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PE midterm Spring'08

midterm notes Physical Examination

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