ICM-1

Question 1

Edema

Answer 1

Observable swelling from the accumulation of fluid in the skin/ in one or more body compartments

Question 2

Unilateral edema

Answer 2

One side of the body is swollen– likely causes: deep vein thrombosis, cellulitis, trauma

Question 3

Bilateral edema

Answer 3

swelling on both sides of the body, likely causes: right side heart failure

Question 4

Dependent edema

Answer 4

swelling in the lower limbs

Question 5

Tightness in shoes

Answer 5

Edema caused by peripheral vascular disorder (cardiac)

Question 6

Puffy eyelids in the morning

Answer 6

Edema caused by renal disease or hypoalbuminemia

Question 7

Had to use a bigger belt

Answer 7

Cause: Ascites– edema in the abdomen caused by fluid in the peritoneal cavity

Question 8

Acute headache

Answer 8

new onset, severe headache –> may be sign of serious illness

Question 9

Chronic headache

Answer 9

recurrent head pain, may not be serious

Question 10

Extracranial headache

Answer 10

Caused by glaucoma, sinusitis, dental distress

Question 11

Intracranial headache

Answer 11

Cuased by: brain tumor, mass lesions, infections and vascular disorders

Question 12

Subarachnoid Hemorrhage

Answer 12

Present with: sudden, severe headache
describe as “thunderclap”/ “explosive”
Bilateral, associated with nausea, vomiting, stiff neck
NO FEVER

Question 13

Acute Meningitis

Answer 13

Present with: sudden, severe headache, preceded by respiratory illness/sore throat, See Triad: fever, headache, stiff neck

Question 14

Migraine

Answer 14

Present with unilateral and diffuse throbbing headache, may see aura, likely had early life onset, have family history of migraines

Question 15

Muscle Tension headache

Answer 15

Chronic headaches, present with dull, throbbing pain with a hat band distribution or pain in occipital region, often stress related

Question 16

Cluster Headache

Answer 16

present with: severe unilaterally tearing headache that occurs at night and wakes them up with rhinorrhea, also doesn’t occur for long periods then start happening again

Question 17

Brain tumor

Answer 17

Present with steadily progressively worse headache that may be worse in the AM and is aggravated by coughing

Question 18

Temporal Arteritis

Answer 18

Present with unilateral throbbing headache in temporal region, see vision changes, pain when brushing hair (temple tenderness), may have fever or myalgias

Question 19

Cardiac Syncope

Answer 19

loss of consciousness resulting from recoverable loss of adequate cerebral blood flow –> caused by reduced cardiac output

Question 20

Vasovagal syncope

Answer 20

loss of consciousness resulting from a recoverable loss of adequate cerebral blood flow–> caused by increased peripheral vasodilation

Question 21

Seizure

Answer 21

alteration of consciousness caused by sudden dysfunction of the electrical control mechanisms of the brain
Causes: idiopathic epilepsy, metabolic imbalances, drug and alcohol withdrawal, CNS infections and high fever

Question 22

Arterial Embolism

Answer 22

Pain, paresthesia, pallor, pulselessness (difficult to palpate pulse), paralysis, perishingly cold

Question 23

Deep Vein Thrombosis

Answer 23

Present with: Virchow’s triad: decreased blood flow rate, damage to blood vessel walls, hypercoagulability, pain, swollen, warm and red legs with engorged superficial veins
Due to formation of a blood clot in a deep vein

Question 24

Chronic Arterial insufficiency

Answer 24

intermittent claudication, decreased/absent pulses/ pale colour especially on elevation of limb, cool to the touch, atrophic skin with hair loss, ulcerations on toes/soles of feet, may have gangrene, also diabetes is a predisposing factor

Question 25

Chronic Venous insufficiency

Answer 25

normal pulse in leg, brown pigmentation, marked edema, thickened skin, ulcerations on medial ankle

Question 26

Dyspnea

Answer 26

sensation of shortness of breath at rest, feeling of being smothered

Question 27

Orthopnea

Answer 27

shortness of breath/smothering feeling on lying flat improves upon sitting up, often ask for more pillows

Question 28

Paroxysmal nocturnal dyspnea

Answer 28

sudden shortness of breath upon waking up 1-2 hours after going to bed two possible causes: acute cardiac: cardiogenic shock, left sided heart failure, chronic cardiac: mitral valve displacement, atrial fibrillation

