Path and Physical Exam Flashcards
Malar Rash
SLE
Heliotrope Rash
Dermatomyositis; Rash around eyes
Rashes over dorsal joints of hand, upper back, around eyes
Dermatomyositis
Rashes with Progressive muscle weakness
Dermatomyositis
Rash on left elbow and forearm with weakness of that arm that is getting worse
Dermatomyositis
Rash on extensors
Psoriasis
Silver Scale Rash
Psoriasis
Rash on Flexors
Eczema
Eczema
Severe Itching. SO Itchy that Pts will scratch till it bleeds; In areas of folded skin;
Psoriasis
Well-defined lesions; thick, silver scale; Feels less itchy (Mild) but more like a burn
Contact dermatitis can cause
Eczema
Skin Conditions to avoid Sun exposure
SLE; Dermatomyositis
Skin lesion with ulceration and crusting; signs of bleeding; Border irregular
Squamous Cell Carcinoma
Shiny Pearly Skin lesion with raised borders and flat center
Basal Cell
Basal Cell Slow or Fast growing
SLow
Hyperpigmented skin lesion that has been changing quickly
Melanoma
Icterus (AKA)
Jaundice
Enopthalmos
Sunken eye
Unilateral Miosis
Horner’s; B/L = Drugs
Dry Eyes could indicate
Sjorgrens
Vertical Nystagmus
Brain Stem or MS; Vertical Nystagmus is not good. Horizontal can be normal or is much more likely to be benign
If asked to perform CN 2 and 3 perform which tests?
Direct; Indirect; Accommodation and convergence (Look for pupil constriction)
Mydriasis is?
Fully Dilated pupil
Anisocoria is?
Irregular pupil size compared B/L; Can be normal; affects 20% of the population??
Pupil that accommodates but does not react to light
Argyll-Robinson Pupil
Nerve responsible for “Opening of eyelid”
CN3
Nerve responsible for “Closing of eyelid”
CN7
Dilation of Pupil (Sympath or parasympathetic Nerve?)
Sympath
Why do chiros eval the eyes?
For early signs of getting MS, MG, DM
Silver Wire/Copper Wire Appearance; AV Nicking (sign of?)
Atherosclerosis
Absent Red light reflex (Sign of?)
Cataracts
DM signs in the EYE?
Hard Waxy Exudates, Microaneurysms
Disc:Cup ratio > 2:1 (Sign of?)
Glucoma or Increased intra-ocular pressure; Volcano disc appearence
Flame Hemorrhages (Sign of?)
HTN
Cotton Wool appearance (Sign of?)
HTN
Coryza (Def?)
Inflammation of Mucus membrane of nose
Red Mucus membrane of nose (Types of conditions?)
Acute Infection
Pale, Grey-Blue Membrane of nose (Types of conditions?)
Chronic Infection or allergies
Clear and Thin Nasal Drainage Indicates
Coryza/allergies
Clear and thin and sweet Nasal Drainage (Indicates?)
Possible Basal Skull Fracture; Ask about trauma. If Trauma ER visit.
Clear and thick Nasal Drainage (Viscous) (Indicates?)
Viral Infection
What should you ask the PT if they have nasal drainage?
Any memory loss, confusion, or recent Trauma? Any recent colds, fevers, headaches, or infections?
Pain with Palpation the Auricle or Tragus could indicate?
Otitis Externa
Pain with palpation of Mastoid Process Could indicate?
Otitis Media
To instrument (Look inside) the Ear pull the ear which direction for Adult and then for child?
Adult = Up and Back Child = DOWN and back
Ear: AC>BC (Normal or abnormal?)
Normal
Perform Rinnes test in which ear after Weber’s Test?
The ear the sound lateralizes to (Do it in the ear that hears the best); Weber’s Lateralizes to the potential conductive deficit side
Examples of Conductive deficit in an Ear
Ear Infection, Wax, or Foreign object
Examples of Sensorineural deficit in an Ear
Presbycusis (Ear hair cell damage); Neuroma, Meniere’s (MC on boards)(AKA CN8 damage).
