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NBCE Part 3 Ty's notes > NBCE Part 3 Ty's Notes > Flashcards

NBCE Part 3 Ty's Notes Flashcards

Study

1
Q

What does a general case history include? (8 things)

A

1) Identifying data
2) Chief Complaint (CC)
3) Present Illness
4) Past History
5) Family History
6) Occupational History
7) Social History
8) Review of Systems (ROS)

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2
Q

In the case history what topics fall under identifying data?

A

Gender, Age, marital status

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3
Q

What falls under the chief complaint? What is the chief complaint?

A
  • Patients own words of the problem

- CC is the reason the person is in your office

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4
Q

What falls under present illness?

A

LOPPQRST and MOI

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5
Q

What does LOPPQRST stand for?

A
  • Location
  • Onset
  • Palliative
  • Provocative
  • Quality
  • Radiate
  • Site/Setting/Severity
  • Timing
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6
Q

What do we have to ask when it comes to location in the case history?

A

We have to ask about the anatomic regions that are in 2’s. 1 area might have brought them in but have to ask about the other if it bothers them as well.

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7
Q

What does bilateral location pain indicate?

A

Systemic issues

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8
Q

What does MOI stand for?

A

Mechanism of injury, must have the patient describe it

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9
Q

What falls under past history? What do we need to know about the patients past?

A
  • Sugeries
  • Trauma
  • Previous illnesses
  • Previous injuries
  • Medications
  • Hospitalizations
  • Need to know if they have seen some else for this same issue and if they were diagnosed with something specific
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10
Q

What falls under family history?

A
  • Dwelling (where did they grow up?)(Exposure to things)
  • Death
  • Diseases
  • Adoption
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11
Q

What falls under occupational history?

A
  • School
  • Work
  • Activities of daily living (no matter what age the patient is we need to find out if what is going on today is bothering them with the things they need/want to do)
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12
Q

What falls under social history?

A
  • Sleep
  • Smoke
  • Stress
  • Sex
  • Diet
  • Drugs (medical/illegal)
  • Alcohol
  • Water intake
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13
Q

Under alcohol is social history what is the questionnaire usually asked? What does it stand for? How many “YES” answers for male and female?

A

CAGE questionnaire
-Cut down (have you ever felt the need to cut down?)
-Annoyed (have you ever felt annoyed by criticism of how much you drink?)
-Guilty (have you ever felt guilty about your drinking?)
-Eye opener (have you ever felt the need for a morning eye-opener drink?)
Male = 2
Female = 1

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14
Q

What is the review of systems?

A

Questions to find any other issues that might be going on with the patient

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15
Q

What are the vital signs

A
  • HR (heart rate/pulse)
  • RR (respiratory rate)
  • BP (blood pressure)
  • Temperature
  • Height
  • Weight
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16
Q

What does pyrexia mean?

A

Elevated temperature.
I have a Fever
Elevated = pyrexia = itis

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17
Q

Where do we take temperatures?

A

Oral, otic, anal, axillary

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18
Q

What happens to temperature in a bacterial infection?

A
  • Sustained, “night sweats” Increased temp
  • Increased neutrophils
  • No change in lymphocytes
  • Increased leukocytes (>10,000 WBCs aka leukocytes)
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19
Q

What is the normal leukocyte count (aka WBC)?

A

5,000-10,000

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20
Q

What is it called if our WBC (leukocyte) count is above 17,000?

A

Schilling Shift. This is an ER moment.

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21
Q

What is neutrophilia?

A

Increased neutrophils

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22
Q

What is leukocytosis?

A

The number of WBC (leukocytes) >10,000

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23
Q

What is leukopenia?

A

The number of WBC (leukocytes) <10,000

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24
Q

What happens to temp in a viral infection?

A
  • Spikes then lowers
  • Decreased neutrophils
  • Increased lymphocytes
  • Decreased leukocytes (<5,000)
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25
Q

Where is the most accurate place to take temperature?

A

Anal

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26
Q

What does apyrexia mean?

A

I do not have a fever

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27
Q

What is the apyrexia”itis” list?

A 
DON'T HAVE A FEVER!!!
Osteoarthritis
Costochondritis
Cystitis and Urethritis
Tendonitis and Bursitis
Osteitis deformans (aka Paget's)
Osteochondritis dessicans (aka AVN- avascular necrosis)
Osteitis Condensans ilii (SI problem)
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28
Q

What are the normal values for pulse (heart rate) in adults, newborns and elderly?

A 
Adult = 60-100 BPM
Newborn = 120-160
Elderly = 70-80
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29
Q

What is the normal respiration rate in adults and newborns?

A 
Adult = 14-20
Newborn = 44
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30
Q

Basic Strep story

A

Mouth –> Kidney –> Heart

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31
Q

What is the Lab test for Strep? What is the definitive test for Strep?

A

Lab test = ASO titre

Definitive = culture

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32
Q

Detailed Strep story

A

Dental work/Sore throat leads to strep throat turns into glomerulonephritis (back ache/ flank pain) a couple weeks later then turns into carditis a couple months later (sub-acute bacterial endocarditis SBE affects the Mitral/Aortic valves)

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33
Q

How do we confirm strep throat?

A

Culture

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34
Q

How do we confirm glomerulonephritis?

A

UA (urine analysis) will have RBC casts

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35
Q

How do we confirm carditis?

A

Blood culture

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36
Q

What special study is for the heart valves?

A

ECHO

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37
Q

What are Osler’s nodes?

A

Painful, red, raised lesions on the hands and feet. Associated with infective endocarditis (sub-acute bacterial endocarditis)

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38
Q

With Osler’s nodes what fingernail change is likely?

A

Splinter. Due to Valve infection in the heart

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39
Q

How do you diagnose hypertension?

A

Must have 3 consecutive visits with elevated blood pressure

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40
Q

What is primary hypertension?

A

aka Essential

The heart and vessels have the disease

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41
Q

What is secondary hypertension?

A

Malignant hypertension due to the kidneys

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42
Q

What is subclavian steal syndrome?

A

When the subclavian artery steals blood from the vertebral artery

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43
Q

What is the cause of clubbing of the nails with dyspnea at night? What is the dyspnea due to?

A

CHF (left sided heart failure)(congestive heart failure)

Dyspnea is due to the left side of the heart failing

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44
Q

What is clubbing of nails due to?

A

Hypoxia, you don’t get enough blood to them

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45
Q

What is ADH (antidiuretic hormone)? What does it deal with? What does antidiuretic mean?

A
  • Peptide made by the posterior pituitary aka vasopressin
  • All about Diabetes Insipidus
  • Antidiuretic = not to pee (so if your not to peer is broken then you pee a lot)
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46
Q

What happens due to decreased ADH?

A

Diabetes Insipidus
polydipsia (increased thirst)
polyuria (increased urinating)

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47
Q

What does a diuretic do?

A

Makes you pee

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48
Q

What does antidiuretic do?

A

Makes you stop peeing

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49
Q

What happens with decreased insulin? What must we get this patient to do?

A 
Diabetes Mellitus
polydipsia
polyuria
polyphagia (increased eating)
Must get this patient moving/exercising (get them off the couch)
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50
Q

Where is insulin made?

A

Tail of the pancreas

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51
Q

What happens with decreased adrenocorticoids (hypoadrenocorticism)?

A

Addison’s disease (weight loss, hypotension, bronze skin, Arroyo sign)

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52
Q

What happens with increased adrenocorticoids (hyperadrenocorticism)?

A
  • Cushing’s (weight gain, swollen, hypertension, moon face, Hirsutism, infertility, thin extremities.
  • These people are swollen on the outside
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53
Q

AKA for Cushings

A

hypercorticism or hyperadrenocorticism

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54
Q

Where are T3, T4 and TSH made?

A

Anterior pituitary

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55
Q

What is decreased T3, T4 and TSH?

A

Secondary hypothyroidism aka Myxedema

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56
Q

What are the characteristics of Myxedema?

A
  • Weight gain, swollen, hypotension, dry skin, constipation, ENophthalmosis, lateral third of eyebrows missing.
  • These people are swollen on the inside
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57
Q

If we have a middle aged woman with swollen, burning peripheral nerve entrapment (hands and feet), what is the differential diagnosis?

A

Hypercorticism (hyperadrenocorticism) aka Cushing’s
OR
Secondary Hypothyroidism aka Myxedema

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58
Q

What is increased T3, T4 and TSH?

A

Secondary Hyperthyroidism aka Grave’s disease (sweaty, diarrhea, EXophthalmosis)

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59
Q

What is hypothyroid?

A

Hashimoto

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60
Q

What does Vitamin D control?

A

Calcium

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61
Q

What happens to adults and children with decreased Vitamin D?

A 
Adult = osteomalacia
Children = Rickets
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62
Q

What is anasarca?

A

Person is swollen all over. Something major in the body is dying.

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63
Q

What is icterus? Found?

A

Jaundice

Eyes

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64
Q

What is kernicterus?

A

Brain jaundice in newborns

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65
Q

What does intracranial pressure cause in the eye?

A

Papilledema, enlargement and blurring

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66
Q

What does intraocular pressure cause?

A

Glaucoma

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67
Q

What do we see with diabetic retinopathy?

A

Waxy exudates and microaneurysms

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68
Q

What does hypertension cause in the eye?

A

Flame hemorrhages, cotton wool exudates

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69
Q

What has an absent red light reflex?

A

Cataract, Retinal detachment

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70
Q

What is Addie’s pupil?

A

Asymmetrical pupil size, ANS (autonomic nervous system) damage
Unilateral
Parasympathetic lesion of CN III

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71
Q

What is lost with glaucoma?

A

Peripheral vision loss

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72
Q

What is lose with macular degeneration?

A

Central vision loss

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73
Q

The optic disc is found on what side of the eye?

A

Medial

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74
Q

What does the iris help prevent?

A

Myopia (nearsightedness) and Presbyopia (farsightedness)

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75
Q

Which is more contagious? Conjunctivitis or Iritis?

A

Conjunctivitis (pink eye) is more contagious because it is superficial. Iritis is deeper and can affect pupillary responses. There is a red rim around the pupil and is an ER moment with iritis.

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76
Q

What is anisocoria?

A

Unequal pupil size

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77
Q

What is a bump inside the eye called?

A

Sty

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78
Q

What is a painless bump inside the eye called?

A

Chalazion

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79
Q

What is a painful bump inside the eye called?

A

Hordeolum (painful sty in the eye)

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80
Q

How do you treat a hordeolum?

A

Hot pad, moist pack, epsom salt, magnesium sulfate

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81
Q

What are the triangles in the eye called?

A

Pterygium and Pinguecula

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82
Q

What are the triangles that do not impede or invade vision in the eye?

A

Pinguecula

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83
Q

What do we need to get people with pterygium or pinguecula to do to help slow the process?

A

Wear sunglasses

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84
Q

What is Argyll Robertson?

A

Bilateral small and irregular pupils that accommodate (change lens shape) but do not react to light.
Seen with tertiary syphilis
aka prostitutes pupil

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85
Q

What is blepharitis?

A

Staph infection in the eye

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86
Q

What are cataracts?

A

Opacities seen in the lens
Common with diabetes and the elderly
Absent light reflex

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87
Q

Pink conjunctica is? Pale? Bright red?

