EENT Physical Exam

Description:	Boards 3 - EENT Physical exam by regions
Category:	Chiropractic
Created by:	dc2bsoon on 2009-08-31

Question	Answer
Red and swollen nasal mucosa indicates?	Viral Rhinitis (common cold)
Pale, blue or red indicates?	Allergic rhinitis
Atrophy, sclerosis, crust formation, foul odor of the nasal mucosa indicates?	Atrophic rhinitis
Polyps of the nasal mucosa indicates	Middle meatus problem
Another name for Hyperthyroidism	Graves
Hyperthyroidism signs	Goiter, tachycardia and atrial fibrillation, widened pulse pressure, warm, fine, weight loss, moist skin, fine tremors, exopthalmosis
Hyperthyroidism symptoms	Nervous, increased appetite with weight loss, insomnia, increased sweating
Hyperthyroidism Laboratory Values	T3 increases most, T4, I^131 uptake normal, decreased TSH
Hypothyroidism also known as	Myxedema
Graves	Toxic, diffuse goiter
Primary cause of hypothyroidism	probably autoimmune, following Hashimoto's
Secondary cause of hypothyroidism	failure of pituitary to secrete TSH or hypo-thalamus o serete TRH
Primary labs used for hypothyroidism	Increased TSH (high), Decreased T3, T4, Increased Cholesterol
Secondary Labs used for hypothyroidism	Decreased TSH; Decreased TRH; Decreased T3, T4; Decreased cholesterol
Skin/Hair for primary hypothyroidism?	Coarse, dry, scaly no pigmentation
Skin/Hair for secondary hypothyroidism?	Dr, but NOT coarse depigmentation
Tongue for primary hypothyroidism	Macroglossia
Eyes appearance for primary hypothyroidism?	Periorbital swelling; dropping eyelids; loss of lateral 1/3 eyebrow
Breast Appearance in primary hypothyroidism?	Normal
Breast Appearance in secondary hypothyroidism?	Atrophic
Menstruation in primary hypothyroidism?	Menorrhagia
Mensturation in secondary hypothyroidism?	Ammenorrhea
Blue skin color of the thorax indicates?	cyanosis
clubbing of the fingernails indicates?	Chronic Lung pathology
Centered trachea indicates?	normal
Lateral displacement of trachea away from lesion indicates?	pleural effusion; pneumothorax
Lateral displacement toward the lesion indicates?	atelectasis
Symmetry of the chest indicates?	Normal
Asymmetrical chest findings indicate?	Scoliosis
Barrel Chest findings indicate?	Emphysema
Duration of vesicular breath sounds?	Inspiratory longer than expiratory
Location of vesicular breath sounds?	Most of lung especially the base
Duration of Bronchovesicular breath sounds?	Inspiratory equals expiratory
Location of Bronchovesicular breath sounds?	Anterior: 1st and 2nd interspace; Posterior: Between scapula at the lung apex
Duration of Bronchial breath sounds?	expiratory longer than inspiratory
Location of Bronchial breath sounds?	over manubrium
Duration of Tracheal breath sounds?	Inspiratory equals expiratory
location of tracheal breath sounds?	over trachea in neck
Asthma breath sound?	wheezing
asthma percussive note?	Resonant
Atelectasis breath sound?	absent
atelectasis percussive note?	flat/dull
Bronciectasis breath sound?	Rales
Bronchitis breath sound?	Rhonchi
Bronchitis percussive note?	Resonant
Emphysema breath sound?	Wheezing
Emphysema percussive note?	Hyperresonant
Pleurisy breath sound?	Crackles (friction rub)
Pleurisy percussive note?	Resonant
Pneumonia Breath Sound?	Egophony, bronchophony, whispered pectoriloquy
Pneumonia percussive note?	dull
Pneumococcal (Lobar) Pneumonia cough/sputum findings?	Productive/Rusty
Pneumococcal (Lobar Pneumonia Organism?	Strep. pneumonia
Friedlander's Pneumonia cough/sputum findings?	Productive/current jelly (red)
Friedlander's Pneumonia organism?	klebsiella Pneumonia
Hemophilus Broncho-pneumonia cough/sputum findings?	Productive/gram neg. coccobacilli
Hemophilus Broncho-pneumonia organism?	hemophilus influenza (usually in children)
Primary Atypical Pneumonia cough/sputum findings?	Dry/mucoid or mucopurulent
