Physical signs Flashcards
1
Q
CVS cyanosis
A
- peripheral vasoconstriction secondary to hypovolemia
- inadequate oxygenation of blood (R-L shunt)
2
Q
CVS SOB
A
CHF
Pericarditis
Pneumonia
PE
3
Q
CVS pallor
A
anemia (hemorrhage, chronic disease) Poor perfusion (CHF)
4
Q
CVS malar flush
A
mitral stenosis
5
Q
CVS edema
A
Pedal or ascites
CHF
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)
7
Q
Clubbing CVS
A
congenital cyanotic heart disease
infective endocarditis
atrial myxoma
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
9
Q
Splinter hemorrhages
A
trauma infective endocarditis sepsis vasculitis psoriatic nail
10
Q
CVS Cold hands
A
poor perfusion
CCF, ACS
11
Q
CVS Cool/clammy hands
A
ACS
12
Q
Long cap refill CVS
A
hypovolemia
CHF
13
Q
CVS radio-radial delay causes
A
subclavian artery stenosis (compression)
aortic dissection
aortic coarctation
14
Q
Collapsing pulse causes
A
normal (fever, preg) cardiac lesion (aortic regurg, patent ductus arteriosus) high output (anemia, av fistula, thyrotoxicosis)
15
Q
Slow rising brachial pulse
A
aortic stenosis
16
Q
bounding brachial pulse
A
aortic regurg
CO2 retention
17
Q
thready brachial pulse
A
intravascular hypovolemia (eg sepsis)
18
Q
Narrow pulse pressure
A
less than 25mhg between sys/dia –> aortic stenosis, CHF, cardiac tamponade
19
Q
wide pulse pressure
A
over 100mmhg between sys/dia –> aortic regurg, aortic dissection
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)
21
Q
Positive hepatojugular reflex
A
constrictive pericarditis
RVF
LVF
restrictive cardiomyopathy
22
Q
corneal arcus
A
grey/blue ring around cornea
benign, but under 50 hypercholesterolemia
23
Q
xanthelasma
A
yellow cholesterol deposts
24
Q
Kayser Fleischer rings
A
around iris, in Wilson’s
Can cause cardiomyopathy
25
central cyanosis
r to l cardiac shunt
26
angular stomatitis
iron deficiency
27
high arched palate
marfans - mitral/aortic prolapse, aortic dissection
28
poor dentition
infective endo
29
pectus excavatum
sunken
30
pectus carinatum
protruding
31
CVS visible pulsation
ventricular hypertrophy
32
median sternotomy
midline
cardiac valve replacement
CABG
33
anterolateral thoracotomy
between lateral border of sternum and mid ax line
| minimally invasive valve surgery
34
infraclavicular scar
pacemaker
35
lef mid ax scar
subcutaneous implantable cardioverter defibrillator
36
parasternal heave
RV hypertrophy
37
Thrill
palpable murmur
38
aortic stenosis
ejection systolic
| hold breath - carotid rad
39
aortic regurg
early diastolic
| sit forward
40
mitral regurg
left leaning diaphragm
expiratory pansystolic murmur
radiate to axilla
41
mitral stenosis
left leaning bell
| espiratory mid diastolic
42
Stethoscope bell
low freq sounds
43
CVS coarse crackles
pulm edema (LVF)
44
CVS absent air entry, dullness to percuss
pleural effusion - LVF
45
CVS sacral/pedal edema
RVF
46
CVS extra tests
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
CN 1
olfactory
48
CN 2
optic
49
CN 3
oculomotor
50
CN 4
Trochlear
51
CN 5
Trigeminal
52
CN 6
Abducens
53
CN 7
Facial
54
CN 8
Vestibulocochlear
55
CN 9
Glossopharyngeal
56
CN 10
Vagus
57
CN 11
Accessory
58
CN 12
Hypoglossal
59
CN 1 test
olfactory
change in smell?
causes: trauma, genetics, blocked nose, parkinsons, covid
60
CN2 test
```
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
relative afferent defect
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
Causes of relative afferent pupil defect
retinal artery or vein occlision
retinal detachment
optic neuropathy: optic neuritis, glaucoma
comprssion from tumour or abscess
63
Colour vision deficiency causes
optic neuritis
vit A defieicnec
chronic solvetn exposure
64
CN 3/4/6 test
Oculomotor, trochlear, abducens
Ptosis - eyelids
Eye movements (double H)
Strabismus (light in eyes, see if symmetric)
65
CN 5 test
Sensation @ 3 points (opthalmic, maxillary, mandibular)
Motor (temporalis, masseter)
Open against resistance - lateral pterygoid muscle
Jaw reflex, corneal reflex
66
CN 7 test
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
Causes of reduced acuity
```
Refractive errors
Amblyopia
Ocular media opacities (cataract, corneal scar)
Retinal disease (macular degen)
CN2 pathology (optic neuritis)
Lesions in visual pathway
```
68
Bitemporal hemianopia
loss of both temporal fields --> central tunnel vision.
