Ty's Gen Dx Cards Flashcards
Study (392 cards)
1
Q
What is involved in the interview and health history?
A
1- Chief Complaint
2- Past health history
3- Personal/Social history
4- Review of systems
2
Q
What is the chief complaint?
A
- The reason the pt is seeking care
- The pt’s own words of what their issue is
- Information the pt volunteers
3
Q
What is involved with the present illness?
A
- OPPQRST
- Information about the chief complain
- Best place to start a working diagnosis
4
Q
Best place to get info about arthritides?
A
Site in present illness
5
Q
Best place to get info about headaches?
A
Timing in present illness
6
Q
What falls into the category of past health history?
A
- Serious illnesses
- Previous illnesses
- Hospitalizations
- Surgeries
- Medications (over the counter, prescribed)
- Allergies
- Past/present Traumas
7
Q
What falls into the family health history category?
A
- Cardiovascular disease (stroke, heart attack, AAA, etc)
- Diabetes
- Cancer (type, who, dead/alive)
8
Q
What is asked in the personal/social history?
A
- Marital status (children, #, age, sex)
- Occupation
- Diet
- Exercise
- Bowel/urinary patterns
- Sleep
- Stress
- Sexual activity
- Smoke
- Drink
- Illicit drugs
- Water intake
9
Q
Purpose of CAGE questionnaire?
A
- used to screen for issues with drinking
- to determine potential alcoholic problems
10
Q
What does CAGE stand for?
A
C- cut down
A- annoyed
G- guilty
E- eye-opener
11
Q
What is a positive cage for M/F?
A
M- 2/4 “Yes” answer
F- 1/4 “Yes” answer
12
Q
What is a review of systems?
A
General exploration of the various organ systems of the body
13
Q
What is the purpose of review of systems?
A
Help find unrelated problems to the chief complaint
14
Q
What are the vital signs examined?
A
- Heart Rate
- Temperature
- Respiratory Rate
- Blood Pressure
- Height
- Weight
15
Q
What are the 2 most important vital signs?
A
- Temperature
- Blood pressure
16
Q
Where is temperature taken?
A
- Anal (rectum)
- Oral (mouth)
- Otic (ear)
- Axillary (armpit)
- Breast
- Vaginal/Testicle
17
Q
Where is the most accurate temperature taken?
A
Anal (rectal)
18
Q
Where is the 2nd most accurate temperature taken?
A
Otic (ear)
19
Q
What does a bacterial infection cause temperature to do?
A
- Sustained increase
- Temp is lower during the day but higher at night causing night sweats
- Predictable
20
Q
What does a viral infection cause temperature to do?
A
- Spike and fall
- Fever and chills
- Unpredictable
21
Q
What is normal temperature? Normal range?
A
-Anal/otic 99.6 F
-Oral 98.6 F
-Axilla 97.6 F
Range = 96-99 F or 35-37.5 C
22
Q
Normal pulse or heart rate
A
Adult- 60-100 BPM
Newborn- 120-160 BPM
Elderly- 70-80 BPM
23
Q
Normal respiratory rate
A
Adult- 12-20 per min Newborn- Avg = 44 0-6 months = 30-60 6-12 months = 24-30 1-5 years = 20-30 6-12 years = 12-20
24
Q
What are the blood pressure values measured as?
A
Systolic
Diastolic
Pulse Pressure
25
What is true systolic pressure?
- Found by performing palpatory systolic pressure
- Find radial pulse, increase cuff pressure until pulse is gone, then add 30 to pressure #
- Example: pulse lost at 110 mmHg, add 30 to get 140 mmHg and true systolic pressure
- This helps us to not misinterpret systolic pressure or make cuff pressure too high and uncomfortable
26
Normal blood pressure
Systolic = less than 120
Diastolic = less than 80
Pulse pressure = 30-40 mmHg
27
What are the values and ranges for blood pressure
```
Normal = S <120 and D <80
Elevated = S 120-129 and D <80
Stage 1 HTN = S 130-139 or D 80-90
Stage 2 HTN = S 140-180 or D 90-120
Crisis = S >180 and/or D >120
```
28
What is an ausculatory gap
- Defn: loss and reappearance of pulsatile sound while listening with stethoscope during cuff deflation
- When pulse pressure is greater than 30-40 mmHg
- Happens in extreme HTN
29
What are Korotkoff sounds
- LOW pitched sounds
| - Produced by turbulent blood flow in arteries
30
What is orthostatic hypotension? Causes? Symptoms?
-When pulse pressure is less than 30-40 mmHg
Causes: standing too fast, bad eating habits, dehydration, menses
Symptoms = fainting and syncope
31
Which is worse? Elevated systolic or diastolic pressure?
- Elevated diastolic
- Diastolic is more crucial and critical
- Elevated diastolic = hypertension
32
What is subclavian steal syndrome
When the subclavian artery steals blood from the vertebral artery leading to fainting
33
What is vertebrobasilar artery insufficiency
(VBAI) lack or loss of blood flow to the brainstem
34
What do the vertebral and basilar arteries supply
Blood, oxygen and nutrients to the brainstem, occipital lobes and cerebellum
35
Most common cause of VBAI
Atherosclerosis
36
Risk factors for VBAI and atherosclerosis
```
Smoking
HTN
Diabetes
Obesity
>50 y/o
Family Hx
Hyperlipidemia
```
37
Tests for VBAI
```
Barre-Lieou
DeKleyn's
Hallpike
Hautant's
Underberg
Maigne's
```
38
How is Barre-Lieou performed
-Pt seated, instructed to maximally rotate head side to side. Start slow and increase to tolerance.
