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Physical Examination 2

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Breasts description
Glandular lobes and ducts, fibrous tissue, fat
Tail, upper outer quadrant, lower outer quadrant, upper inner quadrant, lower inner quadrant
breast examination
redness or other discoloration, thickness, and texture
If nipple inversion present for entire life – probably normal; if a new change in direction, probably cancerous
First arm movement – arms above head
Second arm movement – hands on hips
Leaning forward
three depths, three fingers, circular motion, three minutes per breast
don’t forget to look from the sides
Can have up to 6 extra nipples
Glands of Montgomery
on areola – secrete lubrication to prevent fissures
breast cancer signs
Dimpling-cancer wrapped up around ligament and when patient moves, it pulls on ligament
cancer can cause hormonal changes within the breast (hair, aerola, skin)
Peau D’ Orange-latent sign of cancer
seborrheic keratoses
usually seen in women After 40
probably normal, sometimes not
hyperpigmentation on areola
breast cancer rates
1 in 8 women get breast cancer – comes from point prevalence in 80 year old women
Among 20 year olds – more like 1 in 1000s
intraductal carcinoma
Light shining back from nipple – may be thick and hard
Paget’s disease
larger, irregular shaped areola
Lymph flow in breast
pectoral, sub-scapular, and lateral goes into central axillary – then to infraclavicular and then to supraclavicular
Lymph nodes – note size, shape, consistency, mobility, tenderness
gynecomastia
Klinefelter’s and liver disease
obesity, steroids, marijuana use, hormone use
epitrochlear node
in inner part of elbow
darkening of skin under armpit (or velvety fluffy brown on neck)
insulin resistance
if not diabetic, may be because of a GI malignancy
lichenification
thickening under breast due to yeast infections
Abdominal exam order
position, exposure, inspection, auscultation, percuss, palpation {ask about tenderness prior to palpation
lightly (4 quadrants)
deeply (4 quadrants)
liver
spleen (supine & right lateral position)
kidneys
tests for rebound tenderness ?
Inguinal nodes
femoral pulses}
Hodgkin’s lymphoma
mass between shoulder and breast
Referred pain
Upper right shoulder –
Upper left shoulder –
Red under left arm –
Back –
U shape – on left only –
on right side –
on both sides –
Kidneys stones-
Black circle –
Long li
Referred pain
Upper right shoulder – gall bladder
Upper left shoulder – something under diaphragm
Red under left arm – heart
Back – pancreas
U shape – on left only – diverticulitis, on right side – appendicitis (starts at navel); on both sides – kidneys and ureters
Kidneys stones – patients do not sit still, pain in back
Black circle – bladder
Long line down middle – aortic
number 1 cause of bowel obstructions
past surgeries, adhesions
Striae
-stretch marks from excessive weight gain with rapid loss
Prominent bulge when patient raises head
Diastasis recti
normal variation; (there is a solid fascia band there⬦ just differences in fasica, rectus abdominus, and linea alba)
Caput Medusa
enlarged twisting veinous plexus – advanced liver disease due to portal hypertension
Esophageal varicies
throwing up a lot of bright red blood
Murphy’s sign
tender when they take a deep breath, when palpating right side, they usually stop breathing in – gallbladder disease
Costovertebral angle tenderness
Tenderness on back punch – kidney problems, urethral problems
