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N270: Advanced Health Assessment [Fall 2016] > For Final > Flashcards

For Final Flashcards

1
Q

The retina contains the major landmarks of the eye (4)

A
  • Optic disc
  • Retinal arteries and veins
  • Macula
  • Fovea centralis
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2
Q

Which of the major landmarks of the eye can you see on the fundoscopic exam?

A
  • Optic disc
  • Retinal arteries and veins
  • Macula

generally need to have eye dilated to see the fovea centralis

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3
Q

Infants are born with ____ vision.

A

myopia - 20/200

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4
Q

Middle age adults become presbyopic due to the ___ becoming rigid and the ____ becoming weak.

A

lens becomes rigid

ciliary muscle becomes weak

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5
Q

Oldest adults develop changes in the macula causing ___ or ____

A

low vision or decrease in central vision (macular degeneration)

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6
Q

Adult visual acuity of 20/20 develops by ___

years of age.

A

4 to 6

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7
Q

Can hormonal changes with the onset of puberty cause vision changes?

A

yes, can cause a change in refraction.

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8
Q

Pregnancy vision changes - hormonal adaptations where?

A

Pregnancy causes hormonal adaptations in the cornea and can cause a change in refraction.

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9
Q

By age 70, functionality of the extraocular muscles ___

A

decreases

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10
Q

By age 70, functionality of the extraocular muscles decreases and often upward gaze is limited to ____

A

15 degrees from horizontal plane.

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11
Q

For oldest adults, fibers in the central region of the lens may cause ___ in the lens.

A

cloudiness

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12
Q

For oldest adults, pupil size ___ and pupillary reflex becomes ____

A

decreases

sluggish, reacting slowly to changes in light

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13
Q

RUQ of abdomen - 2 main organs

A

liver, gallbladder

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14
Q

LUQ of abdomen - 2 main organs

A

stomach, body and tail of pancreas

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15
Q

Linea alba

A

white line that runs midline in the superficial layer of abdominal muscles/tendons

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16
Q

Pain from stomach is usually felt where?

A

epigastric area

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17
Q

Duodenum is around the head of the ___, which also extends across quadrants

A

pancreas

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18
Q

Biliary tree refers to

A

all of the ducts from the gallbladder, pancreas, liver that drain into the duodenum

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19
Q

Aorta is slightly ___ of center

A

left

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20
Q

Which is lower: right or left kidney?

A

right

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21
Q

The ___ and ___ muscles are important to assess for appendicitis

A

iliacus and psoas

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22
Q

When dividing the abdomen up into 9 regions, the three that are most referred to are

A

epigastric, umbilical, and hypogastric or suprapubic

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23
Q

LLQ of abdomen main organ: sigmoid colon

A

sigmoid colon

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24
Q

Right Lower Quadrant of abdomen main organ

A

appendix

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25
Q

If stomach pain is in LLQ, think

A

diverticulitis

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26
Q

Diverticulitis is most commonly found in

A

sigmoid colon (LLQ)

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27
Q

Environments that foster low levels of physical activity coupled with dependence on calorie-rich diets have been linked to development of DM and obesity, both of which are risk factors for ____

A

nonalcoholic fatty liver disease.

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28
Q

Hepatitis C infection, a major cause of ____ in the U.S., is associated with low SES, drug use, and incarceration.

A

cirrhosis

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29
Q

Once cirrhosis is established, lower surveillance rates for hepatocellular carcinoma (HCC) are seen in patients with ___ and ___

A

low SES and poor insurance.

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30
Q

What other systems should you be thinking about with abdominal symptoms aside from GI/GU? (5)

A
  • Respiratory
  • Cardiovascular
  • Musculoskeletal
  • Hematologic
  • Psych
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31
Q

Visceral abdominal pain - what is it caused by? what are the chief characteristics?

A

When hollow organs forcefully contract or become distended, or solid organs swell against their capsules

Gnawing, cramping or aching

Often poorly localized—points with hand

May writhe on table

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32
Q

Visceral abdominal pain examples (2)

A

gastroenteritis, biliary colic of gall stones (cholelithiasis) in cystic duct

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33
Q

cholelithiasis

A

biliary colic of gall stones

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34
Q

Parietal abdominal pain - what is it caused by? what are the chief characteristics?

A

When there is inflammation of the parietal peritoneum AKA peritonitis

Steady/constant

Often localized—points with finger

Likely lies still with knees up

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35
Q

peritonitis

A

inflammation of the parietal peritoneum

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36
Q

2 main examples of Parietal abdominal pain

A

appendicitis, inflammation of gall bladder (cholecystitis)

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37
Q

cholecystitis

A

inflammation of gall bladder

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38
Q

RUQ or epigastric visceral pain may be coming from ___ or ___

A

biliary tree or liver

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39
Q

epigastric visceral pain may be coming from ___ or ___ or ____

A

stomach, duodenum, pancreas

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40
Q

periumbilical visceral pain may be coming from what 3 organs?

A

small intestine, appendix, proximal colon

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41
Q

suprapubic or sacral visceral pain may be coming from the

A

rectum

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42
Q

Hypogastric visceral pain may be from what 3 organs?

A

colon, bladder, uterus

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43
Q

Referred pain from gallbladder may be felt in the ___ or ___

A

right shoulder and back

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44
Q

Referred pain from pancreas may be felt in the ___

A

mid-lower back

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45
Q

Hx of abdominal surgery is a risk factor for

A

obstructions

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46
Q

Order of abdominal exam

A

Inspection, auscultation, percussion, palpation

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47
Q

When should you examine painful areas in abdominal exam?

A

last

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48
Q

Signs that hernia might be strangulated (blood supply cut off)

A

changes in color, n/v, fever, pain, no bowel movements

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49
Q

Sign of hernia incarceration

A

can’t push in

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50
Q

Diastasis Recti - is this benign or not? when is it common?

A

When linea alba separates and some abdominal contents protrude

Benign

Common in pregnancy

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51
Q

Normal contour of infant abdomen:

A

round/protuberant

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52
Q

Normal contour of preschool abdomen:

A

lumbar lordosis

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53
Q

8 Fs of Abdominal Distention

A 
Fat
Fetus
Flatus
Feces
Full bladder
Fibroids
Fluid
Fatal tumor
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54
Q

6 conditions where you may hear more bowel sounds

A

diarrhea, colic, malrotation, intussusception, early obstruction, diverticulitis

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55
Q

5 conditions where you may hear less bowel sounds

A

total obstruction, paralytic ileus, peritonitis, severe ascites, post-surgery

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56
Q

Spleen percussion: 2 techniques

A
  1. Percuss for splenic dullness from border of cardiac dullness at 6th rib to anterior axillary line and down to costal margin (Traube’s space)
  2. Splenic percussion sign - percuss, then have patient take deep breathe, and it’ll move - if enlarged, it’ll move into intercostal space that you’re percussing
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57
Q

Easiest to palpate organs in what patient population?

A

younger children

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58
Q

Why does the spleen float and liver doesn’t?

A

Because liver is next to diaphragm and can’t move as easily

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59
Q

What is a hernia?

A

Protrusion of peritoneum or intestine through weakened spot in musculature of abdominal wall

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60
Q

Hernia characteristics

A

Usually painless, intermittent, reducible, bulges with crying/ straining

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61
Q

Umbilical hernias in infants ___ need intervention

A

rarely

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62
Q

What 3 kinds of hernias are surgically corrected?

A

Inguinal, femoral, and most ventral hernias

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63
Q

Scaphoid contour means

A

markedly concave or hollowed

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64
Q

Peristalsis is often seen in what type of patient? Often indicates what?

A

thin

obstruction

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65
Q

Pulsations from the abdominal aorta are often seen in what type of patient? May indicate what 2 things?

