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100 Cards in this Set
- Front
- Back
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glaucoma
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outflow mech at the anterior chamber angle blocked; pushed disc inwardpressure builds
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papilledema
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bilateral disc edema; enlarged blind spot due to intracranial pressure pushing outward on dish
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orthopnia
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trouble breathing when lying down
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hyperpnia
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rapid deep breathing, hyperventilation >20 and deep
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tachypnea
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rapid shallow breathing >20
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bradypnea
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rate under 12
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brady
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slow <60
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tachy
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fast >100
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sequence of events
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inspection palpation percussion auscultation
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stethoscope
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bell-low pitch
diaphragm-high pich tubing 12-18 in |
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red reflex
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refelciton of ligh from retina on eye
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optic disc
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nerve ganglia exit eye to form optic nerve; no rode or cones; nasal to macula
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fovea
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venter of macula; highest conc of cones; sharpest vision
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midriasis
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unopposed dilation of iris due to injry or offense
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hordeolum
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stye; infection of sebaceous glands at eyelashes base
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xanthoplasma
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stye at eylid
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ptosis
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drooping eyelid
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ectopion
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lower eyelid turns outwards; newborns in Harlequin ichthyosis and facial n paralysis
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entropion
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eyelids fold inward; eyelashes rub against cornea; gentic
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strabismus
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can't focus; cross eyes
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hemianopia
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one half of field of vision lose
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hyperopia
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farsighted ness; can't see close
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anopia
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blind
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myopia
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nearsighted ness cant see far
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presbyopia
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can't see close objects at all
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aventitious sounds
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crackles, weezes, pleural friction rubs
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retinopathy
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non-inflammatory damage to retina
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pneumothorax
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air in pleural space
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hemothroax
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accumulation of blood in pleural space
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pleural effusion
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accumulation of fluid in pleural space
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emphysema
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air in tissue can't get out
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atilectasis
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incomplete expansion of lung; congeital or acquired
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pleurisy
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infalmmaiton of pleura...pneumonia
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femitus
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vibration on body; tactile to describe lung sounds; 99 transmits well due to more stuff to vibrate
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crackles
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opening of airways on inspiration
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wheezes
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narrowin go fbronchus almost to clsure; on expiration
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pleural friciton rubs
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low piched grating, rubing, or creaking sound on inspiration
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rales
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rarely used; unexpected lung sounds...crepitus
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sounorous ronchi
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snoring sound; wheezes when snoring
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korotkof sounds
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first sound in BP; flow then thud; 1st sound-highest pressure is systolic
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auscultory gap
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pressure where korotkoss osunds indication true systolic pressure fade away and reappear at lower pressure point. auscultatory gap mistaken for silence when cuf pressure exceepds systolic pressure so you record a lower one so you should take a radial pulse as well; related to atherosclerosis in hypertensive patients
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graphistheisa
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writing on skin by touch
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steiognosis
