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Physical Exam I > Exam 3 review > Flashcards

Exam 3 review Flashcards

1
Q

3 boney landmarks of the shoulder?

A
  1. Acromion
  2. Coracoid Process
  3. Greater Tubercle
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2
Q

3 boney structures of the shoulder?

A
  1. Humerus
  2. Clavicle
  3. Scapula
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3
Q

Which joint is the “ball in socket” of shoulder?

A

Glenohumeral

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4
Q

What test to check internal and external shoulder rotation?

A

Apley Scratch Test

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5
Q

Apley Scratch Test test what movements?

A

Internal and external shoulder rotation

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6
Q

What does a positive Apley Scratch Test mean? 2 things.

A
  1. Rotator cuff disorder

2. Adhesive capitus

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7
Q

How to do Painful Arc Test? What’s positive?

A

Adduct arm 0-160º.

Shoulder pain betwen 60-120º d/t subacromial impingement or rotator cuff tendonitis.

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8
Q

What does the Near Impingement Sign compress?

A

Greater tuberosity against supraspinatus tendon and coracoacromial ligament

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9
Q

Empty Can Test is when arm can’t do what?

A

Inability to hold arm fully abducted at shoulder level -or- control lowering arm

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10
Q

Empty Can Test is due to what?

A

Supraspinatus rotator cuff tear

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11
Q

What is CN 1 and how to test?

A

Olfactory nerve. Check patency and smell with eyes closed and 2 different smells

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12
Q

What is CN 2 and how to test?

A

Optic nerve. Test visual acuity and visual field by controntation.

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13
Q

What is CN 3 and how to test?

A

Oculomotor nerve. Controls eyelids and pupil reaction to light, near response, convergence, accommodation.

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14
Q

What is anisocoria?

A

> 0.4mm pupil diameter size than opposite pupil

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15
Q

What is CN 4? Which muscle does it innervate?

A

Trochlear nerve. Superior Oblique

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16
Q

What is CN 6? Which muscle does it innervate?

A

Trochlear nerve. Lateral rectus.

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17
Q

Ptosis due to which nerve?

A

CN 3

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18
Q

What is CN 5? Which muscle does it innervate?

A

Trigeminal. Muscles of mastication=masseter, pterygoid, temporalis

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19
Q

What is CN 7? Which muscles?

A

Facial nerve. Muscles of facial expression, close eyes tight, puff cheeks.

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20
Q

Which nerve is affected in Bells Palsy?

A

CN 7

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21
Q

Bells Palsy affects which parts of the face?

A

Upper and lower face.

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22
Q

CN 8 is which nerve? What does it do?

A

Vestibularcochlear nerve (acoustic and vestibular). Hearing and balance.

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23
Q

What does the Rinne Test check?

A

Air and bone conduction.

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24
Q

Rinne Test in conductive hearing loss air conduction and bone conduction?

A

BC ≥ AC

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25
Q

Rinne Test in sensorineural hearing loss air conduction and bone conduction?

A

AC>BC

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26
Q

Weber Test checks for what?

A

Lateralization

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27
Q

Weber Test in conductive to which ear?

A

Affected ear

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28
Q

Weber Test in sensorineural to which ear?

A

Good ear

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29
Q

Which nerve in CN 9? What reflex?

A

Glossopharyngeal. Gag reflex.

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30
Q

Which nerve gives “horase voice” and difficulty swallowing?

A

CN 9

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31
Q

CN 10 is which nerve? How to test in throat?

A

Vagus. Uvula and soft palate symmetrical rise.

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32
Q

CN 11 is which nerve? How to test?

A

Spinal accessory. Shoulder shrug.

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33
Q

CN 12 is which nerve? How to test?

A

Hypoglossal. Stick out tongue.

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34
Q

Lower Motor Neuron damage where in medulla?

A

Below crossover point

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35
Q

Lower Motor Neuron damage weakness and paralysis on which side?

A

Ipsilateral

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36
Q

Lower Motor Neuron damage tone, reflex, atrophy, plantar reflex?

