final

Question 1

what is normal location of diameter of PMI?

PMI (also called apex beat)

Answer 1

usually found in 5th Interspace 7 to 9 cm lateral to mid-sternal line

approx size of quarter, 1 to 2.5 cm in diameter

Question 2

JVP reflects what pressure? and from which vein is it best estimated?

Answer 2

Right atrial pressure

best estimated from Right external jugular vein

Question 3

pulmonic valve murmur can be heard where?

Answer 3

left side of anterior chest

close to sternum on 2nd and 3rd interspace

Question 4

aortic valve murmur can be heard where?

Answer 4

right side

2nd and 3rd interspace to apex

Question 5

pulse alternans indicates?

Answer 5

left ventricular failure

Question 6

what are causes of paroxysmal nocturnal dyspnea?

Answer 6

left ventricular heart failure or mitral stenosis

Question 7

what are AHA guidelines for screening of BP, BMI, waist circumference?

Answer 7

routine visit at least every 2 years

Question 8

how do you assess JVP? what is normal?

Answer 8

raise pt head slightly on pillow to relax SCM
raise head of bed to 30 degrees
turn pt’s head slightly to LEFT, to identify top-most point of flickering venous pulsations
place centimeter ruler upright on sternal angle, place card horizontally - to make right angle
mesure distance above sternal angle

normal is 3-4 cm

Question 9

increased pressure of JVP suggest?

Answer 9

right sided congestive heart failure

Question 10

how do you distinguish between internal jugular and carotid pulsation?

Answer 10

internal jugular pulsation has:
soft, biphasic, undulating quality

(vs. Carotid is more vigorous thrust with a single outward component)

Question 11

what is cause of delayed carotid upstroke?

Answer 11

aortic stenosis

Question 12

what is bruit?

Answer 12

murmur-like sound of vascular rather than cardiac origin

Question 13

what is cause of carotid bruit?

Answer 13

aortic valve murmur

Question 14

what is thrill?

Answer 14

humming vibration that feel like throat of purring cat

Question 15

what causes thrills?

Answer 15

aortic stenosis, patent ductus arteriosus, ventricular septal defect, mitral stenosis

Question 16

what is apical impulse?

Answer 16

brief early pulsation of left ventricle as it moves anteriorly during contraction and touches the chest wall

Question 17

the bell of stethoscope is best for what use?

Answer 17

detecting low-pitched sounds like S3, and rumble of mitral stenosis

Question 18

how will you determine whether a murmur is systolic?

Answer 18

systolic murmur falls between S1 and S2

diastolic falls between S2 and S1

Question 19

location of epitrochlear lymph nodes?

Answer 19

located on medial surface of arm approx 3cm above the elbow

Question 20

what is intermittent claudication?

Answer 20

pain or cramping in legs during exertion that is received by rest within 10 min

Question 21

how do you distinguish intermittent claudication from spinal stenosis?

Answer 21

if leg pain with exertion is reduced by leaning forward and stretching spinal cord in the narrowed vertebral canal (spinal stenosis) then it’s spinal stenosis

if relived by rest, then intermittent claudication

Question 22

ischemia of which artery can cause abdominal pain after meals and associated food fear?

Answer 22

celiac or superior or inferior mesenteric arteries

Question 23

what are the causes of asymmetric BP in two arms?

Answer 23

coarctation of aorta

Question 24

what are causes of lymphedema of arm and hand?

Answer 24

axillary lymph node dissection and radiation therapy

Question 25

what is normal pulse grade and character?

Answer 25

2+ brisk, expected (normal)

Question 26

what is common cause of decreased or absent pedal pulse?

Answer 26

diabetes mellitus

Question 27

what are signs of superficial thrombophlebitis?

Answer 27

local swelling, redness, warmth, subcutaneous cord

Question 28

Allen test assess?

Answer 28

potency of ulnar and radial arteries

Question 29

what are aggravating factors of Reynaud's disease?

Answer 29

exposure to cold | emotional upset

Question 30

pain in chronic arterial insufficient feels like?

Answer 30

intermittent claudication progressing to pain at rest

Question 31

edema in chronic Arterial insufficiency | vs. chronic Venous insufficiency

Answer 31

in Arterial - edema is absent or mild if patient lowers leg to relive rest pain in Venous - edema is present, often marked

Question 32

Ulceration in chronic Arterial and Venous insufficiency

Answer 32

Arterial - if present, involves toes or point of trauma to feet Venous - if present, develops at sides of ankles, esp medially

Question 33

in chronic Venous insufficiency, how is the edema, what else happens in skin? it arises from?

Answer 33

edema is soft, with PITTING on pressure, occasionally bilateral brawny changes and skin thickening, esp near ankles ulceration, brownish pigmentation, edema in foot are common arises from chronic obstruction and from incompetent valves in deep venous system

Question 34

in Lymphedema, what does the edema look like? what happens in skin? develops when?

Answer 34

edema is soft in early stages, then becomes indurated, hard, and non-pitting skin is thickened, ulceration is rare, no pigmentation, edema near feet, toes, often bilateral develops when lymph channel are obstructed by tumor, fibrous, inflammation, axillary node dissection and radiation

Question 35

pain of duodenal or pancreatic origin referred to ?

