Gen Diagnosis Flashcards
NBCE Part 2
Classic Sequence of Case History
CC, PI, PMH, FH, Social Hx, ROS
Which is not considered a quality of pain?
a. intermittent
b. sharp
c. deep
d. burning
a. intermittent (timing or frequency of pain)
Pneumonic for attributes of pain
OPQRST Onset Provocation Quality Radiation Severity Timing
Difference between a sign and a symptom
Symptoms= abnormalities perceived by pt Sign= abnormalities perceived by Dr.
What provides the most information regarding the pt?
a. inspection
b. palpation
c. percussion
d. auscultation
a. inspection
(it enables pt to seek physical “signs.”)
It also enables Dr. to observe and recognize a wide variety of conditions based on his knowledge and experience.
BP cuff size determination for accurate BP (correct ratios)
Correct ratio of length of bladder in cuff to circumference of the extremity is 80-100%
(<80% will give falsely elevated BP)
WIDTH of bladder=40% of length
What specific effect does an increase in one degree of temperature have on heart rate?
increases heart rate 10 beats/min
The organ/tissue that is responsible for most body heat (skin, heart, liver, brain, intestines)
Liver
body heat is produced from chemical reactions; most cellular metabolism occurs in liver = max temperature gradient
Ideal body weight calculation (estimate) Female average build
100 pounds for first 5 feet
+5 pounds for each additional inch
+2 pounds for each pregnancy
Subtract/ or add 10% of total to adjust for small/ large frame
Which type of mandibular motion would be palpated in a normal TMJ?
IASS= Inferior, anterior, smooth, symmetrical
TMJ biomechanics can be determined by palpation of mandibular motion anterior to tragus.
Normal motion= smooth, symmetric, inferior to anterior.
Pain on palpation of the supraorbital notch indicates:
A normal finding (elicits pain from emerging
supraorbital nerve)
Used by anesthetists to arouse moribund p[t
Which muscle pulls the condyloid process forward?
External pterygoid
Clicking and crepitation of the jaw occurs with a spasm of which muscle?
External pterygoid
What is the last fontanelle to close on an infant, and when does it close?
Anterior fontanelle persists until 18-24 mo.
Other fontanelles typically close by 2 months of age. Delayed closures: ricketts, hypothyroidism, increase ICP, and some bone disorders
Light palpation of the cranium reveals respiratory pulsations of what rate?
10-14 cycles/min.
Brain & spinal cord normally exhibit a slow, worm-like pulsation. Represents a coiling/uncoiling of the hemispheres and a longitudinal movement of the spinal cord w/i the spinal dura. It is result of the pull of the dural membranes, flow of CSF, & motility of the CNS
What non-neurologial condition is a nodding movement of the head associated with?
Aortic Insufficiency
(causes high jugular regurgitant waves
which may result in head nodding that is synchronized with the arterial pulse)
Common test for distance visual acuity
Snellen chart (test of macular function)
Ishihara color Charts are used for:
testing colorblindness (red/green)
Which auditory acuity test compares air conduction to bone conduction?
Rinne test compares air conduction to bone conduction (normal= air is longer than bone.)
Sensorimotor loss- air is also longer than
bone
Conductive loss- sound is heard longer
through the bone than air.
Normal tympanic membrane appearance
Translucent, pearly gray membrane at end of ear canal.
The handle of malleus appears in center.
A bright triangular cone of light reflects on this membrane (called the “light reflex”)
What does transillumination of the skull reveal?
Method of examination by passage of light through tissues or a body cavity.
Used to identify:
Tissue density, fluid in sinuses,
fluid inside the skull, fluid outside the skull,
Three Muscles of Mastication
Masseter
Pterygoid
Temporalis
(insert on the mandible and affect chewing)
Number of teeth an adult has in full dentition
32 permanent teeth
(4 incisors, 2 canines, 4 premolars, 6 molars including wisdom teeth, in each jaw)
Children: 10 decidous teeth (6 mo-24 mo)
A bluish black line on the gum margin suggests:
Lead poisoning [adults]
(20% of adult patients with lead poisoning)
But uncommon to find in child w/lead poison
Whitish pseudomembrane on buccal mucosa, resembling milk curd, when peeled off leaves a raw erythematous bleeding area suggests:
Candidiasis (moniliasis; thrush)
Common in immunosuppressed/ chronically ill, especially HIV/ AIDS
Purpose and normal findings of a trachial tug
To determine if trachea is fixed in the mediastinum. FIXATION IS ABNORMAL= Neoplasm, TB, or aneurysm.
