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My notes - med > Physical signs > Flashcards

Physical signs Flashcards

1
Q

CVS cyanosis

A
  • peripheral vasoconstriction secondary to hypovolemia

- inadequate oxygenation of blood (R-L shunt)

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2
Q

CVS SOB

A

CHF
Pericarditis
Pneumonia
PE

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3
Q

CVS pallor

A 
anemia (hemorrhage, chronic disease)
Poor perfusion (CHF)
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4
Q

CVS malar flush

A

mitral stenosis

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5
Q

CVS edema

A

Pedal or ascites

CHF

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6
Q

CVS hands

A

Colour (pallor CHF, cyanosis hypoxemia)
Tar staining (smoking–> CAD, HTN)
Xanthomata (cholesterol deposits in palm, tendons, wrists, elbows–> hyperlipidemia)
Arachnodactyly (Marfans–> mitral/aortic valve prolapse, aortic dissection)

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7
Q

Clubbing CVS

A

congenital cyanotic heart disease
infective endocarditis
atrial myxoma

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8
Q

endocarditis hands

A

splinter hemorrhages
janeway lesions - nontender hemorrhagic lesions on palms and soles
oslers nodes - purple raised tender lumps w pale centre on fingers/toes

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9
Q

Splinter hemorrhages

A 
trauma
infective endocarditis
sepsis
vasculitis
psoriatic nail
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10
Q

CVS Cold hands

A

poor perfusion

CCF, ACS

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11
Q

CVS Cool/clammy hands

A

ACS

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12
Q

Long cap refill CVS

A

hypovolemia

CHF

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13
Q

CVS radio-radial delay causes

A

subclavian artery stenosis (compression)
aortic dissection
aortic coarctation

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14
Q

Collapsing pulse causes

A 
normal (fever, preg)
cardiac lesion (aortic regurg, patent ductus arteriosus)
high output (anemia, av fistula, thyrotoxicosis)
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15
Q

Slow rising brachial pulse

A

aortic stenosis

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16
Q

bounding brachial pulse

A

aortic regurg

CO2 retention

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17
Q

thready brachial pulse

A

intravascular hypovolemia (eg sepsis)

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18
Q

Narrow pulse pressure

A

less than 25mhg between sys/dia –> aortic stenosis, CHF, cardiac tamponade

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19
Q

wide pulse pressure

A

over 100mmhg between sys/dia –> aortic regurg, aortic dissection

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20
Q

Raised JVP

A

raised r atrial pressure
venous HTN
- R sided HF (pulm HTN from COPD or ILD)
- tricuspid regurg (infective endo, rheumatic heart)
- constrictive pericarditis (idiopathic, RA, TB)

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21
Q

Positive hepatojugular reflex

A

constrictive pericarditis
RVF
LVF
restrictive cardiomyopathy

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22
Q

corneal arcus

A

grey/blue ring around cornea

benign, but under 50 hypercholesterolemia

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23
Q

xanthelasma

A

yellow cholesterol deposts

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24
Q

Kayser Fleischer rings

A

around iris, in Wilson’s

Can cause cardiomyopathy

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25
Q

central cyanosis

A

r to l cardiac shunt

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26
Q

angular stomatitis

A

iron deficiency

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27
Q

high arched palate

A

marfans - mitral/aortic prolapse, aortic dissection

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28
Q

poor dentition

A

infective endo

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29
Q

pectus excavatum

A

sunken

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30
Q

pectus carinatum

A

protruding

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31
Q

CVS visible pulsation

A

ventricular hypertrophy

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32
Q

median sternotomy

A

midline
cardiac valve replacement
CABG

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33
Q

anterolateral thoracotomy

A

between lateral border of sternum and mid ax line

minimally invasive valve surgery

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34
Q

infraclavicular scar

A

pacemaker

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35
Q

lef mid ax scar

A

subcutaneous implantable cardioverter defibrillator

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36
Q

parasternal heave

A

RV hypertrophy

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37
Q

Thrill

A

palpable murmur

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38
Q

aortic stenosis

A

ejection systolic

hold breath - carotid rad

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39
Q

aortic regurg

A

early diastolic

sit forward

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40
Q

mitral regurg

A

left leaning diaphragm
expiratory pansystolic murmur
radiate to axilla

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41
Q

mitral stenosis

A

left leaning bell

espiratory mid diastolic

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42
Q

Stethoscope bell

A

low freq sounds

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43
Q

CVS coarse crackles

A

pulm edema (LVF)

