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USMLE® Step 1 flashcards
1
Q

Ataxia

A

Lack of voluntary control of muscle movements.

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2
Q

Menarche

A

First menstrual cycle.

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3
Q

Impetigo

A

serious bacterial skin infection. Often acquired from football or wrestling.

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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.

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5
Q

Anisocoria

A

unequal pupils

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6
Q

Hematospermia

A

blood in the semen

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7
Q

Eructation

A

burping

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8
Q

Keratitis

A

Inflammation of the cornea of the eye. Moderate to intense pain!

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9
Q

Listless > Somnolent > Lethargic > Obtunded > Comatose

A

stages of alertness

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10
Q

Angular Cheilosis

A

reddish inflammation of the lip or lips and production of fissures that radiate from the angles of the mouth

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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.

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12
Q

Ceruman

A

the soft, brownish/yellow, waxy secretion (a modified sebum) of the ceruminous glands of the external audiory meatus.

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13
Q

Cheilitis

A

inflammation or cracking of the lips

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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

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15
Q

Epstein Pearls

A

mutliple small white epithelial inclusion cysts found in the midline of the palate in newborn infants (benign)

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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

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17
Q

Frenulum

A

small fold of tissue that attaches the tongue to the floor of the mouth

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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

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19
Q

Presbycusis

A

impairment of hearing due to aging

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20
Q

Rhinitis

A

inflammation of the nasal mucosa

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21
Q

Rhinorhhea and Coryza

A

a thin water discharge from the nose -> profuse

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22
Q

Tophi

A

small, whitish uric acid crystals along the peripheral margins of the auricles in persons who may have gout

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23
Q

Torus Mandibularis

A

a bony protuberance on the lingual aspect of the lower jaw and in the canine-premolar region

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24
Q

Torus Palatinus

A

a bony protuberance in the midline of the hard palate

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25
Q

Tympanosclerosis

A

the formation of dense connective tissue in the middle ear often resulting in hearing loss when the ossicles are involved.

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26
Q

Anisocoria

A

inequality of the diameter of the pupils, may be normal or congenital. often normal if inequality is within 1mm

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27
Q

Aphakia

A

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.

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28
Q

Corneal Arcus

A

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)

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29
Q

Chalazion

A

small, hard tumor analogous to sebaceous cyst developing on the eye lids, formed by the distention of the meibomian gland with secretion.

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30
Q

Cornea

A

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.

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31
Q

Diabetic Retinopathy (background)

A

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

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32
Q

Drusen

A

tiny yellow or white deposits in teh retina of the eye or on the optic nerve head.

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33
Q

Ectropion

A

Eversion (outward rolling) of an edge or margin

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34
Q

Entropion

A

Inversion (inward rolling) of an egde or margin

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35
Q

Exophthalmos

A

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.

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36
Q

Glaucoma

A

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

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37
Q

Hemianopia

A

blindness for half the field of vision in one or both eyes.

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38
Q

Hordeolum

A

(sty) a suppurative inflammation of a sebaceous gland of the eyelid

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39
Q

Hyphema

A

blood in the anterior chamber of the eye in front of the iris

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40
Q

Miosis vs Mydriasis

A

abnormal constriction of pupils vs abnormal dilation

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41
Q

Pinguecula

A

a harmless yellowish traingular nodule in the bulbarconjunctiva on either side of the iris that stops at the limbus

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42
Q

Pterygium

A

a triangular (patch like) thickening of the bulbar conjunctiva on either side of the iris that stops at the limbus.

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43
Q

Punctum

A

a tiny aperture (opening) in the margin of each eyelid that opens to the lacrimal duct.

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44
Q

Ptosis

A

dropping eyelide

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45
Q

Retinitis Pigmentosa

A

a chronic progressive disease, which may occur in childhood, characterized by degernation of the retinal neuroepithelium.

