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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
Q

Finkelstein’s test

A

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).

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26
Q

3 common types of cutaneous injections

A

intradermal
subcutaneous
Intramuscular

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27
Q

what does the gauge size on a needle tell you

A

length

so for intradermal use 27 gauge
for subcutaneous use 23-25 gauge
for intramuscular use 21-25 gauge

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28
Q

what does subcutaneous injection allow for?

A

slow sustained absorption

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29
Q

what is the most common reaction to injection?

A

vasovagal syncope

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30
Q

what are the absolute contraindications for joint injection?

A 
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*.

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31
Q

which anesthetic do you use if vascular disease or if the patient is immuno-compromised

A

lidocaine

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32
Q

which anesthetic is safe for finger,s nose, penis toes and earlobes

A

lidocaine

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33
Q

what is the purpose of using lidocaine

A

Can cause vasodilatation
Quick onset, short duration (30-60 minutes)

use in contaminated wounds

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34
Q

what is the purpose of using lidocaine with epinephrine

A

Causes Vasoconstriction (decreased blood flow)
Longer duration
Use in highly vascular areas to improve visualization of field
Use in clean wounds

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35
Q

which anesthetic can you use in CLEAN wound fields

which one in dirty fields

A

CLEAN–> lidocaine with epineprhine (don’t need fresh blood flow coming in)

Dirty–> lidocaine NO epi

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36
Q

which anesthetic can you NOT use in ears, fingers, toes, penis, earlobes

A

epinephrine (causes vasoconstriction)

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37
Q

what is the purpose of bupivacaine

A

longer duration

for nerve blocks

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38
Q

what is a corticosteroid agent that is short acting

A

hydrocortone

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39
Q

what are two examples of steroids that are long acting and high potency

A

decadron

celestone soluspen

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40
Q

why are corticosteroids good

A

reduce inflammation and swelling and pain

RA, gout, OA, ankylosing spondylitis

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41
Q

why are corticosteroids bad?

A

May accelerate normal, aging related articular cartilage atrophy or periarticular calcification (43%)

weaken tendons and ligaments

post-injection flare

tendon rupture

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42
Q

what do you do before injecting into joints?

A

aspirate

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43
Q

when inspecting lumbar spine what do you make sure is in line

A

Ear in line with the shoulder, greater trochanter, fibular head, and lateral malleolus

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44
Q

what percent of gait is stance.

A

60 (weight bearing)

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45
Q

what are the muscle strength values?

A

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

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46
Q

what is reinforcement when checking reflexes

A

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.

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47
Q

L4 has what reflex and where is its dermatome

5 percent

A

patellar tendon

medial strip of ankle to large toe

anterior tibialis

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48
Q

L5 has what reflex?

A

none

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49
Q

where is L5 dermatome (67 percent)

A

mid top of foot and most of plantar surface of foot

extensor hallucis longus (motor)

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50
Q

where is S1 dermatome and what is the reflex

28 percent

A

achilles tendon reflex

lateral strip of foot

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51
Q

cord levels of small intestine

A

T10-11

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52
Q

cord levels of ovaries and testes

A

T10-T11

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53
Q

Cord levels of colon, rectum
bladder
uterus
prostate

A

T12=L2

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54
Q

what is the most common area of injury and source of pain in the lumbosacral region? why

A

L5S1

Posterior Longitudinal Ligament narrows as it descends down lumbar spine making herniation of the disc into the cord space easier. Rarely bilateral

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55
Q

what is osteoarthritis

A

degenerative disc disease

L5-S1 common site

loss of cartilage and normal bone

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56
Q

osteoporosis

A

thinning of bone

compression fractures occur usually

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57
Q

how do you find Sciatica

A

patient lying on side opposite of pain

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58
Q

sciatic pain is …. what nerve combination

A

unilateral

L4-S3

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59
Q

what is a test for sciatica

A

straight leg raise

by 60 degrees probably have reproduced their pain

central impingement –> both sides

60
Q

what are the three things that are indications for an MRI

A

intractable pain
weakness
atrophy

without these it is NOT surgical

61
Q

where is true hip pain?

