Exam 3 (wks 8-12) Flashcards

Question

# Musculoskeletal System describe osteoporosis

Answer 1

new bone creation (osteoblasts) doesn't keep up with old bone destruction (osteoclasts)

Answer 2

1. long bones 2. vertebrae

Answer 3

decreased estrogen increases bone resorption and decreases calcium deposition, resulting in bone loss and decreased bone density.

Answer 4

1. injury 2. disease of the muscle 3. damage to the motor neuron

Answer 5

pain & immobility --> muscle wasting

Answer 6

* group of genetic disorders involving gradual degeneration of the muscle fibers * musle atrophy, muscle weakness, waddling gait

Answer 7

fasciculation (muscle twitching)

Answer 8

* grating sound/sensation * can be felt when 2 irregular bony surfaces are rubbing together as a joint moves or when 2 rough edges of a broken bone rub together. * if tenosynovitis is present then it could be the tendon rubbing the tendon sheath

Answer 9

* PROM: ask the pt to relax and let you passively move the joints to the end of the ROM, do not force the joint, muscle tone can be assessed * AROM: pt moves their joints individually PROM should be greater than AROM by ~5deg but should be equal bilaterally

Answer 10

1. pain 2. limited ROM 3. spasms 4. joint instability 5. deformity 6. contracture

Answer 11

tool used to precisely measure the angle when a joint appears to have an increase or limitation in its range of motion

Answer 12

* 0: no evidence of movement * 1: trace of movement * 2: full ROM, but not against gravity * 3: full ROM against gravity but not resistance * 4: full ROM against gravity and weak with resistance * 5: full ROM against gravity and full resistance

Answer 13

* exaggerated inward curve of the spine * typically affects lower back/lumbar spine * common in pregnant women

Answer 14

* "hunchback", exaggerated rounding of the back * typically affects the upper back/thoracic spine * common in aging adults

Answer 15

* extreme kyphosis, lookslike individual in folded over * associated w/ collapsed vertebra from osteoporosis

Answer 16

when the shoulder contour is asymmetric and one shoulder has hallows in the rounding contour

Answer 17

anterior serratus muscle nerve damage

Answer 18

observe for a winged scapula, an outward prominence of the scapula, indicating injury to the nerve of the anterior serratus muscle.

Answer 19

5 to 15 deg laterally- the angle between the humerus and radius while the arm is passively extended, palm forward

Answer 20

a lateral angle extending 15 deg

Answer 21

a medial carrying angle- less than 5 deg

Answer 22

may indicate a rheumatoid nodule or gouty tophi

Answer 23

* hard bony overgrowths along the DIPs * associated with osteoarthritis

Answer 24

* hard bony overgrowths along the PIPs * associated w/ osteoarthritis * can cause spindle shape fingers which are associated w/ acute stages of RA

Answer 25

* bending in (flexion) of the base of the finger, a straightening out (extension) of the middle joint, and a bending in (flexion) of the outermost joint * indicates RA

Answer 26

less than 15 deg

Answer 27

* valgum: knees stuck together (knock kneed) * varum: knees don't go together (bow legged)

Answer 28

* varus: toed in * valgus: toed out * pronation: outer edge of heel hits the group first, then foot rolls inward to the arch

Answer 29

* normal: arch in the sagittal plane formed by the calcaneus and the metatarsals; may flatten w/ weight bearing * planus: foot remains flat even when not bearing wt * cavus: foot w/ high instep

Answer 30

* from the ASIS to the medial malleolus of the ankle, crossing the knee on the medial side * from the umbilicus to the medial malleolus if you cannot find the ASIS

Answer 31

* from the acromion process through the olecranon process to the distal ulnar prominence

Answer 32

measured in centimeters at the same distance on each limb from a major landmark

Answer 33

no more than 1 cm bilaterally

Answer 34

* non-flexable * made of connective tissue (collagen) * ex: sutures, homphoses, syndesmoses

Answer 35

* joints that are cushioned by a layer of cartilage that joins the bones together * ex: where ribs meet the sternum

Answer 36

1. hinge joints: knee/elbow 2. ball and socket: shoulder/hip 3. condyloid: wrist/ankle 4. planar: vertebrae 5. saddle: thumb 6. pivot: wrist to the forearm

