PCM Midterm Material Flashcards
What are the 6 positions for a physical examination?
Standing
Sitting
Supine - patient’s back is down
Prone - patient’s stomach is down
Left lateral recumbent - patient’s left side is down
Right lateral recumbent - patient’s right side is down
What are the 4 techniques of an examination?
Inspection - Assess appearance of age, posture, mobility, asymmetry, color changes.
Palpation - Performed with your hands.
Percussion - Note difference when percussing over a hollow organ vs. bone.
Auscultation - Performed with stethoscope; listen to lung, heart, GI, vascular sounds.
What are the steps in performing an eye examination?
- Have patient look over examiner’s shoulder. Place hand NOT holding ophthalmoscope on patient’s forehead.
- Hold ophthalmoscope in RIGHT hand and use RIGHT eye to examine patient’s RIGHT eye (then switch to LEFT hand, LEFT eye, and patient’s LEFT eye).
- Move light lateral to medial —> then move toward patient.
- Identify direct & consensual pupillary light reflex, as well as red reflex.
- PERFORM BILATERALLY.
What is the difference between a DIRECT and CONSENSUAL pupillary light reflex?
Direct Pupillary Light Reflex - Light shined in eye, that eye constricts.
Consensual Pupillary Light Reflex - Light shined in eye, both eyes constrict.
Sara is performing a “robust” eye examination on Matt. While holding the Snellen Eye Chart 14 inches from his face, Sara instructs Matt to cover his right eye. After assessing the other eye as well (because we always do bilaterally), Sara informs Matt that he has 20/80 vision.
What does this mean?
Matt is blind…no, it means that Matt must stand at 20 feet to see what a “normal” person sees at 80 feet.
How do you place the ear of an adult and child when performing an examination? Which instrument is used for this examination?
Adult - Up, Out, Back
Child - Down, Out, Back
Otoscope
Matt is performing DTRs of the UE. Of the 3 that are performed, with which DTR will Matt actually strike his own thumb? What are the other 2 UE DTRs?
Biceps DTR is performed with the physician striking their thumb.
The other 2 UE DTRs are: Brachioradialis and Triceps.
SD Mark is performing a BP check on an old fart. While holding their arm at the level of the heart, where would he place the diaphragm of the stethoscope for optimal listening? Which Korotkoff sounds corresponds with systolic and diastolic numbers?
Place the diaphragm just below the cuff over the BRACHIAL artery.
1st Korotkoff sound = Systolic
Last Korotkoff sound = Diastolic
What are the 5 locations for DTRs and their corresponding dermatomes?
Biceps - C5
Brachioradialis - C6
Triceps - C7
Patellar - L4
Achilles - S1
What are the 5 BP Classifications?
Normal = <120/80 Prehypertension = 120-139/80-89 Stage 1 Hypertension = >140/90 Stage 2 Hypertension = >160/100 Hypertensive Crisis = >180/120
Matt, Sara, and Mark are taking a lovely trip to the local CVS (for the 2nd time), where they decide to have some fun with the BP Monitor near the pharmacy. Matt’s reading is 118/80, Sara is 143/90 and Mark is 162/100. Which BP classifications would these three fall into?
Matt = Normal (<120/80) Sara = Stage 1 Hypertension (>140/90) Mark = Stage 2 Hypertension (>160/100)
What are the 5 Classifications for BMI?
Underweight = <18.5 Normal = 18.5-24.9 Overweight = 25.0-29.9 Obese Type 1 = 30.0-34.9 Obese Type 2 = 35.0-39.9 Extreme Obesity = > or equal 40
While Dr. Bigelow is waiting for her new patient to enter the exam room, she notices that he is shuffling his feet? This gait could be indicative of which of following?
A. Stroke
B. CHF
C. Parkinson’s
D. Agitation
C. Parkinson patient typically shuffle their feet.
What percent of the gait cycle is stance and swing, respectively?
Stance = 60% and Swing = 40%
SD Rose is working at Score One by assessing student posture. As part of this examination, he’s asked to look at the lateral gravitational line (boring, we know). Nonetheless, what are the 7 lateral gravitational line landmarks from cranial to caudal?
- External auditory canal/meatus
- Lateral head of the humerus
- Third lumbar vertebra
- Anterior 1/3 of sacrum
- Greater trochanter of the femur
- Lateral condyle of the knee
- Lateral malleolus
Define the following terms:
- Mono-articular
- Poly-articular
- Extra-articular
- Myalgia
- Arthralgia
Mono-articular - one joint Poly-articular - multiple joints Extra-articular - bones, muscles, tendons, bursa, skin Myalgia - muscle pain Arthralgia - joint pain
Define the following terms:
- Tendonitis
- Bursitis
- Tenosynovitis
- Sprain
- Strain
- Effusion
Tendonitis - inflammation of the tendon Bursitis - inflammation of the bursa Tenosynovitis - inflammation of the tendon sheath Sprain - ligament injury Strain - muscular injury Effusion - fluid in the joint
What is the difference between subluxation and dislocation?
