advanced health assessment final <3
if EEE goes to AA it is
+ egophony and can indicate consolidation
BREAST COMMON OR CONCERNING S/S:
- Breast lump or mass - Breast discomfort or pain - Nipple discharge
important for assessing a newborn (birth to 28-30 days):
- Head [Skull, fontanels, sutures, swellings; Eyes; Ears + Hearing; Nose; Mouth; Visible anomalies; Neck] - Heart [Chest (clavicles); Lungs] - Hepatic [Abdominal organs; masses] - Hernia [Inguinal area; includes genitalia & anal area] - Hips [Developmental Dysplasia = DDH; Legs] - Heels [Ankles; Feet]
heart murmur grading system
- I: Barely audible - II: Faint but easily audible - III: Loud murmur without a palpable thrill - IV: Loud murmur with a palpable thrill - V: Very loud murmur heard with stethoscope lightly on chest - VI: Very loud murmur that can be heard without a stethoscope
the three models of diagnostic reasoning
- Information Processing Model - Intuitive Model - Decision Analysis Model
PAP smear prep:
- Patient should not be menstruating. - Avoid intercourse, douches, tampons, contraceptive foams, or creams etc 48 hours before exam. - Avoid using lubricant on speculum (may interfere with the Pap test interpretation). - If excessive discharge covering cervix use a q-tip applicator to GENTLY remove it.
Three dimensions of cultural humility:
- Self-awareness - Respectful communication - Collaborative partnerships
one to three words
1 year
When are newborns most responsive?
1-2 hours after feeding
toddler
1-3 years
adolescence (late childhood)
13 years to 18 years
Almost all children walk by
15 months
normal RR reaches adult levels at
15 years of age
cooing
2 months
normal RR in early childhood
20-40
By __ months, typical infants lift their heads and clasp their hands.
3
Nocturnal or daytime ejaculation tends to begin around Sexual Maturity Rating
3
Menarche usually occurs when a girl is in breast stage ___. By then, she has passed her peak growth spurt.
3 or 4
normal diaphragmatic excursion
3-5.5 cm
newborn RR
30-68
how many adult teeth are there
32 teeth
late preterm
34-36 weeks
term
37-41 weeks
average oral temperature:
37°C or 98.6°F
Almost all children pedal a tricycle and jump by
4 years
cone of light in right ear
5 o'clock
Mild childhood
5-10 years old
HR in children 6-10 years old
52-130 bpm
HR one month-six months
80-175, average 130
HR in children 1-2 years old
88-155 bpm
A patient who presents to clinic complaining of hand pain says she was told by a friend that it is most likely carpal tunnel syndrome. The nurse practitioner performs all the the following procedures to assess for median nerve compression EXCEPT: A. Ask the patient to grasp the thumb against the palm and then move the wrist toward the midline in ulnar deviation B. Lightly tap over the course of the median nerve C. Ask the patient to raise the thumb straight up as the practitioner applies downward resistance D. Ask the patient to press the backs of both hands together to form right angles.
A. Ask the patient to grasp the thumb against the palm and then move the wrist toward the midline in ulnar deviation
mole evaluation:
ABCDE asymmetry, border, color (more than one hue), diameter (> 6 mm?), elevation/evolving (raised, uneven surface)
(lean forward, hold breath); diastolic murmur LSB or apex; diaphragm.
Aortic regurgitation
systolic murmur - loudest aortic, radiates neck; PMI enlarged; slow carotid upstroke.
Aortic stenosis
Appropriate areas for the general survey include: A. signs of distress, posture, and breath sounds B. level of consciousness, personal hygiene, and facial expression C. ear position, body odor, and apparent state of health D. gait, signs of pain, and reflexes
B. level of consciousness, personal hygiene, and facial expression
Which of the following best represents metrorrhagia? A. Excessive menstrual flow B. Infrequent bleeding C. Bleeding between menses D. Fewer than 21 days between menses
C. Bleeding between menses
Persistence of clenched hand beyond 2 months suggests
CNS damage
Heberden nides
DIP joint, OA
Tangential speech with shifting topics that are loosely connected or unrelated. The patient is unaware of the lack of association.
Derailment (loosening of associations)
THE CHEST CONTRACTS AND THE DIAPHRAGM RELAXES, SHIFTING UP INTO THE RELAXED POSITION.
EXPIRATION
moro reflex
Infant reflex where a baby will startle in response to a loud sound or sudden movement, birth to 4 months
(left lateral position); S3, S4; mitral murmur; bell.
Mitral stenosis
MANIFESTS AS A RECURRENT VASOSPASM IN THE FINGERS AND TOES AND OCCURS AS A RESULT OF STRESS OR COLD TEMPERATURES.
RAYNAUD PHENOMENON
Deep palpation on the LLQ elicits pain in RLQ
Rovsing's sign
condylar joint
TMJ
precursor to SCC
actinic keratoses
Sit forward and listen in aortic area, accentuates
aortic regurgitation
S2 is diminished in
aortic stenosis
delayed carotid upstroke
aortic stenosis, left ventricular outflow obstruction or significant decrease in SV
test for minor effusion
bulge sign
slightly movable joints
cartilaginous joints
chvostek's sign
cheek, facial spasm when cheek is tapped associates with hypocalcemia
GCS 3-8
coma
Seen in Korsakoff syndrome from alcoholism.
confabulation
assess the AC joint, adduct the patient's arm across the chest
crossover test
undescended testes
cryptorchidism
- Failure to illicit critical info in subjective data, sub-optimal weighing, inaccurate or misinterpretation of subjective information, failure in eliciting critical PE findings. - Pt/clinician factors. - Failure to elicit critical data.
data acquisition
cognitive development includes
developmental milestones, language, school performance
bowel sounds
diaphragm
uncomfortable awareness of breathing that is inappropriate to a given level of exertion.
dyspnea
if head circumference is rising
incr ICP
accentuates RIGHT sided murmurs.
inspiration
SCCs that arise rapidly and have a crateriform center
keratoacanthomas
cranial nerve I
olfactory nerve
infancy
one month to one year
hemiplegia
one-sided paralysis
movement of the pinna elicits pain
otitis externa
MRI contraindicated in
patients with metallic joints, pacemakers, and implants
multiple round to oval scaling violaceous plaques on abdomen and back.
pityriasis rosea
8th leading cause of death
pneumonia
a loose, hood-like fold of skin
prepuce/foreskin
PAIN THAT STARTS SOMEWHERE ELSE BUT SHARES THE SAME NERVE INNERVATION.
referred pain
tetanus
rigid newborn
amber color
serous effusion
Inspect the breasts and nipples with the patient in the
sitting position and disrobed to the waist
deeper loss of the epidermis and at least the upper dermis.
ulcers
BMI < 18.5
underweight
knock knees
valgus
"Bag of worms"
varicocele
Refers to gravity-mediated varicose veins of the spermatic cord, usually found on the left. It feels like a soft "bag of worms" in the spermatic cord above the testis, and if prominent, appears to distort the contours of the scrotal skin. A varicocele collapses in the supine position, so examination should be both supine and standing. If the varicocele does not collapse when the patient is supine, suspect a left spermatic vein obstruction within the abdomen.
varicocele
bulging veins
varicose veins
Dilation of lingual veins. Occur with age.
varicosities
bowlegged
varus
inversion of the foot
varus
Laxity or possible tear of LCL. LCL: LATERAL COLLATERAL LIGAMENT. Put one hand on the medial side and push laterally at the knee and medially at the ankle.
varus (adduction) stress test.
cranial nerve VIII
vestibulocochlear nerve
Arise in the narrowed airways of asthma, COPD, and bronchitis.
wheezes
Use this type of language especially when referring to patients with disabilities.
"people-first"
mammography recommendations for women of high risk:
- Annual starting at age of 30 years. - Mammography + MRI starting at age 30 years for women with known BRCA mutation or first-degree family members with BRCA mutation recommended by ACS and ACR/SBI.
important family history for breast exam:
- Breast problems or disorders (3 generations). - History of breast cancer gene mutations (BRCA1 or 2). - History of fibrocystic breast. - Reproductive or endocrine disorders in the family.
Influential factors in APRN reasoning:
- Clinician's experience. - Clinician's knowledge base. - Clinician's ability to recall from memory. - Contextual factors: patient's clinical presentation of problem, prevalence of the disease, diagnostic studies utilized/ resource constraints, time constraints
nose and sinus red flags
- Epistaxis (persistent, recurrent, profuse). - Severe maxillary pain. - Thin, honey-colored sinus drainage following head trauma (skull fracture).
hypothyroidism s/s:
- Fatigue, lethargy - Modest weight gain with anorexia - Dry, coarse skin and cold intolerance - Swelling of face, hands, and legs - Constipation - Weakness, muscle cramps, arthralgias, paresthesias, impaired memory, and hearing - Dry, coarse, cool skin, sometimes yellowish from carotene, with nonpitting myxedema and loss of hair - Periorbital myxedema - Low-pitched speech - Decreased systolic and increased diastolic blood pressures - Bradycardia and, in late stages, hypothermia - Sometimes decreased intensity of heart sounds - Prolonged relaxation phase during ankle reflex - Impaired memory, mixed hearing loss, somnolence, peripheral neuropathy, carpal tunnel syndrome
important for assessing an infant, toddler, and preschool-age child:
- GROWTH - DEVELOPMENT [Neuro-cognitive] - PHYSICAL EXAMINATION, standard format
important for assessing a middle childhood/school age child:
- GROWTH & MATURATION - DEVELOPMENT (Neuro-cognitive) - PE, standard
important for assessing an adolescent:
- GROWTH [ > < ] & MATURATION - COGNITIVE, School Performance - PE, standard + secondary sexual characteristics
less concerning breast findings:
- Multiple or single. - Rubbery texture. - Mobile/ slippery. - Regular borders. - Tenderness (cyclic). - No retraction. - Increase/decrease in size rapidly.
hyperthyroidism s/s:
- Nervousness - Weight loss despite increased appetite - Excessive sweating and heat intolerance - Palpitations - Frequent bowel movements - Tremor and proximal muscle weakness - Warm, smooth, moist skin - With Graves disease, eye signs such as stare, lid lag, and exophthalmos - Increased systolic and decreased diastolic blood pressures - Tachycardia or atrial fibrillation - Hyperdynamic cardiac pulsations with an accentuated S1 - Tremor and proximal muscle weakness
risk factors for melanoma:
- Personal or family history of previous melanoma. - Greater than or equal to 50 common moles. - Atypical or large moles, especially if dysplastic. - Red or light hair. - Solar lentigines (acquired brown macules on sun-exposed areas). - Freckles (inherited brown macules). - Ultraviolet radiation from heavy sun exposure, sunlamps, or tanning booths. - Light eye or skin color, especially skin that freckles or burns easily. - Severe blistering sunburns in childhood. - Immunosuppression from human immunodeficiency virus (HIV) or from chemotherapy. - Personal history of nonmelanoma skin cancer.
abdominal red flags:
- Progressive intractable vomiting - Associated syncope - Acute onset of pain - Pain that progresses in intensity over hours (>6 hrs) - Pain that awakens pt, changes location, followed by vomiting - Radiation of pain in shoulder or back - Pain that is worse with movement - Black tarry stools, hematemesis - Involuntary guarding - Progressive abdominal distention - Fever - Leukocytosis & granulocytosis - Decreased urine output
S/S OF RESPIRATORY DISTRESS IN ADULTS:
- TACHYPNEA (RR > 25) - CYANOSIS OR PALLOR - AUDIBLE SOUNDS OF BREATHING - USE OF ACCESSORY MUSCLES - INCR AP DIAMETER
red flags of headaches:
- Thunderclap headache à has increased moderate severity and comes on quickly. - Worst Headache of a lifetime! - New onset headache after 50 years. - Progressive headache over 3 months. - Aggravated or alleviated by a change in position. - Precipitated by Valsalva maneuver. - Associated symptoms: fever, weight loss, night sweats or signs: neck stiffness, focal neuro deficits, papilledema. - Associated with pregnancy, HIV, and cancer. - Recent head trauma.
concerning breast findings:
- Unilateral. - Size > 1 cm. - Firm/hard texture. - Fixed position. - Irregular borders. - Painless. - Associated retraction of nipple. - Increases in size consistently. - Dimpling over skin.
red flags for male reproductive organs:
- acute onset testicular pain - cellulitis or necrotic changes to skin of scrotum, penis, or perineal area - erection lasting >60 min after cessation of sexual activity, without decrease in turbidity - inability to urinate - new mass, or previously identified mass that is newly painful in scrotum
risk factors for pressure injuries:
- decreased mobility, especially if accompanied by increased pressure or movement causing friction or shear stress. - decreased sensation, from brain or spinal cord lesions or peripheral nerve disease. - decreased blood flow from hypotension or microvascular disease such as diabetes or atherosclerosis. - fecal or urinary incontinence. - presence of fracture. - poor nutritional status or low albumin.
three mechanisms of facial dysmorphogenesis:
- deformations from intrauterine constraint - disruptions from amniotic bands or fetal tissue - malformations from intrinsic abnormality in face/head or brain
factors affecting blood pressure
- left ventricular stroke volume - distensibility of the aorta and the large arteries - peripheral vascular resistance, particularly at the arteriolar level - volume of blood in the arterial system
developmental skills at 1 month:
- lifts chin up in prone position, turns head when prone - hands fisted - makes throaty noises, startles to sound - discriminates parents' voice, follows face
developmental skills at 9 months:
- pulls to stand, bear walks, begins creeping - pincer grasp, bangs two cubes together - says "mama" nonspecificially, imitates sounds, orients to name - follows a paint, enjoys peek a boo, develops stranger anxiety
developmental skills at 6-7 months:
- sits propped on hands, lateral protection, bounces when held - transfers objects from hand to hand, reaches out with one hand, feeds self cracker - babbles, consonant sounds, understands "no" - enjoys reflection in mirror, looks from object to parent and back when wanting help
developmental skills at 4 months:
- sits with support, no head lag, rolls from front to back - hands predominantly open, reaches for objects - laughs out loud, stops crying to soothing voice - social smile
developmental skills at 12 months:
- stands independently, starts taking first steps - scribbles, hold crayon, makes tower with two cubes - says one word with meaning, points to get objects, follows one-step commands with gestures - shows objects to parents to share
grading of pulses:
0: absent 1: weak and diminished (barely palpable) 2: normal (easily palpable) 3: full, increased 4: strong and bounding
pitting edema scale:
1+: Barely detectable impression when finger is pressed into skin 2+: Slight indentation; 15 seconds to rebound 3+: Deeper indentation; 30 seconds to rebound 4+: >30 seconds to rebound
The floating ribs that have no anterior attachments.
11th and 12th ribs
median age of menarche
12-13
Delayed puberty is suspected in boys who have no signs of pubertal development by
14 years of age
normal RR for adults (in her pp)
14-20 per min
normal RR in late childhood
15-25
normal umbilical cord
2 arteries and 1 vein
Almost all children run by
2 years
hand preference is often demonstrated by
2 years
When can we start calculating BMI?
2 years and up
typical menstrual cycle
24-32 days
infants RR
25-60
preschool age
3-6 years
typical menstrual period
3-7 days
BETTER TO ASSESS BREAST TISSUE ___ WITH SELF BREAST EXAM.
5-7 DAYS AFTER START OF MENSTRUAL CYCLE
where is the PMI?
5th intercostal space, midclavicular line
babbling
6 months
roll over, reach for objects, turn to voices, and sit with support
6 months
liver span
6-12 cm @ MCL; 4-8 cm midsternal line
school age (middle childhood)
6-12 years
spleen span
6-9th rib to 11th rib at the left mid-axillary line
HR in children 2-6 years old
65-140 bpm
cone of light in left ear
7 o'clock
By __ months, they imitate sounds, orient to their own name and they may recognize the examiner as a stranger deserving wary cooperation.
9
HR birth-one month
90-165, average 140
HR six months to 12 months
90-170, average 115
ELBW
< 1000 g
VLBW
< 1500 g
LBW
< 2500 g
normal JVP
< 3 cm above level of sternal angle
preterm
< 37 weeks
postterm
> 42 weeks
Which statement belongs most appropriately in the Review of Systems? A. "No chest pain, no dyspnea on exertion." B. "Client's mother recognizes signs and symptoms of asthma." C. "Hospitalized with asthma 6/94." D. "Breath sounds are vesicular; no rales or rhonchi ausculated."
A. "No chest pain, no dyspnea on exertion."
The practitioner knows that the "normal" liver span is approximately how many cm in the right midclavicular line? A. 6-12 cm B. 3-6 cm C. 1- 3 cm D. 12- 15 cm
A. 6-12 cm
A 25 y/o female presents to the clinic with complaints of vaginal discharge that she describes as gray, thin, and malodorous. The pH of the discharge was found to be >4.5 and clue cells were identified on the wet mount microscopic examination. Which of the following is MOST likely? A. Bacterial vaginosis B. Trichomonal vaginitis C. Candidal vaginitis D. Neisseria gonorrhoeae
A. Bacterial vaginosis
A college student presents with a sore throat, fever, and fatigue for several days. You notice exudates on her enlarged tonsils. You do a careful lymphatic examination and notice some scattered small, mobile lymph nodes just behind her sternocleidomastoid muscles bilaterally. What group of nodes is this? A. Posterior cervical B. Tonsillar C. Submandibular D. Occipital
A. Posterior cervical
You are seeing a patient in the clinic with suspected appendicitis. During the examination you place you hand just above the patient's right knee and ask the patient to raise that thigh against your hand. This maneuver is called: A. Psoas sign B. Obturator sign C. Rovsing's sign D. Murphy's sign
A. Psoas sign
A sign which BEST supports the presence of peritonitis is: A. Rebound tenderness B. Borborygmus C. Friction rub D. Voluntary guarding
A. Rebound tenderness
A 32-year-old warehouse worker presents for evaluation of low back pain. He notes a sudden onset of pain after lifting a set of boxes that were heavier than usual. He also states that he has numbness and tingling in the left leg. He wants to know if he needs to be off of work. What test should you perform to assess for a herniated disc? A. Straight-leg raise B. Phalen's test C. Tinel's test D. Apley scratch test
A. Straight-leg raise
Which of the following statements about percussion is true? A. Use the lightest percussion that produces a clear note. B. When performing percussion, the 2nd, 4th, and 5th fingers should also be touching the chest. C. Percussion should be done up and down each side of the chest rather than side to side (one side of the chest to the other). D. Strike using the pad of your tapping finger.
A. Use the lightest percussion that produces a clear note.
A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Which term describes the findings? A. exophthalmos B. ptosis C. chalazion D. ectropion
A. exophthalmos
Muscle tone is BEST assessed by: A. feeling the muscle's resistance to passive stretch B. palpating muscle groups as the client performs active range of motion C. asking the client to resist when the clinician applies opposing force to the muscle D. performing deep tendon reflexes
A. feeling the muscle's resistance to passive stretch
A "positive" Phalen's test indicates A. increased likelihood of carpal tunnel syndrome B. decreased likelihood of carpal tunnel
A. increased likelihood of carpal tunnel syndrome
When you record that a patient's visual fields are full by confrontation, you have assessed: A. peripheral vision B. visual acuity C. pupillary reaction D. EOMs
A. peripheral vision
Which client position is NOT used for the cardiac assessment? A. right lateral recumbent B. sitting and leaning forward C. supine D. sitting
A. right lateral recumbent
Asymmetry (of one side of mole compared to the other). Border irregularity especially if ragged, notched, or blurred. Color variations (more than two colors, especially blue-black, white, or red). Diameter > 6 mm. Evolving or changing rapidly in size, symptoms, or morphology; Elevation. Firmness to palpation. Progressive Growing over several weeks.
ABCDEFG (mole)
REDNESS, SWELLING, BULGING OF TM AND ALTERATION IN CONE OF LIGHT.
ACUTE OTITIS MEDIA
A common cause of acute abdominal pain especially in the RLQ. Assess for signs of McBurney point tenderness, Rovsing sign (indirect tenderness), the psoas sign, and the obturator sign.