Answer 37

* MMSE: mini mental status exam, brief, measures orientation, registration, attention, calculation, recall, ability to follow commands, and language * MoCA-B: more broad, has higher sensitivity and specificity

Answer 38

* grooming: assess hygiene, grooming, appropriate * emotional status: should be cooperative and friendly * body language: note posture, eye contact, facial expression

Answer 39

1. depression 2. psych disorder 3. dementia

Answer 40

* Parkinson's * depression

Answer 41

* tension * mania * anxiety * illicit/prescription drug effects * metabolic disorder

Answer 42

* state of consciousness: A&Ox4, GCS * memory: evaluate their responses to hx questions * response to analogies: ask pt to do simple analogies first then more complex * abstract reasoning: ask pt to tell you the meaning of a fable or metaphor * attention span: ask pt to follow short set of commands

Answer 43

* Person disorientation results from cerebral trauma, seizures, or amnesia. * Place disorientation occurs with psychiatric disorders, delirium, and cognitive impairment. * Time disorientation is associated with anxiety, delirium, depression, and cognitive impairment.

Answer 44

- An inability to describe similarities or differences may indicate a lesion of the left or dominant cerebral hemisphere.

Answer 45

This may be related to fatigue, depression, delirium, or toxic or metabolic causes that result in confusion.

Answer 46

* Ask the patient to do simple arithmetic, without paper and pencil * The calculations should be completed with few errors and within 1 minute when the patient has average intelligence. * Impairment of arithmetic skills may be associated with depression, cognitive impairment, and diffuse brain disease.

Answer 47

* mood/feelings * thought processes

Answer 48

* voice quality * articulation * comprehension * coherence (pt's intentions/perceptions) * aphasia (speech disorders)

Answer 49

* speech disorder that can be repetitive (understand language) or expressive (speaking language) * Wernicke's: can talk but don't understand * Broca's: the mouth is broca, can't talk * Global: everything is gone * can result from facial muscle or tongue weakness

Answer 50

* immediate recall: repeat something right after it's said * recent memory: 3-5 words then ask about them again in a few minutes * remote memory: ask about verifiable past events inability to do any is indicative of dementia

Answer 51

* Confusion: Inability to think or reason in a focused, clear manner. * Lethargy: falls asleep without repeated stimulation * Delirium: fluctuating acute confusion * Stupor: requires vigorous and/or painful physical stimulation to be awakene * Coma: not able to be aroused by any stimulus any sort and no response to the environment

Answer 52

* max points = 15; min points= 3 * evaluates eye opening response, verbal response, motor response * best response: 15 pts * comatose pt: 8 pts * totally unresponsive: 3 pts

Answer 53

* spontaneously = 4 * to speech = 3 * to pain = 2 * no response = 1

Answer 54

* A&Ox3 or 4: 5 pts * confused: 4 pts * inappropriate words: 3 pts * incoherent sounds: 2 pts * no response: 1 pt

Answer 55

* obeys commands: 6 pts * moves to localized pain: 5 pts * flexion withdrawal from pain: 4 pts * abnormal flexion (decorticate): 3 pts * abnormal extension (decerebrate): 2 pts * no response: 1

Answer 56

* decorticate: associated w/ injury above brainstem to corticospinal tracts * decerebrate: associated w/ injury to the brainstem * hemiplegia: associated to damage to ICA, MCA, or ACA

Answer 57

* Delirium: impaired cognition, arousal, consciousness, mood, and behavioral dysfx of acute onset * Dementia: A chronic, slowly progressive disorder of failing memory, cognitive impairment, behavioral abnormalities, and personality changes that often begins after age 60 years * Depression: Feelings of sadness, loss, anger, or frustration that interfere with everyday life for an extended period

Answer 58

1. Observe physical appearance and behavior 2. Investigate cognitive abilities 3. Observe speech and language for voice quality, articulation, coherence, and comprehension. 4. Evaluate emotional stability for signs of depression, anxiety, thought content disturbance, and hallucinations.

