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CMC 3 Final > PEs > Flashcards

PEs Flashcards

1
Q

What is tactile fremitus?

A

increased transmission of sound over area of pneumonia/consolidation

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2
Q

How is tactile fremitus determined?

A

Palpate by placing back of hands bilaterally over posterior lung bases and ask patient to say “99”

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3
Q

What do different tactile fremitus sounds indicate?

A
  1. increased transmission of sound = pneumonia/consolidation
  2. asymmetric decrease in transmission of sound = pleural effusion or pneumothorax
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4
Q

What might cause a dullness to percussion over posterior lung fields?

A

pneumonia

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5
Q

How do we test for a change in egophony

A

Auscultate each lung base while patient says elongated “E”

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6
Q

What does an E to A change in egophony indicate?

A

pneumonia

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7
Q

What is whisper pectoriloquy?

A

Auscultate each lung base while patient whispers “1-2-3”

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8
Q

What are findings from whisper pectoriloquey?

A

Normal - only faint sounds heard
penumonia/consolidation - clear, distinct sounds (NOT pleural effusion)

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9
Q

How do you perform auscultatory percussion?

A
  1. stethoscope 3 cm posteriorly below lowest rib at hemithorax midline
  2. taps fingers in 3 parallel lines down each hemithorax from apex to base
  3. listen for change of resonance to dullness
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10
Q

How might auscultatory percussion change with disease/illness?

A

Pleural effusion - loud percussion at interface of air containing lung and pleural fluid in a horizontal line across the posterior hemithorax

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11
Q

What is arcus senilis?

A

Lipid deposits that appear as rings in the outer part of the cornea

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12
Q

Signs of MI

A
  1. diaphoresis
  2. paradoxic splitting of S2
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13
Q

How are S3 and S4 determined?

A

Auscultate w/ bell at T and M

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14
Q

What do S3 and S4 sounds at T imply?

A

tricuspid stenosis

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14
Q

What do S3 and S4 sounds at M imply?

A

Mitral stenosis

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15
Q

Signs of CAD

A
  1. arcus senilis
  2. earlobe crease
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16
Q

How do we assess chest wall pain?

A

palpate the pain location, assess for tenderness

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17
Q

Signs of pericarditis?

A
  1. diminished heart sounds
  2. edema
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18
Q

Signs of PE

A
  1. edema
  2. calf tenderness
  3. palpable cord
  4. erythema in calves
  5. fever
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19
Q

What can scleral icterus imply?

A

= jaundice
1. choledocholithiasis
2. cholangitis
3. hepatitis

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20
Q

What are Kayser- Fleischer rings?

A

brown rings around the pupil, in the cornea

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21
Q

What are Kayser-Fleischer rings a sign of?

A

Wilson’s disease/copper deposition

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22
Q

What are xanthelasmas and where can they be seen?

A

= cholesterol deposits found by eyelids

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23
Q

What do xanthelasmas indicate?

