Internal: Physical exam

  1. Pain on active movement v. pain on active and passive movement
    • Pain on just active movement indicates a muscular disorder
    • Pain on active and passive movement indicates a joint disorder
  2. First thing to rule out in a patient with monoarthritis
    • Septic arthritis--needs to be treated immediately
    • Characterized by a WBC count over 100,000
  3. Oligoarthritis v. polyarthritis
    • Oligoarthritis--1 to 5 joints
    • Polyarthritis--more than 5 joints
  4. DD for oligo/polyarthritis
    • RA
    • SLE
    • Reactive arthritis/Reiter's
    • IBD
    • Psoriatic arthritis
  5. Morning stiffness in a patient with arthritis
    Characteristic of inflammatory arthritis, as opposed to osteoarthritis. Caused by accumulation of fluid in joints after a long period of immobility.
  6. Schober's test
    • Used to detect ankylosing spondylitis.
    • Mark a line at the level of the PSISs
    • Measure up 10 cm
    • Ask patient to bend over and touch toes; distance between two lines should elongate by at least 4 cm
  7. Does DIP involvement indicate osteoarthritis or RA?
  8. Extra-articular manifestations of RA
    • Rheumatoid nodules, usually on extensor surfaces
    • Pulmonary fibrosis
    • Vasculites (renal disease, hepatic disease)
    • Eye inflammation
  9. Livedo reticularis
    A white, net-like pattern over an erythematous area. Indicative of APLA, which is associated with SLE.
  10. Bouchard's nodules
    Firm, non-tender nodules on the PIPs
  11. Heberden's nodes
    Firm, non-tender nodules over the DIPs
  12. Chronic diarrhae that does not manifest at night
    May indicate IBS--an organic cause of diarrhea would also occur at night
  13. Patient presents with high palate, poor vision, and a heart murmur
  14. What disease causes patients to lose their eyebrows?
  15. Where can pain from lung disease be referred?
  16. Cause of central cyanosis
    Right to left shunt
  17. Cause of peripheral cyanosis
    Vasoconstriction or diminished blood flow in the periphery
  18. When is the a wave (jugular pressure) increased?
    • The a wave indicates atrial contraction, and increases when pressure in the atrium increases:
    • tricuspid stenosis
    • AV block
  19. When is the v wave (jugular pressure) increased?
    The v wave indicates right ventricular contraction, and gets bigger in tricuspid regurg, where the ventricle contracts against a higher volume of blood
  20. Kussmaul's sign
    Increased JVP with inspiration. Goes with pulsus paradoxus, which may indicate constrictive pericarditis or cardiac tamponade.
  21. What is the correlation between the severity of a bruit, and degree of stenosis of an artery?
    None exists
  22. How great a difference between the pulses on the right and left side does there need to be to indicate a pathology?
    10 mm or more
  23. What is the definition of orthostatic hypotension?
    A decrease of 20 or more in systolic bp and 10 or more in diastolic bp when someone stands up
  24. What does lateral displacement of the PMI indicate?
    LV dilation
  25. What maneuver decreases venous return to the right heart?
    Valsalva--increases intrathoracic pressure, which decreases the pull of the blood towards the heart
  26. When does the murmur of HCM increase?
    • When there is less blood flowing through the heart, which allows the hypertrophic heart to contract more violently.
    • Giving fluids to a patient with HCM will increase the volume of blood and decrease severity of symptoms. Inotropic agents would be a really bad idea.
  27. Holosystolic murmer with an S3
    • Mitral regurg, if it does not become louder with inspiration
    • Tricuspid regurg, if it does become louder with inspiration (associated with increased JVP and large v waves)
  28. Harsh, loud, holosystolic murmur with no S3
    Probably VSD (might be mitral or tricuspid regurg)
  29. Crescendo-decrescendo systolic murmur
    • Aortic stenosis
    • Heard best with patient sitting up and leaning forward
  30. Crescendo-decrescendo systolic murmur of variable intensity that radiates to the apex, but not to the carotids
  31. What makes the systolic murmur of HCM increase or decrease?
    • Increases with valsalva
    • Decreases with squatting
  32. Early, decrescendo diastolic murmur that sounds like breath sounds
    Aortic regurg
  33. Rumbling diastolic murmur
    • Mitral stenosis
    • Easier to hear with the patient in left lateral decubitus
Card Set
Internal: Physical exam
Notes from the first week