Exam 3 Flashcards
Thumb abduction test
Isolates strength of abductor pollicis brevis muscle, innervated only by the median nerve
Phalen test
Both wrists fully palmar flexed with dorsal surfaces pressed together for 1 minute
Numbness and paresthesia in median nerve distribution is positive, carpal tunnel
Tinel sign
Strike patients wrist where the median nerve passes under flexor retinaculum
Tingling sensation radiating is positive
Finkelstein
Assesses de quervain’s tenosynovitis
Patient places thumb inside fist, hand is flexed, if pain its positive
Neer test
Forward flex arm 150 degrees while depressing/stabilizing scapula
Hawkins test
Abduct shoulder to 90 degrees, flex elbow 90 degrees, then internally rotate
Hawkins kennedy test
Forward flex shoulder to 90 degrees, flex elbow to 90 degrees, internally rotate to limit
Jobe’s or empty the can test
Abduct shoulder to 90 degrees, flex shoulder forward to 30 degrees, point thumb down, provide resistance
Weakness is a supraspinatus issue
Drop arm test
Patient raise arm to 90 degrees of abduction then lower slowly, if they can’t hold it could be supraspinatus issue
Cross arm test
Forward elevation to 90 degrees and active adduction
Impingement issue if positive
Sulcus sign
Place traction on patient arm, observe sulcus or depression lateral or inferior to acromion
Instability of shoulder
Apprehension test for shoulder
Patient supine, abduction to 90 degrees, elbow flexed 90 degrees, shoulder externally rotated
Relocation test
Immediately after positive apprehension test, posterior force on proximal humerus, shoulder external rotated
Spurling test
Cervical root impingement
Straight leg raising test
Disc herniation with nerve root irritation
Patient lie supine with neck slightly flexed, passive leg raise
Femoral stretch test
Inflammation of nerve root
Patient lies prone and extends him, pain on extension is positive
Thomas test
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
Trendelenburg test
Weak hip abductor muscle
Balance on one foot, drop of the iliac crests is positive
Ballottement
Excess fluid or effusion test
Apply downward pressure on suprapatellar pouch
Push patella sharply downward against femur
Bulge sign
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
Mcmurray test
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
Anterior and posterior draw tests
5 mm is abnormal
Lachman test
Anterior crucial ligament integrity
Heel on table
Thompson’s test
Squeeze calf and observe for plantar flexion of achilles
Inversion talar tilt test
Assesses calcaneofibular ligament and anterior talofibular ligament
Greater than 10 degrees of inversion is positive
Version talar tilt test
Deltoid ligament
Greater than 10 degrees of tilt is positive
Anterior drawer ankle test
Anterior talofibular ligament and calcaneofibular ligament
Anterior force to heel while moving the talus anterior
Limb measurement
No more than 1 cm difference between length and circumference
Dupuytren contracture
Contracture involving the flexor hand tendons
Kyphosis
Rounding of the shoulder
Gibbous
More angulated back changes, vertebral fracture related
Burning
Peptic ulcer
Cramping
Gastroenteritis, biliary colic
Colicky
Appendicitis with impacted feces, renal stone
Aching
Appendices irritation
Knifelike
Pancreatitis
Ripping, tearing
Aortic dissection
Gradual. Onset
Infection
Sudden onset
Duodenal ulcer, acute pancreatitis, obstruction, perforation
Dysphagia
Trouble swallowing
They can point to the location usually, constant or stable or progressing
Odynophagia
Pain with swallowing
Sharp/burning- mucosal inflammation
squeezing/cramping- muscular
Color cancer screening
At 50 unless they have a relative who has had colon cancer, then its 40
Itching without a rash
Associated with pancreatic cancer
Bowel sounds
Can be 5-35 per minute
Clicks and gurgles
Increased bowel sounds
Gastroenteritis, early intestinal obstruction, borborgymi
Decreased bowel sounds
Peritonitis, paralytic ileum
Abnormal abdominal bruit
Systole and diastole!
Systole is normal
Describe liver percussion
Start at mid clavicular line and go up until dullness
Same at umbilicus
Dullness in spleen percussion
Splenic enlargement, left sided pleural effusion, stool filled intestine
Which kidney is easier to palpate?
The right kidney
Shifting dullness
Fluid moves the way you have shifted their body- fluid sounds dull!
