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What are the seven attributes of every symptom? - correct answer 1).Location 2).Quality 3).Quantity or severity 4).Timing: including onset, duration, and frequency 5).Setting in which it occurs 6).Aggravating and relieving factors 7).Associated manifestation Is the following information subjective or objective? Mr. M. has shortness of breath that has persisted for the past 10 days; it is worse with activity and relieved by rest. A.Subjective B.Objective - correct answer A.Subjective The following information is recorded in the health history: "I feel really tired." Which category does it belong to? A. Present illness B. Review of systems C. Personal and social history
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D. Chief complaint - correct answer D. Chief complaint The following information is best placed in which category? "The patient has had three cesarean sections." A. Surgeries B. Obstetrics/gynecology C. Psychiatric D. Adult illnesses - correct answer A. Surgeries A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on this information, which of the following pathologic processes would be the most correct? A. Traumatic B. Hematologic C. Inflammatory D. Infectious - correct answer C. Inflammatory
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Alexandra is a 28-year-old editor who presents to the clinic with abdominal pain. The pain is a dull ache, located in the right upper quadrant, that she rates as a 3 at the least and an 8 at the worst. The pain started a few weeks ago, it lasts for 2 to 3 hours at a time, it comes and goes, and it seems to be worse a couple of hours after eating. She has noticed that it starts after eating greasy foods, so she has cut down on these as much as she can. Initially it occurred once a week, but now it is occurring every other day. Nothing makes it better. From this description, which of the seven attributes of a symptom has been omitted? A. Setting in which the symptom occurs B. Quality C. Associated manifestations D. Timing - correct answer C. Associated manifestations A 25-year-old radio announcer comes to the clinic for an annual examination. His BMI is 26.0 kg/m2. He is concerned about his weight. Based on this information, what is appropriate counsel for the patient during the visit? A. Give the patient information about reduction of fat and cholesterol because he is obese. B. Give the patient information about reduction of fat, cholesterol, and calories because he is overweight.
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C. Reassure the patient that he has a normal body weight. D. Refer the patient to a nutritionist because he is anorexic. - correct answer B. Give the patient information about reduction of fat, cholesterol, and calories because he is overweight. Mr. Garcia comes to your office for a rash on his chest associated with a burning pain. Even a light touch causes this burning sensation to worsen. On examination, you note a rash with small blisters (vesicles) on a background of reddened skin. The rash overlies an entire rib on his right side. What type of pain is this? A. Neuropathic pain B. Idiopathic pain C. Nociceptive or somatic pain D. Psychogenic pain - correct answer A. Neuropathic pain The components of the health history include all of the following except which one? A. Physical Examination of the Thorax and lungs B. Review of systems C. Present illness
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vascular bed during inspiration, which prolongs ejection of blood from the right ventricle, delaying closure of the pulmonic valve. Because the pulmonic component is soft, you may not hear it away from the left second intercostal space. Because it is a low-pitched sound, you may not hear it unless you use the bell of your stethoscope. It is generally easy to hear in school-aged children, and it is easy to notice the respiratory variation of the splitting. A 25-year-old optical technician comes to your clinic for evaluation of fatigue. As part of your physical examination, you listen to her heart and hear a murmur only at the cardiac apex. Which valve is most likely to be involved, based on the location of the murmur? A. Aortic B. Pulmonic C. Tricuspid D. Mitral - correct answer D. Mitral You are concerned that a patient has an aortic regurgitation murmur. Which is the best position to accentuate the murmur? A. Supine B. Upright C. Left lateral decubitus
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D. Upright, but leaning forward - correct answer D. Upright, but leaning forward Leaning forward slightly in the upright position brings the aortic valve and the left ventricular outflow tract closer to the chest wall, so it will be easier to hear the soft diastolic decrescendo murmur of aortic insufficiency (regurgitation). You can further your ability to hear this soft murmur by having the patient hold his breath in exhalation. Which of the following events occurs at the start of diastole? A. Closure of the aortic valve B. Opening of the pulmonic valve C. Closure of the tricuspid valve D. Production of the first heart sound (S1) - correct answer A. Closure of the aortic valve At the beginning of diastole, the valves which allow blood to exit the heart close. It is thought that the closure of the aortic valve produces the second heart sound (S2). Closure of the mitral valve is thought to produce the first heart sound (S1). A 72-year-old teacher comes to your clinic for an annual examination. She is concerned about her risk for peripheral vascular disease and
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A. Radial surface of the forearm and hand; second, third, and fourth fingers B. Ulnar surface of the forearm and hand, little and ring fingers, and ulnar middle finger C. Ulnar surface of the forearm and hand; second, third, and fourth fingers D. Radial surface of the forearm and hand, thumb and index fingers, and radial middle finger - correct answer B. Ulnar surface of the forearm and hand, little and ring fingers, and ulnar middle finger The ankle-brachial index (ABI) is calculated by dividing the systolic BP at the dorsalis pedis by the systolic BP at the brachial artery. Which of the following values would be consistent with mild peripheral arterial disease? A. 0. B. 0. C. 1. D. 0.65 - correct answer A. 0. The mild disease is represented by an ABI of 0.71 to 0.9. Any value above 0.9 is normal. Moderate disease is defined as between 0.7 and 0.41, and severe disease is defined as 0.4 or less. Patients in the "severe" category have a 20% to 25% annual risk of death.
