final Flashcards
(208 cards)
1
Q
Hyperhidrosis
A
increased moisture of skin , typically affects the soles of the feet, usually idiopathic
2
Q
Bromohidrosis
A
FOOT odor causes include poor hygiene, talc powder or topical erythromycin (topical antibiotic) can be used
3
Q
Tinea pedis
A
Athlete’s foot, 3 types: interdigital infections, moccasin distribution, vesiculobullos (arch) infection
4
Q
Interdigital tinea pedis: presentation and tx
A
present in the web spaces, maceration, scaling, erythema. Tx: betadine, powders, antifungal gel, anti septic castallini’s PAINT***
5
Q
Mocassin tinea pedis: presentation and tx
A
scaling of the plantar surface, hyperkeratosis, topical or oral antifungal for tx.
6
Q
Vesicular tinea pedis
A
marked by vesicles in the arch of the foot, crusting tx: topical antifungal
7
Q
What are hyperkeratotic lesions?
A
corns , calluses, hammertoes. Develops in response to friction or pressure, usually over bony prominent areas.
8
Q
What are hyperkeratotic lesions?
A
corns , calluses, hammertoes. Develops in response to friction or pressure, usually over bony prominent areas.
9
Q
What are two types of corns/ hyperkeratotic lesions?
A
heloma dura- dorsal hard corns, usually over the PIPJ and heloma molle- soft corns, usually interdigitial corn
10
Q
What are three types of ulcers?
A
neuropathic, vascular, and pressure
11
Q
What are underlying conditions that cause chronic wounds?
A
diabetes, poor circulation, poor nutritional status, pressure, immunodeficiencies, infection
12
Q
What are arterial ulcers?
A
caused by ischemia, presence of PVD, VERY PAINFUL, no debridement used, send to vascular.
13
Q
What are diabetic ulcers?
A
trauma, pressure is SECONDARY to NEUROPATHIC disease or vascular disease related to DM.
14
Q
What are pressure ulcers?
A
Localized, tissue damage due to pressure ( bed ulcers) decubitus ulcer (aka)
15
Q
What are venous ulcers?
A
Caused by impaired venous return, excessive EDEMA, treated with compression. Dont use compression on sickle cell patients, most sickle cell patients develop salmonella
16
Q
What is gangreene?
A
occurs when tissue dies (necrosis) because its blood supply is interrupted. Can be caused by infection, injury, or a complication of a long term condition.
17
Q
What are the five types of gangreene?
A
- dry gangreene- least severe, 2. wet gangrene 3. gas gangrene- caused by bacteria, medical emergency, can have crackling sound 4. internal gangrene- intestines. 5. fournier’s gangrene- of genitals, causes death
18
Q
Subungual hematoma-
A
blood under the nail, usually painful, caused by trauma. Tx: drill hole with a 18 gauge needle w/ cold water soak, total nail avulsion
19
Q
what is onychocryptosis?
A
ingrown toenail. caused by chronic pressure of the nail fold by the nail plate. Leading edge of the toenail acts like a foreign body and can cause inflammation and infection
20
Q
What is hallux abducto valgus?
A
bunion deformity, lateral deviation of hallux with or without medial and or dorsal prominence of the 1st MT head. BOTH FEET USUALLY AFFECTED** causes: biomechanics, trauma, shoe gear- MOST COMMON CAUSE
21
Q
What are tx for bunions?
A
NSAIDS- motrin, otc pads, wider shoe gear, night splints, custom orthotics, surgery
22
Q
What is hallux rigidus / limitus?
A
Hallux limitus- limited range of motion of the first MTPJ seen at toe off, Hallux rigidus- loss of motion MTPJ
23
Q
What are common causes of hallux rigidus/limitus?
A
dorsiflexed 1st ray, 1st ray hypermobility, long 1st ray , prolonged 1st MTPJ immobilization
24
Q
What are tailors bunions?
