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225 Cards in this Set
- Front
- Back
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RUQ organs
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-liver
-gallbladder -pylorus -duodenum -head of pancreas -right adrenal gland -right kidney: upper pole -hepatic flexure -ascending colon -transverse colon |
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LUQ organs
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-liver (left lobe)
-spleen -stomach -pancreas (body) -left adrenal gland -left kidney: upper pole -splenic flexure -transverse colon -descending colon |
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RLQ organs
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-right kidney: lower pole
-cecum -appendix -ascending colon -right ovary -right fallopian tube -right ureter -right spermatic cord -uterus -bladder |
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LLQ organs
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-left kidney: lower pole
-sigmoid colon -descending colon -left ovary -left fallopian tube -left ureter -left spermatic cord -uterus -bladder |
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Epigastrum organs
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-stomach
-pancreas -liver (portion) -aorta |
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Suprapubic area
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-bladder
-uterus |
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Pruritis
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-itching
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Right shoulder pain
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-acute cholecystitis
-irritation of right hemidiaphragm |
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Testicular pain (3)
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-renal
-colic -appendicitis |
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Periodic epigastric pain, 1 hour after eating
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-gastric peptic ulcer
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Periodic epigastric pain, 2-3 hours after eating
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-duodenal peptic ulcer
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Back pain
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-perforated duodenal ulcer
-pancreas |
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Nocturnal pain
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-duodenal peptic ulcer
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Duodenal ulcer
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-pain 2 hrs after eating
-nocturnal pain -back pain if perforated |
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Postprandial pain
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(after eating)
-1 symptom of abdominal angina triad |
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Abdominal angina triad
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-postprandial pain
-anorexia -weight loss |
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Tenesmus
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-painful spasm of anal sphincter
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Vomiting
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-severe irritation of peritoneum
(perforated abdominal organ) -bile duct, ureter or intestinal obstruction -inflammation of intraabdominal strucs -cardiac ischemia -pregnancy -CNS disorders -meds -drug toxicity |
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Episodic vomiting when pain is worst
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-obstruction
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Persistent vomiting
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-toxin
-CNS |
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Pain before vomiting
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-appendicitis
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Green-yellow vomit
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-biliary colic
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Fecal smelling vomit
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-intestinal obstruction
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Nausea (no vomit)
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-hepatocellular disease
-pregnancy -metastasis |
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Acute onset diarrhea
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-acute infection
-toxin |
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Watery stool
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-small bowel or colon inflammation
-protein-losing enteropathies |
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Bloody diarrhea
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-dysentery
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Diarrhea alternating with constipation
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-colon cancer
-diverticulitis -colitis |
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Floating/light colored/foul smelling stool
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-malabsorption syndrome
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Bloody stool/mucus in stool
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-ulcerative colitis
-Chron's colitis |
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Bloody stool/undigested food
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-small bowel or colon inflammation
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Diarrhea in the morning
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-IBS
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Pencil-thin stool
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-anal or distal rectal carcinoma
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Clay-colored stool
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-obstruction of bile flow
-decreased production of bile |
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Constipation, weight loss
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-colon cancer
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Silver colored stool
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-cancer of ampulla of Vater
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Hematochezia
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-bright red blood per rectum (BRBPR)
-colonic tumor -diverticular disease -ulcerative colitis -hemorrhoids |
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Melena
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-black, tarry stool
-bleeding of 1st section of duodenum or upper GI tract |
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Jaundice
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-yellow discoloration of skin
-hyperbilirubinemia -liver disease -biliary obstruction |
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Icterus
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-yellow discoloration of the sclera of the eyes
-seen before jaundice (b/c eyes are white) |
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Viral hepatitis
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-jaundice
-nausea -vomiting -loss of appetite -aversion to smoke |
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Obstructive jaundice
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-slowly develops
-clay colored stool -cola colored urine |
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Cholangitis
