Bread and Butter (Hx and PE)

Question 1

Kernig’s sign

Answer 1

is positive when the thigh is bent at the hip and knee at 90 degree angles, and subsequent extension in the knee is painful (leading to resistance).[3] This may indicate subarachnoid hemorrhage or meningitis

Question 2

Brudzinski’s sign

Answer 2

is the appearance of involuntary lifting of the legs when lifting a patient’s head off the examining couch, with the patient lying supine

Question 3

Aaron sign

Answer 3

epigastric pain with pressure on McBurney’s point; appendicitis

Question 4

Adson’s sign

Answer 4

Compression between the anterior and middle scalene by having the patient take a deep breath, extend the neck, and rotate the head toward the painful shoulder; thoracic outlet sydrome

Question 5

Auspitz’s sign

Answer 5

punctate bleeding when scales are scraped; psoriasis

Question 6

Babinski sign

Answer 6

Dorsiflection of the hallux with fanning of the remaining phalanges upon soft stimulation of the lateral plantar surface of the foot

Question 7

Beck’s triad

Answer 7

hypotension
increased JVP
distant heart sounds

Question 8

Bence Jones Protein

Answer 8

Multiple myeloma

Question 9

Auer Rods

Answer 9

Acute Myeloid Leukemia

Question 10

Chadwick sign

Answer 10

cianosis of vulva, vagina, and cervix

Question 11

Cullen’s sign

Answer 11

Ecchymosis around umbilicus predicts onset of acute pancreatitis

Question 12

What is koebner’s phenomenon?

Answer 12

The Koebner phenomenon describes skin lesions which appear at the site of injury. It is seen in:[2]

        Psoriasis
        Pityriasis rubra pilaris
        Lichen planus
        Lichen nitidus
        Vitiligo
        Lichen sclerosus
        Elastosis perforans serpiginosa
        Kaposi sarcoma
        Necrobiosis lipoidica
        Systemic Lupus Erythematosus

A similar response occurs in pyoderma gangrenosum and Adamantiades-Behcet’s syndrome, and is referred to as pathergy.[2]

Warts and molluscum contagiosum are often listed as causing a Koebner reaction, but this is by direct inoculation of viral particles

Question 13

Allis sign

Answer 13

noted when knees are of unequal level at full flexion of the hip. This usually presents with unequal gluteal skin folds; congenital dislocation/developmental dysplasia of the hip

Question 14

Grey turner’s sign

Answer 14

flank ecchymosis; retroperitoneal hemorrhage

Question 15

Gunn’s sign

Answer 15

AV nicking; hypertensive retinopathy

Question 16

Homans’ sign

Answer 16

Knee bent, ankle abruptly dorsiflexed, popliteal pain

Question 17

Hutchinson’s sign

Answer 17

lesion on the tip of the nose which an presage ocular herpes zoster

Question 18

Janeway lesion

Answer 18

palmar or plantar erythematous or hemorrhagic papules

Question 19

Murphy’s sign

Answer 19

hesitation on inspiration while gall bladder is palpated

Question 20

Nikolsky’s sign

Answer 20

Mild shear stress applied to skin causes bullae to form

Question 21

Pratt’s sign

Answer 21

Pain elicited by compression of posterior calf; DVT

Question 22

Rovsing’s sign

Answer 22

Palpation of LLQ elicits pain in RLQ; appendicitis

Question 23

Russel’s sign

Answer 23

Scarring of the dorsum of one hand (contact with incisors while purging); bulimia nervosa

Question 24

Spurling’s test

Answer 24

Axial compression and rotation of cervical spine to the side of symptoms causes pain; cervical radiculopathy

Question 25

The inferior tip of the scapula is approximately at which rib/interspace?

Answer 25

7th rib interspace

Question 26

You place your hands on the 10th rib area and ask the pt to breathe deeply. You notice that the chest expansion is unequal. Name some causes of unilateral decrease or delay in chest expansion.

Answer 26

Chronic fibrosis of underlying lung or pleura, pleural effusion, lobar pneumonia, pleuritis with associated splinting, unilateral bronchial obstruction

Question 27

How would you describe the following breath sounds:
Inspiratory sounds last longer than expiratory. Inspiratory: soft; Pitch of expiratory: relatively low; heard over most of both lungs

Answer 27

Vesicular

Question 28

How would you describe “Broncho-vesicular” breath sounds?

Answer 28

Inspiratory and expiratory sounds about equal; Intensity of inspiration and pitch of expiration are intermediate: often heard in the 1st and 2nd interspaces anteriorly and between scapulae

Question 29

Rapid, deep, labored breathing

Answer 29

Kussmaul breathing

Question 30

You hear and observe Kussmaul breathing. What is on your DDx?

Answer 30

DKA; Metabolic acidosis; peritonitis; pneumonia; renal failure; severe hemorrhage; uremia

Question 31

Irregularly interspersed periods of apnea in a disorganized sequence of breaths

Answer 31

Biot respirations

Question 32

Varying periods of increasing depth of respirations, interspersed with apnea

Answer 32

Cheyne-Stokes respiration

Question 33

You hear/see Cheyne-Stokes respirations. What is on your DDx?

Answer 33

heart failure; strokes; traumatic brain injuries; brain tumors; high altitudes; toxic metabolic encephalopathy; carbon monoxide poisoning; morphine use

Question 34

What is the difference between Cheyne-Stokes respirations and Biot respirations?

Answer 34

Cheyne–Stokes respirations are not the same as Biot’s respirations (“cluster breathing”), in which groups of breaths tend to be similar in size.

Question 35

DDx of Biot’s respiration?

Answer 35

Biot’s respiration is caused by damage to the medulla oblongata due to strokes or trauma or by pressure on the medulla due to uncal or tentorial herniation.

It can be caused by opioid use