1 Flashcards
1
Q
Ataxia
A
Lack of voluntary control of muscle movements.
2
Q
Menarche
A
First menstrual cycle.
3
Q
Impetigo
A
serious bacterial skin infection. Often acquired from football or wrestling.
4
Q
Utilitarianism
A
a theory that defines the appropriate use of resources as that which results in the greatest good for the greatest number.
5
Q
Anisocoria
A
unequal pupils
6
Q
Hematospermia
A
blood in the semen
7
Q
Eructation
A
burping
8
Q
Keratitis
A
Inflammation of the cornea of the eye. Moderate to intense pain!
9
Q
Listless > Somnolent > Lethargic > Obtunded > Comatose
A
stages of alertness
10
Q
Angular Cheilosis
A
reddish inflammation of the lip or lips and production of fissures that radiate from the angles of the mouth
11
Q
Anosmia
A
absense of the sense of smell. It may be to due to lesion of the olfactory nerves, obstruction of the nasal fossae, or functional, without any apparent causative lesion.
12
Q
Ceruman
A
the soft, brownish/yellow, waxy secretion (a modified sebum) of the ceruminous glands of the external audiory meatus.
13
Q
Cheilitis
A
inflammation or cracking of the lips
14
Q
Cholesteatoma
A
a mass of keratinizing squamous epithelium and cholesterol in the middle ear, usually caused by chronic otitis media, with squamous metaplasia or extrention of squamous epithelium inward to line an expanding cystic cavity that may involve the mastoid and erode surrounding bone
15
Q
Epstein Pearls
A
mutliple small white epithelial inclusion cysts found in the midline of the palate in newborn infants (benign)
16
Q
Fordyce Spots
A
Ectopic sebaceous glads of the buccal mucosa appearing as small yellow-white raised lesions found on the inner surface and vermilion border of the lips
17
Q
Frenulum
A
small fold of tissue that attaches the tongue to the floor of the mouth
18
Q
Koplik’s Spots
A
small red spots with bluish-white centers on the buccal mucosa opposite the molar teeth, appearing in the prodromal stage of measels
19
Q
Presbycusis
A
impairment of hearing due to aging
20
Q
Rhinitis
A
inflammation of the nasal mucosa
21
Q
Rhinorhhea and Coryza
A
a thin water discharge from the nose -> profuse
22
Q
Tophi
A
small, whitish uric acid crystals along the peripheral margins of the auricles in persons who may have gout
23
Q
Torus Mandibularis
A
a bony protuberance on the lingual aspect of the lower jaw and in the canine-premolar region
24
Q
Torus Palatinus
A
a bony protuberance in the midline of the hard palate
25
Tympanosclerosis
the formation of dense connective tissue in the middle ear often resulting in hearing loss when the ossicles are involved.
26
Anisocoria
inequality of the diameter of the pupils, may be normal or congenital. often normal if inequality is within 1mm
27
Aphakia
a condition in which part of all of the crystalline lens of the eye is absent, usually because of surgical removal for the treament of cataracts.
28
Corneal Arcus
Opaque white ring about corneal periphery, seen in many individuals older than 60 years of age. Due to depoit of lipids in the cornea or to hyaline degradation. May indicate lipid disorder, most commonly type II hyperlipidemia if present before age 40 (if seen in younger individuals is called arcus juvenilis)
29
Chalazion
small, hard tumor analogous to sebaceous cyst developing on the eye lids, formed by the distention of the meibomian gland with secretion.
30
Cornea
the clear, transparent anterior portion of the fibrous coat of the eye comprising about one sixth of its surface. It is the chief refractory structure of the eye.
31
Diabetic Retinopathy (background)
a condition characterized by dot hemorrhages or microaneurysms and the presence of hard and soft exudates. can become proliferative where new vessel formation 2/2 ischemia leads to decreased visual acuity
32
Drusen
tiny yellow or white deposits in teh retina of the eye or on the optic nerve head.
33
Ectropion
Eversion (outward rolling) of an edge or margin
34
Entropion
Inversion (inward rolling) of an egde or margin
35
Exophthalmos
an increase in the volume of the orbital content, causing protrusion of the globes forward.
It may be unilateral or bilateral.
The most common cause of bilateral Grave's disease (thyroid disease), but when unilateral protrusion is noted a retro orbital tumor must be suspected.
36
Glaucoma
a disease of the optic nerve wherein the nerve cells die, producing increased cupping appearance of the optic nerve. An abnormal condition of elevated pressure within an eye resulting from obstruction of the outflow of aqueous humor. Produces defects in the visual field and may result in blindness
37
Hemianopia
blindness for half the field of vision in one or both eyes.
