PhysDxFinal
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| On male pelvic exam, this should feel like the inside of a BIC pen. | Spermatic cords
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| You are palpating from the epididymus to the inguinal ring. What are you feeling for? | Bilateral spermatic cords.
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| During this male pelvic exam you should move slowly and invaginate some scrotal skin as you enter the inguinal ring. Test? | Hernia Exam
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| What method should you use when performing a hernia exam? | "Cross-Handed" Method: Use R hand for Pt's R hand.
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| If performing a hernia check on a child/small adult, what should you use instead of your index finger? | Pinky
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| In order to feel pressure during hernia exam you would ask your patient to turn head and cough or do what? | Valsalva
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| When examining perianal area you should spread buttocks with what to visual anal opening looking for hemorrhoids, fissures, skin tags & lesions. | Spread with thumbs.
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| When performing the rectal and prostate exam you should slowly insert finger how far? | Full length
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| 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.
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| When you check stool for blood called? | Hemoccult/guaiac test
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| This STD caused by a virus begins with painful vesicles that may become ulcerated. | Herpes Simplex Virus-->Genital Herpes
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| This STD caused by HPV usually grows in grouped multiples and spread to perineum & anal area. | Condyloma Acuminata (Genital Warts)
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| This benign viral condition is self-limited and causes umbilicated vesicular lesions. | Molluscum Contagiosum
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| 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
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| What is the most common cause of non-gonococcal urethritis? | Chlamydia
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| 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
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| This begins as a firm nodule or ulcer that doesn't heal. Usually nontender. Occurs more in uncircumsized males. | Penis Carcinoma
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| Most common hernia. Above inguinal ligament, near internal inguinal ring. Often extends into scrotum. Palpable as impulse down inguinal canal. | Indirect Inguinal Hernia
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| Less common hernia, typically in men over 40. Above inguinal ligament. Rarely enters scrotum. Bulges anteriorly. | Direct Inguinal Hernia
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| 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
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| 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
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| This infection of the epididymis produces local pain & swelling. Often associated w/UTI or prostate infection. Usually in adults. | Acute Epididymitis
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| Benign non-tender fluid filled mass within the tunica vaginalis. Transilluminates. | Hyrocele
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| Inflammation/Infection of the testis. Testicular swelling & tenderness. Similar looking to epididymitis. Complication of mumps & other viral infections. | Acute Orchitis
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| Patient has mumps and presents with inflamed testicle with edema and tenderness. Dx? | Acute Orchitis
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| Painless, mobile mass just above testis that's smaller than hydrocele. Contains sperm & can transilluminate. | Spermatocele
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| 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
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| Pt presents w/firm, painless testicular nodule. Does NOT transilluminate. | Testicular Tumor
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| 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
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| Anal issures are dx by what? | History & Anoscopy
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| Swelling and erythema of the butt can be caused by? | Perirectal Abscess
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| Homosexual man has an STD from HPV around anus. Condition? | Perinal Condylomata
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| During digital rectal exam you may be able to feel this condition. | Rectal Carcinoma
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| Pt has enlarged, tender prostate gland which is very tender and presents with fever and chills. | Prostatitis (more likely acute since more tender)
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| How do you treat Prostatitis? | Abx
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| As patient ages see symmetrical enlargement of prostate gland which slows urine stream & causes hesitancy. | Benign Prostatic Hypertrophy
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| 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
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| Where do prostate carcinoma usually metastasize? | Locally & to bone
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| Where do breasts primarily drain? | Axillae
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| Where do breasts secondarily drain? | Internal mammary
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| Where can breasts drain besides axillae & internal mammary | Supraclavicular & Jugular Nodes
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| How many quadrants in the breast? | 5: Upper Outer, Upper Inner, Tail of Spence, Lower Outer, Lower Inner
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| Should you advise your patients on how to perform breast self-exam? | No. Not recommended to teach how to perform own breast exam.
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| Inspection of breast should be done with four motions. Which are? | Arms overhead (palms together), hands on hips & press down, shrug shoulders, lean forward
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| Recent onset of unilateral nipple inversion could be a sign of what? | Underlying malignancy
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| Where are most breast cancers located? | Upper outer quadrant
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| How would you position a patient for a breast exam? | Patient is supine with hand under head.
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| How many levels of pressure should you use to palpate the system. | Superficial, Medium then Deep to chest wall.
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| 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.
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| 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.
