General Diagnosis (Irene Gold) Part II and III Flashcards
What are the five components of a health history?
Chief Complaint Past Health History Personal and Social History Review of Systems (ROS) Present Illness
What six things need to be asked to the patient when asking about Present Illness?
Onset Palliative/Provoking Quality of Pain Radiation/Referral Site/Setting/Severity Timing/Temporal Factors (OPQRST)
What is indicated if there is a sudden onset of pain?
Neuromuscular Problem
If pain has an insidious onset, what is the likely cause?
Cancer
If nothing makes that pain better or worse, what does the patient possible have?
Cancer
How are you able to tell if a patient is having a neuromuscular skeletal problem?
The patient is able to find relief from pain in a certain position
If a patient complains of no localization of pain, where is the pain very likely from?
Originating from an organ
If pain is stated to be a “throbbing pain”, what does it indicate?
Vascular
What is a descriptive word to describe a pain in the muscle?
Aching
If the patient describes the pain as “Burning” what is the likely cause of the pain?
Nerve
What kind of pain is described for a dissecting aneurism?
Tearing Pain
What questions need to be asked to the patient about past health history? (7 Things)
Surgeries
Hospitalizations
Illness (Serious)
Trauma
Previous Injury
Allergies
Medications
What five questions that need to be known from family history?
Cardiovascular Disease Diabetes Stroke Cancer Arthritis
What questions/categories do you need to ask about pertaining to the social/personal history of a patient? (8 Topics)
Marital Status Occupation Diet Exercise Bowel/Urinary Problems Sleep Alcohol, Tobacco, and Drug use Stress
What is the questionnaire to help determine if someone may be an alcoholic?
CAGE Questionnaire
What are the four parts of the CAGE Questionnaire?
C- Cutting Down (Have you ever felt the need to cut down on your drinking?)
A- Annoyed by others criticisms (Have you ever felt annoyed by criticism of your drinking?)
G- Guilty Feeling (Have you ever felt guilty about your drinking?)
E- Eye openers (Have you ever felt that you needed a drink to start your day?)
What is the normal oral temperature?
98.6 F
What is the normal Rectal and Tympanic temperature?
99.6 F
What is the normal Axilla temperature?
97.6 F
What is considered normal range for body temperature?
96-99.5 F (35-37.5 C)
What is the normal pulse rate of an Adult?
60-100 Beats/Min
What is the normal pulse rate for a Newborn?
120-160 Beats/Min
What is the normal pulse rate for a person of older age?
70-80 Beats/Min
What is the normal Respiration Rate of an Adult?
14-18 Breaths/Min
What is the normal Respiration Rate of a Newborn?
44 Breaths/Min
What is the normal Blood Pressure in an Adult?
90-120/60-80
Do blood pressure values increase or decrease in elderly people?
Increase
What blood pressure would indicate Hypertension?
140/90
What blood pressure would indicate Hypotension?
90/60
In what population would it be common to see an auscultatory gap?
Patients with hypertensive blood pressures
What is the definition of an Auscultatory Gap?
The loss and reappearance of the pulsatile sound while listening with the stethoscope during cuff deflation
What is being described as “low pitched sounds produced by turbulent blood flow in the arteries”?
Korotkoff Sounds
If there is a difference of 10-15 mm Hg in systolic reading, what vessels are being disturbed and what is the name of this condition?
Arterial Occlusion- Vessels being disturbed
Subclavian Steal- Name of the condition
What is the AKA for Subclavian Steal?
Transient Ischemic Attack (TIA)
From what artery is blood taken, during a Subclavian Steal?
Vertebral Artery
When the blood pressure is taken in the lower extremity how much higher will the readings be?
20%
Coarctation of the Aorta
Which test can be used to determine if a patient has Vertebrobasilar Artery Insufficiency? (6 exams)
Barre-Lieou DeKleyn's Hallpike Hautant's Underberg Maigne's
How do you perform the orthopedic test of: Barre-Lieou
Patient is seated, Doctor instructs patient to rotate the head maximally from side to side.
This is done slowly to start and then accelerated to patient tolerance
What does a positive Barre-Lieou test indicate?
Vertebrobasilar Artery Insufficiency
What is a positive finding of Vertebrobasilar Artery Insufficiency exams?
Dizziness
Light Headedness
How do you perform the orthopedic test of: DeKleyn’s
Patient is Supine. Doctor instructs patient to rotate and extend the head off the table then to turn to each side for 15-45 seconds.
Doctor can lend minimal support
How do you perform the orthopedic test of: Hallpike
Enhanced DeKleyn’s
Patient supine, head is extended off the table. Doctor offers support of the skull.
Doctor brings the head into extension, rotation and lateral flexion
How do you perform the orthopedic test of: Hautant’s
Patient is seated, arms extended forward to shoulder level with the hands supinated. Patient maintains this position for a few seconds. Patent then closes the eyes, rotates and hyperextends the neck to one side.
Repeated on opposite side
How do you perform the orthopedic test of: Underberg
Patient stands with eyes open, arms at side, feet close together. Patient closes their eyes, extends arms and supinates hands, then the patient extends and rotates head to one side. Then in this position patient is instructed to march in place.
How do you perform the orthopedic test of: Maigne’s
Patient is seated, Doctor brings had into extension and rotation
What clinical significance does scaly eyebrows have?
Seborrhea
In what two categories of people with you see a loss of the lateral 1/3 of the eyebrow?
Myxedema (AKA Hypothyroidism)
Elderly
What is another name for Myxedema?
Hypothyroidism
What condition is described by “sluggish pupillary reaction to light that is unilateral and caused by parasympathetic lesion of CN III”?
Adie’s Pupil
Similar to Argyll Robertson’s; but seen after 25 years of Syphilis
How would you describe Adie’s Pupil?
What age is usually affected?
A sluggish pupillary reaction to light that is unilateral and caused by parasympathetic lesion of CN III
Younger Age: 10-20
What is the description of Anisocoria?
Unequal pupil size
What are three possible cause of Anisocoria?
Drugs
Pathological
Trauma
Name the condition that is described as the following: “bilaterally small and irregular pupils that accommodate but do not react to light”?
Argyll Robertson’s
How would you describe Argyll Robertson’s pupil?
A bilaterally small and irregular pupils that accommodate but do not react to light
In what gynecological disease is Argyll Robertson’s pupil common in?
Syphilis
Argyll Robertson’s pupil with syphilis is called “Prostitutes Pupil”
What is Arroyo Sign?
Sluggish pupillary reaction due to hypo-adrenalism
What is another name for Hypo-adrenalism?
Addison’s Disease
What is the common microorganism to produce Blepharitis?
Staphylococcus, found on the skin
What condition of the eye is described: “inflammation of the eyelid”?
Blepharitis
How would you describe Blepharitis?
Inflammation of the eyelid
In what condition would you commonly see Blepharitis? (3 Conditions)
Seborrhea
Staph Infection
Inflammatory Process
What condition is “opacities seen in the lens” Also had an “Absent Red Light Reflex”?
Cataracts
In what two populations are cataracts frequently found in?
Diabetics
Elderly
What is the description of a Chalazion?
An infection of the meibomian gland causing a nodule which points inside the lid
How is the condition Corneal Arcus described?
Grayish opaque ring around the cornea
What significance does Corneal Arcus have in and elderly person?
No clinical problem and does not indicate anything pathological
If Corneal Arcus is seen in a younger (20-40 year old patient), what is a possible diagnosis?
Hyper cholesterolemia
Which vessel does the condition of Diabetic Retinopathy affect more?
Veins, more than arteries
What finding will you have with Diabetic Retinopathy? (3 Things)
Micro-aneurysms
Hard/Waxy Exudates
Neovascularization
Ectropion and Entropion are most commonly seen in what population?
Elderly
What is Ectropion?
Eyelid turned outward (Dry Eyes)
What is the name of the condition when the eyelid is turned inward?
Entropion
Eye Irritation from the eyelashes rubbing on the eyeball
How is Exophthalmosis described?
Lid lag/failure to cover the eyeball
What two conditions will often be associated with Exophthalmosis?
Grave’s Disease (Aka- Hyperthyroidism)
Will be seen Bilaterally
Tumor
Seen Unilaterally
What condition is described by “increase intraocular pressure causing cupping of the optic disc”?
Glaucoma
Acute Glaucoma will be painful
In Glaucoma what is the cup to disc ratio?
Less than 1:2
What early visual problems with a patient have leading up to Glaucoma?
Blurring of their vision, especially in the peripheral fields
Rings around lights
What is it called in a patient that had Glaucoma and has a tangential lighting of the cornea?
Crescent Sign
What is the fastest blindness seen in a patient with Glaucoma?
Closed Angle Glaucoma
What is the name given to an infection of the sebaceous gland causing a pimple or boil on the eyelid?
Hordoleum (sty)
What are the common finding of a patient with Horner’s Syndrome?
Ptosis
Miosis
Anhydrosis
Which side of the cervical sympathies are effected in Horner’s Syndrome?
Ipsilateral side
What is a common radiographic finding with Horner’s Syndrome?
Pancoast Tumor (Seen in the apex of the lung)
What are signs of Hypertensive Retinopathy? (5 Findings)
Copper Wire Deformity Silver Wire Deformity A-V Nicking Flame Hemorrhages Cotton Wool Soft Exudates
What eye condition will have “dilated pupil with ptosis and lateral deviation”?
Internal Ophthalmoplegia
What two things will Internal Ophthalmoplegia not react to?
Light
Accommodation
What serious disease has Internal Ophthalmoplegia paired with it?
Multiple Sclerosis
What is the name of the condition that has “inflammation of the iris”?
Iritis/ Uveitis
What condition has a finding of Iritis?
Ankylosing Spondylitis
What is the most common reason for blindness in the elderly?
Macular Degeneration
What are early signs of Macular Degeneration?
Central Vision Loss Macular Drusen (Yellow deposits under the retina)
What is Macular Drusen?
Yellow deposits under the retina, seen in the condition of Macular Degeneration
What condition is described as “fixed and constricted pupils that react to light and accommodate”?
Miosis
What three conditions are commonly seen with Miosis?
Severe Brain Damage
Pilocarpine Medications
Narcotic Use
What is the description of Mydriasis?
Dilated and Fixed pupils
When would you most like see a patient with Mydriasis?
Anticholinergic Drugs (i.e. Atropine, Mushrooms, Death)
What is another name for a Choked Disc?
Papilledema
Use the rectangular slit on the Ophthalmoscope to test
What causes Papilledema?
Swelling of the optic disc due to increased intracranial pressure
When would you possible see Papilledema?
Patient with a:
Brain Tumor
Brain Hemorrhage
Is a sign of Papilledema, vision loss?
No
Vision loss is seen with Optic Neuritis
What is the name of the condition with “swelling around the eyes”?
Periorbital Edema
In what three conditions will you see Periorbital Edema?
Allergies (Most Common)
Myxedema
Nephrotic Syndrome (HEP; Hypertension, Edema, Proteinuria)
How would you describe a Pinquecula?
Yellowish Triangular NODULE in the bulbar conjunctiva, that is HARMLESS, and indicates aging
What condition is described as: “triangular THICKENING of the bulbar conjunctiva that grows ACROSS the cornea and is brought on by dry eyes”?
Pterygium
Surgery is needed
How is the condition of Ptosis described?
Drooping of the eyelid
What are four conditions that are common to have Ptosis found in them?
Horner’s Syndrome
Cranial Nerve III (Oculomotor)
Myasthenia Gravis (Bilateral)
Multiple Sclerosis
What disorder is described as “painless sudden onset of blindness”?
Retinal Detachment
What three signs are described leading up to Retinal Detachment?
