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END OF PAGE When do you hear wheezing in an asthmatic patient - ANSWERS-Upon expiration Patient complains of pain after walking, radiating from back into butt cheeks, to calves and relief with sitting. What DDx - ANSWERS- Neurogenic claudication A black woman is 6 - 10 times more likely to die after childbirth; what is this an example of? - ANSWERS-Health bias Patient presents with diabetes, etoh abuse, complains of increasing weakness, epigastric pain radiating to the back, diarrhea, and weight loss. What is on your DDx? - ANSWERS-Pancreatitis - autodigestion/scarring of the pancreas Patient with decreased sensation to light touch around the heel; which dermatome is affected? - ANSWERS-S How do you find the fourth intercostal space? - ANSWERS-Find your sternal notch, 2nd intercostal space and palpate down to 4th
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END OF PAGE If a patient has problems with ocular movements, what cranial nerves can be affected and what could be wrong? - ANSWERS-Cranial nerves 3, 4, and 6; and it could be a potential stroke Nasal exam shows growth that is inflamed, obstructing nasal passage; what do you suspect? - ANSWERS-Nasal polyp What is dysphagia? - ANSWERS-Trouble swallowing If we are assessing anxiety and depression, what else do we check for? - ANSWERS-a. Suicidal ideation b. Thyroid dysfunction c. Substance abuse d. Homicidal ideation Pt presents with problems and has ETOH history and sober for 10 years. What are you thinking? - ANSWERS-Did they start drinking again?
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END OF PAGE Which lymph nodes sit just behind the sternocleidomastoid? - ANSWERS-Posterior cervical chain A patient comes in with really vague overall muscle complaints, fatigue with no accident or mechanism of injury, what is something that is really important to screen for? - ANSWERS-Depression If a patient has double vision with one eye covered? Which cranial nerve are you concerned about? - ANSWERS-Cranial Nerve III A patient that comes in with elbow pain that is worse on the right and pain when she extends her wrist, what would you suspect? - ANSWERS-a. Medial epicondylitis (Golfer's elbow) b. Tennis elbow presents with pain and tenderness experienced on the outside of the elbow, while golfer's elbow can be felt on the inside of your elbow and down the arm. Pt has a lump that requires an I&D and it has a very "cheesy" substance that comes out. You will document that you just removed what? - ANSWERS-A sebaceous cyst.
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END OF PAGE If a patient has a cup to disc ratio of 1:2, then what is happening? - ANSWERS-Flatter disc, so less likely to be a glaucoma suspect What is your #1 DDx if I say I have chest pain that is sharp, right over my sternum - ANSWERS-Angina What is the main cause of Angina? - ANSWERS-Atherosclerosis If you have a patient with sudden, non-painful loss of vision, what would you suspect? - ANSWERS-Retinal detachment If you have a patient with painful loss of vision in one eye, what would you suspect - ANSWERS-optic Neuritis The tender point between the two tendons at the base of the thumb (the snuff box area), we relate that to what type of fracture? - ANSWERS- Scaphoid fracture
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END OF PAGE When I'm doing an eye exam on a patient and I've got blurred disc margins, what are some DDx? - ANSWERS-a. MS b. Meningitis Patient has a uvula deviation; you would suspect a lesion on which cranial nerve - ANSWERS-a. Cranial nerve 10 A patient has a small pea size mass under the skin that is easily moveable; what do you think it is? - ANSWERS-Lymph node What is the medical term for a stye? - ANSWERS-Hordeolum A patient with lupus who comes in with a dark red raised rash on her legs or trunk; what do you suspect? - ANSWERS-That is related to her lupus and is an expected finding What is the DIAPERS mnemonic related to urinary incontinence - ANSWERS-a. Delirium b. Infection c. Atrophy
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END OF PAGE d. Pharmaceuticals e. Excess urine output f. Restricted mobility g. Stool impaction If a patient has pain with active range of motion, and none with passive range of motion, what do you suspect? - ANSWERS-Extraarticular origin Jaundice that we know is related to hepatitis, what are some questions that we want to ask the patient in order to figure out what type of hepatitis they have? - ANSWERS-a. Do you have a history of IV drug use? b. Did you travel outside the US? c. Are you a healthcare worker? d. Are you a daycare worker? (Hepatitis A) A patient comes in with an itchy rash that is all over the joints that bend, going on for several years, better in the summer and worse in the winter; what do you suspect? - ANSWERS-Psoriasis