A

Hypotonia, hyporeflexia, atrophy, normal plantar reflex

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37
Q

Upper Motor Neuron damage where in medulla?

A

Damage above crossover point

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38
Q

Upper Motor Neuron damage weakness and paralysis on which side?

A

Contralateral weakness and paralysis

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39
Q

Upper Motor Neuron damage tone, reflex, atrophy, fasciculation?

A

Hypertonia, hyperreflexia, no atrophy, no fasiculations

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40
Q

Grading range of Deep Tendon Reflex (DTR)

A

0-4

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41
Q

DTR 0 and 1 mean?

A

0=absent reflex

1=Low normal; somewhat diminished

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42
Q

DTR 2 and 3 mean?

A

2=Average, normal

3=Brisker than normal, possible disease

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43
Q

DTR 4 mean?

A

Very brisk. Hyperactive with clonus.

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44
Q

DTR hyperreflexes due to lesions where?

A

CNS lesions of corticospinal tracts

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45
Q

DTR hyporeflexes due to lesions where? (hint: 2 possible places)

A

Lesion of spinal nerves or peripheral nerves

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46
Q

DTR hyperreflexes due associated with Upper or Lower Motor Neuron lesions?

A

Upper Motor Neuron lesions

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47
Q

Positive Babinski’s sign associated with which motor neuon lesion where?

A

Upper motor neuron lesion. CNS lesion of corticospinal tract.

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48
Q

DTR hyporeflexes associated with motor lesions where?

A

Lower Motor Neuron lesion

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49
Q

Muscle weakness, atrophy, and fasciculations due to lesion where?

A

Lesion of spinal or peripheral nerves. Lower motor neuron lesions.

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50
Q

Spastic muscles and positive Babinski due to neuron lesion where?

A

CNS lesion of corticospinal tract. Upper motor neuron lesion.

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51
Q

Babinski Reflex when big toe does what in response to stimulus?

A

Dorsiflexes

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52
Q

Babinski reflext d/t what sort of lesion?

A

CNS lesion affecting corticospinal tract. Upper motor neuron.

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53
Q

Is plantarflexion of big toe with stimulus normal or abnormal?

A

Normal

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54
Q

Can Babinski be positive when unconscious due to EtOH or drug OD?

A

Yes

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55
Q

Muscle Strength range?

A

0-5

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56
Q

Muscle Strength 0 and 1?

A

0=No twitch

1=+ twitch

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57
Q

Muscle Strength 2 and 3?

A

2=some movement, no gravity

3=active movement against gravity, no resist

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58
Q

Muscle Strength 4 and 5?

A

4=move against gravity w/resist

5=strong

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59
Q

3 types of pain?

A
  1. Visceral pain
  2. Parietal pain
  3. Referred pain
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60
Q

Visceral pain due do what happening to abdominal organs?

A

Distended abdominal organs

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61
Q

Visceral pain easy or difficult to localize?

A

Difficult to localize

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62
Q

Renal Colic example of what type of pain?

A

Visceral!

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63
Q

Ischemia what sort of pain?

A

Visceral pain!

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65
Q

Patietal Pain due to what happening to the peritoneum?

A

Inflammed parietal peritoneum

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66
Q

Location of Parietal Pain relative to involved structure?

A

Localized over involved structure

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67
Q

What do PTs with parietal pain prefer to do?

A

Lie still. NOT MOVE!

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68
Q

Referred Pain where and d/t what?

A

Pain at distant site innervated by same spinal nerves

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69
Q

Referred Pain diffuse or localized?

A

Localized

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70
Q

Pleurisy and Inferior MI cause pain to be felt in epigastrum. What sort of pain?

A

Referred

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71
Q

Where is General Splenic Percussion done at?

A

Left 6th ICS from cardiac dullness to Ant Axillary Line “traube’s space”.

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72
Q

General Splenic Percussion if tympanic? Dull?

