Bmd Test 2

Front 1

1. What conditions are caused by GI bleeding?

Back 1

a. Hematochezia, melena

Front 2

2. What symptoms are suggestive of UTI?

Back 2

a. a. Dysuria, hesitancy, urgency, pain, urinary incointinence

Front 3

3. What are the causes of stress, urge, overflow, and functional incontinence?

Back 3

a. (Urinary incontinence) Stress=abdominal pressure, urge=muscle overacting,
overflow= nerves, multiple sclerosis, functional=can’t go to bathroom

Hint 3

>>>case and we will tell what it is

Front 4

4. What is the differential diagnosis of painful and painless Hematuria?

Back 4

Painless is Cancer of Bladder or Kidney, painful is stones

Front 5

5. What is the difference between risky or hazardous and harmful drinking?

Back 5

a. → The difference is Harmful drinking is considered as “Drinking that causes physical, social, or psychological harm from alcohol use but does not meet the criteria for dependence”
→ Risky=hazardous
1) For women, > 7 drinks/wk or > 3 drinks/occasion
2) For men, > 14 drinks/wk or > 4 drinks/occasion

Hint 5

7/3
14/4

Front 6

6. What are the serious complications of hepatitis B virus infection?

Back 6

→ fulminant (violent) hepatitis
→ chronic infection
→ Cirrhosis
→ Carcinoma - Cancer of Liver (Hepatocellular carcinoma)

Front 7

7. At what age does the screening for colorectal cancer start?

Back 7

→ American Cancer Society recommends tests beginning at age 50 (starts at 40 if there are risk factors)
→

Front 8

8. What is the correct sequence of the abdominal examination?

Back 8

→ Sequence is:
1) Inspection

◊ Scars, striate, dilated veins, rashes and lesions

◊ Contour of the abdomen

◊ Peristalsis

◊ Pulsations

2) Auscultation

◊ Performed prior to percussion or palpation because these maneuvers may alter the frequency of bowel sounds

◊ Borborygmi, bruits, friction rubs over the liver and spleen

3) Percussion

◊ Normal: tympani (hyper resonant) with scattered dullness

4) Palpation

◊ Involuntary rigidity-totally relaxed

◊ Abdominal mass

◊ Tender abdomens

◊ Rebound tenderness (Blumberg’s sign)
Class notes
□ Involuntary rigidity-totally relaxed
□ Rebound tenderness (Blumberg’s sign) = severe tenderness, membrane of intestine is tender---appendicitis type of things
□ Don’t confuse with Romberg which is a lack of balance
□ Inspection, auscultation before palpitation may move and change the sound of things 

Hint 8

IAPerPal

Front 9

9. Which element of the physical examination on the abdomen generates most information?

Back 9

→ Abdominal palpation

Front 10

10. What is the definition or indication of Blumberg’s sign, Murphy’s punch sign, McBurney’s sign, (which is outer 1/3 of umbillicus and ASIS anterior superior Illiac spine) and indicates append Rovsing’s sign, and Murphy’s

Back 10

→ Murphy’s sign (a sharp increase in tenderness with a sudden stop in inspiratory effort), right hypochondriac area and lower right indicates acute cholecystitis
→ McBurney’s Point/sign - localized tenderness related to appendicitis
→ Roysings sign – pain in RLQ during left sided pressure related to appendicitis
→ Blumbergs sign - rebound tenderness during palpitation

Front 11

11.How is ascites clinically assessed?

