Examination Skills

Question 1

Central cyanosis results from increased deoxygenated haemoglobin in the arteries, causing blue discolouration in parts of body with good circulation such as the tongue.

Answer 1

True

Question 2

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.

Answer 2

False

Question 3

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)

Answer 3

True

Question 4

The normal range of BMI is considered to be 25 – 29.9

Answer 4

False

Question 5

BMI is an accurate measure of someone’s nutritional state particularly for growing children, frail elderly, professional athletes and pregnant women.

Answer 5

False

Question 6

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.

Answer 6

True

Question 7

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%.

Answer 7

False

Question 8

Turgor is assessed by pinching the skin. Normal skin returns to original position quickly and a slow return suggest moderate dehydration.

Answer 8

True

Question 9

Bowel obstruction can’t give faecal contamination of the breath

Answer 9

False

Question 10

Progeria is a congenital, rare cause of accelerated aging, speeding up the process 6-8 times.

Answer 10

True

Question 11

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.

Answer 11

False

Question 12

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.

Answer 12

True

Question 13

Foot drop occurs due to weakness in tibialis anterior and toe extensor muscles resulting in the inability to dorsiflex the ankle.

Answer 13

True

Question 14

Patients with sensory ataxia usually slap their feet on the ground to increase peripheral input.

Answer 14

True

Question 15

The definition of a positive Romberg sign is the inability to stand for over 30 seconds with feet placed together and eyes open.

Answer 15

False

Question 16

Romberg sign is negative in those with cerebellar ataxia and positive in those with sensory ataxia.

Answer 16

True

Question 17

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.

Answer 17

True

Question 18

Binwanger’s disease is a small subcortical stroke of the white matter in the frontal region which causes apraxic gait.

Answer 18

True

Question 19

Parkinsonian gait is characterized by shuffling.

Answer 19

True

Question 20

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.

Answer 20

True

Question 21

Pause interval is the delay between you finishing a sentence and the patient’s response.

Answer 21

True

Question 22

Consistently long pause interval is consistent with anxiety and hyperthyroidism.

Answer 22

False

Question 23

A mask like expressionless face can be recognised as pathognomonic (specific to) of Parkinson’s disease

Answer 23

True

Question 24

Some specific diseases can be diagnosed from facial features (facies)

Answer 24

True

Question 25

The triad of ptosis, miosis and anhydrosis is referred to as Horner’s syndrome and has many different causes

Answer 25

True

Question 26

When viewing the retina, vessels appearing darker and thicker are likely to be arteries

Answer 26

False

Question 27

The diameter of the cup to disc when performing ophthalmoscopy should not be greater than 50%

Answer 27

True

Question 28

Diabetic retinopathy is not a common cause of blindness

Answer 28

False

Question 29

In Otitis externa the ear drum appears normal

Answer 29

True

Question 30

Strabismus is a misalignment of the eyes and can be congenital or acquired

Answer 30

True

Question 31

Blood vessels in the optic fundus provide an indication of vasculature elsewhere

Answer 31

True

Question 32

Inflammation of the scalp is an unlikely finding in Alopecia

Answer 32

False

Question 33

Bilirubins high affinity the elastic fibres in the conjunctiva is responsible for the yellowing of the sclera

Answer 33

True

Question 34

This face is likely to represent Grave’s Disease (photo on page 40, 3rd down)

Answer 34

True

Question 35

The picture shown (page 47 top right photo) requires urgent further investigation

Answer 35

True

Question 36

The pictures shown (page 46 top and middle picture or just one of these. Remove labels) represent proliferative changes in diabetic retinopathy

Answer 36

False

Question 37

Deviated nasal septum can cause obstruction of either nostril

Answer 37

True

Question 38

Glaucoma is suspected when the cup to disc ratio is increased above 50%

Answer 38

True

Question 39

The abnormality shown (page 49 second picture) is more common in asthmatics

Answer 39

True

Question 40

Tophi on the auricles of the ear have no relationship with Gout

Answer 40

False

Question 41

Acute Otitis media can lead to complications such as mastoiditis

Answer 41

True

Question 42

Squamous cell carcinoma is the most common oral cancer

Answer 42

True

Question 43

Apthous ulcers in the mouth are a common finding and are usually a benign finding

Answer 43

True

Question 44

Oral thrush is uncommon in immunocompromised patients

Answer 44

False

Question 45

Pursed lips breathing is a common method some patients use to generate increased positive end expiratory pressure

Answer 45

True

Question 46

Causes of hoarse voice include; recurrent laryngeal nerve damage, carcinoma and respiratory tract infection

Answer 46

True

Question 47

Conjunctival rim pallor is an important and useful indicator of anaemia

Answer 47

True

Question 48

Arcus senilis is of high significance in all age groups

Answer 48

False

Question 49

Metastatic carcinoma should be suspected in unilateral exopthalmus

Answer 49

True

Question 50

The majority of individuals with Xanthelasma (raised yellow painless lipid deposits on the eyelids) have a lipid abnormality

Answer 50

Fase

Question 51

Clicking of the TMJ heard via stethoscope suggests disc displacement of the joint

Answer 51

True

Question 52

A large, hard, tender and matted lymph node suggests a neoplasm

Answer 52

False

Question 53

The nodes palpated for in the picture shown (page 63 2nd picture down) is likely to be the cervical nodes

Answer 53

True

Question 54

A thyroid swelling (goitre) can still mean that thyroid function is normal

Answer 54

True

Question 55

A raised JVP is unlikely after excess fluid administration

Answer 55

True

Question 56

The JVP should be measured using the external jugular vein and the internal jugular vein should be avoided

Answer 56

False

Question 57

The height of the JVP is measured vertically in cm from the sternal angle

Answer 57

True

Question 58

A double pulsation is more likely to be venous than arterial

Answer 58

True

Question 59

A mass that moves little during swallowing and rises with tongue protrusion is likely to be fixed to the hyoid

