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PCM II > Exam I > Flashcards

Exam I Flashcards

1
Q

Visceral/colic vs Parietal pain

A

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

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2
Q

Borborygmi

A

increased/hyperactive sounds, low pitched rumbling, hyperperistalsis

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3
Q

Percussion of Abdomen

A

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

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4
Q

Rovsing’s sign

A

referred rebound tenderness. Press on LLQ and release, positive if pain is in RLQ

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5
Q

Appendicitis

A

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

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6
Q

Acute cholecystitis

A

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

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7
Q

Lobes of Prostate

A

5 total

posterior most common for cancer

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8
Q

Indirect Hernia

A

into scrotum, the more common type

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9
Q

STDs and lab findings

A

Chlamydia – WBC

Gonorrhea – WBC w/ Gm- intracellular diplococcic

Trichomonas – WBC with moving organisms

GEN probe –> ghlamydia, GC

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10
Q

Hypospadias

A

congenital displacement of urethal meatus on inferior surface of penis, along urethral groove. Assoc with renal abnormalities

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11
Q

Phimosis

A

inability to retract foreskin, erections are painful.

Paraphimosis – foreskin cannot be retracted back over glans

Hygiene issues, tx – circumcision

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12
Q

Hydrocele

A

fluid filled sac between testicle + tunica vaginalis, transilluminates with light

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13
Q

Cryptorchidism

A

undescended testicle, usually atrophied. Inc risk for cancer

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14
Q

Primary syphilis

A

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

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15
Q

Herpes

A

cluster of small vesicles, burning + painful. Dx via opening vesicle and swab the clear fluid –> should hold virus

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16
Q

Scabies

A

parasitic disease, caused by a mite, needs direct skin contact. Nocturnal itching, topically treated

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17
Q

Gonococcal Urethritis

A

purulent discharge of gonorrhea, faster onset, gram staining –> gram-negative intracellular diplococci

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18
Q

Nongonococcal urethritis

A

[chlamydia] – slower onset, mucoid or purulent discharge, with polymorphonuclear lymphocytes

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19
Q

Menopause

A

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]

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20
Q

Dysmenorrhea

A

painful periods beyond usual

Could be endometriosis, cervical stenosis, infection, or congenital anomaly

For pain, use prophylactic NSAIDs 24hrs before

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21
Q

Types of Periods

A
  • 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]
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22
Q

Obstetric history

A

Gravida – how many pregnancies

Para – outcome of pregnancies
T – to term at > 37wks
P – premature
A – abortion

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23
Q

Bartholin’s glands

A

can get cysts/cancers/abcesses [at 5, 7 o’clock position]

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24
Q

Skene’s glands

A

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]

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25
Q

Condylomata

A

warts, raised and of variable size, never tender, “like cauliflower” d/t HPV

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26
Q

Cystocele

A

bladder distends into vagina d/t weakening of vaginal epithelium + ligaments from childbirth

May go to rectum instead –> rectocele

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27
Q

Os of Cervix

A

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

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28
Q

Nabothian cysts

A

inclusion cyst on squamous cells of cervix

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29
Q

Pap smear

A

for pre-cancerous [dysplasia] of cervix, not for finding ovarian cancer, endometrial cancer

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30
Q

Orientation of Uterus

A

Version – relationship between fundus of uterus and the vagina

Flexion – relationship between fundus of uterus and cervix

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31
Q

Breast Anatomy

A

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

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32
Q

Stages of Change

A

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

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33
Q

Cervical Triangles

A
  • Anterior – site of enlarged LN
    • Central – thyroid, malignant, benign cysts
    • Posterior/supraclavicular – dangerous masses
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34
Q

LN of Neck

A

Virchows node [left] – suggests malignancy from thoracic/abdominal region

Right side – suggests malignancy of mediastinum, lungs, esophagus

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35
Q

Thyroglossal duct cyst

A

remnant of thyroid tissue, may be cancerous, midline

36
Q

Branchial cleft cyst

A

non-midline, won’t be dangerous but can get inflamed

37
Q

Radiculopathy

A

symptoms due to central/peripheral nerve impingement [not due to disk]

38
Q

Spurling’s + Distraction Test

A

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]

39
Q

Thoracic outlet syndrome

A

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

40
Q

Roos and Addson’s Tests

A

• 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
41
Q

Rotator cuff muscles

A

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

42
Q

Long thoracic nerve damage

A

causes winged scapula

43
Q

Neurologic Strength Testing Rating

A
  • 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]
44
Q

Apprehension test

A

make force that would normally dislocate shoulder [ext rotate arm, push anteriorly] and watch pt’s face

