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Physical Exam MT

Review questions for quizzes 2,3,4,5,6

QuestionAnswer
Causes of central cyanosis advanced lung disease, congenital heart disease, abnormal Hgb
Where to detect central cyanosis lips, oral mucosa, tongue
Causes of peripheral cyanosis cause of peripheral cyanosis is usually congestive heart failure (in pulmonary edema there could be CENTRAL)
Where to detect peripheral cyanosis nailbeds, fingertips (book says TOES and TOENAILS!!)
Causes of generalized itching (could be systemic liver problem/liver disease)
How common is skin cancer in the US? most common cancer in th eUS
Three types of skin cancer. What do they look like? BSM, basal cell (80%), squamous cell (16%), melanoma (4%)
Most lethal skin cancer melanoma
Most common skin cancer (in the US) basal cell
HARMM risk factors for melanoma. (What are additional risk factors?) History of prior melanoma. Age>50. REGULAR dermatologist absent. Male gender. Mole changes.
Most commonly recommended SCREENING MEASURE for skin cancer patient self-exam
ABCDEs of examining moles for detection of melanomas Asymmetry. Blurred borders. Change in color. Diameter>6mm or Different from other moles. Elevation/Enlargement
How to counsel patient on skin cancer prevention measures k
Two types of sunscreen There are two types of physical sunscreens namely zinc oxide and titanium dioxide.
What is SPF? Using an SPF 15 sunscreen theoretically prevents reddening 15 times longer. SPF 15 filters out approximately 93 percent of all incoming UVB rays. SPF 30 keeps out 97 percent and SPF 50 keeps out 98 percent.
Different skin colors or color changes There are many: cafe au lait spots, tinea versicolor, vitiligo, cyanosis, jaundice, carotenemia, erythema, heliotrope
Causes of pallor decreased blood flow, anemia
What is jaundice? diffuse yellow tint to skin and especially the SCLERA (the whites) of the eye
Possible causes of jaundice liver disease, hemolysis of RBCs
Where to look for jaundice SCLERA of eyes
What is carotinemia? yellow or orange hue to skin d/t eating lots of carotin rich fruits or vegetables (sweet potatoes, kale, carrots, papaya, squash). ONLY SHOWS IN HANDS!
Where to look for carotinemia? HANDS
Causes of dry skin HYPOthyroid
Causes of oily skin acne
Causes of rough skin HYPOthyroid
Causes of velvety skin HYPERthyroid
Usual areas of distribution for acne vulgaris face, upper chest, back
Usual areas of distribution for psoriasis knees and elbows (extensor surfaces)
Usual areas of distribution for Candida albicans "intertriginous areas"
Usual areas of distribution for atopic dermatitis (eczema) cubital and popliteal creases, palms (flexor surfaces)
What do acne lesions look like? duh
What does psoriasis look like? silvery scaly lesions (extensor surfaces)
What was Candida albicans look like? duh
What does eczema (atopic dermatitis) look like? ?
Pattern of lesions in herpes ulcer palpable elevation with fluid-filled cavities
Pattern of lesions in ring worm infection rounded scaling patches
Risk factors for pressure ulcers Decreased mobility, decreased sensation, decreased blood flow, fecal or urinary incontinence, presence o fracture, poor nutritional status
Stages of pressure ulcers (bed sores) Stage 1= color & temp change. Stage 2= beginning of ulceration. Stage 3= skin loss with damage to or necrosis of subcutaneous tissue. Stage 4= Damage extends INTO underlying muscle or bone.
How to catch bed sores (pressure ulcers) before they become ulcerated? k
Causes of hair loss alopecia areata, trichotillomania (hair pulling, twisting), tinea capitis (ring worm)
How to distinguish between/among different possible causes of hair loss k
Type of hair in hypothyroidism slow heart rate, cold intolerant, constipation, weight gain. skin is cool and pale d/t of decreased blood flow. Hair may be COARSE. Hair loss is common, nails become brittle. Anemia is also common. The voice can deepen.
Type of hair in hyperthyroidism Thinning of hair is common, but hair loss is uncommon. Faster HR and slightly higher temperature, sweating. prominent bulging of the eyes and difficulty sleeping. treated with beta blockers to slow metabolism and then drugs to block thyroid secretion.
Define paronychia "para" "onchi": inflammation just before the nail ("proximal & lateral"). red, swollen, tender.
Define clubbing of finger nails distal phalanx is rounded and bulbous. nail plate is more convex. Causes include chronic hypoxia and hepatic cirrhosis.
Define onycholysis painless separation of nail plate from bed
Define Mees' lines transverse white lines
Define pitting of nails small pits. maybe be early signs of psoriasis
Causes of paronychia frequent immersion of nails in water
Causes of finger nail clubbing chronic hypoxia or hepatic cirrhosis
Causes of onycholysis there are many causes
Causes of Mees' lines (aka leukonychia striata) Mees' lines appear after an episode of poisoning with arsenic, thallium or other heavy metals, and can also appear if the subject is suffering from renal failure. They have been observed in chemotherapy patients.