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| Nipple that discharges light & milky is normal or abnormal? | Normal
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| Nipple that discharges serous or bloody is normal or abnormal? | Abnormal
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| This axillary node sweep is anterior to axillary region, including pectoralis m. | 1st Sweep
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| This axillary node sweep is mid-axillar high into apex. | 2nd Sweep
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| This axillary node sweep is posterior to axillary region, beneath teres minor | 3rd Sweep
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| This axillary node sweep is down medial aspect upper arm | 4th Sweep
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| In order to palpate axillary nodes should use what type of motion? | Rotatory/Windshield Wiper Motion
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| Gravity represents what? | Number of times pregnant
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| Parity represents what? | Outcome of each pregnancy: term, preterm, living
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| Need to ask about any what during female exams? | Abortion (spontaneous or induced)
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| Would like to perform a pelvic exam. Should you have a chaperone present? | Yes to protect provider & patient.
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| The verbal outline for the pelvic exam includes what? | Inspection of vaginal exam, Speculum Exam, Bimanual Exam
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| What should the exam table be elevated to for a pelvic exam? | 30 degrees
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| Do not call stirrups, call what? | Heel or Foot rests
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| 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)
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| During internal exam of the pelvis you insert index/middle fingers of non-dominant hand into vagina up to where? | 2nd Knuckle
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| Why would you ask a patient to bear down during a pelvic exam in the female? | Check for cystocele or rectocele
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| Within the vagina you should apply anterior or posterior pressure? | Posterior
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| When performing a PAP smear insert the spatula into cervical os and rotate 360. Rinse by swirling how many times? | 10
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| PAP Smear tests concurrently for what? | HPV, GC, Chlamydia
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| To palpate this structure you palpate the circumference, gently rock it from side-to-side and palpate for firmness. | Cervix
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| When you Place internal fingers on posterior side of cervix and outer hand hand on lower abdomen feeling for what? | Uterine Fundus
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| You expect to feel a pear-shaped, round firm & smooth with this. Described as similar in shape & consistency as a fist. | Uterine Fundus
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| You move internal and external fingers lateral to uterus & use 3 sweeps moving from distal twd pubic fair line attempting to palpate this. | Ovaries
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| You feel something smooth & ovoid, mildly tender to palpation & similar to an almond during a pelvic exam. What is it? | Ovaries
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| What's the most common uterine position? | Anteverted Uterus
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| What type of uterus can be felt during the rectovaginal exam? | Retroverted Uterus
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| Internal emotional tone of the patient | Mood: Dysphoric, Euphoric, Angry, Anxious
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| 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
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| 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
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| 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)
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| Often need painful stimuli (voice & shaking don't work) to wake pt. Lapse into unresponsiveness when stimuli stops. Minimal awareness of self/environment. | Stupor
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| No response to verbal or painful stimuli. Cannot arouse for anything. | Coma
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| Problem w/motor speech or articulatoin. Seen w/bulbar or psedobulbar palsy. | Dysarthria
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| Weak breathy voice bc vocal cords not well approximated. Seen w/presbyphonia, vocal cord nodules, polyps paralysis, or tumors. | Dysphonia
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| Comprehension intact but unable to speak to varying degrees. Aware of Loss. | Broca (Expressive) Aphasia
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| Comprehension NOT intact but able to speak fluently. Sentences just don't make sense. Unaware of Loss. | Wernicke's (Receptive) Aphasia
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| Combination of Broca(Expressive) & Wernicke(Receptive) Aphasia | Global Aphasia
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| These speech disorders are common with MCA strokes, trauma & mass lesions | Aphasia
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| 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
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| Unable to recognize sensory stimuli associated with parieto-occipital-posterior temporal lesion (CVA or demension) | Agnosia
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| Pt has MCA stroke. Sx? | Aphasia
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| Pt has lesion to parietal lobe. Sx? | Apraxia (no learned motor movement)
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| Pt has lesion to parieto-occipital-posterior temporal area. Caused by CVA or dementia. | Agnosia (no sensory stimuli)
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| Level of awareness | Relax-->Lethargy-->Somnolen-->Obtunded-->Stuporous-->Comatose-->Death
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| Acute within last hr/wk. Abnromally alert & impaired time orient. Immediate & Recent memory impaired. Incoherent speech w/speed change. Sees illusions/hallucinations. | Delirium
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| Gradual onset over mos/yrs w/normal alertness. Impaired orientation. Remote & recent memory impaired. Difficulty "finding the word". Absent perception. | Dementia
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| 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
