Post-midterm beyonce slides

Question 1

1) Colicky (comes and goes) pain located in the RUQ that radiates to the back is often ____________.
2) Constant burning and stabbing pain in the LUQ/epigastrium that cuts to the back is often ______________.
3) Colicky aching pain in the flank that radiates to the groin is often __________________.

Answer 1

1) gallbladder
2) pancreatitis
3) renal/ureteral calculus

Question 2

1) Pain that begins at the umbilicus and localizes later to the RLQ, becoming more intense, is often ______________.
2) Unilateral lower quadrant pain that is tearing and increasing in intensity can be __________________
3) Suprapubic pain with burning dysuria and frequency is often ______________.

Answer 2

1) appendicitis
2) ectopic pregnancy
3) cystitis

Question 3

1) Left lower quadrant pain with bloody stools in the elderly is often ______________
2) Burning pain in the epigastrium without radiation is often ________________ and sometimes ________________

Answer 3

1) diverticulitis
2) gastritis and sometimes MI (watch out)

Question 4

1) Difficulty swallowing, painful swallowing can indicate what two things?
2) Vomiting blood is indicative of what?
3) “Coffee ground consistency” of vomitus is often what?

Answer 4

1) GERD, Cancer
2) Cancer, esophageal varices, Malory Weis tear
3) Digested blood

Question 5

1) Define hematochezia
2) Dark-tarry stool (melena) is often what? What part of the GI is this?

Answer 5

1) Blood in stool
2) Slow and chronic bleed; probably will be lower GI, but occasionally slow “upper GI”

Question 6

1) Bright red blood on TP is often what?
2) Bright red blood filling the toilet can be what two things?

Answer 6

1) Hemorrhoids
2) Inflammatory bowel disease, cancer

Question 7

1) What can jaundice indicate?
2) What can recurrent diarrhea indicate?

Answer 7

1) Liver dysfunction
2) Inflammatory bowel disease, irritable bowel syndrome, c. difficile, malabsorption, medicines (antibiotics)

Question 8

1) What can recurrent vomiting indicate?
2) What can recurrent constipation indicate?

Answer 8

1) Ulcer, gastritis, GERD
2) Irritable bowel syndrome, hypothyroid, anticholinergic meds

Question 9

1) Dark stool can indicate what?
2) What about pencil thin stool?
3) What about gray and soft stools?

Answer 9

1) Lower GI bleed
2) Colon cancer
3) Pancreatic cancer

Question 10

1) What can bloody urine indicate?
2) What 3 things can dark urine indicate?
3) What can pain with fever, chills, sweats, shakes indicate? Give examples

Answer 10

1) Bladder cancer
2) Renal disease, hematuria, rhabdomyolysis
3) Infectious process: Pyelonephritis, appy, intraabdominal abscess, possible perforation

Question 11

List 10 red flags for the abdominal region

Answer 11

1) Pain (many different kinds can be red flags)
2) Difficulty swallowing, painful swallowing
3) Vomiting blood
4) Blood in the stool (hematochezia)
5) Jaundice
6) Recurrent vomiting, diarrhea, or constipation
7) Change in stool consistency or color
8) Bloody urine
9) Dark urine
10) Pain with fever, chills, sweats, shakes

Question 12

What are the risk factors for abdominal aortic aneurysm?

Answer 12

Male, over 65, a smoker
*and having 1st degree relative with hx of AAA repair

Question 13

1) Define guarding
2) What must guarding be in order to count?

Answer 13

1) A voluntary contraction of the abdominal wall, often accompanied by a grimace that may diminish when the patient is distracted.
2) Severe

Question 14

1) Define rigidity. What causes it?
2) Define rebound tenderness
3) How do you assess rebound tenderness? When is the maneuver positive? What should you then do?

Answer 14

1) An involuntary reflex contraction of the abdominal wall from peritoneal inflammation that persists over several examinations.
2) Rebound tenderness refers to pain expressed by the patient after the examiner presses down on an area of tenderness and suddenly removes the hand.
3) Ask the patient “Which hurts more, when I press or let go?” Press down with your fingers firmly and slowly, then withdraw your hand quickly.
-The maneuver is positive if withdrawal produces pain.
-Percuss gently to check for percussion tenderness.

Question 15

What are the 3 signs of peritonitis?

Answer 15

1) Guarding
2) Rigidity
3) Rebound tenderness

Question 16

1) What do the 3 signs of peritonitis say about its likelihood?
2) What causes peritonitis?
3) Give 4 examples of these causes

Answer 16

1) Double the likelihood of peritonitis
2) Disease that has spread to inflame the peritoneum
3) Appendicitis (esp. if ruptured), advanced cholecystitis, perforated bowel wall, abscess

Question 17

List 4 red flag symptoms of joint pain

Answer 17

1) Acute onset
2) Redness
3) Pain
4) Fever

Question 18

List 2 causes of joint pain

Answer 18

1) Septic arthritis (infection)
2) Crystalline arthropathy (ex: gout, pseudogout)

Question 19

1) What age range is a red flag w low back pain?
2) What histories are red flags w low back pain?
3) What symptoms are red flags?
4) When is pain a red flag?

