PCM 1 - Final Exam Flashcards
1
Q
Is the diaphragm of the stethoscope best for high- or low-pitched sounds?
A
High Pitched
e.g.,: S1, S2, AR, MR, Friction Rubs
2
Q
The diaphragm of the stethoscope is best for high pitched sounds, give some examples.
A
- S1
- S2
- AR (aortic valve regurgitation)
- MR (mitral valve regurgitation)
- Friction Rubs
3
Q
Is the bell of the stethoscope best for high- or low-pitched sounds?
A
Low Pitched
e.g., S3, S4, MS, Carotid Bruit
4
Q
The bell of the stethoscope is best for low pitched sounds, give some examples.
A
- S3
- S4
- Carotid Bruit
- MS (mitral valve stenosis)
5
Q
What are the 4 major steps, in order, to the cardiovascular exam?
A
- Inspection
- Palpation
- Percussion
- Auscultation
6
Q
List general appearance items to Inspect for during Step 1 of the cardiovascular exam?
A
- consciousness
- cyanosis
- flushing
- respiratory patterns
- anxiety/distress
- body habitus
- diaphoresis (sweating)
- neck veins (JVD)
7
Q
What is the common shape upon inspection of a pt with COPD?
A
Barrel Chested
8
Q
What is the shape of a pt’s chest with Pectus Carinatum upon inspection?
A
Pigeon Chest
9
Q
What is the shape of a pt’s chest with Pectus Excavatum upon inspection?
A
Funnel Chest
10
Q
What are the common landmarks used during Inspection (Step 1) of the cardiovascular exam?
A
- sternal notch
- sternal angle
- sternal border
- mid-clavicular line
- anterior axillary line
- xiphoid process
- nipples
11
Q
During Palpation (step 2) of the cardiovascular exam what is the Point of Maximal Impulse (PMI)?
A
PMI –> used to estimate location of apex/left border of the heart.
> can assess supine or left lateral decubitus position
usually palpated near the 4th-5th intercostal space in the mid-clavicular line
may need to have patient lift her breast
PMI may not e readily felt in healthy heart/patient
12
Q
What does the Point of Maximal Impulse (PMI) estimate?
A
Location of Apex/Left Border of the Heart
13
Q
In what position should the pt be in to determine the Point of Maximal Impulse (PMI) during Step 2 (palpation) of the cardiovascular exam?
A
Supine or Left Lateral Decubitus
14
Q
In what location is the Point of Maximal Impulse (PMI) typically palpated?
A
Normally - near the 4th-5th Intercostal Space in the Midclavicular Line
15
Q
What is typically palpated near the 4th-5th Intercostal Space in the Mid-clavicular Line?
A
Point of Maximal Impulse (PMI)
16
Q
True or False:
The PMI (point of maximal impulse) may not be readily felt in healthy heart/patient.
A
True
17
Q
True or False:
Palpation of an impulse should be felt through the second heart sound (S2).
A
False - should NOT be felt through S2
**Impulse should be a small, brisk beat and measure less than 2.5cm. The impulse should last through the first 2/3 of the systolic period (or less).
18
Q
What location do you auscultate the Aortic Valve?
A
Right 2nd Intercostal Space @ Sternal Border
19
Q
What location do you auscultate the Pulmonic Valve?
A
Left 2nd Intercostal Space @ Sternal Border
20
Q
What location do you auscultate the Tricuspid Valve?
A
Left 4th Intercostal Space @ Sternal Border
21
Q
What location do you auscultate the Mitral Valve?
A
Left 5th Intercostal Space @ Mid-Clavicular Line
22
Q
What location do you auscultate Erb’s Point?
A
Left 3rd Intercostal Space @ Sternal Border
**Erb’s Point –> point at which S1 and S2 is heard equally.
23
Q
What is Erb’s Point?
A
The point at which S1 and S2 are heard equally.
24
Q
Which sound is heard at the Right 2nd ICS @ the SB?
A
Aortic Valve
25
Which sound is heard at the Left 2nd ICS @ the SB?
Pulmonic Valve
26
Which sound is heard at the Left 4th ICS @ the SB
Tricuspid Valve
27
Which sound is heard at the Left 5th ICS @ the Mid-Clavicular Line?
Mitral Valve
28
What causes S1?
Closure of the Tricuspid and Mitral Valves
29
What causes S2?
Closure of the Aortic and Pulmonic Valves
* may split with inspiration (normal)
30
What is the S3 sound?
Dull, Low Pitch, Best Heard with Bell
Due to high pressure and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase of the cardiac cycle.
Physiologic in children/young adults.
