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Physical Diagnosis > Final > Flashcards

Final Flashcards

1
Q

elephant on chest pain; crushing, radiating

A

MI

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2
Q

substernal chest pain?

  • provoked by emotion or ?
  • relieved by ? and/or ?
A

angina
eating
rest, nitroglycerin

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3
Q

burning, substernal, nocturnal, and worse with lying flat

A

esophageal

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4
Q

lasts for hours/days; local tenderness

A

musculoskeletal

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5
Q 
chest pain-
HA
aortic dissection
angina
PE
MVP
spontaneous pneumothorax
acute pericarditis
pneumonia
esophageal pain
costochondritis
herpes zoster`
A

mid chest

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6
Q 
chest pain-
HA
aortic dissection
acute pericarditis
esophageal pain
spontaneous pneumonia
pneumonia
A

back

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7
Q 
chest pain-
HA
angina
acute pericarditis
aortic dissection
perforated viscus
A

shoulder

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8
Q

chest pain-
HA
angina

A

left arm

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9
Q

chest pain-
HA
perforated viscous

A

abdomen

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10
Q

SH - don’t forget to ask about ? demands

A

employment

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11
Q

pancreatitis, pneumonia, and cervical ? are in the Ddx for ?

A

radiculopathy, chest pain

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12
Q

Heart is like plumbing
wiring ?
plumbing ?
walls of house?

A

arrhythmias, electrical activity
ischemia, dissection, clot
endocarditis, pericarditis, amyloidosis

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13
Q

equipment for advanced cardiac exam (4)

A

stethoscope
pen light
cm ruler
pencil

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14
Q

PE:
apical impulse
heaves/lifts
PULSATIONS

A

inspection

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15
Q

PE:
apical impulse
heaves/lifts
THRILLS

A

palpation

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16
Q

eye is included in typical cardiac workup- ?

A

optic fundi

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17
Q

blue sclera ?

A

congenital heart defect, osteogenesis imperfecta

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18
Q

increased arterial pulse:

  • observed in ? blood pressure recordings
  • fever, anemia, ? weather, exercise, pregnancy, ?thyroidism, atherosclerosis, ? fistulas
  • cardiac dz ie ?, ?, and ? and results in a widened pulse pressure
A

typical
hot, hyper, AV
AR, PDA, truncus arteriosus

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19
Q

reduced arterial pressure

  • ? normally
  • from ?, arteriosclerosis, AS, or diabetic ?
A

uncommon

HF, ketoacidosis

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20
Q

unequal pulses

  • ? difference
  • from ? or ?
A

20 mm Hg

AS, subclavian steal

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21
Q

pulsus paradoxus

  • abnormally large decrease in ? and pulse wave amp during ?
  • sign of ?, constrictive pericarditis, restrictive cardiomyopathy, COPD sleep apnea, and ?
A

SBP, inspiration

acute cardiac tamponade, croup

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22
Q

pulsus alternans

  • found by palpating a peripheral artery, preferably the ?
  • ? variation?
  • almost always indicative of ? and carries a ?
A

femoral
beat-to-beat (strong-weak)
LV systolic impairment, poor Px

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23
Q

AS, ruptured chordae tendinae of mitral valve, and severe AR all have ? detected by ?

A

transmitted murmurs

carotid artery bruits

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24
Q

carotid artery bruits occur in obstructive dz in ?

A

cervical arteries (e.g. atherosclerotic carotid arteries, fibromuscular hyperplasia, arteritis

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25
Q

most common Sx of orthostatic htn:

A

dizziness or lightheadedness when sitting up or standing

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26
Q

orthostatic htn:

drop in sys > ? or dis > ? within ? after changing position

A

20, 10, 3 minutes

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27
Q

pressure differs on sides of body in ? or ?

A

occlusive disease, aortic dissection

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28
Q

JVP-

  • patient at ?
  • place ruler on ? and extend tongue depressor from ? to ruler
  • should be ? (if not- RHF, cirrhosis, etc.)
A

45 degrees
sternal angle, highest point of pulsation
<4 cm

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29
Q

hepatojugular/abdominojugular reflux:

  • alternate test for JVP pressure
  • firm pressure on abdomen by ? for ? seconds
  • a rise in JVP = ?
A

palm of hand, 10-60 sec

impaired RV function

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30
Q

left lateral decubitus accentuates?

A

S3, S4, tricuspid and mitral murmurs

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31
Q

inspect- 4 S in advanced peripheral vascular exam?

