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Hannah OS2 final May 2019 > PCM final > Flashcards

PCM final Flashcards

1
Q

relevant past medical history as it relates to the eye

A 
glaucoma 
diabetes
thyroid disease
ASCD (atherosclorisis) 
collagen vascular disease
HIV
IBD

hi cat dg !!!!

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2
Q

thumb dermatome

A

C6

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3
Q

define dysarthria

A

defective articulation (usually caused by duct in motor control of speech apparatus)

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4
Q

illiopsoas muscle test

A

-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

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5
Q

___ can inhibit the absorption of heme and non-heme iron

A

calcium

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6
Q

Adsons Test

A

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)
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7
Q

what does scaly skin around the eyebrows indicate

A

seborrheic dermatitis

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8
Q

what are non conjugated inactivated or killed vaccines ? example>

A

organisms is carefully killed (thermally or chemically) before injection

  • imunogenticity is retained
  • ex: hep A, polio, rabies
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9
Q

what are live attenuated vaccines ? examples

A
  • 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
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10
Q

good sources of Vitamins B1 (thiamin)

A

legumes, lean pork, enriched grains

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11
Q

___ 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.

A

lethargy

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12
Q

when are booster vaccines given

A

4-6 years old

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13
Q

coordination (cerebellar testing)

A

finger- to -nose (dysmetrria and dyspraxia of voluntary movement)

finger-to - finger (postion sense and labyrinth eval)

heel- to - shin

rapid alternating movements

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14
Q

gait is all over the place as if the patient is falling but does not fall and is usual caused by psychogenic idiopaths

A

symmetrical abnormal gait : astasia-abasia (functional)

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15
Q

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

A

kinetic red target test for visual field confrontation

**use with finger wiggle test for high specificity for visual field loss

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16
Q

importance of vitamin B3 (niacin)

A

oxioreductases NAD and NADP

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17
Q

what diseases are in the differential dx with spontaneous episodic symptoms are present with dizziness

A

unilateral hearing loss - menieres dz
migraine associated - vestibular migraine
anxiety associated - psych disorder

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18
Q

anal wink reflex

A

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
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19
Q

elimate what dx before dx dementia

A

depression and delirium

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20
Q

squamous cell and basal cell carcinoma in the eye region can be see with

A

scabs and new skin lesions around the eyelids and eye lashes

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21
Q

coordination of muscle movement involves input from what 4 systems

A
  1. motor (strength)
  2. cerebellar (rhythmic movement and steady posture)
  3. vestibular ( balance and eye coordination)
  4. sensory ( position sense)
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22
Q

good sources of Vitamins B2 (riboflavin)

A

wheat germ , leafy veggies

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23
Q

postive stork test indicates

A

posible pars defect or stress fracture

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24
Q

change in elasticity in periorbital area (eye examination)

A

lipoatrophy or lipohypertrophy from topical meds

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25
Q

importance of vitamin B6 (pyridoxine)

A

carb amino acid and lipid metabolism

neurotransmitter, sphingolipids, and heme synthesis

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26
Q

resting tremor vs action tremors

A

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

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27
Q

what does TiTrATE the evaluation of dizziness mean

A

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

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28
Q

what is a contraindication to dilating pupils (mydriasis)? and what might dilating these patients do

A

NEVER for shallow anterior chambers

-may induce acute angle -closure glaucoma

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29
Q

dizziness that increases with motion is common to ____

A

both peripheral and central causes

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30
Q

gaenslen test

A

-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

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31
Q

what medicines have ocular side effects

A 
steroids
plaquenil 
antihistamines
antidepressants 
antipsychotics
antiarrhythmics
beta blockers

Baps!!!

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32
Q

importance of iron

A

hemoglobin
myoglobin
cytochromes a, b, c

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33
Q

light touch testing for

A

spinothalamic and posterior columns

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34
Q

associated symptoms to screen for with eye complaints

A 
pain 
drainage 
itching
burning 
vision change 
blurry vision 
flashing lights
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35
Q

what are toxoid vaccines ?

A

vaccines with the sub-unit antigen or inactivated toxin

-includes parts that best stimulate the immune response

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36
Q

optic disc cupping might be associated with

A

glaucoma

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37
Q

jefferson fracture

A

axial compression –> C1 fracture

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38
Q

good sources of calcium

A

dark leafy veggies, tofu, broccoli, cauliflower, flax seeds, beans, lentils, dairy

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39
Q

___ 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).

A

stupor

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40
Q

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

A

vertigo

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41
Q

_____ is sometimes palpable through the eyelid. what is it?

A

chalazion (A slow-growing, inflammatory lump in the tear gland of the eyelid)

  • blocks meibomian gland
  • nontender and nonpainful unless inflammed
  • in the LID
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42
Q

lesions of cranial nerve X results in

A

dysphonia
dysphagia
dyspnea
loss of gag / cough reflex

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43
Q

decorticate vs decerebrate posturing

A

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

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44
Q

what is chorea

A

a neurological disorder characterized by jerky involuntary movements affecting especially the shoulders, hips, and face.