Pathologic > 40 y/o ("Ken-Tuck-Y")
31
What is the S4 sound?
Dull, Low Pitch, Best Heard with Bell.
Atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle.
Can be normal in trained athletes.
"Ten-Nes-See"
32
What is systole?
Ventricular Contraction and Ejection
S1 --> S2
33
What is diastole?
Ventricular Relaxation and Filling
S2 --> S1
34
Between which two heart sounds is a systolic murmur heard?
S1 and S2
35
Give 4 examples of pathologies that cause systolic murmurs.
- aortic stenosis
- pulmonic stenosis
- mitral regurgitation
- tricuspid regurgitation
36
Diastolic murmurs are heard between which two heart sounds?
S2 and S1
37
Give 4 examples of pathologies that cause diastolic murmurs.
- aortic regurgitation
- pulmonic regurgitation
- mitral stenosis
- tricuspid stenosis
38
What are the characteristics of a Grade 1 murmur?
very faint
39
What are the characteristics of a Grade 2 murmur?
quiet, but heard easily with stethoscope
40
What are the characteristics of a Grade 3 murmur?
moderately loud, NO THRILL
41
What are the characteristics of a Grade 4 murmur?
loud, with palpable thrill
42
What are the characteristics of a Grade 5 murmur?
very loud w/thrill - may be heard with stethoscope partly off chest
43
What are the characteristics of a Grade 6 murmur?
heard with stethoscope entirely off the chest
44
Rate the grade of murmur:
Murmur heard with stethoscope entirely off the chest.
Grade 6
45
Rate the grade of murmur:
Murmur is very loud w/thrill, and can be heard with stethoscope partly off the chest.
Grade 5
46
Rate the grade of murmur:
Murmur is loud with palpable thrill.
Grade 4
47
Rate the grade of murmur:
Murmur is moderately loud, with no thrill.
Grade 3
48
Rate the grade of murmur:
Murmur is quiet, but heard easily with stethoscope.
Grade 2
49
Rate the grade of murmur:
Murmur is very faint.
Grade 1
50
Is the carotid pulse palpated medial or lateral to the SCM?
Medial
51
What is the carotid pulse palpated for?
Assess for thrills and bruits
** pressure on the carotid baroreceptors may cause a hypotensive reflex and possible fainting
52
What are the 4 grades of the peripheral pulse scale?
```
0: absent, pulse not palpable
1+: pulse diminished, barely palpable
2+: Normal, average intensity, expected
3+ pulse is strong, full, increased
4+: pulse is bounding
```
53
Which grade on the peripheral pulse scale of 4 is considered normal?
2+: normal, average intensity, expected
54
What is the capillary refill test testing?
Test of Digital Perfusion (e.g., arterial occlusion, hypovolemic shock, hypothermia)
**Normal capillary refill time is 2 seconds or less **
55
When performing an examination for pitting edema, how long is pressure firmly applied with your finger tip?
Examined by pressing firmly for 5 seconds over the:
- dorsum of the foot
- anterior tibia
- behind medial malleolus
56
Where are the 3 locations in which you exam for pitting edema?
1) dorsum of the foot
2) anterior tibia
3) behind medial malleolus
57
What are the grades used in the four point scale for the examination for pitting edema?
Absent
1+: barely detectable, slight pitting (2mm); disappears rapidly
2+: slight indentation (4mm); remains for 10-15 seconds
3+: deeper indentation (6mm); may be >1 minute
4+: very marked indentation (8mm); 2-5 minutes
58
From where do the anterior and posterior axillary lines drop vertically from?
Anterior and Posterior Axillary Folds
59
From where does the Mid-Axillary line drop from?
Apex of the Axilla
60
From where does the mid-sternal line drop from?
suprasternal notch
61
From where does the mid-clavicular line drop from?
Vertically from the midpoint of the clavicle.
62
What is the landmark in which the 2nd rib meets with the manubrium and the body of the sternum?
Sternal Angle
63
At which landmark is a needle decompression performed for an emergent decompression tension pneumothorax?
2nd ICS just superior to the 3rd rib margin at the mid-clavicular line for emergent decompression tension pneumothorax, followed by chest tube placement.
**recall: neurovascular bundle runs inferior to each rib, so needles and tubes should be placed superior to the rib margins
64
At what ICS (intercostal space) doe you insert a chest tube?
4th ICS at mid or anterior axillary line in the 4th ICS just superior to the margin of the 5th rib
65
At which vertebral level would the lower margin of an endotracheal tube appear on a chest x-ray?
T4
66
Which intercostal space is a landmark for thoracentesis?