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oject recognition by holding it
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extinction
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can't recognize two simultaneous stimuli on ooppsoing sides of body
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dystonia
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neuro distorder in which sustained mm contraciton cdause twising and repetitive ovments or abnormal psotures
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inner ear
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vesitbule, semicurular canals, and cochelea
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middle ear
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air fille dcavity in temporal bone, ossicle (malleus, incus, stapes)
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outer ear
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tympanic membraneout
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normal vital sign
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HR: 60-100
temp: 98.6 BP-119-79 rr: 12-18- 16-25, 20-30, 20-40 ***3 breaths per 15 secs |
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basic eye exam
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1st visual acuity numerator is distance of patient; demoninator is normal person
external puils-reactive, size motilyt anterior segment posterior segment-macula/disc relationship visula filed/peripheral vision- cover eyes iggle fingers H motion |
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fundus
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optic disc, retina macula, fovea;
posterior portion of eye opp of lens |
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cup to disc ration
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1.5 mm
1:3 |
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general assement vital signs
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postion patient; appropriate cuff size
locate bracial artery inflate/deflate recognize auscultatory endpoints/gap |
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neurological exam
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mm tone in patient
upper/lower extremity mm groups test asses coordination in extremities deep tendon reflexes and findings abnormal reflexes |
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eye exam
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visial accuity
external examination: eyebrows, orbital area, eyelids, conjuctivae, cornea, iris, pupils, lens sclera, lacrimal apparatus extraocular eye mm: H ophtalmoscopic examilation: red relfex, funducs, optic disc, macula, uvea centralis (iris, ciliary body, coroid), A/V disease: papilledema, laucoma, flame, dot, hemoragges, exudate, diabetic retinopathy, cotton wool sponts, arteriolar narrowing, copper wiring, AV necking |
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most common eye abnormality
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lens/ catarcts with centrla opacity of lens
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pink eye
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never give steroids
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hypertensive retinopathy
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damage to back of eye high BP
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diabetic retinopathy
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damgage to back of eye due to complicaiton with diabetes
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dots and blot hemorrhages
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diabetic retinopaty, bleeding deep in retina
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flame hemorrhages
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hypertensive retinopathy; ealkage of bv ue toischemia
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TQ about eyes
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gatewayt to body; only place you can directly see A and v and you can see disease that will affect rest of body like atherosclerosis
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weber test
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lateralizaiton of sound; do this first; lateraliz to deaf ear-conductive loss; good ear-neural loss
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rinne test
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bony conduction then air; mastoid; 2:1
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ear exam
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healthy tympanic membrane: umbo, concave, transclucent, integrity, cone of light
pinaa, helix, antihelix, tragus, concha, antitragus, lobe communicate with patient what you will do otoscope pinna pull back exam with out hurting |
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sinuses you can see
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maxillary and frongal
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pack years
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packers perday X numbe ro fyears smokes
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cheyne stokes
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alternating tachy and brady breathying
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kussmaul
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rapid deep labored breathing like hyperpnia
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stridor
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harsh high piched inspriation
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biot's breathing
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irregular respirations
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sleep apnea
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cessation of respiraiton at sleep
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lung exam
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size, shape, symmetry, clolor, vneous patterns, rib prminence
repsiraiton: rate, rhythm, pattern breathing: symmetry, bulging, accessory mm use audible sounds with respiraiton palpate chest: symmetry, throacic expansion, pulsaitons, sensations, taclile fremitus (99) precussion--diaphragmatic excusion, intensity, pictch duraiton, quality ausculatat: intesity, pitch duration, quality, unexpected breath sounds, vocal resonance *** always comparie bilatierally symmetrically ***starting above the clavicles right lobe: lower right lobe for pneumoia |
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trachea
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angle of louis; right main-tsem bifucations at a less severe angle allowing debris to drop more to that side
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pulse and relfexes
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2/4 good less the 2 is weak more is hyper
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parkinson's gain
