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174 Cards in this Set
- Front
- Back
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Primary Headaches |
Headaches that include migraine, tension, cluster, and chronic daily headaches |
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Secondary Headaches |
Headaches that arise from underlying structural, systemic, or infectious causes such as meningitis or subarachnoid hemorrhage and may be life-threatening |
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Thunderclap Headaches |
Type of headache that reaches maximal intensity over several minutes in 70% of patients with subarachnoid hemorrhage, and are often preceded by a sentinel leak headache from a vascular leak into the subarachnoid space |
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Subarachnoid hemorrhage or meningitis |
If headache is severe and of sudden onset, what should you consider as the cause? |
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Migraine and tension headaches |
What type of headaches are episodic and tend to peak over several hours? |
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Tumor, abscess, or mass lesion |
New and persisting, progressively severe headaches raise concerns of what? |
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Migraine and cluster headaches |
Unilateral headache occurs in what? |
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Temporal areas |
Where do tension headaches often arise? |
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Retro-orbital |
Where do cluster headaches often arise? |
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Migraine, brain tumors, subarachnoid hemorrhage |
nausea and vomiting can occur because of what? |
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Visual aura, such as spark photopsias (flashes of light), fortifications (zig-zag arcs of light), and scotomata (area of visual loss with surrounding normal vision) |
What symptoms are common with migraines? |
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Acute sinusitis or mass lesion due to changing intracranial pressure |
valsalva maneuver may increase pain from what? |
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hyperopia (farsightedness) or presbyopia (aging vision) |
vision difficulty with close work suggests what? |
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myopia (nearsightedness) |
vision difficulty with distances indicates what? |
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vitreous hemorrhage from diabetes or trauma, macular degeneration, retinal detachment, retinal vein occlusion, or central retinal artery occlusion |
If sudden unilateral visual loss is painless what should you consider? |
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corneal ulcer, uveitis, traumatic hyphema, acute glaucoma, and optic nephritis |
If sudden unilateral visual loss is painful what should you consider? |
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Medications that change refraction such as cholinergics, anticholinergics, and steroids |
If sudden bilateral and painless vision loss occurs, what should you consider? |
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chemical or radiation exposures |
If sudden bilateral and painful vision loss occurs, what should you consider? |
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cataracts or macular degeneration |
Gradual bilateral vision loss usually arises from what? |
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nuclear cataract and macular degenration |
Slow central vision loss occurs in what? |
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open-angle glaucoma |
Peripheral vision loss occurs in what? |
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hemianopsia and quadrantic defects |
One-sided vision loss occurs in what? |
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vitreous floaters |
Moving specks or strands in the vision area suggest what? |
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lesions in the retina or visual pathways |
fixed defects, or scotomas, in the vision area suggest what? |
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detachment of vitreous from retina |
Flashing lights or new vitreous floaters in the vision area suggest what? |
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in lesions in the brainstem or cerebellum, or weakness or paralysis of one or more extraocular muscles |
When is diplopia seen? |
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palsy of cranial nerve III or VI |
Horizontal diplopia occurs because of what? |
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palsy of cranial nerve III or IV |
Vertical diplopia occurs because of what? |
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a problem in the cornea or lens |
Diplopia in one eye with the other closed suggests what? |
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Sensorineural hearing loss |
Type of hearing loss where people have particular trouble understanding speech, often complaining that others mumble; noisy environments make hearing worse |
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Conductive hearing loss |
Noisy environments may help this type of hearing loss |
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Aminoglycosides, aspirin, NSAIDs, quinine, and furosemide |
What medications may affect hearing? |
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otitis externa |
Pain occurs in the external ear canal in what? |
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otitis media |
If there is a respiratory infection, pain in the inner ear occurs in what? |
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acute or chronic otitis media |
