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1

63 yo male with shortness of breath, and cough productive small amounts of blood in sputum. This condition is intermittently through last several months

Could be TB or bronchogenic carcinoma

2

56 yo male with acute chest pain. Started one week ago with no trauma and steady course. Pain is 7-8/10, retrosternal and at the front chest area and the left sternal margin. Patient is a smoker for 25 years and smokes up to a pack a day. Pain is associated with cough productive with mucopurulent sputum that started one week ago. 140/90 BP, oral temp 101, pulse 90 bpm.

Pneumonia (most appropriate dx)

3

When auscultating for the carotid artery which part of the stethoscope is best used?

Diaphragm and the Bell (for bruits)

4

Which of the following may indicate fracture of base of skull

Battle Sign

5

Which of the following valvular lesions can cause pulmonary congestion?

Mitral stenosis
This leads to left atrial enlargement
and will cause a murmur that is increased during expiration

6


Tricuspid stenosis may lead to

Right atrial enlargement

and

Will cause a murmur that is increased during inspiration

7

Pulmonic stenosis may lead to ----- enlargement

RV enlargement

8

In hyperthyroidism which of the following is likely to happen?

Tachycardia
Increased metabolic rate

9

Pitting edema associated with pathology in ___, ___, and ____

heart, liver, and kidney

10

Stabbing pain -->

Pleurisy

11

Most significant fault in Tetralogy of Fallot that causes cyanosis at birth?

Aortic valve overriding on both ventricles

12

WOTF blood changes usually accompany emphysema?

Increased RBC number

13

Sound normally heard over trachea and main bronchi of lung is

bronchial

14

Emphysema is accompanied by _______ of fingernails, _________ note upon percussion, and decreased tactile _________.

clubbing of fingernails, hyperessonant note upon percussion, decreased tactile fremitus

15

56 yo male with chest pain. Started one week ago, no trauma and steady course. Pain is 7-8/10, retrosternal and at the front chest area and the left sternal margin. Patient is a smoker for 25 years and smokes up to a pack a day. Pain is associated with cough productive with mucopurulent sputum that started one week ago. 140/90 BP, oral temp 99.6, pulse 90 bpm.

The pain is stabbing, localized above the left costal margin, aggravated by deep breathing. Recent onset, 4 days, associated with dry cough that started one week ago. Cough aggravates the condition.

Most appropriate impression ________
Next step?

Pleurisy (Stabbing, knife-like pain localized above the left costal margin, aggravated by deep breathing)

Patient may continue with his chiropractic care and closely observe the progress of symptoms and signs with recommendation to see a family physician if the condition worsened

16

Precordial heaving is a sign of

Cor Pulmonale

17

TB and bronchogenic carcinoma cause

hemoptysis

18

High fevers over 101
" P, T, N"

Pneumonia, Tonsillitis, Nephritis

19

Carotid artery auscultation – mainly for carotid artery calcification

Is this the only way to dx cacification?
What does the patient do during this exam
and do you use both the diaphragm and bell?

Only way to diagnose is stethoscope over carotid
Pt turns head and holds breath
Use both diaphragm and bell

20

What is the most common valvular lesion of the heart

Mitral stenosis caused by pulmonary congestion

21

FYI Slide

Pitting edema caused by hydrostatic (heart pumping has been compromised – left ventricular failure = orthostatic edema) or loss of osmotic pressure inside BV (albumin – keeps fluid inside) if you lose albumin you lose osmotic pressure and will diffuse into interstitial tissue (liver failure or kidney) liver is sole producer of albumin

Kidney – normal protein but losing it from nephritis = proteinuria  hypoalbuminemia


Pitting edema caused by hydrostatic (heart pumping has been compromised – left ventricular failure = orthostatic edema) or loss of osmotic pressure inside Blood vessels (albumin – keeps fluid inside)

If you lose albumin you lose osmotic pressure and plasma proteins will diffuse into interstitial tissue (common in liver failure or kidney failure )

Liver is sole producer of albumin

Kidney – normal protein but losing it from nephritis = proteinuria  hypoalbuminemia

22

Night fever and night sweats caused by

Hodgkin’s disease and TB

23

Reed Sternberg cells is an associated histopathological finding of which condition?


