General Diagnosis Flashcards
The CAGE questionaire indicates alcoholism. What does CAGE stand for?
Cutting down (felt the need to cut down)
Annoyed by other criticisms
Guilty Feelings
Eye openers (felt the need for a morning “eye opener” drink)
What are normal values of the following temps;
Oral?
Rectal & Tympanic?
Axilla?
Oral = 98.6F
Rectal & Tympanic = 99.6F
Axilla = 97.6F
What are normal pulse values in adults? Newborns? Elderly?
Adults: 60-100
Newborns: 120-160
Elderly: 70-80
What are normal respiratory rates for adults? Newborns?
Adult: 14-18
Newborn: 44
What is normal BP ranges for adults?
90-120/60-80
Low pitched sounds produced by turbulent blood flow in arteries when a BP cuff is deflated. (Sounds you hear when taking a BP)
Korotkoff sounds
A difference of 10-15mmHg b/w sides in systolic readings can indicate what?
Arterial occlusion such as subclavian steal syndrome on the side of decreased value
BP readings are what % higher in the LE?
20%
What are ortho tests for vertebrobasilar artery insufficiency?
Barre-Lieou DeKleyn's Hallpike Hautant's Underberg
Scaly eyebrows indicates what?
Seborrhea
Loss of lat. 1/3rd of eyebrows indicates what?
Myxedema
Drooping of the eyelid
Ptosis
Ptosis is assoc. w/ what conditions?
Horner’s (also see meiosis & anhydrosis)
CN 3 paralysis (also see dilated pupil)
Myastenia Gravis
Lid lag/failure to cover the eyeball seen w/ Graves (bilateral) or tumor (unilateral
Exophthalmosis
Lid is turned outward & seen in the elderly
Ectropion
Lid is turned inward & seen in the elderly
Entropion
Swelling around the eye seen w/ allergies, myxedema, & nephrotic syndrome (HEP)
Periorbital edema
Inflammation of the eye seen w/ seborrhea, staph infection, & inflammatory processes
Blepharitis
Opacities seen in the lens that are commonly seen w/ diabetes & in the elderly. Also has an absent red light reflex
Cataracts
Grayish opaque ring around the cornea. Early (50yoa) is normal
Corneal Arcus
Triangular thickening of the bulbar conjunctiva that grows across the cornea & is brought on by dry eyes
Pterygium
A yellow sclera indicates what? Blue sclera?
Yellow =Jaundice
Blue = Osteogenesis Imperfecta
A pale conjuctiva indicates what? Bright red?
Pale = anemia
Bright red = Infection
An infection of the sebaceous glands causing a pimple or boil on the eyelid
Hordoleum (sty)
An infection of the meibomian gland causing a nodule which points inside the lid
Chalazion
A yellowish triangular nodule in the bulbar conjunctiva that is harmless & indicates aging
Pinquecula
Fatty plaques on the nasal surface of the eyelids that is normal or indicates hypercholesterolemia
Xanthelasma
Bilaterally small & irregular pupils that accommodate but don’t react to light. Seen w/ syphilis (AKA prostitutes pupil)
Argyll Robertson pupils
Dilated pupil w/ ptosis & lat. deviation. Doesn’t react to light or accommodation. Assoc. w/ MS
Internal Opthalmoplegia
Dilated & fixed pupils seen w/ anticholinergic drugs
Mydriasis
Fixed & constricted pupils that react to light & accommodate. Seen w/ severe brain damage, pilocarpine medications, & narcotic use
Miosis
Unequal pupil size
Anisocoria
Sluggish pupillary reaction to light that is unilateral & caused by a parasympathetic lesion of CN III
Adie’s pupil
Sluggish pupillary reaction d/t hypoadrenalism (Addison’s ds)
Arroyo Sign
Ptosis, miosis, & anhydrosis on the same side as an interruption to the cervical sympathetics
Horner’s syndrome
Increased intraocular pressure causing cupping of the optic disc (cup to disc ratio is >1:2). Pt will notice blurring of their vision especially in the peripheral fields as well as rings around lights. Cresecent sign will be present upon tangential lighting of the cornea
Glaucoma
Swelling of the optic disc d/t increased intracranial pressure. No visual loss. May be seen w/ a brain tumor or brain hemorrhage
Papilledema AKA Choked disc
Painless sudden onset of blindness described as curtains closing over vision lightening flashes & floaters
Retinal detachment
M/C cause of blindness in the elderly, central vision lost
Macular degeneration
What is an early sign of Macular degeneration?