Appendicitis
In a healthy adult, the estimated extent of diaphragmatic excursion is: A. 7 to 8.5 cm B. 3 to 5.5 cm C. 10 to 12.5 cm D. 1 to 2.5 cm
B. 3 to 5.5 cm
A patient presents to you with shoulder pain after falling during an ice storm. On examination, he exhibits localized shoulder pain when you perform the "crossover test" (arm moved across the chest toward the opposite side while extended at the elbow). Which is the most likely site of injury? A. Rotator cuff B. Acromioclavicular joint C. Biceps tendon D. Glenohumeral joint
B. Acromioclavicular joint
Which range of motion maneuver is performed when assessing the temporomandibular joint (TMJ)? A. lateral (side to side) motion B. All of these answers C. protrusion and retraction D. opening and closing
B. All of these answers
A 55 y/o female presents for her annual exam. In order to examine her breasts, you ask her first to place her arms over her head, and then place her hands against her hips, and, finally, to lean forward. While in the "leaning forward" position, you notice that she has asymmetry and there is retraction in the left nipple and areola. This finding makes you suspicious for which clinical condition? A. Fibrocystic breast disease B. Breast cancer C. Acanthosis nigricans D. Mastitis
B. Breast cancer
The nurse documents that Mrs. A. has "annular erythematous macules on her abdomen." This describes skin lesions that are: A. Elevated, firm, and circumscribed B. Flat, circumscribed, red, and circular in distribution C. Flat, brownish, and clustered D. Sealy, dense, and scattered
B. Flat, circumscribed, red, and circular in distribution
What is the preferred order for examination of the abdomen? A. Auscultation, inspection, palpation, percussion B. Inspection, auscultation, percussion, palpation C. Percussion, auscultation, palpation, inspection D. Inspection, palpation, auscultation, percussion
B. Inspection, auscultation, percussion, palpation
Ms. Smith is complaining of costovertebral angle tenderness (CVAT). This is MOST OFTEN indicative of: A. Liver enlargement B. Kidney inflammation C. Ovary infection D. Spleen enlargement
B. Kidney inflammation
In the Rinne test, bone conduction is greater than air conduction (BC > AC). What is the most likely explanation? A. The patient has a history of noise exposure. B. The patient has conductive hearing loss. C. The patient has sensorineural hearing loss. D. This is a normal finding.
B. The patient has conductive hearing loss.
Upon palpation of the masseter muscles while the patient is clenching her teeth, decreased motor strength indicates a lesion of which cranial nerve? A. VIII B. V C. III D. VII
B. V
You feel a small mass that you think is a lymph node. It is mobile in both the up-and-down and side-to-side directions. The mass is most likely A. cancer B. a lymph node C. scar tissue D. a muscle
B. a lymph node
The clinical nurse leader asks the client to rub the heel of each foot down the opposite shin. This maneuver tests: A. spinal nerve integrity B. cerebellar function and position sense C. motor tone D. pronator drift
B. cerebellar function and position sense
On examination, you note both eyes turn inward. What is this called? A. pseudostrabismus B. esotropia C. strabismus D. presbyopia
B. esotropia
You are examining a patient with a past medical history of polycystic ovary syndrome. Which hair pattern would you expect to find? A. tinea capitis B. hirsutism C. alopecia areata D. trichotillomania
B. hirsutism
The nurse practitioner is examining the nails of a patient with chronic obstructive pulmonary disease (COPD). Which of the following findings is most likely on physical exam? A. curving transverse white bands B. increased angle of the nail >180 degrees C. nonuniform white spots D. white nail plate with ground glass appearance
B. increased angle of the nail >180 degrees
You are performing a cardiac examination on a patient. Which valvular defect is best heard with the patient in the left lateral decubitus position? A. tricuspid B. mitral C. aortic D. pulmonic
B. mitral
The nurse practitioner is assessing a patient with Raynaud disease. When assessing the wrist pulses, what would the nurse practitioner expect to find? A. bounding pulses B. normal pulses C. diminished pulses D. absent pulses
B. normal pulses
To palpate the axillary lymph nodes, it is BEST to place the patient in a: A. lateral position with arm at side B. sitting position, relaxed, with arm down at their side C. sitting position with arm raised over head D. supine position with arm raised over head
B. sitting position, relaxed, with arm down at their side
Stereognosis and graphesthesia are tested in order to assess: A. cranial nerve V (Trigeminal nerve) B. tactile discrimination in the cerebral cortex C. vestibular function D. spinal nerve intactness
B. tactile discrimination in the cerebral cortex
The healthcare provider is preparing to assess the vibratory sensation of a client during a physical examination. Which piece of equipment is appropriate for this assessment? A. monofilament B. tuning fork C. reflex hammer D. stethoscope
B. tuning fork
MANY TIMES, ASSOCIATED WITH COPD, BUT BARREL CHEST IS NOT EXCLUSIVE TO COPD.
BARREL CHEST
Split with pathology
BBB, atrial septal defects, or pulmonic stenosis
The most common skin cancer is
BCC
WHY AUSCULTATE ABDOMEN FOLLOWING INSPECTION?
BECAUSE WHEN YOU PALPATE OR PERCUSS THE STOMACH YOU ALTER THE BOWEL SOUNDS.
a common finding in men that is not a risk factor for prostate cancer
BPH
A RUMBLING SOUND THAT YOU CAN HEAR.
BRUIT
The nurse practitioner (NP) is performing a special test to evaluate a patient for meningeal inflammation. With the patient supine, the NP flexes the neck and notices flexion of both the hips and knees. This is a "positive" result of which of the following tests? A. Kernig's B. Nuchal Rigidity C. Brudzinski's D. Romberg
C. Brudzinski's
Mr. Wallace comes into the clinic with complaints of left lower quadrant (LLQ) pain that started off crampy at first but is now steady. On examination you note he has LLQ tenderness, abdominal distention, and a palpable mass. Which of the following is the MOST LIKELY cause? A. Urinary tract infection B. Appendicitis C. Diverticulitis D. Kidney stone
C. Diverticulitis
You are conducting a workshop on the measurement of jugular venous pulsation. As part of your instruction, you tell the students to make sure that they can distinguish between the jugular venous pulsation and the carotid pulse. Which characteristic is typical of the carotid pulse? A. Soft, rapid, undulating quality B. Pulsation eliminated by light pressure on the vessel C. Palpable D. Level of pulsation changes with changes in position
C. Palpable
Which scenario is NOT appropriate for a "comprehensive health history"? A. a new patient to the practice B. a patient with numerous chief concerns C. a patient with one acute problem D. a patient who presents for a health maintenance visit
C. a patient with one acute problem
Which of the following are risk factors for cervical cancer? A. smoking B. multiple sexual partners C. all of the others D. failure to undergo screening
C. all of the others
Which of the following signs and symptoms warrant an urgent surgical evaluation in a male patient with a recurrent inguinal hernia? A. tenderness B. erythema C. all of these answers D. nausea and vomiting
C. all of these answers
You assess the nasal mucosa and find the turbinates to be a pale-bluish color. What diagnosis do you suspect? A. viral rhinitis B. bacterial sinusitis C. allergic rhinitis D. this is a normal finding
C. allergic rhinitis
A "positive" Phalen's test indicates an increased likelihood of A. De Quervain's tenosynovitis B. Dupuytren flexion contractures C. carpal tunnel syndrome D. Heberden's nodes
C. carpal tunnel syndrome
Skin turgor refers to degree of: A. stretch B. moisture C. elasticity D. coarseness
C. elasticity
The nurse practitioner is assessing the hair of a patient with a new diagnosis of hypothyroidism. Which of the following is NOT consistent with hypothyroidism? A. brittle hair B. coarse hair C. fine and silky hair D. sparse hair
C. fine and silky hair
Which of the following physical findings would NOT be typical for a patient with chronic obstructive pulmonary disease (COPD): A. tripod posture B. hyperresonance in thoracic percussion C. increased tactile fremitus D. distant breath sounds
C. increased tactile fremitus
Fibrous bands running directly from one bone to another that strengthen the joint and help prevent movement in undesirable directions are called: A. cartilage B. bursae C. ligaments D. tendons
C. ligaments
You are performing a cardiac examination on a patient with shortness of breath and palpitations. When you listen to the heart with the patient on his left side in the left lateral decubitus position which valvular defects is best heard in this position? A. pulmonic B. tricuspid C. mitral D. aortic
C. mitral
Using a small blood pressure cuff in an obese patient may lead to which of the following? A. underestimation of systolic blood pressure B. no change in the reading C. overestimation of systolic blood pressure
C. overestimation of systolic blood pressure
Which of the following terms describes a tight prepuce that cannot be retracted over the glans? A. balantis B. cryptorchidism C. phimosis D. paraphimosis
C. phimosis
Pitting (punctuated depressions of the nail plate) are most common in which chronic condition? A. diabetes B. lung cancer C. psoriasis D. hypothyroidism
C. psoriasis
In evaluating the Romberg test, the nurse notes that which finding is considered abnormal? The client A. is unable to repeat a series of words by reading the speaker's lips B. incorrectly identifies a common object placed in his hand C. steps sideways when standing with feet together and eyes closed D. narrows the base of support to maintain upright posture
C. steps sideways when standing with feet together and eyes closed
The most widely used screening questions for alcohol use are the
CAGE questions about Cutting down, Annoyance when criticized, Guilty feelings, and Eye openers
COMMON IN PATIENTS WITH LONG-STANDING RESPIRATORY DISORDERS, INTERSTITIAL LUNG DISEASE, CHANGES IN THE ANGLE OF THE NAIL BED.
CLUBBING
if head circumference has plateaued
CNS not growing or restricted
decreased to absent, wheezing, crackles, rhonchi, prolonged expiration.
COPD
third leading cause of death
COPD
Generalized hyperresonance is common over the hyperinflated lungs of
COPD or asthma
calcinosis, Raynaud phenomenon, sclerodactyly, matted telangiectasias of face and hands (palms).
CREST syndrome
less expensive than MRI, good for evaluating masses, bone trauma, fractures, bleeding, and aneurysms
CT scan
The leading cause of death in women
CVD
A yellowish discharge on the endocervical swab commonly represents mucopurulent cervicitis from
Chlamydia trachomatis, Neisseria gonorrhoeae, or herpes simplex
sexual maturity rating 4 in girls (pubic hair):
Coarse and curly hair as in adults; area covered greater than in stage 3 but not as great as in the adult and not yet including the thighs
stage 4 sexual maturity in boys:
Coarse and curly hair, as in the adult; area covered greater than in stage 3, but not as great as in the adult and not yet including the thighs Further enlarged in length and breadth, with development of the glans Further enlarged; scrotal skin darkened
Pink-purple striae are a hallmark of
Cushing syndrome
When you perform the test for egophony on a patient with lobar pneumonia, you would expect to hear: A. "OOO" B. Whispered pectoriloquy C. "EEE" D. "AAY"
D. "AAY"
In a healthy adult, the respiratory rate is how many breaths per minute (bpm): A. 4 to 14 bpm B. 26 to 40 bpm C. 14 to 16 bpm D. 14 to 20 bpm
D. 14 to 20 bpm
At what age should women initiate cervical cancer screening according to the ACOG guidelines? A. After they become sexually active B. 30 years C. 18 years D. 21 years
D. 21 years
You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which description correctly defines the ABCDEs? A. A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = elevation B. A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution C. A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution D. A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution
D. A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution
Dawn is a 55 year old female who comes in today for her annual wellness examination. You carefully perform the rectal exam in the lithotomy position and feel a mass against the bowel wall which is firm and immobile. Which of the following is MOST likely? A. Valve of Houston B. Anal fissure C. Hemorrhoid D. Colon cancer
D. Colon cancer
A light is pointed at a patient's pupil, which contracts. It is also noted that the other pupil contracts as well, though it is not exposed to bright light. Which term best describes this latter phenomenon? A. Corneal Light Reflex B. Direct reaction C. Accommodation D. Consensual reaction
D. Consensual reaction
Mr. Jones presents to the clinic with abdominal ascites. When testing for "shifting dullness", the practitioner would expect to find: A. Dullness shifting to the top and tympany shifting to the dependent side B. Dullness throughout C. Tympany throughout D. Dullness shifting to the dependent side and tympany shifting to the top
D. Dullness shifting to the dependent side and tympany shifting to the top
The nurse practitioner is about to perform a pelvic examination on a 40 year old multiparous female with a history of vaginal prolapse. Which speculum is most appropriate to use? A. Small Pedersen specula B. Narrow Pedersen specula C. Medium Pedersen specula D. Graves specula
D. Graves specula
A 65-year-old male presents to clinic for a routine examination. The following is the documentation of his prostate examination. Which statement would be of concern? A. Heart-shaped B. Median sulcus palpable C. 2.5 cm long D. Hard consistency
D. Hard consistency
Which of the following statements about the technique for performing a female breast exam is LEAST true? A. Inspection of the breasts and nipples should be performed with the patient in the sitting position and disrobed to the waist B. Asking the patient to raise her arms above her head or pressing them against the hips can bring out dimpling or retraction C. Palpation should include the axilla and tail of the breast D. Palpation of the breast tissue should be performed with the patient sitting and leaning forward
D. Palpation of the breast tissue should be performed with the patient sitting and leaning forward
A 15 y/o high school student presents to the clinic with a one-day history of nausea and anorexia. He describes the abdominal pain as generalized yesterday, but today it has localized to the right lower quadrant (RLQ). You palpate the left lower quadrant (LLQ) and the patient experiences pain in the RLQ. What is the name of this sign? A. Obturator sign B. Psoas sign C. Cutaneous hyperesthesia D. Roving's sign
D. Roving's sign
A patient is assigned a visual acuity of 20/100 in her left eye. Which is true? A. She can see at 100 feet what a normal person could see at 20 feet. B. She obtains a 20% correct score at 100 feet. C. She can accurately name 100% of the letters at 20 feet. D. She can see at 20 feet what a normal person could see at 100 feet.
D. She can see at 20 feet what a normal person could see at 100 feet.
A 45 y/o male with a known history of hypertension related to renal stenosis comes in to the clinic for follow-up. When auscultating his abdomen you would expect to hear which of the following related to renal artery stenosis? A. Friction rub B. Systolic bruit only C. Borborygmi D. Systolic and diastolic bruit
D. Systolic and diastolic bruit
Which of the following characteristics of a breast mass is LEAST suggestive of malignancy? A. Irregular shape B. Dimpling over skin C. Hard consistency D. Tenderness
D. Tenderness
Which of the following breath sounds are most often auscultated over the majority of both lungs? A. Bronchial B. Bronchovesicular C. None of the above D. Vesicular
D. Vesicular
A patient is being assessed for range of joint movement. You ask him to move his arm in towards the center of his body. This movement is called: A. flexion B. extension C. abduction D. adduction
D. adduction
Upon auscultation of the heart, you note a crescendo-decrescendo murmur that radiates to the carotid arteries. What might this indicate? A. physiologic murmur B. mitral valve prolapse C. cardiomyopathy D. aortic stenosis
D. aortic stenosis
When palpating the skin over the forearm of a patient, tenting is noted. This is indicative of _____? A. hyperthyroidism B. malnutrition C. melanoma D. dehydration
D. dehydration
The "drop arm" sign is positive in which condition? A. biceps tendonitis B. carpal tunnel syndrome C. adhesive capsulitis D. rotator cuff tear
D. rotator cuff tear
stage 3 sexual maturity in boys:
Darker, coarser, curlier hair spreading sparsely over the pubic symphysis Larger, especially in length Further enlarged
sexual maturity rating 3 in girls (pubic hair):
Darker, coarser, curlier hair, spreading sparsely over the pubic symphysis
Loss of sense of smell indicates a lesion of which cranial nerve? A. VIII B. V C. X D. II E. I
E. I
TRIPOD POSITION, CACHEXIA, PURSED LIP BREATHING WHILE ON OXYGEN.
EMPHYSEMA
pain scale used for children 3 years and up
FACES pain scale
patient perspective
FIFE: feelings, ideas, effect on function, and expectations
pain scale used for infants
FLACC scale (face, legs, activity, cry, and consolability)
SIX Fs FOR ABDOMINAL DISTENTION
FLUID, FLATULENCE, FECES, FIBROIDS, FETUS, AND FAT
stage 3 sexual maturity in girls:
Further enlargement of elevation of breast and areola, with no separation of their contours
screening for anxiety
GAD 7
risk assessment tool that identifies risk associated with age at menarche, number of previous breast biopsies, and age at first live birth
GAIL MODEL
SWELLING OF THE BREAST TISSUE IN MALES, CAUSED BY AN IMBALANCE OF ESTROGEN AND TESTOSTERONE.
GYNECOMASTIA
THE LEFT LUNG HAS A DIFFERENT SIZE AND SHAPE BECAUSE OF THE
HEART
IMPORTANT TO KNOW THAT TWO DIFFERENT FISSURE LINES EXIST, ON THE RIGHT-HAND SIDE YOU HAVE THE ___, AND ON THE LEFT SIDE YOU HAVE THE ___.
HORIZONTAL AND THE OBLIQUE; OBLIQUE FISSURE
BOTH LUNGS ARE DIVIDED IN HALF BY THE OBLIQUE FISSURE AND THE RIGHT LUNG IS FURTHER DIVIDED INTO THE
HORIZONTAL FISSURE
the story of the patient's problem.
HPI
- Human Papillomavirus - Genital warts appear as papillary, cauliflower-like lesions - Cervical lesions are dx with visualization, acetic acid, and biopsy - Over 70 types of HPV: 6 & 11 (condyloma acuminata aka genital warts); 16, 18, 31, 33, 45, 52, & 58 (cervical, vulvar, vaginal, and anal neoplasia) - Transmitted through anal/oral/genital intercourse & childbirth
HPV
important meds to ask about during breast exam:
HRT, contraceptives, antidepressants, psychoactives, hypertensives
risk factors for CVD:
HTN, diabetes, obesity, dyslipidemia, sedentary lifestyles, stress, family history, age, gender, > 45 in males, > 55 females, diet, smoking, illicit drugs, ETOH abuse
sexual maturity rating 5 in girls (pubic hair):
Hair adult in quantity and quality, spreads on the medial surfaces of the thighs but not up over the abdomen
stage 5 sexual maturity in boys:
Hair adult in quantity and quality, spreads to the medial surfaces of the thighs but not up over the abdomen Adult in size and shape Adult in size and shape
HEEADSSS assessment for adolescents:
Home environment Education and employment Eating Activities Drugs Sexuality Suicide and depression Safety
RARE BUT AGGRESSIVE DISEASE WHERE CANCER CELLS BLOCK THE LYMPH VESSELS IN THE SKIN AND IN THE BREAST, SKIN LOOKS RED, SWOLLEN, AND INFLAMMED.
INFLAMMATORY BREAST CANCER
THE CHEST EXPANDS, AND THE DIAPHRAGM CONTRACTS WITH INSPIRATORY DESCENT.
INSPIRATION
STRUCTURAL ANATOMICAL MALFORMATION ARISING FROM FAILURE OF THE VERTEBRAL FORMATION OR SEGMENTATION.
KYPHOSIS
meningitis tests
Kernig's and Brudzinski's
WHEN A PATIENT IS COMPLAINING ABOUT PAIN IN A CERTAIN QUADRANT, PALPATE IT
LAST!
pain or a gap in the lateral joint line
LCL injury
BREAST RETRACTION AND DIMPLING, CONCERNING FINDING REGARDING
MALIGNANCY
pain or a gap in the medial joint line
MCL injury
The best-known screening test for dementia but is now copyrighted for commercial use, so is less accessible. Recommended screening tests now include the Mini-Cog and the Montreal Cognitive Assessment (MoCA).
MMSE
best for soft tissue injuries, cartilage, mensci, tendons, ligaments, joints
MRI
stage 5 sexual maturity in girls:
Mature stage: projection of nipple only; areola has receded to general contour of the breast (although in some normal individuals the areola continues to form a secondary mound)
systolic murmur - apex, radiates to axilla; PMI displace laterally; thrill.
Mitral regurgitation:
Elements of HPI:
OLDCARTS
MALIGNANCY THAT CAUSES SKIN CHANGES IN NIPPLE AND LATER AREOLA, CHRONIC ECZEMA LIKE RASH ON NIPPLE AND AREOLA, NEEDS BIOPSY TO CONFIRM.
PAGET'S DISEASE
Hirsutism is common in patients with...
PCOS
THICKENED DIMPLED SKIN THAT RESEMBLES THE RIND OF THE ORANGE, ASSOCIATED WITH INFLAMMATORY BREAST CANCER.
PEAU D'ORANGE
CHEST WALL DEFORMITY CHARACTERIZED BY POSTERIOR DEPRESSION OF THE STERNUM AND ADJACENT COSTAL CARTILAGES, OCCURS MORE FREQUENTLY IN MALES THAN FEMALES, CAN CAUSE COMPRESSION OF THE HEART AND LUNGS, AND CAUSE COSMETIC CONCERNS.
