CPM Written Exam Flashcards
1
Q
What makes the cornea clear?
A
Wavelength of visible light is approx 500nm
Collagen fibrils are closely and regularly spaced (60nm)
As long as the distance bw collagen fibrils is < 200 light will be transmitted and not scattered
2
Q
Emetropia
A
Light is focused right on the retina = a perfect image
3
Q
Myopia
A
Image is focused in front of the retina
=nearsightedness
4
Q
Hyperopia
A
Image is focused behind the retina
=farsightedness
5
Q
Shape of the lens when the ciliary muscle is relaxed:
A
Lens is flattened, more pancake-like
6
Q
Shape of the lens when the ciliary muscle is contracted:
A
Lens is rounder, more spherical-like
7
Q
Order of leading causes of blindness in the US:
A
- Macular degeneration
- Glaucoma
- Diabetic retinopathy
- Cataracts
8
Q
Cotton wool spots
A
Areas of hemorrhage in the retina; seen in diabetic retinopahy
9
Q
Background diabetic retinopathy - fundoscopy:
A
Hemorrhages (“cotton wool spots”)
Lipid deposits in macula
10
Q
Background diabetic retinopathy - pathophysiology:
A
The vessels of the retina become leaky in diabetes -> serum leaks out of vessels, and serum is high in lipid content so you get lipid deposits as well. Basically you see aneurysms, hemorrhages, edema, lipid deposits.
11
Q
Proliferative diabetic retinopathy - fundoscopy:
A
See neovascularization now. But these new vessels are abnormal, immature, leak fluid and bleed, grow in abnormal places & patterns.
12
Q
Proliferative diabetic retinopathy - pathophysiology:
A
The capillaries become so damaged that they shut down –> photoreceptors die –> as they die they release VEGF, which causes the neovascularization
13
Q
Macular degeneration - pathophysiology:
A
RPE not able to efficiently process the metabolic byproducts of phototransduction –> they build up as drusen (yellow blobs seen in the macula). Over time RPE cells become even more dysfunctional and they die, and when they die corresponding photoreceptors die too –> so see large areas of atrophy in severe MD. In wet-type, neovascularization occurs (similar to diabetic retinopathy)
14
Q
Risk factors for macular degeneration - dry type:
A
Mutations in complement factor H pathway Smoking Hyperopia Light iris color Hypertension, hypercholesterolemia Cardiovascular disease Female
15
Q
Natural history of wet age-related macular degeneration:
A
Blood vessels close down and become fibrovascular –> basically you end up with one big sheet of scar tissue
16
Q
Macular degeneration - dry type, treatment:
A
Vitamins & minerals: ascorbate, vitamin E, vitamin A, zinc, selenium, lutein, zeaxanthine
17
Q
Macular degeneration - wet type, treatment:
A
Laser
Low powered laser + hematoporphyrin derivative (PDT) (Visudyne)
VEGF inhibitors (Lucentis, avastin)
Corticosteroids (Triamcinolone)
18
Q
Which cells produce aqueous humor?
A
Nonpigmented cells of ciliary body epithelium
19
Q
Glaucoma treatment:
A
Decrease aqueous production: beta-blockers, alpha-agonists, carbonic anhydrase inhibition
Increase aqueous outflow: prostaglandin analogs, atropine, pilocarpine
Laser & surgical
20
Q
S1:
A
Mitral valve closes before tricuspid, but still heard as one sound
Best heard in mitral area
21
Q
S1 louder in:
A
High cardiac output
Mitral stenosis
Atrial myxoma
22
Q
S1 softer in:
A
Low cardiac output
Tachycardia
Obesity
23
Q
S1 variable intensity in:
A
Certain arrhythmias with a variable HR
24
Q
Best area to hear aortic component of S2:
A
It’s loud and heard everywhere, but often best in 2nd RICS
25
Best area to hear pulmonic component of S2:
It's soft, and only heard in 2nd LICS
26
S2 split:
Aortic closes before pulmonary, and this split is wider during inspiration.
best heard at left second intercostal space
27
Wide, fixed split of S2:
ASD (equalization of pressures bw right and left sides)
28
Paradoxical split of S2:
Aortic component of S2 occurs after pulmonic AND split is wider on expieratino than inspiration --> due to a delay in aortic component --> due to LBBB, HTN, aortic stenosis, etc.
29
Loud S2:
Hypertension
| Dilated aortic root
30
Soft S2
Calcific aortic stenosis
31
Loud P2
Pulmonary hypertension
32
S3
From rapid filling phase of diastole
Occurs w/ dilated LV (HF) or increased flow into LV (MR, AI)
Best heard at apex in LLD position
33
S4
From atrial systole phase of diastole
Occurs w/ stiffened or thickened LV (AS, htn, HF)
Best heard at apex in LLD position
34
Opening snap
From mitral valve opening
Occurs w/ mitral stenosis (often from RF)
High pitched sound best heard with diaphragm
Heard after S2
35
Neck veins - waves & descents
A wave - atrial contraction
X decent - atrial relaxation and descent of base of RA
C wave - bulging of tricuspid valve into RA during isovolumetric contraction
X descent (2nd part): continued atrial relaxation
V wave - from filling of the atrium during systole (w/ tricuspid valve closed)
Y descent - from opening of tricuspid valve
36
Visceral abdominal pain
```
Dull, crampy, aching
Poorly localized
Bilateral autonomic innervation
Slow C fibers
Perceived in midline
Embryologic distribution
```
37
Somatic abdominal pain
```
Involvement of parietal peritoneum
Severe and localized
Ipsilateral
Somatic innervation (spinal nerves)
A-delta fibers (rapid transmitters)
```
38
Onset of abdominal pain
Immediate - peritonitis, usually surgical
Intermediate (developing over hours) - cholecystitis, appendicitis
Delayed (over days) - obstruction, ileus
39
Colicky pain
Comes in waves/paroxysms
| Ex. from kidney stone (shows up well on plain xray btw), intussuception (can see on xray w/ barium enema)
40
Aortic dissection
Severe crushing chest pain
41
Ulcer
Burning epigastric pain
| Food relieves pain for duodenal ulcer, but aggravates pain in gastric ulcers
42
Abdominal pain radiation
Pain is present at site away from point of origin, but still at original site too. (vs. migration)
Ex. ureteric colic (kidney stone) radiates to grown, pancreatic pain radiates to the back
43
Abdominal pain migration
Pain at site away from the point of origin, which has now subsided
Signifies involvement of overlying peritoneum
Ex. RLQ pain in appendicitis, infarction in small intestine with migrating localized pain
44
Abdominal referred pain
Dermatomes!
| Ex. periumbilical pain in early appendicitis, gall bladder pain to angle of scapula
45
Bowel sounds - missing v. hyperactive
Peritonitis - no bowel sounds
| Ileus - hyperactive bowel sounds
46
Abdominal discoloration
Grey turner sign - Flank ecchymosis (bruising)
| Cullen sign - Umbilical ecchymosis
47
Abdominal red flags
fever, vomiting, syncope, blood loss, altered mental status, tachycardia, pain that is out of proportion to PE (bowel infarct)
48
Appearance of abdominal pt - restless v. lying still
restless - colicky pain, ureteric colic, biliary colic
| Lying still - peritonism/peritonitis, blood, bile or pus
49
Distension v. abdominal pain
Ileus - distention without pain
| Acute intestinal obstruction - abdominal pain followed by distention
50
Borbyrigmy
A quality of bowel sound - from food and liquid being pushed in the bowel agianst bowel wall
a rumbling or gurgling noise that occurs from the movements of fluid and gas in the intestines
51
Succession splash
seen in gastric outlet obstruction
move pt back and forth and can hear water swishing inside
(pt must have not eaten for at least 3 hours)
52
Abdominal percussion
tympanic - gas
dull - fluid (ascites or blood)
percussion is a very sensitive sign of peritonitis
53
Ascites, associated findings:
caput medulla
| spider angioma
54
Left supraclavicular lymph node
AKA Virchow's node
= Troisier's sign
Gastric cancer travels up to here through the thoracic duct
55
Conditions mimicking a acute abdomen
acute MI/angina, pericarditis, pneumonia, acute hepatitis, herpes zoster, abdominal wall hematoma, ureteral obstruction, pyelonephritis, sickle cell crisis, DKA, pophyria, leukemia
56
Appendicitis
periumbilical pain --> RLQ pain
pt most comfortable lying still
moderately severe, steady pain
Associated appetite loss & vomiting
57
Pancreatitis
Pain radiates to back
pain is less severe when sitting up & leaning forward but is worse lying down
Pain onsets suddenly (while eating fatty food), is sharp/knife-like quality and very severe
Associated vomiting
58
Cholecytitis
pain in upper abdomen --> RUQ; radiates to inf angle of scapula
Pt most comfortable lying still
Onset while eating fatty food
Associated nausea and vomiting
59
Kidney stone (renal colic)
pain in posterior subcostal region on affected side & radiates to groin
colicky type pain - pt is restless
pain onset very suddenly & very severe
associated urinary urgency & frequency
60
Elderly pt with abdominal disease
high likelihood of surgical disease
61
Appendicitis, pearls:
Consider in all pts with abdominal pain and an appendix, esp in pts with the presumed diagnosis of gastroenteritis, PID or UTI
WBC count is of little clinical importance in a pt with possible appendicitis
A pt with appendicitis by hx and PE doesn’t need a CT scan to confirm the dx, they need an operation
62
What are the 4 ethical principles?
autonomy
nonmaleficence
beneficence
justice
63
Nonmaleficence
Do no harm, avoid harm, prevent harm
64
Autonomy
the ability to understand medical information and to relate this to one's life plan and priorities
65
Beneficence
act in such a way as to provide a benefit for the patient
66
Justice
Give to each that which is due
67
Anesthesia
complete loss of touch appreciation
68
Hypesthesia
decreased appreciation touch
69
Hyperesthesia
increased sensitivity to touch
70
Analgesia
complete loss of pain appreciation
71
hypalgesia
decreased appreciation of pain
72
hyperalgesia/hyperpathia
increased sensitivity to pain
73
dysesthesia/allodynia
misperception of trivial tactile sensation as pain
74
paresthesia
abnormal spontaneous sensation such as tingling, pins and needles, or burning sensation
75
agnosia
the inability to recognize one or more classes of environmental stimuli, even though the required intellectual and perceptual functions are intact
76
anosognosia
inability to recognize one's own impairment
77
Romberg test
positive if unsteadiness is markedly increased by eye closure
indicates gross impairment of joint position in the lower extremities
78
2 point discrimination
impaired side will have increased threshold for 2 point discrimination (the stimuli will have to be further apart)
if peripheral sensory function is intact, impaired 2 point discrimination suggests a disorder of the contralateral sensory cortex
79
Flat lesion, <1cm
macule
80
Flat lesion, >1cm
patch
81
Raised lesion, <1cm
papule
82
Raised lesion, >1cm
plaque
83
Fluid filled lesion, <1cm
vesicle
84
Fluid filled lesion, >1cm
bulla
85
nodule
nodule is deeper (papule is more superficial), can feel under the skin
nodule doesn't have size description
86
pustule
filled with pus
tends to be small lesion but not defined by size
a little more superficial
87
obstructed breathing
slow breathing, prolonged inspiratory
| COPD, asthma
88
restricted breathing
small tidal volume, rapid rate
| restrictive lung diseases
89
kussmaul's breathing
abnormally large tidal volume and usually little apparent effort
metabolic acidosis, during exercise
90
cheyne-stokes respiration
Normal: infants, healthy elderly, high altitude
Abnormal: increased ICP, uremia, coma, respiratory depressant use, CHF, obstructive sleep apnea
91
leaning forward (breathing)
helps you exhale
| if you see leaning forward breathing, they may have heart failure
92
purse-lip breathing
causes increased end-expiratory pressure
| splints open airways and keeps alveoli open
93
Chest expansion
with COPD and lung disease it will move less
| pneumothorax - one side will move more than the other
94
Tactile fremitus
increased with consolidation
| decreases in areas without air
95
Percussion
areas with air - resonant
| areas without air - dull
96
tracheal breath sounds
tracea area, loud, high-pitched
97
vesicular breath sounds
most lung tissue, soft, low-pitch
98
Bronchial breath sounds
manubrium area, loud, high pitched
| abnormal if you hear this in the periphery
99
bronchovesicular breath sounds
1st/2nd ICS ant/post area, intermediate intensity and pitch
100
rales (crackles)
small airways open during inspiration and collapse on expiration, or air bubbles through secretions
101
Wheeze
high pitched sound when air flows through narrowed airways
102
rhonchi
low pitch sound, larger airway obstructed due to secretions
103
stridor
inspiratory wheeze heard loudest over trachea
104
pleural rub
creacking sounds when inflamed pleura rub against each other
105
mediastinal crunch
aka hamman's sign
crackles heard in the chest synchornized with heart beat
from air in mediastinum
106
egophony
e to a in consolidated lung
| fluid in lung transmits voice sounds loudly to the lung periphery
107
whispered pectoriloquy
increased sound with whispered voice if consolidated
108
Cor pulmonale
```
peripheral edema
jugular venous distension
pulmonary rales
cardiac S3
hepatojugular reflex
```
109
effusion - findings
decreased or absent breath sounds
dull to percussion
decreased fremitus
110
consolidations
bronchial breath sounds
dull to percussion
increased fremitus
egophany present
111
embolism w/o infarct
normal to auscultation or rales
JVD
S3
cyanosis
112
pneumothorax
distant breath sounds, rales, wheeze
hyperresonant to percussion or normal
decreased fremitus
JVD
113
CHF exacerbation
rales at base, rarely wheeze
dull at base or resonant
decreased fremitus at bases or normal
JVD, S3, edema
114
Asthma
expiratory wheeze
| resonant or hyperresonant percussion
115
maternal age
inc maternal age - down syndrome
| inc paternal age - autism
116
maternal diabetes
babies are larger
baby becomes hypoglycemic after birth
5-10% have a congenital birth defect - transportion of great arteries, vsd, macrosomia
117
maternal meds
buprenorphrine - opioide agonists --> opiode withdrawal for baby after birth
dilantan (anti-seizure) - malformation of baby
118
transplacental maternal infections
```
TORCH
toxoplasmosis
other (coxsackievirus, syphilis, varicella zoster, parvo)
rubella
CMV
herpes, HIV
```
119
APGARS
```
appearance
pulse
grimase
activity (limp v. active)
respirations
```
120
cord gas
pH less than 7.2 -- more ischemia & hypoxia
| means more difficult outcomes
121
erbs palsy
brachial plexus injury during birth
one arm is flexed while the other is not
denervation -- pronated arm
122
caput succedaneum
edema above the periosteum
forms in late stages of birth
crosses suture lines
123
cephlohematoma
```
bleeding under periosteum
has to conform to suture lines
can feel it in a defined area
it's present after 24hrs to days later
feels like a water balloon
```
124
ankyloglossia
= tethered tongue
| only a problem if they have problems feeding
125
absent femoral pulses?
coarctation of the aorta
| also will have lower bp in lower extremities than upper
126
barlow procedure
try to dislocate femur
pushing back straight on the hip joint
pushing the femoral head out of the acetabulum
127
Arteloni procedure
one leg at a time, to correct the dislocation
| pushing the head back into the socket
128
mongolian spot
very large confluent darkened areas
fade with age
remember to document
129
simian crease
single dominant crease
| downs syndrome
130
erythema toxicum
normal newborn rash
| little white spots look all the same as one another
131
Herpes (newborn)
grouped vesicles at different stages
132
rooting reflex
sucking, looking for nipple
133
marrow reflex
sense of falling
hold head up and drop head
the baby screams and puts hands out
134
atonic neck reflex
move chin to shoulder
| the ipsilateral hand goes out like you are fencing
135
parasupine reflex
rub along the spine and the baby will curve its back
136
who is at risk for hip dysplasia
any baby who is crowded
breached babies
female babies
first born
137
normal findings in a newborn
breast enlargement
vaginal discharge
bluish discoloration (cyanosis) of fingers and toes, with pink lips
palpable spleen tip
138
female anatomy
bladder is anterior to uterus
ovaries fall into cul de sac of douglass
the ureters travel with ovarian blood supply
139
pelvis shapes
gynecoid - ideal for childbirth
android - heart shaped
anthropoid - AP diameter > transverse diameter, most common in non-white
Platypelloid - side transverse diameter
140
cervix
ectocervix = squamous epithelium (pale pink)
endocervix = columnar epithelium (dark pink)
transformation zone = area bw
141
multiperious cervix
previous pregnancy or instrumentation was used on it (ragged appearance)
142
cycle length
35 days = oligomenorrhea
143
axillary tail of spence
breast malignancies common in the upper lateral quadrant
144
gyn health care maintenance
clinical yearly breast exam
mammography annually begininng at age 40
pap smears start at age 21 (dc if low risk pt at 65-70yrs old)
Do pap smears every 2 years under age 30, and over age 30 every 3 years (w/ 3 consecutive normal cytology and negative high risk HPV screen with no other risk factors)
Over age 30 and/or high risk - annually (HIV+, immunosuppressed, DES exposure)
after hysterectomy - if bengin and no history of CIN2-3 for 3 consecutive exams, dc; if for cancer follow specific guidelines; if CIN2-3 at time of surgery annually then dc if 3 consecutive negative results
osteoporosis screening - >65 every 2 years, or <65 if risk factors & all postmeno with fractures
145
Risk factors for osteoporotic fracture in postmenopausal women
hx of prior fracture, fh of osteoporosis, caucasian race, dementia, poor nutrition, smoking, impaired eyesight despite adequate correction, inadequate physical activity, low weight & body mass index, estrogen deficiency (early menopause or prolonged premenopausal amenorrhea), long-term low calcium intake, alcoholism, history of falls
146
Flank pain
renal origin? - obstruction (stone) or inflammatino (infection)
check CVA
nausea
peritoneal irritation from retrop. inflammation
147
Lower quadrant pain
generally not urological
148
mid-ureteric stone
referred to mcburney's point
149
upper ureteric stone
referrred to testis
150
lower ureteric stone
may cause bladder irritability (urgency & frequency)
151
suprapubic pain
bladder pain usually changes with voiding
| etiology: infection or inflammation
152
lower urinary tract symptoms
urgency, frequency, nocturia, dysuria, hesitency, (nonspecific)
153
stress incontinence
sudden increases in intraabdominal pressure forces urine out in spurts
154
urgency
incontinence preceded by a feeling of an urge to urinate
155
mixed incontinence
combination of stress incontinence and urgency
156
overflow (paradoxical) incontinence
pt keeps losing urine not because bladder cannot hold urine but because bladder is so full
157
continuous incontinence
from fistula or ectopic ureter (ureter connects to vagina)
158
occult incontinence
```
may be subtle variant of stress, urge or mixed
urethral pooling (urine pools into bulbar urethra and it leaks out), vaginal voiding (urine flows back into vaginal area and leaks out with positional changes
```
159
pneumaturia/fecaluria
air in urine and foul smelling urine
| from fistula connected to bowels
160
pneumaturia alone
occasionally gas forming organisms (very rare)
| previous catheterization
161
cloudy urine
alkaline: phosphates precipitates
UTI
chyluria (lymphatic abnormality in the kidney)
162
malodorous urine
may be UTI
foods
ammonia
163
urinary discoloration
medications: pyridium, vits., methylene blue, phelophthalein
foods: beets, rhodamine B foodcoloring
infection: pseudomonas
164
initial hematuria
anterior urethra
165
terminal hematuria
trigone, bladder neck or posterior urethra
166
total hematuria
bladder or upper tract
167
significant proteinuria
consider medical renal disease
168
tea colored urine
hematuria --> old blood (clots in bladder that are breaking up)
169
hemospermia
generally not significant
| blood in semen
170
kidney exam
bimanual palpation with inspiration
| renal cell carcinoma is very vascular - can hear a bruit from the arterial fistula formed
171
ureter
not palpable in males, but lower ureter may be felt in female transvaginally
172
verrucal lesions (condylomata)
usually found in warm moist environment under the foreskin
173
penis anatomy
3 spongy cylinders - 2 corpora cavernosa, 1 corpus spongiosum
urethra within corpus spongiosum
174
peyronie's disease
fibrosis in tunica albuginea of corpora
175
corporal fibrosis
priapism (constant erections)
| injection therapy
176
scrotal abscess
scrotal wall/hidradenitis
| scrotal space - epididymitis/testicular (rare)
177
scrotal edema
poor lymphatic drainage
dependent edema common
filariasis (elephantile disease)
178
scrotal cancers
rare
179
testicle anatomy
pampiniform plexus upper part of the cord may take over teh whole epidydimis
tunical vaginalis is actually the peritoneal cavity that came down with the testicles
testies are retroperitoneal
outside space is where a hydrocele would develop
180
hydrocele
```
fluid within tunica vaginalis
may obliterate palpation of other structures, sonogram may be useful
transillumination - cystic v solid
may be isolated to cord
may commincate with peritoneum
```
181
epididymis
```
inflammation/epididymitis
induration
cysts
spermatocele (dilated area where epidydimis and testis meet)
cancers are extremely rare
```
182
vas deferens
inflammation
funiculitis
beaded vas: TB
calcified vas: diabetes, TB
183
spermatic cord
lipoma
hernia: palpate external ring
varicocele - varicosity of pampiniform plexus
embrologic rests - adrenal, splenic
184
paratesticular lesions
lipoma
| masses rare - rhabdomyosarcoma
185
prostate
chestnut size and shape
rubbery
note tenderness, symmetry, nodules, median sulcus
186
seminal vesicles
normally not palpable
187
inguinal nodes
drain genital skin
188
advanced testis tumor
testis are retroperitoneal
abdominal mass from retroperitoneal nodes
supraclavicular nodes
189
Causes of inflammatory arthritis
infectious
crystal induced
autoimmune
190
Causes of noninflammatory arthritis
degenerative
mechanical or traumatic
metabolic or endocrine
191
causes of arthralgia
mild or early arthritis
| psychogenic, fibromyalgia
192
painful arc maneuver
Pain upon abduction of arm
| indicative of tendinitis
193
empty can test/speed's test
pt rotates shoulder actively and physician pushes down
| tests for bicipital tendonitis
194
shoulder impingement syndrome
acromion impinging on tendon
| do hawking's sign
195
Rheumatoid arthritis
synovitis, bone erosion, pannus, cartilage degredation
osteophyte formation
hand and wrist deformitites
swan neck deformity, bouteniere deformity
flexion deformity of elbow
196
finkelsteins maneuver
pt tucks thumb into hand, and dr ulnarly deviates wrist to pull on the tendon
197
lachmans' test
tests ACL
| similar to anterior drawer
198
apley compression test
90 degree knee bend
push down and pivot ankle
pain indicates meniscus tear
199
trendelenberg sign
abnormal pelvis tilts away from stance leg
hip abductor weakness
dropped pelvis on normal side
trunk bends toward involved side
200
thomas test
detecting a flexion deformity of the hip
| affected side of hip can't raise knee past 90 degrees without the other knee also bending
201
schober's test
2 midline marks 10cm apart starting at the PSIS (dimples of venus)
re-measure with lumbar spine at maximal flexion
less than 5cm difference suggests pathology
202
bamboo spine
```
with ankylosing spondylitis
inflammation of ligaments around spine
occurs around age 20
over time ligaments calcify
lose ROM
```
203
atrophy
suggests diseases involving lower motor neuron or disuse of muscle
204
fasciculations
associated with LMN problems, particularly anterior horn cell disease
205
hypotonia
seen with LMH lesions and cerebellar disease
206
hypertonia - spasticity
initial resistance to movement with terminal giveway (clasp-knife)
seen in UMN lesions (corticospinal tract)
spasticity for long period of time gives rise to contractures
spastic posturing - dominance of antigravity muscles (flexion of upper extremity & extension in lower extremity) - plantar flexion causes trip while walking so see circumduction walking as compensation
207
hypertonia - rigidity
a ratcheting catch and give pattern
= cogwheeling
lead pipe
associated with extrapyrimidal nervous system problems
208
strength scale
```
5 = normal power
4 = can generate resistance but less than the expected amount
3 = can oppose gravity, but not resistance
2 = can generate movement only if gravity is eliminated
1 = flicker or trace contraction
0 = no contraction
```
209
pronator drift
have pt close eyes and hold arms with palms outstretched in front of him
weakness in upper extremity will cause the arm to drift downward and the hand will pronate
210
carpal tunnel
median nerve --> opponens pollicis, abductor pollicis
211
tremor
involuntary, regular, rhythmic oscillating movements
| result from alternating or synchronous contraction of reciprocally innervated antagonist muscles
212
chorea
rapid jerks which are irregularly timed, non-repetitive and randomly distributed (nonstereotyped)
213
athetosis
involuntary movements with a slow, writhing character
214
dystonia
involuntary muscle contractions producing twisting movements that may be sustained, producing an abnormal posture of the affected body part
215
tics
brief, rapid, repetitive, purposeless, stereotyped involuntary movement that involve a single muscle group or multiple groups
may have a coordinated patterned sequence of movements
216
myoclonus
sudden, rapid, twitch-like muscle contractions
| may be spontaneous or triggered by arousal, initiation of movement or sensory stimuli
217
grading of reflexes
```
4+ clonus
3+ hyperreflexia
2+ normal
1+ hyporeflexia
0 absent
```
218
Jendrassik maneuver
to help elicit deep tendon reflexes
| have pt hook together flexed fingers and pull
219
babinski maneuver
big toe extends and other toes fan out
can be seen with corticospinal tract damage or diffuse cerebral dysfunction
no response = indifferent plantar response
if big toe goes up and down = equivocal plantar response
220
alternative babinsky maneuvers
bing's maneuver - repeated prcking of the dorsal surface of the great toe with a pin
oppenhiem's maneuver - firmly run the knuckles of your index and middle finger down the anterior tibial border from the knee to the ankle
Chaddock's maneuver - scratch the lateral aspect of the dorsum of the foot from the heel to the base of the toes
221
features of UMN lesions
weakness, spasticity, hyperreflexia, extensor plantar response, little or no atrophy
222
features of LMN lesions
weakness, hypotonia, hyporeflexia or areflexia, flexor or indifferent plantar response, atrophy and fasciculations
223
dysmetria
pt overshooting or undershooting on the finger-nose-finger test
224
shoulder palpation
AC joint tender in AC sprain/separation/arthritis
| Subacromial bursa is tender in acute calcific bursitis
225
shoulder ROM
limited active & passive ROM in frozen shoulder
pain on cross chest adduction with AC injury/arthritis
loss of active movement in acute calcific bursitis
226
impingement sign
tested via hawkings, neer sign
| + impingement sign with rotator cuff disorder
227
rotator cuff strength
test for specific muscle weakness in rotator cuff disorder
228
apprehension test
= crank test
| positive in glenohumeral instability
229
rotator cuff disorder
age >40, upper arm pain, pain with abduction or overhead activity, nocturnal pain, weakness, atrophy, painful arc motion/crepitation, loss of motion, + impingement sign
230
frozen shoulder
late middle age, diabetics, spontaneous onset of progressive pain & stiffness, loss of ROM in all plains w/ end range pain (passive = active), night pain
231
AC injury/arthritis
non-radiating shoulder pain, AC tenderness & swelling, pain with cross chest adduction
232
glenohumeral instability
age <40, Hx of dislocation or subluxation, + apprehension (crank) sign, generalized ligamentous laxity
233
acute calcific bursitis
acute onset of explosive shoulder pain, atraumatic, nocturnal pain, can't move arm, tender subacromial bursa
234
hawking's sign
lift up arm to shoulder height & internally rotate it
| will cause pain if rotator cuff problem
235
neer's impingement sign
raise arm above up all the way and internally rotate thumb
| will cause pain if rotator cuff problem
236
empty can test
tests strength of supraspinatus muscle
have them point their thumb's down, bring arms to 30 degrees forward flexion
press down on both sides simultaneously and see which side hurts and/or is weak
237
drop arm test
indicative of a complete rotator cuff tear
often in elderly
if you lift up their arm and let go, they can't keep it up
238
AC separation grading
grade I - tear or stretch AC ligaments, no elevation of clavicle
grade II - involvment of coracoclavicular ligaments, clavicle elevated less than 1 width
grade III - clavicle elevated more than 1 width
239
sulcus sign
when you pull down on the arm and see a sulcus appear below the acromion
pathognomonic of multidirectional instability (MDI) of glenohumeral joint
240
spondylolisthesis
anterior displacement of lumbar vertebral body
241
spondylolysis
defect in pars interarticularis
242
back pain of disc v. muscle
back pain caused by protruded disc is exacerbated by sitting and bending
pain of lumbar muscular strain is aggravated by standing and twisting movements
243
if valsalva maneuver increases back pain?
almost always herniated disc pressing on lumbar nerve root
244
straight leg raise
evaluating for lumbar radiculopathy
pain below knee at less than 60 degrees hip flexion is positive
suggests compression or irritation of nerve root
245
cauda equina syndrome
massive midline disc herniation or tumor
bilateral sciatica, saddle anesthesia, urinary retention with overflow incontinence, leg weakness, reduced sphincter tone
an emergency! refer to ER immediately!
246
otitis externa microbiology
40% pseudomonas
30% staph species
10% gram negative rods
3% fungal
247
if you see unilateral serous effusion of middle ear in an adult, do what?
check the nasopharynx bc a mass/tumor could be blocking the eustachian tube!
248
Nose functions
defense
olfaction
respiration
cosmesis
249
bacterial rhinosinusitis
streptococcus pneumoniae
moraxella catarrhalis
hemophilis influenzae
250
palatine tonsil anatomy
exist between palatoglossal and palatopharyngeal arches
251
otitis media etiology
strep pneumo 35-40%
non typable H flu 25-30%
moraxella 15-20%
252
if valsalva maneuver increases back pain?
almost always herniated disc pressing on lumbar nerve root
253
straight leg raise
evaluating for lumbar radiculopathy
pain below knee at less than 60 degrees hip flexion is positive
suggests compression or irritation of nerve root
254
cauda equina syndrome
massive midline disc herniation or tumor
bilateral sciatica, saddle anesthesia, urinary retention with overflow incontinence, leg weakness, reduced sphincter tone
an emergency! refer to ER immediately!
255
otitis externa microbiology
40% pseudomonas
30% staph species
10% gram negative rods
3% fungal
256
if you see unilateral serous effusion of middle ear in an adult, do what?
check the nasopharynx bc a mass/tumor could be blocking the eustachian tube!
257
Nose functions
defense
olfaction
respiration
cosmesis
258
bacterial rhinosinusitis
streptococcus pneumoniae
moraxella catarrhalis
hemophilis influenzae
259
palatine tonsil anatomy
exist between palatoglossal and palatopharyngeal arches
260
otitis media etiology
strep pneumo 35-40%
non typable H flu 25-30%
moraxella 15-20%
261
condyloma acunatum
DNA virus
| soft fleshy wartlike growths
262
SPIKES
S-Setting, context, listening skills
P-pt's Perception of current medical problem
I-Invitation from the pt for you to give info
K-Koweldge the disemmination or giveing of Medical facts
E-Explore pt Emotions and Emphasize as pts respond
S-Strategy & Summary
263
inguinal hernia
indirect (congenital) - lateral to IEA
direct (acquired) - medial to IEA
above inguinal ligament
264
Femoral hernia
female > male
passes through femoral canal
underneath inguinal ligament
265
testicular mass
benign: orchitis, TB, adenomatoid tumor
malignant: seminoma, embryonal cell cancer, teratoma, teratocarcinoma, choriocarcinoma, leydig cell tumor, sertoli cell tumor, adenomatoid tumor
266
coverings of spermatic cord
```
external spermatic (intercurral) fascia (derived from ext. oblique apon.)
cremasteric m. & fascia (derived from int. oblique m.)
internal spermatic (infundibularform) fascia (derived from transversalis fascia
```
267
Hesselbach's triangle
inferior epigastric a., lateral morder of rectus sheath, inguinal ligament
268
femoral triangle (scarpa's triangle)
inguinal ligament, medial margin of sartorius, lateral border of adductor longus muscle; roof = fascia lata; floor, from lat to med - ilipsoas, pectineus, portion of adductor brevis; contents = femoral a, v, n and their initial branches & tributaries
269
autonomy
obligation to respect patients as individuals and to honor their preferences in medical care
270
benificence
physicians have a special ethical (fiduciary) duty to act in the pt's best interest
may conflict with autonomy
if the pt can make an informed decision, ultimately the pt has the right to decide
271
nonmaleficence
do no harm
however, if the benefits of an intervention outweight the risks, a pt may make an informed decision to proceed (most surgeries fall into this category)
272
justice
to treat persons fairly
273
autonomy
obligation to respect patients as individuals and to honor their preferences in medical care
274
benificence
physicians have a special ethical (fiduciary) duty to act in the pt's best interest
may conflict with autonomy
if the pt can make an informed decision, ultimately the pt has the right to decide
275
nonmaleficence
do no harm
however, if the benefits of an intervention outweight the risks, a pt may make an informed decision to proceed (most surgeries fall into this category)
276
justice
to treat persons fairly
