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H & P > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Thumb abduction test

A

Isolates strength of abductor pollicis brevis muscle, innervated only by the median nerve

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2
Q

Phalen test

A

Both wrists fully palmar flexed with dorsal surfaces pressed together for 1 minute

Numbness and paresthesia in median nerve distribution is positive, carpal tunnel

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3
Q

Tinel sign

A

Strike patients wrist where the median nerve passes under flexor retinaculum

Tingling sensation radiating is positive

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4
Q

Finkelstein

A

Assesses de quervain’s tenosynovitis

Patient places thumb inside fist, hand is flexed, if pain its positive

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5
Q

Neer test

A

Forward flex arm 150 degrees while depressing/stabilizing scapula

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6
Q

Hawkins test

A

Abduct shoulder to 90 degrees, flex elbow 90 degrees, then internally rotate

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7
Q

Hawkins kennedy test

A

Forward flex shoulder to 90 degrees, flex elbow to 90 degrees, internally rotate to limit

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8
Q

Jobe’s or empty the can test

A

Abduct shoulder to 90 degrees, flex shoulder forward to 30 degrees, point thumb down, provide resistance

Weakness is a supraspinatus issue

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9
Q

Drop arm test

A

Patient raise arm to 90 degrees of abduction then lower slowly, if they can’t hold it could be supraspinatus issue

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10
Q

Cross arm test

A

Forward elevation to 90 degrees and active adduction

Impingement issue if positive

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11
Q

Sulcus sign

A

Place traction on patient arm, observe sulcus or depression lateral or inferior to acromion

Instability of shoulder

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12
Q

Apprehension test for shoulder

A

Patient supine, abduction to 90 degrees, elbow flexed 90 degrees, shoulder externally rotated

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13
Q

Relocation test

A

Immediately after positive apprehension test, posterior force on proximal humerus, shoulder external rotated

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14
Q

Spurling test

A

Cervical root impingement

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15
Q

Straight leg raising test

A

Disc herniation with nerve root irritation

Patient lie supine with neck slightly flexed, passive leg raise

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16
Q

Femoral stretch test

A

Inflammation of nerve root

Patient lies prone and extends him, pain on extension is positive

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17
Q

Thomas test

A

Flexion contract urges of hip

Patient lies supine, fully extend one left flat, flex other leg with knee to chest

Lifting the extended leg off table indicated hip flexion contracture

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18
Q

Trendelenburg test

A

Weak hip abductor muscle

Balance on one foot, drop of the iliac crests is positive

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19
Q

Ballottement

A

Excess fluid or effusion test

Apply downward pressure on suprapatellar pouch

Push patella sharply downward against femur

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20
Q

Bulge sign

A

Excess fluid, milk medial aspect of knee upward then milk lateral side of the patella

Observe for bulge of returning fluid to the hollow area medial to patella

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21
Q

Mcmurray test

A

Torn medial or lateral meniscus

Thumb and fingers on either side of joint space, heel held with other hand, fully flex knee and rotate the foot and knee outward to lateral position, extend and flex

