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Chiro Essentials General Diagnosis > General > Flashcards

General Flashcards

1
Q

History of the Presenting Complaint

O, M, P, P, P, Q, R, S, S, T, A

A 
Onset
Mechanism of injury
Previous care: Did you have any treatment for this? If so, what? Was it helpful?
Provocative factors
Palliative factors
Quality
Radiation
Site
Severity: how does this complaint affect your daily living activities
Timing
Associated symptoms
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2
Q

Past medical history

S, L, I, M, H, D

A

Serious Illness: What and when
Last physical exam: When? Anything noteworthy?
Injuries/accidents/trauma: what and when?
Medications: What, how much, for what?
Hospitalizations/surgeries: When, why?
Diagnostic imaging: X-rays or images taken recently? What did they show

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3
Q

Family and social history:

M, C, F, D, E, A (CAGE), R, S, H, O, T, S

A 
Marital status
Children
Family history
Diet
Exercise
Alcohol: cut down? annoyed by criticism of your drinking? Guilty about your drinking? Early morning eye opener drink?
Recreational drugs
Stress: 0-10 and what
Hobbies
Occupation
Tobacco use
Sleep
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4
Q

ROS

C, A, N, G, R, EENT, G, P, N, C, H, M, E

A

Constitutional: fatigue, weight loss, weight gain, fever
Allergy/immunological: Allergic? Sick easily/frequently? Take long to recover?
Neck: Problems in neck, swollen glands, neck stifness
GI: Nausea, vomiting, abdominal pain, diarrhea, constipaion? Colour of stool? Blood in stool? Jaundice? Black tarry stool?
Respiratory: Cough, SOB, chest pain?
EENT: eyesight, hearing, balance, problems swallowing
Genitourinary: problems with urine? Discharge from private parts? Wake up to pee? Dribble?
Psychological: sad? loss of interest? describe your mood
Integumentary: problems with skin? Itching, dark spots, sores?
Neurological: headaches? Dizziness? Lightheaded? Weakness? Numbness or tingling? Falls?
Cardiovascular: chest pain palpitations or ankle swelling
Hematological/lymphatic: Easy bruising? Lumps in armpit or groin?
Musculoskeletal: any pan in your muscle? Soreness? Stiffness? Cramps?
Endocrine: Increased thirst or intolerance to heat or cold? Any change in hat or shoe size?

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5
Q

Patient Agenda:

C, R, I, M, E, S

A

Concern: what bothers you most about this
Reason for visit
Ideas: What do you think is the cause of your problem?
Meaning to illness: if your body was trying to send you a message through this illness, what do you think your body would be trying to tell you?
Expectations: What would you like me to do for you today?
Support: what support do you have at home? Family? Friends? Finances? Faith?

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6
Q

What age of people get DJD? Disc herniations? Strain/sprain?

A

Old
Middle aged
Young

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7
Q

Do males or females more commonly get: Osteoporosis? AAA? SLE/RA? BPH?

A

Females
Males
Females
Males only

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8
Q

T/F: Obesity does not contribute to DJD, diabetes, hypertension?

A

False it so does

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9
Q

Which ethnic background is more likely to get sickle cell disease? Tay Sachs?

A

African

Ashkenazi Jews

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10
Q

Acute is how many months? Chronic? Which has a better prognosis?

A

<3 months
>6 months
Acute

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11
Q

What type of injury is likely to occur with a rear end collision? Rotation and extension or lateral bend and extension?

A

Whiplash

Facet problem

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12
Q

What type of injury is suspected if flexion aggravates pain? Lateral bend and extension?

A

Disc lesion

Facet problem

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13
Q

What type of injury is suspected if rest relieves pain? Not better with rest or NSAIDs?

A

Strain/sprain

Bone cancer

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14
Q

Burning is associated with what type of pathology? Deep dull ache?

A

Radiculopathy

Bone or muscle

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15
Q

Radiation pattern pathology for dermatomal? Loin to groin? Chest to left arm?

A

Radiculopathy
Kidney stones
MI

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16
Q

Pain worse at night pathologies?

A

Bone cancer or osteomyelitis

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17
Q

T/F Hyperflexion and hyperextension can cause vertebral fractures?

A

True

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18
Q

Lipitor side effect? Diuretics?

A

Muscle ache

Muscle cramp

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19
Q

Immunizations may be linked with what syndrome?

A

GBS

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20
Q

Foods rich in omega 6 make OA or RA worse?

A

RA

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21
Q

T/F alcohol abuse can lead to AVN, pancreatitis, psychological stress?

A

T

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22
Q

IV drug use can lead to what bone pathology?

A

Osteomyelitis

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23
Q

What drug can lead to an MI in a young adult?

A

Cocaine

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24
Q

Asbestosis = ??

