Quiz 2 Flashcards
What are normal findings with aging?
Increased pore size, thin head hair, thick eyebrows, loose skin, reduced taste, skin thinning, diminished hearing. Sensory changes are not normal.
Normal sensory changes include presbyopia, decreased pupil size, yellowing of the lens, and diminished hearing.
What are common abnormal findings with aging?
- Cataracts
- Macular degeneration
- Glaucoma
- Significant hearing loss
- Cognitive decline
- Osteoporosis
- Frailty
These conditions are often observed in older adults.
What are the symptoms of a migraine headache?
- Aura
- Photosensitivity
- Nausea and vomiting
- Unilateral, throbbing pain
- Photophobia
- Phonophobia
Migraines can be debilitating and often require specific treatment.
What are the characteristics of a tension headache?
- Bilateral
- Band-like pressure
- No nausea
- No aura
Tension headaches are the most common type of primary headache.
What distinguishes a cluster headache?
- Unilateral
- Severe, stabbing pain around the eye
- Autonomic symptoms (tearing, rhinorrhea)
- Intense pain behind the eye
autonomic symptoms(tearing, rhinorrhea)
Cluster headaches occur in cyclical patterns or clusters.
What is PERRLA and how is it assessed?
PERRLA = Pupils Equal, Round, Reactive to Light and Accommodation.
Penlight, one eye at a time
Assessment involves checking direct and consensual light reflex and testing accommodation.
What is the expected result when assessing PERRLA?
Symmetric, round pupils that react briskly to light and constrict when focusing on a near object.
This assessment is crucial in neurological examinations.
Test for accommodation
move object closer to the eyes to test for accommodation, pupils should constrict
How is near vision assessed?
Using a handheld Jaeger card or Rosenbaum at 14 inches; normal = 14/14.
Near vision testing is important in detecting presbyopia.
How is far vision assessed?
Using a Snellen or Sloan chart at 20 feet; normal = 20/20.
This is essential for identifying myopia or hyperopia.
Myopia
Nearsightedness
Hyperopia
Farsightedness
Peripheral Vision
Confrontation Test
What is the proper technique for using an ophthalmoscope?
Do not touch the nose; look over patient’s shoulder, same height, focus on the red reflex.
This aids in assessing the retina and optic disc.
Using the Ophthalmoscope
1-Darken the room
2-Set lens to 0 diopters
3-Approach at 15 degree angle, focusing on red reflex
4-Move closer to visualize the retina,, option disc, and blood vessels
What is strabismus?
Misalignment of the eyes (esotropia, exotropia); seen in babies/children.
It can lead to amblyopia if not treated.
What is pseudostrabismus?
False appearance of strabismus due to a wide nasal bridge but normal alignment. Asian/Native Americans
Common in certain ethnic groups.
What does cobblestoning indicate?
Bumpy lymphoid tissue in the posterior pharynx, indicating allergies or infection.
Eye-conjunctivitis
It can also be associated with conjunctivitis.
What is the Weber test used for?
To assess lateralization of sound using a tuning fork on the forehead.
Normal-sound heard equally in both ears
Conductive loss
Normal findings show sound heard equally in both ears.
What are the normal findings for the Rinne test?
Air conduction > bone conduction
Conductive loss- sound cannot reach innner ear.
This test helps differentiate between conductive and sensorineural hearing loss.
What is the grading scale for tonsils?
- 0: Tonsils removed
- 1+: Normal, within pillars
- 2+: Enlarged, beyond pillars
- 3+: Nearly touching uvula
- 4+: Touching each other (kissing tonsils)
Tonsil grading is important in assessing tonsillar hypertrophy.
What are symptoms of tympanic membrane (TM) rupture?
- Tinnitus
- Ear pain
- Hearing loss
- Bleeding
- Sudden ear pain relief
- Possible otorrhea
Signs include perforation in TM and possible discharge.
What are symptoms of obstruction above the glottis?
Supraglottic
- Stridor
- Difficulty swallowing
- Voice changes
Stridor is quieter in supraglottic obstruction.
What are symptoms of obstruction below the glottis?
Subglottic
- Wheezing
- Dyspnea
- Prolonged expiration
Stridor is louder in subglottic obstruction.
What is the normal respiratory rate to heart rate ratio?