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44
Q

CVS absent air entry, dullness to percuss

A

pleural effusion - LVF

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45
Q

CVS sacral/pedal edema

A

RVF

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46
Q

CVS extra tests

A

BP (HTN, discrepancies in arms indicating aortic dissection)
Periph vasc (PVD)
ECG (arrhythmia, MI)
Urine (proteinuria, hematuria from HTN)
Blood gluc (DM - rf for CVD)
Fundoscopy (malignant HTN for papillodema)

47
Q

CN 1

A

olfactory

48
Q

CN 2

A

optic

49
Q

CN 3

A

oculomotor

50
Q

CN 4

A

Trochlear

51
Q

CN 5

A

Trigeminal

52
Q

CN 6

A

Abducens

53
Q

CN 7

A

Facial

54
Q

CN 8

A

Vestibulocochlear

55
Q

CN 9

A

Glossopharyngeal

56
Q

CN 10

A

Vagus

57
Q

CN 11

A

Accessory

58
Q

CN 12

A

Hypoglossal

59
Q

CN 1 test

A

olfactory
change in smell?
causes: trauma, genetics, blocked nose, parkinsons, covid

60
Q

CN2 test

A 
Optic N
Pupil: size/shape/symmetry
- palsy's horners
-Sight
-Acuity: snellen (refractive error, cataracts, amblyopia, optic neuritis )
Pupil reflexes: direct (afferent ipsi), consensual (efferent contra), swing (relative afferent), accommodation
Colour vision
-Feilds - come in w finger
Blind spot
-Fundoscopy
61
Q

relative afferent defect

A

swing light, marcus gunn
Both pupils constrict less when light shone into affected eye compared to healthy eye, will look like they dilate when light hits affected eye

62
Q

Causes of relative afferent pupil defect

A

retinal artery or vein occlision
retinal detachment
optic neuropathy: optic neuritis, glaucoma
comprssion from tumour or abscess

63
Q

Colour vision deficiency causes

A

optic neuritis
vit A defieicnec
chronic solvetn exposure

64
Q

CN 3/4/6 test

A

Oculomotor, trochlear, abducens
Ptosis - eyelids
Eye movements (double H)
Strabismus (light in eyes, see if symmetric)

65
Q

CN 5 test

A

Sensation @ 3 points (opthalmic, maxillary, mandibular)
Motor (temporalis, masseter)
Open against resistance - lateral pterygoid muscle
Jaw reflex, corneal reflex

66
Q

CN 7 test

A

Facial
Taste, hearing changes
Inspect: forehead wrinkles, nasolabial folds, angles of mouth
Raise eyebrows (frontalis)
Close eyes (orbicular oculi)
Blow cheeks (orbicularis oris)
Smile (levator anguli oris, zygomaticus major)
Purse lips (orbicularis oris, buccinator)

67
Q

Causes of reduced acuity

A 
Refractive errors
Amblyopia
Ocular media opacities (cataract, corneal scar)
Retinal disease (macular degen)
CN2 pathology (optic neuritis)
Lesions in visual pathway
68
Q

Bitemporal hemianopia

A

loss of both temporal fields –> central tunnel vision.

Optic chiasm compression by tumour (pit adenoma, craniopharyngoma)

69
Q

Homonymous field defects

A

same side of visual field in each eye - often a stroke, tumour, abscess
Hemi or quadrantanopia

70
Q

Scotoma

A 
area of absent/reduced vision
Demyelinating disease (MS), diabetic maculopathy
71
Q

Monocular vision loss

A

anterior ischemic optic neuropathy, ocular disease (central retinal artery occlusion, retinal detachment)

72
Q

Causes of ptosis

A

occulomotor nerve palsy
Horners
Neuromuscular pathology (MG)

73
Q

Superior rectus

A

elevation

adduction + medial rotation

74
Q

Inferior rectus

A

Depression

adduction + lateral rotation

75
Q

Medial rectus

A

addcuction

76
Q

Lateral rectus

A

abduction

77
Q

Superior oblique

A

depress, abduct, medially rotate

78
Q

Inferior oblique

A

elevate, abduct, laterally rotate

79
Q

CN 3 palsy

A

down and out eye
Ptosis, mydriasis
(superior oblique and lat rec)

80
Q

CN 5 palsy

A

vertical diplopia when looking inferiorly - tild head forward and tuck chin in.
Tilt head to opposite side of affected lesion to fuse image together
(sup oblique)