A

Pink = Normal
Pale = Anemic
Bright red = Infection

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88
Q

What does diabetic retinopathy affect? Presents with?

A

Affects the Veins

Presents with microaneurysms, hard exudates and neovascularization

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89
Q

When is EXophthalmosis bilateral? Unilateral?

A 
Bilateral = Grave's
Unilateral = Tumor
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90
Q

What does glaucoma cause?

A

Cupping of the disc, blurring vision especially in the peripheral fields of view, rings around lights.

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91
Q

Eye problems that also have skin problems are caused by?

A

Staph

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92
Q

Staph is associated with what eye problems?

A

Argyll Robertson, Corneal Arcus, Diabetic retinopathy, EXophthalmosis, Hordoleum, Horner’s syndrome, Macular degeneration, pterygium, retinal detachment, xanthelasma

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93
Q

What is Horner’s syndrome?

A
  • Ptosis, Miosis and Anhydrosis and ENophthalmosis
  • Commonly associated with Pancoast tumor/syndrome
  • Is an interruption to the sympathetics of the face
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94
Q

What is likely to be found with Horner’s syndrome?

A

Lower Brachial plexus involvement
Ptosis, Miosis, Anhydrosis and ENophthalmosis
Flushing of the face
Arm pain

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95
Q

What is seen with hypertensive retinopathy?

A

Copper/Silver wire deformity
A-V nicking
Flame hemorrhages
Cotton wool soft exudates

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96
Q

What is associated with internal ophthalmoplegia?

A

Dilated pupil, ptosis, lateral deviation

Multiple Sclerosis

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97
Q

What is the most common reason for blindness in the elderly?

A

Macular degeneration

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98
Q

What is involved with macular degeneration?

A 
Central vision loss
Macular drusen (early sign, yellow deposits under the retina)
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99
Q

What is swelling of the optic disc?

A

Papilledema aka choked disc due to increased intracranial pressure

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100
Q

What causes periorbital edema?

A

Allergies
Myxedema (hypothyroid)
Nephrotic Syndrome (Severe kidney damage)(HEP = hypertension, edema, proteinuria)

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101
Q

What can cause Ptosis?

A

Horner’s
CN 3 paralysis
Myasthenia Gravis
Multiple Sclerosis

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102
Q

What is retinal detachment?

A

Painless sudden onset of blindness
Closing curtains
Lightning flashes and Floaters

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103
Q

Colors of the sclera?

A 
White = normal
Yellow = jaundice
Blue = osteogenesis imperfecta
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104
Q

What are fatty plaques on the nasal surface of the eyelids?

A

Xanthelasma.

Can indicate hypercholesterolemia

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105
Q

SO4LR6AO3 stands for?

A

Superior Oblique = CN 4
Lateral Rectus = CN 6
All other eye muscles = CN 3

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106
Q

What do the sympathetics control?

A

Sudomotor, Pilomotor, Vasomotor

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107
Q

What is pancoast syndrome?

A

When a pancoast tumor eats its way out of the lung

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108
Q

When you see METS what do you think?

A

METS–>Spine–>Lytic

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109
Q

Prostate or Reproductive cancer you think?

A

METS–>Spine–>BLASTIC

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110
Q

Exophthalmosis bilateral?

A

Graves aka Hyperthyroid

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111
Q

Exophthalmosis unilateral?

A

Space Occupying Lesion (SOL)

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112
Q

Enophthalmosis bilateral?

A

Myxedema aka Hypothyroid

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113
Q

Enophthalmosis unilateral?

A

Horner’s

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114
Q

Lateral third of eyebrow missing (usually bilateral)?

A

Hypothyroidism

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115
Q

Bilateral anhydrosis?

A

Sjogren’s

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116
Q

Unilateral anhydrosis?

A

Horner’s

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117
Q

Mydriasis mean?

A

Dilated

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118
Q

Argyll Robertson pupil is associated with?

A

Tertiary syphilis or Posterior column disease

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119
Q

What is the most common lesion of the mouth?

A

Fordyce spot

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120
Q

What are Koplik spots?

A

White spots from Rubeola

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121
Q

Thrush is from?

A

Candidiasis

Thick white patches that CAN be scraped off

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122
Q

Leukoplakia?

A

White patches that CANNOT be scraped off

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123
Q

Basal cell is?

A

Cancer

Due to exposure to the sun or smoker

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124
Q

What vitamin is a problem with gingivitis?

A

Vitamin C (ascorbic acid)

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125
Q

Red nose equals?

A

Acute rhinitis and coryza

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126
Q

Pale/Gray/Blue nose equals?

A

Chronic infections and allergies

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127
Q

Foul discharge from nose?

A

Foreign object

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128
Q

Clear discharge from nose?

A 
Thin = CSF (ER moment) and allergies
Thick = infection
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129
Q

Associated with conduction loss?

A

Cerumen
Otosclerosis
Infection

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130
Q

Associated with sensorineural loss?

A

Presbycusis

Meniere’s

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131
Q

Bulging tympanic membrane?

A

Acute/Chronic otitis

All inner ear infections

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132
Q

Retracted tympanic membrane?

A

Serous (bubbles)
Altitude
Clogged/Blocked eustachian tube

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133
Q

What are the tests for the ear?

A

Weber and Rinne

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134
Q

Which test is performed first for hearing?

A

Weber

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135
Q

Which way does Weber test migrate?

A

Weber goes to the ear that can hear

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136
Q

What does Rinne test?

A

Air conduction vs bone conduction

Should be 2:1

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137
Q

If air conduction is longer than bone what is going on?

A

That side ear is fine but the other has a nerve dying which is sensorineural hearing loss

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138
Q

If Weber test doesn’t lateralize what does that mean?

A

Everything is normal

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139
Q

If bone and air conduction are equal what does that mean?

A

There is a conduction deficit

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140
Q

AKAs for Meniere’s disease?

A

Central vertigo

Endolymphatic Hydrops

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141
Q

What is Meniere’s disease?

A

Recurrent vertigo, sensory hearing loss, tinnitus and fullness in the ear

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142
Q

What is presbycussis?

A

Sensorineural hearing loss that occurs in people as they age

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143
Q

What are common lymphadenopathies in children? Young adults? Elderly?

A

Children = Leukemia
Young adults = Mono, Hodgkin’s and AIDS
Elderly = Multiple Myeloma

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144
Q

What is a plasma cell cytoma?

A
  • Multiple myeloma in one bone

- Is a primary bone cancer even though it starts in the blood of bone

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145
Q

Where is the most metastatic disease found?

A

Left supraclavicular lymph nodes

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146
Q

Malignant lymph nodes will display?

A 
No fever (except Hodgkins)
Non-mobile
Painless sensitivity/bleeding
Firm texture
Rubbery (Hodgkin's)
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147
Q

Wide mediastinum, irregular, asymmetrical, lumpy, bumpy is what type of case?

A

Hodgkin’s case

Lymphoma

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148
Q

Hypercalcemia equals?

A

Bone cancer

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149
Q

Multiple Myeloma is? (MM)

A 
Primary Bone Malignant Bone Cancer
Hypercalcemia
Hyperproteinemia
Bence Jones Proteinuria
Spares the pedicle
Cold Bone Scan
Elevated IgG
Endosteal scalloping
Punched out lesions (same size)
Collapsed vertebra
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150
Q

Lytic Mets is?

A 
Secondary Bone Malignant Bone Cancer
Hypercalcemia
Targets pedicle (winking pedicle)
Hot Bone Scan
Permeative pattern
Punched out lesions (different sizes)
Long zone of transition
Moth eaten
Collapsed vertebra
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151
Q

Endosteal scalloping and permeative pattern eat bone from?

A

Inside–>Out

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152
Q

How does Lytic Mets do to bone? How does it travel?

A

Eats the bone and uses the blood to travel

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153
Q

What does Multiple Myeloma (MM) eat and affect?

A

Eats and affects the blood products and blood of bone

MM will eat the vertebra and leave the neural arch

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154
Q

Hot bone scan? Lytic Mets or MM?

A

Lytic Mets

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155
Q

Cold bone scan? Lytic Mets or MM?

A

MM

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156
Q

How do you confirm MM?

A

Electrophoresis

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157
Q

What is the aka for MM?

A

Plasma cell sarcoma

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158
Q

ESR (SED) rate >80 with patient over 50 years old?

A

MM

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159
Q

Signs and symptoms of MM?

A

Signs = unrelenting back pain, fatigue, joint pain and swelling
Sx =Cachexia, Weight loss, Anemia, Punched out lesions

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160
Q

What is the most common primary malignancy of bone?

A

MM

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161
Q

What is MM associated with in the skull?

A

Rain drop skull

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162
Q

What are the labs for MM?

A

M spike on immunoelectrophoresis
A/G reversal
Bence Jones proteinuria
Elevated ESR (sed) rate

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163
Q

What is the most common malignant tumor of bone?

A

Lytic Mets

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164
Q

What is the most common tumor in the spine?

A

Lytic Mets

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165
Q

What is the most common form of metastasis in ages 20-40?

A

Hodgkin’s disease

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166
Q

What radiographic signs are seen with Hodgkin’s?

A

Ivory white vertebra with anterior body scalloping

Unilateral hilar lymphadenopathy

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167
Q

How do you confirm Hodgkin’s?

A

Biopsy confirms

Will see Reed Sternberg cells

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168
Q

What radiographic signs are seen with Blastic Mets?

A

Ivory white vertebra

No cortical thickening or bone enlargement

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169
Q

What is the aka for Paget’s?

A

Osteitis deformans

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170
Q

What radiographic signs are seen with Paget’s?

A 
Cortical thickening
Picture frame vertebra
Increased bone density
Coarsened trabeculae
Bone expansion
Bowing deformities
Brim sign (whitening of pelvic brim)
Shepards crook
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171
Q

What are the stages of Paget’s?

A

1) Lytic or destructive
2) Combined
3) Sclerotic
4) Malignant (osteosarcoma)

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172
Q

What are the signs and symptoms of Paget’s?

A

Older male, getting shorter, hat isn’t fitting, can’t hear and shoes don’t fit well

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173
Q

Describe Paget’s

A

Paget’s aka osteitis deformans will not have a fever but will have localized warmth over the areas and body parts it affects.
Replaces calcium bone with phosphorus bone (which is very weak) which leads to deforming of the bone hence osteitis deformans

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174
Q

How do you find and confirm Paget’s?

A

Bone scan

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175
Q

Is Paget’s malignant or benign?

A

Non-malignant (benign) until 4th stage when it becomes an osteosarcoma

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176
Q

What is the most common malignancy found in children age 10-30?

A

Osteosarcoma

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177
Q

What are the radiographic signs of an osteosarcoma?

A

Periosteal reaction that is spiculated, radiating, sunburst in appearance

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178
Q

What malignant neoplasms have ivory white vertebra?

A

Hodgkin’s
Paget’s
Blastic Mets

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179
Q

What is the number one cause of chest pain?

A

Heart burn and GERD

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180
Q

What is achalasia? Cause?

A

Narrowing of the esophagus

Cause = scleroderma

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181
Q

What causes varices?

A

Alcohol

Bulimia

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182
Q

Where do we feel pain from the head of the pancreas?