What to Ask a Patient if Weber’s lateralizes
Do you have any hearing loss?
Do you have Tinnitus or ringing in your ears?
Webers Lateralizes to which ear?
The ear that they hear better
Describe the 3 possibilities of Rinnes test.
Sensorineural = AC>BC (In lateralized ear)
Conductive Hearing loss = AC=/
Signs of Acute Otitis EXTERNA
Canal: Swollen Canal, Moist, Pale red
Signs of Perforated Ear
Black and Chronic Infections
Signs of Chronic Otitis EXTERNA
Canal: Thick, Red, itchy
Serous Otitis Media
A CHRONIC condition; Tympanic Membrane: Bubbles, yellow, retraction
Serous Otitis Media
A CHRONIC condition; Tympanic Membrane: BUBBLES, yellow, retraction
Describe Serous Fluid
Resemble serum; Pale yellow/Transparent; Benign; Fluid found between membranes and provides lubrication to joints or to the lungs between visceral and parietal plura
Describe Herpes Lesion
Vesicles near mouth
Myxedema (What is it?)
Severe Hypothyroidism; Can result in Coma
Hashimotos, Hypothyroidism, and Myxedema (Difference?)
Hashimotos and Myxedema are AI conditions; Hypothyroidism is not AI and could be the result of pituitary abnormality or a thyroid tumor.
Hashimotos, Hypothyroidism, and Myxedema (Difference?)
Hashimotos and Myxedema are AI conditions; Hypothyroidism is not AI and could be the result of pituitary abnormality or a thyroid tumor.
DIabetics Vs Myxedema Vs Cushings
All: Mostly Female and Fat and aging;
DM = Polys (Polyneuropathy, polydipsea, Polyphasia, Polyurea)
Myxedema = Everything in body is slowing down bec it controls BMR (Basal metabolic rate); Constipation, fatigue, cat naps, PERIORBITAL swelling (Anopthalmosis)
Cushings = Moon Face (puffy face), Buffalo hump; takes on male features (Hirutism: Face hair and chest hair, male aggression, short temper)
Anopthalmosis (What is it?)
Periorbital swelling
XRay in Hashimotos?, Graves?, Myxedema?, Cushings?, Addisons?
Addisons and Cushings BECAUSE Tx is Steroids -> Osteoporosis. !!XRAY before CMT!!
Chiro Tx for Addisons and Cushings?
Immune Boosters
Chiro Tx (Vit) for Peripheral Neuropathies?
B6
If you are considering diagnosing a PT with endocrine disease perform lateral skull XRay. (Why?)
Rule out Pituitary Tumor.
If you are considering diagnosing a PT with endocrine disease perform lateral skull XRay. (Why?)
Rule out Pituitary Tumor.
Not always done because a Pit tumor would also cause BiTemporal Hemianopia (Loss of lateral field of vision)
Bitemporal Hemianopia indicates?
Unilateral VIsion loss indicates?
Homonymous hemianopia indicates?
Pituitary Tumor
Optic Nerve Compression
Contralateral cerebrovascular event
There are 4 conditions to consider during male exam (Name them)
Acute Prostatitis; Chronic Prostatitis; Benign Hypertrophy; Cancer
Male Exam: PT has: Warm and tender prostate w/ Fever, Normal PSA (Diagnose)
Acute Prostatitis
Tender Prostate only in Acute Prostatitis
Male Exam: Normal Prostate Exam (DRE = Digital Rectal Exam) except prostate has general enlargement, PSA > 4
Chronic Prostatitis
Male Exam: DRE reveals Enlarged LATERAL lobe of prostate with LOSS of median sulcus, Boggy feel, Nocturia, PSA > 4
Benign Hypertrophy of prostate
PSA will be increased
Nocturia not seen in other prostate issues
Male Exam: Hard Walnut Nodule of Posterior Lobe, non-tender=, PSA > 4
Cancer of Prostate
Cancer of Prostate is Blastic; Most Cancers are lytic. Therefore Alk Phos test is useful.
Alk Phos Measures?
Bone growth and Blastic growths; Blastic Mets (Most Cancers are lytic)
PET is used to evalute?
