Exam 2 Flashcards
(248 cards)
1
Q
Lymph drainage from the penis passes primarily to
A
The deep inguinal and external inguinal lymph nodes
2
Q
Lymph vessels from the scrotum drain into the
A
superficial inguinal lymph nodes
3
Q
Indirect inguinal hernias develop at
A
The internal inguinal ring, where spermatic cord exists the abdomen
4
Q
Direct inguinal hernias arise
A
more medially due to weakness in the floor of the inguinal canal and are associated with straining and heavy lifting
5
Q
Low libido may be due to
A
Depression, endocrine dysfunction, side effects from medications
6
Q
ED may be due to
A
psychogenic causes, decreased testosterone, decreased blood flow in the hypogastric arterial system, diabetes
7
Q
Discharge in gonorrhea
A
Yellow
8
Q
Discharge in non-gonococcal urethritis from chlamydia
A
White
9
Q
Penis pain due to
A
Testicular torsion, epididymitis, orchitis
10
Q
Testicular self-examination
A
Not recommended for asymptomatic adolescent or adult males
11
Q
Phimosis
A
Tight prepuce that can not be retracted over the glans
12
Q
Paraphimosis
A
Tight prepuce that, once retracted, can not be returned and edema ensues
13
Q
Balanitis
A
inflammation of the glans
14
Q
How to check for varicocele
A
have patient stand and palpate spermatic cord while the patient bears down
15
Q
Cystic structure in the spermatic cord suggests
A
hydrocele of the cord
16
Q
Corpora cavernosa
A
2 structures within the shaft of the penis that become engorged with venous blood during erection
17
Q
Peyronie disease
A
Development of fibrous scar tissue within the penis that causes disfigured and painful erections
18
Q
Powerful vasodilators for erection
A
NO and cGMP
19
Q
FSH in males
A
Regulates sperm production in the testes
20
Q
LH in males
A
Simulates synthesis of testosterone
21
Q
Spermatocele
A
Benign, typically painless, movable cystic mass just above the testes that will typically transilluminate with strong light source
22
Q
Acute epididymitis
A
Results from bacterial infection such as chlamydia and presents with scrotal swelling and pain
23
Q
Hydrocele
A
Nontender, fluid filled mass within tunica vaginalis surrounding the testicle; usually congenital defect in which peritoneal fluid travels down in between the testicle and tunica vaginalis from a patent communication that normally closes
24
Q
5a-reductase
A
Enzyme that converts testosterone to 5a-dihydrotestosterone–hormone that triggers pubertal growth of male genitalia, prostate, seminal vesicles, secondary sexual characteristics
25
If male if having problems with infertility
It is usually problem with FSH
26
Area where pap smear is done
Transformation zone--area at risk for later dysplasia
27
Weakness of pelvic floor muscles may cause
Pain, urinary incontinence, fecal incontinence, prolapse of pelvic organs that can cause cystocele, rectocele, enterocele
28
Primary dysmenorrhea due to
Increased prostaglandin production during luteal phase of menstrual cycle, when estrogen and progesterone levels decline
29
Secondary dysmenorrhea due to
Endometriosis, adenomyosis, pelvic inflammatory disease, endometrial polyps
30
Post-coital bleeding suggests
Cervical polyps or cancer; atrophic vaginitis in older adults
31
Causes of post menopausal bleeding
Endometrial cancer, hormone replacement therapy, uterine or cervical polyps
32
Amenorrhea followed by heavy bleeding
Suggests threatened abortion or dysfunctional uterine bleeding related to lack of ovulation
33
Decreased libido may be due to
lack of estrogen, clinical illness, trauma or abuse, surgery, pelvic anatomy, psychiatric conditions
34
Superficial vaginal pain with sex suggests
Local inflammation, atrophic vaginitis, inadequate lubrication
35
Deeper pain with sex suggests
Pelvic disorders or pressure on a normal ovary
36
Most common cause of acute pelvic pain
PID, followed by ruptured ovarian cysts and appendicitis
| Always rule out ectopic pregnancy first
37
Chronic pelvic pain red flag for
History of sexual abuse
38
When to begin pap smears
Age 21
39
Pap smears screening
Every 3 years or 5 years with concomittant HPV testing
End screening >65 assuming 3 negative consecutive results