Answer 59

True

Question 60

A branchial cyst is usually a midline structure

Answer 60

False

Question 61

The facial nerve passes through the parotid gland

Answer 61

True

Question 62

The pressure in the jugular veins reflects the pressure in the right atrium

Answer 62

True

Question 63

Tracheal displacement to the left would be consistent with a tension pneumothorax on the left side

Answer 63

False

Question 64

An increased forced expiratory time is consistent with obstructive lung pathology

Answer 64

True

Question 65

Carotid bruit may be mimicked by a systolic murmur

Answer 65

True

Question 66

Given that the right atrium is approximately 5cm below the sternal angle, by adding 5cm to the JVP you can approximate the CVP

Answer 66

True

Question 67

A JVP of 4cm is normal and not raised

Answer 67

False

Question 68

By firmly compressing the abdomen there should be a small transient rise in the JVP in a normal individual

Answer 68

True

Question 69

JVP normally rises on inspiration

Answer 69

False

Question 70

The normal Jugular waveform shows two main peaks each of which are followed by an immediate drop in pressure

Answer 70

True

Question 71

Looking at a normal jugular neck pulsation the most obvious movement is the X descent- a sudden inward collapse

Answer 71

False

Question 72

The X descent of the JVP occurs immediately following the second heart sound

Answer 72

False

Question 73

A prolonged forced expiratory time of >6sec is consistent with an FEV1/FVC ratio of greater than 60%

Answer 73

False

Question 74

A line that bows outwards from the cricoid cartilage when examining neck contour from the side is consistent with a goitre

Answer 74

True

Question 75

The abdominojugular reflex test may reveal subclinical right ventricular failure

Answer 75

True

Question 76

In normal people with a non-elevated JVP, an absent y-descent is usually pathological

Answer 76

False

Question 77

Orthopnoea is shortness of breath exacerbated by lying flat and relieved by sitting upright.

Answer 77

True

Question 78

Pectus excavatum (funnel chest) is a developmental defect with localised depression of the lower sternum that may limit chest wall movement

Answer 78

True

Question 79

Gynaecomastia in males is often a sign of chronic liver disease, alcoholic cirrhosis, or chronic active hepatitis

Answer 79

True

Question 80

The apex beat is usually the only precordial impulse that can be seen

Answer 80

True

Question 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

Answer 81

True

Question 82

The term “thrill” is used to describe a palpable murmur

Answer 82

True

Question 83

The bell of the stethoscope is used to hear high frequencies and the diaphragm of the stethoscope is used to hear low frequencies

Answer 83

False

Question 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

Answer 84

True

Question 85

The opening snap of mitral stenosis occurs in early diastole

Answer 85

True

Question 86

The respiratory examination of the thorax follows the sequence of inspection, palpation, percussion, and auscultation

Answer 86

True

Question 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

Answer 87

False

Question 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

Answer 88

True

Question 89

With regards to bronchial breath sounds, the audible expiratory phase is usually shorter than the audible inspiratory phase

Answer 89

False

Question 90

There is no silent pause between the inspiratory and expiratory phases of vesicular breath sounds

Answer 90

False

Question 91

A Breath Sound Intensity score less than 9 indicates that chronic obstructive airways disease is likely

Answer 91

True

Question 92

Stridor is a loud, high pitched inspiratory sound related to upper airway obstruction

Answer 92

True

Question 93

A quiet chest in severe asthma indicates resolution of airway obstruction and restoration of adequate air flow

Answer 93

False

Question 94

Orthopnoea can occur with asthma, COPD, pneumonia, and pleural effusion

Answer 94

True

Question 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

Answer 95

False

Question 96

In dextrocardia, the apex beat will not be palpable

Answer 96

False

Question 97

The apex beat is normally palpable in 25-40% of adults in the lateral decubitus position

Answer 97

False

Question 98

The normal, outward systolic apical movement begins with the first heart sound and ends by mid-systole

Answer 98

True

Question 99

Apical location is thought to be a better indicator of cardiomegaly than apical diameter

Answer 99

False

Question 100

The opening snap of mitral stenosis radiates to the lower left sternal edge

Answer 100

True

Question 101

The murmur of aortic regurgitation is best auscultated over Erb’s point on expiration

Answer 101

True

Question 102

The mitral component of S1 (M1) occurs at the same time as the tricuspid component of S1 (T1)

Answer 102

False

Question 103

Left ventricular failure may cause fine, late inspiratory crackles

Answer 103

True

Question 104

At the base of the heart, S1 is usually the sound of M1 alone

Answer 104

True

Question 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

Answer 105

False

Question 106

With regards to the second hear sound (S2), A2 normally closes a little later than P2

Answer 106

False

Question 107

Widened splitting of the second heart sound (S2) occurs in mitral regurgitation because the aortic valve closes prematurely

Answer 107

False

Question 108

Left bundle branch block and aortic stenosis may cause reversed splitting of S2

Answer 108

True

Question 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

Answer 109

True

Question 110

The click of a mitral valve prolapse is best heard over the lower left parasternal area and the apex

Answer 110

True

Question 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

Answer 111

True

Question 112

A systolic murmur that obscures S2, but not S1, is classified as a late systolic murmur

Answer 112

True

Question 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).

Answer 113

True

Question 114

As a general rule, diastolic murmurs are always pathological

Answer 114

True

Question 115

A murmur that is loud and associated with a palpable thrill may not be pathological

Answer 115

False

Question 116

Murmurs are generally louder at a site downstream (in the direction of blood flow) from the site of origin.

Answer 116

True

Question 117

Aortic sclerosis is the most common ejection systolic murmur you are likely to hear.

Answer 117

True

Question 118

The aortic valve must be narrowed by at least 50% to generate the typical systolic ejection murmur of aortic stenosis.

