Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
407 Cards in this Set
- Front
- Back
|
What does OPQRST stand for?
|
Onset
Palliative/Provoking Quality Radiation/Referral Severity/Setting/Site Timing |
|
|
What is Gullian Barre Syndrome?
|
This is ascending paralysis that starts in the feet and moves up
This happens to those who have just received the flu vaccination or had the flu Avery has this! |
|
|
What is Reyes Syndrome?
|
This is caused by a virus plus aspirin
It causes brain damage and hepatomegaly There is persistent recurring vomitting, convulsions and loss of consciousness |
|
|
What are the normal temperature values in the oral, rectal and tympanic, axilla, and what is the range?
|
Oral- 98.6 F
Rectal/Tympanic-99.6 F (+1) Axilla- 97.6 (-1) Range- 96-99.5 F or 35-37.5 C |
|
|
What is the normal pulse in the elderly, adult and newborn?
|
Elderly- 70-80
Adult- 60-100 Newborn- 120-160 |
|
|
What is the normal respiratory rate in an adult or a newborn?
|
Adult- 14-18
Newborn- 44 |
|
|
What is the normal adult value for blood pressure? What values represent hypotension? What values represent hypertension? What does the top number represent? The bottom number?
|
90-120/60-80 (Normal)
Under 90/60 (Hypotension) Over 140/90 (Hypertension) The top number is systolic (blood pumping) The bottom number is diastolic (at rest) |
|
|
What is an ausculatory gap?
|
This is seen in HTN patients by taking a palpatory systolic reading
The ausculatory gap is the loss and reappearance of the pulsatile sound while listening with the stethoscope during deflation of the cuff. This is only seen in HTN patients. Remember all diabetics are HTN because the blood is thicker putting pressure on the vessel walls. |
|
|
What are korotkoff sounds?
|
They are low pitched sounds produced by turbulent blood flow in the arteries
|
|
|
What is subclavian steal syndrome?
|
Its a difference of 10-15 mm HG in systolic readings that indicates that the subclavian is stealing blood from the heart causing an arterial occlusion on the side of the decreased value. Normally this is overuse of the right arm causing the patient to become dizzy. There will be an asymmetric pulse.
|
|
|
How much higher are blood pressure readings in the lower extremities?
|
About 20%
|
|
|
When doing a test from VBAI what should you look for as an abnormal result?
|
5D's- Dizziness, drop attack, diplopia, dysarthria, dysphagia
3N's- Nystamus, Nausea, Numbness 1A- Ataxia |
|
|
What is Barre Lieou for? Demonstrate it.
|
Barre Lieou is when you ask the patient to move their head from side to side and then to increase it to tolerance.
It tests for VBAI |
|
|
What is Dekleyns? Demonstrate it.
|
This is when the patient is put supine and the patient is supposed to rotate and extend their head off the table then turn to each side for 15-45 seconds. The doctor can lend minimal support
It tests for VBAI |
|
|
What is Dix Hallpike Manuever?
|
This is when the patient lays supine with the head off the table completey the examiner offers support for the skull and brings the head into extension, rotaton and lateral flexion. This is an enhanced Dekleyns.
It tests for VBAI |
|
|
What is Hautants Manuever?
|
The patient is seated, arms are extended forward to shoulder level the the hands supinated, this position is mainted for a few seconds then the patients closes their eyes, rotates and hyperextends the neck to one side, repeat on the opposite side.
It tests for VBAI |
|
|
What is Underbergs Manuever?
|
This is when the patient stands with the eyes open and arms at the side and feet close together then closes their eyes extends there arms and supinates their hands then rotates their head side to side then is told to march in place.
It tests for VBAI |
|
|
What does a scaly eyebrow represent?
|
Seborrhea
|
|
|
What does loss of the lateral 1/3 of your eyebrow indicate?
|
Myxedema which is hypothyroidism
|
|
|
What is quantitive loss of the eyebrow indicate?
|
Aging
|
|
|
What is horners?
|
Ptosis (drooping eyelid), meoisis (constricted pupil), and anhydrosis (no sweating) with interruption of cervical sympathetics sometimes associated with a pancoast tumor (lung). This happens on the same side as the interruption of the cervical sympathetics
U/L |
|
|
CN 3 paralysis,,,,
|
similar to horners but instead DILATES the pupil (mydriasis)
|
|
|
What is myasthenia gravis?
|
It is a NM disease that causes ptosis and affects CN 3 & 4. It affects older men and women and usually the facial muscles, eye muscles and swallowing. Pt may have slurred speech as well.
|
|
|
Exopthalmosis
|
Lid lag/failure to cover the eyeball seen with graves dz (B/L) or tumor- intracranial pressure causing papilledema (U/L)
|
|
|
Ectropion
|
eyelid is outward seen in elderly
|
|
|
Entropion
|
eyelid is inward seen in elderly
|
|
|
Periorbital edema
|
swelling around the eyes seen with allergies, myxedema and nephrotic syndrome (HEP)
|
|
|
Blepharitis
|
Inflammation of the eye seen with seborrhea, staph infection & inflammatory response
|
|
|
Cataracts
|
little stones or opacities seen in the lens that are commonly seen with diabetes and in the elderly. There is also an absent red light reflex
|
|
|
What is a corneal arcus?
|
Its a grayish opaque ring around the cornea. Early < 50 year old (hypercholesterolemia) Elderly > 50 (normal)
|
|
|
Pterygium
|
Triangular thickening of the bulbar conjunctiva that grows across the cornea and is brought on by dry eyes
|
|
|
Sclera
|
White= normal
Yellow= Jaundice from beta carotene Blue= osteogenesis imperfecta |
|
|
Conjunctiva
|
Pink= normal
Pale= anemia Bright red= infection |
|
|
Hordoleum
|
Sty
An infection of the sebaceous gland causing a pimple or boil on the outside of the eyelid |
|
|
Chalazion
|
An infection of the meibomiam gland inside of the eye that causes a nodule which points inside the lid and is a flesh colored enlargement
|
|
|
Pinquecula
|
A yellowish triangular nodule in the bublar conjunctiva that is harmless and indicates aging
|
|
|
Xanthelasma
|
Fatty plaques on the nasal surface of the eyelids that is normal or indicates hypercholesterolemia
|
|
|
Argyll Robertson
|
B/L small and irregular pupils that accomodate but do not react to light. Seen with syphillis (prostitues pupil)
|
|
|
Internal Ophthalmoplegia
|
Dilated pupil with ptosis and lateral deviation that doesnt react or accomodate
MS patients |
|
|
Mydriasis
|
Dilated pupil from anticholinergic drugs (atropine/mushrooms/death)
|
|
|
Miosis
|
Fixed and constricted pupils that react to light and accomodate. Seen with severe brain damage pilocarpine medications and narcotic use
|
|
|
Anisocoria
|
unequal pupil size
|
|
|
Adies Pupil
|
sluggish pupillary reaction to light that is U/L and caused by a parasympathetic lesoin with CN III
|
|
|
What is arroyo sign?
|
Its sluggish pupillary reaction due to hypoadrenalism (addisons disease)
|
|
|
What is glaucoma?
|
Increased INTRAOCULAR pressure causing cupping of the optic disc (cup to disc ratio is >1:2) the patient will notice blurring of their vision especially in the peripheral fields as well as rings around lights. Crescent sign will be present upon tangential lighting of the cornea
|
|
|
Papilledema
|
AKA Choked disk
Swelling of the optic disc in the back of the eye due to increased INTRACRANIAL pressure with no vission loss (visual loss with optic neuritis). This may be seen with a brain tumor or brain hemorrhage. |
|
|
Retinal detachment
|
painless sudden of onsent of blindness described as curtains closing over vision with lightening flashes and floaters with an absent red light reflex
|
|
|
Macular Degeneration
|
M/C reason for blindness in the elderly with central vision loss, macular drusen is an early sign of macular degeneration that causes yellow deposits under the retina
|
|
|
Hypertensive retinopathy
|
Damage to the retinal vessels/background will show these signs, copper wire deformity, silver wire deformity, A-V nicking, flame and splinter hemorrhages and cooton wool soft exudates
Remember all diabetics have HTN |
|
|
Diabetic retinopathy
|
affects the veins more than arteries and presents with microaneurysms, hard exudates, and neovasculatization
|
|
|
Iritis
|
Inflammation of the iris (colored portion of the eye) seen with anklyosing spondylitis
|
|
|
Emmetropia
|
Normal vision
|
|
|
Myopia
|
Nearsighted
|
|
|
Hyperopia
|
Farsighted
|
|
|
Presbyopia
|
Loss of lens elasticity due to aging and is a normal finding
|
|
|
Direct light reflex tests...
