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186 Cards in this Set

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rapid changes in weight (over a few days) suggests:
- changes in body fluids...not tissue
causes of weight loss include:
- GI dz
- endocrine disorders(DM, hyperthyroidism, adrenal insufficienc)
- chronic infx
- malignancy
- chronic cardiac, pulmonary or renal failure
- depression
- anorexia nervosa or bulimia
weight loss with relatively high fluid intake suggests:
- DM
- hyperthyroidism
- malabsorption
- consider bulimia w/vomiting
poverty, old age, social isolation, physical disability, emotional or mental impairment, lack of teeth, ill-fitting dentures, alcoholism, drug abuse increase likelihood of:
- malnutrition
fatigue is a common symptom of ____ & ____ but also consider ______ (many)
- depression and anxiety states
- infx, endocrine disorderes, heart failure, chronic dz of lung, kidney, liver, electrolyte imbalance, moderate to severe anemia, malignancies, nutritional deficits, meds.
weakness may suggest possible:
- neuropathy or myopathy
recurrent shaking chills suggest:
- more extreme swings in temp and systemic bacteremia
feelings of heat and sweating, night sweats
- menopause
- TB
- malignancy
words to describe apparent state of health:
- acutely or chronically ill
- frail
- feeble
- robust
- vigorous
signs or cardiac or respiratory stress
- clutching chest
- pallor
- diaphoresis
- labored breathing
- wheezing
- cough
signs of pain
- wincing
- sweating
- protectiveness of painful area
signs of anxiety and depression
- anxious face
- fidgety movements
- cold moist palms
- inexpressive or flat affect
- poor eye contact
very short stature seen in:
- Turner's Syndrome
- childhood renal failure
- achondroplastic and hypopituitary dwarfism
long limbs seen in:
- hypogonadism
- Maran's Syndrome
generalized fat is seen in:
- simple obesity
truncal fat w/relatively thin limbs
- Cushing's Syndrome
- Syndrome X
ways to describe skin color:
- pallor
- cyanosis
- jaundice
- rashes
- bruises
excess clothing
- cold intolerance of hypothyroidism
- hide skin rash or needle marks
- signal personal lifestyle preferences
cut-out holes or slippers may indicate:
- gout
- bunions
- other painful foot condition
untied slippers
- may suggest edema
copper bracelets are sometimes worn for:
- arthritis
facial expressions
- stare of hyperthyroidism
- immobile face of parkinsonism
- flat or sad affect of depression
odors of body and breath
- breath odors of alcohol, acetone(diabetes), pulmonary infx., uremia or liver failure
postural preference in left-sided heart failure
- sitting up
postural preference in COPD
- leaning forward w/arms braced
a) activity of hyperthyroidism

b) activity of hypothyroidism
a) fast, frequent movements

b) slowed activity
BP cuffs that are too short, too narrow, too loose
- falsely high readings
BP will be falsely high if:
- brachial artery is much below heart level
- pt. own effort to support the arm
auscultatory gap
- unrecognized may lead to serious underestimation of systolic pressure or overestimation of diastolic pressure
- record any gap as 200/98 w/ausc. gap from 170-150
T/F: in aortic regurgitation, the hearts sounds never disappear in BP readings
- True
irregular rhythms
- A-fib
- PVCs, PACs
palpation of an irregularly irregular rhythm reliably indicates:
- A-fib
prolonged expiration suggests:
- narrowing in the bronchioles
a) fever/pyrexia

b) hyperpyrexia

c) hypothermia
a) elevated body temp.

b) extreme elevation of temp. (106)