38
Hordeolum
(sty) a suppurative inflammation of a sebaceous gland of the eyelid
39
Hyphema
blood in the anterior chamber of the eye in front of the iris
40
Miosis vs Mydriasis
abnormal constriction of pupils vs abnormal dilation
41
Pinguecula
a harmless yellowish traingular nodule in the bulbarconjunctiva on either side of the iris that stops at the limbus
42
Pterygium
a triangular (patch like) thickening of the bulbar conjunctiva on either side of the iris that stops at the limbus.
43
Punctum
a tiny aperture (opening) in the margin of each eyelid that opens to the lacrimal duct.
44
Ptosis
dropping eyelide
45
Retinitis Pigmentosa
a chronic progressive disease, which may occur in childhood, characterized by degernation of the retinal neuroepithelium.
46
Retinoblastoma
an embryonic malignant glioma arising from the retina usually during the first two years of life. Initial diagnostic finding is usually a yellowish or white light reflect seen at the pupil (cat's eye reflex)
47
Scleritis
superficial and deep inflammation of the sclera
48
Strabismus leads to ambylopia
a condition in which both eyes do not focus on the same object simultaneously, however either eye can focus independently
49
Uveitis
inflammation of the iris, ciliary body, and choroid or the entire uvea
50
Atresia
Abnormal closure of a passageway such as a vessel or digestive tube.
51
Aplasia
Defective development or congenital absence of an organ or tissue.
52
Micrognathia
Small Jaw
53
Adventitious Breath Sounds
Abnormal auscultated breath sounds such as crackles, rhonchi, wheezes and friction rub.
54
Bronchiolitis
inflammation of the bronchioles, RSV
55
Egophony
E sounds like A, consolidation
56
Normal Breath Sounds: Vesicular
lower lung fields, longer inspiration
57
Normal Breath Sounds: Bronchovesicular
upper lung fields, expiration equals inspiration
58
Pectus Carinatum (Pigeon Chest) vs Pectus Excavatum (Funnel Chest)
Forward protrusion of the sternum vs depression of the sternum
59
Areola
pigmented area surrounding the nipple
60
Galactorrhea
lactation not associated with childbearing
61
Lactation
the production and secretion of milk from the breast
62
Mastitis
inflammation of the breast
63
Mastodynia
pain in the breast
64
Borborygmi
a gurgling, splashing sound heard over the large intestine, caused by passage of flatus through the intestine.
65
Cholecystitis vs Cholelithiasis vs Choledocolithiasis
inflammation vs stone in gallbladder vs stone in CBD
66
Colic
spasm in any hollow tubular soft organ accompanied by pain.
67
Kehr Sign
abdominal pain radiating to the left shoulder, due to peritoneal irritation from blood or other irritants
68
Striae
streaks or lines (with a silvery white or purple hue); skin striae result from weakening of the elastic tissue associated with pregnancy, weight gain, rapid growth periods, and high levels of corticosteroids
69
Tympany vs Resonance
t - hollow, stomach
r - dull, lungs
70
Cullen
ecchymosis around umbilicus
*pancreatitis, ectopic pregnancy, hemoperitoneum
71
Markel Sign
Heel / Jar test - pain in abdomen when body rocks
72
Guarding Rigidity Rebound
rebound is peritonitis
73
Scaphoid
Protuberant
Malnurished / Sinking abdomen
Excess gas, ascites, organ enlargement
74
Caput Medusa
overstressed venous networks surrounding umbilical region due to liver disease and hepatic portal hypertension
75
Linea Nigra
linear pigmentation of the abdomen during pregnancy
76
Diastasis Recti
a separation of the rectus abdominus halfs resulting in protrusion of gut in midline.
77
Erb's Point
3rd intercostal space at the left sternal border used for listening to heart sounds in general and obtaining simultaneous auscultation of the aortic and pulmonic valves.
78
AV nicking
A small artery cross a small vein and causes bulging on either side. Typically due to hypertensive retinopathy.
79
Papilledema
Edema of the optic disc due to increases intracranial pressure.
80
Euthymia
Normal Non-depressed, reasonably positive mood.
