test 2 Flashcards
(200 cards)
1
Q
cough less than 3 weeks
A
acute
2
Q
cough 3-8 weeks
A
subacute
3
Q
cough greater than 8 weeks
A
chronic
4
Q
if a toddler has a cough - what’s on your differential
A
FB aspiration
pneumonia
vaccinated? pertussis?
URI
5
Q
geriatric with cough
A
Pulmonary embolism
COPD
from medication? ACE
aspiration
6
Q
cough with seasonal allergies
A
allergic disease with increased pollen count
7
Q
cough with asthma
A
from bronchospasm
8
Q
wheezing or lack of air movement, hypoxia, hypercapnia, acidosis
A
Asthma
9
Q
flushing, pruritis, anxiety, faintness, sneezing, vomiting
A
anaphylaxis
10
Q
difficulty breathing after a trauma
A
think pneumo
11
Q
tall, lanky adolescence with acute SOB
A
spontaneous pneumo
12
Q
risk factors for pulmonary embolism
A
age older than 60yr Pulmonary HTN CHF chronic lung disease ischemic heart disease stroke cancer surgery fracture family history of clotting disorders
13
Q
SOB that worsens with increasing activity and improves by rest
A
pulmonary or cardiac
14
Q
risk factors for pulmonary embolism
A
age older than 60yr Pulmonary HTN CHF chronic lung disease ischemic heart disease stroke cancer surgery fracture family history of clotting disorders Exogenous estrogen malignancy within 6 mos history of DVT/PE
15
Q
not ever vaccinated with shortness off breath - what needs to be ruled out
A
poliomyelitis
tetanus
16
Q
what do you think in a child younger than 1 who has new onset resp distress with vomiting and diarrhea. started eating honey this morning
A
Clostridium botulinum source of contamination by honey cause resp distress
incubation is only a few hours. symptoms include cranial nerve involvement, diplopia, weak suck, facial weakness and absent gag. hypotonia and weakness => resp failure
17
Q
not ever vaccinated with shortness off breath - what needs to be ruled out
A
poliomyelitis tetanus pertussis influenza covid
18
Q
what do you think in a child younger than 1 who has new onset resp distress with vomiting and diarrhea. started eating and trying new foods
A
Honey - botulism
Clostridium botulinum source of contamination by honey cause resp distress
incubation is only a few hours. symptoms include cranial nerve involvement, diplopia, weak suck, facial weakness and absent gag. hypotonia and weakness => resp failure
19
Q
Asymmetrical chest movement
A
lobar pneumonia
pleural effusions
20
Q
involvement of the supraglottic area, proximal to vocal cords, muffled voice
A
tonsillitis
epiglottitis
21
Q
normal voice with stridor
A
subglottic
tracheal lesion
22
Q
common anomalies that predispose infants to upper airway obstruction
A
infants younger than 6 mos
anomalous vascular rings
laryngeal webs
laryngomalacia
tracheomalacia
23
Q
tracheal shift
A
pneumothorax
24
Q
JVD
A
heart failure
25
pallor of sclera or nail beds
severe anemia
26
clubbing
chronic hypoxia
27
rapid new onset clubbing
infective endocarditis
28
edema of lower extremeties
think increased r heart filling -> primary lung disease or Left ventricular failure
29
in young infants edema appears as
hepatomegaly and periorbital or flank edema
30
crepitus
chest injury
pneumothorax
cutaneous emphysema
31
tactile fremitus is diminished in
pneumothorax
asthma
emphysema
other conditions that trap air in the lung
32
can cause a spontaneous pneumo from rupture of subpleural blebs located at the apex of the upper lobe or in the superior seg of the lower lobe
cystic fibrosis
33
most common cause of persistent stridor in infancy
bronchomalacia
34
brassy cough and difficulty swallowing in infants with inspiratory stridor and expiratory wheeze
vascular ring
35
cough that is paroxysmal and young child or infant not vaccinated
pertussis "whooping cough"
36
Persistent nocturnal paroxysmal coughing
asthma
37
coughing at night usually between midnight and 2 am
Asthma hallmark
caused by the low level of cortisol (glucocorticoid) in the body at that time
38
a severe cough in the early morning indicates
postnasal drip, CF or bronchiectasis
39
Cough that is worse at night
