Pdwritten 2 With Lungs And Peripheral

By Day4517
Day4517, MedicalEducation
Jessica, a seasoned Physician Associate with a decade of clinical expertise, seamlessly integrates over five years of teaching experience. Her unique background in journalism adds a distinctive dimension to her multifaceted approach to healthcare and education, creating a rich and diverse professional profile.
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Pdwritten 2 With Lungs And Peripheral - Quiz

Skin, HEENT, lungs, peripheral vascular


Questions and Answers
  • 1. 

    Which would cause unilateral congestion?

    • A.

      Vasomotor rhinitis

    • B.

      Upper respiratory tract infection

    • C.

      Allergies

    • D.

      Septal deviation

    Correct Answer
    D. Septal deviation
    Explanation
    Septal deviation refers to the condition where the nasal septum, which separates the two nostrils, is displaced to one side. This can lead to unilateral congestion, meaning that only one nostril is congested or blocked. The deviation of the septum can obstruct the airflow through the affected nostril, causing congestion and difficulty in breathing. Therefore, septal deviation is the most likely cause of unilateral congestion among the given options.

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  • 2. 

    Brownish discoloration or ulcers just above the malleolus (ankle) suggest:

    • A.

      Chronic arterial insufficiency

    • B.

      Chronic venous insufficiency

    • C.

      Gangrene

    • D.

      Lymphedema

    Correct Answer
    B. Chronic venous insufficiency
    Explanation
    Brownish discoloration or ulcers just above the malleolus (ankle) suggest chronic venous insufficiency. This condition occurs when the veins in the legs are unable to properly pump blood back to the heart, leading to pooling of blood and increased pressure in the veins. Over time, this can cause discoloration of the skin, particularly around the ankle area. Ulcers may also develop due to the poor circulation. Chronic arterial insufficiency, on the other hand, typically presents with symptoms such as pain, pallor, and coolness in the affected limb. Gangrene usually results from severe arterial insufficiency, while lymphedema is characterized by swelling due to impaired lymphatic drainage.

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  • 3. 

    In Buerger's disease or thromboangiitis obliterans, absent or diminished pulses are found at the:

    • A.

      Popliteal artery

    • B.

      Femoral artery

    • C.

      Wrist

    • D.

      Carotid

    Correct Answer
    C. Wrist
    Explanation
    Buerger's disease or thromboangiitis obliterans is a condition that primarily affects the small and medium-sized arteries in the arms and legs. It is characterized by inflammation and clot formation in these arteries, leading to diminished blood flow. The absence or diminished pulses are typically found at the wrist in Buerger's disease. This is because the disease mainly affects the arteries in the upper extremities, including the radial and ulnar arteries that supply blood to the wrist.

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  • 4. 

    Breathing in and out of a paper bag may help to alleviate the associated symptoms.

    • A.

      Asthma

    • B.

      Spontaneous pneumothorax

    • C.

      Left-sided heart failure

    • D.

      Anxiety

    Correct Answer
    D. Anxiety
    Explanation
    Breathing in and out of a paper bag may help to alleviate the associated symptoms of anxiety. This technique, known as bag breathing or paper bag breathing, is often used as a coping mechanism for anxiety attacks. It works by increasing the levels of carbon dioxide in the body, which can help to regulate breathing and reduce symptoms such as hyperventilation and dizziness. This technique is not typically used for the other conditions listed, such as asthma, spontaneous pneumothorax, or left-sided heart failure.

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  • 5. 

    Tophi are deposits of ___ that are characteristic of tophaceous gout.

    • A.

      Otoliths

    • B.

      Uric acid crystals

    • C.

      Calcium crystals

    • D.

      Lipids

    Correct Answer
    B. Uric acid crystals
    Explanation
    Tophi are deposits that form in the joints and soft tissues of individuals with tophaceous gout. These deposits are composed of uric acid crystals, which are formed when there is an excess of uric acid in the body. The accumulation of uric acid crystals leads to the development of tophi, which are often visible as lumps under the skin. Therefore, the correct answer is uric acid crystals.

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  • 6. 

