Practical Exam-Findings Flashcards
What would BMI and Bp show for NAFLD?
BMI: ↑ (central adiposity)
Bp: ↑ due to IR, systemic inflammation + obesity
What would external eye exam show in NAFLD?
Jaundice
Pallor (if liver disease leads to anemia)
What would a skin exam show in NAFLD (4)?
- Spider angiomas
- Signs of portal hypertension → edema, ascites, caput medusae
- Palmar erythema
- Jaundice (eyes + skin)
What would liver percussion + palpation show in NAFLD?
- Hepatomegaly → larger than 12 cm mid-clavicular or 8 cm mid-sternal
- Firmness indicating cirrhosis on palpation
What would a spleen percussion + palpation show in NAFLD?
Splenomegaly → due to portal HTN associated w/ liver fibrosis
Test for ascites in NAFLD?
Ascites due to portal HTN + fluid retention
What would Bp, HR, RR, and WC show in obesity?
- Bp → HTN
- HR → ↑ due to ↑ physiologic demands, potential artherosclerosis
- RR → ↑ due to ↑ physiologic demands
- WC → ↑
What would a skin exam show in obesity (6)?
- Acanthuses Nigerians (IR)
- Striae (stretch marks)
- Acrochordons (skin tags associated w/ IR)
- Edema
- Xanthoma
- Central adiposity
Would would an external eye exam show in obesity?
xanthoma
What would a liver percussion + palpation show in obesity?
Hepatomegaly (due to NAFLD – comorbidity)
What would a heart auscultation show in obesity?
Extra sounds (S3+ S4) due to CV comorbidities
Stenosis + regurgitation due to CV comorbidities
What would a test for ascites show in obesity?
Fluid accumulation due to comorbidities
What would a peripheral edema exam show in obesity?
Edema due to comorbidities such as CHF, venous insuffiency
What would a BP be in someone with diabetes?
elevated - HTN
What would a skin exam show in someone with diabetes (7)?
- Acanthoses nigricans (IR)
- Eruptive xanthomas
- Central adiposity/ weight gain
- Diabetic dermopathy
- Skin tags (IR)
On the feet..
- ulcers
- pre-ulcerative callus/ corn
What would ophthalmoscopic exam show on diabetes (4)?
Diabetic retinopathy:
- micro aneurysms: small swellings attached to vessels
-flame hemorrhages
-hard exudates
-neovascularization
What would a peripheral pulses exam show in diabetes?
Diminished pulses due to PAD (atherosclerosis) or diabetic neuropathy (poor circulation due to nerve damage that control vessel constriction/ dilation)
What would a sensory exam should is diabetes (Ipswich touch test, soft touch, vibration, pain)
Vibration: absence
Ipswich touch test: absence of light touch on 2 or more sites out of 6 = + for diabetic neuropathy
Soft touch, pain: absence
What would a positive external rotation lag test mean?
Supraspinatus + infraspinatus tear
What would a positive internal rotation lag test mean?
Subscapularis tear
What would a positive painful arc test mean?
pain btwn 60-120 → supraspinatus impingement OR rotator cuff tendonitis/ tear
What would a positive drop-arm test mean?
Supraspinatus tear
What would Bp, HR, temp + W:H show in hypothyroidism?
Bp: Diastolic hypertension
HR: Bradycardia
Temp: slightly lower body temperature
W:H: Weight gain (5lbs)
What would a skin exam show in hypothyroidsim (4)?
- Lateral 1/3 eyebrow thinning
- Puffy face/ eyelids
- Skin pallor or yellowing (carotenemia)
- Dry skin
What would a hair + nail exam show in hypothyroidism?
THin brittle nails
Thinning hair/ alopecia
What would a thyroid exam show in hypothyroidism (4)?
Goitre, bogginess, nodules, tenderness
What would DTRs show in hypothyroidism?
Delayed DTRs (grade 1)
What would Bp,HR, RR + temp show in non-organic fatigue?
Bp: mild hypotension
HR: tachycardia
RR: tachypnea
Temp: low grade fever or lower than baseline
looking to rule out infection as a cause of fatigue
What would an oropharyngeal exam show in non-organic fatigue?
Non-exudative pharyngitis
- erythematous posterior pharynx
- grade tonsils to see if swollen
Looking to rule out infection as a cause of fatigue
Cervical + Axillary Lymph node exam for non-organic fatigue?
Lymphadenopathy
Tender lymph nodes
looking to rule out infection as a cause of fatigue
What would an oropharyngeal exam show in insomnia? (rule out 3 conditions)
Use either tonsil grading to see if tonsils enlarged
- grade 3 + 4 have higher risk of obstruction thus insomnia
Or mallampati score class 3 + 4 have higher risk of OSA
Also assess posterior pharynx:
- erythema → evidence of post nasal drip
- ulceration, enamel erosion, cobble stoning → evidence of GERD
Nose (external/ internal) + sinus exam for insomnia?
External:
- asses for deviated septum → any asymmetry
Internal:
- swollen turbinates → rhinitis, allergies, obstruction,
-mucous - can lead to post nasal drip
-polyps, redness of mucous → sinusitis
Sinus:
- if tender → increase suspicion of post nasal drip
Neck circumference in insomnia?
≤ 40cm increases risk of OSA
Lung auscultation in insomnia?
If HF → Fluid/ crackles
Heart auscultation in insomnia?
if HF → Extra heart sounds (S3), regurgitation
Abdominal palpation exam in insomnia?
if IBS → palpation may be sensitive/ tender to touch
if GERD → epigastric pain on palpation
What would BP show in PAD?
hypertension
What would a skin exam show for PAD? (5)
- Cold cool skin
- Presence of foot ulcers, ulcers between toes (kissing ulcers)
- Discolouration (gangrene)
- Rubor
- Distal hair loss + hair loss on toes
What would hair + nail exam show for PAD?
Hair: hair loss on toes + distal ankles
Nails: Dystrophic nail changes → discolouration, hypertrophic nails, splinter hemorrhages
What would a peripheral pulses exam for in PAD?
All will be diminished (carotid, radial, femoral, posterior tibial, dorsalis pedis)
What would auscultation of bruits show in PAD?
if bruits detected → Stenosis/ atherosclerosis (PAD)
What would a sensory exam (soft touch, vibration, pain, show in PAD?
may be absent due to PAD w/ neuropathy
(PAD reduces blood flow can damage nerves)
What would BP, HR + RR show in anemia?
BP: Hypotension
HR: Tachycardia
RR: Tachypnea
What would a skin exam show in anemia?
Pallor: face, skin, palmar, palmar creases (IDA), pallor on tongue
- icterus (hemolytic)
- petechia (aplastic anemia, IDA)
- purpura (aplastic anemia)
- bruising
What would a hair + nail exam show in anemia?
Hair: course, dry hair + evidence of hair loss
Nails: Koiloncyhia (spooning), brittle nails, nail bed pallor (IDA)
What would a nutritional status exam show in anemia?
-Pallor conjunctiva + rim (anterior)
- pallor on nail beds
- pallor on palms
- pallor on oral mucosa + tongue (IDA)
What would BP, Temp, HR + RR show in an UTI?
BP: hypotension (if shock)
Temp: fever
HR: Tachycardia
RR: tachypnea
Abdominal palpation for UTI?
Pain/ tenderness may be felt in lower quad on bladder