Answer 59

* score < 20 may be associated with dementia * score > 26 not associated with dementia. * higher education associated with higher MMSE scores, even when dementia present

Answer 60

● Odor Recognition: check patency of nares first; eyes closed; test one nostril at a time using soap, tobacco, vanilla, PB, orange extract, or coffee)

Answer 61

* Visual acuity using Snellen chart and Rosenbaum pocket chart * Visual Fields by confrontation if 6 cardinal fields of gaze * Fundoscopic Exam

Answer 62

* Inspect for unilateral eyelid ptosis * Direct and consensual pupillary response to light * Pupillary near-far accommodation

Answer 63

* Extraocular Muscles (EOMs) * Corneal Light Reflex, bilaterally

Answer 64

* sensory: corneal touch reflex and sharp/dull and soft touch intactness * motor: temporalis and masseter muscle tone

Answer 65

* sensory: labial speech sounds, salty/sweet taste on anterior 2/3 of tongue * motor: facial expression

Answer 66

* cochlear division: whisper, rinne, weber test * vestibular divison: test of balance

Answer 67

* touch sensation * sour/bitter on posterior 1/3 of tongue

Answer 68

* gag reflex * "ahhhhh" * swallowing

Answer 69

* traps, sternocleidomastoid muscle strength

Answer 70

tongue is midline, ROM, strength

Answer 71

* 128: for vibratory sense testing proprioception in posterior column * 512: for cochlear testing

Answer 72

* C3: proximal neck * C6: thumb, index finger * C7: middle finger * C8: ring and pinky finger * T4: Nipple level * T10: umbilicus * T12: inguinal * L4: medial foot * L5: mid dorsum foot * S1: lateral foot

Answer 73

* tactile agnosia * parietal lobe lesion

Answer 74

* arms held out with palms up and with eyes closed * positive if an arm falls down, associated with corticospinal tract dysfunction

Answer 75

* Vibratory sense * Deep Pressure sensation (only is superficial not intact) * Positional sense * Stereognosis * Point Location * 2 Point discrimination

Answer 76

1. observe gait 2. heel toe walking 3. point to point 4. heel knee shin test 5. RAM (UE and LE)

Answer 77

* superficial pain * temperature sensation

Answer 78

* superficial touch * deep pressure

Answer 79

* stereognosis * 2-point discrimination * extinctation phenomenon * graphesthesia (DISTAL ASPECT = TOP OF PAPER)

Answer 80

Evaluates balance. Ask patient to close their eyes and stand feet together with arms at the sides. Positive sign indicated cerebellar ataxia, vestibular dysfunction, or sensory loss

Answer 81

* Biceps - C5 and C6 * Brachioradialis - C5 and C6 * Triceps - C6, C7 and C8 * Patellar - L2, L3, and L4 * Achilles - S1 and S2

Answer 82

* Absent reflexes may indicate neuropathy or LMN * Hyperactive reflexes indicate UMN

Answer 83

* 0 - No response * 1+ Sluggish or diminished * 2+ Active or expected * 3+ More brisk than expected, slightly hyperactive * 4+ Brisk, hyperactive, with intermittent or transient clonus

Answer 84

* abdominal: slight movement expected (diminished in obese, pregnant women, absent on side of corticospinal tract lesion) * cremasteric: should rise * plantar: babinski indicates pyramidal UMN lesion

Answer 85

* Brudzinski - Flex neck and observe for involuntary flexion of hips and knees * Kernig - Flex the leg at the knee & hip when the patient is supine, and then attempt to straighten the leg * Positive Signs - Indicate meningeal irritation

Answer 86

evaluates posterior column of ascending tract and evaluates for LMN disorders

Answer 87

* Tinel's - Tapping nerve causes tingling sensation to radiate through that area → shows signs of damage to the median nerve, present in carpal tunnel * Phalen's - Positive when flexing wrist to 90 degrees for 1 minute causes symptoms in the median nerve section and suggests carpal tunnel

Answer 88

* Uterus receives increased blood flow * uterus and cervix soften * cervix takes on bluish color. * Vaginal wall thickens which increases length. * Vaginal secretions increase and have an acidic pH to prevent bacteria from multiplying.

Answer 89

* Estrogen levels decrease which cause labia and clitoris to become smaller. * Labia Majora becomes flatter and body fat is lost. * Decrease in muscle mass and strength. * Vaginal introitus constricts and the vagina narrows/shortens. * The mucosa becomes thin, pale, and dry. * Cervix becomes smaller and paler. * Uterus decreases in size and endometrium thins out. * Ovaries decrease and follicles gradually disappear.

