Lecture Flashcards
1
Q
What is normal oral temp?
A
98.6 F
2
Q
What is normal axillary temp?
A
97.6 F
least accurate
3
Q
What is normal rectal temp?
A
99.4 F
most accurate
4
Q
What is normal ear temp? (aural)
A
99.6 F
5
Q
How many cm in an inch?
A
2.54 cm = 1 in
6
Q
How many pounds in a kg?
A
2.2 lbs = 1 kg
7
Q
What are normal systolic BP in 1, 5 & 10 years?
A
80
90
97
8
Q
What is tactile fremitus?
A
feel for vibrations
9
Q
Define calvarium
A
whole head
10
Q
Parotid duct
A
Stenson’s duct
11
Q
Submandibular duct
A
Warton’s duct
12
Q
Why are nasolabial folds important?
A
stroke - won’t appear on affected side
facial droop
13
Q
Why are palpebral fissures importan-t?
A
upslanted in down’s syndrome
14
Q
What are facies?
A
clinial syndromes or disorders w/ distinctive facial features
15
Q
What are the classic features of Down’s syndrome?
A
- Low set ears
- Macroglossia - big tongue
- Brush field spots on iris
- Flat nose
- Upslanted palpebral fissures
- Larger epicanthal folds
16
Q
What are the classic features of Cushing’s?
A
excess cortisol Moon facies 1. Round face 2. Facial flushin = plethoric 3. inc. fact in cheeks 4. Double chin
17
Q
What are the classic features of fetal alcohol syndrome?
A
usually happens in 1st trimester
- Smooth philtrum
- Thin upper lip
- Microcephaly
18
Q
What are the classic features of acromegaly?
A
usually from pituitary adenoma - excess GH
- Enlargement of hands, feet & head
- Frontal bossing - prominent forehead
- Palmar thickening
- Coarse features
- Prognathism - large protruding jaw
19
Q
What is the DDx for acromegaly?
A
Paget’s disease
20
Q
What are the causes of parotid enlargement?
A
- Sjoren’s syndrome
- Mumps
- Chronic disease - DM, obesity, liver cirrhosis
- Neoplasm - unilateral
21
Q
What disease is characteristic for exopthalmos?
A
Graves - autoimmune hyperthyroidism
enlarged thyroid
22
Q
When is supraventricular LAD found?
A
only w/ lung CA, mediastinal, gastric CA
23
Q
With gastric CA, what is supraclavicular LAD called?
A
Virchow’s node
24
Q
What are the HA warning signs?
A
- More frequent/severe over 3 months
- Thunderclap
- New onset after 50
- Fever, sweats, wt loss
- Known CA, HIV, pregnancy
- Recent head trauma
- Focal deficits, vision change, neck stiffness
25
Why is HA w/ pregnancy concerning?
preeclampsia
26
A bounding, tender temporal artery is concerning for?
Temporal/giant cell arteritis
if untreated = blindness
>50 y/o, autoimmune
27
What signs need to be present to diagnose bacterial sinusitis?
1. Sx >7 days
2. Fever
3. Perulent nasal drainage
4. Distinct facial pain
5. Tenderness
28
When can the trachea be deviated?
pneumothorax
29
What does a normal TM look like?
1. Pearly gray
2. Non-injected/non-erythematous
3. Intact
30
Who gets bony exotoses?
in the ear
caused by repeated exposures to cold water
ex. surfers/divers
31
What is the most common reason for conductive hearing loss?
cerumen impaction
use mineral oil to get it out
32
What is tympanosclerosis & what is it caused by?
Hardening of TM caused by recurrent infections
33
What is seen w/ acute otitis media?
Bulging erythematous
No light reflex
Loss of landmarks
34
What is otitis externa, findings & Tx?
Infection of external auditory canal
aka. swimmer's ear
```
most common = P. aeroginosa
Pain w/ touch
Hurts to touch tragus
May be so inflammed you can't look at it
Tx - earwick
```
35
Who commonly gets fungal otitis externa?
