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PhysDxFinal
| Question | Answer |
|---|---|
| On male pelvic exam, this should feel like the inside of a BIC pen. | Spermatic cords |
| You are palpating from the epididymus to the inguinal ring. What are you feeling for? | Bilateral spermatic cords. |
| During this male pelvic exam you should move slowly and invaginate some scrotal skin as you enter the inguinal ring. Test? | Hernia Exam |
| What method should you use when performing a hernia exam? | "Cross-Handed" Method: Use R hand for Pt's R hand. |
| If performing a hernia check on a child/small adult, what should you use instead of your index finger? | Pinky |
| In order to feel pressure during hernia exam you would ask your patient to turn head and cough or do what? | Valsalva |
| When examining perianal area you should spread buttocks with what to visual anal opening looking for hemorrhoids, fissures, skin tags & lesions. | Spread with thumbs. |
| When performing the rectal and prostate exam you should slowly insert finger how far? | Full length |
| When performing a prostate exam, where is it located? Size? Shape? Consistency? | At 6 o'clock Almond Shaped (with 2 lobes) Size of Walnut Firm, like tip of nose or thenar palm. |
| When you check stool for blood called? | Hemoccult/guaiac test |
| This STD caused by a virus begins with painful vesicles that may become ulcerated. | Herpes Simplex Virus-->Genital Herpes |
| This STD caused by HPV usually grows in grouped multiples and spread to perineum & anal area. | Condyloma Acuminata (Genital Warts) |
| This benign viral condition is self-limited and causes umbilicated vesicular lesions. | Molluscum Contagiosum |
| This veneral infection caused by spirochete Treponema Pallidum begins acutely in the primary phase as a painLESS small red macule/papule that erodes into a still painless ulcer. Can become secondarily infected. | Syphilitic Chancre |
| What is the most common cause of non-gonococcal urethritis? | Chlamydia |
| This idiopathic condition leading to fibrosis in the corpora cavernosa may devo into penile curvature, painful erections & occasionally ED. Firm plaques are palpable in the penile shaft. | Peyronie's Disease |
| This begins as a firm nodule or ulcer that doesn't heal. Usually nontender. Occurs more in uncircumsized males. | Penis Carcinoma |
| Most common hernia. Above inguinal ligament, near internal inguinal ring. Often extends into scrotum. Palpable as impulse down inguinal canal. | Indirect Inguinal Hernia |
| Less common hernia, typically in men over 40. Above inguinal ligament. Rarely enters scrotum. Bulges anteriorly. | Direct Inguinal Hernia |
| Least common hernia, more common in women. Below the inguinal ligament. More lateral than an inguinal hernia. May mimic lymph node. Never enters scrotum. | Femoral Hernia |
| Varicose veins of scrotal vessels. Feels like a soft bag of worms. May collapse slowly if scrotum elevated while patient is supine. Associated w/infertility. | Varicocele |
| This infection of the epididymis produces local pain & swelling. Often associated w/UTI or prostate infection. Usually in adults. | Acute Epididymitis |
| Benign non-tender fluid filled mass within the tunica vaginalis. Transilluminates. | Hyrocele |
| Inflammation/Infection of the testis. Testicular swelling & tenderness. Similar looking to epididymitis. Complication of mumps & other viral infections. | Acute Orchitis |
| Patient has mumps and presents with inflamed testicle with edema and tenderness. Dx? | Acute Orchitis |
| Painless, mobile mass just above testis that's smaller than hydrocele. Contains sperm & can transilluminate. | Spermatocele |
| Pt has red, swollen, tender scrotum w/intense pain. Testis may be pulled upwards. Is it a surgical ER? Dx? | Testicular Torsion caused by twisting of spermatic cord. Surgical Emergency |
| Pt presents w/firm, painless testicular nodule. Does NOT transilluminate. | Testicular Tumor |
| A tear in the inside lining of the wall of the anus caused by the passage of very hard stools. Sx: severe pain as stool passes along w/itching, burning, bleeding & wet discharge. | Anal Fissure |
| Anal issures are dx by what? | History & Anoscopy |
| Swelling and erythema of the butt can be caused by? | Perirectal Abscess |
| Homosexual man has an STD from HPV around anus. Condition? | Perinal Condylomata |
| During digital rectal exam you may be able to feel this condition. | Rectal Carcinoma |
| Pt has enlarged, tender prostate gland which is very tender and presents with fever and chills. | Prostatitis (more likely acute since more tender) |
| How do you treat Prostatitis? | Abx |
| As patient ages see symmetrical enlargement of prostate gland which slows urine stream & causes hesitancy. | Benign Prostatic Hypertrophy |
| Pt presents w/enlarged, firm nodule or area of hardness on prostate. There's irregular contour & medial sulcus is obscured. Usually slow-growing. | Prostate Carcinoma |
| Where do prostate carcinoma usually metastasize? | Locally & to bone |
| Where do breasts primarily drain? | Axillae |
| Where do breasts secondarily drain? | Internal mammary |
| Where can breasts drain besides axillae & internal mammary | Supraclavicular & Jugular Nodes |
| How many quadrants in the breast? | 5: Upper Outer, Upper Inner, Tail of Spence, Lower Outer, Lower Inner |
| Should you advise your patients on how to perform breast self-exam? | No. Not recommended to teach how to perform own breast exam. |
| Inspection of breast should be done with four motions. Which are? | Arms overhead (palms together), hands on hips & press down, shrug shoulders, lean forward |
| Recent onset of unilateral nipple inversion could be a sign of what? | Underlying malignancy |
| Where are most breast cancers located? | Upper outer quadrant |
| How would you position a patient for a breast exam? | Patient is supine with hand under head. |
| How many levels of pressure should you use to palpate the system. | Superficial, Medium then Deep to chest wall. |
| How should you palpate the breast? | Begin w/tail of Spence & move in concentric circular fasion progressing from outer breast ending up near the nipple. Palpate areola then region beneath nipple all the way to chest wall. |
| Check for nipple discharge how? | Placing 2 fingers from each hand at areola edge. Press down, inward toward nipple, then up & back down. Repeat at 90 degrees. |
| Nipple that discharges light & milky is normal or abnormal? | Normal |
| Nipple that discharges serous or bloody is normal or abnormal? | Abnormal |
| This axillary node sweep is anterior to axillary region, including pectoralis m. | 1st Sweep |
| This axillary node sweep is mid-axillar high into apex. | 2nd Sweep |
| This axillary node sweep is posterior to axillary region, beneath teres minor | 3rd Sweep |
| This axillary node sweep is down medial aspect upper arm | 4th Sweep |
| In order to palpate axillary nodes should use what type of motion? | Rotatory/Windshield Wiper Motion |
| Gravity represents what? | Number of times pregnant |
| Parity represents what? | Outcome of each pregnancy: term, preterm, living |
| Need to ask about any what during female exams? | Abortion (spontaneous or induced) |
| Would like to perform a pelvic exam. Should you have a chaperone present? | Yes to protect provider & patient. |
| The verbal outline for the pelvic exam includes what? | Inspection of vaginal exam, Speculum Exam, Bimanual Exam |
| What should the exam table be elevated to for a pelvic exam? | 30 degrees |
| Do not call stirrups, call what? | Heel or Foot rests |