Varicoceles
bag of worms
If on left – not necessarily a vascular problem
If on right – vena cava problems
Testicular cancer
15 to 35 years old
Undescended testicles – higher rates of carcinoma
transillumination
to see if it’s a hydrocele – light goes through fluid, not a mass
phymosis
paraphymosis
phymosis – inability to retract the foreskin – prevents adequate exam
paraphymosis – retract skin back, but then it gets stuck, end of penis will get swollen
Peyronie’s disease
crooked, sometimes painful, erections
Palpable plaque or induration curvature of penis; Acquired benign condition
Condyloma
wart – HPV
Testicular torsion
blood supply is cut off – emergency
Balanitis
Clear discharge
Milky discharge
Candidasis
Balanitis – inflammation of the glans
Clear discharge – Chlamydia
Milky discharge – gonorrhea
Candidasis – lots of red lesions; diabetes, high moisture conditions
Anal-Rectal examination
Inspect, Palpate (Tone, Prostate, Masses, Stool), Guiac
Pilondial Cyst
incomplete closure of anus
Prostatitis
difficulty going to bathroom, fever – don’t want to do a lot of palpation in this case
indications for rectal exam
do on males over 40, any abdominal pain
Benign prostatic hypertrophy rates
– 50% >60 and 90% >80)
parous
term used to describe cervix after a women has a baby
tenderness palpating ovaries during bimanual exam
PID, pregnancy
rectocele
cystocele
rectocele (uterus prolapsing)
cystocele (bladder prolapsing into vagina)
nullparous
cervix description when there have been no vaginal deliveries
candida
pruritis, pH 4-5, thick curdy discharge, hypahe present
trichomonas
discharge is thin and copious, pH 5-7, protozoa present, strawberry cervix
Bacterial Vaginosa
odor, pH 4-6, scant discharge, clue cells present
chromosomal abnormality
subdural hematoma
Microcephaly –
Macrocephaly –
measuring pediatric heights and head circumference
Head circumference – measure at every exam for first 2 years, plot on chart
Height – supine length measure up to 2-3 years old; erect height for 2-18 year olds, plot on chart
pediatric respitory rates
Newborns 30-80
Early childhood 20-40
Late childhood 15-25
temperature in pediatrics
Rectal most accurate
Fever >100 in infants – sepsis
fontanelles
Anterior fontanelle closes at 4-26 months
Posterior fontanelle closes by 2 months
Bulging – increased intracranial pressure
Depressed – dehydration
Plagiocephaly
asymmetric craniostenosis due to premature closure of lamboid or coronal sutures
Pectus carinatum
pectus excavatum
Pectus carinatum (pigeon chest); pectus excavatum (funnel chest)
eye sight in pediatrics
Birth – blinks
1 month – fixes on objects
3 months – eyes converge
12 months – 20/50
ears and hearing in pediatrics
To look in ear, pull pinna downward
Draw line from where eye makes a point to the ear – should see about 1/3 of ear above the line
Hearing – birth-4months – startle reflex, 4 – widen eyes to sound, 6 – turns head to sound
Innocent murmurs
loudest at LSB, 2nd and 3rd interspaces
40% of kids have a heart murmur
Location: Loudest LSB, 2nd, 3rd ICS
Radiation: Localized
Timing: Midsystolic usually
Duration: Usually short
Intensity: Grade 2/6 usually
Quality: Soft
Other: Rest of CV/Resp exam normal
Still’s murmur
most common, 2-adolescence, dimishes with sitting, standing, valsalva
Venous hum
common after 3, turbulence in subclavian and jugular veins, disappears if supine
Congenital Hip Dysplasia
Increased risk in first-born females, breech birth, or family history of DDH
