Clinical Flashcards
What is the Blumberg test, what is the positive, and what does it signify?
Sudden release of deep ab pressure causing abdominal pain –> Generalized peritonitis
What is the closed eyes sign, what is the positive, and what does it signify?
Close eyes prior to abdominal area being palpated small chance of serious intra-abdominal pathology
What is the Kehr’s sign, what is the positive, and what does it signify?
Left shoulder and abdominal pain –> splenic rupture
What is the Murphy’s sign, what is the positive, and what does it signify?
Abrupt cessation of inspiration with thumb under tip of 9th rib in RUQ –> cholecystitis
What is the Murphy’s punch, what is the positive, and what does it signify?
Tenderness on percussion of the costovertebral angle = pyelonephritis
What is the Obturator internus test, what is the positive, and what does it signify?
Right iliac fossa pain on internal rotation of the hip = appendicitis
What is the Prehn’s sign, what is the positive, and what does it signify?
Elevation of scrotum, reduces scrotal pain = epididymo-orchitis
What is the Psoas sign, what is the positive, and what does it signify?
Right iliac fossa pain on hyperextension of right hip = appendicitis
What is the Puddle sign, what is the positive, and what does it signify?
Pt on hands and knees, listen with stethoscope near umbilicus and flick abdomen on side,move stethoscope and continue to flick, sound louder then fluid is present = ascites
What is the Rogoff’s sign, what is the positive, and what does it signify?
Pain on deep palpation over 12th rib = adrenal inflammation
What is the Rovsing’s sign, what is the positive, and what does it signify?
Right iliac fossa pain on pressure in left iliac fossa = appendicitis
Alcohol + epigastric pain which is better bending forward =
acute pancreatitis
Recurrent abdominal cramps + diarrhea + flushing + wheezing =
Carcinoid syndrome
Recurrent diarrhea + steatorrhea =
Celiac disease
Recurrent mucous diarrhea, right iliac fossa tenderness =
Crohn’s disease
Left iliac fossa pain, older person, blood in stool =
Diverticulitis
Dysmenorrhea + infertility + no vaginal discharge =
Endometriosis
Dyspepsia with food and worse two hours after eating =
duodenal ulcer
Pain relieved by defecation + recurrent diarrhea =
Irritable bowel syndrome
Old patient + abdominal pain + shock =
Mesenteric vascular occlusion
Recurrent bloody diarrhea, LLQ tenderness =
Ulcerative colitis
What is the Beevor test, what is the positive, and what does it signify?
Ask supine pt to lift head off table if umbilicus deviates there is damage to spinal cord btw T7-T10
What is the Forestier bowstring test, what is the positive, and what does it signify?
Ask standing pt to laterally bend to one side, ipsilateral paraspinals tighten = ankylosing spondylitis
What is the Heel drop test, what is the positive, and what does it signify?
Ask pt to stand on toes and drop weight on heels
If midline thoracic pain =thoracic vertebral fracture
If lateral thoracic pain = facet syndrome
What is the Levine’s sign, what is the positive, and what does it signify?
Clenched fist over pericordium when asked to describe chest pin is indicative of angina pectoris or MI
What is the Schepelmann test, what is the positive, and what does it signify?
Ask pt to laterally bend with hands held over head
Pain on convex side = strain/sprain, myofaciitis, pleurisy
Concave side pain = Intercostal neuritis
Recurrent cough + retrosternal pain =
Bronchitis
Chronic cough, hemoptysis, weight loss =
Bronchogenic carcinoma
Tearing chest pain + sweating + feeling of impending doom =
Dissecting thoracic aorta
Atypical chest pain w/midsystolic click in mitral area =
Mitral valve prolapse
Tenderness on percussion of spinous process + fever =
Osteomyelitis
SOB + sudden sticking chest pain + unilateral absent breath sounds =
Pneumothorax
Squeezing chest pain + <10 minutes =
Prinzmetal angina
Chest pain + SOB + hemoptysis + feeling of impending doom =
Pulmonary embolism
Tender + Swollen 2-5th costochondral junction =
Tietze syndrome
Chronic cough + fever + night sweats + hemoptysis =
Tuberculosis
Angina Pectoris:
Caused by?
Presents as?