croup
postnasal drip
lower resp tract infection
allergic reaction
40
a cough that disappears with sleep
habit cough
41
dry brassy cough indicates
pharyngeal or tracheal irritation, allergy or habit
42
paroxysmal cough
asthma
pertussis
CF
foreign body aspiration
43
sudden short burst of cough in infants (Staccato cough)
C. trachomatis
44
a harsh dry cough caused by airway compression from enlarged nodes in the perihilar or paratracheal regions seem to occur with
TB
| fungal infection
45
sudden short burst of cough in infants (Staccato cough)
C. trachomatis (chlamydial pneumonia)
46
causes cough through direct sim of cough receptors by gastric acid
GERD
47
cobblestone appearance of the posterior pharynx
caused by lymphoid hyperplasia secondary to chronic stimulation of postnasal drip
48
Barrel chest
AP diameter is 1/3 -1/2 of Lateral diameter
COPD
also children with chronic cough secondary to CF or severe asthma
49
diagnostic for CF
sweat test
50
eosinophilia
bronchial asthma
allergic rhinitis
atopic dermatitis
51
greenish or rusty colored sputum
Bacterial pnemonia
52
most common cause of infection in the lower resp tract in children and young adults
mycoplasma pneumoniae
53
infant (3-11 wks)with fine rales, no wheezing. chest x ray shows hyperinflated lungs with diffuse interstitial or alveolar infiltrates
chlamydial pneumonia (C. Trachomatis)
54
```
child younger than 2
fever
rhinorrhea
cough
wheezing
tachypnea
tachycardia
resp distress
nasal flaring
```
x ray shows hyperinflation with mild interstitial infiltrates
bronchiolitis (RSV)
55
steeple sign
croup
56
high risk for gerd
cigarette smokers
overweight
overuse alcohol
57
when does it become chronic bronchitis
at least 3 consecutive months
| for more than 2 years
58
```
rasping, hacking cough
resonant to dull chest
possible barrel chest
prolonged expiration
possible wheezes
```
chronic bronchitis
59
weight loss
hemoptysis
SOB
bronchogenic carcinoma
60
FTT
productive cough
poor weight gain
initially dry and hacking then goes to loose and produces purulent material
scattered or localized coarse rales and rhonchi audible
CF
61
allergic shiners
allergic salute
eczema
rhinorrhea with clear watery drainage
allergic rhinitis
62
chronic cough worse at night
persistent coldlike symptoms
noisy breathing or snoring at night
chronic sinusitis
63
Brassy cough is the most common symptom
TB
64
chronic cough worse at night
persistent cold like symptoms
noisy breathing or snoring at night
chronic sinusitis
65
child or adult with dry cough, headache malaise, sore throat, fever, rales and rhonchi
Mycoplasma pneumoniae
66
dry cough
sore throat
frequent throat clearing
mucoid secretions posterior pharynx with cobblestone appearance, sinuses tender
UACS (upper airway cough syndrome)
67
mimics croup, high fever, copious amounts of purulent sputum
follows infection of S. Aureus or H Influenzae
bacterial tracheitis
68
Risk factors ACS
```
older than 65
>=3 risk factors CAD
-hypercholesterolemia
-htn
-DM
-smoker
-family history
-obesity
```
CAD
Family history of sudden death
Cocaine/tox use
69
Symptoms of ACS
```
Chest pain
pain that radiates to shoulder, arm, neck, jaw and to epigastrium
N/V
Diaphoresis
ischemic pain
```
70
Clinical signs ACS
Hypotension
pain >60 min
Acute decompensated HF signs
ischemic changes on ECG
71
Tearing or ripping pain
sudden onset
pain radiates to back
HTN
thoracic aortic dissection
72
what is stable angina
anginal symptoms present for at least 3 months
does not occur at rest
73
where are the locations for typical anginal pain
substernal chest
jaw
shoulder
arms
74
exacerbating factors for angina
exertion
emotional stress
heavy meal
cold
75
quality of pain for angina
pressure
tight
heavy
similar to prior angina
76
timing for angina
lasting 15 seconds to 15 min
77
relief for angina
rest
| sublingual nitro
78
chest pain after GI procedure or retching
evaluate for esophageal rupture
79
Chest pain with history of Sickle cell disease
evaluate for acute chest
80
