Lecture 1 Reverse Flashcards
1
Q
98.6 F
A
What is normal oral temp?
2
Q
97.6 Fleast accurate
A
What is normal axillary temp?
3
Q
99.4 Fmost accurate
A
What is normal rectal temp?
4
Q
99.6 F
A
What is normal ear temp? (aural)
5
Q
2.54 cm = 1 in
A
How many cm in an inch?
6
Q
2.2 lbs = 1 kg
A
How many pounds in a kg?
7
Q
809097
A
What are normal systolic BP in 1, 5 & 10 years?
8
Q
feel for vibrations
A
What is tactile fremitus?
9
Q
whole head
A
Define calvarium
10
Q
Stenson’s duct
A
Parotid duct
11
Q
Warton’s duct
A
Submandibular duct
12
Q
stroke - won’t appear on affected sidefacial droop
A
Why are nasolabial folds important?
13
Q
upslanted in down’s syndrome
A
Why are palpebral fissures importan-t?
14
Q
clinial syndromes or disorders w/ distinctive facial features
A
What are facies?
15
Q
- Low set ears2. Macroglossia - big tongue3. Brush field spots on iris4. Flat nose5. Upslanted palpebral fissures 6. Larger epicanthal folds
A
What are the classic features of Down’s syndrome?
16
Q
excess cortisolMoon facies1. Round face2. Facial flushin = plethoric3. inc. fact in cheeks4. Double chin
A
What are the classic features of Cushing’s?
17
Q
usually happens in 1st trimester 1. Smooth philtrum2. Thin upper lip3. Microcephaly
A
What are the classic features of fetal alcohol syndrome?
18
Q
usually from pituitary adenoma - excess GH1. Enlargement of hands, feet & head2. Frontal bossing - prominent forehead3. Palmar thickening4. Coarse features5. Prognathism - large protruding jaw
A
What are the classic features of acromegaly?
19
Q
Paget’s disease
A
What is the DDx for acromegaly?
20
Q
- Sjoren’s syndrome2. Mumps3. Chronic disease - DM, obesity, liver cirrhosis 4. Neoplasm - unilateral
A
What are the causes of parotid enlargement?
21
Q
Graves - autoimmune hyperthyroidismenlarged thyroid
A
What disease is characteristic for exopthalmos?
22
Q
only w/ lung CA, mediastinal, gastric CA
A
When is supraventricular LAD found?
23
Q
Virchow’s node
A
With gastric CA, what is supraclavicular LAD called?
24
Q
- More frequent/severe over 3 months2. Thunderclap3. New onset after 50 4. Fever, sweats, wt loss5. Known CA, HIV, pregnancy6. Recent head trauma7. Focal deficits, vision change, neck stiffness
A
What are the HA warning signs?
25
preeclampsia
Why is HA w/ pregnancy concerning?
26
Temporal/giant cell arteritisif untreated = blindness >50 y/o, autoimmune
A bounding, tender temporal artery is concerning for?
27
1. Sx >7 days2. Fever3. Perulent nasal drainage4. Distinct facial pain5. Tenderness
What signs need to be present to diagnose bacterial sinusitis?
28
pneumothorax
When can the trachea be deviated?
29
1. Pearly gray2. Non-injected/non-erythematous3. Intact
What does a normal TM look like?
30
in the earcaused by repeated exposures to cold waterex. surfers/divers
Who gets bony exotoses?
31
cerumen impactionuse mineral oil to get it out
What is the most common reason for conductive hearing loss?
32
Hardening of TM caused by recurrent infections
What is tympanosclerosis & what is it caused by?
33
Bulging erythematous No light reflexLoss of landmarks
What is seen w/ acute otitis media?
34
Infection of external auditory canal aka. swimmer's ear most common = P. aeroginosa Pain w/ touchHurts to touch tragus May be so inflammed you can't look at it Tx - earwick
What is otitis externa, findings & Tx?
35
Diabetics leads to erosino of inner ear
Who commonly gets fungal otitis externa?
36
Fluid from ear
What is otorrhea?
37
Chronic inflammatory lesion on helix or antihelixMust Bx to rule out carcinoma
What is chondrodermatitis helicis?
38
High frequency hearing loss commonly caused by older agedmiss consonants & vowels
What is presbycusis?
39
Disorders of:1. Inner ear2. Brain3. CN VIII
What can cause sensorineural hearing loss?
40
Air conduction > bone conduction
What is a normal result for the Rinne test?
41
C - lateral to bad earS - lateral to good ear 8th CN impairment Obstruction lateralizes to blocked ear
Weber test - conductive vs. sensorineural loss?
42
1. Cleanse2. Humidify3. Control temp of inspired air
What is the function of the nasal mucosa?
43
Cocaine or meth
What are common causes of nasal septum perforation?
