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Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS, Exams of Nursing

Information on health history, including chief complaint, past health history, personal and social history, and review of systems. It also covers attributes of a symptom, family health history, and tests for Vertebrobasilar Artery Insufficiency (VBAI). Additionally, it includes information on eye pathology, such as Adie's pupil, Argyll Robertson pupil, and Papilledema. The document also covers visual acuity, Tinnitis, and Vertigo.

Typology: Exams

2022/2023

Available from 07/17/2023

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Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Health history includes the following: - Answer• chief complaint • past health history • personal and social history • review of systems The chief complaint covers what? - AnswerThe reason the patient is seeking care & should be obtained in the patient's own words This covers the reason the patient is seeking care and should be obtained in the patient's own words: - Answerchief complaint The attributes of a symptom: • Onset • Palliative/Provoking • Quality of pain • Radiation/Referral • Site/Setting/Severity • Timing - AnswerPresent illness Past health history: ++ immunizations are listed separate category than these - Answer• serious illness • previous injuries • hospitalizations • surgeries • medications • allergies Family Health History: - Answer• degenerative diseases • cardiovascular diseases Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS • diabetes • strokes • cancer Social/Personal History: - Answer• martial status • occupation • diet • bowel/urinary patterns • sleep/naps • alcohol, tobacco, and drug use • stress What am I? • Information acquired during history that indicates alcoholism, move to this questionnaire. - Answer•CAGE questionnaire C= cutting down (have you felt the need to cut down on your drinking?) A= annoyed by others criticism (Have you ever felt annoyed by criticism of your drinking?) G= guilty feelings (have you ever felt guilty about your drinking?) E= eye openers (Have you ever felt the need for a morning eye-opener drink?) Review of system: Can Greg Pinch me? - Answer•General exploration of the various organ systems of the body Cardiovascular: palpation, pain you feeling as a while Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What am I? • low pitch sounds produced by turbulent blood flow in arteries - AnswerKorotkoff Sounds What am I? • difference of 10-15mm Hg in systolic readings can indicate arterial occlusion such as _____ on the side of the decreased value - AnswerSubclavian Steal Syndrome Where in the body are blood pressure readings 20% higher? - AnswerLower extremities Blood pressure is what in the lower extremities? - Answer20% higher A difference of 10-15 mmHg in systolic readings can indicate what? - AnswerArterial occlusion such as subclavian steal syndrome on side w/decreased value These are tests for what? • Barre-Lieou • DeKleyn's • HallPike • Hautant • Underberg • Maigne - AnswerVertebrobasilar Artery Insufficiency (VBAI) What is the Barre-Lieou test for Vertebrobasilar artery insufficiency? - Answer•Patient seated •Pt rotate head maximally from side to side •Done slowly at 1st then accelerated to patient tolerance What is the DeKleyn's test for the Vertebrobasilar artery insufficiency? - Answer•Patient supine •Examiner instructs pt to rotate & extend head off table then turn to eat side for 15-45 sec Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS •Doc can lead w/minimal support What is the Hallpike test for Vertebrobasilar artery insufficiency? - Answer•An Enhanced DeKleyn's •Pt Supine •Head extended off table •Examiner offers support for skull •Examiner brings head into extension •Rotation & lateral flexion What is the Hautant's test for Vertebrobasilar artery insufficiency? - Answer•Pt seated •Arm's extended forward to shoulder level w/hands supinated •maintain position for a few seconds •Patient then closes eyes •Rotates & hyperextends neck on one side •Repeat on opposite side What is the Underberg for Vertebrobasilar artery insufficiency? - Answer•Patient stands w/eyes open Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS •Arms at side, feet close together •Patient closes eyes •extends arms & supinates hands •Then patient extends & rotates head to one side •Then in this position patient is instructed to march in place What is Maigne's test for Vertebrobasilar artery insufficiency? - Answer•Patient eated •Examiner brings head into extension & rotation Scaly eyebrow indicates what? - AnswerSeborrhea Loss of lateral 1/3 eyebrows indicates what? - Answermyxedema (hypothyroidism) Quantitative loss of the eyebrow is what? - AnswerNormal with age What is an Adie's pupil?Caused by what? - AnswerSluggish pupillary reaction to light that is unilateral & caused by parasympathetic lesion of CN III What is Anisocoria? - AnswerUnequal pupil size What is Argyll Robertson pupil? - AnswerBilaterally small & irregular pupils that accommodate but do not react to light What is Argyll Robertson pupil seen in? - AnswerSyphilis Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS •Silver sire deformity •A-V nicking •Flame Hemorrhages •Cotton wool soft exudates What is Internal Ophthalmoplegia? - Answer•Dilated pupil w/ptosis & lateral deviation •Doesn't react to light of accommodation Where is Internal Ophthalmoplegia seen? - AnswerMultiple Sclerosis What is Iritis/Uvitis? - AnswerInflammation of the iris Where is Iritis/Uvitis seen? - AnswerAnkylosis Spondylitis What is Macular degeneration? - AnswerCentral vision loss What is an early sign of Macular degeneration? - AnswerMacular Drusen - Yellow deposits under retina What is Miosis? - AnswerFixed & constricted pupils that react to light & accommodate Where is Miosis seen? - Answer•Severe brain damage •Pilocarpine