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Medicine 1 > Block 2 > Flashcards

Block 2 Flashcards

1
Q

fundamental purpose of the cardiorespiratory system

A

to deliver O2 and nutrients to cells and to remove CO2 and other metabolic products from them.

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2
Q

switch from aerobic to anaerobic metabolism

A

Pasteur effect

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3
Q

The adaptations to hypoxia are mediated, in part, by the upregulation of genes encoding a variety of proteins, including

A
  1. glycolytic enzymes, such as phosphoglycerate kinase and phosphofructokinase
  2. glucose transporters Glut-1 and Glut-2
  3. growth factors, such as vascular endothelial growth factor (VEGF) and erythropoietin, which enhance erythrocyte production.
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4
Q

The hypoxia-induced increase in expression of these key proteins is governed by this hypoxiasensitive transcription factor?

A

hypoxia-inducible factor-1 (HIF-1).

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5
Q

During hypoxia, systemic arterioles

A

During hypoxia, systemic arterioles dilate, at least in part, by opening of K-ATP channels in vascular smooth-muscle cells due to the hypoxia-induced reduction in ATP concentration.

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6
Q

What happens in pulmonary vascular smooth-muscle cells during hypoxia?

A

By contrast, in pulmonary vascular smooth-muscle cells, inhibition of K+ channels causes depolarization which, in turn, activates voltage-gated Ca2+ channels raising the cytosolic [Ca2+] and causing smooth-muscle cell contraction.

Hypoxia-induced pulmonary arterial constriction shunts blood away from poorly ventilated portions toward better ventilated portions of the lung; however, it also increases pulmonary vascular resistance and right ventricular afterload.

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7
Q

Acute hypoxia causes

A

impaired judgment, motor incoordination, and a clinical picture resembling acute alcohol intoxication.

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8
Q

High-altitude illness is characterized

by

A

headache secondary to cerebral vasodilation, gastrointestinal symptoms,
dizziness, insomnia, fatigue, or somnolence.

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9
Q

Pulmonary arterial and sometimes venous constriction causes

A

capillary leakage and high-altitude pulmonary edema (HAPE), which intensifies hypoxia, further promoting vasoconstriction. Rarely, high-altitude cerebral edema (HACE) develops, which is manifest by severe headache
and papilledema and can cause coma. As hypoxia becomes more severe, the regulatory centers of the brainstem are affected, and death usually results from respiratory failure.

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10
Q

When hypoxia occurs from respiratory

failure, Pao2 ?

A

declines

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11
Q

when respiratory failure is persistent, the

hemoglobin-oxygen (Hb-O2) dissociation curve?

A

is displaced to the right, with greater quantities of O2 released at any level of tissue Po2.

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12
Q

TRUE OR FALSE:

Arterial hypoxemia, that is, a reduction of O2 saturation of arterial blood (Sao2), and consequent cyanosis are likely to be more marked when such depression of Pao2 results from pulmonary disease than when the depression occurs as the result of a decline in the fraction of oxygen in inspired air (Fio2).

A

TRUE

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13
Q

What happens when the depression occurs as the result of a decline in the fraction of oxygen in inspired air (Fio2)?

A

In this latter situation, Paco2 falls secondary to anoxia induced hyperventilation and the Hb-O2 dissociation curve is displaced to the left, limiting the decline in Sao2 at any level of Pao2.

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14
Q

The most common cause of respiratory hypoxia is ?

A

ventilation-perfusion mismatch resulting from perfusion of poorly ventilated alveoli.

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15
Q

Respiratory hypoxemia may also be caused by hypoventilation, in which
case it is associated with ?

A

an elevation of Paco2

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16
Q

A third cause of respiratory hypoxia is shunting of blood across the lung from the pulmonary arterial to the venous bed (intrapulmonary right-to-left shunting) by perfusion of nonventilated portions of the lung, as in?

A

pulmonary atelectasis or through pulmonary arteriovenous connections.

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17
Q

The low Pao2 in intrapulmonary right-to-left shunting is corrected by?