Answer 118

True

Question 119

Hypertrophic obstructive cardiomyopathy is due to an asymmetric thickening of the interventricular septum at the level of the left ventricular outflow tract.

Answer 119

True

Question 120

Mitral regurgitation is the most common pathological murmur.

Answer 120

True

Question 121

The holosystolic murmur of mitral regurgitation is best heard at the apex, and radiates to the axilla.

Answer 121

True

Question 122

Manoeuvres that increase left ventricular size enhance the murmur of mitral valve prolapse.

Answer 122

False

Question 123

Mitral stenosis may lead to the development of atrial fibrillation.

Answer 123

True

Question 124

A prominent a-wave is common in patients who have developed pulmonary hypertension due to mitral stenosis.

Answer 124

True

Question 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.

Answer 125

False

Question 126

Aortic regurgitation typically elicits a decrescendo murmur beginning at A2 and extending into diastole for a variable period of time.

Answer 126

True

Question 127

Cheynes-Stoke respiration is classically associated with congestive heart failure and describes a form of periodic breathing in which respiration waxes and wanes.

Answer 127

True

Question 128

Resonance on percussion between the left 3rd and 5th intercostal spaces implies over-inflation of the lungs, as in emphysema.

Answer 128

True

Question 129

Low intensity breath sounds are associated with a low peak expiratory flow rate (PEFR) and forced expiratory volume (FEV1).

Answer 129

True

Question 130

Decreased breath sound intensity can occur in chronic obstructive airways disease and in the presence of a pleural effusion.

Answer 130

True

Question 131

A wheeze is an example of a discontinuous adventitious sound.

Answer 131

False

Question 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.

Answer 132

True

Question 133

Early-inspiratory crackles suggest disease of the large airways e.g. chronic.

Answer 133

True

Question 134

Crackles due to heart failure are likely to be heard over the lowermost region of the lung fields.

Answer 134

True

Question 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.

Answer 135

true

Question 136

Preservation of intelligible high frequency sounds on whispering indicates the presence of pectoriloquy due to consolidation in the lung.

Answer 136

True

Question 137

If present, sacral oedema tends to be a better sign of generalised fluid overload than ankle oedema.

Answer 137

True

Question 138

The percussion note over a tension pneumothorax is typically a tympanic note.

Answer 138

True

Question 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.

Answer 139

True

Question 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.

Answer 140

False

Question 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.

Answer 141

True

Question 142

An apical impulse with a lateral zone of retraction is a right ventricular impulse.

Answer 142

True

Question 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).

Answer 143

True

Question 144

S1 may be soft or diminished in first degree heart block, left bundle branch block, and conditions in which cardiac contractility is impaired.

Answer 144

True

Question 145

A pulmonary ejection click can be distinguished from an aortic ejection click as a pulmonary ejection click will increase with inspiration.

Answer 145

False

Question 146

In patients with mitral stenosis, an opening snap may suggest a milder form of mitral stenosis.

Answer 146

False

Question 147

A water hammer pulse may be produced by aortic regurgitation as well as high cardiac output states such as anaemia, pregnancy, and thyrotoxicosis.

Answer 147

True

Question 148

Abdominal paradox is a sign of diaphragmatic fatigue that has high sensitivity and specificity for predicting impending respiratory failure.

Answer 148

True

Question 149

The degree of vocal fremitus does not vary over the normal chest.

Answer 149

False

Question 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.

Answer 150

True

Question 151

1. The ‘Right Hypochondrium’ is located below the right hemidiaphragm

Answer 151

True

Question 152

2. Abdominal distension can be caused by fat, fluid, flatus, foetus, faeces or a “filthy” tumour

Answer 152

True

Question 153

3. Ascitic patients typically have abdominal flanks that appear tense

Answer 153

True

Question 154

4. When inspecting the abdominal contour you should stand at the end of the patient’s bed

Answer 154

False

Question 155

5. Abdominal pulsations can be seen in epigastrum of thin people or may be a sign of abdominal aortic aneurysm

Answer 155

True

Question 156

6. Obvious dull areas identified during abdominal percussion may indicate an underlying mass or enlarged organ

Answer 156

True

Question 157

7. Successful palpation of the abdomen can be achieved with the patient sitting at 45 degrees

Answer 157

False

Question 158

8. Guarding is contraction of the abdominal muscles in response to pain

Answer 158

True

Question 159

9. Voluntary guarding is referred to as rigidity

Answer 159

False

Question 160

10. Rebound tenderness or percussion tenderness can be used to yield whether a patient has peritonitis

Answer 160

True

Question 161

11. A spleen is not normally palpable

Answer 161

True

Question 162

12. A urine filled bladder is resonant to percussion

Answer 162

False

Question 163

13. The aorta bifurcates into the iliac arteries below the umbilicus

Answer 163

True

Question 164

The correct order for abdominal examination is inspection, auscultation, percussion and then palpation

Answer 164

True

Question 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

Answer 165

False

Question 166

3. An ascetic patient will have an everted umbilicus that points upwards, while a pregnant patient’s umbilicus will point downwards

Answer 166

False

Question 167

4. A ‘Sister Mary Joseph Nodule’is a metastatic tumour deposit on the umbilicus where the peritoneum is closest to the skin