81
Anhidrosis
lack of sweat response can lead to over heating, heat stroke AKA Hypohydrosis
82
Chadwick Sign
a bluish discoloration of the cervix that normally occurs with pregnancy at 6-8 weeks duration and remains throughout pregnancy
83
Climacteric
that period that marks the cessation of a woman's reproductive period (female climacteric / menopause);
a corresponding period of lessening of sexual activity in the male (male climacteric)
84
Cystocele
Hydrocele
Rectocele
a bladder hernia, injury to the vesicovaginal fascia during delivery may allow bladder to pouch into the vagina causing a cystocele
the accumulation of serous fluid in a saclike cavity, especially in the tunica vaginalis testes; serous tumors of the testes or associated parts
protrusion or herniation of posterior vaginal wall with the anterior wall of the rectum through the vagina
85
Dysmenorrhea
painful of difficult menstruation, either primary or secondary
86
Dyspareunia
painful sexual intercourse
87
Effacement
refers to the thinning of the cervix that results when myometrial activity pulls the cervix upwards, allowing the cervix to become part of the lower uterine segment during prelabor and early labor.
88
Menarche
the first menstruation and initiation of cyclic menstrual function
89
Oligomenorrhea
infrequent menstruation
90
Oliguria
Polyuria
diminished amount of urine formation or scanty urine production (less than 500ml in 24 hours)
vs 2.5 - 3 L / 24 hrs
91
Pyuria
WBCs in Urine
92
Station
the relationship of the presenting part of the fetus to the ischial spines of the mother's pelvis. The measurement is determined by centimeters superior to and inferior to the ischial spines and is recorded by plus (inferious) and minus (superior) signs.
93
Stress
Urge
Retention / Overflow
Frequency
leakage of urine due to increased intraabdominal pressure that can occur from coughing, laughing, exercise, or lifting heavy things.
the inability to hold urine once the urge to void occurs. causes of the abnormality can be local genitourinary conditions such as infection or tumor, CNS disorders such as stroke...
a mechanical dysfunction resulting from an over distended bladded. This type of urinary incontinence has many causes: anatomic obstruction by prostatic hypertrophy and strictures, neurologic abnormalities that impair detrusor contractility such as MS, spinal lesions
94
Epididymitis
Inflammation of the epididymis
95
Testicular Torsion
twisting of the testis on the spermatic cord
96
Urethritis
Inflammation of the urethra
97
Varicocele
"bag of worms" abnormal turtuosity and dilation of veins of the pampeniform plexus within the spermatic cord. Associated with reduced fertility, probably from increased venous pressure and elevated testicular temperature.
98
Chlamydia
Chlamydia Trachomatis
yellow drainage from cervix >> PID, or ectopoic pregnancy after multiple infections. watery drainage from penis. Dysuria, Urethritis
Treat with Azithromycin, Doxycycline
99
Bacterial Vaginosis
Anaerobic Bacterial Overgrowth
Unpleasant odor, gray thin discharge from cervix "Clue cells on Wet Mount"
Metronidazole
100
Condyloma Acuminata
Human Papilloma Virus (serotypes 16 / 18 associated with squamous cell carcinoma)
Aymptomatic. Pruritis, bleeding, burning, tenderness. If large the mass can interfere with defactation and intercourse.
Chemical/Physicial Destruction of warts, immunologic therapy, surgical excision
101
Gonorrhea
Neisseria Gonorrhoeae
Urethritis, Yellowish cervical discharge in females, Dysuria, penile discharge, testicular pain, pain with defecation and pharyngitis in males.
Ceftriaxone IM with Azithromycin or Doxycyclin
102
Herpes
Herpes Simplex (1 lips, 2 genital)
Fever Malaise, painful genital lesions, headache, and dysuria
Acyclovir, Famciclovir
103
HIV
Human Immunodeficiency Virus
Fatigue, non-specific symptoms, recurrent infections, infections with typically benign orgasms
Antiretrovirals
104
Syphilis
Treponema Pallidum
Three Stages:
- Primary - painless chancer
- Secondary - gummas
- Tertiary - systemic
Penicillin
**Becoming common again.
105
Cathartics
encourages defecation
106
Dystonia
neurological movement disorder where sustained muscle contractions result in twisting, repetitive movements or abnormal postures.
107
Acholic Stool
A lightly colored, grey stool
108
Acrocyanosis
bluish discoloration of the hands and feet, may be present at birth and may persist for several days or longer if the newborn is kept in cool ambient temperatures.
109
Annular
shaped like a ring, used to describ a lesion that forms a ring around a clear center of normal skin.
110
Bulla
vesicle greater than 1 cm in diameter
111
Cellulitis
diffuse, acute infection of the skin and subcutaneous tissue
112
Chloasma
a facial discoloration common during pregnancy; also called the mask of pregnancy.