Not recommended after hysterectomy
Start HPV vaccine at 11/12 years
40
3 symptoms indicating ovarian cancer
Abdominal distention, abdominal bloating and urinary frequency >50 years
41
Lateral displacement of cervix
Suggests endometriosis
42
Cervical motion tenderness
Hallmark for PID, ectopic pregnancy and appendicitis
43
Palpate uterus from outside, noting its
Size, shape, consistency, mobility
44
Where will you usually feel ovarian masses
in the adnexal area
45
Colon cancer screening
<50 years old, annual screening with high-sensitivity fecal occult blood tests, colonoscopy every 10 years or sigmoidoscopy every 5 years
46
Median lobe of the prostate
Located anterior to the urethra and is not palpable on DRE
47
Normal prostate size
2.5cm
48
Small caliber stools
May be caused by narrowing of the colon due to a mass--indicative of colon cancer
49
Black, tarry stools
Represents blood in GI tract, not the colon
50
Risk factors for prostate cancer
family history, african american, unusual history of cancers that may be associated with BRCA gene
51
4 key features to characterize patient's complaint of musculoskeletal disorders
Articular or extra-articular
Acute (<6 weeks) or chronic (>12 weeks)
Inflammatory or non-inflammatory
Localized or diffuse
52
<60 years with musculoskeletal issues, think
Tendinitis, bursitis, RA, psoriatic arthritis, infectious arthritis from gonorrhea, viral or bacterial infection
53
>60 years with musculoskeletal issues, think
OA, gout, osteoporotic fracture, septic bacterial arthritis
54
Synovial joints
freely moveable--knee and shoulder
55
Cartilaginous joints
slightly moveable--vertebral bodies of the spin and symphis pubis
56
Fibrous joints
Immovable--skull sutures
57
Pain in single joint
Suggests injury, monoarticular arthritis, tendinitis, or bursitis
58
Severe pain or rapid onset in red swollen joint suggests
Acute septic arthritis
59
In non-inflammatory disorders, consider
Trauma, repetitive use, degenerative changes, fibromyalgia
60
4 cardinal features of inflammation
Swelling, warmth, redness, pain
61
Morning stiffness that improves with activity
RA
62
Intermittent stiffness not improved by activity
OA
63
Symmetric musculoskeletal pain
RA, SLE, ankylosing spondylitis
64
Asymmetric musculoskeletal pain
Psoriatic, reactive and IBD associated arthritis
65
Midline low back pain
injury, disc herniation, vertebral collapse, spinal cord metastases
66
Off midline low back pain
Muscle strain, bursitis, sciatica, hip arthritis, pyelonephritis, kidney stones
67
Leg pain that resolves with rest and/or lumbar forward flexion
Spinal stenosis
68
Bladder/bowel dysfunction with low back pain
Cauda equina syndrome
69
Red flags for low back pain
Age <20, >50, history of cancer, unexplained weight loss, fever, decline in general health, pain >1 month, pain at night or rest, drug use or immunosuppression, active infection, long term steroid use, bladder or bowel incontinence, neurologic ysmptoms
70
Risk factors for osteoporosis
Postmenopausal, age >50, low BMI, low calcium or vitamin D, tobacco or alcohol use, immobilization, inadequate physical activity, family history, medications
71
Temperomandibular joint swelling and tenderness
Signal TMJ inflammation or arthritis
72
Restricted ROM in shoulder
bursitits, capsulitis, rotator cuff tears or sprains, tendinitis
73
Local swelling in wrist suggests
Ganglion
74
Torticollis
Lateral deviation and rotation of the head; from contraction of the sternocleidomastoid muscle
75
Vertebral tenderness raises concerns for
Fracture, dislocation, underlying infection, arthritis
76
Tenderness over knee tendon or inability to extend the knee
Suggests a partial or complete tear of the patellar tendon
77
Pain on percussion of the spine
May be osteoporosis
78
Role of sternocleidomastoid muscle
Flexes and rotates the neck
79
Role of trapezius muscle
Extends the neck
80
Assessing ability to laterally bend is assessing function of
Scalene and small intrinsic neck muscles
81
Assessing ability to extend the back assesses the function of
Deep intrinsic muscles of the back
82
Tinnel sign
