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PCM > PCMII Midterm > Flashcards

PCMII Midterm Flashcards

1
Q

What goes in the S portion of the SOAP note?

A 
CC
OLDCAAARTS
PMH, PSH
Meds, Alls
SH, FH
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2
Q

What goes in the O portion of soap note?

A

VS

Heart, Lungs, OSE

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3
Q

What is in O portion of a SOAP note?

A

CC: x3 diff diagnosis

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4
Q

What goes in the P portion of the SOAP note?

A 
Any OMT done or planned
Any med recommendations
Followup
Immunizations
Life style changes
Screenings
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5
Q

Who is given the influenza vaccine?
What type of vaccine do pregos get?
What type do >65 y/o get?

A

Give vaccine >6 months old
Pregos- inactivated influenza vaccine
>65 y/o- high does inactivated

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6
Q

How many doses of Tdap do you give?
When do you give boosters?
What about pregos?

A

One dose of Tdap
Booster every 10 years of TD
Tdap for every pregnancy

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7
Q

How many doses of varicella vaccine?
Who is contraindicated?
When do you give varicella zoster shot?

A

2 doses of varicella unless you have chickenpox
Don’t give to pregos or immunocompromised pt
Give varicella zoster at age 60

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8
Q

When do you begin giving HPV vaccines?
How many doses?
When do you stop for males and females?

A

Begin at age 11
3 doses
Male-21
Female-26

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9
Q

Who do you give the pneumococcal vaccine to?

When do you give the second dose?

A

Age 65, smokers, living in nursing home, or kidney problems

Second dose 5 years after vaccine

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10
Q

Who do you give the Hep A vaccine to?

Who do you give the Hep B vaccine to?

A

Hep A- homosexual males or travel to area affected by hep A

Hep B- health care workers

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11
Q

Who do you screen for abdominal aortic aneurysm?

A

Age 65-74 if they ever smoked

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12
Q

Who do you screen for alcohol misuse?

What do you provide?

A

Screen >18 y/o

Provide behavioral counseling

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13
Q

When do you begin mammograms?

How often?

A

Start at age 50, then every 2 years until 75 y/o

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14
Q

When do you begin and stop doing pap smears?

A

Begin at age 21 and do every 3 years until 65

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15
Q

At what ages do you screen for colorectal cancer?

A

Age 50-75

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16
Q

Who do you screen for diabetes?

A

Age 40-70 if overweight

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17
Q

What age do you screen for HIV?

A

Age 15-65

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18
Q

What is the order of the physical exam for an abdominal exam?

A

Inspect
Auscultate
Percuss
Palpate

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19
Q

What are the 4 quadrants of the abdomen?

What are the 9 regions?

A

Quadrants- R and L upper and lower

Regions-R and L hyochondriac and epigastric, R and L lumbar and umbilical, R and L iliac and hypogastric

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20
Q

What is Grey Turners sign?

What is Cullen Sign?

A

Grey Turner- ecchymosis around the flank

Cullen sign- ecchymosis around the umbilicus

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21
Q

What do striae possibly indicate?

A

Cushings syndrome

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22
Q

What does caput medusae indicate?

A

Portal hypertension

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23
Q 
Auscultation of abdomen:
How frequent are normal bowel sounds?
What does absent sounds indicate?
What do dec soudns indicate?
What do inc sounds indicate?
What do high pitched sounds indicate?
A 
Normal- 5 to 34 clicks per minute
Absent sounds- obstruction or ischemia
Dec sounds- peritonitis
Inc sounds- diarrhea 
High pitched- early obstruction
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24
Q

When ascultating the abdomen what vasculature do you listen do?

A

Renal, abdominal aorta, common iliac, and femoral

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25
Q

Tympanic percussion =
Dullness percussion =
Resonant percussion =
Hyperresonant percussion =

A

Tympanic- air filled
Dull- solid
Resonant- hallow organ
Hyperresonant- pneumothorax

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26
Q

Explain percussion of liver?

Explain percussion of the spleen?

A

Liver- 6-12 cm at R mid clavicular line

Spleen- left ribs 6-12 at mid axillary line

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27
Q

What is rebound tenderness of palpation? What does it indicate?

A

Pain when releasing pressure

Peritoneal inflammation

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28
Q

What is abdominal ridigity and what causes it?

A

Hard abdomen due to involuntary abdominal contraction

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29
Q

What is Rovsings sign? What does it indicate

A

RLQ pain when applying P on L side

Indicates appendicitis

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30
Q

Where is mcburneys point?