Pain, audible or palpable click is positive

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22
Q

Anterior and posterior draw tests

A

5 mm is abnormal

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23
Q

Lachman test

A

Anterior crucial ligament integrity

Heel on table

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24
Q

Thompson’s test

A

Squeeze calf and observe for plantar flexion of achilles

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25
Q

Inversion talar tilt test

A

Assesses calcaneofibular ligament and anterior talofibular ligament

Greater than 10 degrees of inversion is positive

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26
Q

Version talar tilt test

A

Deltoid ligament

Greater than 10 degrees of tilt is positive

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27
Q

Anterior drawer ankle test

A

Anterior talofibular ligament and calcaneofibular ligament

Anterior force to heel while moving the talus anterior

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28
Q

Limb measurement

A

No more than 1 cm difference between length and circumference

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29
Q

Dupuytren contracture

A

Contracture involving the flexor hand tendons

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30
Q

Kyphosis

A

Rounding of the shoulder

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31
Q

Gibbous

A

More angulated back changes, vertebral fracture related

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32
Q

Burning

A

Peptic ulcer

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33
Q

Cramping

A

Gastroenteritis, biliary colic

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34
Q

Colicky

A

Appendicitis with impacted feces, renal stone

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35
Q

Aching

A

Appendices irritation

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36
Q

Knifelike

A

Pancreatitis

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37
Q

Ripping, tearing

A

Aortic dissection

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38
Q

Gradual. Onset

A

Infection

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39
Q

Sudden onset

A

Duodenal ulcer, acute pancreatitis, obstruction, perforation

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40
Q

Dysphagia

A

Trouble swallowing

They can point to the location usually, constant or stable or progressing

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41
Q

Odynophagia

A

Pain with swallowing

Sharp/burning- mucosal inflammation

squeezing/cramping- muscular

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42
Q

Color cancer screening

A

At 50 unless they have a relative who has had colon cancer, then its 40

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43
Q

Itching without a rash

A

Associated with pancreatic cancer

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44
Q

Bowel sounds

A

Can be 5-35 per minute

Clicks and gurgles

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45
Q

Increased bowel sounds

A

Gastroenteritis, early intestinal obstruction, borborgymi

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46
Q

Decreased bowel sounds

A

Peritonitis, paralytic ileum

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47
Q

Abnormal abdominal bruit

A

Systole and diastole!

Systole is normal

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48
Q

Describe liver percussion

A

Start at mid clavicular line and go up until dullness

Same at umbilicus

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49
Q

Dullness in spleen percussion

A

Splenic enlargement, left sided pleural effusion, stool filled intestine

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50
Q

Which kidney is easier to palpate?

A

The right kidney

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51
Q

Shifting dullness

A

Fluid moves the way you have shifted their body- fluid sounds dull!

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52
Q

Bowel sounds in chest wall

A

Suggest diaphragmatic hernia

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53
Q

Volvulus

A

Twisting of bowel

Whirl shape! It’s obstructed

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54
Q

Pyloric stenosis

A

Olive shaped mass RUQ!!

Vomiting dramatically and projectile

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55
Q

Intussuception

A

Cramping, sausage mass, drawing up knees, stool is currant jelly

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56
Q

Omphalocele

A

Organs outside of the body

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57
Q

Appendicitis

A 
Cutaneous hypersensitivity
Guarding
Rebound tenderness
Rovsing's
Psoas sign
Obturator sign
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58
Q

Rovsing’s

A

Appendicitis

Referred pain when palpating on left side, they feel in on the left

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59
Q

Mcburney’s point

A

1/3 of the way along the line drawn from the hip to umbilicus

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60
Q

Acute gastroenteritis causes

A

Mostly viral, rotavirus or norwalk virus

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61
Q

Shigellosis

A

Bloody mucoid stool

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62
Q

Cholera

A

Rice water stool

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63
Q

Campylobacter

A

Raw milk/raw meat

Watery blood diarrhea

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64
Q

Giardiasis

A

Malodorous, greasy stool

Copious and frothy

65
Q

Difference between chrohn’s and colitis

A

Cholitis is only the colon, chrohn’s can be small or large intestine

Skip lesions in chrohn’s

66
Q

4 clinical features of chrohn’s

A
  1. Transmural sharlply delineated inflammation
  2. Non-caseating granulomas
  3. Fissuring formation of fistulous tracts
  4. Systemic manifestations
67
Q

Hallmark of ulcerative colitis

A

Bloody diarrhea

68
Q

Diverticulitis

A

Acute LLQ pain, fever, abdominal tenderness and mass

69
Q

Ileus

A

Sleeping belly due to mechanical or paralytic reasons

70
Q

Meckel’s diverticulum

A

Most common GI congenital abnormality

First 2 years of life

Asymptomatic rectal bleeding

71
Q

Bilirubin levels in jaundice

A

> 2.5

72
Q

Cirrhosis

A

Diffuse fibrosis of entire liver with nodules

73
Q

5 F’s for cholecystitis

A 
Fertile
Fat
Forty
Fair skinned 
Female
74
Q

Cholecystits

A

Inflammation of gallbladder usually caused by cholelithiasis (aka obstruction from stone)

RUQ/epigastric pain postprandial fatty meal

75
Q

Ascending cholangitis

A

Charcot’s triad: fever, RUQ pain, jaundice

Complication of acute cholecystitis

76
Q

Rectal exam positions

A

Knee-chest
Lithotomy
Left lateral with hips or knees flexed
Standing with hips flexed and upper body supported by examining table

77
Q

If there is pain during a digital rectal exam, what should you do?