All ST Cancers
Signs of Breast Cancer
Niiple retraction, Dimpling
MC location of Breast Cancer
Tail of Spence (Near Axilla) via lymphatic drainage channels
What is Mastitis?
Inflammed Breasts; Tender, enlarged, red streaks;
ER referal
Age and description of lesion in Fibroadenoma
<30yo; Benign Nodule(s) of Breast
What is Pagets disease of the breast?
Breast Cancer; Not Bone cancer also called Pagets
Where is the Adnexal region?
Ovaries, uterine ligaments, fallopian tubes, uterus.
HCG increased indicates?
Tumors
Back pain and Chiro (Tx?)
Adjust, Nutrition
HCG decreased during pregnancy indicates?
Ectopic
Endometriosis (What is it?)
Ectopic endometrium
Endometriosis (SS?)
Irregular period and trouble getting pregnant (IE Dysmenorrhea and infertility)
Cause OF PID
STD
Such as: Gonorrhea and Chlamydia
Virchow node (What is it?)
Mets; Located in supraclavicular lymph chain
Sentinal Node (What is it?)
Mets; Located in Axilla
Right Vs Left Supraclavicular Lymph node (What is)
Right: Drains Breast, Inside Chest, and Arm
Left: Perform ROS; Rare; Could be from anywhere
Inguinal lymph nodes drain?
Indicate?
Legs and genitals
Possible STD
What is observed with: Lymphangitis, Lymphadenopathy, Lymphoma
Lymphangitis: Red Streak – ER referral
Lymphadenopathy: Swelling – Monitor
Lymphoma: Tumor – Biopsy
3 Conditions that produce Lymphadenopathy: Mono, Hodgkins, AIDs
Describe Chest XRay findings of Hodgkins?
Mono: Neg
Hodgkins: Mediastinal widening due to lymphadenopathy
AIDS: Variable
3 Conditions that produce Lymphadenopathy: Mono, Hodgkins, AIDs
Describe Chest XRay findings of Hodgkins?
Mono: Neg
Hodgkins: Mediastinal widening due to lymphadenopathy (Box Car look, Potato nodules)
AIDS: Variable
Lymphadenopathy with Weight loss, relapsing fever suggests?
Hodgkins
What do these have in common:
TB, Thrush, Herpes, Candida, Toxoplasmosis, Kaposi Sarcoma, Pneumocystic carinii
Opportunistic Infections
Note: Kaposi Sarcoma is caused by the Kaposi Sarcoma virus. Not everyone with the virus develops the ST masses.
Note: These infections occur in late stages of AIDs.
PVE (Stands for?)
Peripheral Vascular Exam
PVE Tx? (General)
Walking
PVE: Arterial Vs Venous disease. Name 3 differences?
A: Skin cool pale cyanotic, Vessel color is red and tortuous, Pulse weak, Raynauds MBS, Vit C def, Skin thinning.
No swelling.
V: Skin warm normal to red color, Pulse normal, Swelling MBS, Stasis dermatitis with Age.
No Vit C def as cause/excarbent, no Raynauds.
Where is the Brachial Artery Palpated?
Medial aspect of arm and press up under biceps
Where is the Subclavian Artery Palpated?
Medial Aspect of Supraclavicular Fossa just deep to Clavicle
Describe Artery Palpation Steps
- Ask PT to remove any clothing that could interfere with Exam
- Palpate Pulse
- Look off into Space as if counting (For test) and count quietly to 5
- Perform B/L
- Always tell PT to relax after each full Exam question (For Test)
Describe the Capillary Refill Test
- Raise Limb above heart level (If possible).
- Pinch each Finger/Toes until blanched/White (Occurs quickly. SO just pinch and let go for test)
- Observe for blood to return to Fingers/Toes
Pos when Remains Blanched >2sec.
Pos indicates dehydration, Shock, PVD, Hypothermia
Describe Allens Test for Arterial Refill
- Pt seated resting hands palm up on legs.
- Have PT make a tight fist.
- Dr Occludes Radial and Ulnar Arteries
- Have PT open hand. (Hand should be blanched/White).
