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physical exam II > final pt 1 > Flashcards

final pt 1 Flashcards

1
Q

what does BP difference of 10-15 in each arm indicate

A
  • subclavian steal sydrome

- aortic dissection

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2
Q

what does HTN in UE and low BP in LE indicate

A
  • coarctation of the aorta

- occlusive aortic disease

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3
Q

what is a normal difference in BP in the UE

A
  • 5-10 mmhg
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4
Q

what effect does a cuff that is too narrow have

A
  • BP that is too high
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5
Q

what effect does a cuff have that is too wide

A
  • BP low in small arm

- BP high in a large arm

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6
Q

hyperopia

A
  • farsightedness
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7
Q

myopia

A
  • nearsightedness
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8
Q

presbyopia

A
  • aging vision
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9
Q

pinguecula

A
  • harmless yellowish triangular nodule in conjunctiva next to iris
  • d/t aging
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10
Q

xanthelasma

A
  • slightly raised, yellow well demarcated plaque
  • on nasal portion of eyelid
  • common with lipid disorders
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11
Q

chalazion

A
  • blocked meibomian gland

- points inside eyelid

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12
Q

episcleritis

A
  • inflammation of episcleral vessels
  • RA
  • Sjorgen’s
  • herpes zoster
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13
Q

dacryocystitis

A
  • inflammation of lacrimal sac
  • swelling btwn lower eyelid and nose
  • tearing prominent
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14
Q

arcus senilus

A
  • corneal acrus
  • thin grey circle close to edge of cornea
  • normal aging
  • hyperlipoproteinemia
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15
Q

kayser- fleischer ring

A
  • Cu deposition
  • golden brown ring in periphery of cornea
  • mutation in chromosome 13 (wilsons)
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16
Q

corneal scar

A
  • greyish white opacity in cornea

- secondary to injury or inflammation

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17
Q

cataracts

A
  • opacity of lens through pupil
  • old age
  • smoking
  • DM
  • steroids
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18
Q

pterygium

A
  • triangular thickening of bulbar conjunctiva

- grows inwards towards cornea

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19
Q

peripheral cataract

A
  • spoke like shadows
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20
Q

CN III paralysis

A
  • dilated pupil fixed
  • ptosis if eyelid
  • lat deviation
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21
Q

horner’s syndrome

A
  • affected pupil is small but reactive to light
  • usu with ptosis of eyelid
  • iris may be lighter
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22
Q

argyll robertson pupil

A
  • small irreg pupils
  • accommodate but dont react to light
  • CNS syphilis
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23
Q

hyphema

A
  • blood in ant chamber
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24
Q

hypopyon

A

pus in ant chamber

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25
Q

lagopthalmos

A
  • inability to fully close eyelid

- CN VII

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26
Q

coloboma

A
  • cat eye
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27
Q

keratoconus

A
  • thinning disorder of cornea
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28
Q

iritis

A
  • inflamm of iris

- marked photosensitivity

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29
Q

mydriasis

A
  • dilation of pupil
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30
Q

sensorineural hearing loss

A
  • problem in inner ear, nerve or connection to brain

- trouble understanding speech

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31
Q

conductive hearing loss

A
  • problem in middle/ external hear

- noise may help hearing

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32
Q

emergent eye complaint

A
  • requires care in one hour
  • chem splash/ burn
  • sudden painless vision loss
  • acute ocular trauma
  • penetrating eye injury
  • severe pain with n/v and/or halos
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33
Q

urgent eye complaint

A
  • requires care within 4-6 hours
  • FB
  • corneal abrasion
  • sudden onset double vision
  • acute onset flashes/ floaters
  • sudden onset red eye +/- pain or change in vision
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34
Q

semi-urgent eye complaint

A
  • requires care within 24 hours
  • painful bump on eyelid
  • itchy eyes
  • mild eye pain with no change in vision over 2-3 days
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35
Q

what is the normal pH of the eye

A
  • 7.0-7.3
36
Q

what type of chemical burns are worse to the eye

A
  • alkali burns

- irrigate for at LEAST 30 min

37
Q

why do you not repeatedly use anesthetic in the eye

A
  • can cause cornea to melt

- permanent damage

38
Q

differential for acute onset flashes and floaters

A
  • retinal detachment
  • posterior vitreous detachment
  • migraine
39
Q

retinal detachment

A
  • flashes and floaters -> veil or shade pulled over visual field
  • high risk if assoc with trauma, high myopia, younger pt, recent surgery
  • requires same day consult
40
Q

posterior vitreous detachment

A
  • flashes -> floaters -> no loss of vision and no peripheral field loss
  • usu in pts > 50
  • normal in aging d/t vitreous fluid shrinking
41
Q

what is the most common cause of conjunctivitis

A
  • viral
42
Q

viral conjunctivitis

A
  • bilat
  • mild photophobia
  • tearing
  • injection
  • often assoc with recent URTI
  • self limited 7-10 days
  • no abx needed
43
Q

epidemic keratoconjunctivitis

A
  • highly contagious viral conjunctivitis
  • photophobia
  • tearing
  • severe red eye
  • pseudomembrane
  • subepithelial infiltrates
44
Q

bacterial conjunctivitis

A
  • injection
  • purulent d/c
  • matting of lashes
  • photophobia
  • blurred vision
  • tx with broad spectrum abx 7-10 d
45
Q

CN I

A
  • olfactory
  • determine patency
  • occlude one nostril
  • with eyes close ID smell
46
Q

