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Clinical History > Physical exams > Flashcards

Physical exams Flashcards

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1
Q

56 Htz tuning fork on patient forehead

A

Weber test

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2
Q

Weber test

A

tests whether bone conduction lateralizes to either ear

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3
Q

Rinne test

A

bone conduction vs. air conduction

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4
Q

base of tuning fork put over mastoid process until pt can’t hear via bone conduction then without restriking fork–hold 1-2 cm from ear canal until pt can no longer hear fork

A

Rinne test

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5
Q

DDx

A

differential diagnosis–driven by H & P

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6
Q

DDx

A

mental list of diseases

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7
Q

CC

A

chief complain–reason for visit–important along with History of Present Illness

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8
Q

PMH

A

Past Medical History

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9
Q

Tay-Sachs disease

A

1:30 ashkenazi jews carrier–neurodegenerative disorder.

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10
Q

Drives interview

A

CC and recognition of commo signs and symptoms

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11
Q

Prioritizing DDx leads to…

A

Though exercise leading to:

  1. leading hypothesis
  2. active alternative hypotheses
  3. must not miss hypotheses
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12
Q

Assessment for first time visit

A

comprehensive assessment vs focused assessment

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13
Q

focused assessment aka

A

problem-oriented assessment

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14
Q

Restructure pt. history and CC into

A

oral presentation and written record

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15
Q

Identifying Data

A

age, gender, marital status, and occupation

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16
Q

Reliability

A

if relevant at end of interview–reflects quality of information

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17
Q

Chief Complaint(s) CC

A

use pt’s own words

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18
Q

Present Illness

A

pt’s history in chronological order

Onset of problem, setting of development, manifestations, and treatments

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19
Q

Details about each symptom

A
  1. location 2. quality 3. quantity or severity 4. timing (onset, duration, frequency) 5. setting where it occurs 6. aggravating/ relieving factors 7. associated manifestations
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20
Q

Most likely diagnoses explaining the pt’s condition

A

differential diagnosis

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21
Q

tobacco reported in

A

pack-years – 1 pack/day for 12 years = 12-pack-year history

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22
Q

Childhood illness section

A

past history– any and all chronic or acute childhood illnesses

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23
Q

ADLs

A

activities of daily living

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24
Q

Review of system questions

A

General, Skin, HEENT, Neck, Breasts, Respiratory, Cardiovascular, Gastrointestinal, Peripheral Vascular, Urinary, Genital, Musculoskeletal, Psychiatric, Neurologic, Hematologic, Endocrine

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25
Q

weakness is

A

different from fatigue–may indicate neuropathy or myopathy if localized in neuroanatomical pattern

26
Q

recurrent shaking and chills suggest

A

extreme swings in temperature and systemic bacteremia

27
Q

feeling hot and sweating may accompany

A

menopause, tuberculosis, and malignancy

28
Q

weight loss with relatively high food intake suggests

A

diabetes mellitus, hyperthyroidism, or malabsorption–consider bulimia

29
Q

eye exam–outside of eye

A

make sure not yellow from jaundice or red from conjunctivitis

30
Q

observation of back of eye

A

fundescopic exam–turn down lights to dilate pupils–numbers: 0 means no refractive correction. turn light up all the way. Angle scope nasaly to view nerve.

31
Q

fundescopic exam irregularities

A

Optic nerve papiladema–margins of nerve will be blurred–spots of blood surrounding nerve

32
Q

inflate BP cuff initially to

A

180 mm Hg

33
Q

When taking BP listen for

A

1st and last korotkoff sound–record what we hear not what we see– first sound / last sound

34
Q

width of BP cuff bladder should be

A

about 40% of upper arm circumference

35
Q

If cuff is too narrow BP will be read

A

too high

36
Q

if heart rate is normal when taking pulse

A

count rate for 30 seconds

37
Q

If heart rate is unusually fast or slow count for

A

60 seconds

38
Q

normal heart rate/ pulse

A

50-90 bpm

39
Q

short, fine, inconspicuous, and relatively unpigmented hair

A

villus hair

40
Q

course, thick, more conspicuous, pigmented hair–scalp and eyebrows

A

terminal hair

41
Q

Norma angle between lateral nail folds and nail plate

A

less than 180 degrees

42
Q

two types of sweat glands in humans

A

eccrine glands–widely distributed

apocrine glands–axillary and genital

43
Q

Early recognition of possible melanoma

A

Asymmetry
irregular Borders (ragged/notched)
variagation in Color (esp. blue/black w/ white)
Diameter >6 mm
Evolution (in size, symptoms, morphology)

44
Q

80% of skin cancers, consists of immature cells similar to basal layer of epidermis, sun-exposed areas

A

basal cell carcinoma

45
Q

skin cancer consisting of more mature cells usually resembling the spinous layer of epidermis, 16% of cases–crusted lesions with rough surfaces or flat reddish patches with inflamed or ulcerated appearance

A

squamous cell carcinoma

46
Q

4% of skin cancers–potentially most lethal–can spread quickly to lymph system and internal organs

A

melanoma

47
Q

Melanoma Risk model

A 
HARMM
History of melanoma
Age over 50
Regular dermatologist absent
Mole changing
Male gender
48
Q

imp life threatening differential diagnosis of headache

A

meningitis, subarachnoid hemorrhage, mass lesion,

49
Q

indications of diplopia

A

brainstem or cerebellum lesion, weakness/paralysis of one or more extraocular muscles.

50
Q

POAG

A

primary open-angle glaucoma–leading cause of blindness in African Americans and second overall

51
Q

primary open-angel glaucoma

A

gradual loss of vision due to loss of retinal ganglion cell axons–risk factors: AA descent, diabetes, myopia, and ocular hypertension

52
Q

IOP

A

intraocular pressure

53
Q

spasmodic or rhythmic contraction of the pupil

A

hippus–symptom of some neurological conditions

54
Q

something the pt explains abt

A

symptom

55
Q

something the provider observes

A

sign

56
Q

comprehensive encounter vs

A

problem specific encounter

57
Q

ID

A

identifying data

58
Q

everything is driven by the

A

history

59
Q

CC drives

A

physical exam

60
Q

CC + PE + History drives

A

DDx

Clinical History (10 decks)

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