ECOS Final Review Flashcards
What is special about the shoulder joint?
It is the only joint in the human body where tendons (rotator cuff) pass between bones (acromion and humerus).
What are important aspects of the Hx and PE to ask with regards to a shoulder complaint?
If it was traumatic or atraumatic.
Ask for discriminators or life threats in the ROS.
What are the normal ROMs of the shoulder?
ADduction - 50 ABduction - 180 Flexion - 180 Extension - 50 Internal Rotation - 90 External Rotation - 90
What is the painful arc test and what does it test for?
Have the patient actively ABduct their arm. If positive, there will be pain between 60 and 120 degrees. A positive test means there is a possible subacromial impingement or rotator cuff injury.
What are the upper extremity reflex tests and what nerves are they associated with?
Biceps - C5
Brachioradialis - C6
Triceps - C7
What upper extremity pulses can be checked?
Brachial, radial, or ulnar
What are common diagnoses that are associated with a traumatic shoulder injury?
Fracture, dislocation, rotator cuff injury, AC joint injury, labral injury, myofascial
What are common diagnoses that are associated with atraumatic shoulder injuryies?
Subacromial impingement, overuse injury, bursitis, tendonitis, arthritis
What is a common deformity in RA patients?
Boutonniere deformity
What are two common deformities in patients with osteoarthritis?
Heberden’s nodes and Bouchard’s nodes
What are the nerve associations for reflex testing in the UE?
C5-6 - Biceps
C5-6 - Brachioradialis
C6-7 Triceps
What are the nerve associations for sensory testing in the UE?
C4 - Lateral neck C5 - Lateral upper arm C6 - Lateral forearm and thumb C7 - Middle finger C8 - Medial wrist and forearm T1 - Medial elbow/upper arm
What are the nerves associated with strength testing in the UE?
C1 - Resisted rotation ROM C2-4 - Scapular elevation C5 - Deltoid, shoulder abduction C6 - Biceps, wrist extension C7 - Triceps, wrist flexion C8 - Finger flexion T1 - Finger abduction
What dermatome is associated with the nipples?
T4
What dermatome is associated with the umbilicus?
T10
What are contraindications to HVLA?
A - Anticoagulants/Arthritis B - Bones - Osteoporosis/disruption C - Carotid/PVD disease/risks of D - Down Syndrome L - Local metastases, ligament disruption
What is arcus senilis?
A ring, usually yellow, encircling the iris
What ocular symptoms are associated with osteogenesis imperfecta?
Blue sclera
What are common diseases associated with cotton wool spots of the eye?
DIABETES, hypertension, HIV
What is blepharitis?
Inflammation at eyelid margin, resulting in irritation
What are the differences between chalazion and hordeolum?
Chalazion - blocked Meibomian gland, generally nontender and nonpainful unless it becomes inflamed, IN THE LID
Hordeolum - Bacterial infection of the Meibomian gland, tender/painful, ALONG THE EYELASH
What is a primary indication for EMG (electromyogram)?
Assessing peripheral nerves and muscles
What is a primary indication for fluoroscopy/swallow study?
Difficulty swallowing
What is a primary indication for an ultrasound?
Carotid artery stenosis/needle guidance to nerves
What is a primary indication for EEG?
Confirming seizure activity
What is a primary indication for myelography?
Spinal nerve impingement/spondylosis
What is a primary indication for fluorescein stain?
Corneal damage
What contrast is used for MRIs?
Gadolinium
What contrast is used for CTs?
Iodine
Quick summary of all of the functions of the CNs
I - Smell
II - Visual acuity
III - Raise eyelid, pupillary constriction, most extraocular movements
IV - Downward, internal rotation of eyes
V - Sensory of the face, motor with clenching jaw, corneal reflex
VI - Lateral deviation of the eye
VII - Motor: Facial movements, including expression, closing of eyes and mouth.
Sensory: Taste for anterior 2/3 of tongue
VIII - Hearing
IX - Motor: Phonation
Sensory: Taste for posterior 1/3 of tongue, gag reflex
X - Raise the palate, gag reflex
XI - Shrug shoulders against resistance, turn head L and R against resistance
XII - Motor involvement of the tongue
What is miosis?
Excessive constriction of the pupil, usually due to a lesion of CN III.
What are common presentations of someone with a CN IV lesion?
Eyes will drift upwards, vertical diplopia, head tilting in the opposite direction, difficulty with coordination while trying to look down.
What are common presentations of someone with a CN V lesion?
Decreased sensation in the face, loss of corneal reflex, weakness of the muscles of mastication, jaw deviation towards the side of the lesion
What are common presentations of someone with a CN VII lesion?
Paralysis of the muscles of facial expression (Bell’s palsy), loss of corneal reflex, hyperacusis, crocodile tears syndrome (sheds tears when chewing)
What are common presentations of someone with a CN VIII lesion?
Vestibular division: Disequilibrium and nystagmus
Cochlear division: Destructive lesion - sensorineural hearing loss, irritative lesion - tinnitus
What are common presentations of someone with a CN IX and X lesion?
Hoarseness of voice, no gag reflex, difficulty swallowing, cannot raise their palate.
What are common presentations of someone with a CN XI lesion?
Inability to shrug shoulder or rotate head to the opposite direction of the lesion against resistance
What are common presentations of someone with a CN XII lesion?
Deviated tongue towards affected side when protruded forward.
What is sterognosis?
The ability to identify shapes of objects, or recognizing objects placed in the hand
What is graphesthesia?
The ability to identify numbers written on the palm
What are the patterns of sensory loss for thalamic, cortical, and functional loss?
Thalamic - Hemisensory loss of all modalities
Cortical loss - Intact primary sensations but loss of cortical sensations
Functional loss - Non-anatomical distribution
What is associated with 4/4 reflexes?
Hyperactive WITH CLONUS
What are the first steps in the evaluation of a patient with dizziness?
TiTrATE - Timing of symptoms, triggers that provoke attack, and a target exam
How do migraines usually present?
Unilateral headache, gradual onset with progressively worsening symptoms, photophobia, nausea and vomiting. Can present with aura (vision changes)
How do cluster HAs usually present?
Usually last 15 min - 3 hours, ALWAYS UNILATERAL, intense sharp stabbing pain. Can have associated tearing of eye, rhinorrhea, sweating, and irritation.
Study SC joint movements
Study SC joint movements
What 3 specialty tests are good for cervical radiculopathy?
Neck compression, neck distraction, and Spurling’s test