(+) test = any of 5 D's or 3 N's
39
How is DeKleyn's performed
-Pt supine, instructed to extend/rotate head off table. Turn head to each side for 15-45 seconds. All performed by the pt
(+) test = any of 5 D's or 3 N's
40
How is Hallpike performed
-Pt supine with head extended off table. Dr supports head, rotates, extends and laterally flexes.
Dr does the work
(+) test = any of 5 D's or 3 N's
41
How is Hautant's performed
-Pt seated. Arms extended to shoulder height, hands supinated and hold.
-Pt closes eyes, rotates/extends neck to one side then the other
(+) test = pt's hands pronate of have difficulty with arm extension. Also any of 5 D's or 3 N's
42
How is Underberg performed
-Pt standing, eyes open, arms at side, feet close together. Close eyes, extend arms, supinate hands, extend/rotate head to one side. March in place
(+) test = any of 5 D's or 3 N's
43
How is Maigne's performed
-Pt seated. Dr brings head into extension/rotation
| (+) test = any of 5 D's or 3 N's
44
Cause of scaly eyebrows
Seborrheic dermatitis
45
What is icterus
- Brain jaundice in babies due to improper liver function
| - Jaundice = think yellow and bilirubin
46
Describe cataracts
- Absent red light reflex
- Bad refraction
- Lens opactiy
- Commonly seen with diabetes and the elderly
47
Describe retinal detachment
- Tearing away of the back of the retina
- Absent red light reflex
- Occurs with trauma, falls and dehydration
- Scintillating scotomas (flashing lights)
- Curtain closing
- Painless
48
What issues with the eyes have an absent red light reflex
Cataracts and Retinal detachment
49
Describe intracranial pressure
- Space occupying lesion (SOL)
- Pressure on optic disc
- Key symptom = headache
- Papilledema = large disc cup, blurred image
50
What is related to intraocular pressure
Glaucoma
Blurred vision
Halos
51
What are Arcus Senilis and Corneal Arcus?
-Crud in the iris
-Develops over time
Arcus Senilis = happens in people >50 y/o. = insignificant
Corneal Arcus = People <30 y/o. = significant. Hyperlipidemia
52
What is diabetic retinopathy
-Waxy exudates
-Microaneurysms
-Neovascularization
Affects veins more than arteries
53
What is hypertensive retinopathy
- damage to retinal vessels
| - Show signs of copper wire deformity, silver wire deformity, A-V nicking, flame hemorrhages, cotton wool soft exudates
54
What are the 5 D's and 3 N's
```
Diplopia
Dizziness
Drop attacks
Dysarthria
Dysphagia
Nausea
Nystagmus
Numbness
```
55
What is the 2nd best answer for eye questions
Hypertensive retinopathy
56
What to think of with MS and Migraines regarding the eyes
- Scintillating scotoma (wormy flashing lights)
| - Due to lack of blood supply
57
Describe Adies pupil
Sluggish pupillary reaction to light that is unilateral and caused by a parasympathetic lesion of CN III
58
Describe Anisocoria
Unequal pupil size
59
What are normal background anomalies of the eye
- Drusen
| - Coloboma
60
Describe Arroyo sign
Sluggish pupillary reaction due to HYPOadrenalism (addisons disease)
61
Describe Argyll Robertson
- Bilaterally small and irregular pupils that accommodate but do not react to light
- Seen with Tertiary Syphilis
- aka prostitues pupil
62
Describe blepharitis
- Inflammation of the eyelid
| - Seen with Seborrhea, Staph infection and inflammatory processes
63
Describe chalazion
-Infection of the meibomian gland causing a nodule which points inside the eyelid
64
Conjunctiva types and color
Pink = Normal
Pale = anemia
Bright red = infection
65
What is exophthalmosis
- Lid lag/failure to cover the eyeball
- Seen with Graves bilaterally
- Seen with tumors unilaterally
- Bulging = Graves = HYPERthroidism
66
Describe glaucoma
- Increased intraocular pressure causing cupping of the optic disc
- Pt will notice peripheral vision blurring and rings around lights
67
Describe a hordoleum
- aka Sty
- Infection of sebaceous glands causing a pimple or boil
- Staph infection
68
Describe Horner's syndrome
-Ptosis
-Miosis
-Anhydrosis
Seen on same side as interruption to cervical sympathetics
69
Describe internal ophthalmoplegia
- Dilated pupil with ptosis and lateral deviation
| - Does NOT react to light or accommodation
70
Describe iritis and uveitis
