Internal 3rd year 1st semester 2013
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Anamnesis consists of:
- 1. familial anamnesis
- 2. enviromental and social anamnesis
- 3. previous diseases
- 4. present complaints
- 5. other aspects in connection with the patient (drugs taken, drug allergy)
List the parts of the general examination:
- 1. inspection
- 2. palpation
- 3. percussion
- 4 auscultation
The temperature of the body is between 37.0 - 37.5°C
The temperature of the body is between 37.6-40°C
The causes of fever are:
- 1. infectious diseases
- 2. tissue-damage or-necrosis
- 3. altered function (damage) of the heat center
- 4. heat congestion
Febris continua means:
Continously high fever, daily change of fever less than 1°C
Febris remittens means:
Changing fever, the changes are higher than 1-1.5 °C per day but the lowest temperature remains above 37°C
Febris intermittens means:
Changing fever, the changes are higher than 1.5°C per day, but the lowest temperature is normal
Broca’s formula is the following:
Ideal weight kg = height in cms minus 100
The following characteristics of the sputum should be analysed:
- 1. quantity
- 2. color
- 3. odor
- 4. consistency
The number of breathing is 16-18/min, with symmetric distension of the thorax.
Frequent breathing, the number of breathing > 18/min
Basic clinical examinations in lung diseases are:
- 1. physical
- 2. radiological
- 3. functional tests
Main directions for examinations of pulmonary diseases are:
- 1. basic clinical diagnosis
- 2. differential diagnosis
- 3. searching for infectious agents
The followings should be followed by auscultation of the lungs:
- 1. comparative auscultation should be done on both sides, on the same places
- 2. the apices of the lungs should be auscultated first, and then medium and lower parts consecutively
- 3. murmurs should be evaluated before and after coughing
- 4. whistling may be analysed if the patient breathes deeply with open mouth
Normal auscultation sound of the lung is:
Sharp, full, not tympanic.
Lower borders of the lungs are ( normal case):
- Right medioclavicular line, lower edge of the 6th rib.
- Medioaxillary line, both side: 8th rib.
- Scapular line, both side: 9th rib.
- Paravertebral line, both side: processus spinosus of the 11th vertebra.
The borders of the Traube’s space are:
Lung, spleen, liver, lowest rib.
The followings should be considered while percussing the thorax:
- 1. ideal position of the patient
- 2. do not percuss above bones
- 3. the percussion sound may differ on different regions of the thorax
Types of cardiac dyspnea are:
- 1. exercise-induced dyspnoe
- 2. resting dyspnoe
- 3. orthopnoe (respiration can be performed only in an erect posture)
- 4. paroxysmal dyspnoe (spasm or involuntary muscular contraction)
Heart rate is over 100/min
Heart rate is below 60/min
What is the difference between central and peripherial cyanosis?
- The central cyanosis is rather generalised, the extremities are warm.
- Peripherial cyanosis is localised, and the extremities are cool.
The borders of the relative heart dullness are:
- 1. Lower border: right medioclavicular line, 5th intercostal space
- 2. Right border: right edge of the sternum
- 3. Upper border: left parasternal line, the upper edge of the 3rd rib
- 4. Left border: the apex beat, or one finger medial from the medioclavicular line
The first heart sound is generated by:
The closure of the mitral and tricuspidal valves and by tension of the myocardium.
The second heart sound is generated by:
The closure of the aortic and pulmonary valves.
The third heart sound is:
The filling sound
The fourth heart sound is:
Presystolic sound (atrial).
The third heart sound becomes loud in general:
In case of volume overload of the heart.
The fourth heart sound becomes loud:
In case of pressure overload of the heart.
Characterize protosystolic murmur:
Murmur at the beginning of the systole.
Characterize mesosystolic murmur:
Murmur in the middle of the systole.
Characterize holosystolic murmur:
Murmur audible through the entire systole.
Characterize presystolic murmur:
Murmur at the end of the diastole, just before the systole.
Characterise gallop rhytm:
Either the third or the fourth heart sound or both become loud and their intensity equals with the first and the second sound.
Describe organic endocardial murmur:
The murmur is caused by structural damage of the great blood vessel walls, valves or orifices.
Murmurs are characterized by the followings:
- 1. In which heart phase is it audible (systolic/diastolic)
- 2. Intensity
- 3. Quality
- 4. Tone
- 5. Punctum maximum (localization)
- 6. Radiation
Describe the borders of the heart on a postero-anterior X-ray picture:
- Left, from above: aorta, a. pulmonalis, left auricle, left ventricle.
- Right, from above: aorta, v. cava superior, right auricle.
Which arteries are palpable on the low extremities?
- a. femoralis
- a. poplitea
- a. dorsalis pedis
- a. tibialis posterior
Describe pulse deficit:
The frequency of the heart beat (by auscultating above the heart) is higher than that of the peripheral pulse waves.
