Icm 2 Final Exam

Front 1

Septic Fever (intermittent vs. relapsing vs hectic)

Back 1

Fever may be sustained, intermittent, remittent or relapsing
Intermittent: exaggeration of normal circadian rhythm when this variation is extremely large the fever is termed hectic or septic. Intermittent or septic fevers are common with deep seated or systemic infections, malignancy and drug fevers (septicemia caused by spread of micro-organisms and toxins in circulation)
Relapsing: episodes separated by interval of normal temperature (malaria or Borrelia) (may be normal in the morning). See Pel-Ebstein below.

Front 2

Heat Stroke (exertional vs. classic)

Back 2

Systemic hyperthermia. Abnormal elevation of core body temp above 40 C (106-108F) Proteins become denatured, vasodilation
Exertional: athletes and laborers. Associated with: hot dry skin, w/ or w/o sweating, lactic acidosis, rhabdomyolysis, myoglobinemia-ATN, DIC (complication sometimes)
Classic Heat Stroke: very young, old, ill, obese, and alcohol-users. Associated with: febrile illness, hot humid weather, w/o sweating, hot dry skin, respiratory alkalosis, increased RR, DIC rare

Front 3

Pel-Ebstein Fever (v.rare, existence debatable)

Back 3

Cyclic fever of 3-10 days followed by afebrile period of 3-10 days. Assoc w/ Hodgkin’s disease and other lymphomas.

Front 4

Breathlessness

Back 4

Respiration: controlled in breathing center in the medulla; normal rate 10-14 breaths/min
Breathlessness: (Dyspnea/SOB): subjective sensation, important manifestations of cardiopulmonary dz, etc.
Bradypnea: abnormal slowing of respiration
Tachypnea: abnormal increase in respiration
Apnea: temporary cessation of breathing

Front 5

Biot’s Breathing

Back 5

Hyperventilation; irregular breathing with long periods of apnea due to increased cranial pressure/brain damage to the medulla

Front 6

Kussmaul’s Breathing

Back 6

Hyperapnea: increased rate and depth of breathing; compensatory hyperventilation with large tidal volumes. Usually associated with metabolic acidosis (DKA)

Front 7

Hyperventilation Syndrome

Back 7

Various causes for the increased ventilatory drive
Hypoxemia, pulmonary disorders, cardiovascular problems, metabolic disorders (acidosis), alveolar hyperventilation (PCO2 < 37-43 mmhg), anxiety, psychiatric syndromes, primary respiratory alkalosis

Front 8

Cheyne-Stokes Respiration

Back 8

Sine wave pattern. Irregular breathing with intermittent periods of increased and decreased rates alternating with apnea. Can be drug induced, due to CHF or brain damage (cerebral)

Front 9

Stridor

Back 9

Harsh type of noisy breathing (audibly difficult on inspiration and expiration) associated with obstruction of the major bronchus (trachea or larynx) that occurs with aspiration (vs wheezing air past a narrowed glottis or tracheo-bronchial airway) High pitched
Epiglottis in children: foreign body emergency

Front 10

Aphasia

Back 10

Total loss of speech
Motor, expressive, nonfluent aphasia: frontal lesion to Broca’s area
Sensory, receptive, fluent aphasia: temperoparietal lesions (Wernicke’s)

Front 11

Dysarthria

Back 11

Difficulty in the articulation generally due to lesions of the tongue and palate (mechanical muscle problem)

Front 12

Pallor

Back 12

Abnormal paleness of the skin due to the decreased blood flow or lack of normal pigment (may be associated with shock, anemia, cancer)

Front 13

Tardus/Parvus Pulse

Back 13

Tardus:, pathologically gradual upstroke slow sustained pulse, delayed systolic peak, result of mechanical obstruction to the left ventricular ejection. Seen in severe aortic stenosis.
Parvus: small weak pulse; associated with a diminished left ventricular stroke volume

Front 14

Corrigan Pulse

Back 14

Waterhammer; rapid, sudden systolic expansion, falls rapidly in late systole and diastole caused by aortic regurge, PDA

Front 15

Pulsus paradoxsus

Back 15

Detected by a bp assessment. Exaggerated drop in systolic bp (10-15) with inspiration; pulse amplitude may disappear but the heart beats on. Caused by tamponade, constriction pericarditis, COPD, severe asthma (b/c these 2 show exaggerated pressure drop on inspiration (increases (-) intrathoracic pressure)
Mech: inspiration increased (-) pressure → increased venous return → increased RV volume → pushes septum to the left → decreased LV volume → Change in cardiac amplitude b/c both ventricles have a decreased vol due to compression by the dense pericardial fluid

Front 16

Pulsus alternans

Back 16

Alternating amplitude of pulse pressure due to CHF, cardiomyopathies; varies beat to beat in amplitude RHYTHM is REGULAR

Front 17

Hypothyroidism

Back 17

Droopy face, raspy voice, loss of hair, intolerance to the cold, slow pulse, reflex: normal upstroke, delayed return, myxedema, anemia, thickened tongue

Front 18

Hyperthyroidism

Back 18

Exopthalmos = proptosis = eyes bugging out of head, goiter, tachycardia, sweating, lid lag, wt loss, hyperreflexia, systolic hypertension, multiple BMs, mood swings

Front 19

Cushing’s Syndrome

Back 19

Moon facies, hirsutism, acne, truncal obesity with peripheral wasting, purple stirae, buffalo hump, osteoporosis, reddened expression, hyperglycemia, HTN (DM) (seen in those on chronic GC tx, hyperadrenalcorticoism (exo/endo)

Front 20

Addison’s Ds

Back 20

Cortical insufficiency, buccal pigmentation (purplish/black), GC def, wt loss, hypotension, hyperpigmentation of the skin as well in the creases, hands elbows(bronze) (b/c the increase in ACTH also leads to an inc in MSH) Scarring does occur b/c it is a developmental dz, wkness, postural hypotension, hypoglycemia

Front 21

Acromegaly

Back 21

Large nose, coarsened enlargement of hands (spatula-like), DM, gigantism (kids), acromegaly (adults) Widening of the hands, jaws, nose, feet due to an increase in GH. Patients will notice that their hats and rings do not fit anymore. Gradual changes

Front 22

Marfan’s Syndrome

Back 22

Tall, lean, arachnodactyly, double jted, CV problems (25% mortality; prophlactic aortic prothesis): aortic aneurysms, AI, aortic dissection (preg related), aortitis, high arched palate, long bones, lax jts, arm span bigger than ht, scoliosis, eye ectopic levitis (lens dislocation)

Front 23

Cretinism

Back 23

Congenital hypothyroidism, floppy, hypotonic, flaccid, lethargic baby, slow pulse, mental retardation, flattened broad nose, protuberant tongue, can tx (looks like Down Sydnrome), umbilical hernia, overwt, short

Front 24

Achondroplasia

Back 24

No mental retardation, normal trunk, shortened limbs, sway back, normal head size

Front 25

Pernicious Anemia

Back 25

Megoblastic, chronic, pallor, B12 def, lemon yellow color/jaundice, pale conjuctiva, Hb less than 6 redlines on hand disappear, increased heart ; tx with B12 will make own RBCs (transfusion a bad idea can lead to pulm edema)

Front 26

Sickle Cell Dz

Back 26

Frontal bossing (extramed hematopoeisis), scleral icterus, jaundice; hemolysis leads to plugging of blood vessels ‡ hemolytic crisis is painful

Front 27

Turner’s Syndrome

Back 27

XO, web neck, no secondary sex characteristics, infertile, broad carrying of arms, coarctation of the aorta

Front 28

Rickets

Back 28

In kids: Vit D def, abnormal mineralization of the bone, bowing of legs, fractures, osteoclasts resorption 40X NL rate, cotton wool on x-ray, leads to high output heart failure
Ricket’s rosary: when press against epigastric region of abdomen the costochondrial connections become more prominent (adults: osteomalacia)

Front 29

Paget’s Dz

Back 29

Disease of older people (50+, peak 70s-80s) enlargement of skull, veins in scalp may become engorged, may be deaf, bowed legs, long bone involvement, bone thickening, increased alkaline phos due to turnover

Front 30

Down Syndrome

Back 30

Varied mental retardation, dull face, prominent epicanthal folds, large protruding tongue, short 5th digit, simian crease in palm, slightly oblique slant to the eyes, blank stare, round head, flat nasal bridge; short stature

Front 31

Malignant Cachexia

Back 31

Severe wasting, muscle degeneration, total temporal wasting seen in AIDS, TB, cancer, despite eating food

Front 32

Virchow’s Node

Back 32

Enlargement of the LN in the left supraclavicular fossa b/c the thoracic duct empties there; suggestive of gastric/pancreatitic (drains LUQ) carcinoma mets; aka sentinel node

Front 33

Pott’s Dz

Back 33

Pulmonary TB which has extended to the vertebral bodies, crushed in wedge shape ‡ kyphoscoliosis (humpback appearance), osteomyelitis, cold abscess if drains out TB

Front 34

Fever Sore

Back 34

Due to HSV-2 on margin of nose, blistery appearance at lips, no mucosal appearance, can be hemorrhagic, cold sores, vesicular-indurated, erythematous margin

Front 35

Obesity (morbid)

Back 35

Impaired lymphatic/vascular drainage (venous stasis), when sitting fat from stomach may compress the femorals and the lymphatics and also they do not move blood b/c they are not walking
Android: apple-shaped, abdominal: has a greater disease (CAD) risk than gynoid obesity (pear-shaped)

Front 36

Edema (pitting)

Back 36

Tense, tubular, shiny appearance, most edema is due to elevated plasma hydrostatic pressure but can also be due to decreased plasma oncotic pressure
Pitting edema: when you press you finger on the edematous surf. for several seconds an impression is left behind (3-4 min)

Front 37

COPD

Back 37

Orthopnea (must sit up to breathe).
No problem getting air in but problem getting the air out→increased AP diameter
Patients appear barrel-chested
Patients have a high Hct and therefore may appear ruddy; cyanotic because of increased levels of deoxyHb in blood

Front 38

Otitis externa

Back 38

Pain when pull back on the ear gently; chronic purulent exudate

Front 39

Otisis media:

Back 39

Middle Ear infection; bulging tympanic membrane, TM bluish-black red and inflamed (vascular)

Front 40

Ramsey-Hunt Sign

Back 40

When varicella-zoster virus (VZV) involves the geniculate nucleus and causes facial paralysis during a bout of shingles, rare but painful; affects the cutaneous branch of the 7th nerve (area around the parotid); look like otitis externa but the canal is clean

Front 41

Tophus:

Back 41

Gout-related uric acid build up; feels like a rock on the external portion of the ear (helix or antihelix); subcutaneous and periarticular nodular deposits of urate crystals. Other than the ear common sites include: 1st MTP jt of the foot, finger, elbow, Achilles tendon, highly specific but non-sensitive sign of gout

Front 42

Exostosis:

Back 42

Boney overgrowth in the ear canal (problem if getting a hearing aid)

Front 43

Scarred, perforated tympanic membrane

Back 43

Painless, if you see this you will recognize it; chronic inflammation

Front 44

Deafness:Conduction vs sensorineural

Back 44

Normally air conduction is better than bone conduction.
Conductive loss: If patient has conductive hearing loss, then bone conduction will be greater than air conduction during the Rinne test
Sensorineural loss: have both AC and BC that is impaired but AC is still better than BC
Then do the Weber test which will show that hearing lateralizes to the ear on the side of the conductive hearing loss

Front 45

Serous otitis

Back 45

Perforation and fluid drain (hearing loss); may have to lance accumulation to release the pressure; the TM will either bulge or retract

Front 46

Nasal Polyp

Back 46

Most common cause of anosmia (loss of smell); usually bilateral and causes obstruction. Commonly seen in patients with allergic rhinitis

Front 47

Arcus senilis

Back 47

Grayish ring at the perimeter of the cornea that is seen with advancing age; does not interfere with vision and isn’t pathologic

Front 48

Arcus cornea

Back 48

High cholesterolemia

Front 49

Scleral icterus

Back 49

Sclera looks yellowish because of jaundice (elevated bilirubin in the blood; levels over 3.5) Also look under the tongue

Front 50

Cataracts

Back 50

Pearly white; can occur in cornea and in the lens (seen through the pupil) Seen over the cornea, pupil, and lens in DM

Front 51

Lid lag

Back 51

Seen in Hyperthyroidism: when the patient quickly looks down you see the sclera above the iris

Front 52

Exopthalmos (proptosis)

Back 52

Seen in hyperthyroidism: bulging eyes, person looks like they are staring

Front 53

Horner’s syndrome

Back 53

Paralysis of the sympathetic system; interruption of the ipsiliteral cervical sympathetic chain:
-Ptosis (drooping eyelide caused by loss of sympathetic innervation of the tarsal muscle can be overcomed by looking up, not like CN VII injury),
-Miosis (papillary constriction b/c the sympathetic system normally dilates the pupil),
-Affected side of face is not sweaty (anhydrosis),

Front 54

Fixed dilated pupil

Back 54

Associated with ingestion of sympathomimetic agents, with glaucoma, or with administration of dilating drops, can also be due to Adie’s tonic pupil (a condition where the pupil constricts little in response to light and accommodation and associated with diminished deep tendon reflexes, in the extremities

Front 55

Keyser-Fleischer ring

Back 55

Copper deposition around the iris of the eye seen in Wilson’s Dz

Front 56

Band Keratopathy

Back 56

Pain and decreased visual acuity.
Metastatic calcification of the central cornea, which by definition, occurs in the presence of hypercalcemia.
Causes can include trauma such as surgery.
Hypercalcemia develops in patients with renal failure, sarcoidosis and certain malignancies.

Front 57

Chemosis

Back 57

Edema of the conjuctiva usually due to low albumin, inflammation but may also occur if the drainage of the blood and lymph from around the eye is obstructed; extraocular tissues are also water-logged (nephrotic syndrome, cirrhosis)

Front 58

Colobomus
Coloboma iridae def

Back 58

Cataract surgery done without laser may show this defect: a wedge cut out of the iris; rarely congenital

Front 59

Extopia lentis

Back 59

Occurrence of the lens in an abnormal location

Front 60

Xanthelasma

Back 60

Cholesterol/LDLs accumulation (yellow deposits) seen in upper and lower eyelids, irregularly scalloped margin; common in the elderly and usually insignificant but may be a sign of hyperTG

Front 61

Chloasma

Back 61

“Mask of pregnancy” Ring of hyperpigmentation surrounding eyes and nose (forehead, temples, and cheeks) due to hyperestrogenic state (pregnancy, Oral contraceptives) May also be seen in cirrhotic patient who has increased levels of estrogen (rare)

Front 62

Subconjuctival petechiae

Back 62

Red dots. Seen in endocarditis (Ag-Ab complexes clog the vessels which then rupture), thrombocytopenia, scurvy.

Front 63

Roth spot

Back 63

A pale area surrounded by hemorrhage sometimes seen in the retina with the aid of an opthalmascope, in those who have bacterial endocarditis, septicemia, or leukemia

Front 64

Argyll-Robertson pupils

Back 64

“Prostitute’s eyes” Accommodates but does not react to light; pupil does not constrict but when the patient is asked to look at something close the pupil accommodates (constricts), a sign of tertiary syphilis, unknown exactly where the lesion is (also true in Lyme Dz) Bilateral and symmetric; loss of papillary reflex

Front 65

HTN evidence in eyes:

Back 65

All of these grades are additive
Grade 1: mild narrowing of the arteries (wall thickened) with respect to the veins
Grade 2: Veins look pinched at crossing pts; blood pushed out of the veins; A-V compression or nicking
Grade 3: Hemorrhages at the branch pts (retina/vitreous), edema, exudates, sclerotic/spastic arteries
Grade 4: papilledema (margins lost, disk becomes engorged b/c of the increased P and the venous blood has a lot of trouble getting out), exudates, and extensive hemorrhages
Cause: HTN

Front 66

Arteriolar narrowing

Back 66

Caused by HTN, has decreased light reflex due to narrowing

Front 67

Flame-shaped hemorrhages

Back 67

Caused by HTN/DM. Looks like red streaks in the retina, originated from nerve fibers layer of retina, linear due to the leakage into the aqueous humor, often due to the rupture of microaneurysms

Front 68

Exudates

Back 68

Caused by DM. Looks like cotton-wool spots which are microinfarcts surrounded by a ring of dilated capillaries or hard exudates due to leakage of protein and lipid from capillaries

Front 69

Papilledema

Back 69

Vague disc margins and engorged vessels, disc also rises; does not effect vision.
Due to increased ICP.

Front 70

DM retinopathy

Back 70

-Simple: retinopathy with increased capillary permeability, capillary closure, and dilatation, microaneurysm → pontate hemorrhage if ruptures (microaneurysm also seen in knuckles in the small arterioles), A-V shunts, dilated veins, hemorrhages (dot and blot), cotton-wool spots, hard exudates
-Proliferative: new vessels (obliterate light from getting into the retina), scarring , vitreal hemorrhage, retinal detachment
NO PAPILLEDEMA

Front 71

Optic atrophy

Back 71

Can be due to MS and several lysosomal storage Dz including: GM2 gangliosidosis (AB variant), metachromatic leukodystrophy), sulfatide lipodosis, neuronal cerois lipofuscinosis
Small optic disk (white disk instead of pink, yellow)

Front 72

Chorioretinitis

Back 72

Can be due to toxo, CMV, AIDS, parasitic and infectious dz
Diffuse inflammatory lesion often called a “bomb-blast”, peripheral visual field affected, possibly the central

Front 73

Cherry Red spots

Back 73

Can be due to several lysosomal storage Dz including: GM1 gangliosidosis, GM2 gangliosidosis, Sandhoff gangliosidosis, Niemann-Pick, sphingomyelin, lipodosis, sialidosis, and galactosialidosis
Bright red spots in the retina

Front 74

Cholesterol embolus

Back 74

Caused by hypercholesteremia
Small white obstruction of the ophthalmic artery. May lose the visual field served by that branch can get amarosis fugax (fleeting blindness). Presents with scotoma

Front 75

Subconjuctival hemorrhage

Back 75

Trauma related
Red eye, painless, resorbs in a few days (red ‡ green yellow)
Could a problem in those on anti-coagulants; might be a sign that one needs to lower the dose

Front 76

Glaucoma

Back 76

Due to increased intraocular pressure. Pushes disc back. Veins push over the lip into the cup

Front 77

Torus palatinus

Back 77

Caused by exostosis (benign bone growth); congenitalHard nodular lesion in the middle of the palate, very slow growing, progressive, painless. Might cause a problem with dentures but is not a speech impediment

Front 78

Atrophic glossitis

Back 78

Divet in tongue seen in pernicious anemia b/c of B12 deficiency

Front 79

Thrush

Back 79

Oral candidiasis. White-yellow plaques, scrapes off, diffuse oral pain and burning, edema difficult to swallow. Seen in the immunosupressed (AIDS), or due to chronic Ab or GC use

Front 80

Chelosis

Back 80

Due to malnutrition. Ulcers are see n in the corners of the mouth. Multi-vitamin deficiency

Front 81

Argyria

Back 81

Due to silver poisoning. Blue-grey deposits of silver

Front 82

Peutz-Jehger Syn

Back 82

Telangectasia of the GIAngiomata of the lips and buccal mucosa, brown pigmentation around the lips, nose, eyes, and ands, associated with intestinal polyposis, smooth muscle tumors and small bowel tumors

Front 83

Koplik’s spots

Back 83

Due to measles (pathognomonic). Small red spots with blue-white center on the buccal mucosa usually in the level of the lower teeth appears 1-2 days before the rash; whitish discoloration. Locally painful

Front 84

Tonsilitis

Back 84

Due to bacterial infection, often Strep. Exudate on tonsils only (spares the uvula and the back of the oropharynx), red swollen tonsils, dysphagia

Front 85

Leukoplakia

Back 85

Multiple often precancerous. White patch on tongue that does not rub off, often with sq metaplasia (pipe/cigar smokers)