Hodgkin’s

24

What is the triad of pancytopenia?

Leukopenia, thrombocytopenia, anemia

25

Tetralogy of Fallot

________ ventricular hypertrophy

Ventricular septal defect – movement of blood between Left Ventricle and Right Ventricle – mixing of oxygenated and deoxygenated blood

________ stenosis
most significant fault in the tetralogy is an _____ ______

Right ventricular Hypertrophy
VSD mixing of O2 and DeO2 blood
Pulmonary Stenosis
Overriding Aorta

26

Systems hypertension may lead to _____ enlargement

Left Ventricular Enlargement

27

Decreased tactile fremitus, breath sounds, chest expansion

Emphysema

28

Malaise (lack of energy)
Polycythemia
Hyperresonant
Usually older patient with Hx of smoking
No movement during respiratory excursion
Barrel chest with decreased chest expansion

Emphysema

29

MC organ abdominal injury is spleen

blunt trauma MVA or fall

30

Bluish coloration around umbilicus indicating
Intra abdominal hemorrhage

Cullen’s sign

31

Melena – peptic/gastric ulcer True or False

True

32

10 yo girl presents with a 4 day history of pain in the knees, hips, shoulders, and wrists. The joints are not swollen, red, or tender. Her temperature is 102. Her mother states that her daughter’s only recent illness was a sore throat 1 month ago. Auscultation of the chest reveals an apical systolic murmur. What does she have?

Rheumatic fever

33

As it relates to Rheumatic fever .....
The causative organism is __________

Antistreptolysin O = ASO positive

This may lead to mitral ______ ______

This can cause ________ congestion

Beta hemolytic strep group A

Mitral valve stenosis

Pulmonary Congestion

34

The ________ impulse is visible, palpable pulsating force against the chest wall caused by Left ventricular contraction and is associated with the S1 sound

Apical

35

Liver cirrhosis ---> esophageal varices --> hematemesis (lethal)

Indicating Advanced ______ failure

Liver failure

36

Hep A – transmitted by food, will go away with 0 complications, with proper

handwashing

37

Hep B – transmitted by ______, blood transfusion, sex, mother to child, post hepatitis cirrhosis/fibrosis, condom use/abstinence

blood

38

separation of rectus abdominis – weak abdominal muscles

Diastasis recti

39

Caput medusa – associated with ______ ______ and liver cirrhosis

portal hypertension – liver cirrhosis

40

Helicobacter pylori is strongly related to _______ ulcer – and has melena and hematemesis

peptic ulcer
melena
hematemesis

41

Virchow lymph nodes = gastric carcinoma and
Left ______ _________

supraclavicular nodes

42

You are assessing a patient with abdominal pain and fever. You are performing an abdominal examination to assess for peritoneal signs. WOTF is not a peritoneal sign?

Voluntary guarding

43

In liver disease, the A/G ratio is altered due to decreased amount of __________ __________

serum albumin

44

WOTF lab findings is associated with hepatic jaundice?

Direct bilirubin

45

MCC of bleeding per rectum

Hemorrhoids

46

MC underlying factor for pancreatitis

Alcohol abuse

47

Spasmodic flank pain that radiates to the groin and is accompanied by mild hematuria is most suggestive of

ureteral stone

48

15 yo student presents to the clinic with a 1 day history of nausea and anorexia. He describes the pain as generalized yesterday, but today it has localized to the right lower quadrant. You palpate the left lower quadrant and the patient experiences pain in the right lower quadrant. What is the name of this sign?

Rovsing’s Sign

49

25 yo female veterinarian presents to the clinic for evaluation of flank pain, dysuria, nausea, and fever. A urine pregnancy test is negative. A urine dipstick is positive for leukocytes. On physical examination, what would be the most likely sign expected?

Murphy’s punch

50

40 yo flight attendant presents with abdominal pain. It is worse after eating, especially if she has a meal that is spicy or high in fat. She has tried OTC antacids, but they have not helped the pain. After examining her abdomen, you strongly suspect a condition that requires which sign on examination?


