General Dx

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ahurshy04
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97704
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General Dx
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2011-09-07 12:08:14
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NBCE
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Terms for General Dx of Part 2 and 3
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  1. Health History includes
    Chief Complaint, Past Health History, Personal & Social History, Review of Systems
  2. Chief Complaint
    • 1. Why the patient is seeking care.
    • 2. In patient's own words
  3. Present Illness History
    • Onset
    • Palliative/Provoking
    • Quality of Pain
    • Radiation/Referral
    • Site/setting/severity
    • Timing
  4. Past Health History
    • Serious Illness
    • Previous Injuries
    • Hospitalizations
    • Surgeries
    • Medications
    • Allergies
  5. Family History
    • Cardiovascular Disease
    • Diabetes
    • Stroke
    • Cancer
  6. Social/Personal History
    • Marital Status
    • Occupation
    • Diet
    • Exercise
    • Bowel/Urinary Patterns
    • Sleep
    • Alcohol, Tobacco, Drug use
    • Stress
  7. Acute Pain History
    Neuromuscular
  8. Chronic/Insideious Pain History
    Systematic, more severe problem
  9. Cancer History
    • Nothing makes the pain worse
    • Nothing makes teh pain better
  10. Multiple Sclerosis History
    No comfortable position
  11. Nerve Root History
    Dermatoganous
  12. Facet Pain
    Scleratogenous
  13. Kidney Pain
    Flank
  14. Ureter Pain
    Groin
  15. Pancreas Pain
    Sharp Knife like pain at T10-T12
  16. Gal Bladder Pain
    Inferior Angle of Right Shoulder
  17. Organ Pain
    Can not localize pain
  18. Throbbing Pain
    Vascular
  19. Aching Pain
    Muscle
  20. Burning Pain
    Nerves
  21. Tearing Pain
    Dissection Anerysm
  22. Peptic Ulcer/ Duodanl Ulcer Pain
    Patient is able to pinpoint where the pain is.
  23. Bursitis Pain
    Patient is able to pinpoint where pain is on the joint.
  24. If there is pain while the xray finding is negative and the joint is swollen, red and hot this means?
    Infection
  25. CAGE questionaire
    • C- Cutting down?
    • A- Annoyed by others criticisms?
    • G- Guilty Feelings?
    • E- Eye Openers? (morning drink needed)
  26. Review of Systems
    A general exploration of the varous organ systems of the body
  27. What do you use to measure height and weight?
    Standing platform scale with a height attachment
  28. Normal Temperature Ranges
    • Oral: 98.6 F
    • Rectal & Tympanic: 99.6 F
    • Axilla: 97.6 F
    • Range: 96-99.5F 35-37.5C
  29. Normal Pulse Values
    • Adults: 60-100
    • Newborns: 120-160
    • Elderly: 70-80
  30. Normal Repiratory Rates
    • Adults: 14-18
    • Newborn: 44
  31. Blood Presure Normal Adult Values
    • 90-120/60-80
    • Increase in elderly is normal
  32. Hypertension
    Over 140/90
  33. Hypotension
    under 90/60
  34. Korotkoff Sounds
    low pitched sounds produced by turbulent blood flow in arteries
  35. Barre- Lieou Test
    VAI Test. Pt seated, doc instructs pt to rotate the head maximally from side to side. Done slowly at first than accelerated to pt tolerance.
  36. DeKleyn's Test
    VAI Test. Pt supine, the doc instructs the pt to rotate and extend the head off the table then turn to each side for 15-45 seconds. doc can lend minimal support.
  37. Hallpike Test
    VAI Test. An enhanced DeKleyn's. Pt supine, head extended off the table. Doc offers support for the skull. Doc brings head into extension , rotation, and lateral flexion.
  38. Hautant's Test
    VAI Test. Pt seated, arms are extended forward to shoulder level with the hands supinated. Maintain position for a few seconds. Pt then closes the eyes, rotates and hyperextends teh neck to one side. Repeated to opp side.
  39. Underberg Test
    VAI Test. Pt stands with eyes open, arms at side, feet close together. Pt closes eyes, extends arms and supinates hands, then pt extends adn rotates head to one side. Then in this position pt is instructed to march in place.
  40. 5 D's
    Dizzy, Drop Attack, Diplopia, Dyserthria, Dysphagia
  41. 3 N's
    nausea, numbness, nystagmus
  42. Scaly Eyebrows
    Seborrhea
  43. Loss of lateral 1/3 of eyebrows
    myxedema ( hypothyroidsim)
  44. Ptosis
    Drooping of the eyelid. Seen with horner's, CN 3 paralysis, Myasthenia Gravis
  45. Exopthalmosis
    Lid lag/ failure to cover the eyeball seen in graves or tumor
  46. Ectropion
    lid is turned outward and seen in elderly
  47. Entropion
    lid is turned inward and seen in the elderly
  48. Periorbital edema
    • swelling around the eye
    • Seen in allergies, myxedema, nephrotic syndrome
  49. Blepharitis
    Inflammation of the eye seen with seborrhea staph infection, inflammatory processes
  50. Cataracts
    • opacities seen in the lens that are commonly seen with diabetes and in the elderly
    • absent red light reflex
  51. Corneal Arcus
    Grayish opaque ring around the cornea. <50= hypercholesterolemia. >50= normal
  52. Pterygium
    triangular thickening of the bulbar conjunctiva that grows across the corena and is brought on by dry eye
  53. Sclera
    • white- normal
    • yellow- jaundice
    • blue- osteogenesis
  54. Conjunctiva
    • pink- normal
    • pale- anemia
    • bright red- infection
  55. Hordoleum (sty)
    an infection of the sebaceious glands causing a pimple or boil on the eye
  56. Chalazion
    an infection of the sebacceous glands causing a pimple or boil on the eyelid
  57. Pinquecula
    a yellowish triangular nodule in the bulbar conjunctiva that is harmless and indicates aging
  58. Xanthelasma
    fatty plaques on the nasal surgace of the eyelids that is normal or indicates hypercholesterolemia
  59. Argyll Robertson
    Bilaterally samll and irregular pupils that accommodate but do not react to light. Seen with syphilis (prostitutes pupil) tertiary syphilis
  60. Internal Ophthalmoplegia
    dilated pupil wit ptosis adn lateral deviation. Don't react to light or accommodation. MS
  61. Mydriasis
    Dilated and fixed pupils seen with anticholinergic drugs
  62. Miosis
    fixed and constricted pupils that react to light and accommodate. seen with severe brain damage, pilocarpine meds, and narcotic use.