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| Psychomotor disturbances seen in schizophrenia characterized by periods of either muscular rigidity, excitement or stupor | Catatonia
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| Impaired bilateral thalamus, bilateral hemispheric injury (RAS) & injury to midbrain or below places for what? | Coma
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| HA, OD, Stroke, Cerebral edema, metabolic conditions, traumatic brain injury, untreated status epilepticus | Coma
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| Glasgow: pt's eyes responds to speech | Stage 3
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| Glasgow: pt's eyes responds to pain | Stage 2
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| Glasgow: pt's eyes responds to nothing | Stage 1
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| Glasgow: pt responds to pain & withdraws | Stage 4
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| Glasgow: pt responds w/abnormal flexor response | Stage 3
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| Glasgow: pt responds w/extensor response | Stage 2
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| Glasgow: pt responds w/confused convo | Stage 4
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| Glasgow: pt responds w/incomprehensible sounds | Stage 2
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| Glasgow: pt responds w/wrong words | Stage 3
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| Glasgow Total Score | 3-15 from E, M & V
15=Awake
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| Head injury, low Glasgow of 8 longer than 72 hrs. | Poor Prognosis
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| 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)
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| Decorticate Position | Flexion/Arm Adduction/Legs Extended caused by lesion in corticospinal tract from cortex to upper midbrain
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| Decerebrate Position | Extension/Adduction/Internal Rot of Arms
Extension of Legs
Lesion in corticospinal tract at level of pons or upper medulla
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| Lesion of corticospinal @pons or upper medulla leads to? | Decrebrate Posturing
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| Lesion of corticopsinal @cortex to upper midbrain leads to? | Decorticate Posturing
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| Associated with trauma, tumors, large strokes brain may do this through falx, tentorium or foramen magnum. | Herniate
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| Seen with uncal herniation may progress bilaterally. Can also see w/aneurysm compressing this nerve | CN3
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| Paralytic Strabismus is when left eye cannot look down when turned inward. CN damage? | CN4
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| If eyes are midposition (2-5mm) & fixed suspect what? | Midbrain Lesion
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| If eyes are pinpoint & reactive suspect what? | Pontine Lesion
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| If eyes are unilateral dilated & fixed suspect what? | CN3 lesion/uncal herniation
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| If eyes are bilateral dilated & fixed suspect what? | Central herniation, Hypoxia
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| 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)
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| If Doll's Eye reflex horizontally absent or assymetric. Lesion where? | Brainstem
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| If Doll's Eye reflex vertically absent or assymetric. Lesion where? | Midbrain
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| The normal response is tonic (slow) twd stimulus; fast nystagmus away during this test. COWS | Vetibulocochlear Reflex
Cold Opposite, Warm Same
Impaired: Brainstem lesion
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| Bihemispheric lesions or metabolic encephalopathy | Cheyne-Stokes breathing pattern
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| Metabolic Acidosis or Herniation | Hyperventilation (Kussmaul's) breathing pattern
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| Pontine Damage | Apneustic breathing pattern
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| Early Medullary Damage | Cluster breathing pattern
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| Medullary Damage | Ataxic (Biot's) breathing pattern
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| Loss of sense of smell, hard to concentrate can be caused by this? | Olfactory Groove Meningioma(damage to CN1)
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| This will present with visual field defect & HA and pituitary hypersecretion signs like acromegaly, infertility, galactorrhea, amenorrhea, Cushing's Disease | Pituitary Adenoma
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| Inc growth hormone would lead from pituitary adenoma would lead to? | Acromegaly
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| Inc prolactin would lead from pituitary adenoma would lead to? | Infertility, Galactorrhea, Amenorrhea
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| Inc ACTH would lead from pituitary adenoma would lead to? | Cushing's Disease
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| Contralateral paralysis of lower face, saving forehead. Lesion where? | Central CN7 lesion
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| Ipsilateral paralysis of entire face. Lesion where? | Peripheral CN7 lesion
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| LMN lesion leading to ipsilateral facial palsy involving entire face. | Bell's Palsy
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| UMN lesion leading to contralateral weakness of lower face (sparing forehead). Seen with stroke or mass lesion. | Central CN7 lesion
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| Benign growth on CN8 associated with SNHL & peripheral CN7 lesion (ipsilateral). May see cerebellar ataxia with large lesions. | Acoustic Neuroma
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| Palate deviates AWAY from lesion. Loss of gag reflex. | CN9 Lesion
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| Tongue deviates TOWARD side of lesion. "Lick the lesion" | CN11 Lesion
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| Pt acutely weak/numb w/abrupt impairment of consciousness & worst headaches of life. Unable to produce language (aphasia) and slurs speech (dysarthria). | CVA (Stroke)
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| What assesses for subtle weakness? | Pronator Drift
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| Weakness in districution, spastic, hyperactive DTR, Clonus & Babinski all signs of? | UMN
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| Weakness in segmental distribution, m atrophy, flaccid, fasciculation, dec or gone DTRs signs of? | LMN
