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

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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