Diabetics
leads to erosino of inner ear
36
What is otorrhea?
Fluid from ear
37
What is chondrodermatitis helicis?
Chronic inflammatory lesion on helix or antihelix
Must Bx to rule out carcinoma
38
What is presbycusis?
High frequency hearing loss commonly caused by older aged
miss consonants & vowels
39
What can cause sensorineural hearing loss?
Disorders of:
1. Inner ear
2. Brain
3. CN VIII
40
What is a normal result for the Rinne test?
Air conduction > bone conduction
41
Weber test - conductive vs. sensorineural loss?
C - lateral to bad ear
S - lateral to good ear
8th CN impairment
Obstruction lateralizes to blocked ear
42
What is the function of the nasal mucosa?
1. Cleanse
2. Humidify
3. Control temp of inspired air
43
What are common causes of nasal septum perforation?
Cocaine or meth
44
What are common causes of a deviated septum?
1. Congenital
2. Trauma
They have problems w/ sleep apnea/anosmia
45
What is an emergent nosebleed from?
Woodruff's plexus - posterior nose bleed
| difficulty breathing
46
Where do nosebleeds commonly come from?
Kiesselbach's plexus - front nasal cavity
47
What commonly causes nasal polyps?
Recurrent allergies
48
What is rhinophyma?
"bumpy nose" from severe rosacia
| benign
49
What is contained in the pulp of a tooth?
Artery, veins & nerves
| under the dentin
50
What are vallate papilla?
Tastebuds in the back of the mouth
51
What are fungiform papilla?
Tastebuds on the front of the tongue
52
What is torus palatinus?
A benign midline lump under the tongue
| may be mandibular or maxillary
53
Which nerve causes the tongue to rise?
CN XII
54
What is a snake-tongue looking uvula called?
bifid
55
What are the normal tongue variants?
1. Fissured
2. Geographic
3. Hairy (tobacco use, poor hygiene, antibiotics, coffee)
56
What is leukoplakia?
Cancerous precursor
| painless white patches on tongue/buccal mucosa
57
What is thrush?
Oral candidiasis
painful
scrapes off w/ red bleeding base
common in immunocompromised/steroids
58
What are common causes of gingival hyperplasia?
1. Leukemia if bleeding
2. Chronic dilantin use
3. Pregnancy
59
What is a periapical abscess?
infection of periapical region of tooth
tender lesion just adjacent to tooth
Tx: I&D, abx
60
What is Kaposi's sarcoma caused by?
Herpes type 8
purple vascular lesion in mouth
61
What are dental caries?
cavities
62
Bulimia
Halitosis
Abrasions on knuckles
Negative gag reflex
Dentition in ill repair
look at back of throat for cuts
63
S/S acute necrotixing ulcerative gingivitis
1. Fever
2. Malaise
3. LAD
4. Halitosis
64
What can cause petechiae on the hard palate?
1. Mono
2. HIV
3. Trauma
4. Coagulopathy
65
What causes Hutchinson's teeth?
Congenital syphilis
66
Causes of atrophic glossitis
Smooth tongue
Deficiency in:
1. Riboflavin
2. Niacin
3. Folic acid
4. Vitamin B12
5. Pyridoxine
6. Iron
7. Tx w/ chemo
67
What CN opens the eye?
III
68
What CN closes the eye?
VII
69
What CN innervates the lateral rectus?
VI
70
What CN innervates the superior oblique?
IV
71
What CNs are responsible for eye accommodation?
CN II & III
72
When is someone considered legally blind?
20/200 vision
73
What is color blindness called?
dichromacy
most common is red/green
affects 1% of males
issue w/ retinal cones
tested w/ ishihara cards
74
How do you test for color blindness?
ishihara cards
75
What is a normal pupil size?
3-5 mm
opiates make pupils very small
76
What are the causes of afferent pupillary defect?
1. Optic nerve disease/lesion - eyes react but don't accommodate
2. Argyll Robinson - Syphillis, hooker will accommodate you but not react to you
3. CN III palsy - diabetes, lid lag & big pupil
77
What is seen with Argyll Robinson?
Cause = syphillis
hooker will accommodate you but not react to you
78
What can cause an absent light reflex?
1. Cataracts
2. Retinoblastoma - seen in newborn exam
3. Retinal detachment
79
Which CN is responsible for the corneal reflex?
III
80
Where is the lesion w/ R homonymous hemianopsia?
L optic tract
81
Where is the lesion w/ bitemporal hemianopsia?
Optic chiasm
common w/ pituitary tumor
82
Where is the lesion w/ homonymous R quandrantic defect?
L optic radiation
83
What is ectropion?
Eversion of eyelid
common w/ old people
causes excessive tearing
84
What is entropion?
Inversion of eyelid
| causes irritation of eye
85
What is blepharitis & common causes?
Inflammation of the eyelid
Staph/fungus/blockage of glands
86
When is periorbital edema commonly seen?
Hypothyroidism
87
What is Herpes Zoster ophthalmicus?
medical emergency
involves CN V - trigeminal
inflammation of cornea leading to blindness
dendritic lesions on eye
88
What is a hordeolum & common cause?
stye
Staph infection of meibomian gland
causes pain, irritation
Tx. - warm compresses, abx ointment
89
What is a chalazion?
A chronic granulomatous inflammation of the meibomian gland
usually follows a hordeolum
not infected
Tx - steroids/removal
90
What is xanthelasma?
lipid deposits around the eye
91
What is dacrocystitis?
bacterial infection of lacrimal sac
common in kids
Tx - systemic abx
92
What are the types of conjunctivitis?
1. Bacterial - usually Strep
2. Viral - usually bilateral
3. Allergic
93
What is subconjunctival hemorrhage & what is it associated with?
benign, well demarcated rupture of small vessels of sclera
can be assoc. w/ HTN, coagulopathy
goes away on its own
94
What is iritis?
```
Medical emergency
Ciliary injection
From autoimmune process - SLE, sarcoidosis, ankylosing spondylitis
Pain w/ eye mvmts & photophobia
"cells in flare"
```
95
What is acute glaucoma?
```
Medical emergency
Painful red eye w/ HA, N&V
Vision loss
---Steamy cornea
fixed, dilated pupil
ciliary injection
Tx - carbonic anhydrase, inhibitor IV, beta-blocker
```
96
What is hyphema?
Blood in anterior chamber of eye, usually from trauma
Tx - Drainage & f/u
97
What is pinguecula?
Benign overgrowth of the sclera
| Caused by sun, wind or dry air on bulbar conjunctiva
98
What is pterygium?
thickening of bulbar conjunctiva onto cornea causing visual disturbance
99
What causes Kayser-Fleischer rings?
Wilson's disease
too much Cu2+
autosomal recessive
100
What is corneal arcus
aka senile arcus
grayish hue around cornea
if young - caused by hyperlipidemia
101
What are Drusens significant for?
Macular degeneration
yellowish spots on fundis exam, range in size, location & coalesce together
102
Where is the angle of Louis?
aka sternal angle
point where 2nd rib attaches to sternum
103
Where does the trachea bifurcate into the L & R main stem bronchus?
T4
104
What is pectus excavatum?
Funnel chest
| can compress mediastinal structures
105
What is pectus carinatum?
pigeon chest
106
What are the accessory breathing muscles?
1. Abdominal
2. SCM
3. Trapezius
107
Where do you typically see retractions (breathing)?
interspaces & supraclavicular fossa
108
What is the normal breathing rate?
14-20/min
109
Dec/absent tactile fremitus?