Curtains closing over vision
Lighting Flashes
Floaters
What does the following color of sclera indicate:
White
Yellow
Blue
White: Normal
Yellow: Jaundice
Blue: Osteogenesis Imperfecta
What condition is described by: “fatty plaques on the nasal surface of the eyelids that may be normal or an indication of hypercholesterolemia”?
Xanthelasma
If you believe a patient has hypercholesterolemia, what two other conditions should you look for?
Xanthelasma
Other vascular problems
What is the clinical name for normal vision?
Emmetropia
What is the clinical word for Nearsightedness?
Myopia
What is the clinical word for Farsightedness?
Hyperopia
If a patient has decrease lens elasticity due to aging and is unable to see close up, but can see far away, they are said to have what clinical description?
Presbyopia
What four tests are carried out to check the integrity of Cranial Nerves II and III?
- Direct Light Reflex
- Consensual Light Reflex
- Swinging Light Test (Also Looking for any eye Pathologies)
- Accommodation
How is Visual Acuity tested on a patient?
Snellen Eye Chart
What cranial nerves are being checked, when Cardinal Fields of Gaze is carried out?
Cranial Nerves: III, IV and VI
What is the name of the cranial nerve IV?
What is it’s primary function?
What would a problem or lesion here look like?
Name- Superior Oblique
Primary Function-
Lesion-
What is the name of the cranial nerve VI?
What is it’s primary function?
What would a problem or lesion here look like?
Name- Lateral Rectus
Primary Function-
Lesion-
What Cranial Nerve is affected in Acoustic Neuroma?
CN VIII
What is Acoustic Neuroma and what is another name of it?
Benign tumor
AKA- Schwannoma
What are three common signs seen with Acoustic Neuroma?
Hearing Loss
Tinnitus
Vertigo
How is Acoustic Neuroma confirmed?
Tumor present on a CT or MRI
What is it called when there is a bacterial infection of the mastoid process?
Acute Mastoiditis
May present similarly to Purulent Otitis Media
What are two common signs will be seen with Acute Mastoiditis?
Inflammation and Palpatory tenderness over the mastoid
Hearing Loss is also commonly associated
What is the clinical term for “infection of the outer ear”?
Acute Otitis Externa
What is the more common name for Acute Otitis Externa?
Swimmer’s Ear
What are the signs of Acute Otitis Externa?
Inflammation and Pain over the outer ear
What is a noninvasive way to see if someone has Acute Otitis Externa?
Tugging on the Pinna will be painful
What condition is brought on by change in head position and is usually brief in it’s duration?
Benign Paroxysmal Positional Vertigo
How is Benign Paroxysmal Positional Vertigo diagnosed?
Orthopedic Exam: Dix-Hallpike Maneuver
How is the Dix-Hallpike Maneuver performed?
Patient rapidly moves from a seated to a supine position with head turned at 45 degrees to the left and waits 30 seconds.
Repeat this procedure on the right side if nystagmus is seen.
What finding indicate a positive Dix-Hallpike Maneuver?
Nystagmus
Nausea
Vertigo
If a patient has a “retraction of the tympanic membrane” what condition do they more than likely have?
Eustachian Tube Block
No fluid bubbles
What are two other names for Meniere’s Disease?
Central Vertigo
Endolymphatic Hydrops
What are the characteristics of Meniere’s Disease? (4 Possible)
Recurrent Prostrating Vertigo
Sensory Hearing Loss
Tinnitus (Ringing of the Ears)
Feeling a fullness in the ear
What condition is described as “Sensorineural hearing loss that occurs in people as they age and may be affected by genetic or acquired factors”?
Prebycussis
What is another name for Bacterial Otitis Media?
Purulent Otitis Media (PUS)
What may be a cause of Bacterial Otitis Media?
Bacterial or viral infection of the middle ear
What is the three classic findings of Bacterial Otitis Media?
Red tympanic membrane
Dilated blood vessels
BULGING tympanic membrane
What are two ways that someone can get Serous Otitis Media?
Effusion of the Middle ear by:
- Incomplete resolution of acute otitis media
- Obstruction of the Eustachian Tube
What is unique about Serous Otitis Media
AND
What does it look like clinically?
Unique- Chronic condition; Sucks the eardrum inward
Clinical Appearance- Fluid is an Amber color and has bubbles
What is the clinically term for “ringing in the ears”?
Tinnitus
How is the condition of Vertigo described?
Abnormal sensation of Rotatory movement
If someone has vertigo, what three things may they have difficulty with?
Difficulty with:
Gait
Balance
Navigation of the Environment
What is the clinical presentation of Allergic Rhinitis?
Nasal mucosa appears Pale/Blue and Boggy
How can you tell if a patient has Atrophic Rhinitis?
Thinning of the nasal mucosa with sclerosis, Crust formation and Foul odor
What condition typically will occur as a consequence of chronic inflammation of the nasal mucosa?
Polyps
If a patient has a nasal mucosa that appears red and swollen with a clear runny nose, what condition do they have?
Viral Rhinitis
What is another name for Cheilosis?
Angular Stomatitis
What condition is described by red sores at the corner of the mouth, that may be accompanied by bleeding?
Cheilosis AKA Angular Stomatitis
What may cause a patient to have Angular Stomatitis?
Deficiency of B2 (Riboflavin)
What is the clinical name for Thrush?
Candidiasis
What three populations are prone to get Candidiasis?
Pregnant Women
Bartenders
Diabetics
How is Candidiasis described?
What is a way to tell a patient has Thrush versus Leukoplakia?
Description: Thick white fungal patches
Thrush; will easily scrape off the tongue
What condition does a patient have if their tongue appears to be “Smooth and Glossy”?
Atrophic Glossitis
A deficiency of what two vitamins/minerals may cause Atrophic Glossitis?
B Vitamins (B-12) Iron
What populations are common to have Leukoplakia?
Smokers and Tobacco users
What is the condition of “Pre-cancerous lesions of white patches that are adherent to the surface of the tongue and not easily removed”?
Leukoplakia
What is commonly found with Leukoplakia?
Fordyce Spots; Yellow Spots on the Tongue
What clinical condition is described by “excessive production of growth hormone, beginning in middle age”?
Acromegaly
What classic characteristics will you see in a person with Acromegaly?
Abnormal/Enlarged Growth in:
Hands
Feet
Facial Bones
In a patient that has Acromegaly, where is the problem located?
Pituitary Tumor
What is the definition of Gigantism?
Excessive production of growth hormone prior to skeletal maturity
What is the most common cause of Hyperthyroidism?
Grave’s Disease (Autoimmune Disorder)
In Hyperthyroidism what hormone is:
Decreased
and
Increased
Decreased: Thyroid Stimulating Hormone (TSH)
Increased: Thyroid Hormones
- T3- Triiodothyronine
- T4- Thyroxine
What is another name for Hypothyroidism?
Myxedema
What causes Myxedema/Hypothyroidism?
Increase in Thyroid Stimulating Hormone (TSH)
What is the most common cause of Hypothyroidism in the United States?
Hashimoto’s Thyroiditis
What is it called when someone has congenital hypothyroidism?
Cretinism
What two problems will and patient with Cretinism have?
Diminished Capacities for:
Physical
Mental
What two conditions will you often see a Barrel Chested appearance?
Chronic Obstructive Pulmonary Disease (COPD)
Cystic Fibrosis
On an x-ray what is the ratio of AP to Lateral, to determine if a patient has a Barrel Chest?
1:1
What are two Congenital Anomalies of the chest?
Pectus Excavatum
Pectus Carinatum
What is an AKA for Pectus Excavatum?
Funnel Chest
What is an AKA for Pectus Carinatum?
Pigeon Chest
How is Pectus Excavatum clinically described?
Marked depression noted in the sternum (Sunken In)
How does Pectus Carinatum present?
Forward protrusion of the sternum (Like the keel of the ship)
How is Tachypnea classified?
Rapid, Shallow Breathing
What is the clinical term for Slow breathing?
Bradypnea
A pattern of breaths defines as follows: “Group of quick, shallow inspirations, followed by IRREGULAR periods of apnea”, is called _______________?
Biot’s Breathing
No Pattern to Breathing
What is the clinically description of Cheyne Strokes Respiration?
Breathing pattern characterized by alternating periods of apnea (no breathing) and hyperpnea (has pattern)
In what condition will you see a patient present with Cheyne Strokes Respiration?
Respiratory Acidosis
What is the name of breathing found in patients with Diabetic Acidosis?
Kussmaul’s
What kind of breathing pattern would a patient with Diabetic Acidosis present with?
Breaths would be rapid and shallow in the beginning, as metabolic acidosis get worse, breathing would become deep, slow, labored and gasping.
Patients that have Metabolic Acidosis, have breathing called:
“Air Hunger Breathing”
What condition would you commonly see Pitted Nails?
Psoriasis
What disorder does a patient have if they have, splinter hemorrhage in the nails?
Subacute Bacterial Endocarditis
A patient with transverse riding associated with acute severe disease has a condition called:
Beau’s Lines
What is the clinically name given to inflammation of the nail fold near the cuticle?
Paronychia
If a patient has clubbing of the nails, what two conditions may they have? One being an early sign, the other being later.
Hypoxia (Early Sign)
COPD (Late)
Clubbing of the nails, indicates a decrease in oxygen in the blood, what condition may this be linked to?
Bronchogenic Carcinoma
If a patient presents with a spooning appearance to their nails, what are they likely deficient in?
Iron, Causing Iron Deficiency Anemia
What is the clinical name of Spoon Nail?
Koilonychia
How do you preform Respiratory Excursion?
Place hands over the patients ribs and have the patient take a few deep breaths
When preforming Tactile Fremitus, if vibrations are increased, what is that a indication of?
Pneumonia- Fluid in the lung
Possible Congestive Heart Failure (CHF); Pulmonary Edema
What may cause Tactile Fremitus to be decreased?
Air:
Emphysema
Pneumothorax
Sound Barrier is Created with:
Atelectasis
Pleurisy
What is the term used over normal lung tissue/sounds?
Resonate
What will cause lung sounds to be hyperresonant?
Increase air in the chest (i.e. Emphysema, Pneumothorax)
If a patient presents with Pneumonia or Atelectasis, what kind of lung sound will be produced?
Dull
How is Diaphragmatic Excursion performed?
Doctor ask patient to exhale and hold. Doctor percusses do the back of the intercostal margins (bone will be dull) starting below the scapula, until the sound changes from resonant to dull. Doctor marks that spot. Then the patient takes a deep breath in and holds. The doctor percusses down again, marking the spot where the sound changes from resonate to dull again. Doctor will measure the distance between the two spots.
If there is LESS than 3-5 cm, patient has pneumonia or pneumothorax, use chest x-ray to diagnose.
What should the tracheal duration be; ratio of Inspiration versus Expiration?
Inspiration should be equal to expiration
Where should the location of the tracheal breath sounds be heard?
Over the Trachea
When comparing Inspirations versus Expirations of the Bronchial breath sounds what is the duration?
Expirations should be LONGER than Inspirations
Where is the best location to hear bronchial breath sounds?
Over the Manubrium
What is normal duration for brochovesicular breath sounds?
Inspiration is equal to Expiration
Where is the best location to hear brochovesicular breath sounds?
Between 1st-2nd rib Anteriorly
Between the Scapulae Posteriorly
Vesicular breath sounds; what is normal duration?
Inspiration LONGER than Expiration
Where is the best location to listen to Vesicular breath sounds?
The remaining lung field
What condition are Rales often associated with?
Bronchitis
A small clicking, bubbling or rattling sound, maybe described as moist, fine, dry or coarse in the lung is a description of _______?
Rales
What abnormal lung sound resembles snoring?
Rhonchi
When does a Rhonchi happen?
When air is blocked or becomes rough through large airways
When is a rale likely to be heard?
When air opens and closed air space
What condition will be see with Rhonchi?
Bronchiectasis
What type of sound and how is a Wheeze produced?