A

The low Pao2 in this situation is only partially corrected by an Fio2 of 100%.

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18
Q

ventilation-perfusion mismatch & hypoventilation can be corrected by?

A

These two forms of respiratory hypoxia are usually correctable by inspiring 100%
O2 for several minutes.

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19
Q

From a physiologic viewpoint, this cause of hypoxia resembles intrapulmonary right-to-left shunting but is caused by congenital cardiac malformations, such as?

A
  1. tetralogy of Fallot
  2. transposition of the great arteries
  3. Eisenmenger’s syndrome
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20
Q

Pao2 in anemic hypoxia

A

normal

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21
Q

the presence of COHb shifts the Hb-O2 dissociation curve to the ?

A

left

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22
Q

This pathophysiology
leads to an increased arterial-mixed venous O2 difference
(a-v-O2 difference), or gradient.

A

circulatory hypoxia

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23
Q

Generalized circulatory hypoxia occurs

in ?

A

heart failure and in most forms of shock

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24
Q

clinical
picture of patients with hypoxia due to an elevated metabolic rate, as
in fever or thyrotoxicosis,

A

the skin is warm and flushed owing to increased cutaneous
blood flow that dissipates the excessive heat produced, and cyanosis is
usually absent.

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25
Q

Cyanide and several
other similarly acting poisons cause cellular hypoxia. The tissues are
unable to use O2, and, as a consequence, the venous blood tends to have
a high O2 tension. This condition has been termed?

A

histotoxic hypoxia.

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26
Q

refers to a bluish color of the skin and mucous membranes
resulting from an increased quantity of reduced hemoglobin (i.e., deoxygenated
hemoglobin) or of hemoglobin derivatives (e.g., methemoglobin
or sulfhemoglobin) in the small blood vessels of those tissues.

A

Cyanosis

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27
Q

Cyanosis is usually most marked in the ?

A

lips, nail beds, ears, and malar eminences.

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28
Q

A cherry-colored flush, rather than cyanosis,

is caused by ?

A

COHb

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29
Q

In some instances, central cyanosis can be detected reliably when the
Sao2 has fallen to _____%; in others, particularly in dark-skinned persons,
it may not be detected until it has declined to _____%.

A

85%

75%.

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30
Q

In general, cyanosis becomes apparent when

the concentration of reduced hemoglobin in capillary blood exceeds?

A

40 g/L (4 g/dL).

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31
Q

the higher the total hemoglobin content, the (greater or lower) the tendency toward cyanosis?

A

greater

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32
Q

the Sao2 is reduced or an abnormal hemoglobin derivative

is present, and the mucous membranes and skin are both affected.

A

central cyanosis

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33
Q

is due to a slowing of blood flow and abnormally
great extraction of O2 from normally saturated arterial blood; it results
from vasoconstriction and diminished peripheral blood flow, such
as occurs in cold exposure, shock, congestive failure, and peripheral
vascular disease.

A

Peripheral cyanosis

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34
Q

Often in these conditions, the mucous membranes of

the oral cavity or those beneath the tongue may be spared.

A

Peripheral cyanosis

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35
Q

Decreased Sao2 results from a

marked reduction in the Pao2.

A

Central Cyanosis

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36
Q 
Which of the ff is are correct
A. Increase in intravascular colloid osmotic
pressure causes absorption
B. Decrease in intravascular hydrostatic
pressure cause filtration
C. Increase in extravascular colloid osmotic
pressure causes edema
D. A and C
A

D. A and C

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37
Q 
Which of the ff does not cause Edema?
A. RAAS
B. Natriuretic peptide
C. ADH
D. Endothelin-1
A

B. Natriuretic peptide

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38
Q 
RAAS, Na and water retention and K excretion
is the effect of what hormone
A. Angiotensin I
B. Angiotensin II
C. Aldosterone
D. Renin
A