Front 86

Gingivitis

Back 86

Bacterial infection. Inflammation of the gums, painless, may bleed

Front 87

Gum hypertrophy

Back 87

Dilantin, pherrytoin, nifedipine, idiopathic familial, associated with leukemia. Gingival hypertrophy may cover the teeth (might not be able to see them), often bleed

Front 88

Palatal petechia

Back 88

Due to mononuceleosis. Small red spots in the mouth

Front 89

Chvostek’s sign

Back 89

Due to hypocalcemia either primary or secondary due to hyperventilation and hypermagnesemia. Neuromuscular irritability, tap on the CN VII and will see twictching of the facial muscles. HypoCa, HypoMg, hyperventilation, tetany

Front 90

Enlarged Thyroid

Back 90

Due to multiple etiologies: iron def, and thyroid pathologySwelling of the neck in thyroid region, not diagnosticGoiter (bottom of the neck moves)

Front 91

Supraclavicular adenopathy

Back 91

Always bad, associated with cancer and TBSeen on the left (Virchow’s) upper GI malig, if it is on the right then it is suggestive of lung cancer (pancostal cancer)Diffuse LAD (AIDS)

Front 92

Hodgkin’s Dz

Back 92

Lymphoma. Firm, rubber, non-tender nodes, often starts in cervical region and then spreads to contiguous LNs

Front 93

Scrofula

Back 93

In developing countries, caused by non-pasteurized milk: sub Q TBCervical/supraclavicular node enlargement that supparates, node is infectious

Front 94

Bell’s Palsy

Back 94

Damage to CN 7Flattening of the naso-labial folds As the patient to smile and if Right side of the face is drawn to the left the patient has right facial palsy. Can also be due to Lyme Dz

Front 95

External JVD

Back 95

Indicates increased RA pressure. RAP is high when there is neck vein distension up to the jaw margin while the patient is seated at a 90 degree angle; usually RAP exceeds 15 mmHg

Front 96

Stiffness of the neck

Back 96

Usually caused by spasm if the cervical muscles and is commonly the cause of tension HA. Sudden occurrence of a stiff neck, fever, and HA suggestive of meningitis. Neck pain may be associated with referred pain from chest. Patients with angina or a MI may complain of neck pain.

Front 97

Cervical adenopathy

Back 97

Posterior cervical chain is felt in the posterior triangle Superficial cervical chain is found along the SCM muscle, and hook around the SCM to feel for the deep cervical chain in the anterior triangle. Observe for mobility, consistency, and tenderness. Tender LNs suggest inflammation, whereas fiexed, firm nodes are consistent with malignancy

Front 98

Thyroglossal Duct Cyst

Back 98

Inspect size and shape of neck of the pediatric patient. The cyst is found midline. Thyroid diverticulum arises from the floor of the primitive pharynx and descends into the neck connected to the tongue by the thyroglossal duct, which normally disappears but may persist. The foramen cecum is a normal remnant of the thyroglossal duct.

Front 99

PULMONARY

Back 99

If dull = fluid or solid / If resonant = air

Front 100

Emphysematous Chest

Back 100

Wide A-P diameter, supporting arms, pursed lips exhalation, no clubbing. Pink puffers. Think weak, severe association with little cough and sputum production. Use of accessory muscles of breathing. Palpation: decreased tactile fremitus Percussion: increased resonance (b/c of decreased density of lung/more air than matter)/decreased excursion of the diaphragm. Auscultation: decreased lung sounds, decreased vocal fremitus

Front 101

Rales = Crackles

Back 101

Can be wet or dry Fluid in the alveoli. Sounds crackly. Excess airway secretions. Etiology: bronchitis, respiratory infection, pulmonary edema, atelectasis, fibrosis, and CHF

Front 102

Ronchi

Back 102

Narrowing due to fluid in large airways (transient airway plugging (i.e. bronchitis); low pitched

Front 103

Wheezes

Back 103

Exhalation. Rapid airflow through obstructed airway. Asthma, pulmonary edema, bronchitis, CHFWheezes sound like ronchi but due to bronchoconstriction not mucus production like ronchi (Ronchi = bronchitis/wheezes = asthma)

Front 104

Pectoriloquy

Back 104

“chest speaking” with transmitted voice sounds. Term given to the intensification of the whispered word heard in the consolidation of the lung. Instruct person to whisper 1,2,3, increased transmission and words will be clearly auscultated over consolitdated lung

Front 105

Pleural Friction Rub

Back 105

Grating sound produced by the motion of the pleura, which is impeded by frictional resistance. Best heard at the end of inhalation and the beginning of exhalation. Described as the sound made by a creaking leather. Heard when pleural surfaces are roughened or thickened by inflammation or neoplastic cells or by fibrin deposits. Etiology: pneumonia, pulmonary infarction

Front 106

Sub-Q Crepitus

Back 106

Feels like bubble wrap under skin. Felt in the pneumothorax and gas gangrene

Front 107

Lobar pneumonia

Back 107

Tachycardia, fever, coughing, purulent sputum, possible cyanosis, splinting on the affected side, affected lobe increased fremitus at site of consolidation, dull to percussion, crackles, bronchial breath sounds (ronchi), (bronchophony, pectriloquy, egophony,

Front 108

PneumothoraxInc air in lungs

Back 108

Tachypnea, tachycardia, often normal lag on the affected side, absent/dec tactile fremitus, trachea may be shifted to unaffected side in mediastinum, hyperresonant to percussion, absent breath sounds

Front 109

Pleural Effusions

Back 109

Tachypnea, tachycardia, often normal lag on the affected side, dec tactile fremitus, absent breath sounds, dull to percussion, SOB, decreased expansion of the chest, bronchial breathing sounds, pleural friction rub

Front 110

Atelectasis

Back 110

Collapse of whole or part of a lung. Tachypnea,, often normal to inspection, trachea shifted to the same side, dull to percussion, absent breath sounds, diaphragm higher, many get consolitdation, collapse due to destruction

Front 111

Asthma

Back 111

Often physical findings not reliable in predicting severity. Tachypnea, tachycardia, dyspnea, use of accessory muscles, possible cyanosis, hyperinflation, often normal can be decreased fremitus b/c of hyperinflation, percussion often normal but can be hyperesonant with a low diaphragm, prolonged expiration, wheezes (esp on expiration), decreased lung sounds, normal CXR with hyperinflation

Front 112

Pulmonary Edema

Back 112

Tachypnea, tachycardia, possible signs of elevated right heart pressures (elevated JVD, pedal edema, H-S), often normal to palpation, usually normal to percussion, crackles, wheezes, fluffy infiltrates in alveoli, congested central vessels, pleural effusion, right sided heart failure.

Front 113

Pulmonary Fibrosis

Back 113

Progressive dyspnea, tachypnea, dry cough, chest pain, SOB on exertion, clubbing ,decreased chest expansion, nl or decreased percussion, nl or decreased breath sounds

Front 114

Cardiac enlargement

Back 114

Percuss the heart borders at the 3rd, 4th, 5th intercostals spaces from the left anterior line to the right anterior axillary line. Normally there will be a change in the percussion note from the resonance to dullness about 6cm lateral to the left of the sternum. This dullness is due to the presence of the heart. The sensitivity of this technique is low for the estimation of the heart size. In some clinical conditions percussion may be useful. Dextocardia and tension pneumothorax of the left chest.

Front 115

Murmurs:

Back 115

Classified according: timing, shape, pitch, grade, location, radiation, length Grades:Soft barely audibleSoft but easily heard Loud without thrill Loud with thrill and palpable over PMI Very loud with an easily palpable thrill Very loud with stethoscope off chest (palpable thrill)Aortic: AS, flow Pulmonic: PS, flow Tricuspid: TR, TS, VSD, ASD Mitral: MR, MS Persistent sounds of vibration occurring at valves or structures near valves; caused by turbulent flow Partial obstruction of a stenotic valve Valvular or intravalvular abnormality (sclerorsis) Increase flow through a normal valve: pregnancy, exercise, anemia, childrenFlow from on chamber to a more dilated one Back flow (regurge)Shunt of blood from high pressure area to a low pressure arewa (A-V fistula, PDA, dialysis shunt)

Front 116

Holosystolic murmur:

Back 116

Occurs throughout systole, begins with S1 and ends after S2. Regurgitant systolic murmurs are produced by retrograde flow from a higher pressure area to a lower pressure area during systole such as mitral or tricuspid regurgitation (VSD (harsh), mid left sternal border) An S3 is indicative of volume overload. These murmurs are high pitched, best heard with the diaphragm, mitral at apex. Flat envelope shaped.

Front 117

Systolic Eject Murmur

Back 117

Produced by turbulence across the semilunar valve during systole, such as in AS or PS, ASD, Idiopathic hypertrophic subaortic stenosis. They are diamond shaped. Crescendo-decrescendo. Begins slightly after S1 and ends before S2. An ejection click from stenosis of the semilunar valve may precede the murmur. Medium pitched, best heard with the diaphragm. The murmurs are based on flow, the intensity doesn’t indicate the severity. Best heard at base.

Front 118

Diastolic murmurs

Back 118

Diastolic AV murmurs begin a finite time after S2 with the opening of the AV valve. Mitral and tricuspid stenosis, ASD. Pause between S2 and the beginning of the murmur. Decrescedo, begins with the opening snap if the valve is mobile. Low-pitches, best heard with the bell while the patient is in a lateral decubitus position. Diastolic semilunar murmurs: begin immediately after S2 seen with aortic or pulmonic regurgitation. High pitched decrescendo murmur best heard with diaphragm of the stethoscope while patient is sitting up and leaning forward.

Front 119

Pericardial Fric Rub

Back 119

Extracardiac sounds of short duration. Sounds like scratching on sandpaper. May result from the irritation of the pericardium. Typically there are 3 components: 1 systolic, 2 diastolic (rapid filling and atrial contraction). Best heard with patient sitting while holding breath in expiration. Chest pain lessened by sitting forward

Front 120

Levine’s Sign

Back 120

Description of agina: clenching fist and placing it over the sternum; pathognomonic of angina. Pain in the cervical distribution: jaw, ulnar nerve

Front 121

Quincke’s Pulsations

Back 121

The capillary pulse as appreciated in the finger and the toenails in aortic regurgitation. Ebb and flow is seen.