PECTUS EXCAVATUM
HELPS ESTABLISH WHETHER UNDERLYING TISSUES ARE FILLED WITH AIR, FLUID, OR SOLID MATTER.
PERCUSSION
screening for depression
PHQ 7
Cervical motion tenderness and/or adnexal tenderness are hallmarks of
PID, ectopic pregnancy, and appendicitis
the most common cause of acute pelvic pain
PID, followed by ruptured ovarian cyst and appendicitis
bouchard nodes
PIP joint, OA
apex can be palpated at the precordium
PMI
CONNECTING WITH CHILDREN WITH CHRONIC CONDITIONS CAN
POSITIVELY AFFECT HEALTH OUTCOMES
Micrognathia may also be part of a syndrome, such as the...
Pierre Robin syndrome
sexual maturity rating 1 in girls (pubic hair):
Preadolescent—no pubic hair except for the fine body hair (vellus hair) similar to that on the abdomen
stage 1 sexual maturity in boys:
Preadolescent—no pubic hair except for the fine body hair (vellus hair) similar to that on the abdomen Preadolescent—same size and proportions as in childhood Preadolescent—same size and proportions as in childhood
stage 4 sexual maturity in girls:
Projection of areola and nipple to form a secondary mound above the level of breast
functions of the skin
Protection, Thermoregulation, Cutaneous Sensation, Vitamin D synthesis, Blood Reservoir, Excretion and Absorption.
Series of questions that take an inventory of body systems to identify s/s that the pt may or may have experienced.
ROS
Closing of mitral and tricuspid valve (together called "atrioventricular valves" or "AV valves"). Represents beginning of systole.
S1
Closing of aortic and pulmonic valves (together called "semilunar valves"). Represents beginning of diastole.
S2
Corresponds to an abrupt deceleration of inflow across the mitral valve.
S3
Early diastole after S2. Low pitch, bell @ apex or left sternal border. AKA "ventricular gallop" when pathologic.
S3
Corresponds to increased left ventricular end diastolic stiffness which decreases compliance.
S4
Late diastole before S1. Usually found under pathologic conditions. AKA "atrial gallop."
S4
most commonly arises on sun-damaged skin of the head, neck, and dorsal arms and hands and can metastasize if left untreated.
SCC
FLUID BEHIND THE TM.
SEROUS OTITIS MEDIA
common or concerning thorax s/s:
SOB, cough, hemoptysis, chest pain, daytime sleepiness, snoring, or disordered sleep
THE TRACHEA BIFURCATES INTO THE MAIN STEM BRONCHI AT THE LEVELS OF THE
STERNAL ANGLE ANTERIORLY AND THE T4 SPINAL PROCESS POSTERIORLY
Red flags for PID
STIs and recent IUD insertion
The most common abnormal dysrhythmias in infants
SVT
a pulse rate too rapid to count in newborns may indicate
SVT (> 220)
Dryness from impaired secretion is seen in
Sjögren syndrome
sexual maturity rating 2 in girls (pubic hair):
Sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, chiefly along the labia
stage 2 sexual maturity in boys:
Sparse growth of long, slightly pigmented, downy hair, straight or only slightly curled, chiefly at the base of the penis Slight or no enlargement Testes larger; scrotum larger, somewhat reddened, and altered in texture
WHEN ASSESSING BREASTS, DON'T FORGET THE
TAIL OF SPENCE
SEROUS MEMBRANES THAT COVER THE OUTER SURFACE OF EACH LUNG.
THE PLEURA
A RUMBLING SENSATION THAT YOU CAN FEEL.
THRILL
one of the strongest risk factors for stroke
TIA
multiple 2-5-mm hypopigmented, hyperpigmented, or tan round to oval macules on upper neck and back, upper chest, and arms with slight inducible scale on scraping.
TINEA VERSICOLOR
VITAL WITH THE ADOLESCENT PATIENT.
TRUST-BUILDING
MOST BREAST CANCERS FOUND IN
UPPER OUTER QUADRANT
Rhonchi in infants
URI
Diopter focus
USUALLY STARTS OFF AT 0
hair tug test
Used to examine hair for fragility Hold a group of hairs in one hand and pull along the shaft with the other; any hair breaking is abnormal
hair pull test
Used to examine hair for shedding from the roots Gently grasp 50-60 hairs with thumb and index and middle fingers and pull firmly away from the scalp If all hairs have telogen bulbs, the most likely diagnosis is telogen effluvium
general survey includes:
VS, height, weight, physical appearance, position, mobility, and behavior
VINDICATE'M
Vascular Inflammatory/ Infectious Neoplastic Degenerative/ Deficiency/Drugs Idiopathic/ Intoxication/Iatrogenic Congenital Autoimmune/ Allergic/ Anatomic Traumatic Endocrine/ Environmental Metabolic
mammography recommendations for women of average risk:
Women 40-49 years (conflicting recommendations): USPSTF: doesn't recommend routine screening, although notes decision is individualized and suggests shared decision making. Women 50-74 years: USPSTF: screening mammography each 2 years. Women greater than 75 years (conflicting recommendations): USPSTF: no recommendations, some say annually, others discontinue.
rooting reflex
a baby's tendency, when touched on the cheek, to open the mouth and search for the nipple, birth to 3-4 months
torus palatinus
a bony protuberance in the midline of the hard palate
A rule of thumb for teeth:
a child will have 1 tooth for each month of age between 6 and 26 months, up to a maximum of 20 primary teeth
Can result from distention of the gastrocnemius semimembranosus bursa from underlying arthritis or trauma.
a popliteal or "Baker" cyst
The purpose of the rectovaginal examination is to assess
a retroverted uterus, to screen for colorectal cancer in women 50 years of age or older, and to detect pelvic abnormality or disease
Feeling cold, goose bumps, and shivering accompany
a rising temperature
You are assessing the Tanner staging of the breast in a young woman. You notice projection of the areola and nipple to form a secondary mound above the level of the breast. Which Tanner stage would this be? a. IV b. II c. III d. I
a. IV
The "Ortolani test" in a newborn is performed to identify a. posteriorly dislocated hip b. hypotonia of limbs c. torsion of the tibia d. clubfoot
a. posteriorly dislocated hip
cranial nerve VI
abducens nerve
moving limb AWAY from midline.
abduction
With the patient supine and the knee slightly flexed, move the thigh about 30° laterally to the side of the table. Place one hand against the lateral knee to stabilize the femur and the other hand around the medial ankle. Push medially against the knee and pull laterally at the ankle to open the knee joint on the medial side (valgus stress). Feel for excessive widening of the joint and lack of endpoint that may signal the ligament is no longer intact.
abduction (or Valgus) Stress Test, MCL
red flags in dermatologic assessment:
abnormal ABCDE findings, generalized rash, widespread blisteing or sloughing, facial swelling or oral swelling, high fever, SOB, hypotension
clubbing
abnormal curving of the nails that is often accompanied by enlargement of the fingertips
pilonidal dimple
abnormal opening between buttocks, can be direct opening to spinal canal
bleeding between menses; includes infrequent, excessive, prolonged, or postmenopausal bleeding
abnormal uterine bleeding
macrocephaly
abnormally large head
microcephaly
abnormally small head
which pulses to assess with a musculoskeletal cc
above and below the area of concern or all pulses on the extremity
extensive bronchial obstruction
absent tactile fremitus
cranial nerve XI
accessory nerve
a disorder of the pilosebaceous unit that involves proliferation of the keratinocytes at the opening of the follicle; increased production of sebum, stimulated by androgens, which combines with keratinocytes to plug the follicular opening; growth of Propionibacterium acnes, an anaerobic diphtheroid normally found on the skin; and inflammation from bacterial activity and release of free fatty acids and enzymes from activated neutrophils.
acne
The most common cutaneous disorder in the United States, affecting more than 85% of adolescents.
acne vulgaris
about 15-20 pustules and acneiform papules on buccal and parotid cheeks bilaterally.
acne vulgaris
Cyanotic congenital heart disease can present with severe ___, which persists despite warming.
acrocyanosis
This bluish discoloration usually appears in the palms and soles.
acrocyanosis
The increased growth hormone of acromegaly produces enlargement of both bone and soft tissues. The head is elongated, with bony prominence of the forehead, nose, and lower jaw. Soft tissues of the nose, lips, and ears also enlarge. The facial features appear generally coarsened.
acromegaly
A precancerous condition that results from excessive exposure to sunlight and affects primarily the lower lip. Fair-skinned men who work outdoors are most often affected. The lip loses its normal redness and may become scaly, somewhat thickened, and slightly everted. Solar damage predisposes to squamous cell carcinoma of the lip, so examine these skin lesions carefully.
actinic cheilitis
Ecchymoses limited to the dorsal forearms and hands but not extending above the "shirt sleeve" line on the upper arm.
actinic purpura
Unlikely until viral URI symptoms persist more than 7 days; both purulent drainage and facial pain should be present for diagnosis (sensitivity and specificity are above 50%).
acute bacterial sinusitis (rhinosinusitis)
diarrhea that lasts less than 14 days
acute diarrhea
An acutely inflamed epididymis is indurated, swollen, and notably tender, making it difficult to distinguish from the testis. The scrotum may be reddened and the vas deferens inflamed. Causes include infection from Neisseria gonorrhoeae, Chlamydia trachomatis (younger adults), Escherichia coli, and Pseudomonas (older adults); trauma; and autoimmune disease. Barring urinary symptoms, urinalysis is often negative.
acute epididymitis
otitis media can progress to
acute mastoiditis
the auricle may protrude forward and outward, and the area over the mastoid bone is red, swollen, and tender
acute mastoiditis
A symptomatic child typically has a red, bulging tympanic membrane with a dull or absent light reflex and diminished movement on pneumatic otoscopy. Purulent material may also be seen behind the tympanic membrane. The most useful symptom in making the diagnosis is ear pain, if combined with the above signs.
acute otitis media
Commonly caused by bacterial infection from S. pneumoniae or H. influenzae. Symptoms include earache, fever, and hearing loss. The tympanic membrane reddens, loses its landmarks, and bulges laterally, toward the examiner's eye.
acute otitis media with purulent effusion
Very tender! Enlarged (usually) Boggy Not nodular
acute prostatitis
bulging red tympanic membrane
acute purulent otitis media
Flank pain, fever, and chills signal
acute pyelonephritis
when to gather focused health history
acute visit, one problem, establish patient coming in with a problem
Hyperpigmentation of oral mucosa as well as sun-exposed skin, sites of trauma, and creases of palms and soles.
addison disease
moving limb TOWARDS midline.
adduction
With the thigh and knee in the same position, change your position so that you can place one hand against the medial surface of the knee and the other around the lateral ankle. Push laterally against the knee and pull medially at the ankle to open the knee joint on the lateral side (varus stress). Feel for excessive widening of the joint and lack of endpoint that may signal the ligament is no longer intact.
adduction (or Varus) Stress Test, LCL
refers to the ovaries, fallopian tubes, and their supporting tissues
adnexa
Can arise from a tubo-ovarian abscess; salpingitis, or inflammation of the fallopian tubes from PID; or ectopic pregnancy. Distinguish such a mass from a uterine myoma.
adnexal mass
Social interaction becomes important in...
adolescence
health promotion for smoking!
adopt the 4 As: - Ask about smoking at each visit. - Advise patients to stop smoking at every visit. - Assist patients to set quit dates & provide self-help material. - Arrange for follow-up visits to monitor progress.
pain scale used for school age children and up
adult numeric scale
Sensitive to aspects of the situation, able to formulate principles, but needs help setting priorities.
advanced beginner
who is at risk for prostate cancer
african american men > age 50
the degree of vascular resistance to ventricular contraction.
afterload
Risk factors for AAA:
age ≥ 65 years, history of smoking, male gender, and a first-degree relative with a history of AAA repair
Risk factors for POAG include
age ≥65 years, African American ethnicity, diabetes, myopia, and ocular hypertension (intraocular pressure [IOP] is ≥21 mm Hg)
The strongest risk factors for prostate cancer.
age, ethnicity, and family history
typical age of menopause
ages 48-55 years, median 51 years
Compares patency of the ulnar and radial arteries. It also ensures patency of the ulnar artery before puncturing the radial artery for blood samples. The patient should rest with hands in lap, palms up.
allen test
The hand is elevated and the patient/person is asked to make a fist for about 30 seconds. Pressure is applied over the ulnar and the radial arteries to occlude both. Still elevated, the hand is then opened. It should appear blanched (pallor can be observed at the fingernails). Ulnar pressure is released and the color should return in 7 seconds, indicating that the ulnar artery supply to the hand is sufficient and it is safe to draw blood from the radial artery. If color does not return or returns after 7 seconds, then the ulnar artery supply to the hand is not sufficient and the radial artery therefore cannot be safely used for blood draw.
allen test
Nasal mucosa & turbinates edematous & pale, bluish (red). Watery drainage.
allergic rhinitis
Pale, boggy nasal mucous membranes are found in children with
allergic rhinitis
absence of menses
amenorrhea
The first reliable sign of puberty in boys, starting between ages 9 and 13.5 years is
an increase in the size of the testes
developmental quotient
an overall developmental score that relates to performance in four domains: motor skills, language use, adaptive behavior, and personal-social
A common cause of blood in the stool of infants which is a superficial break in the surface of the anus and observable with the naked eye.
anal fissure
Reflex important to elicit if possible spinal cord lesion
anal reflex or anal wink, contraction of external anal sphincter when skin surrounding anus is touched
Present in inflammatory bowel disease but are more often an incidental finding when located in the midline.
anal skin tags
- Based on careful consideration. - Often used if it is a complex, ill-defined case, unusual findings, or the practitioner has little experience. - Time, effort. - Greater reliability, less risk of errors.
analytical diagnostic reasoning
severe generalized edema extending to the sacrum and abdomen.
anasarca
Tendency to perceptually lock onto salient features in the patient's initial presentation too early in the diagnostic process and failure to adjust in light of later information.
anchoring bias
examples of causing errors in clinical reasoning:
anchoring, premature closure, availability, representativeness, overconfidence
pallor indicates
anemia
a localized subcutaneous or submucosal swelling caused by leakage of intravascular fluid into interstitial tissue.
angioedema
Starts with softening of the skin at the angles of the mouth, followed by fissuring. It may be due to nutritional deficiency or, more commonly, overclosure of the mouth, seen in people with no teeth or with ill-fitting dentures. Saliva wets and macerates the infolded skin, often leading to secondary infection with Candida, as seen here.
angular cheilitis
unequal pupils
anisocoria
the two most common causes of delayed sexual development in an extremely thin adolescent girl
anorexia nervosa and chronic disease
common causes of delayed puberty in girls
anorexia nervosa, inadequate gonadotropin secretion
+ lens
anterior
Tests ACL injuries/knee stability. ACL: ANTERIOR CRUCIATE LIGAMENT. The patient lays supine with the knees and hips flexed at 90 degrees. Cup hands around the knee with thumbs at medial and lateral joint line, fingers on medial and lateral insertion of hamstrings Draw the tibia forward sliding under the femur. A few degrees of movement are normal, but a forward jerk is not normal. Test bilaterally and compare!
anterior drawer sign
With the patient supine, hips flexed, and knees flexed to 90° and feet flat on the table, cup your hands around the knee with the thumbs on the medial and lateral joint line and the fingers on the medial and lateral insertions of the hamstrings. Sit on the patient's foot to ensure it does not move during the maneuver. Draw the tibia forward and observe if it slides forward (like a drawer) from under the femur. Compare the degree of forward movement with that of the opposite knee. The knee should have a firm endpoint with minimal movement. Lack of a firm endpoint with excessive movement may indicate the ACL is no longer intact.
anterior drawer sign, ACL
place thumbs along each costal margin, hands along the lateral ribcage, and ask the patient to inhale deeply
anterior lung expansion
normal uterus
anteverted, anteflexed
A major component of the pediatric visit.
anticipatory guidance
Compulsions, obsessions, phobias, and anxieties often occur in
anxiety disorders
In the area of the second right intercostal space right sternal border.
aorta
Bounding carotid, radial, and femoral pulses are present in
aortic regurgitation
Normally S1 > S2 @ the
apex
the tapered inferior tip of the LV
apex
tests overall shoulder rotation, the glenohumeral joint, and potential rotator cuff tear, the patient touches the opposite scapula using two motions: abduction and external rotation and adduction and internal rotation
apley scratch test
Sweat glands are found chiefly in the axillary and genital regions and usually open into hair follicles.
apocrine sweat glands
RLQ pain or pain that migrates from the periumbilical region, combined with nausea, vomiting, and loss of appetite is suspicious for
appendicitis
RLQ abdominal pain causes:
appendicitis, salpingitis, ovarian cyst, strangulated hernia, ectopic pregnancy, renal or ureteral stone, IBS
RLQ
appendix, ovary
After infancy, the rate of physical growth slows by
approximately half
four views of inspecting the breasts:
arms at sides, arms over head, arms pressed against hips, and leaning forward (skin appearance, size, symmetry, contour, nipple characteristics)
An auscultatory gap is associated with
arterial stiffness and atherosclerotic disease
The vein appears to stop on either side of the artery. Seen in uncontrolled HTN.
arterio-venous (AV) nicking
joint pain without evidence of arthritis
arthralgia
Will gravitate toward the dependent flank with tympanic sounds toward the superior flank.
ascites
the inability to recognize objects placed in the hand.
astereognosis
vesicular often obscured by wheezing.
asthma
meds that cause transient hypertension in children
asthma meds (prednisone) and ADHD meds (methylphenidate)
Wheezes in infants occur commonly from
asthma or bronchiolitis
ABCDEs of detecting melanoma
asymmetry, border, color, diameter, evolving
The AAP and the group Bright Futures recommend health supervision visits for infants below 1 year of age at the following ages: WHICH IS CALLED THE INFANT PERIODICITY SCHEDULE.
at birth, at 3 to 5 days, by 1 month, and at 2, 4, 6, 9, and 12 months,
clear, with coughing, suggesting secretions/ bronchial plug.
atelectasis
a chronic inflammatory disease initiated by injury (i.e., smoking or hypertension) to vascular endothelial cells, provoking atheromatous plaque formation.
atherosclerosis
bilateral erythematous, lichenified (thickened from rubbing) poorly circumscribed plaques on flexor wrists, antecubital fossae, and popliteal fossae.
atopic dermatitis
Erythema, scaling, dry skin, and intense itching characterize this condition.
atopic dermatitis (eczema)
Smooth, sore tongue. No papillae. Common in patients with vitamin deficiency or chemotherapy.
atrophic glossitis
a reciprocal, dynamic process of interacting and bonding with the caregiver
attachment
An ominous sign of upper airway obstruction in the larynx or trachea that requires urgent airway evaluation.
audible high-pitched inspiratory whistling, or stridor
a silent interval that may be present between the systolic & diastolic blood pressures; i.e., the sound disappears for a while, then reappears.
auscultatory gap
Assumption that a diagnosis is more likely, or more frequently occurring, if it more readily comes to mind.
availability heuristic
AGA
average for gestational age: 10th-90th percentile
skin cancer prevention:
avoid exposure to the sun, use sunscreen that blocks UV rays, wear a hat and long sleeves, avoid the sun between the hours ten and two
A concerned mother calls the clinic reporting that her 1.5 month old baby has an axillary temperature of 100.6 and has been crying more than normal. Which is the most appropriate action? a. Tell the mother not to worry since babies at this age have "higher than normal" temperatures b. Advise the mother to take a rectal temperature and have the baby assessed promptly if greater than 100.4 F c. Advise the mother to continue montioring the axillary temperature and have the baby promptly assessed if greater than 99.0 F d. Give the baby some oral motrin immediately to reduce the fever
b. Advise the mother to take a rectal temperature and have the baby assessed promptly if greater than 100.4 F
spinal extension
backward bending
about 30 2-5-mm erythematous papules and pustules on frontal, temporal, and parietal scalp.
bacterial folliculitis
- Associated w/ sexual activity but not a "STI" - Many women are asymptomatic - Clue cells on microscopy - Increased pH > 4.5 - White/ yellow discharge - *Foul odor "fishy" worse after sex
bacterial vaginosis (BV)
three common causes of vaginal discharge:
bacterial vaginosis (BV), candidiasis (yeast infection), and trichomoniasis
inflammation of the glans
balanitis
inflammation of the glans and prepuce.
balanoposthitis
Place the thumb and index finger of your right hand on each side of the patella; with the left hand, compress the suprapatellar recess against the femur. Palpate for fluid ejected or "ballooning" into the spaces next to the patella under your right thumb and index finger.