Normal findings:
1-2 cm of upward motion
Uncomfortable to pt
Vascular pulsations
Fay’s sign
Digital compression of the carotid bulb may cause pain to spread in the distal branches of the external jaw, ear or temple.
Indicative of: carotid arteritis
Wry neck
Examination of the wry neck will reveal spasm of:
Sternocleidomastoid
Scalenes
Upper trapezius
Which muscle is not spasmodic in torticollis?
a. sternocleidomastoid
b. scalenes
c. platysma
d. trapezius
c platysma
Which exam procedure best identifies restriction of air flow in tracheobronchial tree? a. inspection b. palpitation c. percussion d auscultation
d. auscultation Breath sounds: Normal- loud and high-pitched Best heard over the manubrium Expiratory phase is longer than inspiration, with a definite pause between the phases.
Normal respiratory rate
12-20/ min.
Ratio of respirations: heartbeat= 1 : 4
Purpose of percussion of the thorax
Determine Air - tissue ratio
Percussion is transmitted to underlying tissue & then reflected to examiners tactile and auditory senses. (depends on air:tissue)
Normal= resonant, high amplitude, low-pitched note.
DULLNESS= air tissue is filled with fluid
Percussion of posterior lung field will normally reveal:
Resonance (normal)
Abnormal: Hyperresonance is seen in destruction of the alveoli
Which examination procedures are necessary to determine tactile fremitus?
a. inspection & breath sounds
b. palpation & voice sounds
c. percussions & voice sounds
d. auscultation & breath sounds
b. palpation & voice sounds
Pt’s voice causes vibrations in the bronchial air column called “vocal fremitus.”
When palpated by Dr becomes “tactile” frem.
Fremitus determines density of lung tissue:
Vocal Decreased/ absent= airway blockage
Vocal Increased= consolidation/ inflammed
Purpose of palpation of the thorax during respiration
Determine respiratory excursion (involves both inspection and palpation.)
Should be symmetrical.
Asymmetrical excursion= lesion on lagging side of the chest wall, pleura, or upper lobe of the lung.
Succussion splash
Normal Abdominal sound: (audible splash sound caused by combination of air and fluid in stomach.)
Abnormal if REALLY loud: increased fluid indicating obstruction in the stomach/ gut, or gastric dilatation.
Cause of abdominal Murmur
Turbulent blood flow in a dilated, constricted, or tortuous artery.
Cause of Peristaltic sounds
intestinal activity
What does an abdominal Friction Rub during respiration indicate?
Peritoneal inflammation (peritonitis)
Define causes the following Abd. sounds:
Succussion splash
Peristaltic sounds
Murmur
Friction rub (during respiration)
Succussion splash: combination of air & fluid
in normal stomach.
Peristaltic sounds: normal intestinal activity
Murmur: turbulent blood flow in dilated,
constricted, or tortuous artery
Friction rub: peritoneal inflammation
(peritonits)
A high-pitched continuous murmur in the RUQ abdomen (Cruveilhier-Baumgarten murmur) is diagnostic of:
Portal Hypertension
The murmur becomes louder during the forced expiratory phase of the Valsalva maneuver
Percussion of the umbilicus that illicits hyperresonance is diagnostic of:
Ascites
(severe ascites causes the gas-filled loops of bowel to float to the surface which results in hyperresonance to periumbilical percussion)
The kidney punch test will identify all of the following except?
a. musculoskeletal disease
b. intrinsic renal disease
c. acute pyelonephritis
d. renal abcess
e. perinephritis
b. intrinsic renal disease (will not be painful
to a kidney punch)
The blow of the punch must be started 6” above the kidney. A stronger punch will cause pain in a normal kidney. To differentiate musculoskeletal dz from renal lesions the “thumb pressure test” is diagnostic. (slowly releasing the thumb pressure on the kidney will be painful in musculoskeletal dz but not in renal disease.)
