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Pod Exam 1 > 1: History and Physical Exam - Mahoney > Flashcards

1: History and Physical Exam - Mahoney Flashcards

1
Q

cc should contain…

A 
age
race
sex
occupation
referred by
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2
Q

who needs to be asked about pregnancy?

A

women 12-50 yo

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3
Q

what ROS questions should be asked in regards to DM?

A 
type
duration
last accucheck
last Hgb A1C
last time checked by family physician
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4
Q

gravida vs. para

A

of pregnancies

of births

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5
Q

THE CHADS

A 
thyroid
heart
emphysema
cancer
hypertension
asthma
diabetes
stroke
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6
Q

what info do you need about meds?

A 
dosage
amount
frequency
route 
length of time taking med
last taken
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7
Q

CPMS clinic policy regarding foot exams

A

wash hands AND apply gloves prior to any exam or tx of feet

wash hands after visit completed

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8
Q

normal pulse

A

2/4

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9
Q

pulse with a thrill or bruit

A

4/4

can be associated with a wide pulse pressure (greater than 60 mmHg)

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10
Q

FACTS and wide pulse pressure

A 
fevere
aortic insufficiency
complete heart block
thyrotoxicosis
systolic hypertension
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11
Q

pulses that should always be reported and for each limb separately

A

dorsalis pedis pulse and posterior tibial pulse

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12
Q

technique for CFT capillary fill time

A

apply firm digital pressure to the tip of a toe for 3 sec

after releasing your finger, the skin blanches white

a delay beyond 3 sec of return to normal skin color indicates decrease arterial flow into the capillary bed

avoid pressing over toenail to cause blanching due to frequency of thick nails which makes evaluation of the CFT difficult

any delay in CFT can be associated with either vasospasm or structural changes to the lg vessels supplying the microcirculation

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13
Q

non-pitting vs. pitting edema

A

pitting - prtn poor exudate

non-pitting - prtn rich exudate

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14
Q

method for checking edema

A

press firmly with your thumb for at least 5 sec over area of max swelling

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15
Q

pitting edema scale

A

1+ indentation 2 mm
2+ indentation 4 mm
3+ indentation 6 mm
4+ indentation 8 mm

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16
Q

how do you test for turgor and mobility?

A

lift a fold of skin and note the ease with which it is moved (mobilitiy) and the speed with which it returns into place (turgor)

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17
Q

flat, non-palpable less than .5 cm

A

macule

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18
Q

flat, non-palpable greater than .5 cm

A

patch

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19
Q

palpable, solid less than .5 cm

A

papule

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20
Q

palpable, solid .5-1 cm

A

nodule

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21
Q

palpable, solid greater than 1 cm

A

tumor

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22
Q

palpable, solid elevated surface formed by coalescence of papules greater than .5cm in size

A

plaque

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23
Q

clear, fluid filled less than .5 cm

A

vesicle

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24
Q

clear, fluid filled greater than .5 cm

A

bulla

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25
Q

cloudy, pus filled less than .5 cm

A

pustule

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26
Q

cloudy, pus filled greater than .5 cm

A

abscess

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27
Q

0A ulcer classification

A

no break in skin

no inf. or ischemia

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28
Q

IA ulcer classification

A

to subcutaneous

no infection or ischemia

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29
Q

IIA ulcer classification

A

to tendon

no infection or ischemia

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30
Q

IIIA ulcer classificiation

A

to bone

no inf. or ischemia

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31
Q

IB ulcer classification

A

to subcutaneous

infection

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32
Q

IIB ulcer classification

A

to tendon

infection

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33
Q

IIIB ulcer classification

A

to bone

infection

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34
Q

IC ulcer classification

A

to subcutaneous

ischemia

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35
Q

IIC ulcer classification

A

to tendon

ischemia

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36
Q

IIIC ulcer classification

A

to bone

ischemia

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37
Q

ID ulcer classification

A

to subcutaneous

ischemia and infection

38
Q

IID ulcer classification

A

to tendon

infection and ischemia

39
Q

IIID ulcer classification

A

to bone

infection and ischemia

40
Q

normal hip ROM

A 
45 internal and external rotation
45 abduction
20 adduction
120 flexion
0-15 hyperextension
41
Q

normal knee ROM

A

130 flexion

15 hyperextension

42
Q

normal ankle ROM

A 
10 dorsiflextion (knee extended and flexed)
50 plantarflexion
43
Q

STJ normal ROM

A

20 inversion

10 eversion

44
Q

1st MPJ normal ROM

A

60 dorsiflexion

5-10 plantarflexion

45
Q

1st ray normal ROM

A

10 mm total ROM

46
Q

movement against gravity but not against added resistance

A

3/5

47
Q

movement at joint, but not against gravity

A

2/5

48
Q

b/c normal pod msk exam occurs in sitting position with feet elevated, active movement of the foot and ankle against resistance implies that the muscle strength rating is at least..