Answer 167

True

Question 168

5. Grey Turner’s sign can occur in severe cases of acute pancreatitis

Answer 168

True

Question 169

6. The most common causes of abdominal striae include pregnancy, rapid weight gain/loss, and ascites

Answer 169

True

Question 170

7. In normal people, bowel sounds are heard as clicks or gurgles

Answer 170

True

Question 171

8. Localising bowel sounds and determining their character is diagnostically helpful and should always be attempted

Answer 171

False

Question 172

9. To hear the “tinkling” sounds of bowel obstruction you should listen for 20 minutes

Answer 172

True

Question 173

10. Abdominal bruit occur in between 4-20% of healthy people

Answer 173

True

Question 174

11. When palpating an abdomen it is important to watch the patient’s face for signs of discomfort

Answer 174

True

Question 175

12. Palpation of the abdomen should involve alternate soft and deep palpation over all areas to ensure nothing is missed

Answer 175

False

Question 176

13. Light palpation is used to ascertain the presence of tenderness and any abdominal wall resistance from guarding

Answer 176

True

Question 177

14. Deep palpation is used to detect masses and further areas of abdominal tenderness

Answer 177

True

Question 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

Answer 178

True

Question 179

16. The normal span of the liver is 8-10cm

Answer 179

False

Question 180

17. A diseased liver is not always enlarged and an enlarged liver is not always diseased

Answer 180

True

Question 181

18. ‘Murphy’s sign’ has a 50-80% sensitivity and specificity for cholecystitis

Answer 181

True

Question 182

19. A spleen lies under the left 6th and 7th ribs and moves downwards with inspiration

Answer 182

True

Question 183

20. Pole to pole, the kidneys extend from T12 to L3

Answer 183

True

Question 184

21. The left kidney sits approx. 2cm lower than the right kidney

Answer 184

False

Question 185

22. Tenderness when percussing the kidneys kidneys suggests upper urinary tract inflammation typical of pyelonephritis

Answer 185

True

Question 186

23. The urinary bladder is not identifiable by percussion or palpation until the urine volume is greater than 200mL

Answer 186

False

Question 187

24. Ascites results from an increase in hydrostatic pressure, a decrease in oncotic pressure or secondary to peristaltic inflammation

Answer 187

True

Question 188

25. ‘Rovsing’s sign’ is pain in the right lower quadrant with palpation of the left lower quadrant and suggests appendicitis

Answer 188

True

Question 189

26. A direct inguinal hernia is due to weakness in the abdominal wall in the region of the internal ring

Answer 189

True

Question 190

27. Femoral hernias are more common in females

Answer 190

True

Question 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

Answer 191

True

Question 192

29. Rectal prolapse may be seen as circumferential folds of the rectal mucosa that protrude from the anus

Answer 192

True

Question 193

1. A Pfannestiel/horizontal lower abdominal incision scar is consistent with caesarean section of abdominal hysterectomy

Answer 193

True

Question 194

2. A subcostal incision on the right is consistent with cholecystectomy

Answer 194

True

Question 195

3. A “Scaphoid contour” represents a sunken abdomen, shaped like a boat and is typical of a cachetic patient

Answer 195

True

Question 196

4. A blue hue around the umbilicus is called a ‘Grey Turner’s sign’

Answer 196

False

Question 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

Answer 197

True

Question 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

Answer 198

True

Question 199

7. As a measure of hepatomegaly, the liver span is more important than the position or palpability of the lower edge

Answer 199

True

Question 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

Answer 200

False

Question 201

9. Rectal examination has a low specificity, but high sensitivity for the detection of prostate cancer

Answer 201

False

Question 202

Identifying people with PVD is important even if they are asymptomatic.

Answer 202

True

Question 203

The gold standard measurement of lower limb blood supply is the ankle-brachial pressure index (ABPI).

Answer 203

True

Question 204

Lower limb pulses to palpate include the femoral, popliteal, dorsalis pedis, and posterior tibial arteries on both sides.

Answer 204

True

Question 205

The peripheral pulse volume should be recorded as absent, reduced, normal or bounding.

Answer 205

True

Question 206

Generally, the problem with feeling the popliteal pulsation is from over- or under-flexion of the knee.

Answer 206

True

Question 207

Diabetic peripheral neuropathy is typically characterised by a glove and stocking sensory distribution.

Answer 207

True

Question 208

Less than 25% of diabetic foot ulcers develop over weight-bearing areas.

Answer 208

False

Question 209

The diabetic foot should be examined for evidence of ulceration, neuropathy and vascular insufficiency.

Answer 209

True

Question 210

Peripheral vascular disease (PVD) affects three distinct segments in the lower limbs – the aortoiliac, the femoropopliteal and the peronotibial vessels.

Answer 210

True

Question 211

Half of patients over the age of 60 in the developed world have PVD, however only a quarter of these are symptomatic.

Answer 211

False

Question 212

In the majority of patients with peripheral vascular disease (PVD), the underlying pathology is vasculitis.

Answer 212

False

Question 213

Peripheral vascular disease affects small and medium-sized vessels.

Answer 213

False

Question 214

The external iliac artery is renamed the femoral artery as it passes under the femoral ligament.

Answer 214

False

Question 215

At the ankle, the posterior tibial artery run behind the lateral malleolus.

Answer 215

False

Question 216

The posterior tibial artery can always be felt with proper technique.

Answer 216

False

Question 217

The dorsalis pedis pulse is best felt over the cuneiform bones of the foot.

Answer 217

True

Question 218

Vasodilator medications (ACE inhibitors, CCBs) will give warm feet and better-than-average volume pulses.

Answer 218

True

Question 219

Feel for skin temperature on the knee and dorsum of the foot using the palm of your hand.

Answer 219

False

Question 220

The brachial systolic pressure difference in each arm should be no more than 10mmHg.

Answer 220

True

Question 221

In patients with peripheral vascular disease, the veins of the feet fill abnormally quickly once they are emptied.

Answer 221

False

Question 222

The standard test for identifying peripheral neuropathy is the Semmes-Weinstein monofilament test.

Answer 222

True

Question 223

WHO recommends that the Semmes-Weinstein monofilament test is carried out reguarly in diabetic patients.

Answer 223

True

Question 224

Inability to sense a 10 gram force via a Semmes-Weinstein monofilament is an independent risk factor for development of a foot ulcer.

Answer 224

True

Question 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.

Answer 225

True

Question 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.

