Exam I Flashcards
Visceral/colic vs Parietal pain
Visceral/colic pain – source is a hollow organ caused by distention/stretching. Pain comes and goes, not well localized.
Parietal pain – caused by inflammation of peritoneum, aching pain that is well localized
Borborygmi
increased/hyperactive sounds, low pitched rumbling, hyperperistalsis
Percussion of Abdomen
Fluid wave: pt puts hand on midline, you tap one flank and palpate with the other
Shifting dullness – percuss on back then side to find where fluid is filled until
Should result in resonant [lungs] –> dull [liver] –> tympanic [intestine]
Kidneys should be percussed at the back
Lloyd’s sign – costovertebral angle tenderness tested by lightly hitting CVA with fist
Rovsing’s sign
referred rebound tenderness. Press on LLQ and release, positive if pain is in RLQ
Appendicitis
come in after a few days of pain, d/t obstruction of appendicular lumen [fecal/foreign matter, tumor, lymphoma]
History – anorexia, nausea, vomiting, fever, pain in RLQ
Test for RLQ pain/tenderness, decreased/absent bowel sounds, Rovsings sign, Psoas sign [stretch psoas], obturator sign
Acute cholecystitis
obstruction of cystic duct via gallstone, or maybe neoplasm
Pain can refer/radiate to shoulder
RUQ postprandial pain, biliary colic pain
History of anorexia, nausea, vomiting, obesity, fever
-Five F’s: female, fat, fertile, fair, flatulent
Murphy’s sign – RUQ pain and arrest of inspiration during palpation of liver/gallbladder
Diagnostic triad – RUQ pain, fever, leukocytosis
Lobes of Prostate
5 total
posterior most common for cancer
Indirect Hernia
into scrotum, the more common type
STDs and lab findings
Chlamydia – WBC
Gonorrhea – WBC w/ Gm- intracellular diplococcic
Trichomonas – WBC with moving organisms
GEN probe –> ghlamydia, GC
Hypospadias
congenital displacement of urethal meatus on inferior surface of penis, along urethral groove. Assoc with renal abnormalities
Phimosis
inability to retract foreskin, erections are painful.
Paraphimosis – foreskin cannot be retracted back over glans
Hygiene issues, tx – circumcision
Hydrocele
fluid filled sac between testicle + tunica vaginalis, transilluminates with light
Cryptorchidism
undescended testicle, usually atrophied. Inc risk for cancer
Primary syphilis
primarily caused by treponema pallidum
Chancre – painless round/oval erosion or ulcer, nontender enlarged inguinal lymph nodes
FTA-ABS – positive, or dark field microscopy –> confirmatory test, will see spirochetes
Secondary syphilis – unexplained rash on the body, palms of hand, or soles of feet
Herpes
cluster of small vesicles, burning + painful. Dx via opening vesicle and swab the clear fluid –> should hold virus
Scabies
parasitic disease, caused by a mite, needs direct skin contact. Nocturnal itching, topically treated
Gonococcal Urethritis
purulent discharge of gonorrhea, faster onset, gram staining –> gram-negative intracellular diplococci
Nongonococcal urethritis
[chlamydia] – slower onset, mucoid or purulent discharge, with polymorphonuclear lymphocytes
Menopause
absence of menses for 12 consecutive months [usually age 48-55]
Post-menopausal bleeding 6mo after cessation of menses –> risk factor [cancer]
Post-menopausal vaginal epithelium –> no rugae [d/t no estrogen]
Dysmenorrhea
painful periods beyond usual
Could be endometriosis, cervical stenosis, infection, or congenital anomaly
For pain, use prophylactic NSAIDs 24hrs before
Types of Periods
- Amenorrhea – absence of menses [pregnancy]
- Polymenorrhea – menses at abnormal frequences
- Oligomenorrhea – infrequent menses
- Menorrhagia – excessive bleeding
- Metrorhagia – bleeding between periods
- Post-coital bleeding – after sexual intercourse [STD, polyp]
Obstetric history
Gravida – how many pregnancies
Para – outcome of pregnancies
T – to term at > 37wks
P – premature
A – abortion
Bartholin’s glands
can get cysts/cancers/abcesses [at 5, 7 o’clock position]
Skene’s glands
may open internally [associated with urethra at 10, 2 o’clock]
Pushing up on skene’s glands may cause white discharge from urethra –> possible STI [chlamydia]
Condylomata
warts, raised and of variable size, never tender, “like cauliflower” d/t HPV
Cystocele
bladder distends into vagina d/t weakening of vaginal epithelium + ligaments from childbirth
May go to rectum instead –> rectocele
