What is the name of the format commonly used to organize data obtained during the history and physical examination?
Problem-Oriented Medical Record
What are the components of a SOAP note?
S = subjective
O = objective
A = assessment
P = plan
In which section of a SOAP note does the following information belong:
Patient's heart rate is 72
Objective
In which section of a SOAP note does the following information belong:
Patient's pain is not well controlled
Subjective
In which section of a SOAP note does the following information belong:
Put patient on heparin for DVT prophylaxis
Plan
In which section of a SOAP note does the following information belong:
Patient didn't sleep well last night
Subjective
In which section of a SOAP note does the following information belong:
Patient's breath sounds are clear
Objective
What is an example of a well formatted assessment/plan for a patient who come to your office with high cholesterol and a UTI?
1. Hyperlipidemia
- On 7/8/18 total cholesterol 275
- Continue on atorvastatin 10 mg PO QD
- Counsel on healthy diet and exercise
- Recheck lipid panel in 3 months
2. Uncomplicated cystitis
- Today urine analysis positive for ketones,
nitrites, and leukoc
In which section of a SOAP note does the following information belong:
Patient has a scar on his right lower abdomen
Objective
In which section of a SOAP note does the following information belong:
Patient's had an MI
Assessment
In which section of a SOAP note does the following information belong:
Schedule patient for psych evaluation
Plan
What is a pertinent negative?
The absence of a sign or symptom that can help you rule out or rule in a diagnosis
How should you arrange your physical exam findings?
Head to toe by body system
What four actions should you think about doing when assessing every body system?
Inspect
Palpate
Percuss
Auscultate
When writing pertinent review of systems, what should go first?
The pertinent symptoms that your patient admits to.
For example:
"Patient admits fever, chills, and night sweats. Patient denies shortness of breath, syncope, or chest pain
Name the seven components of the Comprehensive Adult Health History.
1. Identifying data/source/reliability
2. Chief complaint
3. History of present illness
4. Past medical history
5. Family history
6. Social history
7. Review of symptoms
What are the major components of the "past medical history?
Childhood illnesses
Adult illnesses (medical, surgical, OB, psychiatric)
Health maintenance (immunizations, screenings, safety)
What are the major components of the "social history?
Education
Family
Personal interests
Lifestyle
What is the best way to document a chief complaint?
In the patient's own words.
Ex: "pounding headache for 2 days
What is the most important part when documenting a family tree diagram?
A key
What does it mean if a test is sensitive versus specific?
Sensitivity = "SnNout" sensitivity rules out
Specificity = "SpPin" specificity rules in
What is patient centered interviewing?
Following the patient's lead to understand their thoughts, ideas, concerns, and requests, without adding additional information from the professional's perspective.
What is symptom-focused interviewing?
The clinician takes charge of the interview to meet his or her need to acquire details and data in order to identify the disease.
What is the difference between disease and illness?
Disease = the explanation that the clinician brings to the symptoms
Illness = the way the patient experiences all aspects of the disease
What are the eight attributes you should know for every symptom? What is a good mnemonic that can help you remember them?
OLD CARTS:
O = Onset
L = Location
D = Duration
C = Character
A = Aggravating/alleviating factors
R = Radiation
T = Timing
S = Severity
What is cultural competence?
A set of attitudes, skills, behaviors, and policies that enable organizations and staff to work effectively in cross- cultural situations.
What would you want to include in a description of a breast mass?
Tenderness
Induration
Heat
Color
Size
Nipple discharge
Location
Consistency
Shape
Texture
Mobility
Where are the palpebral fissures?
The space between the eyelids
Where are the nasolabial folds? What are the useful for?
The skin folds that run from the side of the nose to the corner of the mouth. Helpful for determining facial symmetry.
What cranial nerves innervate the facial muscles?
V and VII
42 y/o female presents to your office for a well visit. She tells you that her sister was just diagnosed with a "thyroid problem" and she wants to know if she could have it to. What questions do you want to ask her to develop her history of present illnes
Neck swelling?
Changes in hair, skin, nails?
Changes in mood or emotional stability?
Palpitations?
Changes in mensuration?
Changes in bowel habits?
Changes in temperature preference?
What parts of the face are ideal for checking symmetry of facial features?
Nasolabial folds
Palpebral fissures
Where is the temporal artery located?
Between the top of the ear and the eye.
What is it called when you percuss the masseter muscle on the side of the face and it twitches? When would you test this?
Chvostek sign
When checking for hypocalcemia
What is a bruit? What does it sound like?
A "whooshing" over a vessel formed by turbulent flow of blood through a partially obstructed vessel.
How does the skin contribute to blood pressure regulation?
Through constriction of skin blood vessels.
Your four year old patient presents with an intracranial bruit. What is your course of action?
Nothing, that is common
Your patient presents with double vision. During physical exam you hear a bruit over the orbit. What are you worried about?
A cerebral aneurysm
46 y/o male presents to your office complaining of a headache. He says it comes and goes for a few weeks once every year. They feel like an "ice pick" stabbing him in the pack of his eye and last for about 15 minutes, sometimes waking him up from sleep. W
Cluster headache
Oxygen therapy
Moon-shaped face?
Cushing's
Your patient presents with a "tightened-hard" face and thinning of the facial skin?
Scleroderma
What endocrine disease is associated with big bulging eyes? What is this called?
Hyperthyroidism, specifically Grave's Disease
Exophthalmos
Your patient presents with a sharp, shooting pain on the side of his face. It lasts for a few seconds and he describes it like a sudden "electric shock." What is the diagnosis?
Trigeminal neuralgia (Tic douloreux)
Name the salivary glands and locations.
1. Parotids - anterior to ear
2. Submandibular - medial to mandible
3. Sublingual - floor of the mouth
What three structures form the posterior neck triangle?
1. Trapezius
2. Sternocleidomastoid
3. Clavicle
What structures form the anterior neck triangle?
1. Medial border of sternocleidomastoid
2. Mandible
3. Hyoid bone
What should you be inspecting for when you are looking at the neck?
Symmetry, trachea alignment, masses, webbing, carotid artery, JVD, range of motion
You are palpating your patient's check during a physical exam and notice a downward tugging of the trachea during inspiration. What is this called? What is it indicative of?
Tracheal tugging
Indicative of an aortic aneurysm
What is the anatomy of the thyroid?
How do you preform a thyroid exam?
First inspect for size, shape, nodules, enlargement, asymmetry
Watch patient swallow
Stand behind patient and palpate lobes with the tips of your fingers as they swallow
Displace the trachea to the right and to the left and feel the lobes of the thyroid
I
What are the two major autoimmune thyroid disorders?