medications •Narcotic use What is Mydriasis? - AnswerDilated & fixed pupils Where is Mydriasis seen? - AnswerAnticholinergic drugs What is Papilledema? - Answer• aka Choked Disc Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS • Swelling of the optic disc due to increased intracranial pressure •No vision loss Papilledema is seen with what? - AnswerA brain tumor or brain hemorrhage What is Periorbital Edema? - AnswerSwelling around the eye Periorbital edema is seen with what? - Answer•Allergies •Myxedema •Nephrotic syndrome What is Pinquecula? - AnswerYellow triangular nodular nodule in the bulbar conjunctiva that is harmless Pinquecula indicates what? - Answeraging What is a Pterygium? - Answertriangular thickening of bulbar conjunctiva that grows across cornea Pterygium is brought on by what? - AnswerDry eyes What is Ptosis? - AnswerDrooping of the eyelid Ptosis is seen in what? - Answer•Horner's •CN 3 paralysis •Myasthenia Gravis- MS What is a retinal Detachment? - AnswerPainless sudden onset of blindness described as curtains closing over vision What is seen just prior to a Retinal Detachment? - AnswerLightning flashes & floaters Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is the color of normal sclera? - AnswerWhite What is the color of a Jaundiced sclera? - AnswerYellow What is the color of the sclera in Osteogenesis Imperfecta? - AnswerBlue What is Xanthelasma? - AnswerFatty plaques on the nasal surface of the eyelids What can Xanthelasma indicate? - AnswerHypercholesterolemia What is Emmetropia? - AnswerNormal vision What is Myopia? - AnswerNearsighted What is Hyperopia? - AnswerFarsighted What is Presbyopia? - AnswerLoss of lens elasticity due to aging Which CN's are tested for a direct light reflex? - AnswerCN II & III Which CN's are tested on a consensual light reflex? - AnswerCN II & III What CN's are being tested in the swinging light test? - AnswerCN II & IIIEye pathology What CN's are being tested for accommodation? - AnswerCN II & III What is used to check visual acuity? - AnswerSnellen chart Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is Tinnitis? - AnswerRinging in the ears What is Vertigo? - AnswerAbnormal sensation of rotary movement Someone with normal hearing will have what findings for Weber? - AnswerSound heard equally bilaterally Someone with normal hearing will have what findings for the Rinne Test? - AnswerAir conduction > Bone conduction Someone with conduction hearing loss will have what findings for the Rinne test? - AnswerLateralizes to involved ear Someone with conduction hearing loss will have what findings for the Weber test? - AnswerAir conduction < Bone conduction Someone with Sensorineural hearing loss will have what findings on the Weber test? - AnswerLateralizes to uninvolved ear Someone with Sensorineural hearing loss will have what findings for Rinne test? - AnswerAir conduction > Bone conduction w/less time in bad ear Weber vs Rhine CHART - AnswerAC= air conduction BC= bone conduction With Allergic Rhinitis the nasal mucosa can appear how? - AnswerPale or blue to boggy What will be seen for someone with Atropic Rhinitis? - AnswerThinning of the nasal mucosa w/sclerosis, crust formation, & Foul odor Polyps typically occur as a consequence of what? - AnswerChronic inflammation of the nasal mucosa Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Viral rhinitis will have what appearance with what? - AnswerRed & swollen w/clear runny nose What is Angular stomatitis? - Answer•aka Cheilosis •Red sores at the corner of the mouth Angular stomatitis can be caused by what deficiency? - AnswerVit B2 (Riboflavin) What does Atrophic Glossitis cause the tongue to look like? - AnswerSmooth and glossy What causes Atrophic GLossitis? - Answer•B Vitamins (B12) •Iron What does the tongue look like with Candidiasis? - Answer• aka Thrush •Thick white fungal patches that easily scrapes off What is Fissured tongue? - Answer•Scrotal tongue •Deep furrows on the surface of the tongue What is Fissured tongue considered? - AnswerNormal variant What is Leukoplakia? - AnswerPre-cancerous lesion of white patches that are adherent to the surface & not easily removed What causes Acromegaly? - AnswerExcessive production of growth hormone beginning in middle age Acromegaly results in abnormal growth of what? - AnswerHands, feet, & facial bones What is Giantism caused by? - AnswerExcessive growth hormone prior to skeletal maturation Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Hyperthyroidism is most commonly caused by what? - AnswerGrave's disease What blood levels are found with someone with Hyperthyroidism? - Answer•TSH - Decreased •T3/T4 - Increased What is the most common cause of hypothyroidism in the US? - AnswerHashimoto's Thyroiditis What is congenital hypothyroid called? - AnswerCretinism Cretinism causes what? - AnswerDiminished physical & mental capacity These are symptoms of what? •Weight loss •Increased appetite •Irritable & Nervous •Intolerance to heat •Moist skin & fine hair •Exophthalmos •Possible neck swelling due to goiter - AnswerHyperthyroidism These are symptoms of what? •Weight gain w/decreased appetite •Depression, weakness, & Fatigue •Intolerance to cold •Coarse, dry hair & Skin •Periorbital edema •Macroglossia & loss of lateral eyebrows - AnswerHypothyroidism Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What age/sex is associated with a cluster headache? - AnswerAdolescent to adult Males Where is a cluster headache typically felt? - Answer•Occipital •Vertex What are the characteristics of a cluster headache? - Answer•Waking up at night w/headache, lasts 15- 180 minutes •Rhinnorea •Lacrimation •Facial sweating •Red eye •Miosis •Not aggravated by exertion What is a cluster headache provoked by what? - Answer•Alcohol •Occurs in "clusters" Who does a tension headache affect? - AnswerAny age/sex What does a tension headache feel like? - AnswerBand-like What