JVD is normally (X) cm above sternal angle and (Y) cm above R atrium.
X = 4 Y = 9
T/F: If angle of bed is too high, JVP increases.
False - angle of bed doesn’t affect JVP (only ability to see it)
How would you examine patient for ventricular heave?
Ball of hand on right sternal border (at RV)
(Diaphragm/bell) used for high-pitched sound.
Diaphragm
Splitting of (S1/S2) during (inspiration/expiration) is normal and due to delay in (X).
S2 (pulmonic); inspiration
X = pulmonic valve closure
Pan-systolic murmur that projects to (carotids/axilla).
Axilla; mitral valve regurgitation
Aortic regurgitation murmur heard in (early/late) (systole/diastole). Which area is it heard best?
Early diastole
Tricuspid area (with patient sitting upright and holding exhale)
(Standing/squatting) and valsalva (increase/decrease) thoracic pressure. This worsens which murmurs/conditions?
Standing; increase
- Mitral valve prolapse (less volume, lax chordae tendinae, flappy valve)
- Hypertrophic cardiomyopathy (smaller volume, more obstruction)
(Standing/squatting) and valsalva (increase/decrease) thoracic pressure. This “improves” which murmurs/conditions?
Standing; increase
Aortic stenosis (less blood passes lax valve easier)
What’s paradoxical pulse?
Greater than normal (3-4 mmHg) drop in systolic P during inspiration
Paradoxical pulse may suggest which conditions? Star the most common.
- COPD*
- Pericardial tamponade
- Constrictive pericarditis
List the scale used for measuring pulses.
0 (absent)
1 (diminished)
2 (normal)
3 (bounding)
(X) and (Y) murmurs have similar characteristics, but (X) radiates to (carotids/axilla).
X = aortic stenosis Y = pulmonic stenosis
(both systolic crescendo-decrescendo)
carotids
BMI in lbs and inches calculation.
703* (lbs/in^2)
BP cuff that’s too large will read (low/high).
Low on small arm; high on large arm
What does lid lag present as in a patient? It suggests (X) condition/disease.
Rim of sclera visible over iris when patient gazes down;
X = hyperthyroidism
List some causes of ptosis.
(Eyelid droop)
- Horner’s (sympathetic damage)
- Myasthenia gravis
- Oculomotor n damage
HEENT: What is the “near reaction”?
Constriction of pupils when gaze changes from far object to near one
What’s anisocoria?
Difference in pupil size of 0.04 mm or greater
(X)% of people have anisocoria. This is considered benign if:
X = 35
Pupillary reaction is normal
What is pterygium?
Triangular thickening of bulbar conjunctiva over cornea
What is arcus senilis?
Benign whitish lipid ring that develops around limbus (usually in elderly)
What do you expect to see in diabetic retinopathy?
- Microaneurysms (tiny red dots)
- Retinal hemorrhage
- Neovascularization
- Fibrous proliferations
Normal optic cup/disc diameter ratio:
Under 0.5
Retinal SVPs (retinal spontaneous venous pulsations) are lost in (X) condition/disease.
X = high ICP
How is weber test conducted?
Strike tuning fork and place it at center of patient head; ask if patient hears it equally in both ears
Patient with R-sided hearing loss hears tuning fork vibrations better in R ear when you do Weber test. What kind of hearing loss?
Conductive
Dullness to percussion over lung can be indicative of both (emphysema/infiltrate/pneumothorax/pleural effusion). How can you distinguish between these two?
Infiltrate and pleural effusion
Infiltrate will still allow breath sounds to be heard (though altered) over the area; effusion will have loss of breath sounds
Patient with lateral shoulder pain on adduction (arm across body) but not as much with abduction likely has which problem?
AC joint arthropathy/arthritis
Patient with deltoid bursitis likely has pain with (abduction/adduction).
Abduction
Patient with biceps tendinitis likely has pain with (abduction/adduction).
Abduction
(X)/5 grade means the patient has active movement of the muscle group without gravity, but not against gravity
X = 2
T/F: PHx should be in list format and paragraphs should be avoided.
True
T/F: Meds should be included in PHx.
False
Which cause of fever/cough should be immediately considered in differential in a homeless patient?
TB - common in homeless shelters
In patients over the age of 65 the normal visual acuity is considered to be:
20/25
T/F: Medications should be recorded in generic form.
True
Pt with R side hearing loss. On Rinne test, she hears sound longer through air than through bone, indicating (conductive/sensorineural) hearing loss.
