History Taking Notes

Question 1

Levels of TNF-a are decreased in patients with cancer and can contribute to weight lost relating to the cancer

Answer 1

False

Question 2

Rhinovirus and coronovirus tend to produce a scratchy throat

Answer 2

True

Question 3

Dysphagia experienced on swallowing of both solids and liquids make a neuromuscular cause less likely

Answer 3

False

Question 4

In heart failure breathlessness can be associated with lying down

Answer 4

True

Question 5

Increasing fatigue maybe symptoms of sleep apnoea better

Answer 5

True

Question 6

Cachexia is mediated by a variety of cytokines

Answer 6

True

Question 7

TNF-a act to increase fat metabolism without sparing muscle mass

Answer 7

False

Question 8

Amphetamines can result in rapid weight gain

Answer 8

False

Question 9

Melanocytes are located within the basal layer of the epidermis

Answer 9

True

Question 10

Eumelanin is the most dominant form of melanin in the skin

Answer 10

True

Question 11

Levels of melanin in skin remain constant with varying hormone levels

Answer 11

False

Question 12

Melasma is a condition common is pregnant women where skin patches become lighter

Answer 12

False

Question 13

Albanism is often associated with blindness

Answer 13

True

Question 14

It is important to ask females about their menstrual cycle when the present with skin changes

Answer 14

True

Question 15

In infective mononucleosis caused by EBV symptoms typically take about 2-3 days to reach their peak

Answer 15

False

Question 16

The Centor criteria is used to identify GAS infections

Answer 16

True

Question 17

Patients with strep throat commonly present with cough

Answer 17

False

Question 18

It is common for patients with viral throat infection to complain of a metallic taste in their mouth

Answer 18

False

Question 19

The sensation food bolus lodged in the cervical reigon is likely to be eosophageal dysphagia

Answer 19

True

Question 20

Emotion disorders are linked to globus pharyngeus

Answer 20

True

Question 21

Cough due to pulmonary oedema associated with CHF is more prominent at night

Answer 21

True

Question 22

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

Answer 22

False

Question 23

Bradykinin related cough may take up to 4 weeks to resolve after discontinuing medication

Answer 23

True

Question 24

Sputum commonly turns yellow in the presence of WBC

Answer 24

True

Question 25

Wheeze associated with asthma tends to ease early morning and night

Answer 25

False

Question 26

Heavy rapid breathing is characteristic of cardiac de-conditioning

Answer 26

True

Question 27

An overdose of aspirin can produce de-conditioning and low temperature

Answer 27

False

Question 28

Restless leg syndrome describes involuntary jerking movements of ones leg during activity

Answer 28

False

Question 29

Epworth sleepiness scale is used to differentiate daytime sleepiness from fatigue and sleep apnoea

Answer 29

True

Question 30

Narcolepsy typically begins in 50-60 age group

Answer 30

False

Question 31

Sleeping without dentures decreases your risk of obstructive sleep apnoea

Answer 31

True

Question 32

A score of 12 or more on the Epworth sleepiness scale has 100% specificity and 93.5% sensitivity for daytime sleepiness

Answer 32

True

Question 33

Myocardial ischaemia is not a common cardiac cause of chest pain.

Answer 33

False

Question 34

The cardiovascular system is the most common cause of chest pain presentation in general practice and to the emergency department

Answer 34

False

Question 35

Unstable angina is described as symptoms worsening over time without being precipitated by activity

Answer 35

True

Question 36

During a myocardial infarction pain is felt along the corresponding somatic sensory distribution (T1-4) of the chest rather than the visceral organ.

Answer 36

True

Question 37

Pericarditis does not cause chest pain.

Answer 37

False

Question 38

Respiratory chest pain is often pleuritic in nature.

Answer 38

True

Question 39

The phrenic nerves originate from C3, 4, 5 and innervate the diaphragm

Answer 39

True

Question 40

Gastrointestinal disorders that can cause chest pain include oesophageal spasm, reflux and cholecystitis.