balloon sign (major effusion)
Assesses for large effusions of the knee. Compress the suprapatellar pouch and push the patella sharply against the femur (ballotte).
ballottement of patella
Place your hands in the same position as for the Ortolani test. Pull the leg forward and adduct with posterior force; that is, press in the opposite direction with your thumbs moving down toward the table and outward, applying pressure posteriorly. Feel for any movement of the head of the femur laterally. Normally, there is no movement and the hips feel "stable."
barlow test
tests for the ability to sublux or dislocate an intact but unstable hip
barlow test
tests for hip dysplasia in newborns
barlow test, ortolani test
solitary 7-mm oval pink pearly papule with overlying telangiectasias on right nasojugal fold.
basal cell carcinoma
The most common cancer in the world. Fortunately, it rarely spreads to other parts of the body. Nonetheless, it can invade and destroy local tissues, causing significant morbidity to the eye, nose, or brain.
basal cell carcinoma (BCC)
Normally S2 > S1 @ the
base
when approaching sensitive topics, the most important rule is to...
be non-judgemental!
why is cvd often undetected in women?
bec it presents differently
low pitched sounds and murmurs
bell
vascular sounds
bell
multiple scattered 2-4-mm round and oval brown macules, symmetrically pigmented, on back and chest with reticular pattern on dermoscopy.
benign melanocytic nevi
solitary 6-mm dark brown round symmetric macule on upper back.
benign melanocytic nevus
Non-tender Not nodular May be asymmetric May feel normal on rectal exam Middle lobe hypertrophy
benign prostatic hyperplasia (BPH)
palmar grasp reflex
birth to 3-4 months
plantar grasp reflex
birth to 6-8 months
neonate
birth to one month
iron preparation
black stain
MLQ
bladder
erythematous and suggest inflammation.
blanchable lesions
A chronic inflammation of the eyelids at the base of the hair follicles, often from S. aureus. There is also a scaling seborrheic variant.
blepharitis
Red inflamed lid margins, often with crusting.
blepharitis
Sudden interruption of speech in midsentence or before the idea is completed, attributed to "losing the thought." Occurs in normal people.
blocking
Nipple discharge is more likely to be pathologic when it is
bloody or serous, unilateral, spontaneous, associated with a mass, and occurring in women age ≥ 40 years
Extreme bowing or unilateral bowing may be from pathologic causes such as rickets or tibia vara.
blount disease
The bacterial decomposition of apocrine sweat is responsible for adult..
body odor
how do we arrive at a diagnosis, is it an art or science?
both! we use info processing and intuition
genu varum
bowlegged
stage 2 sexual maturity in girls:
breast bud stage, elevation of breast and nipple as a small mound, enlargement of areolar diameter
(Pea-size firm masses inferior to the nipple) are common among both girls and boys entering puberty or during early puberty. They are benign.
breast buds
The first easily detectable sign of puberty is usually the appearance of
breast buds
A hard, irregular, eccentric, or ulcerating painless dominant mass suggests...
breast cancer
Asymmetry due to change in nipple direction suggests
breast cancer
Flattening of the normally convex breast suggests
breast cancer
The most commonly diagnosed cancer in the world and the leading cause of cancer death among women.
breast cancer
Thickening and prominent pores (peau d'orange) suggest
breast cancer
breast pain alone is not typically a sign of...
breast cancer
tanner stages of development female
breast development (1-5)
Unlike the normal dark red menstrual discharge, (menorrhagia) tends to be...
bright red and may include "clots" (not true fibrin clots)
Louder, harsher and higher in pitch, with a short silence between inspiratory and expiratory sounds. Expiratory sounds last longer than inspiratory sounds.
bronchial breath sounds
With inspiratory and expiratory sounds about equal in length, are at times separated by a silent interval. Detecting differences in pitch and intensity is often easier during expiration.
bronchiovesicular breath sounds
the spoken voice sound heard through the stethoscope, which sounds soft, muffled, and indistinct over normal lung tissue
bronchophony
As you flex the neck, watch the hips and knees in reaction to your maneuver. Normally they should remain relaxed and motionless.
brudzinski sign
An audible vascular sound caused by turbulent blood flow in the artery that supplies blood to the brain.
bruit
vascular sounds resembling the whooshing of heart murmurs
bruits
(Seen with an ophthalmoscope) are a ring of white specks in the iris. Although sometimes present in normal children, these strongly suggest Down syndrome.
brushfield spots
These abnormal speckling spots on the iris suggest Down syndrome.
brushfield spots
Tests for minor effusions of the knee. Pt sitting with their knees flexed at 90 degrees. Milk fluid downward. Apply medial pressure to force fluid in the lateral area. Tap the lateral margin of the patella with the other hand and watch for fluid wave.
bulge sign
With the knee extended, place the left hand above the knee and apply pressure on the suprapatellar recess to displace or "milk" fluid downward. Stroke downward on the medial aspect of the knee and apply pressure to force fluid into the lateral area. Tap the knee just behind the lateral margin of the patella with the right hand.
bulge sign
If a fluid-filled spot is larger (>1 cm), it is a
bulla
a circumscribed elevation of the epidermis containing clear fluid >1 cm in diameter. classic autoimmune bullous diseases include pemphigus vulgaris and bullous pemphigoid.
bulla
solitary 8-cm dusky oval patch with smaller inner violaceous patch and central 3.5-cm tense bulla, on right posterior lower back.
bullous fixed drug eruption
sacs that ease joint action by allowing adjacent muscles to glide over each other during movements
bursae disc-shaped synovial sacs
frank breech
butt first, knees extended
breech
butt first, knees flexed
To assess the Moro Reflex in a newborn, the practitioner a. strokes the perioral skin at the corners of the mouth b. suspends the baby prone with one hand c. holds the baby supine, supporting the head, back, and legs. Abruptly lower the entire body about two feet d. with the baby supine, turns head to one side, holding jaw over the shoulder
c. holds the baby supine, supporting the head, back, and legs. Abruptly lower the entire body about two feet
These light-brown pigmented lesions usually have borders and are uniform. They are noted in more than 10% of black infants. If more than five spots exist, consider the diagnosis of neurofibromatosis.
cafe-au-lait spots
Pigmented light-brown lesions (<1 to 2 cm at birth) are
café-au-lait spots
- Age: 30-90 years, most common over age 50 yrs. - Number: usually single, although may coexist with other nodules. - Shape: irregular or stellate. - Consistency: firm or hard. - Delimitation: not clearly delineated from surrounding tissues. - Mobility: may be fixed to skin or underlying tissues. - Tenderness: usually nontender. - Retraction signs: may be present.
cancer
This bright red rash involves the intertriginous folds, with small "satellite lesions" along the edges.
candidal diaper dermatitis
Thick white coating over raw red tongue. Common in patients with immunosuppression! Can be scraped off with a tongue blade.
candidiasis
A newborn's scalp may be swollen over the occipitoparietal region. This results from capillary distention and extravasation of blood and fluid resulting from the vacuum effect of rupture of the amniotic sac. This swelling typically crosses suture lines and resolves in 1 to 2 days.
caput succedaneum
multiple furuncles
carbuncle
The volume of blood ejected from each ventricle in 1 minute, is the product of heart rate and stroke volume.
cardiac output
subclinical hyperthyroidism is associated with
cardiovascular mortality, atrial fibrillation, and decreased bone density
The presence of the orange pigment carotene in the blood due to ingestion of carrots, presents as a yellow discoloration of the skin, especially palms and soles, but not the sclera or mucous membranes.
carotenemia
- Palpable pulsations. - Pulsations not obliterated by pressure above the clavicle. - No changes with respiration. - No effect of abdominal pressure on pulsations. - One pulsation per systole.
carotid arteries
Carotid stenosis:
carotid bruits
pain during thumb abduction test
carpal tunnel syndrome
positive phalen's sign
carpal tunnel syndrome
positive tinel's sign
carpal tunnel syndrome
The joint is slightly movable. Cartilaginous discs separate bony structures. Discs contain nucleus pulposus (shock absorber/cushion bony movement). Found between vertebral bodies.
cartilaginous joint
Occlusion of the red reflex by the lens may represent a...
cataract
Opacity of the lenses visible through the pupil. Risk factors are older age, smoking, diabetes, corticosteroid use.
cataracts
what can exaggerate the pot-belly appearance of toddlers and young children?
celiac disease, cystic fibrosis, constipation
Neurologic development in newborns progresses
centrally to peripherally
A common type of localized swelling of the scalp, caused by subperiosteal hemorrhage from the trauma of birth. This swelling does not cross over suture lines and resolves within 3 weeks.
cephalohematoma
Although not present at birth, appear within the first 24 hours from subperiosteal hemorrhage involving the outer table of one of the cranial bones. The swelling, shown at the arrow, does not extend across a suture though it is occasionally bilateral following a difficult birth. The swelling is initially soft, then develops a raised bony margin within a few days from calcium deposits at the edge of the periosteum. It tends to resolve within several weeks.
cephalohematomas
Human papillomavirus (HPV), particularly types 16 and 18, is found in virtually all
cervical cancers
A subacute nontender, usually painless nodule caused by a blocked meibomian gland. May become acutely inflamed but, unlike a stye, usually points inside the lid rather than on the lid margin.
chalazion
Primary lesion of syphilis Usually, single site of ulceration Usually on glans or inner prepuce May occur on shaft or scrotum or lips Starts as silvery papule Erodes to form superficial ulcer Painless Smooth slightly raised border Indurated base Serous discharge
chancre
Concise statement that describes reason for encounter.
chief complaint
the starting point that triggers the beginning of information gathering by the clinician
chief complaint
components of a health history:
chief complaint, HPI, PMH/PSH, social history, family history, ROS
Various physical, social, and environmental factors, as well as diseases, can affect...
child development and health
A mainstay for health promotion and have been heralded as the most significant clinical achievement in public health worldwide.
childhood immunization
RUQ abdominal pain causes:
cholecystitis, cholangitis, pancreatitis, pneumonia/empyema, pleurisy, hepatitis, budd-chiari syndrome
A fixed, downward bowing of the penis that may accompany a hypospadias.
chordee
- PAIN: INTERMITTENT CLAUDICATTION, PROGRESSING TO PAIN AT REST. - MECHANISM: TISSUE ISCHEMIA. - PULSES: DECR OR ABSENT. - COLOR: PALE, ESPECIALLY ON ELEVATION, DUSKY RED ON DEPENDENCY. - TEMPERATURE: COOL. - EDEMA: ABSENT OR MILD, MAY DEVELOP AS THE PATIENT TRIES TO RELIEVE PAIN BY LOWERING THE LEG. - SKIN CHANGES: TROPHIC CHANGES, THIN, SHINY, ATROPHIC SKIN, LOSS OF HAIR OVER THE FOOT AND TOES, NAILS THICKENED AND RIDGED. - ULCERATION: IF PRESENT, INVOLVES TOES OR POINTS OF TRAUMA ON FEET. - GANGRENE: MAY DEVELOP.
chronic arterial insufficiency (advanced)
vesicular, resonance, wheezing, crackles, rhonchi.
chronic bronchitis
diarrhea as more than 30 days
chronic diarrhea
- PAIN: OFTEN PAINFUL. - MECHANISM: VENOUS STASIS AND HYPERTENSION. - PULSES: NORMAL, THOUGH MAY BE DIFFICULT TO FEEL THROUGH EDEMA. - COLOR: NORMAL OR CYANOTIC ON DEPENDENCY, PETECHIAE AND THEN BROWN PIGMENTATION APPEAR WITH CHRONICITY. - TEMPERATURE: NORMAL. - EDEMA: PRESENT, OFTEN MARKED. - SKIN CHANGES: OFTEN BROWN DEPIGMENTATION AROUND THE ANKLE, STASIS DERMATITIS, AND POSSIBLE THICKENING OF THE SKIN AND NARROWING OF THE LEG AS SCARRING DEVELOPS. - ULCERATION: IF PRESENT, DEVELOPS AT SIDES OF ANKLE, ESPECIALLY MEDIALLY. - GANGRENE: DOES NOT DEVELOP.
chronic venous insufficiency
- leg swelling - skin color and texture changes - venous ulcers
chronic venous insufficiency
Edema is soft, with pitting on pressure, and occasionally bilateral. Look for brawny changes and skin thickening, especially near the ankle. Ulceration, brownish pigmentation, and edema in the feet are common. It arises from chronic obstruction and incompetent valves in the deep venous system.
chronic venous insufficiency
What is far and away the leading risk factor for lung cancer, accounting for about 85% of lung cancer cases?
cigarette smoking
moving arm in a CIRCLE around the shoulder.
circumduction
Occurs in people with obsessions.
circumstantiality
The mildest thought disorder, consisting of speech with unnecessary detail, indirection, and delay in reaching the point. Some topics may have a meaningful connection. Many people without mental disorders have circumstantial speech.
circumstantiality
Occurs in schizophrenia and manic episodes.
clanging
Speech with choice of words based on sound, rather than meaning, as in rhyming and punning. For example, "Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes have it!"
clanging
A congenital fissure of the median line of the palate is a...
cleft palate
- Is a process by which clinicians collect, process, and interpret patient information to develop an action plan. - Creates a story from the patient's history, physical exam, test results and serial observation; - Serves to enhance acquisition and storage of knowledge through repeated exposure to real case examples; - Helps the learner develop memory schemes for representing and relating clinical problems.
clinical reasoning
The name alone implies a process that involves careful and deliberate thought in order to form a conclusion.
clinical reasoning
The thinking & decision-making processes associated with clinical practice.
clinical reasoning
Failure in considering the correct diagnosis or competing hypotheses.
clinician hypothesis generation
Failure to follow up on a result/test or misinterpretation of result, review of previous documentation.
clinician processing
harsh, ejectile (crescendo) systolic murmur, as PDA closes becomes continuous, upper left sternal border
closing ductus
two common benign murmurs in infants:
closing ductus (newborn) and peripheral pulmonary flow murmur (newborn- 1 year)
positive ortolani sign
clunking with abduction of hips
Appear in early inspiration and last throughout expiration (biphasic), have a popping sound, are heard over any lung region, and do not vary with body position. They have a longer duration and lower frequency than fine crackles, change or disappear with coughing, and are transmitted to the mouth. Coarse crackles appear to result from "boluses of gas passing through airways as they open and close intermittently." Found in COPD, asthma, bronchiectasis, pneumonia, and heart failure.
coarse crackles
missing sections of tissue in the eye (e.g., in the iris alone or iris plus retina).
colobomas
PE consideration for pediatrics
comfortable areas first
Goal-directed actions, feeling of mastery based on experience, deliberate planning.
competent
- Is appropriate for new patients in the office or hospital - Provides fundamental and personalized knowledge about the patient - Strengthens the clinician-patient relationship - Helps identify or rule out physical causes related to patient concerns - Provides a baseline for future assessments - Creates a platform for health promotion through education and counseling - Develops proficiency in the essential skills of physical examination
comprehensive patient assessment
Repetitive behaviors that the person feels driven to perform in response to an obsession, aimed at preventing or reducing anxiety or a dreaded event or situation; these behaviors are excessive and unrealistically connected to the provoking stimulus
compulsions
May be better in a noisy environment. Could be caused by a foreign body, cerumen impaction, otitis media, or a perforated eardrum.
conductive hearing loss
Raised, friable, or lobed wart-like lesions are seen with
condylomata or cervical cancer
Fabrication of facts or events in response to questions, to fill in the gaps from impaired memory
confabulation
refers to the shape of single lesions and the arrangement of groups of lesions.
configuration
Seeking supportive evidence for a diagnosis at the exclusion of more persuasive information refuting it.
confirmation bias
Hands 2 feet apart, lateral to patient's ears, GO SLOW! Assess the upper & lower temporal & nasal quadrants. Identify the location of any visual defects. If defect: cover one eye and repeat one eye at a time!
confrontation test
Causes of conductive hearing loss include
congenital abnormalities, ossicular abnormalities, cerumen impaction, trauma, otitis media, and tympanic membrane perforation
Inspiratory stridor beginning at birth suggests a...
congenital abnormality
a single umbilical artery is associated with
congenital and chromosomal anomalies
A dark or bluish pigmentation over the buttocks and lower lumbar regions is common in newborns of African, Asian, Hispanic, and Mediterranean descent. These areas result from pigmented cells in the deep layers of the skin; they become less noticeable with age and usually disappear during childhood.
congenital dermal melanocytosis
These are more common among dark-skinned babies. It is important to note them so that they are not mistaken for bruises.
congenital dermal melanocytosis (mongolian spots)
An enlarged posterior fontanelle may be present in
congenital hypothyroidism
An infant with coarse facial features and other abnormal facial features.
congenital hypothyroidism
The child has coarse facial features, a low-set hair line, sparse eyebrows, and an enlarged tongue. Associated features include a hoarse cry, umbilical hernia, dry and cold extremities, myxedema, mottled skin, and intellectual disability. Since most infants with congenital hypothyroidism have no physical stigmata, the United States and many other nations screen all newborns for congenital hypothyroidism.
congenital hypothyroidism
In utero infection by Treponema pallidum usually occurs after the 16th week of gestation and affects virtually all fetal organs. If it is not treated, the mortality rate is quite high. Signs of illness appear in survivors within the first month of life. Facial stigmata often include bulging of the frontal bones and nasal bridge depression (saddle nose), both from periostitis; rhinitis from weeping nasal mucosal lesions (snuffles); and a circumoral rash. Mucocutaneous inflammation and fissuring of the mouth and lips (rhagades), not shown here, may also occur as stigmata of congenital syphilis, as may craniotabes tibial periostitis (saber shins) and dental dysplasia (Hutchinson teeth)
congenital syphilis
Conjunctival injection: diffuse dilatation of conjunctival vessels with redness that tends to be maximal peripherally. Mild discomfort rather than pain. Vision is not affected except or temporary mild blurring due to discharge. Watery, mucoid, or mucopurulent ocular drainage. Pupil not affected. Clear cornea. Significance: Bacterial, viral, and other infections; highly contagious; allergy; irritation.
conjunctivitis
tenesmus
constant urge to defecate
This irritant rash is secondary to diarrhea or irritation and is noted along contact areas (here, the area touching the diaper).
contact diaper dermatitis
the shaft of the penis is formed by 3 columns of vascular erectile tissue
corpus spongiosum, two corpora cavernosa
seen in HTN and DM
cotton wool sports
a reflex response to stimuli that irritate receptors in the larynx, trachea, or large bronchi
cough
strabismus testing
cover-uncover test
- Continuous. - Intermittent, nonmusical, and brief. - Fine crackles: soft and high pitched. - Very brief. - Coarse crackles: somewhat louder, lower in pitch.
crackles
- Course, medium or fine; early, mid, or late inspiration - Atelectasis, bronchiectasis, CHF, pulmonary fibrosis
crackles
Discontinuous nonmusical sounds that can be early inspiratory (as in COPD), late inspiratory (as in pulmonary fibrosis), or biphasic (as in pneumonia). They are currently considered to result from a series of tiny explosions when small distal airways, deflated during expiration, pop open during inspiration. With few exceptions, recent acoustic studies indicate that the role of secretions as a cause of crackles is less likely.
crackles
Discontinuous sounds near the end of inspiration; they are usually caused by lung disorders and are far less likely to represent cardiac failure in infants than in adults.
crackles (rales)
discontinuous adventitious breath sounds:
crackles or rales
The sense of smell.
cranial nerve number 1
A condition of premature closure of one or more sutures of the skull. This results in an abnormal growth and shape of the skull because growth will occur across sutures that are not affected but not across sutures that are affected.
craniosynostosis
Brushing skin of scrotum in downward direction leads to elevation of testicle Cool room exaggerates this reflex
cremasteric reflex
A full anterior fontanelle with increased intracranial pressure is seen when a baby...
cries or vomits
strabismus
crossed eyes
a process that includes "the difficult work of examining cultural beliefs and cultural systems of both patients and providers to locate the points of cultural dissonance or synergy that contribute to patients' health outcomes."
cultural humility
The increased adrenal cortisol production of Cushing syndrome produces a round or "moon" face with red cheeks. Excessive hair growth may be present in the mustache, sideburn areas, and chin (as well as the chest, abdomen, and thighs).
cushing syndrome
Deep wrinkles on the posterior neck that "crisscross."
cutis rhomboidalis nuchae
the leader in all-cause morbidity and mortality across ages and genders
cvd
what can cause hepatomegaly in children?
cystic fibrosis, parasites, fatty liver, hepatitis, and tumors
A bulge of the upper two-thirds of the anterior vaginal wall, together with the bladder above it. It results from weakened anterior supporting tissues.
