Exam 5 Flashcards
Dysphasia
- impairment of speech resulting from brain lesion
Pulsating LN think….
- Artery. LNs don’t pulsate ☺
What is tenosynovitis?
- Inflammation of sheath of a tendon
What are necessary observations during history with elderly patient?
- Interaction with spouse, family or caregiver - Eye contact - Facial expressions - How clothes are fitting - Hygiene - Voice (depression or disjointed)
Weakness of muscle may be suggestive of what?
- Neurological, myopathy, tendinopathy, muscle injury
In assessing DVT, which sign has higher sensitivity and specificity
- Calf diameter is more sensitive and specific than Homan’s sign (pain with dorsiflexion)
Golfer’s vs Tennis elbow. How to test for them?
- Lateral epicondylitis: tennis elbow – Cozen’s and Maudsley’s test - Medial epicondylitis: golfer’s elbow - Cozen’s: pronation for FA with resisted wrist extension and radial deviation to determine if pain occurs. - Maudsley’s (3rd finger test): resist extension of 3rd PIP stresses ECRB and pain reproduced over lateral epicondyle.
Test for subscapular muscle strength
- Subscapularis lift off (aka Gerber’s)
What does an echo show?
- Aortic valve
Non-fluent aphasia (Broca’s/expressive)
- cannot express oneself using language, few words, laborious effort, uses primarily nouns/verbs – fair to good comprehension - Lesion in frontal lobe
Tongue will protrude in what direction with peripheral lesion? Central lesion? What CN?
- CN XII - Peripheral: ipsilateral - Central: contralateral
What are ways that hinder a good relationship with your patient?
- keep them waiting, no explanation - be in hurry, talk with one foot out of door - belittle their concerns and emotional responses - ignore their life stresses
Most common reason for conductive hearing loss in elderly
- Cerumen impaction
What is nml JVD? What does increase mean?
- 4 cm - Meaning if increased: increase LVEDV, low LV ejection fraction, right heard CHF, constrictive pericarditis, tricuspid stenosis or SVC obstruction.
Test for inversion ankle injuries
- Squeeze test: high ankle sprain/syndesmotic sprain/fracture - External rotation test: syndesmotic injury
What is utility for carotid sinus massage?
- SVT
What is graphesthesia? In what part of spinal cord is this carried?
- Ability to identify number / letter drawn in one’s hand when eyes are closed - Carried in posterior column
What is normal monofilament testing of foot?
- 7/10 sites identified
When is it typical for mother to perceive pregnancy?
- 18-20 weeks
How to examine hips in newborns?
- ) Barlow’s maneuver: grasp leg with thumb on inside of thigh, base of thumb on knee and your fingers gripping outer thigh with fingertips resting on greater trochanter. Adduct thigh and gently apply downward pressure on femur in an attempt to disengage the femoral head from acetabulum. Pos = clunk when femoral head exits acetabulum.
- ) Ortolani’s maneuver: slowly abduct thigh while maintaining axial pressure. With fingertips on greater trochanter, exert a lever movement in opposite direction so that fingertips press head of femur back toward acetabulum center. Pos = femur back into acetabulum with clunk.
- ) Allis sign: infant supine on table flex both knees, keeping feet flat on table and femurs aligned with each other. Position yourself at child’s feet and observe height on knees. Pos = one knee appears lower than the other – short femur or dislocation.
Types of histories
1.) Comprehensive: new pt, yearly physical, preop physical, hospitalized pt 2.) Problem-oriented/focused: typical office progress note, sick visit, problem acute, life-threatening problem, requiring immed attn with need given full attn.
Format of oral presentation
- Give enough of S and O to support A. P should be backed up with necessary information from A. - Brief but include important info - Doesn’t include everything
Relationship bw fundal height and weeks of gestation
- Weeks of gestation = cm from symphysis pubis to top of fundus +/- 2 cm - Fundal height measured at each prenatal visit after 20 weeks
UE MSK exam nerve roots
- C5: elbow flexors - C6: wrist extensors - C7: elbow extensors - C8: long finger flexors - T1: small finger abductor
How to assess tone in newborn baby?
