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PE midterm Spring'08
midterm notes Physical Examination
| Question | Answer |
|---|---|
| The red color of oxyhemoglobin & the pallor in its absence where the horny layer of the epidermis is thinnest & causes the least scatter | the fingernails, the lips, and the mocous membranes |
| Central Cyanosis | identified in the lips, oral mucosa, and tongue |
| Central or peripheral in origin | Cyanosis of the nails, hands, and feet |
| Disease cause of Central Cyanosis | Advanced LU disease, congenital HT disease, & abnormal hemoglobins |
| Pallor | decrease redness in anemia, & decrease blood flow when fainting or arterial insufficiency |
| Peripheral Cyanosis | Congestive HT failure |
| May also be central Cyanosis | Pulmonary Edema |
| Venous obstruction | may cause peripheal cyanosis |
| Suggests LV disease or excessive hemolysis of red blood cells | Jaundice |
| Jaundice | Yellow color, sclera, palpebral conjunctiva, lip, hard palate, undersurface of tongue, tympanice membrane, and skin |
| Carotenemia | yellow color at the palms, soles, and face |
| Cafe- Au- Lait Spot | Slightly but uniformly pigmented macule or patch with a some what irregular border, usually 0.5 to 1.5cm and of no consequence |
| Neurofibromatosis | Six or more Cafe Au Lait spot, each with a diameter > 1.5cm |
| Tinea Vericolor | Superficial fungus infection of the skin, causing hypopigmented, slightly scal macules on trunk, neck, and upper arms |
| Vitiligo | Depigmented macules appear on the face, hands, feet, extensor surfaces |
| Erythema | Red hue, increased blood flow "slapped cheeks" |
| Spider Angioma | Fiery red, <2cm, central body sometimes raised surrounded by erythema and radiating legs, LV disease, pregnancy, vitamin b def., sometime normal |
| Spider Vein | Bluish, various sizes, can resemble a spider or be linear, irregular or cascading. Often accopanies increased pressure in superfical viens, as in varicose viens |
| Cherry Angioma | Bright/Ruby Red 1-3mm, may be surrounded by halo |
| Petechia / Purpura | 1-3mm or larger, deep red or reddish purple, rounded, sometimes irregualr; flat |
| Ecchymosis | Purple or purplish blue, fading to green, yellow, and brown >3mm, blood outside of vessel, often secondary to brusing or trauma; also seen in bleeding disorder |
| Benign Nevus | common mole, appearance usually remains unchanged, defined borders, uniform color, <6mm, flat or raised surface |
| Malignant Melanoma | Asymmetry, irregular borders, variation in colors, >6mm, elevated |
| Increases the likelihood of tumor, abscess, other mass or lesions | Changing or progessively severe headaches |
| Coughing, sneezing, or changing the position of the head | May increase the pain from brain tumors and acute sinusitis |
| Subarachnoid hemorrhage or meningitis | Worst headache of my life |
| assocaited with mirgraine | Visual aura or scintillating scotomas, nausea and vomiting |
| Can also occur with subarachnoid hemorrhage, or brain tumors | Nausea/ vomiting |
| Sudden visual loss | retinal detachment, vitreous hemorrhage, occulsion of the central retinal artery |
| Hyperopia | difficulty seeing close |
| Presbyopia | Difficulty seeing far |
| Myopia | near- sightedness |
| Lesions in the retina or visual pathways | moving specks or strands, vitreous floaters, fixed defects (scotomas) |
| Detachment of vitreous from retina | flashing lights or new vitreous floaters |
| Sensorineural Loss | Problems in the inner ear, the cochlear nerve, or central connections in the brain |
| Conductive Loss | Problems from external or middle ear |
| Sensorineural Loss | trouble understanding speech, complains that others mumble |
| Conductive Loss | noisy environments makes worst |
| Sensorineural Loss | Hearing better in noisy environments |
| Ear pain associated with respiratotry infection | Otitis Media |
| Oititis Externa | Suggest pain in the external ear |
| True Vertigo | Feeling of being pulled, an inner ear problem or a central// peripheral lesion of CN VIII |
| Tinnitus | Sound of no external stimulus, associated with hearing loss and vertigo, it suggests Meniere's disease |
| Chronic Hoarness | Causes includes smoking, allergy, voice abuse, hypothyroidism, chronic infection (TB) and tumors |
| Legally Blind | 20/200 or less |
| Vision of 20/200 | At 20feet the patient can read print that a person wtih normal vision can read at 200 feet |
| Unilateral conductive hearing loss | Sound is heard in the impaired ear |
| Unilateral sensorineural hearing loss | sound is hear in the good ear |
| conductive hearing loss | sound is heard through bone as long as or longer than it is through air |
| Sensorineural hearing loss | sound is heard longer through air |
