General Diagnosis 1 Flashcards by Angela Newland

Health History includes the following:

Chief Complaint
Past Health History
Personal & Social History
Review of Systems

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This covers the reason the patient is seeking care & should be obtained in the patients own words

Chief Complaint history

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Present Illness: the attributes of a symptom should include:

O - onset
P - palliative/provoking
Q - quality of pain
R - radiation/referral
S - site/severity/setting
T - timing

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Past Health History should include:

Serious Illnesses
Previous Injuries
Hospitalizations
Surgeries
Medications
Allergies
Immunizations - Measles DPT (Guillian Bar)

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Family Health History should include:

CVD
Diabetes
Stroke
Cancer

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Social/Personal History should include:

Marital Status
Occupation
Diet
Exercise
Bowel/Urinary patterns
Sleep
Alcohol, Tobacco & Drug Use
Stress

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If information is acquired during the history that indicates alcoholism, move to the CAGE questions:

C - Cutting down (felt the need to cut down your drinking?)
A - Annoyed by criticisms of others
G - Guilty feelings about drinking
E - Eye Openers (felt need for morning eye opener drink)

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A general exploration of the various organs systems of the body

Review of Systems

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What type of scale should you use to take height & weight?

Standing platform scale w/ height attachment

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Temperature: Normal Values- Oral- Rectal & Tympanic- Axilla- Range

Oral: 98.6*
Rectal & Tympanic: 99.6*
Axilla: 97.6*
Range: 96.0-99.5* (35-37.5*C)

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Pulse: Normal Values:- Adults- Newborns- Elderly

Adults: 60-100
Newborn: 120-160
Elderly: 70-80

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Respiratory Rate: Normal Values:

Adult
Newborn

Adult: 14-18
Newborn: 44

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Blood Pressure: Normal adult values

90-120 / 60-80

values increase in the elderly

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Hypertension & Hypotension

Hypertension: over 140/90
Hypotension: under 90/60

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What do you need to check for in a hypertensive patient?

Auscultatory Gap (by taking a palpatory systolic reading)

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The loss or reappearance of the pulsatile sound while listening with the stethoscope during cuff deflation

Auscultatory Gap

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Low pitched sounds produced by turbulent blood flow in the arteries

Korotkoff Sounds

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What does a difference of 10-15mmHg in systolic readings indicate?

Arterial Occlusion such as Subclavian Steal Syndrome on side of decreased value

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Blood pressure readings are _____ higher in lower exteremities

20%

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What are some tests for Vertebrobasilar Artery Insufficiency?

Barre-Lieou
DeKleyn’s
Hallpike
Hautant’s
Underberg
Maigne’s

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Test for Vertebrobasilar Artery Insufficiency:
Pt seated, examiner instructs pt to rotate head maximally from side to side. Done slowly at first than accelerated to pts tolerance.

Barre-Lieou

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Test for Vertebrobasilar Artery Insufficiency:
Pt supine, examiner instructs pt to rotate and extend head off the table then turn to each side for 15-45 seconds. Dr can lend minimal support

DeKleyn’s

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Test for Vertebrobasilar Artery Insufficiency:
Pt supine, head extended off the table. Examiner offers support for the skull. Examiner brings head into extension, rotation & lateral flexion

Hallpike

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Test for Vertebrobasilar Artery Insufficiency:
Pt seated, arms are extended forward to shoulder level with hands supinated. Maintain position for a few seconds. Pt then closes the eyes, rotates & hyperextends the neck to one side. Repeated to opposite side.

Hautant’s

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Test for Vertebrobasilar Artery Insufficiency: Pt stands with eyes open, arms at side, feet close together. Pt closes eyes, extends arms & supinates hands, then pt extends & rotates head to one side. Then in this position pt is instructed to march in place.

Underberg

Test for Vertebrobasilar Artery Insufficiency: | Pt seated, examiner brings head extension & rotation

Maigne's

Eyebrows: - Scaly indicates _____ - Loss of Lateral 1/3 indicates _____ - Quantitative loss is normal with age

Scaly = seborrhea | Loss of Lateral 1/3 = Myxedema

Sluggish pupillary reaction to light that is unilateral & caused by parasympathetic lesion of CN III

Adie's Pupil

Unequal pupil size

Anisocoria

Bilaterally small & irregular pupils that accommodate but do not react to light. Seem with Syphilis (prostitutes pupils)

Argyll Robertson

Sluggish pupillary reaction due to hypo-adrenalism (Addison's Disease)

Arroyo Sign

Inflammation of the eyelid seen with seborrhea, staph infection & inflammatory processes.

Blepharitis

Opacities seen in the lens that are commonly seen with diabetes and in the elderly. Also has an absent red light reflex.

Cataracts

An infection of the meibomian gland causing a nodule which points inside the lid.

Chalazion

What do different colors of the Conjunctive indicate? - Pink - Pale - Bright Red

Pink = normal Pale = anemia Bright Red = infection

Grayish opaque ring around the cornea

Corneal Arcus

Affects the veins more than arteries & presents with microaneurysms, hard exudates & neovascularization.

Diabetic Retinopathy

Lid is turned outward. MC seen in elderly

Ectropion

Lid is turned inward. MC seen in elderly

Entropion

Lid lag/failure to cover the eyeball. Can be seen with graves (bilateral) or tumor (unilateral)

Exophthalmosis

Increased intraocular pressure causing cupping of the optic disc (cup to disc ratio is >1.2). Pt will notice blurring of their vision especially in the peripheral fields as well as rings around lights. Crescent sign will be present upon tangential lighting of the cornea.

Glaucoma

An infection of the sebaceous glands causing a pimple or boil on the eyelid.

Hordoleum (sty)

Ptosis, Miosis & Anhydrosis on the same side as an interruption to the cervical sympathetics.

Horner's Syndrome

Damage to the retinal vessels/background will show these signs:Copper wire deformity, silver wire deformity, A-V nicking, flame hemorrhages, & cotton wool soft exudates.

Hypertensive Retinopathy

Dilated pupil with ptosis & lateral deviation. Doesn't react to light or accommodation. Multiple Sclerosis.

Internal Ophthalmoplegia

Inflammation of the Iris (colored portion of the eye) seen with Ankylosing Spondylitis.

Iritis/Uveitis

MC reason for blindness in the elderly, central vision lost, macular Drusen is an early sign; yellow deposits under the retina

Macular Degeneration

Fixed & constructed pupils that react to light & accommodate. Seen with severe brain damage, pilocarpine medications & narcotic use.

Miosis

Dilated & fixed pupils seen with anticholinergic drugs (atropine/mushrooms/death)

Mydriasis

Swelling of the optic disc due to increased intracranial pressure. NO visual loss (visual loss with optic neuritis). May be seen with a brain tumor or brain hemorrhage.

