Midterm Flashcards
1
Q
pneumonic for cranial nerves
A
On Occasion Our Trusty Truck Acts Funny, Good Vehicle Any How
2
Q
Cranial nerves pneumonic for sensory/motor
A
Some say marry money but my brother says big boobies matters more
3
Q
Facies of cushings
A
moon face, hirsutism, red cheeks
4
Q
facies of hyperthyroidism
A
exophthalmos
5
Q
facies of graves disease
A
hyperthyroidism, exophthalmos
6
Q
facies of bells palsy
A
U/L facial droop; differentiate between stroke
7
Q
facies of nephrotic syndrome
A
edema
8
Q
facies of parkinson’s disease
A
masked face
9
Q
s/s benign postural vertigo
A
<1 min, nystagmus
10
Q
s/s vestibular neuronitis
A
hours-weeks, nystagmus
11
Q
s/s meniere’s dx
A
hours to days, sensory hearing loss, tinnitus
12
Q
s/s acoustic neuroma
A
gradual/insidious onset, U/L hearing impairment, tinnitus
13
Q
causes of hypothyroidism
A
Hashimoto’s Thyroiditis Sub-acute thyroiditis Iodine deficiency (rare in US) Thyroid surgery Severe Illness Rx induced: Lithium, amiodarone, sulfonamides
14
Q
causes of hyperthyroidism
A
Grave’s disease
Toxic multi-nodular goiter
Toxic adenoma
Exogenous thyroid hormone ingestion
15
Q
Signs of hypothyroidism
A
Dry coarse cool skin, hair loss Periorbital puffiness Increased diastolic bp Bradycardia Mixed hearing loss, somnolence, peripheral neuropathy
16
Q
signs of hyperthyroidism
A
Warm, smooth, moist skin Stare, lid lag, exophthalmos Tachycardia or a-fib Increased systolic bp Hyperdynamic cardiac pulsation
17
Q
symptoms of hypothyroidism
A
Fatigue, lethargy Modest weight gain, with anorexia Dry coarse skin, cold intolerance Swelling of face, hands, legs Constipation Weakness, muscle cramps, arthralgia, impaired memory or concentration
18
Q
symptoms of hyperthyroidism
A
Nervousness, palpitations Weight loss, increased appetite Excessive sweating, heat intolerance Frequent bowel movements Tremor and proximal muscle weakness
19
Q
Eye emergencies (symptoms)
A
pain, sudden loss of vision
20
Q
Causes of eye emergencies
A
pain, sudden loss of vision: retinal detachment, vitreous hemorrhage, central retinal artery occlusion, uveitis
21
Q
Characteristics of bacterial conjunctivitis
A
mucopurulent discharge, B/L, highly contagious
22
Q
Characteristics of allergic conjunctivitis
A
pruritic, seasonal, stringy discharge
23
Q
Characteristics of viral conjunctivitis
A
watery discharge, U/L, contagious
24
Q
Acute iritis is?
A
irregular and small pupil, decreased vision, photophobia
25
acute iritis causes
systemic infection (herpes zoster, TB)
26
Tx of acute iritis
immediate referral
27
pupil size <2
miosis
28
pupil size >5
mydriasis
29
Normal fundal exam
The optic disc is pink with sharp outline and a cup-to-disc ratio of ~0.30. The vasculature is sharp and clear radiating outward from the disc.
30
How to perform pupillary reflex?
shine light on eye in dark room
31
papilledema
pink color, disc swollen, raised ICP, "cupping"
32
TMJ
pain, popping and clicking at the TM joint due to stress, anxiety, or dental malocclusion
33
viral vs allergic rhinitis
Viral: mucosa is red/swollen
Allergic: mucus is pale
34
describe allergic rhinitis
turbinates are pale and boggy, seasonal, rhinorrhea/sneezing
35
abnormal lip findings
angular cheilitis, angioedema, herpes simplex, carcinomas, lesions
36
disconjugate gaze
strabismus
37
two types of strabismus
esotropia, exotropia
38
tonic pupil
slow reaction to light and accommodation
39
causes of tonic pupil
surgery, trauma, idiopathic
40
AV Nicking, cotton wool spots, red spots
diabetic retinopathy
41
Abnormal tongue findings
Smooth tongue, hairy tongue, candidiasis
42
What is Temporal arteritis
Throbbing pain of temporal artery d/t inflammation; AKA Giant Cell Arteritis
43
How are tonsils are graded?
