Exam 2: [Abdomen, Dizziness & Headaches] Flashcards
1
Q
Pain in the RUQ Conditions
A
- Gallstones
- Cholangitis
- Liver conditions
- Cardiac/Lung Causes
2
Q
Pain in the LUQ Conditions
A
Spleen Issues
3
Q
Pain in the RLQ Conditions
A
- Appendicitis
- Crohn’s
- Caecum obstruction
- Ovarian cyst/Ectopic pregnancy
- hernias
4
Q
Pain in the LLQ COnditions
A
- Diverticulitis/Ulcerative Colitis
- Constipation
- Ovarian Cyst
- Hernias
5
Q
Pain in the Hypogastric Quadrant Conditions
A
- Testicular torsion
- Urinary Retention
- Cystitis
- Placental Abruption
6
Q
Pain in the Epigastric Quadrant Conditions
A
- Esophagitis
- Peptic or Perforated Ulcer
- Pancreatitis
7
Q
Pain in the Right & Left Pyelonephritis Quadrants Condition
A
Ureteric Colic Pyelonephritis
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
9
Q
Upper GI symptoms
A
- Abdominal Pain
- heartburn
- nausea/vomiting
- dysphagia
- hematemesis
- anorexia
- jaundice
10
Q
Lower GI Symptoms
A
- Diarrhea/constipation
- blood in stool (hematochezia/frank or Melena)
11
Q
Visceral Pain Pattern
A
- When organs are stretched
- Also caused by Ischemia
- Poorly localized/dull
- gnawing/burning
- sweating/nausea
12
Q
Parietal pain patterns
A
- localized/intense
- Inflammation of parietal peritoneum (peritonitis
- aggravated by movement
(Appendicitis)
13
Q
Referred pain patterns
A
Felt in remote area supplied by same nerve
- localized
- appears with intense visceral stimulus
14
Q
Parietal pain is associated with:
A
Physical examination findings of local or diffuse peritonitis & frequently needs surgery
15
Q
Referred Pain Examples (2)
A
Pancreas -> Thoracic Spine
AAA -> Lumbar Spine
16
Q
Achalasia Definition
A
Failure of lower esophageal body & spincter smooth muscles to relax
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)
18
Q
Hematemesis vs. Hemoptysis
A
Hematemesis: vomiting blood (stomach)
Hemoptysis: coughing up blood (lungs)
19
Q
Jaundice: caused by, pain location & painful vs painless
A
- Increased bilirubin
- Pain in RUQ
- Painless = malignancy
- Painful = Infectious
20
Q
Obstipation Signifies
A
Intestinal Obstruction
21
Q
Abdominal Alarm Symptoms
A
- Dysphagia/ Odynophagia
- Vomitting
- GI Bleed evidence
- Early satiety
- Weight loss/Anemia
- Palpable mass
- Painless Jaundice
- Peritonitis signs
22
Q
Peritoneal Signs
A
1) Sharp localized pain
2) pain w/ percussion
3) rebound tenderness
4) absence of bowel sounds
5) rigidity
23
Q
Diff DXI for Angina vs. GERD
A
Is the “indigestion” precipitated by exertion and relieved by rest?
