PCM final Flashcards
relevant past medical history as it relates to the eye
glaucoma diabetes thyroid disease ASCD (atherosclorisis) collagen vascular disease HIV IBD
hi cat dg !!!!
thumb dermatome
C6
define dysarthria
defective articulation (usually caused by duct in motor control of speech apparatus)
illiopsoas muscle test
-pt flex hip against resistance
increased abdominal pain is a positive finding indicating irritation of the posts muscle from inflammation of the appendix
*historical test with low sensitivity and specificity for appendicitis
___ can inhibit the absorption of heme and non-heme iron
calcium
Adsons Test
find pt pulse the extend, abduct, and external rotate arm while pt rotates head to each side and hold inhalation
- is change in pulse or sx reproduction
- indicates thoracic outlet syndrome with compression of subclavian A between scalene (looking away from affected side) or 1st rib/cervical rib (looking toward affected side)
what does scaly skin around the eyebrows indicate
seborrheic dermatitis
what are non conjugated inactivated or killed vaccines ? example>
organisms is carefully killed (thermally or chemically) before injection
- imunogenticity is retained
- ex: hep A, polio, rabies
what are live attenuated vaccines ? examples
- version of microbe that is weakened in lab
- stronger mucosal immunity develops
- do not use if pt is immunocompromised
- do not use if they have received blood products in the recent past (up to 11 months)
ex: MMR, varicella, rotavirus, influenza (nasal) , Zoster
good sources of Vitamins B1 (thiamin)
legumes, lean pork, enriched grains
___ describes severe drowsiness, listlessness, and apathy accompanied by reduced alertness. A lethargic patient often needs a gentle touch or verbal stimulation to initiate a response. Causes can include severe illnesses or infections, recreational drugs, and organ failure.
lethargy
when are booster vaccines given
4-6 years old
coordination (cerebellar testing)
finger- to -nose (dysmetrria and dyspraxia of voluntary movement)
finger-to - finger (postion sense and labyrinth eval)
heel- to - shin
rapid alternating movements
gait is all over the place as if the patient is falling but does not fall and is usual caused by psychogenic idiopaths
symmetrical abnormal gait : astasia-abasia (functional)
move a 5 mm tipped pin inward beyond the boundary along a line bisecting the horizontal and vertical meridians and ask the patient to tell you when the pin first appears
kinetic red target test for visual field confrontation
**use with finger wiggle test for high specificity for visual field loss
importance of vitamin B3 (niacin)
oxioreductases NAD and NADP
what diseases are in the differential dx with spontaneous episodic symptoms are present with dizziness
unilateral hearing loss - menieres dz
migraine associated - vestibular migraine
anxiety associated - psych disorder
anal wink reflex
superficial tendon reflex of S4/5
- useful for caudal equine or lesions that affect the sacral region
- touch areas around perirectal region and not if there is contraction
- abnormal is no contraction is present
elimate what dx before dx dementia
depression and delirium
squamous cell and basal cell carcinoma in the eye region can be see with
scabs and new skin lesions around the eyelids and eye lashes
coordination of muscle movement involves input from what 4 systems
- motor (strength)
- cerebellar (rhythmic movement and steady posture)
- vestibular ( balance and eye coordination)
- sensory ( position sense)
good sources of Vitamins B2 (riboflavin)
wheat germ , leafy veggies
postive stork test indicates
posible pars defect or stress fracture
change in elasticity in periorbital area (eye examination)
lipoatrophy or lipohypertrophy from topical meds
importance of vitamin B6 (pyridoxine)
carb amino acid and lipid metabolism
neurotransmitter, sphingolipids, and heme synthesis
resting tremor vs action tremors
most tremors are action and occur with voluntary muscle contraction (postural, isometric, kinetic, and intention)
resting occurs in body part that is relaxed and supported against gravity, enhanced by mental stress or movement of other body part, diminished by voluntary movement of that body part
what does TiTrATE the evaluation of dizziness mean
timing of the sx (onset, duration, evolution)
triggers of sx (actions movement or situation)
Targeted examination
places dizziness in 1 of 3 scenes - triggered episodic sx, spontaneous episodic sx, or continuous vestibular sx
what is a contraindication to dilating pupils (mydriasis)? and what might dilating these patients do
NEVER for shallow anterior chambers
-may induce acute angle -closure glaucoma
dizziness that increases with motion is common to ____
both peripheral and central causes
gaenslen test
-flex one hip and knee to chest while simultaneously extending opposite hip off side of table
or pt lateral recumbent and pt flexes lower hip and holds and physical extends top hip
-+ = posterior pelvic pain
-indicates SI joint dysfunction or pathology
what medicines have ocular side effects
steroids plaquenil antihistamines antidepressants antipsychotics antiarrhythmics beta blockers
Baps!!!
importance of iron
hemoglobin
myoglobin
cytochromes a, b, c
light touch testing for
spinothalamic and posterior columns
associated symptoms to screen for with eye complaints
pain drainage itching burning vision change blurry vision flashing lights
what are toxoid vaccines ?
vaccines with the sub-unit antigen or inactivated toxin
-includes parts that best stimulate the immune response
optic disc cupping might be associated with
glaucoma
jefferson fracture
axial compression –> C1 fracture
good sources of calcium
dark leafy veggies, tofu, broccoli, cauliflower, flax seeds, beans, lentils, dairy
___ is a level of impaired consciousness in which a person only minimally responds to vigorous stimulation, such as pinching the toe or shining a light in the eyes. Causes can include stroke, drug overdose, lack of oxygen, brain edema, and myocardial infarction (heart attack).
stupor
sensation of self-motion when they are not moving or a distorted self-motion during normal head movement seen with asymmetry in vestibular system or disorder of peripheral labyrinth of its central connection
vertigo
_____ is sometimes palpable through the eyelid. what is it?
chalazion (A slow-growing, inflammatory lump in the tear gland of the eyelid)
- blocks meibomian gland
- nontender and nonpainful unless inflammed
- in the LID
lesions of cranial nerve X results in
dysphonia
dysphagia
dyspnea
loss of gag / cough reflex
decorticate vs decerebrate posturing
decorticate= both arms flexed and legs are stiff and extended
-lesion above brain stem in thalamus
decerebrate = arms are extended and legs are extended, usually indicates a brainstem lesion in the mid brain
what is chorea
a neurological disorder characterized by jerky involuntary movements affecting especially the shoulders, hips, and face.
abdominal reflex
test all 4 quadrants stroking abdomen causes umbilicus to move toward area of stimulation
-if absent = abnormal superficial tendon reflex of T10-12
+ Roos or EAST test indicates
thoracic outlet syndrome with compression of the subclavian A.
good sources of Vitamins D
mushrooms
fortified milk, OJ, cod liver oil, fish, egg, yolk
vertigo paired with abnormal gait and tendency to fall to affected side, and horizontal nystagmus to affected side
vestibular neuritis
-tx with anti-emetic, anti-histamine, or benzos
nuchal rigidity, and brudzinski’s test indicates
inflammation in subarachnoid space (meningitis or subarachnoid hemorrhage)
what are conjugated vaccines ?
pathogens are surrounded by a polysaccharide capsule and are immunogenic
- t-cell dependent immunity to polysaccharides is triggered
- strengthens immune memory
heel strike test
possible appendicitis or peritonitis
-+ = ab pain
3+ vs 4+ DTR documentation
3 = brisk, spread to involve movement across more than one joint 4= hyperactive with clonus
what is indicated by purulence in the conjunctivita
“pink eye” -conjunctivitis
importance of vitamin B2 (riboflavin)
oxioreductases FMN and FAD
what would a brown tint in the cornea be indicative of
hyphema - blood from trauma in the anterior chamber
what is most common vertigo cause in kids
vestibular migraine
importance of vitamin B12 (cobalamin)
- heme structure
- folate recycling
obturator muscles test
- flex pt right hip with knee bent and rotate leg internally at the hip
- rigth hypogastric pain is positive for irritation of muscle by appendicitis
- historical test
psychogenic tremor traits that differ from tremor of organic origin
psychogenic tremor
- abrupt onset, spontaneous remission, changing characteristics (location and frequency), increase with attention and extinction with distraction
- frequently seen in patients employed in allied health professions, those involved in litigation
courvoisers sign
enlarged non tender gallbladder
-indicates pancreatic disease or cancer
types of headache
tension
migraine
cluster
what is the “extremely busy” time period for vaccinations of children
birth to 24 months
cotton wool spots seen with fundscopic exam may be associated with
vascular disease from HTN or DM
what does A&O x 3 mean ? A&O x 4?