7th Intercostal Space
67
List the 4 major things to evaluate during respiration of the patient.
- rate (normal: 14-20x/minute)
- rhythm
- depth
- effort
68
In what respiratory problems does intercostal retractions occur?
- severe asthma
- COPD
- upper airway obstruction
69
What are pursed lips during breathing characteristic of?
Obstructive Lung Disease (COPD)
70
What is a characteristic posture/position of a pt with obstructive lung disorders?
Tend to sit leaning forward with shoulders elevated.
71
Contraction of which accessory muscles can occur in pts with difficult breathing?
- sternomastoid
- scalenes
- supraclavicular retraction
72
Which pathology can cause lateral displacement of the trachea?
Tension Pneumothorax (causes deviation of trahea towards countrlateral side)
73
What is "clubbing" of the fingernails?
- Bulbous swelling of soft tissue at nail base.
- Loss of normal angel between nail and proximal nail fold (>180 degrees) leading to a spongy or floating feeling.
- Involves vasodilation with increased blood flow to the distal potion of the digits, and changes in connective tissue possible due to hypoxia, changes in innervation, or a platelet derived groth factor from fragments of platelet clumps.
74
In which pathologies is fingernail clubbing seen in?
- congenital heart disease
- interstitial lung disease
- bronchiectasis
- pulmonary fibrosis
- lung abscess
- inflammatory bowel disease
- malignancies (lung cancer)
- cystic fibrosis
75
What is Tactile fremitus?
Palpable vibrations transmitted through the bronchopulmonary tree to the chest wall as the patient speaks.
- perform on anterior and posterior chest
- pt says "ninety-nine" or "one-one-one"
- often more prominent in the interscapular area than in the lower lung fields, and is more prominent on the right than the left.
- disappears below the diaphragm
76
What is indicitive of decreased/absent fremitus?
- COPD
- pleural effusions
- fibrosis
- pneumothorax
- thick chest wall
- an infiltrating tumor
77
What is indicitve of increased fremitus?
- pneumonia
| increased transmission through consolidated tissue
78
What is the purpose of percussion of the chest?
To establish whether underlying tissues are:
- air-filled
- fluid-filled
- solid
79
Which finger is used during percussion of the chest?
Hyperextended Middle Finger
- have only hyperextended middle finger firmly contact skin
- strike extended middle finger aiming for the DIP with a quick, sharp, but erlaxed wrist motion
- start superiorly percussing obht sides of the chest working toward the base procedding in a "ladder-like" pattern
- also perform on the anterior chest
- percussion penetrates only 5cm to 7cm into chest, so it can miss deep seated lesions
80
What is the depth that can be accessed by percussion of the chest?
penetrates only 5cm - to - 7cm
** Thus, percussion can miss deep seated lesions. **
81
In what position should the pt be in while performing percussion on the posterior side?
- Seated, with both arms crossed in front of chest.
82
During percussion, what are the 5 percussion notes that you should identify?
- Flat (soft intensity; high pitch)
- Dull (medium intensity; medium pitch)
- Resonant (loud intensity; low pitch)
- Hyperresonant (very loud; lower pitch)
- Tympanitic (loud intensity; high pitch - distinguished mainly by its musical timbre
83
Of the 5 percussion notes, which is expected to be heard in a healthy lung?
Resonant:
- loud intensity
- low pitch
- long duration
84
True or False:
Dullness replaces resonance when fluid or solid tissue replaces air-containing lung or occupies space beneath percussing fingers.
True
85
True or False:
Generalized resonance may be heard over hyperinflated lungs.
False - HYPERRESONANCE may be heard over hyperinflated lungs.
86
Give 2 examples of obstructive disorders that can cause generalized hyperresonance heard over hyperinflated lungs during percussion of the chest.
- COPD/Emphysema
| - Asthma
87
During percussion of the chest you hear unilateral hyperresonance. Name 2 pathologies that this finding could suggest.
- large pneumothorax
| - large air-filled bulla in lung
88
Dullness replaces resonance when fluid or solid tissue replaces air-containing lung or occupies space beneath percussing fingers. Name two pathologies that would be suggestive of this.
- lobar pneumonia (alveoli filled with fluid and blood cells)
- pleural accumulations
> effusion (serous fluid)
> hemothorax (blood)
> emphyema
> fibrous tissue or tumor
89
Pleural accumulation of what substance causes an Effusion?
Serous Fluid
90
Pleural accumulation of what substance causes a Hemothorax?
Blood - treated with chest tube placement.
91
Pleural accumulation of what substance causes a Empyema?