Agitated by laying down = GERD
24
Q
Peptic Ulcers: Provocative & palliative Factors
A
Palliative: foods that are provocative w/ GI cancer
Provocative:Duodenal ulcers wake patients at night
25
Gastric Cancer
NOT relieved by food or antacids
Food is provocative
26
Acute Pancreatitis: Palliative & Provocative factors
Palliative: fetal position/trunk flexion
Provocative: lying supine
27
Cullen Sign
[Acute Pancreatitis]
“Eccymosis & edema in the subcutaneous tissue around umbilicus”
28
Grey Turner Sign
[Acute Pancreatitis]
“Eccymosis of the flank”
29
Predisposing factors for Cholecystitis
- Female around 40 years old
- Multiparous
- DM & Obesity (Sedentary)
- Genetic predisposition
- Progesterone Oral Contraceptives double the risk
30
Cholecystitis: Presentation & Provocative factors
[RUQ pain referring to right shoulder]
- Clay colored stools
- Jaundice
- Fatty meals
- Progress to Peritonitis
31
Cirrhosis What is it? & MC Complication:
Liver scarring/fibrosis
Ascites = MC complication (fluid accumulation in abdominal cavity)
32
MC Symptoms of Celiac
Diarrhea & Flatulence
33
Mesenteric Ischemia is:
Occlusion of blood flow to small bowel (embolus/thrombus)
- Leads to food fear
- look for signs of peritonitis
34
IBS causes & Treatments
Trauma to the gut (flu/food poisoning)
Probiotics
35
Acute Appendicitis pain subsides…
Suspect PERFORATION
36
What is Chronhs disease and where is the pain
Ulceration of intestinal lining
Pain in RLQ
37
Diverticulosis: Location of pain, what is it
[LLQ]
Small pouches in the GI tract w/ increased bowel pressure & decreased complex carbs
(Get CT w/ contrast, ultrasound or Barium X Ray)
38
Diverticulitis: Diagnosis
LLQ Palpable mass, Fever & constipation
39
MC Kidney Stones
Calcium Oxalate & Calcium Phosphate
(High levels of oxalate in diet)
40
Nephrotic Syndrome
1) Generalized Edema
2) Dyslipidemia & Fat oval Bodies
3) Proteinuria
4) Hypoproteinemia
41
Nephritis
1) Oliguria w/ Azotemia
2) HTN
3) Hematuria
42
Pathology of Kidney Failure
(Uremia)
Fibrosis & Hyalination of Bowman’s Capsule
43
Seven “F’s” of Abdominal Protuberance
Fat
Feces
Flatulence
Fluid
Fetus
Fibroid (benign)
Fatal growth (malignant)
44
Bell listens for
Bruits
45
Diaphragm listens for
Rubs
46
Murphey’s Sign
Palpation of the Gallbladder
47
AAA Rupture Triad:
1) Shooting abdomen or back pain
2) Hypotension
3) Pulsatile abdominal mass
[GREATER THEN 3 CM]
48
Carnett Test
- Palpate abdomen & have patient flex
- worse pain during contraction = + test
- If cause of pain is intra-abdominal, tense muscle protect & tenderness decreases with contraction
49
MC cause of abdominal wall pain
Nerve entrapment @ border of lateral rectus muscle
[Anterior nerve Entrapment Syndrome]
Carnett is +
50
Abdominal Reflex:
Umbilicus moves TOWARD the Stimulus
51
Causes of Dizziness
- Vertigo
- Presyncope
- Disequilibrium
- Psychiatric
- Multifactorial/Unknown
52
What factors suggest Cardiac Syncope?
- Recumbent position
- vision closing in
- related to exertion
53
What factors suggest Vasovagal syncope?
-Upright position
- sweating, lightheaded, queasiness
- less than 1 minute
54
What factors suggest hypotension syncope
Standing up when it happened
55
What factors suggest epileptic syncope?
- visual, auditory, olfactory prodome
- confusion w/ possible incontinence
- 5-15 minutes long
56
What factors suggest extreme heat syncope?
