JMC Physical Diagnosis Part 2

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HEENT

HEENT

Only structure of auricle not cartilage

Ear lobe

Structures of auricle

Helix, antihelix, tragus, canal, lobe

Structures seen on tympanic membrane

umbo, light reflex, pars flaccida, pars tensa

Diffuse, erythematous tender swelling of entire auricle

Otitis externa maligna

Otitis externa maligna is infection caused by

Pseudomonas

People at risk for otitis externa maligna

Diabetics, immunocompromised

Decrease hearing on one side, sense of fullness in ear

Cerumen impaction

Otitis externa also called

Swimmer's ear

Decreased hearing on affected side, sense of fullness in ear, swelling, erythema, serous discharge

Otitis externa

Painless ulcer on the ear may be

Squamous Cell carcinoma

Enlargement of Posterior auricular node

Squamous cell carcinoma of auricle

During Otoscopy pull which direction on the ear

Upward and backward

Bulging TM, diffuse erythema, purulent, loss of landmarks

Purulent Otitis media

Used for draining Otitis media

tympanoplasty tube

Swollen, deformed nose with epistaxis

Nasal fracture

Painless enlarged red nose with telangiectasia and enlarged sabecous glands

Rhinophyma

Swollen nasal mucosa with rhinorrhea

Rhinitis

Tenderness to percussion over sinuses, decreased transillumination, green nasal discharge

Sinusitis

Loss of tooth substance with brown/black discoloration

Caries

Recession of gingiva "long of tooth"

Gingivitis (severe)

Nontender nodule/exostosis in palate of mouth (normal varient)

Torus palatinus

Sublingual varices may indicate long term what

Elevated right side pressures

Loss of papillae except circumvallate papillae is called

Atrophic glossitis

Abnormal taste

Dysgousia

White or red ulcerating, firm mass usually on lateral base of tongue

Squamous cell carcinoma

Erythema and swelling of tonsils and posterior pharynx

Non-exudative pharyngitis

Serous Rhinorrhea and serous otitis media often accompany

Non-exudative pharyngitis

Diffuse cervical lymph node enlargement found in

Non-exudative pharyngitis

Swelling, erythema and exudates on posterior pharynx and uvula

Exudative pharyngitis

Enlarged tender jugulodigastric lymph nodes found in

Exudative pharyngitis (Streptococcus)

Smooth nodule or mass in the posterior pharynx ajacent to a tonsil

Quinsy (due to streptococcal abscess)

Edema in face and upper limb with elvated jugular venous pressure and macroglossia

SVC syndrome

Coarsening of features, macroglossia, Queen Anne's sign, delayed relaxation phase or reflexes

Myxedema

External canal of the ear is lined by

Stratified squamous epithelium

The evagination of the malleus on the tympanic membrance is called

Umbo

Nontender, yellow papules on the helix and antihelix are called what and associated with what condition

Auricular tophi, gout

Soft, nontender nodules in the ear lob due to trauma

Ear lobe keloids

Palpable preauricular nodes are due to infection where

Periorbital structures

A marked loss of structure and function of the auricle due to trauma or infection of the auricle is called

Cauliflower ear

Dullness, prominence of landmarks, speckled type of light reflection, arifluid levels behind the tympanic membrane, and sense of ear fullnees

Serous otitis media

Serous otitis media is caused by

Viral or atopic process

Purulent otitis media is caused by

Bacterial infection

Organisms that often cause purulent otitis media

S. pneumo, H. influenza, Moraxella catarrhalis

Manifests as a hole in the membrane itself with loss of cone of light relex, and a dull membran

Perforation of TM

Which turbinates are visible on inspection

Middle and Inferior Turbinates

Discrete purple colored swelling in the nasal septum

Septal hematoma

Complications of a nasal fracture

Septal hematoma and septal deviaton

Soft, red, pedunculated nodules in the nasal canals

Nasal polyps

Nasal polyps can be due to

Atopic rhinitis or foreign bodies

Periorbital plaque-like ecchymosis, macroglossia, finderings of right heart failure

Amyloidosis

Periorbital ecchymosis (racoon's eyes), with Battle's Sign, and hematotympanum

Basilar skull fracture

Bruising behind the eyes is called

Battle's sign

Visible and palpable mass in the anterior neck

Goiter

Goiter can be associated with

Hyper, hypo, or euthyroid

Cervical LN enlargement due to mets

Hard, stoney nodes

Cervical LN enlargement due to lymphoma

Rubbery nodes

Cervical LN enlargement due to infection

Tender swollen nodes

Tender erythematous swelling in anterior nexk, esp submental area with possible airway compromise and stridor

Ludwig's angina

Lateral neck swelling is a manifestion of

Parotid gland enlargement

Parotid glands can be enlarged due to

Mumps, bulimia, or sialolithiasis

Gingival hypertrophy is often due to

AE of meds like phenytoin or cyclosporine A

Diffuse tender swelling, tartar, and calculus at gingive/tooth interface and mild bleeding

Gingivitis vulgaris

Diffuse gingival hypertrophy can be caused by

Acute non-lymphocytic leukemia M5 subtype

Hypertrophic interdental papilla is called

Epulis

Epulis is caused by

Irritation due to flossing of 3rd trimester pregnancy

Mucosa covered, bony benign nodules, usually on lingual side of the mandible are called

Torus mandibularis

Clusters of vesicles that become painful erosions and ulcers on gingiva, mucosa, lip, and skin outside the vermillion border