Answer 226

True?? - Query

Question 227

Cutaneous ulceration of the lower limb may occur both from arterial and venous insufficiency.

Answer 227

True

Question 228

Chronic venous incompetence can lead to stasis dermatitis with scaling, itching and redness over the medial ankle or varicose vein.

Answer 228

True

Question 229

Gangrene, decreased pulses, trophic changes and foot pallor are all signs seen in arterial insufficiency.

Answer 229

True

Question 230

Lipoedema in the legs causes pitting with pressure.

Answer 230

False

Question 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.

Answer 231

True

Question 232

Dilated superficial veins and a difference in calf circumference greater than 2.5cm between each leg is suggestive of DVT.

Answer 232

True

Question 233

The best predictors of DVT are asymmetric calf swelling, thigh swelling, and superfical venous dilatation.

Answer 233

True

Question 234

The accuracy of physical diagnosis for detecting DVT is excellent.

Answer 234

False

Question 235

Risk factors for DVT include active cancer, paralysis, recent plaster immobilisation of lower extremities, recently bedridden, or within 3 days of major surgery

Answer 235

True

Question 236

The Wells scoring scheme is helpful in determining the pretest probability of DVT

Answer 236

True

Question 237

An important mimic of DVT is Baker’s cyst

Answer 237

true

Question 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

Answer 238

True

Question 239

Pregnancy and thrombophlebitis may result in DVT

Answer 239

True ?

Question 240

Erythema nodosum can occur anywhere, but characteristically is pre-tibial

Answer 240

True

Question 241

Cyanosis and clubbing of the toes may occur independently of finger clubbing in the patient with patent ductus arteriosus

Answer 241

True

Question 242

The popliteal artery starts where the femoral artery crosses the medial femoral shaft at the adductor canal.

Answer 242

True

Question 243

Findings of impaired capillary refill, atrophic skin and hairless extremities are diagnostic for peripheral vascular disease.

Answer 243

False

Question 244

Apart from femoral atherosclerosis, a bruit caused by fibromuscular dysplasia may be heard over the femoral artery.

Answer 244

True

Question 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.

Answer 245

True

Question 246

A falsely high ABPI may occur, despite the presence of significant disease, if the peripheral arteries are calcified and non-compressible.

Answer 246

True

Question 247

The incidence of peripheral neuropathy in diabetics is 25% after ten years and 50% after 20 years.

Answer 247

True

Question 248

Cutaneous ulceration of the lower limb may occur both from arterial and venous insufficiency.

Answer 248

True

Question 249

Lymphoedema is a painful, firm swelling that characterstically causes squaring of the toes and a dorsal hump on the foot.

Answer 249

False

Question 250

Primary lymphoedema of the feet is usually bilateral and affects men ten times more frequently than women.

Answer 250

False

Question 251

Xanthomata are not found in the lower limb.

Answer 251

False

Question 252

Contact allergic dermatitis is a cell-mediated immune reaction

Answer 252

True

Question 253

Psoriasis plaques are always associated with a silvery scale

Answer 253

False

Question 254

Systemic steroids are the best treatment for those with severe plaque psoriasis

Answer 254

False

Question 255

Erythroderma is a benign condition which is rarely associated with morbidity or mortality

Answer 255

False

Question 256

The fat composition of a person’s diet has a major role in the aggravation of acne

Answer 256

False

Question 257

Picture bottom pg 184: this picture shows the rosacea affecting the cheeks

Answer 257

False

Question 258

If the skin of a dermatofibroma is pinched a dimple is produced

Answer 258

True

Question 259

Some seborrheic keratoses can be picked off with a fingernail

Answer 259

True

Question 260

Acrochordon are soft pedunculated lesions of 2-5mm that are only seen in obese patients

Answer 260

False

Question 261

Pg 192 top picture: This picture shows cherry angiomas that are also known as Campbell de Morgan spots

Answer 261

True

Question 262

A melanoma arises form melanocytes in the basal layer of the skin

Answer 262

True

Question 263

A nodule is used to describe a lump smaller than 5mm

Answer 263

False

Question 264

The presence of an abscess always signifies the presence of an infection

Answer 264

False

Question 265

Excoriation may be visible in a person who suffers from jaundice

Answer 265

True

Question 266

Purpura will not blanch with the application of pressure. Erythema will blanch because it is caused by the dilation of vessels.

Answer 266

True

Question 267

If applied for a significant duration or in very high concentrations an irritant can cause contact irritant dermatitis in anyone.

Answer 267

True

Question 268

In adults the face ands and nipple area are commonly affected by eczema

Answer 268

True

Question 269

Angular chelitis is a form of intertrigo that can be associated with iron or folate deficiency

Answer 269

True

Question 270

Keratosis piliaris is a common condition that may begin in childhood or early teens and is rarely seen in older age groups

Answer 270

False

Question 271

Lichen planus can be mistaken in appearance for graft versus host disease and reaction to drugs containing gold

Answer 271

True

Question 272

White heads are closed comedones and are not caused by inflammation

Answer 272

True

Question 273

Rosacea is characterized by erythema, pustules, papules and telangiectasia. The eyes are also commonly involved

Answer 273

True

Question 274

The use of steroid creams on the face can lead to the appearance of papules and pustules in the nasolabial folds

Answer 274

True

Question 275

Pemphigus is the result of autoantibodies against a basement membrane protein and mucosal lesions are common

Answer 275

True

Question 276

The most common place to find the lesions of erythema nodosum is on the shins

Answer 276

True

Question 277

A mild respiratory illness may precede acute febrile neutrophilic dermatosis

Answer 277

True

Question 278

Photosensitivity can occur in response to both UVB and UVA rays

Answer 278

True

Question 279

Porphyria cutaenea tarda results in bullae and skin fragility on the palms of the hands and forearms in the summer months

Answer 279

False

Question 280

Granuloma annulare is caused predominantly by infection with Mycobacterium tuberculosis

