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Physical Diagnosis > PD Final Exam Review > Flashcards

PD Final Exam Review Flashcards

Dis is it boi

1
Q

Signs vs symptoms

A

Signs are objective observations made by a clinician during examination, symptoms are subjective feelings the patient reports during a history that cannot be observed by the clinician

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2
Q

History and physical exam relationship

A

A good history will help alert to pertinent findings on a physical exam and type of exam to perform, whether obtained form patient themselves, chart, or family

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3
Q

Indirect percussion, plexor versus pleximeter

A

Plexor is the finger doing the tapping, pleximeter is the finger receiving the tap, important to strike the same location with the same technique

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4
Q

Resonance indicates ____ on the thorax. Hyperresonance indicates ____

A

normal lung, emphysematous lung

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5
Q

Diaphragm is used to listen to… Bell is used to listen to….

A

…high pitched sounds….low pitched sounds

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6
Q

Normal exam sequence vs abdominal exam

A

Inspection, palpation, percussion, auscultation

Inspection, auscultation, percussion, palpation

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7
Q

5-6 vital signs

A 
Temp
BP
Pulse
RR
BMI
Pulse ox (sometimes)
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8
Q

Rapid weight gain suggests….

A

….bodily fluid retention of fluid, could potentially indicate heart failure

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9
Q

Weight loss with high food intake suggests…

A

…diabetes mellitus, hyperthyroidism, bulimia

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10
Q

Temperature is regulated by the ____ of the brain

A

Hypothalamus

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11
Q

Rapid weight loss suggests…

A

….cancer, depression, GI disease

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12
Q

4 ways to measure temp

A

Oral
Axillary
Rectal (only when patient is unconscious or can’t keep mouth closed or other reasons)
Tympanic

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13
Q

Normal oral temp
Rectal temp compared to oral
Axillary temp compared to oral
Tympanic temp compared to oral

A

98.6F/37C
Rectal is 1 degree F higher
Axillary is 1 degree F lower
Tympanic is 1.4 degrees F higher

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14
Q

Hypothermic thermometer

A

Accurate for temperatures below which a normal thermometer is not, indicated for use when temp reading on regular thermometer falls below 94 degrees F

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15
Q

Things that can cause a false temp reading (5)

A
  • rigorous exercise
  • mouth breathing
  • smoking
  • drinking fluids
  • cerumen (ear wax)
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16
Q

Two groups that do not always present with presence of pyrexia

A

Infants and elderly

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17
Q

Pyrexia vs hyperpyrexia

A

Pyrexia is body temp above 98.6 Fand 37C but below hyperpyrexia, hyperpyrexia is temp greataer than 41.1C or 106F,

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18
Q

Hypothermia

A

Body temp below 35 C or 95 F

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19
Q

Noninfectious causes of pyrexia and hypothermia

A
  • ovulation
  • thyroid storm
  • drug effects
  • trauma
  • exposure to cold
  • hypothyroidism or hypoglycmeia
  • shock
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20
Q

Noninfectious causes of pyrexia and hypothermia

A
  • ovulation
  • thyroid storm
  • drug effects
  • trauma
  • exposure to cold
  • hypothyroidism or hypoglycmeia
  • shock
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21
Q

4 pulse sites and important notes about each, what other pulse sites are there?

A

1) radial (easiest)
2) carotid (have to listen for bruits first)
3) femoral (inguinal region, uncomfortable for patients)
4) apical (on the heart, says nothing about perfusion)

Dorsal pedal, posterior tibial, poplitial, brachial

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22
Q

3 concepts to assess while taking pulse

A

1) rate
2) rhythm (if irregular need to count the full minute)
3) Correlation to systolic BP (carotid means at least 60, radial or femoral means at least 80

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23
Q

Sinus tachycardia definition and a few causes

A

Rapid regular elevated heart rate above 100bpm, due to exercise, fever, dehydration, drugs

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24
Q

Sinus bradycardia defintion and a few causes

A

Slow regular heart rate below 50bpm, athlete, heart disease, hypothyroidsim, abnormal electrolytes

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25
Q

Occasionally irregular beat cause and indication

A

Occasional premature atrial or ventricular contractions, indicate normal variation

