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Physical Diagnosis > Exam 2: [Abdomen, Dizziness & Headaches] > Flashcards

Exam 2: [Abdomen, Dizziness & Headaches] Flashcards

1
Q

Pain in the RUQ Conditions

A
  • Gallstones
  • Cholangitis
  • Liver conditions
  • Cardiac/Lung Causes
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2
Q

Pain in the LUQ Conditions

A

Spleen Issues

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3
Q

Pain in the RLQ Conditions

A
  • Appendicitis
  • Crohn’s
  • Caecum obstruction
  • Ovarian cyst/Ectopic pregnancy
  • hernias
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4
Q

Pain in the LLQ COnditions

A
  • Diverticulitis/Ulcerative Colitis
  • Constipation
  • Ovarian Cyst
  • Hernias
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5
Q

Pain in the Hypogastric Quadrant Conditions

A
  • Testicular torsion
  • Urinary Retention
  • Cystitis
  • Placental Abruption
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6
Q

Pain in the Epigastric Quadrant Conditions

A
  • Esophagitis
  • Peptic or Perforated Ulcer
  • Pancreatitis
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7
Q

Pain in the Right & Left Pyelonephritis Quadrants Condition

A

Ureteric Colic Pyelonephritis

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8
Q

Peritoneum Acronym

A

[SADPUCKER]
Suprarenal (adrenal) glands
Aorta/IVC
Duodenum (2nd & 3rd parts)
Pancreas (excluding tail)
Ureters
Colon (ascending & descending)
Kidneys
Esophagus
Rectum

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9
Q

Upper GI symptoms

A
  • Abdominal Pain
  • heartburn
  • nausea/vomiting
  • dysphagia
  • hematemesis
  • anorexia
  • jaundice
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10
Q

Lower GI Symptoms

A
  • Diarrhea/constipation
  • blood in stool (hematochezia/frank or Melena)
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11
Q

Visceral Pain Pattern

A
  • When organs are stretched
  • Also caused by Ischemia
  • Poorly localized/dull
  • gnawing/burning
  • sweating/nausea
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12
Q

Parietal pain patterns

A
  • localized/intense
  • Inflammation of parietal peritoneum (peritonitis
  • aggravated by movement
    (Appendicitis)
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13
Q

Referred pain patterns

A

Felt in remote area supplied by same nerve
- localized
- appears with intense visceral stimulus

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14
Q

Parietal pain is associated with:

A

Physical examination findings of local or diffuse peritonitis & frequently needs surgery

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15
Q

Referred Pain Examples (2)

A

Pancreas -> Thoracic Spine
AAA -> Lumbar Spine

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16
Q

Achalasia Definition

A

Failure of lower esophageal body & spincter smooth muscles to relax

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17
Q

Melena, Hematochezia, & Steatorrhea Definitions

A

Melena: Black tarry stool
Hematochezia: Red/Maroom Stool “Frank blood” (low GI Bleed)
Steatorrhea: fatty diarrheal stools (malabsorption)

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18
Q

Hematemesis vs. Hemoptysis

A

Hematemesis: vomiting blood (stomach)
Hemoptysis: coughing up blood (lungs)

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19
Q

Jaundice: caused by, pain location & painful vs painless

A
  • Increased bilirubin
  • Pain in RUQ
  • Painless = malignancy
  • Painful = Infectious
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20
Q

Obstipation Signifies

A

Intestinal Obstruction

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21
Q

Abdominal Alarm Symptoms

A
  • Dysphagia/ Odynophagia
  • Vomitting
  • GI Bleed evidence
  • Early satiety
  • Weight loss/Anemia
  • Palpable mass
  • Painless Jaundice
  • Peritonitis signs
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22
Q

Peritoneal Signs

A

1) Sharp localized pain
2) pain w/ percussion
3) rebound tenderness
4) absence of bowel sounds
5) rigidity

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23
Q

Diff DXI for Angina vs. GERD

A

Is the “indigestion” precipitated by exertion and relieved by rest?
Agitated by laying down = GERD

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24
Q

Peptic Ulcers: Provocative & palliative Factors

A

Palliative: foods that are provocative w/ GI cancer
Provocative:Duodenal ulcers wake patients at night

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25
Q

Gastric Cancer

A

NOT relieved by food or antacids
Food is provocative

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26
Q

Acute Pancreatitis: Palliative & Provocative factors

A

Palliative: fetal position/trunk flexion
Provocative: lying supine

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27
Q

Cullen Sign

A

[Acute Pancreatitis]
“Eccymosis & edema in the subcutaneous tissue around umbilicus”

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28
Q

Grey Turner Sign

A

[Acute Pancreatitis]
“Eccymosis of the flank”

