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Flashcards in Internal Med - LE 2 Reviewer Deck (50):
1

Which one is true:

A. The external ear compose of auricle and tympanic membrane

B. Ear composed of cartilage and bone

C. The bone behind the ear canal is the mastoid process of temporal bone

D. The mastoid bone is palpable behind the helix

C. The bone behind the ear canal is the mastoid process of temporal bone



Explanation:
A. The external ear compose of auricle and EAR CANAL

B. Ear "consists chiefly of cartilage covered by skin and has a firm elastic consistency"

D. The mastoid bone is palpable behind the LOBULE

2

Which one is false

A. The ear drum marks the limit of middle and external ear

B. The Tympanic membrane is held inward by the malleus

C. The umbo is the area where the eardrum meet the tip of malleus

D. Oval window is part of the eardrum where the malleus is connected

D. Oval window is part of the eardrum where the malleus is connected

Correct: Oval window is part of the eardrum where the STAPES is connected

3

Which of the ff: is false about the pathway of hearing

A. The cochlea senses and code vibration

B. Nerve impulses sent thru the brain by cochlear nerve

C. Sensory conductive phase include inner ear and cochlear nerve

D. 1st part of hearing pathway involve external and middle ear

C. Sensory conductive phase include inner ear and cochlear nerve

Correct: Sensory conductive phase include cochlear nerve and neuronal impulse transmission to the brain

4

n using Weber test:
- 512 Hz set fork into light vibration by briskly stroking it
between the thumb and index finger or by tapping it in your knuckles. Place it in the patient's midforehead.

Ask where the pt hears the sound:

on one side or both sides? (Normally the vibration is heard in the midline or equally in both ears.)

5

In the case of the patient in no 4, the patient then hears on the affected ear (bad ear)

- Conductive Hearing Loss

6

The 19 year old boy comes to the clinic with chief complaints of external pain in the left ear. You will assess the patient’s external ear by:

- Press the tragus, move the auricle up and down, and palpating the mastoid process behind the ear

7

PE findings: Otitis Media

A. The eardrum has an opaque translucent appearance

B. The ear canal is inflamed and reddish

C. The eardrum is bulging with an absent light reflex

D. The ear canal is filled with cerumen that seems to be impacted

C. The eardrum is bulging with an absent light reflex : middle ear is filled with fluid

8

Considering conductive hearing loss...result in Rinne’s test?

A) BC > AC
B) AC > BC
C) AC = BC

A) BC > AC : While air conduction through the external or middle ear is impaired, vibrations through bone bypass the problem to reach the cochlea.



Explanation:
B) AC > BC: The inner ear or cochlear nerve is less able to transmit impulses regardless of how the vibrations reach the cochlea. The normal pattern prevails.

9

Does not include middle ear

- Pseudomonas infection of the tragus

10

10. Which of the ff is false?

A. You apply a gentle pressure with your thumb on the tip of the patient’s nose to widen the nostrils

B. Tenderness of the tip on the nose suggests a furuncle

C. Testing for obstruction involves occluding each nostril and asking the patient to breath in and out

D. None of the above

D. None of the above

11

Palpate frontal nasal sinus by:

a. Press up on the frontal sinus from under the bony
brows

b. Press down on the frontal sinus from over the bony
brows

a. Press up on the frontal sinus from under the bony
brows

12

Case: female patient allergic to flowers has Allergic rhinitis, patient would have?

a. Swollen malleus

b. Swollen turbinates

c. Swollen frontal sinus

d. Swollen maxillary sinus

b. Swollen turbinates

13

PE of mouth and pharynx includes:

a. gums

b. lips

c. mucosa

d. all of the above

ALL OF THE ABOVE (lips, mucosa, gums)

14

Oral cancer is common here except:

a. Base of tongue

b. Side of tongue

c. Tip of the tongue

c. Tip of the tongue

15

The SYMMETRY of the tongue upon protrusion during examination evaluates?

a. Abducens

b. Glossalpharyngeal

c. Hypoglossal

d. Vagus

c. Hypoglossal - CN XII



Explanation:

a. Abducens - CN VI

b. Glossalpharyngeal - CN IX

d. Vagus - CN X

16

The rise of the soft palate when you ask the patient to say “ahh” evaluates the?

a. CN VI

b. CN IX

c. CN X

d. CN XII

c. CN X : In CN X paralysis, the soft palate fails to rise and the uvula deviates to the opposite side.



