Final Review Flashcards
A high correlation for cardiovascular disease is associated with what major physical exam findings?
xanthomas of the eye, abdomen, or fingers
What is the term for diffuse retrosternal pressure after a workout that lasts about 15 minutes and is relieved by rest?
Angina pectoris
What conditions can mimic angina/AMI?
- esophageal spasm
- gall bladder Dz (cholecystitis, cholelithiasis)
- hiatal hernia
- GERD
How does pancreatic disease radiate?
[epigastric pain] straight through to the back
What musculoskeletal conditions can mimic cardiac pain and should be reproducible by palpation or motion?
- costochondritis
- Tietze syndrome
- rib Fx
- intercostal neuralgia
Hypokyphosis/flat back is associated with ____, which is best heard at ____
- split first heart sound (S1)
- tricuspid valve area
What findings on inspection suggest cardiovascular disease, peripheral artery disease, or atherosclerosis?
- xanthomas
- splinter hemorrhages
- palatal petechial hemorrhages
- clubbed fingers
Xanthomas which are yellow/red papules seen on the abdomen, buttocks, and elbows are considered ____
eruptive
Where is the point of maximal intensity?
mitral valve area (5th ICS left MCL)
What is a split S1 sound?
slight delay between mitral/tricuspid
What is a split S2 sound?
slight delay between aortic/pulmonic
What is a midsystolic click heard with?
mitral valve prolapse (MVP)
Which inspection findings are suggestive of CVD?
A. palatal petechial hemorrhages
B. caput medusae
C. Dilated tortuous veins (vericose)
D. purple striae
palatal petechial hemorrhages
What type of murmurs are always bad?
diastolic
Match the following pressure terms: Systolic, diastolic, pulse
A. = Systolic - diastolic
B. Influenced by the aorta
C. Influenced by total peripheral vasculature resistance and HR
- Systolic Pressure = influenced by aorta
- Diastolic pressure = influenced by total peripheral vasculature resistance and HR
- pulse pressure = systolic - diastolic
What is a common sign of benign hypotension?
orthostatic (postural) / post prandial hypotension
A difference in BP of between 10-15 points from arm to arm increases the risk of ____
stroke or dying from CVD
What initial tests can you do for hypotension?
CBC for anemia , thyroid or hypothyroid, electrolytes and fasting glucose
A difference in BP of 15mm or more from arm to arm increases the risk of ____
peripheral artery disease
What is the expected normal pulse grade?
2 = expected
When palpating for bilateral dorsalis pedis pulses you cannot feel them. The feet are equally warm, the toenail capillary refill on the lower extremities is normal. What is the appropriate next step?
check posterior tibial pulse
What is peripheral atherosclerotic occlusive disease (PAOD), and what is the most common location?
- thickening of arterial wall leading to reduced lumen size
- superficial femoral a
What are the clinical manifestations of PAOD in the skin, hair and nails?
- skin pallor/cyanosis
- trophic changes (nail thickening or ulcerations)
- loss/thinning of hair on extremities
- LE muscle atrophy
What physical exam finding of PAOD is considered an emergency?
absent pulses
What test can be done for ankle brachial index (ABI)?
bicycle test
A thoracic aortic aneurysm is usually due to ____
85% atherosclerosis
What should you do if you suspect your patient has an AAA?
- refer to vascular surgeon
- modify adjusting techniques & positions
Extremity pain and paresthesias which increase with emotional disturbances, smoking, and exposure to cold (Raynaud’s) is called ____
Buerger’s Dz
What are the most common sites for a DVT?
- iliofemoral v
- popliteal v
- small vv of the calf
What are the measurements of calf circumference in males and females when concerned for unilateral ankle and calf edema?
- F: >1.2cm difference
- M: >1.5cm difference
Name 5 causes of a rounded abdomen.
- Fat
- Flatus (gas)
- Fluid (ascites)
- Fetus (pregnancy)
- Tumor
Why is the “fatty apron” sometimes lifted?
to expose intertrigous area (to look for inflammation or hernia)
What are the special procedures used for ascites?
- auscultatory percussion
- puddle sign
- shifting dullness
- fluid wave
In pregnant patients, percussion of the abdomen will present with periumbilical ____ and flank ____
dullness
tympany
What is the difference between purple striae and stretch marks?
- purple = Cushings (purple striae)
- silver = old stretch marks
What is caput medusae and what does it suggest?
periumbilical venous dilation suggestive of portal venous HTN d/t hepatic cirrhosis
What is diastasis recti and what is it associated with?