Answer 35

the back

Question 36

pain from biliary tree may be referred to

Answer 36

right shoulder

Question 37

what are causes of doubling over with cramping, colicky pain?

Answer 37

renal stone

Question 38

what cause sudden knifelike epigastric pain?

Answer 38

gallstone pancreatitis

Question 39

what causes Hematemesis

Answer 39

esophageal varices gastritis peptic ulcer disease

Question 40

early satiety maybe be due to?

Answer 40

``` diabetic gastroparesis anticholinergic medication gastric outlet obstruction gastric cancer hepatitis ```

Question 41

what is alcoholic stool?

Answer 41

gray or light colored due to obstructed bile excretion

Question 42

jaundice with itching due to ?

Answer 42

obstructive jaundice

Question 43

what is caput medusa?

Answer 43

collateral pathway of recanalized umbilical veins radiating up abdomen that decompresses portal vein hypertension

Question 44

what are recommendation for screening colorectal cancer in person with average risk?

Answer 44

``` fetal occult blood test - every year flexible sigmoidscopy - every 5 yrs combined of above 2 colonoscopy - every 10 yrs double contrast barium enema - every 5 yrs ```

Question 45

what is sequence of abdominal examination?

Answer 45

inspection auscultation percussion (light, then deep) palpation

Question 46

suprapubic bulge on abdomen can mean?

Answer 46

distended bladder, pregnant uterus or hernia

Question 47

increased peristaltic waves can be due to?

Answer 47

intestinal obstruction

Question 48

increased pulsations visible on abdomen can be due to?

Answer 48

aortic aneurysm

Question 49

peritoneal inflammation presents with?

Answer 49

involuntary abdominal rigidity and rebound tenderness -

Question 50

liver dullness may be displaced downward in which condition?

Answer 50

COPD

Question 51

direction of enlarged spleen is

Answer 51

anteriorly, downward, and medially

Question 52

pyelonephritis will elicit pain with

Answer 52

pressure or percussion

Question 53

ascites may be due to

Answer 53

``` cirrhosis congestive heart failure constrictive pericarditis inferior vena cava hepatic vein obstruction nephrotic syndrome malnutrition ovarian cancer ```

Question 54

positive Murphy Sign means?

Answer 54

acute cholecystitis

Question 55

when the supine patient raises head and shoulder or strain down, thus tightening abdominal mass... what are 2 places mass can be in and how do you determine this?

Answer 55

if mass in abdominal wall, it remain palpable [if mass cannot be felt, it is in intra-abdominal space (bc mass obscured by muscular contraction)]

Question 56

acute pancreatitis is aggravated and alleviated by?

Answer 56

aggravated by - laying supine | alleviated by - learning forward w trunk flexed

Question 57

what are psychological and physiological changes of menopause?

Answer 57

psychological - mood shifts, depression, changes in self-concept physiological - osteoporosis, vulvovaginal atrophy (pain, drying), increase in total LDL,

Question 58

what sign suggest pelvic inflammatory disease on cervical exam?

Answer 58

pain on movement of cervix + Adnexal tenderness

Question 59

what symptom may arise from impaired strength of pelvic muscle?

Answer 59

urinary stress incontinence

Question 60

premature ejactulation is common among which age group?

Answer 60

young men

Question 61

what is phimosis

Answer 61

tight prepuce that cannot be retracted over gland (foreskin)

Question 62

how does testicular cancer present?

Answer 62

painless nodule in testis, typical in men 15 to 35 yrs

Question 63

what are characteristics of cysts in breast?

Answer 63

soft to firm round mobile often tender

Question 64

characteristics of cancerous breast mass

Answer 64

irregular firm maybe mobil or fixed to surrounding tissue

Question 65

BRAC 1 and BRAC 2 gene is?

Answer 65

codes for proteins that suppress tumors in breast and ovaries autosomal dominant

Question 66

breast density plays what role in breast cancer?

Answer 66

it is strong independent risk factor, even after adjusting for effects of other risk factors

Question 67

what is nipple retraction?

Answer 67

recent or fixed flattening or depression of nipple

Question 68

dimpling of breast caused by?

Answer 68

dimpling or retraction of breast suggest underlying cancer

Question 69

breast fibroadenoma number? shape? tenderness?

Answer 69

usually single round, disc-like, or lobular NOT tender

Question 70

breast cysts | tender?

Answer 70

often tender

Question 71

``` breast cancer mass shape? consistency mobility tender? ```

Answer 71

irregular or stellate firm or hard fixed to underlying tissues NOT tender (usually)

Question 72

what are retraction signs of breast?

Answer 72

due to fibrosis (scar tissue), may produce dimpling, changes in contour, and retraction or deviation of nipple

Question 73

what is peau d'orange sign of breast?

Answer 73

thickened skin with enlarged pores due to edema of skin produced by lymphatic blockage

Question 74

what is visible sing in Paget's disease of nipple?

Answer 74

starts as scaly, eczema-like lesion that may weep, crust, or erode, or with persisting dermatitis of nipple and areola