A

Straight through like a knife at xiphoid (T10)

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183
Q

If we feel pain at T10 straight through the xiphoid what are the 2 possible reasons? How do we differentiate the 2?

A

Aorta or Head of pancreas

Differentiate by forward flexion, if pain goes away with forward flexion = head of the pancreas

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184
Q

What is pancreatitis?

A

Infection with fever, painful, bleeding, Grey Turner’s sign, increased amylase and lipase

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185
Q

What is Grey Turner’s sign? Pain? AKA

A

Weeping of blood into the flanks.
There is no pain.
AKA = Echymosis

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186
Q

Where is the head of the pancreas located?

A

Midline

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187
Q

What is the tail of the pancreas involved with?

A

Diabetes Mellitus

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188
Q

What types of Diabetes Mellitus are there?

A

2 types

1) Juvenile onset (type 1) insulin dependent, under 30 years old, thin
2) Adult onset (type 2) non-insulin dependent, over 40 years old, obese

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189
Q

What are the labs for Diabetes Mellitus?

A

GTT (glucose tolerance test)
FBS (fasting blood sugar) FPG (fasting plasma glucose)
Post-Prandial
HBA1C (glycosylated hemoglobin)

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190
Q

Polydypsia, polyphagia, polyuria equals?

A

Diabetes Mellitus

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191
Q

What is Diabetes Mellitus associated with?

A

DISH aka Forestier’s Disease in those older than 50

AS (ankylosing spondylitis) in those 15-35, will have increased vaginal infections

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192
Q

What is the best test for diabetes mellitus?

A

HBA1C

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193
Q

What are gastric and duodenal ulcers considered?

A

Peptic ulcers

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194
Q

What is the most common peptic ulcer?

A

Duodenal

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195
Q

What causes peptic ulcers?

A

Infection

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196
Q

What is chronic gastritis?

A

Abuse, Alcoholism, B12 deficiency

-Denaturing of lining of gut–>pernicious (megaloblastic) anemia–> PLS

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197
Q

What does B12 deficiency lead to?

A

RBC death –> Pernicious (megaloblastic) anemia –> Demyelination of posterior columns and lateral tracts –> loss of fine touch, vibration, 2-point discrimination, and proprioception –> stocking/glove paresthesia aka Posterolateral sclerosis (PLS)

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198
Q

What is secreted by Parietal cells in the gut? What does it do?

A

Intrinsic factor.

Makes B12 absorbable

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199
Q

Vegans have what vitamin deficiency?

A

B12

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200
Q

What is B12 used for in the body?

A
  • RBC maturation

- Myelination of nerves

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201
Q

aka for demyelination

A

sclerosis

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202
Q

demyelination of posterior columns is?

A

Posterolateral sclerosis aka stocking/glove paresthesia

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203
Q

What are the tests for B12?

A
  • B12 assay (checks levels of B12 not confirmation)
  • Schilling’s Test (Best test, if a lot of B12 is in the urine you are getting what you need)
  • Achlorhydria (absence of HCl in gastric secretions)
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204
Q

Signs and symptoms of stomach cancer?

A

Unexplained weight loss (even with eating)
Painless bleeding
Chronic GI disorders
Left virchow/sentinel node

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205
Q

Crohn’s and Ulcerative Colitis have diarrhea but what is the difference between the two?

A

Crohn’s = epsiodes of diarrhea, skip lesions, explosive

Ulcerative Colitis = bloody diarrhea, descending colon, megacolon

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206
Q

What is appendicitis?

A

Periumbilical pain–> Tender McBurney’s point–> Fever–> Relief (burst)–> Rebound tenderness (peritonitis)(all 4 quadrants have pain)–> Death

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207
Q

Cholecystitis and cholelithiasis are connected to what organ?

A

Gallbladder

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208
Q

What is cholecystitis?

A

Severe RUQ pain with nausea, vomiting, precipitated by large fatty meals.
MC seen in Females, Forty years old, fat, fertile
Increased WBCs

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209
Q

What is the most common cause of cholecystitis?

A

Cholelithiasis (gallstones)

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210
Q

Where is McBurney’s point?

A

1/3 the distance from the ASIS to the umbilicus

Base of the appendix where is attaches to the cecum

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211
Q

What are cholelithiasis?

A

Gallstones

Normal WBCs

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212
Q

Where is pain referral for the gallbladder?

A

Right shoulder or tip of the right scapula

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213
Q

When you hear liver what do you think of?

A

Liver = veins

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214
Q

Hepatitis A is?

A

Oral-fecal

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215
Q

Hepatitis B is?

A

Blood born, needles, transfusion, surgeries, sexual, carrier for life

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216
Q

Hepatitis C is?

A

Chronic, blood transfusions

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217
Q

Which Hepatitis is most common to become liver cancer?

A

Hep B

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218
Q

Labs associated with the liver?

A

Alk Phos, SGOT/AST, LDH, Aspartate transaminase, GGT, SGPT/ALT, CPK, BUN (blood urea nitrogen)

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219
Q

Describe BUN.

A

BUN is blood urea nitrogen. BUN is made in the liver and excreted through the kidneys

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220
Q

GGT is the test for?

A

Alcohol

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221
Q

What is the best test for the liver?

A

ALT (alanine transaminase)

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222
Q

What is the most common site for metastatic disease?

A

Liver

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223
Q

What is the most common cause of liver damage? What does it lead to?

A

Alcoholism

Cirrhosis

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224
Q

What does cirrhosis cause?

A

Portal hypertension
Ascites
Esophageal varices

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225
Q

What is Mallory Weiss syndrome?

A

Coughing, tearing esophageal blood vessels and hematemeis with palmar rash due to bile salts

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226
Q

What do we evaluate with a Biliary duct obstruction? What does it lead to?

A

Liver, gallbladder and head of the pancreas

Leads to yellow skin and pale poop (clay gray)

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227
Q

Orthopedic test for the kidney?

A

Murphys punch

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228
Q

What is nephritis?

A 
Infection
Fever
Flank pain
Proteinuria
Single cast
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229
Q

What is nephrosis?

A

Death
Hypertension, Edema, Proteinuria (HEP)
All casts

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230
Q

What is toxemia of pregnancy?

A

HEP + pre-eclampsia

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231
Q

RBC casts equals?

A

Glomerulonephritis (STREP)

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232
Q

WBC and Waxy casts equals?

A

Pyelonephritis

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233
Q

All casts equals?

A

Nephrosis

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234
Q

Hyaline casts equals?

A

Normal/Nephrosis

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235
Q

Where is the referred pain for renal and ureters?

A

Flank

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236
Q

Where is the referred pain for bladder?

A

Suprapubic

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237
Q

Where is the referred pain for the urethra?

A

Groin

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238
Q

Referred pain for a stone?

A

Colicky

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239
Q

Upper Tract infection is due to? What direction?

A

Kidney

Descending

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240
Q

Lower Tract infection is due to? What direction?

A

Bladder, sexual activity, female with poor hygiene, prostate

Ascending

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241
Q

What are the tests for prostate cancer?

A

Acid phos, Alk phos

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242
Q

If acid phos is elevated?

A

Agressive prostate disease

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243
Q

If Alk phos elevated?

A

Blastic Mets

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244
Q

What does alk phos tell us?

A

We are making bone or the liver is in trouble

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245
Q

When will we see and increase in Alk Phos?

A

Puberty, Fracture, Paget’s Blastic Mets

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246
Q

If we have increased acid phos and increased alk phos?

A

Prostate cancer with Blastic Mets

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247
Q

What is a fibroadenoma?

A

A painless, firm lesion, non-malignant lump

Single nodule

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248
Q

What is fibrocystic disease?

A

Painful, multiple, mobile nodules that get worse

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249
Q

Who can get a fibroadenoma?

A

Both Men and Women

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250
Q

Who gets breast cancer?

A

Both men and women

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251
Q

What is breast cancer in men called?

A

Gynecomastia

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252
Q

What is the aka for Paget’s Disease?

A

Nipple cancer

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253
Q

What is the most common are for metastasis of the breast?

A

Axilla

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254
Q

What are the first signs of pregnancy? What do we order if these symptoms are present?

A

LBP, breast tenderness, and nausea

Order HCG test

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255
Q

What does a HCG test tell us?

A

Increased HCG = tumor or twins

Decreased HCG = ectopic pregnancy

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256
Q

What is the second most common primary cancer in females?

A

Uterine/Cervical cancer

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257
Q

Describe Cheyne Stokes

A

Rhythmical apnea, brain lesion, ER moment

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258
Q

Describe Biot’s

A

Irregular apnea, medulla damage, ER moment

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259
Q

Describe Kussmaul

A

Air hunger, associated with diabetic coma, deep breathing, ER moment

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260
Q

Describe Pink puffer

A

Balloon lungs, emphysema

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261
Q

Describe Blue bloater

A

Chronic bronchitis

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262
Q

What does fremitus feel?

A

Fremitus feels fluid

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263
Q

Dull percussion in the lungs associated with? Fremitus will be?

A

Bacterial pneumonia, pulmonary edema, CHF

Fremitus will be increased

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264
Q

Air in the chest will percuss? Associated with what conditions? Fremitus will be?

A

Hyperresonant
Emphysema, pneumothorax, COPD
Fremitus decreased

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265
Q

Gastric air will percuss? Condition?

A

Tympanic

Magenblase

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266
Q

Flat percussion is associated with what condition?

A

Atelectasis

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267
Q

Rales, wheezes and crackles with all have what type of percussion?

A

Dull percussion

Fremitus will be increased

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268
Q

Friction rub equals?

A

Pleurisy

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269
Q

Prolonged expiration associated with?

A

COPD

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270
Q

Rusty sputum associated with?

A

Pneumococcal

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271
Q

Red currant jelly sputum?

A

Klebsiella (Friedlander’s)

Pneumonia, chronic depressed, alcoholics

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272
Q

Walking pneumonia in an adult?

A

Mycoplasma

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273
Q

Mucopurulent, productive sputum?

A

Viral

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274
Q

What is Reye’s syndrome?

A

Children with a recent viral infection, can cause confusion, swelling the the brain and liver damage.

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275
Q

Who is most at risk to get Reye’s syndrome?

A

Children recovering from a viral infection that have a metabolic disorder (ie: diabetes mellitus 1 or 2, PKU, maple syrup urine disease), that have been taking aspirin

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276
Q

Foul sputum?

A

Bronchiectasis, Chronic infections

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277
Q

Protozoan associated with AIDS?

A

Pneumocystic Carinii

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278
Q

Dry cough vs Productive cough

A 
Dry = Marfan's, long standing hypertension, AAA (arch), Laryngitis
Productive = TB (red), CHF (pink, frothy, bubbly)
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279
Q

What are associated with bright red hemoptysis?

A
  • Pulmonary infarct
  • Caner
  • TB
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280
Q

What will an xray look like with someone with COPD?

A

Air gets trapped in the lungs so they look more black,

Narrowed mediastinum, flattened hemidiaphragm, ribs will look horizontal, increased intercostal space

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281
Q

AKA COPD

A

Emphysema

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282
Q

Radiographic signs of lung cancer?

A

Primary (snowball) one nodule

Secondary (cannonballs) multiple nodules

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283
Q

Radiographic sign of lymphoma? Types of lymphoma?

