN? * A. Grade 3 * B. Grade 4 * C. Grade 5 * D. Grade 6 * E. None of the above 36. List the most likely causes of shortness of breath in Mr. AN. * A. Right Heart failure or Chronic Obstructive Pulmonary Disease * B. Left Heart failure or Chronic Obstructive Pulmonary Disease (COPD) * C. Right Heart failure or Asthma * D. Left Heart failure or Asthma * E. Asthma or Pneumonia ### SECTION B: RESPIRATORY SYSTEM Instruction: Choose the single best correct answer Clinical case with questions 1-4 A 50 year old man is picked up from the roadside by the firefighters with his shirt and trousers covered with blood. When he is brought to the emergency department, he tells you that he in the last 2 months he has been coughing at times with streaks of blood in his sputum and he has lost over 15 kg of his weight. He also informs you since the age of 20 years he has been smoking in average two packets of cigarettes every day. 37. How will you qualify the present hemoptysis episode that made the firefighters bring the patient to the hospital? * a. Hemoptysis of mild abundance * b. Hemoptysis of moderate abundance * c. Massive hemoptysis * d. Cataclysmic hemoptysis * e. None of the above ### Clinical case with questions 5-7 A 25 year old lady is brought to the emergency department for chest pain associated with a cough productive of yellowish sputum, dyspnoea on effort and a fever of 39 ºC. She tells you the she started feeling sick only 5 days ago and she has nothing relevant in her past history. 41. Which among the elements listed below isn't a feature of pleuritic chest pain? * a. It is pain that appears with effort or exertion and disappears with rest * b. It is pain that is unilateral * c. It has a stabbing character * d. It worsens with deep breathing * e. It has a sudden onset 42. Looking at the colour of the sputum, it should be described as? * a. Muco-purulent * b. Purulent * c. Salivary * d. Mucoid * e. Rusty 43. Considering that the chest pain is actually pleuritic chest pain, what is the most likely diagnosis of the disease the patient is suffering from? * a. Pulmonary embolism * b. Pneumothorax * c. Pleurisy * d. Acute community acquired pneumonia * e. Bronchiectasis ### Instructions: For questions 8 and 10: choose the wrong answer 44. With regards to dyspnea * a. Dyspnoea is an objective sensation of respiratory discomfort * b. Dyspnoea can be inspiratory or expiratory * c. Platypnoea is dyspnea that occurs when the person is sitting or standing upright * d. Orthopnoea is dyspnea that occurs when the person is in lying in complete dorsal decubitus and relieved when he/she sits up * e. Dyspnoea can be accompanied by other symptoms 45. With regards to dyspnea * a. Polypnoea is rapid breathing (tachypnea) * b. Tachypnoea is an increase in the respiratory rate * c. The normal respiratory rate in adults is 12 to 16 breaths/minute * d. Inspiratory dyspnoea that occurs suddenly in children can be suggestive of inhalation of a foreign body * e. Dyspnoea is always associated with a reduction in the rhythm of breathing 46. As concerns examination in a patient with typical lung consolidation we observe all of the following except one, which one? * a. Fine crackles are heard in the affected side * b. Bronchial sounds are present * c. Transmission of vocal fremitus is decreased in the affected side * d. Chest expansion is reduced in the side affected * e. Percussion reveals dullness in the affected side ### Instructions: Choose the correct answer 47. According to the NYHA (New York Heart Association) classification, Class III dyspnoea corresponds to: * a. No occurrence of dyspnoea except when patient undergoes more than ordinary physical activity * b. Presence of slight limitation of physical activity with dyspnoea occurring during ordinary physical activity * c. Presence of marked limitation of physical activity with dyspnoea appearing for less than ordinary physical activity. The patient is comfortable at rest and there is no dyspnoea. * d. Presence of dyspnoea at rest resulting in inability to carry on any physical activity without discomfort * e. Dyspnoea when the patient walks up a small slope 48. Cyanosis * a. Is bluish colouration of the skin * b. Is