    Which nail sign would be the cause of the most concern?

    • A.

      Leukonychia

    • B.

      Oncholysis

    • C.

      Paronychea

    • D.

      Transverse linear depressions

    Correct Answer
    D. Transverse linear depressions
    Explanation
    Transverse linear depressions, also known as Beau's lines, are a nail sign that can indicate a significant underlying health issue. These depressions occur when there is a temporary interruption in nail growth due to a systemic illness, trauma, or severe stress. The presence of transverse linear depressions may be a cause for concern as it suggests an underlying health problem that requires further investigation and medical attention. Leukonychia, oncholysis, and paronychia are nail conditions that are generally less concerning and can often be treated or managed without significant health implications.

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  • 7. 

    What is normal diaphragmatic excursion?

    • A.

      0cm

    • B.

      1-2cm

    • C.

      5-6cm

    • D.

      9-10cm

    Correct Answer
    C. 5-6cm
    Explanation
    Normal diaphragmatic excursion refers to the range of movement of the diaphragm during normal breathing. The diaphragm is a dome-shaped muscle located at the base of the lungs. It contracts and moves downward during inhalation, allowing the lungs to expand and fill with air. During exhalation, the diaphragm relaxes and moves upwards. A normal diaphragmatic excursion is typically around 5-6cm, indicating that the diaphragm is functioning properly and able to move freely.

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  • 8. 

    The Rinne test lateralizes indicates bone conduction is greater than or equal to air conduction in:

    • A.

      Meniere's disease

    • B.

      Conductive hearing loss

    • C.

      Sensorineural hearing loss

    • D.

      Tinnitis

    Correct Answer
    B. Conductive hearing loss
    Explanation
    The Rinne test is used to evaluate the difference between bone conduction and air conduction. In conductive hearing loss, there is a problem in the middle or outer ear that hampers sound conduction to the inner ear. This results in a greater or equal perception of sound through bone conduction compared to air conduction. Therefore, the Rinne test lateralizes in conductive hearing loss.

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  • 9. 

    Which is not a "red flag" for serious secondary causes of headache?

    • A.

      Recent, sudden and very severe onset

    • B.

      Markedly elevated blood pressure

    • C.

      Reversible sensory changes

    • D.

      Presence of a rash

    Correct Answer
    C. Reversible sensory changes
    Explanation
    Reversible sensory changes are not considered a "red flag" for serious secondary causes of headache. Red flags are warning signs that indicate the need for further evaluation as they may suggest a more serious underlying condition. Reversible sensory changes, such as tingling or numbness, are often associated with migraines or tension headaches and are not typically indicative of a serious secondary cause. Therefore, the presence of reversible sensory changes is not a cause for immediate concern.

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  • 10. 

    Which refers to dilation of the pupil?

    • A.

      Miosis

    • B.

      Mydriasis

    • C.

      Anisocoria

    • D.

      Hemianopsia

    Correct Answer
    B. Mydriasis
    Explanation
    Mydriasis refers to the dilation of the pupil.

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  • 11. 

    Ischemia of which artery is related to erectile dysfunction?

    • A.

      Superficial femoral

    • B.

      Common femoral

    • C.

      Iliac

    • D.

      Iliac-pudendal

    Correct Answer
    D. Iliac-pudendal
    Explanation
    The iliac-pudendal artery is related to erectile dysfunction. Ischemia in this artery can lead to inadequate blood flow to the penis, resulting in difficulties achieving or maintaining an erection.

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  • 12. 

    In advanced arterial insufficiency, what would be remarkable regarding the color of an affected leg?

    • A.

      It would be normal or pale on elevation and normal or cyanotic on dependency

    • B.

      It would be pale, especially on elevation, and red on dependency

    • C.

      Petechiae and brown pigmentation would appear with chronicity

    • D.

