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Which symptom is considered an alarm symptom that could indicate malignancy?

  • Occasional heartburn
  • Mild abdominal discomfort
  • Painless jaundice
  • Early satiety (correct)

    • What distinguishes a malignant mass from a benign mass during a physical examination?

  • Malignant masses are usually smooth and moveable.
  • Benign masses have a positive rebound tenderness.
  • Malignant masses tend to be hard, fixed, and irregular. (correct)
  • Benign masses often cause pain upon palpation.

    • Which of the following is a likely consequence of a hiatal hernia?

  • Recurrent vomiting
  • Increased bowel sounds
  • Pain with swallowing
  • Acid reflux or heartburn (correct)

    • Which symptom would likely require further investigation for pancreatic cancer?

    <p>Painless jaundice</p> Signup and view all the answers

    What is one of the physical examination signs associated with peritonitis?

    <p>Positive rebound tenderness</p> Signup and view all the answers

    Which of the following symptoms is primarily associated with upper gastrointestinal issues?

    <p>Heartburn</p> Signup and view all the answers

    Which organ is NOT classified as a retroperitoneal organ?

    <p>Liver</p> Signup and view all the answers

    What characterizes visceral pain in the abdomen?

    <p>It may cause referred pain.</p> Signup and view all the answers

    What does hematochezia indicate?

    <p>Lower GI bleed</p> Signup and view all the answers

    Which of the following conditions is associated with dysphagia for solids only?

    <p>Esophageal stricture</p> Signup and view all the answers

    What does steatorrhea indicate?

    <p>Malabsorption of fats</p> Signup and view all the answers

    Which symptom is indicative of urinary tract disorders?

    <p>Difficulty urinating</p> Signup and view all the answers

    What is the main symptom of an acute abdomen that differentiates it from chronic issues?

    <p>Severe, sudden pain</p> Signup and view all the answers

    What does the term 'oliguria' refer to?

    <p>Low urine output</p> Signup and view all the answers

    Which is NOT a characteristic symptom of peritonitis?

    <p>Sharp pain localized to one area</p> Signup and view all the answers

    What does the term 'jaundice' refer to?

    <p>Yellowish discoloration of the skin</p> Signup and view all the answers

    Which symptom would most likely indicate a gastrointestinal disorder?

    <p>Nausea and vomiting</p> Signup and view all the answers

    Which of the following best describes referred pain?

    <p>Pain that radiates to remote areas</p> Signup and view all the answers

    What is a common cause of chronic diarrhea?

    <p>Crohn’s disease</p> Signup and view all the answers

    What is a common provocation factor for cholecystitis?

    <p>Sudden jarring movements</p> Signup and view all the answers

    Which symptom is most commonly associated with peptic ulcers?

    <p>Intermittent epigastric pain</p> Signup and view all the answers

    What is an indication of complete bile duct obstruction?

    <p>Light-colored stool</p> Signup and view all the answers

    Which condition is characterized by chronic inflammation leading to intestinal villi atrophy?

    <p>Celiac disease</p> Signup and view all the answers

    What type of jaundice is most commonly associated with infectious diseases?

    <p>Painful jaundice</p> Signup and view all the answers

    Which of the following symptoms is typically relieved by defecation in irritable bowel syndrome (IBS)?

    <p>Abdominal pain</p> Signup and view all the answers

    What is a key palliative factor associated with gastric cancer?

    <p>Relief from antacids</p> Signup and view all the answers

    In which condition is 'currant jelly' stool a hallmark symptom?

    <p>Intussusception</p> Signup and view all the answers

    Which of the following is a risk factor for acute pancreatitis?

    <p>Chronic alcohol abuse</p> Signup and view all the answers

    What is the primary symptom of diverticulitis?

    <p>Cramping pain in the LLQ</p> Signup and view all the answers

    Which dietary component must be avoided in individuals with celiac disease?

    <p>Wheat</p> Signup and view all the answers

    What is a common complication associated with chronic hepatitis?

    <p>Cirrhosis</p> Signup and view all the answers

    The classic pain associated with acute appendicitis is often described as:

    <p>Poorly localized umbilical pain</p> Signup and view all the answers

    In mesenteric ischemia, the abdominal pain is primarily described as:

    <p>Acute and disproportionate</p> Signup and view all the answers

    What is the primary role of lymph nodes in the head and neck?

