Physical Diagnosis All Questions

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All of the questions from the 2 excel files combined If you find something wrong/want to add questions the PW to edit the file is the last name of the physician in our famous painting

Auricular tophi is an early presentation of ____________.

Gout

Pseudomonas manifests in the ear as tender erythematous swelling known as______.

A: Otitis externa Maligna

Pt gets her ear pierced and later notices soft, non-tender nodules on ear lobe. These are most likely __________.

Keloids

A pt has swelling in area anterior to the auricles. This is most likely due to inflammation of the _________ structures.

Periorbital (since swelling is in preauricular lymph nodes)

A compartment syndrome of the auricle invovles swelling of the auricle that blocks drainage. Thiscan eventually turn into _______.

Cauliflower Ear

Which two nerves have contributions to the geniculate ganglion that cross on the lower ear (lobar area)?

CN 7 and CN10

Pt has a tender, erythematous nodule in the external ear canal that drains purulent material. The diagnosis is _________.

Furuncle

Pt complains of decreased hearing and fullness in ear. Inspection with an otoscope is not possible due to blockage of the canal. Paitent uses q-tips. Diagnosis is ________.

Cerumen Impaction

Pt has fullness and decreased hearing in ear. Inspection shows erythmatous swelling and serious discharge from the canal. Which organisms might be responsible?

Staph or Strep infection (causing Otitis Externa)

Which type of cancer manifests as painless ulcers of the auricle with posterior auricular nodes sometimes present?

Squamous Cell Carcinoma of the auricle

Pt complains of lossing of hearing, popping with swallowing, and fullness in ear. Other symptoms include runny nose, coughing, and serous conjunctivitis. Inspection of the ear shows that you can see the umbo and malleus incredibly well and the tympanic membrane is dulled. The diagnosis is ________.

Serous Otitis Media

Pt complains of loss of hearing, severe earache, and fullness. Inspection shows the tympanic membrane is erythmatous and the umbo and maleus are not visible anymore. What is the diagnosis?

Purulent otitis media (due to Strep, H flu, or B. catarrhalis

Purulent otitis media is due to ________ infection while serous otitis media is due to ________ infection.

bacterial; viral

Pt has earache that is relieved while purulent discharge is exiting his ear. Another pt has an earache that gets worse while blood is exiting ear. The second pt is a drummer in a heavy metal rock band. Inspection of both ears suggests dullnig of the tympanic membrane, loss of cone of light reflex, and a hole in the tympanic membrane. The diagnosis is _____.

Perforation of the tympanic membrane

Just redness in the middle ear tells you ______.

NOTHING!

Pt breaks nose. There is no bleeding. What does this tell you?

Patient's nose should be getting larger and his pants are on fire. He is a liar.

Most of the nose (excluding the lower tip) is innervated by ______ of the trigeminal nerve.

v1 division

Pt has rosacea (redness all over face), sebacious gland enlargement, telangiectasia (dilated small blood vessels under nose) and increased nose size. What is the diagnosis?

Rhinophyma

Pt has conjunctivitis, sneezing, serious rhinorrhea, and swelling of the nasal mucous membranes. Diagnosis is _______.

Allergic rhinitis

Pt has non-exudative pharyngitis, nonproductive cough, swelling and congestion, sneezing, conjunctivitis, and nasal discharge that is at different times clear, white, and yellow. What is the diagnosis?

Viral rhinitis

Pt recently had has nose broken. Pt feels pain and nose has discrete, purple colored swelling in the septal are Both nares are effected. What is the diagnosis?

Septal hematoma

Pt comes into office with a nose ring. Examination of her nasal canals reveals soft, red, pedunculated nodules hanging from the septum. These are known as _____.

Nasal Polyps

What symptoms are consistent with nasal fracture?

painful, swollen, echhymotic, and disfigured nose with anterior epistaxis (bleeding)

Pt has periorbital plaque-like ecchymosis, enlarged tongue, and right heart failure (hepatomegaly, peripheral pitting edema, etc). This is consistent with what facial problem?