A

size
symmetry
swelling
skin changes

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32
Q

palpate- 2 T in advanced peripheral vascular exam

A

temperature

tenderness

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33
Q

advanced peripheral vascular exam- don’t forget to asses ? response

A

motor, sensory, and reflex

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34
Q 
pitting- wait 30 seconds
slight?
more pronounced, resolves ?
more severe, takes a while to ?
very ?, takes a long time to resolve
A

1
quickly, 2
resolve, 3
severe, 4

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35
Q 
chronic arterial insufficiency:
pain when ?
pale or ?
cool temp
no ?
thin, ? skin
loss of ?
painful ulcerations/trauma
gangrene***
decreased ?
A 
walking
dusky red
edema
shiny
hair
pulses
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36
Q

5 Ps of arterial insufficiency?

A 
pallor
paresthesia
pain
paralysis
pulselessness
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37
Q 
chronic venous insufficiency:
No ?
cyanotic or ? pigmentation
? temp
pitting edema*** 
? of skin
ulcerations around ?
NO ?
? pulses
A 
pain
brownish
normal
thickening
ankles (stasis dermatitis)
gangrene
normal
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38
Q

assess varicosities while patient is ?

A

standing

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39
Q

calf pain elicited upon acute passive ? of the foot
low ?
called?
be careful not to precipitate ?

A 
DVT
dorsiflexion
sensitivity
Homan's sign
PE
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40
Q

assess patency of radial and ulnar artery
ask patient to clench fist for ?
ask patient to open fist and release ?
watch for filling of hand to assess ulnar artery patency
repeat and assess ?
called ?

A

30s
ulnar artery
radial artery
Allen Test

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41
Q

always evaluate ? and auscultate ?

A

pulmonary system, lungs

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42
Q

always ask about ? complaints

GI complaints over ? or strong hx should have an ? to r/o ? ; especially ?

A

GI

40 yo, EKG, ACS, women

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43
Q

a form of PREVENTIVE medicine evaluation

A

wellness exam

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44
Q

Wellness HPI has two parts:

  1. explore past ? and ?
  2. develop an HPI based on the ?
A

exams, results

complaint

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45
Q

Wellness:
focus on confirming data already?
update info as appropriate

A

in chart

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46
Q

FH should have a minimum of ? generations
in diagrammatic or outline form
concludes with a ? for common genetic dz

A

3

negative statement

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47
Q

when a ? elicited, further details asked to put in the ROS

A

positive response

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48
Q

Wellness- all positive response MUST be ?

A

thoroughly explained

DOCUMENT AS “NO” or “DENIES”

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49
Q

ROS in wellness exam- ? is explored

A

EVERY category

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50
Q

wellness- not a ? ROS but complete

A

focused

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51
Q

ROS can be used to assess patient’s compliance with ?

A

screening tests i.e. cardiac- last EKG?

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52
Q

wellness- F- include ? and ? exams

M?

A

breast, pelvic

rectal, prostate

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53
Q

thorough exam is most basic “screening test” for ? (4)

A

breast
HYPERTENSION
skin
vision/hearing

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54
Q

cholesterol testing for men > ? and women > ?

A

35, 45

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55
Q

check cholesterol at ? to ? if increased risk

A

20-35

56
Q

ACA
mammogram at ? every ?
clinical breast exam (CBE) every ? for women in 20s and 30s
before 40 & increased risk = ? and ? yearly

A

40, year (annually)
3 years
MRI, mammogram
*moderate risk - 15-20% should talk with their provider about the benefits and limits of adding MRI screening

57
Q 
breast cancer risk factors... a bunch
race?
age?
relative?
menarche?
therapy? (2)
alcohol, obesity
A 
caucasian
>55
1st degree
before 12
chest radiation, HRT
58
Q

USPSTF: breast cancer screening

  • mammogram between ? every ?
  • decision to start before 50 is individual
  • against teaching ?
A

50-74, two years

SBE - self-breast exams

59
Q

Colon cancer

  • many modifiable factors including high ? diet, obesity, inactivity, smoking, heavy ? use, D type 2
  • non-modifiable- Hx ? or ?, age, FH ? cancer, genetics
A

red meat, alcohol

polyps/IBD, colorectal

60
Q

colonoscopy at ? every ? years
OR ? every 5 years
OR ? every 5 years
OR ? every 5 years

A

50, 10
sigmoidoscopy
barium enema
CT colonography (virtual colonscopy)

61
Q

tests that mainly find cancer:
fecal occult blood test (FOBT) every ?
fecal immunochemical test (FIT) every ?
stool DNA test (sDNA)– interval ?

A

year
year
uncertain

62
Q

UPSTF:
screen for cervical cancer in ages ? with cytology (Pap Smear) every ?
women ages ? can have a Pap with ? every ?

