Physical Dx. Exam 1
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- rapid changes in weight (over a few days) suggests:
- - changes in body fluids...not tissue
- causes of weight loss include:
-
- GI dz
- endocrine disorders(DM, hyperthyroidism, adrenal insufficienc)
- chronic infx
- malignancy
- chronic cardiac, pulmonary or renal failure
- depression
- anorexia nervosa or bulimia - weight loss with relatively high fluid intake suggests:
-
- DM
- hyperthyroidism
- malabsorption
- consider bulimia w/vomiting - poverty, old age, social isolation, physical disability, emotional or mental impairment, lack of teeth, ill-fitting dentures, alcoholism, drug abuse increase likelihood of:
- - malnutrition
- fatigue is a common symptom of ____ & ____ but also consider ______ (many)
-
- depression and anxiety states
- infx, endocrine disorderes, heart failure, chronic dz of lung, kidney, liver, electrolyte imbalance, moderate to severe anemia, malignancies, nutritional deficits, meds. - weakness may suggest possible:
- - neuropathy or myopathy
- recurrent shaking chills suggest:
- - more extreme swings in temp and systemic bacteremia
- feelings of heat and sweating, night sweats
-
- menopause
- TB
- malignancy - words to describe apparent state of health:
-
- acutely or chronically ill
- frail
- feeble
- robust
- vigorous - signs or cardiac or respiratory stress
-
- clutching chest
- pallor
- diaphoresis
- labored breathing
- wheezing
- cough - signs of pain
-
- wincing
- sweating
- protectiveness of painful area - signs of anxiety and depression
-
- anxious face
- fidgety movements
- cold moist palms
- inexpressive or flat affect
- poor eye contact - very short stature seen in:
-
- Turner's Syndrome
- childhood renal failure
- achondroplastic and hypopituitary dwarfism - long limbs seen in:
-
- hypogonadism
- Maran's Syndrome - generalized fat is seen in:
- - simple obesity
- truncal fat w/relatively thin limbs
-
- Cushing's Syndrome
- Syndrome X - ways to describe skin color:
-
- pallor
- cyanosis
- jaundice
- rashes
- bruises - excess clothing
-
- cold intolerance of hypothyroidism
- hide skin rash or needle marks
- signal personal lifestyle preferences - cut-out holes or slippers may indicate:
-
- gout
- bunions
- other painful foot condition - untied slippers
- - may suggest edema
- copper bracelets are sometimes worn for:
- - arthritis
- facial expressions
-
- stare of hyperthyroidism
- immobile face of parkinsonism
- flat or sad affect of depression - odors of body and breath
- - breath odors of alcohol, acetone(diabetes), pulmonary infx., uremia or liver failure
- postural preference in left-sided heart failure
- - sitting up
- postural preference in COPD
- - leaning forward w/arms braced
-
a) activity of hyperthyroidism
b) activity of hypothyroidism -
a) fast, frequent movements
b) slowed activity - BP cuffs that are too short, too narrow, too loose
- - falsely high readings
- BP will be falsely high if:
-
- brachial artery is much below heart level
- pt. own effort to support the arm - auscultatory gap
-
- unrecognized may lead to serious underestimation of systolic pressure or overestimation of diastolic pressure
- record any gap as 200/98 w/ausc. gap from 170-150 - T/F: in aortic regurgitation, the hearts sounds never disappear in BP readings
- - True
- irregular rhythms
-
- A-fib
- PVCs, PACs - palpation of an irregularly irregular rhythm reliably indicates:
- - A-fib
- prolonged expiration suggests:
- - narrowing in the bronchioles
-
a) fever/pyrexia
b) hyperpyrexia
c) hypothermia -
a) elevated body temp.
b) extreme elevation of temp. (106)
c) abnormally low temp (<95)(conducted rectally) - pressure differences of >10-15mmHg suggests:
- - arterial compression or obstruction on the side with the lower pressure
- a fall in systolic pressure of 20mmHg or more, esp. when accompanied by symptoms, indicates:
- - orthostatic (postural) hypotension
- causes of orthostatic (postural) hypotension
- - drugs, loss of blood, prolonged bed rest, diseases of the ANS
- assessment of HTN also includes its effects on:
- - target organs
- a femoral pulse that is smaller and later than the radial pulse suggests:
- - coarctation of the aorta or occlusive aortic dz
- Systolic BP is usually lower in the legs or arms?