Causes of nail pitting • psoriasis (10-50% of patients have nail pits); • alopecia areata; • eczema; • Reiter’s syndrome;
What is koilonychias? aka spoon nails
Causes of koilonychias hereditary nail disorder and a possible sign of hypochromia anemia, particularly iron-deficiency anemia
How do you record physical exam finding of the skin? k
Causes of palmer erythema Portal hypertension, Chronic liver disease, Pregnancy, Polycythemia, Thyrotoxicosis, Rheumatoid Arthritis (especially in patients with polycythaemia), Coxsackievirus A virus infection, Rocky Mountain Spotted fever, secondary syphilis
Causes of spider angioma liver disease, pregnancy, vit B def (also occurs normally in some people)
Skin pigment in Addison's disease darkened
Cause of café au lait spot IF 6 OR MORE WITH DIAMETER >1.5CM, SUSPECT neurofibromatosis
Causes of (tinea) versicolor superficial fungal infection
Appearance of tinea versicolor hyperpigmented, slightly scaly MACULES on the trunk, neck, upper arms ("short sleeve distribution")
Appearance of vitiligo depigmented macules on face, hands, feet, extensor surfaces
Common sites for vitiligo face, hands, feet, extensor surfaces
Cause of "slapped cheek" aka erythema. caused by erythema infectiosum (??)
What is heliotrope? looks like violet eye shadow! ("violaceous eruption over the eyelids in the collagen vascular disease DERMATOMYOSITIS")
Causes of heliotrope DERMATOMYOSITIS (a vascular disease of the collagen)
Macule small flat spot (</=1cm) e.g. hemangioma, vitiligo
Patch macule >1cm e.g. cafe-au-lait spot
Papule elevated superficial lesion (</=1cm) e.g. psoriasis
Nodule Pick one: either papule >1cm or... "marble-like lesion larger than 0.5cm often deeper and firmer than a papule" e.g. dermatofibroma
Vesicle palpable fluid-filled elevation (</= 1cm) e.g. herpes
Bulla vesicle > 1.0cm e.g. insect bite, burn
Pustule pus filled vesicle e.g. acne, pox lesions
Scales thin flake of dead exfoliated skin e.g. ichthyosis vulgaris, dry skin
Squames keratin layers covering the skin as flakes or sheets that can be scraped away (e.g. seborrheic keratosis, psoriasis)
Fissure dry, linear crack in the skin, often result of excessive dryness e.g. athlete's foot
Five levels of consciousness Alert, lethargic, OBTUNDED (non-response to aural but responsive to GENTLE SHAKE), stupor (responsive only to painful stimulus), coma
Significance of copper bracelet arthritis
Significance of excess clothing hypothyroid
Significance or cut-out holes in shoes, or slippers bunyon
Significance of immobile face Parkinson's
Significane of staring eyes Grave's
Significance of breath odor of acetone DM
Significance of breath odor of urine LR failure
Significance of fast, frequent movements (tachykinesia) Graves
Significance of slow movement (bradykinesia) hypothyroid
Significance of preference for sitting up orthopnea
Significance of preference for leaning forward (with arms braced) emphysema/COPD
Conditions causing short stature Turner's, childhood KD achondroplastic, hypopituitary dwarf
Conditions causing long limbs hypogonadism, Marfanism
Cause of height loss osteoporosis
Causes of generalized fat obesity
Causes of truncal fat metabolic syndrome/Cushing's
What are the causes of weight loss malignancy, DM, hyperthyroidism, depression, "diuresis," chronic illness
How to calculate BMI kg/m2 or lbsx700/inches/inches
Normal BMI 19-24
Underweight BMI <19
Overweight BMI 25-29
BMI cut-offs for the 3 stages of OBESITY 30, 35, 40
At what BMI is waist circumference indicated? >/=35 for women, >/=40 for men
What is normal Upper Limit of wait measurement in both sexes? 102 cm (40") for men. 88 cm (34") for women
What is hip-waist ratio? (Hips should be slightly wider than waist, so ratio of 0.9 is considered normal. Anything > 1.0 considered healthy.)
Prevalence of obesity among ethnic groups in US? 60% of US adults are overweight or obese. 14% of children (Mexican-American boys). AA women: 69%. WHITE men 62%. AA men 58%.
Disease caused by obesity CVD, DM, stroke, RA, sleep apnea
4 tips for promoting optimal weight (and nutrition) Establish BMI and waist circumference. Establish any additional risk factors. Assess dietary intake. Assess patient motivation, provide support, ideas, encouragement as necessary.
"Can slight reduction of weight (5-10%) improve BP and other risk factors?" don't tell me, let me guess: Yes?
Recommended rate of optimum weight loss per week 1/2-1 lb
Recommended rate of optimum weight loss over 6 months 10%
Dietary factors related to BP Too much Na+. Not enough K+. Not enough vit D. Too much ETOH.
