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NPTE > Other Systems 2 > Flashcards

Other Systems 2 Flashcards

1
Q

MSK changes with pregnancy

A

25-35 lb weight gain

Postural changes: forward head, kyphosis, inc lordosis, ant pelvic tilt, COM moves sup/ant, ligament laxity

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2
Q

Cardiovascular changes with pregnancy

A

Low BP 1st/2nd trimester, increases in 3rd trimester

Inc blood volume and CO

RHR inc 10-20 BPM (use RPE)

Supine lying can cause compression of IVC (4 mo in) causing dec CO and supine hypotensive syndrome (no supine after 1st tri)

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3
Q

Benefits of left sidelying during pregnancy

A

dec IVC compression
maximizes CO
dec GERD as internal organs are relaxed
improves maternal/fetal circulation

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4
Q

thermoregulatory changes in pregnancy

A

inc metabolic rate and heat production

lower fasting blood glucose

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5
Q

Preeclampsia

A

pregnancy induced HTN, 20 weeks

sxs:
Inc protein in urine, hyperreflexia, edema, headache, sudden weight gain

BP >140/90. second abnormal BP reading 4 hours after first confirms diagnosis

EMERGENT

Can lead to eclampsia but not always

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6
Q

Eclampsia

A

Occurs post birth
Preeclampsia not a pre-requisite, can occur in isolation

sxs:
seizures, headache, visual disturbances

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7
Q

pregnancy exercise contraindications

A

uncontrolled
- heart disease
- restrictive lung disease
- maternal type 1 DM

incompetent cervix
vaginal bleeding (2nd/3rd tri)
placenta previa after 26 weeks
preclampsia or preg HTN
rupture of membranes
premature labor
severe anemia

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8
Q

Diastasis recti treatment

A

<2 cm - bracing not needed
>2 cm - bracing + head lifts > PPT
>4 cm - bracing + breathing techniques
>6 cm - bracing only

performed in hook lying

all abdominal contractions performed with exhalation to minimize intra-abdominal pressure

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9
Q

LUQ referred pain

A

diaphragm (hiatal hernia), body/tail of pancreas, spleen, kidney (left)

“Don’t Be Stupid Kid”

and esophagus (GERD)

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10
Q

RUQ referred pain

A

gallbladder (cholecystitis), liver, head of pancreas, peptic ulcers

“Good Luck Harry Potter”

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11
Q

RLQ referred pain

A

appendix (appendicitis), crohn’s disease

“AC”

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12
Q

LLQ referred pain

A

diverticulitis, ulcerative colitis, IBS

“DUI”

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13
Q

Pain referral mid-back/scapula

A

esophagus, gallbladder, stomach, pancreas

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14
Q

Pain referral shoulder (left and right)

A

left shoulder: heart, diaphragm, spleen, tail of pancreas

right shoulder: gallbladder, liver, head of pancreas

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15
Q

Pain referral pelvis/low back/sacrum

A

colon, appendix, pelvic viscera

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16
Q

Pancoast tumor pain referral

A

Upper lung tumor

Pain referred in C8-T2 nerve distribution
Mimics TOS
Pain top of ipsilateral shoulder

ddx: SOB, coughing, cancer red flags

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17
Q

GERD main s/s

A

Heartburn: usually occurs 30-60 minutes after eating and at night while lying down supine.

sxs:
dysphagia
sour taste
hoarseness of voice
atypical pain head/neck

complications:
aspiration, pneumonia, asthma
esophagitis

weak or poor closing lower esophageal sphincter

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18
Q

GERD tx

A

maintain upright position
meals 3-4 hours before sleep
sleep on left to prevent nocturnal reflex
exercise 2-3 hours after eating
avoid spicy, chocolate, fatty, peppermint food
drugs
- antacid
- H2 receptor blockers
- proton pump inhibitors

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19
Q

Hiatal hernia

A

Caused by diaphragm weakness
Stomach entrapment
Requires surgical intervention
Post-op: 6-8 weeks no stretching of incision or intense exercise

Pain referred to L shoulder

May present like GERD (ddx)

20
Q

Referral pattern for femoral hernia

A

Lateral pelvic wall pain
Groin pain

21
Q

Referral pattern for inguinal hernia

A

Groin pain

22
Q

Referral pattern for umbilical hernia

A

Pain around umbilical ring in mid to low abdomen

23
Q

Cholecystitis

A

Blockage or impaction of gallstones in the cystic duct resulting in inflammation of the gallbladder

sxs:
Pain referred to R scapula (RUQ)
Nausea, vomiting, fever
Pain increases with FATTY foods

