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AAAA physical exam winter 2016 > final > Flashcards

final Flashcards

1
Q

what is normal location of diameter of PMI?

PMI (also called apex beat)

A

usually found in 5th Interspace 7 to 9 cm lateral to mid-sternal line

approx size of quarter, 1 to 2.5 cm in diameter

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2
Q

JVP reflects what pressure? and from which vein is it best estimated?

A

Right atrial pressure

best estimated from Right external jugular vein

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3
Q

pulmonic valve murmur can be heard where?

A

left side of anterior chest

close to sternum on 2nd and 3rd interspace

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4
Q

aortic valve murmur can be heard where?

A

right side

2nd and 3rd interspace to apex

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5
Q

pulse alternans indicates?

A

left ventricular failure

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6
Q

what are causes of paroxysmal nocturnal dyspnea?

A

left ventricular heart failure or mitral stenosis

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7
Q

what are AHA guidelines for screening of BP, BMI, waist circumference?

A

routine visit at least every 2 years

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8
Q

how do you assess JVP? what is normal?

A

raise pt head slightly on pillow to relax SCM
raise head of bed to 30 degrees
turn pt’s head slightly to LEFT, to identify top-most point of flickering venous pulsations
place centimeter ruler upright on sternal angle, place card horizontally - to make right angle
mesure distance above sternal angle

normal is 3-4 cm

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9
Q

increased pressure of JVP suggest?

A

right sided congestive heart failure

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10
Q

how do you distinguish between internal jugular and carotid pulsation?

A

internal jugular pulsation has:
soft, biphasic, undulating quality

(vs. Carotid is more vigorous thrust with a single outward component)

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11
Q

what is cause of delayed carotid upstroke?

A

aortic stenosis

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12
Q

what is bruit?

A

murmur-like sound of vascular rather than cardiac origin

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13
Q

what is cause of carotid bruit?

A

aortic valve murmur

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14
Q

what is thrill?

A

humming vibration that feel like throat of purring cat

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15
Q

what causes thrills?

A

aortic stenosis, patent ductus arteriosus, ventricular septal defect, mitral stenosis

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16
Q

what is apical impulse?

A

brief early pulsation of left ventricle as it moves anteriorly during contraction and touches the chest wall

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17
Q

the bell of stethoscope is best for what use?

A

detecting low-pitched sounds like S3, and rumble of mitral stenosis

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18
Q

how will you determine whether a murmur is systolic?

A

systolic murmur falls between S1 and S2

diastolic falls between S2 and S1

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19
Q

location of epitrochlear lymph nodes?

A

located on medial surface of arm approx 3cm above the elbow

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20
Q

what is intermittent claudication?

A

pain or cramping in legs during exertion that is received by rest within 10 min

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21
Q

how do you distinguish intermittent claudication from spinal stenosis?

A

if leg pain with exertion is reduced by leaning forward and stretching spinal cord in the narrowed vertebral canal (spinal stenosis) then it’s spinal stenosis

if relived by rest, then intermittent claudication

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22
Q

ischemia of which artery can cause abdominal pain after meals and associated food fear?

A

celiac or superior or inferior mesenteric arteries

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23
Q

what are the causes of asymmetric BP in two arms?

A

coarctation of aorta

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24
Q

what are causes of lymphedema of arm and hand?

A

axillary lymph node dissection and radiation therapy

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25
Q

what is normal pulse grade and character?

A

2+ brisk, expected (normal)

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26
Q

what is common cause of decreased or absent pedal pulse?

A

diabetes mellitus

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27
Q

what are signs of superficial thrombophlebitis?

A

local swelling, redness, warmth, subcutaneous cord

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28
Q

Allen test assess?

A

potency of ulnar and radial arteries

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29
Q

what are aggravating factors of Reynaud’s disease?

A

exposure to cold

emotional upset

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30
Q

pain in chronic arterial insufficient feels like?

A

intermittent claudication progressing to pain at rest

31
Q

edema in chronic Arterial insufficiency

vs. chronic Venous insufficiency

A

in Arterial - edema is absent or mild if patient lowers leg to relive rest pain

in Venous - edema is present, often marked

32
Q

Ulceration in chronic Arterial and Venous insufficiency

A

Arterial - if present, involves toes or point of trauma to feet

Venous - if present, develops at sides of ankles, esp medially

33
Q

in chronic Venous insufficiency, how is the edema, what else happens in skin?

it arises from?

A

edema is soft, with PITTING on pressure, occasionally bilateral
brawny changes and skin thickening, esp near ankles
ulceration, brownish pigmentation, edema in foot are common

arises from chronic obstruction and from incompetent valves in deep venous system

34
Q

in Lymphedema, what does the edema look like? what happens in skin?
develops when?

A

edema is soft in early stages, then becomes indurated, hard, and non-pitting

skin is thickened, ulceration is rare, no pigmentation, edema near feet, toes, often bilateral

develops when lymph channel are obstructed by tumor, fibrous, inflammation, axillary node dissection and radiation

35
Q

pain of duodenal or pancreatic origin referred to ?