Answer 40

True

Question 41

Costochondritis may be described as either sharp pain or dull, aching pain.

Answer 41

True

Question 42

Esophageal spasm and reflux readily radiate to the epigastrium but can also radiate to the right arm, much like cardiac pain.

Answer 42

True

Question 43

Palpitation is an objective sensory symptom with the patient experiencing a conscious awareness of their heart beating.

Answer 43

True

Question 44

Psychiatric causes of palpitations account for around 30% of cases in the emergency setting and around 45% of cases in the primary setting.

Answer 44

True

Question 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.

Answer 45

True

Question 46

The most common cause of nausea and vomiting in all age groups is acute gastroenteritis.

Answer 46

True

Question 47

Vomiting is associated with activation of the gag reflex and is mediated by cranial nerve IX and X.

Answer 47

True

Question 48

Nausea and vomiting require a conscious perception of the toxic condition.

Answer 48

True

Question 49

Severe abdominal pain is not an indication of an upper gastrointestinal cause of nausea and vomiting.

Answer 49

False

Question 50

Red flags for a patient with nausea and vomiting are weight loss, blood-stained vomitus and faeculant vomitus

Answer 50

True

Question 51

Peripheral oedema is caused by an increase in the interstitial fluid volume.

Answer 51

True

Question 52

Hydrostatic pressure within the blood vessels pulls water and other diffusible solutes into the blood vessels.

Answer 52

False

Question 53

An indentation of the skin is known as pitting oedema. It reflects the movement of excess interstitial fluid in response to pressure.

Answer 53

True

Question 54

The most common cause of bilateral oedema is DVT

Answer 54

False

Question 55

A large number of medications may precipitate ankle oedema. These include NSAIDs, steroids and antihypertensives.

Answer 55

True

Question 56

Causes of ankle oedema include increased capillary osmotic pressure, lymphatic obstruction, hyperalbuminaemia and decreased capillary permeability.

Answer 56

True

Question 57

Dyspepsia refers to a vague range of symptoms and is commonly seen in general practice.

Answer 57

True

Question 58

Dyspepsia includes symptoms such as nausea, heartburn and regurgitation of food.

Answer 58

True

Question 59

Gastric motor dysfunction refers to delayed gastric emptying secondary to the failure of the gastric fundus to relax and allow for distension.

Answer 59

True

Question 60

The most common causes of upper abdominal pain are peptic ulcer disease, pancreatitis and biliary pain

Answer 60

True

Question 61

Peptic ulcers penetrate the muscularis mucosae but don’t go any deeper.

Answer 61

False

Question 62

The two major causes of peptic ulcer disease are Helicobacter pylori infection and the use of NSAIDS.

Answer 62

True

Question 63

Most exacerbations of pancreatitis can be linked to excessive alcohol consumption or the presence of gall stones.

Answer 63

True

Question 64

Cholecystokinin is released in response to protein in the small intestine and causes the gall bladder to contract.

Answer 64

False

Question 65

Patients with biliary colic may also experience vomiting and diarrhoea and pain that radiates to the back.

Answer 65

True

Question 66

Food can make pain associated with gastric ulcers better.

Answer 66

True

Question 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.

Answer 67

True

Question 68

Appendicitis refers to the inflammation of the appendix, which can be due to localized ischaemia or obstruction.

Answer 68

True

Question 69

High intraluminal pressure is thought to be the cause of diverticulum formation.

Answer 69

True

Question 70

The majority of diverticula are located in the transverse colon.

Answer 70

False

Question 71

Diverticulitis is the inflammation of one or many diverticulum.

Answer 71

True

Question 72

Haemorrhage in diverticular disease can be severe resulting in per rectum bleeding, anaemia or dizziness.

Answer 72

True

Question 73

As inflammation progresses in appendicitis it can begin to activate the pain receptors in the visceral peritoneum.

Answer 73

True

Question 74

Mesenteric ischaemia is when vascular supply to the gastrointestinal tract is impeded and can result in diffuse abdominal pain.

Answer 74

True

Question 75

Intestinal obstruction is caused by the interruption of normal faecal flow by some sort of occlusion.

