Study Qs Flashcards
History: I am a 34 year old male with a history of hepatitis B Presentation: Pain in abdomen, Pelvis, and lower back. Hematauria, decreased urine output, swollen abdomen. You suspect acute nephritic syndrome. Perform an appropriate physical exam including two specific tests to support your diagnosis. List further options for diagnosis and treatment.
Costa vertebral angle tenderness (CVAT) pain produced upon palpating Gold flam sign, specialized percussion over CVAT
I am a 53 year old woman suffering from diffuse abdominal pain as well as lower back pain. History taking reveals I have been a regular smoker for the past 20 years and have undergone a CABG procedure 3 years previously. My blood pressure is 145/95 (normal is 120/80). I have taken Lipitor for hypercholesterolemia but have not seen a physician since beginning treatment 2 weeks post operatively. Perform an appropriate physical examination.
Physical exam: no hepatosplenomegaly. No pain upon palpating. AUSCULATION: If they listen for the right renal artery, tell them a bruit is present. (Could mean athlerosclerotic plaque is present.) IF THEY DONT LISTEN HERE SAY NOTHING UNTIL THE END. Palpation: no pain elicited but pain upon CVAT or gold flam sign
I’m a 12 year old male complaining of pain around my belly button, light nausea, headache, and malaise. I have no prior medical history. Upon admission to the hospital blood tests revealed a slight elevation in neutrophil counts. Perform an appropriate physical examination including three specific tests to provide support for your diagnosis. Give the correct diagnosis.
Inspection: normal Auscultation: normal if performed before Palpation Palpation: pain in lower left quadrant. Guarding of abdomen. Tests: psoas test, rebound tenderness, macburneys point.
I am a 17 year old female from Southern California. I present to my primary care physician with sharp pain in the right thumb. History reveals i am a frequent ‘tweeter’ and send roughly 1200 text messages a day. Perform an appropriate exam including one specific test.
Test for DeQuervain’s tensynovitis. Pain upon thumb being forcibly opposed with the fingers at the head of 1st and 5th metacarpal OR being asked to make a fist. Either positive is Finklestein’s sign.
I am a 46 year old woman presenting with pain and numbness radiating from my first three digits of my right hand. Perform an appropriate physical exam, and give two specific tests. State the name of the nerve responsible for the condition and how you would locate it with ultrasound. Give your diagnosis.
Pain elicited by tapping the index finger over the flexor retinaculum of the affected hand. (tinnel’s sign) pain reproduced when asked to force wrists into flexion while placing dorsums together (phalen’s test).
I am a 25 year old male presenting with loss of sensation over the skin of my fourth and fifths digits of my left hand and an inability to flex the MCP joint after suffering an injury to the medial aspect of my elbow during a rock climbing accident. Identify the nerve that has been affected and perform an appropriate test to confirm its function has been lost.
Froment’s sign- patient can’t hold a piece of paper between the thumb and first finger without flexing the thumb.
I am a 55 year old male complaining of neck and shoulder pain as well as tingling of my fourth and fifth digits on my right hand upon exertion. Perform an appropriate physical exam, give the diagnosis and list one specific test that could be performed to support your diagnosis
Inspection: there is marked discoloration of the hand and forearm. Palpation: no pain! If pulse is taken, all pulses of the arm are weak. Test: EAST- elevated arm stress test. Patient sits with arms abducted to 90 and elbows flexed to 90 and then open and close hand for 1-3 minutes. PAIN AND SYMPTOMS ARE PRODUCED. Diagnosis: Thoracic outlet syndrome.
I am a 73 year old female Caucasian complaining of nonspecific shoulder pain that has appeared gradually over several months. Pain is worst when she attempts to place items on a high shelf. Perform an appropriate examination including one specific test to support your diagnosis. Give the diagnosis and suggest a treatment strategy for this patient.
Inspection: redness and swelling seen on the superior aspect of the shoulder. Palpation: tenderness elicited by pressing on the superior anterior surface of shoulder. Pain elicited upon active or passive abduction of shoulder Tests: ask patient to abduct arm to 90 and hold for 30-60 seconds. Pain and drop arm indicate rotator cuff injury Diagnosis and management: chronic rotator cuff tear. ( supraspinatus) treatment is physical therapy and steroid Injections, surgery is not advised.
I am a 32 year old male Caucasian tennis professional at a local country club. Recently, I have experienced pain in my forearm after cleaning the windshield of my Ferrari 458 Italia. I have also noticed a similar pain after playing tennis. Perform an appropriate physical examination including one specific test to support your diagnosis. Give your diagnosis.
Inspection: redness on the lateral aspect of my elbow and forearm. Palpation: intense pain just distal to the lateral epicondyle. Test: chair raise test. Ask patient to grip back of chair and attempt to lift it. Intense pain is caused. Diagnosis: lateral epicondylitis (tennis elbow)
I am a 74 year old female presenting to the emergency room with hoarseness of voice persisting for the past three weeks. Blood tests upon admission revealed no abnormalities. The patient complains of angina pectoris. Perform a standard cardiovascular exam and suggest a possible diagnosis and treatment.
Inspection: if this step is skipped say nothing. If they do inspect, say that a prominent pulsation can be seen in the left fifth intercostal space. Palpation: if they skip this step say nothing. If they do palpate, prominent apical beat can be found. Auscultation : heart sounds are all normal. Diagnosis: Thoracic aortic aneurysm at the level of T4. Surgical repair.
I am a 53 year old male complaining of shortness of breath. I have no prior history of smoking. Upon admission, blood tests are normal. Perform an appropriate physical examination and suggest further studies to be performed.
Inspection: asymmetric breaths, right side doesn’t appear to rise Palpation: asymmetric breaths, Percussion: tympanic on both sides Auscultation: absent breath sounds on right side Further studies: X-ray
The 27 year old starting quarterback for the Buffalo bills presents to your office (you are an orthopedic surgeon working for the team) after sustaining a low hit to the lateral aspect of his Perform an appropriate physical examination to assess the condition of the knee joint. Give your diagnosis
Tear in mcl, acl, medial meniscus Perform the anterior and posterior drawer test. Perform mcminneys test.
You are a third year medical student in your internal medicine rotation. Your attending asks you to examine a patient in the ICU who has been in a coma for 4 months. In addition to DVTs, the attending is worried about peripheral artery disease. You are distracted thinking about boobs. You are too afraid to ask her to repeat herself, but you vaguely remember saying something about the lower limb, taking a pulse, and the number three. Identify and locate three areas on the lower limb you can take a peripheral pulse. Give a report on each pulse.
Popliteal, posterior tibial and dorsalis pedis. Report the value, quality, and presence/absence of each.
A 34 year old man presents to your office for a well checkup. During the course of your exam, perform an exam to test his reflexes. Perform an appropriate physical examination, including three separate common reflex tests.
Triceps reflex Biceps reflex Quadriceps reflex (knee jerk)
I am a 13 year old girl 86 lbs with a history of mild aortic stenosis presenting to your office for a routine checkup to asses cardiovascular fitness.
Inspection: normal, apical pulse is slightly visible. Palpation: there is a slight apical pulse. Auscultation: slight whooshing sound heard almost Inaudibly in the left 2nd intercostal space.
