Guided Readings Study Guide Flashcards
from Module 3 on
Identify the risk factors for Melanoma
- Ultraviolet (UV) Radiation Exposure
- Fair Skin
- Family History
- Personal History of Melanoma or Other Skin Cancers
- Multiple or Atypical Moles
- Immune Suppression
- Age
Define the ABCDE’s of Melanoma
A for asymmetry
B for irregular borders, especially ragged, notched, or blurred
C for variation or change in color, especially blue or black
D for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding
E for elevation or enlargement
Differentiate the different types of skin cancer. How would you identify each
a. Melanoma-rarest
only 4% of skin CA
b. Basal cell carcinoma
papule or nodule- waxy or pearly - may be shiny or red w/ a central induration
may be flat, hyperpigmented, border of the lesion appears rolled
solitary
sun exposed areas
c. Squamous cell carcinoma
usually solitary nodules
sun exposed areas/face
subjective- nonhealing lesion that continues to grow in size, tender, hx of actinic keratosis
objective- warty appearance, pink colored plaque, nodule, or papule w/ eroded surface
Describe a physical examination of the skin, hair, and nails (go step-by-step
watch the bates videos idk
a. Inspect and palpate skin for color, moisture, temperature, texture, mobility and turgor, lesions
b. Ask if they notice any changes in pigmentation or loss of pigmentation
c. Look for jaundice in sclera, mucous membranes use back of fingers to assess skin temperature
Describe a macule
a flat discoloration
<1cm
Describe a patch
A flat, discoloration that appears to be a collection of multiple, tiny pigment changes
> 1 cm in size
Describe a papule
Small, elevated firm lesion (example: wart, keratosis, nevi, lichen planus, insect bite)
< 1 cm in size
Describe a Nodule
Large, deep, and elevated firm lesion (examples: cyst, lipoma, fibroma)
> 1 cm in size
Describe a wheal
A raised lesion, related to an allergic reaction or hypersensitivity (extends a bit below the dermis)
1-10 cm in size
Appears most commonly on lateral neck, shoulders, abdomen, arms, and legs
Describe a plaque
A scaly, elevated, and well-circumscribed flat top lesion (erythematous to bright pink in color)
> 1 cm in size
Appears most commonly on knees and elbows
Describe a vesicle
A small, serous fluid filled lesion
<1 cm in size
Describe a bulla
A large, serous fluid filled lesion
> 1 cm in size
Describe a pustule
A small, elevated, circumscribed lesion filled with purulent fluid
<0.5-1 cm in size
IE a pimple
Identify the appropriate documentation for the skin assessment of lesions
a. Number- estimate totaly
b. Size- meaure w/ a rule in mm or CM
c. Shape
d. Color- be creative
e. Texture- palpate that thang
f. Location
g. Configuration- linear/straie, annular, nummular/discoid, target, bullseye etc
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with HERPES ZOSTER
Risk Factors for Herpes Zoster (Shingles):
Age: Most common in adults over 50.
Weakened immune system: Due to conditions like HIV, cancer, or immunosuppressive treatments.
Previous chickenpox: The virus remains dormant in the body and can reactivate as shingles.
Stress: Emotional or physical stress can trigger outbreaks.
Chronic illnesses: Such as diabetes, heart disease, or autoimmune diseases.
Subjective Information (Patient Presentation):
Pain or burning sensation: Often localized to a specific area, typically on one side of the body.
Tingling or itching: Common before the rash appears.
Fatigue: Feeling unwell or fatigued can precede the rash.
Signs/Symptoms:
Rash: Starts as red, blistering clusters, usually on the chest, back, or face, following a dermatome.
Pain: Sharp or burning pain often occurs along the path of the rash.
Fever and headache: Common during the acute phase.
Postherpetic neuralgia: Persistent pain after the rash heals, especially in older adults.
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with SKIN CA
Risk Factors for Skin Cancer:
Ultraviolet (UV) radiation: Excessive sun exposure, especially with a history of sunburns.
Fair skin: Individuals with lighter skin, hair, and eyes are more susceptible.
Family history: A genetic predisposition to skin cancer, especially melanoma.
Age: Older adults are at higher risk, but skin cancer can occur at any age.
Previous skin cancer: A history of nonmelanoma skin cancer increases the risk of recurrence.