    <p>To help protect against foreign invaders</p> Signup and view all the answers

    Which of the following is associated with aortic arch aneurysm?

    <p>Tracheal tugging in rhythm with the heartbeat</p> Signup and view all the answers

    What type of goiter is characterized by diffuse enlargement of the thyroid gland?

    <p>Grave's disease</p> Signup and view all the answers

    In the context of dizziness, which of the following is NOT a type of vertigo?

    <p>Presyncope</p> Signup and view all the answers

    Which type of sensory dysfunction would most often present with nystagmus?

    <p>Central brainstem lesion</p> Signup and view all the answers

    What symptom is commonly associated with nephrotic syndrome?

    <p>Proteinuria</p> Signup and view all the answers

    Which feature differentiates Bell's palsy from a stroke?

    <p>Degree of forehead sparing</p> Signup and view all the answers

    Which condition is characterized by a shiny flesh-colored nodule with overlying telangiectasia on the skin?

    <p>Basal cell carcinoma</p> Signup and view all the answers

    What is a common cause of dizziness associated with anxiety?

    <p>Psychiatric disorders</p> Signup and view all the answers

    Which sign is associated with downward displacement of the cricoid cartilage coinciding with ventricular contraction?

    <p>Oliver's sign</p> Signup and view all the answers

    What is the typical duration of vertigo in benign paroxysmal positional vertigo (BPVV)?

    <p>1-2 minutes</p> Signup and view all the answers

    Which of the following conditions is characterized by unilateral ear fullness and tinnitus?

    <p>Meniere’s disease</p> Signup and view all the answers

    Which of the following is NOT true about cervical movement provocation in cervicogenic dizziness?

    <p>It specifically targets central vestibular mechanisms</p> Signup and view all the answers

    What is the primary function of the Eustachian tube?

    <p>Regulate pressure in the middle ear</p> Signup and view all the answers

    What condition is characterized by unilateral inability to close one eye, alongside drooping of the mouth?

    <p>Bell's Palsy</p> Signup and view all the answers

    Which of the following is associated with a red-brown ring in the cornea due to copper deposition?

    <p>Kayser-Fleischer Ring</p> Signup and view all the answers

    What symptom is NOT typically associated with conjunctivitis?

    <p>Visual changes</p> Signup and view all the answers

    Which condition is characterized by pooling of blood inside the anterior chamber of the eye?

    <p>Hyphema</p> Signup and view all the answers

    Primary open-angle glaucoma is most commonly seen in individuals with which of the following characteristics?

    <p>Family history of glaucoma</p> Signup and view all the answers

    Which of the following statements regarding headaches is accurate?

    <p>Migraine headaches can involve visual auras.</p> Signup and view all the answers

    What is the typical appearance of Xanthelasma on the eyelid?

    <p>Slightly raised yellowish plaque</p> Signup and view all the answers

    Which visual condition is associated with increased intraocular pressure and optic disc cupping?

    <p>Glaucoma</p> Signup and view all the answers

    What condition results in 'ice pick' pain around the eye, often occurring in clusters?

    <p>Cluster headaches</p> Signup and view all the answers

    Which of the following is a common characteristic of tension-type headaches?

    <p>Steady dull pain</p> Signup and view all the answers

    What finds indicate a detached retina during an ophthalmoscopic examination?

    <p>Absence of the red reflex</p> Signup and view all the answers

    Which type of pupil reaction is affected in Horner's Syndrome?

    <p>Anisocoria greater in dim light</p> Signup and view all the answers

    What is a characteristic symptom of meningitis?

    <p>Fever, neck stiffness, altered mental status</p> Signup and view all the answers

    Which condition results from prolonged use of extraocular muscles leading to eye fatigue and pain?

