Cardiovascular
A murmur you can hear without the stethoscope is which grade?
6
True or False:Glaucoma is the leading cause of blindness among Asians?
False. It is the leading cause of blindness among Blacks.
True or False. Grey Turner and Cullen signs indicate appendicitis?
False. They are signs of pancreatitis.
T or F: Post nasal drip is a common cause of cough
True. Other common causes include asthma, GERD, and COPD
62 y.o. female p/w dull aching, chest pain lasting for the last 2 days. It comes and goes and is associated with breathlessness, palpitations, and weakness. Upon examination, you note the location of the pain which is below left breast along the costal cartilage. The most likely dx w/o knowing her PMH is:
a. Pleuritis
b. Angina
c. Costochondritis
c. Costochondritis. It is usually reproducible. Pleuritis is sharp, knifelike, severe pain and usually persistent. It is associated with pna, or Pulmonary embolism. Angina is usually retrosternal or across the anterior chest and sometimes it radiates to shoulders, arms, neck or jaw. Best described as tightness, squeezing, discomfort lasting minutes.
Multiple choice: Pt presents with blurred vision in one eye. He denies pain, redness or discharge. What is the likely diagnosis and why?
a. corneal ulceration
b. acute angle closure glaucoma
c. macular degeneration
C. Macular degeneration. Corneal ulceration is painful. Acute angle closure glaucoma is painful, pt c/o redness and reports seeing halos.
Multiple choice. On abdominal exam, you would suspect acute cholecystitis by which sign?
a. McBurney
b. Rovsing
c. Psoas
d. Murphy
d. Murphy. A positive Murphy sign is assessed by hooking your thumb under the right costal margin at edge of recess muscle. Ask pt to take a deep breath. A sudden stop in inspiration ids a positive Murphy sign in acute cholecystitis. The others (a-c) are indicative of appendicitis.
T or F: Excessive daytime sleepiness and loud snoring are hallmarks of COPD
False. Excessive daytime sleepiness and loud snoring are hallmarks of OSA.
Multiple choice. You auscultate a loud heart murmur with a thrill. What grade murmur is this?
a. 2
b. 3
c. 4
c. a murmur with a thrill is a grade 4 or higher and indicates an incompetent valve.
T or F: Cup to disc ratio is usually <or =to 1:2
True
True or False? The term for high pitched bowel sounds is Borborygmi
True
Multiple choice: A patient p/w DOE. During assessment, you notice decrease lung sounds on the right, decrease tactile fremitus on the right, left tracheal shift and hyper resonant percussed to the right chest area. These findings most likely reveal:
a. Pneumothorax
b. COPD
c. Pleural effusion
a. Pneumothorax, most likely tension pneumothorax given the shift toward the unaffected side.
You auscultate a murmur at the right 2nd intercostal space radiating to the right neck. This is associated with?
a. AS
b. MVR
c. AR
a. AS. The others are auscultated on the left. MVR is heard at left mid clavicular 5th intercostal space. AR is heart at left sternal border between the 3rd and 4th intercostal space.
What are associated symptoms when a pt has exophthalmus and what dx is it associated with?
Eyelids retract, tearing, lid lag. It is associated with Graves disease.
Multiple choice: A pt presents with nausea and vomiting associated with constipation x 4 days and abdominal cramps. He has Borborygmi bowel sounds. This is probably due to?
a. peritonitis
b. obstruction
c. diarrhea
b. obstruction
Multiple choice. A pt with a 20 pack year smoking history presents with a mild, slowly progressive cough x 5 days worse with exertion and improves with expectorating. He denies pain or fever, recent travels or sick contacts. He reports having an URI the prior month. You suspect he probably has COPD. What do you order to confirm your diagnosis?
a. CXR
b. CT
c. Spirometry/PFT
c. Spirometry would best diagnose COPD. Given that he doesn't have a fever or pleuritic pain, not necessary to get a CXR or CT to r/o lung diseases.
Systolic v Diastolic heart murmurs and locations.