Front 122

C-V waves:

Back 122

Right atrial pressure during systole. In jugular venous pulse drop in RAP is the c wave and is due to tricuspid valve closure secondary to right ventricular contraction. The descent of the AV valve ring produces the next change in pressure. During ventricular systole the right atrium begins to fill blood returning via the vena cava. The increase in RAP as a result of its filling produces the v wave.

Front 123

Cannon a wave

Back 123

"Cannon a waves" or increased amplitude 'a' waves, are associated with AV dissociation (third degree heart block), when the atrium is contracting against a closed tricuspid valve.

Front 124

S1

Back 124

Might split a little because to the mitral and tricuspid not closing n’sync. The shorter the PR on the ECG the louder the S1. (listen at apex)

Front 125

S2

Back 125

When the aortic and pulmonic valves close. Splitting may occur with inspiration and heard best at the end of it. (A2/P2)Wide split of S2 is often associated with ASD, PS, RBBB, right ventricular overload (acute massive pulmonary embolus or PS) (MR, VSD, PDA said in class) Paradoxical split (P2 before A2, so split narrows with inspiration) LBBB, AS Listen at base

Front 126

S3Ventricular Gallop

Back 126

Physiologic: Heard frequently in children. May persist in young adults to age 35-40. Common during the last trimester of pregnancy. Most well conditioned athletes have an audible S3. Occurs in early diastole during rapid ventricular filing, later than opening snap. Dull and low in pitch. Heard best at the apex in left lateral decubitus position, using the bell of the stethoscope. Vibrations of the left ventricular structures. Pathological: sounds like physiologic S3. S3 in person over 40 is almost certainly pathologic. May be caused by decreased myocardial contractility, myocardial failure, volume overloading of a ventricle (as in mitral or tricuspid regurgitation). Left sided S3 heard at the apex in the left lateral position. Right sided S3 heard along the left sternal border or below the xiphoid. Louder on inspiration. Overload conditions correlates with rapid diastolic filling. (CHF, DCM)

Front 127

S4Atrial Gallop

Back 127

Occurs just before S1. Dull, low in pitch heard better with the bell.Physiologic: occasionally in the trained athletes or older age groups.Pathologic: due to increased resistance to ventricular filling following atrial contraction (increased resistance is related to decreased compliance of ventricular myocardium). Causes of left sided S4: hypertensive heart disease, coronary artery disease, aortic stenosis, idiopathic hypertrophic cardiomyopathy, acute myocardial ischemia or infarction, and heard best at the apex in the left lateral position. Causes of right sided S4: (Less common) pulmonary HTN, pulmonic stenosis heard along the lower left sternal border or below the xiphoid, louder with inspirationS4 may also be associated with delayed conduction between atria and ventricles-the delay separates the normally faint atrial sound from the louder S1 sand makes is audible S4 is never heard in the absence of atrial contraction as with atrial fibrillation Occasionally a patient with both S3 and S4: will have what sounds like a quadruple rhythm of four heart sounds. At rapid rates, S3 and S4 may merge into one loud extra heart sounds = “Summation gallop”

Front 128

Pericardial Tamponade

Back 128

Prototype of extracardiac obstructive shock in which the major abnormality is the inability of the ventricle to fill during diastole, markedly limiting the stroke volume and ultimately the CO Clinical: hypotension, pulsus paradoxus, distended neck veins, increased PCWP, decreased CO

Front 129

CHF

Back 129

Insufficiency of the cardiac pump mechanism causing dyspnea (exertional or non-exertional, orthopnea, SOB, nocturia, abdominal discomfort, cyanosis, tiredness on minimal exertion peripheral edema (pitting), JVD, pleural effusion, rales (if pulmonary congestion), hepatomegaly (NL e finger breath under costal margin but with CHF 4-5 finger breaths below the costal margin), evidence of pericardial effusion (pulsus paradoxus, distant heart sounds) Tx: by diminishing the cardiac return (diuretics)

Front 130

Cardiogenic Shock

Back 130

Due to sever depression of systolic cardiac performance Systolic arterial pressure less than 80 mmHg and cardiac index is below 1.8 L/min/m2. LV filling pressure is elevated (about 18mmHg)Clinical: Pulmonary edema, may/may not be evident, patient is frequently obtunded, urine output less than 20 ml/h, cold and cyanotic extremities, gallop rhythm, other manifestations of acute heart failure. Caused by: Myopathic: acute MI, DCM, myocardial depression in septic shock, acute myocarditis  lead to a severe reduction in myocardial contractility Mechanical: mitral regurgitation, VSD, ventricular aneurysm, LV outflow obstruction (AS, idiopathic hypertrophic subaortic stenosis) cause reduction in forward COArrhythmic: hypotension

Front 131

Acute bac endocarditis

Back 131

Clinical: fever, arthralgias, arthritis, new cardiac murmurs or change in murmurs (esp aortic regurg), splenomegaly, subconjuctival petechiae (in 30% esp if long term), splinter hemorrhages (subungal, linear, dark red streaks; can also be seen as a result of trauma), Janeway lesions (small hemorrhages with a slightly nodular character on the plams and soles), myocardial abscesses, renal dz (due to renal emboli or GN), Roth’s spots (petechiae with central pallor on retina) Chronic cases: clubbing, splenomegaly

Front 132

Mitral Regurgitation

Back 132

Mitral valve fails to close fully in systole so blood regurgitates from LV to LA causing a murmur. Leakage creates a volume overload on the LV which leads to dilatation and hypertrophy. Murmur: Holosystolic, flat envelope. Located at the apex, radiates to the left axilla, (less often to the left sternal border). The intensity can range from soft to loud with a pitch of medium to high, blowing quality but does not become louder with inspiration. Associated findings include: decreased S1, apical S3 reflects the volume overload on LV, apical impulse is increased in amplitude and may be prolonges. Causes include: Mitral prolapse, endocarditis, MI (ruptured papillary muscles), rheumatic fever

Front 133

Mitral Stenosis

Back 133

Leaflets of the mitral valve thicken and become distorted from the effects of rheumatic fever causing failure of the valve to open sufficiently in diastole Murmur has two components: low pitches diastolic rumble accentuated the systolicMid-diastolic (during rapid ventricular filling) Pre-systolic (during atrial contraction w/atrial kick; murmur disappears if atrial fibrillation develops) Located at the apex with little or no radiation, low pitch (use the bell), best heard during expiration. Heard better with the patient in a left lateral decubidous position to hear it at the apex. Associated findings include: S1 is accentuated and may be palpated at the apex, opening snap often following S2 and initiates the murmur. If pulm-HTN develops P2 is accentuated and RV impulse becomes palpable. Mitral regurg and aortic valve disease may be associated with MS

Front 134

Mitral Valve Prolapse

Back 134

Abnormal systolic ballooning of part of the mitral valve into the LA. Common cardiac condition, affecting about 5% of young adults, more common in women. Systolic click usually mid or late systolic but occasionally early. Click is high pitched and usually crescendos up to S2, usually a single click. Heard best with the diaphragm at or medial to the apex but may also be heard at the lower left sternal border. Click is often followed by a late systolic murmur which indicated mild mitral regurg.

Front 135

Aortic Regurgitation

Back 135

Leaflets of the aortic valve fail to close completely during diastole and the blood regurgitates from the aorta back into the left ventricle resulting in volume overload of the LVMurmur: Early decrescendo diastolic murmur. Two other murmurs may be associated suggesting a large regurgitant flow: 1. mid-sytolic murmur from the increased flow across the aortic valve 2. a mitral diastolic (Austin flint) murmur due to diastolic impingement of the regurgitant flow on the anterior leaflet of the mitral valve Located in the 2nd to 4th intercostals spaces, radiation to the apex and maybe right sternal border, high pitch (used the diaphragm), blowing quality (can sometimes be mistaken for breath sounds). Heard better with the patient leaning forward do the base of the heart is closer to the chest wall. Associated findings include: an ejection sound may be present, an S3 or S4 may be present suggesting severe regurge, progressive changes in the apical impulse including increased amplitude, diaplacement laterally and downward, widened diameter and increased duration, pulse pressure increases and arterial pulses are often light and bounding (Corrigan’s pulse)

Front 136

Aortic Stenosis

Back 136

Impaired blood flow across the aortic valve causing turbulence and increasing the afterload on the left ventricleMurmur: mid-systolic murmur, diamond shaped, crescendo-decrescendo Caused by: rheumatic fever, congenital, degenerative Located in the right 2nd intercostals space and often radiates to the neck and down the left sternal border and even to the apex. Intensity varies: soft – loud with a thrill. Medium in pitch. Harsh quality, may be musical at the apex. Associated findings include: A2 decreases as the stenosis worsens, A2 may be delayed, merging with P2 to form a single paradoxical splitting, an S4 may be present at the apex, reflecting decreased compliance of the hypertrophied LV, a sustained apical impulse often reveals HLV, carotid artery impulse may rise slowly and feel small in amplitude.

