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161 Cards in this Set
- Front
- Back
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Habit history
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TACOS - tobacco, alcohol, caffeine, occupation, street drug use
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Plan for treatment
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MOTHRR
Medication OMM Testing (lab, radiology) Holistic approach (non pharmacologic heat, ice, physical therapy) Referral to specialists Return to office |
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Describe clinical (close-ended) interviews
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Interviewer = "director" of interview
Very focused questions - designed to allow specific information Interviewer is expert in the information Narrowly defined time constraints |
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Describe ethnographic (open-ended) interviews
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Interviewer = facilitator
Open ended questions - designed to allow respondent to talk More open time constraints |
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Best time to do breast exam
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week or two after menses
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Risk factors for breast cancer
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- Prior cancer
- Family history - Early menarche - Late or no pregnancy - Exposure to radiation |
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Redness of breast could indicate _
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Infection or inflammatory carcinoma
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What do you look for when you inspect breast
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- Appearance of skin - color, thickening of skin or unusually prominent pores
- Size and symmetry of breasts, some difference is normal - Contour of breasts - look for masses, dimpling or flattening - compare one breast with another. |
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What do you look for in inspection of nipples
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- Size and shape - occassionally nipple is inverted - depressed below areolar surface, longstanding inversion is usually normal variant
- Direction in which point ( normal outward and downward) - Any rashes or ulcerations - Discharge |
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Recent or short term retraction of the breast means _
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malignancy
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What do you notice on palpation of the breast
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- Consistency of tissue
- Tenderness - Nodules - feel for any lump or mass |
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Isolated axillary adenopathy means _ while general adenopathy (cervical, clavicular) means _
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- Breast CA
- HIV, lymphoma |
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Indications for pelvic exam in female
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- Menstrual irregularities such as amenorrhea, excessive bleeding or dysmenorrhea
- Unexplained abdominal pain - Vaginal discharge - Prescribing of oral contraceptives - Bacterial and cytological studies in sexually active females - The patients own desire for assesment |
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2 types of speculum
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GRAVES - rounded, better suited for sexually active females
PENDERSON - narrow bladed - useful in virgin or elderly woman, may be more comfortable for other women as well |
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Excoriations or small red maculopapules on genitalia mean _
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PEDICULOSIS PUBIS
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Where do you take smears for pap staining - 2 spaces - _
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From endocervical canal and ectocervix
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Pain on bimanual exam suggests _
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PID
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Excoriations on male genitalia suggest _
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scabies
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Syphillis lesion is called _ while painful multiherpetic lesion is called _
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Chancre
Chancroid |
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Angiokeratoma
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pinpoint dark red raised lesion on scrotum in men over 50 - common, normal
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Smegma
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- Cheesy white material under foreskin - normal
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Phimosis
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Condition where foreskin cannot be retracted
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Balanoposthitis
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Inflammation of glans and prepuce
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Balanitis
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Inflammation of the glans penis alone
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Hypospadias
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Meatus opens in ventral surface of penis
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Epispadias
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Less common, meatus on dorsal surface of penis
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Peyronies Disease
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Non tender induration or fibrotic area under skin of shaft of the penis
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Paraphimosis
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Condition which notes the inability to replace foreskin when its retracted behind corona
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Varicocele
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Common enlargement of spermatic cord due to dilation of pinpiniform plexus , usually on left side
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Abdominal exam order
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1. Inspection
2. Auscultation 3. Percussion 4. Palpation 5. Rectal exam |
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Cullens sign
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- Ecchymoses in periumbilical area could be a sign of intrabdominal bleeding from ectopic pregnancy and pancreatitis
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Grey Turner sign
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- Ecchymoses on flank - sign of acute pancreatitis
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High pitch tingling bowel sound means _
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Intestinal obstruction
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Absent bowel sounds mean _
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Bowel obstruction, perforation
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Normal liver size
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4-8 cm in midsternal line
6-12 cm in right midclavicular line |
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Thrill
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Turbulence of vascular flow, vibratory sensation when palpating aorta
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Aortic dissection
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- Tearing or ripping abdominal pain that radiates to the back, expansile pulsations
- Normal aorta shouldnt be more then 2.5 cm wide |
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Two tests to assess ascites
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- Fluid wave - press down on abdomen and create fluid wave