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Asymmetric BPs are seen in which of the following conditions? A. Diffuse atherosclerosis B. Vasculitis, as seen in systemic lupus erythematosus C. Coronary artery disease D. Congenital narrowing of the aorta - correct answer D. Congenital narrowing of the aorta A 47-year-old receptionist comes to your office, complaining of fever, shortness of breath, and a productive cough with golden sputum. She says she had a cold last week and her symptoms have only gotten worse, despite using over-the-counter cold remedies. She denies any weight gain, weight loss, or cardiac or gastrointestinal symptoms. Her past medical history includes type 2 diabetes for 5 years and high cholesterol. She takes an oral medication for both diseases. She has had no surgeries. She denies tobacco, alcohol, or drug use. Her mother has diabetes and high blood pressure. Her father passed away from colon cancer. On examination you see a middle-aged woman appearing her stated age. She looks ill and her temperature is elevated, at 101. Her blood pressure and pulse are unremarkable. Her head, eyes, ears, nose, and throat examinations are unremarkable except for edema of the nasal turbinates. On auscultation she - correct answer B. Pneumonia
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Percussion takes practice to master. Most struggle initially with keeping the wrist and hand relaxed. Other challenges include removing the plexor quickly and keeping the other fingers off the chest wall. These can dampen the sound you are trying to obtain. The ideal target for the plexor is the distal interphalangeal joint. Which lung sound possesses the characteristics of being louder and higher in pitch, with a short silence between inspiration and expiration and with expiration being longer than inspiration? A. Vesicular B. Bronchovesicular C. Tracheal D. Bronchial - correct answer D. Bronchial These sounds are consistent with bronchial breath sounds. Be alert for these, as they may occur elsewhere and indicate a pneumonia or other pathology. The current explanation for this phenomenon is that the sound from the trachea is carried very well to the chest wall by fluid. This same explanation explains "ee" to "aa" changes, whispered pectoriloquy, bronchophony, and other circumstances in which high- frequency sounds, normally blocked by the air-filled alveoli, could be transmitted to the chest wall. Which of the following occurs in respiratory distress?