High pitched sound, through narrow airways
Lower Airway Expansion
Is a wheeze herd upon inspiration or expiration?
Exhalation
What two population will you hear wheezes in? One old and one young population.
Young: Asthma
Older: Emphysema
What is it called when you have a wheeze like sound on inspiration?
Stridor
Upper Respiratory Infection
Stridor is commonly found in children with _________?
Croup
How is stridor produced?
Usually a blockage of airflow
What is a positive finding for Bronchophony?
If clear, distinct sounds are heard as patient says “99”, consolidation is present
What is a positive finding for Egophony?
If you hear “AAAA” as the patient says “EEEEE”, consolidation is present
What is a positive finding for Pectoriloquy?
If the words “1,2,3” are heard clearly and distinctly, consolidation is present
What three Vocal Resonance test can be performed, to see if consolidation is present in the lungs?
Bronchophony
Egophony
Pectoriloquy
Solid substances makes sounds better, knocking on a table
When performing a hearing exam what is “Normal Hearing” for the Weber test?
Equal sound heard bilaterally
What is a positive finding in conduction loss, when performing Weber’s test?
Lateralizes to the involved ear
Sensorineural hearing loss is a positive finding when the Weber test is heard in which ear?
Sound lateralizes to the uninvolved ear
What is considered a positive Rinne test?
Air Conduction (AC) is Greater then Bone Conduction (BC) Normal Hearing
What two findings would indicated a negative Rinne test?
Air Conduction (AC) is Less then Bone Conduction (BC) or Air Conduction (AC) is Equal to Bone Conduction (BC)
Conduction Hearing Loss
What finding will you have in the Rinne test, with a patient who has Sensorineural hearing loss?
Air Conduction (AC) will be Greater than Bone Conduction (BC), with less time in the bad ear
What causes Secondary Hyperparathyroidism?
Decreased stimulation of Thyroid Stimulating Hormone (TSH), from the Pituitary gland
What are four other names for a Common Migraine?
Sick
Vascular
Ocular
Hormonal
What age/time and gender does a Common Migraine usually effect?
Age/time- Childhood and Early Adulthood
Gender- Females
What are the four characteristics of a Common Migraine?
Photophobia
Throbbing
Worse behind one eye
Nausea and/or vomiting
When are three other things to know about Common Migraines?
Familial
Decreases frequency as the person ages
Decreases with pregnancy
What seven things can provoke a Common Migraine and/or a Classic Migraine?
Bright light Chocolate Cheese Tension Red wine Menstrual cycle Hypoglycemia
What are six follow ups that can be done to help with Common Migraine?
Dietary log Adjust Avoid provoking/triggering factors Decrease stress Massage FeverFu- 125QD (Drug to help decrease frequency)
What age/time and gender does a Classic Migraine usually effect?
Classic Migraine, is a Neurologically Event
Age/time- Childhood and Early Adulthood
Gender- Females
Is a Classic Migraine usually Unilateral or Bilateral?
Unilateral
What are the five characteristics of a Classic Migraine?
Aura, Prodrome-sensory changes before it comes on
```
Same as Common Migraine
Photophobia
Throbbing
Worse behind one eye
Nausea and/or vomiting
~~~
What age/time does a patient experience a Hypertension headache?
Adulthood
What is the common location of a Hypertension headache?
Occipital
Vertex
What are two characteristics of a Hypertension headache?
Throbbing
Wake up with a headache
What two follow ups would you do if a patient presents with a Hypertension headache?
Blood pressure
Lipid profile
What age/time and gender does a Cluster headache usually effect?
Age/time- Adolescents to Adulthood
Gender- Males
What are three common sites for a Cluster headache to show up?
Unilateral
Orbital
Temporal
What are the seven characteristics of a Cluster headache?
**Wake up at night with headache (Comes on after sleep)
Last 15-180 minutes
Rhinorrhea (Runny nose)
Lacrimation
Facial sweating
Red eye
Miosis
NOT aggravated by exertion
What are two provoking factors of a Cluster headache?
Alcohol
Seasonal (Allergy testing)
Headaches usually occur together in “clusters”
What age is effected by a Muscular tension headache?
Any age
What is the location/site of a Muscular tension headache?
Band like
What are three characteristics of a Muscular tension headache?
Pressure
Muscle tightness
What are four provoking triggers for a Muscular tension headache?
Fatigue
Tension
Stress
Work
What are two other names for Temporal Arteritis?
Giant cell
Polymyalgia Rheumatica
What age is usually effected by Temporal Arteritis?
Over 50
What site/location will you commonly see Giant Cell headaches?
Unilateral
Temporal
Proximal muscle pain and stiffness
What are the six characteristics of Temporal Arteritis?
Persistent burning Aching Throbbing *Scalp tenderness* *Pain with combing of the hair* Pain with chewing (Jaw Claudication)
What are the two triggers that provoke Giant Cell headaches?
Scalp sensitivity
Tender arteries
What is the follow up with a patient that has Polymyalgia Rheumatica? (3 things)
ESR elevated
Biopsy of arteries
Look at the amount of inflammatory drugs, can cause blindness (Medical Realm)
What is another name for a Cervicogenic headache?
Veterbrogenic headache
What must be done before you adjust someone with a Veterbrogenic headache?
Flexion and Extension Films
What age usually gets Cervicogenic headaches?
Adults
What is the two common site/location or a Veterbrogenic headache?
Occipital
Upper cervical
May have a congenital anomaly
What may provoke a Veterbrogenic headache?
Head movement
What are three characteristics of a Cervicogenic headache?
Often daily
Decrease ROM in upper cervicals and occiput
Pain in the neck that refers to the head
What are the follow up to Cervicogenic headaches?
Flexion and Extension X-rays
Adjust, best treatment
What are three characteristics of a Sinus headache?
Steady throb
Localized tenderness
Worse in the morning
What provokes a Sinus headache?
Chronic sinusitis
Where is a common site of pain for someone who has a Subarachnoid hemorrhage?
Basilar area
What are the four characteristics of a Subarachnoid hemorrhage?
Abrupt onset
Constant
Stiff neck
Excruciating pain, pain like never felt before
What are the two provoking factors of a Subarachnoid hemorrhage?
Stress
Hypertension
What is the follow up to a patient with a Subarachnoid Hemorrhage?
Call 911
High Blood Pressure
Fever
What are the two characteristics of a Subdural hematoma?
Slow bleed following and trauma
Evident days to weeks post injury
What provokes a Subdural hematoma?
Trauma/Injury
What is the follow up to a Subdural hematoma?
Send to ER
What is the painful site/location of a Brain tumor?
Any place and changes with body position
What are the four characteristics or a Brain tumor?
Onset in the morning or evening
Mild to severe pain
Throbbing
Progressively worse
What is the follow up to a Brain tumor?
MRI or CT of the brain
Refer to a Neurosurgeon
What is the worse time of Meningitis?
Bacterial
Where will the pain be for Meningeal Irritation?
Neck
What are the four characteristics or Meningeal Irritation?
Intense pain
Deep pain
Stiff neck
Pain that has never been experienced before
What action will provoke Meningeal Irritation?
Flexion of the neck
What follow up will be done to confirm Meningeal Irritation?
Cerebrospinofluid (CSF) tap
What two orthopedic exams will be positive if a patient has Meningeal Irritation?
Brudzinski
Kernig
When a CSF tap, is done on a patient with Meningeal Irritation, what will be the findings in Bacterial and Viral Meningitis?
Bacterial- Decrease Sugar
Viral- Increase Protein
What can provoke a Hypoglycemic headache?
Skipping meals
Who would you refer a patient to that has a Hypoglycemic headache?
Endocrinologist
What is the follow up of a patient with a Hypoglycemic headache?
Fasting Blood Sugar (FBS)
What are the two characteristics of a Post Concussive injury?
Loss of memory
Visual disturbances
What four things could provoke a Post Concussive injury?
Fall
Motor Vehicle Accident (MVA)
Whiplash injury
Trauma
What is the follow up for a patient that has a Post Concussive injury?
Refer to Neurologist
ER
In what three conditions will you have a Resonant sound on Percussion?
Asthma
Bronchiectasis
Bronchitis
In what three conditions would you have a Dull/Flat sound during Percussion?
Atelectasis
Pleurisy
Pneumothorax
What two conditions will you have a Hyperresonant sound during Percussion?
Emphysema
Pneumonia
What is a common cause of Bronchiectasis?
Post nasal drip
What side will the Trachea deviate on a Pneumothorax and Atelectasis on X-ray?
Pneumothorax- Opposite Side
Atelectasis- Same Side
What five conditions will you have a Decrease in Fremitus?
Asthma Atelectasis Emphysema Pleurisy Pneumothorax
What condition will you have an Increase in Fremitus?
Pneumonia
What two conditions will you have a Normal Fremitus?
Bronchiectasis
Bronchitis
What breath sounds are heard with Asthma and Emphysema?
Wheezing
What breath sound is heard with Atelectasis?
Absent (Nothing heard)
What breath sound is heard with Bronchiectasis?
Rhonchi
What breath sound is heard in Bronchitis?
Rales
With Pleurisy, what breath sounds are heard?
Crackles (Friction Rub)
Are breath sounds increased or decreased with Pneumothorax?
Decreased
What breath sounds will be heard in a patient with Pneumonia?
Egophony (EEEE)
Brocholphony (99)
Whispered Pectoriloquy (1,2,3)
Crackles
What condition has consolidation of the lung?
Lobar Pneumonia
What are the three characteristics of Lobar Pneumonia?
Productive cough for around 10 days
Rusty Brown Sputum
Fever
What x-ray finding is seen with Lobar Pneumonia?
Silhouette Sign
What two populations will have Friedlander’s Pneumonia?
Older aged individuals
Immune-compromised
What are two characteristics of Friedlander’s Pneumonia?
Productive Cough
Currant Red Jelly Sputum Caused by Klebsiella Pneumonia
Seen frequently in Alcoholics
What is the common cause of Pneumocystis Carinii?
Yeast/Fungus
What population is most likely to get Pneumocystis Carinii and Cytomegalovirus?
AIDS patients, opportunistic infection
What is the common presentation of a patient with Tuberculosis? (4 Things)
Low grade fever
Night sweats
Productive cough
Yellow/Green Sputum
What X-ray finding are seen with someone with Tuberculosis?
Ghon lesions (small white lesions)
What three test will be positive in a patient with Tuberculosis?
Mantoux Test
Tine Test
Purified Protein Derivative
What is the most definitive test for Tuberculosis?
Sputum culture
What is the name of the condition that has; “ stabbing chest pain worsened by respiration, with a dry/non productive cough”?
Pleurisy
What are four ways to help determine that a patient has Pleurisy?
Decreased respiration excursion
Deceased tactile fremitus
Dull on Percussion
Friction rub is present
What orthopedic exam is positive in a patient with Pleurisy?
Schepelmann’s Test
What condition is defined as “A ruptured lung causing air to become trapped in the pleural space”?
Pneumothorax
Trachea goes Away
What two things will be deceased in Pneumothorax?
Chest expansion
Breath sounds
Who can a Pneumothorax happen to?
Young, tall thin, previous healthy male individuals (Spontaneous)
How is an Atelectasis described?
Collapse of the lung, usually a result of a Bronchial Obstruction due to a mucous plug
What condition is “Irreversible focal bronchial dilation that is present with a chronic, productive cough”?
Bronchiectasis
Diagnosed by: CT
What is another name for Chronic Bronchitis?
Chronic Obstructive Pulmonary Disorder (COPD)
What is the main cause of COPD?
Cigarette smoking, if the patient is not a smoker, Cigarette Smoke makes it worse
In a patient who has Asthma, what is happening in the lungs?
Bronchospasm constricting the airways
What triggers Type I hypersensitive Asthma?
