Boards Hx and Physical exam

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Boards Hx and Physical exam
2015-02-05 22:16:34

Physical exam
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  1. name the elements of the CAGE questionaire
    • C: have you ever felt the need to CUT down
    • A: Annoyed by others criticism about drinking
    • G: Guilty about drinking
    • E: Eye opener
  2. hypertenson #
    hypotension #
    • Hypertension# > 140/90
    • Hypotension# <90/60
  3. Korotkoff sounds
    low pitched sounds given off by turbulent blood flow in arteries
  4. what does a difference in systolic bp greater than 10-15 mm Hg indicate
    Arterial occlusion
  5. loss of lateral 1/3 of eyebrows
    Myxedema (hypothyroid)
  6. Unilateral sluggish pupillary reaction to light
    Adie's pupil caused by parasympathetic lesion of CNIII
  7. bilaterally small and irregular pupils that accommodate but do not react to light
    • Argyll Robertson pupil (prostitutes pupil)
    • Seen in tertiary syphilis
  8. Bilateral sluggish pupillary reaction
    Arroyo sign

    Hypo-adrenalism (addison's)
  9. Inflammation of the eyelid seen with seborrhea
    Blepharitis (staph infection)
  10. Absent red light reflex in elderly person with diabetes
  11. Infection of the meibomian gland
  12. grayish opaque ring around cornea
    • Corneal Arcus
    • 40> hyper-cholesterolemia
    • 40< Normal variant
  13. lid lag / failure to cover eyeball
    • Exophthalmosis
    • Bilateral = graves (hyperthyroidism)
    • Unilateral= Tumor
  14. posterior cupping of the optic disc decreased peripheral vision, crescent sign.
    • Glaucoma
    • Closed angle: blocked ducts
    • Open angle: increased fluid production
  15. pimple or boil on the eyelid caused by staph infection
  16. Ptosis, miosis, anhydrosis
    Horner's syndrome

    TOS, Whiplash, Tumor
  17. Eye signs: copper wire, silver wire, A-V nicking, flame hemorrhages, cotton wool exudates
    Hypertensive retinopathy
  18. Dilated pupil with ptosis and lateral deviation, non-reactive to direct or accommodation
    Internal ophthalmoplegia: Multiple Sclerosis
  19. inflammation of the iris
    Iritis/Uveitis: seen in AS
  20. most common reason for blindness in the elderly
    macular degeneration
  21. Central vision loss, yellow deposits under the retina, peripheral vision unaffected
    Macular Degeneration
  22. Anterior swelling of the optic disc
    Papilledema (choked disc)

    May be seen with a brain tumor or brain hemorrhage
  23. swelling around the eye
    Periorbital edema