chest pain with skin tenderness or rash
evaluate for herpes zoster
81
chest pain with prominent cough and fever
eval for pneumonia
82
Due to its high sensitivity, a negative d dimer assay is sufficient to r/o a PE in most patients with chest pain
true or false
false
83
Pleuritic pain relieved by sitting forward
```
friction rub
viral prodrome
abrupt onset
sinus tachycardia
low grade fever
```
Pericarditis
84
what does EKG look like for Acute pericarditis vs MI
Diffuse ST elevation
PR depression
```
MI
localized ST elevation
T wave inversion
Q waves
hyper-acute T waves
No PR depression
```
85
```
Chest pain
mild dyspnea
anywhere from fatigue to cardiogenic shock
Orthopnea
edema
JVD
Viral prodrome is common
ischemic pattern on ECG
```
Myocarditis
86
burning epigastric or substernal pain
usually in relation to sleep, eating or when laying supine
acid taste
chronic cough
GERD
Gastritis
PUD
87
risk factors for acute aortic syndrome
```
aortic disease
bicuspid aortic valve
inherited connective tissue dz
-Marfan syndrome
- Ehlers Danlos
Vasculitis
Family hx of aortic disease or sudden death
```
88
Pulse deficit
SBP differential >20mmHg
HTN DBP >100mgHg
focal neurologic deficit
Acute aortic syndrome
89
what do you use diaphragm
higher frequency sounds
| S1, S2
90
when do you use bell
lower frequency
S3, S4
Murmurs grade I-III
91
Atrioventricular valves include
Tricuspid and Mitral
92
acute hoarseness
less than 2 weeks
93
Hoarseness > 2 weeks
refer out to an ENT for possible to r/o neoplasm
94
what cranial nerve is involved in hoarseness and voice change
CN X - vagus nerve
95
damage to CN X can be
hormone imbalance
bacterial infection
tumor
transgender voice surgery
96
what upper resp infections can cause vocal cord inflammation
Acute laryngitis
epiglottitis
Acute laryngotracheobronchitis (Croup)
97
what kind of breathing can lead to morning hoarseness
nasal congestion can lead to mouth breathing
98
Carnett sign
lifting head up and lifting legs up - if the pain worsens, it is a positive Carnett sign meaning that it is an intra abdominal cause (visceral) of pain
99
LLQ
colon
ureter
bladder
uterus
100
diverticulitis
CT with contrast
Bloody diarrhea means one of the diverticula may have ruptured. Go to the ER otherwise it can be managed outpatient
ABX
f/u in a week
101
Kehrs sign
occurence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity
102
Kehr sign
pressure on the LUQ eliciting left shoulder pain - due to diaphragmatic irritation by the ruptured spleen and strongly suggests splenic injury. CT would be used to identify and grade the splenic injury
103
Murphy sign
pain on inspiration when hand placed over gallbladder (cholecystitis)
104
Rovsings sign
Pain in the RLQ with palpation pressure in the LLQ - positive is a sign of acute appendicitis
105
(Hepato-Jugular Reflex)
Pt supine with upper body elevated to 30-45 degrees. Have pt turn head to L and to R
Looking at the IJ - Push on RUQ (Hepato-Jugular Reflex) - Elevated CVP - measure from angle of Louis - normal 7-9 cm
106
where is the apical pulse found in infants and young children younger than 7
fourth intercostal space, left mid clavicular line
107
where is the apical pulse found in adults and children older than 7
5th intercostal space, left midclavicular line
108
if the apical pulse is felt lower, what could it mean
could indicate cardiac enlargement
109
colonoscopy recommendations (no risk factors)
starting at 45, then every 10 years until 75 then physician/health dependent till 85. No colonoscopies after 85
110
murmur
| very soft, heard in quiet room with cooperative pt
Grade I
111
murmur loud with thrill, audible with stethoscope off of chest 1 cm
Grade VI
112
Easily heard murmur, not loud
Grade II
113
Loud murmur with thrill, audible with stethoscope at 45 degree angle
Grade V
114
Murmur loud with palpable thrill
Grade IV
115
Murmur loud but n thrill
Grade III
116
waking up with headaches in mornings for the past 2-3 weeks
neoplasm
117
headache with bilat tight squeezing
