VD Final Lecture Exam

Melissa comes to your office for a scheduled wellness visit after having returned from a trip to Singapore. She tells you that she fell asleep on the plane and that she woke up with a deep pain in her left calf muscle. which of the following should be done earliest in the visit

Perform a physical exam focusing on vascular structures and look for Homans's sign

Later in the Physical exam, you gently press your thumb ( or finger) slightly superior and anterior to the middle malleolus on both her legs and look for the indentation to remain. This test accesses which of the following

Pitting edema

Warfarin (rat poison) has been prescribed to some patients because of its ability to do what?

Prevent blood clotting

If you suspect that Joseph may deep-vein thrombophlebitis, what is your primary concern?

Pulmonary embolism

Voncille, an elderly patient, presents with low back pain. You notice that she has bandages over several areas of her body. She states that she is on blood thinners. She also has been treated for low B12. What test is used to determine whether a patient is adequately absorbing B12/

Schilling's test

A family member tells you that they've been having migraines. After asking some clarifying questions you learn that their headaches come on seasonally due to sinus pressure. How would you categorize this type of headache?

Secondary sinus headache

While evaluating a new patient you notice that they have a dropping face, arm weakness and slurred speech. They most likely are experiencing a:

Stroke

She also complains of episodic headaches over the temporal region. Which structure may be directly involved ?

Temporomandibular Joint (TMJ)

Hemostasis describes which of the following processes in the body relevant to this patients case?

The generation of clotting factors

You notice that the patient has a thickening of the toenails. How does this relate to his underlying condition?

Too little blood flow has caused an increase in fungal infection and tissue damage

Joseph, a 50-year-old male patient presents with inflammation of the skin of the lower legs with a tendency towards brown pigmentation. The patients legs are swollen and the pigmentation does not match the surrounding tissue elsewhere in the body. This is called stasis dermatitis. T/F

True

Which structures in Melissa's venous system are likely contributing to the presentation you are observing

Valves in the tunica intima

Melissa states that she has experienced episodic warmth and swelling in the extremities. She also complains of color changes in the toes. What vascular structures are you concerned about?

Veins

While performing a History and physical exam on Voncille, you suspect she might have hearing loss. What would be a good follow-up test?

Webber's Test

You did evaluate Richard's Ankle Brachial Pressure Index and find a value (ratio) of 0.6 What does this mean?

he has moderate peripheral artery disease

You palpate what feel nodules in Linda's neck that move when she swallows. You decide to auscultate her thyroid. What do you expect to hear?

A bruits indicating increase blood flow

Terry, a long-term patient in your office complains of the acute low back since his last visit. He is 68 years old and explains that he did a lot of heavy lifting over the weekend helping a friend move. When performing an x-ray you notice the following. What do you expect in this case

AAA

Based on our in-class discussion, and given the image above, what would be the next logical thing to do?

Alert the patient to the issue and recommend a follow-up with their MD

A patient who states that they notice a change in their field of vision minutes before the onset of a severe headache is describing what phenomenon?

An Aura before a classic migraine

While performing Allen's Test you notice that when you release the ulnar artery on Richard's right hand that there is a delay of 25 seconds of the hand returning to a normal color. This is a positive test and indicates

Arterial Insufficiency

What would be the next logical action to take for the patient in the previous question?

Call 911

Which headache type likely has the largest impact on a patient's activities of daily living?

Classic migraine

A patient states that he has frequent recurring headaches that last between 15 minutes and 3 hours at a time. When active, he has them up to 3 times per day. He can go months without having them. What kind of headache fits this trend?

Cluster

John, a 38-year-old patient, presents with a severe, acute, stabbing headache behind the right eye. His right eye is tearing and his nose is running. What kind of headache does this describe?

Cluster

Richard's physical exam, a good indicator to determine whether he has peripheral arterial disease and not peripheral venous disease is finding

Decreased pulse amplitude in the extremity

After finding a positive pitting edema test you can confidently assume that Melissa has acute heart failure. T/F

False

While evaluating this patient he explains that he has been diagnosed with diabetes (history of 20 years diabetic) you notice a crater-like ulceration on his heel. This patient most likely has:

Gangrene

While applying pressure to Melissa abdomen you notice that her jugular vein seems distended and the pulsations are apparent: this means the following:

Hepatojugular reflex

While evaluating for bruits of the thyroid gland, you hear a positive finding. This indicates

Hypermetabolic state of the thyroid

Linda, a 45-year-old female patient, presents with irritability and enlargement of the neck. Which of the following should be on your differential diagnosis?

Hyperthyroidism

While taking a case history, Richard tells you that he has pain in both calf muscles when he walks but that is relieved shortly after he stops to rest. This describes

Intermittent Claudication

Based on your diagnosis in the previous question, what would be a logical explanation of the patient's findings

Lack of adequate blood flow

While performing palpation of the cervical spine, you notice a soft, mobile lymph node. The patient states that it is tender to touch. What could this indicate?

Lymphadenitis due to localized infection

This brings to mind the large swelling of the supraclavicular node (aka Signal Node). Were this palpate, what might it indicate?

Malignancy in the abdomen or thorax

Richard, an older male patient presents to your office with fatigue and episodic sharp stabbing pain in his lower legs. He states that it is worse with exercise. You ask the patient to show you his legs. If you suspect an arterial problem, how would you expect his legs to look?

Pale or bluish in color, dry with noticeable hair loss