Answer 19

1) Age < 20 (also be very suspicious of ongoing joint/bone pain in any pediatric patient)
2) Cancer or HIV, immunosuppression
3) Unexplained weight loss, fever, general decline
4) > 1 month – refractory to treatment

Question 20

1) What is a risk of IV drug use with low back pain?
2) What other drugs are red flags with low back pain?

Answer 20

1) Spinal abscess
2) Immunosuppression, and long-term steroid therapy

Question 21

1) What symptoms of cauda equina syndrome should you look out for with low back pain?
2) What neurologic symptoms are red flags w low back pain?

Answer 21

1) Saddle anesthesia, bladder or bowel incontinence/loss of function
2) Severe neurologic symptoms or progressive deficit

Question 22

What symptoms should you always ask abt with low back pain?

Answer 22

Saddle anesthesia, bladder or bowel incontinence/loss of function

Question 23

Weight-bearing physical activity, especially in females, starting early, is important why?

Answer 23

Build up mass to protect against bone/muscle loss

Question 24

Discuss ___________ scan in your elderly patients to measure bone density, especially in female population.

Answer 24

DEXA

Question 25

1) Hip fracture is correlated with mortality within ____________ in geriatric population
2) What should you ask fall risk patients to do?

Answer 25

1) 5 years
2) Get the rugs out of the house and put a bell on the little dog or cat

Question 26

1) Where is rheumatoid arthritis often located?
2) What about osteoarthritis?
3) What do they have in common?

Answer 26

1) Hands; initially small joints (PIP and MCP joints).
2) Knees, hips, hands (distal, sometimes PIP joints).
3) Both chronic and progressive

Question 27

What are the 5 shoulder special tests? What does each test test?

Answer 27

1) Neer impingement sign: rotator cuff tendons
2) Hawkins impingement sign: rotator cuff tendons
3) Empty can test: strength testing /rotator cuff tear
4) Drop arm test: strength testing / rotator cuff tear
5) Internal and external rotation: also tests rotator cuff tear

Question 28

Lateral epicondylitis is also called _________________ and medial epicondylitis is also called __________________

Answer 28

tennis elbow; golfer’s elbow

Question 29

1) What are the clinical features of carpal tunnel? Be specific.
2) When does carpal tunnel often occur?
3) Patients also experience loss of sensation in distribution of the ____________ nerve
4) What does this nerve innervate?

Answer 29

1) Pain or numbness on the first three fingers of the hand
2) At night
3) Patients also experience loss of sensation in medial nerve
4) Palmar surface of thumb, index, middle, and medial 4th fingers

Question 30

1) What is Tinel’s sign?
2) What is Phalen’s sign?

Answer 30

1) Tingling with tapping over the median nerve as it enters the carpal tunnel
2) Numbness or tingling with pressing backs of hands together in acute flexion for 60 seconds

Question 31

List the 7 red flags for the vascular system

Answer 31

1) Abdominal AND back pain
2) Pain with eating or “food fear”
3) Intermittent claudication
4) Cold, numbness, pallor, and hair loss in the legs
5) Swelling in the calves, legs, or feet
-May be unilat or bilat
6) Color change in fingertips or toes in cold weather
7) Swelling with redness or tenderness

Question 32

1) What can food fear be a sign of? Why?
2) Describe intermittent claudication and what condition it can be a sign of
3) What can coldness, numbness, pallor, and hair loss in the legs be a sign of?

Answer 32

1) Chronic mesenteric ischemia or other incomplete occlusion; when you eat more, there’s increased blood demand, causing painful incomplete ischemia
2) Peripheral arterial disease; when you flex muscles and move around, tissues need more circulation, hurts bc of ischemia
3) Peripheral arterial disease (chronic ischemia)

Question 33

1) What can swelling in the calves, legs, or feet be a sign of when it’s bilateral?
2) What about when unilateral?

Answer 33

1) Both sides, esp when red and hot = HF
2) One side = DVT

Question 34

Color change in fingertips or toes in cold weather is a sign of what?

Answer 34

Raynaud’s

Question 35

1) Is AAA bad?
2) What may it be on an abdominal exam?
3) What should you not do?

Answer 35

1) A very bad badness
2) May even be pulsatile on abdominal exam
3) Do not compress or deeply palpate a pulsatile abdominal mass

Question 36

What should you not compress or deeply palpate?

Answer 36

A pulsatile abdominal mass

Question 37

1) What are the two types of mesenteric ischemia?
2) When is there pain but not bowel death?
3) What is an associated symptom of this disease?
4) What is necrosis associated with?

Answer 37

1) Acute or chronic
2) In the chronic case
3) “Food fear”
4) An acute disease

Question 38

1) What does venous insufficiency do to lower extremities?
2) What does it do to the skin?
3) What type of laceration can it cause? Over what bone in particular?

Answer 38

1) Swelling in lower extremity
2) Chronic skin changes
3) Distal, nonhealing, wet ulcers (esp. over medial malleolus bc of great saphenous vein)

Question 39

1) What characterizes DVTs?
2) Where can it also occur?
3) What key question should you ask?

