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Internal Disease > Some important signs, tests & terms > Flashcards

Some important signs, tests & terms Flashcards

1
Q

What is the Chelmonski sign?

A

tenderness over non-palpable liver

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2
Q

What is the Goldflam’s sign?

A

kidney tenderness

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3
Q

What are some meningeal signs?

A

neck mobility, Brudzinski’s sign, Kerning’s sign

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4
Q

How can the shape of the chest be?

A

pigeon or barrel

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5
Q

How do you call the place you should percuss for the examination of the spleen?

A

Traube’s space

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6
Q

Name a test and a sign for the examination of the extremities.

A

Trendelenburg test and sign and Homans sign

Trendeleburg SIGN - positive in people with weak or paralyzed abductor muscles of the hip (gluteus medius and gluteus minimus)
Trendeleburg TEST - vascular insufficiency in the lower extremities
Homans sign - sign of deep vein thrombosis

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7
Q

What is Biot’s breathing?

A

Ataxic breathing –> totally irregular, shallow, short, often fast breathing –> subsequent long pauses (intervals), decreased excitation/excitability of respiratory center (brain damage, tumour, cerebral strokes)

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8
Q

What is Cheyne-Stokes’ breathing?

A

respiration –> irregular, short breaths gradually increasing to deep breaths, then reducing gradually (until breath appears to stop)

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9
Q

What is Kussmaul’s breathing?

A

Hyperventilation –> deep and rapid/fast breathing, during severe metabolic acidosis –> (maybe slow and gasping later??)

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10
Q

What are causes for Dwarfism/stunted growth ?

A

Growth hormone deficiency, Turner’s, childhood renal failure, childhood diabetes, childhood hypothyroidism, childhood Cushings, achondroplasia, hypopituitarism

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11
Q

How do you call the two sides of the stethoscope?

A

diaphragm and bell (deep cup-shaped)

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12
Q

What does rapid, deep breathing (Hyperventilation) suggest?

A

anxiety, severe metabolic acidosis (diabetic coma, renal failure) –> Kussmaul’s breathing

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13
Q

What does Cheyne-Stokes’ breathing suggest?

A

Physiologic in children/aging (sleep); heart failure, uraemia, brain damage, drugs –> usually in unconscious patients (disorder of respiratory brain centre)

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14
Q

What does Biot’s breathing (ataxic breathing) suggest?

A

brain damage: hemorrhagic cerebral stroke, brain tumours

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15
Q

What do you need to assess the patients risk for melanoma?

A 
HARMM risk model:
History of previous melanoma 
Age over 50
Regular dermatologist absent 
Mole changing
Male gender
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16
Q

How do you examine melanoma?

A 
ABCD examination:
Asymmetry
irregular Borders
Change in color (black), bleeding, itching
Diameter (>6mm)
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17
Q

What colour is the skin in an erythema?

Name examples when you can find it.

A

red hue –> increased blood flow

Cushings, rosacea

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18
Q

When is the moisture/texture of the skin velvety?

A

in Marfan, Ehler Danlos, hyperthyroidism

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19
Q

Name flat lesions.

A

Macule (Hemangioma)

Patch (Café au lait spots)

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20
Q

Name lesions with palpable elevations (without fluid).

A 
Plaque (Psoriasis)
Papule (Psoriasis)
Nodule (dermatofibroma)
Cyst
Wheal (Urticaria - localised skin edema)
Crust (Impetigo)
Lichenification (hardening from mechanical stress)
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21
Q

Name lesions with palpable elevations with fluid.

A

Vesicle (Herpes)
Bullae (Bite)
Pustule - pus (Acne, small pox)

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22
Q

Name depressed lesions.

A

Erosion
Excoriation
Fissure
Ulcer

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23
Q

Name vascular lesions.

A

Spider angioma (Liver disease, pregnancy)
Spider veins (accompanies increased pressure in superficial veins - varicose veins)
Cherry angioma (old age)
Petechiae/purpura (microbleeding, subcutaneously)
Ecchymosis (secondary to bruising/trauma)

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24
Q

What is atopic eczema/dermatitis?

A

(atopic dermatitis = a type of eczema) chronic inflammatory, relapsing, pruritic skin disorder

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25
Q

What does clubbing of fingers (nails) suggest and when does it occur?

A

hypoxia –> lung diseases/cancer, congestive heart failure

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26
Q

What is Onycholysis and when does it occur?