- Shifting dullness - percuss to identify areas of dullness and tympany, have patient roll away from you - percuss again for dullness and tympany - if dullness has shifted to areas of prior tympany - patient may have ascites |
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Psoas sign
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- Test for appendicitis
- Place hand above patients right knee, ask patient to flex hip against resistance - Increased abdominal pain - positive psoas sign |
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Obturator sign
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- Test for appendicitis
- Raise pt's right leg with knee flexed, rotate leg internally at hip - Increased abdominal pain - positive obturator sign |
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Rovsings sign
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- Test for appendicitis
- Palpation of the LLQ will result in the pain of RLQ. |
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Describe acute cholecystitis
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- Fatty food tolerance
- RUQ pain with radiation to right scapula |
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Murphys sign checks for _
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Acute cholecystitis
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Hematochezia
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Bright red blood per rectum - from colon
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Melena
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Black tarry like stools
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First Cranial nerve testing
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Test the sense of smell by presenting the patient with familiar and non-irritating odors. Be sure each nasal passage is open. The patient should close both eyes. Ask patient to identify substances such as coffee, vanilla and soap
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Second cranial nerve testing
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- Test visual acuity
- Inspect optic fundi with special attention to optic discs - Determine visual fields - Test for extinction of vision on one side |
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How do you test III, IV and VI CN
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Test extraocular movements in the six cardinal fields of gaze and look for loss of conjugate movements. Check convergence. Identify any nystagmus including direction of quick and slow components
Look for ptosis of upper eyelids |
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How do you test V CN
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Motor - while palpatin masseter and temporalis muscles ask patient to clench teeth
Sensory - use safety pin or other suitable object and ask patient about sensation (sharp or dull) in areas of forehead, below eyes and on lateral chin Test for light touch with patients eyes closed with wisp of cotton Test corneal reflex with fine wisp of cotton |
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How do you test CN VII
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Inspect face for asymmetry at rest and during conversation
Ask patient to raise eyebrows, close eyes against resistance, smile, frown, show upper and lower teeth and puff out both cheeks. |
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How do you test CN VIII
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Assess hearing. If impaired test for lateralization and compare air and bone conduction.
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How do you test IX and X CN's
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Listen to patients voice.
Is there difficulty in swallowing? Ask patient to say ah as you watch movements of soft palate and pharynx Warn patient and test GAG REFLEX by stimulating the back of the throat on each side |
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How do you test XI CN
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From behind look for atrophy or fasciculation in trapezius muscle
Ask patient to shrug both shoulders upward against your hands |
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How do you test XII CN
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Listen to articulation of spoken word
Inspect tongue fo atrophy or fasciculation - with tongue extended look for symmetry atrophy or lateral deviation. Ask patient to move tongue from side to side. You may need to assess tongue strength in each direction by resisting movement with your gloved finger. |
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Tandem walking
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Walk heel to toe in straight line
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A gait that lacks coordination is called )
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Ataxic
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Ataxia occurs due to _
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Cerebellar disease or intoxication
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Rhomberg test
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Have patient stand with feet together and eyes open - then close both eyes and stand for 20-30 seconds without support - normally only minimal swaying occurs
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Pronator drift suggests _
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Mild hemiparesis
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Drifting or weakness suggests
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Hemiparesis or shoulder girdle disease
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Absence of strength of muscle is called _
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Paralysis or plegia
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Impaired muscle strength is called _
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Paresis
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Increased resistance of muscle is called _ Higher form of resistance is called _
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Spasticity
Rigidity |
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Describe grading of muscle strength
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0- no muscular contraction detected
1- barely detectable flicker or trace of contraction 2- active movement of body part with gravity eliminated 3 -active movement against gravity 4- active movement against gravity and some resistance 5- active movement against full resistance without fatigue bormal muscle strength |
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Describe grading of reflexes
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+4 - very brisk, hyperactive, often associated with clonus
+3 - brisker than average, possibly but not indicative of disease +2- average, normal +1 - somewhat diminished, low normal 0 - no response |
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Describe biceps reflex
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Patients arm flexed at elbow with palm down. Place thumb or finger firmly on biceps tendon. Strike with reflex hammer - observe flexion at elbow and watch for and feel contraction of biceps
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Describe triceps reflex
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Flex patients arm at elbow with palm toward body and pull it slightly across chest. Strike triceps tendon above elbow. Watch for contraction of triceps at the extension of elbow
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Brachioradialis reflex
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Patients hand should rest on abdomen or lap with forearm partially pronated. Strike radius about 1-2 inches above wrist. Watch for flexion and supination of forearm
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Abdominal reflexes
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Test abdominal reflexes by lightly but briskly sroking each side of abdomen above and below the umbilicus. With a key or something else, stroke in a downward and medial manner from sides of abdomen. Note contraction of abdominal muscles and deviation of umbilicus toward stimulus.
