PRIMARY CARE DUNPHY & WINLAND-BROWN
FULL REVISION NOTES WITH HEALTH
ASSESSMENT AND DIAGNOSTIC REASONING
CONCEPTS
◉ Marvin, a known alcoholic with cirrhosis, is frequently admitted
for coagulopathies and occasionally receives blood transfusions. His
wife asks you why he has bleeding problems. How do you respond?
1.
"Occasionally he accumulates blood in the gut."
2.
"There is an interruption of the normal clotting mechanism."
3.
"Long-term alcohol abuse has made his vessels very friable."
4.
"His bone marrow has been affected."
Answer: "There is an interruption of the normal clotting
mechanism."
◉ Shelby has recently been diagnosed with pancreatitis. Of the
following objective findings that can result from the pancreatic
inflammatory process, which is known as Grey Turner sign?
,1.
Left-sided pleural effusion.
2.
Bluish discoloration over the flanks.
3.
Bluish discoloration around the umbilicus.
4.
Jaundice.
Answer: Bluish discoloration over the flanks.
◉ Bobby, age 6, has constant periumbilical pain shifting to the right
lower quadrant, vomiting, a small volume of diarrhea, absence of
headache, a mild elevation of the white blood cell count with an
early left shift, and white blood cells in the urine. You suspect:
1.
Appendicitis.
2.
Gastroenteritis.
3.
Acute pancreatitis.
4.
Rocky Mountain spotted fever.
,Answer: Appendicitis.
◉ Melva, age 63, presents with an acute exacerbation of pancreatitis,
and you are going to admit her to the hospital. Which is the most
important factor in determining a negative long-term outcome for
her?
1.
Age.
2.
Infection.
3.
Pain.
4.
Length of time between exacerbations.
Answer: Infection.
◉ Marian, age 52, is obese. She complains of a rapid onset of severe
right upper quadrant abdominal cramping pain, nausea, and
vomiting. Your differential diagnosis might be:
1.
Appendicitis.
2.
Crohn's disease.
, 3.
Cholecystitis.
4.
Irritable bowel syndrome.
Answer: Cholecystitis.
◉ You suspect that Nikki has a gastroduodenal ulcer caused by
Helicobacter pylori and plan to treat her empirically. What
medications should you order?
1.
A proton pump inhibitor (omeprazole), tetracycline or amoxicillin,
and metronidazole (Flagyl).
2.
Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec).
3.
Amoxicillin (Amoxil) and omeprazole (Prilosec).
4.
Clarithromycin (Biaxin) and metronidazole (Flagyl).
Answer: A proton pump inhibitor (omeprazole), tetracycline or
amoxicillin, and metronidazole (Flagyl).
◉ An 83-year-old female presents to the urgent care clinic for
diarrhea. The patient was just discharged from the hospital 1 week
FULL REVISION NOTES WITH HEALTH
ASSESSMENT AND DIAGNOSTIC REASONING
CONCEPTS
◉ Marvin, a known alcoholic with cirrhosis, is frequently admitted
for coagulopathies and occasionally receives blood transfusions. His
wife asks you why he has bleeding problems. How do you respond?
1.
"Occasionally he accumulates blood in the gut."
2.
"There is an interruption of the normal clotting mechanism."
3.
"Long-term alcohol abuse has made his vessels very friable."
4.
"His bone marrow has been affected."
Answer: "There is an interruption of the normal clotting
mechanism."
◉ Shelby has recently been diagnosed with pancreatitis. Of the
following objective findings that can result from the pancreatic
inflammatory process, which is known as Grey Turner sign?
,1.
Left-sided pleural effusion.
2.
Bluish discoloration over the flanks.
3.
Bluish discoloration around the umbilicus.
4.
Jaundice.
Answer: Bluish discoloration over the flanks.
◉ Bobby, age 6, has constant periumbilical pain shifting to the right
lower quadrant, vomiting, a small volume of diarrhea, absence of
headache, a mild elevation of the white blood cell count with an
early left shift, and white blood cells in the urine. You suspect:
1.
Appendicitis.
2.
Gastroenteritis.
3.
Acute pancreatitis.
4.
Rocky Mountain spotted fever.
,Answer: Appendicitis.
◉ Melva, age 63, presents with an acute exacerbation of pancreatitis,
and you are going to admit her to the hospital. Which is the most
important factor in determining a negative long-term outcome for
her?
1.
Age.
2.
Infection.
3.
Pain.
4.
Length of time between exacerbations.
Answer: Infection.
◉ Marian, age 52, is obese. She complains of a rapid onset of severe
right upper quadrant abdominal cramping pain, nausea, and
vomiting. Your differential diagnosis might be:
1.
Appendicitis.
2.
Crohn's disease.
, 3.
Cholecystitis.
4.
Irritable bowel syndrome.
Answer: Cholecystitis.
◉ You suspect that Nikki has a gastroduodenal ulcer caused by
Helicobacter pylori and plan to treat her empirically. What
medications should you order?
1.
A proton pump inhibitor (omeprazole), tetracycline or amoxicillin,
and metronidazole (Flagyl).
2.
Bismuth subsalicylate (Pepto-Bismol) and omeprazole (Prilosec).
3.
Amoxicillin (Amoxil) and omeprazole (Prilosec).
4.
Clarithromycin (Biaxin) and metronidazole (Flagyl).
Answer: A proton pump inhibitor (omeprazole), tetracycline or
amoxicillin, and metronidazole (Flagyl).
◉ An 83-year-old female presents to the urgent care clinic for
diarrhea. The patient was just discharged from the hospital 1 week
