musculoskeletal, neurologic, & GI System Flashcards
kyphosis
thoracic
lordosis
lumbar
scoliosis
s shaped
rheumatoid arthritis
autoimmune
bilateral joint inflammation
osteoarthritis
overuse injury
cartilage breaks down in joints
unilateral
gout
uric acid crystals form in joints
big toe
tophi = uric acid in ears
myalgia
muscle pain
ostealgia
bone pain
OPQRSTU
Onset of the event Provocation or palliation Quality of the pain Region and radiation Severity Time (history)
complete musculoskeletal exam appropriate for:
articular disease
history of musculoskeletal issues
problems with ADLs activity of daily living
always compare side to d=side, head to toe
musculoskeletal physical exam
no auscultation or percussion
- inspect, palpate, test, assess
inspect
bumps, lumps, lesions, bilateral symmetry, muscle circumference, ROM
dislocation
loss of contact between articular cartilage of two bones; complete dislocation
Subluxation
contact between articular surfaces is only partially lost; partial dislocation
Contracture
muscle permanently contracted (due to muscle fiber shortening without an action potential or caused by failure of the sarcoplasmic reticulum even with a available ATP)
Ankylosis
stiffening or immobility of joint
Palpate and Test
stabalize joint with one hand and move distal portion with other hand
- adduction, abduction, flexion, extension
grading muscle strength
0 - no muscle contract
5 - move full ROM against resistance
tests for Carpel Tunnel Syndrome CTS
Phalen’s Test - acute flexion of wrist for 60 seconds and produces no symptoms of numbness or burning
Tindal sign - direct percussion of location of median nerve at wrist produces no symptoms of burning, tingling along its distribution
- repetitive motion injury
- bulge sign
congenital hip dislocation
alli’s test - level of keens, push knees back and to bed
ordilionie’s maneuver - hip disloaction
preschool and school-age children legs and feet
bowlegged - normal 1 year after child begins to walk
knock knees (genu valgum) - normal between 2 and 3 1/2 years
flatfoot (pes planus) - normal until 3 years
broad base stance - normal 12-30 months
pigeon toes - normal til 3 years
tandelenburg’s sign - alignment of pelivis when stunned on one foot
osteoporosis
loss of bone density
decrease in bone strength leads to it
occurs without many symptoms until a break or kyphosis occurs
rheumatoid arthritis
chronic autoimmune disease of connective tissue - onset is gradual with fatigue morning onset ulnur deviation boutonnieres sign swan neck deformity bad in morning but better with use bilateral
osteoarthritis
enlargement of joints overuse injury non-inflammatory swelling and aching worse with use of joints can be worse in morning
bursitis
inflammation of bursa
common in shoulders, elbow, hip, knee
gout
hereditary increase in uric acid great toe edema of joints that is painful with limited ROM tophi - UA in ears kidney stones cause flank pain
herniated nucleus pulpus
- fibrous cartilage surrounding intervertebral disk ruptures and nucleus pulpus is displaced and compresses on spinal nerves
- deep tendon reflexes are depressed or absent
scoliosis
s shaped deformity of vertebrae
carpel tunnel syndrom CTS
median nerve compressed between floor retinacululm and other structures within carpel tunnel
- repetive movements, injury to wrist
- burning, numbers, tingling in hands at night
Syncope
fainting from temporary loss of consciousness due to cerebral ischemia
Paresis
slight or incomplete paralysis
Dysmetria
inability to accurately control the range of movement in muscular acts
Ataxia
failure of muscular coordination
Paresthesia
a skin sensation such as burning, itching, prickling with no apparent cause
Dysarthria
speech disorder caused by disturbances of muscular control because of damage to the central or peripheral nervous system
Dysphasia
inability to fully communicate; usually results from brain injury
Stereognosis
ability to identify objects via touch
Graphesthesia
ability to feel writing on the skin
Kinesthesia-
awareness of one’s own position, weight, tension, and movement (“movement sense”)
Hyperalgesia
extreme sensitivity to pain
Hypoalgesia
diminished sensation of pain
Analgesia
absence of sensibility to pain
Hyperesthesia
increased sensitivity to stimulation, particularly to touch
Hypoesthesia
partial loss of sensitivity to stimuli, diminished sensation
Anesthesia
loss of sensation
Dysdiadochokinesia-
inability to perform rapidly alternating movements, such as rhythmically tapping fingers on knees, etc.