Volume depletion on extreme exertion
(Elevates pt’s legs 12-24 inches)
MUST RULE OUT HYPERTROPHIC CARDIOMYOPATHY IN YOUNG ATHLETES
57
Peripheral Vestibular Dysfunction causing vertigo
Elicited by Head movements causing Nystagmus
(BPPV)
58
Central brain stem lesions causing vertigo
Atherosclerosis, MS, TIA, Stroke
59
BPPV Onset, Duration, Hearing, Tinnitus?, & Other features
Onset: Sudden when rolling to affected side/extending head
Duration:< 1 minute
Hearing: normal
Tinnitus?: Absent
Other features: Nausea, vomitting, nystagmus
60
Acute Labyrinthitis: Onset, Duration, Hearing, Tinnitus?, & Other features
Onset: Sudden
Duration: hours-2 weeks
Hearing: Normal
Tinnitus?: Absent
Other features:nausea, vomitting, nystagmus
61
Meunière Disease: Onset, Duration, Hearing, Tinnitus?, & Other features
Onset: Sudden
Duration: Hours to > 1 day
Hearing: Sensorineural loss
Tinnitus?: Present
Other features: Fullness in ear, nausea, vomitting, nystagmus
62
Drug Toxicity: Onset, Duration, Hearing, Tinnitus?, & Other features
Onset: Variable/diuretics, salicylates, alcohol
Duration: May be permanent
Hearing: Variable
Tinnitus?: Variable
Other features: Nausea, vomitting
63
Acoustic Neuroma: Onset, Duration, Hearing, Tinnitus?, & Other features
Onset: Insidious
Duration: variable
Hearing: Loss on one side
Tinnitus?: Present
Other features: CN 5 & 8 may be involved
64
Central Vertigo: Onset, Duration, Hearing, Tinnitus?, & Other features
Onset: varies
Duration: progressive or constant
Hearing: Normal
Tinnitus?: Absent
Other features: Dyarthria, motor & sensory deficits
65
Dizziness produced by what ear structures?
Membranous labyrinth
(Ampullae, Utricle & Saccule)
66
What maneuvers are best for BPPV
Epley
67
Red flags fro BPPV
- Focal deficits w/ numbness/weakness
- severe ataxia
- unilateral hearing loss
- tinnitus
- direction changing nystagmus
68
4 Characteristics of Cervicogenic dizziness
1) Disequillibrium
2) Neck Pain
3) Reduced Cervical ROM
4) Cervical movement is provocative
69
Vertebrobasilar Ischemia (VBI) MC Symptoms **
- Neck/Head pain (MC complaint)
- Dizziness (MC Symptom)
70
Vertebrobasilar Ischemia (VBI) : Risk Factors **
- RA
- Giant Cell Arteritis
- Ligamentous Hypermobility
71
Vertebrobasilar Ischemia (VBI): When Signs Appear **
- in Practitioners office 69% of the time
- 14% within 24 hours
- (92% within first 24 hours)
72
Vertebrobasilar Ischemia (VBI): MC Signs/Symptoms (5Ds & 3Ns) **
Dizziness
Drop Attacks
Diplopia
Dysarthria
Dysphagia
Nausea
Numbness
Nystagmus
73
Vertebrobasilar Ischemia (VBI): Prognosis **
Death from carotid & vertebral artery dissection is less than 5%
74
Vertebrobasilar Ischemia (VBI): Adjusting techniques associated with occurrence **
60% Rotation
75
3 most important attributes to headaches are
1) Severity
2) Chronological Pattern
3) Associated symptoms
76
Examples of secondary headaches
Analgesic rebound
Acute glaucoma
Post-cuncussion
77
Focal Neurological Deficits as Red Flags for Headaches (5Ds And 3Ns)
Dizziness
Drop Attacks
Diplopia
Dysarthria
Dysphagia
Ataxia
Nausea
Numbness
Nystagmus
78
Tension Headaches
[40% of headaches]
- No nausea
- Not worsened by walking
79
Classic Migraine vs Common Migraine
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
Diagnostic Criteria for Migraine
[POUND] (10% of headaches)
Pulsatile Quality
One-Day duration
Unilateral
Nausea or Vomitting
Disabling Intensity
81
Cluster Headaches
[< 1% of headaches]
- Sweating
- Swelling
- Tearing
- Runny nose
82
Errors of Refraction in Vision Headaches
Emmetropia: normal
Myopia: near sighted
Hyperopia: far sighted
Astigmatism: irregular vision
83
Triad of Bacterial Meningitis
Fever
Neck Stiffness
Altered mental state
84
2 of the following features are present in 95% of patients with bacterial meningitis
Fever
Neck Stiffness
Altered mental state
Headache
85
Tenderness over temporal artery, fever, visual loss, & polymyalgia rheumatica are symptoms of:
Giant Cell (Temporal) Arteritis
86
Complications of Giant cell (temporal) arteritis
Vision loss
Aneurysm
Stroke
87
Provocative factors of Trigeminal Neuralgia (Tic Douloureux)
Touching the face
Chewing
Talking
Brushing teeth
88
Torticollis affet what nerves and what muscles?
