Flashcards in General Diagnosis (Irene Gold) Part II and III Deck (901)
What are the five components of a health history?
Past Health History
Personal and Social History
Review of Systems (ROS)
What six things need to be asked to the patient when asking about Present Illness?
Quality of Pain
What is indicated if there is a sudden onset of pain?
If pain has an insidious onset, what is the likely cause?
If nothing makes that pain better or worse, what does the patient possible have?
How are you able to tell if a patient is having a neuromuscular skeletal problem?
The patient is able to find relief from pain in a certain position
If a patient complains of no localization of pain, where is the pain very likely from?
Originating from an organ
If pain is stated to be a "throbbing pain", what does it indicate?
What is a descriptive word to describe a pain in the muscle?
If the patient describes the pain as "Burning" what is the likely cause of the pain?
What kind of pain is described for a dissecting aneurism?
What questions need to be asked to the patient about past health history? (7 Things)
What five questions that need to be known from family history?
What questions/categories do you need to ask about pertaining to the social/personal history of a patient? (8 Topics)
Alcohol, Tobacco, and Drug use
What is the questionnaire to help determine if someone may be an alcoholic?
What are the four parts of the CAGE Questionnaire?
C- Cutting Down (Have you ever felt the need to cut down on your drinking?)
A- Annoyed by others criticisms (Have you ever felt annoyed by criticism of your drinking?)
G- Guilty Feeling (Have you ever felt guilty about your drinking?)
E- Eye openers (Have you ever felt that you needed a drink to start your day?)
What is the normal oral temperature?
What is the normal Rectal and Tympanic temperature?
What is the normal Axilla temperature?
What is considered normal range for body temperature?
96-99.5 F (35-37.5 C)
What is the normal pulse rate of an Adult?
What is the normal pulse rate for a Newborn?
What is the normal pulse rate for a person of older age?
What is the normal Respiration Rate of an Adult?
What is the normal Respiration Rate of a Newborn?
What is the normal Blood Pressure in an Adult?
Do blood pressure values increase or decrease in elderly people?
What blood pressure would indicate Hypertension?
What blood pressure would indicate Hypotension?
In what population would it be common to see an auscultatory gap?
Patients with hypertensive blood pressures
What is the definition of an Auscultatory Gap?
The loss and reappearance of the pulsatile sound while listening with the stethoscope during cuff deflation
What is being described as "low pitched sounds produced by turbulent blood flow in the arteries"?
If there is a difference of 10-15 mm Hg in systolic reading, what vessels are being disturbed and what is the name of this condition?
Arterial Occlusion- Vessels being disturbed
Subclavian Steal- Name of the condition
What is the AKA for Subclavian Steal?
Transient Ischemic Attack (TIA)
From what artery is blood taken, during a Subclavian Steal?
When the blood pressure is taken in the lower extremity how much higher will the readings be?
Coarctation of the Aorta
Which test can be used to determine if a patient has Vertebrobasilar Artery Insufficiency? (6 exams)
How do you perform the orthopedic test of: Barre-Lieou
Patient is seated, Doctor instructs patient to rotate the head maximally from side to side.
This is done slowly to start and then accelerated to patient tolerance
What does a positive Barre-Lieou test indicate?
Vertebrobasilar Artery Insufficiency
What is a positive finding of Vertebrobasilar Artery Insufficiency exams?
How do you perform the orthopedic test of: DeKleyn's
Patient is Supine. Doctor instructs patient to rotate and extend the head off the table then to turn to each side for 15-45 seconds.
Doctor can lend minimal support
How do you perform the orthopedic test of: Hallpike
Patient supine, head is extended off the table. Doctor offers support of the skull.
Doctor brings the head into extension, rotation and lateral flexion
How do you perform the orthopedic test of: Hautant's
Patient is seated, arms extended forward to shoulder level with the hands supinated. Patient maintains this position for a few seconds. Patent then closes the eyes, rotates and hyperextends the neck to one side.
Repeated on opposite side
How do you perform the orthopedic test of: Underberg
Patient stands with eyes open, arms at side, feet close together. Patient closes their eyes, extends arms and supinates hands, then the patient extends and rotates head to one side. Then in this position patient is instructed to march in place.
How do you perform the orthopedic test of: Maigne's
Patient is seated, Doctor brings had into extension and rotation
What clinical significance does scaly eyebrows have?
In what two categories of people with you see a loss of the lateral 1/3 of the eyebrow?
Myxedema (AKA Hypothyroidism)
What is another name for Myxedema?
What condition is described by "sluggish pupillary reaction to light that is unilateral and caused by parasympathetic lesion of CN III"?
(Similar to Argyll Robertson's; but seen after 25 years of Syphilis)
How would you describe Adie's Pupil?
What age is usually affected?
A sluggish pupillary reaction to light that is unilateral and caused by parasympathetic lesion of CN III
Younger Age: 10-20
What is the description of Anisocoria?
Unequal pupil size
What are three possible cause of Anisocoria?
Name the condition that is described as the following: "bilaterally small and irregular pupils that accommodate but do not react to light"?
How would you describe Argyll Robertson's pupil?
A bilaterally small and irregular pupils that accommodate but do not react to light
In what gynecological disease is Argyll Robertson's pupil common in?
(Argyll Robertson's pupil with syphilis is called "Prostitutes Pupil")
What is Arroyo Sign?
Sluggish pupillary reaction due to hypo-adrenalism
What is another name for Hypo-adrenalism?
What is the common microorganism to produce Blepharitis?
Staphylococcus, found on the skin
What condition of the eye is described: "inflammation of the eyelid"?
How would you describe Blepharitis?
Inflammation of the eyelid
In what condition would you commonly see Blepharitis? (3 Conditions)
What condition is "opacities seen in the lens" Also had an "Absent Red Light Reflex"?
In what two populations are cataracts frequently found in?
What is the description of a Chalazion?
An infection of the meibomian gland causing a nodule which points inside the lid
How is the condition Corneal Arcus described?
Grayish opaque ring around the cornea
What significance does Corneal Arcus have in and elderly person?
No clinical problem and does not indicate anything pathological
If Corneal Arcus is seen in a younger (20-40 year old patient), what is a possible diagnosis?
Which vessel does the condition of Diabetic Retinopathy affect more?
Veins, more than arteries
What finding will you have with Diabetic Retinopathy? (3 Things)
Ectropion and Entropion are most commonly seen in what population?
What is Ectropion?
Eyelid turned outward (Dry Eyes)
What is the name of the condition when the eyelid is turned inward?
Eye Irritation from the eyelashes rubbing on the eyeball
How is Exophthalmosis described?
Lid lag/failure to cover the eyeball
What two conditions will often be associated with Exophthalmosis?
Grave's Disease (Aka- Hyperthyroidism)
**Will be seen Bilaterally**
What condition is described by "increase intraocular pressure causing cupping of the optic disc"?
Acute Glaucoma will be painful
In Glaucoma what is the cup to disc ratio?
Less than 1:2
What early visual problems with a patient have leading up to Glaucoma?
Blurring of their vision, especially in the peripheral fields
Rings around lights
What is it called in a patient that had Glaucoma and has a tangential lighting of the cornea?
What is the fastest blindness seen in a patient with Glaucoma?
Closed Angle Glaucoma
What is the name given to an infection of the sebaceous gland causing a pimple or boil on the eyelid?
What are the common finding of a patient with Horner's Syndrome?
Which side of the cervical sympathies are effected in Horner's Syndrome?
What is a common radiographic finding with Horner's Syndrome?
Pancoast Tumor (Seen in the apex of the lung)
What are signs of Hypertensive Retinopathy? (5 Findings)
Copper Wire Deformity
Silver Wire Deformity
Cotton Wool Soft Exudates
What eye condition will have "dilated pupil with ptosis and lateral deviation"?
What two things will Internal Ophthalmoplegia not react to?
What serious disease has Internal Ophthalmoplegia paired with it?
What is the name of the condition that has "inflammation of the iris"?
What condition has a finding of Iritis?
What is the most common reason for blindness in the elderly?
What are early signs of Macular Degeneration?
Central Vision Loss
Macular Drusen (Yellow deposits under the retina)
What is Macular Drusen?
Yellow deposits under the retina, seen in the condition of Macular Degeneration
What condition is described as "fixed and constricted pupils that react to light and accommodate"?
What three conditions are commonly seen with Miosis?
Severe Brain Damage
What is the description of Mydriasis?
Dilated and Fixed pupils
When would you most like see a patient with Mydriasis?
Anticholinergic Drugs (i.e. Atropine, Mushrooms, Death)
What is another name for a Choked Disc?
Use the rectangular slit on the Ophthalmoscope to test
What causes Papilledema?
Swelling of the optic disc due to increased intracranial pressure
When would you possible see Papilledema?
