Exam 3 review Flashcards
3 boney landmarks of the shoulder?
- Acromion
- Coracoid Process
- Greater Tubercle
3 boney structures of the shoulder?
- Humerus
- Clavicle
- Scapula
Which joint is the “ball in socket” of shoulder?
Glenohumeral
What test to check internal and external shoulder rotation?
Apley Scratch Test
Apley Scratch Test test what movements?
Internal and external shoulder rotation
What does a positive Apley Scratch Test mean? 2 things.
- Rotator cuff disorder
2. Adhesive capitus
How to do Painful Arc Test? What’s positive?
Adduct arm 0-160º.
Shoulder pain betwen 60-120º d/t subacromial impingement or rotator cuff tendonitis.
What does the Near Impingement Sign compress?
Greater tuberosity against supraspinatus tendon and coracoacromial ligament
Empty Can Test is when arm can’t do what?
Inability to hold arm fully abducted at shoulder level -or- control lowering arm
Empty Can Test is due to what?
Supraspinatus rotator cuff tear
What is CN 1 and how to test?
Olfactory nerve. Check patency and smell with eyes closed and 2 different smells
What is CN 2 and how to test?
Optic nerve. Test visual acuity and visual field by controntation.
What is CN 3 and how to test?
Oculomotor nerve. Controls eyelids and pupil reaction to light, near response, convergence, accommodation.
What is anisocoria?
> 0.4mm pupil diameter size than opposite pupil
What is CN 4? Which muscle does it innervate?
Trochlear nerve. Superior Oblique
What is CN 6? Which muscle does it innervate?
Trochlear nerve. Lateral rectus.
Ptosis due to which nerve?
CN 3
What is CN 5? Which muscle does it innervate?
Trigeminal. Muscles of mastication=masseter, pterygoid, temporalis
What is CN 7? Which muscles?
Facial nerve. Muscles of facial expression, close eyes tight, puff cheeks.
Which nerve is affected in Bells Palsy?
CN 7
Bells Palsy affects which parts of the face?
Upper and lower face.
CN 8 is which nerve? What does it do?
Vestibularcochlear nerve (acoustic and vestibular). Hearing and balance.
What does the Rinne Test check?
Air and bone conduction.
Rinne Test in conductive hearing loss air conduction and bone conduction?
BC ≥ AC
Rinne Test in sensorineural hearing loss air conduction and bone conduction?
AC>BC
Weber Test checks for what?
Lateralization
Weber Test in conductive to which ear?
Affected ear
Weber Test in sensorineural to which ear?
Good ear
Which nerve in CN 9? What reflex?
Glossopharyngeal. Gag reflex.
Which nerve gives “horase voice” and difficulty swallowing?
CN 9
CN 10 is which nerve? How to test in throat?
Vagus. Uvula and soft palate symmetrical rise.
CN 11 is which nerve? How to test?
Spinal accessory. Shoulder shrug.
CN 12 is which nerve? How to test?
Hypoglossal. Stick out tongue.
Lower Motor Neuron damage where in medulla?
Below crossover point
Lower Motor Neuron damage weakness and paralysis on which side?
Ipsilateral
Lower Motor Neuron damage tone, reflex, atrophy, plantar reflex?
Hypotonia, hyporeflexia, atrophy, normal plantar reflex
Upper Motor Neuron damage where in medulla?
Damage above crossover point
Upper Motor Neuron damage weakness and paralysis on which side?
Contralateral weakness and paralysis
Upper Motor Neuron damage tone, reflex, atrophy, fasciculation?
Hypertonia, hyperreflexia, no atrophy, no fasiculations
Grading range of Deep Tendon Reflex (DTR)
0-4
DTR 0 and 1 mean?
0=absent reflex
1=Low normal; somewhat diminished
DTR 2 and 3 mean?
2=Average, normal
3=Brisker than normal, possible disease
DTR 4 mean?
Very brisk. Hyperactive with clonus.
DTR hyperreflexes due to lesions where?
CNS lesions of corticospinal tracts
DTR hyporeflexes due to lesions where? (hint: 2 possible places)
Lesion of spinal nerves or peripheral nerves
DTR hyperreflexes due associated with Upper or Lower Motor Neuron lesions?
Upper Motor Neuron lesions
Positive Babinski’s sign associated with which motor neuon lesion where?
