1st Bimonthly Flashcards
Which of the ff breath sounds is considered to be abnormal?
A. Rhonchi
B. Bronchovesicular
C. Bronchial
D. Vesicular
A
Which of the following is a well-constructed chief complaint?
A. Migraine
B. UTI
C. Fever and headache
D. Dysuria for 3 days
D.
Which of the following reasons makes the history taking among pediatric patients unique and distinctive?
A. Content of past medical history
B: Indirect source of information
C: Content variation of Family History
D: Elaboration of HPI
B.
Which of the following signs when absent in neonate may give the physician a signal of probable congenital cararact.
Red-orange Reflex
In what grade is thrill heard?
Grade IV
What grade in which Loud murmur that can be heard if only the edge of the stethoscope is in contact with the skin, a thrill is present
V
A click in the femoral head in congenital hip displacement is called?
Ortolanis
A 3 year old boy was rushed to the ER due to difficulty of breathing. History revealed that he was eating peanuts a few minutes before consultation. Upon auscultation, abnormal sounds were heard upon inspiration. These adventitious sounds are:
Stridor
Discontinuous sounds near the end of inspiration caused by lung disorders or cardiac problems
Rales
Which of the following recording techniques involves a problem-focused system?
A. Problem list
B. POMR
C. Electronic Medical Record
D. Health Information Management
B
The following is true in HPI
A. It includes the checking of symptoms of other systems
B. Interval history may ba part of the HPI
C. It includes intervention tx, consultation, and hospitalization
D. Regardless of the case of the patient, the birth history should be included in the HPI
B
The past medical history gives information of the patient
A. Heredofamilial disease
B. Lifestyle issues
C. medications
D. allergies
B
This part of history taking ensures that nothing is discounted in patient evaluation and history taking?
A. Personal history
B. review of systems
C. family history
D. History of present illness
B
This is part of personal and social history that affects the sustainability and support of Filipino families?
Income
Most crucial part of personal and social history in an elderly living alone?
family support
Which of the following in personal and social history is critical among Filipino patients?
A. educational attainment
B. recent and long term cause of stress
C. religious affiliations and spiritual beliefs
D. Financial resource
D.
A state in which the patient is almost entirely unresponsive and only responses to a stimulus such as pain.
Stupor
People have a more depressed level of consciousness and cannot be fully aroused.
Obtundation
An altered level of consciousness is any measure of arousal other than normal
Lethargy
inability to make any purposeful response.
Coma
What is the BMI computation for woman with a height of 5’6” and a weight of 49kg?
17.43kg/m^2
In the clinic, the patient had his BP taken by the nurse and a difference in pressure of 12 mmHg was noted. The patient may possibly be having this condition:
Aortic Dissection
A pressure difference of more than 10-15 mmHg occurs in subclavian steal syndrome, supravalvular aortic stenosis and aortic dissection should be investigated
Which of the ff statement is true regarding the BP measurement?
A. A single BP elevation take at the clinic is sufficient to establish the diagnosis of hypertension
B. Blood morning dip pressure normally exhibits early
C. A normal diastolic pressure is expected among older persons
D. There is a systolic pressure drop within minutes of standing
D
Using the WPR Classification, a BMI of 25 kg/m 2 is classified as:
A. Obese I
B. Obese II
C. Overweight
D. Normal
C
Using the updated classification for hypertension, the blood pressure reading of 140/85 is classified as?
A. Normal
B. Elevated
C. Hypertension 1
D. Hypertension 2
D
What is the temperature for pyrexia?
> 100 F
Rectal temperature reading is higher than the oral temperature by
0.5C
A 24yo patient has a blood pressure of 120/70; classification falls under.
Elevated
Which of the ff. Factors predispose a person to hypothermia?
Starvation
Ear temperature is higher than oral temperature by:
1.4F
Rectal temperature is usually 0.4-0.5°C (0.70.9°F) higher than oral temperature
A 28 yr old patient came in complaining with headache and anxiousness. His BP was 150/80 without hypertension history
Clinic hypertension
Which of the following can cause a 10mmHg increase in blood pressure taking?
Full bladder
Variance is from 10-15 mmHG
A 30 month old Susan was admitted for the first time. 3 months ago, she developed productive cough and treated with Salbutamol syrup with slight relief. 3 weeks prior to admission she had fever and was given paracetamol with relief. 2 weeks prior to admission, she has vomiting with decrease in appetite. A day prior to admission, productive cough and fever persisted now with no appetite prompted consult and subsequent admission.
What symptom made the patient to seek consultation?
