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My Clinical Medicine > Test 3 > Flashcards

Test 3 Flashcards

1
Q

Leading cause of blindness if not corrected

A

Cataracts: Usually later in life

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2
Q

Leading cause of blindness in the USA

A

Diabetes

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3
Q

What does macular degenration cause

A

Central vision loss

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4
Q
  1. What is glaucoma caused by?
  2. What is effected first?
A
  1. Elevated pressue
  2. Peripheral vision
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5
Q
  1. What causes loss of transient vision in a young person
  2. Old person?
A
  1. migraine
  2. emboli problem
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6
Q

What is associated with retnial detachment?

A

Flashes of light

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7
Q
  1. What is diplopia in one eye significant for?
  2. Both eyes?
A
  1. Optical problem
  2. alignment problem
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8
Q
  1. What does itching of the eye signify?
A
  1. allergies
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9
Q

What changes in the eye happen with thyroid disease

A

Exophthamos (bulging of the eye)

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10
Q

What happens to the eyes with diabetes?

A

Large change of vision corrections and paraylsis of CN III, IV and VI.

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11
Q

KNOW PIC OF EYE FROM LATERAL VIEW

A

On Eye I and II lecture

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12
Q

KNOW EXTRAOCCULAR MUSCLES IN LECTURE

A

ON LECTURE EYE I and II

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13
Q

KNOW EXTERNAL EYE

A

ON LECTURE EYE I AND II

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14
Q

What to look for on periorbital skin

A
  • Swelling
  • Redness
  • Lesions
  • Rashs
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15
Q

What to look for on eyebrows?

A
  • Amount of hair
  • Scaliness
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16
Q

What to look for at the eyelash?

A
  • Crusting
  • Amount of lashes
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17
Q

What to look for on the eye lids?

A
  • Edema
  • Color
  • Width of palpebral fissures
  • Adequacy of eyelid closure
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18
Q

What to look for at the lacrimal apparatus?

A
  • Swelling
  • tearing or dryness
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19
Q

What to look for a tth econjunctiva and sclera?

A
  • Color
  • Vascular pattern
  • Nodules
  • Swelling
  • Foreign bodies
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20
Q

How to remove foreign body in upper eyelid

A
  • Take wooden part of cotton- tipped applicator on outer half of upper eyelid
  • Use your other hand to pull the lid away from the globe
  • As this happens you roll the lid
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21
Q

Snellen Eye Chart:

  1. How to perform test?
  2. What does this test for?
A
    • Well lit area
      - Position patient 20 feet from chart
      - Have patient use glasses if they use the for anything other than reading
      - Cover one eye and read smallest line possible
      - Start left to right in one eye and right to left in other
  2. Visual Acuity
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22
Q

How to test visual fields?

A
  • Stand three feet from patient at eye level
  • Have patient focus on your eye
  • Test one eye at a time
  • Patient should use glasses or contacts
  • Slowly bring fingers into field of vision 45 degrees halfway between you and patient
  • Have them tell you how many fingers
  • Repeat for all 4 fields of the eye
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23
Q

Access EOMI

  1. How
  2. What are you looking for?
A

1.

  • Stand 3 feet from patient and ask them to hold their haead still adn follow your fingers
  • Draw a large X and a + with your index finger
  • Do convergence- bring toward their eye

2.

Nystagmus- jerking or drifting of the eyes

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24
Q

Accomodation testing or near reaction testing

  1. What are you testing for?
  2. How to test
  3. Who looses this abillity
A
  1. Checking to see if the eyes will converge and pupils will constrict.

2.

  • Stand to one side of your patient with yoru index finger or object 18” from your patient’s eyes and ask the patient to look at your finger.
  • At this point eyes should converge and pupils should constrict
  • Next, ask patient to look at the wall further away
  • Eyes should diverge and pupils should should dialate
  • Repeat several times
    3. Older patients
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25
Q

Pupillar Responses

How to?

A
  • First, measure each pupil size under normal light and with light shining
  • Next, direct and consenual response measures what other pupil does in the opposite eye when light is shined in.
  • Should constrict in both when shining light in either eye
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26
Q

Swinging Eye Test:

  1. What it tests for?
  2. How to test
A
  1. Tests for functional impairment in the optic nerves

2.