C. Aldosterone

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39
Q

ACE is an enzyme mainly produced by the
lungs. What is the function of this enzyme?
A. Converts angiotensinogen to angiotensin I
B. Converts angiotensin I to angiotensin II
C. inactivates bradykinin
D. B and C

A

B. Converts angiotensin I to angiotensin II

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40
Q 
Vasopressin/ADH promotes water retention in
which of the ff tubules?
a. Collecting Tublules
b. Proximal
c. Distal
d. A & C
A

d. A & C

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41
Q

60y.o male with chief complaint of eyelid
swelling at the morning. Px had a history of
type1 Diabetes Mellitus and Hypertension.
Physical Exam revealed bipedal pitting edema.
Urinalysis revealed 3+ proteins. What is the
cause of edema?
A. Heart failure
B. Nephrotic syndrome
C. Liver cirrhosis
D. Poor protein intake

A

B. Nephrotic syndrome

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42
Q 
S2 is closure of what valve
A. Mitral
B. Tricuspid
C. Semilunar 
D. A and B
A

C. Semilunar

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43
Q

Loud with palpable thrill -

A

Grade 4

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44
Q 
10% of the causes of palpitations are due to?
a. Cardiac
B. Psychiatric
C. Miscellaneous
D. Unknown
A

C. Miscellaneous

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45
Q 
CD, a 48 year old female, experienced
palpitations of greater than 15 minutes
A. Cardiac
B. Psychiatric
C. Miscellaneous
D. Unknown
A

B. Psychiatric

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46
Q 
The following are cardiovascular disease
that causes dyspnea expect:
a. Coronary artery disease
b. Restrictive pericarditis
c. Pulmonary hypertension
d. Cardiomyopathy
A

a. Coronary artery disease

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47
Q

Type 2 Dypnea

A

Answer:

walk slowly with same age on level ground

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48
Q 
DOB occurring at night is common to what
condition?
A. Orthopnea
B. Asthma
C. MI
D. Interstitial lung disease
A

A. Orthopnea

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49
Q 
Which of the following order is correct in the
examination of the respiratory system?
A. IPPA (palpation, percussion)
B. IPPA (percussion, palpation)
C. IAPP (palpation, percussion)
D. IAPP (percussion, palpation)
A

D. IAPP (percussion, palpation)

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50
Q

High JVP suggests

A

Answer: Elevated Right Atrial Pressure.

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51
Q

Orthopnea is relieved by:

a. Elevation of both feet
b. Use of bronchidilators
c. Sit upright
d. All of the above

A

c. Sit upright

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52
Q

Expiratory muscles contract generating

positive intrathoracic pressure as high as

A

Answer: 300mmHg

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53
Q

Arnold’s nerve is a branch of what cranial

nerve?

A

Answer: Vagus

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54
Q

Most common origin of hemoptysis?

A

Answer: Bronchi

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55
Q

Most common cause of hemoptysis

worldwide

A

Answer: Bronchiectasis

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56
Q 
Classic description of hemoptysis of vascular
origin
A. Blood-tinged
B. Massive
C. Cherry red
D. Pink and frothy
A

D. Pink and frothy

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57
Q 
What is the amount of blood expectorated at
one time that is considered massive
hemoptysis?
A. 500 mL
B. 150-200 mL
C. 400 mL
D. 100-150 mL
A

D. 100-150 mL

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58
Q 
All patients with massive hemoptysis shoud
be tested by:
A. Chest x-ray
B. Culture
C. CT scan
D. AFB
A

C. CT scan

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59
Q 
During massive hemoptysis, the following
should be done except:
a. Protect the non-bleeding lung
b. Intubate the patient
c. Locate the site of bleeding
d. Correct the bleeding
A

d. Correct the bleeding

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60
Q 
Preferred treatment for massive hemoptysis:
A. Bronchial arterial embolization
B. Surgical resection of vessel
C. Angiography
D. Lobectomy
A