1.) Grab infants arm or leg and pull toward you. Assess flexion that occurs after. 2.) Pull baby up towards you by both arms and see what tone is present, what does head to. 3.) Ventral suspension 4.) Vertical suspension: hold baby upright with two hands around chest
What are the bare minimum ADLs to assess in elderly patient that if not met will likely mean they need assistance?
- Bathing, dressing, toileting, transferring, continence, feeding
How to assess LE lymph flow?
- Hemosiderin staining - Chronic skin changes - Pitting edema (grade 1-4)
Describe skin changes in elderly patient
- Thinning, loss of elastic tissue, turgor, signs of cancer, ulcerations
How to test CN VII?
- tightly close eyes, purse lips against resistance, puff out cheeks, resist tapping, grimace, smile and wrinkle forehead
Which CNs control the gag reflex?
- Afferent limb of gag reflex = CN IX *increases risk for aspiration pneumonia - Efferent limb of gag reflex = CN X
Biceps tendon testing
- Speeds test: attempt to flex arm while supinated against physician’s force - Yergason’s test: pts arm flexed at 90 degrees in supination, physician’s thumb over proximal bicipital groove and attempting to pronate and externally rotate while patient resists. Pain elicited with biceps tendionopathy/subluxation.
Patellar, medial hamstring and Achilles reflex are testing what nerve roots respectively
- L4: patellar – L3-4 per O’Shea - L5: medial hamstring - S1: Achilles
Tests for ACL and PCL of knee
- ACL: anterior drawer, Lachman - PCL: posterior drawer
What does a coronary angiogram show?
- Coronary arteries
What is tendinosis vs tendonitis?
- Tendinosis: degeneration of tendon - Tendinitis: inflammation of tendon
Order of musculoskeletal (MSK) exam
- First = prelim neurological screening exam - Inspection - ROM (active then passive) - Muscle strength eval - Reflexes and other neuro evals - Special tests - Palpation (used to confirm what you suspect)
What is superficial thrombophlebitis? What does this look like? In what veins are these found?
- Thrombophlebitis = venous inflammation with thrombus formation - Linear moving erythema that is palpable - Found in superficial veins, can move deep.
Rotator cuff testing
- Arm drop: patient to bring arm up above head and slowly lower to 90, cannot hold at 90 and arm drops - tests for large rotator cuff tear - Empty can (Job aka supraspinatus): internally rotate arm, raise arm and physician tries to push arm down - Lift off (subscapularis): arm behind back palm away from back, press into physician’s hand
Tests for LCL/MCL
- Valgus (MCL) and varus (LCL) stress Apley’s distraction
Tuning fork to determine vibratory sense detection
- 128 or 256 Hz
Special tests for CTS?
- Phalen’s: P for pressure, apply pressure to flexed wrist, symptoms occur in less than 30 seconds with paresthesias in median n distribution - Tinel’s: T for tapping, tap over carpal tunnel (base of thumb), reproduces paresthesias in median n distribution
Allen’s test
- Occlusion of both radial and ulnar arteries, having pt clench hands, release ulnar to verify flow. Repeat and release radial. - Used prior to arterial blood stick. - Nml = reperfusion within 3-5 seconds after release. If reperfusion doesn’t occur within 3-5 seconds, insufficiency of the artery occluded should be suspected.
What is the meaning of G, P, T, P, A, L
- Gravida: number of pregnancies - Parity: number of pregnancies with birth beyond 20 wks - T: number of term pregnancies - P: number of preterm - A: number of abortions/miscarriages/ectopic pregs - L: number of living children
Classic features seen in RA
- Swan neck deformities, Boutonniere deformities, ulnar deviation of fingers, subcut nodules
Specific cancer to ask about during history with elderly patient
- Colon cancer
What immunizations is it important to assess in pregnant pt?
- Influenza, tet, hep, MMR, varicella
Temporal arteritis
- inflammatory disease of vessels primary of those in head, typically affects superficial temporal arteries
What is the thumb 1st CMC grind test?
- Pushing/twisting thumb metacarpal at trapezium with pain/grinding. Seen in osteoarthritis.
When assessing nervous system in elderly, what is important to distinguish?
- Delirium vs depression
What are things to look for at first OB visit?
- Gen physical with focus on pelvic exam: height/weight, uterine size/shape, pelvis size/shape, BP baseline
What are the muscles that move the eyes, in what directions?
picture
What is Trendelenburg’s test?
