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Clinical Medicine > CA-EXAM#2 > Flashcards

CA-EXAM#2 Flashcards

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1
Q

what should you always do before and AFTER exams?

A

visual acuity

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2
Q

why shouldn’t you use topical anestetic

A
  1. can be cytotoxic to the epithelium
  2. retard healing
  3. increased risk of corneal scaring or infection
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3
Q

Hordeolum

A

“stye”, swelling at the margin of the eyelid by plugging of eyelash follicle to tear gland, can harden into a chalazion

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4
Q

dacryoadenitis

A

swelling and pain of the outer portion of the upper eyelid, inflammation of the lacrimal gland

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5
Q

corneal abrasions

A 
severe pain, photophobia, and foreign body sensation
Examination:
1. penlight, look for penetrating trauma
2. visual acuity
3. fundoscopic exam
4. fluorescin stain
5. evert upper eyelid
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6
Q

pterygium

A

triangle wedge of fibrovascular tissue that starts at the nasal conjustiva and extends into the cornea

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7
Q

strabismus

A

dysconjugate gase

  1. imbalance of occular muscle tone
  2. cover-uncover test (the eye will look forward again when the good eye is covered because it is trying to compensate
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8
Q

cataracts, who are they common in? what do you loose?

A

opacity of the lense, problems with night driving or difficulty with fine print

RF: older age, smoking, corticosteroid use

LOSS OF RED REFLEX

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9
Q

open angle glaucoma; how about the cup?

A

rarely symptomatic, usually incidental finding

slow and progressive

“tunnel vision”

increased cupping, cup plaes, Cup>1/2 diameter of the disc, retinal vessels displaced nasally

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10
Q

closed angle gluacoma

A

EMERGENCY rapid increase in IOP, severe pain, nausea, halos around lights

cilliary injection, dilated and fixed pupils, decreased vision

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11
Q

papilledema

A

EMERGENCY, increase in IOP, swelling of the optic disk, blurred margins

Causes: intracranial mass, lesion, or hemmorage meningitis

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12
Q

hypertensive retinopathy

A

AV Nicking- vein appears to stop abruptly on either side of the artery

coper wiring-arteries become full, increased light reflex

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13
Q

diabetic retinopathy

A

neovascularization

cotton wool spots-white or grayish over lesions due to infarction nerve fibers and reintal ischemia

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14
Q

what tool do you use to remove cerumen?

A

ear curettes

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15
Q

ottitis externa

A

ear pain, discharge, tenderness with tragal pressure or when auricle is pulled

wick placement for sever infections

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16
Q

what two methods can you use to check for TM mobility and confirm middle ear effusion?

A

pneumatic otoscopy: creates a puff of air, confirm middle ear effusion

tympanogram: creates vibrations of ear pressure in the canal

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17
Q

tympanosclerosis

A
  1. chalky white patches with irregular margins

2. scarrring from severe AOM

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18
Q

serous effusion; what are two common causes

A

fullness, popping sensation

fluid line and/or bubbles behind the TM

often caused by atmospheric pressure or URI

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19
Q

otitis media, what two bacteria can cause it?

A

TM erythematous and bulging, landmarks obscured, dilated vessles

S.pneumoniae and H. influenzae

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20
Q

eutachian tube dysfunction

A

ear fullness, ear pain, tiniitis, autophony

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21
Q

Weber test

A

UNILATERAL HEARING LOSS

conductive: sound in IMPAIRED ear
[bones aren’t working and sensineural is working so it works in overdrive and works more to pick up the sounds, think of jordan putting the virbrating thing on my head, heard it bad ear]

senorineural loss: sound in GOOD ear

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22
Q

Rinne test

A

checks air vs bone conduction

Normal hearing AC>BC

Conductive: BC>AC or BC=AC

sensorineural: AC>BC

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23
Q

Benign positional vertigo, what causes it? what helps it?

A

triggered by head position change, N/V, NYSTAGMUS

caused by CANALITHIASIS, calcium deposit in the semicircular canal

correct with dix-hallpike position

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24
Q

acute sinusitis; what is important to do?