  • Shine a light in one eye and rapidly swing to the other eye
  • Should have a slight dilation in the second eye while light is crossign the bridge of the nose but should still constrict equally to the first eye as the light enters the pupil.
  • Repeat going in the other direction
  • If it continues to dilate rather than constrict an afferent defect is present (marcus Gunn pupil)
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27
Q

Lateral Penlight Test

  1. What it’s for
  2. How to do it
A
  1. Estimate the depth of the anterior chamber of the eye and should be done before administering mydriatic drops

2.

  • Stand in front of your patient so that you ahve full view of iris
  • Shine a light from teh temporal side fo the head across the front of th eye parallel to the plane of the iris
  • Note the illumination fo the iris nasally
  • If not lighted patient has a shallow anterior chamber indicating a risk of acute angle glaucoma
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28
Q

Corneal light reflex

  1. What testing for?
  2. How to test for?
  3. What is normal?
  4. What are abnormal tests significant of?
A
  1. Ocular alignment by reflecting light off the patient’s pupil

2.

  • Stand in front of the patient from about 2-3 feet away
  • Shine light toward the patient and observe where the light reflects from
    3. Light reflects from the center fo both pupils

4.

  • Esotropic: Eye turned in when light reflects lateral to the puil
  • Exotropic: Eye turned out when light reflects medially to the pupil
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29
Q

Cover Test:

  1. What is test for?
  2. How to perform test?
  3. What’s normal
  4. What are some dysfunctions
A
  1. Detect tropia (full time eye misdirection)

2.

  • Cover one of the patient’s eyes when they are focused on a specific point across the room
  • observe movements of uncovered eye.
    3. No shifting of the eye

4.

  • Exotropic is when eye shifts outward
  • Esotropic is when eye shifts inward
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30
Q

Cover-Uncover testing:

  1. What testing for
  2. How to test
  3. What’s normal
  4. What’s abnormal
A
  1. Testing for presence of phoria (eye moves because of disturbances in binocular vision)

2.

  • Ask patient to focus on a distant object
  • Cover and uncover one eye
  • Observe the covered eye as it’s uncovered looking for movement
  • Repeat for other eye
    3. No movement

4.

  • Esophoria is when eye moves in
  • Exophoria is when eye moves out
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31
Q

Corneal Sensitivity

  1. What it tests for?
  2. How to test?
A
  1. Cranial nerve V

2.

  • Ask patient to look up and away from you
  • Approaching from the other side, out of patients line of vision, avoiding the eyelashes touch the cornea with a wisp of cotton
  • If intact CNV senses the touch and should blink
  • If motor is in tact, it’s CN VII
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32
Q

Ophthalmoscopic Exam

  1. When to use your Small aperature
  2. When to use your large aperature
  3. When to use green light
  4. When to use the grid pattern
  5. When to use the slit?
  6. When to Use Blue?
A
  1. Small pupils when lights are not dimmed
  2. For dialated pupils
  3. Better to see drusen bodies, nerve fiber defects and blood
  4. identify size of lesions
  5. exsamine anterior chamber, corneal injuries
  6. Corneal abrasions using fluorescein strips
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33
Q

Ophthalmoscopic Exam

  1. What deturmines the color or number you use on your scope?
  2. Where to set diopter to begin with?
  3. Where do you keep your finger during the eye exam
  4. What do you use for for near sighted?
  5. What do you use for far sighted?
A
  1. Shape of both parties eyes
  2. 0
  3. on the lens disc so you can focus if needed
  4. Myopic usually uses red
  5. Hyperopic usually uses black
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34
Q

Ophthalmoscope

  1. What hand and eye do you use when looking in patients right eye?
  2. Why?
  3. Where to have patient look during exam?
A
  1. right hand, right eye
  2. Keeps you from breathing or kissing the patient
  3. A spot on the wall to stare at
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35
Q

Ophthalmoscopes

  1. WHere do you shine the light of the ophthalmoscope?
  2. What are you looking for?
  3. What do you do when you find this?
  4. How do you prevent running into the patient?
  5. What happens when you see the red reflex?
A
  1. 45 degree angle about 1 foot away
  2. red reflex that’s seen when light strikes the retina and bounces back
  3. Gradually move in toward the patient and adjust your lens disc appropriately
  4. Use free hand to put on patients forhead.
  5. You will start to see blood vessels, the optic disc and the macula
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36
Q

Look at pictures of:

  • Conreal abrasion
  • Corneal opacification
  • Conjunctivitis
  • Pterygium
  • Hyphema
  • Cataracts
  • Papilledema
  • Diabetic retinopathy
  • Drusen
A

Just look at them. Don’t know where to find them

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37
Q

Hemoptysis

A

Blood streaked sputum

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38
Q

If patient describes sharp pain sternally what is it usually?