Ortolani test – abduct external rotation – palpable click – test for posteriorly dislocated hip
Barlow test
adduct, internal rotation – femur slips – dislocate an intact but unstable hip
Primitive Reflexes
Placing/stepping – birth – 1-2 months
Moro – birth – 3 month (cradle the baby’s head, bring them down, hyperextend the neck (as if they were falling) – they will flail their arms – should be symmetrical on both sides
Grasp – birth – 3 months
Tonic neck reflex – 1-4 months - turn their head to one side – they will extend the arm on that side and bring the other one up (like a fencer)
signs of a child who has severe allergies
– allergic shiners (blue under eyes), Dennie’s lines (creases under lower eyelids), nasal pleat (allergic salute)
most common in Kesselbach’s plexus
Nosebleeds
Grading tonsilis
4+ – kissing tonsils
3+ – close to edge of uvula
2+ -regressed
1+ -barely peaking out
Scoliosis
lateral curvature of spine, onset after 9-10, 80% idiopathic, 20-40 degrees – brace
40+ degrees - surgery
Tinea versicolor
light hypopigmented macules (topical fungal infections)
Tinea corporis
ringworm
Dupuytren’s contracture
- pinky or ring finger contracted up – mainly in males of northern European descent – underneath there is a spider web-like mesh of tissue covering the nerve
loss of extension, flexion, and abduction
Rheumatoid arthritis
atrophy of interosseous muscles on hand, alignment not normal
outer three fingers pointed out – ulnar deviated; swelling, deformities; scaly skin; vertical lines down middle of nails
Beau’s lines
nail stops growing when you get really sick, when you recover it starts growing again – horizontal lines
Raynaud’s
very pale painful skin – cold and stress causes the circulation to shut down, different colors on palms of hand
very painful in cold weather, digits can auto amputate
Anatomic snuffbox
extensor pollicis longus tendon above and extensor pollicis brevis tendon below
Scaphoid fracture (navicular bone)
tender on palpation of anatomical snuffbox
Scapular winging
Can have them do a push up against the wall. , a child with no trauma-is viral, presence of laxity is a torn tendon, SALT
motions of the shoulder
Flexion – arms straight up
Extension – arms back
Abduction – away from body, over head
Adduction – cross in front of body
Internal rotation – elbows bent – arms up
External rotation – elbows bent, arms down
measure leg length
Medial malleus to anterior superior iliac spine
Trochanteric bursitis
side of hip hurts
Knee muscles
Above - Vastus medialis and vastus lateralis
Sides - medial patellar retinaculum and lateral patellar retinaculum
Baker’s cyst
Feel in popliteal fossa (behind knee) for swelling
Genu recorbotum
knee curves backward – more than 0 degrees
Ligamentous laxity
can stretch knee farther than “normal”
Marfan’s syndrome
very tall, ligamentous laxity, narrow teeth, elastic aorta
Injury to posterior cruciate ligament
could cause knee to sag backwards
Posterior tibial tendon dysfunction
one heel would go in, one would not
Hallux valgus
bunions
spinal curvatures
Cervical lordosis
Thoracic kyphosis
Lumbar lordosis
pullman’s test
dorsiflex foot, causes pain – if clot is in calf, not if in thigh
eye movement Nerves
II. Optic – visual acuity, visual fields, papillary response to light (afferent pathway)
III. Occulomotor – superior rectus (moves eye up), inferior rectus (moves eye down), medial rectus (moves eye medial), inferior oblique (moves eye up)
IV. Trochlear – superior oblique (moves eye down)