A

mesothelioma

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25
Miners are prone to getting?
Silicosis
26
Tobacco use increases your chance of getting which cancers?
Lung, bladder, esophageal cancers
27
Clay coloured stool is suggestive of what condition?
Pancreatic cancer
28
Blood in sputum is suggestive of?
TB or lung cancer
29
List the pathology associated with: Silvery plaques Butterfly rash Red shin bumps
Psoriasi SLE Sacroidosis
30
Are muscle cramps associated with hypo or hyperparathyroidism?
Hypoparathyroidism
31
Is heat intolerance associated with hypo or hyperparathyroidism?
Hyperparathyroidism
32
Should you refer out to the hospital if BP <90/60, respiration >28/min, temperature >102oF, pulse is greater >120/min for some or all of these?
Yeppers get all those people to the ER
33
Normal temperatures? How does it differ if taking a rectal or axillary temperature?
98.4-99.5oF | Rectal 0.5-1oF higher and axillary is lower than oral
34
Normal pulse? Tachycardia? Brachycardia?
60-100 >100 <60
35
Does hyperparathyroidism cause tachycardia or bradycardia?
Tachycardia
36
Does sever anemia cause tachycardia or bradycardia?
Tachycardia
37
Does increased intracranial pressure cause tachycardia or bradycardia?
Bradycardia
38
Normal respiratory rate? Tachypnea? Bradypnea?
14-20 >20/min <14/min
39
Does CHF cause tachypnea or bradypnea?
Tachypnea
40
Does diabetic ketoacidosis cause tachypnea or bradypnea?
Tachypnea
41
Does emphysema cause tachypnea or bradypnea?
Tachypnea
42
Does sarcoidosis cause tachypnea or bradypnea?
Tachypnea
43
Does a drug reaction cause tachypnea or bradypnea?
Bradypnea
44
Does brain stem compression cause tachypnea or bradypnea?
Bradypnea
45
How do you diagnose hypertension?
3 readings where it is >140/90
46
What would blood pressure be in a patient with shock?
<90/60
47
How do you calculate pulse pressure? | What is normal pulse presure?
Systolic BP - Diastolic BP | 30-40 mmHg
48
Does Cushing's cause increased or decreased BP?
Increased
49
Does Conn's cause increased or decreased BP?
Increased
50
Does pheochromocytoma cause increased or decreased BP?
Increased
51
Does Addison's cause increased or decreased BP?
Decreased
52
Does shock cause increased or decreased BP?
Decreased
53
Body Mass Index classifications according to the WHO?
``` <18.5 Underweight 18.5-24.9 Normal 25.0-29.9 Overweight 30.0-34.9 Class I obesity 35-39.9 Class II Obesity >40 Class III Obesity ```
54
Snellen chart for farsightednes or nearsightedness? Rosenbaum?
Farsightedness | Nearsightedness
55
What tuning fork do you use for Weber and Rinne?
512 Hz
56
If the AC is 2x as long as BC is this normal or pathologicl? If AC/BC are both decreased in one ear it is what type of deafness? If BC >AC with Rinne is means?
Normal Nerve conduction Serous otitis Media
57
Bilateral dilated pupils can be caused by? Bilateral pinpoint pupils? Bilateral papilledema?
Cocaine, barbiturate, amphetamine abuse heroin Raised ICP, brain tumor
58
Blue sclera in infant with fractures can be caused by?
Osteogenesis imperfecta
59
Blurred margin of the macula or pigmentation?
Macular degeneration
60
Copper or silver wiring of retinal arterioles can be indicative of?
Hypertensive retinopathy
61
Cupped optic disc can be indicative of?
Chronic glaucoma
62
Macroglossia in infants can be caused by hypo or hyprethyroidism? Lid lag?
Hypothryoidism | Hyperthyroidism
63
Exopthalmosis can be indicative of?
Hyperthyroidism or an orbital tumor
64
Flame hemorrhages and microaneurysms are seen in?
Diabetic retinopathy
65
Foul purulent unilateral nasal discharge is caused by?
Sinusitis or foreign body in the nose
66
goiter with brittle dry coarse hair? | Goiter with exophthalmos or tachycardia?
Myxedema (hypothyroidism) | Graves disease
67
Arcus senilis is what around the cornea? Caused by?
Gray ring | Hyperlipidemia
68
Hydrocephalus?
Lard head in child with open fontanelles
69
Loss of red pupil light reflex can be caused by?
cataracts or neuroblastoma
70
Loss of outer third of eyebrow can be caused by?
Leprosy, hypothyroidism
71
Midline neck mass that moves with tongue? | Midline bony mass in the hard palate?
Thyroglossal cyst | Torus palatinus
72
Mucopurulent discharge from the ear is caused by?
Otitis media
73
If a patient has nasal septum perforation you should suspect?
Cocaine abuse
74
Periorbital edema can be caused by?
Cellulitis, cavernous sinus thrombosis
75
``` Painful boil on the margin of the eyelid is? Painful red eye with purulent discharge? Painful eye with circumcorneal redness? Painful red eye with tense eyeball? Painless boil on inside of eyelid? ```
``` External stye (hordeolum) Conjunctivitis Iritis Acute glaucoma Internal style (chalazion) ```
76
Pain pulling ear up and backwards is indicative of?
Otitis externa
77
Pale swollen bluish nasal mucosae is indicative of?
Chronic allergie
78
Psotis billaterally could be? Unilaterally?
Myasthenia gravis, Lambert Eaton syndrome | Horner's syndrome
79
Puffy eyelids esp in the AM is indicative of?
Renal dysfunction
80
If the pupil accommodates but doesn't react to light? If pupil dilates and reacts poorly to light? If pupil is small and constricted (miosis)
Argyll Robertson pupil (3o syphilis) Adie's pupil Horner's syndrome
81
A red bulging tympanic membrane is indicative of? | A retracted tympanic membrane?
Otitis media | Eustachian tube blockage
82
Scales on eyebrows are indicative of? | Swollen itching eyelids?
Seborrheic dermatitis | Blepharitis
83
Tophus on the helix of the ear is indicative of?
Chronic gout
84
Beef red tongue is due to what deficiency? Magenta tongue? Pale tongue?
B12 Riboflavin Iron
85
Triangular fleshy growth in the medial side of sclera?
Pterygium
86
Turned in lower eye lid? Out?
Entropion | Ectropion
87
Unilateral/swollen tonsil with sore throat is indicative of?
Peritonsillar abscess
88
Yellow thickening of bulbar conjunctiva is known as?
Pinguecula
89
Meniere's disease
Vertigo ith hearing loss and tinnitus
90
Xerophthalmia is caused by what deficiency?
Vitamin A
91
Yellow sclera can be indicative of?