| Cushing Sydrome | Increased adrenal hormone produces a round or moon face with red cheeks, hirsutism |
| Nephrotic Syndrome | face edematous and often pale, Swelling first around eyesand in the morning, slitlike when edema is severe |
| Myxedema | Severe hypothrodism, has a dull, puffy facies. Hair and eyebrows are dry, coarse, and thinned. The skin is thin |
| Acromegaly | Increased growth hormone produces enlargement of both bone and soft tissue. Head is elongated, with boney prominence of forehead, nose, lips, and lower jaw. Soft tissues of nose, lips, ears also enlarged |
| Parkison Disease | Decreased facial mobility, blunt expression, mask like face, stare characteristic. Facial skin becomes oily, and drooling may occur |
| Anxiety | Most frequent cause of chest pain in children , also common in costochodritis |
| Wheezing | Partial airway obstruction from secretions, tissue inflammation, or a foreign body |
| Anxious breathing | episodic dyspnea durning both rest and exercise & hyperventilation, or rapid shallow breathing, other times frequent sighing |
| Cough | Can be symptom of left-sided HT failure, stimuli includes mucus, pus, blood , external agents |
| Dry Hacking cough | Mycoplasma pneumonia, productive cough, in bronchitis, viral or bacterial pneumonia |
| Mucoid Sputum | Translucent, white or gray purulent sputum is yellowish or greenish |
| Foul-smelling Sputum | Anaerobic lung abscess; tenacious sputum in cystic fibrosis |
| Large volume of purulent sputum | Bronchiectasis or Lung abscess |
| Hemoptysis | Coughing of blood, rare in children seen in cytic fibrosis |
| Blood from Stomach | darker in color then that from respiratory tract |
| Test Chest Expansion | Hands at level of 10th rib |
| Unilateral decrease or delay chest expansion | Causes includes chronic fibrotic disease of underlying lung or pleura, pleural effusion, lobar pneumonia, pleural pain with associated splinting and unilateral bronchial obstruction |
| Fremitus | Decrease or absent when the voice is soft or when the tranmission of vibrations from larynx to the surface of chest is impeded |
| Fremitus | Caused by obstructed bronchus, COPD, separation of pleural sufaces by fluid, fibrosis, air, or an infiltrating tumor, ad a very thick chest wall |
| Bronchophony | Louder, clearer voice sounds "99" |
| Egophony | "EE" is heard as "AY" lobar consolidation from pneumonia |
| Pectoriloquy | Louder, clearer whispered sounds, whisper "99" |
| Normal Adult Thorax | Wider than deep |
| Funnel Chest | Depression in the lower portion of sternum |
| Barrel Chest | increased anteroposterior diameter |
| Pigeon Chest (Pectus Carinatum) | Sternum is displaced anteriorly, increasing anteroposterior diameter |
| Thoracic Kyphoscoliosis | Abnormal spinal curvatures and vertebral rotation deform the chest |
| Best heard around cardaic apex | Sounds and mummurs arising from mitral valve |
| Best heard at or near left sternal border | Sounds/ mummurs originating from tricuspid valve |
| Best heard around 2nd and 3rd interspaces close to sternum | Sounds/ mummurs arising from pulmonic valve |
| From right 2nd interspace to apex | Sounds/mummurs from aortic valve |
| Angina Pectoris | Exertional chest pain with radiation to left side of neck and down left arm |
| Aortic Dissection | Sharp pain radiating into back or into neck |
| Orthopnea | Dyspnea when lying down, suggests left ventricular heart failure or mitral stenosis, or obstructive lung disease |
| Paroxysmal Nocturnal Dypnea | Sudden dyspnea and orthopnea that awaken pt from sleep, suggests left ventricular heart failure or mitral stenosis, can be mimicked by nocturnal asthma attacks |
| Dependent Edema | Excessive fluids in the interstital space appears in lowest parts of body, causes may be cardiac, nutritional , or postional |
| Edema | Occurs in renal and LV disease: periorbital puffiness, tight rings in nephrotic symdrome, inlarged waistline from ascites and LV failure |
| Thrills | May accompany loud, harsh, or rumbling mummurs as in aortic stenosis, patent ductus arteriosus, ventricular septal defect, |
| Aortic area | Right 2nd interspace |
| Pulmonic area | Left 2nd interspace |
| Right ventricular area | left sternal border |
| Left ventricular area | Apex |
| Apical impulse | may be displaced upward and to the left by pregnancy or high left diaphargm |
| Apical pulse | located 5th interspace in midcalvicular line |
| Presystolic murmur | mitral stenosis in normal sinus rhythm |
| Early diastolic | murmur of aortic regurgitation |
| Midsystolic murmur | Aortic stenosis and innocent flow murmurs |
| Pansystolic murmur | mitral regurgitation |
Created by:
mswilsonlmt
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