cystocele
When the entire anterior vaginal wall, together with the bladder and urethra, produces the bulge, a cystourethrocele is present. A groove sometimes defines the border between the urethrocele and cystocele but is not always present.
cystourethrocele
- Age: 30-50 years, regress after menopause except with estrogen therapy. - Number: single or multiple. - Shape: round. - Consistency: soft to firm, usually elastic. - Delimitation: well delineated. - Mobility: mobile. - Tenderness: often tender. - Retraction signs: absent.
cysts
A quiet 3-year-old is brought in for a routine check-up when you notice a fresh bruise in the axilla and bilateral bruises over the upper back that appear slightly older. There are brown bruises over his shins as well. His mother said this happened when he fell off a couch. What diagnosis should be considered? a. Von Willebrand's disease b. Normal childhood bruises from activity c. Seizure disorder d. Abuse
d. Abuse
You enter the room of a 2-year-old female who is visibly upset and afraid of being at the clinic. To facilitate the examination, which action would be most appropriate? a. Ask the child's permission to examine a body part b. Leave the room and return when the child is calm c. Have the parent leave the room since his or her presence is making the "acting out" worse d. Examine the child in the parent's lap
d. Examine the child in the parent's lap
In a child, the cover-uncover test of the eyes tests for a. retinoblastoma b. reduced visual acuity c. peripheral vision deficits d. strabismus
d. strabismus
contributory factors in diagnostic testing:
data acquisition, clinician processing, clinician hypothesis generation, sub-optimal weighing/prioritization, recognizing urgency
positive finkelstein's test
de Quervain's tenosynovitis
involves the extensor and abductor tendons of the thumb as they cross the radial styloid in the first dorsal compartment of the wrist
de quervain tenosynovitis
posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage. Most Severe.
decerebrate posturing
- Evidence based-apply principles of epidemiology, statistics, and probability to arrive at a "best" diagnosis. - Uses mathematical probability to determine the outcomes of different treatment approaches. - Allows examination of each decision option.
decision analysis model
characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. occurs when the brainstem is not inhibited by the motor function of the cerebral cortex
decorticate posturing
Abnormal fluid or air-filled spaces (example: pleural effusion, pneumothorax, or emphysema)?
decreased tactile fremitus
Persistent nonblanchable deep red, maroon, or purple discoloration.
deep tissue pressure injury
developmental quotient score < 70
delayed
False fixed personal beliefs that are not amenable to change in light of conflicting evidence; types of delusions include:
delusions
May also occur in delirium, severe mood disorders, and dementia.
delusions
The most common health problem in children
dental caries
Assessment of developmental domains (personal, social, fine motor-adaptive, language, gross motor), is indicated for neonates to 6 years old, prematurity adjusted until 24 months
denver (II) developmental screening test
Sense that one's self or identity is different, changed, unreal; lost; or detached from one's mind or body
depersonalization
LOWING a body part.
depression
Seen in schizophrenia, manic episodes, and other psychotic disorders.
derailment
Sense that the environment is strange, unreal, or remote
derealization
solitary blue-brown 1.2-cm firm nodule with positive dimple sign and hyperpigmented rim on left lateral thigh.
dermatofibroma
thicker part of the skin, composed of connective tissue, is vascular. sweat glands
dermis
an increasingly useful office practice for deciding whether a melanocytic lesion is benign or malignant
dermoscope
Early closure of the fontanelles can be due to...
developing microcephaly or craniosynostosis or metabolic abnormalities
The process of mapping the status of a child compared with other children of similar age.
developmental assessment
If a cooperative child fails items on a standardized screening instrument, ____ is possible, necessitating more precise testing and evaluation.
developmental delay
- Stands independently, Starts taking first steps - Scribbles, Hold crayon, Makes tower with 2 cubes - Says one word with meaning, Points to get objects, Follows one-step commands with gestures - Shows objects to parents to share
developmental milestones by 12 months
- Stoops to pick up toys, Climbs on furniture, Runs stiff legged - Uses spoon with some spilling, Places 10 cubes in cup, Turns pages in book - Uses 3-5 words, Mature jargon speech, Points to one body part - Shows empathy, Gives hugs on request
developmental milestones by 15 months
- Creeps down stairs, Runs well - Makes 4-cube tower, Imitates vertical stroke - Uses 10-25 words, Points to three body parts, Points to self, familiar people - Engages in pretend play
developmental milestones by 18 months
- Walks downstairs holding rail, with both feet on one stepKicks ball - Imitates horizontal line, Opens door knob, Sucks through straw - Uses 2-word sentences, Uses 50+ words, Has 50% intelligibility, Refers to self by name - Parallel play
developmental milestones by 24 months
- Goes up stairs without holding on, alternating feet, Pedals tricycle - Copies circle, Strings small beads, Draws a 2-3 part person - Uses 3-word sentences, Has 75% intelligibility, Understands negatives, Knows own gender - Starts to share, Imaginative play, Fears imaginary things
developmental milestones by 3 years
- Walks up stairs, holding on, alternating feet, Jumps in place - Makes tower with 8 cubes, Can wash hands, brush teeth with help - Refers to self with correct pronoun, Understands action words (sleeping, eating, playing), Understands prepositions - Imitates adult actions (cooking, talking on phone, cleaning)
developmental milestones by 30 months
- Balances on one foot for 8 seconds, Throws ball overhand, Catches bounced ball - Copies square, Goes to the toilet alone, Draws a 4-6 part person - Speaks with 100% intelligibility, Follows three-step commands, Understands adjectives - Has a preferred friend, Labels feelings, Group play
developmental milestones by 4 years
- Walks down stairs, alternating feet, Hops on one footSkips - Copies triangle, Cuts with scissors, Writes first name - Speaks in 6-8 word sentences, can count to 10, knows colors, Knows telephone number, Retells story with clear beginning, middle, end, Enjoys rhyming words - Has a group of friends, Apologizes for mistakes
developmental milestones by 5 years
Prioritizing a diagnosis made by prior clinicians, discounting evidence of alternative explanations.
diagnostic momentum
- An aspect of clinical reasoning. - 'A series of clinical judgments made during & after data collection, culminating in informal judgments or formal diagnoses.'
diagnostic reasoning
Can be used for problem-solving, health promotion, or screening for disease.
diagnostic reasoning
Influenced by "what" and "how" the clinician thinks.
diagnostic reasoning
The process of clustering assessment data into meaningful sets & generating hypotheses about the client's human response.
diagnostic reasoning
high pitched sounds and murmurs
diaphragm
the amount that the diaphragm moves during inspiration and expiration.
diaphragmatic excursion
both S3 and S4 occur in
diastole
- List of other diseases that present with similar symptoms. Based on: - Patterns detected (symptoms, health hx, PE, & diagnostic testing). - Understanding of probability & prognosis. - Don't forget: Common diseases present commonly. - Don't forget RED FLAGS.
differential diagnoses
0
diopter lens (retina)
an acute infection caused by Corynebacterium diphtheriae, is now rare but still important. Prompt diagnosis may lead to life-saving treatment. The throat is dull red, and a gray exudate (pseudomembrane) is present on the uvula, pharynx, and tongue. The airway may become obstructed. Prompt diagnosis may lead to life-saving treatment.
diphtheria
characteristic lesions on the sun-exposed skin of the face, especially the forehead, nose, and ear.
discois lupus erythematosus
paronychia
diseased state around the nail
unsteadiness or imbalance when walking, especially in older patients; causes include fear of walking, visual loss, weakness from musculoskeletal problems, and peripheral neuropathy (up to 15%).
disequilibrium
LLQ abdominal pain causes:
diverticulitis, salpingitis, ovarian cyst, ecotpic pregnancy, IBS, IBD, perforated colon
to calculate pack/years smoking
divide the number of cigarettes smoked per day by 20 then multiply by the number of years smoked
During the first 10 days of life, the eyes may stare in one direction if just the head is turned without moving the body.
doll's eye reflex
The child with Down syndrome (trisomy 21) usually has a small, rounded head, a flattened nasal bridge, oblique palpebral fissures, prominent epicanthal folds, small, low-set, shell-like ears, and a relatively large tongue. Associated features include generalized hypotonia, transverse palmar creases, shortening and incurving of the fifth fingers (clinodactyly), Brushfield spots (see p. 1069), and mild to moderate cognitive impairment.
down syndrome
upslanting palpebral fissures
down syndrome
tetracycline examples
doxycycline (Vibramycin) tetracycline (Sumycin)
Tests rotator cuff. Tests for rotator cuff injury or tear. Fully abduct the arm to shoulder level (90 degrees) and lower it slowly.
drop arm test
Causes of generalized itching, without apparent rash, include
dry skin; pregnancy; uremia; jaundice; lymphomas and leukemia; drug reactions
Eczematous changes with rash, scaling, or ulceration on the nipple extending to the areola occurs in Paget disease of the breast, associated with underlying
ductal or lobular carcinoma
Consolidation or pleural fluid (PNA, pleural effusion, severe atelectasis)
dullness
pain with menses, often with bearing down, aching, or cramping sensation in the lower abdomen or pelvis
dysmenorrhea
chronic or recurrent discomfort or pain centered in the upper abdomen, characterized by epigastric pain or burning (or both) and postprandial fullness or early satiety (or both).
dyspepsia
a non-painful but uncomfortable awareness of breathing that is inappropriate to the level of exertion
dyspnea
nonblanchable, larger areas or purpura.
ecchymoses
nonblanchable, raised and palpable.
ecchymoses
Widely distributed, open directly onto the skin surface, and help to control body temperature by their sweat production.
eccrine sweat glands
Occurs in manic episodes and schizophrenia.
echolalia
Repetition of the words and phrases of others
echolalia
the lower lid margin turns outward, exposing the palpebral conjunctiva. When the punctum of the lower lid turns outward, the eye no longer drains well, and tearing occurs. Ectropion is also more common in older adults.
ectropion
the voice sound of "eeeeee" heard through the stethoscope
egophony
The percentage of ventricular volume ejected during each heartbeat and is normally 60%.
ejection fraction
hinge joint
elbow and knee
RISING a body part.
elevation
"the capacity to identify with the patient and feel the patient's pain as your own, then respond in a supportive manner."
empathy
tests the supraspinatus strength, labral tear, elevate arms at 90 degrees and internally rotate with thumbs pointing down (empty can), have the patient resist downward pressure, can indicate rotator cuff injury
empty can test
most common genital cancer in women
endometrial cancer
Nodularity, immobility, and tenderness in the fornices may result from
endometriosis
retrograde menstrual flow and extension of the uterine lining outside the uterus, affects 50% to 60% of women and girls with pelvic pain
endometriosis
More common in the elderly, is an inward turning of the lid margin. The lower lashes, which are often invisible when turned inward, irritate the conjunctiva and lower cornea. This is different from trichiasis where there is aberrant inward growth of the eyelashes, but the eyelid position remains normal. Ask the patient to squeeze the lids together and then open them; then check for an entropion that is less obvious.
entropion
solitary 2-cm tethered subcutaneous cyst with overlying punctum releasing caseous whitish-yellow substance with foul odor.
epidermal inclusion cyst
a thin avascular keratinized epithelium consisting of two layers: an outer horny stratum corneum of dead keratinized cells and an inner cellular layer, the stratum basale, and the stratum spinosum, also known as the malpighian layer, where both melanin and keratin are formed. Migration from the inner to the outer layer takes approximately 1 month.
epidermis
superficial layer, thinner layer, composed of epithelial tissue, avascular layer. horny layer: cellular layer:
epidermis
Relieved by elevation
epididymitis
A benign, usually painless localized ocular inflammation of the episcleral vessels. Vessels appear movable over the scleral surface. May be nodular or show only redness and dilated vessels.
episcleritis
chronic pain
episode of pain that lasts for 6 months or longer; may be intermittent or continuous
Rare Urethra opens dorsally
epispadias
a congenital dorsal displacement of the meatus
epispadias
Tiny white or yellow, rounded mucous retention cysts, are located along the posterior midline of the hard palate. They disappear within months.
epstein pearls
Is the third left intercostal space, left sternal border.
erb's point
loss of epidermal or mucosal epithelium
erosion
loss of epidermal or mucosal epithelium.
erosions
These common yellow or white pustules are surrounded by a red base.
erythema toxicum
Usually appearing on days 2-3 of life, this rash consists of erythematous macules with central pinpoint pustules on an erythematous base, scattered diffusely over the entire body. These lesions are of unknown etiology but disappear within 1 week of birth.
erythema toxicum
moving the sole of the foot OUTWARD at the ankle.
eversion
the most sensitive of the ABCDE criteria
evolution
polycythemia
excess of red blood cells
Menorrhagia
excessive flow
kyphosis
excessive outward curvature of the spine, causing hunching of the back.
a common finding in thyroid eye disease and is found in approximately 60% of patients
exophthalmos
What habits support clinical judgement?
experience, focused attention, self care, rest, limited interruptions, stay current, collaborate, supervise and case conferences
Transcends rules, intuitive grasp of the wholeness of situation, creative response to particularities of situation, flexible responses to situations.
expert
accentuates LEFT sided murmurs.
expiration
STRAIGHTENING a limb at a joint.
extension
polydactyly
extra digits
BMI of > 40
extreme obesity
Red throat, white exudate. Check fever, lymph nodes. Rule out strep or mono.
exudative tonsilitis
This red throat has thick white exudates on the tonsils. This, together with fever and enlarged cervical nodes, increases the probability of group A streptococcal infection or infectious mononucleosis. Anterior cervical lymph nodes are usually enlarged in the former, posterior nodes in the latter.
exudative tonsilitis
Acute chemical exposure/burn. Sudden unilateral loss of vision (acute retinal artery occlusion). Trauma or foreign body. Herpes Zoster involves the eye. Acute Glaucoma: deep pain - often with nausea and vomiting, visual changes - halos, photophobia eye discomfort from bright light, conjunctivae injected, pupil fixed & mid-dilated, globe tender, hard.
eye problems to refer
this birthmark fades, usually within the first year of life.
eyelid patch
anisometropia
eyes with different refractive errors, can result in amblyopia
cranial nerve VII
facial nerve
Asymmetry of the face may reflect
facial nerve palsy
Peripheral (lower motor neuron) paralysis of the facial nerve may be from (1) an injury to the nerve from pressure during labor and birth, (2) inflammation of the middle ear branch of the nerve during episodes of acute or chronic otitis media, or (3) unknown causes (Bell palsy). The nasolabial fold on the affected left side is flattened, and the eye does not close. This is accentuated during crying, as shown here. Full recovery occurs in most children.
facial nerve palsy
(a) growth <5th percentile for age; (b) drop >two quartiles in 6 months; or (c) weight for length <5th percentile
failure to thrive
Feeling hot and sweating accompany a
falling temperature
Body temperature at night
falls
delayed puberty is often
familial or related to chronic illness
positive barlow sign
feel or hear a "clunk" when ADDUCTING thighs
Babies born to women with chronic alcoholism are at increased risk for growth deficiency, microcephaly, and intellectual disability. Facial characteristics include short palpebral fissures, a wide and flattened philtrum (the vertical groove in the midline of the upper lip), and thin lips.
fetal alcohol syndrome
short palpebral fissures
fetal alcohol syndrome
Malaise, headache, and pain in the muscles and joints often accompany
fever
- Age: 15-25 years, usually puberty and young adulthood, but up to age 55 years. - Number: usually single, may be multiple. - Shape: round, disc-like, or lobular, typically small (1-2 cm). - Consistency: may be soft, usually firm. - Delimitation: well delineated. - Mobility: very mobile. - Tenderness: usually nontender. - Retraction signs: absent.
fibroadenoma
The three most common breast masses are
fibroadenoma (a benign tumor), cysts, and breast cancer
The joint is mostly immovable. Layers of fibrous tissue or cartilage hold bones together. Example: sutures of the skull.
fibrous joint
immovable joints
fibrous joints
Softer, higher pitched, and more frequent per breath than coarse crackles. They are heard from mid to late inspiration, especially in the dependent areas of the lung, and change according to body position. They have a shorter duration and higher frequency than coarse crackles. Fine crackles appear to be generated by the "sudden inspiratory opening of small airways held closed by surface forces during the previous expiration." Found in pulmonary fibrosis and interstitial lung disease.
fine crackles
Manipulation of objects with the hands in order to eat, draw, or play are examples of...
fine motor skills
Grasp thumb against the palm and move wrist near the midline in ulnar deviation.
finkelstein's test
thyroid in hashimoto thyroiditis
firm
S1 is diminished in
first-degree heart block
Benign condition. Fissures increase with age. Food may collect and irritate tongue and cause infection.
fissured tongue
BENDING a limb at a joint.
flexion
An almost continuous flow of accelerated speech with abrupt changes from one topic to the next. Changes are based on understandable associations, plays on words, or distracting stimuli, but ideas are not well connected.
flight of ideas
Most frequently noted in manic episodes.
flight of ideas
"are conceptualized as originating within networks limited to one hemisphere."
focal seizures
- Is appropriate for established patients, especially during routine or urgent care visits - Addresses focused concerns or symptoms - Assesses symptoms restricted to a specific body system - Applies examination methods relevant to assessing the concern or problem as thoroughly and carefully as possible
focused patient assessment
Why do we perform developmental assessments?
for early detection of deviation in child's pattern of development and ensure developmental progress
rosenbaum chart
for near vision, 14 inches from eyes
arms at their side, elbows flexed 90 degrees, pronate the wrists, provide resistance when the patient supinates arms.
forearm supination
Foul-smelling, purulent, unilateral discharge from the nose may be due to a
foreign body
spine flexion
forward bending
plain x-ray films
fractures, damaged bone (osteomyelitis, metastases)
Interpretation of information is influenced heavily by the way in which information about the problem are presented (framed).
framing effect
- Loud, grating - Late inspiratory or late expiratory - Inflamed pleura, PNA, malignancy, pleuritis
friction rub
adhesive capsulitis
frozen shoulder
onychomycosis
fungal infection of the nail
two large (2-cm) furuncles on the forehead, without fluctuance. (Note: fluctuant deep infections are abscesses)
furunculosis
test for femoral shortening
galeazzi or allis sign
MUQ
gallbladder
de quervain tenosynovitis
gamers thumb
An increase in pitch or frequency of bowel sounds is heard with
gastroenteritis
congenital abdominal anomalies can range from umbilical hernias to...
gastroschisis
when assessing breasts, it is crucial to include this in the ROS:
general and non-specific complaints (unintended weight loss, fatigue, fever, change in appetite)
Visual observation and provides a review of the WHOLE person.
general survey
Causes of sensorineural hearing loss include
genetic, hereditary congenital infections, ototopic drugs, trauma, and some infections such as meningitis
Shallow small painful ulcers on red bases are suspicious for infection from genital herpes simplex virus 1 or 2. Ulcers may take 2-4 weeks to heal. Recurrent outbreaks of localized vesicles, then ulcers are common.
genital herpes
Benign conditions. Smooth areas without papillae. Normal rough coated areas. Map-like appearance.
geographic tongue
The cup in enlarged due to increased intraocular pressure. Can occupy more than half of the disc's diameter. Vessels sink and under and may be displaced nasally.
glaucoma
peripheral loss is common with
glaucoma
cranial nerve IX
glossopharyngeal nerve
medial epicondylitis
golfer's elbow
yellow penile discharge
gonorrhea
number identification
graphesthesia
- Bartholin's gland - Male Homolog: bulbourethral glands - Location: slightly below and to the left and right of the opening of the vagina - Function: They secrete mucous to provide lubrication, especially when the woman is sexually aroused
greater vestibular
a voluntary contraction of the abdominal wall, often accompanied by a grimace that may diminish when the patient is distracted.
guarding
scattered erythematous round drop-like, flat-topped well-circumscribed scaling papules and plaques on trunk.
guttate psoriasis
what prevents acute epiglottitis
h. influenzae type b vaccination
There is depression of the central nail with a "Christmas tree" appearance from small horizontal depressions, resulting from repetitive trauma from rubbing the index finger over the thumb or vice versa.
habit tic deformity
ability to selectively and progressively shut out negative stimuli (e.g., a repetitive sound)
habituation
Whitish-raised areas that have a feathery pattern. Often on the sides of the tongue. Cannot be scraped off. Candidiasis can be scraped off! See with HIV and AIDS. Leukoplakia is referred because it can be a precursor to cancer.
hairy leukoplakia
Black hairy tongue. Elongated, darkened papillae often due to staining, infection, or antibiotic treatment Benign condition.