Jaundice (icterus) or carotenemia
92
Yellow plaque in upper medial eyelid is called? Caused by?
Xanthelasma | Hyperlipidemia
93
Acute glaucoma: Is? Presentation? Refer to who?
Sudden increase in intra-ocular pressure seen with narrow angle between the iris and cornea which obstructs flow of aqueous humor into canal of Schlemm/sclera venous sinus Painful red eye and hard eyeball, vision hazy in beginning Hospital
94
Adie's pupil/tonic pupil: Is? Presentation? Refer to who?
Benign condition where one pupil is dilated and reacts poorly to light Young women Neurologist
95
Argyll Robertson pupil: Is from what diseases? Presentation? Refer to who?
3o syphillis or MS One pupil is small; react poorly to light but well to accommodation; CDRL will be + Neurologist
96
Blepharitis: Is from? Presentation? Refer to who?
Inflammed eyelids from staph infection, allergies, or seborrhea Swollen itching and tender eyelids Dermatologist
97
Cavernous Sinus thrombosis: Is? Presentation? Refer to who?
Clot formation in cavernous sinus in brain from spread of infection from the face Periorbital edema, diplopia due to damaged CN III, IV/VI (pass through cavernous sinus) Hospital for antibiotics
98
Chalazion: Is? Presentation? Refer to who?
Benign granulomatous lesion in tarsl (meibomian) gland of eyelid Painless swelling on inside of eyelid; may become painful/infected Ohthalmologist
99
Chronic glaucoma: Is? Presentation? Refer to who?
Gradual increase in intra-ocular pressure due to excessive production of aqueous humor or gradual obstruction of canal of Schlemm (sclera venous sinus) Gradual vision loss of periphery, increased cupping of optic disc Ophthalmologist
100
Conjunctivitis: Is? Presentation? Refer to who?
Most commonly a viral infection of the conjunctiva but could be bacterial or gonococcal in neonates Itching, pain, tearing, red eye with discharge Refer to Doctor
101
Diabetic Retinopathy: Is? Presentation? Refer to who?
damage to retina in poorly controlled diabetes mellitus Microaneurysms, flame hemorrhages in retina and blurred vision Refer to ophthalmologist
102
Ectropion: Is? Presentation? Refer to who?
Old age, external sagging of lower eyelid | Refer to plastic surgeon
103
Entropion: Is? Presentation? Refer to who?
in turning of lower eyelid which may be congenital, acquired after scarring from trachomatis Painful Refer to ophthalmologist
104
Eustachian tube blockage: Is? Presentation? Refer to who?
May follow URTI, opening to nasopharynx swollen and causes air w/in middle ear cavity to be absorbed creating a vacuum which pulls the tympanic membrane inwards Partial deafness Referral to ENT specialist if Chiropractic care is unsuccessful
105
Hordeolum: Is? Presentation? Refer to who?
Infected hair follicle of eyelash (often staphyloccocal) Red painful swelling on margin of eyelid Medical doctor as ophthalmic antibiotics may be necessary
106
Horner's Syndrome: Is? Presentation? Refer to who?
Damage to sympathetic chain or ganglia in neck, from pancoast tumor, carotid A dissection, brain stem ischemia Unilateral ptosis, miosis, anhydriosis Neurologist
107
Iritis: Is? Presentation? Refer to who?
Inflammation of the iris associated with SLE, UC, Crohn's diseae, sarcoidosis Painful gritty feeling with redness around iris Refer to ophthalmologist
108
Macular Degeneration: Is? Presentation? Refer to who?
Age related degeneration of the macula more common in caucasion Central vision loss, macula (lateral to optic disc) blurred and pigmented Ophthalmologist
109
Meniere's disease: Is? Presentation? Refer to who?
Recurring vertigo, tinnitus, hearing loss - progresive deafness ENT specialist if dietary changes and Chiropractic care are unsuccessful
110
Myasthenia Gravis: Is? Presentation? Refer to who?
Autoimmune disorder from antibodies to ACh receptors @neuromuscular junction in middle aged females with thymic disorder Bilateral ptosis, and diplopia which worsen as day progresses, positive Tensilon test Co-manage with neurologist
111
Otitis Eterna: Is? Presentation? Refer to who?
Inflammation of external auditory canal; bacterial or fungal or allergy chronic may be related to impacted wax Ear pain wore on traction, swollen canal, scant discharge ENT specialist
112
Otitis Media: Is? Presentation? Refer to who?
Inflammation of middle ear, viral or bacterial (Hem Influenza in kids) common in kids because of straight tubes Ear pain, mild hearing loss, fever, loss of appetite, red and bulging tympanic membrane, Weber's lateralize to affected side, Rinne BC>AC in affected ear ENT specialist if Chiropractic care is unsuccessful
113
Peritonsillar abscess: Is? Presentation? Refer to who?
Related to severe tonsillitis Fever, severe sore throat, unilateral swollen pharyngeal tonsil, hot potato voice ENT specialist
114
Pingecula: Is? Presentation? Refer to who?
yellow triangular thickening of bulbar conjunctiva on inner and outer margins of the cornea with base pointing towards corners of eye and doesn't grow on the cornea No referral
115
Pterygium: Is? Presentation? Refer to who?
Triangular thickening of bulbar conjunctiva from medial corner of eye to cornea with apex pointing towards the pupil from chronic irritation and hot dry climates May encroach cornea Ophthalmologist if starts to encroach cornea
116
Seborrheic Dermatitis: Is? Presentation? Refer to who?
Inflammation of skin with high [sebaceous glands], Pityrosporum ovale may play a role Dandruff, scaly itching eyebrows and eyelids Dermatologist if tx with shampoo with selenium sulfide is not helpful
117
What position is the patient in for anterior chest examination? Posterior?
Supine | Seated
118
How do pleural effusion and pneumothorax affect breath sounds?
No breath sounds
119
Abscence of nail bed angle or Schamroth space is known as?
Clubbing
120
Biot's respiration is? Caused by?
Irregularly irregular rhythm | Damage to medulla --> CVA, trauma, tumor
121
Pneumonia and compression atelectasis causes what type of breath sounds? Known as?
Loud ones --> Bronchophony
122
Cheyne-Stoke breathing is? Caused by?
