PE Midterm Flashcards
(121 cards)
1
Q
define vertigo
These sensations point primarily to a problem in the ?????
A
refers to the perception that the patient or the environment is rotating or spinning
- These sensations point primarily to a problem in the labyrinths of the inner ear,
- peripheral lesions of CN VIII, or lesions in its central pathways or nuclei in the brain.
2
Q
what question should you ask a patient to clarify vertgo
A
- Ask: “Do you feel as if the room is spinning or tilting?” (vertigo)
3
Q
what question should to ask pt to clarify lightheadedness
A
- “Do your symptoms onset/worsen upon sitting up or standing?” (lightheadedness)
4
Q
distinguist b/w vertigo and desquilibrium
A
Vertigo is the sensation of true rotational movement of the patient or the surroundings.
- Disequilibrium, on the other hand, has to do with one feeling unsteady or losing their balance.
5
Q
A helpful special test utilized clinically in the workup to help differentiate between vertigo of a peripheral versus central cause is the _____ ____.
A
Note: A helpful special test utilized clinically in the workup to help differentiate between vertigo of a peripheral versus central cause is the DixHalpike maneuver
6
Q
distinguish b/w primary and secodnary headaches
A
- Primary headaches include migraine, tension, cluster and chronic daily headaches.
- Secondary headaches arise from underlying structural, systemic, or infectious causes such as meningitis or subarachnoid hemorrhage and may be life-threatening.
7
Q
distinguish b/w unilateral and tension hedaches
A
- Unilateral headache occurs in migraine and cluster headaches.
- Tension headaches often arise in the temporal areas; cluster headaches may be retro-orbital.
8
Q
- Difficulty with close work suggests ______ (farsightedness) or presbyopia aging vision),
whereas worsened vision with distances suggests _____ (nearsightedness
A
hyperobia
myopia
9
Q
sudden unilateral painless vision loss think:
A
consider vitreous hemorrhage from D.M.
trauma
retinal detachment
retinal vein occlusion
central retinal artery occlusion
10
Q
sudden painful vision loss usually associated w/ cornea and anterior chamber think:
A
corneal ulcer
uveitis
traumatic hyphema
acute glaucoma
Optic neuritis from multiple sclerosis may also be painful.
11
Q
Slow central loss occurs in
A
catract
macular degeneration
12
Q
peripheral vision loss occurs in
A
advanced open-angle glaucoma
one-sided loss in hemianopsia and quadrantic defects.
13
Q
moving specks or stands in visual pathway suggest
A
- Moving specks or strands suggest vitreous floaters; fixed defects, or scotomas, suggest lesions in the retina or visual pathways.
14
Q
flashing lughts or new vitrous floaters suggest
A
- Flashing lights or new vitreous floaters suggest detachment of vitreous from the retina. Prompt eye consultation is indicated.
15
Q
- Diplopia in one eye, with the other closed, suggests a problem in the _____ or ___.
A
cornea or lens
16
Q
- Diplopia is seen in lesions in the ____ or ______, or from weakness or paralysis of one or more extraocular muscles, as in _____ diplopia from palsy of cranial nerve (CN) III or VI, or _____ diplopia from palsy of CN III or IV.
A
brainstem or cerebellum
horizontal
vertical
17
Q
horizontal diplopia from palsy of cranial nerve
vertical?
A
horiz III or VI
vertical III or IV
18
Q
People with sensorineural hearing loss find being in noisy environments make hearing (worse/better) where in conductive hearing loss noisy environments make hearing (worse/better_
A
seni - worse
conductive - better
19
Q
Name medications that affect hearing
A
- aminoglycosides
- aspirin
- NSAIDs
- quinine
- furosemide.
20
Q
- Pain occurs in the external canal in otitis externa and, if associated with a ____ _____, in the middle ear in otitis media.
A
respiratory infection
21
Q
- Ear pain may also be referred from other structures in the ____, ___ or ___.
A
- Ear pain may also be referred from other structures in the mouth, throat or neck.
22
Q
when tinnitus is associated with hearing loss and vertigo it suggests:
A
Meniere’s disease.
23
Q
most likely cause of acute hoarseness (2)
A
- If hoarseness is acute, voice overuse and acute viral laryngitis are the most likely causes.
24
Q
when examining the eye a crescent shadow is noted nasally.
Dx?
A
narrow-angle glaucoma
25
an increased cup to disc ratio is noted in what dz?
glaucoma
26
name findings associated with angle closure / acute-narrow angle glaucoma
present with conjunctival injection and
fixed, mid-dilated pupil measuring 5-6 mm in diameter.
Due to the elevated intraocular pressure, the eye may feel hard to the touch
The visual acuity is often reduced.
27
findings associated with open angle glaucoma
peripheral vision loss foloowed by central
visual field testing - automated perimetry
"cupping"
(+/-) increase in IOP
28
arteries vs veins on fundascopic exam
color
size
light reflex
29
common retinal findings on fundascopic exam
* Cataract (unable to visualize retina)
* Glaucoma (↑ C/D ratio)
* Papilledema
* Hemorrhage
* Nevi
* HTN (AV nicking, copper/silver wiring)
* Cotton wools spots
* Fatty exudates
* Drusen
* Chorioretinitis
30
define papiledema
* Loss of venous pulsations
* Hyperemic or pink
* Vessels blurred
* Disk margin blurred
* Non-visible physiological cup
31
normal intraocular pressure
gold standard?
10-22 mmHg
* Goldman applanation tonometer (gold standard)
32
how do we assess mobility of TM
* With valsalva (active) - plug nose and blow out
* With pneumatic otoscopy (passive)
33
how should a normal TM look
* Color & Clarity (peds. note; the screaming infant or small child—with fever)
* Landmarks & light reflex
* Contour
* Perforations
* Presence of fluid
34
define strabismus
eye does not properly align
35
what is the **Hirschberg test (Corneal light Reflex)**
and what is it used to diagnose
light equally aligned in pupils
Useful only for manifest deviations(tropias)
36
# define
hypotopia
hypertropia
exotropia
esotropia
37
how do we detect and confirm tropias
phorias?
cover test -
* Good eye is covered
* Observe deviated eye for correction
cover/uncover (latent deviation) -
* As eye is uncovered or cross covered, it deviates back to focused position
38
what do we use "swinging flashlight test" to detect
* Test Relative Afferent Pupillary Defect (RAPD)
* **Marcus Gunn Pupil –**
* if one eye has a problem with detecting light (usually from a problem with the retina or optic nerve), there will be less constriction when light is shown on that eye. Sometimes there may be no constriction or even paradoxical dilation in one or both eyes!
* This can be seen in disease of the retina or optic nerve such as in retinal detachment, retinal ischemia or optic neuritis, among other causes.
39
define ptosis and what CN is effected
* Defined as low lying upper eyelid during primary gaze
* Levator palpebrae muscle & CN III opens the eye
* Do not confuse with lid lag
40
Lagophthalmos
* Defined as inability to fully close the eyelids
* Orbicularis muscle and CN VII close the eye
* Test muscle strength
* Test cranial nerves III & VII
41
when inspecting the cornea what condictions may we see (5)
* **Arcus senilus (corneal arcus)**
* **Kayser-Fleischer ring (Cu+ deposition; think Wilson’s disease)**
* **Corneal abrasion or ulcer (stained versus ‘naked’ eye)**
* **HSV Keratitis**
* Keratoconus (a thinning disorder of the cornea)
42
when looking at the iris what pathologic conditions may we see (2)
* **Coloboma (a defect; hole)**
* **Iritis -** **Ciliary flush**
43
define Near Reaction
note the pupillary constriction with gaze shifted to a near object.
\*Ref. previous slide…coincident with this near reaction (and pupillary constriction), but not part of it, are
* convergence of the eyes (an EOM) and
* accommodation, an increased convexity of the lens--not visible to the examiner…
* Hence, **PERRL** not PERRLA
44
miosis vs mydriasis
mio - excessive constriction
myo - excessive dilation
45
marcus gunn pupul
o less constriction when light is shown on that eye. Sometimes there may be no constriction or even paradoxical dilation in one or both eyes!
swinging flashlight test
46
Tonic Pupil (Adie’s Pupil),
* **pupil** with parasympathetic denervation that constricts poorly to light but reacts better to accommodation (near response
47
Horner's syndrime
ptosis, miosis & anhydrosis) “
48
Argyll Robertson Pupils
small
irregular pupils
49
anisocoria
pupils differ in each eye
50
oculomotor n palyse as with ...
