Examination Skills Flashcards
1
Q
Central cyanosis results from increased deoxygenated haemoglobin in the arteries, causing blue discolouration in parts of body with good circulation such as the tongue.
A
True
2
Q
Peripheral cyanosis occurs when there is increased deoxygenated haemoglobin but the same supply of blood, thus tissues extract more oxygen than normal from the circulating blood, giving the skin a blue discolouration.
A
False
3
Q
Anaemia can cause generalized pallor that becomes particularly noticeable in the mucous membranes of the sclera if it is severe (<70 g/L of Hb)
A
True
4
Q
The normal range of BMI is considered to be 25 – 29.9
A
False
5
Q
BMI is an accurate measure of someone’s nutritional state particularly for growing children, frail elderly, professional athletes and pregnant women.
A
False
6
Q
Central fat distribution is a better predictor of insulin resistance and cardiovascular risk than BMI alone. Thus, someone who is judged to be lean by BMI, may be at increased health risk if the body fat is centrally distributed.
A
True
7
Q
Dehydration can be measured by percentage of total body water (TBW). Mild is less than 10%, moderate is 10-20% and severe is over 20%.
A
False
8
Q
Turgor is assessed by pinching the skin. Normal skin returns to original position quickly and a slow return suggest moderate dehydration.
A
True
9
Q
Bowel obstruction can’t give faecal contamination of the breath
A
False
10
Q
Progeria is a congenital, rare cause of accelerated aging, speeding up the process 6-8 times.
A
True
11
Q
Trendelenberg gait is produced by weakness of the hip abductors (gluteus maximus and medius) which act to elevate the ipsilateral pelvis and abduct and internally rotate the ipsilateral hip. If weakened, they cause the pelvis to fall toward the unsupported side.
A
False
12
Q
Gower’s maneuver is observed when a patient with bilateral abductor weakness tries to get up from a chair. They do this by bending forwards, placing both hands on their knees and pushing themselves up by sliding their hands up the thighs.
A
True
13
Q
Foot drop occurs due to weakness in tibialis anterior and toe extensor muscles resulting in the inability to dorsiflex the ankle.
A
True
14
Q
Patients with sensory ataxia usually slap their feet on the ground to increase peripheral input.
A
True
15
Q
The definition of a positive Romberg sign is the inability to stand for over 30 seconds with feet placed together and eyes open.
A
False
16
Q
Romberg sign is negative in those with cerebellar ataxia and positive in those with sensory ataxia.
A
True
17
Q
After a stroke, patients can end up with a hemiplegic gait. On the affected side, the upper limb shows adduction and flexion at all levels. The lower limb is extended at all levels and the foot is internally rotated. They circumduct with the foot scraping on the ground on its lateral edge.
A
True
18
Q
Binwanger’s disease is a small subcortical stroke of the white matter in the frontal region which causes apraxic gait.
A
True
19
Q
Parkinsonian gait is characterized by shuffling.
A
True
20
Q
Paralanguage is the rate and delivery of speech, which is distinct from the content. The strength, rate, pitch, degree of articulation and quality of delivery may be altered by disease processes.
A
True
21
Q
Pause interval is the delay between you finishing a sentence and the patient’s response.
A
True
22
Q
Consistently long pause interval is consistent with anxiety and hyperthyroidism.
A
False
23
Q
A mask like expressionless face can be recognised as pathognomonic (specific to) of Parkinson’s disease
A
True
24
Q
Some specific diseases can be diagnosed from facial features (facies)
A
True
25
The triad of ptosis, miosis and anhydrosis is referred to as Horner’s syndrome and has many different causes
True
26
When viewing the retina, vessels appearing darker and thicker are likely to be arteries
False
27
The diameter of the cup to disc when performing ophthalmoscopy should not be greater than 50%
True
28
Diabetic retinopathy is not a common cause of blindness
False
29
In Otitis externa the ear drum appears normal
True
30
Strabismus is a misalignment of the eyes and can be congenital or acquired
True
31
Blood vessels in the optic fundus provide an indication of vasculature elsewhere
True
32
Inflammation of the scalp is an unlikely finding in Alopecia
False
33
Bilirubins high affinity the elastic fibres in the conjunctiva is responsible for the yellowing of the sclera
True
34
This face is likely to represent Grave’s Disease (photo on page 40, 3rd down)
True
35
The picture shown (page 47 top right photo) requires urgent further investigation
True
36
The pictures shown (page 46 top and middle picture or just one of these. Remove labels) represent proliferative changes in diabetic retinopathy
False
37
Deviated nasal septum can cause obstruction of either nostril
True
38
Glaucoma is suspected when the cup to disc ratio is increased above 50%
True
39
The abnormality shown (page 49 second picture) is more common in asthmatics
True
40
Tophi on the auricles of the ear have no relationship with Gout
False
41
Acute Otitis media can lead to complications such as mastoiditis
True
42
Squamous cell carcinoma is the most common oral cancer
True
43
Apthous ulcers in the mouth are a common finding and are usually a benign finding
True
44
Oral thrush is uncommon in immunocompromised patients
False
45
Pursed lips breathing is a common method some patients use to generate increased positive end expiratory pressure
True
46
Causes of hoarse voice include; recurrent laryngeal nerve damage, carcinoma and respiratory tract infection
True
47
Conjunctival rim pallor is an important and useful indicator of anaemia
True
48
Arcus senilis is of high significance in all age groups
False
49
Metastatic carcinoma should be suspected in unilateral exopthalmus
True
50
The majority of individuals with Xanthelasma (raised yellow painless lipid deposits on the eyelids) have a lipid abnormality
Fase
51
Clicking of the TMJ heard via stethoscope suggests disc displacement of the joint
True
52
A large, hard, tender and matted lymph node suggests a neoplasm
False
53
The nodes palpated for in the picture shown (page 63 2nd picture down) is likely to be the cervical nodes
True
54
A thyroid swelling (goitre) can still mean that thyroid function is normal
True
55
A raised JVP is unlikely after excess fluid administration
True
56