Special test: Murphy’s sign

24
Q

Murphy’s sign

A

Gallbladder inflammation, cholecystitis

Palpate near right subcostal margin as patient takes a deep breath; if pain and tenderness is elicited during inspiration, the test is positive

25
Q

Gastric (stomach) ulcers

A

Caused by chronic NSAIDS, stress, anxiety, H. pylori

Sxs:
Pain inc with food due to acid secretion
Pain after eating
Pain referred to R shoulder (RUQ)
Burning, cramping in epigastric area

Coffee ground emesis
Melena tarry stools

Relieved w/ antacid and medical tx of bacteria

26
Q

Duodenal ulcers

A

In duodenum
Caused mainly by h. pylori

sxs:
Pain inc with absence of food (early mornings, b/t meals)
Burning, cramping in epigastric area
Refers to R shoulder (RUQ)

Coffee ground emesis
Melena (dark) tarry stools**

Relief w/ tx of infection

27
Q

Ulcerative colitis

A

Inflammatory bowel disease (IBD)

Large intestines and rectum

CONTINUOUS lesions

sxs:
rectal pain
bleeding
bloody diarrhea w/ mucus/pus
fecal urgency
weight loss
LBP

LLQ pain

28
Q

Crohn’s disease

A

Inflammatory bowel disease (IBD)

Occurs anywhere in GI tract

SKIP lesions (non-continuous)

sxs:
Relief w/ passing gas
abdominal pain
weight loss
joint arthritis

RLQ pain

29
Q

Irritable bowel syndrome (IBS)

A

Spastic, nervous, irritable colon

Cause: emotional stress, anxiety, high fat, lactose

Sxs:
Relief w/ defecation
Sharp cramps in morning or after eating
n/v, bloating, foul breath, diarrhea
No sxs during sleep
Ribbon like stools

LLQ pain

tx: stress reduction, dietary modification, exercise, dec fat, inc fiber

30
Q

Appendicitis

A

Inflammation of vermiform appendix
Progression can lead to swollen/gangrenous appendix
Perforated can lead to peritonitis

sxs:
Waves of pain progressing to steady
Anorexia, n/v, inc temp, leukocytosis, fever

RLQ pain

Tender at mcburney’s point
Rovsing’s sign for pain migration
Blumberg’s sign for rebound tenderness

EMERGENT - immediate medial attention required

31
Q

McBurney’s point

A

Palpate 1/2 b/t umbilicus and ASIS
Pain suggestive of acute appendicitis

32
Q

Rovsing’s sign

A

Palpation in LLQ elicits pain in RLQ
Suggestive of acute appendicitis

33
Q

Blumberg’s sign

A

Rebound tenderness

Deep palpation of the abdomen over the suspected inflamed appendix, followed by a sudden release of pressure

Pain when pressure is released from the abdomen

Indicates peritoneal inflammation, such as from appendicitis

34
Q

Psoas sign

A

Resisted R hip flexion or R passive hip extension

Pain suggestive of acute appendicitis

35
Q

Obturator sign

A

Resisted R ER or passive R IR

Pain on R suggestive of acute appendicitis

36
Q

Hop sign

A

Individual jumps up/down
If pain or grimace may suggest acute appendicitis

37
Q

Markle’s sign

A

Raise onto toes then drop quickly down to heels
If pain or grimace may suggest acute appendicitis

38
Q

Hiatal hernia main s/s

A

Same as GERD

LUQ

39
Q

Peptic ulcer main s/s

A

Coffee ground emesis
Melena tarry stools

Gastric ulcer - pain inc w/ presence food
duodenal ulcer - pain inc w/o food

RUQ
epigastric pain

40
Q

Cholecystitis main s/s

A

Pain inc after eating fatty foods
Positive murphy’s sign

RUQ (mainly R scapula)

41
Q

Crohn’s disease main s/s

A

Pain decreased by passing gas
Reactive arthritis

RLQ
Umbilicus and lower back

42
Q

Ulcerative colitis main s/s

A

Bloody diarrhea with mucus/pus

LLQ
Lower back and rectal pain

43
Q

Irritable bowel syndrome main s/s

A

Abdominal cramping
Ribbon like stools
Pains decreased by passing stools and at rest

LLQ

44
Q

Appendicitis main s/s

A

Mcburneys point tenderness
Fever
Inc WBC and all test for appendicitis

RLQ

45
Q

Liver disease main s/s

A

Light (clay) colored stools
Dark colored urine
Palmar erythema
Easy bruising
Asterixis (flapping tremor of hand)

RUQ

NPTE (40 decks)

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