ICM-1 Flashcards
Edema
Observable swelling from the accumulation of fluid in the skin/ in one or more body compartments
Unilateral edema
One side of the body is swollen– likely causes: deep vein thrombosis, cellulitis, trauma
Bilateral edema
swelling on both sides of the body, likely causes: right side heart failure
Dependent edema
swelling in the lower limbs
Tightness in shoes
Edema caused by peripheral vascular disorder (cardiac)
Puffy eyelids in the morning
Edema caused by renal disease or hypoalbuminemia
Had to use a bigger belt
Cause: Ascites– edema in the abdomen caused by fluid in the peritoneal cavity
Acute headache
new onset, severe headache –> may be sign of serious illness
Chronic headache
recurrent head pain, may not be serious
Extracranial headache
Caused by glaucoma, sinusitis, dental distress
Intracranial headache
Cuased by: brain tumor, mass lesions, infections and vascular disorders
Subarachnoid Hemorrhage
Present with: sudden, severe headache
describe as “thunderclap”/ “explosive”
Bilateral, associated with nausea, vomiting, stiff neck
NO FEVER
Acute Meningitis
Present with: sudden, severe headache, preceded by respiratory illness/sore throat, See Triad: fever, headache, stiff neck
Migraine
Present with unilateral and diffuse throbbing headache, may see aura, likely had early life onset, have family history of migraines
Muscle Tension headache
Chronic headaches, present with dull, throbbing pain with a hat band distribution or pain in occipital region, often stress related
Cluster Headache
present with: severe unilaterally tearing headache that occurs at night and wakes them up with rhinorrhea, also doesn’t occur for long periods then start happening again
Brain tumor
Present with steadily progressively worse headache that may be worse in the AM and is aggravated by coughing
Temporal Arteritis
Present with unilateral throbbing headache in temporal region, see vision changes, pain when brushing hair (temple tenderness), may have fever or myalgias
Cardiac Syncope
loss of consciousness resulting from recoverable loss of adequate cerebral blood flow –> caused by reduced cardiac output
Vasovagal syncope
loss of consciousness resulting from a recoverable loss of adequate cerebral blood flow–> caused by increased peripheral vasodilation
Seizure
alteration of consciousness caused by sudden dysfunction of the electrical control mechanisms of the brain
Causes: idiopathic epilepsy, metabolic imbalances, drug and alcohol withdrawal, CNS infections and high fever
Arterial Embolism
Pain, paresthesia, pallor, pulselessness (difficult to palpate pulse), paralysis, perishingly cold
Deep Vein Thrombosis
Present with: Virchow’s triad: decreased blood flow rate, damage to blood vessel walls, hypercoagulability, pain, swollen, warm and red legs with engorged superficial veins
Due to formation of a blood clot in a deep vein
Chronic Arterial insufficiency
intermittent claudication, decreased/absent pulses/ pale colour especially on elevation of limb, cool to the touch, atrophic skin with hair loss, ulcerations on toes/soles of feet, may have gangrene, also diabetes is a predisposing factor
Chronic Venous insufficiency
normal pulse in leg, brown pigmentation, marked edema, thickened skin, ulcerations on medial ankle
Dyspnea
sensation of shortness of breath at rest, feeling of being smothered
Orthopnea
shortness of breath/smothering feeling on lying flat improves upon sitting up, often ask for more pillows
Paroxysmal nocturnal dyspnea
sudden shortness of breath upon waking up 1-2 hours after going to bed
two possible causes: acute cardiac: cardiogenic shock, left sided heart failure, chronic cardiac: mitral valve displacement, atrial fibrillation
Costochondritis
sudden sticking/stabbing/aching pain in the anterior chest, tender to the touch, variable severity and timing, caused by movement of the chest, trunk or arm
Pericarditis
pain gradually started in the central chest, described as sharp and stabbing, radiates to the shoulder, has been going on for a day, feel better when leaning forward, worse when breathing in, also have a respiratory infection
Myocardial Infarction
Sudden retrosternal chest pain that is radiating to the neck and jawline as well as the shoulder and arm, described as a pressing/squeezing feeling, also experiencing nausea, vomiting and sweating, has been going on for more than 30 minutes and was not relieved by GTN spray
Angina
Experience sudden retrosternal chest pain which radiates to the neck, jawline, shoulder and arm, also experience dyspnea, sweating, nausea, pain is mild-moderate and comes and goes approximately every 10 minutes, the pain is relieved by rest and GTN spray, and made worse with exercise or excitement
Pheochromocytoma
present with hypertension, pain, perspiration, palpitations and pallor, symptoms are episodic
Addison’s Disease
Patient with fatigue, muscle weakness, weight loss, low blood pressure, orthostatic hypertension, hyperpigmentation and changes in mood
Addison’s Crisis
present with pain in the legs and back described as penetrating, also see low blood pressure and hypoglycemia, vomitting, diarrhea and dehydration, patient is also confused and psychotic, have slurred speech, convulsions, shock and eventually coma
Cushing’s Disease
rapid weight gain associated with central obesity, see moon face and buffalo hump, also see hyperhydrosis, thinning skin, easy bruising, hirsutism and red striae
Diabetes Mellitus
Hyperglycemia, extreme thirst, urinate often, have dry skin, are constantly hungry, have blurry vision, and are drowsy. When they get cut it doesn’t heal quickly
Diabetes Mellitus
Hypoglycemia, shaky with fast heartbeat and sweating, feel dizzy and anxious, are constantly hungry and have episodes of blurry vision, weakness and fatigue, also have headaches and have been irritable