Answer 75

True

Question 76

Intestinal obstruction can cause dehydration.

Answer 76

True

Question 77

When peritonitis occurs the patient is very ill with fever, tachycardia and other signs of shock.

Answer 77

True

Question 78

In Spontaneous Bacterial Peritonitis there is usually an identifiable cause for the infection.

Answer 78

False

Question 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.

Answer 79

True

Question 80

Endometriosis is a condition that occurs when endometrial tissue assumes an extrauterine position within the pelvis

Answer 80

True

Question 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

Answer 81

True

Question 82

The main concern for patients suffering from endometriosis is the increased risk of infertility inherent in endometriosis

Answer 82

True

Question 83

Chlamydia Trachomatis and Treponema Pallidum are the most common infective agents associated with pelvic inflammatory disease

Answer 83

False

Question 84

With a ruptured ovarian cyst, patients will often experience pain just after their expected menstruation or they may notice their period occurs later

Answer 84

False

Question 85

The most common time for onset of symptoms of an ectopic pregnancy is within 6 - 8 weeks of their last menstruation

Answer 85

True

Question 86

Haematemesis is the vomiting of blood and can appear as frank, red blood-stained vomitus or as “coffee-grounds: vomitus

Answer 86

True

Question 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

Answer 87

True

Question 88

Duodenal ulcers are four times more common than gastric ulcers

Answer 88

True

Question 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

Answer 89

True

Question 90

In patients with known portal hypertension or cirrhosis the most likely source of bleeding is the oesophageal varix

Answer 90

True

Question 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

Answer 91

True

Question 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

Answer 92

True

Question 93

70 % of gastrointestinal secretion and absorption occurs within the small intestine

Answer 93

False

Question 94

Changes in the mechanical phase of digestion is often the most at blame for causes of change in bowel habit

Answer 94

True

Question 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

Answer 95

True

Question 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

Answer 96

True

Question 97

There are four types of diarrhoea: secretory, osmotic, inflammatory, and functional

Answer 97

True

Question 98

Facitial diarrhoea is rarely seen in patients with eating disorders or Munchausen Syndrome

Answer 98

True

Question 99

Antibiotic-associated diarrhoea can occur within 5 - 10 days of initiating treatment and is an overgrowth of the bacterium Clostridium Difficile

Answer 99

True

Question 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

Answer 100

True

Question 101

● in > 90 % cases of constipation, there is an identifiable cause

Answer 101

False

Question 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

Answer 102

True

Question 103

● patients with irritable bowel syndrome will alternate between episodes of diarrhoea and constipation

Answer 103

True

Question 104

● some anticonvulsants like phenytoin and carbamazepine can cause constipation

Answer 104

True

Question 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

Answer 105

True

Question 106

rectorrhagia is rectal bleeding that occurs independently of defecation

Answer 106

True

Question 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)

Answer 107

False

Question 108

● in rectal bleeding, the nature of the blood is usually the best indicator of anatomical source

Answer 108

True

Question 109

● substantial bleeding is associated with angiodysplasia and diverticular disease

Answer 109

True

Question 110

● haemorrhoids can be internal or external, and internal haemorrhoids are clinically graded 1 - VIII based upon the degree of prolapse

Answer 110

False

Question 111

● both ischaemic and inflammatory colitis can result in rectal bleeding, however rectal bleeding is not a common presentation

Answer 111

True

Question 112

● the colour of urine changes from day-to-day and even hour-to-hour depending on the body’s normal physiological fluid balance

Answer 112

True

Question 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

Answer 113

False

Question 114

● haematuria can be a result of bleeding conditions such as haemophilia

Answer 114

True

Question 115

● pneumaturia most commonly occurs in patients suffering from diverticular disease

Answer 115

True

Question 116

● bilirubinemia never causes frothy urine

Answer 116

False

Question 117

● polyuria refers to the passage of vast quantities of urine >3L/day

Answer 117

True

Question 118

● there are two main causes of polyuria: solute diuresis and water diuresis

Answer 118

True

Question 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

Answer 119

True

Question 120

● articular inflammatory joint pain includes diseases such as tendonitis and bursitis

