Lab Information Flashcards
Parts of the _ _ is connected to the large curvature of the stomach and the transverse colon. The _ _ is connected to the small curvature of the stomach, the liver and the duodenum.
GREATER OMENTUM- large curvature of the stomach/ transverse colon
LESSER OMENTUM- small curvature of the stomach/ liver/ duodenum
One theory on the purpose of the greater/ lesser omentum is that it functions as form of _ _ because it can _ _ _ and can _ an infection from spreading to the rest of the abdominal cavity.
It functions as a form of INFECTION CONTROL because it can ENCAPSULATE BURST ORGANS (ex. Appendix) and can SEPERATE an infection from spreading to the rest of the abdominal cavity
The _ is a bilayer of tissue that holds organs in place an serves as a conduit and prevents the tangling of nerves and lymph vessels and is supplied with blood.
The MESENTERY is a bilayer of tissue . . .
What are the 3 parts of the mesentery?
3 parts:
- mesentery PROPER
- MESOCOLON
- BROAD LIGAMENT OF THE UTERUS
Which part of the mesentery is exclusively connected to the small intestines? The Colon (transverse, sigmoid, etc.)?
Mesentery proper- small intestines
Mesocolon- colon
The _, _, and _ ligaments keep the uterus in place.
The BROAD, ROUND and CARDINAL ligaments keep the uterus in place.
The _ _ bifurcates into the left and right _ _ _, which then travel on to become the _ _ (superior and inferior bundles) and the _/ _ _ artery.
The ABDOMINAL AORTA bifurcates in the left and right COMMON ILIAC ARTERY, which then travels on to become the GLUTEAL ARTERY (sup/ inf bundles) and the FEMORAL/ DEEP PROFUNDUS artery
The _ is a filtering organ whose function is infection control. Where is it located in the abdomen?
The SPLEEN is a filtering organ whose function is infection control.
Located in the UPPER LEFT QUADRANT
Which organ has not yet been transplanted? 3 parts?
pancreas
3 parts:
-Head, Body, and tail
If a tumor occurs in the _ of the pancreas in can be removed. If it happens in the _ it is possible it can be removed. If it happens in the _, you’re screwed.
If occurs is the :
TAIL- can be removed
BODY- possibly removed
HEAD- screwed
What are the 3 parts of your small intestine (in order from stomach to colon)?
DJI
- duodenum (first section)
- jejunum (second section)
- ileum (last section)
Meaning of duodenum? Function: bile ducts and pancreas send _ to break down _, _ and _ in the duodenum.
Means- 12 fingers long
Function: bile ducts and pancreas send ENZYMES to break down PROTEINS, LIPIDS AND SUGARS in the duodenum
The _ means empty one. It’s function is to _ _ and _ _ _ from the _. It has the highest?
The JEJUNUM means the empty one
It’s function is to ABSORB ENZYMES and BROKEN DOWN NUTRIENTS from the DUODENUM.
It has the highest BLOOD SUPPLY
The ileum means the _/ _ one. _ _ can occur at the ileum- cecum junction.
The ileum means the TANGLED/ CROOKED one
CELIAC’S DISEASE can occur at the ileum- cecum junction
The _ is the first part of the large intestine. Is the place where _ _ and _ _ can get stuck and result in . Means “ bag”.
The CECUM is the first part of the large intestine.
Is the place where STARCHY FOOD and RED MEAT can get stuck and result in HALITOSIS
Means “EMPTY bag”
The _ _ means ribbon like structure, and is made of _ _ of _ _ that run along the colon that contract and straighten in order to move food through the large intestine.
The TENIA COLI means ribbon like structure, and is made of 3 STRANDS of SMOOTH MUSCLE that run along the colon . . .
What are the 4 sections of the large intestine in order from mouth to anus?
AT DS
- ascending
- transverse
- descending
- sigmoid
The _ is located behind the sternum and pericardium And between the lungs. It’s purpose is to receive immature _ _ that are produced in the _ _ _ and train them into functional mature _ _ that attacK _ _ cells.