Macular drusen (yellow deposits under the retina)
Damage to the retinal vessels. Background will show these signs; copper wire deformity, silver wire deformtiy, A-V nicking, flame & splinter hemorrhages, & cotton wool soft exudates
HTN Retinopathy
This affects the veins more than the arteries in the eyes & presents w/ microaneuryms, hard exudates, & neovascularization
Diabetic Retinopathy
Inflammation of the iris. Seen w/ AS
Iritis
Normal vision is called what?
Emmetropia
Nearsighted is AKA?
Hyopia
Farsighted is AKA?
Hyperopia
Loss of lens elasticity d/t aging
Presbyopia
Direct light reflex test what CN’s?
CN II
CN III
Consensual Light reflex tests what CN’s?
CN III
Accommodation tests what CN’s?
CN II
CN III
Visual acuity is tested w/ what?
Snellen Chart
Cardinal fields of gaze tests what CN’s?
CN III
CN IV
CN VI
The presence of ringing in the ears.
Tinnitus
Sensorineural hearing loss that occurs in people as they age & they may be affected by genetic or acquired factors
Presbycussis
An infection of the outer ear. Pt experiences inflammation & pain of the outer ear. Tugging on the pinna will be painful.
Acute Otitis Externa (Swimmer’s Ear)
Bacterial infection in the mastoid process. Presents clinically w/ the same s/s of acute otitis media, w/ the addition of inflammation & palpatory tenderness over the mastoid. Hearing loss is commonly assoc.
Acute Mastoiditis
A bacterial or viral infection in the middle ear. The tympanic membrane presents w/ a red appearance, dilated blood vessels, & bulging.
Purulent Otitis Media AKA Bacterial Otitis Media
An effusion in the middle ear resulting from incomplete resolution of acute otitis media or obstruction of the Eustachian tube. This condition is usually chronic & the fluid is amber w/ bubbles
Serous Otitis Media
An abnormal sensation of rotary movement assoc. w/ difficulty in balance, gait, & navigation of the environment
Vertigo
A disorder charac. by recurrent prostrating vertigo, sensory hearing loss, tinnitus, & a feeling of fullness in the ear
Meniere’s Disease
A brief episode of vertigo brought on by a change of head position.
Benign Paroxysmal Positional Vertigo
How is BPPV dx?
Perform the Dix-Hallpike Maneuver
Benign tumor of CN VIII (called a schwannoma). Hearing loss, tinnitus, vertigo, & presence of tumor on CT or MRI
Acoustic Neuroma
Nasal mucosa appears red & swollen w/ a clear runny nose
Viral Rhinitis
Nasal mucosa appears pale or blue & boggy
Allergic Rhinitis
Thinning of the nasal mucosa w/ sclerosis, crust formation, & foul odor
Atrophic Rhinitis
These typically occur as a consequence of chronic inflammation of the nasal mucosa
Polyps
Red sores at the corner of the mouth. Can be caused by a Vit. B2 (riboflavin) deficiency
Angular Stomatitis AKA Cheilosis
Thick white fungal patches on the tongue/mouth that are easily scraped off
Candidiasis AKA Thrush
Pre-cancerous lesion of white patches that are adherent to the surface of the tongue & are not easily removed
Leukoplakia
A deficiency of B vitamins or iron that causes the tongue to appear smooth & glossy
Atrophic Glossitis
Deep furrows on the surface of the tongue that is considered a normal variant.
Fissured tongue AKA Scrotal tongue
Excessive production of growth hormone prior to skeletal maturation
Gigantism
Excessive production of growth hormone beginning in middle age. Results in abnormal growth in the hands, feet, & facial bones
Acromegaly
M/C’ly caused by Grave’s ds. TSH production is decreased & the thyroid hormones (T3 & T4) are produced in excess
Hyperthyroidism
Hypothyoidism (AKA Myxedema) is M/C’ly caused by what in the US?
Hashimoto’s thyoiditis
Congential hypothyroid is AKA what?. Causes a diminished physical & mental capacity.
Cretinism
What are charac. of hyperthyoidism?
