PCM extra Flashcards
Unsteady gait
lack of coordination, abnormal posture when walking, gait influenced by pain, muscle abnormalities
Steppage gait
Foot hangs with toes pointing down (scrape the ground when walking).
multiple sclerosis, peritoneal neuropathy, lumbar slipped disc
Populsive gait
stooped and stiff posture
Parkingsons
Waddling gait
walk resembles duck.
Congenital hip disorder
Ataxic gait
unsteady walk, heel comes down first then toe.
Intoxication
Parkinson’s gait
trunk, head, neck forward and knee flexed.
Wide base, small shuffling step.
Tent to fall forward and increase speed (destination)
Hirsutism
Excessive hairiness, especially in females
Polycystic ovary syndrome
Virilization
Secondary male sexual characteristics manifesting in females.
Alopecia
Balding, loss of hair
Papules
Contact dermatitis, shingles
Plaque
Psoriasis
Erythematous macular rash
Drug hypersensitivity
What is the most common site for basal and squamous cell carcinoma?
face
What is the usual angle between nail bed and nail? what is it for clubbed nails?
160 normal
180 clubbed
40% of melanomas on men are located where?
back
What contributes to increased abdominal girth?
The 6 Fs:
Fluid, flatus, feces, fetus, fat, fatal tumor
40% of melanomas on women are located where?
Legs
Oncholysis
When nail detaches from skin
intimate space
1.5 ft away
Personal space
4 ft away
Social space
10 ft away
What level should all pt material be at?
6th grade
When expressing empathy, what does NURSE mean?
N: name U: understand R: respect S: support E: explore
Biochemical model
MSK
Respiratory-circulatory
HEENT (NT part)
Neurological model
HEENT (HEE part)
Metabolic energy model
genitourinary and GI
Behavioral model
Psychosocial system
Steps for obtaining HPI
- set stage for interview
- elicit chief complaint and set agenda
- Open history of present illness (non focused)
- Cont pt centered history of present illness
- transition to clinician centered process
Which family members are concerned in family history?
Mom, dad, siblings, kids
How much exercise does the CDC recommend adults get per week?
How much for children?
150 min of moderate exercise per week, plus 2 days strength training.
Kids= 1 hr of physical activity per day
Pack years=
ppd x years
CAGE
Cut back
Annoyed
Guilty
Eye opener
What is low risk drinking for women
no more than 3 drinks in one day, no more than 7 drinks per week
What is low risk drinking for men?
no more than 4 drinks in one day, no more than 14 drinks per week.
How many ounces in one beer?
12
How many ounces in a glass of wine?
5
How many ounces in liquor
1
FICA
for assessing spirituality
F: faith and belief
I: importance
C: community
A: address in care of assessment of plan
Five Ps for sexual history
Partners, practices, prevention of pregnancy, protection from STI, past history of STI
Steps of joint exam
inspect, palpation, ROM, specialty test
What is the most sensitive indication of joint disease?
ROM
Where should you check for pulse/cap refill?
Distal to injury
what are the top causes of life threatening joint pain?
Septic arthritis, referred pain from acute MI, intraperitoneal hemorrhage, lung pathology
Process for developing and working through a differential diagnosis
- develop broad DDX
- Narrow doen DDX
- Develop working DDX
- Pursure working DDX (lab work)
- Assessment and plan
Septic arthritis
More frequent in above 80 yo and diabetes mellitus, intravenous drug abuse.
Usually occurs in knees.
Joint is erythematous, swollen, warm, painful to touch.
Signs: tachycardia, fever, hypotension
Labs: elevated CBC, ESR, CRP
Actue Arterial occlusion LLE
Unstable–> vascular emergency. IV anticoagulation, immediately to OR
What is the only joint in the body where tendons pass between bones?
Shoulder joint (rotator cuff)
Painful arc test
tests for subacromial impingement and rotator cuff tendon injury.
+ test= shoulder pain from 60-120 degrees
Clavicle fracture
happen most often in kids
Proximal humerus fractures
most common in elderly pt
Scapular fracture
associated with blunt trauma.
Glenohumeral dislocation
dislocated shoulder. 50 % of all major dislocations.
ANTERIOR dislocation is most common
AC separation
separated shoulder.
Rotator cuff injury
Spuraspinatus is most commonly injured. shoulder pain over lateral deltoid. Most common pain at night.
from repetitive overhead activity in sport to work is a major risk.
Impingement syndrome
Rotator cuff pathology.