RDA for sodium < 2,400 mg
How many calorie hours are used by a 154 lb man when he walks 3.5 mph? 140 calories in 30 minutes of walking
How many calorie hours are used by a 154 lb man when he jogs 5 mph (a little more than DOUBLE the 3.5 mpg walking:) 295 calories in 30 minutes of jogging 5 mph
What is the appropriate size of BP cuff? 12 x 23 cm (width s/b 40% of upper arm circumference; length of inflatable bladder about 80% of upper arm circumference)
What happens if you use a too tight BP cuff? "too small a cuff will give falsely high reading"
What happens if you use a too loose BP cuff (or bladder that balloons outside the cuff)? falsely high reading (sounds like if cuff is too loose, it will give falsely low reading on small arm. if cuff is too small/tight, could give falsely HIGH reading on obese arm.)
Steps of accurate BP measuring duh
What happens if arm is positioned TOO HIGH (above level of heart)? 6-7 cm above heart level= 5 cm lower BP reading
What happens if arm is positioned TOO LOW (below level of heart)? 7-8 cm below heart level= 6 cm higher BP reading
What BP is considered normal today? Systolic <120, diastolic <80
What are the target organs of HTN Heart, kidneys, brain, eyes
How to distinguish between coarctation of aorta vs. aortic stenosis when measuring BP? HTN in upper with lower BP (and diminished or delayed pulse) in lower (femoral artery)
The 4 aspects of pulse (RRAC) Rate, Rhythm, Amplitude, CONTOUR
What HR is considered normal? 50-90 bpm
What BP levels are considered pre-hypertension? 120-139 systolic. 80-89 diastolic.
Different patterns of irregular heart beat atrial premature, ventricular premature, sinus arrhythmia, A-fib/A-flutter
Define orthostatic HYPOtension sudden decrease (20 mm Hg or more) in blood pressure when a person stands up
Causes of orthostatic hypotension "side effect of medications, loss of blood, prolonged bed rest, diseases of autonomic nervous system"
4 parameters of RESPIRATION Rate, Depth, Regularity, Effort
What RR is considered normal? 20 breaths per minute?
DIfferent ways of measuring body temp oral, axial, rectal, tympanic
Normal average body temp when measured orally 37
Normal average body temp when measured at axilla 0.5 less
Normal average body temp when measured rectally 0.5 more
Define hyperpyrexia >106 or 41.1C
Define hypothermia <95 (rectally) or 35C
What is the type of arrhythmia found in ATRIAL fibrillation? "totally irregular" (aka IRREGULARLY IRREGULAR?) "Could be regularly irregular over the short term")
What is white coat HTN? duh
Recommendations for overcoming white coat HTN wait until patient has relaxed
Difference between comprehensive and focused History Taking duh
Difference(s) between subjective and objective data duh
SEVEN ATTRIBUTES to patient symptoms OPQRST. Onset Palliation. Quality. Radiation. Severity. Timing. SOCRATES: Severity, Onset, Character, Radiation, Associations, Timing, Exacerbation, Site.
"Symptoms related to each body system" wtf?
Tangential lighting light that casts light across body surfaces to reveal contours, elevations, depressions
What structures are best inspected via tangential lighting? jugular venous pulse, THYROID gland, apical impulse of the heart
FOUR CARDINAL TECHNIQUES of physical exam palpation, auscultation, inspection, PERCUSSION
How is palpation performed? duh
How is percussion performed? hyperextend middle finger of non-dominant hand. other forearm close to surface. strike finger with quick, sharp but relaxed wrist motion. "aim at DIP joint." strike with TIP not pad. finger s/b almost at right angle. withdraw striking finger quickly.
Diagrammatic family history reading... k
How to locate the 2nd rib feel for (first) depression (bump in some) of sternum as you slide hand down (from supraclavicular notch) (This is called the "sternal angle.2)
What clinical procedure is related to the 2nd ICS? murmurs heard @ R 2nd ICS. also great place for S1. (S2 heard better @ L 2nd ICS).
What clinical procedure is related to the 4th ICS (aka Lower Left Sternal Border)? S3 and S4. "great to listen to Right Ventricle"??
What clinical procedure is related to the 4th thoracic vertebra? (trachea bifurcates here?) aortic arch begins (and ends)
What is the surface location of the apex of each lung anteriorly? Extends 2-4 cm above the clavicle!
