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392 Cards in this Set
- Front
- Back
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APGAR
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assessment of color, heart rate, grimace (reflex irritability), activity (muscle tone), and respiratory effort at 1 and 5 minutes after birth
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Cheyne Stokes respirations
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alteration btwn apnea and tachypnea; associated with midbrain/respiratory center CNS damage (cardiac or neurologic in origin)
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Chvostek's sign
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tapping over the facial n. ellicites abnormal muscle contraction; assoc. with HYPOCALCEMIA
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Cushing's triad
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(1) elevated systolic BP; (2) bradycardia; (3) irregular respirations assoc with elev. ICP; often harbinger of impending cerebral herniation
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Hirsutism
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excess facial hair in women, or increased body hair
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Kussmaul breathing
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hyperpnea with labored respirations; assoc, with metabolic acidosis (commonly, DKA)
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Lethargic
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patient is drowsy but opens eyes to look at you, responds to questions, then falls asleep
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Obtunded
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patient opens eyes to look at you but responds slowly; is somewhat confused
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Orthostatic HTN
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drop in systolic BP (>20mmHg) or diastolic BP (>10mmHg) w/in 3 min of standing
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Trousseau's sign
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involuntary carpal spasm with digit extension associted with HYPOCALCEMIA when a BP cuff is elevated about the systolic BP and maintained for up to 3 minutes
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ADLs
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Activities of daily living, including basic self-care abilities (Dressing, Eating, Ambulating, Toileting, Hygiene)
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Age-associated Cognitive Impairment
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even milder cognitive change that occurs later in the life cycle; ppl report cognitive loss but such deterioration cannot be documented on cognitive testing
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Amnestic Mild Cognitive Impairment (MCI)
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when memory is the domain affected by MCI
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Delirium
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acute onset of altered mental status, fluctuating with lucid intervals; lasts hours to weeks and disrupts the sleep/wake cycle; general medical illness or drug toxicity or both may be contributing factors
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Dementia
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acquired syndrome of slow, insidious decline in memory and at least one other cognitive domain (language, visuospatial, or exec function) sufficient to interfere with social or occupaitonal functioning in an alert person; prominent features: short- and long-term memory loss, impaired judgement
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Elder mistreatment
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abuse, neglect, exploitation, or abondonment of older patients; depression, dementia and malnutritition are independent risk factors
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Geriatric conditions
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collection of symptoms and signs common in older adults not necessarily related to a single specific disease; such as delirium, cognitive impairment, falls, dizziness, depression, UI, and functional impairment
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IADLs
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Instrumental activities of daily living, which define a patient's functional independence; Shopping, Housekeeping, Accounting, Food prep, Transportation)
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Mild Cognitive Impairment
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milder syndrome of cognitive loss compared to dementia
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Palliative Care
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medical care with the goal of relieving suffering and improving quality of live for patients with advanced illness and their families; (i.e. communication, management of pain and symptoms, psychosocial, spiritual and bereavement support, coordinator of medical and support services)
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Adie's pupil (Tonic pupil)
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pupil is large and regular; usually unilateral; reaction to light is severely reduced and slowed or absent; near reaction present altho very slow; slow accomodation causes blurred vision; may be associated with decreased DTR; must be differentiated from other causes of anisocoria or unilat. pupillary dilation
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Afferent Pupilary Defect (Marcus Gunn pupil)
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abnormality discovered between eyes during swinging flashlight test; MILD - initial constriction, then dilation; MODERATE - stable constriction, followed by dilation; SEVERE - immediate dilation
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Anisocoria
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unequal pupil size, different by >0.4mm
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Argyll Robertson pupil
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associated with tertiary syphillis; small, irregular pupils that accommodate but do not react to light
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Angular cheilitis
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maceration of the skin at the corners of the mouth; may be due to nutritional deficiency or overclosure of mouth (such as in ppl w/ dentures)
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Arcus senilis
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benign white/gray/pale ring at the edge of the iris assoc. with aging; in young patients, assoc. with hyperlipoproteinemia
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atrophic glossitis
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smooth, red "beefy" tongue with few or no papillae; suggests deficiency in riboflavin, niacin, folate, B12, B6, iron, or chemo
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Battle's sign
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mastoid ecchymoses assoc. with basilar skull fracture
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Bitemporal hemianopsia
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patient missing both temporal fields of vision due to defect in optic chiasm
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Blue sclera
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due to thinning of collagen of the sclera allowing underlying uvea to be seen; due to CT disorders (ED, Marfans) or congenital glaucoma
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Brown sclera
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may be typical in dark-skinned indiv; usually patchy; assoc. with onset of ALKAPTONURIA in 30s-50s
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Brushfield spots
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ring of white specks in the iris of a newborn; may suggest Down Syndrome
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CN III paralysis
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dilated pupil fixed to light and near; ptosis; lateral deviation of eye
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CN IV paralysis
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Diplopia when patient asked to look "down and in" with bad eye (false image lies behind true image - vertical diplopia); patient reports difficulty going downstairs
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CN VI paralysis
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eyes are conjugate in lateral gaze in one direction, but affected eye stays midline when attempting lateral gaze in opposite direction
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CN X paralysis
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soft palate fails to raise and uvula deviates to opposite side
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CN VII (central)
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paralysis of ipsilateral LOWER face only
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CN VII (peripheral)
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paralysis of ipsilateral upper and lower face; Bell's palsy
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Conductive hearing loss
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arises from problems in the external or middle ear; evaluated with Weber test (lateralize to bad ear), Rinne (normal bone conduction, abnormal air conduction) and otoscope
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Diplopia
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double vision
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Dix-Hallpike maneuver
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elicitation of extreme vertigo and nystagmus upon lateral mvmt of pt's head when lying supine; associated with benign paroxysmal positional vertigo (BPPV)
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Ectropion
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margin of lower lid turned outward, exposing palpebral conjunctiva
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Entropion