Upper motor neuron lesion. CNS lesion of corticospinal tract.
DTR hyporeflexes associated with motor lesions where?
Lower Motor Neuron lesion
Muscle weakness, atrophy, and fasciculations due to lesion where?
Lesion of spinal or peripheral nerves. Lower motor neuron lesions.
Spastic muscles and positive Babinski due to neuron lesion where?
CNS lesion of corticospinal tract. Upper motor neuron lesion.
Babinski Reflex when big toe does what in response to stimulus?
Dorsiflexes
Babinski reflext d/t what sort of lesion?
CNS lesion affecting corticospinal tract. Upper motor neuron.
Is plantarflexion of big toe with stimulus normal or abnormal?
Normal
Can Babinski be positive when unconscious due to EtOH or drug OD?
Yes
Muscle Strength range?
0-5
Muscle Strength 0 and 1?
0=No twitch
1=+ twitch
Muscle Strength 2 and 3?
2=some movement, no gravity
3=active movement against gravity, no resist
Muscle Strength 4 and 5?
4=move against gravity w/resist
5=strong
3 types of pain?
- Visceral pain
- Parietal pain
- Referred pain
Visceral pain due do what happening to abdominal organs?
Distended abdominal organs
Visceral pain easy or difficult to localize?
Difficult to localize
Renal Colic example of what type of pain?
Visceral!
Ischemia what sort of pain?
Visceral pain!
Patietal Pain due to what happening to the peritoneum?
Inflammed parietal peritoneum
Location of Parietal Pain relative to involved structure?
Localized over involved structure
What do PTs with parietal pain prefer to do?
Lie still. NOT MOVE!
Referred Pain where and d/t what?
Pain at distant site innervated by same spinal nerves
Referred Pain diffuse or localized?
Localized
Pleurisy and Inferior MI cause pain to be felt in epigastrum. What sort of pain?
Referred
Where is General Splenic Percussion done at?
Left 6th ICS from cardiac dullness to Ant Axillary Line “traube’s space”.
General Splenic Percussion if tympanic? Dull?
Tympanic=no splenomegaly
Dull=splenomegaly
Splenic Percussion Sign done where?
Lowest Left ICS in Ant Axillary Line
Splenic Percussion Sign tympanic and dull upon inspiration?
Tympanic=normal
Dull=splenomegaly
How to palpate for splenomegaly?
PT in abd position, left hand at left lower rib cage and right hand at costal margin. Press in and try to feel. 5% PTs have spleen can palpate.
Causes of splenomegaly?
Portal HTN, malignancy, HIV, infiltrative dz (amyloidosis, splenic infarc).
Spleen is Reticuloendothelial Organ? What does this mean?
Liver and spleen are “connected” and if one enlarges the other is likely to also enlarge
Shifting Dullness with ascites?
Borders of dullness change with shift in PT position. Tympanic borders.
Fluid Wave and ascites?
Palpable shock wave when feeling one side of abdomen and striking opposite side
Ballottement in ascites?
Used to identify mass in ascetic abdomen. Stiff fingers and jab toward mass.
What special test for Cholecystitis?
Murphy’s
How to do Murphy’s for cholecystitis? What’s positive
Hooked fingers at right costal margin and take deep breath. Sharp pain in tenderness with inspiration=positive.
McBurney’s Point Tenderness for what? Sensitivity?
Appendicitis. Highest sensitivity!
Where is McBurney’s Point Tenderness?
2” from ASIS on line from that process to umbilicus.
Rovsing’s Sign?
Referred pain from LLQ to RLQ via deep palpation. Appendicitis.
How many Psoas Signs are there?
2!!!!!!
Appendicitis.
How to do both Psoas Signs? Positive?
Appendicitis
1. Raise thigh against hand above knee
2. PT on L side, extend R leg at hip
Positive=increased abd pain
How to do Obturator Sign? Positive?
Flex right thigh at hip with knee bent and rotate internally.
Positive=right hypogastric pain
How to assess for Ventral Hernia?
Lift head and shoulders off table like a crunch=bulge
Ventral Hernia in abdominal wall exclusive of what other hernia?
Groin hernia
What will intra-abdominal mass be obscrured by?
Muscular contraction
Normal range of abdominal sounds? Time?