yellowish colouration of the skin and mucous membranes * c. Is exaggerated in people with severe anaemia * d. Is masked in polycythemia * e. Is caused by an amount of reduced hemoglobin greater than 5g/100ml of capillary blood 49. Digital clubbing * a. Is a deformity of the extremities of the fingers only * b. Is a deformity of the fingers and toes with these having a drumstick appearance * c. Is a deformity of the extremities of the fingers and toes with nails bulging out like glass of watches * d. Is caused by stroke * e. Is a deformity of the extremities of the toes and fingers 50. The following are characteristics of fine crackles except one, which one? * a. They are fine sounds * b. They are heard exclusively during inspiration * c. They are sounds that become clearer and heard better after the person coughs * d. The sounds are equal in pitch from one breath to another * e. They can be heard during expiration 51. Fine crackles * a. Are heard during the two phases of breathing and predominantly during expiration * b. Are heard during the two phases of breathing and predominantly during inspiration * c. Are heard at the end of inspiration * d. Are heard typically during expiration * e. Are due to the exaggerated transmission of the bronchial sounds 52. The following characteristics about ronchi are true except one, which one? * a. Ronchi are not affected by coughing * b. Ronchi are of bronchial origin * c. Ronchi are modified when patient coughs * d. Ronchi can be heard in patients having Glite bronchitis * e. Ronchi have low tone and are heard during both phases of breathing 53. Choose the correct answer with regards to the descriptions concerning cough below: * a. Cough is not a defence mechanism for the body * b. Cough is exclusively a reflex action * c. Cough can be a reflex act as well as it can be voluntary * d. Cough is solely a voluntary act * e. Pneumonia is a typical cause of chronic cough 54. The following diseases can cause digital clubbing except one, which one? * a. Cyanotic heart disease * b. Bronchiectasis * c. Broncho-pulmonary suppurations * d. Pulmonary fibrosis * e. Asthma 55. The sputum in bronchiectasis * a. Is acute * b. Is predominantly produced in the morning * c. Is not linked with any change in posture * d. Is not usually abundant * e. Does not sediment in many layers 56. Which of the following characteristics points to dyspnoea of metabolic origin? * a. Pursed-lip breathing * b. Rapid, shallow breathing * c. Wheezing * d. Ample and deep Kussmaul breathing * e. Cheynes-Stokes breathing 57. The following sounds heard on auscultation are added sounds except one, which one? * a. Fine crackles * b. Amphoric sound * c. Coarse crackles * d. Wheeze * e. Pleural friction rub 58. On examination of the respiratory system: * a. Sole presence of tympany means there is pneumothorax * b. Duilness must always be present for us to say there is lung consolidation * c. Bronchial sounds are always abnormal when heard at the sternal notch * d. The vesicular breath sounds are best heard next to the sternum * e. The vesicular breath sounds can decrease or disappear in cases of pneumothorax, pleural effusion and lung consolidation 59. Bronchial breath sounds can be heard in one of the foliowing syndromes, which one? * a. Pneumothorax * b. Consolidation syndrome * c. Mediastinal syndrome * d. Pierre-Marie syndrome * e. Superior vena cava syndrome 60. Pleural effusion and pneumothorax can be differentiated during physical examination by one of the following: * a. The transmission of vocal fremitus increased in pneumothorax and decreased in pleural effusion * b. The presence of diminished vesicular breath sounds in pleural effusion but not in pneumothorax * c. The presence of dullness in pleural effusion and hyper-resonance in pneumothorax * d. The presence of crackles in pleural effusion but not in pneumothorax * e. The reduction of chest expansion in pleural effusion but not in pneumothorax 61. In a patient with pleural effusion * a. Presence of a pleural friction rub is heard when the effusion is of moderate abundance * b. Bronchial breath sounds can be heard at the upper limit of the effusion when it is of moderate abundance * c. Swelling