Question 29

Costochondritis

Answer 29

sudden sticking/stabbing/aching pain in the anterior chest, tender to the touch, variable severity and timing, caused by movement of the chest, trunk or arm

Question 30

Pericarditis

Answer 30

pain gradually started in the central chest, described as sharp and stabbing, radiates to the shoulder, has been going on for a day, feel better when leaning forward, worse when breathing in, also have a respiratory infection

Question 31

Myocardial Infarction

Answer 31

Sudden retrosternal chest pain that is radiating to the neck and jawline as well as the shoulder and arm, described as a pressing/squeezing feeling, also experiencing nausea, vomiting and sweating, has been going on for more than 30 minutes and was not relieved by GTN spray

Question 32

Angina

Answer 32

Experience sudden retrosternal chest pain which radiates to the neck, jawline, shoulder and arm, also experience dyspnea, sweating, nausea, pain is mild-moderate and comes and goes approximately every 10 minutes, the pain is relieved by rest and GTN spray, and made worse with exercise or excitement

Question 33

Pheochromocytoma

Answer 33

present with hypertension, pain, perspiration, palpitations and pallor, symptoms are episodic

Question 34

Addison's Disease

Answer 34

Patient with fatigue, muscle weakness, weight loss, low blood pressure, orthostatic hypertension, hyperpigmentation and changes in mood

Question 35

Addison's Crisis

Answer 35

present with pain in the legs and back described as penetrating, also see low blood pressure and hypoglycemia, vomitting, diarrhea and dehydration, patient is also confused and psychotic, have slurred speech, convulsions, shock and eventually coma

Question 36

Cushing's Disease

Answer 36

rapid weight gain associated with central obesity, see moon face and buffalo hump, also see hyperhydrosis, thinning skin, easy bruising, hirsutism and red striae

Question 37

Diabetes Mellitus

Answer 37

Hyperglycemia, extreme thirst, urinate often, have dry skin, are constantly hungry, have blurry vision, and are drowsy. When they get cut it doesn't heal quickly

Question 38

Diabetes Mellitus

Answer 38

Hypoglycemia, shaky with fast heartbeat and sweating, feel dizzy and anxious, are constantly hungry and have episodes of blurry vision, weakness and fatigue, also have headaches and have been irritable

Question 39

Hypothyroidism

Answer 39

Present with menorrhagia, dry skin and hair, general lack of energy, bradycardia, severe cold intolerance, chronic constipation, examination shows slowed thinking and delayed ankle jerk reflex

Question 40

Hyperthyroidism

Answer 40

see weight loss even with increased appetite, notice trembling handds, goiter and excessive nervousness, also complain of increased bowel movements, physical examination shows accelerated heart rate, high blood pressure and goiter

Question 41

Hypopituitarism

Answer 41

see short stature/growth retardation (don't meet normal milestones), decreased muscle mass, impaired attention, delayed puberty, loss of libido, amenorrhea, infertility and hypothyroidism

Question 42

Hyperpituitarism

Answer 42

Gigantism (if early onset), acromegaly (late onset), See spade-like hands, prognathism, large feet, complain of bitemporal hemianopia and galactorrhea, physical exam shows macroglossia and hoarse voice

Question 43

Osteoarthritis

Answer 43

present with oligoarthritis (inflammation of 2/3/4 joints), complain of chronic pain that is sharp and localized, may see changes in bone structure of hands

Question 44

Reactive arthritis

Answer 44

Present with joint pain in one joint, also see visual problems and urinary infection (Writer's syndrome), due to infection outside the joint which leads to an inflammatory response causing pain

Question 45

Gout

Answer 45

high uric acid buildup, monosodium uric crystals deposit in joint spaces, complain of acute onset joint pain that is sharp and localized to one joint, symptoms are exacerbated by alcohol, red meat and drugs

Question 46

Pseudogout

Answer 46

Present with acute onset joint pain that is sharp and localized to one joint, symptoms are exacerbated by alcohol, red meat and drugs, crystals: calcium pyrophosphate

Question 47

Septic Arthritis

Answer 47

Complain of joint pain in one joint, preceded by local infection in the area, associated with fever

Question 48

Acute Diarrhea

Answer 48

Present with frequent defecation over a period of less than 14 days, also have diffuse cramping pain and nausea, and may have fever, likely causes: viral infection, bacterial infection, parasites, medications

Question 49

Chronic Diarrhea

Answer 49

present with frequent defecation for more than 4 weeks, also have diffuse, cramping pain accompanied with nausea, fever and anorexia, likely causes: Crohn's Disease, ulcerative colitis, celiac disease, irritable bowel syndrome

Question 50

Gastroesophageal Reflux Disease

Answer 50

Present with "heartburn", regurgitation, dysphagia, nausea and vomitting that is exacerbated by food, lying down and bending, medications, smoking

Question 51

Acute Myocardial infarction

Answer 51

present with substernal pain that is described as deep aching pressure, also have indigestion, nausea and vomiting, excessive sweating and dyspnea, also had periods of syncope Risk factors: medical history, smoking/cocaine abuse, obesity

Question 52

Acute Pancreatitis

Answer 52

Patient presents with sudden onset dull, severe steady boring pain that radiates to the back, and is alleviated by sitting up and leaning forward but is made worse by coughing and moving around Risk factors: "I GET SMASHED"--> Gall stones, alcohol intake, mumps, auto immune diesease, drugs (ex. steroids)

Question 53

Peptic Ulcer Disease

Answer 53

patient presents with burning, gnawing pain and a consistent sensation of hunger that is alleviated with antacids, exacerbated with food/hunger, also see black stools, nausea and vomiting Also see: infection that was treated with NSAIDs and glucocorticoids, likely a smoker, likely drinks alcohol

Question 54

Pelvic Inflammatory Disease

Answer 54

Patient (likely woman <25 yrs old) presents with lower abdominal pain, vaginal/cervical discharge, fever and chills, irregular vaginal bleeding and dyspareunia, also has history of multiple sexual partners and STDs

Question 55

Acute Appendicitis

Answer 55

Patient complains of right lower quadrant pain that was initially periumbilical, also see nausea, vomiting and anorexia, accompanied by high fever, pain is aggravated by cough and movement

Question 56

McBurney's Point

Answer 56

Looking at a line from the umbilicus to ASIS, 1/3 from asis, 2/3 from umbilicus--> where Appendix is located

Question 57

Ectopic Pregnancy

Answer 57

Patient presents with Lower abdominal/pelvic pain and cramping that started gradually (if sudden then possibility of rupture), also complains of dizziness, vaginal bleeding, shoulder pain and amenorrhea*

Question 58

Hepatitis (general)

Answer 58

Patient presents with fever (possibly low), RUQ pain/discomfort, fatigue, malaise, weakness, nausea and vomiting, anorexia, dark urine, clay/pale stools (jaundice develops later)

Question 59

Hepatitis A

Answer 59

Transmitted from fecal to oral | History of eating contaminated food/ travel to third world

Question 60

Hepatitis B

Answer 60

Vertical transmission via bodily fluids, from blood transfusion or sexual activity

Question 61

Hepatitis C

Answer 61

Transmission via contaminated blood from needles-- often contracted from tatoos or body piercing

Question 62

Hepatitis D

Answer 62

Contracted from needles

Question 63

Hepatitis E

Answer 63

Fecal to oral transmission, contracted from contaminated water

Question 64

Ascending cholangitis

Answer 64

Patient presents with upper right quadrant pain accompanied by fever, jaundice and pale coloured stools, also notice mental status changes and examination shows signs of shock and body malaise

Question 65

Charcot's triad

Answer 65

Pain, fever and jaundice --> ascending cholangitis

Question 66

Reynold's pentad

Answer 66

pain, fever, jaundice, mental status changes and decreased blood pressure --> ascending cholangitis

Question 67

Cholecystitis

Answer 67

patient complains of sudden onset RUQ pain that radiates to the upper back that has lasted for more than 6 hours (come and gone), it started and is made worse upon eating fatty foods and feels better with analgesics, also have fever, chills, nausea, vomiting and a previous history of RUQ pain

Question 68

Murphy's sign

Answer 68

when doing a physical examination put hand on URQ (below rib cage) and ask patient to breathe in --> very painful--> indicative of cholecystitis

Question 69

Acute cholelithiasis

Answer 69

Female patient that is 40+ and overweight complains of sudden right upper quadrant pain that has lasted 1-2 hours and radiates to the scapula/upper back, also complains of nausea and vomiting, physical exam shows no fever