Immunosuppression: Conditions like HIV, organ transplantation, or use of immunosuppressive drugs.
Moles or atypical nevi: Having many moles or irregularly shaped moles increases the risk.
Subjective Information (Patient Presentation):
New or changing lesion: Patients may notice a new mole or a change in an existing one (size, shape, color).
Itching or tenderness: Sensation around a suspicious spot on the skin.
Bleeding or crusting: A mole or spot that bleeds, oozes, or develops a crust.
Signs/Symptoms:
Melanoma: Often presents as a new or changing mole with irregular borders, asymmetry, multiple colors, and a diameter greater than 6mm.
Basal cell carcinoma (BCC): Typically appears as a pearly, flesh-colored bump with small blood vessels or as a scaly, reddish patch.
Squamous cell carcinoma (SCC): Presents as a firm, red nodule or a flat, scaly lesion that may bleed or ulcerate.
Non-healing sores: Sores that don’t heal or heal but return.
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with Sinusitits
Risk Factors for Sinusitis:
Upper respiratory infections:
Allergies:
Nasal polyps:
commonly cause by S. Pneumoniae
Deviated septum:
Environmental factors:
Dental infections:
Subjective Information (Patient Presentation):
Nasal congestion:
Facial pain/pressure:
Headache:
Postnasal drip:
Fatigue: .
Signs/Symptoms:
Nasal discharge:
Fever:
Tooth pain:
Reduced smell/taste:
Tenderness:
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with conjunctivitis
Risk Factors for Conjunctivitis:
Exposure to viral or bacterial infections
Allergies (e.g., pollen, dust)
Contact lens wearers, especially with poor hygiene
Close contact with infected individuals (e.g., daycare, school)
Dry eye syndrome or underlying eye conditions
Environmental irritants (e.g., smoke, chemicals)
Weakened immune system (e.g., diabetes, HIV)
Subjective Information (Patient Presentation):
Redness in the eyes
Itchy, burning, or gritty sensation
Excessive tearing or watery eyes
Discharge from the eyes (watery, mucous, or pus-like)
Sensitivity to light (photophobia)
Blurred vision (due to discharge or irritation)
Signs/Symptoms:
Pink or red color in the white part of the eye
Swelling of the eyelids
Crusting of the eyelashes, especially upon waking up
Clear, watery, or thick discharge, depending on the cause (viral, bacterial, or allergic)
Eye irritation or a feeling of something being in the eye
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with corneal abrasions
Risk Factors for Corneal Abrasions:
Eye trauma
Contact lens use
Dry eyes
Environmental factors (e.g., wind, dust)
Previous eye injuries or surgeries
Subjective Information (Patient Presentation):
Eye pain or discomfort
Sensitivity to light
Feeling of something in the eye
Excessive tearing
Blurry vision
Signs/Symptoms:
Redness of the eye
Visible scratch on the cornea
Blurred vision
Pain with blinking
Mild eyelid swelling
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with AOM
Risk Factors for Acute Otitis Media (AOM):
Age (common in children, especially under 2 years old)
Upper respiratory infections (cold, flu)
Allergies
Exposure to secondhand smoke
Lack of breastfeeding
Pacifier use in infants
Frequent use of bottles while lying down
Family history of ear infections
Craniofacial abnormalities (e.g., cleft palate)
Subjective Information (Patient Presentation):
Ear pain or discomfort
Irritability or fussiness (especially in children)
Difficulty sleeping or lying down
Hearing difficulties
Tugging or pulling at the ear (in infants or toddlers)
Fever
Drainage from the ear (in some cases)
Signs/Symptoms:
Red, swollen eardrum
Decreased mobility of the eardrum on pneumatic otoscopy
Bulging tympanic membrane
Fever (typically low-grade)
Fluid or pus draining from the ear (if the eardrum ruptures)
Hearing loss (temporary)
Describe visual acuity screening using a Snellen Chart. What do the results means (i.e. 20/20, 20/30, 20/40, etc…).
How It Works:
Positioning: The patient stands or sits 20 feet away from the Snellen Chart.
Testing: One eye is tested at a time while the other is covered with an eye patch or occluder. The patient is asked to read the letters on the chart starting from the largest at the top and moving down to the smaller letters.
Scoring: The patient’s ability to read the smallest line of letters determines their visual acuity score.
