DDX 1 LL Oral Final

Question 1

How is serotonin related to photophobia and phonophobia for patients with migraines? AND What differentiates migraine from tension-type HA? List three differences.

Answer 1

Migraine headaches have symptoms of being: pulsatile, debilitating, unilateral and lasting 4-72 hours.
&
Where as tension-type headaches are non-pulsatile, non-debilitating lower grade pain, bilateral and lasting days or longer.

Question 2

What theoretically causes a migraine aura? AND What theoretically is the structural connection to the trigeminal nerve in the cervical spine? Describe the anatomic overlap in location.

Answer 2

The theoretical structural connection between the trigeminal nerve and the cervical spine. The trigeminal nucleus, also known as spinal nucleus, interdigitates with the upper 3 segments of the dorsal horn of the spinal cord. (This is known as the trigeminal cervical nucleus.)

Question 3

What lab tests are indicated for the Dx of temporal arteritis? Name two AND What is the treatment for termporal arteritis and why is it necessary?

Answer 3

The treatment for temporal arteritis is corticosteroids because this is an autoimmune, inflammatory disorder. It’s necessary because it decreases pain, but it also prevents blindness.

Question 4

A 60 yo F complains of spinning dizziness that is worse turning her head to the right. There is no trauma. The attacks are brief. What is most likely the cause of her complaint and what causes this disorder? AND
What is the test used for this disorder and what is the response you would expect? List at least four responses that indicate this disorder.

Answer 4

The test used for BBPV would be Dix-Hallpike (Barrany) Maneuver. The classic response is that when you position the patient in the second position, that there is a latency (no response) → 20-40 seconds later, vertigo & nystagmus present

Question 5

What is the theoretical cause of Miniere’s disease that relates to management approaches? AND Describe a classic presentation of a patient with Meniere’s. Name four components.

Answer 5

A classic presentation for a patient with Meniere’s will be a complaint of fullness in the ear, low tone tinnitus, spinning dizziness, recurrent and generally lasts for about a day and is .

Question 6

Describe two ways in which diabetes can cause a patient to complain of dizziness AND what test findings would confirm those two conditions?

Answer 6

A patient with diabetes with complaints of dizziness could be caused by orthostatic hypotension, which is due to blockage of the normal sympathetic reflex upon standing; or proprioceptive loss.

Question 7

Name the two most common causes of a complaint of being off-balance AND name the two most common causes of a complaint of lightheadedness upon standing.

Answer 7

The 2 Most Common Causes of a Complaint of “Lightheadedness Upon Standing” are diabetes or anti-hypertensive medications.

Question 8

What in-office test can you perform to detect Alzheimer’s? Name three general components.
AND
What is the difference in presentation between multi-infarct dementia and Alzheimer’s?

Answer 8

Multi-infarct dementia has a sudden onset, decrease in memory loss with sensory and motor deficits. Alzheimer’s has a slow and gradual onset of memory loss, with no motor or sensory deficits.

Question 9

What are the two most sensitive historical clues for depression?
AND
List the cluster of physical complaints that depressed individuals often have when they somatize?

Answer 9

In these individuals, the cluster of physical symptoms would be: multiple joint complaints, mild persistent HA, dizziness and mild persistent dyspnea without pain.

Question 10

If a patient presents with numbness and pain from the neck to the 4th and 5th fingers following a traumatic injury and weakness of muscles in the same area, and hypothenar atrophy, what are two possible problems and why?
AND
How is it possible for someone to have a nerve root problem and have intact DTRs?

Answer 10

You can have nerve root problems, while still having intact DTR’s when the nerve roots involved don’t have deep tendon reflexes associated with them. (C8, T1), and C5,6,7 are normal.

Question 11

If a patient presents with numbness and pain from the neck down the medial arm to the 4th and 5th fingers following a traumatic injury and weakness of muscles in the same area, how do you know it is not a neuromuscular junction problem? List three reasons.
AND
What is the difference between neurologic weakness versus that caused by a strain/sprain both on Hx and exam?

Answer 11

The difference is that neurologic weakness may or may not have had trauma, but present with painless-weakness; where a sprain/strain, the patient has a history of overuse and/ or trauma to the affected area. Muscle testing will involved pain and weakness.

Question 12

What are the two types of seizures that have only a 10% chance of progressing to grand mal (tonic-clonic) seizures?
AND
Describe a Grand Mal seizure sequence and timing.

Answer 12

With a Grand Mal seizure, the patient will lose consciousness, stiffen (tonic) and convulse (clonic). This phase will last 1-3 minutes, that may go on and off, with a post-ictal phase beginning when the patient regains consciousness.

