advanced health assessment final <3

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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


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