Back 11

→ Fluid waving in bdomen,
→ shifting dullness sign,
→ tympani surrounded by dullness
1) borborigmus is when fluid moves through the gases,
2) most useful one is percussion for shifting dullness

Front 12

12. What are the causes of loss of libido and erectile dysfunction?

Back 12

→ psychogenic causes (e.g. depression),
→ endocrine dysfunction,
→ side effects of medications
Most common:
1. Psychological
2. Then Endocrine dysfunction or side effects from medications but not STD’s 

Front 13

13.What are the common STDs? List at least 6 examples

Back 13

→ Examples:
1) Chlamydia: approximately 4 million cases,
2) Gonorrhea: approximately 800,000 cases,
3) Trichomas vaginitis and nonspecific urethritis: several million cases,
4) HIV infection: 40,000 cases,
5) syphilis,
6) HPV, HBV,
7) and genital herpes

Front 14

14. What is the most common cancer of young men between ages 15 and 35?

Back 14

→ Testicular cancer
□ Recommendation for screening is monthly

Front 15

15. What are the examples of female sexual dysfunction?

Back 15

→ Lack of desire (frigidity),
→ Inability to reach orgasm,
→ Dyspareunia, or vaginismus (vaginal spasm)
□ are due to psychiatric, medical, or lack of estrogen

Front 16

16. What diseases are associated with postmenopausal bleeding and postcoital bleeding?

Back 16

→ Post menopausal bleeding - Endometrial cancer or carcinoma,
→ postcoital bleeding = cervical cancer

Front 17

17. At what age is the Pap smear test given?

Back 17

→ By 18 or if sexually active it can be anytime is every year after that regardless if you are active or not

Front 18

18. Which viral infection is associated with cervical cancer?

Back 18

→ HPV

Front 19

19. What are the options for family planning or birth control?

Back 19

→ Natural:
}periodic abstinence,
} withdrawal,
→ Barrier:
} condom,
} diaphragm,
→ Implantable: intrauterine device (IUD),
→ Subdermal implant,
→ Pharmacologic interventions:
} OCPs (oral contraceptive pills), injectables,
} spermicides,
→ Surgical:
} tubal ligation,
} vasectomy>>>>

Hint 19

□ IUD sample question on test…is implantable

Front 20

20. What are the changes seen in menopausal women?

Back 20

→ Mood shifts,
→ Vasomotor changes, (hot flashes),
→ Accelerated bone loss (osteoporosis),
→ Increases in total and LDL cholesterol (cardiovascular disease),
→ Vulvovaginal atrophy (vaginal drying, dysuria, dyspareunia)

Front 21

21. What are the risk factors for prostate cancer?

Back 21

→ Age,
→ African Americans (low in Asian and Native Americans),
→ first-degree relative with the prostate cancer,
→ and possibly diet,
→ testosterone supplement, high hormone levels
→ vasectomy, etc.

Front 22

22. What are the 2 principal screening tests for prostate cancer? At what age are they offered?

Back 22

→ DRE (digital rectal exam),
→ PSA-prostate specific antigen,
→ Annually, starting at age 50 and for African Americans and men with a positive family history at age 40

Front 23

23. What are the screening options for colorectal cancer?

Back 23

} DRE,
} FOBT or fecal occult blood test
} Sigmoidoscopy, and
} Colonoscopy

Front 24

24. What is the cause of pain in the arms and legs that arises from the peripheral vascular system?

Back 24

→ Arteriosclerosis

--Pain in the arms or legs: May arise from skin, peripheral vascular system, musculoskeletal system, or nervous system, Visceral pain may be referred to the arms or legs.

Front 25

25. What are the characteristics of intermittent claudication?

Back 25

Exercise-induced pain that is absent at rest, makes the patient stop exertion, and remits within about 10 minutes, Mainly due to atherosclerosis

Front 26

26. What are the features of Raynaud’s phenomenon or disease?

Back 26

→ Digital ischemic changes of blanching,
→ fFollowed by cyanosis,
→ then rubor with cold exposure
→ and rewarming

Front 27

27. What are the risk factors for peripheral arterial disease?

Back 27

→ Current or past tobacco use,
→ diabetes,
→ hypertension,
→ hyperlipidemia,
→ or cardiovascular or cerebrovascular disease,
-Detection of peripheral arterial disease (PAD), Refers to atherosclerotic occlusion of arteries in the lower extremities, Classic triad: vascular claudication, exercise-induced calf pain that causes stopping of exercise, with relief of pain in 10 minutes or less..

