518 Exam 2 Flashcards
1
Q
What colour are conjunctiva normally? When would they be bloodshot?
A
Normally transparent. Blood shot during infection,, inflammation and injury.
2
Q
Lesions on this pathway may impair sympathetic effects that dilate the pupil and cause mitosis.
A
Lesion in : hypothalamus. Brain stem. Cervical cord. Brachial plexus. Superior cervical ganglion.
3
Q
Which cranial nerve innervates lateral rectus muscle ? (Eyes)
A
CN VI , abducens
4
Q
Which cranial nerve supplies superior oblique muscle ? (Eyes)
A
Trochlear Nerve CN IV
5
Q
Which cranial nerve supplies all other extra ocular muscles ? (Excluding lateral rectus and superior oblique)
A
Oculomotor nerve CNIII
6
Q
What is diplopia
A
Double vision
7
Q
What is hyperopia
A
Difficult with close work (farsightedness)
8
Q
What is presbyopia
A
Aging vision
9
Q
What is difficulty with distance vision? Or near sightedness
A
Myopia
10
Q
Sudden visual loss is unilateral and painless. What could it be ?
A
Vitreous hemorrhage from diabetes or trauma, macular degeneration, retinal detachment, retinal vein occlusion or retinal artery occlusion
11
Q
If sudden visual loss is painful , what are typical causes?
A
Usually in the cornea and anterior chamber. Corneal ulcer, uveitis, traumatic hyphema, acute angle glaucoma
12
Q
Unilateral vision loss associated with headache, jaw pain or jaw claudication can be associated with _____?
A
Giant cell arteritis
13
Q
Bilateral and painless vision loss consider ?
A
Vascular etiologies , stroke , or non physiologic causes
14
Q
Bilateral and painful vision loss consider?
A
Intoxication, trauma, chemical or radiation exposure
15
Q
Gradual bilateral vision loss usually arises from?
A
Cataracts, glaucoma, macular degeneration
16
Q
Slow central vision loss can occur with
A
Nuclear cataract and macular degeneration
17
Q
Peripheral vision loss can be seen in
A
Advanced open angle glaucoma
18
Q
What are moving specks or strands that can appear as moving flashes of light across the visual field ? When can they occur?
A
Vitreous floaters. Occurs when posterior vitreous detaches from retina. Can sometimes cause retinal detachment.
19
Q
What is a scotoma? What does it suggest ?
A
Fixed defects or blind spots. Suggests lesions in the retina.
20
Q
Brain disorders such as seizure, migraine or reduced blood flow can cause what temporarily ?
A
Temporary scotoma
21
Q
Red painless eye is seen in ___? What does it look like? It it harmful or harmless
A
Subconjuctival hemorrhage. Bright red patch. Usually harmless.
22
Q
Red painful eye can be seen in
A
Episcleritis
23
Q
What causes episcleritis?
A
Allergic response, autoimmune, vascular disease, infection
24
Q
What are symptoms of episcleritis?
A
Redness, erythema, discomfort in the eyes and clear discharge. Sometimes painful.
25
What are symptoms of episcleritis?
Redness, erythema, discomfort in the eyes and clear discharge. Sometimes painful.
26
What are symptoms of viral conjunctivitis and dry eye
Red eye with gritty sensation
27
Diplopia is seen in lesions where?
Brainstem and cerebellum, and with weakness of one or more extraocular muscles
28
What’s the difference between presbyopia and hyperopia
Both cause blurry close up vision but underlying cause is different. Presbyopia occurs when lens loses flexibility. Hyperopia (farsightedness) occurs when eyeball is too short or cornea is too flat.
29
What’s the difference between presbyopia and hyperopia
Both cause blurry close up vision but underlying cause is different. Presbyopia occurs when lens loses flexibility. Hyperopia (farsightedness) occurs when eyeball is too short or cornea is too flat.
30
What are causes of anterior pathway defects in the visual field?
Glaucoma, optic neuropathy, optic neuritis, compressive lesions
31
What are causes of anterior pathway defects in the visual field?
Glaucoma, optic neuropathy, optic neuritis, compressive lesions
32
What is glaucoma
Chronic, progressive eye disease that causes damage to the optic nerve and leads to visual field loss.
33
What is glaucoma
Chronic, progressive eye disease that causes damage to the optic nerve and leads to visual field loss.
34
Eye pressure is a risk factor for what disease
Glaucoma
35
What is it called when the group of nerve fibers that transfer visual information from the eye to the brain become damaged
Optic neuropathy
36
What is it called when the group of nerve fibers that transfer visual information from the eye to the brain become damaged
Optic neuropathy
37
What is optic neuritis
When inflammation or swelling damage the optic nerve
38
Symptoms of optic neuritis?