Herpes Simplex stomatitis

Diffuse vesicles that become painful erosions and ulcers on gingiva, mucosa, lip, posterior pharynx, and does not cross the vermillion border

Coxsachie stomatitis (herpangina)

White papules and plaques in the mouth

Thrush

Tender erosions on buccal mucosa

Aphthous stomatitis

Wearing down of incisural surfaces of teeth

Tooth attrition

Transverse fissures in the lip

Cheilitis

Crusty fissures on the angles of the mouth

Cheilosis

Cheilosis is due to

Candida or iron deficiency

Atopic glossitis is seen is what conditions

B12 or folate deficiency

A black tongue can be due to bismuth, charcoal, or

Aspergillus niger colonization

Purple vessels of the sublingual surface

Sublingual varicosities

Red patches of denuded tongue epithelium, surrounded by rims of white and areas of normal epi, changes daily

Geographic tongue

Lymph and Extremities

Lymph and Extremities

Lymph nodes are significant at what size

> 1 cm

Rock hard LNs

Neoplastic

Fluctuant LNs

Necrosis and bacterial lymphadenitis

LNs that fistulize and form open sinuses are called

bubos

Mass like conglomerates of LNs called

Matting

Matting is usually a sign of

Malignancy

Tenderness is usually a sign of

Inflammation

Cervical lymphadenitis called

Scrofula

Sister Mary Joseph's node

Periumbilical node

Hard, fixed, or matted axillary nodes

Spread from lung or breast cancer

Enlargement is common in childhood infections but not in adults

Occipital LNs

Enlargement of preauricular nodes

lymphoma or conjunctivitis

High posterior cervical nodes

nasopharyngeal tumor

Enlarged Submental and submandibular nodes

cancer of nose, tip, ant. tongue, ant. floor of mouth

Midjugular nodes

Cancer of base of tongue or larynx

Lower jugular nodes

Cancer of thyroid or cervical esophagus

Anterior cervical lymphadenopathy

URI

Posterior cervical lymphadenopahty

Otitis media

Cluster of prelaryngeal LNs on the thyrohyoid membrane called

Delphian nodes

Enlarged Delphian nodes indicative of

Thyroid disease

Sentinel node

Left supraclavicular node

Palpable supraclavicular node

Metastatic breast or lung cancer

Enlargement of sentinel node

deep-sited carcinoma

Palpable left supraclavicular node also called

Troisier's node

Palpable left supraclavicular node due to gastric metastasis called

Virchow's node

Valsalva maneuver will help in palpating what LN

Superclavicular LNs

Enlarged epitrochlear node

Inflammation of hand or forearm

Enlargement of Sister Mary Joseph's node

Intrapelvic or intraabdominal cancer (usually gastric or ovarian)

Usual sequence in Raynaud's Phenomenon

pallor, cyanosis, rubro (white, blue, red)

Numbness or pain found in Raynaud's Phenomenon during which stage

Rubro (reprofusion)

Excess sensitivity of hands and fingers to cold

Raynaud's Phenomenon (wide differential diagnosis)

Test that assesses patency of radial and ulnar arteries

Allen's test

Delay in refilling in Allen's test is

> 5 seconds

Absence of both pedal pulses suggests

PVD

Claudication affects buttocks, thigh, and calf

PVD of distal aorta

Claudication primarily affects the calf

PVD of femoropopliteal distribution

Claudication of foot

PVD of peroneotibial distribution

PVD of peroneotibial distribution is rare except in

Diabetics

Intermittent limb pain, usually triggered by activity

Claudication

Classic Sx of PVD

Claudication (and arterial insufficiency Sx)

Increased venous filling time as measured in leg

> 20 seconds

Buerger's test is a sign of what characterisitc of PVD

Distribution

An assessment of distribution of PVD is

Buerger's test

Essential to guide arterial puncture and cannulation

Allen's test

Standard for testing diabetic neuropathy

Semmes-Weinstein (SW) monofilament test

Inability to sense a 5.07 SW filament is predictor for

Risk of foot ulceration

Positive SW monofilament test

Loss of sensation in 4/10 sites, or over 3rd and 5th metatarsal head

Other findings in a diabetic foot

Hypertropic calluses, brittle nails, hammer toes, fissures

Neuropathic osteroarthropathy with sensory and motor loss

Charcot's foot

Charcot's foot seen in which diseases

Diabetes, Tertiary syphilis, Charcot-Marie-Tooth

Swelling of a limb caused by accumulation of fluid

edema

Accumulation of serum

venous edema

Accumulation of lymph

lymphedema

Accumulation of fat

lipedema

Formation of a well defined depression in soft tissue following pressure

pitting edema

Pitting edema is graded on what scale

1-4 (4 is highest)

Bilateral lymphedema, more common in women, before age 40

Primary lymphedema

Unilateral lymphedema following infection, surgery, etc.

Secondary lymphedema

Neck vein distension when upright suggests

Right or bi-ventricular failure

Test for functionality of leg vein valves

Trendelenburg's test

Trendelenburg test will have false negative with

arterial insufficiency

Common Sx of DVT

leg pain and swelling

Physical exam for what diagnose is not good

DVT

Musculoskeletal

Musculoskeletal

Medial Knee Structures

MCL, medial meniscus, hamstrings (semimembranosis and semitendinosis), ACL attachment

Lateral Knee Structures

LCL, ITB, lateral meniscus, hamstrings (biceps femoris)

Anterior Knee Structures

Quadriceps tendon, patellar tendon, ACL

Posterior Knee Structures

Hamstrings, Popliteal fossa, PCL

ROM Knee Flexion

150 degrees

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