  63. Anisocoria
    Unequal Pupil size
  64. Adie's Pupil
    sluggish pupillary rxn to light that is unilateral and caused by a parasympathetic lesion of CN 3.
  65. Arroyo Sign
    sluggish pupillary rxn due to hyoadrenalism (Addison's Disease)
  66. Horner's Syndrome
    ptosis, miosis, and anhydrosis on the same side as an interruption to the cervical sympathetics
  67. Glaucoma
    increased intraocular pressure causing cupping of the optic disc (cup to disc ratio is >1:2) Blurry vision in peripheral fields as well as rings around lights. Crescent sign will present upon tangential lighting of the cornea
  68. Papilledema AKA Choked Disc
    swelling of the optic disc due to increased intracranial pressure. No visual loss. Seen with brain tumor or brain hemorrhage
  69. Retinal Detachment
    Painless sudden onset of blindness described as curtains closing over vision. lightning flashes and floaters
  70. Macular Degeneration
    Most common reason for blindness in the elderly, central vision lost, macular drusen is an early sign of macular degeneration ( yellow deposits under the eye)
  71. Hypertensive Retinopathy
    Damage to the retinal vessels/ background will show these signs: copper wire deformity, silver wire deformity, A-V nicking, flame and splinter hemorrhages, and cotton wool soft exucates
  72. Diabetic Retinopathy
    Affects the veins more than ateries and presents with microaneurysms, hard exudates and neovasculariazation
  73. Iritis
    inflammation of the iris seen with ankylosing spondylitis
  74. Tinnitus
    presence of ringing of the ears
  75. Presbycussis
    sensorineural hearing loss that occurs in people as they age and they may be affected by genetic or acquired factors
  76. Acute Otitis Externa
    infection of the outer ear. aka swimmer's ear. inflammation and pain of the outer ear, tugging on the pinna will be painful
  77. Acute Mastoiditis
    Bacterial infection in the mastoid process. same signs and symptoms of acute otitis media with additional inflammation and palpatory tenderness over mastoid. hearing loss associated
  78. Purulent Otitis Media AKA Bacterial otitis Media
    bacterial or viral infection in the middle ear. tympanic membrane is red, dilated blood vessels, and bulging
  79. Serous Otitis Media
    An effusion in the middle ear resulting from incomplete resolution of acute otitis media or obstruction of the eustachian tube. usually chronic and fluid is amber with bubbles!
  80. Vertigo
    abnormal sensation of rotary movement associated with difficulty in balance gait and navigation of the environment.
  81. Meniere's Disease
    A disorder characterized by recurrent prostrating vertigo sensory hearing loss tinnitus and feeling of fullness in the ear
  82. Benign Paroxysmal Postional Vertigo
    Most common vertigo in the USA. Brief episode of vertigo brought on by a change of head position.
  83. Acoustic Neuroma
    Benign tumor of CN 8. hearing loss, tinnitus, vertigo, and presence of tumor on CT or MRI ( SLow growing tumor)
  84. Eustachian Tube Block
    Retraction of the tympanic membrane. Adenoids can block tube as well.
  85. Weber Test
    • Normal Hearing: Eaual sound heard bilaterally
    • Conduction Hearing Loss: Lateralizes to bad ear
    • Sensorineural Hearing Loss: Lateralizes to good ear
  86. Rinne Test
    • Normal hearing: AC>BC (Rhinne +)
    • Conduction hearing loss: AC<BC or AC=BC (Rhinne -)
    • AC>BC with less time in bad ear
  87. Viral Rhinitis
    nasal mucosa appears red and swollen with a clear runny nose
  88. Allergic Rhinitis
    Nasal mucosa appears pale and blue and boggy
  89. Atrophic Rhinitis
    Thinning of the nasal mucosa with sclerosis, crust formation, and foul odor.
  90. Polyps
    typically occur as a consequence of chronic inflammation of the nasal mucosa
  91. Angular stomatitis aka cheilosis
    red sores at the corner of the mouth that are referred to as angular cheilitis/ stomatitis. Can be caused by a vitamin B2 (riboflavin) deficiency.
  92. Candidiasis aka Thrush
    • immunocompremised patient.
    • Thick white fungal patches that are easily scraped off
  93. Leukoplakia
    pre-cancerous lesion of white patches that are adherent to the surface and not easily removed.
  94. Atrophic Glossitis
    red beefy tongue. Deficiency of B vitamins or iron that causes the tongue to appear smooth and glossy
  95. Fissured Tongue aka Scrotal Tongue
    Deep furrows on the surface of the tongue that is considered a normal variant
  96. Kapasis Sarcoma
    multicentric neoplasm caused by herpe vireus 8. appear bruised
  97. Gigantism
    excessive production of growth hormone prior to skeletal maturation
  98. Acromegaly
    excessive production of growth hormone beginning in middle age. Results in abnormal growth in the hands, feet, and facial bones
  99. Hyperthyroidsim
    Grave's Disease- autoimmune. TSH production is decreased and thyroid hormones are produced in excess
  100. Hypothyroidsim aka Myxedema
    Hashimoto's thyroiditis is the most common cause in the USA. Autoimmune disease. Congenital hypothyroid is called cretinism anc causes a diminshed physical and mental capacity.
