Midterm Flashcards
1
Q
what is the diaphragm of the stethoscope used for?
A
high pitched sounds
heart/lungs
2
Q
what is a normal reflex grade?
A
2/4
3
Q
what nerve root is tested for in biceps reflex strike?
brachioradialis?
triceps?
A
C5
C6
C7
4
Q
what nerve root is tested for in an achilles reflex strike?
patella?
A
S1
L4
5
Q
something you get on a physical exam or see goes where?
A
Objective
6
Q
diagnosis goes where?
A
assessment
7
Q
something you get from talking to patients goes where?
A
subjective
8
Q
what you will do for patient goes where?
A
plan
9
Q
when encountering a patient’s emotions what do you do?
A
NURS name the pt's expressed emotion understanding respect them support them
10
Q
CAGE questionnaire?
A
need to cut back
annoyed by criticism
guilty about drinking
need a drink for an EYE opener
11
Q
if someone has been smoking for 30 years and smokes 3 packs a day, how many pack years do they have?
A
90
12
Q
what are the 5 Ps of sex?
A
partners prevention of pregnancy protection from stds sex Practices (vag, anal, oral) past hx of stds
13
Q
SAFE questionnaire?
A
stress/safety
afraid/abused
family/friends
emergency plan
14
Q
what to ask in domestic abuse situation?
A
have you ever been hit, slapped, kicked or otherwise hurt
15
Q
how much exercise does the cdc recommend?
moderate activity and strength?
A
150 min/week
2 days/week
16
Q
for pt’s faith what do you ask?
A
FICA faith and believe importance community address in care
17
Q
what di da Vinci do?
A
1st to study anatomy w/mechanics
analyzed m. forces and joint fx
18
Q
what do Galilei do?
A
anything with bone strength/load bearing
19
Q
what did Borelli do?
A
action of walk/run/heart
center of gravity
inspiration is m. driven
expiration due to tissue elasticity
20
Q
what did A.T. Still do?
A
millwright
waved the banner of D.O.s June 22, 1874
21
Q
what is classified with hard biomaterials?
what can it undergo?
what law associated with hard?
A
bones
mechanical deformation
Wolf’s law - remodels where it’s needed
22
Q
what is classified as soft biomaterial?
A
cartliage, tendon, muscle, skin
23
Q
what kind of biomaterial does a runner experience?
what about old men?
A
soft: stronger, stiffer ligaments
soft: cartilage wearing
24
Q
example of hard biomaterial?
A
heel spur due to plantar fasciitis
25
what are the 3 types of machines in the body?
levers (most common)
wheel axis
pulleys (ex. knee cap)
26
what is the most common lever in body?
ex?
3rd class
bicep curl
27
when force is being applied plus the moment arm is called what?
moment
28
sum of moments and the force of contracting m. is what
| .
joint reaction force
29
the amt of force necessary to bend an object is what?
stiffness
30
what is associated w/viscosity?
CREEP
31
what kind of force is shearing?
parallel
32
folding about an axis is what?
bending
33
twisting around an axis is what?
torsion
34
system in constant state of motion with no acceleration is what?
static
35
system with acceleration is what?
dynamic
36
if a pt walks into clinic with back ache and an xray reveals a hip deformity or tear, what is the most likely diagnosis?
back pain due to GUARDING of hip
37
what are the 2 suture edge types?
squamous (overlapping)
serrated (interlocking)
38
fibrous joints include what?
crianial
syndesmosis
gomphosis
39
2 types of cartilaginous joints?
hyaline (costochondral joint and epip plate)
fibrocartilage (intervertebral discs)
40
characteristic of plane joint
example
minimal sliding
carpal bones
41
hinge joint characteristic
example
ginglymus, large degree of freedom in 1 plane
elbow
42
saddle/seller characteristic
example
1 concave and 1 convex bone allows motion in all planes
thumb
43
ball and socket alternate name?
example
spheroidal
convex head articulates with concave surface
44
condylar characteristic
example
partial flattening of both articular surfaces that limits motion
MCP joint
45
pivot alter name, characteristic
example
trochoid, primary motion is rotation
atlas and axis
46
nerves supplying a joint also supply muscles moving the joint and skin covering muscles is called what?