- - arms
- ____ temps are more reliable when pt. has rapid respiratory rates
- - rectal
- causes of generalized itching w/o obvious reason include:
- - dry skin, aging, pregnancy, uremia, jaundice, lymphomas, leukemia, drug rxn, lice
- "marked facial pallor w/circumoral cyanosis, palms cold and moist, cyanosis in nailbeds of fingers and toes" suggests:
- - central cyanosis
- "facial plethora, skin icteric, spider angioma over anterior torso, single pearly papule w/depressed center and telaniectasia, nails w/clubbing but no cyanosis" suggests:
- - possible liver disease and basal cell carcinoma
- pallor due to decreased redness is seen in:
-
- anemia
- decreased blood flow, as in fainting or arterial insufficiency - causes of central cyanosis:
-
- advanced lung dz
- congenital heart dz
- abnormal hemoglobins
- pulmonary edema - cyanosis in CHF is usually:
- - peripheral
- jaundice suggests:
-
- liver dz
- excessive hemolysis of RBCs - yellow color accompanying high levels of carotene:
- - carotenemia
- moisture changes may be caused by:
-
- dryness in hypothyroidism
- oiliness in acne - temperature changes may be caused by:
-
- generalized warmth in fever
- hyperthyroidism
- coolness in hypothyroidism
- local warmth of inflammation or cellulitis - roughness of skn may be seen in ____.
- - hyperthyroidism
- decreased mobility of skin may occur in:
-
- edema
- scleroderma - decreased turgor of skin is the result of:
- - dehydration
-
normal distributions of skin disease:
a) acne affects...
b) psoriasis affects...
c) candida infx. affects... -
a) face, upper chest, back
b) knees and elbows
c) intertriginous areas - vesicles in a unilateral dermatoral pattern are typical of:
- - herpes zoster
- alopecia
- - hair loss (diffuse, patchy or total)
-
a) sparse hair is seen in ___.
b) fine, silky hair is seen in ___. -
a) hypothyroidism
b) hyperthyroidism - most common kinds of recurring headaches
- - tension and migraine
- tension headaches often arise in the ______ area.
- - temporal
- cluster headaches often arise in the ____ area.
- - retro-orbital
- intolerance for cold, preference for warm clothing and dec'd sweating suggest:
- - hypothyroidism
- palpations, involuntary weight loss suggest:
- - hyperthyroidism
- affects of hypothyroidism on hair
- - coarse hair
- affects of hyperthyroidism on hair
- - fine hair
- tiny white ovoid granules that adhere to hair may be:
- - nits or eggs of lice
- redness and scaling
-
- seborrheic dermatitis
- psoriasis
- pillar cysts (wens) - enlarged skull
-
- hydroencephalus
- Paget's Dz of bone - vision of 20/20 means:
- - at 20ft. the pt. can read print that a person with NL vision can read at 200ft
- visual acuity: the larger the second number...
- - the worse the vision
- 20/40 corrected means:
- - pt. can read 30 line with glasses
- myopia
- - impaired vision
- presbyopia
-
- impaired near vision, found in middle aged and older people
- near vision is often compromised - legally blind in the U.S.
- - when vision in the better eye, corrected by glasses, is 20/200 or less
- field defects that are all or partly temporal include:
- - homonymous hemianospia
- when pts. left eye repeatedly does not see your finger until they have crossed the line of gaze, a ____ is present.
- - left temporal hemianopsia
- enlarged blind spot occurs in conditions affecting the ____.
-
- optic nerve
- glaucoma, optic neuritis, papilledema - position and alignment of the eyes is described in regards to:
- - inward and outward deviation of the eyes
- abnormal protrustion of the eyes is seen in:
-
- Grave's dz
- ocular tumors - scaliness in seborrheic dermatitis may be seen when inspecting:
- - eyebrows
- inflammation of the eyelids along the lid margins, often w/crusting or scales
- - blepharitis
- failure of the eyelids to close exposes the ____ to serious damage.
- - cornea
- excessive tearing may be due to:
-
- increased tear production (caused by conjunctival inflam. and corneal irritations)
- impaired tear drainage (caused by ectropion and nasolacrimal duct obstruction) - miosis
- - constriction of the pupil
- mydriasis
- - dilation of the pupil
- testing the near reaction is helpful in diagnosiing:
- - Argyll Robertson and tonic (Adie's) pupils
- asymmetry of the corneal reflections indicates:
- - deviation from normal ocular alignment
- a temporal light reflection on one cornea indicates:
- - nasal deviation of that eye
- sustained nystagmus w/in the binocular field of gaze is seen in a variety of ____.
