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125 Cards in this Set
- Front
- Back
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Chief Complaint
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statement of why they are here
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Presenting Illness
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description of why they are here
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LMNOPQRST
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L = Location of pain/problem
M = Mechanism of injury N = Nature of symptoms O = Onset P = Palliative/Provocative = Past History of similar Q = Quality (stabbing/burning) R = Radiation/Referral S = Severity/Symptoms (ADL) T = Temporal/Timing |
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Unexplained Weight Change
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change of 7%/year is significant
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Ideal Body Weight
Female Male |
female = 100#'s + 5#'s/inch over 60 inches
male = 106#'s + 6#'s/inch over 60 inches |
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Weight Increase
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hypothyroid = Hashimoto's
hyperadrenalism = cushing's fluid retention = chf, kidney failure, ascites |
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Weight Decrease
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hyperthyroid = grave's
hypoadrenalism = addison's diabetes fever malabsorption = crohn's/celiac anorexia = malignancy, infections, hepatitis, nervosa |
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Types of Temperature and Degrees
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Axillary = 1 degree low (97.6)
Rectal = 1 degree higher (99.6) Aural = 98.6 |
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Types of Fever
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Intermittent
Remittent Continuous Relapsing |
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Intermittent Fever
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High spikes, returns to normal in 24 hr period
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Remittent Fever
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high spikes, not returning to normal
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continous fever
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sustained; doesn't return to normal until it ends
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relapsing fever
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fever for days/weeks with periods of normal temperature
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facticious fever
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above 106 for an extended period
rapid fall in temp without sweating lack of diurnal variation |
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change in heart rate with temp
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10 BPM/ 1 degree temp
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FUO (fever of undetermined origin)
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fever for weeks with failure to diagnose cause
ex. meds, hodgkin's, TB, mono, CA, collagen disorders |
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Tachycardia
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> 100 bpm
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Bradycardia
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< 60 bpm
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Pulse Regularity
Regularly Irregular Irregularly irregular |
Regularly Irregular = 2nd degree heart block
Irregularly Irregular = PVC |
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Dyspnea
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difficulty with breathing
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bradynea
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decreased rate (<12 cpm)
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tachynea
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increased rate (>20 cpm)
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apnea
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cessation of breath
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hyperpnea
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increased depth
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hyperventilation
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increased rate and depth
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orthopnea
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difficulty breathing laying down
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cheyne stokes
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alternating hyperpnea and apnea
medulla not signalling property |
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Karotkoff Sounds
K1 K4 K5 |
K1 = systole (1st tapping sound; ventricular contraction)
K4 = muffled sound K5 = no sound (diastole) |
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Change between R and L
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change of 10-15 mmHg
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False Low Reading
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cuff too wide
arm below heart deflate cuff too rapidly auscultatory gap |
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false high reading
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anxiety
cuff to narrow deflating cuff too slowly arm below heart |
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Children
Pulse Systolic BP |
Pulse = higher
Systolic BP = lower |
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Orhtostatic Hypotension
Systolic decreases by diastolic decreases by |
systolic = 20 mmHg or more
diastolic = 10 mmHg or more |
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Hyper adrenal problem
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increase BP
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Hypo adrenal problem
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decrease BP
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Ectomorph body type
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fragile, thin, tall, flat chest, delicate, high energy, light muscled
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Mesomorph body type
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athletic, muscular body, lose fat easily, gain myo easily
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Endomorph body type
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flabby, gain weight easily, under-developed muscle, slow metabolism
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Linea nigra
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linea alba turns dark (pregnancy)
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chloasma