A

mucopurlulent nasal drainage, inferior turbinate hypertrophy, sinus pressure and pain, transluination of the sinuses

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25
allergic rhinitis; color. what are two signs
pale, boggy nasal mucosa with blueish hue, allergic shiners and allergic salute
26
foreign body; what can you remove it with?
foul smelling, purlulent, unilateral discharge, preschoolers removal: blowing nose, sneezing, aligator forcepts
27
nasal polyp; what can cause them?
grape like growths intranasal corticosteroid spray, refer to ENT
28
angular cheilitis; what can cause it? what do you use to diagnose it?
erythema, maceration, scaling, fissures at the angle of the mouth causes: overclosure of the mouth, nuitritional deficiency candida albicans, KOH prep
29
gingivostomatitis; what can cause it?
cole sole, HSV, cluster of small vesicles, coalesce to form ulcer
30
aphthous ulcer; what is the coloration like?
canker sore, round well definied ulcer, GRAYISH BASE, surrounded by halo of reddened mucose
31
dental decay; what do you want to know?
tooth pain, gum swelling want to know if the infection source is coronal or root surface of the tooth
32
gingivitis; what is the coloration? what causes it?
swelling and blueish purple discoloration of gingiva, bleeding gums after eating or brushing cause: dental plaque
33
oral candidiasis; what can you loose?
thrush pain with eating or swallowing, loss of taste thick white plaques
34
leukoplakia; what type of cell is this in?
thick white plaques, painless | reactive process of squamous eipthelium, doesn't go away if you rub it! biopsy it!
35
sialolothiasis; what should you have to patient do in order to diagnose beter
stones in the salivary glands or ducts, aggrevated by eating, CP: have patient close mouth slightly to relax muscles, allows for better palpation of the floor of the mouth
36
sialadentitis; where would you find swelling?
gland pain and swelling with pus draining from duct, consider CT, US swelling by the parotid gland or submandicular glands
37
actue pharyngitis; what is an importantant characteristic? what/where should you look?
viral, bacteria, allergies, irritants (smoke) COBBLESTONING look for epiglottis, peritonsillar abcess, submandibular space infections, retropharyngeal space infection form HIV
38
submandibular space infections
ludwigs angina
39
what are two conditions that cause exudative tonsillitis
EBV, infectious mono | GAS pharyngitis
40
infectious mono; what two tests can you do? where should you palpate?
POSTERIOR cervical LAD, splenomegly, EBV, monospot and CBC
41
GAS pharyngitis (Group A Strep); what test do you want to do? where do you want to palpate and what might you see?
ANTERIOR cervical LAD, scarlatiniform rash RADT (rapid antigen detecting test) +/- throat culture
42
when will you commonly see a erythematous maculopapular rash?
patient with EBV aftering taking ampicillin/amoxicillin
43
epiglottis; what should you never do? whats something interesting can you see on a xray? symptoms?
muffled voice, drooling, sniffling and tripodding position DO NOT VISUALIZE THROAT WITH TONGUE BLADE Lateral xray and look for THUMB SIGN
44
peritonsillar abscess; explain what happens with the uvula? where is this located? what are the three stages of disease?
muffled voice, trismus pus between palatine tonsil and pharyngeal muscles, FLUCTULANT TONSIL, DEVIATION OF THE UVULA TO OPPOSIT SIDE polymicrobial.....tonsilitis then cellulitis then abcess
45
Jugular venous pressure; what side can you visualize this better on? what can cause it to increase and decrease?
pressure in right atrium, best asscessed in the right internal jugular vein decreased in blood loss and increases in heart failure, pulmonary hyper tension, and tricuspid stenosis
46
the sternal sternal angle remains roughly ____ above the right atrium
5 cm
47
where do you see the internal jugular venous pulsations
suprasternal notches, along the sternocleomastoid muscle, lower neck basicaly
48
normal JVP findings
Less than 4 cm above sternal angle or 9 from right atrium (add 5 to the measurement from sternal angle to get the total distance).
49
what are the differences between carotid and venous pulsations
