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Physical Exam > Lecture > Flashcards

Lecture Flashcards

1
Q

What is normal oral temp?

A

98.6 F

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2
Q

What is normal axillary temp?

A

97.6 F

least accurate

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3
Q

What is normal rectal temp?

A

99.4 F

most accurate

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4
Q

What is normal ear temp? (aural)

A

99.6 F

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5
Q

How many cm in an inch?

A

2.54 cm = 1 in

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6
Q

How many pounds in a kg?

A

2.2 lbs = 1 kg

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7
Q

What are normal systolic BP in 1, 5 & 10 years?

A

80

90

97

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8
Q

What is tactile fremitus?

A

feel for vibrations

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9
Q

Define calvarium

A

whole head

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10
Q

Parotid duct

A

Stenson’s duct

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11
Q

Submandibular duct

A

Warton’s duct

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12
Q

Why are nasolabial folds important?

A

stroke - won’t appear on affected side

facial droop

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13
Q

Why are palpebral fissures importan-t?

A

upslanted in down’s syndrome

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14
Q

What are facies?

A

clinial syndromes or disorders w/ distinctive facial features

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15
Q

What are the classic features of Down’s syndrome?

A
  1. Low set ears
  2. Macroglossia - big tongue
  3. Brush field spots on iris
  4. Flat nose
  5. Upslanted palpebral fissures
  6. Larger epicanthal folds
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16
Q

What are the classic features of Cushing’s?

A 
excess cortisol
Moon facies
1. Round face
2. Facial flushin = plethoric
3. inc. fact in cheeks
4. Double chin
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17
Q

What are the classic features of fetal alcohol syndrome?

A

usually happens in 1st trimester

  1. Smooth philtrum
  2. Thin upper lip
  3. Microcephaly
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18
Q

What are the classic features of acromegaly?

A

usually from pituitary adenoma - excess GH

  1. Enlargement of hands, feet & head
  2. Frontal bossing - prominent forehead
  3. Palmar thickening
  4. Coarse features
  5. Prognathism - large protruding jaw
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19
Q

What is the DDx for acromegaly?

A

Paget’s disease

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20
Q

What are the causes of parotid enlargement?

A
  1. Sjoren’s syndrome
  2. Mumps
  3. Chronic disease - DM, obesity, liver cirrhosis
  4. Neoplasm - unilateral
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21
Q

What disease is characteristic for exopthalmos?

A

Graves - autoimmune hyperthyroidism

enlarged thyroid

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22
Q

When is supraventricular LAD found?

A

only w/ lung CA, mediastinal, gastric CA

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23
Q

With gastric CA, what is supraclavicular LAD called?

A

Virchow’s node

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24
Q

What are the HA warning signs?

A
  1. More frequent/severe over 3 months
  2. Thunderclap
  3. New onset after 50
  4. Fever, sweats, wt loss
  5. Known CA, HIV, pregnancy
  6. Recent head trauma
  7. Focal deficits, vision change, neck stiffness
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25
Q

Why is HA w/ pregnancy concerning?

A

preeclampsia

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26
Q

A bounding, tender temporal artery is concerning for?

A

Temporal/giant cell arteritis

if untreated = blindness

> 50 y/o, autoimmune

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27
Q

What signs need to be present to diagnose bacterial sinusitis?

A
  1. Sx >7 days
  2. Fever
  3. Perulent nasal drainage
  4. Distinct facial pain
  5. Tenderness
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28
Q

When can the trachea be deviated?

A

pneumothorax

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29
Q

What does a normal TM look like?

A
  1. Pearly gray
  2. Non-injected/non-erythematous
  3. Intact
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30
Q

Who gets bony exotoses?

A

in the ear

caused by repeated exposures to cold water
ex. surfers/divers

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31
Q

What is the most common reason for conductive hearing loss?

A

cerumen impaction

use mineral oil to get it out

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32
Q

What is tympanosclerosis & what is it caused by?

A

Hardening of TM caused by recurrent infections

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33
Q

What is seen w/ acute otitis media?

A

Bulging erythematous
No light reflex
Loss of landmarks

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34
Q

What is otitis externa, findings & Tx?

A

Infection of external auditory canal
aka. swimmer’s ear

most common = P. aeroginosa 
Pain w/ touch
Hurts to touch tragus 
May be so inflammed you can't look at it 
Tx - earwick
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35
Q

Who commonly gets fungal otitis externa?

A

Diabetics

leads to erosino of inner ear

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36
Q

What is otorrhea?