What is the surface location of the lower border of each lung posteriorly? Lower border of lung extends to T10 (T6 at MCL, T8 at MAL)
What are the levels of bifurcation of the trachea—anteriorly? posteriorly? sternal angle anteriorly, T4 posteriorly
What are the CV causes of chest pain? angina pectoris, MI, pericarditis, DAA
What are the pulmonary causes of chest pain? inflammation of pleural lining, pneumonia
What are the GI causes of chest pain? reflux esophagitis
Location of chest pain caused by AP retrosternal or anterior chest (but might radiate to shoulders, arms, neck, lower jaw, upper abdomen))
Location of chest pain caused by pleurisy over the chest wall
Location of chest pain caused by esophageal reflux retrosternal (but could radiate to back)
TIMING of chest pain caused by AP 1-3 minutes but sometimes up to 10-20
TIMING of chest pain caused by pleurisy PERSISTENT
TIMING of chest pain caused by acid reflux variable
Quality of chest pain caused by AP pressing, squeezing
Quality of chest pain caused by pleurisy sharp, "knifelike"
Quality of chest pain caused by acid reflux burrning
Usual ways "to point the areas of chest pain by patients" for AP clenched fist over sternum
Usual ways "to point the areas of chest pain by patients" for musculoskeletal chest pain finger pointing to tender area on chest wall
Usual ways "to point the areas of chest pain by patients" for heartburn hand moving from neck to epigastrium
Define wheezing musical respiratory sounds, often audible to patient and others
What condition of airways can cause wheezing? duh... constriction
Causes of dyspnea Left CHF, chronic bronchitis, COPD, asthma, DILD (sarcoidosis), pneumonia, pneumothorax, pulmonary embolism
Timing of dyspnea d/t left-side heart failure could progress slowly, could progress suddenly (if acute pulmonary edema)
Timing of dyspnea d/t bronchitis cough comes FIRST. then gradually progressive dyspnea
Timing of dyspnea d/t COPD slowly progressive (cough comes LATER)
Timing of dyspnea d/t emphysema slowly progressive (cough comes LATER)
Most common causes of acute cough irritation to airways (larynx, trachea, viral/fungal/bacterial pneumonia??)
Causes of chronic cough post-nasal drip, chronic bronchitis, bronchiectasis, TB, lung abscess, asthma, GERD
Causes of cough with blood-streaked sputum bacterial pneumonia, chronic bronchitis, TB, bronchiectasis, (cancer)
Yellowish or greenish sputum "purulent"
Foul-smelling sputum lung abscess
"Tenacious" sputum cystic fibrosis
Large volume of purulent sputum bronchiectasis or LUNG ABSCESS
Blood coming from stomach darker, maybe have food particles
Blood coming from respiratory tract brighter than from stomach
5 "A"s related to counseling for smoking cessation Ask, Advise, Assess readiness, Assist, Arrange for FU
What population(s) indicated for annual (seasonal) flu shot? "Everybody," but populations most at risk for serious sequelae= People with asthma, diabetes, and chronic lung disease; pregnant women, people 65 years and older; household contacts and caregivers of such people
What population(s) indicated for Strep pneumoniae (aka pneumococcal) vaccine, according to CDC? The pneumococcal conjugate vaccine, PCV13 or Prevnar 13® is currently recommended for all children under 5 years of age.
Causes of audible STRIDOR "a wheeze that is entirely or predominantly INSPIRATORY" and often louder in neck than over chest wall. OBSTRUCTION OF TRACHEA, LARYNX and demands IMMEDIATE ATTENTION!!
Causes of increased anteroposterior (AP) diameter of chest? COPD (barrel chest)
Causes of lateral displacement of trachea? pleural effusion or pneumothorax
Causes of abnormal retraction of interspaces of chest? asthma?
Barrel chest just as it sounds
Funnel chest just as it sounds (could compress heart or heart bv´s and cause murmurs)
Pigeon chest "anteroposterior diameter" is INCREASED
Causes of barrel chest COPD. can also happen with age
Causes of traumatic flail chest usually d/t multiple rib fractures
Traumatic flail chest (features) paradoxical mvts of thorax: expanding on exhale and caving in on inhale
Causes of UNILATERAL decrease or delay in chest expansion "chronic fibrosis of the underlying lung or pleura," e.g., pleural effusion, lobar pneumonia, unilateral bronchial obstruction
Fremitus the palpable vibrations transmitted through the bronchopulmonary tree to the chest wall when the patient speaks
Causes of decreased tactile fremitus fluid (pleural effusion), fibrosis (pleural fibrosis), air (pneumothorax), tumor, COPD, other obstruction
Causes of asymmetric decreased fremitus unilater PLEURAL EFFUSION, PNEUMOTHORAX, or neoplasm
Causes of asymmetric increased fremitus UNILATERAL PNEUMONIA
5 types of percussion notes flat, dull, resonance, hyperresonance, tympany
flat as in thigh
dull as in liver
resonance as in lung
tympany as in over air or gastric bubble
Which percussion note would you expect to obtain over gastric bubble? tympany
Normal location of DULLNESS on percussion? liver
What is diaphragmatic excursion? the movement of the thoracic diaphragm during breathing
What is normal measurement of diaphragmatic excursion? 4-6 cm (other sources say 3-5 cm)
What are the causes of abnormally high diaphragmatic dullness? pleural effusion, or a high diaphragm as in atelectasis (or diaphragmatic paralysis)
4 types of normal BREATH sounds vesicular, bronchovesicular, broncial, tracheal
vesicular breath sounds (character, location) soft to intermediate (insp > exp), BOTH LUNGS
bronchovesicular breath sounds (character, location) (insp=exp) 1st and 2nd ICS anteriorly; between the scapulae posteriorly
broncial breath sounds (character, location) LOUD!! (exp. > insp) over manubrium "if at all"
tracheal breath sounds (character, location) VERY LOUD (insp=exp), over trachea in neck
What are the "adventitious" sounds that can be heard in the chest? crackles, wheezes, rhonchi, stridor, pleural rub, mediastinal crunch
How do "crackles" differ from wheezes and rhonchi?? crackles (aka rales) are like "dots in time," are DISCONTINUOUS and nonmusical. (wheezes and rhonchi are like "dashes," are continuous, musical)
Causes of "crackles" crackles are either air bubbles flowing thru secretions/tightly closes airways during EXH or small deflated airways popping open upon INH
Causes of wheezes asthma, COPD, chronic bronchitis, "cardiac asthma"
Causes of rhonchi usually caused by secretion in bronchial airways
How can you determine that an adventitious sound is d/t inspissated secretion!!?? the crackles, wheezes, ronchi will CLEAR after coughing or change in position
How will you determine EGOPHONY? When the patient is asked to make [ē-ē-ē] sounds, they are heard over the peripheral chest wall as [ä-ä-ä]
How will you determine PECTORILOQUY? have pt. whisper 99. Increased resonance of lungs. (Types include egophony and bronchophony.)
