CS 4

Question 1

Are the four criteria for insomnia?

Answer 1

Trouble initiating and maintaining sleep. Adequate opportunity for sleep. Daytime functioning distracted. No other sleep disorder.

Question 2

His normal sleep latency? Sleep latency in insomnia patients?

Answer 2

20-30; >30 Or periods of waking greater than 30 minutes in duration

Question 3

What is short-term and chronic insomnia?

Answer 3

Less than 3 months, greater than 3 months

Question 4

What is initial insomnia? What are the classical cause?

Answer 4

Problems with initiation asleep. Think of poor sleep hygiene, anxiety, a stimulus.

Question 5

What is terminal insomnia? What are the classical causes?

Answer 5

Maintain sleep Or waking up too early. Alcohol or depression

Question 6

Lack of sleep without daytime drowsiness is indicative of what?

Answer 6

Bipolar disorder

Question 7

Insomnia must be distinguished between what two disorders?

Answer 7

Nonrestorative sleep (OSA) or altered sleep schedule (cAcadian rhythm disorder)

Question 8

What should be discussed in the closing encounter for insomnia patients?

Answer 8

Discuss how insomnia can affect well-being social interactions and functional status. Should counsel patients on keeping a sleep diary

Question 9

What should sleep diary consist of?

Answer 9

What time you go to sleep, how long it takes you to fall asleep, number/duration of awakenings, estimated sleep time, daytime symptoms, exercise and dietary habits

Question 10

What are the diagnostic studies that can be done for insomnia patients?

Answer 10

Fasting glucose and HbA1c.
Liver function panel
Sleep study/polysomnography
Urine toxicology 
TSH

Question 11

What are the clinical features for menopause?

Answer 11

Remember VOCALS☝🏾
Cognitive decline, irritability, hot flashes, oligomenorrhea/amenorrhea, vaginal atrophy, sleep disturbances, Depression, decreased libido

Question 12

What is menopause?

Answer 12

Permanent cessation of menses, clinically diagnosed at 45 for duration of 12 months. Average age being 51

Question 13

What is perimenopause or menopause transition? What is considered premature?

Answer 13

Irregular menstrual bleeding for seven years before menopause. 28+-7days; less than 40 yo

Question 14

What are the common reasons a menopausal woman comes office?

Answer 14

Vasomotor (hot flashes) hypo estrogenic vaginal dryness. Fertility problems and Osteoporosis

Question 15

What disorders may mimic menopause, what are the differential diagnosis? What are the associated symptoms?

Answer 15

Thyroid disorders such as hyperthyroidism, palpitations tremor heat intolerance Weight loss hyperreflexia. Pituitary disorders: menstrual disturbances, galactorrhea, mass defects (headache visual field defects). Pregnancy especially if younger than45

Question 16

What is the follow up question for hot flashes? Irregular periods?

Answer 16

How often do they occur? When did the irregular periods start occurring?

Question 17

What question should be asked to a menopausal patient for past medical history?

Answer 17

And we had a hysterectomy or any other surgeries?

Any problems with your ovaries or uterus including cancers?

Question 18

If a patient is having hot flashes what should be noted?

Answer 18

If the patient has any contraindications for hormone therapy (smoking, History of breast cancer)

Question 19

When should FSH be ordered in menopausal patients?

Answer 19

Patients with significant symptoms less than 45 or older patients with uncertain diagnosis (hysterectomy)

Question 20

What diagnostic test should be ran for menopause patients?

Answer 20

TSH
Prolactin
Estradiol and progesterone and FSH
Serum HCG and urine HCG 
Genital and pelvic examination

Question 21

What are the differential diagnosis for a patient with carpal tunnel syndrome?

Answer 21

Fractured, sprained, ligament avulsion.

Carpal tunnel syndrome, ulnar neuropathy, rheumatoid arthritis, Osteoarthritis, de quervain tenosynovitis

Question 22

What are the physical test For carpal tunnel syndrome?

Answer 22

Phalen test and tinel sign

Question 23

Night sweats can arise from what disorders?

Answer 23

Infection, malignancy, Metabolic derangement

Question 24

What causes hot flashes? What causes flushing? Hyperhidrosis?

Answer 24

Hot flashes can because by menopause or male or female hypergonadism. Flushing can be caused by menopause or medication such as Niacin or carcinoid syndrome. Typically is during the day typically affects axilla palms and soles

Question 25

What are the differential for night sweats?

Answer 25

Infection, malignancy, alcohol or Opioid withdrawal,

Hypoglycemia, medications such as antidepressants, Systemic Inflammatory/autoimmune diseases, gastroesophageal reflux

Question 26

What are the diagnostic test necessary for patients with Night Sweats?

Answer 26

CBC, HIV screen, PPD, CXR, ESR, TSH, glucose and electrolytes

Question 27

What the causes for Hemoptysis?

Answer 27

Bronchitis, lung cancer, bronchiectasis, tuberculosis, lung abscess, bacteria pneumonia, Asperogillosis, mitral valve stenosis/Acute pulmonary edema, Granulomatous with polyangitis, Goodpastures, pulmonary embolism, AV malformation, trauma, cocaine (inhalation)

Question 28

What are the common features besides Hemoptysis for TB? Lung abscess?

Answer 28

Cough, weight lost, low grade fever; systemic sx and purulent.

Question 29

Orthopedic this order should be classified how?

Answer 29

Traumatic or aTraumatic. Acute or chronic/repetitive

Question 30

What examination should be done for orthopedic cases?

Answer 30

Examination of the joints immediately above and below the symptomatic area

Question 31

What are the risk factors for plantar fasciitis?

Answer 31

Jogging/running, prolonged standing, dancing, pes planus, obesity

Question 32

Other than mechanical causes for orthopedic disorders what else should be considered?

Answer 32

Rheumatology

Question 33

What orthopedic patients should be evaluated with imaging?

Answer 33

Chronic symptoms that are not improving as expected, acute trauma

Question 34

For orthopedic patients what should be done if patient is experiencing gradual improvement?

Answer 34

Counsel the patient (activity modification) and write “no studies indicated”

Question 35

Evaluation of hands symptoms should address what two aspects?

Answer 35

Symptoms itself (like pain and stiffness). Effect on function (including occupational function)

Question 36

Where is the location of pain for Decore vein tenosynovitis? All their neuropathy? Carpal tunnel syndrome?

Answer 36

Base of the thumb. Medial wrist, hand and fifth digit. Palmer aspect of first three or four digits