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29
Q

Predisposing factors for Cholecystitis

A
  • Female around 40 years old
  • Multiparous
  • DM & Obesity (Sedentary)
  • Genetic predisposition
  • Progesterone Oral Contraceptives double the risk
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30
Q

Cholecystitis: Presentation & Provocative factors

A

[RUQ pain referring to right shoulder]
- Clay colored stools
- Jaundice
- Fatty meals
- Progress to Peritonitis

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31
Q

Cirrhosis What is it? & MC Complication:

A

Liver scarring/fibrosis
Ascites = MC complication (fluid accumulation in abdominal cavity)

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32
Q

MC Symptoms of Celiac

A

Diarrhea & Flatulence

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33
Q

Mesenteric Ischemia is:

A

Occlusion of blood flow to small bowel (embolus/thrombus)
- Leads to food fear
- look for signs of peritonitis

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34
Q

IBS causes & Treatments

A

Trauma to the gut (flu/food poisoning)
Probiotics

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35
Q

Acute Appendicitis pain subsides…

A

Suspect PERFORATION

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36
Q

What is Chronhs disease and where is the pain

A

Ulceration of intestinal lining
Pain in RLQ

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37
Q

Diverticulosis: Location of pain, what is it

A

[LLQ]
Small pouches in the GI tract w/ increased bowel pressure & decreased complex carbs
(Get CT w/ contrast, ultrasound or Barium X Ray)

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38
Q

Diverticulitis: Diagnosis

A

LLQ Palpable mass, Fever & constipation

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39
Q

MC Kidney Stones

A

Calcium Oxalate & Calcium Phosphate
(High levels of oxalate in diet)

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40
Q

Nephrotic Syndrome

A

1) Generalized Edema
2) Dyslipidemia & Fat oval Bodies
3) Proteinuria
4) Hypoproteinemia

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41
Q

Nephritis

A

1) Oliguria w/ Azotemia
2) HTN
3) Hematuria

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42
Q

Pathology of Kidney Failure

A

(Uremia)
Fibrosis & Hyalination of Bowman’s Capsule

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43
Q

Seven “F’s” of Abdominal Protuberance

A

Fat
Feces
Flatulence
Fluid
Fetus
Fibroid (benign)
Fatal growth (malignant)

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44
Q

Bell listens for

A

Bruits

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45
Q

Diaphragm listens for

A

Rubs

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46
Q

Murphey’s Sign

A

Palpation of the Gallbladder

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47
Q

AAA Rupture Triad:

A

1) Shooting abdomen or back pain
2) Hypotension
3) Pulsatile abdominal mass
[GREATER THEN 3 CM]

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48
Q

Carnett Test

A
  • Palpate abdomen & have patient flex
  • worse pain during contraction = + test
  • If cause of pain is intra-abdominal, tense muscle protect & tenderness decreases with contraction
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49
Q

MC cause of abdominal wall pain

A

Nerve entrapment @ border of lateral rectus muscle
[Anterior nerve Entrapment Syndrome]
Carnett is +

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50
Q

Abdominal Reflex:

A

Umbilicus moves TOWARD the Stimulus

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51
Q

Causes of Dizziness

A
  • Vertigo
  • Presyncope
  • Disequilibrium
  • Psychiatric
  • Multifactorial/Unknown
52
Q

What factors suggest Cardiac Syncope?

A
  • Recumbent position
  • vision closing in
  • related to exertion
53
Q

What factors suggest Vasovagal syncope?

A

-Upright position
- sweating, lightheaded, queasiness
- less than 1 minute

54
Q

What factors suggest hypotension syncope

A

Standing up when it happened

55
Q

What factors suggest epileptic syncope?

A
  • visual, auditory, olfactory prodome
  • confusion w/ possible incontinence
  • 5-15 minutes long
56
Q

What factors suggest extreme heat syncope?

A

Volume depletion on extreme exertion
(Elevates pt’s legs 12-24 inches)
MUST RULE OUT HYPERTROPHIC CARDIOMYOPATHY IN YOUNG ATHLETES

57
Q

Peripheral Vestibular Dysfunction causing vertigo

A

Elicited by Head movements causing Nystagmus
(BPPV)

58
Q

Central brain stem lesions causing vertigo

A

Atherosclerosis, MS, TIA, Stroke

59
Q

BPPV Onset, Duration, Hearing, Tinnitus?, & Other features

A

Onset: Sudden when rolling to affected side/extending head
Duration:< 1 minute
Hearing: normal
Tinnitus?: Absent
Other features: Nausea, vomitting, nystagmus

60
Q

Acute Labyrinthitis: Onset, Duration, Hearing, Tinnitus?, & Other features

A

Onset: Sudden
Duration: hours-2 weeks
Hearing: Normal
Tinnitus?: Absent
Other features:nausea, vomitting, nystagmus