Regularly irregular --> CHF, raised intracranial pressure
123
Clubbing of fingers can be caused by what respiratory disorders?
TB, lung abscess, bronchiectasis, lung cancer
124
Crackles can be heard with what lung pathologies?
Pneumonia, CHF, bronchiectasis
125
Central cyanosis causes? Peripheral?
Severe respiratory distress, Fallot's tetralogy | COPD, pleural effusion, asthma
126
What happens to tactile fremitus in COPD, pleural effusion, asthma?
Decreased
127
Egophony is when? Caused by?
E sounds like A | Pneumonia, compression atelectasis
128
Gibbus formation goes with what disease?
Pott's | When TB hits the spine
129
Halitosis is seen with ?
Bronchiectasis and lung abscess
130
Horizontal sloping ribs are seen in what lung pathology?
Emphysema
131
What happens to percussion in pneumothorax, emphysema, and asthma?
Becomes hyper-resonant
132
What lung pathologies increase tactile fremitus?
Pneumonia, TB
133
What lung pathologies increase intercostal spaces? Decreases?
pleural effusion and empyema | Severe asthma, upper airway obstruction
134
Kussmaul's breathing is? Caused by?
Deep rapid breathing | Diabetic ketoacidosis
135
Musty breath is caused by what chemical compound? What pathology?
Ammonia --> Liver failure
136
Pectus carinatum is also known as? Caused by? Pectus excavatum?
Pigeon sternum and funnel chest | Rickets or congenital abnormality
137
Psoriasis does what to nails?
Pits them
138
What lung pathology do you suspect in someone with purseld-lip breathing?
Emphysema
139
Rachitic rosary is? From what pathology?
Swollen costochondral joints | Rickets
140
Red currant jelly sputum suggests what lung pathology?
Klebsiella (Friedlander's) pneumonia
141
Rust coloured sputum suggests what lung pathology?
Pneumococcal pneumonia
142
Stony dull percussion suggests what lung pathology?
Pleural effusion
143
Sweating with chest pain suggests what pathology?
MI, PE, dissecting thoracic aorta
144
Tender swollen costochondral joint is caused by what pathology?
Tietze syndrome
145
Tracheal shift can be seen in what lung pathologies?
Pleural effusion, tension pneumothorax, TB
146
Tracheal tug is suggestive of?
Aneurysm of the arch of the aorta
147
Wheezes are heard with what lung pathologies?
Asthma, bronchiectasis, COPD
148
Whispered pectoriloquy is heard with what lung pathologies?
Pneumonia, compression atelectasis
149
Acute Bronchitis: Is? Presentation? Refer to who?
Acute inflammation of bronchi viral in origin (usually) or in response to irritants Productive cough with white-green sputum, low fever Medical doctor if fever worsens and sputum becomes productive or Vit C/A/hydration don't help
150
Aneurysm of the arch of the aorta: Is? Presentation? Refer to who?
Dilation of arch of the aorta MC cause atherosclerosis, 3o syphilis (also HTN, Marfan's) Bovine Cough, hoarseness, tracheal shift to right and tug, widening of superior mediastinum Refer to vascular surgeon + confirm with CT
151
Asthma: Is? Presentation? Refer to who?
Chronic/episodic reversible airway disease mostly allergic in nature causing bronchospasm and inflammation of bronchial mucosa Paroxysms of dyspnea and wheezing and Charcot Leyden crystals and Curschmann spirals in sputum, FEV1 decreased <80% Refer to hospital if cyanosed or >28 breaths/min
152
Bronchiectasis: Is? Presentation? Refer to who?
Chronic dilation of bronchi caused by long standing lung infection maybe part of Kartagener's syndrome (+ sinusitis, situs inversus) Chronic cough, shortness of breath, excessive production of mucopurulent sputum in AM, halitosis, clubbing of fingers, saccular dilations of bronchi Pulmonologist
153
Chronic Bronchitis: Is? Presentation? Refer to who?
Irreversible airway disease with chronic cough >3 months for at least 2 consecutive years with chronic inflammation of bronchi from smoking or irritants Dyspnea, cough, cyanosis, bilateral ankle swelling (blue bloater) Co-manage with pulmonologist; encourage cessation of smoking
154
Dissecting Thoracic Aorta: Is? Presentation? Refer to who?
Tear in tunica intima, associated with Marfan's, HTN or severe chest trauma Severe tearing chest pain, diminished upper limb pulse, Hypotension, widening of superior mediastinum Call 911
155
Emphysema: Is? Presentation? Refer to who?
Irreversible airway disease from smoking, industrial pollutants, resulting in destruction of walls of alveoli causing overinflation of lungs - pink puffers Dyspnea, barrel-chest horizontal sloping ribs, pursed-lip breathing, overinflated lungs, flattened diaphragm, large retrosternal and retrocardiac windows Co-manage with pulmonologist; getting patient to stop smoking
156
Fallot's Tetralogy: Is? Presentation? Refer to who?
MC cyanotic congenital heart disease; pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect Cyanosis at birth, clubbing of fingers, easily fatigues, left parasternal heave, boot-shaped heart, upward displaced apex due to severe right ventricular hypertrophy, failure to thrive due to poor feeding, pansystolic murmur in 3rd left intercostal space Refer to pediatric cardiologist
157
Liver Failure: Is? Presentation? Refer to who?
Failure of liver to detoxify, process bilirubin and manufacture important substances Jaundice, fetor hepaticus, ascites, gynecomastia, high bilirubin, AST, ALT and alkaline phosphatase Hospital
158
Lung Abscess: Is? Presentation? Refer to who?
Pus-filled cavity in chest associated with Staph. Aureus Chills, fever, halitosis, foul smelling sputum, chest film shows cavity with air-fluid level Hospital
159
Lung Cancer: Is? Presentation? Refer to who?
Malignant, associated with smoking, males more than females Weight loss, chronic cough, hemoptysis, clubbing of fingers, solitary mass with irregular borders, fatigue Thoracic Surgeon or pulmonologist
160
Pericarditis: Is? Presentation? Refer to who?
Inflammation of pericardial sac can be viral, bacterial or chemical Sticking retrosternal chest pain relieved by sitting up and leaning forward, ST elevation on ECG Hospital
161
Pleural Effusion: Is? Presentation? Refer to who?