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46
Q

Retinoblastoma

A

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)

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47
Q

Scleritis

A

superficial and deep inflammation of the sclera

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48
Q

Strabismus leads to ambylopia

A

a condition in which both eyes do not focus on the same object simultaneously, however either eye can focus independently

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49
Q

Uveitis

A

inflammation of the iris, ciliary body, and choroid or the entire uvea

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50
Q

Atresia

A

Abnormal closure of a passageway such as a vessel or digestive tube.

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51
Q

Aplasia

A

Defective development or congenital absence of an organ or tissue.

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52
Q

Micrognathia

A

Small Jaw

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53
Q

Adventitious Breath Sounds

A

Abnormal auscultated breath sounds such as crackles, rhonchi, wheezes and friction rub.

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54
Q

Bronchiolitis

A

inflammation of the bronchioles, RSV

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55
Q

Egophony

A

E sounds like A, consolidation

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56
Q

Normal Breath Sounds: Vesicular

A

lower lung fields, longer inspiration

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57
Q

Normal Breath Sounds: Bronchovesicular

A

upper lung fields, expiration equals inspiration

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58
Q

Pectus Carinatum (Pigeon Chest) vs Pectus Excavatum (Funnel Chest)

A

Forward protrusion of the sternum vs depression of the sternum

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59
Q

Areola

A

pigmented area surrounding the nipple

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60
Q

Galactorrhea

A

lactation not associated with childbearing

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61
Q

Lactation

A

the production and secretion of milk from the breast

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62
Q

Mastitis

A

inflammation of the breast

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63
Q

Mastodynia

A

pain in the breast

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64
Q

Borborygmi

A

a gurgling, splashing sound heard over the large intestine, caused by passage of flatus through the intestine.

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65
Q

Cholecystitis vs Cholelithiasis vs Choledocolithiasis

A

inflammation vs stone in gallbladder vs stone in CBD

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66
Q

Colic

A

spasm in any hollow tubular soft organ accompanied by pain.

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67
Q

Kehr Sign

A

abdominal pain radiating to the left shoulder, due to peritoneal irritation from blood or other irritants

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68
Q

Striae

A

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

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69
Q

Tympany vs Resonance

A

t - hollow, stomach

r - dull, lungs

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70
Q

Cullen

A

ecchymosis around umbilicus

*pancreatitis, ectopic pregnancy, hemoperitoneum

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71
Q

Markel Sign

A

Heel / Jar test - pain in abdomen when body rocks

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72
Q

Guarding Rigidity Rebound

A

rebound is peritonitis

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73
Q

Scaphoid

Protuberant

A

Malnurished / Sinking abdomen

Excess gas, ascites, organ enlargement

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74
Q

Caput Medusa

A

overstressed venous networks surrounding umbilical region due to liver disease and hepatic portal hypertension

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75
Q

Linea Nigra

A

linear pigmentation of the abdomen during pregnancy

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76
Q

Diastasis Recti

A

a separation of the rectus abdominus halfs resulting in protrusion of gut in midline.

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77
Q

Erb’s Point

A

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.

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78
Q

AV nicking

A

A small artery cross a small vein and causes bulging on either side. Typically due to hypertensive retinopathy.

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79
Q

Papilledema

A

Edema of the optic disc due to increases intracranial pressure.

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80
Q

Euthymia

A

Normal Non-depressed, reasonably positive mood.

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81
Q

Anhidrosis

A

lack of sweat response can lead to over heating, heat stroke AKA Hypohydrosis

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82
Q

Chadwick Sign

A

a bluish discoloration of the cervix that normally occurs with pregnancy at 6-8 weeks duration and remains throughout pregnancy

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83
Q

Climacteric

A

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)

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84
Q

Cystocele

Hydrocele

Rectocele

A

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

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85
Q

Dysmenorrhea

A

painful of difficult menstruation, either primary or secondary

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86
Q

Dyspareunia

A

painful sexual intercourse

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87
Q

Effacement

A

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.

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88
Q

Menarche

A

the first menstruation and initiation of cyclic menstrual function

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89
Q

Oligomenorrhea

A

infrequent menstruation

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90
Q

Oliguria

Polyuria

A

diminished amount of urine formation or scanty urine production (less than 500ml in 24 hours)

vs 2.5 - 3 L / 24 hrs

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91
Q

Pyuria

A

WBCs in Urine

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92
Q

Station

A

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.