      Brown pigmentation and ulceration would appear at the medial sides of the ankles

    Correct Answer
    B. It would be pale, especially on elevation, and red on dependency
    Explanation
    The correct answer suggests that in advanced arterial insufficiency, the affected leg would appear pale, especially when elevated, and red when dependent. This is because arterial insufficiency leads to poor blood supply to the leg, causing a lack of oxygen and nutrients. When the leg is elevated, there is even less blood flow, resulting in paleness. However, when the leg is dependent, blood rushes to the area, causing it to appear red. This color change is a characteristic feature of advanced arterial insufficiency.

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  • 13. 

    Abnormal retraction of the interspaces during inspiration can be a sign of:

    • A.

      Pneumonia

    • B.

      Pleural effusion

    • C.

      Upper airway obstruction

    • D.

      Marfan syndrome

    Correct Answer
    C. Upper airway obstruction
    Explanation
    Abnormal retraction of the interspaces during inspiration refers to the inward movement of the spaces between the ribs, which is not a normal respiratory pattern. This can occur due to various reasons, including upper airway obstruction. When there is a blockage or narrowing in the upper airway, such as in conditions like croup, epiglottitis, or foreign body aspiration, it can cause difficulty in breathing and result in abnormal retraction of the interspaces during inspiration. Therefore, upper airway obstruction is a plausible explanation for this sign.

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  • 14. 

    When a patient complains vaguely of "dizziness," and you OPQRST to follow up the complaint, which of the following is the patient most commonly describing?

    • A.

      Vertigo

    • B.

      Presyncope

    • C.

      Dysequilibrium

    • D.

      Psychiatric dizziness

    Correct Answer
    C. Dysequilibrium
    Explanation
    When a patient complains of "dizziness" without providing specific details, they are most commonly describing dysequilibrium. Dysequilibrium refers to a sense of unsteadiness or imbalance, often described as feeling "off" or "woozy." It is different from vertigo, which is a spinning sensation, presyncope, which is a feeling of almost fainting, or psychiatric dizziness, which is dizziness caused by psychological factors.

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  • 15. 

    New onset of dysconjugate gaze in adults is often

    • A.

      The result of trauma

    • B.

      An imbalance in ocular muscle tone

    • C.

      Hereditary

    • D.

      Related to macular degeneration

    Correct Answer
    A. The result of trauma
    Explanation
    The correct answer is "the result of trauma". Dysconjugate gaze refers to a misalignment of the eyes, where they are not properly coordinated in their movements. In adults, this condition is often caused by trauma, such as a head injury or damage to the nerves or muscles that control eye movement. Trauma can disrupt the normal functioning of the ocular muscles and lead to a dysconjugate gaze. Other factors like an imbalance in ocular muscle tone, hereditary factors, or macular degeneration may also contribute to eye problems, but they are not specifically mentioned in the question.

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  • 16. 

    What might cause the fundus to appear grayish brown with an almost purplish cast so the choroidal vessels are obscured?

    • A.

      Hypertensive retinopathy

    • B.

      The patient is a dark skinned person

    • C.

      Preretinal hemorrhage

    • D.

      Microaneurysms

    Correct Answer
    B. The patient is a dark skinned person
    Explanation
    The fundus appearing grayish brown with an almost purplish cast and the obscuring of choroidal vessels can be attributed to the patient being a dark-skinned person. In individuals with darker skin tones, the pigmentation of the retinal pigment epithelium is more pronounced, which can alter the appearance of the fundus and make it appear darker. This can make it difficult to visualize the choroidal vessels, leading to the observed findings.

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  • 17. 

    A silent gap between inspiratory and expiratory breath sounds suggests

    • A.

      Vesicular breath sounds

    • B.

      Tracheal breath sounds

    • C.

      Bronchial breath sounds

    • D.

      Adventitious breath sounds

    Correct Answer
    C. Bronchial breath sounds
    Explanation
    A silent gap between inspiratory and expiratory breath sounds suggests bronchial breath sounds. This is because bronchial breath sounds are characterized by a pause or gap between inspiration and expiration. These sounds are typically heard over the trachea and are louder and higher-pitched compared to vesicular breath sounds, which are heard over the peripheral lung fields. Tracheal breath sounds are harsh and heard over the trachea, while adventitious breath sounds refer to abnormal breath sounds such as crackles or wheezes.

