MEDSURG ENHANCEMENT Flashcards
Tiny red or purple hemorrhagic spots appearing in clusters, may be a sign of thrombocytopenia.
a. Petechiae
b. Ecchymosis
c. Jaundice
d. Bruise
a. Petechiae (Small, nonblanching; <2mm)
Bluish-purple to greenish-yellow bruising or bleeding under the skin often caused by trauma:
a. Petechiae
b. Ecchymosis
c. Jaundice
d. Bruise
b. Ecchymosis (Ruptured BVs; >1cm)
Cerebellar pathology: rhythmic oscillations of the head; axial movement of the trunk
a. Resting tremor
b. Titubation
c. Nystagmus
d. Rebound phenomenon
b. Titubation
Basal ganglia pathology: sustained involuntary contractions of agonist and antagonist muscles
a. Cogwheel rigidity
b. Hyperkinesis
c. Dystonia
d. Dyssynergia
c. Dystonia
Pathway responsible for discriminative sensations, precise localization, and fine intensity gradations.
a. Dorsal column-medial lemniscal
b. Anterolateral spinothalamic
c. Corticospinal
d. Rubrospinal
a. Dorsal column-medial lemniscal
Hormone in charge for fight or flight response:
a. Adrenaline
b. Glucagon
c. Insulin
d. Acetylcholine
a. Adrenaline
**Acetylcholine - Parasympathetic
Pain medication recommended for peptic ulcer
a. Ibuprofen
b. Ketorolac
c. Aspirin
d. Diclofenac
b. Ketorolac
An acute bacterial (often streptococcus) or viral infection that spreads throughout the system; red streaks are often seen in skin proximal to infection site
a. Generalized lymphadenopathy
b. Secondary lymphadenopathy
c. Lymphadenitis
d. Lymphangitis
d. Lymphangitis
Which of the following is a leukotriene receptor blocker?
a. Alprostadil
b. Aspirin
c. Montelukast
d. Ibuprofen
c. Montelukast
**Leukotriene receptor blocker - released by mast cells during asthma attack causing bronchoconstriction
Severe headache for almost 2 hours followed by a sudden loss of consciousness
a. Subarachnoid hemorrhage
b. Viral encephalitis
c. Migraine
d. Brain tumor
a. Subarachnoid hemorrhage (Severe headache + “sudden loss of consciousness”)
Severe headache with photosensitivity, neck stiffness, and abrupt onset of symptoms
a. Subarachnoid hemorrhage
b. Viral encephalitis
c. Migraine
d. Brain tumor
b. Viral encephalitis (Severe headache + “photosensitivity”)
What is the most common indirect cause of TBI?
a. Drugs
b. Alcohol
c. Cigarette smoking
d. Poisonous food
b. Alcohol
If you are rubbing a salt to stimulate the taste receptors, you increase the sensitivity of sweetness. This principle is known as:
a. Simultaneous contract
b. Accommodation
c. Compensation
d. Successive contrast
d. Successive contrast (**Eat sweet then sour food, sourness intensifies)
Noradrenergic receptors are found in the:
a. Substantia nigra
b. Median Raphe nucleus
c. Locus Coeruleus
d. Cerebellar peduncle
c. Locus Coeruleus
**Substantia nigra - Dopamine
**Median Raphe nucleus - Serotonin
Ability to see in the dark
a. Dark adaptation
b. Light Adaptation
c. Dark vision
d. Light vision
a. Dark adaptation
**Light Adaptation - adjustment to bright light after exposure to dim light
Lesion to the third frontal convolution will result to the following, except:
a. Broca’s aphasia
b. Non-fluent speech with good comprehension
c. Poor repetition, naming, writing and reading comprehension
d. All of these
e. None of these
c. Poor repetition, naming, writing and reading comprehension (Global Aphasia)
Fetal movement begins to be felt by:
a. 16th week of gestation
b. 20th week of gestation
c. 22nd week of gestation
d. 24th week of gestation
a. 16th week of gestation
During early phase of rehabilitation of a patient post-right total hip arthroplasty, posterolateral approach, precautions for the following exercises are necessary, EXCEPT FOR:
I. Crossed-leg sitting
II. Ascending stairs with the right leg leading
III. Single-leg standing on the (R) lower extremity
IV. Bending the trunk forward to tie shoes
a. All of the allowed
b. I, II, III
c. IV only
d. All of these
d. All of these (All are contraindications)
In a patient with pituitary adenoma, the mass may put pressure in all of the following structures, EXCEPT:
a. optic nerve compression
b. cranial nerves for extraocular eye movements
c. optic chiasm
d. internal carotid artery
e. NOTA
e. NOTA
Criteria for hip osteoarthritis, except:
a. Pain on internal rotation
b. Hip internal rotation ≥ 15°
c. morning stiffness ≥ 60mins
d. age > 50years
c. morning stiffness ≥ 60mins