Sensorineural
“Transillumination” of sinuses means:
No thickened mucosa or secretions in sinuses
Positive drop arm test indicates:
rotator cuff tear
Greater trochanteric bursitis will likely cause patient pain on (passive/resisted) (X).
Resisted
X = hip abduction
McMurray test that is positive indicates:
Medial posterior meniscal tear
Depigmentation due to autoimmune attack of melanocytes:
Vitiligo
Fungal infection with red ring on outside and pale area inside:
Tinea corporis
Raised lesion up to 1 cm in diameter:
papule
Flat lesion up to 1 cm in diameter:
macule
Raised lesion 1 cm or larger:
plaque
Flat lesion 1 cm or larger:
patch
Loss of entire L or R field of vision is called:
Homonymous hemianopia
When do you test corneal reflex
Coma; assessing lesions of CN V or VII
Muscle strength scale: what would you rate 0 (the lowest)?
No movement of muscle at all
Muscle strength scale: muscle flickers, but doesn’t contract/move. What is the rating?
1
Muscle strength scale: movement, but not against gravity.
2
Muscle strength scale: movement against external resistance, but some weakness.
4
Muscle strength scale: movement against gravity, but not against resistance.
3
BP: If the brachial artery is below heart level, the blood pressure reading will be (lower/higher); if the brachial artery is above heart level, the reading will be (lower/higher).
Higher; lower
(X) intercostal space for needle insertion for tension pneumothorax. (Y) intercostal space for chest tube insertion.
X = 2nd Y = 4th
(X) intercostal space as a landmark for thoracentesis with needle insertion immediately (superior/inferior) to the (Y) rib.
X = T7-8
Superior (inferior part of ribs have neurovascular structures running there);
Y = 8th
Asymmetric expansion occurs in large (X).
X = pleural effusions
A gap between inspiratory and expiratory breath sounds suggests (X) breath sounds.
X = bronchial
In recent studies, an S3 corresponds to (X), and an S4 to (Y).
X = an abrupt deceleration of inflow across the mitral valve
Y = increased left ventricular end diastolic stiffness (decreases compliance)
Carotid pulse is bounding in aortic (stenosis/regurg). Upstroke of carotid pulse is delayed in aortic (stenosis/regurg).
Regurg; stenosis
A palpable S2 in pulmonic area can indicate (X). And in aortic area, (Y).
X = pulm HT Y = systemic HT
Heart: Give examples of high-pitched sounds, best heard with diaphragm of steth.
S1, S2; aortic and mitral regurg; pericardial friction rub
Heart: Give examples of high-pitched sounds, best heard with bell of steth.
S3, S4; mitral stenosis
Expiratory splitting of S2 suggests (X).
X = valvular abnormality
(Diastolic/systolic) murmurs point to valvular disease but can also be physiologic flow murmurs arising from normal heart valves
Systolic
Object on XRay can have high or low (X).
X = density
Opaque or lucent
Object on CT can have high or low (X).
X = attenuation
Object on MR can have high or low (X).
X = signal
Object on US are described as (X) if black and (Y) if white.
X = echo-lucent Y = echo-genic
T/F: In XR, CT, and MR, imaging based on density.
False - not in MR
MR: imaging related to magnetic properties and distribution of (X) within tissue. For example, water has (little/lots) of (X) and fat has (little/lots) of (X).
X = hydrogen atoms
Lots; little
T1-weighted MRI: (increased/decreased) signal from water, which makes it look (bright/dark). Opposite is said of T2.
Decreased; dark
MR: Fat looks (bright/dark) on T1. And T2?
Bright on both!
Looks dark on fat saturated sequences
MR: Cortical bone looks (bright/dark) on T1. And T2?
Dark on all sequences
Ultrasound images tissues based on their ability to:
transmit or reflect sound
US: (X) is the BEST sound (transmitter/reflector) and appears all black.
X = water
Transmitter
Since (X) and (Y) both prevent deeper transmission of a sound beam, some parts of the body cannot be easily imaged with US. Give two examples.
X = bone Y = air
Brain and lung
Child been tugging on her right ear. On examination you notice an erythematous, bulging tympanic membrane. Diagnosis?
Otitis media
(Soft/firm), (fixed/mobile) nodes are of more concerning for malignancy.
Firm and fixed (and large)
Legal mandates that require use of qualified medical interpretors.
- Title VI of Civil Rights Act 1964
2. Clinton Executive order
About (X) proportion of BMC patients considered to have limited English proficiency. And there are (Y) number of requests for interpreters per year at BMC.
X = 1:3 Y = 200,000