Physical Diagnosis Review Back
These bullet points were compiled for the National Boards examinations and were based on lectures, assigned texts and board review notes. Please report any errors; this site welcomes your submissions.
xanthoma indicates hypercholesterolemia (deposits @ palms, ulna, tibia)
xanthelasthma is cholesterol deposits around the eyes (heart disease risk)
A diagonal crease of the earlobe can indicate heart problems (coronary a. dz. 70%)
Corneus arcus is an opaque ring around the cornea, indicates hyperlipidemia/cholesterolemia
Corneus arcus is not a concern in the elderly but is when it occurs to younger people
Roth Spots are white spots with red rings on the retina, indicates infectious endocarditis
Red/Brown streaks of the nail bed are known as splinter hemorrhages (also trauma)
Splinter hemorrhages of the nail beds/petichia of palpebral conjunctiva = infectious endocarditis
Quincke's Pulse indicates severe aortic valve regurgitation
Quincke's Pulse = pinch tip of nail bed. + = the red/white boundary pulsates
3 signs of distress are increased cardiopulmonary function, severe pain, anxiety
Migrating pain can be caused by hypopituitarism, hypothyroidism
A patient that smells like "stale beer" could indicate TB lymphadenitis
A patient that has "dead animal breath" could mean anaerobic infection - lung abscess
A patient that has a "sweet/sour" or "rotten apple" smell could mean clostridium gas gangrene
A patient with a "mousy urine" smell could indicate a proteus infection
A fecal smell could indicate (besides poor hygiene) an intestinal obstruction
A patient with ammonia breath could indicate renal failure
A patient with malabsorption problem can smell like shit (steatorrhea)
Dysphasia could be caused by a lesion to (3) Wernicke's Area, Broca's Area and the cerebellum
(CN = cranial nerve, 12 of them is Roman numbers)
A patient presents with disphonia, check the larynx, CN X, airway obstruction (tumor?)
Disphonia sounds like a hoarse whisper.
The patient has dysarthria (difficult to pronounce); check CN VII, CN IX, and the cerebellum
A patient with a lesion to CN VII will have problems pronouncing: B, P, V, F, M, W
A patient with a lesion to CN IX will have problems pronouncing: vowels, bal. of consonants
A patient with a lesion to the cerebellum will have "drunken or slurred" speech
A good place to check for anemia is the lower palpebral conjunctiva (lower inner eyelid)
The 2 kinds of cyanosis are central (face and trunk) and peripheral (extremities)
Peripheral cyanosis can be caused by heart problem, ANS problem and Raynaud's Phenomenon
Crown to pubis = pubis to heal (normal)
Fingertip to fingertip = height (normal)
When pubis to heal > crown to pubis suspect (male) Kleinfelter's Syndrome (XXY)
Adolescent growth spurt indicates normal hormonal function
The First Golden Rule of Diagnosis is rule out the most serious working diagnosis first.
Signs of male sexual maturity are deepening voice pitch, facial/pubic hair, incr. penis size
Signs of female sexual maturity are areola/nipple development, widening of the hips, Montgomery glands, incr. breast size, menstruation, triangle pubic hair pattern
Patients with Marfan's Disease are at increased risk for aortic and mitral valve disease
Reguritation = large opening, therefore low pitched murmur
Stenosis = small opening, therefore high pitched murmur
Cardiac scar tissue (surgery) can lead to constrictive pericarditis (decr. CO, incr. VR)
CO (cardiac output) is incr. with fever, hyperthyroidism, anemia, and valve problems
A lift is a visible pulsation, a heave is a strong lift (due to incr. CO)
Chest inspection: looking for lifts, heaves and pulsations (nice rack)
Jugular venous pressure is used to assess right heart function
7 primary cardiac conditions include: congenital, ischemic, hypertensive, valvular, pulmonary, cardiomyopathy, pericardial
Complications of cardiac disease: CHF, arrhythmia, emboli, endocarditis, tamponade, pericarditis
Cardiac symptoms include: SOB, chest pain, shoulder/arm pain, fatigue, edema, syncope
A cardiac exam includes: Inspection, Palpation, Percussion, Auscultation
Bell's Palsy is caused by a LMN (lower motor neuron) lesion to CN VII
Bell's Palsy is the paralysis of one side of the face (sags)
Sensory ataxia is caused by the loss of proprioception to the lower extremities
Patients with sensory ataxia rely on visual cues, therefore harder to walk in the dark
TB (tuberculosis) likes the lymphatic system after the lungs.
Ozena is an A.K.A. for atrophic rhinitis (~ mucosal atrophy from too much nose spray)
Ozena or atrophic rhinitis can give dead animal breath
A patient with periodontal disease will have breath that smells like rotten eggs
Patients with Parkinson's disease have a "mask face"
Horner's Sign is ptosis with pupil constriction (sympathetic lesion, Stellate ganglion)
Diagnostic test for Myasthenia gravis: forced upward gaze (+ if can't hold 1 minute)
Supine and seated blood pressure readings are used to determine orthostatic hypotension
Normal pulse range (adult) is 60 - 100 bpm
Normal respiration in an adult should be between 14-20 bpm
Normal adult temperature range is 96.4 deg F to 99.1 deg F
2 types of radiating pain patterns are sclerotogenous, and radicular
Radicular pain: origin at the nerve root: distal numbness, sharp shooting bands of pain (narrow)
Sclerotogenous pain originates from the bones of the spinal column: dull, deep, broad, achy
Referred pain usually indicates a visceral or muscle problem
Sciatica manifests as radiating pain in a narrow band down the back of the thigh and leg
The gall bladder can refer pain to the right shoulder
Muscle pain is usually described as an ache
Burning pain usually indicates an autonomic nerve (ANS) pathology
Tingling pain usually indicates peripheral nerve (PNS) damage
Phono and photo phobia are associated symptoms of Migraine headaches (HA)
A high stress job is OK when the person like the job
A "grape" smell to a patient may mean the patient has a pseudomonas infection
A patient smells like "freshly baked bread" ( he's sick & not a baker); you think typhoid infection
"Ammonia" smell to the urine may mean patient has cystitis (bladder infection)
Patient's breath smells like "acetone"; you suspect patient ketoacidotic condition (DM)
"Fishy vaginal smell" may mean Gardnerella vaginitis
"Musty sulphur" breath can mean fetor hepaticus
Classic heart risk patient: 1. Florid face, 2. Abdominal obesity, 3. Male over 40 years
Levine sign = patient clutches fist over chest when describing chest pain (MI)
Nodular melanoma is always fatal
PMI (point of maximal impulse) assesses the left ventricle (CHF)
Advanced hypothyroidism leads to myxedema