**<60 mins; 30 mins
A 6-year-old woman presents for a routine exam at a doctor’s office. She stands up several times during the visit to check herself in the mirror and asks if her new dress is pretty. On exam, she is wearing revealing clothing and jumps up dramatically, yelling that the stethoscope is “too cold”. At the end of the visit, she starts tearing up and says that no doctor has even been so attentive previously. You suspect that the patient has:
a. Narcissistic personality disorder
b. Obsessive-compulsive personality disorder (OCPD)
c. Histrionic personality
d. Factitious disorder
c. Histrionic personality
**Colorful, dramatic, flamboyant (attention seeker), sexually seductive and provocative
Cluster A: Odd and Eccentric (P.S.S: Paranoid, Schizoid, Schizotypal); Psychotic Disorder
Cluster B: Emotional and Erratic (B.A.H.N: Borderline, Anti-social, Histrionic, Narcissistic); Mood Disorder
Cluster C: Fearful and Anxious (O.D.A: OCPD, Dependent, Avoidant); Anxiety Disorder
A 15-year-old girl presents for a routine appointment. She describes problems at school with social situations, wanting to sit in with the popular crowd and be thinner. She struggles to lose weight but describes feeling out of control with food for the past 6 months, where she eats large amounts of food, such as an entire pizza and a gallon of ice cream. She quickly feels guilty afterward, and then makes herself throw up by sticking her fingers down her throat. These episodes occur at least 2-3 times per week. Her vital signs are normal, her height is 5 feet 2 inches, and she weighs 135 pounds. Her BMI is 27.5. She has sialadenosis (salivary gland
enlargement), dental caries, and abrasion on the dorsum of her right hand (Russell’s sign). You suspect that the patient has:
a. Binge eating disorder
b. Bulimia nervosa
c. Anorexia nervosa
d. Avoidant restrictive food
disorder
b. Bulimia nervosa
A 43-year-old man is seen in the clinic after making a scene in the waiting room after being asked to wait 10 minutes for his appointment. He is annoyed that he had to wait while “regular people got to see the doctor”. He explains that he has a “very important job” and should not have to wait at all for his appointment as it is very burdensome to leave his job even for a few minutes. He explains that he got his job due to his “superior intellect” and “unprecedented business acumen”. He explains that he is “constantly needed” at his work and that his coworkers are jealous of his superiority. Physical findings are normal. You suspect that the patient has:
a. Superiority complex disorder
b. Obsessive-compulsive
personality disorder (OCPD)
c. Narcissistic personality disorder
d. Histrionic disorder
c. Narcissistic personality disorder
(Heightened sense of self importance)
A 27-year-old wheelchair-bound woman comes to the hospital for six days of leg weakness. Four years ago, she had a traumatic stillbirth and since then has had difficulty walking. She has seen six neurologists, and none can give a physiological reason for her weakness. She worries that doctors may think she is taking her symptoms because nothing on the repeated examinations explains her weakness. She says that she would love to walk so she can travel by airplane to be there for her sister who just gave birth to her first son. On exam, she is sitting comfortably in a wheelchair, is smiling, and seems unaffected by her condition. Her weakness is lessened when distracted. You suspect that the
patient has:
a. Factitious disorder
b. Conversion disorder
c. Generalize anxiety disorder
d. Conduct disorder
b. Conversion disorder (Functional neurological symptom disorder)
A 54-year-old woman presents for a routine exam. She states that it has taken 2 years to find a doctor because she was looking for someone who met a list of her criteria, which included making sure the doctor’s medical school was in a state that did not have a
death penalty. She is an attorney and explains that she has been staying late at the office every night because she does not trust
that her staff can format her work in the best way or proofread her documents as well as she can. She reports not engaging in social
activities or hobbies as her reports “could always be made a little bit better”. She has missed some work deadlines as her reports were “not quite right yet”.
