History Taking Notes Flashcards
1
Q
Levels of TNF-a are decreased in patients with cancer and can contribute to weight lost relating to the cancer
A
False
2
Q
Rhinovirus and coronovirus tend to produce a scratchy throat
A
True
3
Q
Dysphagia experienced on swallowing of both solids and liquids make a neuromuscular cause less likely
A
False
4
Q
In heart failure breathlessness can be associated with lying down
A
True
5
Q
Increasing fatigue maybe symptoms of sleep apnoea better
A
True
6
Q
Cachexia is mediated by a variety of cytokines
A
True
7
Q
TNF-a act to increase fat metabolism without sparing muscle mass
A
False
8
Q
Amphetamines can result in rapid weight gain
A
False
9
Q
Melanocytes are located within the basal layer of the epidermis
A
True
10
Q
Eumelanin is the most dominant form of melanin in the skin
A
True
11
Q
Levels of melanin in skin remain constant with varying hormone levels
A
False
12
Q
Melasma is a condition common is pregnant women where skin patches become lighter
A
False
13
Q
Albanism is often associated with blindness
A
True
14
Q
It is important to ask females about their menstrual cycle when the present with skin changes
A
True
15
Q
In infective mononucleosis caused by EBV symptoms typically take about 2-3 days to reach their peak
A
False
16
Q
The Centor criteria is used to identify GAS infections
A
True
17
Q
Patients with strep throat commonly present with cough
A
False
18
Q
It is common for patients with viral throat infection to complain of a metallic taste in their mouth
A
False
19
Q
The sensation food bolus lodged in the cervical reigon is likely to be eosophageal dysphagia
A
True
20
Q
Emotion disorders are linked to globus pharyngeus
A
True
21
Q
Cough due to pulmonary oedema associated with CHF is more prominent at night
A
True
22
Q
Chronic bronchitis is defined as the presence of cough and sputum production on most days over at least a 3 month period over a year
A
False
23
Q
Bradykinin related cough may take up to 4 weeks to resolve after discontinuing medication
A
True
24
Q
Sputum commonly turns yellow in the presence of WBC
A
True
25
Wheeze associated with asthma tends to ease early morning and night
False
26
Heavy rapid breathing is characteristic of cardiac de-conditioning
True
27
An overdose of aspirin can produce de-conditioning and low temperature
False
28
Restless leg syndrome describes involuntary jerking movements of ones leg during activity
False
29
Epworth sleepiness scale is used to differentiate daytime sleepiness from fatigue and sleep apnoea
True
30
Narcolepsy typically begins in 50-60 age group
False
31
Sleeping without dentures decreases your risk of obstructive sleep apnoea
True
32
A score of 12 or more on the Epworth sleepiness scale has 100% specificity and 93.5% sensitivity for daytime sleepiness
True
33
Myocardial ischaemia is not a common cardiac cause of chest pain.
False
34
The cardiovascular system is the most common cause of chest pain presentation in general practice and to the emergency department
False
35
Unstable angina is described as symptoms worsening over time without being precipitated by activity
True
36
During a myocardial infarction pain is felt along the corresponding somatic sensory distribution (T1-4) of the chest rather than the visceral organ.
True
37
Pericarditis does not cause chest pain.
False
38
Respiratory chest pain is often pleuritic in nature.
True
39
The phrenic nerves originate from C3, 4, 5 and innervate the diaphragm
True
40
Gastrointestinal disorders that can cause chest pain include oesophageal spasm, reflux and cholecystitis.
True
41
Costochondritis may be described as either sharp pain or dull, aching pain.
True
42
Esophageal spasm and reflux readily radiate to the epigastrium but can also radiate to the right arm, much like cardiac pain.
True
43
Palpitation is an objective sensory symptom with the patient experiencing a conscious awareness of their heart beating.
True
44
Psychiatric causes of palpitations account for around 30% of cases in the emergency setting and around 45% of cases in the primary setting.