| When should you milk the urethra by gently spreading the urethral meatus and inserting index finger into vagina & gently applying pressure to Anterior vaginal wall as slide finger twds you. | When concerned about infection (urethritis, STI like gonorrhea) |
| During internal exam of the pelvis you insert index/middle fingers of non-dominant hand into vagina up to where? | 2nd Knuckle |
| Why would you ask a patient to bear down during a pelvic exam in the female? | Check for cystocele or rectocele |
| Within the vagina you should apply anterior or posterior pressure? | Posterior |
| When performing a PAP smear insert the spatula into cervical os and rotate 360. Rinse by swirling how many times? | 10 |
| PAP Smear tests concurrently for what? | HPV, GC, Chlamydia |
| To palpate this structure you palpate the circumference, gently rock it from side-to-side and palpate for firmness. | Cervix |
| When you Place internal fingers on posterior side of cervix and outer hand hand on lower abdomen feeling for what? | Uterine Fundus |
| You expect to feel a pear-shaped, round firm & smooth with this. Described as similar in shape & consistency as a fist. | Uterine Fundus |
| You move internal and external fingers lateral to uterus & use 3 sweeps moving from distal twd pubic fair line attempting to palpate this. | Ovaries |
| You feel something smooth & ovoid, mildly tender to palpation & similar to an almond during a pelvic exam. What is it? | Ovaries |
| What's the most common uterine position? | Anteverted Uterus |
| What type of uterus can be felt during the rectovaginal exam? | Retroverted Uterus |
| Internal emotional tone of the patient | Mood: Dysphoric, Euphoric, Angry, Anxious |
| External range of expression. objective assessment of pt's mood | Affect: Full/normal Blunt/Restricted Flat: absence of all or most affect Labile: multiple abrupt changes |
| Harder to arouse w/verbal stimuli, may need to shake. Responds to light stimulation. Responses are slower & tend to be confused. Decreased environmental interest. | Obtundation |
| Sleepy but eyes will open & respond then fall back to sleep. Arousal can be achieved/kept by light stimulation. Verbal stimuli also works to wake. | Lethargic (Somnolence) |
| Often need painful stimuli (voice & shaking don't work) to wake pt. Lapse into unresponsiveness when stimuli stops. Minimal awareness of self/environment. | Stupor |
| No response to verbal or painful stimuli. Cannot arouse for anything. | Coma |
| Problem w/motor speech or articulatoin. Seen w/bulbar or psedobulbar palsy. | Dysarthria |
| Weak breathy voice bc vocal cords not well approximated. Seen w/presbyphonia, vocal cord nodules, polyps paralysis, or tumors. | Dysphonia |
| Comprehension intact but unable to speak to varying degrees. Aware of Loss. | Broca (Expressive) Aphasia |
| Comprehension NOT intact but able to speak fluently. Sentences just don't make sense. Unaware of Loss. | Wernicke's (Receptive) Aphasia |
| Combination of Broca(Expressive) & Wernicke(Receptive) Aphasia | Global Aphasia |
| These speech disorders are common with MCA strokes, trauma & mass lesions | Aphasia |
| Unable to perform a learned motor act. Pt's must be able to understand command, remember & have ability to follow. Seen w/parietal lobe lesions. | Apraxia |
| Unable to recognize sensory stimuli associated with parieto-occipital-posterior temporal lesion (CVA or demension) | Agnosia |
| Pt has MCA stroke. Sx? | Aphasia |
| Pt has lesion to parietal lobe. Sx? | Apraxia (no learned motor movement) |
| Pt has lesion to parieto-occipital-posterior temporal area. Caused by CVA or dementia. | Agnosia (no sensory stimuli) |
| Level of awareness | Relax-->Lethargy-->Somnolen-->Obtunded-->Stuporous-->Comatose-->Death |
| Acute within last hr/wk. Abnromally alert & impaired time orient. Immediate & Recent memory impaired. Incoherent speech w/speed change. Sees illusions/hallucinations. | Delirium |
| Gradual onset over mos/yrs w/normal alertness. Impaired orientation. Remote & recent memory impaired. Difficulty "finding the word". Absent perception. | Dementia |
| Suddenly abandons present activity/lifestyle & starts a new/difft one for a period of time(often in a new city). After pt claims amnesia for events during it, although earlier events are remembered & habits/skills usually unaffected. | Fugue |
| Psychomotor disturbances seen in schizophrenia characterized by periods of either muscular rigidity, excitement or stupor | Catatonia |
| Impaired bilateral thalamus, bilateral hemispheric injury (RAS) & injury to midbrain or below places for what? | Coma |
| HA, OD, Stroke, Cerebral edema, metabolic conditions, traumatic brain injury, untreated status epilepticus | Coma |
| Glasgow: pt's eyes responds to speech | Stage 3 |
| Glasgow: pt's eyes responds to pain | Stage 2 |
| Glasgow: pt's eyes responds to nothing | Stage 1 |
| Glasgow: pt responds to pain & withdraws | Stage 4 |
| Glasgow: pt responds w/abnormal flexor response | Stage 3 |
| Glasgow: pt responds w/extensor response | Stage 2 |
| Glasgow: pt responds w/confused convo | Stage 4 |
| Glasgow: pt responds w/incomprehensible sounds | Stage 2 |
| Glasgow: pt responds w/wrong words | Stage 3 |
| Glasgow Total Score | 3-15 from E, M & V 15=Awake |
| Head injury, low Glasgow of 8 longer than 72 hrs. | Poor Prognosis |
| Patients “act awake”, usually following a deep coma. Eyes open, may cough, yawn and swallow, and meaninglessly use their extremities , but still essentially brain dead | Coma Vigil & Alpha Coma (Persistent Vegetative State) |
| Decorticate Position | Flexion/Arm Adduction/Legs Extended caused by lesion in corticospinal tract from cortex to upper midbrain |
| Decerebrate Position | Extension/Adduction/Internal Rot of Arms Extension of Legs Lesion in corticospinal tract at level of pons or upper medulla |
| Lesion of corticospinal @pons or upper medulla leads to? | Decrebrate Posturing |
| Lesion of corticopsinal @cortex to upper midbrain leads to? | Decorticate Posturing |
| Associated with trauma, tumors, large strokes brain may do this through falx, tentorium or foramen magnum. | Herniate |
| Seen with uncal herniation may progress bilaterally. Can also see w/aneurysm compressing this nerve | CN3 |
| Paralytic Strabismus is when left eye cannot look down when turned inward. CN damage? | CN4 |
| If eyes are midposition (2-5mm) & fixed suspect what? | Midbrain Lesion |
| If eyes are pinpoint & reactive suspect what? | Pontine Lesion |
| If eyes are unilateral dilated & fixed suspect what? | CN3 lesion/uncal herniation |
| If eyes are bilateral dilated & fixed suspect what? | Central herniation, Hypoxia |
| During the oculocephalic reflex (doll's eyes) if eyes stay fixed & move in same direction of head. Suggests lesion where? | Midbrain or Pons (CN3-8 lesion) |
| If Doll's Eye reflex horizontally absent or assymetric. Lesion where? | Brainstem |
| If Doll's Eye reflex vertically absent or assymetric. Lesion where? | Midbrain |
| The normal response is tonic (slow) twd stimulus; fast nystagmus away during this test. COWS | Vetibulocochlear Reflex Cold Opposite, Warm Same Impaired: Brainstem lesion |
| Bihemispheric lesions or metabolic encephalopathy | Cheyne-Stokes breathing pattern |
| Metabolic Acidosis or Herniation | Hyperventilation (Kussmaul's) breathing pattern |
| Pontine Damage | Apneustic breathing pattern |
| Early Medullary Damage | Cluster breathing pattern |
| Medullary Damage | Ataxic (Biot's) breathing pattern |
| Loss of sense of smell, hard to concentrate can be caused by this? | Olfactory Groove Meningioma(damage to CN1) |