|
CN 2 and 3
|
|
|
Consensual light reflex tests
|
CN 3
|
|
|
Accomodation tests
|
CN 2 and 3
|
|
|
Visual acuity is tested with the..
|
snellen chart @ 20 feet
|
|
|
Cardinal fields of Gaze tests..
|
CN 3, 4, and 6
|
|
|
Tinnitus
|
Ringing in the ears
|
|
|
Presbycusis
|
Sensorineural hearing loss that occus in people as they age and they may be affected by genetic or acquired factors, the higher hearing loss is lost first
|
|
|
Acute Otitis Externa
|
An infection of the outer ear. Associated with swimmers ear especially if the water is contaminated. Often called swimmers ear. Tugging on the pinna will be painful and you will see inflammation and pain of the outer ear.
|
|
|
Acute mastoiditis
|
Bacterial infection in the mastoid process that presents with the same signs and symptoms of acute otitis media with the addition of inflammation and palpatory tenderness over the mastoid. Hearing loss is commonly associated
|
|
|
Purulent Otitis Media
|
AKA Bacterial Otitis Media
A bacterial or viral infection in the middle ear. The tympanic membrane presents with a red appearance, dilated blood vessels and bulging with fever and pain |
|
|
Serous Otitis Media
|
An effusion in the middle ear resulting from incomplete resolution of acute otitis media or obstruction of the eustachian tube. This condition is usually chronic and the fluid is AMBER with bubbles. Retracted eardrum
|
|
|
Vertigo
|
An abnormal sensation of rotary movement associated with difficulty in balance, gait, and navigation of the environment. Dizziness
|
|
|
Menieres Disease
|
Endolymphatic hydrops
Recurrent prostrating vertigo, sensory hearing loss (deafness), tinnius (ringing) and a feeling of fullness in the ear |
|
|
Benign Paroxysmal Positional Vertigo
|
A brief episode of vertigo brough on by a change of head position
Dx by the Dix Hallpike Manuever (pt moves from a sitting to supine position with the head turned to 45 degrees to the left and wait 30 seconds then repeat on the right side, if nystagmus is seen or nausea or vertigo then its positive |
|
|
Acoustic Neuroma
|
Benign tumor of CN 8 called a scwannoma
Hearing loss, tinnitus, vertigo and presence of tumor on CT or MRI |
|
|
Eustachian Tube Block
|
Retraction of the tympanic membrane
No amber fluid with bubbles Dx with serous otitis media |
|
|
Viral rhinitis
|
Nasal mucosa appears red and swollen with a clear runny nose
|
|
|
Allergic rhinits
|
Nasal mucose appears pale or blue and boggy
|
|
|
Atrophic rhinits
|
Thinning of the nasal mucose with sclerosis, crust formation and foul odor
|
|
|
Polyps
|
Typically occu as a consequence of chronic inflammation of the nasal mucosa. Grape like lesions with watery discharge
|
|
|
Angular Stomatitis AKA Cheilosis
|
Red sores at the corner of the mouth that are referred to as angular cheilitis/stomatitis. Can be caused by a Vitamin B2 (riboflavin) deficiency
|
|
|
Candidiasis AKA Thrush
|
Thick white fungal patches that are easily scraped off
|
|
|
Leukoplakia
|
Pre cancerous lesion of white patches that are adherent to the surface and not easily removed
|
|
|
Atrophic Glossitis
|
A deficiency of B Vitamins or iron that causes the tongue to appear smooth and glossy
|
|
|
Fissured Tongue AKA Scrotal Tongue
|
Deep furrows on the surfgace of the tongue that is considered a normal variant
|
|
|
Kaposis sarcoma
|
Around the mouth caused by the herpes virus
|
|
|
Giagantism
|
Excessive production of the growth hormone prior to skeletal maturation
Pituitary gland problem |
|
|
Acromegaly
|
Excessive production of growth hormone beginning the middle age. Results in abnormal growth of the hands, feet and facial bones. After ossification.
Pituitary gland problem |
|
|
Hyperthyroidism
|
M/C caused by Graves disease (autoimmune) TSH production is decreased and the thyroid hormones T3 and T4 are produced in excess
Weight loss with increased apetitie Irritable and nervous Intolerance to heat Moist skin and fine hair Exophthalmos Possible neck swelling due to goiter Increase in T3/T4 and decreased TSH The thyroid is working too hard and TSH decreased |
|
|
Hypothyroidism
|
Myxedema
Hashimotos thyroiditis is the most common cause in the US Congential hypothyroid is called cretinism and cauess a diminished physical and mental capacity Weight gain with decreased appetite Depression, weakness, and fatigue Intolerance to cold Coarse, dry hair and skin Periorbital edema Macroglossia and loss of lateral 1/3 eyebrows Decreased T3 and T4 and increased TSH |
|
|
Primary thyroid problem
|
lack of thyroid hormone is due to increased TSH production
Thyroid gland problem |
|
|
Secondary thyroid problem
|
due to lack of TSH and T3 and T4
Pitutary gland problem |
|
|
Common Migraine
|
Childhood and early adulthood
Females U/L or B/L photophobia Throbbing Worse behind one eye Nausea/vomitting Decreasing with advancing age and pregnancy Bright light, chocolate, cheese, tension, red wine, sound, stress, menstrual cycle |
|
|
Classic Migraine
|
Same as the common migraine except U/L with an aura aka prodromal event
|
|
|
Hypertensive headache
|
Adult
Occipital Vertex Throbbing You wake up with a headache before the alarm goes off Laying down produces too much blood in your head and stress intensifies Blood pressure is elevated do a lipid profile |
|
|
Cluster headache
|
Adolescnet to adults
Males college age U/L Orbital Temporal Wake up at night with a h/a that lasts 15-180 minutes. Not aggravated by eertion, rhinorrhea, facial sweating, red eye, miosis Eye tears on one side and nose runs on one side Alcohol usually occurs together in clusters Seasonal Sympathetic overload with sym decline |
|
|
Muscular tension
|
Any Age
Band like Pressure, muscle tightness Fatigue, tension, stress, work Worse as the day progresses |
|
|
Temporal Arteritis
|
Giant Cell
Over 50 year old women Persistent burning, aching, throbbin Polymalgia rheumaticia Scalp sensitive, tender arteries Hurts when the hair is combed or laying down ESR elevated, do a biopsy |
|
|
Cervicogenic
|
AKA Vertebrogenic
Seen in an adult Occipital Upper cervical Often daily, decreased ROM in upper cervical and occiput, pain in neck referred to the head Head movement makes it worse because of abnormal mechanics Do F/E views to see a hemivertebra pathology with is a congenital fusion |
|
|
Sinus
|
Any age
Localised changes with body position Steady throb, local tenderness, worse in the AM or flexing forward at the waist Chronic sinutsitis |
|
|
Subarachoid hemorrhage
|
Any age
Basilar area due to a vessel bursts Abrupt onsent, constant stiff neck, excruciating pain like never before experienced HTN Stress make worse HBP Fever Refer out |
|
|
Subdural hematoma
|
Any age
Slow bleed following a trauma Symptoms are evident for days-weeks post injury Slurring Trauma Send to ER |
|
|
Brain Tumor
|
Any age
Any place and changes with body postion Onset morning and evening Mild to severe, throbbing, neck stiffness worse than ever, progressively worse Tumor growth Relentless Consider METS too |
|
|
Meningeal irritation
|
Any age
Stiff neck Intense, deep pain, single episode Worse in flexion Kernig Brudzinski Birkele positive CSF tap |
|
|
Hypoglycemic
|
Generalized
Loss of apetitie due to stress Skipping meals Fbs |
|
|
Post concussive
|
Any age
Localized general pain Loss of memory, visual disturbances Loss of consciousness Fall MVA Whiplash injury Trauma Refer to neurologist/ER |
|
|
Bacterial meningitis
|
Bacteria in SCF, WBCs fight infection in the blood
|
|
|
Barrel Chest
|
AP= Lateral Diameter 1:1 ratio
Seen with COPD and CF |
|
|
Pectus Excavatum
|
AKA Funnel chest
Marked depression noted in the sternum (sunken in) |
|
|
Pectus carinatum
|
AKA Pigeon Chest
Forward protrusion of the sternum like the keel of a ship |
|
|
Tachypnea
|
Rapid shallow breathing
|
|
|
Bradypnea
|
Slow breathing
|
|
|
Biots Breathing
|
Characterized by group of quick, shallow inspirations followed by irregular periods of apnea (no pattern)
|
|
|
Cheyne Stokes Respiration
|
Breathing pattern characterized by alternation periods of apnea and hyperpnea (has pattern): Respiratory acidosis (diabetes uncontrolled)
|
|
|
Kussmauls
|
Breathing is first rapid and shallow but as metabolic acidosis worsens, breathing gradually becomes deep, slow, labored and hasping, "Air hunger breathing"
|
|
|
Pitted nails
|
Injuinal indentations seen with psoriasis so also look for silver scales on the skin
|
|
|
Splinter hemorrhage
|
Subacute bacterial endocarditis (strep organism)
|
|
|
Beaus lines
|
Transverse ridging associated with acute severe disease
|
|
|
Paronychia
|
Inflammation of the nail fold near the cuticle
|
|
|
Clubbing Nail
|
Nail base has an angle > 180 degrees and may indicate hypoxia or COPD
Chronic lung problems |
|
|
Koilonychia
|
Spoon nail
Iron deficiency anemia Concave presentation |
