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PCM exam 2 > Mumbo jumbo > Flashcards

Mumbo jumbo Flashcards

1
Q

Virchow’s Node-

A

supraclavicular node of the deep chain that is sometimes palpable in thoracic or abdominal malignancies

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2
Q

thyroglossal duct

A

During embryonic development, thyroid tissue migrates from the base of the tongue through the thyroglossal duct into the neck.
If the duct does not close before birth a thyroglossal duct cyst may form

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3
Q

what is thoracic outlet syndrome

A

Occurs when there is compression of vessels and nerves in the area of the clavicle.

Happens when there is an extra cervical rib or because of a tight fibrous band that connects the spinal vertebra to the rib.

Symptoms include:
pain in the neck and shoulders
numbness in the last 3 fingers and forearm.

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4
Q

what are the test’s for thoracic outlet syndrome ?

A

Roo’s test

Adson’s test

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5
Q

what is Roo’s test

A

arms abducted to 90°, externally rotated
Elbows flexed at 90°
Patient slowly opens and closes his hands for 3 minutes.
If there is weakness, numbness or tingling of the hand or arm the test is positive.

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6
Q

what is adson’s test

A

Palpate the radial pulse with the elbow and shoulder in extension
Continue to palpate pulse and move the arm the arm into abduction and external rotation and flex elbow.
Have the patient turn their head away from the side being tested.
If the pulse diminishes then the test is positive for thoracic outlet syndrome.

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7
Q

what are the angles of ROM of the upper lip

A,A,F,E, ER,IR

A 
Abduction- 180° 
Adduction- 75° 
Flexion- 180°
Extension- 60°
External Rotation- 90°                                                                                 
Internal Rotation- 100°
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8
Q

Apley scratch test does what?

A

Upper arm- Tests external rotation and abduction

Lower arm-Tests internal rotation and adduction

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9
Q

tests for supraspinatous

A

empty can test

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10
Q

tests for subscapularis

A

lift off test

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11
Q

test for AC joint disruption or arthritis

A

Cross over test

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12
Q

what does drop arm test for

A

rotator cuff injury

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13
Q

what does o’brien’s test

A

Flex arm to 90°and adduct across the chest
Internally rotate with the thumb pointing DOWN and push down on the arm

Pain is a positive test for a labral tear (SLAP- Superior labrum anterior to posterior).

Confirmed by repeating with thumb pointing up and no pain

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14
Q

what does Speed’s test test for

A

biceps tendonitis

Flex straight arm to 90° with the palm facing upward. The patient resists the student pushing down. If pain occurs in the area of the bicipital groove the test test is positive indicating biceps tendonitis

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15
Q

what is hawkin’s impingement sign

A

Examiner grasps patients elbow with one hand and their distal forearm with the other

Examiner passively externally rotates the shoulder
Impinges subscapularis muscle

Examiner passively internally rotates the shoulder
Impinges supraspinatus muscle, teres minor muscle, and Infraspinatus muscle

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16
Q

cubital tunnel syndrome

A

ulnar nerve compression behind the medial epicondyle

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17
Q

valgus

A

In a valgus alignment, the distal segment deviates laterally with respect to the proximal segment.

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18
Q

varus

A

in a varus alignment, the distal segment deviates medially with respect to the proximal segment.

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19
Q

what is tinel’s sign

A

Sharply tap over the location of the median nerve in the carpal tunnel, on the palmar surface of the wrist, using your index and middle finger, or a reflex hammer.

A positive test is noted by reproduction of the patient’s pain typically a shooting pain or paresthesias in the distribution of the median nerve.

Tinel’s sign is NOT specific for carpal tunnel syndrome. It can be used in the diagnosis of any compression neuropathy.

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20
Q

how does RA and osteoarthritis differ in presentation on the hands?

A

Osteoarthritis:
OA of the hands shows Heberden’s nodes at the DIP joints and Bouchards nodes at the PIP joints. May not be symmetric.

RA:
RA of the hands shows deformity of the wrist, MCP and PIP joints, but not the DIP joints. Ulnar deviation. Symmetric.

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21
Q

what is phalens

A

reverse prayer

testing for wrist problems

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22
Q

what is a colles’ fracture

A

Distal radius fracture with distal fracture fragment displace dorsally.
Often due to falling on an outstretched hand

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23
Q

what is Dupuytren’s contracture

A

inflammation, thickening and contracture of the palmar fascia (4th and 5th digits)

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24
Q

what does the grind test do

A

Tests for carpo-metacarpal osteoarthritis
Most commonly found at 1st carpo-metacarpa joint
Abduct thumb and grasp base of metacarpal and rotate it back and forth looking for discomfort.