A

Tympanic=no splenomegaly

Dull=splenomegaly

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73
Q

Splenic Percussion Sign done where?

A

Lowest Left ICS in Ant Axillary Line

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74
Q

Splenic Percussion Sign tympanic and dull upon inspiration?

A

Tympanic=normal

Dull=splenomegaly

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75
Q

How to palpate for splenomegaly?

A

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.

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76
Q

Causes of splenomegaly?

A

Portal HTN, malignancy, HIV, infiltrative dz (amyloidosis, splenic infarc).

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77
Q

Spleen is Reticuloendothelial Organ? What does this mean?

A

Liver and spleen are “connected” and if one enlarges the other is likely to also enlarge

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78
Q

Shifting Dullness with ascites?

A

Borders of dullness change with shift in PT position. Tympanic borders.

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79
Q

Fluid Wave and ascites?

A

Palpable shock wave when feeling one side of abdomen and striking opposite side

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80
Q

Ballottement in ascites?

A

Used to identify mass in ascetic abdomen. Stiff fingers and jab toward mass.

81
Q

What special test for Cholecystitis?

A

Murphy’s

82
Q

How to do Murphy’s for cholecystitis? What’s positive

A

Hooked fingers at right costal margin and take deep breath. Sharp pain in tenderness with inspiration=positive.

83
Q

McBurney’s Point Tenderness for what? Sensitivity?

A

Appendicitis. Highest sensitivity!

84
Q

Where is McBurney’s Point Tenderness?

A

2” from ASIS on line from that process to umbilicus.

85
Q

Rovsing’s Sign?

A

Referred pain from LLQ to RLQ via deep palpation. Appendicitis.

86
Q

How many Psoas Signs are there?

A

2!!!!!!

Appendicitis.

87
Q

How to do both Psoas Signs? Positive?

A

Appendicitis
1. Raise thigh against hand above knee
2. PT on L side, extend R leg at hip
Positive=increased abd pain

88
Q

How to do Obturator Sign? Positive?

A

Flex right thigh at hip with knee bent and rotate internally.
Positive=right hypogastric pain

89
Q

How to assess for Ventral Hernia?

A

Lift head and shoulders off table like a crunch=bulge

90
Q

Ventral Hernia in abdominal wall exclusive of what other hernia?

A

Groin hernia

91
Q

What will intra-abdominal mass be obscrured by?

A

Muscular contraction

92
Q

Normal range of abdominal sounds? Time?

A

5-34 abdominal sounds in 1 min. If not listen for 2 minutes.

93
Q

6 components of Nervous System exam?

A
  1. Mental Status (most important!)
  2. CNs
  3. Motor Function (2nd most import)
  4. Sensory
  5. Reflexes (DTRs, cutaneous reflexes)
  6. Coordination (aka cerebellar testing)
94
Q

What are Dysethesias and what can it cause?

A

Light touch which causes burning or irritating sensation from sensory neuropathy

95
Q

What is a Sensory Neuropathy?

A

Burning pain due to DM

96
Q

What pattern of sensory loss does Polyneuropathy cause?

A

Stocking-glove sensory loss

97
Q

Mononeuritis Multiplex causes what pattern of sensory loss? D/T?

A

Multiple patchy areas of sensory loss. DM and RA.

98
Q

Feel light-headed and weak but not actually passing out?

A

Near Syncope/Pre-syncope

99
Q

Suddenly but temporary loss of consciousness and postural tone d/t transient global hypoperfusion of brain

A

True Syncope

100
Q

Most common syncope?

A

Vasovagal Syncope

101
Q

Vasovagal Syncope speed and d/t?

A

Slow onset and offset. Unpleasant event.

102
Q

Syncope from arrythmias speed? D/T?

A

Sudden. Loss of cerebral perfusion.

103
Q

Tabes Dorsalis d/t which bacterial infx?

104
Q

Tabes Dorsalis does what to spinal tracts?

A

Demyelination

105
Q

Tabes Dorsalis and position sense, pupils?