A

Lumpy bumpy

Types = Hodgkin’s, Sarcoidosis

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284
Q

Hyperlucent radiographic finding? What does it cause the mediastinum to do?

A

Pneumothorax.

Pushes the mediastinum away from side of involvement

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285
Q

Radiographic findings for atelectasis? What is atelectasis due to?

A

Collapsed area of the lungs, Mediastinum sucked towards side of involvement.
Due to bronchial obstruction, mucous plug

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286
Q

Associated with Schepelmanns ortho test?

A

Pleurisy and Intercostal neuritis
Pleurisy hurts opposite side leaning towards
Intercostal neuritis hurt same side leaning towards

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287
Q

AKA for Myocardial Infarct (MI)? Lab test? Makes it worse? Better?

A 
aka = Coronary infarct
Lab = Troponin, CPK, SGOT, LDH
Worse = anything
Better = Nothing
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288
Q

AKA for Angina? Lab test? Makes it worse? Better?

A 
aka = Coronary ischemia
Lab = Normal labs
Worse = activity
Better = Rest within 10 minutes
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289
Q

What is a normal EKG?

A

P wave, QRS complex, T wave

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290
Q

What is the P wave?

A

Atrial depolarization

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291
Q

What is the QRS complex?

A

Ventricular Depolarization

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292
Q

What is the T wave?

A

Ventricular repolarization

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293
Q

Anything that disrupts QRST?

A

Myocardial Infarct

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294
Q

What does an MI do to EKG?

A

Increases time between QRS and T wave

Inverts T wave

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295
Q

Widened QRS complex?

A

Bundle of HIS lesion, ventricular hypertrophy

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296
Q

When are the heart sounds heard?

A

S1 heard end of QRS (AV shut)

S2 heard end of T (Semilunar shut)

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297
Q

S1 is which valves?

A

AV valves (mitral and tricuspid)

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298
Q

S2 is which valves?

A

Semilunar (Aortic, Pulmonic)

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299
Q

What are the murmurs?

A

Stenosis, Regurgitation

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300
Q

What are the diastolic murmurs?

A

ARMS PRTS
Aortic Regurgitation Pulmonic Regurgitation
Mitral Stenosis Tricuspid Stenosis

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301
Q

What is APETM?

A 
A= Aortic (2nd ICS on R sternal border)
P= Pulmonic (2nd ICS on L sternal border)
E= Erb's Point (3rd ICS L sternal border, all murmurs best heard here)
T= Tricuspid (4th/5th ICS L sternal border)
M= Mitral (5th ICS midclavicular line, best heard in lateral decubitis position)
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302
Q

What is the cause and result of heart failure?

A 
Cause = hypertension
Result = edema
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303
Q

What is the 1st sign of heart failure? Last sign?

A 
1st = fatigue
Last = pitting edema (anasarca)
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304
Q

What is Right sided heart failure?

A

aka Cor Pulmonale (lungs caused the problem)
Cause = pulmonary hypertension (smoking, COPD, emphysema)
R ventricle hypertrophy –> R ventricle failure
Result = body edema, jugular distention, “portal hypertension”

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305
Q

What caused Right sided heart failure?

A

The problem started in the lungs

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306
Q

Right sided heart failure is involved with veins or arteries?

A

Veins

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307
Q

What is Left sided heart failure?

A 
aka CHF (congestive heart failure)
Cause = Systemic hypertension (diet, DM, drugs)(clogged blood from fats and sugars in the blood)
L ventricular hypertrophy --> L ventricular failure (fatigue)(failure to pump forward)
Result = pulmonary edema, nocturnal dyspnea, pink frothy sputum
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308
Q

Progression of heart failure starting from L side

A

L side heart failure –> pulmonary problems –> R side heart failure

309
Q

Which way does the heart fail from?

A

Fails from L –> R

310
Q

Arterial, Venous or Both?

Atherosclerosis/Arteriosclerosis?

A

Arterial

311
Q

Arterial, Venous or Both?

Raynaud’s

A

Arterial

312
Q

Arterial, Venous or Both?

Buerger’s

A

Both

313
Q

Arterial, Venous or Both?

Diabetes Mellitus

A

Arterial

314
Q

Arterial, Venous or Both?

Aneurysm

A

Arterial

315
Q

Arterial, Venous or Both?

Leriche’s

A

Arterial

316
Q

Arterial, Venous or Both?

Coarctation of the Aorta

A

Arterial

317
Q

Arterial, Venous or Both?

RSDS/CRPS

A

Arterial

318
Q

Arterial, Venous or Both?

Shoulder-Hand-Finger Syndrome

A

Venous

Is venous lymphatic return

319
Q

Arterial, Venous or Both?

DVT

A

Venous

320
Q

Arterial, Venous or Both?

Liver disease

A

Venous

321
Q

Arterial, Venous or Both?

Intermittent claudication

A

Arterial

322
Q

What is neurogenic claudication? Pattern? Relief? Cause? Treatment?

A

Pain during activity and relief of pain with change in position.
Pattern = Non-predictable, LBP, bilateral
Relief = Positional, stoop/supine, knees bent, bicycle
Cause = Central canal stenosis, DJD
Treatment = walk and primary cary

323
Q

What is vascular claudication? Pattern? Relief? Cause? Treatment?

A 
Pain during activity and relief of pain with rest
Pattern = Predictable
Relief = Always with rest
Cause = arteriosclerosis, buerger's
Treatment = walk and co-care
324
Q

Normal RBC count?

A

4.5-6 Million

325
Q

What is a reticulocyte?

A

Young (immature) RBC

326
Q

What is polycythemia?

A

Increase RBC count 6-8 Million

327
Q

What is polycythemia vera?

A

RBC count greater than 8 Million

328
Q

Normal WBC count?

A

5-10,000

329
Q

What is a Schillings shift?

A

WBC count 17-18,000

330
Q

Arterial, Venous or Both?

Scleroderma

A

Arterial

331
Q

What is the difference between Raynaud’s Phenomenon and Raynaud’s Disease

A

Both have = Triphasic, cold sensitivity, hands/feet
Difference = If it’s the only thing you have it is considered Raynaud’s Disease. If it is accompanied by anything else (Scleroderma, Buerger’s, other conditions) it is Raynaud’s phenomenon and that makes it secondary

332
Q

aka for Buerger’s?

A

Thromboangitis obliterans. It obliterates the veins then the arteries, usually the veins first

333
Q

What does RSDS/CRPS stand for?

A 
RSDS = Reflex Sympathetic Dystrophy Syndrome
CRPS = Complex Regional Pain Syndrome

Is a lack of sympathetic supply after an injury on the extremity

334
Q

A CBC is all about which cells?

A

RBCs

335
Q

A differential is all about which cells?

A

WBCs

336
Q

What 2 things will increase RBC count?

A

Altitude and smoking

Increased RBC count = polycythemia

337
Q

MCV, MCH, MCHC indicate what?

A

Anemias

338
Q

What are the big 3 anemias?

A

1) Microcytic/Hypochromic = RBC shrunk down, no dark rusty color (lost its iron), tells us person is iron deficient
2) Macrocytic/Normochromic = Reticulocytes are dying, no maturation, this is a B vitamin problem (B9 or B12), B12 pernicious anemia –> PLS, or B9 folate, baby development
3) Normocytic/Normochromic = Pt is on chemo, radiation therapy. Have trouble manufacturing blood products

339
Q

aka for WBC

A

Leukocyte

340
Q

What is an increase in WBCs?

A

Leukocytosis

341
Q

WBC types?

A 
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
342
Q

When do Neutrophils increase?

A

Bacterial infection, Schilling shift, inflammation

343
Q

When do Lymphocytes increase?

A

Viral infection, decreased neutrophils, mononucleosis

344
Q

Monocytes deal with?

A

Chronic infection, lymphoma

345
Q

Eosinophils deal with?

A

Allergies

346
Q

Basophils deal with?

A

Heavy metal and polycythemia

347
Q

What does a urinalysis look for?

A

Protein, Glucose, Ketones, Blood, Casts

348
Q

Protein in the urine due to?

A

Nephron disease and Multiple Myeloma

349
Q

Glucose in the urine due to?

A

Diabetes Mellitus, shock

350
Q

Ketones in the urine due to?

A

Diabetes Mellitus, starvation

351
Q

Blood in the urine due to?

A

Trauma, infection, stone, prostate and cancer

352
Q

Casts in the urine due to?

A

Nephron disease

353
Q 
Urine colors:
Green equals
Yellow =
Orange =
Black =
Red =
Smoky =
A 
Green = Bilirubin
Yellow = Concentrated
Orange = B vitamins
Black = Ochronosis (alkaptonuria- can't change phenylalanine into tyrosine)
Red = Lower tract RBCs
Smoky = Upper tract RBCs
354
Q

Frank blood stool is?

A

Lower GI issue

355
Q

Occult blood stool is?

A

Upper GI issue

GUAIAC- study hidden bleeding

356
Q

What are the immunoglobulins?

A

IgG, IgA, IgM, IgE, IgD

357
Q

What is IgG for?

A

Fights bacterial, fungus and toxins. Second to fight, Increased in Multiple Myeloma

358
Q

What is IgA for?

A

Mucosal linings of GI and Lung

359
Q

What is IgM for?

A

First to fight

360
Q

Acid phosphatase study used for?

A

Prostate disease

361
Q

A/G reversal seen in?

A

Multiple Myeloma

362
Q

Alkaline phosphatase seen in?

A

Blastic bone disease, liver disease

363
Q

ANA (sero +)

A 
Collagen diseases:
SLE (lupus)
Scleroderma
Polyarteritis nodosa
Sjogren's
RA (rheumatoid arthritis)
364
Q

Increased BUN?

A

Kidney disease

365
Q

Decreased BUN?

A

Liver disease

366
Q

GTT study?

A

Diabetes Mellitus, hypoglycemia

367
Q

HLA-B27 (sero -) study?

A 
UCRAPE
Ulcerative Colitis
Crohn's
Reiters (reactive) arthritis
AS (ankylosing spondylitis)
Psoriatic arthritis
Enteropathic arthritis
368
Q

Increased potassium?

A

Addison’s, renal failure

369
Q

Protein (CSF)

A

Viral meningitis, sclerosis

370
Q

Protein (Blood)- Increased?

A

Hyperproteinemia (Multiple Myeloma)

Proteinuria

371
Q

Protein (Blood)- Decreased?

A

Hypoproteinemia (Kidney)

Proteinuria

372
Q

SGOT/AST

A

Heart and Liver disease

373
Q

SGPT/ALT

A

Liver disease

374
Q

T3/T4/TSH

A

Thyroid disease

375
Q

ESR > 80 in a patient > 50 years old =

A

Giant Cell Arteritis
Temporal arteritis shows up with headaches
polymyalgia rheumatica = ache all over
Plasma Cell Cytoma = Primary bone cancer, Multiple Myeloma

376
Q

Nocturnal, boring, deep, achy pain, what should you order? Result?

A

Order bone panel

Result = possible bone cancer

377
Q

What does RA not like?

A

I don’t like my Synovium

378
Q

What does scleroderma not like?

A

I don’t like my smooth muscle

379
Q

What does SLE (lupus) not like?

