Internal Med 1 Minimals Flashcards
1
Q
Anamnesis consists of:
A
- familial anamnesis
- enviromental and social anamnesis
- previous diseases
- present complaints
- other aspects in connection with the patient (drugs taken, drug allergy)
1
Q
List the parts of the general examination:
A
- inspection
- palpation
- percussion
4 auscultation
2
Q
Subfebrility is:
A
The temperature of the body is between 37.0 - 37.5°C
3
Q
Fever is:
A
The temperature of the body is between 37.6-40°C
4
Q
The causes of fever are:
A
- infectious diseases
- tissue-damage or-necrosis
- altered function (damage) of the heat center
- heat congestion
5
Q
Febris continua means:
A
Continously high fever, daily change of fever less than 1°C
6
Q
Febris remittens means:
A
Changing fever, the changes are higher than 1-1.5 °C per day but the lowest temperature remains
above 37°C.
7
Q
Febris intermittens means:
A
Changing fever, the changes are higher than 1.5°C per day, but the lowest temperature is normal
8
Q
Broca’s formula is the following:
A
Ideal weight kg = height in cms minus 100
9
Q
The following characteristics of the sputum should be analysed:
A
- quantity
- color
- odor
- consistency
10
Q
Eupnea means:
A
The number of breathing is 16-18/min, with symmetric distension of the thorax.
11
Q
Tachypnea means:
A
Frequent breathing, the number of breathing > 18/min.
12
Q
Basic clinical examinations in lung diseases are
A
- physical
- radiological
- functional tests
13
Q
Main directions for examinations of pulmonary diseases are:
A
- basic clinical diagnosis
- differential diagnosis
- searching for infectious agents
14
Q
The followings should be followed by auscultation of the lungs:
A
- comparative auscultation should be done on both sides, on the same places
- the apices of the lungs should be auscultated first, and then medium and lower parts
consecutively - murmurs should be evaluated before and after coughing
- whistling may be analysed if the patient breathes deeply with open mouth
15
Q
Normal auscultation sound of the lung is:
A
Sharp, full, not tympanic.
16
Q
Lower borders of the lungs are ( normal case):
A
Right medioclavicular line, lower edge of the 6th rib.
Medioaxillary line, both side: 8th rib.
Scapular line, both side: 9th rib.
Paravertebral line, both side: processus spinosus of the 11th vertebra.
17
Q
The borders of the Traube’s space are:
A
Lung, spleen, liver, lowest rib.
18
Q
The followings should be considered while percussing the thorax:
A
- ideal position of the patient
- do not percuss above bones
- the percussion sound may differ on different regions of the thorax
19
Q
Types of cardiac dyspnea are:
A
- exercise-induced dyspnoe
- resting dyspnoe
- orthopnoe
- paroxysmal dyspnoe
20
Q
Tachycardia means:
A
Heart rate is over 100/min.
21
Q
Bradycardia means:
A
Heart rate is below 60/min.
22
Q
What is the difference between central and peripherial cyanosis?
A
The central cyanosis is rather generalised, the extremities are warm.
Peripherial cyanosis is localised, and the extremities are cool.
23
Q
The borders of the relative heart dullness are:
A
- Lower border: right medioclavicular line, 5th intercostal space
- Right border: right edge of the sternum
- Upper border: left parasternal line, the upper edge of the 3rd rib
- Left border: the apex beat, or one finger medial from the medioclavicular line
24
The first heart sound is generated by:
The closure of the mitral and tricuspidal valves and by tension of the myocardium
25
The second heart sound is generated by:
The closure of the aortic and pulmonary valves.
26
The third heart sound is:
The filling sound.
27
The fourth heart sound is:
Presystolic sound (atrial).
28
The third heart sound becomes loud in general
In case of volume overload of the heart.
29
The fourth heart sound becomes loud:
In case of pressure overload of the heart.
30
Characterize protosystolic murmur:
Murmur at the beginning of the systole.
31
Characterize mesosystolic murmur:
Murmur in the middle of the systole.