Answer 120

False

Question 121

● spondyloarthropathies are inflammatory disorders affecting the transition zone between tendons, ligaments, joint capsules and bones

Answer 121

True

Question 122

● fibromyalgia typically occurs in individuals under age 50 and is a disorder of soft tissue surrounding a joint

Answer 122

True

Question 123

● neuropathic pain is a constant pain that is worse at night, not affected by motion, and has associated paraesthesia and weakness

Answer 123

True

Question 124

● oligoarticular disease involves 5 or more joints

Answer 124

False

Question 125

● psychological factors can affect an individual;s perception of joint pain and may need addressing as well; depression is common in rheumatic conditions

Answer 125

True

Question 126

● the site of insertion of ligaments, tendons, the joint capsule and fascia to bone is known as the enthesis

Answer 126

True

Question 127

In psoriatic arthritis, the proximal interphalangeal joints of the hands and feet are symmetrically affected first with later involvement of large joints

Answer 127

True

Question 128

arthritis can be associated with inflammatory bowel disease as an extraintestinal manifestation of the disease

Answer 128

True

Question 129

In abnormal joints, stiffness may be caused by non-inflammatory and inflammatory diseases.

Answer 129

True

Question 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.

Answer 130

True

Question 131

Rheumatologists classify joint stiffness as discomfort and limitations of the movement of joints following a period of extreme activity.

Answer 131

False

Question 132

Joint stiffness occurs because oedematous fluid within the tendons, tendon sheaths, joint capsule and synovial space impairs the function of the joints acutely.

Answer 132

True

Question 133

Joint stiffness is generally at its worst late in the evening and gets worse with activity.

Answer 133

False

Question 134

Level of stiffness is the symptoms used to differentiate between mechanical non-inflammatory disorders and inflammatory disease.

Answer 134

False

Question 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

Answer 135

True

Question 136

In inflammatory joint conditions, morning stiffness lasts for less than an hour and worsens with activity during the day.

Answer 136

False

Question 137

Disorders affecting the joints include ankylosing spondylitis, rheumatoid arthritis, osteoarthritis and psoriatic arthritis

Answer 137

True

Question 138

Ankylosing sponylitis is a chronic inflammatory disease manifesting as progressive pain and stiffness in the spine of young adults (age 20-30 years)

Answer 138

True

Question 139

Patients with rheumatoid arthritis commonly complain of stiffness in small joints of hands and feet and difficulty doing up buttons

Answer 139

True

Question 140

Stiffness of the joint is common in osteoarthritis and morning stiffness lasts for less than 30 minutes

Answer 140

True

Question 141

Psoriatic arthritis has no associated skin condition

Answer 141

False

Question 142

Disorders affecting soft tissues include: polymyalgia rheumatic, fibromyalgia, enthesopathies, tendon nodules/fibrosis, neurological disorders (e.g. parkinson’s disease) and trauma/injury.

Answer 142

True

Question 143

It is important initially to establish what the patient means by stiffness

Answer 143

True

Question 144

When taking history about joint stiffness, it is important to identify which joints and the number of joints involved.

Answer 144

True

Question 145

With ankylosing spondylitis, patients generally experience stiffness localised to one joint

Answer 145

False

Question 146

With Rheumatoid Arthritis, patients generally experience stiffness, normally involving the big joints

Answer 146

False

Question 147

Joint stiffness is generally present symmetrically with osteoarthritis

Answer 147

False

Question 148

Psoriatic arthritis will asymmetrically involve distal interphalangeal joints of the hands and feet but later will involve larger joints

Answer 148

True

Question 149

Stiffness in polymyalgia rheumatic usually involve fingers and toes

Answer 149

False

Question 150

Patients with fibromyalgia describes widespread morning stiffness

Answer 150

True

Question 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.

Answer 151

True

Question 152

Osteoarthritis, rheumatoid arthritis and fibromyalgia tend to have an acute onset of musculoskeletal symptoms.