Pain with eye movement. Temporary vision loss in one eye.
39
Symptoms of optic neuritis?
Pain with eye movement. Temporary vision loss in one eye.
40
What causes posterior pathway defects in the visual field ?
Stroke. Chiasmal tumours.
41
What does the static finger wiggle test measure
Visual field
42
Colour vision testing can help rule out damage to what?
The optic nerve.
43
If patient sees a desaturation of colour with one eye what does it indicate
Contrast sensitivity
44
What is strabismus
Cross eyed
45
What is esotropia
When one eye deviates inward
46
What is it called when one eye deviates outward
Exotropia
47
A problem with eyesight or visual acuity related to eye alignment or position is called what
Amblyopia
48
What is upward deviation of the eye? What is downward deviation of the eye called ?
Upward is hypertropia, down is hypotropia
49
What is it called when eyelids don’t close fully? What causes it ?
Lagophtalmos, neuromuscular palsy, trauma, thyroid eye disease,
Exposes cornea to damage
50
What is a sagging or outward turning of an eyelid called?
Ectropion
51
What does Sjogren syndrome do to the eyes
Causes dryness from impaired secretion
52
What is a common form of glaucoma ?
Open angle
53
When is a nystagmus seen, what is it
Rhythmic oscillation of the eye. Seen in congenital disorders, labrynthitis, cerebellar disorders and drug toxicity
54
How do you test the 6 extraoccular movements
Six cardinal directions of gaze. Make a H.
55
How do you test for convergence
Have patient look at your finger as you move it toward the patients nose
56
What does absense of a red reflex mean? How do you test this
Dark room with opthalmascope. Absense suggests an opacity of the lenses like cataract or vitreous. Less commonly detached retina.
57
Retinal structures in a myopic eye look , smaller or larger than normal?
Larger
58
Retinal structures in a myopic eye look , smaller or larger than normal?
Larger
59
On an eye exam an enlarged cup suggests what
Chronic open angle glaucoma
60
What is a common finding in thyroid eye disease ?
Exophthalmos - which is abnormal bulging of the eyes from the eye socket
61
Describe acute iritis , pain? Vision changes? Discharge? Cornea ? Significance
Red eyes. Moderate aching deep pain. Photophobia. No discharge. Cornea clear or slightly clouded. Associated with systemic infection, herpes zoster, TB. Autoimmune disease. Refer promptly.
62
Corneal injury or infection. Pain? Vision change? Ocular discharge? Cornea?
Moderate to severe superficial pain. Vision usually decreased. Watery or purulent discharge. Cornea changes depending on cause. Significance: abrasion, injury, viral and bacterial infection
63
Red eye with - Severe aching deep pain with photophobia. Decreased vision. No discharge. Dilated fixed pupils. Steamy and cloudy cornea. Indicates what?
Acute angle closure glaucoma. Emergency.
64
Sore throat or pharyngitis usually associated with?
Acute upper respiratory infection
65
What is Centors rules for predicting streptococcal and fusobacterium pharyngitis?
Fever history, tonsillar exudates, swollen tender anterior cervical adenopathy, absence of cough
66
Hoarse throat for > 2 weeks, consider what?
Laryngoscopy and consider reflux, vocal cord nodules, hypothyroidism, head neck cancer, thyroid mass, neurological disease like Parkinson’s, ALS or myasthenia gravis
67
What is torus palantinus?
Benign lump in the middle of the roof of the mouth
68
A CN XII defect looks like what?
Tongue is not midline
69
Having the patient say AH and the rise of the soft palate tests what nerve
CN X, vagus
70
Asymmetric tonsils may signify what underlying pathology
Lymphoma
71
What would you see on the lips for early sign of measles (rubeola)?
Kolpik spots
72
What are the three bones or ossicles in the middle ear ? Which ones are visible through the tympanic membrane ?
Malleus, incus, stapes. Maleus and incus are visible.
73
What are the two chief landmarks of the middle ear ? What is the light reflection from the umbo?
The handle and short process of the malleus. Cone of light
74
The inner ear: what is each responsible for? Cochlea _____, semicircular canals______, otolith organs______
Cochlea - hearing , semicircular canals- balance. Sense rotational movement. Otolith organs - balance, linear movement.