Interpreting Results (e.g., 20/20, 20/30, 20/40):
20/20: This is considered “normal” vision. It means the patient can see at 20 feet what a person with normal vision can see at 20 feet.
20/30: This means the patient can see at 20 feet what someone with normal vision can see at 30 feet. In other words, the patient’s vision is slightly worse than average.
20/40: The patient can see at 20 feet what someone with normal vision can see at 40 feet. This is often the minimum requirement for driving in many places.
Describe the correct use of an ophthalmoscope
An ophthalmoscope is a medical instrument used to examine the interior of the eye, including the retina, optic disc, macula, and blood vessels
Describe the correct use of an otoscope
instrument used to examine the ear canal and tympanic membrane (eardrum). It is essential for diagnosing ear conditions like infections, impacted earwax, and other abnormalities in the ear.
Describe how to perform the Weber test and what does it test for?
The Weber test is a quick and simple hearing test used to evaluate lateralization (whether the sound is heard in one ear more than the other) and to help differentiate between types of hearing loss (conductive vs. sensorineural).
make the sound and put it on the pts forehead
Normal Hearing: Equal hearing in both ears.
Conductive Loss: Louder sound in the affected ear.
Sensorineural Loss: Louder sound in the unaffected ear.
Describe how to perform the Rinne test and what does it test for?
Strike the tuning fork: Tap a 512 Hz tuning fork on your palm to make it vibrate.
Bone conduction: Place the base of the vibrating tuning fork against the patient’s mastoid bone (behind the ear).
Air conduction: When the patient no longer hears the sound through the bone, move the tuning fork to in front of the ear canal (about 1-2 cm away) and ask if they can still hear the sound.
Compare the sounds:
Normal hearing or sensorineural loss: The patient hears the sound longer through air conduction (AC > BC).
Conductive hearing loss: The patient hears the sound longer through bone conduction (BC > AC).
Describe the technique for palpating sinuses
Frontal Sinuses:
Place your thumbs just above the eyebrows, under the brow ridge.
Apply gentle pressure and ask the patient if they feel any tenderness.
Compare both sides for any differences in tenderness or swelling.
Maxillary Sinuses:
Place your thumbs on the bony part of the upper cheeks, just below the cheekbones.
Apply gentle pressure and ask the patient if they feel any discomfort or tenderness.
Again, compare both sides for consistency.
there should be no pain
Describe the correct evaluation of a lymph node
Inspect: Look for any swelling or redness.
Palpate: Use your fingers to gently feel the node.
Check size (should be less than 1 cm).
Assess shape (should be round or oval).
Feel for firmness (soft is normal, hard could be concerning).
Check if the node is moveable (moveable is usually benign).
Feel for tenderness (tender may indicate infection).
Record the Location: Note where the swollen node is (e.g., neck, armpit).
Assess for Symptoms: Ask about fever, weight loss, or pain, which could indicate infection or illness.
Identify the anatomic location of the lymph nodes of the head and neck
a. Identify the anatomic location of the lymph nodes of the head and neck
b. Posterior auricular
c. Occipital
d. Superficial cervical
e. Deep cervical
f. Posterior cervical
g. Supraclavicular
h. Preauricular
i. Parotid
j. Tonsillar
k. Submental
l. Submandibular
Describe the grading of tonsils.
1- hidden w/in tonsil pillars NORMAL
2- extend pillars NORMAL
3- beyond pillars ABNORMAL
4- tonsils extend to midline- ABNORMAL- there’s prob an infection
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with
OSTEOARTHRITIS
i. Risk factors:
1. Increased age
2. History of wear and tear to joints
3. History of joint injury
ii. Subjective
1. Effects larger joints like hips and knees
2. Effects smaller joints like hands and feet
3. Pain and stiffness in joints (asymmetrical)
4. Worsens with rest
5. Improves with mod activity and movement
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with
MECHANICAL LOWER BACK PAIN
i. Risk factors
1. History of overuse
2. History of repetitive movements
3. History of new physical activity or unusual exertion
4. No major trauma, uncontrolled HTN, infection or malignancy
ii. Subjective
1. Pain in back, buttocks, thigh
2. Pain relieved when laying supine
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with
CARPAL TUNNEL
i. Risk factors:
1. History of overuse
2. Repetitive movements
3. Pregnancy
4. Frequent computer use
5. Painting
ii. Subjective:
1. Symptoms affecting the anterior writst, first three digits, medial palm
2. Pain, paraesthesia, and weakness (relieved by shaking hand)
3. Pain is experienced at night (early symptom)
red flags for lower back pain
pretty sure numbness is bad- = nerve involvement
Describe how to perform Tinel Sign and Phalen Sign. What is a positive result and what does it mean?