A

thin

aneurysm or widened pulse pressure

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66
Q

Abdominal breathing normal in ___ and ___

A

infants and toddlers

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67
Q

Subcostal retractions may indicate ____

A

respiratory distress

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68
Q

___ or ____ may present with complaint of abdominal pain and altered respirations

A

Pneumonia or pleural effusion

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69
Q

If a patient is guarding or having pain with walking or coughing, and abdominal distention may be present, and they prefer supine position with knees flexed, what might this be?

A

Appendicitis/peritonitis

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70
Q

What 2 things are we auscultating the abdomen for?

A
  • Bowel sounds

- Vascular sounds – listen for bruits over aorta, renal, iliac and femoral arteries

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71
Q

____ on abdominal auscultation may be heard with pleural inflammation or peritoneal inflammation

A

Friction rub

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72
Q

In appendicitis, bowel sounds may be ___ or ____

A

decreased OR hyperactive

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73
Q

Why do you need to auscultate right lower lobe (RLL) of lungs carefully with appendicitis pain?

A

to rule out lobar pneumonia with referred pain

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74
Q

Normal bowel sounds are clicks and gurgles, ___/min

A

5-35

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75
Q

Absence of bowel sounds established after ___ minutes

A

5

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76
Q

5 key points/steps of abdominal percussion

A

1) Start w/overview of 4 quadrants for gas, fluid or masses
2) Liver span and tenderness
3) Spleen size
4) Costovertebral angle tenderness (+ or - CVAT)
5) Pain over other areas of
inflammation - Watch facial expressions, may be too uncomfortable to perform in appendicitis

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77
Q

Tympany

A

High pitched sound, musical quality

Heard over air-filled structures (stomach, gas in
GI tract)

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78
Q

Dullness

A

Short high-pitched sound

Little resonance

Heard over solid or fluid filled organs adjacent to air containing organs (liver, spleen, distended bladder)

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79
Q

Resonance

A

Sustained note, moderate pitch

Heard over lung tissue primarily

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80
Q

Liver span in adult usually ___ cm and usually does not extend below right costal margin more than ___ cm

A

6-12 cm

2 cm

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81
Q

Liver percussion for span - how?

A

Start at right mid-clavicular line, below umbilicus, percuss upward until dullness, then percuss downward until dullness

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82
Q

Bimanual percussion for tenderness of liver and kidneys

A

Place palm of one hand over organ

Strike hand with ulnar surface of other hand

If organs are inflamed, there will be pain

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83
Q

What does light abdominal palpation assess for?

A

skin turgor, muscle tone, superficial lesions or masses, areas of resistance, muscular or peritoneal tenderness

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84
Q

What does moderate abdominal palpation assess for?

A

slow approach to deep palpation, further assessment of tender areas

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85
Q

What does deep abdominal palpation assess for?

A

Identify liver edges, kidneys, and masses by location, size, shape, consistency, tenderness, pulsation, mobility

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86
Q

RUQ: liver palpation

A

PALPATE WITH RIGHT HAND
STARTING BELOW UMBILICUS
AND MOVING UPWARD UNTIL LIVER IS PALPABLE

alternative: hooking

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87
Q

If kidney is enlarged, may be felt at ____ between opposing examining hands

A

inferior lateral border of ribs

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88
Q

Which kidney is more likely palpable?

A

right

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89
Q

how to palpate spleen

A
  • With one hand below the left costal margin, palpate under costal margin at the anterior axillary line
  • Attempt to lift spleen anteriorly by lifting with one hand and palpating with the other
  • Roll client onto right side to bring spleen towards midclavicular line and examining hand
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90
Q

palpation of abdominal aorta is particularly important for what patients?

A

Important in adults > 50 and anyone with known or suspected cardiovascular disease

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91
Q

Note that you will __ rupture an aneurysm when palpating abdominal aorta

A

not

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92
Q

Concerned about abdominal aortic aneurysm (AAA) if lateral pulsations ___ cm diameter

A

> 3

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93
Q

If newborn has if scaphoid, abdomen, think

A

diaphragmatic hernia

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94
Q

femoral pulses will be weak or absent in infant with

A

coarctation of the aorta

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95
Q

in newborns/infants, you might be able to palpate liver edge ___ cm and spleen edge ___ cm below costal margin

A

1-3

1-2

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96
Q

normal abdomen contour in toddlers/children is

A

protuberant

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97
Q

If toddler very upset, palpate abdomen when?

A

during inspiration between cries

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98
Q

Why should you percuss suprapubic area in older adults?

A

for urinary retention

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99
Q

While there is abdominal fat accumulation in older adults, there is less ___ and ___, so palpation may be
easier

A

less muscle mass and connective tissue

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100
Q

Positive Murphy’s sign for cholecystitis

A

Palpate deeply at costal margin at mid-clavicular line

Patient takes deep breath, which forces liver and gall bladder down toward examining fingers

Sharp increase in tenderness is +

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101
Q

Most common cause of acute surgical abdomen in childhood

A

appendicitis

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102
Q

When is appendicitis most common? When is it rare?

A

Rare in early childhood or elderly, most common 11-20 y.o.

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103
Q

How is appendicitis diagnosed?

A

Diagnosed by CT or during surgery

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104
Q

Main symptoms of appendicitis

A

Anorexia and dull, aching, steady peri-umbilical pain that localizes to right lower quadrant after 4-6 hours. May have -

▪ nausea and vomiting starting AFTER abdominal pain
▪ diarrhea or constipation
▪ low grade fever
▪ urinary or respiratory symptoms

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105
Q

Inflammation of appendix secondary to obstruction, may suppurate and wall off or rupture, leading to

A

peritonitis

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106
Q

McBurney’s point

A

just below the middle of a line joining the umbilicus and the anterior superior iliac spine

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107
Q

Rovsing’s sign

A

If palpation of LLQ increases the pain felt in the RLQ, the patient is said to have a positive Rovsing’s sign and may have appendicitis

“referred tenderness”

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108
Q

Iliopsoas sign

A

passive extension and flexion of hip - positive if abdominal pain during these exercises

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109
Q

Obturator sign

A

Patient lies supine with right thigh flexed 90 degrees

Examiner immobilizes right ankle with right hand

Left hand rotates right hip by:
Pull right knee laterally (hip external rotation)
Pull right knee medially (hip internal rotation)
Left obturator/Pelvis examined in similar fashion

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110
Q

What 3 CN are you testing with extraocular movements?

A

III, VI, IV

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111
Q

Choroid

A

vascular layer between the retina and scleral area

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112
Q

Visual cortex does processing in the ___ area of the skull

A

occipital

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113
Q

When an athlete presents with concussion, what is sometimes the first symptom they have on the field?

A

blurred vision

because it impacts the occipital area which is the processing area for vision

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114
Q

With latino infants, you’ll see thickened ___ which makes it a little more challenging to evaluate muscle balance

A

thickened epicanthal folds

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115
Q

Myopia more common in what 2 ethnicities?

A

Asian and Filipino-Americans

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116
Q

Latino and Asian - retina appears

A

pale

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117
Q

African American - retina appears

A

dark

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118
Q

European - retina appears

A

reddish or orange

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119
Q

what impacts eye during neonatal?

A

If they need resuscitation or are on oxygen

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120
Q

visual changes can be induced in last trimester by

A

HTN/diabetes

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121
Q

medications in older adults that can cause eye issues?

A

anticholinergics which dry out the eyes, long-term steroids

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122
Q

What does 20/20 mean?

A

You can see at 20 feet what the average person can see at 20 feet

If 20/40, you can see at 20 feet what the average person can see at 40 feet

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123
Q

Start doing visual acuity checks at what age? What result would you refer?

A

age 3

If they’re 20/40 or above

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124
Q

Corneal Light Reflex

A

tests the balance of the extra-ocular muscles.

Light should be symmetrically reflected off the cornea.