45
Q

O’Brien’s test

A

tests for glenoid labrum. Flex arm to 90 and adduct across chest, internally rotate with thumbs down

46
Q

Speed’s test

A

for bicept tendonitis. Flex arm and monitor bicipital groove

47
Q

Hawkin’s Impingement Sign

A

elevate elbow and internally rotate arm –> confirms supraspinatus pathology

48
Q

Neer’s impingement sign

A

internally rotate and flex arm –> confirms supraspinatus pathology

49
Q

Bursitis vs Tendonitis

A
  • Bursitis – pain regardless of active or passive movement

* Tendonitis – pain only in active resistance/movement [not in passive]

50
Q

Radial head subluxation [nursemaids elbow]

A
  • 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
51
Q

• Determining between radial/ulnar head

A

Abduct at elbow, adduct elbow to see which one hurts –> articular degenerative disease

52
Q

Lateral epicondylitis

A

more common than medial

Reproduced by direct palpation, engagement of flexors/extensors

53
Q

Tender snuffbox

A

avascular necrosis

54
Q

Hand osteoarthritis

A
  • Heberden’s nodes – at DIP
    • Bouchard’s nodes – at PIP
    • Ganglion cyst – overuse/misuse problems, usually around tendon of wrist
55
Q

Ulnar deviation

A

flexed hand without MCP changes

56
Q

Tinel’s sign

A

tap over median nerve on carpal tunnel. Positive test –> pain/paresthesia along median nerve

57
Q

Phalens maneuver

A

compress both wrists 90 degrees, placing dorsal hands against each other for one minute

58
Q

Colle’s fracture

A

dorsal displacement fracture

59
Q

Boxer’s fracture

A

metacarpal fracture, usually 5th

60
Q

Scaphoid fracture

A

under snuffbox, could result in avascular necrosis

61
Q

Dupuytren’s contracture

A

inflammation/contracture of 4th/5th digits

62
Q

Trigger finger

A

inflammation of flexor digitorum tendon, gets stuck under retinaculum, makes a pop when you fix it

63
Q

Osteoarthritis

A

mostly shows in carpo-metacarpal joint

Grind test – grab joint and wiggle it around

64
Q

De Quervain’s disease

A

pt grabs their thumb

65
Q

Lumbar Spine Muscle innervation

A

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!]
66
Q

Viscerosomatic reflexes

A

Small intestine; T10-11

Colon/rectum; T12-L2

Bladder; T12-L2

Ovaries/testes; T10-11

Uterus/prostate; T12-L2

67
Q

Osteoarthritis vs Osteoporosis

A

Osteoarthritis - low grade inflammation, deterioration of disks over time

Osteoporosis – thinning of bone –> loss of height, dowagers hump

68
Q

Sciatica

A

impingement of nerve, either central [radiculopathy] or peripheral

Test – straight leg with hamstring

69
Q

Tight piriformis

A

can cause sciatic irritation

70
Q

Femoral neck fracture

A

fovial artery damaged –> necrosis

71
Q

Pelvic Landmarks [Supine, Prone]

A

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

72
Q

Trendellenburg test

A

raise one leg, if hip reamins level –> gluteus medius is level. If hip drops –> positive trendellenburg sign

73
Q

Thomas test

A

[for tight psoas] – flex one hip, see if other leg moves up with it

74
Q

Patrick/FABER test

A

Flex, ABduct, and Externally Rotate hip to test for hip joint issues

75
Q

Psoas Test

A

monitor hand while engaging psoas

76
Q

Patellar bursitis [housemaids knee]

A

anterior

Tendonitis – happens with active ROM only
Bursitis – happens with active or passive ROM

77
Q

Anserine bursa

A

medial, d/t excess running

78
Q

patellofemoral grind test

A

for knee pain

pull patella down, press on it, and have them contract muscles to pull it up

79
Q

Test for ACL tear

A

either anterior draw sign, or Lachman test [grab femur + tibia, and push oppositely]

80
Q

McMurray and Thessaly’s test

A

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]

81
Q

Sx of Knee Problems

A

Does knee lock/give out?

Can they “Trust” their knee when they get off the curb?

Do they have a “catching” sensation?

82
Q

Medial/Lateral Ligament Tests

A
  • MCL test; valgus test

* LCL test; varus test

83
Q

Homans sign

A

for DVT, dorsiflex ankle with leg extended at knee [pain in calf –> positive sign]

84
Q

Thompson test

A

for achilles rupture in first 48 hours, prone pt bends leg at 90 degrees, squeeze calf and look for normal passive plantar flexion

85
Q

Anterior talofibial ligament + calcaneal ligament

A

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

86
Q

Ottawa rules

A

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

PCM II (1 decks)

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