Front 137

Tetralogy of Fallot

Back 137

Pulmonary Stenosis, Right Ventricular Hypertrophy (2ndary to the PS), VSD, overriding aorta. Basic anomaly results from anterior and superior deviation of infundibular ventricular septum away from its usual location in the heart between the limbs of the trabecular septum causing a very small pulmonary artery and a very large aorta. Clinical: Determined by the severity of the RV outflow obstruction (PS). Severe: Markedly reduced pulmonary blood flow leads to shunting of systemic blood from R L across the VSD into the aorta; so blood from both the RV and LV enter the aorta and circ around body without reaching the lungs: severe cyanosis and erythrocytosis occur and symptoms of systemic hypoxemia Associated murmurs: holosystolic, harsh, grades 3-5, best heard at the left 2nd and 3rd intercostals spaces, not well transmitted and may be absent in infancy

Front 138

Tricuspid Regurgitation/ Insufficiency

Back 138

Tricuspid valve fails to close fully in systole causing blood regurgitation from RV to RA producing a holosystolic murmur Caused by: RV failure and dilatation (2ndary to pulm-HTN or LV failute), with resulting enlargement of tricuspid orifice Located lower left sternal border with radiation to the right of the seternum, xiphoid area and maybe to the left midclavicular line but not to the axilla. Has variable intensity, medium pitch, blowing quality, intensity may be slightly increased with inspiration (unlike mitral regurg murmur) Associated findings include: RV impulse is increased in amplitude and may be prolonged, S3 may be audible along the lower left sternal border, JVD often and large v waves may be seen in the jugular veins

Front 139

VSD

Back 139

A congenital abnormality in which blood flows from high pressure LV into low pressure RV through a hole (L R shunt)Holosystolic murmurLocated 3rd-5th left interspaces, often wide radiation, often very loud intensity with a thrill, high pitch, harsh Associated findings include: A2 may be obscured by the loud murmur, findings vary with the severity of the lesions and the other associated defects Must repair in childhood

Front 140

ASD

Back 140

Patients with ASD usually are asymptomatic in early life, beyond the 4th decade a significant # develop atrial arrhythmias, pulmonary arterial HTN, bidirectional and then R  L shunting A grade 1-3 coarse systolic ejection murmur heard in the 2nd and 3rd intercostals spaces (b/c mild pulmonic stenosis); less coarse than the murmur of VSD, rarely accompanied by a thrill, and is not widely distributed Clinical: prominent RV cardiac impulse and palpable pulmonary artery pulsation, S2 is widely split and is relatively fixed in relation to respiration, may find a mid-diastolic rumbling murmur at the 4th intercostals space along the left sternal border which reflects increased flow across the tricuspid valve May not cause problem till adulthood; may not know it exists to repair in childhood

Front 141

PDA

Back 141

Congenital abnormality in which an open channel persists between aorta and pulmonary artery Continuous murmur in both systole and diastole (starts increasing at S1 and then peters out after S2) often with a silent interval in late diastole. Murmur is loudest in late systole, obscures S2 and fades in diastole (Pyramid shaped murmur) Located in 2nd intercostals space and radiates towards the left clavicle, intensity is usually loud and is sometimes associated with a thrill, quality is harsh and machinery-like, medium pitched Must repair in childhood

Front 142

Functional murmur

Back 142

Used to describe the ejection murmur produce by increased ejection velocity over a normal aortic or pulmonic valve in various pathologically/physiologically altered states. Can be heard in fever, anemia, exercise, pregnancy, or in high SV situations (bradycardia, complete heart block, aortic regurgitation)

Front 143

Hepatomegaly

Back 143

A palpable liver does not necessarily indicate Hepatomegaly, but more often results from a change in consistency-from normal softness to abnormal firmess as in cirrhosisApparent: downward displacement of the liver by a low diaphragm is a common finding (emphysema)-the liver edge may be palpable well below the costal margin but percussion reveals a low upper edge indicating that the vertical span of the liver is normal.Normal variations in iver shape-liver elongation (Reidel’s lobe) is a variation in shape, not in liver sizeActual: Smooth large nontender liver: cirrhosis may produce an enlarged liver with a firm nontender edge, however the liver is not always enlarged in this conditionSmooth large tender liver: enlarged liver with a smooth tender edge suggests inflammation-as in hepatitis or venous congestion (right sided heart failure)Large irregular liver: enlarged liver that is firm or hard and has an irregular edge or surface suggests malignancy. There may be one or more nodules and the liver may or may not be tender

Front 144

Splenomegaly

Back 144

When a spleen enlarges it does so anteriorly, downward and medially, often replacing the tympany of stomach and colon with the dullness of a solid organIt becomes palpable below the costal margin (palpation can confirm splenomegaly)Percussion can’t confirm Splenomegaly but can raise suspicions of itTraub’s space is percussed-get hyperresonance if spleen is NOT enlargedEvaluation of SplenomegalyAcute upper left quadrant pain with enlarged tender spleen suggests subcapsular hematomaSplenic infarcts can be due to either in situ red sickling or to emboliAcute febrile illnesss assoc with Splenomegaly may be due to bacterial endocarditis, Mono, TB, and histoplasmosisFever, peripheral adenopathy and spelnomegaly with or without a rash or arthralgias should suggest sarcoidosis, Hodgkin’s lymphoma, a Collagen-Vasc dz, or serum sickness

Front 145

Striae

Back 145

Stretch marks-old silver striae are normalPink purple striae are common in Cushing’s synd

Front 146

Hemorrhoids

Back 146

External (thrombosed)Dilated hemorrhoidal veins that originate below the pectinate line and are covered with skinThey seldom produce symptoms unless thrombosis occurs, which causes acute local pain which is increased by defecation and sittingA tender swollen bluish ovoid mass is visible at the anal marginInternal (prolapsed)An enlargement of the normal vascular cushions that are located above the pectinate lineNot usually palpableSometimes, esp. during bleeding they might cause bright red bleedingMay prolapse through the anal canal and appear as reddish moist protruding mass

Front 147

Courvoisier’s Sign

Back 147

Palpable gallbladderUsually enlarged in patients with CA of the head of the pancreas, but only palpable in 50% of cases. Non-enlarged gall bladder is gallbladder disease in which the organ fibroses

Front 148

Hydrocele

Back 148

A non-tender fluid filled mass that fills the space within the tunica vaginalisThe examining fingers can get above the mass within the scrotumThe mass transilluminates

Front 149

Varicocele

Back 149

Varicose veins of the spermatic cord, usually found on the left b/c of the drainage patternFeels like a soft “bag of worms” separate from the testes and slowly collapses when the scrotum is elevated in the supine patientInfertility may be associated

Front 150

Priapism

Back 150

A persistant painful erection, often unrelated to sexual activityDistinguished from a normal erection by the absence of tumescence of the glans penisMay be idiopathic but can be assoc with Sickle cell anemia, CML, SC injury or rarely injection of vasodilator agents into the penisThe disorder may be secondary to clotting of blood within the sinusoidal spaces of the penis or to abnormalities of the adrenergic-mediated mechanism for detumescenceFailure to treat priapism usually results in fibrosis and loss or erectile function

Front 151

Ascites

Back 151

Ascites fluid seeks the lowest point in the abdomen producing bulging flanks that are dull to percussionThe umbilicus may protrudeTurn the patient onto side to detect the shift in position of the fluid level (shifting dullness)Test for a fluid wave (have Pt. press edges of both hands firmly down the midline of the abdomen, then tap one flank sharply with your fingertips and feel on the opposite flank for an impulse transmitted through the fluid)

Front 152

Ventral hernia

Back 152

Defect in the abdominal wall through which tissue protrudesUmbilical Hernia: Protrudes through a defective umbilical ring. Most common in infants (usually close spontaneously within a year or two) but also occur in adults (usually do not close spontaneously)Incisional HerniaProtrudes through an operative scarA small defect through which a large hernia has passed has a greater risk of complications that a large defectEpigastric HerniaA small midline protrusion through a defect in the linea alba, somewhere between the xyphoid process and the umbilicus

Front 153

Inguinal Hernia

Back 153

Indirect:Most common hernia in the groin in all ages and both sexesPoint of origin is above the inguinal ligament, near its midpoint (internal inguinal ring)Course: Often extends into the scrotumP.E. (w/examining finger in the inguinal canal during straining or coughing): the hernia comes down the inguinal canal and touches the fingertipDirect:Less common, usually in men over 40, rare in womenPoint of origin is above the inguinal ligament, close to the pubic tubercle (near the external inguinal ring)Course: rarely into the scrotumP.E. The hernia bulges anteriorly and pushes the side of the finger forward

Front 154

Gynecomastia

Back 154

Breast enlargement on one or both sides-mediated by estrogen, results from disturbance of normal ratio of active androgen to estrogen in plasma or the breastApprox. 2 out of 3 adolescent boys will develop gynecomastia-usually slight and resolves spontaneously within a year or twoApprox 40% of normal men and up to 70% of hospitalized men have palpable breast tissuePathologic: Due to a deficiency in testosterone production or action, an increase in estrogen production or drugsOften secondary to cirrhosis

Front 155

Steatorrhea

Back 155

Large yellowish or gray, greasy, foul smelling and sometimes frothy or floating stools associated with malabsorption

Front 156

Monilial Vaginitis

Back 156

Inflammation of vagina and vulva marked by pain, itching and characteristic vaginal discharge (white color, absent fishy odor, cottage cheese-like consistency, adherent to walls),erythematous vulva and vaginal mucosa

Front 157

Bartholin’s Abscess

Back 157

Tenderness, swelling or pus in glands of labia. Normally, these glands cannot be seen or felt.

Front 158

Carcinoma of pancreas

Back 158

Major symptoms: Upper abd. PainBack pain, pain relieved by leaning forwardWt. LossJaundiceAnorexiaN/V50% have palpable gallbladderRisk factors: smoking, alcoholism, gall stones

Front 159

Carcinoma of breast

Back 159

Age 25-85Usually 1 lump, irregular shape, stony hard consistency, poorly delimited, fixed lesion, absent tenderness, skin retraction (compare to cystic DZ and benign adenoma)

Front 160

Peau d’orange

Back 160

Orange peel appearance of skin over breast, usually prominent pores indicative of lymphatic obstructionImportant sign of malignancy

Front 161

Mastitis

Back 161

One breast is red and inflamedCellulitis that is responsive to Ab’s

Front 162

Cirrhosis

Back 162

Related to hepatocellular failureSpider angiomataGynecomastiaPalmar erythemaAscitesDecreased body hairJaundiceTesticular atrophyImpotenceBleeding problemChanges in mental functionAsterixis: hands flap forward in a sporadic tremorRelated to portal-HTNAscitesEsophageal varicesHemorrhoidsCaput medusaSplenomegaly

Front 163

Testicular torsion

Back 163

Surgical emergency in which twisting of testis leads to venous obstruction, edema, and eventual arterial obstructionMost commonly seen in adolescents 12-18 yoComplain of acute, unilateral testicular pain with N/VOn PE: testis is enlarged and extremely sensitive, may be retracted and is often lying in the horizontal position

