PDx vocab, exam 1 Flashcards
LOC: alert patient who opens eyes, focuses on you, responds fully and appropriately to stimuli
Alert
LOC: pt must be shaken as if waking a sleeping person. Eyes open but responses are slow and somewhat confused. Requires you to force them to focus
obtunded
LOC: pt is unarousable. eyes closed. no evident response to inner needs or external stimuli
coma
LOC: pt responds to loud voices. Pt appears drowsy but opens eyes and responds to questions and then falls back to sleep. Focuses with effort, but not without encouragement
Lethargic
LOC: Patient arouses from sleep only after painful stimuli. verbal responses are slow or absent. patient lapses into unresponsive state when the stimulus ceases
stupor
What is the formula for BMI?
[(wt# x 700)/ht”]/ht”
FACIES: small, round head, flattened nasal bridge, prominent epicanthl folds, small low-set ears, large tongue, (Also hypotonia, simian lines, MR)
Trisomy21 Down Syndrome
What do you call it when a patient only has a single crease line on the palm of the hand?
Simian line
FACIES: moon face, flushed cheeks, excessive hair growth
Cushings
FACIES: warm, moist, soft, velvet skin. Thin hair, exophthalmos (also pretibial myedema)
Grave’s Dz
FACIES: dry rough pale skin, course brittle hair, alopecia, thin brittle nails, thinning of lateral eyebrows, dull puffy face, edema, especially around the eyes
hypothyroid
FACIES: elongated head, bony prominent forehead, enlarged soft tissures of mouth, nose, and ears, prominent jaw
acromegaly
FACIES: dry skin, temporal wasting, dental caries
Anorexia
What do FACIES actually mean?
You can draw conclusions about a patient’s underlying health condition based on just looking at them during your general survey.
What pressure change constitutes orthostatic BP?
First reading taken in supine position. Second reading taken within 3 minutes of standing from supine position. Pressure in second reading is positive for orthostatic hypotension if the Systolic drops >20mmHg OR the Diastolic drops >10mmHg
A pulse can be weak or bounding. These are examples of _____________
amplitude
The diastolic flow of blood from the aorta into the left ventricle
Aortic regurgitation
The silent interval that may be present b/t the systolic and diastolic BP’s. (Sound that disappears and reappears)
Ascultatory Gap
A patient’s pulse has a decrease in amplitude during inspiration, alerting you that there is a decrease in cardiac output during inspiration
Paradoxical pulse
What are some causes of paradoxical pulse?
pericardial tamponade, constrictive pericarditis, obstructive lung dz
Unpredictable irregularity in breathing, may be shallow or deep and may stop for short periods
Ataxic (Biot’s breathing)
periods of crescendo/decrescendo breathing between apneas
Cheyne-Stokes breathing
When is the body’s temperature naturally cooler?
morning (higher in afternoon)
1) clinical term for fever? 2) how high is the temp to be considered a fever?
pyrexia, 100.4
A fever higher than 106.0 is called___________
hyperpyrexia
Low temperature is called______________. It is any temp under_________degrees. Temp this low can be a sign of _____________.
hypothermia, 95 degrees, sepsis
What type of pain relates to tissue damage?
somatic pain (or nociceptive paint)
What type of pain relates to injury of the nervous system?
Neuropathic pain
What type of pain results from anxiety/depression, personality, or coping style?
Psychogenic pain
What type of pain occurs without an identifiable cause?
Idiopathic pain
What are the names of the glands that produce 1) sweat (no smell) 2) smelly sweat 3) oil?
1) eccrine 2) apocrine 3) sebacious
Holy cow, you’ve eaten a ton of carrots and your hands are orange. What is this?
Carotenia from excess carotin
When you lift a fold of skin on the back of a patient’s hand and note the ease of which you can move that skin, you will be documenting what part of the skin assessment?
Mobility
When you’ve already pinched the skin on the back of a patient’s hand and now you release it. You are looking at how effectively it will resume its shape. What are you looking at here?