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inward turning of lid margin, more common in elderly
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Episcleritis
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localized ocular redness from inflammation of episcleral vessels
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Epistaxis
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nosebleed
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Epley's maneuvers
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performed to reposition otoliths in BPPV
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Exophthalmos
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abnormal protrusion of eye from orbit
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Geographic tongue
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benign condition w/ both scattered smooth red areas denuded of papillae and typical rough or coated areas of tongue; looks like a map
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goiter
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enlarged thyroid gland
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Hairy leukoplakia
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white raised areas on sides of tongue; cannot be scraped off; assoc. with HIV/AIDS
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Hairy tongue
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benign discoloration of tonuge papillae, appearing as "hairy" yellow, black, or brown
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Hematemesis
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throwing up blood; source: GI or swallowed
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Hemoptysis
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coughing up blood; source: pulmonary, oropharynx, upper respiratory
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Homonymous hemianopsia
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patient missing half of visual field in both eye; due to defect in OPTIC TRACT fibers originating on same side of both eye
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Horner's Syndrome
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ptosis, miosis, anhydrosis; affected pupil is small but reacts to light; ipsilateral loss of sweating on forehead; due to injury of sympathetic fibers around the carotid artery (dissection, compression) or upper pulmonary disease
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Hutchinson's teeth
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small, widely spaced teeth with notched biting surfaces, assoc. with congential syphillis
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Hyperopia
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farsightedness and impaired near vision; light rays focus posterior to retina
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Koplik's spots
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white spots on oral mucosa assoc. w/ measles
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Legal blindness
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vision corrected by glasses of 20/200 or less in better eye; OR constricted visual field of 20* or less in better eye
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Leukokoria
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abnormal white retinal reflex in newborn (could be due to retinoblastoma)
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Lid lag
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assoc. with HYPERTHYROIDISM; rim of sclera is visible avoe the iris with downward gaze; may asle be assoc. with "retracted lids"
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Miosis
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pupillary constriction
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Mydriasis
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pupillary dilation
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Myopia
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nearsightedness with impaired far vision; light rays focus anterior to retina
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Nystagmus
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fine, rhythmic oscillation of eyes; may be due to periph or central CN VIII dysfxn, cerebellar pathology, or drug induced (BZ, PCP, alcohol, phenytoin)
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Papilledema
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swelling of optic disc and anterior bulging of physiologic cup; implies increased intracranial pressure (due to hematoma, abscess, meningitis, subarach hem, trauma, mass lesion, pseudotumor cerebri
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Pinguecula
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benign yellow triangular nodule on bulbar conjunctiva on either side of iris; assoc. with aging
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Pterygium
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triangular thickening of bulbar conjunctiva that grows slowly across the outer surface of conea; redening or impaired vision may occur
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Presbycusis
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age-assoc. hearing loss (after age 50)
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Presbyopia
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loss of near vision arising from decreased elasticity of the lens related to aging
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Raccoon eyes
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periorbital echhymoses; in the setting of trauma, assoc. with basilar skull fracture; in children, consider abuse or infiltrative tumor
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rhinorrhea
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drainage from nose; describe the color and consistency
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Scotomoa
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fixed defects in visual field or areas where patient cannot see; may be specks or larger; "floaters" in contrast, move with eye movements
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Sensorineural hearing loss
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arises from problems in inner ear, cochlear nerve, or central CNS connections; Weber: lateralize to good ear; Rinne: air and bone conduction equally affected
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Stye
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(Hordeolum): painful, tender, erythematous sweeling of gland in lid margin; often due to Staph aureus
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Tinnitus
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perceived sound w/o external stimulus (ringing, rushing, or roaring)
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Tori mandibulares
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rounded bone growths on the inner surfaces of the mandible; typically bilateral, asymp, and benign
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Torus palatinus
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midline bony growth in the hard palate; benign
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tympanosclerosis
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chalky, white irregular patch on the tympanic membrane, made of hylaine material, following severe episode of otitis media
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Vertigo
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perception that the pt or environment is spinning; differentiate from dizziness, dysequilibrium, near syncompe; eval. For BPPV
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Xanthelasma
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raised, yellow plaques appearing along nasal portions of one or both eyelids; may be assoc. with lipid disorders
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Angiod streaks
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breaks in Bruch's membrane (elastic tissue of retina) which can become calcifed and crack
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A-V nicking
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artery runs over a vein; sign of HTN
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Cherry red spot of macula
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occurs with central artery occusion due to infarction from thrombus or embolus; sudden and painless; retina becomes pale and macula appears cherry red due to thinning
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Copper wiring
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arteriolar reflex; due to atherosclerosis and HTN
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Cotton wool exudates
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soft exudates; NERVE FIBER LAYER INFARTS
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Flame hemorrhages
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visible at the edge of the optic disc; assoc with glaucoma
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Neovascularization
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increase in thin-vessel proliferation; assoc. with diabetes, retinopathy of prematurity; 90% chance of blindness in 2 yrs w/o tx
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Waxy exudates
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lipid; hard exudates; assoc. with diabetes
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Roth spots
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white-centered hemorrhages seen in patients with bacterial endocarditis
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Anorexia
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loss or lack of appetite
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BRBPR
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bright red blood per rectum
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caput medusa
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distended veins radiating from umbilicus; assoc. with portal HTN; pt may also have sign of esophageal varices and/or significant rectal vein dilation (hemorrhoids)
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Charcot's triad
