Final Flashcards
(126 cards)
1
Q
what does pressure difference of 10-15 mmHg or more in UE suggest?
A
- subclavian steal syndrome
- aortic dissection
2
Q
what does HTN in UE and low BP in LE suggest
A
- coarctation of aorta
- occlusive aortic disease
3
Q
what happens if BP cuff is too narrow
A
- BP reading is falsely high
4
Q
what happens if BP cuff is too wide?
A
- in small arm get low BP reading
- in large arm get high BP reading
5
Q
CN I
A
- olfactory N
- Make sure both nasal passages are patent
- Have pt close eyes, occlude one nostril
- have pt smell and ID familiar substance
6
Q
CN II
A
- optic N
- Test visual acuity- each eye separately and both eyes together
- Inspect size of pupils
- test visual fields
- view with opthalmoscope
7
Q
CN III, IV, VI
A
- extra-occular movements
- check 6 cardinal fields of gaze
- convergence
- nystagmus or ptosis
8
Q
CN V
A
- corneal reflexes, facial sensation, jaw movements
- Motor function- clench jaw while palpating temporal and masseter muscles, move jaw from side to side
- Sensory- use a sharp and dull object to test for sensation on forehead, cheeks and chin
- if sensory loss check- temperature sensation
- corneal reflex with wisp of cotton
9
Q
CN VII
A
- facial N
- raise both eyebrows, frown, close both eyes tightly, show upper and lower teeth, smile, puff out both cheeks
10
Q
CN VIII
A
- vestibulocochlear N
- whispered voice test
- weber and rinne if abnormal
11
Q
CN IX and X
A
- glossopharyngeal n and vagus n
- swallowing and rise of palage, gag reflex
- Listen for hoarseness
- difficulty swallowing?
- Ask patient to say “Ah” and watch movements of soft palate and pharynx
- assess gag reflex
12
Q
CN XI
A
- spinal accessory n
- Assess for atrophy or fasciculations
- turn head against your hand
- shrug both shoulders upwards against your hands
13
Q
CN XII
A
- hypoglossal n
- tongue symmetry, position, and movement
- Listen to articulation of patients words
- Assess movement of tongue and look for atrophy or fasciculations
14
Q
hyperopia
A
- farsightedness
15
Q
myopoia
A
- nearsightedness
16
Q
presbyopia
A
- aging vision
17
Q
scotoma
A
- blind spot
18
Q
diplopia
A
- double vision
- causes: lesion in brainstem or cerebellum, weak/paralyzed muscles
19
Q
ptosis
A
- drooping of upper eyelid
- causes- Horner’s, weak muscles, congential
20
Q
entropion
A
- inward turn of eyelid
21
Q
ectropion
A
- outward turn of eyelid
22
Q
lid retraction + exopthalmos
A
- wide stare with protrusion of eyeball
- occurs in hyperthyroidism, graves, tumor
23
Q
pinguecula
A
- yellowing triangular nodule in conjunctiva next to iris
- due to aging
24
Q
hordeolum
A
- aka stye
- painful tender infection of gland at lid margin
25
xanthelasma
- slightly raised, yellow, well demarcated plaque on nasal portion of eyelid
- common in lipid disorders
26
chalazion
- blocked meibomian gland
| - points inside eyelid
27
episcleritis
- localized inflammation of episcleral vessels
| - occurs in RA, sjogrens, herpes zoster
28
dacryocystitis
- inflammation of lacrimal sac
- swelling between lower eyelid and nose
- prominent tearing
29
arcus senilus
- corneal acrus
- thin grey circle close to edge of cornea
- normal aging process
- hyperlipoproteinemia
30
kayser- fleischer ring
- Cu depositon
- golden/ brown ring in periphery of cornea
- occurs in wilson's disease (mutation in chromosome 13)
31
corneal scar
- greyish white opacity in cornea secondary to injury or inflammation
32
cataracts
- opacity of lens through pupil
| - due to old age, smoking, DM, steroids
33
pterygium
- triangular thickening of bulbar conjunctiva growing outward toward cornea
34
peripheral cataract
- spoke like shadows
35
CN III paralysis
- dilated pupil is fixed
- ptosis if eyelid
- lateral deviation of eye
36
argyll robertson pupils
- small, irregular pupils
- accommodate light but do not react to it
- d/t CNS syphilis
37
hypema
- blood in anterior chamber
38
hypopyon
- pus in anterior chamber
39
lagopthalmos
- inablity to close eyelids
| - CN VII issue
40
coloboma
- cat eye
41
keratoconus
- thinning of cornea
42
iritis
- inflammation around iris
| - marked photosensitivity
43
mydriasis
- dilation of pupil
44
sensorineural hearing loss
- issue in inner ear, nerve conduction to brain
| - trouble understanding speech
45
conductive hearing loss
- problem in middle/ external ear
| - noise may help hearing
46
tinnitus
- perceived sound with no external stimulus
47
rhinitis medicamentosa
- drug induced rhinitis
48
epistaxis
- nose bleed
49
goiter
- enlarged thyroid
| - assoc with increased or decreased function
50
vertigo
- perception that pt or environment is spinning
51
lightheadedness
- sx worse/ start when sitting or standing
52
presycope
- feeling of passing out
53
disequilibrium
- feeling unsteady or losing balance
54
PE findings for glaucoma
- crescent shadow suggests narrow angle glaucoma
| - cup: disc ratio > 3:1
55
normal IOP
- 10-22 mmHg
56
gold standard for IOP measurement
- goldman applanation tonometer
57
marcus gunn pupil
- aka afferent pupillary defect
- swinging light in abnormal eye -> partial dilation of both pupils
- swinging light in normal eye -> consensual constriction
- due to afferent and efferent stimuli reduction -> net dilation
58
Adie's tonic pupil
- pupil is large, regular
- unilateral
- rxn to light is reduced/ slowed/ absent
59
adventitious breath sounds
- additional or superimposed breath sounds
| - will not be heard if there is enough gas exchange
60
crackles
- brief
| - aka rales
61
wheezes
- high pitched
| - suggest narrow airways
62
rhonci
- low pitched
- suggest large airways
- usually heard on inspiration
63
stridor
- high pitched inspiratory noise from severe subglottic or tracheal obstruction
64
what do transmitted breath sounds suggest?
