Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

P2B Med > Clinical Examination Set 1 > Flashcards

Clinical Examination Set 1 Flashcards

1
Q

Will you see scars on a patient with history of venous surgery?

A

Possibly, but most modern venous treatments are now minimally invasive so they’ll be no scars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is venous eczema the result of?

A

Venous hypertension causing fluid to collect in the tissues. The stasis of this fluid results in activation of the innate immune response and subsequent inflammation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is lipodermatosclerosis?

A

A form of panniculitis (inflammation of the subcutaneous fat) caused by ongoing activation of the innate immune response in soft tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the difference between venous and arterial ulcers

A

aaaaa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a saphena varix?

A

Dilation of the saphenous vein at its junction with the femoral vein in the groin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you distinguish between saphena varix and an inguinal hernia?

A

Saphena varix is a lump around 2-4cm inferior-lateral to the pubic tubercle. It has a bluish tinge, is soft to palpate and will vanish when the pt lies down - unlike an inguinal hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Summarise the anatomical difference between the great saphenous vein and the small saphenous vein.

A

The great saphenous vein runs all the way up the medial side of the leg and the small saphenous vein drains the lateral side of the lower leg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are varicose veins on the buttocks and around the genitals suggestive of?

A

Pathology affecting the venous system within the pelvis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you palpate varicosities?

A

Palpate the entire length of each varicosity and ask the patient to let you know if they experience any pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can you distinguish between phlebitis and thrombophlebitis?

A

Overlying erythema in the distribution of the vessel and tenderness on palpation is indicative of phlebitis.
A tender and hard (“cord-like”) varicosity is indicative of thrombophlebitis (thrombosis with associated inflammation).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is phlebitis?

A

Inflammation of a vein, most commonly the superficial veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where is the saphenofemoral junction located?

A

4cm inferior-lateral to the pubic tubercle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the Trendelenburg test used for?

A

To locate the site of the incompetent venous valves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the cough impulse test used for?

A

To identify a saphena varix.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Perthe’s test used for?

A

To distinguish between venous valvular insufficiency in the deep, perforator and superficial venous systems.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What could nipple inversion be caused by?

A

Usually normal. Could be due to breast cancer, breast abscess, mammary duct ectasia and mastitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What could nipple discharge be caused by?

A

Usually benign (e.g. pregnancy or breastfeeding) but can be associated with mastitis or underlying breast cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What could scaling of the nipple and/or areola be caused by?

A

Paget’s disease of the breast, especially if erythema or pruritis is seen too. Paget’s disease is associated with underlying in-situ or invasive carcinoma of the breast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What can cause erythema of the breast?

A

Infection (e.g. mastitis or breast abscess), trauma (e.g. fat necrosis) and underlying breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is puckering of breast tissue associated with?

A

Invasion of the suspensory ligaments of the breast by an underlying malignancy that results in ligamentous contraction which draws the skin inwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What causes peau d’orange? What is it associated with?

A

This is dimpling of the skin resembling an orange peel. It occurs due to cutaneous lymphatic oedema. It is typically associated with inflammatory breast cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why do we ask pts to press their hands into their hips in a breast exam?

A

It contracts pec maj, which can accentuate puckering. When the muscle contracts, any visible masses may move, suggesting it’s tethered to the underlying tissue (e.g. invasive breast malignancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why do we ask pts to but their arms above their head whilst leaning forward in the breast exam?

A

This position exposes the entire breast and will exaggerate any asymmetry, skin dimpling or puckering.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What characteristics do you need to assess if a pt has a breast mass?

A

Location, size, shape, consistency, mobility, fluctuance, overlying skin changes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Where do the majority of breast cancers develop?

A

In the axillary tail

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What can cause erroneous ABPI results?

A 
Incorrectly positioned cuff
Irregular pulse (e.g. atrial fibrillation)
Calcified vessels (e.g. diabetes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the equation to calculate ABPI?