Unusually soft wax, debris from inflammation or rash in the ear canal, or discharge through a perforated ear drum is present in what? |
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Meniere's disease |
When tinnitus is associated with hearing loss and vertigo this suggests what? |
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vertigo |
What represents vestibular disease? |
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benign positional vertigo, labyrinthitis, and Meniere's disease |
Vertigo is usually from peripheral causes in the inner ear such as what? |
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Central neurologic causes in the cerebellum or brainstem such as cerebral vascular disease or posterior fossa tumor. Also consider migraine |
Vertigo associated with ataxia, diplopia and dysarthria signal what? |
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viral infections, allergic rhinitis ("hay fever") and vasomotor rhinitis |
What are the causes of rhinorrhea? |
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allergic rhinitis |
seasonal onset or environmental triggers of rhinorrhea and nasal congestion suggest what? |
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excessive use of decongestant or use of cocaine |
When does drug-induced rhinitis occur? |
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Acute bacterial sinusitis |
unlikely until viral URI symptoms persist more than 7 days; both purulent drainage and facial pain should be present for diagnosis |
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oral contraceptives, resperpine, guanethidine, alcohol, cocaine |
What drugs may induce nasal stuffiness? |
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deviated nasal septum, nasal polyp, foreign body, granuloma (Wegener's), or carcinoma |
What might cause nasal congestion on only one side? |
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Trauma (especially nose-picking), inflammation, drying and crusting of the nasal mucosa, tumors, and foreign bodies |
Local causes of epistaxis include what? |
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Anticoagulents, NSAIDs, and coagulopathies |
What drugs can contribute to epistaxis? |
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Fever history, tonsillar exudates, swollen tender anterior cervical adenopathy, and absence of cough |
What symptoms indicate streptococcal and Fusobacterium necrophorum pharynigitis (bacterial infection)? |
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Nutritional deficiency |
Sore smooth tongue indicates what? |
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gingivitis |
Bleeding gums are most often cause by what? |
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voice overuse and acute viral larygitis |
If voice hoarseness is acute, what are the most likely causes? |
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hypothyroidism, reflux, vocal cord nodules, head and neck cancers, and neurologic disorders like parkinson disease, amyotrophic lateral sclerosis, or myasthenia gravis |
If voice hoarseness lasts more that two weeks, what causes should be considered? |
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pharyngitis |
Enlarged tender lymph nodes commonly accompany what? |
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increased function, decreased function, or normal function |
Goiter may do what to thyroid function? |
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Hypothyroidism |
Intolerance to cold, preference for warm clothing and many blankets, and decreased sweating suggest what? |
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Hyperthyroidism |
Intolerance to heat, increased sweating, palpatations, and involuntary weight loss suggest what? |
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Cataracts |
Clouding of the optic lens is caused by what? |
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Macular degeneration |
Mottling of the macula, variations in retinal pigmentation, subretinal hemorrhage or exudates are caused by what? |
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Glaucoma |
Change in color and size of the optic disc is caused by what? |
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hydrocephalus or Paget's disease of bone |
An enlarged skull may signify what? |
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head trauma |
Palpable tenderness or step-offs of the skull may be present after what? |
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Glaucoma, optic neuropathy, optic neuritis, and glioma |
Causes of anterior pathway defects include what? |
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stroke and chiasmal tumor |
Causes of posterior pathway defects include what? |
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Left temporal hemianopsia |
When the patient's left eye repeatedly does not see your fingers until they have crossed the line of gaze ,what is present? |
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Glaucoma, optic neuritis, and papilledema |
An enlarged blind spot occurs in conditions affecting the optic nerve such as what? |
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Down syndrome |
Upstarting palpebral fissure are seen in what? |
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Blepharitis |
Red inflamed lid margins are seen in what? |
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Conjunctival inflammation and corneal irrtation |
Increased production of tears may be caused by what? |
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ectropion and nasal lacrimal duct obstruction |
Impaired tear drainage may be caused by what? |
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Sjogren's syndrome |
Eye dryness may occur from impaired secretion seen in what? |