a. Superiority complex disorder
b. Obsessive-compulsive personality disorder (OCPD)
c. Narcissistic personality disorder
d. Histrionic disorder
b. Obsessive-compulsive personality disorder (OCPD)
**OCPD Cycle - Obsessions > Anxiety > Compulsion > Relief
A 45-year-old woman without past medical history presents to the emergency room with confusion, dizziness, sweating, “shakiness,” and blurred vision. She denies any alcohol or illicit drug use. She is subsequently admitted to the medical service for severe hypoglycemia. On physical exam, she is tachycardic and hypertensive. She has pale skin with needle marks and is diaphoretic, tremulous, and anxious. You suspect that the patient has:
a. Conversion disorder
b. Histrionic disorder
c. Factitious disorder
d. Malingering
c. Factitious disorder
**Malingering - (+) Obvious external gain; not a psychiatric condition
**Factitious d/o imposed by self: “Munchausen syndrome”; no external gain; (+) internal gain: attention, coping c stress
**Factitious d/o by proxy: uses another individual
**Anxiety Rx: SSRIs (Flouxetine), Benzodiazepine (Most rapid action, no tolerance; Clonazepam, Lorazepam, Diazepam), Tricyclic + Tetracyclic (Clomipramine, Imipramine, Desipramine)
A 37-year-old woman presents for a routine exam. She reports that she was recently arrested for shoplifting cosmetics. She states that her boyfriend “blew up at her” for getting arrested again. She says “I should just kill myself. That will show him!”. She admits that he sometimes physically abuses her, but she stays with him because no one else cares about her. At the end of the visit, she thanks the doctor profusely for being so much better
than the last doctor… and angrily states, “He didn’t care about me at all!”. She is talkative, but all other physical findings are normal. You suspect that the patient has:
a. Generalized anxiety disorder
b. Antisocial personality disorder
c. Post-traumatic stress disorder
d. Borderline personality disorder
d. Borderline personality disorder
A 33-year-old woman presents with worry about an upcoming flight. The patient states she has to fly to her sister’s wedding and is terrified. She has tried to visit her sister three other times in the past, but she has panicked right before takeoff and gotten off the plane. On physical exam she has a euthymic affect but is in notable distress when talking about flying. It means that the patient has:
a. Post-traumatic stress disorder
b. Histrionic disorder
c. Specific phobia
d. Factitious disorder
c. Specific phobia
**Within 6 months
A 24-year-old man presents to urgent care following a physical encounter with a neighbor. He states that the neighbor “looked at him too many times” and “deserves what he got”. He then states, “I didn’t hurt him as bad as the guy last month; he was in the hospital for a week!”. He smiles during the entire encounter and is eager to share more
details. On review of his chart, it is noted that the animal humane society was called in the past due to concern for abuse of his pet dog. When he was 15, he spent the night in jail after assaulting a peer, which he happily discusses. Physical exam findings are normal. This patient has:
a. Antisocial personality disorder
b. Bipolar disorder type 1
c. Bipolar disorder type 2
d. Conduct disorder
a. Antisocial personality disorder
A 26-year-old man presents with anxiety. He is concerned about how his anxiety is impacting his performance at a high-pressure job. He worries that people are judging his work poorly, despite never having a bad job performance evaluation. He also is concerned about his boyfriend’s health, worrying that he will crash his car or become sick. The worrying impacts his efficiency and concentration at work, but he still functions well in his job despite it being so distressful. He also reports fatigue, difficulty sleeping due to worry, and muscle tensions. At times of increased stress, he notes nausea, diarrhea, and increased sweating. This has been going on since college, but it has gotten worse since starting this job 2 years ago. On physical exam, his affect is anxious at times but otherwise normal. Patient has:
a. Major depressive disorder
b. Specific phobia
c. Generalized anxiety disorder
d. Paranoid
c. Generalized anxiety disorder
**MC
**Adult: 3 or > sx
**Child: 1 sx
A 21-year-old man presents for a work physical exam. He is doing a work-from-home job because his last job required him to “interact with too many people”. He is quiet and only answers direct questions. He has been living in his mother’s basement and his mother states that he stays in the basement around 22 hours per day. He is not sexually active, and does not “have much of a social life,” but reports being content with his space and is satisfied with the work that he does. He is quiet, has a restricted affect, but other physical exam findings are normal.