A

deep inguinal NOT lateral

check bursa with complaint of lateral hip pain

62
Q

when palpating the inguinal ligament area. what does NAVEL stand for

A

from lateral to medial

nerve, artery, vein, empty space, lymph nodes

63
Q

trendelenburg test

A

tests gluteus medius muscle

keeps hips stable during gait

64
Q

ober test

A

IT band

abnormal test if leg remains in abducted position

65
Q

thomas test

A

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
Q

patrick or fabere test

A

Most specific for hip joint.
Trying to reproduce their pain.
May elicit SI tenderness

67
Q

what is the piriformis test

A

Supine, knees to chest and hold heels,
rotate knees left and right
comparing ROM

primarily done by palpation

piriformis is on the backside

68
Q

bulge sign

A

minor effusion

69
Q

balloon sign and ballotting

A

large effusion

70
Q

what is the lachman test

A

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
Q

anterior drawer sign

A

Patient supine flex knees and hips 90˚
Pull tibia forward to check for movement anteriorly
Compare to opposite side. Positive test = ACL tear

72
Q

what are tests for meniscus

A

McMurrays

Apley’s

Thessaly’s (more sensitive than Mcmurray’s)

73
Q

what is a test for the medial collateral ligament

A

valgus stress test

74
Q

what is a test for lateral collateral ligament

A

varus stress test

75
Q

what is homan’s sign

A

DVT test

dorsiflex patients ankles
pain in calf is positive sign

76
Q

what is the thompson test

A

achilles tendon rupture

whereas thomas is for flexion contractures of the hip

77
Q

what are the most common ankle sprains

A

Anterior Talofibular and Calcaneofibular are most injured in sprains

78
Q

what joint is inversion and eversion of the foot at

A

transverse tarsal joint

79
Q

what is eversion and inversion at the ankle moving about what joint?

A

subtalar joint (talocalcaneal)

80
Q

what joint is involved with dorsiflex and plantar flexion at the ankle

A

tibiotalar joint

81
Q

what is the talar tilt test testing for

A

If the talus gaps or rocks in the ankle mortise, the Anterior talofibular & calcaneofibular ligs are torn and the test is positive

82
Q

what are the ottowa rules

A

Ottowa Rules (Age > 18yr): Inability to bear weight after 4 steps or tenderness over posterior aspect of either malleolus.

Be suspicious of fracture

83
Q

how do we grade ankle sprain

A

1st degree- mild (not alot of pain, not alot of swelling, bruising)

2nd degree

3rd degree==> full tear (can’t walk)

84
Q

what does a high ankle sprain look like?

A

syndesmosis between fibula and tibia

interosseous membrane sprain

85
Q

what is a test for high ankle sprain

A

Kleiger test

trying to put a twist in distal tibia and fibula
trying to reproduce pain

86
Q

what is pes planus

A

flat feet loss of longitudinal arch

87
Q

what is hallux valgus

A

bunion

abnormal abduction of great toe

88
Q

blue

A

lack of oxygen

89
Q

pale

A

lack of arterial supply

90
Q

purple

A

venous congestion

91
Q

brown or rust colored

A

hemoglobin pigmentation

can be seen in chronic venous insufficiency

92
Q

where is the dorsalis pedis artery

A

lateral to the extensor hallucis longus

93
Q

where is the posterior tibial artery

A

posterior to the medial malleolus

94
Q

how do you grade pulses

A

0-4

0 no pulse palpable
1 diminshed
2 normal
3 bounding

95
Q

with what do you listen to pulses

A

bell

96
Q

what is bruit

A

sound of turbulent flow through artery consistent with obstruciton

97
Q

what is a normal brachial ankle index

A

0.9 to 1.3

98
Q

what does a 0.9 or less brachial ankle index indicate

A

peripheral artery disease

99
Q

what is the allen test

A

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
Q

postural color change assess for what?