of the hemi-thorax can be observed when the effusion is of moderate abundance * d. Amphoric breath sounds are typical in pleural effusion * e. Transmission of vocal fremitus is increased in pleural effusion ### SECTION C: Digestive System 62. Regarding vomiting choose the correct answer * a) Effortless passage of gastric contents in the mouth * b) involves contractions of gut and thoraco-abdominal and perineal wall musculature * c) Vomiting one to several hours after a meal could be suggestive of gastric stasis * d) Early morning vomiting could be caused by small bowel obstruction * e) Considered chronic when it lasts less that 1 week 63. The following are true concerning the nature of vomitus except one * a) Food residue ingested hours or days before suggests gastric stasis * b) feculent smell suggests small bowel obstruction, Ileus, gastrocolic fistula * c) bilious vomiting is suggestive of gastric stasis * d) blood in vomitus may suggest acute GIT bleeding 64. Melena is defined as: * a) Passage of bright red or maroon stools from rectum * b) Passage of dark tarry foul smelling, pungent stools * c) is specific for lower GIT bleeding * d) vomiting of bright red blood 65. Regarding, hematemesis, choose the correct answer * a) Vornitus of bright red blood or coffee ground materials * b) Coughing up of blood or bloody sputum * c) is a sign of lower GIT bleeding * d) Bright red blood suggests mild bleeding while coffee ground emesis moderate to severe bleeding 66. Choose the wrong answer concerning diarrhea * a) Abnormally liquid or unformed stools * b) Increased stool frequency (>3 per day) * c) is said to be acute when it lasts less than 1 month * d) Said to be chronic when it lasts more than 1 month 67. Concerning diarrhea choose the wrong answer * a) Is said to be acute when it lasts more than 2 weeks * b) Bloody-mucoid stools suggests invasive pathogens * c) Recent travel history suggests travellers' diarrhea / * d) Can occur during and after the use of antibiotics 68. The following are true regarding dysphagia except one * a) Defined as painful swallowing * b) Defined as a difficulty in swallowing * c) Could be classified as oropharyngeal or oesophageal, structural or propulsive * d) Oesophageal dysphagia is located in the chest 69. Choose the correct answer concerning oropharyngeal dysphagia * a) Inability to initiate the act of swallowing * b) Located in the chest * c) Not associated with ENT symptoms (hoarseness, aspiration) * d) Difficulties after the act of swallowing 70. Choose the wrong answer concerning dysphagia * a) Sudden onset dysphagia could be due to a foreign body * b) Gradual onset dysphagia could be tumoral in origin * c) In achalasia dysphagia is predominant in liquids (paradoxical dysphagia) * d) In oesophageal dysphagia there's inability to initiate the act of swallowing 71. Choose the wrong answer concerning constipation * a) Defined as the passage of more than 3 stools per week * b) Passage of less than 3 stools per week * c) Classified into 2 main groups; primary and secondary * d) Primary constipation can be divided into 3 subtypes * e) Bristol's chart can be used to assess stool consistency 72. Slow transit constipation is characterized by following except one * a) Normal bowel movements * b) Infrequent bowel movements * c) Decreased urgency * d) Straining to defecate 73. Concerning acute pancreatitis pain the foliowing characteristics are true except one * a) sudden onset and located in the epigastric region * b) Radiates to right shoulder * c) Felt from front to back * d) Relieved by ante flexion (leaning forward) 74. The foliowing are characteristics of peptic ulcer disease pain (PUD) except one * a) Epigastric, gnawing or burning sensation * b) Occurs after meals between 1-3 hours * c) exacerbated by food or antacids * d) Awakens the patient at night 75. Physical examination of the GIT consists of the following choose A if a,b,c are correct, B if a and c are correctCif band d are correct, D if a,b,c,d are correct * a) General appearance * b) Examination of the oral cavity * c) Examination of the abdomen * d) Ano-rectal examination 76. The following elements are assessed during inspection of the abdomen except