Front 28

28. How is the amplitude of arterial pulses graded on a scale of 0 to 4?

Back 28

→ Normal is 2, 4 is bounding
→ Grading the amplitude of the arterial pulses on a scale of 0 to 4
4+: Bounding
3+: Increased
2+: Brisk, expected
1+: diminished, weaker than expected
0: absent, unable to palpate

Front 29

29. What arterial pulses may be felt in the lower extremities?

Back 29

→ Feneral,
→ popliteal,
→ dorsalis pedis,
→ posterior tibia

Front 30

30. What are the causes of peripheral edema in the lower extremities?

Back 30

→ Recent deep vein thrombosis (DVT),
→ Chronic venous insufficiency due to previous DVT or to incompetence of the venous valves,
→ Lymphatic vessel obstruction (lymphedema)

Front 31

31. What are the Allen test and the Trendelenberg test used to evaluate?

Back 31

1) Allen test - Test the patency of the radial and ulnar arteries (blood supply to hand)
→ Recent deep vein thrombosis (DVT),
→ Chronic venous insufficiency due to previous DVT or to incompetence of the venous valves,
→ Lymphatic vessel obstruction (lymphedema)
□ Arterial occlusive disease is much less common in the arms than in the legs
□ Absent or diminished pulses at the wrist are seen in acute embolic occlusion and in thromboangiitis obliterans tren= venous due to
2) Trendelenberg test- Evaluates competency of venous valves in lower legs (incompetent valvles, Saphenous vein.


□ Start with the patient supine

□ Elevate one leg to about 90º to empty it of venous blood

□ Next, occlude the great saphenous vein in the upper thigh by manual compression

□ Ask the patient to stand while you keep the vein occluded

□ Watch for venous filling in the leg

□ Normally the saphenous vein fills from below, taking about 35 seconds as blood flow through the capillary bed into the venous system

□ After the patient has stood for 20 seconds, release the compression and look for sudden additional venous filling

□ Normally there is none, because competent valves in the saphenous vein block retrograde flow

Front 32

32. What is the most common and widespread disorder of the musculoskeletal system?

Back 32

→ Backache and back pain

Front 33

33. What are the 3 steps in guiding subsequent examination and diagnosis of joint pain?

Back 33

1) Point to the pain,
2) Mechanism of injury,
3) Pain is localized or diffuse, acute or chronic, inflammatory or noninflammatory

Front 34

34. What is the difference between infectious and non-infectious joint pain?

Back 34

→ Infectious: septic arthritis
→ Non-infectious: gout or rheumatic fever

Front 35

35. What are the examples of joint pain that is linked to the conditions of other organ systems?

Back 35

→ Psoriasis,
→ Lyme disease,
→ Reiter’s syndrome
□ With systemic features: Rheumatoid arthritis, systemic lupus erythematosus (SLE), polymyalgia rheumatica (PMR)

Front 36

36. What are the risk factors for elderly falls?

Back 36

→ Poor vision,
→ Cognitive physiologic=unstable gait
→ Imbalanced posture
→ Reduced strength
→ Cognitive loss as in dementia

Front 37

37. At what age does the routine bone density screening for women begin?

Back 37

→ 65 + for women

Front 38

38. What is the single best predictor of low bone density?

Back 38

→ low body weight

Front 39

39. What are the risk factors for osteoporosis?

Back 39

1) low body weight (single best predictor of low bone density),
2) estrogen deficiency,
3) white race,
4) family history,
5) smoking,
6) and prior vertebral fractures

Front 40

40. How is a major joint of the body examined?

Back 40

1) Inspection for joint symmetry, alignment, bony deformities
2) Inspection and palpation of surrounding tissues for skin changes, nodules, muscle atrophy, crepitus (an audible or palpable crunching noise during movement of tendons or ligaments over bone)
3) Range of motion (ROM) and maneuvers

Front 41

41. What are the causes of carpal tunnel syndrome?

Back 41

1) Repetitive motion with wrists flexed,
2) pregnancy,
3) rheumatoid arthritis,
4) diabetes,
5) hypothyroidism.