  101. Hyperthyroidism
    • wieght loss with increased appetite
    • irritable & nervous
    • Intolerance to heat
    • moist skin/ fine hair
    • exophthalmos
    • possible neck swelling due to goiter
    • increased T3, T4
    • Decreased TSH
  102. Hypothyroidsim
    • weight gain with decreased appetite
    • depression, weakness and fatigue
    • intolerance to cold
    • corase, dry hair, dry skin
    • periorbital edema
    • macroglossia and loss of lateral 1/3 of eyebrows
    • decreased T3, T4
    • increased TSH
  103. Common Migraine
    • Childhood/ early adulthood
    • hormonal
    • Females
    • unilateral/ bilateral
    • photophobia, throbbing, worse behind one eye, nausea, vomiting, familial, decreased wtih age, pregnancy
    • provoked by bright light, chocolate, cheese, tension, red wine, mentrual cycle
  104. Classic Migraine
    • Childhood & early adulthood, hormonal, Females
    • Typically unilateral
    • Aura/prodrone, photophobia, throbbing, worse behind one eye, nausea, vomiting
    • Provoked by bright light, chocolate, cheese, tension, red wine, menstraul cycle
  105. Hypertension
    • Adult
    • Occipital vertex
    • throbbing, wake up with a headache
    • Test: Blood pressure, lipid profile
  106. Cluster
    • Adolescent to adults, male
    • unilateral, orbital, temporal
    • wake up at night with headache, lasts 150-180 minutes, not aggravated by exertion, rhinorrhea, facial sweating, red eye, miosis, sharp stabbing pain behind the eye
    • provoked by: alcohol, usually occurs together in clusters, seasonal
  107. Muscular Tension
    • any age
    • bandlike
    • pressure, muscle tightenss
    • provoked by fatigue, tension, stress, work
    • alcohol relieves it
  108. Temporal Arteritis
    • Over 50 years old, females more than males
    • Unilateral temporal
    • persistent burning, aching, throbbing (while brushing hair)
    • Scalp sensitivity, tender arteries,
    • Tests: ESR elevated, BIopsy
  109. Cervicogenic aka vertebrogenic headaches
    • in adults
    • occipital or upper cervical
    • often daily, decreased rom in upper cervical and occiput, pain in neck referred to head
    • made worse by head movement
    • Labs: Flex/Ext Views
  110. Sinus Headache
    • Any age
    • Localized and changes with body position
    • Steady trhob, local tenderness, worse in the morning
    • Chronic Sinusitis
  111. Subarachnoid Hemorrhage
    • Any Age
    • Basilar area
    • Abrupt onset, constant, stiff neck, excruciating pain like never before experienced
    • Hypertension and stress make it worse
    • Tests: High Blood Pressure, Fever, Go to ER
  112. Brain Tumor
    • Any age
    • Any place and changes with body position
    • Onset morning and evening, mild to severe, throbbing neck stiffness worse than ever progressively worse, pain is always there
    • Provoked by tumor growth
  113. Meningeal Irritation
    • Any Age
    • Stiff neck
    • Intense, deep pain, single episode
    • worse in flexion
    • Tests: Kernig/brudzinski, CSF tap
  114. Hypoglycemic
    skipping meals, and tests by Fasting blood sugar test
  115. Post Concussive
    • Any age
    • Localized general pain, loss of memory, visual disturbances
    • Provoked by fall, MVA, whiplash injury, and trauma
    • Labs: Refer to neurologist/ ER
  116. Barrel Chest
    • AP= Lateral Diameter. 1:1 ratio.
    • Seen with COPD and cystic Fibrosis
  117. Pectus Excavatum AKA Funnel Chest
    Marked depression noted in the sternum (Sunken in)
  118. Pectus Carinatum AKA Pigeon Chest
    Forward protrusion of the sternum (like keel of a ship)
  119. Tachypnea
    Rapid shallow breathing
  120. Bradypnea
    Slow Breathing
  121. Biots Breathing
    Characterized by groups of quick, shallow inspirations followed by irregular periods of apnea ( no pattern)
  122. Cheyne Stokes Respiration
    Breathing pattern characterized by alternating periods of apnea and hyperpnea (has pattern) Respiratory acidosis
  123. Kussmaul's
    Breathing is first rapid and shallow but as metabolic acidosis worsens, breathing gradually becomes deep, slow, labored and gasping. Air hunger breathing Seen in diabetics
  124. Pitted Nails
    inguinal indentations. Seen with psoriasis so also look for silver scales on elbows and knees
  125. Splinter Hemorrhage in the nails
    Subacute bacterial endocarditis (Strep organism)
  126. Beau's Lines in the nails
    Transverse ridging associated with acute severe disease
  127. Paronychia Nails
    Inflammation of the nail fold near the cuticle
  128. Clubbing of the nails
    Nail base has an angle more than 180 degrees and may indicate hypoxia/COPD (Bronchogenic Carcinoma)
  129. Koilonychia aka Spoon Nail
    Iron deficiency anemia
  130. Respiratory Excursion
    Place hands over the posterior ribs and have the patient take a deep breath
  131. Tactile Fremitus
    • Palpable vibration- pt says 99
    • Increased with fluid (Pneuomina)
    • Decreased with air (Emphysema, Pneumothorax)
    • Decreased with atelectasis and pleurisy because a sound barrier is created
  132. Resonate sound upon percussion
    normal over lung tissue
  133. Hyperresonant sound upon percussion
    increased air in the chest (emphysema, pneumothorax
  134. Dull sound upon percussion
    Increased density (pneumonia, atelectasis)
  135. Diaphragmatic Excursion
    Doc asks pt to exhale and hold it, percusses down the back in the intercostal margins, starting below the scapula, until sounds change from resonant to dull. Doc marks this spot, then pt takes a deep breath in and holds it as the doc percusses down again, makring the spot where the sound changes from resonant to dull again. Doc will measure the distance between the two spots. If it is less than 3-5 cm the pt may have a pneumonia or a pneumothorax in which a chest xray is diagnostic for either
  136. Vesicular Breath Sound
    Heard when inspiration is longer than expiration in most of the lung especially the base
  137. Bronchovesicular Breath Sound
    Heard when inspiration equals expiration in the anterior 1-2 ribs posterior between scapula at apex
  138. Bronchial Breath sounds
    Heard when expriation is longer than inspiration over the manubrium
  139. Trachial Breath Sounds
    Heard when inspiration equals expiration over the trachea in the neck
  140. Rales aka crackles
    small clicking, bubbling, and rattling sounds in the lungs. Described moist, dry, fine and coarse (bronchitis)
  141. Rhonci
    • resemble snoring
    • occur when air is blocked or becomes rough through the large airways (Bronchiectasis)
  142. Wheezes
    • high pitched sounds produced by narrowed airways. heard upon exhalation
    • Asthma in young people
    • Emphysema in old people
  143. Stridor
    wheeze-like sound heard upon inspiration. usually due to a blockage of airflow
  144. Bronchophony
    if clear, distnict sounds are heard as teh patient says 99, consolidation is present
  145. Egophony
    Hear AAAAAA as teh patient says EEE, consolidation is present
  146. Whipsered Pectoriloquy
    if the words 123 are heard clearly and distinctly, consolidation is present
  147. Asthma
    • Percussion: Resonant
    • Fremitus: Decreased
    • Breath Sound: Wheezing
  148. Atelectasis
    • Percussion: Dull/FLat
    • Fremitus: Decreased
    • Breath sound: Absent
  149. Bronchiectasis
    • Percussion: Resonant
    • Fremitus: Normal
    • Breath Sound: Rhonci
  150. Bronchitis
    • Percussion: Resonant
    • Fremitus: Normal
    • Breath SOunds: Rales
  151. Emphysema
    • Percussion: Hyperresonant
    • Fremitus: Decreased
    • Breath Sounds: Wheezing
  152. Pleurisy
    • Percussion: Resonant
    • Fremitus: Decreased
    • Breath SOund: Crackles (Friction Rub)
  153. Pneumothorax
    • Percussion: Hyperresonant
    • Fremitus: Decreased
    • Breath Sound: Decreased
  154. Pneumonia
    • Percussion: Dull
    • Fremitus: Increased
    • Breath Sound: Egophony, Bronchophony, Whispered Pectoriloquy, Crack
  155. Lobar Pneumonia
    • Consolidation of teh lung. Occurs in 4 stages. 1. consolidation. 2. Red Hpatization. 3. Gray Hepatization. 4 Resolution
    • Percussion is dull over fluid, rales aka crackles incrased tactile fremitus, productiove cough at 10 days rusty brown sputum possible fever silhouette sign and air bronchogram
  156. Friedlander's Pneumonia
    Productive or currant red jelly sputum and caused by Klebsiella pneumonia. Seen with old age or immunocompromised hosts.