Patient with a:
Is a sign of Papilledema, vision loss?
Vision loss is seen with Optic Neuritis
What is the name of the condition with "swelling around the eyes"?
In what three conditions will you see Periorbital Edema?
Allergies (Most Common)
Nephrotic Syndrome (HEP; Hypertension, Edema, Proteinuria)
How would you describe a Pinquecula?
Yellowish Triangular NODULE in the bulbar conjunctiva, that is HARMLESS, and indicates aging
What condition is described as: "triangular THICKENING of the bulbar conjunctiva that grows ACROSS the cornea and is brought on by dry eyes"?
Surgery is needed
How is the condition of Ptosis described?
Drooping of the eyelid
What are four conditions that are common to have Ptosis found in them?
Cranial Nerve III (Oculomotor)
Myasthenia Gravis (Bilateral)
What disorder is described as "painless sudden onset of blindness"?
What three signs are described leading up to Retinal Detachment?
Curtains closing over vision
What does the following color of sclera indicate:
Blue: Osteogenesis Imperfecta
What condition is described by: "fatty plaques on the nasal surface of the eyelids that may be normal or an indication of hypercholesterolemia"?
If you believe a patient has hypercholesterolemia, what two other conditions should you look for?
Other vascular problems
What is the clinical name for normal vision?
What is the clinical word for Nearsightedness?
What is the clinical word for Farsightedness?
If a patient has decrease lens elasticity due to aging and is unable to see close up, but can see far away, they are said to have what clinical description?
What four tests are carried out to check the integrity of Cranial Nerves II and III?
-Direct Light Reflex
-Consensual Light Reflex
-Swinging Light Test (Also Looking for any eye Pathologies)
How is Visual Acuity tested on a patient?
Snellen Eye Chart
What cranial nerves are being checked, when Cardinal Fields of Gaze is carried out?
Cranial Nerves: III, IV and VI
What is the name of the cranial nerve IV?
What is it's primary function?
What would a problem or lesion here look like?
Name- Superior Oblique
What is the name of the cranial nerve VI?
What is it's primary function?
What would a problem or lesion here look like?
Name- Lateral Rectus
What Cranial Nerve is affected in Acoustic Neuroma?
What is Acoustic Neuroma and what is another name of it?
What are three common signs seen with Acoustic Neuroma?
How is Acoustic Neuroma confirmed?
Tumor present on a CT or MRI
What is it called when there is a bacterial infection of the mastoid process?
May present similarly to Purulent Otitis Media
What are two common signs will be seen with Acute Mastoiditis?
Inflammation and Palpatory tenderness over the mastoid
Hearing Loss is also commonly associated
What is the clinical term for "infection of the outer ear"?
Acute Otitis Externa
What is the more common name for Acute Otitis Externa?
What are the signs of Acute Otitis Externa?
Inflammation and Pain over the outer ear
What is a noninvasive way to see if someone has Acute Otitis Externa?
**Tugging on the Pinna will be painful**
What condition is brought on by change in head position and is usually brief in it's duration?
Benign Paroxysmal Positional Vertigo
How is Benign Paroxysmal Positional Vertigo diagnosed?
Orthopedic Exam: Dix-Hallpike Maneuver
How is the Dix-Hallpike Maneuver performed?
Patient rapidly moves from a seated to a supine position with head turned at 45 degrees to the left and waits 30 seconds.
Repeat this procedure on the right side if nystagmus is seen.
What finding indicate a positive Dix-Hallpike Maneuver?
If a patient has a "retraction of the tympanic membrane" what condition do they more than likely have?
Eustachian Tube Block
**No fluid bubbles**
What are two other names for Meniere's Disease?
What are the characteristics of Meniere's Disease? (4 Possible)
Recurrent Prostrating Vertigo
Sensory Hearing Loss
Tinnitus (Ringing of the Ears)
Feeling a fullness in the ear
What condition is described as "Sensorineural hearing loss that occurs in people as they age and may be affected by genetic or acquired factors"?
What is another name for Bacterial Otitis Media?
Purulent Otitis Media (PUS)
What may be a cause of Bacterial Otitis Media?
Bacterial or viral infection of the middle ear
What is the three classic findings of Bacterial Otitis Media?
Red tympanic membrane
Dilated blood vessels
BULGING tympanic membrane
What are two ways that someone can get Serous Otitis Media?
Effusion of the Middle ear by:
1. Incomplete resolution of acute otitis media
2. Obstruction of the Eustachian Tube
What is unique about Serous Otitis Media
What does it look like clinically?
Unique- Chronic condition; Sucks the eardrum inward
Clinical Appearance- **Fluid is an Amber color and has bubbles**
What is the clinically term for "ringing in the ears"?
How is the condition of Vertigo described?
Abnormal sensation of Rotatory movement
If someone has vertigo, what three things may they have difficulty with?
Navigation of the Environment
What is the clinical presentation of Allergic Rhinitis?
Nasal mucosa appears Pale/Blue and Boggy
How can you tell if a patient has Atrophic Rhinitis?
Thinning of the nasal mucosa with sclerosis, Crust formation and Foul odor
What condition typically will occur as a consequence of chronic inflammation of the nasal mucosa?
If a patient has a nasal mucosa that appears red and swollen with a clear runny nose, what condition do they have?
What is another name for Cheilosis?
What condition is described by red sores at the corner of the mouth, that may be accompanied by bleeding?
Cheilosis AKA Angular Stomatitis
What may cause a patient to have Angular Stomatitis?
Deficiency of B2 (Riboflavin)
What is the clinical name for Thrush?
What three populations are prone to get Candidiasis?
How is Candidiasis described?
What is a way to tell a patient has Thrush versus Leukoplakia?
Description: Thick white fungal patches
Thrush; will easily scrape off the tongue
What condition does a patient have if their tongue appears to be "Smooth and Glossy"?
A deficiency of what two vitamins/minerals may cause Atrophic Glossitis?
B Vitamins (B-12)
What populations are common to have Leukoplakia?
Smokers and Tobacco users
What is the condition of "Pre-cancerous lesions of white patches that are adherent to the surface of the tongue and not easily removed"?
What is commonly found with Leukoplakia?
Fordyce Spots; Yellow Spots on the Tongue
What clinical condition is described by "excessive production of growth hormone, beginning in middle age"?
What classic characteristics will you see in a person with Acromegaly?
Abnormal/Enlarged Growth in:
In a patient that has Acromegaly, where is the problem located?
What is the definition of Gigantism?
Excessive production of growth hormone prior to skeletal maturity
What is the most common cause of Hyperthyroidism?
**Grave's Disease** (Autoimmune Disorder)
In Hyperthyroidism what hormone is:
Decreased: Thyroid Stimulating Hormone (TSH)
Increased: Thyroid Hormones
-- T3- Triiodothyronine
-- T4- Thyroxine
What is another name for Hypothyroidism?
What causes Myxedema/Hypothyroidism?
Increase in Thyroid Stimulating Hormone (TSH)
What is the most common cause of Hypothyroidism in the United States?
What is it called when someone has congenital hypothyroidism?
What two problems will and patient with Cretinism have?
Diminished Capacities for:
What two conditions will you often see a Barrel Chested appearance?
Chronic Obstructive Pulmonary Disease (COPD)
On an x-ray what is the ratio of AP to Lateral, to determine if a patient has a Barrel Chest?
What are two Congenital Anomalies of the chest?
What is an AKA for Pectus Excavatum?
What is an AKA for Pectus Carinatum?
How is Pectus Excavatum clinically described?
Marked depression noted in the sternum (Sunken In)
How does Pectus Carinatum present?
Forward protrusion of the sternum (Like the keel of the ship)
How is Tachypnea classified?
Rapid, Shallow Breathing
What is the clinical term for Slow breathing?
A pattern of breaths defines as follows: "Group of quick, shallow inspirations, followed by IRREGULAR periods of apnea", is called _______________?
No Pattern to Breathing
What is the clinically description of Cheyne Strokes Respiration?
Breathing pattern characterized by alternating periods of apnea (no breathing) and hyperpnea (has pattern)
In what condition will you see a patient present with Cheyne Strokes Respiration?
What is the name of breathing found in patients with Diabetic Acidosis?
What kind of breathing pattern would a patient with Diabetic Acidosis present with?
Breaths would be rapid and shallow in the beginning, as metabolic acidosis get worse, breathing would become deep, slow, labored and gasping.
Patients that have Metabolic Acidosis, have breathing called:
"Air Hunger Breathing"
What condition would you commonly see Pitted Nails?
What disorder does a patient have if they have, splinter hemorrhage in the nails?
Subacute Bacterial Endocarditis
A patient with transverse riding associated with acute severe disease has a condition called:
What is the clinically name given to inflammation of the nail fold near the cuticle?
