Clinical Evaluation Flashcards
What type of dyspnea is specific for LV heart failure? What other type is commonly seen but not as specific?
Paroxysmal nocturnal dyspnea (PND) is very specific (wake up about 2 hours into sleep SOB, due to redistribution of peripheral fluid into blood).
Orthopnea (simple positional SOB) is seen in CHF but also many other conditions.
What is mononeuritis multiplex?
What conditions is it seen in?
Subacute/acute loss of function (sensory and/or motor, potentially w/ pain) in multiple individual, noncontiguous nerve trunks, either simultaneously or in sequence.
Seen in collagen vascular disease (especially RA, PAN, and multiple vasculitis syndromes), DM, and cancer.
What is the nature of inflammatory pain? How will the patient behave?
Exacerbated by movement, so the patient lays still.
What is the nature of obstructive pain in a hallow viscus?
Colicky waves of pain. Patient will writhe or pace.
What on the CBC differential values against bacterial infection?
The presence of eosinophils (usually cleared by inflammatory mediators and hormonal processes that result)
What on CBC is a good marker of an inflammatory process?
Elevated platelet count
What conditions is ESR particularly useful in?
Temporal arteritis and subacute thyroiditis (ESR typically very high)
(Modest elevations in ESR too nonspecific to be particularly useful in diagnosis).
What CXR view is particularly useful for assessing cardiac chamber enlargement?
How do RV and LV hypertrophy appear?
Lateral views.
RVH: Cardiac silhouette meets the sternum halfway up the sternum, retrosternal space diminished, angle between sternum and silhouette no longer acute. (Normally meets 1/3 of the way up at a steep angle)
LVH: Smaller retrocardiac space, diminished angle with the IVC (LV makes up the posterior border in the lateral view)
What should you look for if CXR shows calcification of the costochondral cartilage?
Mitral valve calcification (as the two often co-occur)
May be seen in mitral regurgitation
What is suggested by air bronchograms without decreased lung volume on CXR?
Decreased lung volume without air bronchograms?
Air bronchograms: Consolidation (e.g. typical pnuemonia)
Volume loss: bronchial obstruction
Where in the lung is TB classically located?
Fungal lung infection?
TB: Posterior segment of upper lobe
Fungal: Anterior segment of upper lobe
What is suggested by bullae in the upper lobes of the lung?
Middle lobe? Lower lobes?
Upper lobes: COPD
Middle/lower lobes: Alpha-1 antitrypsin deficiency
Which diaphragm is usually higher on CXR?
What should you consider if the opposite is true?
R diaphragm usually higher (underlying liver)
If L diaphragm is higher, suspect enlargement in the L upper abdomen (abscess, enlarged spleen, adrenal mass)
What could lead to inability to take a deep breath on CXR?
Pain, weakness, CHF