True
45
Conditions that predispose patients to palpitations include those that cause a parasympathetic overdrive, such as anxiety or panic states, anaemia, heart failure and some medications.
True
46
The most common cause of nausea and vomiting in all age groups is acute gastroenteritis.
True
47
Vomiting is associated with activation of the gag reflex and is mediated by cranial nerve IX and X.
True
48
Nausea and vomiting require a conscious perception of the toxic condition.
True
49
Severe abdominal pain is not an indication of an upper gastrointestinal cause of nausea and vomiting.
False
50
Red flags for a patient with nausea and vomiting are weight loss, blood-stained vomitus and faeculant vomitus
True
51
Peripheral oedema is caused by an increase in the interstitial fluid volume.
True
52
Hydrostatic pressure within the blood vessels pulls water and other diffusible solutes into the blood vessels.
False
53
An indentation of the skin is known as pitting oedema. It reflects the movement of excess interstitial fluid in response to pressure.
True
54
The most common cause of bilateral oedema is DVT
False
55
A large number of medications may precipitate ankle oedema. These include NSAIDs, steroids and antihypertensives.
True
56
Causes of ankle oedema include increased capillary osmotic pressure, lymphatic obstruction, hyperalbuminaemia and decreased capillary permeability.
True
57
Dyspepsia refers to a vague range of symptoms and is commonly seen in general practice.
True
58
Dyspepsia includes symptoms such as nausea, heartburn and regurgitation of food.
True
59
Gastric motor dysfunction refers to delayed gastric emptying secondary to the failure of the gastric fundus to relax and allow for distension.
True
60
The most common causes of upper abdominal pain are peptic ulcer disease, pancreatitis and biliary pain
True
61
Peptic ulcers penetrate the muscularis mucosae but don’t go any deeper.
False
62
The two major causes of peptic ulcer disease are Helicobacter pylori infection and the use of NSAIDS.
True
63
Most exacerbations of pancreatitis can be linked to excessive alcohol consumption or the presence of gall stones.
True
64
Cholecystokinin is released in response to protein in the small intestine and causes the gall bladder to contract.
False
65
Patients with biliary colic may also experience vomiting and diarrhoea and pain that radiates to the back.
True
66
Food can make pain associated with gastric ulcers better.
True
67
Haematemesis and malaena associated with upper abdominal pain are red flags as they are indicative that an ulcer has eroded into an artery or vein.
True
68
Appendicitis refers to the inflammation of the appendix, which can be due to localized ischaemia or obstruction.
True
69
High intraluminal pressure is thought to be the cause of diverticulum formation.
True
70
The majority of diverticula are located in the transverse colon.
False
71
Diverticulitis is the inflammation of one or many diverticulum.
True
72
Haemorrhage in diverticular disease can be severe resulting in per rectum bleeding, anaemia or dizziness.
True
73
As inflammation progresses in appendicitis it can begin to activate the pain receptors in the visceral peritoneum.
True
74
Mesenteric ischaemia is when vascular supply to the gastrointestinal tract is impeded and can result in diffuse abdominal pain.
True
75
Intestinal obstruction is caused by the interruption of normal faecal flow by some sort of occlusion.
True
76
Intestinal obstruction can cause dehydration.
True
77
When peritonitis occurs the patient is very ill with fever, tachycardia and other signs of shock.
True
78
In Spontaneous Bacterial Peritonitis there is usually an identifiable cause for the infection.
False
79
Diffuse abdominal pain associated with feeling hot and cold is suggestive of either intestinal obstruction or peritonitis due to the systemic shock that occurs after perforation.