- Used to assess for venous incompetence and can be used to locate incompetent valves in saphenous and communicating veins. - Pt supine, raise leg above level of heart until veins are emptied and collapsed. Apply pressure on medial aspect of thigh about 5 cm caudal to femoral pulse tightly enough to occlude the superficial veins but not deeper. Have pt stand while maintaining pressure, observe refilling of veins. Release pressure about 20 seconds after they stand. Nml = slow refill below area of pressure less than 1 minute after pt stands, but before pressure removed. Abnml = sudden refilling is noted before removal of pressure in communicating vein. Abnl in saphenous vein when sudden additional refilling takes place following removal of pressure.
How to test for ulnar entrapment neuropathy?
- Tinel sign at elbow in ulnar groove (b/w medial epicondyle and olecranon). Reproduces shooting pain/paresthesias in ulnar distribution. This is cubital tunnel syndrome.
What is Patrick’s (FABER) test used for? How is it done?
- Test for SI joint vs hip joint pathology - Figure 4 setup as in treating inflared innominate. Exaggerate the motions at each hand. If pain in lateral and inguinal area, it is likely hip. If posterior, then SI joint issue.
Myelopathy
- any pathological condition of spinal cord
Palpable superficial lymph nodes
- Occipital - Pre-auricular - Post-auricular - Pre/Post-cervical - Superficial cervical - Supraclavicular - Tonsilar - Submandibular - Submental - Subclavian - Axillary - Pectoral - Popliteal - Inguinal
Clonus
- rapidly alternating involuntary contraction and relaxation of skeletal muscles
Describe CN XII indirect exam in newborn and infact
- Pinch infant’s nose, mouth will open and tip of tongue with rise in midline position
Spurling’s test
- Test for nerve root compression (ie. cervical radiculopathy) - Extend neck back and toward side of pain and push down to decrease foramen side. Positive if radicular pain reproduced. - Opposite of this test is distraction, symptoms are lessened or relieved.
Which CN(s) does taste to the anterior and posterior parts of the tongue?
- CN VII: taste to anterior 2/3rd via chorda tympani - CN IX: taste to posterior 1/3rd
Biceps brachii, brachioradialis and triceps reflex are testing what nerve roots respectively
- Biceps brachii: C5 – C5-6 per O’Shea - Brachioradialis: C6 – C5-6 per O’Shea - Triceps: C7 – C6-7 per O’Shea
Ballottement test
- Intra-articular joint effusion of knee
Fluent aphasia (Wernicke’s/receptive)
- fluent effortless speech. Words are malformed may be totally incomprehensible. Can hear words but cannot relate them to previous eperiences. - Lesion in temporal gyrus
Test for supraspinatus muscle strength
- Empty can or Jobe’s test
Myoclonus
- twitching or colonic spams of muscle or groups of muscles
What vital signs are important to pay attention for in elderly patient?
- Isolated systolic HTN, widened PP, orthostatic HoTN, apical HR, RR, temp, o2 sat, weight and BMI
Name and describe primitive reflexes done on every baby
- Suck reflex: gloved finger in babies mouth and see if sucks. Also by observing a feeding or report of good feeding 2. Plantar/palmar grasp: finger in middle of hand and assess for a grasp, finger touch to sole of foot 3. Moro reflex: releasing arms after pull test OR allowing baby to fall backwards into arm – baby should reach out and grab air
What CN is tested with Dix-Hallpike maneuver?
- CN VIII - Pt taken from upright to supine and further c/o hearing loss and / or dizziness
Common changes in eldery
- Vital signs: systolic HTN with widened PP – concern for orthostatic HoTN - HR decline - A/V ectopy – lead to syncope - Temp – susceptible to hypothermia - Eyes – lens loses elasticity, difficulty with accommodation and near focus, cataracts, glaucoma, macular degeneration - Presbycusis - Descrease salivary secretions, decreased sense of taste, decreased olfaction - Capacity for exercise decreases, chest wall stiffens, resp muscle weakness, increased risk for atelectasis and pneumonia (particularly after immobility), kyphosis - Systolic bruits in neck vessels - Loss of atrial kick d/t diastolic dysfunction - S3 = heart failure - S4 = normal or impaired ventricular filling - Systolic aortic murmur - Aortic stenosis - Mitral regurg - Abdominal aortic aneurysm - Temporal arteritis - Blunting manifestations of acute abdominal dz - Menopause - BPH - Loss of lean body mass and strength - Decrease in mental status, motor and sensory function
What is Dupuytren’s contracture?
