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163 Cards in this Set
- Front
- Back
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Deontology
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Deontology - The study of professional ethics and duties.
The branch of ethics dealing with duty, moral obligation, and moral commitment. |
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Normative ethics - What, 2 subcategories
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The branch of ethics studying Normative ethics - how one ought to act.
Deontological and teleological ethics |
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Teleological ethics
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Teleological ethics - Ethics more concerned with the consequences/utility of our actions.
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Disease/Illness
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Disease/Ilness
Condition in which the function of one or more organs (/organ systems) is altered or disturbed. ¨ (Disease is considered a medically distinct entity (Characterized by >1 of: recognized etiologic agents, identifiable group of S&S, consistent morphologic alteration), whereas illness usually means a temporarily limited change in the condition of health)(Bok) An interruption, cessation, or disorder of a body system, or organ structure or function (Stedman) |
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General procedure for medical diagnosis
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General procedure for medical diagnosis
1. Personal history/Anamnesis 2. PE including vitalia 3. Working/Preliminary diagnosis with differential diagnostic considerations 4. Recommendations for further diagnostic examinations or consultations - Lab, X-ray.. 5. Final diagnosis 6. Therapy plan |
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Diagnosis - The two types
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Diagnoses
1. Clinical diagnosis - Made during the patient's lifetime 2. Pathologic-anatomic diagnosis - Postmortem |
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Personal history/Anamnesis - Outline
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Personal history/Anamnesis
1. Personal data 2. Current/Chief complaint 3. Family history 4. Personal history 5. Work/Occupational history 6. Social history |
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Personal data under anamnesis
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Personal data
1. Name 2. Address 3. Birth date 4. Marital status 5. Occupation - Previous occupations in retirees 6. Next of kin 7. Referring physician 8. Date of P&E |
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Anamnesis - Family history
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Anamnesis - Family history
1. Health condition of parents, grand parents, siblings and children 2. Deceased family members --> Sex, age, cause of death 3. Draw the family tree in heritable diseases |
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Anamnesis - Personal history
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Anamnesis - Personal history
1. Prior illnesses - Chronologically, including surgical procedures and accidents (Duration, treatment, after-effects) 2. Present illness I. OPQRST II. Acute/gradual III. Associated symptoms IV. Similar S&S before? V. Accurate time/dating VI. Smoking (pack-years), alcohol, drugs VII. Veneral diseases VIII. Gyn - menstruation (Menarche, menopause, regularity, contraception), ob. IX. System-related questions |
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Anamnesis - Personal history - History by systems - General
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Anamnesis - Personal history - History by systems - General
1. Overall health condition 2. Unexplained weight changes 3. Elevated temperature 4. Night sweats 5. Frequent infections 6. Headaches 7. Allergies |
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Anamnesis - Personal history - History by systems - Skin and appendages
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Anamnesis - Personal history - History by systems - Skin and appendages
1. Rash 2. Pruritus 3. Pigmentations 4. Unusual hair loss or hair gain over the body 5. Nail deformities 6. Discolorations |
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Anamnesis - Personal history - History by systems - Head
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Anamnesis - Personal history - History by systems - Head
1. Headaches 2. Dizziness 3. Injuries |
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Anamnesis - Personal history - History by systems - Eyes, Ears, Nose
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Anamnesis - Personal history - History by systems - Eyes, Ears, Nose
Eyes: Pain, visual disturbances, swelling of or around eyelids, glasses (when last visual check) Ears: Hearing, pain, discharge Nose: Nosebleeds, sinusitis, frequent colds, allergies |
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Zoonosis
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An infection or infestation shared in nature by humans and other animals.
(Often seen in workers in the meat packing industry) |
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Anamnesis - Social history
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Anamnesis - Social history
1. Family life 2. Eating and health habits 3. Sleep 4. Food intake |
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Aggravation, dissimulation
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Aggravation - Patients who exaggerate symptoms
Dissimulation - Patients who tries to hide their disease or mask their symptoms |
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% of diagnoses confirmed by history, PE, diagnostic exams
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History - 55%
PE - 20% Diagnostic exams - 20% 5% undiagnosed |
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Epicrisis
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Epicrisis
Final medical summary upon discharge (all diagnoses, therapies, suggestions for follow-up and further treatment or examination after discharge) (Also less properly used as weekly summary of findings) |
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The five basic methods of physical examination
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The five basic methods of physical examination
1. Inspection 2. Sense of smell 3. Palpation (Skin, masses (size, surface, texture, motility), pathological lumps, painful areas) 4. Percussion 5. Auscultation |
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Percussion - Two important points about technique
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Percussion
1. The stationary finger has to be in full contact with the patient's body to avoid air pockets under the fingers. 2. Percuss vertically on the stationary finger |
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Percussion - The five types of sounds
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Percussion
1. Resonant percussion sound (Healthy, air-filled lungs) 2. Hyperresonant percussion sound (Overexpanded lungs - Emphysema, pneumothorax. Deeper and of longer duration - like percussing a box) 3. Tympanitic percussion sound/tympany 4. flat percussion sound/Flatness (Over dense, airless organs - Muscles, large pleural exudates) 5. Dull percussion sound |
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Tympanitic percussion sound/Tympany - When
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Tympanitic percussion sound/Tympany
1. Physiological - Air-filled abdominal organs 2. Pathological - Large air-filled cavities in the lung, large pneumothorax |
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Dull percussion sound - What, when
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Dull percussion sound - Transition between resonant and flat (solid organs) percussion
1. Small pleural exudate 2. Lung infiltrate |
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The two parts of the listening devices and their uses
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The two parts of the listening devices and their usage
1. Bell a. Largest b. The side with a 'bell' or hollow-cup c. Press gently on skin d. Low-frequency sounds are heard better --> Lungs 2. Membrane a. Better for high-frequency sounds --> Heart |
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Physical overall examination of the patient - The 10 steps
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Physical overall examination of the patient - The 10 steps
1. Consciousness 2. Position 3. Abnormal movements, postures, gait 4. Abnormal muscle movements 5. Body habitus - Type, contours 6. Changes in voice and disturbances of speech 7. Skin 8. Edema 9. Skin appendages - Hair, Nails 10. Body temperature |
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Consciousness - The types of decreased consciousness
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Consciousness - The types of decreased consciousness
1. Somnolence / Lethargy / Drowsiness 2. Stupor 3. Coma |
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Somnolence/Drowsiness/Lethargy
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Somnolene/Lethargy/Drowsiness
1. Sleep, drowsy, or indifferent 2. Low spontaneous activity, but can be awakened 3. Oriented, but delay in time for answering |
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Stupor
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Stupor ('to be stunned')
1. Unnaturally deep sleep (sopor), but can be awakened with strong, painful stimuli |
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Coma
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Coma
1. 'Light coma' - Withdrawal reaction to painful stimuli 2. 'Deep coma' - No response to painful stimuli a. Incontinent b. Loss of reflexes c. Respiratory and circulatory insufficiencies may follow |
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Conditions that lead to impaired consciousness
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Conditions that leads to impaired consciousness
1. Hypoxia 2. Direct damage to the brain - Trauma, Neoplasm, inflammation 3. Accumulation of metabolites /Secondary metabolic encephalopathy (Uremic, hepatic, diabetic coma) |
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Delirium
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Delirium (deliro - to be crazy)
1. Altered state of consciousness consisting of a. Confusion b. Distractibility c. Disorientation d. Disordered thinking and memory e. Defective perception - Illusions, hallucinations f. Prominent hyperactivity and agitation g. Autonomic NS overactivity 2. Caused by a. Illness b. Medications c. Toxic, structural, and metabolic disorders |
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Confusion
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Confusion
1. State of consciousness where the patient's a. Attention is dulled b. Perception is impaired c. Memory is defective d. Awareness of surroundings is limited e. Disoriented in time, person, and space |
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Position - The following obligatory postures indicates and name of position
a. Sitting position with the head propped up (ie by 2 pillows) b. Lying on the side c. Prone or on all four extremities d. Supine (recumbent) e. Head arched backward and the extremities flexed |
Obligatory postures
a. Orthopneic posture <- SOB from cardiopulmonary condition b. Lying on side/Lateral decubitus 1. Pleuritis - Painful side down c. Prone/All four extremities <- Intraabdominal tumor (alleviate pain) d. Supine/Recumbent in pain <- Peritonitis e. Opisthotonus <- Meningitis |