Papilledema aka Choked Disc

Swelling around the eye seen with allergies, myxedema & nephrotic syndrome (HEP).

Periorbital Edema

Yellowish triangular nodule in the bulbar conjunctiva that is harmless & indicates aging

Pinquecula

Triangular thickening of the bulbar conjunctiva that grows across the cornea & is brought on by dry eyes

Pterygium

Drooping of the eyelid. Seen with conditions such as horner's, CN III paralysis, Myasthenia Gravis, Multiple Sclerosis

Ptosis

Painless sudden onset of blindness described as curtains closing over vision; lightning flashes and floaters are seen prior to visual loss.

Retinal Detachment

Sclera colors: - White - Yellow - Blue

``` White = Normal Yellow = Jaundice Blue = Osteogenesis Imperfecta ```

Fatty plaques on the nasal surface of the eyelids that may be normal or indicates hypercholesterolemia.

Xanthelasma

Vision Terms: - Normal Vision - Nearsighted - Farsighted - Loss of lens elasticity d/t aging

Emmetropia (normal) Myopia (near) Hyperopia (far) Presbyopia (loss of lens elasticity)

Direct Light Reflex tests what CN?

II & III

Consensual Light Reflex tests what CN?

II & III

Swinging Light Test checks what CN?

II & III & eye pathology

Accommodation tests what CN?

II & III

What is tested with the Snellen eye chart?

Visual Acuity

Cardinal Fields of Gaze tests what CN?

III, IV & VI | SO4,LR6,O3

Benign tumor of CN VIII (called schwannoma). Hearing loss, tinnitus, vertigo, & presence of tumor on CT or MRI.

Acoustic Neuroma

Bacterial infection in the mastoid process. Presents clinically with the same signs & symptoms of acute otitis media, with the addition of inflammation & palpatory tenderness over the mastoid. Hearing loss is commonly associated.

Acute Mastoiditis

An infection of the outer ear. Because this condition is often associated with swimming, especially if the water is contaminated, it is frequently referred to as swimmer's ear. The individual will experience inflammation & pain of the outer ear. Tugging on the pinna will be painful.

Acute Otitis Externa

A brief episode of vertigo brought on by a change of head position. This is diagnosed by having the pt perform the Dix-Hallpike Maneuver. The pt rapidly moves from sitting to supine with head turned 45 degrees to the left & wait 30 seconds. Repeat on right side, if nystagmus is seen (+): nystagmus, nausea, vertigo. Tx: Epley's Maneuver

Benign Paroxysmal Positional Vertigo

Retraction of the tympanic membrane

Eustachian Tube Block

A disorder characterized by recurrent prostrating vertigo, sensory hearing loss, tinnitus, & a feeling of fullness in the ear.

Meniere's Disease

Sensorineural hearing loss that occurs in people as they age & they may be affected by genetic or acquired factors.

Presbycussis

A bacterial or viral infection in the middle ear. The tympanic membrane presents with a red appearance, dilated blood vessels & bulging.

Purulent Otitis Media aka Bacterial Otitis Media

An effusion in the middle ear resulting from incomplete resolution of acute otitis media or obstruction of the Eustachian tube. This condition is usually chronic & the fluid is amber with bubbles.

Serous Otitis Media

Ringing of the Ears

Tinnitus

An abnormal sensation of rotary movement associated with difficulty in balance, gait & navigation of the environment.

Vertigo

Neurological Evaluation of the Ear: | - Normal Hearing: Weber & Rinne?

Normal: - Weber: equal sound heard bilaterally - Rinne: AC>BC (Rinne +)

Neurological Evaluation of the Ear: | - Conduction Hearing Loss: Weber & Rinne?

Weber: Lateralizes to involved ear Rinne: AC

Neurological Evaluation of the Ear: | - Sensorineural Hearing Loss: Weber & Rinne?

Weber: Lateralizes to uninvolved ear Rinne: AC>BC with less time in bad ear

Nasal mucosa appears pale or blue & boggy

Allergic Rhinitis

Thinning of the nasal mucosa with sclerosis, crust formation & foul odor

Atrophic Rhinitis

Typically occur as a consequence of chronic inflammation of the nasal mucosa

Polyps

Nasal mucosa appears red & swollen with a clear runny nose

Viral Rhinitis

Red sores at the corner of the mouth that are angular. | Can be caused by a Vitamin B2 (riboflavin) deficiency.

Angular Stomatitis aka Cheilosis

A deficiency of B-vitamins (B12) or iron that causes the tongue to appear smooth and glossy

Atrophic Glossitis

Thick white fungal patches that are easily scraped off

Candidiasis aka Thrush

Deep furrows on the surface of the tongue that is considered a normal variant.

Fissured Tongue aka Scrotal Tongue

Pre-cancerous lesion of white patches that are adherent to the surface and not easily removed.

Leukoplakia

Excessive production of growth hormone beginning in middle age. Results in abnormal growth in hands, feel & facial bones

Acromegaly

Excessive production of growth hormone prior to skeletal maturation

Gigantism

MC caused by Grave's disease (autoimmune). Thyroid Stimulating Hormone (TSH) production is decreased and the thyroid hormones (triiodothyronine/T3 & thyroxine/T4) are produced in excess.

Hyperthyroidism

Hashimoto's thyroiditis is the MC cause in the USCongenitally it's called "cretinism" & causes a diminished physical & mental capacity

Hypothyroidism aka Myxedema

Weight Loss w/ Increased Appetite Irritable & NervousIntolerance to Heat Moist Skin & Fine Hair

Hyperthyroidism

Weight Gain w/ Decreased Appetite Depression, Weakness & Fatigue Intolerance to Cold Coarse, Dry Hair & Skin

Hypothyroidism

Exophthalmos is associated with what thyroid disease

Hyperthyroidism

Periorbital Edema is associated with what thyroid disease

Hypothyroidism

Possible neck swelling d/t goiter (thyroid condition)

Hyperthyroidism

Macroglossia & loss of lateral 1/3 eyebrows (thyroid condition)

Hypothyroidism

High T3, High T4, Low TSH

Hyperthyroidism

Low T3 & T4, High TSH

Hypothyroidism

- Childhood & early adulthood; females - Unilateral or bilateral - Photophobia, throbbing, worse behind one eye, nausea/vomiting, familial, decreasing w/ advancing age, pregnancy - Provoked by bright light, chocolate, cheese, tension, red wine, menstrual cycle - Follow up: dietary log, adjust, avoid provoking/triggering factors

Common Migraine HA"sick""vascular"

- Childhood & early adulthood; females - Typically UNILATERAL - AURA, photophobia, throbbing, worse behind one eye, nausea/vomiting, familial, decreasing w/ advanced age, pregnancy - Bright light, chocolate, cheese, tension, red wine, menstrual cycle

Classic Migraine HA

- Adult - Occipital Vertex - Throbbing, waking up with HA - Follow up: blood pressure, lipid profile

Hypertension HA

- Adolescent to adults; males - Unilateral, Orbital, Temporal - Wake up at night w/HA, lasts 15-180 minutes, rhinorrhea, lacrimation, facial sweating, red eye, miosis, not aggravated by exertion - Provoked by alcohol, seasonal

Cluster HA

- Any age - "Band-like" - Pressure, muscle tightness - Provoked by: fatigue, tension, stress, work

Muscular Tension HA

- Over 50yoa - Unilateral, Temporal, proximal mm pain/stiff - Persistent burning, aching, throbbing - Provoked by: scalp sensitive, tender - Follow up: ESR elevated, biopsy

