THE RATIONAL PHYSICAL EXAMINATION JAMA 2009 Flashcards
1
Q
What is the importance of likelihood ratios in clinical diagnosis?
A
Likelihood ratios help determine how much a test result will change the probability of a disease being present.
2
Q
What is sensitivity?
A
Sensitivity is the proportion of patients with the disease who have a positive test result.
3
Q
What is specificity?
A
Specificity is the proportion of patients without the disease who have a negative test result.
4
Q
Why is pretest probability critical in clinical examination?
A
It establishes the baseline likelihood of a disease before any diagnostic testing.
5
Q
How can you calculate post-test probability?
A
By applying likelihood ratios to pretest probability using a nomogram or mathematical formula.
6
Q
What is the definition of a positive predictive value?
A
The proportion of true positive results among all positive test results.
7
Q
What term describes the ability of a test to consistently provide the same result?
A
Reliability.
8
Q
Why are likelihood ratios preferred over sensitivity and specificity alone?
A
They combine both sensitivity and specificity, providing a direct way to calculate post-test probability.
9
Q
What does a likelihood ratio of 1 indicate?
A
The test provides no additional information about the probability of disease.
10
Q
What is the formula for calculating a positive likelihood ratio?
A
Sensitivity divided by (1 - Specificity).
11
Q
What is the most reliable clinical sign of an abdominal aortic aneurysm?
A
A palpable pulsatile abdominal mass.
12
Q
What diameter is typically considered diagnostic for an abdominal aortic aneurysm?
A
Greater than 3 cm.
13
Q
Which imaging modality is most sensitive for detecting abdominal aortic aneurysm?
A
Abdominal ultrasound.
14
Q
What symptom is commonly associated with a ruptured aneurysm?
A
Sudden severe abdominal or back pain.
15
Q
What risk factor significantly increases the likelihood of an abdominal aortic aneurysm?
A
Smoking.
16
Q
How does family history affect the risk of abdominal aortic aneurysm?
A
A family history of aneurysm increases the risk.
17
Q
What is the most common complication of an untreated large abdominal aortic aneurysm?
A
Rupture.
18
Q
What physical examination finding may indicate an impending rupture?
A
A tender pulsatile mass in the abdomen.
19
Q
What screening recommendation exists for abdominal aortic aneurysm in men?
A
One-time screening with ultrasound for men aged 65-75 who have ever smoked.
20
Q
What is the management for an abdominal aortic aneurysm greater than 5.5 cm?
A
Elective surgical repair.
21
Q
What is an abdominal bruit, and why is it clinically significant?
A
It is a vascular sound heard over the abdomen, often indicating renal artery stenosis.
22
Q
At what point in the cardiac cycle are bruits most concerning for renal artery stenosis?
A
Bruits that persist into diastole.
23
Q
What physical sign increases suspicion for renovascular hypertension?
A
An abdominal bruit in a patient with difficult-to-control hypertension.
24
Q
How effective is auscultation of bruits in diagnosing renovascular hypertension?
A
It has limited sensitivity but good specificity.
25
What additional test is recommended for suspected renovascular hypertension?
Renal Doppler ultrasonography or computed tomography angiography (CTA).
26
What is the prevalence of renal artery stenosis among patients with secondary hypertension?
Approximately 1-5%.
27
What other clinical clue besides a bruit may suggest renovascular hypertension?
A sudden onset of severe hypertension before age 30 or after age 55.
28
What class of medications should be used with caution in suspected renal artery stenosis?
ACE inhibitors or ARBs.
29
What test has high specificity for diagnosing renal artery stenosis?
Magnetic resonance angiography (MRA).
30
What intervention is definitive for treating significant renal artery stenosis?
Revascularization, typically by angioplasty or stenting.
31
What is the CAGE questionnaire used for?
Screening for alcohol use disorders.
32
What does each letter in CAGE stand for?
Cut down, Annoyed, Guilty, Eye-opener.
33
What is considered a positive CAGE screening?
Two or more affirmative responses.
34
What physical findings are associated with chronic alcohol use?
Hepatomegaly, palmar erythema, and spider angiomas.
35
What lab finding is commonly elevated in chronic alcohol use?
Gamma-glutamyl transferase (GGT).
36
What is a common neurological complication of chronic alcohol abuse?
Wernicke-Korsakoff syndrome.
