1 Initial Approach to the Patient: History and Physical Examination Flashcards

1
Q

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

A

Performance status (PS)

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2
Q

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

A

Hodgkin lymphoma

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3
Q

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)

A

Pel-Ebstein fever

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4
Q

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

A

Night sweats

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5
Q

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

A

Hodgkin lymphoma

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6
Q

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

A

Pernicious anemia

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7
Q

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

A

Measles, mumps, and rubella (MMR) vaccine

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

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8
Q

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

A

Frailty

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

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9
Q

The frailty phenotype’s principal features are:

A

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

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10
Q

The frailty index includes

A

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

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11
Q

How is the degree of erythema assessed

A

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

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12
Q

More reliable guides to anemia or polycythemia than the skin

A

Mucous membranes and nail beds

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13
Q

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

A

7 g/dL or less

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14
Q

TRUE OR FALSE

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

A

TRUE

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

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15
Q

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

A
  • 5 g/dL reduced hemoglobin
  • 1.5–2.0 g/dL methemoglobin
  • 0.5 g/dL sulfhemoglobin
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16
Q

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

A

Direct-reacting or conjugated bilirubin

17
Q

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

A

2–3 mg/dL

18
Q

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

A

Petechiae

19
Q

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

A

Vasculitis

20
Q

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

A

Ecchymoses

21
Q

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

Seen in chronic, severe iron-deficiency anemia

A

Koilonychia

22
Q

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

A

Inguinal region

23
Q

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

A

150 g

24
Q

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

A

40%

25
Q

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

A

4–5 cm

26
Q

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.

A

10 cm

2 cm

27
Q

Useful in determining size and demonstrating localized infiltrative lesions.

A

Ultrasonography and computed tomography