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125
Q

Cover uncover test

A

confirms balance of the extraocular muscles and detects unequal refraction in eyes

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126
Q

Pupillary reflex

A

response to light both direct and consensual

Often done in ER if you present with trauma post MVA

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127
Q

If glaucoma, they will have a significant change in the _____ of the cornea

A

curvature

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128
Q

Cornea examination

A

testing the curvature of the cornea by shining the light source obliquely (45 degree angle) - also to evaluate the clarity of the chamber and the lens

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129
Q

Red or Retinal Light Reflex (RLR)

A

Light illuminating from the retina and indicates the clarity of cornea, lens and chamber

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130
Q

Normal cup:disc ratio in retina is

A

<1:2

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131
Q

Comparing the arteries vs. veins in retina

A

arteries are brighter red and narrower than the veins

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132
Q

avascular area on the retina with irregular borders

A

macula

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133
Q

area of central vision on macula

A

fovea centralis

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134
Q

chronic exposure to dust/wind/sun can cause ___ which is common in migrant farm workers

A

pterygium

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135
Q

pooling blood in iris caused by trauma to the head

A

hyphema

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136
Q

Always evaluate ___ in UE complaints, and ____ in LE complaints.

A

neck in UE

lower back in LE

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137
Q

Always include neurovascular exam ___ and ____ to the complaint.

A

distal and proximal

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138
Q

What peripheral nerve is compressed/ entrapped/”pinched” in carpal tunnel syndrome?
A. Ulnar
B. Radial
C. Median

A

C. Median

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139
Q

No numbness, tingling, or pain into thumb, 2nd and 3rd digits bilaterally after 60 seconds. What does this mean?

A

negative Phalen’s bilaterally.

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140
Q

Numbness into 2nd digit at 20 seconds on right hand. What does this mean?

A

positive Phalen’s on right (R=20 seconds at D2)

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141
Q

Pain up into left` forearm at 30 seconds. What does this mean?

A

negative Phalen’s on left

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142
Q

Numbness and pain into all digits on right

A

positive Phalens-all digits on right (but think higher up compression)

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143
Q

Guyon’s canal is what nerve?

A

ulnar

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144
Q

Cubital tunnel is what nerve?

A

ulnar nerve

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145
Q

Tarsal tunnel is what nerve?

A

tibial nerve

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146
Q

Numbness, pain or tingling into thumb, 2nd and/or 3rd digits of left` hand (palmar).

A

– Positive Tinel’s at left carpal tunnel (into thumb)

– Negative Tinel’s at right carpal tunnel.

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147
Q 
What is the name of bony osteophytes on the DIP joint?
A.  Bouchard’s nodes
B.  Rheumatoid nodules 
C.  Heberden’s nodes 
D.  Tophaceous gout
A

C. Heberden’s nodes

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148
Q

Lateral epicondylitis (AKA tennis elbow): the epicondyles are part of what bone?
A. Proximal Ulnar
B. Proximal Radius
C. Distal Humerus

A

C. Distal Humerus

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149
Q

the olecranon is the proximal _____

A

proximal ULNA

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150
Q

High yield questions in MSK presentations (5)

A
  1. Antecedent events leading up to the symptom
    (Any acute trauma? Cumulative exposures?)
  2. Focus on the functional impact of the symptoms: ADL? Work? Sports? Exercise?
  3. Hand dominance?
  4. Trying to identify exact location of pathology: is it bone, joint space, tendon/ligament, muscle, bursa?
  5. Do not forget about referred pain
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151
Q

Key PMH in MSK presentations (6)

A
  • Osteoarthritis?
  • Rheumatoid arthritis?
  • Fibromyalgia?
  • Osteoporosis?
  • Cancer?
  • Obesity/anorexia?
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152
Q

Note that Fluoroquinolone antibiotics (e.g., Ciprofloxacin) have a Black box warning for what?

A

tendon rupture

risk increases with age

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153
Q

Occupational History - Work (“WHACS”) (in/out of home)

A

W- What do they do for work? (Percent time sitting, standing, lifting, pulling, pushing? How much weight lifted, pushed, pulled?)

H - How do they do it?

A - Anyone concerned about exposures on/off the job?

C - Coworkers with similar symptoms?

S - Satisfaction with work?

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154
Q

If you were worried about acute hot red joint….search for what?

A 
Search for port of entry for infection:
• Any STD exposure? 
• IVDA?
• Dental procedures? 
• Abscess/Cellulitis? 
• Cystometrics (bladder testing)?
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155
Q

Example of neck problem that causes acute or chronic referred shoulder pain?

A

Cervical radiculopathy

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156
Q

Example of pulmonary problem that causes chronic referred shoulder pain?

A

Pancoast tumor of the lung (located in the superior pulmonary sulcus)

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157
Q

Example of cardiac problem that causes acute referred shoulder pain?

A

Angina

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158
Q

Example of dermatology problem that causes acute referred shoulder pain?

A

Herpes Zoster (Shingles)

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159
Q

Example of GI problem that causes acute referred shoulder pain?

A

Ruptured colon after colonoscopy

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160
Q

Apley Scratch Test (3 components)

A

External rotation and abduction (Lift and pat self on back)
Internal rotation and adduction (Touch scapula from behind with opposite arm)
Internal rotation and abduction (Scratch shoulders)

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161
Q

4 muscles of the rotator cuff

A
  1. Supraspinatus tendon (posterior)
  2. Infraspinatus tendon (posterior)
  3. Teres minor tendon (posterior)
  4. subscapularis (anterior)
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162
Q

Intrinsic risk factors for tendon injury (2)

A
  • Narrowed space under the acromium

* Excessive physical training with inadequate muscle rest

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163
Q

Example of hip issue that could cause chronic referred pain to lumbar spine?

A

Avascular necrosis of the hip

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164
Q

Example of hip issue that could cause acute or chronic referred pain to lumbar spine?

A

Abdominal aorGc aneurysm

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165
Q

Example of hip issue that could cause acute or chronic referred pain to lumbar spine?

A

Ruptured ovarian cyst or malignancy

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166
Q

Example of hip issue that could cause acute or chronic referred pain to lumbar spine?

A

Acute prostatitis or prostate malignancy

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167
Q

Example of hip issue that could cause acute or chronic referred pain to lumbar spine?

A

Herpes Zoster (Shingles)

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168
Q

Example of hip issue that could cause acute or chronic referred pain to lumbar spine?

A

Pyelonephritis or polycystic kidney disease

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169
Q

Straight leg test for lumbar spine (passive)

A

– 30-60 degrees
– Lower 2 inches to remove hamstring factor
– Dorsiflex ankle

– If painful in lumbar area or down leg, POSITIVE

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170
Q

FABER Hip Exam

A

F: Flexion
AB: Abduction
ER: External Rotation

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171
Q

If patient presents with hand pain, always examine the ____

A

neck

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172
Q

4 point approach to the MSK PE

A

Inspection → Palpation → ROM → Provocative tests

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173
Q

Drawer test

A

pulling the tibia towards you to see if anterior cruciate is intact

if you can open the drawer, it’s positive for a sprain of the ligament which would be grade 1, 2 or 3

complete rupture would be a grade 3 spain

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174
Q

Lachman test is very similar to what other test?

A

Drawer test

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175
Q

Focus of the pre-sports participation exam is what?

A

Injury prevention

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176
Q

Carpal tunnel/median nerve compression could be caused by…?

A

Pregnancy/fluid retention
thyroid disorders
amyloidosis
multiple myelomas → anything that lays down deposits in confined space

Work-related: Repetitive motion, venous congestion, scar tissue

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177
Q

Median nerve primarily innervates sensory portions of which fingers?

A

first, second, third, and palmar ½ of third finger

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178
Q

2 provocative tests for carpal tunnel are what?