  157. Pneumocystis Carinii
    aused by yeast/fungus. most commonly seen in AIDS patients
  158. Cytomegalovirus
    caused by CMV. Most commonly seen in AIDS patients (HHB5)
  159. Tuberculosis
    caused by mycobacterium tuberculosis. Presents with low grade fever, night sweats, productive cough, yellow/green sputum, small white lesions called Ghon lesions seen on xray, starts in apices of the lungs, crackles in upper lobe, tine test/ Mantoux test, positive purified protein derivative test for dx is sputum culture. LOVE APICES
  160. Pleurisy
    Inflammation of the pleura, usually producing an exudative pleural effusion and stabbing chest pain worsened by respiration and cough. Dull on percussion dry or non productive cough, decreased breath sounds. Positive Schepelmann's Test
  161. Pneumothorax
    • a ruptured lung causing air to become trapped in the pleural space. Decreased chest expansion, decreased tactile fremitus, hyper resonant, decreased breath souns. Can occur in young, previously healthy individuals.
    • Unilateral darkening of the chest due to collapse of the lung: tracheal shift away from lesion.
  162. Atelectasis
    Collapse of the lung that is usually the result of bronchial obstruction due to a mucous plug. Presents with decreased tactile fremitus, dull on percussion, decreased chest expansion, decreased or absent breath sounds, on xray teh collapsed lung will display increased density and mediastinal shift to the same side
  163. Bronchiectasis
    Irreversible focal bronchial dilation that presents with a chronic productive cough. CT is necessary to diagnose or confirm. one third of cases caused by cystic fibrosis
  164. Chronic Bronchitis AKA COPD
    Defined by a long term cough with mucus, shortness of breath and wheezing. Cigarette smoking is the main cause. Long exposure to other things such as chemical fumes, dust and other substances may cuase this
  165. Asthma
    bronchospasm constricting airways. Type 1 hyerpsensitivity reaction that is usually triggered by airborneallergens. Presents with tachycardia, tachypnea, decreased tactile fermitus, wheezing, eosinophils and IgE rise. Labs are Curshmann's Spirals and Charcot Laden Cyrstals (Crystals and spirals in sputum from IgE
  166. Emphysema
    Destruction of elastic pulmonary connective tissue results in permanent dilation of the alveoli air sacs adn caused by a deficiency of alpha 1 anti trypsin. Presents with decreased tactile fremitus, hyperresonant percussion, decreased breath sounds, and prolonged expiration with an expiratory wheeze likely. Fluid will accumulate first in the costophrenic recesses. Xray findings: bilaterally darkened lung fields, narrowed compressed heart, horizontal ribs, flattening of the diaphragmatic domes.
  167. Bronchogenic Carcinoma
    Primary malignant lung tumor that starts in teh area of the bronchus. Long term history of smoking (20-30 years). Coughing nonproductive more than 30 days, afebrile, dyspnea, weight loss and clubbing of the fingernails.
  168. Costochondritis
    Inflammation of teh cartilage connection between the ribs and the sternum. It develops as a consequence of physical activity and is worse with exercise. The pain increases while taking a deep breath. There will be palpable tenderness at the costosternal articulation. More females than males
  169. Herpes Zoster AKA Shingles
    Painful rash following the course of a dermatome usually a single nerve. Primarily involves the dorsal root ganglion but when it does involve CN it is morest commonly CN V.
  170. Sarcoidosis
    • Is a disease in which abnormal collections of inflammatory cells (granulomas) form as nodules. most appear in the lungs or lymph nodes. most commonly seen in african descent in the US. Xray bilateral hilar lymphadenopathy
    • Potato Nodes
  171. Hodgkins
    • 15-35 yo. 50-70 yo
    • Cancer of the lymphatic system that can spread to the spleen. Most commonly seen in young caucasian males. Presents with fever, night sweats, wieght loss, intense pruritis (release of IgE) and enlarged spleen. Best diagnosed from biopsy looking for Reed Sternberg Cells. Xray- unilateral hilar lymphadenopathy
  172. Cystic Fibrosis
    Chronic progressive and frequently fatal genetic (inherited) disease of the body's mucus glands an abnormality in the glands that produce or secrete sweat and mucus; loss of excessive amounts of slat, thick accumulations of mucus in the intestines and lungs, COPD, barrel chest, pancreatic insufficiency, meconium ileus
  173. Teitze Syndrome
    Chest pain and inflammation and tenderness
  174. Pulsus Magnus
    Bounding; increase cardiac output, exercise, anxiety, fever, hyperthyroidism
  175. Pulsus Parvus
    Weak or thready, decreased stroke volume; hypovolemia, aortic stenosis, CHF
  176. Pulsus Alterans
    alternates in amplitude, left ventricular failure
  177. Pulsus Bisferiens
    two strong systolic peaks separated by mid systolic dip (best felt at carotid artery) aortic regurgitation. aortic stenosis
  178. Pulsus Paradoxus
    Decreased amplitude on inspiration incraesed with expirations ( less tahn 10 mm Hg amplitude change) COPD bronchial asthma, emphysema, pericardial effusion
  179. Water Hammer Pulse
    a jerky pulse that is rapidly increasing and then collapsing because of aortic insufficiency
  180. Thrills
    vibration produced by turbulent blood flow within the heart (murmurs)
  181. S1
    Closure of AV (mitral and tricuspid) valves (beginning of systole)
  182. S2
    Closure of semilunar valves (pulmonary and aortic) beginning of diastole
  183. S3
    Ventricular gallop: normal in children, young adults, and athletes. less than 40 yo indicates earliest sign of CHF
  184. S4
    Atrial Gallop: similar to S3 and is related to stiffness of the ventricular mycoardium to rapid filling (never normal) Failure of the left ventricle
  185. Stenosis
    valve has trouble opening and the blood swirls through a narrow opening. This murmur has a low pitch and is best heard with the bell of the stethoscope
  186. Regurgitation
    Valve is insufficient and blood seeps or squirts back into the chamber. This murmur has a high pitch and is best heard with the diaphragm of the stethoscope
  187. ARMS
    • A-aortic
    • R- regurgitation
    • M- mitral
    • S-Stenosis
  188. PRTS
    • P-pulmonic
    • R- Regurgitation
    • T- Tricuspid
    • S- Stenosis
  189. Patent Ductus Arteriosus
    failure of shunt to close between the aorta and left pulmonary artery. Creates a continuous/ machinery like murmur that can be heart in both phases of the heart cycle
  190. Tetralogy of Fallot (DRIP)
    Dextraposition of teh aorta, right ventricular hypertrophy, interventricular septal defect, and pulmonic stenosis. Creates a loud ejection murmur during systole and severe cyanosis
  191. Coarctation of the Aorta
    Constriction of the descending aorta (usually distal to the left subclavian). Causes higher blood pressure in the upper extremity by 20 mm Hg (diagnostic) when compared to the lower extremity. Commonly associated with Marfan's Syndrome
  192. Subclavian Steal Syndrome
    Narrowing proximal to the vertebral artery. The Subclavian steals from the vertebrae. Seen in younger females who faint (syncope/drop attacks) while exercising
  193. Left Sided Heart Failure
    • most common cause of left sided heart failure is hypertension (35-55 yo). 2nd most common cause is aortic stenosis.