* As with uncal herniation (seen in cerebral aneurysm, trauma, tumor
51
weber test
unilateral conductive vs sensorinueral
conductive - lateralized to impaired ear
sensori - lateralizes to good ear
52
rinne
condctive
sensorinueral
* In conductive hearing loss, sound is heard through bone as long as or longer than it is through air (BC=AC or BC \>AC).
* In sensorineural hearing loss, sound is heard longer through air (AC\>BC).
53
how would we test CN IX
gag relfex
54
how would we test CN X
have pt say “ahh” note symmetric rice of uvula and soft palate
55
how would we test CN XI
neck ROM
56
how would we test CN XII
stick out tongue should be midline and mobile
57
define true blood pressure
* The “true blood pressure” is the average blood pressure measured over several office visits or, from home, over a one week period.
58
why is it important to feel for radial pulse obliteratign and adding 30 to measurement?
* It also avoids the occasional error caused by an **auscultatory gap**—a silent interval that may be present between the systolic and diastolic pressures.
59
what are Korotkoff sounds and how are they best heard
bell
60
blood pressure differences
* Pressure differences of more than 10-15 mm Hg occur in ____ \_\_\_ ___ and ____ \_\_\_\_\_
* subclavian steal syndrome and aortic dissection.
61
normal temperature?
usually 37 degrees Centigrade (C)
62
what temps should you take on unconcious pts?
rectal - NOT ORAL
63
# define normal and abnormal BMI parameters
overweight
class 1
class 2
class 3
· Overweight (not obese), if BMI is 25.0 to 29.9.
· Class 1 (low-risk) obesity, if BMI is 30.0 to 34.9.
· Class 2 (moderate-risk) obesity, if BMI is 35.0 to 39.9.
· Class 3 (high-risk) obesity, if BMI is equal to or greater than 40.0
64
The risk for diabetes, hypertension and cardiovascular disease increases significantly if the waist circumference is ____ inches or greater in women or ____ inches or greater in men
W 35
M 40
65
the most critical portion of the examination???
the general appearance of a patient and their presenting vital signs
66
define ABCDE
* A for Asymmetry of one side of mole compared to the other
* B for irregular Borders, especially ragged, notched or blurred
* C for variegation in Color (especially blue and black mixed with white and red)
* D for diameter, greater than or equal to 6 mm
* E for Evolution or change in size, symptoms or morphology
67
* Longitudinal bands of pigment may be seen in the nails of ___ \_\_\_\_ who have darker skin, or may represent ____ \_\_\_\_\_
normal peoeple
acral melanoma
68
* Review and understand the significance of palpable cardiovascular exam findings
* Apical impulse (PMI)
* \<2.5cm diameter
* Occupies one interspace
* Brisk and tapping
* Lifts or heaves
* Thrills
* {Murmur + Thrill = Cardiac Pathology}
69
# define
S1
S2
S3
S4
S1 – when the mitral and tricuspid close
S2 – closure of aortic and pulmonary valves
S3 – heart that is dilated / on contracting ventricle (\*CHF) “canned turkey”
S4 - atrium is contracting against a noncompliant ventricle (HTN)“Ten-nes-see”
70
where are S1 and S2 sounds best heard
S1 - mitral and tricuspid
S2 - aortic and pumlonic region
71
how to estimate JVP
bed at 30 degrees
Turn the head slightly away from the side you are examining
* Use tangential lighting to help identify pulsations
•Starting with the right internal jugular vein
* Identify the meniscus (highest point of pulsations)
* Measure the height of the column in relation to the sternal angle
* Ensure 90° angles
The measurement should accurately reflect right atrial pressure
* -Add 5cm to the number obtained to reflect the distance from the right atrium
* The normal value should be ≤ 9cm.