A. Bronchial arterial embolization

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61
Q

All true about vestibular vertigo except
A. May be paroxysmal or due to fixed unilateral
or bilateral vestibular deficit
B.Vertigo or Imbalance
C. Peripheral disorders that affect the labyrinth
or vestibular D nerves
D. Anterior Unilateral Lesion that causes
imbalance and instability of vision

A

D. Anterior Unilateral Lesion that causes

imbalance and instability of vision

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62
Q 
Assessment of eye, ability to fixate two
phases clearly.
A. Pursuit
B. Oacillopia
C. Saccade
D. Visual acuity
A

C. Saccade

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63
Q 
Patient presents with maculopapular rash starting from hair line towards down. Palatal petichia was seen. Upon PE post auricular 
 adenopathy.
A.
B. Rubella
C. Rubeola
D. Exanthem subitum
A

B. Rubella

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64
Q 
PGE2 has 4 receptor but only _ is important
for fever.
A. E3
B. E2
C. E4
D. E1
A

A. E3

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65
Q

What occurs when hypothalamic setpoint is reset downward?

A

B. Heat loss through vasodilation and

sweating

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66
Q

Situational: patient has breathlessness when walking in her own pace and level ground stop to rest-

A

Grade 2

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67
Q

Causes of impaired cough except

A

a. Inc in respiratory muscle contraction

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68
Q 
True of Central cyanosis
A. Slow blood
B. Great oxygen extraction
C. Exposure to cold air/h20
D. Abnormal hgb derivatives
A

D. Abnormal hgb derivatives

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69
Q

Cause of edema in patient with nephrotic

disease.

A

decrease colloid oncotic pressure

due to loss of protein in urine

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70
Q

True of GI bleeding
A. Melena may indicate that blood in gi bleeding
is <14hrs
B.
C. Hemoptysis is indicative of upper gi bleeding
D. Hematochezia…

A

*Melena indicates blood has been present in the GI tract for at least 14 hrs and as long as 3 to 5 days.
*The more proximal the bleeding site, the
more likely the melena will occur
*Hematochezia usually presents a lower GI source of bleeding
*Hematemesis indicates an upper GI source of bleeding

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71
Q

PE for abdominal swelling, except
a. presence of RIGHT supraclavicular lymphadenopathy or Virchow’s node
b. Spider angiomas, palmar erythema, caput
medusae, gynecomastia
c. elevated jvp
d. pericardial knock in heart failure

A

a. presence of RIGHT supraclavicular lymphadenopathy or Virchow’s node

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72
Q 
Attacks of meniers consists of, except...
A. Vertigo
B. Loss of balance
C. Loss of hearing
D. Fullness of affected ear
A

B. Loss of balance

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73
Q

Hypoxia, when respiratory failure is
persistent
A. Hemoglobin-oxygen dissociation curve
shift to the right
B. Hemoglobin-oxygen dissociation curve no
shift
C. Hemoglobin-oxygen dissociation curve shift to
the left
D. Hemoglobin-oxygen dissociation curve shift
downward

A

A. Hemoglobin-oxygen dissociation curve

shift to the right

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74
Q 
What is the main stimulus of increase renin
release?
A. Decrease sodium reab
B. Diminished renal blood flow
C. Decrease O2 in juxtamegulary cells
D. Increase plasma oncotic pressure
A

B. Diminished renal blood flow

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75
Q

Clouding of the eye lens -

A

B. Cataract

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76
Q 
A condition in which eyes are not aligned with each other
A.Amblyopia
B.Myopia
C.Strabismus
D.Diplopia
A

C.Strabismus

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77
Q

Bulging of the eyes between eyelids -

A

Exopthalmos

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78
Q

Assessment of alignment by the location of corneal light reflex within pupil -

A

Hirschberg Test

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79
Q 
The procedure used to detect intraocular
pressure and glaucoma
a. Slit Lamp
b. Tonometry
c. Fundoscopy
d.Perimetry
A

b. Tonometry

80
Q 
Loss of focusing ability of the crystallized
lens due to normal process of old age
A. Myopia
B. Hyperopia
C. Astigmatism
D. Presbyopia
A

