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Physical Dx > PDx > Flashcards

PDx Flashcards

0
Q

Campbell’s sign

A

= tracheal descent with inspiration; due to chronic airflow obstruction
-seen with COPD but not specific to it

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1
Q

Oliver’s sign

A

for trachea

= systolic tug seen with aortic aneurysm; synchronous with each heart beat

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2
Q

Tietze’s syndrome

A

=costochondritis = inflammation of costal cartilages

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3
Q

Clubbing

A

-loss of Lovibond’s angle
-Schamroth’s sign (put fingers together, see if diamond disappears)
-floating nails, ballotability of nail bed
-abnormal phalangeal depth ratio
Causes:
-underlying respiratory disorder (SHUNT)
-GI conditions (cirrhosis, IBD, cancer)
-heart conditions
-hormone imbalance: cirrhosis, pregnancy
*not a feature of emphysema

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4
Q

Hypertrophic osteoarthropathy

A
  • assoc. with clubbing
  • systemic disorder of bones, joints, and soft tissues, most commonly assoc. with intrathoracic neoplasm
  • **painful and tender periosteal new bone proliferation, often but not always assoc. w/clubbing
  • periostosis is prominent in diaphysis of long bones
  • dx with bone radiography or scintigraphy
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5
Q

Dahl’s sign

A

elbows and knees are discolored/chafed from leaning over in tripod position
-COPD sign

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6
Q

Hoover’s sign

A

= flattened diaphragm so both costal margins are drawn towards midline, more acute subcostal angle
sign of COPD

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7
Q

Causes of generalized lymphadenopathy

A
  • disseminated malignancy
  • collagen vascular disease (sarcoidosis)
  • infectious process (mono, syphilis, CMV, toxo, RF, AIDS, TB, plague)
  • rxn to drugs
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8
Q

Delphian nodes

A

prelaryngeal, small, midline nodes on thyrohyoid membrane, indicate thyroid disease

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9
Q

Left supraclavicular node

A

= intraabdominal or intrapelvic tumors
-called a sentinel node or Trosier’s node, signaling deep-sited carcinoma
OR
-Virchow’s node, signaling mets from a gastric carcinoma

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10
Q

Sister Mary Joseph’s nodule

A

periumbilical nodule or hard mass, reflects ovary or stomach malignancy

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11
Q

Raynaud’s Phenomenon

A 
Precedes:
	-CT diseases
	-blood disorders
	-disorders characterized by arterial compression (thoracic outlet, carpal tunnel)
	-vasculitis and atherosclerosis
	-drugs and toxins
	-misc
white
blue
red
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12
Q

Allen’s test

A

to assess the patency of the radial and ulnar arteries and the patency of the deep palmar arch
-if refill time >15 sec, do NOT cannulate the artery

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13
Q

Buerger’s Test

A

-use to assess arterial perfusion to legs/PVD
Stage 1:
-pt lies supine, elevate both legs at 90 deg and hold them up for 2 minutes
-observe color of feet
Stage 2:
-pt sits up with legs over edge of table at 90 deg angle for 2 minutes
-gravity aids blood flow - leg turns blue as blood is deoxygenated while passing through ischemic tissue, then dusky red flush with reactiver hyperemia from post-hypoxic vasodilation
-test is + for PVD when it elicits excessive pallor with elevation and intense rubor with dependency

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14
Q

Diabetic Foot

A

Dx:

  • nerve conduction studies are gold standard but too involved
  • cotton swab test is inaccurate
  • foot drop/neuropathic manifestations are late signs
  • Semmes-Weinstein monofilament test = screening test of choice for protective sensation in foot
    • test is + if pt can’t feel filament at 4/10 sites or more
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15
Q

Charcot’s foot

A

=neuropathic osteoarthropathy caused by both a sensory loss and motor loss

  • results in covex foot with rocker-bottom appearance
  • most common in diabetics but also seen in syphilis or Charcot-Marie-Tooth

foot ulcer classification:

  • *Neuropathic - usually painless, surrounded by callus and exhibits little to no gangrene
  • arterial insufficiency
  • venous insufficiency
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16
Q