5-34 abdominal sounds in 1 min. If not listen for 2 minutes.
6 components of Nervous System exam?
- Mental Status (most important!)
- CNs
- Motor Function (2nd most import)
- Sensory
- Reflexes (DTRs, cutaneous reflexes)
- Coordination (aka cerebellar testing)
What are Dysethesias and what can it cause?
Light touch which causes burning or irritating sensation from sensory neuropathy
What is a Sensory Neuropathy?
Burning pain due to DM
What pattern of sensory loss does Polyneuropathy cause?
Stocking-glove sensory loss
Mononeuritis Multiplex causes what pattern of sensory loss? D/T?
Multiple patchy areas of sensory loss. DM and RA.
Feel light-headed and weak but not actually passing out?
Near Syncope/Pre-syncope
Suddenly but temporary loss of consciousness and postural tone d/t transient global hypoperfusion of brain
True Syncope
Most common syncope?
Vasovagal Syncope
Vasovagal Syncope speed and d/t?
Slow onset and offset. Unpleasant event.
Syncope from arrythmias speed? D/T?
Sudden. Loss of cerebral perfusion.
Tabes Dorsalis d/t which bacterial infx?
Syphillis
Tabes Dorsalis does what to spinal tracts?
Demyelination
Tabes Dorsalis and position sense, pupils?
Reduced position sense, Argyll-Robertson pupils
Define Analgesia
Absence of pain
Define hypalgesia
Decreased sensitivity to pain
Define hyperalgesia
Increased pain sensitivity
Define anesthesia
Absence of touch sensation
Define Hypesthesia
Decreased sensivity to touch
Define hyperesthesia
Increased sensitivity to touh
First sensation lost in peripheral neuropathy?
Loss of vibration sense
Tabes Dorsalis, multiple sclerosis, B12 deficiency cause loss of which sense?
Position.
D/T posterior column disease.
Are the pulsations of the abdominal aorta visible or not?
Yes
Where are abdominal aortic pulsations visible?
Upper abdomen/epigastrum, slightly left of midline.
Normal abd aorta width?
3cm. More is suggestive of AAA.
Most important finding of lung sounds?
Presence of lung sounds!
2 normal breath sounds?
Vesicular and bronchovesicular
Where are Vesicular breath sounds heard?
Between scapulae and 1st and 2nd ICSs
Where are bronchovesicular sounds heard?
Over manubrium
Discontinuous, nonmusical, “dots in time”
Crackles
What happens to the airway in crackles?
Pop open with inspiration
2 types of crackles?
Fine and coarse
Continuous musical sounds
Wheezes
What happens in airways in wheezes?
Bronchial airways narrowed to point of closure
Wheezes are typical of which disease?
Asthma
Rhonchi are a variant of what other sound?
Wheezes
Pitch of Ronchi compared to wheezes?
Lower pitch
Continuous high frequency, high pitched musical sound during airflow
Stridor
What is happening to upper resp tract during Stridor?
Narrowing
3 causes of Stridor?
- Anaphylaxis
- Eppiglotitis
- Foreign body
Discontinouous, low frequency, grating sound?
Pleural Rub
Pleural Rub due to?
Inflammed, roughened visceral pleura that slides against parietal pleura
Normal thorax percussion note?
Resonant
Left-sided HF percussion note?
Resonant
Chronic Bronchitis percussion note?
Resonant
Lobar pneumonia aka Consolidation percussion note?
Dull
Pleural Effusion percussion note?
Dull to flat
Pleural Rub due to what happening in the pleura?
Inflammed and roughened visceral pleural that slides against parietal pleura
Pneumothorax percussion note?
Hyperresonant!
COPD percussion note?
Diffusely hyperresonant
Asthma percussion note?
Resonant to diffusely hyperresonant
How many grades of Murmurs?
6
Define Thrill
Vibration sensation felt on ball of hand d/t underlying tubulent blood flow
Define Heave/Lift
Sustained impulses that rhythmically lift fingers on chest. D/T enlared atrium of ventricle
What grade murmur when thrill first present?
Grade 4
Increased transmission of voice sounds suggests what?
Airless lung aka consolidation
What is a “consolidation”
Air filled lung becomes airless
Describe normal and positive Broncophony
Normal=Hearing muffled 99.