- Observe Hand while letting go of Ulnar A.
- Repeat for Radial A.
- Compare to opposite open hand.
- Perform B/L
- Ask Pt to relax.
Describe Buerger’s Test
- PT supine
- Raise PTs legs to ~45deg
- Pump PTs ankles for 5secs (Dorsiflex/Plantarflex)
- Sit PT up and observe refill (5 Sec)
- Ask PT to relax
Describe Homan’s Test
*Do not perform in my clinic
EX: PT has pain in R calf
1. Raise PTs L leg ~45deg
2. Dorsiflex ankle. Ask if there is pain
3. Squeeze calf w/ Ankle dorsiflex. Ask if there is pain.
4. W PTs legs on table Dorsiflex R Leg. Ask PT if this reproduces pain.
IF there is pain ASK:
Have you recent been immobilized or have been seated for a long period of time? Are you on Blood thinners, birth control, or steroids?
Where is Carotid A. Auscultated?
At Bifurcation of Carotid (C4)
Describe Hepatojugular Reflux test and what is it for
- PT supine. Observe Jugular Vein in Neck. (Should be seen)
- Raise PT to 45 deg inclination. (Jugular V should Disappear)
- Compress Abdomen over Inf. Vena Cava and continue to observe Jugular Vein
- If Jugular V re-appears and stays visible then pos.
Pos indicates CHF.
Because Pressing on a major vein will increase Venous return to the heart and the heart has to work harder to pump this blood out. As the heart works harder the jugular vein will swell until the heart is able to compensate for the increased blood in the veins. If the JUgular vein does not disappear then this means that the heart is not able to pump this extra blood.
CHF
Coronary Heart Failure
Describe the Claudication Test?
What is positive for Vascular Claudication?
- PT Stands and marches in place for 5sec
- Ask if pain
- IF PAIN PT repeats w forward hip flexion
Pain w Flex = Vascular Claudication
Pain reduced w flex = Neurogenic Claudication (Because flexion reduces Canal Stenosis)
Tx or refer? Neurogenic Claudication
Treat
Tx or refer? Vascular Claudication
Co-Manage
Buerger’s disease AKA?
What is Buerger’s Dx?
Thromboangiitis Obliterans
Caludication in LE (Artery of Vein) in younf male smokee
Thrombosis Vs Thrombophlebitis
Thrombosis is superficial. Deep Vein Thrombophlebitis
Describe Raynauds
Triphasic color changel Female; UE; No ice
Perform Serum Chemistry for PAD
Peripheral Arterial disease
What spinal level does the Carotid bifurcate?
C4
Describe the Pattern/TIming for Neurgogenic Claudication?
Unpredictable
Describe Episodes of relief with Vasc and neurogenic claudication
Vasc = No relief Neuro = With rest (Only)
Describe the treatment for vasc and neurogenic claudication
WALK
Vasc = mid-late stage REFER, Early = Walk
Neuro = CMT and have PT walk
Describe the Pattern/TIming for Vasc Claudication?
Predictable with amount of acitivity
Causes of vasc and neurogenic claudication
Neuro = Central Stenosis, DJD, Facet, Disc. Vasc = Arteriosclerosis, DM, PVD, Beurger's
Testing for vasc and neurogenic claudication?
Neuro= Claudication Test, bicycle test, stoop test. Vasc = Claudication test, Serum Chemistry, BP.
Describe Capillary Refill test
Pinch each finger while limb is above heart and watch for refill. (Perform quickly for boards)
Describe Allen’s Test
PT makes a fist and dr compresses Radial and ulnar arteries in hand. PT relaxes hand and dr release an artery
Describe Buerger’s Test
PT Supine. Dr raises (Both) legs of PT to ~45. Dr/PT pumps ankles (Dorsi/Plantar flexion) several times (5sec) pt SITS UP and dr observes blood return to feet (5Sec).
Pos = Blood does not return in 2 min.