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(1) jaundice, (2) fever/chills, (3) RUQ pain associated with ascending cholangitis
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Cullen's sign
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ecchymosis around the umbilicus; assoc. with intraabdominal hemorrhage (i.e. hemorrhagic pancreatitis)
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Dysphagia
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difficulty swallowing from impaired passage of solid foods or liquids from the mouth to the esophagus
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Dyspepsia
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chronic or recurrent discomfort or pain centered in the upper abdomen
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Grey-Turner sign
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ecchymoses of the flanks associated with fulminant hemorrhagic pancreatitis; poor prognostic sign
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Hematochezia
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red or maroon colored stools
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Incarcerated hernia
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hernia contents cannot be reduced into the abdominal cavity
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Strangulated hernia
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blood supply to an incarcerated hernia is compromised
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Involuntary guarding
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abdominal wall has a muscular spasm despite attempts to relax; implies peritoneal inflamm; contrast with "voluntary guarding" in which patient is afraid of possible pain with anticipation of the abd exam
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Kehr's sign
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pain referred to the left shoulder due to sub-diaphragmatic irritation or peritoneal blood
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Melena
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black, tarry stool; if guaiac positive, defines lower GI blood loss
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McBurney's point
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position in the mid-RLQ assoc. with increased tenderness to palpation with appendicitis
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Murphy's sign
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palpation of RUQ at the liver edge or where the rectus muscle intersects with the costal margin during inspiration causes a sharp increase in tenderness; assoc. with acute CHOLECYSTITIS
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Odynophagia
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pain on swallowing
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Obstipation
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no passage of feces/stool or gas/flatus
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Obdurator sign
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flex the pt's R thigh at hip, with knee bent, and rotate leg internally to stretch internal obdurator m; R hypogastric pain produced is positive sign, suggesting irritation of muscle by INFLAMED APPENDIX
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Psoas sign
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increased abdominal pain with: 1) place hand above pt's R knee and pt must raise thigh against resistance; 2) Pt lies on L side, extend pt's R leg at hip; due to irritation of muscle w/ inflamed APPENDIX
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Rebound
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abdominal pain that is induced or increased by quick withdrawal of examining hand; assoc. w/ inflamed peritoneum
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Retching
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involuntary spasm of stomach, diaphragm, and esophagus that precedes and culminates in vomiting
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Rovsing's sign
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pain perceived at RLQ during L-sided abdominal pressure; implies APPENDICITIS
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Tenesmus
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urge to defecate with inability to do so; assoc. with pain, cramping, and straining
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Appendicitis signs
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McBurney's point, Obdurator + Psoas + Rovsing
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Actinic keratosis
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superficial, flattened papules covered by a dry scale; pink, tan or grayish; usually appear on sun-exposed skin of older, fair-skinned patients
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Actinic purpura
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purple patches or macules of the skin of elderly patients caused by blood that has leaked through poorly supported capillaries and spread within purpura
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alopecia
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hair loss; diffuse, patchy, or total
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basal cell carcinoma
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initially a translucent nodule that spreads and leaves a depressed center with a firm elevated border
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Beau's lines
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transverse ridges on nails; may be due to: prior trauma, acute severe illness; will grow out with the nail gradually over months
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carotenemia
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yellow/orange color of the skin assoc. with excessive carotene, noted particularly in the palms, soles, and face
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Clubbing
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angle btwn finger nail and nail base in normally 160*; clubbing causes the angle to first straighten, then exceed 180*; may be a normal variant or due to: chronic hypoxia, cancer
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Herpes Zoster (shingles)
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reactivation of latent varicella zoster virus in the dorsal root ganglia; will follow a nerve root distribution; risk increases with age and impaired cell-mediated immunity
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Jaundice
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yellow discoloration of skin; assoc with liver disease or hemolysis
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Paronychia
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inflammation of the skin around the fingernail with redness and tenderness; pus may be visible
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seborrheic keratosis
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common, benign, yellowish to brown raised lesions; feel greasy, velvety or wart-like
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senile lentigines
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liver spots; brown macules commonly found on the backs of hands, forearm and face
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splinter hemorrhages
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red or brown linear streaks in the nail bed; assoc with subacute bacterial endocarditis, trichinosis, minor trauma, or idiopathic
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spoon nails
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Koilonychia; concave curvature of fingernails; assoc with iron deficiency anemia, but not specific
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squamous cell carcinoma
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firm reddish lesion often in a sun-exposed area
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Telogen effluvium
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molting phenomenon where many hair sync in telogen and mold; lots of hair falls out at once, 3 months after illness, pregnancy, stress, surgery
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Anagen effluvium
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attack of growing hair (i.e. CHEMO); self-limited and non-scarring
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Androgenetic alopecia
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male pattern baldness; hair follicles senstive to over-production of dihydrotestosterone; Tx: Finasteride, Minoxidil
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Alopecia areata
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autoimmune loss of hair in a "patch"
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Folliculitis decalvans
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deep folliculitis due to hyperkeratinization resulting in plugging; causes severe scarring hair loss, esp in black skin
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Fungal scalp folliculitis
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cause of scarring hair loss; TRICHOPHYTON TONSURANS does not fluoresce with wood's lamp
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Hampton's hump
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wedge-shaped consolidation at lung periphery on chest x-ray with base on the pleura assoc. with lung tissue infarction due to PE
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Kerley B lines
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horizontal opaque lines extending to the pulmonary periphery assoc. with pulmonary edema
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Mucoid sputum
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translucent, white or gray
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Stridor
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high pitched wheeze; sign of airway obstruction in larynx or trachea
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Dec. tactile fremitus
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when transmission of vibrations is impeded - COPD, pleural effusion, pleural thickening, pneumothorax, tumor
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Inc. tactile fremitus