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26
Q

Irregularly irregular beat cause and indication

A

Frequent premature ventricular contractions, indicate atrial fib presence

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27
Q

Regularly irregular beat cause and indication

A

Bigeminy or trigeminy, indicates mobitz I AV block

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28
Q

Pulsus altercans definition and cause

A

Alternating strong and weak pulse, indicates left ventricular heart failure

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29
Q

Pulsus bisiferens defnition and cause

A

Biphasic pulse, indicates aortic valve problem

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30
Q

Dicrotic pulse definition and cause

A

2 distinguishable palpable pulses, indicates low cardiac output

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31
Q

Pulsus parvus et tardus defnition and cause

A

Pulse is weak and has late carotid upstroke, caused by aortic valve stenosis

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32
Q

Pulsus paradoxus definition and cause

A

Typically SBP falls more than 10mm during inspiration and pulse gets weaker, caused by cardiac tamponade, asthma, COPD, etc

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33
Q

Normal respiration rate

A

12-18 rpm

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34
Q

Tachypnea vs hyperpnea and causes of both

A

Tachypnea is rapid shallow breathing often brought on in anxiety or restrictive lung disease
Hyperpnea is rapid deep breathing often brought on by exercise or infarct

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35
Q

Bradypnea vs hypopnea and causes of both

A

bradypnea is slow breathing often brought on by coma or respiratory depression
Hypopnea is shallow infrequent breathing often brough on by smoking or sedatives

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36
Q

Kussmaul

A

Fluctuating fast, slow, and normal breathing brought on by metabolic acidosis

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37
Q

Cheyne stokes

A

Breaths with periods of apnea, often seen in head injuries or brain tumors

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38
Q

Biot’s breathing

A

Unpredictable irregular breathing, shallow, deep, stopping for periods, sign of respiratory depression or brain damage at medullary level

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39
Q

A too small blood pressure cuff will give a ___ reading, too large will give a ____

A

Falsely high, falsely low

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40
Q

Auscultory gap

A

Silent period present between blood pressure reading between systole and diastole, indicative of arterial stiffness

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41
Q

Pulse pressure

A

Diff between systolic and diastolic BP

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42
Q

Elevated vs narrow pulse pressure and causes of each

A

Greater than 60mmHg, indicative of heart attack or CV disease

Less than 40mmHg, indicative of shock or cardiac tamponade

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43
Q

Korotkoff sounds

A

Heard during BP, first indicates systolic bp, last heard sound indicates diastolic bp

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44
Q

Autonomy of patient

A

Ethical need of patient to have self determination

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45
Q

Beneficence of provider

A

Provider’s need to do good

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46
Q

Non-maleficence of provider

A

Provider’s responsibility to do no harm

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47
Q

Utilitarianism

A

Appropriate use of resources as a provider to complete the duty of provider to patient

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48
Q

Fairness and Justice

A

Balance between autonomy and competing interest of family and community

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49
Q

Deontological imperitives

A

Duty of providers established by tradition and cultural imperitives

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50
Q

Useful precision

A

The idea that the problem at hand should dictate how precise the information that is needed must be

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51
Q

6 components of all health history, both H&P and SOAP notes

A

1) CC
2) HPI
3) PMH (med and allergies, etc.)
4) Family history
5) Social history
6) Review of systems

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52
Q

Chief complaint

A

1 sentence quote from patient’s own words of why they are visiting you including duration of symptoms

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53
Q

History of present illness

A

Needs to be complete, clear, and chronological background to patient’s response to symptoms and effect it is having on their life, document peritent positives and negatives (other signs and symptoms from ROS related directly to CC)

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54
Q

LORCATES acronym

A 
Location
Other associated signs and symptoms
Radiation
Character
Aggravating or alleviating factors
Timing
Environment/evolution
Severity
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55
Q

A HISTORY Acronym

A 
Allergies
Hospitalization
Immunizations
Surgery
Trauma
(Oral)  medications
Reproductive
Youth illness and disease
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56
Q

FLAMES acronym for social history

A 
Family and Food
Lifestyle
Abuses 
Marital status
Employmnt
Support systems
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57
Q

Review of systems order

A 
General Endo Head Loves Brass, Crass and Gas to Pass Near the Mass
General
Endocrine
HEENT
Lungs
Breast
Cardiovascular
Abdominal/GI
Genitourinary
Psychological
Neurological
Musculoskeletal
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58
Q

Koebner phenomenon

A

Appearance of skin lesions along the lines of trauma to the area

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59
Q

Herpatiform vs zosteriform

A

Herpatiform is random grouping, zosteriform is grouping according to dermatomal distribution