Front 164

Prostatic obstruction

Back 164

Usually from nodular hyperplasia (occurs in 50% of men oer the age of 60)Pts. Have nocturia, frequency, difficulty in starting and stopping urine flow, overflow dribbling, dysuriaInability to completely empty bladder can lead to pyelonephritis

Front 165

Acute abdomen

Back 165

Everything in this list can cause Acute abdomen

Front 166

Pancreatitis

Back 166

Gradual onsetEpigastric pain that goes through to the back, constant and often severePain relieved by leaning forward

Front 167

Acute cholecystitis

Back 167

Gradual onsetRUQ crampy intermittent pain radiating around to the backMay find palpable mass

Front 168

Perforated ulcer

Back 168

Sudden onset of sharp continuous pain that often wakes the patient from sleepStarts in epigastrum and quickly becomes diffusePosterior perforation into pancreas may present with back painGastric fluid in LUQ causes diaphragmatic irritation which may give rise to left shoulder painDiffuse peritonitis presents with rigid abdomen, percussive and rebound tendernessAbsence of liver dullness to percussion is a classic finding of free intra-abdominal air

Front 169

Appendicitis

Back 169

Gradual onset pain starting preumbilical area and moving into RLQNon-specific mild abd. Discomfort, anorexia and vomitingPerforated appendix presents with significant diffuse abd pain and toxic state

Front 170

Diverticulitis

Back 170

Usually LLQ, sometimes RLQ (usually constant pain with variable severity)Diff Dx: ischemic colitis, appendicitis, UTI, ovarian pathologiesRelieved by flexion of the left thigh

Front 171

Intestinal obstruction

Back 171

SBO:Gradual onset of periumbilical crampy intermittent painDiff Dx: appendicitis, Crohns, Meckels, cystitis, pancreatitis, pyelonephritisLBO:Gradual onset of lower abdominal suprapubic crampy painDiff Dx: SBO, UTI, perforated viscus

Front 172

Ectopic Pregnancy

Back 172

Severe abd pain about 6 weeks following a previously normal menstrual period. Shock like state

Front 173

Xanthoma tendinosum

Back 173

Stony hard slightly yellowish mass commonly found on the extensor tendons of fingersPathogneumonic of familial hypercholesterolemiaCan also be found on Achilles tendon and plantar tendon of soles

Front 174

Bunions

Back 174

Inflamed swelling of the small sac of the first joint of the big toe, assoc-with ill-fitting shoes

Front 175

Stasis Dermatitis

Back 175

Usually due to severe varicose veins of the lower extremitiesIn CHFEdema, skin scaliness, brownish pigmentation of lower legs, ulcerationSecondary infection (from scratching) leads to cellulitesCan lose limbs secondary to osteomyelitis

Front 176

Dupuytren’s contracture

Back 176

Irregular of nodular thickening of palmar fascia either unilaterally or bilaterally(50%) Slowly progressive flexion contracture mainly of fourth and fifth fingers of handcorrelated with alcoholism?

Front 177

Podagra

Back 177

Pain in first metatarsophalangeal joint assoc with redness and swellingSuggests GOUTBony excrescences from toescompromise blood supply and increased infection

Front 178

Tophus

Back 178

subQ, periarticular deposits of urate crystals in Goutfound over first metatarsophalangeal joint, finger, ear, elbow, Achilles tendon

Front 179

Varicose veins

Back 179

Abnormally dilated and tortuous veinsUsually in the superficial veins of legsMore common over age 50 in obese persons and in women b/c of elevated venous pressures caused by pregnancyLeads to venous stasis, congestion, edema and thrombosis

Front 180

Clubbing

Back 180

Initially, softening of tissue over proximal nail bed, as it progresses, base of nail becomes swollen and angle b/t nail base and finger exceeds 180 degreesAssoc with: A-V shuntingCongenital cyanotic heart diseaseCystic fibrosisAcquired pulmonary pathology-bronchogenic CA and bronchiectasisCOPD: does not give clubbingIBDInfective endocarditis

Front 181

Joint crepitus

Back 181

Noise or vibration produced by ubbing bone or irregular cartilage surfaces together as by movement of patella against femoral condyles in arthritis and other conditions

Front 182

Splinter hemorrhages

Back 182

Small, reddish brown lines found in nail bed, run from free margin proximally Assoc with subacute bacterial endocarditis (Ab-Ag complexes)Analogous to petechiae on conjunctiva

Front 183

Palmar erythema

Back 183

Clinical feature of hepatic failure, from local vasodilationHyperestrogenemic states

Front 184

Homan’s sign

Back 184

Calf pain on gentle squeezing of calf muscle or slow dorsiflexion of anklePositive in 50% of patients with femoral vein thrombosisLow sensitivity, should not be used as a single criterion for DVT

Front 185

Rheumatoid arthritis nodules

Back 185

Swelling of PIP, MCP and wrist joints, NOT DIPLeads to eventual ulnar deviationAlso on the extensory surfaces of the elbow

Front 186

Filariasis

Back 186

Persistent lymphedema of scrotum, penis, vulva, leg (elephantiasis) or armSee hydrocele, lymph node enlargementInfection with W. bancrofti

Front 187

Bed sore (heel) = ulcer

Back 187

Heel (and sacral area), pressure sores from bed rest, ulceration which can erode through skin and muscle into bone

Front 188

Ganglion cyst

Back 188

Small cystic nodule arising in the tendon sheath or the joint capsule of the wrist.Thought to be caused by myxoid degeneration of CTTx: burst it

Front 189

Knee effusion

Back 189

Increased fluid in synovial cavity of a joint

Front 190

Baker’s cyst

Back 190

A collection of synovial fluid which has escaped from the knee joint or a bursa and formed a new synovial-lined sac in the popliteal spaceSeen in degenerative joint diseases

Front 191

Arterial insuff of leg

Back 191

In diabetic often

Front 192

DVT

Back 192

Occurs when a blood clot forms in lower extremities or pelvic veinsPredisposing factors:Immobilization (leading to venous stasis)Venous incompetenceCHFInjuryHypercoagulable states (malignancy, estrogen use, hyperviscosity syndrome)Symptoms:Unilateral leg pain and swellingTenderness upon compression of leg muscles Pain upon dorsiflexion of foot (Homan’s sign)Dx: IVP, U/S, nuclear scanning, contrast venographyTx: anticoagulants/thrombolytic agents

Front 193

Raynaud’s

Back 193

Tips of fingers undergo triphasic color changeAssociated with scleroderma and vascular occlusive diseasesIce water immersion test

Front 194

RA

Back 194

Chronic inflamm disorder affecting synovial jointsMost common in women 20-50yoPathologyAutoimmune origin (genetic and environmental)Presence of RF, IgM with ant-IgG Fc specificityMost often occurs in HLA-D4MorphologySynovitisScute inflamm rxnhyperplasia and hypertrophy of synovial lining cellspannus granulation tissue over articular cartilagescarring contracture and deformitysubQ rheumatoid nodulesClinicalEpisodic changes: fatigue, malaise, anorexia, wt. loss, fever, myalgiaSwelling of joints and morning stiffnessPolyarticular and symmetric jt involvementPIP and MCP joints of hands are the most common sitesUlnar deviation of fingersMinimal radial deviation of wrist

Front 195

Gout

Back 195

Deposition of urate crystals in a number of tissues, esp. joints as a result of hyperuricemiaInflammatory response that leads to extremely painful acute arthritis and bursitisOccurs most frequently in MTP joint of great toe-acute gouty arthritis in this location is podagraLeads to formation of nodular tophi (joints, ear, Achilles tendon and other areas)TypesPrimary: hyperuricemia without evident causeSecondary: hyperuricemia with evident causeMyeloproliferative syndromesDecreased urate excretion due to chronic renal failureLesch-Nyhan syndrome

Front 196

Osteoathritis

Back 196

Degenerative joint dzChronic non-inflamm jt. Dz characterized by degeneration of articular cartilage accompanied by new bone formation subchondrally and at margins of affected jointRelated to mechanical trauma “wear and tear”Women>menMorphological changesLoss of elasticity, pitting and fraying of cartilage, fragments in synovial fluidEburnation: polished ivory-like appearance of bone, resulting from erosion of overlying cartilageCystic changes in subchondral boneNew bone formation with osteophytes (bony spur) at perimeter of articular surface and pts. Of ligamental attachmentHeberden’s nodes: osteophytes at DIP joints of fingersBouchard’s nodes: osteophytes at PIP joints of fingers

Front 197

Psoriatic arthritis

Back 197

occurs in 10% pts with psoriasisRF negative inflammatory arthritisMost pts. Develop skin lesions before arthritis but 16% develop arthritis firstAn assoc. should be made b/t typical skin and nail lesions and the joint and spine involvement to dxDIP erosions can lead to joint space widening, and prox phalangeal bone resorption can lead to “pencil-in-cup” lesionsHallmark is pitted nailsSpinal involvement: asymmetric sacroiliitis and syndesmophytes are seen and similar to those seen in Reiters syndromeEnthesopathy: calcifications at tendon and ligament insertions

Front 198

SKIN

Back 198

Macule 1cmVesicle: .5cmEcchymosis: reddish-purple, non-blanchablePetechiae: reddish-purple, non-blanchable,

Front 199

Spider Angiomata

Back 199

A telangiectatic arteriole in skin with radiating capillary branches resembling the legs of a spider.Pressure produces pallor which fills from the centerCharacteristic of parenchymous liver diseaseAlso seen n pregnancy and in normal ppl

Front 200

Keloids

Back 200

Nodular, firm, moveable, nonencapsulated often linear mass of hyperplastic scar tissueTender and frequently painfulWide irregularly distributed bands of collagenIn dermis and adjacent subQ tissueUsually after trauma, surgery, burn or severe cutaneous dz such as cystic acne. More common in blacks

Front 201

Psoriasis

Back 201

Chronic inflamm process characterized by erythematous papules and plaques w/characteristic silvery scalingLesions are sharply demarcatedOften involves extensor surfaces of elbows and knees as well as scalp and sacral/intergluteal cleft areaPruritic!