The JVP should be measured using the external jugular vein and the internal jugular vein should be avoided
False
57
The height of the JVP is measured vertically in cm from the sternal angle
True
58
A double pulsation is more likely to be venous than arterial
True
59
A mass that moves little during swallowing and rises with tongue protrusion is likely to be fixed to the hyoid
True
60
A branchial cyst is usually a midline structure
False
61
The facial nerve passes through the parotid gland
True
62
The pressure in the jugular veins reflects the pressure in the right atrium
True
63
Tracheal displacement to the left would be consistent with a tension pneumothorax on the left side
False
64
An increased forced expiratory time is consistent with obstructive lung pathology
True
65
Carotid bruit may be mimicked by a systolic murmur
True
66
Given that the right atrium is approximately 5cm below the sternal angle, by adding 5cm to the JVP you can approximate the CVP
True
67
A JVP of 4cm is normal and not raised
False
68
By firmly compressing the abdomen there should be a small transient rise in the JVP in a normal individual
True
69
JVP normally rises on inspiration
False
70
The normal Jugular waveform shows two main peaks each of which are followed by an immediate drop in pressure
True
71
Looking at a normal jugular neck pulsation the most obvious movement is the X descent- a sudden inward collapse
False
72
The X descent of the JVP occurs immediately following the second heart sound
False
73
A prolonged forced expiratory time of >6sec is consistent with an FEV1/FVC ratio of greater than 60%
False
74
A line that bows outwards from the cricoid cartilage when examining neck contour from the side is consistent with a goitre
True
75
The abdominojugular reflex test may reveal subclinical right ventricular failure
True
76
In normal people with a non-elevated JVP, an absent y-descent is usually pathological
False
77
Orthopnoea is shortness of breath exacerbated by lying flat and relieved by sitting upright.
True
78
Pectus excavatum (funnel chest) is a developmental defect with localised depression of the lower sternum that may limit chest wall movement
True
79
Gynaecomastia in males is often a sign of chronic liver disease, alcoholic cirrhosis, or chronic active hepatitis
True
80
The apex beat is usually the only precordial impulse that can be seen
True
81
The palpable impulse of the apex beat results from systolic rotation of the heart, initially during isovolumetric contraction, and then by recoil force of left ventricular ejection into the aorta
True
82
The term “thrill” is used to describe a palpable murmur
True
83
The bell of the stethoscope is used to hear high frequencies and the diaphragm of the stethoscope is used to hear low frequencies
False
84
The fourth heart sound (S4) of forceful atrial contraction into a stiff ventricle may generate a gallop rhythm (“Ten-ness—ee”) if S1 and S2 are quiet
True
85
The opening snap of mitral stenosis occurs in early diastole
True
86
The respiratory examination of the thorax follows the sequence of inspection, palpation, percussion, and auscultation
True
87
Both the left and right lungs are divided in half by oblique fissures that follow a line from the spinous process of T3 around to the 8th rib in the mid-clavicular line
False
88
Vocal fremitus is assessed by placing your palms firmly on the chest wall, asking the patient to say the words “toy coin” or “ninety-nine”, and noting any perceived difference in vibration between the left and right chest wall
True
89
With regards to bronchial breath sounds, the audible expiratory phase is usually shorter than the audible inspiratory phase
False
90
There is no silent pause between the inspiratory and expiratory phases of vesicular breath sounds
False
91
A Breath Sound Intensity score less than 9 indicates that chronic obstructive airways disease is likely
True
92
Stridor is a loud, high pitched inspiratory sound related to upper airway obstruction
True
93
A quiet chest in severe asthma indicates resolution of airway obstruction and restoration of adequate air flow
False
94
Orthopnoea can occur with asthma, COPD, pneumonia, and pleural effusion
True
95
If a patient has a ratio of the anterio-posterior to the transverse chest diameter greater than 0.7 they are described as having a barrel chest
False
96
In dextrocardia, the apex beat will not be palpable
False
97
The apex beat is normally palpable in 25-40% of adults in the lateral decubitus position
False
98
The normal, outward systolic apical movement begins with the first heart sound and ends by mid-systole
True
99
Apical location is thought to be a better indicator of cardiomegaly than apical diameter
False
100
The opening snap of mitral stenosis radiates to the lower left sternal edge
True
101
The murmur of aortic regurgitation is best auscultated over Erb’s point on expiration
True
102
The mitral component of S1 (M1) occurs at the same time as the tricuspid component of S1 (T1)
False
103
Left ventricular failure may cause fine, late inspiratory crackles
True
104
At the base of the heart, S1 is usually the sound of M1 alone
True
105
A grade 4 heart sound is loud and palpable, and requires only part of the stethoscope diaphragm against the chest wall to be heard
False
106
With regards to the second hear sound (S2), A2 normally closes a little later than P2
False
107
Widened splitting of the second heart sound (S2) occurs in mitral regurgitation because the aortic valve closes prematurely
False
108
Left bundle branch block and aortic stenosis may cause reversed splitting of S2
True
109
A third heart sound (S3) is caused by the dissipation of energy that occurs when there is an abrupt decrease in the inward flow of blood during the rapid filling phase into the ventricle
True
110
The click of a mitral valve prolapse is best heard over the lower left parasternal area and the apex
True
111
The pericardial friction rub that may be audible in patients with pericarditis is caused by the rubbing together of inflamed parietal and visceral pericardium of the right ventricle
True
112
A systolic murmur that obscures S2, but not S1, is classified as a late systolic murmur
True
113
The intensity of a mid-systolic murmur generated by high pressure blood flowing through a semilunar valve during systole is greatest in mid-systole (T, intensity varies with flow and pressure and is greatest in mid-systole, hence the term “crescendo-decrescendo” murmur).