Excess fluid in pleural cavity, from CHF, pneumonia, TB, mets Dyspnea, decreased tactile fremitus, stony dull percussion note, absent breath sounds, local lag, chest film shows no costophrenic angle (50 cc of fluid) and sign of meniscus Hospital
162
Pneumonia: Is? Presentation? Refer to who?
Inflammation of lung parenchyma due to viral, bacterial, fungal, or chemical Chills, fever, dyspnea, pleuritic chest pain, productive cough, increased tactile fremitus, dull on percussion, crackles, rust coloured sputum = Strep. Pneumoniae, red currant jelly = Klebsiella P. Scanty sputum = Pneumo. Jiroveci or mycoplasma pneumoniae< local or patchy consolidation in one lung if lobar or both if bronchopneumonia Hospital if Confused, Urea elevated, Respiration >30/min, BP <90/60 or >65 years
163
Pneumothorax: Is? Presentation? Refer to who?
Air in pleural cavity can be spontaneous or traumatic Chest pain, sudden dyspnea, hyper resonant percussion, absent breath sounds, collasped lung with absent lung markings Hospital
164
Psoriasis: Is? Presentation? Refer to who?
Chronic skin condition due to rapid turnover of skin cells Silvery scaly plaques on extensor aspects of neck, elbow, sacrum, knees, pitting of nails and joint pains, HLA B27+, cup and pencil deformity, sausage fingers Co-manage with dermatologist and rheumatologist
165
Pulmonary Embolism: Is? Presentation? Refer to who?
Breakaway clot from DVT causing obstruction to pulmonary A or branch Classic triad: sudden dyspnea, pleuritic chest pain, hemoptysis and +d-dimer test 911
166
Raynaud's Phenomenon: Is? Presentation? Refer to who?
Vasospastic disorder of small A associated with CT disorders like SLE and scleroderma Intermittent vasospasm, cyanosis, hyperactive hyperemia in response to cold and stress Co-manage with internist or rheumatologist
167
Rickets: Is? Presentation? Refer to who?
Metabolic bone disorder of Vit D deficiency Lethargy, muscle weakness, frontal bossing, bow legs, kyphoscoliosis Padiatrician
168
Sarcoidosis: Is? Presentation? Refer to who?
Chronic multisystem disease of unknown origin, common in black females, characterized by non-caseous granulomas Fatigue, dyspnea, Erythema nodosum, hypercalcemia, leucopenia, bilateral hilar lymphadenopathy, diffuse pulmonary fibrosis, ACE elev Co-manage with pulmonologist
169
Tension Pneumothorax: Is? Presentation? Refer to who?
Air in pleural cavity caused by trauma to chest Sudden dyspnea following chest injury, increasing cyanosis with tracheal deviation to opposite side 911
170
Tietze Syndrome: Is? Presentation? Refer to who?
Inflammation of 2nd-5th costochondral joint with repetitive microtrauma Localized chest pain with swollen tender costochondral joint, if tender and not swollen costochondritis Rheumatologist if Chiropractic care unsuccessful
171
Tuberculosis: Is? Presentation? Refer to who?
Chronic infection of Mycobacterium TB characterized by Ghon focus and complex with caseous necrosis and granulomas Cough, night sweats, fever, hemoptysis, weight loss, apical consolidation and cavitation, Ziehl Neelsen staining bacilli in sputum which grow best in Lowenstein Jensen medium Infection Disease specialist
172
What position is the patient in for a cardiovascular exam?
Supine
173
Causes of diastolic murmurs (PaRTS and ARMS)
Pulmonary Regurgitation, Tricuspid Stenosis, Aortic Regurgitation, Mitral Stenosis
174
Causes of systolic murmurs (A Systolic Murmur Is Present Says The Instructor)
Aortic stenosis, mitral incompetence, pulmonary stenosis, Tricuspid Incompetence
175
What positions exacerbate a mitral murmur? Aortic? Pulmonic?
Left lateral or decubitus leaning forward, exhale and hold Leaning forward, inhale and hold
176
Diagonal earlobe creases signify increase risk of?
MI
177
Dilated chest and arm veins are indicative of ?
SVC obstruction
178
Where can you best hear aortic regurgitation diastolic murmur?
2nd right intercostal space
179
CHF and cardiac tamponade do what to the JVP?
Elevate
180
Where can you best hear mitral stenosis? Diastolic or systolic murmur?
5th left intercostal space, Diastolic
181
If there is left ventricular hypertrophy where do you hear a displaced apex beat?
Outside 5th left intercostal space
182
Erythema marginatum + Cardiac murmur + Joint Pain =
Rheumatic fever
183
Hepatojugular reflex is? Seen with?
Increased JVP with RUQ pressure | CHF
184
Koilonychia is? Seen with?
Spoon shaped nails | Severe iron defeciency anemia
185
Left parasternal heave is seen with?
Right ventricular hypertrophy
186
Malar flush is seen with what pathologies?
Mitral stenosis, carcinoid tumors
187
What do you hear with mitral valve prolapse? Where?
Midsystolic click | 5th left intercostal space
188
What does mitral regurgitation sound like? Where?
Pansystolic murmur | 5th left intercostal space
189
Peripheral edema bilateral is seen with what pathologies? Unilateral?
CHF, chronic bronchitits, cirrhosis, renal failure | DVT, cellulitis
190
Pulsus alternans is? From what? Bigeminus? Magnus? Paradoxus? Pavus?
Alternans: strong beat followed by weak, left ventricular failure Bigeminus: Double beats, hypertrophic obstructive cardiomyopathy Magnus: bounding pulse, fever, anemia, hyperthyroidism (AKA Water hammer pulse) Paradoxus: decreased pulse on inspiration, >10mm Hg asthma, cardiac tamponade Parvus: low volume pulse, shock and aortic stenosis
191
Radio-femoral delay is seen with what pathology? Radial?
Coarctation of the aorta | Suclavian steal syndrome
192
Is the S3 heart sound normally heard? If not with what pathology?
Normal in YA | CHF
193
Is the S4 heart sound normally heard? If not with what pathology?
No - HTN and cardiomyopathy
194
A split S1 sound that varies with breathing is normal in what population? A split S1 sound that is fixed indicates?
Normal: healthy young ~30 yr olds | ASD, ight bundle branch block
195
Splinter hemorrhage is? Indicates what pathology?
Brown streaks on nails | Subacute bacterial endocarditis
196
Aortic Incompetence: Is? Presentation? Refer to who?