Amyloidosis

Pt has loss of laterial eyebrow hair (Queen Anne's sign), coarsening of features, enlarged tongue, and delayed reflexes. Diagnosis is _________.

Myxedema

Pt has enlarged tongue, diffuse non-pitting edema of upper extremeties and face, and elevated jugular venous pressure. Dx is _____.

SVC syndrome

A basilar skull fracture can result in symptoms including __________.

periorbital ecchymosis, decreased consciousness, hematotympanum, and battle's sign (ecchymosis over mastoid processes)

pt comes in with green nasal discharge, tenderness to percussion over affected sinus, and decreased transillumination in the affected sinus. Dx is ___.

sinusitis

Pt's thyroid is enlarged and manifests as large mass in anterior neck. Dx is ______.

Goiter

in cervical lymph node enlargement, nodules in the neck can be due to hard stony nodules (due to _______), rubbery nodes (due to ______), or tender swollen nodes (due to ______).

metatstatic disease; lymphoma, infection

Pt develops difficulty breathing and stridor (high pitched sound) after manifestation of tender erythematous swelling in anterior neck under chin. Dx is ______.

Ludwig's angina

Parotid gland enlargement usually manifests as swelling on which part of the neck?

Lateral

Transplant pt taking cyclospirine A gets diffuse thickening and enlargment of the ______ as a side effect

gingeva

Pt has purulent material at base of teeth, tartar and calculus at gingiva/tooth interface, swelling, and mild bleeding of gums. Dx is ______.

Gingivitis vulgaris

Herpes simplex stomatitis results in the following symptoms: __________.

painful erosions and ulcers on gingiva, mucosa, lips, and skin

Pt works at daycare center and comes in with rashes on palms and soles of feet. Pt has diffuse vasicles that become painful erosions and ulcers on gingiva, mocusa, lip, and posterior pharynx (but stay within lip). Dx is ______.

Coxsachie stomatitis

Pt has white papules and plaques that look like curdled milk on mucosa, pharynx, tongue, and gingiv Dx is ______.

Thrush

Pt shows up with disrupted tooth enamel and brown/black discoloration where gums meet teeth. Dx is _____.

Caries

Pt comes in with a dry mouth following chemo therapy. You should advise him that he is at increased risk of ______.

Tooth decay

Pt has smooth tongue with no papillae in dorsom. Diagnosis is ______.

Atrophic glossitis, due to vit B deficiency (or folate deficiency)

Pt comes in with painless red or white, firm exophytic (grows outward) papule and plaque that ulcerates on tongue. What should you immediately be worried about?

Squamous cell carcinoma

Are submental varices usually a problem?

No.

Sublingual varices suggest _________.

long-term elevated right-sided pressures

A benign, non-tender nodule in the hard palate covered with mucosa is known as _______.

Torus oakatubys

Pt comes in with cervical lymph node enlargement, runny nose, serous otitis media, and erythema and swelling of tonsils and post. pharynx. Diagnosis is ____.

non-exudative pharyngitis

Pt has swelling, erythema, and white foamy substance on surface of posterior pharynx and uvul Diagnosis is _________. If due to strep, which lymph nodes would be concurrently enlarged? If due to mono, which areas would be concurrently enlarged?

exudative pharyngitis; jugulodigastric nodes for strep; diffuse lymphadenopathy and splenomegaly for mono.

Pt comes in with a life-threatening smooth nodule or mass (collection of abscesses) in posterior pharynx adjacent to a tonsil. This nodule is a complication of a previous case of strep throat and can obstruct the patient's airway. Diagnosis is ______.

Quinsy

Pt comes in feeling cold, constipated, depressed, and fat. Measurement shows the patient has indeed gained weight. Pt loses a lot of hair all over body (especially over lateral eye brows), has delayed relaxation of reflexes, bradycardia, thick / doughy skin, proximal muscle weakness, and a goiter. Pt has _____.

hypothyroidism

pt loses lots of weight, feels really hot all the time, and poops a lot. Pt has a goiter and shows brisk deep tendon reflexes, tremor, thin skin, proximal muscle weakness, oncholysis, plummer's nails, and tachycardi Pt is also diagnosed with Graves disease and myxedem Underlying cause is _________.

hyperthyroidism

As women get older, __________ tissue gives way to __________ tissue in the breast.

glandular; adipose

Tanner Staging is from ____ (least developed) to _____ (most developed) and shows breast maturation

1, 5

Breasts become firmer and glandular tissue becomes enlarged during the week before _______.

