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PCM > exam II > Flashcards

exam II Flashcards

1
Q

anterior triangle borders

A

superior- mandible
medial- midline of neck
lateral- sternocleiodomastoid

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2
Q

posterior triangle content

A 
spinal accessory
cervical plexus
roots of brachial plexus
phrenic nerve
subclavian a
transverse cervical a
suprascapular a
external jugular
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3
Q

posterior triangle borders

A

inferior- clavicle
posterior- trapezius
anterior- sternocleidomastoid

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4
Q

cervical lymph nodes

A 
preauricular
postauricular
occipital
deep cervical
submandibular
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5
Q

thryroglossal duct cyst

A

during development thyroid tissue migrates from base of tongue through thyroglossal duct into neck
if duct does not close can form cyst

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6
Q

ROM neck

A

flex- 45
extend- 85
rotate- 90
side bend- 40

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7
Q

mm used in neck rotation

A

trap, scalenes, SCM, splenius, longissimus, semispinalis, and obliqus capitus

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8
Q

mm used in sidebending neck

A

trap, scalene, SCM, splenius, longissiums, semispinalis, obliqus, longus, and rectus capitis

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9
Q

spurling’s maneuver

A

cervical foramina compression test
side bend w/compression produces pain and neruo symptoms
maximum cervical compression test- add extension and rotation to the same side

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10
Q

distraction test

A

pull up on head and neck

used to alleviate radicular symptoms and support a diagnosis of radicuopathy

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11
Q

Roos Test

A

arms abducted to 90 and externally rotated
elbows flexed at 90
patient slowly opens and closes hands for 3 minutes
if there is weakness, numbness, or tingling test is positive or thoracic outlet syndrome

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12
Q

Adson’s test

A

palpate the radial pulse with the elbow and shoulder in extension
continue to palpate pulse while moving arm into abduction and external rotation and flex elbow
have patient turn head away
if pulse diminished positive for thoracic outlet syndrome

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13
Q

apley scratch test

A

upper arm- tests external rotation and abduction

lower arm- tests internal rotation and adduction

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14
Q

internal rotators of the shoulder

A

subscapularis

teres major

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15
Q

external rotators of the shoulder

A

teres minor

infrascapularis

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16
Q

mm strength scale

A

0- no contraction or movement
1- mm contracts, does not move
2- full active ROM when gravity eliminated
3- full active ROM against gravity
4- full active ROM against partial resistance
5- full active ROM overcome full resistance

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17
Q

test supraspinatus

A

patient abducts against resistance

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18
Q

test subscapularis

A

patient rotates forearm medially against resistance

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19
Q

test infraspinatus/teres minor

A

patient rotates forearm laterally against resistance

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20
Q

test thoracohumeral group

A

patient adducts forearm against resistance

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21
Q

test infraspinatus

A

patient flexed elbows to 90 and abducts against bilateral resistance

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22
Q

empty can test

A

tests supraspinatus

abduct arms to 90 and forward flex to 45, internally rotate to point thumb down. patient pushed up against resistance

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23
Q

lift off test

A

hand on lower back palm out
patient pushed against resistance
subscapularis test

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24
Q

cross over test

A

adduct arm across test to compress acromioclavicular joint and caused pain if there has been disruption of AC joint or arthritis

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25
Q

drop arm test

A

examiner abducts patients arm to 90and asks patient to slowly lower it
if arm drops indicative of rotator cuff problem, usually supraspinatus

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26
Q

apprehension test

A

arm abducted to 90 and externally rotated
push inferior on shoulder while extending arm
pain indicative or loose joint capsule or dislocation

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27
Q

O’briens test

A

flex arm to 90 and adduct across chest, internally rotate to point thumb down and push down on arm
pain is positive for labral tear, if thumb points up, no pain

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28
Q

speed test

A

flex straight arm to 90 with palm up

patient resists examiner pushing down, pain in bicipital groove positive or bicipital tendonitis

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29
Q

Hawkins impingement sign

A

examiner grasps elbow with one hand and distal forarm with other
passively externally rotates shoulder impinges subscapularis
passively internally rotates shoulder impinges supraspinatus, teres minor, and infraspinatus