A

I don’t like my body in general, don’t put me in the sun (malar rash)

380
Q

In the HLA-B27 club, which things are related or look alike?

A

UCRAPE-
UC&E = colon-joint club

EA = can look exactly alike in the spine, Bilateral, marginal syndesmophytes (calicification of the ligaments), fragile

PR = look alike in the spine, thick, bulky flowing syndesmophytes (calicification of the ligaments)

381
Q

Enteropathic and AS like which joints?

A

Bilateral SI joints

382
Q

Psoriatic and Reiters (reactive) like which joints?

A

Unilateral SI joints

383
Q

Psoriatic likes?

A

Hands (only one to like the hands)

384
Q

Reiters (reactive) likes?

A

Heel spur

385
Q

Enteropathic all about?

A

diarrhea

386
Q

AS likes getting into?

A

Costovertebral joints leads to trouble breathing, dyspnea

387
Q

In HLA-B27, which parts are not arthritides and not seen on xray?

A

Ulcerative Colitis and Crohn’s

388
Q

Which 2 of HLA-B27 are spine only?

A

Enteropathic and AS

389
Q

Bone panel, increased alkaline phosphatase is

A

Blastic

390
Q

Bone panel, decreased alkaline phosphatase is

A

Lytic

391
Q

Myelopathy: Definition? UMNL or LMNL? Region? Signs/Symptoms? Neurological exam? Ortho exam? Definitive?

A
  • Definition = Spinal cord
  • UMNL or LMNL = UMNL and CNS (only one to cause an UMNL)
  • Region = Upper cervical (ADI, RA), Lower cervical (canal stenosis, OA) lower lordotic curve
  • S/Sx = Cervical flexion
  • Neuro exam = Complete, clonus and pathological reflexes
  • Ortho exam = Lhermitte’s (active test performed by the patient only)
  • Definitive = MRI, EMG, SSEP, Xray (flex/ext views)
392
Q

Radiculopathy: Definition? UMNL or LMNL? Region? Signs/Symptoms? Neurological exam? Ortho exam? Definitive?

A
  • Definition = Root/number. C4, T6, L2.
  • UMNL or LMNL = LMNL and PNS
  • Region = IVF, Lateral recess. C5-T1 lower cervical spine, L4-S1 lower lumbar spine
  • S/Sx = Spinal lateral flexion and extension, rotation towards side of lesion. Radiating pain.
  • Neuro exam = Myotome, dermatome, DTRs
  • Ortho exam = Cervical compression, shoulder depression, Kemps, SLR, WLR
  • Definitive = EMG, Xray (IVF), Disc (MRI)
393
Q

Neuropathy: Definition? UMNL or LMNL? Region? Signs/Symptoms? Neurological exam? Ortho exam? Definitive?

A
  • Definition = Peripheral name (PNE-peripheral nerve entrapment) Sciatic neuropathy
  • UMNL or LMNL = LMNL and PNS
  • Region = Extremities, brachial plexus, sciatica
  • S/Sx = Distal to site of entrapment (adjacent), burning (causalgia)
  • Neuro exam = several muscles in compartment, pure patch
  • Ortho exam = varies
  • Definitive = NCV (nerve conduction velocity), EMG
394
Q

Only one to cause an UMNL. Can be both UMNL and LMNL if really significant diseases. Would have to be CNS involvement, bilateral upper/lower extremities, coordination, increase/decrease in bone density. Mostly systemic problems, might consider co-care

A

myelopathy

395
Q

Always present in an IVF. Always present after the cord ends. Is in the central canal of the lumbar spine but not the cervical or thoracic spine. Always a number. Is a peripheral nervous system lesion, or PNS disorder but not a peripheral nerve entrapment

A

Radiculopathy

396
Q

PNE (peripheral nerve entrapment) is after the IVF when a nerve gets trapped. Gets trapped by spams. Named nerve.

A

Neuropathy

397
Q

What is the traction test for the cervical spine nerve roots?

A

Shoulder depression

398
Q

What is the traction test for the lumbar spine nerve roots?

A

SLR, WLR, Braggard’s, Kemp’s

399
Q

What is the only compression test in the lumbar spine?

A

Kemp’s test. aka Oblique extension test

400
Q

What does NCV test for?

A

PNE (peripheral nerve entrapment), Neuropathy only

401
Q

What does EMG stand for? Test for?

A

Electromyography

PNE, CNS, radiculopathy

402
Q

What does SSEP test for?

A

CNS and PNS

403
Q

What does MRI test for?

A

Disc, Nerve, Brain, Stroke, Joint, Healing

404
Q

What does CT (cat scan, spect) test for?

A

Stenosis, Fracture, Bleeding, Lung

405
Q

What does absorptiometry/DEXA test for?

A

Bone density, osteopenia

406
Q

What does a PET scan test for?

A

Metabolic activity in soft tissue, lymph, breast

407
Q

What does a bone scan (scintigraphy) test for?

A

Lytic and blastic mets

408
Q

Cancer referral

A

Oncologist

409
Q

Arthritide, collagen diseases referral

A

Rheumatologist

410
Q

KUB diseases, infection, stones, prostate referral

A

Urologist

411
Q

Pancreas (DM), thyroid, adrenals, DISH referral

A

Endocrinologist

412
Q

Systemic, alcoholism, DM, inflammatory arthritides, collagen referral

A

Internist

413
Q

MS, ALS, myasthenia gravis, polio referral

A

Neurologist

414
Q

Skin cancer (melanoma) referral

A

Dermatologist then oncologist

415
Q

What type of skin cancer is waxy, indurated or hard and least likely to metastasize?

A

Basal Cell

416
Q

What type of skin cancer is irregular, flaky, bleeding?

A

Squamous cell

417
Q

What type of skin cancer is pigmented, multicolor, invasive skin cancer and the most dangerous?

A

Melanoma

418
Q

What is involved with Psoriasis

A

Silver scales, pitted nails, occurs on extensors, brown patches

419
Q

Associated with purple cancer and AIDS?

A

Kaposi’s sarcoma

420
Q

Associated with butterfly rash, malar rash, sun sensitive?

A

SLE (Lupus)

421
Q

Associated with rash on the eyelids and knuckles, sun sensitive?

A

Dermatomyositis

422
Q

What causes clubbing of the nails?

A

COPD, emphysema, arthritis, cancer, hypertrophic pulmonary osteoarthropathy, CHF, RA
Lack of oxygen (Hypoxia)

423
Q

What causes transverse grooves and lines aka Beau’s lines on the nails?

A

Systemic disease

Must be in all fingers and toes

424
Q

What causes vertical lines on the nails?

A

Valve problems, subacute bacterial endocarditis

aka Splinter hemorrhages

425
Q

What causes pitted nails?

A

Psoriasis

426
Q

What causes spooning aka koilonychia of the nails?

A

Iron deficiency and fungus

427
Q

What is the most common endocrine disease in the geriatric population?

A

Diabetes mellitus

428
Q

What is the most common PNE (peripheral nerve entrapment) disease in the geriatric population?

A

Hypothyroid

429
Q

Most common cause of blindness in the geriatric population?

A

Macular degeneration

430
Q

Most common cause of hearing loss in the geriatric population? Every age group?

A

Cerumen

Cerumen

431
Q

Most common lung disease in the geriatric population?

A

Pneumonia (bacterial)

432
Q

Most common cause of death in the geriatric population?

A

Heart, Cancer, Lung

433
Q

Aka for old eyes?

A

Presbyopia

434
Q

Aka for old ears?

A

Prebycusis (sensorineural deficit)

Otosclerosis (conduction deficit)

435
Q

Most common spontaneous fracture in the geriatric population?

A

Hip

436
Q

Most common traumatic fracture in the geriatric population?

A

Wrist

437
Q

Most common compression fracture in the geriatric population?

A

T4-T8

438
Q

Most common cause of visual loss in the geriatric population?

A

Cataracts

439
Q

Describe temporal arteritis

A
  • Must be in a person 50 years old or older
  • Localized headache (giant cell arteritis) associated with polymyalgia rheumatica (generalized achiness), hypertension, fever, increased ESR
440
Q

How do you confirm temporal arteritis?

A

Aspiration biopsy

441
Q

Most common cancer in the geriatric population both male and female?

A

Lung

442
Q

Second most common cancer in the geriatric population for female? Male?

A 
F = Breast
M = prostate
443
Q

Key words for CHF?

A

Insidious, swollen, fatigue, nocturnal dyspnea

444
Q

Key words for MI?

A

Sudden, painful

445
Q

What is most commonly lost first in neuromuscular issues in the geriatric population?

A

Vibration

446
Q

When evaluating the posterior columns, what test must you always perform?

A

2-point discrimination
Vibration sense
Position sense

447
Q

What will we typically see in the geriatric population with parkinson’s?

A

Shuffling gait, resting tremor, cog wheel rigidity, bradykinesia

448
Q

Symmetrical or Asymmetrical?

OA

A

Asymmetrical

Except in the knee it’s symmetrical

449
Q

Symmetrical or Asymmetrical?

RA

A

Symmetrical

Except in the SI joint in both M/F over 40 years old

450
Q

OA is considered ___ to the joints?

A

Abuse

451
Q

RA is considered ___ to the joints?

A

Patterned

452
Q

Which way does OA do damage?

A

Distal to proximal

453
Q

Which way does RA do damage?

A

Proximal to distal

454
Q

What is the first thing to show up with OA?

A

Geode cyst or small cracks due to trauma

455
Q

What is the second thing to show up with OA?

A

Offset of alignment of the joint

456
Q

What is the end stage of OA?

A

More bone made to help with stability, osteophytes in the spine called spondylophytes
Approximation and widening of the joint surface

457
Q

Instability is associated with OA or RA? What is instability a sign of?

A

OA

Instability is a sign of trauma or abuse

458
Q

OA is a bone ___?

A

Bone maker

459
Q

What is the 1st sign of RA?

A

Soft tissue swelling

460
Q

What is the last sign of RA?

A

Joint fusion, deformity

461
Q

How does RA affect the joints?

A

It goes all the way across the joints, MCPs, PIPs, DIPs, and we see juxta-articular osteoporosis

462
Q

Describe whole process of RA

A

Soft tissue swelling –> Rinsing (hyperemia) loss of bone –>juxta-articular osteoporosis –> bone replaced, subchondral cysts –> Eating/erosion of bare spot (rat bite) –> Joint instability –> Joint migration –> Fusion, deformity

463
Q

Early RA think? Late RA?

A 
Early = Juxta-articular osteoporosis
Late = Instability
464
Q

Does OA or RA fuse?

A

RA will fuse

465
Q

aka spondylosis?

A

DDD (degenerative disc disease)

466
Q

Spondylosis affects which part of the vertebra?

A

Anterior portion

467
Q

Arthosis affects which part of the vertebra?

A

Posterior portion

468
Q

Radiographic features with spondylosis?

A

Eburnation (whitening/thickening of the end plates), decreased disc space, schmorls node, spondylophyte or osteophyte growing from the bone, traction spurs

469
Q

aka arthrosis?

A

DJD (degenerative joint disease)

470
Q

What does AS (ankylosing spondylitis) and DISH preserve?

A

The Disc

471
Q

What is the difference between AS and DISH?