1:4 (one breath for every four heartbeats).
This ratio is a good indicator of respiratory health.
What is the technique for performing percussion on the thorax?
Use the non-dominant middle finger on the chest wall and tap with the dominant finger.
Normal sound is resonant; abnormal sounds include hyperresonance and dullness.
Abnormal sounds - Pecussion thorax
Hyperresonance - Emphysema, pneumothorax
Dullness - Pleural effusion, pneumonia, tumor, atelectasis
Risks for cataract development
Aging
smoking
HTN
obesity
UV exposure
diabetes
corticosteroid use
trauma
indicators of Hypertensive Retinopathy During Eye Exam
AV Nicking (anteriovenous nicking)
cotton wool spots
obstruction
dysedema
hemorrhages
papilledema in severe cases
Evaluation of hearing in pediatrics
4-6 months can turn head to sound
use bell
whisper
Nasal exam findings - Allergies
Pale, boggy, swollen turbinates, clear discharge, sinus colored discharge
Nasal exam findings Drug Abuse (Cocaine)
Septal perforation, irritation, crusting, red swollen, rhinorrhea, nose bleeds
Nasal exam findings: Infections
Erythematous turbinates, purulent discharge
What is the sequence of the physical exam for adults?
Inspect → Palpate → Percuss → Auscultate.
This sequence helps in systematic evaluation.
What are the age-related changes in older adults regarding respiratory function?
- Decreased lung compliance
- Increased AP diameter
- Reduced vital capacity
- Increased residual volume
- Weak cough reflex
- Increased risk of pneumonia
Understanding these changes is crucial for managing respiratory health in the elderly.
What are some causes of bradypnea?
- Opioid overdose
- Brainstem injury
- Hypothyroidism
- Increased intracranial pressure
Bradypnea is defined as <12 breaths/min.
What are some causes of tachypnea?
- Anxiety
- Fever
- Pneumonia
- Sepsis
- Metabolic acidosis
- Pulmonary embolism
Tachypnea is defined as >20 breaths/min.
What is tactile fremitus?
Palpable vibrations transmitted through the lung fields during speech.
It is assessed by asking the patient to say ‘99’ or ‘blue moon.’
What does bronchophony assess?
Increased clarity of sound indicates consolidation (e.g., pneumonia).
Ask patient to say “99”
Normal - muffled sound
Normal findings show muffled sounds.
How to assess whispered pectoriloquy
Whisper 1-2-3
Normal faint or absent sound
Abnormal clearer whispers (consolidation)
What is egophony and how to assess
Ask patient to say ‘EEE”
Normal - EEE heard
Abnormal “EEE” sounds like “AAA” (pneumonia)
How do you differentiate crackles from rhonchi?
Crackles are discontinuous and popping;
Rhonchi are low-pitched and snoring, clear with cough,
Crackles are heard more during inspiration, while rhonchi are heard more during expiration.
What is the significance of a heave in a cardiovascular exam?
A forceful impulse felt on the chest wall, suggesting ventricular hypertrophy.
abnormally large heartbeat
left sternal border
Left-sided heaves indicate left ventricular hypertrophy, while right-sided heaves indicate right ventricular hypertrophy.
What is the significance of jugular venous distension (JVD)?
Indicates increased central venous pressure (CVP) suggesting right heart dysfunction or fluid overload.
Causes right sided heart failure
Common causes include right-sided heart failure and tricuspid regurgitation.
What are the symptoms of Raynaud’s disease?
Resolves on own and often seen in middle aged women
Triphasic color change (white → blue → red), triggered by cold or stress.
It is more commonly seen in middle-aged women.
What are the grading categories for murmurs?
- Grade I: Very faint
- Grade II: Faint but heard immediately
- Grade III: Moderately loud
- Grade IV: Loud with a palpable thrill*
- Grade V: Very loud, heard with the edge of the stethoscope
- Grade VI: Heard without a stethoscope directly on the chest
Grading helps in assessing the severity of heart murmurs.
What is the normal jugular venous pressure (JVP)?
Normal: 6-8 cm above the sternal angle with the patient at 45 degrees.
Basic causes - edema, heat failure, pregnancy
JVP is an important indicator of central venous pressure.
What are common causes of edema?