Strike patient's wrist with finger where the median nerve passes under the flexor retinaculum and volar carpal ligament
Tingling sensation is positive sign
83
Phalen test
Patient holds both wrists in fully palmar flexed position with dorsal surfaces pressed together for 1 minute
Numbness and paresthesia is suggestive of carpal tunnel syndrome
84
Neer test
Tests for shoulder impingement
Internally rotate and forward flex arm at shoulder
Positive finding: pain in anterior lateral aspect of shoulder
85
Hawkin's test
Tests for shoulder impingement
Forward flexing of shoulder to 90 degrees, flexing elbow to 90 degrees and internally rotating arms
Positive finding: pain in the superior-lateral aspect of the shoulder
86
Empty can test
Tests for possible rotator cuff tear
| Internally rotate arms and resist downward pressure
87
Drop arm test/Codman's sign
Tests for rotator cuff tear
| Positive finding: patient can not control descent of the arm as it drops
88
Assess temporomandibular joint for
Pain, crepitus, locking and popping
ROM--Open and close, lateral movement, protrusion, contraction
Strength--temporalis and masseter
89
Assess cervical spine for
Tone, symmetry, tenderness, spasm, head alignment, symmetry of muscles and skinfolds
ROM--expect flexion 45 degrees, extension 45 degrees, rotation 70 degrees
Assess sternocleidomastoid and trapezius muscles
90
Assess hips for
Symmetry, size, gluteal folds
Palpate for stability and tenderness
ROM--flexion 90 degrees, hyperextension 30 degrees, internal rotation 40 degrees, external rotation 45 degrees
91
Thomas test
Observe patient's ability to keep extended leg flat on the exam table as other leg is flexed towards chest
Lifting extended leg indicates hip flexion contracture in extended leg
92
Trendelenburg test
Detects weak hip abductor muscle
| Balance on each foot and note any asymmetry
93
Barlow-Ortolani maneuver
Detects hip dislocation or subluxation in infants
| Positive: clunk or sensation felt as femoral head exits acetabulum posteriorly
94
Assess legs/knees for
Landmarks, concavities, alignment, swelling, tenderness, bogginess, crepitus
ROM--flexion 130 degrees, extension 30 degrees, hyperextention 15 degrees
95
Ballottement
Excess fluid or effusion in knees
96
Bulge sign
Excess fluid in knees
97
McMurray test
tests for torn medial or lateral meniscus
| Positive: palpable or audible click, pain, grinding, lack of tension during outward and inward flexion of knee
98
Anterior and posterior drawer test
Draw tibia forward and backward forcing tibia to slide forward of the femur
Unexpected finding is movement of knee greater than 5mm
99
Lachman test
Tests ACL integrity
100
Assess feet/ankles for
Contour and position, size and number of toes, alignment, weight bearing, arch, heat, swelling ,tenderness
101
Straight leg raising test
Tests for nerve root irritation or lumbar disc herniation at L4, L5, S1 levels
No pain should be felt below the knee with leg raising
Radicular pain below the knee in a dermatome pattern may be associated with disc herniation
102
Femoral stretch test
Used to detect inflammation of the nerve root at L1, L2, L3, L4 level
Presence of pain is positive
103
Basal ganglia
Affects movement
104
Thalamus
Processes sensory impulses and relays them to cerebral cortex
105
Hypothalamus
Maintains homeostasis and regulates temperature, heart rate and BP
106
Cerebellum
Coordinates all movement and helps maintain body upright
107
CN1
Olfactory--sense of smell
| Test with different scents
108
CN 2
Optic--vision
Inspect fundi with opthalmoscope
Inspect for bulging and blurred margins, pallor and cup enlargement
109
CN 3
Oculomotor
Pupillary constriction, opening of eye and most extraocular movements
Test pupillary reaction to light, check near response, convergence and accommodation of the lens
110
CN 4
Trochlear
| Downward and internal rotation of the eye
111
CN 5
Trigeminal
Motor: jaw clenching, lateral jaw movement
Sensory: opthalmic, maxillary and mandibular
Ask patient to firmly clench teeth and open jaw from side to side; use pin and cotton swab for pain; wisp of cotton on eye for corneal reflex
112
CN 6
Abducens