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Knee reflex
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Knee is flexed with patient sitting or lying down. Briskly tap patella tendon below the patella. Note contraction of quadriceps with extension of knee. A hand on anterior thigh helps you feel reflex
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Babinski reflex
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Dorsiflexion of the big toe with fanning of the other toes - indicates upper motor neuron disease, also caused by drug, alcoholic intoxication
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Sustained clonus indicates _
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Upper motor neuron disease
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Analgesia
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Loss of sensation of pain
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Hypalgesia
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Decreased sensation of pain
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Hyperalgesia
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Increased sensation of pain
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Anesthesia
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Absense of touch sensation
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Hyperesthesia
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Increased sensitivity to pain
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Stereognosis
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Ability to identify an object by the feel of it, place familiar object in patients hand and ask to close eyes
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Chaddock reflex
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Same as Babinski reflex but stroking on the side of the foot, not bottom
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Graphesthesia - what it is and what indicates
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Ability to perceive number drawn on hand - activity of higher cortical area
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Jendrassik maneuver
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If reflex is weak or absent - clench teeth which distracts patient and accentuates reflex
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Which nerves responsible for corneal reflex
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V and VII
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Vestibulo-ocular reflex
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Comatose patients - eye should follow turn of the head
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Components of cardiac exam
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- Heart
- Lungs - Neck - Feet - Pulses |
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Jugular veins distention indicate _
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right heart failure
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Carotid bruits is sign of _
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carotid stenosis
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Blowing murmur is a sign of _ Rumbling murmur is a sign of _
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Stenosis
Regurgitation |
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Which murmurs are more common
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Systolic - diastolic murmurs are hard to hear
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Heart murmurs are caused by _
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Turbulent flow - clogged valves and leaky valves
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Aortic valve is auscultated where
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2nd intercostal space, right sternal border
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Pulmonic valve is auscultated where
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2nd intercostal space, left sternal border
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Tricuspid valve is auscultated where
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5th intercostal space, left sternal border
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Mitral valve is auscultated where
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5th intercostal space mid clavicular line
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Name systolic murmurs
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Aortic stenosis and mitral regurgitation
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Name diastolic murmurs
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Mitral stenosis and aortic insufficiency
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Where is point of maximal impact located
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5th ICS mide clavicular line
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WHat happens in cardiomegaly
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Heart drops down and out - 6th ICS and anterior axillary line
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Why does chest pain come on exertion in angina
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Oxygen demand increases and you get supply/demand imbalance
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Describe angina
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Crushing substernal pain which radiates to the left arm, associated with shortness of breath, nausea, vomitting, diaphoresis. Pain comes on exertion and is relieved by rest
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Describe common symptoms of CHF
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Shortness of breath, awakening at night unable to breath, needing to sleep on 3 pillows and ankle swelling. Jugular vein distention.
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In CHF which heart fails
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L ventricle doesnt pump blood - later get both right and left heart failure
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What is the most common cause of right heart failure
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Left heart failure
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What is the difference between symptom and sign
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Symptom - subjective, sign - what you observe
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Why do people with heart problems lean to catch their breath
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Pectoralis major - accessory muscle - leaning allows flipping origin and insertion - helps breathing
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Two types of chest pain
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Pleuritic and non-pleuritic
Pleuritic - chest pain that gets worse when you take deep breath Non pleuritic = angina pain |
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2 patterns of respiration
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Cheyne-Stokes - irregular - alternating rapid and shallow breaths
Kussmaul - deep big expirations - elimination of CO2/acid |
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Dullness on percussion of lungs means _
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fluind in lungs (blood), pneumonia - fluid in parenchyma
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Hyperresonance in lungs on percussion means _
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Pneumothorax
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COPD - what do you find
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Diminished breath sounds, hyperresonant percussion
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Pulmonary embolism
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Blood clot in pulmonary artery
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Pleural space
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Potential space between visceral and parietal pleura
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Hallmark of asthma
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Wheezing
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How does pneumonia usually present
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Productive cough, fever, chills, blood streaked sputum
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Why do people with COPD breathe through pursed lips
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Generating resistance
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Macule
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Well circumscribed flat discoloration which may be red, blue, brown or hypopigmented
Example - freckles Its absolutely flat and if you run fingers over it you wont be able to feel it |
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Papule
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Solid raised lesion which is less then 1 cm in diameter
- Can have variety of shapes - flat, umbilicated, domed - Can be associated with scales or crusts Example - molluscum contagiosum - dome shaped umbilicated papules |
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Nodule
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Solid raised lesion more then 1 cm in diameter - can be in epidermis, dermis or subcutaneous tissue
