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ICM - Block 2 - Part 1

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davidwurbel7's version from 2016-06-30 18:21

HEENT

Question Answer
Migraine, Tension headache and Cluster headaches are classified asPrimary Headache
Headache due to a known cause such as eye disorders, ,Sinusitis, Brain tumors, meningitis, Subarachnoid hemorrhages, Giant cell arteritis, post traumatic headache, Trigeminal neuralgiaSecondary Headache
At least 2 of the following features: Unilateral pain, Throbbing pain, Aggravation by movement. Moderate or severe intensity plus at least 1 of the following features: Nausea/vomiting, Photophobia and phonophobiaMigraine
Commonest type of headache. Due to muscle contraction, bilateral, back of head or upper neck. Present with non-pulsing "bandlike" pressure on both sides of the head, not accompanied by other symptoms. Massage relievesTension Headache
Very rare. trigeminovascular pain, recurrent, intense pain, one side of the head, around the eye. Occurs same time everydayCluster Headache
Observe the patient's facial expression and appearance asymmetry: Acromegaly, parkinsonism, Facial nerve palsy etc. Look for symmetry (e.g. plagiocephaly), size (microcephaly or hydrocephalus), masses and involuntary movementsInspection
Inflammation of the eyelids with scaling, crusting, injection of lid marginBlepharitis
Posterior displacement of the eyeballEnophthalmos
Anterior displacement of the eyeballExophthalmos
Drooping of the eyelidPtosis
Inflammation or infection of lacrimal excretory system. Medial infraorbital pain, erythema, and edema, excessive tears and dischargeDacryocystitis
Inversion of lid margin. Lashes causes ocular irritation. Usually older patients. May occur with trachoma scarringEntropion
Sagging or rolling out of lower eyelid. Irritated eyes. Increased tearingEctropion
Non-infectious and usually nontender subacute inflammation of meibomian glandChalazion
Acute red, tender lump due to infection of ciliary glands (molls glands/ apocrine sweat glands) near lash line and Usually drain spontaneouslyStye
Triangular thickening of conjunctivaPterygium
Pooling of blood in anterior chamber (between iris and cornea). Due to trauma, Resolves spontaneouslyHyphema
Cobble stone pattern seen in palpebral conjunctiva in this conditionAllergic Conjunctivitis
Legal blindness20/200
Near SightednessMyopia
The eyeball is too long. Light rays focused before the retina. Patient can see things close up. Poor score on SnellenMyopia
Corrected by a diverging (Biconcave) lensMyopia
FarsightednessHypermetropia
The eyeball is too short. Light rays focused behind the retina. Patient can see things far away. Poor score on reading chartHypermetropia
Corrected by converging (Biconvex) lensHypermetropia
Degeneration of the eyesight (Hypermetropia) due to agePresbyopia
Disc swollen with blurring of margins. Usually bilateral and denotes increased intracranial pressure. Causes Glaucoma, Meningitis, Subarachnoid hemorrhages, Brain tumors. Often have headache, nausea, vomiting, normal visionPapilledema
Bilateral papilledema is an indication of thisIncrease Intracranial Pressure
Corneal opacity, Hyphema, Opacity of the lens such as Cataract, Vitreous hemorrhage, Retinal detachment, Retinoblastoma, Artificial eye are causing of thisAbsent of Red Reflex
Increased size of central cup (>1/2 diameter of disc) in glaucomaCupping of the Disc
Cupping of the disc is seen most of the time associated with thisGlaucoma
Microaneurysms, Hemorrhages, Exudates, NeovascularizationDiabetic Retinopathy
Arterial narrowing. AV crossing defects. Flame shaped hemorrhages. Cotton wool spots. Disc edema in malignant hypertension. Arteriovenous nicking (box), cotton wool spots (black arrows), and retinal hemorrhage (white arrow)Hypertensive Retinopathy
Vein appears to taper down on each side as it crosses arteryTapering
Vein appears to stop abruptly as it crosses arteryAV Nicking
Twisting, widening of vein after crossing arteryAV Banking
Painless, sudden, unilateral blindness. Seen in Elderly, diabetes, hypertension patients. Causes: Carotid artery atherosclerosis, Giant cell arteritis and Aneurysms. On fundoscopy: Red lesion called “cherry red spot” with surrounding pale retinaRetinal Artery Occlusion
Separation of inner layers of retina from underlying retinal pigment epithelium. Causes include: trauma, surgery, diabetes, sickle cell, tumors. Symptoms: flashing light, floaters, and vision lossDetached Retina
Where ear drum meets the handle of malleus. A light reflection “Cone of light” fans downwards and anteriorlyUmbo
Tenderness on movement of ear lobes suggestsOtitis Externa
Mastoid tenderness suggestsOtitis Media
Common in children. Presents with ear pain, fever. Membrane has: Bulge, redness, exudate oozing from perforationAcute otitis media
Episodes of discharge. Membrane has: perforation, fibrotic changesChronic suppurative otitis media
Local tenderness, Pain, Fever, Nasal discharge. Transillumination: Absent on affected sinusAcute Sinusitis
Red throat with white exudate on tonsils. Fever with enlarged lymph nodes. Enlarged tender Jugulodigastric lymph nodes found in angle of jawTonsillitis
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Neurological Exam