A

Fluid from ear

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37
Q

What is chondrodermatitis helicis?

A

Chronic inflammatory lesion on helix or antihelix

Must Bx to rule out carcinoma

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38
Q

What is presbycusis?

A

High frequency hearing loss commonly caused by older aged

miss consonants & vowels

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39
Q

What can cause sensorineural hearing loss?

A

Disorders of:

  1. Inner ear
  2. Brain
  3. CN VIII
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40
Q

What is a normal result for the Rinne test?

A

Air conduction > bone conduction

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41
Q

Weber test - conductive vs. sensorineural loss?

A

C - lateral to bad ear

S - lateral to good ear
8th CN impairment

Obstruction lateralizes to blocked ear

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42
Q

What is the function of the nasal mucosa?

A
  1. Cleanse
  2. Humidify
  3. Control temp of inspired air
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43
Q

What are common causes of nasal septum perforation?

A

Cocaine or meth

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44
Q

What are common causes of a deviated septum?

A
  1. Congenital
  2. Trauma

They have problems w/ sleep apnea/anosmia

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45
Q

What is an emergent nosebleed from?

A

Woodruff’s plexus - posterior nose bleed

difficulty breathing

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46
Q

Where do nosebleeds commonly come from?

A

Kiesselbach’s plexus - front nasal cavity

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47
Q

What commonly causes nasal polyps?

A

Recurrent allergies

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48
Q

What is rhinophyma?

A

“bumpy nose” from severe rosacia

benign

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49
Q

What is contained in the pulp of a tooth?

A

Artery, veins & nerves

under the dentin

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50
Q

What are vallate papilla?

A

Tastebuds in the back of the mouth

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51
Q

What are fungiform papilla?

A

Tastebuds on the front of the tongue

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52
Q

What is torus palatinus?

A

A benign midline lump under the tongue

may be mandibular or maxillary

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53
Q

Which nerve causes the tongue to rise?

A

CN XII

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54
Q

What is a snake-tongue looking uvula called?

A

bifid

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55
Q

What are the normal tongue variants?

A
  1. Fissured
  2. Geographic
  3. Hairy (tobacco use, poor hygiene, antibiotics, coffee)
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56
Q

What is leukoplakia?

A

Cancerous precursor

painless white patches on tongue/buccal mucosa

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57
Q

What is thrush?

A

Oral candidiasis
painful
scrapes off w/ red bleeding base
common in immunocompromised/steroids

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58
Q

What are common causes of gingival hyperplasia?

A
  1. Leukemia if bleeding
  2. Chronic dilantin use
  3. Pregnancy
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59
Q

What is a periapical abscess?

A

infection of periapical region of tooth
tender lesion just adjacent to tooth
Tx: I&D, abx

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60
Q

What is Kaposi’s sarcoma caused by?

A

Herpes type 8

purple vascular lesion in mouth

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61
Q

What are dental caries?

A

cavities

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62
Q

Bulimia

A

Halitosis
Abrasions on knuckles
Negative gag reflex
Dentition in ill repair

look at back of throat for cuts

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63
Q

S/S acute necrotixing ulcerative gingivitis

A
  1. Fever
  2. Malaise
  3. LAD
  4. Halitosis
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64
Q

What can cause petechiae on the hard palate?

A
  1. Mono
  2. HIV
  3. Trauma
  4. Coagulopathy
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65
Q

What causes Hutchinson’s teeth?

A

Congenital syphilis

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66
Q

Causes of atrophic glossitis

A

Smooth tongue

Deficiency in:

  1. Riboflavin
  2. Niacin
  3. Folic acid
  4. Vitamin B12
  5. Pyridoxine
  6. Iron
  7. Tx w/ chemo
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67
Q

What CN opens the eye?

A

III

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68
Q

What CN closes the eye?

A

VII

69
Q

What CN innervates the lateral rectus?

A

VI

70
Q

What CN innervates the superior oblique?

A

IV

71
Q

What CNs are responsible for eye accommodation?

A

CN II & III

72
Q

When is someone considered legally blind?

A

20/200 vision

73
Q

What is color blindness called?

A

dichromacy

most common is red/green
affects 1% of males
issue w/ retinal cones

tested w/ ishihara cards

74
Q

How do you test for color blindness?

A

ishihara cards

75
Q

What is a normal pupil size?

A

3-5 mm

opiates make pupils very small

76
Q

What are the causes of afferent pupillary defect?