Periods

The shape of breast tissue is _________.

Rectangular

How many levels of palpation should be applied?

3

What is the best method of examining a breast?

Vertical method, then concentric circles, then spokes of wheel method (worst)

The inframammary ridge is at which rib?

6th

5 sets of lymph nodes in the breasts are ____________.

Central axillary, lateral axilla, pectoral, supraclavicular, and infraclavicular

Which quadrant is the most common site of breast cancer manifestation? Which area is second most common?

upper outer; nipple

multicolored discharge is present in _________.

ductal ectasia

serosanguinous discharge and non-tender, small, subareiolar nodules are present in ________.

Intraductal Papilloma

Pt comes in with warm, indurated, tender, erythmatous rash; Dx is ______.

Mastitis

Nipple retraction can be indicative of ___________.

Breast Cancer

erythmatous, scaly rash is known as ___________.

eczema

A movable, well demarcated nontender mass in the breast is known as ____________.

fibroadenoma

Breast abscesses are usually in locations with concurrent _________.

Mastitis

Pt comes in with unilateral erythmatous rash confined to the areol It is later determined that the pt has a subareolar duct carcinoma there. What is the diagnosis?

Paget's disease

What does a horizontal rib slope suggest?

emphysema

Pigeon chest is also known as ________, and invoves the sternum and ribs sticking out, while funnel chest is also known as ________ and involves sternum and ribs pushed inward

Pectus Carinatum, pectus excavitum (which might impinge on the heart and cause mitral valve prolapse)

What are two disorderes linked to shallow respirations during physical exam?

Cheyne-Stokes and Biot's

What is the most common cause of SVC syndrome?

Neoplastic obstruction

Pt comes in with blisters / pustules on his skin in a dermatomeric distribution. What disease does she have?

Herpes Zoster

In Scleroderma, what physical finding regarding skin should you notice?

Tightening of skin

If the trachae is deviated ipsilaterally, you should suspect ____________. If the trachea is deviated contralaterally, you can expect ________.

atelectasis (alveolar collapse); pneumothorax/effusion

What does oliver's sign show us?

If the trachea shifts downward during systole, then the aortic arch is dilated (aneurysm)

Sternal pain suggests two possible diseases. What are they?

CML and Xiphoid-sternal arthritis

What is vocal fremitus

a palpable vibration during speech

What are the various results of percussion of the chest?

Resonant = normal lung; Hyperresonant = emphysema; Dull = atelectasis, pneumonia, hemorrhage; flat = pleural effusion

Tubular breath sounds in the chest are abnormal. They indicate __________.

consolidation; loss of alveolar air (alveolar collapse, edema, pneumonia) either by alveolar collapse or filling

Amphoric breathing suggests ______________.

Cavernous breathing (cavitary disease like TB)

All breathing sounds but ______________ have full inspiratory and expiratory duration.

Vesicular

Early inspiratory crackles are low pitched and suggest ___________.

bronchitis

Mid-inspiratory crackles suggest __________.

bronchiectasis

Late inspiratory crackles are high pitched, sound like velcro, and suggest ___________.

fibrosis OR pneumonia OR CHF OR Alveolar hemorrhage

What percent of diagnosed asthmatics actually have vocal cord dysfunction?

33%

Ronchis are low-pitched and continuous expiratory sounds. They suggest the presence of ___________

neoplasms (vibration of solid tissue is what you hear)

Do all wheezes suggest asthma?

No

Wheezes are continuous, high-pitched sounds during exhalation. They indicate fluttering of the bronchial wal. Do they correlate well with the degree of airway obstruction?

No

How can you distinguish crackles from pleural friction rubs?