A

Stop! Dont force it

78
Q

Describe the digital rectal exam

A

Press pad of finger against anal opening. Wait until sphincter relaxes and slip the fingertip into the anal canal

Palpate subQ external sphincter

Palpate deep external sphincter

Palpate posterior rectal wall

79
Q

Boggy prostate

A

BPH

80
Q

Hard prostate

A

Cancer

81
Q

Tender prostate

A

Infection or abcess

82
Q

Grade 1 prostate

A

1-2 cm, NORMAL

83
Q

Grade IV prostate

A

> 4 cm

84
Q

Hirschsprung disease

A

Primary absence of parasympathetic ganglion cells in a segment of the colon, interrupting intestinal motility

85
Q

Anal wink absence

A

Suggests abuse or spinal cord injury

If you lightly touch the anus it should constrict

86
Q

Pilonidal cyst

A

Cysts around an ingrown hair at the top of the cleft of the butt

87
Q

Condyloma accunatima

A

Anal warts

88
Q

Perianal/perirectal abscess

A

Fever
Painful/tender
Usually polymicrobial
Common in chrohn’s and immunosuppressive

89
Q

Fistula

A

Canal between two things, can be between rectum and vagina, rectum and urethra, etc.

90
Q

Causes of hemorrhoid

A

Increased pressure!

91
Q

Prostatitis

A 
Fever
Bacterial infection
Pain
Dysuria
Sexual dysfunction

If you massage the prostate it can lead to bacteremia

92
Q

BPH type

A

Irritative- increased frequency and urgency, nocturia

Obstructive- peak urine flow is <10/15 sec, dribbling, hesitancy, double stream

93
Q

Prostate cancer risk factors

A 
Age
Lifetime risk: 20%
Lifetime death risk:  40%
Vasectomy
African americans 1.5x > Caucasian
BRCA2
94
Q

Anal cancer

A

Squamous cell most commonly
Associated with HPV

Bleeding, pain, itching, nodule, change in bowel habits

95
Q

What tissues do not have lymph that are still supplied by the vascular system?

