Clinical Flashcards
1
Q
What is the Blumberg test, what is the positive, and what does it signify?
A
Sudden release of deep ab pressure causing abdominal pain –> Generalized peritonitis
2
Q
What is the closed eyes sign, what is the positive, and what does it signify?
A
Close eyes prior to abdominal area being palpated small chance of serious intra-abdominal pathology
3
Q
What is the Kehr’s sign, what is the positive, and what does it signify?
A
Left shoulder and abdominal pain –> splenic rupture
4
Q
What is the Murphy’s sign, what is the positive, and what does it signify?
A
Abrupt cessation of inspiration with thumb under tip of 9th rib in RUQ –> cholecystitis
5
Q
What is the Murphy’s punch, what is the positive, and what does it signify?
A
Tenderness on percussion of the costovertebral angle = pyelonephritis
6
Q
What is the Obturator internus test, what is the positive, and what does it signify?
A
Right iliac fossa pain on internal rotation of the hip = appendicitis
7
Q
What is the Prehn’s sign, what is the positive, and what does it signify?
A
Elevation of scrotum, reduces scrotal pain = epididymo-orchitis
8
Q
What is the Psoas sign, what is the positive, and what does it signify?
A
Right iliac fossa pain on hyperextension of right hip = appendicitis
9
Q
What is the Puddle sign, what is the positive, and what does it signify?
A
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
10
Q
What is the Rogoff’s sign, what is the positive, and what does it signify?
A
Pain on deep palpation over 12th rib = adrenal inflammation
11
Q
What is the Rovsing’s sign, what is the positive, and what does it signify?
A
Right iliac fossa pain on pressure in left iliac fossa = appendicitis
12
Q
Alcohol + epigastric pain which is better bending forward =
A
acute pancreatitis
13
Q
Recurrent abdominal cramps + diarrhea + flushing + wheezing =
A
Carcinoid syndrome
14
Q
Recurrent diarrhea + steatorrhea =
A
Celiac disease
15
Q
Recurrent mucous diarrhea, right iliac fossa tenderness =
A
Crohn’s disease
16
Q
Left iliac fossa pain, older person, blood in stool =
A
Diverticulitis
17
Q
Dysmenorrhea + infertility + no vaginal discharge =
A
Endometriosis
18
Q
Dyspepsia with food and worse two hours after eating =
A
duodenal ulcer
19
Q
Pain relieved by defecation + recurrent diarrhea =
A
Irritable bowel syndrome
20
Q
Old patient + abdominal pain + shock =
A
Mesenteric vascular occlusion
21
Q
Recurrent bloody diarrhea, LLQ tenderness =
A
Ulcerative colitis
22
Q
What is the Beevor test, what is the positive, and what does it signify?
A
Ask supine pt to lift head off table if umbilicus deviates there is damage to spinal cord btw T7-T10
23
Q
What is the Forestier bowstring test, what is the positive, and what does it signify?
A
Ask standing pt to laterally bend to one side, ipsilateral paraspinals tighten = ankylosing spondylitis
24
Q
What is the Heel drop test, what is the positive, and what does it signify?
A
Ask pt to stand on toes and drop weight on heels
If midline thoracic pain =thoracic vertebral fracture
If lateral thoracic pain = facet syndrome
25
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
26
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
27
Recurrent cough + retrosternal pain =
Bronchitis
28
Chronic cough, hemoptysis, weight loss =
Bronchogenic carcinoma
29
Tearing chest pain + sweating + feeling of impending doom =
Dissecting thoracic aorta
30
Atypical chest pain w/midsystolic click in mitral area =
Mitral valve prolapse
31
Tenderness on percussion of spinous process + fever =
Osteomyelitis
32
SOB + sudden sticking chest pain + unilateral absent breath sounds =
Pneumothorax
33
Squeezing chest pain + <10 minutes =
Prinzmetal angina
34
Chest pain + SOB + hemoptysis + feeling of impending doom =
Pulmonary embolism
35
Tender + Swollen 2-5th costochondral junction =
Tietze syndrome
36
Chronic cough + fever + night sweats + hemoptysis =
Tuberculosis
37
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
38
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
39
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
40
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
41
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)
42
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
43
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
44
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
45
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
46
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
47
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
48
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
49
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
50
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
51
Chronic productive cough + Cyanosis + Bilateral ankle edema =
Chronic bronchitis
52
Pale mucosa + spoonshaped nails =
Iron deficiency anemia
53
Stony dull percussion note in lung base =
Pleural effusion
54
Unilateral hyper resonant percussion note =
Pneumothorax
55
Progressive SOB + Erythema nodosum =
Sarcoidosis
56
Iron Deficiency Anemia:
Caused by?