Murphy’s sign

51

Cardiac examination
Apex beat is formed by ___ ______ contraction

Apex beat is normally located at the ____ left ICS mid-clavicular

left ventricular

5th

52



AIDS diagnosis is based on HIV positive status and CD4 count below ____

The time for seroconvergence to HIV positive is believed to be within ___ months

Time of clinical latency which could last up to 10-15 years

Average range of CD4 is ___-____ /mL


200/ml

The time for seroconvergence to HIV positive is believed to be within 3 months

Time of clinical latency which could last up to 10-15 years

Average range of CD4 is 500-1500/mL

53

Headaches

Classic migraine is preceded by an _____

Tension headache has a _____ _____ type pain

The muscle that is implicated in cervicogenic headache is

________ and lacrimation are associated with cluster headaches

Aura

Hat Band

Rectus Capitis Posterior Minor

Rhinorrhea and lacrimation are associated with Cluster headaches

54

MC congenital heart defect
70% of the cases close spontaneously within 2 years

VSD

55

25 yo male with acute abdominal discomfort for several days. Initial evaluation revealed that a tinge of yellowish discoloration in his sclera. Examination reveals tenderness in the right upper quadrant.

Which of the following systems may be suspected as a cause of jaundice?

WTOF inquiries is relevant in the patient’s history?

What is the nature of this jaundice?

GI system

Sexual history and illicit drug use
History of ingestion of contaminated food

Infectious

56

Sense of spinning = vertigo  and is highly suggestive of

inner ear issue

57

Cone of light 7 o’clock

Otoscopic exam

58

Are there any sympathetic Cranial Nerves?

No

59

What are the Autonomic Cranial Nerves?

3, 7, 9, 10 – autonomic Cranial nerves

60

otitis media, wax infiltration, fungus infection that doesn’t affect inner ear

Conductive problem in hearing

61


otitis externa due to constant dampness


Swimmer’s ear – otitis externa due to constant dampness

62

exostosis due to cold weather

Surfer’s ear – exostosis due to cold weather

63

The ear structure that reflects the light while performing otoscopic examination

tympanic membrane

64

Which of the following nerves is not associated with ear pain?

5,7,9, 10, 12

CN XI

5, 7, 9 are associated

65

With of the following will cause lateralization of sound to the right ear during Weber’s Test?


Sensorineural loss in the left ear
Conductive hearing loss – sound goes to bad ear
Sensorineural hearing loss – sound goes to good ear

66

The structure that changes the mechanical impulse into a nerve impulse is the

inner ear (ossicles)

67

WOTF conditions is often a result of surfing/surfer’s ear

Exostoses

68

The structure that is responsible for maintaining the pressure integrity of the middle ear cavity is

Eustachian tube

69

Meniere’s is characterized by

Vertigo, hearing loss, and tinnitus

70

This condition can be described as an abnormal perception of rotation

Vertigo

71

Sudden attacks of whirling vertigo associated with tinnitus and hearing loss with nausea and vomiting at the height of the experience, with hearing loss that persists after the attack best describes

Meniere’s disease

72

WOTF conditions usually presents with vertigo that climaxes in 24-40 hrs with the patient experiencing nausea and vomiting at the height of the problem and finds that being in the horizontal position to limit the problem while raising the head induces the problem?

Acute toxic labyrinthitis

73

This condition is a result of repeated trauma to the pinna and bleeding between the cartilage and the perichondrium

Cauliflower ear

74

In which of the following conditions is a decrease of sodium in the patient’s diet recommended?

Meniere’s Disease

75

While testing the vibration sense, which of the following vibrating tuning fork is applicable?

128 Hz

512 Hz is used for hearing

76

Tinea varcicolor, Monoliasis, Athlete’s foot are three conditions that are caused by

a fungus

77

A white patch that can be found on mucous membranes
Usually found in the mouths of heavy smokers
Premalignant

Leukoplakia

78

WOTF glands are involved in acne vulgaris?

Sebaceous

79

The area in the fundus that represents the highest visual acuity

Macula

80

The area in the fundus that represents the blind spot is

the disc

81

The normal reaction to the ciliospinal reflex is

mydriasis = pupillary dilation

82

The MC pathological condition affecting visual acuity in elderly is

presbyopia

83

MS is a neurological disorder characterized by.