True
114
As a general rule, diastolic murmurs are always pathological
True
115
A murmur that is loud and associated with a palpable thrill may not be pathological
False
116
Murmurs are generally louder at a site downstream (in the direction of blood flow) from the site of origin.
True
117
Aortic sclerosis is the most common ejection systolic murmur you are likely to hear.
True
118
The aortic valve must be narrowed by at least 50% to generate the typical systolic ejection murmur of aortic stenosis.
True
119
Hypertrophic obstructive cardiomyopathy is due to an asymmetric thickening of the interventricular septum at the level of the left ventricular outflow tract.
True
120
Mitral regurgitation is the most common pathological murmur.
True
121
The holosystolic murmur of mitral regurgitation is best heard at the apex, and radiates to the axilla.
True
122
Manoeuvres that increase left ventricular size enhance the murmur of mitral valve prolapse.
False
123
Mitral stenosis may lead to the development of atrial fibrillation.
True
124
A prominent a-wave is common in patients who have developed pulmonary hypertension due to mitral stenosis.
True
125
The Valsalva manoeuvre reduces ventricular filling and ventricular volume and thus allows the click and murmur of mitral valve prolapse to begin earlier in systole.
False
126
Aortic regurgitation typically elicits a decrescendo murmur beginning at A2 and extending into diastole for a variable period of time.
True
127
Cheynes-Stoke respiration is classically associated with congestive heart failure and describes a form of periodic breathing in which respiration waxes and wanes.
True
128
Resonance on percussion between the left 3rd and 5th intercostal spaces implies over-inflation of the lungs, as in emphysema.
True
129
Low intensity breath sounds are associated with a low peak expiratory flow rate (PEFR) and forced expiratory volume (FEV1).
True
130
Decreased breath sound intensity can occur in chronic obstructive airways disease and in the presence of a pleural effusion.
True
131
A wheeze is an example of a discontinuous adventitious sound.
False
132
The pitch of a wheeze is not related to the size of the airway and therefore cannot indicate whether airway obstruction is central or peripheral.
True
133
Early-inspiratory crackles suggest disease of the large airways e.g. chronic.
True
134
Crackles due to heart failure are likely to be heard over the lowermost region of the lung fields.
True
135
Pleural rubs may be distinguished from crackles as a pleural rubs are often palpable and confined to a well circumscribed area of the chest wall.
true
136
Preservation of intelligible high frequency sounds on whispering indicates the presence of pectoriloquy due to consolidation in the lung.
True
137
If present, sacral oedema tends to be a better sign of generalised fluid overload than ankle oedema.
True
138
The percussion note over a tension pneumothorax is typically a tympanic note.
True
139
Trepopnoea (shortness of breath when lying on one side but not the other) is classically associated with unilateral lung collapse and occurs when lying on the side of the collapsed lung.
True
140
Flail chest following the fracture of three or more consecutive ribs will have a flail segment that is drawn in during expiration and pushed out on inspiration.
False
141
In conditions causing high right side pressure, such as pulmonary hypertension or left-to-right shunt, the enlarged ventricle may form the apical impulse.
True
142
An apical impulse with a lateral zone of retraction is a right ventricular impulse.
True
143
A loud S1 may occur in mitral stenosis, conditions with a short PR interval (e.g. Wolf Parkinson White syndrome), and conditions with a short diastole (e.g. sinus tachycardia).
True
144
S1 may be soft or diminished in first degree heart block, left bundle branch block, and conditions in which cardiac contractility is impaired.
True
145
A pulmonary ejection click can be distinguished from an aortic ejection click as a pulmonary ejection click will increase with inspiration.
False
146
In patients with mitral stenosis, an opening snap may suggest a milder form of mitral stenosis.
False
147
A water hammer pulse may be produced by aortic regurgitation as well as high cardiac output states such as anaemia, pregnancy, and thyrotoxicosis.
True
148
Abdominal paradox is a sign of diaphragmatic fatigue that has high sensitivity and specificity for predicting impending respiratory failure.
True
149
The degree of vocal fremitus does not vary over the normal chest.
False
150
Placing the diaphragm of a stethoscope below the 12th rib and delivering percussion blows down the posterior chest from the apex of the lung towards the stethoscope to identify a pleural effusion is an example of auscultatory percussion.
