Part 5 Flashcards
Cisterna chyli
Dilated lymph vessel usually located on the right of the first or second lumbar vertebra marking the beginning of the thoracic duct
Thoracic duct
Receives overwhelming majority of lymphatic drainage from the entire left side and bottom right side of body, travels up the left side of the abdomen and thorax to empty where the left internal jugular and left subclavian vein meet
Right lymphatic duct
Responsible for minimal lymphatic drainage from the body, just the right upper extremity and right side of the head, travels to empty into the junction where the right internal jugular and right subclavian vein meet
Horizontal inguinal lymph nodes
Travel along th einguinal canal and drain the lower abdomen and buttocks, external genitalia (minus testes or ovaries) scrotum, anal, and lower vagina
Vertical inguinal lymph nodes
Travel along the line of the great saphenous vein and drain portions of the leg corresponding
Infraclavicular nodes
Any palpation is abnormal and can be indicative of breast cancer or malignant lymphoma
Virchow’s node and what does it represent
Left supraclavicular node if palpated indicative of stomach, intestinal, breast, lung, or lymphoma cancers
Milroy’s disease
Lymphatic system congenital defect where valves do not work resulting in lymphedema (hard, non pitting, thickened skin)
Cullen’s sign
Bruising around the umbilicus indicative of acute pancreatitis or intra-abdominal bleeding
Grey turner’s sign
Bruising around the flanks, a sign of retroperitoneal hemorrhage or pancreatic necrosis in severe pancreatitis
Caput medusa
Distension and engorging of periumbilical veins seen with late stage hepatic cirrhosis
Rovsing’s sign
Press deeply in LLQ, pain in RLQ with pressure in LLQ is positive for appendicitis
Psoas sign
Test for appendicitis involving either having pt lay on left side and passively extending the right hip past normal orientation to see if pain is elicited, or by pressing on knee and having pt against resistance flex the right hip
Murphy’s sign
Ask patient to exhale, place hand below costal margin on right side of midclavicular line, have patient inspire, if sharp pain then positive test for acute cholecystitis
Inspeection of the breast
Make sure you check for 4 views (hands at sides, hands on hips, hands overhead and leaning forward)
Cervical motion test/chandellier test
A test for PID during the bimanual exam involving physical manipulation of the cervix, positive if patient experiences acute pain from manipulation
MSE Judgement exam
“What would you do if you saw a fire while in a grocery store”
MSE Insight exam
What brings you here today
MSE abstract thinking exam
What does the proverb Rome wasn’t built in a day mean to you?
MSE orientation exam
Tell me your name, where you are, what is the date
MSE attention exam
Serial 7’s, spell world backward
MSE recent memory and remote memory exam
Recent news, name last 4 presidents
MSE new learning ability exam
Give 3 words and have them repeat after 5 minutes
MSE info and vocab exam
Name an object
MSE constructional ability exam
Draw a clock
Cranial nerves sensory, motor, or both
Some (I) Say (II) Money (III) Matters (IV) Some (V 1) Say (V 2) Brains (V 3) My (VI Brother (VII) Says (VIII) Big (IX) Boobs (X) Matter (XI) Most (XII)
CN I function and test
Olfaction, do sniff test, inspect nasal cavity, test each side with smell test
CN II function and test
Vision, visual fields by confrontuation, manipulate to view conjunctiva, snellen chart and color vision test, fundoscopic exam
CN III, function and test
Motor movement of eye and extraocular muscles except superior oblique and lateral rectus, , pupil size test, accommodation, direct and indirect response to light, nystagmus, lid lag,
CN IV and VI test function and tests
eye’s ability to move down and inward torsionally and eye’s ability to move to the lateral side
Strabismus vs ambylopia
Cross eyed due to paralysis or weakness of EOMs vs lazy eye which is visual acuity of cranial nerve ii that results in failure of acuity and favoring of the other eye that cannot be fixed wit hglasses
Adie’s (tonic) pupil
Absence of light response in dilated pupil (cannot constrict), can be seen in diabetic neuropathy or alcoholism
Argyll Robertson pupil
Absence of pupillary dilation in dark, pathognomonic of neurosyphilis
CN V function and test
Facial sensation and motor function of the jaw, sharp dull test, corneal reflex,
corneal reflex
involuntary blinking of both eyelids (direct and consensual) in responnse to stimulus, begins with CN V for sensory afferent fibers and then hits the pons of the brain before triggering efferent fibers of CN VII to initiate the blink
CN VII function and test
Muscle of facial expression and taste on anterior 2/3 of tongue, facial motion test, taste test
Branches of facial nerve motor function (remember the pneumonic two zebras bit my clavicles)
Temporal Zygomatic Buccal Mandibular Cervial
CN VIII function and test
Hearing and balance, finger rub test, rinne and weber
CN IX function and test
Muscles of the throat, posterior 1/3 of tongue taste sensation
Swallow test, gag reflex, taste sensation test
CN X function and test
Esophagus contraction, ear sensation, pericardium, bronchi, stomach, uvula, say ahhh,
CN XI function and test