1. Voice too soft
2. COPD
3. Thick chest wall
4. Pneumothorax
110
Describe vesicular lung sounds
1. Inspiratory sounds longer than expiratory
2. Soft intensity
3. Low pitch
4. Heard over most healthy lung fields
111
Describe bronchovesicular lung sounds
1. Insp = exp
2. Intermediate intensity
3. Intermediate pitch
4. Heard over 1st & 2nd interspaces anteriorly & btwn scapula posteriorly
112
Describe bronchial breath sounds
1. Exp slightly longer than insp
2. Loud
3. High pitched (tubular)
4. Heard over manubrium
113
Describe tracheal breath sounds
1. Insp = exp
2. Very loud
3. High pitched (tubular)
4. Heard over trachea in neck
114
Dec. intensity of normal lung sounds?
1. Obesity
2. Thick chest wall
3. Shallow breaths
4. Pathology
115
Describe crackles
aka rales
| Brief discontinuous sounds, most often at end of inspiration
116
Describe rhonchi
Can have snoring or gurgling quality
| Indicate secretions in large airways
117
Describe wheezes
Musical sounds created when air flows rapidly through bronchi that are narrowed significantly
Heard in expiration & sometimes inspiration
118
Describe stridor
Wheeze heard primarily during insp & mainly over large airways
can be sign of airway obstruction
119
Describe pleural rub
Related to inflammation of pleural surfaces
Coarse grating sound timed w/ lung mvmt
Evidence of local inflammation
120
When are transmitted voice sounds dec?
when fluid or air pushes lung away from chest wall
121
When is bronchophony heard?
consolidation
| common w/ PNA, atelectasis or tumors
122
What is usually heard w/ whispered pectoriloquy?
nothing
123
When is egophony heard?
consolidation
| ex. PNA
124
Normal lung
1. Vesicular sounds
2. Distant spoken words
3. Spoken e = e
4. Distant whispered words
5. Distant tactile fremitus
6. Resonant percussion
7. RR 14-20
125
Consolidated lung
1. Boncho/vesicular breath sounds
2. Inc. spoken words
3. Egophony
4. Inc. whispered words
5. Inc. tactile fremitus
6. Dull percussion
7. Inc. RR
126
Effect of handgrip maneuver on murmurs
```
Inc afterload
Inc. regurg murmurs
1. Aortic regurg
2. Mitral regurg
3. VSD
4. Delayed MVP
Dec. gotward flowing murmurs
1. Aortic stenosis
2. HOCM
```
127
Effect of squatting maneuver on murmurs
1. Inc. venous return (inc. preload)
2. Inc. stroke volume
3. Inc. murmur of AS, PS, TR
4. Delays murmur of MVP
128
Effect of valsalva maneuver on mumurs
1. Dec. venous return (dec. preload)
2. Dec. stroke volume
3. Dec. murmur of AS, PS, TR
129
Where are mitral murmurs best heard?
decubitus position
130
Describe aortic regurg murmur
1. Early diastolic
2. High-pitched
3. Blowing
4. Decrescendo
5. Best heard at 2nd RICS
6. Inc. w/ leaning forward & holding breath in full expiration
7. Inc. w/ handgrip maneuver
131
Describe pulmonary regurg murmur
1. Early diastolic
2. High-pitched
3. Blowing
4. Decrescendo
5. Best heard at 2-3 LICS
6. Inc. w/ handgrip maneuver
132
Describe mitral stenosis murmur
1. Mid-diastolic
2. Rumbling
3. PMI inc. in L decubitus position
4. Crescendo assoc w/ opening snap
133
Describe Tricuspid stenosis murmur
1. Mid-diastolic
2. Rumbling
3. May inc. w/ inspiration
4. Wide splitting of S1
134
Describe aortic stenosis murmur
1. Mid systolic
2. Crescendo-decrescendo
3. Usually harsh but can be musical
4. Best heard at 2nd RICS
5. May radiate to carotids
6. Dec. w/ standing or valsalva maneuvers or handgrip maneuver
135
Describe pulmonic stenosis murmur
1. Mid systolic
2. Crescendo-decrescendo
3. Harsh
4. Best heard at 2nd LICS
5. May radiate to L neck
6. May cause wide S2 splitting
136
Describe Mitral valve prolapse murmur
1. Late systole
2. May be preceded by clicks
3. Best heard over the apex w/ the diaphragm
137
Describe tricuspid valve prolapse murmur
Uncommon except in presence of mitral valve prolapse
138
Describe a tricuspid/insufficinecy/regurgitation murmur
1. 4th LSB
| 2. Inc. w/ respiration (Varcalios sign)
139
Describe mitral regurg murmur
1. Apex in L lateral decubitus position
2. High pitched
3. No change w/ respiration
4. May radiate to axilla
140
Describe WSD murmur
1. L 3-4 ICS along sternal border
| 2. Inc. w/ handgrip maneuver
141
What are innocent mumurs in kids?