VI. Abducens – lateral rectus (moves eye laterally)
VII. Facial – raise eyebrows, frown, close eyes, close mouth, pucker, taste on anterior 2/3 tongue
III, IV, V – Extraocular muscle control, papillary reaction, eye position
Abnormal or Asymmetric Pupils – II and III – optic and occulomotor work together to control papillary constriction and dilation
cranial nerve names and functions
I. Olfactory – not brainstem, smell, test each nostril separately
II. Optic – visual acuity, visual fields, papillary response to light (afferent pathway)
III. Occulomotor – superior rectus (moves eye up), inferior rectus (moves eye down), medial rectus (moves eye medial), inferior oblique (moves eye up)
IV. Trochlear – superior oblique (moves eye down)
V. Trigeminal – motor: muscles of mastication – palpate temporal and masseter muscles
sensory: V1 opthalmic, V2 maxillary, V3 mandibular
VI. Abducens – lateral rectus (moves eye laterally)
VII. Facial – raise eyebrows, frown, close eyes, close mouth, pucker, taste on anterior 2/3 tongue, bells palsy; asymmetry of lower face only
VIII. Acoustic – auditory acuity, weber and rinne, balance vestibular division
IX. Glossopharyngeal – motor: pharynx sensory: ear canal, taste posterior 1/3 tongue
X. Vagus – palate elevation (say “ah”), dysphagia, slurred speech, hoarse, gag reflex on comatose patients
XI. Spinal accessory – sternomastoid and trapezius (shrug)
XII. Hypoglossal – tongue deviation during protrusion (points to affected side)
pediatric sight milestones
In children
Age 3 20/50
Age 4 20/40
Age 5 20/30
Age 6 20/20
Vagus
– increased parasympathetic stimulation to the heart
Horner’s syndrome
sympathetic pathway, ptosis, miosis – small pupil reacts to light, anhidrosis
(40% idiopathic, 13% tumor, 12% cluster headaches, 10% iatrogenic)
Levels of Consciousness
• Alert – normal response to verbal questions
• Lethargic – drowsy, responds to raised voice
• Obtunded – appears asleep, responds slowly after shaking
• Stuporous – appears asleep, responds to painful stimuli only
• Comatose – unarousable, does not respond
Romberg Test
stand with eyes open, then closed
Pronator Drift
arms up, eyes closed, tap fingertips gently
Positive sign is most likely a sign of stoke
Tandem gait
heel-to-toe – requires good sense of balance
Circumducted gait-result of a stroke
Shuffle-Parkinson’s Disease
Muscle Strength graded
0/5 no muscle movement
1/5 visible muscle movement, no movement at joint
2/5 movement at joint, but not against gravity
3/5 movement against gravity, but not against resistance
4/5 movement against resistance, but less than normal
5/5 normal strength
Reflexes grading
0 absent
1+ hypoactive
2+ normal
3+ hyperactive
4+ hyperactive with clonus
Plantar response (Babinski sign)
to assess upper motor neuron lesions
Incorrect to say that a patient has a “normal” or “down-going Babinski”… if normal simply state the plantar reflex is normal or that the toes are down going
Point-to-point movements (coordination)
their finger to your finger and then to their nose
Position sense
proprioception on big toe – bilaterally with eyes closed
Graphesthesia
draw number on hand
Stereognosis
object recognition
CN I
olfactory
test smell in each nostril
CN II
optic
test visual fields, acuity, pupil responses to light
CN III
occulomotor
pupillary size and reaction to light, direct and consensual (with help from CN II)
Occulomotor-moving eyes
CN IV
Trochlear
CN V
trigeminal
test jaw clenching and temporalis and masseter strength, also test V1, V2, and V3
CN VI
Abducens
lateral rectus (moves eye laterally)
CN VII
Facial
test by having patient close eyes, smile, and pucker lips
CN VIII
acoustic
test with Weber and Rinne
CN IX
glossopharyngeal
CN X
vagus
parasympathetic response, abrupt flow to slow down heart rate, typically will yawn right before you pass out
CN XI
spinal accessory
test strength of trapezius and sternomastoid muscles
CN XII
hypoglossal
test by having patient protrude tongue and move side to side
C5 and C6 test
bicep and brachioradialis reflexes nerve numbers
C6 and C7 test
tricep reflexes
L2-L4 test
patellar reflexes nerve numbers
S1 test
achilles reflexes
Clonus test
push it up and foot flaps-normal 1 or 2 flaps, positive could be a sign of MS
Posterior column is associated with what senses
Proprioception
Moving toe up/down
Vibration
Fine touch (paper clip
spinothoracic is associated with what senses
Pain
Temp
Crude Touch
Monofilament test
for diabetic test, should feel when the filament breaks
Fluid extravasation
infusing fluid into arm and not vein with IV’s
Ulnar problems
have weakness in the hand
Radiculapathy
when the sciatic pain goes to foot
Vastus medialis obliquous (VMO)
on stairs and is in front of knee due to weak VMO, brace, rest, and must strengthen VMO by doing straight leg raises w/ external rotation
Positive Trendelenberg sign
gluteus maximus weakness, lift leg and is hip drops
hip pain
Almost all hip pain will be anterior and radiate into the knee, opterator nerve,
Internal rotation is tender is bad