CN XI
SCM, Splenius Capitis & Trapezius
89
Hypertensive headache
Systolic > 160 mm/Hg
Present upon awakening & resolved during the morning
90
Hypoglycemic Headache
Blood sugar falls too low or too rapidly
Patient w/ DM or pt’s who fast for prolonged period of time
91
Normocephalic, Microcephaly & Macrocephaly
Normocephalic: normal sized skull
Microcephaly: small skull
Macrocephaly: large skull
92
Muscles of mastication are innervated by what cranial nerve?
CN V
93
Face muscles are innervated by what CN?
CN VII
94
Innervation of Sensation to the Face/head
CN V
C2
C1-C4 (cervical plexus)
95
What is found in the posterior triangle of the neck?
External Jugular vein
96
Lymphatic drainage from 3/4ths of the body is to the…
Left supraclavicular region
97
Olivers Sign
Downward displacement of the cricoid cartilage that coincides w/ ventricular contraction (S1, Systole)
- Aortic Arch Aneurysm
98
Campbell Sign
Downward displacement of the thyroid cartilage that coincides with inspiration
- COPD
99
Enlarged Goiter Indicitive of:
Graves Disease
100
Multinodular Goiter Indicitive of:
- Toxic goiter
- genetics
- iodine deficient diet
101
Single Nodule Goiter Indicitive of:
- Cyst
- Benign or Malignant
102
Signs of Hypothyroidism
- Dry, course hair & skin
- Brittle nails
- puffy face
- enlarged thyroid (goiter)
- cold intolereance
- fatigue, depression
- heavy menstrual periods
- weight gain
- constipation
103
Signs of Hyperthyroidism
- 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
Acronym to Spot a Stroke
[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
Bells Palsy affects what cranial nerve?
CN VII
106
Cushing Syndrome vs. Myxedema
Cushing: Hypercortisolism
Myxedema: Hypothyroidism
107
Cushing Syndrome: Clinical Signs
108
Graves’ disease: Clinical Signs
109
Nephrotic Syndrome: Clinical Signs
- Proteinuria
- hypoproteinemia
- anascara
- dyslipidemai
110
Acromegaly: Clinical Signs
[excess growth hormone from pituitary]
- Prominent Brow & Jaw
- Large Nose, Ears & Lips
111
Nephritic Syndrome/Nephritis: Clinical Signs
- Hematuria (RBC’s)
- Oliguria w/ Azotemia
- Hypertension
112
Renal Failure: Clinical Signs
- Uremia
- Hyaline Casts
113
Parkinson’s: Clinical Signs
- Blank facial expression
- forward tilt posture
- reduced arm swinging
- slow, slurred speech
- extremity tremor
- short shuffled gait
114
Keloid Lump on the ear
Excessive deposition of scar tissue
115
Auricular Hematoma Lump on the ear
Shearing separates PERICHONDRIUM from a cartilage (cauliflower ear)
116
Tophi Lump on the ear
Deposits of crystalline Uris acid on skin surface
117
Basal cell carcinoma lump on the ear
SHINY FLESH COLORED NODULE WITH OVERLYING TELANGIECTASIA
118
Auscultation of the temporal artery
With the Bell if Hardeningor Nodularity is noted during palpation
119
Facial sensation from what CN?
CN 5
120
Facial Motor from what CN?
CN 7
121
Division of the Trigeminal Nerve (CN 5)
Ophthalmic
Maxillary
Mandibular
122
How many pars of lymph nodes are in the neck?
10
123
Trapezius & SCM Innervated by what CN?
CN 11
124
Auscultation of the neck tips
Lateral Lobes of the thyroid
Place Bell over Carotid Bifurcation
125
Myxedema (Hypothyroidism): Clinical Signs
- Dry, coarse hair
- lateral eyebrows = thin
- periorbital edema
- puffy dull face w/ dry skin
