Cardiac/Lymph/Abdominal/Thyroid

Question 1

To diagnose hypertension, how many readings over how many visits are required?

Answer 1

2 or more readings on at least 2 visits

Question 2

List the systolic and diastolic levels of pre-hypertension

Answer 2

120-139 over 80-89

Question 3

List 3 examinee factors that may affect BP

Answer 3

white coat effect, recent tobacco or caffeine, full bladder, talking, legs crossed

Question 4

Sinus Bradycardia

Answer 4

Less than 60

Question 5

Sinus Tachycardia

Answer 5

Greater than 100

Question 6

When comparing BP in the upper extremity bilaterally, what is the allowable difference in mmHg from side to side?

Answer 6

10-12 mmHg from side to side (diastolic doesn’t change much)

Question 7

Of the following conditions that can decrease systolic BP in an extremity which is more common?

Answer 7

Peripheral arterial disease

Question 8

List the sequence of evaluation when assessing the arterial system:

Answer 8

Inspect, Auscultate, Palpate

Question 9

List the arteries auscultated in an arterial exam

Answer 9

Carotid, Subclavian, Abdominal Aorta, Renal, Femoral (controversy as to the usefulness of this)

Question 10

List the arteries palpated in an arterial exam

Answer 10

Carotid, Temporal, Abdominal Aorta, Iliac, Femoral, Popliteal, Posterior Tibial, Dorsal Pedal

Question 11

Name the three qualities you assess when taking a Radial pulse

Answer 11

a) Rate or beats/minute; b) Amplitude or “strong”; c) Rhythm or “regular”

Question 12

What is the “classic” but unreliable measurement of the abdominal aorta upon supra-umbilical palpation?

Answer 12

2.5-4 CM

Question 13

When auscultating the carotid artery, we ask the patient to briefly hold their breath?

Answer 13

True

Question 14

We use the ? or the Diaphragm to auscultate the carotid artery?

Answer 14

Bell

Question 15

What is a bruit?

Answer 15

A Bruit is the term for the unusual sound that blood makes when it rushes past an obstruction called turbulent flow in an artery when the sound is auscultated with the bell portion of a stethoscope.

Question 16

Which is better for detecting an aneurysm of the abdominal aorta, palpation or auscultation?

Answer 16

Palpation

Question 17

What 2 possible findings might we get from palpating the anterior chest wall?

Answer 17

a) Thrills or Heaves; b) MFTPs

Question 18

How might you position a patient to better hear the heart sounds?

Answer 18

Either lean them forward and/or off to the left side

Question 19

See diagram to the right: a) Label auscultatory points

Answer 19

a) Label the auscultatory points

Question 20

See diagram to the right: b) What point is missing from this diagram?

Answer 20

ERBs

Question 21

In a US primary care setting, what is the most likely cause of chest pain?

Answer 21

Musculoskeletal conditions (36%)

Question 22

Define Arrhythmia

Answer 22

Heartbeats that are too slow, too rapid, irregular, or too early

Question 23

Atrial Fibrillation is

Answer 23

considered the most common form of arrhythmia, is associated with high rates of morbidity and mortality and is thought to be responsible for 15% to 20% of all strokes. It is most often seen in patients over 60, especially those with coronary heart disease, high blood pressure, COPD, etc.

Question 24

S1 marks the beginning of

Answer 24

Ventricular Systole

Question 25

S1 marks the beginning of Ventricular Systole. What valves are closing?

Answer 25

AV Valves

Question 26

S1 marks the beginning of Ventricular Systole. Where do you listen to hear S1 best?

Answer 26

Apex of heart Mitral and Tricuspid points

Question 27

S2 marks the end of

Answer 27

Ventricular Systole

Question 28

S2 marks the end of Ventricular Systole. What valves are closing?

Answer 28

Aortic and Pulmonic

Question 29

S2 marks the end of Ventricular Systole. Where do you listen to hear S2 best?

Answer 29

Aortic and Pulmonic points

Question 30

Name all of the lymph node groups covered in lab in the head and neck region:

Answer 30

Posterior auricular, pre-acuricular, submandibular, submental, anterior cervical chain, posterior cervical chain and supraclavicular

Question 31

Which lymph nodes have the highest risk of malignancy estimated at 90% in patients over 40 and 25% in those under 40?

Answer 31

Supraclavicular

Question 32

Virchow’s node, also known as the Sentinel Node, is located where?

Answer 32

Left supraclavicular fossa

Question 33

T or F: The vertical inguinal lymph nodes drain the abdomen?

Answer 33

False, they drain the lower extremity, the horizontal nodes drain the abdomen

Question 34

Most patients with an enlarged thyroid or goiter have which of these?

Answer 34

Euthyroidism (80% and accompany NO signs or symptoms of thyroid disease)

Question 35

Describe the physical findings of a HYPERPLASTIC “REACTIVE” lymph node:

Answer 35

Firm, moveable, non-tender, discrete margins, less than 1 cm

Question 36

Barrel chest is a finding that may indicate what?

Answer 36

Late Stage COPD (Board Q)

Question 37

Normal thoracic excursion should be symmetric with thumbs moving ? CM apart during deep inspiration.

Answer 37

3-5 CM

Question 38

Digital clubbing has been classically associated with what?

Answer 38

Advanced chronic bronchitis

Question 39

What is the normal tone heard when percussing the lung?

Answer 39

Resonant

Question 40

Where would we percuss to hear a “flat” or “dull” tone in a normal patient?

Answer 40

Directly over bone, over large skeletal muscle, or over a normal liver

Question 41

List the sequence of evaluation when assessing the abdomen system:

Answer 41

i) inspection/observation, ii) auscultation, iii) percussion, iv) light palpation, v) deep palpation

Question 42

Name the test used to differentiate between pain in the superficial wall of the abdomen and deeper structures.

Answer 42

Carnett’s