Trapezius and SCM function, test with resistance
CN XII function and test
Motor tongue innervation, look for deviation, cheek test
Hyperactive DTR’s and spacticity are a sign of
Upper motor lesion
Hypoactive DTR’s and flaccidity are a sign of
Lower motor lesion
Recall corticospinal, spinothalamic, and posterior column tracts
Corticospinal - voluntary movement and muscle tone
spinothalamic - pain, temp, crude touch
posterior column - position, vibration, refinded touch
Stereognosis test
Hold hands out and close eyes, give object and have them know it
Graphesthesia test
Draw a number on a patient’s hand and have them tell you what it is
Vibratory sensation test
Place tuning fork distally and tell patient when senesation stops
Light touch test
Cotton ball when is touch felt, compare side to side
2 point discrimination test
Have patient determine difference between 1 point or 2 on finger pads
Point localization test
Touch skin with patient’s eyes closed, have them point to where they were touched
Normal strength test would be graded a ___/5
5/5
Babinski sign
A reflex test on infants after the sole of the foot has been firmly stroked causing fanning of the toes and movement upward being positive, normal in infants but a sign of disease in adults
Rapid alterrnating movements test
Cerebellar test where they tap hands alternatively
Romberg test
Have patient close eyes, slight push and watch for maintanance of balance
Pronator drift test (2 parts)
1) Place hands out and supine while eyes are closed, if unable to hold patient will start to slowly pronate hand indicative of contralateral stroke
2) push down on arms and see if they return to normal position, if not or overshoot then positive indactive of contralateral storke
How are DTR’s graded?
0-4 with 2 being normal
Location of the different DTR tests
Ankle Knee Brachioradialis Biceps Triceps Abdominal
Brudzinski’s sign
Flexion of hips and knees in response to passive neck flexion by examiner positive for meningitis
Kernig’s sign
Pain bilaterally behind knee when flexed knee is extended, positive for meningitis
Direct hernia
Above the inguinal ligament, rarely in the scrotum, hernia bulges anteriorally and pushes side of finger forward
Indirect hernia
Above inguinal ligament, often into the scrotum, touches the fingertip
What 2 serotypes of HPV are high risk?
16 and 18
Poorly controlled afib can progress to what?
Afib with RVR that can cause myocardial ischemia >110 bpm
Medial plantar artery is derived from what artery?
Posterior tibial
Lateral plantar artery is derived from what artery?
Posterior tibial
Posterior tibial artery is derived from what artery? What branches from it? What is it’s path?
Popliteal artery, fibular artery, travels deep before wrapping around the medial malleolus and then dividing into medial and lateral plantar arteries
Fibular artery is derived from what, and what does it supply?
Posterior tibial artery, lateral chamber of the leg
Anterior tibial artery derived from what? And what is it’s course?
Popliteal artery, travels anteriorally through hole at top of interosseous membrane and then inferiorally to the anterior chamber of the leg
Dorsal pedal artery derived from?
Anterior tibial artery
Popliteal artery is derived from what? What is it’s course?
Derived from femoral artery, name change at adductor hiatus at the medial posterior thigh just above the knee before entering the popliteal fossa where the genicular arteries branch from
How many genicular arteries are there?
5, superior lateral, superior medial, middle, inferior lateral, inferior medial
Femoral artery is derived from what? What is it’s course?
External iliac artery, travels on the anterior side of the thigh with profunda femoral artery branch going deep from it, continues inferior and medial penetrating adductor hiatus
Profunda femoral artery is derived from what and what is its course?
Femoral artery, travels deep into the thigh and has 2 circumflex branches off of it as well as 3 perforating arteries
Medial circumflex branch of profunda femoral artery path
1st branch off profunda femoris that travels around anatomic neck of the femur
Lateral circumflex branch of profunda femoral artery path
2nd branch of profunda femoris that travels around surgical neck of femrur
Perforating arteries are derived from what and how do they travel?
profunda femoris artery, travel posteriorally on the medial side of the thigh penetrating adductor magnus to supply hamstring muscles posteriorally
Descending limb of lateral circumflex branch of profunda femoris artery
Travels inferiorally to supply vastus lateralis on the lateral side of the thigh and is clinically relevant for administration of injectable medications
Obturator artery is derived from what? and what is it’s course?
Internal iliac artery, travels inferiorally through obturator foramen to supply muscles ther
Sural nerve is derived from what? what is it’s path?
Derived from tibial nerve, travels superficially and provides innervation to posterior calf
medial plantar nerve is derived from what?
(Posterior) tibial nerve
Any reference to tibial nerve below the knee is reference to ____ tibial nerve because ____ tibial nerve is also called ____
posterior, anterior deep fibular
Lateral planter nerve is derived from what?
