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A patient with hypovolemic shock would most likely exhibit what sign?
- Hypovolemic Shock - decreased circulating blood...
- Decreased CVP (RV) -- decreased BP and increased pulse rate
Examination of the heart in chronic heart failure frequently reveals?
- S3 = LV becomes stiff and inters with blood entering during filling.
- As LV loses compliance - impaired filling - increased LV filling pressures - LV failure. Initially contraction isn't affected.
Splitting of S2
Results from inspiration lengthening the time different between closure of AV and PV
Paradoxical Splitting of S2
results from conditions that either delay the closure of the aortic valve, such as aortic stenosis or LBBB; or premature closure of PV
When can you hear a holosystolic murmur?
MR or VSD
What is most suggestive of an asymptomatic abdominal aortic aneurysm?
- Abdominal Mass
- (If symptomatic - upper abdominal mass would be pulsating)
(AAA presents with midabdominal to lower back pain; syncope is not common unless rupture occurs)
Post- infarction syndrome (Dresslers) occurs after acute MI presenting as?
Pericarditis and pleuritis - several days to weeks following an MI
Severe pericardial effusion or hemorrhage into the pericardium can cause?
What is a typical exam finding in scarlet fever?
Patient presents with fever, chills, sore throat, and a generalized fine papular rash with a sandpaper texture which begins on the chest
What infection is associated with a "slapped cheek" appearance?
What infection is associated with koplik spots?
In myxedema, the patient commonly complains of?
Cold intolerance - both associated with hypothyroidism along with constipation and fatigue
(Tremors and palpatations - hyperthyroidism)
What sign/symptom differentiates acute sinusitis from viral rhinitis?
Frontal headache, swollen mucous membranes, rhinorrhea, sneezing and scratchy throat and fever may all be signs of viral rhinitis as in sinusitis.
Sinusitis usually follows a viral rhinitis - when you see pain and tenderness over involved sinus.
What S/S is most commonly seen in viral croup?
Inspiratory stridor, barking cough
- Drooling - epiglottitis
- Wheezing - asthma
- No sputum production
A patient presents with double vision when turning eyes to right. Exam shows he cannot move his eyes laterally. Cranial nerve involved?
Abducens - affects lateral eye movement, if paralyzed will cause double vision with lateral gaze
- Trochlea - affects downward, inward movement
- Oculomotor - affects pupillary contriction and movement of eye medial, upward and downward lateral
- Optic - affects vision - no EOM
On physical exam, the edge of the spleen is felt. What is a better position to confirm findings?
By rolling patient onto the right side, gravity may bring spleen forward and medial so that it is in a palpable location.
Finding of vitamin A deficiency
Earliest symptom - Night blindness
Finding with Vitamin K deficiency?
Finding with Vitamin E deficiency?
Finding with vitamin A toxicity?
Suspect food poisoning from S.aureus in a patient who presents with?
Abdominal Cramps and vomiting
- Cramps/N/V and watery diarrhea - typically last 1-2 days with Staph food poisoning.
- Incubation is short 1-8 hours
- Associated with low-grade fever or subnormal temps
What is the most common location of bleeding seen in patients with von Willebrand's disease?
- Mucosal surfaces - epistaxis, gingival bleeding, menorrhagia
- (Splenic bleeding is typically associated with trauma)
Hemophilia is more associated with bleeding, where?
Into joint spaces (especially knees, ankles and elbows) and into muscle groups
What physical finding suggests pernicious anemia?
Loss of position and vibratory sensation - common neurologic findings
- Hemolytic anemias - splenomegaly and hepatomegaly
- Thrombocytopenia - Petechiae and ecchymosis
- Iron deficiency anemia - cheilosis and koilonychia
Most common early presenting sign in patients with Alzheimer's disease?
- Loss of memory - changes occur first with short-term memory
- A late finding includes - change in personality
Hx of multiple physical complaints = somatization disorders
What is the most frequent finding in a person with a brain abscess?