Turgor
circumscribed flat discoloration <1cm
macule
circumscribed, flat discoloration, >1cm
patch
elevated skin lesion up to 1 cm
papule
elevated superficial lesion greater than 1 cm, formed by a confluence of papules
plaque
elevated, solid lesion more than 1 cm in diameter, deeper in dermis
nodule
fluid-filled blister, usually less than 1 cm
vesicle
large fluid-filled blister, greater than 1 cm
bullae
pus-filled vesicle
pustule
group papules or vesicles that resemble herpes
herpetiform lesion
elevated, circumscribed encapsulated lesion in dermis or subcutaneous layer filled with liquid of semisolid material
cyst
elevated, solid lesion may be clearly demarcated; deeper in dermis and greater than 2 cm
tumor
dead epidermal cells, white flakes of skin
scale
collection of dried serum or cellular debris (scab)
crust
area of thickened epidermis induced by scratching and rubbing
lichenification
focal loss of epidermis, does not penetrate below dermal epidermal junction
erosion
focal loss of epidermis and dermis
ulcer
linear ulcer, a “crack” in the skin
fissure
erosion caused by scratching, usually linear or circular
excoriation
a plug in a follicular orifice.
comedone (blackhead-open, whitehead-closed)
dilated superficial blood vessel
telangectasia
non-blanchable circumscribed deposit of blood 5mm or less in diameter
petechiae
circumscribed deposit of blood greater than 5mm
purpura
collection of pus surrounded by inflammation
abscess
hive or welt. raised, well-circumscribed lesion
wheal
thinning of skin surface and loss of markings
atrophy
discolored, fibrous tissue
scar
very thick and raised scar
keloid
the most common form of skin cancer (80%)
BCC
the 2nd most common form of skin cancer (16%)
SCC
least common, but most deadly form of skin cancer (4%)
melanoma
what are the ABC’s of melanoma?
A–asymmetry B–borders C–color
D–Diameter>6mm E–Elevation/enlargement
What type of hair is independent of androgens, its short, fine, and covers much of the body?
Vellus hair
What type of hair is thick, pigmented and found on head, beard, axilla, pubic areas? It’s influenced by androgens.
Terminal hair
_______________ is the presence of terminal hair in a female with a male pattern on face chest or areolas.
Hirsutism
_____________ is the asymptomatic disease characterized by the onset of total hair loss in sharply defined round areas. Thought to be autoimmune
Alopecia areata
______________ is the 100% loss of scalp hair
Alopecia totalis
______________ is the 100% loss of hair everywhere
Alopecia universalis
What is the term for the production of finger/toenails?
Eponychium
You are looking at fingers that have enlarged, rounded distal phalanges. The nails are curved, hard, and thick. The angle made by the proximal nail fold and nail plate (Lovibond’s angle) approaches or exceeds 180 degrees. This is _____________?
clubbing
The most common nail change found in psoriasis
Pitting
Separation of nail plate from nail bed
onycholysis
White spots, very common, possibly result from cuticle manipulation or other mild trauma
Leukonychia
white transverse lines at the time of acute illness
Mees Lines
Nail grooves appear after a very severe illness
Beau’s lines
“spoon nails”. can be a sign of Fe deficiency anemia. Nails become thin and lose convexity
koilonychia
White nail bed with only a thin zone of healthy pink at the distal end (a/w cirrhosis, CHF, DMII, old age)
Terry’s Nails
painful bright red swelling of the proximal and/or lateral nailfold due to infection. When lanced, it produces purulent drainage
Paronychia
Fungal infection of nails that makes them very thick
Onychomaycosis
herpes infection of the finger
herpetic whitmore….(haha, see what I did there?)
What is the name of the screening tool used to monitor central vision loss?