Grinding, compression of rotator cuff tendons and subacromial bursa between greater tubercle and acromion process.
Tendon injury
Rotator cuff pathology.
sprain or tear
Tendinopathy
Rotator cuff pathology
chronic injury to supraspinatus
Most common acute shoulder pain
rotator cuff injuries, fractures/dislocations, AC joint injuries, myofasical injury
Most common chronic shoulder pain
greater than 6 months.
Adhesive capsulitis, shoulder instability, arthritis
Anterior shoulder pain common causes
gout, osteoarthritis
Lateral shoulder pain common causes
lateral epicondylitis
Medial shoulder pain common causes
cubital tunnel syndrome, medial epicondylitis
Posterior shoulder pain common causes
olecranon bursitis
Lateral epicondylitis (tennis elbow)
Gradual onset of pain at lateral elbow, pain is aggravated by wrist extension
Medial epicondylitis (golfers elbow)
gradual onset of pain at medial elbow with or without grip weakness. Aggravated by wrist flexion
Olecranon bursitis
most commonly seen after trauma from leaning on elbow. can be septic or aseptic
Cubital tunnel syndrome
ulnar nerve compression.
pain at night in elbow when fully flexed. diagnose with tingle sign.
often accompanies medial epicondylitis
Phalen’s sign
Carpal tunnel syndrome
Tinels sign
carpal tunnel syndrome
Finkelsteins test
deQuervains tenosynovitis
deQuervains tenosynovitis
inflammation of tendon and synovial sheath covering extensor policies brevis and longus.
Picking up kids.
pain in base of thumb and wrist.
Rheumatoid arthritis
autoimmune, inflammatory arthritis.
Symmetric joint pain
Stiffness lasts more than an hour
Osteoarthritis arthritis
most common arthritis in adults. Gradual onset, asymmetric joint pain.
Joint stiffness lasts less than 1 hour.
heerden’s nodes.
ganglion cyst
soft tissue finding of wrist/hand. most common on dorsal wrist.
scaphoid fracture
most common. FOOSH. young people. Wrist pain near snuff box, decreased grip strength
Main symptoms of hip disease
pain, stiffness, deformity, limp
What is an early symptom of hip disease?
difficultly putting on shoes. Requires external rotation of hip, which is the first motion lost
Most common hip issues
trochanteric and gluteus medius bursitis osteoarthritis, fracture of femur
Mealgia paresthetica
lateral femoral nerve entrapment. Hip pain associated with parenthesis, hypesthesia in anterolateral thigh.
Anterior hip or groin pain
Suggests primary involvement of hip joiny
Posterior hip (gluteus) pain
lease common pain affecting hip. usually indicates sacroiliac joint disease, lumbar radioculopathy, herpes zoster.
SLR pain between 30-70 degrees
indicates lumbar disc herniation L4-S1
SLR pain over 70 degrees
tight hamstrings or glut Max
Locking in knee
meniscal tear
Knee popping at time of injury
ligament rupture
“giving out” knee
ligament rupture, patellar subluxation
rapid onset knee effusion
ACL
slow onset knee effusion
meniscal or ligamentous
recurrent knee effusion
meniscal
Ottawa knee rules
indications for radiography in pts with acute knee injury:
older than 55
inability to bear weight for 4 steps
inability to flex knee to 90
tenderness over head of fibula or isolated to patella without other bony tenderness
ACL injury
most common knee ligament injury. Sudden onset effusion and severe knee pain, popping sensation or instability “giving out”
Meniscal injury
slow onset knee pain with swelling.
locking or catching during extension.
+ mcmurrays test
patellofemoral pain syndrome
anterior knee pain, worsens when knee is flexed during weight bearing activities.
Pain under patella
Tibial apophysitis (osgood-schlatter disease)
children 9-14. gradually worsening anterior knee pain, low grade, causes limp.
tenderness of bony prominence over tibial tuberosity
Pes anserinus pain syndrome
medial knee pain. worse at night. sudden onset medial knee pain worsened by repetitive knee flexion and extension
Iliotibial band syndrome
overuse injury. slow onset, diffuse, lateral knee/leg pain. Intermittent, sharp pain
Plantar fascitis
common foot pain in adults. Overuse causing micro tears in fascia. sharp, stabbing, medial planter heel.
Pain worse with dorsiflexion
Gout flare
urate crystals in joint space leading to inflammatory reaction
- negative birefringement needle shaped crystals on polarized light