A

Separation of nail from nail bed –> diabetes, anemia, hyperthyroidism, syphilis

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27
Q

What are Mees’ lines and when do they occur?

A

Transverse white lines on the nails –> arsenic poison, heart failure, CO poisoning

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28
Q

What is cachexia?

A

loss of more than 5 % of body weight over 12 months or less, when not trying to lose weight & have known illness or disease;
other criteria include: loss of muscle strength, decreased appetite, fatigue, inflammation

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29
Q

What is the eye disorder hordreolum/stye?

A

an infection of the gland at the bare of an eyelash

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30
Q

What is the eye disorder avud senilis?

A

white ring around cornea that is normal with age (also in hypercholesterolemia)

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31
Q

What in the nose is examined with Transillumination?

A

maxillary sinus

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32
Q

What does proptosis or exophthalmus suggest?
How should you inspect it?
How does it develop?
What accompanies it?

A

Grave’s disease
Inspect from side
Due to retro-orbital inflammation and lymphocyte infiltration
Conjunctivitis

exophthalmus - a bulging of the eye anteriorly out of the orbit

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33
Q

What is the Graefes sign?

What does it suggest?

A

Lid lag (eye sign) –> inability of upper eyelids to follow eye’s downward movements –> a rim of sclera appears between the upper lid margin

sign of thyrotoxicosis (hyperthyroidism) or exophthalmos

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34
Q

What is Kocher’s sign?

A

Lid retraction (eye sign)

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35
Q

What does an enlarged skull (hydrocephalus) suggest?

A

Paget’s disease

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36
Q

How does the face look like in Cushings?

A

moon face

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37
Q

How does the face look like in Nephrotic syndrome?

A

Periorbital edema, puffy face

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38
Q

How does the face look like in Myxedema?

A

Periorbital edema, puffy face, coarse hair, thin lateral eyebrows

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39
Q

How does the face look like in Parkinson?

A

Parkinsonian stare, decreased facial mobility

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40
Q

What is hirsutism on the skin?

A

condition in women that results in excessive growth of dark or coarse hair in male-like pattern (face, chest & back) –> often from excess male hormones (androgens), primarily testosterone
Symptom of Cushings syndrome

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41
Q

What is Hyperopia of the eyes?

A

farsightedness (can’t see close)

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42
Q

What is Presbyopia of the eyes?

A

ageing vision, farsightedness

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43
Q

What is Myopia of the eyes?

A

nearsightedness (can’t see far)

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44
Q

What is Diplopia of the eyes?

A

double vision

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45
Q

What is Miosis of the pupils?

A

Constriction

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46
Q

What is Mydriasis of the pupils?

A

Dilation

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47
Q

What is Anisocoria of the pupils?

A

asymmetric pupils (>0,5mm) –> benign if pupillary reflex is normal, brain stem lesion

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48
Q

What is Horner’s syndrome?

A

one pupil cannot dilate in the dark (+ ptosis + heterochromia) –> sympathetic fibers

49
Q

What is CN III paralysis?

A

one pupil cannot constrict in light (+ ptosis + lateral deviation) –> parasympathetic fibres

50
Q

What is Argyle-Robertson pupil?

A

Accommodation but NO pupillary reflex –> syphilis!

51
Q

What extra-ocular movements do you look for when doing the “H”-test?

A

(move in H formation to assess vertical & horizontal motion) –> check for nystagmus (repetitive, uncontrolled movements of eyes), CN-palsies

52
Q

What is left homonymous hemianopsia in the visual field?

A

left eyes visual field is impaired –> lesions of right optic tract!

53
Q

What does the Kaiser Fleischer ring of the iris suggest?

A

Wilson disease (ceruloplasmin deficiency –> Cu accumulation)

54
Q

What does the Lisch nodules of the iris suggest?

A

NF (neurofibromatosis)

55
Q

What does the Brushfield spots of the iris suggest?

A

Down’s

56
Q

What does the Arcus senilis (corneal) of the iris suggest?

A

hyperlipoproteinemia, hyperlipidemia

57
Q

What does Xanthelasma (sharply demarcated deposit of cholesterol underneath the skin) on or around the eyelids suggest?

A 
Grave's sign (lid lag) = sign of thyrotoxicosis --> upper lid lags when looking down
Kocher sign (lid retraction) --> upper lid retracts when looking up
58
Q

What does the sensorineural loss with symptoms of hearing loss, tinnitus + vertigo suggest?

