Final Exam Flashcards
normal lymph nodes
less than 1/2 cm, movable, firm, non-tender
infected node
enlarged, tender
malignant lymph node
hard, non-tender, irregular, fixed
thyroid assessment
below cricoid, need to do labs to see hyper/hypo, have pt swallow
presbycusis
lose hearing of higher frequency
weber test
Tuning fork top of head or forehead
Should be equal in both ears
-lateralization is bad!
rinne test
air is twice as long as bone conduction (indicates conductive hearing loss, external and middle air)
acute closed angle glaucoma
medical emergency
- dilated pupil, red sclera
- pt can go blind
aging eyes
-thick cornea, astigmatism, arcus senilus, glaucoma, acuity issues, floaters, presyopia
arcus senilus
white fat deposits around rim of cornea
presbyopia
lose close vision as you age
exam far vision
snellen chart, 20 20 normal
glaucoma
Usually complain about peripheral vision
macular degeneration
loss of central vision
peritonsillar abscess
increasing difficulty with swallowing, speaking
-monitor airway, drooling is bad
mono
exudates on tonsils
-inflamed posterior nodes and spleen issues
group a strep
inflammation with white/gray tonsilar exudate
-anterior lymph nodes palpable
strep vs mono
anterior nodes-strep
posterior nodes-mono
infant skin
- lanugo, vernix caseosa
- stork bite, cradle cap, milia
- more prone to fluid loss (poor temp regulation)
psoriasis
a plaque
- silvery appearance
- usually on extensor surfaces like knuckles or elbows
- can have systemic changes like pitting nails
HARMM melanoma risk model
hx previous melanoma
- age > 50
- reg dermatologist absent
- mole change
- male gender
ABCDE for lesions
A (asymmetrical) B (borders) irregular C (color) is it changing or multicolored D (diameter) > ½ cm *head of an eraser E (elevation)- is it enlarging?
basal cell carcinoma
translucent nodule, firm border with depressed center
Normally on sun exposed areas
Very common
squamous cell carcinoma
firm scale; often face or back of hand
scaly!
actinic keratosis
pre-cancerous squamous cell
-white scale
malignant melanoma
- irregular, can be dark
- blacks can get this in nail
- can be anywhere on body
comprehensive health history
- patient identifiers
- reliability
- chief complaint
- HPI, PMH, FH, SH, ROS
Fungal
(tinea, candidiasis under skin folds) red, drainage, satellite lesions
papilledema looks like
a bright sun spot or blown up disc
pneumonia
- bronchial breath sounds, rales, crackles, dullness, egophony, whispered pectoriliquoy , inc fremitis
COPD
- dec breath sounds, dec tactile fremities, hyperresonance
pleural effusion
- dullness and asymmetry
clubbing
> 180 degrees
s1
best heard at apex
s2
best heard at base
s3
worse sound, early diastolic, best heard with bell at apex, low sound, associated with CHF in adults
s4
late diastolic, stressed heart, assoc with HTN, CAD, best heard at apex, ventricular filling sound
PMI
shouldn’t be bigger than2 cm
grading scale murmurs
- starting at 4 you can feel it, not normal, called a thrill if feel it
rubs
- high pitched scratchy sounds, pericarditis (best heard at LLSB with diaphragm)- pt will have chest pain. Will be systolic and diastolic
Arterial insufficiency
- no pulses, cool feet, shiny pale hairless, can be ruddy, get sores on toes first
venous insufficiency
- edema, pulses, thick leathery skin, brownish coloring, get sores at ankles
DVT
what are risk factors? On the pill, smoke, calf pain and swelling and redness, pregnancy
ABI
test for arterial insufficiency, can’t use with diabetics
-test for peripheral artery disease
ascites
- shifting dullness, fluid wave
gray turner
flank bruising
cullen
bruising around umbilicus
murphys
gallbladder test, have pt hold breath and they have pain with palpation
appendicitis tests
rebound pain upon release in RLQ, Rovsing (pain R when feeling L), Psoas (lay left when right leg is bent), Obturator (flex right leg and knee)
hepatitis
- jaundice, pain in RUQ, dry itchy skin, icteric sclera, darkening urine
Abdominal pain
gallbladder can be referred to shoulder, triple A can be back pain, GERD can have sore throat and cough
diverticulitis
LLQ pain
most common disability
speech impediment or other communication disorders
effects of disability
access to care is problem
changes in elderly
-incontinence not normal, weak pelvic floor, kyphosis, more prone to PNAs and atelectasis
Muscle grading system
- 0 = paralysis, no muscle contraction
- 1 = slight muscle contraction
- 2 = movement with gravity
- 3 = movement against gravity
- 4 = movement against gravity with some resistance
- 5 = movement against gravity with full resistance
kyphosis
bend over, accentuated thoracic curve
Scoliosis
have patient lean forward and you look at scapula, look at scapula and iliac crest to see if they are even
Lordosis
- accentuated lumbar curve, flatten back out against wall? pregnancy
RA
systemic, fever, rash, ulcers, younger patients, can be multiple joints
-swan neck, ulnar deviation, boutineer
DJD/osteo
wear and tear, herbertans on dip, bochards on pips
swan neck
hyperextension of the PIP with flexion of the DIP
boutineer
- flexion of PIP with hyperextension of DIP
carpal tunnel tests
- numb and tingle up to 3rd finger
phalen and tineal
phalens
put back of palms together
tineal test
tap on median nerve and get a zinger
herniated disc test
pain on straight leg raise and cross-over test
cauda equina syndrome
- pressure on cord that leads to permanent damage, ask about bowel and bladder function
Tennis elbow
lateral epicondylitis
Golfers elbow
medial epicondylitis
nerve root compression can cause
absent or depressed DTR
McMurray test
- meniscus tear, Flex the knee, place forefingers on lateral side of joint line, then with applying valgus stress and internal rotation of leg, extend the knee looking for both pop/click and pain
Apley’s Test
with knee flexed apply pressure to foot and counter pressure to knee, twist and listen for clicks.