tension headache
118
recent surgery, anxious and sob
think pulmonary embolism
119
a thrill felt in the suprasternal notch
Aortic stenosis
pulmonary stenosis
PDA
COA
120
Thrill ULSB
originates from pulmonary valve or artery
pulmonary stenosis
PA stenosis
PDA (rare)
121
Thrill URSB
aortic origin
| Aortic stenosis
122
Thrill LLSB
VSD
123
why would you listen to heart in the axillaries on the back
listening for pulmonary stenosis
124
new onset fever and diarrhea x 4 days
shigella
125
fever and diarrhea
Campylobacter
126
Issues with dizziness and vertigo what CN
VIII (8)
127
what is S1 and where is it best heard
closure of mitral and tricuspid
| Apex or Lower left sternal border
128
wide splitting can be due to
Ebstein's anomaly (displaced tricuspid valves down towards the apex)
129
GERD symptoms
```
Vomiting
Food refusal
Feeding aversion
Unexplained crying
Sleep disturbances
Abd pain
Choking
Coughing
Gagging
Older children and adolescents
Epigastric pain
Heartburn
Pain in relation to sleep, eating or when lying supine
Acid taste
Chronic cough
```
130
S2 what is it
closure of aortic and pulmonic valves
131
A2
closure of Aortic
132
P2
closure of pulmonic
133
Unstable angina vs. stable angina
Unstable- does not improve with rest/ medication
Last greater than 15 minutes
Chest pain occurs with very little activity
134
Male vs. female cardiovascular disease
Men generally develop CVD at a younger age and have a higher risk of coronary heart disease than women. Women in contrast, are at a higher risk of stroke, which often occurs at an older age.
135
cranial nerves 2, 4, 6
2- optic nerve
IV- Trochlear nerve
VI- Abducens nerve
all control eyes
136
what can cause a wide S2 split
ASD
Pulmonary stenosis
Right Bundle branch block
Mitral regurgitation
137
What can cause a narrow S2 split
pulmonary HTN
| Aortic Stenosis
138
Patient can’t taste or smell
| what cranial nerves
Facial nerve (CN VII)
glossopharyngeal (CN IX)
Vagus nerve (CN X)
Olefactory (CNI)
139
holosystolic is most commonly heard in
VSD
140
Midsystolic murmurs
Aortic Stenosis or Pulmonary stenosis
141
Lat systolic murmurs
mitral valve prolapse
142
Most common innocent murmur
Stills
worsens with fever, infection, anxiety
ages 3-7
LLSB
143
What neuro disease causes demyelination in the 3rd and 4th decade of life?
Multiple sclerosis
144
recent surgery than gets anxious and short of breath
PE
145
Newborn with systolic murmur
Don't worry, normal finding
146
dizzy when stands up
hypovolemic
147
morning headaches
neoplasm
148
headache with bilat tight squeezing
Tension headache
149
CN
```
1- olefactory
II - Optic
III Oculomotor
IV Trochlear
V Trigeminal
VI Abducens
VII Facial
VIII Vestibulocochlear
IX Glossopharyngeal
X Vagus
XI Accessory
XII Hypoglossal
```
150
self limited means
it goes away on its own
151
CN can you smell your coffee
I olefactory
152
what CN controls muscle function and pupil response
Oculomotor III
153
early diastolic murmur caused by a
incompetent aortic or pulmonary valve
154
Mid diastolic begins with ____ and is caused by ___- usually from ___
Begins with S3
| Caused by turbulence from the mitral or tricuspid valves usually from stenosis
155
Late diastolic caused by active
atrial contraction into the ventricle
156
CN responsible for downward, outward and inward eye movements
Trochlear (IV)
157
When do you refer murmurs
```
greater than III/VI
Loudest at the LUSB
Harsh quality
Pansystolic (holosystolic)
Systolic click
Abnormal second heart sound
```
158
largest of your cranial nerves
opthalmic - sends sensory info from your upper part of face
maxillary - sensory form middle part of face
mandibular - sensory infor from ears, lower lip, and chin
controls muscles of jaw and ear
CN V
| Trigeminal
159
CN thats associated with eye movement (lateral rectus muscle)
CN VI Abducens
160
CN for making facial expressions
taste for most of your tongue
salivary glands
tear producing glands
communicating sensations from outer parts of ear
VII facial
161
CN
think ear