A

Meniére’s disease; acoustic schwannoma (benign tumour) –> Neurofibromatosis Type 2 (NF2)

59
Q

Hutchinson teeth are a sign of what disease?

A

congenital syphilis

60
Q

What does the abbreviation GERD stand for?

A

Gastroesophageal reflux disease

61
Q

Name 4 thoracic deformities.

A

kyphosis, funnel chest, pigeon chest, barrel chest (pink puffer or blue bloater)

62
Q

What is kyphosis?

A

hunchback (gibbus) –> excessive backward curvature of thoracic part of back

63
Q

What is funnel chest?

A

pectus excavatum –> congenital, chest depressed in center

64
Q

What is pigeon chest?

A

pectus carinatum –> congenital, protrusion of sternum and ribs

65
Q

What is barrel chest?

A

increased anterior-posterior diameter & diaphragmatic flattening –> can be pink puffer or blue bloater

66
Q

What kind of thoracic deformity is pink puffer and what causes it?

A

barrel chest
can be due to emphysema (irreversible) and severe COPD, respiratory failure, chronic dyspnea –> breathing so fast that get enough oxygen (therefore not blue) but skin looks pink

67
Q

What kind of thoracic deformity is blue bloater and what causes it?

A

barrel chest
chronic bronchitis, (not emphysema!?), in obese people (= “blue and overweight”) –> prevalently in blue-collar workers formed –> one of complications is increased number red-blood cell (to try compensate reduced oxygen levels) which makes blood thicker and can lead to clotting

68
Q

What is the hunchback deformity “gibbus”?

A

structural kyphosis typically in upper lumbar & lower thoracic vertebrae –> one or more adjacent vertebrae become wedged –> in young children as result of spinal tuberculosis and is result of collapse of vertebral bodies

69
Q

When can you and when can you not palpate “Tactile fremitus”?

A

(= vibration of chest wall resulting from sound vibrations created by speech or other vocal sounds –> vocal resonance is its auscultatory counterpart)

  • -> Increased in: pneumonia (inflammation and consolidation (making more solid) create dense medium –> increases transmission lower frequency sounds & vocal fremitus)
  • -> Decreased in: COPD, obstruction, effusion, fibrosis, pneumothorax, tumour, edema (accumulation of air/fluid in potential space between chest wall and lung parenchyma decreases transmission)
70
Q

When do you experience flatness in percussion of the chest?

A

(suggestive of fluid in lungs) –> large pleural effusion, large tumour

71
Q

When do you experience dullness in percussion of the chest?

A

(indicative of abnormal lung density) –> lobar pneumonia, pleural effusion, tumour, fibrosis, edema, atelectasis (collapse or closure of a lung)

72
Q

When do you experience resonance in percussion of the chest?

A

simple chronic bronchitis

73
Q

When do you experience hyperresonance in percussion of the chest?

A

(too much air present within lung tissue) –> emphysema, COPD (generalised), pneumothorax (unilateral)

74
Q

When do you experience tympany in percussion of the chest?

A

(gas-containing cavity produces hollow, high, drum-like sounds) –> large pneumothorax

75
Q

How is the normal sound in percussion of the chest?

A

resonant

76
Q

Where can you hear vesicular sounds when auscultating breathing sounds?

A

over most of lungs –> inspiration, no pause, fade away 1/3 into expiration

77
Q

Where can you hear bronchiovesicular sounds when auscultating breathing sounds?

A

1st and 2nd ICS anterior & between scapulae (main bronchi) –> equal inspiration + expiration, continuous

78
Q

Where can you hear bronchial sounds when auscultating breathing sounds?

A

manubrium (if at all) –> louder, high pitch, small pause, longer expiration

79
Q

Where can you hear tracheal sounds when auscultating breathing sounds?

A

loud, harsh sounds only over trachea

80
Q

What does Chelmonski sign indicate?

A

Cholelithiasis or cholecystitis

Cholelithiasis - presence of gallstones or to any disease caused by gallstones
Cholecystitis - inflammation of the gallbladder.

81
Q

Name added sounds you can find on auscultation.

A

Crackles, Wheezes, Stridor, Rhonchi, Pleural rub, Hamman’s sign

82
Q

Describe crackles and name the factors you should note when finding them.