A

2/5

49
Q

early loss of strength is usually seen in

A

extensor digitorum brevis

weakness is normal after 65 yo

50
Q

more sever m. strength loss seen with

A

ankle dorsiflexion

most severe loss seen with ankle plantarflexion

51
Q

mediate voluntary movement, particularly fine, discrete, conscious movement

A

corticospinal or pyramidal tract

problem could be CVA

52
Q

helps to maintain m. tone and to control body movements, especially gross automatic movements such as walking

A

extrapyramidal tract

problem could be parkinsons

53
Q

receives both sensory and motor input and coordinates muscular activity - maintains equilibrium and helps control posture

A

cerebellar system

problem could be seen as a loss of the sense of balance

54
Q

after entry into the dorsal (posterior sensory) spinal cord, the sensory impulse proceeds along one of two courses:

A

posterior column

lateral spinothalamic tract

55
Q

pt complains of burning, cramping

A

lateral spinothalamic tract

56
Q

sharp and dull pain
temp
crude touch

A

lateral spinothalamic tract

57
Q

composition of lateral spinothalmic tract

A

aka small tract

C and Adelta fibers

58
Q

composition of large fiber tract

A

a alpha fibers

aka posterior column

59
Q

position
vibration
fine touch

A

posterior column

60
Q

patient complains of pins and needles or electric shock sensation

A

posterior column

61
Q

SWM tests which tract?

A

lateral spinothalamic

62
Q

describe how to use the SWM

A

using a 5.07 SWM apply pressure to 1st, 3rd,5th metatarsal heads and toes, the plantar arch, the plantar hell, beneath the 5th metabase and the dorsal midfoot

inability to detect the pressure in more than 3 areas suggests the potential for neurotrophic ulceration, especially in the diabetic

63
Q

describe the sharp dull test

A

use th cotton tip and opposite end to test dull vs. sharp along at least 2 dif dermatomes

ask pt to close eyes then touch asking “which is sharper the first touch or the second touch or are they same?”

64
Q

sensory tests for posterior column

A

vibration
position sense
2pt discrimination

65
Q

describe the vibration test

A

use a 128 cyc/sec tuning fork over IPJ of hallux, ask pt to tell you when it stops vibrating

place tuning fork over DIPJ of your index finger - vibration should extinguish withing 10 SECONDS

if sensed found to be decreased, proceed more proximally over bony prominences until vibration felt and note area of normal pallesthesia

66
Q

normal minimal distance at which the pt can discriminate one from two pts on the tip of great toe

A

5-6 mm

67
Q

when is an absent achilles reflex normal?

A

after 80 yo

68
Q

using reinforcement to facilitate observation of reflexes in LE

A

jendressic maneuver

document as “reflex with reinforcement”

knee: L2,3,4
ankle: S1,2

69
Q

deep reflexes are dependent on 5 things. They are NOT dependent upon higher levels of motor function in brain and cord.

A 
intact sensory n.
functional synapse in spinal cord
intact motor n. fiber
NMJ 
competent m.
70
Q

normal reflex grade

A

2/4

4/4 may be associated with clonus and indicates UMN disease
0/4 no response, LMN disease

71
Q

reflex and dermatome patterns ***

A 
hip - L23
knee  - L34
ankle - L45
achilles- S12
back of  knee - L5,S1
butt - L45
72
Q

ankle reflex associated with which n. roots?

A

S1,2

73
Q

normal babinski (superficial reflex)

A

flexing

fanning and dorsiflexion is abnormal and indicates UMN disease

74
Q

how do you do the bedside babinski

A

remove pt socks in bed or after placing bedsheet under heel, pull it out from under heel and over toes

75
Q

if pt can stand on tiptoes but not on heels =

A

peripheral neuropathy

stand on heels but not on tiptoes = spinal lesion

76
Q

hop in place with each foot

A

intact motor system in legs
normal cerebellar function
good position sense

77
Q

another word for diagnosis

A

impression

78
Q

why might a child present with a limp?

A

Hip AVN
Kohler’s disease (AVN of navicular)
tarsal coalition
child abuse

79
Q

what should you ask about fetal movements?

A

was the mother aware of fetal movements beginning in 4th mo of pregnancy?

80
Q

APGAR *** =

A 
appearance (skin color)
pulse (heartbeat)
grimace (response to touch or pin-prick)
activity (muscle tone)
respirations (breathing)

taken immediately and 5 min post birth

desirable score greater than 7

less than 5 - 20% chance breathing difficulty

81
Q

no hand preference until the age of…

A

2

if before 2 could be neuromuscular prob

82
Q

lift head

A

3 mo

83
Q

control head position while sitting

A

6 mo

84
Q

crawl

A

6 mo

85
Q

pull self to stand

A

9 mo

86
Q

walk

A

14 mo

87
Q

ascend stairs with 2 hand support

A

18 mo

88
Q

run forward

A

2 yr

89
Q

pedal tricycle

A

3 yr

90
Q

balance or hop on one foot

A

4 yr

91
Q

heel-toe walk

A

5 yr (normal heel-toe gait)

92
Q

skip one foot at a time

A

6 yr

Pod Exam 1 (16 decks)

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