PDx Flashcards
Campbell’s sign
= tracheal descent with inspiration; due to chronic airflow obstruction
-seen with COPD but not specific to it
Oliver’s sign
for trachea
= systolic tug seen with aortic aneurysm; synchronous with each heart beat
Tietze’s syndrome
=costochondritis = inflammation of costal cartilages
Clubbing
-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
Hypertrophic osteoarthropathy
- 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
Dahl’s sign
elbows and knees are discolored/chafed from leaning over in tripod position
-COPD sign
Hoover’s sign
= flattened diaphragm so both costal margins are drawn towards midline, more acute subcostal angle
sign of COPD
Causes of generalized lymphadenopathy
- disseminated malignancy
- collagen vascular disease (sarcoidosis)
- infectious process (mono, syphilis, CMV, toxo, RF, AIDS, TB, plague)
- rxn to drugs
Delphian nodes
prelaryngeal, small, midline nodes on thyrohyoid membrane, indicate thyroid disease
Left supraclavicular node
= 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
Sister Mary Joseph’s nodule
periumbilical nodule or hard mass, reflects ovary or stomach malignancy
Raynaud’s Phenomenon
Precedes: -CT diseases -blood disorders -disorders characterized by arterial compression (thoracic outlet, carpal tunnel) -vasculitis and atherosclerosis -drugs and toxins -misc white blue red
Allen’s test
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
Buerger’s Test
-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
Diabetic Foot
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
Charcot’s foot
=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
Trendelenburg test
= 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
Cullen’s sign
periumbilical ecchymosis associated with acute hemorrhagic pancreatitis
-poor sensitivity and specficity
Grey Turner’s sign
= bilateral frank reddish/purple discoloration assoc. w/acute hemorrhagic pancreatitis
Respiratory alternans
= alternate use of diaphragm or intercostal resp. mm; rock in one direction then switch to other direction
-predicts resp. failure
Venous patterns on abdomen
- 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
Cruveilhier-Baumgarten murmur/sign
= 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
Techniques for percussion of spleen
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
Murphy’s sign
=painful reflex arrest of inspiration, triggered by palpation of the edge of an inflamed gallbladder
- specificity is higher than sensitivity
- -> cholecystitis
Boas’ sign
= area of hypersensitivity over right costophrenic angle (and right shoulder)
= sign of cholecystitis
Courvoisier’s Law
painless jaundice + enlarged, palpable, non-tender gallbladder
–> indicates cancer of the biliary tract or pancreatic head
25-50% sensitivity but 80-90% specificity
PE for ascites
only good for 500-1000cc
- bulging flanks
- flank dullness
- shifting dullness
- fluid wave (only truly specific test)
- ballottement sign
signs of liver disease
- spider telangiectasias (nevi)
- palmar erythema
- asterixis
- palpable spleen
- fetor hepaticus
- dilated abdominal vv.
- clubbing
- orthodeoxia and platypnea b/c created shunts
Biceps Brachii reflex
C5/6
Triceps reflex
C7
Quadriceps reflex
L4
Plantar reflex
S1
Romberg test
tests numbness of feet 4 steps: -stance -forward flex arms like zombie -close eyes -push on arms -stand next to them!!!
Lateral epicondyle
thumb side
- origin of extensors and supinators
- radial n.
Medial Epicondyle
- origin of flexors and pronators
- median n
- ulnar n. (can get entrapped in cubital tunnel)
Pronator syndrome
= 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)
Cubital tunnel
weak fingers 2-5 and can’t flex digits 4-5
-atrophy of hypothenar mm and flexor carpi ulnaris
5 signs of ACL tear
- 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
+ Varus stress test
LCL strain, lateral knee pain
+ Valgus stress test
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)
Mitral Stenosis
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
Early Systolic Ejection sound
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
Cheyne-Stokes respiration
-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
Positional dyspnea
Trepopnea = down with the good lung, except intra-bronchial spillage of pneumonia or hemorrhage
Platypnea:
-causes –> hepatopulmonary syndrome, R–>L shunt
Maranon’s sign
= red, itchy skin over thyroid, usually seen in Graves disease
Pemberton’s sign
= obstruction of the SVC due to substernal goiter upon arm elevation
Berry’s sign
= absent carotid pulses seen in thyroid malignancy
Modigliani’s syndrome
= pseudogoiter caused by a long, curving neckline
Facts related to rectal exam
-one third of rectal cancers are palpable ( must follow up with PSA/ultrasound
Aortic Regurg
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
Mitral Regurgitation
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
Aortic Stenosis
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
Bronchial breath sound
- high frequency
- noisy
- present throughout inspiration and expiration
- pause between inspiration and expiration
Vesicular breath sound
- low frequency
- quiet
- absent in 2/3’s of expiration
- NO pause between inspiration and expiration
Rotator cuff muscles, innervated by same nerve root, different nerves
C5!! Deltoid - axillary Supraspinatus - suprascapular Infraspinatus - suprascapular Teres minor - axillary Subscapularis - upper and lower subscapular nerves