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60
Q

Macule

A

Non palpable lesion with distinc borders, less than 1cm in diameter

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61
Q

Patch

A

Non palpable lesion with distinct borders, greater than 1 cm in diameter

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62
Q

Papule

A

Palpable solid lesion less than 1 cm in diameter

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63
Q

Plaque

A

Palpable solid lesion greater than 1cm in diameter

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64
Q

Nodule

A

Palpable lesion more than 1cm in diameter taller than it is wide

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65
Q

Vesicle

A

Fluid containing superficial thin walled cavity <1cm

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66
Q

Bulla

A

Fluid containing superficial thin walled cavity >1cm

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67
Q

Erosion

A

A skin defect where there has been loss of epidermis only

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68
Q

Ulcer

A

A skin defect where there has been loss of dermis and epidermis

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69
Q

Pustule

A

Pus containing, superficial, thin walled cavity

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70
Q

Abscess

A

Pus containing, superficial, thick walled cavity

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71
Q

Scale

A

Desquamating layers of stratum corneum

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72
Q

Crust

A

Dried serum, blood, or purulent exudate

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73
Q

Lichenification

A

Thickening of skin resulting from crhronic rubbing, corn

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74
Q

Scar

A

Lesion formed as a result of dermal damage

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75
Q

Excoriation

A

Superficial excavations of epidermis from scratching

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76
Q

Fissure

A

Thin linear painful crack on skin

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77
Q

Wood’s lamp

A

Long wavelength uv light lamp that can determine if a lesion is hypo or depigmented or to see if a fungal infection is present and fluoresces

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78
Q

Normal nail bed angle, and how do hepatic necrotic nails appear? Anemic? Hypoxic? Anxiety? Nephrotic? Hypothyrodic?

A

160 degrees, half and half coloration, white, clubbing, bitten, alternating white and pink bands, brittleness

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79
Q

Shoulder separation vs shoulder dislocation

A

Separation is known as AC separation, occurs between acromion and clavicle (clavicle protrudes upward)

Dislocation is known as glenohumoral dislocation, occurs at the glenohumoral joint

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80
Q

Bony step off

A

Clear unusual drop in a bone

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81
Q

If you can move a patient thru passive ROM but they cannot do active, what does this mean?

A

There is nothing blocking them from moving but the muscle or tendon is compromised

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82
Q

Bone spurs

A

Osteomites that rub on muscles such as the supraspinatus and irritate it

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83
Q

Boutennaire vs swan neck deformity

A

Boutennaire is due to a severing of a tendon at the PIP causing it to point flexed while swan neck is the volar plate being damaged causing an extension curve

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84
Q

Q angle

A

Angle formed from the vertical of the inward displacement of the thigh and legs,larger in females than males generally

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85
Q

Pain with active and passive internal rotation of the hip is associated with….

A

….osteoarthritis

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86
Q

Patient with trisomy 21 facial features

A

Flattened nose and face, upward slanting eyes

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87
Q

Patient with nephrotic syndrome facial features

A

Periorbital edema, puffy pale face

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88
Q

Patient with cushing syndrome facial features

A

Red cheeks, moon face, hirsutism, buffalo hump on back of neck

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89
Q

Patient with hypothyroidism facial features

A

Periorbital edema, hair coarse dry and sparse as well as eyeballs, puffy dull face

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90
Q

Patient with acromegaly facial features

A

Prominant jaw, soft tissues of nose, ears, and lips enlarged, prominant brow

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91
Q

Patient with parotiditis facial features

A

Local swelling obscuring one or both ear lobes

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92
Q

Patient with parkinson’s disease facial featuers

A

Far off stare, slow blinking, decreased facial mobility

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93
Q

LR VI, SO IV

A

Latral rectus muscle controlled by abducens nerve, Superior oblique muscle controlled by trochlear nerve

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94
Q

Ipsalateral monocular vision loss

A

Caused by a lesion at the optic nerve creating blindness in one eye

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95
Q

Bitemporal hemianopia

A

Caused by a lesion at the optic chiasm causing blindness on the lateral sides of both visual fields

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96
Q

Ipsalateral nasal hemianopia

A

Caused by lesion at the uncrossed optic nerve fiber creating blindness on the nasal side of one visual field

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97
Q

Contralateral homonymous hemianopia

A

Caused by a lesion at the optic tract creating blindness in the same side of both visual fields (one nasal side one temporal side)

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98
Q

Contralateral homonymous hemianopia with macular sparing

A

Caused by a lesion at the optic nerve creating blindness in the same side of both visual fields (one nasal side one temporal side) while sparing the macula

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99
Q

Ipsalateral central scotoma

A

Caused by a lesion in the eye at a fixed point creating a blind spot in the middle of one eye

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100
Q

Ipsalateral horizontal defect

A

Caused by vascular occlusion

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101
Q

Presbyopia

A

Hyperopia occuring with age

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102
Q

Corneal light reflex

A

Checking for normal occular alignment thru watching how light is reflected between both eyes, indicates a lazy eyeif asymmetric

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103
Q

PERRLA acronym

A

Pupils equal, round, react to light, accommodate

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104
Q

Inferior oblique muscle moves the eye….