carotid: palpable, single outward movement, stronger, not elimated when pushing, heigh unchanged by position, height not effected by pulsations internal jugular: rarely palpable, soft, height changes with position, falls with inspiration
50
what are you accessing for when you listen to carotids?
bruits
51
thrills; How do you find it? what does it sound like?
humming vibrations, like a cat when purring PALPABLE MURMER, FEEL FOR IT
52
bruits; how do you find it
a mumur like sound from tuburlent flow, LISTEN FOR IT
53
lift and heaves; where do you access for these? specifically? How do you access for them?
on chest, you feel for them not listen, S3 and S4 at the apex
54
PMI-point of maximum impulse
apical pulse, 4th or 5th interspace along the mid clavicular line
55
2nd right intercosta space you hear
aortia
56
2nd left intercostal space you hear
pulmonary area
57
3rd intercostal space you hear; what can you hear best here
erbs point, best for S2 auscultation
58
4th/5th inercostal space you hear
tricuspid area
59
5th intercostal space in the midclavicular line you hear
apex, mitrial area
60
left lateral decubitus position; where do you listen? what does it help you to hear?
ascultate with the bell at the apex at the apex or 5th intercostal space, brings left ventricle closer to the chest wall and accentuates MITRIAL MURMERS S3 and S4
61
by having the person lean forward and listening to their left 2nd and 3rd intercostal spaces, it accentuates
an aortic murmer
62
explain the sounds you would hear when precussing
flat-thigh dull-liver resonant- healthy lung tympanic-gastric air bubbles in the intestines
63
vesicular sound explination
inspiration>expiration
64
broncho-vesicular
expiration=inspiration, 1st and 2nd intercostal spaces anteriorly
65
bronchial
exp>inspiration over manubrium
66
tracheal
insp=exp over trachea
67
where do you place your hands to measure respiratory excursion
10th ribs
68
what are the number of percussion and auscultation fields on the back and front for the lungs?
4 anterior, 2 lateral, and 7 posterior
69
what is the difference between respiratory expasion and diaphragmatic excursion
respiratory expansion is when you pinch the skin in the back and have them take a deep breath in diaphragmatic excursion is when you have them take a deep breath in and measure where the percussion sounds change from resonant to dull, and do the same thing coming back up 3-5.5 cm normal values
70
what is the normal measurement for diaphragmatic excursion
3-5.5 cm
71
where do you precuss on your hand
pleximeter finger at the dip joint
72
explain the different between pleximeter finger and plexor finger when precussing
pleximeter finger is the left middle finger plexor finger is the right middle finger
73
how do you distinguish between resonant and tympanic?
resonant: loud intensity, low pitch tympanic: loud intensity, HIGH pitch
74
coarse crackles or rales
20-30 sec, louder
75
fine crackles or rales
5-10 sec, very brief and soft
76
wheezes
whistles, high pitched
77
rhonchi
snoring, coarse
78
what are the grades for pulses
0-none, unable to palpate/absent 1- weak pulse, diminished 2+ normal pulse, brisk 3+ too strong, bounding
79
what is the order for the cardiac exam
1. look at neck 2. palpate down the sternal boarder, the the PMI which is between 4th and 5th intercostal in mid clavicular line 3. roll over and listen to the apex 4. proceed with listening to the rest 5. then have them sit up and lean forward listening to the aorta
80
where should your hands be to palpate the kidney on the back?
12th ribs
81
striking the back allows you to access for
costovertebral tendernous
82
what is the rating scale for pitting
``` 0-none 1+- depression, disappeares 2+-2-4 mm, 10-20 seconds 3+-4-6 mm, >1 min 4 6-8 mm for many minutes ```
83
S1 systolic is usually ______ than S2
S1 systolic is usually louder than S2 at apex
84
T or F, you PALPATE for heaves, lifts and thrills. where do you palpate for them?
TRUE, 4-5th intercostal space on midclaicular line
85
average size of the aorta is
2.5 cm
86
HOW DO YOU FIND LIFTS, THRILLS, AND HEAVES?
FEELING THEM, NOT LISTENING!!

Clinical Medicine (3 decks)

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