A

1/3 of way from ASIS to umbilicus and indicates where appendix is usually located

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31
Q

What is murphys sign of the gallbladder?

A

When palpating R costal margin for gallbladder it is pain or cessation of inhalation and indicates acute cholecystitis

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32
Q

What is Courvosiers sign of the gallbladder?

A

Palpate large non tender gallbladder

Indicates pancreatic cancer

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33
Q

What are shifting oulines for ascites?

A

Percuss from tympany to dullness supine then lateral recumbent and if borders change so tympany is on top then it may be ascites

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34
Q

What is fluid wave of ascites?

A

Assistant places ulnar aspects along midline at top and bottom
Then tap flank on one side and feel for impulse on other side
If other side impulse is felt then maybe ascites

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35
Q

What is the Psoas test for abdomen? What does a positive test indicate?

A

Flex hip against R

If abdominal pain then appendicitis

36
Q

What is the obturator test for abdomen? What does a positive test indicate?

A

Flex hip and knee over opposite knee

Pain may indicate appendicitis

37
Q

What is lloyds punch and what does it indicate?

A

Apply force on posterior aspect of kidney region

Pain indicates kidney infeciton

38
Q

What does a positive heel strike test indicate?

A

Appendicitis

39
Q

What does chovsket sign indicate? What is it?

A

Tap facial nerve and it triggers facial muscle twitches

Indicates hypocalcemia/hypoparathyroidism

40
Q

What is trousseaus sign and what does it indicate?

A

Inflate BP cuffs leads to muscle spasm

Indicates hypocalcemia/hypoparathyroidism

41
Q

Bones, groans, and stones are complaints associated with?

A

Hypercalcemia/hyperparathyroidism

42
Q

What are thyroid hormone levels associated with hypothryoidism vs hyperthryoidism

A

Hypo- elevated TSH and low T4 T3

Hyper- low TSH and high T4 and T3

43
Q

What are some signs and symptoms of cushings disease?

A

Moon face, buffalo hump, trunk obesity, striae

44
Q

Explain mechanics of OA, AA, and typical C spine

A

OA- modified type 1 (main F/E)
AA- rotation only
Typical C spine- modified type II and I

45
Q

What makes the anterior and posterior triangle of the neck

A

Ant triangle- SCM, mandible, midline

Post triangle- SCM, traps, clavicle

46
Q

When palpating the thryoid
Soft indicates
Firm indicates
Tender indicates

A

Soft- GD
Firm- hashimotos
Tender- thyroiditis

47
Q

What is ROM of C spine

A

Flex- 45-90
Extend- 70-90
Rotate 70-90
SB- 20-45

48
Q 
Explain muscle strength testing of:
C1
C2-4
C5
C6
C7
C8
T1
A 
C1- rotate head
C2-4- elevate scapula
C5- abduct shoulders
C6- flex elbow and extend wrist
C7- extend elbow and flex wrist
C8- flex finger
T1- abduct finger
49
Q

Explain dermatomes from C1- T1

A 
C1-4 from head to shoulder
C5- shoulder and upper arm
C6- lateral forearm and 6 shooter
C7- middle finger
C8- medial forearm
T1- medial upper arm
50
Q

DTR spinal n.
Biceps
Brachioradialis
Triceps

A

Biceps- C5
Brachioradialis- C6
Triceps- C7

51
Q

What is a compression neuropathy?

A

MSK or myofascial tissue is compressing a nerve leading to pain and paresthesia

52
Q

What is the compression, distraction, and spurling test? What may it indicate?

A

Compression- axial load
Distraction- relieve pain
Spurlings- compress in neutral, extension, and SB/rotated

53
Q

What are the boundaries of the thoracic outlet?

A

Manubrium, t1, and first rib

54
Q

What is found within the thoracic outlet?

A

Brachial plexus, subclavian a/v

55
Q

What are the zones of the thoracic oulet?

A

Scalene triangle
Costoclavicular space
Retropectoralis minor

56
Q

What is the EAST test? What may it indicate

A

Abduct and externally rotate shoulders 90 and flex elbow 90
Then open and close fist for 3 min
Pain may indicate compressed subclavian a

57
Q

What is adson test? What may it indicate?

