Exam I Flashcards
what is pruritus?
itching
what is utricaria?
hives
what is xeroderma?
extreme dryness of the skin
what causes nail clubbing?
pulmonary conditions (80% of the time)
what causes Leukonychia of nails? (3)
(1) alcohol
(2) nutrition defects
(3) MI
what causes Splinter
hemorrhages of nails?
endocarditis
what causes Koilonychia (spoon) of nails? (3)
(1) anemia
(2) thyroid
(3) syphilis
what causes Beau’s lines in nails? (3)
(1) alcohol
(2) nutrition defects
(3) MI
what causes nail pitting?
psoriasis
what causes nail thickening?
poor circulation
what causes melanoma in nails?
malignance
the butterfly rash occurs with what condition?
lupus erythematosus (systemic) (NOT CHRONIC INTEGUMENTARY LUPUS)
what are the ABCs of screening for skin cancer?
Asymmetry: unequal Border: irregular Color: multiple colors Diameter: > 6mm Elevation / Evolution: elevation or quick changes
what is the most common and slowest metastasizing type of skin cancer?
basal cell carcinoma
what is the second most common type of skin cancer?
squamous cell carcinoma
where do 80% of squamous cell carcinoma lesions occur?
head and neck regions
what is the most severe and fastest metastasizing skin cancer?
melanoma
what is psoriasis? what is the most common complaint?
(1) chronic skin disorder; red patches covered by dry silvery scales
(2) itching
what is systemic
sclerosis? what population is more affected?
(1) connective tissue disease that causes fibrosis of skin, joints, blood vessels, and organs
(2) women 2-3x more than men
what is lyme disease? how do patients present?
(1) infection caused by a deer tick
(2) fever, headache, stiff neck; may only present with shoulder or knee pain initially
what is herpes zoster? what are the symptoms?
(1) shingles; caused by varicella-zoster virus
(2) pain and tingling along affected spinal or cranial nerve dermatome; fever, chills, GI problems
what is rosacea?
a form of adult acne
what is tinea corporis?
ringworm
what is palmar erythema commonly caused by?
hepatic disorders
how can you differentiate between anxiety and stress?
panic and fear are associated with anxiety
what are the DASS and GDS scales? what are scores that require referral?
(1) Depression, Anxiety and Stress Scale (scores >7 in any sub scale require referral)
(2) Geriatric Depression Scale (6 or >)
what are the 6 types of somatoform disorders?
(1) somatization
(2) undifferentiated
(3) hypochondriac
(4) somatoform pain disorder (5) body dysmorphic disorder
(6) conversion disorder
what demographic has the lowest suicide rates?
African American females
what are the 5 types of anemia?
(1) iron deficiency
(2) anemia caused by inflammation
(3) aplastic anemia
(4) renal insufficiency
(5) megaloblastic anemia (lack of vitamin B12)
what is the most severe type of anemia?
aplastic (type III)
what is often the first symptom of aplastic anemia?
bleeding
what anemia is due to synthesis of abnormal hemoglobin?
sickle cell anemia
what type of anemia is due to decreased synthesis of structurally normal hemoglobin?
thalassemia
what form of sickle cell is more severe?
homozygotes
what does sickle cell anemia put the patient at risk for?
increased clotting puts the patient at increased risk for stroke
which type of thalassemia is the most severe?
homozygotes
what are the normal hemoglobin and hematocrit values in males and females?
MALES
Hgb: 13-17
Hct: 39-49
FEMALES
Hgb: 12-16
Hct: 36-48%
what is polycythemia? what are the two types and what causes them?
increased hematocrit and hemoglobin
Types
I. primary: early bone morrow precursor cells
II. secondary: increased erythropoietin
what is a common physical finding with polycythemia?
pressure in left upper quadrant due to an enlarged spleen
what are common complications of polycythemia?
increased clot formation: stroke, MI, DVT, life threatening hermorrhage of upper GI tract
what is thrombocytopenia?
decreased number of platelets
what is nadir?
lowest point of WBC count following chemotherapy (usually occurs 7-14 days)
what are normal INR levels? what INR level is at risk for hemarthrosis?
(1) normal: 0.8-1.2
(2) at risk: >3
what are the two types of hemophilia?
