What are components of history taking?
- 1. Chief Complaint - main reason / symptoms the patient is in your clinic
- 2. HPI (History of Present Illness) - "OPQRST" (please refer to Clinical Counseling for details)
- 3. PMHx (Past Medical History)
- 4. Medications
- 5. Allergies
- 6. Family History
- 7. Social History
- 8. ROS (Review of Systems) - "10 Questions"
What is the term for a subjective feeling of complaint (i.e. pain, warmth, palpitations)?
- *Cheif Complaint is considered a symptom
What is the term for an objective finding or evidence (i.e. tenderness, fever, tachycardia)?
Please identify the Tinea's and their respective locations?
What are Shingles? What is another name for this term? Where is its distribution?
- A painful, blistering skin rash due to the varicella-zoster virus, the virus that causes chickenpox.
- Distribution: unilateral dermatomal pattern
- Complication: Post-Herpetic Neuralgia
A common skin condition affecting teens?
Acne - due to the bacteria acne vulgaris
When a light is shined on one eye there is contraction (pupilary reflex), but the other eye also contracts. What is the term for this response?
An eye doctor preforms what is called a Red Reflex / Dilating Exam. What patients get this most?
Patients with Diabetic Retinopathy
What is the name of the condition associated with Increased Intraocular Pressure?
What is the name of the condition associated with Loss of Central Vision?
What is the name of the condition associated with Eye Deviation?
Strabismus (most common - eye deviating medially)
What is the name of the condition associated with Near Vision?
What is this disease called when both tinnitus and vertigo occur at the same time?
Meniere's Disease (both hearing and balance deficit)
What are good signs when examining any lump?
- Circular / Nodular / Smooth
- Soft, Fluid filled (cyst)
- Tender - inflammation
- Regular Edges
- Same Size
What are bad signs when examining any lump?
- Irregular, not smooth contours
- Firm / Hard
- Non-tender - cancerous
- Jagged Edges
- Change in size
- "Dimpling" - think cancer
How often should breast exam be done (self or otherwise)?
Once a month
How often should mammograms be done in young women?
Never, unless otherwise indicated
What month during pregnancy does the mother start producing milk?
Which two hormones are responsible for breast milk production and stimulates secretion, respectively?
- Prolactin - production
- Oxytocin - secretion (also stimulate uterine contraction during labor)
Clear to yellow fluid found in breast milk that contains the maternal antibodies vital for providing immunity in the neonate's (baby) first few months of life.
A 26 year old female with bilateral nipple discharge with swollen breasts. What does she have?
What can you tell me about Fibrocystic Disease?
It is not actually a disease, a physiological change over time (age)
Rash / ulceration found in the area of the fold of breast.
5 year old child with high fever that is pulling and tugging on the ear a lot. Shining a light into the ear you see swelling of the ear drum. What is the diagnosis?
Hard fixed non-tender lump on the right side of the neck. What is the next step?
Cranial Nerve VI (6) is responsible for what?
Lateral Eye Movement
A 66 year old had syncopal episode lasting 20 minutes. He woke up with extreme left sided arm and leg weakness. Exam of the mouth reveals left latterally deviated tongue. Which CN is affected
CN XII - Hypoglossal (Motor)
35 year old complains of right cheek / upper teeth pain. Which CN is affected?
CN V - Trigeminal (Sensory)
A 22 year old went sailing on a windy day, and came back with right eyelid and facial drooping. What CN is affected?
CN VII - Facial (Motor)
Which CN is responsible for sensory of taste in the back of the tongue?
CN IX - Glossopharyngeal (Sensory)
What vertebral levels are the angles of the scapula laying on?
- Superior Angle - T2
- Root of Scapula Spine - T3
- Inferior Angle - T7
Please identify the sections that make up the sternum
- 1. Suprasternal Notch
- 2. Manubrium
- 3. Sternal Angle (Angle of Louis - @ the level of 2nd intercostal space / 2nd rib)
- 4. Body
- 5. Xiphoid Process
- 6. Sternocostal Angle
What level is the inferior border of the lung found?
- Varies with respiration due to diaphragmatic excursion
- *generally lower with COPD
Air entering pleural space is called?
When air is introduced into the pleural space (during chest trauma from motor vehicle accident (MVA), or puncture of thoracic cavity as with an acupuncutre needle), a pleural cavity is created and the lung collapses (partially or totally)
Water entering the pleural space is called?
Pleural Effusion (edema)
What monitors CO2 levels of the blood?
Respiratory Control Center (RCC)
How long can one hold his breath?