AKA Melasma
113
Crust
dried serum blood or purulent exudates; slightly elevated; size varies; red brown black tan or straw colored.
114
Cutis Marmorata
a marbled or mottled appearance to the skin of a newborn when exposed to decreased temperatures
occurs because the newborn's immature vascular systems are unable to adapt to temperature changes
115
Erosion
loss of part of the epidermis; depressed moist glistening; follows rupture of a vesicle or bulla
116
Excoriation
loss of the epidermis,linear or hallowed out, crusted area
117
Fissure
linear crack or break from the epidermis to the dermis; may be moist or dry.
118
Folliculitis
Inflammation and infection of the hair follicle and surrounding dermis.
119
Furuncle
a deep-seated infection of the pilosebaceous unit
120
Keloid
irregular shaped, elevated, progressively enlarging scar; grows beyond the boundaries of the wound; caused by excessive collagen formation during healing.
different than hypertrophic scars which do not grow beyond the original border of the wound.
121
Lanugo
Fine silky hair of newborns
122
Lichenification
rough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation; often involves flexor surface of extremity.
123
Macule
a flat circumscribed area that is a change in color of the skin, less that 1cm in diameter.
124
Nodule
elevated firm circumscribed lesion, deeper in dermis than a papule, 1 - 2 cm diameter.
125
Papule
an elevated firm circumscribed area less than 1 cm in diameter
126
Patch
a flat, nonpalpable irregular shaped macule greater than 1 cm in diameter
127
Plaque
elevated firm and rough lesion with a flat top surface greater than 1 cm in diameter
128
Pustule
elevated, superficial lesion, similar to a vesicle but filled with purulent fluid.
129
Scale
heaped up, keratinized cells; flaky skin; irregular; thick or thin; dry or oily; variation in size
130
Scar
thin to thick fibrous tissue that replaces normal skin following injury or laceration to the dermis
131
Telangiectasion -> Petechiae -> -> Purpura -> Ecchymosis
various bleeding into skin
132
Vesicle
elevated, circumscribed superficial not into dermis; filled with serous fluid; less than 1 cm in diameter
133
Wheal
elevated, irregular shaped area of cutaneous edema, solid, transient, variable diameter.
134
Ulcer
loss of epidermis and dermis; concave, varies in size.
135
Ballottement test
assess for large effusions or excess knee fluid.
-(knee extended) apply pressure to the suprapatellar pouch, with other hand push the patella into femur (fluid will make the patella float out)
136
Bulge Sign
assess for minor effusions of the knee
-(knee extended) downward pressure over suprapatellar pouch "milking", milk medially 2-3x, tap lateral aspect of patella watch for fluid movement
137
McMurray Test
assess for torn meniscus in knee of posterior side
-pt. supine flex knee, monitor joint,
Medial meniscus - external rotate tibia, valgus stress (medial knee translation) *Often tears alongside MCL because they are attached*
Lateral Meniscus - internal rotation tibia, varus stress (lateral knee translation)
138
Anterior / Posterior Drawer Test
Pt. supine, hip at 45, knee at 90, foot on table (sit on top of foot)
Anterior - pull tibia away from pt., ACL
Posterior - push tibia in towards pt., PCL
139
Lachman Test
sometimes the quadricepts can hide a torn ACL
pt. supine, extending the knee, hold the femur in one hand while applying a translational force with the tibia anteriorly (toward the ceiling)
140
Varus (abduction) Valgus (adduction) Stress Tests
Varus - LCL
Valgus - MCL
pt. supine, lift leg, (push knee medially, external rotate - valgus) ... (push knee laterally, internal rotate - varus)
* watch for laxity, paint, crepitus
141
Subluxations
partial or complete dislocation of a joint.
142
Apley Compression / Distraction Tests
torn meniscus (medial or lateral), pt complains of knocking.
Compression - pt prone - knee to 90, stabilize femur, dorsiflex foot, internal external rotation while depressing tibia into table. (clicking, locking, pain)
Distraciton - same set up, but now stabilize femur with your knee, pull traction through the tibia. (change in location of the pain)
143
Brudzinski sign
flexion of the hips when the neck is flexed from a supine position. Occurs in patients with meningeal inflammation.
144
Kernig's Sign
a sign of meningeal irritation evidenced by reflex contraction and pain in the hamstring muscles, when attempting to extend the leg after flexing the hip.