A

AS affect both the anterior and posterior joints

DISH affects anterior only

472
Q

Which ligaments does AS affect?

A

ALL and PLL

473
Q

Complications of AS?

A

Trouble breathing and getting a full breath of air

474
Q

Which ligaments does DISH affect?

A

ALL only

475
Q

DISH is associated with?

A

Diabetes mellitus

476
Q

When will we see facet ankylosis?

A

In patients with AS

477
Q

Describe lytic mets. What labs?

A

Osteoclasts break down bone and send out calcium in the urine. Replace calcium with phosphorus. bone is cheap bone so it gets thicker to help with strength
Hallmark of phosphorus is thickening the cortex and expanding bone
Labs = UA

478
Q

What will Mixed and blastic mets have

A

Increased Alk Phos but normal calcium

479
Q

Radiographic feature called picture frame associated with?

A

Mix of lytic and blastic mets

480
Q

What happens to bone in blastic mets?

A

The body sends in more and more phosphorus, in the spine this is called ivory white vertebra, in the skull it’s cotton wool.

481
Q

What can blastic mets turn into?

A

Osteosarcoma

482
Q

What lab values give away osteosarcoma?

A

Increased alk phos and increased calcium

483
Q

What to think of with hypercalcemia?

A

Bone cancer

484
Q

How do we tell what areas of the body are involved with bone cancer?

A

Order a bone scan

485
Q

Describe Paget’s

A

Cortex thickening, increased spider web trabeculae, brim sign (whitening of the pelvic brim), shepherds crook femur

486
Q

aka for Paget’s

A

Osteitis deformans

487
Q

What happens with osteopetrosis?

A

Can’t absorb cartilage, so it gets left and ossified, bone is not as strong.

488
Q

Radiographic features with osteopetrosis

A

Sandwich vertebra

489
Q

Radiographic features with Secondary Hyperparathyroidism

A

Rugger jersey spine, salt and pepper skill, radial erosions of the fingers, distal tuft resorption, vessel calcification

490
Q

Describe secondary hyperparathyroidism

A

Life threatening. Refer this person out. Hypercalcemia

491
Q

What is secondary hyperparathyroidism really?

A

It is a renal problem causing bone disturbances trying to maintain blood calcium.

492
Q

What is the aka for secondary hyperparathyroidism

A

Renal osteodystrophy

493
Q

Where is the most common place for a congenital block?

A

Cervical spine. Lower cervical spine due to most degeneration

494
Q

What do we call a congenital block on xray

A

wasp waist

495
Q

Radiographic features of congenital block

A

Was waist deformity, hypoplastic or rudimentary disc, posterior joint fusion. Can see IVF on lateral cervical film

496
Q

How do you differnetiate Legg Calve Perthes (LCP) against Slipped Capital Femoral Epiphysis (SCFE)?

A

AGE of the patient!
4-8 year old = LCP
12-16 year old = SCFE

497
Q

What is Legg Clave Perthes?

A

Affects 4-8 year olds, lack of blood supply to the bone. Bone degeneration of one side. If the joint is healthy on the opposite side of the degeneration then there is an asceptic problem.

498
Q

What is an asceptic problem in a joint due to?

A

Lack of blood supply from trauma, idiopathic, growth spurt, anemia, crisis anemias (sickle cell)

499
Q

What does an asceptic proble lead to?

A

Leads to AVN (avascular necrosis)

500
Q

Describe SCFE (slipped capital femoral epiphysis)

A

Bone slips up. Shaft points coxa vara called juvenile coxa vara, is a Salter Harris type/grade 1 fracture

501
Q

What is “SOC HOP”

A

SOC HOP = ways to think of bone problems for age group 12-16 year olds.
4 S’s = Scoliosis (girls), Scheurmannns (boys), SCFE, osgood Schlotter’s (knee)

502
Q

Describe an Aneurysmal bone cyst (ABC).

A

ABC = fluid filled cyst, multiple cysts gathered together, soap bubble appearance, does not have to be symmetrical, causes pain.

503
Q

Describe a Unicameral bone cyst (UBC).

A

aka Simple bone cyst or single bone cyst, symmetrical balloon shaped single cyst

504
Q

How do we find benign bone tumors?

A

Incidentally

505
Q

Which benign bone tumors have pain?

A

ABC (aneurysmal bone cyst) and Osteoid osteoma

506
Q

What has ulnar deviation?

A

SLE (lupus) and RA (rheumatoid arthritis)

507
Q

What has reducible ulnar deviation?

A

SLE, doesn’t usually go into the fingers but can and can be reducible on a table (meaning they can be straightened)

508
Q

Describe RA

A

Permanent joint deformity, causes destruction throughout the hand, affects all of the MCP’s then PIP’s the DIP’s. Moves in unifrom pattern.
If you have it on the right you have it on the left
Destroys proximal to distal

509
Q

Who destroys the distal tufts?

A

Scleroderma, Psoriatic, Secondary Hyperparathyroidism (renal osteodystrophy)

510
Q

OA attacks the joint

A

Distal to proximal and usually only those being abused

511
Q

Associated with sausage digit

A

Psoriatic, which attacks an entire MCP, PIP, DIP at the same time

512
Q

Is psoriatic symmetrical or asymmetrical?

A

Very asymmetrical, can attack whatever it wants

513
Q

Of scleroderma, psoriatic and secondary HPT, which one destroys joint?

A

Psoriatic only

514
Q

What do scleroderma and secondary HPT have in common?

A

Distal tuft erosion, vessel calcification

515
Q

How does scleroderma calcify?

A

Calcifies vessels through smooth muscle

516
Q

How does secondary HPT calcify?

A

Calcifies vessels through the kidneys releasing calcium leading to hypercalcemia in blood products

517
Q

Patient has distal tuft erosion, good looking joints, can’t swallow, Diagnosis?

A

Scleroderma

518
Q

See a hand film, skull film, spine film, diagnosis?

A

Secondary HPT, salt and pepper skull, rugger jersey spine

519
Q

Primary bone cancer

A

Multiple Myeloma, Osteosarcoma, Chondrosarcoma, Ewings sarcoma

520
Q

Secondary bone cancer

A

Lytic and Blastic Mets

521
Q

Periosteal reaction

A

Osteosarcoma, chondrosarcoma, ewings sarcoma

522
Q

No periosteal reaction

A

Multiple myeloma, lytic and blastic mets

523
Q

Holes in the bone

A

Multiple myeloma, lyitc mets

524
Q

Blastic mets radiographic features

A

build up of bone, ivory white vertebra, cotton balls

525
Q

Multiple Myeloma (MM) is

A 
Primary bone cancer
No periosteal reaction
Hole in the bone
Raindrop skull
Blood, bone, protein problem
Bence Jones Proteinuria
Increased ESR, A/G reversal, IgG
Cold Bone Scan
526
Q

Winking pedicle

A

Lytic mets

527
Q

Which primary/secondary bone cancers have +/hot bone scan?

A

Osteosarcoma, chondrosarcoma, ewing’s sarcoma, lytic mets, blastic mets

528
Q

What is the purpose of kVp? Low kVp will have? High kVp will have?

A

Controls contrast
low = High contrast
high = Low contrast

529
Q

If there is more of someone, or something what needs to happen with kVp?

A

More of me = more kVp

530
Q

With OA what will need to happen to kVp?

A

OA is a bone make, there will be more bone, so kVp will need to be increased

531
Q

Developer will reduce?

A

Exposed silver bromide crystals

532
Q

What does the fixer do?

A

Clears/removes unexposed silver bromide crystals

Hardens the film by removing unexposed silver bromide crystals

533
Q

What is normal aortic diameter?

A 
Normal = 3.5 cm
>3.5 = aneurysm
6+ = medical emergency
534
Q

Avulsion fracture aka

A

Clay shoveler’s

535
Q

Tansverse fracture aka

A

Pathological Disease

536
Q

Fatigue fracture aka

A

Repetitive physical stress

537
Q

Comminuted fracture aka

A

more than 2 pieces

538
Q

Impacted fracture aka

A

One part driven into the other

539
Q

Greenstick fracture aka

A

Children

540
Q

Compound fracture aka

A

Protruding through the skin

541
Q

Growth plate fracture aka

A

Salter Harris (children)

542
Q

Silhouette sign aka

A

Bacterial pneumonia

543
Q

Stair step gas aka

A

Paralytic ilii

544
Q

Multiple blocked vertebra in the cervical spine?

A

Klippel Feil

545
Q

Most common congenital anomaly of the spine?

A

Spina Bifida

546
Q

aka for PSS (progressive systemic sclerosis)

A

Scleroderma

547
Q

Where is the most common spondylolisthesis?

A

L5

548
Q

L5 spondylolisthesis found in which types?

A

Type 1 = dysplastic - congenital defect in the pars
Type 2 = Isthmic - broken early in life, broken pars
Type 5 = Pathological - disease causes pars defect

549
Q

Where is degenerative spondylolisthesis found?

A

L4

550
Q

Can you adjust a spondylolisthesis?

A

Yes you can adjust 1-3 but have to rule out instability

551
Q

What are the types of spondylolisthesis’?

A 
1 = Dysplastic
2 = Isthmic
3 = Degenerative
4 = Traumatic
5 = Pathological
6 = Iatrogenic
7 = Pending
552
Q

What is the most common spondylolisthesis?

A

Type 2 - Isthmic

too early of weight bearing

553
Q

Paget’s is what type of disorder?

A

Bone disorder

554
Q

What happens in Paget’s?

A

Thickened cortex, increased trabeculae, increased Alk. Phos, normal calcium, bowing of legs, increased head size (hat doesn’t fit), deafness

555
Q

Is Paget’s benign or malignant?

A

Non-malignant (benign)

556
Q

Progression of Paget’s?

A

Lytic –> Mixed –> Blastic/Sclerotic –> Malignant (Osteosarcoma)

557
Q

aka for Paget’s

A

Osteitis deformans

558
Q

What is the screen for Paget’s?

A

Bone scan

559
Q

Is there going to be a fever with Paget’s?

A

No, but there will be localized warmth over the areas with a lot of metabolic activity

560
Q

What is happening in Paget’s to the bone?

A

Replacing calcium with phosphorus

561
Q

aka for osteochondrosis?

A

Ischemic necrosis, Aseptic necrosis, AVN (avascular necrosis)

562
Q

What is the initial treatment for osteochondrosis?

A

Brace, support, rest and heat

563
Q

Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the vertebral body is?

A

Kummel’s

564
Q

Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the vertebral end plates is?

A

Scheuermann’s aka Juvenile Disc Disease, Juvenile Postural Syndrome
Is a lack of blood to the disc not bone

565
Q

Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the carpal lunate is?

A

Kienbock’s

566
Q

Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the scaphoid is?

A

Prissier’s

567
Q

Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the hip is?

A

Legg Calve Perthes

568
Q

Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the medial femoral condyle is?

A

Osteochondritis dissecans

569
Q

Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the medial tibial condyle is?

A

Blount’s

570
Q

Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the anterior tibial tuberosity is?

A

Osgood Schlatter’s

571
Q

Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the tarsal navicular is?

A

Kohler’s

572
Q

Osteochondrosis (ischemic necrosis, aseptic necrosis, AVN) of the second metatarsal is?

A

Freiberg’s

573
Q

How does infection affect the joint?