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Abnormal movements, posture, and gait
a. Parkinsonism b. Hemiparesis/Hemiplegia |
a. Parkinsonism
1. Small steps 2. Body leaning forward 3. Gait begins slowly and hesitantly, then picks up in speed (4. Tremor and muscular rigidity) b. Hemiparesis/Hemiplegia 1. Gait with circumduction (Increased tonus of lower extremity extensor muscles) 2. Flexed upper extremity |
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Abnormal muscle movements
a. Tic b. Tremor |
Abnormal muscle movements
a. Tic I. Spontaneous, unconscious twitch of a muscle group II. Less during sleep, more during excitement b. Tremor/Shaking I. Automatic, involuntary, rhythmical (oscillating) movement affecting the extremities, head or eyelids 2. Usually disappear at sleep (Parkinsonian tremor - Rhythmical shake affecting the fingers ('money-counting'/'pill-rolling'), head, and the chin at rest - Resting tremor. Coarse alternation of flexion and extension) |
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Tremors
a. Parkinsonian tremor b. Tremor in thyrotoxicosis c. Tremor of neurosis |
a. Parkinsonian tremor
I. Rhythmical shaking affecting the fingers ('pill-rolling'), chin, and head first II. Resting tremor III. Coarse alternation between flexion and extension b. Tremor in thyrotoxicosis I. Hand tremor first II. Rapid, discrete tremors of the fingers (Diagnose by having patient extend his/her arm forward with fingers spread and eyes closed) c. Tremor of neurosis I. Coarser than from thyrotoxicosis |
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Body habitus - The 3 types
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Body habitus - The 3 types
1. Normosthenic (sthenos - strength)/Mesomorph 2. Asthenic/Endomorph (Slender, weak musculature) 3. Hypersthenic / Ectomorph / Pyknic(Pyknos - thick) (Stout, short-necked, muscular, tendency to obesity) |
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Broca's general rule for optimal body weight
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Broca's general rule for optimal body weight (kg) = heigh (cm) - 100
(Obesity - Exeeds optimal weight by 10%) |
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Pickwickian syndrome
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Pickwickian syndrome
I. Combination of severe obesity, respiratory insufficiency, somnolence and general debility II. Theoretically resulting from hypoventilation from obesity |
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Cachexia
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Cachexia (Kakos - bad, -hexis - condition of the body)
I. General weight loss and wasting occurring during the course of chronic disease II. Lost fat reserves and atrophic musculature II. Often pale skin III. Sometimes accompanied by bradycardia and hypothermia |
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Changes in voice
a. Hoarseness b. Coarse voice c. Nasal slur d. Weak, decreased resonance (dysphonia) |
Changes in voice
a. Hoarseness 1. Laryngitis 2. Laryngeal tumors 3. Tuberculosis, syphilis b. Coarse voice 1. Myxedema from hypothyroidism (Infiltration of the vocal cords with myxedema) c. Nasal slur 1. Palsy of soft palate after diphtheria or split palate d. Weak, decreased resonance/altered voice production (dysphonia) 1. Paresis of recurrent nerve from strumectomy, pressing tumor, enlarged left atrium in mitral stenosis |
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Language/Speech disorders
a. Aphonia b. Aphasia c. Anarthria/Dysarthria |
Language/Speech disorders
a. Aphonia (a-, phonia - voice) I. Loss of voice, not speech/language b. Aphasia (phasia - speech/language) I. Inability to form speech/language II. Mild --> Dysphasia III. Receptive/Wernicke and Motor/Brocas c. Anarthria I. Defect in articulation II. Causes 1. Motor disorders of the muscles of articulation 2. Damage to the brain centers of speech from thromboemboli or hemorrhage II. Dysarthria - Mild |
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Skin - Look for
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Skin - Look for
1. Color 2. Rash 3. Pathological formations/Lesions 4. Scars 5. Hemorrhage 6. Skin moisture 7. Skin turgor |
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Skin color
a. Determined by which 3 pigments |
Skin color
a. Skin pigments 1. Melanine 2. Carotenoids 3. Hemoglobin |
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Red variations of the skin
a. Erythema fugax pudoris/Transient redness of embarassment b. Flush c. Polycythemia/Polyglobulia d. CO poisoning |
Red variations of the skin
a. Erythema fugax pudoris/Transient redness of embarrassment I. Especially of face, neck or anterior chest II. Diffuse or spotty III. Always transient b. Flush I. More violet hue II. Diffuse or spotty II. Face and upper parts of the body (<- Carcinoid tumors (chromaffin tumors of the intestinal mucosa), usually with liver metastases. The tumors produce serotonin) c. Polycythemia and/or polygobulia I. Face, acral parts, mucosal membranes II. Cherry-colored d. CO poisoning I. Face II. Bright red |
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Pallor of skin and mucous membranes - Causes
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Pallor of skin and mucous membranes - Causes
1. Anemia (With dizziness, tinnitus, exertional dyspnea, tachycardia) 2. Vasomotor paleness from circulatory insufficiency 3. Pallid fever - Facial pallor in rheumatic fever and sepsis 4. Cafe au lait pallor in Hodgkin's disease |
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Jaundice
a. Occurs if the plasma bilirubin level exceeds b. Subicterus c. Differential diagnosis |
Jaundice
a. occurs if the plasma bilirubin level exceeds 35 uM b. Subicterus I. Mild jaundice that cannot be detected with certainty in artificial light c. Hypercarotenemia I. Following large ingestion of carotenes II. In hypercarotenemia the palms and soles are affected mostly, but the sclerae remain white |
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Cyanosis
a. Occurs when the level of deoxygenated Hb exceeds b. Central cyanosis c. Peripheral cyanosis d. Other types of cyanosis |
Cyanosis
a. Cyanosis occurs when the level of deoxygenated hemoglobin exceeds 50g/L b. Central cyanosis I. From pulmonary disease or decreased inspired pO2 II. Diffuse (Typical for congenital heart disease with right-to-left shunting) c. Peripheral cyanosis I. Characteristic of CHF of the right ventricle and similar mechanisms due to blood stagnation II. Most prominent on the acral parts of the body - lips, ear lobes, finger tips (Local peripheral cyanosis from vasomotor disturbances or varicose veins) d. Other types of cyanosis I. Methemoglobinemia (> 15g/l, pale blue/brownish, congenital or caused by toxic agents such as nitrites or sulfonamides) II.Sulfhemoglobin cyanosis (Increased sulfides in the gut, >5g/L) |
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Pigmentation
a. Pigmentation disturbance in Addison's disease b. Hypothyroidism c. Chloasma gravidarum d. Solar chloasma e. Lack of melanin - Term for diffuse and local |
Pigmentation
a. Addison's disease I. Predilected areas - Creases of the palms, periorbital, neck, oral mucosa II. Increased melanin deposits - Gray-brown (blue-black on oral mucosa) III. First occurs on sun-exposed areas b. Hypothyroidism I. Pigmentation of the eyelids c. Chloasma gravidarum I. Pigmented brown spots on the face during pregnancy (Can also get hyperpigmentation in certain areas - breast nipples, linea alba) d. Solar chloasma I. Pigmentation after sun exposure e. Lack of melanin I. Diffuse -> Albinism II. Local -> Vitiligo |
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Skin eruptions
a. Erythema b. Exanthema c. Urticaria |
Skin eruptions
a. Erythema ('Flush') I. Redness due to capillary dilation, usually signaling a pathologic condition such as inflammation or infection b. Exanthema ('Eruption') I. A skin eruption occurring as a symptom of an acute viral or coccal disease, as in scarlet fever or measles c. Urticaria (Urtica - To burn) I. Sudden or repeated eruption of pink/red itching wheals ('hives') on the skin (Hive - A raised itchy (pruritic) area of the skin that is almost always a sign of allergy) II. From hypersensitivity, foci of infection, physical agents (light, temperature, friction), or psychic stimuli |
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Skin eruptions
a. Lupus erythema b. Erythema nodosum |
Skin eruptions
a. Lupus erythema I. In systemic lupus erythematosus II. Butterfly rash on the face over the base of the nose III. 1st transient and reddish-violet --> 2nd atrophic/follicular hyperkeratosis b. Erythema nodosum I. Can accompany TB, rheumatic fever, coccidioidomycosis, histoplasmosis, sarcoid, ulcerative colitis, some drug reactions (penicillins, sulfonamides) II. Tender or painful, slight elevated reddish-violet nodules, < 2cm III. Usually bilaterally on the extensor side of the lower extremities (Herpes zoster cause small vesicles in the intercostal spaces along the intercostal nerve accompanied by localized neuralgic pain) |
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Pathological formations/lesions and scars
a. Osler's nodes b. Rendu-Osler's disease c. Papule |
Pathological formations/Lesions and scars
a. Osler's nodes I. Often present in infective (subacute bacterial) endocarditis II. Red-purplish, < 1cm subcutaneous papules III. Especially on fingertips and pulps (Rendu-Osler-Weber syndrome / Hereditary hemorrhagic telangiectasia: Multiple small telangiectasis most frequently on the lips, tongue, and oro-nasal mucosa) c. Papule ('Pimple') I. A circumscribed, solid elevation II. < 1cm |
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Pathological formations/Lesions and scars
a. Nevus b. Telangiectases c. Spider nevi/Spider angioma |
Pathological formations/Lesions and scars
a. Nevus ('Mole') I. Benign, localized, overgrowth of melanocytes of the skin b. Telangiectases (Telos - end, angeion - vessel, ektasias - stretching out) I. A lesion formed by a dilated capillary or terminal artery II. Most commonly on the skin c. Spider nevi/Spider angioma I. A telangiectatic arteriole in the skin with radiating capillary branches simulating the legs of a spider II. Seen on the skin of the anterior chest and epigastrium in liver cirrhosis (Also seen in pregnancy and sometimes in healthy people) |
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Skin hemorrhage/Purpura
a. Purpura b. Petechiae c. Ecchymosis d. Hematoma |
Skin hemorrhage
a. Purpura (Porphyra - Purple) I. Condition characterized by hemorrhage into the skin II. Appearance varies with type, duration, acuteness of onset III. Typically 1st red --> Purple --> Brownish-yellow --> Disappears (2-3 weeks) b. Petechiae I. Pinpoint to pinhead (knappenålshode) size II. Not blanched by pressure III. Typical for thrombocyte defect - Thrombocytopenia, thrombopathy, thrombasthenia c. Ecchymosis I. > 3 mm II. Differ only from petechiae in size d. Hematoma I. A collection of blood that extends into deeper tissues (Not the same as hemangioma which is a vascular tumor of proliferation of blood vessels, most often in skin and subcutaneous tissue. Purpura are flat, hemangiomas protrude above the skin) |
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Skin - Look for
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Skin
1. Skin eruptions - Rashes/erythemas, exanthemas 2. Lesions/Pathological formations and scars 3. Purpuras/Skin hemorrhages 4. Skin moisture (Increased from rheumatic fever, hyperthyroidism, vascular insufficiency, salicylates and quinine) 5. Skin turgor |
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Edema
a. Dropsy b. Phlebothrombosis c. In generalized edema - How much does the amount of ECF have to increase to be visible |