Answer 152

False

Question 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

Answer 153

True

Question 154

In general, rest is an relieving factor of joint stiffness

Answer 154

False

Question 155

Differential diagnosis for lower limb pain on exertion commonly includes peripheral vascular disease, spinal stenosis, nerve root compression, musculoskeletal trauma and DVT/emboli.

Answer 155

True

Question 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

Answer 156

True

Question 157

Peripheral vascular disease is a fast, progressive disease that will result in gradually worsening symptoms over a short period of time.

Answer 157

False

Question 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.

Answer 158

True

Question 159

Nerve root compression doesn’t cause pain until the condition is severe

Answer 159

False

Question 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

Answer 160

True

Question 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.

Answer 161

True

Question 162

Nerve root compression is made worse to a degree by lying down, but eased by extending legs (like when walking)

Answer 162

False

Question 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.

Answer 163

True

Question 164

The pain of claudication occurs in different regions depending on the location of the arterial stenosis.

Answer 164

True

Question 165

Risk factors for peripheral vascular disease related to that of coronary artery disease include diabetes mellitus, smoking, dyslipidaemia, obesity, hypertension and increasing age.

Answer 165

True

Question 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.

Answer 166

True

Question 167

Keratitis refers to inflammation of the cornea and is a minor condition.

Answer 167

False

Question 168

Keratitis and conjunctivitis are the most common causes of red eyes.

Answer 168

True

Question 169

Keratitis caused by HSV infection can result in the formation of dendritic ulcer. They are painful and only occur once.

Answer 169

False

Question 170

Glaucoma is an elevation in intraocular pressure secondary to a blocked canal of schlemm.

Answer 170

True

Question 171

Red flags which indicate towards acute glaucoma include red eyes, pain and visual loss.

Answer 171

True

Question 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.

Answer 172

True

Question 173

If a patient reports having red eye, discharge and are contact lens wearers, then the most important differential diagnosis to consider is conjunctivitis.

Answer 173

False

Question 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”.

Answer 174

False

Question 175

Risk factors for getting red eyes include: sharing communal living environments, contact lens, being exposed to biohazards, advanced age.

Answer 175

True

Question 176

Red flags for bacterial keratitis include red eye, +/- visual changes, foreign body sensation and photophobia.

Answer 176

True

Question 177

Syncope occurs when there is inadequate restoration of mean arterial blood pressure by reflex mechanisms on sudden or prolonged standing.

Answer 177

True

Question 178

During a syncopal episode, the patient is unconscious for a few minutes and can lie motionless or exhibit myoclonic jerks.

Answer 178

True

Question 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.

Answer 179

False

Question 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.

Answer 180

True

Question 181

When taking history of syncopal symptoms, it is not important to determine the setting in which the patient is found unconscious.

Answer 181

False

Question 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.

Answer 182

True

Question 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.

Answer 183

True

Question 184

Medications like antihypertensives (ACE inhibitors), diuretics , oral hypoglycaemics and antidepressants can cause syncope.

Answer 184

True

Question 185

Common differential diagnoses for syncope include epilepsy, vasovagal attack, orthostatic hypotension, concussion, cardiac arrhythmia.

Answer 185

True

Question 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.

Answer 186

True

Question 187

Hemicrania continua is a continuous symmetrical headache of moderate intensity.

Answer 187

False

Question 188

SUNCT stands for short lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing. It is a cause of trigeminal autonomic cephalalgia.

Answer 188

True

Question 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

Answer 189

True

Question 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.

Answer 190

True

Question 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.

Answer 191

False

Question 192

Temporal arteritis presents as a generalised headache with focal tenderness over the affected superficial temporal or occipital artery

Answer 192

True

Question 193

Pain associated with cervicogenic headache is normally in the frontal/parietal region of the head

Answer 193

False

Question 194

Pain associated with paroxysmal hemicranias can radiate to the ear, neck and shoulder

Answer 194

True

Question 195

Determining how the headache started is essential for establishing a differential diagnosis

Answer 195

True

Question 196

A headache that is described to be progressively worse suggests an expanding intracranial lesion.