- Fibrous contraction of palmar fascia with flexion contraction of MCP and PIP joints - Non-painful. Unable to extend finger actively or passively.
What are the physical skills milestones for a toddler (1-3 yrs old)?
- Walks alone - Pulls toys behind when walking - Begins to run - Stands on tiptoe - Kicks a ball
Hyperacusis could be issue with what CN?
- peripheral CN VII palsy
Fetal positions/lie
- Longitudinal: breech (buttocks) or cephalic - Oblique - Transverse
Define claudication
- pain resulting from muscle ischemia presenting with dull ache, muscle fatigue and cramps
Snuffbox tenderness may indicate what is fractured
- Scaphoid d/t FOOSH injury
Affect
- person’s external expression of his/her inner emotional state
In what direction does motor maturation in older child proceed?
- Cephalocaudal progression: head and neck first followed by trunk
Tests for meningeal signs
- Nuchal rigidity: inability to flex neck - Brudzinski’s: pt supine, passive flexion of neck causes involuntary flexion of hips - Kernig’s: pt supine, hip and knee flexed; attempt to passive extend the knee is painful and cannot be done
Classic features seen in osteoarthritis
- Bouchard nodes (PIP) - Heberden nodes (DIP)
What is stereognosis? In what part of spinal cord is this carried?
- Ability to correctly identify familiar solid object in hand based on touch and manipulation alone - Abnormal = tactile agnosia (parietal lobe or posterior column issue) - Carried in posterior column
Is Romberg test a cerebellar function test?
- Test of proprioception not cerebellar function. If proprioceptive issue, one relies on eyes to determine where things are. - If cerebellar dysfunction, pt can’t stand on 2 feet even with eyes open
picture
- a: rebound from right atrial systole - c: expansion of underlying carotid artery - V: filling of right atrium from systemic veins while tricuspid closes Note: prominent a = increased resistance to right atrial contraction in tricuspid stenosis, also in 1st degree AV block, SVT, junctional rhythms, pulmonary HTN and pulmonic stenosis. Absent a in afib. Large v waves in tricuspid regurg and constrictive pericarditis.
What is Thomas’ sign used for?
- Looking for hip flexor tightness or contractures - Hyperflexion of hip causes flexion at contralateral hip
Strain vs sprain
- Strain is trauma to muscle - Sprain is trauma to ligament
Define hum
- non-pathologic venous phenomenon commonly found in children
Describe drainage of lymphatics back into the venous system
- Left and right trunks of subclavian veins accept drainage of lymphatics.
Tremor or spasm symptoms of MSK system may be indicative of what?
- Neurologic or muscle injury
Slow enlargement of LNs over weeks or months think…
- Benign CA
Agraphia
- loss of ability to express oneself in writing
Joint locking or crepitus symptoms at joint may be suggestive of what?
- Meniscal injury
How to test for radial and ulnar collateral ligament instability?
- Varus stress: radial collateral - Valgus stress: ulnar collateral • With these add 20 degree of flexion at elbow
Baseball finger
- Aka Mallet finger - Avulsion of extensor tendon at DIP. DIP is flexed and unable to extend.
Rating scales for LOC
- AVPU: alert, responds to visual, responds to pain/physical, unresponsive - GCS: Glasgow Coma Scale (eye opening, best motor response, best verbal response – lowest = 3) Eye: spontaneous, to speech, to pain, no response Motor: obeys verbal command, localizes pain, flexion (withdraws from pain), flexion (abnml), extension, no response Verbal: oriented and converses, disoriented and converses, inappropriates words, incomprehensible sounds, no response
Enlarged left sided supraclavicular LN think…
- thoracic or abdominal malignancy
What is Gower’s sign and what it is indicative of?
- Moving from sitting to upright position using both arms and then walking to upright position using legs. Sign for LE weakness, classic for muscular dystrophy.
How are pregnancies dated?