Airborne allergens
What are two clinical presentations of a patient who has Asthma?
Tachycardia (Increased heart rate)
Tachypnea (Increased breathing)
What two microorganisms will increase with an Asthma patient?
IgE
Eosinophils
What two lab test are done to confirm Asthma?
- *Curshmann’s Spirals**
- *Charcot Laden Crystals**
(Crystals and spirals in the sputum from IgE)
What condition is described as “destruction of elastic pulmonary connective tissue resulting in permanent dilation of the alveoli air sacs”?
Emphysema
What is the cause of Emphysema?
Deficiency of Alpha 1 Anti Trypsin
What is Bronchogenic Carcinoma?
Primary malignant lung tumor, starts in bronchus of the lung
What population is diagnosed with Bronchogenic Carcinoma?
Long term smokers, 20-30 years
What are the four common characteristics of Bronchogenic Carcinoma?
Non productive cough for more than 30 days
Afebrile (No fever)
Dyspnea (Difficult breathing)
Weight loss
In a patient that has Costochondritis, will there be swelling?
No
Where is the pain felt in a patient with Costochondritis?
On the cartilage between the ribs and the sternum (Cartilage is inflamed)
What makes Costochondritis worse?
Physical activity, get worse with exercise
Deep breath
Where is the most likely place to palpate Costochondritis?
3rd, 4th, 5th costosternal articulation
What is another name for Herpes Zoster?
Shingles
Vascular lesion
Must have had chicken pox to have Shingles
Where is Herpes Zoster often found?
Painful rash, along a dermatome (Single nerve root)
What structures are primarily involved in Shingles?
Dorsal root ganglion
If cranial nerve is involved- Cranial Nerve V
What population is Sarcoidosis most commonly seen in?
African Americans in the United States
What is Sarcoidosis?
Abnormal collection of inflammatory cells (granulomas) that form an nodule
What two locations does Sarcoidosis most commonly appear?
Lungs
Lymph nodes
What is a cancer that if from the lymphatic system and can spread to the spleen?
Hodgkin’s
What population most commonly has Hodgkin’s?
Young Caucasian males
Is Hodgkin’s unilateral or bilateral?
Unilateral
What is the best diagnosis for Hodgkin’s?
Biopsy
What must Hodgkin’s have to be termed cancer?
Reed Sternberg Cells
What characteristics will a patient present with if they have Hodgkin’s?
Fever Night sweats Weight loss Intense pruritus (Release of IgE) Enlarged spleen
What appearance will a Cystic Fibrosis patient have?
Barrel chested, similar to COPD
What do the glands of a Cystic Fibrosis patient produce?
Sweat and/or mucus
What characteristics will a Cystic Fibrosis patient present with?
Chronic progressive cough
Frequently a fatal genetic disease, of the body’s mucus glands
What two places does the mucus of a Cystic Fibrosis patient accumulate?
Lungs
Intestine
What test can be done on a patient with Cystic Fibrosis?
Sweat test, loss of excessive amounts of salt, Salty Tears
What organ is insufficient in a Cystic Fibrosis patient?
Pancreas
Calcium Channel Insufficiencies
What side of the heart does Jugular Venous Pulsations measure?
Right
When is it possible to have more pronounced Jugular venous pulsations?
When Congestive heart failure (CHF) is present and pressure is applied to the liver (Heptojugular Reflex)
What is a “Bounding” peripheral pulse termed?
Pulsus Magnus
In what four conditions will you see Pulsus Magnus?
**Increase in Cardiac Output** Exercise Anxiety Fever Hyperthyroidism
How is Pulsus Parvus defined?
Weak or Thready
What three conditions would you likely see Pulsus Parvus?
Decrease in Stroke Volume
Hypervolemia
Aortic stenosis
Congestive heart failure (CHF)
What pulse would be seen in Left ventricular failure?
Pulsus Alternans
What peripheral pulse is defined as an “alternates in amplitude”?
Pulsus Alternans
What peripheral pulse is described as “two strong systolic peaks separated by mid systolic dip”?
Pulsus Bisferiens
What location is Pulsus Bisferiens felt at?
Carotid artery
What two valve conditions is Pulsus Bisferiens seen?
Aortic Stenosis
Aortic Regurgitation
What is the name of the peripheral pulse that has a “decrease amplitude on inspiration and increased with expiration”?
Pulsus Paradoxus
How big of a change does the amplitude need to be for a positive Pulsus Paradoxus?
Greater than 10 mm Hg
What four conditions will you see Pulsus Paradoxus?
Chronic Obstructive Pulmonary Disease (COPD)
Bronchial asthma
Emphysema
Pericardial effusion
What is the name of the peripheral pulse that is “a jerky pulse that is rapidly increasing and then collapsing because of aortic insufficiency”?
Water hammer pulse
What is the clinical term for “vibrations produced by turbulent blood flow within the heart”?
What does this cause?
Term- Thrills
Cause- Murmurs
What is it called when the ventricles of the heart contract?
Systole
When the ventricles are relaxed and filling this is termed what?
Diastole
What causes the S1 heart sound?
Closure or the AV valves (Mitral and Tricuspid)
What two valves make up the Atrioventricular valves?
Mitral on the Left
Tricuspid on the Right
What to valves make up the Semilunar valves?
Aortic on the Left
Pulmonary on the Right
What causes the S2 heart sound?
Closure of the Semilunar valves (Aortic and Pulmonary)
The S3 heart sound is called ___________?
Ventricular gallop
The S4 heart sound is called ____________?
Atrial gallop
In what population is the S3 heart sound heard in?
Normal in:
Children
Young Adults
Athletes
If the S3 heart sound is heard in a patient over the age of 40, what may that be an early sign for?
Congestive heart failure (CHF)
Which heart sound, is “related to stiffness of the ventricular myocardium to rapid filling”?
S4 (Atrial gallop)
Atrial gallop is always classified as __________?
Pathological
What test is done to evaluate all of the heart valves?
Echocardiogram/Doppler (Ultrasound of the heart)
What is the best place to hear the Aortic heart valve?
2nd intercostal space on the right at the sternal boarder
What is the best patient position to listen to the Aortic heart valve?
Patient seated, leaning forward and exhaling
Where is the Pulmonic valve best heard?
Left sternal boarder at the 2nd intercostal space
Erb’s point is best heard where?
Left sternal boarder at the 3rd intercostal space
What clinical significance does Erb’s point have?
Best place to hear murmurs
What is the location to place the stethoscope to listen to the Tricuspid valve?
Left sternal boarder at the 5th intercostal space
Which valve is best auscultated at the mid-clavicular line on the left at the 5th intercostal space?
Mitral valve
What patient position is the best to listen to the Mitral valve?
Left lateral decubitus
What sound will a Stenosis make when listening to the heart?
Snapping sound
What does Stenosis mean?
The valve does not open all the way
What sound does a Regurgitating valve make?
Clicking sound
Regurgitation is defined as ____________?
Valve not closing all the way
What kind of sound will a Stenosis murmur have?
Low pitch
Which side of the stethoscope is used for Stenosis murmurs?
Bell
What sound will a Regurgitation murmur make?
High pitch
What side of the stethoscope is used when listening to Regurgitation murmurs?
Diaphragm
What is the pneumonic used to help with Diastolic murmurs?
ARMS and PRTS Aortic Pulmonic Regurgitation Regurgitation Mitral Tricuspid Stenosis Stenosis
Opposite in Systolic Murmurs
What congenital heart defect is described as “Failure of shunt to close between the aorta and left pulmonary artery”?
Patent Ductus Arteriosus
What kind of murmur is produced when a patient has Patent Ductus Arteriosus?
Continuous/Machinery like
Heard in both phases of the heart cycle
What is Tetralogy of Fallot?
Congestive heart defect D-dextapositon/overriding of the aorta R-right ventricular hypertrophy I-intraventricular septal defect P-pulmonic stenosis
Know exactly what each of these are
When is the murmur of Tetralogy of Fallot heard and what condition may be present?
Murmur- Ejection murmur during Systole
Condition- Severe cyanosis
What is it called when there is “constriction of the descending aorta”?
Coarctation of the Aorta
Where does Coarctation of the Aorta usually take place?
Distal to the left subclavian
What happens to the patient’s blood pressure if they have Coarctation of the Aorta?
Increased Blood pressure in the upper extremities by 20 mm Hg, when compared to the lower extremity
What is the condition called when there is “proximal stenosis of the subclavian artery”?
Subclavian Steal Syndrome
In what population do you see Subclavian Steal Syndrome?
Young females who faint (syncope/drop attacks) while exercising
What is the most common cause of left sided heart failure in 35-55 year old people?
Hypertension
What is the 2nd most common cause of left sided heart failure?
Aortic stenosis
What are the three early signs of left sided heart failure?
Pulmonary edema (Fluid in the lungs)
Shortness of breath (Exertional dyspnea)
Orthopnea (Feeling of drowning when laying flat, patient is able to be in a semi recumbent position)
Where does the fluid collect first in left sided heart failure?
Costophrenic angles, (Will be blurred/blunted or nonexistent on x ray)
What is the most common cause of right sided heart failure?
Left sided heart failure
What is the most common cause of Mitral stenosis?
Rheumatic fever
What is the definition of Cor Pulmonale?
Right side of the heart fails by itself (LUNG CONDITION that causes right sided heart failure)
If there is an increase in the right ventricle what condition is likely to be present?
Chronic Obstructive Pulmonary Disease (COPD)
When right sided heart failure occurs, where is the blood back up into?
Superior and Inferior Vena Cava
What eight complications does right sided heart failure lead to?
Edema and fluid in the extremities Jugular vein distension (via Superior vena cava) Enlargement of liver and Spleen Positive Heptojugular reflex Ascites (Fluid in abdomen caused by portal hypertension) Caput medusa/ Spider angioma Pitting Edema Stasis dermatitis
Will there be an increase or decrease in heart rate, when a patient has Right sided heart failure?
Increase
What heart sound is heard in a patient that has Right sided heart failure?
S3 gallop
What will the blood pressure of a patient with Right sided heart failure do, increase or decrease?
Decease
What condition is possible if there is bilateral pitting edema?
Hepatomegaly
What is “an interruption of the intima allowing blood into the vessel wall with immediate “tearing” pain”?
Aortic Dissection
What three conditions are Aortic Dissection associated with?
Hypertension
Arteriosclerosis (Descending Aorta)
Marfan’s (Ascending Aorta)
How is Marfan’s Syndrome defined?
Inherited connective tissue disorder with ventricular weakening and enlargement
What is a common patient presentation with Marfan’s Syndrome? (4 things)
Tall
Long finger/limbs
Lens subluxation
Cardiovascular and Lung problems
What is another name for Angina Pectoris?
Coronary Vasospasm
During rest of activity does Angina Pectoris come on?
Exertion (Activity)
When does Printzmetal Angina come on?
At rest
How is Angina Pectoris relieved?
Vasodilators, under tongue
Usually nitroglycerin
What may cause a myocardial infarction?
Atherosclerosis
What labs will be elevated in a Myocardial infraction?
- CK-MB
- LDH
- SGOT
Lab levels decrease in the opposite order (3,2,1,)
What condition is described as “abnormal widening that involves all 3 layers; defect in elastic-media tissues”?
Aneurysm
What does the P wave on an ECG indicate?
Atrial depolarization
What does the QRS complex represent on the ECG?
Depolarization of the ventricles.
Repolarization of the atria are hidden here
The T wave on an ECG, represents ____________?
Repolarization of the ventricles
Which wave on the ECG represents repolarization of the papillary muscles?
U wave
What does an increased PR interval indicate?
Prolonged AV nodal delay (Primary heart block)
If there is two P waves on and ECG before the QRS complex, this is indicative of what?