If a patient has clubbing of the nails, what two conditions may they have? One being an early sign, the other being later.
Hypoxia (Early Sign)
Clubbing of the nails, indicates a decrease in oxygen in the blood, what condition may this be linked to?
If a patient presents with a spooning appearance to their nails, what are they likely deficient in?
Iron, Causing Iron Deficiency Anemia
What is the clinical name of Spoon Nail?
How do you preform Respiratory Excursion?
Place hands over the patients ribs and have the patient take a few deep breaths
When preforming Tactile Fremitus, if vibrations are increased, what is that a indication of?
Pneumonia- Fluid in the lung
Possible Congestive Heart Failure (CHF); Pulmonary Edema
What may cause Tactile Fremitus to be decreased?
Sound Barrier is Created with:
What is the term used over normal lung tissue/sounds?
What will cause lung sounds to be hyperresonant?
Increase air in the chest (i.e. Emphysema, Pneumothorax)
If a patient presents with Pneumonia or Atelectasis, what kind of lung sound will be produced?
How is Diaphragmatic Excursion performed?
Doctor ask patient to exhale and hold. Doctor percusses do the back of the intercostal margins (bone will be dull) starting below the scapula, until the sound changes from resonant to dull. Doctor marks that spot. Then the patient takes a deep breath in and holds. The doctor percusses down again, marking the spot where the sound changes from resonate to dull again. Doctor will measure the distance between the two spots.
If there is LESS than 3-5 cm, patient has pneumonia or pneumothorax, use chest x-ray to diagnose.
What should the tracheal duration be; ratio of Inspiration versus Expiration?
Inspiration should be equal to expiration
Where should the location of the tracheal breath sounds be heard?
Over the Trachea
When comparing Inspirations versus Expirations of the Bronchial breath sounds what is the duration?
Expirations should be LONGER than Inspirations
Where is the best location to hear bronchial breath sounds?
Over the Manubrium
What is normal duration for brochovesicular breath sounds?
Inspiration is equal to Expiration
Where is the best location to hear brochovesicular breath sounds?
Between 1st-2nd rib Anteriorly
Between the Scapulae Posteriorly
Vesicular breath sounds; what is normal duration?
Inspiration LONGER than Expiration
Where is the best location to listen to Vesicular breath sounds?
The remaining lung field
What condition are Rales often associated with?
A small clicking, bubbling or rattling sound, maybe described as moist, fine, dry or coarse in the lung is a description of _______?
What abnormal lung sound resembles snoring?
When does a Rhonchi happen?
When air is blocked or becomes rough through large airways
When is a rale likely to be heard?
When air opens and closed air space
What condition will be see with Rhonchi?
What type of sound and how is a Wheeze produced?
High pitched sound, through narrow airways
Lower Airway Expansion
Is a wheeze herd upon inspiration or expiration?
What two population will you hear wheezes in? One old and one young population.
What is it called when you have a wheeze like sound on inspiration?
Upper Respiratory Infection
Stridor is commonly found in children with _________?
How is stridor produced?
Usually a blockage of airflow
What is a positive finding for Bronchophony?
If clear, distinct sounds are heard as patient says "99", consolidation is present
What is a positive finding for Egophony?
If you hear "AAAA" as the patient says "EEEEE", consolidation is present
What is a positive finding for Pectoriloquy?
If the words "1,2,3" are heard clearly and distinctly, consolidation is present
What three Vocal Resonance test can be performed, to see if consolidation is present in the lungs?
**Solid substances makes sounds better, knocking on a table**
When performing a hearing exam what is "Normal Hearing" for the Weber test?
Equal sound heard bilaterally
What is a positive finding in conduction loss, when performing Weber's test?
Lateralizes to the involved ear
Sensorineural hearing loss is a positive finding when the Weber test is heard in which ear?
Sound lateralizes to the uninvolved ear
What is considered a positive Rinne test?
Air Conduction (AC) is Greater then Bone Conduction (BC)
What two findings would indicated a negative Rinne test?
Air Conduction (AC) is Less then Bone Conduction (BC)
Air Conduction (AC) is Equal to Bone Conduction (BC)
Conduction Hearing Loss
What finding will you have in the Rinne test, with a patient who has Sensorineural hearing loss?
Air Conduction (AC) will be Greater than Bone Conduction (BC), with less time in the bad ear
What causes Secondary Hyperparathyroidism?
Decreased stimulation of Thyroid Stimulating Hormone (TSH), from the Pituitary gland
What are four other names for a Common Migraine?
What age/time and gender does a Common Migraine usually effect?
Age/time- Childhood and Early Adulthood
What are the four characteristics of a Common Migraine?
Worse behind one eye
Nausea and/or vomiting
When are three other things to know about Common Migraines?
Decreases frequency as the person ages
Decreases with pregnancy
What seven things can provoke a Common Migraine and/or a Classic Migraine?
What are six follow ups that can be done to help with Common Migraine?
Avoid provoking/triggering factors
FeverFu- 125QD (Drug to help decrease frequency)
What age/time and gender does a Classic Migraine usually effect?
*Classic Migraine, is a Neurologically Event*
Age/time- Childhood and Early Adulthood
Is a Classic Migraine usually Unilateral or Bilateral?
What are the five characteristics of a Classic Migraine?
**Aura, Prodrome-sensory changes before it comes on**
(Same as Common Migraine)
Worse behind one eye
Nausea and/or vomiting
What age/time does a patient experience a Hypertension headache?
What is the common location of a Hypertension headache?
What are two characteristics of a Hypertension headache?
**Wake up with a headache**
What two follow ups would you do if a patient presents with a Hypertension headache?
What age/time and gender does a **Cluster** headache usually effect?
Age/time- Adolescents to Adulthood
What are three common sites for a Cluster headache to show up?
What are the seven characteristics of a Cluster headache?
**Wake up at night with headache (Comes on after sleep)
**Last 15-180 minutes**
**Rhinorrhea** (Runny nose)
NOT aggravated by exertion
What are two provoking factors of a Cluster headache?
Seasonal (Allergy testing)
Headaches usually occur together in "clusters"
What age is effected by a Muscular tension headache?
What is the location/site of a Muscular tension headache?
What are three characteristics of a Muscular tension headache?
What are four provoking triggers for a Muscular tension headache?
What are two other names for Temporal Arteritis?
What age is usually effected by Temporal Arteritis?
What site/location will you commonly see Giant Cell headaches?
*Proximal muscle pain and stiffness*
What are the six characteristics of Temporal Arteritis?
*Pain with combing of the hair*
Pain with chewing (Jaw Claudication)
What are the two triggers that provoke Giant Cell headaches?
What is the follow up with a patient that has Polymyalgia Rheumatica? (3 things)
Biopsy of arteries
Look at the amount of inflammatory drugs, can cause blindness (Medical Realm)
What is another name for a Cervicogenic headache?
What must be done before you adjust someone with a Veterbrogenic headache?
Flexion and Extension Films
What age usually gets Cervicogenic headaches?
What is the two common site/location or a Veterbrogenic headache?
*May have a congenital anomaly*
What may provoke a Veterbrogenic headache?
What are three characteristics of a Cervicogenic headache?
Decrease ROM in upper cervicals and occiput
Pain in the neck that refers to the head
What are the follow up to Cervicogenic headaches?
Flexion and Extension X-rays
**Adjust, best treatment**
What are three characteristics of a Sinus headache?
Worse in the morning
What provokes a Sinus headache?
Where is a common site of pain for someone who has a Subarachnoid hemorrhage?
What are the four characteristics of a Subarachnoid hemorrhage?
Excruciating pain, pain like never felt before
What are the two provoking factors of a Subarachnoid hemorrhage?
What is the follow up to a patient with a Subarachnoid Hemorrhage?
High Blood Pressure
What are the two characteristics of a Subdural hematoma?
Slow bleed following and trauma
Evident days to weeks post injury
What provokes a Subdural hematoma?
What is the follow up to a Subdural hematoma?
Send to ER
What is the painful site/location of a Brain tumor?
Any place and changes with body position
What are the four characteristics or a Brain tumor?
Onset in the morning or evening
Mild to severe pain
What is the follow up to a Brain tumor?
MRI or CT of the brain
Refer to a Neurosurgeon
What is the worse time of Meningitis?
Where will the pain be for Meningeal Irritation?
What are the four characteristics or Meningeal Irritation?
Pain that has never been experienced before
What action will provoke Meningeal Irritation?
Flexion of the neck
What follow up will be done to confirm Meningeal Irritation?
Cerebrospinofluid (CSF) tap
What two orthopedic exams will be positive if a patient has Meningeal Irritation?
When a CSF tap, is done on a patient with Meningeal Irritation, what will be the findings in Bacterial and Viral Meningitis?
Bacterial- Decrease Sugar
Viral- Increase Protein
What can provoke a Hypoglycemic headache?