44
1. Congenital2. TraumaThey have problems w/ sleep apnea/anosmia
What are common causes of a deviated septum?
45
Woodruff's plexus - posterior nose bleed difficulty breathing
What is an emergent nosebleed from?
46
Kiesselbach's plexus - front nasal cavity
Where do nosebleeds commonly come from?
47
Recurrent allergies
What commonly causes nasal polyps?
48
"bumpy nose" from severe rosaciabenign
What is rhinophyma?
49
Artery, veins & nervesunder the dentin
What is contained in the pulp of a tooth?
50
Tastebuds in the back of the mouth
What are vallate papilla?
51
Tastebuds on the front of the tongue
What are fungiform papilla?
52
A benign midline lump under the tonguemay be mandibular or maxillary
What is torus palatinus?
53
CN XII
Which nerve causes the tongue to rise?
54
bifid
What is a snake-tongue looking uvula called?
55
1. Fissured2. Geographic3. Hairy (tobacco use, poor hygiene, antibiotics, coffee)
What are the normal tongue variants?
56
Cancerous precursorpainless white patches on tongue/buccal mucosa
What is leukoplakia?
57
Oral candidiasispainfulscrapes off w/ red bleeding basecommon in immunocompromised/steroids
What is thrush?
58
1. Leukemia if bleeding2. Chronic dilantin use3. Pregnancy
What are common causes of gingival hyperplasia?
59
infection of periapical region of toothtender lesion just adjacent to toothTx: I&D, abx
What is a periapical abscess?
60
Herpes type 8 purple vascular lesion in mouth
What is Kaposi's sarcoma caused by?
61
cavities
What are dental caries?
62
HalitosisAbrasions on knuckles Negative gag reflexDentition in ill repairlook at back of throat for cuts
Bulimia
63
1. Fever2. Malaise3. LAD4. Halitosis
S/S acute necrotixing ulcerative gingivitis
64
1. Mono2. HIV3. Trauma4. Coagulopathy
What can cause petechiae on the hard palate?
65
Congenital syphilis
What causes Hutchinson's teeth?
66
Smooth tongueDeficiency in:1. Riboflavin2. Niacin3. Folic acid4. Vitamin B125. Pyridoxine6. Iron7. Tx w/ chemo
Causes of atrophic glossitis
67
III
What CN opens the eye?
68
VII
What CN closes the eye?
69
VI
What CN innervates the lateral rectus?
70
IV
What CN innervates the superior oblique?
71
CN II & III
What CNs are responsible for eye accommodation?
72
20/200 vision
When is someone considered legally blind?
73
dichromacymost common is red/greenaffects 1% of males issue w/ retinal conestested w/ ishihara cards
What is color blindness called?
74
ishihara cards
How do you test for color blindness?
75
3-5 mmopiates make pupils very small
What is a normal pupil size?
76
1. Optic nerve disease/lesion - eyes react but don't accommodate2. Argyll Robinson - Syphillis, hooker will accommodate you but not react to you3. CN III palsy - diabetes, lid lag & big pupil
What are the causes of afferent pupillary defect?
77
Cause = syphillishooker will accommodate you but not react to you
What is seen with Argyll Robinson?
78
1. Cataracts2. Retinoblastoma - seen in newborn exam 3. Retinal detachment
What can cause an absent light reflex?
79
L optic tract
Where is the lesion w/ R homonymous hemianopsia?
80
Optic chiasmcommon w/ pituitary tumor
Where is the lesion w/ bitemporal hemianopsia?
81
L optic radiation
Where is the lesion w/ homonymous R quandrantic defect?
82
Eversion of eyelidcommon w/ old peoplecauses excessive tearing
What is ectropion?
83
Inversion of eyelidcauses irritation of eye
What is entropion?
84
Inflammation of the eyelidStaph/fungus/blockage of glands
What is blepharitis & common causes?
85
Hypothyroidism
When is periorbital edema commonly seen?
86
medical emergencyinvolves CN V - trigeminalinflammation of cornea leading to blindnessdendritic lesions on eye
What is Herpes Zoster ophthalmicus?
87
styeStaph infection of meibomian glandcauses pain, irritationTx. - warm compresses, abx ointment
What is a hordeolum & common cause?
88
A chronic granulomatous inflammation of the meibomian glandusually follows a hordeolumnot infectedTx - steroids/removal
What is a chalazion?
89
lipid deposits around the eye
What is xanthelasma?
90
bacterial infection of lacrimal saccommon in kidsTx - systemic abx
What is dacrocystitis?
91
1. Bacterial - usually Strep2. Viral - usually bilateral3. Allergic
What are the types of conjunctivitis?
92
benign, well demarcated rupture of small vessels of scleracan be assoc. w/ HTN, coagulopathygoes away on its own
What is subconjunctival hemorrhage & what is it associated with?