* Levels above 9 cm reflect increased right atrial volume
72
when measuring JVP in hypervolemic and hypovolemic pts how should we adjust the bed
* For hypovolemic patients → lower the head of the bed
* For hypervolemic patients → raise the head of the bed
73
Conditions elevating right atrial pressure
* Heart failure
* Tricuspid valve disease
* Pulmonic stenosis
* Pericardial disease
74
Conditions decreasing the right atrial pressure
dehydration
75
define "a" wave
* Corresponds to atrial contraction
* Immediately precedes S1 in diastole
76
what does it mean to have an increased "a" wave
* a” waves increased resistance to right atrial emptying
* Decreased right ventricular compliance
* Right ventricular hypertrophy, pulmonary valve stenosis, chronic obstructive pulmonary disease with associated pulmonary hypertension, or restrictive cardiomyopathy
Tricuspid stenosis
77
define "x" descent
* Corresponds to atrial relaxation
78
what could be the cause of absent "a"waves
afib
junctional/ventricular rhythms
79
_what could cause Intermittent_ prominent “a” waves (cannon “a” waves)
* Atrial-ventricular dissociation (i.e. complete heart block)
* Ventricular Tachycardia
80
what could cause prominent "x" descent
* constrictive pericarditis
* restrictive cardiomyopathy
* pericardial tamponade
81
* _Decreased_ or absent “x” descent is caused by
* severe tricuspid regurgitation
* Atrial fibrillation
82
what does "c" wave represent
* Represents the bulging of the tricuspid valve during systolic contraction
* May or may not be present in every patient
83
"v” wave reflects ?
prominent v wave may indicate?
* Reflects increased atrial pressure as venous return increases after systole
* prominent
* severe tricuspid regurgitation
84
"y" descent represents
* Represents the reduced pressure observed with tricuspid valve opening and atrial emptying during diastole
85
prominent or rapid "y" descent may inidcate?
* Constrictive pericarditis
* Restrictive cardiomyopathy
* RV infarctions
* ASD
* Tricuspid regurgitation
86
slow "y"descent may indicate ?
absent y may indicate?
slow tricuspid stenosis
absent - pericardial tamponade
87
name some common JVP disorders
atrial septal defect
tricuspid regurg
artial fib
first degree AV block
constrictive pericarditis
complete AV block
tricuspid stenosis
88
what is Kussmaul’s Sign
* Kussmaul's sign is the observation of a JVP that rises with inspiration.
* Kussmaul's sign suggests impaired filling of the right ventricle due to either fluid in the pericardial space or a poorly compliant myocardium or pericardium.
ordiarly JVP should fall w inspiration due to reduced pressure in thoracic cavity
89
what is the Hepato-jugular Reflex
* JVP is observed while pressure is firmly applied to the right upper quadrant, primarily used in patients with subacute right-sided heart failure and/or passive hepatic congestion
* The increased pressure augments venous return to the right atrium
* In an individual with normal cardiac function, the increased volume of blood return is accommodated and only a transient change in the intensity of the JVP is observed
* In an individual with impaired right cardiac function, there is a progressive rise in CVP and, subsequently, increased JVP waveform intensity
distension of the neck veins precipitated by the maneuver of firm pressure over the liver. It is seen in tricuspid regurgitation, heart failure due to other non-valvular causes, and other conditions including constrictive pericarditis, cardia tamponade, and inferior vena cava obstruction.
90
S1 and S2 represent
* S1= sound when mitral and tricuspid valves slam shut
* S2= sound when blood is ejected out of L ventricle, and the aortic and pulmonic valves slam shut
91
Murmur +\_\_\_\_ = Cardiac Pathology}
thrill
92
when are systolic vs diastolic mumurs heard
* Systolic murmurs occur between (S1) **and** (S2).
* MR
* AS
* TR
* PS
* ASD
* VSD
* Pericarditis
* HCM
* Diastolic occur between S2 **and** S1
93
* Regarding exam of the abdomen, review that which is considered ‘best practice’
evaluating tender area last
94
define visceral pain
* **With distension/stretching of hollow abdominal organs**
* **May be difficult to localize**
* Typically palpable near the midline
* Varying quality—gnawing, burning, cramping, aching
95
define parietal pain
* A/W inflammation, parietal peritoneum
* Steady, aching pain—usually worse than visceral pain
* **More precisely localized over involved structure**
* **Typically aggravated by movement or coughing (e.g., ambulance ride)**
96
define referred pain
* Felt in distant sites
* Distant sites (where pain felt) innervated at roughly same spinal levels as disordered structures…typically non t.t.p.