Who would you refer a patient to that has a Hypoglycemic headache?
What is the follow up of a patient with a Hypoglycemic headache?
Fasting Blood Sugar (FBS)
What are the two characteristics of a Post Concussive injury?
Loss of memory
What four things could provoke a Post Concussive injury?
Motor Vehicle Accident (MVA)
What is the follow up for a patient that has a Post Concussive injury?
Refer to Neurologist
In what three conditions will you have a Resonant sound on Percussion?
In what three conditions would you have a Dull/Flat sound during Percussion?
What two conditions will you have a Hyperresonant sound during Percussion?
What is a common cause of Bronchiectasis?
Post nasal drip
What side will the Trachea deviate on a Pneumothorax and Atelectasis on X-ray?
Pneumothorax- Opposite Side
Atelectasis- Same Side
What five conditions will you have a Decrease in Fremitus?
What condition will you have an Increase in Fremitus?
What two conditions will you have a Normal Fremitus?
What breath sounds are heard with Asthma and Emphysema?
What breath sound is heard with Atelectasis?
Absent (Nothing heard)
What breath sound is heard with Bronchiectasis?
What breath sound is heard in Bronchitis?
With Pleurisy, what breath sounds are heard?
Crackles (Friction Rub)
Are breath sounds increased or decreased with Pneumothorax?
What breath sounds will be heard in a patient with Pneumonia?
Whispered Pectoriloquy (1,2,3)
What condition has consolidation of the lung?
What are the three characteristics of Lobar Pneumonia?
Productive cough for around 10 days
**Rusty Brown Sputum**
What x-ray finding is seen with Lobar Pneumonia?
What two populations will have Friedlander's Pneumonia?
Older aged individuals
What are two characteristics of Friedlander's Pneumonia?
**Currant Red Jelly Sputum** Caused by Klebsiella Pneumonia
Seen frequently in Alcoholics
What is the common cause of Pneumocystis Carinii?
What population is most likely to get Pneumocystis Carinii and Cytomegalovirus?
AIDS patients, opportunistic infection
What is the common presentation of a patient with Tuberculosis? (4 Things)
Low grade fever
What X-ray finding are seen with someone with Tuberculosis?
Ghon lesions (small white lesions)
What three test will be positive in a patient with Tuberculosis?
Purified Protein Derivative
What is the most definitive test for Tuberculosis?
What is the name of the condition that has; " stabbing chest pain worsened by respiration, with a dry/non productive cough"?
What are four ways to help determine that a patient has Pleurisy?
Decreased respiration excursion
Deceased tactile fremitus
Dull on Percussion
Friction rub is present
What orthopedic exam is positive in a patient with Pleurisy?
What condition is defined as "A ruptured lung causing air to become trapped in the pleural space"?
Trachea goes Away
What two things will be deceased in Pneumothorax?
Who can a Pneumothorax happen to?
Young, tall thin, previous healthy male individuals (Spontaneous)
How is an Atelectasis described?
Collapse of the lung, usually a result of a Bronchial Obstruction due to a mucous plug
What condition is "Irreversible focal bronchial dilation that is present with a chronic, productive cough"?
Diagnosed by: CT
What is another name for Chronic Bronchitis?
Chronic Obstructive Pulmonary Disorder (COPD)
What is the main cause of COPD?
Cigarette smoking, if the patient is not a smoker, Cigarette Smoke makes it worse
In a patient who has Asthma, what is happening in the lungs?
Bronchospasm constricting the airways
What triggers Type I hypersensitive Asthma?
What are two clinical presentations of a patient who has Asthma?
Tachycardia (Increased heart rate)
Tachypnea (Increased breathing)
What two microorganisms will increase with an Asthma patient?
What two lab test are done to confirm Asthma?
**Charcot Laden Crystals**
(Crystals and spirals in the sputum from IgE)
What condition is described as "destruction of elastic pulmonary connective tissue resulting in permanent dilation of the alveoli air sacs"?
What is the cause of Emphysema?
Deficiency of Alpha 1 Anti Trypsin
What is Bronchogenic Carcinoma?
Primary malignant lung tumor, starts in bronchus of the lung
What population is diagnosed with Bronchogenic Carcinoma?
Long term smokers, 20-30 years
What are the four common characteristics of Bronchogenic Carcinoma?
Non productive cough for more than 30 days
Afebrile (No fever)
Dyspnea (Difficult breathing)
In a patient that has Costochondritis, will there be swelling?
Where is the pain felt in a patient with Costochondritis?
On the cartilage between the ribs and the sternum (Cartilage is inflamed)
What makes Costochondritis worse?
Physical activity, get worse with exercise
Where is the most likely place to palpate Costochondritis?
3rd, 4th, 5th costosternal articulation
What is another name for Herpes Zoster?
Must have had chicken pox to have Shingles
Where is Herpes Zoster often found?
Painful rash, along a dermatome (Single nerve root)
What structures are primarily involved in Shingles?
Dorsal root ganglion
If cranial nerve is involved- Cranial Nerve V
What population is Sarcoidosis most commonly seen in?
African Americans in the United States
What is Sarcoidosis?
Abnormal collection of inflammatory cells (granulomas) that form an nodule
What two locations does Sarcoidosis most commonly appear?
What is a cancer that if from the lymphatic system and can spread to the spleen?
What population most commonly has Hodgkin's?
Young Caucasian males
Is Hodgkin's unilateral or bilateral?
What is the best diagnosis for Hodgkin's?
What must Hodgkin's have to be termed cancer?
Reed Sternberg Cells
What characteristics will a patient present with if they have Hodgkin's?
Intense pruritus (Release of IgE)
What appearance will a Cystic Fibrosis patient have?
Barrel chested, similar to COPD
What do the glands of a Cystic Fibrosis patient produce?
Sweat and/or mucus
What characteristics will a Cystic Fibrosis patient present with?
Chronic progressive cough
Frequently a fatal genetic disease, of the body's mucus glands
What two places does the mucus of a Cystic Fibrosis patient accumulate?
What test can be done on a patient with Cystic Fibrosis?
Sweat test, loss of excessive amounts of salt, Salty Tears
What organ is insufficient in a Cystic Fibrosis patient?
Calcium Channel Insufficiencies
What side of the heart does Jugular Venous Pulsations measure?
When is it possible to have more pronounced Jugular venous pulsations?
When Congestive heart failure (CHF) is present and pressure is applied to the liver (Heptojugular Reflex)
What is a "Bounding" peripheral pulse termed?
In what four conditions will you see Pulsus Magnus?
**Increase in Cardiac Output**
How is Pulsus Parvus defined?
Weak or Thready
What three conditions would you likely see Pulsus Parvus?
**Decrease in Stroke Volume**
Congestive heart failure (CHF)
What pulse would be seen in Left ventricular failure?
What peripheral pulse is defined as an "alternates in amplitude"?
What peripheral pulse is described as "two strong systolic peaks separated by mid systolic dip"?
What location is Pulsus Bisferiens felt at?
What two valve conditions is Pulsus Bisferiens seen?
What is the name of the peripheral pulse that has a "decrease amplitude on inspiration and increased with expiration"?
How big of a change does the amplitude need to be for a positive Pulsus Paradoxus?
Greater than 10 mm Hg
What four conditions will you see Pulsus Paradoxus?
Chronic Obstructive Pulmonary Disease (COPD)
What is the name of the peripheral pulse that is "a jerky pulse that is rapidly increasing and then collapsing because of aortic insufficiency"?
Water hammer pulse
What is the clinical term for "vibrations produced by turbulent blood flow within the heart"?
What does this cause?
What is it called when the ventricles of the heart contract?
When the ventricles are relaxed and filling this is termed what?
What causes the S1 heart sound?
Closure or the AV valves (Mitral and Tricuspid)
What two valves make up the Atrioventricular valves?
Mitral on the Left
Tricuspid on the Right
What to valves make up the Semilunar valves?
Aortic on the Left
Pulmonary on the Right
What causes the S2 heart sound?
Closure of the Semilunar valves (Aortic and Pulmonary)
The S3 heart sound is called ___________?
The S4 heart sound is called ____________?
In what population is the S3 heart sound heard in?
If the S3 heart sound is heard in a patient over the age of 40, what may that be an early sign for?
**Congestive heart failure (CHF)**
Which heart sound, is "related to stiffness of the ventricular myocardium to rapid filling"?
S4 (Atrial gallop)
Atrial gallop is always classified as __________?
What test is done to evaluate all of the heart valves?
Echocardiogram/Doppler (Ultrasound of the heart)
What is the best place to hear the Aortic heart valve?
2nd intercostal space on the right at the sternal boarder
What is the best patient position to listen to the Aortic heart valve?
Patient seated, leaning forward and exhaling
Where is the Pulmonic valve best heard?