Presents as?
Management?
Lack of iron in diet, excessive loss of menstrual blood/GI bleed
SoB, dyspnea on exertion, palpitations, pale mucous membranes, koilonychias
Co-manage with medical practitioner
57
What is the direct pupillary light reflex, what is the positive, and what does it signify?
Shine light into one eye, pupil constricts = normal
| doesn't constrict = ipsilateral CN III damaged if pt confirms they see light, CN II if they can't see the light
58
What is the Consensual pupillary light reflex, what is the positive, and what does it signify?
Shine light into one eye, pupil on opposite side constricts = normal
Doesn't constrict but ipsilateral one does = Contralateral CN III damage
59
If diplopia occurs in the cardinal gaze test which cranial nerve is affected if the patient looks left or right? Down?
Ipsilateral CN VI or contralateral CN III
| CN IV
60
Tense + hard + painful + red eyeball =
Acute (closed angle) glaucoma
61
Red + swollen + itchy + painful eye =
Belpharitis
62
Tunnel vision + deep cupping of optic disc =
Chronic (open angle) glaucoma
63
Local red area on sclera =
Episceritis
64
Painful swelling pointing to lid margin =
Hordeolum/Stye
65
Cirumcorneal conjunctial redness w/o eyelid redness =
Iritis (uveitis)
66
Yellow nodule in bulbar conjunctiva =
Pinguecula
67
Bilateral hemianopia =
Pituitary tumor
68
Decreased vision with age =
Presbyopia
69
Conjunctivitis + urethral discharge + joint pain =
Reiter's syndrome
70
Painless visual streaks + floaters + closing curtain =
Retinal detachment
71
Retinal Detachment:
Caused by?
Presents as?
Management?
Separation in neural layer from pigment layer of retina following trauma to eye or in diabetic neuropathy
Flashing lights followed by decreased peripheral/central vision often described as a "curtain coming down"
Ophthalmologist
72
Reiter's Syndrome:
Caused by?
Presents as?
Management?
Associated w/Chlamydia, Shigella, Salmonella, Campylobacter infectiona and HLA B27
Conjunctivitisj, urethral discharge, reactive arthritis
Rheumatologist or M.D. for antibiotics
73
Hypotension + darkened skin creases + Arroyo's sign =
Addison's disease
74
Headache + polyuria + hypertension =
Conn's disease
75
Bronze skin + decreased libido + polyuria + polydipsia =
Hemochromatosis
76
Bilateral ptosis + old man + lung tumor =
Lambert Eaton syndrome
77
Anorexia + blue gum line + constipation =
Lead poisoning
78
Rubbery nodes in neck + cyclical low grade fever =
lymphoma
79
Constipation + bone pain + renal stones =
Paget's
80
Palpitations + bouts of slow and fast arrythmias =
Sick sinus syndrome
81
Addison's Disease:
Caused by?
Presents as?
Management?
Endocrine disorder due to failure of adrenal cortex function, autoimmune destruction
Fatigue, weakness, nausea vomiting, weight loss, hair loss, amenorrhea, decreased libido, hyperpigmentation
Na+ low, K+ high <30:1, cortisol won't rise after ACTH injection, Ragland's + (drop in BP on standing)
Co-manage w/endocrinologist
82
Chronic Fatigue Syndrome:
Caused by?
Presents as?
Management?
Prolonged fatigue worse on exertion, unknown etiology
Sore throat, tender cervical lymph node, unrefreshing sleep, muscle pain, post-exertional malaise, impaired memory
Co-manage with cognitive behavioural therapist, dietary supplements, graded exercise
83
Colon Cancer:
Caused by?