- - neurologic conditions
- T/F: hyperthyroidism can present with a lid lag
- - true
- In paralysis of CN VI, the eyes are conjugate in ___ lateral gaze but in in ___ lateral gaze. (right or left)
-
- right
- left - In lid lag of hyperthyroidism, a ____ is seen b/w upper lid and iris
- - rim of sclera
- T/F: poor convergence is a result of hypothyroidism
-
- false
- hyperthyroidism - contraindications for mydriatic drops include:
-
1. head injury and coma, in which continuing observations in papillary rxns are essential
2. any suspiscion of narrow angle glaucoma - absence of red reflex suggests:
-
- opacity of lens (cataracts)or possibly of the vitreous
- less commonly, a detached retina
- in children, a retinoblastoma
- artificial eye - refractive error
-
- light rays from a distance do not focus on the retina
- myopia: focus anterior to it
- hyperopis: posterior to it - retinal structures in a myopic eye look much ____ (larger or smaller) than NL
- - larger
- enlarged cup suggests:
- - chronic open-angle glaucoma
- loss of venous pulsations in pathologic conditions like head trauma, meningitis or mass lesions may be an early sign of:
- - elevated intracranial pressure
- important cause of poor central vision in the elderly
- - macular degeneration
- Types of Macular Degeneration
-
- dry atrophic (more common but less severe)
- wet exudating
- neovascular - drusen
-
- undigested celluar debris
- may be hard and sharply defined or sot and confluent with altered pigmentations - _____ signals inc'd intracranial pressure from such serious conditions as trauma, mass, lesions, subarachnoid hemorrhage or meningitis
- - papilledema
- may be seen as dark specks or strands b/w fundus and lens
- - vitreous floaters
- densities in the lens
- - cataracts
- "Tug Test"
-
- movement of auricle and tragus is painful in acute otitis externa but not in otitis media
- tenderness behind ear may be present in otitis media - nontender nodular swellings covered by NL skin deep in the ear canal suggest:
- - exostoses: nonmalignant overgrowths which may obscure the drum
- acute otitis externa
- - canal is often swollen, narrowed, moist, pale, tender, may be reddened
- chronic otitis externa
- - skin of the canal is often thickened, red and itchy
- red bulging ear drum
- - acute purulent otitis media
- amber ear drum
- - serous effusion
- a serous effusion, a thickened drum, or purulent otitis media may decrease ____.
- - mobility
- in U/L conductive hearing loss, sound is heard in (lateralized to) the ____ ear.
- - impaired ear
- Visible explanations of U/L conductive hearing loss include:
-
- acute otitis media
- perforation of eardrum
- obstruction of ear canal (cerumen) - in U/L sensorineural hearing loss, sound is heard in the ___ ear.
- - good ear
- in conductive hearing loss, how is sound heard through bone compared to through air?
- - heard through bone as long or longer than it is through air
- in sensorineural hearing loss, how is sound heard through bone compared to through air?
- - sound is heard longer through air
- tenderness of the nasal tip or alae suggests:
- - local infx such as furuncle
- does deviation of the septum commonly obstruct flow of air?
- - no
- viral rhinitis: mucosa is...
- - reddened and swollen
- allergic rhinitis: mucosa is...
- - pale, bluish or red
- causes of septal perforations:
- - trauma, surgery, intranasal use of cocaine or amphetamines
- polyps
- - pale, semitranslucent masses that usually come from the middle meatus
- nasal ulcers may arise from the use of ____.
- - cocaine
- local tenderness, together w/sxs of pain, fever and nasal discharge suggest:
-
- acute sinusitis involving the frontal or maxillary sinuses
- transillumination may be diagnostically helpful - bright red edematous mucosa underneath a denture suggests:
-
- denture sore mouth
- there may be ulcers or papillary granulation tissue - abnormal colorations that may be observed on the lips
- - cyanosis and pallor
- redness and swelling of interdental papillae indicate:
- - gingivitis
- black line indicates:
- - lead poisoning
- roof of mouth should be inspected for a ____.
- - midline lump (torus palatinus)
- asymmetric protrusion suggests a lesion of ____.
- - CN XII
- second most common cancer of the mouth
- - cancer of tongue
- most common cancer of mouth
- - cancer of lip
- any persistent nodule, ulcer (red or white) is suspect of:
- - cancer of tongue
- cancer occurs more often on what part of the tongue?
-
- on the side of the tongue
- next most often at its base - soft palate fails to rise and uvula deviates to opposite side of paralysis of which nerve?
- - CN X
- "tonsillar node" that pulsates
- - really the carotid artery
- small, hard, tender "tonsillar node" high and deep b/w the mandible and sternomastoid is probably a ____.