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general inflamm of biliary tract
-jaundice -fever -chills -causes: gallstone, pancreatic cancer (stasis of bile) |
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Liver failure
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-jaundice
-abdominal distention -ascites -caput medusae -spider telangiectasia |
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Abdominal distention
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-increased gas in GI tract
-ascites |
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Ascites
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-free intraperitoneal fluid
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Increased gas
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Causes:
-malabsorption -irritable colon -air swallowing |
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Ascites
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Causes:
-cirrhosis -CHF -portal hypertension -peritonitis -neoplasia |
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Intermittent distention (relieved by flatulence or belching)
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-gas
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Ascites + loss of appetite
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-cirrhosis
-malignancy -CHF |
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Ascites + shortness of breath
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-CHF
-decreased pulmonary capacity with unrelated ascites |
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Abdominal mass
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-neoplasm
-hernia -organomegaly -stool -pregnancy |
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Scrotal/groin mass
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-inguinal hernia
-hydrocele -varicocele |
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Pulsatile mass
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-AAA
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Generalized pruritis
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-skin disorder
-chronic renal or hepatic disease |
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Intense pruritis
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-lymphoma
-Hodgkin's -GI malignancies |
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Anal pruritis
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-fistulae
-fissure -psoriasis -parasite -poor hygiene |
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Tips for abdominal exam
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-go to site of pain last
-place hand on top of yours if they are ticklish -do GU and rectal exam at the end *Inspection *ASCULTATION *Percussion *Palpation *Special tests |
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Scaphoid abdomen
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-stomach is concave when pt lying down
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Inspection
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-also examine eyes for icterus, skin for jaundice / caput medusae / spider telangiectasias and extremities for peripheral edema
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Spider telangiectasias
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-small patches of prominent, thin veins
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Auscultation
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-normal sounds occur every 5-10 seconds
-absence of bowel sounds = no sounds within 2 minutes |
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Borborygmi
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-hyperperistalsis
-low pitched rumbling sounds |
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No bowel sounds
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-paralytic ileum (diffuse peritoneal irritation)
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High pitched, rushing bowel sounds
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-intestinal obstruction
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Bruits
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-can be detected by ab auscultation
-stenosis of renal artery or aorta |
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Percussion
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-tympany predominates, though there are areas of dullness
-liver percussion: midclavicular line, above nipple, percuss down until it changes from resonance to dullness (upper edge of liver); then go from umbilicus upwards until changes from hyperresonance to dullness (lower edge) -percuss spleen |
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Shifting dullness
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-detects ascites
-percuss abdomen laterally from midline above umbilicus to find where tympany changes to dullness; tympany should be above area of dullness -turn patient to side, repeat; if ascites is present, dullness/tympany interface will shift with patient b/c fluid will collect in dependent part of cavity |
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Light palpation
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-detects tenderness, muscle spasms, rigidity
-lift from area to area, don't slide |
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Deep palpation
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-to find organ size, masses
-left hand for pressure, right to detect masses |
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Rigidity
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-involuntary muscle spasm
-indicates peritoneal irritation (diffuse or localized) **=rigidity |
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Guarding
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-abdominal wall muscle tension (localized or diffuse)
-may be voluntary (can control it with encouragement) or involuntary = rigidity |
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Liver palpation
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-technique 1:
on right side, put left hand b/w 12th rib and iliac crest; place right hand on RUQ, ask patient to take deep breathe, press inward and upward with right hand while pulling left hand upward Normally: edge is firm, regular, smooth -2nd technique: stand at head, put both hands below rt. costal margin, have pt. breathe in while you pull in and up like a hook |
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Spleen palpation
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-on rt side, put left hand in left lower ribcage, pull ribcage up
-put rt hand below left costal margin and pull in and up -normally not palpable |
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Kidney palpation
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-left hand on right flank b/w costal margin and iliac crest
-right hand below costal margin, deep palpation; lower pole of kidney feels smooth and round |
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Fluid waves
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-ascites
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Rovsing's Sign
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-test for appendicitis
-special peritoneal irritation test -push on LLQ, see if pain still occurs at McBurney's point |
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Obturator sign
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-inflammation, appendicitis, peritoneal irritation
-flex patient's leg at the hip, bend knee, rotate leg internally/externally -pain may indicate appendicitis, abcess or something irritating obturator muscles |