Explanation:
a. CN VI - Abducens

b. CN IX - Glossalpharyngeal

d. CN XII - Hypoglossal

17

Color of gums are normally:

a. Brown

b. Pink

c. Red

b. Pink

18

What is the sequence of nodes?

Deep cervical chain

Occipital

Posterior auricular

Posterior cervical

Preauricular

Submandibular

Submental

Superficial cervical

Supraclavicular

Tonsillar

1. Preauricular—in front of the ear

2. Posterior auricular—super cial to the mastoid process

3. Occipital—at the base of the skull posteriorly

4. Tonsillar—at the angle of the mandible

5. Submandibular—midway between the angle and the tip of the mandible.

6. Submental—in the midline a few centimeters behind the tip of the mandible.

7. Superficial cervical—super cial to the sternomastoid

8. Posterior cervical—along the anterior edge of the trapezius

9. Deep cervical chain—deep to the sternomastoid and often inaccessible to examination.

10. Supraclavicular—deep in the angle formed by the clavicle and the sternomastoid

19

A 20 yr. old male, noted with exudative tonsillitis. What are the common findings?

a. Tonsils protrude medially beyond the pillars and even to the midline

b. Red throat with white exudate on the tonsils

c. Redness is diffuse and intense with sore throat

d. Gray exudate on the uvula, pharynx, and tongue

b. Red throat with white exudate on the tonsils


Explanation:

a. Tonsils protrude medially beyond the pillars and even to the midline - LARGE NORMAL TONSIL

c. Redness is diffuse and intense with sore throat - PHARYNGITIS

d. Gray exudate on the uvula, pharynx, and tongue - DIPTHERIA

20

Occipital lymph nodes can be palpated in the?

a. Base of the skull posteriorly

b. Base of the skull superiorly

c. Subclavicularly

d. Subcervial

a. Base of the skull posteriorly

21

This lymph node can be felt along the anterior edge of the trapezius:

a. Submandibular

b. Submental

c. Superficial cervical

d. Posterior cervical

d. Posterior cervical— along the anterior edge of the trapezius


Explanation:

a. Submandibular—midway between the angle and the tip of the mandible.

b. Submental—in the midline a few centimeters behind the tip of the mandible.

c. Superficial cervical—superficial to the sternomastoid

22

Which can be rolled in two directions; up and down, and side to side?

a. artery

b. lymph node

c. muscle

b. lymph node

23

Ask the patient to sip some water and to extend the neck and swallow. Which will rise then fall back to resting position?

a.cricoid cartilage

b. thyroid cartilage

c. thyroid gland

d. all of the above

d. all of the above

24

Signs of hyperthyroidism:

a. Excessive Sweating

b. Heat Intolerance

c. Hypohidrosis

d. Xerosis

e. a and b

f. a and c

g. b and c

h. b and d

e. a and b;
a. Excessive Sweating
b. Heat Intolerance



Explanation:

c. Hypohidrosis - Hypothyroidism; absent sweating

d. Xerosis - Hypothyroidism; abnormally dry skin

25

Jugular venous distention is common in

a. congestive lung failure

b. heart failure

c. kidney failure

d. liver failure

b. heart failure

26

Aside from Aging, common causes of smell loss except:

A. Alcoholism

B. Severe upper respiratory infection (URI)

C. Head Trauma

D. Rhinosinustis

A. Alcoholism

27

What is the mechanism by which diabetes influences taste?

A. Damage to central structures

B. Systemic disturbance of metabolism

C. Damage to the taste bud

D. Damage to central structures

B. Systemic disturbance of metabolism

28

Oral pilocarpine can be used to treat excessive dryness to the mouth. This can be explained by which mechanism of the drug?