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25
Finkelstein’s test
Put the patient’s thumb inside their fist, and then gently ulnar deviate 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).
26
3 common types of cutaneous injections
intradermal subcutaneous Intramuscular
27
what does the gauge size on a needle tell you
length so for intradermal use 27 gauge for subcutaneous use 23-25 gauge for intramuscular use 21-25 gauge
28
what does subcutaneous injection allow for?
slow sustained absorption
29
what is the most common reaction to injection?
vasovagal syncope
30
what are the absolute contraindications for joint injection?
``` Local cellulitis Septic arthritis Acute fracture Bacteremia Joint prosthesis Achilles or patella tendinopathies ``` History of allergy or anaphylaxis to injectable pharmaceuticals or constituents More than 3 previous corticosteroid injections within the past year in a single joint*.
31
which anesthetic do you use if vascular disease or if the patient is immuno-compromised
lidocaine
32
which anesthetic is safe for finger,s nose, penis toes and earlobes
lidocaine
33
what is the purpose of using lidocaine
Can cause vasodilatation Quick onset, short duration (30-60 minutes) use in contaminated wounds
34
what is the purpose of using lidocaine with epinephrine
Causes Vasoconstriction (decreased blood flow) Longer duration Use in highly vascular areas to improve visualization of field Use in clean wounds
35
which anesthetic can you use in CLEAN wound fields | which one in dirty fields
CLEAN--> lidocaine with epineprhine (don't need fresh blood flow coming in) Dirty--> lidocaine NO epi
36
which anesthetic can you NOT use in ears, fingers, toes, penis, earlobes
epinephrine (causes vasoconstriction)
37
what is the purpose of bupivacaine
longer duration | for nerve blocks
38
what is a corticosteroid agent that is short acting
hydrocortone
39
what are two examples of steroids that are long acting and high potency
decadron celestone soluspen
40
why are corticosteroids good
reduce inflammation and swelling and pain | RA, gout, OA, ankylosing spondylitis
41
why are corticosteroids bad?
May accelerate normal, aging related articular cartilage atrophy or periarticular calcification (43%) weaken tendons and ligaments post-injection flare tendon rupture
42
what do you do before injecting into joints?
aspirate
43
when inspecting lumbar spine what do you make sure is in line
Ear in line with the shoulder, greater trochanter, fibular head, and lateral malleolus
44
what percent of gait is stance.
60 (weight bearing)
45
what are the muscle strength values?
0= no movement 1= muscle twitch without joint movement 2= movement only with gravity eliminated 3= movement against gravity only 4= movement against gravity + some resistance 5= movement against gravity + full resistance
46
what is reinforcement when checking reflexes
Reinforcement is engaging bilateral muscle groups in a region above the spinal level of the reflex being tested at the moment of testing the lower reflex. This fires the motor neurons blocking any ascending signal from below, allowing a more prominent spinal reflex to manifest in the area being treated.
47
L4 has what reflex and where is its dermatome | 5 percent
patellar tendon medial strip of ankle to large toe anterior tibialis
48
L5 has what reflex?
none
49
where is L5 dermatome (67 percent)
mid top of foot and most of plantar surface of foot extensor hallucis longus (motor)
50
where is S1 dermatome and what is the reflex | 28 percent
achilles tendon reflex lateral strip of foot
51
cord levels of small intestine
T10-11
52
cord levels of ovaries and testes
T10-T11
53
Cord levels of colon, rectum bladder uterus prostate
T12=L2
54
what is the most common area of injury and source of pain in the lumbosacral region? why
L5S1 Posterior Longitudinal Ligament narrows as it descends down lumbar spine making herniation of the disc into the cord space easier. Rarely bilateral
55
what is osteoarthritis
degenerative disc disease L5-S1 common site loss of cartilage and normal bone
56
osteoporosis
thinning of bone compression fractures occur usually
57
how do you find Sciatica
patient lying on side opposite of pain
58
sciatic pain is .... what nerve combination
unilateral L4-S3
59
what is a test for sciatica
straight leg raise by 60 degrees probably have reproduced their pain central impingement --> both sides
60
what are the three things that are indications for an MRI
intractable pain weakness atrophy without these it is NOT surgical
61
where is true hip pain?
deep inguinal NOT lateral check bursa with complaint of lateral hip pain
62
when palpating the inguinal ligament area. what does NAVEL stand for
