Health Assessment Midterm

Question 1

Occlusion and inflammation of the salivary gland leads to

Answer 1

Sialadenitis

Question 2

What is the most common neurologic problem caused by Lyme disease

Answer 2

A Bell’s palsy-like facial paralysis

Question 3

Signs & symptoms of Hyperthyroidism

Answer 3

Nervousness, irritability, weight loss, tachycardia, heat intolerance, smooth/ silky skin, fine hair (with frequent loss), thin nails, loose stools

Question 4

Signs and symptoms of Hypothyroidism

Answer 4

Periorbital edema, facial edema, bradycardia, weight gain, lethargy, cold intolerance, muscle weakness, coarse/ brittle hair, osteoporosis, constipation, menorrhagia, pitting edema of LE

Question 5

Diagnostic test for CHF

Answer 5

Brain natriuretic peptide (BNP)

Question 6

Differential Dx for chest pain

Answer 6

Pneumonia

Question 7

Apply pressure downward & slightly upward on the liver. Up to 30 seconds of pressure. Watch for jugular vein distention. (If present, it should recede within seconds. Abnormal if JVD stays while you are pressing on the liver). This checks for right-sided heart failure

Answer 7

Hepatojugular Reflux

Question 8

Most common valve abnormality in adults. Develops gradually. Decreased HR, faint pulse (Crescendo-decrescendo) systolic murmur. Radiates to the carotids. Heard @ 2nd ICS RSB

Answer 8

Aortic Stenosis (Systolic Murmur)

Question 9

Most common in women w/ rheumatic heart disease. Atrial dilation & hypertrophy, thrombi formation from fibrillation (Rumbling decrescendo) diastolic murmur. Heard @ Apex, PMI, 5th ICS MC

Answer 9

Mitral Stenosis (Diastolic Murmur)

Question 10

Seen in RHD, bacterial endocarditis, syphilis ( blowing decrescendo murmur in 3rd & 4th ICS) bounding peripheral pulses (Corrigan pulses). Heard @ 3rd & 4th ICS/ ERBs point

Answer 10

Aortic Regurgitation (Diastolic Murmur)

Question 11

Caused by MVP, RHD, ineffective endocarditis, MI, Marfan syndrome (Loud holosystolic murmur at APEX) Left ventricular dilation/ hypertrophy, atrial dilation/fibrillation. Heard @ the Apex

Answer 11

Mitral Regurgitation (Systolic Murmur)

Question 12

Lab test for myocardial damage

Answer 12

Troponin

Question 13

Common cause of tricuspid regurgitation

Answer 13

Pulmonary HTN

Question 14

Signs/ symptoms of right sided heart failure (“right = GI”)

Answer 14

JVD (normal< 4cm), enlarged spleen, enlarged liver causing anorexia, nausea and abdominal pain, LE edema

Question 15

Signs/ symptoms of left sided heart failure (“left = lung”)

Answer 15

Crackles, cough, dyspnea, dullness to percussion, paroxysmal nocturnal dyspnea, orthopnea, non-productive cough & wheezing

Question 16

MI, elevated BP, smoking, dyspnea w/ exertion lead to

Answer 16

Left-sided heart failure = decreased cardiac output

Question 17

Most common causes of S4

Answer 17

Left ventricular hypertrophy (LVH), normal in some elderly, poorly controlled HTN, unstable angina

Question 18

Most common causes of S3

Answer 18

CHF, pregnancy, possible thyrotoxicosis, possible normal for adolescent athletes, always abnormal if occurs > 35yo “Kentucky” - best heard at pulmonic area (AKA ventricular gallop or S3 gallop)

Question 19

S3 ( Use Bell to hear)

Answer 19

“Kentucky” - best heard at the pulmonic area (AKA ventricular gallop or S3 gallop)

Question 20

S4 ( Use Bell to hear)

Answer 20

Occurs late is diastole and best heard at apex with bell (Tennessee) (atrial gallop or atrial kick)

Question 21

Closure of AV- mitral/ tricuspid (lub)
M =(mitral valve)
T= (tricuspid valve)
AV= (atrioventricular valves)

Answer 21

S1 = systole

Question 22

Closure of semilunar - aortic/ pulmonic valves (dub)
A= (aortic)
P= (pulmonic)
S= (semilunar)

Answer 22

S2 = diastole

Question 23

Grading of murmurs

Answer 23

Grade I = Barely audible
Grade II = Audible but faint
Grade III = Moderately loud, easily heard (as loud as S1)
Grade IV = Loud, associated with a thrill
Grade V = Very loud, heard one corner of the stethoscope off the wall
Grade VI = Loudest heard w/o a stethoscope

Question 24

Occurs in severe anemia, dehydration & becomes louder when lying down

Answer 24

Physiologic Murmur

Question 25

Systolic murmurs (MR Peyton Manning AS MVP)

Answer 25

``` MR Peyton Manning AS MVP MR = mitral regurgitation ( radiates to axilla) P/M = physiologic murmur AS = aortic stenosis ( radiates to neck) MVP = mitral valve prolapse ```

Question 26

DIastolic murmurs (ARMS)

Answer 26

ARMS AR = aortic regurgitation MS = mitral stenosis

Question 27

JNC- 8 Guidelines

Answer 27

Implement lifestyle modifications BP goal Anyone w/ DM or CKD < 140/90 No DM or CKD < 150/90

Question 28

JNC-8 Guidelines (MEDS)

Answer 28

Non AA= thiazide or ACEI/ ARB or CCB alone or in combo AA = thiazide or CCB alone or in combo CKD = ACEI or ARB alone or in combo w/ other class

Question 29

CENTOR critieria

Answer 29

``` Absence of cough Tonsillar exudate Anterior cervical adenopathy Hx of fever Age Score > 2 screen for strep ```

Question 30

Sudden onset of floaters associated with looking through a curtain sensation w/ sudden flashes of light (photopsia)

Answer 30

Retinal Detachment

Question 31

Acute onset of severe eye pain with redness & vision changes. Accompanied by headache, N/V, halos around lights & decreased vision. Cornea appears cloudy. Funduscopic exam reveals cupping of optic nerve

Answer 31

Acute Angle Closure Glaucoma (Opthalmological emergency)

Question 32

Gradual onset increased IOP greater than 22. Presents with a gradual change in peripheral vision

Answer 32

Open Angle Glaucoma

Question 33

Gradual or sudden loss of central vision in one or both eyes. Straight lines become distorted or curved (scotoma)

Answer 33

Macular degeneration

Question 34

Causes by EBV. Symptoms (3F's & an L) fever, fatigue, pharyngitis, lymphadenopathy sore throat, enlarged posterior cervical nodes, peak ages 15-24

Answer 34

Mononucleosis

Question 35

Chronic inflammation of meibomian gland, painless nodule with gradual onset. Tx I &D or corticosteroid injections

Answer 35

Chalazion

Question 36

Acute onset swollen, red and warm abscess on the eyelid may spontaneously rupture & drain purulent exudate. Caused by staph. Tx w/ hot compresses & erythromycin

Answer 36

Hordeoleum (stye)

Question 37

``` Confusion of new onset Blood urea nitrogen > 19 Respiratory rate > 30 Blood pressure diastolic < 90 or systolic < 60 Age 65 or older ```

Answer 37

CURB 65 (Pneumonia)

Question 38

PPD x Years =

Answer 38

Packs per year

Question 39

COPD: FEV1/ FVC < 70

Answer 39

Mild > 80 Moderate < 50 Severe < 30

Question 40

Increased tactile fremitus

Answer 40

Indicates consolidation

Question 41

Functional murmurs

Answer 41

Are due to increased blood flow. Normal in children @ 2nd- 3rd L ICS. Will disappear with sitting

Question 42

Risk factors for pulmonary emboli

Answer 42

Hx of A-fib, pregnancy, recent travel, smoking, prolonged inactivity, birth control, estrogen therapy, surgery, cancer, long bone fx

Question 43

Midsternal chest pain, numbness/ tingling left jaw, pain provoked by eating heavy meals or exercise. Pain or discomfort at rest. Women present w/ fatigue, sleep disturbance, anxiety, dyspnea, weakness, back pain, nausea & syncope

Answer 43

ACS (acute coronary syndrome)= STEMI, NSTEMI & unstable angina

Question 44

What type of pain can you reproduce?

Answer 44

Muscloskeletal pain

Question 45

Three factors that can cause thrombus formation (Virchow Triad)

Answer 45

Vessel wall injury Blood flow abnormalities Altered blood constituents leading to hypercoagulability

Question 46

Alveolar damage from loss of elastic recoil lungs, chronic cough (2 yrs), chronic sputum production, SOB worse w/ exertion, barrel chest, weight loss, hyperresonance upon precision, tactile fremitus & egophony are decreased, hyperinflation w/ CXR. (* pack per year smoker*)

Answer 46

COPD

Question 47

Thrombi developed from stasis, trauma, inflammation or coagulation. Gradual onset of swelling in LE after prolonged sitting, painful, red, warm, swollen extremity. (If PE abrupt onset CP, dyspnea, dizziness or syncope. + Homan's sign

Answer 47

Deep vein thrombosis (DVT)

Question 48

Narrowing or occlusion of medium to larger arteries in LE

Answer 48

Arterial insufficiency

Question 49

Worsening pain on ambulation instantly relived by rest (claudication- angina of calf muscles). Thin skin, hairless toes, thick toenails/ discolored, decreased or absent dorsal pedal pulse

Answer 49

Peripheral artery disease (PAD)

Question 50

What crescendo- decrescendo murmur presents in older patients with syncope, angina & dyspnea (SAD), or calcified valve? These murmurs radiate to the carotids

Answer 50

Aortic Stenosis

Question 51

What holosystolic murmur presents in a patient with Hx of Rheumatic fever? This murmur radiates to the axilla.

Answer 51

Mitral regurgitation

Question 52

What holosystolic murmur presents in patients with Hx of intervenous drug abuse (IVDA)?

Answer 52

Tricuspid Regurgitation

Question 53

What murmur has an opening snap sound and presents in a patient with Hx of Rheumatic fever?

Answer 53

Mitral Stenosis

Question 54

What murmur presents in young women w/ psychiatric Hx ( anxious or depressed)? Has a mid-systolic click. Can be caused by myxomatous valve disease

Answer 54

Mitral valve prolapse