| This will present with visual field defect & HA and pituitary hypersecretion signs like acromegaly, infertility, galactorrhea, amenorrhea, Cushing's Disease | Pituitary Adenoma |
| Inc growth hormone would lead from pituitary adenoma would lead to? | Acromegaly |
| Inc prolactin would lead from pituitary adenoma would lead to? | Infertility, Galactorrhea, Amenorrhea |
| Inc ACTH would lead from pituitary adenoma would lead to? | Cushing's Disease |
| Contralateral paralysis of lower face, saving forehead. Lesion where? | Central CN7 lesion |
| Ipsilateral paralysis of entire face. Lesion where? | Peripheral CN7 lesion |
| LMN lesion leading to ipsilateral facial palsy involving entire face. | Bell's Palsy |
| UMN lesion leading to contralateral weakness of lower face (sparing forehead). Seen with stroke or mass lesion. | Central CN7 lesion |
| Benign growth on CN8 associated with SNHL & peripheral CN7 lesion (ipsilateral). May see cerebellar ataxia with large lesions. | Acoustic Neuroma |
| Palate deviates AWAY from lesion. Loss of gag reflex. | CN9 Lesion |
| Tongue deviates TOWARD side of lesion. "Lick the lesion" | CN11 Lesion |
| Pt acutely weak/numb w/abrupt impairment of consciousness & worst headaches of life. Unable to produce language (aphasia) and slurs speech (dysarthria). | CVA (Stroke) |
| What assesses for subtle weakness? | Pronator Drift |
| Weakness in districution, spastic, hyperactive DTR, Clonus & Babinski all signs of? | UMN |
| Weakness in segmental distribution, m atrophy, flaccid, fasciculation, dec or gone DTRs signs of? | LMN |
| Cervical Radiculopathy may cause nerve root compression because of? | HNP or bone spur |
| Lateral upper arm & shoulder numb, cannot move deltoid or biceps for shoulder abduction. Loss of biceps/brachioradialis DTR. Lesion | C5 Cervical Root |
| Dorsolateral arm/forearm/thumb numb, cannot move biceps, brachioradialis for forearm flexion. Also lose wrist extensors. Loss of biceps/brachioradialis DTR. Lesion | C6 Cervical Root |
| Mid-dorsal forearm & middle finger numb, cannot move triceps for forearm extension. Also lose wrist flexors/finger extensors. Loss of triceps DTR. Lesion | C7 Cervical Root |
| Medial forearm & ring & small finger numb, cannot move thenar eminence & interossei of hands(intrinsic hand muscles). Loss of triceps DTR. Lesion | C8 Cervical Root |
| Sensory loss to anterior thigh, lose iliopsoas motor, knee jerk DTR. | L3 Lumbar Root |
| Sensory loss to anteromedial thigh to medial leg, lose quads motor, knee jerk DTR. | L4 Lumbar Root |
| Sensory loss to lateral thigh & anterior calf, lose foot dorsiflexion, AT/EHL, NO DTR. | L5 Lumbar Root |
| Sensory loss to posterior calf & heel, lose gastrocnemius motor (plantarflexion of fott), achilles DTR. | S1 Lumbar Root |
| Spastic quadriplegia, C4 sensory level, 3+ DTRS throughout and toes upgoing bilaterally sign of what? | C4 Root Damage |
| Spastic paraplegia motor function is 5/5 in BUE. T10 sensory intact LT/PP. Biceps & triceps +1 and symmetric. Knee/Ankle Jerks +3 symmetric. Toes upgoing bilaterally. FTN & RAMs intact in BUE. | T10 cord lesion |
| Decreased vibration & proprioception on R lower extremity bc of disruption of posterior columns on right. DEC light touch & pinprick on Left Lower Extremity due to damaged spinothalmic on right. RLE paralysis bc of corticospinal damage on right. | Brown-Sequard Lesion (Hemisection). For these sx on R side. |
| Distal weakness, diminished reflexes, distal sensory loss. | Nerve Disease |
| Increased weakness with effort, normal reflexes, no sensory loss | NM Disease |
| Proximal weakness, normal or late reflexes, no sensory loss | Muscle Disease |
| UMN lesion above medulla leads to? | Contralateral Weakness |
| UMN lesion below medulla leads to? | Ipsilateral Weakness |
| UMN disease can result from? | Stroke, Mass Lesion, MS, Trauma |
| Mononeuropathy (LMN) from carpal tunnel leads to median nerve compression and what sx? | sensory loss in first 3.5 digits, thenar motor loss (abd pollicus brevis, opponens), nocturnal pain in forearm & first 3.5 digits) |
| Mononeuropathy (LMN) from ulnar entrapment leads to ulnar nerve compression and what sx? | Sensory loss of 4th and 5th digits, motor loss of hypothenar (abductor digiti minimi, 1st dorsal interosseus). Pain @4th/5th digits & tender elbow. |
| Dec lt touch, pink prick in BLE in stocking distribution; vibration gone @big toe & present, but smaller at medial malleolus. DTRs are +1 & symmetric @knees & gone from both ankles. Toes go down bilaterally. | Diabetic Neuropathy |
| Associated w/corticospinal dz UE flexed, LE extended, draws/drags foot. | Spastic Hemiparesis |
| Associated w/foot drop bc of LMN dz. Pt either drags their feet or lift them high w/knees flexed then slap floor. | Steppage Gait |
| Associated w/loss of proprioception in the legs; unsteady, wide gait. Watch ground while walking and have + Romberg. | Sensory Ataxia |
| Associated w/cerebellar disease or assoc tracts. Staggering, unsteady & wide-based gait. INC turn difficulty & unable to stand w/eyes open or closed. | Cerebellar Ataxia |
| Idiopathic degeneration of dopaminergic neurons in substantia nigra. See bradkinesia, cog wheel, pill roll, masked facies, and sometimes dementia. | Parkinson's |
| Automated movement is controlled here. | Basal Ganglia |
| Primary Sensory Relay controlled here. | Thalamus |
| periorbital cellulitis | bacterial infection around the eye |
| chalazion | points into lid, unlike sty |
| pterygium | conjunctiva frows slowly across cornea from the nasal side. |
| conjunctivitis | conjunctiva infection |
| episcleritis | engorged radially oriented vessels & a nodule adj to limbus |
| subconjunctival hemorrhage | leakage of blood outside vessels producing a homogenous sharply demarcated red area that fades over days to yellow. |
| hyphema | bleeding in anterior chamber |
| corneal burn | burn of cornea |
| corneal abrasion | USE fluorescein staining. Abrasion from something hitting eye. |
| eye puncture | stabbing in eye |
| cataract | opacity of the lens visible thru pupil. most common in old age. |
| Ischemic optic neuropathy | insufficient bloody supply to optic n, acute. |
| HTN Retinopathy | marked arteriolar venous crossing changes are seen especially along inferior vessels. Cotton wool spot (white/yellow patches) unrelated to HTN. |
| DM Retinopathy | Leads to blindness. Hemorrhage & exudates damage. |
| Proliferative DM Retinopathy | neovascularization more num/torturous, narrowerred arcades |
| Glaucoma w/cupping | INC pressureINC cupping & atrophy. Base of enlarged cup=pale |
| Papilledema | venous stasis leads to edema. |
| Optic Atrophy | death of optic nerve fibersloss of tiny disc vessels |
| Macular Degeneration | Damaged retina loss of center of visual field(macula)blindness |
| Serous Otitis Media | buildup of serous fluid by viral upper resp infections. |
| Acute otitis media | caused by bacterial infectioneardrum red & swelling |
| Tympanosclerosis | large chalky white patch w/irreg margins made of hyaline. Scarring after otitis media. |
| Angular Cheilitis | saliva wets & macerates the infolded skin (usually bc of no teeth)secondary infection |
| Marginal Gingivitis | common in young adults. Gingival margins are red and swollen and interdental papillae are blunt, swollen & red |
| Gingival Hyperplasia | gums enlarged by hyperplasia are swollen into heaped up masses that may cover the teeth. Puberty, pregnancy, leukemia |
| Thrush on palate | yeast infection Candida |
| Exudative Tonsillitis | red throat w/white exudates. Usually strep or mono. |
| Fissured tongue | scrotal tongue |