- Inflammation of the iris
| - Seen with Ankylosing Spondylitis (AS)
71
What is macular degeneration
- MC reason for blindness in the elderly
| - Central vision loss
72
Describe miosis of the eye
- Fixed/constricted pupils
- React to light and accommodation
- Seen with severe brain damage, pilocarpine medications and narcotic use
73
Describe mydriasis
dilated/fixed pupils seen with anticholinergic drugs
74
What is papilledema
- aka choked disc
- Swelling of the optic disc due to increased intracranial pressure
- No visual loss
- Brain tumor or hemorrhage
75
What is periorbital edema
- Swelling around the eyes
| - Seen with allergies, myxedema and nephrotic syndrome
76
Most common reason for periorbital edema
Nephrotic syndrome
77
Describe a pinquecula
Harmless, yellowish, triangular nodule in the bulbar conjunctiva
78
Describe Pterygium
- Triangular thickening of the bulbar conjunctiva
- Grows across the cornea
- Brought on by dry eyes
- Can cause blindness
79
Describe Ptosis
- Drooping of the eyelid
| - Seen with Horner's syndrome, CN III paralysis, Myasthenia Gravis and MS
80
Colors of the slcera
```
White = normal
Yellow = jaundice
Blue = osteogenesis imperfecta
```
81
Describe xanthelasma
- Fatty plaques on nasal surface of the eyelids
| - Can be normal or indicates hypercholesterolemia
82
AKA for normal vision
Emmetropia
83
AKA for nearsighted
Myopia
84
AKA farsighted
Hyperopia
85
What is presbyopia
- Loss of lens elasticity due to aging
| - Can't see up close but can see far away
86
What does CN II do
Sees light
87
What does CN III do
Constricts the eye
88
What does direct light reflex test
CN II/III
89
What does consensual light reflex test
CN II/III
90
What does swinging light test
CN II/III and eye pathology
91
What does accommodation test
CN II/III
92
Visual acuity is done by
Snellen Chart
93
What CN's are involved in cardinal fields of gaze
CN III (3), IV (4), VI (6)
94
What is SO4 LR6 AO3
```
SO4 = superior oblique gets CN IV
LR6 = lateral rectus gets CN VI
AO3 = all other eye muscles get CN III
```
95
How do you straighten the tympanic canal on an adult? child?
- Pull up for an adult
| - Pull down and out for a child
96
Describe otitis externa
- aka swimmers ear
- crusty discharge
- pain and inflammation of the outer ear
97
Bulging tympanic membrane think of
Otitis media (otitis interna)
98
Describe otitis media (otitis interna)
- infection
- acute, chronic, anywhere in between
- Red tympanic membrane
- Dilated blood vessels
- Bulging
99
Retracted tympanic membrane think of
Blocked eustachian tube
100
Cause of retracted tympanic membrane
- Blockage
- Altitude
- Serous (bubbly)
101
Describe myringitis
- Acute infection
| - Redness
102
Describe otosclerosis
Chalky white eardrum
103
Describe acute mastoiditis
- Abnormal finding in the ear
- Bacterial infection in mastoid process
- Same S/Sx as otitis media plus inflammation and palpatory tenderness over mastoid
- Hearing loss common
104
Describe acoustic neuroma
- Abnormal finding in the ear
- Benign tumor of CN VIII (8)(vestibulocochlear) called a schwannoma
- Hearing loss
- Tinnitus
- Vertigo
- Found on CT or MRI
105
What is benign paroxysmal positional vertigo (BPPV)
- Abnormal finding in the ear
- Brief episode of vertigo due to change in head position
- Exam = Dix-Hallpike maneuver
- Tx = Epley's maneuver
- (+) Dix-Hallpike = nystagmus, nausea, vertigo
106
Describe Meniere's Disease
- Abnormal finding in the ear
- aka endolymphatic hydrops central vertigo
- Recurrent prostrating vertigo
- Sensory hearing loss
- Tinnitus
- Ear fullness
107
What is presbycusis
- Abnormal finding in the ear
- Sensorineural hearing loss with aging
- Genetic or acquired
108
Describe tinnitus
- Abnormal finding in the ear
| - Ringing in the ears
109
Describe vertigo
Abnormal sensation of rotary movement associated with difficulty in balance, gait and navigation
110
The ear is all about what CN
CN VIII (8, vestibulocochlear)
111
What are the tests for the ear concerning hearing
- Weber
| - Rhinne
112
Which test of the ear is performed first
Weber
113
What tuning fork is used for Weber
512 Hz
114
Who lose hearing high tones? Low tones?