Primary atypical pneumonia organism?	mycoplasma pneumonia (most common lung infection 5-35 yr. old
Viral pneumonia cough/sputum findings?	Dry/mucopurulent
Viral pneumonia organism?	Adenovirus; parainfluenze (failure to find bacteria)
Viral pneumonia accompanied by?	headache, fever, myalgia, and cough
Pneumocystis carinii organism?	Protozoan (AIDS patients)
Cytomegalovirus organism	CMV (AIDS patients)
S1 Heart Sound	AV values closing (mitral and tricuspid)
S2 Heart Sound	Semilunar Valves closing (pulmonary and aortic)
S3 Heart Sound	Venticular Gallop/Protodiastolic gallop
S4 heart Sound	Presystolic gallop/Atrial gallop
When the venticles contract it is called?	Systole
When the ventricles rest (the smaller atria contract) the ventricles are filling, this is called?	Diastole
From the Body (deoxygenated blood) travels from?	The Right atrium -> Right Ventricle -> To the Lungs
From the Lungs (oxygenated blood) travels from?	The Left Atrium -> Left Ventricle -> To the Body
Stenosis murmurs pitch	Low
Listen to Stenosis murmurs with?	Bell of Stethescope
Description of Stenosis murmur	Valve has trouble opening. Blood swirls through a narrow opening.
Regurgitation aka	Insufficiency
Description of Regurgitation murur	Valve is insufficient. Blood seeps or squirts back into chamber.
Regurgitation pitch	high
Listen to regurgitation murmur with?	Diaphragm of stethescope
The mnemonic for heart murmurs ARMS occurs in?	Aortic, Regurgitation, Mitral, Stenosis occurs in Diastole
The mnemonic for heart murmurs PRTS occurs in?	Puilmonic, Regurgitation, Tricuspid, Stenosis occurs in Systole.
Laboratory values with Myocardial Infarction	CPK, SGOT, LDH
CPK appears and returns to bormal by when?	appears 3-6 hours, returns to nornmal by 3rd day.
SGOT appears and returns to normal by when?	appears 6-8 hours, returns to normal by 4-6 days
LDH appears and returns to normal by when?	10-12 hours, returns to normal after 14 days
Which sided heart failure occurs with Pulmonary edema?	Left sided
Which sided heart failure occurs with Nocturnal dyspnea?	left sided
Which sided heart failure occurs with Exertional dyspnea?	Left sided
Which sided heart failure occurs with Tachycardia?	Left sided
Which sided heart failure occurs with systemic hypertension?	Left sided
Which sided heart failure occurs with Orthopnea and coughing?	Left sided
Which sided heart failure occurs with Rales heard at the lung bases?	Left sided
Which sided heart failure occurs with pitting edema	Right sided
Which sided heart failure occurs with ascites?	Right sided
Which sided heart failure occurs with cor pulmonale	Right sided
Which sided heart failure occurs with hepatomegaly with portal hypertension?	Right sided
Which sided heart failure occurs with jugular venous distention?	Right sided
Which sided heart failure occurs with esophageal varices?	Right sided
Which sided heart failure occurs with Right ventricular hypertrophy?	Right sided
Which sided heart failure occurs with Esohageal varices?	Right sided
Which sided heart failure occurs with hemorrhoids?	Right sided
Which sided heart failure occurs with testicular varicosities?	Right sided
P wave results	atrial depolarization
QRS complex results	Ventricular depolarization
T wave results	Ventricular varicosities
Prinzmetal angina (angina pectoris at rest) and pistol shot pulse produce?	Aortic regurgitation
Triphasic color change of a localized area due to an arterial spasm. First the area turns white, then blue, and finally the spasm relaxes and the area is red.	Raynaud's Phenomenon
Primary Condition seen in the upper extremities of females	Raynauds's Phenomenon
Buerger's aka Thromboangitis obliterans age/sex and associated with?	20-40 year old males, excess tobacco smoking
