USMLE 1 physical findings
Terms
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- mid-abdominal pulsatile mass, lower back pain, abdominal bruit
- Abdominal Aortic Aneurysm
- deficiency causing erythematous pustules and scales resembling psoriasis around mouth genitalia anus feet elbows knees
- zinc deficiency
- fever, n/v, diffuse periumbilical pain that moves to R lower quadrant
- Acute appendicitis
- R lower quadrant pain
- Acute Appendicitis; Ectopic pregnancy; PID; ovarian cyst; mittelschmerz; Meckel's; Intussusception.
- acute onset constant dull aching RUQ pain, 30 min after eating, pain radiates to R shoulder
- Acute Cholecystitis
- dysuria, frequency, urgency, discomfort over the bladder
- Acute cystitis
- high fever, drooling, inspiratory stridor, severe dyspnea in a child. Thumbprint sign on x-ray of head/neck.
- Acute epiglottitis; H. influenza type B
- fever, steady boring midepigastric pain that penetrates straight thru to the back, hemorrhage in the flank's (Gray Turner's sign)
- Acute Pancreatitis
- knife-like midepigastric pain radiating through to the back
- Acute pancreatitis
- sudden onset spiking fever, flank pain, chills, n/v, dysuria, frequency
- Acute Pylenoephritis
- fever, HA, facial pain, postnasal d/c, chronic cough
- Acute sinusitis
- hyperpigmentation, weakness/fatigability, weight loss, hypotension, decreased Na; increased K
- Addison's disease; adrenal insuff.
-
Virus causing:
pharyngitis, pneumonia, conjuctivitis, gastroenteritis, hemorrhagic cystitis - Adenovirus
- colicky abdominal pain, abdominal distention, obstipation, radiograph (distended loops of bowel w step-ladder appearance)
- Adhesions; GI obstruction
- high fever, dehydration, n/v, hypotension
- adrenal crisis
- HTN, hematuria, berry aneurysm, mitral valve prolapse, bliateral abdominal masses
- Adult Polycystic Kidney Disease
- café au lait spots, polyostotic fibrous dysplasia, precocious puberty, short stature, young girls
- Albright syndrome
- pale boggy nasal mucosa
- Allergic rhinitis
- hereditary nephritis with nerve deafness
- Alport’s Syndrome
- progressive dementia
- Alzheimer’s
- substernal chest pain radiating to L arm or jaw, pain lasts longer than 30 min, pain relieved by nitroglycerin, sweating
- AMI
- awkwardness of finger movements, weakness of hands arm, spasticity of legs, hyperreflexia, no loss of sensory function
- Amyotrophic lateral sclerosis
- bent over posture, decreased ant flexion of lumbar spine, limited chest expantion
- Ankylosing spondilitis
- increase in fine hair of the body (hypertrichosis)
- Anorexia
- high pitched blowing diastolic murmur
- Aortic insufficiency
- crescendo-decrescendo systolic at second R intercostal space
- Aortic stenosis
-
Murmur:
dyspnea on exertion, syncope, angina pectoralis - Aortic stenosis
- pupil reacts to accomodation, but not to direct light
- Argyll Robertson pupil; neurosyphilis
- abdominal pain, fever, chills, jaundice
- Ascending cholangitis
- bulging of flanks, shifting dullness to percussion in the abdomen
- Ascites; portal HTN, hypoalbuminemia
- Murmur; fixed spliting of S2
- ASD
- fever, HA, n/v, confusion, nuchal rigidity
- Aseptic Meningitis
- inspiratory / expiratory wheezing, dyspnea, cough worse at night
- Asthma
- feet are widely spaced, foot lifted too high, walks w slapping feet
- Ataxic gait
- sudden onset fever, dyspnea, cyanosis, inspiratory lag, increased A-a
- Atelectasis
-
Diastolic murmur; high pitched blowing murmur directly following S2;
wide pulse pressure -
Aortic Insufficiency
(reguritation) - Murmur; Systolic; crescendo decrescendo murmur
- AV/PV stenosis
- dorsiflexion of big toe, and fanning of other toes on plantar reflect
- Babinski's sign; UMN lesion
- petechiae on palms [Janeway's], painful erythematous nodules on fingers [Osler's], subconjunctival hemorrhage, splinter hemorrhage
- Bacterial endocarditis
- fever, HA, nuchal rigidity; CSF - increased PMN, decreased glucose, increased protein
- Bacterial meningitis
-
fever, HA, nuchal rigidity; CSF - increased PMN, decreased glucose, increased protein
What bug is most common in newborn?