- Weight loss w/ increased appetite
- Irritable & nervous
- Intolerance to heat
- Moist skin & fine hair
- Exophthalmos
- Possible neck swelling d/t goiter
- Increased T3, T4, & decreased TSH
What are charac. of hypothyroidism?
- Weight gain w/ decreased appetite
- Depression, weakness, & fatigue
- Intolerance to cold
- Coarse, dry hair & skin
- Periorbital edema
- Macroglossia & loss of lat. 1/3rd of eyebrows
- Decreased T3, T4, & increased TSH
Barrel chest is seen w/ what ds’s?
COPD
Cystic fibrosis
Marked depressio nnoted in the sternum
Pectus Excavatum AKA Funnel Chest
Forward protrusion of the sternum
Pectus Carinatum AKA Pigeon Chest
Rapid, shallow breathing
Tachypnea
Slow breathing
Bradypnea
Charac. by groups of quick, shallow inspirations followed by irregular periods of apnea (no pattern)
Biot’s Breathing
Breathing pattern charac. by alternating periods of apnea & hyperpnea (has pattern); Respiratory acidosis
Cheyne-Stokes Respiration
Breathing is first rapid & shallow but as metabolic acidosis worsens, breathing gradually b/co deep, slow, labored, & gasping. “Air hunger breathing”
Kussmaul’s
Pitted nails are assoc. w/ what condition?
Psoriasis
Splinter hemorrhage in the nails is assoc. w/ what?
Subacute bacterial endocarditis (Strep organism)
Transverse ridging of the nails assoc. w/ acute severe ds is called what?
Beau’s Lines
Inflammation of the nail fold near the cuticle
Paronychia
When the nail base has an angle >180 deg. & may indicates hypoxia/COPD
Clubbing
Koilonychia AKA Spoon nails are assoc. w/ what condition?
Iron deficiency anemia
Small, clicking, bubbling, or rattling sounds in the lung. They are believed to occur when air opens closed air spaces. Can be described as moist, dry, fine, & coarse. Assoc. w/ bronchitis
Rales
Lung sounds that resemble snoring. They occur when air is blocked or b/co rough through the large airways. Assoc. w/ Bronchiectasis
Rhonchi
Lung sounds that a high-pitched sounds produced by narrowed airways. They can be heard upon exhalation. Assoc. w/ asthma in young people & emphysema in older people
Wheezes
A wheeze-like sound heard upon inspiration. Usually d/t a blockage of airflow
Stridor
Consolidation of the lung. Occurs in 4 stages (consolidation, red hepatization, grey hepatization, resolution). Percussion is dull (over fluid), rales aka crackles, increased tactile fremitus, productive cough at 10 days, rusty brown sputum, possible fever, silhouette sign, & air bronchogram
Lobar Pneumonia
Productive/currant red jelly sputum & caused by Klebsiella pneumonia. Seen w/ old age or immunocompromised hosts
Friedlander’s Pneumonia
Lung condition caused by yeast/fungus. M/C seen in AIDS pts.
Pneumocystis Carinii
Caused by CMV. M/C seen in AIDS pts
Cytomegalovirus
Presents w/ low grade fever, night sweats, productive cough, yellow/green sputum, small white lesions called Ghon lesions seen on x-ray, starts in apices of the lung, crackles in upper lobe, tine test/Mantoux test, positive purified protein derivative. Most definitive test for dx is sputum culture
TB (caused by mycobacterium tuberculosis)
Inflammation of the pleura, usually producing an exudative pleural effusion & stabbing chest pain worsened by respiration & cough. Dull on percussion, dry/non-productive cough, decreased respiratory excursion, decreased tactile fremitus, dull on percussion, friction rub is present, decreased breath sounds, (+) Schepelmann’s Test
Pleurisy
A ruptured lung causing air to b/co trapped in the pleural space. Decreased chest expansion, decreased tactile fremitus, hyper-resonant, decreased breath sounds. Can occur in young, previously healthy individuals. Unilateral darkening of the chest d/t collapse of the lung; tracheal shift away from lesion.