WOTF vitamin deficiency has been recently implicated in MS?

patchy sclerosis of the CNS

Vitamin D

84

The conjunctiva covers some or all parts except

The lid

It does cover the cornea and sclera

85

The term presbyopia is referring to a

disorder of the lens

86

This condition often accompanies lipid disorders and presents as a slightly raised yellow flat well-circumscribed plaque in the skin 

xanthelasma

87

A patient suffers from left homonymous hemianopia. You suspect a lesion of the?

Right optic tract

88

Which muscle is involved with extraocular motion of the right eye towards the right inferior gaze?

Superior oblique – down and out



Inferior oblique – up and in

89

Glaucoma is an eye disorder characterized by all of the following except?

Papilledema

It is characterized by increased cup:disc ratio, decreased field of vision, and increased intra ocular pressure

90

Hypersecretion of the thyroid gland will lead to

Graves Disease

91

WOTF is associated with exophthalmos?

Hyperthyroidism

92

The cause of exophthalmos in hyperthyroidism is due to proliferation of the

retro bulbar fat

93

Horner’s syndrome is not associated

with syphilis

94

WOTF is not a CN lesion?

Horner’s syndrome

95

Which CN is involved with extraocular motion of the right eye towards the left lateral gaze?

Oculomotor nerve

96

Which muscle is involved with extraocular motion of the right eye towards the left superior gaze?

Inferior oblique = up and in

97

The red light reflex is a reliable way to detect the presence of

cataract

98

Angular stomatitis (cheilosis) is associated with WOTF vitamin deficiency?

Riboflavin = vitamin B2

99

Vitamin B3 deficiency (Niacin)

pellagra

100

B12 vitamin deficiency

pernicious anemia, demyelination disease

101

What vitamin is associated with night vision?

Vitamin A

102

What is the most common type of stoke?

Embolic

103

What color changes are associated with Raynaud’s disease?

White, blue, red

104

Scurvy is a disorder of the gum due to deficiency of WOTF vitamins?

L-ascorbic "Vitamin C"

105

WOTF fundoscopic exam nerve may indicated an increase intracranial pressure?

Papilledema

106

The most abundant hormone secreted by the anterior pituitary gland is GH

Growth Hormone

107

The pathway for direct light reflex is

Afferent = 2
Efferent = 3

108

Glaucoma is medically managed by

Mydriatic eye drops == to dilate the eye to restore fluid flow within the eye

109

Argyll Robertson pupils =

neurosyphilis – responds well to dark

110

Right eye, right lateral gaze, what muscle?

Abducens

111

Accommodation pathway (Afferent and Efferent)

2 afferent 3 efferent

112

What CN's supply the eye?

2-7 CN’s supply the eye

113

20/40 vision

person can see at 40 ft what a normal person sees at 20 feet

114

Which lab value would you use for Reiter’s?


HLA B27


It is associated with Chlamydia

115

Rhomberg’s (dorsal column) =

joint position/pallesthesia

116

Lateral column =

pain and temperature

117

Light touch =

anterior/posterior columns

118

Poliomyelitis – LMNL or UMNL

LMNL

119

Beam of light will follow:

C, AC, L, VC

cornea, anterior chamber, lens, vitreous humor

120

Bell’s Palsy – _____ of facial nerve

Hemiplasia – UMNL from stroke affecting _____ nerve

LMNL

Hemiplasia – UMNL from stroke affecting facial nerve

121

spastic, decreased muscle strength without atrophy, path reflex

Right side of brain affects left side of body (Vice versa)


UMNL

122

Any lesion from brain to pyramidal tract which synapses in anterior horn cell then it becomes