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Nodualr episcleritis, rheumatoid arthritis, and lupus erythematosus |
Local eye redness is seen in what? |
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Acute narrow-angle glaucoma |
A sudden increase in intraocular pressure when drainage of the aqueous humor is blocked |
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Open-angle glaucoma |
The common form of glaucoma where the normal spatial relation between iris and cornea is preserved and the iris is fully lit |
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Miosis |
Refers to contriction of the pupils |
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Mydriasis |
Refers to dilation of the pupils |
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Argyll Roberton and tonic (Adie's) pupils |
Testing the near reaction is helpful in diagnosing what? |
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A deviation from normal ocular alignment |
Asymmetry of the corneal reflections indicates what? |
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In lid lag of hyperthyroidism |
When is a rim of sclera visible above the iris with downward gaze? |
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In paralysis of CN VI |
When are they eyes conjugate in right lateral gaze but not in left lateral gaze? |
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proptosis |
abnormal protrusion of the eyeballs |
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orbital tumor or retrobulbar hemorrhage from trauma |
If unilateral proptosis is present, what should you consider? |
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hyperthyroidism |
When does poor eye convergence occur? |
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head injury and coma, in which continuing observations of pupillary reactions are essential and any suspicion of narrow-angle glaucoma |
What are contraindications for mydriatic drops? |
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Opacity of the lens (cataract) or possibly of the vitreous. Less commonly a detached retina or in children, a retinoblastoma |
What causes absence of a red reflex? |
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Light rays from a distance do not focus on the retina |
What happens to light rays in a refractive error? |
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They focus anterior to the retina |
What happens to light rays in myopia? |
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They focus posterior to the retina |
What happens to light rays in hyperopia? |
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They look larger than normal |
How do retinal structures look in a myopic eye? |
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Chronic open-angle glaucoma |
What does an enlarged physiologic cup suggest? |
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With intracranial pressures that change the pressure gradient between cerebral spinal fluid pressure and intraocular pulse pressure in the optic disc |
When does loss of SVPs (spontaneous venous pulsations) in they eye occur? |
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Dry atrophic (more common but less severe) and wet exudative, or neovascular |
What are the different types of macular degeneration (an important cause of poor central vision in older adults)? |
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conductive hearing loss |
Hearing disorders of the external and middle ear cause what type of hearing loss? |
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infection (otitis externa), trauma, squamous cell carcinoma, and benign bony growths such as exostoses or osteomas |
What are hearing disorders of the external ear? |
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Congenital conditions, benign cholesteatomas and otosclerosis, tumors, and perforation of the typanic membrane |
What are hearing disorders of the middle ear? |
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sensorineural hearing loss |
Disorders of the inner ear cause what kind of hearing loss? |
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congenital and hereditary conditions, presbycusis, viral infections such as rubella and cytomegalovirus, Meniere's disease, noise exposure, and acoustic neuroma |
What are hearing disorders of the inner ear? |
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Painful in acute otitis externa but not in otitis media |
movement of the auricle and tragus is painful in what? |
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otitis media |
Tenderness behind the ear may be present in what? |
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Exostoses (nonmalignant overgrowths which may obscure the drum) |
Nontender nodular swellings covered by normal skin deep in the ear canal suggests what? |
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acute otitis externa |
When is the ear canal often swollen, narrowed, moist, pale, and tender (may be reddened)? |
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chronic otitis externa |
When is the skin of the ear canal often thickened, red, and itchy? |
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acute purulent otitis media |
When is the ear drum red and bulging? |
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serous effusion |
When is the ear drum amber? |
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retracted drum |
An unusually prominent short process and a prominent handle that looks more horizontal suggests what? |
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serous effusion, a thickened drum, or purulent otitis media |
What might decrease mobility of the ear drum? |
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Higher frequency hearing loss (more likely to miss consonants) |