Temporal Arteritis (Giant Cell)"Polymyalgia Rheumatica"

- Adult - Occipital, Upper Cervical - Often daily, decreased ROM in upper cervical & occiput, pain in neck referred to head - Provoked by: head mvmt - Follow up: Flexion/Extension X-Rays, Adjust

Cervicogenic aka Vertebrogenic HA

- Any Age - Localized & changes with body position - Steady throb, local tenderness, worse in morning - Provoked by: chronic sinusitis

Sinus HA

- Any age - Basilar area *** - Abrupt onset, constant, stiff neck, excruciating pain like never before experienced - Provoked by: hypertension, stress - Follow up: High BP, Fever

Subarachnoid Hemorrhage

- Any Age - Slow bleed following a trauma - s/s evident days - weeks post injury - Provoked by: Trauma - Follow up: Send to ER

Subdural Hematoma

- Any Age - Any place & changes with body position - Onset morning & evening, mild to severe, throbbing, progressively worse - Provoked by: tumor growth - Follow up: MRI or CT of brain; refer to neurosurgeon

Brain Tumor

- Any Age - Neck - Intense, deep pain, never experienced before, stiff neck - Provoked by: worse in flexion - Follow up: Kernig/Brudzinski CSF tap

Meningeal Irritation

- Generalized HA - Provoked by skipping meals - Follow up: FBS (?)

Hypoglycemic HA

- Any Age - Localized general pain - Loss of memory, visual disturbances - Provoked by: Fall, MVA, whiplash injury, trauma - Follow up: refer to neurologist/ER

Post Concussive HA

Deformities of the Thorax: - AP = Lateral diameter (1:1 ratio) - Seen with COPD & Cystic Fibrosis

Barrel Chest

Deformities of the Thorax: | - Marked depression noted in the sternum (sunken in)

Pectus Excavatum akaFunnel Chest

Deformities of the Thorax: | Forward protrusion of the sternum (like keel of a ship)

Pectus Carinatum akaPigeon Chest

Rapid, shallow breathing

Tachypnea

Slow Breathing

Bradypnea

Characterized by groups of quick, shallow inspirations followed by irregular periods of apnea (no pattern)

Biot's Breathing

Breathing pattern characterized by alternating periods of apnea and hyperpnea (has pattern); Respiratory Acidosis

Cheyne Stokes Respiration

Breathing is first rapid & shallow but as metabolic acidosis worsens, breathing gradually becomes deep, slow, labored & gasping"Air hunger breathing"

Kussmaul's

Unguinal indentations in nails; seen with Psoriasis

Pitted

Subacute bacterial endocarditis (strep organism) in the nails

Splinter Hemorrhage

Transverse ridging associated with acute severe disease in the nails.

Beau's Lines

Inflammation of the nail fold near the cuticle

Paronychia

Nail base has an angle >180* | Hypoxia (early) / COPD (late)

Clubbing

Spoon Nail | Iron deficiency anemia

Koilonychia

How do you palpate for respiratory excursion?

Place hands over posterior ribs & have patient take a deep breath

Palpable vibration when pt says "99"

Tactile Fremitus

Tactile Fremitus: increased with fluid

pneumonia

Tactile Fremitus: decreased with air

Emphysema, Pneumothorax

Tactile Fremitus: decreased with atelectasis and pleurisy because a _____ is created.

Sound Barrier

Tactile Fremitus is increased with...

Pneumonia (fluid)

Tactile Fremitus is decreased with....

Emphysema, Pneumothorax, Atelectasis, Pleurisy

When percussing over lung tissue what tone should you hear if normal?

Resonate

When percussing over lung tissue what causes the tone to be hyperresonant?

Increased air in the chest | Emphysema, Pneumothorax

When percussing over the lung tissue what causes the tone to be dull?

Increased density | Pneumonia, Atelectasis

Dr asks pt to exhale and hold it, percusses down the back in the intercostal margins (bone will be dull), starting below the scapula until the sounds change from resonant to dull. Dr marks this spot.Dr asks pt to take a deep breath in and hold it as Dr percusses down again, marking the spot where the sound changes from resonant to dull again.Dr will measure the distance between the 2 spots.

Diaphragmatic Excursion

If diaphragmatic excursion is less than 3-5 cm, the pt may have...

Pneumonia or Pneumothorax

Auscultation: Breath Sounds: - Duration: inspiration equal to expiration - Location: over trachea

Tracheal

Auscultation: Breath Sounds - Expiration longer than Inspiration - Over Manubrium

Bronchial

Auscultation: Breath Sounds: - Inspiration equal to Expiration - Between 1st & 2nd ribs anteriorly; between scapulae posteriorly

Bronchovesicular

Auscultation: Breath Sounds: - Inspiration longer than Expiration - Remaining lung field

Vesicular

Small clicking, bubbling or rattling sounds in the lung. They are believed to occur when air opens closed air spaces. Can be further described as moist, dry, fine & coarse (Bronchitis)

Rales

Sounds in lung that resemble snoring. | They occur when air is blocked or becomes rough thru large airways (Bronchiectasis)

Rhonchi

High-pitched sounds produced by narrowed airways. They can be heard upon exhalation. Asthma in young people; Emphysema in elderly

Wheezes

Wheeze-like sound heard upon inspiration. Usually d/t blockage of airflow

Stridor

If abnormal breath sounds are heard, proceed with _____

Vocal Resonance (stethoscope)

If clear, distinct sounds are heard as the pt says "99", consolidation is present.

Bronchophony

If you hear "aaaaa" as the patient says "eeeee", consolidation is present.

Egophony

If the words "1,2,3" are heard clearly and distinctly, consolidation is present.

Whispered Pectoriloquy

Name the Condition: - Percussion: Resonant - Fremitus: Decreased - Breath Sound: Wheezing

Asthma

Name the Condition: - Percussion: Dull/Flat - Fremitus: Decreased - Breath Sound: Absent

Atelectasis

Name the Condition: - Percussion: Resonant - Fremitus: Normal - Breath Sound: Rales

Bronchiectasis

Name the Condition: - Percussion: Resonant - Fremitus: Normal - Breath Sound: Rales

Bronchitis

Name the Condition: - Percussion: Hyperresonant - Fremitus: Decreased - Breath Sound: Wheezing

Emphysema

Name the Condition: - Percussion: Dull - Fremitus: Decreased - Breath Sound: Crackles (friction rub)

Pleurisy

Name the Condition: - Percussion: Hyperresonant - Fremitus: Decreased - Breath Sound: Decreased

Pneumothorax

Name the Condition: - Percussion: Dull - Fremitus: Increased - Breath Sound: Egophony, Bronchophony, Whispered Pectoriloquy, Crackles

Pneumonia

PPW productive cough (rusty brown sputum) for around 10 days & fever Percussion is dull; Rales; Increased Tactile Fremitus Silhouette sign & air bronchogram

Lobar Pneumonia | consolidation of the lung

Productive/currant red jelly sputum & caused by Klebsiella pneumonia Seen with old age or immune-compromised hosts

Friedlander's Pneumonia

Caused by yeast/fungusMC seen in AIDS pts

Pneumocystis Carinii

Caused by CMV | MC seen in AIDS pts

Cytomegalovirus

PPW low-grade fever, night sweats, productive cough (yellow/green sputum) Small white lesions called Ghon lesions seen on X-Ray Positive Tine test/Mantoux test, Purified Protein Derivative Most definite test for dx is Sputum culture

Tuberculosis (caused by mycobacterium tuberculosis)

