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Clinical Assessment > CAII > Flashcards

CAII Flashcards

1
Q

Butterfly rash on the cheeks

A

Systemic lupus erythematosus

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2
Q

Scaly rash and pitted nails

A

Psoriatic arthritis

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3
Q

Papules, pustules, vesicles on red bases on distal extremities

A

Gonococcal arthritis

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4
Q

Erythematous patch expanding, mental status change, facial weakness, stiff neck

A

Lyme disease

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5
Q

Hives

A

Serum sickness, drug reaction

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6
Q

Erosings or scaling of the penis and crusted scaling papules on soles and palms. Uveitis, urethritis, arthritis

A

Reiter’s syndome

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7
Q

Maculopapular rash

A

Rubella

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8
Q

Clubbing of fingernails

A

COPD

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9
Q

Red, burning, and itchy eyes

A

Reiter’s syndrome

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10
Q

Preceding sore throat

A

Rheumatic fever or gonococcal arthritis

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11
Q

Diarrhea, abdominal pain, cramping

A

Ulcerative colitis

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12
Q

Urethritis

A

Reiter’s syndrome

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13
Q

Hours per week of moderate-intensity exercise

A

150 minutes

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14
Q

Hours per week of vigorous-intensity

A

75 minutes

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15
Q

Muscle-strengthening activity involving all major muscle groups

A

2 days or more per week.

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16
Q

S2-S4 midline disc or tumor and bowel or bladder dysfunction

A

Cauda equina syndrome

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17
Q

Gluteal and posterior leg pain that radiates

A

Sciatica

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18
Q

Leg pain that resolves with rest of lumbar flexion

A

Spinal stenosis

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19
Q

What is a predictor of low back pain?

A

Depression

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20
Q

Osteoporosis: risk factor prior incidence of:

A

Fraigility fracture

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21
Q

Osteoporosis: risk factor for women:

A

Postmenomause

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22
Q

Osteoporosis: risk factor of age

A

> 50 y/o

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23
Q

Osteoporosis: risk factor of weight

A

< 70 kg or 154 lbs

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24
Q

Osteoporosis: risk factor of mineral

A

Low Ca levels

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25
Q

Osteoporosis: risk factor of vitamin:

A

Vit D

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26
Q

Osteoporosis: risk factor for drugs

A

Tobacco and alcohol

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27
Q

Osteoporosis: risk factor for family

A

Family history of fracture in a first-degree relative

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28
Q

Osteoporosis: risk factor for medication

A

Corticosteroids, breast cancer meds, antiseuizure meds, immunosuppressive meds, antigonadal therapy

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29
Q

Osteoporosis: risk factor for disease

A

Inflammatory disease of MS, lungs, GI, or RA

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30
Q

Osteoporosis: risk factor for conditions

A

Thyrotoxicosis, celiac sprue, renal organ, DM, HIV, hypogonadism, myeloma, anorexia

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31
Q

Who should be screened for OP?

A

Women older than 65 and younger women with risk factors.

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32
Q

How can bone density be measured?

A

Dual Energy X-ray Absoptiometry (DXA)

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33
Q

Osteoporosis T score

A

<-2.5

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34
Q

Osteopenia T score

A

-2.5 to 1.5

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35
Q

Normal levels of 25OHD

A

20-50 ng/mL

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36
Q

Ages 19-50 Calcium and Vit D

A

1000 mg and 600 IU

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37
Q

Age 50-71 Women

A

1200 mg and 600 IU

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38
Q

Age 50-71 Men

A

1000 mg and 600 IU

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39
Q

Age >71

A

1200 mg and 800 IU

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40
Q

Involvement of only one joint

A

Trauma, septic arthritis, gout

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41
Q

Polyarticular and symmetrical

A

RA

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42
Q

Limited extension, normal flexion. Nodule on ring finger

A

Dupuyren’s contracture

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43
Q

Bowleg

A

Genu varum

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44
Q

Knock-knees

A

Genu valgum

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45
Q

Effusion is associated with

A

Trauma

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46
Q

Subcutaneous nodules are associated with

A

Rheumatoid arthritis or Rheumatic fever

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47
Q

Crepitus is associated with

A

Inflamed joints as in osteoarthritis or inflamed tendon sheaths

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48
Q

Excess mobility of joint ligaments or ligamentous laxity is associated with what 2 things

A

ACL tear in knee trauma or muscle atrophy seen in RA

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49
Q

Decreased ROM is associated with what 3 things

A

Arthritis, inflammation of tissues around a joint/fibrosis of the joint, or bone fixation (ankylosis)

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50
Q

Bogginess or doughiness accompanied by effusion from the palpable joint fluid

A

Synovitis

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51
Q

Tenderness over the tendon sheath

A

Tendinitis

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52
Q

Increased warmth seen in 4 things

A

Arthritis
Tendinitis
Bursitis
Osteomyelitis

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53
Q

Diffuse tenderness and warmth suggests

A

Infection of arthritis

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54
Q

Focal tenderness suggests

A

Injury

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55
Q

Redness over a tender joint suggests three things

A

Septic arthritis
Gouty arthritis
RA

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56
Q

Most active joint in the body

A

TMJ

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57
Q

ESR/CRP

A

Chronic inflammatory arthritis

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58
Q

Facial asymmetry is seen in

A

TMJ syndrome

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59
Q

UL chronic pain with chewing, jaw clenching, teeth grinding, stress, HA

A

TMJ syndrome

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60
Q

Pain with chewing is also seen in

A

Trigeminal neuralgia

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61
Q

Swelling in TMJ may appear as a rounded bulge .5 cm from what

A

EAM

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62
Q

Elevation of one shoulder

A

Scoliosis

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63
Q

Rounded aspect of the shoulder appearance flattened

A

Anterior dislocation of the shoulder

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64
Q

Supraspinatus and infraspinatus atrophy

A

Rotator cuff tear

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65
Q

Localized tenderness near SITS muscles

A

Subacromial or subdeltoid bursitis, degenerative changes, calcific deposits near rotator cuff.

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66
Q

The most common cause of shoulder pain is

A

Rotator cuff injury

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67
Q

The best predictor of rotator cuff tear

A
  1. Supraspinatus weakness on abduction
  2. Infraspinatus weakness on external rotation
  3. Positive impingement sign
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68
Q

Age > 60 y/o and positive drop-arm test

A

Degenerative rotator cuff tear

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69
Q

Swelling around the olecranon process

A

Olecranon bursitis

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70
Q

Lateral epicondylitis, tenderness distal to epicondyle

A

Tennis elbow

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71
Q

Medial epicondylitis, tenderness distal to epicondyle

A

Pitcher’s/Golfer’s elbow.

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72
Q

Preservation of active ROM helps to…

What specific movement?

A

Rule out fracture

Elbow extension

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73
Q

Full elbow extension rules out

A

Hemarthrosis and intra-articular effusion

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74
Q

Degenerative changes at the 1st CM joint are most common among who?

A

Women

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75
Q

Complaints of dropping objects, inability to twist lids off jars, aching at the wrist of forearm, numbness of first three digits.

A

CTS

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76
Q

Other CTS signs include

A

Typing, pregnancy, RA, DM, hypothyroidism, thenar atrophy

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77
Q

Impaired hand movement

A

Dupuytren’s contracture, trigger finger, arthritis

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78
Q

Phalen’s sign within how many seconds is positive

A

60 seconds

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79
Q

Weakness on thumb abduction

A

CTS because abductor pollicis is innervated by median nerve

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80
Q

De Quervains tenosynovitis

A

Inflammation of the abductor pollicis longus and extensor pollicis brevis tendons. CTS and this is more common in women

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81
Q

Local swelling

A

Ganglion

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82
Q

Diffuse swelling

A

Arthritis or infection

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83
Q

Heberden’s nodes

A

DIP OA

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84
Q

Bouchard’s nodes

A

PIP OA

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85
Q

Thenar atrophy

A

Median nerve compression/CTS

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86
Q

Hypothenar atrophy

A

Ulnar nerve compression

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87
Q

Tenderness over distal radius

A

Colles’ fracture

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88
Q

BL tenderness

A

RA

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89
Q

Snuffbox tenderness

A

Scaphoid fracture

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90
Q

MCPs are boggy and tender in this disease but not in this disease

A

YES RA

NO OA

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91
Q

DIP also involved in

A

Psoriatic arthritis

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92
Q

Lateral deviation and rotation of the head from SCM contraction

A

Torticollis

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93
Q

Level of iliac crest

A

L4

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94
Q

Step offs of lower lumbar area

A

Spondylolisthesis

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95
Q

Increase in this with age but should be a correctable structural deformity in children

A

Thoracic kyphosis

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96
Q

Lateral and rotatory curvature of the spine evident during adolescence

A

Scoliosis

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97
Q

Unequal shoulder height

A

Scoliosis, Sprengel’s deformity of the scapula b/c extra bone between it and C7, winging from loss of innervation

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98
Q

Unequal iliac crest

A

Pelvic tilt, unequal length of the legs,

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99
Q

Listing of the trunk

A

Herniated lumbar disc

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100
Q

Birthmarks, port-win stains, hair patch, lipoma

A

Spina bifida and other bone defects

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101
Q

Cafe au lait, skin tag, fibrous tumor

A

Neurofibromatosis

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102
Q

Most serious cause of low back pain because associated with paralysis of affected limb or loss of bladder or bowel control

A

Cauda equina compression

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103
Q

Lumbar lordosis or muscle spasm

A

Ankylosing spondylitis

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104
Q

When do most hip problems appear?

A

During the weight bearing stage

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105
Q

Wide base

A

Cerebellar disturbance

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106
Q

Bulge along the ligament

A

Inguinal hernia or aneurysm

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107
Q

Ischiogluteal bursitis, may mimic sciatica

A

Weaver’s bottom makes sitting painful

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108
Q

Unequal leg length

A

Scoliosis

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109
Q

Arthritic joint vs ligamentous sprain

A

Arthritic joints are painful when moved in any directions

Ligamentous sprains produce pain when the ligament is stretched.

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110
Q

Tenderness over the 3rd and 4th MT heads, women wearing high healed shoes

A

Morton’s neuroma

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111
Q

Housemaid’s knee

A

Prepatellar bursitis

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112
Q

Bulge sign with tapping laterally

A

Minor effusion

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113
Q

Balloon sign using both hands

A

Major effusion

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114
Q

Ballotting the patella compress the patella again the femur

A

Major effusion

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115
Q

Aching pain in the lumbosacral area along L5 lateral leg and S1 posterior leg

A

Mechanical low back pain

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116
Q

What are the risk factors of mechanical low back pain?

A

Heavy lifting, poor conditioning, obesity

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117
Q

What are the causes of mechanical low back pain?

A

Muscle, ligament injury, Spondylolisthesis

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118
Q

When the sharp edge of a toenail digs into the lateral nail fold causing inflammation and infection. Includes a tender, reddened, overhanging nail fold usually affecting the great toe.

A

Ingrown toenail.

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119
Q

Hyperextension at MP joint, flexion at PIP involving 2nd toe. A corn may also be present

A

Hammer toe.

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120
Q

Hammer toe what joint is flex and hyperextended

A

PIP, MP

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121
Q

Painful conical thickening of skin

A

Corn

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122
Q

On 5th toe usually from pressure

A

Corn

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123
Q

Painless conical thickening

A

Callus

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124
Q

Thickened skin of sole, may be accompanied by what

A

Callus, plantar wart

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125
Q

Hyperkeratotic lesion caused b HPV on sole of foot resembling a callus

A

Plantar wart

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126
Q

Pain sensation is diminished or absent on pressure points of feet. Deep infect, indolent painless. Common in DM

A

Neuropathic ulcer

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127
Q

Tenderness over the plantar surface between 3rd and 4th MT heads of common digital nerve. Hyperesthia, numbness, aching, burning.

A

Morton’s Neuroma

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128
Q

Lateral deviation of the great toe and enlargement of the head of the first MT on medial side forming a bunion usually in women

A

Hallux valgus

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129
Q

Apparent when the patient stands because the longitudinal arch flattens so that the sole touches the floor as a result of the medial side of the foot developing a convex cavity. Tenderness commonly.

A

Flat foot

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130
Q

Flat foot is common among who

A

Obese, DM, prior foot injury

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131
Q

Very painful, tender, hot, dusky, red swelling of the MP of great toe

A

Acute gouty arthritis

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132
Q

When gout affects the big toe

A

Pedagra

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133
Q

Process of fibromyalgia

A

Widespread MS pain and tender points, these people move well

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134
Q

Location of fibromyalgia

A

All over but especially in the neck, shoulders, hands, low back, and knees

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135
Q

Pattern of spread of fibromyalgia and what makes it worse

A

Shifts unpredictably or worsen in response to immobility, excessive use, exposure to cold

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136
Q

Onset of fibromyalgia

A

Variable

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137
Q

Duration of fibromyalgia

A

Chronic with ups and downs

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138
Q

Swelling of fibromyalgia

A

None

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139
Q

Redness, warmth, tenderness of fibromyalgia

A

Multiple trigger points that aren’t recognized until an exam

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140
Q

Stiffness of fibromyalgia

A

Present usually in morning

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141
Q

Limitation of motion of fibromyalgia

A

Absent, just stiffness of movement

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142
Q

Generalized symptoms of fibromyalgia

A

Disturbance of sleep, morning fatigue, DEPRESSION

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143
Q

Process of polymyalgia rhematica

A

Unclear etiology, > 50 y/o, women

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144
Q

Location of polymyalgia rhematica

A

Muscles of hip shoulder girdles neck

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145
Q

Pattern of spread of polymyalgia rhematica

A

N/A

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146
Q

Onset of polymyalgia rhematica

A

Insidious, abrupt

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147
Q

Progression of polymyalgia rhematica

A

Chronic, but self limiting

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148
Q

Swelling of polymyalgia rhematica

A

Hands, wrist, feet

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149
Q

Redness, warmth, and tenderness of polymyalgia rhematica

A

Tender

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150
Q

Stiffness of polymyalgia rhematica

A

In morning

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151
Q

Limitation of motion of polymyalgia rhematica

A

Restricts movement especially in shoulders

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152
Q

Symptoms of polymyalgia rhematica

A

Malaise, depression, anorexia, weight loss, fever, not true weakness

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153
Q

Process of chronic tophaceous gout

A

Multiple local accumulations of sodium urate in the joints and other tissues (tophi)

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154
Q

Location of chronic tophaceous gout

A

Feet, ankles, wrists, fingers, elbows,

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155
Q

Spread of chronic tophaceous gout

A

Additive, not symmetric like RA

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156
Q

Onset of chronic tophaceous gout

A

Gradual dev

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157
Q

Progression of chronic tophaceous gout

A

Chronic symptoms with acute exacerbations

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158
Q

Swelling of chronic tophaceous gout

A

Present as tophi and SUBQ tissues

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159
Q

Redness, warmth, and tenderness of chronic tophaceous gout

A

All 3

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160
Q

Stiffness of chronic tophaceous gout

A

Present

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161
Q

Limitation of motion of chronic tophaceous gout

A

Present

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162
Q

Symptoms of of chronic tophaceous gout

A

Fever, renal failure, renal stones.

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163
Q

Process of acute gout

A

Inflammatory rxn to microcrystals of monosodium urate

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164
Q

Location of of acute gout

A

Base of big toe, first MP, dorsum of foot, ankles, knees, elbows

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165
Q

Spread of acute gout

A

Confined to one joint

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166
Q

Onset of acute gout

A

Sudden

167
Q

Progression of acute gout

A

Isolated occasionally lasting days to 2 weeks and they may get more frequent and severe

168
Q

Swelling of acute gout

A

Present with the involved joint

169
Q

Redness, warmth, tenderness of acute gout

A

Exquisitely tender, hot, and red yes

170
Q

Stiffness of acute gout

A

No

171
Q

Limitations of motion of acute gout

A

Limited by pain

172
Q

Symptoms of acute gout

A

Fever, septic arthritis must be considered

173
Q

Process of OA

A

Degeneration and loss of cartilage within joints followed by the formation of new bone at the margins of the cartilage

174
Q

Location of OA

A

Knees, hips, hands (PIP/DIP), cervical, lumbar, wrist first CM

175
Q

Spread of OA

A

Additive, only one joint may be involved

176
Q

Onset of OA

A

Insidious

177
Q

Progression of OA

A

Slow progressive with temporary exacerbations after period of overuse

178
Q

Swelling of OA

A

Small effusions in joint especially in knees with bony enlargement

179
Q

Redness, warmth, tenderness of OA

A

Sometimes tender, seldom warm, and rarely red

180
Q

Stiffness of OA

A

Frequent but brief, in morning and after inactivity

181
Q

Limitation of motion of OA

A

Often

182
Q

Symptoms of OA

A

Absent

183
Q

Process of RA

A

Inflammation of synovial membranes with erosion of adjacent cartilage and bone

184
Q

Location of RA

A

PIP and MP of Hands, MT of feet, wrists, knees, elbows ankles

185
Q

Spread of RA

A

Symmetrically

186
Q

Onset of RA

A

Insidious

187
Q

Progression of RA

A

Remissions and exacerbations

188
Q

Swelling of RA

A

SUBQ NODULES, synovial tissue swelling

189
Q

Redness, warmth, tenderness of RA

A

Tender, warm, NOT RED

190
Q

Stiffness of RA

A

Prominent

191
Q

Limitation of motion of RA

A

Often develops

192
Q

Symptoms of RA

A

Weakness, fatigue, weight loss, fever

193
Q

Injury to the fingertip resulting in infection usually from this virus. Can be from this if vesicle are present.

A

Staphyloccocus aureus. Herpetic whitlow

194
Q

Localized tederness, swelling, dusky red, usually requires incision and drainage of fingertip after infection. HSV common for these HC workers

A

Felon. Dentists

195
Q

Infection of tendon sheath of the fascial space of the palm, index finger, thenar space are common

A

Acute tenosynovitis and thenar space involvement

196
Q

Pain on extension, so finger held in flexion of tendon from distal phalanx to MP joint

A

Acute tenosynovitis.

197
Q

Cystic, round, nontender swellings along tendon sheaths. Cyst contains synovial fluid and flexion of the wrist makes it more apparent

A

Ganglion

198
Q

Ganglion is commonly found at

A

Wrist

199
Q

Acute tenosynovitis it hurts to do what

A

Extend, so finger is slightly flexed

200
Q

Median nerve disorder/CTS

A

Thenar atrophy

201
Q

Hypothenar atrophy

A

Ulnar nerve disorder

202
Q

Painless nodule on flexor tendon in palm near what is trigger finger

A

MC head

203
Q

Nodule is too big to enter the tendon sheath during extension of the fingers from a flexed position, but with extra effort the finger extends and flexes with a palpable and audible snap as the nodule pops into the tendon sheath.

A

Trigger finger.

204
Q

Thickened nodule overlying the flexor tendon finger of the ring finger limiting what

A

Extension, may gradually dvelop flexion contracture

205
Q

Extension is limited because of a nodule over the flexor tendon of the ring finger

A

Dupuytren’s contracture

206
Q

Associated with eating meat, knobby swellings white chalklike urate discharge

A

Chronic Tophaceous Gout

207
Q

Bony overgrowth of DIP

A

Herberden’s node, OA

208
Q

Bony overgrowth of PIP

A

Bouchard’s node, OA, less common

209
Q

OA usually spares what joint

A

MP

210
Q

Is OA painless

A

No

211
Q

Hyperextension of PIP, flexion of DIP

A

Swan neck deformity RA

212
Q

Hyperextension of DIP, flexion of PIP

A

Boutonniere deformity, RA, less common

213
Q

Which way to the fingers deviate in RA?

A

Ulnar deviation

214
Q

Nodules

A

RA

215
Q

Involvement of joints in RA is usually symmetrical or asymmetrical?

A

Symmetrical

216
Q

Tennis elbow

A

Lateral epicondylitis, extension of wrist, repeated pronation and supination of forearm developing 1 cm distal to lateral epicondyle

217
Q

What aggravates tennis elbow?

A

Extending wrist vs resistance

218
Q

Pitcher’s, Golfer’s elbow

A

Medial epicondylitis, wrist flexion (throwing),

219
Q

What aggravates pitcher’s elbow?

A

Flexing wrist vs resistance.

220
Q

Synovial inflammation, boggy, soft, fluctuant swelling,

A

Many causes: arthritis of elbow

221
Q

What increases arthritis of elbow risk

A

Alcohol

222
Q

SUBQ nodules at pressure points on extensor surface of ulna. Firm, nontender

A

Rheumatoid nodules from RA or Acute rhematic fever

223
Q

Swelling and inflammation of the olecranon bursa form trauma, gout, or RA

A

Olecranon bursitis, can be 6 cm in diameter

224
Q

From throwing or swimming causing edema, hemorrhage and inflammation involving this tendon. Pain is maximal just below acromion

A

Supraspinatus usually

225
Q

Aggravation of activity causing inflammation. Report sharp catches of pain, grating, weakness when lifting arms overhead. May have bone spur

A

Rotator cuff tendinitis/impingement syndrome

226
Q

Subscapularis

A

Internal rotation

227
Q

Supraspinatus

A

Elevation/abduction

228
Q

Infraspinatus/Teres minor

A

External rotation

229
Q

Patient complains of chronic shoulder pain, at night, catching, grating when raising the arm overhead, pain starts at supraspinatus tendon and progresses posteriorly and anteriorly. Characteristic shoulder shrug of affected shoulder

A

Rotator cuff tearr

230
Q

Degenerative process int he tendon associated with the depostion of calicum involving the supraspinatus tendon. Often in women over 30. Tenderness is maximal below tip of acromion and the subacromial bursa which overlies the supraspinatus tendon may be inflamed

A

Calcific tendinitis

231
Q

Inflammation of the long head of the biceps tendon and tendon sheaths. May coexist with rotator cuff tendinitis

A

Bicepital tendinitis

232
Q

Frozen shoulder. Fibrosis of GH joint capsule manifested by diffuse, dull aching pain in the shoulder that restricts the active and passive ROM.

A

Adhesive capsulitis

233
Q

Prior direct injury to shoulder girdle with degenerative changes over AC joint tenderness

A

Acromionclavicular arthritis

234
Q

Shoulder instability so that the shoulder slips out of the joint when the arm is adbducted and externally rotated causing a positive apprehension sign

A

Anterior dislocation of humerus

235
Q

Adhesive capsulitis especially limits what ROM

A

External rotation

236
Q

What other condition is an antecedent to adhesive capsulitis

A

MI, other shoulder disorder. Stretching helps though

237
Q

Neck pain with B/L weakness and parasethesia in UE, LE with urinary frequency. Hand clumsiness palmar paresthesia, gait change

A

Cervical Myelopathy from cervical cord compression

237
Q

Neck pain with B/L weakness and parasethesia in UE, LE with urinary frequency. Hand clumsiness palmar paresthesia, gait change

A

Cervical Myelopathy from cervical cord compression

238
Q

Cause of cervical myelopathy

A

Cervical spondylosis, cervical degenerative disc disease from spurs, protrusion of ligamentum flavum,

238
Q

Cause of cervical myelopathy

A

Cervical spondylosis, cervical degenerative disc disease from spurs, protrusion of ligamentum flavum,

239
Q

Signs of cervical myelopathy

A

Hyperreflexia, clonus at the wrist, knee, or ankle, extensor plantar reflexes, positive Babinski sign, gait disturbance. Lhermitte’s sign: neck flexion causes electrical shock radiating down the spine.

239
Q

Signs of cervical myelopathy

A

Hyperreflexia, clonus at the wrist, knee, or ankle, extensor plantar reflexes, positive Babinski sign, gait disturbance. Lhermitte’s sign: neck flexion causes electrical shock radiating down the spine.

240
Q

Sharp burning or tingling pain in the neck and one arm associated paresthesia and weakness. Sensory symptoms in myotomoal pattern, deep inmuscle rather than dermatomal pattern

A

Cervical radiculopathy from nerve root compression

240
Q

Sharp burning or tingling pain in the neck and one arm associated paresthesia and weakness. Sensory symptoms in myotomoal pattern, deep inmuscle rather than dermatomal pattern

A

Cervical radiculopathy from nerve root compression

241
Q

Cause of cervical radiculopathy

A

Dysfunction of cervical spine nerve, nerve roots, or encroachment of spinal nerve, herniated cervical disc. Involving hypoxia of the nerve root, dorsal ganglion, and release of inflammatory mediators.

241
Q

Cause of cervical radiculopathy

A

Dysfunction of cervical spine nerve, nerve roots, or encroachment of spinal nerve, herniated cervical disc. Involving hypoxia of the nerve root, dorsal ganglion, and release of inflammatory mediators.

242
Q

What nerve root is affected most often in cervical radiculopathy?

A

C7: affecting extensors and flexors. Triceps weakness. C6 is also common with weakness in biceps, brachioradialis, wrist extensors

242
Q

What nerve root is affected most often in cervical radiculopathy?

A

C7: affecting extensors and flexors. Triceps weakness. C6 is also common with weakness in biceps, brachioradialis, wrist extensors

243
Q

Mechanical neck pain with aching paracervical pain and stiffness beginning the day after injury.

A

Mechanical neck pain: Whiplash

243
Q

Mechanical neck pain with aching paracervical pain and stiffness beginning the day after injury.

A

Mechanical neck pain: Whiplash

244
Q

If mechanical neck pain is prolonged and accompanied by abnormal neck posture, muscle spasm, so neck goes to one side and chin goes to the other…what should you suspect?

A

Torticollis

244
Q

Associated symptoms of mechanical neck pain

A

Aching, occipital HA, dizziness, malaise, fatigue.

245
Q

Chronic whiplash syndrome lasts more than how many months

A

6 months

246
Q

Cause of mechanical neck pain whiplash

A

Hyperflexion followed by hyperextension injury to the neck causing a musculoligamentous sprain or strain. Often from rear-end collisions.

247
Q

Signs of low back pain referred from abdomen or pelvis

A

Local vertebral tenderness, spinal movements are not painful and ROM is not restricted.

248
Q

Aching pain in paracervical muscles and ligaments associated muscle spasm stiffness, tightness in upper back and shoulder lasting up to 6 weeks.

A

Mechanical neck pain

249
Q

Associated symptoms of mechanical neck pain

A

HA, local muscle tenderness, no neurologic deficits.

No radiation, paresthesia, weakness.

250
Q

How is mechanical neck pain related to fibromyalgia?

A

Trigger points

251
Q

If mechanical neck pain is prolonged and accompanied by abnormal neck posture, muscle spasm, so neck goes to one side and chin goes to the other…what should you suspect?

A

Torticollis

252
Q

Cause of mechanical neck pain

A

Sustained muscle contraction associated with poor posture, stress, poor sleep, poor head position during activiies such as computer use, watching TV, and driving.

253
Q

Deep aching pain that varies with the source but doesn’t affect ROM

A

Pain referred from the abdomen or pelvis causing low back pain

254
Q

Cause of low back pain referred from abdomen or pelvis

A

Peptic ulcer, pancreatitis, pancreatic cancer, prostatitis, endometriosis, dissecting AA, retroperitoneal tumor.

255
Q

Signs of low back pain referred from abdomen or pelvis

A

Local vertebral tenderness, spinal movements are not painful and ROM is not restricted.

256
Q

Back pain at night, is it relieved by rest?

A

Unrelieved by rest: noctural back pain

257
Q

Cause of noctural back pain

A

Metastatic malignancy to spine from cancer of prostate, breast, lung, thyroid, kidney, multiple myeloma

258
Q

Tumor or midline disc herniation in bowel or bladder dysfunction with leg weakness associated with lower back pain. This is emergent.

A

Cauda equina syndrome.

259
Q

Signs of sciatic

A

Calf wasting, weak ankle dorsiflexion, absent ankle jerk, positive crossed straight leg raise (pain in affected leg when healthy leg) Negative straight leg raise makes it less likely. Ipsilateral straight leg raise.

260
Q

Signs of lumbar spinal stenosis

A

Posture may be flexed forward with LE weakness and hyporeflexia. Thigh pain after 30 second of lumbar extension. Straight leg raise is negative.

261
Q

Cause of mechanical low back pain.

A

Muscle and ligament injuries. Intervertebral disc or facet. Herniated disc, spinal stenosis

262
Q

Pseudoclaudication pain in the back or legs with walking that improves with rest lumbar flexion which decompresses spinal cord. Pain vague but B/L with paresthesia in one or both legs.

A

Lumbar spinal stenosis

263
Q

Radicular low back pain

A

Sciatica

264
Q

Shooting pain below the knee into lateral leg l5 or posterior calf s1 accompanied by low back pain. Associated paresthesia, weakeness, bending sneezing, coughing straining during bowel movements will worsen pain

A

Sciatica

265
Q

Cause of sciatica

A

Disc herniation of intervertebral disc compressing the nerve root in people 50 y/o or older. Involving l5 or s1 disc herniation.

266
Q

Tumor or midline disc herniation in bowel or bladder dysfunction with leg weakness associated with lower back pain

A

Cauda equina syndrome.

267
Q

Signs of sciatic

A

Calf wasting, weak ankle dorsiflexion, absent ankle jerk, positive crossed straight leg raise (pain in affected leg when healthy leg) Negative straight leg raise makes it less likely. Ipsilateral straight leg raise.

268
Q

Signs of mechanical low back pain

A

Paraspinal muscle or facet tenderness, pain with back movement, loss of normal lumbar lordosis, but no motor or sensory loss or reflex abnormalities. In OP check for thoracic kyphosis, percussion tenderness, over a spinaous process.

269
Q

What does hepatocellular carcinoma often present with

A

Nodules

270
Q

What is a palpable liver the result of?

A

Change in consistency from normal softness to abnormal firmness or hardness as in CIRRHOSIS

271
Q

Downward displacement of the liver

A

Caused by a low diaphragm, indicating COPD

272
Q

Normal variation in liver shape associated with what?

A

Lanky build causing elongation so that the right lobe is palpable as it projects downward towards the iliac crest.

273
Q

In visceral tenderness is there muscular rigidity or rebound tenderness

A

No muscular rigidity or rebound tenderness.

274
Q

Cirrhosis

A

Firm, nontender edge, or hemochromatosis, amyloidosis, lymphoma

275
Q

Smooth large liver, tender

A

Inflammation, hep, venous congestion as in RSHF

276
Q

Irregular large liver that is firm or hard and has an irregular edge or surface

A

Hepatocellular carcinoma.

277
Q

What does hepatocellular carcinoma often present with

A

Nodules

278
Q

Tenderness persists when the patient raises the head and shoulder for this type of lesion

A

Superficial tender area

279
Q

Tenderness goes away when the patient raises the head and shoulders

A

Deep tender area because the tightened muscles protect the pain.

280
Q

Right rectal tenderness accompanies

A

Acute appendicitis

281
Q

In visceral tenderness is there muscular rigidity or rebound tenderness

A

No muscular rigidity or rebound tenderness.

282
Q

Chest signs, abdominal pain and tenderness from inflammation of this?
This can mimic what when U/L?

A

Acute pleurisy.

Acute cholecystitis or appendicitis.

283
Q

Inflammation of fallopian tubes above the inguinal ligaments with rebound tenderness and rigidity. Pressing on this causes pain?

A

Acute salpingitis

Pressing on the pelvis.

284
Q

Signs in RUQ, Murphy’s sign

A

Acute cholecystitis

285
Q

Epigastric tenderness, rebound tenderness, abdominal wall may be soft

A

Acute pancreatitis

286
Q

Right lower quadrant sign with McBurney’s point, also consider the right flank

A

Acute appendicitis.

287
Q

High-pitched tinkling sounds suggests

A

Intestinal fluid and air under tension in a dilated bowel.

288
Q

Rushes of high-pitched sounds

A

Abdominal cramp indicating intestinal obstruction.

289
Q

What is more severe peritoneal inflammation or visceral tenderness?

A

Peritoneal inflammation.

290
Q

Common symptoms of peritoneal inflammation

A

Muscular rigidity and rebound tenderness

291
Q

Exquisite tenderness throughout abdomen with boardlike muscular rigidity

A

Generalized peritonitis.

292
Q

Increased bowel sounds

A

Diarrhea or early intestinal obstruction

293
Q

Systolic bruit accompanies hepatic friction rub

A

Liver carcinoma

294
Q

How long must you sit down and listen before declaring bowel sounds are absent?

A

2 minutes

295
Q

High-pitched tinkling sounds suggests

A

INtestinal fluid and air under tension in a dilated bowel.

296
Q

“Pelvic mass” reported by females

A

Pregnancy, listen for fetal heart

297
Q

Hepatic bruits

A

Carcinoma of the liver or alcoholic hepatitis

298
Q

Occlusion of renal artery

A

HTN

299
Q

Arterial bruits with both systolic and siastolic components suggest occlusion of what

A

Aorta of large arteries

300
Q

Grating sounds with respiratory variation, indicates inflammation of peritoneal surface of an organ. For liver…

A

Friction rub.

301
Q

Systolic bruit accompanies hepatic friction rub

A

Liver carcinoma

302
Q

Fluid seeking the lowest position in the abdomen producing bulging flanks that are dull to percussion. Umbilicus may protrude.

A

Ascitic fluid

303
Q

Where is distention more pronounced when gas is involved from adynamic or paralytic ileus?

A

Colon rather than small bowel.

304
Q

“Pelvic mass”

A

Pregnancy, listen for fetal heart

305
Q

Large solid mass rising out of the pelvis and is dull to percussion. Displaces the bowel to the periphery.

A

Ovarian tumor, uterine myomata.

306
Q

This is sometimes misdiagnosed as a tumor

A

Distended bladder.

307
Q

Most common cause of a protuberant abdomen that thickens the abdominal wall, the mesentery, and omentum.

A

Fat.

308
Q

How does the umbilicus appear in a fat abdomen?

A

Sunken.

309
Q

Apron of fatty tissue that extends below the inguinal ligaments.

A

Pannus

310
Q

Gas causes what type of percussion?

A

Tympanic.

311
Q

Where is distention more pronounced when gas is involved from adynamic or paralytic ileus?

A

Colon rather than small bowel.

312
Q

Localied bulge in the abdominal wall through which a tissue protudes

A

Ventral hernia

313
Q

Subcutaneous tumor

A

Lipoma

314
Q

Most common ventral hernia

A

Umbilical, incisional, epigastric

315
Q

What makes a hernia and rectus diastasis move evident?

A

Patient raises head and shoulders from a supine position.

316
Q

Protrusion through a defecive umbilical ring most common in infant

A

Umbilical hernia

317
Q

Separation of the two rectus abdominis muscles through which abdominal contents form a midline ridge when the patient raises head and shoulders. Seen in pregnancies, obesity, and chronic lung disease. It has no clinical consequences

A

Diastasis recti

318
Q

Protrusion through an operative scar. A small defect has a greater risk for complications than a large defect.

A

Incisional hernia

319
Q

Strong detrusor contraction that overcome the normal urethral resistance. Bladder is small.

A

Urge incontinence

320
Q

Common, benign fatty tumor in subcutaneous tissue almost anywhere in the body including the abdominal wall. Small or large, they are usually soft and lobulated.

A

Lipoma

321
Q

When you press your finger down on the edge of a lipoma what happens to it?

A

The tumor slips out from under it.

322
Q

Drugs contributing to incontinence like sedatives, tranquilizers, anticholinergics, sympathetic blockers, potent diuretics

A

Incontinence secondary to medications

323
Q

Detrusor contractions are strong

A

Urge incontience

324
Q

Detrusor contractions are insufficient to overcome urethral resistance and the bladder is large even after an effort to void caused by an obstruction of the bladder as in benign prostatic hyperplasia or tumor. Weakness of the detrusor muscle associated with peripheral nerve disease at the sacral level. Impaired bladder sensation that interrupts the reflex arc. DM related.

A

Overflow incontinence

325
Q

Symptoms of overflow incontinence

A

A continuous dripping or dribbling incontinence, decreased force of urinary stream, obstruction or peripheral nerve disease hx as in DM,

326
Q

Signs of overflow incontinence

A

Enlarged bladder and may be tender. Prostatic enlargement, motor signs of peripheral nerve disease, decrease in sensation, diminished absent reflexes.

327
Q

Strong detrusor contraction that overcome the normal urethral resistance. Bladder is small.

A

Urge incontience

328
Q

Bladder is small.

A

Urge incontinence

329
Q

Bladder is large

A

Overflow incontinence

330
Q

Detrusor contractions are weak

A

Overflow incontience

331
Q

Detrusor contractions are strong

A

Urge incontience

332
Q

Is there a desire to urinate is pure stress incontinence?

A

No.

333
Q

Symptoms of urge incontinence

A

Involuntary urine loss preceded by an urge to void, urgency, frequency and nocturia with small to moderate volumes, pain on urination, pseudo stress incontinence voiding 10 to 20 seconds after stresses such as a change of position going up or down stairs and possibly coughing laughing or sneezing.

334
Q

Signs of urge incontinence

A

Bladder is not detectable on abdominal exam. Cortical inhibition is decreased, mental deficits or motor signs of CNS, local pelvic problems or fecal impaction

335
Q

The urethral sphincter is weakened so that transiet increases in intra-abdominal pressure raise the bladder pressure to levels that exceed urethral resistance. In women a pelvic floor weakness with inadequate muscular support of the bladder and proximal urethra and a change in the angle of the bladder and urethra from childbirth and surgery. Also local conditions that affect the internal urethral sphincter.
In men after prostatic surgery

A

Stress incontience

336
Q

Cause of stress incontinence in men

A

Prostatic surgery

337
Q

Cause of stress incontinence in women

A

Weakness of pelvic floor or chaange in internal urethral sphincter, postmenopausal atrophy.

338
Q

Symptoms of stress incontinence

A

Momentary leakage of small amounts of urine with coughing, laughing, sneezing while person is in upright position

339
Q

Signs of stress incontinence

A

Bladder is not detected, atrophic vaginitis.

340
Q

Is there a desire to urinate is pure stress incontinence?

A

No.

341
Q

Prolonged exposure of eophagus to gastric acid due to impaired esophageal motility or lower esophageal sphincter action

A

GERD

342
Q

What bacterial infection is associated with GERD?

A

H. pylori

343
Q

Location of GERD

A

Chest or epigastric

344
Q

Quality of GERD

A

Burning, heartburn, regurgitation.

345
Q

When does GERD occur?

A

After meals

346
Q

What aggravates GERD?

A

Lying down, bending over, activity physical, alcohol, fatty meals, chocolate, calcium channel blockers

347
Q

What relieves GERD?

A

Antacids,

348
Q

Symptoms of GERD

A

Burning, wheezing, cough, SOB, hoarseness, choking, halitosis, sore throat.

349
Q

GERD increases the risk of what

A

Barrett’s esophagus/esophageal cancer.

350
Q

Demonstrated ulcer usually in duodenum or stomach. Dyspepsia.

A

Peptic ulcer

351
Q

Infection with peptic ulcer

A

H. pylori

352
Q

Location of peptic ulcer

A

Epigastric to back

353
Q

Quality of peptic ulcer

A

Gnawing, burning, boring, aching, pressing, hungerlike

354
Q

Pain epigastric that causes patient to wake at night

A

Duodenal ulcer timing.

355
Q

What relieves a peptic ulcer?

A

Food and antacids bring relief in duodenal ulcer

356
Q

Symptoms of peptic ulcer

A

Nausea, vomiting, belching , bloating, heartburn, weight loss , dypepsia

357
Q

Weight loss peptic ulcer

A

Gastric ulcer

358
Q

Heartburn peptic ulcer

A

Duodenal ulcer

359
Q

Cancer of stomach that is slowly progressive

A

Adenocarcinoma

360
Q

Location of cancer of stomach

A

Cardia or GE junction

361
Q

Cancer of stomach is aggravated by

A

Food

362
Q

Cancer of stomach is relieved

A

NOT BY FOOD or ANTACIDS

363
Q

Symptoms of cancer of stomach

A

Anorexia, nausea, early satiety, weight loss, bleeding

364
Q

Progression of acute appendicitis

A

Periumbilical pain followed by RLQ that begins as mild and becomes more steady and severe.

365
Q

What makes an acute appendicitis worse?

A

Coughing or movement.

366
Q

What do you suspect if pain of appendix subsides temporarily

A

Perforation of the appendix

367
Q

Symptoms of acute appendicitis

A

Anorexia, nausea, vomiting, LOW FEVER

368
Q

Inflammation of the gallbladder from obstruction of the cystic duct by gallstone.

A

Acute cholecystitis

369
Q

Acute cholecystitis

A

RUQ

370
Q

Where does an acute cholecystitis radiate to?

A

Right scapular area.

371
Q

Quality of acute cholecystitis

A

Steady, aching

372
Q

What aggravates acute cholecystitis

A

Deep breathing.

373
Q

Symptoms of acute cholecystitis

A

Anorexia, nausea, vomiting fever

374
Q

Obstruction of the bowel lumen caused by adhesions or hernia (small bowel) or cancer or diverticulitis (colon)

A

Acute bowel obstruction

375
Q

Biliary colic location

A

Epigastric or RUQ that may radiate to the right scapula and shoulder

376
Q

Is biliary colic colicky?

A

No, steady and aching! NOT COLIC

377
Q

Timing of biliary colic

A

Episodic

378
Q

Symptoms of biliary colic

A

Anorexia, nausea, vomiting, restlessness

379
Q

Blood supply to the bowel and mesentery blocked from thrombosis or embolus or reduced from hypoperfusion,

A

Mesenteric ischemica

380
Q

Location of mesenteric ischemia

A

Periumbilical then diffuse

381
Q

Symptoms of mesenteric ischemia

A

Cramping then steady, abrupt then persistent with vomiting diarrhea that might be bloody constipation, shock and older age.

382
Q

Acute inflammation of a colonic diverticulum which is a saclike mucosal outpouching through the colonic muscle.

A

Acute diverticulitis

383
Q

Where is the pain in acute diverticulitis?

A

LLQ

384
Q

Describe acute diverticulitis pain

A

Cramping and then steady

385
Q

Acute diverticulitis symptoms

A

Fever constipation, diarrhea

386
Q

Location of acute bowel obstruction small bowel

A

Periumbilical or upper abdominal

387
Q

Location of acute bowel obstruction colon

A

Lower abdominal or generalized

388
Q

Symptoms of acute bowel obstruction small bowel

A

Vomiting of bile, mucus or fecal material, obstipation

389
Q

Symptoms of acute bowel obstruction colon

A

Obstipation, vomiting.

390
Q

Acute inflammation of pancreas

A

Acute pancreatitis

391
Q

Fibrosis of pancreas secondary to recurrent inflammation

A

Chronic pancreatitis

392
Q

Adenocarcinoma of epigastric and upper quadrants

A

Cancer of pancreas

393
Q

Where does pancreatitis or cancer of pancreas radiate to?

A

Back

394
Q

Where is pancreatitis or cancer of pancreas located

A

Epigastric and radiates to the back

395
Q

Pancreas pain that is epigastric quality

A

Steady and deep

396
Q

Symptoms of pancreatic cancer

A

FEVER, constipation.

397
Q

What makes chronic pancreatitis worse?

A

Alcohol, heavy or fatty meals

398
Q

What relieves acute pancreatitis?

A

Leaning forward with trunk flexed intractable

399
Q

What relieves chronic pancreatitis?

A

Leaning forward with trunk flexed intractable

400
Q

Symptoms of acute pancreatitis

A

Nausea, vomiting, abdominal distention, FEVER. Alcohol abuse, gallstone history.

401
Q

Symptoms of chronic pancreatitis

A

Pancreatic enzyme insufficiency, diarrhea with fatty stools steatorrhea, DM

402
Q

What relieves cancer of pancreatitis?

A

Leaning forward with trunk flexed intractable

403
Q

Symptoms of pancreatic cancer

A

FEVER, constipation.

404
Q

Decreased bladder capacity caused by bladder sensitivity to stretch from inflammation, decreased elasticity of bladder wall, decreased cortical inhibition of bladder contraction.

A

Frequency

405
Q

Cause of frequency

A

Infection, stones, tumor

Clinical Assessment (1 decks)

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