Left sternal boarder at the 2nd intercostal space
Erb's point is best heard where?
Left sternal boarder at the 3rd intercostal space
What clinical significance does Erb's point have?
Best place to hear murmurs
What is the location to place the stethoscope to listen to the Tricuspid valve?
Left sternal boarder at the 5th intercostal space
Which valve is best auscultated at the mid-clavicular line on the left at the 5th intercostal space?
What patient position is the best to listen to the Mitral valve?
Left lateral decubitus
What sound will a Stenosis make when listening to the heart?
What does Stenosis mean?
The valve does not open all the way
What sound does a Regurgitating valve make?
Regurgitation is defined as ____________?
Valve not closing all the way
What kind of sound will a Stenosis murmur have?
Which side of the stethoscope is used for Stenosis murmurs?
What sound will a Regurgitation murmur make?
What side of the stethoscope is used when listening to Regurgitation murmurs?
What is the pneumonic used to help with Diastolic murmurs?
ARMS and PRTS
Opposite in Systolic Murmurs
What congenital heart defect is described as "Failure of shunt to close between the aorta and left pulmonary artery"?
Patent Ductus Arteriosus
What kind of murmur is produced when a patient has Patent Ductus Arteriosus?
Heard in both phases of the heart cycle
What is Tetralogy of Fallot?
Congestive heart defect
D-dextapositon/overriding of the aorta
R-right ventricular hypertrophy
I-intraventricular septal defect
**Know exactly what each of these are**
When is the murmur of Tetralogy of Fallot heard and what condition may be present?
Murmur- Ejection murmur during Systole
Condition- Severe cyanosis
What is it called when there is "constriction of the descending aorta"?
Coarctation of the Aorta
Where does Coarctation of the Aorta usually take place?
*Distal* to the left subclavian
What happens to the patient's blood pressure if they have Coarctation of the Aorta?
Increased Blood pressure in the upper extremities by 20 mm Hg, when compared to the lower extremity
What is the condition called when there is "proximal stenosis of the subclavian artery"?
Subclavian Steal Syndrome
In what population do you see Subclavian Steal Syndrome?
Young females who faint (syncope/drop attacks) while exercising
What is the most common cause of left sided heart failure in 35-55 year old people?
What is the 2nd most common cause of left sided heart failure?
What are the three early signs of left sided heart failure?
Pulmonary edema (Fluid in the lungs)
Shortness of breath (Exertional dyspnea)
Orthopnea (Feeling of drowning when laying flat, patient is able to be in a semi recumbent position)
Where does the fluid collect first in left sided heart failure?
Costophrenic angles, (Will be blurred/blunted or nonexistent on x ray)
What is the most common cause of right sided heart failure?
Left sided heart failure
What is the most common cause of Mitral stenosis?
What is the definition of Cor Pulmonale?
Right side of the heart fails by itself (LUNG CONDITION that causes right sided heart failure)
If there is an increase in the right ventricle what condition is likely to be present?
Chronic Obstructive Pulmonary Disease (COPD)
When right sided heart failure occurs, where is the blood back up into?
Superior and Inferior Vena Cava
What eight complications does right sided heart failure lead to?
Edema and fluid in the extremities
Jugular vein distension (via Superior vena cava)
Enlargement of liver and Spleen
Positive Heptojugular reflex
Ascites (Fluid in abdomen caused by portal hypertension)
Caput medusa/ Spider angioma
Will there be an increase or decrease in heart rate, when a patient has Right sided heart failure?
What heart sound is heard in a patient that has Right sided heart failure?
What will the blood pressure of a patient with Right sided heart failure do, increase or decrease?
What condition is possible if there is bilateral pitting edema?
What is "an interruption of the intima allowing blood into the vessel wall with immediate "tearing" pain"?
What three conditions are Aortic Dissection associated with?
Arteriosclerosis (Descending Aorta)
Marfan's (Ascending Aorta)
How is Marfan's Syndrome defined?
Inherited connective tissue disorder with ventricular weakening and enlargement
What is a common patient presentation with Marfan's Syndrome? (4 things)
Cardiovascular and Lung problems
What is another name for Angina Pectoris?
During rest of activity does Angina Pectoris come on?
When does Printzmetal Angina come on?
How is Angina Pectoris relieved?
Vasodilators, under tongue
What may cause a myocardial infarction?
What labs will be elevated in a Myocardial infraction?
Lab levels decrease in the opposite order (3,2,1,)
What condition is described as "abnormal widening that involves all 3 layers; defect in elastic-media tissues"?
What does the P wave on an ECG indicate?
What does the QRS complex represent on the ECG?
Depolarization of the ventricles.
Repolarization of the atria are hidden here
The T wave on an ECG, represents ____________?
Repolarization of the ventricles
Which wave on the ECG represents repolarization of the papillary muscles?
What does an increased PR interval indicate?
Prolonged AV nodal delay (Primary heart block)
If there is two P waves on and ECG before the QRS complex, this is indicative of what?
Weinkbochs- Block at the bundle of HIS (2nd Heart Block)
If there is complete heart block, no ventricular contraction what part of the ECG will not be seen?
If the ST segment of an ECG is either enlarged or inverted what does that mean?
Myocardial Infraction (Acute heart failure)
What wave will be absent in a Myocardial Infarct?
If not P wave is present what condition is present?
What is the proper order to perform an abdominal exam?
When there is a an early intestinal obstruction, what happens to the bowel sounds?
Increase in bowel sounds (Car Accident Analogy)
There is a decrease or absent in bowel sounds when?
Late intestinal obstruction
With a late intestinal obstruction what may be present?
Adynamic (paralytic) ileus
What is the clinical term for "vomiting up blood"?
What does the term Hemoptysis mean?
Coughing up blood
Blood in the stool is called ______________?
What test is best for testing the liver?
What test is best for seeing if a patient is an alcoholic?
Gamma-Glutamyl Transpeptidase (GGT)
(Gotta Get Tanked)
What lab is done to test Liver and Kidney?
Blood Urea Nitrogen (BUN)
What will the BUN test do for each Liver and Kidney?
What is another word for Jaundice?
What condition is classically described as "yellowing of the skin, sclera and mucus membranes"?
Jaundice (Can occur in any liver disorder)
What is the most common destruction of the liver?
What three things can Cirrhosis of the liver cause?
If an alcoholic has, coughing, tearing of the esophageal blood vessels and hematemesis, with a rash on the palmer surface due to bile salts, what condition do they have?
What syndrome is described as a "Thiamin deficiency form alcoholism that leads to dementia"?
Wernicke Korsakoff Syndrome
What is Beri Beri Syndrome?
Thiamin deficiency without alcoholism
What is the name of the disease when "liver may be tender and enlarged but the edge remains soft and smooth"?
How does one contract Hepatitis A?
From food through oral/fecal route
Self limiting and NOT a carrier
Which type of Hepatitis is obtained via blood transfusions?
This type of Hepatitis is most common to become liver cancer?
What are two ways someone get Hepatitis B?
Which type of Hepatitis is a carrier for life and has to do with both blood and venereal diseases?
What kind of cancer is the most common site for metastatic disease?
What are two common findings of liver cancer?
Hard and irregular boarder
What is a specific marker for Hepatocellular Carcinoma?
Alpha fetoprotein (Liver Cancer)
Is Direct/Conjugated bilirubin water soluble?
Under what three conditions will there be in increase in Conjugated bilirubin?
Duct obstruction **(Gallstones)**
If there is an increase in the amount of direct bilirubin in the blood, it may go to the urine, what is it called?
Which type of bilirubin is not water soluble; Direct (Conjugated) or Indirect (Unconjugated)?
Indirect (Unconjugated) Pre-hepatic
Sickle Cell Anemia, Rh- condition
What are three conditions that will have an increase in Indirect bilirubin?
An increase in reticulocyte count is called_________?
Is Hemolytic anemia pre or post hepatic?
What is the name of the test to determine Hemolytic Anemia?
Where is the two pain points of referral for a gallbladder issue?
Tip of the right scapula
What is the classification of Gallbladder pain to the shoulder region?
What is the most common population of patient to have Cholecystitis?
Females over the age of 40
(Female, Forty, Fertile, Fatty Fast Food, Fatty Stool, Flatulence)
If a patient has Cholecystitis what are the four characteristics they will present with?
Severe right upper quadrant pain
After eating a large fatty meal
What is Murphy's Sign?
Inspiration Arrest Sign
Who would you refer a patient with Cholecystitis to?
Which two test would be ordered to confirm Cholecystitis?
Oral Cholecystogram (Swallow Contrast Medium)
What condition is defined as "Calcification that can become malignant due to chronic inflammation"?
What is the location of epigastric pain?
Straight through the T10-T12 area like a knife
In what condition would you see chronic pancreatitis?