A

….upward and inward

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105
Q

Nystagmus

A

Abnormal movement of the eye

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106
Q

Optic disk

A

Entry point into the retina for ganglion cells forming the optic nerve and small vessels entering the posterior eye, lacks any rods or cones and forms the blind spot of the eye, 3-4mm toward the nasal side of the fovea, has an optic cup central depression within

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107
Q

Fovea

A

Small pit of closely packed cones in the eye at the center of the macula, forming central vision

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108
Q

Tonometry

A

Testing of intraocular pressure, either via numbing the eye (contact) or via air puff method

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109
Q

Fluorescin eye exam

A

Applied via drops to most medial area of eye, use cobalt blue light to examine eyes with lights dimmed where abrasions will appear yellow

110
Q

Anisocoria

A

Unequal pupil size distribution

111
Q

Red reflex

A

Reddish orange reflection of the retina when observed under opthalmoscope

112
Q

Weber tuning fork exam

A

Place tuning fork on top of patient’s head and ask if they hear it equally in both ears or if one is louder. Conductive hearing loss has the sound heard well in the impaired ear as well as the good. Sensorineural hearing loss has the sound heard better in the good ear.

113
Q

Normal cup to disk ratio

A

Less than .5

114
Q

AV nicking

A

Retinovascular signs during the fundoscopic exam that is often seen in hypertension

115
Q

Rinne tuning fork exam

A

Place sound through bone until they lose it, then move to ear. In normal hearing or sensorineural hearing loss, sound is heard longer thru air than bone, but in conductive hearing loss, sound is heard thru bone longer than it is thru air

116
Q

Auditory acuity test

A

Have patient occlude 1 ear, finger rub while pulling away slowly

117
Q

At what age are frontal sinuses developed?

A

7-8

118
Q

Transillumination of sinuses

A

Placing a bright light source on the maxilla, and having the patient open their mouth and look for an orrange glow on the hard palate - decreased or absent glow indicates something other than air

119
Q

Buccul gingival sulcus

A

Space where gums lining meet the inside of the cheek lining

120
Q

The uvula deviates to which side when there is a weakness? What about the tongue?

A
  • Uvula to the opposite side to which the lesion is (vagus nerve)
  • Tongue to same side the lesion is (hypoglossal nerve)
121
Q

Diaphgram contraction during inspiration causes it to move….

A

….downward

122
Q

Directly behind the body of the sternum sits….

A

….The right ventricle of the heart

123
Q

RALS system

A

Determines the orientation of the pulmonary arteries in the hilus of the lung, with the right lung having anterior placed 2 pulmonary arteries to the main bronchus and the left lung having superior 1 placed pulmonary artery to the main bronchus

124
Q

The left side has ____ bronchial arteries, the right side has ___

A

2, 1

125
Q

Which bronchus has a more direct path to the lung?

A

Right

126
Q

Where is the carina of the bronchus located?

A

Directly behind the sternal angle, about the 2nd rib

127
Q

Pectus excavatum

A

Caved in chest,

128
Q

Pectus carinatum

A

Caved out chest

129
Q

Decreased bilateral tactile fremitus indicates….

A

……..obstruction, copd, pleural effusion, fibrosis, or pneumothroax

130
Q

Vesicular breath sounds definition and where they can be heard

A

Normal breath sounds at a higher pitch with a longer inspiratory and shorter expiratory phase, heard throughout most of lung fields and not the sternal borders

131
Q

Bronchial breath sounds definition and where they can be heard

A

Normal breath sounds at a lower pitch with a longer expiratory phase and shorter inspiratory phase, heard over large airways, between the scapulae, or on the sternum best

132
Q

Rales breath sound definition and what it indicates (3 things)

A

Adventitious breath sound like a cracking pop indicating atelectasis, chronic bronchitis, or COPD

133
Q

Rhonchi breath sound definition and what it indicates (2 things)

A

Adventitious breath sound like snoring rough coarse sound indicating bronchitis or COPD

134
Q

Bronchovesicular breath sounds definition and where they can be heard

A

Normal breath sound at medium pitch with equal length inspiratory and expiratory phases, heard best between scapula

135
Q

Assymetric decreased fremitus indicates…

A

…unilateral pleural effusion

136
Q

Asymmetric increased tactile fremitus indicates….