| Geographic Tongue | benign, dorsum shows scattered smooth red areas of papillae. Gives maplike pattern that changes over time. |
| Leukoplakia | thickened white patch in oral mucosa. From tobacco. Could lead to cancer. |
| Goiter | enlarged thyroid (thyromegaly) |
| Tinea Capitis | Fungal Infect"scalp dermatophytosis"-Kerion(raised, boggy, secondarily infected fungal lesion of hair) |
| Acromegaly | Excess growth hormone production. Lrg hands/feet/facial bone growth |
| Down Syndrome | Trisomy 21 |
| Bell's Palsy | Facial n (CN7) paralysis. Hard to close eye. Flat nasolabial fold. Oral steroids/antivirals. |
| Corneal Reflex | CN V and VII |
| Strabismus | Deviation of eyes from norm position |
| Paralytic Strabismus | Weakness/paralysis of extraocular mm |
| Non-Pararlytic Strabismus | Due to imbalanced mm tone |
| Left CN3 Paralysis | (Paralytic Strabismus)Dilated pupil, fixed to light & near effort. Ptosis of upper lid; lateral deviation of eye |
| Left CN4 Paralysis | (Paralytic Strabismus) Left eye cannot look dwn when turned inward. |
| Left CN6 Paralysis | (Paralytic Strabismus)Looking ahead: one eye turns nasally (esotropia). Looking to Left: Esotropia is max |
| Horner's Syndrome | 1)Ptosis 2)Miosis 3)Anhidrosis (no sweat on effected side) |
| Anisocoria | unequal pupil size (>.5mm)_Sympathetic n dysfunction |
| Tonic (Adie's) Pupil | Reduced rxn to light; mydriasis. Slowed near rxn. Impaired parasymp fcn. |
| Chalazion | Meibomian gland inflamm; pts inward |
| Hordeolum(Stye) | Tender, red infection near eyelash hair follice. Like pimp, boil pting inward |
| Entropion | Lid Inversion |
| Ectropion | Lid Eversion |
| Dacrocystitis | Lacrimal Sac Inflammation |
| Pingueculum | Yellow nodule on bulbar conjunctiva, on either side of the iris. |
| Pterygium | Medial sclera, extends from inner canthus to cornea |
| Scleral Icterus | INC bilirubin, jaundice--> Yellow eye |
| Uveitis(iritis or iridocyclitis) | Inflammation of middle layer of eye |
| Hyphema | Bleeding in anterior chamber |
| Corneal Abrasion | Use fluorescein staining |
| Hypertensive Retinopathy | Flame hemorrhages & cotton wool patches |
| Diabetic Retinopathy | Hemorrhages & Exudates |
| Proliferative Diabetic Retinopathy | Neovascularization |
| Glaucoma w/Cupping | Phys cup is >1:2 (abnormal!) |
| Normal Eye Arteries | Light red, smaller, bright light reflex |
| Normal Eye Veins | Dark red, larger, min light reflex |
| Normal AV Crossing in Eyes | Normal AV crossing lets light in 1/4th. Can look to see if narrowed in HTN (Copper, Silver wire) |
| Gouty Tophi | Deposit of uric acid crystals on ears. After yrs of chronically hi uric acid in tophaceous gout. |
| Tympanosclerosis | Calcificatin of tissues in middle ear. |
| Bullous Myringitis | Viral infection; painful hemorrhagic vesicles |
| Rinne Normal | AC>BC |
| Rinne Conductive | AC<BC |
| Rinne Sensorineural | AC>BC |
| Weber sound lateralizes to affected ear if canals occluded | Conduction Loss=Otitis Media, Perforation, Cerumen, Otosclerosis |
| Sound lateralizes to opposite ear | Sensorineural Loss. Presbycusis, noise exposure, head trauma |
| Septal Deviations | Sx: nasal obstructio, headache, change in smell. See spurs & crests |
| Septal Perforations | Sx: epistaxis. Small lesions may whistle. Seen w/trauma, infection, cocaine, post-surgery |
| Nasal Polyps | Soft, translucent growth-->nasal obstruction & anosmia |
| Septal Hematomas | Soft, tender swelling. INC nasal obstruction, pain, tenderness. Seen w/trauma. More common in children. |
| Torus Palatinus | Benign bony prominence |
| Angular chelitis | Crust of lips, inversion of lips. |
| Thrush | Oral Candidiasis |
| Exudative Tonsillitis | Group A Strep |
| Tonsillar Hypertrophy | Numerous Tonsillar crypts |
| Leukoplakia | Premalignant changes |
| Tracheal Deviation | Deviates to right/left due to lung tumor |
| Jugular Venous Distension | Cardiac v pulmonary cause |
| Synarthrosis | Immovable: skull |
| Amphiarthrosis | Slightly moveable: pubic symphysis, IV disc |
| Diarthrosis | Freely moveable (Synovial): knee, shoulder |
| Hinge | Flexion/Extension (Elbow/Knee) |
| Saddle | Flexion, Extension, Adduction, Abduction: Thumb |
| Pivot | Uniaxial rotation (Atlas jt btwn C1/C2) |
| Condyloid | Biaxial movement at R angles to eachother:_Wrist: Flex, Extend, Ulnar/Radial Deviation_MCPs: Flex, Extend, Adduct, Abduct |
| Ball & Socket | Flex, Extend, Adduct, Abduct, Internal Rot, External Rot_Hip, Shoulder |
| Grade 0 | No contraction 0% Normal |
| Grade 1 | Slight contraction 10% Normal |
| Grade 2 | Full ROM no gravity 25% Normal |
| Grade 3 | Full ROM gravity 50% Normal |
| Grade 4 | Full ROM some resistance 75% Normal |
| Grade 5 | Full ROM full resistance 100% Normal |
| 0 | Unable to palpate |
| 1+ | Diminished, weaker than expected |
| 2+ | Brisk, expected |
| 3+ | Increased |
| 4+ | Bounding |
| Loss of contour of normally rounded shoulder | Dislocation of shoulder |
| Atrophy | Chronic dislocations, Rotator cuff tears |
| Proximal humerus deformity w/INC soft tissue swell | Humerus fracture; previous trauma |
| Winged Scapula | Paralysis of the serratus anterior due to long thoracic n damage |
| Impingement Syndrome | Pain when arms elevated overhead, localized tenderness. Aka Rotator Cuff Tendonitis. Caused by impingement of acromion, coracoacromial lig, AC jr & coracoid process on underlying bursa, biceps tendon & rotator cuff |
| Rotator Cuff Tear | Supraspinatus tendon rupture (Pt unable to fully ABduct arm) |
| Supraspinatus | Abduction against resistance |
| Subscapularis | Medial rotation against resistance |
| Infraspinatus | Lateral rotation against resistance |
| Teres Minor | Lateral rotation against resistance |
| Thoracohumeral Group | Adduction against resistance |
| Adhesive Capsulitis (Frozen Shoulder) | Diffused, dull, aching pain Progressive restriction of ROM Usually no localized tenderness, unusually unilateral Pt's age 50-70. Course is chronic. |
| Inflammation of subacromial bursa, w/pain on ABduction Subacromial tenderness present. Pain may radiate to forearm & hand. | Subacromial Bursitis |
| Occurs after excess use of biceps. Pain @bicipital groove in prox humerus Shoulder motion may be limited Yergason's Sign: Flex elbow to 90,pronate forearm, grasp pt's hand & ask him to supinate against resistance. Pain @anteromedial shoulder is + sign | Bicipital Tenosynovitis (Tendonitis) |
| Biceps tendon may rupture from its origin or insertion (more common for origin) Biceps muscle then shortens & becomes spherical. | Biceps Rupture |
| Swelling/Pain in shoulder caused by | Epicondylitis, Olecranon Bursitis, Arthritis, Acute trauma(Nursemaid's) |
| Nodules in shoulder caused by | Rheumatoid Arthritis, sometimes Gout. Usually firmer & non-tender. Distal to olecranon bursa |
| Tenderness of Lateral Epicondyle | Tennis Elbow (Pain w/wrist extension) |
| Tenderness of Medial Epicondyle | Pitcher/Golfer's Elbow (Pain w/wrist flexion) |
| Olecranon Bursitis | Inflamm of bursa w/fluid accum. May be due to local irritation, trauma or infection. |
| Nursemaid's Elbow | Dislocation of radial head(common 2-6yo) |
| Subcutaneous Nodules | Gouty Tophi, Rheumatoid Arthritis |
| Colle's Fracture | Fracture distal radius & ulna |
| Allen Test | Stop Radial/Ulnar aa. Release ULNAR 1st. |
| Carpal Tunnel Syndrome | Caused by compression of MEDIAN NERVE. Neuropathy w/pain/parasthesias of fingers. Thenar atrophy |
| Tinel's Sign | Percuss over median n. sensitivity/tingling shows carpal tunnel |
| Phalen's Test | Hold hands in flexed position together 30-60s. Positive test results show parasthesias in MEDIAN N. Consistent w/carpal tunnel. |