Positive=loudly hearing 99
Describe normal and positive Egophony
Normal=hearing muffled “ee”
Positive=“E-to-A”
Describe normal and positive Whispered Pectoriloquy
Normal=whispered “99” faintly heard
Positive=Loud and clear “99”
What to do if feel goiter on thyroid?
Ascultate for bruit
Definition of HTN?
≥140/90
Normal BP?
≤120/80
BP measurment done in the home or clinic is more predictive of CV disease and end-organ damage than office measurment?
Home measurment
- End-organs damaged by HTN?
- Brain
- Eyes
- Heart
- Kidneys
2 places where lordosis normally occurs?
Cervical and Lumbar spine
Cause of loss of lordosis in cervical and lumbar spine?
Paravertebral spasm
What causes excess lordosis in lumbar spine?
Flexion deformity of hip
Who is S3 normal in?
Children, preggers women, well-trained athletes
Which is always pathological- S3 or S4?
S4!
Which condition is S4 associated with?
Left Ventricular Hypertrophy (LVH)
Listen for S3 and S4 with which part of stethoscope?
Bell
PT position for auscultating S3 and S4?
Left semilateral
Sequence for fundoscopic exam?
a. Darken the room
b. Dial the lens disk to 0
c. Hold the device in the right hand for examining the pt’s right eye (Vice versa for left)
d. Have pt look directly ahead and focus on a fixed object
e. Stand 15” from the pt at 15° lateral to them
f. Observe red reflex
g. Brace your opposite hand on the pt’s forehead
h. Find a vessel and follow it centrally until you find the optic disk (track towards larger vessels)
i. Once found, rotate your lens disk until it is in sharp focus
j. Observe Optic Disk: Sharpness & clarity, color, size of cup
k. Observe the retina: Arteries & veins including crossings, venous pulsations, retinal lesions
l. Observe the fovea & macula: have pt stare into the light, look for tiny light reflection
Which vessels in eye are light red and small?
Arteries
Which vessels in eye are dark red and large?
Veins
Swinging flashlight test for which condition?
Marcus Gunn Pupil
Light in “bad eye” of Marcus Gunn pupil does what to pupils?
Partial dilation of both pupils
Marcus Gunn Pupil d/t which CN?
CN 2 optic nerve
Normal cup to disc ratio?
0.3
Normal IOP range?
10-22
One large pupil with delayed or absent light reaction is which condition?
Tonic “Adie” Pupil
Unilateral dilated pupil with slow or no light reaction?
Tonic “Adie” pupil
Most common form of headache
Tension headache
Headache without an identified underlying disease
Primary Headache
Headache with an identified underlying disease called?
Secondary Headache
3 life-threatening causes of HA
- Meningitis
- Subarachnoid hemorrhage
- Mass lesion
Define Hyperopia
Difficulty focusing on close work (Farsightedness)
Define Myopia
Difficulty focusing on distant objects (Nearsightedness)
Define Presbyopia
Difficulty with close work due to aging vision
Hyphema blood is where?
Blood in anterior chamber
Define Optic Neuritis. Associated with?
Painful vision loss usually associated with MS
Cataracts does what to lens? Gradually leads to what?
Opacification of lens leading to gradual central vision loss
Define Vitreous Floaters
Moving debris inside vitreous humor, often protein fragments
Define Scotoma
Areas of vision loss within the patient’s visual field
Horizontal Diplopia and CNs affacted?
Double vision in which images are side-by-side (may be physiologic); may suggest palsy of CN-III or VI
Vertical Diplopia and CNs affected?
Double vision in which images are on top of each other (always pathologic); may suggest a palsy of CN-III or IV
Conductive Hearing Loss arises from where?
Arises in external or middle ear
Sensorineural Hearing Loss arises from where?
Arises in the inner ear, cochlear nerve or brain
Define Tinnitus
Perceived sound that has no external stimulus
Define Vertigo
Sensation of true rotational movement of the patient or the surroundings
Define Rhinorrhea
Drainage from the nose often associated with nasal congestion
Define Epistaxis
Bleeding from the nasal passage
Define Pharyngitis
Sore throat
Define Aphthous
Related to benign ulcers of the mouth (eg. Aphthous stomatitis)
Define Gingivitis
Inflammation of the gums
4 types of pulse amplitude?
- thready
- weak
- strong
- bounding