are the characteristics of a tension headache? - Answer• Pressure • Muscle tightness Tension headaches are provoked by what? - Answer• Fatigue • Tension • Stress • Work Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Who is typically affected by Temporal Arteritis? - AnswerOver 50 yo Wat are the AKAs for temporal arteritis? - Answer• giant cell • polymyalgia rheumatica Where is temporal arteritis usually felt? - Answer• Unilateral temporal • Orbital • Prox mm pain/stiff What are the characteristics of temporal arteritis? - Answer• Persistent • Burning • Aching • Throbbing Temporal arteritis is provoked by what? - Answer• Scalp sensitive • tender arteries What should be checked with a suspected temporal arteritis? - Answer• ESR elevated • Biopsy What is the AKA for cerviogenic? - AnswerVertebrogenic Who most commonly gets a cervicogenic headache? - AnswerAdults Where is a cervicogenic headache felt? - Answer• Occipital • Upper cervical What are characteristics of a cervicogenic headache? - Answer• Often daily Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS • Decreased ROM in upper cervicals & occiput • Pain in neck referred to head What provokes a cervicogenic headache? - AnswerHead movement What should be checked for someone with a cervicogenic headache? - Answer• Flexion/extension • X-ray • Adjust Who does a sinus headache affect? - AnswerAnyone Where is a sinus headache typically felt? - AnswerLocalized & changes w/body position What are the characteristics of a sinus headache? - Answer• Steady throb • local tenderness • Worse in morning A sinus headache is provoked by what? - AnswerChronic Sinusitis Who can a subarachnoid headache affect? - AnswerAnyone Where is a subarachnoid headache felt? - AnswerBasilar area What are the characteristics of a subarachnoid headache? - Answer• Abrupt onset • Constant • Stiff neck • Excruciating pain like never before experienced before What is a subarachnoid headache provoked by? - Answer• Hypertension Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is Pectus Carinatum? - Answer• Pigeon chest • Forward protrusion of sternum What is Tachypnea? - AnswerRapid shallow breathing What is Bradypnea? - AnswerSlow breathing What is Biot's breathing characterized by? - AnswerGroups of quick, shallow inspirations followed by irregular periods of apnea What is Cheyne Stokes Respiration? - AnswerBreathing pattern characterized by alternating periods of apnea & hyperpnea (has pattern) Cheyne Stokes Respiration is associated with what? - AnswerRespiratory acidosis What is Kussmaul's Breathing? - AnswerBreathing 1st rapid & shallow but as metabolic acidosis worsens breathing gradually becomes deep, slow, labored gasping- Air hunger breathing How is pitted nails described? - AnswerUnguinal indentations Where is pitted nails seen? - AnswerPsoriasis Splinter hemorrhage nails are seen with what condition? - AnswerSubacute bacterial endocarditis What are Beau's Lines? - AnswerTransverse ridging Where is Beau's lines seen? - AnswerAcute severe disease What is Paronychia? - AnswerInflammation of the nail fold near cuticle Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is nail clubbing? - AnswerNail base has angle >180° What is nail clubbing seen with? - Answer• Hypoxia - early • COPD - Late What is Koilonychia nail? - AnswerSpool nails What is Koilonychia nails seen with? - AnswerIDA: iron deficiency anemia How is Respiratory excursion performed? - Answerplace hands over posterior ribs & have the patient take deep breaths What is tactile fremitus? - Answerpalpable vibration Tactile fremitus is decreased with what conditions? - Answer• Emphysema • Pneumothorax Tactile fremitus is increased with what conditions? - AnswerPneumonia Tactile fremitus is decreased with atelectasis & pleurisy because of what? - AnswerSound barrier is created During percussion what is a normal sound over the lung tissue? - AnswerResonate What does hyperresonance mean during lung percussion? - AnswerIncreased air in chest Hyper-resonance is a sign of what conditions? - Answer• emphysema • pneumothorax Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What does dull mean during percussion of the lung field? - AnswerIncreased density What would cause a dull sound during percussion of the lungs? - Answer• Pneumonia • Atelectasis How do you do Diaphragmatic Excursion? - Answer• Pt exhale & hold it • Percuss down back in intercostal margins starting below scapula until sound changes from resonant to dull • Repeat with pt holding inhalation If diaphragmatic excursion is less than 3-5cm, this indicates possible what? - AnswerPneumonia or pneumothorax Tracheal breath sounds duration is what? - AnswerInspiration = expiration Where is tracheal sounds heard? - AnswerOver the trachea What is the duration of tracheal sounds? - AnswerExpiration longer than inspiration Where are bronchial sounds heard? - AnswerOver manubrium What is the duration of of bronchovesicular breath sounds? - AnswerInspiration = expiration Where are bronchovesicular breath sounds heard? - Answer• Between 1st-2nd ribs anteriorly • Between scapulae posteriorly What is the duration of vesicular breath sounds? - AnswerInspiration longer than expiration Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS •Breath Sounds: Crackles (friction rub) With Pneumothorax, what will be heard for percussion, fremitus, & breath sounds? - Answer•Percussion: Hyperresonant •Fremitus: Decreased •Breath sounds: Decreased With pneumonia, what will be heard for percussion, fremitus, & breath sounds? - Answer•Percussion: Dull •Fremitus: Increased •Breath sounds: Egophony, bronchophony, whispered pectoriloquy, crackles Breathe Sounds CHART - Answer Vocal Resonance CHART ** All done with a stethoscope - Answer What is lobar pneumonia? - AnswerConsolidation of the lung What will the patient present with for lobar pneumonia? - AnswerProductive (rusty brown sputum) cough for around 