Pleural friction rubs also have an expiratory component

A late inspiratory squeak with crackles suggests __________

inflammation of the small airways

A tubular sounds and crackling sound at the same time suggests ____________.

alveolar fluid filling

Pt breathes with pursed lips during lung examination. In order to breathe, pt has to lean forward and rest elbows on knees. This produces Dahl's sign (hyperpigmented callouses above knees). What does this suggest?

COPD

During paradoxical respiration, the abdomenal wall contracts while the chest expands due to asynchronious movement of which two muscles?

Diaphragm and intercostals; diaphragm is paralyzed bilaterally; paradoxical respiration is a good indicator of respiratory failure

Pt is rocking in one direction, then rocking in another direction, while breathing. You notice that the pt is alternating between using the intercostals and diaphragm. What is your diagnosis?

Respiratory Alternans

Pt's RLQ of abdominal wall remains still while breathing. This is suggestive of ____________.

Peritonitis (specifically appendicitis in this case0

You ask your pt to take a deep breath. You notice that the chest doesn't uniformly expand (there is local lagging). What does this suggest?

Protracted lung collapse

What two methods help determine severity of scoliosis in pts?

Cobb angle and chest radiography (cobb angle greater than 100 is severe)

A doctor describes a patient as Gibbus. What does this mean?

Hunchback; kyphosis

Pt comes in and the slope of his ribs are measured. What is a normal slope? What does a horizontalized slope suggest?

45 degrees; emphysema, bronchitis, or asthma, aging

Pt displays hoover's sign. What symptoms does he show?

Lower rib cage moves inward during breathing because diaphragm is flattened. Happens during inspiration in COPD

Insufficient ventilation shows up as ____________ while ineffective oxygenation shows up as __________.

Cyanosis; pallor

Expiratory bulging can suggest ________ if focal and _________ if diffuse.

pneumothorax; obstructive disease

A physician places his fingers on a pt's thyroid cartilage. He does this to measure if there is a tracheal descent with inspiration, which is correlated with airflow obstruction. What sign is this?

Campbell's sign

A physician places his hands on each side of a pt's chest to measure the vibrations made by the pt when the pt is asked to repeat numbers or letters. Symmetry is measured. What test is this?

VCT (vocal tactile fremitus)

Does pneumonia increase or decrease VCT?

Depends; if it is alveolar then it increases VCT; if alveolar AND bronchiolar, then it decreases VCT

Regarding specificity and sensitivity, percussion has good _________ but poor ________ for detection of pneumothorax, consolidation, atelectasis, and pleural effision.

Specificity; sensitivity

Regarding specificity and sensitivity, percussion has good ______ but poor ______ for detection of LARGE pleural effisions

Sensitivity; specificity

With chest percussion, bilateral hyperresonance suggests _________.

Airflow obstruction

Which conditions does Fremitus decrease in?

status asthmaticus, pleural effusion, and emphysema

Which conditions does Fremitus increase in?

pneumonia, hemorrhage, fibrosis, and atelectasis

The preferential frequency band in humans is ____________.

1000-5000 Hz

How can you tell early-inspiratory crackles from late-inspiratory crackles?

Early-inspiratory crackles may clear with coughing

Late inspiratory crackles where the breath sound remains vesicular are usually caused by _________ while late-inspiratory crackles where the breath sound is bronchial are caused by _________.

Fibrosis (in posterior base of lung); interstitial fluid

Bronchial breath sounds with no crackles indicate _________.

Collapsed alveoli

How can you differentiate stridor from a wheeze?

Stridor is ONLY inspiratory (while wheezes are both inspiratory and expiratory)

Can you include cardiac asthma (left ventricular failure) in the differential for wheezing?

Yes

Wheezes are ____ pitched while rhonchi are _____ pitched.

High; low

Grating, creaky, and rubbing sounds present in both inspiration and expiration, non-continuous (noise), and present over the chest are known as ________.

Pleural Friction Rub

Pleural Friction Rubs present in _________.