a. Tinel: tapping over the transverse carpal ligament, signs of carpal tunnel syndrome
b. Phalen- wrist flexion for 60 seconds, pain anestheisa or paresthesia positive = carpal tunnel syndrome
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with
migraine headaches
i. Risk factors:
1. History of prior headache episodes
2. Exposure to common triggers
a. Stress
b. Sleep alterations
c. Food
d. Alcohol
e. Perfumes
ii. Subjective
1. Pulsating quality
2. Unilateral
3. Pain 4-72 hours
4. Nausea, vomiting, photophobia
5. Phonophobia
6. Aura:
a. Feeling of dread or anxiety, fatigue, nervousness, excitement, GI, visual or olfactory alteration
b. Dysfunction of cerebral or brain stem dysfunction
c. Aura lasting >1hour seizure activity
7. Without aura
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with
cluster headaches
i. Risk factors
1. 20% fam history
ii. Subjective
1. Steady, intense pain
2. Unilateral
3. Intense pain behind one eye
4. 15min-3 hours
5. Ipsilateral autonomic signs
a. Lacrimation
b. Conjunctival injection
c. Ptosis
d. congestion
Describe the risk factors and subjective information (patient presentation and signs/symptoms) of a patient with
tension headaches
i. Risk factors
1. No family history
ii. Subjective
1. Pressing, non pulsatile pain
2. Wraps around the head
3. Pain lasts 30 min-7 days
Tell me all the cranial nerves and if they are sensory or motor
Olfactory-sensory
Optic- sensory
Occulomotor- motor
Trochlear- motor
Trigeminal- both
Abducens- motor
Facial-both
Auditory- sensory
Glossopharyngeal- both
Vagus- both
Spinal Accessory- motor
Hypoglossal- motor
Oh Oh Oh To Touch And Feel A Girls Vagina And Hymen
Some Say Marry Money But My Brother Says Big Boobs Matter More
CN 1- name and how to test
olfactory- sniff sniff
CN2- name and how to test
optic
Test visual acuity with Snellen eye chart or hand-held card; inspect fundi; screen visual fields by confrontation
2 and 3 tested together
CN3- name and how to test
Occulomotor
Inspect size and shape of pupils; test reactions to light and near response
2 and 3 tested together
CN4- name and how to test
Trochlear
Test extraocular movements in 6 cardinal directions of gaze; lid elevation; check convergence
CN V- name and how to test
Trigeminal
Palpate temporal and masseter muscles while patient clenches teeth; test forehead, each cheek, and jaw on each side for sharp or dull sensation; test corneal reflex
CN VI- name and how to test
Abducens
tested w/ II IV VI
Test extraocular movements in 6 cardinal directions of gaze; lid elevation; check convergence
CN VII- name and how to test
Facial
Assess face for asymmetry, tics, abnormal movements. Ask patient to raise eyebrows, frown, close eyes tightly, show teeth (grimace), smile, puff both cheeks.
CN VIII- name and how to test
Auditory
Test hearing, lateralization, and air and bone conduction.
CN IX- name and how to test
Glossopharyngeal
Assess if voice is hoarse; assess swallowing. Inspect movement of palate as patient says “ah.” Test gag reflex, warning patient first.
IX and X together
CN X- name and how to test
Vagus
Assess if voice is hoarse; assess swallowing. Inspect movement of palate as patient says “ah.” Test gag reflex, warning patient first.
IX and X together
CN XI- name and how to test
Spinal Accessory
Assess strength as patient shrugs shoulders up against your hands. Note contraction of opposite sternocleidomastoid, and force as patient turns head against your hands.
CN XII- name and how to test
Hypoglossal
Ask patient to protrude tongue and move it side to side. Assess for symmetry, atrophy.
describe muscle strength 0-5
0- no muscular contraction
1- flicker
2- active mvmt w/ gravity eliminated
3- active mvmt against gravity
4- active mvmt against gravity and some resistance
5- normal muscle strength
how do u assess a pts gait?