93
Medical emergency Ciliary injectionFrom autoimmune process - SLE, sarcoidosis, ankylosing spondylitisPain w/ eye mvmts & photophobia "cells in flare"
What is iritis?
94
Medical emergencyPainful red eye w/ HA, N&VVision loss---Steamy corneafixed, dilated pupilciliary injectionTx - carbonic anhydrase, inhibitor IV, beta-blocker
What is acute glaucoma?
95
Blood in anterior chamber of eye, usually from traumaTx - Drainage & f/u
What is hyphema?
96
Benign overgrowth of the sclera Caused by sun, wind or dry air on bulbar conjunctiva
What is pinguecula?
97
thickening of bulbar conjunctiva onto cornea causing visual disturbance
What is pterygium?
98
Wilson's diseasetoo much Cu2+autosomal recessive
What causes Kayser-Fleischer rings?
99
aka senile arcus grayish hue around corneaif young - caused by hyperlipidemia
What is corneal arcus
100
Macular degenerationyellowish spots on fundis exam, range in size, location & coalesce together
What are Drusens significant for?
101
aka sternal anglepoint where 2nd rib attaches to sternum
Where is the angle of Louis?
102
T4
Where does the trachea bifurcate into the L & R main stem bronchus?
103
Funnel chestcan compress mediastinal structures
What is pectus excavatum?
104
pigeon chest
What is pectus carinatum?
105
1. Abdominal2. SCM3. Trapezius
What are the accessory breathing muscles?
106
interspaces & supraclavicular fossa
Where do you typically see retractions (breathing)?
107
14-20/min
What is the normal breathing rate?
108
1. Voice too soft2. COPD3. Thick chest wall4. Pneumothorax
Dec/absent tactile fremitus?
109
1. Inspiratory sounds longer than expiratory2. Soft intensity3. Low pitch4. Heard over most healthy lung fields
Describe vesicular lung sounds
110
1. Insp = exp 2. Intermediate intensity3. Intermediate pitch4. Heard over 1st & 2nd interspaces anteriorly & btwn scapula posteriorly
Describe bronchovesicular lung sounds
111
1. Exp slightly longer than insp2. Loud3. High pitched (tubular)4. Heard over manubrium
Describe bronchial breath sounds
112
1. Insp = exp2. Very loud3. High pitched (tubular)4. Heard over trachea in neck
Describe tracheal breath sounds
113
1. Obesity2. Thick chest wall3. Shallow breaths4. Pathology
Dec. intensity of normal lung sounds?
114
aka ralesBrief discontinuous sounds, most often at end of inspiration
Describe crackles
115
Can have snoring or gurgling qualityIndicate secretions in large airways
Describe rhonchi
116
Musical sounds created when air flows rapidly through bronchi that are narrowed significantlyHeard in expiration & sometimes inspiration
Describe wheezes
117
Wheeze heard primarily during insp & mainly over large airways can be sign of airway obstruction
Describe stridor
118
Related to inflammation of pleural surfacesCoarse grating sound timed w/ lung mvmtEvidence of local inflammation
Describe pleural rub
119
when fluid or air pushes lung away from chest wall
When are transmitted voice sounds dec?
120
consolidationcommon w/ PNA, atelectasis or tumors
When is bronchophony heard?
121
nothing
What is usually heard w/ whispered pectoriloquy?
122
consolidationex. PNA
When is egophony heard?
123
1. Vesicular sounds2. Distant spoken words3. Spoken e = e4. Distant whispered words5. Distant tactile fremitus6. Resonant percussion7. RR 14-20
Normal lung
124
1. Boncho/vesicular breath sounds2. Inc. spoken words3. Egophony4. Inc. whispered words5. Inc. tactile fremitus6. Dull percussion7. Inc. RR
Consolidated lung
125
Inc afterloadInc. regurg murmurs 1. Aortic regurg2. Mitral regurg3. VSD4. Delayed MVPDec. gotward flowing murmurs1. Aortic stenosis2. HOCM
Effect of handgrip maneuver on murmurs
126
1. Inc. venous return (inc. preload)2. Inc. stroke volume3. Inc. murmur of AS, PS, TR4. Delays murmur of MVP
Effect of squatting maneuver on murmurs
127
1. Dec. venous return (dec. preload)2. Dec. stroke volume3. Dec. murmur of AS, PS, TR
Effect of valsalva maneuver on mumurs
128
decubitus position
Where are mitral murmurs best heard?