A

Tinel’s test

Phalen’s test

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179
Q

Tinel’s test

A

Percuss reflex hammer over the pillar of the palm - trying to stimulate the numbness/tingling (if they feel it, it would be positive) - positive is reproduction of their paresthesias in D1, D2, D3, or D4

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180
Q

Phalen’s test

A

Forced flexion of wrists (hold wrists against one another) for 60 seconds

If patients say they feel buzzing in a particular hand/digit - you time it - the EARLIER they’re feeling the symptoms, the higher the predictive value that they have carpal tunnel syndrome

If all digits, you might not think CT - maybe think diabetes or compression in brachial plexus

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181
Q

Classic symptoms of carpal tunnel:

A

numbness, tingling, pain, wake up in middle of night with numbness (because we curl up and flex our wrists)

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182
Q

thenar wasting/atrophy on the hand is an associated advanced finding of what?

A

carpal tunnel

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183
Q

osteoarthritis

A

usually symmetrical

common finding with aging

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184
Q

Swann neck deformities

A

(NOT normal but sadly common in rheumatoid arthritis) - subluxation of the joint

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185
Q

How do you treat Ganglion cyst?

A

Hit them with a bible - they’ll rupture and reabsorb

Sometimes they’ll spontaneously reabsorb within 9-12 months

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186
Q

Tendons vs. ligaments

A

Tendons are muscles to bone

Ligaments are bone-to-bone

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187
Q

Grade 3 sprain would indicate what

A

total rupture off the bone - worried about can that person weight-bear off that joint?

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188
Q

Remember that you’re supposed to approach a task with your arms ____

A

supinated

not pronated (protects the elbows)

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189
Q

Tennis elbow (Lateral epicondylitis) test

A

Take the wrist straight in neutral position, make them flex wrist, and have them extend and lift - examiner will apply resisted wrist flexion - if they say “ouch” at the elbow, that’s positive

This is diagnostic for Lateral epicondylitis

Same test for medial epicondylitis

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190
Q

septic joint? Think

A

STI

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191
Q

___ is probably most important access point of infection

A

IV drug use

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192
Q

Medial and Lateral Collateral Ligaments…
• A. Prevent the anterior-posterior movement of the tibia
• B. Stabilize the meniscus placement between the femur and the tibia.
• C. Stabilize the lateral motion of the tibia relative to the femur
• D. Prevent the patella from grinding between the femoral condyles.

A

• C. Stabilize the lateral motion of the tibia relative to the femur

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193
Q

Sperm is produced in ___, mature in ___, travel up the ____

A

testes

Epididymis

Vas Deferens

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194
Q

Spermatic Cord is what we examine anatomically, and it contains what 4 things?

A

arteries, veins, nerves, lymphatics

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195
Q

Where Glans meets penile shaft

A

Corona

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196
Q

Opening at tip of glans

A

Meatus

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197
Q

Covers the glans

A

foreskin

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198
Q

Connects foreskin to glans

A

Frenulum

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199
Q

When performing Femoral Vein venipuncture, aim ___ to pulse

A

medially

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200
Q

If there’s a Femoral Vein DVT, you would see pain and tenderness in the ____

A

medial upper thigh

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201
Q

If there is an increase in testicular or penile size before age 9, would you refer?

A

yes, urgent referral

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202
Q

If there is an increase in pubic hair before age 9, would you refer?

A

non-urgent but would refer

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203
Q

Delayed puberty in boys is defined as

A

no increase in penile or testicular size by age 14

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204
Q

Ages 40-60 in men sees decrease in testosterone, which leads to what 6 things?

A
  • Takes longer to achieve erection
  • Erection maintained longer
  • Orgasm may be less intense
  • Longer refractory period
  • Penile size decreases
  • Scrotum more pendulous
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205
Q

If there’s Dysuria in the Meatus, think

A

local lesion

206
Q

If there’s Dysuria in the Length of penis, think

A

urethritis

207
Q

If there’s Dysuria in the Suprapubic area, think

A

cystitis

208
Q

What type of incontinence: Leakage w/ exertion, sneezing, coughing

A

Stress incontinence

209
Q

What type of incontinence: Can’t make it to void; can’t defer urge

A

Urge incontinence

210
Q

What type of incontinence: Leaks from full bladder or Nocturnal enuresis (bedwetting)

A

Overflow incontinence

211
Q

Lice vs nits

A

Nits: stuck on hair base
Lice: move

212
Q

Maculae Ceruleae

A

bluish spots where lice have fed

213
Q

Foreskin too tight is known as

A

Phimosis

214
Q

What is it called if the Foreskin is stuck in retraction? Is this an emergency?

A

Paraphimosis

yes, surgical emergency

215
Q

Fordyce Spots: where are they found? Are they normal?

A
  • From sebaceous glands. Normal. Harmless.

* Commonly on penis, scrotum, labia, lips

216
Q

Peyronie’s Disease

A

painful erections

217
Q

Herpes progression

A

Vesicles / Pustules –>  Ulcers –>  Crusts

218
Q

If there is a solitary, painless, non-tender ulcer w/ raised borders, think

A

Primary Syphilis – Chancre

219
Q

Balanitis

A

Usually Yeast
Red; not just Smegma
***Itchy

220
Q

Warts with “Cauliflower” appearance are called

A

Condylomata Acuminata (warts)

221
Q

Pearly Penile Papules (PPP’s) are a ___ variant

A

normal

222
Q

Penile Enlargement Surgery is or is not approved by Amer. Urological Assoc.

A

not

223
Q

Average Flaccid Penile Length and girth

A

length: 9cm
girth: 10cm

224
Q

When would you perform Transillumination of testes?

A

If unexplained swelling

225
Q

Are Testes usually the same size? Average size? What testis normally hangs lower?

A

Yes

3.5-5.0 cm. long x 3 cm. x 3 cm.

Left

226
Q

___ in particular is sensitive to touch on PE

A

Epididymis

227
Q

Testicular Cancer has a : ____ incidence, ___ cure rate. Occurs in men: ___ y.o. 4 main risk factors:

A

low incidence, high cure rate

15-35 years old

Risk factors: Cryptorchidism, Down’s, Fam. Hx, HIV

228
Q

Do any professional organizations recommend routine screening for testicular cancer?

A

no

229
Q

Undescended testes/ Cryptorchidism

A

– High risk of cancer

– Common in infancy; 1% of 1 y.o. boys

230
Q

How do you treat Epididymitis-Orchitis? More common in what age?

A

Cultures and Antibiotics
(maybe IV)

Adults

231
Q

How do you treat Testicular Torsion? More common in what age?

A

emergency surgery

Kids

232
Q

Varicocele most commonly feels like what? Which side?

A

Bag of worms

Left side (right side very rare)

it’s Varicose veins

usually asymptomatic, can affect fertility

233
Q

Spermatocele

A
  • Fluid-Filled Cyst
  • Always superior to testis, posterior aspect
  • Palpated as distinct from testis
  • Ultrasound if necessary
  • No treatment unless big and uncomfortable
234
Q

Hydrocele

A
  • Fluid within scrotal membranes
  • Transilluminates (solid masses don’t)
  • Usually develop over long period of time
  • New acute onset may warrant ultrasound
  • No treatment unless uncomfortable
235
Q

If you detect Suprapubic Dullness, think

A

bladder distention

236
Q

Prostate exam is part of the ___ exam

A

rectal

237
Q

Perform an inguinal exam only ___

A

if indicated by history

238
Q

What is the most common type of herniation

A

Indirect Inguinal Hernia

239
Q

Indirect Inguinal Hernia

A
  • Most common type
  • Herniation through internal inguinal ring
  • Often not visible
  • Can remain in canal or pass into scrotum
  • May only be felt during Valsalva
240
Q

Findings of Incarceration or strangulation

A

very tender

often nausea / vomiting

241
Q

Rectum is __ cm long and ___ to anus

A

12 cm long, superior to anus

242
Q

Anus: how long? Lower vs. upper half

A

• 2.5-4.0 cm long (adult)