The THYMUS is located behind the sternum and the pericardium and between the lungs.
It’s purpose is to receive immature T CELLS that are produced in the RED BONE MARROW and train them into functional mature T CELLS that attack ONLY FOREIGN cells
Cranial nerve I, aka _ nerve doesn’t need to be evaluated routinely, however it should be looked at in a patient with a suspected _ _ disorder. What sense does it control?
CN I, aka OLFACTORY nerve doesn’t need to be evaluated routinely . . . Should be looked at in a patient with a suspected FRONTAL LOBE disorder.
Controls SMELL
A _ loss of smell, known as _ _, is more important than _ loss because it indicates a lesion effecting the _ nerve on _ _ _.
A UNILATERAL loss of smell, known as UNILATERAL ANOSMIA, is more important than BILATERAL loss because it indicates a lesion affecting the OLFACTORY nerve ON THE SAME SIDE.
What are 2 common techniques used to test visual acuity? What nerve is being tested?
2 common techniques:
- SNELLEN chart
- POCKET VISUAL ACUITY CARD
CN II, Optic nerve is being tested
What test is being described: examiner stands 3’ in front of and facing the patient, patient is asked to close one eye and then the examiner holds up fingers/ and asks patient ‘how many’. The test is repeated in the upper and lower quadrants on the open eye side. Then repeated with on the other eye. What nerve is being tested?
CONFRONTATION TESTING
The CN II, optic nerve is being tested
The pupillary light reflex is tested by? The response to light is controlled by sensory nerves that travel with _ _ , and the motor nerves that travel with _ _ . Both of which innervate the _ _ which controls the size of the pupil.
Tested by shining a light in the patients pupil and assessing the response (direct/ consensual) in both eyes.
The response to light is controlled by sensory nerves that travel with CN II and the motor nerves that travel with CN II
Both innervate the CILIARY MUSCLE which controls the size of the pupil
If you shine a light in a persons right eye and the right pupil constricts it is called a _ _, if you shine a light in a persons right eye and the left pupil constricts it is known as a _ _.
Same pupil reacts- DIRECT RESPONSE
Opposite pupil reacts- CONSENSUAL RESPONSE
Asymmetry of the pupils is known as _, some people have no underlying neuropathy.
Known as ANIOSOCORIA
What test looks at a the eye’s motor response? Which nerves are being tested? (3)
SMOOTH PURSUIT TEST
Looks at CN III, IV, VI
CN V, or the _ nerve has _ _. Name them.
CN V, or TRIGEMINAL nerve, has 3 BRANCHES
3 branches (MOM):
- Maxiallary
- ophthalmic
- mandibular
How is the sensory nerves tested from the trigeminal nerve? Motor nerves?
Sensory- touch patients face using cotton ball/ pin (light touch/ sharp touch) in each of the 3 branches bilaterally
Motor- palpate the temporalis and masseter muscles bilaterally while patient tightly closes their jaw
What is the name of the test in which the examiner takes a q-tip and lightly brushes the lateral aspect of the sclera of each of the eyes, and observes for bilateral blinking reflex? What nerves are being tested? (2)
The CORNEAL REFLEX test
Nerves tested:
- sensory limb of the CN V/ Trigeminal nerve
- motor limb of the CN VII/ Facial nerve
How are the branches of the facial nerve (CN VII) that innervate facial muscles tested? (4)
- Have pt. smile and observe for symmetry
- Have pt. puff out cheeks against resistance (with fingers)
- Have pt. wrinkle forehead
- Have pt. shut eyes/ keep them shut as therapist attempts to open
What test is being described: Therapist strikes tuning fork to start vibration, then applies it to the patients mastoid process, should conduct vibration and pt. should hear. When they can no longer hear the sound move the tuning fork towards the opening of the ear, pt. should be able to hear it again. Is repeated on both sides/ ears.