Loss of appetite
A 30 month old Susan was admitted for the first time. 3 months ago, she developed productive cough and treated with Salbutamol syrup with slight relief. 3 weeks prior to admission she had fever and was given paracetamol with relief. 2 weeks prior to admission, she has vomiting with decrease in appetite. A day prior to admission, productive cough and fever persisted now with no appetite prompted consult and subsequent admission.
Susan was treated with salbutamol syrup 3 months ago. Where should this info be included?
HPI
Upon Susan’s admission her vital signs were: HR 120, RR 60, Temp. 37*C. What are the interpretation of these findings?
Normal hr and temperature, increased rr
HR
1-2y.o – 70-150 bpm
2-6y.o – 68-138 bpm
6-10y.o – 65-125 bpm
RR
Early Childhood – 20-40
Late Childhood – 15-25
Temp Same as adult
a 30 month child came to a hospital weighing 17 kg and with a length of 87 cm according to BMI for children <13.2 is underweight >18.6 over weight and >20.4 is obese. Which is true about susan’s BMI?
is obese
When auscultation was performed in Susan’s chest, occasional expiratory wheezings are appreciated.
Obstructive airway disease
When performing physical examination to Susan, which of the following statements is true?
A. Gather data by systemic examination of inspection, percussion, palpation and auscultation
B. Position appropriately on examining table
C. Conduct swiftly the painful examination ensuring the child that it won’t hurt even though it hurts (non verbatim, pero mao ni ang thought)
D. Distraction is a valuable tool in examining children
D
In ROS which of the ff is asked or observed in psychiatric part
Memory change
Which of the following is true on Personal and Social History
A. Written permission is needed.
B. A series of questions is asked starting from head to toe
C. Captures the patient’s personality
C
Should be present in Identifying Data
A. Age
From lecture note
B. Chief complaint
C. Medications taken
D. Maternal history
A
A complete HPI should include
A. Narrative and Chronological details of disease
B. Differential diagnosis
C. Past hospitalization
D. Cause of death
A. HPI is a complete, clear, and chronologic account of the problems prompting the ptx to seek care.
This part of the history is a brief statement of the primary problem
A. History of present illness
B. Past medical history
C. Chief complaint
D. Review of Systems
C
At what age do we usually test for blood pressure screening
3 yr old
Up to what age is the ideal recumbent length taken?
up to 2 years
Emmanuel, 2 month infant is schedule for Rotavirus Vaccine, you are intended to give the pentavalent vaccine (RV5) per orem. All 3 doses must be administered prior reaching the age of?
8 months
Ballards scoring is a tool used to determine the gestational age based on clinical evidence of a newborn, what scoring uses posture, square window,arm recoil, scarf sign, and heel to ear?
Neuromuscular scoring
what blood pressure category does a child belong if his average systolic and diastolic pressure of age, sex and height belongs to 90-95th percentile?
Prehypertension
what part of developmental milestone do we ask for when px toilet train, relationship with parents and peers and sleep patterns?
Social development
In doing pediatric physical exam, one should
A. In examining a pediatric patient, there should be less questions asked and more physical examination
B. Perform less invasive maneuvers early and potentially distressing maneuvers near the end of the examination
C. Have a specific cephalocaudal order
D. Sequence should vary according to the pediatricians comfort level
B
Ellie, a 2 year old toddler, complained of ear pain. She was immediately brought for consultation to a pediatrician. Upon examination, no discharge were noted but pain was elicited upon manipulation of the pinna. Her mother also said that she complained two days ago after they went swimming. What is her condition?
A. Acute otitis media
B. Chronic otitis media
C. Otitis media with effusion
D. Otitis externa
D
What age is complementary feeding usually given/begins?
A. 10 months
B. 6 months
C. 9 months
D. 8 months
B
It is a widely used developmental screening test for examining the performance of children aged 0-6years on various age-appropriate tasks having 4 parameters.
Denver Development Screening Test
This is the line of depression I the bottom of rib cage along the attachment of diaphragm. The long duration indicate poor lung compliance
Harrison’s groove
First visble sign of puberty in males, and a hallmark of Sexual Maturity Rating (SMR) 2
Testicular enlargement
What reflex will you elicit when you stroke the perioral skin of the mouth and the mouth will open, the baby will turn its head towards the stimulation and start sucking
Rooting reflex
Which of the following signs when absent in neonate may give the physician a signal of probable congenital cataract?
Red-orange reflex
What is the characteristic lesion of chronic plaque type psoriasis vulgaris?
Plaques are well demarcated and covered by a silvery scale
Tina, 15/F, has headache, myalgia and low grade fever. 2 days later she develops a rash that appears on her face, trunk, and proximal extremities. Which of these correctly describe the lesions of Varicella?
A. Presence of vesicles only
B. Presence of multiple lesions in different developmental
C. Once the secondary lesion of lichenification occurs, the patient is no longer considered infectious
D. Intense pain accompanies vesicles
B.