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93
Q

Stress

Urge

Retention / Overflow

Frequency

A

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

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94
Q

Epididymitis

A

Inflammation of the epididymis

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95
Q

Testicular Torsion

A

twisting of the testis on the spermatic cord

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96
Q

Urethritis

A

Inflammation of the urethra

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97
Q

Varicocele

A

“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.

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98
Q

Chlamydia

A

Chlamydia Trachomatis

yellow drainage from cervix&raquo_space; PID, or ectopoic pregnancy after multiple infections. watery drainage from penis. Dysuria, Urethritis

Treat with Azithromycin, Doxycycline

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99
Q

Bacterial Vaginosis

A

Anaerobic Bacterial Overgrowth

Unpleasant odor, gray thin discharge from cervix “Clue cells on Wet Mount”

Metronidazole

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100
Q

Condyloma Acuminata

A

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
Q

Gonorrhea

A

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
Q

Herpes

A

Herpes Simplex (1 lips, 2 genital)

Fever Malaise, painful genital lesions, headache, and dysuria

Acyclovir, Famciclovir

103
Q

HIV

A

Human Immunodeficiency Virus

Fatigue, non-specific symptoms, recurrent infections, infections with typically benign orgasms

Antiretrovirals

104
Q

Syphilis

A

Treponema Pallidum

Three Stages:

  • Primary - painless chancer
  • Secondary - gummas
  • Tertiary - systemic

Penicillin

**Becoming common again.

105
Q

Cathartics

A

encourages defecation

106
Q

Dystonia

A

neurological movement disorder where sustained muscle contractions result in twisting, repetitive movements or abnormal postures.

107
Q

Acholic Stool

A

A lightly colored, grey stool

108
Q

Acrocyanosis

A

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
Q

Annular

A

shaped like a ring, used to describ a lesion that forms a ring around a clear center of normal skin.

110
Q

Bulla

A

vesicle greater than 1 cm in diameter

111
Q

Cellulitis

A

diffuse, acute infection of the skin and subcutaneous tissue

112
Q

Chloasma

A

a facial discoloration common during pregnancy; also called the mask of pregnancy.

AKA Melasma

113
Q

Crust

A

dried serum blood or purulent exudates; slightly elevated; size varies; red brown black tan or straw colored.

114
Q

Cutis Marmorata

A

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
Q

Erosion

A

loss of part of the epidermis; depressed moist glistening; follows rupture of a vesicle or bulla

116
Q

Excoriation

A

loss of the epidermis,linear or hallowed out, crusted area

117
Q

Fissure

A

linear crack or break from the epidermis to the dermis; may be moist or dry.

118
Q

Folliculitis

A

Inflammation and infection of the hair follicle and surrounding dermis.

119
Q

Furuncle

A

a deep-seated infection of the pilosebaceous unit

120
Q

Keloid

A

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
Q

Lanugo

A

Fine silky hair of newborns

122
Q

Lichenification

A

rough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation; often involves flexor surface of extremity.

123
Q

Macule

A

a flat circumscribed area that is a change in color of the skin, less that 1cm in diameter.

124
Q

Nodule

A

elevated firm circumscribed lesion, deeper in dermis than a papule, 1 - 2 cm diameter.

125
Q

Papule

A

an elevated firm circumscribed area less than 1 cm in diameter

126
Q

Patch

A

a flat, nonpalpable irregular shaped macule greater than 1 cm in diameter

127
Q

Plaque

A

elevated firm and rough lesion with a flat top surface greater than 1 cm in diameter

128
Q

Pustule

A

elevated, superficial lesion, similar to a vesicle but filled with purulent fluid.

