Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
122 Cards in this Set
- Front
- Back
|
What is Cullen's sign?
|
bruising around the umbilicus. Indicates bleeding in abdomen and predicts a severe attack of pancreatitis
|
|
|
What is Grey-Turner's sign?
|
bruising of the flanks, indicates kidnesy injury, attack of pancreatitis
|
|
|
What is included in abdominal exam?
|
percussion, palpation, rectal, genital
|
|
|
What might cause abdominal distention?
|
Fluid, full bladder, fat, fibroid, fatal tumor, flatus, feces, fetus, false pregnansy
|
|
|
What should different organs sound like?
|
-Intestines-fluid and air so resonant
-Liver-dull |
|
|
How do you tell where the liver is?
|
Percuss over mid-clavicular line from resonance of intestine until hear dullness of the liver. Or scratch test with stethoscope
|
|
|
Where is the fundus at 20 weeks?
|
At umbilicus
|
|
|
What dx tests might you run for a GI complaint?
|
Urine dipstick, CBC, Chem-7, LFTs, H pylori, Hemoccult, fecal occult blood testing, culture and sensitivity, ova and parasites, fecal leukocytes, fecal DNA
|
|
|
What does a urine dipstick tell you?
|
For WBCs in urine, nitrites that bacteria produce, pregnancy, ketone, protein
|
|
|
What do the WBC differentials tell you?
|
-Shift to left means increased neutrophils or bands (with bacterial infection), shift to right means increased lymphocytes (with viral infection possibly)
|
|
|
What is a BMP?
|
basic metabolic profile, this includes BUN and creatinine
|
|
|
What are LFTs? What is included?
|
liver function tests. If ALT, AST are elevated that means there is inflammation somewhere, could be other than the liver. Biliary- ALP elevation could indicate a blockage or a growth spurt, normally higher in adolescence, signifies enzymatic activity going on
|
|
|
What type of fecal occult blood testing is more sensitive for CA?
|
6-sample that pt takes home is more sensitive, single digit rectal exam has low sensitivity
NOTE cannot eat red meat while doing this |
|
|
What does a FIT (fecal immuochemical test) test for?
|
tests protein from hemoglobin in blood, no dietary limitations, comes in a kit for pt to use
|
|
|
What does fecal DNA test for?
|
DNA of cancer cells, specific but expensive, must have a complete stool sample and mail it off. ick.
|
|
|
What is an upper GI series?
|
looks at esophagus, stomach, duodenum. Barium can cause constipation
|
|
|
What will US of gall bladder and liver look for?
|
Stones or infection. Must eat a fat free meal and fast
|
|
|
What does a hepatobilliary (HIDA) scan show?
|
gall bladder stones and infections. Must fast and have an injection
|
|
|
What does an esophagogastroduodenoscopy (EGD) show?
|
Light to look into GI, mostly for stomach and duodenum cancers and ulcers
|
|
|
What is a spiral CT?
|
pt moves to increase contrast, this is good to look at appendix.
|
|
|
Why might a patient have a barium enema?
|
to detect differences in lining of the colon
|
|
|
What could you use for lower GI visualization?
|
-barium enema to show on x-ray and lesions
-sigmoidoscopy- see lower colon -colonoscopy- see to secum. Prep with diuretic, sedation. Can see lesions and polyp removal -Virtual- a CT scan but if see anything have to have colonoscopy anyway |
|
|
What are upper GI cancers? What are S&S? How will you dx?
|
-include stomach, pancreas, and liver
-S&S- dysphagia (swallowing), odynophagia, early satiety, pain, wt loss, or NONE -dx when advanced and poor prognosis |
|
|
What is colorectal cancer? What do you ask the pt? What are the sx?
|
-ask about personal hx of polyps and family hx of different colon cancers. Transition to cancer from plyps increases with age
Sx- dysphagia, hemoptysis, hematuria, rectal bleeding |
|
|
What are sx of ovarian cancer?
|
abdominal pain, distension, bloating, urinary urgency and frequency
|
|
|
What are cancer screening recommendations/
|
-CRC- FOBT (false positives), colonoscopy, start at 50 every 10 years or sigmoidoscopy every 5
-Ovarian- if family hx |
|
|
What are GI red flags?
|
Acute onset of severe pain 9might be ischemia), bleeding, displaced aortic pulsation, absent bowel sounds, hypovolemia, weight loss (cancer symptom)
|
|
|
What is parietal pain?