- Headache - 70%
- Nuchal rigidity 35%
- Seizures 35%
- Vomiting 35%
28 year old female with enlarged ovaries bilaterally. Diagnosis of PCOS is enhanced by what finding?
Most common findings are infertility, menstrual irregularities, obesity and hirsutism.
What S/S is common in candidal vulvovaginitis?
Extrema vulvar irritation
Patient presents with pruritis, vulvovaginal erythema, white, cheese like (curd) discharge that is malodorous
Subacromial bursitis is associated with?
Pain with Abduction of the arm from 70-100 degrees
Subacromial bursitis is believed to be part of the continuum of inflammatory conditions affectingthe shoulder; initial overuse or trauma involves the rotator cuff, supraspinatus, and bicipital tendons. Theinflammation then leads to secondary involvement of the subacromial bursae. Pain and tenderness arelocalized to the lateral aspect of the shoulder, with signs of impingement on active motion noted on exambetween 70-100°abduction
Kanavel's sign is associated with?
Flexor tenosynovitis - infection of the flexor tendon sheath (can cause rapid loss of function)
- The sign consists of four components:
- the affected finger is held in slight flexion.
- there is fusiform swelling over the affected tendon.
- there is tenderness over the affected tendon.
- there is pain on passive extension of the affected finger.
Test designed to assess pathology in the long head of biceps tendon
- Patient's elbow is flexed and their forearm pronated. The examiner holds their arm at the wrist - patient actively supinates against resistance.
- Positive - pain located to bicipital groove area
What physical exam findings is consistent with a herniated disk at L5-S1?
- Depression/Absent of Achilles reflex
- May also be seen with L4-L5 disk disease
Upgoing Babinski reflex indicates?
upper motor neuron disease
Hypesthasia of the medial thigh is consistent with a herniated disk at what level?
Decreased sensation in the groin is consistent with a herniated disk at what level?
65 year old with schizophrenia treated with phenothiazines. PE patient difficulty sticking out her tongue, facial tics, increased blink frequency, and lip-smacking behavior. These involuntary movements are most suggestive of?
Tardive dyskinesia is characterized by abnormal involuntary movements of the face, mouth,tongue, trunk, and limbs and may develop after months or years of treatment with neuroleptic drugs
Characteristics of Parkinsonism
Infrequent blinking, tremor, rigidity, and bradykinesia
Syndrome that facial motor tics are the most common manifestations, but begin before age 21?
Gilles de la Tourette's syndrome
Huntington's disease, like tardive dyskinesia has the same involuntary movements but to make diagnosis you need...
Positive family history and usually appears by age 50.
A typical symptom of depression includes...
- multiple somatic complaints ---
- depressed patients often focus on their bodies and tend to have multiple complaints
Auditory hallucinations are commonly seen with which disorder?
47 year old with DM I presents in a coma due to DKA. Patient noted to have rapid deep breathing - this pattern is called?
Kussmaul breathing - deep breathing, and is a compensatory mechanism for metabolic acidosis.
Cheyne Stokes breathing?
characterized by periods of deep breathing alternating with periods of apnea. Caused by heart failure, uremia, drug-induced respiratory depression and brain damage.
Paradoxical motion of the chest wall occurs in?
If multiple ribs are fractured in multiple places, paradoxical movements of the thorax may be seen. As descent of the diaphragm decreases intrathoracic pressure on inspiration, the injured area caves inward. On expiration it moves outward.
An increased AP diameter is seen in?
chest condition characterized by a depression in the lower portion of the sputum. Compression of the heat and great vessels may also caused murmurs.
the sternum is displaced anteriorly, increasing the AP diameter. The costal cartilages adjacent to the protruding sternum are depressed
49 year old male presents with complaints with Peyronie's disease. PE for this patient?
Fibrous band on the lateral portion of the penis.
typically presnts with fibrotic areas under the penile skin along with a history of penile curvature during erection.