Amsler grid
When you’re legally blind, your best eye…even when corrected…is no better than 20/____? OR your field of vision is constricted so that you only see _____% of your visual field
20/200 or 20% of the field
impaired near vision found in older people
presbyopia
impaired far vision
myopia
double vision
diplopia
Patient has a lesion of the optic chiasm and cannot see laterally in either eye
bitemporal hemianopsia
Patient has a lesion of the optic tract and they cannot see anything on the left side out of either eye
left homonymous hemianopsia (vise versa on the right)
drooping of the upper eyelid
ptosis
lower lid is creeping up
reverse ptosis (bummer)
slightly raised, yellowish, well-circumscribed plaques that appear along the nasal portions of an eyelid (think lipid disorder)
xanthelasma
margin of lower lid turned outward, exposing palpebral conjunctiva
ectropion
inward turning of the eyelid margin, common in elderly
entropion
painless(usually) nodule caused by obstruction of Meibomian gland (no infection)
chalazion
painful, tender, red, infection of pilosebacious gland of Moll
sty/hordeolum
outward bulging of the eyes
exopthalmos
inflammation of the lacrimal sac, infection due to obstruction
dacryocystitis
harmless, yellowish triangular nodule in the bulbar conjunctiva on either side of the iris
just a little pinguecula.
triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea
pterygium
localized ocular redness from inflammation of the episcleral vessels
episcleritis
inflammation of the conjunctiva, most common eye disease
conjunctivitis
thin grayish-white arc near edge of the cornea suggestive of hyperlipoproteinemia
corneal arcus (Or arcus senilis when occurring in old age)
opacity in the crystalline lens. gradual painless loss of vision
cataract
constriction of pupils, iris contracted, heroin
miosis (pinpoint)
dilation of pupils, iris dilated, cocaine
mydriasis (blown)
pupil inequality of 0.5mm+.
anisocoria
What is the formal name for the corneal light reflex?
Hirschberg test
constriction of the left eye when light is shined in the right eye is called the _________________
consensual reflex
What is the Hirschberg Test looking for?
position and alignment of eyes
If you asked your patient to look strait ahead into your own eyes, and you observed a normal response in the left eye. But the patient’s right eye deviated toward the patient’s nose, what would you call this in your documentation?
Right esotropia
If you are looking for pupil reflexes and you shine a light on the left eye and neither eye responds, you’d document what?
Marcus Gunn pupils (sensory afferent defect…blindness of left eye)
Ptosis of upper lid and lateral deviation of the eye are almost always present in what?
oculomotor nerve (CNIII) paralysis
This reflex occurs when a person shifts their gaze from a far object to a near one and you see their pupils constrict
Accommodative reflex
This pupil is the “prostitute pupil” that will accommodate, but not respond. (Common in syphilis). Small irregular pupils that do not respond to light, but do accommodate to the near reaction
Argyll Robertson Pupil (problem with CNIII)
____________ stimulation will cause pupil dilation and elevation of the upper eyelid. (This response can also occur with cocaine and meth)
sympathetic stimulation
Your patient’s left eye has a small pupil that reacts to light and near reaction, but does not dilate normally. You notice that the left side of their face is much drier than the right side. What do you suspect?
Horner syndrome
drugs like heroine and morphine will cause the constriction of pupils, this reaction is due to _________________ stimulation
parasympathetic stimulation
You shine your light in someones eye and there is little or no pupil constriction. This patient has no complaints about their vision, other than an transient blurred vision when focusing on a new object. When documenting this exam, how would you describe this pupil?
tonic pupil or Adie’s pupil
You are checking the ocular movements of your patient’s eyes. You notice a problem with the lateral gaze. What cranial nerve is this?
6-abducens (this is a problem with the lateral rectus)
Your patient cannot look strait down or down and toward their nose. Which cranial nerve is having a problem?
4–trochlear (this is a problem with the superior rectus)
any deviation from perfect ocular alignment is called _____________
strabismus
the affected eye is always turned in
esotropia
the affected eye is always turned out
exotropia
the affected eye is always turned up
hypertropia
the affected eye is always turned down
hypotropia
latent deviation of the eyes held straight by binocular fusion. (Patient normally has a conjugate gaze, but may see a deviation with fatigue)
phoria
what nerve helps you look down and in?
trochlear
what nerve helps you look laterally?
abducens
If you can’t look any direction EXCEPT down and out….then you will be loved by no one. And also, there is a problem with your __________ nerve
oculomotor (III)
repetitive, rhythmic oscillations of one/both eyes
nystagmus
what part of your opthalmascope focuses light at different distances?