| Tensynovitis of the Wrist | Irritation or swelling of the extensor tendons of the thumb_Sx: Pain over radial styloid, worsened by attempts to move thumb/make fist. |
| Finkelstein's Test | Have person tuck thumb and extend. |
| Scaphoid (Navicular) Fracture | Tender Anatomical Snuffbox |
| Radial Deviation | Most common @wrist/DIP. Assoc w/OA |
| Ulnar Deviation | Most common @wrist/PIP/MCP. Assoc w/RA |
| Swan Neck | Hyperextension of PIP jts w/fixed flexion of DIP. Assoc w/RA |
| Boutonniere | Persistent flexion of PIP jt w/hyperextension of DIP jt |
| Heberden's Nodes | OA. NOT characteristic of RA. Dorsolateral aspects of DIP jts. Usually hard, painless and assoc w/arthritic changes. |
| Bouchard's Nodes | OA/RA Nodes @PIP jts, less common in OA |
| Rheumatoid Nodules | Common on dorsum of hand |
| DIP Swelling/nodules(Heberd) | OA |
| PIP Swelling (Bouchard's) | OA |
| MCP & PIP Swelling | RA |
| Ulnar Deviation of MCP | RA |
| Ganglion Cyst | Round, non-tender, swellings located on tendon sheaths/jts capsules on dorsum of hand or wrist. Flexion or wrist makes more prominent. |
| Trigger Finger | Painless nodule in flexor tendon, near metacarpal. Results in a jerky, "triggering" effect w/extension. |
| Dupuytrens Contracture | Scar tissue devo in flexor tendons of hand(4th/5th digits). Results in thickened fibrotic cord w/flexion contacture of digits. |
| Septic Tenosynovitis | Infection in space btwn 2layers of synovium which cover flexor tendons of finger/thumb. Usually after puncture wound. Swelling, tenderness & DEC ROM. |
| Digital Ischemia | May be transient or persistent: Raynaud's, Buerger's |
| Hypothenar Atrophy | Ulnar nerve disorder |
| Metacarpal Tenderness | Dislocation, Hyperextension Inj |
| This fracture effects the 5th metacarpal | Boxer's |
| This fracture effects the base of 1st metacarpal | Bennett's |
| Radial N | top of hand to medial side of ring finger |
| Ulnar N | lateral side of ring finger to end of hand (dorsum AND plantar) |
| Median N | Palm of hand to medial side of ring finger |
| Percussion over air hear what? | Resonance. Over tissue is dull. |
| Apex | ~2-4cm above clavicle |
| Lower Border | 6th rib MCL, 8th rib MAL, T10 Posterior |
| Major(Oblique) Fissure | T3 spinous process (obliquely)-->6th rib @MCL |
| Minor(Horizontal) Fissure | Close to 4th rib |
| Trachea Bifurcation | Sternal Angle (Ant), T4 (Post) |
| Bronchial | Loud_High_Exp Longer than Insp_Over manubrium |
| Tracheal | Very LOUD_High_Insp & Exp Equal_Over trachea in neck |
| Bronchovesicular | Moderate_Mod_Insp & Exp Equal_Ant: 1st/2nd Interspaces. Post:interscapular |
| Vesicular | Soft_Low_Insp Longer than Exp_Most of both lung fields |
| Pectus Carinatum | Pigeon Chest |
| Pectus Excavatum | Hollowed Chest |
| Kyphosis | Hunchback |
| Kyphoscoliosis | Scoliosis |
| COPD/Emphysema | Accessory muscles in use. Prominent ribs. |
| Tracheal Deviation | Deviation due to lung tumor. |
| Jugular Venous Distension | Cardiac v. Pulmonary Cause |
| Normal Breathing Is? | 14-20 breaths/min |
| Apnea | Absence of breathing |
| Cheyne-Stokes | INC/DEC rates & depths w/apnea |
| Bradypnea | Slower than normal breathing |
| Tachypnea | Faster than normal breathing |
| Kussmaul | Fast & Deep |
| Hyperventilation | Deeper, usually faster breathing |
| Sighing | Periodic, deeper breaths |
| Pleural Friction Rub is what? | Occasionally Palpable |
| Decreased Fremitus | Obstructed bronchus, COPD, effusion, fibrosis, pneumothorax |
| Increased Fremitus | Consolidated pneumonia |
| Bone Crepitus | rib movement from fracture |
| SubQ Crepitus | subcutaneous emphysema |
| Crackles | Discontinuous_Fine, Medium, Coarse |
| Rhonchi | Low Pitch_Continuous_Sonorous "wheeze," snoring quality |
| Wheeze | High Pitch_Continuous_Sibilant wheeze, high-pitched whistle |
| Mediastinal Crunch (Hamman) | LOUD pitch_Crackles, clicks, gurgles_Mediastinal emphysema. Synchronize with heartbeat. |
| Stridor (Type of Wheeze) | High Pitch_Largely Inspiratory_Usually louder in neck. Indicates laryngeal/upper airway obstruction. |
| Bronchophony | 99 heard louder & clearer even @distance from larynx (norm=muffled)_Presence of fluid or soft tissue in alveoli_Pneumonia, atelectasias, tumor |
| Egophony | "E" sounds like "A"_Any lung tissue consolidation_Pneumonia, atelectasias, tumor |
| Whispered pectoriloquy _Most noticeable when compare norm to abnorm | Whisper is heard MORE loudly through consolidated tissue |
| Vocal Resonance Decrease | Emphysema _Increased lung, reduced air flow |
| Airless Lung | Pneumonia_Breath sounds bronchial or bronchovesicular over involved area_Spoke words louder (bronchophony),E-->A(Egophony), AND whispered pectoriloquy_Increased tactile fremitus |
| Atelectasias | Partial lung collapse, DEC lung Vol |
| Acute Bronchitis | May hear crackles, rhonchi, wheezes. NORM tactile fremitus/resonance. Exam could be normal |
| Pleurisy/Pleuritis | May hear friction or rub |
| Pneumonia | RUL infiltrate/consolidation_Dyspnea, crackles, reduced breath sounds_Dullness to percussion |
| Pleural Effusion | Dullness to percussion_In pleura vs infiltrate in LUNG.Reduced breath sounds @base_Decreased fremitus |
| Empyema | Pus in pleural space_Dull to percussion, reduced breath sounds, dec fremitis |
| Hemothorax | Blood in pleural space_Dull to percussion, reduced breath sounds, dec fremitis |
| Asthma | Inspiration short, expiratory LONG_Wheezes high-pitched (heard in insp/exp)_Looks like pt wrking hard to breathe_Chest Xray typically normal |
| Emphysema/COPD | Flat diaphragms_INC AP diam_DEC breath sounds_Hyper-resonant to percussion_purse-lip breathing_Use accessory mm |
| Macule | <1cm |
| Patch | >1cm |
| Vesicle | <1cm |
| Bulla | >1cm |
| Pustule | Filled w/pus |
| Nodule | >.5 cm; Deeper & firmer than a papule |
| Papule | <1cm |
| Plaque | >1cm |
| Tumor | >2cm |
| Wheal | Irreg, transient superficial edema |
| Erosion | loss of superfic epiderm, heals w/o scarring |
| Ulcer | deeper loss of epiderm, heals w/scarring |
| Fissure | linear crack, or break from epiderm-->dermis |
| Crust | Dried residue of serum, pus, blood |
| Scale | Thin flake of exfoliated epidermis |
| Atrophy | Thinning of skin w/loss of normal markings. Skin looks shinier, more translucent |
| Excoriation | Abrasion,scratch. Linear OR rounded. |
| Lichenification | Thickening & roughening of the skin, increase visibility of skin markings |
| Petichiae | <.5cm Non-Blanch Blood outside vessel |
| Purpura | >.5cm Larger petichiae |
| Ecchymosis | Purple lesions of variable size (bruise) |
| Spider Angiomas | <2cm Blanch Fiery red lesions |
| Cherry Angiomas | 1-3mm Non-Blanch Bright red papules |
| Telangectasias | Blanch Fine, irreg lines 2' to dilation of capillaries |
| Hemangioma | Red, irregular lesion secondary to dilation of dermal |
| Papulosquamous | Papules, plaques & scales_Psoriasis, Lichen Planus(Pruritic, Polygonal, Purple, Planar, Papules) |
| Nodular | Benign/Malignant dermal/epidermal nodules_Nevi, Cherry Angiomas, Epidermoid Cysts, Squamous & Basal Cell Carcinoma |
| Vesiculobullous | Vesicles & Bullae_Impetigo, Herpes, Pemphigus(poss. fatal) |
| Maculopapular | Macules & Papules_Viral Exanthems, Drug Eruptions |
| Clubbing: Rounded,bulbous. Feels spongy | Chronic hypoxia,congenital heart disease, lung Ca |
| Beau's Lines | Transverse depressions 2' to trauma/illness (Lines will grow w/nail) |
| Paronychia: Inflamm of nail folds:swollen,red,tender | Frequent immersion in water |
| Onychocryptosis | Ingrown toenail_Improperly cut nails, tight shoes |