Separation of nail plate from the nail bed is called:
Onycholysis
A periodic idiopathic shedding of the nails beginning at the proximal end, possibly caused by the temporary arrest of the function of the nail matrix
Onychomadesis
also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed.
Onychomycosis
also known as spoon nails, is a nail disease that can be a sign of hypochromic anemia, especially iron-deficiency anemia.
Koilonychia
Luis 56/male complained of painful grouped unilateral lesions over erythematous base over his left chest (T5 dermatome). No associated fever, myalgia, sore throat but there is pruritus and pain two days prior to the appearance of rash. No other lesion is found in the body. What is the diagnosis?
Herpes zoster
It is a secondary lesion associated with thickening of the skin with accentuated skin markings due to excessive scratching
Lichenification
Amy, 35yo, Female. Extremely pruritic lesions after vacuuuming and cleaning her room. Relieved when taken with antihistamine. What was the primary lesion.
Wheal
Mark has a palpable encapsulated domefilled lesion measuring 5cm on his back. There is a central umbilication when pressed, a yellowish foul smelling semisolid material comes out. What is the primary lesion?
A. Plaque
B. Bullae
C. Papule
D. Cyst
D
Secondary lesion with serum, blood, or purulent exudate dries on the skin surface
Crusting
Multiple excoriations of the skin are a clinical clue of what symptom?
Pruritus
JR, 7/M present with 2 round, scaly gray non-erythematous patches on scalp and absence of hair for 3 mos; no fever; lesions only localized on scalp. What is the condition of the patient?
A. Psoriasis vulgaris
B. Seborrheic dermatitis
C. Tinea versicolor
D. Tinea capitis
D.
Alfie started self medicating with a cream that was given to him by relatives abroad for itching. After 1 year of applying it everyday to his face, he noticed that the skin became thin, shiny, and with visible telangiectasia. What secondary lesion developed as a result of continued application of this cream?
A. Atrophy
B. Excoriation
C. Erosion
D. Abrasion
A
The bullae erupted. What is its accompanying feature?
Erosion
Amanda a 3 mos. old baby was brought to the clinic by her parents because of erythymatous weeping scaly plaques with multiple excoriations which started on her cheeks 2 weeks then spreading to trunk,arms, and legs sparing the diaper area. You also noticed that the skin was dry. What will you ask in the history that will help diagnose atopic dermatitis?
A. APGAR history at birth.
B. History of cradle cap
C. History of drug allergy
D. History of asthma and eczema in the family
D
25/F consulted for recurrent fluid filled blister on the corner of mouth. Happened twice thus year. Previous occurrence lasted for 2 weeks. Suspected to have herpes simplex and was prescribed with antivirals. What is the primary lesions?
Vesicle
Hyperpyrexia is defined as the temperature of:
A. > or equal to 95F
B. > or equal to 98F
C. > or equal to 100F
D. > or equal to 106F
D
A 65-yr old patient has a blood pressure of 180/100 mmHg. He is under the JNC 7 BP classification of?
stage 2 hypertension
Which of the ff is correct in BP measurement?
A. Measure is 2.5
B. 40% thingy
C. the bell is used for high pitched Korotkoff sound
D. The auscultatory gap is avoided
D
According to the JNC 7 BP Classification, Prehypertension is defined as:
A. SBP ≤ 120mmHg; DBP ≤ 80 mmHg
B. SBP ≤ 130mmHg; DBP ≤ 89 mmHg
C. SBP ≥ 140mmHg; DBP ≥ 90 mmHg
D. SBP ≥ 120mmHg; DBP ≤ 80 mmHg
B
What is the rectal temperature of a patient with a previously taken oral temperature of 39.3 ^C?
39.8
Ratio:
Rectal temperature are higher than oral temperature by an average of 0.4 - 0.5 C but this difference is quite variable.
- 3+0.4= 39.7 Or
- 3.=0.5=39.8
According to the Asia Pacific Guidelines, a 48 y.o woman with a BMI of 24.9 is classified as:
Overweight
Ratio: Asia Pacific Underweight: <18.5 Normal: 18.5-22.9 Overweight: 23-24.9 Obese: >25
Which among the following is true in choosing an appropriate BP Cuff?
The standard width of the bp cuff is 14 cm
After taking the BP on both arms, a difference of 15 mmHg was noted. The patient may have what condition?
Subclavian Steal Syndrome
Choose which of the following statements is true regarding orthostatic hypotension
A.It is usually caused by prolonged bedrest and drugs
B. Systolic blood pressure falls 10mmhg
C. Fall in systolic blood pressure and bradychardia are hallmarks of this condition
D. Systolic blood pressure falls 15mmhg within 3 minutes after standing
A.