A

discontinuous,
intermittent, nonmusical, brief –> “like pouring milk on Rice Crispies”,
occur when deflated airways pop open during inspiration –> also when air bubbles flow through fluid during respiration (pneumonia)

Loudness, number, timing, location, persistence

83
Q

What do early inspiratory crackles suggest?

A

chronic bronchitis, asthma

84
Q

What do late inspiratory crackles suggest?

A

interstitial lung disease (fibrosis), early congestive heart failure, pneumonia

85
Q

What do mid-inspiratory + expiratory crackles suggest?

A

bronchiectasis

86
Q

Describe wheezes, name the factors you should note when finding them, and what they suggest.

A

continuous,
musical, prolonged, high pitched,
occur when air flows rapidly through narrow/obstructed bronchi

Timing, location

  • -> Asthma, COPD, bronchitis, left ventricular heart failure (cariogenic asthma)
  • -> persistent wheezing, non moving = tumor!
87
Q

When can we hear stridor and what does it suggest?

A

Entirely inspiratory

–> obstruction of trachea/larynx

88
Q

Describe rhonchi and name what they suggest.

A

continuous,
low pitched, snoring sound (from secretions into airways)

–> chronic bronchitis, COPD

89
Q

Describe pleural rub.

A

Inflamed pleuras rubbing against each other,

creaking sounds, “as walking in wet snow”

90
Q

Describe the Hamman’s sign and name what it suggests.

A

= Mediastinal crunch,
Series of crackles associated with heartbeat, NOT respiration

–> Mediastinal emphysema

91
Q

Describe the upper borders of the lungs and name what causes could change them.

A

Upper borders:
Apex of lungs (apical fields of Krönig), 3.5 cm in width

  • -> wides in emphysema
  • -> narrow in TB, pneumonia, fibrosis
92
Q

Describe the lower borders of the lungs and name what causes could change them.

A 
Lower borders:
6th rib in right midclavicular line,
4th rib in left parasternal (midclavicular) line,
8th rib in midaxillary line,
10th rib in scapular line

Moves down: emphysema
Moved up: pleural effusion, intra-abdominal pressure

93
Q

Describe the areas for routine lung percussion in the front.

A

2nd intercostal space in midclavicular line,
5th intercostal space in anterior axillary line,
6th intercostal space in midaxillary line

94
Q

Describe the areas for routine lung percussion in the back.

A

suprascapular region,
interscapular region (Th5-6),
infrascapular region

95
Q

Name the 5 percussion notes, their sound quality and where they can normally be heard.

A
  1. Resonance –> Hollow –> Normal lung
  2. Hyperresonance –> Booming –> Air-filled lungs
  3. Tympany –> Drumlike –> Abdomen
  4. Dullness –> Thudlike –> Liver
  5. Flatness –> Flat –> Muscle, bone
96
Q

Describe the resonant (percussion) note (when can you hear it?).

A

(normal note) –> striking over air-filled structure (tissue) like normal lung => low pitch and higher loudness

97
Q

Describe the hyperresonant (percussion) note (when can you hear it?).

A

striking over hyperinflated lungs (air trapping) –> e.g. emphysema => quality of percussion sound is between resonance and tympany

98
Q

Describe the tympanic (percussion) note (when can you hear it?).

A

striking over air-filled chest (large emphysema) and hollow air-containing structure (abdomen (e.g. stomach), pneumothorax, large lung’s cavities (if diameter > 3cm and distance from chest wall < 5cm))

99
Q

Describe the dull (percussion) note (when can you hear it?).

A

striking over solid tissue (liver) or fluid or infiltrated lung –> fluid in pleural cavity - pleurisy (hydrothorax), pleural thickness, pneumonia, TB, pulmonary edema, pulmonary embolism, pulmonary fibrosis, large tumors, atelectasis, lung abscess

100
Q

Describe flatness on percussion (when can you hear it?).

A

very short, high pitched note (absolute dullness) –> no air present in underlying tissue –> for example found over muscle of the thigh or massive hydrothorax

101
Q

What is the Damoiseau’s curve?

A

“In the case of a moderate pleural effusion the upper border of the area of dullness corresponds to a parabolic curve with convexity upward, the highest point of which is in the axillary line.”

102
Q

What is the Grocco’s triangle area?

A

“triangular area of paravertebral dullness at the base of the chest near the spinal column, on the side opposite a pleural effusion”

103
Q

How does Pleural effusion manifest?