37
What vitamin deficiency is often linked to chronic alcoholism?
Thiamine (Vitamin B1) deficiency.
38
What withdrawal symptom is considered a medical emergency?
Delirium tremens.
39
What medication is commonly used for alcohol withdrawal management?
Benzodiazepines.
40
What score is used to assess the severity of alcohol withdrawal?
The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar).
41
What is McBurney's point, and why is it significant in appendicitis?
It is a point one-third the distance from the anterior superior iliac spine to the umbilicus, where tenderness is a classic sign of appendicitis.
42
What is Rovsing's sign?
Pain in the right lower quadrant upon palpation of the left lower quadrant, suggesting appendicitis.
43
What does a positive psoas sign indicate?
Irritation of the iliopsoas muscle, often due to an inflamed appendix.
44
What imaging study is most commonly used to confirm appendicitis in adults?
Computed tomography (CT) scan.
45
What white blood cell count typically supports a diagnosis of appendicitis?
A count greater than 10,000/µL with a left shift.
46
What is the Alvarado score used for?
Assessing the likelihood of appendicitis based on clinical and laboratory findings.
47
What symptom is classically the first to appear in appendicitis?
Periumbilical pain that later localizes to the right lower quadrant.
48
What complication can result from untreated appendicitis?
Perforation and peritonitis.
49
What population is at increased risk for atypical presentations of appendicitis?
Pregnant women and elderly patients.
50
What is the definitive treatment for acute appendicitis?
Appendectomy.
51
What physical examination technique is used to detect shifting dullness?
Percussion of the abdomen while the patient is supine and then repositioned.
52
What finding on fluid wave test suggests ascites?
A transmitted impulse felt on the opposite side of the abdomen after tapping one side.
53
What is the most common cause of ascites?
Cirrhosis.
54
What serum-ascites albumin gradient (SAAG) value indicates portal hypertension?
A SAAG of 1.1 g/dL or greater.
55
What is the significance of a positive puddle sign?
It suggests free fluid in the peritoneal cavity.
56
What diagnostic procedure is essential for confirming the cause of ascites?
Paracentesis.
57
What complication is associated with spontaneous bacterial peritonitis (SBP)?
Infection of ascitic fluid without an apparent intra-abdominal source.
58
What is a key clinical feature of SBP?
Fever and abdominal pain in a patient with cirrhosis and ascites.
59
What is the most common pathogen causing SBP?
Escherichia coli.
60
What laboratory value is typically elevated in SBP?
Ascitic fluid polymorphonuclear leukocyte count >250 cells/µL.
61
What red flag symptom requires immediate evaluation in a patient with low back pain?
Saddle anesthesia or bowel/bladder dysfunction.
62
What is the straight leg raise test used for?
Assessing for lumbosacral nerve root irritation or sciatica.
63
What physical exam finding suggests spinal cord compression?
Hyperreflexia or positive Babinski sign.
64
What imaging modality is recommended for new-onset low back pain without red flags?
None initially; conservative management is preferred.
65
What condition is characterized by low back pain relieved by sitting and worsened by walking?
Spinal stenosis.
66
What is the hallmark symptom of cauda equina syndrome?
Severe back pain with bilateral leg weakness and incontinence.
67
What is the most common cause of acute low back pain?
Muscle strain or ligament sprain.
68
When is MRI indicated in low back pain?
When there are neurological deficits or suspicion of serious pathology.
69
What symptom is highly suggestive of ankylosing spondylitis in young adults?
Morning stiffness and pain that improves with activity.
70
What test assesses for sacroiliac joint dysfunction?
FABER (flexion, abduction, external rotation) test.
71
What is the most common presenting symptom of breast cancer?
A palpable, painless breast mass.
72
What mammographic finding is highly suggestive of malignancy?
Spiculated or irregular mass.
73
What is the recommended screening age for mammography in average-risk women?
Age 50-74 according to USPSTF guidelines.
74
What breast skin change is associated with inflammatory breast cancer?
Peau d'orange (skin dimpling).
75
What physical finding is suspicious for axillary lymph node involvement?
Firm, immobile lymph nodes.
76
What is the significance of a new nipple inversion?
It can indicate an underlying malignancy.
77
What is the triple assessment for a breast mass?
Clinical examination, imaging (mammogram/ultrasound), and biopsy.