pediatrics will complain about knee pain although the problem is hip
Sciatica
inflammation of the sciatic nerve, common with guys and thick wallets who sit on it
Ecchymosis around toes
can be a sign of an ankle injury in which they have not elevated the foot and gravity has pooled the blood
Loss of boney landmarks is due to significant amount of fluid
Anterior talo fibular
main tendon involved in most ankle sprains with rolling of ankle sprains
Eccymosis and tenderness around maleolus
could be torn deltoid ligament or fracture, need xray
ankle sprain grades
Grade 2-limping
Grade 3-eccymosis lateral and medial
Pes planus
flat footed, no arch
Plantar warts
under metatarsal heads-calcuses has formed, can be from wearing high heels-get xray
morton’s nuroma
tenderness between 3 and 4th interspace of metatarsal head
developmental milestone at 8 months
pincher grasp, pick up things, fine motor skills
Autism
is a common diagnosis in children today
parents complain child never smiles, doesn’t hear, no responses
Is very key to catch early and repair or make adjustments
lactating when not pregnant
-Psychotropic drugs
-adenoid tumor
-over-stimulation from sexual activity
Linea Nigra
line down mid line of abdomen (normal
Prostate Carcinoma rates
(29% of male CA)
considerations before a pelvic
LMP
⬢ Pregnancy
⬢ Bladder Fullness
⬢ Prior Surgery
⬢ Prior Exam Results
⬢ Psychological Trauma
⬢ Environment
when to palpate Bartholin’s
if infection is suspected
patient unable to make fist
possible CVA or arthritis
upper and lower face Asymmetry
Bell's Palsy
Asymmetry
Lower face
Central lesion -
Brain- involving
only part of the
face
Hoarse Voice-nerve affected
X-vagus
Articulation
Problems-nerves affected
(V, VII, X, XII)
tongue deviations
point to affected side
uvula deviations
point to unaffected side
Bilateral small pinpoint pupils
⬢ Hypothalamic injury
⬢ Metabolic encephalopathy
⬢ Hemorrhage in the pons
⬢ Morphine Heroin Narcotics
⬢ Chemical exposure-nerve agent
screening test used for developmental milestones for pedis
Denver Developmental Screening Test
retinopathy
If visual acuity is off, do pinhole test, which takes out refractive error. If pinhole test is also positive, patient could have...
head injury
projectile vomiting, blown pupil-suspect acute bleed
Anyone with head trauma needs a cranial nerve evaluation
Trauma involving tip of the nose, must worry about blindness
Brain Tumor
papilloedema, visual deficits, reflex changes (babinski’s sign-adult should have toes go down, but if the toes go out in a dorsal flexion-upper motor neuron lesion)
Headaches-later sign of brain tumor and will usually have other symptoms before the headaches (rarely will have normal neuron exam, but look for a change in HA symptoms/severity)
Patient with large reactive pupils
hole in septum
cocaine use
diabetic
Monofilament test for diabetic test, should feel when the filament breaks
Pupils symmetrical, eye points down and out
testicular exam
Palpate testicles, then follow cords up and have patient cough
Look posteriorly and move testicles to each side to see
palpate inguinal area for lymph nodes
most common hernia in males
indirect inguinal hernia
Vitiliga
loss of pigmentation
(michael jackson)
Anal Rectal exam
Inspection:
Tone for history of incontinence
Back pain in elderly is assoc with rectal cancer and must do rectal exam
Palpate for masses
Guiac the stool in the vault
Perirectal Abscess
emergency, any erythema that extends down to rectum, cant always differentiate between cellulitis and this abscess, bowel fluid is leaking out and can go septic really rapidly, do not let patient leave, immediately have patient go to ER and be evaluated by surgeon
Rectal Prolapse
really bright pink, fleshy, bubble looking, mucosal tissue on outside of anus, rectal tissue coming through anus
Rectal Neoplasm
flesh colored, large mass, irregular borders, pigmented, punduncles-often though by the patient that they have hemorrhoids
Digit exam
Preferred position – lying on side, bottom leg straight, top bent (lateral decubitus position)
Touch anus, don’t stick finger in…. looking for the “anal wink”, have patient bear down which allows sphincter to relax in order for you to put your finger in, assure them that they will not have a BM
Lubricate
Gently insert finger but do not fight sphincter because you can tear something including your glove
Do this for anyone with a possible spinal cord injury or transient paralysis
Feel all the way around
Then feel the prostate – with flexed DIP joint; should feel firm; should feel a sulcus (canal) in the middle of the prostate
If it feels swollen or like a water balloon, could be enlarged, feel for nodules
Do hemocult test – if it turns blue, positive – hemolyzed blood in stool
Paniculus
extra adipose tissue that is like an apron and can be difficult to do pelvic exam
Adnexa
from the sides of the uterus - ovaries and fallopian tubes
pelvic exam
Tell the patient you are going to examine….you may feel pressure and a little discomfort
Look for hair distribution and spread for lice
Palpate lymphnodes