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pneumonia
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Flat percussion
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pleural effusion
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Dull percussion
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lobal pneumonia
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Resonant percussion
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chronic bronchitis
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Hyperresonant percussion
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COPD, pneumothorax
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Tympany
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pneumothorax
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Anacrotic pulse
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Pulsus parvus et tardus; small, slow rising, delayed pulse with a notch on ascending limb; AORTIC STENOSIS
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Waterhammer pulse
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rapid and sudden systolic expansion seen in AORTIC REGURG
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Bisfiriens pulse
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double-peaked pulse with mid-systolic dip; seen in AR, combined AR-AS, IHSS
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Pulsus alternans
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alternating amplitude of pulse pressure seen in CHF
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Bigeminal pulse
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can mimic pulsus alternans; normal beat alternating with PVC; stroke volume of premature beat is diminished
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paradoxical pulse
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detected by BP assessment; exaggerated drop in systolic BP of >10mmHg during inspiration; seen in cardiac tamponade, constrictive pericarditis, COPD
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Austin Flint murmur
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mid-diastolic rumble heard at apex assoc. with AR
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Beck's triad
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assoc. with cardiac tamponade (1) HoTN, (2) increased central venous pressure, (3) muffled heart sounds
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Amenorrhea
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absence of menses; 1*: failure to initiate periods; 2*: cessation of periods after they have been established
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Balanitis
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inflammation of the glans of penis; commonly due to yeast
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Balanopsothitis
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inflammation of glans and prepuce
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Blue dot sign
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small are of blue discoloration on the affected testicle assoc. with torsion of the appendix testis
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Braxton Hicks contractions
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contractions of "false labor"; sporadic; must be differentiated from true labor
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Chadwick's sign
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cyanosis/bluish-purple discoloration of vulva, vagina and cervix assoc with pregnancy due to increased blood flow
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Cervical motion tenderness
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assessed when examining cervix on bimanual exam
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condyloma acuminatum
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warts assoc with HPV
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condyloma latum
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wart-like papules assoc with 2* syphillis; contagious
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cystocele
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bulging of the upper 2/3 of anterior vaginal wall and bladder due to weakened supporting tissues
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cystourethrocele
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when the entire vaginal wall together with the bladder and urethra bulges out of the vagina
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cryptorchidism
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undescended testicle
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dysmenorrhea
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pain with menses
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dyspareunia
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painful intercourse
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hypospadius
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congenital ventral displacement of urethral meatus of the penis or perineum
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incontinence
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involuntary loss of bowel or bladder function; may be stress-induced or overflow
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lie
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describes position of testicle scrotum; vertical = nl. Horizontal + abdominal/testicular pain = testicular torsion
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menopause
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absence of menses for 12 mos; usually 48-55yrs
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menorrhagia
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excessive menstrual flow
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metorrhagia
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intermenstrual bleeding; "breakthrough" bleeding
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Nabothian cyst
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translucent nodules seen on the surface of the cervix
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Paraphimosis
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tight prepuce that, once retracted, cannot be returned over the glans; reqs urgent attn if blood flow to glans is impaired
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phimosis
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tight prepuce that cannot be retracted over the glans
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Phren's sign
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pain relief upon scrotal elevation
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polymenorrhea
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fewer than 21 days btwn menses
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postcoital bleeding
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suggests cervical polyps or cancer, or in an older woman atrophic vaginitis
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prolapse of uterus
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results from weakness of supporting structures of pelvic floor; 1*: cervix in vagina; 2*: cervix is introitus; 3*: cervix outside of introitus (PROCIDENTIA)
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rectocele
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herniation of rectum into post vaginal wall due to weakness of supporting structures
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retroverted uterus
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entire uterus tilted backwards
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retroflexed uterus
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body of uterus tilted backwards, but cervix maintains position
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Tanner stages
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stages of devel. Of 2* sexual characteristics
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uterine fibroids
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benign myomas of uterus
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vaginismus
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involuntary spasm of mm surrounding the vaginal orifice that makes penetration during intercourse painful or impossible
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varicocele
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multiple tortuous veins of spermatic cord in proximal testicle; may be palpable or visible
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virilizaition
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extensive hirsutism assoc with receding temporal hair, deepening of voice, and clitoral enlargement
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fibroadenoma
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round, discoid, or lobular nodule in breast; usually well-delineated, mobile, non-tender, w/o skin retraction
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gynecomastia
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increase size of male breast tissue; due to imbalance of estrogens and androgens; consider cancer if hard, irregular, ulcerating
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nonpuerperal galactorrhea
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milky discharge elicited from breast unrelated to pregnancy or lactation; due to hormones/drugs
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Peau d'orange
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"orange peel" appearance of breast skin due to edema produced by lymphatic blockage assoc w breast cancer
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Adson's sign
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obliteration of the radial pulse when arm is abducted to position over shoulder, causing compression of proximal vessel; assoc with thoracic outlet syndrome
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Allen's test
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tests for presence of palmar ulnar-radial anastomosis and integrity of palmar arch; performed before invasive procedures on radial a.