32
Characterize holosystolic murmur:
Murmur audible through the entire systole.
33
Characterize presystolic murmur:
Murmur at the end of the diastole, just before the systole.
34
Characterise gallop rhytm:
Either the third or the fourth heart sound or both become loud and their intensity equals with the
first and the second sound.
35
Describe organic endocardial murmur:
The murmur is caused by structural damage of the great blood vessel walls, valves or orifices
36
Murmurs are characterized by the followings:
1. In which heart phase is it audible (systolic/diastolic)
2. Intensity
3. Quality
4. Tone
5. Punctum maximum (localization)
6. Radiation
37
Describe the borders of the heart on a postero-anterior X-ray picture:
Left, from above: aorta, a. pulmonalis, left auricle, left ventricle.
Right, from above: aorta, v. cava superior, right auricle.
38
Which arteries are palpable on the low extremities?
a. femoralis
a. poplitea
a. dorsalis pedis
a. tibialis posterior
39
Describe pulse deficit:
The frequency of the heart beat (by auscultating above the heart) is higher than that of the
peripheral pulse waves.
40
List the characteristics of pulse:
frequency
rhythmicity
altitude
velocity
equality
stiffness
41
Describe Homan’s test:
By bent knees, sudden dorsalflexion of the foot results in pain of the sural muscles (charateristic
for deep vein thrombosis)
42
Describe Lövenberg’s or cuff sign:
Increasing the pressure gradually in a cuff located on the patient’s thigh or leg at pressure of
80-120 mmHg, the patient feels intense pain (in the case of deep vein thrombosis).
43
The Trendelenburg’s and Perthes’ tests inform about:
The permeability of the superficial and the deep veins.
44
The Gartner’s sign informs about:
The central venous pressure.
45
List the regions of the abdomen:
right and left hypochondrium
epigastrium
umbilical region
right and left lumbar region
right and left inguinal region
hypogastrium
46
What is examined by superficial palpation of the abdomen?
The tension of the abdominal muscles, local or diffuse muscle guarding.
47
The disappearance of the liver dullness indicates:
Free air in the abdominal cavity, as the consequence of gastric or intestinal perforation
48
Describe normal borders of the spleen:
Between the 9th and 11th ribs on the left, between the anterior and medial axillary lines
49
Pollakisuria is:
Painful, frequent irritation for urination, small amount of exerted urine.
50
What is anuria?
The amount of daily urine is less than 100 ml
51
What is oliguria?
The amount of daily urine is less than 500 ml
52
General examination of the urine involves the following:
specific gravity - osmolality
protein
pus
sugar
urobilinogen
aceton
bilirubin
microscopic examination of the sediment
53
The clearance indicates the following:
The excretion of a particular material by the kidney, during 1 minute.
54
Proteinuria means:
Detectable protein present in the urine
55
Pyuria means:
Detectable pus in the urine.
56
Bacteriuria means:
Bacteria are detectable in the urine (105
/ml or more)
57
Microscopic hematuria means:
Red blood cells (RBC) are detectable in the sediment by microscopic examination.
58
What is microscopic hematuria?
RBC of different size and shape are present in the sediment of the urine
59
The diagnosis means:
Identification of a certain disease or disorder
60
Diagnostic procedures cover
Methods and examinations aiming to get a diagnosis
61
Differential diagnosis means:
Differentiation between diseases that have similar symptoms
62
Simulation means:
Healthy person pretends to be sick.
63
Aggravation means:
The patient demonstrates more severe complaints than he actually has.
64
Dissimulation means:
Neglecting or diminishing real complaints or symptoms
65
List the possible outcomes of a disease:
Complete recovery
Partial recovery with persistent defects
Relapse or worsening
Death
66
. Describe the different periods of a particular disease:
Latency (from the beginning of the disease till the development of complaints)
Morbid stage (from the appearance of signs and symptoms till their disappearance)
Recovery
67
Describe the parts of the patient chart:
- Personal data
- History (familial, environmental, social, previous diseases, present complaints, drugs taken,
drug allergy)
- Physical examination (state at the admission)
- Epicrisis
68
How to detect free air in the abdominal cavity?