    • Early signs: pulmonary edema causing shortness of breath(exertional dyspnea- first sign of heart failure) and orthopnea (difficulty in breathing that is relieved in the upright position) Fluid collects first at the costophrenic angles
  194. Right sided Heart Failure
    • Most common cause is left sided heart failure. Most common cause of mitral stenosis is Rheumatic Fever (ASO TIter). Cor Pulmonale- when the right side fails by itself (lung condition that causes rigth sided heart failure).
    • Backs up to SVC and IVC and leads to edema and fluid in the extremities, jugular venous distention (SVC), liver/spleen enlargement, positive hepatojugular reflex, stasis dermatitis, ascites, pitting edema, increased heart rate, S3 gallop, and decreased blood pressure. Jugular venous pulsations are caused by backup of blood if present while supine and seated.
  195. Aortic Dissection
    An interruption of teh intima allowing blood into the vessel wall with immediate tearing pain. Acute surgical emergency. Associated with hypertension/arteriosclerosis (descending aorta) and marfan's (ascending aorta). Marfan's has a ventricular weakning and enlargment. pt presents with spider like fingers, tall stature, and subluxation of the lens.
  196. Angina Pectoris-coronary vasospasm (Stable Angina)
    • Comes on with exertion
    • Printzmetal angina comes on with rest (atypical)
    • Relieved by vasodilators under tongue (usually nitroglycerin)
    • Should go away when you stop or rest from the exercise you are doing
  197. Myocardial Infarction
    Acute heart failure, comes on with rest, caused by atherosclerosis, CK-MB is elveated, increased SGOT, increased LDH
  198. Aneurysm
    • Abnormal widening that involves all 3 layers; defect in elastic-media tissues.
    • 3.8-5 mm go to vascular specialist
    • >5mm go to ER
  199. ECG
    • Increased PR interval- prolonged AV nodal delay (primary heart block)
    • Two P waves before QRS- Weinkbochs- block of bundle of HIS (secondary heart block)
    • No QRS- complete heart block(no ventricular contraction)
    • ST segment- enlarged or inverted= MI (acute heart failure)
  200. ECG for heart attack
    Inverted ST, Elongated ST, inverted T wave
  201. Increased Bowel Sounds
    Early Intestinal Obstruction
  202. Absent bowel sounds
    Late intestinal obstruction
  203. Hematemesis
    vomitting up blood
  204. Hemoptysis
    coughing up blood
  205. Hematochesia
    Blood in stool
  206. Non specific tests for the liver
    increased alkaline phosphatase, serum-glutamate-oxalacetate transaminase (SGOT/AST) aspartate transaminase, lactate dehydrogenase LDH
  207. Classice liver tests
    Gamma-Glutamyl Transpeptidase (GGT) and Serum Glutamic Pyruvic Transaminase (SGPT/ALT) Alanine Transaminase
  208. Liver Labs
    Creatine Phosphokinase (CPK), SGOT, LDH-MI
  209. Liver tests
    • Blood Urea Nitrogen (BUN)- liver and kidneys
    • Increased in kidneys
    • Decreased in Liver
  210. Jaundice aka Icterus
    Yellowing of the skin, sclera, and mucuous membranes. Can occur with any liver disorder
  211. Cirrhosis
    • Alcoholism is the most common cause of liver destruction. Causes portal hypertension, ascites, esophageal varices, Mallory Weiss syndrome (coughing, tearing, esophageal blood vessels, and hematemesis) and palmar rash due to bile salts.
    • Thiamin deficiency without alcoholism is Beri Beri
    • In the brain: Wernicke Korsakoff Syndrome (Thiamin Deficiency leading to dementia)
  212. Hepatitis
    • Liver may be tender and enlarged but the dege remains soft and smooth
    • Hepatitis A- from food through fecal or oral route, self limiting and not a carrier
    • Hepatitis B- dirty needles, and sexual contact, carrier for life most common to become liver cancer
    • Hepatitis C- Blood Transfusion (tattoo parlors)
    • Hepatits D- Can only coour with hep B
  213. Liver Cancer
    • Most common site for metastatic disease. Liver will be enlarged with a hard and irregular border.
    • Alpha fetoprotein is a tumor marker specific for hepatocellular carcinoma. Liver biopsy is performed for definitive diagnosis
  214. Direct or Conjugated Bilirubin
    • Water soluble
    • Increasaes with duct obstruction (galstones), hepatic disease, pancreatic cancer
    • Increase amounts in the blood may cause bilirubin in the urin (urobilinogen)
  215. Indirect or Unconjugated Bilirubin
    • Not water Soluble
    • Increases with hemolytic diease, drugs, and spleen disorders
    • Hemolytic anemia- increase in reticulocyte count (Coomb's Test)
    • Increased amounts in the blood may cause increased urobilinogen in the urine
  216. Gallbladder
    pain referral to right shoulder or tip of right scapula (viscerosomatic)
  217. Cholecystitis
    • Most commonly seen in overweight females more than 40 yo.