A

Reduced position sense, Argyll-Robertson pupils

106
Q

Define Analgesia

A

Absence of pain

107
Q

Define hypalgesia

A

Decreased sensitivity to pain

108
Q

Define hyperalgesia

A

Increased pain sensitivity

109
Q

Define anesthesia

A

Absence of touch sensation

110
Q

Define Hypesthesia

A

Decreased sensivity to touch

111
Q

Define hyperesthesia

A

Increased sensitivity to touh

112
Q

First sensation lost in peripheral neuropathy?

A

Loss of vibration sense

113
Q

Tabes Dorsalis, multiple sclerosis, B12 deficiency cause loss of which sense?

A

Position.

D/T posterior column disease.

114
Q

Are the pulsations of the abdominal aorta visible or not?

115
Q

Where are abdominal aortic pulsations visible?

A

Upper abdomen/epigastrum, slightly left of midline.

116
Q

Normal abd aorta width?

A

3cm. More is suggestive of AAA.

117
Q

Most important finding of lung sounds?

A

Presence of lung sounds!

118
Q

2 normal breath sounds?

A

Vesicular and bronchovesicular

119
Q

Where are Vesicular breath sounds heard?

A

Between scapulae and 1st and 2nd ICSs

120
Q

Where are bronchovesicular sounds heard?

A

Over manubrium

121
Q

Discontinuous, nonmusical, “dots in time”

122
Q

What happens to the airway in crackles?

A

Pop open with inspiration

123
Q

2 types of crackles?

A

Fine and coarse

124
Q

Continuous musical sounds

125
Q

What happens in airways in wheezes?

A

Bronchial airways narrowed to point of closure

126
Q

Wheezes are typical of which disease?

127
Q

Rhonchi are a variant of what other sound?

128
Q

Pitch of Ronchi compared to wheezes?

A

Lower pitch

129
Q

Continuous high frequency, high pitched musical sound during airflow

130
Q

What is happening to upper resp tract during Stridor?

131
Q

3 causes of Stridor?

A
  1. Anaphylaxis
  2. Eppiglotitis
  3. Foreign body
132
Q

Discontinouous, low frequency, grating sound?

A

Pleural Rub

133
Q

Pleural Rub due to?

A

Inflammed, roughened visceral pleura that slides against parietal pleura

134
Q

Normal thorax percussion note?

135
Q

Left-sided HF percussion note?

136
Q

Chronic Bronchitis percussion note?

137
Q

Lobar pneumonia aka Consolidation percussion note?

138
Q

Pleural Effusion percussion note?

A

Dull to flat

139
Q

Pleural Rub due to what happening in the pleura?

A

Inflammed and roughened visceral pleural that slides against parietal pleura

140
Q

Pneumothorax percussion note?

A

Hyperresonant!

141
Q

COPD percussion note?

A

Diffusely hyperresonant

142
Q

Asthma percussion note?

A

Resonant to diffusely hyperresonant

143
Q

How many grades of Murmurs?

144
Q

Define Thrill

A

Vibration sensation felt on ball of hand d/t underlying tubulent blood flow

145
Q

Define Heave/Lift

A

Sustained impulses that rhythmically lift fingers on chest. D/T enlared atrium of ventricle

146
Q

What grade murmur when thrill first present?

147
Q

Increased transmission of voice sounds suggests what?

A

Airless lung aka consolidation

148
Q

What is a “consolidation”

A

Air filled lung becomes airless

149
Q

Describe normal and positive Broncophony

A

Normal=Hearing muffled 99.

Positive=loudly hearing 99

150
Q

Describe normal and positive Egophony

A

Normal=hearing muffled “ee”

Positive=“E-to-A”

151
Q

Describe normal and positive Whispered Pectoriloquy

A

Normal=whispered “99” faintly heard

Positive=Loud and clear “99”

152
Q

What to do if feel goiter on thyroid?

A

Ascultate for bruit

153
Q

Definition of HTN?

154
Q

Normal BP?