78
What genetic mutations are associated with hereditary breast cancer?
BRCA1 and BRCA2.
79
What is the most common type of breast cancer?
Invasive ductal carcinoma.
80
What breast cancer subtype has the worst prognosis?
Triple-negative breast cancer.
81
What is a carotid bruit?
A turbulent flow sound heard over the carotid artery.
82
What condition is commonly associated with a carotid bruit?
Carotid artery stenosis.
83
How is the severity of carotid artery stenosis best evaluated?
Carotid duplex ultrasonography.
84
What symptom increases the urgency of evaluating a carotid bruit?
Transient ischemic attack (TIA) or stroke symptoms.
85
What physical examination maneuver can help differentiate carotid bruit from cardiac murmur?
Auscultation while holding breath.
86
What degree of stenosis typically warrants consideration for carotid endarterectomy?
Greater than 70% stenosis.
87
What risk factor most strongly correlates with carotid artery disease?
Hypertension.
88
What clinical sign might indicate significant carotid stenosis besides a bruit?
Amaurosis fugax.
89
What imaging study is most commonly used after duplex ultrasound for carotid stenosis?
Magnetic resonance angiography (MRA) or computed tomography angiography (CTA).
90
What medication is recommended for patients with carotid artery stenosis?
Antiplatelet agents, such as aspirin.
91
What nerve is compressed in carpal tunnel syndrome?
The median nerve.
92
What is Tinel's sign?
Tingling in the fingers when tapping over the median nerve at the wrist.
93
What is Phalen's test?
Numbness or tingling when the wrists are flexed together for 60 seconds.
94
What physical finding may be present in severe carpal tunnel syndrome?
Thenar muscle atrophy.
95
What occupational factor increases the risk of carpal tunnel syndrome?
Repetitive hand and wrist motions.
96
What is a common symptom of carpal tunnel syndrome?
Nocturnal hand numbness and tingling.
97
What diagnostic test confirms carpal tunnel syndrome?
Nerve conduction studies.
98
What systemic condition is associated with an increased risk of carpal tunnel syndrome?
Diabetes mellitus.
99
What splint position is recommended for conservative treatment of carpal tunnel syndrome?
Neutral wrist position.
100
What surgical procedure is performed for refractory carpal tunnel syndrome?
Carpal tunnel release.
101
What does jugular venous distention indicate about central venous pressure?
Elevated central venous pressure.
102
How is hepatojugular reflux tested?
By applying pressure to the right upper quadrant and observing jugular vein distention.
103
What is Kussmaul's sign?
Increased jugular venous pressure during inspiration, associated with conditions like constrictive pericarditis.
104
Which physical sign can estimate right atrial pressure?
Jugular venous pulsation height.
105
What condition is commonly associated with elevated central venous pressure?
Congestive heart failure.
106
How can one differentiate carotid pulsations from jugular venous pulsations?
Jugular venous pulsations are non-palpable and vary with respiration.
107
What maneuver decreases jugular venous pressure?
Upright positioning of the patient.
108
How is central venous pressure measured invasively?
Using a central venous catheter.
109
What effect does tricuspid regurgitation have on jugular venous pressure?
Prominent v waves.
110
What is the normal upper limit of jugular venous pressure above the sternal angle?
3 to 4 cm.
111
What laboratory findings are associated with acute cholecystitis?
Elevated white blood cell count, alkaline phosphatase, and bilirubin.
112
What complication can arise from untreated cholecystitis?
Gallbladder perforation or gangrene.
113
What physical examination sign can distinguish acute cholecystitis from biliary colic?
Positive Murphy's sign.
114
What imaging test is used when ultrasound is inconclusive for cholecystitis?
Hepatobiliary iminodiacetic acid (HIDA) scan.
115
What is the initial management for acute cholecystitis?
Intravenous fluids, antibiotics, and fasting.
116
What is the definitive treatment for acute cholecystitis?
Cholecystectomy.
117
What is a common cause of acalculous cholecystitis?
Critically ill patients or those on prolonged fasting.
118
What physical finding is uncommon in acute cholecystitis?
Jaundice, unless there is concurrent choledocholithiasis.
119
What antibiotic coverage is recommended for acute cholecystitis?
Gram-negative and anaerobic organisms, typically ceftriaxone and metronidazole.
