Part 3 Board Review (pt.2)

Nephritis (infection)

fever, flank pain, proteinuria

“a” cast

Nephrosis (death)

Hypertension, Edema, Proteinuria

All casts

RBC casts

Glomerulonephritis (strep)

WBC and waxy casts

pyelonephritis

All casts

nephrosis

Hyaline casts

normal /nephrosis

Cystitis

young female and old male, ascending, E-coli and nitrates

Cancer =

PAINLESS BLEEDING!!

Kidney stones

males, 20 year old, sedentary life style, colicky

dx = IVP

TX = lithotripsy, decrease vitamin C, and calcium

Toxemia of pregnancy

HEP, pre-eclampsia/eclampsia

Referred pain

renal and ureters = flank

Bladder = suprapubic

Urethra = groin

Stone = colicky

Femoral hernia

female and male

Direct inguinal hernia

older male on scrotum

indirect inguinal hernia

young male in scrotum

Prostate

PSA identifies prostate organ involvement

Digital exam → rectal and prostate evaluation

Acid phos. identifies aggressive prostate disease

alkaline phos, identifies blastic metastasis to bone

Rectal prolapse

Valsalva

rectal fissure

frank blood

Acute prostatitis

general enlargement

Tender (high fever)

firm and warm

additional info

Chronic prostatitis

normal DRE

less tender ( no fever)

Often normal

painful ejaculation (bloody semen)

Benign hypertrophy

enlarged lateral lobes

non-tender median sulcus obliterated

boggy

obstructs stream, nocturnal micturition (nocturia)

Cancer (primary vs mets)

starts in posterior lobe

non-tender, median sulcus obliterated

firm and nodular (walnut)

Gleason score determines aggressiveness and tx (1-5)

Fibroadenoma

one painless, firm lesion, non-malignant (most common lump)

Fibrocystic disease

regresses after menses, painful, multiple and mobile

Breast cancer

may cause nipple retraction, unilateral dimpling, bleeding, orange peel appearance to skin of the breast

most common area for mets is axilla by way of lymph system (pagets disease = nipple cancer)

Pregnancy

LBP, breast tenderness, nausea are first signs

NO XRAY

Pregnancy: HCG increased

Tumors and twins

pregnancy: HCG decreased

ectopic pregnancy (CT and CBC for blood loss)

endometriosis

ectopic endometrium, progressive dysmenorrhea, infertility

Uterine tumor

leiomyoma, uterine fibroid

Uterus/cervic

second most common primary cancer in females

ovaries

ovulation on the opposite side every other month (adnexa)

salpingitis

PID → adnexal region

Cheyne stokes

rhythmical apnea, brain lesion (ER)

Biot’s

irregular apnea, medulla damage, ER

Kussmaul

air hunger, associated with diabetic coma, deep breathing (ER)

Hyperventilation

rapid breathing, circumoral tingling

tx - carbon dioxide

pink puffer

balloon lungs → emphysema

Blue bloater

chronic bronchitis

Percussion and fremitus: Flat

lung tissue (collapse) → atelectasis

Percussion and fremitus → Dull

Fluid → bacterial pneumonia, pulmonary edema, and CHF (fremitus increased)

percussion and fremitus → resonance

normal → asthma, bronchitis and pleural effusion (fremitus normal)

Percussion and fremitus: hyperresonance

air → emphysema and pneumothorax (fremitus decreased)

percussion and fremitus: tympany

gastric air → meganblase

Fremitus feels

fluid (inspiratory and exp crackles)

Tracheal breath sounds

1:1

Bronchial breath sounds

1:3

Bronchovesicular breath sounds

1:1

Vesicular breath sounds

3:1

Rales/wheezes/crackles

fluid in smaller airways or base

friction rub

pleurisy

prolonged expiration

COPD

Pneumococcal

rusty sputum (lobar → yellow/green)

klebsiella

currant jelly sputum (alcoholics, debilitated patients)

haemophilius influenza

older (lung)

children (ear and brain(

mycoplasma

walking pneumonia in an adult

Viral pneumonia

mucopurulent, productive (reye’s syndrome)

Bronchiectasis

foul sputum (chronic infections)

pneumocystic carinii

protozoan associated with AIDS

X-ray: lung cancer

primary (snowball)

secondary (cannonballs)

X-ray: COPD

asthma (normal xray)

Emphysema

X-ray: lymphoma

hodgkin’s

sarcoidosis

(mediastinum enlargement)

X-ray: pneumothorax

young males, hyperlucent

expiratory film

pushes mediastinum away

X-ray: atelectasis

collapse, infection and cancer

radio-opaque

pulls mediastinum towards

X-ray: pleurisy

normal xray

friction rub, sudden onset

Dry

AAA (arch)

Laryngitis

Productive

TB (red)

CHF (pink, bubbly)

Systole

work (110-140)

Diastole

rest (60-90)

Tachycardia

>100bpm

Bradycardia

<60bpm

MI

coronary infarct

Labs: troponin, CPK, SGOT, LDH

anything makes pain worse

nothing makes it better

Angina

coronary ischemia

Labs are normal

Activity makes it worse and rest makes it better within 10 minutes

CRP =

risk test for inflammation of arterial wall

Pain that lasts over 10 minutes at rest

suggests MI (DURATION is key)

P

atrial depolarization

QRS

ventricular depolarization

T

ventricular repolarization

Increased ST segment

Increased time between ventricular depolarization and repolarization

MI

Inverted T wave

MI

AV node causes

increase between P and QRS waves

Widen QRS

Bundle of HIS lesion, ventricle hypertrophy

Atrial flutter

saw tooth P waves

clot

Atrial fibrillation

irregular and multiple P waves

clot

Premature atrial contraction

premature P waves or deforms T wave

ventricular fibrillation

chaotic EKG → death

Bell

low stenosis

Diaphragm

high regurgitation

Sounds: S1

AV valves (Mitral and tricuspid valves)

S2 sounds

semilunar valves (Aortic and pulmonic valves)

Murmurs

Stenosis (low), regurgitation (high)

Diastolic murmurs

Aortic Regurgitation

Mitral stenosis

Pulmonic regurgitation

Tricuspid stenosis

Heart failure is named by etiology → caused by hypertension and results in edema

1st sign: fatigue,

last sign: pitting edema (anasarca)

echocardiogram and kidney eval

Cor Pulmonale: right sided heart failure first

cause: pulmonary hypertension (smoking, COPD)

right ventricle hypertrophy

right ventricle failure

result: body edema, jugular distension and portal hypertension

Congestive heart failure: left sided failure first

cause: systemic hypertension (diet, DM, drug)

left ventricle hypertrophy, left ventricle failure fatigue)

Result: pulmonary edema, nocturnal dyspnea, pink frothy sputum

Arterial disease

cool skin, pale and cyanotic skin

red, tortuous vessels

No swelling, raynauds present

hair loss, thin skin (smoking) vitamin C

Weak pulse (heavy legs = PAD)

No valve incompetence

Venous disease

warm skin, normal and rubor (cyanosis late)

Blue, bulging vessel color

swelling is dependent (drains when elevated)

absent raynaud’s

hair loss, stasis dermatitis (bronze medial malleolus)

normal pulse and valve incompetence is present

atherosclerosis/arteriosclerosis

coat arteries, heart works harder, increased peripheral blood pressure

arterial