- Naegele’s rule: substract 3 months from first day of LMP and add 7 days - PEX to check uterine size - Ultrasound at 1st prenatal visit (accurate to within 5 days if crown-rump length measured in first 7 weeks of pregnancy). Accuracy inverse prop to length of gestation.
How to assess for varicose veins?
- Stand on toes 10 times in succession, observe if increased pressure in veins disappear.
Give-way symptoms of joint may be suggestive of what?
- Ligamentous or meniscal injury
When woman presents with early pregnancy, what are two Qs to ask yourself?
1.) Where is pregnancy? 2.) Is it viable?
Reflex exam scaling
- 0 through 4 - 0 = absent - 1 = reduced (hypoactive) - 2 = normal - 3 = increased (hyperactive) - 4 = clonus
What changes to CV physiology are seen in pregnant patient?
- Increase blood volume: plasma volume up by 30%, RBC volume increases 20% - CO increases 30-50% - Systemic vascular resistance decreases under progesterone – this facilitates circulation to pelvis
Patient arrives in labor. What are important history Qs? Physical determinations?
- History: onset of contractions (+ frequency), fluid (bleeding, amniotic, meconium), fetal activity – other symptoms such as BP, NV help to determine BP status - PEX: pertinent such as assessing cervical status (effacement, dilation), presentation (Leopold maneuvers, vaginal exam to determine vertex presentation), fetal assessment etc.
Dysesthesia
- sensations (pins/needles/crawling)
What does edema of the LE indicate?
- venous insufficiency, thrombosis, DVT, lymphedema
What is labor curve?
- Way to determine if length of patient’s labor is corresponding to what is expected for cervical dilation/effacement.
Aphasia
- inability to express oneself properly through speech or loss of verbal comprehension
Depression evaluation
- SIGECAPS - Sleep, interest, guilty, energy, concentration, appetite, psychomotor, suicidal
Reflex signs of frontal lobe pathology
- Primitive reflexes (frontal release signs): grasp, root, snout, palmomental
What is ankylosing spondylitis?
- Chronic inflammatory dz of spine and SI joints where fusion can start to occur. Sometimes referred to as bamboo spine
What is trigger finger?
- Direct/repetitive trauma to flexor tendons. Difficulty flexing until sudden snap on finger into full flexion with inability to extend
LE MSK exam nerve roots
- L2: hip flexors - L3: knee extensors - L4: ankle dorsiflexion - L5: long toe extensors - S1: ankle plantarflexion
Dementia
- loss of memory and other intellectual functions that is of sufficient severity to interfere with daily function. Irrecoverable deteriorative mental state.
Dysarthria
- defective articulation secondary to motor deficit involving lips tongue palate….
How to determine pregnancy viability and location?
- Dates - Doppler for FHTs - Beta-HCG - US: r/o ectopic
Distinguish between peripheral VII facial weakness and central VII facial weakness
- peripheral: unable to wrinkle forehead, eyelid droops very slightly, cannot show teeth on affected side in attempt to smile and lower lip droops slightly - central: incomplete smile with subtle flattening of affected nasolabial fold, relative preservation of brow and forehead movement
Tests for ankle instability
- Anterior drawer test (also for anterior talofibular tear) - Talar tilt (inversion stress): also for anterior talofibular and calcaneofibular tears
Tests used to check for sciatica
- Straight leg raise (Laseque’s): raise hip to 90 degrees - Confirmatory SLR (aka Bragard’s/Lasegue’s sign): when SLR is positive, limb lowered just until pain is relieved then ankle is dorsiflexed.
Shoulder impingement testing
- Neer’s sign: pronate arm, flex shoulder - Hawkins test: flex shoulder, flex elbow, internally rotate
Describe CN V indirect exam in newborn and infant
- Rooting reflex: touch corner of mouth, should open and turn its head in direct of stimulation. If infant has been recently fed, minimal or no response is expected. - Sucking reflex: place your finger in infant’s mouth feeling sucking, tongue should push up against your finger with good strength
What are examples of conditions/syndromes that can be modified or prevented to maintain functional status in elderly?