- High = Men
| - Low = Women
115
How to perform Weber test
- Place 512 Hz tuning fork on top of middle of head
- Sound heard equally bilaterally test is done, no issues
- Sound migrates to one ear, perform Rhinne
116
How to perform Rhinne test
- Place tuning fork on mastoid
- Tell pt to say when they can no longer hear sound
- Place tuning fork by the ear, have pt say when sound is no longer heard
- Air conduction should be 2X longer than bone
117
Purpose of Weber and Rhinne
Identify a conduction deficit or sensorineural problem
118
What are sensorineural problems
- Presbycusis
- Neuroma
- Tumor
- Meniere's disease
- Can't hear in loud environment
119
What are conduction deficit problems
- Infection
- Cerumen (ear wax)
- Otosclerosis
- Can hear in loud environments
120
Weber migrates to R ear, what is the possibility
- Conduction deficit in R ear
| - Sensorineural in L ear
121
What CN is involved with the nose
CN I (olfactory)
122
Colors and types of rhinitis
- Red = acute rhinitis
- Pale, blue and boggy = Allergic
- Thinning of mucosa, sclerosis, crusty, foul, polyps = Atrophic
- Red, swollen, clear runny nose = Viral
123
What has happened if there is a foul discharge from the nose
A foreign object is in the nose
124
Clear discharge and blood from the nose indicates
CSF (cerebrospinal fluid)
125
Watery discharge on one side of the nose is
Fracture of cribriform plate
126
A depressed bridge of the nose could indicate
Possible fracture of the nasal bone
127
Fancy name for a nose bleed
Epistaxis
128
What are the lymph drainages
Right and Left sentinel or supraclavicular node drainage
129
What does the R supraclavicular node drain
- Above the diaphragm on the right
- Right side of the face and neck
- Right arm
130
What does the L supraclavicular node drain
- Left side of face and neck
- Left arm
- Left diaphragm
- Everything else below the diaphragm
131
What is hardening of the lymph called
Virchows node
132
T or F. Right sided Virchows nodes are more dangerous than left sided Virchows nodes?
- False
| - Both are bad but Left is worse
133
T or F. Hard tissue cancer is cancer of bone.
True
134
What is soft tissue cancer
- Anything not considered bone
| - Lymph, lung, breast, prostate, colon, skin, etc
135
Warning sign for soft tissue cancer
- Firm
- Large
- Non-tender
136
Soft tissue cancer is due to
Chronic irritation
137
Diagnosis and treatment of soft tissue cancer
- Dx = biopsy
| - Tx = chemotherapy, radiation, surgery
138
Where is the pancreas located
- Epigastric
- Retroperitoneal
- Below the Xiphoid
139
Where is pain of the pancreas felt
Straight through midline T10-T12
140
What issues are associated with the head of the pancreas
- Pancreatitis
| - Pancreatic cancer
141
What is associated with the tail of the pancreas
Diabetes Mellitus
142
Non-painful, bruising of the flanks is involved with what organ
Pancreas
143
How many types of diabetes mellitus
- 3
- Type 1 = Juvenile insulin dependent
- Type 2 = adult onset non-insulin dependent
- Gestational
144
Most dangerous type of diabetes
Gestational (not only for mom but could kill baby)
145
What is discoloration of the skin from bleeding typically caused by bruising
Ecchymosis
146
Lab tests for diabetes mellitus
- FBS
- GTT
- A1C
147
Best test for diabetes mellitus
A1C
148
Classic triad of diabetes mellitus
- Polyphagia
- Polyuria
- Polydypsia
149
Where is the gallbladder located
RUQ
150
Where does pain refer to with appendix issues
- Right shoulder
| - Tip of right scapula
151
What are the "F's" for gallbladder issues
- Fat
- Female
- Forty
- Flatulence
- Fertile (multiparous)
152
Describe cholecystitis
- MC seen in obese, female, >40 y/o
- MC caused by cholelithiasis
- Severe RUQ pain, nausea, vomiting
- Brought on by eating large fatty meals
153
Best test for cholecystitis
Diagnostic Ultrasound (Dx US)
154
What is cholelithiasis
Stones
155
Describe porcelain gallbladder
Calcification that becomes malignant due to chronic inflammation
156
How does appendicitis start out
Starts as a stomach ache and progressively gets worse
157
Where is the appendix located
RLQ
158
Where can you pinpoint the base of the appendix
McBurneys point
159
Where is McBurneys point
Between the Umbilicus and the ASIS
160
Describe Schilling Shift
- The body make between 17-18,000 WBC in a few days
- >17,500 = Schilling shift
- ER situation
161
Test for appendicitis
- Psoas test
- Obturator
- Blumberg's (rebound tenderness)
- Rovsing's
- Markle (ankle jar)
162
Where is Rovsing's test performed
- LLQ
| - Put pressure in the LLQ for pain in the RLQ
163
What is the special test for appendicitis
CT scan
164
The stomach is located
Epigastric region
165
What are peptic ulcers
- Gastric ulcer
- Duodenal ulcer
- Peptic is the umbrella term
166
Most common peptic ulcer
Duodenal
167
Cause of peptic ulcers
Helicobacter pylori
168
When do duodenal ulcers occur
About 2 hours after eating (postprandial)
169
Where is a gastric carcinoma virchows node located
Left virchows node
170
What does chronic gastritis lead to
- Denaturing of gut lining
- Pernicious anemia (megaloblastic anemia)
- PLS (posterolateral sclerosis)
171
What is the aka for B12
Cobalamin
172
Purpose of B12
- RBC maturation
| - Myelination of nerves
173
Vegans have what vitamin deficiency
B12
174
Parietal cells in the gut secrete
- HCl
| - Intrinsic factor
175
What make B12 absorbalable
Intrinsic factor
176
Big immature RBC's are called
Reticulocytes
177
What is an aka for demyelination
Sclerosis
178
What happens to RBC's as they mature
Get smaller, shrink
179
Name for RBC death due to lack of B12
Megaloblastic anemia aka pernicious anemia
180
What nerves are affected first by B12 deficiency
Posterior columns (lateral tracts)
181
What is the purpose of the Posterior columns (lateral tracts)
- Sensory pathway from skin and joints
- Fine touch
- Vibration
- 2 point discrimination
- Proprioception (position sense)
182
Demyelination of the Posterior Columns leads to
Stocking and Glove paresthesia aka PLS (posterolateral sclerosis)
183
B12 story/pathology
Chronic gastritis --> Megaloblastic anemia (pernicious anemia) --> PLS (posterolateral sclerosis)
184
What does chronic gastritis affect
Denatures parietal cells
185
What does denaturing parietal cells affect
- No secretion of HCl or intrinsic factor, therefore no absorption of B12
- B12 needs intrinsic factor to be absorbed
186
What is the effect when B12 is not absorbed
- RBC death which leads to anemia (perncious --> fatigue)
| - Demyelination of nerves of Posterior columns (lateral tracts)
187
What is the effect of demyelination of Posterior column nerves (lateral tracts)
Stocking and glove paresthesia aka PLS
188
What is the name when PLS sets in
Combined systems disease
189
Tests for B12
- B12 assay
- Schillings Test
- Achlorhydria
190
Best test for B12
Schillings test
191
Explain schillings test
- Radioisotope tag B12
- Swallow it
- Monitor/check urine for 24 hours
192
Is B12 in the urine good or bad? Why?