A

Affects both sides of the joint

574
Q

What is osteochondritis dissecans? S/Sx?

A

AVN of the medial femoral condyle

S/Sx = pain and swelling, “catches” and “locks” during movement.

575
Q

What happens in septic arthritis?

A

The joint gets widened and then destroyed

576
Q

What is the STAPH story?

A

IV drug user (something that can get through the skin) –> discitis –> carditis (tricuspid valve).
skin -> disc (discitis)-> bone (osteomyelitis) -> heart (carditis) -> tricuspid valve

577
Q

aka for joint infection?

A

septic arthritis

578
Q

Marfan’s affects?

A

Long bones, heart

Ehlers Danlos = hyperflexible joints

579
Q

What is cleidocranial dysplasia?

A

It’s a clavicle/head problem in development.
Father to son problem.
The clavicle usually has 3 parts but these guys only have 2.
Rounded shoulders
Wormian bones in the skull

580
Q

Xray findings of secondary hyperparathyroidism?

A 
Radial finger erosion
Rugger jersey spine
Salt and pepper skull
calcification of vessels
acro-osteolysis in fingertips
581
Q

What is the most aggressive of all primary bone cancers?

A

Osteosarcoma

582
Q

Where will we see osteosarcoma in the young? Old?

A 
Young = knee
Old = Paget's stage IV
583
Q

Most common secondary cancer?

A

Lytic

584
Q

Types of secondary cancers?

A

Lytic or Blastic

585
Q

What is blastic (secondary) cancer?

A

Reproductive cancer

586
Q

aka for secondary bone cancer?

A

metastases

587
Q

How do we differentiate spinal METS?

A 
Lytic = Moth eaten, permeative pattern, winking pedicle, vertebral collapse
Blastic = Ivory white vertebra, cotton balls
588
Q

What are the epiphyseal tumors? aka for epiphyseal?

A

Chondroblastoma (<20 years old), Giant cell aka quasi-malignant (>20 years old)
aka for epiphyseal = subarticular, bone end tumor

589
Q

What is a chondroblastoma?

A

Well encapsulated tumor in the epiphysis of a pre-puberty child (The growth plate will still be visible)

590
Q

What is a giant cell tumor?

A

aka quasi-malignant bone end tumor seen in a person post-puberty (no growth plate visible). Not encapsulated

591
Q

What are the diaphyseal tumors?

A

Ewing’s sarcoma (children) and Multiple Myeloma (MM)(adults)

592
Q

Most common complication of giant cell arteritis?

A

Blindness (temporal arteritis)

593
Q

Most common benign bone tumor of the hand? multiple? Affects soft tissue as well?

A

Enchondroma
Multiple enchondroma’s = Olliers
Soft tissue = Maffucci’s

594
Q

Most common benign bone tumor of the spine?

A

Hemangioma

595
Q

Most common benign bone tumor of the body?

A

Osteochondroma

596
Q

Name for many osteochondromas?

A

Hereditary multiple exostosis (HME) which can lead to chondrosarcoma

597
Q

Most common malignancy of the body?

A

Lytic METS

598
Q

Most common primary malignancy of bone?

A

Multiple Myeloma (MM)

599
Q

Most common fracture?

A

Clavie

600
Q

Most common malignancy of bone?

A

Lytic METS

601
Q

Most common skin cancer?

A

Basal cell

602
Q

Most common complication of giant cell tumor?

A

Cancer (quasi-malignant)

603
Q

What are the non-inflammatory arthritides?

A

OA and DISH

604
Q

Which arthritides make syndesmophytes?

A

AS, Enteropathic arthropaty, Psoriatic, Reiter’s(reactive)

605
Q

Which syndesmophyte maker likes the hands/feet?

A

Psoriatic

606
Q

Which syndesmophyte maker likes the feet but not the joints?

A

Reiter’s (Reactive Arthritis)

607
Q

Which syndesmophyte makers like the spine?

A

AS and Enteropathic

608
Q

Which syndesmophyte maker causes explosive diarrhea?

A

Enteropathic

609
Q

Which syndesmophyte maker has trouble breathing?

A

AS

610
Q

Which arthritides erode the distal tufts?

A

Psoriatic and Scleroderma

611
Q

Which arthritides have trouble swallowing?

A

Scleroderma and DISH

612
Q

Which arthritide has normal labs?

A

OA

613
Q

What does OA attack?

A

weight bearing joints

614
Q

What does RA attack?

A

wrist, symmetrical MCPs, DIPs, PIPs, cervical spine, ADI

615
Q

What does gout attack?

A

big toe (podagra), elbow, hands and feet

616
Q

What does CPPD attack?

A

knee

617
Q

What does AS attack?

A

SI joints, spine, rib joints (costovertebral)

618
Q

What does Enteropathic attack?

A

SI joints, spine

619
Q

Which arthritides attack the SI joint?

A

Enteropathic, AS, Psoriatic, Reiter’s(reactive)

620
Q

What does scleroderma attack?

A

Hands

621
Q

What can scleroderma turn into?

A

PSS (progressive systemic sclerosis)

622
Q

What does psoriatic attack?

A

DIPs, hands, feet, SI, spine

623
Q

What does SLE (lupus) attack?

A

hands and feet

624
Q

What does Reiter’s (reactive) attack?

A

Feet, SI, spine

Heel spur

625
Q

What does DISH attack?

A

Cervical and thoracic spine (works its way down)

626
Q

What is associated with a thick flowing hyperostosis?

A

DISH

627
Q

What is the enemy of scoliosis?

A

Cardio-Pulmonary compromise

628
Q

Best way to measure scoliosis?

A

Cobb’s angle

629
Q

Most common scoliosis?

A

Right convexity

630
Q

How is a scoliosis classified?

A

Lovett’s classification

631
Q

What is a positive Lovett’s scoliosis?

A

Rotatory, is the least symptomatic

632
Q

What is a negative Lovett’s scoliosis?

A

Simple, usually has multifidi spasm, quite symptomatic

633
Q

What is Lovett’s failure?

A

List, very bad/mad disc at the bottom of the list, get a really bad disc lesion

634
Q

How do we determine if a scoliosis is structural or functional?

A

Adam’s test.
Any improvement = functional
No improvement = Structural

635
Q

Protocol for scoliosis?

A

0-20 degrees = adjust
20-40 degrees = brace
> 40 degrees = surgery
> 50 degrees = Cardiopulmonary compromise

636
Q

Which is worst? Left or Right thoraco scoliosis? Why? Who should they be referred to?

A

Left because it impedes on the heart

Referred to cardiologist

637
Q

What can cause a structural scoliosis?

A

Hemivertebrae

638
Q

What causes a kyphoscoliosis? Can you adjust?

A

Neurofribromatosis. No do not adjust this is a very dangerous situation

639
Q

Normal ADI in a child? Adult?

A 
Child = < 5mm
Adult = < 3mm
640
Q

What diseases affect the cerebellum?

A

Alcoholism and MS

641
Q

What is the cerebellar tract in charge of?

A

motor, coordination, speech, gait

642
Q

What is Charcot’s triad?

A

SIN- Speech, Intention tremor, Nystagmus

643
Q

What is the posterior column tract in charge of?

A

Sensory, 2-point discrimination, vibration, position sense

644
Q

What part of the Posterior columns is in charge of the upper extremity? lower?

A

Upper extremity = Cuneatus

Lower extremity = Gracilis

645
Q

What diseases affect the posterior columns?

A

PLS, MS, Syphilis, DM

646
Q

What is the Extra-Pyramidal tract in charge of?

A

Posture, flexor tone

647
Q

What disease affects the Extra-pyramidal tract?

A

Parkinsons

648
Q

What is the lateral-spinal thalamic tract in charge of? A lesion would cause?

A

Sensory, pain and temperature

Lesion = Bilateral loss of pain and temp

649
Q

What disease affects lateral-spinal thalamic tract?

A

Syringomyelia

650
Q

What is the corticospinal tract in charge of?

A

Voluntary motor

651
Q

What affects the corticospinal tract?

A

UMNL and LMNL

652
Q

What is a UMNL?

A 
Brain or cord lesions
Increased Motor responses:
Spastic paralysis
Increased DTR
Present pathological reflex
Clonus present
Hypertrophy
Absent fasciculations
Absent superficial reflex
653
Q

Where do we see UMNL? Treatment?

A

CNS, bilateral

Tx = Co-care

654
Q

When can you test for UMNL?

A

Must have 3 or more features present to test

655
Q

What is a LMNL?

A 
Decreased Motor responses:
Flaccid Paralysis
Decreased DTR
Absent pathological reflex
Absent clonus
Atrophy present
Fasciculations present
Absent superficial reflex
656
Q

Where do we see LMNL? Treatment?

A

PNS, Unilateral

Tx= Primary care provider

657
Q

What kind of gait will we see with posterior columns disturbance?

A

Wide gait base, bilateral foot slappage (CNS issue), have to look down to see where their feet are going

658
Q

An UMNL is associated with?

A

Myelopathy

659
Q

A LMNL is associated with?

A

Radiculopathy and Neuropathy

660
Q

What neurological diseases are motor only?

A

5: Muscular dystrophy, Amyotrophic lateral sclerosis (ALS, Lou Gherig’s Disease), Myasthenia Gravis, Cerebral Palsy, Parkinsonism (aka Paralysis Agitans)

661
Q

What will we see in muscular dystrophy?

A 
Young boys
muscle destruction
pseudohypertrophy of the calves
waddling gait
Gower's sign
albuminuria, creatinuria
662
Q

Where does ALS start?

A

In the intrinsic muscles of the hands

663
Q

When ALS affects the neck what happens?

A

Bulbar palsy, can’t swallow or breathe

664
Q

Symptoms of myasthenia gravis?

A

Diplopia, trouble swallowing, fatigue

665
Q

What helps myasthenia gravis?

A

Naps

666
Q

What does myasthenia mostly affect?

A

The CNs of the face

667
Q

What is cerebral palsy?

A

Stroke at birth. lack of oxygen to the brain at birth. Non progressive (one time thing)

668
Q

aka for parkinsonism?

A

paralysis agitans

669
Q

S/Sx of parkinson’s?

A 
Resting tremor (pill rolling)
blank stare
festinating gait
no arm swing in gait
Hard to initiate movement, also hard to stop once started
670
Q

What is Guillain Barre?

A

Rapidly ascending paralysis (post viral polyneuropathy)

671
Q

Where does Guillain Barre start?

A

Feet

672
Q

What is Brown Sequard’s?

A

Hemisection of the spinal cord with ipsilateral loss of motor and paresthesia and contralateral loss of pain and temp

673
Q

What is Charcot Marie Tooth? aka?

A

aka = Peroneal disease

Calf weakness and sensory loss, steppage gait

674
Q

Cauda equina causes?

A

Radiculopathy (S2-4)

Bowel and bladder control (nerve root compression) LMNL

675
Q

What does stroke spare that Bell’s palsy does not?

A

The forehead

676
Q

What is syringomyelia?

A

Lesion that puts pressure on the lateral spinothalamic tract causing bilateral loss of pain and temp in a shawl or cape like distribution
Will feel burning in hands

677
Q

What is PLS?