Graves - hyperthyroid
Hashimoto - hypothyroid
Thyroglossal duct versus branchial cleft cysts?
Thyroglossal - anterior neck by the thyroid gland
Branchial - lateral neck
Describe fetal thyroid functioning. What does a large thyroid in a pregnant woman usually indicate?
The fetal thyroid doesn't become functional until the second trimester so the mother supplies the thyroid hormone. An enlarged thyroid means that mom probably isn't getting enough iodine
What is choasma?
Also called melasma - dark discolored patches. A "mask of pregnancy.
When should the fontanels close?
Posterior - 1-2 months
Anterior - 9-18 months
Your newborn patient presents with a neural tube defect where there are protrusions of the brain and membranes through openings in the skull. What is this?
Encephalocele
What is craniosynostosis?
Premature closing of cranial sutures before the brain growth is complete.
What is Macewen sign? What is it indicative of?
When you percuss the skull with one finger and hear stronger resonant sounds.
Indicative of hydrocephalus or a brain abscess
What are the layers of the skin?
epidermis, dermis, hypodermis
What is the outermost layer of the skin?
Epidermis
What are the layers of the epidermis? And what do they do?
1) Stratum Corneum = protects and restricts water loss
2) Cellular Stratum = synthesizes keratin cells
Epidermis vs. dermis - which is vascular?
Dermis is richly vascular, epidermis is avascular and depends on dermis for its nutrients
What are the major components of the dermis?
Elastin, collagen, reticulin
Sensory nerve fibers
Autonomic motor nerves
What layer of the skin generates heat, provides insulation, shock absorption, and calorie reserve?
Hypodermis
What is the difference between eccrine and apocrine sweat glands?
Eccrine are on the surface, most parts of the body, and regulate temperature through secretion
Apocrine are larger, deeper, found in the axilla, anogenital, ears, etc, and secrete protein and carb rich fluid
What is body odor caused by?
Bacterial decomposition of the apocrine sweat
What are the types of hair on the human body?
Vellus = short, soft, non pigmented hair
Terminal = coarse, thicker, pigmented hair
What are hair cells formed by?
Epidermal cells which invaginate into the dermal layers
What are the parts of the nail?
What is the nail formed by?
Epidermal cells get converted to hard plates of keratin
What systemic problems do you want to ask about when interviewing a patient with a skin/hair/nails complaint?
Thyroid of liver disorder
Autoimmune diseases
Malnutrition
Skin disorders
Congenital anomalies
What do you want to know about a patient's family who presents with a skin/hair/nail problem?
Dermatologic diseases
Allergic diseases like asthma
Hair loss of coloration patterns
What eight components must be observed and documented when you are performing a skin exam?
1. color
2. vascularity
3. temperature
4. texture
5. turgor
6. mobility
7. moisture
8. lesions
What is the Woods Lamp used for?
It uses fluorescent light to detect bacterial or fungal skin infections, detect pigment disorders, or determine corneal abrasion
How do you determine turgor and mobility during your skin exam?
Pinch resilient skin
How should you be testing temperature on your skin exam?
Using the dorsal surface of your hands/finger, test symmetrically
How do you document "normal" skin texture?
Smooth, soft, and even
What parts of the body are absent of eccrine glands?
Lips, tympanic membranes, nail beds, prepuce, glans penis
What are sebaceous glands?
Glands associated with hair follicles that secrete sebum and keep the skin and hair from dying out
What do Asian and Native Americans tend to have less body odor?
Fewer apocrine glands
Define primary versus secondary skin lesions.
Primary - initial spontaneous manifestations of a pathologic process
Secondary - result from later evolution or external trauma to a primary lesion
What are the major characteristic you should be examining/documenting for a skin lesion?
Size
Shape
Color
Texture
Elevation/Depression
Attachment
Exudates
Configuration
Location/distribution
In what ways can a skin lesion be attached to the base?
With a stalk (pedunculated)
Without a stalk (sessile)
What is a arciform configured skin lesion?
Bow-shaped
Macule
flat, colored spot on the skin
Papule
small, solid, raised lesion on surface of the skin
Nodule
solid, raised clump of skin cells
Patch
a flat, discolored area on the skin larger than 1 cm
Plaque
a solid mass greater than 1 cm in diameter and limited to the surface of the skin
Tumor
mass of rapidly dividing cells that can damage surrounding tissue
Vesicle
A small cavity or sac that contains materials
Pustule
elevation of skin containing pus
Bulla
a large blister that is usually more than 0.5 cm in diameter
Cyst
sac containing fluid
Keloid
Thick scar resulting from excessive growth of fibrous tissue
Scale
Petechiae vs purpura
Spider angioma
Venous star
Capillary hemangioma
Cherry angioma
Furuncle versus carbuncle?
Infectious boil usually filled with staph aureus that originates in the hair follicle. Carbuncle is bigger involving more hair follicles.
Herpes simplex versus herpes zoster?
Simplex is genital or oral warts
Zoster is the shingles rash
Name the fungal infection based on the location:
1. Athlete's foot
2. Jock itch
3. Ringworm (body)
4. Ringworm (scalp)
5. Nails
1. Tinea pedis
2. Tinea cruris
3. Tinea corporis
4. Tinea capitis
5. Onychomycosis
Your 6 y/o male patient presents with a itchy rash on his hands and feet. His mom tells you he came home from school one day with the itching. On physical exam you see a linear bites between his fingers and toes. What is your diagnosis? Treatment?
Scabies
Treat with permethrin, kwell, or lindane
What is the medical term for lice?
Pediculosis
Your patient presents with eczema. What other two disease processes is he at increased risk for? What is this triad called?
Atopy - eczema, asthma, and allergies
What is the medical term for eczema?
Atopic dermatitis
What surfaces are normally affected by eczema/atopic dermatitis?
Flexural surfaces
What is lichenification of the skin?
Thickening from chronic irritation, such as eczema
4 y/o male presents to your office with a rash above the lips and round the nose. Mom tells you it used to be a bunch of little "boils" but now it looks to you as if it crusted over like a honey-colored plaque. What is the likely diagnosis? What bacteria
Impetigo
Staph aureus or group A strep
What widespread macular papular rash is caused by a type IV hypersensitivity reaction associated with medications like penicillins, sulfonamids, barbituates, salicylates, and some infectious processes? What is a severe and life threatening form?