A

Muscle spasm

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39
Q

Where do bronchi bifurcate?

A

Angle of Louis

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40
Q

Which Bronchi runs straighter?

A

Right so if you aspirate something it usually goes into the right lung

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41
Q

Most common cause of hemoptysis (blood-streaked sputum)

A

Ammonia

42
Q

4 things you should be doing during the physical exam for thorax

A
  1. Look
  2. Listen
  3. Palpate
  4. Percuss
43
Q

5 Things to look for during physical exam of thorax

A
  1. Shape
  2. Movement
  3. Posture
  4. Acting
  5. Accessory Muscles
44
Q
  1. How to use the Bell?
  2. What is it useful for?
A
  1. Light touch that just seals to the skin
  2. heart, not as often with the lungs
45
Q
  1. How to use the diaphragm?
  2. Used on?
A
  1. You can press hard or dimple the skin
  2. Lungs and others
46
Q

What am I describing?

Thorax has moderate kyphosis, increased anteroposterior diameter and decreased expansion. Lungs are hyperresonant. Breath sound distant with delayed expiraory phase and scattered expiratory wheezes. Fremitus (Palpable vibration) decreased; no bronchophony (abnormal transmission of sound from lungs), egophony (Increased voice sounds when auscultating the lungs) or whispered pectoriloquy (increased resonance). Diaphragm descends 2cm (rather than 4).

A

COPD

47
Q

What disease is described?

Flattened kyphosis of thorax, normal anteroposterior diameter. Lungs are resonant. Breath sounds broncho-vesicular breath sounds and scattered expiratory wheezes. Wheezes strongly with forces expiration. No bronchophony (unusual sounds from lungs), egophony (increased resonance of voice sounds upon auscultation) or whispered pectoriloquy (resonance is increased when auscultating the lungs)

A

Asthma

48
Q

What disease is being described?

Thorax asymmetric with decreased movement on the left. Lung is hyerresonant on the left. Breath sounds decreased on the left in all lobes. Diaphragms descend 4cm bilaterally on right and not percussed on left.

A

Pneumothorax (abnormal amount of air in plerual cavity)

49
Q
  1. Where do the lymphatics of the breast drain?
  2. What are the nodes?
  3. Three other groups of nodes?
  4. What is the route of lymph drainage once it gets to #2
  5. How do malignant cells spread in the breast?
A
  1. Toward the axilla
  2. Central nodes that lie along the chest wall and are high in the axilla, midway between the anterior and posterior axillary folds
    • Pectoral: drains chest wall and much of breast
      - Subscapular: Drains posterior chest wall and a portion of the arm
      - Lateral: Drains most of the arm
  4. Central axillary nodes to infraclavicular and supraclavicular nodes
  5. Spread directly to the infraclavicular node or into the internal mammary chain of lymph
50
Q

Thelarche Stages

A

Breast development

51
Q

Tanner 1

  1. Name of stage
  2. What happens?
A
  1. Prepubertal
  2. Elevation of only papilla
52
Q

Tanner II

  1. Name of stage
  2. What happens
A
  1. Breast bud stage
  2. Elevation of breast and papilla as a small mound and enlargement of diameter of areola
53
Q

Tanner III

What happens?

A

Further enlargement of breast and areola with no separation of contours

54
Q

Tanner IV

What happens in this stage

A

Areola projected above level of breast as a secondary mound

55
Q

Tanner V

  1. Name of stage
  2. What happens
A
  1. Mature stage
  2. Recession of areola mound to the general contour of the breast and projection of papilla only
56
Q
  1. When does breast development begin compaired to pubic hair?
  2. Compared to Menarche
A
  1. 1 year prior
  2. 2 years prior
57
Q
  1. Where is the milk line located?
  2. What can grow here?
  3. Are these growths generally bilateral or unilateral?
A
  1. From axillary, over nipple and down to inguinal region. One on either side
  2. Breast tissue or nipples
  3. 50% each
58
Q
  1. What position should the patient be in during breast examination?
  2. What part of the breast should be inspected?
  3. What can alter size of breasts?
  4. Are most breasts symmetric?
  5. What are three common shapes of breasts?
  6. When does areola darken?
  7. What are retractions indicitive of?
  8. What is dimpling indicitave of?
  9. What is Peau d’orange indicitive of?
A
  1. Seated and arms at their side
  2. 4 quandrants (Upper inner, lower inner, lower outer and upper outer) and tail of Spence (anterior axillary fold)
  3. Menstrual cycle or nursing
  4. No
  5. Convex (nipple kind of facing up), pendulous (Nipple pointing down) and conical (Sticking straight out)
  6. During pregnancy
  7. Cancer
  8. Cancer or scar tissue
  9. Blocked lymphatic drainage
59
Q