Collagen vascular diseases and bacterial pneumonias

Whispered pectoriliquy is a transmitted voice sound that suggests _______.

a small consolidation

Late inspiratory squeaks are characterized by short, high-pitched, vesicular sounds which are often accompanied by late inspiratory crackles. They are diagnostic of _________.

fibrosis, bronchiolitis, allergic alveolitis;

Though the general rule is that lymph nodes greater than 1 cm are possibly pathologic, we can be certain that nodes > _____ cm are always neoplastic

5

Neoplastic nodes are usually described as _________ while necrosis and bacterial lymphadenitis causes nodes to feel ________.

Hard; fluctuant

Tenderness of lymph nodes usually suggests ________.

Inflammation, though sometimes it can mean malignancy too.

Matting (or fusion) of lymph nodes suggests _________.

Malginancy, though sometimes this happens in inflammatory processes too.

For which lymph nodes does a size of less than 1 cm still suggest malignancy?

preauricular

Hard, fixed, matted lymph nodes in the axilary region suggest __________.

Spready from malignancy (lung or breast)

During a lymph node exam, you notice an enlarged epitrochlear lymph node. What could this mean?

IV drug use, systemic illness, inflammation in hand/forearm

Which are more important: Inguinal or Femoral nodes?

Inguinal (which are more lateral)

An enlarged node is found in the paraumbilical region. What is this nodule called?

Sister Mary Joseph's nodule; suggests metastasis of stomach or ovarian malignancy

Asymmetric pulses mean suggest ________ in younger patients and ________ in older patients.

coarctation; atherosclerosis or dissection

What is the triple response of Raynaud's?

Pallor (white), Cyanosis (blue), and rubro (red); rubro causes the most numbness and pain

A pt comes in and demonstrate's Raynaud's syndrome after immersion of her hand in a bucket of ice water. What should you be worried about?

Systemic diseases, blood disorders, etc; eventual gangrene and necrosis

Which test measures radial and ulnar artery proficiency?

Allen Test

Both Dosalis Pedis and Tibialis posterior pulses are absent in _____ % of patients

2%

What is the major cause of peripheral vascular disease?

Atherosclerosis

What are the major symptoms of PVD?

Claudication (limping), poor healing of sores/ulcerations, muscle weakness, paresthesia

What are four major physical findings of PVD?

Absent pulses, atrophic foot changes, vascular bruits (femoral), increased venous filling time, and unilateral cool limb

A 70 y/o pt walks into the office and immediately shows signs of limping. You get no foot pulses on him. You measure his venous filling time and it is greater than 20 seconds. What do you suspect?

Severe PVD

You examine your pts legs by elevating them to 90 degrees for 2 minutes and then lowering them at a 90 degree angle for 2 minutes. You note pallor during the first part of the test and then redness during the second part. What test are you performing?

Buerger's test (for arterial perfusion in the leg)

Two predisposing factors for "the diabetic foot" are ________.

peripheral neuropathy and atherosclerotic arterial disease

The test used to identify peripheral neuropathy in diabetic pts is known as _____________

Semmes-Weinstein (SW) monofilament test

A patient comes in with an ulcer on the inside of his ankle, skin thickening in his foot, and brown hyperpigmentation of his skin. He feels no pain due to the ulcer and doesn't suffer from gangrene. What type of ulcer is this?

An ulcer due to chronic venous stasis

How can you tell neuropathic ulcers from ischemic ones?

Neuropathic ulcers are surrounded by callouses, are painless, and have little gangrene. Both types will usually be on the toes or other trauma sites.

What symptoms are present in Charcot's foot?

neuropathic osteoarthropathy due to sensory and motor loss. This manifests as a convex foot with rocker-bottom appearance and unnoticed fractures/bone deformities

Which three arteries are suitable for arterial waveform examination?

carotid, brachial, and femoral arteries (all central)

Which factors cause limitations to arterial analysis to determine left ventricular outflow obstruction?

Hypertension and atherosclerosis

What does an abnormal carotid pulse suggest?

aortic regurgitation

You read a pt's arterial pulse and notice a slow rate of rise. What does this suggest?

Aortic Stenosis

You read a pt's arterial pulse and notice a fast rate of rise. The time between systolic and diastolic sounds is normal. What does this suggest?

ventricular septal defect (right ventricle issue) or mitral regurgitation (left atrium issue), or hypertrophic obstructive cardiomyopathy

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