Podcast
Questions and Answers
Which examination finding is most indicative of consolidation in a lung assessment?
Which examination finding is most indicative of consolidation in a lung assessment?
Which of the following symptoms is most closely associated with heart failure?
Which of the following symptoms is most closely associated with heart failure?
A patient with a history of shortness of breath and peripheral edema is most likely experiencing which condition?
A patient with a history of shortness of breath and peripheral edema is most likely experiencing which condition?
What physical exam finding is indicative of bronchial breathing sounds?
What physical exam finding is indicative of bronchial breathing sounds?
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Which condition is most likely to present with paroxysmal nocturnal dyspnea?
Which condition is most likely to present with paroxysmal nocturnal dyspnea?
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Which sign can help differentiate between consolidation and emphysema during lung assessment?
Which sign can help differentiate between consolidation and emphysema during lung assessment?
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What assessment finding might you expect in a patient with pneumonia during auscultation?
What assessment finding might you expect in a patient with pneumonia during auscultation?
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Which of the following is a common cause of decreased vocal fremitus?
Which of the following is a common cause of decreased vocal fremitus?
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What is the expected change in vocal fremitus in the presence of pneumonia or lung consolidation?
What is the expected change in vocal fremitus in the presence of pneumonia or lung consolidation?
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Which auscultation finding is characterized by a change in the quality of sound from 'E' to 'A'?
Which auscultation finding is characterized by a change in the quality of sound from 'E' to 'A'?
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What type of note is expected on percussion of a chest affected by pneumothorax?
What type of note is expected on percussion of a chest affected by pneumothorax?
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During examination for tactile fremitus, what should the patient do?
During examination for tactile fremitus, what should the patient do?
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In cases of pleural effusion, which physical examination finding is commonly observed?
In cases of pleural effusion, which physical examination finding is commonly observed?
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What is a common percussion finding in the presence of pleural effusion?
What is a common percussion finding in the presence of pleural effusion?
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What palpatory finding is expected in the presence of pneumothorax?
What palpatory finding is expected in the presence of pneumothorax?
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What should the practitioner ask the patient to do to assess whispering pectoriloquy?
What should the practitioner ask the patient to do to assess whispering pectoriloquy?
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What is the primary purpose of performing a systematic assessment of the chest and lungs?
What is the primary purpose of performing a systematic assessment of the chest and lungs?
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In which condition would you likely observe a barrel chest with a 1:1 ratio of anterior to lateral diameter?
In which condition would you likely observe a barrel chest with a 1:1 ratio of anterior to lateral diameter?
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Which of the following patterns of respiration is marked by cycles of increasing and decreasing breathing that lead to temporary pauses?
Which of the following patterns of respiration is marked by cycles of increasing and decreasing breathing that lead to temporary pauses?
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What observation during physical examination indicates the use of accessory muscles, signifying respiratory distress?
What observation during physical examination indicates the use of accessory muscles, signifying respiratory distress?
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Which term describes a breathing pattern where the chest wall moves inward during inhalation and outward during exhalation?
Which term describes a breathing pattern where the chest wall moves inward during inhalation and outward during exhalation?
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What is the effect of bronchial asthma on tactile fremitus during examination?
What is the effect of bronchial asthma on tactile fremitus during examination?
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Which of the following assessments is NOT a key step in examining the chest and lungs?
Which of the following assessments is NOT a key step in examining the chest and lungs?
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What can decreased vocal fremitus during palpation suggest about the state of the lung parenchyma?
What can decreased vocal fremitus during palpation suggest about the state of the lung parenchyma?
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What auscultatory finding is characterized by a louder sound over an area of consolidation?
What auscultatory finding is characterized by a louder sound over an area of consolidation?
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What percussion note is expected when evaluating a chest affected by pleural effusion?
What percussion note is expected when evaluating a chest affected by pleural effusion?
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What change in vocal resonance occurs when sound frequencies pass through consolidation?
What change in vocal resonance occurs when sound frequencies pass through consolidation?
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How should a practitioner assess tactile fremitus during chest examination?
How should a practitioner assess tactile fremitus during chest examination?
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Which examination finding is most likely associated with pneumothorax during palpation?