A

PAD

watch for return of pinkness within 10 seconds

101
Q

what is homan’s sign

A

dorsiflex patients foot
deep calf pain is positive
tests for DVt

102
Q

what is virchow’s triad

A

stasis
hypercoagulability
endothelial injury

103
Q

lymphedema

A

non pitting edema
thickened skin
no pigmentation change

104
Q

where are lymph nodes more often felt in the adult?

what about the adult smoker

A

inguinal region

smoker- cervical (same as children)

105
Q

bengin disease lymphadenopathy

A 
Less than 1 cm
Tender
May be firm but not hard
Freely movable
Discreet borders
106
Q

malignant lymphadenopathy

A 
Greater than 1 cm
Non tender
Rock-hard
Fixed to surrounding tissue
Difficult to palpate borders
107
Q

what causes increased interstitial fluid?

A

increase in hydrostatic pressure

decrease in oncotic pressure

108
Q

how do you grade edema?

A

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
Q

what is erythema nodosum

A

inflammation of the skin of the shins

110
Q

what is cellulitis

A

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
Q

what is the lumbus

A

where the conjuntiva meets the cornea

112
Q

what is the 1st and most important part of the eye exam

A

visual acuity

113
Q

how far from the snellen chart do you place a patient

A

20 feet

no squinting

114
Q

how many directions are in the extraocular movements exam

A

6

115
Q

what is nystagmus

A

Involuntary rapid, rhythmic movement of eye in any direction

116
Q

what is strabismus

A

Misalignment of eyes relative to each other. If untreated can cause amblyopia (visual loss) of one eye

117
Q

what does the cover test test for?

A

strabismus

118
Q

to see the ear canal and drum what do you use?

A

an otoscope with the largest ear speculum that the canal will accomodate

pull the ear upward, backward and slightly away from the head

119
Q

what is visualized well in a normal ear

A

malleus

120
Q

what does a nonmobile TM tell us

A

fluid, mass . sclerosis

121
Q

hypermobile TM?

A

ossicle bones disrupted

122
Q

what if weber is normal?

A

well it could be normal OR it could be normal or equal in bilateral hearing loss

123
Q

what if weber lateralizes?

A

then check rinne

124
Q

what is the process for the rinne test

A

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
Q

what if the patient can’t hear the air conduction after the bone conduction has ended

A

they probably have

126
Q

90 percent of older person hearing loss is

A

sensorineural

127
Q

what are the causes of sensorineural hearing loss

A

include loud noise exposure (>85 db), inner ear infections, trauma, tumors, congenital and familial disorders, and aging

128
Q

what are the causes of conductive hearing loss

A

include foreign body, otitis media, perforated eardrum, and otosclerosis of ossicles

129
Q

what part of the nose can you see with the otoscope

A

middle and inferior turbinates (NOT superior)

130
Q

s3 heart sound

A

ventricular gallop

normal in kids

131
Q

s4 heart sound

A

atrial gallop

always pathological

132
Q

grading of murmurs?

A

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
Q

best position for PMI

A

left lateral decubitus to bring apex closer to the chest wall

134
Q

which pulse Gives useful information of cardiac function especially detecting aortic valve stenosis/insufficiency.

A

carotid pulse

135
Q

how do carotid and cardiac sounds correlate?

A

S1 occurs just before carotid upstroke

S2 occurs just after carotid upstroke

136
Q

what does jugular venous pressure indicate function of

A

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
Q

measuring JVP

A

take measure distance and add 5 cm

138
Q

what is an abnormal JVP

A

> 9 cm above RA is abnormal

CHF?

139
Q

what is the a wave

A

RA contraction

precedes S1

increased with tricuspid stenosis, 1st degree av block,
SVT, junctional rhythms, pulm. HTN and pulm. stenosis

140
Q

what is the X-descent

A

RA relaxation

late in systole just before S2

141
Q

what is the V wave

A

RA filling and increased pressure

coincides with S2

142
Q

what is the Y descent

A

RA emptying

follows S2 early in diastole

143
Q

no a waves

A

atrial fib

144
Q

large v waves

A

tricuspid regurg

145
Q

diaphragm is better for hearing

A

high ptiched sounds of S1S2

firm pressure

146
Q

bell

A

lightly to skin

low pitched sounds of S3/S4
bruits, thrills, murmurs

147
Q

what is optimal for listening to aortic insufficiency

A

lean forward,
exhale completely
using diaphragm to listen along left lower sternal border

PCM exam 2 (1 decks)

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