Diagnosis and how to read lab Questions Flashcards
When you sweat what type of loss solution loss is this and how would you treat it?
For an adult it is hypotonic loss of Na+ and you would treat with giving a isotonic solution 1st to maintain blood pressure than you can switch to a hyptonoic solution.
What type of fluid loss does Hyperglycemia cause?
Loss of Hypotonic fluid (Na+ is lost in the urine w/ glucose)
Example:
Diabetic Ketoacidosis (Type 1 DM) - because insullin is an anti-ketotic Hormone. The individual can not make this hormone (can occur in Type 2 DM but less common due to the individual being able to produce their own insulin but can occur when there is a deficiency of insulin)
Hyperosmolar non-Ketotic Coma - Common for Type 2 DM due to the person can make insullin
What are the type of fluid disorders and what are some examples of symptoms.
Question
1A patient gets light headed when shaving his neck.
or
- A guy kisses a girl on her neck and she faints and thinks she is in love.
What could be causing this.
Some individuals have extremely sensitive receptors and in this case the baroreceptor in the neck called the carotid baroreceptors is being pressed causing dilation thus the symptoms.
P.s. - you are not a good lover she just has this condition even a dog can cause this bwahaha.
**Case 1 **
What physical exams and diagnosis and Ddx would be appropriate?
67-year-old male
CC: reduced exercise tolerance
History
Onset of reduced exercise tolerance Three months ago.
Progression of exercise tolerance It has progressively worsened.
Shortness of breath at rest No.
Shortness of breath with activity Yes.
Walking distance before shortness of breath A short distance, less than a block.
Nighttime shortness of breath No.
Swelling in legs Yes.
Swelling in ankles Yes, especially by the end of the day.
Recent weight change No significant changes.
History of heart problems Yes, I have hypertension.
History of high blood pressure Yes, I have hypertension.
History of lung diseases No.
History of asthma No.
Recent respiratory infections No.
Recent colds No.
Current smoking status I quit six months ago.
Past smoking history Yes, I smoked one pack per day for 40 years.
Smoking quantity One pack per day.
Medications for breathing Yes, I use an albuterol inhaler occasionally.
Inhalers for breathing Yes, I use an albuterol inhaler occasionally.
Relief from inhaler Some relief.
Presence of cough Yes.
Duration of cough Several years.
Productive cough Yes.
Sputum appearance White sputum.
Presence of wheezing Yes.
Chest pain No.
Discomfort No.
Palpitations No.
Irregular heartbeats No.
Recent fevers No.
Recent night sweats No.
Changes in appetite No.
Known allergies No.
Current medications Just the albuterol inhaler.
Family history of heart diseases No significant family history.
Family history of lung diseases No significant family history.
Occupation Retired factory worker.
Daily diet: I eat three meals a day, mostly home-cooked.
24-hour diet recall:
Breakfast: Two scrambled eggs, whole wheat toast
with butter, a banana, and black coffee.
Mid-morning: An apple.
Lunch: Grilled chicken sandwich with lettuce and
tomato, a small salad with Italian dressing, and
water.
Afternoon: A handful of almonds.
Dinner: Baked salmon, steamed broccoli, brown
rice, and a glass of water.
Evening: A bowl of mixed berries and a cup of
herbal tea.
Alcohol consumption per week I drink socially, maybe a few drinks on the
weekends.
Recreational drug use No.
Physical Exams
General appearance assessment Mildly distressed due to dyspnea.
Measurement of blood pressure 145/90 mmHg.
Measurement of heart rate 92 bpm.
Measurement of respiratory rate 20 breaths per minute.
Measurement of oxygen saturation 94% on room air.
Inspection for jugular venous distention Present.
Auscultation of the lungs for crackles Bilateral crackles at the bases.
Auscultation of the lungs for wheezes Expiratory wheezes.
Auscultation of the lungs for other abnormal sounds None.
Auscultation of the heart for gallops S3 gallop present.
Auscultation of the heart for murmurs None.
Auscultation of the heart for other abnormal sounds None.
Inspection for peripheral edema Present.
Palpation for peripheral edema Pitting edema in both ankles.
Palpation of the chest wall for tenderness No tenderness.
Palpation of the chest wall for abnormalities No abnormalities.
Inspection of the extremities for cyanosis None.
Inspection of the extremities for clubbing None.
Abdominal palpation for hepatomegaly None.
Abdominal palpation for ascites None.
Assessment of capillary refill time Normal.
Palpation of radial pulse Normal.
Palpation of femoral pulse Normal.
Palpation of dorsalis pedis pulse Normal.
Palpation of posterior tibial pulse Normal.
Examination of the oral cavity for signs of infection None.