Edema
a. Dropsy I. Older term for generalized edema - Also called anasarca II. Most often associated with cardiac failure b. Phlebothrombosis (Phlebo-: vein) I. Thrombosis or clotting in a vein without primary inflammation c. The amount of ECF in generalized edema must increase by several liters to be visible |
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Edema
a. Where is edema most visible in an ambulant patient and a supine patient b. Edema in peritoneal, pleural, and pericardial cavities |
Edema
a. Where is edema most visible in.. I. Ambulant -> Tibial and perimalleolar II. Supine -> Lumbosacral area b. Ascites, hydrothorax, hydropericardium |
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Changes in body hair distribution
a. Loss of hair - Causes b. Alopecia areata |
Changes in body hair distribution
a. Loss of hair 1. Liver cirrhosis (body hair) 2. Serious febrile illnesses - Typhoid, septicemia 3. After cytostatica (Total hair loss is called Alopecia diffusa) b. Alopecia areata I. Limited/patchy hair-loss II. Can be found in disorders of the thyroid, ovarian, or pituitary glands |
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Nail changes
a. Increased brittleness b. Spheric nails/Clubbing c. Flat/planinychia or concave/koilonychia nails |
Nail changes
a. Increased brittleness I. Seen in thyroid disorders and in iron-deficiency anemias b. Spheric nails/Clubbing I. Convex nails II. Usually associated with clubbed/drumstick fingers III. Can be seen in congenital cyanotic heart diseases, pulmonary diseases (lung cancer, bronchiectasis), subacture bacterial endocarditis, inherited anomaly c. Flat/planinychia or concave/koilonychia nails I. Associated with iron-deficiency anemia along with brittle nails |
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Body temperature
a. Normal body temperature b. Subfebrile/Low-grade fever c. Fever d. Hyperpyrexia |
Body temperature
a. Normal body temperature I. 36-37C (0.5C higher with rectal/oral) b. Subfebrile/Low-grade fever I. 37-38C c. Fever I. 38-40C d. Hyperpyrexia (Pyrexis - Feverishness) I. >40C |
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Body temperature - Types of fever patterns
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Body temperature - Types of fever patterns
1. Continuous fever/Febris continua (Steady fever above 38C, diurnal fluctuation less than 1C below, typical with untreated typhoid fever or lobar pneumonia) 2. Remittent fever/Febris remittens (Fever fluctuates by more than 2C over 24 hours, but does not return to normal. Pre-antibiotics it used to be typical in serious infections) 3. Intermittent fever/Febris intermittens (High temperature which during the day falls to normal/subnormal levels. Septicemia, cholangitis, pyelonephritis..) 4. Recurrent fever/Febris recurrents (Alternative periods of fever and normal, recurrent typhus (borrelia) 5. Undulating fever/Febris undulans (Crescendo-decrescendo pattern over a few days, Hodgkin's disease -> Pel-Ebstein fever, brucellosis) |
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Examination of the head
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Examination of the head
1. Skull - Inspection, palpation, percussion 2. Eyes - Inspect, movement, ophthalmoscopy 3. Nose 4. Lips and mouth 5. Ears |
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Inspection of the skull
a. A normal skull is called b. Brachycephalus c. Dolichocephalus d. Microcephalus |
Inspection of the skull
a. A normal skull is called mesocephalus/normocephalic b. Brachycephalus - Shortened AP diameter c. Dolichocephalus - Elongated AP diameter d. Microcephalus - Small skull I. Due to disturbances in brain development -> Virtually always connected with some brain dysfunction and mental deficiency |
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Macrocephaly - Abnormally large skull. Causes
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Macrocephaly - Abnormally large skull. Causes
1. Hydrocephalus before fontanelles are closed (Face is of normal size) 2. Osteitis deformans - Skull deformation in Paget's disease I. Thickening of skull, mainly in the frontal area 3. Caput quadratum/Square skull I. Prominent frontal and parietal bones I. Used to be common in rickets |
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Inspection of the skull
a. Oxycephaly/Turricephaly b. Opisthotonus c. Torticollis |
Inspection of the skull
a. Oxycephal (Oxy- point)y/Turricephaly (Turris - tower) I. Malformed skull with a pointed vertex II. Due to premature closure of the sutures III. Not accompanied by mental deficiencies b. Opisthotonus (Opistho-: backward/behind, Tonos - Tension) I. The head is dorsiflexed while the spine is rigid II. Sign indicating meningitis c. Torticollis (Tortus - twisted, collum) I. The head is flexed sideways |
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Edema
a. Dropsy b. Phlebothrombosis c. In generalized edema - How much does the amount of ECF have to increase to be visible |
Edema
a. Dropsy I. Older term for generalized edema - Also called anasarca II. Most often associated with cardiac failure b. Phlebothrombosis (Phlebo-: vein) I. Thrombosis or clotting in a vein without primary inflammation c. The amount of ECF in generalized edema must increase by several liters to be visible |
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Edema
a. Where is edema most visible in an ambulant patient and a supine patient b. Edema in peritoneal, pleural, and pericardial cavities |
Edema
a. Where is edema most visible in.. I. Ambulant -> Tibial and perimalleolar II. Supine -> Lumbosacral area b. Ascites, hydrothorax, hydropericardium |
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Changes in body hair distribution
a. Loss of hair - Causes b. Alopecia areata |
Changes in body hair distribution
a. Loss of hair 1. Liver cirrhosis (body hair) 2. Serious febrile illnesses - Typhoid, septicemia 3. After cytostatica (Total hair loss is called Alopecia diffusa) b. Alopecia areata I. Limited/patchy hair-loss II. Can be found in disorders of the thyroid, ovarian, or pituitary glands |
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Nail changes
a. Increased brittleness b. Spheric nails/Clubbing c. Flat/planinychia or concave/koilonychia nails |
Nail changes
a. Increased brittleness I. Seen in thyroid disorders and in iron-deficiency anemias b. Spheric nails/Clubbing I. Convex nails II. Usually associated with clubbed/drumstick fingers III. Can be seen in congenital cyanotic heart diseases, pulmonary diseases (lung cancer, bronchiectasis), subacture bacterial endocarditis, inherited anomaly c. Flat/planinychia or concave/koilonychia nails I. Associated with iron-deficiency anemia along with brittle nails |
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Body temperature
a. Normal body temperature b. Subfebrile/Low-grade fever c. Fever d. Hyperpyrexia |
Body temperature
a. Normal body temperature I. 36-37C (0.5C higher with rectal/oral) b. Subfebrile/Low-grade fever I. 37-38C c. Fever I. 38-40C d. Hyperpyrexia (Pyrexis - Feverishness) I. >40C |
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Body temperature - Types of fever patterns
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Body temperature - Types of fever patterns
1. Continuous fever/Febris continua (Steady fever above 38C, diurnal fluctuation less than 1C below, typical with untreated typhoid fever or lobar pneumonia) 2. Remittent fever/Febris remittens (Fever fluctuates by more than 2C over 24 hours, but does not return to normal. Pre-antibiotics it used to be typical in serious infections) 3. Intermittent fever/Febris intermittens (High temperature which during the day falls to normal/subnormal levels. Septicemia, cholangitis, pyelonephritis..) 4. Recurrent fever/Febris recurrents (Alternative periods of fever and normal, recurrent typhus (borrelia) 5. Undulating fever/Febris undulans (Crescendo-decrescendo pattern over a few days, Hodgkin's disease -> Pel-Ebstein fever, brucellosis) |
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Examination of the head
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Examination of the head
1. Skull - Inspection, palpation, percussion 2. Eyes - Inspect, movement, ophthalmoscopy 3. Nose 4. Lips and mouth 5. Ears |
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Inspection of the skull
a. A normal skull is called b. Brachycephalus c. Dolichocephalus d. Microcephalus |
Inspection of the skull
a. A normal skull is called mesocephalus/normocephalic b. Brachycephalus - Shortened AP diameter c. Dolichocephalus - Elongated AP diameter d. Microcephalus - Small skull I. Due to disturbances in brain development -> Virtually always connected with some brain dysfunction and mental deficiency |
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Macrocephaly - Abnormally large skull. Causes
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Macrocephaly - Abnormally large skull. Causes
1. Hydrocephalus before fontanelles are closed (Face is of normal size) 2. Osteitis deformans - Skull deformation in Paget's disease I. Thickening of skull, mainly in the frontal area 3. Caput quadratum/Square skull I. Prominent frontal and parietal bones I. Used to be common in rickets |
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Inspection of the skull
a. Oxycephaly/Turricephaly b. Opisthotonus c. Torticollis |
Inspection of the skull
a. Oxycephal (Oxy- point)y/Turricephaly (Turris - tower) I. Malformed skull with a pointed vertex II. Due to premature closure of the sutures III. Not accompanied by mental deficiencies b. Opisthotonus (Opistho-: backward/behind, Tonos - Tension) I. The head is dorsiflexed while the spine is rigid II. Sign indicating meningitis c. Torticollis (Tortus - twisted, collum) I. The head is flexed sideways |
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Muffet's sign
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Muffet's sign
I. Synchronous nodding of the head with every systole II. Sign of severe aortic insufficiency |
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Inspection of the face
a. Facies febrilis/Febrile face b. Facies myxoedematosa/ Myxedema face c. Facies mitralis/Mitral face |
Inspection of the face
a. Facies febrilis/Febrile face I. Burning face with glistening eyes in patient with high fever b. Facies myxoedematosa/ Myxedema face I. Yellowish, doughy skin II. Noticeable periorbital myxedema III. Thinned out lateral parts of the eyebrows IV. Spotty redness of the cheeks and nose in contrast to the otherwise yellowish color - Clown's face' c. Facies mitralis/Mitral face I. Vermillion blush and cyanotic hue II. Pallor around the eyes, mouth, and forehead and cyanosis of acral parts (the ear lobes, lips and the tip of the nose) |
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Inspection of the face
a. Cushingoid face b. Face of patients with polycythemia vera/Vaques-Osler's disease c. Face in Parkinson's disease d. Facies acromegalica |
Inspection of the face
a. Cushingoid face I. In Cushing's syndrome II. The face is rounded ('moon face') and dusky b. Face of patients with polycythemia vera/Vaques-Osler's disease I. Acral parts of the face (ear lobes, tip of nose, lips) and facial mucosa becomes dark blue in color c. Face in Parkinson's disease I. Mask-like - Hypomimia (Decreased mimics) II. Oily skin III. Coarse resting tremor of the chin d. Facies acromegalica I. Enlargement of the supraorbital ridges II. Large and broad nose III. Widened, protruding chin IV. Large tongue |
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Motor innervation of the face
a. Central/UMN palsy b. Peripheral/LMN/Bell's palsy |
Motor innervation of the face