10 days & fever In lobar pneumonia percussion is what?Fremitus? - Answer• Dull • Increased What is seen on film for lobar pneumonia? - Answer• Silhouette sign • air bronchogram Friedlander's pneumonia is caused by what? - AnswerKlebsiella pneumonia Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Friedlander's pneumonia presents with what? - AnswerProductive/currant red jelly sputum Who is Friedlander's pneumonia seen in? - Answer• Old age • immune-compromised hosts Pneumocystis carinii is caused by what? - Answeryeast/fungus Pneumocystis carinii is most commonly seen in what patients? - AnswerAIDs patients Cytomegalovirus is caused by what? - AnswerCMV Cytomegalovirus is most commonly seen in whom? - AnswerAIDs patients Tuberculosis is caused by what? - AnswerMycobacterium tuberculosis With Tuberculosis the patient will present with what? - Answer• Low grade fever • Night sweats • Productive cough (yellow/green sputum) What will be seen on film What will be seen on film for tuberculosis? - AnswerSmall white lesions known as Ghon lesions What is the most definitive test for Tuberculosis? - AnswerSputum culture What is Pleurisy? - AnswerInflammation of the pleura Pleurisy usually produces what? - AnswerExudative pleural effusion What will a patient with pleurisy present with? - Answer• Stabbing chest pain worsened by respiration Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS • Dry/non-productive cough What are clinical findings for pleurisy? - Answer• Decreased respiratory excursion • decreased tactile fremitus • dull on percussion • friction rub is present • (+) Schepelmann's test What is a Pneumothorax? - AnswerRuptured lung causing air to become trapped in the pleural space What are clinical findings for a pneumothorax? - Answer• Decreased chest expansion • Decreased tactile fremitus • Hyperresonant on percussion • Decreased breath sounds Pneumothorax can occur in who? - AnswerYoung previously healthy individuals What is an atelectasis? - AnswerCollapse of the lung that is usually a result of bronchial obstruction due to mucous plug What are the clinical findings for atelectasis? - Answer• Decreased tactile fremitus • Dull percussion • Decreased chest expansion • Decreased or absent breath sounds What is Bronchiectasis? - AnswerIrreversible focal bronchial dilation Bronchiectasis presents with what? - AnswerChronic productive cough Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is seen with someone who has Herpes Zoster? - AnswerPainful rash following the course of a dermatome Herpes Zoster primarily involves what? - AnswerDorsal root ganglion What CN can Herpes Zoster affect? - AnswerCN V What is Sarcoidosis? - AnswerAbnormal collections of chronic of inflammatory cells form as nodules Sarcoidosis most often appear where? - Answer• Lungs • Lymph nodes What population is Sarcoidosis most commonly seen in? - AnswerAfrican american descent What is Hodgkin's? - AnswerCancer of the lymphatic system that can spread to the spleen Who is Hodgkin's most commonly seen in? - AnswerYoung caucasian males Someone with hodgkin's usually presents with what? - Answer• Fever • Night sweats • Weight loss • Intense pruritus (release of IgE) • Enlarged spleen What is the best way to diagnose Hodgkin's? - Answer• Biopsy via Reed Sternberg cells • XRay: unilateral hilar What condition can you see Cystic fibrosis in? - AnswerCOPD Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is Cystic Fibrosis? - AnswerChronic, progressive, & frequently fatal genetic disease of the bodies mucus glands With cystic fibrosis, the glands produce or secrete what? - AnswerSweat &/or mucus Where can the mucus collect in Cystic fibrosis? - AnswerIntestines & lungs What is a sign of cystic fibrosis? - AnswerLoss of excessive amounts of salt (sweat test) What can cystic fibrosis case? - Answer• Pancreatic insufficiency • Meconium ileus Jugular venous pulsations measures what? - AnswerPressure of right side of heart Jugular venous pulsations can be more pronounced in what condition? - AnswerCHF (Congestive Heart Failure) due to applying pressure to the liver (Hepatojugular reflex) What is Pulsus Magnus? - AnswerBounding • Increased cardiac output What can cause Pulsus Magnus? - Answer• Exercise • Anxiety • Fever • Hyperthyroidism What is Pulsus Parvus? - AnswerWeak or thready pulse Pulsus Parvus is seen with what? - Answer•Decreased stroke volume • Hypovolemia Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS • Aortic stenosis • CHF What is Pulsus Alternans? - Answeralternating weak and strong pulses Where is Pulsus Alternans seen? - AnswerLeft ventricular failure What is Pulsus Bisferiens? - Answer2 strong systolic peaks separated by mid-systolic dip Where is Pulsus Bisferiens seen? - Answer• Aortic regurgitation • Aortic stenosis What is Pulsus Paradoxus? - AnswerDecreased amplitude on inspiration, increased on exhalation(>10mmHg change) What is Pulsus Paradoxus seen? - Answer• COPD • Bronchial ASthma • Emphysema • Pericardial effusion What is Water Hammer Pulse? - AnswerA jerky pulse that is rapidly increasing & then collapsing because of aortic insufficiency What are thrills? - AnswerVibration produced by turbulent blood flow w/in the heart (murmurs) What is it called when the ventricles contract? - Answersystole What is it called when the ventricles are filling? - AnswerDiastole Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is Patent Ductus Arteriosus? - AnswerFailure of shunt to close between the aorta & left pulmonary artery A Patent Ductus arteriosus will crease what sound? - AnswerContinuous/machinery like murmur that can be heard in both phases of the heart cycle That is Tetralogy of Fallot? - AnswerDetraposition/overriding of the aorta, right ventricular hypertrophy. interventricular septal defect, & pulmonic stenosis Tetralogy of Fallot creates a loud ejection murmur when? - AnswerDuring systole Tetralogy of Fallot has what