Examination of the oral cavity for signs of cyanosis None.
Evaluation of the patient’s gait Mildly impaired due to dyspnea.
Evaluation of the patient’s exercise tolerance Reduced.
Observation of respiratory effort Increased effort noted.
Observation of use of accessory muscles Mild use of accessory muscles.
Assessment of skin turgor Normal.
Assessment of skin temperature Normal.
Inspection of the nail beds for signs of hypoxia None.
Physical Exams
Physical Exams
1. Vital signs
2. Heart/lung sounds
3. Liver palpation
4. Anthropometrics
Diagnosis: Heart Failure
DDx: Fatty liver disease, Pulmonary Edema, Obesity
Case 2
What physical exams and diagnosis and Ddx would be appropriate?
28-year-old female
CC: dysmenorrhea
History
Onset of pain The pain started about a year ago.
Pain description The pain is sharp and cramping, located in the lower abdomen and pelvis.
Pain radiation Yes, it sometimes radiates to my lower back and thighs, especially during my
periods.
Pain duration It starts a few days before my period and lasts until it ends, usually about a
week in total.
Pain outside menstruation Yes, sometimes during intercourse and bowel movements, which makes
these activities very uncomfortable.
Changes in menstrual cycle No
Regular periods Yes, every 28 days.
Duration of menstrual period About 5 days.
Medications tried Yes, over-the-counter pain medications.
Effectiveness of treatments They provide minimal relief, sometimes I have to take more than the
recommended dose to get any relief.
Pain during intercourse Yes, it is painful, especially deep penetration, which has affected my
relationship.
Pain during bowel movements Occasionally, yes, particularly during my period, making it quite distressing.
Episodes of fever or malaise Occasionally, especially around my periods, I feel feverish and generally
unwell.
Abnormal vaginal discharge No
History of urinary tract infections Yes, I’ve had recurrent urinary tract infections, about 3-4 times in the past
year.
Number of sexual partners I have had multiple partners in the past, about five.
Current relationship status Yes, for the past two years, I have been in a monogamous relationship.
Consistent condom use No, not consistently, sometimes we rely on other forms of contraception.
Other medical conditions No other medical conditions.
Regular medications No, not regularly.
Allergies No known allergies.
Family medical history My mother has diabetes, and my father is healthy. My maternal
grandmother had some gynecological issues, but I’m not sure of the details.
Occupation I work as a marketing manager, which involves long hours and a fair amount
of stress.
Tobacco use No
Alcohol or drug use I occasionally drink alcohol, but no recreational drugs.
Typical day’s diet I usually have a balanced diet with fruits, vegetables, and lean proteins,
though I sometimes skip meals due to work.
Children or pregnancy history No children and I’ve never been pregnant.
** Physical Exam**
Blood pressure 120/80 mmHg
Heart rate 76 bpm
Respiratory rate 16 breaths/min
Temperature 37°C (98.6°F)
General appearance The patient appears uncomfortable but in no acute distress.
Abdominal inspection No visible abnormalities.
Abdominal palpation Mild tenderness in the lower quadrants, more pronounced on the left.
Rebound tenderness No rebound tenderness.
Guarding No guarding observed.
Pelvic inspection No visible abnormalities.
Palpation of the uterus Uterus is normal in size and shape.
Palpation of the adnexa Tenderness upon palpation of the adnexa bilaterally, more on the left.
Adnexal masses No adnexal masses palpated.
Cervical motion tenderness Cervical motion tenderness is present.
Abnormal vaginal discharge No abnormal vaginal discharge noted.
Speculum exam No abnormalities detected.
Bimanual exam Confirmed tenderness in the adnexa bilaterally.
Assess for fever No acute fever.
Assess for malaise Occasional malaise reported.
Assess for chills No chills reported.
Costovertebral angle tenderness No costovertebral angle tenderness.
Lower back tenderness Mild lower back tenderness reported.
Lower limb muscle strength Normal muscle strength.
Lower limb reflexes Normal reflexes.
Sensation in lower limbs Normal sensation.
Physical exam
1. Pelvic exam
2. vital signs
Diagnosis: STI
DDX cyst, adnexal tumors
Which diagnostic test is considered the gold standard for confirming endometriosis?
A) Transvaginal ultrasound
B) MRI of the pelvis
C) Laparoscopy
D) CA-125 blood test
Correct Answer: C) Laparoscopy
A) Transvaginal ultrasound: Incorrect. While useful for identifying ovarian cysts or fibroids, it cannot definitively diagnose endometriosis.
B) MRI of the pelvis: Incorrect. MRI may help in advanced cases, but it is not the gold standard for endometriosis.
C) Laparoscopy: Correct. This minimally invasive surgery allows for direct visualization and confirmation of endometriosis.