(2) -
- Group B strep
- E. coli - fever, HA, nuchal rigidity; CSF - increased PMN, decreased glucose, increased protein. What bug is most common in a child?
- H. influenza
- fever, HA, nuchal rigidity; CSF - increased PMN, decreased glucose, increased protein. What bug is most common in a young adult?
- N. menigitis
- fever, HA, nuchal rigidity; CSF - increased PMN, decreased glucose, increased protein. What bug is most common in an older adult?
- S. pneumonia
- slow growing waxy nevi w vascular pattern
- Basal cell carcinoma
- Upper lip tumor
- Basal cell carcinoma
- resting tremor
- Basal ganglia lesion
-
where is lesion:
slow, writhing movements - Basal ganglia lesion
-
Where is lesion:
sudden jerky, purposeless movements; choreaform - Basal ganglia lesion
- unilateral dropping of mouth & facial m, inability to close eye
- Bells' aplsy
- coffe ground emesis
- Bleeding peptic ulcer
-
Bug:
paralysis of striated mm, dry mouth, dry eyes - Botulism
-
Adenopathy - axillary
(2) -
- Breast CA
- Cat scratch disease - subdural hematoma
- Bridging veins; sup cerebral v.
- pt understands written & spoken, but can't articulate
- Broca's aphasia
- broken speech; motor expressive aphasia
- Broca's area lesion
- fever, cough w foul smelling sputum that layers on standing, hemopytsis, recurrent respiratory infections
- Bronchiectasis
- hemisection of cord (contralateral loss of pain & temp / ipsilateral loss of fine touch, UMN)
- Brown-Sequard
- raised bright red lobulated vascular tumor
- Capillary hemangioma
- cutaneous flushing, diarrhea, valvular disease
- Carcinoid
- numbness tingling and pain along thumb long and ring fingers, worse at night, atrophy of thumb
- Carpal tunnel syndrome, Median n. injury
- Intention tremor
- cerebellar lesion
- sleeping disease, cardiomegaly with apical atrophy, achlasia, megacolon
- Chagas’ Disease
- large painful genetial ulcers
- Chancroid; Hemophilus ducreyi
- rhythmic alternating pattern of apnea and hyperpnea
- Cheyne-Stokes breathing; hypoxia of medulla oblongata
- dyspnea, JVD, pitting edema
- CHF
- notching of ribs, weak femoral pulse, well developed upper body underdeveloped lower body, claudication
- Coarctation of aorta
-
Virus causing:
fever, HA, myalgia, retro-orbital pain - Colorado tick fever virus
-
fever, HA, coughing, sneezing, sore throat
What is number 1 cause? -
Common cold
(Rhinovirus) - patent ductus, deafness, retardation, cataracts
- Congenital Rubella Syndrome
- palpable upper right quadrant mass, projectile vomiting
- Congential pyloric stenosis
- HTN, suppresed renin, increased Na+, decreased K+ , muscle weakness.