D. Presbyopia

81
Q

Mr Goo a 45 yr old male, sought medical
check up from an opthalmologist complaining
that he cant read text messages but having no
problem with target shooting. Visual acuity is
20/25 jaeger 6. What diagnosis is this.
A. Myopia
B. Presbyopia
C. Beginning of cataract
D. Astigmatism

A

B. Presbyopia

82
Q

All are central corneal ulceration except

a. Bacterial
b. Fungal
c. acanthomoeba
d. Moreens

A

d. Moreens

83
Q

Abbreviation for both eyes -

A

Oculus Universal

84
Q 
Procedure used to detect abnormalities in
cornea, anterior chamber and lens.
A. Endoscopy
B. Slit lamp
C. Gonioscopy
D. Fundoscopy
A

C. Gonioscopy

85
Q

mr. KB. Went for eye check up due to upper

left eyelid infection. Stye?

A

Hordelium

86
Q

The white in the eye?

A

-SCLERA

87
Q

Drooping of upper eyelid
A. Proptosis (abnormal protrusion or
displacement of an ey or other body part)
B. Ptosis
C. Blepharospasm (involuntary tight closure of eyelids)
D. Entropion (eyelid folds inward)

A

B. Ptosis

88
Q 
Optic nerve finding is the most concerning in glaucomatous damage
A. Large disk size
B. Horizontal cupping
C. Vertical cupping
D. Tilted disk
A

C. Vertical cupping

89
Q 
Finding is most characteristic of orbital
cellulitis
A. Chemosis
B. Warmth and Erythema of Eyelid
C. Physical taut-feeling eyelid
D. Proptosis
A

D. Proptosis

90
Q

A 27 year old contact lens wearer presents
to the ER with irritation. 2 mm Corneal abrasion.
What should you do?

A

Treat with ciprofloxacin drops

91
Q

A woman presents to you complaining of a
red eye with stinging and some photophobia.
Her vision has slightly dropped to 20/30. She
has a history of diabetes and is taking drops for
glaucoma. What is the likely cause of the
redness?
A. Angle-closure glaucoma
B. Viral conjunctivitis
C. Diabetic retinopathy
D. Papilledema

A

B. Viral conjunctivitis

92
Q 
Patient presented with MVA and fracture in
the orbital floor
a. Double vision and worsen upon upward
looking
b. Chemosis
c. Restricted forced ductions
d. Decreased extraocular movement
A

c. Restricted forced ductions

93
Q 
Which condition leads to innacurately high
reading with applanation pressure
measurement?
a. Thin cornea
b. Thick cornea
c. Edematous cornea
d. Keratoconus
A

b. Thick cornea

94
Q

32 y/o white man with type-1 diabetes
complains of decreased vision. Havent seen
doctors for years. On exam: numerous dot blot
hemorrhages, hard exudates and abnormal
vasculature. Pan-retinal photocoagulation might
be used to:
A. Kill ischemic retina
B. Tamponade retinal tears
C. Ablate peripheral blood vessels
D. Seal off leaking blood vessels

A

A. Kill ischemic retina

95
Q

effect of doxycycline to blepharitis

a. therapeutic antibiotic tear secretion
b. inhibition of cytokines
c. change in lipid viscosity
d. increased lacrimal secretion

A

c. change in lipid viscosity

96
Q

A man complains of splashed bleach in his eyes.

A

Irrigate for 15 minutes and go to

opthalmologist

97
Q

You are trying to measure the deviation in a
child with strabismus. The corneal light reflex
seen in the pupillary margin temporal to the pupil
in the right eye. How much deviation would you
estimate?
A. 10 diopters esotropia
B. 20 diopters exotropia
C. 30 diopters esotropia
D. 40 diopters exotropia

A

C. 30 diopters esotropia

98
Q 
What is the color of fluorescein stain in
corneal ulceration
a. Yellow
B. Blue
C. Green
D. Royal blue
A

C. Green

99
Q

Chalazion is a chronic inflammation

granulomatous of:

A

Meibomian gland

100
Q

Most common sensations that is not

dizziness:

A

Headache

101
Q 
Which is paired correctly?
A. Superior SC- up and down head
movement (nodding)
B. Later SC- head tilt towards shoulder
C. Posterior SC- side to side
D. Anterior- shake head side to side
A

A. Superior SC- up and down head

movement (nodding)

102
Q 
Which of the following differential diagnosis
of dizziness lasted for seconds?
A. TIA
B. BBVP
C. Meniers Dse
D.
A

B. BBVP

103
Q

Maneuver to treat BBVP

A

Epley Maneuver

104
Q 
the most useful bedside test for peripheral
vestibular function
a. Epley maneuver
d. Dix- Hallpike maneuver
c. Head elevation test
d. Dix Epley maneuver
A

d. Dix- Hallpike maneuver

105
Q

Which of the following is true?
A. Nystagmus caused by acute peripheral lesion
changes direction with gaze
B. Unilateral hearing loss is suggestive of central
disorder
C. Nystagmus due to peripheral lesion is
inhibited by visual fixation
D. Central nystagmus is inhibited by visual
fixation

A

C. Nystagmus due to peripheral lesion is

inhibited by visual fixation

106
Q

Otoconia

A

-Calcium carbonate

107
Q 
What are the key features of Meniere's
disease?
A. Low frequency hearing loss
B. Aural symptoms
C. Both
D. None of the above
A

C. Both

108
Q 
Also known as endolymphatic hydrops
A. Vestibular margination
B. Menieres disease
C. Vestibular schwanomma
D. Nota
A

B. Menieres disease

Menieres disease is thought to be due to excess fluid (endolymph) in the inner ear; hence the term endolymphatic hydrops

109
Q

Components of vestibular system

a. semicircular and olith
b. semicircular and Cochlea
c. cochlea and saccule
d. saccule and utricle

A

d. saccule and utricle

110
Q

25 yo male had a motor vehicular accident
and suffered a shock like sensation at the left
leg. It is also triggered by light touch. What type
of pain?
A. Acute pain
B. Neuropathic pain
C. Chronic pain
D. Visceral pain

A

B. Neuropathic pain

111
Q

Behavioral Arousal and Stress Responses

compose of the ff. except:

A

-Pupillary Constriction

Stress activates the Sympathetic ANS which causes Pupillary Dilatation not constriction

112
Q

The cellular body of the primary sensory

afferent is found in the?

A

-Dorsal root ganglia

113
Q 
Primary afferent classification except.
A. Diameter
B. Degree of myelination
C. Response to stimuli
D. Conduction velocity
A

C. Response to stimuli

114
Q 
All sympathetic postganglionic fibers are:
A. Unmyelinated
B. Myelinated
C. None of the above
D. All of the above
A

A. Unmyelinated

115
Q

Which is true about the secondary activation
of primary afferent receptors?
A. Cell damage induces decrease in pH and
release of potassium
B. Prostaglandins increases the sensitivity of
the terminals by bradykinins and other pain
producing substances
C. Direct activation by pressure and noxious
stimuli

A

B. Prostaglandins increases the sensitivity of
the terminals by bradykinins and other pain
producing substances

116
Q

Major neurotransmitter in pain

A

-Glutamate

117
Q

The brain circuits that modulates the activity
of pain transmission pathway is?
A. Hypothalamus-midbrain-medulla
B. Hypothlamus -spinal cord-somatosensory
cortex

A

A. Hypothalamus-midbrain-medulla

118
Q

True mechanism of referred pain

A

-convergence of sensory inputs to a single
pain-transmission neuron and the
convergence patterns are determined by the spinal segment of the dorsal root ganglion that supplies the afferent innervation of a structure.