|
|
Respiratory Excursion
|
Place hands over the posterior ribs and have the patient take a deep breath
|
|
|
Tactile fremitus
|
Palpable vibration: have the pt say 99
Increased with fluid Decreases with asthma, atelectasis, emphysema, pleurisy and pneumothroax Normal with your bonchs (bronchitis, bronchtieasis) Increases with pneumonia |
|
|
Percussion tones
|
Resonate/Normal: Asthma, bronchietasis, bronchitis
Hyperresonant/Increase air in the chest: emphysema, pneumothorax Dull/Increased density: pneumonia/atelectasis |
|
|
Diaphragmatic Excursion
|
Dr asks the patient to exhale and hold it and starts percussing the pts back until the dr hears a sound change form resonant to dull, the dr then marks that spot. then the dr asks the pt to take a deep breath in and hold it then does the same thing again and marks it. If it is less than 3-5 cm the patient may have pneumonia or a pneumothorax in which case you should order imaging.
|
|
|
Vesicular breath sounds
|
I longer then E
base of the lung |
|
|
Bronchovesicular and Tracheal breath sounds
|
I=E
Bronchovesicular is anterior 1-2 ribs post between scap at apex Tracheal is over the trachea in the neck |
|
|
Bronchial breath sound
|
E is longer then I
Over manubrium |
|
|
Bronchophony
|
If clear distinct sounds are heard as the patient says 99... consolidation is present
|
|
|
Egophony
|
If you hear "aaaaa" as the patients says "eeee" consolidation is present
|
|
|
Whispered pectoriloquy
|
If the words 1, 2, 3 are heard clearly and distinctly consolidation is present
|
|
|
Bell
|
Low
|
|
|
Lobar Pneumonia
|
Consolidation of the lung
1. Consolidation 2. Red Hepatization 3. Gray Hepatization 4. Resolution Productive cough Rusty brown sputum Possible fever Silhouette sign Air Bronchogram |
|
|
Friedlanders pneumonia
|
Curreant red jelly and caused by klebsiella pneumonia seen with old age or immunocompromised hosts
|
|
|
Pneymocystis Carinii
|
Caused by yeast/fungus.
Most commonly seen in AIDS patients |
|
|
Cytomegalovirus
|
Caused by CMV Most commonly seen in AIDS patients
|
|
|
Tuberculosis
|
caused by myobacterium tuberculosis
presents with low grade fever, night sweats, productive cough, yellow/green sputum, small white lesions called ghon lesions seen on cray starts in the apices of the lung with crackers in the upper lobe. Tine test or Mantoux test Purified protein derivative Most definitive test for Dx is sputum culture Youll see military spots in the lungs |
|
|
Pleurisy
|
Inflammation of the pleura usually producing an exudative pleural effusion and stabbing chest pain worsened by respiration and cough. Dry non productive cough
Friction rub is present with decreased breath sounds + Schpelmanns Test |
|
|
Pneumothorax
|
A ruptured lung causing air to become trapped in the pleural space
Decreased chest expansion Decreased breath sounds Can occur in young previously health individuals U/L darkening of the chest due to collapse of the lung Tracheal shift away from the lesion |
|
|
Atelectasis
|
Collapse of the lung that is usually the result of bronchial obstruction due to a mucous plug
Decreased chest expansion Decreased or absent breath sounds On the xray the collapsed lung will display increased density and mediastinal shift towards the affected side (PULLS IT CLOSER) |
|
|
Bronchiectasis
|
Irreversible focal bronchial dilation that presents with a chronic productive cough
CT is necessary to dx/confirm |
|
|
Chronic bronchitis/COPD
|
Defined by long term cough with mucus, shortness of breath and wheezing. Cigarette smoke is the main cause. Long exposure to other things such as chemical fumes, dust and other substances may cause this.
|
|
|
Asthma
|
Bronchospasm constricting airways. Type 1 hypersensitivity reaction that is usually triggered airborne alergens
Presents with tachycardia, tachypnea, wheezing, eosinphils and IgE rise. Labs: Curshmanns spirals and charcot Laden Crystals from the IgE |
|
|
Emphysema
|
Too much air in the lung
Destruction of elastic pulmonary connective tissue results in permanent dilation of the alveoli air sacs and caused by a deficiency of alpha 1 anti trypsin Decreased breath sounds and prolonged expiratory wheeze likely. Fluid will first accumulate in the costophrenic recesses Xray: B/L darkened lung field with narrowed compressed hear horizontal ribs, flattening of the diaphragmatic domes, clubbing of the nails, coughing up blood and bareel chest |
|
|
Bronchogenic carcinoma
|
Primary malignant lung tumor that starts in the area of the bronchus. Long term history of smoking (20-30 years) coughing, non productive more than 30 days, afebrile, dyspnea, weight loss and clubbing of the fingernails
|
|
|
Costochondritis
|
Inflammation of the cartilage connection between the ribs andsternum. It develops as a consequence of physical activity and is worse with exercise. The pain increases while taking a deep breath. There will be aplpable tenderness at the costosternal articulation. B/L regional
|
|
|
Tietze Syndrome
|
Inflammation and swelling in 1 rib only, usually secondary to infection U/L
|
|
|
Herpes Zoster
|
AKA Shingles
Painful rash following the ourse of a dermatome, usually a single nerve. Primarily involves the dorsal root gangion but when it does involve CN it is most commonly CN5 on one side of the face |
|
|
Sarcoidosis
|
Is a disease in which abn collection so finflammatory cells (granulomas) form as nodules
Most often appear in the lungs of lymph nodes M/C seen in african descent in the US Xray: B/L hilar lymphadenopathy |
|
|
Hodgkins
|
Cancer of the lymphatic system that can spread to the spleen
M/C seen in young caucasian males (30 yo) Presents with fever, night sweats, weight loss, intense pruritis (release of IgE) and enlarged spleen Best dx from biopsy looking for Reed Sternberg cells Xray U/L hilar lymphadenopathy Anterior body scalloping, ivory white vertebra w/o enlargement |
|
|
Cystic Fibrosis
|
Chronic progressive and freuently fatal genetic inherited disease of the bodies mucus glands an abnormality in the glands that produce or secrete sweat and mucus. Loss of excessive amounts of salt. Thick accumulations of mucus in the intestines and lungs. COPD barrel chest, pancreatic insufficiency meconium ileus
Baby with salty tears Dx with sweat test |
|
|
Jugular Venous Pulsations
|
Measure the pressure of the right side of the heart. Can be made more pronounced when CHFis present by applying pressure to the liver (hepatojuglar reflex)
|
|
|
Pulsus Magnus
|
Bounding
Increased CO exercise, anxiety, fever, hyperthyroidism |
|
|
Pulsus Parvus
|
weak or thready
Decreased SV, hypovolemia, aortic stenosis, CHF |
|
|
Pulsus Alterans
|
Alternates in amplitude
Left ventricular failure |
|
|
Pulsus Bisferiens
|
Two strong systolic peaks sperated by mid systolic dip
Best felt at carotid artery sometimes signifying aortic regurgitation and aortic stenosis |
|
|
Pulsus paradoxus
|
Decreasd amplitude on inspiration, increased with expiration over a 10 mm HG amplitude change
COPD Bronchial asthma, emphysema pericardial effusion |
|
|
Water Hammer Pulse
|
A jerky pulse that is rapidly increasing and then collapsing because of aortic insufficiency
|
|
|
Thrills
|
Vibration produced by turbulent blood flow within the heart (murmurs)
|
|
|
When the ventricles contract its called
|
systole this is hte top number in a blood pressure reading
|
|
|
When the ventricles relax its called
|
diastole this is the lower number in a blood pressure reading
|
|
|
S1
|
Closure of the AV (mitral and tri) valves
|
|
|
S2
|
Closure of SL (pulmonary and aortic) valves
|
|
|
S3
|
Ventricular gallop this is normal in children young adults and athletes but if you are over 40 this is a sign of CHF
|
|
|
S4
|
Atrial gallop
Similar to S3 and is related to stiffness of the ventricular myocardium to paid filling use an ECG to evaluate |
|
|
Draw out locations for cardiac auscultation
|
A PET M
A- 2nd right intercostal (patient seated, leaning forward and exhaling) P- 2nd left intercostal E- 3rd left intercostal (Where you can hear the heart the best) T- 4th or 5th left intercostal M- 5th intercostal midclavicular line best heard in the left lateral decubitus position |
|
|
Stenosis
|
Valve has trouble opening and the blood swirls thrugh a narrow opening. This murmur has a low pitch and is best heard with the bell of the stethoscope
|
|
|
Regurgitation
|
Valve is insufficient and blood seeps or squirts back into the chamber. This murmur has a high pitch and is best heard with the diaphragm of the stethoscope
|
|
|
What is the mnemonic for heart murmurs
|
ARMS and PRTS
This is for diastole and is opposite for systole. It is more clinically significant to have murmurs in diastole because that is when there is no pressure on the heart. |
|
|
What is Patent Ductus Arteriosus?