Describe Homans Test
PT has calf pain. PT supine. Dr raises unaffected limb to 45 and then dorsiflexes ankle. Then Squeezes the calf. Ask PT if this changes the pain. Perform on opposite limb but start small. Do not raise the limb right away. First try dorsiflex to see if pain increases. If no pain then raise the affected limb and dorsiflex.
Where do you palpate the heart?
AT the 4 listening points (A,P,T,M)
What and where are the 4 listening points for the heart?
A = 2nd R intercoastal (Para-sternal)
P = 2nd L intercoastal (Para-sternal)
T = 4th L intercoastal (Para-sternal)
M = 5th L intercoastal space (Mid-clavicular)
*When palpating press w/3 palpating fingers for 5sec at each location.
Point of maximum impulse?
How to percuss the heart
Percuss from mid-axillary line on left to left boarder of heart. Repeat 3 times starting at R4 then R5 then R6.
How to Auscultate the heart
A PeT Monkey; 5 Sec each pnt; Bell for low sounds = Bruit (Stenosis).
Diaphragm for higher sounds = (Regurgitation)
State: I am listening for murmurs of splitting and evaluating the rate, rythym, and syncopation (Disturbance of rythym).
How to Ausc and Palpate the Abdominal Aorta
Palpate lateral to medial for both sides (Dont press on the ab. Aorta. It can rupture if enlarged.)
Ausc with Bell.
Disease when R side heart fails
Cor Pulmonale (Rare)
Cause of Cor Pulmonale?
Pulmonary HTN -> R side heart failure
SS of Cor Pulmonale
Jugular distention; Portal HTN (Liver dx)
Tests/Monitor for Cor Pulmonale
Spirometry, Pulse Ox.
Tests/Monitor for CHF
BP; Labs; Stress test; Xray Cardiomegaly; Echo
Cause of CHF
Left sides heart failure
SS of CHF
Nocturnal Dyspnea, Pul edema (Fluid in lungs), Pul Effusion (Pink and frothy sputum)(Fluid around lungs)
Thirsty all the time = dx?
Diabetes insipidous
Pitting edema = dx?
CHF
Pitting edema how to perform
Depress tissue and count for recovery time
MI SS
Pain > 10m after rest
MI labs (Cardiac enzymes) explain
Troponin > CPK > SGOT (AST) > LDH
Troponin shows up first
Next is CPK
Angina Vs MI
Anginia = pain with activity and stops w rest
Aortic Aneurysm Vs Heart
Heart = pain everywhere in chest (“Its the big one”)
Aortic Aneurysm = Localized pain (Knife like)(Straight through chest)
Pneumonia Vs Pleurisy
Pneumonia = Pain w fever, no position of relief. Pleurisy = Positional Relief (Pt holds side of chest and leans towards that side)
How to Ausc the lungs?
Where is the R middle lobe?
*Be able to tell them which lobes you are ausc.
Right middle lobe is directly across from heart. Note that the R inferior lobe is more lateral and slightly inferior to middle lobe.
Flat Sound with Percussion indicates?
Tumor or Atelectasis (Collapse)
Dull Sound with Percussion indicates?
Fluid; Pneumonia
Resonant Sound with Percussion indicates?
Normal; But can occur with Bronchitis/laryngitis
Hyper-resonant Sound with Percussion indicates?
Air trapping; COPD
Respiratory Excursion performed where/how?
At T10 with both hands
Decreased B/L Respiratory excursion could indicate?
Emphysema, AS
Decreased U/L Respiratory excursion could indicate?
Pneumothorax
Rhonchi vs Rales/wheezing/Crackling
Rhonchi = Fluid in larger airways Rales/wheezing/Crackling = Fluid in SMALLER airways
Whispered pecteriloquay looks for?
Fluid
What is Stridor and what is Tx?
Tx = ER
High pitched whistling sound (Crowing), often heard wo stethescope.
Indicates: Upper airway obstruction.
What does Rhonchi sound like?
Low pitched rattle that resembles snoring
What does Rales sound like?
Low pitched velcro sound; Crackly; Crackles and Rales are the same thing (Sort of). Rales are crackles occuring LATE in the inspiration cycle.
Prolonged inspiration indicates?
CHF
Prolonged expiration indicates?