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Psoas sign
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-intra-abdominal inflammation, appendicitis, psoas abscess
-pt lying on unaffected side, extend right leg at hip against resistance |
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Murphy's sign
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-acute cholecysitis
-patient supine, palpate liver (hook under it) head on inspiration, if patient stops test, positive |
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Dysmennorhea
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-pain with menstruation
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Dyspareunia
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-pain during sexual intercourse
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Mittelschmerz
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-menstruation
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Flank pain
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-hydronephrosis of kidney
-distention of bladder or ureter -referred from testicle or labia |
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Low pelvic pain
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-salpingo-oophoritis
-cystitis -complication of pregnancy -hernia -ovarian torsion |
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Urinary patterns
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-hesitancy in initiating a stream
-incontinence -increased frequency -polyuria (too much voided urine) -dysuria (pain .. find out whether it is early in stream or throughout) |
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Abnormal vaginal bleeding
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-age of menarche
-normal menstrual flow -duration and timing -use of contraception -clots -sexual activity |
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Labial mass
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-syphilis
-Bartholin's gland abcess -herpes -condylomata -tumor |
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Vaginal mass
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-cystocele
-rectocele -uterine prolapse |
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Vaginal pruritis
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-candida infection
-glycosuria -contact dermatitis |
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GU Female exam
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-lithotomy position
-inspection -speculum exam (inspection) -bimanual exam (palpation) -rectovaginal exam (palpation) |
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Inspection
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-touch hand to thigh first
-vulva, look for redness, discharge, lesions; clitoris, urethral opening, labia, perineum |
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Speculum exam
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-lubricate
-inspect cervix for size, shape, discharge, lesions |
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Bimanual exam
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-dominant gloved hand
-lubricate -nondominate hand on suprapubic region -separate labia, insert index and middle finger into vaginal canal -palpate canal for lesions, pain -palpate cervix for shape, consistency, mobility, size, tenderness; quite mobile -look for masses, pain -trap uterus by holding it between fingers w/in vagina and hand; doesn't work for retroverted uterus -feel size, tenderness, consistency, shape, masses -feel adnexa; move hands to one side then other -last, palpate posterior fornyx (immediately adjacent to pouch of douglas) |
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CMT
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-cervical motion tenderness (pain when moved)
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Rectovaginal exam
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-palpation of posterior wall of vagina, anterior wall of rectum
-index finger into vagina, middle finger into rectum -lubricate -tenderness, masses, irregularities -test stool for occult blood |
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Auscultation
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-for fetal heart tones with a doppler stethoscope in patients >12 weeks
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Male GU exam
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-perform in both standing and lying positions
-inspection -palpation |
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Inspection
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-skin and hair for infestation of lice, masses, rashes, fungal disease
-penis for circumcision, phimosis, masses, lesions, ulcers -retract skin, inspect glans for fungal infection, mass, warts, nodules, inflamm -inspect urethral opening and scrotum |
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Palpation: Inguinal Region
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-lymph nodes
-hernias |
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Palpation: penis
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-scar tissue, nodules masses
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Palpation: testes
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-mass, size, tenderness, consistency
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Palpation: epididymis
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-on posterior aspect of testes for tenderness, size, nodularity
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Palpation: vas deferens
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-part of spermatic cord; insert finger up to external inguinal ring to palpate sperm cord
-can also palpate hernias |
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Palpation: Scrotum
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-palpate scrotum for additional masses
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Cremasteric reflex
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-stroking inner thigh, causes testicle to retract on ipsilateral side
**absent in testicular torsion often, but is a nonspecific reflex |
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Scrotal Transilumination
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-if detect a mass in scrotum
-hydroceles or spermatoceles are fluid filled and will transilluminate -solid masses (tumors, blood clots, hernias) will not transilluminate |
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Rectal exam: Male positions
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-supine
-curled on side - left or right lateral prone positions -bent over exam table with feet spread (children examined in knee-chest position) |
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Inspection
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-anus for external hemorrhoids, lesions, masses, fissures, anomalies
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Palpation
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-lubricate
-spread cheeks of buttocks with nondominate hand -index finger past external sphincter, into rectum; can ask pt to bear down if they need to relax the sphincter -palpate anterior, posterior and lateral walls of rectum for nodules, tenderness, stool -assess stool (rock hard in impacted patients) |
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Prostate gland
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-palpate in males