physical symptom? - AnswerSevere cyanosis What is Coarctation of the aorta? - AnswerConstriction of the descending aorta that causes a higher blood pressure in the upper extremity by 20 mmHg when compared to lower extremity What is Subclavian Steal Syndrome? - AnswerProximal stenosis of the subclavian artery Who is Subclavian Steal syndrome commonly seen in? - AnswerYounger females who faint while exercising What is the most common cause of left sided heart failure? - AnswerHypertension What is the 2nd most common cause of left-sided heart failure? - AnswerAortic stenosis What are early signs of left-sided heart failure? - AnswerPulmonary edema that causes shortness of breath & orthopnea Where does fluid collect during left-sided heart failure? - AnswerCostophrenic angles Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is the most common cause of right-sided heart failure? - AnswerLeft-sided heart failure What is the most common cause of mitral stenosis? - Answerrheumatic fever (ASO titer) What is Core Pulmonale? - AnswerWhen the ride side of heart fails by itself Right sided heart failure causes blood to back up where? - AnswerSVC & down the IVC RIght sided heart failure leads to what? - Answer• Edema & fluid in extremities • Jugular venous distention • Liver/spleen enlargement • Hepatojugular reflex • Ascites • Caput medusa/spider angiomas • pitting edema • Stasis dermatitis What clinical findings would right-heart failure cause? - Answer• Increased HR • S3 gallop • Decreased blood pressure What is an Aortic dissection? - AnswerInterruption of the intima allowing blood into the vessel wall w/immediate "tearing" pain Aortic dissection should be treated as what? - AnswerSurgical emergency Aortic dissection is associated with what? - Answer• Hypertension/arteriosclerosis • Marfans Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is Marfan's? - AnswerInherited connective tissue disorder w/ventricular weakening & enlargement What would a patient with Marfan's present with? - Answer• Tall • Long fingers/limbs • Lens subluxation • Cardiovascular & lung problems Angina pectoris-coronary vasospasm comes on with what? - AnswerExertion Prinzmetal angina comes on with what? - AnswerRest (typical) Angina Pectoris is relieved by what? - AnswerVasodilators under tongue What is a myocardial infarction (MI)? - AnswerAcute heart attack A myocardial infarction (MI) is caused by what? - AnswerAtherosclerosis What is increased in an myocardial infarction (MI)? - Answer• CK-MB is elevated • ↑ LDH • ↑ SGOT What is an Aneurysm? - Answer• Abnormal widening that involves all 3 layers • defect in elastic-media tissue What is the P-wave? - AnswerNormal arterial depolarization What is the QRS complex? - AnswerVentricular depolarization and atrial repolarization What is the T wave? - Answerventricular repolarization Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS A thiamin deficiency w/o alcoholism is called what? - AnswerBeri Beri With Hepatitis the liver may be what? - AnswerEnlarged but the edge remains soft & smooth Where can you get Hep A? - Answer•Food through fecal/oral route •not a carrier Where can you get Hep B? - Answer• Dirty needles & sexual contact • carrier for life Where do you get Hep C? - AnswerBlood transfusion Which form of Hepatitis will most commonly form lung cancer? - AnswerHep B What is the most common site for metastatic disease? - AnswerLiver What will be characteristics of the liver for liver cancer? - Answer• enlarged • hard • irregular border What is the tumor marker specific for hepatocellular carcinoma? - AnswerAlpha fetoprotein What is used for a definitive diagnosis for hepatocellular carcinoma? - AnswerLiver biopsy Direct bilirubin/conjugated has what characteristics? - AnswerWater soluble Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Direct bilirubin increases with what? - Answer• Obstruction • Hepatic disease • Pancreatic cancer Increased direct bilirubin in the blood may result in what? - AnswerBilirubin in the urine (urobilinogen) What is the characteristic of indirect bilirubin? - AnswerNot water soluble Indirect bilirubin is increased with what? - Answer• Hemolytic disease • Drugs • Spleen disorders Hemolytic anemia has increased count of what? - AnswerReticulocyte count (coombs test) Where does pain refer for gallbladder? - AnswerRight shoulder or tip of right scapula Cholecystitis is most commonly seen in whom? - AnswerOverweight females over 40 What symptoms would the patient have for cholecystitis? - Answer• Right upper quadrant pain • Nausea • Vomiting • Precipitated by eating a large fatty meal What is Porcelain gallbladder? - AnswerCalcification that can become malignant due to chronic inflammation What is the pain described as for pancreatitis? - AnswerEpigastric pain straight through the T10-T12 area like a knife Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Chronic pancreatitis is seen with what? - AnswerAlcoholism What is acute pancreatitis considered? - Answer911 emergency What is Grey turners sign? - AnswerBleeding into the flank What is Cullen's sign? - AnswerPeriumbilical ecchymosis (a discoloration of the skin resulting from bleeding underneath, typically caused by bruising) Cullen's sign is associated with what? - Answer• Intraperitoneal hemorrhage • ruptured ectopic pregnancy What labs will be elevated for pancreatitis? - AnswerAmylase & lipase Where does Pancreatic cancer usually hit? - AnswerHead of pancreas What does the patient with pancreatic cancer usually present with? - Answer• Dark urine • Clay colored stools • Jaundice What is Diabetes mellitus? - AnswerPancreas does not produce a sufficient amount of insulin to take the sugar out of the blood & transport it to the tissues of the body In DM The starved tissues force what? - AnswerThe breakdown of fats in order to obtain energy What signs are seen in someone with DM? - Answer• Polydipsia (increased thirst & need