True
80
Endometriosis is a condition that occurs when endometrial tissue assumes an extrauterine position within the pelvis
True
81
The implantation theory of endometriosis suggests that during menstruation, some of the shed endometrial cells make their war from the uterus to sites within the pelvis
True
82
The main concern for patients suffering from endometriosis is the increased risk of infertility inherent in endometriosis
True
83
Chlamydia Trachomatis and Treponema Pallidum are the most common infective agents associated with pelvic inflammatory disease
False
84
With a ruptured ovarian cyst, patients will often experience pain just after their expected menstruation or they may notice their period occurs later
False
85
The most common time for onset of symptoms of an ectopic pregnancy is within 6 - 8 weeks of their last menstruation
True
86
Haematemesis is the vomiting of blood and can appear as frank, red blood-stained vomitus or as “coffee-grounds: vomitus
True
87
The dark colouring of melaena is due to the blood having been in the gastrointestinal tract for at least 24 hours and becoming partially digested
True
88
Duodenal ulcers are four times more common than gastric ulcers
True
89
Mallory-Weiss tears are vertical tears in the mucosal lining of the oesophagus that commonly cause bleeding after an episode of forceful or persistent vomiting
True
90
In patients with known portal hypertension or cirrhosis the most likely source of bleeding is the oesophageal varix
True
91
Haemorrhagic gastropathy (erosive gastropathy or gastritis) refers to small mucosal lesions or areas of haemorrhage and can be a result of of chronic NSAID ingestion, heavy alcohol consumption, and stress
True
92
During the process of digestion on average a total of 9 L of fluid enters the lumen of the gastrointestinal tract, however only 1 L of this fluid is present by the time the luminal content passes through the small intestine
True
93
70 % of gastrointestinal secretion and absorption occurs within the small intestine
False
94
Changes in the mechanical phase of digestion is often the most at blame for causes of change in bowel habit
True
95
The migrating motor complex, which acts to clear non-digestible contents of the bowel, is initiated every 60 - 90 minutes and contractions cycle for 4 minutes
True
96
The mucosal walls of the large intestine do not have great absorptive capacity, but can absorb water, hence allowing for eh compaction and concentration of faecal matter
True
97
There are four types of diarrhoea: secretory, osmotic, inflammatory, and functional
True
98
Facitial diarrhoea is rarely seen in patients with eating disorders or Munchausen Syndrome
True
99
Antibiotic-associated diarrhoea can occur within 5 - 10 days of initiating treatment and is an overgrowth of the bacterium Clostridium Difficile
True
100
● constipation refers to the condition where patients experience a persistent difficulty passing stool, their bowel motions are infrequent or they have a sensation of incomplete defecation
True
101
● in > 90 % cases of constipation, there is an identifiable cause
False
102
● slow transit time is related to constipation as there is more opportunity for the gut mucosa to reabsorb the fluid from the stool and therefore create a hard, pellet-like motion
True
103
● patients with irritable bowel syndrome will alternate between episodes of diarrhoea and constipation
True
104
● some anticonvulsants like phenytoin and carbamazepine can cause constipation
True
105
● fibre is a partially-digestible component of a healthy diet which acts as an osmotic agent within the bowel lumen and draws water into the hardened stool to soften and improve the symptoms of constipation
True
106
rectorrhagia is rectal bleeding that occurs independently of defecation
True
107
60 % of gastrointestinal bleeding resulting in a per rectal bleed is most likely caused by a pathology in the lower gastrointestinal system (distal to the Ligament of Trietz)
False
108
● in rectal bleeding, the nature of the blood is usually the best indicator of anatomical source
True
109
● substantial bleeding is associated with angiodysplasia and diverticular disease
True
110
● haemorrhoids can be internal or external, and internal haemorrhoids are clinically graded 1 - VIII based upon the degree of prolapse
False
111
● both ischaemic and inflammatory colitis can result in rectal bleeding, however rectal bleeding is not a common presentation
True
112
● the colour of urine changes from day-to-day and even hour-to-hour depending on the body’s normal physiological fluid balance
True
113
● when the blood is seen immediately upon initiation of urine with the stream becoming clear near termination, this suggests the source of the blood is the bladder