RINNE TEST
What does the Rinne test look at? What is considered normal/ positive? Negative result suggests?
The Rinne test looks at conductive hearing loss/ deafness (using air conduction AC, and bone conduction BC)
Normal/ positive result: AC is greater than BC
Negative result (BC greater than AC) suggests/ indicates conductive deafness
What test is being described: therapists strikes tuning fork to start vibration, then holds it against the pt. forehead/ or place on face that is equal distance between each ear. Asks patient if sound is heard equally in both ears, or is one louder than the other.
WEBER TEST
The Weber tests allows clinician to differentiate between _ hearing loss and _ hearing loss. How?
Allows clinician to differentiate between CONDUCTIVE hearing loss and SENSORINEURAL hearing loss.
If the Rinne confirms conductive hearing loss AND the sound is heard LOUDER on the SAME SIDE as the positive Rinne test it is- CONDUCTIVE
If the Rinne test is NEGATIVE, but patients reports hearing sound LOUDER on one side (ex. Right) versus the other than it is indicative of SENSORINEURAL hearing loss on the opposite side (ex. LEFT CN PROBLEM)
Both the Rinne test and the Weber test are looking at the function of which CN?
CN VIII
- Vestibulocochlear
Both the _ _ and _ _ (aka CN _ and _) are tested by looking at elevation of the soft palate (uvula) or gag reflex with a tongue depressor.
Both the GLOSSOPHARYNGEAL NERVE AND VAGUS NERVE (aka CN IX and CN X) are tested by looking . . .
Which cranial nerve is tested by resisted muscle testing of the upper traps (shoulder elevation) and sternocleidomastoid (contralateral head rotation)?
CN XI, Accessory (spinal) nerve
Which nerve is tested by having patient stick out tongue and observing for any deviations from midline? What if tongue protrudes more to one side, next test? Negative result- indication?
CN XII hypoglossal nerve
If it protrudes more to one side, have patient place tongue on inside of that cheek and apply resistance (MMT for the tongue)
If tongue is still weak to the one side it will indicate dysfunction of the CN XII on the SAME SIDE
What quadrant are the following organs located: left kidney (lower pole), sigmoid colon, portion of descending colon, left ovary/ Fallopian tube, left ureter, left spermatic cord, uterus (if enlarged), bladder (if distended)
Left LOWER quadrant (Sigmoid colon)
What quadrant are the following organs found in: liver, gall bladder, pylorus, duodenum, pancreas (head), right adrenal gland, right kidney (upper pole), hepatic flexors, ascending colon (portion), and transverse colon (portion)
Right UPPER quadrant (GDP, most of liver)
What quadrant do the following organs lie in: Cecum, appendix, ascending colon (portion), right ovary/ Fallopian tube, right ureter, right spermatic cord, right kidney (lower pole), uterus (if enlarged) and Bladder (if distended).
Right LOWER quadrant (CA)
What quadrant are the following organs in: Spleen, stomach, pancreas (body), splenic flexure, transverse colon (portion), descending colon (portion), left adrenal gland, liver (left lobe), and left kidney (upper pole)
Left UPPER quadrant (SSP)
What part of the pancreas is found in the right upper quadrant? Left upper quadrant?
Right- head
Left- body
Easing factors for: stomach-gastric distention? Stomach/ duodenum- peptic ulcer? Stomach/ duodenum- pyloric obstruction (no bile)?
Distention- BELCHING
Peptic ulcer- EATING
Pyloric obstruction (no bile)- VOMITING
Easing factors for: retroperitoneal structures- pancreatic cancer or pancreatitis? Peritoneum- peritonitis?
Retroperitoneal/ pancreas- LEANING FORWARD
Peritoneum- FLEXION OF HIPS/ KNEES
If a patient has appendicitis what muscle will the commonly feel it? Diverticulitis? What are the easing factors for each condition?