PPW stabbing chest pain worsened by respiration. Dry/non-productive cough Decreased respiratory excursion; decreased tactile fremitus; dull on percussion; friction rub is present Positive Schepelmann's Test

Pleurisy (inflammation of the pleura, usually producing an exudative pleural effusion)

A ruptured lung causing air to b/c trapped in the pleural space Decreased chest expansion, decreased tactile fremitus, hyperresonant on percussion, decreased breath sounds Can occur in young, previously healthy individuals (spontaneous)

Pneumothorax

Collapse of the lung that is usually the result of bronchial obstruction due to a mucous plug. Presents with decreased tactile fremitus, dull percussion, decreased chest expansion, decreased or absent breath sounds

Atelectasis

Irreversible focal bronchial dilation that presents w/ chronic, productive cough

Bronchiectasis

Defined by a long-term cough with mucus Shortness of breath & wheezing Cigarette smoking is main cause Long exposure to other things such as chemical fumes, dust & other substances may also cause this.

Chronic Bronchitis / COPD

Bronchospasm constricting airways Type I hypersensitivity reaction that is usually triggered by airborne allergens PPW tachycardia, tachypnea, decreased tactile fremitus & wheezing Eosinophils & IgE rise Labs: Curshmann's spirals & Charcot Laden Crystals (crystals & spirals in sputum from IgE)

Asthma

Destruction of elastic pulmonary connective tissue results in permanent dilation of the alveoli air sacs. Caused by deficiency of alpha 1 anti-trypsinPPW decreased tactile fremitus, hyperresonant on percussion, decreased breath sounds & wheezing

Emphysema

Primary malignant lung tumor that starts in the area of the bronchus Long-term history of smoking (20-30 years) PPW coughing (non-productive) more than 30 days, afebrile, dyspnea & weight loss

Bronchogenic Carcinoma

Inflammation that develops as a consequence of physical activity & is worse with exercise. Pain increases while taking a deep breath Palpable tenderness at the 3rd, 4th or 5th costosternal articulation Similar to Tietze Syndrome which affects only one articulation & radiates pain. Can be Chronic

Costochondritis | Inflammation of the cartilage connection b/t ribs & sternum

Shingles Painful rash following the course of a dermatome (usually single nerve) Primarily involves the dorsal root ganglion, but when it does involve cranial nerves it is most commonly seen at CN V

Herpes Zoster

Disease in which abnormal collections of inflammatory cells (granulomas) form as nodules. Most often appear in lungs or lymph nodes.MC seen in African descent in the US

Sarcoidosis

Cancer of the lymphatic system that can spread to the spleen. MC seen in young caucasian males PPW fever, night sweats, weight loss, intense pruritis (release of IgE) & enlarged spleenBest diagnosed from biopsy

Hodgkin's

COPD (barrel chest) Chronic, progressive & frequently fatal genetic disease of the body's mucus glands. The glands produce or secrete sweat and/or mucus Thick accumulations of mucus in the intestines & lungs Loss of excessive amounts of sale (sweat test) Pancreatic insufficiency Meconium ileus

Cystic Fibrosis

Measures the pressure of the right side of the heart. Can be made more pronounced when congestive heart failure is present by applying pressure to the liver (hepatojugular reflex)

Jugular Venous Pulsations

Palpation: Peripheral Pulses: Bounding Increased cardiac output Exercise, anxiety, fever, hyperthyroidism

Pulsus Magnus

Palpation: Peripheral Pulses: Weak or thready Decreased stroke volume Hypovolemia, aortic stenosis, CHF

Pulsus Parvus

Palpation: Peripheral Pulses: Alternates in amplitude Left Ventricular failure

Pulsus Alternans

Palpation: Peripheral Pulses:2 Strong systolic peaks separated by mid-systolic dip (best felt at carotid artery)Aortic regurgitation, Aortic stenosis

Pulsus Bisferiens

Palpation: Peripheral Pulses: Decreased amplitude on inspiration, increased w/ expiration (>10mmHG amplitude change) COPD, bronchial asthma, emphysema, pericardial effusion

Pulsus Paradoxus

Palpation: Peripheral Pulses: | A jerky pulse that is rapidly increasing then collapsing b/c of aortic insufficiency

Water Hammer Pulse

Vibration produced by turbulent blood flow within the heart (murmurs)

Thrills

When the ventricles of heart contract, it is called _____

Systole

When the ventricles of the heart rest & are filling, it is called _____

Diastole

Closure of AV valves (mitral & tricuspid)

Closure of semilunar valves (aortic & pulmonary)

Ventricular Gallop Normal in children, young adults & athletes >40 yo earliest sign of CHF

Atrial Gallop | Similar to S3 & is related to stiffness of the ventricular myocardium to rapid filling

Right sternal border at the 2nd intercostal spaceBest auscultated with pt seated, leaning forward & exhaling

Aortic Valve

Left sternal border at the 2nd intercostal space

Pulmonic Valve

Left sternal border at the 3rd intercostal space

Erb's Point

Left sternal border at the 4th or 5th intercostal space

Tricuspid Valve

Mid-clavicular line at the 5th intercostal space | Best auscultated in the left lateral decubitus position

Mitral Valve

Valve has trouble opening & the blood swirls thru a narrow opening. This murmur has a low pitch & is best heard w/ bell of stethoscope

Stenosis

Valve is insufficient & blood seeps or squirts back into the chamber. This murmur has a high pitch & is best heard w/ diaphragm of stethoscope

Regurgitation

What is the mnemonic for heart murmurs that occur in diastole? (opposite in systole)

ARMS & PRTS Aortic Regurgitation & Mitral Stenosis Pulmonic Regurgitation & Tricuspid Stenosis

Failure of shunt to close between the aorta & left pulmonary artery. Creates a continuous/machinery like murmur that can be heard in both phases of the heart cycle.

Patent Ductus Arteriosus

Dextraposition/overriding of the aorta, right ventricular hypertrophy, interventricular septal defect & pulmonic stenosis.Creates loud ejection murmur during systole & severe cyanosis.

Tetralogy of Fallot

Constriction of the descending aorta (usually distal to left subclavian) Causes higher blood pressure in upper extremity by 20mmHg (diagnostic) when compared to the lower extremity.

Coarctation of the Aorta

Proximal stenosis of the subclavian artery. | Seen in younger females who faint (syncope/drop attacks) while exercising

Subclavian Steal Syndrome

MC cause of left sided heart failure is _____ (35-55yoa)

Hypertension

2nd MC cause of left sided heart failure is...

Aortic Stenosis

What are some early signs of left sided heart failure?

Pulmonary edema (fluid in the lungs) causing shortness of breath (exertional dyspnea) and orthopnea.Fluid collects first at the costophrenic angles.

MC cause of Right sided heart failure

Left sided heart failure

MC cause of Mitral Stenosis (asso w/ right sided heart failure)

Rheumatic Fever(ASO-titer)

When the right side fails by itself --- lung condition that causes right sided heart failure

Cor Pulmonale

Right sided heart failure backs up to the ______ and down the _____

Up to the SVC & Down to the IVC