A

…consolidated tissue thru unilateral pneumonia

137
Q

Hyperresonance during thorax percussion indicates…

A

…copd and asthma

138
Q

Diaphragm normal size measured during diaphragmatic excursion

A

3-5 cm

139
Q

Wheeze breath sound definition and what it indicates (3 things)

A

Adventitious breath sound like high pitched squeal with musical quality indicating asthma, bronchitis, or COPD

140
Q

Bronchophony

A

Amplification of sound by fluid in a certain space, heard when ascultating by having a patient say 99, it will be louder where there’s consolidation

141
Q

Egophony

A

Alteration of sound heard when auscultating by having a patient say eeee and you may hear aaaa if egophony is present, indicative of lung or pleural disease

142
Q

Whispered Pectriloquy

A

Loudness due to consolidation tranmission of sound by having a patient whisper 99 while ausculatating, should be barely heard in healthy lungs

143
Q

Bronchitis findings on lung exam

A
  • Tachypnea
  • rhonchi and rales
  • clears up with cough
144
Q

COPD findings on lung exam

A
  • Increased A/P diameter
  • audible wheezing
  • cyanosis
  • peripheral edema
  • clubbing fingers and toes
  • hyperresonance
  • rhonchi
  • wheezing
  • crackles
145
Q

Pleural effusion findings on lung exam

A
  • Diminished respiratory movement on affected side
  • Dullness on effusion, hyperresonance superior to effusion
  • trachea shifted to contralateral side (unaffected side)
146
Q

Consolidated pneumonia findings on lung exam

A
  • Tachypnea
  • Shallow breathing
  • dullness to percussion
  • crackles and rhonchi
  • egophony, bronchophony, whispered pectriloquy
147
Q

Pneumothorax findings lung exam

A
  • tachypnea
  • cyanosis
  • tracheal deviation to contralateral unaffected side
  • Decreased fremitus
  • shifts mediastinal structures to opposite side (diff from tension pneumothorax)
148
Q

Mitral valve is on the ___ side of the heart and part of the__ circulation, what is the tricuspid?

A

Left, systemic, right, pulmonary

149
Q

Apex of heart location

A

5th intercostal space mdiclavicular line on left side

150
Q

PMI

A

Point of maximal impulse, typically same as apical impulse in a healthy individual

151
Q

2 causes of Right ventricular hypertrophy, 2 causes of left

A

1) pulmonic valve stenosis, pulmonary hypertension

2) aortic valve stensois, systemic hypertension

152
Q

S1 heart sound

A

Closure of mitral and tricuspid valves at the beginning of systole

153
Q

S2 heart sound

A

Closure of aortic and pulmonic valves at the end of systole indicating the beginning of diastole

154
Q

Physiologic splitting of S2

A

A delayed closure of the pulmonic valve during inspiration causing S2 to split into A2 and P2, very subtle and not pathologic

155
Q

S3 heart sound and associated pathology

A

Also known as an early diastolic sound heard quickly after S2, indicates heart failure, large ventricle, and ventricular dysfunction most of the time except in young people

156
Q

S4 heart sound and associated pathology

A

Also known as a latae diastolic sound heard shortly before S1, indicates atria trying to push blood into a noncompliant ventricle, causes include diastolic dysfunction and LV hypertrophy

157
Q

Aortic area cardiac exam

A

Right 2nd intercostal space

158
Q

Pulmonic area cardiac exam

A

Left 2nnd intercostal space

159
Q

Tricuspid area cardiac exam

A

4th left intercostal space

160
Q

Mitral or apex area cardiac exam

A

5th left intercostal space, midclavicular line

161
Q

Erb’s point cardiac exam

A

Left 3rd intercostal space, left sternal border

162
Q

Systolic vs diastolic heart murmurs

A

Systolic are often benign and present in 60% of people, diastolic is always pathology

163
Q

Aortic and pulmonic regurgitation is a…

A

…diastolic murmur

164
Q

Aortic and pulmonic stenosis is a….

A

….systolic murmur

165
Q

Mitral and tricuspid regurgitation is a….

A

….systolic murmur

166
Q

Mitral and tricuspid stenosis is a….