A
abduction of the 5th metatarsal , lateral bowing of the 5th metatarsal, enlargement of the 5th MT head, biomechanical, arthritic changes of the 5th MT head.
25
What are hammertoes?
They are contracted at the plantarflexed PIP****, DIP- neutral or hyperextended, MTP- dorsiflexed. Can be flexible, semi rigid or rigid.
26
What is plantar fascitis associated with?
cavus and planus feet. Hallmark symptom: first step in the morning is extremely painful- POST STATIC DYSKINESIA. Plantar pain due to repeated microtrauma. Straining of the posterior attachment to the medial tubercle.
27
What are treatments for plantar fasciitis?
NSAIDS, local steroid injection, strappings, orthotics, stretching, PT, SX
28
What is Gout?
joints are red, swollen, and extremely tender. Tophi can be at base of toe. Patients usually complain of the bed sheets touching the toe causes pain. It is a metabolic disorder with depositions of monosodium urate crystals
29
Why does gout occur, what body parts are involved?
Metabolic disorder, deposition of urate crystals form at coldest locations. Pred. dx in adult men. Acute gouty arthritis is the most clinical manifestation. 75% 1st MTPJ involved.
30
What sign helps dx Gout?
Martel's sign xray, serum uric acid levels increased, TX- NSAIDS, colcrys, injection
31
What are DVT's?
blood clots which usually form in the deep venous system of the LE. Can lead to Pulm Emb. Pain, heat, SWELLING in the affected limb, compression of calf causes pain ***
32
What causes DVT's?
trauma, prolonged bed rest, chronic deep venous insufficiency, estrogen/oral contraceptive use
33
What are treatments for DVT?
anticoagulents, blood thinners (heparin, warfarin, coumadin, eliquis, rivaroxaban( Xarelto)
34
What is diabetic neuropathy?
Related to serum glucose, encompasses sensory, motor, and autonomic, loss of sensation, atrophy of interosseous, tingling/shooting pain
35
What are tx for diabetic neuropathy?
creams- Arnica, pills- GABA, injections
36
What is objective medical documentation?
****written documentation of observable, measurable and reproducible findings from examination and supporting lab or tests
37
Why is documentation important?
patient care, communication, written records, legal records
38
What are the elements of good documentation?
accuracy, legibility, timeliness, unaltered, professionalism, completeness
39
BUN
blood urea nitrogen
40
COPD
chronic obstructive pulm disease
41
ECG/ EKG
electrocardiogram
42
GI
gastrointestinal
43
RBC
Red blood cell
44
ROM
range of motion
45
What is the chief complaint?
In patient's words, brief statement of the reason the patient is seeking care.
46
What is the history of present illness?
HPI includes facts that explore in detail the CC
47
NLDOCAT used for HPI
nature( pain) , location, duration, onset, cause, aggravating/alleviating, treatments attempted*****
48
Past medical history includes:
childhood illness, major adult illnesses , accidents, immunizations, dev't history
49
Past surgical history
Operations include: indication, date, outcome complications
50
Social history includes: travel,smoking/alcohol. What are pack years?
number of cigarettes/ packs per day and duration of time. If patient has smoked 2 packs per day for 20 years: 2x 20= 40 pack years*****
51
Medications asked can include:
name, dose, freq., duration, alt/compli medical practices, herbal therapies, vitamins, supplements
52
Allergies can include:
drug causing reactions, PCN , Sulfa drugs, codeine
53
Review of systems:
typically 3 questions for each system- general: fatigue, fever, sweating. Start from head , work way down. Excessive thirst, hunger- DIABETES
54
healthy pulse and resp rate should be:
60-100, and 15-20
55
For the physical exam, General includes:
Awake, alert, oriented (AAOx3)
56
Objective physical exam includes:
vascular, neurologic, orthopedic, dermatologic
57
Assessment-
your opinion, evaluation, diagnosis, diff. diagnosis
58
Subjective vs objective data:
subj- what the patient relates, what others relate to you about the patient obj- what YOU observe, direct measurements( bp, temp) labs, xrays, etc
59
Symptoms vs signs
symptoms are SUBJECTIVE , and a response to what the patient feels , described by the patient to clarify the illness, symptoms are not absolute. Signs are OBJECTIVE finding upon physical examination of the patient. signs can be observed and quantified.