61
Q

Meunière Disease: Onset, Duration, Hearing, Tinnitus?, & Other features

A

Onset: Sudden
Duration: Hours to > 1 day
Hearing: Sensorineural loss
Tinnitus?: Present
Other features: Fullness in ear, nausea, vomitting, nystagmus

62
Q

Drug Toxicity: Onset, Duration, Hearing, Tinnitus?, & Other features

A

Onset: Variable/diuretics, salicylates, alcohol
Duration: May be permanent
Hearing: Variable
Tinnitus?: Variable
Other features: Nausea, vomitting

63
Q

Acoustic Neuroma: Onset, Duration, Hearing, Tinnitus?, & Other features

A

Onset: Insidious
Duration: variable
Hearing: Loss on one side
Tinnitus?: Present
Other features: CN 5 & 8 may be involved

64
Q

Central Vertigo: Onset, Duration, Hearing, Tinnitus?, & Other features

A

Onset: varies
Duration: progressive or constant
Hearing: Normal
Tinnitus?: Absent
Other features: Dyarthria, motor & sensory deficits

65
Q

Dizziness produced by what ear structures?

A

Membranous labyrinth
(Ampullae, Utricle & Saccule)

66
Q

What maneuvers are best for BPPV

A

Epley

67
Q

Red flags fro BPPV

A
  • Focal deficits w/ numbness/weakness
  • severe ataxia
  • unilateral hearing loss
  • tinnitus
  • direction changing nystagmus
68
Q

4 Characteristics of Cervicogenic dizziness

A

1) Disequillibrium
2) Neck Pain
3) Reduced Cervical ROM
4) Cervical movement is provocative

69
Q

Vertebrobasilar Ischemia (VBI) MC Symptoms **

A
  • Neck/Head pain (MC complaint)
  • Dizziness (MC Symptom)
70
Q

Vertebrobasilar Ischemia (VBI) : Risk Factors **

A
  • RA
  • Giant Cell Arteritis
  • Ligamentous Hypermobility
71
Q

Vertebrobasilar Ischemia (VBI): When Signs Appear **

A
  • in Practitioners office 69% of the time
  • 14% within 24 hours
  • (92% within first 24 hours)
72
Q

Vertebrobasilar Ischemia (VBI): MC Signs/Symptoms (5Ds & 3Ns) **

A

Dizziness
Drop Attacks
Diplopia
Dysarthria
Dysphagia
Nausea
Numbness
Nystagmus

73
Q

Vertebrobasilar Ischemia (VBI): Prognosis **

A

Death from carotid & vertebral artery dissection is less than 5%

74
Q

Vertebrobasilar Ischemia (VBI): Adjusting techniques associated with occurrence **

A

60% Rotation

75
Q

3 most important attributes to headaches are

A

1) Severity
2) Chronological Pattern
3) Associated symptoms

76
Q

Examples of secondary headaches

A

Analgesic rebound
Acute glaucoma
Post-cuncussion

77
Q

Focal Neurological Deficits as Red Flags for Headaches (5Ds And 3Ns)

A

Dizziness
Drop Attacks
Diplopia
Dysarthria
Dysphagia
Ataxia
Nausea
Numbness
Nystagmus

78
Q

Tension Headaches

A

[40% of headaches]
- No nausea
- Not worsened by walking

79
Q

Classic Migraine vs Common Migraine

A

Classic: Aura Present has to have 2 of the following:
- No motor weakness
- reversible visual/sensory symptoms
- reversible dysphagia speech
- at least 5 minutes no longer than 60 minutes

80
Q

Diagnostic Criteria for Migraine

A

[POUND] (10% of headaches)
Pulsatile Quality
One-Day duration
Unilateral
Nausea or Vomitting
Disabling Intensity

81
Q

Cluster Headaches

A

[< 1% of headaches]
- Sweating
- Swelling
- Tearing
- Runny nose

82
Q

Errors of Refraction in Vision Headaches

A

Emmetropia: normal
Myopia: near sighted
Hyperopia: far sighted
Astigmatism: irregular vision

83
Q

Triad of Bacterial Meningitis

A

Fever
Neck Stiffness
Altered mental state

84
Q

2 of the following features are present in 95% of patients with bacterial meningitis

A

Fever
Neck Stiffness
Altered mental state
Headache

85
Q

Tenderness over temporal artery, fever, visual loss, & polymyalgia rheumatica are symptoms of:

A

Giant Cell (Temporal) Arteritis

86
Q

Complications of Giant cell (temporal) arteritis

A

Vision loss
Aneurysm
Stroke

87
Q

Provocative factors of Trigeminal Neuralgia (Tic Douloureux)

A

Touching the face
Chewing
Talking
Brushing teeth

88
Q

Torticollis affet what nerves and what muscles?