Answer 39

1) One-sided redness swelling and pain, usually in the calf
2) Although they can occur in the upper extremity
3) About SOB (bc DVTs turn into PEs)

Question 40

What 3 things should you screen for regarding vascular?

Answer 40

1) AAA
2) PAD
3) ABIs

Question 41

1) What demographic is most likely to have AAA?
2) What demographic is most likely to have PAD?
3) What should you obtain when PAD is suspected?

Answer 41

1) 65, male, smoker
2) 65 (*or 50 with smoking or DM)
3) ABI

Question 42

Name 2 characteristics of PAD

Answer 42

1) Leg claudication with exertion
2) Nonhealing (dry) wounds

Question 43

1) What is ABI?
2) What should it be more than?

Answer 43

1) Highest ankle pressure/ highest arm pressure
2) 0.9

Question 44

1) Acute, unilateral loss of sensation should be concerning first and foremost for what?
2) What 3 symptoms can occur with some focal seizures or with atypical migraine?
3) What is correlated heavily with advanced and uncontrolled diabetes?

Answer 44

1) Stroke
2) Numbness, tingling, and paresthesia
3) Distal, chronic, and bilateral sensation loss

Question 45

1) Stroke is characterized by what kind of sensation loss?
2) What 2 conditions are associated with numbness, tingling, or paresthesia?

Answer 45

1) Acute, unilateral
2) Some focal seizures or with atypical migraine

Question 46

1) What can cause syncope? What is key?
2) Give examples of potential causes

Answer 46

1) Can be varied; details are key.
2) Vasovagal response, orthostatic hypotension, mechanical cardiac failure, arrhythmia, the (rare) central nervous cause, sudden PE, electrolyte imbalance, blood sugar imbalance, psychogenic cause

Question 47

List 8 potential causes of syncope

Answer 47

1) Vasovagal response
2) Orthostatic hypotension
3) Mechanical cardiac failure
4) Arrhythmia, the (rare) central nervous cause
5) Sudden PE
6) Electrolyte imbalance
7) Blood sugar imbalance
8) Psychogenic cause

Question 48

What is the mnemonic to remember the warning signs/ symptoms of a stroke? (according to AHA/ ASA)

Answer 48

FAST
1) Face Drooping: Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
2) Arm Weakness: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
3) Speech Difficulty: Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like “The sky is blue.” Is the sentence repeated correctly?
4) Time to call 9-1-: if someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately.
-Check the time so you’ll know when the first symptoms appeared

Question 49

1) Where is the biceps reflex?
2) How is it tested?

Answer 49

1) C5,C6
2) Elbow flexed, forearm pronated, thumb or finger over biceps tendon

Question 50

1) Where is the triceps reflex?
2) Where is the brachioradialis reflex?
2) How is the brachioradialis tested?

Answer 50

1) C6,C7
2) C5,C6
3) Rest hand on abdomen or lap, forearm slightly pronated, strike 1-2 in above the wrist

Question 51

1) Where are the quadriceps or patellar reflexes?
2) Where are the Achilles or ankle reflexes?
3) How are Achilles/ ankle reflexes tested?

Answer 51

1) L2 - L4
2) Primarily S1)
3) Dorsiflex the foot and strike

Question 53

1) What is the C2 dermatome?
2) What is the C3 dermatome?

Answer 53

1) Ear and upper neck
2) Bottom of neck and clavicle to shoulder both anterior and posterior

Question 54

What is the T10 dermatome?

Answer 54

Umbilical

Question 55

What is the L1 dermatome?

Answer 55

Inguinal (“bikini” line)

Question 56

What is the C6 dermatome?

Answer 56

Lateral forearm and distal lat bicep, plus thumb and pointer finger

Question 57

What is the C8 dermatome?

Answer 57

Medial arm and ring and little fingers + part of wrist

Question 58

1) What is the L4 dermatome?
2) What is the L5 dermatome?

Answer 58

1) Anterior knee and thigh from lateral to medial side going downward
2) Anterior shin from lateral to medial, plus ankle and big toe + toe next to it both anterior and posterior

Question 59

What is the pattern of spread of rheumatoid arthritis?

Answer 59

Symmetrically additive; goes to other joints symmetrically

Question 60

When might unilateral osteoarthritis occur?

Answer 60

Repeated use injury from only using one side of body for a task, or if there was a fracture that didn’t heal right

Question 61

What is osteoarthritis also called?

Answer 61

DJD

Question 62

Between rheumatoid arthritis and osteoarthritis, which:
1) Is chronic in over 50%?
2) Has remissions?
3) Has temporary exacerbations?
4) Primarily involves joint cartilage?

Answer 62

1) Rheumatoid arthritis
2) Rheumatoid arthritis
3) Osteoarthritis
4) Osteoarthritis

Question 63

Between rheumatoid arthritis and osteoarthritis, which:
1) Is additive but can also only involve one joint?
2) Involves damage to underlying bone?
3) Involves the synovial membranes?
4) Involves damage to ligaments, tendons, and erosion of adj. cartilage and bone?

Answer 63

1) Osteoarthritis
2) Both
3) RA
4) RA