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30
Q

subacromial bursa test

A

stabalize shoulder and extend humerus

pain indicates subacromial bursitis, could be rotator cuff problem

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31
Q

nursemaids elbow

A

radial head dislocation

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32
Q

lateral epicondylitis

A

extensor tendinitis
tennis elbow
generally chronic
pain in lateral elbow and dorsal forarem, worse with wrist extension, gripping, or lifting

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33
Q

medial epicondylitis

A

flexor tendinitis
golfers elbow
chronic
pain in medial elbow worse with flexion, gripping, or lifting

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34
Q

lateral epicondylitis test

A

palpate lateral epicondyle while resisting patient wrist extension, pain is positive test

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35
Q

medial epicondylitis test

A

palpate medial epicondyle while resisting patients wrist flexion, pain positive test

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36
Q

radiohumeral and ulnohumeral joint tests

A

position elbow where discomfort occurs, radially or ulnarly deviate the wrist to compress radial head or ulna, pain indicates problem

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37
Q

boutonniere deformity

A

knucle large and raised

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38
Q

bouchards nodes

A

at proximal IP joint, osteroarthritis, may not be symmetric

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39
Q

heberdens nodes

A

at distal IP joint, osteroarthritis, may not be symmetric

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40
Q

tinels sign

A

tap on median nerve at wrist -> pain indicative of compression, not specific to carpel tunnel

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41
Q

phalens manuver

A

point fingers down to bring wrists together, opposite of prayer, carpel tunnel

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42
Q

tenosynovitis

A

dequervain’s disease and others

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43
Q

rheumatoid arthritis

A

symmetric

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44
Q

psoriatic arthritis

A

involves DIP joints and inflammation of skin

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45
Q

colels fracture

A

distal radius fracture with distal fragment displaces dorsally
usually from falling on outstretched hand

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46
Q

boxers fracture

A

distal 5th metacarpal fracturewith volar angulation

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47
Q

duptrens contracture

A

inflammation, thickening, and contracture of palmar fascia, most commonly 4th and 5th digits

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48
Q

trigger finger

A

inflammation of flexor digitorum tendon sheath which becomes trapped under pulley just proximal to MCP joints during flexion so cannot extend

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49
Q

grind test

A

tests for carpo-metacarpal osteoarthritis
most commonly found at 1st carpo-meta joint
abduct thumb and grasp base of meta rotating, pain positive

50
Q

finkelstein test

A

thumb inside fist and gently ulnar deviate wrist, pain positve for tenosynovistis of the extensor pollicis brevis brevis and abductor pollicis longus mm
aka dequervains disease

51
Q

major contraindications to injections

A

known hypersensativity to the drug or its excipients (flu vaccine has eggs)
skin is inflamed, irritated, excoriated, or infected
patient is pregnant or breastfeeding (Botox, rubella, hormones, opiates)
stopper is latex and patient has latex allergy

52
Q

ID

A

intradermal
administered at 10-15 degress
primarily for diagnositc purposes or applying local anesthetics
usually uses small syringes and small gauge needles, ex 1cc syringe with 27 gauge 1/2 in needle
creates wheal
usually done on arm or back

53
Q

SQ

A

administered into subcutaneous layer at 45-90, 45 preferred
allows for slow sustained absorption of medications such as insulin, hormones, and opiates
uses a variety of syringe and needle sizes
1-3cc with a 23-25 gauge 1/2-5/8 needle
at abdomen, lateral and posterior arm, anterior thigh, and ventrolateral gluteal region, wherever there is a good layer of fat

54
Q

IM

A

well perfused m at 90 degrees
rapid and systemic action of relatively large doses (1-2 cc)
includes vaccines
size varies greatly, usually a 3cc cyringe, 21-25 gauge and 1-1.5 inch needle
deltoids, gluteus medius, vastus lateralis, rectus femoris, gluteus maximus

55
Q

absolute contraindications to joint injections

A 
local cellulitis
septic arthritis
acute fracture
bacteremia
joint prosthesis
achilles or patella tendiopathies
hx of allergy or anaphylaxis to injectable pharmaceuticals 
more then 3 injections to same joint w/in year
56
Q

relative contraindications to joint injections

A 
minimal relief after 2 attempts
underlying coagulopathies
anticoagulation therapy
evidence of surrounding joint osteoporosis
anatomically inaccessible joints
uncontrolled diabetes
57
Q

lidocaine

A

anesthetic
vasodilator
quick onset, short duration (30-60min)
safe in fingers, nose, penis, toes, and earlobes
use in contaminated wounds
use if vascular disease is present or pt is immunocompromised