a. Central/UMN palsy I. Stroke II. The upper one-third of the face is spared III. Signs: Flattened nasolabial fold, unable to whistle or puff his cheek (air escapes from deformed mouth) b. Peripheral/LMN/Bell's palsy I. Damage to the facial nerve II. All muscles of facial expression are affected III. Additional signs: Unable to wrinkle forehead, elevate eyebrow, tightly close eyes. Lagophthalmos (inability to close the eye - tears and secretions accumulate) |
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Examination of the eyes
a. Markedly protruding eyeballs can be seen in b. Overabundant, thick eyebrows in females may be due to c. Thinning or loss of the lateral parts of the eyebrows is seen in |
Examination of the eyes
a. Markedly protruding eyeballs can be seen in facies acromegalica b. Overabundant, thick eyebrows in females may be due to virilism. c. Thinning or loss of the lateral parts of the eyebrows is seen in myxedema and thallium poisoning. |
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Examination of the eyelids
a. Swelling of the eyelids is seen in b. Pigmentation of the eyelids is common in c. Xanthelasma - What, encountered in |
Examination of the eyelids
a. Swelling of the eyelids is seen in 1. Blepharitis (blephar- eyelid) 2. Kidney disease 3. Myxedema 4. Angioneurotic edema/Angioedema/Quincke's edema (The rapid swelling (edema) of the dermis, subcutaneous tissue, mucosa and submucosal tissues. It is very similar to urticaria, but urticaria, commonly known as hives, occurs in the upper dermis. The term angioneurotic oedema was used for this condition in the belief that there was nervous system involvement, but this is no longer thought to be the case. Can be acquired (allergic) or congenital) b. Pigmentation of the eyelids is common in 1. Addison's disease/Adrenocortical insufficiency 2. Thyrotoxicosis/Graves'-Basedow's disease c. Xanthelasma (Xanth- yellow, Elasma - Beaten metal plate) - What, encountered in I. Yellow plaques/spots on and around the lids II. Particularly on the medial parts of the eyelid and the medial canthus III. The most common form of xanthoma IV. Causes 1. Biliary cirrhosis 2. Lipid disturbances - Hypercholesterolemia, hyperlipidemia (Xanthoma: A yellow nodule or plaque, especially of the skin, composed of lipid-laden histiocytes) |
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Expophthalmos
a. What b. Seen with c. Mechanism |
Expophthalmos
a. Ventral protrusion of the eyeballs b. Seen with I. Thyrotoxicosis - Bilateral II. Unilateral 1. Retrobulbar tumors or tumors of the posterior fossa of the cranium 2. Thrombosis of the cavernous sinus (With unilateral congestive periorbital edema, chemosis (swelling of the conjunctiva). Often also evidence of an inflammatory process boil/furuncle on the face, nose, upper lip, or eyebrow) c. Mechanism in thyrotoxicosis I. TSH --> Swelling of the retrobulbar tissue II. Sympathicus --> Retractioof the eyelids (Boil ('Swelling')/Furuncle - Localized pyogenic infection originated deep in a hair follicle, most often due to s. aureus) (Unilateral enophthalmus --> Horner's syndrome. + Miosis, ptosis, anhidrosis, due to loss of sympathetic input) |
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Ocular signs in thyrotoxicosis
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Ocular signs in thyrotoxicosis
1. Exophthalmus 2. Graefe's sign - Lid lag (When the patient looks downward, the eyelids don't follow the globes and a narrow layer of white sclera remains visible) 3. Moebius' sign - The eyes diverge upon near point focusing 4. Stellwag's sign - Infrequent blinking and stare |
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Movement of the eyeballs
a. Squinting/Strabismus b. Nystagmus c. Nystagmus - Types d. How is nystagmus best examined |
Movement of the eyeballs
a. Squinting/Strabismus/Crossed eye/Heterotropia (tropy- turning) I. Lack of parallelism of the visual axes of the eyes II. Convergent or divergent b. Nystagmus I. Involuntary rhythmic oscillations/jerking of the eyeballs c. Nystagmus - Types I. Vertical (Drift up and down), horizontal, rotational II. Depending on the direction of the faster component of nystagmus we recognize right, left, cranial and caudal nystagmus d. How is nystagmus best examined - In the extreme positions of the eyeballs |
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Conjunctiva
a. Very pale conjunctiva is found in b. Purple conjunctiva is encountered in c. Redness of the conjunctiva is typical of d. Bloody suffosions/hematomas can be found in e. Xerophthalmia (dryness of the conjunctiva) can be a sign of |
Conjunctiva
a. Very pale conjunctiva is found in anemia b. Purple conjunctiva is encountered in polycythemia c. Redness of the conjunctiva is typical of conjunctivitis/Pinkeye d. Bloody suffosions/hematomas can be found in bleeding disorders e. Xerophthalmia (dryness of the conjunctiva) can be a sign of 1. Antixerophthalmic vitamin A deficiency 2. Sicca/Sjogren's syndrome |
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Examination of oral mucosa
a. Thrush - What b. Thrush - In who c. Blue-gray spots/Graphite spots on the buccal mucosa can be found in patients with which disease |
Examination of oral mucosa
a. Thrush - What I. Infection of the oral mucosa with candida albicans II. Starts as stomatitis with small whitish specks --> enlarge, coalesce, turn yellow-brown III. Can spread to pharynx, esophagus, or the stomach (Generic term for a group of fungi commonly known as fruit molds. A few closely related pathogenic organisms formerly classified in this genus are now properly termed Candida. Monilia fungus can also appear in other moist areas of the body - axilla, under female breasts, groins, vagina)) b. Thrush - In who I. After broad-spectrum ATB II. In immunocompromised patients - AIDS, leukemia c. Blue-gray spots/Graphite spots on the buccal mucosa can be found in patients with which disease |
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Examination of the gingiva
a. Bleeding gums, along with swelling of the oral mucosa and interdental papilla are hallmark findings for b. Bleeding gums alone most frequently indicate c. Necrosis of the gums may be associated with ... d. Colored bands on the gums and around the teeth may be signs of |
Examination of the gingiva
a. Bleeding gums, along with swelling of the oral mucosa and interdental papilla are hallmark findings for scurvy/Vitamin C deficiency b. Bleeding gums alone most frequently indicate gingivitis (Resulting from poor dental hygiene, result in paradentosis) c. Necrosis of the gums may be associated with acute leukemia, agranulocytosis and bone marrow failure d. Colored bands on the gums and around the teeth may be signs of intoxication with heavy metals - Mercury, Cadmium |
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Examination of the teeth
a. Points of the exam b. Prognathia c. Progenia |
Examination of the teeth
a. Points of the exam I. Jaw II. Number of teeth, bridges, dentures (Dentures have to be immediately removed in unconscious or gravely ill patients!) III. Gingivitis with pocket or abscess formation b. Prognathia I. Protrusion of maxilla c. Progenia I. Protrusion of the mandible |
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Examination of the tonsils - Check for
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Examination of the tonsils - Check for
1. Presence and size - Hypertrophic, atrophic, absent post-tonsillectomy 2. Contain purulent specks (flekker) 3. Covered with films or pseudomembranes 4. Inflamed and swollen |
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Foetor ex ore/Bad breath
a. Normal foul odor from the mouth are most commonly from b. Breath resembling the odor of freshly cut liver --> c. Smell of ammonia --> d. Fruity odor --> e. Putrid (råtten), very repulsive odor --> |
Foetor ex ore/Bad breath
a. Normal foul odor from the mouth are most commonly from dental caries or gingivitis b. Breath resembling the odor of freshly cut liver --> Foetor hepaticus in hepatic coma c. Smell of ammonia --> Foetor uremicus/uremic breath in uremia d. Fruity odor --> Acetones from DKA e. Putrid (råtten), very repulsive odor --> 1. Lung processes - Abscess, gangrene, bronchiectasis 2. GI: Ileus |
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Examination of the ears
a. Whitish deposits of the pinna (outer ear) are what and are found in which disease b. Discharge from the meatus indicates some inflammatory process, most often in the c. Myringitis |
Examination of the ears
a. Whitish deposits of the pinna (outer ear) are deposits of uric acid (urate tophi) seen in gout b. Discharge from the meatus indicates some inflammatory process, most often in the midlde ear (otitis media) (If the drainage has a bad odor it may be caused by a purulent mastoiditis or by cholesteatoma) c. Myringitis (Myring - tympanic membrane) I. Inflammation of the tympanic membrane II. Associated with otitis media (Cholesteatoma (Cholesterol, stear - tallow (talg), -oma) - Squamous metaplasia or extension of squamous cell epithelium inward to line an expanding cystic cavity that may involve the middle ear or the mastoid, erode surrounding bone, and become filled with a mass of keratinized squamous cell epithelial debris) |
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Examination of the neck - Points
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Examination of the neck - Points
1. Examination of the neck arteries 2. Examination of the neck veins 3. Examination of the cervical lymph nodes 4. Examination of the thyroid gland |
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Examination of the neck arteries
a. Intensive visible pulsation of the internal carotid arteries is encountered in b. Findings indicative of thrombotic obstruction of the carotid arteries |
Examination of the neck arteries
a. Intensive visible pulsation of the internal carotid arteries is encountered in 1. Physical exercise 2. Hypertension 3. Thyrotoxicosis 4. Arteriosclerosis b. Findings indicative of thrombotic obstruction of the carotid arteries 1. Unilateral weakening/absence of the carotid pulse 2. Bruit (-> Narrowing from atheromatous plaque or dilation from aneurysm) |
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Examination of the neck veins
a. How is the JVP measured b. JVP - Normal value c. Causes of increased JVP d. Stokes' collar |
Examination of the neck veins
a. How is the JVP measured I. From a horizontal line drawn through the sternoclavicular junction when the patient is lying with the head elevated 45 degrees (a pillow) II. Indicates approximate venous pressure in cm of water b. JVP - Normal value - < 2cm c. Causes of increased JVP 1. Right heart failure 2. Tricuspidal incompentence (Can see a systolic venous pulsation) 3. Constrictive pericarditis 4. Pericardial tamponade 5. Tension pneumothorax 6. Compressing abdominal herniation d. Stokes' collar I. Edematous infiltration of the neck and face with stagnation cyanosis II. From compression of the SVC |
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Examination of the cervical lymph nodes - Which are palpated and where
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Examination of the cervical lymph nodes
I. On the head 1. Preauricular 2. Postauricular 3. Occipital/Suboccipital 4. Submandibular 5. Submental II. On thea neck 1. Anterior and posterior to SCM 2. Supraclavicular nodes (Virchow's node on the left) |
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Examination of oral mucosa
a. Thrush - What b. Thrush - In who c. Blue-gray spots/Graphite spots on the buccal mucosa can be found in patients with which disease |
Examination of oral mucosa
