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EENT Physical Exam
Boards 3 - EENT Physical exam by regions
| 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 |
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