Pus
92
What is Diaphragmatic Excursion?
Used to determine the distance between inhale and exhale of the diaphragm.
1) patient exhale completely and hold it
2) percuss level of diaphragm
3) mark with pen
4) patient breathes normally for a few breaths
5) patient inhales completely and holds it
6. percuss for level of diaphragm
7) mark level with pen
8) distance between the two is diaphragmatic excursion
93
What can cause asymmetry with one side of the diaphragm than another, noticed during diaphragmatic excursion assessment?
- pleural effusion (will have dullness to percussion)
- high diaphragm secondary to:
> atelectasis
> phrenic nerve paralysis
94
What is the range of normal diaphragmatic excursion?
Normal Excursion = 3-5.5 cm
95
What would dullness at a level higher than expected during diaphragmatic excursion suggest?
- pleural effusion
| - high diaphragm (as in atelectasis, or phrenic nerve paralysis)
96
Which side of the stethoscope do you use during auscultation of the lungs?
- Diaphragm of the Stethoscope
97
While listening to auscultations with the diaphragm of your stethoscope, should the patient breath through an open or closed mouth?
Open Mouth
98
True or False:
Compare auscultation side to side at each level before going to the next level ("ladder-like pattern").
True
99
At minimum, how many spots should auscultation be assessed during a lower respiratory exam?
- Listen at Minimum to each lobe of the lungs:
> upper and lower lobe (left lung)
> upper, middle, and lower lobe (right lung)
100
What are the 4 normal breath sounds?
- vesicular (sound heard over most of lungs (parenchyma))
- bronchovesicular
- bronchial
- tracheal
101
What is the intensity and pitch of Vesicular Breath Sounds?
Soft and Low Pitched
102
During which potions of the respiratory cycle are vesicular breath sounds heard?
Heard through inspiration and about 1/3 of expiration.
103
What is the intensity and pitch of Bronchovesicular breath sounds?
Intermediate Intensity and Pitch
104
During which portions of the respiratory cycle are bronchovesicular breaths sounds heard?
Heard equally in Inspiration and Expiration
105
In which location are bronchovesicular breath sounds best heard?
1st and 2nd Interspaces Aneriorly and Between the Scapulae
106
What is the intensity and pitch of Bronchial Breath Sounds?
Loud Intensity and High Pitched
107
During which portion of the respiratory cycle are bronchial breath sounds heard?
Expiratory sounds heard longer than inspiratory.
108
In which location are bronchial breath sounds best heard?
Over Manubrium (larger proximal airways)
109
What is the intensity and pitch of Tracheal Breath Sounds?
Very Loud Intensity and High Pitched
110
During which portion of the respiratory cycle are Tracheal Breath Sounds heard?
Equally in Inspiration and Expiration
111
In which location are tracheal breath sounds best heard?
over trachea in neck
112
What is suggestive if bronchovesicular or bronchial breath sounds are heard more distal to expected locations?
- air-filled lung has been replaced by fluid-filled or solid lung tissue
113
Decreased breath sounds may be due to?
- decreased air flow (COPD, muscular weakness)
| - poor transmission of sound (COPD, pleural effusion, pneumothorax)
114
What are adventitious breath sounds?
Added Breath Sounds that are Superimposed on the Usual Breath Sounds
e.g., crackles (rales), wheezes, rhonchi, stridor, pleural friction rub)
115
Define Crackles (rales)
- fine crackles: soft, high-pitched, very brief (5-10 msec)
(sometimes likened to sounding like "velcro")
- coarse crackles: louder, lower in pitch, brief (20-30 msec)
Timing in Respiratory Cycle --> Inspiratory, Expiratory, or Mid-Inspiratory/Expiratory
116
Crackles (rales)
discontinuous; intermittent, nonmusical, and brief adventitious (added) breath sounds
117
Wheezes
continuous; musical quality and prolonged (not necessarily the entire respiratory cycle)
relatively high pitched, musical, hissing, or shirll quality:
> suggest narrowed airways (asthma, COPD, bronchitis
118
Rhonchi
relatively low-pitched, snoring quality
suggests secretions in large airways
119
What is rhonchi suggestive of?
secretions in large airways
120
What is a stridor?
Wheeze that is entirely or predominantly inspiratory in nature.
Often louder in neck vs. chest wall.
Indicates partial obstruction of larynx or trachea (medical emerency: immediate attention needed)
121
In which location is a stridor often heard the loudest?