- Conn's syndrome
- fever, sore throat, vessicles in oropharynx
- Coxsackie virus
- calcinosis of fingertips, Raynaud's phenomenon, esophageal motility problems, sclerodactly, telangiectasia
- CREST syndrome
- dwarfism, mental retardation, puffy face, protruding tongue
- Cretinism, Hypothyroid
- IBD; ileocecum, transmural, skip lesions, lymphocytic infiltrate, granulomas
- Crohn’s
- (contrast to UC: limited to colon, mucosa & submucosa, crypt abscesses, pseudopolyps, colon cancer risk)
- moon facies, buffalo hump, truncal obesity, abdominal striae, diastolic HTN, hyperglycemia, thin hair, protein depletion, depression
- Cushing's
- progressive muscle weakness, hyperkeratotic cuticles, periungual telangiectasaia, flat topped violacious papulesover the knuckles
- Dermatomyositis
- acute onset severe retrosternal chest pain, tearing pain w radiation to back
- Dissecting Aneurysm
- maroon colored stool
- Diverticular hemorrhage
- fever, rebound tenderness, constant pain, L lower quadrant
- Diverticulitis
- epicanthal folds, broad nose, square ears, protruding tongue, endocardial cushion defects, duodenal atresia, megacolon
- Downs' syndrome
- post gastrectomy: post-prandial; dizziness, tachycardia, palpitations
- Dumping syndrome
- fever, pain in calf on compression or dorsiflexion, ankle edema
- DVT
- hypogastric pain, abnormal uterine bleeding, adnexal mass, missed menstrual period, hypovolemic shock
- Ectopic Pregnancy
- micrognathia, prominent occipet, low-set ears, cleft palate, flexion deformities of fingers
- Edward's syndrome
- increased elasticity of skin and of connective tissue (contortionist)
- Ehlers-Danlos
- fever, HA, nuchal rigidity, n/v --> seizures --> coma --> death
- Encephalitis
- vaginal bleeding, pain, ascites, weight loss, palpable pelvic mass, post menopausal female
- Endometrial Adenocarcinoma
- female w/ chronic pelvic pain, painful intercourse, painful defecation, lower back pain
- Endometriosis
- purple lesion w central clearing, arthritis, endocarditis, meat/fish handler
- Erisipeloid
- tendon xanthoma
- Familial Hypercholesterolemia
- acute respiratory distress following skeletal trauma
- Fat embolism syndrome
- peg-leg gait; knee fully extended throughout
- Femoral n. damage
- absent patellar reflex
- Femoral n. damage [L2-L4]
- common cause of newborn ASD
- Fetal alcohol syndrome
- Auscultation; scratchy sounds over pericardium
- Fibrinous pericarditis
-
sore, beefy red tongue w papillary necrosis
(4) -
- Folate deficiency;
- iron deficiency;
- scurvy;
- pellagra - personality change, deficits in concentration, judgement
- Frontal [lobe] release signs
- right upper quadrant pain, abdominal distention 30 min post prandial
- Gall stones
- colonic polyposis, soft tissue tumors, bone tumor
- Gardner's syndrome
- hyperpigmentation of the axilla
- Gastric CA
- n/v, diarrhea,
- Gastroenteritis; Rotavirus
- fever, malaise, posterior auricular lymphadenopathy
- German measels; Rubella
- Adenopathy - left supraclavicular
- GI CA
- enlarged supraclavicular lymph node
- GI malignancy
- fever, unilateral HA, temporal swelling tenderness, jaw claudication, ÝESR
- Giant cell (temporal) arteritis
- urethritis w creamy purulent penile discharge; cervicitis, Bartholin gland cyst
- Gonorrhea
- male presenting first w hemoptysis, then acute glomerulonephritis
- Goodpasture's; anti-basement membrane antibodies
- creeping raised genital sores that heal by scaring
- Granuloma inguinale
- exophthalmos, proptosis, periorbital edema, thyroid bruit, tachycardia, afib, systolic HTN, nervousness, heat intolerance, weight loss
- Graves disease
- large hands, prominent brow & jaw,
- Growth hormone
