Diagnosis

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 MADDUCn & 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.