LMNL

123

flaccid muscles, no patho reflex, muscle wasting/atrophy, absent reflex

LMNL

124

Olfactory center is found in the ______ in the temporal lobe

Uncus

125


Temporal lobe migraine where aura is olfactory in origin

Temporal lobe epilepsy

Smell something then go into epileptic fit
Due to uncus irritation

126


Visual cortex in


occipital lobe

127

Horner’s syndrome =

ptosis, miosis, anhydrosis

128

spirochete hidden for several years and likes the CNS – neurosyphilis

Tabes dorsalis

129


Lose cerebellum – you will have robotic movements

Dysdiadochokinesia – lost the ability to perform repeated movements such as

Cerebellum controls the ________ side


pronation supination / patting

ipsilateral

130

Biggest diseases affect cerebellum

MS likes the optic nerve (optic neuritis) and the ______

stroke and MS

Cerebellum

131

Homan’s sign is involved in the diagnosis of

DVT

132


While testing hearing, the ______ tuning fork is used

512 Hz

133

The facial nerve controls the _____ muscle which raises _______

fronatalis

raises the eyebrows

134

Corneal reflex
Afferent =
Efferent =

A- 5
E-7

135

Patient presents with hearing loss in his right ear due to Meniere’s disease (SENSORINEURAL) during Weber’s test where would the vibration lateralize?


Left ar

136

Parkinson’s disease is characterized by what type of tremors?

static/resting tremors

137

A patient suffers from optic chiasm lesion may present with

bitemporal hemianopsia

138


L’Hermitte’s sign may indicate _____

Brudzinski’s sign indicates involvement of the ________


L’Hermitte’s sign may indicate MS

Brudzinski’s sign indicates involvement of the meninges

139

If a patient experiences difficulty in hip abduction, which DISC is most likely involved?

L4 disc L5 NR

140


WOTF describes grade 3 reflex status?

Slightly _________ response, possibility of disease pathology exists

increased

141

The autonomic sympathetic nervous system originates from the ____ and _____ regions of the spine

thoracic and lumbar

142

WOTF lines is best diagnosis for spinal stenosis?

Eisenstein’s

143

Constant low-back pain which is unrelieved by position, activity, or rest is most likely the result of

visceral disease

144

WOTF is considered a common and serious complication in patients with Bell’s palsy that requires immediate referral with co-management?

Corneal irritation/ulceration

145

29 yo male with left sciatic pain shooting down the lateral aspect of the leg and the top of the foot with antalgic lean to the left. The following tests were positive: Valsalva, SLR on the left, Bragard’s on the left, Kemp’s test the pain is exaggerated upon leaning the patient to the right
What is the clinical impression?

Left medial disc L4

146

Which disease affects the anterior horn of the spinal cord?

Poliomyelitis

147

Guillan-Barre syndrome is an

infectious polyneuritis, ascending type

148

WOTF tests may indicate radiculitis due to neural sleeve adhesions?

Shoulder depressor test

149

WOTF may constitute precaution to chiropractic management?

Purpura  low platelets = easy bruising / poor clotting – can cause hemarthrosis

150

Which neurological disorder has a regressive course?

Bell’s Palsy

151

Parkinson’s disease is characterized by all of the following except
Degeneration of the frontal lobe

It is characterized by static tremors, dull mask-like expression, rigidity and weakness

152

WOTF is an UMN in nature

Cervical myelopathy

153

The prevalence of instability syndrome associated with long-term RA is believed to be?

50%

154

Wolf’s law governs the deposition of calcium in bones through the piezoelectric effect (the bones will remodel in accordance with the stress imposed upon them). WOTF is applicable to soft tissue?

Davis’s law

155

Patient presents with claudication, impotence and coldness of the extremities. This is most characteristic of a

vascular condition

156

WOTF is the MC presenting complaint of a patient with multiple myeloma?

back pain

157

WOTF conditions is characterized by pain that reaches its full intensity almost immediately after its first appearance?

Dissecting aneurysm

158

Chest pain that is exacerbated by exercise and is relieved by rest is most likely due to

coronary ischemia

159

in a normal heart, the S2 heart sound is the loudest in the

aortic and pulmonic areas

160


WOTF is the most likely finding when examining a patient with emphysema?

Hyperresonant percussive note

161


WOTF types of skin lesion is commonly associated with psoriasis?

SCALES

162


A 35 yo female who is pregnant for the first time presents with frequent severe headaches that are sometimes accompanied by visual disturbances. She has recently been examined by her obstetrician and has gained 70 lbs during the pregnancy. She appears to have some puffiness of the face, fingers, and ankles

Which of the vital signs presented is most significant?

WOTF initial screening procedures is indicated?

WOTF immediate sequela gives the poorest prognosis in this case?

WOTF is the most appropriate initial case management?