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Baker's cyst
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popliteal fossa cyst due to distention of gastrocnemius semimembranous bursa; assoc. with inflammatory d/o (gout, prior trauma, osteoarthritis)
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Barlow maneuver
|
newborn hip eval with adduction of hip to evaluate for congenital dislocation
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Ortolani maneuver
|
palpable clunk on anterior-posterior pressure applied to the newborn hip exam to check for congenital hip dislocation
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Boutonniere deformity
|
assoc with chronic RA; persistent flexion of proximal interphalangeal joint with hyperextension of distal interphalangeal joint
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Carpal tunnel syndrome
|
median nerve entrapment; check Phalen's and Tinel's
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Phalen's sign
|
compression on backs of hands for 30-60 sec
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Tinel's sign
|
tap over volar median nerve
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Depuytren's contracture
|
flexion contracture of ring, small, or long fingers from thickening of the palmar fascia
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De Quervain's tenosynovitis
|
on Finkelstein's test: flexed thumb is placed under flexed digits, wrist is laterally abducted to stretch radial-side musculature; pain elicited is a positive sign
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Empty can test
|
drop arm sign; possible rotator cuff tear
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Felon
|
localized infection in the fascial space of finger pad
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Hawkin's impingement sign
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flex pt's shoulder and elbow to 90* with palm facing down; with one hand on forearm and one on arm, rotate the arm internally to compress the greater tuberosity against the coracoacromial ligament. Pain is a positive test
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Gibbus deformity
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assoc. with tuberculous spondylitis which removes anterior wedge of vertebrae leaving palpable bump in spine
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Schober's sign
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2 midline marks 10cm apart drawn on spine; with flexion, distance change <3.5cm is positive sign
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Janeway lesion
|
palmar or plantar erythematous or hemorrhagic papule assoc with INFECTIVE ENDOCARDITIS
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Osler's nodes
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painful red lesions/soft tissue swellings on the pads of finger and plantar surfaces, assoc with INFECTIVE ENDOCARDITIS
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Kanavel's sign
|
assoc with flexor tenosynovitis of the flexor digitorum; signs include: finger held in slight flexion, diffuse swelling of the affected digit, tenderness to palpation along the flexor tendon sheath, and pain with passive extension of digit
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Valgus Stress Test
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Abduction; MCL
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Varus Stress Test
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Adduction; LCL
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Anterior Drawer Sign
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does the tibia draw forward under the femur? ACL
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Lachman Test
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ACL
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Posterior Drawer Sign
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does tibia push back under femur? PCL
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McMurray Test
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menisci
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Neer's impingement sign
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to assess rotator cuff tear; press on scapula and raise patient's arm to compress the greater tuberosity of the humerus against the acromion; pain is positive
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Analgesia
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absence of pain sensation
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Hypalgeisa
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decreased sensitivity to pain
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Hyperalgesia
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increased sensitivty to pain
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Anesthesia
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absence of touch sensation
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Pronator drift
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pronation of one forearm during test indicates corticospinal tract lesion in contralateral hemisphere
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Spondylolisthesis
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forward mvmt of one vertebra on another, which may compress the spinal cord or contribute to low back pain
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Swan neck deformities
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hyperextension of the proximal interphalangeal joints with fixed flexion of the distal interphalangeal joints; assoc with RA
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Valgus
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"knock knees"
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Varus
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"bow legs"
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Tophi
|
local accumulation of sodium urate in the joints or soft tissue, with or without inflammation
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Agnosia
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failure to recognize a sensory stimulus despite normal primary sensation
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Apraxia
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inability to perform a voluntary mvmt in the absence of deficits in motor strength, sensation or coordination
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Amaurosis fugax
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transient visual loss lasting up to 3 min.; feature of internal carotid a. disease or other embolic disease
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aphasia
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disorder in producing or understanding language; receptive = processing; expressive = articulating
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astereognosis
|
inability to identify objects placed in the hand
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asterixis
|
sudden, brief, nonrhythmic flexion of hands that occurs when the arms are extended and hands pointed up to the ceiling with fingers spread; seen with liver dz, uremia, and hypercapnia
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ataxia
|
gait that lack coordination, with reeling and instability; may also describe mvmts or respirations
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Aura
|
physiologic event preceding migraine which can include transient autonomic, visual, motor, or sensory phenomena
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Brudzinksi's sign
|
neck flexion elicits hip and knee flexion; assoc. with MENINGITIS
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Contstructional apraxia
|
patient is unable to draw or construct simple designs after the examiner draws a shape and asks the pt to copy it
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dysarthria
|
defective articulation of speech due to a defect in the muscular components to produce speech
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Decerebrate rigidity
|
jaw clenched, neck extended, arms adducted and stiffly extended at elbows, forearms pronated and wrists and fingers flexed, legs extended at knee, feet plantar flexed; caused by a lesion in diencephalon, midbrain or pons, or severe metabolic d/o
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Decorticate rigidity
|