A. Adrenergic effect

B. Sympathetic effect

C. Anticholinergic effect

D. Cholinergic effect

D. Cholinergic effect

29

What innervates the anterior part of the tongue?

a. CN VII

b. CN IX

c. CN X

d. CN XII

a. CN VII - anterior sensory



Explanation:
b. CN IX - posterior sensory

c. CN X - posterior tongue

d. CN XII - The SYMMETRY of the tongue upon protrusion during examination evaluates

30

This is the area of the brain where odor identification occurs.

a. Anterior Cingulate

b. Amygdala

c. Olfactory Bulb

d. Orbitofrontal Cortex





d. Orbitofrontal Cortex

31

G-protein coupled receptor that radiates bitter taste -

a. T1R

b. T2R

c. T3R

d. T4R

b. T2R

32

In physiology of hearing, what is the function of external and middle ear?

a. Amplify sound

b. Collect sound

c. Conduct sound

d. Interpret Sound

a. Amplify sound

33

In general what causes sensorineural hearing loss?

A. Lesion in auricle, external ear or middle ear

B. Impedence in sound transmission

C. Lesion that impair mechanotransduction

D. Transmission of electrical signals to the 8th nerve of the brain

C. Lesion that impair mechanotransduction

34

Which is true:

a. In Conductive Loss sound lateralizes to good ear; In Sensorineural Loss sound lateralizes to impaired ear.

b. In Conductive Loss sound lateralizes to good ear; In Sensorineural Loss sound lateralizes to good ear

c. In Conductive Loss sound lateralizes to impaired ear; In Sensorineural Loss sound lateralizes to good ear

d. In Conductive Loss sound lateralizes to impaired ear; In Sensorineural Loss sound lateralizes to impaired ear

c. In Conductive Loss sound lateralizes to impaired ear; In Sensorineural Loss sound lateralizes to good ear

Explanation:

Conductive hearing loss: Sound lateralizes to impaired ear—room noise not well heard, so detection of vibrations improves. Bone conduction longer than or equal to air conduction (BC ≥ AC). While air conduction through the external or middle ear is impaired, vibrations through bone bypass the problem to reach the cochlea.


Sensorineural hearing loss:
Sound lateralizes to good ear—inner ear or cochlear
nerve damage impairs transmission to affected ear. Air conduction longer than bone conduction
(AC > BC). The inner ear or cochlear nerve is less able to transmit impulses regardless of how the vibrations reach the cochlea. The normal pattern prevails.

35

You performed Rinne Test on the same patient and air conduction is more than bone conduction. What type of hearing loss is this?

a. Conduction hearing loss

b. Neural hearing loss

c. Sensorineural hearing loss

d. Transconduction hearing loss

c. Sensorineural hearing loss - Air conduction longer than bone conduction
(AC > BC). The inner ear or cochlear nerve is less able to transmit impulses regardless of how the vibrations reach the cochlea. The normal pattern prevails.



Explanation:

Conduction hearing loss - Bone conduction longer than or equal to air conduction (BC ≥ AC). While air conduction through the external or middle ear is impaired, vibrations through bone bypass the problem to reach the cochlea.

36

An 18 year old female came to you complaining of headache for the past 3 days on the right temporal area, dull to throbbing, non-radiating, mild to moderate in intensity, lasting for several hours, aggravated by bright lights and relieved by staying in a dark and quiet room. Based on this history, she is most likely having what type of primary headache syndrome?

a. Cluster Headache

b. Migraine Headache

c. Tension Headache

d. Sinus Headache

b. Migraine Headache

37

“Dizziness” is a nonspecific term used by patients encompassing several disorders. Vertigo is described as what kind of sensation?

a. aura and headache

b. disequilibrium and imbalance

c. pain, pressure, and/or fullness in the affected ear

d. spinning sensation of the surrounding or the environment

d. spinning sensation of the surrounding or the environment


Explanation:

a. aura and headache - migraine

b. disequilibrium and imbalance - lightheadedness

c. pain, pressure, and/or fullness in the affected ear - when paired with vertigo it is Meniere's disease

38

A 20 year old male comes to you complaining of diplopia after a sports related injury, what would you ask if you were suspecting either lens or cornea

a. Ask the patient to look up as you depress both lower lids with your thumbs, expos- ing the sclera and conjunctiva.

b. Ask the patient to look to each side and down.

c. a and b

d. none of the above

a. Ask the patient to look up as you depress both lower lids with your thumbs, expos- ing the sclera and conjunctiva.

b. Ask the patient to look to each side and down.

