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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, narrowerred arcades
Glaucoma w/cupping INC pressureINC cupping & atrophy. Base of enlarged cup=pale
Papilledema venous stasis leads to edema.
Optic Atrophy death of optic nerve fibersloss 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 infectioneardrum 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
Created by: glittershined