Walk normally across room, walk heel to toe, walk on toes
Describe the Romberg test and what does it test for?
Romberg test: stand with feet together/close eyes for up to 30 seconds;
loss of balance is a positive test
Describe the pronator drift test and what does it test for?
Unilateral Pronator Drift: Suggests weakness or a neurological lesion on the contralateral side of the brain or spinal cord (usually in the corticospinal tract).
Possible Conditions: Stroke, brain injury, multiple sclerosis, or other CNS pathologies.
Vibration
Steps:
Use a tuning fork strike it gently to make it vibrate.
Place the vibrating fork on a bony prominence, such as the great toe or wrist.
Ask the patient to tell you when they can feel the vibration and when it stops.
Repeat on both sides of the body for comparison.
Positive Result:
Normal: The patient can correctly identify the vibration’s onset and cessation.
Abnormal: The patient cannot feel the vibration or detects it on only one side.
What It Means:
Normal: Indicates intact vibratory sense, which relies on the dorsal column of the spinal cord.
Abnormal: Loss of vibration sensation suggests peripheral neuropathy (often seen in diabetes), spinal cord pathology, or neurodegenerative diseases (e.g., multiple sclerosis, syphilis).
Proprioception
Ask the patient to close their eyes.
Hold the patient’s finger or toe and move it up or down.
Ask the patient to identify the direction of movement (up or down) without looking.
Positive Result:
Normal: The patient accurately identifies the direction of movement.
Abnormal: The patient is unable to correctly identify the direction of movement.
What It Means:
Normal: Intact proprioception, indicating proper sensory and motor pathways in the joints and nervous system.
Abnormal: Difficulty detecting movement suggests proprioceptive dysfunction, often due to peripheral neuropathy, spinal cord injury, or neurological conditions (e.g., multiple sclerosis, stroke).
Stereogenesis
Steps:
Ask the patient to close their eyes.
Place a familiar object (e.g., a coin, key, or pen) in the patient’s hand.
Ask the patient to identify the object solely by touch.
Positive Result:
Normal: The patient can correctly identify the object.
Abnormal: The patient is unable to identify the object.
What It Means:
Normal: Intact sensory perception, specifically the ability to recognize objects by touch.
Abnormal: Difficulty identifying the object suggests sensory loss or dysfunction, often due to parietal lobe damage, nerve injury, or neurological conditions (e.g., stroke, peripheral neuropathy).
Graphethesia
Steps:
Ask the patient to close their eyes.
Using a blunt object (e.g., the tip of a pen or your finger), write a letter or number on the patient’s palm or back.
Ask the patient to identify the letter or number they feel.
Positive Result:
Normal: The patient can correctly identify the letter or number.
Abnormal: The patient is unable to identify the letter or number.
What It Means:
Normal: Sensory function is intact, specifically in the parietal lobe.
Abnormal: Difficulty identifying the shape suggests sensory loss or neurological dysfunction, often related to conditions affecting the somatosensory cortex (e.g., stroke, lesions, or nerve damage).
Two point discrimination
- briefly touch a point on the patient’s skin. Then ask the patient to open both eyes and point to the place touched. Normally a person can do so accurately.
grading of reflexes
0- no response
1- somewhat diminished; low normal
2- normal
3- brisker than average; still normal
4- very brisk and hyperactive w/ clonus
LOC- Alert
awake and oriented, answering ? appropriately
LOC- Lethargic
u must speak to the pt in a loud and forceful manner to get a response
LOC- Obtunded
shake pt to get a response
LOC- Stupor
awakens to pain only IE sternal rub
LOC- COMA
unarousable
How do you perform a Lachman test? What is a positive result and what does it mean?
Steps:
Patient lies on their back with knee slightly flexed (20-30°).
Stabilize femur with one hand.
Grasp tibia with the other hand and apply an anterior (forward) force.
Assess tibia for excessive movement compared to the opposite leg.
Positive Result:
Increased forward movement or lack of a firm endpoint in the tibia.
What It Means:
Indicates a tear of the anterior cruciate ligament (ACL).
How do you perform a McMurray test? What is a positive result and what does it mean?
Position: Have the patient lie flat on their back with the knee fully flexed (as much as possible).