Which examination finding is most likely associated with pneumothorax during palpation?
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What is the typical inspection finding when assessing pleural effusion?
What is the typical inspection finding when assessing pleural effusion?
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In the examination of a patient with consolidation, what type of voice change is referred to as 'E to A' change?
In the examination of a patient with consolidation, what type of voice change is referred to as 'E to A' change?
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What is a common finding during auscultation of a lung affected by pleural effusion?
What is a common finding during auscultation of a lung affected by pleural effusion?
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What examination finding could indicate the presence of bronchial breathing sounds?
What examination finding could indicate the presence of bronchial breathing sounds?
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Which symptom is most directly associated with potential left-sided heart failure?
Which symptom is most directly associated with potential left-sided heart failure?
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What is a potential sign observed during a physical examination of a patient with heart failure?
What is a potential sign observed during a physical examination of a patient with heart failure?
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What is the physiological reason for decreased vocal fremitus in conditions like pleural effusion?
What is the physiological reason for decreased vocal fremitus in conditions like pleural effusion?
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Which condition is least likely to contribute to increased vocal fremitus?
Which condition is least likely to contribute to increased vocal fremitus?
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What clinical detail is essential when assessing symptoms such as paroxysmal nocturnal dyspnea in a patient?
What clinical detail is essential when assessing symptoms such as paroxysmal nocturnal dyspnea in a patient?
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Which physical exam finding is most indicative of congestion associated with heart failure?
Which physical exam finding is most indicative of congestion associated with heart failure?
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What is the significance of assessing for hepatomegaly in a patient presenting with symptoms of heart failure?
What is the significance of assessing for hepatomegaly in a patient presenting with symptoms of heart failure?
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Which of the following findings is least indicative of elevated filling pressures in heart failure patients?
Which of the following findings is least indicative of elevated filling pressures in heart failure patients?
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What characteristic of heart murmurs in children is most accurately described?
What characteristic of heart murmurs in children is most accurately described?
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Which condition is referenced as a necessary screening for all infants regarding heart murmurs?
Which condition is referenced as a necessary screening for all infants regarding heart murmurs?
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In the context of assessing cardiac index/perfusion, which statement is most accurate?
In the context of assessing cardiac index/perfusion, which statement is most accurate?
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What is the significance of the Stevenson profiles in managing heart failure?
What is the significance of the Stevenson profiles in managing heart failure?
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Which emerging technology is mentioned as potentially aiding in the evaluation of heart murmurs?
Which emerging technology is mentioned as potentially aiding in the evaluation of heart murmurs?
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What aspect of the clinical examination is emphasized regarding heart failure patients?
What aspect of the clinical examination is emphasized regarding heart failure patients?
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Why are routine ECG and chest x-ray not considered cost-effective for evaluating heart murmurs without additional signs of heart disease?
Why are routine ECG and chest x-ray not considered cost-effective for evaluating heart murmurs without additional signs of heart disease?
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What is the predominant treatment option for migraine headaches?
What is the predominant treatment option for migraine headaches?
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Which type of headache is most prevalent among the population?
Which type of headache is most prevalent among the population?
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Which approach is included in the diagnostic evaluation of a headache?
Which approach is included in the diagnostic evaluation of a headache?
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Which of the following best describes secondary headaches?
Which of the following best describes secondary headaches?
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What role do neuromodulation devices play in headache management?
What role do neuromodulation devices play in headache management?
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Which preventive treatment is effective for migraines?
Which preventive treatment is effective for migraines?
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In the context of headache disorders, what distinguishes trigeminal autonomic cephalalgias (TACs)?
In the context of headache disorders, what distinguishes trigeminal autonomic cephalalgias (TACs)?
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What is the percentage of people affected by migraines?
What is the percentage of people affected by migraines?
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What is a primary objective of the neurological examination?
What is a primary objective of the neurological examination?
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Which component is NOT typically included in the neurological examination?
Which component is NOT typically included in the neurological examination?
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What does the Head Impulse Test (HI-test) assess?
What does the Head Impulse Test (HI-test) assess?
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What aspect does the Skew Deviation Test evaluate?