Valvular heart disease caused by rheumatic fever, Marfan's, syphilitic aortitis Titubation, diastolic murmur in 2nd right intercostal space Cardiologist to confirm with Echocardiography
197
Aortic stenosis: Is? Presentation? Refer to who?
Valvular heart disease caused by rheumatic fever Angina, systolic murmur in 2nd right intercostal space Cardoiologist to confirm with echocardiography
198
Bacterial endocarditis: Is? Presentation? Refer to who?
Valvular heart disease of IV drug users MC caused by Staph. Aureus Fatigue, fever, harsh murmur (MC tricuspid valve) Hospital
199
Cardiac Tamponade: Is? Presentation? Refer to who?
Compression of heart by fluid/blood in pericardial sac; infective or traumatic in origin Distant heart sounds, high jugular venous pressure, hypotension (Beck's triad) Hosptial, echocardiography
200
Coarctation of Aorta: Is? Presentation? Refer to who?
Congenital narrowing of aorta beyond left subclavian A Hypertension in upper limbs, delayed radiofemoral pulse Vascular surgeon - CT confirmation
201
Hyperthyroidism: Is? Presentation? Refer to who?
Overactive thyroid gland with excess production of thyroxin Goiter, tachycardia, diarrhea, bilateral exophthalmos (Graves), unblinking stare, fine physiological tremor of outstretched hands; older patients with atrial fibrillation, high T3/T4, low TSH in primary Co-manage with endocrinologist
202
Mitral Incompetence: Is? Presentation? Refer to who?
Valvular heart disease caused by rheumatic fever Pansystolic murmur in 5th left intercostal space in midclavicular line Cardiologist
203
Mitral Stenosis: Is? Presentation? Refer to who?
Valvular heart disease caused by rheumatic fever Malar flush, diastolic murmur at 5th left intercostal space midclavicular, fatigue Cardiologist --> echocardiography
204
Mitral Valve Prolapse: Is? Presentation? Refer to who?
Valvular heart disease of unknown origin, associated with Marfan's Atypical chest pain, mid-systolic click in 5th left intercostal space midclavicular Cardiologist --> echography
205
Subacute Bacterial Endocarditis Is? Presentation? Refer to who?
Disease by infection of previously damaged heart valves by Strep Viridans, associated with dental caries Fatigue, low grade fever, anemia, splinter hemorrhages, clubbing of fingers, splenomegaly Hospital
206
Subclavian Steal Syndrome: Is? Presentation? Refer to who?
Congenital occlusion of subclavian A with shunting of blood via vertebral A Syncope on upper body exercise and radio-radial delay, >10 mmHg difference between arms Cardiologist
207
SVC Obstruction: Is? Presentation? Refer to who?
Obstruction of SVC by large mass in superior mediastinum, often seen in lymphoma Edema of face and distended neck and upper limb V, wide superior mediastinum Cardiothoracic surgeon
208
If you hear an abdominal bruit in the middle of the epigastrium one should suspect what pathology?
AAA
209
If you hear an abdominal bruit left of the midline of the epigastrium one should suspect what pathology?
Unilateral renal A stenosis
210
Absent bowel sounds AKA _____ ____ signify ?
Paralytic ileus | Generalized peritonitis
211
Ascites is? Caused by?
Fluid in the abdomen, a shifting dullness | Cirrhosis, nephrotic syndrome, cancer
212
Bluish discolouration in flanks is what sign? Indicative of?
Grey Turner sign | Pancreatitis or ectopic pregnancy
213
Bluish discolouration in umbilicus is what sign? Indicative of?
Cullen sign | Pancreatitis or ectopic pregnancy
214
Caput medusa is? Signifies what?
Dilated veins radiating from the navel | Portal hypertension in cirrhosis
215
Cessation of inspiration on RUQ pressure is what sign? Indicative of?
Murphy sign | Cholecystitis
216
CVA tender on percusssion is what test and indicative of what pathology?
Murphy's punch | Pyelonephritis
217
Dull percussion note in Traube's space is indicative of what pathology?
Splenomegaly
218
Hyperactive bowel sounds w/borborygmi and hyper-resonance on percussion is indicative of?
Intestinal obstruction
219
Kehr's sign is? Indicative of?
Left shoulder pain in the acute abdomen | Ruptured ectopic pregnancy or spleen
220
Left iliac fossa tenderness can be indicative of?
Diverticulitis and ulcerative collitis
221
Non-tender hepatomegaly can be indicative of what pathologies?
Cirrhosis, hepatic mets
222
What is the obturator internus test? What pathology does it indicate?
Pain on hip internal rotation | Appendicits
223
What does a hard prostate indicate? Boggy?
Cancer | Prostatitis
224
Prehn's sign signifies what pathology?
Epididymo-orchitis
225
Painless testicular indicates?
Testicular cancer
226
Puddle sign = ?
Ascites
227
A reproducible gurgling mass in the inguinal region indicates what pathology?
Inguinal hernia
228
Right iliac fossa tenderness with recurrent diarrhea indicates what pathology?
Crohn' disease
229
Rogoff's sign is indicative of?
Adrenal inflammation
230
A scaphoid abdomen is indicative of?
Severe malnutrition
231
AAA: Is? Presentation? Refer to who?
saccular or fusiform dilation of aorta below renal A; caused by atherosclerosis, often asymptomatic may present w/LBP, a pulsatile midline mass in abdomen above umbilicus and bruit in epigastric region X-ray may show curvilinear lines of calcification adjacent to lumbar vertebrae, US will confirm and determine size Vascular surgeon esp if >5cm
232
Acute pancreatitis: Is? Presentation? Refer to who?
Acute inflammation of pancreas from alcohol abuse, stone in ampulla of Vater or viral infxn (mumps) Severe epigastric pain radiates through to back Cullen and Grey Turner signs in small percentage, serum amylase and lipase elevated, CT shows swollen pancreas Hospital
233
Appendicitis: Is? Presentation? Refer to who?
Acute inflammtion of appendix maybe from fecalith obstructing orifice of appendix or viral infxn Periumbilical pain, nausea, vomiting, fever, pain radiates to right iliac fossa, positive Rovsing, psoas, obturator signs Hospital, CT confirmation
234
Celiac disease: Is? Presentation? Refer to who?