* May be felt superficially or deeply—usually localized
* **Pain felt in abdomen may be referred from chest, spine or pelvis**
97
how do we percuss the spleen
* Percuss the left lower anterior chest wall at Traube’s Space
* Lateral tympany suggests normal size spleen
98
what is splenic percussion sign
* Percuss the lowest interspace at the left AAL. Have the patient inhale deeply while percussing.
* **Tympany at full inhalation suggests normal size spleen**
99
name peritoneal indicators
* Tenderness with movement
* Tenderness with cough (tussive tenderness)
* Tenderness with light palpation or percussion
* Hyperaesthesia
* Rebound tenderness
* Tap tenderness (e.g., heel tap; and Markle’s sign: pt. standing, with subsequent jarring to heels)
100
name conditions associated w splenic enlargement
* Large in portal HTN, HIV, Splenic infarct, hematoma, mononucleosis
101
when palpating the aorta ir should not be wider then
3cm
102
pain in RLQ on heel tap suggest
peritonitis
103
Assessing Ventral Hernia’s
* Have patient perform a “crunch” on the exam table
* Look for obvious bulge or increase in size of lesion
* Palpate for defect
104
special locations on anterior vertical axis of thorax
* 2nd intercostal space for needle insertion to treat tension pneumothorax;
* 4 th intercostal space for chest tube insertion.
105
special locations on posterior thorax
* Posteriorly, the 12th rib is a starting point for counting ribs and interspaces
* * Note: The T7-8 interspace is a landmark for thoracentesis.
106
the principle muscle of inspiration is the
diaphragm
107
• During exercise and in certain diseases, extra work is required to breathe, and accessory muscles are recruited; the \_\_\_\_\_and the _____ may become visible.
SCM
scalenes
108
Regarding auscultation of the lungs, what is considered to be the most important finding?
the presence of breath sounds
109
define vesicular breath sounds
or soft and low pitched—heard through inspiration; breath sounds are predominantly
110
define bhronchovesicular
with inspiratory and expiratory sounds about equal in length
111
define bronchial
or louder, harsher and higher in pitch
112
\*Note: If bronchovesicular or bronchial breath sounds are heard in locations distant from where they are expected to be heard , suspect that \_\_\_\_\_\_lung has been replaced by _______ or ___ lung tissue
air-filled
fluid-filled or solid
113
name adventitous lung sounds
_Crackles_ (brief—like dots in time; sometimes called rales)
_Wheezes_ (relatively high-pitched; suggest narrowed airways)
_Rhonchi_ (relatively low-pitched; suggest secretions in large airways)
114
name percussion sounds you would hear in the lungs
* Flat
* Dull
* Resonant (Healthy lungs are resonant)
* Hyperresonant
* Tympanitic
115
where are
vesicular
bronchovesicular
bronchial
sounds heard within thorax?
vesicular sounds are heard over most of the lung fields,
bronchovesicular sounds are heard between the 1st and 2nd interspaces on the anterior chest,
bronchial sounds are heard over the body of the sternum, and tracheal sounds are heard over the trachea.
116
what do S3 and S4 show
* S3 – heart that is dilated / on contracting ventricle (\*CHF)
* S4 - atrium is contracting against a noncompliant ventricle (HTN)
117
what does CVA tenderness indicate
* polynephritis, low back pain, spasm, kidney stone with urine collecting around it
118
define hochum test
* Listen over *Erb’s point*
* Squat slowly with patient and then stand up
* Decreases /dissappears with squatting – squatting increases preload on the heart
* causes an increase in venous return resulting in an increased stroke volume and arterial pressure
* Aortic stenosis, mitral stenosis, aortic regurgitation, and mitral regurgitation
* Increases or reappears with standing up or Valsalva maneuver
119
normal diaphragmatic excursion
3-5 cm
abnormal phrenic n palsy
120
(Mcburney / Murphy) is used for apendicities
McBERNY
MURPHY - cholicystitis
121
* Coarctation of the aorta and occlusive aortic disease are characterized by
* HTN in the upper extremities and low blood pressure in the legs (along with diminished or delayed femoral pulses).