True
151
1. The ‘Right Hypochondrium’ is located below the right hemidiaphragm
True
152
2. Abdominal distension can be caused by fat, fluid, flatus, foetus, faeces or a “filthy” tumour
True
153
3. Ascitic patients typically have abdominal flanks that appear tense
True
154
4. When inspecting the abdominal contour you should stand at the end of the patient’s bed
False
155
5. Abdominal pulsations can be seen in epigastrum of thin people or may be a sign of abdominal aortic aneurysm
True
156
6. Obvious dull areas identified during abdominal percussion may indicate an underlying mass or enlarged organ
True
157
7. Successful palpation of the abdomen can be achieved with the patient sitting at 45 degrees
False
158
8. Guarding is contraction of the abdominal muscles in response to pain
True
159
9. Voluntary guarding is referred to as rigidity
False
160
10. Rebound tenderness or percussion tenderness can be used to yield whether a patient has peritonitis
True
161
11. A spleen is not normally palpable
True
162
12. A urine filled bladder is resonant to percussion
False
163
13. The aorta bifurcates into the iliac arteries below the umbilicus
True
164
The correct order for abdominal examination is inspection, auscultation, percussion and then palpation
True
165
2. A patient should be lying flat with their head on a pillow and their arms above their head when carrying out an abdominal examination
False
166
3. An ascetic patient will have an everted umbilicus that points upwards, while a pregnant patient’s umbilicus will point downwards
False
167
4. A ‘Sister Mary Joseph Nodule’is a metastatic tumour deposit on the umbilicus where the peritoneum is closest to the skin
True
168
5. Grey Turner’s sign can occur in severe cases of acute pancreatitis
True
169
6. The most common causes of abdominal striae include pregnancy, rapid weight gain/loss, and ascites
True
170
7. In normal people, bowel sounds are heard as clicks or gurgles
True
171
8. Localising bowel sounds and determining their character is diagnostically helpful and should always be attempted
False
172
9. To hear the “tinkling” sounds of bowel obstruction you should listen for 20 minutes
True
173
10. Abdominal bruit occur in between 4-20% of healthy people
True
174
11. When palpating an abdomen it is important to watch the patient’s face for signs of discomfort
True
175
12. Palpation of the abdomen should involve alternate soft and deep palpation over all areas to ensure nothing is missed
False
176
13. Light palpation is used to ascertain the presence of tenderness and any abdominal wall resistance from guarding
True
177
14. Deep palpation is used to detect masses and further areas of abdominal tenderness
True
178
15. An abdominal mass should be carefully described as characterised, noting location, tenderness, size and shape, surface contour, edge contour, consistency, mobility (including with inspiration), and pulsatility
True
179
16. The normal span of the liver is 8-10cm
False
180
17. A diseased liver is not always enlarged and an enlarged liver is not always diseased
True
181
18. ‘Murphy’s sign’ has a 50-80% sensitivity and specificity for cholecystitis
True
182
19. A spleen lies under the left 6th and 7th ribs and moves downwards with inspiration
True
183
20. Pole to pole, the kidneys extend from T12 to L3
True
184
21. The left kidney sits approx. 2cm lower than the right kidney
False
185
22. Tenderness when percussing the kidneys kidneys suggests upper urinary tract inflammation typical of pyelonephritis
True
186
23. The urinary bladder is not identifiable by percussion or palpation until the urine volume is greater than 200mL
False
187
24. Ascites results from an increase in hydrostatic pressure, a decrease in oncotic pressure or secondary to peristaltic inflammation
True
188
25. ‘Rovsing’s sign’ is pain in the right lower quadrant with palpation of the left lower quadrant and suggests appendicitis
True
189
26. A direct inguinal hernia is due to weakness in the abdominal wall in the region of the internal ring
True
190
27. Femoral hernias are more common in females
True
191
28. A rectal examination should be carried out in all patients admitted to hospital over the age of 40, unless the examiner has no fingers
True
192
29. Rectal prolapse may be seen as circumferential folds of the rectal mucosa that protrude from the anus
True
193
1. A Pfannestiel/horizontal lower abdominal incision scar is consistent with caesarean section of abdominal hysterectomy
True
194
2. A subcostal incision on the right is consistent with cholecystectomy
True
195
3. A “Scaphoid contour” represents a sunken abdomen, shaped like a boat and is typical of a cachetic patient
True
196
4. A blue hue around the umbilicus is called a ‘Grey Turner’s sign’
False
197
5. Systolic epigastric murmurs from the aorta are heard in one third of patients with aortic aneurysm and 90% of patients with stenosis of the celiac or superior mesenteric artery
True
198
6. A systolic bruit auscultated anteriorly in a horizontal band either side of the umbilicus has a high sensitivity, but low specificity for renal artery stenosis
True
199
7. As a measure of hepatomegaly, the liver span is more important than the position or palpability of the lower edge
True
200
8. If a patient;s gall bladder is enlarged and they are jaundiced, obstruction is more likely to be caused by gallstones than a tumour
False
201
9. Rectal examination has a low specificity, but high sensitivity for the detection of prostate cancer
False
202
Identifying people with PVD is important even if they are asymptomatic.
True
203
The gold standard measurement of lower limb blood supply is the ankle-brachial pressure index (ABPI).
True
204
Lower limb pulses to palpate include the femoral, popliteal, dorsalis pedis, and posterior tibial arteries on both sides.
True
205
The peripheral pulse volume should be recorded as absent, reduced, normal or bounding.
True
206
Generally, the problem with feeling the popliteal pulsation is from over- or under-flexion of the knee.
True
207
Diabetic peripheral neuropathy is typically characterised by a glove and stocking sensory distribution.
True
208
Less than 25% of diabetic foot ulcers develop over weight-bearing areas.
False
209
The diabetic foot should be examined for evidence of ulceration, neuropathy and vascular insufficiency.
True
210
Peripheral vascular disease (PVD) affects three distinct segments in the lower limbs – the aortoiliac, the femoropopliteal and the peronotibial vessels.
True
211
Half of patients over the age of 60 in the developed world have PVD, however only a quarter of these are symptomatic.
False
212
In the majority of patients with peripheral vascular disease (PVD), the underlying pathology is vasculitis.
False
213
Peripheral vascular disease affects small and medium-sized vessels.
False
214
The external iliac artery is renamed the femoral artery as it passes under the femoral ligament.
False
215
At the ankle, the posterior tibial artery run behind the lateral malleolus.
False
216
The posterior tibial artery can always be felt with proper technique.
False
217
The dorsalis pedis pulse is best felt over the cuneiform bones of the foot.
True
218
Vasodilator medications (ACE inhibitors, CCBs) will give warm feet and better-than-average volume pulses.
True
219
Feel for skin temperature on the knee and dorsum of the foot using the palm of your hand.
False
220
The brachial systolic pressure difference in each arm should be no more than 10mmHg.
True
221
In patients with peripheral vascular disease, the veins of the feet fill abnormally quickly once they are emptied.
False
222
The standard test for identifying peripheral neuropathy is the Semmes-Weinstein monofilament test.
True
223
WHO recommends that the Semmes-Weinstein monofilament test is carried out reguarly in diabetic patients.
True
224
Inability to sense a 10 gram force via a Semmes-Weinstein monofilament is an independent risk factor for development of a foot ulcer.
True
225
The term “charcot joint” refers to an accelerated degenerative change and ultimate joint destruction that follows repetitive trauma to insensitive neuropathic joints, as well as muscle weakness and instability.
True
226
To be diagnosed with a Charcot joint, a patient must present with a limp, difficulty putting on shoes, soft tissue swelling and a sprain.