Causes of orthostatic hypotension include drugs, moderate or sever blood loss, prolonged bed rest and diseases of the autonomic nervous system
Which of the ff factors predisposes a person to hypothermia
A. Drug Reaction
B. Malignancy
C. Infection
D. Starvation
D.
causes of hypothermia: Prolonged cold exposure Alcohol intoxication Hypoglycemia Old age Substance abuse Anorexia nervosa
What framework is when good consequences must outweigh the bad
utilitarian framework
The framework that do not look at the consequences, look at the nature of the act itself (ontological)
Kantian framework
there is no absolute principle to justify your decision where Everything is about duties
Exercise moral judgement
WD Ross Framework
Define the Principle of AUTONOMY, BENEFICENCE, NONMALEFICENCE, JUSTICE
Autonomy – you should never get in the way of a px’s authonomy
Beneficcence – try to promote the welfare of px
Nonmaleficence - not to harm the px
Justice - All px must have access to it
Focus is not on the action but on the person.
This framework focuses on “character”
Virtue ethics
the purpose of ethics is not about principles, it’s about relationships
Ethics of Care
Care about you patients, nurture them, let them grow
Given the chance to redeem yourself/relationships
What are the 5 approaches to understanding what is the context of the decision your making
- Appeal to tradition (check the textbooks)
- Appeal to authority
- Trial and error
- Appeal to theory (justify what you’re doing)
- Evidence based practice
Joint National Committee has identified four levels of systolic and diastolic hypertension. What stage is when sbp 140-159 mmHg?
Stage 1 Hypertension
is a drop in systolic blood pressure of 20 mmHg or greater or in diastolic blood pressure of 10 mmHg or greater within 3 minutes of standing
Orthostatic hypotension
For the obese arm, use a cuff with how many cm in width.
15 cm
To determine blood pressure in the leg, use a wide, long thigh cuff that has a bladder size of
18 x 42 cm
Rectal temperatures are higher than oral temperatures by an average of
0.4 to 0.5C
axillary temperatures are lower than oral temperatures by approximately
1C
TYMPANIC TEMPERATURES measures core body temperature, which is higher than the normal oral temperature by approximately
0.8C (1.4F)
In Asia-pacific, what is the BMI For overweight people
23-24.9
What developmental history refers to weight and height at all ages; head circumference at birth and younger than 2 years; periods of slow or rapid growth
Physical growth
What developmental history refers to performance in preschool and school
Speech development
What developmental history refers day and night sleeping patterns; toilet training; habitual behaviors; discipline problems; school behavior; relationships with family and peers
Social development
What developmental history refers ages child held head up, rolled over, sat, stood, walked, and talked
Developmental milestones
a sympathetic consciousness of the another’s distress together with a desire to alleviate it
Caring and compassion
willingness to hear, accept, deal with the views of others without reserve or pretense
Openness
Respect and ensure subjective well-being and sense or worth in others and recognize the patient’s personal freedom and choice and right to participate fully in his/her care
patient dignity and autonomy
self-awareness; to recognize and understand the patient’s and one’s actions, motivations and emotions
Insight
ability to recognize, elicit and foster the power to heal inherent in each patient
Respect for the healing function
to be fully represent for a patient without distraction and to fully support and accompany the patient throughout care
Presence
master and keep current knowledge and skills relevant to medical practice
Competence
– not to divulge patient information without just care
Confidentiality
being obliged or emotionally impelled to act in the best interest of the patient
Commitment
unselfish regard for or devotion to the welfare of others
Autonomy
– firm adherence to a code of moral values, incorruptibility
Integrity and Honesty –
to act for the public good, conformity to the ideals of right Human Conduct in dealings with patients, colleagues and society
Morality and Ethical Conduct
reliable
Trustworthiness
the commitment to maintain integrity of the moral and collegial Nature of the profession and to be accountable for one’s conduct to the profession
Responsibility to the profession
the privilege of setting standards; being accountable for one’s actions and conduct in medical practice and for the conduct of one’s colleagues
Self-regulation –
the obligation to use one’s expertise for and to be accountable to, society for those actions both personal and for the profession which relate to Public good
Responsibility to Society
ability to recognize and respect the expertise of others and work with them in the Best interest of the patient
Teamwork
Limited by growth of patient autonomy, accountability to third party payers (government, corporate and society)
- Autonomy has a reciprocal relationship with Accountability
Physical Autonomy
Addressing the need to respond to growing demand for health services in the presence of modern scientific health care system
- Conflict between “social purpose” vs “fiduciary duty”
Responsibility to Society
Growing reports of well publicized failures
Self-regulation
Paternalistic attitude
Teamwork
