Medicine 1

Question 1

At what rate should the cuff be deflated when measuring blood pressure?

Answer 1

2-3mmHg per second

Steps to ensure accurate BP measurement.
1. Position the cuff & arm
- arm should be at heart level
- center the inflatable bladder over the brachial artery
- lower border of the cuff should be 2.5cm above the antecubital crease
2. Estimate the systolic pressure and add 30mmhg
- palpate the radial artery with the fingers of one hand & rapidly inflate the cuff until the radial pulse disappears; add 30 mmHg - deflated the cuff after and wait for 15-20 seconds
3. IdentifythesystolicBP
- inflate the cuff again rapidly to the computed target level
- deflate the cuff slowly at a rate of 2-3 mmHg/sec
- systolic pressure: the level you hear the
sounds of at least 2 consecutive beats
4. Identifythediastolicpressure
- continue to deflate the cuff slowly until the sound become muffled & disappear
- listen until the pressure falls another 10- 20 mmhg from the muffled sounds
- diastolic pressure: the disappearance point
Normal difference in both arms: 5-10mmHg **>10-15 mmHg could mean subclavian steal syndrome, supraclavicular aortic stenosis, and aortic dissection

Question 2

In choosing the right cuff in your BP apparatus ,how much should the width of the cuff based on the arm circumference of the patient

Answer 2

40% of the arm circumference

Length - 80% of upper arm circumference
Standard cuff. 12 x 23 cm

Cuff that is too narrow - BP falsely elevated
Cuff that is too wide - BP falsely decreased

Question 3

Presence of all these may point to focal neurologic deficits, except:

A. Disturbance in higher intellectual functions
B. Weakness
C. language impairment
D. Headache and vomiting

Answer 3

Headache and vomiting

Question 4

A 75-year-old is seen with incoherent and slowed responses with difficulty following instructions. This level of consciousness is:

Answer 4

Disorientation

1. Alert & oriented: alert & oriented to PPT
2. Disoriented/confused: incoherent & slowed responses; difficulty following
   instructions
3. Somnolent: excessive drowsiness, need to
   have tactile stimulation, can have mumbles
   with disorganized movement
4. Stuporous: marked reduction in mental,
   physical activity, not just tactile, need
   painful stimuli to arouse the patient
5. Comatose: even with pain stimulation, the patient is unconscious; absence of
   voluntary movement, +/- reflexes

Question 5

Schwabach’s test is done to check for:

a. Bone conduction of both the patient and examiner
b. Air conduction of patient and examiner both
c. Bone conduction and air conduction of patient
d. Bone conduction and air conduction of examiner

Answer 5

Bone conduction for both the patient and examiner

Schwabach’s test principle:
The Schwabach’s test is a bone conduction test. It compares the hearing sensitivity of a patient with that of an examiner.

Question 6

Diplopia is seen in lesions in the brainstem or cerebellum and with weakness or paralysis with one or more extraocular muscles. What will be the presentation of diplopia if there is CN III or VI palsy?

A. Horizontal diplopia
B. Vertical diplopia
C. Oblique diplopia
D. Transverse diplopia

Answer 6

Horizontal diplopia

Question 7

A type of patent assessment that is more appropriate for established patients, especially during routine or urgent care visits

A. Focused assessment
B. Comprehensive assessment
C. problem-based assessment
D. A and C
E. A and B

Answer 7

D. Focused assessment and Problem-based assessment

Question 8

Office blood pressure <140/90 but an elevated daytime blood pressure >135/85 on home or ambulatory testing

A. Nocturnal hypertension
B. Masked hypertension
C. White-coat hypertension
D. None of the above

Answer 8

B. Masked hypertension

White coat hypertension: BP >140/90 & mean awake ambulatory readings <135/85
Nocturnal hypertension: average nighttime BPs of >110/65 mmHg

Question 9

A 74-year old male was complaining of tearing on the left eye. There was no associated redness or purulent discharges, no blurring of vision, no pain. Physical examination revealed the outward turning of the lower lid margin partially exposing the palpebral conjunctiva

A. Esotropia
B. Entropion
C. Exotropia
D. Ectropion

Answer 9

Ectropion

Entropion - Inward turning of the lid
Ectropion - outward turning of the lid

Question 10

Which of the following would be considered as sub-acute cough?

A. Brochiectasis
B. Viral Upper Respiratory Infection
C. Heart Failure
D. Post-infectious cough

Answer 10

Post-infectious cough

Acute (<3 weeks): viral URTI, acute
bronchitis, pneumonia, left-sided heart failure, asthma, foreign body, smoking and ACE inhibitory therapy
Subacute (3-8 weeks): post-infectious, pertussis, acid-reflux, bacterial sinusitis, asthma
Chronic (>8 weeks): postnasal drip, asthma, GERD, chronic bronchitis, bronchiectasis