    • most common cause is cholelithiasis
    • severe right upper quadrant pain, nausea, vomiting, and preceipiated by eating a large fatty meal
    • Tests: dx ultrasound, oral cholecystogram, murphy's sign- inspiratory arrest sign.
  218. Porcelain Gallbladder
    Calcification that can become malignant due to chronic inflammation
  219. pancreatitis
    • Epigastric pain going straight through the T10-T12 area like a knife (viscerosomatic)
    • Chronic: seen in alcoholism- Acute call 911
    • Grey Turner Sign: Bleeding into the flank.
    • Cullen's Sign: Periumbilical ecchymosis
    • Labs: Increased amylase and lipase
  220. Pancreatic Cancer
    Usually at the head of the pancreas. Presents with dark urin, clay colored stools and jaundice
  221. Diabetes Mellitus
    • A condition in which the pancreas does not produce a suficient amount of insulin to take the sugar out of the blood and transport it to teh tissues of the body. Polydypsia, polyphagia, and polyuria is seen
    • Labs: glucose tolerance test, fasting plasma glucose, HbA1C, Glycosylated Hemoglobin
    • Insulin Dependent Type 1: Production Problem- juvenile, under 30, usually thin
    • Non-insulin Dependent Type 2- (insulin doesn't do its job)- adults over 40 and usually obese
  222. Diabetes Insipidus
    Condition of the posterior pituitary gland in which there is insufficient ADH. May have polydypsia, polyuria, but NOT polyphagia
  223. Hiatal Hernia
    Protusionof the stomach above teh diaphragm. Presents with palpable tenderness in LUQ, reflux esophagitis (acid reflux), dyspepsia (indigestion), made worse after eating large meal or when lying down
  224. Reflux Esophagitis
    • Upward reflux of acid contents of the stomach into the esophagus. Caused by siding hiatal hernia
    • worse when lying down, after big meal, valsalva, or bearing down
    • tests are xray of upper gi
    • Barrett's esophagus- destruction of esophagus due to reflux esophagitis
  225. peptic Ulcers
    includes gastric and duodenal ulcers caused by H. Pylori bacteria coffe ground emesis, burning epigastric pinpoint pain
  226. Gastric Ulcer
    has no consisten pain pattern. Sometimes food causes the pain and other times it relieves the pain
  227. Duodenal Ulcer
    • Pain occurs 2 hours after eating, black/tarry stool. Most common type of peptic ulcer
    • GUAIAC Test- occult blood in teh stool
  228. Pyloric Stenosis
    Projectile vomitting in teh newborn
  229. Stomach cancer
    most common on the lesser curvature and affects teh left supraclavicular lymph node (Virchow's Node)
  230. Mononucleosis
    • Caused by the epstein barr virus and is een in young adults (18-25 yo)
    • presents with symptoms similar to the flu such as fever, headache fatigue, lymphadenopathy in the cervical region, splenomagaly
    • Atypical lymphocytes in blood (Downey cells)
    • Monospot aka heterophile agglutination aka paul bunnell test
  231. Osteopetrosis aka Marble Bone
    A systemic or metabolic condition that involves every bone. The bone marrow becomes sclerotic so red blood cells aren't made. The liver adn spleen make RBC's and beome enlarged. (osteoclast is affected)
  232. Small intestine Referral pain
    goes to peri-umbilical
  233. Adynamic Ileus
    gas in teh intestine
  234. Regional Ileitis aka Crohn's Disease (Rt side of intestines)
    • nonspecific inflammatory disorder that affects distal ileum and colon.
    • inflammation is patchy with healthy tissue between teh patches which is referred to as a cobblestone appearance. Do NOT absorb B12.
    • Presents with RLQ pain, chronic diarrhea, no blood in diarhea
    • leads to malabsorption syndromes: nontropical sprue/ celiac sprue
    • dx with sigmoidoscopy
  235. Ulcerative Colitis (left side of the intestines)
    • most common at the colon and rectum
    • Presents with bloody mucous in diarrhea, fever
    • can lead to sacroilitis (enteropathic arthropathy)
    • Sigmoidoscopy
  236. Irritable Bowel Syndrome aka Spastic Colon
    • variable degrees of constipation and diarrhea in response to stress
    • seen more commonly in females
    • abdominal pain and gas relieved by bowel movements
  237. Appendicitis
    • dull periumbilical pain that radiates to lower right quadrant
    • presents with fever, nausea, vomitting, and anorexia
    • increased WBC (shilling shift to the left)
    • Test: McBurney's Point, rebound tenderness-peritonitis, rovsing's sign, psoas sign, obturator sign CT scan
  238. Diverticulitis
    • consequence of inadequate fiber in the diet
    • chronic constipation causes small outpouchings within colon that becomes infected
    • LLQ pain
    • Meckel's Diverticulitis: outpouching of Ileium (congentital)
    • Zenker's Diverticulitis- outpouching of Esophagus
  239. Carcinoid Syndrome
    intestinal cancer that mets to the liver... liver releases enzymes causing flushing of the face
  240. Cushing's Disease
    • Increased Cortisol
    • Increased production of adrenal cortex hormone; hyperadrenalism. hypercortisolism
    • Moon face pie face buffalo hump, pendulous abdomen with pruple striae, hirsutism, weakness, and hypertension
  241. Addison's Disease
    • decreased cortisol, decreased aldosterone
    • Decreased aldosterone; hypoadrenalism hypocortisolism
    • Increased ACTH causes melanin deposition
    • Thin person, decreased blood pressure, hyperpigmented mouth and face, weakness, fatigue, lethargy, nausea and vomitting and hair loss
  242. Pheochromocytoma
    • grey cell tumor of the adrenal medulla
    • Increased epinephrine production (catecholamine)
    • Will cause tachycardia, jitters, and extreme hypertension. Signs and symptoms are similar to hyperthyroidism
  243. Conn Syndrome
    Increased aldosterone (primary hyperaldosteronism) High BP, Retains Water
  244. Nephrolithiasis
    • Made of Calcium: Calcium oxalates, calcium urates, calcium phosphates
    • Back pain radiating into the groin (ureter stone) Pain is writhing pain
    • Murphy's kidney punch
    • evaluate by increased BUN, Uric Acid, Creatine Clearance, KUB study
    • UA reveals hematuria (cut ureters so could be infection)
    • Staghorn calculi- most common cause is hydronephrosis due to kidne stonde
  245. Actue Glomerulonephritis aka Nephritic syndrome
    • Caused by group A hemolytic strep (strep pyogenes-ASO titre)
    • RBC casts in urine wtih small amount of protein
  246. Nephrotic Syndrome
    • HEP: hypertension, edema, massive proteinuria, waxy or fatty casts in urine
    • In pregnant women it is called pre-eclampsia after 20 weeks
  247. Pyelonephritis
    • E Coli From UTI
    • WBC casts
  248. Polycystic Kidney Disease
    Inherited disorder characterized by many bilateral renal cysts that increase renal size but reduce functioning renal tissue
  249. Urethritis
    • Caused most commonly by E Coli in females and N. Gonorrhea in males
    • Nitrites in the urine
  250. Cystitis
    noninfectious bladder inflammation that causes burning painful and frequent urination with incontinence. Pt will also have suprapubic and low back pain.