COPD
Bacterial Vs Viral: Chills indicate?
Virus; Fever goes up and down often.
Bacterial Vs Viral: Night Sweats indicate?
Bacterial
Bacterial Vs Viral: What would auscultation reveal for each?
Viral = Clear/Normal Bacterial = Rales, Wheezing, Voice changes
Bacterial Vs Viral: Neutrophils and lymphocytes. Which are elevated and which are decreased for each condition?
Viral = DEC Neutrophils; INC Lymphocytes; WBC 5000 - 10000. Bacterial = INC Neutrophils; WBC 10k+, (Schilling shift)
Opportunistic infections causes:
Pneumocystic Carnii =caused by what AI dx?
Klebsella pneumonia =caused by what AI dx?
Pneumocystic Carnii = AIDs
Klebsella pneumonia = Alcohol
TB describe Xray finding progression
Ghon lesions develop from healing lymph tissue.
What is a Ranke Complex
From healing Primary TB.
Ghon lesion and Fingernail calcifications
Milliary TB. Primary or secondary TB?
Secondary
What diagnostic test is used to determine primary or secondary TB?
XRay
Name 2 Screening tests for TB and describe them?
Mantoux = More commonly used
Tine
Both Use Tuberculin injection; Size of resulting lesion measured
XRay: Widening of the Mediastinum indicates?
Hodgkin’s Lymphoma
What is Cachexia?
Weakening and Wastin of the body due to illness; Occurs with Cancer and eating disorders.
Chronic un-productive cough could indicate?
Lung Cancer
Causes of Stridor?
Pertusses, Croup, Epiglotitis, Aspiration of an object.
Upper airway obstruction
Crackling heard in late inspiration indicates?
Rales
Crackling heard in late inspiration indicates?
Rales; Occurs in Bronchiectasis, Pul. Edema, Asthma, Bronchitis
Rales are best heard at what part of the lung
Base
Rales are sounds that cant be cleared by coughing
But posture and deep breaths may clear it
Name of normal breath sounds heard over small airways?
Vesicular
Crackles heard at start of inspiration is characteristic of what dx?
COPD or emphysema = air trapping. Air can get in (a bit) but cant get out easily.
Bronchiectasis: Chronic bronchiole thickening and fibrosis from chronic inflamm and infections
SS of Bronchiectasis?
Abnormal breath sounds, Chronic bad breath, Recurrent respiratory infections with green/yellow sputum, chronic coughing, SOB
What is Bronchiectasis?
Thickening of the bronchioles
Pleurisy/Pluritis of lung. Causes (Plural)?
Flu or pneumonia OR Pul. Embolism
Cause: Inflamm of the lung tissue.
Symptoms of Pleurisy?
Sudden onset. PT leans towards side of lesion to decrease pain. PT may hold their side. Fever MBS if cause is infection.
XRay findings of Pleurisy?
NONE
XRAY findings of COPD/Emphysema?
Barrel chest: Horizontal ribs w/ INC space BTW ribs.
Narrow mediastinum
Flattening of B/L diaphrams because increasing lung sizes.
Widdening of mediastinum indicates
Hodgkins
XRAY findings of Lobar pneumonia?
Silhouette sign
Describe Silhouette sign?
Blurring of the borders of the heart due to fluid buildup in bronchioles
Cause of Silhouette sign?
Pneumonia (Lobar)
Describe Meniscus sign? Indicates?
Occurs in late Plural effusion. Significant sign. Indicates plural effusion; Fluid accumulation (Outside the lungs)!!
Describe XRAY findings in both Plural effusion and Pul. edema?
Early findings appear the same: Fluid covering costophrenic angles.
Late Plural effusion = occurs w meniscus sign; fluid outside the lungs
Pul. Edema = occurs w/ CHF; Kerley B Lines
Characteristic XRAY finding of late Plural effusion?
Meniscus sign
Pul edema occurs in CHF. Is the fluid inside or outside the lungs? Name another characterisitc XRAY finding?
Inside the lungs; Kerely B lines
XRAY finding of Kerely B lines occur in what Dx?
CHF; Pul edema