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Tumor
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Solid mass of skin or subcutaneous tissue - larger then nodule - can be benign or malignant
If ulcerated or erodes skin - worse prognosis Example - basal cell skin carcinoma |
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Plaque
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Solid raised flat topped lesion more then 1 cm in diameter
Psoriasis plaque - prototypical plaque disease |
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Wheel
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Area of edema in upper epidermis - elevated, palpable, usually disappears in less then 24 hours, also called hives
Example - allergy, urticaria |
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Vesicle
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Raised lesion filled with clear fluid less then 1 cm in diameter'
Example - poison ivy contact dermatitis, herpes lesions, usually linear pattern |
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Bullae
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Circumscribed fluid filled lesions more then 1 cm in diameter
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Pustule
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Circumscribed elevated lesions that contain pus
Example - streptococcal skin infection |
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Scales
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Secondary lesion caused by desquamation of the skin
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Crust
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Secondary lesion - collection of dried cellular debris, can occur after herpetic lesions resolve
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Fissure
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Secondary lesion - linear crack through the skin, can extend to dermis
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Erosion
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Focal loss of epidermis
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Ulcer
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Focal loss of epidermis and dermis, erosions can evolve into ulcers
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Atrophy
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Depression of skin due to thinning of epidermis - striae or stretch marks - can be due to systemic injection of steroids. Adolescents can have striae due to excessive growth - can also be observed with radiation dermatitis or from old insulin injections which are not used any more
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Scar
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Permanent fibrotic change of skin due to injury to dermis
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Burrow
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Lesion that occurs due to infestation of skin and making tunnels in skin by scabies or other parasites
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Most common causes of death during first year of life
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Congenital and chromosomal - 20%
Short gestation and low birth weight - 16% Sudden infant death syndrome - 8.1 % Maternal complications of pregnancy - 5.4 % |
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Which screening test is used to assess development of the baby
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Denver Developmental Screening test
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Mnemonic for history taking in adolescents
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HEADS
Home environment Education and Employment Activities (peers) Drugs (also alcohol and tobacco included here) Sexuality and Suicide |
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APGAR score is taken when
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At 1 min and 5 minutes
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Plethora in baby means _
Palor means |
Plethora - very red
Palor - very white |
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Mongolian spots
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Flat birthmarks in baby that can be confused with bruises and suggest abuse
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Port wine stain
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Also called nevus flammeus
Can be sign of Sturge Weber syndrome (seizure disorder) |
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Transient neonatal pustular melanosis
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Present at birth - pustules and vesicles, resolve within month, but brown macules may persist for a while
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Erythema toxicum
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Common rash of babies - presents in different ways and may be confused with something more serious (herpes), will resolve on own
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Cavernous hemangioma
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Like strawberry nevus but more deep and may be more permanent
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Milia
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Common benign keratin filled cysts
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Caput succedaneum
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Diffuse swelling of the scalp in newborns caused by pressure of uterus or vaginal wall during delivery
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Cephalohematoma
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Not the same as caput succedaneum - caput is more generalized and resolves fast, while cephalohematoma becomes more obvious within first few days of life - collection of blood under periosteum.
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Barlows test
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Hip is flexed and thigh adducted while pushing posteriorly in line of the shaft of the femur causing femoral head to dislocate posteriorly from acetabulum
Dislocation is palpable as femoral head slips out of acetabulum Diagnosis is confirmed with Ortolanis test |
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Ortolanis test
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Hips are examined one at a time - flex infants hips and knees to 90 degrees, thigh is gently abducted and bringing femoral head from its dislocated posterior position to opposite acetabulum, hence reducing femoral head into acetabulum
In positive finding there is audible and palpable click as hip reduces |
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Sweaty feet odor from baby can indicate
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Isovalericacidemia
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Acetone odor from baby can indicate
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Diabetic ketoacidosis
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Fish odor from baby can indicate
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Methionine metabolism aberration
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Excessive elasticity of the skin indicates _
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Ehlers Danos syndrome
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If baby presents with chronic unilateral foul smelling nasal discharge suspect _
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Foreign body
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Stridor - what it is and what indicates
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High pitched breathing sounds - indicates upper airway problem
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Signs of CHF in baby
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Tachycardia, tachypnea and enlarged liver. Possible feeding problems and failure to thrive
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Skin condition common in young children (1-5) and caused by Strep A or S. aureus
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Impetigo - contagious
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Legg- Calves - Perthes disease
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Idiopathic osteonecrosis of femoral head
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Abnormal red reflex of the eye is present with _
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Cataracts
Retinoblastoma Retinal detachment Chorioretinitis |
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How do you test for strabismus
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Cover test - cover one eye at a time - observe for shifts of uncovered eye or of the covered eye after cover is quickly removed
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Nasal polyps are found in _
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Allergy and cystic fibrosis
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Forscheimers spots are signs of _
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Rubella
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Koplicks spots are signs of _
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Measles
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Osgood Schlatter
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Unilateral separation of tibial tuberosity
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