    <p>Vision headaches</p> Signup and view all the answers

    Study Notes

    ### Eye Anatomy

    • Conjunctiva - transparent layer, covers sclera and mucous membranes.
      • Sclera = bulbar conjunctiva
      • Mucous membrane = palpebral conjunctiva
    • Pupil - window - light passes through to focus on retina.
    • Iris - “shutters” - changes shape of pupil to control light.
    • Limbus – where sclera and iris meet.
    • Cornea - most anterior surface of the eye.
    • Lens - behind pupil - focuses light onto fovea centralis.
    • Meibomian Glands - sebaceous glands.
    • Lacrimal glands - superior and lateral to eye.
      • Tears composed of water, oil, and mucus.
        • Water - lacrimal gland
        • Oil - sebaceous gland in eyelid
        • Mucus - conjunctiva
    • Retina
      • Peachy portion = optic disc
      • Bright portion in disc = optic cup
      • Darker spot = fovea
      • Surrounding fovea = macula
      • Thicker vessels = veins
      • Thinner vessels = arteries
    • Muscles
      • SO4, LR6, All Else 3
      • Superior Oblique = Trochlear (IV)
      • Lateral Rectus = Abducens (VI)
      • All Others = Oculomotor (III)

    Vision

    • Acuity - clarity/crispness
      • Increased acuity = good vision
      • Decreased acuity = bad vision
    • Accommodation - lens thickness changes.
      • Thins = see distance
      • Thickens = see near
    • Emmetropia - normal vision.
    • Myopia - nearsightedness - can see near objects.
      • As we age, elasticity decreases, we lose the ability for lens thickening.
    • Hyperopia - farsightedness.
      • Can see distant objects.
      • Presbyopia: farsightedness caused by loss of elasticity of the lens of the eye.
    • Astigmatism - irregularly shaped cornea or lens scatters light.

    Vision Tests

    • Acuity
      • Snellen Chart - distance vision
        • Patient stands 20ft away and covers one eye.
        • Reads the smallest line of print possible.
        • Patient must correctly identify more than half of the letters on a line to receive credit.
      • Rosenbaum Chart - near vision.
        • Test near vision with a hand-held Rosenbaum card.
        • Hold 14” from the face.
    • Color Blindness
      • Ishihara Plates
        • Patient stands 75cm from the plates.
        • Attempts to read plates #1-17 one at a time.
          • Must read the plate within 3 seconds.
        • ≤ 9 correctly read plates = deficient color vision.
    • Visual Field
      • The entire area seen by an eye when it looks at a central point.
      • Blind spot – there are not retinal receptors at the optic disc - 15° temporal to the line of gaze.
      • Monocular vs binocular vision
      • Anything identified by medial retina will cross to contralateral side.

    Anopsia

    • Visual field defect
      • Hemianopia
      • Quadratic defect
      • Monocular defect – blindness in one eye.
    • Quadrant loss = opposite of lesion location.
      • Lower left loss = upper right lesion.
    • Superior retina = inferior field of vision.
    • Inferior retina = superior field of vision.

    Static Fields by Confrontation

    • Static Finger Wiggle Test
      • Stand in front of the patient.
      • Instruct the patient to cover his/her right eye.

    Lymphatics

    • Multiple chains of lymph nodes and ducts drain the head and neck
    • Ten pairs of nodes may be palpable within the head and neck
    • Lymphatic drainage from ¾ of the body is to the left supraclavicular region

    Tracheal Tugging

    • Rhythmic downward pull in time with the heartbeat, suggests an aortic aneurysm

    Oliver’s Sign

    • Downward displacement of the cricoid cartilage that coincides with ventricular contraction (S1, systole)
    • Associated with aortic arch aneurysm

    Campbell’s Sign

    • Downward displacement of the thyroid cartilage that coincides with inspiration
    • Associated with COPD

    Thyroid

    • Thyroid Cartilage = shield-shaped, creates Adam’s apple
    • Thyroid Gland = butterfly-shaped, highly vascular
    • Enlargement – 5% = malignant
      • Diffuse enlargement (goiter - visually and palpably enlarged thyroid gland = Grave’s disease)
      • Multinodular goiter = metabolic (toxic, genetics, iodine deficient)
      • Single nodule – cyst, benign, or malignant

    Stroke

    • Brain ischemia due to disruption of blood flow
      • Ischemic or hemorrhagic
    • Stroke vs Bell’s Palsy
      • Stroke = lesion in the brain, Forehead preserved
      • Bell’s Palsy = lesion of a cranial nerve after it has left its nuclei, temporary disruption of CN VII (facial nerve)