Stabilize: Hold the patient’s ankle with one hand and place the other hand on the knee joint.
For Medial Meniscus:
Rotate the foot outward (external rotation of the tibia).
While maintaining the foot in this position, extend the knee slowly.
For Lateral Meniscus:
Rotate the foot inward (internal rotation of the tibia).
While maintaining this position, extend the knee slowly.
Palpation: As you extend the knee, feel for any clicking or popping and assess for pain or tenderness.
Positive Result:
For Medial Meniscus: Pain or a click felt on the inner (medial) side of the knee.
For Lateral Meniscus: Pain or a click felt on the outer (lateral) side of the knee.
What It Means:
A positive McMurray test suggests a meniscal tear in the knee, either medial or lateral, depending on the location of the pain or click.
How do you test for bulge sign and balloon sign? What is a positive result and what does it mean?
hehe bulge
Bulge Sign:
Position: Patient lies supine with the knee extended.
Action: Press above the knee to move fluid downward.
Action: Use your other hand to press the medial side of the knee and push fluid laterally.
Check: Release pressure on the medial side and look for a bulge of fluid on the lateral side.
Positive: Bulge of fluid on the lateral side = small effusion.
Balloon Sign:
Position: Patient lies supine with the knee extended.
Action: Compress the suprapatellar pouch to push fluid downward.
Action: Palpate the sides of the patella to check for “ballooning” or
fluid under the patella.
Positive: Ballooning under the patella = large effusion.
Key Takeaways:
Bulge Sign detects a small effusion.
Balloon
Describe how to perform the following and what do the results mean?
Drop-arm test
examines shoulder
Purpose: The drop-arm test is used to assess for rotator cuff injuries, particularly a supraspinatus tear.
Steps:
Patient Position: Have the patient raise both arms to the side, at shoulder level, and then slowly lower them back down.
Procedure: Ask the patient to slowly lower their arms from an elevated position.
What the Results Mean:
Positive Test: If the patient is unable to slowly lower the arm or it drops suddenly, it suggests a rotator cuff tear (often supraspinatus).
Negative Test: If the patient can control and lower the arm smoothly, it suggests no significant rotator cuff injury.
Describe how to perform the following and what do the results mean?
Neer impingement sign
examines shoulder
Purpose: The Neer impingement sign is used to test for shoulder impingement, often involving the rotator cuff tendons (specifically the supraspinatus tendon) or the subacromial bursa.
Steps:
Patient Position: Have the patient stand or sit with their arm relaxed at their side.
Procedure: The examiner stabilizes the patient’s scapula with one hand and uses the other hand to passively elevate the patient’s arm in full forward flexion (bringing the arm overhead).
Motion: Raise the arm as far as possible while maintaining stabilization of the scapula.
What the Results Mean:
Positive Test: Pain or discomfort in the shoulder during the maneuver suggests shoulder impingement, potentially involving the rotator cuff tendons or subacromial bursa.
Negative Test: No pain or discomfort suggests that impingement is less likely.
Describe how to perform the following and what do the results mean?
Hawkins impingement sign
examines shoulder
Purpose: The Hawkins impingement sign is used to assess for shoulder impingement, particularly of the rotator cuff tendons (especially the supraspinatus tendon), or the subacromial bursa.
Steps:
Patient Position: The patient should be seated or standing with their arm relaxed at their side.
Procedure: The examiner flexes the patient’s shoulder to 90 degrees and the elbow to 90 degrees (forming a right angle).
Motion: The examiner then passively internally rotates the patient’s shoulder (bringing the hand down toward the opposite shoulder).
What the Results Mean:
Positive Test: Pain or discomfort in the shoulder during internal rotation suggests shoulder impingement, particularly involving the rotator cuff tendons or subacromial structures.
Negative Test: No pain or discomfort during the maneuver suggests that impingement is less likely.
Describe the purpose of and how to perform Barlow’s Maneuver
Barlow’s Maneuver is used to screen for hip dysplasia in newborns and infants (typically under 6 months old). It helps detect a dislocated or dislocatable hip, specifically hip instability.
Steps:
Position the baby: Place the infant in a supine position (lying on their back) on a firm surface.
Stabilize the pelvis: Hold the baby’s thighs and hips with your fingers.
Adduct the hip: Gently flex the baby’s hips and knees to 90 degrees.