Erythema multiforme
Steven-Johnson Syndrome (and Toxic Epidermal Necrolysis)
You are performing a skin exam on a patient with rheumatoid arthritis. You notice an erythematous, sharply demarcated rash with silvery white scales on the back of both his elbows. He tells you that he's seen the rash before, it comes and goes, and he's n
Psoriasis
What do you want to look for when you are preforming a skin exam on an obese, diabetic, patient?
Acanthosis nigrans - dark, velvety discoloration in the body folds and creases
What are the three major types of skin cancer?
1. Basal cell carcinoma
2. Squamous cell carcinoma
3. Melanoma
Your patient presents to your office with pearly white, non-healing lesion on his nose. He is a landscaper. What is the likely diagnosis? What is the prognosis?
Basal cell carcinoma
Good prognosis, most common type of skin cancer and very rarely metastasizes
You are preforming a skin exam and you notice a firm, pinkish patch with a poorly defined base on the back of your patient's left ear. What kind of cancer could this be?
Squamous cell carcinoma
What mnemonic do you use to determine the risk of a skin lesion being cancerous?
A - asymmetry
B - border
C - color
D - diameter >6mm
E - evolution
What is the most malignant type of skin cancer?
Melanoma
Name three types of alopecia.
1. Alopecia areata = sudden patchy hair loss
2. Scarring alopecia = skin disorder results in scarring and destruction of hair follicles
3. Traction alopecia = prolonged tension breaks the hair shaft
Your 40 y/o female patient presents to you complaining of excess hair growing on her face and upper back. What is this called?
Hirsutism
What is the name for an infection of the cuticles?
Paronychia
Define leukonychia punctata
White spots on the nail that form from injury
Define onycholysis
Separation of the nail plate from the underlying and lateral supporting structures.
Nails are firm, smooth and without inflammation.
What is the term for central depression of the nail with lateral elevation of the nail plate?
Koilonychia
What are beau lines in the nails? Terry nails?
Transverse depressions
Transverse white bands
What is the term for the white cottage-cheese like substance that covers an infant's body at birth?
Vernix caseosa
What is the term for the fine, short, silky hair on the newborn's body?
Lanugo
You are examining the skin of a newborn and you see milia. What is this? How is this different from miliaria?
Small white bumps on the baby's face filled with keratin (see below)
Miliaria is a disorder of blocked sweat glands
You are rotating with a psychiatrist and reading a patient's chart. Under Psychiatric History it says "trichotellimania," what does this mean?
Impulse control disorder where the patient pulls out his or her own hair
Why may spider veins and hemangiomas increase in size when a patient becomes pregnant?
There is increased blood flow to the skin during pregnancy
Your patient is 32 weeks pregnant with her first child and comes into your office complaining of itchy hives that started on her abdomen and has spread. She has no allergies and has not changes any hygiene products. What is high on your differential diagn
Pruritic urticarial papules and plaques of pregnancy
No concern, this is a benign condition
What is actinic keratosis?
It is a premalignant skin condition associated with squamous cell carcinoma of the skin. Develops in sun damaged areas typically in older people
What nerves control eye movements?
What cranial nerve innervates the levator palpebrae muscles, medial rectus muscle, inferior rectus muscle, superior rectus muscle, and inferior oblique muscle? - which raise the upper eyelid, and do the majority of eye movements.
Oculomotor nerve (III)
What cranial nerve innervates the superior oblique muscle? - allowing the eye to abduct, depress, and internally rotate the eye?
Trochlear nerve (IV)
What cranial nerve innervates the lateral rectus muscle? - allowing the eye to abduct laterally?
Abducens nerve (VI)
What is the name of the corner of the eye where the upper and lower eyelids meet?
Canthus
(lateral and medial)
What is the name of the opening between the eyelids?
Palpebral fissure
Where is the lacrimal gland located? What is it's function? Describe the passage and drainage of tears?
Within the body orbit, above and lateral to the eye.
Produces tears.
Tears protect the cornea and conjunctiva from getting dry. Lacrimal gland (and meibomian glands and conjunctival glands) product tears. Tears spread across the surface of the eye and dra
What part of the eye controls the thickness of the lens, allowing the eye to focus on near or distant objects?
The ciliary body
What is the name of the instrument you use to examine the back of the eye?
Ophthalmoscope
What is the posterior part of the eye called (the part you look at through the ophthalmoscope)? What 6 structures are located here?
Fundus
Made up of the:
1. retina
2. choroid
3. fovea
4. macula
5. optic disc
6. retinal vessels (veins and arteries)
What vitamin deficiency is associated with night blindness?
Vitamin A
What does a normal fundus look like?
What is the name of the center of vision?
Fovea
Explain why everyone has a natural blind spot (scotoma)?
It is due to the lack of photoreceptors (rods and cons) where the optic nerve exits the retina
Exposure to UV radiation predisposes the patient to what eye condition?
Cataracts
Describe the eye's direct versus consensual reactions reaction to light?
Direct = in response to light the pupil on the side you shining the light will constrict
Consensual = the pupil of the opposite eye (not the one you are shining the light in) will constrict
You are performing an eye exam on your patient. You ask the patient to gaze from a far object to a near one. What do you expect to happen? What is this called?
The pupils constrict
The Near Reaction
Your schizophrenic patient has been put on risperadol by his psychiatrist. What do you want to make sure you assess at every encounter?
Fundoscopic exam for retinitis
On your eye exam you notice that your patient's eyes are yellow. Besides hepatitis/biliary issues what else should you be thinking?
Your patient may be taking rifampin (tuberculosis) or lovastatin
What past medical history do you want to ask about when evaluating a patient's eye complaint?
Past eye surgeries
Eye trauma
Chronic illnesses - HTN, diabetes, glaucoma, IBD, thyroid, autoimmune, HIV.
Your patient with newly diagnosed Crohn's disease is in your office for a well check. What eye complains do you want to ask about?
Blurry vision, burning, pain, photophobia, loss of acuity
What ocular cancer is often hereditary?
Retinoblastoma
You are performing an eye exam and your patient has a lazy eye. What is the medical term for this?
Amblyopia
How do you test visual acuity?
Smellen eye chart
What does it mean if your patient's eyesight it 20/50 on the Snellen Chart?
20 = the distance the patient is from the chart
50 = the patient reads at 20 feet what the average person can read at 50 feet
Your patient normally wears glasses and you want to check their vision with a Snellen chart. Do you test him with or without glasses?
Both
What is the name for the eye chart used for assessing near vision?
Jaeger card
J2 = 20/20 vision
Oculus dexter versus sinister?
versus uterque?
