LE 1 PD-IM Flashcards
Which level of consciousness is heralded by depressed
response, which is more of grimacing and drawing away from
the painful stimuli, and the presence of deep tendon reflexes?
a) Stuporous
b) Obtunded
c) Confused
d) Comatose
Stuporous
Rationale:
• Normal level when alert and responds to questions
spontaneously and promptly, oriented to time, place and
person and is easily awakened from sleep
• Confused when disoriented, with slow response to questions,
with impaired thinking and with difficulty in following
commands • Lethargy when the patient is drowsy but can
easily be aroused by minimal stimuli either by voice or touch
and can sustain arousal without requiring constant
stimulation
• Somnolence is characterized by being more drowsy and
needs constant stimulation to maintain arousal
• Obtunded when the person sleeps more than usual,
responds slowly to verbal or painful stimuli with
incomprehensible verbal responses
• Stuporous is only responsive to repeated and vigorous
stimuli, mostly painful, responding only by grimacing or
drawing away from the painful stimuli. (+) deep tendon
reflexes
• Comatose when there is no response to any stimuli, no gag,
corneal and deep tendon reflexes
If weighing scale is absent, which of the following can be
utilized to measure the weight of the patient?
a) Mid-arm circumference
b) Mid-forearm circumference
c) Ankle circumference
d) Wrist Circumference
Mid-arm circumference
Korotkoff sounds heard during BP measurement may never disappear in which condition? a) Dilated cardiomyopathy b) Aortic regurgitation c) Right sided heart failure d) Subclavian steal syndrome
Aortic regurgitation
All of the following are true about peripheral cyanosis,
EXCEPT:
a) Can be due to respiratory disorder
b) Can be secondary to poor peripheral circulation
c) Can be due to vasculitis
d) Can be due to peripheral vasoconstriction
a) Can be due to respiratory disorder
Rationale:
• Clinically significant cyanosis associated with disturbance in
oxygenation seen as bluish or purplish discoloration of the
mucous membrane of the mouth (central cyanosis)
→ Respiratory problem
→ Cardiac dysfunction
→ Abnormalities in the hemoglobin molecule
• Bluish discoloration of the nails/fingers (peripheral cyanosis)
→ Poor peripheral circulation
→ Peripheral vasoconstriction
→ Vasculitis
TRANS: 2.1.1 GENERAL SURVEY
Which disorder is characterized by repetitive periods of apnea,
lasting 20-30 seconds, and could be longer during REM
phase?
a) Obstructive Sleep Apnea
b) Chronic Obstructive Pulmonary Disease
c) Hypothalamic lesions
d) Metabolic Acidosis
Obstructive Sleep Apnea
Rationale:
APNEA
• Cessation of respiration for at least 10 seconds.
• Seen in patients with neuromuscular problems, obstruction or
• drugs. Common in kids.
• Obstructive sleep apnea – periods of apnea last 20 to 30
seconds and are longer during rapid eye movement (REM)
sleep than during non-rapid eye movement (NREM).
• • Final event in all cases of respiratory failure.
Which of the following is a key feature of patient-centered
consultation?
a) Helping the patient to feel at ease at the outset
b) Providing care concordant to the person’s preferences
c) Active listening
d) Eliciting person’s goals of care
Eliciting person’s goals of care
Rationale:
PATIENT-CENTERED COMMUNICATION
GOAL
• To help doctors provide care that is concordant with the patient’s
values, needs and preferences, and enables the person to
participate actively in decisions regarding health and health
care.
KEY FEATURES:
• Exploring the patient’s experience of illness
• Eliciting the person’s goal of care
• Working in partnership to define the problems to be
addressed and choosing a course of action
ELEMENTS of a consultation which can facilitate this include:
o Helping the patient to feel at ease at the outset
o Use of open questions
o Active listening
o Picking up and responding to verbal and non-verbal cues
o An emphatic approach
Evidence have shown that when doctors communicate well
with their patients the effect will be
a) Doctors are more satisfied with their medical decisions
b) Patients become more independent of their doctor’s advice
c) Health outcomes are achieved
d) Efficient consultation is done
d) Efficient consultation is done
Rationale:
When doctors communicate well with patients:
o More accurate and comprehensive information is gathered,
aiding accurate diagnosis
o Patients are more satisfied with care and less anxious
o Patients understand, recall and act better on information
o More involvement from patients in making decisions about
their own care and more satisfied decisions o More efficient
consultations
o Improved health outcomes
Which disorder has a characteristic immobile, mask-like facies? A. Systemic Lupus Erythematous B. Parkinsonism C. Hypothyroidism D. Cushing’s Syndrome
B. Parkinsonism
Rationale:
• Parkinson’s Disease: Decreased facial mobility blunts
expression. A masklike face may result, with decreased blinking
and a characteristic stare.