A

21-65, 3 years

30-65, HPV, 5 years

63
Q

UPSTF recommends against:

  • screening women over ?
  • screening for cervical cancer with HPV (alone or in combo with cytology in women ?
  • screening women with ? (unless for cervical cancer)
A

65
less than 30
hysterectomy

64
Q

when getting a PAP smear- check for ? and ? if at risk

A

chlamydia

gonorrhea

65
Q

prostate cancer

  • both PSA (prostate-specific Ag) blood and digital rectal exam (DRE) were recommended in the past to be offered to men beginning at age ?
  • high risk- start at age ? race at risk? FH?
  • higher risk- FH? start testing at ?
A

50
45, AA, 1st degree relative Dx before 65
40, more than one 1st degree affected early

66
Q
  • USPSTF recommends against ? for prostate ca
  • task force doesn’t think AA have diff balance of benefits/harms from PSA screening than whites
  • high risk- talk to patient about ?
  • many risks i.e. AA, genetics, diet, exercise, VASECTOMY, age?
A

PSA screening
PSA/DRE screening risk/benefit
>65

67
Q

bone scan for women ages ? or younger if risk; men at risk

A

> /= 65

68
Q

ECG - USPSTF against screening w/ resting OR exercise ECG for prediction of ? in ? adults at low risk for CHD; screen those with FH, condition or risk factors

A

CHD, asymptomatic

69
Q

ALL men who ? should have and u/s to screen for ? at age ? ; ONE time screening

A

smoked, AAA, 65

70
Q

aspirin 81 mg daily

  • men over ?
  • postmen women or age ?
  • pts at risk for ?
  • USPSTF recommends aspirin for men at age ? if the benefit of preventing ? outweighs risk for ?
A

45
55
CVD
45-79, MI, GI hemorrhage

71
Q

exercise- 30 min ? d/week

A

5

72
Q

alcohol- F? M?

A

1 drink, 2 drinks

73
Q

oral case presentations- present in an ? and ? manner

A

oral, brief

74
Q

OCP- a ? story; never a ?

A

simple, surprise

75
Q

OCP- emphasize ? and ?&?

A

HPI, assessment & plan

76
Q

? sees if there is a successful intro sentence and you can say no to “do any surprises appear after this sentence?”

A

litmus test

77
Q

OCP- only ? in P.E.

A

key findings

78
Q

OCP- <1m, on rounds or in hallways; very brief?

A

bullet or capsule

79
Q

OCP- 2-3 min, rounds, consultations, more thorough than bullet/capsule

A

formal

80
Q

OCP- 5-10 min, grand rounds, presentations, consults, oral form of written record

A

complete

81
Q

OCP- org exactly as ?

A

written report

82
Q

OCP- describe all Sx ?

  • keep info chronological
  • pertinent ? and ?
A

fully

positives, negatives

83
Q

OCP- all ? precede all ? elements

A

positive, negative

84
Q

OCP- Intro statement includes? (4)

A

age
gender
pertinent PMH
CC

85
Q

OCP- PMH and surgical Hx is ? but ?

-no need to include ? unless pertinent

A

comprehensive, brief

dates

86
Q

OCP- ALWAYS include ? and ?
only include pertinent parts of ? and ?
ROS- only mention ?

A

allergies, meds
FH, SH
pertinent positives

87
Q

OCP- P.E.

  • begin with ?
  • followed by ?
  • present PERTINENT findings in ?
  • describe ? in detail
A

vitals
general survey
head-to-toe fashion
abnormal findings

88
Q

OCP- labs/Dx tests

  • if tests normal, state ?
  • in ? presentation state results of all values
A

WNL

comprehensive

89
Q

OCP- assessment

  • 1 or 2 sentences summarizing patient case
  • transition from findings to ?
  • summarize highlights of case
A

critical thinking process

90
Q

OCP- DDX

-try to have ? differentials

A

3 or more

91
Q

OCP- Delivery

  • use ? statements rather than ? statements
  • DO NOT ? or ? as you present; just tell the ‘facts’ as they were obtained by you (you’re telling your patient’s story not yours)
A

positive, negative

editorialize, rationalize

92
Q

patients with underlying ? may be very Sx of severe anemia but with a ? up to ?

A

CAD, high Hg- 10gm/dL

93
Q

cardiac adjustment to anemia = ? at rest

A

high CO

94
Q

anemia causes cerebral hypoxia and ? in ear or ? in head

A

roaring, humming sound

95
Q

B12 deficiency

  • degeneration of DORSAL columns of s.c.: unsteadiness of ?
  • degen of LATERAL columns: ? weakness
  • peripheral neuropathy- ? sensation in hand, feet
A

gait (ataxia), falling
motor
pins & needles

96
Q

general Sx of anemia:

? of blood away from splanchnic bed, loss of ?, abdominal discomfort, indigestion, nausea

A

shunting, appetite

97
Q

thalassemia major
sickle cell dz
spherocytosis
all are ?