  251. Acute Renal Failure
    Rapid steadily decreasing renal failure with or without oliguria
  252. Chronic Renal Failure
    Insufficency of renal excretory and somthing function
  253. Renal Carcinoma
    Heatin, flank pain, palpalble mass
  254. Nephroblastoma aka Wilm's Tumor
    Malignant tumor of the kidney; less than 5 years of age, abdominal mass, hematuria
  255. Urinary Incontinence
    • overactive bladder
    • urgent need to get to the bathroom
    • Stress- an increase in abdominal pressure such as exercise, cough, sneeze, laugh, due to weakened pelvic floor muscles
    • Overflow- if you are not able to completely empty your bladder when you urinate. As a result, you have a constant or frequent dirbble of urine
  256. Indirect Inguinal Hernia
    • most common type
    • hernia passes through inguinal canal and exits at the external inguinal ring and into the scrotum.
    • Often in children- maybe in adults
  257. Direct Inguinal Hernia
    • does not pass through the inguinal canal but exits directly through the external inguinal ring instead. It is usually acquired from obesity or heavy lifting.
    • Felt when pt coughs or bears down
  258. Femoral Hernia
    • not an inguinal hernia. It appears as a bulge lateral and inferior to the external inguinal ring at the site of the femoral pulse
    • Female more than male
  259. Endometrosis
    • abnormal endometrial tissue found outside its normal location
    • most commonly found in ovaries
    • laparscopy
    • presents with abdominal pain, back pain, menorrhagia, painful intercourse and possible infertility
  260. Uterine Fibroids
    • benign uterine tumors of smooth muscle origin (leiomyoma)
    • Heavy menstrual bleeding, pelvic pain, painful intercourse
  261. Pelvie Inflammatory Disease
    • infection of upper female genital tract
    • common complication of an STD (Chlamydia or Gonorrhea)
    • includes salpingitis
  262. Ectopic Pregnancy
    • implantation occurs outside the endometrium/endometrial cavity
    • Decrease in HCG
  263. Normal Pregnancy
    • increase HCG, nausea, weight gain, breast tenderness
    • Increase in HCG
  264. Hydatiform Mole
    • Very high HCG
    • Benign Tumor
  265. Choriocarcinoma
    malignancy of the placenta due to abnormal epithelium
  266. Fibrocystic Breast Disease
    Multiple, round, freely movable masses can be palpated. Bilateral breast tenderness made worse with caffeine and ovulation adn menses
  267. Fibroadenoma
    Most common benign breast tumor usually less than 30 years old, non tender, singular lump 75% unilateral
  268. Breast Cancer
    • 2nd most common cause of cancer death in women, most common more than 50yo most common location is upper/outer quadrant
    • nipple retraction, bleeding, orange peel appearance, dimplty
    • lytic when it metastisises
  269. Varicocele
    Tortuous dilation of the spermatic veins. BAG OF WORMS feeling upon palpation that diminishes from standing to supine
  270. Spermatocele
    • fluid filled mass in the epididymis
    • painless, moveable, pea sized lump located superior and posterior to the testicle
    • transilluminates light because it is fluid filled
  271. Hydrocele
    • Excess accumulations of water in the testicle
    • feels swollen, painless, heavy and tight
    • Transilluminated
  272. Epididymitis
    • consequence of an STD
    • Scrotum enlarged and tender and relieved by raising the testicle
    • 19-35 yo
    • Gonorrhea and Chlamidia
  273. Testicular Cancer
    • most common form of cancer in males 20-34.
    • painless nodule appears on or in the testicle
    • most common type of seminoma
    • does NOT transilluminate
  274. Benign Prostatic Hyperplasia
    Enlarged, non tender, firm, smooth, and loss of median sulcus
  275. Prostatitis
    • Boggy, soft, enlarged and tender
    • increased urgency
  276. Prostatic Carcinoma
    • Posterior lobe is hard, nodular, painless, and enlarged
    • most common place to metastasize to is the lumbar spine via Batson's plexus
  277. Priapism
    painful persistant erection, unaccompanied by sexual desire
  278. Phimosis
    constriction of foreskin that doesn't allow retraction-normal in newborns
  279. Paraphimosis
    foreskin trapped behind the glans penis and can not be pulled back to its flaccid position
  280. Hypospadias
    ventrally displaced uritha
  281. Epispadias
    dorsal displaced urinary meatus
  282. Testicular torsion
    rotation strangulation of blood supply of testicles
  283. Orchitis
    inflammation of testes (STD/Mumps)
  284. Cryptochism
    absence of one or both testes from scrotum and causes of testicular cancer
  285. Intermittent Claudication
    pain appears while walking adn disappears after rest
  286. Claudication Time
    • patient walks at a rate of 120 steps/minute for 1 minutes
    • positive: pain in calves
  287. Bicycle Test
    • patient pedals fat until painful rest until painless repeat
    • positive: pain in the calves
  288. stoop
    • walking causes pain, stooping or flexion relieves it
    • positive: pain in legs
    • positive- neurogenic
  289. Buerger's aka thromboangitis obliterans
    • seen in 20-40yo males adn is associated with excess tobacco smoking. presents with intermittent caludication non-healing ulcers adn gangrene
    • test: claudication time and buerger's test
  290. Raynaud's
    • seen in patients more than 15yo. disease associated with buerger's collagen disease ad scleroderma
    • brought on by cold, stress or emotion
    • presents with arterial spasm, triphasic color changes whit, blue, red, finger tip ulcers, gangrene and cold sensitivity
    • test: allen's
  291. Aneurysm
    an abnormal widening that involves all three layers of a vessel
  292. Varicose Veins
    • more than 20 yo.