- Falls, incontinence, low BMI, dizziness, impaired vision/hearing, cognitive impairment
Describe muscle strength grading
0: no movement 1: trace 2: full ROM with elimination of gravity 3: full ROM against gravity but not resistance 4: full ROM against gravity and with some resistance, but weak 5: full ROM against gravity, full strength
Which spinal columns and what functions are dimished with syphilis and B12 deficiency?
- Dorsal columns. Issue with vibration and joint position sense.
Test for shoulder dislocation
- Apprehension test: shoulder at 90 degrees, elbow at 90 flexion. Physician attempts to externally rotate arm while abducting shoulder. Look for signs of pain.
Differentiate bw smooth vs breakaway weakness
- Smooth: neurologic weakness - Break-away: more likely MSK issue (tendon, muscle etc.) – hurts to resist or I can’t
Common physical changes in pregnant pt
- NV, dehydration, constipation - Constipation - Reflux - Hemorrhoids - Pica - Varicose veins - Urinary frequency - SOB - Breast changes - Late changes: contractions, edema, excessive weight gain, skin rashes/pigmentation (chloasma, spider angiomas), MSK changes (lordosis, softer ligaments), CTS
Gibbus
- sharp, angular deformity associated with collapsed vertebra d/t osteoporosis
4 C’s of communication with pt
- Courtesy, comfort, connection, confirmation
Differential diagnosis if one of the newborn baby’s arm is not flexed?
- Clavicle fracture: palpate clavicle while moving arm - Brachial plexus injury: decreased tone. Consider especially if delivery complicated by shoulder dystocia.
How is cerebellar testing completed?
- Minimum of one test from each of the following areas: 1.) Rapidly alternating movements: finger-thumb / palm-up down 2.) Accuracy of upper and lower extremity movements: finger nose, finger nose finger, heel-shin 3.) Assessment of balance: observe walk of pt while entering exam room or move from chair to exam table 4.) Gait and stance: stance (concern if wide), tandem gait, ability to walk on heels/toes, pronator drift (lesion of corticospinal tract and proprioception)
Describe CN VIII indirect exam in newborn and infact
- Acoustic blink reflex: loudly clap hands about 30 cm form infant’s head - Moves eyes in direction of sound - Doll’s eye maneuver: hold infant under axilla in upright position with head steady. Rotate infant first in one direction and again in other to see if eyes move.
What are you assessing in feet of newborn?
1.) Clubfoot (talipes equinovarus): in turning at hind and mid foot 2.) Metatarsus adductus: in turning at mid foot
Should a musculoskeletal exam be completed in the absence of a neurological exam?
- No, a neurological exam is a prerequisite
Clicking, popping or tearing of MSK system is indicative of what injury?
- Tear or soft tissue injury
What is Ober’s test used for?
- Test for IT band tightness or TFL tightness
What is the name of the full mini-mental status exam?
- Folstein’s
Tender LN think…
- inflammatory
What are abnormal states of LOC?
- Confusion - Lethargy: not entirely the same as sleepiness - Obtunded: can wake the pt up, then they fall back to sleep - Stupor - Coma
What is Trendelenburg sign?
- Pelvis sags downwards on unaffected side
Quick shoulder ROM test
- Apley scratch test
Marcus-Gunn pupil
- Continued pupillary dilation instead of constriction in eye with pre-chiasmatic lesion (eg. optic neuritis) in response to light in damaged eye after first shining it in nml eye
What things to check on pregnant pts history?
- Current complaints - Chronic illnesses - Diet (NB) - Prior surgery (esp previous c-s) - Current meds - Past gynecologic hx (menses, STDs, pap results, infertility) - Past ob hx (deliveries, c-s, complications such as shoulder dystocia, hemorrhage, breech, PE/E) - FHx of inherited disorders, birth defects) – include fathers - SocHx: drug, etoh, smoking, sexual abuse, partner involvement
Crackles vs consolidation of lungs upon auscultation
- Crackles: fluid leaking out of circulation - Consolidation: lymphatic overload
What do reactive/large lymph nodes indicate?