a. Thrush - What I. Infection of the oral mucosa with candida albicans II. Starts as stomatitis with small whitish specks --> enlarge, coalesce, turn yellow-brown III. Can spread to pharynx, esophagus, or the stomach (Generic term for a group of fungi commonly known as fruit molds. A few closely related pathogenic organisms formerly classified in this genus are now properly termed Candida. Monilia fungus can also appear in other moist areas of the body - axilla, under female breasts, groins, vagina)) b. Thrush - In who I. After broad-spectrum ATB II. In immunocompromised patients - AIDS, leukemia c. Blue-gray spots/Graphite spots on the buccal mucosa can be found in patients with which disease |
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Examination of the gingiva
a. Bleeding gums, along with swelling of the oral mucosa and interdental papilla are hallmark findings for b. Bleeding gums alone most frequently indicate c. Necrosis of the gums may be associated with ... d. Colored bands on the gums and around the teeth may be signs of |
Examination of the gingiva
a. Bleeding gums, along with swelling of the oral mucosa and interdental papilla are hallmark findings for scurvy/Vitamin C deficiency b. Bleeding gums alone most frequently indicate gingivitis (Resulting from poor dental hygiene, result in paradentosis) c. Necrosis of the gums may be associated with acute leukemia, agranulocytosis and bone marrow failure d. Colored bands on the gums and around the teeth may be signs of intoxication with heavy metals - Mercury, Cadmium |
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Examination of the teeth
a. Points of the exam b. Prognathia c. Progenia |
Examination of the teeth
a. Points of the exam I. Jaw II. Number of teeth, bridges, dentures (Dentures have to be immediately removed in unconscious or gravely ill patients!) III. Gingivitis with pocket or abscess formation b. Prognathia I. Protrusion of maxilla c. Progenia I. Protrusion of the mandible |
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Examination of the tonsils - Check for
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Examination of the tonsils - Check for
1. Presence and size - Hypertrophic, atrophic, absent post-tonsillectomy 2. Contain purulent specks (flekker) 3. Covered with films or pseudomembranes 4. Inflamed and swollen |
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Foetor ex ore/Bad breath
a. Normal foul odor from the mouth are most commonly from b. Breath resembling the odor of freshly cut liver --> c. Smell of ammonia --> d. Fruity odor --> e. Putrid (råtten), very repulsive odor --> |
Foetor ex ore/Bad breath
a. Normal foul odor from the mouth are most commonly from dental caries or gingivitis b. Breath resembling the odor of freshly cut liver --> Foetor hepaticus in hepatic coma c. Smell of ammonia --> Foetor uremicus/uremic breath in uremia d. Fruity odor --> Acetones from DKA e. Putrid (råtten), very repulsive odor --> 1. Lung processes - Abscess, gangrene, bronchiectasis 2. GI: Ileus |
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Examination of the ears
a. Whitish deposits of the pinna (outer ear) are what and are found in which disease b. Discharge from the meatus indicates some inflammatory process, most often in the c. Myringitis |
Examination of the ears
a. Whitish deposits of the pinna (outer ear) are deposits of uric acid (urate tophi) seen in gout b. Discharge from the meatus indicates some inflammatory process, most often in the midlde ear (otitis media) (If the drainage has a bad odor it may be caused by a purulent mastoiditis or by cholesteatoma) c. Myringitis (Myring - tympanic membrane) I. Inflammation of the tympanic membrane II. Associated with otitis media (Cholesteatoma (Cholesterol, stear - tallow (talg), -oma) - Squamous metaplasia or extension of squamous cell epithelium inward to line an expanding cystic cavity that may involve the middle ear or the mastoid, erode surrounding bone, and become filled with a mass of keratinized squamous cell epithelial debris) |
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Examination of the neck - Points
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Examination of the neck - Points
1. Examination of the neck arteries 2. Examination of the neck veins 3. Examination of the cervical lymph nodes 4. Examination of the thyroid gland |
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Examination of the neck arteries
a. Intensive visible pulsation of the internal carotid arteries is encountered in b. Findings indicative of thrombotic obstruction of the carotid arteries |
Examination of the neck arteries
a. Intensive visible pulsation of the internal carotid arteries is encountered in 1. Physical exercise 2. Hypertension 3. Thyrotoxicosis 4. Arteriosclerosis b. Findings indicative of thrombotic obstruction of the carotid arteries 1. Unilateral weakening/absence of the carotid pulse 2. Bruit (-> Narrowing from atheromatous plaque or dilation from aneurysm) |
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Examination of the neck veins
a. How is the JVP measured b. JVP - Normal value c. Causes of increased JVP d. Stokes' collar |
Examination of the neck veins
a. How is the JVP measured I. From a horizontal line drawn through the sternoclavicular junction when the patient is lying with the head elevated 45 degrees (a pillow) II. Indicates approximate venous pressure in cm of water b. JVP - Normal value - < 2cm c. Causes of increased JVP 1. Right heart failure 2. Tricuspidal incompentence (Can see a systolic venous pulsation) 3. Constrictive pericarditis 4. Pericardial tamponade 5. Tension pneumothorax 6. Compressing abdominal herniation d. Stokes' collar I. Edematous infiltration of the neck and face with stagnation cyanosis II. From compression of the SVC |
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Examination of the cervical lymph nodes - Which are palpated and where
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Examination of the cervical lymph nodes
I. On the head 1. Preauricular 2. Postauricular 3. Occipital/Suboccipital 4. Submandibular 5. Submental II. On thea neck 1. Anterior and posterior to SCM 2. Supraclavicular nodes (Virchow's node on the left) |
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Examination of the thyroid gland
a. Goiter b. Classification of goiters c. How can a goiter be inspected |
Examination of the thyroid gland
a. Goiter/Struma I. Any enlargement of the thyroid regardless of etiology b. Classification of goiters I. Simple goiter - Goiter not associated with inflammatory or neoplastic processes or with functional disturbances (thyrotoxicosis or hypothyroidism), euthyroid (Can cause pathology by compression on trachea or esophagus or by causing pain) II. Hyperthyroid goiter - Increased function III. Hypothyroid goiter - Decreased function c. How can a goiter be inspected I. Tilt the patient's neck back and have the patient II. Look for any ascending mass in the midline or behind the SCM |
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Examination of the thyroid gland
a. How can the thyroid gland be palpated? b. What is assessed when palpating the thyroid gland? |
Examination of the thyroid gland
a. How can the thyroid gland be palpated? 1. Have the patient lower his chin to relax the neck muscles --> Run your fingers over the tracheal rings to feel for the isthmus I. Not present in a normal-sized thyroid gland. II. Helps if patient swallows on command 2. Have the patient lower his chin to relax his neck muscles and look to the ipsilateral side as palpated to relax the SCM --> Feel for the thyroid gland behind and in front of SCM with the thumb I. Not palpable in a normal sized thyroid gland II. Helps if the patient can swallow on command b. What is assessed when palpating the thyroid gland? 1. Size 2. Symmetry/Asymmetry 3. Surface - Smooth, irregular, nodular 4. Consistency - Soft, firm, stone-hard 5. Tenderness 6. Mobility - Against the skin and surrounding structures 7. Accelerated blood flow through it - Pulsation, thrill, bruit (Goiters can be retrosternal or intrathoracic (in mediastinum)) |
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Goiters - Characteristics of
a. Parenchymatous goiters b. Goiter in Graves'-Basedow's disease c. Colloid goiter |
Goiters - Characteristics
a. Parenchymatous goiters I. Mainly in puberty II. Diffuse, soft, smooth b. Colloid goiter I. Adult II. Diffuse, symmetrical III. Firmer than parenchymatous goiter c. Goiter in Graves'-Basedow's disease I. Diffuse, soft, symmetrical II. Signs of increased vascularity a. Stroma pulsans - Palpated b. Stroma vibrans/thrill c. Stroma fremens/bruit - Auscultated |
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Goiters - Characteristics
a. Nodular goiter b. Malignant goiter c. Hashimoto's thyroiditis |
Goiters - Characteristics
a. Nodular goiter I. Uninodular, multinodular (>1) --> Asymmetric II. Parenchymal III. Irregular surface IV. Can be associated with displacement/compression of the trachea and esophagus to cause stridor or dysphagia b. Malignant goiter/Struma maligna I. Asymmetric, stone-hard, tender II. Invade neighboring tissue --> a. Not mobile b. Vocal cord paralysis by recurrent laryngeal nerve c. SVC obstruction c. Hashimoto's thyroiditis/Struma lymphomatosa I. Small, firm, nontender, irregular surface, can have nodules II. Hypothyroidism (Sometimes can cause acute inflammation --> Enlargement, tender, compression) |
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Goiters - Characteristics
a. Subacute thyroiditis of viral origin b. Riedel's thyroiditis |
Goiters - Characteristics
a. Subacute thyroiditis of viral origin I. Asymmetrical, firm, tender (-> Dynophagia) II. Pain referred to jaw and ears III. Can be low-grade fever b. Riedel's thyroiditis I. Unknown etiology II. Intense fibrosis --> Hard, compress surrounding structures |
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Examination of the chest - Orientation lines
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Examination of the chest - Orientation lines
Anterior surface 1. Midsternal line - Connects the suprasternal notch/jugular fossa with the pubic symphysis 2. Parasternal lines 3. Midclavicualr lines 5. Axillary lines - Anterior, Middle, Posterior Posterior surface 6. Scapular line - Over the lower angle of the scapula 7. Paravertebral line 8. Midspinal line |
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Inspection of the chest - Overview
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Inspection of the chest - Overview
1. Shape of the chest 2. Respiratory movements 3. Soft parts - Signs of neoplastic process, Breasts |
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Abnormal chest shapes
a. Barrel chest b. Pigeon breast/Pectus carinatum c. Funnel breast/Pectus excavatum d. Kyphoscoliosis |
Abnormal chest shapes
a. Barrel chest I. Consequence of prolonged obstructive lung disease II. The chest is permanently in an 'inspired position' III. The sternum is arched out, the spine can be kyphotic IV. Ribs: More horizontally, widened intercostal spaces, blunted epigastric angle V. Shallow respiratory movements b. Pigeon breast/Pectus carinatum I. Protruding sternum II. Characteristic for rickets (With rachitic rosary bilateral knobs at the costochondral junctions) c. Funnel breast/Pectus excavatum I. Usually without clinical significance d. Kyphoscoliosis I. Common in childhood rickets II. Can compromise ventilation --> Hypoxic vasoconstriction --> Cor pulmonale kyphoscolioticum (Chest deformities: congenital heart disease/early valvular disease --> bulge/vossure on chest, TB --> retractio hemithoracis (from fibrotic and adhesive changes) |
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Respiratory movements
a. How can one see evidence of diseases of the pleura, such as pleuropneumonic adhesions, pleural effusions or pneumothorax b. Respiratory rate in adult c. Tachypnea - Causes |
Respiratory movements