Dexter = right eye
Sinister = left eye
Uterque = the eyes, in general, without corrective lenses
What medication can cause halos when your patient looks around lights?
Digoxin
What is a blindspot surrounded by either normal or slight peripheral vision? What is it often an indication of?
Scotoma
Acute angle glaucoma
What ocular side affects is amiodarone known to have?
Corneal scarring
How far away should your patient stand from the Snellen chart? How many inches away from the Jaeger?
20 feet
12-14 inches
If your patient's vision is less than 20/20 what can you conduct?
The pinhole test - patient looks through a pinhole and if improvement in visual acuity is by at least one line then there is a refractive error
What is myopia? Presbyopia?
Decrease in the ability of eye to accomodate
Myopia = far vision
Presbyopia = near vision (from decreases lens flexibility)
How do you test your patient's peripheral vision?
Confrontation test (cover
Wiggle finger test - pt covers right eye/you cover left, the wiggle finger in 4 fields (nasal, temporal, superior, and inferior) and ask the patient to tell you when they see it wiggle
What structures do you want to examine on the external eye?
Eyelids
Conjunctiva
Lacrimal gland
What is the purpose of the conjunctiva?
Protects the eye from foreign bodies and dryness
What is the term for upper eyelid drooping?
Ptosis
What is Horner's syndrome?
Ptosis, Miosis, Anhydrosis
Result from interruption of sympathetic nerve supply to the eye (CN III)
Ectropion vs. Entropion
Ectropion--loose, lower lid that rolls OUTWARD and does not completely close with the upper eyelid
Entropion--a loose, lower lid that rolls INWARD and irritates the eye (the eyelashes consistently rub on the cornea)
Hordeolum vs Chalazion?
Hordeolum (sty)
- painful, tender, infection around hair follicle of eyelashes on lid margin.
Chalazion
- chronic inflammatory "beady nodule" of meibomian gland. Usually inside lid.
Your patient presents with redness and crusting along the eyelid margins. What is this called?
Blepharitis
What is the term for inflammation of the lacrimal tract?
Dacrocystitis
How does a lacrimal duct obstruction present?
Excessive tearing
Pterygium vs pinguecula?
pterygium - wedge shaped/ fleshy/ over the cornea, surgical fix
pinguecula - yellow/small --> leave alone
Pale conjunctiva may indicate what? (normally light pink)
Anemia
What you are testing extra ocular movements what do you want to tell your patient?
Follow you finger with eyes only, do not move neck or head
What is the corneal light reflex? What if it's not right?
Shining a light towards the persons' nose. Reflection of light should be in the exact same spot on each eye.
If it's not right go on to the cover-uncover test
What is strabismus? What are the types?
Both eyes do not focus on an object simultaneously
Paralytic - extraocular muscles or nerve is impaired
Nonparalytic - cannot focus with both eyes simultaneously
What are the layers of the inner eye?
Outer fibrous layer (sclera and cornea)
Uvea (choroid, ciliary body, and iris)
Retina
What is the role of sclera?
The white part -
Supports the internal eye structures, avascular
What is the purpose of the cornea?
Sensory innervation for pain, eye refraction
What part of the eye supplies the color and controls the light that travels to the pupil?
Iris
What part of the eye produces the aqueous humor and contains the muscles that control accommodation?
Ciliary body
What part of the eye supplies oxygen to the outer layer of the retina?
Choroid
Where is the eye lens located?
Directly behind the iris
What is the cotton wisp test in your ocular exam?
You touch the edge of the cornea with the wisp of a cotton ball to elicit blink and test for cranial nerve VII (movement) and V (sensation)
What is the primary cause of reversible blindness? What is the mechanism?
Cataracts
Clouding/opacity of the lens due to age, trauma, inflammation, drugs
What is inflammation of the superficial layers o the sclera anterior to the insertion of the rectus muscle?
Episcleritis
You are performing an eye exam on your 75 year old patient. You notice a white/grey opaque ring in the corneal margin. What is this? What is the cause?
Corneal arcus(arcus senilis)
Caused by lipid accumulation
What is band keratopathy?
The deposition of calcium crystals across the cornea in a "band" due to hypercalcemia.
What is important to document when you check pupil dilation?
Check for direct and consensual light response
Pupil size and equality
Speed of response
Aniscoria is unequal pupil size by how much? Is this normal?
> 0.5 mm
It can be normal
Miosis vs Mydriasis?
Miosis - constriction
Mydriasis - dilation
What is accommodation (eye exam)?
When you bring something close to the patient's face his eyes converge and pupils constrict
What is normal pupil size?
~ 3-5 mm
What part of the eye transforms light into electrical impulses?
Retina
What is the macula?
The yellow area surrounding the fovea near the center of the retina which has the most cones - best vision
How should you change the settings on the opthalamoscope for your patient?
Start at zero
Farsighted patient = positive number
Nearsighted patient = negative number
Retinal arterioles versus venules?
Arterioles - bright red and smaller
Venules - dark red and larger
You are doing a eye exam on your patient with uncontrolled hypertension. What do you expect to see?
AV nicking (abnormal tapering and crossing of the vessels)
What is the term for swelling of the optic disc? What are possible causes?
Papilledema
Increased intracranial pressure
When could you see cotton wool exudates on an eye exam?
Diabetic patient
What is optic nerve cupping and when would you expect to see it?
Increased pressure causes loss of blood flow to the optic nerve and the fibers begin to die
Glaucoma
Open angle vs closed angle glaucoma (acute)?
Open angle - slow clogging of the drainage canals causing increase in pressure, insidious loss of vision
Closed angle/acute - quick, intense pain, blurred vision, sudden obstruction to fluid flow
Dry vs Wet macular degeneration
Loss of central visual acuity
Dry - progressive and slow in one or both eyes
Wet - rapid with visions of wavy lines and loss of central vision usually in one eye. (quickly getting splashed in one eye)
You are preforming and eye exam and you see Drusen bodies on the retina. What is this indicative of?
Macular degeneration
Your patient is concerned he might have macular degeneration. How do you want to test him?
Ambler grid test
Also do a fundoscopic exam
Your patient calls you up in a panic. He tells you he had some spots and floaters and now it feels like a curtain is being drawn over his left eye. What is this? What should you tell him?
Retinal detachment - separation of the retina from the choroid
Get to a hospital for surgical repair ASAP otherwise he may go blind
What is lipemia retinalis?
When the vessels in the eyes are filled with triglycerides
Visual fields
The area an individual can see when looking straight ahead
You are testing your patients' visual fields. The patient cannot see the outer (temporal) half of both the right and left visual fields. What is this called? What are some possible causes?