Answer 90

* Try to find the source of apprehension/discomfort. * Table can be set up with slight elevation of HOB. * Pt arms to side or under SI joints/upper buttocks. * Explain what you are going to do, elicit permission for exam, let Pt know can say “no”, explain next steps as doing, maintain eye contact, show and explain equipment. * Use “neutral touch” on inner thighs to signal you are starting exam/touching (this touch decreases startle for next maneuvers). * Tell them to let you know about discomfort. * Plan ahead for speculum size choices based upon sexual/reproductive history and external female GU exam and prior documentation (if available).

Answer 91

* lithotomy position: stabilize feet in stirrups and slide butt to edge of table * dent drape in between pt's knees to see their face

Answer 92

Gaping or close, dry or moist. Symmetric and either shriveled or full. Tissue should feel soft and homogenous. No swelling, excoriation, rashes, or lesions should be noted.

Answer 93

May appear symmetric or asymmetric, and the inner surface should be moist and dark pink. The tissue should feel soft, homogeneous, and without tenderness. Look for inflammation, irritation, excoriation, or caking of discharge in the tissue folds, which suggests vaginal infection or poor hygiene. Discoloration or tenderness may be the result of traumatic bruising. Ulcers or vesicles may be signs of an STI. Palpate for irregularities or nodules.

Answer 94

Inspect the clitoris for size. Generally, the clitoris is about 2 cm or less in length and 0.5 cm in diameter. Enlargement may be a sign of a masculinizing condition. Observe also for atrophy, inflammation, or adhesions.

Answer 95

Appears as an irregular opening or slit. It may be close to or slightly within the vaginal introitus and is usually in the midline. Inspect for discharge, polyps, caruncles, and fistulas. A caruncle is a bright red polypoid growth that protrudes from the urethral meatus; most urethral caruncles cause no symptoms. Signs of irritation, inflammation, or dilation suggest repeated urinary tract infections or insertion of foreign objects.

Answer 96

Can be a thin vertical slit or a large orifice with irregular edges from hymenal remnants (myrtiform caruncles). The tissue should be moist. Look for swelling, discoloration, discharge, lesions, fistulas, or fissures.

Answer 97

If a discharge occurs, note its color, consistency, and odor, and obtain a culture. Discharge from the Skene glands or urethra usually indicates an infection—most commonly, but not necessarily, gonococcal. Note any swelling, tenderness, masses, heat, or fluctuation. Swelling that is painful, hot to the touch, and fluctuant is indicative of infection of the Bartholin gland. The infection is usually gonococcal or staphylococcal in origin and is filled with pus. A nontender mass is indicative of a Bartholin cyst, which is the result of chronic inflammation of the gland.

Answer 98

Should be smooth; episiotomy scarring may be evident in patients who have borne children. The tissue will feel thick and smooth in the nulliparous patient. It will be thinner and rigid in multiparous patients. In either case, it should not be tender. Look for inflammation, fistulas, lesions, or growths.

Answer 99

More darkly pigmented, and the skin may appear coarse. It should be free of scarring, lesions, inflammation, fissures, lumps, skin tags, or excoriation.

Answer 100

* warm water (NOT GEL) * gel can obscure cellular element and interfere w/ specimen analysis and interpretation

Answer 101

* The cervix should be located in the midline. * Deviation to the right or left may indicate a pelvic mass, uterine adhesions, or pregnancy. * The cervix may protrude 1 to 3 cm into the vagina. * Projection greater than 3 cm may indicate a pelvic or uterine mass. * The cervix of a patient of childbearing age is usually 2 to 3 cm in diameter.

Answer 102

* nulliparous: size is 5.5 to 8cm long, 3.5 to 4 cm wide, 2 to 2.5 cm thick; approx 40 to 50 g * parous: larger by 2 to 3 cm in any dimension.