A

PLS = posterolateral sclerosis aka combined systems disease
B12 problem
Gastritis leads to anemia (perncious anemia) which then leads to PLS.

678
Q

S/Sx of PLS?

A

Paresthesia, weakness, pain and temperature loss, progressive neurological deficits
Schillings test
Reticulocytosis

679
Q

What is multiple sclerosis?

A

MS = demyelination of the cord

680
Q

S/Sx of MS? Diagnose?

A

diplopia, intention tremors, slurred speech, incontinence, exacerbations and remissions.
+ Lhermitte’s Test
Charcot’s triad
Dx = MRI, CSF eval, eye exam, EMG

681
Q

What is subclavian steal?

A

TIA (transient ischemic attack)
Vertebral artery steals blood from subclavian
Stenosis of the subclavian artery

682
Q

aka for Meniere’s? S/Sx?

A 
aka = endolymphatic hydrops
S/Sx = tinnitus, vertigo, transient deafness
683
Q

What is Horner’s?

A

Interruption of the sympathetics to the face.

Ptosis, Miosis, Anhydrosis and Enophthalmosis

684
Q

What cuases Horner’s?

A

TOS, Pancoast tumor, Whiplash, birth

685
Q

What is a pancoast tumor?

A

Bronchogenic carcinoma (tumor in the apex of the lung)

686
Q

What is Pancoast syndrome?

A

Metastasis, TOS (neuropathy), Horner’s syndrome

687
Q

aka Festinating gait?

A

shuffling, mincing, propulsion

Parkinson’s

688
Q

aka Motor ataxia?

A

staggering

Cerebellum

689
Q

aka Sensory ataxia?

A

slappage

Posterior columns, neurological

690
Q

aka steppage gait?

A

foot drop, toe drag, foot slap
Tibialis anterior
L4 nerve root

691
Q

aka Glut medius lurch?

A

lateral sway over weight bearing leg

L5 nerve root

692
Q

aka Glut maximus lurch?

A

A-P sway (leans back during mid stance)

S1 nerve root

693
Q

aka circumduction?

A

CVA, weak quads (unilateral)

694
Q

aka waddling?

A

muscular dystrophy

clumsy and weak

695
Q

aka scissors?

A

cerebral palsy

adductor spasm

696
Q

What is normal gait?

A

Heel strike, mid-stance, toe-off, accelerate, mid-swing, deaccelerate

697
Q

In normal gait which parts happen at the same time?

A

Toe off and heel strike

698
Q

Where are the most changes in gait seen?

A

Mid-stance, mid-swing

699
Q

What does S1 cover?

A

Plantar foot, little toe, glut max, hip extension

700
Q

C5 nerve root cover?

A

Arm abduction, biceps (myotome)
lateral arm (dermatome)
Biceps DTR

701
Q

L4 nerve root cover?

A

Tibialis anterior (myotome), Heel walk (foot drop)
Medial leg, ankle (dermatome)
Patella DTR

702
Q

L5 nerve root?

A

Glut medius, extensor hallicus longus (heel walk) (myotome)
Lateral leg, dorsum of foot (dermatome)
Posterior tibial, medial hamstring DTR

703
Q

C6 nerve root?

A

Wrist extension (myotome)
Lateral forearm, 1st 2 digits (dermatome)
Brachioradialis DTR

704
Q

What is the DTR scale?

A 
0-5
0 - nothing
1 - hyporeflexia
2- normal
3 - Hyperreflexia
4 - transient clonus
5 - sustained clonus
705
Q

What DTR describes an UMNL? LMNL?

A 
UMNL = 3-5
LMNL = 0-1
706
Q

Which headaches have a fever?

A

Sinusitis, Giant cell Temporal arteritis, meningitis

707
Q

Which headaches occur in the morning?

A

hypertension, metabolic

708
Q

which headache is post-prandial?

A

hypoglycemic (hyperinsulinemia)

709
Q

What is Morton’s neuroma?

A

Burning pain in the 2nd-4th metatarsals.

pain refers to dorsal surface

710
Q

What is the terrible triad?

A

Medial meniscus, ACL, MCL

711
Q

Positive sag sign in the knee?

A

PCL problem

712
Q

What orthos perfomred for S.O.L.?

A

Valsalva, Naffziger’s, Milgram’s
Valsalva- C/S
Milgram’s- L/S
Naffziger’s- occlude jugulars

713
Q

Cervical spine orthos for IVF encroachment? Identify?

A

Compression, Jackson’s, Maximal, Spurling’s

Identify radiculopathy

714
Q

Cervical spine orthos for nerve root?

A

Bakod’ys, choulder depression, distraction

715
Q

What does Lhermitte’s of the cervical spine check for?

A

MS, cord degeneration

716
Q

What is a general cervical spine ortho?

A

Soto Hall

717
Q

What orthos are for TOS?

A

Adson’s, Modified Adson’s, Eden’s, Wright’s, Reverse Bakody’s, Allen’s maneuver, Roo’s

718
Q

Which TOS orthos are general tests?

A

Reverse Bakody’s, Allen’s maneuver, Roo’s

719
Q

What is TOS considered?

A

NVE (neurovascular entrapment)

720
Q

What are the orthos for the shoulder?

A 
CAADDYS
Codmans- rotator cuff
Apley'- ROM
Apprehension- Chronic dislocation
Dugas'- Anterior dislocation (Kocher's, Milch's)
Dawbarns- Bursitis
Yerguson's- bicipital tendon instability (Abbott-Saunders)
Speed's- tendonitis
721
Q

Orthos for the elbow?

A

Lateral epicondylitis = Cozen’s, Mill’s

Medial epicondylitis = Reverse Cozen’s, reverse Mill’s

722
Q

aka lateral epicondylitis?

A

Tennis elbow

723
Q

aka medial epicondylitis?

A

Golfer’s elbow, little leaguers elbow

724
Q

orthos for LBP?

A

SLR, Braggard’s, Sicard’s, Bowstring’s, Kemps, Bonnet’s

SOTO, WLR, Fajersztajn’s, Lindner’s, Bechterew’s

725
Q

which orthos for LBP radiculopathy?

A

SLR, Braggard’s, Sicard’s, Bowstring’s, Kemp’s (only if it radiates below the knee)

726
Q

which orthos for medial disc LBP?

A

WLR, Fajersztajn’s

727
Q

which orhtos for lateral disc LBP?

A

Lindner’s

728
Q

which orthos for piriformis syndrome?

A

Bonnet’s, SOTO

729
Q

Kemps has radiating pain to the knee but not below it what does this mean?

A

Localized, facet, sclerotogenous

730
Q

What does Bechterew’s test for?

A

Sciatica or hamstrings

731
Q

Which tests are for tight hamstrings?

A

Tripod sign, Neri Bowing’s, Beery’s (aka chair test)

732
Q

Which orhtos are for AS?

A

Forestier’s bowstring, Lewin supine, Chest expansion

733
Q

Which orthos are for the SI joint?

A

Belt, Iliac compression, Lewin-Gaenslen’s, Gaenslen’s, Goldthwait’s, Mennell’s, Hibb’s, Yeoman’s

734
Q

In the belt test if SI pain gets better (decreases), then where is the issue?

A

SI joint

735
Q

What is a general test for the lumbosacral region?

A

Ely’s test

736
Q

What are the orthos for the hip?

A

Anvil, FABERE (aka Patrick), Laguerre, Thomas, Hibbs, Ober’s/Nobles, Trendelenburg’s, Ortolani, Barlow

737
Q

Which orthos for the knee?

A

Drawer, rotary instability, Lachman’s, grinding, effusion, McMurray’s, Apley’s, Sag sign

738
Q

Which orthos in the knee have the heel point to pathology?

A

Rotary instability, McMurray’s (external rotation = medial meniscus, internal rotation = lateral meniscus), Apley’s

739
Q

Orthos for meningitis?

A

Brudzinski’s, Kernig’s

740
Q

What are the malingering ortho exams?

A

Hoover’s, Burn’s bench, Magnusson’s, Mannkopf’s

741
Q

What are the vascular orthos?

A

Stress test, MAigne (VBAI)(DeKlyn’s, Hallpike), , Barre-Leiou’s, Allen’s test (upper extremity artery competency), Buerger’s (lower extremity artery compentency), Homan’s (DVT)

742
Q

What is Rust’s sign for?

A

ADI instability

743
Q

What causes rust sign?

A

RA, trauma, Downs syndrome

744
Q

Treatment for rust sign?

A

Hard collar, ER, orthopedist

745
Q

When performing Schepelmann’s and pain is on the same side as lateral flexion? Opposite side?

A

Same side = intercostal neuritis

Opposite side = Pleurisy

746
Q

What does DRCUMA stand for?

A

Drop wrist = Radial nerve
Claw hand = Ulnar nerve
Median nerve = Ape hand

747
Q

aka for wrist drop or radial nerve entrapment?

A

crutch palsy

748
Q

What does common peroneal nerve entrapment lead to?

A

foot drop

749
Q

What is aka for meralgia paresthetica? Located?

A

Lateral femoral cutaneous nerve entrapment

Located L2-L3

750
Q

Long thoracic nerve entrapment? Muscle?

A

Winging of the scapula

Serratus anterior

751
Q

Dorsal scapula nerve entrapment? Muscle?

A

Flaring of the scapula

Rhomboids

752
Q

Is TOS a neuropathy? What structures are involved?

A

Yes TOS = neuropathy aka peripheral nerve entrapment

Structures = Scalenes/Cervical rib, Pec minor, Costoclavicular

753
Q

Disc pressure from least to most?

A

Supine, side posture, standing, sitting, sitting with leaning forward.

754
Q

What are William’s exercises?

A

Flexion exercises

755
Q

What are McKenzie’s exercises?

A

Extension exercises

756
Q

What causes a hyperlordosis or the lumbar spine?

A

Weak abs weak hams, weak glut max

Tight paraspinals, quads, psoas

757
Q

What is the treatment for hyperolordosis?

A

Sole lifts
Strengthen abs, hams, and glut max
Stretch paraspinals, quads, psoas

758
Q

What is Upper Cross syndrome? aka? Weak muscles? Tight muscles?

A

Anterior head carriage.
aka protraction
weak = suprahyoid, deep neck flexors, subscapularis, lower trapezius, serratus anterior, diaphragm
tight = pectorals, SCM, masseters, suboccipital, upper trapezius, levator scapulae

759
Q

T5 is what landmark?

A

Sternal angle, 2nd intercostal space

760
Q

T2 is what landmark?

A

Jugular notch

761
Q

T6 is what landmark?

A

Inferior angle of the scapula while prone

762
Q

T7 is what landmark?

A

Inferior angle of the scapula sitting or standing

763
Q

T10 is what landmark?

A

Xiphoid, 7th rib, 7th dermatome

764
Q

L3 disc is what landmark?

A

Umbilicus

765
Q

L4 is what landmark?

A

Iliac crest

766
Q

S2 is what landmark?

A

PSIS

767
Q

What is the first spinous we feel?

A

C2

768
Q

What does the pelvic listing IN mean?

A

Obturator foramen gets smaller, Ilium shadow gets bigger

External foot flare, gluteal widening, long leg

769
Q

What does PI pelvic listing mean?

A

obturator and ilium get taller

NBCE Part 3 Ty's notes (1 decks)

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