c) abnormally low temp (<95)(conducted rectally)
pressure differences of >10-15mmHg suggests:
- arterial compression or obstruction on the side with the lower pressure
a fall in systolic pressure of 20mmHg or more, esp. when accompanied by symptoms, indicates:
- orthostatic (postural) hypotension
causes of orthostatic (postural) hypotension
- drugs, loss of blood, prolonged bed rest, diseases of the ANS
assessment of HTN also includes its effects on:
- target organs
a femoral pulse that is smaller and later than the radial pulse suggests:
- coarctation of the aorta or occlusive aortic dz
Systolic BP is usually lower in the legs or arms?
- arms
____ temps are more reliable when pt. has rapid respiratory rates
- rectal
causes of generalized itching w/o obvious reason include:
- dry skin, aging, pregnancy, uremia, jaundice, lymphomas, leukemia, drug rxn, lice
"marked facial pallor w/circumoral cyanosis, palms cold and moist, cyanosis in nailbeds of fingers and toes" suggests:
- central cyanosis
"facial plethora, skin icteric, spider angioma over anterior torso, single pearly papule w/depressed center and telaniectasia, nails w/clubbing but no cyanosis" suggests:
- possible liver disease and basal cell carcinoma
pallor due to decreased redness is seen in:
- anemia
- decreased blood flow, as in fainting or arterial insufficiency
causes of central cyanosis:
- advanced lung dz
- congenital heart dz
- abnormal hemoglobins
- pulmonary edema
cyanosis in CHF is usually:
- peripheral
jaundice suggests:
- liver dz
- excessive hemolysis of RBCs
yellow color accompanying high levels of carotene:
- carotenemia
moisture changes may be caused by:
- dryness in hypothyroidism
- oiliness in acne
temperature changes may be caused by:
- generalized warmth in fever
- hyperthyroidism
- coolness in hypothyroidism
- local warmth of inflammation or cellulitis
roughness of skn may be seen in ____.
- hyperthyroidism
decreased mobility of skin may occur in:
- edema
- scleroderma
decreased turgor of skin is the result of:
- dehydration
normal distributions of skin disease:
a) acne affects...
b) psoriasis affects...
c) candida infx. affects...
a) face, upper chest, back
b) knees and elbows
c) intertriginous areas
vesicles in a unilateral dermatoral pattern are typical of:
- herpes zoster
alopecia
- hair loss (diffuse, patchy or total)
a) sparse hair is seen in ___.
b) fine, silky hair is seen in ___.
a) hypothyroidism
b) hyperthyroidism
most common kinds of recurring headaches
- tension and migraine
tension headaches often arise in the ______ area.
- temporal
cluster headaches often arise in the ____ area.
- retro-orbital
intolerance for cold, preference for warm clothing and dec'd sweating suggest:
- hypothyroidism
palpations, involuntary weight loss suggest:
- hyperthyroidism
affects of hypothyroidism on hair
- coarse hair
affects of hyperthyroidism on hair
- fine hair
tiny white ovoid granules that adhere to hair may be:
- nits or eggs of lice
redness and scaling
- seborrheic dermatitis
- psoriasis
- pillar cysts (wens)
enlarged skull
- hydroencephalus
- Paget's Dz of bone
vision of 20/20 means:
- at 20ft. the pt. can read print that a person with NL vision can read at 200ft
visual acuity: the larger the second number...
- the worse the vision
20/40 corrected means:
- pt. can read 30 line with glasses
myopia
- impaired vision
presbyopia
- impaired near vision, found in middle aged and older people
- near vision is often compromised
legally blind in the U.S.
- when vision in the better eye, corrected by glasses, is 20/200 or less
field defects that are all or partly temporal include:
- homonymous hemianospia
when pts. left eye repeatedly does not see your finger until they have crossed the line of gaze, a ____ is present.
- left temporal hemianopsia
enlarged blind spot occurs in conditions affecting the ____.
- optic nerve
- glaucoma, optic neuritis, papilledema
position and alignment of the eyes is described in regards to:
- inward and outward deviation of the eyes
abnormal protrustion of the eyes is seen in:
- Grave's dz
- ocular tumors
scaliness in seborrheic dermatitis may be seen when inspecting:
- eyebrows
inflammation of the eyelids along the lid margins, often w/crusting or scales
- blepharitis
failure of the eyelids to close exposes the ____ to serious damage.
- cornea
excessive tearing may be due to:
- increased tear production (caused by conjunctival inflam. and corneal irritations)
- impaired tear drainage (caused by ectropion and nasolacrimal duct obstruction)
miosis
- constriction of the pupil
mydriasis
- dilation of the pupil
testing the near reaction is helpful in diagnosiing:
- Argyll Robertson and tonic (Adie's) pupils
asymmetry of the corneal reflections indicates:
- deviation from normal ocular alignment
a temporal light reflection on one cornea indicates:
- nasal deviation of that eye
sustained nystagmus w/in the binocular field of gaze is seen in a variety of ____.
- neurologic conditions
T/F: hyperthyroidism can present with a lid lag
- true
In paralysis of CN VI, the eyes are conjugate in ___ lateral gaze but in in ___ lateral gaze. (right or left)
- right
- left
In lid lag of hyperthyroidism, a ____ is seen b/w upper lid and iris
- rim of sclera
T/F: poor convergence is a result of hypothyroidism
- false
- hyperthyroidism
contraindications for mydriatic drops include:
1. head injury and coma, in which continuing observations in papillary rxns are essential
2. any suspiscion of narrow angle glaucoma
absence of red reflex suggests:
- opacity of lens (cataracts)or possibly of the vitreous
- less commonly, a detached retina
- in children, a retinoblastoma
- artificial eye
refractive error
- light rays from a distance do not focus on the retina
- myopia: focus anterior to it
- hyperopis: posterior to it
retinal structures in a myopic eye look much ____ (larger or smaller) than NL
- larger
enlarged cup suggests:
- chronic open-angle glaucoma
loss of venous pulsations in pathologic conditions like head trauma, meningitis or mass lesions may be an early sign of:
- elevated intracranial pressure
important cause of poor central vision in the elderly
- macular degeneration
Types of Macular Degeneration
- dry atrophic (more common but less severe)
- wet exudating
- neovascular
drusen
- undigested celluar debris
- may be hard and sharply defined or sot and confluent with altered pigmentations
_____ signals inc'd intracranial pressure from such serious conditions as trauma, mass, lesions, subarachnoid hemorrhage or meningitis
- papilledema
may be seen as dark specks or strands b/w fundus and lens
- vitreous floaters
densities in the lens
- cataracts
"Tug Test"
- movement of auricle and tragus is painful in acute otitis externa but not in otitis media
- tenderness behind ear may be present in otitis media
nontender nodular swellings covered by NL skin deep in the ear canal suggest:
- exostoses: nonmalignant overgrowths which may obscure the drum
acute otitis externa
- canal is often swollen, narrowed, moist, pale, tender, may be reddened
chronic otitis externa
- skin of the canal is often thickened, red and itchy
red bulging ear drum
- acute purulent otitis media
amber ear drum
- serous effusion
a serous effusion, a thickened drum, or purulent otitis media may decrease ____.
- mobility
in U/L conductive hearing loss, sound is heard in (lateralized to) the ____ ear.
- impaired ear
Visible explanations of U/L conductive hearing loss include:
- acute otitis media
- perforation of eardrum
- obstruction of ear canal (cerumen)
in U/L sensorineural hearing loss, sound is heard in the ___ ear.
- good ear
in conductive hearing loss, how is sound heard through bone compared to through air?
- heard through bone as long or longer than it is through air
in sensorineural hearing loss, how is sound heard through bone compared to through air?
- sound is heard longer through air
tenderness of the nasal tip or alae suggests:
- local infx such as furuncle
does deviation of the septum commonly obstruct flow of air?
- no
viral rhinitis: mucosa is...
- reddened and swollen
allergic rhinitis: mucosa is...
- pale, bluish or red
causes of septal perforations:
- trauma, surgery, intranasal use of cocaine or amphetamines
polyps
- pale, semitranslucent masses that usually come from the middle meatus
nasal ulcers may arise from the use of ____.
- cocaine
local tenderness, together w/sxs of pain, fever and nasal discharge suggest:
- acute sinusitis involving the frontal or maxillary sinuses
- transillumination may be diagnostically helpful
bright red edematous mucosa underneath a denture suggests:
- denture sore mouth
- there may be ulcers or papillary granulation tissue
abnormal colorations that may be observed on the lips
- cyanosis and pallor
redness and swelling of interdental papillae indicate:
- gingivitis
black line indicates:
- lead poisoning
roof of mouth should be inspected for a ____.
- midline lump (torus palatinus)
asymmetric protrusion suggests a lesion of ____.
- CN XII
second most common cancer of the mouth
- cancer of tongue
most common cancer of mouth
- cancer of lip
any persistent nodule, ulcer (red or white) is suspect of:
- cancer of tongue
cancer occurs more often on what part of the tongue?
- on the side of the tongue