Weinkbochs- Block at the bundle of HIS (2nd Heart Block)
If there is complete heart block, no ventricular contraction what part of the ECG will not be seen?
QRS pattern
If the ST segment of an ECG is either enlarged or inverted what does that mean?
Myocardial Infraction (Acute heart failure)
What wave will be absent in a Myocardial Infarct?
Q wave
If not P wave is present what condition is present?
Atrial Fibrillation
What is the proper order to perform an abdominal exam?
Inspection Auscultation Percussion Light Palpation Deep Palpation
When there is a an early intestinal obstruction, what happens to the bowel sounds?
Increase in bowel sounds (Car Accident Analogy)
There is a decrease or absent in bowel sounds when?
Late intestinal obstruction
With a late intestinal obstruction what may be present?
Adynamic (paralytic) ileus
What is the clinical term for “vomiting up blood”?
Hematemesis
What does the term Hemoptysis mean?
Coughing up blood
Blood in the stool is called ______________?
Hematochesia
What test is best for testing the liver?
Alkaline Phosphatase
What test is best for seeing if a patient is an alcoholic?
Gamma-Glutamyl Transpeptidase (GGT)
Gotta Get Tanked
What lab is done to test Liver and Kidney?
Blood Urea Nitrogen (BUN)
What will the BUN test do for each Liver and Kidney?
Liver- Decrease
Kidney- Increase
What is another word for Jaundice?
Icterus
What condition is classically described as “yellowing of the skin, sclera and mucus membranes”?
Jaundice (Can occur in any liver disorder)
What is the most common destruction of the liver?
Alcoholism
What three things can Cirrhosis of the liver cause?
Portal hypertension
Ascites
Esophageal varices
If an alcoholic has, coughing, tearing of the esophageal blood vessels and hematemesis, with a rash on the palmer surface due to bile salts, what condition do they have?
Mallory-Weiss Syndrome
What syndrome is described as a “Thiamin deficiency form alcoholism that leads to dementia”?
Wernicke Korsakoff Syndrome
What is Beri Beri Syndrome?
Thiamin deficiency without alcoholism
What is the name of the disease when “liver may be tender and enlarged but the edge remains soft and smooth”?
Hepatitis
How does one contract Hepatitis A?
From food through oral/fecal route
Self limiting and NOT a carrier
Which type of Hepatitis is obtained via blood transfusions?
Hepatitis C
This type of Hepatitis is most common to become liver cancer?
Hepatitis B
What are two ways someone get Hepatitis B?
Dirty needles
Sexual contact
Which type of Hepatitis is a carrier for life and has to do with both blood and venereal diseases?
Hepatitis B
What kind of cancer is the most common site for metastatic disease?
Liver Cancer
What are two common findings of liver cancer?
Enlarged liver
Hard and irregular boarder
What is a specific marker for Hepatocellular Carcinoma?
Alpha fetoprotein (Liver Cancer)
Is Direct/Conjugated bilirubin water soluble?
Yes
Under what three conditions will there be in increase in Conjugated bilirubin?
Duct obstruction (Gallstones)
Hepatic disease
Pancreatic cancer
If there is an increase in the amount of direct bilirubin in the blood, it may go to the urine, what is it called?
Urobilinogen
Which type of bilirubin is not water soluble; Direct (Conjugated) or Indirect (Unconjugated)?
Indirect (Unconjugated) Pre-hepatic
Sickle Cell Anemia, Rh- condition
What are three conditions that will have an increase in Indirect bilirubin?
Hemolytic disease
Drugs
Spleen disorders
An increase in reticulocyte count is called_________?
Hemolytic Anemia
Is Hemolytic anemia pre or post hepatic?
Pre-Hepatic
What is the name of the test to determine Hemolytic Anemia?
Coomb’s Test
Where is the two pain points of referral for a gallbladder issue?
Right shoulder
Tip of the right scapula
What is the classification of Gallbladder pain to the shoulder region?
Viscerosomatic
Grey Poop
What is the most common population of patient to have Cholecystitis?
Females over the age of 40
Female, Forty, Fertile, Fatty Fast Food, Fatty Stool, Flatulence
If a patient has Cholecystitis what are the four characteristics they will present with?
Severe right upper quadrant pain
Nausea
Vomiting
After eating a large fatty meal
What is Murphy’s Sign?
Inspiration Arrest Sign
Who would you refer a patient with Cholecystitis to?
Gastroenterologist
Which two test would be ordered to confirm Cholecystitis?
Diagnostic ultrasound Oral Cholecystogram (Swallow Contrast Medium)
What condition is defined as “Calcification that can become malignant due to chronic inflammation”?
Porcelain Gallbladder
What is the location of epigastric pain?
Straight through the T10-T12 area like a knife
In what condition would you see chronic pancreatitis?
Alcoholism
What is the approach to be carried out for acute pancreatitis?
Call 911 Emergency
What is a positive Grey Turner sign?
Bleeding of the flanks
What “Sign” is present with “Periumbilical ecchymosis caused by intraperitoneal hemorrhage or seen with a ruptured ectopic pregnancy”?
Cullen’s Sign
What two lab values will be increased with Pancreatitis?
Amylase
Lipase
What part of the pancreas is usually effected with cancer?
Head of the Pancreas
What are three signs, that a patient has pancreatic cancer?
Dark urine
Clay colored stool
Jaundice
What condition is being described in the following: “condition in which the pancreas does not produce a sufficient amount of insulin to take the sugar out of the blood and transport it to the tissues of the body”?
Diabetes Mellitus
If the tissues of the body do not have enough insulin to work, what will they breakdown to obtain energy?
Fats
What are the classic three signs of Diabetes Mellitus?
Polydipsia (Increase in Thirst)
Polyphagia (Increase in Hungry)
Polyuria (Increase in Urination)
What lab would you order for a screening of Diabetes Mellitus?
Fasting Blood Sugar (FBS)
What three labs would you order to help confirm Diabetes Mellitus?
Glucose Tolerance Test (GTT)
Fasting Plasma Glucose (FPG)
HbA1C (Glycosylated Hemoglobin)
In what population do you usually see Type 1 or Insulin Dependent diabetes?
Juvenile, under 30, usually thin
What population is often associated with Type II or Non-Insulin Dependent diabetes?
Adult, over 40, usually obese
Diet choice and lack of exercise, is what causes this!!
In the condition of Diabetes Insipidus, what structure is not functioning properly and what hormone is being decreased?
Structure- Posterior Pituitary Gland
Hormone- Insufficient Anti-diuretic hormone (ADH) AKA Vasopressin
What sign will NOT show up in Diabetes Insipidus?
Polyphagia (Increase in Hungry)
What is another name for Diffuse Idiopathic Skeletal Hyperostosis? (DISH)
Forestier’s disease
When you see Forestier’s Disease, what is a common condition that goes along with it?
Diabetes, do a Fasting Blood Sugar (FBS) and/or Glucose Tolerance Test (GTT)
What condition should be suspected if you see an air bubble around the diaphragm on an X-ray?
Hiatal hernia
What is a Hiatal hernia?
Protrusion of the stomach above the diaphragm
In a patient that has a hiatal hernia, what are six signs they have this condition?
Tenderness in Left Upper Quadrant Reflux esophagitis (Acid Reflux) Dyspepsia (Indigestion) Pain worse when lying down Pain worse after eating a large meal Difficulty Breathing
Barrett’s esophagus is a precursor to what?
Esophageal cancer
What condition is caused by a sliding Hiatal hernia?
Reflux Esophagitis
What four things make Reflux Esophagitis worse?
Lying down
Eating a large meal
Valsava’s Maneuver
Bearing down
What two special test would you order to confirm Reflux Esophagitis?
X-ray
Upper GI series
What two categories are included in peptic ulcers?
Gastric (Stomach)
Duodenal
What is the causative agent for Peptic ulcers?
H. Pylori bacteria
Why is pain in Peptic ulcers, “pinpoint pain”?
Hydrochloric acid is burning a hole in the epigastric region
What is the appearance of vomit from a patient with a Peptic ulcer?
Coffee ground appearance
Does gastric ulcers have a consistent pain pattern?
No
What is the unique thing about Gastric ulcers?
Pain is decreased by eating
Pain comes on right after eating
What is the most common type of peptic ulcers?
Duodenal
When does the pain of a duodenal ulcer occur?
Two hours after eating
What kind of stool is found in a patient that has a duodenal ulcer?
Black/tarry stool
What is the confirmatory test done, looking for occult blood in the stool, common in patients with duodenal ulcers?
Guaiac test
What condition is seen often in males and first time mothers and described as “projectile vomiting in a newborn”?
Pyloric Stenosis
String Sign on x-ray: palpable node in the epigastric area
What location of the stomach is the most common for gastric carcinoma?
Lesser curvature
What is it called when the left supraclavicular lymph node is involved?
Virchow’s node
What is the most common cause of Mononucleosis?
Epstein Barr Virus
What age is most likely to have Mononucleosis?
Young adults (18-25)
What is the name of the atypical lymphocytes found in the blood of patients with Mononucleosis?
Downey Cells
What are the symptoms of Mononucleosis? (5 symptoms)
Similar to the flu Fever Headache Fatigue Splenomegaly Lymphadenopathy in cervical region
What condition is called “Marble Bone”?
Osteopetrosis
What two organs become enlarged in Osteopetrosis?
Liver
Spleen
Where is the referral pain of the small intestine to?
Periumbilical region
What is another name for Regional Ileitis?
Crohn’s Disease
Where is Crohn’s disease located?
Right side of the intestine
What disease is described as a nonspecific inflammatory disorder that affects the distal ileum and colon?
Regional Ileitis
Patient’s that have Crohn’s disease, will have what three symptoms?
Pain in Right Lower Quadrant (RLQ) Chronic diarrhea (Usually bloody) Cobblestone appearance on Sigmoidoscopy
Regional Ileitis leads to malabsorption of what vitamin?
B 12
How is Crohn’s disease confirmed? What is a finding on the test?
Sigmoidoscopy, Skip lesions will be present
What can cause Regional Ileitis?
Non-Tropical Sprue/Celiac Sprue (Gluten Allergy)
Where is Ulcerative Colitis located?
Left side of the intestine
In what two parts of the intestine is Ulcerative Colitis most commonly found?
Colon
Rectum
What is the major indicator of Ulcerative Colitis?
Bloody Diarrhea
How is Ulcerative Colitis diagnosed?
Sigmoidoscopy
What is another name for Irritable Bowel Syndrome?
Spastic Colon
What disorder has “variable degrees of constipation and diarrhea in response to stress”?
Irritable Bowel Syndrome
What gender more commonly has Spastic Colon?
Females
What age, gender,symptom is it common to see Diverticulitis?
Over the age of 50, Female with a Fever
What causes someone to get Diverticulitis?
Inadequate fiber in the diet
What condition is described as “Chronic constipation which causes small out pouchings within the colon that become infected?
Diverticulitis
Where is the pain in a patient that has Diverticulitis
Lower Left Quadrant (LLQ)
What is Meckel’s Diverticulitis?
Out pouching of the Ilium
If a patient has an appendicitis, where should they be referred to?
ER
What special test can be done, to confirm and Appendicitis?
CT
What four (orthopedic) tests will be positive in a patient that has an Appendicitis?
Rebound Tenderness (Peritonitis)
Rovsing’s Sign
Psoas Sign
Obturator Sign
What is the name of the test that is done to diagnosis an Appendicitis and what does it indicated?
Test name- Shilling Shift
Indicates- Increase in White Blood Cells (WBC)
What four symptoms will a patient with an appendicitis present with?
Fever
Nausea
Vomiting
Anorexia
Where will the pain be present at in a patient’s abdominal region if they have an appendicitis?
Dull Periumbilical region or epigastric pain that radiates to the lower right quadrant (LRQ) (McBurney’s Point)
What are the six characteristics of Cushing’s Disease?