Older adults which presbycusis have hearing loss of what frequency? |
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The impaired ear |
In unilateral conductive hearing loss sound is heard in (lateralized to) which ear? |
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otosclerosis otitis media, perforation of the eardrum, and cerumen |
What are explanations unilateral conductive hearing loss? |
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The good ear |
In unilateral sensorineural hearing loss, sound is heard in which ear? |
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heard through bone as long as or longer than it is through air |
In conductive hearing loss, is sound heard longer through bone or through air? |
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heard longer through air |
In sensorineural hearing loss, is sound heard longer through bone or through air? |
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local infection such as a furuncle |
What does tenderness of the nasal tip or alae suggest? |
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reddened and swollen |
In viral rhinitis, how does the nasal mucosa appear? |
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pale, bluish, or red |
In allergic rhinitis, how does the nasal mucosa appear? |
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trauma, surgery, and intranasal use of cocaine or amphetamines |
What are causes of septal perforation? |
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nasal polyps |
pale saclike growths of inflamed tissue that can obstruct the air passage or sinuses |
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allergic rhinitis, aspirin sensitivity, asthma, chronic sinus infections, and cystic fibrosis |
What conditions are conductive to polyps |
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acute sinusitis |
Local tenderness, together with symptoms such as pain, fever, and nasal discharge suggest what? |
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denture sore mouth |
Bright red edematous mucosa underneath a denture suggests what? |
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Gingivitis |
Gum redness and swollen interdental papillae are characteristics of what? |
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lead poisoning |
When is a black line in the gums seen? |
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Torus palatinus |
A benign midline lump on the roof of the mouth |
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lesion of CN XII |
Asymmetric protrusion of the tongue suggests what? |
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CN X paralysis |
What causes the soft palate to fail to rise and the uvula to deviate to the opposite side? |
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streptococcal pharyngitis |
When are tonsillar exudates common? |
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Possible metastasis from a thoracic or an abdominal malignancy |
What does an enlargement of a supraclavicular node, especially on the left, suggest? |
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HIV or AIDS, infectious mononucleosis, lymphoma, leukemia, and sarcoidosis |
When is general lymphadenopathy seen? |
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Retrosternal goiter |
May cause hoarseness, shortness of breath, stridor, or dysphagia from tracheal compression |
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Soft in Grave's Disease. Firm in Hashimoto's thyroiditis and malignancy. Tender in thyroiditis. |
When is the thyroid gland soft? Firm? Tender? |
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Hyperthyroidism |
When may a localized systolic or continuous bruit be heard? |
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Obstructed nasolacrimal duct |
Discharge of mucopurulent fluid from puncta suggests what? |
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Women |
Is ostheoarthritis more common in women or men? |
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Articular disease |
Typically involves swelling and tenderness of the entire joint and limits both active and passive range of motion due either to stiffness or to pain |
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Extra-articular disease |
Typically involves selected regions of the joint and types of movement |
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Musculoligamentous injury, disc herniation, vertebral collapse, spinal cord metastases, and, rarely, epidural abscess |
For midline back pain, what should you assess for? |
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muscle strain, sacroilitis, trochanteric bursitis, sciatica, and hip arthritis; also for renal conditions like pyelonephritis or stones |
For pain off the midline of the back, what should you assess for? |
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Sciatica |
Radicular gluteal and posterior leg pain in the S1 distribution that increases with cough or vals |
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Spinal Stenosis |
Leg pain that resolves with rest and/or lumbar forward flexion occurs in what? |
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Cauda equina syndrome from S2-4 midline disc or tumor |
If there is bowel or bladder dysfunction, especially if there is saddle anesthesia or perineal numbness what should be considered? |
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Spinal nerve compression, most commonly C7 followed by C6; foraminal impingement from degenerative joint changes |
Radicular back pain arises from what? |
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Injury, monoarticular arthritis, possible tendinitis, or bursitis |
What does pain in one joint suggest? |