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posture is stooped body is rigid, steps short and shiffling; can't start or start weel
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cranial nevers
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1:smell
2: visual acuity--rosenbaum, snellen 3,4,6 -H test; 6 is the longest nerve and greatest chance to suffer compression s 5: clench teeth, facial feeling 7: facial expression, taste 8: hearing; vesibular 9: parotid; uvula 10: uvula 11: trap 12: tonue movement; post 1/3 taste |
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romberg's test
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feet together eyes close; sway ect cerebellar dysfunction or ataxia or you can have a patient walk if you have time for only one test
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caotid bruit
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swishing sound over carotid artery; stenosis; 40-90 percent occlusion heard only
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interviewing patient
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open ended quesiton: chief complain: agenda; focused
closed ended: differential diagnosis ask permission, lay hands on patinet listen, be empathetic acknowledgemistakes call patient by name; introduce self, smile sit down eye contact P: pallative; Q quality R radiation severity tming associated symtoms clarify and summarize be attentive, empathetic- genuine, praise support, partnership summarize--infomr patient about next step |
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mouth exam
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tongue blade, exam gloves
sublingual fold, hard palate, soft palate, uvula, anter/post tonsillar pillar, posterior wall of pharynx, stnesens's duct (parotid gland), whartons's duct (submandibular glands, pull down lip, frenulum, sublingual veins protrude tongue and see side to side teeth gingivae oral mucosa |
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nose exam
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nose asymmetring, swlling trauma
columella ala nasi, anterior nares nalsal septum deviated inf/ iddle turbinates discharge color palpation patency smell color of mucosa, ischarge ect |
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diabetes diagnosis
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>126 FBS 8 hr fast; 2 hr PG>200; oral glucose tolerance test
random glucose 200 w/ symptoms HbA1C >6.5% (can't diagnose w/) |
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IGT
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prediabetes 100-126; 2 hr 140-200
A1C 5.7-6.4 <200 |
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T1DM
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no insulin; AI/idiopathic HLA 3,4, younger, thin ~10% patients
T lymphocytes H4HS hyperglycemia and ketosis AFTER >90% OF B CELLS DESTROYED virus may initiate polyuria, polyphagia, polydipsia |
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T2DM
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obese, older, FH reduced insulin receptors, raised insulin resistance, dec secretion, no HLA 90%
genetic inc to 20-40% versus 5-7% in normal population glucose toxicity and lipotoxicity-->B cells shrink polyuria, polyphagia, polydipsia, weak, fatigue risk: >45, obese BMI >25 or >120% IBW, FH, ethnicity (AA, hispanic, native, asian, pacific islander) |
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complications of DM
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NEG, arteriolosclerosis w/ irreversible AGE
macrovascular-med/large b/v CAD, cerebrovascular disease, peripheral vascular disease microvascular-retinopathy, neuropathy, renal GN LDL trapping in vessel in intima polyol pathway--nerves, lens, kidneys, b/v; do not require glucose for transport; sorbitol inc fluid influx osmotic cell injury |
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glycogen syn primarily in the
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liver
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somatostain
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D cells, inhib glucagon and GH dec blood sugar
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HbA1C
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glycosylation; irrev binding of lgucose w/ AA in Hb; 8-12 weeks; <5.7 normal >6.5 DM
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dyslipidemia in DM
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inc TG, LDL, VLDL, dec HDL
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insulin resistance syndrome
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central obesity, glucose intolerance, HTN, atherosclerosis, PCOS; hyperinsulinemia high lipids low HDL fibrinolysis inc PAI-1
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metabolic syndrome
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atherosclerosis, systemic inflammation, endothelail dysfucntion, complex dyslipidemia (inc TG, LDL, dec HDL), disordered fibrionlysis, HTN, T2DM, visceral obesity
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treat metabolic syndrome
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exercise; correct atherogenic dyslipiemia (lower TG in cHDL), correct HTN, aspriin for prothrombotic state; correct insulin resistance by losing weight, inc physical activity; dec insulin resistance is not proved to reduce CHD risk
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diagnsosi of metabolic syndrome
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abdominal obsity men >102 cm, 40inc; women 88 cm 35 inc waist; TG >150; HDL <50 F <40 M BP >130/85; fasting glc >110
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CV risk factors assc w/ insulin resistance
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inc BP, hyperlipidemia, inc apo B, endothelial dysfucntion, inc fibirnogen, inc plasminogen act i nhibitor 1; inc c reactive portein; inc blood vsicocity, microalbuminuria
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acute complications of DM
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hypoglycemia <50 DKA or HHS >600 w/ severe dhydration
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macrovascular w/ inc risks
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HA leading cause of diabetic deaths 2-4x; stroke 2-4; PVD--impaired sensation in limbs, slowed diegestion, carpal tunnel syndrome, 60% of non traumatic limb amputations
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microvascular w/ inc risk
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eye disease leading to blinding MCC 20-74; kidney disease, microalbuminuria, HTN dec GFR-->RF; ; leading cause of blindness 20-74 >60% of T2DM
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2011 guidlines and recommendations for DM ranges
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HbA1C <7%; preprandial 70-130, postprandial <180
LDL <100; TG <150; HDL >40; non-DHL <130 BP <130/80 AI/Cr <30 aspriin, pneumococcal and influenza vaccines |