Moon face/ "pie face" Buffalo hump Pendulous abdomen with purple striae Hirsuitsm (Male hair growth pattern usually on women) Weakness Hypertension
What causes Addison’s Disease?
Decrease in aldosterone
What are the two cause of Cushing’s Disease?
Increase production of adrenal cortex hormone
Long standing Cortical Steroid use
What are two other names for Cushing’s Disease?
Hyperadrenalism
Hypercortisolism
What are two other names for Addison’s Disease?
Hypoadreanalism
Hypocortisolism
In increase in what hormone will cause melanin deposition in a person with Addison’s Disease?
Adrenocorticotropic Hormone (ACTH)
What eight signs/symptoms will a person with Addison’s Disease present with?
*Decreased blood pressure* Thin Weakness Fatigue Lethargy Nausea Vomiting Hair loss
What is it called when there is a tumor or the Adrenal Medulla?
Pheochromocytoma
Grey Cell Tumor
If a person has an increase in ACTH, (Addison’s Disease)where will the hyperpigmentation show up?
Mouth
Face
In the condition of Pheochromocytoma what is increased?
Catecholamine
Epinephrine and Norepinephrine
What condition has a similar appearance to hyperthyroidism?
Pheochromocytoma
What is the name of the condition that produces EXTREME hypertension?
Pheochromocytoma
Diastolic number if over 100
What would you refer a patient that you think has a Pheochromocytoma?
ER (Medical Emergency)
What condition is has an increase of calcium made in the body?
Nephrolithiasis
What are the three “things” made of calcium in the condition of Nephrolithiasis?
Calcium oxalates (Most Common)
Calcium urates
Calcium phosphates
Where will the pain be located in a patient with Nephrolithiasis?
Flank pain described as writhing
What orthopedic test will be positive in a patient with Nephrolithiasis?
Murphy’s Test (Kidney Punch)
What four test will be increased in a patient with Nephrolithiasis?
Blood Urea Nitrogen (BUN)
Uric acid
Creatinine clearance
Kidney, Ureter, Bladder (KUB) study
What is the most specific test for Nephrolithiasis?
Creatinine clearance
What is always one positive finding in Nephrolithiasis?
Blood will be found in the urine
What can Hydronephrosis cause?
Staghorn calculi
In a patient with Nephrolithiasis, if they take in Vitamin C what will that lead to?
Increase in kidney stones
What is another name for Acute Glomerulonephritis?
Nephritic Syndrome
What causes Acute Glomerulonephritis?
Group A hemolytic strep, will have a Positive ASO Titer test
What are the findings in Nephritic syndrome?
Red blood cells (RBC) cast in the urine with small amount of protein
What are the three classic signs in Nephrotic syndrome?
HEP
Hypertension
Edema
Proteinuria (Massive)
What is Nephrotic syndrome in a pregnant woman called?
Pre-eclampsia
What is the definition of Eclampsia?
Nephritic syndrome with convulsions during pregnancy
What kind of cast are found in the urine in a patient that has Nephrotic syndrome?
Waxy or fatty
How does someone get Polynephritis?
E-coli infection for a Urinary Tract Infection (UTI)
In the condition of Polynephritis what kind of cast will be found in the urine?
White Blood Cell (WBC) cast
What condition is described as “Inherited disorder with many bilateral renal cysts that increase renal size but reduce function of the renal tissue”?
Polycystic Kidney Disease
What three findings will be present in a person who has a Renal Carcinoma?
Bleeding
Flank pain
Enlarged mass
What is found in the urine of a person with Urethritis?
Nitrites
What is the most common cause of Urethritis in females?
E. Coli
What are the two diagnosis of Urethritis?
What causes each classification?
Gonococcal (Caused by Gonorrhea) More often seen in Males
Non-Gonococcal (Caused by Chlamydia)
What two areas will the patient with Cystitis have pain?
Suprapubic
Low back pain
How is Cystitis defined?
Noninfectious bladder inflammation Urination will be: Burning Pain (During and after urination) Frequent urination with incontinence
What is another name for a Wilm’s tumor?
Nephroblastoma
What condition is seen in a younger person, with abdominal mass and hematuria?
Nephroblastoma
What is a Nephroblastoma?
Malignant tumor of the kidney
What is the clinical term for an “Overactive Bladder”?
Urinary Incontinence; Neurological Problem
What is the most common cause of Urinary Incontinence?
Stress
How is Stress Incontinence define?
Increase in Abdominal pressure
i.e.: Exercise, Cough, Sneeze, Laugh
What causes Urinary Incontinence?
Weakness in the pelvic floor muscles
What exercises may be given to a patient with an Overactive Bladder?
Kegal Exercises
What type of urinary incontinence has “the inability to completely empty your bladder when you urinate”?
Overflow
What is a common result of an Overflow bladder? (Urinary Incontinence)
Constant flow
Frequent dribble
What is a condition that is common in people with an Overflowing bladder?
Prostate Enlargement
What type of urinary incontinence is most commonly seen in “older adults with arthritis, Parkinson’s and Alzheimer’s”?
Functional
What is the most common type of hernia?
What is the location of this type of hernia?
Indirect Inguinal Hernia
Location-Lateral and Inferior to the Epigastric Vessels
What population do you see Indirect Inguinal hernias in?
Children and young adults
How is an Indirect Inguinal Hernia described?
Passes down the inguinal canal and exits the external inguinal ring and into the scrotum
Where does a Direct Inguinal hernia exit from?
What is the Location of a Direct Inguinal Hernia?
External inguinal ring, does not pass through the inguinal canal
Location-Medial and Inferior to the Epigastric Vessels
What two things usually cause a Direct Inguinal hernia?
Obesity
Heavy lifting
During what two times is a Direct Inguinal hernia often felt?
When the patient:
Coughs
Bears down
What age is a Direct Inguinal hernia often seen?
Older, over the age of 40
Where is a Femoral Hernia found?
Bulge lateral and inferior to the external inguinal ring at the site of the femoral pulse
Is a femoral hernia, classified as a inguinal hernia?
No
What condition is “Abnormal endometrial tissue found outside of it’s normal location”?
Endometriosis
Where is endometriosis most commonly found?
Ovaries
What are five signs of Endometriosis?
Abdominal pain Back pain Severe menorrhagia Painful intercourse (Dyspareunia) Possible infertility
What is the most common reason for a hysterectomy?
Uterine fibroids
What condition is described as “Benign uterine tumor of smooth muscle origin”?
Uterine fibroids
What are three symptoms present with Uterine Fibroids?
Heavy menstrual bleeding
Pelvic pain
Painful intercourse
How will the uterus feel in a patient with Uterine Fibroids?
Painless nodules that are irregular and firm
What condition is an “infection of the upper female genital tract”?
Pelvic Inflammatory Disease
Which two STD’s are the most common cause of Pelvic Inflammatory Disease?
Gonorrhea
Chlamydia
What other condition is often seen with Pelvic Inflammatory Disease?
Salpingitis (Inflammation of the fallopian tubes)
What condition is described as a “pregnancy in which implantation has happened outside of the endometrial cavity”?
Ectopic pregnancy
What three signs will be present is a patient with an Ectopic pregnancy?
Spotting
Decreased blood pressure
Decrease in Human Chorionic Gonadotropin (HCG)
What is the common cause for the first and second reason for an Ectopic Pregnancy?
First- Prior Gonococcal infection
Second- Intrauterine Device (IUD)
What are four common finding in normal pregnancy?
Increase in Human Chorionic Gonadotropin (HCG)
Nausea
Weight gain
Breast tenderness
What condition will have a very high level of Human Chorionic Gonadotropin (HCG)?
Hydatiform Mole
What is the condition that is described as “A non-viable embryo which develops in the placenta and presents with all the signs of pregnancy”?
Hydatiform Mole
What is the name of the condition that is “A malignancy of the placenta due to abnormal epithelium”?
Choriocarcinoma
What condition is found in young women, that have Multiple, round, freely movable masses that can be palpated?
Fibrocystic Breast Disease
Lumpy Bumpy Breast around menses
What make Fibrocystic Breast Disease worse?
Caffeine
Ovulation
Menses
In what population is Fibrocystic Breast Disease commonly seen in?
Overweight Diabetics
What is the most common benign breast tumor?
Fibroadenoma
What age is Fibroadenoma usually seen in?
Less than 30
What are three things to know about Fibroadenoma?
Non tender
Singular lesion
Unilateral 75% of the time
What is the 2nd most common cause of death in women?
Breast cancer
What is the most common location of breast cancer?
Upper/outer quadrant (Axillary area, tail of Spence)
What are the four common findings associated with breast cancer?
Nipple retraction
Dimpling (Paget’s Disease of the breast)
Bleeding
Orange peel appearance
Where will breast cancer metastasis to?
What kind of appearance does breast cancer have on bone?
Metastasis- Axilla via lymphatic system
Appearance- Lytic (Metastases from the Lymph vessels)
What is it called when there is “Tortuous dilation of the spermatic veins”?
Varicocele
When will the pain from Varicocele diminish?
Standing
Supine
What is a common name for Varicocele?
“Bag of Worms”
What condition is “A fluid filled mass in the epididymis”?
Spermatocele
Is a Spermatocele and Hydrocele transiluminatable?
Yes, it’s fluid filled
Where is a Spermatocele located?
Superior and posterior to the testicle
What are three characteristics of a Spermatocele?
Painless
Moveable
Pea sized lump
What is a Hydrocele?
Excessive accumulation of water in the testicles
What are four characteristics of a Hydrocele?
Swollen
Painless
Heavy
Tight scrotum
How is a Hydrocele able to be distinguished from a scrotal hernia?
Being able to palpate about the mass, indicates its a Hydrocele
How does a patient get Epididymitis?
Consequence of an STD
What is a positive finding of a Epididymitis?
Enlarged tender scrotum
What is the most common type of cancer found in men aged 20-34?
Testicular cancer
What is the most common type of testicular cancer?
Seminoma
Is testicular painful and/or transiluminatable?
No
What condition is “Enlarged, Non tender, Firm, Smooth, and has not Median Sulcus”?
Benign Prostatic Hyperplasia
What condition happens in younger men from the venereal disease of Gonorrhea?
Prostatitis
What are the four characteristics of Prostatitis?
Boggy
Soft
Enlarged
Tender; Painful
What is one complication of Prostatitis?
Urinary problems, increased urgency
What does Prostatic Carcinoma almost always look like/be associated with on x-ray?
Blastic Mets- Blood
Where is the most common place for Prostatic Carcinoma to metastasize to?
Lumbar spine via Batson’s plexus
What are the finding of Prostatic Carcinoma?
Hard Posterior lobe
Nodular
Painless
Enlarged
What is the skin temperature in an arterial problem?
Cool
What color is the skin in an arterial issue?
Pale or Blue
What kind of pulse is found in a patient that has an arterial issue?
Weak or absent
What two things will be present in a patient with an arterial problem?
Numbness
Raynaud’s Phenomenon
Is there swelling in an arterial issue?
Not usually
Will and venous or arterial issue have thin/shiny skin?
Arterial (Think about wrapping a rubber band around your finger, for all Arterial signs and symptoms)
What is the skin temperature of a patient with a venous problem?
Warm
Venous problem, think of a Deep Vein Thrombosis (DVT) in the femoral vein
In a patient that has a venous issue what two categories will be Normal?
Skin color
Pulse
Will numbness and Raynaud’s Phenomenon be absent or present in a patient with a venous issue?
Absent
If a patient has a venous issue what two things will be present?
Swelling
Valve incompetence
What kind of tropic changes would you expect to see in a venous issue?
Stasis Dermatitis
What type of claudication is predictable?
Vascular
In what position would a patient with Neurogenic claudication find relief?
Flexed, this is a position related condition
What type of claudication always has relief at rest?