Bitemporal hemianopsia
Something interrupting the optic chiasm, like a pituitary tumor
You are testing your patients' visual fields. The patient cannot see anything on the right side. What is this called? What are some possible causes?
Homonymous hemianopsia
Stroke, lesion in optic nerve, etc
Your newborn is crying but not producing tears. Is this normal?
No he is probably dehydrated. The lacrimal drainage system is completely developed at birth,
What are Brushfield spots?
Focal areas of iris hyperplasia surrounded by relative hypoplasia
In 90% of pts w/ Down Syndrome.
Called Wofflin nodules if not associated w/ down's
You see retinal hemorrhages on your infant patient. What are you concerned about?
Abuse - shaken baby syndrome
Your pregnant patient tells you her vision has been blurry recently. She wears corrective lenses. What is a likely reason?
Tears contain increased lysozyme, causing greasiness and blurred vision
Your 80 year old patient tells you he has been having eye pain at night. What are you concerned about?
Glaucoma
What are the parts of the ear?
What are the parts of the external ear?
Auricle - helix, antihelix, lobule, tragus
Ear canal
You patient tells you he has ringing in his ears. What is this called? What are possible causes?
Tinnitus
HTN, cerumen, meds, Meniere's Disease, loud noises
What medications can cause ototoxicity?
Loop diuretics, aminoglycosides, aspirin, cisplatin
What is otalgia?
Ear pain
What is otorhhea?
Ear drainage
What is vertigo?
Sensation of spinning
What is a Darwin's tubercle?
Painless white nodule on helix - normal variation
Why do low set ears make you think to look for genitourinary disorders?
The ears and the kidneys are formed at the same time during embryology
What are exostoses?
Nodular swellings inside the ear canal
When doing an ear exam when do you pull the pinna up and when do you pull the auricle down?
Pinna up = adults
Auricle down = infants
21 y/o male patient presents to your office with a red swollen ear. You do an ear exam and see purulent drainage. What do you suspect? What may the cause be? How do you want to treat it?
Otitis externa
Usually staph or pseudomonas
Patient may be a surfer or swimmer
Keep the ear dry + cortisporin drops (neomycin + steroid)
What is a pneumatic otoscope used for?
Used in pediatrics to look at the mobility of the tympanic membrane
What should a normal tympanic membrane look like?
-Shiny
-Pearly Gray
-Translucent
What would you see when you do an otoscopic exam?
1. Cone of light
2. Umbo(center of TM)
3. Some of the malleus
4. Tympanic membrane
What does a bulging tympanic membrane indicate?
Fluid build up - otitis media, serous otitis media
How does sound travel through the ear?
1. Soundwaves are collected through the outer ear (pinna)
2. It moves down the auditory canal into the eardrum which causes it to vibrate
3. The vibrations then cause the ossicles (malleus, incus, stapes) to vibrate as well
4. Motion in the middle ear cau
What bacteria most commonly cause otitis media?
Strep pneumoniae
H. influenzae
Moraxella catarrhalis
If your patient with otitis media has purulence draining out of the ear what happened?
The tympanic membrane perforated
3 y/o female presents to your office with an ear ache. Parents tell you she has been cranky and pulling at her ear in pain. On physical exam you see bulging and redness of the tympanic membrane. What is the treatment?
Otitis media -
Amoxicillin
Augmentin if this has happened before
If PCN allergy - erythromycin
What is tympanometry?
Tympanometry is an examination used to test the condition of the middle ear and mobility of the eardrum (tympanic membrane) and the conduction bones by creating variations of air pressure in the ear canal.
Procedure in which acoustic immitance is measured
Your 5 year old patient has chronic otitis media with effusion from allergies. What are you most concerned about?
Hearing, speech, and language development
What is cholesteatoma?
An epidemial cyst in the ear behind the tympanic membrane, highly associated with otitis media.
What is the cochlea?
Inner ear structure containing the central hearing apparatus - transfers vibration to sound via CN VIII
How do you assess your patient's hearing in the primary care setting?
Whispered voice test
Weber and Rinne
What is a labyrinth?
Fluid filled structures of the inner ear
What structures in the ear sense position and head movements to maintain balance?
Vestibule and semicircular canals (3)
Define conductive hearing loss. What are some possible causes?
Interference with the conduction of sound waves through the external and middle ear.
Cerumen, foreign body, infection, etc
What is the most common cause of conductive hearing loss?
Cerumen impaction
Define sensorineural hearing loss. What are some possible causes?
Hearing loss caused by damage to the cochlea's receptor cells or to the auditory nerves; also called nerve deafness
Nerve damage, brain damage, etc
Define prebycusis
Loss of hair cells at the base of the basilar membrane resulting in the loss of the ability to hear high-pitch sound.
Most common type of age-related hearing loss (after 50)
What is a normal Weber test?
The patient will hear the vibration equally in both ears
What is a normal Rinne test?
The patient will hear air conduction longer than bone conduction
What would a Weber and Rinne test look like for a patient with cerumen impaction on the left?
Weber will lateralize to the left
Rinne will be BC > AC on the left
You are preforming an auditory exam on your patient. You do a whispered voice test and the patient misses 2/3 of the letter/number combination you say on the left side. You go on to do a Weber test and the vibration lateralizes to the to the right. Rinne
Sensorineural loss in the left ear
Name the salivary glands
parotid, sublingual, submandibular
What dental problem can phenytoin cause?
Gingival hyperplasia
What is anklyoglossia?
Short frenulum
What is a geographic tongue?
Benign but permanent condition in which a portion of the tongue has a rough, unusual appearance
What is Wharton's duct?
The duct of the submandibular gland, which is located on the posterior surface of the tongue.
What cranial nerve are you assessing when you ask your patient to open their mouth and say "ah.
Looking for the rise and fall of the soft palate
Vagus Nerve (X)
What is a bifed uvula? What can it indicate?
Split uvula
May indicate a partially cleft palate. Important to note on an infant exam
What do you want to note when you are examining the tonsils?
Location (between the pillars)
Color
Size
Exudates
Lesions
How do you diagnose strep pharyngitis using the Centor Score?
Fever
No cough
Exudate on tonsils
Anterior cervical lymphadenopathy
Your patient presents with a erythematous, inflamed pharynx. Based on the age of the patient what do you think is the most likely cause of the pharyngitis?
< 2 - viral
> 5 - strep
Adolescents - clostridium, mycoplasma, G/C
A 7 y/o boy presents to your office having recently been treated for strep throat. He now has a fine sandpaper rash covering his entire body and a strawberry red tongue. What is this?