a. Laid back personality disorder
b. Borderline personality
disorder
c. Depressive personality
disorder
d. Schizoid personality disorder
d. Schizoid personality disorder (Detachment)
A 26-year-old man is referred to his dermatologist for severely chapped skin on his hands bilaterally. He reports vigorously washing his hands in scalding hot water dozens of times daily in response to uncontrollable and intrusive fears that his hands are dirty and contaminated. He realizes this is unrealistic but feels a great deal of anxiety when he is unable to wash them. These difficulties have occurred for many years, but he was recently encouraged to seek help because it has affected his work as a waiter. On physical exam, he has erythematous, chapped hands bilaterally and is anxious appearing. This patient is probably suffering from:
a. Obsessive compulsive disorder (OCD)
b. Obsessive compulsive personality disorder (OCPD)
c. Generalized anxiety disorder
d. Panic disorder
a. Obsessive compulsive disorder (OCD)
A 25-year-old man who was recently discharged from the military presents with nightmares for the past 3 months. He states that he watched a tank get blown up by an improvised explosive device, and one of his friends who was on the tank died. He reports often thinking about this event in places where it “sneaks up on him”, sometimes at work or at church. He also describes being on edge and is easily startled by loud noises, and he feels guilty that he survived while his friends didn’t. The patient has:
a. Borderline personality disorder
b. Post-traumatic stress disorder
c. Compulsive behavior
d. Bipolar disorder
b. Post-traumatic stress disorder
A 35-year-old woman presents with chest pain. She states that it started about 2 hours ago while she was on the phone with her
sister. She had sudden onset of chest pain, heart palpitation, shortness of breath, numbness/tingling around mouth and on tips of anger, and a sense of impending doom. He symptoms lasted for 20 minutes before resolving. This is her fourth presentation with the same cluster of symptoms in the last 5 months. Despite previous evaluations and reassurances, she remains concerned about these symptoms. You suspect that the patient has:
a. Generalized phobia
b. Specific phobia
c. Panic disorders
d. Generalized anxiety disorder
c. Panic disorders
A 45-year-old woman presents with 4 weeks of feeling very sad and hopeless about the future. She reports that she used to walk her dog every day, but lately she hasn’t been feeling up to it. She thinks this may be because she has been having trouble sleeping through the night. She says that she has no energy to take care of her house of family, but even if she did have the energy, she doesn’t think it would make any difference. She denies suicidal ideation or plan. On physical exam, she has had a 15-pound weight loss since her last visit. She has slow speech and does not make eye contact.