Pneumothorax
Collapse of the lung that is usually the result of bronchial obstruction d/t a mucous plug. Presents w/ decreased tactile fremitus, dull on percussion, decreased chest expansion, decreased or absent breath sounds, on x-ray the collapsed lung will display increased density, & mediastinal shift to the same side
Atelectasis
Irreversible focal bronchial dilation that presents w/ a chronic, productive cough. CT is necessary to dx/confirm
Bronchiectasis
Defined by a long term cough w/ mucus, shortness of breath & wheezing. Cigarette smoking is the main cause. Lon g exposure to other things such as chemical fumes, dust & other substances may cause this
Chronic bronchitis/COPD
Bronchospasm constricting airways. Type I hypersensitivity rxn that is usually triggered by airborne allergens. Presents w/ tachycardia, tachypnea, decreased tactile fremitus, wheezing, eosinophils & IgE rise. Labs: Curshmann’s spirals & Charcot Laden Crystals (crystals & spirals in sputum from IgE)
Asthma
Destruction of elastic pulmonary connective tissue results in permanent dilation of the alveoli air sacs & caused by a deficiency of alpha I anti-trypsin. Presents w/ decreased tactile fremitus, hyperresonant percussion, decreased breath sounds, & prolonged expiration w/ an expiratory wheeze likely. Fluid will accumulate first in the costophrenic recesses. X-ray findings: bilat. darkened lung fields; narrowed compressed heart; horizontal ribs; flattening of the diaphragmatic domes
Emphysema
Primary malignant lung tumor that starts in the area of the bronchus. Long term hx of smoking (20-30yrs). Coughing (non-productive) more than 30 days, afebrile, dyspnea, weight loss & clubbing of the fingernails
Bronchogenic Carcinoma
Inflammation of the cartilage connection b/w the ribs & sternum. It develops as a consequence of physical activity & is worse w/ exercise. The pain increases while taking a deep breath. There will be palpable tenderness at the costosternal articulation.
Costochondritis AKA Tietze Syndrome
Painful rash following the course of a dermatome usually a single nerve. Primarily involves the DRG but when it does involve CN it is M/C’ly CN V
Herpes Zoster aka Shingles
A ds in which abnormal collection of inflammatory cells (granulomas) form as nodules. Most often appear in the lungs or lymph nodes. M/C seen in African descent in the US. X-ray: bilat. hilar lymphandenopathy
Sarcoidosis
Cancer of the lymphatic system that can spread to the spleen. M/C seen in young Caucasian males. Presents w/ fever, night sweats, weight loss, intense pruritis (release of IgE), & enlarged spleen. Best dx from biopsy looking for Reed Sternberg cells. X-ray: Unilateral hilar lymphadenopathy.
Hodgkin’s
Chronic, progressive, & frequently fatal genetic (inherited) ds of the body’s mucus glands; an abnormality in the glands that produce or secrete sweat & mucus; Loss of excessive amounts of salt; Thick accumulation of mucus in the intestines & lungs; COPD, barrel chest, pancreatic insufficiency, meconium ileus.
Cystic fibrosis
Measures the pressure of the R side of the heart. Can be made more pronounced when CHF is present by applying pressure to the liver (hepatojugular reflex)
Jugular Venous Pulsations
“Bounding” pulse; Seen w/ increased cardiac output; exercise anxiety, fever, hyperthyroidism
Pulsus Magnus
Weak or thready pulse. Seen w/ decreased stroke volume, hypovolemia, aortic stenosis, CHF
Pulsus Parvus
Pulse that alternates in amplitude. Seen w/ L ventricular failure
Pulsus Alterans
2 strong systolic peaks separated by mid-systolic dip (best felt at carotid artery; Seen w/ aortic regurgitation, aortic stenosis
Pulsus Bisferiens
Pulse w/ decreased amplitude on inspiration, increased w/ expiration (>10mmHg amplitude change); Seen w/ COPD, bronchial asthma, emphysema, pericardial effusion
Pulsus Paradoxus
A jerky pulse that is rapidly increasing & then collapsing b/c of aortic insufficiency
Water Hammer Pulse
Vibration produced by turbulent blood flow w/i the heart
Thrills (murmurs)
This heart sound is normal in children, young adults, & athletes. In >40yoa it is the earliest sign of CHF
S3 (Ventricular gallop)
This heart sound is related to stiffness of the ventricular myocardium to rapid filling
S4 (atrial gallop)
This type of murmur has a low pitch & is best heard w/ the bell of the stethoscope
Stenosis
This type of murmur has a high pitch & is best heard w/ the diaphragm of the stethoscope
Regurgitation
The mnemonic for heart murmurs which occur in diastole is ARMS & PRTS. What does it stand for?