- Good
| - Means you are absorbing B12 properly
193
Treatment for B12 deficiency
B12 intramuscular injections
194
Describe a hiatal hernia
- Protrusion of the stomach above the diaphragm
- Palpable tenderness in LUQ
- Reflux esophagitis (acid reflux)
- Dyspepsia (indigestion)
- Worse after eating large meal or lying down
195
Describe reflux esophagitis
- Acid reflux of stomach contents into the esophagus
- Caused by sliding hiatal hernia
- Worse lying down or after a big meal
- Valsalva makes it worse
- Bearing down makes it worse
196
What are the major players in the colon
- Chron's
| - Ulcerative colitis
197
Key words for Chron's
- Skip lesions
| - String sign
198
What is Chron's disease
- Narrowing, scarring, stricture of the lumen
- Leads to malabsorption of B12
- Gluten allergy
199
What does Chorn's affect
- Distal ileum
| - Colon
200
Where is pain for Chron's
RLQ
201
Key word(s) for ulcerative colitis
Megacolon
202
What does ulcerative colitis affect that Chron's doesn't
Meissner and Auerbach Plexuses
203
Inhibition of Meissner and Auerbach plexus leads to
- Inability to contract tissue
| - Tissue expansion called a megacolon
204
MC place for ulcerative colitis
Colon and rectum
205
Both Chron's and ulcerative colitis are prone to
- HLA-B27
- Bloody diarrhea
- Back ache
- Enteropathic Arthropathy
206
What is diverticulosis
Outpouching of the walls in the sigmoid and descending colon
207
Diverticulosis is due to
Inadequate fiber intake
208
Pain for diverticulosis is located
LLQ
209
Pre-cancerous lesions in the colon are
Polyps
210
Break off of polyps can cause
Painless bleeding
211
What has an early sign of constipation
Cancer
212
What is ascites
Fluid in the abdomen with organ failure
213
Borborygmi
Bowel sounds
214
Aborborygmi
- Absent bowel sounds
| - Must listen for >5 minutes (1+ minute in each quadrant) to diagnose
215
Small intestine referral pain is
Periumbilical
216
What is the aka for irritable bowel syndrome
Spastic colon
217
Describe irritable bowel syndrome
- Variable degrees of constipation and diarrhea
- MC in females
- Pain/gas relieved by bowel movement
218
What to think of when hear or see LIVER
- VEINS
| - Liver = veins = portal hypertension
219
What is involved with portal hypertension
- Varicosities in the legs
- Caput medusa around the belly button
- Esophageal varices
220
4 major disease of the liver
- Acute hepatitis
- Chronic hepatitis
- Cirrhosis
- Cancer
221
Describe acute hepatitis
- Tender**
- Swollen
- Boggy
- IgM**
- Decrease WBC (leukocytopenia)
- Increase lymph (lymphocytosis)
- Hep A = oral/fecal
- Hep B = blood
222
Describe chronic hepatitis
- Non-tender
- Swollen
- Boggy
- IgG**
- Increase/normal WBC + enzymes
223
Describe cirrhosis
- Non-tender
- Variable swollen**
- Hard (smooth)
- Increase GGT
- MCC is alcoholism
224
What is cirrhosis
Thiamine deficiency with alcoholism
225
What does cirrhosis cause
- Portal Hypertension
- Ascites
- Esophageal varices
226
Describe liver cancer
- Non-tender
- Swollen
- Hard (nodular-irregular)**
- Biopsy**
227
What are acute and chronic hepatitis due to
Viral infection
228
What is hematemesis
Vomiting blood
229
What is hemoptysis
Coughing blood
230
What is hematochesia
Blood in stool
231
Liver labs
- Increase Alkaline Phosphatase (Alk-Phos)****
- SGOT/AST
- LDH
- GGT
- SGPT/ALT
- CPK
- BUN
232
What is Mallory Weiss syndrome? Associated with?