39

How far to position patient from chart?

a. 14 ft from Jaeger's; 20 ft from Snellen

b. 14 ft from Jaeger's; 14 ft from Snellen

c. 20 ft from Jaeger's; 14 ft from Snellen

d. 20 ft from Jaeger's; 20 ft from Snellen

a. 14 ft from Jaeger's; 20 ft from Snellen

40

A 25 year old female comes to you complaining of visual impairment. The left eye is adducted or deviated inward. What is your finding?

a. Right Esotropia

b. Left Esotropia

c. Left Exotropia

d. Right Hypertrophia

b. Left Esotropia
- The left eye is adducted or deviated inward


Explanation:
a. Right Esotropia
- The right eye is adducted or deviated inward

c. Left Exotropia
- The left eyes is abducted or deviated outwards

d. Right Hypertrophia
- The right eye is deviated upwards

41

After doing a visual acuity test, you report that the findings on the right eye are 20/40, what is the significance of the denominator?

A. The patient’s right eye can read the line of the Snellen chart from 40 feet.

B. The patient’s right eye can read line 40 of the Snellen chart.

C. A normal eye could read the line from 40 feet.

D. A normal eye could read the line from 40 feet with glasses.

C. A normal eye could read the line from 40 feet.

42

After doing a wiggle test, you note that the patient has a visual defect on the temporal side of the right eye and the nasal side of the left eye. This leads you to think that a lesion may be along which parts of the visual pathway?

A. Left optic tract and left optic radiation.

B. Right optic tract and right optic radiation.

C. Left optic tract and right optic radiation.

D. Right optic tract and left optic radiation.

A. Left optic tract and left optic radiation.



Explanation:
B. Right optic tract and right optic radiation. - temporal side of the left eye and the nasal side of the right eye

C. Left optic tract and right optic radiation.

D. Right optic tract and left optic radiation.

43

After doing direct and consensual light reflex examination in your patient, you note the following results;

* Direct: contraction of right pupil, no reaction on the left

* Consensual: no contraction on both pupils

Which cranial nerves are likely affected?

A. CN I and CN III of the left eye.

B. CN I and CN III of the right eye.

C. CN I of the left eye and CN III of the right eye.

D. CN I of the right eye and CN III of the left eye.

B. CN I and CN III of the right eye.

44

44. In examining the ear, what is the proper way of straightening the ear canal before inserting the otoscope?

A. Grasp the auricle firmly but gently and pull it downward, backward, and slightly toward the head

B. Grasp the auricle firmly but gently and pull it downward, backward, and slightly away from the head

C. Grasp the auricle firmly but gently and pull it upward, backward, and slightly toward the head

D. Grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head

D. Grasp the auricle firmly but gently and pull it upward, backward, and slightly away from the head

45

Cone of light seen, with respect to umbo?

a. Above umbo

b. Below umbo

c. Lateral umbo

d. Medial umbo

b. Below umbo

46

Nasal obstruction, manifestation?

a. Inflamed turbinates

b. Inflamed sinus

c. Runny nose

d. Sneezing

a. Inflamed turbinates

47

On inspection of the inside of the nose with an otoscope and the largest ear speculum available, which of the following structures is not usually seen?

A. Superior Turbinate

B. Middle Turbinate

C. Inferior Turbinate

D. Nasal Septum

A. Superior Turbinate

48

How will you properly palpate for the frontal and maxillary sinuses?

A. Press up on the frontal sinuses and maxillary sinuses

B. Press down on the frontal sinuses and maxillary sinuses

C. Press up on the frontal sinuses and down on the maxillary sinuses

D. Press down on the frontal sinuses and up on the maxillary sinuses

A. Press up on the frontal sinuses and maxillary sinuses

49

What is the significance of asking the patient to protrude his tongue and noting the symmetry of the tongue?

A. Test cranial nerve XII

B. Test cranial nerve VII

C. Test cranial nerve IX

D. Test cranial nerve X

A. Test cranial nerve XII

50

After visualizing the pharynx and asking the patient to say “ah”, you noted that the soft palate on the right failed to rise. What is the significance of this finding?

A. Paralysis of cranial nerve XII

B. Paralysis of cranial nerve VII

C. Paralysis of cranial nerve IX

D. Paralysis of cranial nerve X

D. Paralysis of cranial nerve X