Physical Diagnosis Flashcards
1
Q
Case history questionnaire
A
What brings you in today? When did it start? What happened? Was it gradual or sudden? Have you had pain like this in the past? Is it getting better, worse, or staying the same? How would you rate the pain? How would you describe the pain? Does the pain travel? Are there other symptoms you experience? Can you point to the pain? Is there a position or place associated with it? What time of day do you feel the pain? Is the pain constant or does it come and go? Does the pain wake you up at night? Have you had any past surgeries? hospitalizations? infections? Immunizations? major illnesses? trauma? allergies? Does anyone in your family have or had any major illnesses like diabetes, cancer, stroke, or heart disease? What do you do for a living? has the condition affected your work? is the work the cause of the condition? Do you smoke? How much? How long? How is your sleep? Does this wake you up at night? Are you sexually active? Do you use protection? Are you monogomous? Are there any other signs and symptoms you have noticed since your pain began, even if they seem unrelated?
2
Q
normal temperature values
A
oral: 98.6
3
Q
normal adult pulse values
A
60-100
4
Q
normal respiratory rate values?
A
14-18
5
Q
normal adult BP values?
A
90-120/60-80
6
Q
hypertension
A
140/90
7
Q
hypotension
A
90/60
8
Q
herpes zoster
A
vesicle- elevated serous filled cavity .5cm that follows a thoracic dermatome
9
Q
psoriasis
A
silver scales on the extensor surfaces
10
Q
SLE
A
butterfly rash
11
Q
lyme disease
A
tick bite, bull’s eye rash
ELISA, IgG, IgM (western blot)
internist, infectious disease specialist
treatment: antibiotics for 3 weeks to months
12
Q
Dekleyn’s
A
patient supine with head extended off table, doctor instructs patient to hyperextend and rotate the head for 15-45 seconds. doctor may provide minimal suport. repeat on opposite side
positive: vertigo, blurred vision, nausea, syncope, nystagmus
13
Q
VBAI test
A
patient seated. auscultate (bell) and palpate subclavian and carotid arteries. If no bruits, patient rotates and hyperextends head to each side
positive: vertigo, blurred vision, nausea, syncope, nystagmus
14
Q
bilateral ptosis
A
myasthenia gravis
15
Q
unilateral ptosis
A
horner’s syndrome
16
Q
horner’s syndrome
A
loss of cervical sympathetics, ptosis, miosis, anhydrosis, CN III lesion, pancoast tumor
17
Q
iritis/uveitis
A
early stages of AS
18
Q
papilledema
A
an indication of increased intracranial pressure
19
Q
arteriosclerosis
A
AV nicking, silver wire arterioles, widened light reflex
20
Q
HTN
A
flame hemorrhages, cotton wool spots, narrow light reflexx
21
Q
diabetes mellitus
A
yellow, hard, waxy exudates, neovascularization, microaneurysms, absent red light reflex
22
Q
conditions associated with external ear
A
otitis externa
air conduction loss
23
Q
conditions associated with middle ear
A
otitis media
otosclerosis
meniere’s disease
24
Q
conditions associated with inner ear
A
meniere's disease labyrinthitis vertigo acoustic neuroma ototoxicity (aspirin, antibiotics)
25
Weber test
512 tuning fork on the vertex of the patient's head. Ask the patient if they can hear the sound the same on both sides.
If not it's called lateralization.
air conduction on louder side
nerve deficit on the other side
26
Rinne test
used to determine air conduction or sensorineural problem. Test side that is louder first. Placetuning fork on mastoid process and ask the patient to verbalize when they can no longer hear it. After sound stops place in front of EAM. Normal is hearing 2x longer in front of EAM compared to mastoid. if not, consider air conduction on that side. if normal (rinne +), consider nerve on opposite side
27
palpation of sinuses
palpate the frontal sinuses at the medial aspect of the eyebrow and the maxillary sinuses underneath the medial aspect of the zygomatic arches. Tenderness can indicate sinusitis
28
respiratory excursion/expansion
place hands over posterior ribs and have patient take 3 deep breaths
29
tactile fremitus
palpable symmetrical vibrations. Have patient say 99 each time you touch them
increased indicates pneumonia
decreased indicates emphysema
30
locate and name the lobes of the lung
Anterior right side: above the clavicle to the 4th rib is upper lobe. from 4th to 6th rib medially is the middle lobe. from 6th to 8th rib laterally is the lower lobe.
anterior left side: above clavicle to 6th rib is the upper lobe. from 6th to 8th rib laterally is lower lobe
posterior: t3 toward axilla, above that line is upper lobe and below to T10 is lower lobe bilaterally
31
diaphragmatic excursion
dr asks patient to exhale and hold it, percuss down the back in the intercostal margins, starting below the scapula, until the sounds change from resonant to dull. Then the patient takes a deep breath in and holds it as the dr will measure the distance between two spots.