What leads to: - Edema & fluid in extremities - Jugular venous distention (SVC) - Liver/Spleen enlargement - (+) Hepatojugular reflex - Ascites (fluid in abdomen from portal hypertension) - Caput Medusa/Spider angioma - Pitting Edema - Stasis Dermatitis

Right Sided Heart Failure

Right Sided Heart Failure causes: - _____ heart rate - _____ gallop - _____ blood pressure

Increased HR S3 gallop Decreased BP

An interruption of the intima allowing blood into the vessel wall with immediate "tearing" pain. Acute surgical emergency.Associated w/ Hypertension/Arteriosclerosis (Descending Aorta) & Marfan's (Ascending Aorta)

Aortic Dissection

Inherited connective tissue disorder with ventricular weakening & enlargement. PPW tall, long fingers/limbs, lens subluxation, cardiovascular & lung problems

Marfan's Syndrome

Comes on with Exertion Printzmetal angina comes on with rest (atypical) Relieved by vasodilators under tongue (nitroglycerin)

Angina Pectoris - Coronary vasospasm

Acute heart failure Comes on with rest Caused by Atherosclerosis CK-MB is elevated, LDH increased & SGOT increased

Myocardial Infarction

Abnormal widening that involves all 3 layers; defect in elastic-media tissues

Aneurysm

ECG: Normal atrial depolarization

P-wave

ECG: Depolarization of ventricles; repolarization of atria hidden here

QRS complex

ECG: Repolarization of ventricles

T-wave

ECG: Repolarization of papillary muscles

U-wave

Increased PR interval - prolonged AV nodal delay

Primary Heart Block

Two P-waves before QRS complex

Weinkbochs block of bundle of HIS Secondary Heart Block

No QRS pattern

Complete Heart Block no ventricle contraction no atrial repolarization

Enlarged or Inverted ST segment

MI (acute heart failure)

What is an echocardiogram/Doppler used for?

Used to evaluate heart valves

Increased bowel sounds indicate...

Early intestinal obstruction

Absent bowel sounds indicate...

Late intestinal obstructionAdynamic (paralytic) Ileus

Vomiting up blood is called...

Hematemesis

Coughing up blood is called...

Hemoptysis

Blood in stool is called...

Hematochesia

Abdomen & GI Labs: | What labs are non-specific for the liver?

- Increased Alkaline Phosphatase - Serum.Glutamate.Oxaloacetate.Transaminase (SGOT) - Aspartate Transaminase (AST) - Lactate Dehydrogenase (LDH)

Abdomen & GI Labs: | What labs are classic for liver?

- Gamma.Glutamyl.Transpeptidase (GGT) - Serum.Glutamic.Pyruvic.Transaminase (SGPT) - Alanine Transaminase (ALT)

Yellowing of the skin, sclera & mucous membranes. Can occur with any liver disorder

Jaundice

What is the MC cause of liver destruction?

Alcoholism

Causes portal hypertension, ascites, esophageal varices

Cirrhosis

Coughing, tearing esophageal blood vessels & hematemesis with palmar rash d/t bile salts Cirrhosis***

Mallory Weiss Syndrome

Thiamin deficiency from alcoholism that leads to dementia | Cirrhosis ***

Wernicke Korsakoff syndrome

Thiamin deficiency without alcoholism that causes cirrhosis

Beri Beri

Liver may be tender & enlarged but the edge remains soft & smooth

Hepatitis

Caused from food thru fecal/oral route, self-limiting, not a carrier

Hepatitis A

Caused from dirty needles & sexual contact, carrier for life, MC to b/c liver cancer

Hepatitis B

Caused from blood transfusions

Hepatitis C

MC site for metastatic disease in abdomen & GI

Liver Cancer

Describe a liver with Liver Cancer

Liver will be enlarged, with a hard & irregular border

What is the tumor marker specific for hepatocellular carcinoma?

Alpha fetoprotein

What is performed for definitive diagnosis of liver cancer?

Liver biopsy

Type of Bilirubin:- - water soluble - increases with duct obstruction (gallstones), hepatic disease, pancreatic cancer - increased amounts in blood may cause bilirubin in urine (urobilinogen)

Direct/Conjugated Bilirubin

Type of Bilirubin: - Not water soluble - Increases with hemolytic disease, drugs & spleen disorders - Dx Hemolytic anemia

Indirect/Unconjugated Bilirubin

Increase in reticulocyte count (Coomb's test) dx:

Hemolytic anemia

Pain referral to right shoulder or tip of right scapula (viscerosomatic)

Gallbladder

- MC seen in overweight females >40yoa - MC cause of cholelithiasis - Severe URQ pain, nausea, vomiting, & precipitated by eating large fatty meal - Murphy's sign - Inspiratory arrest sign - Tests: diagnostic Ultrasound, Oral Cholecystogram

Cholecystitis

Calcification that can become malignant d/t chronic inflammation

Porcelain Gallbladder

Epigastric pain going straight thru the T10-T12 area like a knife (viscerosomatic)Chronic: seen in alcoholismAcute: 911 emergencyTests: increased Amylase & Lipase

Pancreatitis

Pancreatitis bleeding into flank

Grey Turner Sign

Periumbilical ecchymosis caused by intraperitoneal hemorrhage or seen with a ruptured ectopic pregnancy

Cullen's Sign

Usually at the head of the pancreas | Presents with dark urine, clay colored stools & jaundice

Pancreatic Cancer

A condition in which the pancreas does not produce a sufficient amount of insulin to take the sugar out of the blood and transport it to the tissues of the body.These starved tissues force the breakdown of fats in order to obtain energy.- Polydypsia, polyphagia & polyuria are all seen

Diabetes Mellitus

What labs test DM?

- Glucose Tolerance Test - Fasting Plasma Glucose (FPG) - HbA1C (Glycosylated Hemoglobin)

Type of Diabetes:- Juvenile, under 30, usually thin

Insulin Dependent Type I

Type of Diabetes:- Adult, over 40, usually obese

Non-Insulin Dependent Type II

Condition of the posterior pituitary gland in which there is insufficient ADH. May have polydypsia, polyuria, but NOT polyphagia

Diabetes Insipidus

Upward reflux of acid contents of the stomach into the esophagus. Caused by sliding hiatal hernia. Worse when lying down, after big meal, valsalva, or bearing down. Tests: X-Ray or upper GI series

Reflux Esophagitis

- Includes gastric & duodenal ulcers - Caused by H.pylori bacteria - Burning pinpoint epigastric pain - Coffee ground emesis

Peptic Ulcers

Ulcer with no consistent pain pattern

Gastric Ulcer

MC type of peptic ulcer - pain occurs 2 hours after eating - black/tarry stool - Guaiac test: occult blood in the stool

Duodenal Ulcer

Projectile vomiting in the newborn

Pyloric Stenosis

Gastric Carcinoma is MC found on the _____

Lesser Curvature

What node is MC involved in Gastric Carcinoma?

Virchow's Node - left supraclavicular lymph node involvement

Spleen: Caused by the Epstein Barr Virus & is seen in young adults (18-25yo) Presents w/ symptoms similar to the flu such as fever, HA, fatigue, lymphadenopathy in the cervical region, splenomegaly

Mononucleosis

- Atypical lymphocytes in blood (Downey cells) - Monospot - Heterophile Agglutination - Paul Bunnell

Mononucleosis

The bone marrow b/c sclerotic, thus the RBC's are not made properly. Liver & Spleen b/c enlarged

Osteropetrosis "Marble Bone"

Referral of pain is Periumbilical

Small Intestines

- Nonspecific inflammatory disorder that affects distal ileum & colon - Presents with RLQ pain, chronic diarrhea, cobblestone appearance on sigmoidoscopy - Leads to malabsorption of B12 - Non-tropical Sprue / Celiac Sprue (gluten allergy) can cause this condition