Vascular
What are three common cause of Neurogenic Claudication?
DJD- thin disc, overriding of the facets
Spinal Canal stenosis
What two causes will lead to Vascular Claudication?
Arteriosclerosis
Buerger’s
Stoop Test- will decrease pain (Flexed Position)
How is the claudication test performed?
Patient walks at a rate of 120 steps/min for 1 minute
What is a positive finding for the claudication test?
Pain in the claves
What does the Bicycle test confirm?
Pain in the calves, vascular Claudication
What is another name for Buerger’s?
Thromboangitis Obliterans
How do you test for Buerger’s?
Claudication time
What is the population that is usually effected with Thromboangitis Obliterans?
Males 20-40 years old
Excessive tobacco/smoking use
What three other symptoms is Buerger’s associated with?
Intermittent vascular claudication
Non-healing ulcers
Gangrene (Amputation)
What two populations and what age are often seen with Varicose veins?
Population:
Pregnant women
Overweight adults
Age: Older than 20 years old
What three symptoms are present with Deep Vein Thrombosis?
Tenderness
Edema
Pain
What orthopedic test is done to diagnosis Deep Vein Thrombosis?
Homan’s test
How is Homan’s test performed?
Patient is supine with leg extended while the doctor raises the leg off the table to a 45 degree angle, dorsiflex the foot and squeeze the calf
What is a positive finding to Homan’s test?
Pain in the calf
What labs can be ordered to help diagnosis Deep Vein Thrombosis?
D-Dimer
Complete Blood Count (CBC), Thrombocyte count
Who often has Raynaud’s?
Females
What three other conditions are seen with Raynaud’s?
Buerger’s
Collagen Disease
Scleroderma
What are three triggers of Raynaud’s Phenomena?
Cold
Stress
Emotion
What orthopedic exam can be done to diagnosis Raynaud’s/
Allen’s Test
What five other signs are present with Raynaud’s?
Arterial spasms **Triphasic color changes (White, Blue, Red)** Finger tip ulcers Cold sensitivity Gangrene
What is the clinical term for a pinpoint hemorrhage?
Petechia
What condition is described as “Blockage of an artery in the lung by a substance that has come from somewhere else in the body via the bloodstream”?
Pulmonary Embolism
What is the main cause of a Pulmonary Embolism?
Thrombus (blood clot) from the veins of the legs
What are the three symptoms often associated with a Pulmonary Embolism?
Difficulty breathing
Chest pain on inspiration
Palpitations
What are two increased risk of someone with Pulmonary Embolism?
Flying
Prolonged bed rest
**(Both will lead to Deep Vein Thrombosis (DVT))
What condition is described as “small superficial dilated blood vessels”?
Telangiectasia
What is the common location of Telangiectasia?
Around the:
Nose
Cheeks
Chin
What are the two other names for Reflex Sympathetic Dystrophy?
Complex Regional Pain Syndrome
Sudeck’s Atrophy
What is the treatment for Reflex Sympathetic Dystrophy?
Sympathetic nerve block
Tens Unit
What are the typical associated findings with Sudeck’s atrophy?
- Dramatic changes in skin color and temperature in the affected area
- Intense burning
- Skin sensitivity
- Swelling
- Sweating (Excessive sweating; Hyperhidrosis)
- Hypertrichosis (excessive hair growth)
What condition is “a chronic pain condition, with continuous intense pain out of proportion to the severity of the injury, which gets worse rather than better over time”?
Complex Regional Pain Syndrome
What does an increase in Red Blood cell indicate?
1: Polycythemia Vera
2: High altitude
A decrease in what three hematology categories will indicate Anemia?
Red blood cells
Hemoglobin
Hematocrit
What two things does an increase in Hemoglobin and Hematocrit indicate?
Dehydration: loss of blood fluid volume
Polycythemia Vera
What type of Anemia is present if there is an increase in:
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Macrocytic Anemia (>100)
What would cause a patient to have Microcytic Anemia?
A decrease in anyone of the following: (
What three conditions will have an increase in Platelets Thrombocytes?
Polycythemia
Trauma
Blood loss
What three conditions can a decrease in Platelets Thrombocytes be seen in?
Anemia Extensive
Burns
Thrombocytopenia
What is the of number Leukocytes that must be seen in a person to be diagnosed as Leukemia?
Over 50,000
What three conditions will have an increase in White Blood Cells (WBC)?
Acute Infection
Inflammation
Leukemia
What two conditions will see a decrease in White Blood Cells (WBC)?
Overwhelming infections
Viral conditions
What are the five different categories of White Blood Cells (WBC) and there associated percentages?
Neutrophils-60% Lymphocytes-30% Monocytes-8% Eosinophils-3% Basophils-0%
Never Let My Engine Blow
60,30,8,3,0
What does an increase in Neutrophils indicate?
Bacterial Infection
In increase in what White Blood Cell (WBC) category would indicate a viral infection?
Lymphocytes
What does and increase in Monocytes indicate?
Chronic inflammation
An increase in Eosinophils means what?
Allergies
Parasites
What is the radiographic finding of a Sickle Cell Anemia patient?
H-shaped vertebrae
What population makes up about 10% of those with Sickle Cell?
African American
What is another name for Thalassemia?
Mediterranean Anemia
What two conditions are present with Thalassemia?
Microcytic anemia
Target cells
What is the cause of Erythroblastosis Fetalis?
Rh+ Father and Baby
Rh- Mother
What is the most common Megaloblastic Anemia?
Macrocytic Normochromic
In what type of Megaloblastic Anemia will be seen in chronic alcoholics, pregnancy and malabsorption?
B9/Folic Acid
What type of Anemia is seen in “Lack of intrinsic factor due to chronic atrophic gastric mucosa causing loss of parietal cell”?
B12/Cyanocobalamin
Pernicious Anemia
(Unconjugated, Indirect bilirubin= Pre-Hepatic (All have Prefixes)–> Decrease in B Vitamins
What test is done for the diagnosis of Pernicious anemia?
Schilling test (24 hour urine)
What is the treatment for Pernicious Anemia?
B12 Shots
What can prolonged Pernicious Anemia lead to and what is it’s AKA?
Posterolateral Sclerosis (PLS)
AKA- Combined systems disease
Iron Deficiency anemia is what kind of anemia?
Hypochromic Microcytic (Too Tiny)
Who often is seen with having Hypochromic Microcytic anemia?
Chronic blood loss
Pregnancy
In Iron Deficiency Anemia where is blood often found?
Occult blood in the stool
What type of anemia is Aplastic Anemia?
Normochromic Normocytic
What nine populations are seen to have Normochromic Normocytic Anemia?
Drug users
Chemotherapy
Radiation
Multiple Myeloma
Rheumatoid Arthritis
Leukopenia
Acute Blood Loss
Benzene poisoning
Thrombocytopenia
What two things does red urine indicate?
Blood (Infections or Cancer)
Food pigments
What are three things green urine indicate?
Biliary duct obstruction
Pseudomonas Infection
Bad protein digestion
What are three problems if a patients urine is Blue?
Diuretic Therapy
Pseudomonas infection
Bad protein digestion
What are the indications associated with Brown urine?
Bile Pigments Blood Biliary duct obstruction Occult blood Homogentisic acid
What does black urine indicate?
Homogentisic Acid Urobilin Ochronosis (Accumulation of Homogentisic Acid) Hemolysis Bacteria
What six things can cause the appearance of urine to be hazy/cloudy?
Epithelial Cells White Blood Cells (WBC) Red Blood Cells (RBC) Crystals Sperm Microorganisms
What two things will give urine a Milky appearance?
Fat
White Blood Cells (WBC)
What three things can cause an increase in Specific Gravity of urine?
Bacterial infections
Diabetes Mellitus
Kidney Abnormalities
What five conditions will be seen if there is an increase in glucose in the urine?
Diabetes Mellitus Shock Head injury Pancreatic disease Renal tubular disease
An increase in \_\_\_\_\_\_\_\_ in the urine will indicate the following: Starvation Diabetes Mellitus Weight loss diets Inadequate Carbohydrate intake
Ketones
What four conditions are seen with and increase in protein in the urine?
Kidney disorder
Toxemia of Pregnancy
Diabetes Mellitus
Multiple Myeloma
What does and increase in Urobilinogen indicate? (Two things)
Hemolytic Disease
Hepatic Disease
What does and increase in Urobilinogen indicate?
Biliary Obstruction
What two conditions are indicated with an increase in Bilirubin in the urine?
Hepatic Disease
Biliary Obstruction
An increase of blood in the urine can indicate ____________? (6 Things)
Tumor Trauma Kidney Infection Kidney Stone Hypertension Bleeding Disorder
What is the clinical term for Red Blood Cell Cast?
Glomerulonephritis
Know what all Cast means for Boards
What is the clinically term for White Blood Cell Cast?
Pyelonephritis
What does a waxy cast indicate? (Two things)
Renal failure
Nephritis
What does and Increase on the Acid Phosphatase (PAP) indicate?
Prostatic Carcinoma
What does a reversed Albumin/Globulin (A/G) Ratio indicate?
Multiple Myeloma
What three things does an increase in Alkaline Phosphatase indicate?
Osteoblastic lesions
Hepatic Disease
Hyperparathyroidism
What does an increase in the Amylase test indicate?
Acute Pancreatitis
What does the ANA (FANA) test indicate?
Collagen diseases
i.e. Systemic Lupus Erythematous
Scleroderma
What is the spelt out name of ASO-Titer?
Antistreptolysin-O
What two conditions have an increase in ASO-Titer?
Rheumatic Fever
Acute Glomerulonephritis
What does an increase in direct bilirubin indicate? (Two things)
Hepatitis
Duct obstruction
What does an increase in indirect bilirubin indicate?
Hemolytic Disease
What does an increase in Blood Urea Nitrogen (BUN) indicate? (Four things)
Renal disease
Dehydration
Hypotension
Urinary tract infection
What two indications does a decrease in Blood Urea Nitrogen (BUN) have?
Hepatic disease
Pregnancy
What four conditions have an increase in Calcium?
Muscle weakness
Hyperparathyroidism
Hypervitaminosis D
Metastatic Disease
What four conditions does an decrease in Calcium indicate?
Muscle tetany
Chvostck’s Sign; Hypocalcaemia (tap facial nerve, mastication muscle contracts)
Renal Failure
Malnutrition
What does CK BB indicate?
Brain tissue
What does CK MB indicate?
Myocardial Tissue
What does CK MM indicate?
Skeletal Muscle
What does and increase in Creatine Phosphokinase (CPK) indicate?
Muscle Necrosis
What is the best test for the kidney?
Creatinine
What two conditions are indicated by in increase in Creatinine?
Kidney disease
Hypovolemic Shock
What does a decrease in Creatinine indicate?
Muscular Dystrophies
An increase in C-Reactive Protein indicates what three conditions?
Tissue necrosis
Infections
Rheumatoid Arthritis
(This test is more Sensitive than Erythrocyte Sedimentation Rate (ESR))
What is the name of the Screening test for AIDS?
ELISA
What two conditions are indicated by a decrease in Erythrocyte Sedimentation Rate (ESR)?
Sickle Cell Anemia
Polycythemia
In increase in Erythrocyte Sedimentation Rate (ESR) is indicative of what five conditions?
Infection Rheumatoid Arthritis Tuberculosis Temporal Arteritis Multiple Myeloma
What test is positive in Syphilis?
Florescent Treponema Antibody (FTA)
An increase in blood Glucose indicates what three possible conditions?
Diabetes Mellitus
Cushing’s
Renal/Liver Disease
What does a decrease in blood glucose indicate? (3 conditions)
Insulin overdose
Addison’s
Starvation
What Is the best test for Chronic Alcoholism?
Gamma-Glutamyl Transferase (GGT)
What is the name of the test used for Diabetics?
