Part 3 Board Review (pt.1)

General case history includes:

Identifying data

Chief complaint

Present Illness

Past

Family

Occupational

Social

Review of systems

Identifying data

Gender, AGE, marital status

Present illness

LMNOPQRST and MOI

LMNOPQRST

L = location of complaint

M = modifiers (aggravating/alleviating factors)

N = numbness (weakness or other symptoms)

O = Onset (time, date, setting, circumstances)

P = Prior episodes

Q = Quality of pain (sensation, weakness and or functional limitation)

R = Radiation and referral pattern from pain site

S = Severity at its worst, best and on average (0-10)

T = timing (% day, frequency, duration and course of this and previous episodes)

Past

surgeries, trauma, illnesses, medications

family

Dwelling, death, diseases, adoption

(where did they grow up?)

Occupational

School, work, ADLs

Social

Sleep, smoke, stress, diet, drink (CAGE)

CAGE → Cut down, annoyed, guilty, eye opener

Review of systems

questionnaire (which system?)

Case history quiz: swollen tingling feet

DM = vascular (crud in the blood)

LBP = neurological (look for things like “flexion/forward antalgia improves symptoms = neurological/canal stenosis)

Case history quiz: Chronic cough for 2 months

60 year old smoker: cancer

25 year old episodic: asthma/allergies

Case history quiz: clubbing nails, dyspnea at night

Left CHF (lungs aren’t working due to left sided CHF)

Case history quiz: lymphadenopathy

fever, swollen, illness history (how many times have you been sick this past year)

Organs: lymph, liver, spleen, thymus, tonsils, bone marrow (PEP checks this)

Temperature

Elevated = pyrexia = itis

where: oral, otic, anal (1 degree higher), axillar (1 degree lower)

Bacterial fever

sustained → night sweats

Viral fever

Spikes then lowers

Temperature: Hodgkin’s

relapsing

Temperature: ewings

low grade fever

Bacterial

increased fever

Increased neutrophils (neutrophilia)

normal lymphocytes

Increased leukocytes

Viral

spikes then lowers

decreased neutrophils (neutropenia)

increased lymphocytes

decreased leukocytes

17,000-18,000 Leukocytes = ER

shilling shift

Apyrexia list

Osteoarthritis

costochondritis

cystitis and urethritis

tendonitis and bursitis

osteitis deformans (pagets)

osteochondritis dissecans

Osteitis condenses ilii

Strep story

1.) dental work/sore throat leads to strep throat → confirmation = throat culture (throat)

2.) Two week sequelae: glomerulonephritis → confirmation = UA (RBC casts)

3.) two month sequelae: carditis → confirmation = blood culture

Sub acute bacterial endocarditis (SBE) effects mitral and aortic heart valves

What special study is indicated for heart valves: ECHO

With osler’s nodes what fingernail change is likely → splinter hemorrhage = valve infection

Adult pulse rate

70-80bpm

Child pulse rate

90 bpm

Infant pulse rate

140bpm

Respiration

12-18

Blood pressure

110-140 systole (ventricular contraction)

60-90 diastole (ventricular rest)

30-40 = pulse pressure

primary = essential

normal = 110/70

Diagnosis of Hypertension

3 consecutive visits

140/90 mild

Secondary hypertension (malignant)

kidney, hereditary, drugs (oral contraceptives), hormone therapy, endocrine (DM and adrenals) and obesity (20% overweight)

Apoplexy

cell death w/ paralysis (stroke → FAST (face, arms, slurred/sloppy, time)

Decreased ADH → posterior pituitary

Diabetes insipidus → polydipsia, polyuria

Decreased insulin → pancreas (tail)

diabetes mellitus → polydipsia, polyuria, and polyphagia

decreased adrenocorticoids → adrenal cortex (Hypothyroidism)

Addison’s → weight loss, hypotension, bronze skin

Increased adrenocorticoids → adrenal cortex (hyperthyroidism)

Cushing’s → weight gain, swollen, HYPOTENSION, Moon face, Hirsutism, infertility, thin extremities

Decreased T3, T4 and TSH → secondary thyroid (anterior pituitary)

Myxedema: weight gain, swollen, HYPERTENSION, Dry skin, constipation, enophthalmos, lateral third of eyebrow missing