129
Q

Scale

A

heaped up, keratinized cells; flaky skin; irregular; thick or thin; dry or oily; variation in size

130
Q

Scar

A

thin to thick fibrous tissue that replaces normal skin following injury or laceration to the dermis

131
Q

Telangiectasion -> Petechiae -> -> Purpura -> Ecchymosis

A

various bleeding into skin

132
Q

Vesicle

A

elevated, circumscribed superficial not into dermis; filled with serous fluid; less than 1 cm in diameter

133
Q

Wheal

A

elevated, irregular shaped area of cutaneous edema, solid, transient, variable diameter.

134
Q

Ulcer

A

loss of epidermis and dermis; concave, varies in size.

135
Q

Ballottement test

A

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
Q

Bulge Sign

A

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
Q

McMurray Test

A

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
Q

Anterior / Posterior Drawer Test

A

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
Q

Lachman Test

A

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
Q

Varus (abduction) Valgus (adduction) Stress Tests

A

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
Q

Subluxations

A

partial or complete dislocation of a joint.

142
Q

Apley Compression / Distraction Tests

A

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
Q

Brudzinski sign

A

flexion of the hips when the neck is flexed from a supine position. Occurs in patients with meningeal inflammation.

144
Q

Kernig’s Sign

A

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
Q

Nuchal Rigidity

A

resistance to flexion of the neck, seen in individuals with meningitis.

146
Q

Allen’s Test

A

Check for collateral circulation by occluding both radial and ulnar, pt squeeze fist, release one, repeat with other. 3-5s

147
Q

JVD

A
  • 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
Q

Muscle Strength Grading

A

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
Q

Subscapular Strength Test / Gerber’s Test

A
  • assesses internal rotation, subscapularis muscle

- pt reaches behind back, pushes palm up off small of back against physician resistance.

150
Q

Supraspinatus Muscle Strenght / Jobe’s Test

A

-empty can test - supraspinatus - bring pt’s arms up to 90 degrees, internally rotate hand, resist clinician pushing down. (rotator cuff tear)

151
Q

Arm Drop Test

A

Pt lifts arm to 90 laterally, smoothly lowers arm back to side. if not suggests rotator cuff injury.

152
Q

Neer’s Test

A

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
Q

Yergason’s Test

A

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
Q

Flexor Digitorum Superficialis

A
  • 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
Q

Flexor Digitorum Profundus

A
  • assesses integrity of FDP tendon

- hold the metacarpophalangeal and proximal interphalangeal joints in extension. pt flexes distal phalanx

156
Q

Snuffbox Tenderness

A
  • palpate snuffbox

- tenderness over snuffbox indicates scaphoid fracture

157
Q

Phalen’s Test

A
  • 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
Q

Tinel’s Sign

A
  • 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
Q

Thomas Test

A
  • tests for hip flexion contracture

- unaffected leg brought to chest, knee flexion in affected leg off the table.

160
Q

Trendelenburg Test

A
  • test for weak hip abductors

- patient stands and lifts one leg… the pelvis sinks when hip abductors are weak.

161
Q

Boutonniere Deformity

A

hyperflexed proximal interphalangeal (PIP), hyperextended distal interphalangeal (DIP)

162
Q

Swan Neck Deformity

A

hyperflexed DIP, hyperextended PIP

163
Q

Dupuytren’s Contracture

A

you know

164
Q

Trigger Finger

A

tendon nodule causes stucked flexed digit

165
Q

De Quervains Tendonitis

A

inflammed tendon sheath, tenderness over extensor and abductor tendon

166
Q

Finkelstein Test for De Quervains

A

thumb in fist, adduct wrist, pain is positive for De Quervain’s

167
Q

Ankylosing Spondylitis

A

hereditary chronic inflammitory Disease affecting lumbar spine and sacroiliac joints

168
Q

Carpal Tunnel Syndrome

A

pressure on median nerve through carpal tunnel

169
Q

Fibromyalgia

A

painful non-articular condition that leads to diffuse musculoskeletal discomfort

170
Q

Tenosynovitis

A

inflammation of a sheath of a tendon or the tendon

171
Q

Confusion

A

not oriented to person place or time but has normal level of consciousness

172
Q

Lethargy

A

drowsy, sleepy, but will respond correctly when awoken then fall back asleep.