60
Proper way to correct a written note:
initial and date, cross out with black ink, one line cross out
61
osteoblasts
bone formation
62
osteoclasts
bone resorption
63
What are ligaments
specialized connective tissue that connects bones, joint stability, barrier protection . Composed of COLLAGEN type I 90%, similar to tendons however, more elastin, uniform microvascularity, not under muscle tension. Exercise increases strength
64
What is articular cartilage?
covers articulating surfaces, decreases friction, distributes loads, avascular, aneural
65
What is articular cartilage composed of?
water 65-80% , 90% in osteo arthritis , increase water, decrease strength. Collagen type II - 95%, proteoglycan 10-15% provides compressive strength. Chondrocytes: 5 % collagen
66
What is a capsule?
connective fibers, attaches around articular ends of bones, richly vascularized, reinforced by collateral ligaments * heals similar to tendons, however, more vascular- faster healing w/less complication**
67
What are the three types of muscle and their differences?
SKELETAL- attached to bones with single long multinucleated cells with striations, CARDIAC- walls of the heart, uninucleate cells striations with intercalated disks, SMOOTH-walls of hollow visceral organs, single fusiform cells, uninucleate, NO striations
68
Basic unit of contration
myofibril that consists of sarcomere with H band(thick) and I (thin) band endoym-perimy-epimysium bind fasicles to form muscles
69
What are differences between the types of muscle fiber?
type 1 : slow twitch, red fiber, aerobic oxidation, endurance actibity. type 2- fast twitch, white fiber, anarobic , strength activity
70
What are the different types of muscle contraction?
isotonic- contraction in which the muscle length will shorten and movt of a limb takes place. isometric- muscles shortens, but no movement in limb takes place. Isokinetic- muscle shortens and movt takes place, speed of contraction remains the same through entire motion.
71
What are tendons?
collagen structures that transmit muscle motion to produce joint motion. Composed of fibroblasts 85% type 1 collagen, 5% type 2 collagen
72
What is the sagittal plane
a vertical plane dividing the body into right and left parts
73
Coronal /frontal plane
a vertical plane dividing body into anterior and posterior parts
74
transverse/horizontal plane
A plane parallel to the floor or supporting surface, dividing body into superior and inferior parts
75
what are the cardinal planes of the foot
sagittal- dividing foot into med and lat, frontal- distal(ant) and prox (post) parts, transverse- dorsal (sup) and plantar (inf) parts
76
inversion
movement in which the plantar surface of the foot moves toward the midline. medial border is elevated. vara/ varus /varum- sole/calcaneus moves medially
77
genu varum-
bow legged (knees out)
78
genu valgus
knock kneed (knees close together)
79
active vs passive ROM
active- movement by the PATIENT. Joint range of motion available. Passive- movement by the examiner, joint range of motion available
80
1st MPJ- dorsiflexion is what degree
greater than 65 degrees dorsiflexion
81
Subtalar joint ROM
prone position,20 degrees inversion 10 degrees eversion 30 degrees total
82
Pes cavus
high arch
83
pes planus
flat foot
84
Ankle equinus
a limitation of normal range of dorsiflexion motion of the ankle less than 10 degrees dorsiflexion
85
pseudo ankle equinus
cavus foot,not true equinus
86
What occurs during the swing phase
foot is not in contact with the ground
87
General survey of patient includes:
signs of distress, gait/motor activity, weight, height, inspection of patient
88
What is auscultation and how are sounds heard?
listening to sounds produced by the body . Indirect- uses stethescope. FLAT diaphragm picks up HIGH - pitched respiratory sounds best. BELL picks up LOW pitched sounds such as heart murmurs. *****
89
What is the order of techniques for assessment?