A

ABPI = (highest pressure of either PTA or DP) ÷ (highest brachial pressure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What does peripheral cyanosis show?

A

It is a bluish discolouration of the skin associated with low SpO2 in the affected tissues, which can show poor perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are xanthomata?

A

Raised yellow cholesterol-rich deposits that are often noted on the palm, tendons of the wrist and elbow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are xanthomata associated with?

A

Hyperlipidaemia (typically familial hypercholesterolaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What must you do before performing a cap refill test?

A

Ask if the pt has any pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Give two causes of radio-radial delay

A

Subclavian artery stenosis (e.g. compression by a cervical rib)
Aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

A pt has a 25mmHg difference in BP between the arms. Is this normal?

A

A more than 20 mmHg difference in BP between arms is abnormal and is associated with aortic dissection.

34
Q

Define wide pulse pressure. What can it show?

A

Wide pulse pressure (more than 100 mmHg of difference between systolic and diastolic blood pressure) can be associated with aortic regurgitation and aortic dissection.

35
Q

When palpating the aorta, your hands move outwards with each pulsation. Is this normal?

A

In healthy individuals, your hands should begin to move superiorly with each pulsation of the aorta.
If your hands move outwards, it suggests the presence of an expansile mass (e.g. abdominal aortic aneurysm).

36
Q

What is ischaemic rubour?

A

A dusky-red discolouration of the leg that typically develops when the limb is dependent. Ischaemic rubour occurs due to the loss of capillary tone associated with PVD

37
Q

Describe the peripheral neuropathy often seen in significant PVD

A

Slowly progressive, glove and stocking distribution of sensory loss

38
Q

A pt comes to see you with rapid onset parathesia in his left leg. What could this indicate?

A

Acute critical limb ischaemia

39
Q

What could a hoarse voice indicate?

A

Caused by compression of the larynx due to thyroid gland enlargement, e.g. thyroid malignancy

40
Q

What are you looking for when you inspect a pts hands in the thyroid examination?

A

Dry skin, excessive sweating, thyroid acropachy, onycholysis, palmar erythema

41
Q

Is onycholysis associated with hyper or hypothyroidism?

A

Hyper

42
Q

Is loss of the outer third of the eyebrow associated hyper or hypothyroidism?

A

Hypo

43
Q

Where would you see lid lag, hyper or hypothyroidism?

A

Graves’

44
Q

Why do we assess eye movements in the thyroid examination?

A

To assess for opthalmoplegia (e.g. restricted eye movement, diplopia) and pain during eye movement, which can be caused by Graves’

45
Q

How do we identify thyroglossal cysts?

A

Caused by persistence of the thyroglossal duct. They rise during tongue protrusion, as the tongue is attached to the thyroglossal duct.

46
Q

What can cause tracheal deviation?

A

A large goitre

47
Q

What might a bruit of the thyroid gland indicate?

A

Increased vascularity due to Graves’

48
Q

What is pretibial myxoedema and where do you see it?

A

It usually presents itself as a waxy, discoloured induration of the skin on the anterior aspect of the lower legs (pre-tibial region). Pretibibial myxoedema is a rare complication of Graves’ disease.

49
Q

Where do you see proximal myopathy?

A

Multinodular goitre and Graves’ disease. Pts develop wasting of their proximal musculature causing difficulties in tasks such as standing from a sitting position

50
Q

What is cachexia?

A

Ongoing muscle loss that isn’t entirely reversed with nutritional supplementation. Commonly associated with underlying malignancy and other end-stage resp diseases.

51
Q

What could skin thinning on the hand show?

A

Long term steroid use

52
Q

What could finger clubbing indicate?

A

Lung cancer, ILD, cystic fibrosis, bronchiectasis

53
Q

What could a fine tremor be the result of?

A

Beta-2-agonist use

54
Q

What causes asterixis?

A

Flapping tremor is most likely caused by CO2 retention.

55
Q

What could asymmetries in the expiratory and inspiratory phases of respiration show?