Regional Heitis aka Crohn's Disease(right side of intestines)

- MC at the colon & rectum - Presents w/ bloody diarrhea - Diagnosed with sigmoidoscopy

Ulcerative Colitis(left side of intestines)

Variable degrees of constipation & diarrhea in response to stress Seen more commonly in females Abdominal pain & gas relieved by bowel movements

Irritable Bowel Syndrome aka Spastic Colon

Dull periumbilical or epigastric pain that radiates to LRQ (McBurney's Point)- presents with fever, nausea, vomiting, anorexia- increased WBC (shilling shift to the left)- Tests: Rebound Tenderness (peritonitis), Rovsing's sign, Psoas sign, Obturator sign- Special Test: CT Scan- Refer to ER

Appendicitis

Consequence of inadequate fiber in the diet | Chronic constipation which causes small outpouchings within the colon that b/c infected

Diverticulitis

Increased production of adrenal cortex hormone; hyperadrenalism; hypercortisolism Moon face "pie face", buffalo hump, pendulous abdomen w/ purple striae, hirsutism, weakness, hypertension

Cushing's Disease

Decreased aldosterone; hypoadrenalism; hypocortisolism Increased ACTH causes melanin deposition (hyperpigmented mouth & face) Thin person, decreased blood pressure, weakness, fatigue, lethargy, nausea, vomiting, hair loss

Addison's Disease

Tumor of the Adrenal Medulla Increased catecholamine production (epi & norepi) May appear similar to hyperthyroidism but this produces extreme hypertension

Pheochromocytoma

Made of Calcium: Calcium oxalates (MC), Calcium urates, Calcium phosphates- Flank pain described as writhing- Murphy's Test (kidney punch)- Evaluate by increased BUN, uric acid, creatinine clearance & KUB study- Hydronephrosis can cause a staghorn calculi

Nephrolithiasis

Caused by group A hemolytic strep | RBC casts in urine with small amount of protein

Acute Glomerulonephritis aka Nephritic syndrome

HEP = Hypertension, Edema, massive Proteinuria In pregnant women is called pre-eclampsia Waxy or fatty casts in urine

Nephrotic syndrome

E-coli from UTI | WBC casts in urine

Pyelonephritis

Inherited disorder characterized by many bilateral renal cysts that increase renal size but reduce functioning renal tissue

Polycystic Kidney Disease

This diagnosis is classified as gonococcal (caused by Gonorrhea) or non-gonococcal (caused by Chlamydia).- caused MC by E. Coli in females- Nitrites in urine

Urethritis

Noninfectious bladder inflammation that causes burning, painful & frequent urination with incontinence. Pt will also have suprapubic & LBP.

Cystitis

Malignant tumor of the kidney; less than 5 yoa, abdominal mass, hematuria

Nephroblastoma aka Wilm's Tumor

Urinary Incontinence often called "overactive bladder". The urgent need to get to the bathroom.

Urge

Urinary Incontinence - an increase in abdominal pressure such as exercise, cough, sneeze, laugh. Due to weakened pelvic floor muscles.

Stress

Urinary Incontinence - inability to completely empty your bladder when you urinate. As a result, the patient has a constant or frequent dribble of urine.

Overflow

Urinary Incontinence - MC among older adults with arthritis, Parkinson's, Alzheimer's (disorders that involve moving, thinking, or communicating)

Functional

MC type of hernia This hernia passes down the inguinal canal & exits at the external inguinal ring into the scrotum. MC in children & young adults

Indirect Inguinal Hernia

Does not pass thru the inguinal canal but exits directly thru the external inguinal ring instead. It is usually acquired from obesity or heavy lifting. This hernia is felt when the patient coughs or bears down. MC in adults over the age of 40

Direct Inguinal Hernia

Not an inguinal hernia. It appears as a bulge lateral & inferior to the external inguinal ring at the site of the femoral pulse.

Femoral Hernia

Protrusion of the stomach above the diaphragm. Presents with palpable tenderness in LUQ, reflux esophagitis (acid reflux), dyspepsia (indigestion), made worse after eating large meal or when lying down.

Hiatal Hernia

Abnormal endometrial tissue found outside its normal location. (ex: myometrium, Fallopian tubes, peritoneum) MC found in ovaries. LaparscopyPresents w/ abdominal pain, back pain, menorrhagia, painful intercourse & possible infertility

Endometriosis

Benign uterine tumors of smooth muscle origin (Leiomyoma) Presents w/ heavy menstrual bleeding, pelvic pain & painful intercourse. Uterus will have painless nodules that are irregular & firm

Uterine Fibroids

An infection of the upper female genital tract. It is the MC complication of an STD (usually Chlamydia or Gonorrhea).Includes salpingitis (inflammation of the Fallopian tubes)

Pelvic Inflammatory Disease

Pregnancy in which implantation occurs outside the endometrium/endometrial cavity. Presents with spotting, decreased BP, decrease in HCG

Ectopic Pregnancy

Increase HCG, nausea, weight gain, & breast tenderness | Blood test - HCG (human chorionic gonadotropin)

Normal Pregnancy

A non-viable embryo which develops in the placenta & presents with all the signs of pregnancy. Very high HCG

Hydatiform mole

A malignancy of the placenta due to abnormal epithelium

Choriocarcinoma

Multiple, round, freely movable masses can be palpated. Bilateral breast tenderness that is made worse w/ caffeine intake, ovulation or menses. Can be common among overweight diabetics.

Fibrocystic Breast Disease

MC benign breast tumor, usually <30yo, non-tender, singular lump, 75% unilateral

Fibroadenoma

2nd MC cause of cancer death in women, MC >50yoa, MC location is upper/outer quadrant. Presents with nipple retraction, bleeding, orange peel appearance & dimpling (Paget's disease of the breast). Metastasis to axilla via the lymphatic system & will most likely be lytic when seen in the bone.

Breast Cancer

Tortuous dilation of the spermatic veins. "Bag of worms" feeling upon palpation that diminishes from standing to supine

Varicocele

A fluid filled mass in the epididymis. It is painless, moveable, pea sized lump located superior & posterior to the testicle. it transilluminates light because it is fluid filled.

Spermatocele

Excess accumulations of water in the testicle. It feels swollen, painless, heavy & tight. The ability to palpate above the mass distinguishes it from a scrotal hernia. It transilluminates.

Hydrocele

Usually a consequence of an STD. The scrotum is enlarged & tender but tenderness may be relieved somewhat by raising the testicle.

Epididymitis

MC form of cancer in males age 20-34. Painless nodule appears on or in the testicle. MC type is a Seminoma. Does NOT transilluminate light.

Testicular Cancer

Enlarged, non-tender, firm, smooth, with loss of median sulcus

Benign Prostatic Hyperplasia

Boggy, soft, enlarged & tender. Urinary problems such as increased urgency.

Prostatitis

Posterior lobe is hard, nodular, painless & enlarged. MC place to metastasize is to the lumbar spine via Batson's Plexus

Prostatic Carcinoma

Muscle pain classically in the calf muscle, which occurs during exercise

Claudication