Presents as?
Management?
Malignant tumor in colon, adenocarcinoma in nature associated w/lack of fiber in diet and Vit D deficiency
Change in bowel habit either constipation or diarrhea, weight loss, fecal occult blood +
Gastroenterologist --> colonoscopy and biopsy
84
Congestive heart failure:
Caused by?
Presents as?
Management?
Inability of heart to pump blood out
Left sided MC cause of Right heart failure
Coronary heart disease --> HTN --> aortic valve disease
Dyspnea on exertion, paroxysmal nocturnal dyspnea, basal crackles in both lungs, distended jugular V, bilateral ankle edem; BNP >500 pg/dL
Hospital
85
Conn's diseae:
Caused by?
Presents as?
Management?
Excess aldosterone may e due to adrenal cortical adenoma/hyperplasia
HTN, headache, muscle weakness, polyuria, polydypia, hypokalemia, hypernatremia, elevated serum aldosterone levels
CT scan --> endocrinologist
86
Cushings Disease:
Caused by?
Presents as?
Management?
Excess cortisol due to ACTH secreting pituitary adenoma or exogenous steroids or abdominal tumor
Truncal obesity, moon face, buffalo hump, purple adominal striae, recurrent infections, hypokalemia, hypernatremia, elevated cortisol
Refer endocrinologist
87
Depression:
Caused by?
Presents as?
Management?
Mental illness involving body, thoughts, moods
>=4: sleep disturbance, interest loss, guilty feelings, lack of energy, poor concentration, appetite change, psychomotor retardation/agitation, suicidal thoughts for 2 weeks
Co-manage with psychologist, advice on exercise, stress management, dietary supplement with omega 3 hospital referral if suicidal
88
Diabetes Mellitus:
Caused by?
Presents as?
Management?
Metabolic condition due to absolute/relative insulin levels - T1 in juveniles T2 in overweight adults
Polyuria, Polydypsia, Polyphagia, peripheral neuropathy, cataracts, FBG >126 mg/dL
Co-manage w/endocrinologist, advice on weight loss and chromium supplements
89
Hemochromatosis:
Caused by?
Presents as?
Management?
Autosomal rescessive, excess accumulation of iron in body (liver, pancreas, skin, testis)
Fatigue, polyuria, polydypsia, increased skin pigmentation, joints pains, hair loss, decreased libido, excessive serum levels, beak-like osteophytes at radial margins of metacarpal heads
Refer to hematologist
90
HIV/AIDS:
Caused by?
Presents as?
Management?
Acquired immune deficiency disease associated w/RNA retroviral infection, sexual transmission, blood transfusions
Flu-like illness, recurrent infections (Pnumocystis jiroveci, Cryptosporidium parvum, HHV Type 8), + Elisa and western blots
Co-manage w/infectious disease specialist, supplements, adjustments as MC deaths are from opportunistic infections
91
Hypothyroidism:
Caused by?
Presents as?
Management?
Underactive thyroid gland; MC cause Hashimoto's
Fatigue, weight gain, hoarse voice, coarse brittle hair, constipation, goiter, hair loss, loss of outer 1/3 of eyebrows, Woltman's sign (slow to relax DTR), T3/4 low, TSH high in 1o
Co-manage w/endocrinologist
92
Lambert Eaton Syndrome:
Caused by?
Presents as?
Management?
Autoimmune disorder associated w/small cell lung cancer; MC in men >60
Fatigue better w/repetitive movements, bilateral ptosis, -Tensilon test, antibodies to Ca2+-gated channels at the neuromuscular junction
Refer to thoracic surgeon
93
Lead Poisoning:
Caused by?
Presents as?
Management?
Multisystem disorder resulting from excess exposure to lead in paint/industrial fumes
Anemia/anorexia, blue gum line, clumsiness/constipation, difficult behaviour, epileptic seizure, emesis, fatigue, wrist drop, microcytic hypochromic anemia (basophilic stippling), long bones w/thick transverse radiodense metaphyseal line
Refer to pediatrician
94
Lung Cancer:
Caused by?