|
Failure of the shunt to close between the aorta and left pulmonary artery. This creates a continuoous machinery like murmor that can be heard in both phases of the heart cycle
|
|
|
Tetralogy of Fallot
|
Detraposition of the aorat, right ventricular hypertrophy, Interventricular septal defect, and pulmonic stenosis. Creates a loud ejection murmur during sstole and severe cyanosis
|
|
|
Coarctation of the Aorta
|
Constriction of the descending aorta usually distal to the left subclavian that causes higher blood pressure in the upper extremity by 20 mmhg (diagnostic) when compared to the lower extremity. Commonly associated with Marfans syndrome
|
|
|
Left sided heart failure
|
M/C cause of left sided heart failure is HTN (35-55) this is from the lung to the body.
The 2nd m/c cause is aortic stenosis Early signs are pulmonary edema (fluid in lungs) causing shortness of breath, exertional dyspnea-- first sign of heart failure and orthopnea (difficulty in breathing that is relieved in the upright position Fluid collects first at the costophrenic angles Lung problems= L Sided problems |
|
|
Right sided heart failure
|
From body to the lungs accumulates in the veings to cause right sided problems
Most Common cause is left sided heart failure (arteriosclerosis) M/C cause of mitral stenosis is rheumatic fever (ASO-titre) Cor Pulmonale is when the right side fails by itself because the lung condition that causes right sided heart failure. Basically its a lung condition associated with a problem in the heart. This backs up to SVC and IVC and leads to edema and fluid in the extremities, jugular venous distention, liver/spleen enlargement and a positive hepatojugual reflex, stasis dermatitis (late sign of CHF) ascites (fluid in the abdomen by partial HTN) caput medusa, spider angioma, piutting edema (late stages) increased heart rate, S3 gallop and decreased blood pressure, Jugular venous pulsations are caused by backup of blood if present while supine and seated. |
|
|
The largest vein in the body is..
|
portal vein
|
|
|
What is aortic dissection
|
An interruption of the intima allowing blood into the vessel wall with immediate tearing pain. Acute surgical emergency. Associated with HTN/Arteriosclerosis (descending aorta) and Marfans (ascending aorta). Marfans has a ventricular weakening and enlargement. Patient presents with spider like fingers, tall stature and subluxation of the lens.
L2 is m/c area to look Refer out |
|
|
What is angina pectoris-coronary vasospasm
|
Comes on with exertion
Printzmetal angina comes on with rest (atypical) Relieved by vasodilators under the tongue (usually nitroglycerin) |
|
|
Myocardial infection
|
Acute heart failure that comes on with rest and is caused by atherosclerosis
CK-MB is elevated Increased SGOT Increased LDH Doesnt go away and has absent pulses everywhere |
|
|
Aneurysm
|
Abn widening that involves all 3 layers that causes a defect in elastic media tissues
|
|
|
Increased PR Interval
|
Prolonged AV nodal delay
Primary heart block |
|
|
Two P Waves before QRS
|
Weinkbochs-block of bundle of HIS
Secondary heart block |
|
|
No QRS
|
Complete heart block
No ventricular contraction Atrial repolarization is hidden under QRS complex |
|
|
ST segment enlargement or inverted
|
MI
|
|
|
Inverted T wave
|
Ventricular fibrillation
|
|
|
P
|
Atrial depolarization
|
|
|
QRS
|
Ventricular depolarization
|
|
|
T
|
Ventricular repolarization
|
|
|
Echocardiogram
|
Used to detect murmurs
|
|
|
Early intestinal obstruction bowel sounds
|
increased
|
|
|
Late intestinal obstruction bowel sounds
|
Absent
Adynamic paralytic ileus |
|
|
Hematemesis
|
Vomitting up blood
Stomach cancer |
|
|
Hemoptysis
|
Coughing up blood
Lung cancer |
|
|
Hematochesia
|
Blood in stool
Colon Cancer |
|
|
What is the order of palpation for the abdomen?
|
Inspection, Auscultatoin, Percussion, Light palpation and Deep palpation
|
|
|
What is jaundice?
|
Yellowing of the skin, sclera, and mucous membranes. They can occur with any liver disorder
|
|
|
Cirrohosis
|
Alcoholism is the most common causes of liver destruction. Causes protal hypertension, ascites, esophageal varices, Marllory Weiss syndrome (coughing, tearing esophageal blood vessels and hematemesis) and palmar rash due to bile salts
Thiamin deficicency without alcoholism is beri beri In the brain wernicke kosakoff syndrome (hiamin deficiency leading to dementia) |
|
|
Hepatitis in general
|
this is when the liver may be tender and enlarged but the edge remains soft and smooth
|
|
|
Hepatitis A
|
from FOOD through fecal/oral route self limiting not a carrier
|
|
|
Hepatitis B
|
Dirty needles and sexual contact
Carrier for life M/C to become liver cancer |
|
|
Hepatitis C
|
Blood transfusions
|
|
|
Liver cancer
|
M/C site for metastatic disease. Liver will be enlarged with a hard and irregular border.
Alpha fetoprotein is a tumor marker specific for hepatocellular carcinoma Liver biopsy is performed for definitive dx |
|
|
Direct/Conjugated Bilirubin
|
Liver- gallbladder (storage)-common bile duct- small intestine (digestion)
Water soluble Increases with duct obstruction (gallstones), hepatic disease, pancreatic cancer Increased amounts in the blood may cause bilirubin in the urine (urobilinogen) |
|
|
Indirect/Unconjugated Bilirubin
|
Made in RBC- spleen- liver to be conjugated
Not water soluble Increases with hemolytic disease, drugs, and spleen disorders Hemolytic anemia- increase in reticulocyte count (coomb test) Increased amounts in the blood may cause increased urobilinogen in the urine. |
|
|
Gallbladder
|
Pain referral to the right should ot tip of the right scap
Viscerosomatic |
|
|
Cholecystitis
|
M/C seen in overweight females over the age of 40
M/C cause is cholelithiasis (stone) Severe right upper quad pain, nausea, vomitting, and precipitated by eating a large fatty meal Dx: US oral cholecystogram, Murphys SIGN inspiratory arrest sign |
|
|
Porcelain Gallbladder
|
Calcification that can become malignant due to chronic inflammation
|
|
|
Pancreatitis
|
Epigastic pain going straight through the the back of T10-T12 area like a knoe
Viscerosomatic Chronic is seen with alcholism Acute is a 911 ER Grey Turner sign: bleeding into the flank Cullens Sign: periumbilical ecchymosis (around the belly button) Lab tests: increased amylase and lipase |
|
|
Pancreatic Cancer
|
Usually at the head of the pancreas.