Until CO2 gets to critical levels
Where does O2 and CO2 perform gas exchange?Alveoli
What are the most common Respiratory Conditions (Hyperactive Airway Disease)?
- Asthma - the inability to exhale (bronchospasm / wheezing) (occurs during childhood --> early adulthood)
- Chronic Bronchitis - inpairment of mucocilliary escalator - persistant cough, esp. in smokers (occurs during age >= 40-50 years)
- COPD - Chronic Obstructive Pulmonary Disease - lose the abiltiy of elastic recoil (occurs during age >= 60 years)
A 5 year old child playing outdoors for hours and develops sudden wheezing. What does this person have?
A 60 year old smoker with shortness of breath and periodic wheezing. What does this person have?
A 45 year old with smokers cough. What does the person have?
What is the difference between COPD and Emphysema?
- COPD - Diagnosed clinically
- Emphysema - Diagnosed by Biopsy (Bronchoscopy)
This procedure is often used for staging of lymph nodes of lung cancer
Which two western examinations are most specific to the chest and abdomen?
This percussion note has a soft intensity, high pitch and short duration. Heard over the Muscles. Which kind is this?
This percussion note has a medium intesnity, pitch and duration. Heard over the Liver and pathological fluid. Which kind is this?
This percussion note has a loud intensity, low pitch and long duration. Heard over Normal Lung. Which kind is this?
This percussion note has a loud, short duration, high pitch. Heard over Gastric Air Bubbles. Which kind is this?
This percussion note has a very loud intensity, lower pitch and longer duration. Heard over the Emphasematous Lung. Which kind is this?
On examination, what is the difference between pleural effusion and a pathological process (i.e. pneumonia)?
- Ask patient to lie flat (supine or sideways)
- Pleural Effusion - fluid moves based on body positioning
- Pneumonia - fluid doesn't move based on body positioning
What are 3 types of Added Breath / Lung Sounds?
- 1. Crackles - collapses lung tissue attempting to expand (typically found with pneumonia)
- 2. Wheezing - bronchospasms (typically found with asthma)
- 3. Friction Rub - inflammation of one (or both) pleural linings causing a "sandpaper"-like effect (sharp pain) (typically found with pleuritis)
What are some of the common causes of edema?
- Deep venous thrombosis (DVT) - Blood clot (unilateral edema)
- Enlarging Cancer Mass (unilateral)
- Congestive Heart Failure (pump failure) - systematic problem (bilateral)
- Protein Calorie Malnutrition (anywhere)
Elderly male woken up in the middle of the night because of stabbing chest pain. What is the preliminary diagnosis?
Patient goes to hospital and is diagnosed with Myocardial Infarction. Three days later he suffers from palpiations. What condition could this be?
Which vessel has the most concern of blockage?
- Prelim: Unstable Angina
- Three days later: Atrial Fibrillation
- Vessel: LAD (Left Anterior Descending artery - nourishes the Left Ventricle)
A disease of the heart valves in which the opening of the aortic valve is narrowed. Who does it commonly affect?
- Aortic Stenosis (type of murmur)
- Affects elderly mostly
A disease of the heart valves in which the mitral valve is weakened. Who does it commonly affect?
- Mitral Valve Prolapse (type of murmur)
- Affect young women mostly
What are the two common types of arrhythmia's (irregular heart beat)? Which of the two are more common?
- Atrial Fibrillation 90%
- Atrial Flutter 10%
What is the difference between AFIB and AFLUTTER?
- AFIB - Rapid irregular rhythm (Heart Rate 100 --> 150 bpm)
- AFLUTTER - super rapid but regular rhythm (HR 200-300 bpm)
20 year old male with chest pain; has strong history of cocaine abuse. What condition does this patient have?
Variant / Prinzmetal Angina
What are some methods to check for heart conditions?
- Bruce Protocol Stress Test (treadmill)
What is the difference between a Significant DVT and an Insignificant DVT?
- Significant DVT - clot formation above the knee (veins are larger in above the knee than below, more serious)
- Insignificant DVT - clot formation below the knee (veins are smaller than above the knee, less likelihood of embolism)
What are some methods to diagnosis a patient with DVT?
- Clinically: Unilateral Edema
- Homan's Sign to check for pain (squeeze / palpate calf, dorsiflex foot, if pain is present in calf it is positive indication for DVT -- works on 20% of patients)
- Radiographically: Venous Ultrasound
What are some methods for treating DVT / Embolism?
- Blood Thinners
- Physical Therapy (promoting circulation)