What aspect does the Skew Deviation Test evaluate?
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During a cranial nerve examination, what types of functions are primarily assessed?
During a cranial nerve examination, what types of functions are primarily assessed?
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What is the significance of Deep Tendon Reflexes (DTR) testing in a neurological exam?
What is the significance of Deep Tendon Reflexes (DTR) testing in a neurological exam?
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What function does coordination testing primarily evaluate?
What function does coordination testing primarily evaluate?
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Which neurological condition might be indicated by significant findings during a reflex testing?
Which neurological condition might be indicated by significant findings during a reflex testing?
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Study Notes
Normal Anatomy of Chest and Lungs
- Trachea: Windpipe; carries air to the lungs
- Bronchi: Two main branches of the trachea; carry air to the lungs
- Bronchioles: Smaller branches of the bronchi; carry air to the alveoli
- Alveoli: Small air sacs in the lungs; where gas exchange takes place
- Pleura: Membrane that surrounds the lungs; helps to lubricate the lungs and prevent friction
- Diaphragm: Muscle that separates the chest cavity from the abdominal cavity; helps with breathing
HPI: Cough
- Productive cough: Coughing up sputum, may indicate infection
- Nonproductive cough: Dry cough, may indicate irritation
- Acute cough: Onset of less than 3 weeks
- Chronic cough: Lasting more than 3 weeks
HPI: Shortness of Breath (SOB)
- Dyspnea on exertion: Shortness of breath when exercising or performing activities
- Orthopnea: Difficulty breathing when lying down
- Paroxysmal nocturnal dyspnea: Sudden shortness of breath at night, often waking the person up
- Platypnea: Difficulty breathing when upright, often relieved by lying down
HPI: Wheezing
- Expiratory wheezing: Wheezing that occurs when breathing out, common in asthma
- Inspiratory wheezing: Wheezing that occurs when breathing in, can be a sign of airway obstruction
Review of Systems: Environmental & Exposure History
- Smoking history: Current smoker, past smoker, never smoked
- Exposure to allergens: Pollen, dust mites, pet dander, mold, etc.
- Occupational hazards: Exposure to dust, fumes, chemicals
Physical Exam for Respiratory Concern
- Purpose: Detect abnormalities such as fluid, air, consolidation, or masses
- Goal: Early diagnosis and intervention of respiratory conditions
- Key Steps: Inspection, Palpation, Percussion, Auscultation
Inspection:
- Chest wall: Symmetry, deformities, and movement
- Respiratory rate: Normal is 12-20 breaths per minute
- Respiratory rhythm: Regular or irregular
- Effort of breathing: Use of accessory muscles, labored breathing
Palpation:
- Tactile fremitus: Vibrations felt on the chest wall when the patient speaks
- Chest expansion: Symmetry of chest movement bilaterally
- Trachea: Position and deviation
Percussion:
- Sound: Resonance (normal lung tissue), dullness (fluid or consolidation), hyperresonance (air trapping)
Auscultation:
- Breath sounds: Normal, diminished, adventitious (wheezing, rales, rhonchi)
- Vocal resonance: Bronchophony, whispered pectoriloquy, egophony
Notes:
- AP Diameter: Ratio of chest width front-to-back compared to side-to-side; normal is 2:1
- Barrel Chest: 1:1 ratio, seen in COPD due to air trapping
- Pectus Excavatum: Scooping out of chest wall, "bowl on chest wall"
- Pectus Carinatum: Poking out of the chest, "pigeon chest"
- Respiratory Distress: Sternocleidomastoid muscle use (accessory muscle use), intervene immediately
- Hyperpnea: Abnormal deep breathing, often associated with metabolic acidosis
- Cheyne-Stokes Breathing: Cycle of increasing and decreasing breathing leading to apnea (pause in breathing)
- Paradoxical Breathing: Chest wall moves inward during inhalation and outward during exhalation (opposite of normal)
- Diaphragmatic Excursion: Distance the diaphragm moves during inspiration
Vocal Fremitus
- Tactile fremitus: Palpable vibrations felt on the chest wall
- Pathophysiology: Transmission of sound depends on lung parenchyma and pleural space
- Increased vocal fremitus: Dense lung tissue, consolidation (pneumonia, lung abscess)
- Decreased vocal fremitus: Air or fluid in the pleural space, emphysema, COPD, bronchial obstruction
Patient with Shortness of Breath Video
- Scenario: 65-year-old man experiencing progressive SOB with exertion over 3 weeks
- Pertinent Positives: Breathlessness at night, dry cough, dyspnea on exertion, peripheral edema
- Physical Exam: General, Skin, HEENT, Respiratory, Cardiac, Peripheral Vascular, GI
- HF Signs/Symptoms: S3 gallop, S3 heart sound, JVD, hepatomegaly, splenomegaly crackles (rales), wheezing, peripheral edema, positive hepatojugular reflex
LAB ARTICLES
- Cardiovascular Disease and Risk Management in Diabetes: 2021 Recommendations on screening, primary & secondary prevention
- Assessing and Managing the Metabolic Syndrome in Children and Adults: Guidelines for diagnosing and managing metabolic syndrome
- The 5 As framework for obesity management: Assessment, advice, agreement, assistance, arrangement
Key Facts
- Air is a poor conductor of low sound frequencies, dense media transmit low frequencies.