upper arms are flexed tightly to the sides with elbow, wrists, and fingers flexed; legs are extended and internaly rotated; feet are plantar flexed; implies destructive lesion of corticospinal tracts w/in (near) cerebral hemispheres)
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Vertigo
|
spinning sensation accompanied by nystagmus and ataxia; usually due to peripheral vestibular dysfxn
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Presyncope
|
near faint from "feeling faint/lightheaded"; cause: orthostatic HoTN, arryth, vasovagal attacks
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Dysequilibrium
|
unsteadiness or imbalance when walking, esp in older patients; cause: fear of walking, visual loss, weakness from musculoskel probs, peripheral neuropathy
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Psychiatric dizziness
|
anxiety, panic d/o, hyperventiliation, depression, somatization d/o, alcohol, substance abuse
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Dysdiadochokinesis
|
abnormality of rapid alternating movements
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Dysmetria
|
during finger-to-nose, mvmts are clumsy, unsteady, varying in force/speed/direction; occurs with CEREBELLAR DZ
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Dysphonia
|
difficulty in phonation which leads to alteration in the tone and volume of voice; assoc with structural head and neck d/o
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Flaccidity
|
marked loss of tone; usually results from dz of peripheral motor neuron
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Hoffman's sign
|
tapping/downward flicking distal phalanx of long or ring finger elicits flexion of distal thumb; assoc with CORTICOSPINAL TRACT lesions
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Hypoactive DTR
|
suggest dz of spinal n roots, spinal n, plexuses or peripheral n
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Hyperactive DTR
|
suggest a CNS lesion along descending corticospinal tract
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Kernig's sign
|
when hip and knee is fully flexion, extension of knee elicits pain and/or opisthotonus; assoc. with MENINGITIS
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Migraine
|
biphasic h/a assoc with prodromal phase (aura) followed by headache phase
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Muscle atrophy
|
loss of muscle bulk or wasting of mm that occurs due to peripheral neuropathy or mm dz
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Muscle hypertrophy
|
increase of muscle bulk with proportionate increase in strength
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Oculocephalic reflex
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Doll's eyes; turn head quick, first to one side, then the other; absence of doll's eye mvmts suggests a lesion in midbrain or pons
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Paralysis
|
absence of strength
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Paresis
|
weakness
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Babinski sign
|
dorsiflexion of big toe indicates CNS dz; also seen in unconscious states due to alcohol or drugs, or in postictal state
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Postictal period
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period of confusion, decreased awareness/arousal, or decreased level of consciousness following a seizure/convulsion
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Pseudohypertrophy of muscle
|
increase of muscle bulk with decrease in strength (i.e. MUSCULAR DYSTROPHY)
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rigidity
|
increased resistance through the range of movement and in both directions; not rate dependent
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sciatica
|
intense shooting pain down the leg; may be increased with straight leg raise
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Seizure
|
paroxysmal d/o caused by sudden excessive electrical discharge in the cerebral cortex or its underlying structures
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Spasticity
|
increased resistance that worsens at the extremes of range
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Stereognosis
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ability to identify an object by feeling it
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stroke
|
sudden neurologic deficit caused by cerebrovascular ischemia or hemorrhage
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subarachnoid hemorrhage
|
"worst headache of my life"
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sustained clonus of ankle
|
indicates CNS dz; assoc with hyperactive DTR
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syncope
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sudden but temporary loss of consciousness and postural tone that occurs with decreased blood flow to the brain
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TIA
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sudden focal neurologic deficity last less than 24 hrs and w/o any underlying structural defects
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Tremor
|
involuntary mvmts that occur w/ or w/o other neuro manifestations
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Trigeminal neuralgia
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tic douloureux; severe, jabbing pain lasting seconds in the distribution of the maxillary or mandibular divisions of CN V
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Vasovagal syncope
|
syncope preceded by emotional stress, feeling warm, flushing, or nausea; due to stimulation of vagus n
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Benign Paroxysmal Positional Vertigo
|
onset usually sudden, upon rolling to one side or tilting head, lasting a few seconds to a few weeks; may recur; hearing not affected; not assoc w/ tinnitus; can be assoc with nausea, vomiting and nystagmus
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Vestibular neuronitis
|
usually sudden onset, lasting hours to weeks, may recur over 12-18 mos; hearing not affected; not assoc with tinnitus; can be assoc with N/V, nystagmus
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Meniere's Disease
|
onset sudden; lasts several hrs to a day or more, usually recurrent and progressive; assoc with sensorineural hearing loss; assoc with tinnitus which can be fluctuating; assoc with fullness or pressure of ear, N/V and nystagmus
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Drug-induced vertigo
|
onset insidious or acute; assoc w/ loop diuretics, aminoglycosides, salicylates, alcohol; duraton may or may not be reversible
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Acoustic Neuroma
|
insidious onset from CNVIII compression, vestibular branch; duration variable; hearing impaired on one side; tinnitus present; can involve CN V and VII
|
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Central vertigo
|
onset may be sudden, duration variable; hearing not affected, tinnitus absent; assoc with brainstem deficits like dysarthria, ataxia, and crossing motor/sensory deficits
|
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Functional syndrome
|
medically unexplained syndromes (IBS, fibromyalgia, TMJ); Depression, anxiety, chronic pain, etc. may contribute to somatoform symptoms
|
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|
Mental Status Exam
|
attention, memory, orientation, perception, thought process, thought content, insight, judgement, mood, affect, language, higher congnitive fxn
|
|
|
Personality disorders
|
dysfunctional interpersonal coping styles that disrupt or destabilize relationships
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|
Somatoform disorder
|
d/o lack adequate physical/medical cause; includes somatization, conversion, pain, hypochondrias, and body dysmorphic d/o; facticious d/o, malingering, and dissociative d/o
|
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|
Leukoplakia
|
thickened white patch on the oral mucosa; may be a precursor to oral cancer
|
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|
Acute cough
|
Cough lasting less than 3 weeks. The most common cause is a viral upper respiratory infection. Can also be caused by bronchitis, pneumonia, left ventricular heart failure, asthma, foreign body.
|
|
|
Subacute cough
|
Cough of 3 to 8 weeks duration.
causes include post-infectious cough, bacterial sinusitis, asthma. |
|
|
Chronic cough
|
Cough lasting more than 8 weeks. Causes include postnasal drip, asthma, gastroesophageal reflux, chronic bronchitis and bronchiectasis."
