Vitals, cardiac
HEENT/Skin
Abdomen/liver
Neuro/psych
MISC
100
Chronic alcohol can cause what changes to your blood pressure?
What is raise it? Heavy drinkers who cut back to moderate drinking can lower their systolic blood pressure (the top number in a blood pressure reading) by 2 to 4 millimeters of mercury (mm Hg) and their diastolic blood pressure (the bottom number in a blood pressure reading) by 1 to 2 mm Hg. -mayoclinic.org *however, cirrhosis or end stage liver disease due to alcoholism can cause lower blood pressure*
100
yellowing of the skin, or blank, is associated with alcoholic hepatitis
What is jaundice?
100
a night of binge drinking can cause fatty liver, and over time can cause fatty liver disease (steatohepatitis). This can be associated with what PE finding on liver examination
What is large liver (hepatomegaly)?
100
Drunk people are known to have awesome reaction times, perfect diction, and the balance of a ballerina; true or false?
what is false (shocking!)?
100
a chronic alcoholic who has nausea, vomiting and intense abdominal pain is diagnosed with pancreatitis. what abdominal finding would be characteristic of this disease?
What is epigastric TTP
200
Binge drinking can cause "Holiday Heart syndrome" is most strongly associated with which of the following changes in heart rhythm: cardiac arrest, bradycardia, atrial fibrillation, or complete heart block
What is atrial fibrillation? -2014 JACC paper showed dose dependent risk of afib and >1 drink/day with highest risk >5d/day (47% more likely than non drinker to develop afib)
200
Alcoholics can often present with fatigue due to the nutritional deficiency and bone marrow effects of alcohol causing anemia. What PE findings would corroborate this diagnosis
what is pale conjunctiva, general pallor
200
The upper limit of normal liver span measured at the mid clavicular line is how many cm?
What is 12 cm. normal span 6-12cm mid sternal line (4-8cm) -http://stanfordmedicine25.stanford.edu/the25/liver.html
200
what is asterixis?
flapping of hands when outstretched wrist extended to 90 degrees. associated with cirrhosis of liver.
200
Splenomegaly is often seen in very advanced liver disease due to alcoholism among other causes. the normal spleen is less than 17cm, less than 13cm, or less 11cm in craniocaudal length?
What is 11cm?
300
A patient with chronic alcohol use comes in with dyspnea, orthopnea, PND. You diagnose alcoholic cardiomyopathy. Name three PE findings that would corroborate this possible disease
What is lung crackles, S3 heart sound, laterally displaced PMI. (systolic Left heart failure)
300
Individuals with jaundice, which can be seen in alcoholics with liver disease, is seen where on physical exam of darker skinned people. NAME TWO locations
What is sclera, and oral mucosa (inner lips, gums)
300
cirrhosis, or scarring of the liver, is also known as end stage liver disease. Your liver, no longer able to break down hormones like estrogen, can cause what findings on a male patient?
What is gynecomastia, testicular feminization (aka shrinkage)
300
chronic alcohol use is associated with depression. name a short, validated screening test for depression.
phq-2. 3 or more points has around 80% sensitivity and 90% specificity for major depressive disorder
300
A patient is diagnosed with cirrhosis, or end stage liver disease, and has dilated, blanching, blood vessels extending from his umbilicus. what is the two word name for this finding?
What is caput medusae?
400
A certain vitamin deficiency not uncommon in alcoholics, can cause a positive hepatojugular reflex, increased JVP, and dependent edema. These are all signs of which sided heart failure?
What is right sided heart failure? *jump to GI section for more on this vitamin deficiency*
400
A chronic alcoholic who comes in with chronic sore throat, feeling of lump in back of throat, hoarse raspy voice, fatigue, and positive smoking history raises your concern for what underlying process?
What is oropharyngeal cancer? cancer.gov states drinking more than 50g/day (3.5 drinks/day) raises your risk of head and neck cancer by 2.5-3.5 times)
400
Cirrhosis, or scarring of the liver, would have what size on liver exam
Trick question! Anything, it can be large, normal, small.
400
chronic alcoholics can sometimes have b12 deficiency causing problems with proprioception, sensation, and motor strength. what is a great PE test for proprioception?
What is romberg test
400
cirrhosis is thought to occur in how many alcohol abusers (give a percentage, that must fall within the range or be closest without going over). PE question: spider angiomas, are little dilated radiating blood vessels (telangiectasias) found in cirrhotics, can be seen usually on what parts of the body?
What is 10 to 20%? PE: chest, trunk, arms, face
500
DAILY DOUBLE! Explain how to perform a good hepatojugular reflex and interpretation
What is "[apply] firm, sustained pressure for 10 to 15 seconds over the upper abdomen while the patient is breathing quietly. In normal subjects, this maneuver transiently increases jugular pressure by only approximately 1 to 3 cm. In patients with right ventricular failure, however, sustained elevation of venous pressure usually greater than 3 cm is observed during continued compression (positive hepatojugular reflux). -UptoDate
500
a patient who does not have intact extraocular eye movements, in the setting of ataxia (unsteady gait), and confusion raises concern for what disease process?
What is Wernicke's encephalopathy. a deficiency in vitamin B1 (thiamine)
500
DAILY DOUBLE! ascites, or fluid build up in the peritoneal cavity, is associated with liver cirrhosis and portal hypertension. explain two physical exam tests you can do to assess for ascites?
What is fluid wave, shifting dullness, lateral dullness.
500
thiamine deficiency can cause signs of heart failure, confusion, opthalmoplegia, and ataxia known as beriberi. What simple test would you do to confirm ataxia?
What is have the patient walk!
500
an alcoholic states he was found unconscious two days ago in a pool of his own vomit. now he presents with coughing, fever, chills, and trouble breathing. you suspect pneumonia, what PE findings (name 4) will corroborate this diagnosis and how did the patient get pneumonia?
What is egophany, decreased breath sounds over consolidation, increased pectoriloquy, increased tactile fremitus, dullness to percussion. This is case of aspiration pneumonia most likely
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