from lateral to medial nerve, artery, vein, empty space, lymph nodes
63
trendelenburg test
tests gluteus medius muscle keeps hips stable during gait
64
ober test
IT band abnormal test if leg remains in abducted position
65
thomas test
For flexion contractures of the hip due to tight Psoas (Iliopsoas) watch to make sure the leg that is extended out is touching the table
66
patrick or fabere test
Most specific for hip joint. Trying to reproduce their pain. May elicit SI tenderness
67
what is the piriformis test
Supine, knees to chest and hold heels, rotate knees left and right comparing ROM primarily done by palpation piriformis is on the backside
68
bulge sign
minor effusion
69
balloon sign and ballotting
large effusion
70
what is the lachman test
good for ACL testing Knee flexed 15˚ and externally rotated if possible Grasp femur with one hand and tibia with other Move femur and tibia in opposite directions Asymmetric, forward movement of tibia against femur suggests positive test = ACL tear always test both knees asymmetric findings most important
71
anterior drawer sign
Patient supine flex knees and hips 90˚ Pull tibia forward to check for movement anteriorly Compare to opposite side. Positive test = ACL tear
72
what are tests for meniscus
McMurrays Apley's Thessaly's (more sensitive than Mcmurray's)
73
what is a test for the medial collateral ligament
valgus stress test
74
what is a test for lateral collateral ligament
varus stress test
75
what is homan's sign
DVT test dorsiflex patients ankles pain in calf is positive sign
76
what is the thompson test
achilles tendon rupture whereas thomas is for flexion contractures of the hip
77
what are the most common ankle sprains
Anterior Talofibular and Calcaneofibular are most injured in sprains
78
what joint is inversion and eversion of the foot at
transverse tarsal joint
79
what is eversion and inversion at the ankle moving about what joint?
subtalar joint (talocalcaneal)
80
what joint is involved with dorsiflex and plantar flexion at the ankle
tibiotalar joint
81
what is the talar tilt test testing for
If the talus gaps or rocks in the ankle mortise, the Anterior talofibular & calcaneofibular ligs are torn and the test is positive
82
what are the ottowa rules
Ottowa Rules (Age > 18yr): Inability to bear weight after 4 steps or tenderness over posterior aspect of either malleolus. Be suspicious of fracture
83
how do we grade ankle sprain
1st degree- mild (not alot of pain, not alot of swelling, bruising) 2nd degree 3rd degree==> full tear (can't walk)
84
what does a high ankle sprain look like?
syndesmosis between fibula and tibia | interosseous membrane sprain
85
what is a test for high ankle sprain
Kleiger test trying to put a twist in distal tibia and fibula trying to reproduce pain
86
what is pes planus
flat feet loss of longitudinal arch
87
what is hallux valgus
bunion | abnormal abduction of great toe
88
blue
lack of oxygen
89
pale
lack of arterial supply
90
purple
venous congestion
91
brown or rust colored
hemoglobin pigmentation | can be seen in chronic venous insufficiency
92
where is the dorsalis pedis artery
lateral to the extensor hallucis longus
93
where is the posterior tibial artery
posterior to the medial malleolus
94
how do you grade pulses
0-4 0 no pulse palpable 1 diminshed 2 normal 3 bounding
95
with what do you listen to pulses
bell
96
what is bruit
sound of turbulent flow through artery consistent with obstruciton
97
what is a normal brachial ankle index
0.9 to 1.3
98
what does a 0.9 or less brachial ankle index indicate
peripheral artery disease
99
what is the allen test
Have the patient open and close the fist several times quickly, then will hold it closed tightly. Apply firm pressure over the radial and ulnar arteries. Ask the patient to open the hand slowly. Release the pressure on one of the arteries and observe the return of pink coloration of the hand. Repeat the process to test the collateral artery supply
100
postural color change assess for what?
PAD watch for return of pinkness within 10 seconds
101
what is homan's sign
dorsiflex patients foot deep calf pain is positive tests for DVt
102
what is virchow's triad
stasis hypercoagulability endothelial injury
103
lymphedema
non pitting edema thickened skin no pigmentation change
104
where are lymph nodes more often felt in the adult? | what about the adult smoker
inguinal region smoker- cervical (same as children)
105
bengin disease lymphadenopathy
``` Less than 1 cm Tender May be firm but not hard Freely movable Discreet borders ```
106
malignant lymphadenopathy
``` Greater than 1 cm Non tender Rock-hard Fixed to surrounding tissue Difficult to palpate borders ```