119
Q

The suggestion that the pain will worsen ff

the administration of innate substances

A

-Nocebo effect

120
Q 
The ff are included in the physical
examination of aortic dissection except
A. Murmur
B. Pericardial rub
C. Loss of peripheral pulse
D. Inc in JVP
A

D. Inc in JVP

121
Q 
Thermoregulation in what part of
hypothalamus?
A. Preoptic hypothalamus only
B. preoptic hypothalamus and posterior
C. post optic and posterior
D. Posterior hypothalamus only
A

B. preoptic hypothalamus and posterior

122
Q

Most common cause on noncardiac chest

discomfort

A

-Gastroesophageal diseases

123
Q 
Pain in dermatomal distribution may be
caused by:
A. burns
B. GERD
C. Herpes zoster
D. Acute myocardial infarction
A

C. Herpes zoster

124
Q 
Pain arising from abdominal wall is:
A. Dull, low quality
B. Steady and aching
C. Poorly localized, intermittent
D. Diffuse, severe
A

B. Steady and aching

125
Q

accounts for 80% of clinician visits.

A

Pain

126
Q

is an unpleasant sensation localized to a part of the body

A

Pain

127
Q

Any pain of moderate or high intensity is accompanied by anxiety which explains the duality of pain:

A

SENSATION and EMOTION

128
Q

→ Also known as Vanilloid receptor

→ Mediates perception of some noxious stimuli especially heat sensations.

A

TrpV1 (Transient receptor potential cation channel subfamily member 1)

129
Q

TrpV1 is activated by:

A

o Acidic pH
o Endogenous mediators
o Capsaicin, a component of chili peppers

130
Q

OD

A

Right Eye (Oculus Dexter)

131
Q

OS

A

Left Eye (Oculus Sinister)

132
Q

OU

A

Both Eyes (Oculus Universal)

133
Q

VA

A

Visual Acuity

134
Q

sc

A

Without correction (Sans correction)

135
Q

cc

A

With correction (Core correction)

136
Q

PH

A

Pinhole

137
Q

Normal visual acuity:

A

20/20 or 6/6

138
Q

The First number of visual acuity indicates ?

A

the distance of the patient from the chart,

139
Q

The second number of visual acuity indicates ?

A

the distance at which normal eye can read the line of letters.

140
Q

As the number increases the vision becomes ?

A

worse or more blur.

141
Q

What should be done if the patient cannot see the largest letter on the chart from 20 feet away?

A

Move patient closer to the chart

o 15/200, 10/200, 5/200

142
Q

if the patient still can’t read at 5ft use CF but start at ?

A

4ft to 1ft.

143
Q

Hand Movements (HM)

A

1ft, done after CF

144
Q

Light Perception (LP)

A

done after HM, make sure the other eye is well covered

145
Q

No Light Perception (NLP)

A

blind (endpoint)

146
Q

VISUAL ACUITY at Near is tested for patients that are how old?

A

usually 40 years and above

147
Q

Test for Presbyopia – do not have the ability to accommodate

Affected : _________

A

Lens, zonules, ciliary muscles

148
Q

Normal VISUAL ACUITY at Near

A

JAEGER 1-3

149
Q

Jaeger Chart value is from __ to ___

A

Jaeger 1 to 16

150
Q

Small chart with gradations, as the number increases, more difficult to read.

A

Jaeger Chart

151
Q

Proper distance for Jaeger Chart

A

Proper distance is 14 inches

152
Q

Newspaper, Magazine or Telephone Directory

A

Jaeger 1-3

153
Q

Can be use even without any sophisticated machines only penlight

A

EXTERNAL EXAMINATION

154
Q

Normal external examination of the eyes:

Lids

A

Not swollen

155
Q

Normal external examination of the eyes:

Lashes

A

Not matted

156
Q

Normal external examination of the eyes:

Conjunctiva

A

Pink

157
Q

Normal external examination of the eyes:

Sclera

A

Anicteric

158
Q

Normal external examination of the eyes:

Cornea

A

Clear

159
Q

Normal external examination of the eyes:

Pupils(Lens)