False
114
● haematuria can be a result of bleeding conditions such as haemophilia
True
115
● pneumaturia most commonly occurs in patients suffering from diverticular disease
True
116
● bilirubinemia never causes frothy urine
False
117
● polyuria refers to the passage of vast quantities of urine >3L/day
True
118
● there are two main causes of polyuria: solute diuresis and water diuresis
True
119
● inflammatory joint pain can be accompanied by systemic symptoms such as fever, fatigue, weight loss, and skin rashes; these changes are mediated by the release of inflammatory cytokines such as interleukins 1 and 6, and tumour necrosis factor alpha, which upregulate acute phase proteins
True
120
● articular inflammatory joint pain includes diseases such as tendonitis and bursitis
False
121
● spondyloarthropathies are inflammatory disorders affecting the transition zone between tendons, ligaments, joint capsules and bones
True
122
● fibromyalgia typically occurs in individuals under age 50 and is a disorder of soft tissue surrounding a joint
True
123
● neuropathic pain is a constant pain that is worse at night, not affected by motion, and has associated paraesthesia and weakness
True
124
● oligoarticular disease involves 5 or more joints
False
125
● psychological factors can affect an individual;s perception of joint pain and may need addressing as well; depression is common in rheumatic conditions
True
126
● the site of insertion of ligaments, tendons, the joint capsule and fascia to bone is known as the enthesis
True
127
In psoriatic arthritis, the proximal interphalangeal joints of the hands and feet are symmetrically affected first with later involvement of large joints
True
128
arthritis can be associated with inflammatory bowel disease as an extraintestinal manifestation of the disease
True
129
In abnormal joints, stiffness may be caused by non-inflammatory and inflammatory diseases.
True
130
Patients often have difficulty differentiating stiffness as a symptom separate from pain and swelling, though difficulty moving a joint may be due to a combination of all three.
True
131
Rheumatologists classify joint stiffness as discomfort and limitations of the movement of joints following a period of extreme activity.
False
132
Joint stiffness occurs because oedematous fluid within the tendons, tendon sheaths, joint capsule and synovial space impairs the function of the joints acutely.
True
133
Joint stiffness is generally at its worst late in the evening and gets worse with activity.
False
134
Level of stiffness is the symptoms used to differentiate between mechanical non-inflammatory disorders and inflammatory disease.
False
135
In non-inflammatory mechanical joint conditions, stiffness lasts for less than half an hour and is worse after rest. The accompanying pain is worst at the end of the day
True
136
In inflammatory joint conditions, morning stiffness lasts for less than an hour and worsens with activity during the day.
False
137
Disorders affecting the joints include ankylosing spondylitis, rheumatoid arthritis, osteoarthritis and psoriatic arthritis
True
138
Ankylosing sponylitis is a chronic inflammatory disease manifesting as progressive pain and stiffness in the spine of young adults (age 20-30 years)
True
139
Patients with rheumatoid arthritis commonly complain of stiffness in small joints of hands and feet and difficulty doing up buttons
True
140
Stiffness of the joint is common in osteoarthritis and morning stiffness lasts for less than 30 minutes
True
141
Psoriatic arthritis has no associated skin condition
False
142
Disorders affecting soft tissues include: polymyalgia rheumatic, fibromyalgia, enthesopathies, tendon nodules/fibrosis, neurological disorders (e.g. parkinson’s disease) and trauma/injury.
True
143
It is important initially to establish what the patient means by stiffness
True
144
When taking history about joint stiffness, it is important to identify which joints and the number of joints involved.
True
145
With ankylosing spondylitis, patients generally experience stiffness localised to one joint
False
146
With Rheumatoid Arthritis, patients generally experience stiffness, normally involving the big joints
False
147
Joint stiffness is generally present symmetrically with osteoarthritis
False
148
Psoriatic arthritis will asymmetrically involve distal interphalangeal joints of the hands and feet but later will involve larger joints
True
149
Stiffness in polymyalgia rheumatic usually involve fingers and toes
False
150
Patients with fibromyalgia describes widespread morning stiffness
True
151
Golfer’s elbow is inflammation of tendon insertion sites at the medial epichondyle while tennis elbow is inflammation of tendon insertion sites at the lateral epicondyle.