a. Generalized anxiety disorder
b. Major depressive disorder
c. Bipolar disorder
d. Schizophrenic disorder
b. Major depressive disorder
**MAO Inhibitor (Isocarboxazid)
A 24-year-old man presents with 2 weeks of irritability and uncontrolled energy. He reports that he has recently become aware that he has been chosen by God to be the next great poker champion. He is proud that he has been training for 22 hours a day, requiring little sleep. He reports that he has had to take a break from practicing in the casino as he lost all of his earning last weekend but reports that he has a plan on how to win it all back so he can earn his title. On physical exam, he is pacing around the room, has very quick speech, and is hyperverbal and distractible. Patient has:
a. Schizophrenia
b. Bipolar disorder type 1
c. Paranoia
d. Major depressive disorder
b. Bipolar disorder type 1
**Manic episode: atleast 1-week
**Depressed episode: atleast 2-weeks
**Rx: Lithium carbonate (Prototypical mood stabilizer), Valproic acid (Deparene), Carbamazepine + Lamotrigine
**Bipolar disorder type 2 - hypomanic (4 days), MDD (atleast 2-weeks)
A 6-year-old boy is referred for evaluation after displaying unruly behavior in school. His teachers report that he often makes careless mistakes; submits incomplete, sloppy homework; speaks out of turn; and gets out of his seat without permission. The boy’s mother notes he does not listen at home and is always running around. He has trouble following routines, like getting ready for school in the morning. Exam reveals fidgety and social disinhibited behavior, with poor concentration, and loud, rapid speech.
a. Autism spectrum disorder (ASD)
b. Conduct disorder
c. Attention- deficit/hyperactivity disorder (ADHD)
d. Dissociative identity disorder
c. Attention- deficit/hyperactivity disorder (ADHD)
A 28-year-old man presents with suicidal thoughts for the last 2 weeks. Patient states that voices have been telling him to “kill himself” and “finish it”. He believes that these voices are part of a conspiracy at work to get him to leave his job. According to him, he first noticed his coworkers were starting to plot against him 7 months ago when they started to blame him to work that wasn’t done. He started to hear voices 2 months after that. He has also been feeling very sad since the voices started and now feels depressed most days. Two weeks ago, he started to seriously think about suicide and developed a plan to hang himself but then decided to come seek help. On physical exam, he has restricted affect and is fearful at times. He has suicidal ideation, auditory hallucinations, and appears to be responding to internal stimuli (looks over his shoulder, saying “Stop”). Patient is most likely suffering from:
a. Schizophrenia
b. Major bipolar disorder
c. Minor bipolar disorder
d. Schizoaffective disorder
d. Schizoaffective disorder
A 3-year-old boy’s mother says he has failed to say any coherent words causing worry for speech delay. The child also does not reciprocate affection, such as hugging her back. Regarding his behavior, she has noticed that he constantly lines up his trains and examines their wheels intently and becomes easily agitated with changes in routine. On exam, he does not respond to questioning and exhibits limited eye contact and occasionally rocks back and forth while seated. You suspect that these are signs of:
a. Autism spectrum disorder (ASD)
b. Conduct disorder
c. Attention- deficit/hyperactivity disorder (ADHD)
d. Dissociative identity disorder
a. Autism spectrum disorder (ASD)
A 21-year-old man presents with 2 months of paranoia and odd behavior. He reports that someone planted a microchip in his brain and his thoughts are being intercepted. He hears their voices for most of the day and believes the voices are CIA officers. His family reports that the odd behavior started 7 months ago, which they thought was due to school stress. On physical exam, he is paranoid, disheveled, malodorous, nervous, and has flat affect. His thoughts are illogical and disorganized with thought blocking. Patient has:
a. Schizophrenia
b. Major bipolar disorder
c. Paranoid disorder
d. Schizoaffective disorder
a. Schizophrenia
**Schizophrenia - “Dementia Precox”; Rx: Antipsychotics (Dopamine receptor antagonist)
**Typical antipsychotic: Haloperidol, Chlorpromazine
**Atypical antipsychotic: Serotonin, Dopamine antagonist (Ex: Risperidone, Olanzapine, Quetiapine)
**Intramuscular: Flophenazine, Flopentixol