Presents with dark urine, clay colored sools and jaundice |
|
|
Diabetes Mellitus
|
A condition in which he pancreas does not produce a sufficient amout of insulin to take the sugar out of the blood and transport it to the tissues of thebody. These starved tissues for force the breakdown of fats in order to obtain energy. Polydypsia, polyphagi and polyuria is seen
Labs: GTT, FPG, HbA1C 30% correlation between DISH aka Forrestiers Disease and Diabetes Mellitius Labs: GTT, Fasting |
|
|
Insulin Dependent DM
|
Juvenile Type 1 under 30 and usually thin
|
|
|
Non-Insulin Dependent DM
|
Adult Type II usually over 40 and obese
|
|
|
Diabetes Insipidus
|
Condition of the posterior pituitary gland in which there is insufficient ADH. May have polydypsia, polyuria but NOT polyphaghia
|
|
|
Bilirubin life cycle
|
Its born in the RBC (unconjugated/indirect and not water soluble) at 120 days RBC goes to the speen, its opened and recycled then goes to the liver and becomes conjugatged where it is then stored in the gallbladder, to the common bile ductm then to small intestine to aid in fat digestion
|
|
|
Are gallstones conjugated or not?
|
Yes
|
|
|
Is hemolytic anemia conjugated or not?
|
Not
|
|
|
If there is a mixture of conjugated and unconjugated bilirubin in the blood what does this mean?
|
Liver problem
|
|
|
If there is urobilinogen in the urine what does this mean?
|
That there is an increase of indirect and unconjugated bili in blood
|
|
|
Pancreatic cancer and bili
|
increase in direct/conjugated bili and increase in amylase and lipase
|
|
|
Hiatal Hernia
|
protrusion of the stomach above the diaphragm and cardiac angle. Present with a palpable tenderness in the LUQ refkex esiphagitis (acid reflux), dyspepsia (indigetsion), made worse after eating a large meal or when lying down
|
|
|
Reflex esophagitis
|
Upward reflex of acid contents of the stomah into the esophagus. This is caused by a sliding hiatal hernia and is worse when lying down after a big meal, valsalva or bearing down. Tests: Xray or upper GI series Pain while eating that becomes constant
Barretts esophagus: destruction of the esophagus due to reflux esophagitis (precursor to esophageal cancer) |
|
|
Peptic Ulcers
|
Includes gastric and duodenal ulcers caused by H Pylori bacteria coffee ground emesis burnging epigastic pinpoint pain
|
|
|
Gastric Ilcer
|
Has no consistent pain pattern. Sometimes food causes the pain and other times it relieves the pain. Sit down to eat and pain begins before eating
|
|
|
Duodenal ulcer
|
Pain occurs 2 hours after eating, black tarry stool. Most common type of peptic ulcer.
GUAIAC test: occult blood in the stool for upper GI bleeding |
|
|
Pyloric stenosis
|
Projectile vomitting in the newborn
|
|
|
Stomach cancer
|
M/S on the lesser curvature and affects the L supraclavicular lymph node (virchows node) most drastic weight loss
|
|
|
Mono
|
Caused by the Epstein Barr Virus and is seen in the young adults ages 18-25 years
Present with symptoms similar to the flu such as fever, headache, fatigue, lymphadenopathy in the cervical region, splenomegaly, sore throat Atypical lymphocytes in the blood (Downey cells) Mono spost AKA Heterophile agglutination AKA Paul Bunnell Test |
|
|
Osteopetrosis
|
Marble bone
Extra medullary portion on the bone marrow A systemic metabolic condition that involves every bone. The bone marrow becomes sclerotic so red blood cells arent made The liver and spleen make RBCs and become enlarged |
|
|
Referral of pain for Small Intestines..
|
Peri-umbilical and can cause malabsorption
|
|
|
Adynamic Ileus
|
Lack of motion with gas in the intestines
|
|
|
Regional Ileitis AKA Crohns Disease
|
Right side of the intestines
Nonspecific inflammatory disorder that affects distal ileum and colon No blood, no fever Inflammation is patchy with healthy tissue between the patches which is referred to as a cobblestone appearance. Do not absorb B12 due to location of the problem Presents with RLQ pain, chronic diarrhea Leads to malabsorption syndromes: Non Tropical Sprue/Celiac Sprue (Gluten allergy) DX with sigmoidoscopy +HLA-B27 Autoimmune arthritides |
|
|
Ulcerative Colitis
|
Left side of the intestines
Most common at the colon and rectum Present with bloodmucous in diarrhea and fever Bacterial infection can enter the blood Can lead to sacroilitis (enteropathic arthrpathy) Sigmoidoscopy |
|
|
Irritable Bowel Syndrome
|
AKA Spastic Colon
Variable degrees of constipation and diarrhea in response to stress Seen more commonly in females Abdominal pain and gas relieved by bowel movements |
|
|
Appendicitis
|
Dull periumbilical pain that radiates to lower right quadrant
Presents with fever, nausea, comitting and anorexia Increased WBC (shilling shift to the left) Neutrophil with bacterial infection Tests: Mcburneys point, rebound tenderness-peritonitis, Rosvings sign, Psoas sign, Obturator sign Special test is CT scan |
|
|
Diverticulitis
|
Older patient
Consequence of inadequate fiber in the diet Chronic constipation causes small outpouchings within colon that become infected LLQ pain Meckels diverticulitis: outpouching of Ileum Zenkers diverticulitis: outpouching of the esophagus |
|
|
Carcinoid Syndrome
|
Intestingal cancer that spreads to the liver and causes skin cancer darkening)
|
|
|
Cushings disease
|
Increased production of adrenal cortex hormone: hyperadrenalism (epi/nor), hypercortisolism
Moon face, pie face, buffalo hump, pendulous abdomen with purple striae, hirsutism, weakness and HTN Redistribution of fat (truncal adiposity) |
|
|
Addisons disease
|
Decreased aldosteron, hypoadrenalism, hypocortisolism
Increased ACTH causes melanin deposition Thin person, decreased blood pressure, hyperigmented mouth and face, weakness, fatigue, lethary, nausea, and vomitting, hair loss DDx for bronze: bronze diabetes- hyperchromatosis |
|
|
Pheochromocytoma
|
Grey Cell Tumor of the Adrenal Medulla
Increased epi production (catecholamine) Will cause tachycardia, jitters and extreme HTN. S/S are similar to hyperthyroidism |
|
|
Nephrolithiasis
|
Made of calcium caclium oxalates are the most common
Back pain radiating into the groin (ureter stone) Pain is writhing pain fever Murhpys PUNCH Evaluate by increased BUN uric acid creatinine clearance KUB study UA reveals hematuria (cut ureters so could have infection) blood in the urine, ammonia in cuts Staghorn calculi= most common causeis hydronephrosis due to kidney stones |
|
|
Acute Glomerulonephritis AKA Nephritis syndrome
|
Caused by group A hemolytic strep (strep pyogenes-ASO titre) Anti streptolysin O
RBC casts in urine with small amount of protein |
|
|
Nephrotic syndrome
|
Kidneys stopped filetering
HEP: HTN Edema massive Proteinuria: waxy or fatty casts in urine In pregnant women is called pre eclampsia |
|
|
Pyelonphritis
|
E coli from UTI
WBC casts |
|
|
Polycystic kidney disease
|
Inherited disorder characterized by man bilateral renal cysts that increase renal size but reduce functioning renal tissue
|
|
|
Urethritis
|
Caused most commonly by E Coli in females and N Gonorrhea in males
Nitrites in the urine |
|
|
Cystitis
|
Noninfectious bladder inflammation that causes burning painful and frequent urination with incontinence. Patient will also have suprapubic and low back pain
|
|
|
Nephroblastoma
|
AKA Wilms Tumor
Malignant tumor of the kidney Less than 5 years of age Abdominal mass Hematuria |
|
|
Urinary Incontinence
|
Urge- often called overactive bladder. The urgent need to get to the bathroom
Stress- an increase in abdominal pressure such as exercise, cough, sneeze, laugh. Due to weakness pelvic floor muscles Overflow- If you are not able to completely empty your bladder when you urinate. As a result you have a constant or frequent dribble of urine |
|
|
Indirect inguinal hernia
|
M/C type
This hernia passes down the inguinal canal and exits at the external inguinal ring and into the scrotum. Often in children, may be in adults |
|
|
Direct inguinal hernia
|
from lifting, does not pass through the inguinal canal but exits directly through the external inguinal ring instead. It is usually acquired from obesity or heaving lifting.