- air filled lungs have become airless/ consolidated
65
when is tactile fremitus decreased
- obstructed bronchus
- COPD
- pneumothorax
- pleural effusion
- fibrosis
- tumor
66
when is tactile fremitus increased
- pneumonia
67
when is percussion to thorax dull
- consolidation/ pneumonia
- atelectasis
- pleural effusion
68
when is percussion to thorax hyper-resonant
- pneumothorax
- COPD
- asthma
69
a wave
- JVP corresponding to atrial contraction
| - immediately precedes S1
70
when is a wave increased
- increased resistance to R atrial emptying
- decreased RV compliance- RVH, COPD, restrictive CMP, pulm valve stenosis
- tricuspid stenosis
71
when is a wave absent
- a fib
| - junctional/ ventricular rhythms
72
when is a wave intermittent
- cannon a waves
- AV dissociation
- v tach
73
grade 1 murmur
- very faint
- listener must be "tuned in"
- may not be heard in all positions
74
grade 2 murmur
- quiet but immediately herad
75
grade 3 murmur
- moderately loud
76
grade 4 murmur
- loud with palpable thrills
77
grade 5 murmur
- very loud with thrill
| - may be heard with stethoscope partially off chest
78
grade 6 murmur
- very loud with thrill
| - may be heard with stethoscope entirely off chest
79
aortic stenosis
- systolic murmur
- heard best when pt sits and leans forward
- Location- 2nd and 3rd interspace
- Radiation- carotid, down left sternal border and apex
80
HOCM
- systolic murmur
- heard best with squatting and valsalva
- Location- left 3rd and 4th interspaces
- Radiation- down left sternal border to apex
81
mitral regurg
- holosystolic murmur
- doesn’t change with inspiration
- can have S3
- Location- ape
- Radiation- L axilla
- If loud associated with apical thrill
82
pulmonic stenosis
- crescendo-decrescendo systolic murmur
- can have thrill
- Location- left 2nd and 3rd interspaces
- Radiation- if loud towards L shoulder and neck
83
tricuspid regurg
- holosystolic murmur
- increases with inspiration
- Lower L sternal border
- if RV pressure is high and V is enlarged murmur is loudest at apex and may be confused for mitral regurgitation
- Radiation- R sternum, xiphoid area, L midclavicular line
84
VSD
- holosystolic murmur
- usually with thrill
- Location- left 3rd, 4th and 5th interspaces
- Radiation- usually wide
- Smaller defect= louder murmur
85
aortic regurg
- decrescendo diastolic
- heard best leaning forward with exhalation
- Location- L 2nd to 4th interspaces
- Radiation- if loud, to apex
86
mitral stenosis
- decrescendo diastolic
- opening snap after S2
- use bell
- heard best in LLD with hand grips and exhalation
- Location- usually limited to apex
- Radiation- none
87
venous hum
- continuous humming murmur
- loudest in diastole
- listen with bell
- Location- above medial third of clavicles especially on right
- Best heard when pt is sitting, disappears in supine
- Radiation- left 1st or 2nd interspaces
88
pericardial friction rub
- sounds close to the stethoscope
- best with pt leaning forward with exhalation
- Location- usually heard best in 3rd interspace next to sternum
- Radiation- minimal
- Quality- scratchy, scraping, grating
89
PDA
- machine like
- sometimes with thrill
- Location- 2nd left interspace
- Radiation- L clavicle
90
S3 sounds
- ventricular gallop
- brief mid-diastolic
- physiologic in kids, young adults, and in 3rd trimester
91
S4 sounds
- atrial gallop
- right before systolic apical beat
- marks atrial contraction
- due to increased resistance to filling
92
L sided causes for S4
- HTN heart disease
- myocardial ischemia
- aortic stenosis
- CMP
93
R sided causes for S4
- pulm HTN
| - pulmonic stenosis
94
special tests for ascites
- shifting dullness
- fluid wave
- ballottement
95
shifting dullness
- percuss for dullness while pt is supine
- have pt to turn on side, percuss and mark borders of dullness
- In pt with ascites → tympany shifts to top
96
fluid wave
- ascites test
- pt press side of hand on midline of abdomen
- tap one flank and feel opposite flank for impulse
97
ballottement
- test for ascites
- straighten and stiffen fingers, make brief jabbing motion
- will displace fluid
98
special tests for appendicitis
- McBurney's point tenderness
- Rosving's sign
- psoas sign
- obuterator sign
99
McBurney's point tenderness
- for appendicitis
- 2in from ASIS
- check for guarding, rigidity, rebound tenderness
100