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mask of pregnancy (similar to portwine stain)
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Addison's disease
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dark spots over bucal mucosa, skin folds, stretch marks
destruction of adrenals bp low weight loss/loss of appetite hypoglycemia dehydration intolerance to cold fatigue |
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cushing's disease
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purple striae
hypercortisolism pituitary tumor bp increase elevated glucose level weight gain truncal obesity moon face buffalo hump |
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Pallor
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anemia
shock |
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Syndrome X
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increase trigs
truncal obesity increase BP |
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Adrenal Gland Cortex
glucocorticoids mineral coricoids sex hormone |
Endocrine
cortisol (increase sugar) aldosterone (increase salt) dhea/pregnanalone (decrease sex) |
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Adrenal Gland Medulla
Adrenaline |
Neuroendocrine
epinephrine |
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DHEA
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increase sensitivity to insulin
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Insomnia
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increase cortisol
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Cafe' au lait spots
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>5-6 spots
neurofibromatosis (VonReckinghausens Dz.) |
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Acromegally
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excess production of endogenous growth hormone
pituitary tumor weight gain hirtuism |
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Halitosis (causes)
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peptic ulcer
GERD Diabetes Liver disorders Kidney disorder |
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Hirsutism
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cushings
acromegally excessive hair growth |
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Alopecia
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hypothyroidism = coarse, dry
hyperthyroidism = fine, velvety |
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Koilonychia
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spoon shaped nails
plummer vinson syndrome IDA hemochromatosis |
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Clubbing
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chronic respiratory conditions
lung ca hypertrophic pulmonary osteoarthropathy cardiac failure hepatic cirrhosis |
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Lindsay's Nails
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half/half nails
renal failure |
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Mee's Lines
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transverse white band
arsenic intoxication renal failure hodgkins pneumonia |
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Terry Nail
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all white
hepatic cirrhosis CHF RA |
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Beau Lines
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transverse depression
coronary occlusion skin disorder trauma |
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oncholysis
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separation of distal nail
psoriasis trauma thyroid dz. |
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pitting
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psoriasis
eczema alopecia areata |
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onychomycosis
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fungal infection
trauma heat moisture diabetes |
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yellow nail syndrome
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edema
defective lymph drainage chronic bronchitis |
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Splinter hemorrhage
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SBE
SLE Rheumatoid Trauma |
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Paronychia
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infx of cuticle
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Ataxic sensory
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loss of posterior columns
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propulsion
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parkinson's
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steppage
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anterior crural myo deficit
can't dorsiflex foot poliomyelitis |
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staggering (reeling)
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cerebellar ataxia
MS |
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Scissors (spastic)
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MS
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Trendelenburg Gait
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Weak glut
hip pathology |
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Exam of Neck Lymph Nodes
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1 - superficial (ant)
2 - posterior cervical nodes 3 - deep cervical nodes 4- supraclavicular areas |
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Exam of Head Lymph Nodes
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1 - occipital
2 - postauricular 3 - preauricular 4 - parotid 5 - tonsillar 6- submandibular 7 - submental |
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Lymph Node drainage
Ant. cervical Post. cervical tonsillar sub-mandibular sub-mental preauricular postauricular occipital supraclavicular |
Ant. cervical - throat, post. pharynx, tonsils, thyroid
Post. cervical - skin on back of head tonsillar - post. pharynx submandibular - floor of mouth submental - teeth preauricular - eyes postauricular - scalp occipital - skin back of head supraclavicular - thoracic cavity, Virchow's node |
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Thyroid Evaluation
Hypothalamus Pituitary Gland Thyroid Gland |
Hypothalamus - thyroid releasing factor
Pituitary Gland - thyroid stimulating factor thyroid gland - secretes T4 |
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Thyroid Evaluation
Primary Secondary Tertiary |
Primary - thyroid problem (thyroid gland is over/under producing T4)
Sedondary - pituitary problem (pituitary gland is over/under producing TSH) Tertiary - hypothalamic problem |
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Graves Dz.