a. How can one see evidence of diseases of the pleura, such as pleuropneumonic adhesions, pleural effusions or pneumothorax --> The movements of the chest on the affected side may be diminished or absent b. Respiratory rate in adult - 16-20 c. Tachypnea - Causes 1. Pulmonary disease 2. Cardiac disease 3. Neurological disease 4. Anemia 5. Toxic and metabolic processes 6. Excitement and nervousness 7. Fever 8. Exercise 9. Hypoxia from circulatory insufficiency |
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Respiratory movements
a. Cheyne-Stokes periodic respiration - Causes b. Biot's breathing c. Sighing respiration |
Respiratory movements
a. Cheyne-Stokes periodic respiration - Causes 1. Heart failure 2. Uremia 3. Severe pneumonia 4. Increased ICP - Cerebral hemorrhage b. Biot's breathing I. Irregular irregular breathing with apneic periods II. Seen in meningitis, encephalitis III. Caused by decreased sensitivity of the respiratory center c. Sighing respiration I. The normal respiratory rhythm is interrupted by a long deep inspiration, usually followed by a sigh and a prolonged expiration II. Seen in neurasthenic/neurotic individuals |
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Examination of the breasts
a. Inspection - Overview b. Palpation - Overview |
Examination of the breasts
a. Inspection - Overview 1. Overall size 2. Shape 3. Bilateral symmetry (Asymmetry due to cystic enlargement, mastitis, or neoplasm) 4. Skin appearance 5. Condition of the nipple 6. Skin retraction b. Palpation - Overview 1. Structure 2. Density/Consisteny --> Masess/lumps? a. Size b. Shape c. Regularity d. Blunt or sharp surface e. Mobility |
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Examination of the breasts
a. Gynecomastia - Causes b. Skin - Evaluate c. Nipples - Evaluate d. Secretion - Evaluate |
Examination of the breasts
a. Gynecomastia - Causes 1. Endocrine disturbances 2. Obesity 3. Hormonal treatment with female steroids 4. Liver cirrhosis b. Skin - Evaluate 1. Color (Redness --> Swollen breast) 2. Swelling 3. Bulges - Lumps 4. Dimples ('smilehull') 5. P'eau d orange/Skin of orange (Adenocarcinoma, mastitis --> Lymphatic blockage --> Edema --> retractions) c. Nipples - Evaluate 1. Changes - Size, position, redness, fissures 2. Recent (Weeks, months) changes are important 3. All unilateral changes are suspicious for malignancies d. Secretion - Evaluate 1. Purulent (yellow, green, gray) --> Mastitis 2. Small amount of clear or cloudy secretion --> Usually harmless 3. Blood secretions from the same nipple --> Cancer 4. Abnormal lactation --> Endocrine (pituitary, thyroid) |
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Palpation of the breast
a. Method b. What is evaluated in a lump c. Benign cyst or fibroadenoma - Characteristics d. Adenomatosis, Cancer - Characteristics |
Palpation of the breast
a. Method I. Supine and standing II. Examine bimanually to compare III. Circular movements and gentle pressure against the chest wall, stepwise in small areas IV. Evaluate structure and density/consistency V. Ask for tenderness VI. Complete by examining axillary lymph nodes b. What is evaluated in a lump/mass 1. Size 2. Shape 3. Regularity 4. Surface/Margins - Blunt or sharp 5. Mobility - Against the rest of the gland, the chest wall, and the covering skin c. Benign cyst or fibroadenoma - Characteristics I. Distinctly circumscribed II. Smooth III. Rounded, oval, or polycystic node/lump d. Adenomatosis, Cancer - Characteristics I. Irregular and ragged surface II. Indistinct margins |
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Vocal/Tactile/Pectoral fremitus
a. Fremitus b. Vocal/tactile/Pectoral fremitus - What, method |
Vocal/Tactile/Pectoral fremitus
a. Fremitus (Fremo - To roar, resound) I. A vibration imparted to the hand resting on the chest or any other part of the body b. Vocal/tactile/Pectoral fremitus - What, method I. The perception of vibration of the chest wall caused by phonation of the patient II. The patient loudly pronounces certain words (one-two-three) to cause resonance, the examiner places the palms bilaterally over corresponding areas on the hemithoraces and compares vibrations (Dependent on proper functioning of the vocal cords, unobstructed trachea and bronchi, elastic chest wall. Best felt over the right upper lobe, as this point is closest to the trachea) |
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Vibratory/Vocal/Tactile/Pectoral fremitus
a. Causes of increased fremitus b. Causes of decreased or absent fremitus |
Vibratory/Vocal/Tactile/Pectoral fremitus
a. Causes of increased fremitus 1. Larger infiltrative processes of the lungs as found in pneumonia b. Causes of decreased or absent fremitus 1. Pleural a. Pleural exudates/effusions b. Pneumothorax c. Massive adhesions (Asses borders by palpating with the ulnar surface of the hand during phonation) 2. Bronchial obstruction causing local atelactasis a. FAO b. Tumor 3. Lung emphysema (Not enough normal lung tissue to transmit the sound) |
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Pleural friction rub
a. What b. Where is it best palpated c. Differential diagnosis |
Pleural friction rub
a. What I. Tactile perception of the rub between the pleural layers in pleuritis b. Where is it best palpated I. At the lower edges of the lung in the midaxillary line (Where the movements between the pleural layers are largest. Both during expiration or inspiration) c. Differential diagnosis I. Broken rib |
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Percussion
a. Pattern of percussion on the back b. Characteristics of the percussion sound over normal lungs |
Percussion
a. Pattern of percussion on the back 1. Start up in the neck (backside of supraclavicular notch) 2. Percuss along the scapular and paravertebral lines in a comparative fashion toward the bottom of the lungs b. Characteristics of the percussion sound over normal lungs 1. Sonorous, resonant, clear 2. Slightly hyperresonant toward the lung bases (In the front one used to start in the supraclavicular notch and proceed in the midclavicular lines) |
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Topographic percussion
a. Delineation of the inferior percussion borders b. Where is the largest displacement during respiration |
Topographic percussion
a. Delineation of the inferior percussion borders 1. In the front and sides - In relation to the ribs and intercostal spaces (Parasternal line -> 6th rib Medioclavicular line -> 6th intercostal space (not on left due to heart) Midaxillary line -> 8th rib) 2. In the back - In relation to the vertebral spinous processes (Scapular line -> 10th rib, Paravertebral line - Left -> T11, Right -> T10) (One prominent vertebra on the back -> C7, 2 -> Lower is C7, 3 -> Middle is C7) b. Where is the largest displacement during respiration - In the midaxillary lines (Up to 8 cm) (2nd scapular lines (4cm), 3rd - front) |
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Topographic percussion
a. Bilateral diminished respiratory movements and percussory displacement - Causes b. Unilaterally diminished percussion displacement - Causes |
Topographic percussion
a. Bilateral diminished respiratory movements and percussory displacement - Causes 1. Pulmonary emphysema 2. Ascites 3. Elevated diaphragm in pregnancy 4. Massive bilateral pleuropulmonary adhesions b. Unilaterally diminished percussion displacement - Causes 1. Pleural effusion 2. Pneumothorax 3. Pleuropulmonary adhesions 4. Atelactasis of the lower lobe 5. Phrenic nerve paresis 6. Elevated diaphragm, ie due to a suphrenic abscess |
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Bronchial/Tubular breathing
a. Description of sound b. Mechanism of sound c. Physiologically heard at |
Bronchial/Tubular breathing
a. Description of sound I. Sounds like a throaty ''kh'' II. Short inspiratory phase and long expiratory phase b. Mechanism of sound I. Originates from air rushing through the larynx and vibrating the air column in the larynx and trachea b. Physiologically heard at 1. Over the larynx and trachea in the supraclavicular fossa and over the upper part of the sternal manubrium 2. In the vicinity of C7 3. To the right of Th4 4. In the axilla (Particularly in children) |
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Pathologic vesicular breathing
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Pathologic vesicular breathing
1. Increased/Intensified vesicular breathing I. Hyperventilation - Kussmauls.. II. Unilateral compensation for pathologic process on the other side a. Massive lobar pneumonia b. Pneumothorax c. Massive pleural effusion 2. Weakened/Decreased vesicular breathing I. Quiet breathing in obese patient II. Hypoventilation secondary to pain from trauma or pleuritis III. Large pleuropulmonary adhesions IV. Pleural effusion V. Pneumothorax VI. Emphysema (Due to numerical reduction of pulmonary alveoli and loss of elasticity, the lungs are in a hyperinflated position with reduced ventilation) VII. Obstructive atelactasis 3. Inaudible breathing I. Extremely weakened ventilation II. Large pneumothoraces III. Massive pleural effusions IV. Massive atelactases 4. Vesicular breathing with prolonged expiration I. Bronchial asthma II. Bronchiolitis III. Emphysema (When the prolonged expiration is a consequence of bronchiolar resistance due to spasm, swelling, and/or the presence of secretion) |
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Pathologic bronchial/tubular breathing
a. Mechanism b. Causes c. Amphoric breathing d. Compressive breathing |
Pathologic bronchial/tubular breathing
a. Mechanism I. Occurs if the vesicular/alveolar areas are compromised, but the bronchial tree is unobstructed b. Causes - Mostly pathologic with airless alveoli 1. Alveoli filled with I. Blood in pulmonary infarction II. Inflammatory exudate in pneumonia III. Tumorous tissue 2. If the alveoli are compressed from the outside I. Fluid in the pleural cavity c. Amphoric breathing I. Tubular breathing heard over a large pulmonary cavity that communicates with a bronchus d. Compressive breathing I. Observed at/above the border of a large pleural effusion II. Caused by pressure of the pleural fluid upon the adjacent lung tissue III. Can be considered an intermediate between bronchial and vesicular breathing IV. Best audible during expiration |
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Adventitious breath sounds/Rales
a. What b. Types |
Adventitious breath sounds /Rales
a. What I. Sounds heard on auscultation of abnormal lungs II. Rales are not modifications of normal breath sounds, but arise from the flow of air and the presence of 1. Liquid or semiliquid material in the alveoli, bronchioli and bronchi 2. Bronchospasm b.Types 1. Dry rales I. Sibilant rales (High pitched: whistles) II. Sonorous rales (Low pitched: rhonchi) 2. Moist rales/Crackles I. Crackling - Fine bubbles II. Crepitant - Medium bubbles III. Coarse/Gurgling rales - Large bubbles (Also sometimes called rhonchi) |
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Dry rales
a. Mechanism b. Types c. Heard in which diseases |
Dry rales
a. Mechanism I. They arise in medium or larger bronchi if they are filled with thick or viscous exudate adhering to the bronchial wall II. The exudates vibrates like a string or a pseudomembrane during respiration II. Spasms of bronchi may contribute to their development b. Types 1. Sibilant/Whistling/Wheezing - High-pitched 2. Sonorous/Musical - Low-pitched c. Heard in which diseases 1. Acute and chronic bronchitis 2. Bronchial asthma - Then called wheezes (Present on inhalation and exhalation) |
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Moist rales/Crackles
a. Description of the sound b. Moist crackles/rales are heard in c. A flood of crackling (and crepitant) rales are heard in |
Moist rales/Crackles