A

hereditary anemias

98
Q

? may be Dx later in life i.e. thalassemia trait (alpha or beta thalassemia minor)

A

hetero hereditary anemias

99
Q

hereditary hemolytic anemia that has acute episodes of hemolysis; occur within hours to few days after exposure to oxidant stressor i.e. medications

A

glucose-6-phosphate dehydrogenase deficiency

100
Q

life threatening, hemolytic, schistocytes?

A

TTP (thrombotic thrombocytopenic purpura)

101
Q

hemolytic & schistocytes also, increased aTPP and dimers?

A

DIC (disseminated intravascular coagulation)

102
Q

painful crisis in hours to days upon exposure to heat or cold exertion, dehydration, infection, etc.

A

SC disease

103
Q

sulfonamides and antimalarial drugs i.e. primaquine or nitrofurantoin can trigger an acute hemolytic crisis in ?

A

glucose-6-phosphate dehydrogenase deficiency

104
Q

sulfonamides, cephalosporins, penicillin can cause ?

A

AI hemolytic

105
Q

NSAIDS can cause gastritis or PUD (GI bleeding)&raquo_space; ?

A

iron def anemia

106
Q

isoniazid Tx can cause ?

A

sideroblastic anemia

107
Q

methotrexate, phenytoin, and trimethroprim can cause ?

A

folate def anemia

108
Q

cytotoxic cancer chemo, anti-seizure meds, i.e. valproic acid, phenytoin, and a/b i.e. sulfonamides; CHLORAMPHENICOL can lead to ?

A

aplastic anemia

109
Q

AA predisposed to ? and ?

A

SC anemia, G6PD def (more males)

110
Q

African, mediterranean, indian, SE asian predisposed to ? and ?

A

G6PD def, thalassemias

111
Q

northern europeans ?

A

hereditary spherocytosis

112
Q

alc toxicity can cause ? anemia

A

mildly macrocytic

113
Q

chronic liver failure (cirrhosis) can lead to ?

A

iron def anemia

114
Q

tea and toast diet in elderly ?

A

folate def

115
Q

strict vegetarians and preggos who are ‘moderate’ vegetarians are at increased risk for ?

A

B12 def

116
Q

long distance runners - chronic GI blood loss?

A

iron def anemia

117
Q

travel - tropical countries- endemic for ?

A

malaria - hemolytic anemia

118
Q

smoking causes ? due to increased binding of carbon monoxide to Hgb; which stim EPO release

A

‘relative tissue hypoxia’

119
Q

complications of hereditary hemolytic anemias?

A

jaundice, bilirubin gallstones

120
Q

colon cancer will have unintentional ? and ? stool; abdominal pain

A

weight loss, ‘pencil-like’

121
Q

GI bleeding can be of ? origin- difficult to detect and treat; people exposed to this ? (3)» can cause significant chronic disabling anemia

A

obscure

CRF, vW dz, elderly

122
Q

hypothyroidism may cause ? anemia; ask about difficulty concentrating, constipation, hoarseness

A

macrocytic

123
Q

chronic renal disease can be a cause of anemia of renal failure due to ?

A

decreased EPO production

124
Q

iron def

  • heavy menses at least ?; clots of blood
  • vaginal bleeding b/w periods
  • post meno bleeding may be ?
A

4 days

uterine cancer

125
Q

RA?

SLE?

A

anemia of chronic dz

hemolytic anemia

126
Q

TB can result in ?

A

anemia of chronic dz

127
Q

nail changes = ? anemia

A

chronic iron deficiency i.e. brittleness, longitudinal ridging, flattening, spooning (koilonychia)

128
Q

chronic ankle ulcers in ?

A

SC dz

129
Q

petechiae, purpura in ? from acute leukemia or aplastic anemia

A

thrombocytopenia

130
Q

cheilosis in ?

A

vit b12 and folate def, iron def

131
Q

chipmunk facies in ?

A

thal major

132
Q

frontal bossing ?

A

SC dz

133
Q

severe anemia- ? murmur in ? area

A

sys ejection, pulmonic

134
Q

sternal tenderness due to ? of b.m. w/ ? cells or ? plasma cells

A

infiltration, leukemic, multiple myeloma

135
Q

malignancies of WBC will have ? and the leukemic cells replace ? and cause anemia

A

splenomegaly, bone marrow

Physical Diagnosis (4 decks)

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