for fluids) • Polyphagia (an increased appetite) Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is Pyloric stenosis? - AnswerProjectile vomiting in a newborn Where is gastric carcinoma most commonly found? - AnswerLesser curvature of stomach Gastric carcinoma most commonly has lymph node involvement where? - AnswerVirchow's Node (Left supraclavicular) Mononucleosis is caused by what?Seen in who? - AnswerEpstein Barr virus- Young adults (18-25 yo) Someone with Mononucleosis will present with what symptoms? - Answer• Fever • Headache • Fatigue • Lymphadenopathy in cervical region • Splenomegaly What will be seen in the blood of someone with Mono? - AnswerAtypical lymphocytes (Downey cells) What happens to the bone marrow of someone with Osteopetrosis? - Answer• becomes sclerotic • RBC's aren't made properly What happens to someone with Osteopetrosis? - AnswerLiver & spleen become enlarged Where do small intestines refer pain? - AnswerPeriumbilical What is another name for Regional Ileitis? - AnswerCrohn's disease (right side of intestines) Crohn's affects what part of the GI? - AnswerDistal ileum & colon Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Someone with Crohn's presents with what symptoms? - Answer• RLQ pain • Chronic diarrhea • Cobblestone appearance on sigmoidoscopy Crohn's leads to malabsorption of what vitamin? - AnswerB12 What can cause Crohn's? - Answer• Non-tropical spruce • Celiac spruce Ulcerative colitis is most common where in the GI? - AnswerColon & rectum A patient with ulcerative colitis will present with what? - AnswerBloody diarrhea How is ulcerative colitis diagnosed? - AnswerSigmoidoscopy What is another name for IBS? - AnswerSpastic colon What is IBS? - AnswerVariable degrees of constipation & diarrhea in response to stress IBS is more common in what sex? - AnswerWomen IBS has what symptoms relieved by what? - AnswerAbdominal pain & gas relieved by BM Someone with an Appendicitis has what type of pain? - AnswerDull periumbilical or epigastric pain that radiates to lower right quadrant (McBurney's point) Someone with an Appendicitis will present with what symptoms? - Answer• Fever • Nausea • Vomiting Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS • anorexia What will be elevated on a CBC for someone with appendicitis? - AnswerWBC What exams can be done for a suspected appendicitis? - Answer• Rebound tenderness • Rovsing's sign • Psoas sign • Obturator sign What special test can be done for an appendicitis? - AnswerCT scan What should be done for someone with an appendicitis? - AnswerRefer to ER Diverticulitis is a consequence of what? - AnswerLack of fiber in the diet Someone with diverticulitis will have what that will cause what? - AnswerChronic constipation that will cause small outpouching within the colon that become infected Where is the pain in someone with diverticulitis? - AnswerLLQ pain What causes Cushing's disease? - AnswerIncreased production of adrenal cortex hormone • Hyperadrenalism • Hypercortisolism What symptoms would someone with Cushing's disease have? - Answer• Moon face • Buffalo hump • Pendulous abdomen w/purple striae • Hirsutism • Weakness Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Urethritis is classified one of what 2 ways? - Answer• Gonococcal • Non-Gonococcal Urethritis is commonly caused by what in females? - AnswerE. Coli What would be seen on a UA for Urethritis? - AnswerNitrites What is Cystitis? - AnswerNoninfectious bladder inflammation that causes burning, painful & frequent urination w/incontinence Where will be patient feel pain with cystitis? - AnswerSuprapubic & low back pain What is Urinary incontinence? - AnswerUrgent need to get to the bathroom What is Overflow urinary incontinence? - AnswerInability to completely empty your bladder when you urinate. As a result, patient has constant or frequent dribble of urine What is Functional urinary incontinence? - AnswerMost common among older adults w/arthritis, Parkinson's or Alzheimer's(disorders that involve moving, thinking, or communicating) What is an Indirect Inguinal Hernia? - AnswerHernia passes down the inguinal canal & exits at the external inguinal ring & into the scrotum • Most common • Seen in Children & young adults What is a Direct Inguinal Hernia? - AnswerDoes not pass through the inguinal canal but exits but exits directly through the external inguinal ring instead. A direct inguinal hernia is usually acquired from what?Seen in whom? - AnswerObesity or heavy lifting • Adults over 40 Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS when does someone with a direct inguinal hernia feel the hernia? - AnswerPatient coughs for bears down A femoral hernia appears how?Felt where? - AnswerA bulge lateral & inferior to the external inguinal ring at the site of the femoral pulse What is Endometriosis? - AnswerAbnormal endometrial tissue found outside its normal location Endometriosis is most commonly found where? - AnswerIn ovaries Someone with endometriosis presents with what symptoms? - Answer• Abdominal pain • Back pain • Menorrhagia • Painful intercourse • Possible infertility What are uterine fibroids? - AnswerBenign uterine tumors of smooth muscle origin Someone with uterine fibroids present with what? - Answer• Heavy menstrual bleeding • Pelvic pain • Painful intercourse What will the uterus have with uterine fibroids? - AnswerPainless nodules that are irregular & firm What is Pelvic inflammatory disease? - AnswerAn infection of the upper female genital tract - includes inflammation of fallopian tubes (salpingitis) Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Pelvic inflammatory disease is the most common complication of what? - AnswerSTD's- Chlamydia or Gonorrhea What is an Ectopic pregnancy? - AnswerPregnancy which implantation occurs outside the endometrium/endometrial cavity What will someone with a normal pregnancy present with? - Answer• Nausea • weight