2014/15 Final Retake

Question 1

Most common causes of crackles

Answer 1

1. Pneumonia -> consolidation
2. Fibrosis
3. Bronchitis
4. Early congestive heart failure (left)

Question 2

Areas of heart auscultation
Pulmonary
Aortic
Tricuspid
Mitral

Answer 2

Pulmonary - Left 2nd intercostal space
Aortic - Right 2nd intercostal space
Tricuspid - 4th intercostal space left of sternal border
Mitral - Left 5th intercostal space in anterior axillary line

Question 3

What is bronchial sound and when does it occur

Answer 3

It is a consolidation, occurring during pneumonia,onia, lung abscesses or dense fibrosis

Question 4

When can you hear bronchial breathing

Answer 4

During a collapsed lung if the airway is patent

Question 5

Characteristic sound for asthma

Answer 5

Wheezes

Question 6

Normal oral temperature

Answer 6

35.8 in the morning -> 37.3 in the afternoon

Question 7

Rheumatoid arthritis

Answer 7

Joint pain, swelling and tender to the touch
Puffy red hands
Rheumatoid nodules
Fatigue
Fever
Weight loss

Question 8

Kidney stone risk factors

Answer 8

High protein diet
Low water intake
Hyperparathyroidism
Family history
Dehydration
Obesity

Question 9

Malignant vs inflamed lymph nodes

Answer 9

Enlarged, firm, fixed, painful if inflamed

Question 10

Lid lag phenomenon / Graefe’s sign

Answer 10

Sign for hyperthyroidism (thyrotoxicosis)
Inability of upper eyelids to follow the eyes downwards
Rim of sclera appears between the upper lid margin

Question 11

What is pleuritic pain

Answer 11

Inflammation of the parietal pleura
Occurs in pleurisy, pneumonia, pulmonary infarction, neoplasm
Occurs overlying the inflammation
Sharp, knife-like pain increasing with inspiration

Question 12

Cor pulmonale / Right sided heart failure

Answer 12

Enlargement of right ventricle due to high blood pressure in the lungs (chronic lung diseases like COPD or pulmonary embolism/fibrosis)
Causes:
1. Enlarged liver and spleen
2. Ascites
3. Fatigue
4. Increaed peripheral venous pressure

Question 13

Describe diastolic heart failure

Answer 13

Systolic pumping is normal
Ejection fraction is normal or elevated
Lower compliance in cardiac muscle
Increased after-load

Question 14

Describe ejection fraction

Answer 14

Fraction of blood ejected out of the ventricles
Ejection Fraction = Systolic Volume/End Diastolic Volume
Normal 50-70%

Question 15

Glasgow Comma Scale

Answer 15

3 = Brain dead
6-8 = Unconscious
15 = Alert, normal

Question 16

3 signs of acute (surgical) abdomen

Answer 16

Absence of bowel sounds
Involuntary muscle guarding
Positive Blumberg sign (rebound tenderness)

Question 17

What causes acute pancreatitis

Answer 17

Intake of alcohol and large amounts of fatty food

Question 18

Physiological S2 split describe

Answer 18

Occurs during inspiration
= Inspiration -> Drop in intrathoracic pressure -> increased venous return -> increased right ventricular filling -> increased right ventricular stroke volume -> increased RV ejection time -> delayed closure of pulmonary valve

Normal only in childhood and adolescence
Don’t look on the right side, look on the left in the 2nd and 3rd inter-costal space

Question 19

4 groups of lymph nodes at level of head and neck

Answer 19

Occipital
Parotid
Buccal
Submental