``` Artery or Vein: Temp: Cool Color: Pale or Blue Pulse: Absent or Weak Numb: Yes Swelling: No Raynauds: Yes Trophic Changes: Thin Skin Valve Incompetence: N/A ```

Artery

``` Artery or Vein: Temp: Warm Color: Normal or Discolored Pulse: Normal Numb: No Swelling: Yes Raynauds: No Trophic Changes: Stasis Dermatitis Valve Incompetence: Yes ```

Vein

Type of Claudication:- Non-predictable pattern- Position related relief (seated with flexion)- Common Cause: DJD, Spinal Canal Stenosis

Neurogenic

Type of Claudication: - Predictably reproducible pattern - Relief always with rest - Common Cause: Arteriosclerosis, Buerger's

Vascular

Test: pt walks at a rate of 120 steps/minute for 1 minute | (+) = pain in calves

Claudication Timeindicates: Vascular Claudication

Test: pt pedals fast until painful, rest until painless, repeat. (+) = pain in calves

Bicycle Test(indicates: vascular claudication)

Seen in 20-40yo males & is associated w/ excess tobacco smoking. Presents with intermittent vascular claudication, non-healing ulcers & gangrene. Test: Claudication Time

Buerger's akaThromboangitis Obliterans

Seen in pts >15yoa. Disease associated with Buerger's, Collagen Disease & Scleroderma. It's brought on by cold, stress, emotion. Presents with arterial spasms, triphasic color changes (white-blue-red), finger tip ulcers, gangrene & cold sensitivityTest: Allen's test

Raynaud's

Seen in pts >20yo, pregnant women or overweight adults | Presents w/ incompetent valves, dilated tortuous channels

Varicose Veins

Presents with tenderness, edema & pain Test: Homan's - pt is supine w/ leg extended while examiner raises the leg off the table 45*, dorsiflexes the foot & squeezes the calf (+) = pain in calf

Deep Vein Thrombosis

A blockage of an artery in the lung by a substance that has traveled from elsewhere in the body thru the bloodstream (embolus). Usually this is due to a thrombus (blood clot) from the deep veins in the legs.Symptoms include difficulty breathing, chest pain on inspiration & palpitation.Risk is increased in various situations, such as flying & prolonged bed rest

Pulmonary Embolism

A chronic pain condition The key symptom is continuous, intense pain out of proportion to the severity of the injury, which gets worse rather than better over time. Typical features include dramatic changes in the color & temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating & swelling

Reflex Sympathetic Dystrophy aka | Complex Regional Pain Syndrome

Small superficial dilated blood vessels. They can develop anywhere on the body but are commonly seen on the face around nose, cheeks & chin.

Telangiectasia

Pinpoint hemorrhage (local trauma)

Petechia

RBC - Red Blood Cells - Definition - Normal Level - Increased? - Decreased?

Def: Absolute # of RBC per unit volume of blood Norm: 4-6 million/cm3 Inc: 1*= Polycythemia Vera, 2*=High Altitude Dec: Anemia

Hb (Hemoglobin) - Definition - Normal Level - Increased - Decreased

Def: Direct measure of weight of hemoglobin/unit volume of blood Level: 15 gm% Inc: Dehydration (loss of blood fluid volume) & Polycythemia Vera Dec: Anemia

Hct (Hematocrit) - Definition - Normal Level - Increased - Decreased

Def: Packed Cell Volume, ratio of volume of RBC's to that of whole blood Level: 42 (+/-) 5% Inc: Dehydration & Polycythemia Vera Dec: Anemia

MCV (Mean Corpuscular Volume) - Definition - Normal Level - Increased - Decreased

Def: Calculated measure of the size of the average circulating RBC Level: 90 Increased: Macrocytic Anemia (>100) Decreased: Microcytic Anemia (<80)

MCH (Mean Corpuscular Hb) - Definition - Normal Level - Increased - Decreased

Def: Calculated weight of Hb in the average circulating RBC Level: 30 Inc: Macrocytic Anemia (>100) Dec: Microcytic Anemia (<80)

MCHC (Mean Corpuscular Hb Concentration) - Definition - Normal Levels - Increased - Decreased

Def: Average concentration of Hb in a given volume of packed cells Levels: 33 Inc: Macrocytic Anemia Dec: Microcytic Anemia

Platelets Thrombocytes - Def - Level - Inc - Dec

Def: Absolute quantification of circulating thrombocytes/volume Level: 200,000-350,000 mm3 Inc: Polycythemia, Trauma, Blood Loss Dec: Anemia, Extensive or Burns, Thrombocytopenia

WBC (Leukocyte Count) - Def - Level - Inc - Dec

Def: Absolute quantification of total circulating WBC/unit of blood Level: 5,000-10,000/mm3 Inc: Acute Infection, Inflammation, Leukemia (over 50,000) Dec: Overwhelming infection, Viral conditions

WBC Differential Count: List Normal Level & Increased - Neutrophilia - Lymphosytosis - Monocytosis - Eosinophilia - Basophilia