What four motions should you have your patient perform when doing a breast exam? What does this do to benifit your observation? What does this change in the patient’s body?

A
  1. Arms over head which accentuates dimpling and may reveal variations in contour and symmetry. Adds tension to suspensory ligaments.
  2. Hands pressed against hips which can reveal deviations in contour and symmetry. Contracts pectoral muscles.
  3. Hands pressed together which can reveal deviations in contour and symmetry. Contracts pectoral muscles.
  4. Seated leaning forward from waist while supporting her by the hands which is helpful for assessing the contour and symmetry of large breasts. Causes tension in suspensory ligaments.
60
Q
  1. Which way should the patient be positioned duing palpation of the breasts?
  2. What are three ways to palpate?
  3. WHere do most malignancies occur in the breast?
  4. What are normal findings of the inframammary ridge?
  5. How to flatten out the breast tissue
  6. When is it appropriate to compress nipple?
A
  1. Supine
  2. Vertical (best), circular and spoke
  3. Upper outer quadrent
  4. transverse ridge of compressed tissue along the edge of the breast
  5. Place a towel or small pillow under the patients scapula
  6. If it has discharge
61
Q

5 D’s related to nipples

A
  1. Discharge
  2. Depression or Inversion
  3. Discoloration
  4. Dermatologic changes
  5. Deviation compared to opposite side
62
Q

Three groups of risk factors for breast cancer

A

Modifiable (Postmenopausal obesity, exercise, alcohol, childbirth, etc.): Lifestyle related, changable

Non-modifiable (Gender, family history, race, Dense breast tissue, DES exposure, menstrual periods, lobular carcinoma in situ, etc): Things you can’t change.

Uncertain, controversial or Unproven (Diet and viatmin intake, antiperspirants, bras, induced abortion, breast implantsd, chemicals in environment, tobacco smoke, etc)

63
Q
  1. WOmen 40 and older should have breast examinations how often?
  2. Clinical breast exams (CBE) should be performed how often in women 20-39?
  3. What should high risk women do in addition?
A
  1. Yearly
  2. Every 1-3 years
  3. Yearly MRI’s and Mammogram
64
Q

What are the following symptoms indicitave of?

  • 20-50 years old
  • Bilateral
  • Multible or single
  • Round
  • Soft to firm
  • Mobile
  • No retraction
  • Tender
  • Well defined borders
  • Variation with Menses
A

Fibrocystic Changes

65
Q

What are the following symptoms indicative of?

  • 15-25 years old
  • Bilateral
  • Single or multiple
  • Round, disclike or lobular
  • Firm and rubbery
  • Very mobile
  • No retraction
  • Nontender
  • Well defined borders
  • No variation with menses
A

Fibroadenoma

66
Q

What are the following symptoms indictave of?

  • 30-90 years old
  • Unilateral
  • Single
  • Irregular or stellate
  • Firm, hard and stonelike
  • Fixed
  • Usually have retraction
  • Nontender
  • Poorly defined borders
  • No variation with menses
A

Cancer

67
Q

When nipple is crusting and flaking, eczematous patches, nipple redness and burning, which disease should be considered?

A

Paget’s Disease (form of cancer)

68
Q

If nipple becomes retracted or deviated what disease should be considered?

A

Cancer

69
Q

If one breast becomes venous what disease should be considered?

A

Cancer

70
Q

Cystosarcoma Phyllodes

A

Benign Tumor. Large bulky mass of cysts and connective tissue. Rapidly growing.

71
Q

Fibroadenoma

A

Benign Tumor. Most common tumor under 25 years of age. Small movable and firm. No variation in size with menses and pregnancy.

72
Q

Intraductal Papilloma

A

Benign Tumor. Tumor of lactiferous ducts. Presents with nipple discharge.