Front 42

42. What physical examinations are performed for carpal tunnel syndrome?

Back 42

1) Thenar atrophy on inspection,
2) Thumb abduction: Ask the patient to raise the thumb perpendicular to the palm as you apply downward pressure on the distal phalanx
3) Tinel’s sign,---Light percussion (with your forefingers) over the course of the median nerve in the carpal tunnel with your finger causes tingling or electric sensations in the nerve distribution (positive sign),
4) Phalen’s test,---Asking the patient to press the backs of both hands together to form right angle causes numbness and tingling over the nerve distribution (positive test)

Front 43

43. How is the herniated lumbar disc clinically evaluated?

Back 43

1) Straight leg raising test
□ For patients with low back pain that radiates down the leg
□ With the patient supine, raise the relaxed and straightened leg until pain occurs, then dorsiflex the foot (pain increases)
2) Crossed straight leg raising test
□ Increased pain in the affected leg when the opposite leg is raised strongly confirms radicular pain due to compression of the nerve roots (L5 and S1) from a herniated lumbar disc

Front 44

44. What are Lachman test and McMurray test used for?

Back 44

1) Lachmen test = ACL tear

2) McMurray test = for injuries on medial and lateral meniscus

Front 45

45. What are the features of rotator cuff syndrome, frozen shoulder, tennis elbow, and golfer’s elbow?

Back 45

→ Rotator cuff syndrome
• Repeated shoulder motion, as in throwing or swimming, can cause edema and hemorrhage followed by inflammation, most commonly involving supraspinatus tendon
→ Frozen shoulder (adhesive capsulitis)
• Fibrosis of the glenohumeral joint capsule, manifested by diffuse, dull, aching pain in the shoulder and progressive restriction of active and passive range of motion, but usually no located tenderness
• Occurs in people aged 50 or over and is degenerative
→ Tennis Elbow or Lateral epicondylitis (tennis elbow)
• Follows repetitive extension of the wrist or pronation-supination of the forearm
• Pain and tenderness over the lateral epicondyle and in the extensor muscles close to it
• When the patient tries to extend the wrist against resistance, pain increases
→ Golfer's Elbow or Medial epicondylitis (pitcher’s, golfer’s, or Little League elbow)
• Follows repetitive wrist flexion
• Tenderness is maximal at medial epicondyle
• Wrist flexion against resistance increases pain

Front 46

46. How is rheumatoid arthritis different from osteoarthritis in terms of clinical manifestations?

Back 46

→ Rheumatoid arthritis = hands and fingers, swollen and red, worse after rest, joints are affected on both sides
→ Osteoarthritis = larger joints hips and knees, short term pain, better after rest, only joints on one side may be affected
□ Rheumatoid arthritis definition= Tender, painful, stiff joints with symmetric involvement, Subcutaneous nodules and muscular atrophy in the hands, Ulnar deviation, swan neck deformity(fingers), and Boutonnière deformity

□ Osteoarthritis definition =
◊ Degenerative joint disease
◊ Radial deviation of distal phalanx
◊ Heberden’s node (in DIP) and Bouchard’s node (in PIP) without involvement of MCP joints

Front 47

47. What are the characteristics of gout?

Back 47

→ mostly affects the 1st MTP joint or dorsum of the foot with a very painful and tender, hot, dusky red swelling that extends beyond the margin of the joint
→ Deformities of long-standing chronic gout can mimic rheumatoid arthritis and osteoarthritis
→ Knobby swellings around the joints ulcerate and discharge white chalklike urates
→ Hyperuricemia