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45
Q

abdominal reflex

A

test all 4 quadrants stroking abdomen causes umbilicus to move toward area of stimulation
-if absent = abnormal superficial tendon reflex of T10-12

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46
Q

+ Roos or EAST test indicates

A

thoracic outlet syndrome with compression of the subclavian A.

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47
Q

good sources of Vitamins D

A

mushrooms

fortified milk, OJ, cod liver oil, fish, egg, yolk

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48
Q

vertigo paired with abnormal gait and tendency to fall to affected side, and horizontal nystagmus to affected side

A

vestibular neuritis

-tx with anti-emetic, anti-histamine, or benzos

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49
Q

nuchal rigidity, and brudzinski’s test indicates

A

inflammation in subarachnoid space (meningitis or subarachnoid hemorrhage)

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50
Q

what are conjugated vaccines ?

A

pathogens are surrounded by a polysaccharide capsule and are immunogenic

  • t-cell dependent immunity to polysaccharides is triggered
  • strengthens immune memory
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51
Q

heel strike test

A

possible appendicitis or peritonitis

-+ = ab pain

52
Q

3+ vs 4+ DTR documentation

A 
3 = brisk, spread to involve movement across more than one joint 
4= hyperactive with clonus
53
Q

what is indicated by purulence in the conjunctivita

A

“pink eye” -conjunctivitis

54
Q

importance of vitamin B2 (riboflavin)

A

oxioreductases FMN and FAD

55
Q

what would a brown tint in the cornea be indicative of

A

hyphema - blood from trauma in the anterior chamber

56
Q

what is most common vertigo cause in kids

A

vestibular migraine

57
Q

importance of vitamin B12 (cobalamin)

A
  • heme structure

- folate recycling

58
Q

obturator muscles test

A
  • 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
59
Q

psychogenic tremor traits that differ from tremor of organic origin

A

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
60
Q

courvoisers sign

A

enlarged non tender gallbladder

-indicates pancreatic disease or cancer

61
Q

types of headache

A

tension
migraine
cluster

62
Q

what is the “extremely busy” time period for vaccinations of children

A

birth to 24 months

63
Q

cotton wool spots seen with fundscopic exam may be associated with

A

vascular disease from HTN or DM

64
Q

what does A&O x 3 mean ? A&O x 4?

A 
"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

65
Q

positive valsalva test indicates

A

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

66
Q

what is a hordeolum and how is it different than a chalazion

A

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
67
Q

straight leg test

A

pain between 30-60 degrees = lumbosacral radiculopathy or sciatic neuropathy

  • > 70 = LBP to muscle strain
  • > 15 = IT band contracture
68
Q

signs and history that suggest parkinson’s disease

A
  • 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
69
Q

action tremor associated with voluntary movement and includes intention tremor which is produced with target direct movement (i.e. reaching for a pen)

A

kinetic tremor

70
Q

high steppage, broad based gait seen with posterior column damage and peripheral neuropathy

A

symmetrical abnormal gait: sensory ataxia

71
Q

rash in the periorbital region of the face that extends to the hairline might indicate what

A

herpes zoster (shingles)

72
Q

big toe and little toe dermatome

A

big toe = L 5

little toe = S1

73
Q

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

A

occipital neuralgia

74
Q

importance of vitamin A

A

vision
baby development
skin integrity
cell growth, proliferation, differentiation

75
Q

when would you do inversion of the upper eyelid during examination

A
  • not rountine

- only if concerned about foreign body being stuck

76
Q

5 “P”s of Sexual history interviewing

A 
partners
practices
protection from STDs
past history of STDs
prevention of pregnancy
77
Q

causes of nystagmus

A

early vision impairment
labyrinth or cerebellar disorder
drug toxicity

78
Q

wrights hyper abduction test

A

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

79
Q

importance of vitamin B9 (folic acid)

A
  • one carbon transfer rxns
  • choline production of amino acids
  • purine and pyridine synthesis (thymine )
80
Q

small steps, feet do leave ground, seen in frontal lobe processes and hydrocephalus

A

symmetrical abnormal gait: magnetic

81
Q

4 myth of vaccines

A
  1. MMR casuses autism
  2. ppl with egg allergy cannot get flu vaccine
  3. vaccines cause the disease
  4. not getting immunization decreases the overall lifetime risk for the child
82
Q

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.

A

Obtundation

83
Q

what dx BPPV

A

dix-hallpike maneuver to observe canaliths movement in semicircular canals

84
Q

parkisonian tremor

A
  • 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
85
Q

how might papilledema be seen in PE

A

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

86
Q

what does SNOOP stand for in identifying a mass, lesion, or metabolic neurological problem

A

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

87
Q

what is herd immunity

A

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
88
Q

what is blepharitis and how is it indicated

A

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
89
Q

what is leukocoria

A

white reflex in eyes

  • serious pathology
  • commonly congenital cataract
  • also retinal detachment and retinoblastoma
90
Q

boundaries or thoracic outlet

A

1st ribs 1 thoracic vertebra and manubrium

91
Q

good sources of Vitamins E

A

wheat germ, avocado

seeds and nuts

92
Q

does UMN or LMN resullt in pyramidal pattern of weakness (wk extensors in arms and flexors in legs)

A

UMN

LMN = peripheral pattern of weakness (weak arm flexors and leg extensors)

93
Q

retinal proliferation seen with fundscopic exam may be associated with

A

HTN or DM

94
Q

delirium dx

A

screen with CAM diagnostic algorithm

-common in older adults during hospitalization

95
Q

if there is a hard sensation or pain when palpating the eyelid what might be indicated

A

hyperthyroidism
glaucoma
retrobulbar tumor

96
Q

action tremor: maintaining a position against gravity (i.e. arm elevation)

A

postural tremor

97
Q

good sources of Vitamins A

A

dark green and yellow veggies, tomatoes, eggs, dairy, meat, oily salt water fish

98
Q

pathologic findings of the cover uncover test for EOM

A

esotropia- eye turns in
exotropia - eye turns out
*if not treated the affected eye with lose vision

99
Q

feet crossing over with toes dragged, often seen in CP or MS

A

symmetrical abnormal gait : scissoring

100
Q

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.

A

coma

101
Q

nipple dermatome

A

T4

102
Q

modest weight loss of ______ % improves blood pressure and decreases insulin resistance

A

5-10%

103
Q

drusen bodies seen with fundscopic exam may be associated with

A

precursor for macular degeneration

104
Q

Meningococcal and HPV vaccines are given

A

to older children

105
Q

pain and temp testing for

A

spinothalamic tract

106
Q

good sources of iron

A

dark leafy veggies, broccoli, cauliflower, nuts, lentils, tofu , prunes,

107
Q

costoclavicular test (military/ halstead test)

A

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

108
Q

importance of vitamin B1 (thiamine)

A

carb and amino acid metabolism

109
Q

1/2 cup fits __

A

in the palm of the hand

110
Q

lesions of cranial nerve IX results in

A

loss of gag reflex
loss pf sensation in pharynx and posterior 1/3 tongue
slight dysphagia

111
Q

structures in thoracic outlet

A

subclavian A and V, thoracic duct, and brachial plexus

112
Q

whitish linear (lipid deposition) encircling the colored iris

A

arcus senilis

  • common in pt over 60
  • if seen in under 40 check cholesterol levels
113
Q

hangmans fracture

A

hyperextension injury –> C2 bilateral arch fracture

114
Q

importance of vitamin E

A

ROS scavenger (antiox)

115
Q

little finger dermatome

A

C8

116
Q

waddling pelvis indicates what

A

asymmetrical abnormal gait from myopathic disease

117
Q

proprioception, 2 pt tactile discrimination and vibratory testing for

A

posterior columns

118
Q

positive kernigs sign indicates

A

meningeal / dural irritation

(pt supine and flex hip and knee to 90 degrees passively, + = increases resistance to extension and pain behind the knee)

119
Q

proptosis and exopthlmos might indicated what

A

hyperthyroidism

120
Q

phases of nystagmus

A

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.

121
Q

action tremor: muscle contraction against a rigid stationary object (i.e. making a fist)

A

isometric tremor

122
Q

abnormal plantar response indicates

A

babinski sign with big toe extension = UMN dysfunction

123
Q

2/5 vs 3/5 vs 4/5 vs 5/5 strength documentation

A

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

124
Q

clay shovelers fracture

A

C6 or C7

125
Q

brief episodes of intermittent dizziness lasting seconds to hours with common triggers of head motion or body change position

A

episodic triggered symptoms: most likely benign paroxysmal positional vertigo (BPPV)
(other possible is orthostatic hypotension)

126
Q

importance of vitamin C

A

anti ox,

collagen, bile acid, and neurotransmitter synthesis

127
Q

what is the patient at risk for if the eyelids do not close completely

A

corneal abrasions

Hannah OS2 final May 2019 (2 decks)

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