exam I Flashcards
(88 cards)
1
Q
ligamentum trite
A
bleeding above this will be melena, below will be red
2
Q
visceral pain
A
aka colic
comes and goes, crescendo/decrecendo
not well localized
3
Q
parietal pain
A
steady ache, well localized
4
Q
kurrs sign
A
spleen referred pain to left shoulder
5
Q
pancreas referred pain
A
right shoulder
6
Q
expose abdomen
A
from xiphoid to pubic symphisis
7
Q
bowel sounds
A
normal- high pitched ‘tinkle’ about every 3-5 seconds
no sounds for 2 minutes- report as absent
8
Q
borborygmi
A
increased hyperactive bowel sounds
low pitched rumbling
hyperperistalisis
9
Q
percussion of abdomen
A
tympany over intestines
dull over liver
10
Q
liver
A
should be less then 10 cm along MCL
11
Q
Fluid wave
A
place patients or assistants hand in midline
tap on one flank and palpate w/the other hand, easily detected impuse indicative of ascites
12
Q
shifting dullness
A
percuss the patient on their back and then their side, where the sound changes from tympany to dull and the shift of the sound when patient on their side
shift indicative of ascites
13
Q
rebound pain
A
peritoneal tenderness and inflammation
Rovsing sign- referred rebound tenderness test LLQ but get pain in RLQ
14
Q
palpation of liver
A
under right 11th and 12th rib
15
Q
palpation of spleen
A
under left 11th and 12th ribs
16
Q
Llyods sign
A
CVA (costovertebral angle) tenderness during kideny percussion
17
Q
obturator sign
A
place right lef in figure 4 press on right knee while holding down left iliac crest- appendicitis
18
Q
appendicitis
A
annorexia!! nausea, vomiting pain rovsing sign psoas pain obturator sign
19
Q
lower abdominal pain
A
MUST DO RECTAL
PREGNANCY EXAM IN FEMALES
20
Q
murphys sign
A
RUQ pain, sudden arrest of inspiration during palpation of liver and gallbladder -> acute cholecytitis
21
Q
diagnostic tirad
A
RUQ pain, fever, and leukocytosis ->acute cholecystitis
22
Q
five ‘f’s
A
female, fat, fertile, fair, flatulent -> acute cholecytitis
23
Q
newborn
A
0-28 days
24
Q
infancy
A
0-12
25
toddler/early childhood
1-4 yrs
26
school-aged/middle childhood
5-10
27
adolensence
11-20, subdivided into early, middle, late
28
APGAR
```
A- appearance
P-pulse
G- grimace
A- activity
R-respiratory effort
assesses neuroglogic recovery
each rated on a 0-3, 3 the best
done at 1 and 5 minutes
```
29
shortly after delivery
erythromycin ointment in eyes, prevents infection
vitamin K injection to prevent bleeding
full bath
30
ballard scoring system
to determine gestational age
nueromuscular -1-5
physical maturity -1-5
add both categories and use scale to get age
this considered more accurate then mom n dads dates
31
normal birth weight
>2,500 grams
32
weight
normal to loose up to 10% in first week
| should be gained bak in 10-14 days of life
33
voiding
3-4 in first 1-2 days by day 5-5 should see 6-8 in 24 hours
34
stooling
initial stools are meconium, w/in first 24 hours of life, dark black, tarry
by day 4-5 stool changes depending on diet
35
jaundice
transcutaneous bilimeter or serum w/in 24 hours
elevated levels with in first 24 hours more concerning
photobathing
36
hospital discharge
vaginal 2-days
c-section 3 days
given hep B, hearing screen, neonate screening blood test, circumcision
37
follow up
24-48 hours
weight?
bilirubin?
38
well visits
```
3-4 days of life
2wks (not in all states)
1mo
2mo
4mo
6mo
9mo (check hemoglobin)
12mo
```
39
components used to assess development
physical (gross and fine motor)
language/cognative
personal/social
40
language
2 months- cooing
6 months- babbling
1yr- 1-3 words
41
palmar grasp
place finger in hand and press, fingers curl around your finer, disappear by 4 mo
42
plantar grasp
touch sole at base of toes -> toes curl
| gone by 9m
43
rooting
stroke perioral skin at corner of mouth-> mouth opens and turn head towards stimulation
gone by 3-4 mo
44
hip exam
use barlow and ortolani maneuvers to test for signs of dislocation
DHD- developmental hip dysplasia, need imaging to diagnose
tests are reliable up to 3mo, but then hip capsule tightens, other signs -> galeazzi
45
ortolani test
posterior hip dislocation
| externally rotate with fingers underacetabulum pushing anterior, will put it back in place
46
barlow
`tests for ability to sublux intact, but unstable hip
| internally rotate pushing acetabulum posterior, will dislocate
47
stills murmur
grade II, musical, vibratory midsystole, worse when patient supine
48
venous hum
sof continuous, louder in diastole
49
carotid bruit
midsystolic, louder on left, eliminated by carotid compression
50
tanner breast
1- preadolescent, elevation of nipple only
2-elevation breast, nipple small mound
3- further enlargement of breast/areola, no separation of contour
4- projection of areola/nipple to form secondary mound
5- mature, projection of nipple only
51
tanner female pubic hair
1- preadolescent, no hair except for fine body hair
2- sparse growth of long slightly pigmented downy hair, straight or slightly curly, along labia
3-darker, curlier, spreading to pubic sympthysis
4- course and curly hair, not yet on thigh
5- spread out onto inner thigh
52
tanner-male 1
1- preadolescent, no hair, penis/testes same size as childhood
53
tanner- male 2