Anosmia-
lacking sense of smell
Papilledema-
swelling of the optic nerve at the point where it meets the eye
Ptosis
drooping of the upper eyelid (also called blepharoptosis); can affect one or both eyes
Strabismus
when the eyes do not point in the same direction; deviation away from center
Nystagmus
“shaking” of the eyeballs; rapid to-and-from motion
Fasciculations
small, local involuntary muscular contraction visible under the skin because of spontaneous discharge of fibers
senile tremors
go away with alcohol use
Glasco Coma Scale
Eye Does not open eyes Opens eyes in response to painful stimuli Opens eyes in response to voice Opens eyes spontaneously N/A N/A
Verbal Makes no sounds Incomprehensible sounds Utters inappropriate words Confused, disoriented Oriented, converses normally N/A
Motor Makes no movements Extension to painful stimuli (decerebrate response) Abnormal flexion to painful stimuli (decorticate response) Flexion / Withdrawal to painful stimuli Localizes painful stimuli Obeys commands
Apgar Scale
Appearance/Complexion blue or pale all over blue at extremities
body pink
(acrocyanosis) no cyanosis
body and extremities pink Appearance
Pulse rate absent 100 Pulse
Reflex irritability no response to stimulation grimace on suction or aggressive stimulation cry on stimulation Grimace
Activity none some flexion flexed arms and legs that resist extension Activity
Respiratory Effort absent weak, irregular, gasping strong, lusty cry Respiration
cranial nerves
olfactory optic occulomotor trochlear tigeminal abducens facial vestibulocholcear glossopharyngeal vagus accessory hypoglossal
palpate muscles and note:
paresis (weakness), paralysis, pain, flaccidity (weakness/paralysis), spasticity, rigidity
tests for cerebellar functions
observe gait tandem walking romberg test - eyes closed, feet together, arms at side, don't sway knee bending - one legged squats toe heel walking
tests for coordination
RAM (Rapid alternating movements) - touch each finger to tips of thumbs, dysdiadochokinesia
finger to finger - dysmetria
finger to nose
heel to shin
tests for peripheral nerves
spinothalmic tract - diabetic neuropathy. paoin, temp, light touch
posterior column tract - vibration with tuning fork, tactile discrimination - stereognosis, graphesthesia, two point discrimination, point location
accessing deep tendon reflexes
biceps reflex - contraction of biceps muscle, flexion of elbow
triceps reflex - contraction of triceps
brachioradial reflex - pronation of forearm, flexion of elbow
petellar reflex - quads reflex, extension of lower leg
achilles reflex - ankle jerk
Clonus - dorsiflexion of foot
Grading scale: 0 - none, 4 - very brisk
accessing superficial reflexes
abdominal reflexes - stroke abdomen away from umbilicus
cremasteric reflex - men, stroke upper inner thigh, testicle should rise slightly
plantar reflex - upside down J, dorsiflexion is abnormal . positive bobiski
infant relfexes
rooting - birth -3 months, baby turns head to touch
sucking - birth - 10 months
palmar - 1-2 months
plantar - bith - 8 months. touch ball of baby’s foot and toes curl
babinski - birth to 24 months, plantar etching, toes fan
multiple sclerosis
demyelnation
automimmune
fatigue, depression, paresthesias
meningitis
inflammation of meninges that surround brain and spinal cord
- invasion of bacteria, virus, fungi, parasites, or other toxins
- severe headache, fever, malaise, stiff neck, positive brudzinskis and kernigs
- viral easier to treat and recover from
encephalitis
inflammation of brain tissue and meninges
- headache, lethargy, irritability, nausea, nucal rigidity, vomiting
- decreased consciousness
spinal cord injury
traumatic disruption of spinal cord
-
head injury
craniocerebral injury - LOC, may affect memory, cognition, motor or sensory abilities
parkinsons
degenerate nerves
resting tremor, bradykinesia, rigidity
mask like face muscle weakness, shuffling gait, finger pill rolling tremors
CVA Stroke
occulded arteries in brain
- signs/symptoms directly related to affected area
- sudden unilateral numbness, weakness
