PDx vocab, exam 1 Flashcards by Ryan C

LOC: alert patient who opens eyes, focuses on you, responds fully and appropriately to stimuli

Alert

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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

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LOC: pt is unarousable. eyes closed. no evident response to inner needs or external stimuli

coma

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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

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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

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What is the formula for BMI?

[(wt# x 700)/ht”]/ht”

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FACIES: small, round head, flattened nasal bridge, prominent epicanthl folds, small low-set ears, large tongue, (Also hypotonia, simian lines, MR)

Trisomy21 Down Syndrome

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What do you call it when a patient only has a single crease line on the palm of the hand?

Simian line

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FACIES: moon face, flushed cheeks, excessive hair growth

Cushings

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FACIES: warm, moist, soft, velvet skin. Thin hair, exophthalmos (also pretibial myedema)

Grave’s Dz

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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

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FACIES: elongated head, bony prominent forehead, enlarged soft tissures of mouth, nose, and ears, prominent jaw

acromegaly

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FACIES: dry skin, temporal wasting, dental caries

Anorexia

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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.

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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

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A pulse can be weak or bounding. These are examples of _____________

amplitude

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The diastolic flow of blood from the aorta into the left ventricle

Aortic regurgitation

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The silent interval that may be present b/t the systolic and diastolic BP’s. (Sound that disappears and reappears)

Ascultatory Gap

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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

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What are some causes of paradoxical pulse?

pericardial tamponade, constrictive pericarditis, obstructive lung dz

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Unpredictable irregularity in breathing, may be shallow or deep and may stop for short periods

Ataxic (Biot’s breathing)

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periods of crescendo/decrescendo breathing between apneas

Cheyne-Stokes breathing

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When is the body’s temperature naturally cooler?

morning (higher in afternoon)

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1) clinical term for fever? 2) how high is the temp to be considered a fever?

pyrexia, 100.4

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A fever higher than 106.0 is called___________

hyperpyrexia

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Low temperature is called______________. It is any temp under_________degrees. Temp this low can be a sign of _____________.

hypothermia, 95 degrees, sepsis

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What type of pain relates to tissue damage?

somatic pain (or nociceptive paint)

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What type of pain relates to injury of the nervous system?

Neuropathic pain

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What type of pain results from anxiety/depression, personality, or coping style?

Psychogenic pain

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What type of pain occurs without an identifiable cause?

Idiopathic pain

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What are the names of the glands that produce 1) sweat (no smell) 2) smelly sweat 3) oil?

1) eccrine 2) apocrine 3) sebacious

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Holy cow, you’ve eaten a ton of carrots and your hands are orange. What is this?

Carotenia from excess carotin

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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

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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

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circumscribed flat discoloration <1cm

macule

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circumscribed, flat discoloration, >1cm

patch

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elevated skin lesion up to 1 cm

papule

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elevated superficial lesion greater than 1 cm, formed by a confluence of papules

plaque

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elevated, solid lesion more than 1 cm in diameter, deeper in dermis

nodule

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fluid-filled blister, usually less than 1 cm

vesicle

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large fluid-filled blister, greater than 1 cm

bullae

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pus-filled vesicle

pustule

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group papules or vesicles that resemble herpes

herpetiform lesion

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elevated, circumscribed encapsulated lesion in dermis or subcutaneous layer filled with liquid of semisolid material

cyst

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elevated, solid lesion may be clearly demarcated; deeper in dermis and greater than 2 cm

tumor

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dead epidermal cells, white flakes of skin

scale

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collection of dried serum or cellular debris (scab)

crust

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area of thickened epidermis induced by scratching and rubbing

lichenification

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focal loss of epidermis, does not penetrate below dermal epidermal junction

erosion

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focal loss of epidermis and dermis

ulcer

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linear ulcer, a “crack” in the skin

fissure

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erosion caused by scratching, usually linear or circular

excoriation

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a plug in a follicular orifice.

comedone (blackhead-open, whitehead-closed)

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dilated superficial blood vessel

telangectasia

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non-blanchable circumscribed deposit of blood 5mm or less in diameter

petechiae

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circumscribed deposit of blood greater than 5mm

purpura

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collection of pus surrounded by inflammation

abscess

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hive or welt. raised, well-circumscribed lesion

wheal

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thinning of skin surface and loss of markings

atrophy

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discolored, fibrous tissue

scar

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very thick and raised scar

keloid

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the most common form of skin cancer (80%)

BCC

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the 2nd most common form of skin cancer (16%)

SCC

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least common, but most deadly form of skin cancer (4%)

melanoma

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what are the ABC’s of melanoma?

A–asymmetry B–borders C–color

D–Diameter>6mm E–Elevation/enlargement

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What type of hair is independent of androgens, its short, fine, and covers much of the body?

Vellus hair

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What type of hair is thick, pigmented and found on head, beard, axilla, pubic areas? It’s influenced by androgens.

Terminal hair

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_______________ is the presence of terminal hair in a female with a male pattern on face chest or areolas.

Hirsutism

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_____________ is the asymptomatic disease characterized by the onset of total hair loss in sharply defined round areas. Thought to be autoimmune

Alopecia areata

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______________ is the 100% loss of scalp hair

Alopecia totalis

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______________ is the 100% loss of hair everywhere

Alopecia universalis

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What is the term for the production of finger/toenails?

Eponychium

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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

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The most common nail change found in psoriasis

Pitting

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Separation of nail plate from nail bed

onycholysis

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White spots, very common, possibly result from cuticle manipulation or other mild trauma

Leukonychia

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white transverse lines at the time of acute illness

Mees Lines

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Nail grooves appear after a very severe illness

Beau’s lines

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“spoon nails”. can be a sign of Fe deficiency anemia. Nails become thin and lose convexity

koilonychia

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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

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painful bright red swelling of the proximal and/or lateral nailfold due to infection. When lanced, it produces purulent drainage

Paronychia

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Fungal infection of nails that makes them very thick

Onychomaycosis

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herpes infection of the finger

herpetic whitmore….(haha, see what I did there?)

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What is the name of the screening tool used to monitor central vision loss?

Amsler grid

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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

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impaired near vision found in older people

presbyopia

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impaired far vision

myopia

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double vision

diplopia

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Patient has a lesion of the optic chiasm and cannot see laterally in either eye

bitemporal hemianopsia

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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)

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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?

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

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PDx vocab, exam 1 Flashcards

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