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Trochanteric bursitis |
Lateral hip pain near the greater trochanter suggests what? |
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Rheumatic fever or gonococcal arthritis |
Migratory pattern of spread (of joint pain) is seen in what? |
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Rheumatoid arthritis |
Progressive additive pattern (of joint pain) with symmetric involvement is seen in what? |
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Women |
Are inflammatory arthritides more common in men or women? |
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In inflammation of bursae (bursitis), tendons (tendinitis), or tendon sheaths (tensosynovitis); also in sprains from stretching or tearing of ligaments |
When does extra-articular pain occur? |
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acute septic arthritis or gout; in children consider osteomyelitis in bone contiguous to a joint |
What does severe pain of rapid onset in a red, swollen joint suggest? |
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septic arthritis; also consider gout or possible rheumatic fever |
Fever, chills, warmth and redness of a joint are seen in what? |
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Articular joint pain |
Pain, swelling, loss of active and passive motion, or "locking" of a joint suggests what? |
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Nonarticular pain |
Loss of active but not passive motion and tenderness outside the joint are seen in what? |
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Degenerative joint disease |
Stiffness and limited motion after inactivity, sometimes called gelling, occurs in what? |
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Rheumatoid arthritis and other inflammatory arthritides; fibromyalgia and polymyalgia rheumatica (PMR) |
Stiffness lasting 30 minutes or more is present in what? |
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Rheumatoid arthritis, systemic lupus erythematosus (SLE), PMR, and other inflammatory arthritides |
Generalized systemic symptoms accompanied by joint pain are common in what? |
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An infectious cause |
High fever and chills accompanied by joint pain suggest what? |
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Hepatic and renal disease |
Osteoporosis is common in what diseases? |
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Trauma, septic arthritis, or gout |
Acute involvement of only one joint suggests what? |
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Rheumatoid arthritis |
Type of arthritis that is typically polyarticular and symmetrical |
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Subcutaneous nodules- rheumatoid arthritis or rheumatic fever; Effusions-Trauma; Crepitus over inflamed joints- osteoarthritis; Crepitus over inflamed tendon sheaths- Tenosynovitis |
When are subcutaneous nodules around joints present? When is effusion present? When is crepitus over inflamed joints present? Over inflamed tendon sheaths? |
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Arthritis, inflammation of tissues around a joint, fibrosis in or around a joint, fibrosis in or around joint, or bony fixation (ankylosis) |
When is decreased range of motion present? |
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Knee trauma |
When does ligamentous laxity of the ACL occur? |
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Rheumatoid arthritis |
When is muscle atrophy or weakness seen? |
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Synovitis |
What does palpable bogginess or doughiness of the synovial membrane indicate? |
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Arthritis, tendinitis, bursitis, osteomyelitis |
When is increased warmth around a joint seen? |
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Arthritis or infection |
What does diffuse tenderness and warmth over a thickened synovium suggest? |
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Injury |
What does focal tenderness around a joint suggest? |
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septic or gouty arthritis, or possibly rheumatoid arthritis |
Redness over a tender joint suggests what? |
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TMJ syndrome |
Symptoms include facial asymmetry, unilateral chronic pain with chewing, jaw clenching, or teeth grinding, often associated with stress; patients may also present with headache |
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TMJ syndrome, trigeminal neuralgia, and temporal arteritis |
When does pain with chewing occur? |
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poor occlusion, meniscus injury, or synovial swelling from trauma |
When is palpable crepitus or clicking present? |
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Scoliosis |
This may cause elevation of one shoulder |
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Anterior dislocation of the shoulder |
When does the rounded lateral aspect of the shoulder appear flattened? |
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Atrophy of the supraspinatus and infraspinatus with increased prominence of scapular spine |
What can occur within 2 to 3 weeks of a rotator cuff tear? |
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Subacromial or subdeltoid bursitis, degenerative changes, or calcific deposits in the rotator cuff |
localized tenderness around the subacromial and subdeltoid bursae and the sits muscles arises from what? |
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Bursal tear that communicates with the articular cavity. |
Swelling around the subacromial and subdeltoid bursae and the sits muscles suggests what? |