True?? - Query
227
Cutaneous ulceration of the lower limb may occur both from arterial and venous insufficiency.
True
228
Chronic venous incompetence can lead to stasis dermatitis with scaling, itching and redness over the medial ankle or varicose vein.
True
229
Gangrene, decreased pulses, trophic changes and foot pallor are all signs seen in arterial insufficiency.
True
230
Lipoedema in the legs causes pitting with pressure.
False
231
“Pitting” is due to the accumulation of interstitial fluid and should be palpated for behind the medial malleolus and distal shaft of the tibia by compressing the area for 2-3 seconds with thumb or fingers.
True
232
Dilated superficial veins and a difference in calf circumference greater than 2.5cm between each leg is suggestive of DVT.
True
233
The best predictors of DVT are asymmetric calf swelling, thigh swelling, and superfical venous dilatation.
True
234
The accuracy of physical diagnosis for detecting DVT is excellent.
False
235
Risk factors for DVT include active cancer, paralysis, recent plaster immobilisation of lower extremities, recently bedridden, or within 3 days of major surgery
True
236
The Wells scoring scheme is helpful in determining the pretest probability of DVT
True
237
An important mimic of DVT is Baker’s cyst
true
238
Varicose veins are most commonly found in the leg because the lower limb veins and their valves are subject to considerably higher hydrostatic pressure than others
True
239
Pregnancy and thrombophlebitis may result in DVT
True ?
240
Erythema nodosum can occur anywhere, but characteristically is pre-tibial
True
241
Cyanosis and clubbing of the toes may occur independently of finger clubbing in the patient with patent ductus arteriosus
True
242
The popliteal artery starts where the femoral artery crosses the medial femoral shaft at the adductor canal.
True
243
Findings of impaired capillary refill, atrophic skin and hairless extremities are diagnostic for peripheral vascular disease.
False
244
Apart from femoral atherosclerosis, a bruit caused by fibromuscular dysplasia may be heard over the femoral artery.
True
245
An ABPI of 0.5-0.8 may be associated with claudication of the legs, and below 0.5 may be associated with pain.
True
246
A falsely high ABPI may occur, despite the presence of significant disease, if the peripheral arteries are calcified and non-compressible.
True
247
The incidence of peripheral neuropathy in diabetics is 25% after ten years and 50% after 20 years.
True
248
Cutaneous ulceration of the lower limb may occur both from arterial and venous insufficiency.
True
249
Lymphoedema is a painful, firm swelling that characterstically causes squaring of the toes and a dorsal hump on the foot.
False
250
Primary lymphoedema of the feet is usually bilateral and affects men ten times more frequently than women.
False
251
Xanthomata are not found in the lower limb.
False
252
Contact allergic dermatitis is a cell-mediated immune reaction
True
253
Psoriasis plaques are always associated with a silvery scale
False
254
Systemic steroids are the best treatment for those with severe plaque psoriasis
False
255
Erythroderma is a benign condition which is rarely associated with morbidity or mortality
False
256
The fat composition of a person’s diet has a major role in the aggravation of acne
False
257
Picture bottom pg 184: this picture shows the rosacea affecting the cheeks
False
258
If the skin of a dermatofibroma is pinched a dimple is produced
True
259
Some seborrheic keratoses can be picked off with a fingernail
True
260
Acrochordon are soft pedunculated lesions of 2-5mm that are only seen in obese patients
False
261
Pg 192 top picture: This picture shows cherry angiomas that are also known as Campbell de Morgan spots
True
262
A melanoma arises form melanocytes in the basal layer of the skin
True
263
A nodule is used to describe a lump smaller than 5mm
False
264
The presence of an abscess always signifies the presence of an infection
False
265
Excoriation may be visible in a person who suffers from jaundice
True
266
Purpura will not blanch with the application of pressure. Erythema will blanch because it is caused by the dilation of vessels.
True
267
If applied for a significant duration or in very high concentrations an irritant can cause contact irritant dermatitis in anyone.
True
268
In adults the face ands and nipple area are commonly affected by eczema
True
269
Angular chelitis is a form of intertrigo that can be associated with iron or folate deficiency
True
270
Keratosis piliaris is a common condition that may begin in childhood or early teens and is rarely seen in older age groups
False
271
Lichen planus can be mistaken in appearance for graft versus host disease and reaction to drugs containing gold
True
272
White heads are closed comedones and are not caused by inflammation
True
273
Rosacea is characterized by erythema, pustules, papules and telangiectasia. The eyes are also commonly involved
True
274
The use of steroid creams on the face can lead to the appearance of papules and pustules in the nasolabial folds
True
275
Pemphigus is the result of autoantibodies against a basement membrane protein and mucosal lesions are common
True
276
The most common place to find the lesions of erythema nodosum is on the shins
True
277
A mild respiratory illness may precede acute febrile neutrophilic dermatosis
True
278
Photosensitivity can occur in response to both UVB and UVA rays
True
279
Porphyria cutaenea tarda results in bullae and skin fragility on the palms of the hands and forearms in the summer months
False
280
Granuloma annulare is caused predominantly by infection with Mycobacterium tuberculosis
False
281
Impetigo is a highly contagious skin infection caused by Streptococcus pyogenes that is spread by autoinoculation
True
282
Tinea crurispresents as erythema extending from the groin down the inner thigh and is commonly seen in females
False
283
Tinea versicolour can cause hypopigmented areas with fine scale and is commonly seen in Adisson’s disease
False
284
Campbell de Morgan Spot are small acquired haemangiomas that do not blanche and have a significant malignant potential
False
285
Solar keratoses are a form of squamous cell carcinoma seen in at least 50% of New Zealanders over the age of 65
True
286
A keratoacanthoma is a bit like a self-resolving SCC and looks like SCC both clinically and histologically
True
287
Basal cell carcinomas rarely metastasise but can cause considerable damage through local invasion
True
288
Superficial BCCs are usually well-circumscribed with a thin, raised, pearly rim