Inspect, palpation, percussion, auscultation*** except for the abdomen which is Inspect, auscultation, percuss , palpate***
90
Where is the apex of the heart located? point of impulse sound?
point of max impulse where the apex of the heart is resting against the anterior chest wall. This is the best place to listen to the heart. Between the 5th and 6th rib.
91
Where are heart sounds heard?
PATM pulmonic- 2nd and 3rd left interspace, aortic- 2-3 right interspace, tricuspid- left sternal border, mitral- apex of heart
92
What is the 5th vital sign?
pulse rate, blood press sys/dias, respiration rate, temperature, PAIN -5th
93
What is a pulse rate?
The rhythmic dilation of an artery that results from beating of the heart
94
What is the most common cause of an abnormal pulse?
Atrial Fibrilation
95
What can a fast pulse indicate?
infection, dehydration, stress, anxiety, thyroid disorder, shock, anemia, heart conditions. LOW heart rate for those who are athletic.
96
Where should pulses be checked?
DP, PT, bilaterally on both sides. If these pulses are absent, check the popliteal or femoral pulses
97
Where is the dorsalis pedis pulse?
between the 1st and 2nd MT
98
Where is the posterior tib pulse?
posterior to medial malleolus
99
What does capillary refill show?
Cap refill times greater than 2 to 3 seconds suggests peripheral vascular disease , arterial blockage, dehydration, or heart failure.
100
What is an avg respiration rate?
12-20 breaths per minute, for infants- 30-60 bpm
101
What is tachypnea?
shallow, rapid breathing
102
Bradypnea
abnormally slow breathing rate
103
What is a desired BP?
90-119 systolic measures the pressure in the arteries when the heart beats. Diastolic- measures the pressure in the arteries between heartbeats when the heart muscle is resting between beats and refilling with blood. 60-79 diastolic ** MORE concerned about lower #
104
hypertension
blood pressure reading of 180/110 or greater
105
Pectus excavatum
depression pushes heart to the side , depression in sternum
106
What peripheral clues may suggest pulmonary or cardiac difficulties?
clubbing of fingers, odor of breath, cyanosis or pallor of skin, nails and lips, lips pursing, nostrils flaring. i.e Pink puffer- pink cheeks, thin, leaning forward EMPHYSEMA decrease in CO. or blue bloater- airway obstructed, chronic bronchitis, decrease ventilation, hypoxemia, increase CO bluish appearance ( common sympt)
107
what three lines divide the chest?
mid sternal, mid clavical ,right ant axillary line
108
what three lines are on the side of the chest?
posterior axillary line, midaxillary line, ant axillary line
109
lines on back?
vertebral and scapular line
110
The interior of the chest is divided into what three spaces?
mediastinum, right and left pleural cavities
111
characteristics of the lungs
highly elastic, lungs paired but not symetric right lung: 3 lobes, left lung: 2 lobes and a lingula lobes contain bv's, lymph, nerves, alveoli
112
what are the parts of the tracheobronchial tree
trachea divides into right and left main bronchi. R bronchus divides into 3 branches, Left bronchus divides into two branches each branch divides into bronchioles Acini are the terminal resp units
113
for infants and children the circumfrence of the chest is _____ as head circumference until 2 yrs
the same
114
what mechanical changes occur to pregnant women?
lower ribs flare, diaphragm rises above usual position , diaphragm movement increases so that major work of breathing is done by the diaphragm, tidal volume increases
115
what changes can be viewed in older adults?
barrel chest from loss of muscle strength in thorax and loss of lung resiliency, decrease in vital capacity , fatigue cannot keep up with demand, increase in residual volume.