gain • Breast tenderness • Increased HCG What is a Hydatidiform mole? - AnswerA non-viable embryo which develops in the placenta Someone with a Hydatidiform mole presents with what? - Answer• All signs of pregnancy • Very high HCG What is Choriocarcinoma? - AnswerA Malignancy of the placenta due to abnormal epithelium What is Fibrocystic breast disease? - AnswerMultiple round freely moveable masses that can be palpated Fibrocystic breast disease will present with what symptoms? - AnswerBilateral breast tenderness that is made worse w/caffeine intake, ovulation, or menses Fibrocystic Breast disease is common in whom? - AnswerOverweight diabetics What is Fibroadenoma? - AnswerMost common benign breast tumor Who is a Fibroadenoma most commonly seen in? - Answer• <30 yo • Non-tender • Singular lump Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Vein - Warm What would the skin color be for an arterial disease?Venus disease? - AnswerArtery - Pale or blue Vein - Normal or discolored What would the pulse be for an arterial disease?Venus disease? - AnswerArtery - Weak or absent Vein - Normal Would there be numbness present for an arterial disease?Venus disease? - AnswerArtery - Present Vein - Absent Is there swelling present for an arterial disease?Venus disease? - AnswerArtery - Not usually Vein - Present Is Raynaud's Phenomenon present in an arterial disease?Venus disease? - AnswerArtery - Present Vein - absent Is there trophic changes in an arterial disease?Venus disease? - AnswerArtery - Thin skin Vein - Stasis dermatitis Is there valve incompetance in an arterial disease?Venus disease? - AnswerArtery - Not applicable Vein - Present Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is Claudication? - AnswerMuscle pain classically in the calf muscle which occurs during exercise In neurogenic claudication, What is the pattern? How to get relief? Common cause? - AnswerPattern - Not predictable Relief - Position related (seated w/flexion)Common Cause - DJD, Spinal Stenosis In vascular claudication, what is the pattern? How to get relief? Common cause? - AnswerPattern - Predictably reproducible Relief - ALways w/rest Common cause - Arteriosclerosis, Buerger's What is the Claudication Time test? - AnswerPatient walks at a rate of 120 steps/minute for 1 minute (+) = pain in calves = Vascular claudication What is the Bicycle test for claudication? - AnswerPatient pedals fast until painful, rest until painless, repeat (+) = Pain in calves = Vascular claudication What is Buerger's disease? - AnswerThromboangiitis obliterans Inflammatory disease of arteries Buerger's is usually seen in who? - Answer20-40 yo males Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Buerger's is associated with what? - AnswerExcess tobacco smoking The patient with Buerger's will present with what symptoms? - Answer• Intermittent vascular claudication • Non-healing ulcers • Gangrene What test should be done for someone with Buerger's? - AnswerClaudication Time Who is Raynaud's usually seen in? - Answer>15 yo Raynaud's is associated with what? - Answer•Buerger's •Collagen disease •Scleroderma Raynaud's is brought on by what? - Answer• Cold • Stress • Emotions A patient with Raynaud's will present with what? - Answer• arterial spasms • Triphasic color changes • finger tip ulcers • Gangrene • cold sensitivity What test can be done for Raynaud's? - AnswerAllen's test Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is the normal level of RBC's in a CBC? - Answer4-6 million What can cause elevated RBC's? - Answer• Primary polycythemia vera • High altitude What can decreased RBC's cause? - AnswerAnemia What is hemoglobin (Hb)? - AnswerDirect measure of weight of hemoglobin/unit volume of blood What is a normal level of hemoglobin (Hb)? - Answer15 What can cause increased hemoglobin (Hb)? - Answer• Dehydration • Polycythemia vera What can decreased hemoglobin (Hb) cause? - AnswerAnemia What is hematocrit (Hct)? - AnswerPacked cell volume, ratio of the volume of RBC's to that of whole blood What is the normal levels of hematocrit (Hct)? - Answer42 +/- 5 What can cause increased hematocrit (Hct) levels? - Answer• Dehydration • Polycythemia vera What can decreased hematocrit (Hct) cause? - AnswerAnemia What is mean corpuscular volume (MCV)? - AnswerCalculated measure of the size of the average circulating RBC Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is the normal level for mean corpuscular volume (MCV)? - Answer90 What can increased mean corpuscular volume (MCV) cause? - AnswerMacrocytic anemia (>100) What can decreased mean corpuscular volume (MCV) cause? - AnswerMicrocytic anemia (<80) What is mean corpuscular hemoglobin-Hb (MCH)? - AnswerCalculated weight of hemoglobin in the avg. circulating RBC What is the normal level for mean corpuscular hemoglobin-Hb (MCH)? - Answer30 What does increased mean corpuscular hemoglobin-Hb (MCH) cause? - AnswerMacrocytic anemia What is mean corpuscular hb concentration (MCHC)? - AnswerAvg concentration of Hb in a given volume of packed cells What is the normal level for mean corpuscular hb concentration (MCHC)? - Answer33 What does increased levels of mean corpuscular hb concentration (MCHC) cause? - AnswerMacrocytic anemia What does decreased levels of mean corpuscular hb concentration (MCHC) cause? - AnswerMicrocytic anemia What is the normal levels for platelets? - Answer200,000-350,000 What causes increased platelets? - Answer• Polycythemia • Trauma • Blood loss Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What can cause decreased platelets? - Answer• Anemia • Extensive burns • Thrombocytopenia What is a normal level of white blood cell (WBC's)? - Answer5,000-10,000 What can cause increased WBC's? - Answer• Acute infection • Inflammation • Leukemia (over 50,000) What can cause decreased WBC's? - Answer• Overwhelming infection • Viral conditions What are neutrophils associated with? - AnswerBacterial