diopter
If you spin the diopter counter clock wise, you’ll see red numerals. Assuming you have normal vision, if you bring your patient’s eye into focus at -3. you can assume the patient is nearsighted? or farsighted?
near-sighted
impaired near vision, not associated with age
hyperopia
Looking at the optic nerve, you notice the disc takes up more than 1/2 the cup. What do you suspect?
chronic glaucoma
optic disc swelling due to elevated intracranial pressure
papilledema
creamy or yellowish lesions with well-defind hard borders (common w/ DM and htn)
hard exudates
“cotton-wool patches” seen commonly in htn or when there have been infarcted nerves
soft exudates
blood accumulated in the superficial nerve fiber layer of the retina. Indistinct borders
flame hemorrhages
ruptured microaneurysms in the deeper retina
blot and dot hemorrhages
blood has escaped into the potential space b/t the retina and the vitreous fluid
preretinal hemorrhage
this is seen in hypertensive retinopathy and is characterized by a seeming disappearance of a vein on either side of a nearby artery
AV nicking
What is the common otoscopic finding in patients with proliferative diabetic retinopathy?
neovascularization
yellowish round spots composed of undigested cellular debris
drusen
the presence of drusen and neovascularization within the macula are the hallmarks of _________________
wet age related mac degen
FACIES: decreased facial mobility, blunt expression and mask like face
Parkinson’s
FACIES: periorbital edema, puffy pale face, swollen lips
nephrotic syndrome
ten sites for lymph nodes on head and neck
pre-auricular, post-auricular, occipital, superficial cervical, posterior cervical, cupraclavicular, deep cervical, tonsillar, submandibular, submental
what is the most active joint in the body?
temporomandibular joint
true/false, the lady in the pictures looks exceptionally happy to participate in her ENT exam..
Did you even look at the book? She is pissed.
that bony thingy in the hard palate
torus palatinus
loss of vermillion border
actinic cheilitis
black/red spots in mouth common in AIDS
karposi’s sarcoma
sebaceous spots in the mouth
Fordyce spots
Measles spots in the mouth
Koplik’s spots
hard deposits on ears caused by excess uric acid
tophis
On the posterior of your patient, toward the spine, the top of the horizontal fissures are typically at what vertebral level?
T3
subjective sensation of difficulty breathing
dyspnea. Seriously. you better get this one
musical respiratory sounds
wheezing
response to stimuli that irritates receptors in the larynx, trachea, or large bronchi
cough
coughing up blood from the lungs
hemoptysis
chest pain could be caused by what GENERAL systemic problems?
cardio, pulm, GI, MS, psych
Brownlee said the 5 “A’s” of tobacco cessation would be on the test. Go:
Ask (do you smoke) Advise (I love you sir, please stop smoking) Assess (are you ready to quit) Assist (set quit dates, make solid plan) Arrange (follow up, support)
what are the 4 activities in correct order for EVERY pulm exam?
Inspect, palpate, percuss, ascultate
sunken chest is called
pectus excavatum
poking out Sigourney Weaver bony chest
pectus carinatum
fast, normal, or slow deep breathing (thanks, really narrows that one down). Common with metabolic acidosis
Kussmaul breathing
voice vibrations transmitted to the chest vall
fremitus
when is fremitus reduced?
fluid or air outside the lung
you’re left handed, your right middle finger is your____________ and your left middle finger is your________________ when you are percussing
pleximeter, plexor
what are the percussion sounds?
resonance, hyperresonance, tympany, flat, dull,
How many sites are there to percuss and ascultate on the front of your patient in a resp exam? The back?