Rosving's sign
- for appendicitis
| - press in LLQ → RLQ pain if positive
101
Psoas sign
- for appendicitis
- place your hand above R knee → pt raise thigh against resistance
- OR
- turn pt on L side → extend R leg at hip →
- Positive: abdominal pain
102
obturator sign
- test for appendicitis
- flex pt R hip with knee bent then internally rotate hip
- Positive: R hypogastric pain
103
murphys sign
- for cholecystitis
- hook fingers under costal margin
- ask pt to take deep breath
- Positive: sharp increase in tenderness and sudden stop of inspiration
104
visceral pain
- Distension/ stretching of hollow abdominal organs
- Typically palpable near midline
- Varying quality- gnawing, burning, cramping, aching
- Sweating, pallor, n/v, restlessness when severe
105
parietal pain
- a/w inflammation, parietal inflammation
- Steady, aching pain- usually worse than visceral
- More precisely localized over structures
- aggravated by movement or coughing
- prefers to lie still
106
referred pain
- Felt in distant sites that are innervated at roughly the same spinal level
- May be felt superficially or deeply, usually localized
- Pain in abdomen may be referred from chest, spine, or pelvis
107
traube's space
- left lower anterior chest wall, from the border of cardiac dullness at the 6th rib to the anterior axillary line and down to the costal margin
108
RTC tendinitis
- repeated shoulder motion that can cause edema & hemorrhage followed by inflammation
- usu supraspinatus tendon
- PE: tenderness just below the tip of the acromion
109
RTC tear
- usu from fall, trauma, repeated impingement
- most common clinical problem of the shoulder
- complete tear normally has impaired active abduction and forward flexion
- pos drop arm test
110
apley scratch test
- Testing overall shoulder rotation
- Touch opposite scapula from top (ER) and bottom (IR)
- Pain suggest a rotator cuff disorder
111
painful arc test
- Fully adduct pt’s arm from 0-180 degrees
- Positive: shoulder pain from 60-120 degrees
- subacromial impingement/ rotator cuff tendinitis disorder
112
neer impingement sign
- Raise pt’s arm while pressing on the scapula to prevent movement
- compresses greater tuberosity against the acromion
- Positive: pain
- subacromial impingement/ rotator cuff tendonitis disorder
113
hawkins impingement sign
- Flex pt’s shoulder & elbow to 90 with palm facing down
- rotate arm internally
- compresses the greater tuberosity against the supraspinatus tendon & the coracoacromial ligament
- Positive: pain
- supraspinatus impingement/ rotator cuff tendinitis
114
drop arm test
- abduct arm to 90 and lower it slowly
- pos- weakness
- supraspinatous tear
115
empty can test
- Elevate arms to 90 & IR arms w/ thumbs pointing down
- pt resist as you push arms down
- Positive: inability for pt to hold the arms fully abducted at shoulder level or control lowering of arm
- supraspinatus rotator cuff tear
116
what is the most common type of knee bursitis
- pes anserine
117
when is babinski transiently positive
- unconscious states from drug or alcohol intoxicatino
| - postictal periods following seizures
118
upper motor neuron lesions
- hypertonia
- hyperreflexia
- no fasciculations
- no atrophy
- + babinski
119
lower motor neuron lesions
- hypotonia
- hyporeflexia
- fasciculations
- atrophy
- normal plantar reflex
120
guiding questions for neuro exam
- is mental status intact?
- are your findings symmetric?
- where is lesion? central vs. peripheral vs. both
121
don'ts assoc with assessment of comatose pt
- dont dilate pupils- single most important clue for underlying cause of coma
- dont flex neck
122
facial paralysis due to peripheral lesion
- paralyze entire half of face including forehead
- only half of forehead wrinkles
- eyebrows dont raise
- eyes no dont close and eyeballs roll up
- i.e. bells palsy
123
facial paralysis due to central lesions
- paralyze lower face but cortical innervation to forehead is preserved
- entire forehead wrinkles
- eyebrows raise
- eyes close but with weakness
- i.e. cerebral infarction
124
components of NS
- mental status
- cranial nerves
- motor system
- sensory system
- deep tendon, abdominal, and plantar reflexes
- coordination
125
normal 2 point discrimination in fingertips
- 2- 5 mm
126
dysdiadochokinesis
- Abnormal rapid alternating movement where finger tips touch thumb
