307 Exam 5 Study Guide Questions Flashcards
What kinda of arthritis of the hands produces Herberden nodes and sometimes Bouchard nodes (bony overgrowth)
Osteoarthritis (degenerative joint disease)
What kind of arthritis of the hands presents as fingers deviating towards ulnar side, fingers may form swan neck deformities, and boutonniere deformities might develop?
CHRONIC rheumatoid arthritis
What disease creates knobby swelling around the joints that ulcerate and discharge white chalk like urates?
Chronic toohaceous gout
What is a positive Tinel sign?
When Tapping over the median nerve produces aching and numbness
How long do you hold a phalens sign for a positive result
60 seconds
What is the phalen test
Holding the wrists in flexion pressed together
Tests for carpal tunnel
When testing opposition of the thumb, the client has difficulty opposing your resistance. What could this indicate
Median nerve disorder
Carpal tunnel syndrome
Swelling over the patella suggests what?
bursitis, synovial thickening,
Effusion, ruptured achilles tendon
What is the process for physical inspection of the knee
Observe the gait, check the alignment and contours of knee, observe any muscle atrophy, look for swelling or hollows on or around knee
Palpate
Tibialfemoral joint
Suprapatellar pouch
Prepatellar bursa and anserine bursa
Gastroc, so keys and Achilles
ROM
Muscle strength test
What position is the patient in during palpating of a knee examination
Sitting on the edge of the examining table with knees in flexion.
What is the patellofemoral grinding test?
With the patient supine, and knee extended, compress the patella against underlying femur. Ask patient to tighten quads. Check for a smooth sliding motion of patella moving distally in the trochlear groove
If there is tenderness over the patellar tendon or an inability to extend the leg what does this suggest
Partial or complete tear of tendon
What movements do you assess with ROM of hip
Flexion
Hyperextension
Abduction
Adduction
External and internal rotation
Restricted hip abduction is common with what
Hip osteoarthritis
Risk factors for osteoporosis measuring tool is called what?
FRAX
Over 50
Low body mass
Low calcium
Low vit d
Poor fragility fracture
Relative with osteoporosis
Sedentary
Tobacco and alcohol
Inflammatory disorders
Corticosteroids use
Long term anticoagulants
What is a scaphoid fracture
A broken bone near the base of the thumb.
Tenderness over the “snuff box” is a sign of this. It is the most common injury of carpal bones
4 signs of inflammation in a joint
Swelling
Warmth
Tenderness
Redness
Relieving factors for spinal stenosis
Flexion
What spinal nerve innervates the diaphragm and controls breathing?
Phrenic nerve
The brachial plexus nerves innervate what area
The arms
The axillary nerve innervates
Teres minor and deltoid
What nerve runs down the anterior region of the arm?
Musculocutaneous nerve.
Innervates
Biceps brachii
Coracobrachialis
Brachialis
Nerve runs down back of arm and back of forearm
Radial nerve.
Triceps, all wrist extensors
Brachioradialis
Nerve that runs along anterior medial side of forearm and innervates pinky and ring finger is?
Ulnar nerve
What nerve runs down the middle of fore arm into the hand innervates carpal tunnel
Median nerve
Nerve that runs through anterior portions of thigh
Femoral nerve
Hip flexors are innervated by what nerve
Femoral nerve
Nerve that runs down the medial portion of thigh.
Obtruratur nerve.
Adductor muscles innervated
Nerve that innervates Posterior thigh
And is actually 2 nerves bundled
Sciatic nerve.
Branches off at knee into
Tibial (posterior) and peroneal (anterior and lateral)
Primary sensory modalities tested on physical exam include
Pain; light touch; vibration ; temperature; proprioception.
T4 dermatome sensory area?
Chest at the level of nipple
(Remember “T4 at Teet port”)
T7 dermatome sensory area
Chest at level of xyphoid process
Remember T7- at the bottom of sternum
T10 dermatome level of sensory area
Abdomen at umbillicus
Remember T10 at belly button
C6 dermatome innervates
Radial sure of forearm and Thumb
C7 dermatome innervates
Middle finger
C8 dermatome innervates
Pinky
T4 dermatome innervates
Thorax at level of nipples
Spinal stenosis relieving factors
Pain decrease with sitting or walking uphill (flexion)
More pain with extension
Scoliosis ABDC
A=Adams test
B=bending
C= cobbs
D= degrees
Adams test is bending foreword
Cobbs measures the degrees
Treatment for various degrees of scoliosis?
(Hint doubles)
If scoliometer is greater than 5 degrees - get X-ray.
10 degrees = definition of scoliosis
20 degrees= brace
40 degrees= surgery
C5 dermatome is associated with what deep tendon reflex
Biceps
C6 dermatome sensation and DTR
Dorsal lateral arm, forearm and thumb
Brachioradialis Deep tendon reflex
C 7 dermatome goes along where?
What dtr?
Posterior arm.
Triceps DTR
C8 dermatome controls what?