Check the fundus of eye, visual fields, Pupillary reflex, extraocular movements & facial expression Bare Minimum

Male Genital Tract 1

Question Answer
Carcinoma scrotal skin50 y
Teratoma20 – 30 y
Seminoma30 – 40 y
Torsionteen age + h/o straining
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Hydrocele: infants + 20-40y

 

Tuberculous orchitis

 

Spermatocele

 

Varicocele

 

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Acute epididymo-orchitisfever
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Pain that is dull + constant / flanks is suggestive of thisRenal
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Uretericsharp / loin  groin
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Bladder + Urethraldull / suprapubic
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Prostatic: perianal / rectal

 

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Young children with UTI + cystitiscries on micturation
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A specific form of discomfort arising from the urinary tract in which there is pain immediately before, during or immediately after micturitionDysuria
An unpleasant + painful desire to void urine when the bladder is empty or nearly so described as "wrenching" sensation at the end of urination. Could mean stone in the lower ureter / bladder or CystitisStrangury
Passage of air in urinePneumaturia
Presence of fecal material in urineFecaluria
Pus in urinePyuria
>2500ml urine output / 24 hoursPolyuria and Nocturia
<400ml urine output / 24 hoursOliguria & Anuria
Foreskin cannot be retractedPhimosis
Foreskin cannot be returnedParaphimosis
Congenital / secondary to trauma, STDsStricture
Persistent painful erection. Blood cannot exit the corpus cavernosumPriapism
Abnormal urethra opening on the dorsal surface of the penisEpispadias
Abnormal urethra opening on the ventral surface of the penisHypospadias
High attachment of tunica vaginalis. Predisposes to testicular torsionBell Clapper Deformity
Fever, Pyuria, Normal position of testis. Onset gradual. Elevation of the testis relieves the pain – Prehn’s signEpididymitis
No fever, pyuria. Testis is high in the scrotum. Onset sudden. Absent cremasteric reflexTesticular Torsion
Prostate is tender on digital rectal exam is suggestive of thisProstatitis
Prostate is firm, nodular and can be non-painful or painful on digital rectal exam is suggestive of thisProstatic Cancer
Prostate is enlarged on digital rectal exam is suggestive of thisBPH
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Male Genital Tract 2
Question Answer
Skin, Prepuce (Foreskin), Glans, Note location of urethral meatus, Compress the glans between the index and thumb and inspect for dischargePenile Inspection
No pubic hair at all (below 10 yrs)Tanner I
Small amount of long, downy hair with slight pigmentation at the base of the penis (males) or on the labia majora (females) (10–11.5)Tanner II
Hair becomes more coarse and curly, and begins to extend laterally (11.5–13)Tanner III
Adult–like hair quality, extending across pubis but sparing medial thighs (13–15)Tanner IV
Hair extends to medial surface of the thighs (above 15)Tanner V
Crooked painful erection with hard plaques under skinPeyronie's disease
Crooked erecetion, usually seen in hypospadiasChordee
Exfoliated epithelial cells underneath the prepuceSmegma
Oval in shape, 3 x 5 cm (width, length), rubbery in consistency with no tendernessNormal Testis
On examination, can approximate fingers to get above the swellingScrotal Swelling
On examination, cannot approximate fingers to get above the swellingInguinal Hernia
Inguinal hernia that does not descend down to the scrotal sacIncomplete Inguinal Hernia
Inguinal hernia that descends down to the scrota lsacComplete Inguinal Hernia
During palpation, the patient coughs and the mass touches the tip of the fingerIndirect Inguinal Hernia
During palpation, the patient coughs and the mass touches the side of the fingerDirect Inguinal Hernia
During palpation, the patient coughs and the mass does not touch the fingerFemoral Hernia
Deep test, the patient coughs and no mass can be seenIndirect Inguinal Hernia
Deep test, the patient coughs and a mass can be seenDirect Inguinal Hernia
This is located at the just above the midpoint of the inguinal ligamentDeep Ring
Inflammatory tract between the anal canal + skin. Originate in anal crypts, which become infected with abscess formation. When the abscess is opened or ruptures, a fistula is formedAnal Fistula
Superficial linear tear in the anoderm. Commonly caused by passage hard stoolAnal Fissure
Assess anal sphincter: normal tone. Assess rectal wall condition: any abnormal consistency. Assess prostateDigital Rectal Exam
Digital rectal exam findings as follows - Smooth, Convex, Firm consistency, Rectal mucosa moves over prostate and Residual urine may be feltBPH
Digital rectal exam findings as follows - Irregular indurations, Nodule - asymmetry, difference in texture, and bogginess, Hard consistency, Mucosa fixed over prostate surfaceProstatic Cancer
Test residual stool for occult bloodGuaiac Test
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PSA: Prostate specific antigen
Question Answer
PSA level <4ng/mlNormal PSA
PSA level >4ng/mlBPH
PSA level 4 - 10ng/mlProstatic Cancer
Imaging test used to observe the prostateTrans-Rectal Ultrasound
Test for PSA increase per yearPSA Velocity
A PSA velocity of 0.75 ng/ml per yearProstatic Cancer
PSA / volumePSA Density
PSA density greater than 0.15 ng/ml/ccProstatic Cancer
A Gleason score of greater than or equal to 7 indicates thisProgressive Prostatic Cancer Tumor
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