Front 48

48. What are the definitions of bunion, corn, and callus?

Back 48

1) Bunion keyword is bone,
→ Bunion (hallux valgus):
• Great toe is abnormally abducted in relationship to the 1st metatarsal, which itself is deviated medially. The head of the 1st metatarsal may enlarge on its medial side at the pressure point
2) Corn keyword is skin and painful
→ A painful conical thickening of skin that results from recurrent pressure on normally thin skin, especially on the 5th toe over the bony prominence
3) Callous keyword is skin
→ A painless corn that involves skin in a region of recurrent pressure, which is normally thick, such as the sole

Front 49

49. Define terms used in mental status examination

Back 49

1) Level of consciousness
• Alertness or state of awareness of the environment
2) Attention
• Ability to focus or concentrate over time on one task or activity
3) Memory
• Process of registering or recording information
4) Orientation
• Awareness of personal identity, place, and time, which requires both memory and attention
5) Perceptions
• Sensory awareness of objects in the environment and their interrelationships (external stimuli); also refers to internal stimuli, such as dreams or hallucinations
6) Thought processes
• Logic, coherence, and relevance of the person’s thought as it leads to selected goals, or how people think
7) Thought content
• What the person thinks about, including the level of insight and judgment
8) Insight
• Awareness that symptoms or disturbed behaviors are normal or abnormal
9) Judgment
• Process of comparing and evaluating alternatives when deciding on a course of action; reflects values that may or may not be based on reality and social conventions or norms
10) Affect
• Observable, usually episodic, feeling or tone expressed through voice, facial expression, and demeanor
11) Mood
• More sustained emotion that may color a person’s view of the world (mood is to affect as climate to weather)

Front 50

50. What is mini mental status examination? What are the 5 aspects?

Back 50

} It is useful in screening for cognitive dysfunction or dementia and following their course over time
→ 5 Aspects:
1) Orientation
2) Registratio
3) Attention
4) Calculation
5) Recall
6) Language

Front 51

51. Which aspect accounts for the highest percentage of the total score in MMSE?

Back 51

→ Orientation and is a total of 10 points

Front 52

52. What are the early clues to the diagnosis of major depression?

Back 52

1) Low self-esteem
2) Anhedonia (failure to find pleasure in daily life activties)
3) Sleep disorders
4) Difficulty concentrating or making decisions

Front 53

53. What are the risk factors for major depression?

Back 53

1) Young, female, single, divorced, separated, seriously or chronically ill, or bereaved
2) Prior history of depression or positive family history

Front 54

54. What are the risk factors for dementia?

Back 54

1) Age,
2) dyslipidemia,
3) hypertension,
4) mild cognitive impairment,
5) and positive family history

Front 55

55. What are the 2 most common concerning symptoms in neurologic disorders?

Back 55

→ Near-syncope (presyncope) is feeling faint, light-headed, or weak, but without actual loss of consciousness
→ Syncope (fainting) is sudden but temporary loss of consciousness that occurs with decreased blood flow to the brain

} Syncope Causes: vasovagal, postural or othorstatic, cough, micturition, cardiovascular (arrhythmias, aortic stenosis with hypertrophic cardiomyopathy, myocardial infarction) and Massive pulmonary embolism

Front 56

57.What are the different types of seizures?

How are tremors clinically differentiated?

Back 56

→ Partial seizures start with focal manifestations
→ Simple partial seizures do not impair consciousness, while complete partial seizures do
→ Generalized seizures begin with bilateral body movements, impairment of consciousness, or both
→ Pseudoseizures mimic seizures but are due to a conversion reaction,
→ Tremors or involuntary movements
1) Resting (static) tremors
◊ Most prominent at rest, and may decrease or disappear with voluntary movement
◊ Seen in Parkinson’s disease
2) Postural (action) tremors
◊ Appear when the affected part is actively maintaining a posture, and may worsen with intention
◊ Examples include anxiety and fatigue, hyperthyroidism, and benign essential (and sometimes familial) tremor
3) Intention tremors
◊ Absent at rest, appear with activity, and often get worse as the target is neared
◊ Causes are cerebellar disord