infection 60% What are lymphocytes associated with? - AnswerVirus 30% What are monocytes associated with? - AnswerChronic infection 8% What are Eosinophils associated with? - AnswerAllergies, parasites 2% What are basophils associated with? - AnswerHeparin production/Histamine release 0% WBC differential count: Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS • Biliary duct obstruction • Pseudomonas infection • Bad protein digestion What does Blue urine mean? - Answer• Diuretic therapy • Pseudomonas infection • Bad protein digestion What does Brown urine mean? - AnswerBile pigmentsBlood • Biliary duct obstruction • Occult blood • Homogentisic acid What does Black urine mean? - Answer• Homogentisic acid • Urobilin • Ochronosis • Hemolysis • Bacteria What does it mean if the urine is hazy or cloudy? - Answer• Epithelial cells • WBC's • Crystals • Sperm • Microorganisms What does Milky urine mean? - AnswerWBC's or fat What is the normal pH for urine? - Answer4-8 Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS What is the specific gravity for urine? - Answer1.01-1.03 What causes the specific gravity in urine to increase? - Answer• Bacterial infections • Diabetes mellitus • Kidney abnormalities What is the renal threshold for glucose? - Answer>180 mg Glucose increases in urine due to what? - Answer• DM • Shock • Head injury • Pancreatic disease • Renal tubular disease Should ketones be detected in the urine? - AnswerNo What can cause increased ketones in the urine? - Answer• DM • Starvation • Weight loss diets • Inadequate carbohydrate intake What causes proteins to increase in the urine? - Answer• Kidney disorders • Toxemia of pregnancy • DM • Multiple Myeloma What is the normal urobilinogen levels in the urine? - Answer.1-1 El unit/mL What causes urobilinogen to increase in the urine? - Answer• Hemolytic disease Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS • hepatic disease What causes Urobilinogen to decrease in the urine? - AnswerBiliary obstruction What causes bilirubin to increase in the urine? - Answer• Hepatic disease • Biliary obstruction What causes blood to increase in the urine? - Answer• Tumors • Trauma • Kidney infection • Kidney stones • Hypertension • Bleeding disorders What do hyaline casts in the urine mean? - AnswerNormal What do Epithelial casts in the urine mean? - AnswerTubular damage What does RBC causes in the urine mean? - AnswerGlomerulonephritis What does WBC casts in the urine mean? - AnswerPyelonephritis What do waxy casts in the urine mean? - Answer• Renal failure • Nephrosis Increased Acid Phosphatase (PAP) = - AnswerProstatic carcinoma Reversed Albumin/globulin ratio = - AnswerMultiple Myeloma Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS • polycythemia (+) Fluorescent treponema antibody (FTA) = - AnswerSyphilis Increased blood glucose = - Answer• DM • Cushing's • Renal/liver disease Decreased blood glucose = - Answer• Insulin OD • Addison's • Starvation Decreased glucose in the CSF = - Answer• Meningitis • Acute pyogenic infections Gamma-Glutamyl transferase (GGT) = - Answer• Liver cell dysfunction • Alcohol induced liver disease Glucose tolerance testing is used for what? - AnswerDM testing Glycosylated hemoglobin tests what? - AnswerAbility to utilize glucose over 2-3 month period Increased Heterophile = - Answer• Monoviral meningitis Increased Human Chorionic Gonadotropin (HCG) = - Answer• Hydatidiform mole • Choriocarcinoma • Seminoma • Multiple Pregnancy • Testicular teratoma Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Decreased Human Chorionic Gonadotropin (HCG) = - Answer• Ectopic pregnancy • Threatened abortion Where is HLA-B27 found? - Answer6th chromosome from birth What does HLA-B27 indicate? - Answer• AS • Reiter's • PA • Enteropathic arthritis Increased HDL cholesterol = - AnswerLow risk for coronary heart disease Decreased HDL cholesterol = - AnswerHigh risk of coronary heart disease Increased I-131 uptake = - Answer• Hyperthyroidism • Endemic goiter Decreased I-131 uptake = - Answer• Hypothyroidism • Thyroid cancer M-spike = - AnswerMultiple Myeloma Ketones = - Answer• Diabetic acidosis • Starvation Increased Lactic dehydrogenase (LDH) = - Answer• Myocardial infarction • CHF • Muscular dystrophy Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS Decreased Lactic dehydrogenase (LDH) = - AnswerCancer therapy Increased lipase = - AnswerAcute pancreatitis Increased lipids (cholesterol) = - Answer• Early starvation • DM Decreased lipids (cholesterol) = - Answer•Late starvation •Liver disease Increased Triglycerides = - Answer•Hyperlipidemia •DM •Atherosclerosis Decreased Triglycerides = - Answer•Cirrhosis •Malabsorption LE cell = - AnswerActive systemic Lupus Increased phosphorus = - Answer•Acromegaly •Kidney disease •Hypervitaminosis D Decreased Phosphorus = - Answer•Rickets •Hypovitaminosis D •Hyperparathyroidism Increased protein = - AnswerMMDiabetic acidosis Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS •arthritic/metabolic disorders DEXA scan= - Answerosteoporosis Doppler= - Answerarterial alterations EEG (Electroencephalography)= - Answer•epilespsy •sleep disturbance •encephalopathies EMG (electromyography)- - Answermuscle atrophy endoscopy= - AnswerGI tract Laparoscopy= - Answerabdominal tumor mantoux test= - AnswerTB (also TINE and PPD) MRI (Magnetic Resonance Imaging)= - AnswerSpinal Tumor NCV (Nerve Conduction Velocity)= - AnswerPeripheral nerves PET (Positron Emission Tomography)= - Answer• Bone and soft tissue • tumor • heart • brain SPECT (Single Photon Emission Computed Tomography)= - Answer•Musculoskeletal system • Heart Irene Gold PART 2 HISTORY/GENERAL DIAGNOSIS • Brain • Abdomen Spirometer= - AnswerCOPD Sputum Culture= - Answer• strep • TB Stress Test= - Answer• Atherosclerosis • Angina Tonometer= - Answerglaucoma UltraSound= - Answer•Aneurysm •Organs •Pregnancy Direct/Indirect Bilirubin - Answer COPD vs Emphysema - Answer