Louder in Neck vs. Chest Wall
122
What does a stridor indicate?
partial obstruction of larynx or trachea (medical emergency)
123
What is a Pleural Friction Rub?
inflamed and roughened pleural surfaces grate against each other as they are momentarily and repeatedly delayed by increased friction
usually confined to a relatively small area of the chest wall
sounds like creaking, usually during expiration but can occur in both phases of respiration
124
When should transmitted voice sounds be assessed?
If abnormally located bronchovesicular or bronchial breath sounds are heard (pneumonia, consolidations, effusions)
125
List 3 pathologies that can cause abnormally located bronchovesicular or bronchial breath sounds.
- pneumonia
- consolidations
- effusions
126
Bronchophony
Spoken words become louder and clearer (indicates consolidation) when while listening to lungs while patient says "ninety-nine" (99).
Normal Lungs --> sounds transmitted through healthy lungs are muffled and indistinct.
127
Egophony
The "ee" sounds like "A". The "A: has a nasal bleating quality and should be localized.
Normally --> will hear a muffled long E sound "ee"
** in pts with fever and cough, the presence of bronchial breath sounds and egophony more than triples the likelihood of pneumonia! **
128
Whispered Pectoriloquy
Patient Whispers ("ninety-nine" or "one-two-three") are heard louder and clearer during auscultation.
Normally --> whispered voice is faint and indistinct or not heard at all.
129
medical term for canker sores
Aphthous Ulcers
130
what is indicated by Cheilitis?
B12 or Iron Deficiency, red cracks at corners of mouth.
131
What is gingivitis?
swelling or ulcerations of gums
132
What is Torus palatinus?
benign lump on hard palate
133
Which cranial nerves control the soft palate?
CN IX and X
**paralysis -> uvula deviates to opposite side and soft palate does not rise with saying "ah". **
134
Which sinus does not open until after 7 years of age?
A) frontal
B) maxillary
C) ethmoid
D) sphenoid
frontal sinus
135
Where is the best location to palpate the frontal sinuses?
press up under bony brows
136
Where is the best location to palpate the maxillary sinuses?
press up on location of maxillary sinuses
137
What is the function of Turbinates?
Cleansing, Humidification, and Temperature control of Inspired Air
** turbinates are covered by highly vascular mucous membrane and protrude into the nasal cavity
138
What is indicated by a redness and edema of nasal mucosa?
viral rhinitis
139
Describe the appearance of nasal mucosa in a patient with viral rhinitis?
Red with Edema
140
Describe the appearance of nasal mucosa in a patient with allergies.
Can be pale, bluish, or red in color.
141
What is indicated by a pale, bluish, or red nasal mucosa in a patient upon inspection?
Allergic reaction (allergies)
142
What can cause a septal perforation of the nasal mucosa?
- cocaine
- meth
- trauma
- surgery
143
what is the medical name for acne rosacea?
rhinophyma
144
What does the Weber Test assess?
Test for Lateralization
* * vibrating tuning fork placed on top of patient's head or on middle of forehead:
- normal: sound lateralizes to both ears equally
- if sound lateralizes to one ear, it is iether conduction loss in that ear or sensorineural lossin the opposite ear
145
What are the normal results of the Weber Test?
Sound lateralizes to both ears equally.
** vibrating turing fork placed on top of patient's head or on middle of forehead.
146
What does it mean if sound lateralizes to one ear, instead of both, while performing the Weber Test?
It is either:
- conduction loss in that ear, or
- sensorineural loss in the opposite ear
147
What does the Rinne Test compare?
Compares Air and Bone Conduction of Sound
148
What is the Rinne Test?
Vibrating tuning fork placed on mastoid bone behind ear and level with the canal.
When patient no longer hears sound, quickly place fork close to ear canal and inquire if can hear the sound and for how long they hear it.
Normal: AC>BC
If AC=BC or BC>AC: there is conductive loss to that ear.
If Weber test was abnormal and Rinne was normal, suspect sensorineural loss in the opposite ear.
149
What is the whisper test?
Doctor stands behind the patient.
Have patient occlude one ear.
The doctor exhales fully and then whispers a combination of numbers and letters (ex: 2-K-4).
The patient repeats the sequence.
Repeat with a different sequence if responds incorrectly.
150
What is a normal result for the Whisper Test?
Patient correctly repeats the sequence or after 2 sequences, can identify 3 of the 6.
Abnormal: patient incorrectly identifies 4 of the 6.
151
What is an abnormal result for the Whisper Test?
pt incorrectly identifies 4 of the 6 after 2 sequences (3 items per sequence [ex: 2-K-4]) that the doctor whispered when fully exhaled
152
What causes conductive hearing loss?
external or middle ear problem (conductive phase)
153
What causes sensorineural loss?
inner ear, cochlear nerve or central brain connections problem (sensorineural phase)
154
Describe the normal appearance of the Tympanic Membrane upon inspection?