Increased T3, T4 and TSH → secondary thyroid (anterior pituitary)

graves: sweaty diarrhea, exophthalmos

Thyroglobulin → thyroid

hashimoto

Decreased vitamin D

Rickets: child

Osteomalacia: adult

Cushing’s and Myxedema →

swollen, burning, PNE (burning hands and feet)

Anasarca

renal failure, CHF, endo (hypothyroid and hypoadenocorticoid), CNS, allergies

swollen all over

Icterus

jaundice

Intracranial pressure

papilledema, enlarged and blurred

Intraocular pressure

glaucoma, small, tonometry

Diabetic retinopathy

waxy exudates, and microaneurysms

Hypertension

flame hemorrhage, cotton wool

Absent red light reflex

glass eye, cataract

Retinal detachment (flashing light)

Addie’s Pupil

asymmetrical pupil size (ANS damage)

glaucoma

peripheral loss

Macular degeneration

central loss

Pterygium (significant

grows over iris

Pinguecula

insignificant (grows around the eye, not on iris)

Sunglasses recommended → both pinguecula and pterygium are from sun exposure

Chalazion

pain-less, inside eye

Hordeolum

Painful sty

outside eye

Conjunctivitis

superficial → more contagious

Iritis

deep, red rim around iris/pupil

medical emergency

red light reflex distured

Xanthelasma

hyperlipidemia

liver disease

Superficial infections of the eye

Sty, marginal blepharitis (eyelid), conjunctivitis, hordeolum

Non-superficial eye infections

iritis and glaucoma

Horner’s

Brachial plexus involvement

miosis present

anhidrosis present

enopthalmosi’s is present

flushing of the face is likely

arm pain

Pancoast syndrome

lytic mets, horner’s syndrome and TOS (neuropathy)

Pancoast tumor

bronchogenic carcinoma

apex of lungs and apical lordotic x-ray view helpful

Ectropion

lower eyelid folded OUT

Entropion

lower eyelid folded IN

Exopthalmosis bilateral

Grave’s disease

Exopthalmosis unilateral

SOL

Enopthalmosis bilateral

myxedema

Enopthalmosis unilateral

Horner’s syndrome

Later 1/3 of eyebrow missing

hypothyroidism

Bilateral anhydrosis

sjogren’s

Unilateral anhidrosis

horner’s

Mydriasis means

dilated

Adie’s pupil and anisocoria

dilated unilaterally

Argyl Roberston pupils bilaterally

both accommodate but don’t react to light

(syphilis / posterior column disease)

Fordyce Spot

yellow

Aphthous Stomatitis

yellow center, red halp (canker sore)

Leukoplakia

white (can not peel off)

thrush

white (can peel off)

Diphtheria

pseudomembrane (in throat)

Hepes

vesicles

Koplik spots

White spots on red bas (Rubeola)

Nose: red

Acute rhinitis or coryza

Nose: pale/gray/blue

chronic infection and allergies

Foul discharge from nose

foreign object

Clear discharge from nose

thin → CSF and allergies

Thick → infection

Conduction loss

cerumen, osteosclerosis and infection

sensorineural loss

presbycusis, meniere’s

painful tragus

otitis externa

painful mastoid

otitis media

bulging Tympanic membrane

acute and chronic otitis

Retracted tympanic membrane

serous (bubbles) and altitude

Pearly gray tympanic membrane

normal

Lymph: RT supraclavicular

above diaphragm (right side only)

Lymph: LT superclavicular

most metastatic disease

Common lymphadenopathies

Children: leukemia

Young adults: mono, hodgkin’s, AIDS

Elderly: multiple myeloma (plasma cell cytoma, primary bone cancer)

Malignant

No fever (except hodgkin’s)

Non-mobile

Painless

firm

bleeding from orifice

rubbery (lymphoma)

Benign

fever

mobile

painful

soft texture

bleeding is rare

calcified (shotty)

Multiple Myeloma

Hypercalcemia

hyperproteinemia

proteinuria

cold bone scan

SPARES pedicle

(Ca and protein = MM)

ENDOSTEAL SCALLOPING

Lytic mets

hypercalcemia

targets pedicle

hot bone scan

(Ca only = mets)

Permeative pattern