MOST IMP.

1ST STEP IN DX & TX: THOROUGH HX & PE

What is the sequence and content of auscultation?
What are the peritoneal singn?
what are the sign of meningeal irritation during neurologic examination ?

MOST ACCURATE IN TEMP [PEDIATRIC]----RECTAL 2 MIN

[CARDIAN POSN OF GAZE] PAIRING OF OCULAR M. & AXN-----SUP. OBLIQUE M-

ADDUCn & DEPRESSION

SEQUENCE EX. LUNG ---INS,PALPN,PERC,AUSC

RT-SIDED LUNG D. PREFERRED RECUMBENT POSn ----- LT LAT DECUBITUS POSn

MAN- STABBED-> ER [30MIN] TRACHEA AWAY FROM PUCT. SIDE; PE?------

HYPERRESONANT PERCUSSION [PNEUMOTHORAX]

N TRACHEAL ANATOMY & STR----- TRACHEA DIVIDES RT & LT MAIN BRONCHI

BELOW STERNAL ANGLE

LUNG SEGMENTS SUSCEPTIBLE TO ASPIRATn PNEUMONIA----- POST. SEGMENT OF

RT UPPER LOBE ©

55M EMPHYSEMA RESP. BREATHING PATTERN?---------RAPID & SHALLOW

BREATHING [PROLONG EXPIRATN; PURSE THEIR LIP; RR INC. -SHORTED INSPIRATn

CLUBBING ASSOCIATED WITH----------CYSTIC FIBROSIS [ LUNG

CANCER,CONGENITAL HD, CIRRHOSIS, COLITIS, THYROID D]

AUSCULTATn - BREATHING SOUND------------BRONCHIAL SOUND ARE N AT

TRACHEA [TUBULAR]

S1 SPLIT COMMON CAUSE?----------RBBB

LOUD S1 [INC. INTENSITY]-----------MITRAL STENOSIS [MS]

GRADING OF HEART MURMER ,TRUE ?-------GRADE 4 MURMER-LOUD OBVIOUS

MURMER + PALPABLE THRILL

STANDING INCREASES WHICH MURMER?-----HYPERTROPHIC CARDIOMYOPATHY

(MCP)

S2--TRUE?-----------WHEN IT SPLIT, SPLIT MAY BE INCREASED BY INSPIRATION

S4--TRUE? ------------ -CE IN PT WITH ATRIAL FIBRILLATION

ABD- EX PROPER SEQUENCE?----- INSP, AUS, PERC, PALPN

SCAPHOID ABD------ -CE IN OBESE PT

LOCATION- MC BURRNEY'S PT----------1/3 OF LINE FROM RT ASIS TO UMBILICUS

TRUE- PALPn OF THYROID GLAND-----PT POSN NECK FLEXED SLIGHTLY FORWARD &
LAT. TOWARD SIDE BEING EX.

RISK FACTOR --BREAST CANCER?----NULLIPARITY

Sign of meningeal irritaiton

Irritation by meningitis, subarachnoid hemorrhage, drug, increased intracranial

pressure cause abnormal contraction of various muscle group, which are identified in
PE

1. NUCHAL RIGIDITY: Pt place chin on chest. Passive flexion of neck limited by

involuntary muscle spasm, but passive extension & rotation are normal

2. KERNIG SIGN: With pt supine, passively flexed hip to 90degree while knee is
flexed at about 90 degree. With hip kept in flexion, attempt to extend knee
produce pain in the hamsting & resistance to further extension.

This is reliable sign of meningeal irritation, which may occur with meningitis,
herniated disk or tumor of cauda equina.

3. BRUDZINSKI SIGN: Pt in supine, limb extended--passively flex neck. If

involuntary flexion of hip (& knee) occurs,then it a POSITIVE brudzinski sign.

4. SPINAL RIGIDITY: Movement of spine are limited by spasm of erector spinae.

In extreme case, spinal muscle are in tetanic contraction, producing rigid
hyperextension of entire spine with head forced backward & trunk thrust
forward. This condition is called opisthotonos.