129
1. Early diastolic2. High-pitched3. Blowing4. Decrescendo 5. Best heard at 2nd RICS6. Inc. w/ leaning forward & holding breath in full expiration7. Inc. w/ handgrip maneuver
Describe aortic regurg murmur
130
1. Early diastolic2. High-pitched3. Blowing4. Decrescendo5. Best heard at 2-3 LICS6. Inc. w/ handgrip maneuver
Describe pulmonary regurg murmur
131
1. Mid-diastolic 2. Rumbling3. PMI inc. in L decubitus position4. Crescendo assoc w/ opening snap
Describe mitral stenosis murmur
132
1. Mid-diastolic2. Rumbling3. May inc. w/ inspiration4. Wide splitting of S1
Describe Tricuspid stenosis murmur
133
1. Mid systolic2. Crescendo-decrescendo3. Usually harsh but can be musical 4. Best heard at 2nd RICS5. May radiate to carotids 6. Dec. w/ standing or valsalva maneuvers or handgrip maneuver
Describe aortic stenosis murmur
134
1. Mid systolic2. Crescendo-decrescendo3. Harsh4. Best heard at 2nd LICS 5.May radiate to L neck6. May cause wide S2 splitting
Describe pulmonic stenosis murmur
135
1. Late systole2. May be preceded by clicks3. Best heard over the apex w/ the diaphragm
Describe Mitral valve prolapse murmur
136
Uncommon except in presence of mitral valve prolapse
Describe tricuspid valve prolapse murmur
137
1. 4th LSB2. Inc. w/ respiration (Varcalios sign)
Describe a tricuspid/insufficinecy/regurgitation murmur
138
1. Apex in L lateral decubitus position2. High pitched3. No change w/ respiration4. May radiate to axilla
Describe mitral regurg murmur
139
1. L 3-4 ICS along sternal border2. Inc. w/ handgrip maneuver
Describe WSD murmur
140
1. Still's murmur2. Physiologic systolic ejection murmur3. Cervical venous hum
What are innocent mumurs in kids?
141
1. Pansystolic murmurs2. Diastolic murmurs3. Loud murmurs (>3/6)4. Other evidence of heart disease, SOB, fatigue, failure to thrive, cyanosis, pulse defecits
Red flags of pathologic murmurs?
142
1. Pregnancy2. Anemia3. Thyroid conditions4. Exercise
What are innocent murmurs in adults?
143
Pericarditisleathery raspy soundBest hear w/ Pt leaning forward at end of expiration
When are friction rubs heard?
144
1+ slight, disappears rapidly 2mm2+ disappears in 10-15 sec 4mm3+ noticeably deep, >1 min swollen 6mm4+ deep pit, lasts 2-5min, gross swlling 8mm
Grading Pitting Edema
145
1. Redial mastectomy w/ node resection2. Tumor blockage3. Inflammation4. Fibrosis
What are some common causes of lymphedema?
146
1. Snake bites2. Afib3. IE4. Pelvic fracture5. Aneurysm6. Arterial dissections7. Fat embolism8. Trauma
Common causes of acute arterial occlusion?
147
1. Prolonged capillary refill2. Loss of hair3. Thinning of skin4. Shiny skin5. Dependent rubor6. Painful ulcers
Skin changes w/ chronic arterial insuffiency
148
Right
Which kidney is lower?
149
1. Pancreas2. Kidneys3, Ureters4, Aorta5. Vena cava
Retroperitoneal organs?
150
Weakening of linea alba so have bump when you crunch
What is diastasis recti?
151
1. Gastroenteritis2. Hunger3. Early obstruction
When would you have inc. bowel sounds?
152
1. Peritonitis2. Adynamic ileus3. Late obstruction
When would you have dec. bowel sounds?
153
full - dull
What sound is expected w/ percussion over the bladder?
154
dull
What sound is expected w/ percussion over the liver
155
empty - tympanicfull - full
What sound is expected w/ percussion over the stomach?
156
dull
What sound is expected w/ percussion over the spleen?
157
dull
What sound is expected w/ percussion over most of the abdomen if the Pt is very constipated?
158
Pyelonephritiscould also be MSK
What does a +CVA tenderness suggest?
159
1. Poorly localized periumbilical pain2. Then RLQ pain aggravated by mvmt/cough Palpate at McBurney's point
What Sx would a Pt have w/ acute appendicitis?
160
Pain on other side of palpation
What is Rovsing's sign?
161
appendicitis
What does a + psoas sign suggest?
162
cholecystitispress on gall bladder & inspiratory arrest
What does a + Murphy's sign suggest?
163
ascites
What does shifting dullness test for?
164
Pain in L shoulder from splenic rupture
What is Kehr's sign?
165
stomach goes through gastroesophageal junction into the thorax most commonly sliding hernia
What is a hiatal hernia?
166
herniated disc
What is a herniated nucleus pulposus?
167
weakness or disruption of the linea alba w/ protrusion of peritoneal contents
What is an epigastric hernia?
168
ulnar side
What side of the hand do epitrochlear lymph nodes drain?