Translucent and Pearly
155
In what direction do you pull to straighten the ear canal for inspection in adults?
pull up, out, and away
156
In what direction do you pull to straighten the ear canal for inspection in children?
pull down, out, and away
157
What is presbycusis?
Loss of higher frequency hearing; common in older adults.
Determined by Whisper Test.
Whisper Test --> 90% - 100% sensitive and 70-87% specific to detect hearing loss of > 30 decibels
Note: Consonants use higher frequencies than vowels!
158
What is the normal range of the Carrying Angle?
5-15 degrees
159
What Carrying Angle is required for cubitus varus?
< 5 degrees
160
What Carrying Angle is required for cubitus valgus?
> 15 degrees
161
What nerve root is tested during the biceps reflex?
C5
162
What nerve root is tested during the brachioradialis reflex?
C6
163
What nerve root is tested during the triceps reflex?
C7
164
What is a positive valgus stress test?
Pain/Tenderness with palpation and valgus stress; increased laxity (degree of laxity correlates to degree of injury to UCL)
165
What does a positive valgus stress test indicate?
- sprained medial (ulnar) collateral ligament
166
What does a positive varus stress test indicate?
sprained lateral (radial) collateral ligament
167
What is a positive varus stress test?
Pain or Increased Laxity in LCL (lateral collateral ligament)
168
What is indicated by a positive Tinel Test of the Elbow?
Ulnar Nerve Entrapment/Cubital Tunnel Syndrome
+ Test = eliciting tingling sensation down forearm within ulnar nerve distribution
169
What is indicated by a positive Golfer's Elbow Test?
Medial Epicondylitis
- pain/tenderness around the medial epicondyle
170
What pathology typically causes Little League Elbow in children?
medial apophysitis
171
What pathology typically causes Little League Elbow in adolescence?
medial epicondyle avulsion fracture
172
What pathology typically causes Little League Elbow in adults?
Medial Collateral Ligament Tear
173
What is Nursemaid's Elbow (radial head instability) caused by?
annular ligament tear and/or radial head subluxation from annular ligament
pain with palpation of radial head with anterior displacement of radial head and restriction to posterior glide
174
What are the coupled motions at the elbow joint?
- ulnar adduction with supination
- ulnar abduction with pronation
- radial head anterior glide with supination
- radial head posterior glide with pronation
175
What is the coupled motion with ulnar adduction?
supination
176
What is the coupled motion with ulnar abduction?
pronation
177
What is the coupled motion with radial head anterior glide?
supination
178
What is the coupled motion with radial head posterior glide?
pronation
179
What muscle is the medial border of the anatomic snuffbox?
extensor pollicus longus m.
180
What muscle is the lateral border of the anatomic snuffbox?
extensor pollicus brevis, abductor pollicus longus muscles
181
What is the proximal border of the anatomic snuffbox?
radial styloid process
182
What nerve is tested with the "OK" Sign test?
anterior interosseous nerve
motor branch of median nerve innervating:
- flexor pollicis longus
- deep flexors of digits 2 and 3
- pronator quadratus
183
What does the Allen Test assess?
evaluates functioning of radial and ulnar arteries
184
What pathology does the Phalen's sign test for?
Carpal Tunnel Syndrome
185
What does a positive Finkelstein Test indicate?
DeQuervain's tenosynovitis
186
What is the most common carpal bone to fracture when falling on outstretched hand (FOOSH)?
scaphoid fracture
187
What is a Colle's Fracture?
fracture of the distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand.
188
What is a Monteggia Fracture?
- fracture of the proximal ulna
| - dislocation of the radial head
189
What is a Galeazzi Fracture?
- fracture of the distal radius
| - dislocation of the ulna
190
What is a nightstick fracture?
isolated fracture of the mid-shaft of the ulna from a direct blow
191
What ligament is the primary stabilizer of the medial ankle?
Deltoid Ligament
192
What bones make up the medial longitudinal arch?
- navicular
- cuneiforms (1-3)
- talus
- metatarsals (1-3)
193
Which longitudinal arch of the foot is our weight-bearing arch?
Medial Longitudinal Arch
194
What are the components of the lateral longitudinal arch?
- calcaneus
- cuboid
- metatarsals (4-5)
195
What bone is a component of both the medial- and lateral-longitudinal arch of the foot?
calcaneus
196
Which 3 tendons pass through the Tarsal Tunnel?