120
What is the main diagnostic criterion for cholecystitis on ultrasound?
Gallbladder wall thickening or pericholecystic fluid.
121
What is the primary symptom of COPD?
Chronic cough with sputum production and progressive dyspnea.
122
What is the hallmark physical examination finding in advanced COPD?
Barrel-shaped chest.
123
What is the best initial diagnostic test for COPD?
Spirometry.
124
What is the key spirometric finding in COPD?
FEV1/FVC ratio less than 70%.
125
What physical sign suggests hyperinflation in COPD?
Decreased diaphragmatic excursion.
126
What auscultatory finding is common in COPD?
Prolonged expiratory phase with wheezing.
127
What test distinguishes between chronic bronchitis and emphysema?
Diffusing capacity for carbon monoxide (DLCO) is reduced in emphysema but normal in chronic bronchitis.
128
What lifestyle modification is most effective in slowing COPD progression?
Smoking cessation.
129
What pharmacological treatment improves survival in COPD?
Long-term oxygen therapy for severe hypoxemia.
130
What complication is common in advanced COPD?
Pulmonary hypertension and cor pulmonale.
131
What is costochondritis?
Inflammation of the costosternal, costochondral, or sternoclavicular joints.
132
What is the typical presentation of costochondritis?
Sharp anterior chest pain worsened by palpation or movement.
133
How is costochondritis diagnosed?
Clinically, based on history and physical examination.
134
What is a key differential diagnosis for costochondritis?
Acute coronary syndrome (ACS).
135
What is the common age group affected by costochondritis?
Young adults.
136
What imaging is necessary to confirm costochondritis?
None; it is a clinical diagnosis.
137
What treatment is recommended for costochondritis?
NSAIDs and rest.
138
What is Tietze syndrome?
A variant of costochondritis with visible swelling of the affected joint.
139
What other condition can mimic the chest pain of costochondritis?
Pericarditis.
140
What physical exam finding is most reassuring in costochondritis?
Reproducible tenderness on palpation of the chest wall.
141
What is the most common risk factor for DVT?
Immobility or recent surgery.
142
What is Homan’s sign?
Calf pain on dorsiflexion of the foot, although it is non-specific for DVT.
143
What is the most sensitive diagnostic test for DVT?
Compression ultrasonography.
144
What clinical prediction rule is used for DVT?
The Wells score.
145
What laboratory test is often elevated in DVT?
D-dimer.
146
What is the initial treatment for confirmed DVT?
Anticoagulation with heparin or direct oral anticoagulants.
147
What is the primary complication of untreated DVT?
Pulmonary embolism.
148
What medication is commonly used for long-term anticoagulation?
Warfarin or direct oral anticoagulants.
149
What symptom distinguishes DVT from superficial thrombophlebitis?
Deep calf tenderness and swelling versus localized erythema and tenderness.
150
What physical exam finding is classic but rare in DVT?
A palpable cord along the affected vein.
151
What is the most common type of dementia?
Alzheimer’s disease.
152
What cognitive domain is most affected early in Alzheimer’s disease?
Memory.
153
What is the utility of the Mini-Mental State Examination (MMSE)?
Screening and assessing the severity of dementia.
154
What is a hallmark finding on brain imaging in Alzheimer’s disease?
Cortical atrophy, particularly in the hippocampus.
155
What condition can mimic dementia but is reversible?
Depression, often referred to as pseudodementia.
156
What feature distinguishes Lewy body dementia from Alzheimer’s disease?
Visual hallucinations and parkinsonian features.
157
What genetic factor is associated with increased Alzheimer’s disease risk?
Apolipoprotein E4 (ApoE4) allele.
158
What medication class is commonly used in the treatment of Alzheimer’s disease?
Cholinesterase inhibitors.
159
What differentiates vascular dementia from other types?
A stepwise decline in cognitive function.
160
What is the primary feature of frontotemporal dementia?
Behavioral changes and language difficulties.
161
What is the most common type of diabetic neuropathy?
Distal symmetric polyneuropathy.
162
What symptom is typically first in diabetic neuropathy?
Numbness and tingling in the feet.
163
What physical exam technique is used to assess for diabetic neuropathy?
Monofilament testing for loss of protective sensation.
164
What complication is associated with diabetic neuropathy?
Foot ulcers and Charcot joint.