Trendelenburg test

A

= test functionality of leg veins’ valves

- raise leg of supine pt to drain veins of blood, apply tourniquet to mid thigh, compress greater saphenous vein
- ask pt to stand, observe leg veins, nL if greater saphenous slowly refills from below, should take  backfilling from incompetent valves
- pts with arterial insufficiency may have false negative test
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17
Q

Cullen’s sign

A

periumbilical ecchymosis associated with acute hemorrhagic pancreatitis
-poor sensitivity and specficity

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18
Q

Grey Turner’s sign

A

= bilateral frank reddish/purple discoloration assoc. w/acute hemorrhagic pancreatitis

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19
Q

Respiratory alternans

A

= alternate use of diaphragm or intercostal resp. mm; rock in one direction then switch to other direction
-predicts resp. failure

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20
Q

Venous patterns on abdomen

A
  • Obstructed SVC: vv. are engorged on upper abd wall, when milked they go downward
  • Obstructed IVC: vv. are engorged on lateral abd wall, when you milk them you get upward flow
  • Obstructed portal system: network of periumbilical vv., rostral drain upward (toward internal mammary), and lower drain down (toward inferior mammary v.)
  • Caput medusae: seen in cirrhotics and portal HTN when umbilical v. has reopened
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21
Q

Cruveilhier-Baumgarten murmur/sign

A

= continuous venous hum/murmur

- recanalization of umbilical v. because of portal HTN
- reverse blood flow from cirrhotic liver into abd wall vv.
- decompression of blood into shunts on abd wall - louder during expiration in valsalva
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22
Q

Techniques for percussion of spleen

A

Nixon’s technique = percuss whole spleen while pt in R lateral decubitus (best specificity)
Castell’s = percuss lowest intercostal space while pt breathes in and out (best sensitivity)
Percussion of Traube’s semilunar space = triangular space bordered by left 6th rib superiorly, left midaxillary line, and left costal margin inferiorly –> dullness may indicate splenomegaly

23
Q

Murphy’s sign

A

=painful reflex arrest of inspiration, triggered by palpation of the edge of an inflamed gallbladder

  • specificity is higher than sensitivity
  • -> cholecystitis
24
Q

Boas’ sign

A

= area of hypersensitivity over right costophrenic angle (and right shoulder)
= sign of cholecystitis

25
Q

Courvoisier’s Law

A

painless jaundice + enlarged, palpable, non-tender gallbladder
–> indicates cancer of the biliary tract or pancreatic head
25-50% sensitivity but 80-90% specificity

26
Q

PE for ascites

A

only good for 500-1000cc

  1. bulging flanks
  2. flank dullness
  3. shifting dullness
  4. fluid wave (only truly specific test)
  5. ballottement sign
27
Q

signs of liver disease

A
  • spider telangiectasias (nevi)
  • palmar erythema
  • asterixis
  • palpable spleen
  • fetor hepaticus
  • dilated abdominal vv.
  • clubbing
  • orthodeoxia and platypnea b/c created shunts
28
Q

Biceps Brachii reflex

A

C5/6

29
Q

Triceps reflex

A

C7

30
Q

Quadriceps reflex

A

L4

31
Q

Plantar reflex

A

S1

32
Q

Romberg test

A 
tests numbness of feet
4 steps:
	-stance
	-forward flex arms like zombie
	-close eyes
	-push on arms
	-stand next to them!!!
33
Q

Lateral epicondyle

A

thumb side

  • origin of extensors and supinators
  • radial n.
34
Q

Medial Epicondyle

A
  • origin of flexors and pronators
  • median n
  • ulnar n. (can get entrapped in cubital tunnel)
35
Q

Pronator syndrome

A

= pain and tingling in palmar side of forearm and digits 1-3
+ Tinel’s sign over pronator mm.
-due to entrapment of proximal medial n. and anterior interosseous n. (a branch)

36
Q

Cubital tunnel

A

weak fingers 2-5 and can’t flex digits 4-5

-atrophy of hypothenar mm and flexor carpi ulnaris

37
Q

5 signs of ACL tear

A
  • rapid ballooning out of knee d/t effusion
  • severe, excruciating pain
  • can’t bear weight
  • audible pop
  • clenched fist when try to do any procedures
38
Q