- trouble walking, disease, loss of balance
- severed and sudden headache
- sudden confusion, difficulty swalling, difficulty speaking
alzheimers disease
most common dementia
- 3 stages: 1st 2-4 years, memory fails 2nd 2-12 years progressive memory loss, difficulty with ADLs, language decreases 3rd total care required and unable to communicate
- body can ‘forget how to work’ and death
10 warning signs of alzheimers
- memor changes that disrupt daily life
- challengs in planning or solving problems
- difficulty completeing familiar tasks
- confusion to time or place
- trouble understanding visual images and spatial relations
- new problems with word in speaking or writing
- misplacing things and losing ability to retrace steps
- decreased or poor judgement
- withdrawal from work or social
- changes in mood and personality
trigeminal neuralgia
short intense pain on trigeminal nerve
- neuropathic pain with no stimulus
- intense pain on one side of face
bell’s palsy
paralysis of facial nerve
- unilateral paralysis of facial nerve
- 80% of patients recover
myasthenia gravis
problem with ACH
- gradua weakness
- eyes or throat weakness
- weakness of voluntary muscles
- improves with rest or anti cholinesterase drugs
- ACH receptor sites destroyed - fewer muscle contractions
- occlar, swallowing, skeletal muscle
guillain barre syndrom
demyelination of nerves of PNS
- recover
- deep tendon reflexes absent, weakness and paresthesia
- starts in feet and works its way up the body
mcburney’s point
appendix
pouparts ligament
hernias
RUQ
liver gallbladder duodenium head of pancreas right kidney and adrenal
LUQ
stomach spleen left lobe liver body of pancreas left kidney
RLQ
cecum appendix right ovary right ureter right spermatic cord
LLQ
descending colon sigmoid colon left ovary left ureter lef spermatic cord
midline
aorta
uterus
bladder
Anorexia
lack or loss of appetite for food
Dysphagia
difficulty swallowing
Pyrosis-
heartburn
Eructation
belching/burping
Melena-
dark stool containing partially digested blood
Pica
eating nonfood substances (paper, sand, etc.)
Ascites-
abnormal accumulation of fluid in the abdomen
Hernia
bulge or protrusion of an organ through the structure or muscle that usually contains it
incontinence
leak urine
dysuria
painful urination
before abdominal exam always ask
are (could you be) you pregnant
causes of nausea and vomiting
headache, viral infection, heart attack, severe pain, pregnancy
motion sickness, alcohol poisoning, food poisoning, medication
jaundice
bilirubin in baby adults - blocked bile duct, hepatitis cirrhosis of liver hep a - goes away hep b - vaccination
abdominal health assess
inspect
auscultate
palpate
percuss
auscultate
listen for 5 minutes before you determine no bowel sounds - start in RLQ = illiosacal junctuons - listen to vascular sounds with bell - venous hum - hepatoic portal system - bruie - abdominal anyeurism renal artery
palpate
lay flat with knees up to relax ab muscles
percussion and common tests
typany
ullnes over liver or fill bladder
pain tests: rebound tenderness, mcburney’s test (appendicitis), obturator muscle test (move leg up, appendix of pelvic absess)
ascites
shifting dullness - gravity
fluid wave - hands n both sides of abdomen and feel fluid move side to side
gerd
flow of gastric secretions up into esophogus
- hearburn, regurgitation, dysphaga
hiatal hernia
protrusion of stomach through esophageal hiatus or diaphgragm
- muscle weakness is primary factor - pregnancy, obesity, ascites
- hearburn, regurgitation, dysphagia
peptic ulcer disease
lower end of esophagus, stomach or duodenum
- caused by stress, medications (asprin, nasals,)
crohn’s disease
chronic inflame of bowel disease
- can affect mouth to anus, common in iliac and colon
- ulcerated fistulas, fissures and abscesses
- cramping, diarrhea, nausesa, fever, chills, weakness, anorexia and weight loss
ulceratve colitis
chronic IBD starts in recturm and progress through large intestine
- may progress to colon cancer
- severe abdominal pain,fever, chills, anemia, weight loss