- separation of rectus abdominus mm
- multiparity, obesity, COPD, geriatrics
What is Cullen’s sign?
periumbilical bruising seen with intra-abdominal bleeding (ruptured spleen, ectopic pregnancy, or acute pancreatitis)
What is Grey-Turner’s sign?
flank bruising seen w/ acute pancreatitis
What is the normal liver size?
- MCL = 6-12cm
- MSL = 4-8cm
What can cause fever and RLQ pain?
appendicitis
What can cause fever and LLQ pain?
diverticulitis
What causes RUQ pain and positive Murphy’s sign?
cholecystitis
History of ETOH abuse, trauma, and high triglycerides is associated with ____
pancreatits
Intense abdominal, flank and/or inguinal pain, in which the patient cannot find comfort is associated with ____
renal colic/calculi or pyelonephritis
Severe lower abdominal pain radiating to the low back is suggestive of ____
AAA rupture
A 22 year old patient has a severe sore throat, fatigue and fever for 3 days. What is your diagnosis? What diagnostic test may be indicated?
Mono
CBC with diff
Your 23 year-old patient has a PMH of kidney stones 2 years ago and a UTI 1 year ago. Today she complains of cramping lower abdominal pain (4/10) 2 days duration, with vaginal bleeding. She has had significant nausea in the past few weeks. What are your differentials?
pregnant, ectopic pregnancy
What factors can cause fertility problems in males?
Environmental:
- heat exposure (clothing, hot tubs)
- radiation (cell phones)
- chemicals
Life-style:
- Drugs, ETOH, tobacco abuse
- chronic Dz & meds
- Hx undescended testes (cryptochordism)
- Hx mumps
What is the term for fixed foreskin that won’t retract?
phimosis
What is the term for retracted and fixed foreskin impeding circulation and causing swelling?
paraphimosis
What is the term for inflammation of the glans penis due to bacterial or fungal infections seen in men with poor hygiene or diabetes?
balantitis
Where is the urethral meatus located with Hypospadias?
ventral side of penis
Where is the urethral meatus located with Epispadias?
dorsal side of penis
A fibrous band in the corpus cavernosum causing deviation of an erect penis is called ____
Peyronie Dz
A prolonged painful erection which is associated with leukemia and sickle cell anemia is called ____
priapism
An oval or round, dark red erosion or ulcer of the penis with an indurated base is called ____
syphilitic chancre
A flat, moist papular growth after a syphilitic chancre resolves, which is seen on the glans, coronal sulcus or perianal region in males is called ____
condylomata lata
(lesion of secondary syphilis)
Lesions due to Human Papilloma Virus (HPV) are called ____
condylomata acuminata (genital warts)
A cluster of small vesicles with shallow, painful, non-indurated ulcers on red bases is characteristic of ____
genital herpes
A non-tender fluid mass that occupies tunica vaginalis and remains in the scrotum is called ____
hydrocele
A pregnant woman may get what type of hernia when the inguinal ring does not close up?
indirect hernia
A femoral hernia occurs below what structure?
inguinal ligament
What is prostatitis?
acute febrile condition caused by bacterial infection (STD)
What are the findings of BPH on a prostate exam?
- symmetrical enlargement
- smooth & boggy
A hard, non-tender prostate with irregular nodules is suggestive of ____
cancer of the prostate
What are the findings of infectious prostatitis?
tender, swollen, warm
Post-menopausal bleeding is a red flag for ____
endometrial cancer
Pediculosis Pubis is also known as ____. Other than the genitalia, it may also be seen in ____
- crabs
- eyebrows & lashes
Symmetric red swollen vesicles that may “weep” and then crust over or look scaly are indicative of ____
contact dermatitis
HSV (Herpes genitalis) increases the risk of ___
cervical cancer
A small solitary silvery covered papule on genitalia that erodes to a more red ulcer-type lesion, and has a firm button-like non-tender consistency on palpation is called ____
syphilitic chancre
A ____ is a benign distal urethral lesion most commonly found in postmenopausal women as a small, deep red benign tumor visible at the urethral meatus.
urethral caruncle
Describe the discharge associated with Trichomonas vaginitis.
- malodorous
- associated pruritis (itchy)
- profuse
- green/grey
- frothy yellow
Describe the discharge associated with Candida vaginitis.