|
local irritiation from type A delta pain fibers. such as a muscle spasm
|
|
|
What is visceral pain?
|
autonomic type c pain fibers, poorly localized
|
|
|
What will ischemic pain feel like?
|
HURTS, sudden onset, continuous, progressive
|
|
|
What are you thinking if a pt has abdominal pain with fever?
|
infection, inflammation
|
|
|
What is psoas sign?
|
pt on side with leg extended behind and push against resistance. if abdominal pain might be appendicitis
|
|
|
What is obturator sign?
|
rotation against resistance of the hip, for appendicitis
|
|
|
What is murphy's sign
|
inspiratory arrest and pain when palpating RUQ, or with US pain with tranducer
|
|
|
**What does sensitivity mean?**
|
pts with the dx who test positive
|
|
|
**What does specificity mean?**
|
pts without the dw who test negative
|
|
|
Describe appendicitis?
|
-More common age 10-30, rare under 5 and over 50
-RLQ pain that migrates from umbilical area, pain precedes nausea!! -will not be hungry -abdominal rigidity -could use alvarado score- old but includes exam pts. If over 7 then operate |
|
|
What is choleycystitis?
|
-More common in "fair, fat, fertile, forty and flatulent"
-RUQ pain that is worse after meals -estrogen can precipitate gall stones so be aware if post partum or OCPs -rapid weigh loss -murphy's sign |
|
|
What is pancreatitis?
|
-Acute, severe, epigastric to back pain
-vomiting -fever -increased amylase, lipase -usually due not to alcohol but to obstruction of sphincter leading to autodigestion -can occur after gall stone |
|
|
What will you see if UTI or pyelonephritis?
|
dysuria, flank pain, ask about suprapubic pain
|
|
|
What will you see in PID?
|
usually in younger women who are sexually active with vaginal discharge
|
|
|
What are the diarrhea definitions?
|
greater than 3 times a day. acute if < 2weeks, persistent if 2-4 weeks, chronic if > 4 weeks
|
|
|
What is gastroenteritis?
|
-pain and diarrhea
-contagious -might be as short as 24 hrs -bacterial can be from many different pathogens -passed fecal oral -viral or bacterial |
|
|
What foods might induce foodborne illness?
|
seafood, dairy, beef, pork, poultry and raw eggs, veggies, fruit
|
|
|
What is irritable bowel syndrome?
|
-pain and diarrhea
-alternating constipation/diarrhea or one -cramping and urgency -does not wake from sleep |
|
|
What is small intestinal bacterial overgrowth?
|
might be a cause of IBS, gas, bloated, diarrhea, only will know if scope and culture
|
|
|
What is inflammatory bowel disease?
|
pain and diarrhea, bloody, wakes from sleep.
Includes Crohn's and ulcerative colitis |
|
|
What is celiac disease?
|
-pain and diarrhea
-**NO WHEAT b/c it triggers inflammation **weight loss** -cramping, bloating, might have an itchy rash -more common with RA, thyroid, downs -usually long delay in dx, dx with blood test |
|
|
What will you see in lactose intolerance?
|
carmping and diarrhea, try a lactose free trial
|
|
|
What does HAND stand for?
|
in bulimia
-Halitosis -Abrasions on Knuckles -Negative gag -Poor dentition |
|
|
What might a person have if they no longer have a gall bladder?
|
diarrhea, might need treatment
|
|
|
What might C difficile with ab treatment induce?
|
extreme diarrhea
|
|
|
What drugs would you ask about with constipation?
|
calcium channel blockers
|
|
|
Why would a person with peptic ulcer disease vomit? with gall bladder disease?
|
-blood into stomach induces vomiting
-if meal was too fattening |
|
|
What will you see with an intestinal obstruction?
|
-obstipation- no stool b/c nothing is getting past the blockage
-fecal smell to vomit -might be due to adhesions from past surgery |
|
|
What would a person with dyspepsia present with?
|
-indigestion, heartburn, bloating, n/v, regurgitation, anorexia, early satiety
|
|
|
What must you rule out with upper abdominal or epigastric pain?
|
cardiac etiology
|
|
|
What are the diff dx for epigastric pain?
|
-GERD- after meals, burping
-PUD- pain between meals b/c nothing in stomach to counteract acid -dyspepsia -gall bladder- fatty meals, RUQ -hepatitis- exposure, jaundice -pancreatitis- severe pain |
|
|
What are some red flags?