hairy tongue
Perception-like experiences that seem real but, unlike illusions, lack actual external stimulation. The person may or may not recognize the experiences as false. Hallucinations may be auditory, visual, olfactory, gustatory, tactile, or somatic. False perceptions associated with dreaming, falling asleep, and awakening are not classified as hallucinations.
hallucinations
tests for inflammation of the rotator cuff, shoulder and elbow flexed at 90 degrees, pal facing down, rotate arm internally
hawkin's impingement sign
May also be seen in infants with severe respiratory distress.
head bobbing
vital metric during early childhood
head circumference
Every interaction with a child and family is an opportunity for
health promotion
BMI 5th to 85th percentile
healthy weight
If infants are not making age-appropriate sounds and language, consider testing for a...
hearing deficit
the inability to hear tones at frequencies between 500 and 4,000 Hz, the most important for speech processing
hearing loss
Angina from inferior wall coronary ischemia along the diaphragm may also present as
heartburn
tandem gait
heel to toe
young children are easiest to examine when...
held by a parent
production of RBCs in the bone marrow
hematopoiesis
Extreme jaundice may signify a...
hemolytic process or biliary or liver disease
the coughing up of blood from the lungs; it may vary from blood-streaked phlegm to frank blood
hemoptysis
Seen in patients with HTN, DM, or a sudden increase in intracranial pressure.
hemorrhages
most prevalent chronic bloodborne pathogen in the United States
hepatitis C
single, oval, flat-topped superficial erythematous to skin-colored plaque on right abdomen.
herald patch of pityriasis rosea
rectocele
hernia of the rectum
Produces recurrent and painful vesicular eruptions of the lips and surrounding skin. A small cluster of vesicles first develops. As these break, yellow-brown crusts form. Healing takes 10-14 days. Both new and erupted vesicles are visible here.
herpes simplex (HSV)
multiple 2-4-mm vesicles and pustules on erythematous base, grouped together on left neck.
herpes simplex virus
- HSV type I & II - Type I can be transmitted to genital area during oral sex activity - Dx: PE, may swab lesion, blood test not as helpful b/c treatment is the same for type I vs II - Lesions 2-3 weeks after exposure - 10-15% are asymptomatic but still can shed virus. - Red itchy/"tingly" area with prodromal systemic symptoms, lesions small vesicles - May be painful and tender for 2 weeks
herpes simplex virus (HSV)
grouped 2-5-mm vesicles on erythematous base on left upper abdomen and trunk in a dermatomal distribution that does not cross the midline.
herpes zoster, or shingles
involves skin containing a high density of apocrine glands, including the axillae, groin, and under the breasts.
hidradenitis suppurativa
flat, planar, or slightly curved, allowing only a gliding motion in a single plane, as in flexion and extension of the elbow
hinge joint
Hypocalcemic tetany, congenital hypothyroidism, or unilateral vocal cord weakness.
hoarse cry
perforated TM
hole in eardrum
Airway obstruction or lower respiratory tract disease in infants can result in paradoxical (seesaw) breathing in which the abdomen moves outward while the chest moves inward during inspiration.
hoover sign
a sign of genital syphilis, teeth that are smaller and more widely spaced than normal and are notched on biting surfaces
hutchinson teeth in congenital syphilis
Transilluminates
hydrocele
The anterior fontanelle is bulging, and the eyes may be deviated downward revealing the upper sclerae and creating the setting sun sign, as shown on the left.
hydrocephalus
A girl's initial signs of puberty are
hymenal thickening and redundancy secondary to estrogen, widening of the hips, and beginning of a height spurt
> 34 bowel sounds a min
hyperactive bowel sounds
Air trapping, COPD, or tension pneumothorax
hyperresonance
The infant's chest is ___ throughout, and it is difficult to detect abnormalities on palpation or percussion.
hyperresonant
Fine hair is seen in
hyperthyroidism
Fine, silky hair in
hyperthyroidism
Thyrotoxicosis (Graves disease) occurs in approximately 2 per 1,000 children younger than 10 years. Affected children exhibit tachycardia, hypermetabolism, and accelerated linear growth. Facial characteristics shown in this 6-year-old girl are "staring" eyes (not true exophthalmos, which is rare in children) and an enlarged thyroid gland (goiter).
hyperthyroidism
intolerance to heat, weight loss, moist velvety skin, and palpitations point to possible
hyperthyroidism
lid lag
hyperthyroidism
warm, moist, soft, and velvety skin; thin and fine hair; alopecia; vitiligo; pretibial myxedema (in Graves' disease); hyperpigmentation (local or generalized)
hyperthyroidism
Milky discharge unrelated to a prior pregnancy and lactation is nonpuerperal galactorrhea. Causes include
hyperthyroidism, pituitary prolactinoma, and dopamine antagonists, including psychotropics and phenothiazines
< 5 bowel sounds a min
hypoactive bowel sounds
cranial nerve XII
hypoglossal nerve
long limbs in proportion to trunk
hypogonadism and Marfan's syndrome
Abnormal location of the urethral orifice to some point along the ventral surface of the glans or shaft of the penis. The foreskin is incompletely formed ventrally.
hypospadias
Congenital Urethra may open anywhere along ventral glans shaft or at penoscrotal junction Often at neck of penis
hypospadias
a congenital ventral displacement of the meatus on the penis
hypospadias
the most common congenital penile abnormality
hypospadias
Intolerance to cold, weight gain, dry skin, and slowed heart rate point to
hypothyroidism
Sparse hair is seen in
hypothyroidism
coarse hair in
hypothyroidism
dry, rough, and pale skin; coarse and brittle hair; myxedema; alopecia (lateral third of the eyebrows to diffuse); skin cool to touch; thin and brittle nails
hypothyroidism
pain with no identifiable etiology
idiopathic pain
Misinterpretations of real external stimuli, such as mistaking rustling leaves for the sound of voices.
illusions
Local redness of the skin warns of
impending necrosis
This infection is due to bacteria and can appear bullous or crusty and yellowed with some pus.
impetigo
Respiratory signs and symptoms that warrant prompt medical intervention:
inability to speak in full sentences, use of accessory muscles, cyanosis, evidence of low oxygen saturation, and pulsus paradoxus
Seen in severe psychotic disturbances (usually schizophrenia).
incoherence
Speech that is incomprehensible and illogical, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use. Flight of ideas, when severe, may produce incoherence.
incoherence
common s/s of BPH
incomplete emptying, frequency, intermittency, urgency, weak stream, straining, nocturia
Changes in diet for patients with HTN:
incr food high in potassium (baked white or sweet potatoes, white beans, yogurt, tomatoes, bananas, plaintains, orange juice, spinach, lentils) and decr food high in sodium (canned foods, processed foods, fried foods, table salt)
barrel chest
increased AP diameter, COPD
increased soft tissue laxity leading to
increased ROM
subclinical hypothyroidism is associated with
increased risk for cardiovascular disease
Compression, solidity, or consolidation of lung tissue (example: PNA, tumor)?
increased tactile fremitus
beau's lines
indentations that run across the nail
School-age children have a drive for...
independence
vagina
index finger
distress associated with eating that can have many meanings
indigestion
rovsing sign
indirect tenderness
Causes of urethritis include
infection from C. trachomatis and N. gonorrhoeae
Splenomegaly in an adolescent who has had sore throat and fever, may be a sign of
infectious mononucleosis
Tenderness noted on rectal examination of a child usually indicates an
infectious or inflammatory cause, such as an abscess or appendicitis
orchitis
inflammation of the testes
positive crossover test
inflammation or arthritis of the AC joint
a communication process in which a clinician educates a patient about the risks, benefits, and alternatives of a given procedure or intervention.
informed consent
arms at their side, elbows flexed 90 degrees (thumbs turned up), provide resistance as the patient presses their forearms outward, rotator cuff tear
infraspinatus strength test
Oligomenorrhea
infrequent bleeding
xerostomia
insufficient saliva
Metrorrhagia
intermenstrual bleeding
- Rely on experience, pattern recognition, and intuition. - Rapid, less effort. - Less reliable, higher risk for errors. - Developed through clinical experience.
intuitive diagnostic reasoning
Knowing without needing to use conscious processes. Three Aspects of Intuition: - Immediate reception of the knowledge of the situation. - Perception of the wholeness of the situation. - Knowledge that is gained without a conscious deliberation process.
intuitive model
moving the sole of the foot INWARD at the ankle.
inversion
asterixis
involuntary flapping movements of the hands
Physiologic ___ occurs during days 2-5 of life and progresses from head to toe as it peaks.
jaundice
connect muscle to bone
joints
- No pulsations palpable. - Pulsations obliterated by pressure above the clavicle. - Level of pulse wave decreased on inspiration; increased on expiration. - Usually two pulsations per systole. - Pulsations sometimes more prominent with abdominal pressure.
jugular vein
A hallmark of heart failure
jugular venous distention
The deep purple color of these lesions suggests Kaposi sarcoma (KS), a low-grade vascular tumor associated with human herpesvirus 8 (HHV-8). These nontender lesions may be raised or flat. About a third of patients with KS have lesions in the oral cavity; other affected sites are the gastrointestinal tract and the lungs.
kaposi sarcoma
Deep purple lesions that can be flat or raised. A common finding in patients with AIDS.
kaposi's sarcoma
mucosal erythema (lips, tongue, and pharynx), strawberry tongue, cherry red lips, polymorphous rash (primarily on trunk), erythema of palms and soles with later desquamation of fingertips
kawasaki disease
solitary 4-cm pink and brown scar-like nodule on central chest at site of previous trauma.
keloid
Flex the patient's leg at both the hip and the knee, and then slowly extend the leg and straighten the knee. Discomfort behind the knee during full extension is normal but should not produce pain.
kernig sign
an early sign of measles (rubeola). Search for small white specks that resemble grains of salt on a red background. They usually appear on the buccal mucosa near the first and second molars. In this photo, look also in the upper third of the mucosa. The rash of measles appears within a day.
koplik spots
what is the preferred test for ACL injury?
lachman
Tests for ACL damage. The patient lays supine with the knee flexed at 15 degrees and external rotation. Stabilize the femur with one hand at the proximal tibia with the other hand. Pull the tibia forward and the femur backward (simultaneously). Estimate the degree of excursion.
lachman test
Place the knee in 15° of flexion and mild external rotation. Grasp the distal femur on the lateral side with one hand and the proximal tibia on the medial side with the other. With the thumb of the tibial hand on the joint line, forcefully and simultaneously pull the tibia forward and the femur back. Estimate the degree of forward excursion. There should be a firm endpoint to any forward movement. Lack of a firm endpoint with excessive movement may indicate the ACL is no longer intact.
lachman, ACL
fine, downy hair at birth (esp in premature infants)
lanugo
LGA
large for gestational age, > 90th
Unilateral hyperresonance suggests a
large pneumothorax or an air-filled bulla
scoliosis
lateral curvature of the spine
left testis
lays lower the right testis
ambylopia
lazy eye, found in 1-4% of US children
When interviewing a patient, it is important to avoid
leading questions, yes or no questions, multiple questions at once
vesicular late crackles, wheezes.
left heart failure
ridged nails
lengthwise, wavy ridges seen in normal aging
any single area of altered skin
lesion
Polymenorrhagia
less than 21-day intervals between menses
normal abdominal aorta size
less than 3 cm
- Paraurethral (aka Skene's) - Male Homolog: prostate - Location: upper wall of the vagina, around the lower end of the urethra - Function - mucus production to aid lubrication during intercourse. Drain into the urethra and near the urethral opening
lesser vestibular anatomy glands
scale for murmur grading
levine scale
Pubic or genital excoriations suggest
lice or scabies
connect bone to bone
ligaments
solitary 9-cm mobile rubbery subcutaneous mass on left temple.
lipoma
RUQ
liver
green stain
liver disease
solid abdominal viscera
liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus
Breast redness suggests
local infection or inflammatory carcinoma
hard drive of the computer, stored for a lifetime, use different types of memory
long term memory
Dilated scalp veins are indicative of...
long-standing increased intracranial pressure
recommended lung cancer screening for current smokers
low dose CT annually
expiration is prolonged and often accompanied by wheezing (as well as coughing)
lower airway obstruction like asthma
which erupt earlier: upper or lower teeth?
lower teeth
apex of the heart
lower tip of the heart, apical pulse
The second most frequently diagnosed cancer in the United States and the leading cause of cancer death for both men and women.
lung cancer
scoliosis changes the ability of
lung expansion
central vision loss is common with
macular degeneration and cataracts
a circumscribed flat area of change in color of the skin < 1 cm in diameter examples: freckles, flat moles, port-wine stains, rashes of rickettsia infections, rubella, and measles
macule
The most common causes of diffuse hair thinning
male and female pattern baldness
cvd is more common in
males before age 50, females after age 50
solitary dark brown, blue-gray, and red 7-mm macule with irregular borders and fingerlike projections of pigment, on right forearm.
malignant melanoma
why is scrotal edema present for several days following birth?
maternal estrogen
Tests for medial and lateral meniscus
mcmurray and thessaly test
With the patient supine, grasp the heel and flex the knee. Cup your other hand over the knee joint with fingers and thumb along the medial joint line. From the heel, externally rotate the lower leg, then push on the lateral side to apply a valgus stress on the medial side of the joint. At the same time, slowly extend the lower leg in external rotation.
mcmurray test
Characteristic rash, in the presence of a child who also has coryza, conjunctivitis, fever, and this diffuse rash
measles
common diseases occur commonly
medical adages
The most lethal skin cancer.
melanoma
blue or black color within a larger pigmented lesion is especially concerning for
melanoma
Caused by increased pigmentation in the nail matrix, leading to a streak as the nail grows out. This may be a normal ethnic variation if found in multiple nails. A thin uniform streak may be caused by a nevus, but a wide streak, especially if growing or irregular, could represent a subungual melanoma.
melanonychia
onset of menses
menarche
In children, the presence of nuchal rigidity is a more reliable indicator of ___ than Brudzinski sign or Kernig sign.
meningeal irritation
nuchal rigidity
meningitis
a palpable click or pop along the medial or lateral joint line is a positive test. the tear may displace tissue causing "locking" on full knee extension or movement of the loose tissue causing clicking.
meniscal tear
if patient has a click during flexion and extension or if tenderness is noted at the joint line, assess for
meniscal tear
absence of menses for 12 consecutive months, usually occurring between ages 48 and 55 years
menopause
An abnormally small chin is called...
micrognathia or mandibular hypoplasia
A normally structured penis with length <1.9 cm.
micropenis
Children become "concrete operational" —capable of limited logic and more complex learning. They remain rooted in the present with little ability to understand consequences or abstractions. School, family, and environment greatly influence learning. A major developmental task is self-efficacy, or the child's belief in their ability to thrive in different situations. Language becomes increasingly complex.
middle childhood
Movement of the tympanic membrane is absent in...
middle ear effusion (otitis media with effusion)
rectum
middle finger
Pinhead-sized white, pearly papules, without surrounding erythema, on the nose (seen here), chin, and forehead result from retention of sebum in the openings of the sebaceous glands. Although occasionally present at birth, they usually appear within the first few weeks and disappears over several weeks.
milia
Scattered erythematous papules, vesicles, or pustules, usually on the face, neck and trunk, result from obstruction of the sweat gland ducts; this condition disappears spontaneously within weeks.
miliaria rubra
Fifth intercostal space left midclavicular line.
mitral
Ask pt to roll onto their left side and listen in the mitral area with bell, this accentuates
mitral stenosis
a mild unilateral pain lasting for a few hours to a few days arising at midcycle from ovulation, ruptured ovarian cyst, or tubo-ovarian abscess
mittelschmerz
Dome-shaped, fleshy lesions with central umbilication.
molluscum contagiosum
multiple 3-5-mm pink firm smooth-domed papules with central umbilications, in mons pubis, and on penile shaft.
molluscum contagiosum:
- Yeast vaginitis - Fungal (candida albicans) - Many OTC preparations - Recurrent yeast infections & diabetes or immunocompromised - Recent ABX use - Thick white "curd-like" discharge - pH <4 hyphae & yeast buds Itching & irritation
monilia (candidiasis)
multiple 3-8-mm erythematous confluent round macules on chest, back, and arms.
morbilliform drug eruption
Recurrent shaking chills suggest...
more extreme swings in temperature and systemic bacteremia
metatarsus adductus
most common deformity of the foot, marked by the middle bones of the foot pointing in toward the body
myelomeningocele
most severe form of spina bifida in which the spinal cord and meninges protrude through the spine
bartholin's gland cyst
mucus filled swelling of the greater vestibular gland
An enlarged thyroid gland with two or more nodules suggests a metabolic rather than a neoplastic process. Positive family history and continuing nodular enlargement are additional risk factors for malignancy.
multinodular goiter
A sound/vibration made by blood flowing through a normal valve or an abnormal valve. A sound made by blood flowing backwards through a leaking valve.
murmur
- Hook fingers or thumb around right costal margin & ask pt to take a deep breath - Indirect fist percussion - RUQ pain may indicate inflammation of the gallbladder or liver & is (+)
murphy's sign (cholecystitis)
Persistence of lumbar lordosis suggests decreased ROM at the lumbar spine and suggests
muscle spasm or ankylosing spondylitis
In certain forms of this disease with weakness of the pelvic girdle muscles, children will rise to standing by rolling over prone and pushing off the floor with the arms while the legs remain extended (Gower sign).
muscular dystrophy
generalized muscle aches and pains
myalgias
most common visual disorder in childhood, near sightedness
myopia
In severe hypothyroidism (myxedema) mucopolysaccharide deposition in the dermis leads to a dull, puffy facies. The edema, often pronounced around the eyes, does not pit with pressure. The hair and eyebrows are dry, coarse, and thinned, classically with loss of the lateral third of the eyebrows. The skin is dry.
myxedema
plates of tightly packed hard keratinized epidermal cells that form a clear solid covering over the dorsal surfaces of the distal portions of our digits
nails
Signs of respiratory distress in newborns.
nasal flaring, grunting, retractions, and wheezing
Gray/yellow-colored growths inside the nares.
nasal polyps
tests for inflammation of the rotator cuff, press on the scapula to prevent motion, and passive elevation of the patient's arm (with the other hand)
neer's impingement sign
Invented or distorted words, or words with new and highly idiosyncratic meanings.
neologisms
Observed in schizophrenia, psychotic disorders, and aphasia.
neologisms
Red pustules and papules are most prominent over the cheeks and nose of some normal newborns.
neonatal acne
Cramping pain radiating to the flank or groin accompanied by urinary symptoms may be suggestive of
nephrolithiasis (renal stone)
Glomerular disease causes excess albumin excretion, which reduces intravascular colloid osmotic pressure, causing hypovolemia, then sodium and water retention. The face becomes edematous and often pale. Swelling usually appears first around the eyes and in the morning. When severe, the eyes appear slit like.
nephrotic syndrome
more info is networked, the easier it is to recall, the more you retrieve the info, the more it is accessible, doesn't always hold up
neural network
Café-au-lait spots (discolored patches of skin), skin tags, and fibrous tumors are common in
neurofibromatosis
Characteristic features include more than 5 café-au-lait spots and axillary freckling. Later findings include neurofibromas and Lisch nodules (not shown).
neurofibromatosis
pain resulting from direct trauma to the peripheral or CNS
neuropathic
It is often described as electric shock-like, stabbing, burning, or "pins and needles."
neuropathic pain
when to gather comprehensive health history
new patients, patients with numerous chief concerns, health maintenance, review of chart
obligate nasal breathers and have difficulty breathing through their mouths
newborns
Occur in tuberculosis and malignancy.
night sweats
Tiny white ovoid granules that adhere to hairs may be
nits (lice eggs)
Common errors of family history
no ages, leaving out siblings and children, leaving out age if deceased
delayed puberty in girls
no breast or pubic hair development by age 12
Common error of PMH:
no dates, no results
pain related to tissue damage
nociceptive or somatic
a solid elevation of the skin >1 cm in diameter that usually extends into the deeper skin layers. examples include cysts, lipomas, and fibromas.
nodules
white penile discharge
non-gonococcal urethritis from chlamydia
lesions such as petechiae, purpura, and vascular structures (cherry angiomas, vascular malformations) are not erythematous, but rather bright red, purple, or violaceous. They are nonblanching because blood has extravasated out from the capillaries into the surrounding tissues.
nonblanching lesions
downslanting palpebral fissures
noonan syndrome
An S3 or S4 in athletes is
normal
developmental quotient score > 85
normal
BMI 18.5-24.9
normal weight
Common errors in social history
not specific, saying normal, leaving out pertinent negatives
Rule-based actions, unaware of context.