By the disappearance of the liver dullness.
69
Claudicatio intermittens covers:
After walking a certain distance, a crampy, intense pain develops in the sural muscles which
relieves after rest.
70
Dysbasic (claudication ) index covers:
The walking distance, after which the crampy pain develops in the sural muscles. It indicates
arteriosclerosis obliterans, shorter distances indicate worse condition.
71
The Perthes’ test informs about:
The permeability of the deep veins and the condition of the venae perforantes
72
What is the difference between transsudate and exsudate regarding protein content?
Protein content of the exsudate ≥ 4 g%, vs. protein content of the transsudate: 1-2 g%.
73
Which test is used to differentiate between pleural transsudate and exsudate?
Rivalta’s test
74
Vital capacity is:
The maximal amount of exhaled air after the deepest inspiration.
75
. If the patient complains about pain, the followings must be described:
Location, radiation
Quality (type), severity
Frequency
Time-relations
The setting in which it occurs
Factors that make it better or worse
Associated symptoms
76
Where should the aortic valve be auscultated?
Right parasternal line, second intercostal space
77
Where should the a. pulmonalis be auscultated?
Left parasternal line, second intercostal space.
78
Where should the mitral valve be auscultated?
On the place of the apex beat.
79
Orthopnea may suggest:
Left ventricular failure, mitral stenosis, obstructive lung disease.
80
What is the typical location of the pain caused by myocardial infarction?
Retrosternal pain that may radiate to the left shoulder, arm, to the neck or to the lower jaw. The
pain can be localised into the epigastrial region.
81
List the lines that demarcate the regions of the abdomen:
The right and left medioclavicular lines, the subcostal and the interspinal lines.
82
What is meteorism?
Increased gas content of the bowels with consequent elevation of the anterior abdominal wall
83
The causes of diffuse enlargement of the abdomen are the followings:
Obesity, meteorism, ascites, pregnancy, filled urinary bladder.
84
What does hernia mean?
Inherited or aquired weakness of the abdominal wall (abdominal muscles) and increased
intraabdominal pressure result in the protrusion of the bowels or the omentum pushing forward
the parietal peritoneum.
85
Describe the normal male and female pubic hair:
The male pubic hair extends to the umbilicus showing an inverted V form. The female pubic hair
ends as a sharp, horizontal or slightly convex line above the mons pubis.
86
List the different ways of the abdominal palpation:
Superficial, medium deep and deep, penetrating, bimanual and balloting
87
How to characterize an intraabdominal resistance?
Localisation, shape, surface, size, consistency, mobility, tenderness, borders, connection with
breathing.
88
The characteristics of the free intraabdominal fluid are the followings:
Lying on the back, it has a concave border and follows changes in the position of the body. The
fluid fluctuates.
89
The characteristic percussion sound of the abdomen is:
Tympanic, characteristic for air-containing cavities.
90
Describe the borders of the absolute liver dullness:
Right medioclavicular line, from the lower edge of the 6th rib till the costal margin.
91
Hematemesis means:
Vomiting blood.
92
Melena means:
Digested blood in the stool (tarry black stool).
93
Hematochesia means:
Undigested, fresh blood in the stool.
94
The acholic stool looks like:
Grayish-white, fatty-shining stool indicating obstruction of the bile ducts
95
Hypermemesis means:
Extensive vomiting.
96
Which is the ideal position of the patient for examination of the spleen?
The patient lies on his right side, the left arm above his head.
97
What is subicterus?
Slight jaundice, when yellow coloration of the sclera is detectable. The concentration of the
serum bilirubin is about 35 umol/l.
98
Where is the McBurney’s point?
In the right iliacal (inguinal) region, at the border of the lateral and medial thirds of the line
between the umbilicus and the spina iliaca anterior superior
99
Where is the place of the abdominal puncture (paracentesis)?