Scarlet fever
Peritonsillar abscess?
Collection of pus or fluid around the tonsil
Retrophayngeal abscess?
Presesnts in young children
neck stiffness with insidous onset, no tonsil involvement
presence of discrete mass and generalized swelling within the midline
50 y/o overweight female presents to your office complaining that her husband complains she snores very loud. She says in the morning she feels tired still and sometimes she wakes herself up in the middle of the night gasping. What is the probably diagnos
Obstructive sleep apnea
Confirm with polysomnogram (sleep study)
Suggest weight loss, smoking cessation, CPAP, possibly uvelectomy
On nasal exam you see swollen blueish gray turbinates. What do you think?
Allergies
What is the role of the nasal turbinates?
They help warm and moisturize air as it flows through the nose.
Where is Kiesselbach's plexus?
Nasal septum
When do the facial sinuses fully develop?
Around age 21
What sinuses are palpable on physical exam?
Frontal and maxillary
What is the "allergic salute"?
When your patient habitually wipes or rubs his nose in an upward and transverse manner
What is transillumination of the sinuses used for?
Press a flashlight against the cheek and observe the lighting of the sinuses in the mouth - normal unobstructed sinuses show the red light reflecting through
Used to determine if the sinuses are obstructed or infected (sinusitis)
When do children develop teeth? Lose their baby teeth?
Baby (deciduous teeth) develop between 6-24 months
Adult (permanent teeth) erupt between 6-14 years old
What is band keratopathy?
The deposition of calcium crystals across the cornea in a "band" due to hypercalcemia.
Pale conjunctiva may indicate what?
Anemia
Hordeolum vs Chalazion
Hordeolum (sty)
- painful, tender, infection around hair follicle of eyelashes on lid margin.
Chalazion
- chronic inflammatory "beady nodule" of meibomian gland. Usually inside lid.
Describe the normal pathway of blood starting at the left ventricle
Left ventricle --> aorta --> body --> vena cava --> right atrium --> right ventricle --> pulmonary artery --> lungs --> pulmonary veins --> left atrium --> left ventricle
What is dextrocardia? How is that different from situs inversus?
Dextrocardia = heart positioned to the right
Situs inversus = heart and stomach are placed to the right and liver to the left
What are the layers of the heart?
Pericardium
Epicardium
Myocardium
Endocardium
What happens during systole? During diastole?
Systole = pumping
Diastole = relaxation
What and where are the valves of the heart?
Tricuspid - between RA and RV
Mitral - between LA and LV
Pulmonic - between RV and pulmonary artery
Aortic - between LV and aorta
What are you hearing with S1 and S2?
S1 - closing of mitral and tricuspid valves
S2 - closing of pulmonic and aortic
What is stroke volume?
Amount of blood pumped from the heart with each contraction
What is cardiac output?
Amount of blood pumped by the ventricles during one minute
= Heart rate x stroke volume
What is the electrical conduction pathway of the heart?
SA node --> AV node --> bundle of His --> purkinje fibers
Describe the wave forms of an ECG
What are some associated symptoms do you want to know about if your patient tells you he has chest pain?
Sweating, palpitations, shortness of breath, fevers, orthopnea, cough, edema, numbness, tinging, cyanosis, claudication etc
What is claudication?
Leg pain that occurs with exercise, indicative of poor perfusion
You ask your cardiac patient how many pillow they have to use when they are lying down. What are you assessing for?
Orthopnea
What is a thrill?
Vibratory sensation felt from light palpation over the chest wall
You are assessing your patient's carotid arteries. What are you assessing?
Pulses
Palpate for inequality
Auscultate for bruits
What heart sound is a result of vibrations from turbulent blood flow during early ventricular filling?
S3
In what patients is an S3 heart sounds considered normal?
Infants, athletes, pregnant women
You are performing a cardiac exam and you hear an extra heart sound after S2. What abnormalities are high in your differential diagnosis? What does the cadence sound like?
CHF, myocardial failure, mitral or tricuspid regurg
Sounds like "Kentucky
Your attending tells you he thinks his patient has an S3 extra heart sound and wants you to double check. Where and how do you want to listen?
Listen with the bell
Over the apex
Best at left lateral decubitus
Inspiration
What extra heart sounds is indicative of turbulent blood flow during contraction of the atria at the end of diastole?
S4
Is S4 ever normal?
Not usually, usually indicative of decreased ventricular compliance, HTN, stenosis, etc
What does S4 sound sound like in comparison to S3?
S4 = "Tennessee"
S3 = "Kentucky
What is a summation gallop?
When both S3 and S4 sounds are heard = severe heart failure
How do you differentiate a pericardial friction rub versus a pleural friction rub?
Have the patient hold his breath
You are performing a cardiac exam and you hear a high-pitched leathery sound over the left parasternal border during systole. What is high on your differential? What could it indicate?
Pericardial friction rub
Indicates inflammation, effusion, etc
How do you grade the intensity of heart murmurs?
I = really hard to hear with the stethoscope
II = faint with stethoscope
III IV - moderately loud with palpable thrill
V - loud with stethoscope
VI - audible without a stethoscope
What characteristics are important to note when describing a murmur?
Grade
Timing
Intensity changes
Quality
Pitch
Location
Radiation/Transmission
What part of the stethoscope is best to use when listening for a murmur?
Bell
Left vs Right sided hear failure
Left sided:
Blood backs into lungs, can't fill, CAD and HTN
Side effects:
Fatigue, activity intolerance, dyspnea, SOB, cough, orthopnea, inspiratory crackles, wheezes, S3 gallop.
Right sided:
Blood backs in the periphery. Third spacing.
Side effects:
COPD
What is the accumulation of effused fluids or blood between the pericardium?
Cardiac tamponade
What is right heart failure in the absence of left heart failure - usually secondary to chronic lung disease
Cor pulmonale
Sudden cardiac death of a teenager during a football - what should you think?
Hypertrophic cardiomyopathy
What are the components of Tetralogy of Fallot?
Define an innocent murmur. What are some examples?
Heard between the left sternal border and apex and disappears when the client sits, indicates turbulent blood across the aorta and indicates structural problems without symptoms
Venous hum = heard above the clavicles
Mammary souffle - high-pitched continu
You are preforming a cardiac exam on your patient with a high fever from a UTI. You hear a murmur. One week later the patient returns and her UTI and fever are gone. You no longer hear a murmur. What is this murmur called?