Pinky finger
L5 Dermatome is associated with what area
Lateral thigh. Top of foot. First and second toe (flip flop area)
Decreased big toe extension
S1 dermatome is associated with what area and DTR
Posterior leg and calf
Achilles tendon DTR (decreased ankle jerk)
Decreased plantar flexion (stepping on gas)
Leg pain that resolves with rest or lumbar forward flexion suggests what
Spinal stenosis
What are tremors that would be associated with Parkinson’s and present as fine pill rolling that are prominent with test and disappear with voluntary movement
Resting static tremors
What tremors can appear with hyperthyroidism, anxiety and fatigue?
Postural (action) tremors
What tremors are absent at rest and get worse as the intended object of reach is neared? Seen with what disease?
Intention tremors
Multiple sclerosis
What is receptive aphasia?
Wernicke aphasia
Articulation is good but Sentences lack meaning; speech incomprehensible
Lesion on posterior superior temporal lobe.
Comprehension is not there
What is expressive aphasia?
Broca aphasia
Nonfluent or laborious effort to speak. Lesion on posterior inferior frontal lobe
Comprehension is there but cannot express
Tandem walking can reveal what
Ataxia that might not be obvious
Corticospinal tract damage is tested with what
Inability to heel walk
During a hop in place test ,Difficulty with hopping may be due to what
Weakness, lack of position sense, or cerebellar dysfunction
Reflex grading scale
0- no response
1 -diminished
2 -average
3-brisker than average (maybe disease)
4- hyperactive
Hyperactive reflexes occur with what kind of lesions
CNS lesions along the descending Corticospinal tract
What is clonus
And what does sustained clonus indicate?
Rhythmic oscillations
CNS disease
How to assess an unconscious patient
Assess abc are stable
Assess w/ Glasgow coma scale
Assess level of consciousness
Interview friends, relatives, witnesses to establish speed of onset.
***
Observe pupil reactions
Ocular movement
Posture and muscle tone
Meninges signs
During examination of a comatose patient what 2 things should you not do!
Don’t dilate the pupils
Don’t flex the neck if there is any question of trauma to head or neck.
Large, fixed dilated pupils in a comatose patients suggests what
Severe anoxia and sympathomimetic effects (stimulant drugs), as seen after cardiac arrest.
Or
Atropine like agents.
One large pupil that is fixed and dilated in a comatose patient warns of what
Herniation of temporal lobe cause of compression of oculi motor nerve and midbrain.
Common in diabetic patients with CN3 palsy
Small pin point pupils less than 1mm suggests what in a comatose patient
A hemorrhage in the pons OR
Effects of morphine or narcotics
Mid position fixed pupils in a comatose patient means what
Structural damage in the midbrain
Structural lesions from stroke, bleeding, abscess, or tumor mass may lead to what assessment finding in a comatose patient
Asymmetric pupils and loss of light reaction due to pressure on cranial nerves.
How to reduce risk of diabetic neuropathy
Maintaining optimal glycemic control.
Having feet examined regularly
(128hz tuning fork, semmes-Weinstein monofilament, check for skin breakdown, poor circulation and musculoskeletal abnormalities
FAST acronym for stroke warning signs?
Face drooping
Arm weakness
Speech difficulty
Time to call 911
Stroke risk factors
HTN
Smoking
Dyslipidemia
Diabetes
Obesity
Poor diet(high salt high fat)
Inactive
Alcohol
Sleep apnea
CAD
A fib
To assess the ROM what instrument to do you use?
Goniometer
what 3 ROM do you assess in TMJ
Open close of mouth
Protrusion and retraction
Lateral (side to side)
What would palpable crepitus or clicking over the TMJ suggest
Meniscus injury, dislocation, trauma, Tmj syndrome
What are the posterior sensory nerve columns of the spinal cord responsible for?
Sensations of vibrations,
Proprioception
Kinesthesia
Pressure
Fine touch
What is a hemorrhagic stroke
Bleeding into the brain
What is an ischemic stroke
Blood flow to brain in blocked.
These have 3 causes
Thrombus- blood clot in brain or neck
Embolus- moving blood clot from another area of body
Stenosis- narrowing of artery in brain
What are important meningeal signs
Neck mobility (nuchal rigidity)
-neck stiffness with flexion 👎
Brudzinski sign
- flexion of hips and knees during neck flexion 👎
Kernig sign
-
How to assess weakness in the hands
Test extension against resistance and test grip.
Finger abduction
Opposition of the thumb
What nerve would be impaired with weak finger abduction?
Ulnar nerve
C3 dermatome is associated with what part of the body
Neck
L5 dermatome innervates what area of body
L5 vertebral area of low back and wraps around the hips, down side of legs and into the front of clad below the knee. Top of foot. Big toe, second toe
Interventions for spinal stenosis
NSAIDs
Epidural steroid injections
Decompression surgery
PT
Weight loss
Muscle strength grading scale
0-5
0 = No contraction
1= barely noticed
2= active without gravity
3= active w/ gravity
4= active against some resistance
5= active against full resistance (normal)
Tenderness and warmth over a thickened synovium suggests what
Arthritis or infection
Muscle atrophy or weakness occurs in rheumatoid arthritis t/f
True
Restless leg syndrome. Aka Willis-ask I’m disease
Unpleasant sensation in legs w/ urge to move especially at night. Worse w/rest and improve w/ movement
What are reversible causes of restless leg syndrome
Pregnancy
Renal disease
Iron deficiency
What are oral facial dyskinesias
Bizarre facial movements and tix that involve tongue protrusions, jaw deviations, and opening closing of mouth
Can come from psychosis, or be a complication of psychotropic drugs.