Bowel sounds in chest wall
Suggest diaphragmatic hernia
Volvulus
Twisting of bowel
Whirl shape! It’s obstructed
Pyloric stenosis
Olive shaped mass RUQ!!
Vomiting dramatically and projectile
Intussuception
Cramping, sausage mass, drawing up knees, stool is currant jelly
Omphalocele
Organs outside of the body
Appendicitis
Cutaneous hypersensitivity Guarding Rebound tenderness Rovsing's Psoas sign Obturator sign
Rovsing’s
Appendicitis
Referred pain when palpating on left side, they feel in on the left
Mcburney’s point
1/3 of the way along the line drawn from the hip to umbilicus
Acute gastroenteritis causes
Mostly viral, rotavirus or norwalk virus
Shigellosis
Bloody mucoid stool
Cholera
Rice water stool
Campylobacter
Raw milk/raw meat
Watery blood diarrhea
Giardiasis
Malodorous, greasy stool
Copious and frothy
Difference between chrohn’s and colitis
Cholitis is only the colon, chrohn’s can be small or large intestine
Skip lesions in chrohn’s
4 clinical features of chrohn’s
- Transmural sharlply delineated inflammation
- Non-caseating granulomas
- Fissuring formation of fistulous tracts
- Systemic manifestations
Hallmark of ulcerative colitis
Bloody diarrhea
Diverticulitis
Acute LLQ pain, fever, abdominal tenderness and mass
Ileus
Sleeping belly due to mechanical or paralytic reasons
Meckel’s diverticulum
Most common GI congenital abnormality
First 2 years of life
Asymptomatic rectal bleeding
Bilirubin levels in jaundice
> 2.5
Cirrhosis
Diffuse fibrosis of entire liver with nodules
5 F’s for cholecystitis
Fertile Fat Forty Fair skinned Female
Cholecystits
Inflammation of gallbladder usually caused by cholelithiasis (aka obstruction from stone)
RUQ/epigastric pain postprandial fatty meal
Ascending cholangitis
Charcot’s triad: fever, RUQ pain, jaundice
Complication of acute cholecystitis
Rectal exam positions
Knee-chest
Lithotomy
Left lateral with hips or knees flexed
Standing with hips flexed and upper body supported by examining table
If there is pain during a digital rectal exam, what should you do?
Stop! Dont force it
Describe the digital rectal exam
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
Boggy prostate
BPH
Hard prostate
Cancer
Tender prostate
Infection or abcess
Grade 1 prostate
1-2 cm, NORMAL
Grade IV prostate
> 4 cm
Hirschsprung disease
Primary absence of parasympathetic ganglion cells in a segment of the colon, interrupting intestinal motility
Anal wink absence
Suggests abuse or spinal cord injury
If you lightly touch the anus it should constrict
Pilonidal cyst
Cysts around an ingrown hair at the top of the cleft of the butt
Condyloma accunatima
Anal warts
Perianal/perirectal abscess
Fever
Painful/tender
Usually polymicrobial
Common in chrohn’s and immunosuppressive
Fistula
Canal between two things, can be between rectum and vagina, rectum and urethra, etc.
Causes of hemorrhoid
Increased pressure!
Prostatitis
Fever Bacterial infection Pain Dysuria Sexual dysfunction
If you massage the prostate it can lead to bacteremia
BPH type
Irritative- increased frequency and urgency, nocturia
Obstructive- peak urine flow is <10/15 sec, dribbling, hesitancy, double stream
Prostate cancer risk factors
Age Lifetime risk: 20% Lifetime death risk: 40% Vasectomy African americans 1.5x > Caucasian BRCA2
Anal cancer
Squamous cell most commonly
Associated with HPV
Bleeding, pain, itching, nodule, change in bowel habits
What tissues do not have lymph that are still supplied by the vascular system?