In the left iliacal (inguinal) region, at the border of the lateral and medial thirds of the line
between the umbilicus and the spina iliaca anterior superior.
100
Describe edema and the place of its occurence:
Increase of the interstitial fluid. Edema may be local and generalized.
Cardiac edema occurs in the lower body parts (legs, sacral region) of the body due to the
gravitation. Renal edema may develop anywhere (mainly in loose connective tissue, i.e. around
the eyes and in the scrotum). Hypoproteinemic edema is generalized. Deep vein thrombosis and
chronic venous insufficiency result in edema present on the corresponding extremity.
101
How to carry out and evaluate Babinski’s sign?
Scratching along the lateral surface of the sole from the heel forward. In pathological case,
dorsalflexion of the hallux and fanning of the other toes are detectable, indicating upper motor
neuron disease.
102
What characteristics of the pupils should be examined?
Width, round shape, sharp edge, central location, equality, narrowing to light and
convergence, consensual reactions.
103
The hypnoid mental disturbances are the followings:
Somnolence, sopor, coma.
104
The most frequently tested reflexes of the upper extremity are:
Radius, ulna, biceps and triceps reflexes.
105
The most frequently tested reflexes of the lower extremity are:
Patella and Achilles reflexes.
106
The meningeal excitation signs are:
Vomitus, nausea, bradycardia, fixed occiput (stiffness of the neck), Brudzinsky’s sign, Kernig’s
sign.
107
Describe the investigation of the Lasegue’s sign:
Patient lying on his back and elevating his fully streched legs, pain develops below 90 degrees of
elevation.
108
Gout affects most frequently the following joints:
Metatarso-phalangeal (MTP) articulation of the hallux.
109
Rheumatoid arthritis affects most frequently the following joints:
Metacarpo-phalangeal (MCP) and proximal interphalangeal (PIP) articulations
110
Which of the chronic dermatological diseases involves polyarthritis?
Psoriasis.
111
List the main pathological types of breathing:
Cheyne-Stokes’
Kussmaul’s
Apnoe
Paradox
112
List the main symptomes of nephrotic syndrome:
Generalized edema
Heavy proteinuria
Hypoalbuminemia
Hypercholesterolemia
113
Describe Courvoisier’s sign:
Icterus and painless enlargement of the gallbladder.
114
What may the Courvoisier’s sign indicate?
Carcinoma in the head of the pancreas.
115
The positive Mennel’s test may indicate:
Disease of the sacroiliacal (SI) articulation.
116
The spider nevi are characteristic of:
Cirrhotic liver.
117
The biceps reflex informs about the following vertebral radix:
C5-6.
118
The triceps reflex informs about the following vertebral radix:
C6-7.
119
The radius reflex informs about the following vertebral radix:
C7-8
120
The abdominal cutaneous reflex informs about the following vertebral radix:
Th7-12.
121
The patella reflex informs about the following vertebral radix:
L2-4.
122
The Achilles reflex informs about the following vertebral radix:
S1.
123
What sould be registered by inspection of the abdomen?
The level of the anterior abdominal wall as compared to the anterior wall of the thorax
Symmetricity
Its movement with breathing
Hair
Lumps, hernias
Scars and other alterations (coloration) of the skin
The umbilicus (normal, extroverted, introverted)
124
The inspection of the thorax informs about:
The shape of the thorax
Deformities
Scars and other abnormalities of the skin (eruption, nevi, etc.)
Extraordinary pulsation of the thorax
The state of the jugular veins (empty or dilated)
Cyanosis
125
The pectoral (tactile) fremitus informs about:
The resonance and conductance of the lungs and thoracic wall
126
Give the normal concentration of serum Na:
137-145 mmol/l.
127
Give the normal concentration of serum K:
3.5-5.2 mmol/l
128
Give the normal concentration of serum glucose:
3.6-6.0 mmol/l
129
Give the normal concentration of the white blood cells:
4.8-9.0 G/l
130
Give the normal concentration of hemoglobin:
120-150 g/l