173
Q

Obtunded

A

able to open eyes and look, but slow responses and confused, decreased alertness

174
Q

Stupor

A

slow responses, simple motor or moaning to stimuli. arousable for short periods of time.

175
Q

Coma

A

not awake

176
Q

Glasgow Coma Scale - Eyes (1-4)

A

1- none
2- to pain
3- to voice
4- spontaneous

177
Q

Glasgow Coma Scale - Verbal (1-5)

A 
1- none
2- incomprehensible
3- inappropraite
4- disoriented
5- normal
178
Q

Glasgow Coma Scale - Motor Response (1-6)

A 
1- none
2- extends to pain
3- flexes to pain
4- withdrawls to pain
5- localizes to pain
6- normal
179
Q

Cranial Nerve Tests: CNI

A

use two scents, one for each nostril

180
Q

Cranial Nerve Tests: CNII

A

Snellen or Rosenbaum Charts

Visualize Fundi, optic disc

Confrontation Test, peripheral fields

181
Q

Cranial Nerve Tests: CNII, III (PERLA)

A

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
Q

Cranial Nerve Tests: CNIII

A

all movements except lateral gaze and inward rotation when looking down (intorsion) are controlled by CNIII

183
Q

Cranial Nerve Tests: CNIV

A

superior oblique - inferomedial - superior oblique (SO4)

184
Q

Cranial Nerve Tests: CNV

A

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
Q

Cranial Nerve Tests: CNVI

A

lateral rectus (LR4) increased intracranial pressure due to long course of nerve will cause LOF here

186
Q

Cranial Nerve Tests: CNVII

A

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
Q

Cranial Nerve Tests: CNVIII

A

Auditory - whisper test, weber test, Rinne test

Vestibular - Romberg test

188
Q

Cranial Nerve Tests: CNIX, X

A

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
Q

Cranial Nerve Tests: XI

A

motor to SCM - test strength against hand

motor to trapezius - test shoulder shrug strength

190
Q

Cranial Nerve Tests: CNXII

A

motor to tongue, speech (l, t, d, n) swallowing.

assess tongue semetry, tongue lift to nose

assess tongue strength against inside of cheek

191
Q

Cerebellar Function - Finger Thumb Test (diadochokinesia)

A

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
Q

Cerebellar Function - Palm up/down

A

ipsilateral

palms on lap, up and down, faster and faster

samesies as finger thumb test

193
Q

Cerebellar Function - Finger to Nose

A

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
Q

Cerebellar Function - Finger-Nose-Finger

A

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
Q

Cerebellar Function - Heel to Shin

A

ipsilateral - lower extremity

any position, sitting standing lying, heel to shine (straight line)

abnormal - ataxia, dysmetria, intention tremors, proximal muscle weakeness

196
Q

Cerebellar Function - Balance (Romberg)

A

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
Q

Cerebellar Function - Hop Test

A

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
Q

Cerebellar Function - Observe gait

A

abnormal gait = cerebellar, vestibular, hemiplegia, parkinson’s , cerebellar ataxia, footdrop, sensory ataxia

199
Q

Cerebellar Function - Heel - Toe Walking (Tandem walk)

A

like the cops do.

abnormal - like the drunks do

200
Q

Cerebellar Function - Heel walk, Toe walk

A

assess corticospinal tract in conjunction with muscular function

Abnormal Heels - corticospinal tract - foot drop

Abnormal Toes - gastrocnemius weakness

201
Q

Cerebellar Function - Pronator Drift

A

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
Q

Sensory Function - Superficial Pain

A

pt eyes closed, dull and sharp cotton swab, if cannot identify = spinothalamic tract, peripheral neuropathy, thalamis damage, sensory cortex damage

203
Q

Sensory Function - Superficial Touch

A

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
Q

Sensory Function - Vibration Sense

A

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
Q

Sensory Function - Proprioception

A

pt eyes closed, hold joint in neutral, demonstrate up and down, then quiz up and down. Abnormal = posterior column lesion or peripheral neuropathy