  • Lower half innervated by somatic sensory nerves
  • Upper half under autonomic control – Insensitive
243
Q

internal vs external sphincter

A

• Internal is involuntary
– Urge to defecate when feces fill rectum
– Reflexive stimulation to relax sphincter

• External is voluntary

244
Q

By 12 months, infants should have ___ stools per day. Control external sphincter by ___ months

A

1-2

18-24

245
Q

Afferent neurons in rectal wall ___ with aging – interferes with relaxation of internal sphincter

A

degenerate

246
Q

Aging leads to rectal ___ with stool

A

distention

– Requires increased pressure to sense stool – Leads to stool retention and constipation

247
Q

Internal sphincter ___ tone with aging

A

loses

248
Q

Minor vs major fecal incontinence

A

– Minor: staining w/ flatus or liquid stool

– Major: involuntary excretion of feces

249
Q

Technique for rectal exam on kids

A

On back, legs lifted up and held flexed on abdomen

250
Q

“Smooth, firm, symmetrical, sulcus palpable. No tenderness, no nodules.” -

A

normal prostate

251
Q

“Sulcus palpable” =

A

Not Enlarged

252
Q

Normal prostate not palpable in __ and ___

A

Children, Young Adolescents

253
Q

Normal prostate size:

A

walnut

254
Q

If there is tenderness from local lesion, you might think

A

Fissure; Perirectal abscess

255
Q

Diffuse Rectal Tenderness – think

A

Proctitis

256
Q

Main cause of bladder cancer?

A

Cigarettes

257
Q

The one orifice you can’t get Chlamydia from?

A

the mouth

258
Q

Highly unlikely to get HIV from __ sex

A

oral

259
Q

What single question can distinguish Organic etiology (physical causes) from Psychological etiology of erectile dysfunction?

A

Early morning erections?

260
Q

Retrograde ejaluation (goes back into the bladder) can be a side effect of __ meds

A

BPH

261
Q

Urethral discharge indicates

A

STI of some sort

262
Q

Masses of testicular cancer

A

Hard and fixed

non tender

263
Q

Best patient position to examine inguinal lymphadenopathy or femoral pulse?

A

supine

264
Q

Best patient position to examine hernia?

A

patient standing, examiner sitting

265
Q

Which hernia is more common in women?

A

femoral

266
Q

5 parts of the neuro exam

A

1) Mental Status
2) Cranial Nerves
3) Motor and Reflexes
4) Sensory
5) Cerebellar and Gait

267
Q

What is consciousness?

A

State of awareness of self and environment

268
Q

Wakefulness - what is it, what part of brain is it associated with?

A

● eye opening (spontaneous or to external stimulus)

● in cerebral hemispheres, particularly in cortex –> brainstem and thalamic reticular activating system (RAS)

269
Q

Awareness- what is it, what part of brain is it associated with?

A

● cognition, affect, memory, and other mental functions

● cerebral hemispheres (with RAS)

270
Q

coma definition - how would you test

A

eyes-closed state of unarousable unresponsiveness

sternal rub, nailbeds

271
Q

To assess wakefulness, choose what tool?

A

Glasgow Coma Scale

272
Q

What are the 3 parts of the GCS?

A

eye opening
verbal response
motor

273
Q

Cognitive Impairment and Dementia - 5 components

A
  • Orientation, attention, and memory
  • Language impairment
  • Visuospatial dysfunction
  • Executive dysfunction
  • Personality and behavioral changes
274
Q

Vast majority of language impairment is in the ___ hemisphere

A

left - dominant

275
Q

Visuospatial dysfunction and some forms of attention live in the ____ hemisphere

A

right/non-dominant

276
Q

Executive dysfunction (ability to solve problems, not perseverate) live ____ lobes

A

bilaterally in frontal lobes

277
Q

Personality/behavior is ___ distributed in the brain

A

diffusely distributed in the brain

278
Q

_____ is where motor function lives (picking something up)

A

prefrontal gyrus in the frontal lobe

279
Q

____ lobes have analog of sensory function (pain, temp, proprioception, light touch, etc.) - sensory association cortex

A

parietal lobes

280
Q

____ lobe contains auditory processing and comprehension of language, both together important in memory

A

temporal lobes

281
Q

____ lobe processes visual information that comes in from eyes (eye exam is high-yield part of neuro exam b/c the pathways)

A

occipital

282
Q

Orientation becomes more fluid going from ____ to ____

A

eft to right (patients are rarely disoriented to person/often know at base level who they are)

Person, place, date, situation

283
Q

4 components of orientation

A

Person, place, date, situation

284
Q

How do you assess attention in the general part of the mental status exam?

A

Digits - 6 forward or 4 backward, serial 7s or 3s

spelling WORLD backwards and forwards

285
Q

How do you assess memory in the general part of the mental status exam?

A

— 3 objects: ask patient to remember them, then ask for them at 5 minutes

  • “2/3 @ 5 min without cues, 3/3 with cues”
286
Q

___ hemisphere is dominant in nearly all right-handed, most left-handed people

A

Left

287
Q

Test language carefully if ___ hemiparesis

A

right

288
Q

Dysarthric

A

abnormality in motor articulation of speech

289
Q

Testing the left hemisphere/dominant hemisphere for language: 3 components

A

naming, repetition, comprehension

Indicates lesions in various areas/lobes

“No ifs, ands, or buts about it”

290
Q

___ hemisphere controls Neglect and Visuospatial Function

A

Nondominant Hemisphere – right

291
Q

___ hemisphere is the non-dominant hemisphere in nearly all righties, most lefties

A

Right

292
Q

Test for neglect syndromes carefully if ___ sided hemiparesis

A

left

293
Q

striking, memorable syndromes (3) of there being an issue in the Nondominant (right) Hemisphere relating to Neglect and Visuospatial Function

A

anosognosia
asomatognosia
hemispatial neglect

294
Q

anosognosia

A

can’t articulate what’s wrong with them (can’t articulate that they have paralysis in one arm)

295
Q

asomatognosia

A

don’t recognize their own hand

loss of recognition or awareness of part of the body

296
Q

Hemispatial neglect

A

not moving left side of body, head turned to right

characterised by reduced awareness of stimuli on one side of space, even though there may be no sensory loss

297
Q

4 points of exam of Nondominant (right) Hemisphere relating to Neglect and Visuospatial Function

A
  • constructional apraxia (inability of patients to copy accurately drawings or three-dimensional constructions)
  • agraphesthesia (can’t tell what shape being drawn in hand)
  • extinction
  • neglect clock
298
Q

symptoms of Frontal lobe dysfunction (4)

A

disinhibited, slow, concrete, perseverative

299
Q

Mini-Mental Status Exam – how many points are there? Whats the cutoff score? What are the limitations?

A
  • 30 point scale that’s a screening battery
  • Typical cutoff is 24 (below that is considered cognitively impaired)
  • Limitations: education level, language, NOT diagnostic
  • Should not be used for anyone under 8th grade school level
300
Q

Causes of anosmia:

A
  • head trauma
  • early Parkinson’s
  • normal aging
  • URI, meds, and many others
301
Q

Is CN I (olfactory) tested in clinical?

A

Not really/rarely

302
Q

How do you test CN I (olfactory)? What is the primary symptom of CN I (olfactory) dysfunction?