73
Q

Best time to evaluate breasts?

A

5-7 Days after menses

74
Q

What level are the aortic and pulmonic valves at?

A

Angle of Louis

75
Q

What level is the apex of the heart?

A

Midclavicular line near the 5th rib interspace.

76
Q

Where are heart sounds loudest?

A

Outside the left ventrical

77
Q

What nerve is the paricardium innervated with?

A

Phrenic nerve

78
Q

What are sounds when listeing to heart?

A

Blood flow, not valves opening or closing

79
Q

What happens in S1

A

When mitral valve and tricuspid valve closes and slight amount of reverse flow into the atrium is shut off during ventricular contraction. Disrupts the laminar blood flow.

Near the start so the line for the left ventricular pressure goes up just before the mitral valve shuts.

80
Q

What happens in S2

A

Left ventricular pressure goes back down as the aortic and pulmonic valves close because now the pressure in the vessel is greater than the pressure in the ventrical.

81
Q
  1. What happens in S3
  2. Who is this normal for?
  3. What disease could this signify?
A
  1. Ventrical fills very rapidly during the atrail phase as blood flows passivly through the atrium. Hear an extra sound. “Ken-Tuck-Y”.
  2. Marathon runners
  3. Heart failure
82
Q

What happens in S4

A

The ventrical is stiff or overfull and it’s hard to force the blood into it. “Tenn-E-See”. Third heart sounds is created by turbulent blood flow ina ventricle as the atrium contracts to eject any remaining blood during a late diastole.

83
Q
  1. Why does splitting occur?
  2. Who is more likely to have splitting?
  3. When does this happen and when does it get better?
A
  1. Because the right atrium, right ventricle and pulmonary artery pressures are lower than the left artery, left ventrical and aorta. Therefore the right side may lag somewhat behind those created on the left side.
  2. Marathon runners
  3. When you breathe in it gets worse and when you breath out it gets better.
84
Q

Is it normal to hear a valve?

A

NO! Something is wrong if you hear a valve.

85
Q

What are normal heart sounds?

A

Blood flow acceleration and deceleration with accompanying turbulence

86
Q

What is the first thing you do for heart patients?

A

Assess stabillity before taking history which could only include vitals.

87
Q

What is another name for aplpitations

A

Dysrhythmias

88
Q

What is more likely to be if you have chest pain longer than 15 min

A

Heart attack.

89
Q

What are some associated symptoms of heart attacks?

A

Nausea, vomiting, dizziness, unilateral numbness/tingling, cyanosis of nail beds or lips, swelling of legs, sweating, shortness of breath.

90
Q

PROS for Cardiac. What to look for in:

  1. General
  2. HEENT
  3. Respiratory
  4. GI
  5. 3 others
A
  1. Fatigue, fever
  2. Generally negative
  3. Cough, sputum, blood, orthopnea (SOB), paroxysmal nocturnal dyspnea (attacks of severe shortness of breath and coughing that generally happen at night)
  4. Heart burn, epigastric pain, history, waterbrash (Excessive saliva from the lower esophogus)
  5. Rash, trauma, psychiatric.
91
Q

How many of THE CHADS can present with chest pain?

A

7

92
Q

Which Risk factor is most prevelant in America?

A

Poor diet

93
Q

Which shaped obese person is healthy?

A

Pear shaped

94
Q

Where to examine PMI

A

Mid Clavicular line

95
Q

When do you percuss during a cardiac exam?

A

You usually dont

96
Q

What are the 5 aucultation points for cardiac?

A
  1. Aortic area: Just right of sternum in 2nd intercostal space
  2. Pulmonic area: Just left of sternum in 2nd intercostal space
  3. Erb’s Point: Just left of sternum at 3rd intercostal space
  4. Tricuspid area: just left of sternum at 5th intercostal space
  5. Mitral area: in mid clavicular line on left side in 5th intercostal space
97
Q

How many beats do you listen for per spot?

A

4

98
Q

What part of your stethescope do you use to listen to the heart?

A
  1. Diaphragm for S1, S2 and breath sounds
  2. Bell for murmurs, S3 and S4: Press lightly and shouldn’t dimple skin
99
Q
  1. How many grades of murmurs are there?
  2. Which is the loudest and heard even with the stethoscope off of the body?
A
  1. 6
  2. Grade 6
100
Q
A

My Clinical Medicine (2 decks)

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