novice
marked resistance to movement of the head in any direction
nuchal rigidity
signs of chronic sun damage
numerous solar lentigines on the shoulders and upper back, many melanocytic nevi, solar elastosis (yellow, thickened skin with bumps, wrinkles, or furrowing), cutis rhomboidalis nuchae (leathery thickened skin on the posterior neck), and actinic purpura
a fine rhythmic oscillation of the eyes
nystagmus
> 95th percentile for age and sex
obese
BMI > 95th percentile
obese
BMI 30-39.9
obesity
HTN in children is associated with
obesity
Recurrent persistent thoughts, images, or urges experienced as intrusive and unwanted that the person tries to ignore, suppress, or neutralize with other thoughts or actions (e.g., performing a compulsive behavior)
obsessions
a disorder characterized by repeated episodes of upper airway collapse, particularly during rapid eye movement (REM) sleep, leading to hypoxemia and disrupted sleep
obstructive sleep apnea (OSA)
- Performed by raising the patient's right leg with the knee flexed and internally rotating at the hip - Increased abdominal pain suggests irritation of the obturator muscle which could indicate appendicitis or peritoneal inflammation
obturator sign (appendicitis)
Development progression
occurs in a cephalo-caudal and a proximo-distal progression
cranial nerve III
oculomotor nerve
pain with swallowing
odynophagia
The most common cause of nail thickening and subungual debris is onychomycosis, most often from the dermatophyte Trichophyton rubrum, but also from other dermatophytes and some molds such as Alternaria and Fusarium species.
onychomycosis
The room should be darkened for the...
ophthalmoscopic examination to promote pupillary dilation and improved visibility of the fundi
a round, yellow-orange to creamy pink structure with a pink neuroretinal rim and central depression that often takes practice to locate
optic disc
cranial nerve II
optic nerve
This infection is common in infants. The white plaques do not rub off.
oral candidiasis
Common in infants. The white plaques are difficult to wipe away and have an erythematous raw base. They are found on the buccal mucosa, palate, and tongue.
oral candidiasis (thrush)
dyspnea that occurs when the patient is supine and improves when the patient sits up.
orthopnea
Place the baby supine with the legs pointing toward you. Flex the legs to form right angles at the hips and knees, placing your index fingers over the greater trochanter of each femur and your thumbs over the lesser trochanters. Abduct both hips simultaneously until the lateral aspect of each knee touches the examining table.
ortolani test
tests for the presence of a posteriorly dislocated hip
ortolani test
Fever, chills, and pain with pressure injury suggest underlying
osteomyelitis
Tenderness behind the ear occurs in
otitis media and mastoiditis
Temporary hearing loss for several months can accompany...
otitis media with effusion
Associated with hereditary cancer syndromes such as mutations in the BRCA1 or BRCA2 genes, which increase risks for breast and ovarian cancers.
ovarian cancer
LLQ
ovary, colon
BMI 25-29.9
overweight
BMI 5th to 95th percentile
overweight
between 85th and 95th percentile for age and sex
overweight
Report cigarette use in
packs/years
in allergic rhinitis, mucosa may be
pale, bluish, or red
decr circulation or hemoglobin
pallor
unpleasant awareness of heartbeat
palpitations
- Elevated intracranial pressure causes intra-axonal edema along the optic nerve, leading to engorgement and swelling of the optic disc. - Color pink, hyperemic - Often with loss of venous pulsations - Disc vessels more visible, more numerous, curve over the borders of the disc - Disc swollen with margins blurred - The physiologic cup is not visible - Seen in intracranial mass, lesion, or hemorrhage, meningitis
papilledema
Blurred edges of the optic disc, disc vessels more visible, the disc is swollen: seen with increased intracranial pressure.
papilledema
If a raised spot is small (<1 cm), it is a
papule
a small solid elevation of the skin <1 cm in diameter. examples include nevi, warts, lichen planus, insect bites, seborrheic keratoses, actinic keratoses, some lesions of acne, and skin cancers.
papule
Tight foreskin retracted becomes edematous Cannot resume normal position Circulation impeded causing swelling May be reduced manually or may require surgery
paraphimosis
a tight prepuce that, once retracted, cannot be returned, edema ensues.
paraphimosis
- Caused by inflammation - Aching & more severe - Localized over the involved structure - Aggravated by moving and coughing
parietal pain
- WHEN THERE IS INFLAMMATION FROM A HOLLOW OR SOLID ORGAN THAT AFFECTS THE PARIETAL PERITONEUM. - USUALLY MORE SEVERE BUT EASIER TO LOCALIZE.
parietal pain (like appendicitis)
Lines the pleural cavity along the inner rib cage and the upper surface of the diaphragm.
parietal pleura
In this neurodegenerative disorder linked to loss of the neurotransmitter dopamine, there is decreased facial mobility and masklike facies, with decreased blinking and a characteristic stare. Since the neck and upper trunk tend to flex forward, the patient seems to peer upward toward the observer. Facial skin becomes oily, and drooling may occur.
parkinson disease
A superficial infection of the proximal and lateral nail folds adjacent to the nail plate. The nail folds are often red, swollen, and tender. Represents the most common infection of the hand, usually from Staphylococcus aureus or Streptococcus species, and may spread until it completely surrounds the nail plate. Arises from local trauma due to nail biting, manicuring, or frequent hand immersion in water.
paronychia
Chronic bilateral asymptomatic parotid gland enlargement may be associated with obesity, diabetes, cirrhosis, and other conditions. Note the swellings anterior to the ear lobes and above the angles of the jaw. Gradual unilateral enlargement suggests neoplasm. Acute enlargement is seen in mumps.
parotid gland enlargement
a circumscribed flat area of change in color of the skin >1 cm in diameter.
patch
normal bronchophony
patient says "99," normal transmission is muffled.
pigeon chest
pectus carinatum
funnel chest
pectus excavatum
- Infection of uterus, fallopian tubes, & adjacent pelvic structures - Often 2/2 to STI infection (G&C) - Fever, N/V, abdominal pain, rebound tenderness, mucopurulent d/c, dysuria, cervicitis, CMT
pelvic inflammatory disease
ability to regard faces, turn to voices, quiet in presence of singing, track colorful objects, respond to touch, and recognize familiar scents
perception
sensory awareness of objects in the environment and their interrelationships (external stimuli). They also refer to internal stimuli such as dreams or hallucinations.
perceptions
- Assesses for air, fluid, & solid matter. - Identifies margins of organs. - Performed posteriorly (superior à inferior to diaphragm). - AVOID SCAPULAR AREAS. - USE THE MIDDLE FINGER OF THE NONDOMINANT HAND, MAKE SURE OTHER FINGERS ARE NOT TOUCHING THE SURFACE, AND STRIKE THE FINGER AT THE DIP.
percussion
- Start at the right midclavicular line above & parallel to the expected upper border of the liver. - Percuss in a downward fashion to identify the upper liver border (dullness). - GO FROM TYMPANY (LUNGS) TO A DULLER SOUND (UPPER LIVER BORDER).
percussion - upper liver border
Assessment for infants and children:
perform less invasive maneuvers early and potentially distressing maneuvers near the end of the examination
Distal heart tones suggest
pericardial effusion
atherosclerotic disease distal to the aortic bifurcation, although some guidelines also include the abdominal aorta
peripheral arterial disease (PAD)
soft, ejectile, systolic, upper left sternal border, radiating to lung fields and axillae
peripheral pulmonary flow murmur
how to assess the major branches of the aorta
peripheral pulses
Arterial: pulses 1+ or absent; minimal edema; shiny; hairless. Venous: pulses 2+; edema; brownish, thickened skin.
peripheral vascular disease
- Pain (front, back, sides, shoulders) - Electrolytes fall (shock ensues) - Rigidity (or rebound tenderness of anterior abdominal wall) - Immobile abdomen and patient - Tenderness (with involuntary guarding) - Obstruction - Nausea & Vomiting - Increased pulse rate, decreased B/P - Temperature falls then rises, tachypnea - Increasing girth of abdomen - Silent abdomen
peritonitis
A silent, tympanic, distended, and tender abdomen suggests
peritonitis
a positive cough test, involuntary guarding, rigidity, rebound tenderness, and percussion tenderness.
peritonitis
hot potato voice
peritonsillar abscess
Occurs in schizophrenia and other psychotic disorders.
perseveration
Persistent repetition of words or ideas
perseveration
diarrhea as lasting 14 to 30 days
persistent diarrhea
Absent factors, which, had they been present, would have suggested another diagnosis.
pertinent negatives
expected symptoms or signs that are not present, facts that you would expect to find if a possible cause for a patient's problem were true, which then weaken this diagnosis by their absence.
pertinent negatives
Symptoms the patient endorses...says they do have.
pertinent positives
symptoms or signs that you would expect to find if a possible cause for a patient's problem were true, which then supports this diagnosis.
pertinent positives
paroxysmal cough with a whoop at the end
pertussis
nonblanchable punctate foci of hemorrhage.
petechiae
palpable, nontender, hard plaques are found just beneath the skin, usually along the dorsum of the penis. The patient complains of curved, painful erections.
peyronie disease
patient holds wrist in flexion for 60 seconds
phalen's sign
Erythema/reddened, vascularity on assessment. Can be a bacterial or viral infection, Sometimes referred to as "cobblestone appearance."
pharyngitis
Foreskin cannot be retracted May be congenital or due to adhesions from infection Lips of prepuce are pallid, striated, thickened Retained smegma and dirt may cause inflammation and calculus May obstruct urination
phimosis
a tight prepuce that cannot be retracted over the glans
phimosis
Persistent irrational fears accompanied by a compelling desire to avoid the provoking stimulus
phobias
One of the first signs of puberty in girls:
physical changes in a girl's breasts
In general, pediatric clinicians assess five critical domains of development:
physical including gross and fine motor skills, cognitive (or problem-solving), language (communication), and social-emotional domains
three 6-8-mm mobile subcutaneous cysts on vertex scalp, that on excision reveal pearly white balls.
pilar cysts
A harmless yellowish triangular nodule in the bulbar conjunctiva on either side of the iris. Appears frequently with aging, first on the nasal and then on the temporal side.
pinguecula
Oval lesions on trunk, in older children, often in a Christmas tree pattern, sometimes a herald patch (a large patch that appears first).
pityriasis rosea
If a raised spot is larger (>1 cm), it is a
plaque
a large flatter elevation of the skin, sometimes formed by papules coalescing. examples: lesions of psoriasis and granuloma annulare commonly form plaques.
plaque
scattered erythematous to bright pink well-circumscribed flat-topped plaques on extensor knees and elbows, with overlying silvery scale.
plaque psoriasis
Parents can enhance the development of their children through...
play
decreased to absent, flat, rub.
pleural effusion
May be heard in pleurisy, pneumonia, and pulmonary embolism.
pleural friction rub
A discontinuous, low-frequency, grating sound that arises from inflammation and roughening of the visceral pleura as it slides against the parietal pleura. This nonmusical sound is biphasic, heard during inspiration and expiration, and often best heard in the axilla and base of the lungs.
pleural rub
Localized bronchophony and egophony are seen in lobar consolidation from...
pneumonia
Crackles can be heard with
pneumonia and bronchiolitis
decreased to absent, tympany.
pneumothorax
Red patches in sun-damaged areas, especially the V of the neck, and lateral neck (usually sparing the shadow inferior to the chin) with fine telangiectasias, and both hyper- and hypopigmentations.
poikiloderma
Hirsutism (excessive facial hair) may appear in some women with
polycystic ovary syndrome
ruddy or purple complexion
polycythemia
noncardiac findings commonly found in infants with cardiac disease:
poor feeding, FTT, irritability, tachypnea, hepatomegaly, clubbing, poor overall appearance, weakness, fatigue
why is the infant abdomen protuberant
poorly developed abdominal musculature
what can cause hepatomegaly and splenomegaly in children?
portal hypertension, storage diseases, chronic infections, and malignancy
primary treatment for OSA
positive airway pressure (CPAP, APAP< BPAP)
developmental quotient score 70-85
possibly delayed, follow up needed
Suggests cervical polyps or cancer or, in an older woman, atrophic vaginitis.
postcoital bleeding
- lens
posterior
Tests PCL injuries/knee stability. PCL: POSTERIOR CRUCIATE LIGAMENT. The patient lays supine with knees and hips flexed at 90 degrees. Cup hands around the knee with thumbs at the medial and lateral joint line, fingers on medial and lateral insertion of hamstrings. Push the tibia posteriorly and observe the degree of backward movement of the femur.
posterior drawer sign
Position the patient and place your hands in the positions described for the anterior drawer test. Sit on the patient's foot to minimize foot movement. Push the tibia posteriorly and observe the degree of backward movement in the femur. There should be minimal posterior movement and excursion of the tibia relative to the femur. Excessive movement suggests an insufficient or torn PCL.
posterior drawer sign, PCL
place thumbs at the level of the tenth rib, fingers loosely grasping and parallel to the lateral ribcage, have the patient inhale deeply, thumbs should move apart symmetrically
posterior lung expansion
bleeding occurring 6 months or more after cessation of menses.
postmenopausal bleeding
stage 1 sexual maturity in girls:
preadolescence, elevation of nipple only
Child development proceeds along a ___ pathway.
predictable
Uterine enlargement suggests
pregnancy, uterine myomas (fibroids), or malignancy
the load that stretches the cardiac muscle before contraction.
preload
a cluster of emotional, behavioral, and physical symptoms occurring 5 days before menses for three consecutive cycles
premenstrual syndrome (PMS)
Causes focusing problems for near vision, found in middle-aged and older adults. A person with presbyopia often sees better when the card is farther away.
presbyopia
localized damage to the skin and underlying soft tissue usually over a bony prominence or related to a medical or other device.
pressure injury
a near faint from "feeling faint or lightheaded"; causes include orthostatic hypotension, especially from medication, arrhythmias, and vasovagal attacks (~5%).
presyncope
Results from increased prostaglandin production during the luteal phase of the menstrual cycle, when estrogen and progesterone levels decline.
primary dysmenorrhea
A leading cause of visual impairment and blindness in the United States, affecting more than 2.5 million adults, including roughly 2% of adults older than age 40 years.
primary open-angle glaucoma (POAG)
examples: macule, patch, papule, plaque, nodule, pustule, vesicle, bulla, wheal, erosions, ulcers, petechiae, purpura, and ecchymoses.
primary skin lesions
those that develop as a direct result of, and therefore are most characteristic of, the disease process.
primary skin lesions
Sees situation as a whole, immediate grasp of meaning, recognizes patterns of normalcy or aberrance, uses maxims to guide action.
proficient
turning forearm so palm DOWN.
pronation
May feel normal Often Nodular Or Hard Enlarged unless early stages Most old men have a prostate cancer that goes undetected Should also do Blood PSA test?
prostate cancer
The leading cancer diagnosed in men in the United States, and the 3rd leading cause of death
prostate cancer
Presents with fever and urinary tract symptoms such as frequency, urgency, dysuria, incomplete voiding, and sometimes low back pain. The gland feels tender, swollen, "boggy," and warm.
prostatitis
function of nails:
protection of the distal ends of fingers and toes
hair functions:
protection, sense touch, reduce heat loss
moving body part FORWARD (parallel to the ground).
protraction
- Place hand on thigh above pt's right knee & have pt raise right leg against OR.... - Pt turns on the left side, then extend the patient's right leg at the hip § Increased abdominal pain with either maneuver is a (+) psoas sign
psoas sign (appendicitis)
frequently affects the scalp, extensor surfaces of the elbows and knees, umbilicus, and the gluteal cleft
psoriasis
relates to factors that influence the patient's report of pain
psychogenic
Delusions and feelings of unreality or depersonalization are often associated with
psychotic disorders
A triangular thickening of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side. Reddening and irritation may occur. May interfere with vision as it encroaches on the pupil.
pterygium
A drooping of the upper lid. Causes include senescence, myasthenia gravis, damage to the oculomotor nerve (CN III), and damage to the sympathetic nerve supply (Horner syndrome). A weakened muscle, relaxed tissues, and the weight of herniated fat may cause senile ptosis. Ptosis may also be congenital.
ptosis
when using the otoscope in 0-3 year olds
pull the pinna down and back
when using the otoscope in 3+ year olds
pull the pinna up and back
semilunar valves:
pulmonary and aortic
split S2 heard anywhere but the pulmonic area.
pulmonary hypertension
Is in the second left intercostal space left sternal border.
pulmonic
almost always indicates severe left ventricular dysfunction.
pulsus alternans
nonblanchable, raised and palpable.
purpura
nonblanchable, raised, and palpable.
purpura
- Study from 7 burn centers over a 10 year period (70 total patients). - Neisseria meningitidis most common in infants through adolescents. - Streptococcus most often found in adults. - Treatments consisted of antibiotic treatment of the underlying infection. - Volume replenishment and ventilatory and inotropic support. - Corticosteroids used (38%) of time. - Protein C replaced in (9%) of patients. - Skin grafting and amputations required in (90%). - 25% amputation of all extremities. - Early fasciotomoies reduced amputation in 6 of 14 patients.
purpura fulminans
a small, circumscribed elevation of the epidermis filled with purulent fluid. examples: ustules are common in bacterial infections and folliculitis.
pustules
Deep palpation in the right upper quadrant or midline can reveal an "olive," or a 2-cm firm pyloric mass. While the infant is feeding you might see peristaltic waves pass across the abdomen. Infants present at about 4 to 6 weeks of age.
pyloric stenosis
Persistence of palmar grasp reflex beyond 4 to 6 months suggests
pyramidal tract dysfunction
Persistence of plantar grasp reflex beyond 8 months suggests
pyramidal tract dysfunction
To bring out dimpling or retraction that may otherwise be invisible, ask the patient to
raise her arms over her head, then press her hands against her hips to contract the pectoral muscles
a widespread eruption of lesions.
rash
- Gentle deep palpation & quick release - Abdominal pain associated with the sudden release of pressure is a sign of (+) rebound tenderness
rebound tenderness
- Failure to recognize the acuity of illness, and complications. - Failure to refer or consult. - Failure to arrange follow-up.
recognizing urgency/complications
most accurate temp for newborns
rectal
A herniation of the rectum into the posterior wall of the vagina, resulting from a weakness or defect in the endopelvic fascia.
rectocele
In viral rhinitis, the mucosa is
reddened and swollen
- Superficial or deep - Felt at distant sites innervated @ about the same spinal level - Ulcer - back pain - Gallbladder - right shoulder pain - Pleurisy or MI - upper abdomen
referred pain
The 5 Rs of cultural humility:
reflection, respect, regard, relevance, and resiliency
Suggests the possibility of sexual abuse involving the rectum and requires more complete examination by an expert.
reflex anal dilatation
causes of sustained hypertension in newborns:
renal artery disease (stenosis, thrombosis), congenital renal malformations, and coarctation of the aorta
Caused by sudden obstruction of a ureter, for example, from renal or urinary stones or blood clots.
renal or ureteral colic
Learning for clinical reasoning is driven by...
repeated exposures to real case examples that illustrate multiple aspects of clinical reasoning
Failure to take prevalence into account when estimating the probability of a diagnosis.
representation error
what causes leukocoria?
retinoblastoma, glaucoma, exudative retinopathy (cholesterol) or coats' disease, congenital cataracts, PHPV, toxocara canis, uveitis
moving body part BACKWARD (parallel to the ground).
retraction
Considered by some to be a variant of wheezes, arising from the same mechanism, but lower in pitch. Unlike wheezes, rhonchi may disappear with coughing, so secretions may be involved.
rhonchi
- Low or high pitched - Inspiration or expiration - COPD, acute/ chronic bronchitis, asthma, PNA, bronchiectasis
rhonchi, wheezes
scattered 2-5-mm erythematous papules and vesicles with transudate crust, some with linear arrays, on forearms, neck, and abdomen.
rhus dermatitis or allergic contact dermatitis from poison ivy
an involuntary reflex contraction of the abdominal wall from peritoneal inflammation that persists over several examinations.
rigidity
Assess & compare the ability to hear via bone & air conduction (BC & AC). Start vibration on the mastoid bone then when no longer heard position tines in front of the ear. Rinne (+) result is normal. Air conduction > Bone conduction. Conductive hearing loss à BC = AC or BC > AC.
rinne
Body temperature during the day
rises
moving head AROUND CENTRAL AXIS.
rotation
also called the "stork bite," or "angel kiss," this splotchy pink mark fades with age.
salmon patch
multiple small (3-6-mm) erythematous papules on abdomen, buttocks, scrotum, and shaft and head of penis, with four burrows noted on interdigital web spaces.
