MIDTERM 634 Proper sequence of examination

MIDTERM 634 Proper sequence of examination

MIDTERM 634 Proper sequence of examination

Which is the proper sequence of examination for the abdomen?

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A) Auscultation, inspection, palpation, percussion

B) Inspection, percussion, palpation, auscultation

C) Inspection, auscultation, percussion, palpation

D) Auscultation, percussion, inspection, palpation

Mrs. R. is a 92-year-old retired teacher who comes to your clinic accompanied by her daughter. You ask Mrs. R. why she came to your clinic today. She looks at her daughter and doesn’t say anything in response to your question. This is an example of which type of challenging patient?

A) Talkative patient

B) Angry patient

C) Silent patient

D) Hearing-impaired patient

Which of the following is a clinical identifier of metabolic syndrome?

A) Waist circumference of 38 inches for a male

B) Waist circumference of 34 inches for a female

C) BP of 134/88 for a male

D) BP of 128/84 for a female

Bill, a 55-year-old man, presents with pain in his epigastrium which lasts for 30 minutes or more at a time and has started recently. Which of the following should be considered?

A) Peptic ulcer

B) Pancreatitis

C) Myocardial ischemia

D) All of the above

A 75-year-old retired teacher presents to your clinic, complaining of severe, unrelenting anterior chest pain radiating to her back. She describes it as if someone is “ripping out her heart.” It began less than an hour ago. She states she is feeling very nauseated and may pass out. She denies any trauma or recent illnesses. She states she has never had pain like this before. Nothing seems to make the pain better or worse. Her medical history consists of difficult-to-control hypertension and coronary artery disease requiring two stents in the past. She is a widow. She denies any alcohol, tobacco, or illegal drug use. Her mother died of a stroke and her father died of a heart attack. She has one younger brother who has had bypass surgery. On examination you see an elderly female in a great deal of distress. She is lying on the table, curled up, holding her left and right arms against her chest and is restless, trying to find a comfortable position. Her blood pressure is 180/110 in the right arm and 130/60 in the left arm, and her pulse is 120. Her right carotid pulse is bounding but the left carotid pulse is weak. She is afebrile but her respirations are 24 times a minute. On auscultation her lungs are clear and her cardiac examination is unremarkable. You call EMS and have her taken to the hospital’s ER for further evaluation. MIDTERM 634 Proper sequence of examination

What disorder of the chest best describes her symptoms?

A) Angina pectoris

B) Pericarditis

C) Dissecting aortic aneurysm

D) Pleural pain

A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following is true?

A) She obtains a 20% correct score at 100 feet.

B) She can accurately name 20% of the letters at 20 feet.

C) She can see at 20 feet what a normal person could see at 100 feet.

D) She can see at 100 feet what a normal person could see at 20 feet.

A 46-year-old former salesman presents to the ER, complaining of black stools for the past few weeks. His past medical history is significant for cirrhosis. He has gained weight recently, especially around his abdomen. He has smoked two packs of cigarettes a day for 30 years and has drunk approximately 10 alcoholic beverages a day for 25 years. He has used IV heroin and smoked crack in the past. He denies any recent use. He is currently unemployed and has never been married. On examination you find a man appearing older than his stated age. His skin has a yellowish tint and he is thin, with a prominent abdomen. You note multiple “spider angiomas” at the base of his neck. Otherwise, his heart and lung examinations are normal. On inspection he has dilated veins around his umbilicus. Increased bowel sounds are heard during auscultation. Palpation reveals diffuse tenderness that is more severe in the epigastric area. His liver is small and hard to palpation and he has a positive fluid wave. He is positive for occult blood on his rectal examination.

What cause of black stools most likely describes his symptoms and signs?

A) Infectious diarrhea

B) Mallory-Weiss tear

C) Esophageal varices

Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn’t blanch. What would you tell her regarding her rash?

A) It is likely to be related to her lupus.

B) It is likely to be related to an exposure to a chemical.

C) It is likely to be related to an allergic reaction.

D) It should not cause any problems.

A 21-year-old receptionist comes to your clinic, complaining of frequent diarrhea. She states that the stools are very loose and there is some cramping beforehand. She states this has occurred on and off since she was in high school. She denies any nausea, vomiting, or blood in her stool. Occasionally she has periods of constipation, but that is rare. She thinks the diarrhea is much worse when she is nervous. Her past medical history is not significant. She is single and a junior in college majoring in accounting. She smokes when she drinks alcohol but denies using any illegal drugs. Both of her parents are healthy. Her entire physical examination is unremarkable.

What is most likely the etiology of her diarrhea?

A) Secretory infections

B) Inflammatory infections

C) Irritable bowel syndrome

D) Malabsorption syndrome

A 27-year-old policewoman comes to your clinic, complaining of severe left-sided back pain radiating down into her groin. It began in the middle of the night and woke her up suddenly. It hurts in her bladder to urinate but she has no burning on the outside. She has had no frequency or urgency with urination but she has seen blood in her urine. She has had nausea with the pain but no vomiting or fever. She denies any other recent illness or injuries. Her past medical history is unremarkable. She denies tobacco or drug use and drinks alcohol rarely. Her mother has high blood pressure and her father is healthy. On examination she looks her stated age and is in obvious pain. She is lying on her left side trying to remain very still. Her cardiac, pulmonary, and abdominal examinations are unremarkable. She has tenderness just inferior to the left costovertebral angle. Her urine pregnancy test is negative and her urine analysis shows red blood cells. MIDTERM 634 Proper sequence of examination

What type of urinary tract pain is she most likely to have?

A) Kidney pain (from pyelonephritis)

B) Ureteral pain (from a kidney stone) (Answer)

C) Musculoskeletal pain

D) Ischemic bowel pain

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

B) Cholecystitis

C) Pancreatitis

D) Appendicitis


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