A

dullness to percussion in area affected with a rim of hyperresonance on superior aspect (=”Skodiac resonance”)

104
Q

Describe the percussion in pleural effusion.

A

Skodiac hyperresonance in upper part of lung above the effusion due to compensatory emphysema,
Dullness just above the level of effusion due to lung collapse (Grocco’s triangle),
Dullness on the opposite side of effusion (Garland’s triangle) due to shift of the mediastinum

105
Q

What kinds of pleural effusion are there?

A

hydrothorax (serous fluid) –> when unspecified usually this
hemothorax (blood)
pyothorax or pleural empyema (pus)
chylothorax (chyle)
urinothorax (urine) –> very rarely
–> dependent on the various kinds of fluid that can accumulate in the pleural space

106
Q

Name causes of Pleural effusion.

A
  1. Transudate: heart failure, nephrotic syndrome, liver cirrhosis, SVC (=superior vena cava) obstruction, myxoedema (=severely advanced hypothyroidism)
  2. Exudate: lung diseases (e.g. TB-Pneumonia –> Malignancy), connective tissue disease (e.g. SLE), sub diaphragmatic abscess, pulmonary infarction, myxoedema, uraemia –> pancreatitis (left sided effusion)
  3. Hemorrhagic: tuberculosis, malignancy (e.g. bronchogenic carcinoma, mesothelioma)
  4. Bloody: haemothorax in chest injuries
  5. Chylous: obstruction of thoracic duct by tumour, filariasis (=parasitic disease)
107
Q

Define Pleural effusion.

A

an abnormal accumulation of fluid in the pleural space

108
Q

What is the Skodiac Sign?

A

Hyper resonance on the upper part of the lung above effusion due to compensatory emphysema

109
Q

Define a transudate.

A

a filtrate of blood –> due to increased pressure in veins and capillaries that forces fluid through vessel walls or to a low level of protein in blood serum => accumulates in tissue outside blood vessels and causes edema (swelling)

110
Q

What is the Garland’s triangle area?

A

“a triangular area of relative resonance in the lower back near the spine, found in the same (decreased) side as a pleural effusion”

111
Q

Where can you find dullness in a Hydrothorax?

A

Garland’s triangle area,
Damoiseau’s curve,
Grocco’s triangle area

112
Q

What is the etiology of pleural effusion?

A
  1. Transudates (=fluid buildup caused by systemic conditions that alter pressure in blood vessels, causing fluid to leave vascular system)
  2. Exudates (=fluid buildup caused by tissue leakage due to inflammation or local cellular damage)
113
Q

What is a hydrothorax?

A

type of pleural effusion in which transudate accumulates in pleural cavity –> most likely to develop secondary to congestive heart failure, following increase in hydrostatic pressure within lungs

114
Q

What are the auscultatory areas of the lung’s borders?

A

–> same as percussion

routine in the front:
2nd intercostal space in midclavicular line,
5th intercostal space in anterior axillary line,
6th intercostal space in midaxillary line

routine in the back:
suprascapular region,
interscapular region (Th5-6),
infrascapular region

115
Q

What are the normal breath sounds, how are they created and what do they sound like?

A

Bronchial sound –> produced by turbulence of the airflow
=> loud and high-pitched

Vesicular sound –> modified bronchial sound altered by vesicular air working as a filter and reducing high frequency sounds
=> quiet and low-pitched

116
Q

Where can we find normal bronchial sound?

A

loud breath sound (over trachea and larynx => tracheal sound) and over large airways (e.g. large bronchi at level of 4th intercostal vertebra in right interscapular area, right suprascapular, supraclavicular and 2nd intercostal space besides sternum (bronchiovesicular sound)

117
Q

Where can we find normal vesicular sound?

A

faint breath sound present over most of lungs –> does not occur in alveoli of lungs (can’t produce sound –> moves slow?)

118
Q

What is the inspiratory-expiratory ratio of the normal breath sounds?

A

bronchial sound:
inspiratory-expiratory ratio is close to 1:1 or even 5:6
–> heard over trachea/larynx or in a skinny girl on right side at level Th4 vertebra –> right bronchus very close to chest (=only thin layer)

vesicular sound:
auscultation inspiratory:expiratory ratio = 3:1
–> remember: I:E of chest (wall motion) reflecting respiratory inspiratory-expiratory cycle is 5:6

Internal Disease (5 decks)

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