(posterior) tibial nerve
Tibial division of sciatic nerve derivation and course
Derived from: L4-S3
Travels inferiorally around the pyraformis in close tandem with the common fibular division of sciatic nerve until splitting above the popliteal fossa, in which the tibial division enters the deep posterior chamber of the leg
Musculocutaneous/superficial fibular nerve derivation and course
Common fibular nerve, Travels inferior lateral into the lateral chamber of the leg where it innervates both muscles and cutaneous area
Anterior tibial/deep fibular nerve derivation and course
Derived from common fibular nerve, travels inferior and enters the anterior chamber of the leg
Common fibular division of sciatic nerve derivation and course
Derived from: L4-S3
Travels inferiorally around the pyraformis in close tandem with the tibial division of sciatic nerve until splitting above the popliteal fossa, in which the common fibular division wraps laterally around the knee to the anterior side before dividing into the superficial and deep fibular nerves
Great saphenous vein course
Travels superiorally from the medial malleolus up the medial part of the knee, then the medial thigh before draining into the femoral vein in the femoral triangle
Small saphenous vein course
Travels from lateral maleolus posteriorally upward the posterior side of the leg before draining into the popliteal vein at the level of the popliteal fossa
How is sickle cell evolutionarily advantageous?
Protection against malaria (plasmodium falciparum) the altered shape of the cells gives natural resistance to malaria’s reshaping of protein on the surface of RBCs to adhere to capillaries and organs
Pathogen definition
Any microorganism capable of causing disease
Opportunistic infections definition
Microorganisms that may or may not cause disease generally colonize but do not infect a host unless introduced to an area not normally found or immunosuppression
Normal human flora 3 major functions
- Prevent colonization by pathogens for competing for attachment
- Excrete vitamins in excess of their own needs for absorption by the host
- kill pathogen pathogens through released factors
Community acquired vs hospital acquired criteria
Hospital acquired must be 48 hours after hospitalization OR within 30 days after discharge
Virulence definition
Capacity to cause disease
Vector definition
Agent that carries pathogen from one organism to another
TORCHS Test components
Test to check for different diseases of the newborn in cases of failure to thrive,
Toxoplasmosis
Other (varicella or zika)
Rubella
Cytomegalovirus
HIV
Syphilsi
Most common trace element deficiency in the world
Iron
Community onset healthcare associated MRSA definition
MRSA that occurs outside the hospital within 12 months of exposrure to healthcare
Obligate anaerobe definition
Requires anaerobic environment to thrive, die in o2 rich environments
Facultative anaerobe definition
Capable of making ATP by aerobic respiration if O2 is available, but also capable of making ATP via fermentation if O2 is not present
a hemolysis
Incomplete destruction of erythrocytes, resulting in green coloration
B hemolysis
Complete destruction of erythrocytes results in clear distinct zone around colonies
gamma hemolysis
no hemolysis on blood agar, no visible effect on agar
Viridan’s streptococci causes these 2 things
…-dental caries, bacterial endocarditis
Enterococci
Formerly known as group D streptococci, are part of normal fecal flora, but can colonize oral mucosa membranes and skin, particularly in a hospital setting. Very resistant to environment, fairly common cause of nosocomial infections
VRE
Vancomycin resistant enterococci
Complications of untreated gonorrhea in females
PID or sterility
Most common bacterial agent cause of UTI
E. coli
Bacteroides genus definition
Genus composed of obligate anaerobic gram neg rods that do not form spores, primarily inhabit the GI tract, may account for 99% of fecal flora, often seen in a mixed flora infection with other bacteria
Chlamydia is uniquely a ____
obligate intracellular bacteria
Universal/Standard precautions definition
Infection control practices used to prevent transmission of infectious agents transmitted via blood, body secretions, non-intact skin, or mucus membranes not only to healthcare providers but also patients and hospital/clinic guests through assumption that all fluids listed are infectious with all blood borne pathogens, implemented standard in all patient care interactions
What bodily fluids do standard precautions ignore?
-Feces, nasal secretions, vomit, saliva, sweat, tears, and urine (unless containing frank blood)
3 types of standard precautions
Primary - Immunizations, PPE, work practices
Secondary - Post exposure prophylaxis (PEP)
Expanded - Techniques specific to highly contagious diseases to limit exposure such as negative pressure rooms or isolation
3 Common modes of exposure
1) Percutaneous injury - penetration of skin by needle or other sharp object formerly in contact with blood/body fluid/etc
2) Mucus membrane exposure - Contact of mucus membrane (eyes, nose, mouth) with fluid, tissues, or specimen
3) Non-intact skin exposure - Contact with fluid, tissues, or specimen
What bodily fluids to standard precautions typically include?
-Semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and amniotic fluid, blood
Most common healthcare worker exposure type
percutaneous injury
Transmission based precautions
Secondary tier of techniques to be used in conjunction with standard precautions in regards to patients with specific infectious agents such as airborne, droplet, or contact
N-95 respirator
Very efficient respiratory protective devices that block 95% of .3 micron or greater particles
Seroconversion
Time period in which a specific antibody develops and becomes detectable in blood, transition from seronegative to seropositive, indicative of exposure
Disease with highest seroconversion rate post needle stick injury (NSI)
Hepatitis B (up to 30%)
3 Steps to handle blood spill
1) Clean area with absorptive towels
2) clean area with soap and water
3) Disinfect area with 1:10 solution of bleach
