NBS II General Diagnosis random notes Flashcards
Ear crusty discharge
Otitis externa, swimmers ear
Bulging tympanum
Otitis media
Retracted tympanum - blocking Eustachian tube
Serrous (bubbly) and altitude
Myringitis
Redness (acute infection)
Meningitis
Common complication
Ear black discharge
Perforation
Ear: Pearly gray
Normal
Otosclerosis
chalky white ear drum
Conduction problem conditions/ disease
INfection
Cerumen
Otosclerorsis
Ear conduction problem can hear better or worse in lout environment?
Better
Weber lateralizes to the side of? (Ear that can hear)
Conduction problem
Rhinne air vs bone conduction
Air 2: Bone 1
Nose: Red
Acute rhinitis
Nose: Pale/ gray/ blue
Allergies or chronic “itis”
Nose: Foul discharge
Foreign object
Nose: Clear discharge/ bloody
CSF
Nose: Watery unilateral
Cribriform plate fracture
Nose bleed
Epistaxis
Nose: Mass in mucosa
Polyp
Supraclavicular lymph drains …..
Right side; above the diaphragm
Abnormal Rhinne test indicate
Air conduction problem
What vertebra level is pancreas located
T10
Epigastric, fetal position, alcoholism, ECHYMOSIS in the flank that is NOT painful
Pancreatitis (head)
diseases in pancreas head
Pancreatitis
Cancer
Diseases in pancreas tail
Diabetes Melitus
Tests for diabetes
A1C (best) - looking for glycosylation in blood
GTT (8-12 hours)
FBS
Glycosylated Hemoglobin
Does pancreatitis patient experience pain?
Yes, sharp pain that goes through and patient leans FORWARD to alleviate pain
What can be used (substance) to help with diabetes
Chromium
When sugar combines with protein causing inflammation and free radicals
Glycation
Sensorineural hearing conditions
Presbycusis
Neuroma
Menierre’s
GB quadrant
RUQ
Murphy’s sign is associated with
GB
Female, multiparous, flatulence, distension, obese, steatorrhea, right scapular pain, jaundice
GB
Shilling’s Shift
WBC 17,500
Appendicitis
Shilling’s Test
PLS
What quadrant is Appendicitis
RLQ
Where is appendicitis pain located
McBURNEY’s point
B/w ASIS and umbilicus (Right Lower)
Tests for appendicits
Psoas test & Obturator Test
Blumberg (Rebound tenderness)
Rovsing’s (Pressure in LLQ)
Markle (Heel Jar)
Which quadrant is being pressed in Rovsing’s
LLQ
What condition cause pain at every point during Blumber Rebound Tenderness
Peritonitis
How to test obturator
Internal and external rotate hip
How to do psoas test
Flex or extend hip
Peptic ulcer includes
Duodenal and Gastric Ulcer
Helicobacter Pylori, infection
Peptic ulcer
What study is needed for peptic ulcer
Barium Study
Virchow’s node on the left, occult blood
Cancer
Elderly, alcohol problem, B12 absorption problem, PLS (stocking and glove paresthesia)
Gastritis
Which one is more common? Gastric/ duodenal ulcer
Duodenal - due to stress, acidic condition, lack of sleep
Which one may be relieved after eating? Gastric/ duodenal ulcer
Gastric ulcer
Duodenal - 2 hours after eating
B12 extrinsic factor, diet (animal product)
CYANOCOBALAMIN
B12 intrinsic factor
Secreted by parietal cells in gut (ext and int combined to allow B12 absorption)
B12 function
RBC maturation
Myelination of nerves
Demyelination of nerves is
Sclerosis
Parietal cell degradation from chronic diet abuse, proton inhibitor pump meds (Nexium)
Chronic gastritis
What kind of anemia is related to chronic gastritis
Pernicious anemia (reticulocytosis) Megaloblastic anemia (b/c b12 helps RBC to mature)
What nerves are targeted with B12 deficiency
Posterior column
Lateral tract
Increase number of immature RBC
Reticulocytosis
Chronic gastritis test
B12 assay
Schilling’s test
ACHLORHYDRIA
COLON: elderly, outpouching, fiber
Diverticulosis
COLON: Abrupt constipation, follows polyps
Cancer
COLON: SKIP LESION, STRING SIGNS, rectal bleeding
Crohn’s
COLON: stress, bloody diarrhea, MEGACOLON, stoll transplant (microbiota)
Ulcerative colitis
COLON: early: increased distal or late; decreased
Obstruction
COLON: Fluid in abdoment, with organ failure
Ascites
Ascites test
Fluid wave
Puddle sign
How long to listen for ABOBORYGMI
5 minutes
Tender, swollen, boggy, IgM, leukocytopenia, lymphocytosis
Acute Hepatitis (A&C)
Non tender, swollen, boggy, IgG, Increase or normal WBC and enzymes
Chronic Hep
Leukocytopenia
Decrease WBC
Lymphocytosis
Increase lymph
Non tender, Variable (swollen or not), Hard (smooth), increase GGT
Liver cirrhosis
Non tender, swollen, hard (nodule), increase biopsy
Liver cancer
Colon disease related with HLAB27
Crohns
Ulcerative Collitis
Kidney is located at which vertebra level?, which side is slightly lower
T12-L3
Right
HEP abrev
HTN
Edema
Proteinuria
HEP, chronic failure, fat OVAL BODIES, ALL casts
Nephrosis
Female, ascending, E. Coli, No cast, No fever, NITRATES
Cystitis
PAINLESS BLEEDING
cancer
Male, 20 yo, sedentary lifestyle, colicky
Stones
Toxemia of pregnancy
Pre-eclampsia (HEP)
Eclampsia (HEP + convulsion)
Proteinuria indicates Upper or Lower tract infection?