- next most often at its base
soft palate fails to rise and uvula deviates to opposite side of paralysis of which nerve?
- CN X
"tonsillar node" that pulsates
- really the carotid artery
small, hard, tender "tonsillar node" high and deep b/w the mandible and sternomastoid is probably a ____.
- styloid process
enlarged supraclavicular node, especially on the left, suggests:
- possible metastasis from a thoracic or abdominal malignancy
tender nodes suggest:
- inflammatioin
hard or fixed nodes suggest:
- malignancy
changes or progressively severe headaches increase the likelihood of:
- tumor, abscess, other mass lesion
extremely severe headaches suggest:
- subarachnoid hemorrhage
- meningitis
what may increase pain from a brain tumor or acute sinusitis?
- coughing, sneezing or changing position of head
refractive errors most commonly explain:
- gradual blurring
high blood sugar levels may cause ____ of the eyes
- blurring
sudden visual loss suggests:
- retinal detachment
- vitreous hemorrhage
- occlusion of central retinal artery
difficulty seeing w/close work suggests:
- hyperopia (farsightedness)
- presbyopia (aging vision)
difficulty seeing w/distance suggests:
- myopia (nearsightedness)
slow central loss of vision suggests:
- nuclear cataract
- macular degeneration
peripheral loss of vision suggests:
- advanced open angle glaucoma
one-sided loss of vision suggests:
- hemianopsia and quadrantic defects
moving specks or strands suggests (seen upon fundoscopic exam):
- vitreous floaters
fixed defects (seen upon fundoscopic exam) suggests:
- lesion in retinas or visual pathway
flashing lights or new vitreous floaters suggest:
- detachment of vitreous from retina
- prompt consult is indicated
diplopia in adults may arise from:
- lesion in brainstem or cerebellum
- weakness or paralysis of one or more EOM
horizontal diplopia
- palsy of CN III or VI
vertical diplopia
- palsy of CN III or IV
diplopia in one eye with the other closed suggests:
- problem with cornea or lens
- understanding speech
- c/o others mumbling
- noisy environment makes hearing worse
- sensorineural hearing loss
- noisy environments may help hearing
- conductive hearing loss
medications that affect hearing include:
- aminoglycosides
- aspirin
- NSAIDs
- quinine
- furosemide
- others
pain suggests a problem in which part of the ear?
- external ear (otitis externa
pain associated with symptoms of respiratory infx suggest what type of ear problem?
- inner ear (otitis media
unusually soft wax, debris from inflam. or rash in ear canal, or discharge through a perforated eardrum occur secondary to:
- acute or chronic otitis media
tinnitus is a common symptom increasing in frequency with ____.
- age
tinnitus is associated with hearing loss and vertigo suggests:
- Meniere's Dz
feeling unsteady, light-headed or dizzy in the legs sometimes suggests:
- a cardiovascular etiology as opposed to vertigo
feeling of being pulled suggests:
- true vertigo from an inner ear problem or a central or peripheral lesion of CN VIII
rhinorrhea, pain and tenderness in the face and sinus along with local headache or fever suggest:
- sinusitis
if pt. nasal congestion is limited to one side, consider:
- deviated nasal septum
- foreign body
- tumor
local causes of epistaxis include:
- trauma (esp. nose picking)
- inflammation
- drying & crusting of nasal mucosa
- tumors
- foreign bodies
- bleeding disorders may contribute to epistaxis
fever, pharyngeal exudates and anterior lymphadenopathy, esp. in absence of cough suggest:
- streptococcal pharyngitis or strep throat
may cause a sore tongue
- aphthous ulcers and hairy tongue (due to vitamin deficiency)
bleeding gums are most often caused by:
- gingivitis
most likely causes of hoarseness
- overuse of voice (cheering)
- acute infxs
causes of chronic hoarseness
- smoking
- allergy
- voice abuse
- hyperthyroidism
- chronic infx (TB)
- tumors
enlarged tender lymph nodes commonly accompany:
- pharyngitis
thyroid function may be ___ with goiter
- increased, decreased or NL
diffuse lymphadenopathy raises suspicion of:
- infx from HIV or AIDs
tracheal deviation
- may be caused by masses in the neck
- may also signify important problems in thorax (mediastinal mass, etelectasis, large pneumothorax)
goiter
- general term for enlarged thyroid gland
a) thyroid gland is ___ in Grave's Dz

b) thyroid gland is ___ in Hashimoto's Thyroiditis and malignancy
a) soft
b) firm
a localized systolic or continuous bruit may be heard in _____.
- hyperthyroidism
exophthalmos
- abnormal protrusion of the eye
regurgitation of the mucopurulent fluid from the puncta suggests:
- obstructed nasolacrimal duct