    Pathologies

    • Cushing Syndrome – hypercortisolism
    • Myxedema – hypothyroidism
    • Jaundice
    • Nephrotic syndrome – glomeruli damage, proteinuria, hypoproteinemia, anasarca (diffuse swelling), dyslipidemia
    • Nephritic Syndrome - hematuria (RBCs), oliguria w/ azotemia, hypertension
    • Parotid gland enlargement
    • Uremia – fatigue, vomiting, anorexia, decreased mental acuity, neuropathy, muscle cramps
    • Acromegaly – excess GH from pituitary
    • Seizures
    • Arrythmias
    • Parkinson Disease – neurodegenerative disorder that affect dopamine-producing neurons in a specific area of the brain
    • Renal failure - uremia

    Lumps on or Near the Ear

    • Keloid – excessive deposition of scar tissue
    • Auricular Hematoma – shearing separates perichondrium from cartilage (Cauliflower ear)
    • Tophi – deposit of crystallin uric acid on the skin surface
    • Basal Cell Carcinoma – shiny flesh colored nodule with overlying telangiectasia

    Alopecia – Hair Loss

    • Diffuse hair loss – male and female pattern hair loss
    • Focal hair loss – alopecia areata (autoimmune), tinea capitis (ringworm)

    Tracheal Deviation

    • Ipsilateral = atelectasis, pneumothorax
    • Contralateral = space-occupying lesion

    Muscles

    • Muscles of Mastication = CN V - temporalis, masseter, medial pterygoid, lateral pterygoid
    • Muscles of Facial Expression = CN VII

    Dizziness

    • Dizziness – a non-specific term patients use encompassing several disorders, usually identified by a detailed history
    • Vertigo – spinning sensation
      • Peripheral vestibular dysfunction ~40%
      • Central brainstem lesion ~10%
    • Presyncope – a near faint
      • Orthostatic hypotension (drop 10mmhg in systole or 10mmHg in diastole)
      • Medication – usually ones that decrease BP
      • Arrythmias
      • Vasovagal attacks
    • Disequilibrium – unsteadiness or imbalance when walking
      • Visual loss, weakness from musculoskeletal problems, peripheral neuropathy
      • Cervicogenic dizziness
    • Psychiatric - anxiety, panic disorder, hyperventilation, depression, alcohol and substance abuse
    • Multifactorial/Unknown - multiple pathologies at one time

    Vertigo

    • A spinning sensation accompanied by nystagmus (slow beat + fast beat) and ataxia
    • Usually from peripheral vestibular dysfunction
    • Types of Peripheral Vertigo
      • Benign Positional Vertigo – sudden onset of dizziness due to a particular head position, lasts for at most a minute or two, patient has a hx of trauma or is older, horizontal nystagmus that fatigues and adapts, no tinnitus
      • Meniere’s Disease – recurrent attacks of vertigo, sudden attacks come without warning and are associated with severe vertigo, lasts hours to days, report of fullness in the ear and tinnitus, may be a hx of diabetes or problems with fluid retention
      • Labyrinthitis – sudden onset of dizziness that is constant, slowly improves over days or weeks, often with an associated hearing loss, affects cochlea
      • Vestibular Neuronitis – same presentation as labyrinthitis WITHOUT hearing loss
      • Vertebrogenic Vertigo – hx of whiplash injury, dizziness is reproduced by body rotation with the head held constant

    Bony Structures

    • Perilymph = between bony and membranous labyrinths
    • Endolymph = inside membranous labyrinth
    • Semicircular canals – rotational acceleration, ampulla - cone-shaped gel
    • Macula – horizontal acceleration

    Cervicogenic Dizziness

    • Diagnosis of exclusion
    • Can be treated effectively with adjustment, spinal manipulation/mobilization
    • Disequilibrium, neck pain, reduced cervical ROM, cervical movement is provocative
    • Effective in adults for several conditions: acute, subacute, and chronic low back pain; migraine and cervicogenic headache; cervicogenic dizziness; several extremity joint conditions; and thoracic manipulation/mobilization is effective for acute/subacute neck pain