58
Q

lidocaine w/epi

A 
anesthetic
causes vasoconstriction
longer duration
highly vascular areas to improve visualization
use in clean wounds
59
Q

bupivacaines

A

longer duration

for nn block

60
Q

adverse leeffects of corticosteroids

A

accelerate normal aging related articular cartilage atrophy or periarticular calcification
may weaken tendons or ligaments
post-injection steroid flare
infection, bleeding
tendon rupture
facial flushing, skin atrophy, and or depigmentation
hypersensitivity rxn, transient paresis

61
Q

reiters syndrome

A

uveitis, sacroilits, urethritis

62
Q

tredelenburg test

A

evaluates gluteus medius- > hip drop

63
Q

ober test

A

IT band

with patient on side flex knee to 90 and abduct leg at hip, if leg maintains abduction positive test

64
Q

thomas test

A

flexion contractures of hip due to tight psoas
flex hip with patient supine so thigh touches abdomen, upon extending one hip should lie flat on table, positive if does not fully extend

65
Q

patrick

A

aka fabere

supine put ankle over knee, apply pressure to bent knee, may elicit SI tenderness

66
Q

buldge sign

A

minor effusion

67
Q

balloon sign

A

large effusions

68
Q

balloting

A

large effusion

69
Q

prepatellar bursitis

A

anterior
dome swelling over patella associated with tenderness
from excessive kneeling
aka housemaids knee

70
Q

tenonitis vs bursitis

A

tendonitis hurts with active, but not passive motion

bursitis, equal pain with active and passive motion

71
Q

anserine bursitis

A

medial, tibial plateau
also from valgus knee defrmity and arthritis
hard to tell from pes anserine tendonitis

72
Q

bakers cyst

A

posterior in popliteal fossa

leg extended check posterior/medial aspect of knee for swelling or fullness, sometimes tenderness as well

73
Q

patellofemoral grind test

A

patient supine with knee extended
compress patella against femur
instruct patient to tighten quads
assess for roughness of motion, crepitus, or pain
chrondromalaicia/patellofemoral syndrome
usually hurts while going up stairs or rising from chair

74
Q

apprehension test

A

test for dislocation of patella
attempt to dislocate patella laterally
watch for pain

75
Q

anterior drawer sign

A

patient supine and flex knee and hip to 90
pull tibia forward to check for movement anteriorly
compare to opposite side
ACL tear

76
Q

lachmans test

A

only for ACL
knee flexed 15, externally rotateda
grasp femur and tibia, move in opposite directions
forward movement of femur positive

77
Q

posterior drawers sign

A

supine knee and hip flexed 90
push tibia posteriorly
PCL

78
Q

mcmurray test

A

heal points towards direction of meniscus being tested
patient supine grasp heal and fully flex knee
hold knee joint with other hand palpating along joint line
rotate lower leg internally to engage lateral meniscus and extend leg, pop, click, or pain in knee positive
not specific

79
Q

apleys compression

A

patient prone knee flexed to 90
stabalize thigh with one hand while leaning onto heal compressing medial and lateral menisci, rotate heal during compression noting pain

80
Q

thessaly test

A

standing, rotatory motion on one leg

more specific for meniscal tear then mcmurray

81
Q

medial collateral ligament

A

valgus stress test
abduction stress test
patient supine and flex knee
one hand against lateral knee the other around medial ankle, push medially against knee while laterally against ankle

82
Q

lateral collateral ligament

A

varus stress test
adduction stress test
patient supine with slight knee flexion
hands against medial knee and lateral ankle

83
Q

homans sign

A

evaluates for DVT

dorsiflex foot with leg extended at knee, pain posiitve test

84
Q

thompson test

A

patient prone, leg bent to 90, squeeze calf and observe normal passive plantar flexion, best to determine achilles rupture w/in 48hours

85
Q

talar tilt test

A

sitting with legs dangling off table
invert calcaneus
if talus gaps or rocks in ankle mortise the ATF and calcaneofibular ligs are torn and test is positive