-anterior -bilobed -symmetric -midline groove = median sulcus *observe for symmetry of lateral lobes, nodules, consistency, tenderness |
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Breast exam positionns
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-arms at sides
-arms overhead -hands pressed against hips -torso leaning forward |
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Inspection
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-appearance of skin (discolorations, lesions)
-size and symmetry of breasts -breast contour (should be symmetrical) -nipple exam (size, color, lesions, discharge) |
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Vertical strip method
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-palpation of breasts while pt is supine
-expose 1 breast, cover the other -finger pads of 2nd, 3rd, 4th digits in small concentric circles -start in axilla, vertical pattern up and down breast until reach midline -look at consistency of tissue, masses, tenderness -palpate nipples for masses or discharge, don't pinch, just slight pressure on areola |
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SIGECAPS
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-screening for depression during mental status exam
S = sleep disturbances, increased or decreased? I = interest, same level of pleasure in things? G = guilt E = energy level C = concentration A = appetite P = psychomotor (agitation, retardation?) S = suicidal thoughts |
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10 Components of MSE
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-Appearance and behavior
-Motor Activity -Mood and Affect -Speech and Language -Thought process -Thought content -Perception -Insight -Judgement -Cognition |
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Appearance and behavior
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-moment pt walks in
-focus on observations, no inferences -body type, physical stigmata, posture, bearing, clothes, grooming, alertness, comfort level, ambulation status -unusual or repetitive behaviors |
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Motor activity
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-amount = moves a lot? little?
-speed = slow, normal, fast? -posture -gait = normal, slow, antalgic, Parkinsonian? |
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Hyperactivity
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-increased activity for goal-directed behaviors
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Agitation
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-increased activity without a purpose
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Tremor
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-rhythmic oscillation of a body part
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Dystonia
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-sustained abnormal posture
-muscle spasm |
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Chorea
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-irregular, rapid, uncontrollable, involuntary movements
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Tic
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-involuntary, sudden, rapid, recurrent, non-rhythmic, stereotyped movement or vocalization
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Bradykinesia
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-slow movement
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Akinesia
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-absence of movement
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Psychomotor retardation
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-visible generalized slowing of movements and speech
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Mannerism
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-unusual way of performing a functional motor act
-waving goodbye with both hands |
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Stereotypy
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-frequent, repetitive, seemingly driven, nonfunctional motor behavior
-head banging |
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Mood
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-self described emotional state
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Affect
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-emotional response observed by examiner
-observations -range, intensity, stability, appropriateness, relatedness |
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Range
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-refers to amount of variation in affect (flat affect = no emotion)
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Intensity
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-mild to highly intense
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Stability
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-how affect changes during interview (normally only in context of speech or thinking)
-unstable affect (happy 1 instant, crying next, then angry) = emotional instability |
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Appropriateness
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-match between affect and content of speech (lack of appropriateness would be if pt laughed while talking about death, etc)
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Relatedness
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-how pt interacts with examiner and others
-poor eye contact, acts as if examiner not in room = poor relatedness |
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Congruent
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-affect and mood agree (vs. incongruent)
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Euthymic
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-normal mood
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Dysphoric
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-unhappy-appearing (affect) or unpleasant (mood)
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Euphoric
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-elated, "high"
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Labile
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-variable, volatile
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Shallow
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-low intensity affect
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Restricted
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-mild reduction in range and intensity of affect
-constricted |
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Blunted
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-reduced intensity of affect
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Flattened
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-absence of any signs of affective expression
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Testing for abnormal speech articulation
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-have them enunciate
"l-k-g" "yellow lorry" "baby hippopotamus" |
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5 parameters of speech
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-amount
-speed -volume -clarity (how well can they articulate?) -fluency (how smooth is flow of speech?) |
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3 parameters of language
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-complexity (complex vs simple words)
-comprehension of language -coherence (how well is language ordered? logically?) |
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Paucity