Apply posterior pressure: While keeping the hips flexed, gently apply downward and outward pressure on the thighs towards the table.
Positive Result:
A clunk or a “thunk” (feeling or hearing the hip dislocating) suggests that the hip is dislocatable (positive Barlow’s sign). This indicates hip instability or hip dysplasia.
What It Means:
A positive Barlow test suggests that the hip is dislocatable but not necessarily dislocated. If positive, the baby should undergo further diagnostic testing (like ultrasound) and possible treatment to prevent long-term hip deformities (e.g., using a Pavlik harness).
Describe the purpose of and how to perform Ortolani’s Maneuver
Ortolani’s Maneuver is used to confirm a dislocated hip in infants and screen for hip dysplasia. It helps to detect hip reduction in cases of dislocation or subluxation (partial dislocation).
Steps:
Position the baby: Place the infant in a supine position (lying on their back) on a firm surface.
Stabilize the pelvis: Hold the baby’s thighs with your thumbs and the pelvis with your fingers.
Flex the hips and knees: Flex the baby’s hips and knees to 90 degrees.
Gentle abduction: Slowly abduct the hips (move the legs outwards), applying gentle pressure.
Listen and feel: While abducting the legs, watch for any movement and listen for a “clunk” sound, which indicates that the hip has relocated.
Positive Result:
A “clunk” or a feeling of the hip relocating suggests a positive Ortolani sign, meaning the hip was dislocated and has now been reduced (moved back into the socket).
What It Means:
A positive Ortolani test confirms a dislocated hip that has been successfully reduced during the maneuver, indicating hip dysplasia. A positive result requires further diagnostic follow-up (like ultrasound) and possibly treatment (e.g., Pavlik harness) to ensure proper hip development.
normal timeframe for: palmar grasp
birth to 3-4 m
normal timeframe for: plantar grasp
birth - 3-4m
involuntary curling of the toes when the sole of the foot is gently stimulated, typically by applying pressure to the ball of the foot
normal timeframe for: rooting reflex
birth - 6-8m
What it looks like: When the baby’s cheek or mouth is touched or stroked, the baby will turn their head toward the stimulus and may open their mouth, often making sucking or lip-smacking movements.
normal timeframe for: moro reflex
birth - 4 m
What it looks like:
When startled (e.g., by a loud noise or sudden movement), the baby extends their arms and legs outward, spreads their fingers, and then quickly brings their arms back toward their body, often in a “hugging” motion.
normal timeframe for: asymmetric tonic neck reflex
birth - 2-3m
What it looks like:
When an infant’s head is turned to one side, the arm and leg on the same side extend, and the opposite arm and leg flex. It often appears as if the baby is “reaching” with the extended arm while the other arm is bent, resembling a fencing stance.
normal timeframe for: trunk incurvation
birth - 3-4 months
What it looks like:
When the skin along the side of an infant’s lower back is stroked (usually from the shoulder to the hip), the baby will respond by arching or curving their body toward the side that is being stimulated. This movement is often described as the baby “arching” or “involuntarily bending” to the side.
normal timeframe for: landau reflex
birth - 6 months
What it looks like:
When the infant is held in a prone (face-down) position, the baby will raise their head, arch their back, and extend their arms and legs. It resembles a “superman” pose, with the head lifted, the back arched, and the limbs extended. This reflex is often stronger when the baby is around 6 months old.
normal timeframe for: parachute reflex
birth - 8 months
What it looks like:
The parachute reflex is observed when an infant is held in an upright position and then tilted suddenly forward, as though they are falling. In response, the baby will extend their arms and hands forward, as if trying to protect themselves from the fall (much like an adult would put their hands out to break a fall). This reflex is similar to a “parachute” opening, hence the name.
does not disappear
normal timeframe for: positive support reflex
emerges around 2-3 months
What it looks like:
When a baby is held upright with their feet placed on a firm surface (such as a table or floor), they will extend their legs and bear weight on their feet. This may not be a full, controlled “standing” position, but the infant will attempt to push down with their legs in a weight-bearing posture. The response may be somewhat stiff or jerky, but the legs will often show signs of bearing weight.
normal timeframe for: placing and stepping
birth - variable disappearance
- Identify atypical symptoms that present in the geriatric population during disease development
Urinary Tract Infection
Mental status changes (e.g., confusion or delirium) are a red flag for a possible UTI in older adults.
