Written Exam (CDUPA2022)

Who lives longer with better health, shorter people or taller people?

Shorter people

How is BMI calculated?

(Weight in Kg) / (Height in meters x height in meters)

BMI 30 and over is classified as what?

Overweight

What is cachexia?

A state of protein-energy malnutrition secondary to an underlying illness that causes chronic muscle breakdown despite nutritional supplementation.

How can you approximate height in normal patients and substitute height in patients with kyphoscoliosis and bilateral limb amputation?

Arm span

Abnormal arm span greater than height is associated with which conditions?

Kallmann Syndrome and Klinefelter Syndrome

Which conditions can you observe disproportionate short stature?

Chondrodysplasia

Hypothermia is defined as a temperature below what level?

Less than 36 degrees C or 96.8F

What are some causes of Hyperthermia?

Hot environments and adverse drug reactions

What are some causes of fever?

Infections, tumors, autoimmune reactions, thyrotoxicosis

What is chronotropic competence?

The ability to increase a bradycardia heart rate using stimuli (ex: situps)

What is chronotropic incompetence?

The inability to increase a bradycardia heart rate using stimuli (ex:situps) because of a bradyarrhythmia.

A heart rate of 40-60 in a person who is chronotropically incompetent implies what kind of disorder?

Junctional Rhythm

A heart rate under 40 in a person who is chronotropically incompetent implies what kind of disorder?

Idioventricular Rhythm

Sinus tachycardia carries a heart rate between which values?

100-150 BPM

Atrial/ventricular tachycardia carries a heart rate between which values?

150-250 BPM

Atrial/ventricular flutter carries a heart rate between which values?

250-350 BPM

Atrial/ventricular fibrillation carries a heart rate between which values?

Over 350 BPM

What effect do vagotonic procedures have on heart rate?

Cause bradycardia

What is the mnemonic for causes of low heart rate?

SASHIMI: Sleep, athletic conditioning, sick sinus syndrome, hypothyroidism, intracranial hypertension, myocardial infarction (inferior), and intraocular hypertension.

What is the mnemonic for causes of high heart rate?

PAPER SHAFT: Pain, anxiety, pheochromocytoma, exercise, respiratory failure, shock, heart failure, anemia, fever, and thyrotoxicosis.

What is Car von Liebermeister rule?

Each degree increase in an adult body temperature above 99F is associated with an increase in 8 beats per minute

What is the mnemonic for causes of narrow pulse pressure?

CLASH: Constrictive pericarditis, left ventricular failure, aortic stenosis, shock, and hypovolemia.

What is the mnemonic for causes of wide pulse pressure?

HAD: Hyperdynamic circulation, arteriosclerosis, and direct vasodilators.

What happens to respiratory rate as children get older?

It decreases

Palmar erythema in the presence of headache can tip you off to which diagnosis?

Brain neoplasms

Which palmar abnormality is associated with chromosomal anomalies?

Single palmar crease

Clubbing of the fingernails implies what conditions?

Cardiovascular, pulmonary, GI, and Thyroid diseases

Koilonychia is associated with which conditions?

Iron deficiency and overload

Beau lines are associated with which conditions?

Chronic illnesses

Mees lines are associated with which conditions?

Heavy metal poisoning

Pincer nails are associated with which conditions?

SLE/psoriasis, onychomycosis

Muehrcke's nails are associated with which conditions?

Hypoalbuminemia

Splinter hemorrhages are associated with which conditions?

Infective endocarditis, trauma, connective tissue diseases

The difference between the pulse and heart rate is called what?

Pulse deficit

Occasional pulse irregularities are caused by what?

Ectopic or escape beat

Regularly irregular heart rhythms are caused by what?

SA or AV heart block

Irregularly irregular heart rhythms are caused by what?

Atrial tachycardia or fibrillation

A pulse deficit over 10 implies what?

Atrial fibrillation

Asymmetry in radial pulses can be caused by which conditions?

Ascending aortic dissection

Asymmetry in radial-femoral pulses can be caused by which conditions?

Descending aortic dissection

If two different blood pressures are obtained from different arms, which arm should you measure on the next visit?

The arm that produced the higher reading

Orthostatic hypotension is defined as a ______ drop in SBP or _____ drop in DBP and a ______ % rise in PR within 3 minutes.

20; 10; 10-20

What rate should you deflate a blood pressure cuff?

At the same rate as the patient's heart rate

Low blood pressure is usually associated with a _________ (increase/decrease) in heart rate except in patients in cardiogenic shock.

Increase

The Frank sign/earlobe crease is associated with what?

An increased risk of cardiovascular disease

A transverse nasal ridge is associated with what?

Allergic rhinitis

What could cause a uvular deviation?