BP = 140/90

UA

Oliguria

Refer patient to a specialist for further evaluation

163


48 yo female with right-sided low back pain following a misstep off a curb. She has numbness over the right buttock, but the patient’s posture is not antalgic
WOTF is the most accurate initial neurological screening procedure?

WOTF clinical procedures most accurately distinguishes between lumbar joint and sacroiliac involvement?


WOTF complications requires a second opinion or consultation?

Deep tendon reflex
Goldthwait’s test
Deterioration of neurological signs

164

36 yo male with low back and right leg pain following a fall off a ladder. He has numbness over the right malleolus and lateral aspect of the small toe of the right foot. The patient’s posture is antalgic with the trunk inclined toward the left.

WOTF examination procedures most effectively tests the motor level corresponding to the dermatome pain pattern described in the case history?

WOTF procedures most accurately determines the presence of increased intrathecal pressure?

WOTF is the most likely location of the nerve root impingement?

WOTF complications is a contraindication to rotational adjustments of the lumbar spine?

Achilles tendon reflex
Valsalva maneuver

Lateral to the S1 nerve root

Neurological deficit

165

24 yo male presents with right leg pain. The pain originates on the lateral aspect of his posterior thigh and crosses over to the medial side of his lower leg at the knee. When the pain is most severe, it extends down to the medial aspect of his ankle. He also has vague paresthesias on the medial side of his knee. Examination reveals that light touch, pin prick, and two-point discrimination are decreased on the medial side of the lower leg. He states that he experienced moderate low-back pain for two months and currently the low back pain has subsided considerably; the leg pain has increased. Examination consisting of resisted dorsiflexion and inversion reveals a grade 3/5 weakness on the right side

WOTF muscles is being tested by resisted dorsiflexion and inversion?


WOTF neurological level is the most likely source of these findings?

WOTF screening tests is most likely to demonstrate motor weakness?

A four week treatment program consisting of side-posture spinal adjustments three times per week fails to provide any symptomatic or functional improvement. WOTF courses of action is most appropriate?

Tibialis anterior

L4

Heel walk/ Squat and rise

To order additional diagnostic tests and re-evaluate

166

48 yo female complaining of headaches for several months. Her job involves typing, copying, and filing. The headaches started 3 months ago with slow and progressive course. She got worse in the last month. Head movement, leaning forward, coughing and sneezing tend to worsen the attacks. Headache is partially relieved by OTCs. The headaches are mostly behind the eyes, temporal and occipital areas and associated with visual difficulties. Headache is worse in the morning and sometimes during night time. She has a hard time sleeping. No past history of headaches, no trauma, no hospitalization or major illness. Family history: mother used to have headaches and she has a medicine cabinet full of headache pills, father is hypertensive. No other health issues.

WOTF would be the most appropriate initial clinical impression?

What is the appropriate management?

Space occupying lesion

Refer to a MD for further evaluation

167

A patient complains of nervousness, fatigue, and weight loss. WOTF systems review findings would support a thyroid dysfunction as the principal mechanism for this condition?

Fine tremors, insomnia, and slight bulging of the eyes

168

Patient presents with periodic attacks of vertigo that occurs in the form of a series of attacks over a period of the last 3 months, with few periods of remission of variable duration. The attack consists of dizziness or vertigo. The sensation of spinning may produce nausea, vomiting, sweating, and all they symptoms normally associated with extreme motion sickness. The onset of vertigo may be preceded by a sensation of fullness or pressure in the ear, hearing loss, and ringing of the right ear as described by the patient. The onset is frequently sudden, reaching peak intensity within minutes and lasting for an hour or more before subsiding. Unsteadiness may persist for the following hours or days. Vertigo is specially aggravated by movement.

What is the most appropriate diagnosis?

The proper management for case

Meziere’s disease


Initiate chiropractic care
Dietary recommendation

169

45 yo woman noted decreased temperature sensation in her left foot in 2003, which slowly progressed until 2005 when she experienced loss of temperature sensation and noted numbness and a tight feeling below the left L2 dermatome. In the spring of 2006, she noticed motor weakness in her right lower extremity and a burning sensation on the left side that extended over the T10 and L1 dermatomes. She denied any history of trauma or surgery involving the spine. Neurological exam revealed that her right lower extremity was moderately weak. The right patellar and Achilles tendon reflexes were slightly hyperactive and a Babinski sign was present on the right side. She complained of numbness, tightness, and loss of temperature sensation below T6 on the left side, vibration sense is lost at the right malleoli and right tibial tubercle.