Buerger's aka Thromboangitis obliterans signs/symptoms and orthopedic tests	Intermittent claudication, small arteries of feet and hands, non-healing ulcers and gangren. Orthopedic tests: claudication time, buerger's test
Raynauds age/sex and associated with?	>15 yr. females, associated with Buerger's, collagen disease, scleroderma
Raynauds signs/symptoms and orthopedic tests?	Arterial spasms; triphasic color change in fingers: white-blue-red. Finger tip ulcers and gangrene. Cold sensitive. Orthopedic tests: Allen's test
Aneurysm associated with?	Heart disease cardiovascular disease
Aneurysm signs and symptoms	Abnormal widening that involves all 3 layers (defect in elastic-media tissues) DX: ultrasound (size and thickness)
Dissecting Aneurysm associated with?	abrupt onset epigastic pain
Dissecting Aneurysm signs and symptoms	interruption of the intima allowing blood into the vessel wall with immediate "tearing" pain DX: aortography
Dissecting aneurysm of the ascending aorta associated with?	Marfan's
Dissecting aneurysm of the descending aorta associated with?	Hypertension, arteriosclerosis
Commencement of pain while walking and disappearance of pain after rest.	Intermittent claudication
2 causes of Intermittent claudication	neurogenic and vascular
Neurogenic claudication pattern	not predictable
what relieves neurogenic claudication?	position related (lying down with knees bent)
what is the common cause of neurogenic claudication?	Degenerative joint disease central canal stenosis
Vascular claudication pattern	predictably reproducible
What relieves vascular claudication	always with rest
What is the common cause of vascular claudication?	arteriosclerosis or Buerger's disease
Venous disorders are diagnosed by?	Doppler
Signs and symptoms of varicose veins	Incompetent valves, dilated tortuous channels (visible-bluish) Ortho: Homan's
Signs and symptoms of deep vein thrombosis	tenderness, edema, pain Ortho: Homan's
Homan's orthopedic test indicates?	deep vein thrombosis
homan's procedure and postive test?	Patient leg extended, examiner dorsiflexes foot. Positive test is pain in calf.
Perthe's aka tourniquet test orthopedic test indicates?	Deep vein obstruction, common veins are incompetent.
Claudication procedure and postive test?	Walk at rate of 120 teps/min for 60 secs. Positive test is pain in calves.
Bicycle orthopedic test indicates?	+ vascular, - neuro
Bicycle test procedure and positive	Pedal fast until painful, rest until painless, repeat. Positive test: pain in calves
Stoop orthopedic test indicates?	+ Neuro, - Vascular
Stoop test procedure and postive	Walking causes pain, stooping or flexing forward relieves it, positive test: pain in calves.
RBC increased	Polycythemia vera
RBC decreased	anemia
WBC increased	acute infection, inflammation, leukemia
WBC decreased	overwhelming infection, viral conditions
RBC aka	erythrocyte
WBC aka	leukocyte
Hgb aka	hemoglobin
Hct aka	hematocrit
Platelets aka	thrombocytes
Hgb increased	dehydration, polycythemia vera
Hgb decreased	Anemia
Hct increased	dehydration, polycythemia vera
Hct decreased	Microcytic Anemia
Platelets increased	Polycythemia, trauma, blood loss
Platelets decreased	Anemia, extensive or severe burns, thrombocytopenia
neutrophils associated with?	bacteria; acute infection
Lymphocytes associated with?	virus; chronic infection
Monocytes associated with?	chronic infection
Eosinophils associated with	allergies or parasites
Basophils associated with	heparin production
neutrophils increased in	bacterial infection; pneumonia
Lymphocytes increased in	Mononucleosis; lymphocytic leukemia
Monocytes increased in	Hodgkin's
Eosinophils increased in	Asthma; worm infections
Basophils increased in	Myeloid leukemia
Band cells	immature neutraphils (form of wbc)
Segs cells	mature cells
Shilling shift to the left	increase in band cells and a reduction in segs seen in fulminating infections and acute appendicitis.