Subluxation - residual contact between 2 articular surfaces.
Dislocation - COMPLETE LACK OF CONTACT between 2 articular surfaces.
What is another name for Genu Valgus? Genu Varum?
Genu Valgus = Knock Knees
Genu Varum = Bowlegs
What is the scale for assessing DTRs (Deep Tendon Reflexes)?
0/4 = No response. 1+/4 = Somewhat diminished, low normal. 2+/4 = Average, normal. 3+/4 = Brisker than average, possibly but not necessarily indicative of disease. 4+/4 = Very brisk, hyperactive, WITH CLONUS (rhythmic oscillation b/t flexion and extension)
What is the scale for assessing Muscle Strength?
\+0/5 = No muscular contraction detected. \+1/5 = Barely detectable flicker/trace of contraction. \+2/5 = Active movement with GRAVITY ELIMINATED. \+3/5 = Active movement AGAINST GRAVITY. \+4/5 = Active movement AGAINST GRAVITY and SOME RESISTANCE. \+5/5 = Active movement AGAINST GRAVITY and FULL RESISTANCE. (Normal Muscle Strength)
What is assessed during a capillary refill test? Which conditions could indicate inadequate refill time?
Tests digital perfusion
Inadequate refill time could be indicated by:
- Arterial occlusion
- Hypovolemic Shock
- Hypothermia
What is the scale for assessing pulses? What is considered a normal pulse?
0/4 = Absent, not palpable. \+1/4 = Diminished, barely palpable. \+2/4 = Average intensity, expected, normal. \+3/4 = Strong, full, increased. \+4/4 = Bounding.
NORMAL = +2/4
Where are the 3 locations for assessing edema? What is the scale for assessing edema?
3 Locations:
- Dorsum of foot
- Anterior tibia
- Behind medial malleolus
0 = Absent 1+ = Barely detectable, slight pitting (2mm); disappears rapidly 2+ = Slight indentation (4mm); 10-15 seconds 3+ = Deeper indentation (6mm); > 1 minute 4+ = Very marked indentation (8mm); 2-5 min
SD Godin is at Score One, wherein he’s assigned the task of assessing the upper extremities of each student. After inspecting, palpating, checking ROM (active/passive), and performing a few specialty tests, he realizes there are 2 other steps to assessing extremities. What are those two extra steps?
Here’s the order for assessing extremities:
Inspection Palpation ROM (Active/Passive) Specialty Testing REFLEXES NEUROVASCULAR TESTING - Neuro = Motor/sensory - Vascular = Pulses/Cap Refill - Notes: Always check DISTAL to the injury!
What are the 4 muscles of the Rotator Cuff? Which one is NOT palpable?
SITS
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis (Not Palpable)
What are the Shoulder Range of Motion (ROM) Values?
Flexion Extension Abduction Horz. Abudction Horz. Adduction Ext. Rotation / Int. Roation
Flexion - 180 Degrees Extension - 60 Degrees Abduction - 180 Degrees Horz. Abudction - 130-145 Degrees Horz. Adduction - 130-140 Degrees Ext. Rotation / Int. Rotation - 90 Degrees
What are the 2 special tests for Glenohumeral Instability? What is a positive finding?
- Apprehension Test. (+) Test = Patient apprehensive of repeat dislocation.
Indicates - Glenohumeral instability. - Sulcus Sign. (+) Test = Indention appears in area beneath acromion.
Indicates - Glenohumeral instability.
What are the 2 special tests for Bicipital Tendon Pathology? What is a positive finding?
- Yergason’s Test. (+) = Pain and/or tendon subluxation out of groove.
Indicates - Unstable bicipital. - Speed’s Test. (+) = Pain in the bicipital groove.
Indicates - Bicipital tendonitis of longhead biceps.
What are the 2 special tests for Rotator Cuff Pathology? What are the positive findings?
- Empty Can Test. (+) = Pain or weakness.
Indicates - Rotator cuff pathology (specifically supraspinatus). - Drop-Arm Test. (+) = Arm will drop or gentle tap on wrist will cause arm to drop.
Indicates - Full thickness tear of supraspinatus.
What are the 3 special tests for Rotator Cuff Impingement? What are the positive findings?
- Painful Arc Test. (+) = Pain elicited within 60-120 degrees of shoulder abduction.
Indicates - Subacromial impingement and/or rotator cuff pathology. - Neer Impingement. (+) = Pain
Indicates - Subacromial bursa or rotator cuff impingement. - Hawkins Test. (+) = Pain
Indicates - Rotator Cuff or subacromial bursa impingement.
What is the special test for assessing the Subscapularis?
Lift Off Test. (+) = Weakness (inability to resist).
Indicates - Subscapularis weakness.
What is the special test for the Acromioclavicular joint?
Cross Arm Test. (+) = Pain in AC joint with end range adduction.
Indicates - AC Joint Pathology.