- Vocal resonance is the auscultatory counterpart of vocal fremitus.
- Consolidation increases vocal fremitus and vocal resonance.
- Air or fluid in the pleural space decreases vocal fremitus and vocal resonance.
- Bronchophony: Louder sound over an area of consolidation.
- Whispering pectoriloquy: Whispered words heard clearly in presence of consolidation.
- Egophony (E-to-A): Qualitative change in voice, "E" perceived as "A" or "AAAH".
- Rhonchial fremitus: Palpable rhonchi.
- Pleural fremitus: Palpable pleural rub.
Examination for Tactile Fremitus
- Patient folds arms across chest.
- Ask patient to repeat "ninety-nine" or "one, two, three."
- Palpate chest wall bilaterally with ulnar border of hand or palmar base.
- Compare vibrations on both sides, moving hands from apex to base.
Pneumothorax
- Inspection: Diminished chest movement on affected side.
- Palpation: Decreased chest movement, decreased vocal fremitus on affected side.
- Percussion: Tympanic note on affected side.
- Auscultation: Diminished breath sounds and vocal resonance on affected side.
Pleural Effusion
- Inspection: Fullness of intercostal spaces, diminished chest movement on affected side.
- Palpation: Decreased chest movement, decreased vocal fremitus, trachea may be shifted to the opposite, apical impulse may not be palpable.
- Percussion: Stony dullness on percussion of the affected side.
- Auscultation: Diminished breath sounds, vocal resonance on affected side, egophony may be present on the upper border of the effusion.
Lung Sounds and Palpation
- Lung parenchyma density affects sound transmission:
- Decreased density: Pleural effusion and pneumothorax cause decreased transmission of lower frequency sound vibrations.
- Increased density: Inflammation and consolidation create a denser medium, leading to increased vocal fremitus and transmission of lower frequency sounds.
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Vocal fremitus: Palpable vibrations felt on the chest wall when the patient speaks.
- Increased vocal fremitus: Suggests consolidation (e.g., pneumonia, lung abscess).
- Decreased vocal fremitus: Suggests conditions like pleural effusion, pneumothorax, emphysema/COPD, bronchial obstruction, bronchial asthma.
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Vocal resonance: Auscultatory counterpart of vocal fremitus.
- Bronchophony: Louder sound over an area of consolidation.
- Whispering pectoriloquy: Whispered words are heard clearly over an area of consolidation.
- Egophony: Sound frequencies passing through consolidation distort vowel sounds, making "E" sound like "A" or "AAAH."
- Rhonchial fremitus: Palpable rhonchi (coarse, rattling sounds).
- Pleural fremitus: Palpable pleural rub (scratchy, grating sound).
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Examining tactile fremitus:
- Patient folds arms across the chest wall to displace scapulae.
- Patient repeats "ninety-nine" or "one, two, three" in a constant tone.
- Practitioner palpates the chest wall on both sides using the ulnar border of hand or palmar base.