What is the approach to be carried out for acute pancreatitis?
Call 911 Emergency
What is a positive Grey Turner sign?
Bleeding of the flanks
What "Sign" is present with "Periumbilical ecchymosis caused by intraperitoneal hemorrhage or seen with a ruptured ectopic pregnancy"?
What two lab values will be increased with Pancreatitis?
What part of the pancreas is usually effected with cancer?
Head of the Pancreas
What are three signs, that a patient has pancreatic cancer?
Clay colored stool
What condition is being described in the following: "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"?
If the tissues of the body do not have enough insulin to work, what will they breakdown to obtain energy?
What are the classic three signs of Diabetes Mellitus?
Polydipsia (Increase in Thirst)
Polyphagia (Increase in Hungry)
Polyuria (Increase in Urination)
What lab would you order for a screening of Diabetes Mellitus?
Fasting Blood Sugar (FBS)
What three labs would you order to help confirm Diabetes Mellitus?
Glucose Tolerance Test (GTT)
Fasting Plasma Glucose (FPG)
HbA1C (Glycosylated Hemoglobin)
In what population do you usually see Type 1 or Insulin Dependent diabetes?
Juvenile, under 30, usually thin
What population is often associated with Type II or Non-Insulin Dependent diabetes?
Adult, over 40, usually obese
Diet choice and lack of exercise, is what causes this!!
In the condition of Diabetes Insipidus, what structure is not functioning properly and what hormone is being decreased?
Structure- **Posterior Pituitary Gland**
Hormone- Insufficient Anti-diuretic hormone (ADH) AKA Vasopressin
What sign will NOT show up in Diabetes Insipidus?
Polyphagia (Increase in Hungry)
What is another name for Diffuse Idiopathic Skeletal Hyperostosis? (DISH)
When you see Forestier's Disease, what is a common condition that goes along with it?
Diabetes, do a Fasting Blood Sugar (FBS) and/or Glucose Tolerance Test (GTT)
What condition should be suspected if you see an air bubble around the diaphragm on an X-ray?
What is a Hiatal hernia?
Protrusion of the stomach above the diaphragm
In a patient that has a hiatal hernia, what are six signs they have this condition?
Tenderness in Left Upper Quadrant
Reflux esophagitis (Acid Reflux)
Pain worse when lying down
Pain worse after eating a large meal
Barrett's esophagus is a precursor to what?
What condition is caused by a sliding Hiatal hernia?
What four things make Reflux Esophagitis worse?
Eating a large meal
What two special test would you order to confirm Reflux Esophagitis?
Upper GI series
What two categories are included in peptic ulcers?
What is the causative agent for Peptic ulcers?
H. Pylori bacteria
Why is pain in Peptic ulcers, "pinpoint pain"?
Hydrochloric acid is burning a hole in the epigastric region
What is the appearance of vomit from a patient with a Peptic ulcer?
Coffee ground appearance
Does gastric ulcers have a consistent pain pattern?
What is the unique thing about Gastric ulcers?
Pain is decreased by eating
Pain comes on right after eating
What is the most common type of peptic ulcers?
When does the pain of a duodenal ulcer occur?
Two hours after eating
What kind of stool is found in a patient that has a duodenal ulcer?
What is the confirmatory test done, looking for occult blood in the stool, common in patients with duodenal ulcers?
What condition is seen often in males and first time mothers and described as "projectile vomiting in a newborn"?
String Sign on x-ray: palpable node in the epigastric area
What location of the stomach is the most common for gastric carcinoma?
What is it called when the **left supraclavicular lymph node** is involved?
What is the most common cause of Mononucleosis?
Epstein Barr Virus
What age is most likely to have Mononucleosis?
Young adults (18-25)
What is the name of the atypical lymphocytes found in the blood of patients with Mononucleosis?
What are the symptoms of Mononucleosis? (5 symptoms)
Similar to the flu
Lymphadenopathy in cervical region
What condition is called "Marble Bone"?
What two organs become enlarged in Osteopetrosis?
Where is the referral pain of the small intestine to?
What is another name for Regional Ileitis?
Where is Crohn's disease located?
Right side of the intestine
What disease is described as a nonspecific inflammatory disorder that affects the distal ileum and colon?
Patient's that have Crohn's disease, will have what three symptoms?
Pain in Right Lower Quadrant (RLQ)
Chronic diarrhea (Usually bloody)
Cobblestone appearance on Sigmoidoscopy
Regional Ileitis leads to malabsorption of what vitamin?
How is Crohn's disease confirmed? What is a finding on the test?
Sigmoidoscopy, Skip lesions will be present
What can cause Regional Ileitis?
Non-Tropical Sprue/Celiac Sprue (Gluten Allergy)
Where is Ulcerative Colitis located?
Left side of the intestine
In what two parts of the intestine is Ulcerative Colitis most commonly found?
What is the major indicator of Ulcerative Colitis?
How is Ulcerative Colitis diagnosed?
What is another name for Irritable Bowel Syndrome?
What disorder has "variable degrees of constipation and diarrhea in response to stress"?
Irritable Bowel Syndrome
What gender more commonly has Spastic Colon?
What age, gender,symptom is it common to see Diverticulitis?
Over the age of 50, Female with a Fever
What causes someone to get Diverticulitis?
Inadequate fiber in the diet
What condition is described as "Chronic constipation which causes small out pouchings within the colon that become infected?
Where is the pain in a patient that has Diverticulitis
Lower Left Quadrant (LLQ)
What is Meckel's Diverticulitis?
Out pouching of the Ilium
If a patient has an appendicitis, where should they be referred to?
What special test can be done, to confirm and Appendicitis?
What four (orthopedic) tests will be positive in a patient that has an Appendicitis?
Rebound Tenderness (Peritonitis)
What is the name of the test that is done to diagnosis an Appendicitis and what does it indicated?
Test name- **Shilling Shift**
Indicates- Increase in White Blood Cells (WBC)
What four symptoms will a patient with an appendicitis present with?
Where will the pain be present at in a patient's abdominal region if they have an appendicitis?
Dull Periumbilical region or epigastric pain that radiates to the lower right quadrant (LRQ) (McBurney's Point)
What are the six characteristics of Cushing's Disease?
Moon face/ "pie face"
Pendulous abdomen with purple striae
Hirsuitsm (Male hair growth pattern usually on women)
What causes Addison's Disease?
Decrease in aldosterone
What are the two cause of Cushing's Disease?
Increase production of adrenal cortex hormone
Long standing Cortical Steroid use
What are two other names for Cushing's Disease?
What are two other names for Addison's Disease?
In increase in what hormone will cause melanin deposition in a person with Addison's Disease?
Adrenocorticotropic Hormone (ACTH)
What eight signs/symptoms will a person with Addison's Disease present with?
*Decreased blood pressure*
What is it called when there is a tumor or the Adrenal Medulla?
Grey Cell Tumor
If a person has an increase in ACTH, (Addison's Disease)where will the hyperpigmentation show up?
In the condition of Pheochromocytoma what is increased?
(Epinephrine and Norepinephrine)
What condition has a similar appearance to hyperthyroidism?
What is the name of the condition that produces EXTREME hypertension?
Diastolic number if over 100
What would you refer a patient that you think has a Pheochromocytoma?
ER (Medical Emergency)
What condition is has an increase of calcium made in the body?
What are the three "things" made of calcium in the condition of Nephrolithiasis?
Calcium oxalates (Most Common)
Where will the pain be located in a patient with Nephrolithiasis?
Flank pain described as writhing
What orthopedic test will be positive in a patient with Nephrolithiasis?
Murphy's Test (Kidney Punch)
What four test will be increased in a patient with Nephrolithiasis?
Blood Urea Nitrogen (BUN)
Kidney, Ureter, Bladder (KUB) study
What is the most specific test for Nephrolithiasis?
What is always one positive finding in Nephrolithiasis?
Blood will be found in the urine
What can Hydronephrosis cause?
In a patient with Nephrolithiasis, if they take in Vitamin C what will that lead to?
Increase in kidney stones
What is another name for Acute Glomerulonephritis?
What causes Acute Glomerulonephritis?
Group A hemolytic strep, will have a Positive ASO Titer test
What are the findings in Nephritic syndrome?
Red blood cells (RBC) cast in the urine with small amount of protein
What are the three classic signs in Nephrotic syndrome?
What is Nephrotic syndrome in a pregnant woman called?
What is the definition of Eclampsia?
Nephritic syndrome with convulsions during pregnancy
What kind of cast are found in the urine in a patient that has Nephrotic syndrome?
Waxy or fatty
How does someone get Polynephritis?
E-coli infection for a Urinary Tract Infection (UTI)
In the condition of Polynephritis what kind of cast will be found in the urine?