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-reduced amt of speech
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Latency
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-time taken to respond
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Pressured speech
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-increased in amount, speed and volume
-difficult to interrupt |
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Word salad
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-incoherent collection of words and phrases
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Dysarthria
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-unclear speech from poor articulation
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Verbigeration
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-manner of speaking that conveys little information b/c of vagueness, empty repititions or obscure phrases
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Aprosodia
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-absent rhythm, melody, emotional inflection of language
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Anomia
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-inability to name
-problems with finding words |
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Paraphasic error
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-word substitution
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Neologism
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-made up word, means something only to patient
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Incoherence
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-words with no logical connection
*may be due to disordered thought process |
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Receptive Aphasia
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-language deficit
-inability to understand speech/language |
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Expressive Aphasia
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-language deficit
-inability to express thought through speech/language |
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Word salad
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-incoherent collection of words and phrases
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Dysarthria
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-unclear speech from poor articulation
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Verbigeration
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-manner of speaking that conveys little information b/c of vagueness, empty repititions or obscure phrases
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Aprosodia
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-absent rhythm, melody, emotional inflection of language
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Anomia
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-inability to name
-problems with finding words |
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Paraphasic error
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-word substitution
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Neologism
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-made up word, means something only to patient
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Incoherence
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-words with no logical connection
*may be due to disordered thought process |
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Receptive Aphasia
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-language deficit
-inability to understand speech/language |
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Expressive Aphasia
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-language deficit
-inability to express thought through speech/language |
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Quantity of thought
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-part of thought process
-amount of thinking pt is engaged in |
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Poverty of thought
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-reduction in amount of thought (part of quantity of thought)
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Thought preservation
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(part of quantity of thought)
-thought restricted to limited set of ideas |
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Tempo of thought
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-flight of ideas
-retarded thinking |
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Flight of ideas
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-continuous flow of speech that jumps from topic to topic based on clear associations
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Retarded thinking
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-thought proceeds slowly
-limited associations |
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Coherence/form of thought
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-linear thought
-circumstantiality -tangentiality |
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Linear thought
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-logical, progressive
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Circumstantiality
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-symptom of disordered thought
-tedious, unnecessary detail -speaker eventually reaches point |
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Tangentiality
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-subsequent thoughts are linked but proceed in new or different direction
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Loosening of associations
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-jumping from subject to subject with no logical or sequential connection
"derailment" |
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Clang associations
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-words or phrases connected due to characteristics of the words themselves(rhymes or puns) instead of their meaning
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Incoherent speech
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-usually represents disordered thought process b/c words are together within sentences with no logical connection
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Thought content
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-preoccupations
-disturbances (delusions, etc) -disorders may be transient or fixed -ask about suicidal thoughts or plans, homicidal thoughts or plans, delusions, obsessions, phobias, and health preoccupations (hypochondriac) |
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Persecutory delusions
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-paranoia
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Delusion
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-fixed, false belief
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Rumination
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-overvalued idea
-like a delusion but less intense |
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Obsession
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-recurrent, intrusive, distressing thought
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Phobia
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-irrational fear of specific object or situation
-avoid that situation/object |
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Hypochondriasis