What is Dystonia
Neck twisting. Like from torticollis
Athetosis is what
Slow twisting and writhing of fingers and hands. Causes include cerebral palsy
Brief, rapid, jerky, unpredictable movements that occur at rest and seldom repeat are called.
Chorea. From huntingtons and rheumatic fever
What is the Pound acronym and what is it for?
Pulsatile or throbbing
One day duration or 4-72 hrs untreated
Unilateral
Nausea or vomiting
Disabling
If 3/5 are present it is likely a migraine especially is preceded by aura or prodrome
Glasgow coma scale scores less than 10 are concerning for severe brain injury? T/f
False.
Scores of 3-8 considered coma
15= fully functioning
3= lowest possible score. No response in any area
What assessment techniques are done during a vertebral assessment
Inspection and palpation
Damage to the sympathetic pathways if the hypothalamus can cause what symptoms.
Bilaterally small pupils.
What part of the nervous system plays a role in anxiety
Autonomic nervous system
—sympathetic nervous system is fight or flight
—parasympathetic nervous system is test and digest
(Think parasympathetic = paralyzed, aka relaxed)
When assessing levels of consciousness what techniques are used
Alertness- speak in normal tone(responds appropriately)
Lethargy- speak in loud voice( responds drowsy and falls back asleep)
Obtunded- shake patient gently(responds slowly w/ decreased interest in environment)
Stupor- apply painful stimulus (responds only to that)
Coma- apply repeated painful stimuli (no response=coma)
Pinpoint pupils in a comatose patient means
Pons hemorrhage or narcotic effects
Mid position fixed pupils in comatose patient means what
Damage to midbrain
Abnormal postures in comatose patients
Decorticate rigidity- everything flexed, destructive lesion in Corticospinal tract
Hemiplegia- one sided paralysis, unilateral brain damage
Decerebate rigidity- jaw clenched, extended neck, knees and elbows. Probated forearms. Caused by a lesion in the diencephalon, midbrain, pons or from hypoxia or hypoglycemia
Aphonia is what
Loss of voice
Laryngitis, vocal cord paralysis (CN X) laryngeal tumor.
Dysarthria is what
Defect in muscle control of speech
(Lips, tongue, palate & pharynx. )
Motor lesion of central and peripheral nervous system. Parkinson’s and cerebral disease
Apisia is what
A disorder in producing or understanding language.
Lesion in dominant cerebral hemisphere (usually left)
When referring to gait what is swing?
Gait phase where the foot does not touch the ground
Sacral segments dermatomes innervate where
Sacral region, back of the legs, and lateral side of feet
glasgow coma scale rating
13-15 minor
9-12 moderate
3-8 severe
eye response scoring for glasgow coma scale
spontaneous = 4
to speech= 3
to pain= 2
not= 1
verbal response for glasgow coma scale
A&O x4 = 5
confused=4
inappropriate verbal response= 3
incomprehensible sounds = 2
none=1
motor response for glasgow coma scale
obeys commands = 6
moves to localized pain= 5
withdrawas from painful stimuli= 4
abnormal flexion= 3
abnormal extension =2
none= 1
comatose clients would rate what on the glasgow scale
8 or less (sever brain injury)
glasgow rating of 9-12 means
moderate brain injury
If a person can write a correct sentence can they still have apashia?
No
A person who scores less than 17 points on a mini mental state exam would indicate what?
Severe cognitive impairment
30 is the max points as cognition declines, so does score.
What is the PHQ used to screen?
Patient health questionnaire is used to screen for depression
What screening tools are used for depression
PHQ
Geriatric depression scale
EDS (Edinburgh postnatal depression scale)
SAFE-T evaluates what?
Suicide risk
What is anhedonia?
Not finding pleasure in daily activities
Clients most at risk for depressive symptoms would include
Females
Divorced or single
Chronically Ill
Young
Bereaved
Prior or family history of depression
What is confabulation
Fabrication of facts or events in response to questions, to fill in the gaps of an impaired memory.
Often seen in Korsakoff syndrome from alcoholism, dementia, schizophrenia, aphasia or psychotic disorders.
Korsakoff syndrome is what
A memory disorder results from vitamin B1 deficiency associated with alcoholism.
Derailment is what
Tangential speech with shifting topics that are loosely connected or unrelated. Seen with schizophrenia
Neologisms are what
Invented or distorted words
Words with new and highly idiosyncratic meanings.
Occurs with Korsakoff syndrome from alcoholism.
Metabolic syndrome risk factors include
Large waist circumference (m> 40, f> 35)
High blood pressure >130/85
High fasting blood sugar 100mg/dL
High triglycerides 150mg/dL or higher
What cranial nerve is involved with chewing
Trigeminal
