Primary Flashcards
Overweight BMI is __-___
25-29.9 BMI (kg/m2)
Underweight BMI is >
<18.5 BMI (kg/m2)
Normal BMI is __-___
18.5-24.9 BMI (kg/m2)
Obese BMI is __-__
30-39.9 BMI (kg/m2)
Extreme obesity is > BMI
> 40 BMI (kg/m2)
Weight circumference of > __inches is associated with an increase risk in DM & CVD who are classified as overweight or obese
> 35 inches (88cm) in females with a BMI 24.9-39.9
Difference between primary and secondary lesion
Primary: result of initial insult (exterior or internal) (e.g., bug bite, papules, vesicles)
Secondary: result from trauma or evolution of primary lesion (e.g., excoriations, fissures, scars, ulcers, crusts, impetigo, lichen simplex chronicus)
ABCDE of skin lesions
Asymetry, Border irregular, Color changes (blue/black), Diameter >6mm, Evolution
Describe the difference between macules and patches
Both are flat, circumcised areas, change in color of skin; macules are <1cm; patches are >1cm (e.g. Pityriasis Versicolor)
Describe the difference between papules, pustules, and vesicles.
Papules: elevated, <1cm, circumscribed, firm
Pustules: same but filled with mucopurulent discharge.
(e.g. acne)
Vesicles are elevated, <1cm, circumscribed, filled w/clear fluid >1cm=bulla (e.g., Herpes Zoster)
Describe plaques
Firm, rough, flat top surface, elevated, >1cm (e.g., psoriasis)
Describe wheals
Wheals are elevated, irregular cutaneous diameter, varying in size; often red and itchy. (e.g., allergic reaction)
Basal cell carcinoma
Raised border, ulcer
Most common type of skin cancer
basal cell carcinoma
How deep is an ulcer?
Dermis and epidermis
Impetigo: s/sx and tx
yellow, honey-crusted lesions usually around mouth. Highly contagious.
Tx: Mupirocin, pens, erythromycin.
Types of psoriasis
plaque. guttate. inverse pustular. erythrodermic psoriatic arthritis
Number one cause of goiter (enlarged, contender thyroid)
Grave’s dz (autoimmune hyperthyroidism)
Single thyroid nodule
usually cyst, benign, but need to consider malignancy
PERRLA stands for…
Pupils Equal, Round and Reactive to Light and Accommodation
Visual fields full by confrontation test
fingers wiggling laterally
Extraocular movements EOM test
6 cardinal directions of gaze
No nystagmus (few beats, but not sustained)
No lid lag
Define Presbyopia
Far-sighted (cannot see things close up–light focuses behind retina)
Define Myopia (20/100)
Near-sighted (cannot see far things far away, light focuses in front of retina)
What might you see with cataracts?
opacity of lens
What might dysconjugate gaze mean? (when eyes don’t follow one another in the same direction–aka lazy eye)
Diseases, injuries, or lesions affecting CNIII, IV, or VI
What might cause nystagmus?
Cerebellar system disorders
Drug toxicity
Vestibular disorders (ears)
What might cause lid lag?
exophthalmos/ hyperthyroidism
What might you see during the eye exam w/HTN?
AV nicking, when the vein appears to stop on either side of artery, or retinal hemorrhages.
What might you see during subarachnoid hemorrhage, trauma or brain mass causing increased ICP–papilledema?
Optic disc margin blurred, bulging physiologic cup.
Conductive hearing loss test results
Rinne test: bone conduction greater than air (air usually greater)
Weber: sound materializes to affected ear
Conductive hearing loss is usually impaired through….
the external or middle ear
e.g., exudate/swelling, perforated eardrum
Sensorineural hearing test results
Rinne test: air conduction greater than bone (normal)
Weber: sound materializes to NORMAL ear
Sensorineural hearing loss results in defect in…
the inner ear due to loud noise, aging or acoustic neuroma
S/sx of squamous cell carcinoma
white patch on side or undersurface of tongue=leukoplakia
+lymph enlargement
S/sx of streptococcal pharyngitis
Tonsils 3+ w/white exudate
Enlarged, tender anterior cervical nodes
Erythematous pharynx
S/sx of allergic rhinitis
pale blue nasal mucosa watery nasal d/c Posterior pharynx Mucoid secretions Cobblestone appearance
Normal lung percussion
Resonant: loud, low pitch, hollow
Normal lung sounds
Vesicular, soft, low pitch, inspiration last longer than expiration. No adventitious sounds
Emphysema exam findings
Percussion: hyperresonance (very loud, low pitch, booming)
Decreased fremitus
Pneumothorax exam findings
Percussion: Tympany (loud, high pitched, drum-like), decreased fremitus
Lobar pneumonia exam findings
Dull: soft-moderate, mod-pitch, thud. Increased fremitus and ego phony (E–> A)
Exam findings in large pleural effusion
Percussion is flat: soft, high-pitch, very dull; decreased fremitus
Normal percussion sound over liver
dull
Normal percussion sound over bone
flat
Crackles, heard during inspiration, may be fine or coarse and heard during…
bronchitis, pneumonia, early heart failure
Rhonchi, low-pitch, loud sound heard on inspiration and expiration due to air passing by thick secretions. May be seen in…
Pneumonia and bronchitis
Wheezes, heard during inspiration and/or expiration during…
Louder during expiration in asthma
Heard during asthma, COPD, or bronchitis.
Louder during expiration in asthma
Pleural Friction rub is dry, grating sound heard during inspiration OR expiration during…
Pneumonia, inflammation, pleurites, tumor.
Exam findings in COPD:
Increased AP diameter, decreased tactile fremitus
exam findings w/tumor in lung
Increased tactile fremitus and egophony
Where is the point of maximal impulse (PMI) best heard/felt?
5th intercostal space (ICS), 7-9 cm lateral to midsternal line
What extra cardiacsound is a normal variation in pregnancy?
S3
S1 is best heard at the…
apex
S2 is best heard at the…
base
S1 indicates the closure of…
closure of tricuspid and mitral valves, the start of systole
S2 indicates the closure of…
pulmonic and aortic valves, the start of diastole
S3 & S4 are best heard over the____ with the ____ of the stethoscope when the patient is supine or _________.
S3 is best heard over the APEX with the BELL of the stethoscope when the patient is supine or left lateral. (low pitch)
S4 may be seen in older adults or….
well trained athletes (due to forceful atrial ejection int distended ventricle)
S3 may be seen in 1______, 2.________, and 3._______-
children, young adults, and pregnant people. (due to rapid ventricular filling)
In pregnancy, one may have a D or S murmur?
Systolic murmur
What kind of murmur might you hear during valvular disease?
Diastolic murmur +/- clicks and snaps
Glandular breast tissue may feel…
bumpy
Only press nipple for d/c if patient reports…
nipple d/c