116
hemoptysis
blood in cough
117
pectus carinatum
sternum protruding
118
kyphoscoliosis
very curved vertebrae
119
tet spell
children with teratology of fallot exhibit bluish skin during episodes of crying or feeding, decrease in O2
120
splinter hemorrhages
bacterial endocarditis
121
inspection for airway obstruction includes:
stridor- high pitched noise, nostril flaring, cough, chest retraction
122
what is a normal respiratory rate
12 -20 breaths per min
123
bradypnea
less than 12/min
124
tachypnea
more than 20 breaths/min
125
hyperventilation
deeper, quick breaths
126
sighing
freq interspersed deep breathing
127
cheyne stokes
varying periods of increased depth interspersed with apnea
128
kussmaul
rapid, deep, labored
129
ataxic
disorganization with irregular and varying depths of respir
130
biot
irregularly interspersed periods of apnea in a disorganized seq of breaths
131
tactile fremitus
vibrations felt with the hands during vocal fremitus
132
least reliable test
percussion - compares tones bilaterally, direct and indirect
133
hyper resonance indicates what condition
emphysema or pneumothorax
134
dullness indicates what
diminished air exchange, pleural effusion or lobar pneumonia
135
vocal resonance
increased resonance of voice sounds heard during ausculation of the lungs. Fluid causes sound of voice to be transmitted loudly
136
bronchophony
abnormal transmission of sounds from the lung or bronchi
137
pectoriloquy
when ausculating lungs, the resonance increases
138
egophony
increase resonance of voice sounds heard, caused by fibrosis or lung consolidation
139
PMI location
5th and mid clav.
140
heart sounds- which are most distinct
S1 or S2
141
which heart sounds are most difficult
S3 and S4
142
S1 heart sound
beginning of systole, coincides with upswing of carotid pulse
143
S2
beginning of diastole , splits during inspiration
144
S3
occurs in diastole, difficult to hear louder with increased venous pressure
145
S4
heard in older patients, before S1 gallop pushes blood into LV
146
direct vs indirect observations
direct- emg/ncv, lab studies, indirect- examination, inference to known pathologies
147
upper motor neurons
always and everywhere in the CNS pathology
148
lower motor neurons
central or peripheral pathology
149
basal ganglia(CNS)
abnormal movements , disorders of tone, NOT TO BE CONFUSED WITH MYOTONIA
150
schwan cells
myelin in the peripheral system
151
oligodendrites
myelin in the central ns.
152
cerebellar
coordination of smooth mov'ts , decomposition of movt , dysdiadochokinesia- inability to do rapid alt movts, dysmetria, tremors
153
extrapyramidal CNS
akinesia/bradykinesia, failure of gait initiation, postural changes, rigidity, tremors , PARKINSONISM IS CLASSIC EXAMPLE cog wheel rigidity
154
Pyramidal
corticospinal, CNS, upper motor syndrome, extraspinal- descending signs and symptoms, intraspinal- ascending signs and symptoms, lower motor syndrome
155
upper motor manifestations
diffuse weakness, fatigue, hyperreflexia, incoordination, clonus, ipsi/contralateral to lesion, increased tone, rigidity/spasticity, decreased superficial reflexes EXCEPT BABINSKI REFLEX, upgoing extensor-plantar reflex
156
Lower motor manifestations
decreased reflexes, diffuse or local weakness, fasciculations, hypotonia, muscle atrophy, ipsilateral to lesion, sup reflexes decreased or absent, downgoing or mute extensor -plantar reflex
157
cortex
unimodal, contralateral to lesions
158
posterior column/medial leminiscus
conscious proprioception, light touch, vibratory sensation, epicritic sensations
159
spinocerebellar
unconscious proprioception,ipsilateral to lesions
160
spinothalalamic
ligh touch, pain/tickle, and temp (lateral) often characterized by dissociated sensory loss
161
PNS sensory classifications
nerve root (post) dorsal root ganglion, plexes, peripheral nerves ALWAYS pan sensory and ipsilateral to LESIONS
162
spacial classifications: proximal and distal
proximal is further from end organ and has a worse prognosis. Distal (nearer to end organ) has a better prognosis.