- Begin at the lung apex and move to the same location on the opposite side of the chest wall.
- Compare vibrations on both sides while moving hands from apex to base.
- Repeat on anterior and lateral chest walls.
Examination Findings for Respiratory Conditions
-
Pneumothorax:
- Inspection: Diminished chest movements on the affected side.
- Palpation: Diminished chest movements, decreased vocal fremitus on the affected side.
- Percussion: Tympanic note on percussion of the affected side.
- Auscultation: Diminished breath sounds and vocal resonance on the affected side.
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Pleural effusion:
- Inspection: Fullness of intercostal spaces, diminished chest movements on the affected side. Apical impulse may not be visualized.
- Palpation: Diminished chest movements, decreased vocal fremitus on the affected side. Trachea may be shifted to the opposite side. Apical impulse may not be palpable.
- Percussion: Stony dullness on percussion of the affected side.
- Auscultation: Diminished breath sounds and vocal resonance on the affected side. Egophony may be present on the upper border of the effusion.
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Consolidation:
- Inspection: Diminished chest movements on the affected side.
- Palpation: Diminished chest movements, increased vocal fremitus on the affected side.
- Percussion: Dullness on percussion of the affected side.
- Auscultation: Bronchial breathing sounds may be present. Increased vocal resonance on the affected side may be associated with bronchophony and whispering pectoriloquy.
Patient with Shortness of Breath - Key Points
- 65-year-old Caucasian male presenting with progressive shortness of breath (SOB) when walking, started 3 weeks ago.
- Concerns about new onset of symptoms, difficulty breathing.
- Reports needing to stop halfway up stairs to catch their breath.
- No palpitations, chest tightness, or syncope.
- Dry, nonproductive cough during night and day, started 3 weeks ago.
- Breathlessness at night while lying in bed, waking up needing to catch breath (paroxysmal nocturnal dyspnea).
- 2 pillows under head helps slightly.
- Fullness in abdomen, started 3 weeks ago.
- Swollen ankles (as day goes on), a new finding.
- Pertinent positives: breathlessness at night, dry cough, dyspnea on exertion, peripheral edema.
- Physical exam considerations: General, Skin, HEENT, Resp, Cardiac, Peripheral vasc, GI.
- Heart failure (HF) symptoms to look for: S3 gallop, S3, JVD, Hepatomegaly, splenomegaly, Crackles (rales), wheezing peripheral edema, positive hepatojugular reflex.
Cardiovascular Disease & Metabolic Syndrome
-
American Diabetes Association Standards of Medical Care in Diabetes – 2021:
- Purple highlighted area: Recommendations and guidelines for management of cardiovascular disease in diabetes patients.
- Screening recommendations: Early identification and management of cardiovascular risk factors in diabetes.
- Primary/secondary prevention: Strategies to prevent or delay the progression of cardiovascular disease in diabetes.
-
Assessing and Managing the Metabolic Syndrome in Children and Adults:
- Focus on identifying and managing the metabolic syndrome, a cluster of risk factors associated with cardiovascular disease.
-
Obesity management:
- 5 A’s framework for obesity management: Assess, Advise, Agree, Assist, Arrange.
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Clinical examination in heart failure:
- Fundamental in assessing hemodynamic state.
- Stevenson classification: Categorize patients based on volume status (wet/dry) and perfusion (warm/cold).
Assessing Elevated Filling Pressures in Heart Failure:
- Jugular venous distention (JVD)
- Hepatojugular reflux (HJR)
- Orthopnea: Dyspnea when lying flat
- Square wave blood pressure response to Valsalva maneuver
- Bendopnea: SOB when bending forward
Assessing Cardiac Index/Perfusion:
- More challenging and fewer reliable clinical findings.
- Traditional signs like pulmonary rales and peripheral edema may have limitations in chronic heart failure.
Heart Murmurs in Children
- Common, occurring in up to 80% of children.
- Most are innocent, but some indicate underlying heart disease.
- In infants, 37% of murmurs are associated with congenital heart disease.
- Beyond infancy, only about 1% of murmurs are associated with structural heart disease.