75
Conductive hearing loss is caused by disorders of
The external ear - From cerumem impacting, infection (otitis externa), trauma, squamous cell carcinoma, benign bony growths
The middle ear / from otitis media, congenital conditions, cholesteatomas, otosclerosis, tympanosclerosis, tumour, perforated tympanic membrane
76
Sensorineural hearing loss occurs from disorders of _____? I.e ?
Inner ear. From congenital or hereditary conditions, presbycusis (old age), viral infection, meniere disease, noise exposure, ototoxic drug exposure, acoustic neuromas
77
Air conduction with normal hearing
Is AC> BC or BC> AC
AC>BC Air conduction is more sensitive than bone
78
Which sinuses can be readily examined
Frontal and maxillary
79
Yellow discharge from the ear associated with what ?
Acute otitis externa or chronic otitis media with perforation
80
Tinnitus associated with fluctuating hearing loss and vertigo. What is the condition ?
Meniere disease
81
Causes of vertigo:
Vestibular disease - usually peripheral from the inner ear. Includes. BPPV, labrynthitis, vestibular neuritis, meniere disease
Central causes - cerebral vascular disease or posterior fossa tumour
82
Acute bacterial sinusitis is unlikely until viral URI symptoms persist more than 7 days and what else should be present for diagnosis?
Purulent drainage and facial pain
83
Movement of the auricle and tragus is painful in what condition
Acute otitis externa
84
Tenderness behind the ear occurs in
Otitis media and mastoiditis
85
Postauricular swelling, fluctuance, erythema and significant tenderness are presentations of what ?
Otitis media which progressed to acute mastoiditis
86
Painful hemorrhagic vesicles on the tympanic membrane are presentations of what ?
Blistering TM from bullous myringitis
87
S&S of acute otitis externa
Canal is swollen, narrow, moist, erythmatous or pale, tender
88
Sign of otitis media
Red bulging tympanic membrane
89
Otitis media with serous effusion occurs with what? How long to resolve?
Cold,, sore throat or upper respiratory infection. Resolves in 2-3 weeks or myringotomy indicated if no improvement in 1-3 months
90
What does the Weber test test for and how do you do it
Test for lateralization , place tuning form middle top of head, ask if sound is louder in one ear or same in both ears. Normally heard midline or equally in both ears. Unilateral hearing loss- sound is heard in or lateralized to the impaired ear.
91
If sound goes to hearing impaired ear in the Webber test, how do you classify it ?
Unilateral conductive hearing loss
92
If sound goes to hearing impaired ear in the Webber test, how do you classify it ?
Unilateral conductive hearing loss
93
If sound goes to good ear in Webber test, how do you classify it ?
Unilateral sensorineural hearing loss
94
If sound goes to good ear in Webber test, how do you classify it ?
Unilateral sensorineural hearing loss
95
What test compares air and bone conduction for hearing ? How do you do it ?
Rinne test. Place vibrating tuning fork behind ear on mastoid bone. When pt says sound is no longer heard place near the ear canal and ask if sound can be heard. Normal: sound heard longer through air than bone.
96
BC > AC means what
Sound heard through bone longer than air = conductive hearing loss
97
Local tenderness, facial pain /pressure or fullness, purulent nasal discharge, nasal obstruction and smell disorder present for >7 days suggests ?
Acute bacterial rhinosinusitis involving frontal or maxillary sinus
98
Sudden dizziness or vertigo from rolling over or tilting head that lasts a few seconds , unaffected hearing, sometimes nausea, vomitting or nystagmus. Characterizes what?
BPV (benign positional vertigo)
99
Sudden dizziness, lasts hours up to 2 weeks, may reoccur over 12-18 months, hearing unaffected , nausea, vomit or nystagmus may be present. Characterizes what?
Vestibular neuritis
100
Sudden onset of lasts hours up to 2 weeks. May reoccur over 12-18 months. Sensorineural hearing loss that’s unilateral with possible tinnitus, nausea vomitting and nystagmus. Characterizes what?
Acute labrynthitis
101
Describe meniere disease.
Sudden onset of dizziness. Lasts 7 hours to a day. Recurrent. Sensorineural hearing loss which progresses. Tinnitus is present and fluctuates. Pressure or fullness in affected ear, nausea. Vomit. Nystagmus.
102
Acoustic neuroma involves what cranial nerves
Primary VIII, then CN V and VII.
103
Sudden onset dizziness with variable but rarely continuous duration , unaffected hearing. But with other brainstem defects like dysarthia, ataxia, crossed motor and sensory deficits describes what?