Spread the labia
Stay away from the clitoris
Do not milk urethra unless indicated
Palpate for the bartholins gland, checking for infection and swelling
C position of hand over speculum – very good
Go in at angle, then turn
Push down on PC muscle as you insert
If someone is very large, may have a lot of folds to make examination difficult, use a condom to hold side walls back
Lack of rugeations is lack of estrogen and thin lining, common in elderly
Cervix should be shiny, moist
Swab test to see what color discharge is
Clear or yellow
Pap smear:
Spatula – run it around on the surface
Brush – insert into os slightly
bi-manual exam:
– feel about what size the fundus is if you can
-if it hurts to move the cervix around – possibility of ascending PID, pregnancy
Cervical motion tenderness with pain on palpation
If patient comes off the table with palpation-chandalier sign-PID
-will feel soft like a hard boiled egg, very small, will not always feel in larger abdomen, if you feel in a larger person, its swollen
Spread the anus for visual inspection:
rectal vaginal exam – to look at strength of vaginal wall
delayed or precocious puberty, hypogonadism
virilism
truncal fat with thin limbs
Cushing's Syndrome
fever or pyrexia
extreme elevation in temp above 106F
hypothermia
abnormally low temp below 95F
carotenemia
high levels of carotene yellow color in palms, soles, and face
causes for central cyanosis
adv lung disease, cong heart disease, abn Hbg
Herpes Zoster
vesicles in a unilateral dermatomal pattern
sparse/coarse hair texture vs. silky fine hair texture
hypothyroidism vs. hyperthyroidism
macule
flat, small <1 cm,
i.e. freckle, petechia
papule
skin elevated solid mass < .5 cm
patch
flat and is larger than a macule >1 cm
nodule
skin elevation > 1 cm