- All infants should be screened for critical congenital heart disease using pulse oximetry, ideally 24 hours after birth.
- Referral to pediatric cardiology is indicated for:
- New murmur in a child >3 years old
- Murmur lasting longer than 6 months without clear explanation
- Presence of heart disease symptoms
- Abnormal heart rhythm
- Concerns about genetic or familial history of heart disease
- Abnormal physical findings
- Echocardiography is not routinely needed for evaluation of innocent-sounding murmurs without other concerns. Routine use of ECG, chest x-ray, etc. is not cost-effective for evaluating murmurs without other signs of heart disease.
- Emerging technologies like phonocardiography and AI algorithms may aid in murmur evaluation in the future.
Neurological Examination:
- Overview: A comprehensive assessment of the nervous system to diagnose and manage disorders affecting the nervous system.
- Focus: Localizing lesions, identifying signs of normal and abnormal neurological function, guiding diagnostic and management decisions.
-
Key Objectives:
- Evaluate mental status, cognitive function, and language.
- Assess cranial nerve function.
- Examine motor function, including strength, tone, and reflexes.
- Test sensory function, including touch, pain, temperature, and proprioception.
- Evaluate coordination and gait.
Neurological History:
- Goals: Obtain information relevant to neurological function, understand the patient's background, and uncover clues leading to a diagnosis.
-
Review of History:
- Present illness: Detailed description of current symptoms, onset and progression, aggravating and alleviating factors.
- Past medical history (PMH): Relevant medical conditions, surgical history, medications, allergies.
Indications for Neurological Examination:
- New or changing neurological symptoms
- Suspected neurological disorders
- Routine screening for neurological conditions
- Monitoring of patients with known neurological conditions
Components of the Neurological Exam:
Mental Status Testing:
- Mini-Mental State Examination (MMSE): 30-item questionnaire used to assess cognitive function.
Cranial Nerve Examination:
- Overview: Assessment of 12 cranial nerves (CN I-XII), considering sensory, motor, and reflex functions.
-
Testing Overview:
- CN I (Olfactory Nerve): Sense of smell.
- CN II (Optic Nerve): Vision, visual acuity, fields, pupillary reflexes.
- CN III (Oculomotor Nerve): Eye movements, pupil constriction.
- CN IV (Trochlear Nerve): Downward and inward eye movements.
- CN V (Trigeminal Nerve): Sensory function of the face, muscles of mastication (chewing).
- CN VI (Abducens Nerve): Lateral eye movement.
- CN VII (Facial Nerve): Facial expressions, taste sensation on anterior two-thirds of tongue.
- CN VIII (Vestibulocochlear Nerve): Hearing, balance.
- CN IX (Glossopharyngeal Nerve): Taste sensation on posterior third of tongue, swallowing.
- CN X (Vagus Nerve): Swallowing, voice production, parasympathetic control of heart and digestive system.
- CN XI (Accessory Nerve): Shoulder and neck muscle movement.
- CN XII (Hypoglossal Nerve): Tongue movement.
Motor System Examination:
-
Muscle Bulk, Tone, and Strength:
- Bulk: Size and development of muscles.
- Tone: Resistance to passive movement.
- Strength: Ability to contract muscles against resistance.
Motor Strength Testing:
- Testing: Assesses muscle strength against resistance, typically graded on a scale from 0 to 5.
Motor System Testing:
- Gait: The patient's manner of walking.
- Coordination: Ability to perform smooth, coordinated movements.
Reflex Testing:
- Deep Tendon Reflexes (DTR): Assessment of reflex responses elicited by tapping on tendons.
Sensory Testing:
- Light Touch: Patient's ability to detect light touch.
- Pain: Patient's ability to perceive pinprick.
- Temperature: Patient's ability to distinguish between hot and cold.
- Proprioception: Patient's awareness of body position without visual input.
Coordination and Gait Examination:
Coordination Testing:
- Finger-to-nose Test: Touching the tip of the nose with alternating fingers.
- Heel-to-shin Test: Running the heel of one leg down the shin of the opposite leg.
- Rapid Alternating Movements (RAM): Alternating rapid tapping with palms and backs of hands.