• SLE: Butterfly malar rash; Hypothyroidism: Loss of lateral
eyebrows, dry skin, brittle hair; Cushing’s Syndrome: moon
facies
Which type of gait is usually secondary to peripheral motor unit disease, with associated foot drop? A. Spastic Hemiparesis B. Steppage Gait C. Cerebellar Ataxia D. Scissors Gait
Steppage Gait
Rationale:
• Steppage gait is the inability to lift the foot while walking due to
the weakness of muscles that cause dorsiflexion of the ankle
joint
• Spastic hemiparesis/ hemiplegic gait: impaired natural swing at
the hip and knee with leg circumduction.
• Cerebellar ataxia: widened base, unsteadiness and irregularity
of steps, and lateral veering
• Scissors gait: seen in patients with spastic paraplegia, the
features are: rigidity and excessive adduction of the leg in swing.
plantar flexion of the ankle. flexion at the knee. adduction and
internal rotation at the hip
BM, 71/Female came to your clinic because of bipedal edema for 3
weeks, with associated 2 pillow orthopnea and easy fatigability. On
PE, you noted that both of her legs, abdomen and face have edema.
According to the involved area what is the grade of edema of the
patient?
a) 2
b) 1
c) 4
d) 3
3
A 25-year-old female student came to the clinic due to
abdominal pain of one day duration. Which of the following
information is pertinent to be asked and be placed in the
history of present illness of this patient?
A. Presence of intentional weight loss
B. Intake of maintenance medications
C. Changes in the bowel movement
D. The food that she is allergic with
C. Changes in the bowel movement
Which of the following statements is true about BP
measurement?
A. If the brachial artery is 7-8 cm below the heart level, the blood
pressure will read ~ 5 cm lower.
B. Instruct the patient to avoid smoking or drinking coffee for ~ 30
minutes before measuring blood pressure.
C. If the cuff is too small, the blood pressure will read low in a large
arm.
D. BP can be measured in an arm with arteriovenous fistula
Instruct the patient to avoid smoking or drinking coffee for ~ 30
minutes before measuring blood pressure.
Rationale:
• Caffeine and smoking increased BP. With each cigarette, BP
rises transiently and the effect may be missed if BP is measured
30 min after last smoke.
• If below heart level, lower position will result in erroneously
higher systolic and diastolic blood pressure measurements
• Small cuff also increases BP; AV fistula have wide pulse
pressure
A BMI of 23 in a 26/Male Filipino is best classified according to the Asia Pacific classification as? A. Underweight B. Normal C. Overweight D. Obese 1
C. Overweight
A group composed of four 2nd year medical students was
assigned to interview a 70-year-old female, single Filipino
Muslim who was admitted at Quirino Memorial Medical
Center for moderate risk community acquired pneumonia
manifesting as sore throat, dry cough and fever. Based on
how the study done by Dr. Peter Maguire and his colleagues,
the student who is most likely to be likened by the patient upon
starting the interview:
A. Student D who uttered, “Manang, mga estudyante po kami ng
San Beda. Tanungin lang po sana namin kayo? Anong
pangalan po nila? Ilang taon na po kayo? Ay oo nga po pala,
para po pala sa subject namin ito sa medicine.”
B. Student B who told the patient, “Magandang umaga. Ako po si
Student B, mga student doctors po kami ng San Beda
University. Maari ko po ba kayong interview-hin? Ano pong
pangalan nila?”
C. Student C who said, “Ma’am, pasensya na po sa abala. Ma’am
maari ko po naming kayong tanungin para po sa subject naming
Physical Diagnosis sa San Beda College of Medcine? Ma’am,
apat kaming students na mag-interveiw. Bakit po kayo na-admit,
ma’am?”
D. Student A who approached her with “Lola, kumusta po kayo?
Kawawa naman kayo. May I ask po if anong nangyari sa inyo
bakit po kayo naka-confine dito? Pwede pong pakilakasan ang
boses nila”
Student B who told the patient, “Magandang umaga. Ako po si
Student B, mga student doctors po kami ng San Beda
University. Maari ko po ba kayong interview-hin? Ano pong
pangalan nila?”
Which of the following does not belong to the group
A. Did you fall when you felt dizzy?
B. Why have you come to the doctor today?
C. What kind of pain was it?
D. Tell me about your problem
Did you fall when you felt dizzy?
______ are the standards we use to measure our own and
other’s beliefs and behaviors
Values
Clinical communication is defined as the ______ that you
have with others in one’s role as a medical professional,
either with the patients or about patient care.
Interactions
The first step to effective reassurance is to simply identifying
and acknowledging the patient’s _____?
Feelings
According to the WHO, whenever we do hand washing its’
duration should be ____ to ___ seconds
40 - 60
Patient-centered communication is providing care that is
respectful of and responsive to the individual patient’s _____,
needs and values and ensuring the patient’s values guide all
clinical decisions
Preferences