145
Nuchal Rigidity
resistance to flexion of the neck, seen in individuals with meningitis.
146
Allen's Test
Check for collateral circulation by occluding both radial and ulnar, pt squeeze fist, release one, repeat with other. 3-5s
147
JVD
- a measure of central venous pressure.
- elevated JV pressure is indicative of rise in left ventricular end diastolic pressure and decreased ejection fraction
A - wave - rebound from Rt Atrial Systole (prominant with resistance to Rt atrial contraction) (absent in atrial fib)
C - wave - expansion of the underlying carotid artery
V - wave - filling of Rt atrium while tricuspid closes (large in tricuspid regurgitation)
148
Muscle Strength Grading
5 - normal (full motion on gravity and resistance)
4 - weak (full on gravity, some resistance)
3 - full on gravity, no resistance
2 - full motion, not against gravity
1 - trace movement
0 - none
149
Subscapular Strength Test / Gerber's Test
- assesses internal rotation, subscapularis muscle
| - pt reaches behind back, pushes palm up off small of back against physician resistance.
150
Supraspinatus Muscle Strenght / Jobe's Test
-empty can test - supraspinatus - bring pt's arms up to 90 degrees, internally rotate hand, resist clinician pushing down. (rotator cuff tear)
151
Arm Drop Test
Pt lifts arm to 90 laterally, smoothly lowers arm back to side. if not suggests rotator cuff injury.
152
Neer's Test
Assesses rotator cuff impingement or tear. Cl presses scapula raises arm with other hand. No pain should be felt.
-rotator cuff tear "Neer's impingement sign"
153
Yergason's Test
assesses rotator cuff tear, or long hear of bicepts tendon.
pt 90 degree flex arm, pronate hand, pt supinates against resistance. pain is abnormal.
154
Flexor Digitorum Superficialis
- assess whether a laceration has damaged tendon
| - hold fingers on table, palm up, have patient flex proximal interphalangeal joint on finger at a time.
155
Flexor Digitorum Profundus
- assesses integrity of FDP tendon
| - hold the metacarpophalangeal and proximal interphalangeal joints in extension. pt flexes distal phalanx
156
Snuffbox Tenderness
- palpate snuffbox
| - tenderness over snuffbox indicates scaphoid fracture
157
Phalen's Test
- assess median nerve compression (contained in carpal tunnel)
- both hands touching on dorsal surface fingers down, hold for 60s. numbness or parasthesias indicating carpal tunnel syndrome
158
Tinel's Sign
- assess median nerve
- tap where the median nerve passes under flexor retinaculum and volar carpal ligament. tingling radiating from wrist to hand within 60s. (carpal tunnel)
159
Thomas Test
- tests for hip flexion contracture
| - unaffected leg brought to chest, knee flexion in affected leg off the table.
160
Trendelenburg Test
- test for weak hip abductors
| - patient stands and lifts one leg... the pelvis sinks when hip abductors are weak.
161
Boutonniere Deformity
hyperflexed proximal interphalangeal (PIP), hyperextended distal interphalangeal (DIP)
162
Swan Neck Deformity
hyperflexed DIP, hyperextended PIP
163
Dupuytren's Contracture
you know
164
Trigger Finger
tendon nodule causes stucked flexed digit
165
De Quervains Tendonitis
inflammed tendon sheath, tenderness over extensor and abductor tendon
166
Finkelstein Test for De Quervains
thumb in fist, adduct wrist, pain is positive for De Quervain's
167
Ankylosing Spondylitis
hereditary chronic inflammitory Disease affecting lumbar spine and sacroiliac joints
168
Carpal Tunnel Syndrome
pressure on median nerve through carpal tunnel
169
Fibromyalgia
painful non-articular condition that leads to diffuse musculoskeletal discomfort
170
Tenosynovitis
inflammation of a sheath of a tendon or the tendon
171
Confusion
not oriented to person place or time but has normal level of consciousness
172
Lethargy
drowsy, sleepy, but will respond correctly when awoken then fall back asleep.
173
Obtunded
able to open eyes and look, but slow responses and confused, decreased alertness
174
Stupor
slow responses, simple motor or moaning to stimuli. arousable for short periods of time.
