High yield Flashcards
what are the borders of the anterior triangle of the neck?
superior mandable lateral by the medial border of the sternocleidomastoid m, medially by the midline
border of posterior triangle
medial border is sternocliedomastoid m, clavicle is inferior border and trap is lateral border/ the spinal accesory nereve runs through the posterior triangle
what is a virchows node and what does it suggest
left sided enlarged supraclavicular lymph node that suggest malignancy of thorax or abdoman
what does a right sided englarged supraclacicular lymph node suggest
malignancy of lungs, mediasteinum, esophogus
what muscle attaches to the labrum of the shoulder
biceps
what does O’Brians test test for?
O’Brien’s test: positions the arm for resistance testing in a way that specifically targets a SLAP (superior labrum anterior to posterior) labral tear.
Flex arm to 90°and adduct across the chest
Internally rotate with the thumb pointing down and push down on the arm
what does the apprehesnsion test test for?
Apprehension test: positions the shoulder in abduction and external rotation that reduces stability of the joint and can promote anterior dislocation. Patient may become apprehensive in this position.
Drop arm test
Drop arm: used to assess a severe tear or full rupture of the supraspinatus tendon. ROM 0-90° = supraspinatus, 90-120° (or so) = deltoid. When a full supraspinatus tear exists, the patient cannot hold the arm in a position between 0-90° .
speeds test
Speed’s test: resisted bicep flexion reproduces pain localized to the tendon suggesting tendonitis.
cervical compression test
aka Axial/Vertical Compression Test
Apply direct vertical compression without sidebending or rotation to provoke symptoms of a pinched nerve.
spurlings maneuver
**Sidebending to the affected side with compression down along the spinal axis. Reproduces radicular symptoms
distraction test
Alleviates radicular symptoms and supports a diagnosis of radiculopathy pull up on head
Roo’s test
Arms abducted to 90°, externally rotated
Elbows flexed at 90°
Patient slowly opens and closes his hands for 3 minutes.
tests for thoracic outlet syndrome
Adson’s test
The arm of the standing (or seated) patient is abducted 30 degrees at the shoulder and maximally extended.
• The radial pulse is palpated and the examiner grasps the patient’s wrist.
• The patient then extends neck and turns the head toward the symptomatic shoulder and is asked to take a deep breath and hold it.
• The quality of the radial pulse is evaluated in comparison to the pulse taken while the arm is resting at the patient’s side.
• Some clinicians have patients turn their heads away from the side tested in a modified test.
lift off test
: With arm internally rotated so dorsum of hand rests on low back, have patient lift the hand off their low back posteriorly against your resistance.
tests for subscap injury
crossover test
Adduct the arm across the chest which compresses the acromioclavicular joint and causes pain if there has been disruption of the AC joint or arthritis.
neers impingement sign
Stabilize scapula Internally rotate and flex arm Subacromial impingement Supraspinatus pathology hail hitler one
Hawkins impingment sign
The patient is examined while sitting with their shoulder flexed to 90° and their elbow flexed to 90°. The examiner grasps and supports proximal to the wrist and elbow to ensure maximal relaxation, the examiner and the patient then quickly rotate the arm internally. Pain located below the acromioclavicular joint with internal rotation is considered a positive test result for subacromial impingement or rotator cuff tendinitis
medial epicondylititis test what
flex wrist
lateral epicondylitits test what
extend wrist
finkelsteins test
Patient grips thumb inside fist. Examiner gently ulnar-deviates the wrist. If pain occurs along the thumb or wrist, the test is positive for tenosynovitis of the extensor pollicis brevis and abductor pollicis longus (De Quervain’s Disease).
tinels test or sign
tap over median nerve
phalens sign
median nerve impingment
reverse phalens sign
median nerve impingemnt
Describe visceral pain
source is usually hollow organ caused by distension or stretching. Comes and goes, crescendo/decrescendo pattern. Not well localized
describe parietal pain
Caused by inflammation of the peritoneum. Steady aching pain that is usually well localized.
what refers pain to the right shoulder?
glabladder/liver
what refers pain to the back?
aorta/pancreas
What refers pain to the left shoulder?
spleen
What refers pain to the flank and groin?
kidney
what is adequate exposure of the abdomen
xiphoid to the pubis
what is rovsings sign?
deep palpation of llq cause pain in rlq
What is lloyds sign?
tenderness as CVA striking of back
Condyloma acuminata caused by ?
HPV
Condylomata lata caused by?
syphilis
five f’s of acute cholyctstitis
The 5 “f’s” – female, fat, fertile, fair, flatulent.
what is murpheys sign?
RUQ pain and sudden arrest of inspiration during palpation of the liver and gallbladder.
what is the diagnostic triad for acute cholectystits?