Central vertigo
104
Hearing improves in a noisy environment, Weber test reveals sound materialized to impaired ear, rinne test reveals BC greater than or equal to AC - what type of hearing loss is this?
Conductive loss
105
Hearing worsens in a noisy environment, Weber test reveals sound materialized to good ear, inner ear or cochlear nerve damage impairs transmission to affected ear, and AC > BC. What type of hearing loss is this?
Sensorineural
106
Visceral pain in RUQ caused by what?
Liver distention from hepatitis or biliary pathology
107
Visceral Periumbilical pain could indicate ?
Early acute appendicitis from distension of inflamed appendix
108
Pain worsened by movement so the patient lies still is what?
Peritonitis
109
Patients often move around trying to find comfortable position with what type of pain?
Colic from renal stone
110
Duodenal or pancreatic pain may be referred to where ?
The back
111
Pain from biliary tree refers where
Right scapular region and right posterior thorax
112
Pain from pleurisy of inferior wall MI refers where
Epigastric
113
Pathology of the biliary tree and liver has pain where ?
RUQ
114
Difficulty swallowing (dysphasia) pain when swallowing (odynophagia) , recurrent vomiting, evidence of GI bleed, early satiety , weight loss, anemia, palpable mass, risk factors for gastric cancer, painless jaundice are “alarm symptoms” associated with what?
GERD in patients >55 who fail empiric therapy and should have endoscopy.
115
Normal squamous to columnar epithelium as a meta plastic change in the esophagus lining is called what term?
Barret esophagus
116
RLQ pain, nausea, vimiting, appetite loss could be what diagnosis?
Appendicitis
In women consider PID, ectopic pregnancy or ruptured ovary
117
Cramping pain radiating to flank or groin accompanied by urinary symptoms. What the condition?
Nephrolithiasis (renal stone)
118
Cramping pain radiating to flank or groin accompanied by urinary symptoms. What the condition?
Nephrolithiasis (renal stone)
119
Pain in LLQ, diarrhea and history of constipation indicate what?
Diverticulitis
120
Signs of bowel obstruction ?
Non specific abdominal pain, abdominal distention, nausea, emesis, lack of flatus and or BM
121
Signs of bowel obstruction ?
Non specific abdominal pain, abdominal distention, nausea, emesis, lack of flatus and or BM
122
Severe diffuse abdominal pain with guarding or rigidity on exam with or without abdominal distention ?
Peritonitis. Urgent surgical intervention needed.
123
Severe diffuse abdominal pain with guarding or rigidity on exam with or without abdominal distention ?
Peritonitis. Urgent surgical intervention needed.
124
What causes peritonitis?
Infection or hole in the bowel or burst appendix. Causes redness and swelling or inflammation of the abdominal lining , the peritoneum
125
What causes peritonitis?
Infection or hole in the bowel or burst appendix. Causes redness and swelling or inflammation of the abdominal lining , the peritoneum
126
Change in bowel habits with palpable mass is ?
Late stage colon cancer
127
What is obstipation and what causes it?
Inability to pass gas and stool, bowel obstruction
128
Mallory weiss test or PUD can have what as a symptom
Hematemesis
129
Xerostomia is what and who experiences it
Insufficient saliva. Older than 70 and they have sensation of difficulty swallowing food
130
Stroke, Parkinson’s disease and ALS , muscular dystrophy and myasthenia gravis, and structural causes like esophageal stricture or hypopharyngeal diverticuli (zenker diverticulum) can cause what problem with swallowing
Oropharangyeal dysphasia
131
Difficulty swallowing solids and liquid , a motility disorder is called what?
Achalasia
132
What is schatzki ring ?
Webbing or narrowing of structures related to swallowing
133
Diarrhea that’s usually pathological happens when
At night, nocturnal diarrhea
134
Fat diarrheal stool with oil or froth is called
Steatorrhea
135
Fat diarrheal stool with oil or froth is called
Steatorrhea
136
Which meds cause diarrhea
Penicillin and macrodes
Magnesium based antacids
Metformin
Herbals and alternative meds
137
Which meds cause diarrhea
Penicillin and macrodes
Magnesium based antacids
Metformin
Herbals and alternative meds
138
What abx most often lead to c diff infection in immunocompromised people or recently hospitalized pt
Clindamycin, cephalosporins, penicillins, fluoroquinolones
139
What abx most often lead to c diff infection in immunocompromised people or recently hospitalized pt
Clindamycin, cephalosporins, penicillins, fluoroquinolones
140
Apple core lesions that result in thin pencil like stools occur from what
An obstructing apple core lesion of the distal colon, from a stenosising colon malignancy
141
Melena is what and what does it signal
Black stool. Upper GI bleed.