| Lateral deviations of eye
113
CN 7
Facial
Motor: facial movements such as facial expression, closing the eye and closing the mouth
Sensory: taste for salty, sweet, sour and bitter and sensations from the ear
Ask to raise both eyebrows, frown, close both eyes tightly , puff out both cheeks
114
CN 8
Acoustic
Hearing and balance
Whispered voice test, rinne test, weber test
115
CN 9
Glossopharyngeal
Motor: pharynx
Sensory: posterior portions of the eardrum and ear canal; pharynx and posterior tongue, including taste
Patient's voice quality, difficulty swallowing, say ahh, test gag reflex
116
CN 10
Vagus
Motor: palate, pharynx, larynx
Sensory: pharynx, larynx
117
CN 11
Spinal accessory
Motor: sternocleidomastoid muscles and upper portion of the trapezius
Move shoulders against resistance
118
CN 12
Hypoglossal
Motor: tongue
Listen to articulation of words, inspect patient's tongue, ask to move tongue side to side
119
Pyramidal tract
Mediates voluntary movement and integrated skilled, complicated or delicate movements by stimulating selected muscular actions and inhibiting others
120
Diabetic patients with small-fiber neuropathy report
Sharp, burning or shooting foot fain
121
Diabetic patients with large-fiber neuropathy report
Numbness and tingling or no sensation at all
122
Proximal limb weakness, when symmetric with intact sensation
Occurs in myopathies from alcohol, drugs such as glucocorticoids, and inflammatory muscle disorders
Ask about difficulty combing hair, reaching shelf, climbing stairs
123
Parkinson disease s/s
low frequency, unilateral resting tremor, rigidity, and bradykinesia
124
Essential tremors
High frequency, bilateral, upper extremity tremors that occur with both limb movement and sustained posture and subside when limb is relaxed
Relieved by alcohol
125
Causes of restless leg syndrome
Pregnancy, renal disease, iron deficiency
126
Mental status exam includes
Level of alertness, appropriateness of responses, orientation to date and place
127
Dysarthria
Impairment of the voice due to dysfunction of the muscles that allow speech but does not affect ability to understand or express oneself
128
Broca's aphasia
Verbose, meaningless, verbal expression with sparing of language interpretation
Usually due to lesion in the posterior inferior frontal lobe
129
Automatism for seizures
Eyelid fluttering, chewing, lip smacking, swallowing
130
Brudzinski sign
Involuntary flexion of the hips and knees when flexing the neck is positive meningeal irritation
Positive for meningeal irritation
131
Kernig sign
Pain in lower back when flexing the leg at the knee and attempting to straighten the leg
Positive for meningeal irritation
132
Circumstantiality
Speech with unnecessary detail, indirection and delay in reaching the point
133
Derailment
Shifting topics that are loosely connected or unrelated
134
Flight of ideas
Continuous flow of accelerated speech with abrupt changes from one topic to another
135
Neologisms
Invented or distorted words
136
Most common issue in early cognitive decline
Short term memory storing
137
Possible causes of delirium
Hypoglycemia, hypoxia, injury, medications
138
Delirium Tremens
Brain's response to withdrawal from alcohol consumed in large quantities over time
Withdrawal signs: agitation, confusion, combativeness, panic, seizures, hallucinations, illusions
139
Depression differential diagnosis medical reasons
Adrenal disease, thyroid disorder, diabetes, hypercalcemia, lupus, chronic fatigue syndrome, fibromyalgia, anemia, substance abuse, bipolar, dementia
140
Dysthmyic disorder
Symptoms of depression for most of the day, more days than not, for at least 2 years
141
In kids with OCD, check for
Precedent strep infection
142
Sensitivity
Percentage of individuals with the target condition who would have an abnormal or positive result
Higher sensitivity means a greater percentage of people with the given condition will have an abnormal result
143
Specificity
Percentage of healthy individuals who would have a normal result
144
Patients with anxiety typically present initially with
Chest pain, irritable bowel syndrome, unexplained dizziness, migraines, chronic fatigue