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  • 18. 

    Egophony is a characteristic of

    • A.

      COPD

    • B.

      Asthma

    • C.

      Lobar consolidation

    • D.

      Pleural effusion

    Correct Answer
    C. Lobar consolidation
    Explanation
    Egophony is a characteristic of lobar consolidation because it refers to a change in the quality of vocal resonance heard during auscultation of the lungs. In lobar consolidation, there is consolidation or solidification of a lobe of the lung due to accumulation of fluid, pus, or cellular debris. This causes a change in the normal lung sounds, resulting in a nasal or bleating quality to the voice when heard through a stethoscope. This phenomenon is known as egophony and is commonly associated with lobar consolidation.

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  • 19. 

    If you see a firm, button-like, ulcerative lesion on the lip that you suspect may be carcinoma, a similar lesion resulting from what disease should be ruled out before biopsy?

    • A.

      Peutz-Jeghers syndrome

    • B.

      Actinic cheilitis

    • C.

      Syphilis

    • D.

      Hereditary hemorrhagic telangiectasia

    Correct Answer
    C. Syphilis
    Explanation
    Before performing a biopsy on a firm, button-like, ulcerative lesion on the lip suspected to be carcinoma, it is important to rule out syphilis as a possible cause. Syphilis can present with similar oral lesions, known as syphilis chancres, which can mimic carcinoma. Therefore, it is crucial to exclude syphilis as a potential diagnosis before proceeding with a biopsy.

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  • 20. 

    Epitrochlear lymphadenopathy may arise from which?

    • A.

      Chronic venous or arterial insufficiency

    • B.

      Local or distal infection

    • C.

      Raynaud's disease

    • D.

      Aneurysm

    Correct Answer
    B. Local or distal infection
    Explanation
    Epitrochlear lymphadenopathy refers to the enlargement of lymph nodes in the epitrochlear region, which is located in the inner elbow. It can occur as a result of various causes, including local or distal infection. Infections in the arm, hand, or fingers can lead to the enlargement of epitrochlear lymph nodes. These lymph nodes become enlarged as they work to filter and fight off the infection. Therefore, local or distal infection is a plausible explanation for the occurrence of epitrochlear lymphadenopathy.

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  • 21. 

    A normal pulse is which of the following?

    • A.

      Bounding

    • B.

      Brisk

    • C.

      Diminished

    • D.

      Absent

    Correct Answer
    B. Brisk
    Explanation
    A normal pulse is considered brisk. A brisk pulse indicates a healthy and strong heartbeat, with a normal rhythm and adequate blood flow. It can be felt easily and has a moderate strength. A brisk pulse is a positive sign of good cardiovascular health and normal functioning of the heart.

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  • 22. 

    Marked pallor in the feet on elevation suggests

    • A.

      Arterial insufficiency

    • B.

      Venous insufficiency

    • C.

      Varicose veins

    • D.

      Buerger's disease

    Correct Answer
    A. Arterial insufficiency
    Explanation
    Marked pallor in the feet on elevation suggests arterial insufficiency. Arterial insufficiency occurs when there is a decrease in blood flow to the extremities, often due to atherosclerosis or arterial occlusion. When the feet are elevated, blood flow should increase to the area, causing a normal pink color. However, in arterial insufficiency, there is a lack of blood flow, resulting in pallor. This is a characteristic finding in arterial insufficiency and helps differentiate it from other conditions such as venous insufficiency or varicose veins. Buerger's disease, a condition that affects the blood vessels in the extremities, can also cause arterial insufficiency and may present with similar findings.

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  • 23. 

    If hoarseness has lasted more than two weeks:

    • A.

      Suspect streptococcal pharyngitis

    • B.

      Visually examine the larynx with a mirror

    • C.

      It may be exacerbated by excessive use of OTC decongestants

    • D.