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| Cervical Radiculopathy may cause nerve root compression because of? | HNP or bone spur
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| Lateral upper arm & shoulder numb, cannot move deltoid or biceps for shoulder abduction. Loss of biceps/brachioradialis DTR. Lesion | C5 Cervical Root
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| 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
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| 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
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| Medial forearm & ring & small finger numb, cannot move thenar eminence & interossei of hands(intrinsic hand muscles). Loss of triceps DTR. Lesion | C8 Cervical Root
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| Sensory loss to anterior thigh, lose iliopsoas motor, knee jerk DTR. | L3 Lumbar Root
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| Sensory loss to anteromedial thigh to medial leg, lose quads motor, knee jerk DTR. | L4 Lumbar Root
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| Sensory loss to lateral thigh & anterior calf, lose foot dorsiflexion, AT/EHL, NO DTR. | L5 Lumbar Root
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| Sensory loss to posterior calf & heel, lose gastrocnemius motor (plantarflexion of fott), achilles DTR. | S1 Lumbar Root
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| Spastic quadriplegia, C4 sensory level, 3+ DTRS throughout and toes upgoing bilaterally sign of what? | C4 Root Damage
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| 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
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| 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.
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| Distal weakness, diminished reflexes, distal sensory loss. | Nerve Disease
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| Increased weakness with effort, normal reflexes, no sensory loss | NM Disease
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| Proximal weakness, normal or late reflexes, no sensory loss | Muscle Disease
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| UMN lesion above medulla leads to? | Contralateral Weakness
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| UMN lesion below medulla leads to? | Ipsilateral Weakness
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| UMN disease can result from? | Stroke, Mass Lesion, MS, Trauma
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| 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)
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| 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.
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| 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
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| Associated w/corticospinal dz UE flexed, LE extended, draws/drags foot. | Spastic Hemiparesis
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| 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
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| Associated w/loss of proprioception in the legs; unsteady, wide gait. Watch ground while walking and have + Romberg. | Sensory Ataxia
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| 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
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| Idiopathic degeneration of dopaminergic neurons in substantia nigra. See bradkinesia, cog wheel, pill roll, masked facies, and sometimes dementia. | Parkinson's
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| Automated movement is controlled here. | Basal Ganglia
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| Primary Sensory Relay controlled here. | Thalamus
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| periorbital cellulitis | bacterial infection around the eye
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| chalazion | points into lid, unlike sty
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| pterygium | conjunctiva frows slowly across cornea from the nasal side.
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| conjunctivitis | conjunctiva infection
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| episcleritis | engorged radially oriented vessels & a nodule adj to limbus
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| subconjunctival hemorrhage | leakage of blood outside vessels producing a homogenous sharply demarcated red area that fades over days to yellow.
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| hyphema | bleeding in anterior chamber
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| corneal burn | burn of cornea
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| corneal abrasion | USE fluorescein staining. Abrasion from something hitting eye.
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| eye puncture | stabbing in eye
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| cataract | opacity of the lens visible thru pupil. most common in old age.
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| Ischemic optic neuropathy | insufficient bloody supply to optic n, acute.
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| HTN Retinopathy | marked arteriolar venous crossing changes are seen especially along inferior vessels. Cotton wool spot (white/yellow patches) unrelated to HTN.
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| DM Retinopathy | Leads to blindness. Hemorrhage & exudates damage.
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| Proliferative DM Retinopathy | neovascularization more num/torturous, narrowerred arcades
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| Glaucoma w/cupping | INC pressureINC cupping & atrophy. Base of enlarged cup=pale
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|
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| 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
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| Over site of most tenderness press in then suddenly release to test for peritoneal irritation. Called? | Rebound tenderness
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| 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
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| Pt supine, R knee bent. Internally rotate R leg at hip stretching the internal obturator m. Used to see inflamed appendix. | Obturator sign
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| Tests for referred rebound tenderness by pressing hard in LLQ referring to RLQ. Shows appendicitis | Rovsing's
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| Rectal exam of RLQ/LLQ. Pain in RLQ suggests appendiceal inflamm | Rectal Exam
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| 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
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| 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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