(1) type A: hereditary (x-chromosome linked)
2) type B: acquired (liver failure, vitamin K deficiency, coumadin therapy
what is the difference in clinical presentation between platelet disorders and clotting factor deficiencies?
(1) platelet disorder: bleed in superficial sites
(2) clotting factor: bleeding into muscles, joints, and cavities
what is the most common finding with hemophilia? where does this usually occur?
(1) hemarthrosis (muscle bleeding 2nd most common finding)
2) knee, shoulder, hip, ankle elbow (larger joints
what type of angina do women usually have and where does it present?
(1) microvascular disease
(2) localized to chest and mid back
what type of angina do men usually have and where does it present?
(1) coronary artery disease
(2) pain that radiates into the shoulder, traps, and down the arm
what is the difference between stable and unstable angina?
stable: predictable
unstable: can occur anytime, during sleep, throughout day etc.
what is orthopnea?
shortness of breath while lying down
what is syncope?
fainting
what is vasovagal syncope?
fainting due to very strong parasympathetic response
what are abnormal vital signs for CVD with exercise?
(1) systolic BP that doesn’t increase with intensity
(2) systolic BP that falls during exercise
(3) increased in diastolic BP >15-20 mm Hg
with patients taking beta blockers, how is exercise prescribed?
RPE
what is myalgia?
myotoxic event associated with statins
what is rhabdomyolysis associated with?
impaired renal and liver function
what are classic signs of liver impairment?
dark urine, white stools, asterixis (liver flap), bilateral carpal tunnel syndrome, ascites
what is the most common symptom of HTN?
headache
what is considered HTN?
> 140 systolic
>90 diastolic
what is the number 1 risk factor that predisposed a person to CHF?
hypertension
what is orthostatic hypotension?
(1) decrease of systolic BP by 20 mm HG or more
(2) decreased systolic and diastolic BP by 10 mm Hg AND increased HR by 15bpm
what is a common MSK symptom of infective endocarditis?
(1) arthralgia (joint pain) most commonly the shoulder
(2) 1/3 of these patients have low back pain
what can pericarditis mimic?
MI (pain radiates to the left shoulder)
how do you differntiate between pericarditis and MI?
patient position wont be affected by MI; leaning forwards or going to all 4s makes pericarditis pain decrease
what is an aneurysm?
stretching of the wall of an artery (50% greater than normal); most common site for arterial aneurysm is the aorta
what are the most common symptoms of abdominal aorta aneurism?
(1) pulsating mass in abdomen (with or without pain)
(2) abdominal and back pain
where do 95% of aortic aneurysms occur?
just below the renal arteries near the belly button
who is at a higher risk for abdominal aorta aneurism?
(1) males
(2) congenital heart defects / diseases
how is well’s clinical prediction rule for DVT graded?
0 - less than 5% chance of DVT
1-2 - 25% chance of DVT
3+ - 50% chance of DVT
what are O2 saturation ranges required for exercise?
D/C exercise if O2 falls below:
- 90% for medically monitored patients
- 92% for outpatient
what should O2 levels be at rest?
> 96% in young / adults at rest
>94% for healthy elderly at rest
when should you send a patient for immediate referral with the use of nitroglycerin?
15-20 minutes if angina doesn’t subside following administration of nitroglycerin
what is the most powerful risk factor for stroke?
HTN (>140mm Hg)
what is the difference between hypoxemia and hypoxia?
hypoxemia: deficient oxygenation of arterial blood
hypoxia: diminished availability of oxygen to the body tissues
what is hemoptysis?
coughing up blood
what is hypercapnia?
a condition that decreases ventilation increases the retention of CO2
what is pneumothorax?
collapsed lung; causes mediastinal shift towards unaffected side
what is the primary symptom of pneumothorax?
dyspnea
what is the most common symptom of GI disease? what is the 2nd most common?
(1) abdominal pain (including heart burn)
(2) nausea
why do some people have back pain with constipation?
muscle guarding
what is the difference in abdominal exam between diverticulitis and appendicitis?
(1) diverticulitis presents usually in left lower quadrant
(2) appendicitis usually presents in the right lower quadrant
what does the heel jar test for?
peritonitis and appendicitis
what MSK disorder can Crohn’s disease cause?
arthritis
what is the most common GI problem?
IBS
what is Kern’s sign most commonly associated with?
ruptured spleen or bleeding in peritoneal cavity