Answer 280

False

Question 281

Impetigo is a highly contagious skin infection caused by Streptococcus pyogenes that is spread by autoinoculation

Answer 281

True

Question 282

Tinea crurispresents as erythema extending from the groin down the inner thigh and is commonly seen in females

Answer 282

False

Question 283

Tinea versicolour can cause hypopigmented areas with fine scale and is commonly seen in Adisson’s disease

Answer 283

False

Question 284

Campbell de Morgan Spot are small acquired haemangiomas that do not blanche and have a significant malignant potential

Answer 284

False

Question 285

Solar keratoses are a form of squamous cell carcinoma seen in at least 50% of New Zealanders over the age of 65

Answer 285

True

Question 286

A keratoacanthoma is a bit like a self-resolving SCC and looks like SCC both clinically and histologically

Answer 286

True

Question 287

Basal cell carcinomas rarely metastasise but can cause considerable damage through local invasion

Answer 287

True

Question 288

Superficial BCCs are usually well-circumscribed with a thin, raised, pearly rim

Answer 288

True

Question 289

Changes in naevocellular naevi are commonplace and can involve changes in colour and shape

Answer 289

True

Question 290

Nodular melanomas develop the potential to metastasise more quickly than superficial spreading

Answer 290

True

Question 291

The ABCDE criteria for diagnosing moles is an acronym for asymmetry, borders that are irregular, colour variability, depth >6mm and evolving lesion

Answer 291

True

Question 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

Answer 292

True

Question 293

Pitting of the nail plate is seen in parachonychia

Answer 293

False

Question 294

Keratinocytes lose their nuclei in the prickle layer

Answer 294

False

Question 295

The average time taken for a keratinocyte to go from the basal layer to desquamation is 30 days

Answer 295

False

Question 296

The term guttate is used to describe a profusion of either small macules or small plaques

Answer 296

True

Question 297

The Koebner phenomenon is the presence of skin lesions on the line of trauma

Answer 297

True

Question 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

Answer 298

True

Question 299

An inflammatory reaction of the skin involving more than 90% of the skin surface is termed pandermatitis and may be seen in lymphoma

Answer 299

False

Question 300

In some people seborrheic dermatitis may occur due a hypersensitivity reaction to Malassezia yeasts

Answer 300

True

Question 301

Picture 2nd down on pg 185: This rash is an immunological reaction that is usually a result of Herpes Zoster infection

Answer 301

True

Question 302

Toxic Epidemal Necrolysis involves a rash that shows acral predominance

Answer 302

False

Question 303

A differentiating feature of morphoea is that it is not associated with calcinosis

Answer 303

False

Question 304

Pg 187 3rd picture down – This picture of a well-marginated erythematous scaling plaque is caused by a fungal infection

Answer 304

True

Question 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

Answer 305

False

Question 306

In most cases of aloplecia aerata the hair will regrow within a year

Answer 306

True

Question 307

Pic 4 (bottom) pg 191 – This picture shows a malignant melanoma and requires careful investigation

Answer 307

False

Question 308

A milium may occur following subepidermal bullae

Answer 308

True

Question 309

Pg 193 second picture: This picture shows a basal cell carcinoma of the cheek

Answer 309

True

Question 310

1. The rheumatological system includes diseases of the joints, tendons and muscles

Answer 310

True

Question 311

2. GALS exam stands for ‘Gait, Arms, Legs, Stance’

Answer 311

False

Question 312

3. Tenderness gives no guide to the acuteness of inflammation

Answer 312

False

Question 313

4. When assessing the shoulder you palpate the bony landmarks for tenderness

Answer 313

True

Question 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.

Answer 314

True

Question 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.

Answer 315

true

Question 316

7. Assess hip abductor strength by performing the Trendelenberg test, this involves the patient alternatively standing on one leg alone.

Answer 316

True

Question 317

8. An antalgic gait means that the patient is protecting against pain, normally resulting in a limp.

Answer 317

true

Question 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.

Answer 318

True

Question 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.

Answer 319

true

Question 320

1. Check the spine from behind for scoliosis and from the sides for abnormal kyphosis or lordosis

Answer 320

True

Question 321

2. Joint deformity indicates a chronic process, usually from destructive arthritis

Answer 321

true

Question 322

3. Deviation away from the midline is varus, towards is called valgus

Answer 322

False

Question 323

4. Subluxation occurs when dislocated joint surfaces remain in partial contact i.e. an incomplete dislocation

Answer 323

True

Question 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.

Answer 324

True

Question 325

6. You assess median nerve sensation by gently touching over both the index and little fingers.

Answer 325

False

Question 326

7. Assess radial nerve sensation by lightly touching over the thumb and index finger web space

Answer 326

True

Question 327

8. If synovitis is present, the joints will be warm, swollen and tender and may have a “rubber” feel.

Answer 327

True

Question 328

9. Extensor tendon rupture will not affect the patient’s ability to straighten their fingers fully against gravity

Answer 328

False

Question 329

10.Test the median nerve power through thumb abduction and the ulner nerve power through finger spread

Answer 329

True

Question 330

11. Synovitis at the elbow is usually felt as a fullness between the olecranon and the lateral epicondyle.

Answer 330

True

Question 331

12. Signs of golfer’s elbow and tennis elbow can be felt by palpating the common extensor and flexor muscle origins.

Answer 331

True

Question 332

13. It is not worthwhile feeling for crepitus at the elbow

Answer 332

False

Question 333

14. Tenderness on palpation of the insertions of supraspinatus and infraspinatus is a sign of rotator cuff impingement.

Answer 333

True

Question 334

15. Contractures at the lumbosacral junction due to scoliosis is not a possible cause for leg length discrepancy

Answer 334

False

Question 335

16. If there is a true leg length discrepancy, you must determine if it is in the femur or the tibia.

Answer 335

True

Question 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.