- nonmalodorous
- associated pruritis (itchy)
- white
- thick & curdy
Describe the discharge associated with Bacterial vaginitis.
- malodorous (fishy/musty)
- no pruritis
- minimal to moderate amount
- grey/white
- thinner than candida discharge
Upon bimanual palpation, a hard, immobile, nodular/irregular and tender feel suggests ____
malignancies of the cervix
What are the common clinical features of PCOS?
- amenorrhea
- irregular menses
- obesity
- hirsutism
- infertility
In what condition are the ovaries 2-5 times larger than normal, with elevated estrogen and androgen (testosterone) levels which may create diabetes?
PCOD (polycystic ovary Dz)
What are the risk factors for ovarian cancer?
- 50+
- obesity
- prolonged estrogen exposure
- family Hx
What sign is associated with pelvic inflammatory disease (PID)?
Chandelier’s sign
(intense pain when moving cervix)
Multiple bilateral palpable ovarian cysts in a 20-year-old female with hirsutism is suggestive of ____
PCOS
Upon performing an inspection of your female patient’s genitalia, you note clusters of shallow, small vesicles. This is associated with ____
Herpes
What is true about the presentation of ovarian cancer?
has very few early SSx:
- abdominal bloating
- early satiety
- wt loss
- pelvic pain
- change in bowel/bladder habits
A blueish discolouration of the cervix is known as ____, which indicates ____
- Chadwicks sign
- pregnant uterus (6-8wks)
Symptomatic endometriosis would have what physical sign upon palpation?
uterus is fixed (immobile)
Which of the following is a normal finding when assessing peripheral vasculature?
A. extremities feel cold
B. swelling of the ankles
C. capillary refill <3 sec
D. absence of pulses
capillary refill <3 sec
Unilateral thin, watery, yellow-staining nipple discharge is associated with ____
benign intraductal papilloma
(serous discharge)
Bilateral thin, watery, yellow-staining nipple discharge is associated with ____
BCPs
(serous discharge)
What should be ruled out first when presenting with bloody nipple discharge?
cancer
(*referral)
What type of nipple discharge may be associated with a pituitary tumor in males or females?
milky
Purulent nipple discharge is associated with ____
breast abscess
(*referral)
Multicoloured, sticky nipple discharge is associated with ____
mammary duct ectasia, burning & itching around nipple
(ectasia = clogged duct)
What is the greatest risk factor for female breast cancer?
early puberty or late menopause
What is the greatest risk factor for male breast cancer?
late puberty
(opposite of females)
Benign fibrocystic change is also called ____, and would have what findings upon examination?
- lumpy bumpy breast
- tenderness, especially at menses
Thickening of breast skin and enlargement (dimpling) of pores is known as ____, which indicates ____
- peau d’orange
- advanced breast cancer
What breast lesion occurs in 15-30-year-olds, is smooth, mobile, round (marble-like), and is the most common breast lesion?
fibroadenoma
What breast lesion occurs in 30-55-year-olds, is round, mobile, and smooth, and is tender during menses?
benign fibrocystic breast
Irregular, star-shaped, hard, fixed breast lesions with irregular contour upon palpation is associated with ____
breast cancer
Ductal carcinoma in situ (DCIS) is (invasive/non-invasive)
non-invasive
What is the most common type of breast cancer? What parts of the breast are affected?
- invasive ductal carcinoma (IDC)
- starts in milk duct and breaks through wall growing into fatty tissue
What parts of the breast are affected by invasive lobular carcinoma?
starts in milk glands and is able to metastasize
(hard to detect on mammograms)
What are the findings of inflammatory breast cancer?
(uncommon)
- no single lump/tumor
- unilateral: red, warm, itchy, peau d’orange
- often mistaken as mastitis
- may not show on mammogram
- highly metastatic
What parts of the breast are affected by Paget disease of the nipple? How does this appear?
- starts in breast ducts, spreads to skin of nipple areola
- skin appears crusty, red, oozing/bleeding; may burn & itch
What types of breast cancer is Paget disease of the nipple associated with?
DCIS or IDC
What type of breast discharge can be seen bilaterally and be a side effect of birth control?
serous
Describe the breast discharge seen with male pituitary disorder.
bilateral milky
The absence of menses for at least 3 months following established menarche is called ____
Amenorrhea (secondary)
Menstrual interval exceeding 37 days between periods is called ____
Oligomenorrhea
Menstrual interval of less than 19 days is called ____
Polymenorrhea