Hilton's law
47
what controls muscles acting on joints?
reflexes
48
what is found in the articular capsule?
nerve endings
49
what happens in inflammatory joint degeneration?
rheumatoid arthritis
| condition in which the immune system attacks synovium and cartilage
50
characteristics of osteoarthritis
joint disease that gets worse over time, NOT inflammatory
cartilage eroding
effects 16 million people
51
what causes avascular necrosis
traumatic joint injury
52
what condition has loss of proteoglycans
erosion of cartilage
ground glass appearance
Fibrillation
53
what has loss of articular cartilage, thickening of subchondral bone
hardened and polished bone
permanent lesion
pain on weight bearing
eburnation
54
what is assoc. with catching or locking of joint
| fragments of bone floating in synovial fluid
joint mice
55
what % is stance phase
swing phase?
60
40
56
what has the greatest % during stance phase
50-60%
57
what are the 5 requirements for gait?
Pre SAFE
```
stability
foot clearance
pre-position
adequate step length
energy conservation
```
58
what is an antalgic gait
painful
59
what is a stiff pathological gait?
arthogenic
60
what kind of pathologic gait is unstable?
ataxic
61
what is characteristic of a parkinson's pathological gait
shuffling, slow
62
what kind of pathological gait has high knees to compensate for foot drop?
steppage
63
what kind of gait is associated with polio and syphillis
steppage
64
what is characteristic of of hemiplegic gait
no flexion of knee or ankle, semicircle made w/hip
65
what muscles are responsible for shoulder ext. rotation
infraspinatus
teres minor
66
what muscles responsible for shoulder extension
latissimus dorsi and teres major
67
what muscles for shoulder flexion?
coracobrachialis and deltoid
68
what muscles for shoulder adduction?
pec major
lat
69
muscles for shoulder abduction?
supraspinatus, deltoid
70
what motion at wrist is coupled with flexion?
extension?
dorsal carpal glide
ventral carpal glide
71
what muscles are responsible for ext rotation at hip?
glud med, min, sartorius
72
what nerve innervates the hip extension muscles?
what is the muscle?
roots?
inf. gluteal n.
glut MAX
L5-S2
73
what innervates hip abduction muscles?
What is the muscle
nerve roots
sup. gluteal n
glut med and min
L5-S1
74
what innervate hip adduction muscles?
what is the muscle
nerve roots?
obturator n.
adductor longus
L2-L4
75
what are the test for central compartment?
```
San Fran Cisco LL
Scour
FABER
C-sign
Log roll
labral loading/distraction
```
76
Peripheral compartment tests
Travis RELeford plays on the PERIPHERY
Rectus femoris
Ely's test
Log roll
77
Lateral compartment tests?
BOS Fucks The Pussy
```
Bursitis (jump sign)
Ober's
Straight leg raise
FABER
Trendelenburg
Piriformis
```
78
Anterior compartment tests?
Fuck The Police
FABER
psoas
Thomas test
79
trendelenburg hip drops on right side
| which side has the dysfunction?
Left side
80
what nerve root is tested in the achilles tendon?
S1
81
what ear condition does not yet require antibiotics?
OME
82
according to the Centor score, when should you give antibiotics for strep?
+4 score or more
83
what does a tonsil score of +2 indicate?
tonsils are greater than 25% in the fossa but less than 50%
84
when do frontal sinuses open?
7 years old
85
what is the term for loss of higher frequencies as you age?
presbycusis
86
what is the proper sequence of phys exam assessment for cardiac function?
inspect
palpate
percuss
auscultate
87
what is responsible for the 1st heart sound?
where is it best heard?
closing of bi and tri cuspid valves
apex
88
what is responsible for the 2nd heart sound?
where is it best heard?
closing of the pulmonary and aortic valves
base
89
what are the 5 things you need to assess in a cardiovascular exam?
```
PLEXH
physical
lab tests
ECG
Xray
history
```
90
what is happening in the heart during the 1st heart sound?
beginning of ventricular systole
91
what's happening at 2nd heart sound?
end of systole, beginning of diastole
92
where is the aortic valve located?
pulmonary valve?
2nd intercostal space Right of sternum
2nd intercostal space Left of sternum
93
where is the tricuspid located?
bicuspid?
4th intercostal space at Left side base
apex of heart
94
where is the point of maximal intensity located?
5th left intercostal space (at the apex)
95
grade 1 murmur means what?
barely audible
96
grade 2 murmur means what?
soft, but easily heard
97
grade 6 murmur means what?
loud, can be heard w/out stethoscope, has thrill
98
grade 4 murmur means what?
loud w/thrill
99
grade 5 murmur means what?
loud w/minimal contact bw stethoscope and chest, has Thrill
100
grade 3 murmur?
loud, NO thrill
101
what is thrill
turbulent blood flow causing murmurs
102
what is the bell of the stethoscope used for?
another name for it?
low pitched sounds
bruitis
103
Who loves Parrott's Promise more than anyone?
what is this person's favorite club?