Presents as?
Management?
Malignant lung tumor, smokers, males
Fatigue, chronic cough, hemoptysis, weight loss, irregular mass on chest x-ray
Refer to pulmonologist or thoracic surgeon
95
Lymphoma:
Caused by?
Presents as?
Management?
Malignant lymph node disease, may be related to HHV type 4, Hodgkin's (Reed Sternberg cells) or not
Fatigue, painless cervical lymphadenopathy, anemia, weight loss, cyclical fever, night sweats, SoB, recurrent infections
Hematologist
96
Obstructive sleep apnea:
Caused by?
Presents as?
Management?
Upper airway, Overweight males w/very short necks
Excessive snoring w/repeated apnea >10s, daytime sleepiness, headaches
Refer to sleep lab for confirmation of diagnosis and management
97
Paget's disease of the bone:
Caused by?
Presents as?
Management?
Metabolic bone disorder with repeated episodes of osteolysis and excessive/ineffective osteoblastic activity, can be caused by paramyxo viral infection
Fatigue, increased hat size, visual/hearing defects; cotton wool appearance in skull
Refer to rheumatologist
98
Pernicious anemia:
Caused by?
Presents as?
Management?
Vit B12 deficiency due to lack of IF caused by autoimmune destruction of parietal cells in stomach
Fatigue, beef-coloured tongue, paresthesia in fingers/toes, balance problems, hypersegmented neutrophils, macrocytic RBC
Refer to hematologist
99
Renal Failure:
Caused by?
Presents as?
Management?
Acute/chronic kidney damage resulting in improper function
Fatigue, pale mucosa, puffy eyelids, bilateral pitting edema, fishy breath, elevated BUN/creatinine
Refer to hospital if acute and nephrologist if chronic
100
Riboflavin deficiency:
Caused by?
Presents as?
Management?
B2 low diet
Fatigue, magenta coloured tongue, angular stomatitis, cheilosis
Tx with nutritional supplements
101
Sick Sinus Syndrome:
Caused by?
Presents as?
Management?
Damage to SA node due to ischemic heart disease
Episodes of tachycardia alternating w/bradycardia + fatigue
Refer to cardiologist
102
Slow flow + nocturia + smooth enlarged prostate =
Benign prostatic hyperplasia
103
Total painless hematuria =
Bladder cancer
104
Polyuria + polydypsia - polyphagia =
Diabetes insipidus
105
Puffy eyelids in morning + smoky urine =
Glomerulonephritis
106
Dysuria + increased frequency + nocturia - nitrites =
Interstitial cystitis
107
Incontinence + dementia + ataxia =
Normal pressure hydrocephalus
108
Generalized edema + frothy urine + recurrent infxn =
Nephrotic syndrome
109
Chills + fever + vomiting + costovertebral angle tenderness =
Pyelonephritis
110
Total hematuria w/flank mass =
Renal carcinoma
111
Severe loin to groin pain + hematuria =
Renal colic
112
Dysuria + increased frequency - nocturia - nitrities=
Urethral syndrome
113
Dysuria + mucoid urethral discharge =
Urethritis - Chlamydia
114
Dysuria + purulent urethral discharge =
Urethritis - Gonorrhea
115
Dysuria + frequency + nocturia +nitrites =
UTI
116
BPH:
Caused by?
Presents as?
Management?
Age-related fibroglandular hyperplasia of prostate
Poor stream, frequency, dribbling, nocturia, smooth and enlarged prostate, median sulcus palpable
Co-manage w/urologist, saw palmetta supplements (?)
117
Bladder Cancer:
Caused by?
Presents as?
Management?
Malignant tumor of transitional epithelial origin, associated w/chronic smoking and Schistosoma infxn
Painless hematuria, weight loss
Refer to urologist for cytoscopy
118
Diabetes Insipidus:
Caused by?
Presents as?
Management?
Loss of ADH secretion, associated w/head trauma
Polyuria, polydypsia, unable to [urine], <1.006 SPG
Co-manage w/endocrinologist
119
Goodpasture:
Caused by?
Presents as?
Management?