Question 13

List three historical indicators that would point in the direction of your patient not having epilepsy even though they had convulsions.
AND
What is the most common cause of convulsions that are not epilepsy in adults?

Answer 13

The most common cause of non-epileptic convulsions is syncope, especially if they’re unconscious for more than 20-30 seconds.

Question 14

In addition to high fasting glucose levels, what other lab findings are abnormal with diabetics? Which of these laboratory findings indicates that the patient did not fast?

AND
What test would you run for a known diabetic and why? Two reasons?

Answer 14

The test performed for a known diabetic would be Glycosolated Hb test (HA1C). The test measures glycemic control of over 2-3 months and the patient doesn’t need to fast.

Question 15

What are the signs/symptoms you would expect to find with someone with early adult (non-insulin dependent) diabetes?
AND
What finding is often present on lab testing of female diabetics?

Answer 15

The S/Sx you would expect to find w/ someone w/ Early Adult (non-insulin dependent) Diabetes include: Fatigue,
Numbness & Tingling in the distal Extremities and Changes in Vision Throughout the Day.
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For female diabetic patients, it is common to find indicators of a yeast infection

Question 16

Name and describe two of the four neuropathies associated with diabetes?
AND
Describe what happens in small blood vessels with diabetes?

Answer 16

Small blood vessels react to the hyperglycemic environment (high sugar levels) and hyper proliferate the intimate.
Thus blocking circulation and leading to different “-opathies.”

Question 17

If a senior patient has a BP of 180/120 but was normal three months ago, what could cause this sudden increase? 2 reasons; 1 pathologic
AND
Name two classifications of medications used to treat hypertension and their general mechanism.

Answer 17

ACE Inhibitors block the conversion of Antiogensin 1 to Angiotensin 2, or diuretics. Both of these help decrease the blood volume, causing a decrease in blood pressure.

Question 18

Is there anything you could do in your office to determine if someone has renal artery stenosis?

AND

What are three high- risk factors listed on the clinical prediction rule chart presented in class for renal artery stenosis?

Answer 18

Three high-risk factors are: female, smoker, and age.

Question 19

List three reasons why a patient’s BP may be transiently high?

AND

Name four ways to conservatively manage or influence HTN? Be specific.

Answer 19

Weight loss, if needed, decrease Na intake, increase K intake, aerobic exercise and

Question 20

What are the tests necessary to Dx asthma and why are they needed?
AND

What types of medications are used to control asthma (not for an acute attack)?

Answer 20

Corticosteroids (oral or aerosol), Beta 2 agonists and leukotriene receptor antagonists.

Question 21

How do non-selective beta-blockers affect respiration?
AND
Name three pathological actions that occur during an asthma attack and one that is always present even when the patient is asymptomatic?

Answer 21

3 Pathological actions during an acute attack are: bronchoconstriction, mucosal edema and increased mucous production. Inflammation is always present, even in an asymptotic patient.

Question 22

Describe a classic presentation of a patient with cardiac ischemia.
AND
Why does the pain refer into typical areas?

Answer 22

Because of the overlap of sympathetic visceral afferene and somatic sensory nerve innervation.
T1-T5 overlap where sympathetic nerve cell bodies are origins are located in the medial and lateral subcolumns
T1 overlap for arm, fibers transmit up the chain gang and synapse upper cerv chain gang (reason for jaw pain – C2)

Question 23

How would you evaluate a patient with a suspected rib fracture? List in sequence.
AND

What complication of rib fracture do you need to evaluate with imaging?

Answer 23

History: A traumatic history with a complaint of severe pain on laughing, coughing, sneezing and lying supine.
Exam: Increased pain at fracture site with compression or tuning fork. Radiographs, P-A and lateral chest film, looking for both rib fracture and pneumothorax
PA Lateral
–
Pneumothorax

Question 24

Name three major categories that would cause a sudden onset of severe abdominal pain?
AND
Which are survivable and often recurrent and why?

Answer 24

Blockage of non-intestinal lumen represented by kidney stones and gallstones. The reason why they are surviving and recurring is because there is caused by stones, which can be passed

Question 25

What are three differences between regional enteritis and ulcerative colitis?
AND

What association is there between patients with inflammatory bowel disease and peripheral arthritis?
AND
Name a lab test that would be positive in this relationship.

Answer 25

Regional enteritis: involves mainly small bowel, patchy, on barium (on contrast) would demonstrate areas of normal and obstructed areas demonstrated by the + string sign;
It’s transmural, mainly obstructive.
UC: superficial,
Presentation: bouts of bloody diarrhea; mainly colon and large intestine
–
Many patients with inflammatory bowel disease are positive for HLA-B27, which is related to the sero-negative arthritities. A positive test for HLA-B27 would indicate this correlation of IBD and peripheral arthritis.