| Terry's Nails | Mostly white w/distal band of red/brwn_Aging, DM, cirrhosis, heart failure |
| Leukonychia | Area of white discoloration_Trauma & manicures |
| Koilonychia(spoon) | Spooning of nails |
| Onycholysis: Painless separation of nail from bed | Trauma, Psoriasis, Contact Dermatitis |
| Onychomycosis | Fungal infection of nail bed/plate/matrix_Footwear, locker rooms etc |
| Nail Pitting | Psoriasis, RA, SLE, Alopecia |
| This heart sound makes a Lub | S1: closure of AV valves during systole |
| This heart sound makes a Dub | S2: closure of aortic & pulmonic valves during diastole |
| This sound occurs by early passive rapid filling of the ventricles as blood rushes from atria. Heard in early diastole. Made by rapid distension of ventricle walls causing a vibration. | S3 |
| Sound made by 2nd phase of ventricle filling as atria contract & eject blood into ventricles. Caused by rush of blood causing vibration of valves, papillary mm, ventricle walls. | S4 |
| Consistency like an eraser or a “hard‐boiled egg. | Testicle |
| located on top of testicle and posterolateral. Like small “bag of worms” or “wad of noodles | Epididymis |
| Palpable murmur due to vibrations from stensosis' that accompany loud murmurs. | Thrills |
| When cardiac impulse feels more vigorous than normal, and can be felt through chest wall. Can be caused by ventricle hypertrophy or hyperdynamic ventricles | Lift(or Heave) |
| Place R hand on chest under pec w/heel of hand on lower sternum & fingertops at apex to feel this, which represents the pulsation of the left ventricle. | Apical Impulse=PMI |
| Palpation of PMI should be done when? | When patient is supine or left lateral decubitis(on left side) |
| You would use the diaphragm to listen to which heart sounds? | High pitched S1 and S2 |
| You would use the bell to listen to which heart sounds? | Low pitched S3 and S4 apply lightly |
| Listening at the 2nd ICS, RSB for what? | Aortic |
| Listening at the 2nd ICS, LSB for what? | Pulmonic |
| Listening at the 3rd ICS, LSB for what? | Second Pulmonic |
| Listening at the 4th and 5th ICS, LSB for what? | Tricuspid |
| Listening at the 5th ICS, MCL for what? | Mitral (Apex) |
| Ideally during axillary node examination you should stand on which side the whole time and use which hand? | Stay on Right side: Use L hand on their R arm Use R hand on their L arm |
| Systolic minus pressure called? | Pulse Pressure |
| JVD is a sign of what? | Fluid Overload |
| How many degrees do you elevate head to measure JVD? | 30 degrees |
| Sternal angle is thought to be how far above R atrium. | 5cm |
| To measure JVD where should you start? | Sternal Angle |
| What is considered elevated R heart pressure? | Over 4 cm(=over 9cm above R atria since you're measuring @sternal angle=5cm) |
| This test requires sustained pressure to RUQ and observing the neck for an INC in JVD followed by DEC as hand is released. Will be exaggerated in R heart failure. | Hepatojugular Reflex |
| The PMI should not be greater than this in diameter | 2.5cm or one intercostal space |
| R Ventricle Hypertrophy will show a parasternal lift where? | Left Lower Sternal Border |
| Where should you begin percussion of the heart? | 5th intercostal space in midaxillary line & percuss MEDIALLY |
| Auscultating the heart while patient is sitting up & leaning forward is helpful to hear what? | Soft Murmurs: _Caused by Regurg of Semilunars |
| Auscultating the heart while patient is in left lateral decubitis is helpful to hear what? | Low pitched filling murmurs: _Caused by gallops or murmurs |
| Where is S1 best heard? | Apex of the heart |
| S1 louder than S2 at apex, normal or not? | Abnormal _Because of dz AV valve or more forceful closing(mitral stenosis, tachycardia, fever, HBP) |
| S2>S1 at base, normal or not? | Abnormal _Because of weak contraction of heart or DEC sound transmission from thick chest wall or emphysematous lungs. |
| Where is S2 best heard? | Base of heart |
| It's normal for S1 and S2 during inspiration. When is it not? | ASD, Pulm Stenosis, R Ventricle Heart Block, R Bundle Branch Block |
| Physiologic splitting during inspiration, heard at 2nd & 3rd left interspace (pulmonic area); normal or not? | Abnormal S2 |
| Wide splitting due to delayed closure of pulm.valve; normal or not? | Abnormal S2 (pulm stenosis; RBBB) |
| “Fixed splitting”--does not vary with respiration. What type of abnormal sound (atrial septal defect, RV failure) | Abnormal S2 |
| A2 follows P2 in this split; normal or not? | Abnormal S2 (Pardoxical splitting present during expiration & gone during inspiration). _Delayed contraction of L ventricle bc of LBBB |
| Where is S3 best heard? | With a bell at the Apex |
| S1+S2+S3 is described as what? | A ventricular gallop rhythm |
| When is S3 gallop normal? | Children, healthy young adults, pregnant women. |
| When is S3 gallop abnormal? | Over 40, usually pathologic. HF, Anemia, Vol Overload of Ventricle, DEC myocardial contraction |
| Where is S4 best heard? | With bell at Apex |
| When is S4 gallop normal? | Trained athletes |
| When is S4 gallop abnormal? | HBP, CAD, AS, Cardiomyopathy R sided S4 from pulm HBP or pulm stenosis |
| BP>100bpm | Tachycardia: sinus, supraventricular, ventricular or flutter. |
| BP<60bpm | Bradycardia: sinus, 2 degree AV block or complete heart block |
| Arrhythmia that's rhythmically or sporadically irregular can be caused by | Premature contraction (atria, node, ventricle) |
| Arrhythmia that's irregularly irregular can be caused by | Atrial Fibrillation Atrial Flutter w/varying block |
| High pitched indicating valve disease or dilated aorta or pulm artery, pulm HTN | Aortic or Pulmonic Ejection Click -hear w/diaphragm |
| Mid-late click w/variable pitch caused by ballooning of mitral leaflets into L atrium during systole. Mitral regurg can also happen. | Systolic click from mitral valve prolapse |
| Crescendo-Decrescendo murmur bc of blood flow across semilunar valves. | Systolic Ejection Murmur |
| Plateau murmur bc of regurg across AV valves or VSD | Pansystolic (Holosystolic) Murmur |
| Mitral prolapse can cause this systolic murmur | Late Systolic Murmur |
| Innocent "flow murmur" from HI P-->HI P caused by Aortic/Pulm stenosis. Can be heard at R & LSB | Systolic Ejection Murmur |
| A systolic ejection murmur caused by Left Ventricle is because: | From LV-->aortic valve-->aorta murmur gets louder and increases as more blood enters, increasing pressure. This creates resistance to further inflow from LV & murmur will soften bc of DEC Q |
| A systolic ejection murmur caused by Right Ventricle is because: | From Right ventricle to pulmonic valve to pulmonary a. P is not as great as in L-sided system bust same principles. |
| These murmurs result from turbulent blood flow without valve narrowing or obstruction. Grade 1-2, medium pitch. May DEC be gone w/sitting. | Innocent Systolic Murmur -children, young adults, pregnancy |
| This murmur is caused by going from high pressure to low pressure through mitral/tricuspid regurg | Plateau: Pansystolic(Holosystolic Murmur) |
| If you have a leaky bicuspid valve, ventricle pressure will stay above atrial thruout systole & blood flow will not slow. Intensity stays same because of such an increased ventricular pressure. | High to low pressure causing pansystolic murmur _Bicuspid Regurg _VSD(by Rheumatic Heart dz) |
| Will hear a harsh systolic murmur at LLSB, a thrill because of this | VSD (L to R shunt) |
| This diastolic murmur is usually decrescendo | Early Diastolic _Regurg flow across leaking semilunar valve (aortic or pulm) |
| A mid diastolic murmur is caused by? | Turbulent flow across AV valves _Bicuspid Stenosis |