This hernia is felt when the patient coughs or bears down |
|
|
Femoral hernia
|
Not an inguinal hernia. It appears as abulge lateral and inferior to the external inguinal ring at the site of the femoral pulse
|
|
|
Endometriosis
|
Abnormal endometrilatissue found outside its normal location (i.e. myometrium, fallopian tubes and peritoneum. M/C found in the ovaries. Laparscopy
Presents with abdominal pain, back pain, menorrhagia, painful intercourse and possible infertility |
|
|
Uterine Fibroids
|
Benign uterine tumors of smooth muscle origin Leiomyoma
Present with heavy mentrual bleeding, pelvic pain, painful intercourse. Uterus will have painless nodules that are irregular and firm |
|
|
Pelvic inflammaotry disease
|
An infection of the upper female gintal tract. It is the most common complication of an STD usually chlamydia or gonorrhea. Includes salpingitis (inflammation of the fallopian tubes)
|
|
|
Ectopic pregnancy
|
preg. in which implantation occurs outside the endometrium/endometrial cavity
Presents with spotting, decreased BP, decrease in HCG (initially HCG increases and then decrease) |
|
|
Normal pregnancy
|
OIncrease HCG, nausea, weight gain and breast tenderness
Blood test- HCG |
|
|
Hydatiform Mole
|
A non viable embryo which develops in the placenta and presents with all the signs of pregnancy very high HCG
|
|
|
Choriocarcinoma
|
A malignancy of the placenta due to abnormal eqithelium cancerous placenta
|
|
|
Fibrocystic Breast Disease
|
Multiple round freely movable masses can be palpated. B/L breast tenderness that is made worse with caffeine intake, ovulation or menses Increase in FSH
|
|
|
Fibroadenoma
|
M/C benign breast tumor. Usually under 30 years non tender singular lump 75% U/L
|
|
|
Breast cancer
|
2nd M/C cause of cancer death in women, M/C over 50 years old and in the upper outer quardrant. Present with nipple retraction, bleeding, orange peel appearance and dimpling (pagets disease of the breast). Metastasis to axilla via the lymphatic system and will most likely by litic when seen in the bone
|
|
|
Varicocele
|
Tortuous dilation of the spermatic veins "bag of worms" feeling upon palpation that diminshes from standing to supine
|
|
|
Spermatocele
|
A fluid filled mass in the epididymis. It is a painless, moveable, pea sized lump located superior and posterior to the testicle. Its transilluminates light because it is fluid filled
|
|
|
Hydrocele
|
Excess accumulations of water in the testicle. It feels swollen, painless, heavy and tight. The ability to palpate above the mass distinguishes it from a scrotal hernia. It transilluminates
|
|
|
Epididymitis
|
Usually a consequence of an STD. The scrotum is enlarged and tender but tenderness may be relieved somewhat by raising the testicle
|
|
|
Testicular Cancer
|
M/C form of a cancer in males age 20-34 Painless nodule appears on or in the testicle. Most common type is a seminoma. Does not transilluminate light Refer out.
|
|
|
Benign Prostatic Hyperplasia
|
Enlarged, non tender firm, smooth with loss of median sulcus
|
|
|
Prostatitis
|
Boggy soft enlarged and tender. Urinary problems such as increased urgency
|
|
|
Prostatic carcinoma
|
Posterior lobe is hard, nodular, painless and enlarged. M/C place to metastasize is to the lumbar spine via Batsons Plexus
Increase PSA Acid Phophatase Alkaline Phosphatase |
|
|
Orchitis
|
inflammation of the teste caused by mumps
|
|
|
Paraphimosis
|
Foreskin trapped behind the glans penis and cannot be pulled back to its flaccid position because its stuck in retraction
|
|
|
Testicular Torsion
|
Gangrene in testes
Sports injury |
|
|
What are the characteristics of an artery problem?
|
Cool temp
Pale/blue Weak or absent pulse Numbness No swelling Raynauds phenomenon is present Thin skin |
|
|
What are the characteristics of a venous problem?
|
Warm temperature
Normal or discolored skin color Normal pulse Swelling is present Stasis dermatitis Valve incompetence |
|
|
Explain neurogenic claudication.
|
Not a predictable pattern
Position related and seated with flexion DJD Spinal Canal Stenosis |
|
|
Explain vascular claudication
|
Predictably reproducible
Always gets relief with rest Arterisclerosis and Buergers |
|
|
What tests can test for claudication?
|
Claudication time like when a patient walks at a rate of 120 steps/minute for 1 minute and if there is pain in the calves is positive
Bicycle test: Patient pedals fast until painful, rest until painless, repeat pain in the calves is positive for vascular claudication Stoop Test: Walking causes the pain, stooping or flexion relieves it, positive pain the legs is neurogenic claudication |
|
|
What is intermittent claudication?
|
Pain appears while walking and disappears after rest
|
|
|
What can cause ulcerations of the feet and ankles?
|
Stasis dermatitis and diabetes
|
|
|
What is Buergers?
|
Its known as thromboangitis obliterans
Its seen in 20-40 year old males and is associated with excess tobacco smoking. It presents with intermediate claudication, non healing ulcers and gangrene. Test with claudication time and buergers test |
|
|
What is Raynauds?
|
This is seen in patients over 15 years of age. This disease is associated with Buergers, collagen disease and scleroderma. Raynauds phenomena is brought on by cold, stress or emotion. Presents with arterial spasms, triphasic color changes (white-pallor blue-cyanosis red-rubor) finger tip ulcers, gangrene, and cold senstivity.
Test: Allens test |
|
|
What is the difference between raynauds phenomena and raynauds disease?
|
Phenomenon: associated with other symptoms
Disease: Color change only |
|
|
What is an aneurysm?
|
Its an abnormal widening that involves all three layers of a vessel
|
|
|
What are varicose veins?
|
They are seen in patients over the age of 20 years old. It presents with incompetent valves, dilated tortuous channels. A positive test is perthes AKA tourniquest test where you put a tourniquet around the upper thigh of the patient and instruct them to exercise the leg for 60 seconds while noting prominence of varicosities if its positive the varicosities will distend and the patient will experience pain
|
|
|
What is deep vein thrombosis?
|
This present with tenderness, edema and pain and will have a red hot swollen calf. You can test with a positive homans where the patient is supine with the lef extended while the examiner raises the lef off the table to 45 degrees and dosiflexes the foot and squeezing the calf. Pain the calf is positive. A d dimer is a lab test
|
|
|
What is a pulmonary embolism?
|
Its a blockage of an artery in the lung by a substance that has teravelled from elsewhere in the body through the bloodstream (embolism). Usually this is due to a thrombus (blood clot) from the deep veins in the legs. Symptoms of pulmonary embolism include difficulty breathing, chest pain on inspiration and palpitations. The risk is increased in various situations, such as flying and prolonged bed rest. There is a history of clotting or risks include fracture, BC and smoking
|
|
|
What is reflex sympathetic dystrophy?
|
Its a chronic pain condition. The key symptom is continuous intense pain, sympathetic nervous system out of proportion to the severity of the injury, which gets worse rather than better over time. Typical features include dramatic changes in the color and temperature of the skin over the affected limb or body part accompanied by intense buring pain, skin sensitivity, sweating, and swelling. The pain is worse then original pain and ice helps but not much that can be done. Sudecks Atrophy is osteopenia of bone at the site of original injury and is associated by RSD
|
|
|
What is telengectasia?