| Optic chiasm compression by tumour (pit adenoma, craniopharyngoma)
69
Homonymous field defects
same side of visual field in each eye - often a stroke, tumour, abscess
Hemi or quadrantanopia
70
Scotoma
```
area of absent/reduced vision
Demyelinating disease (MS), diabetic maculopathy
```
71
Monocular vision loss
anterior ischemic optic neuropathy, ocular disease (central retinal artery occlusion, retinal detachment)
72
Causes of ptosis
occulomotor nerve palsy
Horners
Neuromuscular pathology (MG)
73
Superior rectus
elevation
| adduction + medial rotation
74
Inferior rectus
Depression
| adduction + lateral rotation
75
Medial rectus
addcuction
76
Lateral rectus
abduction
77
Superior oblique
depress, abduct, medially rotate
78
Inferior oblique
elevate, abduct, laterally rotate
79
CN 3 palsy
down and out eye
Ptosis, mydriasis
(superior oblique and lat rec)
80
CN 5 palsy
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
CN 6 palsy
Convergent squint from unopposed adduction of eye
Horizontal diplopia worsened by trying to look towards affected side
(lat rect)
82
Cover test: @ rest eye is lateral, shifts medially
exotropia
83
Cover test: @ rest eye is medial, shifts lateral
esotropia
84
Cover test: @ rest eye is superior, shifts inferior
Hypertropia
85
Cover test: @ rest eye is inferior, shifts superior
hypotropia
86
CN 7 palsy LMN
weakness all ipsilateral muscles of expression
| Bell's palsy
87
CN 7 palsy UMN
unilateral facial muscle weakness, upper spared because of bilateral cortical representation
Stroke
88
CN 8 test
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
Rinne test
512 Hz Mastroid --> front
Normal: air>bone (+ve)
Sensorineural: air>bone (cuz both reduced equally)
Conductive: bone>air
90
Webber test
512Hz Forehead
Norm: equal in both ears
Sensori: louder on intact ear
Conductive: louder on affected ear
91
Conductive hearing loss
sound cant transfer between outer ear to middle ear
| Ear wax, otitis externa/media, perforated TM, otosclerosis
92
Sensorineural hearing loss
Dysfunction in cochlea or vestibulocochlear nerve
| Presbycusis, excessive noise exposure, genetic mutations, viral infx, ototoxic meds
93
CN 9/10 test
```
Glossopharyngeal/Vagus
Swallow, voice, cough?
Inspect palate + uvula
Uvula deviates away (10 lesion)
"Ahh"
Cough (vagus)
Swallow assess
Gag reflex
```
94
Glossopharyngeal nerve function
stylopharyngeus muscle to elevate pharynx
taste post 1/3 tongue
Gag aff
95
Vagus n. function
motor og mouth muscles, gag eff
96
CN 11 test
Accessory
Wasting?
Shrug
Turn head
97
CN 11 fucntion
sternocleidomastoid and trapezius motor
98
CN 12 function
extrinsic muscles of tongue
99
CN 12 test
Open mouth - tongue wasting/fasiculations
Stick out - deviates towards lesion
Puff cheeks - push against
100
CN exam further Ix
upper and lower limb
Neuroimaging
Hearing assess
101
CN 2 function
sensory visual information
102
CN 3/4/6 functions
Motor to extraocular muscles, eyelid function, pupil constriction
103
Hernia ex: Abdo distension
obstruction secondary to incarcerated hernia
104
Hernia ex: pallor
underlying anemia from GI bleed or malignancy
105
Hernia ex: cachexia
malignancy (pancreatic/bowel/stomach), liver fail
106
Hernia ex: bruit on aus
AV malformation
107
Hernia ex: can get above
scrotal mass
108
Hernia ex: transilluminated
hydrocele
109
inguinal hernia location
above, medial to pubic tubercle
110
femoral hernia location
below and lateral, below inguinal ligament, through femoral canal
111
Deep inguinal ring location
midway ASIS and pub tub
112
Indirect hernia comes through
deep inguinal ring through to superficial
113
direct inguinal hernia comes through
defect in posterior wall
114
Hernia exam
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)