| A late diastolic (presystolic) murmur usually will continue decreasing till? | S1 |
| Aortic Stenosis/Insufficiency causes outflow obstruction w/leakage of blood back into L ventricle causing this murmur | Systolic-Diastolic Murmur "crescendo-decrescendo" |
| An opening snap w/diastolic murmur can be caused by this? | Mitral stenosis |
| Standing or strain phase of valsalva does what to a murmur | Dec L Ventricle Vol-->DEC Venous Return to heart-->DEC Vascular Tone, DEC BP, DEC PVR |
| Squatting or release phase of valsalva does what to a murmur | Inc L Ventricle Vol-->INC Venous Return to heart-->INC Vascular Tone, INC BP, INC PVR |
| A "to and fro" murmur can be caused by what? | Severe aortic regurg, aortic stenosis/regurg |
| Controls automated movement | Basal Ganglia |
| Controls primary sensory relay | Thalamus |
| Impt for coordination of voluntary movements, balance, equilibrium | Cerebellum |
| Relay for ascending/descending tracts, cranial n nuclei, cardio-respiratory center | Brainstem |
| Injury to spinal cord ABOVE this level=not compatible to life | Above C5 |
| Spinal cord diseases called? | Myelopathies |
| Transmits motor info | Corticospinal, Extrapyramidal, Cerebellar |
| Transmits sensory info | Spinothalmic, Posterior Columns |
| Controls voluntary motor movement, UMN in precentral gyrus and cross contralat to medulla. Descend ipsilateral to synapse at Anterior Horn | Corticospinal |
| Tract that carries light touch, pain, temp, pressure. | Spinothalmic |
| Carries vibration, proprioception, & discriminative rouch | Posterior Columns |
| Increased tone w/"Stiff man" gait, INC reflexes & proprioceptive changes (posterior column), +Romberg & crossed findings(sensory & motor). Changes sensory levels. | Myelopathy (spinal cord damage) |
| Disease of the muscle with proximal distribution | Myopathy |
| Disease that affects NMJ characterized by? | Proximal Weakness & fatigability that's improved w/rest |
| Disease that involves peripheral nerves | Peripheral Neuropathy |
| Light touch, pin prick, vibration, proprioception & m strength all tested for this dx? | Peripheral Neuropathy |
| Upper extremity Peripheral nerves? | median, ulnar, radial, musculocutaneous, axillary |
| Lower extremity nerves | femoral, obturator, sciatic, tibial, peroneal |
| Musculocutaneous n (C5/6) supples m to biceps, coracobrachialis & brachialis. Sensory to lat forearm. Damage? | Weak flexion of supinated arm & loss of sensation on lateral forearm |
| Median n (C5-T1) m to flexors & sensory to lateral hand side of ring. Damage? | Weak finger flex, thumb ABduct, loss of sensation over radial aspect of hand. |
| Ulnar n (C8-T1) m to wrist flexors, abduction of thumb, interossei. Sensory to dorsal/palmar medial pinky side. Damage? | Weak wrist flexion Ulnar deviates "Claw Hand" Loss of ulnar distrib of hand |
| Radial n (C5-C8) m to triceps, anconeus, brachioradialis, wrist/thumb extensors, supinators & thumb ABduct. Sensory to posterior upper arm, forearm & hand. Damage? | Weak extension & flexion of elbow Weak forearm supination Weak wrist & finger extension Weak thumb ABduct Loss of posterior forearm & dorsum of hand |
| Axillary n (C5,6) m to deltoid, teres minor. Damage? | Deltoid atrophy, shoulder weakness |
| Femoral n. (L2-L4) m to flex/extend of hips and knee extend. Sensation to Ant thigh & medial & LE & foot. Damage? | Weak knee extension Weak hip flexion Quads atrophy Loss of sensation to anterior thigh |
| Obturator n. (L2-L4) m to adductors & rotational mm. Sensory to internal thigh. Damage? | Weak thigh ADDuct Weak external hip rotation Lose inner thigh sensation |
| This n (L4-S3) m to biceps femoris, semi-tendinosis & semimembranosis mm & regulates flexion of lower leg. Branches into tibial & common peroneal nn. | Sciatic n |
| Tibial n (L4-S2) m to gastroc/soleus/foot FLEXors. Sens to lateral calf/foot/heel/small toe (sural n), medial heel, sole of foot. Damage? | Weak plantarflexion, weak foot inversion, weak toe flexion, loss of sensation of lateral calf & plantar aspect of foot. |
| Peroneal nn (L4-S1) tibialis ant, extensors of foot, plantarflexion & eversion of foot. Sens to lateral leg below knee & dorsum of foot. Damage? | Weak foot dorsiflexion Weak toe extension Loss of sensation on Lat lower leg/dorsal foot. |
| Brachial Plexus | C5-C8 |
| Lumbosacral Plexus | L3-S1 |
| Loss of reflexes, wide distributed weakness & multifactorial numbness with or without pain | Plexopathy (damage to lumbar or brachial plexus) usually caused by infiltrates or compression |
| Radiculopathies | Disease of the roots usually caused by compression or other mechan injuries |
| C5-C8 innervate what? | UE |
| L3-S1 innervate what? | LE |
| Reflex for C5,6 | Biceps |
| Reflex for C7,8 | Triceps |
| Reflex for L3,4 | Patellar |
| Reflex for S1,S2 | Achilles |
| Note what when examining mental status? | Behavior, Orientation, Level of Consciousness |
| JOMAC stands for? | Judgement, Orientation, Memory, Affect, Cognition |
| Pupillary response tests for which n? | CN3 |
| Afferent limb of corneal reflex is? | CN5 |
| Efferent limb of corneal reflex is? | CN7 |
| How can you test for roots C5-8? | Shoulder ADDuction |
| How can you test for roots C5-6? | Shoulder ABduction Forearm flexion |
| How can you test for roots C6-8? | Forearm Extension Forearm Extension |
| How can you test for roots C7-T1? | Wrist Flexion Thumb ABDuction |
| How can you test for roots C8 & T1? | Thumb ADDuction Thumb Opposition |
| How can you test for roots L1-3? | Hip Flexion |
| How can you test for roots L4-S2? | Knee Flexion |
| How can you test for roots L2-4? | Knee Extension |
| How can you test for roots L4-5? | Foot/Toe Dorsiflex |
| How can you test for roots L5-S2? | Foot/Toe Plantarflex |
| Pt stands with arm extended, hands PALMS UP (supinated) for 20-30s w/closed eyes to see if pronation occurs. | Pronator Drift _Good to detect contralat UMN lesion secondary to CVA |
| Rhyhthmic, repetitive bizarre movements of face, mouth, jaw & tongue due to psych meds. | Oral-Facial Dyskinesias |
| This tremor occurs when actively keeping posture. Seen w/benign familial tremor & hypothyroidism | Postural Tremor |
| This tremor is ABSENT at rest and appears when reaching for target. Seen w/aging, cerebellar dz & MS. Can be familial. | Intention Tremor |
| Rapid, jerky movements seen w/Huntingtons | Chorea |
| Writhing, twisting movements of face, trunk & extrem. SLOWER than chorea. | Athetosis |
| Sudden & rapid jerks faster than chorea. May be seen w/infections, strokes & anoxia | Myoclonus |
| Romberg should be tested when? | Before gait testing to avoid a fall. Tests position sense(Dorsal Column) |
| Seen w/basal ganglia disease & cog wheel in Parkinsons | Rigidity (INC tone & resistance to movement, independent of rate of movement) |
| Can assess this by moving thumb up & down asking direction. Repeat w/great toe holding the sides of the digits. | Proprioception |
| Normal cortical sensation for 2point, fingertips | 2mm |
| Normal cortical sensation for 2point, toes | 3-8mm |
| Normal cortical sensation for 2point, palms | 8-12mm |
| Normal cortical sensation for 2point, back | 40-60mm |
| aka "Extinction" simultaneously touch 2 separate sides on opposite sides of the body asking what's felt. | Tactile localization |
| Reflex Dance | 1,2 Achilles-S 3,4 Patellar-L 5,6 Biceps-C 7,8 Triceps-C |
| For reflexes normal is? | +2 |
| Hyperactive reflexes | +4 (clonus) |
| Diminished relfex | +1 |
| Biceps Reflex (C5,6) tap where? | Biceps tendon-->Forearm flexion |