A

…diastolic murmur

167
Q

AXVY waves jugular venous pulsation

A

A - atrial contraction prior to S1
X - atrial relaxation between S1 and 2
V - atrial filling
Y - Atrial emptying into ventricle

168
Q

Murmur scale heart

A

1-4 diastolic, 1-6 systolic
1 very faint
2 loud enough to be obvious
3 louder than 2
4 has thrill
5 heard with stethoscope partially off chest with thrill
6 heard with stethoscope completely off chest with thrill

169
Q

What value for JVP’s measured from sternal angle is considered elevated

A

> 3cm

170
Q

Leaning patient forward and listening at the aortic area while they hold their breath exhaled tests for….

A

….aortic stenosis

171
Q

Left lateral decibutus and listening to the mitral area tests for….

A

….mitral stenosis

172
Q

5 P’s of PAD

A

Pain, pulselessness, pallor, paralysis, parasthesia, poikilothermia (rare 6th P)

173
Q

Virchow’s triad and what it indicates

A

Intimal trauma
coagulopathy, hypercoagulable state
venous stasis

Indicates DVT

174
Q

Arterial claudication

A

Indicative of atherosclerotic disease, pain in defined group of muscles relieved with rest

175
Q

Neurogenic claudication

A

Indicative of spinal stenosis, improves leaning forward

176
Q

Subclavian steal syndrome

A

Stenosis of subclavian artery between causing syncope

177
Q

Rest pain and what it indicates

A

Waking up with pain, laying legs over side of bed and pain goes away, indicative of PAD

178
Q

ABI index

A

Measurement of systolic blood pressure with doppler ultrasound in each arm then in dorsal pedis and posterior tibial, should get higgher ankle pressure than arm by dividing ankle/arm, .9-1.3 is normal, .410.9 is mild pvd, 0-.41 is severe pvd

179
Q

How to record pulse

A 
4- boudning
3- increased 
2- brisk 
1- weak 
0- abscen
180
Q

Males are more likely to have ____ vascular disease while females are more likely to ahve _____

A

arterial, venous

181
Q

Are varicose veins a risk for DVT?

A

Nahhh fam

182
Q

Arterial vs venous characteristics

A

Cool vs warm
Sharp vs achy
No pulse vs pulse
No edema vs edema

183
Q

Allen’s test*****

A

Shows interconnection between between superfical and deep palmar arch arteries still intact between radial and ulnar part of hand by occluding and then testing

184
Q

Term for erythematous, swollen, tender lymph nodes

A

Lymphadenitis

185
Q

Lymphatic return is faciliated by….

A

….skeletal muscle pump, respiration, one way valves

186
Q

Cisterna chyli

A

Dilated lymph vessel usually located on the right of the first or second lumbar vertebra marking the beginning of the thoracic duct

187
Q

Thoracic duct

A

Receives overwhelming majority of lymphatic drainage from the entire left side and bottom right side of body, travels up the left side of the abdomen and thorax to empty where the left internal jugular and left subclavian vein meet

188
Q

Right lymphatic duct

A

Responsible for minimal lymphatic drainage from the body, just the right upper extremity and right side of the head, travels to empty into the junction where the right internal jugular and right subclavian vein meet

189
Q

Horizontal inguinal lymph nodes

A

Travel along th einguinal canal and drain the lower abdomen and buttocks, external genitalia (minus testes or ovaries) scrotum, anal, and lower vagina

190
Q

Vertical inguinal lymph nodes

A

Travel along the line of the great saphenous vein and drain portions of the leg corresponding

191
Q

Testes and ovaries lymphatic drainage

A

Separate pattern from horizontal and vertical inguinal lymph nodes going to paraoritc lymph nodes following testicular arteries deep into abdomen

192
Q

Each breast is drained by ___ lymphatically

A

Different sides (thoracic duct vs right lymphatic duct)

193
Q

Infraclavicular nodes

A

Any palpation is abnormal and can be indicative of breast cancer or malignant lymphoma

194
Q

Virchow’s node

A

Left supraclavicular node if palpated indicative of stomach, intestinal, breast, lung, or lymphoma cancers

195
Q

Right supraclavicular node

A

Any palpation indicates cancer of lung, mediastinum, or esophagus

196
Q

Lymphatic drainage of the testes vs scrotum

A

They are different - scrotum drains to inguinal lymph nodes while testes drains paraaortically

197
Q

Milroy’s disease

A

Lymphatic system congenital defect where valves do not work resulting in lymphedema (hard, non pitting, thickened skin)

198
Q

Pain in the gut is interesting because if cut open, it results in ___ but distension, results in _____