Appendicitis- Right psoas muscle, flexion of right thigh eases pain
Diverticulitis- Left psoas muscle, flexion of left thigh eases pain
When examining/ inspecting the abdomen what are the two main techniques that are applied?
Visual inspection and palpation
Where is the cross point that divides the abdomen into quadrants?
Umbilicus
What test is being described: pt. is supine, therapists selects a site away from area of pain, then with a perpendicular hand on abdomen slowly pushes down deeply, holds for a moment and then quickly releases. Ask patient which hurts more, deep pressure or quick release pressure. Red flag findings? Indicative of?
BLUMBERG’S SIGN- REBOUND TENDERNESS W/ VISCERAL PALPATION
Red flag: test is positive if patient reports more pain with quick release
Indicative of PERITONEAL INFLAMMATION
What test is being described: standing to the right of supine patient, therapist places right fingers on right rectus abdominus just below rib cage (RUQ), then applies pressure with left hand and asks patient to take a deep breath.
MURPHY’S SIGN for the gall bladder (gall bladder palpation)
Red flags for Murphy’s sign: sudden pain that _ with _ is suggestive of a gall bladder pathology. _ abdominal muscle _. Pain is also increased with _ _.
Sudden pain that CEASES WITH INHALATION is suggestive of gall bladder pathology
ABRUPT abdominal muscle TENSING
Pain is also increased with FORWARD BENDING
The liver palpation test is very similar to the Murphy’s sign, except? Red flags: _ of _, _, and _ or _ borders.
Except therapist uses LEFT HAND to palpate posteriorly/ UNDER the patients 11/ 12 RIBS and right hand on right rectus abdominus with pressure in an UPWARD AND INWARD direction
Red flags: REPRODUCTION of SYMPTOMS, TENDERNESS, and ENLARGEMENT or IRREGULAR borders.
Enlargement of the liver may be indicative of: _, _, _ or _ congestion.
CIRRHOSIS, HEPATITIS, NEOPLASM or VASCULAR congestion
What is an alternate position used for palpating the liver in larger patients.
Side lying, and hook fingers under the right ribs
How is the spleen palpated? (2)
Bi-manually, have patient in supine and and pull up/ anteriorly on left posterior abdomen while simultaneously pushing down/ posteriorly just medial to left ribs and instruct patient to breathe in.
Or done in side lying by hooking fingers under left rib cage
Red flags for spleen palpation: _ of patients _, if spleen is , it is probably _ ().
REPRODUCTION of patients SYMPTOMS
If spleen is PALPABLE it is probably ENLARGED (SPLENOMEGALY)
SPLENOMEGALY is due to: a recent history of _ especially _, _, , or infiltration by _ ( _).
A recent history of INFECTION, especially MONONUCLEOSIS, HYPERPLASIA, CONGESTION, or infiltration by TUMORS (MYELOCYTIC LEUKEMIA)
What test is being described: patient is supine with foot of the bed/ patient’s legs elevated (trendelenburg position). What is being tested? Positive result?
KEHR’S TEST
Testing for a RUPTURED SPLEEN
Positive result: severe LEFT SHOULDER PAIN within a few minutes of LE elevation
How are the kidney’s palpated?
Pt. is supine, therapist places on hand on back (b/w ribs and iliac crest) and one hand in same area on front of abdomen then presses hands together. Has patient breathe in. Trying to capture right lower pole between fingers.
The _ _ is located more superiorly to the _ _. Typically the neither kidney is palpable in an _, but both are typically palpable in _.
The LEFT KIDNEY is located more superiorly than the RIGHT KIDNEY
Typically neither are palpable in- ADULTS
Both are palpable in- CHILDREN
What is the name of the test for Kidneys/ renal tenderness that involves tapping/ percussing the kidneys on the patients back, just below the rib cage. Reproduction of pain/ positive sign is indicative of?
McMurphy’s test
Positive sign: indicative of PYLONEPHRITIS
Where is McBurney’s point palpated? What organ is being targeted? Red flag?