165
What test is used to evaluate autonomic dysfunction in diabetes?
Heart rate variability with deep breathing.
166
What pharmacologic treatment can be used for neuropathic pain?
Gabapentin or pregabalin.
167
What is a key feature of autonomic neuropathy in diabetes?
Orthostatic hypotension.
168
What is the role of glycemic control in preventing diabetic neuropathy?
It reduces the risk and slows progression.
169
What is a sign of motor neuropathy in diabetic patients?
Foot drop.
170
What vitamin deficiency may mimic diabetic neuropathy?
Vitamin B12 deficiency.
171
What is the strongest predictor of future falls in the elderly?
History of previous falls.
172
What test assesses balance and gait in fall risk evaluation?
Timed Up and Go (TUG) test.
173
What medication class increases fall risk?
Benzodiazepines and other sedatives.
174
What environmental modification can reduce fall risk?
Removing loose rugs and improving lighting.
175
What is orthostatic hypotension?
A drop in blood pressure upon standing, contributing to falls.
176
What physical exam finding may indicate frailty?
Decreased grip strength.
177
What is the recommended exercise to prevent falls?
Strength and balance training.
178
What visual impairment is commonly linked to falls?
Cataracts or reduced visual acuity.
179
What chronic condition commonly contributes to falls?
Peripheral neuropathy.
180
What is sarcopenia?
Loss of muscle mass and strength associated with aging.
181
What is the most common primary headache disorder?
Tension-type headache.
182
What distinguishes migraine from other headache types?
Unilateral throbbing pain with nausea and photophobia.
183
What is an aura in the context of migraines?
A sensory disturbance that precedes the headache.
184
What physical exam finding suggests increased intracranial pressure?
Papilledema.
185
What feature differentiates cluster headaches?
Severe, unilateral periorbital pain with autonomic symptoms.
186
What is the first-line treatment for acute migraine?
Triptans.
187
What lifestyle modification can help prevent migraines?
Avoiding known triggers, such as certain foods or stress.
188
What symptom requires urgent imaging in a headache presentation?
A sudden onset "thunderclap" headache.
189
What prophylactic medication is commonly used for chronic migraines?
Beta-blockers, such as propranolol.
190
What secondary cause of headache should be considered in a patient with fever and stiff neck?
Meningitis.
191
What is the most common cause of heart failure in developed countries?
Ischemic heart disease.
192
What physical exam finding is associated with left-sided heart failure?
Bibasilar crackles on lung auscultation.
193
What is the primary symptom of right-sided heart failure?
Peripheral edema.
194
What biomarker is elevated in heart failure?
B-type natriuretic peptide (BNP).
195
What imaging modality is most useful for diagnosing heart failure?
Echocardiography.
196
What medication class improves survival in heart failure with reduced ejection fraction?
ACE inhibitors or ARBs.
197
What is a common cause of diastolic heart failure?
Hypertension leading to left ventricular hypertrophy.
198
What finding on jugular venous pressure is seen in heart failure?
Elevated JVP with a positive hepatojugular reflux.
199
What lifestyle modification is crucial for managing heart failure?
Sodium restriction and fluid management.
200
What is the role of beta-blockers in heart failure?
They improve survival by reducing sympathetic activation.
201
What is hepatomegaly?
Enlargement of the liver beyond its normal size.
202
What condition is commonly associated with hepatomegaly and jaundice?
Hepatitis.
203
What physical exam technique is used to detect hepatomegaly?
Percussion and palpation of the right upper quadrant.
204
What imaging study is most commonly used to confirm hepatomegaly?
Abdominal ultrasound.
205
What metabolic disorder is a frequent cause of fatty liver and hepatomegaly?
Nonalcoholic fatty liver disease (NAFLD).
206
What is a common infectious cause of hepatomegaly?
Mononucleosis (Epstein-Barr virus).
207
What is the significance of a liver edge palpable below the costal margin?
It may indicate hepatomegaly or liver displacement.
208
What laboratory test is commonly elevated in hepatomegaly due to cholestasis?
Alkaline phosphatase.
209
What condition can present with hepatomegaly and a bruit over the liver?
Hepatocellular carcinoma or vascular abnormalities.
210
What symptom commonly accompanies hepatomegaly in congestive heart failure?
Ascites or peripheral edema.