- watery diarrhea of blood, mucus and pus
Ulcerative clolitis vs chrones
chrones = areas of ischemia and dead tissue
ulcerative - large areas of inflammation
diverticulitisis
inflammation of diverticula, herniations through muscular wall in colon
- presence of fecal material through thin-awl;ed diverticula causes inflame nd acscesses
- cramping in LLQ, nausea, vomiting, altered bowel habits, usually constipation
- distended abdomen, tympanic, decreed bowel sounds and local tenderness
viral hepatits
inflammation of liver from viruses
- anorexia, vague abdominal pain, nausea, vomiting, malaise, fever
- enlarged liver, spleen
- jaundice, stools appear clay colored, urine is dark amber
cirrhosis
degenerative liver disease, causes include viral hep, bilary obstruction, alcohol abuse
- liver becomes palpable and hard, ascites, jaundice, cutaneaou spider angiomas, dark urine, clay colored solos
- end stage is hepatic encephalopathy and coma
cholecystitis
inflamm of gallbladder with gall stones (cholelithiasis)
- bike duct becomes obstructed either by edema or inflamm or gall stones
- RUQ colicky pain may radiate to mid torso or right scapula
- indigestion and mile jaundice
pancreatitis
acute or chronic inflame from autodigestions
- digestive flow of enzymes into duodenum obstructed. digestive enzymes start to act on pancreas itself
- pain, stady, boring, dull or sharp, radiates from epigastrum to back
- nausea and vomiting, weight loss, steatorrhea, glucose intolerance
urinary tract infection
urinary bladder, urethra, renal pelvis
- result from gram negative bacteria
- frequency, urgency, dysuria
- flank pain, dysuria, nocturia, frequency
nephrolithiasis
formation of stones in kidney pelvis
- stones made of calcium salts, uric acid, cystine, stuvite
- alkaline urine forms sones
- fever, hematuria, flank pain may radiate to groin and genitals
ab health history
We covered most of this in class – a few important highlights are below
See vocabulary associated with abnormal findings
Note questions about drinking – and long term effects on the liver (cirrhosis)
& smoking - ↑ risk of cancers of mouth, esophagus, stomach, pancreas, liver, colon, rectum
Also Smoking contributes to many common disorders of the digestive system, such as heartburn and GERD, peptic ulcers, and some liver diseases. Smoking increases the risk of Crohn’s disease, colon polyps, and pancreatitis, and it may increase the risk of gallstones.
changes in Bowel Habits
May be related to new foods or change in diet, but may also indicate a pathologic condition like:
Steatorrhea – presence of fat in the stool – may be r/t malabsorptive syndrome, cystic fribrosis, IBD, removal of the gall bladder and others
Liver Disease like Hepatitis – may see dark urine and very light (white or grey) feces
Blood in the stool -
Frank, bright red blood = lower GI bleed, hemorrhoids, anal fissures
Dark Tarry stools (from digested blood) = upper GI issue, bleeding peptic ulcer, etc
Questions about problems with urination
Remember how a UTI may present differently depending on age
Considered what a decrease in urinary output might mean – heart failure? Kidney failure? Dehydration?
With heart and kidney failure, ↓ in urine output means ↑in water retention (and dependent edema)
Physical Exam
ab physical exam
IAPP – auscultation is done BEFORE palpation or percussion
Inspection
Note surface characteristics and appearance of skin and contour of abdomen. Note presence of striae (stretch marks), scars, lesions, lumps, bumps, etx
Auscultation
Listening for bowel sounds - DIAPHRAGM
Usually start in RLQ – sounds usu most active at ileocecal junction
Touch/auscultate painful area LAST
Listen 3-4 places in each quad – must listen 5 full minutes before reporting NO BS
Note absent, hypoactive, Normoactive, or hyperactive BS
Know the term borborygmus (pleural borborygmi)
Listening for vascular sounds = BELL
See text and ppt for locations of sounds
Listen for bruit over descending aorta, R&L renal arteries, R&L Iliac arteries, R&L femoral arteries.