UPPER tract, DESCENDING Indicates kidney (nephron) condition
Fever, Strep, Sequela is carditis
Nephritic (infection)
Strep, HEP, Cast, Proteinuria, STONES, Fever
Kidney (nephron), Upper tract, descending
STD, E.Coli, NITRATES, No fever, FUB (Frequency, Urgency, Burning) urination
Ascending tract, Lower tract
Strep story
Mouth - Kidney - Heart
RBC cast
Glomerulonephritis
WBC and Waxy cast
Pyelonephritis
All cast
Nephrosis
Hyaline cast
Normal
Which kind of hemorrhoids; Often symptoms free unless defecating (portal HTN)
External Hemorrhoids (Thrombosed)
Which kind of hemorrhoids; painful, bloody defecation
Internal hemorrhoid (Prolapsed)
Strain produces donut shape anus
Rectal prolapse
Linear tear, bloody defecation
Rectal fissure
Firm, palpable growth
Rectal polyps
Which valves are open and shut during S1 Systole?
AV shut (mitral, tricuspid) Semilunar opens (Aortic, pulmonic)
Stenosis means …. and it has …. pitch, heard using …. part of stethoscope
Can’t fully open
Low pitch
Bell
Regurgitation means (or AKA)
Insufficient, prolapse, incompetent
High pitch, diaphragm of stethoscope
Auscultation point: aortic valve
Right second intercostal space
Auscultation point: pulmonic valve
Left 2nd ICS
Auscultation point: Erb’s point
Left 3rd ICS
Auscultation point: Tricuspid
Left 4th ICS
Auscultation point: Mitral
5th ICS midclavicular
Difficult to hear, AV valves out of sync
S1 Splitting
S1 splitting is heard where?
Near tricuspid location (L 4th ICS)
S2 ONLY during inspiration, children and athletes, PULMONIC shuts LATE
Physiological S2 splitting
S2 splitting is heard where?
At pulmonic (L 2nd ICS)
S2 always split, AORTIC valve shuts EARLY d/t HTN
Pathological S2
S3&S4 Which one can be normal and abnormal
S3
S4 is always abnormal
Low Pitch, Bell at Apex, Associated with AV regurgitation
S3
S3 Physiological
Under 40, often heard in children and late pregnancy
S3 Pathological
Over 40, called ventricular gallop
Midsystolic Murmur
Semilunar Stenosis
Pansystolic Murmur
AV Regurgitation
Pan means all throughout systole
Associated with AV Regurgitation
Pansystolic Murmur
S3
When does Ejection usually occur?
Usually systolic; Valve opening, Semilunar stenosis
Aortic Ejection …. during respiration
Stays the same
Pulmonic Ejection ….. with respiration
Decreases
Occurs in late systolic, valve shutting, mitral prolapse (apex and 2nd intercostal space)
Clicks
“Clicks” are evaluated in what position
Multiple position (standing, squatting, supine)
Occurs in very early diastole, mitral stenosis, high pitched, heard in apex in pulmonic region
Opening Snap
Is opening snap affected by respiration?
No
Opening snap is often misdiagnosed as
Pulmonic Valve Abnormality
Innocent murmur that is heard in children
Stills murmur
- Persistent opening between two major blood vessel exiting heart after birth
Patent ductus arteriosis
Patent ductus arteriosis is associated with ….. murmur
Machinery murmur
Strong association with clot formation (stroke potential)
Atrial flutter or fibrilation
Inflammation around the heart, rub present (4th intercostal)
Pericarditis
Infection of the heart muscle itself (MC is strep)
Endocarditis
Evaluates heart rhythms
EKG - MI, Arrhythmia
Evaluates chamber size and fluid (murmur, CHF, carditis)
Echocardiogram - (murmur, CHF, carditis)
MI Cardiac enzymes (4)
- Troponin
- CK-MB (1 hour)
- SGOT/AST (2-3 hours)
- LDH (2-3 days)