Causes of egophony? PLEURAL EFFUSION
Causes of pectoriloquy? increase in sound exists because sound travels faster with less degradation through denser (fluid or solid mass) media (versus air) in the lung. C/b cancer (solid mass) or pneumonia (fluid mass)
Preferred posture of COPD patient leaning forward (lips c/b pursed)
How COPD affects position of liver displaces the upper border downward
How COPD affects diaphragmatic dullness lowers the level where you will here D.D.
Indicated physical examination to dx FRACTURED RIB CAGE k
Red flags for HA? CHANGING OR PROGRESSIVELY SEVERE
Characteristics of migraine HA? VISUAL AURA OR SCINTILLATING SCOTOMA (also could be N/V)
Scintillating scotoma a spot of flickering light near or in the center of the visual field, which prevents vision within the scotoma area. The affected area flickers but is not dark, tthen gradually expands outward from the initial spot. Heralds the onset of migraine HA
Characteristics of cluster HA? "excruciating unilateral headaches[3] of extreme intensity" sometimes called suicide headaches b/c they are so unbearable
Characteristics of cluster HA? lancinating or boring/drilling in quality, located behind the eye (periorbital) or in the temple, sometimes radiating to the neck or shoulder
Characteristic of subarachnoid hemorrhage? severe HA that starts suddenly and is often worse near the back of the head. Patients often describe it as the "worst HA ever" and unlike any other type of HA pain. HA may start after a popping or snapping feeling in the head.
Characteristics of brain tumor? New onset or change in pattern of HA, HA that become more frequent and more severe, Unexplained N/V, blurred vision, double vision, loss of peripheral vision, difficulty with balance, speech difficulties
What maneuvers may aggravate pain of brain tumor and sinusitis? COUGHING, SNEEZING, CHANGING POSITION OF HEAD
What type of headache may be caused by overuse of pain medications? ANALGESIC REBOUND HEADACHE
myopia NEARSIGHTEDNESS
hyperopia FARSIGHTEDNESS
What are the causes of sudden unilateral visual loss, painless? Central Retinal Artery (or Vein) Occlusion, Atherosclerotic Ischemic Optic Neuropathy
What are the causes of sudden unilateral visual loss, PAINFUL? Optic Neuritis
What are the causes of sudden bilateral visual loss, painless? RETINAL DETACHMENT, VITREOUS HEMORRHAGE, OCCLUSIONS OF CENTRAL RETINAL ARTERY
What are the causes of sudden bilateral visual loss, PAINFUL? migraine
What are the causes of gradual bilateral visual loss? refractive error, cataracts, macular degeneration
Chronic glaucoma leads to... loss of peripheral visual field (tunnel vision)
Macular degeneration leads to... loss of central vision (central scotoma) and may cause distortion of straight lines
What are the causes of moving specks in the vision? VITREOUS FLOATERS
What are the causes of fixed defects in the vision? FIXED (“SCOTOMAS”) SUGGEST LESION IN RETINA
What are the causes of flashing lights in the vision? retinal detachment, (head trauma), migraine HA
What are the causes of diplopia (double vision)? BRAIN LESION. WEAKNESS/PARALYSIS OF EXTRAOCULAR MUSCLES. CORNEA/LENS PROBLEM (IF ONLY ONE EYE).
