3rd Assessment Flashcards
As the intern rotating in internal medicine, you were assigned in the OPD for the diabetes clinic. Your job is to screen diabetic patients for early peripheral arterial disease. You noted this one patient in particular with the following ABI results: BP in right brachial 150/90 mmHg, BP in right ankle 90/60 mmHg. What is your
interpretation?
Moderate peripheral arterial disease
An 18 years old male consulted in the OPD for throbbing headache. Your senior resident instructed you to take his blood pressure. Your initial reading was 160/90 mmHg, so you rechecked it after 15 min in both arms which was now at 170/90mmHg. You asked your groupmate to recheck the BP. his reading in both arms was 160/90 mmHg. What would you suspect the patient has?
Mitral valve prolapse
As you were making rounds with your attending, he asked you to check for postural color changes in his patient with chronic arterial insufficiency. What test will you perform?
Buerger test
Your senior resident instructed you to examine an obese patient for signs of peripheral arterial disease. You anticipate that it will be difficult to palpate the pulses in the lower extremities due to his body weight. Which among the following will help you correctly identify his pulse?
- Linger and vary the pressure of your fingers to pick up a strong pulsation
- Count your own heart rate using your carotid pulse and compare with his heart rate
- All of the above are correct
- Avoid awkward positioning as it increases tactile sensitivity
Count your own heart rate using your carotid pulse and compare with his heart rate
As an intern rotating in pediatrics, you were assigned to do physical examination on students enrolled in SWU for their annual PE. As you were taking the blood pressure of a 16 year old student, you noticed his BP on his right arm was 90/60 mmHg and 130/90 mmHg on his left arm. What should you suspect and screen for this
student?
Coarctation of the aorta
Your cousin who lives in the province called you for a consult. He states that he has what the local doctor called anasarca. He has been experiencing this for about a month. At what level would you assume is the extent of his edema?
Abdomen
You are the intern assigned to a patient who just suffered a stroke. Your senior resident ordered to have an ultrasound of the neck. As you accompanied the patient, the ultrasound finding was a “high-grade” stenosis of the right carotid artery. You remembered that higher grade stenoses produce a low-pitch sound. What part of your stethoscope will you use to listen?
Bell
A 50 year old male consulted in the OPD due to a severe pain on his right foot after walking. He states that the pain is relieved by rest. You suspect the patient has peripheral arterial disease. Where is the likely the site of occlusion?
- Superficial femoral artery
- Popliteal artery
- Tibial artery
- Common femoral artery
Superficial femoral artery
Peter works as a heavy machine operator. During his shift, he had a fight with his boyfriend. Due to his frustration, he intentionally placed his hand inside a meat grinder. He was rushed to SWU-MC for treatment. His BP was 80/50 mmHg, HR: 130 BPM, afebrile. What is Peter’s pulse pressure?
30mmHg
A 40 year old female patient was admitted in your service ward for heparin treatment for his deep venous thrombosis. As you inspected her lower extremities, you noted that her entire right leg was swollen /
edematous. Where is the most likely point of occlusion?
Ileofemoral vein
You are the intern assigned to a patient admitted in the general medicine ward. as you review his medical record, you notice that he has a history of mitral stenosis. In fact, he is presently admitted because he plans on having surgery for his mitral valve. You want to appreciate the murmur of his mitral stenosis. At what position should you place the patient to hear it best?
Left lateral decubitus position
A patient came in the out patient department for an anterior chest pain, which he describes as tearing or ripping in character, which radiates to the back. What should be your primary clinical impression?
Acute aortic dissection
The senior resident assigned to your service instructed you to assess the carotid pulse of his patient in the ICU. The following are expected of you to perform except?
• Palpate the carotid pulse with your thumb
• Place the patient in a supine position with the head of the bed elevated to about 30 degrees and assess
amplitude and contour
• Palpate the carotid pulse with your index and middle fingers
• Palpate both the left and right carotid simultaneously using your index and middle fingers to
compare their contour
Palpate both the left and right carotid simultaneously using your index and middle fingers to compare their contour
Which among the different ECG components reflects an upward deflection from ventricular depolarization?
R wave
As you were practicing your auscultation technique on your grandmother, you noted a murmur which was heard best at the right 2nd interspace to the apex. what is the likely origin of the murmur?
Mitral valve
You were making rounds with your attending physician in the general ward. as he was palpating the radial pulse of his patient, he told you to document the pulse as bounding. What grade will you write down on the record?
3+
A 28 years old male was rushed to the emergency room of SWU-MC due to loose watery stools and vomiting. You were the intern assigned in the ER to take his history. You noted that he had 8 episodes of LBM and 5 episodes of vomiting after eating shellfish with his friends. At what level would you expect his JVP is?
6 cm from the sternal angle with patient positioned at 45 degrees
You are the intern assigned in the OPD tasked to take the initial history and physical examination of our employees for their annual PE. Peter is a 35 years old male who works in SWU as a faculty, came in the OPD for his annual PE. He is healthy, with no family history of diabetes, exercises regularly, and currently has a BMI of 22 kg/m2. At what age should Peter begin screening for diabetes?
40 y.o
A patient diagnosed with severe chronic obstructive pulmonary disease was admitted in your ward. As the intern on duty, you were asked by your senior resident to perform a cardiac exam. At what area would you expect the point of maximal impulse to be most prominent?
Epigastric area
During the bedside rounds of a patient diagnosed with HIV, the attending physician asked you to palpate for
epitrochlear lymph nodes. What landmark will help you locate the said lymph node?
3 cm above the medial epicondyle
As you were attending a case presentation of a patient with heart failure in SWU-MC, the presenter described the intensity of the murmur as grade three (3). This means that the murmur is _______.
Moderately loud
This refers to the load that stretches the cardiac muscle before contraction.
Preload
The following are auscultatory areas except?
- 2nd right interspace
- Apex
- Lower right sternal border
- 2nd left interspace
Lower right sternal border
Peter works as a heavy machine operator. During his shift, he had a fight with his boyfriend. Due to his
frustration, he intentionally placed his hand inside a meat grinder. He was rushed to SWU-MC for treatment.
His BP was 80/50 mmHg, HR: 130 BPM, afebrile. Which among these factors is responsible for his blood pressure?
- Volume of blood in the arterial system
- Peripheral vascular resistance
- Distensibility of the aorta and large arteries
- Left ventricular stroke volume
Peripheral vascular resistance