Systolic: MRASS: Mitral Regurgitation (pan systolic) Aortic Stenosis are Systolic
v
Diastolic: MSARD: Mitral Stenosis (opening snap) Aortic Regurgitation (Early diastolic) are Diastolic
Severe eye pain, a red eye with dilated fixed pupil, reduced or blurred vision and vomiting are associated with which diagnosis?
a. Acute angular closure glaucoma
b. Subconjunctival hemorrhage
c. Acute iritis
a. Acute angular closure glaucoma is a medical emergency and may lead to blindness. Subconjunctival hemorrhage is painless and vision is not affected usually resolves within 2 weeks. Acute iritis presents moderate pain and photophobia, redness, but pupil is small and irregular
A Pt is following up on her elevated liver function tests (LFTs). You order a hepatitis panel which shows: IgM anti-HBc +, HBsAg+, Anti-hBs -. You tell her she has:
a. chronic infection
b. acute infection
c. immunity
b. Acute infection given IgM +.
68-year-old man presented to the pulmonary clinic at Mayo Clinic for evaluation of chronic cough and weight loss. He had a medical history of stroke, insomnia, chronic mucocutaneous candidiasis, spontaneous left-sided pneumothorax, and pneumonia. He had been in good health until experiencing a left pontine stroke in 2006, which caused transient right-sided weakness and dysphagia. Although these symptoms resolved, a cough continued for 18 months before evaluation. Findings on chest radiography and a pulmonary function test were normal 5 months before evaluation. The cough had recently become productive, and the sputum was occasionally red. The patient thought the cough was worse when he was in certain positions. His cough was not triggered by exertion or fumes. He denied sinus disease, postnasal drip, gastroesophageal reflux, and asthma. He had never been a smoker. He had no relevant chemical, occupational, or animal exposures. He reported fever, chills, and a weight loss of 13.6 kg (30 lbs) during the previous 2 months. One month before evaluation, he developed hemoptysis. He was found to have a pleural effusion and was treated for pneumonia at another hospital. Cultures from a bronchoscopy and thoracentesis were reportedly negative. He did not complete the antibiotic course because of mucocutaneous candidiasis.
On the basis of the available clinical information, which one of the following conditions is the least likely explanation? a. Chronic obstructive pulmonary disease (COPD)
b. Mycobacterium tuberculosis infection
c. Lung cancer
d. Aspiration pneumonia
e. Human immunodeficiency virus (HIV)
a. COPD.Chronic cough is defined as a cough lasting more than 8 weeks. Asthma, gastroesophageal reflux, and postnasal drip are the most common causes of cough. This patient denied having a history or symptoms of these diseases. Chronic obstructive pulmonary disease is also a well-known cause of chronic cough, with 70% of patients with COPD reporting coughing. Chronic obstructive pulmonary disease is highly associated with cigarette smoking. The patient denied any occupational exposures that would put him at risk of COPD. Hemoptysis is not associated with COPD.
Common causes of hemoptysis include pulmonary infection, bronchiectasis, lung cancer, pulmonary or gastrointestinal hemorrhage, bronchitis, and chronic heart failure.
Pulmonary function studies show airflow obstruction in patients with COPD. Because the patient had never smoked, had hemoptysis, and did not have airway obstruction as evidenced by normal findings on a pulmonary function test, COPD is the least likely diagnosis. Mycobacterium tuberculosis is commonly in the differential diagnosis of patients with cough, hemoptysis, fever, and weight loss. This infection is a public health risk and a treatable disease. Because the patient had all of these symptoms, this diagnosis was important to exclude. On the basis of these findings, tuberculosis cannot be ruled out. Lung cancer is also a concern in any patient who presents with these symptoms. Having experienced dysphagia after his stroke in 2006, the patient was at risk of aspiration and aspiration pneumonia. Although he was not at high risk of HIV, his weight loss, fever, and chills could be due to HIV. His history of chronic mucocutaneous candidiasis increased the possibility that he was immunosuppressed, supporting a diagnosis of HIV.