Brian LeSage
KCU climbing club with Marc Larsen-Halleck
104
Who loves Parrott's Promise more than anyone?
what is this person's favorite club?
Brian LeSage
KCU climbing club with Marc Larsen-Halleck
105
what makes up the joint reaction force?
sum of separate moments with the force
106
what is the magnitude of force applied to something called?
strain
107
impingement syndrome in the peripheral compartment has what 2 types associated with what anatomy?
Pincer - acetabulum
CAM - femoral neck
108
what pathology is associated with jumper's knee?
patellar tendonitis
109
what pathology for overuse injury as in soccer, volleyball or running?
quadriceps tendonitis
110
what is osgood-schlatter?
avulsion of secondary ossification center of tibial tubercle
111
what is another name for osteochromatosis ?
joint mice/ loose bodies
112
what does the eversion Test evaluate?
what do you do?
deltoid ligament
evert/pronate foot
113
what does the talar tilt test evaluate?
what do you do?
calcaneofibular l. and ant. talofibular l.
invert foot
114
what does the anterior drawer test of the foot evaluate?
anterior talofibular ligament
115
what do you do in homan's sign?
testing for what?
dorsiflex foot
DVT
116
how do you do moses's sign?
testing for what?
pt supine, ant. compression of gatroc
posterior tibial vein DVT
117
what tests for long head of biceps?
Yergason
Speed
Getting Head - You Suck
118
what tests for rotator cuff impingement?
Neer impingement
Hawkins Test
New Hampshire Roads
119
what are the landmarks of the gravitational line?
```
lateral malleolus
lateral condyle of knee
greater trochanter
ant. 1/3 of sacrum
3rd lumbar vertebrae
lateral head of humerus
external auditory canal
```
120
where are pain fibers found in joints?
fibrous capsule
121
where are nerve endings found in joints?
articular capsule
122
ellipsoid joint characteristics?
example
head is ellipsoid
greater motion than condylar, less than spheroidal
radiocarpal
123
What is the order of physical exam basic steps for a lower respiratory exam?
Inspect
Palpate
Percuss
Auscultate
124
When does an acute cough usually occur?
At night
125
When do people with chronic cough have the most trouble?
Mornings
126
If the sputum has leukocytes and macrophages, where is the infection located?
Lower respiratory tree
127
What does foul smelling sputum indicate?
Anaerobic infection
128
What are the accessory muscles of breathing that can hypertrophy?
Traps
Scalenes
SCM
129
What disease process are present with nail clubbing?
Hypoxia
Interstitial lung disease
Cystic and pulmonary fibrosis
IBD
130
What is the most common type of chest deformity?
| What is their CO and SV like?
Pectus excavatum
DEC CO and SV
131
When is tactile fremitus increased?
Pneumonia or consolidations
132
When is tactile fremitus decreased?
COPD, tumor, pleural effusion, pneumothorax
133
When is a dull percussion sound heard?
Over fluid or solid tissue
134
What does hyperrsonance indicate?
COPD
| Pneumothorax
135
When is a resonant sound heard?
Over air
136
When percussing and you find a tympanic sound, what does this indicate?
Gastric air bubble
137
Name the auscultation of the chest sounds from superior to inferior
Bronchial
Broncho-vesicular
Vesicular
138
When do you hear crackles or rales?
Fluid in interstitial space
| Pneumonia
139
What is a pleural friction rub?
What does it sound like?
Visceral and parietal layers rub together and are irritated
Leathery, scratchy sound best heard in EXPIRATION
140
What are rhonchi?
Secretions that can be heard in the chest
141
What is Stridor?
Sound generated from the neck
142
What does Stridor indicate?
Partial occlusion of the trachea or larynx
Emergency
Foreign body in airway
143
What is egophony?
Spoken words become more distinct to auscultation
| E becomes A
144
Where are vesicular lung sounds heard?
What are they like?
Most inferior, over lung fields
Low pitch, soft and short expiration a
145
Where are bronchial lung sounds heard?
What are they like?
Over the trachea
High pitch, loud and long expirations
146
Where are bronchovesicular lung sounds heard?
What are they like?
Over main bronchus, over upper right post. Lung field
Medium pitch, expiration equals inspiration
147
Where is the apex of the heart located?