|
It is small superficial dilated blood vessels. They can develop anywhere on the body but are commonly seen on the face around the nose, cheeks and chin. This is seen with CREST syndrome
|
|
|
What is petechia?
|
It is pinpoint hemorrhaging from local trauma
|
|
|
Explain the general tract from the heart that the blood takes to become oxygenated.
|
The right ventricle takes deoxy to the lungs where the blood is then oxygenated and then drops it off to the left atrium which in turn oushes it to the left ventricle where the oxygenated blood goes to the body and becomes deoxy where is goes to the right atrium and then gets dumped into the right ventricle
|
|
|
What is sickle cell anemia?
|
It presents with nucleated RBC's thats caused by Hgb S and is seen in 10% of African Americans
H Shaped vertebra with hair on end apparance in the skull |
|
|
What is thalassemia
|
Its Cooleys anemia AKA mediterranean anemia it presents with microcytic target cells that are caused by decreased beta chain synthesis and is seen in mediterranean, NBorth Africa and South East Asia
|
|
|
What is erythroblastosis fetalis?
|
Its caused by an Rh+ father and baby and an Rh- mother
|
|
|
What is megaloblastic anemia?
|
This is if a RBC is too big
Macrocytic normochromic B9/Folic Acid: Chronic alcholics, pregnancy malabsorption, used to prevent neural tube defects. B12/ cyanocobalamine deficiency: pernicious anemia: lack of IF due to chronic atrophic gastric mucosa causing a loss of parietal cells. Yuou can dx with shilling test which is a 24 hour urine test and treat with B12 shots. This can progress to become posterolateral sclerosis (PLS) of SC which is also known as combined systems disease with numbess and tingling in the extremities and stocking glove paresthesia with irreversible damage |
|
|
What is iron deficiency anemia?
|
Hypochromic microcytic
Seen with chronic blood loss and pregnancy Gastric and intestinal |
|
|
What is aplastic anemia?
|
This is normochomic normocytic
Panhypoplasia of the bone marrow with patelets. There is a decrease in all blood cells. This is seen with drugs, chemotherapy and radiation, Multiple myeloma, RA, leukopenia, acute blood loss, benzene poisoning and thrombocytopenia. There will be fatigue, H/A weakness, lethargy with a high risk of infection and bleeding. |
|
|
Straw colored urine
|
Normal
|
|
|
Red colored urine
|
Blood or food pigments (infection, cancer or food dyes)
|
|
|
Green colored urine
|
Biliverdin
Biliary duct obstruction, pseudomonas infection, bad protein digestion |
|
|
Blue colored urine
|
Diuretic therapy, pseudomonas infection, bad protein digestion
|
|
|
Brown colored urine
|
Bile pigments or blood
Biliary duct obstruction Occult blood Homogentisic acid |
|
|
Black colored urine
|
Homogentisic acid or urobilin
Ochronosis, hemolysis, bacteria |
|
|
Hazy or cloudy urine
|
epithelial cells, WBC's, RBC's crystal, sperm, microorganism
|
|
|
Milky colored urine
|
WBC's or fat
|
|
|
What is the normal pH of urine?
|
4-8
|
|
|
What is the specific gravity of urine?
|
1.01-1.03
Increases with bacterial infection, DM, and kidney abnormalities |
|
|
What causes glucose in urine to increase?
|
DM
Shock Head injury Pancreatic disease Renal Tubular disease The renal threshold is over 180 mg % |
|
|
What causes ketones to be present in the urine?
|
Starvation, DM, Weight loss diets, inadequate carb intake
|
|
|
What causes protein in the urine?
|
Kidney disorders, toxemia of pregnancy, DM, MM (Bence Jones Protein)
|
|
|
What is the normal level for urobilinogen?
|
.1-1 El unit/mL
This is increased with hemolytic disease or hepatic disease and decreased with biliary obstruction |
|
|
What is bilirubin increased with?
|
Hepatic diesease or biliary obstruction
|
|
|
What causes blood in the urine?
|
Tumors, cancer, trauma, kidney infection, kidneystones, hypertension, bleeding disorders
|
|
|
Hyaline casts
|
Normal
|
|
|
Epithelial casts
|
Tubular damage
|
|
|
RBC casts
|
Glomerulonephritis
|
|
|
WBC Casts
|
Pyelonephritis, E Coli, Gonorrhea
|
|
|
Waxy casts
|
Renal failure, nephrosis, nephrotic syndrome because the kidney stops filtering
|
|
|
Acid Phosphatase (PAP)
|
Increased with prostatic carcinoma and metastatic disease
|
|
|
Albumin/Globulin (A/G) Ratio
|
Reversed in Multiple Myeloma
|
|
|
Albumin
|
Increased in dehydration
Decreased in nephrosis |
|
|
Alkaline Phosphatase
|
Increased in osteoblastic lesions, hepatic disease and HPT
|
|
|
Amylase
|
Increased in acute pancreatitis
|
|
|
ANA (FANA)
|
Collagen disease (SLE, scleroderma) lupus, autoimmune
|
|
|
Antistreptolysin-A (ASO) titre
|
Increased in rheumatic fever and acute glomerulonephritis
|
|
|
Bilirubin
|
Increased: Direct- Hepatitis, Duct Obstruction and pancreatic cancer
Indirect- hemolytic disease, drug, spleen disorder |
|
|
BUN (Blood Urea Nitrogen)
|
Increased- Renal disease, dehydration, hypotension, urinary tract obstruction
Decreased: hepatic disease, pregnancy |
|
|
Calcium (Ca)
|
Increased: Muscle weakness, Hyperparathyroidism, Hypervitaminosis D, metastatic disease
Decreased: Muscle tetany, opposite from above, renal failure and malnutrition |
|
|
Carcinembronic Antigen (CEA)
|
Increased: Biliary tract obstruction, hepatitis
|
|
|
CPK (Creatine Phosphokinase)
|
CK BB: Brain Tissue
CK MB: Myocardial tissue- release after heart attack CK MM: Skeletal muscle Increased in Muscle Necrosis |
|
|
Creatinine
|
Increased is kidney disease and hypovolemic shock
Decreased in muscular dystrophies Best kidney function tests |
|
|
C-Reactive Protein (CRP)
|
Increased in tissue necrosis, infections, RA and inflammation
|
|
|
ELISA
|
Screening test for AIDS
|
|
|
Erythrocycte Sedimentation Rate
|
Increased with infection, RA, TB, temporal arteritis, MM
Decreased with sickle cell anemia, polycythemia Inflammation |
|
|
Fluorescent Treponema Rate (FTA)
|
Present with syphilis AKA Dark Field Microscopy
AKA DFM |
|
|
Glucose (Blood)
|
Increased: DM, Cushings, Renal/Liver disease
Decreased: Insulin overdose, addisons, starvation |
|
|
Glucose CSF
|
Decreased: Meningitis, Acute Pyogenic infections
|
|
|
Gamma-Glutamyl Transferase (GGT)
|
Liver cell dysfunction and alcohol induced liver disease
Alcoholic |
|
|
Glucose Tolerance Test( GTT)
|
Used for diabetes testing
|
|
|
Glycosylated Hemoglobin Hb-A1C
|
Tests ability to utilize glucose over 2-3 month period
Long term diabetes test |
|
|
Heterophile (Paul Bunnel)
|
Increased in Mono and viral meningitis
|
|
|
Human Chorionic Gonadotopin (HCG) Uterus
|
Increases with hydatidiform mole, choriocarcinoma, seminoma, multiple pregnancy, testicular teratoma
Decreased with ectopic pregnancy, threatened abortion |
|
|
Human Leukocyte Antigen Locus (HLA B-27)
|
Ankylosing Spondylitis, Reiters, PA, Enteropathic
|
|
|
HDL Cholesterol
|
Increased: low risk of coronary heart disease
Decreased: high risk of coronary heart disease Too much fat in the blood |