|
|
|
Purulent sputum
|
yellowish or greenish colored
|
|
|
Decreased breath sounds
|
heard when air flow is decreased, such as obstructive lung disease or muscular weakness, or when transmission of sound is poor, i.e. pleural effusion, pneumothorax, COPD.
|
|
|
Bronchophony
|
louder, clearer voice sounds heard when auscultating lungs
|
|
|
Egophony
|
"e-to-a"; heard in lobar consolidation from pneumonia
|
|
|
Whispered pectoriloquy
|
louder, clearer whispered sounds
|
|
|
Elevated JVP
|
greater than 4 cm above the sternal angle, equivalent to 9 cm above the right atrium; 98% specific for an increased left ventricular end diastolic pressure and low left ventricular ejection fraction, and it increased the risk of death from heart failure.
|
|
|
Cardiac Thrills
|
can be noted in aortic stenosis, patent ductus arteriosus, ventricular septal defect, and mitral stenosis, and can be palpated in positions that accentuate the murmur.
|
|
|
What can displace the PMI laterally?
|
cardiac enlargement from congestive heart failure, cardiomyopathy, and ischemic heart disease, or deformities in the thorax or mediastinal shift. In the left lateral decubitus position, a diffuse PMI with diameter greater than 3 cm indicates left ventricular enlargement.
|
|
|
What can increase the amplitude of the PMI?
|
after exercise; hyperthyroidism; severe anemia; pressure overload of the left ventricle (aortic stenosis); volume overload of the left ventricle (mitral regurgitation)
|
|
|
A sustained, high-amplitude PMI that is normally located
|
suggests left ventricular hypertrophy from pressure overload (as in hypertension). If such an impulse is displaced laterally, consider volume overload.
|
|
|
A sustained, low-amplitude (hypokinetic) impulse
|
may result from dilated cardiomyopathy.
|
|
|
Midsystolic murmurs
|
typically occur across the semilunar (aortic and pulmonic) valves
|
|
|
Pansystolic murmurs
|
typically occur with regurgitant flow across the atrioventricular valves.
|
|
|
Early diastolic murmurs
|
typically accompany regurgitant flow across incompetent semilunar valves.
|
|
|
Middiastolic & presystolic murmurs
|
reflect turbulent flow across the atrioventricular valves.
|
|
|
Grade 1 Murmur
|
Very faint, heard only after listener has tuned in; may not be heard in all positions
|
|
|
Grade 2 Murmur
|
Quiet, but heard immediately after placing the stethoscope on the chest
|
|
|
Grade 3 Murmur
|
Moderately loud
|
|
|
Grade 4 Murmur
|
Loud, with palpable thrill
|
|
|
Grade 5 Murmur
|
Very loud, with thrill. May be heard when the stethoscope is partly off the chest
|
|
|
Grade 6 Murmur
|
Very loud, with thrill. May be heart with stethoscope completely off the chest
|
|
|
Ejection Clicks
|
high-pitched sounds that occur early in systole at the onset of ejection and are produced by the opening of pathologically deformed semilunar valves
|
|
|
Midsystolic click
|
they occur in the middle of systole and can be single or multiple, and can change position during the cardiac cycle; commonly associated with mitral valve prolapse or tricuspid valve prolapse
|
|
|
Carotid thrill
|
a vibration that can be felt on palpation of the carotid artery.
|
|
|
Carotid bruit
|
a murmur-like sound of vascular origin that can be heard on auscultation of the carotid artery.
|
|
|
Dyspnea
|
an uncomfortable awareness of breathing that is inappropriate to a given level of exertion.
|
|
|
Edema
|
accumulation of excessive fluid in the extravascular interstitial space. May be pitting (need to grade it 1-4+) or non-pitting. Note location, particularly of dependent areas.
|
|
|
Orthopnea
|
dyspnea that occurs when the patient is lying down and improves when the patient sits up.
|
|
|
Paroxysmal Nocturnal Dyspnea (PND)
|
episodes of sudden dyspnea and orthopnea that awaken the patient from sleep, prompting the patient to sit up, stand up or go to a window for air.
|
|
|
Palpitations
|
the unpleasant awareness of the heartbeat.
|
|
|
Pre-hypertension
|
systolic BP of 120-139, diastolic blood pressures of 80 -89. Initiate therapeutic lifestyle interventions.
|
|
|
Stage I Hypertension
|
systolic BP of 140 to 159, diastolic blood pressure of 90-99 mm Hg or both, warrants antihypertensive therapy.
|
|
|
Stage II Hypertension
|
systolic BP of >160 mm Hg, diastolic BP of >100 or both.
|
|
|
Voluntary guarding
|
the patient is afraid of possible pain with anticipation of the abdominal examination
|
|
|
Stress Incontinence
|
urinary incontinence when straining or coughing
|
|
|
Overfow Incontinence
|
when the pressure in the bladder exceeds the urethral pressure in the absence of bladder contraction
|
|
|
Postmenopausal bleeding
|
bleeding occurring 6 months or more after cessation of menses
|
|
|
Premenstrual syndrome
|
includes emotional and behavioral symptoms such as depression, angry outbursts, irritability, anxiety, confusion, crying spells, sleep disturbance, poor concentration, and social withdrawal that interfere with daily activities and which occur within 5 days before menses in at least 3 consecutive cycles; symptoms and signs stop within 4 days after cessation of menses
|
|
|
Location of the cervix in First degree prolapse
|
the cervix is still within the vagina
|
|
|
Location of the cervix in Second degree prolapse
|
the cervix is at the introitus
|
|
|
Location of the cervix in Third degree prolapse (procidentia)
|
the cervix and vagina are outside the introitus
|
|
|
Finkelstein's test
|
the flexed thumb is placed under the flexed digits, then the wrist is laterally abducted to stretch the radial side musculature; pain elicited with this maneuver is a positive sign of De Quervain's tenosynovitis
|
|
|
Hypesthesia
|
decreased sensitivity to touch
|
|
|
Hyperesthesia
|
increased sensitivity to touch
|
|
|
Expressive Aphasia
|
speech pattern is hesitant and labored, with poor articulation but the patient has no problem with comprehension
|
|
|
Near syncope/ presyncope
|
symptoms of feeling faint, lightheaded or weak, but without actual loss of consciousness; cause may be neurologic, cardiac, volume-related, drug related, etc.