145
Medications that can cause anxiety
Caffeine, thyroid medications, theophylline, albuterol
146
GAD
Worried most of the time about many different concerns, both reasonable and unfounded; occurs on most days for at least 6 months
147
Drugs that can cause depression
Antihypertensives, corticosteroids, estrogen and progesterone, antiparkinsonian drugs, antianxiety drugs, accutane, birth control
148
Assessment of depression should always be followed up with
Assessment for bipolar disorder
149
Bipolar 1
one or more manic episodes or mixed episodes
| Suicide ideation and attempts more likely to occur in depressive or mixed state
150
Bipolar 2
Clinical course includes one or more major depressive episodes and at least one hypomanic episode; no manic or mixed episodes
151
Cyclothymic disorder
Chronic, fluctuating mood disturbance, including hypomanic and depressive symptoms that do not meet criteria for manic episode; does not lack severity to meet criteria for depressive episode
Symptoms present for 2 years
152
Physical findings with bulimia
Loss of dental enamel due to recurrent vomiting, increased parotid glands, calluses on hand from inducing vomiting, electrolyte imbalances
153
How to differentiate between delirium and psychosis
Ask patient to state time of day when hallucinations occur
154
Anticholinergics and delirium
Can cause it--especially in elderly
155
Reactive attachment disorder
Emotionally withdrawn/inhibited
Indiscriminately social/disinhibited
Due to social neglect or other situations that limit a young child's opportunity to form selective attachments
156
4 major groups of musculoskeletal complaints
Mechanical problems, soft tissue conditions, inflammatory diseases, noninflammatory diseases
157
Conditions commonly associated with joint pain
OA, tendonitis, infection, gout, RA, lupus
158
Medications that may cause rhabdomyolysis
Anti-inflammatories, statins, fibrates, erythromycin
159
SE of quinolones
Tendinitis and tendon rupture
160
Polyarthralgia
pain in 5 or more joints
Joint pain and discomfort rather than joint inflammation or degeneration
X ray first line dx
161
RA
Progressive, inflammatory and erosive condition affecting multiple joints
Symmetric joints
Prolongedm orning stiffness and fatigue with tender, swollen and warm joints
162
OA
Loss of cartilage and progressive erosion of bone
Pain and stiffness improves with moderate use and worsens after long periods of rest
X ray Dx
163
Fibromyalgia
Noninflammatory soft tissue disorder
| Generalized pain, stiffness, decreased ROM and multiple point tenderness in 11/18 sites for >3 months
164
SLE
Chronic autoimmune disorder: malar rash, arthralgias, myalgias, fever, fatigue, Raynaud's syndrome, neuropathy
165
Sarcoidosis
Inflammatory disorder; develop granulomas and joint pain, fatigue, fever, altered appetite, cough, wheezing, SOB
Dx: biopsy and chest x ray
166
Gonococcal arthritis
Migratory and affects lower extremities and hands
| Nonpruritic dermatitis and tenosynovitis with generalized muscle aches
167
Lyme Disease
Transmitted by deer tick bite
Migratory polyarthralgia, myalgia, neurologic findings including meningitis or neuropathy
Early finding: solitary target lesion followed by multiple lesions
Dx: ELISA
168
Acute rheumatic fever
Occurs following infection with streptococcal pharyngitis usually
Migratory pain in larger joints; cardiac symptoms may be present, subcutaneous nodules
169
Cervical disk disease
Morning stiffness, tightness and pain, coughing and straining increase the pain, which may radiate to shoulder and arm
Elevating arm may provide relief
Numbness along scapula may occur
Altered upper extremity DTR, weakness, sensation
170
Cervical stenosis/spondylosis
Bony osteophytes compress the spinal cord
| Dx- X ray
171
Syringomyelia
Fluid cavity in spinal cord; usually caused by Chiari malformation
Burning pain in the neck or thoracic area and paresthesia/numbness in the neck or thoracic area and extremities
Progressive weakness
172
Mechanical low back pain
Onset occurs after new or unusual exertion
| Pain relief achieved by lying down
173
Herniated intervetebral disk