A

Test with aromatic, not noxious, compounds.

sx: anosmia
common and underrecognized consequence of traumatic brain injury

303
Q

Note that anosmia can diminish ___ and is associated with ___

A

taste

weight loss in the elderly

304
Q

CN I (olfactory) is not a peripheral nerve but a ___

A

CNS tract

305
Q

CN I

A

olfactory

306
Q

CN II

A

optic

307
Q

CN III

A

oculomotor

308
Q

CN IV

A

trochlear

309
Q

CN V

A

trigeminal

310
Q

CN VI

A

abducens

311
Q

CN VII

A

facial

312
Q

CN VIII

A

vestibulocochlear - auditory

313
Q

CN IX

A

glossopharyngeal

314
Q

CN X

A

vagus

315
Q

CN XI

A

spinal accessory

316
Q

CN XII

A

hypoglossal

317
Q

CN II (optic) is not a peripheral nerve but a ____

A

CNS tract

318
Q

What is the only part of the nervous system that you can directly look at

A

CN II optic

319
Q

CN II is the ___ limb of the pupillary reflex

A

afferent

320
Q

4 components of CN II assessment

A
  • Check acuity: “+C” (if possible) - eye card
  • Fundi
  • Pupillary reflex
  • Visual fields (also tests optic chiasm & optic radiations to occipital lobe)
321
Q

Large lesions in the optic chiasm will take out the ____ fields of both eyes (bitemporal hemianopsia)

A

outer

322
Q

If there’s a lesion behind the optic chiasm, there will be a loss of the ___ optic fields

A

homonymous

323
Q

If there’s a lesion behind the ____ lobe, the patient will have difficulty with less visual field in each eye

A

right occipital

324
Q

Is Binasal hemianopsia rare?

A

yes

325
Q

CN 3 (oculomotor), 4 (trochlear), 6 (abducens) are the ___ to extraocular muscles

A

motor

326
Q

CN ___ is levator palpebrae, pupillary sphincter

A

3

327
Q

Eye muscles: Lateral rectus muscle corresponds to CN ___ = 6
Superior oblique = 4
Everything else is 3

A

6

328
Q

Eye muscles: Superior oblique muscle corresponds to CN ___

A

4

329
Q

CN ___ is the efferent limb of the pupillary reflex

A

3

330
Q

Assessment of CN 3, 4, 6

A
  • PERRL (pupils equal, round, reactive to light)
  • ptosis
  • Ask patient to track your finger in “H” shape: eyes should move smoothly & conjugately
331
Q

Ptosis would be present if there’s a ___ palsy

A

3rd nerve

332
Q

3 divisions of the trigeminal nerve

A

VI Ophthalmic
VII Maxillary
VIII Mandibular

333
Q

Sx of CN 3, 4, 6

A

diplopia, that goes away if they close one eye

334
Q

CN V trigeminal is ____ to the face and ___ to the temporalis muscle and other muscles of mastication

A

Sensory to face

motor to the muscles

335
Q

Positive and negative CN V (trigeminal) symptoms

A

numbness (negative), pain or paresthesias (positive)

336
Q

CN V (trigeminal) is the ___ part of the corneal reflex

A

afferent

337
Q

How to assess CN V (trigeminal)

A

Touch on both sides in all 3 divisions (not easy to do in patient who isn’t cooperative)

To check motor: bite down while palpating

338
Q

CN VII (facial) is ___ to the muscles of facial expression. It’s also the ___ part of the corneal reflex.

A

motor

efferent

339
Q

Symptoms of CN VII (facial) dysfunction

A
  • weak face
  • labial dysarthria (manifests as P and B sounds - they’ll get gutturals or linguals but can’t say Pa Pa Pa)
  • hyperacusis
  • loss of taste in anterior 2/3 of tongue
340
Q

How to test the corneal reflex

A

touch cornea with cotton swab - eyes closing consensually

341
Q

How to assess CN VII (facial)

A

Raise eyebrows
Close eyes tightly
Smile
Say pa-pa-pa, ba-ba-ba

note that nasolabial fold asymmetry on one side would be problematic

342
Q

Upper vs Lower Motor Neuron Facial Weakness: Weak right face could indicate what 2 things?

A

Either problem with the right CN7 (aka a LMN facial weakness

OR

Problem on left mid-pons/brainstem or above the medulla (UMN facial weakness)

343
Q

If a patient is very weak on the right side, the forehead will be

A

smooth

344
Q

LMN lesions involve the upper and lower face ____, while UMN lesions tend to relatively spare the ___ part of the face

A

symmetrically

upper

so if a patient really can’t close their eye, that’s probably a lower motor neuron lesion -

give them eye drops and eye patch so they don’t dry out the cornea

345
Q

Sx of CN 8 (Vestibulocochlear - Acoustic) (4)

A

hearing loss, tinnitus, vertigo, imbalance

346
Q

Assessment of CN 8 (Vestibulocochlear - Acoustic)

A

Compare whisper or rubbed fingers side to side.

May see nystagmus when checking extraocular movements.

347
Q

CN 9 (glossopharyngeal) and 10 (vagus) are the ____ and ____ of pharynx, with autonomic functions. Also the ___ reflex

A

sensory and motor

also gag reflex

(important in patients that are comatose, may help to decide if they need to be intubated)

348
Q

Sx of CN 9 (glossopharyngeal) and 10 (vagus)

A 
dysphagia, 
palatal dysarthria (K and G sounds are sloppy)
349
Q

How to assess CN 9 (glossopharyngeal) and 10 (vagus)

A

“Say ah:” uvula deviates AWAY from affected side

Say ka-ka-ka, ga-ga-ga (gag reflex)

350
Q

CN 11: Spinal Accessory is ___ to trapezius and sternocleidomastoid

A

motor

351
Q

Sx of CN 11 dysfunction:

A

shoulder weakness, pain

352
Q

How to assess CN 11

A

Ask patient to:
Shrug
Turn head side to side against resistance

353
Q

If there is an issue with right CN 11, the patient will ____

A

Raise R shoulder Turns head to L

354
Q

CN XII Hypoglossal is ___ to the tongue muscles

A

motor
sx: lingual dysarthria Ask patient to:
Protrude tongue: deviates toward affected side (with atrophy if chronic)
Say la-la-la

355
Q

Sx of CN XII Hypoglossal dysfunction

A

lingual dysarthria - motor speech disorder

sometimes trouble swallowing

356
Q

How to assess CN XII Hypoglossal

A

Protrude tongue: deviates TOWARDS affected side (with atrophy if chronic)

Say la-la-la

357
Q

Pupillary reflex: afferent is CN ___, efferent is CN ___

A

a: 2
e: 3

358
Q

Corneal reflex: afferent is CN ___, efferent is CN ___

A

a: 5 (VI)
e: 7

359
Q

Gag reflex: afferent is CN ___, efferent is CN ___

A

a: 9
e: 10

360
Q

single cranial neuropathies

A

Bell’s

DM CN 6 palsy

(many others)

361
Q

multiple cranial neuropathies could signal issue in the

A

subarachnoid space?

362
Q

If you see multiple neuropathies, are they all in the same side, which might indicate ____ or ____?

A

a mass in subarachnoid space or compression in skull where nerves run together

363
Q

If you see multiple neuropathies, are they in multiple levels on different sides, which could indicate ____?

A

Chronic meningitis

364
Q

Multiple neuropathies on long tract sides, think ____

A

Problem in brainstem bc nuclei live here and long tracts

365
Q

Weak in limbs and only motor impairment in cranial nerves, think ___ problem

A

motor

366
Q

3 long tracts

A

corticospinal (motor)

spinothalamic (sensory) - carries pain and temp

dorsal column (sensory) - carries proprioception

367
Q

If it’s UMN weakness - ___ and ___ are common early signs

A

stiffness and spasticity

368
Q

When performing the motor exam and reflexes, you’re assess motor system function of

A

corticospinal tract + motor unit (also extrapyramidal system)

369
Q

When performing the motor exam and reflexes, can often assess ____ of weakness by history

A

pattern

distal vs proximal, generalized, focal

370
Q

Proximal weakness complaints example

A

they might tell you they do ok walking on flat surface but have trouble getting upstairs, because they’re having weakness in hip girdle muscles

371
Q

Distal weakness complaints example

A

buttoning buttons, zippers

372
Q

Lower extremities weakness example

A

catching toe on stairs bc you can’t dorsiflex foot to clear the step

373
Q

For EPS (extra pyramidal symptoms) ___ is key

A

DISTRIBUTION knowledge is key i.e. is it right side, left side, both sides? Legs, arms, both? Proximal, distal, both?