- idiopathic polyneuritis (ascending muscle weakness & paralysis; usually self-limiting)
- Guillain-Barre
- dyspnea, cough, swelling of the feet, wheezing
- Heart failure
- sudden wild flailing of one arm
- Hemiballismus
- cool clammy skin, delayed capillary refill, later ⬦ pallor, tachycardia
- Hemorrhagic shock
- nails are white at proximal and middle portions, nails are pink distally
- Hepatic cirrhosis
- jaundice, fever, anorexia, n/v
- Hepatitis A
- jaundice, fever, n/v, anorexia
- Hepatitis B virus
- fever, abdominal pain, weight loss, abdominal mass, hypoglycemia,
- Hepatocellular CA
- weakness of quadriceps, decreased knee jerk
- Herniated disk at L3-L4
- weakness of dorsiflexion, decreased ankle jerk
- Herniated disk at L5-S1
- encephailitis in the temporal lobes
- Herpes simplex I
- keratoconjuctivitis
- Herpes simplex I
- painful vessicles that ulcerate in the genital area
- Herpes simplex II
- dilation & hypertrophy of colon w fecal retention
- Hirschsprung's disease; Megalcolon
- fever, lethargy, sore throat, lymphadenopathy, splenomegaly, rash, leukopenia
- HIV initial presentation
- constricted pupil, dropping eyelid, loss of sweating
- Horner's syndrome
- AV nicking, retinal hemorrhage / exudates, S4
- HTN
- morning HA, dizziness, blurry vision, sweating, chest pain, dyspnea
- HTN
- choreiform movement, hypotonia, progressive dementia
- Huntington's
- progressive dementia, urinary incontinence, ataxic gait
- Hydrocephalus; normal-pressure
- hirsutism, truncal obesity, poor wound healing
- hyperadrenocorticalism
- gray band of corneal opacity
- Hyperlipidemia
- increased Ca, decreased phosphate, osteitis fibrosa, polyuria, kidney stones, increased alk phos
- Hyperparathyroidism
- stones, bones, abdominal groans, psychic moans
- Hyperparathyroidism
- heat intolerence, tachycardia, fine oily hair, tremor weight loss
- Hyperthyroidism
- cold intolerence, bradycardia, lethargy, inc cholesterol, dry brittle hair
- Hypothyroidism
- decreased insulin, decreased C-peptide, increased glucose, ketoacidosis
- IDDM; type I diabetes
- sudden death in young athletes
-
Idiopathic Hypertrophic Subaortic Stenosis; outflow obstruction
(IHSS) - rash on face w discrete vessilcles that rupture and form yellow/honey colored crust
- Impetigo
- painful Adenopathy - Ant cervical
- Infection, ie pharyngitis
- Roth spots, splinter hemprrhages, Osler's nodes (painful nodules), Janeway's lesions (painless nodules), glomerulonephritis
- Infective endocarditis
- weakness in climbing stairs; pt throws torso back during heel strike while walking
-
Inferior gluteal n. [L5-S2]
-> gluteus maximus -
virus causing:
fever, HA, cough, myalgia - Influenza virus
- increased insulin, increased C-peptide, decreased glucose
- Insulinoma
- dyspnea on exertion, nonproductive cough, hemoptysis, and chest pain
- Interstitial (restrictive) lung disease
- post prandial pain, anorexia, weight loss
- Intestinal ischemia
- abdominal pain, distention, vomiting, constipation
- Intestinal obstruction
- alternating diarrhea / constipation, cramping abdominal pain, pain relieved by bowel movement
- Irritable bowel syndrome
- sudden onset severe abdominal pain, n/v, abdominal distention, bloody diarrhea, hypotension, absent bowel sounds
- Ischemic bowel - infarct
- post-prandial pain of splenic flexure, 30 min
- Ischemic bowel - warning sign
- yellow skin, yellow sclera, dark yellow urine, light colored stool
- Jaundice
- AIDS pts; progressive multifocal leukoencephalopathy
- JC virus
- multiple red-purple lesions that progress macule -> papule -> nodule
- Kaposi's sarcoma
- situs inversus, recurrent pulmonary infections, sterility infection
- Kartagener’s Syndrome; immotile cilia secondary to defective dynein arms.