5th ICS to the left
| 1cm medial to MCL
148
Where is the PMI located?
4th-5th intercostal space at the Mid-clavicular line
149
What vein is best used to estimate jugular venous pulse?
IJ
150
What is the most common cause of an elevated JVP?
Elevated RV diastolic pressure
151
What is normal JVP?
What does it indicate?
0-9
RAP
152
When does the a wave occur?
| What does it coincide with?
R atrial contraction, Tricuspid Valive open
| S1
153
What can cause a giant a wave?
```
Obstruction bw RA and RV (stenosis)
Inc Pressure in RV
Pulmonary HTN
Pulmonary embolism
AV dissociation (RA contracts against the closed TV)
```
154
What happens in the V wave?
Atrial filling
155
When is a prominent V wave seen?
Tricuspid regurgitation
| Pulmonary HTN
156
When do you have increased JVP?
SVC obstruction
severe heart failure
Constrictive pericarditis, cardiac tamponade, RV infarction
Restrictive cardiomyopathy
157
When do you see a positive HJR?
Constrictive pericarditis
Poorly compliant RV
Obstructive RV filling
158
What is the S3 heart sound?
| When is it pathologic?
Abrupt decceleration of inflow across mitral valve at the end of the rapid filling phase
Adults over 40 --> CHF
159
What is the S4 sound?
Atrial gallop due to stiffened ventricle
160
What is the 1st component of S1?
2nd?
Where is it the loudest?
MV closes
TV closes
apex of heart
161
1st component of S2?
2nd component?
Where is it the loudest?
AV close
PV closes
Base of heart
162
When is splitting of S1 between S2 heard?
Inspiration
163
Location of Aortic valve?
Pulmonary valve?
Tricuspid?
Mitral?
```
All Physicians Take Money
2nd ICS R (of sternum)
2nd ICS L
4th ICS L
5th ICS L
```
164
Grading system for edema and depth for each level
Length of time indentation lasts?
0-4
Starting at 1: 2, 4, 6, 8mm
Starting at 2: 10-15s, 1 minute, 3-5 minutes
165
```
What does a pulse of 1 indicate?
2?
3?
4?
0?
```
```
Barely palpable
Average intensity
Strong
Bounding
Absent
```
166
Where is the carotid pulse located?
Medial to SCM m.
167
Where are the best places to check peripheral edema?
Dorset of foot, ant. Tibia, behind medial malleolus
168
Generally speaking, what does clubbing indicate?
Interstitial disease
169
Where doe you insert a needle for decompression of pneumothorax?
2nd ICS
170
Where do you insert chest tube?
4th ICS
171
Where do you perform a thoracentesis?
7th ICS
172
Pts with lung disease have a SD where?
T1-T6
173
When can bronchial sounds best be heard?
Expiration
174
When can vesicular sounds best be heard?
Inspiration
175
What is a positive whispered pectorlioquy?
Whispered sound heard loud and clear during auscultation
176
What type of genetics are associated with Renal Cell Carcinoma?
VHL - Von Hippel Lindau
177
What is the most common type of renal cell carcinoma?
Clear-cell
178
What does lloyd's punch assess?
CVA - costovertebral angle
179
How does pyelonephritis occur?
Vescioureteral reflux, intrarenal reflux, bad functioning of vesicoureteral junction
180
Who is most prone to pyelonephritis?
What normally causes it?
Young women and old men
E.coli from the bladder
181
What are the presentations of pyelonephritis?
Fever, flank pain, dyspraxia, polyuria, nocturnal
182
What does increased capillary refill indicate?
What disease processes?
Under perfusion
Hypovolemia, hypothermia
183
Shift of the trachea from midline indicates what?
Atelectasis or pneumothroax
184
What is flat sounds pitch?
Duration?
Location
Intensity
High
Short
Thigh
Soft
185
Intensity
Pitch
Duration of dull sound
Location?
All medium
Liver
186
Intensity
Pitch
Duration
Location of resonant
Loud
Low
Long
Healthy lung
187
Intensity
Pitch
Duration
Location of tympanitic sound
Loud
High
Longer
Gastric air bubble
188
Where can transitional cell urinary tract cell cancers occur?
Renal pelvis to proximal 2/3 of the urethra
189
What is a pay systolic (holosystolic) murmur?
Starts at S1 and stops at S2 without a gap bw murmur and heart sounds
190
What is kussmauls sign?
Where is it seen?
JVP rises during inspiration rather than falling
Seen in R heart failure, RV infarction, pericarditis
