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PCM exam 1 > PCM extra > Flashcards

PCM extra Flashcards

1
Q

Unsteady gait

A

lack of coordination, abnormal posture when walking, gait influenced by pain, muscle abnormalities

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2
Q

Steppage gait

A

Foot hangs with toes pointing down (scrape the ground when walking).

multiple sclerosis, peritoneal neuropathy, lumbar slipped disc

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3
Q

Populsive gait

A

stooped and stiff posture

Parkingsons

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4
Q

Waddling gait

A

walk resembles duck.

Congenital hip disorder

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5
Q

Ataxic gait

A

unsteady walk, heel comes down first then toe.

Intoxication

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6
Q

Parkinson’s gait

A

trunk, head, neck forward and knee flexed.

Wide base, small shuffling step.
Tent to fall forward and increase speed (destination)

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7
Q

Hirsutism

A

Excessive hairiness, especially in females

Polycystic ovary syndrome

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8
Q

Virilization

A

Secondary male sexual characteristics manifesting in females.

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9
Q

Alopecia

A

Balding, loss of hair

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10
Q

Papules

A

Contact dermatitis, shingles

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11
Q

Plaque

A

Psoriasis

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12
Q

Erythematous macular rash

A

Drug hypersensitivity

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13
Q

What is the most common site for basal and squamous cell carcinoma?

A

face

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14
Q

What is the usual angle between nail bed and nail? what is it for clubbed nails?

A

160 normal

180 clubbed

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15
Q

40% of melanomas on men are located where?

A

back

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16
Q

What contributes to increased abdominal girth?

A

The 6 Fs:

Fluid, flatus, feces, fetus, fat, fatal tumor

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17
Q

40% of melanomas on women are located where?

A

Legs

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18
Q

Oncholysis

A

When nail detaches from skin

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19
Q

intimate space

A

1.5 ft away

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20
Q

Personal space

A

4 ft away

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21
Q

Social space

A

10 ft away

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22
Q

What level should all pt material be at?

A

6th grade

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23
Q

When expressing empathy, what does NURSE mean?

A 
N: name
U: understand
R: respect
S: support
E: explore
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24
Q

Biochemical model

A

MSK

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25
Q

Respiratory-circulatory

A

HEENT (NT part)

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26
Q

Neurological model

A

HEENT (HEE part)

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27
Q

Metabolic energy model

A

genitourinary and GI

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28
Q

Behavioral model

A

Psychosocial system

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29
Q

Steps for obtaining HPI

A
  1. set stage for interview
  2. elicit chief complaint and set agenda
  3. Open history of present illness (non focused)
  4. Cont pt centered history of present illness
  5. transition to clinician centered process
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30
Q

Which family members are concerned in family history?

A

Mom, dad, siblings, kids

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31
Q

How much exercise does the CDC recommend adults get per week?
How much for children?

A

150 min of moderate exercise per week, plus 2 days strength training.

Kids= 1 hr of physical activity per day

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32
Q

Pack years=

A

ppd x years

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33
Q

CAGE

A

Cut back
Annoyed
Guilty
Eye opener

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34
Q

What is low risk drinking for women

A

no more than 3 drinks in one day, no more than 7 drinks per week

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35
Q

What is low risk drinking for men?

A

no more than 4 drinks in one day, no more than 14 drinks per week.

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36
Q

How many ounces in one beer?

A

12

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37
Q

How many ounces in a glass of wine?

A

5

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38
Q

How many ounces in liquor

A

1

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39
Q

FICA

A

for assessing spirituality

F: faith and belief
I: importance
C: community
A: address in care of assessment of plan

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40
Q

Five Ps for sexual history

A

Partners, practices, prevention of pregnancy, protection from STI, past history of STI

41
Q

Steps of joint exam

A

inspect, palpation, ROM, specialty test

42
Q

What is the most sensitive indication of joint disease?

A

ROM

43
Q

Where should you check for pulse/cap refill?

A

Distal to injury

44
Q

what are the top causes of life threatening joint pain?

A

Septic arthritis, referred pain from acute MI, intraperitoneal hemorrhage, lung pathology

45
Q

Process for developing and working through a differential diagnosis

A
  1. develop broad DDX
  2. Narrow doen DDX
  3. Develop working DDX
  4. Pursure working DDX (lab work)
  5. Assessment and plan
46
Q

Septic arthritis

A

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

47
Q

Actue Arterial occlusion LLE

A

Unstable–> vascular emergency. IV anticoagulation, immediately to OR

48
Q

What is the only joint in the body where tendons pass between bones?

A

Shoulder joint (rotator cuff)

49
Q

Painful arc test

A

tests for subacromial impingement and rotator cuff tendon injury.

+ test= shoulder pain from 60-120 degrees

50
Q

Clavicle fracture

A

happen most often in kids

51
Q

Proximal humerus fractures

A

most common in elderly pt

52
Q

Scapular fracture

A

associated with blunt trauma.

53
Q

Glenohumeral dislocation

A

dislocated shoulder. 50 % of all major dislocations.

ANTERIOR dislocation is most common

54
Q

AC separation

A

separated shoulder.