Gluten hypersensitivity causing chronic disease of SI, associated with iron def anemia or folic acid/B12 def Weight loss, fatigue, diarrhea, steatorrhea, failure to thrive, dermatitis herpetiformis, elevated IgA and IgG Gastroenterologist formucosal biopsy
235
Cholecystitis: Is? Presentation? Refer to who?
acute inflammation of gallbladder MC E.Coli, in fair, fat, fertile females in 40's, 95% associated with gallstones RUQ pain may radiate to right infrascapular region, Murphy's sign may be present with fever, nausea, vomiting Hospital for US
236
Cirrhosis: Is? Presentation? Refer to who?
Condition of chronic liver damage by alcohol abuse, hepatitis C infection Liver cell necrosis, fibrosis and regeneration nodules, fatigue, jaundice, palmar erythema, enlarged non-tender, gynecomastia, hemorrhoids, elevated AST, ALT, Alkaline phosphatase, bilirubin Co-manage with gastroenterologist
237
Crohn's Disease: Is? Presentation? Refer to who?
Chronic inflammatory bowel disease of unknown etiology with cobblestone appearance of mucosa of terminal ileum, skip lesions and non-caseous granulomas Recurrent RLQ pain, diarrhea, fatigue, macrocytic normochromic anemia Vit B12 deficiency Co-manage with gastroenterologist
238
Diabetic Ketoacidosis: Is? Presentation? Refer to who?
Condition in poorly controlled T1DM with excess ketone production from beta oxidation of fats SoB with acetone smell, polyuria, polydypsia, polyphagia, Kussmaul breathing, 50% with ab pain, ketonuria, elevated FBG, hyperkalemia Hospital
239
Diverticulitis: Is? Presentation? Refer to who?
Acute inflammation of diverticula in LI associated w/lack of fiber, MC >70 Lower left-sided ab pain with blood in stool and low grade fever Hospital if bright red rectal bleeding - barium enema or colonoscopy to confirm
240
Ectopic Pregnancy: Is? Presentation? Refer to who?
Pregnancy outside of uerus MC fallopian tube associated with gonorrhea or chlamydia hx 6-8 weeks of amenorrhea followed by lower ab pain and vaginal spotting, Kehr's sign Hospital, 911 if BP <90/60 - ab US to confirm
241
Epididymo-orchitis: Is? Presentation? Refer to who?
Acute inflammation of epididymis and testis caused by Neisseria infxn, Gonorrhea, Chlamydia Pain in scrotum, swollen testis and epididymis and periumbilical region, hx of dysuria and urinary frequency, Prehn's test + Hospital
242
Femoral Hernia: Is? Presentation? Refer to who?
Defect in femoral canal; MC in females Irreducible swelling inferior and lateral to pubic tubercle General surgeon
243
Generalized Peritonitis: Is? Presentation? Refer to who?
Acute inflammation of peritoneum caused by rupture of bowel or ectopic pregnancy Severe generalized ab pain, guarding, fever, absent bowel sounds, Blumberg's sign +, X-ray show distended loops of bowel with multiple air-fluid levels Hospital
244
Hepatitis: Is? Presentation? Refer to who?
Acute/chronic inflammation of liver caused by viral infxns (Hep A, B, C, E) Nausea, fever, vomiting, jaundice, tender swollen liver, AST/ALT/Alkaline phosphotase and bilirubin elevated Gastroenterologist
245
Inguinal hernia: Is? Presentation? Refer to who?
Congenital defect or traumatic, direct or indirect, MC type, more in males Reducible mass in inguinoscrotal region General Surgeon
246
Intestinal obstruction: Is? Presentation? Refer to who?
Blockage of small/large bowel due to mass inside bowel or adhesions from previous surgery obstructing bowel from outside Cramping, ab pain, ab distension w/hyperactive bowel sounds, X-ray show distended loops of bowel w/multiple air fluid levels Hospital
247
Irritable Bowel Syndrome: Is? Presentation? Refer to?
Chronic functional gut disorder of unknown etiology Bouts of abdominal pain relieved by defecation along w/diarrhea or constipation, closed eyes sign Co-manage w/gastroenterologist
248
Mesenteric Vascular Occlusion: Is? Presentation? Refer to?
Sudden blockage of a mesenteric A/V, associated w/atherosclerosis Severe ab out of proportion to ab findings, blood in stool, shock Hospital, angiography confirmatory
249
Nephrotic Syndrome: Is? Presentation? Refer to?
Chronic kidney disease affecting BM, associated w/DM and SLE Fatigue, bilateral ankle swelling, ascites, Muehrcke's lines (curved transverse lines on nails) and frothy or foamy urine, massive proteinuria >3.5g/day, hypoproteinemia, hyperchoesterolemia Hospital --> renal biopsy confirms
250
Pelvic Inflammatory Disease: Is? Presentation? Refer to?
Inflammatory disease of uterus, fallopian tube and surrounding pelvic CT caused by N. gonorrhea or Chlamydia trachomatis Fever, lower ab pain, cervical motion tenderness and mucopurulent discharge Hospital
251
Peptic Ulcer Disease: Is? Presentation? Refer to?
Ulceration of either stomach or duodenum, assocated w/H. Pylori, NSAIDs, smoking, alcohol Epigastric pain made worse w/food (gastric ulcer) or better w/food (duodenal ulcer), melena if ulcer bleeds Co-manage w/gastroenterologist w/stress reduction and dietary modification, gastroscopy/biopsy to confirm diagnosis
252
Portal HTN: Is? Presentation? Refer to?
Complication of cirrhosis in which flow of blood from portal V to liver is obstructed due to increased fibrosis seen in cirrhosis Fatigue, caput medusae, esophageal varices and internal hemorrhoids and ascites Gastroenterologist
253
Prostatitis: Is? Presentation? Refer to?
Acute/chronic inflammation of prostate often E. Coli or Chlamydia Suprapubic/perineal discomfort, dysuria, frequency of urination and tender/soft/boggy prostateg Urologist
254
Pyelonephritis Is? Presentation? Refer to?
Acute/chronic inflammation of the pelvis of the kidney and the ureter, E. coli MC Chills, fever, nausea, vomiting, flank pain w/costovertebral angl tenderness, + Murphy's punch, urinalysis will show increased WBC, casts, bacteria Hospital
255
Tertiary Syphilis: Is? Presentation? Refer to?
3rd stage caused by Treponema pallidum, devo 3-15 years after exposure Lightning pains in abdomen, chronic non healing ulcers with gumma, Romberg's sign, Argyll Roberston pupils in neurosyphilis, VDRL/FTA-abs test + Neurologist
256
Testicular Cancer: Is? Presentation? Refer to?