- flexor digitorum longus tendon
- flexor hallucis longus tendon
- posterior tibialis tendon
197
What does the Anterior Drawer Test of the ankle test for?
ATF ligament pathology/tear (lateral ankle sprain)
198
What does the Talar Tilt Test assess?
Calcaneofibular ligament pathology/tear and some ATF (lateral ankle sprain)
199
What does the Eversion Test assess?
Deltoid ligament pathology (medial ankle sprain)
200
What does the squeeze test assess?
syndesmosis pathology (high ankle sprain)
201
What does the cross leg test assess?
syndesmosis pathology (high ankle sprain)
202
What does the Thompson test of the ankle assess?
achilles tendon rupture
203
What does a positive Homan's sign indicate?
thrombophlebitis or acute deep venous thrombosis (DVT)
**not always performed clinically due to potential risk of embolus
204
What does a positive Moses sign indicate?
deep vein thrombosis of the posterior tibial veins
**not always performed clinically due to potential risk of embolus
205
Which ligament always tears first in an inversion (lateral) ankle sprain?
anterior talofibular ligament (ATF)
206
What type of sprain accounts for 10% of all ankle sprains?
high ankle sprain
207
What is a Morton's Neuroma?
inflammation and thickening of tissue that surrounds the nerve between toes.
Most commonly between 3rd and 4th toes.
Patient reports that it feels as if they are walking on a marble.
208
What is a Turf Toe?
inflammation and pain at base of 1st MTP
caused by hyperextension of great toe causing damage to the joint capsule
209
What does a positive Apprehension Test indicate?
glenohumeral instability
210
What does a positive Sulcus Sign indicate?
glenohumeral instability
211
What are the 2 special tests for assessing glenohumeral instability?
- apprehension test
| - sulcus sign
212
What does a positive Yergason's Test indicate?
unstable bicipital tendon/subluxation bicipital tendonitis
213
What does a positive Speed's test indicate?
bicipital tendonitis of longhead biceps
214
What does a positive empty or full can test indicate?
rotator cuff pathology (specifically supraspinatus)
215
What does a positive drop-arm test indicate?
full thickness tear of supraspinatus
216
What does a positive neer impingement test indicate?
subacromial bursa or rotator cuff impingement
217
What does a positive Hawkins test indicate?
rotator cuff or subacromial bursa impingement
218
What does a positive Lift Off Test indicate?
subscapularis weakness
219
What does a positive Cross Arm Test indicate?
AC joint pathology
220
What does an Upper Apley Scratch Test assess?
test ROM and is coupled external rotation and abduction of the shoulder
221
What does an Lower Apley Scratch Test assess?
test ROM and is coupled internal rotation and adduction
222
What is the posture of a patient with Genu valgum?
knees close together and feet farther apart (knock-kneed)
223
What is the posture of a patient with Genu varus?
where the legs appear bowed with feet together (bow-legged)
224
What is the posture of a patient with Genu recurvatum?
posture seen from a lateral view, where the knee has a backward curvature (hyperextension)
225
What is the normal Q-angle in degrees?
15 degrees
226
How is the Q-angle measured?
Measured by creating a straight line from the ASIS to the center of patella and another line through the tibial tuberosity and the same point on the patella.
This difference between these two lines forms the "Q-angle".
Females typically have an increased Q-angle.
227
Do males or females generally have an increased Q-angle.
females
228
What does a positive valgus stress test indicate?
medial collateral ligament (MCL) disruption
229
What does a positive varus stress test indicate?
lateral collateral ligament (LCL) disruption
230
What does a positive anterior drawer test indicate?
ACL insufficiency
231
What does a positive Lachman's test indicate?
ACL insufficiency
232
What does a positive posterior drawer test indicate?
PCL deficiency
posterior capsular injury
disruption
233
What does a positive reverse Lachman's test indicate?
PCL deficiency/posterior capsule deficiency
234
What does a positive McMurray's test indicate?
possible medial or lateral meniscus tear
235
What does a positive Apley's Grind Test-Compression test indicate?
possible meniscal injury
possible collateral ligament injury
or both
236
What does a positive Apley's Grind Test-Distraction test indicate?
possible collateral ligament damage
237
What does a positive Patellar Laxity and Apprehension test indicate?
possible previous patellar dislocation or severe instability
238
What does a positive Patellar Compression (grind) test indicate?
possible inflammation, chondromalacia, or injury to the patellofemoral articular surfaces
239
What does a positive Patella-Femoral Grinding test indicate?
roughness of articulating surfaces (e.g., chondromalacia)
240
What does a positive Patellar Glide Test indicate?
possible damage to the articular surface
241
What is the superior border of the femoral triangle?
inguinal ligament
242
What is the medial border of the femoral triangle?
medial border of adductor longus muscle
243
What is the lateral border of the femoral triangle?
medial border of sartorius muscle
244
What is the major flexor of the hip?