Glucose Tolerance test (GTT)
What is the best test to monitor the progression of Diabetes Mellitus over a 2-3 month period?
Glycosylated Hemoglobin
What is the Hetrophile (Paul Bunnel) test used to indicate? (2 things)
Mononucleosis
Viral Meningitis
In what five conditions will there be an increase in Human Chorionic Gonadotropin (HCG)?
Hydatiform mole
Choriocarcinoma
Seminoma
Testicular Teramtoma
Multiple pregnancies
What are two indications where you would see a decrease in Human Chorionic Gonadotropin (HCG)?
Ectopic pregnancy
Threatened abortion
What four conditions will you see Human Leukocyte Antigen Locus (HLA) B27?
Psoriatic Arthritis
Enteropathic Arthritis
Ankylosing Spondylitis
Reiter’s (Reactive Arthritis)
PEAR
An increase in HDL cholesterol indicates what?
Low risk of coronary heart disease
What test would indicate a high risk of coronary heart disease?
Decreased levels of HDL cholesterol
What does and M-spike on Immunoelctrophoresis indicate?
Multiple Myeloma
Immunoelctrophoresis is the BEST test for Multiple Myeloma
What two conditions are indicated by a decrease in Cerebrospinal Fluid (CSF) glucose?
Bacterial Meningitis
Acute Pyogenic infections
What two indications does and increase in I-131 uptake have?
Hyperthyroidism
Endemic Goiter
What does a decrease in I-131 uptake indicate? (Two conditions)
Hypothyroidism
Thyroid Cancer
In what two conditions would you test for ketones?
Carb Restriction
Diabetic Acidosis
Starvation
What test is specific for AIDS?
Western Blot
What is the name of the serologic screening test for syphilis?
Venereal Disease Research Laboratory (VDRL)
What does an increase in uric acid indicate? (Two conditions)
Gout (Podagra; inflammation of the big toe)
Renal Failure
What test indicates Syphilis?
Treponema Pallidum Immobilizing Agent (TPI)
What three conditions are indicated by an increase in Lactic Dehydrogenase (LDH)?
Myocardial Infarction (MI)
Congestive Heart Failure (CHF)
Muscular Dystrophy
When would you expect to see a decrease in Lactic Dehydrogenase?
Cancer Therapy
What does an increase in Lipase indicate?
Acute Pancreatitis
An increase in Cholesterol lipids indicates what two things?
Early starvation
Diabetes Mellitus
What two conditions are seen with a decrease of Cholesterol lipids?
Late starvation
Liver disease
A decrease in Triglyceride lipids indicates what two conditions?
Cirrhosis
Malabsorption
What three conditions are seen when there is an increase in Triglyceride lipids?
Hyperlipidemia
Diabetes Mellitus
Atherosclerosis
In what condition would you expect to see LE Cell
Active Systemic Lupus Erythematous
In what three conditions would you see and increase in Phosphorous?
Acromegaly
Kidney disease
Hypervitaminosis D
What are three conditions that you would see a decrease in Phosphorous?
Rickets
Hypovitaminosis D
Hyperparathyroidism
What two conditions will you see an increase in Proteins?
Multiple Myeloma
Diabetic Acidosis
In what two conditions will you see a decrease Proteins?
Liver disease
Kidney syndrome
What will be increased if a patient has Viral Meningitis?
Proteins of the Cerebrospinal Fluid (CSF)
In what two conditions will there be an increase in Prothombin time?
Clotting Time
Vitamin K deficiency
Hepatocellular disease
In what three conditions will you see an increase in Serum Glutamic Oxaloacetic Transaminase (SGOT/AST)?
Myocardial Infarction
Liver conditions
Muscular Dystrophy
When would you expect to see a positive RA Latex? (7 Conditions)
Seropositive Arthritis Systemic Lupus Erythematous (SLE) Tuberculosis (TB) Cancer Sjogren's Still's Disease Scleroderma
In what two conditions would you see in increase in Serum Glutamic Pyruvic Transaminase (SGPT/ALT)?
Hepatitis Myocardial Infarction (MI)
In what two condition would you see an increase in Triiodothyronine (T3) and Thyroxine (T4)?
Hyperthyroidism
Pregnancy
In what two condition would you see an decrease in Triiodothyronine (T3) and Thyroxine (T4)?
Cirrhosis
Hypothyroidism
What condition are you looking for if you order an Arterial Blood Gas test?
Advance Chronic Obstructive Pulmonary Disease (COPD)
What two conditions are confirmed by an Aspiration test?
Gout
Bacterial Arthritis
What condition does a Balloon Angioplasty test for?
Obstructive Atherosclerosis
What does a biopsy test for?
Cancer, Tumor; i.e Hodgkin’s
What two conditions can a Bone Scan be helpful for?
Intrinsic Bone changes
Hidden fracture
What condition would you order a Bronchoscopy?
Bronchogenic Carcinoma (Lung Cancer)
For what condition would a Colonoscopy be ordered?
Lower Gastrointestinal (GI) Disease
What conditions would you order a Computed Tomography (CT)? (Five Topics)
Trauma Infection Vascular Neoplastic Arthritic/Metabolic Disorders
Lung, Appendix, Canal Stenosis
For what condition is a DEXA scan ordered?
Osteoporosis
When is a Doppler ultrasound ordered?
Arterial Alterations
What three conditions would you order a Electroencephalography (EEG)?
Epilepsy
Sleep disturbance
Encephalopathies
When would you order a Electromyography (EMG)?
Muscle Atrophy
Lower Motor Neuron Lesion (LMNL)
What is an Endoscopy test for?
Gastrointestinal (GI) tract
What test is used for indicating an abdominal tumor?
Laparoscopy
What condition is the Mantoux test ordered to confirm?
Tuberculosis (TB)
Additional test to be ordered:
TINE
PPD
What conditions would be appropriate to order a Magnetic Resonance Image (MRI)? (Six Topics)
Soft Tissues Spinal tumor Disc Rotator Cuff Meniscus Avascular Necrosis
What is the appropriate test for Peripheral nerves?
Nerve Conduction Velocity (NCV)
Lower Motor Neuron Lesion (LMNL)
What two test “should be” order together?
Nerve Conduction Velocity (NCV)-Peripheral nerves
Electromyography (EMG)- Muscle Atrophy
Lower Motor Neuron Lesion (LMNL)
What conditions should a Positron Emission Tomography (PET) be ordered? (Four Topics)
Bone and Soft tissue
Tumor
Heart
Brain
What is the Spirometer used for?
Chronic Obstructive Pulmonary Disease (COPD)
What two conditions are indicated using a Sputum culture?
Strep throat
Tuberculosis (TB)
What two conditions are confirmed by the use of the Stress Test?
Atherosclerosis
Angina
How is Glaucoma tested?
Tonometer
Ultrasound is used to test what three conditions?
Aneurysm
Organs
Pregnancy
What is the Stalk Test used to diagnosis?
Spondylolisthesis
For what five conditions would you order a Single Photon Emission Computed Tomography (SPECT)?
Musculoskeletal System Heart Brain Abdomen Spondylolisthesis
What is the most important part of a patient history, for Boards?
Age
What is the least important part of a patient’s history for Boards?
Gender
When a patient has a fever what two things will increase?
Heart Rate; 10 beats per minute for every degree increased
Respiratory Rate
What are three causes of Horner’s Syndrome?
Thoracic Outlet Syndrome (TOS)
Whiplash
Apical Lung Tumor (Pancoast)
All cranial nerve lesions are considered what?
Ipsilateral Lesions
When two cranial nerves are affected in a condition which one is sensory?
The lower numbered of two cranial nerves will be considered sensory AKA Afferent
When two cranial nerves are affected in a condition which one is motor?
The higher numbered of two cranial nerves will be considered motor AKA Efferent
If there is a Cranial Nerve II problem when doing Direct/Indirect light reflex which pupils are affected?
Both, Cranial Nerve II (2 Pupils are effected, even numbers go together)
If there is a Cranial Nerve III problem when doing Direct/Indirect light reflex which pupils are affected?
One, Cranial Nerve III (1 Pupil is effected, odd numbers go together)
In Secondary Hyperparathyroidism (2 HPT), there is a decrease stimulation for the Pituitary Gland and also a decrease in Thyroid-stimulating hormone (TSH), what are three finding associated with this condition?
Breast Atrophy
Amenorrhea
Macroglossia
What are three causes of Chronic Obstructive Pulmonary Disease (COPD)?
Chronic Bronchitis
Asthma
Emphysema
What condition has an x-ray finding of Bilateral Hylarlymphadnopathy AKA Angel Wings?
Sarcoidosis
What condition to Tietze Syndrome which only affects one articulation and radiates pain?
Costochondritis
How can you tell Hodgkin’s from Paget’s and Blastic Metastases?
Hodgkin’s: Anterior Vertebral Scalloping
Paget’s: Ivory White Vertebra is much BIGGER than the others
If Tetralogy of Fallot is left untreated what will happen?
Clubbing of the fingernails
What condition is associated with Coarctation of the Aorta?
Marfan’s Syndrome
Where do all signs and symptoms of Left Sided Heart Failure show up?
In the Lungs
Who do you refer a patient to that has Heart Failure?
Cardiologist
What condition has pain in the chest for longer than 10-15 minuets?
Myocardial Infarction (MI)
How is an Aneurysm diagnosed?
When the aorta is wider than the vertebral bodies
After a Myocardial Infraction, when does the enzyme CK-MB appear?
3-6 hours
After a Myocardial Infraction, when does the enzyme CK-MB peak?
24-36 hours
After a Myocardial Infraction, when does the enzyme CK-MB return to normal?
By day 3
After a Myocardial Infraction, when does the enzyme SGOT/AST appear?
6-8 hours
After a Myocardial Infraction, when does the enzyme SGOT/AST peak?
24 hours
After a Myocardial Infraction, when does the enzyme SGOT/AST return to normal?
By day 4-6
After a Myocardial Infraction, when does the enzyme LDH appear?
10-12 hours
After a Myocardial Infraction, when does the enzyme LDH peak?
48-72 hours
After a Myocardial Infraction, when does the enzyme LDH return to normal?
After 14 days
What are two things to understand about Myocardial Infarction enzymes for Board questions?
Order of:
Elevation
How long
Return to Normal
First (CK-MB) to Last (LDH), follow the same order
What is the most common cause of Cholecystitis?
Cholelithiasis (Gall Stones)
What is Zenker’s diverticulum?
Out pouching of the Esophagus
The Shilling test does not absorb Vitamin B12 leading to what condition?
Pernicious Anemia
What condition has a rapid, steady decrease of renal function with or without no urine production?
Acute Renal Failure
What are three things you will see in an older male patients urinary functions?
Patient will have:
Frequency
Urgency
Hesitancy
An increase in the D-Dimer test indicates what condition?
Deep Vein Thrombosis (DVT)
What headache is relieved by Alcohol?
Muscular Tension headache
What condition will the patient present with neck and shoulder stiffness?
Polymyalgia Rheumatica (Temporal Arteritis, Giant Cell)
Who do you refer a patient to that has Polymyalgia Rheumatica?
Ophthalmologist
What age do you often seen a patient with a Tempromandibular Joint (TMJ) Headache?
Teens
What signs and symptoms will you seen in a Tempromandibular Joint (TMJ) Headache?
Pain in the jaw, Tempromandibular Joint (TMJ) area
Pain with chewing
Clicking of the jaw
What will you see in the past history of a patient with Tempromandibular Joint (TMJ) Headache?
Recently visited the dentist
Who do you refer a patient with Tempromandibular Joint (TMJ) Headache to?
Back to the Dentist
What term is associated with Uterine Fibroids?
Leiomyoma
What is both a treatment and a diagnosis of Endometriosis?
Laparoscopy