|
|
I- 131 Uptake
|
Increased: Hyperthyroidism, endemic goiter
Decreased: Hypothyroidism, thyroid cancer in young women |
|
|
Immunoelectrophoresis
|
MSpike indicates MM
|
|
|
Iron
|
Increased: Hemolytic diesease and acute liver problems
Decreased: Iron deficiency anemia, chonic blood loss |
|
|
Ketones
|
: Diabetic acidosis and starvation
|
|
|
Lactic Dehydrogenase (LDH)
|
Increased: MI, CHF, Muscular Dystrophy
Decreased: Cancer therapy |
|
|
Lipase
|
Ibncreased: Acute pancreatitis
|
|
|
Lipids (cholesterol)
|
Increased: Early starvation, DM
Decreased: Late starvation, liver disease |
|
|
Lipids (Triglycerides)
|
Increased: Hyperlipidemia, DM, Atherosclerosis
Decreased: Cirrhosis, malabsorption |
|
|
LE Cell
|
Active systemic lupus erythematosus
|
|
|
Phosphorus
|
Increased: Acromegaly, kidney disease, hypervitaminosis D
Decreased: Rickets, hypovitaminosis D, hyperparathyroidism |
|
|
Potassium
|
Increased: Addisons diseaserenal failure
Decreased: Chronic renal disease, insulin, diuretics |
|
|
Protein
|
Increased: MM, diabetic acidosis
Decreased: Liver disease and kidney syndromes |
|
|
Protein (CSF)
|
Increased: Viral meningitis
|
|
|
Prothrombin time
|
Increased: Vitamin K deficiency and hepatocelluar disease
Clotting time |
|
|
RA Latex
|
Positive: RA, SLE, TB, Cancer, Sjogrens, Stills disease
|
|
|
Serum Glutamic Oxaloacetic Transaminase (SGOT/AST)
|
Increased in MI, liver conditions, Muscular dystrophy
|
|
|
Serum Glutamic Pyruvic Transaminase (SGPT ALT)
|
Increased in MI and hepatitis
|
|
|
Triiodothyronine (T3) and Thyroxine (T4)
|
Increased: Hyperthyroidism, pregnancy
Decreased: Cirrhosis, hypothyroid |
|
|
Trepoonema Pallidum Immoblizing Agent (TPI)
|
Syphilis
Tertiary: Tabes dorsales--> Charcots Joint---> Neurogenic athropathy |
|
|
Uric Acid
|
Increased: Gout and renal failure (metabolic disorder)
|
|
|
Venereal disease research laboratory (VDRL)
|
Serologic screening for syphilis
|
|
|
Western Blot
|
Specific test for AIDS
|
|
|
Seronegative Arthropathy HLA B 27
|
Psoriatic Arthritis
AS Reiters Enteropathic Arthritis (AS+ diarrhea) PEAR Autoimmune |
|
|
Seropositive arthropathy + RA Latex
|
RA
SLE Scleroderma Sjogrens disease (RA+ dry eyes, and mouth) Autoimmune |
|
|
Angiography
|
Tumor
|
|
|
Arterial Blood Gas
|
Advanced COPD, clubbed nail with oxygen
|
|
|
Aspiration
|
Gout
Bacterial arthritis |
|
|
Balloon angioplasty
|
Obstructive atherosclerosis
|
|
|
Biopsy
|
Tumor (Hodkins)
|
|
|
Bone Scan
|
Sensitve, visualize the whole skeleton and is not specfic
Intrinsic bone changes, hidder fractures Cold: white, MM, lytic Hot: Blastic (fx/tumor), black |
|
|
Bronchoscopy
|
Bronchogenic carcinoma
|
|
|
CT Scan (CT)
|
best test for lung/bleeding
Trauma, infection, vascular, neoplastic, arthritic/metabolic disorders |
|
|
Doppler US
|
Arterial alterations
|
|
|
EEG
|
Electroencephalograph
Epilepsy Sleep disturbance, Encephalopathies |
|
|
EMG
|
Electromyography
Muscle Atrophy |
|
|
Laparoscopy
|
Abdominal tumor
Endometriosis |
|
|
Mantoux Test
|
TINE test also for TB
Ghon tubercle, miliary spots, night sweats |
|
|
MRI
|
Magnectic Resonance Imaging
Spinal tumor Disc Must be immobilized unless in thorax |
|
|
Myelography
|
Lateral recess canal protrusion
|
|
|
NCV
|
Nerve conduction velocity
Peripheral nerves |
|
|
PET
|
Positron Emission Tomography
Bone and soft tissue, tumor, heart, brain |
|
|
SPECT
|
Single photon emission Computed Tomography
Musculoskeletal system, heart, brain and abdomen |
|
|
Spirometer
|
COPD breathing volume
|
|
|
Sputum culture
|
Strep, TB
|
|
|
Stress test
|
Atherosclerosis, Angine, CVD
|
|
|
Tonometer
|
Glaucoma
|
|
|
US
|
Aneurysm, organs, pregnancy, differing density in abdomen
|
|
|
Upper Crossed Syndome
|
Weak/Inhibited Muscles (need strenghtened)
- Deep beck flexors - Lower traps - Serratus anterior Tight/Facilitated Muscles (Stretch/Elongate) - Pectoralis - Upper Trapezius - Levator scapula |
|
|
Lower Crossed Syndrome (
|
Hyperlordosis
Weak/Inhibited Muscles (need strenghtened) - Abdominals - Gluteus Maximus - Hamstrings Tight/Facilitated Muscles (Stretch/Elongate) - Iliopsoas - Quadriceps - Erector Spinae |
|
|
Any recent injury
|
Use ice
|
|
|
Closed Chain Exercise
|
Toe Raises (the body part doesnt leave the ground)
|
|
|
Tibial apopysitis
|
Cho Pat brace
Osgood Schlatter |
|
|
Contraindication to deep massage
|
Deep vein thrombosis
|
|
|
Vitamin A (retinol)
|
Deficiency causes night blindess
Hypervitaminosis: beta- caratinema (yellow/orange skin with normal sclera |
|
|
Vitamin B1 (Thiamine)
|
Deficiency causes beri beri (encephalopathy and psychosis
Deficiency from alcohol causes wernike kosakoff syndrome |
|
|
Vitamin B2( riboflavin)
|
Deficiency causes cheilosis (sore cracks at the corner of the mouth) apthous stomatitis
|
|
|
Vitamin B3 (Niacin)
|
Deficiency casues pellagra (4D's: dementia, dermatitis, diarrhea and death)
|
|
|
Vitamin B6 (Pyridoxine)
|
Recommended for peripheral nerve healing (CTS)
Natural diuretic Used to treat carpal tunnel |
|
|
Vitamin B9 (Folic Acid)
|
Deficiency is a megaloblastic (macrocytic) Anemia seen in alcoholics
Preg increased demand for B9 to precent neural tube defect Pains in legs at night improve with B9 Deficiency produces glossitis |
|
|
Vitamin B12 (Cobalamin)
|
Lack of intrinsic factor produces pernicious anemia
Deficiency is a megaloblastic anemia (+ Schilling test) May present with PLS (combined systems disease) stocking glove paresthesia that is often reversible Neuropathies persist after B12 is administered Folic acid masks the symptoms of this deficiency |
|
|
Vitamin C (ascorbic acid)
|
Deficiency causes scurvy and capillary fragility, bleeding bruise easily and bleeding gums with poor wound healing
Smoker are often deficient and should supplement Connective tissue healing Needed for iron absorption Avoid if kidney stones are present Excessive causes diarrhea |
|
|
Vitamin D
|
Deficiency is rickets (osteomalacia- bone softening)
Present with rachitic rosary near sternum, saber shin M/C deficiency in children not in warm, climates Supplementation increases bone density Paintbrush metaphysis on xray Sunlight helps |
|
|
Vitamin E (tocopherol)
|
An antioxidant for the cardiovascular system
|
|
|
Vitamin K
|
Made by intestinal flora
Used for clotting, injected into newborns at the hospital Destroyed by antibiotic therapy Anticoagulants are contraindicated with vitamin K deficiency |
|
|
Omega 3 fatty acids
|
used to treat hypercolesterolemia, natural anti inflammatory
|
|
|
Zinc
|
Necessary for prostate health, wound healing, and immune system
|
|
|
Selenium
|
Toxic doses produce damage to the hair, nails and skin
|
|
|
Chromium
|
Glucose tolerance factor
Essentail for diabetics |
|
|
Number one mineral deficiency in the world
|
Iron
|
|
|
Number one mineral deficiency in th eUS
|
Calcium
Animal products leach calcium from bones |