A
  1. primary biliary cholangitis
  2. primary sclerosing cholangitis
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24
What's a test to check for alcohol use?
palpate the parotid glands
25
What are signs of SBO?
bowels moving = visible peristalsis
26
What are tests for ascites?
1. shifting dullness (air-fluid level shifts from supine to lateral decubitus) - percuss from flank to umbilicus w/ patient supine (dullness on percussion = fluid) 2. Fluid wave - patient places hand midline. Tap one side of abdomen while feeling and inspecting for fluid wave on opp side
26
Where can xanthomatas be found?
1. forearm extensor surfaces 2. eyelids
27
What does ascites indicate?
Liver disease - cirrhosis
28
What and where is McBurney's point?
1.5 -2" from anterior superior spinous process of ilium on straight line drawn to umbilicus 2. Tests for appendicitis
29
What is Rovsing's Sign?
Palpate the LLQ, ask if there's RLQ pain -can indicate appendicitis
30
What is the psoas test and indication?
Flex right thigh against resistance to elicit pain in RLQ - (+) indicates appendicitis
31
What does palmar erythema indicate?
liver disease, cirrhosis pregnancy SLE RA
32
What is Murphy's sign?
Palpate over gallbladder during inspiration. Observe for tenderness or catch in breath
33
What are Terry's nails?
pink part of finger nail turns white - indicates liver disease or HF
34
What does palpable purpura on lower legs indicate?
Cryoglobulinemia (vasculitis) of chronic Hep C or B
35
What can altered mental status indicate?
Liver disease - ammonia not being broken down -> toxic to brain
36
What is the postural tremor test?
Extend arms prone at shoulder height with palms down, then flexes at elbows
37
What can a positive postural tremor test indicate?
Flapping tremor of Wilson's
38
What is the test for asterixis and what does (+) indicate?
1. extend arms prone at shoulder height w/ bilateral hands extended back 2. flapping hands = asterixis 3. sign of liver disease, EtOH
39
What is the speech test and what can it indicate?
repeat "la-la-la," "pa-pa-pa" then "ka-ka-ka" dysarthria(difficulty w/ speech) - Wilson's, EtOH
40
What are 5 pathologies epigastric pain can indicate?
1. cholecystitis 2. choledocholithiasis 3. cholangitis 4. pancreatitis 5. PUD
41
What does LUQ pain suggest?
pancreatitis
42
What does RLQ pain suggest?
1. appendicitis 2. ectopic pregnancy
43
What does LLQ pain suggest?
1. divurticulitis (most common) 2. ectopic pregnancy
44
What does diffuse pelvic pain suggest?
ectopic pregnancy
45
What does pain in any abdominal quandrant suggest?
Possible SBO
46
Explain wide physiologic S2 splitting
A2 occurs just before P2 and it slightly louder on expiration
47
Explain wide fixed S2 split
The same as wide physiologic but A2 and P2 have a slight separation
48
Explain paradoxic S2 splitting
P2 is smaller but occurs just before A2 so A2 is late
49
What does paradoxic S2 splitting indicate?
1. Electrical delay of LV systole -> LBBB, RV paced or ectopic beats 2. Prolongation of LV systole -> aortic stenosis or ischemic heart disease
50
What does wide physiologic S2 splitting indicate?
1. P2 late: a. electrical delay of RV systole -> RBBB, LV paced or ectopic beats b. prolongation of RV systole -> pulmonic stenosis, acute cor pulmonale c. increased hangout interval -> dilation of pulmonary artery 2. A2 early: a. shortening of LV systole -> mitral regurgitation
51
What do spider angiomatas indicate and where are they found?
Liver disease chest & shoulders
52
What are the abnormal blood vessels that may be buldging around the umbilicus and what do they indicate?
caput medusa liver disease
53
What is a maneuver to check for kidney disease?
costovertebral tapping or palpating for tenderness
54
What is a healthy liver span?
6-12 cm
55
What does CVP reflect?
A measure of preload and right atrial pressure (RAP)
56
What is Castell's point and what is done there?
The most inferior interspace on the left anterior axillary line Percuss while the patient takes full inhalation/expiration to determine if there's splenomegaly
57
58
What is clubbing a sign of?
Chronic hypoxemia
59
What is a normal range for CVP?
6-8 cm
60
What is bronzing a sign of?
Hemochromatosis = high levels of iron
61
How do we assess mental status?
Alert? Oriented? Person (name) Place Date Situation
62
What are three things to check with alcohol use?
1. palpate parotid glands 2. liver span 3. mental status 4. asterixis 5. dysarthria - "la-la-la," "pa-pa-pa," "ka-ka-ka"
63
What is a likelihood ratio?
Probability of a finding a (+) or (-) in an exam
64
What are 2 consequences of primary hypothyroidism?
1. hyperprolactinemia 2. galactorrhea B/c increaesd levels of TRH will increase secretion of prolactin as well as TSH
65
What 3 things can increase prolactin production?
1. high estrogen 2. hypothyroidism 3. low dopamine levels 4. lactotroph (pituitary) macroadenoma
66
What are 4 conditions in which pain would worsen after eating?
1. cholecystitis 2. choledocholithiasis 3. pancreatitis 4. PUD
67
What is the Cullen sign?
ecchymosis and edema around the umbilicus
68
What is the Grey Turner sign?
Ecchymosis of the flank
69
Risk factors for gallstones
Fat, female, fertile Age > 40
70
What labs would you obtain when assessing abdominal pain?
1. Creatinine 2. CMP - BUN 3. CMP - calcium 4. CMP - albumin 5. amylase 6. lipase 7. CBC - WBC 8. Bilirubin
71
How much alcohol is associated with liver disease?
>2 drinks/day female >3 drinks/day male
72
Signs of primary biliary cholangitis
Female (90-95%) Age: 40's - 50's light stool color steatorrhea pruritis xanthelasmas
73
Signs of primary sclerosing cholangitis
more common in males light stool color steatorrhea pruritis hx IBD hx bile duct cancer xamthelasmas
74
Risk factors for hemachromatosis
40-50 yo males >50 yo females T1 or 2 DM Fhx Fhx T1 or T2 DM Fhx hypopituitarism Fhx hypogonadism Fhx hypothyroidism
75
What tests are ordered for chest pain?
EKG Echo troponin BNP CXR
76
Cardiac murmurs and locations for listening
77
Liver tests
1. CMP - ALT, AST 2. alk phos (cholestasis) 3. GGT (gallbladder) 4. CMP - albumin 5. Bilirubin - direct, indirect (cholestasis) 6. Prothrombin time 7. US (MAFLD) 8. biopsy - gold standard
78
Causes of cirrhosis
1. MAFLD 2. EtOH use 3. meds 4. hemochromatosis 5. Wilson's 6. alpha-1 antitrypsin def 7. viral hepatitis 8. vascular 9. AI hepatitis 10. PBC 11. PSC 12. biliary obstruction
79

CMC 3 Final (1 decks)

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