scabies
an excessive number of dead keratinocytes produced by abnormal keratinization.
scales
strawberry tongue
scarlet fever, kawasaki disease
Blocking may be striking in
schizophrenia
Best test for development in school-aged children
school performance
measure scoliosis with a
scoliometer or plumb line
a loose, wrinkled pouch divided into two compartments, each containing a testis
scrotum
The salmon red, scaly eruption often involves the face, neck, axilla, diaper area, and behind the ears.
seborrhea
bilaterally symmetric erythematous patches on central cheeks and eyebrows, some with overlying greasy scale.
seborrheic dermatitis
Needle insertion for decompression of a tension pneumothorax.
second intercostal space
Inner ear disorder involves cochlear nerve and neuronal impulse transmission to the brain. Causes include loud noise exposure, inner ear infections, trauma, acoustic neuroma, congenital and familial disorders, and aging.
sensorineural hearing loss
May have trouble understanding speech. Mumble. More difficult in a noisy environment. History of loud noise exposure, trauma, congenital, aging.
sensorineural hearing loss
attention testing:
serial 7s and digit span
Usually caused by viral upper respiratory infections (otitis media with serous effusion) or by sudden changes in atmospheric pressure as from flying or diving (otitic barotrauma). The eustachian tube cannot equalize the air pressure in the middle ear and outside air. Air is absorbed from the middle ear into the bloodstream, and serous fluid accumulates in the middle ear instead. Symptoms include fullness and popping sensations in the ear, mild conduction hearing loss, and, sometimes, pain.
serous effusions
Physical signs include lacerations, ecchymoses and newly healed scars of the hymen, lack of hymenal tissue from 3 to 9 o'clock while the patient is in the supine position, and healed hymenal transections. Other signs such as purulent discharge and herpetic lesions are concerning as well.
sexual abuse
chronic pelvic pain is a red flag for
sexual abuse
working memory, only holds 7 things at a time, limited
short term memory
Increased intracranial pressure. Also, in a newborn born to a mother with an addiction to narcotics.
shrill or high-pitched cry
spinal abduction
side to side lateral bending
Intestinal obstruction often produces a
silent abdomen
Children with (1) purulent rhinorrhea for more than 10 days, (2) worsening course, or (3) severe symptoms, high fever, and purulent rhinorrhea >3 days may have
sinusitis
muscle under voluntary control
skeletal muscle
The largest of all organs, covering 2 square meters/22 feet, and weighs about 10-11 pounds.
skin
The most commonly diagnosed cancers in Americans, with a lifetime risk estimated to be about one in five.
skin cancer
multiple 2-4-mm soft, fleshy skin-colored to light brown papules on lateral neck and axillae in skin folds.
skin tags
SGA
small for gestational age (<10th percentile)
secretions of the glans
smegma
thyroid in graves disease
soft
if male breast in enlarged, distinguish between
soft fatty (obesity) and firm disc (glandular enlargement, gynecomastia)
Yellowish white macules or papules in sun-exposed skin, especially on the forehead.
solar elastosis
Bilaterally symmetric brown macules located on sun-exposed skin, including the face, shoulders, and arms and hands.
solar lentigo
children who are severely tongue tied by develop
speech impediments
Non-tender mass of fluid and sperm
spermatocele
The testes produce
spermatozoa and testosterone
ball and socket joint
spheroidal, shoulder and hip
main congenital anomalies on the back
spina bifida, myelomeningocele, pilonidal dimple
Midline hair tufts over the lumbosacral spine region suggest a possible...
spinal cord defect
LUQ
spleen
where would you hear friction rubs in abdominal assessment?
spleen and liver
LUQ abdominal pain causes:
splenic rupture, gastritis, gastric ulcer, pancreatitis, AAA, pneumonia, perforated colon
Intact skin with a localized area of nonblanchable erythema, which may appear differently in darkly pigmented skin.
stage 1 pressure injury
Partial-thickness loss of skin with exposed dermis.
stage 2 pressure injury
Full-thickness skin loss, in which adipose (fat) is visible in the ulcer and granulation tissue and rolled wound edges, is often present.
stage 3 pressure injury
Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer.
stage 4 pressure injury
Based on the principle that all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes may contain transmissible infectious agents. Standard precautions apply to all patients in any setting. They include hand hygiene; use of personal protective equipment (gloves; gowns; and mouth, nose, and eye protection); safe injection practices; safe handling of contaminated equipment or surfaces; respiratory hygiene and cough etiquette; patient isolation criteria; and precautions relating to equipment, toys, solid surfaces, and laundry handling.
standard precautions
ability to modulate the level of arousal in response to different degrees of stimulation (e.g., self-consoling)
state regulation
the ability to identify an object by feeling it
stereognosis
the reference point for JVP
sternal angle
borborygmi
stomach growling
hollow abdominal viscera
stomach, gallbladder, small intestine, colon, bladder, large intestine, appendix
Strabismus, or misalignment of the eyes, can lead to visual impairment. Esotropia, shown here, is an inward deviation.
strabismus
lumbosacral radiculopathy
straight leg raise
Fear of strangers common among children 9-15 months of age
stranger anxiety
This common childhood infection has a classic presentation of erythema of the posterior pharynx and palatal petechiae. A foul-smelling exudate is also commonly noted.
streptococcal pharyngitis
typically produces white or yellow exudates on the tonsils or posterior pharynx, a beefy-red uvula, and palatal petechiae
streptococcal pharyngitis
An adolescent with persistent fever, sore throat, swollen tonsils, and cervical lymphadenopathy may have
streptococcal pharyngitis or infectious mononucleosis
Arises from decreased intraurethral pressure.
stress incontinence
A continuous, high-frequency, high-pitched musical sound produced during airflow through a narrowing in the upper respiratory tract. Stridor is best heard over the neck during inspiration but can be biphasic. Causes of the underlying airway obstruction include tracheal stenosis from intubation, airway edema after device removal, epiglottitis, foreign body, and anaphylaxis. Immediate intervention is warranted.
stridor
an ominous, high-pitched musical sound from severe subglottic or tracheal obstruction that signals a respiratory emergency
stridor
The volume of blood ejected with each heartbeat, and it is dependent on preload, myocardial contractility, and afterload.
stroke volume
A painful, tender, red infection at the inner or outer margin of the eyelid, usually from Staphylococcus aureus (at the inner margin—from an obstructed meibomian gland; at the outer margin—from an obstructed eyelash follicle or tear gland).
stye (hordeolum)
Low weight on a high priority or probable diagnosis.
sub-optimal weighing/prioritization
contains adipose tissue, a storage unit for fat, contains large blood vessels that supply the skin
subcutaneous/hypodermis
The second leading cause of death among 15- to 24-year-olds.
suicide
Risk factors for skin cancers:
sun exposure, patients who sunburn easily, fair skin or freckles, red or light hair, blue eyes, or a history of skin cancer
turning the forearm so the palm is UP.
supination
Breast palpation is best performed with the patient
supine, thus flattening the breast tissue
cryptochordism after the infant stage requires
surgical correction
On palpation, the ___ feel like ridges and the ___ like soft concavities.
sutures, fontanelles
In acute otitis externa, the canal is often
swollen, narrowed, moist, erythematous or pale, and tender
normal prostate
symmetrical, non-tender, free of nodules, smooth, rubbery consistency
The joint is freely movable. Bones are covered by articular cartilage. Bones are separated by synovial cavities. The synovial membrane secretes synovial fluid that lubricates joint movement.
synovial joint
freely movable joints
synovial jpints
- Primary syphilis w/in 3 weeks of contact - Vulva, cervix, anus - Usually solitary lesions but may be "kissing lesions" - Raised, firm, red papules - Chancre erodes to creates ulcerative crater - Heals within 4-8 weeks with or without treatment
syphilis
This firm painless ulcer from primary syphilis forms ∼21 d after exposure to Treponema pallidum. It may remain hidden and undetected in the vagina and heals regardless of treatment in 3-6 weeks.
syphilitic chancre
malar erythema (mid cheeks, spans bridge of nose), relative sparing of nasolabial folds, periungual erythema, interphalangeal erythema
systemic lupus erythematosus
Palpating in symmetric areas with the palmar surfaces, noting the locations for feeling fremitus. Assess symmetrically and avoid the scapular area.
tactile fremitus
The most common severe congenital foot deformity is...
talipes equinovarus or clubfoot
positive hair pull test
telogen bulbs are on all the hairs that are pulled out
important vs for skin/nail cc
temperature and RR
lateral epicondylitis
tennis elbow
(example: scalp hair, eyebrows): coarse, longer, thicker, pigmented
terminal
Scalp hair and eyebrows are examples of
terminal hair
Nail plate turns white with a ground-glass appearance, a distal band of reddish brown, and obliteration of the lunula Seen in: Liver disease, Congestive Heart failure, Diabetes
terry nails
Nail plate turns white with a ground-glass appearance, a distal band of reddish brown, and obliteration of the lunula.
terry nails
ovoid, somewhat rubbery structures approximately 4.5 cm long
testes
Torsion, or twisting, of the testicle on its spermatic cord produces an acutely painful, tender, and swollen organ that is often retracted upward in the scrotum. The cremasteric reflex is nearly always absent on the affected side in boys or men with testicular torsion, though this can be difficult to assess during acute pain episodes. If the presentation is delayed, the scrotum becomes red and edematous. There is no associated urinary infection. Torsion is most common in neonates and adolescents but can occur at any age. It is a surgical emergency because of obstructed circulation and requires urgent surgical consultation.
testicular torsion
intrinsic stains can be caused by
tetracycline use
May be helpful, especially when the patient is obese. Stand to the right of the patient's chest. Place both hands, side by side, on the right abdomen below the border of liver dullness. Press in with your fingers and up toward the costal margin. Ask the patient to take a deep breath. The liver edge shown in is palpable with the fingerpads of both hands.
the "hooking technique"
Best for parous women with vaginal prolapse.
the Graves specula
Involves forcible exhalation against a closed glottis after full inspiration, causing increased intrathoracic pressure.
the Valsalva maneuver
binocularity
the ability of the eyes to function together
Can be elicited by gently stroking upward or downward along the medial aspect of the thigh. The testis on the side being stroked will move upward.
the cremasteric reflex
Includes the larynx, trachea, bronchi, and lungs.
the lower respiratory system
Usually most comfortable for women who are sexually active.
the medium Pedersen speculum
Best for the patient with a small introitus, such as a virgin or an elderly woman.
the narrow-bladed Pedersen speculum
A small whitish depression in the optic disc, the entry point for the retinal vessels. Although sometimes absent, the cup is usually visible either centrally or toward the temporal side of the disc. Grayish spots are often seen at its base.
the physiologic cup
inguinal hernia
the protrusion of a small loop of bowel through a weak place in the lower abdominal wall or groin
A clinical test for functional impairment of the optic nerves. In dim light, note the size of the pupils. After asking the patient to gaze into the distance, swing the beam of a penlight for 1 to 2 seconds first into one pupil, then into the other. Normally, each illuminated eye constricts promptly. The opposite eye also constricts consensually.
the swinging flashlight test
Includes the nose, nasal cavity, pharynx, and associated structures.
the upper respiratory system
corpus spongiousum contains
the urethra
In chronic otitis externa, the skin of the canal is often
thickened, red, and itchy
Abnormal spinal curvatures and vertebral rotation deform the chest. Distortion of the underlying lungs may make interpretation of lung findings very difficult.
thoracic kyphoscoliosis
What is the foundation of clinical assessment?
thorough HEALTH HISTORY & PHYSICAL EXAM
What the patient thinks about, including level of insight and judgment. To assess thought content, follow the patient's leads and cues rather than asking direct questions.
thought content
For persons first being vaccinated at ages 15 through 26 and immunocompromised persons ages 9 through 26, the recommendation is for (for HPV)
three doses of HPV vaccine (0, 1 to 2, and 6 months)
abnormal vibration associated with grade 4-6 heart murmurs
thrill
Patient to raise thumb straight against up while applying downward resistance.
thumb abduction
retroverted
tilted uterus
bilateral erythematous, geographic patches with peripheral scaling, on inner thighs bilaterally, sparing the scrotum.
tinea cruris
tap lightly over the course of the medial nerve in the carpal tunnel.
tinel's sign
Loud harsh sounds heard over the trachea in the neck.
tracheal breath sounds
Seen more commonly in black infants, the rash presents at birth as some combination of pustules, scale, and hyperpigmented macules. The pustules and scale resolve by around 2 weeks, leaving behind hyperpigmented macules that resolve after several months.
transient neonatal pustular melanosis
Multiple rib fractures may result in paradoxical movements of the thorax. As descent of the diaphragm decreases intrathoracic pressure, on inspiration, the injured area caves inward; on expiration, it moves outward.
traumatic flail chest
rhythmic oscillatory movements, which may be roughly subdivided into three groups: resting (or static), postural, and intention.
tremors
- STI - Trichomonas vaginalis - Unicellular, flagellate protozoan - Vaginal discharge (thin and frothy) & itching (no foul odor) - Strawberry spots on vaginal walls - Male partner may be asymptomatic
trichomoniasis
Fourth left intercostal space left sternal border.
tricuspid
AV valves:
tricuspid and mitral (bicuspid)
cranial nerve V
trigeminal nerve
By 1 year, the infant's birth weight should have ___ and height increased by ___ from weight and height at birth.
tripled, 50%
cranial nerve IV
trochlear nerve
The discharge of milk-containing fluid unrelated to pregnancy or lactation, is most commonly caused by hyperprolactinemia.
true galactorrhea
Toddlers may acquire nursemaid's elbow or subluxation of the radial head from a ... They will hold their arms slightly flexed at the elbows.
tugging injury
For persons being vaccinated for HPV before age 15, the recommendation is
two doses of HPV vaccine within 6 to 12 months
speculum exam requires at least
two pair
deeper loss of the epidermis and at least the upper dermis.
ulcer
Thickening of the nipple and loss of elasticity suggest an
underlying cancer
BMI < 5th percentile
underweight
A set of guidelines designed to prevent parenteral, mucous membrane, and noncontact exposures of health care workers to bloodborne pathogens, including HIV and Hepatitis B virus (HBV). Immunization with the HBV vaccine for health care workers with exposure to blood is an important adjunct to universal precautions. The following fluids are considered potentially infectious: all blood and other body fluids containing visible blood, semen, and vaginal secretions and cerebrospinal, synovial, pleural, peritoneal, pericardial, and amniotic fluids. Protective barriers include gloves, gowns, aprons, masks, and protective eyewear. All health care workers should follow the precautions for safe injections and prevention of injury from needlesticks, scalpels, and other sharp instruments and devices.
universal precautions
Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.
unstageable pressure injury
obligate nose breathers
until about 6 months
inspiration is prolonged and accompanied by stridor, cough, or rhonchi
upper airway obstruction like croup
more prone to dental caries in early childhood
upper teeth
The urethra opens into the vertical, slit-like
urethral meatus
many variably sized (1-10-cm) wheals on lateral neck, shoulders, abdomen, arms, and legs.
urticaria
levine scale
used to grade murmurs; Grade I (difficult to hear) through Grade VI (Loudest)
the snellen chart
used to measure visual acuity
The most common vulvovaginal symptoms are
vaginal discharge and itching
cranial nerve X
vagus nerve
Laxity or possible tear of MCL. MCL: MEDIAL COLLATERAL LIGAMENT. Put one hand on the lateral side and push medially at the knee and laterally at the ankle.
valgus (abduction) stress test
Evaluates for varicocele Standing in warm room leads to palpable distention of vessels ("bag of worms" if present)
valsalva maneuver for varicocele
facial hair on women, short, fine, inconspicucous, unpigmented hair
vellus
warty lesions on the labia and within the vestibule are often condyloma acuminata from infection with human papillomavirus.
venereal wart (condyloma acuminatum)
heaves/lifts; PMI displaced.
ventricular hypertrophy
a cheesy white material composed of water, proteins, and lipids that covers the newborns body
vernix caseosa
a spinning sensation accompanied by nystagmus and ataxia; usually from peripheral vestibular dysfunction (∼40% of "dizzy" patients), but may be from a central brainstem lesion (~10%; causes include atherosclerosis, multiple sclerosis, vertebrobasilar migraine, or transient ischemic attack).
vertigo
If the lesion is raised, filled with fluid, and small (<1 cm), it is a
vesicle
a small, circumscribed elevation of the epidermis containing clear fluid <1 cm in diameter.
vesicle
Soft and low pitched. They are heard throughout inspiration, continue without pause through expiration, and then fade away about one third of the way through expiration.
vesicular breath sounds
normal breath sounds:
vesicular, bronchovesicular, bronchial
coated tongue
viral infection
Purulent rhinitis is common in
viral infections
Nasal mucosa & turbinates are erythematous and swollen. Discharge is variable.
viral rhinitis
Visceral arousal (negative and positive feelings toward patients) lead to poor diagnostic decisions.
visceral bias
- Hollow organs contract forcefully - Encapsulated organs stretch - Difficult to localize - Deep, dull, diffuse
visceral pain
- WHEN HOLLOW ORGANS ARE FORCEFULLY CONTRACTED OR BECOME DISTENDED. - USUALLY CRAMPING OR ACHING AND IS DIFFICULT TO LOCALIZE.
visceral pain (hepatitis)
Covers the outer surface of the lungs.
visceral pleura
large confluent completely depigmented patches on dorsal hands and distal forearms.
vitiligo
may be patchy and isolated or may group around the distal extremities and face, particularly around the eyes and mouth.
vitiligo
Can be caused by external irritants, bubble baths, masturbatory activity, pinworms, or other infections such as Candida or sexually transmitted infections.
vulvovaginal pruritis and erythema
Women report internal burning in urethritis and external burning in
vulvovaginitis
Examples of gross motor skills include:
walking, sitting, or transferring from one position to another
verruca
wart
syndactyly
webbed fingers or toes
Ability to hear sound bilaterally. Tap the fork & place it in the middle of the head. Normal = equal vibration in both ears. Ask patient if louder in one ear or equal. Impaired ear - conductive hearing loss = louder; sensorineural loss = quieter.
weber
BMI =
weight (kg) / height (m^2)
a circumscribed, raised lesion consisting of dermal edema and is also known as hives or urticaria, wheals typically last < 24 hours.
wheal
a common manifestation of hypersensitivity to drugs; stings or bites; autoimmunity; and, less commonly, physical stimuli including temperature, pressure, and sunlight.
wheal
Continuous musical sounds that occur during rapid airflow when bronchial airways are narrowed almost to the point of closure. Wheezes can be inspiratory, expiratory, or biphasic. They may be localized, due to a foreign body, mucous plug, or tumor, or heard throughout the lung. Although wheezes are typical of asthma, they can occur in a number of pulmonary diseases. Recent studies suggest that as the airways become more narrowed, wheezes become less audible, culminating finally in "the silent chest" of severe asthma requiring immediate intervention.
wheezes
- Sinusoidal, musical, prolonged (but not necessarily persisting throughout the respiratory cycle). - Wheezes: relatively high-pitched with hissing or shrill quality. - Rhonchi: relatively low-pitched with snoring quality.
wheezes and rhonchi
continuous adventitious breath sounds:
wheezes or rhonchi
musical respiratory sounds that may be audible to the patient & to others
wheezing
Louder, clearer whispered sounds are called
whispered pectoriloquy
a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue
whispered pectoriloquy
leukocoria
white pupil
fluoride
white stain
The range of normal development is...
wide
Slightly raised, yellowish, well-circumscribed cholesterol-filled plaques that appear along the nasal portions of one or both eyelids. Half of affected patients have hyperlipidemia; it is also common in primary biliary cirrhosis.
xanthelasma
risk factors for osteoporosis
● Postmenopausal status in women ● Age ≥50 years ● Prior fragility fracture ● Low body mass index ● Low dietary calcium ● Vitamin D deficiency ● Tobacco and excessive alcohol use ● Immobilization ● Inadequate physical activity ● Osteoporosis in a first-degree relative, particularly with history of fragility fracture ● Clinical conditions such as thyrotoxicosis, celiac sprue, IBD, cirrhosis, chronic renal disease, organ transplantation, diabetes, HIV, hypogonadism, multiple myeloma, anorexia nervosa, and rheumatologic and autoimmune disorders ● Medications such as oral and high-dose inhaled corticosteroids, anticoagu- lants (long-term use), aromatase inhibitors for breast cancer, methotrexate, selected antiseizure medications, immunosuppressive agents, proton-pump inhibitors (long-term use), and antigonadal therapy for prostate cancer