142
Red or frank stools signify what and what’s this called
Hematochezia, typically lower GI bleeding
143
What does unconjugated bilirubin occur from?
Increased production, decreased uptake by the hepatocytes, decreased liver ability to conjugate bilirubin
144
Increased production of bilirubin occurs in what condition
Hemolytic anemia
145
What causes impaired excretion of conjugated bilirubin?
Viral hepatitis; cirrhosis. Primary biliary cirrhosis. Drug induced cholestasis (the slowing or stalling of bile through the biliary system)
146
Impaired secretion of bile occurs from
Damaged hepatocytes or impaired intrahepatic ducts
147
Gallstones or pancreatic, cholangio or duodenal carcinoma may obstruct what
The common bile duct
148
Impaired excretion of bilirubin into the GI tract shows as what?
Dark urine and jaundice
149
Painful jaundice points to what?
Malignant obstruction of the bile ducts seen in duodenal or pancreatic carcinoma
150
Hep A and cholangitis have what common sign
Painful jaundice
151
What is grey or light coloured stool called? What causes this?
Acholic stool. Occurs briefly in viral hepatitis, common in obstructive jaundice.
152
When bilirubin levels are markedly elevated, pt may experience what?
Itching or pruritus
153
Internal urethral discomfort in a woman, diagnosis?
Urethritis
154
What does urinary urgency suggest
UTI, irritation from urinary calculi
155
What does urinary frequency suggest
UTI, bladder neck obstruction
156
What does urinary frequency suggest
UTI, bladder neck obstruction
157
In men, back pain or flank pain suggests?
Pyelonephritis
158
Decreased secretion of ADH, decreased renal sensitivity to ADH, high fluid intake from poorly controlled diabetes can cause what
Polyuria. Roughly defined as >3L urine volume in 24 hr
159
Describe the 5 types of incontinence
Stress- increased abdominal pressure exceeds urethras resistance, poor sphincter tone
Urge - involuntary leakage from uncontrolled detrusor contractions
Overflow- neurological or anatomical obstruction limits bladder from emptying until it becomes over distended
Functional - from impaired cognition, msk problems or immobility
Mixed - combined stress and urge
160
Flank pain, fever and chills signal what?
Pyelonephritis
161
Symptoms of pyelonephritis:
Flank pain at or below posterior costal margin near CVA, radiates anterior toward umbilicus, dull pain, aching pain, steady pain
162
Sudden obstruction of a ureter caused what? Where is the pain
Ureteral or renal colic. Radiates around trunk into lower abdomen and groin possibly upper thigh, testicle or labium
163
Pink purple striae are hallmark of what syndrome
Cushing
164
Dilated veins on the abdomen suggest
Portal hypertension from cirrhosis, inferior vena cava obstruction
165
Ecchymosis of abdominal wall is seen in
Intraperitoneal or retroperitoneal hemorrhage
166
Normactive bowel sounds - how many?
Hypoactive? Hyperactive ?
5-34 per min normal
Hypo <5, hyper > 34 per min
167
What is borborymgi?
Hyperactive bowel sounds from hyperperistalsis
168
Where could a friction rub occur on abdominal exam ?
Over the liver, spleen or abdominal mass.
169
What sounds do you hear when percussing abdomen? What do they indicate
Tympany - gas in GI tract, common
Dullness - normal with scattered areas of fluid and feces.
Dull areas outside scattered fluid or feces suggest: underlying mass, enlarged organ, intrauterine pregnancy, ovarian tumour, distended bladder , ascites, enlarged liver or spleen
170
What does dullness on percussion of both flanks warrant further assessment for
Ascites
171
What is a gastric bubble
A radiolucent rounded area nestled under the left hemidiaphragm representing gas in the fundus of the stomach
172
Signs of peritonitis ?
Positive cough test , involuntary guarding, rigidity, rebound tenderness, percussion tenderness
173
Spleen percussion. What should you hear and what indicates normal?
Splenomegaly is unlikely if tympany is prominent especially laterally
174
What is a splenic percussion sign (castell sign)?
Ask pt to take deep breath to let air filled lungs push spleen and diaphragm and push again, if note changes from tympany to dullness on inspiration, positive splenic percussion sign
175
Causes of splenomegaly ?
Portal hypertension, hematologic malignancy, HIV, infiltrative disease amyloidodis, splenic infarct or hematoma
176
How to test for ascites
Shifting dullness , percuss border of tympany and dullness with pt supine, then have them roll to one side to see if fluid moves
Flank dullness - pt supine, percussion from unbilicus to flanks , note when tympany changes to dullness. Positive test when dull over flanks and lateral abdomen
177
Appendicitis signs
RLQ tenderness
McBurney point tenderness
Rovsing sign (indirect tenderness)
Psoas sign
Obturator sign
178
McBurney point , where is it and what does tenderness mean in that spot
Over right side of the abdomen 1/3 the distance from anterior superior iliac spine to umbilicus. Near most common location of the appendix.
179
What is Rovsing sign?
Indirect tenderness and referred rebound tenderness in RLQ during left sided pressure.
180
What is Psoas sign
Patient supine, place hand above patients knee and have them raise the thigh against your hand. Flexion of the thigh at the hip makes Psoas muscle contract. (Leg straight) Increased pain is a positive sign. Suggests irritation of the Psoas muscle from an inflamed retrocecal appendix
181
What is obturator sign
Pt laying. Have them bend the knee and rotate the leg internally at the hip. This stretches obturator muscle. Right hypo gastric pain is positive sign.
Low sensitivity.
182
On rectal exam what causes right sided rectal tenderness
Appendicitis but can also be an inflamed adnexa or seminal vesicle
183
What is Murphy sign and what does it assess?
Acute cholecystitis (swelling of gallbladder).
Murphy = pain in RUQ with palpitation in inspiration
Pt laying, deeply palpate RUQ, pt takes deep breath, sharping hating in inspiratory effort due to pain = positive sign
184
Where does a spleen expand when enlarged
Anterior, downward and medially
185
What structures are in the RUQ?
Liver, gallbladder, pylorus, duodenum, hepatic flexure of colon, head of pancreas
186
What structures are in the RUQ?
Liver, gallbladder, pylorus, duodenum, hepatic flexure of colon, head of pancreas
187
What structures are in the LUQ?
Spleen, splenic flexure of colon, stomach, body and tail of pancreas
188
What structures are in the LUQ?
Spleen, splenic flexure of colon, stomach, body and tail of pancreas
189
What structures are in the LLQ
Sigmoid colon, descending colon, left ovary
190
What structures are in the LLQ
Sigmoid colon, descending colon, left ovary
191
What structures are in RLQ
Cecum, appendix, ascending colon, terminal ilieum, right ovary
192
What structures are in RLQ
Cecum, appendix, ascending colon, terminal ilieum, right ovary
193
What is CVA tenderness seen in?
Pyelonephritis
194
Where is traube space and what’s its significance
An area to detect spleen enlargement. It is from the border of the cardiac dullness at the 6th rib to the anterior axillary line and down to the costal margin
195
Where is traube space and what’s its significance
An area to detect spleen enlargement. It is from the border of the cardiac dullness at the 6th rib to the anterior axillary line and down to the costal margin
196
What percussion sound do you hear when the spleen is of normal size
Tympany
197
What can neck stiffness signal
Arthritis, muscle strain, underlying pathology.
198
Which neck vertebra and facet joints are palpated?
C2-C7
199
Which neck vertebra and facet joints are palpated?
C2-C7
200
Tenderness at C1-C2 indicates what
In RA- possible subluxation and high cervical cord compression
201
Tenderness at C5-6
Indicates muscle or fascial tightness , related to poor posture, trauma, excessive loading , altered mechanics from things like OA
202
Tenderness over so joint is common in ?
Sacroilitis and AS
203
Characteristics of scoliosis
Deformity of the thorax on forward bending , height of scapulae is inequal
204
What is the spurling test, how is it performed
Tests cervixal nerve root compression
Pt looks over shoulder and up at ceiling, examiner stands behind pt and puts gentle pressure downward. Pain going down the arm on the same side the patients head is turned to indicates cervical nerve root involvement
205
What level is the iliac crest at
L4
206
What level is the posterior superior iliac spine at
S2
207
Adduction of the hip / what does it look like
Pulls the thigh inward toward the body
208
Abductor of the hip, what does it look like
Lateral muscle group and pulls the thigh away from the body
209
Pelvis dropping on opposite side and causing a waddling gait (trendelenburg gait) is caused by what
Abductor weakness
Arthritis
Unequal leg lengths
210
Name anterior landmarks of the hip
1) iliac crest at upper margin of pelvis level of L4, follow downward to
2) iliac tubercle, marking widest point of the crest
3) anterior superior iliac spine
4) greater trochanter of femur
5) public tubercle, lies at same level of greater trochanter
211
Posterior hip landmarks
1) posterior superior iliac spine - directly underneath visible dimples above buttocks
2) greater trochanter laterally with fingers at level of gluteal fold and place thumb medially on ischial tuberosity
3) SI joint not always palpable but may be tender. Crosses the joint at S2.