Aortic Regurgitation, Mitral Stenosis
Pulmonic Regurgitation, Tricuspid Stenosis
(opposite occurs during systole)
Failure of shunt to close b/w the aorta & L pulmonary art. Creates a continuous/machinery like murmur that can be heart in both phases of the heart cycle
Patent Ductus Arteriosus
Dextraposition of the aorta, R ventricular hypertrophy, Interventricular septal defect, & Pulmonic stenosis. Creates a loud ejection murmur during systole & severe cyanosis
Tetralogy of Fallot (DRIP)
Constriction of the descending aorta (usually distal to the L subclavian). Causes higher blood pressure in the UE by 20mmHg (diagnostic) when compared to the LE. Commonly assoc. w/ Marfan’s Syndrome.
Coarctation of the Aorta
Narrowing prox. to the vertebral art. Seen in younger females who faint (syncope/drop attacks) while exercising.
Subclavian Steal Syndrome (“Subclavian steals from the vertebral”)
What are the M/C causes of L-sided heart failure?
HTN (M/C)
Aortic stenosis
What is the M/C cause of R-sided heart failure?
L-sided heart failure
What is the M/C cause of mitral stenosis?
Rheumatic fever
Lung condition that causes R-sided heart failure. When the R-side fails by itself
Cor Pulmonale
On an ECG, an increased PR interval indicates what?
Prolonged AV nodal delay (primary heart block)
On an ECG, two P waves before the QRS is what?
Weinkbochs-block of bundle of HIS (Secondary heart block)
On an ECG, no QRS wave indicates what?
Complete heart block (no ventricular contractions)
On an ECG, if the ST segment is enlarged or inverted it indicates what?
MI (acute heart failure)
Increase in what lab values indicate MI?
Creatine Phosphokinase (CPK)
SGOT
LDH
BUN is used to test what organ(s) functions?
Liver
Kidneys
Tumor marker specific for hepatocellular carcinoma
Alpha fetoprotein
Calcification of the gallbladder that may b/co malignant d/t chronic inflammation
Porcelain Gallbladder
This organ can refer pain to the R shoulder or tip of R scapula
Gallbladder
Epigastric pain going straight through the T10-T12 area like a knife should make you think what organ?
Pancreas (pancreatitis)
Bleeding into the flank assoc. w/ pancreatitis is what sign?
Grey Turner sign
Periumbilical ecchymosis assoc. w/ pancreatitis is what sign?
Cullen’s Sign
Pancreatic cancer usually affects what part of the pancreas?
Head
Condition of the pos. pituitary gland in which there is insufficient ADH. May have polydypsia, polyuria, but not polyphagia
Diabetes Insipidus
Protrusion of the stomach above the diaphragm. PResents w/ palpable tenderness in LUQ, reflux esophagitis, dyspepsia, made worse after eating large meal or when lying down
Hiatal Hernia
Projectile vomiting in the newborn
Pyloric Stenosis
Presents w/ symptoms similar to the flu such as fever, HA, fatigue, lymphadenopathy in the cervical region, splenomegaly. Atypical lymphocytes in blood (Downey cells). Tested w/ Monospot AKA Heterophile Agglutination AKA Paul Bunnell Test. Caused by Epstein Barr Virus
Mononucleosis
A systemic or metabolic condition that involves every bone. The bone marrow b/co sclerotic so RBCs aren’t made. The liver & spleen make RBCs & b/co enlarged
Osteopetrosis “Marble Bone”
Nonspecific inflammatory disorder that affects distal ileum & colon. Inflammation is patchy w/ healthy tissue b/w the patches, which is referred to as a ‘cobblestone’ appearance. Doesn’t absorb B12.
Regional Ileitis AKA Crohn’s Ds
M/C at the colon & rectum. Presents w/ bloody mucous in diarrhea, fever. Can lead to sacroiliitis (enteropathic arthropathy)
Ulcerative Colitis
Variable degrees of constipation & diarrhea in response to stress. Seen more commonly in females. Abdominal pain & gas relieved by bowel movements
IBS AKA Spastic colon
