1 Initial Approach to the Patient: History and Physical Examination

Question 1

Used to establish semiquantitatively the extent of a patient’s disability

Answer 1

Performance status (PS)

Question 2

In patients with “fever of unknown origin,” lymphoma, particularly_______________, should be considered.

Answer 2

Hodgkin lymphoma

Question 3

A prolonged cyclic fever, first associated with Hodgkin lymphoma (it occurs rarely), but may occur, also, in some infections (cytomegalovirus or Mycobacterium tuberculosis infection in an immunocompromised host)

Answer 3

Pel-Ebstein fever

Question 4

Suggest the presence of low-grade fever and may occur in patients with lymphoma or leukemia

Answer 4

Night sweats

Question 5

In patients with_____________, ingestion of alcohol may induce pain at the site of any lesion, including those in bone.

Answer 5

Hodgkin lymphoma

Question 6

The skin of patients with _________ is said to be “lemon yellow” because of the simultaneous appearance of jaundice and pallor.

Answer 6

Pernicious anemia

Question 7

Vaccinations can be complicated by acute immune thrombocytopenia. In infants, this is most notable after _________vaccine

Answer 7

Measles, mumps, and rubella (MMR) vaccine

Occurs within 6 weeks of vaccination, and in the majority of occurrences is self-limited

Question 8

A pathophysiologic syndrome in older adults that predisposes to a risk for poor health outcomes including falls, disability, hospitalization, and mortality

Answer 8

Frailty

It also limits tolerance to certain forms of therapy, including intensive chemotherapy for cancer.

Question 9

The frailty phenotype’s principal features are:

Answer 9

(a) decreased functional reserve
(b) impairment of physiologic systems, and
(c) inability to regain a physiologic steady-state after a stressful event (eg, chemotherapy

Question 10

The frailty index includes

Answer 10

(a) unintended weight loss,
(b) decreased grip strength,
(c) ease of exhaustion,
(d) slow gait speed, and
(e) low physical activity

Question 11

How is the degree of erythema assessed

Answer 11

Pressing the thumb firmly against the skin, as on the forehead, so that the capillaries are emptied, and then comparing the color of the compressed spot with the surrounding skin immediately after the thumb is removed

Question 12

More reliable guides to anemia or polycythemia than the skin

Answer 12

Mucous membranes and nail beds

Question 13

The palmar creases are useful guides to the hemoglobin level and appear pink in the fully opened hand unless the hemoglobin is

Answer 13

7 g/dL or less

Question 14

TRUE OR FALSE

Liver disease may induce flushing of the thenar and hypothenar eminences of the palm, even in patients with anemia.

Answer 14

TRUE

Liver disease may induce flushing of the thenar and hypothenar eminences of the palm, even in patients with anemia.

Question 15

The minimum amounts of these pigments that cause detectable cyanosis are approximately _______ blood of reduced hemoglobin, ________ of methemoglobin, and _______of sulfhemoglobin

Answer 15

• 5 g/dL reduced hemoglobin
• 1.5–2.0 g/dL methemoglobin
• 0.5 g/dL sulfhemoglobin

Question 16

Direct or Indirect

Jaundice is a result of actual staining of the skin by bile pigment, and bilirubin glucuronide (______________ bilirubin) stains the skin more readily

Answer 16

Direct-reacting or conjugated bilirubin

Question 17

Jaundice of the skin may not be visible if the bilirubin level is below __________

Answer 17

2–3 mg/dL

Question 18

Small (1–2 mm), round, red or brown lesions resulting from hemorrhage into the skin and are present primarily in areas with high venous pressure, such as the lower extremities

Do not blanch on pressure

Answer 18

Petechiae

Question 19

Petechiae may occasionally be elevated slightly, that is, palpable; this finding suggests_________.

Answer 19

Vasculitis

Question 20

May be of various sizes and shapes and may be red, purple, blue, or yellowish green, depending on the intensity of the skin hemorrhage and its age

Blanch with pressure

Answer 20

Ecchymoses

Question 21

Nail finding wherein nails are ridged longitudinally and flattened or concave rather than convex.

Seen in chronic, severe iron-deficiency anemia

Answer 21

Koilonychia

Question 22

Under normal conditions in adults, the only readily palpable lymph nodes are in the __________, where several firm nodes 0.5–2.0 cm long are normally attached to the dense fascia

Answer 22

Inguinal region

Question 23

The normal spleen weighs approximately _______and lies in the peritoneal cavity against the diaphragm and the posterolateral abdominal wall at the level of the lower three ribs

Answer 23

150 g

Question 24

Spleens enlarged only _____ above normal may be palpable, but significant splenic enlargement may occur and the organ still not be felt on physical examination.

Answer 24

40%

Question 25

The normal liver may be palpable as much as _____ below the right costal margin, but is usually not palpable in the epigastrium.

Answer 25

4–5 cm

Question 26

The vertical span of the normal liver determined in this manner will range approximately ________ in an average-size adult male and approximately ______smaller in an adult female.

Answer 26

10 cm

2 cm

Question 27

Useful in determining size and demonstrating localized infiltrative lesions.

Answer 27

Ultrasonography and computed tomography