86
Q

pes planus

A

loss of longitudinal arch of foot

87
Q

pseugogout

A

from calcium crystals

88
Q

hammer toes

A

hyperextension of MTP joint and flexion of IP joint, usually in digit 2

89
Q

ankle-brachial index

A

should be .9-1.3, less then that is indicative of loss of blood flow to LL below .4 is severe

90
Q

virchow’s triad

A

stasis, hypercoaguability, endothelial injury

91
Q

lymphangitis

A 
get erythema
usually tender
localized bacterial infection 
acute onset
pain and fever
92
Q

benign lymphadenopathy

A 
less then 1 cm
tender
may be firm, but not hard
freely moveable
discreet borders
93
Q

malignant lyphadeopathy

A 
greater then 1 cm
not tender
rock hard
fixed to surrounding tissue 
difficult to palpate borders
94
Q

grading edema

A

1- 2mm, resolves quickly
2-4mm resolves in less then 1 min
3- 6mm, last1-2 min
4-8mm lasts 2-5min

95
Q

erythema nodosum

A

inflammation of skin of shins
gradual onset often associated with infection or immune reaction, not vascular disease
recurrent and b/l
no aggravating or alleviating factors
associated with fatigue, joint pain, fever
examination raised red inflammatory nodules

96
Q

cellulitis

A

inflammation of skin and/or subcutaneous tissues
almost always bacterial infection, ususally strep or staph
acute onset
usually with pain, redness, and warmth
well demarcated area very tender
frequently accompanied by lymphadenopathy

97
Q

S3

A

ventricular gallop
rapid ventricular filling
better heard with bell

98
Q

S4

A

atrial gallop
marks atrial contraction
always pathologic
better heard will bell

99
Q

murmur grading

A

1- very faint
2-quiet, but heard with stethoscope
3-moderately lous
4- loud w/palpable thrill
5-very loud with thrill, may be heard with stethoscope partially off chest
6-very loud with thrill, may be heard with stethoscope entirely off chest

100
Q

carotid pulse

A

between S1 and S2

101
Q

innocent murmurs

A

stills murmur

venous hum

102
Q

stills murmur

A

mid-systolic, best left lower sternal border
musical quality
louder in supine position
innocent

103
Q

venous hum

A

continuous humming, best heard right upper sternal border
flow of venous blood from head and neck into thorax
continuous while sitting
disappears with light pressure over jugular v

104
Q

fremitus

A

strongest intrascapular right side
increased indicative of consollidation (pneumonia)
decreased/absent indicative of COPD, obstruction, pleural cavity, effusion, pneumothorax

105
Q

flat

A

soft, high pitch, thigh

106
Q

dull

A

medium volume, medium pitch, liver

107
Q

resonance

A

loud, low pitch, lungs

108
Q

hyperresonance

A

very loud, very low pitched, not normal

109
Q

tympany

A

loud, high pitched, gastric bubble,

110
Q

vesicular

A

over lung fields, soft, low pitched, inspir>expir

111
Q

bronchovesicular

A

1/2nd ICS anterior and btwn scapula, intermediate volume and pitch
inspir=expir

112
Q

bronchial

A

loud, high pitched, manubrium

expir>inspir

113
Q

tracheal

A

very loud and high pitched over trachea

inspir=expir

114
Q

Wheeze

A

relatively high pitched with hissing or shrill quality
continuous, musical, prolonged
suggests partial airway obstruction- secretions, inflammation, or foreign body

115
Q

rhonchi

A

relatively low pitched with snoring quality
continuous, musical, prolonged
suggests partial airway obstruction- secretions, inflammation, or foreign body

116
Q

stridor

A

wheeze only during inspiration
louder in neck then chest
indicates partial obstruction of larynz or trachea

117
Q

crackles/rales

A

discontinuous, non-musical, brief

only inspiration

118
Q

pleural rub

A

like crackles but in both inspiration and expiration

119
Q

bronchophony

A

‘99’ muffles and indistinct normally, abnormal very loud and clear

120
Q

egophony

A

‘ee’ sounds like ‘aa’

121
Q

whispered pectoriloquy

A

abnormal can hear loud n clear

PCM (1 decks)

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