- Coughing, tearing of esophageal blood vessels and hematemesis with palmar rash due to bile salts
- Cirrhosis
233
What is Wernicke Korsakoff syndrome? Associated with?
- Thiamine deficiency from alcoholism that leads to dementia
| - Cirrhosis
234
What is Beri Beri? Associated with?
- Thiamine deficiency without alcoholism
| - Cirrhosis
235
Most common site for metastatic disease
Liver
236
Where are the kidneys located
Retroperitoneal, close to midline
237
Which kidney is slightly higher
Left
238
What spinal levels are the kidneys located
T12-L3
239
What is nephrosis
- aka Nephrotic syndrome
| - Kidney disease characterized by Edema, Proteinuria and Hypertension (HEP)
240
What does HEP stand for? What does it mean?
- HEP = Hypertension, Edema, Proteinuria
| - Means a kidney is going through chronic failure
241
aka for HEP in pregnant female
Pre-Eclampsia
242
What word always describes a disease with proteinuria
"NEPH"
243
Describe cystitis
Non-infectious bladder inflammation that causes burning, painful, and frequent urination with incontinence
244
Where is pain located in cystitis
Suprapubic and low back pain
245
aka for nephroblastoma? describe it
- aka Wilm's tumor
- <5 y/o
- abdominal mass
- hematuria
246
aka for kidney stones
Nephrolithiasis
247
Describe nephrolithiasis
- Colicky
- Sedentary
- 20 y/o male
- Made of calcium (calcium oxalates**, calcium urates, calcium phosphates) **MC
248
Most common type of kidney stone
Calcium oxalate
249
Describe kidney stone pain
Flank pain describes as writhing
| writhing = continual twisting, squirming or contortions of the body
250
What test is used for the kidney
Murphy's test (kidney punch)
251
How do you evaluate kidney stones
- Increased BUN
- Uric acid
- Creatinine clearance
- KUB
252
Describe eclampsia
HEP + convlusions
253
What is Nephritic syndrome
- aka acute glomerulonephritis
- Caused by Group A Hemolytic Strep
- RBC casts in urine
254
What is the route for strep
Mouth --> Kidney --> Heart
255
What is strep in the kidney
Glomerulonephritis
256
What is strep in the heart
Carditis
257
What has RBC casts in the urine
Glomerulonephritis
258
What has WBC + waxy casts in the urine
Pyelonephritis
259
What has ALL casts in the urine
Nephrosis (nephrotic syndrome)
260
Hyaline casts in the urine is
Normal finding
261
Nephritic due to?
| Nephrotic due to?
- Nephritic = Infection
| - Nephrotic = HEP
262
What causes pyelonephritis
E. Coli from a UTI
263
What causes urethritis
E. Coli
264
Describe urethritis
- Classified as gonococcal and non-gonococcal
- Gono = gonorrhea
- Non-gono = chalmydia
- MC in females caused by E. coli
- Nitrites in the urine
265
Types of urinary incontinence
- Urge
- Stress
- Overflow
- Functional
266
Describe urge incontinence
- Often called "overactive bladder"
| - Urgent need to get to the bathroom
267
Describe stress incontinence
- Increased abdominal pressure from exercise, cough, sneeze, or laugh
- Due to weakened pelvic floor muscles
268
Describe overflow incontinence
- Inability to completely empty the bladder
- Constant or frequent dribble of urine
- MC in males with prostate problems
269
Describe functional incontinence
- MC among older adults with arthritis, parkinsons, alzheimers (disorders that involve moving, thinking, or communicating)
- Can't get to a bathroom fast enough
270
Path of Upper Tract kidney infections
Descending
271
Path of Lower Tract kidney infections
Ascending
272
Anatomy involved with upper tract kidney infections
- Kidney
| - Ureter
273
Anatomy involved with lower tract kidney infections
- Bladder
- Prostate
- Urethra
274
Key words for upper tract kidney infection
- Strep
- Fever
- Casts
- Proteinuria
- Stones
- HEP
275
Key words for lower tract kidney infection
- STD
- E. Coli
- Nitrates/Nitrites
- No fever
- FUB = frequency, urgency, burning
276
What are the deformities of the thorax
- Barrel Chest
- Pectus Excavatum (funnel chest)
- Pectus Carinatum (pigeon chest)
277
What is barrel chest seen with
- COPD
| - Cystic Fibrosis
278
Describe pectus excavatum
- Funnel chest
- marked depression in the sternum
- Sternum is sunk in
279
Describe pectus carinatum
- Pigeon chest
| - Forward protrusion of the sternum
280
What is tachypnea
Rapid, shallow breathing
281
What is bradypnea
Slow breathing
282
What is Biot's breathing
- Irregular apnea indicating medulla involvement
| - ER situatio
283
What is Cheyne Stokes
- Rhythmical apnea due to brain lesion
| - ER situation
284
What is Kussmaul's
- Air hunger associated with diabetic coma
- Deep breathing
- Diabetes Mellitus
285
Treatment for hyperventilating
- CO2 (carbon dioxide)
| - Breathe into a paper bag
286
Pink puffer related to
Emphysema (balloon lungs)
287
Blue bloater related to
Chronic Bronchitis
288
What is respiratory excursion
Dr places hands on the pt's posterior ribs and has the pt take deep breaths