Acid phos indicates	prostrate carcinoma
A/G ratio indicates	Reversal - multiple myeloma, RA
Albumin indicates	increased: dehydration; decreased: Nephrosis
Alk. Phos	Increased: osteoblastic lesions (bone), Hepatic disease (liver)
Amylase/Lipase	Increased: Acute Pancreatitis
Ana (FANA)	Collagen disease (SLE, Scleroderma)
ASO Titre	Increased: Pheumatic Fever, Acute Glomerulopnephritis
Increased direct bilirubin	hepatic disease, duct obstruction
increased indirect bilirubin	hemolytic disease, drugs, spleen
Increased unconjugated (indirect bilirubin) in the blood causes	increased urobilinogen in the urine
Increased conjugated (direct bilirubin) in the blood causes	increased bilirubin the in the urine
In normal urine there is a trace of urobilinogen but no	bilirubin
BUN increased	kidney disease
BUN decreased	liver disease
CA increased	(muscle weakness) hypothyroidism, hyperparathyroidism, icnreased vitamin D, metastatic bone disease
CA decreased	(muscle tetany) opposite of above
Coombs indicates	hemolytic disease
CPK (Creatine) increased:	muscle necrosis (skeletal, heart, brain)
C-reactive protein increased	tissue necrosis
Creatinine increased	kidney disease
creatinine decreased	MD
Downey Cell indicates	Mono (atypical lymphocyte)
ESR increased:	Infection
ESR decreased:	Sickle Cell, polycythemia
glucose (blood) increased	DM, Cusings, emotional
glucose (blood) decreased	overdose, insulin, addison's
glucose (CSF) decreased:	meningitis (bacterial)
heterophile (paul bunnel)	Mono
HCG (pregnancy only) increased	hydatidiform node, choriocarcinoma, seminoma, multiple pregnancy
HCG (pregnancy only) decreased	ectopic pregnancies
Cholesterol	heart disease
ketones (fat metabolism)	diabetic acidosis/starvation
LDH increased:	MI, muscular dystrophy
Lipids Atherosclerosis increased	Early starvation, DM
Lipids Atherosclerosis decreased	Late starvation, Liver disease
LE Prep	SLE (most specific test)
Mono Test	MONO
Phosphorus increased	acromegaly, kidney, hyper D
Phosphorus decreased	Rickets, hypo D, hyperparathyroidism
Potassium increased:	Addison's, kidney failure
Potassium decreased:	Renal disease, insulin,duretics
Protein (CSF) increased	meningitis (viral)
Protein Increased	MM/diabetiscs acidosis
Protein Decreased	Liver disease/Kidney syndromes
RA latex increased	In RA, may be absent in Still's
RA Latex negative	sero negative arthrities, includes Psoriatic, AS enteropathic, Reiters
SGOT (AST) increased:	MI Liver
SGPT (ALT) increased:	Liver
T3/T4 increased:	hyperthyroidism
T3/T4 decreased:	hypothyroidism
uric acid increased	Gout/kidney
Type and most common cause of iron deficiency	Hypochromic Microcytic, chronic blood loss and pregnancy
Appearance of iron deficiency	spoon nails
Type and most common cause of acute post -hemorrhagic	Normocytic, rapid massive hemorrhage
Type and most common cause of chronic post-hemorrhagic	hypochromic microcytic, iron deficiency
Type and most common cause of aplastic	Normochromic Normocytic, panhypoplasia of bone marrow; drugs/radiation
aplastic associated with	leukopenia and thrombocytopenia
Type and Most common cause of Megaloblastic	macrocytic normochromic, defective DNA synthesis, B12 and Folic acid deficiency