374
Q

EPS

A

Slow to move (Parkinson’s)
tremor
myoclonus (jerk/twitching)
chorea (jerky movements of shoulder/hip/face)

375
Q

Parts of the motor exam:

A
  1. Inspect: atrophy (and fasciculations)

abnormal movements: tremor, chorea,
myoclonus vs paucity of movement

  1. Palpate: tenderness
  2. Examine:
    - tone
    - pronator drift and dexterity (finger/toe taps):
    - sensitive corticospinal tract tests
    - reflexes
    - strength testing
376
Q

tendon reflexes may diminish with ___, especially Achilles

A

age

age 65 or so - not pathological

377
Q

pathological Babinski (toe goes up) is a ___ sign

A

UMN

tends to be confirmatory rather than hanging diagnosis on in isolation

378
Q

Increased tone (hypertonia) is ____ sign

A

UMN

379
Q

Decreased tone (hypotonia) is ___ sign

A

LMN

380
Q

____ is a very sensitive sign of corticospinal tract dysfunction

A

Pronator drift (hold arms up and close eyes)

381
Q

are there are nerve roots that don’t have reflexes that are associated with it?

A

yes

382
Q

Achilles reflex may also be abnormal in patients with peripheral neuropathies, even if it’s subclinical – examples (4)

A

long-standing diabetes, alcoholism, advanced HIV, neurotoxic chemotherapy

383
Q

Documenting DTRS is a ___ grading. What grade is “normal”?

A 
0 absent
1+ diminished
2+ normal
3+ increased
4+ transient clonus   
5+ sustained clonus
384
Q

“Breakway” weakness suggests

A

poor effort

385
Q

UMN weakness

A

“pyramidal” (anti- gravity muscles

relatively spared)

386
Q

UMN atrophy

A

miminal or absent

387
Q

UMN fasiculations

A

absent

388
Q

UMN tone

A

increased

389
Q

UMN reflexes

A

increased

390
Q

UMN Babinski

A

present

391
Q

LMN weakness

A

myopathy: proximal polyneuropathy: distal focal: root, plexus, nerve

392
Q

LMN atrophy

A

prominent, especially if peripheral nerve

393
Q

LMN fasciculations

A

present in motor neuron disease (rarely neuropathy)

394
Q

LMN tone

A

diminished or normal

395
Q

LMN reflexes

A

diminished or normal

396
Q

LMN Babinski

A

absent

397
Q

MRC scale (strength):

A 
0 no contraction
1 contraction, no movement 
2 movement without gravity 
3 movement against gravity 
4 with resistance (4- to 4+) 
5 normal
398
Q

Spinothalamic tract - carries what?

A

pain, temperature

399
Q

Dorsal column - carries what?

A

vibration, proprioception, Romberg

400
Q

Cortical modalities (2)

A
  • Graphesthesia (recognize writing on hand)

- Stereognosis (can say what the object is with eyes closed)

401
Q

C2 and 3 are above the ___

A

neck

402
Q

C3 and 4 are ___

A

shoulder

403
Q

Sensory exam is best interpreted in context of ___, ___, or both

A

in context of sensory symptoms, motor signs, or both

404
Q

Brown-Séquard syndrome

A

incomplete spinal cord lesion

patient who was, say, stabbed in the back at the thoracic level

they will have:

  • Pain/temp down on contralateral side
  • Diminished proprioception and weakness on ipsilateral side
405
Q

B12 deficiency or balance issues - check ____

A

proprioception

406
Q

What 3 symptoms may indicate cerebellar dysfunction?

A

Dysarthria, nystagmus or hypotonia

407
Q

How to assess Cerebellar hemispheres:

A

finger-nose-finger, heel-knee-shin, rapid alternating movements

408
Q

How to assess Midline cerebellum:

A

truncal, gait ataxia

409
Q

signs of early gait ataxia

A

gait appears normal, with impaired tandem (can occur with advanced age)

410
Q

signs of late gait ataxia

A

broad-based gait (think EtOH intoxication)

411
Q

hemiparetic gait

A

problem with unilateral corticospinal tract

412
Q

scissoring gait

A

problem with bilateral corticospinal tract

413
Q

waddling gait

A

problem with proximal weakness (myopathy)

414
Q

steppage gait

A

problem with distal weakness (neuropathy)

415
Q

Considerations in assessing gait: (4)

A

age, pain, injury (acute or old), medications

416
Q

___ and ___ are sensitive long tract signs

A

Drift and dexterity

417
Q

High yield parts of the neuro exam: (3)

A

eyes, reflexes, gait

418
Q

Good idea to check CN with ____ exam

A

HEENT

419
Q

Check strength ___ tone and TRs

A

after

420
Q

Arm + leg Face + arm (+/-leg): think

A

cord or brain

421
Q

Face + arm (+/-leg) Hemiparesis: think

A

aphasia if right, neglect if left

422
Q

Which of the following is NOT a normal finding upon ophthalmoscopic examination?

A. A cup to disk ratio of <1:2
B. Dark red veins larger than bright red arteries
C. An avascular macula with an irregular border
D. An optic disc with diffuse margins

A

D. An optic disc with diffuse margins

423
Q 
Pain of duodenal or pancreatic origin may be referred to the:
A.  right shoulder
B.  epigastric region
C.  back
D.  right flank
A

C. back

424
Q 
Your client presents with a complaint of worsening abdominal pain over the past few hours, beginning as mild and now severe. The pain is described as being in “my whole belly.” Physical examination reveals rebound tenderness upon palpation of the right lower quadrant. You suspect:
A.  Acute cholecystitis
B.  Acute diverticulitis
C.  Appendicitis
D.  Small bowel obstruction
A

C. Appendicitis

425
Q

Risk factors for abdominal aortic aneurysm (AAA) include:
A. Age 65 or older
B. Smoking history
C. First-degree relative with a history of AAA repair
D. All of the above

A

D. All of the above

426
Q

Which of the following is NOT a normal finding upon digital rectal examination?
A. Smooth prostate gland with palpable sulcus
B. Tarry stool on the examiner’s gloved finger
C. Walnut-sized prostate gland
D. Palpation of two sphincters within the anal complex

A

B. Tarry stool on the examiner’s gloved finger

427
Q 
Which of the following is a urological emergency?
A.  epididymitis
B.  varicocele
C.  testicular torsion 
D.  hydrocele
A

C. testicular torsion

428
Q 
Impulse control is located in which lobe?
A.  temporal 
B.  frontal 
C.  occipital 
D.  parietal
A

B. frontal

429
Q 
Which cranial nerve is affected in Bell’s Palsy?
A.  V 
B.  VI 
C.  VII 
D.  VIII
A

C. VII

430
Q 
Upper motor neuron lesions presents with:
A.  hypertonia
B.  hypotonia
C.  muscle atrophy 
D.  fasciculations
A

A. hypertonia

431
Q 
Significant anterior excursion of the knee (positive Lachman’s test) indicates an injury to which ligament?
A.  Anterior cruciate 
B.  Posterior cruciate 
C.  Medial collateral 
D.  Lateral collateral
A

A. Anterior cruciate

432
Q 
Which type of skin cancer consists of more mature cells that usually resemble the spinous layer of the epidermis?
A.  basal cell carcinoma
B.  squamous cell carcinoma
C.  melanoma
D.  kaposi’s sarcoma
A

B. squamous cell carcinoma

433
Q 
Hypopigmented macules that appear on the face, hands, feet, extensor surfaces, and other regions and may coalesce into extensive areas that lack melanin suggest:
A.  café-au-lait spot
B.  seborrheic dermatitis
C.  vitilgo
D.  cyanosis
A

C. vitilgo

434
Q

Where is McBurney’s point? important for appendicitis

A

halfway between the umbilicus and the right iliac crest

435
Q

Description of skin condition should always include what 5 points?