What is your diagnostic impression?

What is etiology and pathophysiological mechanism of this case?

Brown Sequard Syndrome  same side cord compression
Loss of pain and temperature on the opposite side
Motor loss on the same side


Right sided cord hemi compression

170

The MC malignancy of the spine is

Multiple Myeloma

171

62 yo male with past history of chronic alcoholism with multiple episodes of liver trouble in the form of hepatitis B and few episodes of jaundice. He was recently diagnosed by his physician and lab work as compensated liver cirrhosis. A tinge of jaundice is observed in his sclera.

WOTF lab findings may be associated?

WOTF lab findings may be associated?

Decreased amount of serum albumin
Serum alkaline phosphatase
Altered A/G ratio
Elevated both direct and indirect bilirubin

172

30 yo male with swelling at the angle of the mandible, slight fever, malaise of three day duration. Upon examination there is hotness, redness, and tenderness with obvious swelling of the right cheek and mandibular angle area.

WOTF lab findings is most likely to help in establishing a clinical impression?


Lipase and amylase
Leukocytosis with lymphocytosis (for mumps)

173


45 yo male presented with foot pain about two days ago. Patient wakes up in the mornings with redness and tenderness of the big toe. He can barely walk. Patient indicated that he had several episodes of the same condition in the last six months. Aggravating factors are alcohol and high protein diet

Gout

174

14 yo boy presented with multiple episodes of asthmatic attacks. His mother also indicated that he is developing a form of skin rash of which her physician determined it as a possible allergy.

Eosinophils

175


19 yo male of Italian descent complaining of acute torticollis which happened yesterday. After initial chiropractic screening and first aid chiropractic management in the form of passive gentle neck mobilization and resisted active neck muscle contraction. He has dramatic improvement. Upon system review he revealed that he gets episodes of yellowish discoloration (jaundice once or twice a year) usually brought on by stress or infection. Currently he has a tinge of jaundice in his sclera. Examination of the liver and gall bladder revealed no abnormalities or tenderness

Hemolytic jaundice = increased indirect bilirubin and total bilirubin

176

General osteopenia, mild ESR elevated, 50 yo female, small lytic lesions around pelvis, skull sternum 

Next lab test?

Dx?

Next test to order = A/G ratio
Would have hyperglobulinemia!!

177


ANA test  lupus


ANA test  lupus

178

High reticulocytic count =

Reticulocytes – RBC with nucleus still in cell

pathopneumonic for hemolytic jaundice/anemia

179

Zollinger-Ellison tumor is associated with what?

Peptic ulcer

180

Brown Sequard syndrome is associated with WOTF?

Upper motor neuron lesion on the same side of lesion
Loss of pain and temperature on the opposite side of lesion
It is an incomplete spinal cord lesion characterized by a clinical picture reflecting hemisection of the spinal cord

Brown Sequard syndrome is associated with WOTF?

Upper motor neuron lesion on the same side of lesion
Loss of pain and temperature on the opposite side of lesion
It is an incomplete spinal cord lesion characterized by a clinical picture reflecting hemisection of the spinal cord

181

WOTF presentations can cause a conductive hearing loss?

Tympanosclerosis

182

Which muscle is involved with extraocular motion of the right eye towards the right superior gaze?

Superior rectus

183

WOTF valvular lesions can cause drop attacks (blackouts)?

Aortic stenosis
This leads to Left ventricular enlargement
Will cause a murmur that is increased during expiration

184

The normal reaction to pupillary light reflex is?

Bilateral miosis and convergence of the eye

185

WOTF will not be found in the eyelid?

Pinguecula – a slow growth caused by the degeneration of the conjunctiva’s collagen fibers.

186

WOTF is associated with leukemia?

Marked increase in WBC

187

MC form of skin malignancy =

rodent ulcer

188

WOTF will cause lateralization of sound to the left ear during Weber’s Test?

Perforated ear drum in left ear  conductive hearing loss
Tympanosclerosis is conductive hearing loss