one * a) Liver span * b) Shape of the abdomen * c) Skin of abdominal wall * d) Movements of abdominal wall 77. The following are some elements necessary to characterise and abdominal mass; choose A if a,b,c are correct, B if a and c are correct, Cif band d are correct, D if a,b,c ,d are correct * a) Site and size * b) Shape * c) Surface and edge * d) Consistency 78. In mechanical obstruction of the small bowel, the following are true on abdominal auscultation: choose A if a,b,c are correct, B if a and care correct, Cif band dare correct, D if a,b,c,d are correct * a) bowel sounds are excessive and exaggerated * b) bowel activity rapidly disappears * c) Frequent, loud, low-pitched gurgies (borborygmi) are heard * d) The abdomen is silent 79. In generalized peritonitis the following are observed on abdominal auscultation; choose A if a,b,c are correct, B if a and care correct, Cif band d are correct, D if a,b,c ,d are correct * a) state of paralytic ileus ensues * b) In between bouts of peristaltic activity and colicky pain, the bowel is quiet and no sounds are heard on auscultation * c) bowel activity rapidly disappears * d) Frequerit, loud, low-pitched gurgles (borborygmi) are heard 80. The following are stigmata of chronic liver failure except one * a) Spider naevi * b) Collateral vessels * c) Leuconychia * d) Gynecomastia 81. A patient presenting at the ED for Jaundice admits to consume 5 botties of 33 export every day, the aicohol consumption rate in grams per day is * a) 26g * b) 130g * c) 65g * d) 40g 82. Biliary pain has the following characteristics; choose the correct answer; choose A if a,b,c are correct, B if a and c are correct, Cif b and d are correct, D if a,b,c,d are correct * a) Located in the right upper quadrant or epigastrums * b) Radiates to the right shoulder * c) Colicky in nature * d) Could be associated with nausea 83. Choose the correct answer concerning Jaundice:; choose A if a,b,c are correct, B if a and c are correct, Cif band d are correct, D if a,b,c,d are correct * a. Gradual onset jaundice can be caused by a tumour * b. Fluctuating jaundice is common with cholelithiasis * c. Sudden onset jaundice with flu-like symptoms could be suggestive of viral hepatitis * d. Stool and urine color are not necessary when evaluating a patient with jaundice 84. Ano-rectal examination has the following steps except one * a. Inspection * b. Palpation * c. Percussion * d. Digital rectal examination * e. Anuscopy 85. The following elements can be assessed during inspection of the anorectal region; choose the wrong answer * a. Skin tags * b. Fissures * c. Anal sphincter tone * d. Rectal prolapse 86. Choose the correct answer with regards to abdominal palpation; choose A if a,b,c are correct, B if a and c are correct, Cif band d are correct, D if a,b,c,d are correct, E if only D is correct * a. The spleen is normally palpable * b. The gallbladder is normally palatable * c. The liver is normally palpable * d. The kidneys are not normally palpable 87. Epigastric pain could have the following causes choose the wrong answer * a. Peptic ulcer * b. Perforated ulcer * c. Pancreatitis * d. Renal colic 88. The following are suggestive of a typical acute pancreatitis pain choose the correct answer * a) Epigastric and radiating to the back, relieved by bending forward * b. Epigastric and retrosternal * c. Peri-ombilical and relieved by stooi * d. Relieved by eating 89. Tenesmus is defined as; choose the correct answer choose A if a, b, c are correct, B if a ands are correct. Cif band d are correct, D if a,b,c,d are correct * a. A feeling of incomplete defecation * b. Inability to empty the bowel at defecation * c. One of the symptoms for rectal urgency * d. Inability to control bowel movements 90. Fecal incontinence is defined by the following choose the correct answer * a. A feeling of incomplete defecation * b. Inability to control bowel movements causing stool to leak from the rectum * c. Difficulty to empty bowel at defecation * d. Only exists for solids 91. A patient presenting at the ED for Jaundice admits to consume 2 bottles of Big Guiness every day, the alcohol consumption rate in grams per day is * a. 26g * b. 130g * c. 65g * d. 44g