White Blood Cell (WBC) cast
What condition is described as "Inherited disorder with many bilateral renal cysts that increase renal size but reduce function of the renal tissue"?
Polycystic Kidney Disease
What three findings will be present in a person who has a Renal Carcinoma?
What is found in the urine of a person with Urethritis?
What is the most common cause of Urethritis in females?
What are the two diagnosis of Urethritis?
What causes each classification?
Gonococcal (Caused by Gonorrhea) More often seen in Males
Non-Gonococcal (Caused by Chlamydia)
What two areas will the patient with Cystitis have pain?
Low back pain
How is Cystitis defined?
Noninfectious bladder inflammation
Urination will be:
Pain (During and after urination)
Frequent urination with incontinence
What is another name for a Wilm's tumor?
What condition is seen in a younger person, with abdominal mass and hematuria?
What is a Nephroblastoma?
Malignant tumor of the kidney
What is the clinical term for an "Overactive Bladder"?
**Urinary Incontinence**; Neurological Problem
What is the most common cause of Urinary Incontinence?
How is Stress Incontinence define?
Increase in Abdominal pressure
i.e.: Exercise, Cough, Sneeze, Laugh
What causes Urinary Incontinence?
Weakness in the pelvic floor muscles
What exercises may be given to a patient with an Overactive Bladder?
What type of urinary incontinence has "the inability to completely empty your bladder when you urinate"?
What is a common result of an Overflow bladder? (Urinary Incontinence)
What is a condition that is common in people with an Overflowing bladder?
What type of urinary incontinence is most commonly seen in "older adults with arthritis, Parkinson's and Alzheimer's"?
What is the most common type of hernia?
What is the location of this type of hernia?
Indirect Inguinal Hernia
Location-Lateral and Inferior to the Epigastric Vessels
What population do you see Indirect Inguinal hernias in?
Children and young adults
How is an Indirect Inguinal Hernia described?
Passes down the inguinal canal and exits the external inguinal ring and into the scrotum
Where does a Direct Inguinal hernia exit from?
What is the Location of a Direct Inguinal Hernia?
External inguinal ring, does not pass through the inguinal canal
Location-Medial and Inferior to the Epigastric Vessels
What two things usually cause a Direct Inguinal hernia?
During what two times is a Direct Inguinal hernia often felt?
When the patient:
What age is a Direct Inguinal hernia often seen?
Older, over the age of 40
Where is a Femoral Hernia found?
Bulge lateral and inferior to the external inguinal ring at the site of the femoral pulse
Is a femoral hernia, classified as a inguinal hernia?
What condition is "Abnormal endometrial tissue found outside of it's normal location"?
Where is endometriosis most commonly found?
What are five signs of Endometriosis?
Painful intercourse (Dyspareunia)
What is the most common reason for a hysterectomy?
What condition is described as "Benign uterine tumor of smooth muscle origin"?
What are three symptoms present with Uterine Fibroids?
Heavy menstrual bleeding
How will the uterus feel in a patient with Uterine Fibroids?
Painless nodules that are irregular and firm
What condition is an "infection of the upper female genital tract"?
Pelvic Inflammatory Disease
Which two STD's are the most common cause of Pelvic Inflammatory Disease?
What other condition is often seen with Pelvic Inflammatory Disease?
Salpingitis (Inflammation of the fallopian tubes)
What condition is described as a "pregnancy in which implantation has happened outside of the endometrial cavity"?
What three signs will be present is a patient with an Ectopic pregnancy?
Decreased blood pressure
Decrease in Human Chorionic Gonadotropin (HCG)
What is the common cause for the first and second reason for an Ectopic Pregnancy?
First- Prior Gonococcal infection
Second- Intrauterine Device (IUD)
What are four common finding in normal pregnancy?
Increase in Human Chorionic Gonadotropin (HCG)
What condition will have a very high level of Human Chorionic Gonadotropin (HCG)?
What is the condition that is described as "A non-viable embryo which develops in the placenta and presents with all the signs of pregnancy"?
What is the name of the condition that is "A malignancy of the placenta due to abnormal epithelium"?
What condition is found in young women, that have *Multiple*, round, freely movable masses that can be palpated?
Fibrocystic Breast Disease
Lumpy Bumpy Breast around menses
What make Fibrocystic Breast Disease worse?
In what population is Fibrocystic Breast Disease commonly seen in?
What is the most common benign breast tumor?
What age is Fibroadenoma usually seen in?
Less than 30
What are three things to know about Fibroadenoma?
Unilateral 75% of the time
What is the 2nd most common cause of death in women?
What is the most common location of breast cancer?
Upper/outer quadrant (Axillary area, tail of Spence)
What are the four common findings associated with breast cancer?
Dimpling (Paget's Disease of the breast)
Orange peel appearance
Where will breast cancer metastasis to?
What kind of appearance does breast cancer have on bone?
Metastasis- Axilla via lymphatic system
Appearance- Lytic (Metastases from the Lymph vessels)
What is it called when there is "Tortuous dilation of the spermatic veins"?
When will the pain from Varicocele diminish?
What is a common name for Varicocele?
**"Bag of Worms"**
What condition is "A fluid filled mass in the epididymis"?
Is a Spermatocele and Hydrocele transiluminatable?
Yes, it's fluid filled
Where is a Spermatocele located?
Superior and posterior to the testicle
What are three characteristics of a Spermatocele?
Pea sized lump
What is a Hydrocele?
Excessive accumulation of water in the testicles
What are four characteristics of a Hydrocele?
How is a Hydrocele able to be distinguished from a scrotal hernia?
Being able to palpate about the mass, indicates its a Hydrocele
How does a patient get Epididymitis?
Consequence of an STD
What is a positive finding of a Epididymitis?
Enlarged tender scrotum
What is the most common type of cancer found in men aged 20-34?
What is the most common type of testicular cancer?
Is testicular painful and/or transiluminatable?
What condition is "Enlarged, Non tender, Firm, Smooth, and has not Median Sulcus"?
Benign Prostatic Hyperplasia
What condition happens in younger men from the venereal disease of Gonorrhea?
What are the four characteristics of Prostatitis?
What is one complication of Prostatitis?
Urinary problems, increased urgency
What does Prostatic Carcinoma almost always look like/be associated with on x-ray?
Blastic Mets- Blood
Where is the most common place for Prostatic Carcinoma to metastasize to?
Lumbar spine via Batson's plexus
What are the finding of Prostatic Carcinoma?
Hard Posterior lobe
What is the skin temperature in an arterial problem?
What color is the skin in an arterial issue?
Pale or Blue
What kind of pulse is found in a patient that has an arterial issue?
Weak or absent
What two things will be present in a patient with an arterial problem?
Is there swelling in an arterial issue?
Will and venous or arterial issue have thin/shiny skin?
Arterial (Think about wrapping a rubber band around your finger, for all Arterial signs and symptoms)
What is the skin temperature of a patient with a venous problem?
(Venous problem, think of a Deep Vein Thrombosis (DVT) in the femoral vein)
In a patient that has a venous issue what two categories will be Normal?
Will numbness and Raynaud's Phenomenon be absent or present in a patient with a venous issue?
If a patient has a venous issue what two things will be present?
What kind of tropic changes would you expect to see in a venous issue?
What type of claudication is predictable?
In what position would a patient with Neurogenic claudication find relief?
Flexed, this is a position related condition
What type of claudication always has relief at rest?
What are three common cause of Neurogenic Claudication?
DJD- thin disc, overriding of the facets
Spinal Canal stenosis
What two causes will lead to Vascular Claudication?
Stoop Test- will decrease pain (Flexed Position)
How is the claudication test performed?
Patient walks at a rate of 120 steps/min for 1 minute
What is a positive finding for the claudication test?
Pain in the claves
What does the Bicycle test confirm?
Pain in the calves, vascular Claudication
What is another name for Buerger's?
How do you test for Buerger's?
What is the population that is usually effected with Thromboangitis Obliterans?
Males 20-40 years old
**Excessive tobacco/smoking use**
What three other symptoms is Buerger's associated with?
Intermittent vascular claudication
What two populations and what age are often seen with Varicose veins?
**Age: Older than 20 years old**
What three symptoms are present with Deep Vein Thrombosis?
What orthopedic test is done to diagnosis Deep Vein Thrombosis?
How is Homan's test performed?
Patient is supine with leg extended while the doctor raises the leg off the table to a 45 degree angle, dorsiflex the foot and squeeze the calf
What is a positive finding to Homan's test?
Pain in the calf
What labs can be ordered to help diagnosis Deep Vein Thrombosis?
Complete Blood Count (CBC), Thrombocyte count
Who often has Raynaud's?
What three other conditions are seen with Raynaud's?
What are three triggers of Raynaud's Phenomena?
What orthopedic exam can be done to diagnosis Raynaud's/
What five other signs are present with Raynaud's?