- band of golden-brown pigment on the posterior corneal surface
- Kayser-Fleischer ring; Wilson's diseas
- intense abdominal pain radiating to left shoulder
- Kehr's sign; ruptured spleen
- hematuria, proteinuria, oligouria
- Kidney problem
- male genetalia, female fat distribution
- Klinefelter's
- tall stature, eunuchoid appearance, gynecomastia, testicular atrophy
- Klinefelter's
- hyperoral, hypersexual, disinhibition, visual agnosia
- Kluver-Bucy; Amygdala lesion
- slow deep respirations with increased tidal volume
- Kussmaul's breathing; ketoacidosis
-
non-tender Adenopathy - cervical
(2) -
- Laryngeal CA
- Thyroid CA - low grade fever, mild inspiratory stridor, Steeple sign on lateral x-rays of neck.
- Laryngotracheobronchitis;
- "Seal-bark" cough
-
Croup
(parainfluenza virus) - black pigmentation of bowel
- Laxative abuse
- gout, HTN, renal insufficiency
- Lead poisoning
- gout, retardation, self-mutilation
- Lesch-Nyhan; HGPRT deficiency
- white patch on the buccal mucosa which does not wipe off
- Leukoplakia
- pruritic flat-topped violet papules of forearm neck thigh buccal mucosa and glans penis
- Lichen planis
- Winged scapula
- Long thoracic n. damage; paralysis of serratus ant m.
- dysuria, frequency, hematuria
- Lower urinary tract infection
- clubbing of nails
- Lung CA if acute
- Chronic lung infection if chronic
- Bone growth w/ cap of cartilage in men < 25
- Osteochondroma
- Cough, weight loss, chest pain, hemoptysis, hoarseness
- Lung CA; bronchogenic
-
non-tender Adenopathy - right supraclavicular
(2) -
- Lung CA
- Esophageal CA. -
Adenopathy - abdominal, retroperitoneal
(3) -
- Malignant Lymphoma
- Testicular CA
- Prostate CA - arachnodactyly (spider fingers), dolichocephaly (long skull), dislocated lens, dissecting aortic aneurysm, mitral valve prolapse, thumb sign (thumb protrudes across clenched fist)
- Marfan syndrome
- Marphan's problem
- fibrillin defect
- Adenopathy - postauricular
- Measles
- fever, HA, malaise, myalgia, photophobia, burning eye pain, white spots on buccal mucosa [Koplic's
- Measles
- fever, malaise, Koplik's spots
- Measles; Rubeola virus
- diverticulum 2 inches long, 2 feet from the ileocecal valve
- Meckel's diverticulum
- newborn that is unable to pass meconium, absence of stool in ampulla of rectum
- Megacolon; Hirschsprung's, Down's, Chaga's
- ovarian fibroma, ascites, R pleural effusion
- Meigs' syndrome
- amenorrhea, hot flashes, night sweats, female 52 yo
- Menopause
- chest pain, diaphoresis, dyspnea, n/v
- MI
- epidural bleed
- Middle Meningeal a.