289
What is tactile fremitus
- Palpable vibration
| - Pt says "99" when the Dr puts their hands on the pt's back
290
What does fremitus feel
Fremitus feels fluid
291
What increases fremitus
- Bacterial pneumonia
- CHF (congestive heart failure)
- Pulmonary edema
292
What tones will be heard on percussion
- Resonant
- Hyperresonant
- Dull
293
What does resonant tone mean
Normal lung tissue
294
What does hyperresonant tone mean
- Increased air in the chest
- COPD
- Emphysema
- Pneumothorax
295
What does dull tone mean
- Increased density
- Pneumonia (bacterial)
- Atelectasis
- CHF
- Pulmonary edema
296
Types of fremitus
- Normal
- Increased
- Decreased
297
What has a normal fremitus
Normal tissue: Viral pneumonia, laryngitis, pleural effusion
GI-Air: Meganblase, flatulence
298
What has a decreased fremitus
Solid lung tissue: Atelectasis, tumor, pneumoconiosis
Air in lung: COPD, emphysema, pneumothorax
299
What has increased fremitus
Fluid: Bacterial pneumonia, CHF, pulmonary edema
300
Normal lung tissue has what percussion tone and fremitus? What is involved with normal lung tissue
Normal = viral pneumonia, laryngitis, pleural effusion
Percussion = resonant
Fremitus = normal
301
Solid lung tissue has what percussion tone and fremitus? Causes of solid tissue?
Solid tissue = atelectasis, tumor, pneumoconiosis
Percussion = flat
Fremitus = decreased
302
GI-Air has what percussion tone and fremitus? Cause of air in GI?
GI-Air = meganblase, flatulence
Percussion = tympany
Fremitus = normal
303
Fluid in the lung has what percussion tone and fremitus? Cause of fluid in the lung?
Fluid = bacterial pneumonia, CHF, pulmonary edema
Percussion = dull
Fremitus = increased
304
Air in lung tissue has what percussive tone and fremitus? Causes of air in lung?
Air = COPD, emphysema, pneumothorax
Percussion = hyper-resonant
Fremitus = decreased
305
What are the types of breath sounds
- Tracheal
- Bronchial
- Bronchovesicular
- Vesicular
306
What should tracheal breathing duration be? Where is it located?
- Located over the trachea
| - Inspiration to expiration should be 1:1
307
Duration and location of bronchial breath sounds
- Inspiration to expiration should be 1:3
| - Located over the manubrium
308
Duration and location of bronchovesicular breath sounds
- Inspiration to expiration is 1:1
| - Location: Anterior is between 1st/2nd ribs. Posterior is between scapulae
309
Duration and location of vesicular breath sounds
- Inspiration to expiration is 3:1
| - Location is the remaining lung field. Mid axillary
310
Describe rhonchi
- Sonorous wheeze
- Large tracheal or bronchial obstruction
- Resembles snoring
- Low pitched
311
Describe sibilant wheezing
- More common that sonorous wheezing
- Musical rales
- Fine crackles
- High pitched
- Asthma (young)
- Emphysema (old)
312
Describe stridor
- Wheeze like sound on inspiration
- Only inspiration breath sound
- Highest pitched
- ER situation
313
What breathing issues has prolonged expiration
COPD
314
If there is respiratory lag you have a
Pneumothorax
315
Describe rales
- Small, clicking, bubbling or rattling sounds in the lung
| - Bronchitis
316
AKA for friction rub
- Pleurisy
| - Pleurisy is an infection. Will have a fever --> pleuritis
317
What is a friction rub in the abdomen called
- Peritonitis
| - Large/enlarged viscera
318
What are adventitious sounds
- Bronchophony
- Egophony
- Whispered pectoriloquy
319
What happens in bronchophony
If the spoken word "99" gets clearer then consolidation is present
320
What happens in egophony
- Pt says "EEEEE"
| - If "EEEEE" sounds like "AAAAA" consolidation is present
321
What happens in whispered pectoriloquy
whisper is heard louder and more clear then consolidation is present
322
What is consolidation
Lung tissue that has filled with fluid (liquid)
323
What produces a yellow/green sputum
- Bronchiectasis
| - Chronic bronchitis
324
What produces a rusty sputum
Pneumococcal
325
What produces red currant jelly sputum
- Klebsiella
| - Friedlanders
326
What produces a foul sputum
Lung abcess
327
What produces pink sputum
Strep
328
What produces a pinky and frothy sputum
- CHF (chronic heart failure)
| - Pulmonary edema
329
What produces a red sputum
- TB
- Infarct
- Cancer
330
Describe hypospadias
- ventral surface defect of the urethra
| - "leak on boots"
331
Describe epispadias
- dorsal surface defect of the urethra
| - "wear googles while peeing"
332
Both hypospadias and epispadias are what type of defect
Congenital urethral defect
333
What is phimosis
- When the foreskin cannot be fully retracted
| - Head is trapped in
334
What is paraphimosis
- When the foreskin becomes trapped behind/under the glans penis
- Turtleneck. Trapped out
335
Describe hydrocele
- Excess water in the testicle
- Painless, non-tender
- Transilluminates