A

CN XI
SCM, Splenius Capitis & Trapezius

89
Q

Hypertensive headache

A

Systolic > 160 mm/Hg
Present upon awakening & resolved during the morning

90
Q

Hypoglycemic Headache

A

Blood sugar falls too low or too rapidly
Patient w/ DM or pt’s who fast for prolonged period of time

91
Q

Normocephalic, Microcephaly & Macrocephaly

A

Normocephalic: normal sized skull
Microcephaly: small skull
Macrocephaly: large skull

92
Q

Muscles of mastication are innervated by what cranial nerve?

A

CN V

93
Q

Face muscles are innervated by what CN?

A

CN VII

94
Q

Innervation of Sensation to the Face/head

A

CN V
C2
C1-C4 (cervical plexus)

95
Q

What is found in the posterior triangle of the neck?

A

External Jugular vein

96
Q

Lymphatic drainage from 3/4ths of the body is to the…

A

Left supraclavicular region

97
Q

Olivers Sign

A

Downward displacement of the cricoid cartilage that coincides w/ ventricular contraction (S1, Systole)
- Aortic Arch Aneurysm

98
Q

Campbell Sign

A

Downward displacement of the thyroid cartilage that coincides with inspiration
- COPD

99
Q

Enlarged Goiter Indicitive of:

A

Graves Disease

100
Q

Multinodular Goiter Indicitive of:

A
  • Toxic goiter
  • genetics
  • iodine deficient diet
101
Q

Single Nodule Goiter Indicitive of:

A
  • Cyst
  • Benign or Malignant
102
Q

Signs of Hypothyroidism

A
  • Dry, course hair & skin
  • Brittle nails
  • puffy face
  • enlarged thyroid (goiter)
  • cold intolereance
  • fatigue, depression
  • heavy menstrual periods
  • weight gain
  • constipation
103
Q

Signs of Hyperthyroidism

A
  • Hair loss
  • bulging eyes
  • sweating
  • enlarged thyroid (goiter)
  • rapid heartbeat
  • heat intolerance
  • muscle weakness
  • nervousness
  • scant menstrual periods
  • weight loss
  • warm, moist palms & soft nails
104
Q

Acronym to Spot a Stroke

A

[BE FAST]
Balance (loss of balance, headache or dizziness)
Eyes (blurred vision)
Face (one side drooping)
Arms & Legs (weakness)
Speech (difficulty)
Time (call for emergency)

105
Q

Bells Palsy affects what cranial nerve?

A

CN VII

106
Q

Cushing Syndrome vs. Myxedema

A

Cushing: Hypercortisolism
Myxedema: Hypothyroidism

107
Q

Cushing Syndrome: Clinical Signs

A
108
Q

Graves’ disease: Clinical Signs

A
109
Q

Nephrotic Syndrome: Clinical Signs

A
  • Proteinuria
  • hypoproteinemia
  • anascara
  • dyslipidemai
110
Q

Acromegaly: Clinical Signs

A

[excess growth hormone from pituitary]
- Prominent Brow & Jaw
- Large Nose, Ears & Lips

111
Q

Nephritic Syndrome/Nephritis: Clinical Signs

A
  • Hematuria (RBC’s)
  • Oliguria w/ Azotemia
  • Hypertension
112
Q

Renal Failure: Clinical Signs

A
  • Uremia
  • Hyaline Casts
113
Q

Parkinson’s: Clinical Signs

A
  • Blank facial expression
  • forward tilt posture
  • reduced arm swinging
  • slow, slurred speech
  • extremity tremor
  • short shuffled gait
114
Q

Keloid Lump on the ear

A

Excessive deposition of scar tissue

115
Q

Auricular Hematoma Lump on the ear

A

Shearing separates PERICHONDRIUM from a cartilage (cauliflower ear)

116
Q

Tophi Lump on the ear

A

Deposits of crystalline Uris acid on skin surface

117
Q

Basal cell carcinoma lump on the ear

A

SHINY FLESH COLORED NODULE WITH OVERLYING TELANGIECTASIA

118
Q

Auscultation of the temporal artery

A

With the Bell if Hardeningor Nodularity is noted during palpation

119
Q

Facial sensation from what CN?

A

CN 5

120
Q

Facial Motor from what CN?

A

CN 7

121
Q

Division of the Trigeminal Nerve (CN 5)

A

Ophthalmic
Maxillary
Mandibular

122
Q

How many pars of lymph nodes are in the neck?

A

10

123
Q

Trapezius & SCM Innervated by what CN?

A

CN 11

124
Q

Auscultation of the neck tips

A

Lateral Lobes of the thyroid
Place Bell over Carotid Bifurcation

125
Q

Myxedema (Hypothyroidism): Clinical Signs

A
  • Dry, coarse hair
  • lateral eyebrows = thin
  • periorbital edema
  • puffy dull face w/ dry skin

Physical Diagnosis (7 decks)

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