True
152
Osteoarthritis, rheumatoid arthritis and fibromyalgia tend to have an acute onset of musculoskeletal symptoms.
False
153
Non-inflammatory joint disease normally has morning stiffness lasting less than 30 minutes while inflammatory joint conditions tend to have stiffness lasting for longer than one hour
True
154
In general, rest is an relieving factor of joint stiffness
False
155
Differential diagnosis for lower limb pain on exertion commonly includes peripheral vascular disease, spinal stenosis, nerve root compression, musculoskeletal trauma and DVT/emboli.
True
156
Intermittent claudication occurs when perfusion of the muscles is limited, so that when oxygen demand is increased by exercise it cannot be matched by the oxygen supply. The muscles then perform anaerobic respiration, resulting in an accumulation of waste products which stimulate chemoreceptors to produce the sensation of pain
True
157
Peripheral vascular disease is a fast, progressive disease that will result in gradually worsening symptoms over a short period of time.
False
158
Neurogenic claudication will often develop slowly over many years as a result of vertebral bone degeneration, intervertebral disc degeneration and prolapsed and joint disease.
True
159
Nerve root compression doesn’t cause pain until the condition is severe
False
160
As well as a reproducible time to onset, claudication should also be entirely relieved within 10 minutes of rest. If the pain is still present after 10 minutes, then you need to consider non-vascular causes of leg pain
True
161
With neurogenic claudication, patients often walk in a hunched over position to minimise the nerve impingement that occurs if they extend their lumbar spine.
True
162
Nerve root compression is made worse to a degree by lying down, but eased by extending legs (like when walking)
False
163
Neurogenic claudication is pain caused by compression of the spinal cord in the lumbar spine, usually due to osteophytes causing stenosis of the spinal canal.
True
164
The pain of claudication occurs in different regions depending on the location of the arterial stenosis.
True
165
Risk factors for peripheral vascular disease related to that of coronary artery disease include diabetes mellitus, smoking, dyslipidaemia, obesity, hypertension and increasing age.
True
166
With regards to causes of red eyes, bacterial and viral conjunctivitis present similarly. They are highly infectious and the patient often complains of having irritated red eye without pain or visual disturbances.
True
167
Keratitis refers to inflammation of the cornea and is a minor condition.
False
168
Keratitis and conjunctivitis are the most common causes of red eyes.
True
169
Keratitis caused by HSV infection can result in the formation of dendritic ulcer. They are painful and only occur once.
False
170
Glaucoma is an elevation in intraocular pressure secondary to a blocked canal of schlemm.
True
171
Red flags which indicate towards acute glaucoma include red eyes, pain and visual loss.
True
172
A good measure of visual severity of a visual condition is to ask the patient if they can read newspaper text out of the affected eye. If they can do that, then it is less likely that the condition is sinister.
True
173
If a patient reports having red eye, discharge and are contact lens wearers, then the most important differential diagnosis to consider is conjunctivitis.
False
174
Reactive arthritis is an autoimmune condition in which the body cross-reacts to an infection in another part of the body. Patient complains that they cannot “see, pee, or bend the knee”.
False
175
Risk factors for getting red eyes include: sharing communal living environments, contact lens, being exposed to biohazards, advanced age.
True
176
Red flags for bacterial keratitis include red eye, +/- visual changes, foreign body sensation and photophobia.
True
177
Syncope occurs when there is inadequate restoration of mean arterial blood pressure by reflex mechanisms on sudden or prolonged standing.
True
178
During a syncopal episode, the patient is unconscious for a few minutes and can lie motionless or exhibit myoclonic jerks.
True
179
One feature that can be used to distinguish between syncope and seizure is that following a syncope episode, the patient recovers slowly and experiences a post-ictal state of drowsiness and confusion.
False
180
When taking history of syncopal symptoms, it is important to determine what exactly the patient means when they say they experienced a funny turn or blackout.
True
181
When taking history of syncopal symptoms, it is not important to determine the setting in which the patient is found unconscious.
False
182
Micturition induced syncope often occurs in males in the middle of the night after urination. It can be associated with drinking alcohol before bed and is likely to reflex peripheral vasodilation in response to the release of intravesicular pressure and bradycardia.
True
183
It is important to establish the course of event that occurred over the syncopal period. Clinicians should enquire about the presence of clonic movements during the faint as well as colour changes, sweating, respiration, incontinence and the nature of the recovery.
True
184
Medications like antihypertensives (ACE inhibitors), diuretics , oral hypoglycaemics and antidepressants can cause syncope.
True
185
Common differential diagnoses for syncope include epilepsy, vasovagal attack, orthostatic hypotension, concussion, cardiac arrhythmia.
True
186
Chronic daily headache is defined as a headache that lasts for four hours or more for 15 days each month for the past 3 months.
True
187
Hemicrania continua is a continuous symmetrical headache of moderate intensity.
False
188
SUNCT stands for short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. It is a cause of trigeminal autonomic cephalalgia.
True
189
Cluster headache is a short lasting, unilateral headache caused by activation of the trigeminal and parasympathetic systems. It typically occurs in males ages 20-50 that are smokers. Patients also often experience ipsilateral autonomic ocular symptoms
True
190
For cluster headache, pain can be described as a feeling of their eye being pushed out of its socket or a hot poker being put through their eye.
True
191
For temporal arteritis, pain can be described as a tight band headache. It may have severe burning quality and the patient may have a scalp that is tender to touch.
False
192
Temporal arteritis presents as a generalised headache with focal tenderness over the affected superficial temporal or occipital artery
True
193
Pain associated with cervicogenic headache is normally in the frontal/parietal region of the head
False
194
Pain associated with paroxysmal hemicranias can radiate to the ear, neck and shoulder
True
195
Determining how the headache started is essential for establishing a differential diagnosis
True
196
A headache that is described to be progressively worse suggests an expanding intracranial lesion.
True
197
Average age onset of hemicranias continua is 55 years.
False
198
The onset of a cluster headache is 1-2 hours after falling asleep. The onset is normally abrupt with maximal pain peaking rapidly and may be preceeded by a sensation of pressure in the soon to be sore area.
True
199
SUNCT is a long lasting headache syndrome with up to 200 attacks per day
False
200
Subarachnoid Haemorrhage is described as gradual in onset
False
201
Tension type headache is often relieved by alcohol, massaging the head and the application of ice or heat. It is exacerbated by stress, over working and skipping meals
True
202
Hemicrania continua do not respond to indomethacin
False
203
There are no relieving factors for pain associated with temporal arteritis.
False
204
Associated symptoms of temporal arteritis include polymyalgia rheumatic, jaw claudication, tenderness of the scalp, a non-productive cough, sore throat and diplopia or acute monocular blindness.
True
205
Associated symptoms of SUNCT include ispilateral conjunctival injection and lacrimation
True
206
Two thirds of patients with migraine have a family history of the disorder.
True
207
Caffeine is known to have no effect on headache.
false
208
Alcohol can trigger cluster headaches but is used to relieve symptoms in patients with tension type headache
True
209
Cluster headache occurs less frequently in heavy cigarette smokers
False
210
Red flags of headaches include sudden onset of headache, sever and debilitating headache pain, fever, vomiting, weight loss, disturbed level of consciousness, worsening pain on bending or coughing, maximal pain in the morning, neurological symptoms and new onset of headache in elderly >50 years
True
211
Mild hearing loss is when sound is not registered until it is between 20-40dB. Patients often have difficulty in hearing softly spoken voices and higher frequency sounds such as “s”, “f” and “th”.
True
212
Moderate hearing loss is defined as hearing loss up to 20-40 dB, which is the intensity of most normal voices. They will have difficulty hearing in most situations.