336
Describe a varicocele
- Dependant edema
- Bag of worms
- Due to portal hypertension
337
What should we evaluate if a person has a varicocele
Evaluate the liver
338
Describe epididymitis
- Reddened testes
- Tender
- Posterior-Superior scrotal swelling
- Usually caused by an STD
339
Describe testicular torsion
- Usually due to blunt trauma
- Painful
- ER situation, surgical
340
Describe cryptochism
- Non-descending testicle
| - Leads to increased risk of cancer
341
What is priapism
- Sustained erection for >4 hours
| - Due to head trauma or increased intracranial pressure
342
What is balanitis
Inflammation of the glans penis
343
Medical term for crooked penis
Peyronie's
344
What is a spermatocele
Fluid filled mass in the spididymis
345
MC type of cancer in the testicle is
Seminoma
346
S/Sx of acute prostatitis
- Fever***
- Warm
- Tender
347
S/Sx of chronic prostatitis
Painful ejaculation
348
What is benign prostatic hypertrophy (BPH)
Enlarged, non-tender, firm, smooth prostate
349
What happens to the median sulcus in BPH (benign prostatic hypertrophy)
Gets obliterated
350
What happens to the median sulcus with prostatic cancer
Gets obscured
351
S/Sx of prostate cancer
- Firm posterior lobe
- Nodular
- Non-tender
352
Where does the prostate most commonly metastasize to
To the lumbar spine via Batson's plexus
353
Hernias are always made worse by
- Cough
| - Valsalva maneuver
354
Female hernia MC found
Femoral (males can get this too)
355
Hernia in older male MC found
Direct on scrotal sac
356
Hernia in young male MC found
Indirect on scrotal sac
357
MC type of hernia
Indirect inguinal
358
Indirect hernia feels best while
laying down
359
Hiatal hernias feels best while
standing up
360
What is it called when a ventricle contracts
Systole
361
When a ventricle is at rest and atrium are contracting is durinig
Diastole
362
What is the S1 heart sound
Closure of the AV valves
363
What are the AV valves
- Mitral
| - Tricuspid
364
Where is the tricuspid valve located
Between the right atrium and right ventricle
365
Where is the mitral valve located
Between the left atrium and left ventricle
366
What is the S2 heart sound
Closure of semilunar valves
367
What are the semilunar valves
- Aortic
| - Pulmonic
368
Where is the pulmonary valve located
Between the right ventricle and pulmonary artery (which goes to the lungs)
369
Where is the aortic valve located
Between the left ventricle and aorta (delivers blood to entire body)
370
What is S3
Ventricular gallop
371
What is S4
Atrial gallop
372
Describe S3 of the heart
- Low pitched
- Use bell of stethoscope at Apex (in left lateral decubitus position)
- Has physiological and pathological characteristics
373
What makes S3 physiological
- <40 y/o
- children
- young adult
- athletes
- late trimester pregnancy
374
What makes S3 pathological
- >40 y/o
| - Earliest sign of CHF
375
Describe S4 of the heart
- Use bell at the apex (supine)
- associated with pulmonic stenosis and pulmonary hypertension
- stiffness of ventricular myocardium
376
Is S4 physiological or pathological
Always pathological
377
What must be done when S4 is heard
Echocardiogram
378
What does APET-M stand for
```
-Location of auscultation points of the heart
A = aortic valve
P = pulmonic valve
E = Erb's point
T= tricuspid valve
M = mitral valve
```
379
Where is the Aortic valve auscultated
- Right sternal border
- 2nd intercostal space
- best heard sitting or leaning forward on exhalation
380
Where is the pulmonic valve auscultated
- Left sternal border
| - 2nd intercostal space
381
Where is Erb's point
- Left sternal border
- 3rd intercostal space
- all murmurs best heard here
382
Where is the tricuspid valve auscultated
- Left sternal border
| - 4th/5th intercostal space (depends on pt size)
383
Where is the mitral valve auscultated
- Left midclavicular line
- 5th intercostal space
- Best heard in left lateral decubitus position
384
What are the types of murmurs
- Stenotic
| - Regurgitation
385
What is a stenotic murmur
- A valve that has trouble opening
| - Low pitched (use bell)
386
Are there any other terms stenosis goes by
NO!!! Stenosis = Stenosis
387
What is a regurgitation murmur
- A valve that has trouble staying shut
| - High pitched (use diaphragm)
388
Are there any other terms regurgitation goes by
YES!!
- Insufficient
- Insufficiency
- Prolapse
- Incompetent
389
What are the systolic murmurs
SL open: Atrial/Pulmonic Stenosis
| AV shut: Mitral/Tricuspid regurgitation
390
What are the diastolic murmurs
Mnemonic: arms and parts (atrial regurgitation, mitral stenosis and pulmonic regurgitation, tricuspid stenosis)
SL shut: atrial/pulmonic regurgitation
AV open: mitral/tricuspid stenosis
391
What happens to the valves in systole
- AV shut
| - SL open
392
What happens to the valves in diastole
- AV open
| - SL shut