81
Q

CN 6 palsy

A

Convergent squint from unopposed adduction of eye
Horizontal diplopia worsened by trying to look towards affected side
(lat rect)

82
Q

Cover test: @ rest eye is lateral, shifts medially

A

exotropia

83
Q

Cover test: @ rest eye is medial, shifts lateral

A

esotropia

84
Q

Cover test: @ rest eye is superior, shifts inferior

A

Hypertropia

85
Q

Cover test: @ rest eye is inferior, shifts superior

A

hypotropia

86
Q

CN 7 palsy LMN

A

weakness all ipsilateral muscles of expression

Bell’s palsy

87
Q

CN 7 palsy UMN

A

unilateral facial muscle weakness, upper spared because of bilateral cortical representation
Stroke

88
Q

CN 8 test

A

Vestibulocochlear
Change in hearing?
Whisper 3 things from 60cm, cover non tested ear w tragus rub, close eyes
Rinne
Webber
Could also do turning test (march on spot w eyes closed, will rotate towards lesion) and head thrust test (sit, have them look at nose, quickly turn head to R/L, should be able to keep eyes on nose)

89
Q

Rinne test

A

512 Hz Mastroid –> front
Normal: air>bone (+ve)
Sensorineural: air>bone (cuz both reduced equally)
Conductive: bone>air

90
Q

Webber test

A

512Hz Forehead
Norm: equal in both ears
Sensori: louder on intact ear
Conductive: louder on affected ear

91
Q

Conductive hearing loss

A

sound cant transfer between outer ear to middle ear

Ear wax, otitis externa/media, perforated TM, otosclerosis

92
Q

Sensorineural hearing loss

A

Dysfunction in cochlea or vestibulocochlear nerve

Presbycusis, excessive noise exposure, genetic mutations, viral infx, ototoxic meds

93
Q

CN 9/10 test

A 
Glossopharyngeal/Vagus
Swallow, voice, cough?
Inspect palate + uvula
Uvula deviates away (10 lesion)
"Ahh"
Cough (vagus)
Swallow assess
Gag reflex
94
Q

Glossopharyngeal nerve function

A

stylopharyngeus muscle to elevate pharynx
taste post 1/3 tongue
Gag aff

95
Q

Vagus n. function

A

motor og mouth muscles, gag eff

96
Q

CN 11 test

A

Accessory
Wasting?
Shrug
Turn head

97
Q

CN 11 fucntion

A

sternocleidomastoid and trapezius motor

98
Q

CN 12 function

A

extrinsic muscles of tongue

99
Q

CN 12 test

A

Open mouth - tongue wasting/fasiculations
Stick out - deviates towards lesion
Puff cheeks - push against

100
Q

CN exam further Ix

A

upper and lower limb
Neuroimaging
Hearing assess

101
Q

CN 2 function

A

sensory visual information

102
Q

CN 3/4/6 functions

A

Motor to extraocular muscles, eyelid function, pupil constriction

103
Q

Hernia ex: Abdo distension

A

obstruction secondary to incarcerated hernia

104
Q

Hernia ex: pallor

A

underlying anemia from GI bleed or malignancy

105
Q

Hernia ex: cachexia

A

malignancy (pancreatic/bowel/stomach), liver fail

106
Q

Hernia ex: bruit on aus

A

AV malformation

107
Q

Hernia ex: can get above

A

scrotal mass

108
Q

Hernia ex: transilluminated

A

hydrocele

109
Q

inguinal hernia location

A

above, medial to pubic tubercle

110
Q

femoral hernia location

A

below and lateral, below inguinal ligament, through femoral canal

111
Q

Deep inguinal ring location

A

midway ASIS and pub tub

112
Q

Indirect hernia comes through

A

deep inguinal ring through to superficial

113
Q

direct inguinal hernia comes through

A

defect in posterior wall

114
Q

Hernia exam

A

1: intro etxc
2: Gen inspect (Pain, scars, pallor, distension, cachex, hernia)
3: objects (stoma, drains, mobility)
4: standing - overlying skin, hair, size/site/shape/swell/scars/genitals
5: cough - impulse?
6: palp - temp @ thighs/hernia, scrotum, reduce
7: lie down, palp deep ring, cough (impulse), remove hand cough again (bulge = indirect)
8: further: testicular exam, abdo exam, LN assess, DRE, imaging (US/CT)

My notes - med (14 decks)

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