Palpated at the half way point between the patients ASIS and umbilicus, with vertical pressure
Targets the APPENDIX
Red flags: increased abdominal pain
What are 2 other signs/ tests for appendicitis? Brief description of each.
PSOAS/ ILIOPSOAS sign (resisted hip flexion with patient in supine, stabilizing at Ipsilateral shoulder)
OBTURATOR SIGN (patient is supine with knee slightly bent and adducted across body- resist ER (procedure 1), and then active or passive IR w/ or w/o OP)
Red flag for both Psoas and Obturator sign tests is _ or _ of abdominal _. Initially appendicitis pain is felt at the _ but symptoms travel to the _ within _ to _ hours after initial event.
Red flags for both is PRODUCTION OR REPRODUCTION of abdominal PAIN
Initially appendicitis pain is felt at the UMBILICUS but symptoms travel to the RLQ within 1 to 3 hours after initial event.
What organ is being palpated: patient is supine with right hip flexed to 45, and right knee flexed to 90, therapist palpated just left of midline in the upper abdomen halfway between the Xiphoid process and the umbilicus, and uses index/ middle fingers of both hands to estimate the width.
ABDOMINAL AORTA
Red flags with Abdominal aorta palpation: _ aorta (greater than _ _) or lateral _ may indicate _ _, should refer out. _ _ with palpation, or _ on auscultation. Other symptoms may include _ sensation or _ pain followed by _ pain.
WIDE aorta (greater than 4 CM) or lateral PULSATION may indicate AORTIC ANEURYSM, should refer out.
BACK PAIN with palpation, or BRUITS on auscultation.
Other symptoms may include ‘TEARING’ sensation (dissecting aorta) or CHEST pain followed by ABDOMINAL pain
If patient experiences symptoms in the _ _ _ you should consider lung, heart, stomach, duodenum, pancreas, kidney or aorta as possible sources.
Experiences symptoms in the RIGHT UPPER QUADRANT
If patient experiences pain the in _ _ _ you should consider lung, heart, esophagus, stomach, duodenum, pancreas, kidney, ureter, spleen, or aorta as possible sources.
Experiences pain the LEFT UPPER QUADRANT
If patient experiences pain/ symptoms in the left lower quadrant which organs might you suspect? (3)
LOB
LARGE more than small BOWEL
OVARIES
BLADDER
If patient experience symptoms in the right lower quadrant what organs should you consider? (4)
BOAS
BLADDER
OVARIES
APPENDIX
SMALL more than large BOWEL
If patient experiences _ _ _ organs to consider would be the heart, pancreas, aorta, and bladder.
If patient experiences MID ABDOMINAL PAIN
Red flags that should be communicated to the medical provider: _ or _ _ _ in the epigastric region for suspected large abdominal _ _. Positive _ _ or other signs of _ _.
VISIBLE or PALPABLE PULSATILE MASS in the epigastric region for a suspected large abdominal AORTIC ANEURYSM
Positive REBOUND SIGN or other signs of PERITONEAL INFLAMMATION
4 major types of abdominal hernia? How can you differentiate if the hernia is in the abdominal wall or in deeper abdominal tissue?
Erin’s IUD
-epigastric, inguinal, umbilical, diastasis recti (ventral hernia- separation of 2 rectus abdominus muscles)
You can differentiate by having painted raise head and shoulders (activate abdominal muscles) if it is still present and/ or tenderness persists it is in the abdominal wall, if no to both then it is located in deeper abdominal tissue (Carnett test)
What are the 3 most important aspects of writing a referral for a patient: state _ _, state relevant _ _ _ and _; state _ of _.
State PT DIAGNOSIS, state relevant COMORBID MEDICAL HISTORY; state PLAN of ACTION (once patient is medically clear patient needs PT)
During a patient interview it is important to master: how to _ a _ (use _ _ _); the art of _ (give patient _ _ _ ), and _ of patient _/ _.