Answer 336

True

Question 337

18. In an abnormal Trendelenberg test the pelvis will dip on the contralateral side.

Answer 337

True

Question 338

19. Trendelenberg gait results from distal muscle weakness and commonly results in patients waddling as they walk.

Answer 338

True

Question 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.

Answer 339

True

Question 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.

Answer 340

True

Question 341

22. You feel behind the knee joint for a Baker’s cyst

Answer 341

True

Question 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.

Answer 342

True

Question 343

24. Disease of the ankle or subtalar joints will never affect varus or valgus deformity.

Answer 343

False

Question 344

25. When you assess the spine the sacroiliac joint is not required to be palpated, only the spinal processes.

Answer 344

False

Question 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.

Answer 345

False

Question 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.

Answer 346

True

Question 347

1. Diastasis is when there is separation of parts of the body that are usually joined together e.g. rectus muscle

Answer 347

True

Question 348

2. You cannot distinguish synovitis from an effusion by palpation

Answer 348

False

Question 349

3. Muscle wasting at the thenar and hypothenar eminences suggest carpel tunnel syndrome

Answer 349

False

Question 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.

Answer 350

True

Question 351

5. If the true leg lengths are equal but the functional lengths are different, then a functional leg length discrepancy is present.

Answer 351

True

Question 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.

Answer 352

True

Question 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

Answer 353

True

Question 354

2. Before beginning the cranial nerve examination, it is important to gain an impression of the patients mental status

Answer 354

True

Question 355

3. If a visual field defect is suspected using finger movement, test the field with a small 10mm red object

Answer 355

True

Question 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)

Answer 356

True

Question 357

5. When examining cranial nerve VIII, it is important to always inspect the ear drums

Answer 357

False

Question 358

6. Cranial Nerve IX and X are tested by saying ‘ah’ and asking patient to make an explosive cough

Answer 358

True

Question 359

7. The plantar response is a deep tendon reflex

Answer 359

True

Question 360

8. Cranial Nerve I is tested using scent inhaled through both nostrils simultaneously

Answer 360

False

Question 361

9. When testing olfaction, using ammonia, solvent or oil of cloves can produce a false negative response

Answer 361

True

Question 362

10. Visual acuity is recorded as: Line read- errors/distance from the chart

Answer 362

False

Question 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

Answer 363

False

Question 364

12. A pinhole lens is used to determine if the result of a poor visual acuity test is due to refractive error.

Answer 364

True

Question 365

13. A droopy eyelid and large pupil suggest a cranial nerve II palsy

Answer 365

False

Question 366

14. Myasthenia gravis is an important cause of a slow pupil reaction to light

Answer 366

False

Question 367

15. Nuclear or infranuclear lesions causing disorders of eye movement affect the lower motor neuron pathway

Answer 367

True

Question 368

16. The misalignment of the eyes in binocular diplopia is commonly due to strabismus (squint)

Answer 368

True

Question 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

Answer 369

True

Question 370

18. There are 8 cardinal positions of gaze

Answer 370

False

Question 371

19. Saccades are fast eye movements made to shift eye fixation to a particular point in space

Answer 371

True

Question 372

20. The underlying abnormality in nystagmus is a slow drift of the eyes away from steady fixation

Answer 372

True

Question 373

21. The corneal reflex involves touching the iris of the eye with a wisp of cotton wool

Answer 373

False

Question 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

Answer 374

True

Question 375

23. Second degree nystagmus is present when the eyes are looking to a particular side

Answer 375

False

Question 376

24. Loss of touch (but not pain) may very rarely occur from a lesion of the main sensory nucleus in the pons

Answer 376

True

Question 377

25. The jaw jerk is always present in normal people

Answer 377

False

Question 378

26. The Weber test uses a vibrating tuning fork placed on the patients mastoid

Answer 378

False

Question 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.

Answer 379

True

Question 380

28. In normal people, air conduction is better heard than bone conduction owing to the amplification by the tympanic membrane and ossicles

Answer 380

True

Question 381

29. People with acute unilateral vestibular lesions will often wander when heel-toe walking, typically towards the side of the lesion.

Answer 381

True

Question 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).

Answer 382

False

Question 383

31. In a neurological setting, commonly wasted muscles include the small hand muscles, quadriceps, anterior tibialis muscles and the calves

Answer 383

True

Question 384

32. The MRC scale assesses power on a scale of 0-5

Answer 384

True

Question 385

33. Wrist extension is being tested in this picture (Page 229, second picture down, labeled ‘Testing wrist flexion’

Answer 385

False

Question 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

Answer 386

False

Question 387

35. The nerve segments involved in the supinator reflex are C5-6.

Answer 387

True

Question 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.

Answer 388

True

Question 389

37. Test proprioception at the distal inter-phalangeal joint of the index finger first on each hand in the upper limb

Answer 389

True

Question 390

38. Pupil size in normal people reflects the balance of sympathetic and parasympathetic tone, intensity of the light and ocular accommodation

Answer 390

True

Question 391

39. For any sensory defect, test from the area of normal vision to the deficit area

Answer 391

False??

Question 392

40. The trigeminal nerve has 3 branches; VI ophthalmic, V2 mandibular, V3 maxillary

Answer 392

True

Question 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

Answer 393

True

Question 394

42. Bilateral sternocleidomastoid weakness causes weakness of head flexion

Answer 394

True

Question 395

43. The hypoglossal nerve contains only motor fibres to the tongue

Answer 395

True

Question 396

44. The picture shows an abnormal plantar reflex response

Answer 396

True

Question 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

Answer 397

True

Question 398

46. Hypotonia is a common finding in lower motor neuron lesions

Answer 398

True

Question 399

47. Atrophy and fasciculation’s are often seen in upper motor neuron lesions

Answer 399

False

Question 400

48. In spasticity, there is a ‘catch’ on supination of the forearm and on extension at the elbow

Answer 400

True

Question 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

Answer 401

True

Question 402

50. This picture is testing finger Adduction

Answer 402

False

Question 403

When examining the hand, begin with the palmar surface of the hand and then the extensor surface, and then the nails.