Which structure, in its normal state, cannot be inspected, palpated, percussed, or auscultated?
(liver, kidney, pancreas, spleen, abd. aorta)
Pancreas
(How is the Pancreas like a faithless woman? B/c all day long it lies in the arms of the duodenum and at night it gives its tail to the spleen.)
Tenderness and rigidity during palpation of LUQ abd. would indicate all except?
a. pancreas
b. ruptured spleen
c. gastric ulcer
d. acute perinephritis
e. acute cholecystitis
e. acute cholecystitis (right side)
Differential diagnosis of LUQ AP would include: pancreas, spleen, stomach, and
L kidney.
RUQ AP- gall bladder (acute cholecystitis)
During a routine rectal exam, a RIGHT-handed examiner may fail to detect a small lesion in which quadrant! (clock times)
12 to 3 o’clock
(Imposs to examine the entire circumference of the rectal wall due to limitation in wrist ROM. Proper procedure to complete wrist supination is for examiner to turn his back towards pt which will allow complete examination of this quadrant.)
Normal size of a prostate
Young adult- walnut
Older male w/ enlarged prostate- lemon
Which structure is normally palpated posteriorly on rectal exam?
a. prostate
b. pyriformis
c. bladder
d. seminal vesicles
b. pyriformis muscle (POSTERIOR)
* Prostate, bladder, & seminal vesicles are all palpated ANTERIOR.
Most reliable sign of puberty in male
Testicular growth (first clinical indication of onset of male puberty) W/i the next 2 years there is an increase in penile length and growth of pubic hair. Followed by: increase in long bone growth, muscle mass, prostate size and enlargement of larynx.
An underdeveloped scrotum suggests:
An imperfect descent of the testes known as “cryptorchism.”
Normally testes descend during the 8th fetal month. Cryptorchism occurs in 5% of male infants. Undescended testicles will typically descend during the following year. If they remain undescended, the defect will lead to testicular atrophy & increased risk of testicular cancer. Spermatogenesis cannot occur at the temperature w/i abd. cavity
Hernia definition and most common type
Protrusion of peritoneum through a weak point in the abdominal wall.
MOST COMMON: “INDIRECT” hernia which descends through the inguinal canal into the scrotum.
Less common: “direct” hernia which does not
enter the scrotum
Femoral hernia: occurs at the fossa ovalis
where the fem. artery exits the abd.
Ventral hernia: protrudes into anterior abd
wall.
Umbilical hernia: rare, occurs at umbilicus
Most common type of HA
Muscle TENSION HA
Characterized by inability to relax the muscles of the neck and head.
“Classic” Migraine symptoms
Unilateral HA
Preceded by aura (flashing lights 1/2 hour of
before pain.)
N/V with severe pain
Last for 2-3 days
Worsens when taking BCPs
“Common” migraine- No pre-HA aura
“Hemiplegic” & Opthalmoplegic- severe form
“Basilar artery” migraine- more severe neuro symptoms including tinnitus, hearing loss, diplopia, dysarthria, ataxia, & motor symptoms
Cluster Headache Symptoms
Occurs in paroxysms, bursts, or “clusters”
Severe, burning, UNILATERAL
Nocturnal and SHORT duration
Pain so severe that pt feels better with
movement than lying down.
No aura
Predominantly occurs in male smokers
Classic Triad of Intracranial Pressure
symptoms
- HA
- Vomiting
- Papilledema
(other symptoms of IC tumors may include:
sz, mental confusion, hyper-reflexia)
Horner’s Syndrome
definition/ symptom triad
Interruption of the sympathetic nerves to the eye results in Horner's Syndrome: 1. Miosis 2. Anhydrosis 3. Ptosis (Some sources also include enopthalmos.)
Cotton wool spots on the retina suggest:
Ischemic infarct of the nerve fiber
Caused by occlusions of the arterioles and capillaries leading to infarcts of the nerve fiber layer of the retina.