Sciatica symptoms
Lying with hips flexed provides pain relief
May have diminished reflexes and strengths
174
Spinal stenosis
Pain usually worse during the day; aggravated by standing; relieved by rest and leaning forward
May have weakness and bladder/bowel dysfunction
175
Spinal infection
Fever, chills, possible weight loss, pain worse at night, point percussive tenderness and elevated skin temperature
176
Ankylosing spondylitis
Early symptoms: lower back pain and stiffness
Bony tenderness, malaise, loss of appetite, fever, fatigue, loss of spine mobility
Neck pain is late symptom
177
Rotator cuff syndrome/impingement
Anterior and lateral shoulder pain that increases with arm elevation and reaching overhead; Pain is progressive and associated with repetitive activities; ROM usually preserved
178
Rotator cuff tear
Usually follows chronic impingement
Pain sudden and worse at night
Associated weakness and atrophy of surrounding structures occurs
179
Radiating pain to shoulder from
Cardiac, pulmonary and gallbladder disease
180
Olecranon bursitis
Swelling and tenderness at the tip of the elbow over the olecranon; point tenderness common
181
Most common cause of hip pain
OA
182
Avascular necrosis of the femoral head
Bone deterioration associated with diminished circulation from trauma or malignancy or infection
Hip pain and difficulty bearing weight
Coughing increases pain and it persists at rest and night
Radiates down thigh
183
Slipped femoral capital epiphysis
Hip pain in adolescents
Involves slippage of the femoral epiphysis on the femoral neck; more common in overweight male adolescents during time of rapid growth
Referred pain to groin, thigh, knee
Gradual progression with stiffness progressing to pain and development of hip
Comfort increased with external rotation of hip
184
ACL injury
Usually due to deceleration combined with sudden turning or pivoting
Hear a pop at time of injury
185
Plantar fascitis
Caused by prolonged standing, walking or running in poorly designed shoes with no arch support
Pain on undersurface of heel, worse upon weight bearing
186
Achilles tendinitis
Chronic overuse of the calf muscles from activities such as jumping
Patient can not stand on ball of foot and has tenderness and hemorrhage at site of rupture; ROM diminished
187
Tests to test for coordination
Finger to nose
Rapid alternating movements
Heel to shin
Romberg
188
Migraine
Generally lasts 4-76 hours can be associated with menstrual cycle
Unilateral initially but can become generalized
Aggravated by movement, light, noise
Accompanying symptoms: nausea, vomiting, phototobia, phonophobia, dizziness, chills, ataxia
189
Cluster headaches
Most incapacitating
Episodic and unpredictable headaches that may be cyclic, occurring more in spring and fall
Cluster periods last 2-3 months and may remit for months to years
Unilateral, penetrating, sharp, excruciating, and unrelenting pain
190
Tension headache
Mild to moderate non-throbbing pressure or squeezing pain that can occur anywhere in neck or head
191
Subdural hematoma
Dull and aching headache that may be transient
| Usually due to blow to the head, fall or other injury
192
Subarachnoid hemorrhage
Severe and acute pain; thunderbolt headache; made worse by lying down
Usually due to head trauma, ruptured aneurysm, vascular malformation, uncontrolled hypertension
193
Viral/bacterial meningitis
Diffuse and throbbing headache + fever, phototobia, nausea, vomiting, nuchal rigidity
194
Chiari malformation
Persistent headache in occipital area radiating behind eyes; triggered or worsened by vasalva maneuver or flexion/extension of neck
May have dizziness, tinnitus, decreased hearing, weakness, numbness, paresthesias, extremity pain, fatigue
195
Temporal arteritis
Chronic inflammation and presence of giant cells in large arteries usually in temporal artery
Can lead to blindness
Bitemporal, frontal or vertex head pain that is lancinating, sharp, or ice pick in nature
Visual changes, scalp and jaw tenderness, facial pain, tenderness to palpation over affected artery
196
Normal pressure hydrocephalus