Functional decline, increased incontinence, and abdominal pain can be signs of a UTI.
It’s important to look for non-specific symptoms like fatigue, nausea, and changes in urinary appearance in geriatric patients.
probs won’t develop fever- may get hypothermic even
- Identify atypical symptoms that present in the geriatric population during disease developmentPneumonia
Delirium or confusion is often the primary sign of pneumonia in older adults.
Low-grade fever or absence of fever is common, along with subtle signs like fatigue, weakness, and loss of appetite.
Respiratory symptoms, such as cough or shortness of breath, may be absent or mild.
Chest pain, tachycardia, or nausea can be misleading or nonspecific symptoms in elderly individuals.
Hypoxia may occur without obvious signs of respiratory distress, and mental status changes are often the first clue to an underlying infection.
presentation of dementia in the older adult
onset- insidious-
duration- months to years
fluctuations- not really, occasionally d/t stress
affect- labile
alertness- normal or lethargic
attention- normal to progressively inattentive
orientation- impaired but may be close to correct
memory- abnormal
speech/language- worse
speech content- empty or sparse
perceptual - normal to mod abnormal
presentation of depression in older adults
onset- insidious or precipitated by an event
duration- months- years
fluctuations- some- may feel worse in the AM
affect- flat
alertness- normal
attention- normal to mildly distracted
orientation- normal
memory- normal
speech/language- normal to slow
speech content- normal
perceptions- normal
presentation of the delirious old person
onset- acute
duration- hours-days
fluctuations- prominentk w/ abnormal day/night cycles
affect- variable
alertness- variable like A LOT
attention- fluctuates
orientation- usually abnormal- may fluctuate
memory- normal when it registers
speech/language- dysarthic/misnaming
speech content- CONFUSED AF or incoherent
perceptions- hallucinations are common
Identify the use of the MMSE and the clock drawing test in determining driving safety in the elderly
MMSE the best-known screening test for dementia but is now copyrighted for commercial use, so is less accessible. Recommended screening tests now include the Mini-Cog and the Montreal Cognitive Assessment (MoCA)
define affect
i. The observable mood of a person expressed thru facial expression, body movements, and voice
define mood
sustained emotion
euthymic- stable
dysthymic- low/sad
manic- cray
define language
\The complex symbolic system for expressing written and verbal thoughts, emotion, attention, and memory
how we communicate
define higher cognitive functions
i. Level of Intelligence
ii. Assessed by vocabulary, knowledge base, calculations, and abstract thinking
define
circumstantiality
i. Speech characterized by indirection and delay due to the patient’s excessive use of details that have no connection to the point
define derailment
i. Speech in which a person shifts topics with no apparent relation between topics
define flight of ideas
joanna does this a lot
i. Accelerated change of topics in a very fast but generally coherent manner
define neoglisms
i. Invented or distorted words
define confabulations
my fav
i. Fabrication of facts to hide memory impairment
define echolalia
another fav
i. Repitition of words or phrases of others
Echo echo echo ech…
what is the difference b/t hallucinations an illusions
illusions are misinterpretations of real stimuli while hallucinations are not real at all
hallucinations can be auditory, visual, olfactory, gustatory, tactile
whats a leopold maneuver and why would you do it
Leopold maneuvers are used to determine the fetal position in the maternal abdomen beginning in the second trimester; accuracy is greatest after 36 weeks’ gestation (Fig. 26-13).27 Although less accurate for assessing fetal growth,28 these examination findings help determine readiness for vaginal delivery by assessing:
Sally is a 32-year-old female who comes to you for her prenatal assessment. She is currently 25 weeks pregnant with twins. She has 5 living children where in four were born at 39 weeks gestation, and one child was born at 28 weeks gestation. Two years ago, she reported she had a miscarriage at 10 weeks gestation.
Whats her GPTAL
note parity is not used in the usually but give that to me to
Gravida- 7
Premature- 1
Term- 4
abortion- 1
Living- 5
para= number of pregnancies that went above 20 weeks
-6
Joy, a 30-year-old female, had two pregnancies that end in miscarriages at 12 weeks and is now 12 weeks pregnant. Her obstetric history would be document as follows:
Gravida- 3
premature- 0
term- 0
abortion- 2
living- 0