A

3-4mm RTL

160
Q

timos-timos

A

hordeolum

161
Q

(lagob) sandwiched in conjunctiva and sclera

A

sub conjunctival hemorrhage

162
Q

sub conjunctival hemorrhage management

A

usually summer time, apply cold compress for 2 days

163
Q

To examine the patient’s RIGHT eye, the Examiner should use his:

A

→ RIGHT eye

→ RIGHT hand

164
Q

visualize fundus

A

Ophthalmoscope

165
Q

Normal ophthalmoscopy:

ROR

A

(+)

166
Q

Normal ophthalmoscopy:

Media

A

Clear

167
Q

Normal ophthalmoscopy:

Disc Margins

A

Distinct

168
Q

Normal ophthalmoscopy:

Cup-Disc Ratio

A

0.3

169
Q

Normal ophthalmoscopy:

A-V

A

2:3

A-V Ratio – artery(smaller):vein

170
Q

Normal ophthalmoscopy:

Exudates, Hemmorhage

A

none

171
Q

Journey of light as it enters the eye

A

Light ➡Cornea➡ Lens➡ Vitreous

172
Q

Eye movement:

Medial rectus

A

adduction

173
Q

Eye movement:

Lateral rectus

A

abduction

174
Q

Eye movement:

Inferior rectus

A

Primary: depression
Secondary: extorsion
Tertiary: adduction

175
Q

Eye movement:

Superior rectus

A

Primary: elevation
Secondary: intorsion
Tertiary: adduction

176
Q

Eye movement:

Inferior oblique

A

Primary: extorsion
Secondary: elevation
Tertiary: abduction

177
Q

Eye movement:

Superior oblique

A

Primary: intorsion
Secondary: depression
Tertiary: abduction

178
Q

Corneal Light Reflex Test

A

Hirschberg Test

179
Q

Hirschberg Test is used to?

A

Assesses eye alignment by the location of the Corneal Light Reflex within the pupil

180
Q

Temporal Displacement

A

Esotropia

181
Q

Nasal Displacement

A

Exotropia

182
Q

Inferior Displacement

A

Hypertropia

183
Q

What test is used to measure Intraocular Pressure?

A

TONOMETRY

184
Q

Normal Intraocular Pressure

A

10 – 20 mm HG

*21 mm HG still normal

185
Q

How is Intraocular Pressure measured?

A

• Palpation
• Schiotz- Indention tonometer
Rarely used, inaccurate, used on bedside pxn
• Goldmann Applanation Tonometer (Gold Standard)

186
Q

Why is it important to learn how to use the Ophthalmoscope?

A
  • Screen for GLAUCOMA, which is one of the most common causes of preventable blindness. Glaucoma is asymptomatic in early stages.
  • Recognize Papilledema (swelling of pupils).
  • Stage Hypertensive Retinopathy and Diabetic Retinopathy, other retinal diseases
187
Q

Significance of the CD Ratio

A
  • Glaucoma Screening
  • The C:D Ratio is the Ratio of the DIAMETER of the CUP to the DIAMETER of the DISC
  • NORMAL CD RATIO = 0.3
  • Examine also, the RIM: look for “thinning” and “notching”
188
Q

Significance of Blurred Disc Margins:

A

Papilledema

189
Q

Significance of the AV Ratio:

A

Hypertensive Retinopathy

190
Q

Murphy’s sign

A

→ Apply pressure inward then upward at right upper quadrant then instruct the patient to inhale
→ If there is a respiratory arrest while inhaling, that is the positive murphy’s sign

191
Q

The most common causes of abdominal pain on admission:

A

→ acute appendicitis
→ nonspecific abdominal pain
→ pain of urologic origin
→ And intestinal obstruction.

192
Q

Location of auscultation:

Aortic

A

2nd ICS right parasternal area

193
Q

Location of auscultation:

Pulmonic

A

2nd ICS left parasternal area

194
Q

Location of auscultation:

Tricuspid

A

5th ICS left parasternal area

195
Q

Location of auscultation:

Mitral

A

5th ICS midclavicular line

Medicine 1 (7 decks)

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