|
-cheast pain to L arm, SOB nausea, diaphoresis
-bleeding- hematemesis melena, -dysphagia |
|
|
When is someone low risk for appendicitis?
|
no pain migration, bilateral tenderness, no N/V
|
|
|
What is ischemia bowel?
|
When blood shuts off to bowel as a whole or a part, more in older adults
|
|
|
What is diverticulitis?
|
-pooching of bowel
-**LLQ pain** -fever, vomiting** might have blood in stool if no infection it is called diverticulosis |
|
|
What is an abdominal aortic aneurysm?
|
will see displaced aortic pulse, aortic bruit. male, older, smoker
|
|
|
What are some zebras of GI?
|
sickle cell crisis, DKA, food allergies, lactose intolerance, ovarian cancer, abuse
|
|
|
What might cause rectal bleeding?
|
hemorrhoids, fissure, diverticulitis, cancer, constipation/ hard stool, inflammatory bowel disease (ulcerative colitis and crohn's)
|
|
|
**What is the difference between ulcerative colitis and Crohn's?**
|
UC- diarrhea with blood, mucous, pus, mild to moderate abdominal pain, fatigue, joint pain, LLQ tenderness
Crohn's- bloody diarrhea, abd cramping, spasm, weight loss, anorexia, fever, joint pain, abd tenderness, mass, perineal/rectal lesions |
|
|
What will you see with jaundice?
|
yellos, look at liver size, murphy's sign, get LFTs and hepatitis panel
|
|
|
When could a C difficile infection happen?
|
up to 6 months after antibiotics
|
|
|
What is claudication?
|
vessel pain caused by activity, relieved by rest
"angina of the vessel" chronic ischemia |
|
|
What causes the S1 sound?
|
ventricular contraction, systole
|
|
|
What causes the S2 sound?
|
diastole, relaxation and filling
|
|
|
What are S3 and S4?
|
S3- early diastole, resistance and L ventricle is failing as a pump
S4- occurs closer to S1, forcing blood into stiff ventricle |
|
|
What is a click?
|
valve that is flapping or prosthetic valve
|
|
|
What is a rub?
|
two enflamed surfaces rubbing against each other
|
|
|
What do you need to document with murmurs?
|
**timing (more in systole), grade, location, radiation (does it go anywhere else)**
|
|
|
What is included in the vascular exam?
|
opthamoscopic exam, bruits, jugular venous pressure, abd aortic pulsations
|
|
|
What does jugular vein distension tell you?
|
back up from heart or pressure from liver
|
|
|
What is homan's sign?
|
dorsifexion of foot --> pain in calf. might mean clot, might dislodge DVT. Evidence says this test doesn't mean anything
|
|
|
**What is the ankle-brachial index?**
|
ABI= highest systolic ankle BP/ highest brachial systolic BP. Normal > .95, PVD < .95
|
|
|
What are some risks for CVD?
|
HTN, DM, obesity, smoking, hyperlipidemia, little exercise, age, sex, family hx of premature cardiac disease (male before 55, female before 65), race
|
|
|
What hear rate will make you think?
|
resting rate >75 or exercise less than 89
|
|
|
Must have three of these five things for metabolic syndrome?
|
waist, HDL, triglycerides, BP, glucose
|
|
|
Is sleep apnea associated with CV disease?
|
yes
|
|
|
When should you screen for cholesterol levels
|
After 35-45 if no risk
|
|
|
What labs might you draw in a cardiac patient?
|
-c-reactive protein- made by liver in inflammation
-homocysteine- amino acid that can cause vasular damage -LpPLA2- biomarker of inflammatory response -Brain NP- from ventricles, released by stretch, high indicate HF EKG! |
|
|
What are some lethal dysrhthmias?
|
asystole, ventricular tachycardia, ventricular fibrillation
|
|
|
**What is ejection fraction?**
|
% ejected of total amount of blood in ventricle per systole. Normal is 55%
|
|
|
Do you test low risk populations?
|
no, most are not recomended in low risk
|
|
|
What are possible origins of chest pain?
|
cardiac, circulatory, pulmonary, gastrointestinal, musculoskeletal
|
|
|
What is acute coronary syndrome?
|
ustable angina, may or might not have ST segment elevation
|
|
|
What is pleuritic chest pain?
|
comes and goes with breathing
|
|
|
the likelihood of an MI decreases with these factors
|
Pleuritic chest pain
chest pain reproducible with palpation sharp/stabbing chest pain positional chest pain |
|
|
What will myocardial damage look like on EKG?