Gait disorder followed by clouding of thought processes and urinary incontinence
Increased DTR, inability to tandem walk, positive babinski, positive romberg
197
Meniere disease
Due to increased fluid and pressure in the labyrinth
Severe vertigo, tinnitus, hearing loss
Vertigo associated with N/V
198
Benign paroxysmal positional vertigo
Due to otolithic crystals/particles detaching from the utricle membrane and migrating to the semicircular canal
Sudden onset dizziness lasting less than 30 seconds and following head position change
Sensation of room spinning
199
Multiple sclerosis
Inflammation and degeneration of myelin of the brain's white matter--leads to decreased brain mass and obstructed transmission of nerve impulses
200
Encephalitis
Acute inflammation of brain and spinal cord, involving meninges, often due to virus such as HSV
201
Trigeminal neuralgia
Recurrent paroxysmal sharp pain that radiates into one or more branches of 5th cranial nerve
202
Peripheral neuropathy can be due to
Diabetes, B12, folate deficiency, Lyme disease, HIV
203
Dx for ADHD
Symptoms must occur before age 12 but after 6 months and be noticed in at least 2 settings, not explained by another disorder
204
Horner's syndrome
Sympathetic innervation to the head, neck, and eye is interrupted somewhere along the 3rd neuron arc
Triad of ipsilateral miosis, eyelid ptosis, and anhidrosis of face and neck (inability to sweat)
Loss of facial flushing in pediatrics
205
Bell's palsy
CN7 issue; flaccid muscles of face unilaterally; impaired ability to raise eyebrows, impaired closure of eye, impaired smile, grin and pursed lip
206
Bacterial meningitis
Triad of fever, neck stiffness, altered mental status
| May have meningococcal rash
207
PD
Decreased emotional display, general motor slowing and stiffness, resting tremor, soft and muffled speech, history of falling
208
MS
Fatigue, depression, emotional instability, epilepsy, memory loss, diplopia, sudden vision loss, facial palsy, dysphagia, muscle weakness and spasm, vertigo, falls, bladder/bowel incontinence
Optic disc swelling or pallor, nystagmus
209
lidocaine injection test for rotator cuff
If complete resolution of pain--impigement syndrome rather than rotator cuff
210
MCL injury
Twisting or hyperflexion mechanism of injury, increased pain with stairs, squatting locking or catching, sensation of giving out
211
Paget Disease
Frequently asymptomatic; resting or nocturnal bone pain; hearing loss; headaches; head enlargement; pathologic fractures and muscle weakness
CVA tenderness from renal calculi
Serum alkaline phosphatase elevated
212
With fatigue, pay particular attention to
Thyroid + lymph system, arrhythmias or murmurs, skin changes, neurologic system
213
Addison's disease
Chronic, progressive, hypofunctioning of the adrenals caused by atrophy or destruction of adrenal cortex
Hyperkalemia + hyponatremia
Cortisol deficiency leads to hypoglycemia
214
How can you alleviate restless leg syndrome symptoms
eliminate tobacco and alcohol and add exercise to daily routine
215
Myasthenia gravis
Limb weakness and fatigability of affected muscles diagnostic sign
Ocular, facial, masticatory and pharyngeal muscles most affected
Sustained activity increases weakness; symptoms improve with rest
Administer edrophonium chloride to test
216
ALS
muscle weakness and atrophy usually starting in the hands and progressing randomly and asymmetrically
217
Cushing Disease
Excess cortisol and corticosteroid hormones due to adrenal tumors, pituitary adenomas, administration of steroids
Amenorrhea and hirsutism may be first symptom
Moon face + buffalo hump + central obesity
Purple striae around thighs. breasts and abdomen
Dx: give IV dexamethasone at bedtime and check cortisol levels 8-10 hours later
218
Weight loss is significant if
>5% of the usual body weight over 6-12 month period
219
Top differential dx for weight loss
diabetes, digestive disease, thyroid disease, depression
220
Signs of malnutrition
dry skin and hair, pale conjunctivae, glossitis, bruising, lethargy, decreased vibratory sensation, decreased DTR, bone demineralization, muscle wasting
221
Hemolytic uremic syndrome