A

Abduct, extend, and externally rotate arm while monitoring radial pulse
Have patient look at arm to evaluate rib
have patient look forward to evaluate scalene
Indicates one is compressing subclavian a

58
Q

What is wrights hyperabduction test? What does it indicate

A

Abduct shoulder fully and apply some extension while monitoring radial pulse for any change
Indicates pec minor compression of thoracic outlet

59
Q

What is the costoclavicular test and what does it indicate

A

Extend shoulder and apply caudad force on superior ascpect of shoulder while monitoring radial pulse
Change in pulse indicates compression by the clavicle and first rib

60
Q

Explain nuchal ridigity

Explain brudzinskis

A

Rigidity- supine then flex head to chest to evaluate any stiffness which may indicate subarachnoid inflammation

Brudzinkis- when doing ridigity it causes the patients hips and knees to flex which indicates subarachnoid inflammation

61
Q

Posture evaluation
Slumped over-
Erect-

A

Slumped over- depression, muscle spasm, or to relieve pressure

Erect- relieve hernia or spinal stenosis

62
Q

What is a spinal step off? What may it indicate

A

An abnormally prominent or recessed spinous process that may indicate spondylolisthesis

63
Q

What is the ROM of lumbar spine

A

Flex- 40-90
Extend- 20-45
SB- 15-30
Rotate- 3-18

64
Q 
Explain muscle evaluation of:
L1-3
L4 
L5
S1
A

L1-3- hip flexion
L4- knee extension
L5- Dorsiflex/heel walk
S1- plantarflex/ toe walk

65
Q

DTR
Patellar
Achilles

A

Patellar- L4

Achilles- S1

66
Q

Explain straight leg raise and contralateral straight leg raise for lumbar spine and why you do both

A

Straight leg raise- flex hip and extended knee where pain usually appears between 30-60, greater than 70 is mechanical issue and indicates disc hernia

Contralateral leg raise- do straight leg raise of not affected leg to see if it recreates symptoms in affected leg

Straight leg is sensitive but contralateral is specific for disc herniation

67
Q

What is hoovers sign?

A

Place hand under unaffected legs heel then have patient flex hip of affected leg against resistance

Should feel heel push

If it doesnt- function weakness or malingering

68
Q

Explain thomas test and what it indicates

A

While supine hold one knee to chest and let other fall over table to evaluate if it extends fully
Indicates psoas contracture

69
Q

What is gaenslens test and what does it indicate?

A

One hip off with leg extending down and other hip and knee pulled to chest
Evaluates SI joint problems

70
Q

What is stork test and what does it indicate

A

Standing, have patient flip one hip and knee then have them extend back for pain

Indicates pars fracture

71
Q

Whiplash is a combo of what two actions in what is refered as a what type of injury

A

Whiplash= hyperextend and hyperflex

Inertia injury

72
Q

Does hyperextension or hyperflexion in whiplash do more damage and why?

A

Hyperextension because the chin/chest limits hyperflexion

73
Q

What is the most commonly affected muscle of whiplash?

A

SCM

74
Q

What ligament does hyperextension/flexion in a whiplash injury affect in the vertebra?

A

Hyperextension- anterior longitidunal

Hyperflexion- posterior longitudinal

75
Q

Torticolis-
Laterocolis-
Anterocolis-
Retrocolis-

A

Torticolis- rotation
Laterocolis- SB
Anterocolis- flex
Retrocolis- extend

76
Q

Is congenital or adult torticolis more common?

A

Adult

77
Q

What is scoliosis and what plane does the injury occur in?

A

Abnormal lateral curvature of spine in coronal plane

78
Q

How do you name a scoliosis?

A

The side of convexity (what side the curve points to)

79
Q

What form of scoliosis is most common?

A

Double major curvature

80
Q

Idiopathic scoliosis
Infantile- ages, gender, side, when to refer
Juvenile- age and when to refer
Adolescent- age, gender, progression

A

Infantile- age 0-3, M>F, L>R, angle over 35
Juvenile- age 4-9, angle over 20
Adolescent- age 10, most common, M=F, F progress more

81
Q

What are some related symptoms of congenital scoliosis?

A

Urinary, cardiac, and spinal dysraphia (spine doesn’t close along midline and leads to club feet)

82
Q

What are conditions associated with neuromuscular scoliosis?

A

Polio, duchenes, cerebral palsy

83
Q

What are conditions associated with syndromic scoliosis?

A

Marfans, elhlers danlos, and neurofibromatosis

84
Q

When do you generally begin screening for scoliosis?

A

Age 10

85
Q

How do you measure cobbs angle and what is the gold standard angle for scoliosis and when to refer

A

Superior aspect of most superior vert involved in curvature
Inferior aspect of most inferior vert involved in curvature
Make right angles from both lines to create angle
10 degrees for scoliosis and 20 to refer

PCM (3 decks)

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