**Triphasic color changes (White, Blue, Red)**
Finger tip ulcers
What is the clinical term for a pinpoint hemorrhage?
What condition is described as "Blockage of an artery in the lung by a substance that has come from somewhere else in the body via the bloodstream"?
What is the main cause of a Pulmonary Embolism?
Thrombus (blood clot) from the veins of the legs
What are the three symptoms often associated with a Pulmonary Embolism?
Chest pain on inspiration
What are two increased risk of someone with Pulmonary Embolism?
Prolonged bed rest
**(Both will lead to Deep Vein Thrombosis (DVT))
What condition is described as "small superficial dilated blood vessels"?
What is the common location of Telangiectasia?
What are the two other names for Reflex Sympathetic Dystrophy?
Complex Regional Pain Syndrome
What is the treatment for Reflex Sympathetic Dystrophy?
Sympathetic nerve block
What are the typical associated findings with Sudeck's atrophy?
-Dramatic changes in skin color and temperature in the affected area
-Sweating (Excessive sweating; Hyperhidrosis)
-Hypertrichosis (excessive hair growth)
What condition is "a chronic pain condition, with continuous intense pain out of proportion to the severity of the injury, which gets worse rather than better over time"?
Complex Regional Pain Syndrome
What does an increase in Red Blood cell indicate?
1: Polycythemia Vera
2: High altitude
A decrease in what three hematology categories will indicate Anemia?
Red blood cells
What two things does an increase in Hemoglobin and Hematocrit indicate?
Dehydration: loss of blood fluid volume
What type of Anemia is present if there is an increase in:
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Macrocytic Anemia (>100)
What would cause a patient to have Microcytic Anemia?
A decrease in anyone of the following: (
What three conditions will have an increase in Platelets Thrombocytes?
What three conditions can a decrease in Platelets Thrombocytes be seen in?
What is the of number Leukocytes that must be seen in a person to be diagnosed as Leukemia?
What three conditions will have an increase in White Blood Cells (WBC)?
What two conditions will see a decrease in White Blood Cells (WBC)?
What are the five different categories of White Blood Cells (WBC) and there associated percentages?
What does an increase in Neutrophils indicate?
In increase in what White Blood Cell (WBC) category would indicate a viral infection?
What does and increase in Monocytes indicate?
An increase in Eosinophils means what?
What is the radiographic finding of a Sickle Cell Anemia patient?
What population makes up about 10% of those with Sickle Cell?
What is another name for Thalassemia?
What two conditions are present with Thalassemia?
What is the cause of Erythroblastosis Fetalis?
Rh+ Father and Baby
What is the most common Megaloblastic Anemia?
In what type of Megaloblastic Anemia will be seen in chronic alcoholics, pregnancy and malabsorption?
What type of Anemia is seen in "Lack of intrinsic factor due to chronic atrophic gastric mucosa causing loss of parietal cell"?
(Unconjugated, Indirect bilirubin= Pre-Hepatic (All have Prefixes)--> Decrease in B Vitamins
What test is done for the diagnosis of Pernicious anemia?
Schilling test (24 hour urine)
What is the treatment for Pernicious Anemia?
What can prolonged Pernicious Anemia lead to and what is it's AKA?
Posterolateral Sclerosis (PLS)
AKA- Combined systems disease
Iron Deficiency anemia is what kind of anemia?
Hypochromic Microcytic (Too Tiny)
Who often is seen with having Hypochromic Microcytic anemia?
Chronic blood loss
In Iron Deficiency Anemia where is blood often found?
Occult blood in the stool
What type of anemia is Aplastic Anemia?
What nine populations are seen to have Normochromic Normocytic Anemia?
Acute Blood Loss
What two things does red urine indicate?
Blood (Infections or Cancer)
What are three things green urine indicate?
Biliary duct obstruction
Bad protein digestion
What are three problems if a patients urine is Blue?
Bad protein digestion
What are the indications associated with Brown urine?
Biliary duct obstruction
What does black urine indicate?
Ochronosis (Accumulation of Homogentisic Acid)
What six things can cause the appearance of urine to be hazy/cloudy?
White Blood Cells (WBC)
Red Blood Cells (RBC)
What two things will give urine a Milky appearance?
White Blood Cells (WBC)
What three things can cause an increase in Specific Gravity of urine?
What five conditions will be seen if there is an increase in **glucose** in the urine?
Renal tubular disease
An increase in ________ in the urine will indicate the following:
Weight loss diets
Inadequate Carbohydrate intake
What four conditions are seen with and increase in **protein** in the urine?
Toxemia of Pregnancy
What does and increase in Urobilinogen indicate? (Two things)
What does and increase in Urobilinogen indicate?
What two conditions are indicated with an increase in Bilirubin in the urine?
An increase of blood in the urine can indicate ____________? (6 Things)
What is the clinical term for Red Blood Cell Cast?
(Know what all Cast means for Boards)
What is the clinically term for White Blood Cell Cast?
What does a waxy cast indicate? (Two things)
What does and Increase on the Acid Phosphatase (PAP) indicate?
What does a reversed *Albumin/Globulin (A/G) Ratio* indicate?
What three things does an increase in *Alkaline Phosphatase* indicate?
What does an increase in the Amylase test indicate?
What does the *ANA (FANA*) test indicate?
i.e. Systemic Lupus Erythematous
What is the spelt out name of *ASO-Titer*?
What two conditions have an increase in **ASO-Titer**?
What does an increase in direct *bilirubin* indicate? (Two things)
What does an increase in indirect *bilirubin* indicate?
What does an increase in Blood Urea Nitrogen (BUN) indicate? (Four things)
Urinary tract infection
What two indications does a decrease in Blood Urea Nitrogen (BUN) have?
What four conditions have an increase in Calcium?
What four conditions does an decrease in Calcium indicate?
**Chvostck's Sign; Hypocalcaemia (tap facial nerve, mastication muscle contracts)**
What does CK BB indicate?
What does CK MB indicate?
What does CK MM indicate?
What does and increase in Creatine Phosphokinase (CPK) indicate?
What is the best test for the kidney?
What two conditions are indicated by in increase in Creatinine?
What does a decrease in Creatinine indicate?
An increase in C-Reactive Protein indicates what three conditions?
(This test is more Sensitive than Erythrocyte Sedimentation Rate (ESR))
What is the name of the Screening test for AIDS?
What two conditions are indicated by a decrease in Erythrocyte Sedimentation Rate (ESR)?
Sickle Cell Anemia
In increase in Erythrocyte Sedimentation Rate (ESR) is indicative of what five conditions?
What test is positive in Syphilis?
Florescent Treponema Antibody (FTA)
An increase in blood Glucose indicates what three possible conditions?
What does a decrease in blood glucose indicate? (3 conditions)
What Is the best test for Chronic Alcoholism?
Gamma-Glutamyl Transferase (GGT)
What is the name of the test used for Diabetics?
Glucose Tolerance test (GTT)
What is the best test to monitor the progression of Diabetes Mellitus over a 2-3 month period?
What is the Hetrophile (Paul Bunnel) test used to indicate? (2 things)
In what five conditions will there be an increase in Human Chorionic Gonadotropin (HCG)?
What are two indications where you would see a decrease in Human Chorionic Gonadotropin (HCG)?
What four conditions will you see Human Leukocyte Antigen Locus (HLA) B27?
Reiter's (Reactive Arthritis)
An increase in HDL cholesterol indicates what?
Low risk of coronary heart disease
What test would indicate a high risk of coronary heart disease?
Decreased levels of HDL cholesterol
What does and M-spike on Immunoelctrophoresis indicate?
Immunoelctrophoresis is the BEST test for Multiple Myeloma
What two conditions are indicated by a decrease in Cerebrospinal Fluid (CSF) glucose?
Acute Pyogenic infections
What two indications does and increase in I-131 uptake have?
What does a decrease in I-131 uptake indicate? (Two conditions)
In what two conditions would you test for ketones?
What test is specific for AIDS?
What is the name of the serologic screening test for *syphilis*?
Venereal Disease Research Laboratory (VDRL)
What does an increase in uric acid indicate? (Two conditions)
Gout (Podagra; inflammation of the big toe)
What test indicates *Syphilis*?
Treponema Pallidum Immobilizing Agent (TPI)
What three conditions are indicated by an increase in Lactic Dehydrogenase (LDH)?
Myocardial Infarction (MI)
Congestive Heart Failure (CHF)
When would you expect to see a decrease in Lactic Dehydrogenase?
What does an increase in Lipase indicate?
An increase in Cholesterol lipids indicates what two things?
What two conditions are seen with a decrease of Cholesterol lipids?
A decrease in Triglyceride lipids indicates what two conditions?
What three conditions are seen when there is an increase in Triglyceride lipids?