A
  1. Primary lesion (i.e. papule)
  2. Secondary change (i.e. scaly) or absence of Color
  3. Size, shape, demarcation
  4. Configuration, Distribution (rash) or location (growth/lesion)
436
Q

Primary morphology: Smaller than 1cm + completely flat (non- palpable)

A

Macule

437
Q

Primary morphology: Greater than 1cm + completely flat (non- palpable)

A

Patch

438
Q

Vitiglio is an example of a

A

patch

439
Q

petechiae is an example of

A

Macules

440
Q

Primary morphology: Smaller than 1 cm, Raised (palpable), may be thin (“flat topped”) or thick (“dome-shaped”)

A

Papule

441
Q

molluscum is an example of

A

Papules

442
Q

Primary morphology: Greater than 1 cm, Raised (palpable)

A

plaque

443
Q

psoriasis is an example of a

A

plaque

444
Q

____ = smaller than 1 cm, serous or bloody fluid

A

Vesicle

445
Q

____ = greater than 1cm, serous or bloody fluid

A

Bulla

446
Q

____: always under 1cm, purulent fluid

A

Pustule

447
Q

Zoster is an example of

A

vesicles

448
Q

bullous pemphigoid is an example of

A

Bulla

449
Q

pustular psoriasis is an example of

A

Pustules

450
Q

When the epidermis is partially removed, this is an ___; fully removed would be an ____

A

erosion

ulcer

451
Q

pyoderma gangrenosum is an example of an

A

ulcer

452
Q

Primary morphology: Dome-shaped growth > 1cm, May be above or below skin surface

A

nodule

453
Q

keratoacanthoma is an example of a

A

Nodule

454
Q

Secondary changes are adjectives to describe the ___ of primary morphology

A

surface

455
Q

Ring-shaped but clear in the center would be what?

A

Annular

456
Q

Coin-shaped solid circle would be what?

A

Nummular

457
Q

erythema multiform is an example of a ____ shape lesion

A

Targetoid

458
Q

cutaneous larva migrans is an example of a ____ shape lesion

A

Serpiginous

459
Q

lichen planus is an example of a ____ shape lesion

A

Polygonal

460
Q

subacute cutaneous lupus is an example of a ____ shape lesion

A

Arcutate

461
Q

Atopic dermatitis is often on the ___ parts of the body

A

flexural (like backs of knees)

462
Q

Psoriasis is often on the ___ parts of the body

A

extensoral (backs of elbows)

463
Q

Primary lesions of Dermatitis a.k.a Eczema are _____

A

Ill-defined erythematous papules/plaques of highly variable size and spacing

464
Q

If Dermatitis a.k.a Eczema appears wet/weeping with microvesicles/round crusts or combination scale/crust, you know it’s what stage?

A

Acute

465
Q

If Dermatitis a.k.a Eczema appears dry, scaly and lichenified, you know it’s what stage?

A

chronic

466
Q

History for Dermatitis a.k.a Eczema is almost always ___

A

itchy

467
Q

Tx for Dermatitis a.k.a Eczema

A

steroids/gentle skin care

468
Q

Nummular eczema vs Tinea

A

Solid circle is more consistent with eczema

Ring (clearing in the center): Tinea - almost concentric circles (ripple-like effect)

469
Q

a flake, a build up of stratum corneum or dead skin on the surface of the lesion

A

scale

470
Q

dried fluid (serum, blood, pus)

A

crust

471
Q

shiny, cigarette paper type wrinkling

A

atrophy

472
Q

accentuation of the skin markings due to chronic rubbing and scratching - kind of like a callous - this is itchy

A

Lichenification

473
Q

True red erythema

A

think neutrophils, cellulitis is an example

474
Q

Purple erythema

A

lymphocytic inflammation

475
Q

Red-brown erythema

A

granulomas

476
Q

superficial (melasma) is what kind of brown

A

Muddy-tan brown

477
Q

Tindle effect

A

more transmission of the blue tones so that’s why we see grey when we have a deeper lesion

478
Q

Most tinia will be what shape?

A

annular

479
Q

Ezcema is what shape

A

nummular

480
Q

Koebner phenomenon

A

Papules in linear fashion - lesions pop up along the line where it was scratched

481
Q

Koebner phenomenon

A

Papules in linear fashion - lesions pop up along the line where it was scratched

482
Q

Seborrheic

A

hair-bearing areas of the skin: scalp, eyebrows and globella, nasal creases, beard region for men, then hair areas in chest, genitals, etc.

483
Q

Photodistributed

A

accentuated where the sun hits exposed skin

484
Q

Flexures

A

crooks of arms

485
Q

Extensors

A

elbows and knees

486
Q

Inverse

A

affect the body folds like trunk, under breast, armpits, groin

487
Q

Is there any utility in biopsy for dermatitis?

A

no

488
Q

small eczematous papules - very specific areas - finger webs, wrists, umbilicus/waist, genitals, ankles

A

scabies

489
Q

honey-colored crusting or pustules superimposed on dermatitis/eczema would indicate

A

staph infection

490
Q

Tinea

A

= dermatophyte

  • Scale, erythema, omen papules at the leading edge of the plaque
  • Not always annular– omen “waves” of papules expanding concentrically like ripples in a pond
491
Q

Example of Class I topical steroid to tx dermatitis

A

Clobetasol

492
Q

Example of Class II topical steroid to tx dermatitis

A

Fluocinonide

493
Q

Example of Class III topical steroid to tx dermatitis

A

Triamcinolone 0.1%

494
Q

Example of Class V topical steroid to tx dermatitis

A

Desonide

495
Q

Example of Class VI topical steroid to tx dermatitis

A

Hydrocortisone 2.5%

496
Q

Example of Class VII topical steroid to tx dermatitis

A

Hydrocortisone 1%

497
Q

Topical steroids come in Class IX- VII, with Class I is ____, VII is ____

A

I is strongest

VII is weakest

498
Q

Face, axillae, groin– use topical steroid class ___ or weaker

A

V

499
Q

Hands, feet, elbows, knees– use topical steroid class ___ or stronger

A

III

500
Q

Primary morphology of Psoriasis

A

well-marginated scaly papules/plaques (“papulosquamous” reaction pattern)

501
Q

With Psoriasis, there is often no scale on ____ skin

A

moist intertriginous

502
Q

Psoriasis treatment depends on what 4 things

A
  • body sites involved
  • type of psoriasis
  • body surface area
  • presence of arthritis
503
Q

Treatment for dermatitis/eczema

A

Bathe daily with lukewarm water - no soap or very gentle soap like Dove only to armpits and groin

Follow bath with grease up in something thick - oily emollient to trap the water - Aquaphor, Vaseline, coconut oil (eucerin, cerave) - scoop out from jar rather than pump

topical steroids if necessary

504
Q

for infant less than a year, use class ___ or lower of topical steroids

A

V

505
Q

Benign: Brown/pink/white/yellow lesion, very common, warty sticker-like

A

Seborrheic keratosis

506
Q

Benign: Bright red/pink/purple dilations in the skin - occur with aging

A

cherry angioma

507
Q

Benign: Face/hands - “age or sun spots” - from sun damage

A

solar lentigines

508
Q

As moles age, they go from flat and brown to dome-shaped, flesh toned, and lose pigment– becoming

A

Benign intradermal nevis

509
Q

4 main types of Malignant neoplasms

A

Melanoma
Squamous cell carcinoma
Basal cell carcinoma
Actinic keratosis - precursor to squamous cell carcinoma

510
Q

If they’ve already had a skin cancer, are they much more likely to have another?

A

yes

511
Q

classic “drug eruption” presentation

A

Pink macules/papules that look like measles

N270: Advanced Health Assessment [Fall 2016] (2 decks)

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