175
Coma
not awake
176
Glasgow Coma Scale - Eyes (1-4)
1- none
2- to pain
3- to voice
4- spontaneous
177
Glasgow Coma Scale - Verbal (1-5)
```
1- none
2- incomprehensible
3- inappropraite
4- disoriented
5- normal
```
178
Glasgow Coma Scale - Motor Response (1-6)
```
1- none
2- extends to pain
3- flexes to pain
4- withdrawls to pain
5- localizes to pain
6- normal
```
179
Cranial Nerve Tests: CNI
use two scents, one for each nostril
180
Cranial Nerve Tests: CNII
Snellen or Rosenbaum Charts
Visualize Fundi, optic disc
Confrontation Test, peripheral fields
181
Cranial Nerve Tests: CNII, III (PERLA)
PERLA pupils equal reactive to light and accommodation
evaluate pupils - size (mm) shape compare side to side
defects in accommodation can be due to CNII or III lesion
accommodation test - look at distance then close up object (should constrict with less distance)
Extraocular motion - have patient follow X and then follow +
182
Cranial Nerve Tests: CNIII
all movements except lateral gaze and inward rotation when looking down (intorsion) are controlled by CNIII
183
Cranial Nerve Tests: CNIV
superior oblique - inferomedial - superior oblique (SO4)
184
Cranial Nerve Tests: CNV
motor - jaw opening, clenching, chewing mastication (observe atrophy, jaw deviation, tremors) unilateral weakness indicates CNV damage
sensory - cornea, iris, lacrimal glands, conjunctiva, eyelids, forehead, nose, nasal function, mouth mucosa, teeth, tongue, ear, facial skin (sharp dull light touch)
semetric blink requires CNV CNVII, touch face forehead, cheek, chin (sharp or dull)
185
Cranial Nerve Tests: CNVI
lateral rectus (LR4) increased intracranial pressure due to long course of nerve will cause LOF here
186
Cranial Nerve Tests: CNVII
motor to face, sensory to tongue, parasympathetics to lacrimal and salivary glands.
facial expressions - raise eyebrows, squeeze eyes shut, puff cheeks, smile show teetch, purse lips and blow
sensory - test taste anterior 2/3rds, point to that which was tasted, sip water betwen
187
Cranial Nerve Tests: CNVIII
Auditory - whisper test, weber test, Rinne test
Vestibular - Romberg test
188
Cranial Nerve Tests: CNIX, X
IX - stylopharyngeus (m), tongue pharynx, middle ear (s) parotid (parasympathetic)
IX - swallowing and phonation
IX & X - "Ah" testing (watch for soft palate to rise) gag, listening to speech, observe swalowing
IX - nasopharynx senstation, taste to posterior 1/3rd of tongue
X - sensation behind ear
IX - parasympathetic salivary secretion, carotid reflex
X - parasympathetic - digestive secretion, peristalsis, carotid reflex, involuntary heart lungs and digestive tract.
189
Cranial Nerve Tests: XI
motor to SCM - test strength against hand
motor to trapezius - test shoulder shrug strength
190
Cranial Nerve Tests: CNXII
motor to tongue, speech (l, t, d, n) swallowing.
assess tongue semetry, tongue lift to nose
assess tongue strength against inside of cheek
191
Cerebellar Function - Finger Thumb Test (diadochokinesia)
ipsilateral cerebellar eval.
fingers to thumb in sequence index to pinky then back.
abnormal is obvious - stroke, tumor, trauma, MS, parkinsons, corticospinal tract, extrapyramidal disease, sensory ataxia, upper motor neuron dz, basal ganglion disease.
192
Cerebellar Function - Palm up/down
ipsilateral
palms on lap, up and down, faster and faster
samesies as finger thumb test
193
Cerebellar Function - Finger to Nose
pt upright, your finger 18 inches away, they alternate between nose (pronated) to your finger (supinated, fully extended), one hand at a time.
abnormal - misjudgement (dysmetria), overshooting (hypermetria), undershooting (hypometria), side to side tremor (intention/kinetic tremor), muscle weakness
194
Cerebellar Function - Finger-Nose-Finger
ipsilateral
eyes closed, spread arms, touch nose with index one hand at a time, slowly increase speed.
abnormal - hypermetria, hypometria, dysmetria, muscle weakeness, vestibular dysfunction
195
Cerebellar Function - Heel to Shin
ipsilateral - lower extremity
any position, sitting standing lying, heel to shine (straight line)
abnormal - ataxia, dysmetria, intention tremors, proximal muscle weakeness
196
Cerebellar Function - Balance (Romberg)
should be able to stand for 60s with eyes closed.