    Kidney problems, myxedema, allergies
  24. Yellowish triangular nodule in the bulbar conjunctiva
    Pinquecula normal variant with aging
  25. disorders associated with ptosis
    Horner's syndrome, CN3 paralysis, myasthenia gravis, multiple sclerosis
  26. Painless sudden onset of blindness
    retinal detachment
  27. blue sclera
    osteogenesis imperfecta
  28. fatty plaques on the nasal surface of the eyelid
    Xanthelasma: may be normal or indicate hypercholesterolema
  29. Loss of lens elasticity due to aging
  30. Direct light reflex
    CNII and CNIII
  31. Consensual light reflex
    CNII and CNIII
  32. Swinging light test
    CN II and CNIII
  33. Cardinal fields of gaze
    • CNIII
    • CNIV superior oblique
    • CN VI Lateral rectus
  34. hearing loss, tinnitus, vertigo
    Schwannoma of CNVIII
  35. revealed by Dix-Hallpike maneuver
    Benign paroxysmal positional vertigo
  36. recurrent prostrating vertigo, sensory hearing loss, tinnitus and fullness in the ear.
    Meniere's disease (endolymphatic hydrops, central vertigo)
  37. tympanic membrane presents with a red appearance, dilated blood vessels and bulging
    Purulent otitis media (Bacterial otitis media)
  38. chronic amber fluid bubbles in ear
    Serous otitis media
  39. DX: Weber lateralizes to right ear, Rinne air conduction less or equal to bone conduction
    Conduction hearing loss (512 tuning fork)
  40. Weber test lateralizes to right ear, Rinne air conduction is greater than bone conduction
    Sensorineural hearing loss
  41. DDX:
    1) Nasal mucosa appears pale/blue or boggy
    2) Thinning of nasal mucosa with sclerosis, crust formation, foul ordor
    3) Red swollen nasal mucosa with clear discharge
    • 1) Allergic Rhinitis
    • 2) Atrophic Rhinitis
    • 3) Viral Rhinitis
  42. DX: Red sores at the corners of the mouth
    Angular Stomatitis (Cheilosis): May be related to riboflavin (B2) deficiency
  43. Smooth and glossy tongue
    • Atrophic Glossitis
    • Vitamin B12
  44. DX: Increased T3/T4, decreased TSH
    Primary hyperthyroidism (graves, exopthalmosis)
  45. Dx: increased T3/T4 and Increased TSH
    Secondary hyperthyroidism (pituitary tumor)
  46. Dx: decreased T3/T4 and increased TSH
    Primary hypothyroidism (Hashimotos, cretinism)
  47. Dx: Decreased T3/T4 and Decreased TSH
    Secondary hypothyroidism
  48. HA may be caused by hypoglycemia, that decreases with age and pregnancy
    Common Migraine (sick, vascular)
  49. HA typicaly unilateral, aura, prodrome
    Classic Migraine
  50. Throbbing HA that wakes up at night, starts in occipital region and moves to the vertex
    Hypertension HA
  51. Unilateral orbital HA lasting 15-180 min accompanied by rhinorrhea, lacrimation, facial swelling, red eye, miosis, not aggravated by exertion
    • Cluster
    • Autonomic disturbance
    • Hemicranial
    • vasomotor
  52. Band like headache increased by fatigue, tension, stress, work
    Muscular tension HA
  53. Unilateral temporal HA with buring, aching, throbbing, pain when combing hair, jaw claudication
    • Temporal arteritis
    • polymyalgia rheumatica
    • (Biopsy for giant cells)-can cause blindness
  54. Frequent occipital HA with decreased ROM
    • Cervicogenic (vertebrogenic)
    • (Check ADI flex ext)
  55. Localized frontal HA that is worse at night
    Allergy HA
  56. Abrupt excruciating basilar HA
    Subarachnoid Hemorrhage (911)
  57. Insidious onset of dull HA after injury
    Subdural Hematoma
  58. HA that may change body position, onset in AM and PM, get progressively worse
    Brain tumor (MRI, CT)
  59. Intense deep HA with stiff neck, fever, photophobia
    • Meningeal Irritation
    • CSF tap: increased protein = Viral
    •              decreased glucose = bacterial
  60. Barrel Chest (1:1) ap to lateral demension
    • COPD
    • Cystic fibrosis in young
  61. Quick, shallow inspirations followed by irregular periods of apnea without pattern
    Biot's Breathing (neurological dysfunction)
  62. Breathing pattern characterized by alternating periods of apnea and hyperpnea in a pattern
    • Cheyne Stokes Respiration
    • - Respiratory acidosis
    • - Stroke
  63. Breathing that is fast and shallow that turns to deep, slow, labored breathing
    • Kussmaul's (air hunger breathing)
    • - Diabetic acidosis
  64. Splinter hemorrhage nails
    Subacute bacterial endocarditis (Strep)
  65. nail base angle greater than 180
    Clubbing: hypoxia, COPD, Bronchogenic carcinoma
  66. Spoon nail
    Koilonychia (iron deficiency)
  67. Increased tactile fremitus
  68. Decreased tactile femitus
    Atelectasis, Pleurisy
  69. Hyperresonant percussion over lungs
    • Emphysema, pneumothorax
    • (increased air in lungs)
  70. Dull percussive note of lungs
    • Pneumonia, atelectasis, pleurisy
    • (Increased density)
  71. Distinct 99 heard through stethoscope
    • Bronchophony
    • Consolidations present (pneumonia)
  72. Pt says AAAA sounds like EEEEEEEEEEE
    • Egophony
    • Consolidations present (pneumonia)
  73. Resonant percussion
    Decreased fremitus
  74. Dull/flat percussion
    decreased fremitus
    absent breath sounds
  75. Resonant percussion
    normal fremetus
  76. resonant percussion
    normal fremitus
  77. Hyperresonant percussion
    Decreased Fremitus
    Wheezing/decreased breath sounds
  78. Percussion Dull
    Fremitus Decreased
    Crackles and friction rub
  79. Hyperresonant percussion
    Decreased Fremitus
    Decreased breath sounds
  80. Dull percussion
    Increases Fremitus
    Egophony, Bronchophony, whispered Pectoriloquy, Crackles