+ Varus stress test

A

LCL strain, lateral knee pain

39
Q

+ Valgus stress test

A 
MCL strain (pain medial knee)
lateral meniscus tear = Bohler's sign, pain in lateral compartment with valgus test (opposite for Medial meniscus also = Bohler's sign)
40
Q

Mitral Stenosis

A 
Auscultation:
	-heard with bell in left lateral decubitus
	-opening snap	
	-loud S1
	-mid to late diastolic rumble
Physical sx:
	-dyspnea
	-hemoptysis
Physical signs:
	-atrial fibrillation
	-mitral facies - purple nose/cheeks
Cause:
	-rheumatic disease
41
Q

Early Systolic Ejection sound

A 
Auscultation:
	-heard at apex
	-no murmurs
	-extra sound closest to S1
-no physical sx or signs
Cause:
	-congenital bicuspid aortic valve
Complications:
	-early onset aortic stenosis/regurgitation
	-predisposed to endocarditis
42
Q

Cheyne-Stokes respiration

A

-cyclic pattern of progressively deeper (maybe faster) breathing followed by gradual decrease and an apnea
Causes:
-heart failure, damage to respiratory center of the brain

43
Q

Positional dyspnea

A

Trepopnea = down with the good lung, except intra-bronchial spillage of pneumonia or hemorrhage
Platypnea:
-causes –> hepatopulmonary syndrome, R–>L shunt

44
Q

Maranon’s sign

A

= red, itchy skin over thyroid, usually seen in Graves disease

45
Q

Pemberton’s sign

A

= obstruction of the SVC due to substernal goiter upon arm elevation

46
Q

Berry’s sign

A

= absent carotid pulses seen in thyroid malignancy

47
Q

Modigliani’s syndrome

A

= pseudogoiter caused by a long, curving neckline

48
Q

Facts related to rectal exam

A

-one third of rectal cancers are palpable ( must follow up with PSA/ultrasound

49
Q

Aortic Regurg

A

Ausc: blowing diastolic, heard at 2nd intercostal space or Erb’s point
-may have murmur of functional mitral stenosis (Austin Flint)
-may have systolic ejection sound (indicates severe insufficiency)
Physical sx: -left sided heart failure = dyspnea on exertion, orthopnea, PND
-palpitations, chest pain
Physical signs:
-water hammer pulse, bisfiriens pulse
-wide pulse pressure
-inferolaterally placed PMI
-deMusset, Traube, Quincke pulse, Mueller, etc
Causes:
-Rheumatic fever
-bicuspid aortic valve
-infective endocarditis
-dilated aortic root

50
Q

Mitral Regurgitation

A

Ausc: holosystolic, heard at apex, radiates to axilla
-may have diastolic flow murmur (indicates severe insufficiency)
-soft S1
-widely split S2
-S3 common
Sx: -left sided heart failure
signs: -bounding pulse but normal pulse pressure
-inferolaterally displaced PMI
Causes:
-dilated cardiomyopathy
-Rheumatic heart disease
-myxomatous valve degeneration
-papillary muscle/chordae tendineae rupture

51
Q

Aortic Stenosis

A

Ausc: -mid-systolic, harsh, heard at right 2nd intercostal space, radiates to carotids
-soft/absent S2
-may have S4
-may have Gallavardin phenomenon (sounds like MR at apex)
Sx: -dyspnea, dizziness, angina on exertion
Signs:
-pulsus parvus et tardus and brachio-radial delay
-may have prominent A wave (Bernheim phenomenon)
-sustained and mildly displaced PMI with apical thrill
Cause:
-bicuspid aortic valve
-Rheumatic fever
-degenerative changes

52
Q

Bronchial breath sound

A
  • high frequency
  • noisy
  • present throughout inspiration and expiration
  • pause between inspiration and expiration
53
Q

Vesicular breath sound

A
  • low frequency
  • quiet
  • absent in 2/3’s of expiration
  • NO pause between inspiration and expiration
54
Q

Rotator cuff muscles, innervated by same nerve root, different nerves

A 
C5!!
Deltoid - axillary
Supraspinatus - suprascapular
Infraspinatus - suprascapular
Teres minor - axillary
Subscapularis - upper and lower subscapular nerves

Physical Dx (1 decks)

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