A
  1. Optic nerve disease/lesion - eyes react but don’t accommodate
  2. Argyll Robinson - Syphillis, hooker will accommodate you but not react to you
  3. CN III palsy - diabetes, lid lag & big pupil
77
Q

What is seen with Argyll Robinson?

A

Cause = syphillis

hooker will accommodate you but not react to you

78
Q

What can cause an absent light reflex?

A
  1. Cataracts
  2. Retinoblastoma - seen in newborn exam
  3. Retinal detachment
79
Q

Which CN is responsible for the corneal reflex?

A

III

80
Q

Where is the lesion w/ R homonymous hemianopsia?

A

L optic tract

81
Q

Where is the lesion w/ bitemporal hemianopsia?

A

Optic chiasm

common w/ pituitary tumor

82
Q

Where is the lesion w/ homonymous R quandrantic defect?

A

L optic radiation

83
Q

What is ectropion?

A

Eversion of eyelid
common w/ old people
causes excessive tearing

84
Q

What is entropion?

A

Inversion of eyelid

causes irritation of eye

85
Q

What is blepharitis & common causes?

A

Inflammation of the eyelid

Staph/fungus/blockage of glands

86
Q

When is periorbital edema commonly seen?

A

Hypothyroidism

87
Q

What is Herpes Zoster ophthalmicus?

A

medical emergency
involves CN V - trigeminal

inflammation of cornea leading to blindness
dendritic lesions on eye

88
Q

What is a hordeolum & common cause?

A

stye
Staph infection of meibomian gland

causes pain, irritation

Tx. - warm compresses, abx ointment

89
Q

What is a chalazion?

A

A chronic granulomatous inflammation of the meibomian gland
usually follows a hordeolum
not infected

Tx - steroids/removal

90
Q

What is xanthelasma?

A

lipid deposits around the eye

91
Q

What is dacrocystitis?

A

bacterial infection of lacrimal sac
common in kids

Tx - systemic abx

92
Q

What are the types of conjunctivitis?

A
  1. Bacterial - usually Strep
  2. Viral - usually bilateral
  3. Allergic
93
Q

What is subconjunctival hemorrhage & what is it associated with?

A

benign, well demarcated rupture of small vessels of sclera
can be assoc. w/ HTN, coagulopathy
goes away on its own

94
Q

What is iritis?

A 
Medical emergency 
Ciliary injection
From autoimmune process - SLE, sarcoidosis, ankylosing spondylitis
Pain w/ eye mvmts & photophobia 
"cells in flare"
95
Q

What is acute glaucoma?

A 
Medical emergency
Painful red eye w/ HA, N&V
Vision loss
---Steamy cornea
fixed, dilated pupil
ciliary injection
Tx - carbonic anhydrase, inhibitor IV, beta-blocker
96
Q

What is hyphema?

A

Blood in anterior chamber of eye, usually from trauma

Tx - Drainage & f/u

97
Q

What is pinguecula?

A

Benign overgrowth of the sclera

Caused by sun, wind or dry air on bulbar conjunctiva

98
Q

What is pterygium?

A

thickening of bulbar conjunctiva onto cornea causing visual disturbance

99
Q

What causes Kayser-Fleischer rings?

A

Wilson’s disease
too much Cu2+
autosomal recessive

100
Q

What is corneal arcus

A

aka senile arcus
grayish hue around cornea

if young - caused by hyperlipidemia

101
Q

What are Drusens significant for?

A

Macular degeneration

yellowish spots on fundis exam, range in size, location & coalesce together

102
Q

Where is the angle of Louis?

A

aka sternal angle

point where 2nd rib attaches to sternum

103
Q

Where does the trachea bifurcate into the L & R main stem bronchus?

A

T4

104
Q

What is pectus excavatum?

A

Funnel chest

can compress mediastinal structures

105
Q

What is pectus carinatum?

A

pigeon chest

106
Q

What are the accessory breathing muscles?

A
  1. Abdominal
  2. SCM
  3. Trapezius
107
Q

Where do you typically see retractions (breathing)?

A

interspaces & supraclavicular fossa

108
Q

What is the normal breathing rate?

A

14-20/min

109
Q

Dec/absent tactile fremitus?