Most common cause of B12 deficiency	Lack of IF due to atrophic gastic mucosa; Dx: shilling test (24 hour urine) tx: B12 shots
Most common cause of folic acid deficiency	Chronic alcohol abuse; pregnancy; malabsorption
Cell type and cause of sickle cell	Howell Jolly bodies, caused by Hgb S
Cell type and cause of Thalassemia ("Cooley's Anemia")	Microcytic Target cells caused by decreased synthesis of beta chains
Cause of Erythro-blastosis Fetalis	Rh+ father, Rh- mother, Rh+ baby, Fetus neonate
Stomach diseases	Ulcer, Gastritis, Chronic Gastritis, Carcinoma
Stomach disease laboratory values	Serum: CBC, Iron; Urine: Shilling Test; Stool: Guaiac (occult blood in the stool); X-Ray: Upper GI series
Laboratory values for Hodgkins	Reed Sternberg Cell
Lab values for Mononucleosis	Monospot Test, Atypical lymphocytes (downey cells), Paul Bunnel = Heterophile agglutination test
Lab values for Leukemia	CBC, Bone Marrow aspiration
lab values for AIDS	Elisa, Western Blot
Lab values for Hemolytic Anemia of the spleen	CBC, Indirect Bilirubin
Lab Values for ruptured spleen	CBC
Laboratory values of Liver hepatitis viral type A, B, Non A-NonB	Liver enzymes: SGPT, SGOT, GGT, LDH, A/G ration, BUN, bilirubin, alkaline phosphatase
Laboratory values of Liver Cancer	Alpha fetoprotein, liver biopsy
Lab value of cholecystitis	Murphy's sign
Lab value of cholelithiasis	cholecystogram
Lab values of Pancreatitis (usually alcohol related)	amylase/lipase
Pancreatic Cancer usually where?	Head of Pancreas
Lab values for diabetes mellitus	FBS2 hr. post prandial glucoseGTTGlycosylated HgbUA (glucosuria)
Lab value for duodenal ulcer	Upper GI series, CBCStool: Guaiac
Lab value for Regional ileitis (chrohn's , men 15-30)	General: Lower GI seriesGI series: skip lesionsStool: diarrhea
Lab values for ulverative colitis (fever)	Stool: bloody diarrhea
lab values for irritable Bowel Syndrome	Stool: alternating diarrhea and constipation
lab values for appendicitis	CBC, Shilling shift to the left
Lab values for Diverticulitis	GI series:outpocketings in descending colon
lab values for Carcinoma (most common recto-sigmoid)	Stool: frank blood (painless)
lab values for hemorrhoids	Stool: frank blood (painful)
Lab values for Cushings (hyper-Adrenalism)	buffalo hump, moon face, hirtsuism
Lab values for addison's (hypo-adrenalism)	bronze skin, electrolyte imbalance, confusion
Lab values for pheochromocytoma (medulla)	hypertensive crisis, sweating
Hyaline casts in urine indicates	Normal
RBC casts in urine indicates	Glomerulonephritis
WBC casts in urine indicates	pyelonephritis
Waxy fatty oval bodies casts in urine indicates	nephrotic syndrome
Straw urine color indicates?	Normal
Red urine color caused by blood, food pigments indicates what?	Infection, cancer, foods
Green urine color caused by Biliverdin indicates?	Biliary duct obstruction
Blue urine color indicates?	Diuretic therapy
Brown urine color caused by bile pigments, blood indicates?	Biliary duct obstruction, occult blood
Black or bownish-black urine color caused by homogenistic acid, urobilin indicates?	ochronosis, hemolysis, bacteria