211
What condition is indicated by both hepatomegaly and splenomegaly?
Hepatosplenomegaly.
212
What infectious disease frequently causes hepatosplenomegaly?
Malaria or infectious mononucleosis.
213
What hematologic disorder is associated with hepatosplenomegaly?
Chronic myelogenous leukemia (CML).
214
What liver condition may lead to hepatosplenomegaly?
Cirrhosis with portal hypertension.
215
What diagnostic imaging is most commonly used to evaluate hepatosplenomegaly?
Abdominal ultrasound or CT scan.
216
What physical finding helps differentiate splenomegaly from a left kidney mass?
Splenic enlargement moves with respiration; a kidney mass does not.
217
What is a common cause of splenomegaly in children?
Congenital infections or hemolytic anemia.
218
What physical technique improves detection of splenomegaly?
Percussing the left lower anterior chest wall (Traube's space).
219
What laboratory marker is often elevated in hepatosplenomegaly due to hemolysis?
Indirect bilirubin.
220
What syndrome includes hepatosplenomegaly, fever, and pancytopenia?
Visceral leishmaniasis.
221
What is the most common cause of hip pain in older adults?
Osteoarthritis.
222
What test is used to assess for hip joint pathology?
The FABER (flexion, abduction, external rotation) test.
223
What physical exam finding is suggestive of trochanteric bursitis?
Lateral hip pain with palpation over the greater trochanter.
224
What imaging modality is most useful for initial evaluation of hip pain?
X-ray of the hip.
225
What condition causes pain in the groin with weight-bearing activities?
Femoral neck stress fracture.
226
What condition may cause hip pain in children with a limp?
Legg-Calvé-Perthes disease or slipped capital femoral epiphysis.
227
What physical test evaluates hip flexor tightness?
The Thomas test.
228
What is a common cause of anterior hip pain in young athletes?
Iliopsoas strain or hip flexor tendonitis.
229
What condition is characterized by reduced internal rotation of the hip?
Osteoarthritis of the hip.
230
What is avascular necrosis of the hip?
Death of bone tissue due to disrupted blood supply.
231
What is the most common cause of acute hoarseness?
Acute laryngitis, often viral.
232
What is the primary risk factor for laryngeal cancer?
Tobacco use.
233
What nerve injury causes hoarseness due to vocal cord paralysis?
Recurrent laryngeal nerve injury.
234
What condition presents with hoarseness and gastroesophageal symptoms?
Laryngopharyngeal reflux (LPR).
235
What systemic disease can cause hoarseness?
Hypothyroidism.
236
What benign vocal cord lesion is common in singers?
Vocal cord nodules.
237
What is the recommended management for persistent hoarseness lasting more than two weeks?
Laryngoscopy.
238
What autoimmune disorder can cause hoarseness?
Sjögren's syndrome.
239
What is spasmodic dysphonia?
A neurological disorder causing involuntary spasms of the vocal cords.
240
What medication may cause hoarseness as a side effect?
Inhaled corticosteroids.
241
What is the definition of hypertension according to current guidelines?
Blood pressure ≥130/80 mmHg.
242
What is the most common type of hypertension?
Primary (essential) hypertension.
243
What lifestyle modification has the greatest impact on lowering blood pressure?
Dietary salt reduction.
244
What physical exam finding is suggestive of secondary hypertension?
Abdominal bruit indicating renal artery stenosis.
245
What is the first-line medication for most patients with hypertension?
Thiazide diuretics, ACE inhibitors, or calcium channel blockers.
246
What complication is associated with long-standing uncontrolled hypertension?
Left ventricular hypertrophy.
247
What is a hypertensive emergency?
Severe hypertension with acute target organ damage.
248
What laboratory test is part of the initial evaluation for hypertension?
Serum creatinine to assess kidney function.
249
What symptom may suggest pheochromocytoma as a cause of hypertension?
Episodic headaches, sweating, and palpitations.
250
What blood pressure pattern is common in white-coat hypertension?
Elevated readings in the clinical setting but normal readings at home.
251
What is the most common cause of hyperthyroidism?
Graves' disease.
252
What symptom is commonly associated with hyperthyroidism?
Heat intolerance and weight loss.
253
What physical sign is characteristic of Graves' disease?
Exophthalmos or bulging eyes.
254
What laboratory findings are typical in primary hyperthyroidism?