Which of the following is NOT a possible cause of diplopia (double vision)? Uveitis, cataracts, acute angle compression glaucoma, paralysis of extra-ocular muscles
two types of hearing loss CONDUCTIVE, SENSORINEURAL
SENSORINEURAL hearing loss NOISY IS BAD
CONDUCTIVE hearing loss NOISE HELPS
Type of hearing loss in Ménière's disease? sensorineural
What medications can cause hearing loss? AMINOGLYCOSIDES, FUROSEMIDE (LASIX), “NSAID, ASPIRIN, QUININE”
Which condition causes discharge through perforated eardrum? otitis media
What is tinnitus? RINGING, RUSHING OR ROARING NOISE IN IONE OR BOTH EARS
What are the features of Meniere’s disease? TINNITUS+HEARING LOSS (sensorineural)+VERTIGO
What are the possible causes of dizziness? LIGHTHEADEDNESS SUGGESTS CARDIOVASCULAR ETIOLOGY. SENSATION OF “BEING PULLED” (TO THE GROUND OR OFF TO ONE SIDE) SUGGESTS “TRUE VERTIGO” AND IMPLICATES AN INNER EAR PROBLEM OR CENTRAL OR PERIPHERAL LESION ON CN8!!
What are the causes of vertigo? “SENSATION OF ROOM SPINNING (OR OF PATIENT SPINNING). POINTS PRIMARILY TO PROBLEM OF INNER EAR, PERIPHERAL LESIONS OF CN8, OR LESIONS IN ITS CENTRAL PATHWAYS OR NUCLEI IN THE BRAIN.”
What are the causes of rhinorrhea and nasal congestion? ALLERGIC AND VASOMOTOR RHINITIS
What is rhinitis medicamentosa? CHRONIC FEELING OF NASAL CONGESTION D/T OVERUSE OF NASAL DECONGESTANT SPRAYS
How does acute sinusitis present? PAIN/TENDERNESS IN FACE OR OVER SINUSES. LOCAL HEADACHE. C/B FEVER.
Local causes of epistaxis TRAUMA, NOSE PICKING, DRY NASAL MUCOSA, INFLAMMATION, TUMOR, FB
Systemic causes of epistaxis BLEEDING DISORDERS
Symptoms of Strep pharyngitis AKA STREP THROAT FEVER, PHARYNGEAL EXUDATES, ANTERIOR LYMPHADENOPATHY “ESPECIALLY IN ABSENCE OF COUGH”
Causes of acute hoarseness of voice INFECTIONS/OVERUSE
Causes of chronic hoarseness of voice SMOKING, ALLERGY, ABUSE, HYPOTHYROIDISM, TB, TUMOR
cause of red and scaly scalp SEBORRHEIC DERMATITIS
cause of enlarged skull HYDROCEPHALUS, PAGET’S DISEASE OF BONE
cause of excessive facial hair in women PCOS
Paget's disease of the bone chronic d/o that results in enlarged & misshapen bones. The excessive breakdown & formation of bone tissue causes affected bone to weaken, resulting in pain, misshapen bones, fractures, & in the skull, overgrowth. typically affecting just 1 or a few bones
Define visual field the entire area seen by an eye when it looks at a central point
What are the near reactions when a person shifts gaze from a far object to a near one? (THERE ARE THREE!!) 1. Pupillary constriction 2. Convergence (an extraocular mvt) 3. Accommodation (increased convexity of the lens)
six cardinal directions of gaze 4 Rectus. 2 Oblique: 4 RECTUS= SUPERIOR, INFERIOR, LATERAL, MEDIAL. 2 OBLIQUE= INFERIOR, SUPERIOR
How will you test visual acuity? SNELLEN EYE CHART
How will you test near vision? SPECIAL HANDHELD CARD-- HELD 14 INCHES FROM PATIENT!! (25-25 CM= 10-14¨)
How will screen visual field? k
What are the causes of eyeball protrusion? HYPERTHYROIDISM (GRAVES) OR OCULAR TUMOR
What are the causes of eyebrow "scaliness?" SEBORRHEIC DERMATITIS
What are the causes of upstarting palpebral fissure? Down syndrome
ptosis drooping
Possible causes of upper eyelid drooping (ptosis) MYASTHENIA GRAVIS, HORNER'S SYNDROME (DAMAGE TO SYMPATHETIC NERVE SUPPLY), DAMAGE TO OCULOMOTOR NERVE
causes of excessive tearing, INCREASED PRODUCTION: CONJUNCTIVAL INFLAMMATION, CORNEAL IRRITATION.
causes of excessive tearing, IMPAIRED DRAINING: ECTROPION, NASOLACRIMAL DUCT OBSTRUCTION.
How will you test nasolacrimal duct obstruction? PRESS ON MEDIAL LOWER LID @ CANTHUS, “JUST INSIDE RIM OF THE BONY ORBIT.” (HAVE PATIENT LOOK UPWARD)
size of LARGE pupil >5mm
size of small pupil <3mm
normal pupil 4mm
Argyl Robertson pupils (think Argyl: SMALL IRREGULAR, accommodate but do NOT react to light. think CNS syphilis!!)
Adie’s pupils LARGE, REGULAR, USUALLY UNILATERAL, (reactivity to slight severely reduced or slowed)
ANISOCORIA! pupils of unequal size
How will you test for lid lag? penlight or a flicking finger, is held before the midline of the patient above the eye leel; as the target is moved downward, the patient's upper lid is oserved for its ability to follow the iris in its downward movement.