Gait and Balance Testing:
- Gait: Patient walks normally, heel-toe fashion, on toes and heels, and tandem gait (heel of front foot touching toe of back foot).
- Balance: Assess Romberg test and one legged stance to assess balance.
HINTS Exam:
- Specialty test used to help differentiate central from peripheral causes of acute vestibular syndrome (AVS).
-
Components:
- Head Impulse Test (HI-test): Checks vestibulo-ocular reflex by moving the patient's head and assessing for corrective saccades.
- Nystagmus Observation: Identifies spontaneous nystagmus and direction of the eye movements.
- Skew Deviation Test: Checks for ocular misalignment by covering and uncovering one eye, observing for corrective movements.
Interpretation of Neurological Examination:
- Findings: Analysis of exam results to identify neurological abnormalities and localize lesions.
- Diagnosis: Using exam results to determine a possible diagnosis.
Clinical Conditions in Neurological Exam:
- Stroke: Sudden onset of neurological deficits.
- Parkinson's Disease: Rigidity, tremor, bradykinesia.
- Multiple Sclerosis: Inflammation and demyelination of the central nervous system.
- Alzheimer's Disease: Progressive cognitive decline.
- Spinal Cord Injury: Damage to the spinal cord.
Headache Article:
-
Prevalence and classification of headache types:
- Primary headaches: Migraines, tension-type headaches (TTH), trigeminal autonomic cephalalgias (TACs), and others.
- Secondary headaches: Resulting from underlying medical conditions, such as vascular, infectious, or neoplastic causes.
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Primary Headaches:
- Migraine: The most disabling and prevalent primary headache disorder, affecting 12% of people, treated with NSAIDs, triptans, gepants, and lasmiditan.
- Tension-type Headache (TTH): Affects 38% of the population, managed with simple analgesics like acetaminophen and NSAIDs.
- Trigeminal Autonomic Cephalalgias (TACs), including cluster headaches, rarer and present with unilateral pain and autonomic symptoms.
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Secondary Headaches:
- Headaches due to underlying issues and require evaluation for potential urgent conditions such as cerebrovascular events or infections.
-
Management:
- Acute treatment: Over-the-counter analgesics, triptans, and newer agents like gepants.
- Preventive treatment for migraines: Antihypertensives, antidepressants, antiepileptics, botulinum toxin, and monoclonal antibodies targeting the calcitonin gene--related peptide (CGRP).
-
Diagnostic Approach:
- Thorough history and examination to distinguish between primary and secondary causes.
- Diagnostic imaging or lumbar puncture recommended in high-risk cases.
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Emerging Therapies:
- Neuromodulation devices and behavioral therapies are gaining popularity for patients with contraindications or who prefer nonpharmacological treatments.
Concussions:
- Key symptoms: Headache, dizziness, nausea, vomiting, confusion, memory problems, balance issues, fatigue, blurred vision, sensitivity to light or noise.
- Mechanism of injury: Direct impact to the head or an indirect force that causes the brain to move rapidly inside the skull.
- Pathophysiology: Mild traumatic brain injury (TBI) that causes diffuse axonal injury, resulting in temporary disruption of brain function.
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Initial Evaluation:
- On-field assessment: Immediate evaluation by athletic trainer or medical personnel to ensure safety and determine extent of injury.
- Sideline evaluation: Comprehensive assessment by medical personnel, including cognitive testing, balance testing, and neurological examination.
- Hospital or Clinic Evaluation: If symptoms are severe, prolonged, or concerning, further evaluation by a healthcare professional is needed.
-
Management:
- Immediate Management: Rest, avoiding physical exertion and cognitive tasks.
- Gradual Return to Activity: Progressive increase in activity levels with close monitoring of symptoms.
- Prolonged Symptoms and Special Considerations: May require specialized management by neurologists or concussion specialists.
- Preventive Strategies: Proper equipment, safe playing environment, concussion education, and rule changes to minimize impact forces.
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Description
Test your knowledge on the normal anatomy of the chest and lungs. This quiz covers essential structures such as the trachea, bronchi, and alveoli, as well as common symptoms like cough and shortness of breath. Assess your understanding of respiratory anatomy and physiology.