a. Description of the sound I. Compared to the sound of bursting bubbles on top of a liquid b. Moist crackles/rales are heard in 1. Pneumonia 2. Bronchopneumonia 3. Bronchiectasis c. A flood of crackling (and crepitant) rales are heard in 1. Pulmonary edema (Some distinguish between accentuated and unaccentuated according to their intensity. Accentuated rales are "clear" and appear to be closer. Unaccentuated rales seem to be "flat" and coming from a distance. The difference is due to the presence or absence of an infiltrative process at the origin of the rales: infiltration of the tissue transmits the crackling sound better than tissue filled with air. The rales are accentuated in pneumonia. Continuous accentuated rales over one or both lower lobes may be indicative of bronchiectasis) |
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Inspiratory crepitations
a. Description of the sound b. Causes |
Inspiratory crepitations
a. Description of the sound I. Similar to the sound of hair rubbed between the thumb and the index finger II. Resemble fine, clear, sharp crackling rales which create a continuous hum toward the end III. Only inspiratory b. Cause 1. Physiologic in shallow breathing (In shallow breathing some of the alveolar sacs in the lung bases collapses, but during the first deep breaths their walls expand by the rushing air that causes the crackling sounds. After a few deep breaths this phenomenon disappears) 2. Pathologically I. Pneumonia (A small amount of exudate causes the walls of the alveoli to stick together. With the flow of inspired air the alveolar walls are forcefully separated, causing the crackling sound) (Lobar pneumonia: Early -> Crepitus indux, Late -> Crepitus redux) II. Pulmonary infarction (III. Tuberculous infiltrate in the subclavicular area after coughing if the lung apices are involved) |
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Syndrome of bronchial obstruction - Chronic and acute bronchitis
a. Mechanism b. Findings |
Bronchitis - Chronic and acute
a. Mechanism I. Swelling II. Increased mucus production III. Bronchospasm b. Findings 1. Percussion - Resonant 2. Auscultation I. Vesicular breathing II. Prolonged exhalation III. Sibilant dry rales/Wheezes (High-pitced) IV. Copious sputum --> Moist rales/Crackles |
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Syndrome of bronchial obstruction - COPD - Findings
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Syndrome of bronchial obstruction - COPD - Findings
1. Percussion is hyperresonant 2. Auscultation I. Vesicular, but weakened II. Prolonged expiration III. Wheezes and whistles are audible IV. Moist rales/crackles can be heard if copious mucus production (The prolonged expiration is caused by bronchial obstruction and decreased elasticity of the lung in emphysema) |
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Syndrome of bronchiectasis
a. What b. Mechanism c. Findings |
Syndrome of bronchiectasis
a. What I. A disease characterized by dilatation of the lumina of the small bronchi II. Localized and diffuse bronchiectasis b. Mechanism I. Secretions, usually purulent, accumulate in the dilated bronchi II. Mostly acquired not congenital c. Findings 1. Percussion - Resonant 2. Auscultation I. Vesicular breathing II. Moist accentuated crepitant or coarse crackles/rales (Confirmed by bronchography, recurrent pneumonia is a common complication. Composite symptomatology when combined with COPD) |
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Syndrome of lung consolidation
a. Causes b. Findings in the presence of a patent bronchus |
Syndrome of lung consolidation
a. Causes 1. Lobar pneumonias 2. Pulmonary infarctions 3. Neoplasms 4. Atelactasis b. Findings 1. Percussion dullness or flatness 2. Increased fremitus pectoralis 3. Bronchial breathing 4. Accentuated moist crackling or crepitant rales 5. Increased bronchophony (In atelactasis where the supplying bronchus is obstructed, vesicular breathing is reduced/absent, fremitus and bronchophony are weakened) |
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Bronchophony
a. What b. Where is decreased bronchophony found c. Pectoriloquy - What d. Pectoriloquy - Causes |
Bronchophony
a. What I. Auscultation of voice sounds - Voice is transmitted through the airways to the chest wall II. Ask the patient to repeat certain words (''coockoo'') and compare both sides of the chest III. Over normal healthy lung tissue the spoken words are very indistinct and unclear. Heard somewhat better in the areas of physiologic bronchial breathing b. Where is decreased bronchophony found I. Over a pleural exudate II. Over a pneumothorax III. In obstructive atelactasis IV. Over massive pleural thickenings c. Pectoriloquy (Loquor - To speak) I. Exaggerated bronchophony II. Syllables can be heard and distinguished clearly III. Use whispered voice d. Pectoriloquy - Causes: Consolidation 1. Pneumonia 2. Pulmonary infarction |
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Pneumonia
a. Anatomical types b. Acute pneumonia: Inflammation, scant serous exudation of the alveoli. Physical findings c. Next phase - Exudation entirely fills the alveoli. Physical findings d. Next phase: Leukocytic enzymes dissolves the alveolar exudate which then gets absorbed -> Aeration resumes. Physical findings |
Pneumonia
a. Anatomical types 1. Alar - Affect entire right or left wing of the lung 2. Lobar b. Acute pneumonia: Inflammation, scant serous exudation of the alveoli. Physical findings 1. Percussion - Resonant, mildly dulled over consolidation 2. Vesicular breathing, sometimes weakened 3. Crepitus indux - Initial crepitations c. Next phase - Exudation entirely fills the alveoli. Physical findings 1. Flat percussion sounds 2. Bronchial breathing 3. Accentuated rales 4. Fremitus, increased bronchophony (can be pectoriloquy) d. Next phase: Leukocytic enzymes dissolves the alveolar exudate which then gets absorbed -> Aeration resumes. Physical findings 1. Percussion - Dullness, resonant 2. Vesicular breathing 3. Crepitus redux - Final crepitations (4. Pleural rub - If the pleura is involved in the inflammation) |
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Atelactasis
a. What b. Types c. Physical findings in extensive atelactasis due to obstruction of a main bronchus |
Atelactasis (Ateles - Incomplete, Ektasis - Extension)
a. What I. Non-distension/expansion of the lung tissue (In a stricter sense it means non-aeration of lung tissue that has not yet breathed - neonate atelactasis) b. Types 1. Neonate atelactasis 2. Acquired obstructional atelactasis I. Foreign object II. Blood clot III. Mucus clot IV. Neoplasm compressing externally c. Physical findings in extensive atelactasis due to obstruction of a main bronchus 1. Flat percussion sound 2. Absent vocal fremitus 3. Inaudible respiration 4. Absent pectoriloquy (If it only affects a small portion of the lung (ie a lung segment), other lung areas expand and compensate, which then cannot be identified by the physical diagnosis) |
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Cavitary (Cavity) syndrome
a. What b. Detectable by physical findings only if the cavity is larger than ... and ... c. Method of diagnosis |
Cavitary (Cavity) syndrome
a. What I. Cavity in the lung II. Mostly caused by tuberculosis or a lung abscess b. Detectable by physical findings only if the cavity is larger than 6 cm and near the lung surface and surrounded by infiltrated/condensed tissue c. Method of diagnosis - Radiology |
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Syndrome of diminished lung volume
a. Acute volume diminution b. Chronic volume diminution |
Syndrome of diminished lung volume
a. Acute volume diminution I. When an entire lung collapses b. Chronic volume diminution I. Develops if the aerated lung is replaced by fibrous tissue - Seen in 1. Fibrous tuberculosis 2. Extensive pleuropulmonary adhesions 3. Other fibrotic processes of the lung (Can affect single lobe (-> intercostal retractions, internal structures pulled toward it (ie esophagus, trachea)) or a whole lung (hemithorax reduced in size, retracted, ribs are closer, the spinal column is curved toward the affected side, the heart, trachea, and esophagus are pulled toward the diseased side) |
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Syndrome of enlarged lung volume - Acute
a. Cause b. Physical findings |
Syndrome of enlarged lung volume - Acute
a. Cause - Acute asthmatic attack b. Physical findings I. Inspection 1. Prolonged expiration 2. Orthopneic position (erect or sitting) 3. Respiration is labored 4. The chest is in inspiratory position 5. Respiratory excursions are diminished II. Percussion 1. Hyperresonance 2. Inferior borders are percussed lower caudally III. Auscultation 1. Vesicular with prolonged expiration 2. Musical rales - Wheezes/whistles (high-pitched), rhonchi (low-pitched) (The basic breathing then become inaudible) |
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Syndrome of enlarged lung volume - Chronic lung volume enlargement
a. Cause b. Physical findings |
Syndrome of enlarged lung volume - Chronic lung volume enlargement
a. Cause - Pulmonary emphysema (En- in, Physa - Bellows) b. Physical findings I. Inspection 1. Barrel chest in inspiratory position 2. Filled out supraclavicular fossae II. Percussion 1. Hyperresonant 2. Lower lung borders extended caudally (Sometimes to L1) 3. Respiratory excursions are diminished III. Auscultation 1. Weakened, reduced breath sounds 2. Prolonged expiration (Decreased elasticity) 3. Soft to inaudible heart sounds |
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Syndrome of effusion in the pleural cavity (Fluidothorax)
a. Types b. Distribution of pleural effusion c. Only effusions over ... can be detected by physical examination |
Syndrome of effusion in the pleural cavity (Fluidothorax)
a. Types 1. Exudate - Inflammatory effusion 2. Transudate - Non-inflammatory fluid in cardiac failure 3. Hemorrhagic fluid - Hemothorax 4. Purulent fluid - Empyema/Pyothorax b. Distribution of pleural effusion 1. Gravity -> Costophrenic angles (Lowest point) 2. Areas with highest lung elasticity -> Areas farthest from the hilum -> Space between the scapular and anterior axillary lines - Contains most of the fluid (Curve of Damoiseau - Tip of curve lies in axilla - descends anteriorly to the sternum and posteriorly to the spine. Seen in inflammatory effusions) c. Only effusions over 200-400 mL can be detected by physical examination |
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Syndrome of effusion in the pleural cavity (Fluidothorax) - Physical findings on affected side
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Syndrome of effusion in the pleural cavity (Fluidothorax) - Physical findings on affected side
I. Inspection 1. Hemithoracic expansion (In large effusions in thin patients) 2. Fuller intercostal spaces 3. Shallower respiratory excursions II. Percussion 1. Dull, flat 2. Skodaic resonance/Skoda's sound - Strip with tympanitic resonance above the upper border of the dullness (Corresponds to the area with distended alveoli above the compressed lung) III. Auscultation 1. Respiration above the fluid is faint, over the lung bases inaudible 2. Vocal fremitus and bronchophony are caudally diminished or absent |
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Pneumothorax
a. Complete and partial pneumothoraces b. External and internal pneumothoraces c. Open, closed, tension pneumothoraces |
Pneumothorax