Answer 196

True

Question 197

Average age onset of hemicranias continua is 55 years.

Answer 197

False

Question 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.

Answer 198

True

Question 199

SUNCT is a long lasting headache syndrome with up to 200 attacks per day

Answer 199

False

Question 200

Subarachnoid Haemorrhage is described as gradual in onset

Answer 200

False

Question 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

Answer 201

True

Question 202

Hemicrania continua do not respond to indomethacin

Answer 202

False

Question 203

There are no relieving factors for pain associated with temporal arteritis.

Answer 203

False

Question 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.

Answer 204

True

Question 205

Associated symptoms of SUNCT include ispilateral conjunctival injection and lacrimation

Answer 205

True

Question 206

Two thirds of patients with migraine have a family history of the disorder.

Answer 206

True

Question 207

Caffeine is known to have no effect on headache.

Answer 207

false

Question 208

Alcohol can trigger cluster headaches but is used to relieve symptoms in patients with tension type headache

Answer 208

True

Question 209

Cluster headache occurs less frequently in heavy cigarette smokers

Answer 209

False

Question 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

Answer 210

True

Question 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”.

Answer 211

True

Question 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.

Answer 212

False

Question 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.

Answer 213

True

Question 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.

Answer 214

True

Question 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.

Answer 215

True

Question 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.

Answer 216

False

Question 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.

Answer 217

True

Question 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.

Answer 218

True

Question 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.

Answer 219

True

Question 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.

Answer 220

True

Question 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.

Answer 221

True

Question 222

Most patients losing their hearing will report an initial difficulty with hearing sounds of low frequency such as “s”, “f” and “th”

Answer 222

True

Question 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.

Answer 223

True

Question 224

Alcohol, aminoglycazide (gentamicin, streptomycin), diuretics (frusemide), chemotherapeutics, quinines and salicylates are known to be ototoxic.

Answer 224

True

Question 225

Otosclerosis is a hereditary condition that appears to be transmitted in an autosomal recessive pattern.

Answer 225

False

Question 226

When taking history for a patient with hearing loss, it is always important to ask what work the patient does for a living.

Answer 226

True

Question 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.

Answer 227

True

Question 228

Muscle weakness can be caused by disorders affecting the central and peripheral nervous system, the neuromuscular junction or the muscle itself.

Answer 228

True

Question 229

Amyotrophic lateral sclerosis is not a common motor neuron disorder that causes weakness.

Answer 229

False

Question 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.

Answer 230

True

Question 231

Guillain Barre Syndrome commonly occurs after Campylobacter infection.

Answer 231

True

Question 232

Polymyositis is a common inflammatory disorder resulting in distal muscle weakness.

Answer 232

False

Question 233

Alcohol, corticosteroids, statins and colchicines can cause both acute and chronic myopathic syndrome.

Answer 233

True

Question 234

When taking history from a patient with weakness, it is important to determine what the patient means by the word weak.

Answer 234

True

Question 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.

Answer 235

True

Question 236

Myasthinia Gravis often presents with weakness in distal muscles

Answer 236

False

Question 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.

Answer 237

True

Question 238

Bilateral limb weakness suggests a lesion of the brainstem.

Answer 238

False

Question 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.

Answer 239

True

Question 240

Antihypertensives (eg. Beta blockers), anaesthetic agents (ketamine and diazepam), antibiotics (aminoglycosides), anti-convulsants and anti-psychotics can exacerbate the symptoms of Myasthenia Gravis.

Answer 240

True

Question 241

Cardiac papillary muscles contract late in systole.

Answer 241

True

Question 242

Mitral valve prolapse most commonly involves the anterior mitral valve leaflet.

Answer 242

False

Question 243

Mitral valve prolapse click occurs during diastole.

Answer 243

FAlse

Question 244

Mitral valve prolapse click occurs earlier in systole, the worse the condition.

