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Differential Diagnosis > Physical Exam Lecture > Flashcards

Physical Exam Lecture Flashcards

1
Q

What are the 7 vital signs, according to the Diff Dx Physical Exam lecture?

A 
 Pulse
 Respirations
 Pulse oximetry
 Blood pressure
 Core body temperature
 Skin temperature
 Pain
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2
Q

What is one looking for when conducting inspection and palpation?

A 
Texture, mobility or movement
 Location, size, position, alignment
 Color
 Shape, contour, symmetry
 Tenderness
 Temperature
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3
Q

What are the palpation depths for light and deep palpation?

A

 Light = up to ½ inch

 Deep = up to 1 inch

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4
Q

What does the “5 students and 5 teachers around the CAMPFIRE” stand for (Could only find 6 students and 3 teachers online)

A 
Site, Size, Shape, Surface, Skin, Scar
Tenderness, Temperature, Transillumination
Consistency
Attachment
Mobility
Pulsation
Fluctuation
Irreducibility
Regional lymph nodes
Edge
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5
Q

What does pallor mean and what might it indicate?

A

pale; decreased pigmentation;
possibly from blood abnormality or liver
disease

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6
Q

What does cyanosis mean and what might it indicate?

A

Blue skin from decreased oxygen delivery

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7
Q

What does jaundice mean and what might it indicate?

A

Yellow, orange, or green skin; excess billirubin

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8
Q

What does rubor mean and what might it indicate?

A

Dusky red from arterial insufficiency from

PVD

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9
Q

What does hyperpigmentation mean and what might it indicate?

A

Darkened skin; Addison’s disease, pregnancy

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10
Q

What additional considerations might one have to make when assessing dark skin?

A

 Observe palms of hands and soles of feet;
tongue, lips and gum; sclera and conjunctiva
of eyes
 Pallor may present as yellow or ashen-gray
 Skin rashes – check for texture changes
 Edema may lighten skin
 Inflammation – check temperature
 Normal oral mucosa may appear freckled
 Petechiae – check areas with lighter skin such
as abdomen, gluteal area, volar aspect of
forearm
 Differentiate petechiae from erythema
 Pressure causes erythema to blanch but no
change in skin if petechiae or bruising

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11
Q

How are benign and malignant skin lesions different in terms of shape?

A

Benign: Symmetric
Malignant: Asymmteric

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12
Q

How are benign and malignant skin lesions different in terms of borders?

A

Benign: Distinct/smooth
Malignant: Indistinct/irregular

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13
Q

How are benign and malignant skin lesions different in terms of color?

A

Benign: Uniform
Malignant: Varied/black

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14
Q

How are benign and malignant skin lesions different in terms of size?

A

Benign: < 6 mm
Malignant: > 6 mm

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15
Q

How are benign and malignant skin lesions different in terms of consistency?

A

Benign: Soft to firm
Malignant: Firm to hard

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16
Q

How are benign and malignant skin lesions different in terms of friability?

A

Benign: None
Malignant: Often

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17
Q

How are benign and malignant skin lesions different in terms of ulceration?

A

Benign: Seldom
Malignant: Often

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18
Q

How are benign and malignant skin lesions different in terms of mobility?

A

Benign: Mobile
Malignant: Mobile or non-mobile

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19
Q

How are benign and malignant skin lesions different in terms of rate of change?

A

Benign: Slow
Malignant: Slow or rapid

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20
Q

Which aspects of skin lesions are most important?

A

 Irregular borders more important than size
 Spot of blood may be basal or squamous
cell

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21
Q

Describe a spider angioma

A

fiery red, radiating “legs”; small up to 2 mm; associated with liver disease,
pregnancy, estrogen therapy

22
Q

Describe a cherry angioma

A

fiery red, round, smooth borders; small up 3 mm

23
Q

Describe a xanthoma

A 
Benign fatty fibrous yellow plaques or nodules in
subcutaneous layer; intracellular accumulation of
cholesterol
 Occur with:
 Aging
 Disorders of lipid metabolism:
 primary biliary cirrhosis
 uncontrolled diabetes
 May occur with leukemia, lymphoma, or
myeloma
24
Q

What are the risk factors for melanoma?

A 
 Prolonged sun exposure
 Pre-malignant skin lesions
 Family history
 Previous history of melanoma
 Caucasian – fair skin, blond hair, red hair,
blue eyes
25
Q

What are the risk factors for basal cell carcinoma?

A 
 Family history
 Immunosuppression
 Prolonged sun exposure
 Characteristics – depressed center
surrounded by raised, firm border
26
Q

What are the risk factors for squamous cell carcinoma?

A 
 Prolonged sun exposure
 Pre-malignant skin lesions
 Radiation therapy
 Local exposure to tar and oil
 Characteristics – scaling, crusty nodules or
plaques
27
Q

What follow-up questions should be asked if a concerning skin lesion is found?