Low TSH and elevated free T4.
255
What medication is used to manage hyperthyroid symptoms?
Beta-blockers, such as propranolol.
256
What is a potential complication of untreated hyperthyroidism?
Thyroid storm.
257
What is the role of radioactive iodine in hyperthyroidism?
Ablation of thyroid tissue to reduce hormone production.
258
What physical finding is associated with toxic multinodular goiter?
Palpable thyroid nodules with hyperthyroid symptoms.
259
What test differentiates Graves' disease from other causes of hyperthyroidism?
Thyroid-stimulating immunoglobulin (TSI) levels.
260
What is a common cause of postpartum hyperthyroidism?
Postpartum thyroiditis.
261
What is the most common cause of hypothyroidism worldwide?
Iodine deficiency.
262
What autoimmune disorder causes hypothyroidism in developed countries?
Hashimoto's thyroiditis.
263
What symptom is frequently seen in hypothyroidism?
Fatigue and cold intolerance.
264
What is myxedema?
Severe hypothyroidism with swelling and mental status changes.
265
What laboratory findings indicate primary hypothyroidism?
Elevated TSH and low free T4.
266
What is the treatment for hypothyroidism?
Levothyroxine replacement therapy.
267
What reflex change is characteristic of hypothyroidism?
Delayed relaxation phase of the deep tendon reflexes.
268
What skin manifestation is common in hypothyroidism?
Dry, coarse skin.
269
What is the effect of hypothyroidism on cholesterol levels?
Elevated total and LDL cholesterol.
270
What test is used to confirm autoimmune thyroid disease?
Anti-thyroid peroxidase (anti-TPO) antibodies.
271
What is the most common cause of knee pain in older adults?
Osteoarthritis.
272
What test evaluates the integrity of the anterior cruciate ligament (ACL)?
Lachman test.
273
What condition presents with knee locking and joint line tenderness?
Meniscal tear.
274
What physical test is used to diagnose patellofemoral pain syndrome?
Clarke's sign or patellar grind test.
275
What finding on examination is suggestive of a Baker's cyst?
Swelling behind the knee.
276
What test assesses for a posterior cruciate ligament (PCL) injury?
Posterior drawer test.
277
What imaging is typically first-line for evaluating knee pain?
X-ray of the knee.
278
What is the hallmark symptom of iliotibial band syndrome?
Lateral knee pain.
279
What maneuver tests for medial collateral ligament (MCL) injury?
Valgus stress test.
280
What condition is the most common cause of knee effusion in young athletes?
Traumatic injury or ligament tear.
281
What is a key feature of septic arthritis?
Fever, warmth, and joint effusion.
282
What condition is characterized by the presence of crystals in joint fluid?
Gout or pseudogout.
283
What test confirms the diagnosis of gout?
Identification of monosodium urate crystals in synovial fluid.
284
What is the appearance of pseudogout crystals?
Rhomboid-shaped and positively birefringent.
285
What knee condition involves chronic joint swelling and deformity?
Rheumatoid arthritis.
286
What is the significance of a positive bulge sign?
Small joint effusion.
287
What is the Ballottement test used for?
Detecting large knee effusions.
288
What imaging is used when septic arthritis is suspected?
Joint aspiration for synovial fluid analysis.
289
What is hemarthrosis?
Bleeding into the joint space, often following trauma.
290
What is radiculopathy?
Pain, weakness, or numbness due to nerve root compression.
291
What condition is the most common cause of lumbar radiculopathy?
Herniated disc.
292
What physical exam maneuver tests for sciatic nerve irritation?
Straight leg raise (SLR) test.
293
What imaging is preferred for persistent radiculopathy?
MRI of the lumbar spine.
294
What symptom differentiates cauda equina syndrome?
Saddle anesthesia and bowel/bladder dysfunction.
295
What is the initial management for acute lumbar radiculopathy?
Conservative treatment with rest, NSAIDs, and physical therapy.
296
What is a positive cross SLR test indicative of?
Large disc herniation.
297
What reflex is commonly diminished with L4 nerve root compression?
Patellar reflex.
298
What motor weakness is associated with L5 radiculopathy?
Weakness in foot dorsiflexion.
299
What is the role of epidural steroid injections in radiculopathy?
They may provide temporary pain relief in severe cases.