RUQ pain, fever and leukocytosis.
presentation of chlaymdyia?
elevated WBC non gonococcal urethritis
presentation of Gonhearra
WBC with Gm(-) intracellular diplococci
hypospadias def
congenital displacement of the urethral meatus on the inferior surface of the penis along the urethral groove.
Important in a new born exam. Maybe associated with congenital renal abnormalities.
epispadias def
congenital displacement of the urethral meatus on the superior surface of the penis
causative organism and path of primary syphilis
Treponema pallidum – causative organism
Syphilitic Chancre – painless round or oval erosion or ulcer. Non-tender enlarged inguinal lymph nodes are common.
RPR and VDRL are positive, screening test, many false positives.
FTA- ABS is positive or Dark Field Microscopy, confirmatory test.
gentital herpes pathology?
cluster of small vesicles. Burning and painful. Progress to ulcers on a erthymic base. Dx – viral culture of the fluid in the vesicle.
Herpes simplex virus 1 and 2 – causative organism
what causes venereal warts?
HPV
gonococcal urethritis gram stain
Gram-negative intracellular diplococci of GC
WBC = neutrophils
abrupt incubation period
non-gonococcal urethritis gram stain
polymorphonuclear leukocytes NGU=chlamydia
define menorrhagia
excessive bleeding
define Metrorrhagia –
Metrorrhagia – bleeding between periods
where does LNMP info go?
very fist sentence of HPI
how should you insert a speculum?
horizontally and inferiorly gently downward posterior force
what is the purpose of a pap smere?
To find “pre-cancerous” (i.e., DYSPLASIA) lesions of the cervix
what is version?
Version is the relationship between the fundus of the uterus and the vagina
what is flexion for cervix?
Flexion is the relationship between the fundus of the uterus and the cervix – think of uterus as having a HINGE at internal os of cervix
what supplies the breast with blood
(1) perforating branches of the internal mammary artery
(2) lateral branches of the posterior intercostal arteries
(3) branches from the axillary artery, including the highest thoracic, lateral thoracic, and pectoral branches of the thoracoacromial artery.
where does the axilary tail of the breast drain lymph?
subscapular group of axillary nodes.
where does the upper portion of the breast drain lymph?
into infra clavicular group.
Most of the lymph from subareolar and submammary plexus is drained to the?
anterior or pectoral group of axillary nodes
Medial part of the breast is drained by
sub mammary plexus of the opposite
breast and also to the lymph glands along the internal thoracic artery and then to the mediastinal nodes
The inferior part of the breast is drained by?
lymphatics of abdominal wall and to the extra peritoneal lymphatic plexus.
when is the optimal time to examine the breast?
5-7 days from “day 1” of the LNMP (estrogen is lower, thus less swelling/tenderness w/exam)
stages of change for motivational interviewing?
Precontemplation Contemplation Preparation Action Maintenance Relapse
torticollis pathology
spasm of sternocleidomastoid causing ipsilateral sidebending and contralateral roatation
in thoracic outlet syndrome adsons tests what?
tests the radial pulse for compression of the subclaciamn artery betweeen the MIDDLE AND ANTERIOR SCALENE and 1st rib…extension with abduction test for pec minor impingment
trap primary action
Superior portion- elevates scapula
Middle portion- retracts scapula
Lower portion- depresses scapula
Pectoralis major action
Depresses, adducts, internally rotates humerus
Coracobrachialis action
Flexes and adducts humerus
Deltoid action
Anterior portion- flexes humerus
Middle portion- abducts humerus after 90°
Posterior portion- extends humerus
Teres Major action
Internally rotates humerus
Rhomboids action
Retracts scapula
Latissimus Dorsi action
Internally rotates and extends humerus
Serratus Anterior action
Protracts and stabilizes scapula/ assocaited with winged scapula due to damage of long thoracic nerve
Supraspinatus action
Abducts up to 90°
Infraspinatus action
Externally rotates humerus
Teres Minor action
Externally rotates humerus
Subscapularis action
Internally rotates humerus
the crossover test checks?
AC joint pathology or arthritis of AC joint
what ligament holds the radial head in place?
annular ligament
what fracture is associated with snuffbox tenderness?
scaphoid bone… problematic because of limited blood supply
pathology of mallet finger?
Mallet finger reflects an avulsion of the extensor tendon at the DIP joint.
Boutonniére Deformity pathology
Boutonniére Deformity reflects an avulsion of the extensor tendon at the PIP joint.
what does homans sign test for?
Evaluates for DVT (deep venous thrombosis)
Dorsiflex patient’s ankle with leg extended at knee. Pain in calf is a positive sign.
FABER testing?