Front 57

58. What are the risk factors for stroke?

Back 57

1) Hypertension (leading contributor to both ischemic and hemorrhagic stroke)
2) Dyslipidemia –abnormal lipid profile
3) Heavy alcohol use
4) Physical inactivity
5) Obesity
6) Diabetes

Front 58

59. How is muscle strength graded on a scale of 0 to 5?

Back 58

Þ Keywords is Normal/5, and 2/no gravity
• 0 – no muscle contraction detected
1 – barely detected flicker or trace of contraction
• 2 – active movement of the body part with gravity eliminated
• 3 – active movement against gravity
• 4 – active movement against gravity and some resistance
• 5 – active movement against full resistance without evident fatigue (normal muscle strength

Front 59

60. What 4 areas of the nervous system function are required for coordination?

Back 59

1) Motor system for muscle strength
2) Cerebellar system for rhythmic movement and steady posture
3) Vestibular system for balance and coordination of eye, head, and body movement
4) Sensory system for position sense

Front 60

61. What are the commonly used tests for coordination?

Back 60

1) Rapid alternating movements
2) Finger-nose test
3) Heel-shin test
4) Walk heel-to-toe
5) Walk on the toes
6) Romberg test (standing with eyes closed for 20-30 seconds)
7)Test for pronator drift (arms straight forward with palms up and eyes closed for 20-30 seconds)

Front 61

62. What are the dermatomes for hand and foot?

Back 61

→ Dermatomes for the hand are C6, C7, C8
→ Dermatomes for the foot are L5 and S1
→ Others:
□ T4 (nipple),
□ T10 (umbilicus),
□ L1 (inguinal),
□ L4 (knee)

Front 62

63. What are the common tests for sensations?

Back 62

→ Pain and temperature
→ Position and vibration
→ Light touch
→ Discriminative sensations
→ Stereognosis (ability to identify an object by feeling it)
→ Graphesthesia (number identification)writing on your body
→ 2-point discrimination
→ Point localization
→ Extinction (ability to feel stimulation on both side

Front 63

64. How are deep tendon reflexes graded according to a scale of 0 to 4?

Back 63

→ Scale for grading reflexes
→ 0 – no response
→ 1+ - somewhat diminished (low normal)
→ 2+ - average (normal)
→ 3+ - brisker than average (not necessarily indicative of disease)
→ 4+ - hyperactive with clonus (rhythmic oscillations between flexion and extension)

Front 64

66. What is a Babinski’s response of the plantar reflex?

Back 64

a. Abnormal (Babinski’s) response: dorsiflexion of the big toe with fanning of the other toes, suggesting CNS or upper motor neuron lesions

Front 65

67. What are the typical meningeal signs? List 3 examples.

Back 65

1) Neck mobility-Pain in the neck and resistance to flexion (stiff Neck)
2) Brudzinski’s sign-As you passively flex the neck, both hips and knees are actively flexed
3) Kernig’s sign-You flex the patient’s leg at both the hip and the knee, and then straighten the knee, Pain and increased resistance to extending the knee

Front 66

68. What are the common concerns during 1st, 2nd, and 3rd trimesters of pregnancy?

Back 66

Throughout pregnancy:
► Heartburn
► Constipation
► Backache
► Leukorrhea
► Amenorhrea
1) 1st trimester -
► amenorhrea
► nausea with or without vomiting
► Breast tenderness and tingling
► weight loss
2) 2nd trimester - 14-20 weeks
► Amenorhea
► groin and lower abdominal pain
3) 3rd trimester -
► Edema
► Urinary frequency
► Fatigue

Front 67

69. What aspects are included in the 10-minute geriatric screener?

Back 67

→ Vision
→ Hearing
→ Leg mobility
→ Urinary incontinence
→ Nutrition/weight loss
→ Memory
→ Depression
→ Physical disability
---bowel movement
• Does not include:
□ SEXUAL aspects