HISTORY/PHYSICAL Flashcards
<p>Pulses measurements</p>
<p>0/4: absent 1/4: weakly palpated 2/4: normal 3/4: bounding 4/4: strongest, associated w/ thrill or bruit</p>
<p>bounding pulses </p>
<p>-assocated w/ wide pulse pressure (over 60mmHg difference)
- FACTS (causes)
- FEVER
- AORTIC INSUFFICIENCY
- COMPLETE HEART BLOCK
- THYROTOXIOSIS
- SYSTOLIC HYPERTENSION </p>
<p>which pulses should be reported?</p>
<p>ALWAYS dorsalis pedis and posterior tibial
| -also do: peroneal, popliteal, femoral </p>
<p>edema pitting vs non, how to perform exam?</p>
<p>-non pitting (protein rich exudate)
-pitting (protein poor)
-press down on leg for at least 5 seconds on an area of MAX swelling (pitting if over 5 seconds)
</p>
<p>scale of pitting edema </p>
<p>1+: indentation 2mm
2+: indentation 4mm
3+: indentation 6mm
4+: indentation 8mm </p>
a lesion less than 0.5cm, filled w/ pus is called?
-pustule
hip Joint motion values
Hip:45 internal/external/ABduction
- 20 ADDuction
- 120 flexion
- 0-15 hyperextension
Knee joint motion values
- 130 flexion
- 15 hyperextension
Ankle joint motion values
- 10 dorsiflexion w/ knee extended/ flexed
- 50 plantarflexion
STJ joint motion values
- 20 inversion
- 10 eversion
1st MPJ joint motion values
- 60 dorsiflexion
- 5-10 plantarflexion
1st ray joint motion
10mm total ROM
Muscle strength values
-5/5 normal
4/5: movement against resistance, but less than normal
3/5: movement against gravity but not resistance
2/5: movement at the joint but not against gravity
1/5: visible movement but not at the joint
0/5: no muscle movement
what is seen w/ early strength loss?
- extensor digitorum first to go
- dec of ankle dorsi and plantarflexion
what are the corticospinal/ pyramidal tract in charge of?
- voluntary movement
- fine, discrete, conscious movement
what is the extrapyramidal tract in charge of?
- maintains muscle tone
- controls body movements (large)
- issue w/ this tract for parkinson’s
Cerebellar system, what is it in charge of?
- receives sensory/ motor input
- coordinates muscular activity
- maintains equilibrium/ controls posture
after entry to the dorsal spinal cord, what tracts does the sensory cord proceed along?
- posterior column
- lateral spinothalamic tract
Lateral spinothalatmic tract
- small fiber tract due to composition of C and A delta fibers
- sharp/dull pain
- temp
- crude touch
- burning/ cramping
- crude touch
posterior colum
- large fivers cause A alpha fibers
- position
- vibration
- fine touch
- pins and needles/ electric shock sensation
which tests are for lateral spinothalamic?
SWM
sharp/dull
temperature
SWM
-Semmes Weinstein Monofilament
-measure of low threshold mechanoreception
-apply monofilament to
1/3/5 met heads
1/3/5 toes
Plantar arch/heel
5 met base
dorsal midfoot
-more than 3 areas missed= neurotrophic ulceration
tests for posterior column
-vibration/ position sense/ 2 point discrimination tests
Deep reflexes
- may need to use Jendressic technique
- knee: L 2,3,4
- ANkle: S 1,2
Jendressic
-involves isometric contraction of muscles, incrase reflex activity (pull fngers and pull one hand against the other)
Deeo reflexes scale
4/4: brisk, hyperactive, clonus (UMN) 3/4: brisker than average 2/4: normal 1/4:diminished 0/4: no response LMN, peripheral neuropathy
Babinski response indicates?
- dorsiflexion= abnormal exam
- UMN
Peripheral neuropathy vs spinal lesion (regarding tip toes)
- stand on tiptoes but not heels= peripheral
- stand on heels but not tiptoes- spinal lesion
Apgar score
-tesets for birth crap APPERANCE PULSE GRIMACE ACTIVITY RESPIRATIONS -2 points/category, need a score of 7 or more for normal
developmental landmarks
head lift-3mo control head-6mo crawl=6mo stand-9mo walk-14mo stairs w/ hand support-18mo run-2years tricycle-3 years hop on 1 foot-4years heel-toe walk-5 years skip on 1 foot-6years