|
|
|
Hemiparesis
|
weakness of one half of the body
|
|
|
Papule
|
raised lesion less than 5-10mm
|
|
|
Macule
|
flat lesion less than 1cm
|
|
|
Patch
|
flat lesion 1.0 cm or larger
|
|
|
Plaque
|
raised lesion 1.0 cm or larger; often formed by a coalescence of papules
|
|
|
Nodule
|
similar to plaque or papule but deeper and firmer
|
|
|
Vesicle
|
elevated blister containing clear fluid less than 1.0cm
|
|
|
Bulla
|
elevated blister containing clear fluid larger than 1.0cm
|
|
|
Pustule
|
vesicle filled with pus instead of clear, serous fluid
|
|
|
Scales
|
desquamating masses of laminated keratin; think flake of dead exfoliated epidermis
|
|
|
Eczematous
|
manifested by scling and erythema; along with vesicles if acute, dry if chronic; ATOPIC ECZEMA found in flexor regions
|
|
|
Papulosquamous
|
papules and plaques + scales, usually thicker than eczematous
|
|
|
Wheal
|
evanescent, pink, slightly elevated lesion due to edema; lesions will blanch; also called URTICARIA or HIVES
|
|
|
Purpura
|
bleeding into the skin; RBC are extravasated; lesions do NOT blanch
|
|
|
Petechia
|
pinpoint purpura
|
|
|
Ecchymoses
|
larger purpura; a bruise
|
|
|
Erosion
|
superficial defect in skin, not all the way through the epidermis
|
|
|
Ulcer
|
defect or excavation of skin, deeper than erosion; extends at least into dermis
|
|
|
Crust
|
scab, dried blood, or serum; black crust = eschar
|
|
|
Cyst
|
circumscribed walled process, usually in the dermis or SQ tissue
|
|
|
Indurated
|
thickened or hard firm skin; also called sclerotic
|
|
|
Lichenification
|
thickening of skin, usually by repeated rubbing or scratching
|
|
|
Excoriation
|
ulcer obviously dug by fingernails
|
|
|
Fissure
|
linear crack in the skin, usually due to extreme dryness
|
|
|
Atrophy
|
thinning of skin; epidermal atrophy can exhibit "cigarette paper" wrinkling
|
|
|
Telangiectasia
|
dilated capillary visible with naked eye; blanches; ex: spider angioma and spider vein
|
|
|
Infiltrated
|
~indurated; implies introduction of neoplastic or inflammatory cells
|
|
|
Erythematous
|
red
|
|
|
Pedunculated
|
nodule or papule on a thin stalk
|
|
|
Verrucous
|
very jagged, irregular surface, like a wart
|
|
|
Annular
|
ring-shaped lesion; not necessarily ring worm
|
|
|
Reticulated
|
net-like pattern
|
|
|
Serpingous
|
creeping or enlarging in a linear fashion, like a snake
|
|
|
Gyrate
|
round concentric circles, woud up like a coil
|
|
|
Umbilicated
|
central depression in lesion
|
|
|
Herpetiform
|
grouped lesion (usually vesicles)
|
|
|
Maculopapular
|
macules + papules, no scales; drug reactions, viral xanthems, 2* syphillis
|
|
|
Onychauxis
|
thick or hypertrophied nails (usually trauma or fungus)
|
|
|
Onychogryphosis
|
ram's horn nails, due to trauma or fungus
|
|
|
Onycholysis
|
separation of nail from bed (thyroid dz, psoriasis, tinea, trauma)
|
|
|
onychomadesis
|
nail shedding starting from the base (chemo)
|
|
|
onychorrhexis
|
longitudinal striation or splitting
|
|
|
onychoschizia
|
splitting of nail into layers; trauma, thyroid dz
|
|
|
trachyonychia
|
rough nails
|
|
|
unguis incarnatus
|
ingrown nail
|
|
|
Mee's lines
|
longitudinal white or brown stripes from inorganic arsenic
|
|
|
Muehreke's nails
|
transverse white bands with hypoalbuminemia; does not grow out with the nail
|
|
|
Transverse leukonychia
|
white bands that grow out with nail, usually trauma
|
|
|
Yellow nails
|
pulmonary dz, AIDS, edema, nail grows slowly
|
|
|
blue nails
|
Wilson's dz, antimalarial meds, argyria (silver)
|
|
|
green nails
|
pseudomonas infxn
|
|
|
Lindsay's nails
|
half and half nails where proximal half is white; assoc with RENAL DISEASE
|
|
|
Terry's nails
|
total white nails or with distal rim of red; assoc with LIVER DISEASE
|
|
|
Pincer nails
|
claw-like nails ingrow at sides
|
|
|
Hamman's crunch
|
air in the mediastinum or pericardial sac; as you breathe the air is causing friction with the pericardium
|