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hyperthyroidism
autoimmune antibodies against TSH continuous secrestion of T4/T3 |
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Hashimotos Dz. (chronic thyroiditis)
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aka Auto immune thyroiditis
antithyroid peroxidase Ab takes up receptor sites and doesn't secrete T3/T4 |
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Thyroid Physical Exam
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diffuse enlargement
single nodule multiple nodules thyroiditis (tenderness) |
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Benign Lymph Node
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elastic
regular mass movable painful |
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Barnes Test (thyroid self test)
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evaluates basal metabolic rate
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Tracheal Tug
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aortic aneurysm
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Auscultation of the Head
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ocular
temporal (olymyalgia rheumatica) occipital |
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Sinusitis (referral patterns)
Maxilla frontal ethmoid sphenoid |
maxilla - cheek
frontal - forehead ethmoid - upper face & retro orbital sphenoid - head or occiput aggravated by bending forward |
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TMJ (ROM)
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3-6 cm space between upper/lower jaw
1-2 cm laterally press inside the external auditory meatus on the anterior aspect of the canal |
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Mental Status
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orientation x3
(time, person, place) |
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Pupillary Reactions
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accomodation
light convergence |
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PERLA
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pupils equal, reactive to light & accomodation
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Miosis
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iridocyclitis (small pupil)
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Mydriasis
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large pupil (acute glaucoma)
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Argyll Robertson
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fails to constrict with light
3 syphyllis |
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Anisocoria
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unequal pupils
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adie pupil
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tonic pupil
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Peripheral fields of gaze
superior medial inferior lateral |
superior - 50
medial - 60 inferior - 70 lateral - 90 |
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dorsal column
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proprioception, vibration, 2 pt. touch, light touch
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pyramidal
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reflexes
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spinothalamic
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sharp pain, temp, crude touch
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Trigeminal (CN V)
Sensory Motor |
sensory - opthalmic, maxillary, mandibular
motor - temporalis, masseter, open mouth, clench teeth |
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Corneal Reflex
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afferent 5
efferent 7 |
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Facial Nerve (CN VII)
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frown, smile, puff out cheeks, show teeth, close eye
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Hearing Loss (line of demarcation)
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oval window
(window out is conduction) (window in is sensorineural) |
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Weber Test
(lateralizes to one side) |
conduction block on same side
sensory/neuro deficit on opposite side |
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Glossopharyngeal (CN 9)
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uvula pulled to opposite side
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Vagus (CN 10)
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gag reflex
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Spinal Accessory (CN 11)
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trapezius
scm |
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Hypoglossal (CN 12)
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tongue to same side
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Pronator Drift
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UMN lesion with general weakness
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LMN
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decreased tone
flaccid paralysis |
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UMN
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increase tone
rigidity spasticity |
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rigidity
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extrapyramidal tract
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spasticity
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pyramidal tract
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Indicator Muscles
c5 c6 c7 c8 t1 l4 l5 s1 |
c5 - deltoid
c6 - biceps, wrist extension c7 - triceps, wrist extension, finger extension c8 - finger flexion t1 - finger abduction/adduction l4 - tib anterior (dorsiflex/invert) l5 - extensor hallicus longus s1 - plantar flexors |
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Deep Tendon Reflex needs what 5 things
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1 - sensory nerve fibers
2 - function synapse in cord 3 - intact motor fibers 4- functional nm jxn. 5 - competent muscle fibers |
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Reflexes
c5 c6 c7 l4 s1 |
c5 - biceps
c6 - brachioradialis c7 - triceps l4 - patellar s1 - achilles |
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Plantar Response (babinski)
normal response abnormal response |
normal - flexion
abnormal - extension (UMN lesion) |
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abdomen superficial reflex
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upper t7-9
lower t10-11 |
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cremasteric reflex
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T12, L1, L2
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plantar reflex
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L4,L5,S1
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anal reflex
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S2-4
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gag reflex
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CN 9&10
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Hoffman response
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press nail downward
abduction of thumb or flexion of fingers |
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Tromner's Sign
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tapping palmar surface of tip 3rd digit
abduction of thumb and flexion of fingers UMN lesion |
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clonus
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UMN lesion
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Weber
Normal Conductive Hearing Loss Sensorineural Loss |
Normal - no lateralization
Conductive - lateralization to deaf ear Sensorineural - lateralization to better ear |
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Rinne
normal conductive hearing loss sensorineural hearing loss |
normal - AC>BC
conductive hearing loss- BC>AC sensorineural hearing loss - AC>BC but reduced |