206
Q

Sensory Function - Graphesthesia

A

pt eyes closed, draw a letter or number on skin, abnormal = cannot identify the number posterior column or peripheral neuropathy

207
Q

Sensory Function - Stereognosis

A

pt eyes closed, hand pt everyday object, identify, Abnormal = tactile agnosia = parietal lobe lesion (sensory cortex), posterior column

208
Q

Sensory Function - Two Point Discrimination

A

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
Q

Reflexes - DTRs (deep tendon reflexes)

A

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
Q

Reflexes - Bicepts, Brachioradial, Tricepts, Patellar, Achilles

A

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
Q

Reflexes - Clonus

A

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
Q

Reflexes - Superficial Reflexes -Plantar, Cremasteric, Abdominal

A

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
Q

Miscellaneous - Monofilament Testing

A

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
Q

Affect

A

person’s external expression of his or her inner emotional state

215
Q

Afferent Pupillary Defect (Marcus-Gunn Pupil)

vs.

Internuclear Ophthalmoplegia

A

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
Q

Agraphia

A

loss of ability to express one’s self in writing due to central lesion or to muscular incoordination

217
Q

Akathisia (acathisia)

A

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
Q

Akinesia

A

complete of partial loss of muscle movement

219
Q

Aphasia

A

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
Q

Ataxia

A

impaired ability to coordinate muscular movement usually assiciated with staggering gait and postural imbalance.

221
Q

Athetosis

A

slow twisting writhing movements with larger amplitude than chorea, commonly involving the hands

222
Q

Chorea

A

dance like involuntary rapid movements, can be associated with huntington’s disease, rheumatic fever, systemic lupus erythematosus, and other conditions

223
Q

Dysarthria

A

defective articulation secondary to a motor deficit involving the lips tongue palate or pharynx (anability to pronounce or articulate words)

224
Q

Dysadochokinesia

A

inability to quickly substitute antagonistic motor impulses to produce antagonistic muscular movements. Inbability to perform rapid alternating movements (pronation/suination)

225
Q

Dysesthesia

A

Sensations, as of the pricks of pins and needles or crawling.

226
Q

Dyskinesia

A

defect in voluntary movement. usually used in relation to extrapyramidal disorders

227
Q

Dysphasia

A

Impairment of speech resulting from brain lesion

228
Q

Dysphonia

A

difficuly in speaking, hoarsness. often related to weakness of laryngeal muscles in which sound production is impaired

229
Q

Dystonia

A

impaired disordered tonicity, especially muscle tone (involuntary muscle spasms)

230
Q

Fasciculations

A

a localized, uncoordinated twitching of a single muscle group innervated by a single motor nerve filament. it is visible or palapable.

231
Q

Fluent Aphasia (Wernicke’s or receptive aphasia)

A

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
Q

Graphesthesia

A

the ability to recognize symbols, shapes, numbers, and letters traced on the skin.

233
Q

Hemianopia

A

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
Q

Hemiballismus

A

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
Q

Myelitis

A

Inflammation of the spinal cord or bone marrow

236
Q

Myelopathy

A

any pathological condition of the spinal cord.

237
Q

Myoclonus

A

twitching or clonic spasm of a muscle or group of muscles

238
Q

Myopathy

A

any disease or abnormal condition of striated muscle (weakness that is greater proximal than distal)

239
Q

Non-Fluent Aphasia (Broca’s or expressive aphasia)

A

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
Q

Paralysis

A

temporary suspension or permanent loss of function (especially loss of sensation or voluntary motion)

241
Q

Paresis

A

partial or complete paralysis

242
Q

Paresthesia

A

unusual sensation such as numbnness, tingling, or burning

243
Q

Stereognosis

A

ability to recognize form of solid objects by touch

244
Q

Tremor

A

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
Q

Res Ipsa Loquitur

A

the thing speaks itself

246
Q

Kobayashi Maru

A

the unbeatable test

247
Q

stomatitis

A

sore mouth

248
Q

Glossitis

A

inflammation and soreness of the tongue

Medical School (3 decks)

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