107
what causes increased interstitial fluid?
increase in hydrostatic pressure decrease in oncotic pressure
108
how do you grade edema?
grade 1-4 (hold in extremity for 5 seconds) Grade 1 = 2 mm pit and resolves quickly Grade 2 = 4 mm pit and resolves in less than 1 minute Grade 3 = 6 mm pit lasts from 1-2 minutes Grade 4 = 8 mm pit and lasts from 2- 5 minutes
109
what is erythema nodosum
inflammation of the skin of the shins
110
what is cellulitis
Inflammation of the skin and/or subcutaneous tissues Almost always a bacterial infection usually strep or staph Acute onset Usual presenting symptoms: pain, redness and warmth (dolor, rubor and calor) Physical findings: well demarcated area that is exquisitely tender to palpation Frequently accompanied by localized lymphadenopathy
111
what is the lumbus
where the conjuntiva meets the cornea
112
what is the 1st and most important part of the eye exam
visual acuity
113
how far from the snellen chart do you place a patient
20 feet | no squinting
114
how many directions are in the extraocular movements exam
6
115
what is nystagmus
Involuntary rapid, rhythmic movement of eye in any direction
116
what is strabismus
Misalignment of eyes relative to each other. If untreated can cause amblyopia (visual loss) of one eye
117
what does the cover test test for?
strabismus
118
to see the ear canal and drum what do you use?
an otoscope with the largest ear speculum that the canal will accomodate pull the ear upward, backward and slightly away from the head
119
what is visualized well in a normal ear
malleus
120
what does a nonmobile TM tell us
fluid, mass . sclerosis
121
hypermobile TM?
ossicle bones disrupted
122
what if weber is normal?
well it could be normal OR it could be normal or equal in bilateral hearing loss
123
what if weber lateralizes?
then check rinne
124
what is the process for the rinne test
first stick the end on the temporal bone for "bone" conduction until they can't hear it then stick it vertical next to the ear for "air" conduction they should be able to hear hear the air continued after the bone ends
125
what if the patient can't hear the air conduction after the bone conduction has ended
they probably have
126
90 percent of older person hearing loss is
sensorineural
127
what are the causes of sensorineural hearing loss
include loud noise exposure (>85 db), inner ear infections, trauma, tumors, congenital and familial disorders, and aging
128
what are the causes of conductive hearing loss
include foreign body, otitis media, perforated eardrum, and otosclerosis of ossicles
129
what part of the nose can you see with the otoscope
middle and inferior turbinates (NOT superior)
130
s3 heart sound
ventricular gallop | normal in kids
131
s4 heart sound
atrial gallop | always pathological
132
grading of murmurs?
1: very faint, heard only after listener “tuned-in” 2: quiet but immediately heard with stethoscope on chest 3: moderately loud 4: loud with palpable thrill 5: very loud with thrill may be heard with stethoscope partially off chest 6: very loud with thrill, may be heard with stethoscope entirely off chest
133
best position for PMI
left lateral decubitus to bring apex closer to the chest wall
134
which pulse Gives useful information of cardiac function especially detecting aortic valve stenosis/insufficiency.
carotid pulse
135
how do carotid and cardiac sounds correlate?
S1 occurs just before carotid upstroke | S2 occurs just after carotid upstroke
136
what does jugular venous pressure indicate function of
right heart right atrial pressure clues to: ``` Volume status R & L ventricular fxn Patency of right heart valves Pressures in pericardium Arrhythmias ``` BETTER IN RIGHT internal jugular b/c more direct into right atrium
137
measuring JVP
take measure distance and add 5 cm
138
what is an abnormal JVP
>9 cm above RA is abnormal CHF?
139
what is the a wave
RA contraction precedes S1 increased with tricuspid stenosis, 1st degree av block, SVT, junctional rhythms, pulm. HTN and pulm. stenosis
140
what is the X-descent
RA relaxation late in systole just before S2
141
what is the V wave
RA filling and increased pressure coincides with S2
142
what is the Y descent
RA emptying follows S2 early in diastole
143
no a waves
atrial fib
144
large v waves
tricuspid regurg
145
diaphragm is better for hearing
high ptiched sounds of S1S2 firm pressure
146
bell
lightly to skin low pitched sounds of S3/S4 bruits, thrills, murmurs
147
what is optimal for listening to aortic insufficiency
lean forward, exhale completely using diaphragm to listen along left lower sternal border

PCM exam 2 (1 decks)

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