A
  1. Voice too soft
  2. COPD
  3. Thick chest wall
  4. Pneumothorax
110
Q

Describe vesicular lung sounds

A
  1. Inspiratory sounds longer than expiratory
  2. Soft intensity
  3. Low pitch
  4. Heard over most healthy lung fields
111
Q

Describe bronchovesicular lung sounds

A
  1. Insp = exp
  2. Intermediate intensity
  3. Intermediate pitch
  4. Heard over 1st & 2nd interspaces anteriorly & btwn scapula posteriorly
112
Q

Describe bronchial breath sounds

A
  1. Exp slightly longer than insp
  2. Loud
  3. High pitched (tubular)
  4. Heard over manubrium
113
Q

Describe tracheal breath sounds

A
  1. Insp = exp
  2. Very loud
  3. High pitched (tubular)
  4. Heard over trachea in neck
114
Q

Dec. intensity of normal lung sounds?

A
  1. Obesity
  2. Thick chest wall
  3. Shallow breaths
  4. Pathology
115
Q

Describe crackles

A

aka rales

Brief discontinuous sounds, most often at end of inspiration

116
Q

Describe rhonchi

A

Can have snoring or gurgling quality

Indicate secretions in large airways

117
Q

Describe wheezes

A

Musical sounds created when air flows rapidly through bronchi that are narrowed significantly
Heard in expiration & sometimes inspiration

118
Q

Describe stridor

A

Wheeze heard primarily during insp & mainly over large airways
can be sign of airway obstruction

119
Q

Describe pleural rub

A

Related to inflammation of pleural surfaces
Coarse grating sound timed w/ lung mvmt
Evidence of local inflammation

120
Q

When are transmitted voice sounds dec?

A

when fluid or air pushes lung away from chest wall

121
Q

When is bronchophony heard?

A

consolidation

common w/ PNA, atelectasis or tumors

122
Q

What is usually heard w/ whispered pectoriloquy?

A

nothing

123
Q

When is egophony heard?

A

consolidation

ex. PNA

124
Q

Normal lung

A
  1. Vesicular sounds
  2. Distant spoken words
  3. Spoken e = e
  4. Distant whispered words
  5. Distant tactile fremitus
  6. Resonant percussion
  7. RR 14-20
125
Q

Consolidated lung

A
  1. Boncho/vesicular breath sounds
  2. Inc. spoken words
  3. Egophony
  4. Inc. whispered words
  5. Inc. tactile fremitus
  6. Dull percussion
  7. Inc. RR
126
Q

Effect of handgrip maneuver on murmurs

A 
Inc afterload
Inc. regurg murmurs 
1. Aortic regurg
2. Mitral regurg
3. VSD
4. Delayed MVP
Dec. gotward flowing murmurs
1. Aortic stenosis
2. HOCM
127
Q

Effect of squatting maneuver on murmurs

A
  1. Inc. venous return (inc. preload)
  2. Inc. stroke volume
  3. Inc. murmur of AS, PS, TR
  4. Delays murmur of MVP
128
Q

Effect of valsalva maneuver on mumurs

A
  1. Dec. venous return (dec. preload)
  2. Dec. stroke volume
  3. Dec. murmur of AS, PS, TR
129
Q

Where are mitral murmurs best heard?

A

decubitus position

130
Q

Describe aortic regurg murmur

A
  1. Early diastolic
  2. High-pitched
  3. Blowing
  4. Decrescendo
  5. Best heard at 2nd RICS
  6. Inc. w/ leaning forward & holding breath in full expiration
  7. Inc. w/ handgrip maneuver
131
Q

Describe pulmonary regurg murmur

A
  1. Early diastolic
  2. High-pitched
  3. Blowing
  4. Decrescendo
  5. Best heard at 2-3 LICS
  6. Inc. w/ handgrip maneuver
132
Q

Describe mitral stenosis murmur

A
  1. Mid-diastolic
  2. Rumbling
  3. PMI inc. in L decubitus position
  4. Crescendo assoc w/ opening snap
133
Q

Describe Tricuspid stenosis murmur

A
  1. Mid-diastolic
  2. Rumbling
  3. May inc. w/ inspiration
  4. Wide splitting of S1
134
Q

Describe aortic stenosis murmur

A
  1. Mid systolic
  2. Crescendo-decrescendo
  3. Usually harsh but can be musical
  4. Best heard at 2nd RICS
  5. May radiate to carotids
  6. Dec. w/ standing or valsalva maneuvers or handgrip maneuver
135
Q

Describe pulmonic stenosis murmur

A
  1. Mid systolic
  2. Crescendo-decrescendo
  3. Harsh
  4. Best heard at 2nd LICS
  5. May radiate to L neck
  6. May cause wide S2 splitting
136
Q

