Exam 3 Flashcards
musculoskeletal system functions
support body, movement, encase and protect vital organs, produce RBC in bone marrow, storage of certain minerals
most active joint in the body?
temporomandibular joint
bony landmarks of shoulder
acromion, coracoid process, acromioclavicular joint
temporomandibular joint motion and expected range
open mouth maximally, protrude lower jaw and move side to side, stick out lower jaw
shoulder motion and expected range
arms forward and up, arms behind back and hands up, arms to sides and up over head, touch hands behind head
elbow joint bones
ulnar, radius and humerus
palpable landmarks of elbow joints
olecranon process, later and medial epicondyles
“funny bone”
ulnar nerve
elbow motion and expected range
bend and straighten elbow, pronation and supination
wrist/hand motion and expected range
bend hand up, bend hand down, bend fingers up and down, turn hands out and in, spread fingers, make fist, touch thumb to each finger
ulnar nerve controls sensation where?
pinky and half of ring finger
median nerve controls sensation where?
part of thumb, index, middle and part of ring finger
radial nerve controls sensation where?
part of thumb
tests for checking for carpal tunnel
phalen’s test (press backs of hand together for 30 sec) and tinel’s test (tap median nerve)
osteoarthritis
degenerative joint disease, hard, nontender nodules 2-3mm in size, heberden’s nodes (bony overgrowth at DIP), bouchard’s nodes (PIP), metacarpophalangeal joints are sparred
rheumatoid arthritis
autoimmune, tender, painful, stiff joints, symmetric, PIP and MCP involvement (warm and tender), ulnar deviation, swan neck deformity, boutonniere deformity
ulnar deviation
middle, ring and pinky fingers deviated to the side
swan neck deformity
DIP flexion, PIP hyperextension
boutonniere deformity
PIP flexion, DIP hyperextension
hip expected range and motion
raise leg, knee to chest, flex knee and hip, swing foot in and out, swing leg laterally and medially, stand and swing leg back
knee joint ligaments
anterior and posterior cruciate, medial and lateral collateral
collateral ligaments provide support for what kind of motion
stability for side to side movement
ankle/foot expected range and motion
point toes up and down, turn soles in and out, flex and straighten toes
cervical spine motion and expected range
chin to chest, lift chin, each ear to shoulder, turn chin to shoulder
area of language comprehension
wernicke’s area
area for motor function for lanuage
broca’s area
corticospinal tract controls
skilled voluntary movement like writing
extrapyramidal tract controls
gross motor movements like arm swinging when walking
posterior column functions
proprioception, vibration, localized touch
peripheral nervous system is made of
cranial nerves, spinal nerves, reflex arc
what are the 5 components of reflexes
functional synapse, intact sensory nerve, intact motor nerve, neuromuscular junction is intact, muscle is competent
light headedness is usually a sign of a problem with
heart
vertigo is a sign of a problem with
neuro
3 important things to remember for neuro exam
mental status intact?, are right and left sided findings the same/symmetric, if findings are asymmetric does the lesion lie in the CNS or PNS
7 components of neuro exam
mental status, cranial nerves, motor system, sensory system, coordination, romberg/gait, reflexes
p wave of ekg is
atria depolarizing and contracting
QRS wave is
beginning of ventricles contracting
ST segment represents
plateau phase of repolarization
T wave represents
final rapid phase of ventricular repolarization/ventricle contracting
long QT interval warms that a patient is
vulnerable to irregular rhythms
hesitancies in speech could be a sign of
aphasia in a patient with a stroke
monotone inflection could be a sign of
schizophrenia or severe depression
circumlocutions
words or phrases are substituted for things pt cant remember
paraphasias
words are malformed or wrong
Bell’s palsy signs
peripheral lesion in CN 7, paralysis in upper and lower part of the face, eye would not close on that side, flat nasal labial fold
central lesion/stroke signs
lesion in CNS, little bit of innervation in upper face so eyes would close, flat nasal labial fold
spastic muscle tone
upper motor neuron of corticospinal tract at any point from the cortex to the spinal cord, causes clasp knife rigidity
rigid muscle tone
basal ganglia system is effected, constant state of resistance in any direction, lead pipe and cogwheel rigidity
flaccid muscle tone
effects the lower motor neuron at any point from the anterior horn cell to the peripheral nerves
fasciculation