I-4. 1-2 is normal, 1 = visualized, 4 = touching
44
normal lung sound on percussion?
resonant
45
lung percussion - sounds with COPD
hyperresonant
46
lung percussion - sounds with pneumothorax
hyperresonant
47
Lung percussion - sounds with pneumonia
dull
48
Lungs - stridor
high pitched crowing sound, obstruction, upper airway. Epiglottitis
49
Rhonchi
low pitched, snoring like. Suggests secretions in large airway
50
Physical findings of Asthma
- anxious, labored breathing, wheezing
- decreased TF
- hyperresonant percussion
- prolonged expiration/wheezing on auscultation
51
Physical findings of bronchitis
- rasping cough or normal, wheezing
- normal fremitus, normal resonance
- normal breath sounds, may have crackles/rhonchi
52
Physical Findings of COPD or chronic bronchitis
- history of sputum
- exposed to tobacco
- cough has rattle, fremitus normal/increased
- hyperresonant percussion
- auscultation: prolonged expiratory with crackles
53
physical findings of COPD/emphysema
increased AP/L diameter, barrel chest, use of accessory muscles
- TF decreased, expansion decreased
- hyperresonant
- breath sounds decreased, crackles, wheezes
54
decreased expansion & TF, dull percussion, decreased breath sounds/crackles
atelectesis
55
Increased TF, dull percussion, breath sounds louder so bronchophony, ego are present
consolidation
56
Pleural effusion vs pneumothorax similarities
absent breath sounds (especially pneumothorax)
57
differences of pleural effusion vs. pneumothorax
effusion will be DULL percussion (fluid in lungs) and pneumothorax will be HYPERRESONANT because there’s lots of air
58
Chest pain differential diagnosis
CV: MI, Aortic Dissection, Aortic Stenosis, Acute Coronary Syndrome, HOCM, MVP, Myocarditis, Rheumatic Fever
Pulm: Pulmonary Embolism, Pneumonia, Bronchitis, Pulmonary Hypertension, Pleurisy, Asthma
GI: GERD, PUD, Pancreatitis
MSK: Costochondritis
Psych: Anxiety
59
Stable angina
Most common symptom - chest pain behind the breastbone or slightly left. Pain begins slowly, gets worse over a few minutes before going away. Occurs with exercise, walking up stairs.
60
Unstable angina
chest pain that is sudden and gets worse, last longer than 15-20 min, occurs without cause, does not respond to nitroglycerin, associated with SOB drop in BP.
61
Variant or Prinzmetal’s angina
Coronary artery spasm - temporary, sudden narrowing of coronary arteries. May occur at the same time everyday, usually btw 12 mn and 8 am., not usually associated with exercise.
62
Orthopnea
Dyspnea that usually occurs soon after the patient lies down is relieved by
sitting up or standing; Two or three pillows at night; Seen in COPD, CHF, Mitral Stenosis/Regurg
63
Paroxysmal Nocturnal Dyspnea
Dyspnea after lying down for 1-2 hours. Usually wakes at night dyspneic, not relieved easily after sitting or standing; Seen in early CHF, pulmonary edema, nocturnal asthma attack
64
Causes of dyspnea
Left-sided Heart Failure, COPD, Asthma, Pneumonia, Pneumothorax, Pulmonary Emboli, Anxiety
65
What is syncope?
Temporary loss of consciousness.