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-excessive, persistent concern about having a disease or serious health problems
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Perception
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-awareness and understanding of internal or external sensory info
-auditory hallucinations (talking to someone who isn't there) -unilateral neglect (shaved only 1 side of face) |
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Modalities of perceptual abnormalities
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-auditory
-gustatory -visual -olfactory -tactile |
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Types of perceptual abnormalities
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-positive
-negative -distorted |
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Hallucination
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-sensory perception occuring in absence of external stimulus
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Illusion
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-misperception or misinterpretation of real external stimulus
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Neglect
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-perceptual inattention
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Depersonalization
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-feeling that one's self isn't real
-distortion |
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Derealization
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-feeling that the world isn't real
-distortion |
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Impaired insight
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-denial
-minimization -indifference -anosognosia |
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Denial
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-defense mech to block anxiety
-blocks awareness of troublesome thoughts or feelings |
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Minimization
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-cognitive strategy to make a problem seem less significant
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Indifference
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-lack of concern
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Anosognosia
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-lack of recognition of illness
-from brain disease |
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Judgement
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-cognitive process of evaluating and comparing alternatives
-what would you do if you found a stamped, addressed letter on the street? -day to day affairs, paying bills, etc -part of assessment of capacity to consent ("competency evaluation") |
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Cognition
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-general ability of patient to think and reason
-mini mental state exam -level of conscious awareness, general intellectual function, ability to use abstraction |
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Level of consciousness
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-continuum from normal to coma
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Intellectual function
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-current events
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Abstraction
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-similarities, differences
-proverbs (stitch in time saves nine) - keep culture barriers in mind |
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Comatose
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-not responsive
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Stuporous
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-responsive with stimulation
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Concrete
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-lacking abstract reasoning
-apple and orange alike because both are round |
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Distractible
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-attention easily drawn away to irrelevant stimuli
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Amnesia
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-inability to form new memories
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Registration
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-immediate memory
-phone number just looked up, etc |
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Recent memory
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-memories from past hours or days
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Apraxia
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-inability to perform motor acts where there are no motor deficits
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Acalculia
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-inability to perform arithmetic calculations
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Folstein Mini Mental Status Exam
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-Orientation
-Registration -Attention and Calculation -Recall -Language |
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Delirium
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-mental disturbance of short duration
-toxic state -illusions, hallucinations, delusions, excitement, restlessness, incoherence -acute onset -fluctuating, lucid intervals, worse at night -lasts hours to weeks -sleep disrupted -often due to medical illness, drug toxicity, or both |
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Dementia
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-organic mental syndrome
-loss of intellectual abilities, memory impairment, judgement problems, loss of abstract thinking -changes in personality **does not include symptoms due to depression or other functional mental disorder *can also have delirium on top of dementia -insidious onset -slowly progresses over months to years -fragmented sleep -medical illness/toxicity absent |
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Causes of delirium
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-delirium tremens due to alcohol withdrawal
-uremia -acute hepatic failure -acute cerebral vasculitis -atropine poisoning |
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Causes of dementia
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-B12 deficiency
-thyroid disorder (both reversible) -Alzheimer's -vascular dementia from infarcts -head trauma (irreversible) |
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Mental status in delirium
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-altered consciousness
-abnormal increase or decrease in behavior -hesitant, slow or rapid, incoherent speech -fluctuating mood -disorganized, incoherent thought process -delusions common in thought content -illusions, hallucinations usually visual (perceptions) -impaired judgement -disoriented esp with time -fluctuating attention, easily distracted -impaired immediate and recent memory |
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Mental status in dementia
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-normal consciousness until late in illness
-normal to slow behavior -difficulty finding words -flat, depressed mood -impoverished, speech gives little info -delusions or hallucinations may occur -increasingly impaired judgement over time -fairly well oriented until late in illness -attention unaffected until late in illness -recent memory and new learning impaired |