Os of Cervix
External Os – opening between cervix and outside world
Nulliparious – slightly oval opening
Parous – horizontal slit, post birth
Canal connects external and internal os
Cervical Os – where transformation zone occurs [premalignant neoplasmic changes d/t HPV]
Holds squamous metaplasia – stem cells
TZ moves inwards with age, outwards with childbirth
Nabothian cysts
inclusion cyst on squamous cells of cervix
Pap smear
for pre-cancerous [dysplasia] of cervix, not for finding ovarian cancer, endometrial cancer
Orientation of Uterus
Version – relationship between fundus of uterus and the vagina
Flexion – relationship between fundus of uterus and cervix
Breast Anatomy
15-20 lobules, each with several lobes
Each lobe ends in a duct
Blood supply of breast; internal mammary, posterior intercostal, and axillary artery
CT travel through breast [ligaments of cooper] and provide structural support
Stages of Change
Precontemplation – Pt isnt thinking about change, may be resigned to behavior. Lots of denial, believes consequences are not serious
Contemplation – Weighing benefits/costs, change feels like loss, assessing barriers to change
○ “I know I need to, but …”
Preparation – Experimenting with small, specific change
Action – Taking definitive action to change, praise is necessary
Maintenance – Maintaining over time, encouraging support + continued appreciation are important
Relapse – A normal part of change, results in demoralization. Doesn’t mean pt starts from zero again. Downplay sense of failure
Cervical Triangles
- Anterior – site of enlarged LN
- Central – thyroid, malignant, benign cysts
- Posterior/supraclavicular – dangerous masses
LN of Neck
Virchows node [left] – suggests malignancy from thoracic/abdominal region
Right side – suggests malignancy of mediastinum, lungs, esophagus
Thyroglossal duct cyst
remnant of thyroid tissue, may be cancerous, midline
Branchial cleft cyst
non-midline, won’t be dangerous but can get inflamed
Radiculopathy
symptoms due to central/peripheral nerve impingement [not due to disk]
Spurling’s + Distraction Test
Spurling’s – sidebend, compress neck towards complaining side –> trying to worsen protrusion of disk
Distraction test – open foramen up to relieve symptoms [good for relieving constant symptoms]
Thoracic outlet syndrome
compression of vessels/nerves as it comes through 1st rib/clavicle
• Vascular/neurologic symptoms – muscle anomalies, tight fibrous band
• Could be due to injury [whiplash] or work [working overhead]
• Sx – pain in neck/shoulders, numbness in last 3 fingers + forearm
Dx with Roos, Addson’s
Roos and Addson’s Tests
• Roo’s test – abduct arms to 90 degree, externally rotate for 3 minutes
○ If weakness/numbing/tingling –> positive
• Adson's test -- palpate radial pule with elbow, shoulder in extension ○ Have pt turn head away while you do it too If pulse diminishes then test is positive for thoracic outlet syndrome
Rotator cuff muscles
supraspinatus [most common], infraspinatus, teres minor, subscapularis
• Pain is usually around anterior acromion, deltoid
• Test by abducting shoulder against resistance [isolate elbows]
• Empty can test [supraspinatus] – arms out in front, thumbs down [like emptying can] –> pain is positive
Long thoracic nerve damage
causes winged scapula
Neurologic Strength Testing Rating
- Test resistance of normal side, then compare against afflicted side
- Rate 0-5 [0=paralyzed, 3=can move against gravity but not against resistance, 5 = 5 perfect]
Apprehension test
make force that would normally dislocate shoulder [ext rotate arm, push anteriorly] and watch pt’s face
O’Brien’s test
tests for glenoid labrum. Flex arm to 90 and adduct across chest, internally rotate with thumbs down
Speed’s test
for bicept tendonitis. Flex arm and monitor bicipital groove
Hawkin’s Impingement Sign
elevate elbow and internally rotate arm –> confirms supraspinatus pathology
Neer’s impingement sign
internally rotate and flex arm –> confirms supraspinatus pathology
Bursitis vs Tendonitis
- Bursitis – pain regardless of active or passive movement
* Tendonitis – pain only in active resistance/movement [not in passive]
Radial head subluxation [nursemaids elbow]
- Sudden distraction of arm, or tugging at his arm
- Not red, a little swollen, but pain on touch