- holosystolic murmur at apex
- Mitral regurgitation
- diastolic rumbling low-pitch murmur at apex following opening snap
- Mitral stenosis
- warts
- Papillomavirus
- fever, lethargy, atypical lymphs, neg heterophil Ab
- Mononucleosis; Cytomegalovirus
- fever, lethargy, sore throat, lymphadenopathy, splenomegaly, atypical lymphs, Monospot test
- Mononucleosis; Epstein-Barr virus
- lytic lesions of the skull
- multiple myeloma
- nystagmus, intention tremor, scanning speech
- multiple sclerosis
- fever, malaise, swelling of parotids
- Mumps virus
- child with difficulty walking, tendency to fall
- Muscular dystrophy
- Murmur; Systolic; holosystolic murmur
- MV/TV regurgitation
- Murmur; Diastolic; early, mid-diastolic rumble following opening snap
- MV/TV stenosis
- bilateral ptosis
- Myasthenia gravis
- difficulty talking, diplopia, muscular weakness upon exertion
- Myasthenia gravis
- puffiness of hands, face, feet, tired, weak; yellow skin
- Myxedema; Hypothyroid
- abrupt onset oligouria, HTN, periorbital edema, hematuria
- Nephritic syndrome
- abrupt onset severe, colicky, flank pain radiating into the groin
- Nephrolithiasis
- periorbital edema
- Nephrotic syndrome
- increased insulin, increased C-peptide, increased glucose, osmotic coma
- NIDDM, type II diabetes
- nml biceps DTR
- nml C5
- nml triceps DTR
- nml C7
- nml pupil light reflex
- CN II -> CN III
- nml gag reflex
- CN IX -> CN X
- nml corneal reflex
- CN V-1 -> CN VII
- nml jaw jerk
- nml CN V-3
- nerve for nml cough
- CN-X -> recurrent laryngeal n.; phrenic n.; spinal motor n.
- nml hip adduction
- nml L1-L2
- nml knee extension
- nml L3-L4
- nml patellar DTR
- nml L4
- nml great toe extension
- nml L5
- nml knee flexion
- nml L5-S1
- nml achilles DTR
- nml S1
- nml great toe flexion
- nml S1
- diarrhea, n/v for 1 day
- Norwalk virus
- pain of weight bearing joints, worsens by end of day, DIP, Heberden's nodes
- Osteoarthritis
- multiple bone fractures, blue sclera, deafness
- Osteogenesis imperfecta
- hip pain that worsens at night and is dramatically relieved by aspirin
- Osteoid osteoma
- Migratory thromboplebitis
- Pancreatic CA
- condyloma accuminata
- Papillomavirus - types 6, 11
- absent bowel sounds
- Paralytic Ileus
- stooped posture, resting tremor, festinating (shuffling) gait, cogwheel rigidity, pill-rolling tremor
- Parkinson's
- machine like murmur, widened pulse pressure, bounding pulses
- PDA
- Murmur; machinery murmur, differential cyanosis (upper body pink, lower body blue)
- PDA
- sudden pleuritic chest pain, tachypnea, dyspnea, tachycardia
- PE
- dermatitis, diarrhea, dementia
- Pellagra; niacin deficiency
- air under the diaphragm
- Perforated Ulcer
-
rebound pain, abdominal guarding
(3) -
- Perforated ulcer
- pancreatitis
- appendicitis - friction rub
- pericarditis
- abdominal guarding, rebound tenderness, pts sits perfectly still
- Peritonitis
- pigmentation around mouth, colonic hamartomatous polyps
- Peutz-Jeghers syndrome
- HTN, HA, perspiration, palpitation, feelings of dread, abdominal pain, hyperglycemia
- Pheochromocytoma
- fever, lower abdominal pain, adnexal tenderness to cervical motion
- PID; chlamydia, gonorrhea
- bitemporal hemianopsia
- Pituitary adenoma
- bitemporal hemianopsia, diabetes insipidus, cranial nerva palsy
- Pituitary adenoma
- acute solitary oval annular lesion of 2-6 cm on the trunk, followed weeks later by eruption of small of christmas tree pattern w wrinkled center and scaly border w hyperpigmentation
- Pityriasis rosea
- dysphagia for solids, glossitis, leukoplakia, achlorhydria, iron deficiency
- Plummer-Vinson syndrome
- upper lobe centrilobular emphysema, cor pulmonale, lungs are black w/ nodular masses & antracotic pigment
-
Pneumoconiosis
(Coal miner's) - insidious onset low grade fever, pleuritic chest pain, chills, myalgia, non productive cough
- Pneumonia, Atypical; Mycoplasma, Tb, Legionella, Chlamydia⬦
- sudden onset spiking fever, pleuritic chest pain, chills, cough w rusty sputum
-
Bacterial Pneumonia, Typical
(Strep pneumo)