False
213
Severe hearing loss is defined as hearing loss up to 70-90 dB which is the intensity of someone shouting at them. Profound hearing loss is anything over 90 dB.
True
214
Conductive hearing loss is due to an abnormality in the transmission of sound from the auricle and external auditory canal to the middle ear and is commonly caused by impacted cerumen, otosclerosis, cholesteatoma, perforated tympanic membrane or chronic otitis media.
True
215
Sensorineural hearing loss is generally due to lesions within the inner ear or vestibulocochlear (VIII) nerve and can be caused by conditions such as Presbyacusis and Meniere’s disease.
True
216
Patients with sensorineural hearing loss will report hearing better in noisy situations as the person talking to them will often raise their voice to drown out the background noise.
False
217
Noise induced hearing loss is believed to be caused by overstimulation of the hair cells within the inner ear, resulting in a release of damaging amounts of reactive oxygen species and cell death within the cochlea.
True
218
Presbyacusis refers to the progressive, unilateral sensorineural hearing loss that comes with age. It presents with loss of low frequency hearing, with or without tinnitus and is sensitive to very loud sounds.
True
219
Otosclerosis is a condition in which the bone surrounding the structures of the inner ear becomes vascular and spongy. Eventually, the bones become sclerosed and impair conductive hearing. It mainly affects those in their 20s and 30s.
True
220
Cholesteatoma is a condition where the keratinized squamous epithelium shed and aggregate into a ball of skin cells within the ear. The ball of skin cells can invade into and destroy the tympanic membrane, ossicles and cochlea, resulting in hearing impairments.
True
221
Meniere’s disease is characterised by episodes of vertigo, tinnitus, the sensation of aural fullness and fluctuating sensorineural hearing loss. It commonly occurs in people in their 5th decade of life and is believed to be due to an excess of fluid within the inner ear.
True
222
Most patients losing their hearing will report an initial difficulty with hearing sounds of low frequency such as “s”, “f” and “th”
True
223
It is important to understand how hearing loss affects the patient. In the elderly, it can cause them to become more socially isolated as they find conversing with others too difficult.
True
224
Alcohol, aminoglycazide (gentamicin, streptomycin), diuretics (frusemide), chemotherapeutics, quinines and salicylates are known to be ototoxic.
True
225
Otosclerosis is a hereditary condition that appears to be transmitted in an autosomal recessive pattern.
False
226
When taking history for a patient with hearing loss, it is always important to ask what work the patient does for a living.
True
227
Risk factors for hearing loss include ototoxic drugs, noise exposure >85 dB, age, family history of otosclerosis and trauma to the head or ear.
True
228
Muscle weakness can be caused by disorders affecting the central and peripheral nervous system, the neuromuscular junction or the muscle itself.
True
229
Amyotrophic lateral sclerosis is not a common motor neuron disorder that causes weakness.
False
230
In myasthenia gravis, acetylcholine receptor antibodies attack postsynaptic nicotinic acetylcholine receptors at the neuromuscular junction causing inefficient action potential transmission and progressive muscle weakness on repeated use.
True
231
Guillain Barre Syndrome commonly occurs after Campylobacter infection.
True
232
Polymyositis is a common inflammatory disorder resulting in distal muscle weakness.
False
233
Alcohol, corticosteroids, statins and colchicines can cause both acute and chronic myopathic syndrome.
True
234
When taking history from a patient with weakness, it is important to determine what the patient means by the word weak.
True
235
Amyotropic lateral sclerosis results in unilateral weakness of the distal limbs. It is often first noticed in the hands by weakness of grip and in the feet.
True
236
Myasthinia Gravis often presents with weakness in distal muscles
False
237
Guillain Barre Syndrome often presents with symmetrical ascending weakness in the limbs. It starts in the legs and spreads to the arms and affects both the proximal and distal muscles.
True
238
Bilateral limb weakness suggests a lesion of the brainstem.