Normal is 2" bilaterally
32
percuss the lungs
anterior: start midclavicular about the second intercostal space and go about a half moon shape
posterior: start about base of neck and percuss between intercostal spaces until T10, then laterally.
dullness: pneumonia, atelectasis, pleurisy
resonance: normal, bronchitis
hyperresonance: emphysema and pneumothorax
33
breath sounds
tracheal: over the trachea
bronchial: over manubrium
bronchovesicular: between 1-2 ribs anteriorly, between scapulae posteriorly
vesicular: remaining lung field
34
vocal resonance
bronchophony: if clear, distinct sounds are heard as the patient says 99, consolidation is present
egophony: if you hear aaaa as the patient says eeee, consolidation is present
whispered pectoriloquy: if 99 is heard clearly and distinctly, consolidation is present
35
lobar pneumonia
percussion is dull over fluid, rales/crackles, increased tactile fremitus, productive cough at 10 days, rusty brown sputum, possible fever
36
tuberculosis
caused by mycobacterium tuberculosis. low grade fever, night sweats, productive cough, yellow/green sputum, starts in apices of the lung, crackles in upper lobe, tine test/Mantoux test, positive purified protein derivative, most definitive test for dx is sputum culture
37
pleurisy
inflammation of the pleura, usually producing an exudative pleural effusion and stabbing chest pain worsened by respiration and cough. dull on percussion, dry/non-productive cough, decreased respiratory excursion, decreased tactile fremitus, dull on percussion, friction rub is present, decreased breath sounds, +shepellman's test
38
pneumothorax
ruptured lung causing air to become trapped in the pleural space. decreased chest expansion, decreased tactile fremitus, hyper-resonant, decreased breath sounds. can occur in young, previously healthy, tall, thin runners
unilateral darkening of the chest due to collapse of the lung; tracheal shift away from lesion
39
atelectasis
collapse of the lung that is usually the result of bronchial obstruction due to a mucous plug. presents with decreased tactile fremitus, dull on percussion, decrease chest expension, decreased or absent breath sounds
on x ray the lung collapsed lung will display increased density and mediastinal shift to same side
40
emphysema
destruction of elastic pulmonary connective tissue results in permanent dilation of the alveoli air sacs. presents with decreased tactile fremitus, hyperresonant percussion, decreased breath sounds, and prolonged expiration with an expiratory wheeze and 20-30 years of smoking likely. fluid will accumulate in costophrenic recess
bilaterally darkened lung fields; narrowed compressed heart; horizontal ribs; flattening of the diaphragmatic domes
41
bronchogenic carcinoma
primary malignant lung tumor that starts in the area of the bronchus. long term mistory of smoking (20-30 years). coughing (non-productive) more than 30 days, afebrile, dyspnea, weight loss, and clubbing of finger nails
42
costochondritis
inflammation of the cartilage connection between the ribs and sternum. it develops as a consequence of physical activity and is worse with exercise. the pain increases while taking a deep breath. there will be palpable tenderness at the 3rd, 4th or 5th costosternal articulation
43
tietze syndrome
inflammation of the costal cartilage at one articulation. this pain can radiate and be chronic in nature
44
herpes zoster (shingles)
painful rash following the course of a dermatome usually a single nerve. primarily involves the dorsal root ganglion, but when it does involve a CN is is most commonly CN V
45
sarcoidosis
abnormal collections of inflammatory cells (granulomas) form as nodules. most often appear in the lungs or lymph nodes. most commonly seen in people of african american descent
xray: bilateral hilar lymphadenopathy
46
hodgkin's
cancer of the lymphatic system that can spread to the spleen, most commonly seen in young caucasion males, presents with fever, night sweats, weight loss, INTENSE PURITIS (release of IgG) and enlarged spleen, best diagnosed from biopsy looking for reed sternberg cells
xray: unilateral in hilar lymphadenopathy
47
breath sounds are decreased in
COPD
muscular weakenss
pleural effusion
pneumothorax
48
percuss heart
percuss from midaxillary line to the right side of the sternum in the 3rd, 4th and 5th intercostal spaces for cardiomegaly
49
palpate heart
abnormal pulsations (with pads of 2nd and 3rd digits) and thrills (with the ball of the hand)
50
auscultation
detection of high-pitched (with diaphragm) or low pitched murmurs (with the bell)
aortic valve: right sternal border at the 2nd intercostal space
pulmonic valve: left sternal border at the 2nd intercostal space
tricuspid valve: left sternal border at 4th or 5th intercostal space
mitral valve: mid-clavicular line at the 5th intercostal space
51
sternal compression test
knife edge on sternum
| pain on lateral aspect of ribs (rib fracture)
52
right sided heart failure
presents with cardiomegaly jugular venous pulsations/distension, bilateral leg swelling (pitting edema), and difficulty breathing. common causes include left sided heart failure and cor pulmonale
53
angina pectoris- coronary vasospasm
comes on with exertion
printzmetal angina comes on with rest (atypical)
relieved by vasodilators under tongue (usually nitroglycerin)
54
myocardial infarction
acute heart failure, comes on with rest, severe substernal chest pain, referral to left arm, labored breathing, caused by atherosclerosis, CPK is elevated, increased SGOT, increased LDH
55
tests for heart conditions
electrocardiogram
echocardiogram (valves)
refer to cardiologist
56
bacterial endocarditis
usually caused by strep infection (ASO titre)
fever, friction rub, increased WBCs and ESR, treated with antibiotics
can produce cardiac tamponade (life threatening)
57
cholecystitis/cholelithiasis/choledocholithiasis
most commonly seen in overweight females
most common cause is cholelithiasis
severe right upper quadrant pain, nausea, vomiting, and precipitated by eating a large fatty meal
tests: diagnositc ultrasound, oral cholecystogram, murphy's sign-inspriatory arrest sign
58
murphy's sign
poke up under the right side of the ribs, have the patient breathe in while you push (they'll stop breathing for the test to be positive)
