Physical exams

Question 1

56 Htz tuning fork on patient forehead

Answer 1

Weber test

Question 2

Weber test

Answer 2

tests whether bone conduction lateralizes to either ear

Question 3

Rinne test

Answer 3

bone conduction vs. air conduction

Question 4

base of tuning fork put over mastoid process until pt can’t hear via bone conduction then without restriking fork–hold 1-2 cm from ear canal until pt can no longer hear fork

Answer 4

Rinne test

Question 5

DDx

Answer 5

differential diagnosis–driven by H & P

Question 6

DDx

Answer 6

mental list of diseases

Question 7

CC

Answer 7

chief complain–reason for visit–important along with History of Present Illness

Question 8

PMH

Answer 8

Past Medical History

Question 9

Tay-Sachs disease

Answer 9

1:30 ashkenazi jews carrier–neurodegenerative disorder.

Question 10

Drives interview

Answer 10

CC and recognition of commo signs and symptoms

Question 11

Prioritizing DDx leads to…

Answer 11

Though exercise leading to:

1. leading hypothesis
2. active alternative hypotheses
3. must not miss hypotheses

Question 12

Assessment for first time visit

Answer 12

comprehensive assessment vs focused assessment

Question 13

focused assessment aka

Answer 13

problem-oriented assessment

Question 14

Restructure pt. history and CC into

Answer 14

oral presentation and written record

Question 15

Identifying Data

Answer 15

age, gender, marital status, and occupation

Question 16

Reliability

Answer 16

if relevant at end of interview–reflects quality of information

Question 17

Chief Complaint(s) CC

Answer 17

use pt’s own words

Question 18

Present Illness

Answer 18

pt’s history in chronological order

Onset of problem, setting of development, manifestations, and treatments

Question 19

Details about each symptom

Answer 19

1. location 2. quality 3. quantity or severity 4. timing (onset, duration, frequency) 5. setting where it occurs 6. aggravating/ relieving factors 7. associated manifestations

Question 20

Most likely diagnoses explaining the pt’s condition

Answer 20

differential diagnosis

Question 21

tobacco reported in

Answer 21

pack-years – 1 pack/day for 12 years = 12-pack-year history

Question 22

Childhood illness section

Answer 22

past history– any and all chronic or acute childhood illnesses

Question 23

ADLs

Answer 23

activities of daily living

Question 24

Review of system questions

Answer 24

General, Skin, HEENT, Neck, Breasts, Respiratory, Cardiovascular, Gastrointestinal, Peripheral Vascular, Urinary, Genital, Musculoskeletal, Psychiatric, Neurologic, Hematologic, Endocrine

Question 25

weakness is

Answer 25

different from fatigue--may indicate neuropathy or myopathy if localized in neuroanatomical pattern

Question 26

recurrent shaking and chills suggest

Answer 26

extreme swings in temperature and systemic bacteremia

Question 27

feeling hot and sweating may accompany

Answer 27

menopause, tuberculosis, and malignancy

Question 28

weight loss with relatively high food intake suggests

Answer 28

diabetes mellitus, hyperthyroidism, or malabsorption--consider bulimia

Question 29

eye exam--outside of eye

Answer 29

make sure not yellow from jaundice or red from conjunctivitis

Question 30

observation of back of eye

Answer 30

fundescopic exam--turn down lights to dilate pupils--numbers: 0 means no refractive correction. turn light up all the way. Angle scope nasaly to view nerve.

Question 31

fundescopic exam irregularities

Answer 31

Optic nerve papiladema--margins of nerve will be blurred--spots of blood surrounding nerve

Question 32

inflate BP cuff initially to

Answer 32

180 mm Hg

Question 33

When taking BP listen for

Answer 33

1st and last korotkoff sound--record what we hear not what we see-- first sound / last sound

Question 34

width of BP cuff bladder should be

Answer 34

about 40% of upper arm circumference

Question 35

If cuff is too narrow BP will be read

Answer 35

too high

Question 36

if heart rate is normal when taking pulse

Answer 36

count rate for 30 seconds

Question 37

If heart rate is unusually fast or slow count for

Answer 37

60 seconds

Question 38

normal heart rate/ pulse

Answer 38

50-90 bpm

Question 39

short, fine, inconspicuous, and relatively unpigmented hair

Answer 39

villus hair

Question 40

course, thick, more conspicuous, pigmented hair--scalp and eyebrows

Answer 40

terminal hair

Question 41

Norma angle between lateral nail folds and nail plate

Answer 41

less than 180 degrees

Question 42

two types of sweat glands in humans

Answer 42

eccrine glands--widely distributed | apocrine glands--axillary and genital

Question 43

Early recognition of possible melanoma

Answer 43

Asymmetry irregular Borders (ragged/notched) variagation in Color (esp. blue/black w/ white) Diameter >6 mm Evolution (in size, symptoms, morphology)

Question 44

80% of skin cancers, consists of immature cells similar to basal layer of epidermis, sun-exposed areas

Answer 44

basal cell carcinoma

Question 45

skin cancer consisting of more mature cells usually resembling the spinous layer of epidermis, 16% of cases--crusted lesions with rough surfaces or flat reddish patches with inflamed or ulcerated appearance

Answer 45

squamous cell carcinoma

Question 46

4% of skin cancers--potentially most lethal--can spread quickly to lymph system and internal organs

Answer 46

melanoma

Question 47

Melanoma Risk model

Answer 47

``` HARMM History of melanoma Age over 50 Regular dermatologist absent Mole changing Male gender ```

Question 48

imp life threatening differential diagnosis of headache

Answer 48

meningitis, subarachnoid hemorrhage, mass lesion,

Question 49

indications of diplopia

Answer 49

brainstem or cerebellum lesion, weakness/paralysis of one or more extraocular muscles.

Question 50

POAG

Answer 50

primary open-angle glaucoma--leading cause of blindness in African Americans and second overall

Question 51

primary open-angel glaucoma

Answer 51

gradual loss of vision due to loss of retinal ganglion cell axons--risk factors: AA descent, diabetes, myopia, and ocular hypertension

Question 52

IOP

Answer 52

intraocular pressure

Question 53

spasmodic or rhythmic contraction of the pupil

Answer 53

hippus--symptom of some neurological conditions

Question 54

something the pt explains abt

Answer 54

symptom

Question 55

something the provider observes

Answer 55

sign

Question 56

comprehensive encounter vs

Answer 56

problem specific encounter

Question 57

ID

Answer 57

identifying data

Question 58

everything is driven by the

Answer 58

history

Question 59

CC drives

Answer 59

physical exam

Question 60

CC + PE + History drives

Answer 60

DDx