False
239
Associated symptoms of myasthenia gravis include muscle fatigue, ptosis, diplopia, difficulty breathing, chewing, swallowing and speaking, difficulty climbing stairs and getting our of chair and drooping of the head.
True
240
Antihypertensives (eg. Beta blockers), anaesthetic agents (ketamine and diazepam), antibiotics (aminoglycosides), anti-convulsants and anti-psychotics can exacerbate the symptoms of Myasthenia Gravis.
True
241
Cardiac papillary muscles contract late in systole.
True
242
Mitral valve prolapse most commonly involves the anterior mitral valve leaflet.
False
243
Mitral valve prolapse click occurs during diastole.
FAlse
244
Mitral valve prolapse click occurs earlier in systole, the worse the condition.
True
245
A mitral valve prolapse click implies the presence of mitral regurgitation.
False
246
A mitral valve prolapse murmur in the absence of a click implies a worse prognosis that one with a click.
True
247
The mitral valve prolapse click is best heard with the bell.
False
248
The mitral valve prolapse click is best heard over the apex and lower left sternal edge.
True
249
Mitral valve prolapse is the most common congenital heart valvular lesion, occurring in 1-2% of the population, especially in women.
True
250
An opening snap occurs in early systole.
False
251
An opening snap is best heard with the diaphragm over the left lower sternal edge.
True
252
An opening snap occurs soon after the aortic component of the second heart sound, and therefore may be confused with a split S2.
True
253
Most patients with mitral stenosis will have an opening snap, although it may be absent if the stenosis is severe.
True
254
An opening snap is likely to be associated with a soft S1.
False
255
An opening snap is differentiated from a split S2 by assessing its amplitude along the left sternal edge.
True
256
High cardiac output states may cause an ejection click.
True
257
An ejection click occurs immediately following the first heart sound.
True
258
An ejection click may be associated with an abnormal mitral valve.
False
259
Ejection clicks are usually best heard in the sash area between apex and upper right sternal edge.
False
260
An ejection click may be confused with a split S2.
False
261
Most heart murmurs encountered in the community will be benign.
True
262
As a general rule diastolic murmurs are always pathological.
True
263
Benign systolic murmurs tend to peak late in systole.
False
264
Benign systolic murmurs usually have an S2 of normal intensity.
True
265
Pathological systolic murmurs usually associated with a loud S2.
False
266
Vibrations and murmurs created by turbulence will be best transmitted through a tense and full ventricle as opposed to one that is relaxed and empty.
True
267
A murmur heard over the spine is likely to arise from the aortic valve.
False
268
George Still’s systolic murmur of childhood is present in about 10% of children between 2 and 5 years of age.
False
269
A loud early systolic murmur is likely to obscure S2.
False
270
In the presence of an ejection systolic murmur, S1 and S2 are likely to be heard.
True
271
A holosystolic (or pansystolic) murmur is likely to obscure both S1 and S2.
True
272
An early diastolic murmur is likely caused by regurgitation of blood.
True
273
Early diastolic murmurs are best heard with the bell of the stethoscope.
False
274
A mid diastolic murmur is most likely caused by valvular stenosis.
True
275
Patent ductus arteriosus is associated with a midsystolic murmur.
False
276
A ventricular septal defect may be associated with pulmonary hypertension.
True
277
The murmur of aortic stenosis is the most likely ejection systolic murmur you are likely to hear.
False
278
An ejection systolic murmur caused by aortic sclerosis is associated with a 40% increased risk of myocardial infarction.
True
279
The incidence of aortic stenosis is about 1-2% in the elderly population.
False
280
Mortality and hospitalisation rates for rheumatic heart disease are twice greater for Maori compared to non-Maori.
False
281
Bicuspid aortic valve occurs in 2% of the population.
True
282
The Bernheim phenomena is associated with prominent a-waves in the JVP.
True
283
The murmur of aortic stenosis is associated with loud S2.
False
284
The murmur of HOCM begins earlier in systole than that of aortic stenosis.
False