A

the back

36
Q

pain from biliary tree may be referred to

A

right shoulder

37
Q

what are causes of doubling over with cramping, colicky pain?

A

renal stone

38
Q

what cause sudden knifelike epigastric pain?

A

gallstone pancreatitis

39
Q

what causes Hematemesis

A

esophageal varices
gastritis
peptic ulcer disease

40
Q

early satiety maybe be due to?

A 
diabetic gastroparesis
anticholinergic medication
gastric outlet obstruction
gastric cancer
hepatitis
41
Q

what is alcoholic stool?

A

gray or light colored due to obstructed bile excretion

42
Q

jaundice with itching due to ?

A

obstructive jaundice

43
Q

what is caput medusa?

A

collateral pathway of recanalized umbilical veins radiating up abdomen that decompresses portal vein hypertension

44
Q

what are recommendation for screening colorectal cancer in person with average risk?

A 
fetal occult blood test - every year
flexible sigmoidscopy - every 5 yrs
combined of above 2
colonoscopy - every 10 yrs
double contrast barium enema - every 5 yrs
45
Q

what is sequence of abdominal examination?

A

inspection
auscultation
percussion (light, then deep)
palpation

46
Q

suprapubic bulge on abdomen can mean?

A

distended bladder, pregnant uterus or hernia

47
Q

increased peristaltic waves can be due to?

A

intestinal obstruction

48
Q

increased pulsations visible on abdomen can be due to?

A

aortic aneurysm

49
Q

peritoneal inflammation presents with?

A

involuntary abdominal rigidity

and rebound tenderness -

50
Q

liver dullness may be displaced downward in which condition?

A

COPD

51
Q

direction of enlarged spleen is

A

anteriorly, downward, and medially

52
Q

pyelonephritis will elicit pain with

A

pressure or percussion

53
Q

ascites may be due to

A 
cirrhosis
congestive heart failure
constrictive pericarditis
inferior vena cava 
hepatic vein obstruction
nephrotic syndrome
malnutrition 
ovarian cancer
54
Q

positive Murphy Sign means?

A

acute cholecystitis

55
Q

when the supine patient raises head and shoulder or strain down, thus tightening abdominal mass… what are 2 places mass can be in and how do you determine this?

A

if mass in abdominal wall, it remain palpable

[if mass cannot be felt, it is in intra-abdominal space (bc mass obscured by muscular contraction)]

56
Q

acute pancreatitis is aggravated and alleviated by?

A

aggravated by - laying supine

alleviated by - learning forward w trunk flexed

57
Q

what are psychological and physiological changes of menopause?

A

psychological - mood shifts, depression, changes in self-concept

physiological - osteoporosis, vulvovaginal atrophy (pain, drying), increase in total LDL,

58
Q

what sign suggest pelvic inflammatory disease on cervical exam?

A

pain on movement of cervix
+
Adnexal tenderness

59
Q

what symptom may arise from impaired strength of pelvic muscle?

A

urinary stress incontinence

60
Q

premature ejactulation is common among which age group?

A

young men

61
Q

what is phimosis

A

tight prepuce that cannot be retracted over gland (foreskin)

62
Q

how does testicular cancer present?

A

painless nodule in testis, typical in men 15 to 35 yrs

63
Q

what are characteristics of cysts in breast?

A

soft to firm
round
mobile
often tender

64
Q

characteristics of cancerous breast mass

A

irregular
firm
maybe mobil or fixed to surrounding tissue

65
Q

BRAC 1 and BRAC 2 gene is?

A

codes for proteins that suppress tumors in breast and ovaries

autosomal dominant

66
Q

breast density plays what role in breast cancer?

A

it is strong independent risk factor, even after adjusting for effects of other risk factors

67
Q

what is nipple retraction?

A

recent or fixed flattening or depression of nipple

68
Q

dimpling of breast caused by?

A

dimpling or retraction of breast suggest underlying cancer

69
Q

breast fibroadenoma
number?
shape?
tenderness?

A

usually single
round, disc-like, or lobular
NOT tender

70
Q

breast cysts

tender?

A

often tender

71
Q 
breast cancer mass
shape?
consistency
mobility
tender?
A

irregular or stellate
firm or hard
fixed to underlying tissues
NOT tender (usually)

72
Q

what are retraction signs of breast?

A

due to fibrosis (scar tissue), may produce dimpling, changes in contour, and retraction or deviation of nipple

73
Q

what is peau d’orange sign of breast?

A

thickened skin with enlarged pores due to edema of skin produced by lymphatic blockage

74
Q

what is visible sing in Paget’s disease of nipple?

A

starts as scaly, eczema-like lesion that may weep, crust, or erode, or with persisting dermatitis of nipple and areola

AAAA physical exam winter 2016 (1 decks)

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