cochlear - detect vibrations from sound based off of the sounds loudness and pitch This generates nerve impulses that are transmitted to cochlear nerve
Vestibular - adjust balance and equilibrium
CN VIII - Vestibulocochlear
162
CN
sensory from sinuses, back of throat, inner ear and back of your tongue
providing a sense of taste for back part of your tongue
stimulating voluntary movement of a muscle in back of throat called the stylopharyngeus
CN IX glossopharyngeal
163
CN
sensation from ear canal and parts of throat
sensory from organs in chest and trunk such as heart and intestines
motor control of muscles in throat
stim muscles of organs in chest and trunk (to include food through digestive tract - peristalsis)
sense of taste near root of tongue
CN X Vagus nerve
164
father died from colon cancer. what do you need to know to find out when to screen pt
what age did his father get diagnosed? Back it up 10 years from that point
165
CN controls the muscles in your neck
CN XI Accessory
166
CN responsible for movement of tongue
XII hypoglossal
167
LLQ
colon
ureter
bladder
uterus
168
Pain worse after meals and when laying down, better when stand
GERD
169
what sign
| push on the left side of the abdomen and the Right side sings
RoVsings
appendicitis
170
Psoas sign
lift one leg, you apply resistance
appendicitis
171
flex right thigh
rotate knee inward
you do it for them (passive)
obturator
| Appendicitis
172
Markels sign
stand up on the tippy toes and drop down
pain and it hurts
or hit heel of foot
appendicitis
pain = positive
173
murphys sign
acute cholecystitis - asking pt to take a deep breath while palpating the r subcostal area - pain with inspiration - positive
174
tests for H pylori
Breath in a bag
cant be on PPI for 2 weeks. send to the lab
serum
stool antigen
direct biopsy (if already in)
175
Mallory weiss tear caused from
from retching too hard
176
main symptom for pancreatitis
severe pain mid epigastric
177
what are you doing for pancreatitis
NPO complete bowel rest
watch for a pseudocyst
178
what kind of meds (for what problem) causes pancreatitis
diabetic meds
179
what signs are specific for pancreatitis and where is it
Grey turners on the flank (bruising)
Cullens - bruising on the (C around umbilicus)
180
what sign?
extend arms, flex hands at wrists, close eyes. push lightly back and watch them flap their hands
Asterixis sign
"liver flap"
liver disease
181
McBurney's point
appendicitis
182
skin issue on liver disease
Spider nevi
183
Fluid in abdomen
aceites
184
Murphys sign
instruct pt to let out all breath, you will push in under your R rib area then pt inflate lungs with full breath
if pt sucks back in with pain its a positive murphys sign
gallbladder
185
what 2 big chronic issues have bloody diarrhea
```
Ulcerative colitis (only cure is to take out colon)
Crohns - colon resections - no cure
```
only definitive is biopsy to determine which it is
186
gluten intolerance
celiac disease
| biopsy confirms
187
mesenteric vessels problems
DVT of mesenteric veins
| Arterial stenosis
188
drugs that can call bowel ischemia
vasopressin
189
double vision associated with what CN
VI -
190
headache thunderclap or with exertion or sex
Subarachnoid hemorrhage
191
headache that wakes them from sleep
think increased intracranial pressure
192
which cranial nerve is sweet vs salty
CN VII
193
```
headache unilateral
throbbing
nausea
photophobia
exacerbation with activity
```
migraine without aura
194
what criteria is for migraine
```
POUND criteria
pulsatile
last between 4-72 hours without meds
unilateral
nausea
debilitating
4/5 migraine diagnosis
```
195
what headache is not disabling
tension
196
```
photophobic
paresthesia
numbness
weakness
nausea
vomiting
```
migraine with aura
197
headache not emergency
migraine
tension
cluster
198
headache
| throbbing constant pain during waking hours with symptoms of tightness, pressure and muscle contraction
mixed headache
199
occurs with movement of head/rolling/turning
vertigo
200
falling over, lack of balance
Disequilibrium:
