General Dx

Chief Complaint, Past Health History, Personal & Social History, Review of Systems

• 1. Why the patient is seeking care.
• 2. In patient's own words

• Onset
• Palliative/Provoking
• Quality of Pain
• Radiation/Referral
• Site/setting/severity
• Timing

• Serious Illness
• Previous Injuries
• Hospitalizations
• Surgeries
• Medications
• Allergies

• Cardiovascular Disease
• Diabetes
• Stroke
• Cancer

• Marital Status
• Occupation
• Diet
• Exercise
• Bowel/Urinary Patterns
• Sleep
• Alcohol, Tobacco, Drug use
• Stress

Neuromuscular

Systematic, more severe problem

• Nothing makes the pain worse
• Nothing makes teh pain better

No comfortable position

Dermatoganous

Scleratogenous

Flank

Groin

Sharp Knife like pain at T10-T12

Inferior Angle of Right Shoulder

Can not localize pain

Vascular

Muscle

Nerves

Dissection Anerysm

Patient is able to pinpoint where the pain is.

Patient is able to pinpoint where pain is on the joint.

Infection

• C- Cutting down?
• A- Annoyed by others criticisms?
• G- Guilty Feelings?
• E- Eye Openers? (morning drink needed)

A general exploration of the varous organ systems of the body

Standing platform scale with a height attachment

• Oral: 98.6 F
• Rectal & Tympanic: 99.6 F
• Axilla: 97.6 F
• Range: 96-99.5F 35-37.5C

• Adults: 60-100
• Newborns: 120-160
• Elderly: 70-80

• Adults: 14-18
• Newborn: 44

• 90-120/60-80
• Increase in elderly is normal

Over 140/90

under 90/60

low pitched sounds produced by turbulent blood flow in arteries

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.

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.

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.

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.

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.

Dizzy, Drop Attack, Diplopia, Dyserthria, Dysphagia

nausea, numbness, nystagmus

Seborrhea

myxedema ( hypothyroidsim)

Drooping of the eyelid. Seen with horner's, CN 3 paralysis, Myasthenia Gravis

Lid lag/ failure to cover the eyeball seen in graves or tumor

lid is turned outward and seen in elderly

lid is turned inward and seen in the elderly

• swelling around the eye
• Seen in allergies, myxedema, nephrotic syndrome

Inflammation of the eye seen with seborrhea staph infection, inflammatory processes

• opacities seen in the lens that are commonly seen with diabetes and in the elderly
• absent red light reflex

Grayish opaque ring around the cornea. <50= hypercholesterolemia. >50= normal

triangular thickening of the bulbar conjunctiva that grows across the corena and is brought on by dry eye

• white- normal
• yellow- jaundice
• blue- osteogenesis

• pink- normal
• pale- anemia
• bright red- infection

an infection of the sebaceious glands causing a pimple or boil on the eye

an infection of the sebacceous glands causing a pimple or boil on the eyelid

a yellowish triangular nodule in the bulbar conjunctiva that is harmless and indicates aging

fatty plaques on the nasal surgace of the eyelids that is normal or indicates hypercholesterolemia

Bilaterally samll and irregular pupils that accommodate but do not react to light. Seen with syphilis (prostitutes pupil) tertiary syphilis

dilated pupil wit ptosis adn lateral deviation. Don't react to light or accommodation. MS

Dilated and fixed pupils seen with anticholinergic drugs

fixed and constricted pupils that react to light and accommodate. seen with severe brain damage, pilocarpine meds, and narcotic use.

Unequal Pupil size

sluggish pupillary rxn to light that is unilateral and caused by a parasympathetic lesion of CN 3.

sluggish pupillary rxn due to hyoadrenalism (Addison's Disease)

ptosis, miosis, and anhydrosis on the same side as an interruption to the cervical sympathetics

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

swelling of the optic disc due to increased intracranial pressure. No visual loss. Seen with brain tumor or brain hemorrhage

Painless sudden onset of blindness described as curtains closing over vision. lightning flashes and floaters

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)

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

Affects the veins more than ateries and presents with microaneurysms, hard exudates and neovasculariazation

inflammation of the iris seen with ankylosing spondylitis

presence of ringing of the ears

sensorineural hearing loss that occurs in people as they age and they may be affected by genetic or acquired factors

infection of the outer ear. aka swimmer's ear. inflammation and pain of the outer ear, tugging on the pinna will be painful

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

bacterial or viral infection in the middle ear. tympanic membrane is red, dilated blood vessels, and bulging

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!

abnormal sensation of rotary movement associated with difficulty in balance gait and navigation of the environment.