- Cardiac (heart failure) – Bilateral, pitting
- Hepatic (cirrhosis) – Ascites, lower extremity edema
- Renal (nephrotic syndrome) – Generalized, periorbital swelling
- Lymphatic (lymphedema) – Non-pitting, unilateral, firm
Understanding the type of edema can help in diagnosing underlying conditions.
What does a bruit indicate?
Turbulent blood flow due to narrowing (stenosis) or aneurysm.
Common sites for bruits include carotid and renal arteries.
What are the characteristics of arterial disease?
- Intermittent claudication
- Cool, pale, shiny skin
- Weak or absent pulses
- Ulcers on toes
These features help differentiate arterial from venous disease.
What are the characteristics of venous disease?
- Lower extremity edema
- Warm, erythematous, thickened skin
- Normal pulses
- Ulcers on medial malleolus
This helps distinguish it from arterial disease.
What is Intermittent Claudication?
Pain worse with walking/exercise, relieved by rest.
What are the skin characteristics associated with arterial disease?
Cool, pale, shiny, hair loss.
What are the skin characteristics associated with venous disease?
Warm, erythematous, thickened.
How are pulses affected in arterial disease?
Weak or absent.
How are pulses affected in venous disease?
Normal.
Where do ulcers typically occur in arterial disease?
Toes, pressure points, deep.
Where do ulcers typically occur in venous disease?
Medial malleolus, superficial.
What are the vascular changes during pregnancy?
↑ Blood volume (~50%), ↑ stroke volume, ↓ systemic vascular resistance.
What is a common finding in Tetralogy of Fallot?
Boot-shaped heart on X-ray due to right ventricular hypertrophy.
What causes a Venous Hum in a child?
Turbulent venous blood flow.
What is the significance of a Venous Hum?
Benign, commonly found in healthy children.
What are the key aspects to evaluate when assessing breast lumps?
History, physical exam, diagnostic tests.
Do not perform test around period
What diagnostic tests are used for breast lumps?
- Ultrasound
- Mammogram
- Biopsy
What are the benign causes of breast lumps?
- Fibroadenoma
- Cysts
- Lipomas
- Infections
What are modifiable risk factors for breast cancer?
- Hormone replacement therapy (HRT)
- Nulliparity or late first pregnancy
- Obesity
- Alcohol consumption
- Smoking
What is gynecomastia?
Benign enlargement of male breast tissue.
What are the physiologic causes of gynecomastia?
- Newborns
- Puberty
- Elderly
What is the sequence of a GI physical exam?
- Inspection
- Auscultation
- Percussion
- Palpation
- Special maneuvers
What controls peristalsis in the GI tract?
Autonomic system.
What are signs of bowel obstruction?
Increased bowel sounds: hyperactive, high-pitched, tinkling.
What are subjective findings for colon cancer?
- Smoker
- Hx of polyps
- Bloody stool
- Change in bowel habits
What is the normal size for the liver at the midclavicular line?
6-12 cm.
What is the significance of CVA tenderness?
Pain/tenderness indicates pyelonephritis, nephrolithiasis, kidney infection.
What is the most common congenital GI tract anomaly?
Meckel’s Diverticulum.
What is the average age for menopause?
51 years.
What are the signs of pregnancy?
- Amenorrhea
- Nausea
- Breast tenderness
- Fatigue
What is the first recommendation for a pelvic exam?
First pelvic exam by age 21 unless symptoms warrant earlier evaluation.
What findings on wet mount indicate Trichomonas?
Motile, pear-shaped flagellated protozoa.
What are the findings for bacterial vaginosis on wet mount?
- Clue cells
- Positive whiff test
- Thin gray discharge
What are the risk factors for testicular cancer?
- Age 15-35
- Cryptorchidism
- Family history
- HIV infection
What is the best way to identify an inguinal hernia?
Inspect for bulging in groin when standing or coughing.
What does transillumination of the testes help differentiate?
Fluid-filled vs. solid masses.
What are the symptoms associated with Pyronine’s disease?
- Painful erections
- Curved penis during erection
- Palpable fibrous plaques
What is the purpose of the scratch test for liver size evaluation?
To hear scratch sound on stethoscope in obese patients.
What are abnormal findings with aging
cataracts, macular degeneration, glaucoma, significant hearing loss, cognitive decline, osteoporosis