    Vertebrobasilar Ischemia

    • HINTS – Head Impulse Test, Nystagmus, Test of Vertical Skew
    • 5 D’s and 3 N’s – Dizziness, Drop Attacks, Diplopia, Dysarthria, Dysphagia, Nausea, Numbness, Nystagmus
    • Risk Factors – Smoking, Hypertension, Alcohol consumption, Rheumatoid Arthritis, Giant cell arteritis, Ligamentous hypermobility
    • When Do Signs Appear – 69% of the time in practitioners office
    • When Do Signs Appear – 9% within one hour
    • When Do Signs Appear – Another 14% within 24 hours
    • 92% appear in first 24 hours
    • Symptoms – Severe neck or head pain, Dizziness
    • Prognosis – Reported rate of death from dissections of the carotid and vertebral arteries is less than 5%
    • Adjustment Techniques Associated with More Occurrence – 60% = rotation, 10% = rotation with extension, 4% = rotation with flexion and hyperextension

    Ears

    • Movement
      • Semicircular canals – rotary acceleration
      • Vestibule – linear acceleration
      • Utricle – horizontal acceleration
      • Saccule – vertical acceleration
    • Eustachian Tube – connects the middle ear to nasopharynx
    • Antrum (passageway) – eardrum to mastoid air sacs
    • Middle-Ear Bones = malleus – incus – stapes

    Ear Pathology

    • Microtia – small ear (auricle), congenital
    • Keloid – overgrowth of scar tissue
    • Cauliflower Ear - perichondrium and cartilage undergo shearing force and are separated, undrained auricular hematoma
    • Tophi – uric acid crystals, uncontrolled gout
    • Otitis Externa – outer ear infection, otorrhea = discharge
    • Perichondritis – common w/ piercings, infection of the perichondrium
    • Mastoiditis – travels from outer ear to mastoid via antrum, infection can erode the thin sacs and get into the brain, strong antibiotics or mastoid resection
    • Basal Cell Carcinoma – M/C form of skin cancer, flesh colored papule w/ dimpling and telangiectasia

    Instrumentation Exam

    • External Auditory Canal
      • Normal
    • Tympanic Membrane
      • Normal, direction indicated by cone of life and malleus

    Ear Pathology - Instrumentation

    • Otitis Externa – redness, swelling, otorrhea, exudates
    • External Ear Obstruction – M/C cause of conductive hearing loss
    • Collection of Fluid and Air – chronic ear infections, serous fluid
    • Inflamed Tympanic Membrane - bulging ear drum, dull or absent light reflex
    • Obstruction – Foreign Body
    • Fungus
    • Attic Cholesteatoma – skin cyst (rapid growth and death of cells) visible behind ear drum
    • Attic Perforation
    • Scarring – tympanosclerosis (healed perforation)
    • Tympanostomy – drains fluid not draining from eustachian tube

    Hearing Pathways

    • Conduction Phase
      • External Ear and Middle Ear – air conduction, bone conduction through mastoid
      • External Ear - Cerumen impaction, infection (otitis externa), trauma, foreign objects, squamous cell carcinoma, benign bony growths (exostoses and osteomas)
      • Middle Ear - otitis media, congenital conditions, cholesteatomas, otosclerosis, tumors, perforation of tympanic membrane
    • Sensorineural Phase
      • Inner ear – congenital and hereditary conditions, presbycusis (hearing loss that occurs w/ old age due to damage to hair cells), viral infections (rubella [German Measles] and cytomegalovirus), Meniere disease (excess endolymph), noise exposure, ototoxic drug exposure, and acoustic neuromas

    Hearing Tests

    • Whispered Voice Test – detects mild hearing loss (20-40 decibels), always first test
    • Weber’s Test – on the crown of the head, lateralization of sound
      • Normal = if sound is equal in both ears
      • Louder in ‘Bad’ Ear = conductive hearing loss
      • Louder in ‘Good’ Ear = sensorineural loss
      • Occlusion Effect = sound conducted through bone causes the cochlea, the ossicular chain, and the air in the external auditory canal to vibrate, some lower frequency sound escapes from the canal, when the ear is occluded these frequencies cannot escape and the sound seems to be louder
    • Rinne’s Test – on the mastoid process and close to ear canal
      • Normal – Air > Bone
      • Conduction – Air < Bone
      • Sensorineural – Air > Bone but decreased compared to normal

    Hearing Test Progression

    • Whisper Voice Test – Loss detected in right ear
    • Weber’s Test – Sound louder in R ear (conduction), sound louder in L ear (sensorineural)

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