Answer 103

* Collect specimens as indicated for Pap smear, HPV testing, sexually transmitted infection screening, and wet mount. * Be sure to follow Standard Precautions for the safe collection of human secretions. * Label the specimen with the patient's name, date, and a description of the specimen (e.g., cervical smear, vaginal smear, culture). (LMP)

Answer 104

* Obtain a specimen of vaginal discharge using a swab. * Smear the sample on a glass slide and add a drop of normal saline. * Place a coverslip on the slide, and view under the microscope. * The presence of trichomonads indicates T. vaginalis. * The presence of bacteria-filled epithelial cells (clue cells) indicates bacterial vaginosis. * On a separate glass slide, place a specimen of vaginal discharge, apply a drop of aqueous 10% KOH, and put a coverslip in place. * The presence of a fishy odor (the “whiff test”) suggests bacterial vaginosis. * The KOH dissolves epithelial cells and debris and facilitates visualization of the mycelia of a fungus. * View under the microscope for the presence of mycelial fragments, hyphae, and budding yeast cells, which indicate candidiasis.

Answer 105

* Immediately after the Pap smear is obtained, introduce a sterile cotton swab into the vagina and insert it into the cervix * Hold it in place for 10 to 30 seconds. * Withdraw the swab and spread the specimen in a large Z pattern over the culture medium, rotating the swab at the same time. * Label the tube or plate, and follow agency routine for transporting and maintaining appropriate temperature of the specimen of the specimen.

Answer 106

* Use a Dacron swab (with plastic or wire shaft) when collecting your specimen, as wooden cotton-tipped applicators may interfere with the test results. * Insert the swab into the cervical os and rotate the swab in the endocervical canal for 30 seconds to ensure adequate sampling and absorption by the swab. * Avoid contact with the vaginal mucous membranes, which would contaminate the specimen. * Remove the swab and place it in the tube containing the specimen reagent.

Answer 107

anteverted (straight up toward belly) or anteflexed (curved up toward belly)

Answer 108

* retroverted: straight down * retroflex: curved toward anus * midposition: straight back

Answer 109

* ovaries: firm, smooth, ovoid, 3x2x1 cm in size; moderately tender on palpation * adnexal: hard to palpate (location, position, fat tissue)

Answer 110

* Structures Assessed - Vaginal walls, cervix, uterus, ovaries and adnexal areas * Normal findings - Cervix smooth, firm, mobile. No cervical motion tenderness. Uterus midline, anteverted, firm, smooth, and nontender; not enlarged. Ovaries not palpable. No adnexal tenderness. * Abnormal - Tenderness, nodules, irregularities, enlargements, motion tenderness

Answer 111

* medical concerns: evidence of abuse/neglect, trauma in sensitive regions, unusual skin color in sensitive areas, STI, itching/bleeding/pain, rashes/sores. * behavior concerns: problems with school, weight changes, depression, anxiety, sleep problems increased aggression * sexual behaviors: provocative mannerisms, inappropriate sexual knowledge

Answer 112

* Hydrocolpos - Distention of the vagina caused by accumulation of fluid due to congenital vaginal obstruction * Vulvovaginitis - Inflammation of vulvar and vaginal tissues * Atrophic vaginitis - Inflammation of the vagina due to the thinning and shrinking of the tissues, as well as decreased lubrication

Answer 113

* Phimosis: the foreskin is tight and cannot be retracted * Paraphimosis: the inability to replace the foreskin to its usual position after it has been retracted behind the glans * Epispadias: rare birth defect at the opening of the urethra where the urethra does not develop into a full tub, and the urine exits the body from an abnormal location. Causes are unknown. * Hypospadias: congenital defect in which the urethral meatus is located on the ventral surface of the glans penile shaft or the base of the penis * Balanitis: inflammation of the glans (head) of the penis; occurs most often in uncircumcised males * Balanoposthitis: inflammation that affects both the glans penis and prepuce. * Smegma: thick, white, cheesy substances that collects under the foreskin of the penis

Answer 114

Separation of the prepuce from the glans normally occurs around ages 3 to 4 years in uncircumcised children. If the foreskin is forcibly retracted, it can get permanently stuck behind the glands.