True
289
Changes in naevocellular naevi are commonplace and can involve changes in colour and shape
True
290
Nodular melanomas develop the potential to metastasise more quickly than superficial spreading
True
291
The ABCDE criteria for diagnosing moles is an acronym for asymmetry, borders that are irregular, colour variability, depth >6mm and evolving lesion
True
292
A mole that is asymmetric, looks different from all the others or which has areas of jet black should be excised or referred to an expert for evaluation
True
293
Pitting of the nail plate is seen in parachonychia
False
294
Keratinocytes lose their nuclei in the prickle layer
False
295
The average time taken for a keratinocyte to go from the basal layer to desquamation is 30 days
False
296
The term guttate is used to describe a profusion of either small macules or small plaques
True
297
The Koebner phenomenon is the presence of skin lesions on the line of trauma
True
298
Picture of lichen planus (bottom picture on 182): This picture shows buccal involvement of lichen planus with a similar appearance to the Wickhams striae seen on cutanoeus lesions in the disease
True
299
An inflammatory reaction of the skin involving more than 90% of the skin surface is termed pandermatitis and may be seen in lymphoma
False
300
In some people seborrheic dermatitis may occur due a hypersensitivity reaction to Malassezia yeasts
True
301
Picture 2nd down on pg 185: This rash is an immunological reaction that is usually a result of Herpes Zoster infection
True
302
Toxic Epidemal Necrolysis involves a rash that shows acral predominance
False
303
A differentiating feature of morphoea is that it is not associated with calcinosis
False
304
Pg 187 3rd picture down – This picture of a well-marginated erythematous scaling plaque is caused by a fungal infection
True
305
Pitted keratolysis is a bacterial infection causing erosions of the spiny layer of the heel or ball of the foot resulting in a honeycomb appearance
False
306
In most cases of aloplecia aerata the hair will regrow within a year
True
307
Pic 4 (bottom) pg 191 – This picture shows a malignant melanoma and requires careful investigation
False
308
A milium may occur following subepidermal bullae
True
309
Pg 193 second picture: This picture shows a basal cell carcinoma of the cheek
True
310
1. The rheumatological system includes diseases of the joints, tendons and muscles
True
311
2. GALS exam stands for ‘Gait, Arms, Legs, Stance’
False
312
3. Tenderness gives no guide to the acuteness of inflammation
False
313
4. When assessing the shoulder you palpate the bony landmarks for tenderness
True
314
5. In the GALS exam, ask the patient to put their hands behind their head to assess external rotation and then behind their back to assess internal rotation.
True
315
6. Measuring true leg length involves using a tape measure recording the distance between anterior superior iliac crest to the to the medial malleolus.
true
316
7. Assess hip abductor strength by performing the Trendelenberg test, this involves the patient alternatively standing on one leg alone.
True
317
8. An antalgic gait means that the patient is protecting against pain, normally resulting in a limp.
true
318
9. To check the stability of the cruciate knee ligaments the knee is flexed to 90° and an anterior and posterior draw test is performed.
True
319
10. To assess lateral flexion of the spine, ask the patient to slide each hand in turn down the outside of the adjacent thigh and note the position on the thigh that each hand reaches.
true
320
1. Check the spine from behind for scoliosis and from the sides for abnormal kyphosis or lordosis
True
321
2. Joint deformity indicates a chronic process, usually from destructive arthritis
true
322
3. Deviation away from the midline is varus, towards is called valgus
False
323
4. Subluxation occurs when dislocated joint surfaces remain in partial contact i.e. an incomplete dislocation
True
324
5. If there is loss of active movement but passive movement is intact, this suggests a muscle, tendon or nerve problem rather than joints.
True
325
6. You assess median nerve sensation by gently touching over both the index and little fingers.
False
326
7. Assess radial nerve sensation by lightly touching over the thumb and index finger web space
True
327
8. If synovitis is present, the joints will be warm, swollen and tender and may have a “rubber” feel.
True
328
9. Extensor tendon rupture will not affect the patient’s ability to straighten their fingers fully against gravity
False
329
10.Test the median nerve power through thumb abduction and the ulner nerve power through finger spread
True
330
11. Synovitis at the elbow is usually felt as a fullness between the olecranon and the lateral epicondyle.
True
331
12. Signs of golfer’s elbow and tennis elbow can be felt by palpating the common extensor and flexor muscle origins.
True
332
13. It is not worthwhile feeling for crepitus at the elbow
False
333
14. Tenderness on palpation of the insertions of supraspinatus and infraspinatus is a sign of rotator cuff impingement.
True
334
15. Contractures at the lumbosacral junction due to scoliosis is not a possible cause for leg length discrepancy
False
335
16. If there is a true leg length discrepancy, you must determine if it is in the femur or the tibia.
True
336
17. To compensate for an inability to fully extend the hips, a patient may hyperextend the lumbar spine. This results in a flexion contracture of the hip.
True
337
18. In an abnormal Trendelenberg test the pelvis will dip on the contralateral side.
True
338
19. Trendelenberg gait results from distal muscle weakness and commonly results in patients waddling as they walk.
True
339
20. The knee exam should always start with the patient standing so you can look at the front, side and back of the joint.
True
340
21. Using the back of your hand you assess the temperature of the knee joint, starting first from the mid thigh and then assessing down to the knee joint.
True
341
22. You feel behind the knee joint for a Baker’s cyst
True
342
23. It is useful to look at the patient’s footwear, checking for asymmetrical wearing of the sole, which may be evidence of poor fit or special insoles.
True
343
24. Disease of the ankle or subtalar joints will never affect varus or valgus deformity.
False
344
25. When you assess the spine the sacroiliac joint is not required to be palpated, only the spinal processes.
False
345
26. Cervical spine movements can be assessed by asking the patient to tilt and rotate their head, passive movement should always be done first.