propulsive
parkinsons
scissor
cerebral palsy
spastic
hemiplegic, CVA
waddling
toddlers, hip dislocation
steppage
neuropathy, MS
Romberg
for balance
pronator
shows balance
torn meniscus tests
apley and mcmurrary
torn ACL tests
Lachman, if tug on tibia and fibula they shouldn’t move
referred gallbadder pain
right scapular pain
rotator cuff injury
cant raise hand above shoulder
rotator cuff tests
abduct and bring down slowly the arm just stops (drop arm test), empty can movement and arm drops
ligament tear tests
lachman or drawer
NIH
don’t want a high score
first test for stroke
=pre-hosp screen
will make a decision at that point to call stroke alert (smile, droop, slurred speech, look for pronator drift) CT, vitals and glucose then NIH
Cushings
(widening pulse pressure, bradycardia, irregular breathing)
DTR
- Biceps- indirect, will have contraction
- Triceps- will have extension
- Brachioradialis- may have a slight supination and flexion of hand
- Patellar- extension of leg
- Achilles- will have plantar flexion
cerebellar function
balance, Romberg test (feet together eyes open then closed), ability to walk, 4 inch base of support, stride length 14 inches
pronator drift
muscle weakness
-hold out hands like holding a pizza
cystic breast
occur 20-30s, tender, change according to point in cycle, can be affected by chocolate and caffeine
Fibroadenoma
one round firm non-tender mass, often in teens-20s
Breast cancer
- hard irregular non-tender, occur more when older
Inflammatory breast ca
- red and inflamed, can have orange peel skin
Pagets
- breast ca around nipple, will see redness/discharge/flaking
when to check breast tissue
4th to 7th day after cycle pre-menopausal
-can do exam anytime when post-menopausal
gonorrhea
bacterial, white/yellow discharge, burning urination
herpes
hurts, small ulcers on red bases, recurrent outbreaks
genital warts, HPV
cauliflower
primary syphilis
- one painless lesion, develops into a rash covering entire body
bacterial vaginosis
(fishy smell)- inc risk with multiple partners, douching or smoking
candidiasis
cottage cheese
prostate
digital rectal exam, specific antigen, usually first present as urinary problems
testes
torsion, severe pain, one sided, cremasteric (stroke inner aspect of thigh, normal testes will move up)
vaginal complaint also checks
associated urinary symptoms (CVA tenderness)
PID can lead to
infertility
Apgar
initial then 5 min
- Assesses neurologic recovery from delivery and adaptation to extrauterine environment
low APGAR 1 min
nervous system depression, very low scores need resuscitation
low APGAR 5 min
- high risk for ongoing developmental problems
Examine older infant
- use a toy or other distractor, do exam in parents lap, gather developmental info from parent, make sure infant is fed beforehand
milia
- pin-head sized white papular lesions on nose, chin, forehead caused by sebum retained in sebaceous glands; also clear in a few weeks
Acrocyanosis
common in 1st few days of life and early infancy & into infancy- caused by exposure to cold
Mongolian spots
dark bluish or dark pigmentation over the buttocks & lower back- these tend to fade with age, but should be documented to avoid concern about bruising later.
Jaundice
physiologic occurs in half of infants, appearing 2-3 days after birth, jaundice within first 24 hours is hemolysis, jaundice longer than 2 weeks is liver or biliary disease
peds respiratory
obligatory nose breathers, nasal flaring is bad
normal newborn HR
120s
Social development in infants
- relationship between them and caregiver is critical
gross motor age
1-4 years
fine motor age
4 years
age 5-10 development
- is goal directed, concrete operational stage, learn from school and family
early adolesence
10-14, start puberty
middle adolesence
15-16
late adolesences
appear as adults