Answer 115

* The scrotum usually appears asymmetric because one testes tends to develop faster than the other. * The right seems to develop more quickly than on the left and the one on the left hangs lower

Answer 116

* Incarcerated Hernia: a mass that neither changes in size nor transilluminates and trapped in the intestine or abdominal tissue * Strangulated Hernia: the blood supply to the protruded tissue is compromised; nonreducible → prompt surgical intervention

Answer 117

* most common * pts usually young males * hernia in the internal inguinal ring * may pass into the scrotum * expect soft swelling in area of internal ring, touches fingertip on examination

Answer 118

* males > females; 40 y/o * through external inguinal ring, located in Hesselbach's triangle (rarely enters scrotum) * bulge in area of Hesselbach's triangle, usually painless, easily reduced, bulges anteriorly, pushes against side of finger on examination

Answer 119

* least common * females * through femoral ring, femoral canal, fossa ovalis * R sided presentation more common L; pain is severe; inguinal canal empty on exam

Answer 120

* located on posterolateral surface of the testis * should be smooth, discrete, larger cephalic, non-tender

Answer 121

* has accompanying arteries and veins, but cannot be precisely identified by palpation * smooth and discrete (if bumpy = DM)

Answer 122

* stroke inner thigh with a blunt instrument such as the handle of the reflex hammer or for a child, your finger. * the testicle and scrotum should rise on the stroked side

Answer 123

usually associated with other GU anomalies or ambiguous genitalia

Answer 124

* hormonal: can give hCG * surgery: orchidopexy (frees testicle from restrictive tissues) or testicular auto-transplant (indicated when testicle is located very high in the abdomen)

Answer 125

* if a bright penlight transilluminates the mass and there is no change in size when reduction is attempted, it most likely contains fluid (hydrocele w/ a closed tunica vaginalis) * a mass that does not transilluminate but does change in size when reduction is attempted is probably a hernia

Answer 126

appearing neither clearly male or female

Answer 127

* seminomas and non-seminomas arise from germ cells * non-germ cell tumors arise from supportive and hormone-producing tissue

Answer 128

associated with HPV 16 and 18

Answer 129

* screening * prostate exams * colonoscopies * DRE

Answer 130

* The anal canal is normally kept securely closed by concentric rings of muscle, the internal and external sphincters. * The internal ring of smooth muscle is under involuntary autonomic control. The urge to defecate occurs when the rectum fills with feces, which causes reflexive stimulation that relaxes the internal sphincter. * Defecation is controlled by the striated external sphincter, which is under voluntary control. * The lower half of the canal is supplied with somatic sensory nerves, making it sensitive to painful stimuli, whereas (the upper half is under autonomic control and is relatively insensitive.) * Therefore conditions of the lower anus may cause pain, whereas those of the upper anus will usually not.

Answer 131

* large chestnut * 4x3x2 cm * diameter is 4cm

Answer 132

* knee chest * Lithotomy * L lateral w/ hips & knees flexed * standing w/ hips flexed and upper body supported by examining table

Answer 133

* Anal lesions can be documented as if looking at the face of a clock or by dividing the perianal area into (4) anatomic quadrants: right anterior, right posterior, left anterior, left posterior.

Answer 134

Rectal pain is almost always indicative of a local disease. Look for irritation, rock-hard constipation, rectal fissures, fluctuance from a perianal abscess, or thrombosed hemorrhoids. Always inquire about previous episodes of pain.

Answer 135

* classified by amout of protrustion into the rectum * Grade I: 1-2 cm * Grade II: 2-3 cm * Grade III: 3-4 cm * Grade IV: 4+ cm

Answer 136

* hard, irregular nodule * asymmetric * median sulcus may be obliterated

Answer 137

* smooth, rubbery, symmetric, enlarged * +/- median sulcus

Answer 138

rubbery or boggy consistency

Answer 139

* enlarged, acutely tender, asymmetric * abscess may develop and feels like a fluctuant mass

Answer 140

Hard, nodular lesions felt at the anterior rectal wall. Because the anterior rectal wall is in contact w/ the peritoneum, you may be able to detect the tenderness of peritoneal inflammation and nodularity of peritoneal metastases.

Answer 141

* tan/gray: obstructive jaundice * black: upper intestinal bleed * pencil: spasmodic contraction in rectal area (intermittent); permantnet stenosis from scarring/pressure from malignancy (persistent) * ribbon: rectal cancer * mucoid: intestinal inflammation and mucous colitis; bloodstained mucus in liquid feces (amebiasis) * fatty: pancreatic disorders or malabsorption syndromes

Answer 142

Rectal exam to obtain fecal sample on finger that can then be tested for occult blood using a chemical guaiac procedure.

Answer 143

Lack of contraction may indicate a lower spinal cord lesion or chronic abuse.