Physiologic murmur
What maneuvers during physical exam would increase all murmurs EXCEPT hypertrophic cardiomyopathy and mitral valve prolapse?
Squatting
Hand grip
What maneuvers during physical exam would decrease all murmurs EXCEPT hypertrophic cardiomyopathy and mitral valve prolapse?
Valsalva
You hear a harsh systolic ejection murmur at the 2nd right intercostal space that radiates to the carotid...? When would you expect the murmur to get louder?
Aortic stenosis
Gets louder when you have the patient squat
You hear a diastolic high pitched blowing murmur....?
Aortic regurg
You hear a loud diastolic rumbling decrescendo murmur...? What do you want your patient to do so you can hear the murmur better?
Mitral stenosis
Have the patient turn on their left side
What does elevated JVP indicate?
Right heart failure
What is the PMI and where is it located? What if it is displaced?
PMI = point of maximal impulse = the point where the apical impulse is most readily seen or felt
Displaced = left ventricular hypertrophy
What five areas do you want to auscultate during you cardiac exam?
Aortic
Pulmonic x2
Tricuspid
Mitral
"All Patients Take Medicine
Where should you listen for mitral valve prolapse?
At the PMI
Better in left lateral decubitus
What is the prognosis for a patient with chest pain associated with pulmonary disease?
Bad - probably something late stage
You are evaluating your patient with a cough. He says he's been coughing up rust colored sputum. What is on your differential?
TB and pneumococal pneumonia
Pink, frothy sputum is most typically indicative of?
Pulmonary edema in a CHF exacerbation
6 y/o male patient presents to your office with a bad high pitched intractable cough, along with nasal congestion, fever, and vomiting lasting for over a month. What is high on your differential?
Pertussis
What are you worried about in any patient who is older, immunocompromised, or neurological compromised with an unexplained cough?
Aspiration
51 y/o male presents to you office for a new onset HTN follow up. His blood pressure is 132/74 on his medications. He tells you he feels great but he thinks he might be getting a cold because he can't stop coughing. What are you thinking? What do you want
Possibly bradykinin cough from ACEi
If it's really bothering him you can switch to an ARB
What cardiac medications do you want to avoid in a patient with asthma?
Beta blockers
How do you calculate smoking pack years?
# packs x # years smoked
What is normal respiratory rate? What are the terms for too quick and too slow?
10-24
Fast = tachypnea
Slow = bradypnea
You are in the ICU seeing a patient. On exam you hear progressively deeper respirations that increase in rate and depth and then decrease in alternating cycles. What is this called?
Cheyne Strokes respirations
You are preforming a pulmonary exam and you hear deep and labored gasping breathing. What is this called? What could it be a sign of?
Kussmaul
Acidosis, DKA, etc
The breath cycle of a COPD patient typically sounds like what?
Normal inspiration and prolonged expiration
What is the difference between hypercapnia and hypoxemia and hypoxia?
Hypoxia = decreased O2 in the tissues
Hypoxemia = decreased O2 in the blood
Hypercapnia = increased CO2 in the blood
You are preforming a pulmonary exam and start by inspecting your patient. What are you looking for?
Signs of difficulty breathing: accessory muscles, bulging intercostal spaces, cyanosis
Erythema, bleeding, bruises, scars
Asymmetries, A:P diameter
Sternum abnormalities
Pectus excavatum versus carinatum?
Excavatum = sunken in
Carinatum = protrusion
You are inspecting a patient with long standing COPD. You notice he has increased anterior posterior diameter with a costal angle > 90 degrees. What is this called?
A barrel chest
What is a normal AP:T diameter?
2:1
You preforming a sports physical for your 10 y/o patient. You notice when she bends over her spine curves medially at the thoracic spine. What is this called?
Scoliosis
What is kyphosis
You are preforming a pulmonary exam and palpating the chest. What are you looking for?
Tenderness
Crepitus
Masses
Asymmetries
Tactile fremitus
How do you assess for symmetric chest expansion?
Have you patient inhale deeply and line up your hands symmetrically on his lower back with your thumbs in the middle, watch your thumbs move apart symmetrically as the patient breathes
How do you assess for tactile fremitus?
Touch the patient's chest with the edge of your hands by your pinkies, start at the lung apices and make your way down. Have the patient say the words "ninety nine" as you feel for vibration
Compare your physical exam for a patient with pneumonia, pleural effusion, and pneumothorax.
Pneumonia =
dull percussion
increased fremitus
bronchial breath sounds
positive egophony
Pleural effusion =
dull percussion
decreased fremitus
decreased breath sounds
Pneumothorax =
hyperresonant percussion
decreased fremitus
decreased breath sounds
What does increased tactile fremitus mean?
Consolidation - there is something solid and it causes vibration
What does decreased tactile fremitus mean?
There is air in the way so the sound doesn't travel well and less vibration
What does normal pulmonary percussion sound like?
What are abnormal chest percussion tones?
Resonant
Hyperressonant - increased air
Dull - abnormal consolidation
Tympany - drum sound, hollow
How do you measure diaphragmatic excursion? What is normal?
Have your patient take a deep breath and hold it - percuss down from scapula until it sounds dull and mark it
Then have your patient exhale completely and hold it - percuss up until it sounds resonant and mark it
Measure the distance between the two marks
What part of the stethoscope do you want to use to listen to your patient's lungs? In what pattern?
Diaphragm
In a ladder formation. Do it anterior and posterior over the entire lung field
Describe bronchial breath sounds
High pitch, loud
Harsh and hollow
Inspiration < expiration
Normal over the trachea
Describe bronchovesicular breath sounds
Moderate pitch
Inspiration = expiration
Normal posterior between scapulae and anterior over upper sternum
Describe vesicular breath sounds
Low pitch
Inspiration > expiration
Rustling, like wind
Normal over peripheral lung fields
What are adventitious breath sounds? Name some
Abnormal extra sounds over the breath sounds
Crackles/Rales
Wheezes
Rhonchi
Stridor
Pleural friction rub
Which breath sounds are discontinuous interrupted explosive sounds that are low in pitch like hairs being rubbed together?
Coarse crackles
Which breath sounds are discontinuous, interrupted explosive sounds that are louder and higher in pitch, with popping quality?
Fine crackles
Which breath sounds are continuous high-pitched hissing with musical quality?
Wheeze
Which breath sounds are continuous, low-pitched snoring/gurgling?
Rhonchi
You are seeing a 18 m/o old in your office. Parents tell you they looked away for a few moments and since she's been coughing. On physical exam you hear high-pitched inspiratory crowing. What do you suspect?