55
Q

Rotator cuff injury

A

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.

56
Q

Impingement syndrome

A

Rotator cuff pathology.

Grinding, compression of rotator cuff tendons and subacromial bursa between greater tubercle and acromion process.

57
Q

Tendon injury

A

Rotator cuff pathology.

sprain or tear

58
Q

Tendinopathy

A

Rotator cuff pathology

chronic injury to supraspinatus

59
Q

Most common acute shoulder pain

A

rotator cuff injuries, fractures/dislocations, AC joint injuries, myofasical injury

60
Q

Most common chronic shoulder pain

A

greater than 6 months.

Adhesive capsulitis, shoulder instability, arthritis

61
Q

Anterior shoulder pain common causes

A

gout, osteoarthritis

62
Q

Lateral shoulder pain common causes

A

lateral epicondylitis

63
Q

Medial shoulder pain common causes

A

cubital tunnel syndrome, medial epicondylitis

64
Q

Posterior shoulder pain common causes

A

olecranon bursitis

65
Q

Lateral epicondylitis (tennis elbow)

A

Gradual onset of pain at lateral elbow, pain is aggravated by wrist extension

66
Q

Medial epicondylitis (golfers elbow)

A

gradual onset of pain at medial elbow with or without grip weakness. Aggravated by wrist flexion

67
Q

Olecranon bursitis

A

most commonly seen after trauma from leaning on elbow. can be septic or aseptic

68
Q

Cubital tunnel syndrome

A

ulnar nerve compression.
pain at night in elbow when fully flexed. diagnose with tingle sign.

often accompanies medial epicondylitis

69
Q

Phalen’s sign

A

Carpal tunnel syndrome

70
Q

Tinels sign

A

carpal tunnel syndrome

71
Q

Finkelsteins test

A

deQuervains tenosynovitis

72
Q

deQuervains tenosynovitis

A

inflammation of tendon and synovial sheath covering extensor policies brevis and longus.
Picking up kids.
pain in base of thumb and wrist.

73
Q

Rheumatoid arthritis

A

autoimmune, inflammatory arthritis.
Symmetric joint pain
Stiffness lasts more than an hour

74
Q

Osteoarthritis arthritis

A

most common arthritis in adults. Gradual onset, asymmetric joint pain.
Joint stiffness lasts less than 1 hour.
heerden’s nodes.

75
Q

ganglion cyst

A

soft tissue finding of wrist/hand. most common on dorsal wrist.

76
Q

scaphoid fracture

A

most common. FOOSH. young people. Wrist pain near snuff box, decreased grip strength

77
Q

Main symptoms of hip disease

A

pain, stiffness, deformity, limp

78
Q

What is an early symptom of hip disease?

A

difficultly putting on shoes. Requires external rotation of hip, which is the first motion lost

79
Q

Most common hip issues

A

trochanteric and gluteus medius bursitis osteoarthritis, fracture of femur

80
Q

Mealgia paresthetica

A

lateral femoral nerve entrapment. Hip pain associated with parenthesis, hypesthesia in anterolateral thigh.

81
Q

Anterior hip or groin pain

A

Suggests primary involvement of hip joiny

82
Q

Posterior hip (gluteus) pain

A

lease common pain affecting hip. usually indicates sacroiliac joint disease, lumbar radioculopathy, herpes zoster.

83
Q

SLR pain between 30-70 degrees

A

indicates lumbar disc herniation L4-S1

84
Q

SLR pain over 70 degrees

A

tight hamstrings or glut Max

85
Q

Locking in knee

A

meniscal tear

86
Q

Knee popping at time of injury

A

ligament rupture

87
Q

“giving out” knee

A

ligament rupture, patellar subluxation

88
Q

rapid onset knee effusion

A

ACL

89
Q

slow onset knee effusion

A

meniscal or ligamentous

90
Q

recurrent knee effusion

A

meniscal

91
Q

Ottawa knee rules

A

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

92
Q

ACL injury

A

most common knee ligament injury. Sudden onset effusion and severe knee pain, popping sensation or instability “giving out”

93
Q

Meniscal injury

A

slow onset knee pain with swelling.
locking or catching during extension.

+ mcmurrays test

94
Q

patellofemoral pain syndrome

A

anterior knee pain, worsens when knee is flexed during weight bearing activities.
Pain under patella

95
Q

Tibial apophysitis (osgood-schlatter disease)

A

children 9-14. gradually worsening anterior knee pain, low grade, causes limp.
tenderness of bony prominence over tibial tuberosity

96
Q

Pes anserinus pain syndrome

A

medial knee pain. worse at night. sudden onset medial knee pain worsened by repetitive knee flexion and extension

97
Q

Iliotibial band syndrome

A

overuse injury. slow onset, diffuse, lateral knee/leg pain. Intermittent, sharp pain

98
Q

Plantar fascitis

A

common foot pain in adults. Overuse causing micro tears in fascia. sharp, stabbing, medial planter heel.
Pain worse with dorsiflexion

99
Q

Gout flare

A

urate crystals in joint space leading to inflammatory reaction
- negative birefringement needle shaped crystals on polarized light

PCM exam 1 (9 decks)

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