Management?
Reversible damage to myocardium due to narrowing of coronary A
Severe squeezing retrosternal/pre-cordial pain precipitated by exertion and relieved by rest, + Levine
Co-manage w/cardiologist w/chriopractic adjustments, weight reduction, stress management, dietary mod to reduce saturated fats
Bronchogenic carcinoma:
Caused by?
Presents as?
Management?
Malignant lung tumor, smokers and males more affected
Weight loss, chronic cough, hemoptysis, clubbing of fingers, x-ray shows solitary mass in lung with irregular borders
Thoracic surgeon
Fibromyalgia:
Caused by?
Presents as?
Management?
Chronic widespread MSK pain disorder of unknown origin mainly in women
11/18 tender points w/fatigue and unrefreshing sleep, normal blood tests
Chiropractic care with dietary advice and nutritional supplements
GERD:
Caused by?
Presents as?
Management?
Relaxation of lower esophageal sphincter allows regurgitation of stomach acid
Burning retrosternal pain worse after lying down after meal, cough worse at night, nocturnal wheezing, endoscopy shows erosion and inflammation of lower end of esophagus
Gastroenterologist if raising head of bed 6”, eating small meals and not laying down after them and avoiding irritant foods (Chocolate, peppermint) and adjustments aren’t helpful
Herpes Zoster:
Caused by?
Presents as?
Management?
Infection caused by HHV 3-varicella zoster lies dormant in DRG
Prodrome of unilateral chest pain, band of hyperesthesia, typical band of vesicles/pustules along a dermatome, + Schepelmann on concave sides
Chiropractic adjustments, low level laser, nutritional supplements (B1, B6)
Myocardial Infarction:
Caused by?
Presents as?
Management?
Irreversible damage to myocardium due to occlusion of coronary A
Severe squeezing retrosternal/pre-cordial chest pain, sweating, feeling of mpending doom, + Levine’s, ST elevation, T wave inversion, pathological Q waves, elevated Troponin I/CK-MB
911
Pancoast Tumor:
Caused by?
Presents as?
Management?
Malignant tumor in apex of lung, associated with cigarette smoking
Upper chest pain, shoulder pain or pain in upper limb, features of Horner’s (ptosis, anhydrosis, miosis) due to damage to sympathetic trunk
Cardiothoracic surgeon/pulmonologist
Panic attack/disorder:
Caused by?
Presents as?
Management?
Pysch condition characterized by intense fear of unknown origin
Chest pain, choking sensation, feeling of dying/losing control, palpitations, sweating, SoB
Co-manage with cognitive behavioural therapist
Prinzmetal Angina:
Caused by?
Presents as?
Management?
Condition caused by reversible damage to myocardium due to spasm of coronary A
Severe squeezing retrosternal/pre-cordial chest pain @rest, + Levine’s
Co-manage w/cardiologist with Chiropractic adjustments, weight reduction, anger management, dietary modification to decrease saturated fat
Rib fracture:
Caused by?
Presents as?
Management?
MC @angle due to blunt force trauma
Chest pain worse on breathing deeply, coughing, sneezing, steral compression aggravates
Conservative care
Spinal Fracture:
Caused by?
Presents as?
Management?
Due to axial compression in previously diseased bone
Upper back pain radiating into chest, worse of jarring movements, Gibbous may be present, spinal percussion + heel drop are positive
Orthopedist
What is the Bronchophony exam, what is the positive, and what does it signify?
Listen w/stethoscope over area of suspected consolidation and ask pt to say “99” in normal voice; if loud = pneumonia
What is the Egophony exam, what is the positive, and what does it signify?
Listen w/stethoscope over area of suspected consolidation and ask pt to say “EE” in normal voice; if sounds like AA = pneumonia
What is the Whispered pectoriloquy exam, what is the positive, and what does it signify?
Listen w/stethoscope over area of suspected consolidation and ask pt to say “99” in normal voice; if normal sounding = pneumonia
Chronic productive cough + Cyanosis + Bilateral ankle edema =
Chronic bronchitis
Pale mucosa + spoonshaped nails =
Iron deficiency anemia
Stony dull percussion note in lung base =
Pleural effusion
Unilateral hyper resonant percussion note =
Pneumothorax