212
Tenderness in ischiogluteal bursitis or weavers bottom mimics what
Sciatica
213
Restricted abduction and internal and external rotation of the hip are common in what
Hip OA
214
What does the faber test/ Patrick test test for ?
Groin strain.
(Flexion, ABduction, external rotation)
215
MCL and LCL provide what stability to the knee joint
Medial and lateral. Duh
216
What does the ACL do for the knee
Prevents the tibia from sliding forward on the femur
217
What does the PcL do for the knee
Prevents the tibia from slipping backward on the femur
218
If 2/3 of these occur: Pain with quadriceps contraction, pain with squatting , and pain with palpitation of the posteromedial or lateral patellar border occur during what syndrome?
Patellofemoral pain syndrome
219
Pain with compression and patellar movement during quadriceps contraction occur in what
Chondromalacia
220
Pain with compression and patellar movement during quadriceps contraction occur in what
Chondromalacia
221
What is the McMurray test? How do you do it ?
Test medial and lateral meniscus
Patient is supine. Grasp heel and flex the knee. Cup hand over the knee joint with fingers and thumb along medial joint line. From the heel, externally rotate the lower leg, then push on the lateral side to apply a valgus stress on the medial side of the joint. At the same time, slowly extend the lower leg in external rotation.
A click felt or hear at the joint line or if tenderness is noted along joint line, assess for meniscus tear.
222
What is the McMurray test? How do you do it ?
Test medial and lateral meniscus
Patient is supine. Grasp heel and flex the knee. Cup hand over the knee joint with fingers and thumb along medial joint line. From the heel, externally rotate the lower leg, then push on the lateral side to apply a valgus stress on the medial side of the joint. At the same time, slowly extend the lower leg in external rotation.
A click felt or hear at the joint line or if tenderness is noted along joint line, assess for meniscus tear.
223
Abduction or blacks stress test for MCL. What is it ?
Pt supine. Knee slightly flexed. Move thigh about 30degree laterally to the side of the table. Place one hand against lateral knee to stabilize femur. Other hand around medial ankle. Push medially against the knee and pull laterally at the ankle the OPEN the knee joint on the medial side. (Valgus stress) Feel for excessive widening of the joint
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Abduction or blacks stress test for MCL. What is it ?
Pt supine. Knee slightly flexed. Move thigh about 30degree laterally to the side of the table. Place one hand against lateral knee to stabilize femur. Other hand around medial ankle. Push medially against the knee and pull laterally at the ankle the OPEN the knee joint on the medial side. (Valgus stress) Feel for excessive widening of the joint
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What is the ADDuction (varus) stress test ? For LCL
Pt lays flat, leg out 30 degrees. Push laterally against the knee and pull medially at the ankle to open the knee joint on the lateral side (varus stress). Feel for excessive widening.
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What is the ADDuction (varus) stress test ? For LCL
Pt lays flat, leg out 30 degrees. Push laterally against the knee and pull medially at the ankle to open the knee joint on the lateral side (varus stress). Feel for excessive widening.
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What’s is the anterior drawer sign?
Pull tibia forward and observe if it slides forward like a drawer from under the femur. It should have a firm end point
Tests ACL
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Posterior drawer sign, what is it ?
Push the tibia posteriorly and observe the degree of backward movement in the femur.
Tests the PCL
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What is Lachman test?
Place knee in 15degree of Flexion and mild external rostion. Graspcdistsl femur on lateral side and proximal tibia on medial side with the other. Forcefully a simultaneously pull the tibia forward and the femur back. There should be a firm endpoint to any forward movement. Excessive movement or lack of endpoint = ACL not intact
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What test is more sensitive for ACL tear?
Lachman or anterior drawer
Lachman
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What is the Ottawa ankle and foot rules ?
After trauma. Pain in the malleolar zone plus either bone tenderness over the posterior aspects of either malleolus (or the navicular or base of 5th metatarsal) or an inability to bear weight for four steps is suspicious for ankle fracture and warrants radiography
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Where does Morton neuroma have pain ?
Tenderness over third and fourth metatarsal heads on the plantar surface of the foot
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Where does Morton neuroma have pain ?
Tenderness over third and fourth metatarsal heads on the plantar surface of the foot
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What is hallux valgus and who is it common in?