163
What are three functional classifications?
diffuse- diabetes, alcohol, HIV , focal- vascular , multifocal- mult sclerosis
164
axonopathy
at axon, neuropraxia
165
myelinopathy
ms in periphery, compression
166
neuronopathy
affect cell body, polio, breast cancer
167
plexopathy
plexes/nerve crossing
168
radiculopathy
spinal nerve involvement/spinal roots
169
etiology: cryptogenic disease
do not know cause
170
What is the difference between signs and symptoms
signs are NOTED BY PHYSICIAN on examination, symptoms are what the patient is aware of.
171
Common motor symptoms:
fatigue, incoordination, invol movement.
172
If you can swallow liquids and not solids, what does that mean?
if you cannot swallow liquids, there is nerve damage. If you cannot swallow solids, there is musculature damage.
173
Without a thorough history, everything else is without context. More info per second can be obtained by doing what?
watching the patient stand and walk
174
A structured examination has a far higher info yield than what
labratory studies
175
Taking a good history makes or breaks a physician's ability to do what ?
To take an assessment properly a good history will make or break you
176
What is the grading scale for reflexes?
0= no visible rxn, 1- hyporeflexia, 2= normal, 3= brisk, 4- hyperactive common modifiers: clonus, hung, pendular
177
what is the extensor plantar reflex?
Babinski sign, graded upgoing - upper motor lesion, downgoing = normal, mute- nothing happens
178
inversion synonyms
vara, varus, varum
179
eversion synonyms
valga, valgus, vagum
180
subjective
what the patient relates, what others relate to you about the patient, CC, HPI
181
objective
what YOU observe, direct measurements (bp, temp) Labs, xray, physical findings
182
symptoms are ____________
subjective , from the patient
183
signs are ____________
objective , can be observed and quantified
184
assesment
evaluation, diagnosis, differential diagnosis
185
plan
orderly progression of steps, diagnostic tests, therapeutic plans
186
professionalism in charting
include only objective info, no slang , always write clearly
187
addendum
as soon as the need for revision is identified. date and time must be documented, always made by the original author
188
parkinson's disease
extrapyramidal CNS basal ganglia Failure of gait initiation, resting tremor, cog wheel rigidity, flexion
189
upper motor neuron lesions include:
diffuse weakness, fatigue, incoordination, ipsilat or contral to region, preserved muscle mass, increased tone, rigidity, decreased babinski reflex sign, upgoing extensor-plantar reflex****
190
lower motor neuron lesions include:
central or peripheral, decreased reflexes, hypotonia, muscle atrophy, ipsilateral to lesion, fasciculations
191
allodynia
experience of pain from a non painful stimulus . Pain response from stimuli that normally does not cause pain
192
Romburg sign
arms forward , eyes closed. testing to see if patient can close eyes and extend arms without losing balance. tests the loss of motor coordination (ataxia)
193
ptosis
drooping of eyelid CN 3 occulomotor
194
hordeolum
infection acute with discharge int or ext stye
195
chalazion
inflam of tear gland
196
zanthoma
yellow on skin , high chl athersclerosis
197
aniscoria
unequal pupil above 1mm *problem
198
horner's syndrome
sympathetic disease
199
hearing tests
whisper, tuning fork, rinne's test, weber's test lateralize to good ear- neurosensory loss, lateralizing to bad ear- conductive hearing loss
200
deontology / non consequentialism
Deon- duty. Some acts are right or wrong indep. of their consequences. Look to one's obligation to determine what to do.
201
consequentialism
actions determined by consequence of the act. Consider ALL consequences prior to action
202
utilitarian ethics
greatest good for the largest number of people
203
intuitionism
resolves dilemmas by appealing to one's intuition
204
rights theory
resolves ethical dilemmas by first determining what rights or moral claims are involved and take precedence. personal/societal
205
virtue ethics
tells us what kind of person one ought to be, rather than what they do. Focus is one the character of the person.
206
veracity
the duty to tell the truth
207
non comparative justice
method of distributing needed kidneys using a lottery system
208
comparative justice
making decision based on criteria and outcomes