- - styloid process
- enlarged supraclavicular node, especially on the left, suggests:
- - possible metastasis from a thoracic or abdominal malignancy
- tender nodes suggest:
- - inflammatioin
- hard or fixed nodes suggest:
- - malignancy
- changes or progressively severe headaches increase the likelihood of:
- - tumor, abscess, other mass lesion
- extremely severe headaches suggest:
-
- subarachnoid hemorrhage
- meningitis - what may increase pain from a brain tumor or acute sinusitis?
- - coughing, sneezing or changing position of head
- refractive errors most commonly explain:
- - gradual blurring
- high blood sugar levels may cause ____ of the eyes
- - blurring
- sudden visual loss suggests:
-
- retinal detachment
- vitreous hemorrhage
- occlusion of central retinal artery - difficulty seeing w/close work suggests:
-
- hyperopia (farsightedness)
- presbyopia (aging vision) - difficulty seeing w/distance suggests:
- - myopia (nearsightedness)
- slow central loss of vision suggests:
-
- nuclear cataract
- macular degeneration - peripheral loss of vision suggests:
- - advanced open angle glaucoma
- one-sided loss of vision suggests:
- - hemianopsia and quadrantic defects
- moving specks or strands suggests (seen upon fundoscopic exam):
- - vitreous floaters
- fixed defects (seen upon fundoscopic exam) suggests:
- - lesion in retinas or visual pathway
- flashing lights or new vitreous floaters suggest:
-
- detachment of vitreous from retina
- prompt consult is indicated - diplopia in adults may arise from:
-
- lesion in brainstem or cerebellum
- weakness or paralysis of one or more EOM - horizontal diplopia
- - palsy of CN III or VI
- vertical diplopia
- - palsy of CN III or IV
- diplopia in one eye with the other closed suggests:
- - problem with cornea or lens
-
- understanding speech
- c/o others mumbling
- noisy environment makes hearing worse - - sensorineural hearing loss
- - noisy environments may help hearing
- - conductive hearing loss
- medications that affect hearing include:
-
- aminoglycosides
- aspirin
- NSAIDs
- quinine
- furosemide
- others - pain suggests a problem in which part of the ear?
- - external ear (otitis externa
- pain associated with symptoms of respiratory infx suggest what type of ear problem?
- - inner ear (otitis media
- unusually soft wax, debris from inflam. or rash in ear canal, or discharge through a perforated eardrum occur secondary to:
- - acute or chronic otitis media
- tinnitus is a common symptom increasing in frequency with ____.
- - age
- tinnitus is associated with hearing loss and vertigo suggests:
- - Meniere's Dz
- feeling unsteady, light-headed or dizzy in the legs sometimes suggests:
- - a cardiovascular etiology as opposed to vertigo
- feeling of being pulled suggests:
- - true vertigo from an inner ear problem or a central or peripheral lesion of CN VIII
- rhinorrhea, pain and tenderness in the face and sinus along with local headache or fever suggest:
- - sinusitis
- if pt. nasal congestion is limited to one side, consider:
-
- deviated nasal septum
- foreign body
- tumor - local causes of epistaxis include:
-
- trauma (esp. nose picking)
- inflammation
- drying & crusting of nasal mucosa
- tumors
- foreign bodies
- bleeding disorders may contribute to epistaxis - fever, pharyngeal exudates and anterior lymphadenopathy, esp. in absence of cough suggest:
- - streptococcal pharyngitis or strep throat
- may cause a sore tongue
- - aphthous ulcers and hairy tongue (due to vitamin deficiency)
- bleeding gums are most often caused by:
- - gingivitis
- most likely causes of hoarseness
-
- overuse of voice (cheering)
- acute infxs - causes of chronic hoarseness
-
- smoking
- allergy
- voice abuse
- hyperthyroidism
- chronic infx (TB)
- tumors - enlarged tender lymph nodes commonly accompany:
- - pharyngitis
- thyroid function may be ___ with goiter
- - increased, decreased or NL
- diffuse lymphadenopathy raises suspicion of:
- - infx from HIV or AIDs
- tracheal deviation
-
- may be caused by masses in the neck
- may also signify important problems in thorax (mediastinal mass, etelectasis, large pneumothorax) - goiter
- - general term for enlarged thyroid gland
-
a) thyroid gland is ___ in Grave's Dz
b) thyroid gland is ___ in Hashimoto's Thyroiditis and malignancy -
a) soft
b) firm - a localized systolic or continuous bruit may be heard in _____.
- - hyperthyroidism
- exophthalmos
- - abnormal protrusion of the eye
- regurgitation of the mucopurulent fluid from the puncta suggests:
- - obstructed nasolacrimal duct