Iliopsoas muscle
* femoral nerve (L2-4)
* ventral rami of lumbars (L1-2)
245
What is the main extensors of the hip?
Gluteus maximus muscle
* inferior gluteal nerve (L5, S1-S2)
246
What is the main abductor of the hip?
Gluteus Medius and Minimus Muscles
* superior gluteal nerve (L5, S1)
247
What is the main adductor of the hip?
Adductor longus muscle
* obturator nerve (L2-4)
248
What are the main central compartmental structures of the hip?
- labrum
- ligamentum teres
- articular surfaces
249
What are the main peripheral compartmental structures of the hip?
- femoral neck
| - synovial lining
250
What are the main lateral compartmental structures of the hip?
- gluteus medius
- gluteus minimus
- piriformis
- IT band
- trochanteric bursae
251
What are the main anterior/iliopsoas compartmental structures of the hip?
- iliopsoas insertion
| - iliopsoas bursae
252
What is hypopnea?
decreased depth (shallow) and rate (slow) of respiration
253
What is bradypnea?
regular rhythm but slower than normal rate (RR < 14/min)
254
What is hyperpnea?
increased depth (deep) of breathing and rate (fast) of respiration (normal in exercise)
255
What is tachypnea?
rapid breathing (RR> 20/min)
256
What is dyspnea?
feeling short of breath
257
What is hypoxemia?
oxygen deficiency in arterial blood
258
what is apnea?
no breathing
259
what is atelectasis?
collapse of lung tissue that affects the alveoli from normal oxygen absorption
260
what is pleximeter finger?
hyperextended middle finger of non-dominant hand in percussion
261
what is plexor finger?
"tapping" finger, dominant hand, for percussion
262
the chief complaint is always stated in who's words?
the patient's words, not the nurse or physician
263
List the 13 steps of the physical examination for an extensive lower respiratory workup.
1. sitting position and breathing pattern
2. use of accessory muscles for breathing
3. color of fingers and lips. shape of nails
4. breathing thru pursed lips
5. ability to speak (e.g., 2 word conversational dyspnea)
6. chest deformities
7. spinal deformities
8. is the trachea in the mid-line?
9. chest excursion
10. tactile fremitus
11. percussion
12. lung sounds
13. lymphadenopathy (think axillary LNs in respiratory patient workup)
** vital exams - pulse oximetry reading (important tool to get heart rate and oxygen saturation of patient quickly)
264
Which 2 tests make up the pulmonary function test (PFT)?
- plethysmography
| - spirometry
265
What are the things you're looking for during the Inspection portion of the lower respiratory exam?
- rate, rhythm, depth, and effort
- color
- inspect the neck (accessory muscle use)
- inspect the hands (e.g., capillary refill time, clubbing)
- shape of the chest (e.g., barrell chest = COPD)
- how the chest moves
266
What is a common posture of a patient presenting sitting in a "Tripod Position"?
Emphysema (COPD is a subtype)
267
What are the expiratory accessory muscles of respiration?
- abdominals
| - expiratory intercostals
268
What are the inspiratory accessory muscles of respiration?
- inspiratory intercostals
- sternomastoids
- scalenes
- external obliques
269
what can cause racheal deviation in a pt?
- pneumothorax (tension and non-tension)
- pleural effusion
- atelectasis
- mass
270
List as many pathologies as you can that can cause clubbing of the fingernails (8).
- congenital heart disease
- interstitial lung disease
- bronchiectasis
- pulmonary fibrosis
- cystic fibrosis
- lung abscess
- malignancy
- inflammatory bowel disease
** clubbing not caused by COPD!!! **
271
clinical name for "funnel chest"?
pectus excavatum
272
clinical name for "pigeon chest"?
pectus carinatum
273
"pick puffer" is a typical appearance in patients with what pathology?
emphysema
274
"blue bloater" is a typical appearance in patients with what pathology?
chronic bronchitis
275
what does the presenation of traumatic flail chest look like?
- on inspiration the injured area caves inward
- on expiration the injured area moves outward
** multiple rib fractures may result in PARADOXICAL MOVEMENTS of the THORAX **
276
is thoracic kyphoscoliosis only a musculoskeletal condition?
No, thoracic kyphoscoliosis is caused by a musculoskeletal disorder, but can affect breathing greatly because it compresses against the lungs, and other organs.