155
Q

BP measurment done in the home or clinic is more predictive of CV disease and end-organ damage than office measurment?

A

Home measurment

156
Q
  1. End-organs damaged by HTN?
A
  1. Brain
  2. Eyes
  3. Heart
  4. Kidneys
157
Q

2 places where lordosis normally occurs?

A

Cervical and Lumbar spine

158
Q

Cause of loss of lordosis in cervical and lumbar spine?

A

Paravertebral spasm

159
Q

What causes excess lordosis in lumbar spine?

A

Flexion deformity of hip

160
Q

Who is S3 normal in?

A

Children, preggers women, well-trained athletes

161
Q

Which is always pathological- S3 or S4?

162
Q

Which condition is S4 associated with?

A

Left Ventricular Hypertrophy (LVH)

163
Q

Listen for S3 and S4 with which part of stethoscope?

164
Q

PT position for auscultating S3 and S4?

A

Left semilateral

165
Q

Sequence for fundoscopic exam?

A

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

166
Q

Which vessels in eye are light red and small?

167
Q

Which vessels in eye are dark red and large?

168
Q

Swinging flashlight test for which condition?

A

Marcus Gunn Pupil

169
Q

Light in “bad eye” of Marcus Gunn pupil does what to pupils?

A

Partial dilation of both pupils

170
Q

Marcus Gunn Pupil d/t which CN?

A

CN 2 optic nerve

171
Q

Normal cup to disc ratio?

172
Q

Normal IOP range?

173
Q

One large pupil with delayed or absent light reaction is which condition?

A

Tonic “Adie” Pupil

174
Q

Unilateral dilated pupil with slow or no light reaction?

A

Tonic “Adie” pupil

175
Q

Most common form of headache

A

Tension headache

176
Q

Headache without an identified underlying disease

A

Primary Headache

177
Q

Headache with an identified underlying disease called?

A

Secondary Headache

178
Q

3 life-threatening causes of HA

A
  1. Meningitis
  2. Subarachnoid hemorrhage
  3. Mass lesion
179
Q

Define Hyperopia

A

Difficulty focusing on close work (Farsightedness)

180
Q

Define Myopia

A

Difficulty focusing on distant objects (Nearsightedness)

181
Q

Define Presbyopia

A

Difficulty with close work due to aging vision

182
Q

Hyphema blood is where?

A

Blood in anterior chamber

183
Q

Define Optic Neuritis. Associated with?

A

Painful vision loss usually associated with MS

184
Q

Cataracts does what to lens? Gradually leads to what?

A

Opacification of lens leading to gradual central vision loss

185
Q

Define Vitreous Floaters

A

Moving debris inside vitreous humor, often protein fragments

186
Q

Define Scotoma

A

Areas of vision loss within the patient’s visual field

187
Q

Horizontal Diplopia and CNs affacted?

A

Double vision in which images are side-by-side (may be physiologic); may suggest palsy of CN-III or VI

188
Q

Vertical Diplopia and CNs affected?

A

Double vision in which images are on top of each other (always pathologic); may suggest a palsy of CN-III or IV

189
Q

Conductive Hearing Loss arises from where?

A

Arises in external or middle ear

190
Q

Sensorineural Hearing Loss arises from where?

A

Arises in the inner ear, cochlear nerve or brain

191
Q

Define Tinnitus

A

Perceived sound that has no external stimulus

192
Q

Define Vertigo

A

Sensation of true rotational movement of the patient or the surroundings

193
Q

Define Rhinorrhea

A

Drainage from the nose often associated with nasal congestion

194
Q

Define Epistaxis

A

Bleeding from the nasal passage

195
Q

Define Pharyngitis

A

Sore throat

196
Q

Define Aphthous

A

Related to benign ulcers of the mouth (eg. Aphthous stomatitis)

197
Q

Define Gingivitis

A

Inflammation of the gums

198
Q

4 types of pulse amplitude?

A
  1. thready
  2. weak
  3. strong
  4. bounding

Physical Exam I (8 decks)

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