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A. Patient torso leans posteriorly B. Skin between the ribs moves inward with inspiration C. Speaking in sentences of 10-20 words D. Neck muscles are relaxed - correct answer B. Skin between the ribs moves inward with inspiration A grandmother brings her 13-year-old grandson to you for evaluation. She noticed last week when he took off his shirt that his breastbone seemed collapsed. He seems embarrassed and tells you that it has been that way for quite awhile. He states he has no symptoms from it and he just tries not to take off his shirt in front of anyone. He denies any shortness of breath, chest pain, or lightheadedness on exertion. His past medical history is unremarkable. He is in sixth grade and just moved in with his grandmother after his father was deployed to the Middle East. His mother died several years ago in a car accident. He states that he does not smoke and has never touched alcohol. On examination you see a teenage boy appearing his stated age. On visual examination of his chest you see that the lower portion of the sternum is depressed. Auscultation of the lungs and heart are unremarkable. What disorder of the thorax best d - correct answer A. Funnel chest (pectus excavatum) A 25-year-old accountant presents to your clinic, complaining of intermittent lower right-sided chest pain for several days. He describes
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When crackles, wheezes, or rhonchi clear with a cough, which of the following is a likely etiology? A. Heart failure B. Bronchitis C. Simple asthma D. Cystic fibrosis - correct answer B. Bronchitis Which of the following percussion notes would you obtain over the gastric bubble? A. Hyperresonance B. Flatness C. Resonance D. Tympany - correct answer D. Tympany A 76-year-old retired farmer comes to your office complaining of abdominal pain, constipation, and a low-grade fever for about 3 days. He denies any nausea, vomiting, or diarrhea. The only unusual thing he remembers eating is two bags of popcorn at the movies with his grandson, 3 days before his symptoms began. He denies any other recent illnesses. His past medical history is significant for coronary
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artery disease and high blood pressure. He has been married for over 50 years. He denies any tobacco, alcohol, or drug use. His mother died of colon cancer and his father had a stroke. On examination he appears his stated age and is in no acute distress. His temperature is 100. degrees and his other vital signs are unremarkable. His head, cardiac, and pulmonary examinations are normal. He has normal bowel sounds and is tender over the left lower quadrant. He has no rebound or guarding. His rectal examination is unremark - correct answer B. Acute diverticulitis Diverticulitis is caused by localized infections within the colonic diverticula. Constipation, fever, and abdominal pain are common. Mesenteric ischemia classically presents in older people with a history of vascular disease elsewhere. The typical pain is unusual in that it is not made worse by examination despite being severe. Some mistake this feature to indicate malingering, with bad results. Chris is a 20-year-old college student who has had abdominal pain for 3 days. It started at his umbilicus and was associated with nausea and vomiting. He was unable to find a comfortable position. Yesterday, the pain became more severe and constant. Now, he hesitates to walk, because any motion makes the pain much worse. It is localized just medial and inferior to his iliac crest on the right. Which of the following is most likely? A. Peptic ulcer
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presence of renal artery bruits. These are usually heard best in the upper quadrants. It may be necessary to have the patient hold her breath, to have a very quiet room, and to listen with the diaphragm for a very soft, high-pitched sound with systole. It may also help to simultaneously feel the patient's pulse (a bruit with both a systolic and diastolic component is very specific for a significant blockage, while a lone systolic bruit may not be abnormal). Obtaining a CT scan is not likely to be useful, and you may save the delay, expense, and inconvenience of a nephrology referral if you can hear a bruit. Which of the following is consistent with obturator sign? A. Pain with extension of the right thigh while the patient is on her left side or while pressing her knee against your hand with thigh flexion B. Right hypogastric pain with the right hip and knee flexed and the hip internally rotated C. Pain distant from the site used to check rebound tenderness D. Pain that stops inhalation in the right upper quadrant - correct answer B. Right hypogastric pain with the right hip and knee flexed and the hip internally rotated Obturator sign is seen in appendicitis. It is pain with the stretching of the internal obturator muscle because of inflammation. Pain distant from the site used to check rebound tenderness is Rovsing's sign and is a reliable sign of peritonitis. Answer "C" describes psoas sign, which is
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also seen in appendicitis. Palpation in the right upper quadrant that causes pain severe enough to stop inhalation is consistent with inflammation of the gallbladder and is called Murphy's sign. An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect? A. Malingering B. Ischemia C. Neuropathy D. Physical abuse - correct answer B. Ischemia A 60-year-old coach comes to your clinic, complaining of difficulty starting to urinate for the last several months. He believes the problem is steadily getting worse. When asked he says he has a very weak stream and it feels like it takes 10 minutes to empty his bladder. He also has the urge to go to the bathroom more often than he used to. He denies any blood or sediment in his urine and any pain with urination. He has had no fever, weight gain, weight loss, or night sweats. His medical history includes type 2 diabetes and high blood pressure treated with medications. He does not smoke but drinks a six pack of beer weekly. He has been married for 35 years. His mother died of a myocardial infarction in her 70s and his father is currently in his 80s