a very large nodule is a tumor
wheal
irregular borders, usually red, and usually hives
vesicle
up to .5 cm raised, fluid filled, blister looking

i.e. herpes
bulla
> .5 cm fluid filled raised, bubble looking, usually result of a burn
pustule
elevated filled with pus

i.e. acne, impetigo
primary lesions
macule, papule, pustule, patch, plaque, tumor, wheal, vesicle, bulla
secondary lesions

(result of changes to 1 lesion)
erosion, ulcer, fissure, scale, crust
erosion
loss of superficial epidermis, moist, no bleeding

i.e. after popping blister
ulcer
deeper loss of skin surface, may bleed and scar

i.e. syphillis chancre
fissure
linear crack in skin

i.e. athletes foot
crust
dried residue usually serum, pus, blood

i.e. honey colored in impetigo
scale
thin flaky exfoliated skin surface

i.e. dandruff, psoriasis
plaque
elevated > .5 cm

(macule is to patch as papule is to plaque)
cafe-au-lait spots
uniformly slightly pigmented spots with irregular borders (macules and patches), fairly benign unless there are 6 or more >1.5 cm (neurofibromatosis)
spider angioma
red spider like spot (looks like broken vessels) can be liver disease, pregnancy, vit B def and also can be normal
spider vein
bluish vein most often on legs, can be varicose veins
cherry angioma
little ruby red spots usually on trunk, usually with aging
petechia/purpura
deep red to purple means blood outside the vessels and can be a blood disorder
kaposi's sarcoma
malignant tumor usually with AIDS and can be anywhere in several forms, pigmented, usually purple on palate in mouth
hirsutism
excessive facial hair in women
myopia
impaired far vision
presbyopia
impaired near vision usually found in older people
Legal blindness
20/200
visual field defects on R side of both eyes
homonymous hemianopsia
visual field defects on r side of one eye and the L side of the other
bitemporal hemianopsia
enlarged blind spots
glaucoma, optic neuritis, papilledema
abnormal protrusion of the eyes
Grave's Disease
cresent shadow on iris with shining of light
increased risk for glaucoma
miosis
constriction of pupils
mydriasis
dilation of pupils
nystagmus
seen in many neurological conditions
absence of the red reflex
cataract, detached retina, artifical eye, retinoblastoma
enlarged physiological cup
glaucoma
an important cause of central vision loss
macular degeneration
exostoses
nontender nodule swellings covered by normal skin in ear canals, can obscure drum but is benign
red bulging ear drum
acute otitis media
may decrease motility
amber looking ear drum
serous effusion
may decrease motility
usually caused by upper respitory viral infection
unusually prominent short process and prominent handle that looks more horizontal
retracted ear drum
in unilateral conductive hearing loss (weber test)
sound is lateralized to the impaired ear because sound is heard through the bone longer than air
in unlateral sensorineural hearing loss (rinne test)
sound is heard in the good ear because sound is heard longer through air
torus palatinus
midline lump on palate, normal in some
tracheal deviation
mediastinal mass, atelectasis, pneumothorax
marcus gunn pupil
pupil responds less vigorously and then dilates while the other responds to light normally/optic nerve damage
xanthelasma
raised yellowish plaques in the skin near eyes along nasal portions usually due to high cholesterol
angioedema
bottom lip swollen, very red, nonpitting, develops rapidly, usually as a result of an allergy
clubbing of the nails
long sustained hypoxia or lung cancer
APGAR scoring
assesses the infant's immediate adaptation to extrauterine life by making 5 observations and assigning a score of 0, 1, or 2, the total score can be 0-10
at 1 minute APGAR, a score 7 or less indicates...
4 or less....
nervous system depression
severe depression needing resuscitation
nerves that attach to spinal cord
31 pairs
8 cervical, 12 thoracic, 5 lumbar, 5 saccral, 1 coccygeal
What is the name for a folded false synovial membrane in the knee
Medial plica
proper sequence for lung examination
Inspect, palpate, percuss, ascultate
What muscles help to control the mitral valve
Papillary
What is the most vascular structure in the femoral triangle
Femoral artery
What will accentuate a mitral valve prolapse, other than the left lateral decubitus position
Val Salva
What murmur occurs between S1 & S2 with no gap
Pansystolic/holosystolic
What condition will give papillary involvement in CN III abnormality
Pressure from aneurysm or tumor
What causes S1 sound
Closure of mitral and tricuspid valves (AV valve closure)
What artery divides into the pedis and tibial
Popliteal
What causes displacement of PMI
Pregnancy, cardiomegaly, CHF
red streaks up an extremity is a sign of infection and is called
Lymphangitis
What is the normal range from an oral temp in Celsius
35.8 to 37.3
Mobile, non-tender mass in a woman age 15 – 20
Fibroadenoma
Intense urge to have a bowel movement
Tenesmus
Blue feet and nail beds 30 min. after birth
Acrocyanosis
Condition associated with acanthosis nigricans-velvety skin in axilla
occult cancer
Most common cause of rapid recent weight loss in child
fluid loss / fluid shifts
Ethnic group with lowest risk of breast cancer
Asian
BMI range for overweight
25 – 29.9
Grey or lightly colored stool
acholic (without bile)
components of APGAR score
Heart rate greater than 100; Respiration; muscle tone; color (pink)
Most common cause of nonpuerperal galactorrhea
Hormonal changes and drugs
pituitary tumor
Large yellow or grey greasy stool
Steatorrhea.
Thin pencil-like stool
apple core tumor of sigmoid colon
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