6 pairs of sites on the front, 7 pairs of sites on the back
while performing the ___________________ you notice a difference in position of the lower lung fields between inspiration and expiration. (could be paralyzed diaphragm, atelectasis, or pleural effusion)
diaphragmatic excursion
lung sound produced over most of the lungs. it is soft, and inspiratory sound lasts longer than expiratory sound
vesicular
Inspiratory and expiratory sounds are equal with no gap In between sounds
bronchovesicular
expiratory sounds last longer than inspiratory sounds (best heard over the manubrium)
bronchial
inspiratory and expiratory sounds are equal, but there is a gap in sound between them
tracheal
intermittent nonmusical brief sounds created when air is forced through respiratory passages that are narrowed by fluid, mucus, or pus. Frequently heard at the end of inspiration
crackles
continuous course whistling sound, due to narrowing in the respiratory tree and increased airflow velocities across these narrowed spaces
wheezes
high pitched wheeze that is primarily inspiratory, louder over the neck than chest and indicates partial obstruction of larynx or trachea
stridor
similar to wheeze though lower pitch with snore quality. suggestive of secretions in large airways
rhonchi
when vocal sounds are CLEAR and LOUD when you ascultate a patients chest and ask them to speak
bronchophony
easily distinguishable whispered words on respiratory exam
whispered pectoriloquy
Patient says “eeeeee” but you hear “aaaaaaa”
egophony
4 activities in correct order for the abdominal exam
inspection, auscultation, percussion, palpation
loss of appetite
anorexia
localized post-prandial epigastric discomfort
indigestion
inability to consume a normal size meal
early satiety
sense of retrosternal or epigastric burning with radiation to the neck a/w GERD
heartburn
3 mo h/o nonspecific upper abd discomfort of nausea. no structural abnormality
nonulcer dyspepsia
spasmodic movement of chest and diaphragm
retching
raising gastric contents w/o n/v or retching
regurgitation
forceful expulsion of gastric contents through mouth
vomiting
vomiting blood
hematemesis
pain with swallowing
odynophagia
difficulty swallowing
dysphagia
s/wk with lumpy hard stools
constipation
failure to pass stool or gas
obstipation
increased water content or stool volume
diarrhea
black tarry stool (GI bleed)
melena
red/maroon stool (low GI bleed)
hematochezia
greasy/oily stool (malabsorption vs pancreatic insufficiency)
steatorrhea
pain occurring in hollow organs when they distend stretch or contract in an unusual way. difficult to localize
visceral
pain that originates in the parietal perioneum, caused by inflammation, steading aching pain that’s more difficult to localize, and more severe than visceral pain
parietal
pain that is experienced at a distant site that shares innervation with affected area
referred pain
veins that transport blood from digestive organs and spleen, pancreas, and gall-bladder to the liver
portal circulation
scarring of the liver (cirrhosis) or inflammation of the liver (hepatitis) can cause _________ because blood cannot easily flow through the liver
portal hypertension
weak-walled vessels that are prone to rupture and hemorrhage
varices
an abnormal layer of fibrovascular tissue or granulation tissue
pannus
the predominant percussion note over the abdomen
tympany
percussion note heard with ascites, organomegaly, or tumor
dullness
What spot will be tender or distended with splenomegaly?
Traube’s space
for suspicion of pyelonephritis, you will percuss here_________________-
CVA-costovertebral angle
while palpating, your patient seems to be in pain, and their abdomen is rigid and board-like, you susect______________
guarding
while palpating, you push down on a tender area and release suddenly. The patient has more pain on the release. What is this called?
rebounding
abnormal accumulation of fluid in the abdomen
ascites
+ pain on extension of right thigh
psoas sign
pain on internal rotation of right thigh
obturator
pain in RLQ with palpation of LLQ
Rovsing’s sign
Increased pain with coughing
Dunphy’s sign
Area over the appendix that is acutely painful during appendicitis
McBurney’s point
You think your patient has appendicitis, but their pain isn’t in the normal location. Could this still be appendicitis? What explanation do you have for the different pain locations?
yes! could be retrocecal appendix, or pelvic appendix
Increased sensitivity to sensory stimuli such as pain or touch (ex: pt has exquisite pain from pinching a small superficial amt of skin)
cutaneous hyperesthesia (caused by inflammation of parietal pleura)
Move extended fingers of right under the costal margin, ask the patient to exhale and as they take a deep breath, advance the fingers under the costal margin.
A sharp increase in tenderness with a sudden stop in inspiratory effort is a positive sign.
(for cholecystitis)
Murphy’s sign