2-pubic hair sparse slightly pigmented, penis slight to no enlargement, testes/scrotum larger, slightly reddened
54
tanner male 3
3- pubic hair darker, coarser, curlier, localized, penis larger in length, testes further enlargement
55
tanner male 4
4-pubic hair coarser, curlier, not yet on thighs
| further enlargement length, breadth w/developement of glands
56
tanner male 5
5- pubic hair spread to thigh, penis/scrotum adult size and shape
57
when do you start doing exam on parents lap
9 months, this is when they develop a sense of strangers
58
head circumfrence
measured until 36 months
59
vaccines by 6 months
- Hepatitis B (Hep B)
- Rotavirus (RV)
- Diphtheria, tetanus, acellular pertussis (DTaP)
- Haemophilus influenza type B (HIB)
- Pneumococcal (PCV)
- Inactivated poliovirus (IPV)
- Influenza
60
vaccines by 12 months
- Measles, mumps, rubella (MMR)
- Varicella
- Hepatitis A (Hep A)
61
puberty begins
8-13 females
| 9-13.5 males
62
early adolescences
```
10-14
puberty begins
concrete operational
focus on present
'am I normal'
independence/ambivalence
```
63
middle adolescence
15-16
physical- females more comfortable, males more awkward
transitional- many ideas
begin to develop insight, reflect on thoughts/feelings of others
'who am i' introspective
independence, rebellious, push boundaries
64
late adolescence
```
17-20
adult appearance
formal operative
identify self w/respect to others
independence from family
```
65
adrenarche
Activation of adrenal medulla for production of adrenal androgens
Occurs before the onset of puberty
66
Gonadarche
Earliest gonadal changes of puberty-GnRH released
Boys-LH stimulates testosterone production and FSH stimulates sperm maturation
Girls-FSH stimulates estrogen & follicle formation and LH stimulates corpus luteum after ovulation
67
Thelarche
Beginning of breast development at puberty
68
Pubarche
Beginning of pubic hair
69
Ab pain thru 1yr
- Colic
- Gastroenteritis
- Constipation
- Urinary tract infection
- Intussusception
- Volvulus
- Incarcerated hernia
- Hirshsprung’s Disease
70
Ab pain 2-5 yrs
- Gastroenteritis
- Trauma
- Appendicitis
- Pharyngitis
- Constipation
- Urinary tract infection
- Intussusception
- Sickle cell syndrome
- Henoch-Schonlein purpura
- Volvulus
- Mesenteric lymphadenitis
71
ab pain 6-11 yrs
- Gastroenteritis
- Trauma
- Appendicitis
- Pharyngitis
- Constipation
- Urinary tract infection
- Pneumonia
- Sickle cell syndrome
- Henoch Schonlein purpura
- Functional pain
- Mesenteric lymphadenitis
72
ab pain 12-18 yrs
- Appendicitis
- Gastroenteritis
- Constipation
- Dysmenorrhea
- Mittelschmerz
- Pelvic inflammatory disease
- Threatened abortion
- Ectopic pregnancy
- Ovarian/testicular torsion
73
things that cause mesenteric lymphadenitis
```
Beta hemolytic streptococcus
Staphlococcus species
E. coli
Streptococcal viridans
Yersinia species (most cases currently)
Mycobacterium tuberculosis
Viruses
Coxsackievirus A & B
Rubeola virus
EBV
Adenovirus serotypes 1,2,3,5 & 7
```
74
labs to run if jaudice w/in 24 hours
```
Sepsis panel
CBC, CMP, DIC panel
Rubella abs
Toxo abs
Coombs test
ABO/Rh typing
CBC/Retic count
Periph smear
Fractionated bilirubin level
```
75
labs to run if jaundice in a 24hours-2wks
```
Fractionated bilirubin level
Includes direct and indirect
(conjugated &unconjugated)
CBC
Retic count
Peripheral smear
```
76
labs to run if jaundice after 2 wks
```
CBC/retic
Fractionated bilirubin level
Urine bili levels
Thyroid studies
Sepsis eval
Genetics for metabolic disorders
```
77
phimosis
cannot retract foreskin back over penis
| hygiene issues root cause
78
Paraphimosis
cannot pull foreskin back around glans
79
Cryptorchidism
undescended testicles
80
syphillis
causative organism Treponema pallidum
Syphilitic Chancre – painless round or oval erosion or ulcer. Non-tender enlarged inguinal lymph nodes are common.
RPR and VDRL are positive, screening test, many false positives.
FTA- ABS is positive or Dark Field Microscopy, confirmatory test.
81
Genital Herpes
cluster of small vesicles. Burning and painful. Progress to ulcers on a erthymic base.
Dx – viral culture of the fluid in the vesicle.
Herpes simplex virus 1 and 2 need serological testing to determine which one
82
Venereal warts
(Condyloma acuminatum) - caused by HPV (human papillomavirus. Grow in clusters.
Difficult to treat – cryosurgery, laser surgery, electrosurgery, podophyllin, Aldara(imiquimod), surgery.
83
Genital Scabies
Genital Scabies:
- Contagious disease caused by a mite (Sarcoptes scabiei)
- Direct skin contact.
- Nocturnal pruritus is very characteristic progressing to intense pruritus.
- Linear, curved or s-shaped burrows.
- Diagnosis: clinical suspicion, slide mount preparation.
- Treatment: Permethrin cream (Elimite), Lindane; oral steroids or antihistamines for pruritus.
84
Gonococcal Urethritis
purulent discharge
Gram-negative intracellular diplococci of GC
WBC = neutrophils
85
axillary tail drains to
subscapular grp of axillary nodes
86
upper breast drains to
subclavicular nodes
87
medial beast drains to
submammary plexus of the opposite
breast
lymph glands along the internal thoracic artery -> mediastinal nodes
88
inferior breast drains to
lymp of ab wall and to extraperitoneal lymph