a. Complete and partial pneumothoraces I. Complete - the entire lung retracts to its hilus II. Partial - Collapses only partially due to adhesions between the pleurae b. External and internal pneumothoraces I. External - If the pleural space is connected with the ambient atmosphere from chest injuries II. Internal pneumothorax - Due to disruption of visceral pleura from perforation of 1. Tuberculous focus 2. Lung abscess 3. Emphysematous bleb 4. Lung cyst c. Open, closed, tension pneumothoraces I. Open - The communicating hole remains open during inhalation and exhalation II. Closed - The communicating hole closes due to the lung collapsing III. tension - The communicating hole remains open during inhalation only (Right-sided tension pneumothorax is particularly dangerous, because pressure is exerted upon the SVC, the right atrium and ventricle, which all have thin walls) |
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Pnemuothorax - physical findings
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Pneumothorax - Physical findings
I. Inspection 1. Expansion of the hemithorax 2. Distended intercostal spcaces and bulging supra- and infraclavicular fossae 3. The affected hemithorax don't participate in respiratory excursions II. Palpation 1. Reduced or absent fremitus III. Percussion 1. Hyperresonant to tympanitic 2. Metallic character in higher intrathoracic pressure IV. Auscultation 1. Inaudible or very faint breathing 2. Vocal fremitus and bronchophony are absent in a complete pneumothorax and reduced in a partial pneumothorax (In a left-sided pneumothorax cardiac dullness is absent and heart sounds are faint or absent) |
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Mediastinal syndrome
a. What b. Causes c. Symptoms |
Mediastinal syndrome
a. What I. Combination of symptoms and signs due to increased pressure in the mediastinum from enlarged organs or other structures b. Causes 1. Enlarged lymph nodes - Malignant lymphoas, lymphogranuloma, paramalignant lymphomas 2. Thyroid gland - Hyperplasia, tumor 3. Parathyroid gland - Hyperplasia, tumor 4. Thymus - Hyperplasia, tumor 5. Various cysts 6. Aneurysms of the aorta 7. Connective tissue tumors 8. Neurogenic neoplasms c. Symptoms I. Respiratory 1. Cough (If the pressure-causing structure lies in the vicinity of tussigenic zones (trachea, large bronchi. Dry, irritative and paroxysmal cough) 2. Stridor 3. Inspiratory dyspnea (Next to trachea or main bronchus) II. Neurologic 1. Hoarseness due to compression of the recurrent laryngeal nerve 2. Compression of the phrenic nerve -> Paresis/Palsy of the diaphragm 3. Horner's syndrome from pressure on the superior cervical sympathetic ganglion III. Symptoms from vascular impingement 1. SVC syndrome (Engorgement in the face, neck and arms, cyanosis and edema of the neck and face (Collar of stokes), conjunctival congestion) IV: Symptoms from pressure on the esophagus -> Dysphagia |
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Lung condensation
a. Respiratory movements of the thorax b. Mediastinal displacement c. Percussion d. Auscultation/Breath sounds e. Adventitious breath sounds f. Bronchophony and pectoral fremitus |
Lung condensation
a. Respiratory movements of the thorax I. Reduced on affected side b. Mediastinal displacement I. No c. Percussion I. Dullness d. Auscultation/Breath sounds I. Bronchial e. Adventitious breath sounds I. Crackles (Accentuated rales) f. Bronchophony and pectoral fremitus I. Increased |
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Pleural effusion
a. Respiratory movements of the thorax b. Mediastinal displacement c. Percussion d. Auscultation/Breath sounds e. Adventitious breath sounds f. Bronchophony and pectoral fremitus |
Pleural effusion
a. Respiratory movements of the thorax I. Reduced to absent on affected side b. Mediastinal displacement I. To healthy side c. Percussion I. Dull to flat d. Auscultation/Breath sounds I. Vesicular II. Weak to absent e. Adventitious breath sounds I. Occassionally friction rub f. Bronchophony and pectoral fremitus I. Decreased |
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Pneumothorax
a. Respiratory movements of the thorax b. Mediastinal displacement c. Percussion d. Auscultation/Breath sounds e. Adventitious breath sounds f. Bronchophony and pectoral fremitus |
Pneumothorax
a. Respiratory movements of the thorax I. Reduced to absent on the affected side b. Mediastinal displacement I. To healthy side c. Percussion I. Hyperresonant d. Auscultation/Breath sounds I. Vesicular II. Weak to absent e. Adventitious breath sounds I. None f. Bronchophony and pectoral fremitus I. Weak to absent |
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Emphysema
a. Respiratory movements of the thorax b. Mediastinal displacement c. Percussion d. Auscultation/Breath sounds e. Adventitious breath sounds f. Bronchophony and pectoral fremitus |
Emphysema
a. Respiratory movements of the thorax I. Symmetrically reduced b. Mediastinal displacement I. No c. Percussion I. Hyperresonant d. Auscultation/Breath sounds I. Vesicular II. Weak III. Prolonged expiration e. Adventitious breath sounds I. No f. Bronchophony and pectoral fremitus I. Reduced |
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Acute asthma
a. Respiratory movements of the thorax b. Mediastinal displacement c. Percussion d. Auscultation/Breath sounds e. Adventitious breath sounds f. Bronchophony and pectoral fremitus |
Acute asthma
a. Respiratory movements of the thorax I. Symmetrically reduced b. Mediastinal displacement I. No c. Percussion I. Resonant to hyperresonant d. Auscultation/Breath sounds I. Vesicular II. Prolonged expiration e. Adventitious breath sounds I. Whistles f. Bronchophony and pectoral fremitus I. Normal |
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Bronchitis
a. Respiratory movements of the thorax b. Mediastinal displacement c. Percussion d. Auscultation/Breath sounds e. Adventitious breath sounds f. Bronchophony and pectoral fremitus |
Bronchitis
a. Respiratory movements of the thorax I. Normal b. Mediastinal displacement I. No c. Percussion I. Resonant d. Auscultation/Breath sounds I. Vesicular II. Prolonged expiration e. Adventitious breath sounds I. Whistles and wheezes f. Bronchophony and pectoral fremitus I. Normal |
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Bronchiectasis
a. Respiratory movements of the thorax b. Mediastinal displacement c. Percussion d. Auscultation/Breath sounds e. Adventitious breath sounds f. Bronchophony and pectoral fremitus |
Bronchiectasis
a. Respiratory movements of the thorax I. Normal b. Mediastinal displacement I. No c. Percussion I. Resonant d. Auscultation/Breath sounds I. Vesicular e. Adventitious breath sounds I. Accentuated wet rales f. Bronchophony and pectoral fremitus I. Normal |
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Atelactasis
a. Respiratory movements of the thorax b. Mediastinal displacement c. Percussion d. Auscultation/Breath sounds e. Adventitious breath sounds f. Bronchophony and pectoral fremitus |
Atelactasis
a. Respiratory movements of the thorax I. Reduced on affected side b. Mediastinal displacement I. To affected side c. Percussion I. Flat d. Auscultation/Breath sounds I. Vesicular II. Reduced to absent e. Adventitious breath sounds I. No f. Bronchophony and pectoral fremitus I. Reduced to absent |
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The principal symptoms of pulmonary diseases
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The principal symptoms of pulmonary diseases
1. Dyspnea 2. Cough (Most frequent symptom in diseases of the respiratory system) 3. Hemoptysis 4. Chest pain 5. Cyanosis |
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Dyspnea
a. Causes b. Classification c. Orthopnea |
Dyspnea
a. Causes 1. Pulmonary 2. Cardiovascular 3. Anemias 4. Neuro-psychiatric b. Classification 1. Expiratory 2. Inspiratory 3. Mixed c. Orthopnea I. The patient assumes a half-sitting or sitting position to better utilize the auxiliary respiratory muscles II. Typical for dyspnea in cardiovascular disease. Can also be seen in attacks of bronchial asthma, large pleural effusions, and pneumothoraces |
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Dyspnea
a. Expiratory dyspnea - Causes and findings b. inspiratory dsypnea - Causes and findings |
Dyspnea
a. Expiratory dyspnea - Causes and findings I. Causes 1. Bronchial asthma 2. Pulmonary emphysema II. Findings 1. Prolonged expiration 2. Wheezes, whistles, musical rhonchi b. inspiratory dsypnea - Causes and findings I. Causes - Obstruction of the upper respiratory airways 1. Laryngeal tumor 2. Tumor growing in the trachea or the main bronchus 3. Goiter 4. Edema 5. Hematoma of the glottis 6. Epiglottitis 7. Croup 8. Foreign body aspiration II. Findings 1. Inspiratory retractions - Jugular fossa, supraclavicular fossa, intercostal spaces, epigastrium |
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Cough
a. Tussigenic zones b. Function c. Paroxysmal cough |
Cough
a. Tussigenic zones 1. Larynx 2. Carina trachea 3. Bronchi - 1st and 2nd order 4. Parietal pleura b. Function 1. Maintains the patency of the airways 2. Removes pathologic products and foreign objects from them c. Paroxysmal (Paryoxysmos - Irritation) cough I. A severe attack of coughing, as may accompany whooping cough, bronchiectasis, or a lung injury |
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Cough
a. Dry, unproductive cough b. Wet, productive cough - Evaluate c. Wet, productive cough - Distinction according to macroscopic appearance |
Cough
a. Dry, unproductive cough I. If there is no material to be removed from the airways II. Causes 1. At the onset of acute inflammation 2. Pneumothorax 3. In pressure upon tussigenic structures from enlarged structures 4. In incipient heart failure (Old, heavy smoker, dry cough, hemoptysis -> Bronchogenic cancer) b. Wet, productive cough - Evaluate 1. When is it most abundant during the day (Early morning -> bronchiectasis) 2. Macroscopic appearance 3. Presence of blood 4. Volume/24h 5. Lab tests - Cytology, microscopic, bacteriologic c. Wet, productive cough - Distinction according to macroscopic appearance 1. Serous (Watery, thin, frothy, copious, can be blood-tinged (pink). <- Pulmonary edema) 2. Mucous (Glassy, tenacious (seig). <- Acute bronchitis, end of asthmatic attack (scant, mucoid)) 3. Mucopurulent (Yellowish or greenish. <- Chronic bronchitis, bronchiectasis, TB..) 4. Purulent (--!!--. <- Bronchiectases, lung abscesses, pulmonary TB..) 5. Putrid (Typical for anerobic infections - pulmonary gangrene) (In croupus (lobar) pneumonia a rusty sputum is produced (sputum croceum)) |
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Hemoptysis
a. Hemoptysis b. Massive hemoptysis/Hemoptoe c. Classification |
Hemoptysis
a. Hemoptysis I. Coughing out of blood alone or mixed with sputum II. Usually develops from damage to a smaller blood vessel b. Massive hemoptysis/Hemoptoe I. Spitting or coughing up pure blood from the respiratory tract II. From damage to a larger blood vessel III. It can be life-threatening by causing either exasnguination or suffocation c. Classification 1. Bleeding from pulmonary tuberculosis (Early infiltrative stage - bleeding from necrosis of a small pulmonary branch. Necrotic lymph node ruptures into a bronchus, and the node communicates with a blood vessel) 2. Bleeding from non-tuberculous causes (Bronchogenic cancer (necrosis of tumorous tissue or erosion of vessel), bronchiectasis (the damaged bronchial wall is replaced by granulation tissue which is prone to bleeding), coagulation disorders (congenital or drug-induced), early pneumonia (later a rusty/prune-juice sputum develops) 3. Bleeding from circulatory disturbances (Pulmonary infarction (dark brownish red blood), pulmonary hypertension disorders (mitral stenosis)) |
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Cyanosis
a. The amount of reduced hemoglobin in the blood must increase above b. Contributing cause to cyanosis in chronic lung diseases |
Cyanosis
a. The amount of reduced hemoglobin in the blood must increase above 50 g/L b. Contributing cause to cyanosis in chronic lung diseases - secondary polycythemia (polygobulia) |