``` N: 60% - Bacterial Infection L: 30% - Virus M: 8% - Chronic Inflammation E: 2% - Allergies, Parasites B: 0% - Heparin Production/Histamine Release ```

How do you test for Excessive Hemolysis?

(+) Coombs Test - Increased indirect bilirubin - Increased reticulocytes

Presents w/ nucleated RBC's | Caused by Hgb S & seen in 10% of African Americans

Sickle Cell Anemia

Presents with microcytic, target cells. | Caused by decreased beta chain synthesis & is seen in Mediterranean, North Africa & South East Asia

Thalassemia aka Mediterranean Anemia

Caused by Rh+ father & baby, and Rh- mother

Erythroblastosis Fetalis

Name the 3 types of Excessive Hemolytic Anemia & Name the 3 types of Defective Erythopoiesis Anemia

EHA: "SET" - Sickle Cell - Erythroblastosis Fetalis - Thalassemia (mediterranean) DEA: "AIM" - Aplastic - Iron Deficiency - Megaloblastic

- Macrocytic Normochromic- B9/Folic Acid: seen w/ chronic alcoholics, pregnancy, malabsorption - Used to prevent neural tube defects - B12/Cyanocobalamin Pernicious Anemia - Progresses to posterolateral sclerosis (PLS) of SC, which is also known as, combined systems disease

Megaloblastic Anemia

Anemia asso. w/ lack of IF due to chronic atrophic gastric mucosa causing loss of parietal cells. Dx: Shilling Test (24 hour urine) Tx: (?)

B12 / Cyanocobalamin Pernicious Anemiatx: B12 shots

Hypochromic Microcytic anemia | Seen with Chronic blood loss & pregnancy

Iron Deficiency Anemia

Normochromic Normocytic Anemia Panhypoplasia of the bone marrow, decrease in all blood cells Seen w/ drugs, chemo, radiation, MM, RA, leukopenia, acute blood loss, benzene poisoning & thrombocytopenia

Aplastic Anemia

UA: Color- Straw

Normal

UA Color: REd

Blood or Food Pigments | infection, cancer, food dyes

UA Color: Green

Biliverdin | biliary duct obstruction, pseudomonas infection, bad protein digestion

UA Color: Blue

Diuretic Therapy, Pseudomonas infection, Bad protein digestion

UA Color: Brown

Bile Pigments or Blood | biliary duct obstruction, occult blood, homogentisic acid

UA Color: Black

Homogentisic Acid or Urobilin | Ochronosis, hemolysis, bacteria

Hazy or Cloud appearance in UA

Epithelial cells, WBC's, RBC's, crystals, sperm, microorganisms

Milky appearance of UA

WBC's or fat

What is normal pH of a UA

4-8

What is specific gravity of UA?

1.01-1.03

What causes an increase of specific gravity in UA

Bacterial infection, DM, kidney abnormalities

Glucose in UA indicates...

DM, shock, head injury, pancreatic disease, renal tubular disease

Ketones in UA indicates...

Starvation DM Weight Loss Diets Inadequate Carb Intake

Protein in UA indicates...

Kidney Disorders Toxemia of Pregnancy DM MM

Increased Urobilinogen in UA indicates....

Hemolytic Disease or Hepatic Disease

Decreased Urobilinogen in UA indicates...

Biliary Obstruction

Bilirubin in UA indicates...

Hepatic Disease or Biliary Obstruction

Blood in UA indicates...

``` Tumors Trauma Kidney Infection or Stones Hypertension Bleeding Disorders ```

UA Casts: - Hyaline - Epithelial - RBC - WBC - Waxy

``` Hyaline - normal Epithelial - tubular damage RBC - glomerulonephritis WBC - pyelonephritis Waxy - Renal Failure, Nephrosis ```

Increased Acid Phosphatase (PAP)

Prostatic Carcinoma

Reversed Albumin/Globulin (A/G) Ratio

Multiple Myeloma

Increased Alkaline Phosphatase

Osteoblastic Lesions Hepatic Disease Hyperparathyroidism (HPT)

Increased Amylase

Acute Pancreatitis

ANA (FANA) in labs

Collagen disease (SLE, Scleroderma)

Increased Antistreptolysin - O (ASO) Titre

Rheumatic Fever | Acute Glomerulonephritis

Increased Direct Bilirubin

Hepatitis | Duct Obstruction

Increased Indirect Bilirubin

Hemolytic Disease

Increased BUN (Blood Urea Nitrogen)

Renal Disease Dehydration Hypotension Urinary Tract Obstruction

Decreased BUN

Hepatic Disease | Pregnancy

Increased Calcium (Ca)

Muscle Weakness HPT Hypervitaminosis D Metastatic Disease

Decreased Calcium (Ca)

Muscle Tetany Chvostck's Sign (facial tetany) Renal failure Malnutrition

CPK (Creatine Phosphokinase) - CK BB - CK MB - CK MM - Increased:

BB - Brain Tissue MB - Myocardial Tissue MM - Skeletal Muscle Increased - Muscle Necrosis

Increased Creatine

Kidney Disease | Hypovolemic Shock

Decreased Creatine

Muscular Dystrophies

Increased C-Reactive Protein (CRP)

Tissue Necrosis Infections RA

ELISA

Screening test for AIDS

Increased Erythrocyte Sedimentation Rate (ESR)

Infection RATB Temporal Arteritis MM

General Diagnosis 1 Flashcards

(385 cards)