D) CA-125 blood test: Incorrect. While elevated in some cases of endometriosis, it is nonspecific and not diagnostic.
A 50-year-old patient presents with dizziness and imbalance. During the head impulse test, their eyes move with their head and then rapidly saccade back to the fixation point. What does this finding most likely indicate?
A) A central pathology such as a brainstem stroke
B) A peripheral vestibular dysfunction such as vestibular neuritis
C) A normal response to the head impulse test
D) Vertical diplopia caused by a skew deviation
Answer:
B) A peripheral vestibular dysfunction such as vestibular neuritis
Rationale:
Corrective saccades during the head impulse test suggest a peripheral vestibular problem (e.g., vestibular neuritis).
A central pathology would usually show no saccade (CNS compensation).
A normal response involves no corrective saccades.
Skew deviation causes vertical diplopia, not horizontal corrective saccades.
Which of the following findings on the nystagmus test is most specific for central pathology?
A) Unidirectional nystagmus that does not change with gaze
B) Bidirectional nystagmus that changes with gaze direction
C) Rotary nystagmus with no other abnormalities
D) Absence of nystagmus
Answer:
B) Bidirectional nystagmus that changes with gaze direction
Rationale:
Bidirectional or vertical nystagmus is highly specific for central pathology, often associated with conditions like stroke or multiple sclerosis.
Unidirectional nystagmus is typically seen in peripheral vestibular dysfunction.
Rotary nystagmus is less common and can occur in both peripheral and central disorders.
Absence of nystagmus is not diagnostic.
A patient undergoes the skew test, and a vertical corrective movement is observed when one eye is uncovered. What does this finding suggest?
A) Peripheral vestibular dysfunction
B) Central vestibular pathology
C) Normal vestibular function
D) Optic nerve lesion
Answer:
B) Central vestibular pathology
Rationale:
A vertical skew indicates central pathology (e.g., brainstem or cerebellar dysfunction).
Peripheral vestibular dysfunction does not typically cause skew deviation.
Normal vestibular function would show no skew or corrective movement.
The optic nerve is not involved in this test.
Which combination of findings is most consistent with a peripheral vestibular disorder?
A) Positive head impulse test, unidirectional nystagmus, no skew deviation
B) Negative head impulse test, bidirectional nystagmus, vertical skew
C) Positive head impulse test, bidirectional nystagmus, vertical skew
D) Negative head impulse test, unidirectional nystagmus, vertical skew
Answer:
A) Positive head impulse test, unidirectional nystagmus, no skew deviation
Rationale:
Peripheral vestibular disorders are characterized by corrective saccades on the head impulse test, unidirectional nystagmus, and the absence of skew deviation.
Central disorders show negative head impulse tests, bidirectional/vertical nystagmus, and skew deviation.
What is the primary purpose of the head impulse test?
A) To identify nystagmus in patients with dizziness
B) To determine if the vestibulo-ocular reflex (VOR) is functioning normally
C) To assess visual acuity changes with head movement
D) To evaluate for skew deviation and vertical diplopia
Answer:
B) To determine if the vestibulo-ocular reflex (VOR) is functioning normally
Rationale:
The head impulse test evaluates the VOR by testing the ability of the eyes to maintain focus during rapid head movements.
Nystagmus is tested separately.
Visual acuity changes with head movement are not assessed in this test.
Skew deviation and vertical diplopia are assessed using the skew test.
Why Bidirectional Nystagmus Suggests Central Pathology:
Vertical Nystagmus is Rare in Peripheral Disorders:
The peripheral vestibular system (inner ear and vestibular nerve) primarily generates horizontal or rotary nystagmus, as these motions align with the semicircular canals.
Vertical nystagmus (upward or downward beating) indicates a problem in the brainstem or cerebellum, as these structures coordinate vertical gaze control.
Specific Causes of Vertical Nystagmus:
Upbeat Nystagmus:
Often linked to lesions in the brainstem (e.g., medulla) or anterior cerebellum.
Downbeat Nystagmus:
Commonly associated with dysfunction in the cervicomedullary junction (e.g., Arnold-Chiari malformation) or damage to the flocculus of the cerebellum.
Why This Distinction Matters:
Central pathology is far more serious than peripheral vestibular dysfunction and requires immediate attention, as it could indicate conditions such as:
Stroke (e.g., posterior circulation stroke)
Multiple sclerosis
Tumors or masses in the brainstem or cerebellum
Neurodegenerative diseases affecting central vestibular pathways
Peripheral vestibular disorders, while uncomfortable and distressing, are usually less life-threatening (e.g., vestibular neuritis, benign paroxysmal positional vertigo).