- Is an anterior dislocation –> posterior pressure on radial head during pronation
• Determining between radial/ulnar head
Abduct at elbow, adduct elbow to see which one hurts –> articular degenerative disease
Lateral epicondylitis
more common than medial
Reproduced by direct palpation, engagement of flexors/extensors
Tender snuffbox
avascular necrosis
Hand osteoarthritis
- Heberden’s nodes – at DIP
- Bouchard’s nodes – at PIP
- Ganglion cyst – overuse/misuse problems, usually around tendon of wrist
Ulnar deviation
flexed hand without MCP changes
Tinel’s sign
tap over median nerve on carpal tunnel. Positive test –> pain/paresthesia along median nerve
Phalens maneuver
compress both wrists 90 degrees, placing dorsal hands against each other for one minute
Colle’s fracture
dorsal displacement fracture
Boxer’s fracture
metacarpal fracture, usually 5th
Scaphoid fracture
under snuffbox, could result in avascular necrosis
Dupuytren’s contracture
inflammation/contracture of 4th/5th digits
Trigger finger
inflammation of flexor digitorum tendon, gets stuck under retinaculum, makes a pop when you fix it
Osteoarthritis
mostly shows in carpo-metacarpal joint
Grind test – grab joint and wiggle it around
De Quervain’s disease
pt grabs their thumb
Lumbar Spine Muscle innervation
L4 – ankle inversion, patellar reflex, sensation at medial foot
L5 – big toe extension, no reflex, sensation at dorsal + plantar foot
S1 – calf raise, achilles tendon reflex, sensation at lateral dorsal foot
• L5-S1 is most common area of injury + source of pain from lumbar spine [rarely bilateral!]
Viscerosomatic reflexes
Small intestine; T10-11
Colon/rectum; T12-L2
Bladder; T12-L2
Ovaries/testes; T10-11
Uterus/prostate; T12-L2
Osteoarthritis vs Osteoporosis
Osteoarthritis - low grade inflammation, deterioration of disks over time
Osteoporosis – thinning of bone –> loss of height, dowagers hump
Sciatica
impingement of nerve, either central [radiculopathy] or peripheral
Test – straight leg with hamstring
Tight piriformis
can cause sciatic irritation
Femoral neck fracture
fovial artery damaged –> necrosis
Pelvic Landmarks [Supine, Prone]
Supine; ASIS, pubic symp, inguinal ligament
Inguinal ligament; test by putting pt supine, heel on opposite knee
NAVEL; lateral-to-medial –> nerve, artery, vein, empty space, lymph nodes
Prone; SI joint, PSIS, ischial bursa
Trendellenburg test
raise one leg, if hip reamins level –> gluteus medius is level. If hip drops –> positive trendellenburg sign
Thomas test
[for tight psoas] – flex one hip, see if other leg moves up with it
Patrick/FABER test
Flex, ABduct, and Externally Rotate hip to test for hip joint issues
Psoas Test
monitor hand while engaging psoas
Patellar bursitis [housemaids knee]
anterior
Tendonitis – happens with active ROM only
Bursitis – happens with active or passive ROM
Anserine bursa
medial, d/t excess running
patellofemoral grind test
for knee pain
pull patella down, press on it, and have them contract muscles to pull it up
Test for ACL tear
either anterior draw sign, or Lachman test [grab femur + tibia, and push oppositely]
McMurray and Thessaly’s test
McMurray test; heel towards meniscus getting tested, rotate heel, and straighten leg out. Pain/pop/click –> positive
Thessaly; standing on one leg, pt twists at hip to reproduce pain/dysfunction [better than mcmurray]
Sx of Knee Problems
Does knee lock/give out?
Can they “Trust” their knee when they get off the curb?
Do they have a “catching” sensation?
Medial/Lateral Ligament Tests
- MCL test; valgus test
* LCL test; varus test
Homans sign
for DVT, dorsiflex ankle with leg extended at knee [pain in calf –> positive sign]
Thompson test
for achilles rupture in first 48 hours, prone pt bends leg at 90 degrees, squeeze calf and look for normal passive plantar flexion
Anterior talofibial ligament + calcaneal ligament
most commonly involved in ankle sprains
Test with talar tilt
Nerve tests; check for pulses, sensation, and atrophy
Strain; stretching or tear of ligament [1st-3rd degree –> 3rd is full tear]
Kleiger’s test; for high ankle sprain
Ottawa rules
only need xray if
- Ankle has pain at either malleolus, tenderness in posterior malleolus
- Pain at malleolus and cant wt bear more than 4 steps
- Pain in mid foot and either tenderness at pinky toe, or cant wt bear