Front 202

Measles

Back 202

Acute exanthematous dz caused by measles virus.Generalized maculopapular eruption of dusky red colorEruption occurs early on buccal mucosa in the form of Koplik’s spots which do not scrape off.Also erythematous rash on trunk

Front 203

Chicken Pox

Back 203

Maculopapular “tear drop” vesicles on erythematous baseUsually on trunk, face and scalpCentrifugal spread (out from center)

Front 204

Erythema multiforme

Back 204

Characterized by multiple erythematous plaques with a target or iris morphology and usually represents a hypersensitivity rxn to drugs or infections (esp. HSV), drug-sensitivity, regnancy, food allergy, deep X-ray, CASymmetrical and sharply demarcatedResolution without scarringAssoc with muscle and joint pain, mucosal erosion, itching, malaise, slight fever

Front 205

Poison IvyContact dermatitis

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Inflammatory rxn of skin that is precipitated by contact with an irritant or allergen (poison ivy plant).Vesicles in epidermis as well as perivascular inflammationLinear distribution of papules, vesicles and bullae where leaves of the plant touched

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Junction nevi

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mole found in the junction (border) between the epidermis and dermis layers of the skinNevi are benign proliferations of nevomelanocytes charac by regularly shaped hyperpigmented macules or papules of a uniform colorLess than 6 mm is benignDysplastic neviIrregularly pigmented and shaped nevomelanocytic lesions which may be assoc. with familial melanoma

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Seborrheic keratosis

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noncancerous (benign) wart-like growths on the surface of the skin. Spontaneous lesionsMiddle aged and older pplMost numerous on the trunkUniform tan/brown, velvety/granular round plaques mm to cm’s in diameterKeratin filled plugs may be evidentCoalescent coin like lesions

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Malignant melanoma

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Pruritic, variegated, irregular maculopapular lesions most commonly on skin but occasionally involving the mucosa, conjunctiva, orbit, nail beds, esophagus, and leptomeningesChange in coloration is diagnostically importantLesions are irregular in contour and pigmentMacular areas correlated with the radial growth phaseRaised areas correspond to nodular aggregates of malignant cells in the vertical phase of growthABCD’s of melanomaAsymmetryBorderColorDiameter

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Basal cell epithelioma

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Typically in sun exposed areas of skin, rarely metsPearly papules or expanding plaques, some are melanin pigmentedAdvanced lesions ulcerate with extensive invasion “rodent ulcer”

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Cherry angiomata

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Common, arise in middle-aged to older adultsMultiple erythematous to dark purple papules located on trunk

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Vitiligo

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Common disorder presenting as irregular well-demarcated macules devoid of pigmentationMost apparent in darkly-igmented pplInvolves wrists, axilla, and perioral, periorbital and anogenital regions

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Meningococcemia

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Extensive angular purpuric patches

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Mumps

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Parotitis (bilateral 70%)Glands are enlarged with a doughy consistency and are moist, glistening and reddish brown on cross sectionIn mumps orchitis testicular swelling may be marked and compromise blood flow causing infarction

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Herpes Zoster

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Hemorrhagic vesicles and pustules on an erythematous base grouped in dermatomal distributionMarked burning and pain

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Small Pox

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Vesicular eruptionsAll lesions are the same stageSerum, is in the vesicles so pts are losing albumin into their skinPts die from pneumonia

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Chancre

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Painless single ulcerated lesion with indurated borderCentral necrosis seenTender lymphadenitis may be presentSeen in primary syphilis

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Secondary Syphilis

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Palms and Souls Secondary syphilisScaling, firm red-brown papulesRocky Mt. spotted feverRed lesions that do not blanch on pressure Bilateral symmetric purpura of soles

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Neurofibramatosis

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Neurofibroma is a benign tumor produced by a focal proliferation of neural tissue in the dermisEpidermis is normalMay appear as papules or nodulesCutaneous neurofibromas are softMultiple café au lait patches and axillary freckling

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Rosacea

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Type of acne charac by erythema, telangiectasias, pustules and papulesCommonly on blush areas of cheeks, nose, forehead and chin

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Ringworm

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Tinea corporisSuperficial fungal infection charac by an erythematous annular scaly plaque with central clearing

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Seborrheic dermatitis

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inflammatory skin condition that causes flaky, white to yellowish scales to form on oily areas such as the scalp or inside the ear. Central facial erythema with overlying greasy, yellow scale. Dandruff results

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Pemphigus

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Blisters and scales on elbows

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Erythema marginatum

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A variant of E. multiforme assoc. with Scarlet feverLesions are pink-red, flat to mildly elevated and transientRash may be migratoryScarlet FeverPharyngitis from GBS hemolytic toxinSore throatVomitingMalaiseRed, edematous pharynx with gray/white exudayeCervical adenopathyDenuded tongue (beefy red color)Maculopapular erythematous blanching eruption on neck, axillae, groin, and becomes later generalizedAfter rash desquamation begins around the nails

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Wart (verruca)

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Genital wart = condyloma acuminateFlesh colored growth charac. By circumscribed hypertrophy of the papillae of the corium with thickening of the malphigian, granular and keratin layers of the epidermisCaused by HPVTerm also implies to epidermal verrucous tumors of non-viral originCommon wart (verruca vulgaris)Keratotic papilloma of epidermisOccurs in young with local infection of HPV type 2,4Undergoes spontaneous regression of variable duration

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Erythema Nodosum

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inflammation of the fat cells under the skin (panniculitis) characterized by tender red nodules or lumpsPanniculitis (inflamm of SubQ adipose tissue) marked by sudden formation of painful nodules on extensor surface of lower extremitiesSelf-limiting with recurrencesAssoc. with arthralgia and feverAssoc. with drug sensitivity, allergic rxn, sarcoidosis, infection, IBD, leprosySymptomsMalaise, N/VAbd crampsCrops of transient symmetrically distributed, tender, painful erythematous nodules under the skinNo ulceration or supparationAfter involution areas of pigmentation are left

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Kaposi’s sarcoma

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Multifocal malignant neoplasm of primitive vasoformative tissue occurring in skin, some lymph nodes and visceraVisceral involvement and LAD more common in AIDS ptsCutaneous lesion of reddish purple to dark blue macules, plaques or nodules, painful burning, itching lesionsInfiltrated with hemosiderin-pigmented macrophages and extravasated RBC’sIn men >60 and AIDS ptsConfirm with biopsy

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Fever sore (cold sore, fever blister)

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Group of vesicles containing clear fluid surrounded by area of erythema that can become pustular and coalesce to form single/multiple ulcers and scab before healingHSV-1: can be isolated until the crusting phasePrimary infection usually as young childrenUsually on lips, can also infect skin/mucosa of pharynx, skin, eye, brainMay burnUsually lights up as a local infection only when carrier develops another infection (pneumonia, cerebrospinal meningitis, malaria, common cold)

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HSV genitalis ()

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Eruption of a small group of vesicles filled with serous fluid and viral particles surrounded by erythemaPainfulVesicles rupture and produce superficial ulcers that heal in 5-7 aysHSV-2 in lumbar and sacral sensory gangliaTransmitted via sexual contact or perinatal infectionCan reactivate with sunlight, hormonal changes, trauma, stress, feverMigrates down and causes skin lesionsDx: Tzanc smear: cells from the base of the vesicle and Giemsa stain will show MULTINUCLEAR GIANT CELLSTx: acyclovir-reduces duration of lesions and decreases viral shedding but no effect on latent infection

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Lupus erythematous

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Chronic: discoid phase, painful skin lesions aloneSubacute: recurring superficial nonscarring lesions, disseminatedSystemic or Disseminated: ANA +, involves vital structuresDiscoid L.E.On faceAtrophic plaques w/erythema, hyperkeratosis, follicular plugging, telangiectasiaMay progress to SLESLEChronic inflamm dz of CT involving many systemsMalar erythema on cheeks (butterfly rash)3 most common symptoms80-90% constitutional sympotoms of fever and fatigue90% arthritis and arthralgia50-60% skin rashesmusculoskeletalpain in jointsresembles RAmucocutaneousmaculopapular scaly erythematous rash on nose and cheeksmore intense after sun exposurerenalacute nephritisnephrotiuc syndromeCV33% endocarditispercarditis/myocarditisPulmonaryPleurisy with effusionFriction rubAlectasis on CXRNeuroPersonality disorder, depression, psychosesSeizuresPeripheral neuropathyGIAnorexiaNauseaWt. lossRESSplenomegalyAdenopathyLabs:AnemiaThrombocytopeniaIncreased ESRFalse + VDRL+ ANA, anti-DS DNA, anti-Smdecreased hemolytic complement in active dz

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Acne

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Inflamm follicular, popular and pustular eruption involving the pilosebaceous apparatusTwo formsAcne vulgarisEruption mostly of face, upper back, and chest composed of comedomes, cysts, papules and pustules on an inflammatory baseOccurs mostly during puberty and adolescence due to androgenic stim of sebum secretion wirh plugging of follicles by keratinization assoc. with proliferation of proprionibacterium acnesAcne hypertrophicaScars

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Scalded Skin

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S. aureus of phage group two produces a toxin = EXOFLIATINExofliatinCauses scalded skin syndrome in young children (5yo), neonates and rarely in immunocomp adultsSuperantigenPrimary staph lesion may be minor (conjunctivitis)Toxin absorbed into the bloodstreamErythema and intraepithelial desquamation at remote sites where the organism cannot be isolatedAffects face, axilla and groin. Later the eryhtema, bullous formation and desquamation becomes generalizedMilder form of same dz is Scarlet fever(erythema without desquamation)Bullous impetigo (local desquamation)

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Homonymous hemianopsia

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Blindness in the corresponding (R or L0 field of each eye (bilateralAssoc with severing or damage to an optic tractWith tract lesion, papillary reflex is lostPupils react when lesion is in the brain (involve the calcarine cortex or nearby optic radiations)

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Bitemporal hemianopsia

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Blindness in the temporal field of vision of both eyesAssoc. with damage or lesion at optic chiasmNormally caused by tumor of the pituitary gland

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Amaurosis Fugax

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Amaurosis: blindness, especially that occurring without an apparent change in the eye itselfFugax: a transient blindness that may result from transient ischemia due to:Carotid artery insufficiencyRetinal artery embolusCentrifugal force (visual blackout in flight)