66
Causes of syncope
Vasovagal Reflex, Arrhythmias, Cardiac Outflow obstruction, MI, Carotid Sinus Syncope, Hypovolemia
67
S3
-due to rapid ventricular filling
-After s2 dull, soft, low
-normal in children
“Kentucky”
68
S4
```
atrial gallop (tennessee)
-before s1
```
69
Risk factors for CV disease
High BP, cholesterol, DM, obesity, smoking, diet, sedentary lifestyle, alcohol
70
Three types of murmurs
1. innocent
2. physiology - changes
3. patho- abnormality of the heart
71
innocent heart murmurs
low, musical, no symptoms/disease
72
aortic stenosis
loud/harsh. Fatigue, dizzy
73
pulmonic stenosis
harsh, mid systolic
74
Pansystolic murmur
pathologic, (from s1 to s2, throughout, when valve should be closed)
75
mitral regurgitation
PANSYSTOLIC, loud, fatigued
76
tricuspid regurg
soft. RVH...engorged veins
77
pneumonic for systolic murmurs
Mr. PASS MVP
78
pneumonic for diastolic murmurs
Ms. Ard
79
Which murmurs are indicative of heart disease
diastolic - ms. ard
80
Systolic murmurs
```
Mr. Pass MVP
mitral regurg
physiologic
aortic stenosis
systolic
mitral valve prolapse
```
81
diastolic murmurs
Ms. Ard
mitral stenosis
aortic regurgitation
diastolic
82
most common type of murmur
mid systolic ejection murmur, start after s1, stop before s2
83
A midsystolic murmur would be __________ while a pansystolic murmur would be ________
innocent/pathologic
84
what does pansystolic murmur mean
blood flowing when valves should be closed
85
what does midsystolic murmur mean
mid = there is a start/stop point
86
How many grades of murmurs are there?
I-VI
87
What is the difference between the Mid systolic click and a systolic (or mid-systolic) murmur?
Click: mitral valve prolapse as the valve closes and goes backwards. Sharp, high.
Murmur: mid systolic is most common and the click would be heard before it
88
Describe an innocent murmur
(musical, disappears when sitting, no heart symptoms)
89
Describe an aortic stenosis murmur
(loud, harsh/musical, fatigued patient)
90
Describe a pulmonic stenosis murmur
(medium pitch, coarse)
91
Mitral Regurgitation
loud, blowing, fatigued patient with palpations
92
Tricuspid Regurgitation
soft, blowing. Signs of Right heart failure: increased JVP
93
What would a high pitched scraping sound indicate?
Pericardial friction rub
94
What are the 5 P’s and what are they assessed for?
Pulseless, pallor, pain, paresthesia, paralysis, for peripheral arterial or vascular disease
95
Signs of PAD?
Fatigue, pain on walking, numbness. Poorly healing leg wounds. Abdominal pain after eating. Relative with AAA.
Check pulses, skin, aorta, cap refill
Think - color, pulse, edema, skin….
96
Intermittent claudication is a sign of ?
PAD
97
Describe characteristics of a patient with PAD
Intermittent claudication, cool legs, hard to feel pulses, wound/ulcer on feet non-healing, pale when elevated, dusky when dangled, atrophic, shiny skin, hair loss.
98
Why is health history important?
70-80% of diagnoses can be made based on history alone.
| 90-100% of diagnoses can be made when the physical exam is added.
99
Is HPI objective or subjective?
subjective
100
is ROS objective or subjective?
subjective
101
is CC subjective or objective?
subjective
102
List the components of the health history
```
◦ Identifying Data
◦ Chief Complaint
◦ History of Present Illness
◦ Past Medical History
◦ Family History
◦ Personal/Social History (may or may not include genogram)... how does this differ for pediatric or elderly patient?
◦ Review of Systems
```
103
What are the steps in Clinical Decision Making?
1. Identify the patient problem
2. Assess: collect history and physical data
3. Formulate competing diagnoses (differential)
4. Order diagnostics
5. Select diagnosis
6. Develop a treatment plan
7. Implement and evaluate: Follow Follow-up
104
What are the goals of Motivational Interviewing?
Finding out which stage the client is at, and addressing the concerns specific to their stage… utilize scales
Have the client articulate their “pros” and “cons” so they can better process and ultimately resolve the conflict between them.
Empathizing and empowering the client to take steps towards change by affirming their strengths as well as the centrality of their initiative in lasting change
105
What are prochaska and Diclementes stages of change?
1. precontemplation - enter here
2. contemplation
3. preparation - temporary exit
4. action
5. maintenance - permanent exit
6. relapse
106
Normal or abnormal?
| •Head: normocephalic, atraumatic (NC/AT), no lesions, lumps or infestations, face symmetric, normal hair distribution
Normal
107
Normal or abnormal?
| •Neck: soft supple, trachea midline, no thyromegaly or enlarged lymph nodes
Normal
108
Normal or abnormal?
| •Head: bossing (bulging) forehead, prolonged chin, no lesions, lumps or infestations, normal hair distribution
abnormal
109
Normal or abnormal?
| •Neck: thyroid diffusely enlarged; firm, non-tender and fixed lymph nodes
abnormal