Stridor
Foreign body - upper airway obstruction
You are rounding on a patient post-op. On pulmonary exam you hear high pitched short crackling sounds that disappear when they start coughing. What is this called?
Atelectatic crackles
Tests for bronchophony vs egophony vs pectoriloquy
Positive bronchophony = patient says "ninety-nine" while you listen to chest wall and you hear increased vibration
Positive egophony = patient says "ee" and it sounds like "a" with stethoscope
Positie pectoriloquy = patient whispers "one, two, three" and
What is purulent exudative fluid collection in the pleural space?
Empyema
What is an inflammatory process involving the visceral and parietal pleura?
Pleurisy
What is the normal chest circumference in a neonate?
2-3 cm smaller than head circumference
You are seeing a 1 m/o for a well visit. The parents are concerned because their child doesn't seem to ever breath through his mouth and sometimes stops breathing for a few seconds. What do you do?
Reassure them that this is normal, neonates are obligate nose breathers and periods of apnea 10-15 seconds is normal
Tell them to keep an eye on it and make sure baby never becomes cyanotic, nasal flaring, stridor, grunting, etc
What do neonatal lungs sound like in comparison to adults?
What about pediatric?
Louder (due to thinner chest wall)
Bronchovesicular throughout
Pediatric - more resonant, can be predominantly bronchovesicular
What two holes in the neonates heart allow for fetal/maternal blood supply?
Foramen ovale
Ductus arteriosus
What is the normal respiratory rate of a child?
18-25
What is a diaphragmatic hernia?
An abnormal hole in the diaphragm, causing the abdominal organs to move into the chest, and causes difficulty breathing.
4 y/o male presents to your ER with "shortness of breath." Patient is leaning forward trying to breathe. He has inspiratory stridor, a muffled voice, and is drooling. What is it? What don't you want to do?
Epiglottitis
Do not put anything in the mouth, could cause spasm and block the airway, this is a medical emergency
What is the medical term for croup? What virus most commonly causes it?
Laryngotracheitis
Parainfluenza virus
Your patient has lack of rigidity of the trachea. What is this called?
Tracheomalacia
What is small airway inflammation learning to hyperinfilation of the lungs, typically seen in infants?
Bronchiolitis
You are doing a pulmonary assessing your pregnant patient. What normal anatomic variants would you expect to see? What WILL NOT change?
Diaphragm rises higher
Tidal volume increases so minute ventilation increases
No change in respiratory rate
What is chronic permanent dilation of the airways due to repeated infection and obstruction?
Bronchiectasis
What is normal JVP? What if it is higher? Lower?
Normal 3-4 cm above the sternal angle
Increased in fluid overload and right heart failure
Decreased in hypovolemia
How do you measure jugular venous pressure?
Have your patient sit with their head at a 45 degree angle and measure the jugular vein pulsations from the angle of the sternum
You are examining your patient's legs and you notice their skin is cold and pale with loss of hair. What kind of disease is this most likely?
Arterial insufficiency
You are examining you patient's legs and you notice his skin is warm and brown. He says they ache when he drives in the car or walks up the stairs. What kind of disease?
Venous disease
Arterial versus venous pressure ulcers?
Arterial = painful, minimal drainage, smooth, occur at pressure areas like toes, LATERAL ankle
Venous = painless, irregular bleeding, occur at lower legs or MEDIAL ankle
24 y/o female presents to your office with "blue fingers." She tells you that when she goes out in the cold her fingers rapidly change color and turn "red, white, and blue," bilaterally. They also burn. She has no other medical history and physical exam i
Raynaud's Syndrome
Your are assessing a patient with CHF. What do you want to look for in his fingers?
Cyanosis
Clubbing (flattening of the angle between the fingernail and nail bed)
What is a normal capillary refill? How do you test it?
< 2 seconds
You press on the patient's fingernail until it turns white and then watch the blood flow
What pulses do you want to assess when doing a peripheral vascular exam?
(Carotid)
Brachial
Radial
Ulnar
Femoral
Popliteal
Dorsalis pedis
Posterior tibial
What is thoracic outlet syndrome?
Compression of one or more of the structures passing
out of the thoracic outlet. The subclavian artery or vein or lower portion of the brachial plexus is often involved.
You need to do an Arterial Blood Gas (ABG) on a patient. What test do you need to do first? How do you do it?
Allen Test
Have your patient make a first and occlude both their ulnar and radial arteries. Have the patient open their palm and let go of the arteries. Watch the pink coloration return to their palms. Color should return within 3-5 seconds
What is the scale for pitting edema?
0 = none
1+ = tissue returns to normal almost immediately
2+ = tissue returns after 15-20 seconds
3+ = tissue returns after 1 - 1.5 mins
4+ = tissue returns after 2-3 mins
NA = tissue no longer pits due to tissue hardness
How do you grade pulses? What is normal?
How do you test for arterial sufficiency?
Have your patient lay down. Elevate the legs for a few seconds and watch for the color to leave. Then have the patient sit up and dangle his legs. Watch as the color comes back, should return within 10-15 seconds.
You are concerned your patient may have a DVT. What physical exam test would help you?
Homan's Test - dorsiflex foot and look for pain behind the knee
Your patient presents with redness, thickening, and tenderness along a peripheral vein. What is this?
Superficial vein trhombophlebitis
1 y/o presents to your office with blood pressures different in the arms and legs, cyanosis, and diminished pulses. What congenital disorder is this?
Coarctation of the aorta
What is Kawasaki disease?
An autoimmune disease involving the inflammation of blood vessels, lymph nodes, skin, and mucosa - initial symptom is a high fever, later symptoms include conjunctivitis, rash, peeling, and edema
What happens to blood pressure during normal pregnancy?
Decreases
Preeclampsia vs eclampsia
Preeclampsia = hypertension, edema, and proteinuria during pregnancy
Eclampsia = above plus seizure
Where do you want to listen for bruits during your peripheral vascular exam?
Carotid arteries
Aorta
Renal arteries
Iliac arteries
Femoral arteries
What is peristalsis?
The sequential autonomic muscular contractions that move nutrients along the digestive tract
What are the parts of the stomach?
The fundus, antrum and the body
What are the parts of the small intestine?
duodenum, jejunum, ileum
What lines the surface of the small intestine to help absorb nutrients?
Villi
In what part of the digestive system are fats and proteins broken down?
The stomach - uses HCL and enzymes
What are the parts of the large intestine?
Cecum
Asending colon
Transverse colon
Descending colon (sigmoid, rectum, anal)