A disorder characterized by recurrent prostrating vertigo sensory hearing loss tinnitus and feeling of fullness in the ear

Most common vertigo in the USA. Brief episode of vertigo brought on by a change of head position.

Benign tumor of CN 8. hearing loss, tinnitus, vertigo, and presence of tumor on CT or MRI ( SLow growing tumor)

Retraction of the tympanic membrane. Adenoids can block tube as well.

• Normal Hearing: Eaual sound heard bilaterally
• Conduction Hearing Loss: Lateralizes to bad ear
• Sensorineural Hearing Loss: Lateralizes to good ear

• Normal hearing: AC>BC (Rhinne +)
• Conduction hearing loss: AC<BC or AC=BC (Rhinne -)
• AC>BC with less time in bad ear

nasal mucosa appears red and swollen with a clear runny nose

Nasal mucosa appears pale and blue and boggy

Thinning of the nasal mucosa with sclerosis, crust formation, and foul odor.

typically occur as a consequence of chronic inflammation of the nasal mucosa

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.

• immunocompremised patient.
• Thick white fungal patches that are easily scraped off

pre-cancerous lesion of white patches that are adherent to the surface and not easily removed.

red beefy tongue. Deficiency of B vitamins or iron that causes the tongue to appear smooth and glossy

Deep furrows on the surface of the tongue that is considered a normal variant

multicentric neoplasm caused by herpe vireus 8. appear bruised

excessive production of growth hormone prior to skeletal maturation

excessive production of growth hormone beginning in middle age. Results in abnormal growth in the hands, feet, and facial bones

Grave's Disease- autoimmune. TSH production is decreased and thyroid hormones are produced in excess

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.

• 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

• 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

• 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

• 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

• Adult
• Occipital vertex
• throbbing, wake up with a headache
• Test: Blood pressure, lipid profile

• 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

• any age
• bandlike
• pressure, muscle tightenss
• provoked by fatigue, tension, stress, work
• alcohol relieves it

• 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

• 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

• Any age
• Localized and changes with body position
• Steady trhob, local tenderness, worse in the morning
• Chronic Sinusitis

• 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

• 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

• Any Age
• Stiff neck
• Intense, deep pain, single episode
• worse in flexion
• Tests: Kernig/brudzinski, CSF tap

skipping meals, and tests by Fasting blood sugar test

• Any age
• Localized general pain, loss of memory, visual disturbances
• Provoked by fall, MVA, whiplash injury, and trauma
• Labs: Refer to neurologist/ ER

• AP= Lateral Diameter. 1:1 ratio.
• Seen with COPD and cystic Fibrosis

Marked depression noted in the sternum (Sunken in)

Forward protrusion of the sternum (like keel of a ship)

Rapid shallow breathing

Slow Breathing

Characterized by groups of quick, shallow inspirations followed by irregular periods of apnea ( no pattern)

Breathing pattern characterized by alternating periods of apnea and hyperpnea (has pattern) Respiratory acidosis

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

inguinal indentations. Seen with psoriasis so also look for silver scales on elbows and knees

Subacute bacterial endocarditis (Strep organism)

Transverse ridging associated with acute severe disease

Inflammation of the nail fold near the cuticle

Nail base has an angle more than 180 degrees and may indicate hypoxia/COPD (Bronchogenic Carcinoma)

Iron deficiency anemia

Place hands over the posterior ribs and have the patient take a deep breath

• 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

normal over lung tissue

increased air in the chest (emphysema, pneumothorax

Increased density (pneumonia, atelectasis)

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

Heard when inspiration is longer than expiration in most of the lung especially the base

Heard when inspiration equals expiration in the anterior 1-2 ribs posterior between scapula at apex

Heard when expriation is longer than inspiration over the manubrium

Heard when inspiration equals expiration over the trachea in the neck

small clicking, bubbling, and rattling sounds in the lungs. Described moist, dry, fine and coarse (bronchitis)

• resemble snoring
• occur when air is blocked or becomes rough through the large airways (Bronchiectasis)

• high pitched sounds produced by narrowed airways. heard upon exhalation
• Asthma in young people
• Emphysema in old people

wheeze-like sound heard upon inspiration. usually due to a blockage of airflow

if clear, distnict sounds are heard as teh patient says 99, consolidation is present

Hear AAAAAA as teh patient says EEE, consolidation is present

if the words 123 are heard clearly and distinctly, consolidation is present

• Percussion: Resonant
• Fremitus: Decreased
• Breath Sound: Wheezing

• Percussion: Dull/FLat
• Fremitus: Decreased
• Breath sound: Absent

• Percussion: Resonant
• Fremitus: Normal
• Breath Sound: Rhonci

• Percussion: Resonant
• Fremitus: Normal
• Breath SOunds: Rales

• Percussion: Hyperresonant
• Fremitus: Decreased
• Breath Sounds: Wheezing

• Percussion: Resonant
• Fremitus: Decreased
• Breath SOund: Crackles (Friction Rub)

• Percussion: Hyperresonant
• Fremitus: Decreased
• Breath Sound: Decreased

• Percussion: Dull
• Fremitus: Increased
• Breath Sound: Egophony, Bronchophony, Whispered Pectoriloquy, Crack

• 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

Productive or currant red jelly sputum and caused by Klebsiella pneumonia. Seen with old age or immunocompromised hosts.

aused by yeast/fungus. most commonly seen in AIDS patients

caused by CMV. Most commonly seen in AIDS patients (HHB5)

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

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

• 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.

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

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

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

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

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.

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.

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

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.

• 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

• 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

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

Chest pain and inflammation and tenderness

Bounding; increase cardiac output, exercise, anxiety, fever, hyperthyroidism

Weak or thready, decreased stroke volume; hypovolemia, aortic stenosis, CHF

alternates in amplitude, left ventricular failure

two strong systolic peaks separated by mid systolic dip (best felt at carotid artery) aortic regurgitation. aortic stenosis

Decreased amplitude on inspiration incraesed with expirations ( less tahn 10 mm Hg amplitude change) COPD bronchial asthma, emphysema, pericardial effusion

a jerky pulse that is rapidly increasing and then collapsing because of aortic insufficiency

vibration produced by turbulent blood flow within the heart (murmurs)

Closure of AV (mitral and tricuspid) valves (beginning of systole)

Closure of semilunar valves (pulmonary and aortic) beginning of diastole

Ventricular gallop: normal in children, young adults, and athletes. less than 40 yo indicates earliest sign of CHF

Atrial Gallop: similar to S3 and is related to stiffness of the ventricular mycoardium to rapid filling (never normal) Failure of the left ventricle

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

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

• A-aortic
• R- regurgitation
• M- mitral
• S-Stenosis

• P-pulmonic
• R- Regurgitation
• T- Tricuspid
• S- Stenosis

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

Dextraposition of teh aorta, right ventricular hypertrophy, interventricular septal defect, and pulmonic stenosis. Creates a loud ejection murmur during systole and severe cyanosis

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

Narrowing proximal to the vertebral artery. The Subclavian steals from the vertebrae. Seen in younger females who faint (syncope/drop attacks) while exercising

• 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

• 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.

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.

• 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

Acute heart failure, comes on with rest, caused by atherosclerosis, CK-MB is elveated, increased SGOT, increased LDH

• Abnormal widening that involves all 3 layers; defect in elastic-media tissues.
• 3.8-5 mm go to vascular specialist
• >5mm go to ER

• 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)

Inverted ST, Elongated ST, inverted T wave

Early Intestinal Obstruction

Late intestinal obstruction

vomitting up blood

coughing up blood

Blood in stool

increased alkaline phosphatase, serum-glutamate-oxalacetate transaminase (SGOT/AST) aspartate transaminase, lactate dehydrogenase LDH

Gamma-Glutamyl Transpeptidase (GGT) and Serum Glutamic Pyruvic Transaminase (SGPT/ALT) Alanine Transaminase

Creatine Phosphokinase (CPK), SGOT, LDH-MI

• Blood Urea Nitrogen (BUN)- liver and kidneys
• Increased in kidneys
• Decreased in Liver

Yellowing of the skin, sclera, and mucuous membranes. Can occur with any liver disorder

• 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)

• 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

• 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

• Water soluble
• Increasaes with duct obstruction (galstones), hepatic disease, pancreatic cancer
• Increase amounts in the blood may cause bilirubin in the urin (urobilinogen)

• 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

pain referral to right shoulder or tip of right scapula (viscerosomatic)

• 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.

Calcification that can become malignant due to chronic inflammation

• 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

Usually at the head of the pancreas. Presents with dark urin, clay colored stools and jaundice

• 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

Condition of the posterior pituitary gland in which there is insufficient ADH. May have polydypsia, polyuria, but NOT polyphagia

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

• 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

includes gastric and duodenal ulcers caused by H. Pylori bacteria coffe ground emesis, burning epigastric pinpoint pain

has no consisten pain pattern. Sometimes food causes the pain and other times it relieves the pain

• Pain occurs 2 hours after eating, black/tarry stool. Most common type of peptic ulcer
• GUAIAC Test- occult blood in teh stool

Projectile vomitting in teh newborn

most common on the lesser curvature and affects teh left supraclavicular lymph node (Virchow's Node)

• 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

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)

goes to peri-umbilical

gas in teh intestine

• 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

• most common at the colon and rectum
• Presents with bloody mucous in diarrhea, fever
• can lead to sacroilitis (enteropathic arthropathy)
• Sigmoidoscopy

• variable degrees of constipation and diarrhea in response to stress
• seen more commonly in females
• abdominal pain and gas relieved by bowel movements

• 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

• 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

intestinal cancer that mets to the liver... liver releases enzymes causing flushing of the face

• 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

• 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

• 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

Increased aldosterone (primary hyperaldosteronism) High BP, Retains Water

• 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

• Caused by group A hemolytic strep (strep pyogenes-ASO titre)
• RBC casts in urine wtih small amount of protein

• HEP: hypertension, edema, massive proteinuria, waxy or fatty casts in urine
• In pregnant women it is called pre-eclampsia after 20 weeks

• E Coli From UTI
• WBC casts

Inherited disorder characterized by many bilateral renal cysts that increase renal size but reduce functioning renal tissue

• Caused most commonly by E Coli in females and N. Gonorrhea in males
• Nitrites in the urine

noninfectious bladder inflammation that causes burning painful and frequent urination with incontinence. Pt will also have suprapubic and low back pain.

Rapid steadily decreasing renal failure with or without oliguria

Insufficency of renal excretory and somthing function

Heatin, flank pain, palpalble mass

Malignant tumor of the kidney; less than 5 years of age, abdominal mass, hematuria

• 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

• 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

• 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

• 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

• 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

• benign uterine tumors of smooth muscle origin (leiomyoma)
• Heavy menstrual bleeding, pelvic pain, painful intercourse

• infection of upper female genital tract
• common complication of an STD (Chlamydia or Gonorrhea)
• includes salpingitis

• implantation occurs outside the endometrium/endometrial cavity
• Decrease in HCG

• increase HCG, nausea, weight gain, breast tenderness
• Increase in HCG

• Very high HCG
• Benign Tumor

malignancy of the placenta due to abnormal epithelium

Multiple, round, freely movable masses can be palpated. Bilateral breast tenderness made worse with caffeine and ovulation adn menses

Most common benign breast tumor usually less than 30 years old, non tender, singular lump 75% unilateral

• 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

Tortuous dilation of the spermatic veins. BAG OF WORMS feeling upon palpation that diminishes from standing to supine

• 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

• Excess accumulations of water in the testicle
• feels swollen, painless, heavy and tight
• Transilluminated

• consequence of an STD
• Scrotum enlarged and tender and relieved by raising the testicle
• 19-35 yo
• Gonorrhea and Chlamidia

• 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

Enlarged, non tender, firm, smooth, and loss of median sulcus

• Boggy, soft, enlarged and tender
• increased urgency

• Posterior lobe is hard, nodular, painless, and enlarged
• most common place to metastasize to is the lumbar spine via Batson's plexus

painful persistant erection, unaccompanied by sexual desire

constriction of foreskin that doesn't allow retraction-normal in newborns

foreskin trapped behind the glans penis and can not be pulled back to its flaccid position

ventrally displaced uritha

dorsal displaced urinary meatus

rotation strangulation of blood supply of testicles

inflammation of testes (STD/Mumps)

absence of one or both testes from scrotum and causes of testicular cancer

pain appears while walking adn disappears after rest

• patient walks at a rate of 120 steps/minute for 1 minutes
• positive: pain in calves

• patient pedals fat until painful rest until painless repeat
• positive: pain in the calves

• walking causes pain, stooping or flexion relieves it
• positive: pain in legs
• positive- neurogenic

• 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

• 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

an abnormal widening that involves all three layers of a vessel

• more than 20 yo.
• incompetent valves, dilated tortuous channels

• #1 cause of pulmonary embolism
• tenderness, edema and pain
• homans test

most common cause of death in pregnancy

• 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

small superficial dilated blood vessels, face around the nose cheeks and chin

• pinpoint hemorrhage (local trauma0
• bruise

• 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

• direct measure of weight of hemoglobin/ unit of volume of blood
• Increased: dehydration loss of blood fluid volume polycythemia vera
• decreased: anemia

• packed cell volume ratio of the volume of the RBC's to that of whole blood
• increased: pdehydration polycythemia vera
• decreased: anemia

• calculated measure of the size of the average circulating rbc
• Increased- macrocytic anemia less than 100
• decreased- microcytic anemia more than 80

• calculated weight of hemoglobin in the average circulating RBC
• increased macrocytic anemia
• Decreased: microcytic anemia

• average concentration of HB in a given volume of packed cells
• Increase: macrocytic anemia
• decrease: microcytic anemia

• 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

• Neutrophilia- 60% bacterial infection
• Lymphocytosis-30% virus
• Monocytosis- 8% chronic infection
• Eosinophilia-2% allergies, parasites
• Basophilia- 0% heparin production/ histamine release

positive Coombs Test, increased indirect bilirubin and increased reticulocytes

• presents with nucleated RBC's. Caused by Hgb S and seen in 10% of African Americans
• Howell Jolly Bodies

• presents with microcytic, target cells
• caused by decreased beta chain synthesis and is seen in mediterranean, north africa, and south east asia

caused by an Rh pos father and baby and an Rh neg mom

• 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

• hypchromic microcytic
• seen with chronic blood loss and pregnancy

• 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

rapid massive hemorrhage will have increased rbc, hgb and hc levels

• hypochromic microcytic anemia.
• mostly common in iron deficiency

normal

blood or food pigments (infection, cancer, and food dyes)

biliverdin (biliary duct obstruction, pseudomonas infection , bad protein digestion)

diuretic therapy, pseudomonas infection, bad protein digestion

bile pigments or blood (biliary duct obstruction, occult blood, homogentisic acid)

homogentisic acid or urobilin (Ochronosis, hemolysis, bacteria)

epithelial cells, wbcs, rbcs, crystals, sperm, microorganisms

wbcs or fat

4-8

1.01-1.03 increases with bacterial infection, diabetes mellitus, and kidney abnormalities

• normal: none detected. renal threshold is more than180mg
• increases with diabetes mellitus, shock, head injury, pancreatic disease, renal tubular disease

• normal: none detected
• increased with starvation, diabetes mellitus, weight loss diets, inadequate carbs intake

• normal: none detected
• increased with kidney disorders, toxemia of pregnancy, diabetes mellitus, mm

• normal is .1-1 El unit/mL
• increased: with hemolytic disease or hepatic disease
• decreased: with biliary destruction

• normal: none detected
• increased with hepatic disease or biliary obstruction

• normal: none dectected
• increased: with tumors, trauma, kidney infection, kidney stones, hypertension, bleeding disorders

• hyaline-normal
• epithelial- tubular damage
• rbc- glomerulonephritis
• wbc- pyelonephritis
• Waxy- renal failure, nephrosis

incrased prostatic carcinoma, metastatic disease

reversed- mm

• increased: dehydration
• decreased: nephrosis

incrased osteoblastic lesions, hepatic disease, HPT

increase: acute pancreatitis

collagen disease (SLE< Scleorderma)

increase Rheumatic fever, actue glomerulonephrits

• increased- direct- hepatitis, duct obstruction
• decreased- indirect hemolytic disease