rapid continuous twitching of a resting muscle
tetany
involuntary muscle spasm
myoclonus
rapid sudden jerk
spinothalamic tract senses
pain, temperature, light or crude touch
posterior column senses
vibration, proprioception, fine discrimination
clonus test
rapidly flex foot, if foot oscillates after that is positive, test of upper motor lesion
cremasteric reflex
stroke inner thigh causes cremator muscle to pull up testes
upper motor neuron problems
CVA, stroke, MS, cerebral palsy, spastic/increased tone, positive babinksi
lower motor neuron problems
polio, spinal cord lesion, loss of tone
growth and development pattern
cephalocaudal, proximal to distal, gross to fine
hypertonic muscle
heightened muscle tone
hypotonic muscle
floppy and lose muscles
scoliosis
screen with scholiometer (if angle is greater than 7 it is bad)
hip dysplasia
hip dislocation
barlow maneuver
adduct hip, push thigh posteriorly and hip goes out of socket
ortolani maneuver
abduct thigh, apply downward pressure, clunk means unstable hip has been reduced
trendelenburg gait
colateral side drops, causes uneven gait
genu varum “bow legged”
normal until 3, refer if angle is acute
genu valgum “knock kneed”
normal until age 7, correctable until age 9
3 causes of intoeing
from hip (femoral anteversion, caution on child’s seating), from tibia (tibial tortion, knees still face forward), from the foot (metatarsal adductus, distal half of the foot points in)
disappearing baby reflexes
palmar grasp, placing/stepping, rooting/sucking, moro, tonic neck, plantar reflex, babinski
abnormal childhood reflexes
oppenheimer, chaddock, snouting
oppenheimer
run reflex hammer down interior calf, abnormal if big toe fans out
chaddock
reflex hammer down outer foot, abnormal if big toe fans out
snouting
reflex hammer on philtrum, abnormal if lips scrunch up
normal PR interval
less than .2sec
Normal QRS interval
less than .08 sec
QT interval
less than .4sec
where do limb leads record activity
frontal plane of the body
chest leads record activity
in the horizontal plane of the body
lichen sclerosis
labia/clitoris is reabsorbed
cystocele
bladder prolapses out bc anterior wall of vagina is too weak
rectocele
rectum protrudes out, posterior wall of vagina is too weak
reducable hernia
can be moved out of the way
irreducable hernia
can’t be moved, can become gangrenous
indirect hernia
internal ring, canal, external ring, scrotum, bulge over midpoint of ligament, pain with baring down, most common type of hernia, auscultate for bowel sound, more common in young men
direct hernia
painless, herniates directly behind and through external ring, rarely goes into scrotum, usually in older men from weight lifiting or obesity
femoral cana hernia
can become strangulated, extremely painful, least common in men and most common in women
how to calculate HR from EKG
300-150-100-75-60-50
regular heart rhythm
all RR intervals are equal in length
regularly irregular heart rhythm
RR intervals are different lengths but overall pattern is similar
irregularly irregular heart rhythm
no overall pattern
sinus tach rate
greater than 100
saw tooth ekg
atrial flutter, 240-360bpm, single ectopic foci
afib ekg
multiple weak ectopic foci resulting in weak tiny p wave, irregularly irregular rate, don’t know when ventricles will contract
pts with afib need to be on
coumadin bc blood pools in atria
what can irritate a ventricular foci
low O2 and hypokalemia
what does a PVC look like
giant ventricular complex and a compensatory pause
how many PVCs in a minute is considered pathological
6 or more
PVCs can lead to
vtach or vfib
vtach is the result of
one strong ventricular focus that hijacks the conduction system of the heart, can’t sustain life for long, usually leads to vfib
what does vtach look like
very rapid, enormous PVC like waves
vfib looks like
beating of many weak ectopic foci, uncoordinated contractions
how to treat vfib
CPR and defibrilation
what is first degree AV heart block
PR interval >.2, consistent
second degree AV heart block types
wenckebach and mobitz type 1
wenckeback second degree AV block
progressively longer PR duration until a nonconducted PR, regularly irregular
mobitz type 2
normal p waves and interval until no QRS, can have different degrees (2:1 is 2 p waves per QRS)
3rd degree or complete heart block
AV node is totally blocked so there is no relationship between P wave and QRS complex, treat with a pacemaker
tendons
hook muscle to bone
ligaments
hook bone to bone
what bone is not involved in the knee
fibula
broca’s aphasia
expressive
wernickes aphasia
receptive
positive babinski could indicate
stroke, MS, meningitis, etc.