False
346
27. A GALS exam also includes a brief neurological examination which includes the assessment of sensation of dermatome and peripheral nerve distribution, an assessment of muscle power of each of the movements of each of the joints and the tendon reflexes.
True
347
1. Diastasis is when there is separation of parts of the body that are usually joined together e.g. rectus muscle
True
348
2. You cannot distinguish synovitis from an effusion by palpation
False
349
3. Muscle wasting at the thenar and hypothenar eminences suggest carpel tunnel syndrome
False
350
4. The Apley scratch test is used to assess external rotation of the shoulder by asking the patient to reach behind their back as if to scratch an itch in the midline.
True
351
5. If the true leg lengths are equal but the functional lengths are different, then a functional leg length discrepancy is present.
True
352
6. Abduction contracture is a condition in which tightness of the hip abductor muscles prevents the patient’s hip from being adducted to the neutral (0°) position.
True
353
1. In a patient with back pain and leg weakness, upper motor neuron signs in the weak leg muscles suggests a spinal cord lesion
True
354
2. Before beginning the cranial nerve examination, it is important to gain an impression of the patients mental status
True
355
3. If a visual field defect is suspected using finger movement, test the field with a small 10mm red object
True
356
4. When testing visual acuity, it is important that the patient is tested without and with their glasses (if they have been prescribed glasses previously)
True
357
5. When examining cranial nerve VIII, it is important to always inspect the ear drums
False
358
6. Cranial Nerve IX and X are tested by saying ‘ah’ and asking patient to make an explosive cough
True
359
7. The plantar response is a deep tendon reflex
True
360
8. Cranial Nerve I is tested using scent inhaled through both nostrils simultaneously
False
361
9. When testing olfaction, using ammonia, solvent or oil of cloves can produce a false negative response
True
362
10. Visual acuity is recorded as: Line read- errors/distance from the chart
False
363
11. The ability to discriminate colour, particularly blue, is impaired earlier and is a more sensitive test of optic nerve function than visual acuity
False
364
12. A pinhole lens is used to determine if the result of a poor visual acuity test is due to refractive error.
True
365
13. A droopy eyelid and large pupil suggest a cranial nerve II palsy
False
366
14. Myasthenia gravis is an important cause of a slow pupil reaction to light
False
367
15. Nuclear or infranuclear lesions causing disorders of eye movement affect the lower motor neuron pathway
True
368
16. The misalignment of the eyes in binocular diplopia is commonly due to strabismus (squint)
True
369
17. In determining ocular deviation, the unilateral cover test is used to ascertain the cause of deviation and the alternating cover test measures the amount of deviation
True
370
18. There are 8 cardinal positions of gaze
False
371
19. Saccades are fast eye movements made to shift eye fixation to a particular point in space
True
372
20. The underlying abnormality in nystagmus is a slow drift of the eyes away from steady fixation
True
373
21. The corneal reflex involves touching the iris of the eye with a wisp of cotton wool
False
374
22. Unilateral pterygoid weakness causes jaw deviation to the same side as the weakness and can be confirmed by lateral pressure on the partially open jaw
True
375
23. Second degree nystagmus is present when the eyes are looking to a particular side
False
376
24. Loss of touch (but not pain) may very rarely occur from a lesion of the main sensory nucleus in the pons
True
377
25. The jaw jerk is always present in normal people
False
378
26. The Weber test uses a vibrating tuning fork placed on the patients mastoid
False
379
27. If there is sensori-neural hearing deafness, bone conduction is decreased on that side and the sound is heard loudest in the normal ear during a Weber test.
True
380
28. In normal people, air conduction is better heard than bone conduction owing to the amplification by the tympanic membrane and ossicles
True
381
29. People with acute unilateral vestibular lesions will often wander when heel-toe walking, typically towards the side of the lesion.
True
382
30. The 5th cranial nerve is being examined when the following movements are tested (include all 4 pictures on page 222 labelled hallux, show teeth, puff out cheeks, purse lips).
False
383
31. In a neurological setting, commonly wasted muscles include the small hand muscles, quadriceps, anterior tibialis muscles and the calves
True
384
32. The MRC scale assesses power on a scale of 0-5
True
385
33. Wrist extension is being tested in this picture (Page 229, second picture down, labeled ‘Testing wrist flexion’
False
386
34. If the flexion of fingers 4 and 5 are weak during testing, the lesion is probably localized to the radial compression at the elbow
False
387
35. The nerve segments involved in the supinator reflex are C5-6.
True
388
36. It is important to ask the patient to report the sensation they feel in response to a sensory stimulus rather than ‘is this sharp/vibrating’ etc.
True
389
37. Test proprioception at the distal inter-phalangeal joint of the index finger first on each hand in the upper limb
True
390
38. Pupil size in normal people reflects the balance of sympathetic and parasympathetic tone, intensity of the light and ocular accommodation
True
391
39. For any sensory defect, test from the area of normal vision to the deficit area
False??
392
40. The trigeminal nerve has 3 branches; VI ophthalmic, V2 mandibular, V3 maxillary
True
393
41. To test the gag reflex, you must touch the posterior pharyngeal wall in order to test cranial nerve IX/X, avoiding areas supplied by cranial nerve V
True
394
42. Bilateral sternocleidomastoid weakness causes weakness of head flexion
True
395
43. The hypoglossal nerve contains only motor fibres to the tongue
True
396
44. The picture shows an abnormal plantar reflex response
True
397
45. When testing vibration sense you must test in this order: DIP joint of the index finger, MCP joint, Wrist, Lateral epicondyle of the humerus, lateral clavicle
True
398
46. Hypotonia is a common finding in lower motor neuron lesions
True
399
47. Atrophy and fasciculation’s are often seen in upper motor neuron lesions
False
400
48. In spasticity, there is a ‘catch’ on supination of the forearm and on extension at the elbow
True
401
49. Deep tendon reflexes test the local reflex arc, when it is intact the state of upper motor neuron inhibition can also be assessed
True
402
50. This picture is testing finger Adduction
False
403
When examining the hand, begin with the palmar surface of the hand and then the extensor surface, and then the nails.