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Confabulation

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Making bizarre or incorrect responsesReady to give a fluid but tangential answer with no regard to facts, to any question posedSeen in amnesia, wernicke-korsakoff

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Formication

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A form of paresthesia or tactile hallucinationSensation as If small insects are crawling under the skin

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Clonus

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Form of involuntary movement marked by involuntary contractions and relaxations of a muscle occurring in rapid successionMay occur at rest, with sensory stimuli or with voluntary mvmtWhen only single motor unit is involved it is fasciculationsSeen with spasticity, seizure disorders, metabolic disorders, lipid storage diseases, encephalitides and encephalopathiesTest wrist, ankle and toe

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Ataxic gait

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Wide-based gait with lateral veering, unsteadiness, and irregular footstepsTendency to fall to one side or the other, forward or backward

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Painful gait “antalgic gait”

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Charac. Gait resulting from pain on weightbearing in which the stance phase is shortened on the affected side

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Hemiplegic gait, circumduction

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Gait during which the leg is stiff, no flexion at the knee and ankleLeg is rotated away from the body, then towards it with each step, forms a semicircleWith bilateral hemiplegic gait…scissor gaitOne leg swings across the other instead of straight forward, criss-cross motion of legs; footprints are reversed

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Asterixis (negative myoclonus)

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Involuntary jerking motion (esp. in hands) best elicited by having the patient extend the arms, dorsiflex the wrists and spread the fingersDue to arrhythmic lapses of sustained posture (brief interruption of background tonic muscle contractions and dropping of hands due to ravity)Primary with metabolic and toxic encephalopathies (esp. with hepatic encephalopathy, anticonvulsant drugs

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Superficial reflexes

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Any reflex which is elicited by the stimulation of the skin (receptor organ in the skin rather than the muscle fiber)Adequate stimulation is stroking, scratching, touchingEx: 1. abd. R. (upper, middle, lower) contraction on ipsilateral side2. cremaster r. prompt elevation of testes3. plantar r. plantar flexion of toes and foot4. superficial anal reflexexternal anal sphincter contracts

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Babinski sign

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Considered indicative of CNS dz (esp. Corticospinal tract) after about the 14-15th month of lifeAfferent limb dorsal root ganglia at L5-S1Efferent limb ventral horn motor neuron at L4-S1In dz of the pyramidal tract, get four components with a firm stroke alog the bottom of the footdorsiflexion of the big toefanning of all toesdorsiflexion of ankleflexion of knee and thigh

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Signs of dementia

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Loss, usually progressive of cognitive and intellectual functions without impairment of perception or consciousnessCaused by a variety of diseasesparenchymal brain dz (alzheimers, picks, senile dementia)metabolic (myxedema, Wilson’s, chronic liver dz, severe HTN, multiple infarct dementia, hypoxia, anoxia)deficiency dz (B1, B12, folate, pellagra)toxins and drugs (EtOH, sedatives, tranquelizers)brain (tumor, metastatic CA, subdural hematoma, trauma)infection (CNS syphilis, fungal meningitis, slow virus meningitis)Characterized by:Disorientation, disinterest, apathy, only traces of joy, sorrow, flashes of irritability, impaired memory (loss in dementia is greater than loss in depression), perserevation (pt. returns to the same complaint every few minutes)Slurred speech, slow body mvmts, normal neuro exam, impaired intelligenceAlzheimers Dementia (presenile)4th-5th decade of liferapid deterioration of mental statusassoc with amnesia, aphasia, agnosia, cortical blindnessWernicke’s dementiaVit B1 def, EtOH abuse, Beriberi, malnutritionKorsakoff’s psychosisAmnesia, confusion, confabulation, DT’sW and K:CN involvementnystagmus, ptosis, paresis of external rectus ocular muscle, conjugate gaze, peripheral neuritis, ataxiaTx: Vit B1 (relieves ataxia and ocular problems but not the mental problems)

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Confusion

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Mental state in which pts reaction to env. Stimuli are inappropriate b/c the pt is bewildered, perplexed, unable to orient oneselfClouding of consciousness with impaired alertness, awareness and attentionCharac. By impared memory, cognitive fxn, perception, disturbances in emotion and psychomotor changes (invol. Mvmt)

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CVA = cerebral strokeLeft hemiparesis

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Weakness of ½ of the body, may be caused by a lesion in the corticospinal tract or the following conditionsintrinsic to blood vessels (atherosclerosis, lipohyalinosis, inflamm. Amyloid, arterial dissection, developmental abnormalities, aneurismal dilatation, venous thrombosis)originate remotely (embolus from heart or extracranial circulation gets lodged in an intracranial vessel)decreased perfusion pressure or increased blood viscosity with adequate cerebral blood flowrupture of a vessel in the subarachnoid spacePrimary risk factors for a stroke: HTN, hypercholesterolemia, smoking (for atherosclerotic heart dz/AFib/recent MI/embolism/HTNlipohyalinosis (lacunar dz)Characterized by a toppling gait

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Meningitis

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Chronic, fulminant, acute (aseptic, pyogenic, non-pyogenic)formsInflamm of membranes of brain and SCMemingococcal meningitis = acute infection affecting children and young adults caused by N. memingitidesCharacterized by: HA, nuchal rigidity, photophobia, seizures, vomiting, fever, kernig’s sign (subject in supine position, thigh flexed and perpendicular to trunk axis, complete extension of the leg from the thigh is impossible)Fulminant form in kids (

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Parkinson’s DZ

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Neuro syndrome usually resulting from a deficiency of dopamine as the consequence of degenerative, vascular, or inflamm changes in the basal gangliaCharacterized by: cogwheel rigidity of mvmt, festinating gait (trunk is flexed, legs are flexed at the knees and hips, stiff, steps are short and progressively more rapid), droopy posture, masklike facies, monotonous tone of speech, rhythmical resting tremors of the hands (pill rolling), arms, lips, eyelids

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T10 cord compression

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Syndrome that results depends on which part of the SC is compressed. May be due to tumors, epidural abscess, epidural hemorrhage, acute disc protrusion, ankylosing spondylititsT10 dermatome is at the level of the umbilicusANS nerves leave via T10: lesser thoracic splanchnic n to the aorticorenal ganglion to the adrenals, kidneys, SI, descending colonBrown Sequard Synndrome:(symptoms may occur +/- 2 vertebral levels from the lesion)idealized hemicord injury with ipsilateral mono/hemiplegia, ipsilateral loss of joint position and vibratory sensation, contralateral loss of pain and temp (STT)segmental signs include radicular pain, muscle atrophy and decreased tendon reflexes bilaterally

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Muscular dystrophy

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A generalized term for a number of hereditary, progressive degenerative disorders affecting skeletal muscles. Hereditary and mostly in males, insidious onset.Waddling gait, rolling gait in which weight bearing hip is not stabilized and buldges out with each step, opposite pelvis drops, alternating lateral trunk mvmts (gluteus medius weakness)Lumbar lordosis, protruberant abdomen, muscle atrophy around shoulder girdle, pelves, thighs, spinal extensors; psedohypertrophy of calves, decreased deep tendon reflexesLABS: increased creatinine, increased SGOT, increased aldolase, myopathic features on EMG and muscle biopsy

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6th nerve palsy

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Abducens nerve is located beneath the floor of the 4th ventricle and lateral to the midline of the pons at the pons/medulla jxn. A motor nerve that innervates the ipsilateral lateral rectus muscle and has a pool of interneurons whose axons cross the midline, ascend via the medial longitudneal fasciculus to the oculomotor subnucleus to nnervate the medial rectus muscle of the opposite eyetherefore the nerve controls horizontal mvmt of the eyeWith palsy get inward deviation of the eye and paresis of abduction. May be caused by an infarction, aneurysm, tumor, trauma, leptomeningitis, MS, but is usually idiopathicIf associated with increased intracranial pressure may be assoc with papilledema

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Myasthenia gravis

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Disorder of neuromuscular transmission marked by fluctuating weakness, esp. of oculofacial muscles and proximal limbs. Due to an Auto-Ab to Ach receptor at NMJWeakness increases with increased activity, increased fatiguability, transient muscle weakness, diplopia, ptosis, easy fatigue with chewing or talking, regurgitation, dysphagia, lack of facial expression, abnormal speech, weakness relieved by injection o edrophonium or neostigmine

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Neurological Exam

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Mental statusLevel of arousal/consciouness: alert, drowsy, lethargic, unresponsive/comatoseOrientation: person, place and timeAffect: depressed, euphoric, are mood and affect congruent?Speech: slurred, dysarthric, hypophonic, scanning, anarthriaLanguage: dsyphasias: naming, repetition, comprehension, Broca’s (epressive) or Wernicke’s (receptive) aphasiasHigher cortical Fxn/Memory: calculations, spelling forward and reverse, repeat back a series of digits; test recent vs remote hx, command comprehensionCranial NervesI: smell and taste-if no complaints its not tested, if tested use coffee or mintII: dural sheath covers it so it is a window into the brainpapilledema is swelling of optic discFundoscopic exa,: see sharp disc margin and pulsating vesselsVisual fieldsVisual acuity: lost in MS; opticatrophy; easily damaged b/c of the long course of through the cranium (DM)III, IV (superior oblique), VI (lateral rectus) tested togetherEOMPupillary fxn: dilitaton (diabetes spares pupil fxn; whereas a PCA aneurysm hits the outside and does not spare the papillary fxn)Ptosis completely shut (if assoc with pain it is a posterior communicating artery aneurysm)VFacial sensationCorneal reflexes: direct/consensual response to cotton touching the cornea; important in those who are not responsive Muscles of mastication: clench teeth; palpate templeVIIMotor Function Nasolabial fold: flattening Palpebral Fissure: eye is wide open; no blinking Central vs Peripheral: Central: cerebral problem above the pons: spares the forehead; shows bilateral representation; Peripheral: peripheral nuc pons: face Special Sense Salivation Lacrimation Taste (Anterior 2/3 of the tongue) Stapedius Muscle: tension on tympanic membrane; transiently weak – distorted sounds