How will you assess extraocular movements? the finger H, I think (extraocular muscles include: medial, inferior, and superior recti, the inferior & superior oblique muscles-- all innervated by the oculomotor nerve (III)
What are important tips for ophthalmoscopy? have pt. fix gaze on an object. your L eye to pt. L eye, or R to R. (BMA says do not close your other eye!) find orange or white reflection farther out then follow it in.
contraindications of mydriatic eye drop HEAD INJURY AND COMA. ANY SUSPICION OF NARROW ANGLE GLAUCOMA
What is the significance of absent red reflex? usually CATARACT
papilledema? ENGORGEMENT AND SWELLING OF OPTIC DISC D/T VENOUS STASIS.
What is the cause of enlarged cup? INCREASED PRESSURE WITHIN THE EYE (GLAUCOMATOUS CUPPING)
causes of red eye? CONJUNCTIVITIS, SUBCONJUNCTIVAL HEMORRHAGE, CORNEAL INJURY OR INFECTION, ACUTE IRITIS, GLAUCOMA
What are the pain, vision and pupils in CONJUNCTIVITIS? Moderate pain. Vision and pupil size generally unaffected.
What are the pain, vision and pupils in SUBCONJUNCTIVAL HEMORRHAGE? Little to moderate pain. Vision and pupil size unaffected.
What are the pain, vision and pupils in CORNEAL INJURY OR INFECTION? Superficial, moderate to severe pain. Vision could be affected in some cases.
What are the pain, vision and pupils in ACUTE IRITIS? Pain: MODERATE, ACHING, DEEP. Vision decreased. Pupil c/b small, irregular.
What are the pain, vision and pupils in GLAUCOMA? Pain: SEVERE, ACHING, DEEP. Vision decreased. Pupli DILATED and FIXED.
How does nasal mucosa look like in viral rhinitis? reddened and swollen
How does nasal mucosa look like in allergic rhinitis? pale/bluish or red
What are the possible causes of nasal septal perforation? nasal piercings, long-term cocaine use or decongestant nasal sprays, chronic epistaxis, aggressive digital nasal cleaning, complication of nasal surgery (septoplasty or rhinoplasty)
What are the characteristics of nasal polyps? Pale, semi-translucent masses coming from the middle meatus
What are the signs and symptoms of acute sinusitis? Local tenderness with pain, fever and nasal discharge
What are the two infections causing exudative tonsillitis? Group A Streptococcal infection (anterior cervical), Infectious Mononucleosis (posterior cervical nodes)
What are the signs and symptoms of exudative tonsillitis? Red throat/white exudate, fever, enlarged cervical nodes
What are the characteristics, causes, and associated conditions (if any) of angular cheilitis softening of the skin at the angles of the mouth, then fissuring. d/t nutritional deficiency, overclosure of the mouth or ill-fitting dentures. Secondary infection --> candida
What are the characteristics, causes, and associated conditions (if any) of actinic cheilitis? excessive exposure to sunlight, affects primarily the lower lip. Lip loses normal redness and may become scaly, thickened, and slightly everted. Solar damage also predisposes to carcinoma of the lip.
What are the characteristics, causes, and associated conditions (if any) of angioedema? diffuse, nonpitting, tense swelling of the dermis and subcutaneous tissue. Develops rapidly and typically disappears over a few hours/days. Usually allergic in nature. **Does not itch.
What are the characteristics, causes, and associated conditions (if any) of hereditary hemorrhagic telangiectasia? multiple small red spots on lips. Spots may also be on hands/face/mouth. Spots are dilated capillaries and may bleed when traumatized. These pts often have nosebleeds and GI bleeding.
What are the characteristics, causes, and associated conditions (if any) of Peutz Jeghers syndrome? Kpigmented spots on the lips are more prominent than freckling of the surrounding skin. Pigment in buccal mucosa confirms diagnosis. Associated with multiple intestinal polyps.
What are the physical exam findings in oral cavity and throat in diphtheria? dull red and gray exudate is present on uvula, pharynx and tongue. Airway might become obstructed.
What are the physical exam findings in oral cavity and throat in thrush? Thick white plaques are adherent to underlying mucosa. Predisposing factors: #1: prolonged treatment with antibiotics/corticosteroids and #2: acute HIV infection or frank disease
What are the physical exam findings in oral cavity and throat in Kaposi’s sarcoma? deep purple colored lesions (raised or flat). "Palate is common site."
What are the physical exam findings in oral cavity and throat in measles (rubeola)? Sx= fever, cough, runny nose, red eyes and a generalized, maculopapular, erythematous rash
What is the gum finding in lead poisoning? black line
What are the causes of marginal gingivitis? soft white film of salivary salts, protein and bacteria that covers the teeth/lead to gingivitis
What are the causes of gingival hyperplasia? PPP-L: Dilantin (phenytoin) therapy, puberty, pregnancy, leukemia
Describe Hutchison’s teeth Smaller and more widely spaced than normal and are notched on their biting surfaces. Sides of teeth taper toward the biting edges. Upper central incisors of the permanent teeth are most affected.