What is the special test for Range of Motion (Shoulder OSCE)?
Apley Scratch Test.
What is the normal carrying angle in males? Females?
What is Cubitus Varus vs. Cubitus Valgus?
Normal carrying angle males = 5 degrees
Normal carrying angle females = 10-15 degrees
Cubitus Varus = <5 degrees (ADDUCTION of ulna)
Cubitus Valgus = >15 degrees (ABDUCTION of ulna)
SD Bigelow is examining a drug abusing patient with a c/c of hand pain. Upon further examination, it appears that he hurt his snuffbox (le sigh). Just then, the patient asks SD Bigelow to explain the “snuffxbox”.
SD Bigelow says that it’s bound by ________ on the medial, lateral, and proximal border respectively.
Anatomic Snuffbox
Medial Border - Extensor Pollicus Longus
Lateral Border - Extensor Pollicus Brevis, ABductor Pollicus Longus
Proximal Border - Radial Styloid Process
What are the normal Range of Motion (ROM) values for the Elbow?
Flexion
Extension
Supination
Pronation
Flexion - 140-150 Degrees
(Biceps Brachii, Brachialis, Brachioradialis, Coracobrachialis)
Extension - 0 to -5 Degrees
(Triceps Brachii, Anconeus)
Supination - 90 Degrees
(Supinator, Biceps Brachii)
Pronation - 90 Degrees
(Pronator Teres, Pronator Quadratus)
What are the normal Range of Motions (ROM) for the Wrist/Hand?
Flexion
Extension
Adduction
Abduction
Flexion = 80-90 Degrees
Extension = 70 Degrees
Adduction (Ulnar Deviation) = 30-40 Degrees
Abduction (Radial Deviation) = 20-30 Degrees
What are the normal Range of Motions (ROM) for the Hip?
Flexion (Knee Straight) Flexion (Knee Flexed) Extension Internal Rotation External Rotation ABduction w/ Knee Extended ADduction w/ Knee Extended
Flexion (Knee Straight) = 90 Degrees
Flexion (Knee Flexed) = 120-135 Degrees
Extension = 15-30 Degrees
Internal Rotation = 30-40 Degrees
External Rotation = 40-60 Degrees
ABduction w/ Knee Extended = 45-50 Degrees
ADduction w/ Knee Extended = 20-30 Degrees
What are the 5 special tests for the Central Compartment of the Hip?
- C-Sign. (+) = Patient points to source of pain with 2 fingers/cups above trochanter.
Indicates - Labral pathology. - Labral Loading. (+) = Pain
Indicates - Labral or cartilaginous pathology. - Labral Distraction. (+) = Improvement of pain.
Indicates - Labral or cartilaginous pathology. - Scour Test. (+) = Pain.
Indicates - Labral or articular cartilage pathology. - Apprehension FABER 1 of 3. (+) = Anterior subluxation of hip or apprehension/pain.
Indicates - Labral pathology. Can also be positive with impingement.
What is the ONE special test for the Peripheral Compartment?
Rectus Femoris Test. (+) = Knee Flexion < 90 Degrees
Indicates - Rectus Femoris Contraction
What are the 4 special tests for the Lateral Compartment?
- Jump Sign. (+) = Patient withdraws/jumps with pressure.
Indicates - Trochanteric Bursitis - Straight Leg Raise Test. (+) = Pain over lateral leg, especially at > 15 Degrees.
Indicates - IT Band Contracture
30-60 Degrees = Lumbosacral radiculopathy/sciatic neuropathy
> 70 Degrees = Mechanical lower back pain from muscle strain/joint disease - Piriformis Test. (+) = Pain over posterior aspect of greater trochanter.
Indicates - Piriformis spasm or pathology. - Patrick FABER 2 of 3. (+) = Pain or weakness.
Indicates - Gluteus Medius pathology.
What are the 2 special tests for the Anterior/Illiopsoas Compartment?
- Patrick Faber 3 of 3. (+) = Anterior or medial groin pain/weakness.
Indicates - Illiopsoas insufficiency or pathology. - Thomas Test. (+) = Inability to fully extend or extended leg raises off table.
Indicates - Hip flexor contraction.
What are the major muscles associates with:
Hip Flexion
Hip Extension
Hip ABduction
Hip ADduction
Hip Flexion - Iliopsoas
Hip Extension - Gluteus Maximus
Hip ABduction - Gluteus Medius, Gluteus Minimus
Hip ADduction - Adductor Longus
What are the 3 structures of the Hip Central Compartment?
Labrum
Ligamentum Teres
Articular Surfaces
What are the 2 structures of the Peripheral Hip Compartment?
Femoral Neck
Synovial Lining
What are the 5 structures of the Lateral Hip Compartment?
Gluteus Medius Gluteus Minimus Piriformis IT Band Trochanteric Bursae
What are the 2 structures of the Anterior Hip Compartment?
Iliopsoas Insertion
Iliopsoas Bursae