True
404
Sweating in the hands is mediated by parasympathetic activity.
False
405
Hyperhydrosis is primary excessive perspiration which is an autosomal recessive condition and starts commonly during adolescence.
True
406
Causes of secondary hyperhydrosis include: hyperthyroidism, menopause, phaeochromocytoma, hypoglycaemia, neuropathies, brain or spinal cord lesions and fever.
True
407
Horner’s syndrome can present with anhydrosis.
True
408
Brown pigmentation of palmar creases may be due to hepatic insufficiency.
False
409
Palmar erythema is usually a sign of chronic liver disease and occurs similar conditions to that of spider naevi. It can also occur in pregnancy and polycythemia.
True
410
Janeway lesions are non-tender, flat, erythematous or haemorrhagic lesions occurring in the palms or pulps of fingers in 10-20% of patients with endocarditis.
True
411
Osler nodes are red, raised, tender nodules that may appear on the pulps of fingers, the thenar or hypothenar eminences. They are indicative of infective endocarditis.
True
412
Isolated wasting of the thenar eminence can occur in median nerve compression from carpal tunnel syndrome.
True
413
Dupuytren’s contracture is a palpable thickening of the palmar fascia leading to flexion contractions of the 4th and 5th digits. The patient becomes unable to fully extend the affected fingers.
True
414
Most patients with Dupuytren’s contracture have unilateral contractures.
False
415
When looking at the extensor surface of the hands, look for colour changes, nodules and joint abnormalities.
True
416
Vitiligo is associated with alopecia, thyroiditis, Grave’s disease, Addison’s disease, IBS, psoriasis and diabetes.
True
417
. This presentation here is indicative of osteoarthritis
False
418
Tendon xanthomata are not linked with congenital hyperlipidaemia syndromes.
False
419
Osteoarthritis affects the interphalangeal joints symmetrically.
False
420
Bouchard nodes are present at the proximal interphallangeal joints of patients with osteoarthritis
False
421
. This picture represents a patient with rheumatoid arhtirits
True
422
Systemic lupus erhythematosus is rarely associated with true joint deformity.
True
423
The lunule is nail root which produces the nail plate.
True
424
Cherry red nails may be seen in carbon monoxide poisoning and deeper red is seen in polycyhemia.
True
425
. This picture shows localized leukonychia which can occur with trauma, typhoid and ulcerative colitis.
True
426
. Broad splinter haemorrhages are usually due to trauma.
False
427
Lovibond angle is the angle between the base of the nail and its surrounding nails.
False
428
A prolonged capillary refill time may suggest hypovolaemia or peripheral vascular disease.
True
429
Cut marks are usually present in the non-dominant forearm.
True
430
Compression of the central arteriole from a spider naevi will cause the lesion to blanch.
True
431
Ecchymosis is a small bruise less than 0.5 cm
False
432
Renal haemodialysis shunts are arteriovenous fistulae usually appearing as large pulsatile blood vessel, commonly with a palpable thrill.
True
433
. Lymphangitis often occurs commonly by Streptococcus pyogenes.
True
434
Acanthosis nigricans occurs due to epidermal thickening and hyperpigmentation. Often occurs in diabetes, Cushing’s syndrome, polycystic ovary syndrome and malignancy.
True
435
Epitrochlear nodes drain the ulnar part of the forearm and hand, including the little, ring and ulnar half of the middle finger.
True
436
Pectoral anterior nodes, subscapular posterior nodes and lateral nodes at the axillae all drain into the central nodes which then drain into the infraclavicular and supraclavicular nodes.
True
437
Asterixis is present if hands and fingers show jerky, brief, irregular movements at the wrist and MCP joints. It is a common finding in hepatic encephalopathy.
True
438
Sinus arrhythmia in normal people is defined as slight acceleration of the pulse during inspiration and slowing of the pulse during expiration. This occurs due to waxing and waning of vagal input to the sinus node.
True
439
Regular tachycardia is defined as regular rhythm with a rate greater than 60/min
False
440
Pulsus alternans is an alternating strong and weak arterial pulsation in the presence of an otherwise regular rhythm. It is usually caused by severe left ventricular dysfunction and is best assessed in peripheral arteries such as radial artery.
True
441
Pulsus paradoxus occurs in patients with asthma and pericardial tamponade. It is an exaggerated fall in systolic blood pressure during inspiration
True
442
If the result of the Allen test is a delay of more than 15 seconds, then the artery should not be used for cannulation.
True
443
Pulsus parvus et tardus pulse waveform is the slow rising and low amplitude pulse which is associated with aortic stenosis.
True
444
Pulsus bisferiens is a double peaked pulse suggestive of moderate to severe aortic regurgitation.
True
445
“water hammer” pulse classically occurs in aortic stenosis.
False
446
Patients with hypertropic obstructive cardiomyopathy (HOCM) usually presents with hypokinetic pulse waveform.
True
447
If the pressure difference is greater than 10 mmHg, then partial occlusion of the subclavian artery should be suspected.
False
448
Inspiratiion is associated with a fall in systolic pressure and expiration with an increase.
True
449
Pulsus paradoxus is the difference in systolic blood pressure between inspiration and expiration. Normally it is between 3-12 mmHg.
True
450
Pulsus alternans is the presence of strong and then weak heart beats. It is seen in patients with heart failure.
True
451
Orthostatic hypotension is defined as a fall of more than 10 mmHg in systolic pressure and 5 mmHg in diastolic pressure.
False
452
Use the valsalva maneuver to unmask the presence of borderline heart failure.
True
453
The valsalva maneuver is a test for reflex autonomic control of the cardiovascular system through changes in intrathoracic pressure.
True
454
With regards to blood pressure response to valsalva; someone with significant ventricular dysfunction will generate Korotkoff sounds following relaxation.
False
