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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
Q

What’s a test to check for alcohol use?

A

palpate the parotid glands

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25
Q

What are signs of SBO?

A

bowels moving = visible peristalsis

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26
Q

What are tests for ascites?

A
  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
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26
Q

Where can xanthomatas be found?

A
  1. forearm extensor surfaces
  2. eyelids
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27
Q

What does ascites indicate?

A

Liver disease - cirrhosis

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28
Q

What and where is McBurney’s point?

A

1.5 -2” from anterior superior spinous process of ilium on straight line drawn to umbilicus
2. Tests for appendicitis

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29
Q

What is Rovsing’s Sign?

A

Palpate the LLQ, ask if there’s RLQ pain
-can indicate appendicitis

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30
Q

What is the psoas test and indication?

A

Flex right thigh against resistance to elicit pain in RLQ
- (+) indicates appendicitis

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31
Q

What does palmar erythema indicate?

A

liver disease, cirrhosis
pregnancy
SLE
RA

32
Q

What is Murphy’s sign?

A

Palpate over gallbladder during inspiration. Observe for tenderness or catch in breath

33
Q

What are Terry’s nails?

A

pink part of finger nail turns white
- indicates liver disease or HF

34
Q

What does palpable purpura on lower legs indicate?

A

Cryoglobulinemia (vasculitis) of chronic Hep C or B

35
Q

What can altered mental status indicate?

A

Liver disease - ammonia not being broken down -> toxic to brain

36
Q

What is the postural tremor test?

A

Extend arms prone at shoulder height with palms down, then flexes at elbows

37
Q

What can a positive postural tremor test indicate?

A

Flapping tremor of Wilson’s

38
Q

What is the test for asterixis and what does (+) indicate?

A
  1. extend arms prone at shoulder height w/ bilateral hands extended back
  2. flapping hands = asterixis
  3. sign of liver disease, EtOH
39
Q

What is the speech test and what can it indicate?

A

repeat “la-la-la,” “pa-pa-pa” then “ka-ka-ka”
dysarthria(difficulty w/ speech) - Wilson’s, EtOH

40
Q

What are 5 pathologies epigastric pain can indicate?

A
  1. cholecystitis
  2. choledocholithiasis
  3. cholangitis
  4. pancreatitis
  5. PUD
41
Q

What does LUQ pain suggest?

A

pancreatitis

42
Q

What does RLQ pain suggest?

A
  1. appendicitis
  2. ectopic pregnancy
43
Q

What does LLQ pain suggest?

A
  1. divurticulitis (most common)
  2. ectopic pregnancy
44
Q

What does diffuse pelvic pain suggest?

A

ectopic pregnancy

45
Q

What does pain in any abdominal quandrant suggest?

A

Possible SBO

46
Q

Explain wide physiologic S2 splitting

A

A2 occurs just before P2 and it slightly louder on expiration

47
Q

Explain wide fixed S2 split

A

The same as wide physiologic but A2 and P2 have a slight separation

48
Q

Explain paradoxic S2 splitting

A

P2 is smaller but occurs just before A2 so A2 is late

49
Q

What does paradoxic S2 splitting indicate?

A
  1. Electrical delay of LV systole -> LBBB, RV paced or ectopic beats
  2. Prolongation of LV systole -> aortic stenosis or ischemic heart disease
50
Q

What does wide physiologic S2 splitting indicate?

A
  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
Q

What do spider angiomatas indicate and where are they found?

A

Liver disease
chest & shoulders

52
Q

What are the abnormal blood vessels that may be buldging around the umbilicus and what do they indicate?

A

caput medusa
liver disease

53
Q

What is a maneuver to check for kidney disease?

A

costovertebral tapping or palpating for tenderness

54
Q

What is a healthy liver span?

55
Q

What does CVP reflect?

A

A measure of preload and right atrial pressure (RAP)

56
Q

What is Castell’s point and what is done there?

A

The most inferior interspace on the left anterior axillary line
Percuss while the patient takes full inhalation/expiration to determine if there’s splenomegaly

58
Q

What is clubbing a sign of?

A

Chronic hypoxemia

59
Q

What is a normal range for CVP?

60
Q

What is bronzing a sign of?

A

Hemochromatosis
= high levels of iron

61
Q

How do we assess mental status?

A

Alert? Oriented?
Person (name)
Place
Date
Situation

62
Q

What are three things to check with alcohol use?

A
  1. palpate parotid glands
  2. liver span
  3. mental status
  4. asterixis
  5. dysarthria - “la-la-la,” “pa-pa-pa,” “ka-ka-ka”
63
Q

What is a likelihood ratio?

A

Probability of a finding a (+) or (-) in an exam

64
Q

What are 2 consequences of primary hypothyroidism?

A
  1. hyperprolactinemia
  2. galactorrhea

B/c increaesd levels of TRH will increase secretion of prolactin as well as TSH

65
Q

What 3 things can increase prolactin production?

A
  1. high estrogen
  2. hypothyroidism
  3. low dopamine levels
  4. lactotroph (pituitary) macroadenoma
66
Q

What are 4 conditions in which pain would worsen after eating?

A
  1. cholecystitis
  2. choledocholithiasis
  3. pancreatitis
  4. PUD
67
Q

What is the Cullen sign?

A

ecchymosis and edema around the umbilicus

68
Q

What is the Grey Turner sign?

A

Ecchymosis of the flank

69
Q

Risk factors for gallstones

A

Fat, female, fertile
Age > 40

70
Q

What labs would you obtain when assessing abdominal pain?

A
  1. Creatinine
  2. CMP - BUN
  3. CMP - calcium
  4. CMP - albumin
  5. amylase
  6. lipase
  7. CBC - WBC
  8. Bilirubin
71
Q

How much alcohol is associated with liver disease?

A

> 2 drinks/day female
3 drinks/day male

72
Q

Signs of primary biliary cholangitis

A

Female (90-95%)
Age: 40’s - 50’s
light stool color
steatorrhea
pruritis
xanthelasmas

73
Q

Signs of primary sclerosing cholangitis

A

more common in males
light stool color
steatorrhea
pruritis
hx IBD
hx bile duct cancer
xamthelasmas

74
Q

Risk factors for hemachromatosis

A

40-50 yo males
>50 yo females
T1 or 2 DM
Fhx
Fhx T1 or T2 DM
Fhx hypopituitarism
Fhx hypogonadism
Fhx hypothyroidism

75
Q

What tests are ordered for chest pain?

A

EKG
Echo
troponin
BNP
CXR

76
Q

Cardiac murmurs and locations for listening

77
Q

Liver tests

A
  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
Q

Causes of cirrhosis

A
  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

CMC 3 Final (1 decks)

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