Positive Romberg? Stop here. Typically they fall toward side of lesion. Vestibular function = swaying with eyes closed, no swaying with eyes open. gentle push can indicate many diseases such as parkinson's
197
Cerebellar Function - Hop Test
cerebellar function in addition to postural, proprioception, joint position, and visual input.
pts eyes open, hop in place on one foot for 5s then other foot.
abnormal - cant do it, muscle weakness, cerebellar disease, position sense issue.
198
Cerebellar Function - Observe gait
abnormal gait = cerebellar, vestibular, hemiplegia, parkinson's , cerebellar ataxia, footdrop, sensory ataxia
199
Cerebellar Function - Heel - Toe Walking (Tandem walk)
like the cops do.
abnormal - like the drunks do
200
Cerebellar Function - Heel walk, Toe walk
assess corticospinal tract in conjunction with muscular function
Abnormal Heels - corticospinal tract - foot drop
Abnormal Toes - gastrocnemius weakness
201
Cerebellar Function - Pronator Drift
CONTRALATERAL LESION
pt stands, palms up, eyes closed 20-30s, you tap arms briskly down,
Abnormal - unable to maintain extension and supination, hands will drift into pronation, corticospinal lesion (contralateral side of pronated hand - upper motor neuron disease)
202
Sensory Function - Superficial Pain
pt eyes closed, dull and sharp cotton swab, if cannot identify = spinothalamic tract, peripheral neuropathy, thalamis damage, sensory cortex damage
203
Sensory Function - Superficial Touch
pt eyes closed, light strokes on skin without depressing skin, pt points to area touched, if not (spinothalamic, poterior column, peripheral neuropathy, thalamic or sensory cortex damage)
204
Sensory Function - Vibration Sense
pt eyes closed, use tuning fork against bony processes of toe and finger joints, what do you feel? abnormal = posterior spinal tract or peripheral neuropathy
205
Sensory Function - Proprioception
pt eyes closed, hold joint in neutral, demonstrate up and down, then quiz up and down. Abnormal = posterior column lesion or peripheral neuropathy
206
Sensory Function - Graphesthesia
pt eyes closed, draw a letter or number on skin, abnormal = cannot identify the number posterior column or peripheral neuropathy
207
Sensory Function - Stereognosis
pt eyes closed, hand pt everyday object, identify, Abnormal = tactile agnosia = parietal lobe lesion (sensory cortex), posterior column
208
Sensory Function - Two Point Discrimination
pt eyes closed, two sterile needles, determine minimum distance of recognition of two points. Dorsal Column/ sensory cortex
```
fingers 2mm
palm 10mm
upper arm 45mm
back 40mm
thigh 45mm
sole 20mm
big toe 10mm
```
209
Reflexes - DTRs (deep tendon reflexes)
tendon tapping
```
grading
0 = none
1 = sliggish
2 = expected
3 = more brisk
4 = brisk hyperactive with intermittent transient clonus
```
Abnormal = upper motor neuron, anxiety, prolonged test for clonus, hyperthryroidism; absent = lower motor neuron disorder, neuropathy, NMJ deficiency
210
Reflexes - Bicepts, Brachioradial, Tricepts, Patellar, Achilles
Bicepts = flex to 45 degrees, palm down, place thumb over tendon, tap on top of thumb
Brachioradial = hand resting on lap, strike directly 1-2 inches above wrist, supination of hand/forearm
Tricepts = C6/C7 flex elbow to 90, support antecubital fossa, strike tricepts tendon directly.
Patellar = L2, L3, L4
Achilles = Tibial Nerve, S1, S2 primarily
211
Reflexes - Clonus
test when DTR are hperactive, ankle clonus confirms upper motor neuron dz
pt supine, support knee partially flexed, briskly dorsiflex foot with hand while maintaining foot flexion.
Abnormal = sustained clonus is dorsi/plantar flexion oscillations = upper motor neuron disease
212
Reflexes - Superficial Reflexes -Plantar, Cremasteric, Abdominal
not dependent on stretch receptors as DTRs are, rather they are dependent on multiple synapses. DTR grading scale not used.
Plantar = pt supine, relax foot/leg, scratch from heel to lateral ball of foot medially. normal = negative Babinski's sign, toes going down, plantar flexion Abnormal = pyramidal tract disease (though is normal in infants)
Cremasteric (L2, L3) = stroke inner thigh, scrotum and testes rise on stroked side. L2, L3 lesion
Abdominal (above umbilicus T8-T10, below T10-T12) use wooden stick or tongue blade, stroke top of each quadrant toward umbilicus, umbilicus contracts toward stroke. Lesion to T8-T12
213
Miscellaneous - Monofilament Testing
test sensory neuropathy esp diabetes mellitus
pt closes eyes,apply just enough pressure to bend filament, ten sites for 1.5 seconds, when do you feel it? vary intervals, both feet
abnormal = unable to feel a least 7/10 spots (cannot feel more than 3 spots) peripheral neuropathy
Ten Spots = three toes, three ball of foot below toes, two lateral of arch, one on heel, one on dorsum of foot.
