General Diagnosis Pt I (Pt II Boards)

case history includes

chief complaint (own words, open ended)

present illness (OPQRST), past

family and occupational, social ROS

vital signs

6 total

temperature, BP, RR, HR, oxygen, pain

what does orthostatic hypertension cause

syncope

bacterial temperature

sustained

viral temperature

spikes with fever and chills

icterus

green jaundice

cataracts

no red light reflex and Lens opacity

retinal detachment

no red light reflex, flashing lights, falling curtains from trauma

intracranial pressure

pailledema

intraocular pressure

glaucoma (blurred, halos)

acres seniles

insignificant, elderly

corneal arcus

significant under 30 y/o

diabetic retinopathy

waxy exudates and micro aneurysms

hypertension issues in eyes

flame hg, cotton wool, copper wires

MS and migraines in the eyes

scintillating scotomas (neuromuscular)

drusen and coloboma in eyes

normal background anomalies

crusty ear discharge

otitis externa, swimmers ear

bulging tympanum

otitis media

retracted tympanum

Serous (bubbly) and altitude

blocks Eustachian tube

myrinigitis

redness (acute infection)

black ear

perofration

pearly gray tympanic membrane

normal

otosclerosis

chalky white eardrum

serorienural ear loss

presbycusis

neuroma

menieres

can't hear in a noisy environment

conduction ear loss

infections

cerumen

ostosclerosis

can hear better in noisy environment

weber and rinne

weber to louder side

loud side is conduction loss (abnormal rinne)

soft side is sensorineural

red nose

acute rhinitis

smell nerve

CN I

pale, gray, or blue nose

allergies and chronic itis

foul discharge from nose

foreign object

clear discharge/bloody from nose

CSF

watery unilateral nasal discharge

cribriform plate fx

depressed nose bridge

possible nasal bone fracture

epistaxis

nose bleed

polyp

mass in mucosa

soft tissue cancer story

chronic irritation

proliferation of cells

soft tissue turns rigid

non tender mass, painless bleeding

malignant lymph

non mobile and non tender

benign lymph

mobile and tender

supraclavicular lymph

right: above diaphragm on right

left : everything else

virchows node

bad

pancreatitis and cancer

T10, epigastrium, fetal position, alcoholism, ecchymosis in the flanks

HEAD

diabetes mellitus

insulin, polydipsia, polyuria, polyphagia

TAIL

tests for pancreas and diabetes

FBS, GTT, glycosylated hemoglobin, A1C

flank pain

kidneys

type I DM

juvenile, thin, insulin dependent

type II DM

obese, receptor site malfunction

what does fat metabolism cause

ketones, ketoacidosis, fruity breath and urine

glycation

when sugar combines with protein causing inflammation and free radicals

Murphys sign

RUQ for gallbladder

cholecystitis (fever) and cholelithiasis

female, multiparous, flatuence, dissension, obese, right scapular pain, jaundice, sterorrhea

appendicits labs

WBC 17,500

neutrophilia

schilling shift

RLQ

appendicitis tests

psoas test, blumbergs (rebound tenderness), rovings (pressure LLQ), marble (heel jar)

what abdomen pain

peritonits

peptic ulcer

gastric, duodenal, barium study, infection, h pylori

stomach cancer

virchows node on the left and occult blood

gastritis

elderly, alcohol, B12 absorption problem, PLS

cyancobalamin

extrinsic factor, diet high in animal products

gut has parietal cells that secrete

HCL and intrinsic factor, makes B12 absorbable

B12 responsibilities

RBC maturation

myelination of nerves

B12 pathology

chronic gastritis from diet abuse, proton inhibitor pump, meds

pernicious anemia

posterolateral sclerosis (stocking and clove paresthesia

B12 tests

B12 assay, schillings test, achlorhydria

B12 treatment

intramuscular injections

diverticulosis

elderly, out pouching of colon, need fiber

cancer of colon

abrupt constipation, follows polyps

ulcerative colitis

stress, bloody diarrhea, megacolon, stool transplant

obstruction

early is increases

late is decreases

ascites

fluid in abdomen with organ failure

aborborygmi

absence of bowel sounds >5 minutes

veins for liver

portal hypertension and should not percuss >1 in below costal margin

acute hepatitis

tender, swollen, boggy, IgM

Dec WBC, inc. lymph

chronic hepatitis

non tender, swollen, boggy

IgG, increased or normal WBC and enzymes

cirrhosis

non tender, variable, hard and smooth

increased GGT

liver cancer

non tender, swollen, hard nodular

increase biopsy

kidney location

T12-L3

right is slightly lower

nephrosis

HEP

chronic failure, fat oval bodies, all casts

cystitis

female, ascending, e coli, no casts, no fever, nitrates

kidney cancer

painless bleeding

kindey stones

male, 20 y/o, sedentary lifestyle, colicky

toxemia of pregnancy

pre-eclampsia (HEP)

nephritic

fever, strep, sequela is carditis

glomerulonephritis

RBC casts

pyelonephritis

WBC casts and waxy

top to bottom kidney pathologies

strep

fever

casts

proteinuria

stones

HEP

bottom up kidney pathologies

STD

E coli

nitrates

no fever

frequency

urging

burning

external hemorrhoids

thrombosed

often symptom free ones defecating (portal hypertension)

internal hemorrhoids (prolapsed)

bloody defecation and often painful

rectal prolapse

strain produces donut shaped anus

rectal fissure

linear tear, bloody defecation

rectal polyps

firm, palpable growth

viral pneumonia, laryngitis, pleural effusion

resonance percussion

normal fremitus

atelectasis, tumor, pneumoconiosis

flat percussion

decreased fremitus

magenblase, flatulence

tympanic percussion

normal fremitus

bacterial pneumonia, CHF, pulmonary edema

dull fluid with percussion

increased fremitus

COPD, emphysema, pneumothorax

hyper resonance percussion

decreased fremitus

massive pleural effusion

decreases fremitus

stops lung vibration because flood is outside the lung

rhonchi

sonorous wheeze

low pitched indicating large bronchial or tracheal obstruction

sibilant wheezing

musical rales, fine crackles

high pitched, usually asthma

stridor

inspiratory crowing

highest pitched noise indicating a medical emergency

prolonged expiration

COPD

respiratory lag

pneumothorax