A

The brain and placenta

96
Q

Lymph fluid

A

Made of protein and WBS, is cloudy, clear or milky

97
Q

Right upper extremities are drained by…

A

Right subclavian vein

98
Q

Thorax and left upper extremities are drained by…

A

Left subclavian vein

99
Q

3 physical signs of lymph disorders

A

Lymphadenopathy

Lymphangitis, red streaks in the skin

Lymphedema

100
Q

Submandibular or cervical nodes normal

A

Less than 1 cm

101
Q

Inguinal nodes normal

A

Less than 2 cm in diameter

102
Q

Matted nodes

A

Group of nodes that feel connected and seem to move as a unit

103
Q

Shotty nodes

A

No clinical consequence, enlargement of nodes following a viral infection

104
Q

Extremely hard and painless nodes

A

Likely malignancy

105
Q

Increased tenderness with nodes

A

More likely inflammation

106
Q

Virchow node

A

Supraclavicular on the left side

Suggests malignancy

107
Q

Superficial cervical nodes at…

A

Sternocleidomastoid

108
Q

Posterior cervical nodes along…

A

Anterior trapezius

109
Q

Cervical nodes deep to…

A

Sternocleidomastoid

110
Q

Inguinal and popliteal nodes

A

Check when patient is supine

Inguinal LAD can be a scrotal or penile infection

111
Q

Pregnant women and lymph concerns

A

Exposure to cat feces or litter, think toxoplasmosis

112
Q

Facial muscles are innervated by…

A

CN V and VII

113
Q

Posterior fontanelle closes…

A

2 months of age

114
Q

Anterior fontanelle closes…

A

12-15 months

115
Q

Anterior triangle

A

In front of SCM to mid line of neck

116
Q

Posterior triangle

A

Behind SCM to trapezius

117
Q

Think migraine if…

A

HA then nausea

Blind spots

118
Q

If aneurysm, think…

A

Nausea then HA

Worst HA of their life. They have to mean it

119
Q

Hippocratic facies

A

Sunken appearance of eyes, cheeks, temporal areas

Sharp nose

Dry, rough skin

120
Q

Myxedema facies

A

Dull, puffy, yellowed skin

Coarse, sparse hair

Temporal loss of eyebrows

Periorbital edema

Prominent tongue

121
Q

Hyperthyroid facies

A

Fine moist skin

Fine hair

Prominent eyes and lid retraction

122
Q

Bell palsy facies

A

Asymmetry of one side of the face and eyelid not closing completely

123
Q

Pierre-robin sequence

A

Triad of micrognathia, glossoptosis, palatial clefting

124
Q

Apert syndrome

A

Severe maxillary and midfacial hypoplasia

125
Q

Crouzon syndrome

A

Severe maxillary and midfacial hypoplasia with low set ears

126
Q

Vellous hair

A

Thin, unpigmented, peach fuzz

127
Q

Terminal hair

A

Coarse, pigmented, scalp and eyebrows

128
Q

Eccrine glands

A

Wide distribution, regulate temperature

129
Q

Apocrine sweat glands

A

Stimulated by stress, axilla/groin, body odor

130
Q

Sebaceous glands

A

Access skin through hair follicles, on all surfaces except soles of feet

131
Q

Melanoma risk factors

A

Sun sensitivity, fair skin, exposure to sunlight or UV, family history, moles

132
Q

Basal and squamous cell risk factors

A 
Older age
Radiation or sunlight
Fair complexion
Sun burning easily
Trauma or irritation

Chronic exposure- squamous cell
Intermittent- basal cell

133
Q

Halo nevus

A

Sharp oval or circular

Has a depigmented halo around it

Benign

134
Q

Intradermal nevus

A

Dome shaped, raised, pedunculated or hair bearing

135
Q

Junction nevus

A

Flat or slightly elevated, dark brown

136
Q

Compound nevus

A

Slightly elevated, indistinguishable border

137
Q

Hair nevus

A

Present at birth usually, may cover large area, hair growth may occur after several years

138
Q

Primary skin lesions

A

Occur as initial spontaneous manifestations of a pathological process

139
Q

Secondary skin lesion

A

Result from later evolution of or external trauma to a primary lesion

140
Q

Patch

A

Macule >10 mm

141
Q

Nodule

A

Papule >10 mm

142
Q

Plaque

A

Plateau like, >10 mm

143
Q

Bulla

A

Vesicle >5 mm

144
Q

Macerated

A

Soggy, soft, water saturdated

145
Q

Where do you test for turgor on an infant?

A

Their abdomen

146
Q

Salmon patches

A

Aka stork bites

Flat, deep pink localized areas usually on mid forehead, eyelids, uppper lip and back of neck

147
Q

Cutis marmorata

A

Mottled appearance of a baby when they are cold

148
Q

Basal cell carcinoma appearance

A

Pearly or translucent

Open sore

149
Q

Squamous cell carcinoma presentation

A

Elevated growth with central depression

Scaly red. Patch

May have crusted

150
Q

Kaposi sarcoma

A

Found most commonly in immunosuppressed patients

Soft, vascular, bluish purple, painless lesions

151
Q

Alopecia are at a

A

Sudden, rapid, patchy loss of hair usually from scalp or face

152
Q

Scarring alopecia

A

Replacement of hair follicles with scar tissue

Permanent hair loss

153
Q

Traction alopecia

A

Hair loss from the result of prolonged, tightly pulled hairstyles

154
Q

Hirsutism

A

Growth of terminal hair in women in the male distribution pattern on the face, body and pubic areas

155
Q

Paronychia

A

Inflammation or infection between nail fold and nail plate, causes purulent drainage

156
Q

Beau lines

A

Associated with coronary occlusion, hypercalcemia

157
Q

White banding aka terry nails

A

Associated with cirrhosis, chronic congestive HF, adult onset DM and age

158
Q

Measles

A

Rubeola

Koplik spots on the buccal mucosa

Macular rash on face and neck, maculopapular on trunks nd extremities

159
Q

Rubella

A

Aka german measles

Light pink to red maculopapular rash

Reddish spots on soft palate

H & P (4 decks)

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