Answer 403

True

Question 404

Sweating in the hands is mediated by parasympathetic activity.

Answer 404

False

Question 405

Hyperhydrosis is primary excessive perspiration which is an autosomal recessive condition and starts commonly during adolescence.

Answer 405

True

Question 406

Causes of secondary hyperhydrosis include: hyperthyroidism, menopause, phaeochromocytoma, hypoglycaemia, neuropathies, brain or spinal cord lesions and fever.

Answer 406

True

Question 407

Horner’s syndrome can present with anhydrosis.

Answer 407

True

Question 408

Brown pigmentation of palmar creases may be due to hepatic insufficiency.

Answer 408

False

Question 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.

Answer 409

True

Question 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.

Answer 410

True

Question 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.

Answer 411

True

Question 412

Isolated wasting of the thenar eminence can occur in median nerve compression from carpal tunnel syndrome.

Answer 412

True

Question 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.

Answer 413

True

Question 414

Most patients with Dupuytren’s contracture have unilateral contractures.

Answer 414

False

Question 415

When looking at the extensor surface of the hands, look for colour changes, nodules and joint abnormalities.

Answer 415

True

Question 416

Vitiligo is associated with alopecia, thyroiditis, Grave’s disease, Addison’s disease, IBS, psoriasis and diabetes.

Answer 416

True

Question 417

. This presentation here is indicative of osteoarthritis

Answer 417

False

Question 418

Tendon xanthomata are not linked with congenital hyperlipidaemia syndromes.

Answer 418

False

Question 419

Osteoarthritis affects the interphalangeal joints symmetrically.

Answer 419

False

Question 420

Bouchard nodes are present at the proximal interphallangeal joints of patients with osteoarthritis

Answer 420

False

Question 421

. This picture represents a patient with rheumatoid arhtirits

Answer 421

True

Question 422

Systemic lupus erhythematosus is rarely associated with true joint deformity.

Answer 422

True

Question 423

The lunule is nail root which produces the nail plate.

Answer 423

True

Question 424

Cherry red nails may be seen in carbon monoxide poisoning and deeper red is seen in polycyhemia.

Answer 424

True

Question 425

. This picture shows localized leukonychia which can occur with trauma, typhoid and ulcerative colitis.

Answer 425

True

Question 426

. Broad splinter haemorrhages are usually due to trauma.

Answer 426

False

Question 427

Lovibond angle is the angle between the base of the nail and its surrounding nails.

Answer 427

False

Question 428

A prolonged capillary refill time may suggest hypovolaemia or peripheral vascular disease.

Answer 428

True

Question 429

Cut marks are usually present in the non-dominant forearm.

Answer 429

True

Question 430

Compression of the central arteriole from a spider naevi will cause the lesion to blanch.

Answer 430

True

Question 431

Ecchymosis is a small bruise less than 0.5 cm

Answer 431

False

Question 432

Renal haemodialysis shunts are arteriovenous fistulae usually appearing as large pulsatile blood vessel, commonly with a palpable thrill.

Answer 432

True

Question 433

. Lymphangitis often occurs commonly by Streptococcus pyogenes.

Answer 433

True

Question 434

Acanthosis nigricans occurs due to epidermal thickening and hyperpigmentation. Often occurs in diabetes, Cushing’s syndrome, polycystic ovary syndrome and malignancy.

Answer 434

True

Question 435

Epitrochlear nodes drain the ulnar part of the forearm and hand, including the little, ring and ulnar half of the middle finger.

Answer 435

True

Question 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.

Answer 436

True

Question 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.

Answer 437

True

Question 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.

Answer 438

True

Question 439

Regular tachycardia is defined as regular rhythm with a rate greater than 60/min

Answer 439

False

Question 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.

Answer 440

True

Question 441

Pulsus paradoxus occurs in patients with asthma and pericardial tamponade. It is an exaggerated fall in systolic blood pressure during inspiration

Answer 441

True

Question 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.

Answer 442

True

Question 443

Pulsus parvus et tardus pulse waveform is the slow rising and low amplitude pulse which is associated with aortic stenosis.

Answer 443

True

Question 444

Pulsus bisferiens is a double peaked pulse suggestive of moderate to severe aortic regurgitation.

Answer 444

True

Question 445

“water hammer” pulse classically occurs in aortic stenosis.

Answer 445

False

Question 446

Patients with hypertropic obstructive cardiomyopathy (HOCM) usually presents with hypokinetic pulse waveform.

Answer 446

True

Question 447

If the pressure difference is greater than 10 mmHg, then partial occlusion of the subclavian artery should be suspected.

Answer 447

False

Question 448

Inspiratiion is associated with a fall in systolic pressure and expiration with an increase.

Answer 448

True

Question 449

Pulsus paradoxus is the difference in systolic blood pressure between inspiration and expiration. Normally it is between 3-12 mmHg.

Answer 449

True

Question 450

Pulsus alternans is the presence of strong and then weak heart beats. It is seen in patients with heart failure.

Answer 450

True

Question 451

Orthostatic hypotension is defined as a fall of more than 10 mmHg in systolic pressure and 5 mmHg in diastolic pressure.

Answer 451

False

Question 452

Use the valsalva maneuver to unmask the presence of borderline heart failure.

Answer 452

True

Question 453

The valsalva maneuver is a test for reflex autonomic control of the cardiovascular system through changes in intrathoracic pressure.

Answer 453

True

Question 454

With regards to blood pressure response to valsalva; someone with significant ventricular dysfunction will generate Korotkoff sounds following relaxation.

Answer 454

False