Patrick’s test or FABER test (for Flexion, ABduction, and External Rotation) is performed to evaluate pathology of the hip joint or the sacroiliac joint. The test is performed by having the tested leg flexed and the thigh abducted and externally rotated.
what is the thessely test for?
standing and twisting tests for meniscal tears more specific than mcmurry test
what does mcmurrays test for?
meniscal tear the knee is held by one hand, which is placed along the joint line, and flexed to complete flexion while the foot is held by the sole of the foot with the other hand. The examiner then places one hand on the medial side of the knee to pull the knee towards varus position,pulling the knee laterally (bow legged). The other hand rotates the leg internally while extending the knee.
thompson test?
test for the rupture of the Achilles tendon. The patient lies face down with feet hanging off the edge of the bed squeeze calf.
Kleiger test
Maneuver used to determine stability of the deltoid ligament. The examiner stabilizes the leg just above the ankle with one hand and everts the foot with the other. Pain or instability suggests injury to the deltoid ligament.
motor, reflex and sensation for L4
motor: anterior tibialis
reflex: patellar tendon
sensation: medial aspect of foot
motor, reflex and sensation for L5
motor: extensor hallucis longus
reflex: none
sensation: medial aspect of dorsal and plantar foot surfaces not including heel
motor, reflex and sensation S1
motor: gastroc/soleus (repetitive toe raises)
reflex: achiles tendon
sensation: lateral aspect of foot
straight leg raises tests for?
sciatica
what describes true hip pain?
pain in groin
what is the thomas test?
patien supine grab knee and bring it to chest
If the iliopsoas muscle is shortened, or a contracture is present, the lower extremity on the involved side will be unable to fully extend at the hip.
what is ballottment test?
indicates increased fluid in the suprapatellar pouch over the patella at the knee joint. To test ballottement the examiner would apply downward pressure towards the foot with one hand, while pushing the patella backwards against the femur with one finger of the opposite hand. A “milking” motion is used with the downward pressure. If a bogginess around the joint occurs, then the test is positive for ballottement.
where is the pes anserine bursa located?
medial and just below the tibial plateau
what does lachmans test for?
ACL injury pull anterior and externally rotate
What are the most common ligaments injured in an ankle sprain?
Anterior talofibular and calcaneofibular
components of a plumb line
ear shoulder greater trochanter, fibular head, lateral malleolus
stance phase and swing phase percent of gait cycle
60 stance 40 swing
T3 spinous process is at what level?
spine of scapula
t7 spinous process is at what level?
inferior angle of the scapula
L4 spinous process at what level?
level of iliac crest
Small intestine vicerosomatic reflex?
T10-T11
colon and rectum vicerosomatic reflex?
T12-L2
Bladder vicerosomatic reflex?
T12-L2
Ovaries/testes viscerosomatic reflex?
T10-T11
Uterus/prostate vicerosomatic reflex
T12-L2
what is the most common site of injury to the lumbar spine
L5/S1
what is reiter syndrome?
triad of arthritis, conjunctivitis, and urethritis
osteoarthritis pathology
degenerative disc disease common in L5-S1
Deterioration and loss of cartilage and normal bone
Low grade inflammatory issue
osteoporosis pathology
thinning of bones
sciatic nerve cord levels
l4-s3
what type of joint is the hip?
Hip is Spheroidal
Synovial
Joint
what test is most specific to the hip joint?
FABER test figure four may elicit SI tenderness
the pes anserinas is the attachment point for what muscles?
sartorius, gracilis, semitendinosus
what is a bakers cist
Cyst in the popliteal fossa, most often medial
Leg extended check posterior/medial aspect of knee for swelling or fullness, sometimes tenderness as well
Prepatellar Bursitis: Anterior pathology
associated with excessive kneeling pain is equal active and passive ROM for bursitis
what does apelys compression test check for?
Patient prone with knee flexed to 90˚
Stabilize thigh with one hand while leaning onto heel compressing medial and lateral menisci. Rotate heel during compression noting any pain
what does a valgus stress on the knee check for?
medial meniscus tear Push medially against knee while laterally against ankle
what does a varus stress in the knee check for?
lateral meniscus tear Push laterally against knee while medially against ankle
what does the talar tilt test for?
Pt is sitting with legs dangling off table
Doc inverts the calcaneus
If the talus gaps or rocks in the ankle mortise, the ATF & calcaneofibular ligs are torn and the test is positive
what is a high ankle sprain?
Syndesmosis between Fibula and Tibia
when should you perform a foot x-ray
Pain around the malleolus and tenderness in posterior malleolar area or tip of fibula
OR
Pain around the malleolus and unable to weight bear immediately and more than 4 steps in ED
OR
Pain in mid-foot and either
1. Tenderness at base of 5th metatarsal or navicular, OR
2. Inability to weight bear immediately OR more than 4 steps in ED