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END OF PAGE What do I do to a patient to confirm a diagnosis of claudication? - ANSWERS-Raise their leg for 2 minutes and if their foot displays pallor, then that is consistent with claudication (think pain, pallor, and pulses) Patient has painful ulcerations of the ankle, and the patient also has a lot of discoloration; what do you suspect is happening? - ANSWERS- Venous stasis Patient presents with a tremor that gets worse as they get closer to their target; what is this called? - ANSWERS-Intention tremor If you have a patient who has a full thickness area on the sacrum that is 5 cm in diameter; you will stage this ulcer as? - ANSWERS-Stage 3 (< 6 cm and no mention of bone) The patient presents with a thickening of their conjunctiva on the outer surface of the cornea; what do you suspect? - ANSWERS-Pterygium
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END OF PAGE What happens to the cup to disc ratio in glaucoma patients? - ANSWERS-The cupping gets larger/deeper What kind of percussion would you expect to hear over the abdomen? - ANSWERS-Tympany Pain and drainage in the left ear, pain especially when we go to move around the tragus, what do you suspect? - ANSWERS-Otitis externa/Swimmer's ear If a patient presents with a bulging tympanic membrane, what do you suspect? - ANSWERS-Otitis media If a patient has numbness and tingling with the Tinel's or Phalen's test, which nerve is affected? - ANSWERS-Median nerve You are palpating pulses and it's going from weak to strong, from weak to strong, over and over; what do you suspect? - ANSWERS-Severe left sided heart failure - pulsus paradoxus
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END OF PAGE What do we allow to happen to a geriatric patient's systolic blood pressure? - ANSWERS-It will raise as a normal pathological process of aging If you have a nurse come get you to show you an EKG and it said that the patient's heart rate was 32, what should be your next question? - ANSWERS-Are they symptomatic and what do they look like? A patient presents with difficulty with speaking for the past 6 months and using single syllables; what part of the brain do you think is affected? - ANSWERS-Cerebellar What is aphasia - ANSWERS-Inability to speak (unable to produce or understand language) If you have a patient that comes in and they've been checking their blood pressure at home, and it's been high three consecutive times, how many of those readings will we say that the patient had hypertension? - ANSWERS-All three readings (use your patient's data) What are the 5 As when helping a patient to quit smoking - ANSWERS- a. Ask
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END OF PAGE b. Advise c. Assess d. Assist e. Arrange What are we listening to when assessing Korotkoff sounds? - ANSWERS-Systolic vs diastolic pressure pulses when checking BP Which reflex is going to tell me about your S1 nerve? - ANSWERS- Achilles' reflex What is the order of exam for pulmonary assessment? - ANSWERS-a. Inspect b. Palpate c. Percuss d. Auscultate If a patient admits to smoking; what is your next question? - ANSWERS-How many packs per day X how many years
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END OF PAGE What is the most concerning sign with regard to cancer? - ANSWERS-a. Night sweats b. Weight loss A patient that you have a known diagnosis of acromegaly, what is one of the top things that you need to assess at every visit? - ANSWERS-a. Sleep pattern (large tongue can cause sleep apnea) b. Swallow A patient present with ringing in the ears that never goes away (tinnitus) that is going on for 6 months with no other signs or symptoms. What is the big diagnosis associated with tinnitus? - ANSWERS-Vertigo What on the EKG would show atrial enlargement? - ANSWERS-Change in the P wave If I am using my 3rd finger to determine the health of internal organs, what am I doing? - ANSWERS-Percussing
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END OF PAGE Patient presents with complaints of shortness of breath for about a week, what do you want to know? - ANSWERS-Any life changes, as it may be anxiety What part of the history is it when asking about education and work - ANSWERS-Social Deep air movement with high pitch whistling on expiration; what DDx?
- ANSWERS-Asthma What does dull percussion of the lungs indicate? - ANSWERS- Consolidation/pneumonia A patient presents with spiderweb veins all up the neck. What are your DDx - ANSWERS-Esophageal varices, spiderweb angiomas What are some physical exam findings of meningitis - ANSWERS- Nuchal rigidity, HA, fever, rash, light sensitivity, blurred margins around the fundus on eye exam
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END OF PAGE Young health patient has SOB, stress EKG has resting HR of 30, exercising of 100. What is next? - ANSWERS-Redo the EKG; don't believe it and question the validity of it.
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