Causes of Hutchinson's teeth congenital syphilis
Paralysis of which nerve causes asymmetric tongue protrusion? 12
What are the exam findings in soft palate and uvula in CN 10 paralysis? soft palate fails to rise and the uvula deviates to the opposite side
What is the most common site of cancer in the mouth? Tongue
What is the 2nd most common site of cancer in the mouth? Lip
What types of lesions are suspicious of cancer? Persistent nodule/ulcer, red/white, side of tongue or at base
What are the causes and characteristics of smooth tongue? deficiency of riboflavin (B2), niacin (B3), folic acid (B9), B12, pyridoxine (B6), iron—or side effect of chemotherapy
What are the causes and characteristics of hairy leukoplakia? whitish raised areas with feathery/corrugated pattern. Cannot be scraped off. Results from infection with the Epstein-Barr virus (EBV)
Name the lymph nodes of head and neck in sequence of examinations Preauricular, Postauricular, Occipital, Tonsillar, Submandibular, Submental, Superficial Cervical, Posterior Cervical, Deep Cervical, Supraclavicular,
What aspects of a lymph node should you note? Size, shape, delimitation (discrete vs. matted together), mobility, consistency, and tenderness.
How to differentiate healthy LN from problematic ones Small, mobile, discrete, nontender nodes are found in normal patients. Tender nodes suggest inflammation. Hard/fixed nodes suggest malignancy.
What are the thoracic causes that can cause deviation of trachea from its usual midline position? Mediastinal masses in the neck may deviate trachea. (also atelectasis or large pneumothorax)
What are the tips for palpating thyroid gland from posterior approach? Ask patient to flex neck slightly forward to relax the sternomastoid. Place index fingers JUST BELOW the cricoid cartilage. Ask patient to sip/swallow water. Feel for the THYROID ISTHMUS rising up under your fingers.
What are the causes of enlarged SOFT thyroid gland? Grave’s disease (hyper)
What are the causes of enlarged FIRM thyroid gland? Hashimoto’s (autoimmune HYPO) thyroiditis, malignancy
What are the three important causes of facial swelling? Cushing’s syndrome, nephrotic syndrome, myxedema
What are the characteristic features of Cushing's syndrome? round ‘moon’ face with red cheeks. Excessive facial hair growth (purple red striae @ umbilicus?)
What are the characteristic features of nephrotic syndrome? edematous and often pale. Swelling appears around the eyes in morning. If severe, eyes may become slitlike.
What are the characteristic features of myxedema? Severe hypothyroidism, dull/puffy facies. Pronounced around the eyes, non-pitting with pressure. Hair/eyebrows are dry, coarse and thinned. Skin is dry.
What are the causes each of the chronic bilateral asymptomatic enlargement of parotid glands? obesity, diabetes, cirrhosis
What are the causes each of the gradual unilateral enlargement of parotid glands? NEOPLASM
What are the causes each of the acute enlargement of parotid glands? mumps
What are the facial features in Parkinson’s disease? Decreased facial mobility blunts expression. Mask-like face results, decreased blinking, Characteristic stare. Neck and upper trunk tend to flex forward, facial skin becomes oily. Drooling may occur.
What's the most common skin cancer in US (80%) of cases? basal cell
What's the rarest (well, of the 3 most common) type of skin cancer in the US (4% of cases)? melanoma
What does basal cell carcinoma look like? shiny, translucent, slow to grow
What does squamous cell carcinoma look like? CRUSTED, SCALY, ulcerated!!
What does melanoma look like? doesn't say. MS said only, "very easy to diagnose d/t color change"
What's the worst skin cancer to get? melanoma
Which skin cancer rarely spreads (metastisizes)? basal cell
What's the shiny, translucent, slow growing skin cancer ("vase")? basal cell
What's the crusty, scaly, ulcerated skin cancer? squamous cell
Which skin cancer grows telangiectasia? basal cell carcinoma
Which skin cancer appears as "pearly papule," often with dilated blood vessels overlying it (telangiectasia)? basal cell carcinoma
Increased risk of melanoma >/=50 moles total, >/="1-4" atypical moles, ACTINIC LENTIGINES, heavy sun exposure (esp. in childhood), red or light hair, blue eyes, light skin color, freckles, family history
actinic lentigines (singular: lentigo) aka senile lentigines, solar lentigines, "liver spots" and "age spots" that occur on the sun-exposed skin of the middle-aged and elderly
actinic lentigines (singular: lentigo) harmless, flat, brown discolorations of the skin which usually occur on the back of the hands, neck and face of people older than 40 years of age
What makes pink flamingos pink (at least the ones in Tanzania)? The beta-carotene they absorb from the blue-green algae in their diet. ("If fed a carotene-free diet they become white.") !!
tumor nodule >5cm
nodule ("similar to") papule >1cm (e.g. nevus/mole)
Created by: mrbarr