A

The expiratory phase is often prolonged in asthma exacerbations and in patients with COPD

56
Q

What does a raised JVP show? Which respiratory disease is linked to it?

A

Venous hypertension. Pulmonary hypertension, which causes RHF, often caused by ILD or COPD

57
Q

What is a plethoric complexion, and what does it show?

A

A congested red-faced appearance associated with polycythaemia (e.g. COPD) and CO2 retention

58
Q

A pt comes to see you with ptosis, miosis and enopthalmos. What is the likely diagnosis?

A

All features of Horner’s syndrome (anhydrosis is another important sign associated with the syndrome). Horner’s syndrome occurs when the sympathetic trunk is damaged by pathology such as lung cancer affecting the apex of the lung (e.g. Pancoast tumour).

59
Q

What can cause oral candidiasis in respiratory patients?

A

A fungal infection commonly associated with steroid inhaler use (due to local immunosuppression).

60
Q

What might asymmetry of the chest wall indicate?

A

Typically associated with pneumonectomy (e.g. lung cancer) and thoracoplasty (e.g. tuberculosis).

61
Q

Give causes of tracheal deviation.

A

The trachea deviates away from pneumothorax and large pleural effusions.
The trachea deviates towards lobar collapse and pneumonectomy.
Palpation of the trachea can be uncomfortable, so warn the patient and apply a gentle technique

62
Q

What can cause an abnormal cricosternal distance?

A

A distance of fewer than 3 fingers suggests underlying lung hyperinflation (e.g. asthma, COPD).

63
Q

Give respiratory causes of symmetrical reduced chest expansion

A

Pulmonary fibrosis reduces lung elasticity, restricting overall chest expansion.

64
Q

Give respiratory causes of asymmetrical reduced chest expansion

A

Pneumothorax, pneumonia and pleural effusion would all cause ipsilateral reduced chest expansion

65
Q

What diseases would you associate a wheeze with?

A

Asthma, COPD and bronciectasis

66
Q

What diseases would you associate stridor with?

A

Foreign body inhalation (acute) and subglottic stenosis (chronic).

67
Q

What diseases would you associate coarse crackles with?

A

Pneumonia, bronchiectasis and pulmonary oedema

68
Q

What diseases would you associate fine end-inspiratory crackles with?

A

Pulmonary fibrosis

69
Q

What are some respiratory causes of lymphadenopathy?

A

Lung cancer with mets, TB, sarcoidosis

70
Q

What disease is malar flush associated with?

A

Mitral stenosis

71
Q

What is arachnodactyly a sign of?

A

Marfan’s syndrome, which is associated with mitral/aortic valve prolapse and aortic dissection.

72
Q

What might finger clubbing be caused by (CVS)

A

Congenital cyanotic heart disease, IE

73
Q

Give some causes of radio-radial delay

A

Subclavian artery stenosis (e.g. compression by a cervical rib), aortic dissection, aortic coarctation

74
Q

Give some causes of a collapsing pulse

A

Fever, pregnancy, cardiac lesions (aortic regurg, patent ductus arteriosus), high cardiac output

75
Q

Give the four types of pulse character

A

Normal, slow rising, bounding, thready

76
Q

What is a slow-rising pulse associated with?

A

Aortic stenosis

77
Q

What is a bounding pulse associated with?

A

Aortic regurg, CO2 retention

78
Q

What is a thready pulse associated with?

A

Intravascular hypovolaemia (e.g. in sepsis)

79
Q

Give some causes of narrow pulse pressure

A

<25mmHg difference between systolic and diastolic. Aortic stenosis, CHF and c tamponade

80
Q

Give some causes of narrow pulse pressure

A

> 100mmHg. Aortic regurg, aortic dissection

81
Q

More than 20mmHg difference in BP between each arm might indicate…

A

Aortic dissection

82
Q

What does a positive hepatojugular reflux result show?

A

That the right ventricle is unable to accommodate an increased venous return, but it is not diagnostic of any specific condition

P2B Med (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions