Exam 1 Flashcards
What length should be the cuff’s bladder at least be compared to the circumference of the upper arm?
What about the width?
at least 80%
at least 40%
how high should the blood pressure cuff be compared to the cubital fossa?
1 inch above
Technically which part of the stethoscope should you be using over the brachial artery?
Bell is technical, but most people use the diaphragm
What is the first knocking sound called and which pressure is this?
Korotkoff
Systolic
What is an Auscultory gap?
period of absent korotkoff sounds. so you can accidentally underestimate systolic or overestimate diastolic
patient should be free of what and for how many minutes before a bp reading?
smoking, caffeine, exercise 30 minutes prior
How can you get a falsely high reading for bp?
cuff too small
cuff too large on a large arm
brachial artery is below the heart
How can you get a falsely high reading for bp?
cuff too large for a small arm
brachial artery above heart
What’s the average respiratory rate?
15-20 per min
If you’re looking at someone’s right eye, how do you hold the ophthalmoscope?
hold it with right hand, with your right eye, and have them look over your right shoulder and look at their eye from lateral to medial
Which way do you pull the ear when looking in their ears for a kid less than 12 months?
Down and back
Which way do you pull the ear when looking in their ears for a kid greater than 12 months?
Up and back
What is sensitivity?
proportion of patients with the diagnosis who have the physical sign
I.e. have the positive result
What is “True positive” and is it with specificity or sensitivity
the “True Positive” rate
the probability that a person with the disease has a positive test
Sensitivity
What is Specificity
the proportion of patients without the diagnosis who Lack the physical sign (i.e. have the negative result)
What are you looking at with “red free” light on the Opthalmoscope?
visualize the vessels and hemorrhage
What are you looking at with “slit beam” light on the Opthalmoscope?
contour abnormalities
What are you looking at with “blue light” light on the Opthalmoscope?
abrasions and ulcers after fluorescein staining
What is the direct pupillary light reflex?
when the light is shined in the eye, the pupil constricts
What is the consensual pupillary light reflex?
when the light shined in the eye, the pupil of the other eye also constricts
What lasts longer, air conduction or Bone conduction
Air conduction lasts longer
Where do you hold the fork for air conduction
hold fork in front of external auditory meatus
Where do you hold the fork for bone conduction?
boney area behind the ear
Where do you put the tuning fork for the weber test?
forehead
Rinne Test: In normal ears and ears with sensorineural loss, what sounds louder, the air-conducted sound or the bone conduction sound?
air conducted
AC>BC
Rinne Test: In conductive hearing loss, what sounds louder, the air-conducted sound or the bone conduction sound?
BC>AC
What does 20/20 mean?
20/40
always X/Y, where X is the pt, Y is the normal
20 feet 20 feet
normal person sees 40 ft what you see in 20 feet
How do you percuss?
put your fingers over the thorax/abdomen. strike the distal knuckle with 3rd finger to elicit the sound
What is a dull sound of percussion mean?
fluid
What is a flat sound of percussion mean?
solid
What does a tympanic sound of percussion mean?
air
What does uremic fetor mean?
its a smell.. fishy, urine odor (ammonia like)
what is fetor hepaticas?
smell –> breath of the dead
bell is for what sounds?
low - bruits
diaphragm for what sounds?
high pitched. breath sounds/heart tones
What’s a normal bp?
120/80
what’s considered stage 1 hypertension?
140/90
what’s considered stage 2 hypertension?
160/100
hypertensive crisis?
180/120
Normal temperature is what?
97.8-99
what locations reflect a higher temperature?
Axillary .3 to .4 higher
rectally .5 to .7 higher
what temperature reflects core temperature?
Ear
When should you get an annual lung cancer screening?
30 pack years between 55 and 80 and currently quit or have quit within the past 15 years
CAGE stands for what?
Cut Back
Annoyed
Guilt
Eye Opener
How many drinks for women?
3 per day 7 per week
drinks for men?
4 per day 14 per week
Spirituality and religion mnemonic?
FICA
Faith and belief
Importance
Community
Address in Care or Assessment and plan
What does SAFE stand for?
Stress
Afraid
Friends
Emergency plan
5 p’s of sexual history?
Partners Practices Prevention of Pregnancy Protection from STIs Past History of STIs
Which model are patients more likely to adhere to the treatment?
patient-centered
Sprain Vs strain?
LISP
ligament = sprain
pop
MUST
muscle strain
grabbing feeling
Nipple line is what dermatome?
What about the belly button?
T4
T10
8mm is what edema classification?
4+
What tests indicate a glenohumeral instability?
Apprehension Test
Sulcus Sign
What are the tests for unstable bicipital or bicipital tendonitis?
Yergasons and Speed’s test
What Indicates a rotator cuff pathology?
Empty Can Test
Drop Arm Test
What indicates a rotator cuff impingement?
Painful Arc Test
Neer Impingement
hawkins Test
What indicates a subscapularis weakness?
Lift Off Test
AC joint pathology test?
Cross Arm Test
Genu Valgum vs Genu Varus, which has an increased q angle?
valgum
varus has less
Q angle normal? who has a bigger one?
15
females
Valgus test indicates what?
MCL disruption
Varus test indicates what?
LCL disruption
McMurray tests what
lateral or medial meniscus
valgus = medial meniscus varus = lateral meniscus
apley grind test with compression tests what?
could be meniscus or Collateral ligament injury or both
Apley grind test with distraction does what?
if you have relief, it’s a possible meniscus injury
if it’s painful then it’s a collateral ligament problem
What goes into the Subjective of a soap note?
CC, HPI, ROS, PMH, PSH, Meds, All, FH, SH
what you learn by taking the patient’s history
what goes into objective
physical exam findings including structural findings, labs and radiology
what goes in Assessment
what you think is going on with the patient
What’s the difference between diagnosis and differential diagnosis
diagnosis is the art of identifying disease from its signs and symptoms
differential is the probable causes of the assessment, listed in order from most likely to least likely
What is the patellar laxity test? patellar apprehension?
pushing against the medial side of the patella laterally
if there is apprehension or laxity it’s a previous patellar dislocation or severe instability
What do you do for a patellar compression (grind test)
push down on the patella with one hand while moving the patella medial and lateral
pain with compression
inflammation, chondromalacia, injury to the patellofemoral articular surfaces
What’s the patella-femoral grinding test?
compress patella caudally into trochlear groove and instruct the patient to tighten quads
you should feel it go up
positive would be pain and indicates roughness of articulating surfaces
Fundoscopic refers to what instrument?
opthalmoscope
Tachypnea means what?
increased respiratory rate
any treatments, including OMT should be put in what?
PLAN
Which one is 40%, stance phase or swing phase?
Swing phase
What’s the proper order of examination? Mnemonic
I’m A PP
Inspection, Auscultation, Percussion, Palpation
FH what degree of family do you document?
first degree relatives = because strongest genetic risk.
ROS is for what?
refers to other potential problems in systems OTHER than what the CC falls in
Foot drop is considered what muscle strength?
0/5
Extrinsic causes of shoulder pain refers to what?
have no shoulder pathology at all.
intrinsic relates to the shoulder itself
Step off refers to what?
acromioclavicular joint separation
Assessment portion should be from what to what?
broad to specific
snuffbox tenderness, what should you be worried about
scaphoid fracture, sometimes can’t be seen on first xray
pain over greater trochanter, what’s the problem?
trochanteric bursitis usually
when the patient lifts up their left leg, what happens to their right leg
the right leg is bearing weight so the left hip drops because the right gluteus medium is not doing its job
O sign refers to what nerve?
anterior interesses N.
What is in the central compartment of the hip?
Labrum, Ligamentum Teres, Articular Surfaces
What is in the peripheral compartment of the hip?
Femoral Neck, Synovial Lining
What is in the lateral compartment of the hip?
gluteus medius, gluteus minimus, piriformis, IT band, trochanteric bursae
What is in the anterior compartment of the hip?
iliopsoas insertion, iliopsoas bursae
What muscle is the primary flexor of the hip?
iliopsoas
What is the primary extensor of the hip
gluteus Maximus followed by the hamstrings
what ab the primary abductors of the hip?
gluteus medius and minimus
what is the primary adductor of the hip?
adductor longus
what are the external rotators of the hip to know?
sartorius, gluteus medius, gluteus maximus
What does the Ober test evaluate?
external snapping hip, greater trochanteric pain syndrome
What are the three evaluated muscles of the Ober test?
Tensor Fascia Lata
Gluteus Medius
Gluteus Maximus
Trendelenburg tests what?
labral tear, transient synovitis, Legg Calve Perthes Disease
What side does the hip drop on in the trendelenburg test?
the side that has the lifted leg
What test do you use for piriformis syndrome?
PACE or FAIR test
Log Roll
What are the two tests that are done for dysplasia of the hip?
what happens if they’re positive
ortolani test and the Barlow test
if positive they do ultrasound
what tests do you do to check for trochanteric bursitis?
FABER and Ober tests
when is Legg-Calve-Perthes disease happening?
3-12 year old kids, male more often.
shows osteochondral loose bodies
When does SCFE usually present?
what happens during SCFE?
obese kids, or a growth spurt, but mostly obese kids
femoral epiphysis slips posteriorly, leads to pain and limitation
What sign is seen for piriformis syndrome?
wallet sign
What is septic arthritis?
infection in the joint, need to aspirate the joint fluid to make sure. person can have fever
what tests do you do for a femoroacetabular impingement?
C sign, FABER, FADIR
What happens to kids that are held by the arm from 1-5 years old?
how is it treated
subluxation of the radial head
hyperpronation
what motion with the hand is with tennis elbow?
extension, lateral epicondylitis
What motion with the and is with golfers elbow?
Flexion, Medial epicondylitis
What’s the difference between bursitis and effusion?
bursitis = can fully extend the elbow without severe pain
effusion = pain with extension due to increased pressure at the joint
What’s the classical presentation of De Quervian Tenosynovitis?
what test do you do?
radial wrist pain at the base of thumb especially with movement of the thumb
mom picking up child
finkelstein’s test
What is Trigger Finger?
pain, locking, and clicking of MCP joint. common in the 5th and 6th decade of life. usually the ring finger
What is depuytren’s contracture?
fibrosis of the palmar fascia. thickening of that due to fibroblastic proliferation
more common in white males.
cord-like structure and flexed digit w/ palpable cord
Most common FOOSH injury?
Colles
What do you see in rheumatoid arthritis people?
commonly seen in MCP and PIP joints of the fingers but can affect large and small joints
What test do you do for an suspected MCL injury?
Valgus Stress test
what test do you do for a suspected MCL injury?
Varus Stress test
Meniscal injury, what tests do you do?
McMurray
Apley Grind Test
What test do you do for patellofemoral pain
Have them squat
patellar glide
Osteoarthritis is what?
occurs in many large joints
degenerative wear and tear and inflammation
pain worsens as day progresses
Tibial tubercle is being stretched.. what is the disease
Osgood Schlatter
What are the Ottawa knee rules
55 or older
tenderness at head of fibula
isolated tenderness of the patella
inability to flex knee to 90 degrees
can’t walk 4 weight bearing steps in the ER
What is the Pittsburgh decision rules
younger than 12 years or older than 50 years
more specific for knee injuries
what do you do for diabetic neuropathy?
pressure sensation using monofilament testing
vibration sensation using tuning fork
superficial pain using pinprick
checking pulses, checking for skin lesions, and check between the toes
What’s the most common ankle sprain?
aTFL
What decides if you get imaging?
Ottawa ankle and foot rules or just the rules in general
Ottawa foot rules?
pain in the mid foot zone and any of the following: bone tenderness at 5th metatarsal, navicular bone, or the inability to walk 4 steps immediately after the injury
Ottawa ankle rules?
pain in the malleolar zone and any of the following findings:
bone tenderness at the lateral malleolus or posterior edge of the medial malleolus or the inability to walk 4 weight bearing steps
What is a syndesmotic ankle injury?
high ankle sprain
injury to one or more ligaments in the distal tibiofibular syndesmosis
What test do you use for a syndesmotic ankle injury?
squeeze test
Where is the pain localized on plantar fasciitis?
what’s the treatment
heel pain
there’s specific exercises you can do
what is Morton neuroma?
pain between the metatarsal heads from the plantar digital nerve, most commonly affecting the 3rd web space
What is the most common presentation of Morton neuroma?
what symptoms do they have?
stress due to tight fitting shoes, typically high heels
typically have burning pain in the 3rd metatarsal space
What sign is used for Morton Neuroma?
Mulder’s Sign: clicking sensation when palpating the third inter metatarsal space
Gout
monosodium urate crystals in the joint space
what are the risk factors for gout?
high red meat
Hallux Rigidus?
Stiffness of the grey toe, due to osteoarthritis
Hallus Valgus?
valgus malformation of the great toe
What is tinea pedis?
fungal infection of the foot…
athletes foot
Onchomycosis?
weird ass nails
fungal infection
What is the mnemonic for social history?
FEDTACOS
if you can’t go into flexion, what muscle is affected
coracobrachialis
How does the sensitivity/sensitivity chart look?
True positive, False Positive
False Negative, True Negative
It’s sensitivity then specificity
Other than picking your baby up, what else causes de-quarvians?
playing video games
what’s the normal carrying angle?
10-15 degrees
what is a galeazzi fracture?
fracture of distal radius with dislocation of the ulna
what’s a nightstick fracture
fracture of mid/distal ulna from direct blow
What is the monteggia fracture?
fracture of proximal ulna and dislocation of radial head (FOOSH injury)
What is jersey finger?
can’t flex finger at DIP
What is mallet finger?
can’t extend finger at DIP
What’s the most common dislocation of the glenohumeral joint
anterior then posterior then inferior
What’s the log roll good for?
Piriformis syndrome testing
Ober = 1st positioning?
what does it test
lateral recumbent, knee and hip extended and passively adducting.
tests the IT band/TFL
Ober #2 = positioning?
What does it test
lateral recumbent but instead of hip and knee extended the knee is now flexed. same movement of adduction but it’s testing the gluteus medius
Ober #3 positioning?
What does it test
modified lateral recumbent with your shoulders on the table and your leg extended off the table. you then go up and it tests the gluteus maximus
McMurray’s Test for medial meniscus
Varus + Internal rotation
McMurray’s Test for Lateral Meniscus
Valgus + external rotation
Normal bpm? Tachycardia? bradycardia?
60-100
above 100 = tachycardia
below 60 = bradycardia
normal breaths per minute? Bradypnea? Tachypnea?
12-20
20+ tachypnea
less than 12 = bradypnea
What are the 5 central compartment tests?
C-Sign Labral Loading Labral Distraction Scour Apprehension Faber 1/3
What is the 1 peripheral compartment test?
Rectus Femoris Test
What are the 4 lateral compartment tests of the hip?
Jump Sign
Straight Leg Test
Piriformis Test
Patrick Faber 2/3
What are the 2 anterior compartment tests?
Patrick faber 3/3
Thomas Test
Anterior Drawer Test of the foot and ankle tests what?
ATF ligament (lateral ankle sprain)
What way are you tilting the foot in the Talar Tilt Test? What is it testing?
Inversion
ATFL
Eversion Test tests what?
Deltoid
Squeeze test tests what?
syndesmosis pathology (high ankle sprain)
What else besides squeeze test tests syndesmosis pathology
Cross Leg test
What is the Thompson test? Not the Thomas test
you’re testing for achilles tendon rupture..
grabbing at the calf and seeing plantarflexion
What is the Homan’s Sign
Put them into dorsiflexion (can apply lateral compression of the calf). if pain you can have Deep vein thrombosis
What is the Moses Sign?
also looking for DVT like Homan’s sign
you’re putting an anterior compression on gastrac muscle and looking with pain in the anterior compartment
Turf Toe?
inflammation and pain at the base of 1st MTP
caused by hyperextension of the great toe causing damage to joint capsule
What is Achilles Tendonitis?
sharp heel pain and stiffness.
micro tears in tendon causes swelling and thickening
Pretty much what’s the Ottawa rules for ankle and foot
if they have pain in the malleolar zone / mid foot zone AND
either pain in the posterior edge or tip of lateral or medial malleolus / 5th metatarsal or navicular
OR
can’t walk 4 weight bearing steps
Medial Meniscus for McMurray’s?
Valgus and External Rotation
lateral Meniscus for McMurrays
Varus and Internal Rotation
Olecranon Bursitis is also known what
student’s elbow or miner’s elbow.
“little league elbow”?
pain over medial epicondyle, initially after throwing. progresses to persistent pain.
OK sign =
Anterior Interosseus N.
Handlebar Palsy is also what and what area is affected
Ulnar Nerve Entrapment
Guyon canal
Gamekeeper’s thumb/skier’s thumb?
tear of ulnar collateral ligament of MCP due to hand positioning when killing game or falling on ski pole
Ganglion cyst?
fluid filled sac along tendon sheath or joint
Clubbed fingers
focal bulbous enlargement of terminal fingers
What tests for glenohumeral instability?
apprehension
sulcus
What tests for bicipital tendon pathology?
yergason
speeds
Rotator Cuff pathology?
Empty Can
Drop Arm
Rotator cuff impingement?
Painful Arc
Neer
Hawkins
Subscapularis?
lift off test
Acromioclavicular joint pathology?
Cross Arm Test