Triad of microangiopathic hemolytic anema, thrombocytopenia, and uremia
222
Cholecystitis/cholelithiasis
Episodic RUQ pain radiating to back, worse pain after meal high in fat, /V, indigestion with bloating
Positive murphy's sign, fever, jaundice, RUQ pain
223
Cirrhosis
Fatigue, malaise, weakness, anorexia, weight loss, RUQ pain, irregular menses, ED, tea colored urine, clay colored stools, abdominal swelling, spider angiomas, ecchymosis, hepatomegaly, splenomegaly, pitting edema, muscle wasting
224
Pancreatitis
Acute onset of epigastric pain which may radiate to back, N/V, alcohol use, history of gall stones, abdominal trauma
Epigastric tenderness, decreased bowel sounds, jaundice, percussive dullness in lungs, flank discoloration, elevated lipase levels
225
PUD
Epigastric gnawing or burning pain after meals or on empty stomach, nocturnal pain, heartburn, loss of appetite
226
Diverticulitis/diverticulosis
Abdominal pain, dull and colicky primarily in LLQ, exacerbated by eating and bowel movement, diarrhea or constipation, anorexia, N/V, dysuria or frequency, hematochexia, melena
Rebound tenderness in LLQ
227
When does bacterial gastroenteritis develop
6-24 hours after ingestion of contaminated food
228
Crohn disease
Fatigue, fever, weight loss, prolonged idarrhea, perianal disease, cramping abdominal pain
Rectal bleeding
229
Ulcerative colitis
Bloody diarrhea, cramping rectal pain, abdominal pain, rectal urgency, fecal incontinence
230
Chlamydia
White discharge, pain with urination, urgency to urinate, abdominal and genital pain
231
Gonorrhea
yellow, green or white thick discharge, pain with urination, urgency to urinate, abdominal and genital pain
232
Trichomoniasis
Itching to genitals, burning with urination, yellow or green or white discharge, urgency to urinate
233
Herpes
Flu like symptoms, small and painful blisters on mouth or genitals
234
Hepatitis B
flu like symptoms, tiredness, yellowing skin, dark urine, light stool
235
Galactorrhea
Milky discharge not associated with pregnancy usually bilaterally
Check breasts and visual fields
May be due to pituitary gland overproduction
236
Mastitis
Fever, N/V, breast tenderness, swelling, redness, malaise
237
Balanitis
Pain, drainage, dysuria, odor, ballooning of foreskin when voiding, redness
Erythema, tenderness, edema, discharge, ulceration, plaque
238
Varicocele
Scrotal pain and heaviness
Feeling of bag of worms in scrotum
Can cause infertility
239
Hydrocele
Acute or chronic swelling of scrotum or inguinal canal; usually painless; feeling of heaviness; edema of scrotum or inguinal canal that transilluminates
240
Spermatocele
Smooth, soft, well-circumscribed mass at head of epididimysis that will transilluminate
241
Epididymitis
Scrotal pain and swelling usually unilateral; have have discharge
Epididymis very tender and asymmetric
Usually due to STD
242
Testicular torsion
Acute onset of pain, often during inactivity; N/V; enlarged, erythemic, painful scrotum ; testicular swelling; severe testicular pain; testes may be high in the scrotal sac
Contraction of cremasteric muscle during trauma, exercise, cold and sex may precede
243
Endometriosis
Dysmenorrhea, dyspareunia, chronic pelvic pain that worsens with menstruation, hematochezia, abdominal distention
Focal pain and tenderness on pelvic exam; pelvic mass present; immobile pelvic pain
244
Hemorrhoids
Bright red rectal bleeding, constipation or diarrhea, straining with defecation
May report itching
Can be associated with pregnancy, liver disease, HTN, constipation
245
BV
abnormal vaginal discharge, fishy odor
246
Yeast infection
Itching, burning, irritation, dyspareunia, white and thick discharge that may look like cottage cheese , may smell like bread
247
Trichomonias
Abnormal discharge, itching, burning, postcoital bleeding
| Greenish discharge with amine odor may be seen
248
PID
Lower abdominal pain, pelvic pain that is dull, crampy, bilateral and constant; worse pain with exercise, coitus or motion; new or abnormal discharge; fever, chills, cramping, low back pain, postcoital vaginal bleeding
Fever and lower abdominal pain with cervical motion tenderness on pelvic exam