Answer 244

True

Question 245

A mitral valve prolapse click implies the presence of mitral regurgitation.

Answer 245

False

Question 246

A mitral valve prolapse murmur in the absence of a click implies a worse prognosis that one with a click.

Answer 246

True

Question 247

The mitral valve prolapse click is best heard with the bell.

Answer 247

False

Question 248

The mitral valve prolapse click is best heard over the apex and lower left sternal edge.

Answer 248

True

Question 249

Mitral valve prolapse is the most common congenital heart valvular lesion, occurring in 1-2% of the population, especially in women.

Answer 249

True

Question 250

An opening snap occurs in early systole.

Answer 250

False

Question 251

An opening snap is best heard with the diaphragm over the left lower sternal edge.

Answer 251

True

Question 252

An opening snap occurs soon after the aortic component of the second heart sound, and therefore may be confused with a split S2.

Answer 252

True

Question 253

Most patients with mitral stenosis will have an opening snap, although it may be absent if the stenosis is severe.

Answer 253

True

Question 254

An opening snap is likely to be associated with a soft S1.

Answer 254

False

Question 255

An opening snap is differentiated from a split S2 by assessing its amplitude along the left sternal edge.

Answer 255

True

Question 256

High cardiac output states may cause an ejection click.

Answer 256

True

Question 257

An ejection click occurs immediately following the first heart sound.

Answer 257

True

Question 258

An ejection click may be associated with an abnormal mitral valve.

Answer 258

False

Question 259

Ejection clicks are usually best heard in the sash area between apex and upper right sternal edge.

Answer 259

False

Question 260

An ejection click may be confused with a split S2.

Answer 260

False

Question 261

Most heart murmurs encountered in the community will be benign.

Answer 261

True

Question 262

As a general rule diastolic murmurs are always pathological.

Answer 262

True

Question 263

Benign systolic murmurs tend to peak late in systole.

Answer 263

False

Question 264

Benign systolic murmurs usually have an S2 of normal intensity.

Answer 264

True

Question 265

Pathological systolic murmurs usually associated with a loud S2.

Answer 265

False

Question 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.

Answer 266

True

Question 267

A murmur heard over the spine is likely to arise from the aortic valve.

Answer 267

False

Question 268

George Still’s systolic murmur of childhood is present in about 10% of children between 2 and 5 years of age.

Answer 268

False

Question 269

A loud early systolic murmur is likely to obscure S2.

Answer 269

False

Question 270

In the presence of an ejection systolic murmur, S1 and S2 are likely to be heard.

Answer 270

True

Question 271

A holosystolic (or pansystolic) murmur is likely to obscure both S1 and S2.

Answer 271

True

Question 272

An early diastolic murmur is likely caused by regurgitation of blood.

Answer 272

True

Question 273

Early diastolic murmurs are best heard with the bell of the stethoscope.

Answer 273

False

Question 274

A mid diastolic murmur is most likely caused by valvular stenosis.

Answer 274

True

Question 275

Patent ductus arteriosus is associated with a midsystolic murmur.

Answer 275

False

Question 276

A ventricular septal defect may be associated with pulmonary hypertension.

Answer 276

True

Question 277

The murmur of aortic stenosis is the most likely ejection systolic murmur you are likely to hear.

Answer 277

False

Question 278

An ejection systolic murmur caused by aortic sclerosis is associated with a 40% increased risk of myocardial infarction.

Answer 278

True

Question 279

The incidence of aortic stenosis is about 1-2% in the elderly population.

Answer 279

False

Question 280

Mortality and hospitalisation rates for rheumatic heart disease are twice greater for Maori compared to non-Maori.

Answer 280

False

Question 281

Bicuspid aortic valve occurs in 2% of the population.

Answer 281

True

Question 282

The Bernheim phenomena is associated with prominent a-waves in the JVP.

Answer 282

True

Question 283

The murmur of aortic stenosis is associated with loud S2.

Answer 283

False

Question 284

The murmur of HOCM begins earlier in systole than that of aortic stenosis.

Answer 284

False