List the characteristics of pulse:
Describe Homan’s test:
By bent knees, sudden dorsalflexion of the foot results in pain of the sural muscles (charateristic for deep vein thrombosis).
Describe Lövenberg’s or cuff sign:
Increasing the pressure gradually in a cuff located on the patient’s thigh or leg at pressure of 80-120 mmHg, the patient feels intense pain (in the case of deep vein thrombosis).
The Trendelenburg’s and Perthes’ tests inform about:
The permeability of the superficial and the deep veins.
The Gartner’s sign informs about:
The central venous pressure.
List the regions of the abdomen:
- right and left hypochondrium
- umbilical region
- right and left lumbar region
- right and left inguinal region
What is examined by superficial palpation of the abdomen?
The tension of the abdominal muscles, local or diffuse muscle guarding.
The disappearance of the liver dullness indicates:
Free air in the abdominal cavity, as the consequence of gastric or intestinal perforation.
Describe normal borders of the spleen:
Between the 9th and 11th ribs on the left, between the anterior and medial axillary lines.
Painful, frequent irritation for urination, small amount of exerted urine.
What is anuria?
The amount of daily urine is less than 100 ml.
What is oliguria?
The amount of daily urine is less than 500 ml.
General examination of the urine involves the following:
- specific gravity - osmolality
- microscopic examination of the sediment
The clearance indicates the following:
The excretion of a particular material by the kidney, during 1 minute.
Detectable protein present in the urine
Detectable pus in the urine.
Bacteria are detectable in the urine (105/ml or more).
Microscopic hematuria means:
Red blood cells (RBC) are detectable in the sediment by microscopic examination.
What is microscopic hematuria?
RBC of different size and shape are present in the sediment of the urine.
The diagnosis means:
Identification of a certain disease or disorder.
Diagnostic procedures cover:
Methods and examinations aiming to get a diagnosis.
Differential diagnosis means:
Differentiation between diseases that have similar symptoms.
Healthy person pretends to be sick.
The patient demonstrates more severe complaints than he actually has.
Neglecting or diminishing real complaints or symptoms.
List the possible outcomes of a disease:
- Complete recovery
- Partial recovery with persistent defects
- Relapse or worsening
Describe the different periods of a particular disease:
- Latency (from the beginning of the disease till the development of complaints)
- Morbid stage (from the appearance of signs and symptoms till their disappearance)
Describe the parts of the patient chart:
- - Personal data
- - History (familial, environmental, social, previous diseases, present complaints, drugs taken, drug allergy)
- - Physical examination (state at the admission)
- - Epicrisis
How to detect free air in the abdominal cavity?
By the disappearance of the liver dullness.
Claudicatio intermittens covers:
After walking a certain distance, a crampy, intense pain develops in the sural muscles which relieves after rest.
Dysbasic (claudication ) index covers:
The walking distance, after which the crampy pain develops in the sural muscles. It indicates arteriosclerosis obliterans, shorter distances indicate worse condition.
The Perthes’ test informs about:
The permeability of the deep veins and the condition of the venae perforantes.
What is the difference between transsudate and exsudate regarding protein content?
Protein content of the exsudate ≥ 4 g%, vs. protein content of the transsudate: 1-2 g%
Which test is used to differentiate between pleural transsudate and exsudate?
Vital capacity is:
The maximal amount of exhaled air after the deepest inspiration.
If the patient complains about pain, the followings must be described:
- Location, radiation
- Quality (type), severity
- The setting in which it occurs
- Factors that make it better or worse
- Associated symptoms
Where should the aortic valve be auscultated?
Right parasternal line, second intercostal space.
Where should the a. pulmonalis be auscultated?
Left parasternal line, second intercostal space.
Where should the mitral valve be auscultated?
On the place of the apex beat.
Orthopnea may suggest:
Left ventricular failure, mitral stenosis, obstructive lung disease.
What is the typical location of the pain caused by myocardial infarction?
Retrosternal pain that may radiate to the left shoulder, arm, to the neck or to the lower jaw. The pain can be localised into the epigastrial region.
List the lines that demarcate the regions of the abdomen:
The right and left medioclavicular lines, the subcostal and the interspinal lines.
What is meteorism?
Increased gas content of the bowels with consequent elevation of the anterior abdominal wall.
The causes of diffuse enlargement of the abdomen are the followings:
Obesity, meteorism, ascites, pregnancy, filled urinary bladder.
What does hernia mean?
Inherited or aquired weakness of the abdominal wall (abdominal muscles) and increased intraabdominal pressure result in the protrusion of the bowels or the omentum pushing forward the parietal peritoneum
Describe the normal male and female pubic hair:
- The male pubic hair extends to the umbilicus showing an inverted V form.