A

No pain, extreme pain

199
Q

Tenesmus

A

Feeling of incomplete defecation

200
Q

Right upper quadrant is associated iwth…

A

Liver, gallbladder, duodenum, head of pancreas, right kidney, right adrenal gland, portions of ascending and transverse colon

201
Q

Left upper quadrant is associated with…

A

Left lobe of liver, spleen, stomach, pancreas, left adrenal gland, left kidney, portions of descending and transverse colon

202
Q

Right lower quadrant pain is associated with…

A

Cecum, appendix, portion of ascending colon, right ovary, right spermatic cord and inguinal canal, right ureter, part of bladder

203
Q

Left lower quadrant pain is associated with…

A

Descending and sigmoid colon, left ovary, left spermatic cord and inguinal canal, left ureter, part of bladder

204
Q

Cullen’s sign

A

Bruising around the umbilicus indicative of acute pancreatitis or intra-abdominal bleeding

205
Q

Grey turner’s sign

A

Bruising around the flanks, a sign of retroperitoneal hemorrhage

206
Q

Caput medusa

A

Distension and engorging of periumbilical veins seen with late stage hepatic cirrhosis

207
Q

Shifting dullness

A

Can indicate presence of freely mobile fluid by having a patient lie on back and measure where dullness begins vs on the side where dullness begins

208
Q

CVA tenderness indicates…

A

….pyelonephritis

209
Q

Abdominal wall mass test

A

Ask patient to raise head/shoulders to see if mass remains palpable (on the wall) or not (in the vicera) to see if abdominal wall or cavity based

210
Q

Roysing’s sign

A

Press deeply in LLQ, pain in RLQ with pressure in LLQ or with RLQ rebound tenderness is positive for appendicitis

211
Q

Psoas sign

A

Flex right hip to test for appendicities

212
Q

Obturator sign

A

Flex right thigh at hip with knee bend, internally rotate hip, positive if pain for appendicitis

213
Q

Murphy’s sign

A

Ask patient to exhale, place hand below costal margin on right side of midclavicular line, have patient inspire, if sharp pain then positive test for acute cholecystitis

214
Q

Most important factor for risk of breast cancer

A

Age

215
Q

Inspeection of the breast

A

Make sure you check for 4 views (hands at sides, hands on hips, hands overhead and leaning forward)

216
Q

Cervical motion test/chandellier test

A

A test for PID during the bimanual exam involving physical manipulation of the cervix, positive if patient experiences acute pain from manipulation

217
Q 
Meaning of common thought process defects seen in mental status exam
Circumstantiality
derailment
flight of ideas
neologisms
incoherence
blocking
confabulation
echolalia
clanging
perseveration
A
  • rambling
  • shifting topics
  • abrupt change in topics one to next
  • Geroge W Bush
  • making no sense
  • losing train of thought
  • fabricating
  • echoing what you say
  • talking in rhyme only
  • repeating
218
Q

MSE Judgement exam

A

“What would you do if you saw a fire while in a grocery store”

219
Q

MSE Insight exam

A

What brings you here today

220
Q

MSE abstract thinking exam

A

What does the proverb Rome wasn’t built in a day mean to you?

221
Q

MSE orientation exam

A

Tell me your name, where you are, what is the date

222
Q

MSE attention exam

A

Serial 7’s, spell world backward

223
Q

MSE recent memory and remote memory exam

A

Recent news, name last 4 presidents

224
Q

MSE new learning ability exam

A

Give 3 words and have them repeat after 5 minutes

225
Q

MSE info and vocab exam

A

Name an object

226
Q

MSE constructional ability exam

A

Draw a clock

227
Q

Cranial nerves sensory, motor, or both

A 
Some (I)
Say (II)
Money (III)
Matters (IV)
Some (V 1)
Say (V 2)
Brains (V 3)
My (VI
Brother (VII)
Says (VIII)
Big (IX)
Boobs (X)
Matter (XI)
Most (XII)
228
Q

CN I function and test

A

Olfaction, do sniff test, inspect nasal cavity, test each side with smell test

229
Q

When pointing an otoscope, point…

A

….straight back, not upward

230
Q

CN II function and test

A

Vision, visual fields by confrontuation, manipulate to view conjunctiva, snellen chart and color vision test, fundoscopic exam

231
Q

CN III, IV, VI function and test

A

Motor movement of eye and extraocular muscles, pupil size test, accommodation, direct and indirect response to light, nystagmus, lid lag,

232
Q

Strabismus vs ambylopia

A

Cross eyed vs lazy eye

233
Q

Adie’s (tonic) pupil

A

Absence of light response in dilated pupil (cannot constrict), can be seen in diabetic neuropathy or alcoholism

234
Q

Argyll Robertson pupil

A

Absence of pupillary dilation in dark, pathognomonic of neurosyphilis

235
Q

Trochlear palsy often manifests as….