The brain and placenta
Lymph fluid
Made of protein and WBS, is cloudy, clear or milky
Right upper extremities are drained by…
Right subclavian vein
Thorax and left upper extremities are drained by…
Left subclavian vein
3 physical signs of lymph disorders
Lymphadenopathy
Lymphangitis, red streaks in the skin
Lymphedema
Submandibular or cervical nodes normal
Less than 1 cm
Inguinal nodes normal
Less than 2 cm in diameter
Matted nodes
Group of nodes that feel connected and seem to move as a unit
Shotty nodes
No clinical consequence, enlargement of nodes following a viral infection
Extremely hard and painless nodes
Likely malignancy
Increased tenderness with nodes
More likely inflammation
Virchow node
Supraclavicular on the left side
Suggests malignancy
Superficial cervical nodes at…
Sternocleidomastoid
Posterior cervical nodes along…
Anterior trapezius
Cervical nodes deep to…
Sternocleidomastoid
Inguinal and popliteal nodes
Check when patient is supine
Inguinal LAD can be a scrotal or penile infection
Pregnant women and lymph concerns
Exposure to cat feces or litter, think toxoplasmosis
Facial muscles are innervated by…
CN V and VII
Posterior fontanelle closes…
2 months of age
Anterior fontanelle closes…
12-15 months
Anterior triangle
In front of SCM to mid line of neck
Posterior triangle
Behind SCM to trapezius
Think migraine if…
HA then nausea
Blind spots
If aneurysm, think…
Nausea then HA
Worst HA of their life. They have to mean it
Hippocratic facies
Sunken appearance of eyes, cheeks, temporal areas
Sharp nose
Dry, rough skin
Myxedema facies
Dull, puffy, yellowed skin
Coarse, sparse hair
Temporal loss of eyebrows
Periorbital edema
Prominent tongue
Hyperthyroid facies
Fine moist skin
Fine hair
Prominent eyes and lid retraction
Bell palsy facies
Asymmetry of one side of the face and eyelid not closing completely
Pierre-robin sequence
Triad of micrognathia, glossoptosis, palatial clefting
Apert syndrome
Severe maxillary and midfacial hypoplasia
Crouzon syndrome
Severe maxillary and midfacial hypoplasia with low set ears
Vellous hair
Thin, unpigmented, peach fuzz
Terminal hair
Coarse, pigmented, scalp and eyebrows
Eccrine glands
Wide distribution, regulate temperature
Apocrine sweat glands
Stimulated by stress, axilla/groin, body odor
Sebaceous glands
Access skin through hair follicles, on all surfaces except soles of feet
Melanoma risk factors
Sun sensitivity, fair skin, exposure to sunlight or UV, family history, moles
Basal and squamous cell risk factors
Older age Radiation or sunlight Fair complexion Sun burning easily Trauma or irritation
Chronic exposure- squamous cell
Intermittent- basal cell
Halo nevus
Sharp oval or circular
Has a depigmented halo around it
Benign
Intradermal nevus
Dome shaped, raised, pedunculated or hair bearing
Junction nevus
Flat or slightly elevated, dark brown
Compound nevus
Slightly elevated, indistinguishable border
Hair nevus
Present at birth usually, may cover large area, hair growth may occur after several years
Primary skin lesions
Occur as initial spontaneous manifestations of a pathological process
Secondary skin lesion
Result from later evolution of or external trauma to a primary lesion
Patch
Macule >10 mm
Nodule
Papule >10 mm
Plaque
Plateau like, >10 mm
Bulla
Vesicle >5 mm
Macerated
Soggy, soft, water saturdated
Where do you test for turgor on an infant?
Their abdomen
Salmon patches
Aka stork bites
Flat, deep pink localized areas usually on mid forehead, eyelids, uppper lip and back of neck
Cutis marmorata
Mottled appearance of a baby when they are cold
Basal cell carcinoma appearance
Pearly or translucent
Open sore
Squamous cell carcinoma presentation
Elevated growth with central depression
Scaly red. Patch
May have crusted
Kaposi sarcoma
Found most commonly in immunosuppressed patients
Soft, vascular, bluish purple, painless lesions
Alopecia are at a
Sudden, rapid, patchy loss of hair usually from scalp or face
Scarring alopecia
Replacement of hair follicles with scar tissue
Permanent hair loss
Traction alopecia
Hair loss from the result of prolonged, tightly pulled hairstyles
Hirsutism
Growth of terminal hair in women in the male distribution pattern on the face, body and pubic areas
Paronychia
Inflammation or infection between nail fold and nail plate, causes purulent drainage
Beau lines
Associated with coronary occlusion, hypercalcemia
White banding aka terry nails
Associated with cirrhosis, chronic congestive HF, adult onset DM and age
Measles
Rubeola
Koplik spots on the buccal mucosa
Macular rash on face and neck, maculopapular on trunks nd extremities
Rubella
Aka german measles
Light pink to red maculopapular rash
Reddish spots on soft palate