"alert and oriented" x 1 = person x 2 = person and place x 3 = person, place, time x 4 = person, place, time, and event
belongs in O part of SOAP notes
positive valsalva test indicates
sciatica (sx: sharp burning pain down the posterior or lateral aspect of the leg, usually the foot or ankle)
or
space occupying lesion in cervical canal if there is neck pain
what is a hordeolum and how is it different than a chalazion
aka a stye- A red, painful lump near the edge of the eyelid that may look like a boil or pimple
similar
-blocked meibomian gland
different
- can block tear eyelash follicle or tear gland
- tender and painful
- along the lash line
straight leg test
pain between 30-60 degrees = lumbosacral radiculopathy or sciatic neuropathy
- > 70 = LBP to muscle strain
- > 15 = IT band contracture
signs and history that suggest parkinson’s disease
- tremor; decrease dexterity
- decreased arm swing
- soft voice
- sleep disturbances
- decreased sense of smell
- symptpms of autonomic dysfunction (constipation, sweating)
- decreased facial expression
- general feeling of weakness or malaise,
- depression or anhedonia
- slowness in thinking
action tremor associated with voluntary movement and includes intention tremor which is produced with target direct movement (i.e. reaching for a pen)
kinetic tremor
high steppage, broad based gait seen with posterior column damage and peripheral neuropathy
symmetrical abnormal gait: sensory ataxia
rash in the periorbital region of the face that extends to the hairline might indicate what
herpes zoster (shingles)
big toe and little toe dermatome
big toe = L 5
little toe = S1
dx: unilateral pain, starts at the area where the neck meets the skull and moves forward to involve the ear and forehead. pain caused by trauma. confirmed dx with greater occipital nerve block. tx is massage, NSADS, and muscle relaxants
occipital neuralgia
importance of vitamin A
vision
baby development
skin integrity
cell growth, proliferation, differentiation
when would you do inversion of the upper eyelid during examination
- not rountine
- only if concerned about foreign body being stuck
5 “P”s of Sexual history interviewing
partners practices protection from STDs past history of STDs prevention of pregnancy
causes of nystagmus
early vision impairment
labyrinth or cerebellar disorder
drug toxicity
wrights hyper abduction test
find pt pulse and abduct above head and add some extension
+ = loss or change of pulse and sx reproduction
-thoracic outlet syndrome with nuerovascular entrapment by pec minor muscle
importance of vitamin B9 (folic acid)
- one carbon transfer rxns
- choline production of amino acids
- purine and pyridine synthesis (thymine )
small steps, feet do leave ground, seen in frontal lobe processes and hydrocephalus
symmetrical abnormal gait: magnetic
4 myth of vaccines
- MMR casuses autism
- ppl with egg allergy cannot get flu vaccine
- vaccines cause the disease
- not getting immunization decreases the overall lifetime risk for the child
level of consciousness that refers to reduction in alertness with slow responses to stimuli, requiring repeated stimulation to maintain attention, as well as having prolonged periods of sleep, and drowsiness between these periods. Causes can include poisoning, stroke, brain edema (swelling), sepsis (a blood infection), and advanced organ failure.
Obtundation
what dx BPPV
dix-hallpike maneuver to observe canaliths movement in semicircular canals
parkisonian tremor
- can be caused by meds that deplete dopamine
- resting tremor
- classic tremor starts as pill-rolling motion of fingers
- bradykinesia includes difficulty rising from a seated position, reduced arm swing while walking, and micrographia
how might papilledema be seen in PE
irregular swollen borders of the optic disc in fundoycopic exam ( the yellowish orange oval seen in the back of the eye)
-associated with increased intracranial pressure
what does SNOOP stand for in identifying a mass, lesion, or metabolic neurological problem
Systemic sx (fever, wt less, cancer, pregnancy, immunocompromised)
Neuro sx (confusion, papilledema)
Onset is new (sudden, “thunder clap”)
Other associated sx (head trauma, drug use, precipitated by sex)
Previous HA history with HA progression or change
what is herd immunity
aka community immunity
- protection is provided to everyone in a community with high vaccination rates
- ppl who are unable to get vaccine, are not fully immunized, are less than 100% effectiveness of vaccine, are still protected because the the vaccination rates are above threshold
- depends on a certain % of population being vaccinated and it differs for each disease
what is blepharitis and how is it indicated
An inflammation of the eyelid that affects the eyelashes or tear production.