A

….diplopia on downwrd gaze

236
Q

Oculomotor palsy symtpoms

A

Ptosis, dilation of pupil

237
Q

CN V function and test

A

Facial sensation and motor function of the jaw, sharp dull test, corneal reflex,

238
Q

CN VII function and test

A

Muscle of facial expression and taste on anterior 2/3 of tongue, facial motion test, taste test

239
Q

Branches of facial nerve motor function (remember the pneumonic two zebras bit my clavicles)

A 
Temporal
Zygomatic
Buccal
Mandibular
Cervial
240
Q

CN VIII function and test

A

Hearing and balance, finger rub test, rinne and weber

241
Q

CN IX function and test

A

Muscles of the throat, posterior 1/3 of tongue taste sensation
Swallow test, gag reflex, taste sensation test

242
Q

CN X function and test

A

Esophagus contraction, ear sensation, pericardium, bronchi, stomach, uvula, say ahhh,

243
Q

CN XI function and test

A

Trapezius and SCM function, test with resistance

244
Q

CN XII function and test

A

Motor tongue innervation, look for deviation, cheek test

245
Q

Hyperactive DTR’s and spacticity are a sign of

A

Upper motor lesion

246
Q

Hypoactive DTR’s and flaccidity are a sign of

A

Lower motor lesion

247
Q

Recall corticospinal, spinothalamic, and posterior column tracts

A

Corticospinal - voluntary movement and muscle tone
spinothalamic - pain, temp, crude touch
posterior column - position, vibration, refinded touch

248
Q

Parasthesia

A

Peculiar sensation without obvious stimulation

249
Q

Up down proprioception test

A

Move toe in up and down position, same with fingers

250
Q

When doing sensory tests, always work from ___ to ____

A

distal to proximal

251
Q

Vibratory sensation test

A

Place tuning fork distally and tell patient when senesation stops

252
Q

Light touch test

A

Cotton ball when is touch felt, compare side to side

253
Q

Stereognosis test

A

Hold hands out and close eyes, give object and have them know it

254
Q

Graphesthesia test

A

Draw a number on a patient’s hand and have them tell you what it is

255
Q

2 point discrimination test

A

Have patient determine difference between 1 point or 2 on finger pads

256
Q

Point localization test

A

Touch skin with patient’s eyes closed, have them point to where they were touched

257
Q

Fasciculations definition

A

Random involuntary muscle twitches

258
Q

Normal strength test would be graded a ___/5

A

5/5

259
Q

Babinski sign

A

A reflex test on infants after the sole of the foot has been firmly stroked causing fanning of the toes and movement upward being positive, normal in infants but a sign of disease in adults

260
Q

Rapid alterrnating movements test

A

Cerebellar test where they tap hands alternatively

261
Q

Point to point movements

A

Cerebellar teset of movement of finger to nose to finger

262
Q

Rhomberg test

A

Have patient close eyes, slight push and watch for maintanance of balance

263
Q

Pronator drift test (2 parts)

A

1) Place hands out and supine while eyes are closed, if unable to hold patient will start to slowly pronate hand indicative of contralateral stroke
2) push down on arms and see if they return to normal position, if not or overshoot then positive indactive of contralateral storke

264
Q

DTR ratings

A

0-4 scale, 5 refers to sustained clonus

265
Q

Hyperactive DTR suggests…

A

….central lesion, corticospinal tract corsses at medulla, so lesion is contralateral

266
Q

Sequence of DTR tesets

A 
Ankle
Knee
Brachioradialis
Biceps
Triceps
Abdominal
267
Q

Brudzinski’s sign

A

Flexion of hips and knees in response to neck flexion positive for meningitis

268
Q

Kernig’s sign

A

Pain bilaterally behind knee when flexed knee is extended, positive for meningitis

269
Q

Preferred positoining for rectal exam

A

Either bend over or left lateral decuibuts

270
Q

Direct hernia

A

Above the inguinal ligament, rarely in the scrotum, hernia bulges anteriorally and pushes side of finger forward

271
Q

Indirect hernia

A

Above inguinal ligament, often into the scrotum, touches the fingertip

272
Q

Anorectal junction

A

Region of transition for cell type as a result experiences increased risk of cancer

Physical Diagnosis (10 decks)

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