Exam #4: Lower Extremity Flashcards
Outline the classification of pulses.
0/4= absent 1/4= weakly palpated 2/4= normal 3/4= bounding 4/4= strongest & associated with thrill or bruit
What are bounding pulses associated with?
Fever Aortic insufficiency Complete heart block Thryotoxicosis Systolic HTN
Describe a technique for locating the DP.
1) Ask the patient to extend great toe
2) DP should be between Extensor Tendon of the Great Toe & adjacent tendon
Where is the posterior tibial artery?
Posterior to the medial malleolus
Where is the popliteal pulse?
Lateral 1/2 of the popliteal fossa
What is the normal capillary refill time in the great toe?
3 seconds or less
What are the causes of delayed capillary refill time in the great toe?
vasospasm
structural changes in the large vessels
What is the difference between pitting and non-pitting edema?
Non-pitting= acute Pitting= chronic
What is the criteria for pitting edema?
If indentation lasts more than 5 seconds after pressing in an edematous area for 5 seconds= pitting
What causes pitting edema?
Systemic disease leading to protein rich exudate (CHF)
What causes non-pitting edema?
Systemic disease leading to protein deficient exudate (liver & kidney problems)
Outline the classification scheme for pitting edema.
1+ = 2mm 2+ = 4mm 3+ = 6mm 4+ = 8mm
What is a macule?
Non-palpable skin change less than 0.5 cm
What is a patch?
Non-palpable skin change greater than 0.5 cm
What is a papule?
Palpable solid skin mass that is less than 0.5cm
What is a nodule?
Palpable solid skin mass that is less than 0.5cm
What is a plaque?
Palpable solid skin mass that is greater than 0.5cm
What is a vesicle?
Clear fluid filled skin less than 0.5 cm
What is a bulla?
Clear fluid filled skin greater than 0.5 cm
What is a pustule?
Cloudy pus-filled skin less than 0.5 cm
What is an abscess?
Cloudy pus-filled skin greater than 0.5 cm
What is the difference between a primary and secondary lesion?
Primary= initial changes in skin brought about by disease or process
Secondary= Progressive changes in primary lesion or lesion with external cause
What is a verruca papule?
Wart
What is a paronychia?
A nail disease that is an often-tender bacterial or fungal infection of the hand or foot where the nail and skin meet at the side or the base of a finger or toenail.
What is onychomycosis?
Fungal infection of the toe nail
What is the mnemonic for thick toe nails?
TOE CLYPT
T=trauma O= onchymycosis E= eczema C= circulatory problem L= lichen planus Y= yellow nail syndrome P= psoriasis T= tumor
What are the causes of dry skin?
- Insufficient sweat glands
- Autonomic dysfunction (DM)
- Tinea pedis
- Psoriasis
- Eczema
What is the classification system of muscle testing?
0/5= No muscle movement 1/5= See tendon contract but no movement 2/5= Able to perform movement when gravity is not a factor 3/5= Able to perform the movement against gravity 4/5= Slight decrease in strength 5/5= Normal
Describe the sensory pathway to the brain.
- Receptor
- DRG
- Posterior column or lateral spinothalamic tract
What are the fibers of the spinothalamic tract associated with?
Patient complains of “burning or cramping” pain
- Small fibers
- Sharp & dull pain
- Temp
- Crude touch
What are the fibers of the posterior column associated with?
Patient complains of “pins & needles or electric shock”
- Large fibers
- Position
- Vibration
- Fine touch
What is your diagnosis of a patient cannot discriminate between sharp and dull?
Small fiber disease– spinothalamic tract
*Remember Spinothalamic = Small
What does a lack of temperature sensation suggest?
Small fiber disease–spinothalamic tract
What does a loss of vibration in >10 seconds indicate?
Large fiber disease– posterior column
What does a loss of proprioception indicate?
Large fiber disease– posterior column
Is the absence of an Achilles tendon reflex after 80 years an abnormal finding?
No, this is normal
How are deep tendon reflexes graded?
0/4= hypo-reflexive i.e. lower motor neuron disease 2/4= normal 4/4= hyper-reflexive (upper motor neuron disease, stroke)
What spinal levels innervate the knee jerk reflex?
L2,3,4
What spinal levels innervate the ankle reflex?
S1 & 2
What is the Jendrassie maneuver?
Pulling hands apart while doing reflexes
What is the Babinski response a sign of?
Upper motor neuron disease
What is suggested if a patient is able to stand on tiptoes but not heels?
Peripheral neuropathy
What is suggested if a patient is able to stand on heels but NOT tiptoes?
Spinal lesion