- The female pubic hair ends as a sharp, horizontal or slightly convex line above the mons pubis.
List the different ways of the abdominal palpation:
Superficial, medium deep and deep, penetrating, bimanual and balloting.
How to characterize an intraabdominal resistance?
Localisation, shape, surface, size, consistency, mobility, tenderness, borders, connection with breathing.
The characteristics of the free intraabdominal fluid are the followings:
Lying on the back, it has a concave border and follows changes in the position of the body. The fluid fluctuates.
The characteristic percussion sound of the abdomen is:
Tympanic, characteristic for air-containing cavities.
Describe the borders of the absolute liver dullness:
Right medioclavicular line, from the lower edge of the 6th rib till the costal margin.
Digested blood in the stool (tarry black stool).
Undigested, fresh blood in the stool.
The acholic stool looks like:
Grayish-white, fatty-shining stool indicating obstruction of the bile ducts.
Which is the ideal position of the patient for examination of the spleen?
The patient lies on his right side, the left arm above his head.
What is subicterus?
Slight jaundice, when yellow coloration of the sclera is detectable. The concentration of the serum bilirubin is about 35 umol/l.
Where is the McBurney’s point?
In the right iliacal (inguinal) region, at the border of the lateral and medial thirds of the line between the umbilicus and the spina iliaca anterior superior.
Where is the place of the abdominal puncture (paracentesis)?
In the left iliacal (inguinal) region, at the border of the lateral and medial thirds of the line between the umbilicus and the spina iliaca anterior superior.
Describe edema and the place of its occurence:
Increase of the interstitial fluid. Edema may be local and generalized.Cardiac edema occurs in the lower body parts (legs, sacral region) of the body due to the gravitation. Renal edema may develop anywhere (mainly in loose connective tissue, i.e. around the eyes and in the scrotum). Hypoproteinemic edema is generalized. Deep vein thrombosis and chronic venous insufficiency result in edema present on the corresponding extremity.
How to carry out and evaluate Babinski’s sign?
Scratching along the lateral surface of the sole from the heel forward. In pathological case, dorsalflexion of the hallux and fanning of the other toes are detectable, indicating upper motor neuron disease.
What characteristics of the pupils should be examined?
Width, round shape, sharp edge, central location, equality, narrowing to light and convergence, consensual reactions.
The hypnoid mental disturbances are the followings:
- Somnolence, sopor, coma.
- somnolence - drowsiness/sleepiness
- sopor - a deep, lethargic, or unnatural sleep
The most frequently tested reflexes of the upper extremity are:
Radius, ulna, biceps and triceps reflexes.
The most frequently tested reflexes of the lower extremity are:
Patella and Achilles reflexes.
The meningeal excitation signs are:
Vomitus, nausea, bradycardia, fixed occiput (stiffness of the neck), Brudzinsky’s sign, Kernig’s sign.
Describe the investigation of the Lasegue’s sign:
Patient lying on his back and elevating his fully streched legs, pain develops below 90 degrees of elevation.
Gout affects most frequently the following joints:
Metatarso-phalangeal (MTP) articulation of the hallux.
Rheumatoid arthritis affects most frequently the following joints:
Metacarpo-phalangeal (MCP) and proximal interphalangeal (PIP) articulations.
Which of the chronic dermatological diseases involves polyarthritis?
List the main pathological types of breathing:
List the main symptomes of nephrotic syndrome:
- Generalized edema
- Heavy proteinuria
Describe Courvoisier’s sign:
Icterus and painless enlargement of the gallbladder.
What may the Courvoisier’s sign indicate?
Carcinoma in the head of the pancreas.
The positive Mennel’s test may indicate:
Disease of the sacroiliacal (SI) articulation.
The spider nevi are characteristic of:
The biceps reflex informs about the following vertebral radix:
The triceps reflex informs about the following vertebral radix:
The radius reflex informs about the following vertebral radix:
The abdominal cutaneous reflex informs about the following vertebral radix:
The patella reflex informs about the following vertebral radix:
The Achilles reflex informs about the following vertebral radix:
What sould be registered by inspection of the abdomen?
- The level of the anterior abdominal wall as compared to the anterior wall of the thorax.
- Its movement with breathing.
- Lumps, hernias.
- Scars and other alterations (coloration) of the skin.
- The umbilicus (normal, extroverted, introverted)
The inspection of the thorax informs about:
- The shape of the thorax.
- Scars and other abnormalities of the skin (eruption, nevi, etc.).
- Extraordinary pulsation of the thorax.
- The state of the jugular veins (empty or dilated).
The pectoral (tactile) fremitus informs about:
The resonance and conductance of the lungs and thoracic wall.
Give the normal concentration of serum Na:
Give the normal concentration of serum K:
Give the normal concentration of serum glucose:
Give the normal concentration of the white blood cells:
Give the normal concentration of hemoglobin:
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