Autoimmune disorder causing destruction of basement membrane in lung and kidney
Hemoptysis, hematuria
Nephrologist for renal biopsy
120
Glomerulonephritis:
Caused by?
Presents as?
Management?
Inflammation of glomeruli post-strep infxn
Puffy eyelid, smoky urine, HTN, RBC casts, proteinuria, +ASOT, elevated BUN/creatinine
Hospital --> renal biopsy
121
Interstitial Cystitis:
Caused by?
Presents as?
Management?
Chronic inflammation of bladder wall, autoimmune, MC in females and IBS
Pain worse w/full bladder, relieved by urination, dysuria, frequency, nocturia, WBCs in urine
Co-manage w/urologist, dietary advice and lumbar adjustments are helpful
122
Normal Pressure Hydrocephalus:
Caused by?
Presents as?
Management?
Ventricular dilation in elderly, idiopathic
Incontinence, reversible dementia, ataxia (Hakim's triad)
Refer to neurologist --> CT/lumbar puncture
123
Renal Carcinoma:
Caused by?
Presents as?
Management?
Malignancy of renal tissue, cigarette smoking and genetic play a role
Painless flank mass and hematuria
Nephrologist for CT scan, urine cytology
124
Urethral Syndrome:
Caused by?
Presents as?
Management?
Unknown cause (hormone, psychological), MC in fibromyalgia
Urinary frequency, dysuria, NO NOCTURIA, normal urinalysis
Co-manage w/urologist
125
Urethritis:
Caused by?
Presents as?
Management?
Inflammation of urethra, chlamydia/gonorrhea
Mucoid or thick purulent urethral discharge + dysuria and frequency of urination
Refer to M.D
126
Urinary Tract Infection:
Caused by?
Presents as?
Management?
Bacterial infection of urinary tract especially bladder, E.coli MC
Dysuria, frequency, nocturia, urinalysis shows WBC, bacteria, leucocyte esterase, nitrites (except Staph. Sap)
Refer to M.D. if increasing fluid and unsweetened cranberry juice is not helpful in 72 hours
127
Dysphagia with fluids in young adults =
Achalasia of the cardia
128
Achalasia of the Cardia:
Caused by?
Presents as?
Management?
Absent myenteric ganglion cells in the lower end of the esophagus causing lower end of esophagus to remain contracted
Dysphagia with fluids and not solids w/regurgitation of undigested foods, chest pain, rat tail sign with barium swallow
Co-manage w/gastroenterologist
129
Breast Cancer:
Caused by?
Presents as?
Management?
Malignant tumor of glandular breast tissue, genetic factors, diets fail a role
Painless breast lump, recent nipple retraction, peau d'orange, axillary lymph node, sanguinous nipple discharge or tethering of skin
Breast cancer specialist --> mammography + biopsy
130
Chronic Mesenteric Ischemia:
Caused by?
Presents as?
Management?
Narrowing of mesenteric blood vessels w/atherosclerosis
Reurrentcramping abdominal pains after a meal,anorexia (fear of eating)
Gastroenterologist --> Angiography
131
Endometrial Carcinoma:
Caused by?
Presents as?
Management?
Malignancy of lining of uterine cavity, exposure to unopposed excess estrogens, MC in childless women
Postmenopausal bleeding, weight loss
Gynecologist --> endometrial biopsy
132
Gastric Carcinoma:
Caused by?
Presents as?
Management?
Malignancy of lining of stomach, usually adenocarcinoma, caused by H. Pylori, smoked meats
Weight loss, fatigue, hard mass in L supraclavicular fossa (Trossier's sign) due to spread via thoracic duct
Gastroenterologist --> endoscopy and biopsy
133
Pancreatic Cancer:
Caused by?
Presents as?
Management?
Malignancy of glandular tissue of pancreas, adenocarcinoma
LBP, weight loss, jaundice, pruritus
Gastroenterologist --> CT scan
134
Cyclical fever (Pel Ebstein phenomenon/fever) =
Lymphoma
135
Step ladder fever =
Typhoid fever
136
Words used for prognosis are?
Excellent, good, fair, guarded, poor, pending