1. Still's murmur
2. Physiologic systolic ejection murmur
3. Cervical venous hum
142
Red flags of pathologic murmurs?
1. Pansystolic murmurs
2. Diastolic murmurs
3. Loud murmurs (>3/6)
4. Other evidence of heart disease, SOB, fatigue, failure to thrive, cyanosis, pulse defecits
143
What are innocent murmurs in adults?
1. Pregnancy
2. Anemia
3. Thyroid conditions
4. Exercise
144
When are friction rubs heard?
Pericarditis
leathery raspy sound
Best hear w/ Pt leaning forward at end of expiration
145
Grading Pitting Edema
1+ slight, disappears rapidly 2mm
2+ disappears in 10-15 sec 4mm
3+ noticeably deep, >1 min swollen 6mm
4+ deep pit, lasts 2-5min, gross swlling 8mm
146
What are some common causes of lymphedema?
1. Redial mastectomy w/ node resection
2. Tumor blockage
3. Inflammation
4. Fibrosis
147
Common causes of acute arterial occlusion?
1. Snake bites
2. Afib
3. IE
4. Pelvic fracture
5. Aneurysm
6. Arterial dissections
7. Fat embolism
8. Trauma
148
Skin changes w/ chronic arterial insuffiency
1. Prolonged capillary refill
2. Loss of hair
3. Thinning of skin
4. Shiny skin
5. Dependent rubor
6. Painful ulcers
149
Which kidney is lower?
Right
150
Retroperitoneal organs?
1. Pancreas
2. Kidneys
3, Ureters
4, Aorta
5. Vena cava
151
What is diastasis recti?
Weakening of linea alba so have bump when you crunch
152
When would you have inc. bowel sounds?
1. Gastroenteritis
2. Hunger
3. Early obstruction
153
When would you have dec. bowel sounds?
1. Peritonitis
2. Adynamic ileus
3. Late obstruction
154
What sound is expected w/ percussion over the bladder?
full - dull
155
What sound is expected w/ percussion over the liver
dull
156
What sound is expected w/ percussion over the stomach?
empty - tympanic
full - full
157
What sound is expected w/ percussion over the spleen?
dull
158
What sound is expected w/ percussion over most of the abdomen if the Pt is very constipated?
dull
159
What does a +CVA tenderness suggest?
Pyelonephritis
could also be MSK
160
What Sx would a Pt have w/ acute appendicitis?
1. Poorly localized periumbilical pain
2. Then RLQ pain
aggravated by mvmt/cough
Palpate at McBurney's point
161
What is Rovsing's sign?
Pain on other side of palpation
162
What does a + psoas sign suggest?
appendicitis
163
What does a + Murphy's sign suggest?
cholecystitis
| press on gall bladder & inspiratory arrest
164
What does shifting dullness test for?
ascites
165
What is Kehr's sign?
Pain in L shoulder from splenic rupture
166
What is a hiatal hernia?
stomach goes through gastroesophageal junction into the thorax
most commonly sliding hernia
167
What is a herniated nucleus pulposus?
herniated disc
168
What is an epigastric hernia?
weakness or disruption of the linea alba w/ protrusion of peritoneal contents
169
What side of the hand do epitrochlear lymph nodes drain?
ulnar side