| Brachioradialis Reflex (C5,6) tap where? | tendon/radius 1-2in above wrist-->forearm flexion & supination |
| Triceps Reflex (C7,8) tap where? | Triceps tendon |
| Patellar Reflex (L3,4) tap where? | Patellar tendon |
| Achilles Reflex (S1,2) tap where? | Achilles tendon-->plantarflexion |
| Reinforcement techniques for getting reflexes. UE? | Grit teeth |
| Reinforcement techniques for getting reflexes. LE? | Isometric Exercises "Jendrassik's Maneuver" |
| Abnormal Babinski | Dorsiflexion of great toe & fanning of other toes |
| Finger to nose tests for? | Dysmetria seen in cerebellar disease |
| Heel to shin tests for what? | Pt must do slow and smooth. Tests cerebellar function |
| Rapid Alternating Movement looks for what? | Cerebellar Function |
| Dysdiadochokinesia? | Unable to do rapid alternating movement. Slow, but irregular=Cerebral Dysfunction Fast, but irregular=Cerebellar Dysfunction |
| Heel walk tests for which root? | L5 |
| Heel-to-toe should be avoided when? | Positive Romberg |
| Toe walk tests for which root? | S1 |
| Kernig's Sign | Patient lying down, flex hip & knee then attempt to straighten leg. If have lower back pain= +. Meningitis |
| Brudzinski's Sign | Pt supine life neck. Involuntary flexion of hips/knees is + for meningitis |
| Straight Leg Raise Tests for? | Sciatic n Impinge |
| Flip sign (Seated SLR Test) tests for? | Sciatic n Impinge |
| Antalgic Gait | Pain during stance. Remains on painful leg only shortly. Trendelenburg Lurch |
| Trelendenburg Test | Raise one knee, if hip drops. Weak hip abductors on side of straight leg. |
| Genus Varus | Open angle of Lateral side "Bow Legs" |
| Genu Valgus | Open angle Medial side "Knock Knees" |
| Synovial fluid in popliteal space best palpated while knee extended. | Baker's Cyst |
| Most common aneurysm of peripheral vascular system | Popliteal a. Aneurysm (due to atherosclerotic vascular dz). Usually bilateral. Extend knee to palpate. |
| Leg straight, milk knee joint fluid one side up & other down to observe for bulge | Bulge Sign |
| Leg slightly flexed, stabilize knee and ABduct | Valgus stress test (medial side) |
| Leg slightly flexed, stabilize knee and ADDuct | Varus stress test (lateral side) |
| This test flexes knee, rotate foot laterally and extend to test for medial meniscal tear. | McMurray's test |
| This test flexes knee, rotate foot medially and extend to test for lateral meniscal tear. | McMurray's Test |
| Ballottement of Patella tests for? | Knee Effusion |
| Stabilizing distal tibia, grasping calcaneous & pulling forward? | Anterior Drawer test of Ankle |
| Capillary refill >2s sign of? | Peripheral a. insufficiency |
| Dilated, tortuous superficial veins that result from defective structure and function of the valves of the saphenous system | Varicosities _Dull ache/P sense after long standing better w/elevation _Dependent ankle edema may devo _Ankle ulcerations may devo _Superficial thrombosis/thrombophlebitis |
| Due to chronic venous insufficiency with incompetent valves and higher pressure in capillary bed. Tissue is damaged and inflamed. • “Brawny” non‐pitting edema | Stasis Dermatitis |
| Tests for DVT. Passive dorsiflexion of foot causes calf pain if tender swollen | Homan's sign |
| Where can posterior tibial pulse be felt? | Behind & slightly below MEDIAL malleolus |
| Patrick's test tests for what? | External rotation |
| For ankle ROM what should be going on with knees? | Kept together |
| Palpation of the spine can be done when? | During flexion of the spine, palpating along the spinous processes |
| Order of abdominal exam | Inspect, Auscultate, Percuss, Palpate |
| Before palpation in the abdomen what should you do? | Auscultate abdominal sounds, aorta for bruits, femoral aa. Then Percuss. Then palpate. |
| To palpate the liver edge you place fingers where and have pt do what? | In RUQ pointing twds shoulder. Have pt take deep breath and liver should move down. Always stand on right side. |
| To palpate the spleen you place fingers where and have pt do what? | In LUQ pointing twds left lateral chest. Have pt take deep breath and liver should move down. Always stand on right side. |
| By placing right hand on anterior abdomen and palpating deeply to both sides of aorta feeling for what? | Kidneys Should reach around back with left hand and lift forward to press them anteriorly. |
| Palpating just left of the midline (btwn xiphoid & umbilicus) allows you to palpate for what? | Aorta _Should not be >3cm or Aneurysm |
| Paralytic Ileus is a sign of. What hear on abdominal exam? | Little to no bowel activity=Hypoactive Bowel Sounds |
| Peritonitis would sound what | Initially hyperactive but eventually hypoactive possibly even becoming and Ileus |
| CHF, Cirrhosis, Hepatitis, Abscess, Tumor and Cysts can all cause what? | Enlarged Liver |
| Free peritoneal fluid | Ascites _Go to dependent part of abdominal cavity |
| Gas-filled loops of bowel will float to the top & percussion will be tympanic until fluid level is reached when have these. | Ascites |
| With pt supine, percuss border then repeat when pt's on side. An obvious shift in location of border shows free peritoneal fluid. Test? | Shifting Dullness |
| Ask pt to apply P down middle abdomen to stop impulse transmission will ck for what? | Ascites |
| Paracentesis | Tap for free fluid in peritoneum |
| Mono & other infections along w/lymphoma, leukemia, myelofibrosis & hemolysis, also cirrhosis w/portal HTN, cysts, and hypersplenism can all cause this? | Splenomegaly |
| Upper adbominal reflex tests | T7-9 |
| Lower adbominal reflex tests | T11,12 |
| Cremastericreflex tests | T12-L2 |
| Very common site for pain from diverticulitis (large bowel) | LLQ |
| Coronary occlusion, biliary colic, ruptured viscus or aneurysm, and renal colic(ureteral calculus) can all cause what? | Explosive, Excruciating Pain |
| Acute pancreatitis, bowel strangulation, mesenteric thrombosis can all cause? | Severe, constant pain |
| Acute cholecystitis, Acute appendicitis, Diverticulitis, & PID can all cause? | Gradual-onset Steady Pain |
| Early subacute pancreatitis & mechanical small bowel obstruction can all cause? | Intermittent, colicky pain |
| Increased rigidity & tenderness of abdominal wall when touched(guarding) along w/abdominal wall rigidity & rebound/contralat rebound tenderness signs of? | Peritoneal Signs |
| Rebound, Psoas sign, Obturator sign, Rovsings sign & rectal exam can all test for? | Acute Appendicitis |
| Over site of most tenderness press in then suddenly release to test for peritoneal irritation. Called? | Rebound tenderness |
| Place hand above pt’s R knee & have pt raise thigh against resistance or W/pt on L side,gently hyperextend his thigh @hip •Maneuver#1 tenses the iliopsoas m; #2 stretches the iliopsoas m. Both cause pain if there is irritation by an inflamed appendi | Psoas Sign |
| Pt supine, R knee bent. Internally rotate R leg at hip stretching the internal obturator m. Used to see inflamed appendix. | Obturator sign |
| Tests for referred rebound tenderness by pressing hard in LLQ referring to RLQ. Shows appendicitis | Rovsing's |
| Rectal exam of RLQ/LLQ. Pain in RLQ suggests appendiceal inflamm | Rectal Exam |
| Place fingers of R hand under R costal margin & ask pt to take deep breath or lay L hand against liver & use fist to percuss for this test which shows what? | Murphy's Sign _GB or liver inflammation |
| Hook L thumb or fingers of R hand under R costal margin & ask pt to take breath. Sudden pain & abrupt stopping of inspiration suggests this? | Cholecystitis or Liver Inflamm |
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