A 
 Is patient aware of it?
 Any associated signs and symptoms?
 How long present?
 Has it changed?
 Is doctor aware? Has doctor seen it?
28
Q

What are Terry’s nails?

A

Nail bed is white for more than 2/3 of its length

Common with cirrhosis and hypoalbuminea

29
Q

What is Spoon nail?

A

Refers to a concavity in the fingernail itself, resulting in a depression in the nail that gives an appearance of a spoon shape to the entire nail. The spooning is typically such that a water droplet may be placed and held in the depression within the nail.

Found in pt’s with iron deficiency

30
Q

What condition is relatively common if nail bed pitting is observed?

A

Psoriasis - found in 50% of these pt’s

31
Q

What are Mee’s lines?

A

A white discoloration of the nail plate that form transverse lines across the nail.

Found in patients after arsenic poisoning, also found in renal failure, heart disease, pneumonia

32
Q

What are half-and-half nails?

A

White proximal portion with a brownish distal portion, the latter being more than one third of the nail plate.

Indicates chronic renal failure

33
Q

What does the term clubbing mean with respect to nail inspection?

A

Broadening of the distal appendage with an increased Lovibond’s angle

34
Q

What are Beau’s lines?

A

Transverse depressions in the nail

Found in pt’s with a severe systemic issue - high fever, infection, renal disease, hepatic disease

35
Q

What are key facts to remember when examining lymph nodes?

A

 Normally not visible or easily palpable (pea
size)
 Enlarged >1 cm due to: Infections, allergies, viruses, allergies, THA, cancer
 Hard, immovable, and tender = concern for
cancer
 Palpate lightly

36
Q

What is the appropriate sequence for abdominal exam activities?

A

 Inspect
 Auscultate
 Percuss
 Palpate

37
Q

What would a flat percussive sound indicate?

A

solid, dense tissues like anterior thigh

38
Q

What would a dull percussive sound indicate?

A

solid organs such as liver, heart, diaphragm, spleen

39
Q

What would a resonating percussive sound indicate?

A

lung when clear, dull if congested or mass; hyperresonance with emphysemic lung

40
Q

What would a tympanic percussive sound indicate?

A

gastric bubble, bowel

41
Q

What is the Patellar-pubic percussion test?

A

A form of Osteophony or auscultatory percussion which is used in the assessment of bone integrity by analyzing its vibrations through the use of a stethascope and bony prominence percussion. The patient is positioned in supine and the bell of the stethascope is placed on the pubic symphysis, held in place by the patient. The patient’s legs are positioned symmetrically and extended while the clinician percusses each patella. The clinician stabilizes the patella, insuring that the leg being tested remains in the neutral position. The clinician compares the sounds from each leg for differences in pitch and loudness. These sounds should be equal in the case of normal bony structure. If there is a bony disruption, the affected side will have a duller, more diminished sound when compared to the unaffected side.

42
Q

How useful are the results of a Patellar-pubic percussion test?

A 
High Sp (0.86) and Sn (0.96)
A positive test warrants advanced imaging

Above stats with respect to a study looking for occult femoral neck fx

43
Q

What is the fulcrum test?

A

for femoral shaft stress fractures; pt sitting PT forearm under area of thigh pain, gentle dorsal pressure on distal femur

44
Q

What is the axial percussion test?

A

for compression fracture; finger or reflex hammer tapping of spinous process (except if suspect fracture there)

45
Q

What is asterixis?

A

liver flap; have patient extend arm, spread fingers, extend wrist; positive if hand flaps

46
Q

What is Murphy’s percussion?

A

Direct or indirect, ulnar surface of fist over kidney area; vibration reproduces pain

47
Q

What is Murphy’s sign?

A

Hook fingers around right anterior lower rib cage, patient inspires; exquisite tenderness = possible acute cholecystitis

48
Q

What is Blumberg’s sign?

A

rebound tenderness; palpate deeply and slowly away from suspected area, remove quickly; pain experienced on side of inflammation

49
Q

What is the pinch-an-inch test?

A

Alternate less provocative test; if negative do rebound tenderness

50
Q

What is McBurney’s point?

A

pain from appendicitis or peritonitis; half way between R ASIS & umbilicus; palpated legs straight vs iliopsoas hooklying position; 11th thoracic nerve

51
Q

What are the tests for psoas or obturator abscess from peritonitis

A

 Heel tap – supine, tap heel; positive if
reproduces lower abdominal pain
 Hop test – unable & clutches abdomen
 Iliospoas muscle test – abdominal pain
reproduced w/ hip flexion
 Passive hip extension – abdominal pain
reproduced
 Obturator muscle test – flex hip and knee
rotate hip - abdominal pain reproduced
 Iliopsoas muscle palpation – abdominal pain
reproduced

Differential Diagnosis (5 decks)

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