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CPM II Fall > CPM Written Exam > Flashcards

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

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2
Q

Emetropia

A

Light is focused right on the retina = a perfect image

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3
Q

Myopia

A

Image is focused in front of the retina

=nearsightedness

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4
Q

Hyperopia

A

Image is focused behind the retina

=farsightedness

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5
Q

Shape of the lens when the ciliary muscle is relaxed:

A

Lens is flattened, more pancake-like

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6
Q

Shape of the lens when the ciliary muscle is contracted:

A

Lens is rounder, more spherical-like

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7
Q

Order of leading causes of blindness in the US:

A
  1. Macular degeneration
  2. Glaucoma
  3. Diabetic retinopathy
  4. Cataracts
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8
Q

Cotton wool spots

A

Areas of hemorrhage in the retina; seen in diabetic retinopahy

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9
Q

Background diabetic retinopathy - fundoscopy:

A

Hemorrhages (“cotton wool spots”)

Lipid deposits in macula

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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.

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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.

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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

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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)

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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
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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

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16
Q

Macular degeneration - dry type, treatment:

A

Vitamins & minerals: ascorbate, vitamin E, vitamin A, zinc, selenium, lutein, zeaxanthine

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17
Q

Macular degeneration - wet type, treatment:

A

Laser
Low powered laser + hematoporphyrin derivative (PDT) (Visudyne)
VEGF inhibitors (Lucentis, avastin)
Corticosteroids (Triamcinolone)

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18
Q

Which cells produce aqueous humor?

A

Nonpigmented cells of ciliary body epithelium

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19
Q

Glaucoma treatment:

A

Decrease aqueous production: beta-blockers, alpha-agonists, carbonic anhydrase inhibition
Increase aqueous outflow: prostaglandin analogs, atropine, pilocarpine
Laser & surgical

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20
Q

S1:

A

Mitral valve closes before tricuspid, but still heard as one sound
Best heard in mitral area

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21
Q

S1 louder in:

A

High cardiac output
Mitral stenosis
Atrial myxoma

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22
Q

S1 softer in:

A

Low cardiac output
Tachycardia
Obesity

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23
Q

S1 variable intensity in:

A

Certain arrhythmias with a variable HR

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24
Q

Best area to hear aortic component of S2:

A

It’s loud and heard everywhere, but often best in 2nd RICS

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25
Q

Best area to hear pulmonic component of S2:

A

It’s soft, and only heard in 2nd LICS

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26
Q

S2 split:

A

Aortic closes before pulmonary, and this split is wider during inspiration.
best heard at left second intercostal space

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27
Q

Wide, fixed split of S2:

A

ASD (equalization of pressures bw right and left sides)

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28
Q

Paradoxical split of S2:

A

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.

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29
Q

Loud S2:

A

Hypertension

Dilated aortic root

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30
Q

Soft S2

A

Calcific aortic stenosis

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31
Q

Loud P2

A

Pulmonary hypertension

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32
Q

S3

A

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

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33
Q

S4

A

From atrial systole phase of diastole
Occurs w/ stiffened or thickened LV (AS, htn, HF)
Best heard at apex in LLD position

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34
Q

Opening snap

A

From mitral valve opening
Occurs w/ mitral stenosis (often from RF)
High pitched sound best heard with diaphragm
Heard after S2

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35
Q

Neck veins - waves & descents

A

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

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36
Q

Visceral abdominal pain

A 
Dull, crampy, aching
Poorly localized
Bilateral autonomic innervation
Slow C fibers
Perceived in midline
Embryologic distribution
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37
Q

Somatic abdominal pain

A 
Involvement of parietal peritoneum
Severe and localized
Ipsilateral
Somatic innervation (spinal nerves)
A-delta fibers (rapid transmitters)
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38
Q

Onset of abdominal pain

A

Immediate - peritonitis, usually surgical
Intermediate (developing over hours) - cholecystitis, appendicitis
Delayed (over days) - obstruction, ileus

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39
Q

Colicky pain

A

Comes in waves/paroxysms

Ex. from kidney stone (shows up well on plain xray btw), intussuception (can see on xray w/ barium enema)

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40
Q

Aortic dissection

A

Severe crushing chest pain

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41
Q

Ulcer

A

Burning epigastric pain

Food relieves pain for duodenal ulcer, but aggravates pain in gastric ulcers

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42
Q

Abdominal pain radiation

A

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

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43
Q

Abdominal pain migration

A

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

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44
Q

Abdominal referred pain

A

Dermatomes!

Ex. periumbilical pain in early appendicitis, gall bladder pain to angle of scapula

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45
Q

Bowel sounds - missing v. hyperactive

A

Peritonitis - no bowel sounds

Ileus - hyperactive bowel sounds

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46
Q

Abdominal discoloration

A

Grey turner sign - Flank ecchymosis (bruising)

Cullen sign - Umbilical ecchymosis

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47
Q

Abdominal red flags

A

fever, vomiting, syncope, blood loss, altered mental status, tachycardia, pain that is out of proportion to PE (bowel infarct)

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48
Q

Appearance of abdominal pt - restless v. lying still

A

restless - colicky pain, ureteric colic, biliary colic

Lying still - peritonism/peritonitis, blood, bile or pus

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49
Q

Distension v. abdominal pain

A

Ileus - distention without pain

Acute intestinal obstruction - abdominal pain followed by distention

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50
Q

Borbyrigmy

A

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

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51
Q

Succession splash

A

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)

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52
Q

Abdominal percussion

A

tympanic - gas
dull - fluid (ascites or blood)
percussion is a very sensitive sign of peritonitis

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53
Q

Ascites, associated findings:

A

caput medulla

spider angioma

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54
Q

Left supraclavicular lymph node

A

AKA Virchow’s node
= Troisier’s sign
Gastric cancer travels up to here through the thoracic duct

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55
Q

Conditions mimicking a acute abdomen

A

acute MI/angina, pericarditis, pneumonia, acute hepatitis, herpes zoster, abdominal wall hematoma, ureteral obstruction, pyelonephritis, sickle cell crisis, DKA, pophyria, leukemia

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56
Q

Appendicitis

A

periumbilical pain –> RLQ pain
pt most comfortable lying still
moderately severe, steady pain
Associated appetite loss & vomiting

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57
Q

Pancreatitis

A

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

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58
Q

Cholecytitis

A

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

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59
Q

Kidney stone (renal colic)

A

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

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60
Q

Elderly pt with abdominal disease

A

high likelihood of surgical disease

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61
Q

Appendicitis, pearls:

A

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

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62
Q

What are the 4 ethical principles?

A

autonomy
nonmaleficence
beneficence
justice

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63
Q

Nonmaleficence

A

Do no harm, avoid harm, prevent harm

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64
Q

Autonomy

A

the ability to understand medical information and to relate this to one’s life plan and priorities

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65
Q

Beneficence

A

act in such a way as to provide a benefit for the patient

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66
Q

Justice

A

Give to each that which is due

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67
Q

Anesthesia

A

complete loss of touch appreciation

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68
Q

Hypesthesia

A

decreased appreciation touch

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69
Q

Hyperesthesia

A

increased sensitivity to touch

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70
Q

Analgesia

A

complete loss of pain appreciation

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71
Q

hypalgesia

A

decreased appreciation of pain

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72
Q

hyperalgesia/hyperpathia

A

increased sensitivity to pain

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73
Q

dysesthesia/allodynia

A

misperception of trivial tactile sensation as pain

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74
Q

paresthesia

A

abnormal spontaneous sensation such as tingling, pins and needles, or burning sensation

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75
Q

agnosia

A

the inability to recognize one or more classes of environmental stimuli, even though the required intellectual and perceptual functions are intact

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76
Q

anosognosia

A

inability to recognize one’s own impairment

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77
Q

Romberg test

A

positive if unsteadiness is markedly increased by eye closure
indicates gross impairment of joint position in the lower extremities

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78
Q

2 point discrimination

A

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

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79
Q

Flat lesion, <1cm

A

macule

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80
Q

Flat lesion, >1cm

A

patch

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81
Q

Raised lesion, <1cm

A

papule

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82
Q

Raised lesion, >1cm

A

plaque

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83
Q

Fluid filled lesion, <1cm

A

vesicle

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84
Q

Fluid filled lesion, >1cm

A

bulla

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85
Q

nodule

A

nodule is deeper (papule is more superficial), can feel under the skin
nodule doesn’t have size description

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86
Q

pustule

A

filled with pus
tends to be small lesion but not defined by size
a little more superficial

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87
Q

obstructed breathing

A

slow breathing, prolonged inspiratory

COPD, asthma

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88
Q

restricted breathing

A

small tidal volume, rapid rate

restrictive lung diseases

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89
Q

kussmaul’s breathing

A

abnormally large tidal volume and usually little apparent effort
metabolic acidosis, during exercise

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90
Q

cheyne-stokes respiration

A

Normal: infants, healthy elderly, high altitude
Abnormal: increased ICP, uremia, coma, respiratory depressant use, CHF, obstructive sleep apnea

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91
Q

leaning forward (breathing)

A

helps you exhale

if you see leaning forward breathing, they may have heart failure

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92
Q

purse-lip breathing

A

causes increased end-expiratory pressure

splints open airways and keeps alveoli open

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93
Q

Chest expansion

A

with COPD and lung disease it will move less

pneumothorax - one side will move more than the other

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94
Q

Tactile fremitus

A

increased with consolidation

decreases in areas without air

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95
Q

Percussion

A

areas with air - resonant

areas without air - dull

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96
Q

tracheal breath sounds

A

tracea area, loud, high-pitched

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97
Q

vesicular breath sounds

A

most lung tissue, soft, low-pitch

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98
Q

Bronchial breath sounds

A

manubrium area, loud, high pitched

abnormal if you hear this in the periphery

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99
Q

bronchovesicular breath sounds

A

1st/2nd ICS ant/post area, intermediate intensity and pitch

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100
Q

rales (crackles)

A

small airways open during inspiration and collapse on expiration, or air bubbles through secretions

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101
Q

Wheeze

A

high pitched sound when air flows through narrowed airways

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102
Q

rhonchi

A

low pitch sound, larger airway obstructed due to secretions

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103
Q

stridor

A

inspiratory wheeze heard loudest over trachea

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104
Q

pleural rub

A

creacking sounds when inflamed pleura rub against each other

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105
Q

mediastinal crunch

A

aka hamman’s sign
crackles heard in the chest synchornized with heart beat
from air in mediastinum

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106
Q

egophony

A

e to a in consolidated lung

fluid in lung transmits voice sounds loudly to the lung periphery

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107
Q

whispered pectoriloquy

A

increased sound with whispered voice if consolidated

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108
Q

Cor pulmonale

A 
peripheral edema
jugular venous distension
pulmonary rales
cardiac S3
hepatojugular reflex
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109
Q

effusion - findings

A

decreased or absent breath sounds
dull to percussion
decreased fremitus

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110
Q

consolidations

A

bronchial breath sounds
dull to percussion
increased fremitus
egophany present

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111
Q

embolism w/o infarct

A

normal to auscultation or rales
JVD
S3
cyanosis

112
Q

pneumothorax

A

distant breath sounds, rales, wheeze
hyperresonant to percussion or normal
decreased fremitus
JVD

113
Q

CHF exacerbation

A

rales at base, rarely wheeze
dull at base or resonant
decreased fremitus at bases or normal
JVD, S3, edema

114
Q

Asthma

A

expiratory wheeze

resonant or hyperresonant percussion

115
Q

maternal age

A

inc maternal age - down syndrome

inc paternal age - autism

116
Q

maternal diabetes

A

babies are larger
baby becomes hypoglycemic after birth
5-10% have a congenital birth defect - transportion of great arteries, vsd, macrosomia

117
Q

maternal meds

A

buprenorphrine - opioide agonists –> opiode withdrawal for baby after birth
dilantan (anti-seizure) - malformation of baby

118
Q

transplacental maternal infections

A 
TORCH
toxoplasmosis
other (coxsackievirus, syphilis, varicella zoster, parvo)
rubella
CMV
herpes, HIV
119
Q

APGARS

A 
appearance
pulse
grimase
activity (limp v. active)
respirations
120
Q

cord gas

A

pH less than 7.2 – more ischemia & hypoxia

means more difficult outcomes

121
Q

erbs palsy

A

brachial plexus injury during birth
one arm is flexed while the other is not
denervation – pronated arm

122
Q

caput succedaneum

A

edema above the periosteum
forms in late stages of birth
crosses suture lines

123
Q

cephlohematoma

A 
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
Q

ankyloglossia

A

= tethered tongue

only a problem if they have problems feeding

125
Q

absent femoral pulses?

A

coarctation of the aorta

also will have lower bp in lower extremities than upper

126
Q

barlow procedure

A

try to dislocate femur
pushing back straight on the hip joint
pushing the femoral head out of the acetabulum

127
Q

Arteloni procedure

A

one leg at a time, to correct the dislocation

pushing the head back into the socket

128
Q

mongolian spot

A

very large confluent darkened areas
fade with age
remember to document

129
Q

simian crease

A

single dominant crease

downs syndrome

130
Q

erythema toxicum

A

normal newborn rash

little white spots look all the same as one another

131
Q

Herpes (newborn)

A

grouped vesicles at different stages

132
Q

rooting reflex

A

sucking, looking for nipple

133
Q

marrow reflex

A

sense of falling
hold head up and drop head
the baby screams and puts hands out

134
Q

atonic neck reflex

A

move chin to shoulder

the ipsilateral hand goes out like you are fencing

135
Q

parasupine reflex

A

rub along the spine and the baby will curve its back

136
Q

who is at risk for hip dysplasia

A

any baby who is crowded
breached babies
female babies
first born

137
Q

normal findings in a newborn

A

breast enlargement
vaginal discharge
bluish discoloration (cyanosis) of fingers and toes, with pink lips
palpable spleen tip

138
Q

female anatomy

A

bladder is anterior to uterus
ovaries fall into cul de sac of douglass
the ureters travel with ovarian blood supply

139
Q

pelvis shapes

A

gynecoid - ideal for childbirth
android - heart shaped
anthropoid - AP diameter > transverse diameter, most common in non-white
Platypelloid - side transverse diameter

140
Q

cervix

A

ectocervix = squamous epithelium (pale pink)
endocervix = columnar epithelium (dark pink)
transformation zone = area bw

141
Q

multiperious cervix

A

previous pregnancy or instrumentation was used on it (ragged appearance)

142
Q

cycle length

A

35 days = oligomenorrhea

143
Q

axillary tail of spence

A

breast malignancies common in the upper lateral quadrant

144
Q

gyn health care maintenance

A

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
Q

Risk factors for osteoporotic fracture in postmenopausal women

A

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
Q

Flank pain

A

renal origin? - obstruction (stone) or inflammatino (infection)
check CVA
nausea
peritoneal irritation from retrop. inflammation

147
Q

Lower quadrant pain

A

generally not urological

148
Q

mid-ureteric stone

A

referred to mcburney’s point

149
Q

upper ureteric stone

A

referrred to testis

150
Q

lower ureteric stone

A

may cause bladder irritability (urgency & frequency)

151
Q

suprapubic pain

A

bladder pain usually changes with voiding

etiology: infection or inflammation

152
Q

lower urinary tract symptoms

A

urgency, frequency, nocturia, dysuria, hesitency, (nonspecific)

153
Q

stress incontinence

A

sudden increases in intraabdominal pressure forces urine out in spurts

154
Q

urgency

A

incontinence preceded by a feeling of an urge to urinate

155
Q

mixed incontinence

A

combination of stress incontinence and urgency

156
Q

overflow (paradoxical) incontinence

A

pt keeps losing urine not because bladder cannot hold urine but because bladder is so full

157
Q

continuous incontinence

A

from fistula or ectopic ureter (ureter connects to vagina)

158
Q

occult incontinence

A 
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
Q

pneumaturia/fecaluria

A

air in urine and foul smelling urine

from fistula connected to bowels

160
Q

pneumaturia alone

A

occasionally gas forming organisms (very rare)

previous catheterization

161
Q

cloudy urine

A

alkaline: phosphates precipitates
UTI
chyluria (lymphatic abnormality in the kidney)

162
Q

malodorous urine

A

may be UTI
foods
ammonia

163
Q

urinary discoloration

A

medications: pyridium, vits., methylene blue, phelophthalein
foods: beets, rhodamine B foodcoloring
infection: pseudomonas

164
Q

initial hematuria

A

anterior urethra

165
Q

terminal hematuria

A

trigone, bladder neck or posterior urethra

166
Q

total hematuria

A

bladder or upper tract

167
Q

significant proteinuria

A

consider medical renal disease

168
Q

tea colored urine

A

hematuria –> old blood (clots in bladder that are breaking up)

169
Q

hemospermia

A

generally not significant

blood in semen

170
Q

kidney exam

A

bimanual palpation with inspiration

renal cell carcinoma is very vascular - can hear a bruit from the arterial fistula formed

171
Q

ureter

A

not palpable in males, but lower ureter may be felt in female transvaginally

172
Q

verrucal lesions (condylomata)

A

usually found in warm moist environment under the foreskin

173
Q

penis anatomy

A

3 spongy cylinders - 2 corpora cavernosa, 1 corpus spongiosum
urethra within corpus spongiosum

174
Q

peyronie’s disease

A

fibrosis in tunica albuginea of corpora

175
Q

corporal fibrosis

A

priapism (constant erections)

injection therapy

176
Q

scrotal abscess

A

scrotal wall/hidradenitis

scrotal space - epididymitis/testicular (rare)

177
Q

scrotal edema

A

poor lymphatic drainage
dependent edema common
filariasis (elephantile disease)

178
Q

scrotal cancers

A

rare

179
Q

testicle anatomy

A

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
Q

hydrocele

A 
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
Q

epididymis

A 
inflammation/epididymitis
induration
cysts
spermatocele (dilated area where epidydimis and testis meet)
cancers are extremely rare
182
Q

vas deferens

A

inflammation
funiculitis
beaded vas: TB
calcified vas: diabetes, TB

183
Q

spermatic cord

A

lipoma
hernia: palpate external ring
varicocele - varicosity of pampiniform plexus
embrologic rests - adrenal, splenic

184
Q

paratesticular lesions

A

lipoma

masses rare - rhabdomyosarcoma

185
Q

prostate

A

chestnut size and shape
rubbery
note tenderness, symmetry, nodules, median sulcus

186
Q

seminal vesicles

A

normally not palpable

187
Q

inguinal nodes

A

drain genital skin

188
Q

advanced testis tumor

A

testis are retroperitoneal
abdominal mass from retroperitoneal nodes
supraclavicular nodes

189
Q

Causes of inflammatory arthritis

A

infectious
crystal induced
autoimmune

190
Q

Causes of noninflammatory arthritis

A

degenerative
mechanical or traumatic
metabolic or endocrine

191
Q

causes of arthralgia

A

mild or early arthritis

psychogenic, fibromyalgia

192
Q

painful arc maneuver

A

Pain upon abduction of arm

indicative of tendinitis

193
Q

empty can test/speed’s test

A

pt rotates shoulder actively and physician pushes down

tests for bicipital tendonitis

194
Q

shoulder impingement syndrome

A

acromion impinging on tendon

do hawking’s sign

195
Q

Rheumatoid arthritis

A

synovitis, bone erosion, pannus, cartilage degredation
osteophyte formation
hand and wrist deformitites
swan neck deformity, bouteniere deformity
flexion deformity of elbow

196
Q

finkelsteins maneuver

A

pt tucks thumb into hand, and dr ulnarly deviates wrist to pull on the tendon

197
Q

lachmans’ test

A

tests ACL

similar to anterior drawer

198
Q

apley compression test

A

90 degree knee bend
push down and pivot ankle
pain indicates meniscus tear

199
Q

trendelenberg sign

A

abnormal pelvis tilts away from stance leg
hip abductor weakness
dropped pelvis on normal side
trunk bends toward involved side

200
Q

thomas test

A

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
Q

schober’s test

A

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
Q

bamboo spine

A 
with ankylosing spondylitis
inflammation of ligaments around spine
occurs around age 20
over time ligaments calcify
lose ROM
203
Q

atrophy

A

suggests diseases involving lower motor neuron or disuse of muscle

204
Q

fasciculations

A

associated with LMN problems, particularly anterior horn cell disease

205
Q

hypotonia

A

seen with LMH lesions and cerebellar disease

206
Q

hypertonia - spasticity

A

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
Q

hypertonia - rigidity

A

a ratcheting catch and give pattern
= cogwheeling
lead pipe
associated with extrapyrimidal nervous system problems

208
Q

strength scale

A 
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
Q

pronator drift

A

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
Q

carpal tunnel

A

median nerve –> opponens pollicis, abductor pollicis

211
Q

tremor

A

involuntary, regular, rhythmic oscillating movements

result from alternating or synchronous contraction of reciprocally innervated antagonist muscles

212
Q

chorea

A

rapid jerks which are irregularly timed, non-repetitive and randomly distributed (nonstereotyped)

213
Q

athetosis

A

involuntary movements with a slow, writhing character

214
Q

dystonia

A

involuntary muscle contractions producing twisting movements that may be sustained, producing an abnormal posture of the affected body part

215
Q

tics

A

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
Q

myoclonus

A

sudden, rapid, twitch-like muscle contractions

may be spontaneous or triggered by arousal, initiation of movement or sensory stimuli

217
Q

grading of reflexes

A 
4+ clonus
3+ hyperreflexia
2+ normal
1+ hyporeflexia
0 absent
218
Q

Jendrassik maneuver

A

to help elicit deep tendon reflexes

have pt hook together flexed fingers and pull

219
Q

babinski maneuver

A

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
Q

alternative babinsky maneuvers

A

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
Q

features of UMN lesions

A

weakness, spasticity, hyperreflexia, extensor plantar response, little or no atrophy

222
Q

features of LMN lesions

A

weakness, hypotonia, hyporeflexia or areflexia, flexor or indifferent plantar response, atrophy and fasciculations

223
Q

dysmetria

A

pt overshooting or undershooting on the finger-nose-finger test

224
Q

shoulder palpation

A

AC joint tender in AC sprain/separation/arthritis

Subacromial bursa is tender in acute calcific bursitis

225
Q

shoulder ROM

A

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
Q

impingement sign

A

tested via hawkings, neer sign

+ impingement sign with rotator cuff disorder

227
Q

rotator cuff strength

A

test for specific muscle weakness in rotator cuff disorder

228
Q

apprehension test

A

= crank test

positive in glenohumeral instability

229
Q

rotator cuff disorder

A

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
Q

frozen shoulder

A

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
Q

AC injury/arthritis

A

non-radiating shoulder pain, AC tenderness & swelling, pain with cross chest adduction

232
Q

glenohumeral instability

A

age <40, Hx of dislocation or subluxation, + apprehension (crank) sign, generalized ligamentous laxity

233
Q

acute calcific bursitis

A

acute onset of explosive shoulder pain, atraumatic, nocturnal pain, can’t move arm, tender subacromial bursa

234
Q

hawking’s sign

A

lift up arm to shoulder height & internally rotate it

will cause pain if rotator cuff problem

235
Q

neer’s impingement sign

A

raise arm above up all the way and internally rotate thumb

will cause pain if rotator cuff problem

236
Q

empty can test

A

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
Q

drop arm test

A

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
Q

AC separation grading

A

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
Q

sulcus sign

A

when you pull down on the arm and see a sulcus appear below the acromion
pathognomonic of multidirectional instability (MDI) of glenohumeral joint

240
Q

spondylolisthesis

A

anterior displacement of lumbar vertebral body

241
Q

spondylolysis

A

defect in pars interarticularis

242
Q

back pain of disc v. muscle

A

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
Q

if valsalva maneuver increases back pain?

A

almost always herniated disc pressing on lumbar nerve root

244
Q

straight leg raise

A

evaluating for lumbar radiculopathy
pain below knee at less than 60 degrees hip flexion is positive
suggests compression or irritation of nerve root

245
Q

cauda equina syndrome

A

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
Q

otitis externa microbiology

A

40% pseudomonas
30% staph species
10% gram negative rods
3% fungal

247
Q

if you see unilateral serous effusion of middle ear in an adult, do what?

A

check the nasopharynx bc a mass/tumor could be blocking the eustachian tube!

248
Q

Nose functions

A

defense
olfaction
respiration
cosmesis

249
Q

bacterial rhinosinusitis

A

streptococcus pneumoniae
moraxella catarrhalis
hemophilis influenzae

250
Q

palatine tonsil anatomy

A

exist between palatoglossal and palatopharyngeal arches

251
Q

otitis media etiology

A

strep pneumo 35-40%
non typable H flu 25-30%
moraxella 15-20%

252
Q

if valsalva maneuver increases back pain?

A

almost always herniated disc pressing on lumbar nerve root

253
Q

straight leg raise

A

evaluating for lumbar radiculopathy
pain below knee at less than 60 degrees hip flexion is positive
suggests compression or irritation of nerve root

254
Q

cauda equina syndrome

A

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
Q

otitis externa microbiology

A

40% pseudomonas
30% staph species
10% gram negative rods
3% fungal

256
Q

if you see unilateral serous effusion of middle ear in an adult, do what?

A

check the nasopharynx bc a mass/tumor could be blocking the eustachian tube!

257
Q

Nose functions

A

defense
olfaction
respiration
cosmesis

258
Q

bacterial rhinosinusitis

A

streptococcus pneumoniae
moraxella catarrhalis
hemophilis influenzae

259
Q

palatine tonsil anatomy

A

exist between palatoglossal and palatopharyngeal arches

260
Q

otitis media etiology

A

strep pneumo 35-40%
non typable H flu 25-30%
moraxella 15-20%

261
Q

condyloma acunatum

A

DNA virus

soft fleshy wartlike growths

262
Q

SPIKES

A

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
Q

inguinal hernia

A

indirect (congenital) - lateral to IEA
direct (acquired) - medial to IEA
above inguinal ligament

264
Q

Femoral hernia

A

female > male
passes through femoral canal
underneath inguinal ligament

265
Q

testicular mass

A

benign: orchitis, TB, adenomatoid tumor
malignant: seminoma, embryonal cell cancer, teratoma, teratocarcinoma, choriocarcinoma, leydig cell tumor, sertoli cell tumor, adenomatoid tumor

266
Q

coverings of spermatic cord

A 
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
Q

Hesselbach’s triangle

A

inferior epigastric a., lateral morder of rectus sheath, inguinal ligament

268
Q

femoral triangle (scarpa’s triangle)

A

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
Q

autonomy

A

obligation to respect patients as individuals and to honor their preferences in medical care

270
Q

benificence

A

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
Q

nonmaleficence

A

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
Q

justice

A

to treat persons fairly

273
Q

autonomy

A

obligation to respect patients as individuals and to honor their preferences in medical care

274
Q

benificence

A

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
Q

nonmaleficence

A

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
Q

justice

A

to treat persons fairly

CPM II Fall (1 decks)

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