Describe Mitral valve prolapse murmur

A
  1. Late systole
  2. May be preceded by clicks
  3. Best heard over the apex w/ the diaphragm
137
Q

Describe tricuspid valve prolapse murmur

A

Uncommon except in presence of mitral valve prolapse

138
Q

Describe a tricuspid/insufficinecy/regurgitation murmur

A
  1. 4th LSB

2. Inc. w/ respiration (Varcalios sign)

139
Q

Describe mitral regurg murmur

A
  1. Apex in L lateral decubitus position
  2. High pitched
  3. No change w/ respiration
  4. May radiate to axilla
140
Q

Describe WSD murmur

A
  1. L 3-4 ICS along sternal border

2. Inc. w/ handgrip maneuver

141
Q

What are innocent mumurs in kids?

A
  1. Still’s murmur
  2. Physiologic systolic ejection murmur
  3. Cervical venous hum
142
Q

Red flags of pathologic murmurs?

A
  1. Pansystolic murmurs
  2. Diastolic murmurs
  3. Loud murmurs (>3/6)
  4. Other evidence of heart disease, SOB, fatigue, failure to thrive, cyanosis, pulse defecits
143
Q

What are innocent murmurs in adults?

A
  1. Pregnancy
  2. Anemia
  3. Thyroid conditions
  4. Exercise
144
Q

When are friction rubs heard?

A

Pericarditis

leathery raspy sound
Best hear w/ Pt leaning forward at end of expiration

145
Q

Grading Pitting Edema

A

1+ slight, disappears rapidly 2mm
2+ disappears in 10-15 sec 4mm
3+ noticeably deep, >1 min swollen 6mm
4+ deep pit, lasts 2-5min, gross swlling 8mm

146
Q

What are some common causes of lymphedema?

A
  1. Redial mastectomy w/ node resection
  2. Tumor blockage
  3. Inflammation
  4. Fibrosis
147
Q

Common causes of acute arterial occlusion?

A
  1. Snake bites
  2. Afib
  3. IE
  4. Pelvic fracture
  5. Aneurysm
  6. Arterial dissections
  7. Fat embolism
  8. Trauma
148
Q

Skin changes w/ chronic arterial insuffiency

A
  1. Prolonged capillary refill
  2. Loss of hair
  3. Thinning of skin
  4. Shiny skin
  5. Dependent rubor
  6. Painful ulcers
149
Q

Which kidney is lower?

A

Right

150
Q

Retroperitoneal organs?

A
  1. Pancreas
  2. Kidneys
    3, Ureters
    4, Aorta
  3. Vena cava
151
Q

What is diastasis recti?

A

Weakening of linea alba so have bump when you crunch

152
Q

When would you have inc. bowel sounds?

A
  1. Gastroenteritis
  2. Hunger
  3. Early obstruction
153
Q

When would you have dec. bowel sounds?

A
  1. Peritonitis
  2. Adynamic ileus
  3. Late obstruction
154
Q

What sound is expected w/ percussion over the bladder?

A

full - dull

155
Q

What sound is expected w/ percussion over the liver

A

dull

156
Q

What sound is expected w/ percussion over the stomach?

A

empty - tympanic

full - full

157
Q

What sound is expected w/ percussion over the spleen?

A

dull

158
Q

What sound is expected w/ percussion over most of the abdomen if the Pt is very constipated?

A

dull

159
Q

What does a +CVA tenderness suggest?

A

Pyelonephritis

could also be MSK

160
Q

What Sx would a Pt have w/ acute appendicitis?

A
  1. Poorly localized periumbilical pain
  2. Then RLQ pain
    aggravated by mvmt/cough
    Palpate at McBurney’s point
161
Q

What is Rovsing’s sign?

A

Pain on other side of palpation

162
Q

What does a + psoas sign suggest?

A

appendicitis

163
Q

What does a + Murphy’s sign suggest?

A

cholecystitis

press on gall bladder & inspiratory arrest

164
Q

What does shifting dullness test for?

A

ascites

165
Q

What is Kehr’s sign?

A

Pain in L shoulder from splenic rupture

166
Q

What is a hiatal hernia?

A

stomach goes through gastroesophageal junction into the thorax
most commonly sliding hernia

167
Q

What is a herniated nucleus pulposus?

A

herniated disc

168
Q

What is an epigastric hernia?

A

weakness or disruption of the linea alba w/ protrusion of peritoneal contents

169
Q

What side of the hand do epitrochlear lymph nodes drain?

A

ulnar side

Physical Exam (6 decks)

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