|
ischemia- inverted T waves
injury- ST segment changes Infarct- Q waves |
|
|
What ar ethe differences in chest pain between MI and angina?
|
MI- pressure, substernal to L arm and neck, lasts more than 5 min, unrelieved by nitroglycerin or rest, accompanied by nausea, SOB, diaphoresis
Angina- pressure, substernal to l arm and neck. lasts less than 5 minutes, relieved by nitro |
|
|
What are the symptoms women might have with an MI?
|
atypical- SOB, fatigue, jaw/ back pain, CP at rest, epigastric pain
|
|
|
Why is a woman who had breast CA more likely to have an MI?
|
meds are cardiotoxic
|
|
|
What is the reynolds risk score?
|
For women, quantifies the risk of MI
|
|
|
Who is likely to have atypical presentation/
|
women, elderly, AA's
|
|
|
What is mitral valve prolapse?
|
might hear a click, turbulence, worsens with standing or squatting, can cause blood to back up
|
|
|
What is pericarditis?
|
inflammation of the pericardium, lean forward and pain should improve, friction rub
|
|
|
What are some circulatory causes of chest pain?
|
aortic dissection, AAA (back pain), DVT, sickle cell crisis
|
|
|
What is an abdominal aortic aneurysm?
|
dilation of 3 cm or more in wall of adbominal aorta, screen if have ever smoked
|
|
|
What are some pulmonary causes of chest pain?
|
pneumonia (fever, cough), pleuritis (inc pain with breathing, friction rub), pneumothorax (sudden onset dyspnea)
|
|
|
What are some GI causes of chest pain?
|
GERD, PUD, gallbladder, pancreatitis
|
|
|
What are the red flags in chest pain?
|
*Pneumothorax- pleuritic CP, decreased BS, dyspnea
*PE- acute dyspnea, tachycardia, tachypnea, hemoptysis *Aortic dissection- back pain, pulse asymmetry, murmur *Pericarditis- pericardial rub, pleuritic/ positional sx |
|
|
What are the zebras of chest pain?
|
herpes zoster, cocaine, pericardial tamponade
|
|
|
What are premature ventricular contractions (PVCs)?
|
compensatory pause and then back to the same rhythm, can be unifocal or multifocal, feel like heart stopping and feel compensatory pause, CP, SOB related to exertion
|
|
|
What is heart failure?
|
inability of the heart to maintain adequate vital organ perfusion. First two stages will have no symptoms!
|
|
|
What is syncope?
|
sudden transient loss of consciousness with loss of postural tone, followed by spontaneous recovery. REturn to baseline without confusion. caused by interruption of blood flow and cerebral cellular perfusion
-can be neuro, neurocardiogenic (vasovagul), vascular, metabolic, psychogenic |
|
|
What is a CVA?
|
decreased blood flow to brain --> ischemia
|
|
|
how do you test for initial signs of a stroke?
|
smile, talk, raise arms
|
|
|
What family hx of breast cancer is significant?
|
-dx <50?
-*2 or more with breast or ovarian CA *1 with breast AND ovarian cancer |
|
|
how often CBE?
|
q3yrs until 40, then yearly
|
|
|
What breast skin changes might you see with Paget's disease?
|
-peau d'orange, erythema, scaling, nipple excoriation, tissue thickening
-poss bloody discharge |
|
|
What is inflammatory breast disease?
|
rapid increase in size, pain, tenderness
|
|
|
What are the lab tests for syphilis?
|
RPR/ VDRL
|
|
|
What is normal vaginal pH/
|
3.8-4.5
|
|
|
What are the bethesda criteria?
|
adequacy of specimen, negative for intraepithelial lesion/malignancy, positive findings (squamous or glandular cells)
-tells you if you don't have the right cells in the sample |
|
|
What is the normal number of WBCs in a high powered slide?
|
up to 4
|
|
|
What is a clue cell?
|
has bacteria in and on cell, membrane is not distinct, indicative of bacterial vaginosis
|
|
|
What is pelvic inflammatory disease?
|
infection in pelvis, in ovaries, in tubes. Positive cervical motion tenderness, caused by STIs but other infections too, diffuse tenderness all over abdomen
|
|
|
What are symptoms of ovarian cancer?
|
acute onset abd pain, inc abd size, bloating, urinary frequency/urgency
|