Hypothyroidism
Present with menorrhagia, dry skin and hair, general lack of energy, bradycardia, severe cold intolerance, chronic constipation, examination shows slowed thinking and delayed ankle jerk reflex
Hyperthyroidism
see weight loss even with increased appetite, notice trembling handds, goiter and excessive nervousness, also complain of increased bowel movements, physical examination shows accelerated heart rate, high blood pressure and goiter
Hypopituitarism
see short stature/growth retardation (don’t meet normal milestones), decreased muscle mass, impaired attention, delayed puberty, loss of libido, amenorrhea, infertility and hypothyroidism
Hyperpituitarism
Gigantism (if early onset), acromegaly (late onset), See spade-like hands, prognathism, large feet, complain of bitemporal hemianopia and galactorrhea, physical exam shows macroglossia and hoarse voice
Osteoarthritis
present with oligoarthritis (inflammation of 2/3/4 joints), complain of chronic pain that is sharp and localized, may see changes in bone structure of hands
Reactive arthritis
Present with joint pain in one joint, also see visual problems and urinary infection (Writer’s syndrome), due to infection outside the joint which leads to an inflammatory response causing pain
Gout
high uric acid buildup, monosodium uric crystals deposit in joint spaces, complain of acute onset joint pain that is sharp and localized to one joint, symptoms are exacerbated by alcohol, red meat and drugs
Pseudogout
Present with acute onset joint pain that is sharp and localized to one joint, symptoms are exacerbated by alcohol, red meat and drugs, crystals: calcium pyrophosphate
Septic Arthritis
Complain of joint pain in one joint, preceded by local infection in the area, associated with fever
Acute Diarrhea
Present with frequent defecation over a period of less than 14 days, also have diffuse cramping pain and nausea, and may have fever, likely causes: viral infection, bacterial infection, parasites, medications
Chronic Diarrhea
present with frequent defecation for more than 4 weeks, also have diffuse, cramping pain accompanied with nausea, fever and anorexia, likely causes: Crohn’s Disease, ulcerative colitis, celiac disease, irritable bowel syndrome
Gastroesophageal Reflux Disease
Present with “heartburn”, regurgitation, dysphagia, nausea and vomitting that is exacerbated by food, lying down and bending, medications, smoking
Acute Myocardial infarction
present with substernal pain that is described as deep aching pressure, also have indigestion, nausea and vomiting, excessive sweating and dyspnea, also had periods of syncope
Risk factors: medical history, smoking/cocaine abuse, obesity
Acute Pancreatitis
Patient presents with sudden onset dull, severe steady boring pain that radiates to the back, and is alleviated by sitting up and leaning forward but is made worse by coughing and moving around
Risk factors: “I GET SMASHED”–> Gall stones, alcohol intake, mumps, auto immune diesease, drugs (ex. steroids)
Peptic Ulcer Disease
patient presents with burning, gnawing pain and a consistent sensation of hunger that is alleviated with antacids, exacerbated with food/hunger, also see black stools, nausea and vomiting
Also see: infection that was treated with NSAIDs and glucocorticoids, likely a smoker, likely drinks alcohol
Pelvic Inflammatory Disease
Patient (likely woman <25 yrs old) presents with lower abdominal pain, vaginal/cervical discharge, fever and chills, irregular vaginal bleeding and dyspareunia, also has history of multiple sexual partners and STDs
Acute Appendicitis
Patient complains of right lower quadrant pain that was initially periumbilical, also see nausea, vomiting and anorexia, accompanied by high fever, pain is aggravated by cough and movement
McBurney’s Point
Looking at a line from the umbilicus to ASIS, 1/3 from asis, 2/3 from umbilicus–> where Appendix is located
Ectopic Pregnancy
Patient presents with Lower abdominal/pelvic pain and cramping that started gradually (if sudden then possibility of rupture), also complains of dizziness, vaginal bleeding, shoulder pain and amenorrhea*
Hepatitis (general)
Patient presents with fever (possibly low), RUQ pain/discomfort, fatigue, malaise, weakness, nausea and vomiting, anorexia, dark urine, clay/pale stools (jaundice develops later)
Hepatitis A
Transmitted from fecal to oral
History of eating contaminated food/ travel to third world
Hepatitis B
Vertical transmission via bodily fluids, from blood transfusion or sexual activity
Hepatitis C
Transmission via contaminated blood from needles– often contracted from tatoos or body piercing
Hepatitis D
Contracted from needles
Hepatitis E
Fecal to oral transmission, contracted from contaminated water
Ascending cholangitis
Patient presents with upper right quadrant pain accompanied by fever, jaundice and pale coloured stools, also notice mental status changes and examination shows signs of shock and body malaise
Charcot’s triad
Pain, fever and jaundice –> ascending cholangitis
Reynold’s pentad
pain, fever, jaundice, mental status changes and decreased blood pressure –> ascending cholangitis
Cholecystitis
patient complains of sudden onset RUQ pain that radiates to the upper back that has lasted for more than 6 hours (come and gone), it started and is made worse upon eating fatty foods and feels better with analgesics, also have fever, chills, nausea, vomiting and a previous history of RUQ pain
Murphy’s sign
when doing a physical examination put hand on URQ (below rib cage) and ask patient to breathe in –> very painful–> indicative of cholecystitis
Acute cholelithiasis
Female patient that is 40+ and overweight complains of sudden right upper quadrant pain that has lasted 1-2 hours and radiates to the scapula/upper back, also complains of nausea and vomiting, physical exam shows no fever