Bunions. In people who wear high heel shoes or pointed toe shoes
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What is the talar tilt test?
Tests integrity of the subtalar joint
Stabilize the ankle with one hand, grasp the heel with the other. Invert and every the foot by turning the heel inward then outward.
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What’s the difference between arthritis ankle pain and ligament sprain ?
Arthritis has pain with both ankle inversion and eversion
Ligament sprain has pain when the ligament is stretched during inversion
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Does rest worsen pain in RA or OA?
Rest worsens pain in RA, rest improves pain in OA. Activity leads to increased pain and stiffness in OA
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Does rest worsen pain in RA or OA?
Rest worsens pain in RA, rest improves pain in OA. Activity leads to increased pain and stiffness in OA
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Does morning stiffness improve with RA or OA
Improves in RA
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Symptoms of a cauda equina lesion ?
Bladder or bowel dysfunction, saddle anesthesia or perineal numbness
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Symptoms of a cauda equina lesion ?
Bladder or bowel dysfunction, saddle anesthesia or perineal numbness
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What are the dynamic shoulder stabilizing muscles
SITS muscles of the rotator cuff (Supraspinatus, Infraspinatus, Teres minor, Subscapularis)
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What is the Apley scratch test ?
Tests shoulder overall rotation. Have them reach over the back to scratch it (over the head) (tests abduction and external rotation) then have them reach behind their back to scratch it (tests addiction and internal rotation)
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Tennis elbow affects what?
Golfers elbow affects what?
Tennis - lateral epicondylitis - tender epicondyle.
Golf - medial epicondylitis. Less common.
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What are ROM tests of the elbow joint ?
Flexing - bend elbows
Extension - straighten elbow
Supination - turn palms up, carry soup
Pronation - turn palms down
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What is the Cozen test
Tests for lateral epicondylitis. Have patient pronate and extend wrist against resistance. Pain should reproduced along lateral aspect of elbow
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What is the Cozen test
Tests for lateral epicondylitis. Have patient pronate and extend wrist against resistance. Pain should reproduced along lateral aspect of elbow
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What is the pain provocation test
Rotator cuff - patient fully abducts arm from 0-180 degrees. Pain from 60-120 degrees - subacromial pain
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What’s the Neer Impingement sign ?
Tests rotator cuff / press on scapula and then raise the patients arm. Compresses greater tuberosity of humerus against the acromion
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What is Hawkins impingement sign
Rotator cuff test. Pain test. Flex patient shoulder and elbow to 90degrees with palm down. One hand on forearm and one on the arm. Rotate arm internally.
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What’s the drop arm test
Strength test of the shoulder. Pt abduct shoulder 90degrees. (To shoulder level) and lower slowly.
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Restricted ROM of the shoulder occurs in what conditions (during the 6 cardinal movements of the shoulder)
Bursitis, capsulitis, rotator cuff tears or sprains, tendinitis
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Tenderness over the SITS muscle insertions and inability to ABduct the arm above the shoulder level occurs in
Sprains, tears and tendon rupture of the rotator cuff. Most commonly supraspinatus
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Tenderness over the distal radius after a fall is suspicious for what injury
Colles fracture
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In de Quervain tenosynovitis and gonoccal tenosynovitis , there is tenderness over what areas
The extensor and abductor tendons of the thumb
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In de Quervain tenosynovitis and gonoccal tenosynovitis , there is tenderness over what areas
The extensor and abductor tendons of the thumb
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What is Snuffbox tenderness suspicious for if the wrist is in ulnar deviation with pain at the scaphoid tubercle
Occult scaphoid fracture
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What are Heberden nodes ? Where are they ? What about Bouchard nodes?
Herberden - bony dwellings along the DIPs of patients with OA. More common than Bouchard
Bouchard - in the PIPs, classic sign of OA
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Grip weakness and wrist pain are often present in what condition
De Quervain tenosynovitis
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What does Finkelstein test test for
Thumb tenosynovitis. Thumb tucked into palm and flex wrist down. Pain is a positive test “Gamers thumb”
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In carpal tunnel syndrome, decreased sensation in the fingers correspond to what nerves ? 5th finger ____? Thumb and index dorsal web space _____?
5th finger - ulnar nerve
Dorsal web of thumb and index finger - radial nerve
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Tests for carpal tunnel?
Thunb ABduction - weakness is a positive test because of median nerve innervation
Tinel sign - tapping on median nerve - worsening numbness , pain, aching is positive test
Phalen sign - tops of hands together pointing down for 60 seconds, numbness tingling = positive sign