Listen for venous hum near umbilicus (may indicate portal hypertension) - Venous hum is continuous, softer and lower pitched than bruit.
ab Palpation – LIGHT ONLY
Deep palpation can be painful to patients (some tests purposely elicit pain), additionally, you run the risk of rupturing an enlarged spleen, so deep palpation is typically only performed by advanced practitioners (NPs, PAs, MDs).
Lightly palpate for lumps, bumps, muscle tone, pain.
Note: some people are very ticklish and as a result consciously or unconsciously tighten their abdominal muscles and resist palpation. Two hints for helping with this exam
Ask the patient to bend the knees and place his or her feet on the bed like this:
(the helps the abdominal muscles relax more than when the legs are straight)
Take the patient’s hands and place yours on top of his or hers. The place the patient’s fingers in between your fingers and use both your hand and the patients hand to do the palpation.
ab percussion
Use same pattern as auscultation.
Normal tone over most of the abdomen is TYMPANY.
You may hear a dull sound over organs (liver, spleen, etc) and over a full bladder (it is commonly helpful to offer your pt the opportunity to empty the bladder before the exam)
Percussion for CVA tenderness – this tests for kidney inflammation (pyelonephrosis)
It is a part of the abdominal exam, and should be documented as such, but it is usually done after IPPA of the back (with resp system) before moving to the thorax
ascites tests
2 tests for Ascites
Shifting Dullness – watch this video and see text & ppt
https://www.youtube.com/watch?v=JTUUQSe0-MA
Fluid wave test – watch this video and see text & ppt
https://www.youtube.com/watch?v=dkq5Ld1vuAQ
Tests for Appendicitis & Abdominal Inflammation
Rebound Tenderness test - watch this video and see text & ppt
https://www.youtube.com/watch?v=2mfiGIDJfnM
McBurney’s Sign – pain at McBurney’s Point - watch this video and see text & ppt
https://www.youtube.com/watch?v=FOQTkz57u2I
Iliopsoas Muscle Test - watch this video and see text & ppt
https://www.youtube.com/watch?v=-YxHpmWmm_U
Obturator Muscle Test - watch this video and see text & ppt
https://www.youtube.com/watch?v=pTtgD6RpOiI
GERD
caused by weakness of cardiac sphinter r/t smoking or ↑pressure from stomach contents/gas/pregnancy.
Acid from stomach moves into esophagus and burns it.
See slides and text for expected findings with this condition
PUD –
May be related to H. Pylori infection, may also be exacerbated by corticosteroids, NSAIDs, and ASA
a) Gastric Ulcer – in the stomach – pain usually 1-2 hours after easting b) Duodenal Ulcer – pain usually 3-4 hours after eating
IBD
inflammation of the intestinal tract, may cause severe, debilitating pain, diarrhea – may hear increased BS
a) Crohn’s - multiple lesions in different locations in digestive tract b) UC – continuous lesion in digestive tract
Diverticulitis
inflammation of little herniations through the muscular wall of the colon. Associated with cramping, N&V, and constipation. Expect decreased bowl sounds
Viral Heptitis
inflammation/infection of the liver (types A, B, C, D, E)
“A” commonly comes from infected food – (by food workers, etc) – especially uncooked foods like shellfish. More commonly acquired when traveling abroad.
“B” associated with blood and body fluids. A series of 3 vaccinations is required to prevent this.
S/S: severe malaise/exhaustion, jaundice, anorexia, N&V, abdominal pain. Light/grey stools & dark urine
Cirrhosis –
degenerative liver disease, “hardening” of the liver so it cannot function properly. Ascites, jaundice, light colored stools. With end stage disease, may see confusion & hepatic encephalopathy.
Cholecystitis –
nflammation of the gallbladder. May be r/t cholelithiasis - gall stones. (see text and slides – where would you expect pain). Also what is colickly pain?
Pancreatitis –
may be cause by obstruction of pancreatic ducts which causes autodigestion. May be related to alcoholism or gall stones or a genetic disorder. See ppt and text for expected findings.
Nephrolithiasis
Kidney stones. Severe pain (flank pain) & CVA tenderness. May present with fever and hematuria