      Suspect Eustachian tube dysfunction

    Correct Answer
    B. Visually examine the larynx with a mirror
    Explanation
    If hoarseness has lasted more than two weeks, visually examining the larynx with a mirror is the appropriate action. This is because hoarseness that persists for such a duration could be indicative of an underlying condition affecting the larynx, such as vocal cord nodules or polyps. By visually examining the larynx, a healthcare professional can assess the condition of the vocal cords and identify any abnormalities or inflammation that may be causing the hoarseness. This can help in determining the appropriate treatment or further diagnostic steps to be taken.

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  • 24. 

    What might cause diffuse enlargement of the thyroid gland?

    • A.

      Abnormal metabolic process

    • B.

      Tumor

    • C.

      Hashimoto's thyroiditis

    • D.

      Prior radiation

    Correct Answer
    C. Hashimoto's thyroiditis
    Explanation
    Hashimoto's thyroiditis is an autoimmune disorder where the immune system mistakenly attacks the thyroid gland, leading to inflammation and eventual destruction of the gland. This chronic inflammation can cause diffuse enlargement of the thyroid gland, known as goiter. The immune system's attack on the thyroid gland disrupts its normal function, leading to decreased production of thyroid hormones. This can result in symptoms such as fatigue, weight gain, and sensitivity to cold. Therefore, Hashimoto's thyroiditis is a possible cause for diffuse enlargement of the thyroid gland.

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  • 25. 

    The trachea can be displaced laterally in

    • A.

      COPD

    • B.

      Severe asthma

    • C.

      Tuberculosis

    • D.

      Pleural effusion

    Correct Answer
    D. Pleural effusion
    Explanation
    Pleural effusion is the accumulation of fluid in the pleural space, the space between the lungs and the chest wall. This excess fluid can cause displacement of the trachea, pushing it to one side. In conditions like COPD, severe asthma, and tuberculosis, the trachea may not be displaced laterally. However, in pleural effusion, the presence of fluid can cause the trachea to shift from its normal position.

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  • 26. 

    Esotropia

    • A.

      Is a type of strabismus in which the eyes are deviated outward

    • B.

      Is a type of strabismus in which the eyes are deviated inward

    • C.

      Is a condition in which the eyelid folds outward

    • D.

      Is a condition in which the eyelid folds inward

    Correct Answer
    B. Is a type of strabismus in which the eyes are deviated inward
    Explanation
    Esotropia is a type of strabismus in which the eyes are deviated inward. This means that one eye turns inward while the other eye remains straight. This condition can cause double vision and can affect depth perception. It is often caused by a muscle imbalance in the eyes or a problem with the brain's control of eye movement. Treatment for esotropia may include wearing glasses, using eye patches, or undergoing surgery to correct the muscle imbalance.

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  • 27. 

    A finding of rhonchi on auscultation

    • A.

      Is not worthy of concern

    • B.

      Can indicate agonal breath sounds

    • C.

      Indicates narrowed airways

    • D.

      Is higher pitched than a wheeze

    Correct Answer
    B. Can indicate agonal breath sounds
    Explanation
    A finding of rhonchi on auscultation can indicate agonal breath sounds. Agonal breath sounds are abnormal breathing patterns that occur in the final moments of life or in individuals experiencing severe respiratory distress. These breath sounds are typically characterized by deep, gasping, and irregular breaths. Therefore, if rhonchi are heard during auscultation, it may suggest that the patient is in a critical condition and requires immediate medical attention.

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  • 28. 

    Your patient complais of abdominal pain after meals, "food fear" and weight loss.  You suspect:

    • A.

      Aortioiliac ischemia

    • B.

      Decreased arterial perfusion

    • C.

      Superior mesenteric ischemia

    • D.

      Abdominal aortic aneurysm

    Correct Answer
    C. Superior mesenteric ischemia
    Explanation
    The patient's symptoms of abdominal pain after meals, "food fear" (fear of eating due to pain), and weight loss suggest superior mesenteric ischemia. This condition occurs when there is decreased blood flow to the intestines due to a blockage or narrowing of the superior mesenteric artery. This can result in severe abdominal pain, especially after eating, and can lead to weight loss due to malnutrition. Aortoiliac ischemia and abdominal aortic aneurysm may cause similar symptoms but are less likely based on the given information. Decreased arterial perfusion is a general term that does not specifically explain the patient's symptoms.

