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