CN II

A
  • optic n
  • visual acuity
  • visual fields
  • fundoscopy
47
Q

CN III, IV, VI

A
  • PERRL
  • RAPD
  • EOM
  • cover/ uncover
  • convergence
  • ptosis
  • near reaction
  • nystagmus
48
Q

CN V

A
  • trigeminal
  • motor -> muscles of mastication
  • sensory to face
  • corneal reflex
49
Q

CN VII

A
  • facial symmetry
  • facial expressions
  • sensory to anterior 2/3 of tongue
50
Q

CN VIII

A
  • gross hearing

- weber and rinne

51
Q

CN IX and X

A
  • glossopharygneal and vagus
  • symmetric rise of uvula
  • gag reflex
  • hoarseness
  • check swallowing
  • taste posterior 1/3 of tongue
52
Q

CN XI

A
  • spinal accessory
  • shoulder shrug
  • head turned against resistance
53
Q

CN XII

A
  • hypoglossal
  • observe tongue for atrophy or fasciculations
  • stick tongue out
  • push tongue into cheek
54
Q

tests for discriminative sensations

A
  • stereognosis
  • graphesthesia
  • 2 point discrimination
  • point localization
  • extinction
55
Q

stereognosis

A
  • ID common object in hand
56
Q

graphesthesia

A
  • recognize number drawn on palm
57
Q

2 point discrimination

A
  • pt touched with 2 points
  • distance btwn 2 points measured when the pt can feel them
  • normal in fingers: 2-5 mm
  • normal on palm: 8-15 mm
58
Q

point localization

A
  • touch pt on skin

- have them open eyes and ID area touched

59
Q

extinction

A
  • touch same point on each side of body at same time

- ask pt to ID both spots

60
Q

upper motor neuron lesions

A
  • hypertonia
  • hyperreflexia
  • no fasciculations
  • no atrophy
    • babinski
61
Q

lower motor neuron lesions

A
  • hypotonia
  • hyporeflexia
  • fasciculations
  • atrophy
  • normal plantar reflex
62
Q

guiding questions of the neuro exam

A
  • is mental status intact
  • findings symmetric
  • where is lesion- central, peripheral, or both
63
Q

nociceptive pain

A
  • somatic pain
  • tissue damage to skin, MSK system, or viscera
  • sensory NS in tact
  • acute or chronic
  • mediated by a-delta and c- fibers
  • sensitized by inflam mediators, psych processes, and neurotransmitters
64
Q

neuropathic pain

A
  • lesion or disease affecting somatosensory system
  • becomes indep of inciting injury
  • burning, shock like
  • induce neuronal plasticity -> pain that persists beyond yealing
65
Q

central sensitization

A
  • CNS processes sensation -> amplification of pain signals

- lower pain threshold to non-painful stimulus

66
Q

psychogenic pain

A
  • based on psych cond, personality, cultural norms, social support
67
Q

idiopathic pain

A
  • pain without identifiable cause
68
Q

pain assessment tools

A
  • numeric rating 0-10

- wong baker faces: kids, language barrier, cognitive impairment

69
Q

anatomic landmarks for LP

A
  • from out to in
  • spinous process
  • supraspinal ligament
  • interspinal ligament
  • ligamentum flavum -> “pop”
  • epidural space
  • dura mater
  • arachnoid mater
70
Q

location of LP

A
  • L3-L4
  • L4- L5
  • can be in lat recumbent or upright
71
Q

normal opening pressure

A
  • 18- 20 mm H2O
72
Q

WBCs on LP

A
  • > 5 cells - possible infection
  • bacterial infx: increased neutrophils
  • viral infx: increased lymphocytes
73
Q

RBCs on LP

A
  • < 10 cells is normal

- traumatic tap can be r/o by xanthochromia

74
Q

glucose on LP

A
  • 50-80 is normal
  • low: bacterial meningitis, sarcoid, syphilis, SAH
  • viral: variable
  • serum hyperglycemia may mask depressed CSF glucose
75
Q

protein on LP

A
  • 15-45 is normal

- elevated with infections

76
Q

common GN diplococci on LP

A
  • n meningitidis
77
Q

common GN bacilli on LP

A
  • h flu
78
Q

common GP oraganisms on LP

A
  • s pneumo
  • other strep spp
  • staph
79
Q

xanthochromia on LP

A
  • prod of RBC lysis
  • yellow orange discoloration
  • helps differentiate from traumatic tap
80
Q

diagnostic indications for LP

A
  • CNS infx
  • inflam process
  • suspected spont SAH
  • unexplained seizure
  • certain malignancy or paraneoplastic syndrome
81
Q

therapeutic indications for LP

A
  • relieve sx from increased ICP

- deliver meds

82
Q

absolute C/I to LP

A
  • local skin infx
  • intracranial or SC mass lesion
  • raising ICP
  • uncontrolled bleeding diathesis or coagulopathy
  • coumadin
83
Q

relative C/I to LP

A
  • raised ICP with known cerebral herniation
  • SC deformities
  • body deformities at puncture site
  • suspected lumbar epidural abscess
  • thrombocytopenia
  • elevated INR
84
Q

tube sequencing for LP

A
  • 1: cell count and diff
  • 2: glucose and protein
  • 3: culture and stain
  • 4: cell count and dif
85
Q

most common complication s/p LP

A
  • HA
  • d/t leak in dural layer
  • appears 1-3 days after procedure
  • can last up to months
  • put in recumbent position for 1 hour and hydrate to prevent
86
Q

grading of DTR

A
  • 0: no reflex
  • 1+: diminished
  • 2+: normal
  • 3+: brisk (can be normal)
  • 4+: hyperactive, brisk with clonus
  • if hyperreflexia present do babinski

physical exam II (5 decks)

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