How to ASK a QUESTION (use OPEN-ENDED QUESTIONS)
The art of LISTENING (give patient TIME TO RESPOND)
OBSERVATION of patient RESPONSE/ REACTION
When asking questions about current/ past medical history or symptoms it is important to?
Group questions by system (ex. CV, pulmonary, GI, etc)
What is the name of the Questionairre that is often used to assess a patients pain by having them chose words and rate their intensity to determine the properties of pain experience and provide quantitative measures of clinical pain. Is not used?
McGill Pain questionnaire (MPQ)
Is not used very often in a clinical setting
With the McGill Pain Questionairre the patient score is then placed on a _ _ that uses common _ of _ as a reference. Very _.
Score is then placed on a BAR GRAPH that uses common CAUSES OF PAIN as a reference.
Very SUBJECTIVE
What are the three main classes of word descriptors used in the MPQ?
Sensory, affective and evaluative
The 3 major measures taken with the MPQ: the _ _ _, based on two types of numerical values that can be assigned to each word, the _ of _ _, and the present _ _ based on a - scale.
The PAIN RATING INDEX, based on . . . .
The NUMBER OF WORDS CHOSEN
The present PAIN INTENSITY based on a 1-5 scale
With the modified McGill Pain questionnaire: group a suggests? Group B-H suggests? Group I suggests? Group J-T suggest?
Vicki Haines Mangles Turkeys
A: VASCULAR DISORDER
B-H: NEUROGENIC disorder
I: MUSCULOSKELETAL disorder
J-T: EMOTIONAL DISORDER
Scoring guide to Modified McGill Pain Questionnaire (adding up number of words chosen): greater than 16? 10-16? 8-10? 4-8?
Greater than 16: UNLIKELY TO RESPOND TO THERAPY
10-16: MAY BE BETTER HELPED BY PSYCHOLOGIST THAN PT
8-10: FOCUSING TOO MUCH ON PAIN
4-8: NORMAL
C-Spine rules- High Risk factor/ mandates X-rays/ imaging: Age _ than _, _ _, or _ in the _.
Age GREATER THAN 65
DANGEROUS MECHANISM
PARATHESIAS in the EXTREMITIES
A fall from an elevation of greater than 3 feet/ 5 stairs, an axial load to the head (diving injury), MVC at high speed or with rollover or ejection, a collision involving a recreational vehicle, or a bicycle collision are all considered a?
A DANGEROUS MECHANISM according to Canadian C-spine rules.
Low- risk factors that allow for safe assessment of C-spine rules include: simple _ _ _, able to _ in ER, _ at any time, or delayed not immediate onset of _ _, or absence of _ _ _ tenderness. If patient answers yes to these questions how should you proceed? No?
Simple REAR END MVC or able to SIT in the ER, AMBULATORY at any time, or delayed no immediate onset of CERVICAL NECK PAIN, or absence of MIDLINE CERVICAL SPINE tenderness.
- If yes, then check neck rotation ROM
- if no, then they do not need to be referred for imaging
A simple rear-end motor vehicle accident (C-spine rule) excludes being _ into _ _, being hit by a _ or _ _, a _, and being hit by a _ _ vehicle.
Excludes being PUSHED into ONCOMING TRAFFIC, being hip by a BUS or LARGE TRUCK, a ROLLOVER, and being hit by a HIGH SPEED vehicle.
When used appropriately the application of the C-spine rule will _ the number of _ and _ the _ of _ of these patients in the ER.
Will REDUCE the number of X-RAYS and SHORTEN THE LENGTH OF STAY of these patients in the ER
What is the normal amount of rotation that occurs in the C1-C2 spinal segments?
25 degrees
If you find that the patient does have low risk factors, and but you cannot assess neck rotation ROM you should? If you can, and they have more than 45 degrees? Less than 45 degrees?
If you cannot assess neck ROM- REFER for X-Ray
If you can, they have more than 45 degrees- DO NOT need X-Ray
If you can, they have LESS than 45- REFER for X-Ray