- Cancer, infection (+/- lymphangitis)
Describe indirect CN II, III, IV and VI exam in newborn and infant
- Shine light at infant’s open eyes, observe quick closure of the eyes and dorsal flexion of the infant’s head. - Intense gazing at close object or face - Focuses on and tracks an object with both eyes - Doll’s eye maneuver
Define Raynaud phenomenon
- vascular disorder resulting in exaggerated spasms of arterioles in response to cold
Tests for knee meniscal injury
- McMurray’s tests both medial and lateral meniscus (mnemonic: whichever way the heel is pointing is the menisci that is being tested – ie. heel to lateral aspect = lateral menisci is being tested). - Apley’s compression (not distraction)
What does warmth vs coldness of LE indicate?
- Warmth: superficial thrombophlebitis or infection - Coldness: Arterial occlusion, arterial insufficiency – with pallor
Lab studies to order in pregnant pt
- Dependent on risk - Genetic screening - STD - Cervical cytology (after age 21): not done if younger even if pregnant - Blood group - Urine culture
Shotty LNs
- small non-tender nodes that feel like BBs
What is praxis?
- Knowing how to use object
Antalgic
- behavior used to limit pain
Akathisia
- inability to sit down b/c the thought of doing so causes severe anxiety
Goals of history with pregnant pt
- Risk assessment - Dating of pregnancy: determine fetal growth, correct labor time - Specific to GA
Matted LNs
- group of nodes that feel connected and appear to move as unit
Peripheral CN XI lesion clinically presents how? Central lesion?
- Peripheral: ipsilateral trap and SCM weakness - Central: ipsilateral trap and contralateral SCM ???? what?
Test for sciatic nerve irritation vs hamstring/SI pain
- SLR and confirmatory SLR
Dyskinesia
- defect in voluntary movement
At what position should the newborn baby’s limbs be?
- Flexed
What is the mini-cog test?
- Give 3 words, ask pt to repeat immediately and recall later in exam - Also ask to draw clock-face
Define phlebitis
- inflammation of a vein
Rapid enlargement and no signs of inflammation of lymph nodes think…
- malignancy
Osteomyelitis
- infection of the bone
Special test for de Quervain’s tenosynovitis?
- De Quervain’s tenosynovitis is swelling or stenosis of sheath that surrounds the APL and EPB on thumb side at wrist caused by direct injury or repetitive activity. Pinching/gripping wrist and thumb movements produce pain that may radiate to proximal forearm. - Test = Finkelstein’s = thumb flex with fingers fisted over it. Examiner twists wrist into ulnar deviation. Pos = pain over radial wrist.
Red flag findings during MSK visit
- numbness, tingling, weakness esp if painless, incontinence, retention of bowel/bladder, weight loss, night time pain
Types of PEX
1.) Expanded: If CP involves that system or they have had morbidity in this system in past. Eg. f/u for stroke and history of emphysema, do expanded neuro and resp exam 2.) Basic: test major function of system, no fine tuning of exam, no deficit is found. Give all pts a basic heart and lung.
T/F. Tetanus shots are no longer necessary in elderly.
- False. Grandma Pearl may get infected with working with manure-filled rose beds
Describe CN VII indirect exam in newborn and infant
- Observe facial expression when crying – ability to wrinkle forehead and symmetry of smile
Hard and discrete lymph nodes think…
- Malignancy
How to handle communicating bad news with patients?
- Turn off pager or cell phone - Involve others such as family, SO or clergy - Be specific - Be deliberate in flow of information and adjust to pts needs - Jargon free language adapted to pts understanding - Inform pt ASAP provided no decrease in sensorium - Provide time for Qs - Repeat info when needed
Akinesia
- complete or partial loss of muscle movement
Evaluation of ligaments, joint surfaces and cartilages takes place how
- Ligaments: elongate them, push or pull on bones that they are attached to - Joint surfaces: rubbing them against each other - Cartilages: squeeze them between bones
Describe CN IX and X indirect exam in newborn and infact
- Swallowing and gag
What causes varicose veins?
- Dysfunctional valves, incompetent vessels or obstruction of proximal vein
What do brownish discolorations or ulcers above malleolus indicate?
- Chronic venous insufficiency
Stages of labor
- 1st: onset of labor to complete 10 cm dilation of cervix (~ 8- 20 hours for first baby) - 2nd: complete cervical dilation to infant delivery (minutes to 3-4 hours) - 3rd: delivery of infant to delivery of placenta (up to 30 mins)
Cap refill procedure
- Hand above heart, squeeze to blanch, normal refill time =