    • incompetent valves, dilated tortuous channels
  293. Deep Vein Thrombosis
    • #1 cause of pulmonary embolism
    • tenderness, edema and pain
    • homans test
  294. Pulmonary embolism
    most common cause of death in pregnancy
  295. Reflex sympathetic Dystrophy aka Complex Regional Pain Syndrome
    • chronic pain condition.
    • dramatic changes in the color and temperature of the skin over the affected limb or body part accompanied by intense burning pain skin sensitivity, sweating, and swelling
  296. Telengectasia
    small superficial dilated blood vessels, face around the nose cheeks and chin
  297. Petechia
    • pinpoint hemorrhage (local trauma0
    • bruise
  298. RBC
    • Absolute number of circulating RBC's per unit volume of blood
    • normal level- 4-6 million /cm3
    • increased primary polycythemia vera relative/ secondary to high altitudes
    • Decreased- anemia
  299. Hemoglobin
    • direct measure of weight of hemoglobin/ unit of volume of blood
    • Increased: dehydration loss of blood fluid volume polycythemia vera
    • decreased: anemia
  300. Hematocrit
    • packed cell volume ratio of the volume of the RBC's to that of whole blood
    • increased: pdehydration polycythemia vera
    • decreased: anemia
  301. Mean corpuscular volume
    • calculated measure of the size of the average circulating rbc
    • Increased- macrocytic anemia less than 100
    • decreased- microcytic anemia more than 80
  302. Mean Corpuscular hemoglobin
    • calculated weight of hemoglobin in the average circulating RBC
    • increased macrocytic anemia
    • Decreased: microcytic anemia
  303. Mean corpuscular HB concentration
    • average concentration of HB in a given volume of packed cells
    • Increase: macrocytic anemia
    • decrease: microcytic anemia
  304. Platelets thrombocytes
    • absolute quantification of total circulating WBC/unit of blood
    • 5,000 to 10,000/mm3
    • increased: acute infection inflammation leukemia over 50,000
    • decreased overwhelming infection viral conditions
  305. WBC differential count
    • Neutrophilia- 60% bacterial infection
    • Lymphocytosis-30% virus
    • Monocytosis- 8% chronic infection
    • Eosinophilia-2% allergies, parasites
    • Basophilia- 0% heparin production/ histamine release
  306. Excessive Hemolysis
    positive Coombs Test, increased indirect bilirubin and increased reticulocytes
  307. Sickle Cell Anemia
    • presents with nucleated RBC's. Caused by Hgb S and seen in 10% of African Americans
    • Howell Jolly Bodies
  308. Thalassemia aka Cooley's Anemia aka Mediterranean Anemia
    • presents with microcytic, target cells
    • caused by decreased beta chain synthesis and is seen in mediterranean, north africa, and south east asia
  309. Erythroblastosis Fetalis
    caused by an Rh pos father and baby and an Rh neg mom
  310. Megaloblastic Anemia
    • macrocyctic normochromic
    • B9/Folic Acid: chronic alcoholics, pregnancy, malabsorption used to prevent neural tube defects
    • B12/Cyanocobalamine deficiency (pernicious anemia) lack of IF due to chronic atrophic gastric mucosa causing loss of parietal cells dx with shilling test treatment is b12 shots
    • progresses to posterolateral sclerosis of SC which is also known as combined systems diesease
  311. Iron Deficiency Anemia
    • hypchromic microcytic
    • seen with chronic blood loss and pregnancy
  312. Aplastic Anemia
    • normochromic normocytic
    • panhypoplasia of the bone marrow, decrease in all blood cells
    • seen with drugs, chemotherapy, radiation, mm, ra, leukopenia, acute blood loss, benzene poisoning, thrombocytopenia
  313. Acute post hemorrhagic anemia
    rapid massive hemorrhage will have increased rbc, hgb and hc levels
  314. Chronic Post hemorrhagic anemia
    • hypochromic microcytic anemia.
    • mostly common in iron deficiency
  315. Straw colored urine
    normal
  316. red colored urine
    blood or food pigments (infection, cancer, and food dyes)
  317. Green Colored urine
    biliverdin (biliary duct obstruction, pseudomonas infection , bad protein digestion)
  318. Blue colored urine
    diuretic therapy, pseudomonas infection, bad protein digestion
  319. Brown colored urine
    bile pigments or blood (biliary duct obstruction, occult blood, homogentisic acid)
  320. Black Colored Urine
    homogentisic acid or urobilin (Ochronosis, hemolysis, bacteria)
  321. Hazy appearance to urine
    epithelial cells, wbcs, rbcs, crystals, sperm, microorganisms
  322. milky appearance to urine
    wbcs or fat
  323. Normal pH of urine
    4-8
  324. SPecific gravity of Urine
    1.01-1.03 increases with bacterial infection, diabetes mellitus, and kidney abnormalities
  325. Glucose in urine
    • normal: none detected. renal threshold is more than180mg
    • increases with diabetes mellitus, shock, head injury, pancreatic disease, renal tubular disease
  326. Ketones in urine
    • normal: none detected
    • increased with starvation, diabetes mellitus, weight loss diets, inadequate carbs intake
  327. Protein in urine
    • normal: none detected
    • increased with kidney disorders, toxemia of pregnancy, diabetes mellitus, mm
  328. Urobilinogen
    • normal is .1-1 El unit/mL
    • increased: with hemolytic disease or hepatic disease
    • decreased: with biliary destruction
  329. Bilirubin
    • normal: none detected
    • increased with hepatic disease or biliary obstruction
  330. Blood in urine
    • normal: none dectected
    • increased: with tumors, trauma, kidney infection, kidney stones, hypertension, bleeding disorders
  331. Casts in urine
    • hyaline-normal
    • epithelial- tubular damage
    • rbc- glomerulonephritis
    • wbc- pyelonephritis
    • Waxy- renal failure, nephrosis
  332. acit phosphatase (PAP)
    incrased prostatic carcinoma, metastatic disease
  333. Albumin/globulin ratio
    reversed- mm
  334. albumin
    • increased: dehydration
    • decreased: nephrosis
  335. Alkaline phosphatase
    incrased osteoblastic lesions, hepatic disease, HPT
  336. Amylase
    increase: acute pancreatitis
  337. ANA or FANA
    collagen disease (SLE< Scleorderma)
  338. Antistreptolysin-O (ASO) titre
    increase Rheumatic fever, actue glomerulonephrits
  339. Bilirubin
    • increased- direct- hepatitis, duct obstruction
    • decreased- indirect hemolytic disease

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