- erythema and crusty yellow flakes around the eyelids or eyelash area
- can be associated with contact dermatitis or allergies
what is leukocoria
white reflex in eyes
- serious pathology
- commonly congenital cataract
- also retinal detachment and retinoblastoma
boundaries or thoracic outlet
1st ribs 1 thoracic vertebra and manubrium
good sources of Vitamins E
wheat germ, avocado
seeds and nuts
does UMN or LMN resullt in pyramidal pattern of weakness (wk extensors in arms and flexors in legs)
UMN
LMN = peripheral pattern of weakness (weak arm flexors and leg extensors)
retinal proliferation seen with fundscopic exam may be associated with
HTN or DM
delirium dx
screen with CAM diagnostic algorithm
-common in older adults during hospitalization
if there is a hard sensation or pain when palpating the eyelid what might be indicated
hyperthyroidism
glaucoma
retrobulbar tumor
action tremor: maintaining a position against gravity (i.e. arm elevation)
postural tremor
good sources of Vitamins A
dark green and yellow veggies, tomatoes, eggs, dairy, meat, oily salt water fish
pathologic findings of the cover uncover test for EOM
esotropia- eye turns in
exotropia - eye turns out
*if not treated the affected eye with lose vision
feet crossing over with toes dragged, often seen in CP or MS
symmetrical abnormal gait : scissoring
a state of unresponsiveness, even to stimuli. A person in a coma may lack a gag reflex or a pupillary response. It is caused by severely diminished brain function, usually due to extreme blood loss, organ failure, or brain damage.
coma
nipple dermatome
T4
modest weight loss of ______ % improves blood pressure and decreases insulin resistance
5-10%
drusen bodies seen with fundscopic exam may be associated with
precursor for macular degeneration
Meningococcal and HPV vaccines are given
to older children
pain and temp testing for
spinothalamic tract
good sources of iron
dark leafy veggies, broccoli, cauliflower, nuts, lentils, tofu , prunes,
costoclavicular test (military/ halstead test)
find pt pulse, elbow extended and supinated and shoulder extended, apply caudal pressure on shoulder
+ = loss/ change of pulse or sx reproduction
-indicates TOS with neuromuscular entrapment between 1st rib and clavicle
importance of vitamin B1 (thiamine)
carb and amino acid metabolism
1/2 cup fits __
in the palm of the hand
lesions of cranial nerve IX results in
loss of gag reflex
loss pf sensation in pharynx and posterior 1/3 tongue
slight dysphagia
structures in thoracic outlet
subclavian A and V, thoracic duct, and brachial plexus
whitish linear (lipid deposition) encircling the colored iris
arcus senilis
- common in pt over 60
- if seen in under 40 check cholesterol levels
hangmans fracture
hyperextension injury –> C2 bilateral arch fracture
importance of vitamin E
ROS scavenger (antiox)
little finger dermatome
C8
waddling pelvis indicates what
asymmetrical abnormal gait from myopathic disease
proprioception, 2 pt tactile discrimination and vibratory testing for
posterior columns
positive kernigs sign indicates
meningeal / dural irritation
(pt supine and flex hip and knee to 90 degrees passively, + = increases resistance to extension and pain behind the knee)
proptosis and exopthlmos might indicated what
hyperthyroidism
phases of nystagmus
jerk nystagmus has 2 phases: (1) a slow phase drift from the target of interest, followed by (2) a corrective saccade (fast phase) back to the target.
action tremor: muscle contraction against a rigid stationary object (i.e. making a fist)
isometric tremor
abnormal plantar response indicates
babinski sign with big toe extension = UMN dysfunction
2/5 vs 3/5 vs 4/5 vs 5/5 strength documentation
2/5 = active movement with no gravity
3/5 = full ROM against gravity, no resistance
4/5 = full ROM against gravity and with some resistance. some movement at joint
5/5= full ROM against gravity and full resistance, no movement at joint
clay shovelers fracture
C6 or C7
brief episodes of intermittent dizziness lasting seconds to hours with common triggers of head motion or body change position
episodic triggered symptoms: most likely benign paroxysmal positional vertigo (BPPV)
(other possible is orthostatic hypotension)
importance of vitamin C
anti ox,
collagen, bile acid, and neurotransmitter synthesis
what is the patient at risk for if the eyelids do not close completely
corneal abrasions