MC type is seminoma Dull ache in scrotum, enlarged irregular testis, gynecomastia can spread to para-aortic lymph nodes Urologist - US confirm echodensity of mass and biopsy
257
Torsion of testis: Is? Presentation? Refer to?
Long mesorchium Sudden onset testicular/scrotal pain (periumbilical region), nausea, vomiting, - Prehn's sign, affected testis higher than other Hospital - surgical correction
258
Ulcerative Colitis: Is? Presentation? Refer to?
Chronic inflammatory bowel disorder of unknown etiology, characterized by superficial ulcerations of descending and sigmoid colon Left sided ab pain, fatigue, anemia, recurrent bloody diarrhea, microcytic hypochromic anemia due to blood loss Co-manage w/gastroenterologist - colonoscopy and biopsy confirm
259
Volvulus: Is? Presentation? Refer to?
Acute twisting of bowel on itself, MC sigmoid colon Severe ab pain and distension w/hyperactive bowel sounds, X-ray show coffee-bean (Inverted U) sign Hospital
260
Bag of worms sensation in the scrotum is indicative of what pathology?
Varicocele
261
Buboes in groin are? and is indicative of what pathology?
Draining lymph nodes | Lymphogranuloma venereum
262
Cheesy white curds in the vagina is indicative of what pathology?
Cadidiasis
263
Erosion of the cervix is indicative of what pathology?
Cervical cancer
264
Irregular uterine enlargement is indicative of what pathology?
Uterine fibroids
265
Frothy malodorous vaginal discharge is indicative of what infection?
Trichomonas
266
Non-healing penile or vulvar ulcer is indicative of what pathology?
Carcinoma of penis/vulva
267
Painful bluish mass from anal orifice is indicative of what pathology?
Thrombosed external hemorrhoid
268
Painful nodules in the adnexa is indicative of what pathology?
Endometriosis
269
Painless fleshy mass protruding from anal orifice is indicative of what pathology?
Internal hemorrhoid
270
Painful soft yellow genital ulcer is indicative of what pathology?
Chancroid
271
Painless soft red genital ulcer is indicative of what pathology?
Granuloma inguinale
272
Painless firm genital ulcer is indicative of what pathology?
Syphillis
273
Pelvic mass in a postmenopausal woman is indicative of what pathology?
Ovarian cancer
274
Sign of the groove (swollen inguinal nodes w/groove) is indicative of what pathology?
Lymphogranuloma venereum
275
Strawberry cervix is indicative of what pathology?
Trichomons
276
Tenderness on motion of the cervix is indicative of what pathology?
Pelvic inflammatory disease
277
Transilluminable mass in the scrotum is indicative of what pathology?
Hydrocele
278
Watery, fishy vaginal discharge is indicative of what pathology?
Bacterial vaginosis
279
Bacterial vaginosis: Is? Presentation? Refer to?
Inflammatory condition of vagina asociated with overgrowth of Gardnerella species Fishy smelling watery vaginal discharge often after sex or menstruation, pH >4.5, + amine test Gynecologist
280
Cancer of the penis: Is? Presentation? Refer to?
Associated w/chronic HPV infxn Non-healing ulcer or mass on glans penis or foreskin w/inguinal node spread Urologist
281
Cancer of the vulva: Is? Presentation? Refer to?
Often associated with chronic HPV infection Non-healing ulcer/mass in vulva w/spread t involve inguinal nodes Gynecologist for biopsy to confirm
282
Candidiasis: Is? Presentation? Refer to?
Infxn of vulva and vagina overgowth of Candida albicans, after broad-spectrum antibiotic and diabetics Severe vulvar/vaginal itching w/thick cottage-cheese discharge, buds and branching hyphae Gynecologist
283
Cervical Cancer: Is? Presentation? Refer to?
Neoplasia of cervix MC associated w/chronic HPV infxn (16 and 18) Post-coital bleeding and non-healing erosion of cervix Gynecologist --> Pap smear
284
Chancroid: Is? Presentation? Refer to?
STD caused by H. Ducreyi Painful yellow genital ulcers w/swollen tender inguinal lymph nodes M.D. --> Tissue culture
285
Endometriosis: Is? Presentation? Refer to?
Deposition of endometrial tissue outside uterine cavity (broad ligament, ovary, pelvis) Severe dysmenorrhea, painful nodules in adnexa, retroverted uterus, infertility, chocolate cysts Co-manage w/gynecologist
286
Granuloma Inguinale: Is? Presentation? Refer to?
STD caused by Klebsiella granulomatis Painless beef red ulcer in genital region M.D.
287
Herpes Genitalis: Is? Presentation? Refer to?
STD from Herpes simplex type 2 Painful recurrent multiple vesicles and shallow ulcers in genital region M.D.
288
Lymphogranuloma Venereum: Is? Presentation? Refer to?
Uncommon STD from Chlamydia trachomatis L1-3 Fleeting rah, swollen painful draining inguinal lymph nodes (buboes), rectal structures, sign of groove M.D. for antibiotics
289
Prostate Cancer: Is? Presentation? Refer to?
Slow growing malignancy of prostate gland Asymptomatic, may have hematuria and hard irregular prostate, LBP, fatigue, weight loss, Elevated PSA, alkaline phosphatase, hypercalcemia Urologist
290
Ovarian Cancer: Is? Presentation? Refer to?
Malignancy of ovary MC >50 Bloating, ab discomfort, ascites, enlarged ovary Gynecologist for ultrasound and biopsy
291
Thrombosed external hemorrhoid: Is? Presentation? Refer to?
Painful thrombosed tributary of inferior rectal V Constipation, tender blue swollen nodule at end of anal orifice below pectinate line Proctologist if conservative care w/sitz bath and Preparation H are not helpful
292
Trichomonas: Is? Presentation? Refer to?
STD from protozoan called Trichomonas vaginalis Vulvar itching, malodorous frothy yellow-green vaginal discharge in females, asymptomatic in males, motile flagellates on microscopic exam Gynecologist
293
Uterine Leiomyome (fibroids): Is? Presentation? Refer to?
Benign smooth muscle tumor of uterus, related to estrogen stim Polymenorrhagia, irregularly enlarged uterus, anemia if chronic - microcytic hypochromic Gynecologist
294
Varicocele: Is? Presentation? Refer to?
Varicose V in pampiniform plexus, MC on left Dragging sensation in scrotum and bag of worms on palpation Urologist

Chiro Essentials General Diagnosis (3 decks)

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