214
Affect
person's external expression of his or her inner emotional state
215
Afferent Pupillary Defect (Marcus-Gunn Pupil)
vs.
Internuclear Ophthalmoplegia
continued pupillary dilation instead of constriction in the eye with a pre-chiasmic optic pathway lesion (optic neuritis) in response to shining light in the damaged eye after first shining it in the normal eye
216
Agraphia
loss of ability to express one's self in writing due to central lesion or to muscular incoordination
217
Akathisia (acathisia)
inability to sit down because of the thought of doing so causes server anxiety. Pt has a feeling of restlessness and an urgent need of movement and complains of a feeling of muscular quivering.
218
Akinesia
complete of partial loss of muscle movement
219
Aphasia
inability to express oneself properly though speech, or loss of verbal comprehension. It is considered to be complete or total when both sensory and motor systems are involved.
220
Ataxia
impaired ability to coordinate muscular movement usually assiciated with staggering gait and postural imbalance.
221
Athetosis
slow twisting writhing movements with larger amplitude than chorea, commonly involving the hands
222
Chorea
dance like involuntary rapid movements, can be associated with huntington's disease, rheumatic fever, systemic lupus erythematosus, and other conditions
223
Dysarthria
defective articulation secondary to a motor deficit involving the lips tongue palate or pharynx (anability to pronounce or articulate words)
224
Dysadochokinesia
inability to quickly substitute antagonistic motor impulses to produce antagonistic muscular movements. Inbability to perform rapid alternating movements (pronation/suination)
225
Dysesthesia
Sensations, as of the pricks of pins and needles or crawling.
226
Dyskinesia
defect in voluntary movement. usually used in relation to extrapyramidal disorders
227
Dysphasia
Impairment of speech resulting from brain lesion
228
Dysphonia
difficuly in speaking, hoarsness. often related to weakness of laryngeal muscles in which sound production is impaired
229
Dystonia
impaired disordered tonicity, especially muscle tone (involuntary muscle spasms)
230
Fasciculations
a localized, uncoordinated twitching of a single muscle group innervated by a single motor nerve filament. it is visible or palapable.
231
Fluent Aphasia (Wernicke's or receptive aphasia)
fluent, effortless speech; words are malformed, may be totally incomprehensible. can hear words but cannot relate them to previous experiences. Impairment of language comprehension including impaired repetition due to lesion of the posterior left superior temporal gyrus.
232
Graphesthesia
the ability to recognize symbols, shapes, numbers, and letters traced on the skin.
233
Hemianopia
blindness of half of the field of vision in one or both of the eyes (indicating a lesion behind, posterior to the optic chiasm)
234
Hemiballismus
jerking and twitching movements of one side of the body (involuntary violent flinging or jerking of a limb or limbs in an uncoordinated manner caused by a lesion of the contralateral subthalamus)
235
Myelitis
Inflammation of the spinal cord or bone marrow
236
Myelopathy
any pathological condition of the spinal cord.
237
Myoclonus
twitching or clonic spasm of a muscle or group of muscles
238
Myopathy
any disease or abnormal condition of striated muscle (weakness that is greater proximal than distal)
239
Non-Fluent Aphasia (Broca's or expressive aphasia)
cannot express oneself using language; few words; laborious effort, primarily uses nouns and verbs (eat pie, get mail) fair to good comprehension due to a lesion of the left inferior frontal lobe
240
Paralysis
temporary suspension or permanent loss of function (especially loss of sensation or voluntary motion)
241
Paresis
partial or complete paralysis
242
Paresthesia
unusual sensation such as numbnness, tingling, or burning
243
Stereognosis
ability to recognize form of solid objects by touch
244
Tremor
an involuntary movement of a part or parts of the body resulting from alternate contractions of opposite muscles. The trembling may be fine or coarse, rapid or slow, may appear on movement (intention tremor) or improve when the part is employed.
245
Res Ipsa Loquitur
the thing speaks itself
246
Kobayashi Maru
the unbeatable test
247
stomatitis
sore mouth
248
Glossitis
inflammation and soreness of the tongue