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  • 29. 

    The patient is supine.  You lift her right leg to a 90 degree angle with the rest of her body.  The foot is markedly pale after 60 seconds.  When she sits up on the table with her legs dangling over the edge, the foot takes 45 seconds to turn pink, and it is a minute before you notice the filling of the veins.  After a minute the right foot also turns red and stays red for the rest of the exam.  Which is correct (two answers)?

    • A.

      The findings suggest venous insufficiency

    • B.

      The findings suggest arterial insufficiency

    • C.

      The findings are not reliable unless you know the status of the venous valves

    • D.

      You should calculate the ankle-brachial index immediately after this test.

    Correct Answer(s)
    B. The findings suggest arterial insufficiency
    C. The findings are not reliable unless you know the status of the venous valves
    Explanation
    The findings suggest arterial insufficiency because the foot becomes pale when elevated and takes a long time to turn pink and fill with veins when dependent. This indicates poor blood flow to the foot, which is characteristic of arterial insufficiency. Additionally, the fact that the foot turns red and stays red for the rest of the exam suggests that there may be chronic arterial insufficiency. However, the findings are not reliable unless you know the status of the venous valves because venous insufficiency can also cause similar symptoms. Therefore, further evaluation of the venous valves is necessary to confirm the diagnosis.

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  • 30. 

    You may mistakenly hear crackles on lung auscultation if a patient has a hairy chest.  What should you do to fix this problem?

    • A.

      Shave the patient's chest

    • B.

      Press harder on the stethoscope or wet the hair

    • C.

      Skip this step of the examination

    • D.

      Change the patient's position

    Correct Answer
    B. Press harder on the stethoscope or wet the hair
    Explanation
    The presence of hair on the chest can interfere with the proper placement of the stethoscope and result in crackles being heard during lung auscultation. By pressing harder on the stethoscope or wetting the hair, the clinician can ensure better contact between the stethoscope and the patient's chest, reducing the interference caused by the hair and improving the accuracy of the examination. Shaving the patient's chest is not necessary as there are alternative solutions available. Skipping this step of the examination or changing the patient's position would not address the issue caused by the hair.

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  • 31. 

    If bronchovesicular or bronchial breath sounds are heard in other places than over the manubrium and in the 1st and 2nd interspaces, it could be because

    • A.

      The lung is full of fluid or solid tissue

    • B.

      The lung is hyperinflated

    • C.

      The patient has asthma

    • D.

      The patient is suffering from anxiety

    Correct Answer
    A. The lung is full of fluid or solid tissue
    Explanation
    If bronchovesicular or bronchial breath sounds are heard in other places than over the manubrium and in the 1st and 2nd interspaces, it could be because the lung is full of fluid or solid tissue. This can occur in conditions such as pneumonia, pulmonary edema, or tumors. When the lung is filled with fluid or solid tissue, the normal air-filled spaces are replaced, leading to abnormal breath sounds being heard in different areas of the lungs.

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  • 32. 

    The palpable lymphatics of the lower limb are the ___.  The ___ group follows the femoral vein and the ___ group follows the inguinal ligament.

    • A.

      Deep inguinal nodes, horizontal, vertical

    • B.

      Deep inguinal nodes, vertical, horizontal

    • C.

      Superficial inguinal nodes, horizontal, vertical

    • D.

      Superficial inguinal nodes, vertical, horizontal

    Correct Answer
    D. Superficial inguinal nodes, vertical, horizontal
    Explanation
    The correct answer is "superficial inguinal nodes, vertical, horizontal". The superficial inguinal nodes are the palpable lymphatics of the lower limb. The lymphatics in this group follow a vertical course along the great saphenous vein and then turn horizontally along the inguinal ligament. This explanation aligns with the given answer choice.

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Day4517 |MedicalEducation |
Jessica, a seasoned Physician Associate with a decade of clinical expertise, seamlessly integrates over five years of teaching experience. Her unique background in journalism adds a distinctive dimension to her multifaceted approach to healthcare and education, creating a rich and diverse professional profile.
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