Palatal paralysis or a mass (abscess/neoplasm)

Macroglossia of the tongue could be caused by what?

Congenital or acquired (angioedema, hypothyroidism)

Pediatric lymph enlargement tends to be more _________ while the same in adults tends to be more ____________.

Inflammatory, neoplastic

A ______(lower/higher) waist to hip ratio is associated with lower morbidity and mortality.

Lower

A large/small cuff can lead to a BP inaccuracy of what range?

10-40 mmHg

Pain can lead to an BP increase of what range?

10-30

Cuff bladder length should be _____% of arm circumference, and cuff bladder width should be ______% of arm circumference.

80-100;40

What are some headache red flags?

Thunderclap headache, "worst headache of my life", aggravated/improved with position

What is the most active joint in the human body?

TMJ

Is a snapping TMJ a bad thing?

TMJ disorder but can also be normal

Normally, when the mouth is opened wide, how many fingers can be inserted between the incisors?

Three

Periorbital edema, puffy pale face, and swollen lips describes which condition?

Nephrotic syndrome

Dry, coarse, sparse hair, thin eyebrows, periorbital edema, and a puffy dull face with dry skin describes which condition?

Myxedema

What part of the eye is white and buffy colored at the periphery?

Sclera

What tool do you use to test visual acuity?

Snellen chart or Rosenbaum chart

Which cranial nerve is tested on a visual acuity test?

CN II

Which test is to assess the anterior and posterior visual pathway?

The Static Finger Wiggle Test

If a defect is found on a static finger wiggle test, what further testing should be performed?

Test for direct confrontation

Oblique lighting tests for what during an eye exam?

Corneal and lens opacities, and margins and abnormal shadows of the Iris

A pupil that constricts when a light is shone into it has what quality?

Direct reaction

A pupil that constricts when a light is shone into the opposite eye has what quality?

Consensual reaction

A pupil that constricts when redirecting its gaze to a near object has what reaction?

Near reaction

A light reflection that is slightly nasal to the center of the pupils when a light is shone directly at a patient is called what?

Corneal light reflection

Which test allows you to assess for normal conjugate movements of the eye?

Extraocular muscle testing

What is the range of normal pupil size?

3-5mm

What is the most important step for a fundoscopic exam?

Darken the room

When examining the right eye, your ophthalmoscope should be in your _____ hand using your own _____ eye.

Right; right

When using the ophthalmoscope, place yourself _____ inches away from the patient at a ______-degree angle from the patients line of vision.

15; 15

When observing the optic disc, the cup to disc ratio should be what?

2:1

What test should you use if corneal reflection are asymmetric of if you suspect strabismus?

Cover/uncover test

A flipped lid exam requires the applicator or tongue blade to be placed at least ____ cm above the lid margin at the upper border of the tarsal plate.

1

An enlarged optic disc should indicate what condition?

Papilledema

Cotton wool spots and hemorrhage should indicate what condition?

Diabetic retinopathy

Macular star should indicate what condition?

Hypertensive retinopathy

What is the most common cause of conductive hearing loss?

Cerumen impaction

What is the most common cause of sensorineural hearing loss?

Presbycusis

What is the first test to use when assessing hearing loss?

Whispered voice test

Which test involves placing the base of a vibrating tuning fork firmly on top of the patient's head?

Weber test

During a weber test, sound that is lateralized to the affected ear suggests what?

Unilateral conductive hearing loss

During a weber test, sound that is lateralized to the normal ear suggests what?

Unilateral sensorineural hearing loss

Which test compares air conduction and bone conduction by placing the base of a vibrating tuning fork on the mastoid bone?

Rinne test

In a normal patient, sound is heard longer through the air or through the bone?

The air

To perform an otoscope exam, how should the auricle be positioned?

Pull upward, backward, and slightly away.

A normal tympanic membrane should be what color?

Pearly and gray

Mobility of the tympanic membrane can be assessed with what instrument?

Pneumatic otoscope

What is transillumination of the sinuses performed for?

Assessing for sinusitis

Where does the parotid gland exit in the cheek?

Stensen's duct

Where does the submandibular gland exit under the tongue?

Wharton's duct

Asking the patient to protrude their tongue is to test which cranial nerve?

CN XII

Asking the patient to say "ah" to visualize the rise of the soft palate is to test which cranial nerves?

CN IX and CN X

What characteristics are you assessing for when inspecting lymph nodes?

Size, shape, mobility, consistency, and tenderness

What are the layers of the epidermis, from outermost to innermost?

Corneum, lucidum, granulosum, spinosum, and basale

What does ABCDE refer to in assessing melanoma?

Asymmetry, Borders, Color, Diameter, Evolution