PCMII Midterm Flashcards
What goes in the S portion of the SOAP note?
CC OLDCAAARTS PMH, PSH Meds, Alls SH, FH
What goes in the O portion of soap note?
VS
Heart, Lungs, OSE
What is in O portion of a SOAP note?
CC: x3 diff diagnosis
What goes in the P portion of the SOAP note?
Any OMT done or planned Any med recommendations Followup Immunizations Life style changes Screenings
Who is given the influenza vaccine?
What type of vaccine do pregos get?
What type do >65 y/o get?
Give vaccine >6 months old
Pregos- inactivated influenza vaccine
>65 y/o- high does inactivated
How many doses of Tdap do you give?
When do you give boosters?
What about pregos?
One dose of Tdap
Booster every 10 years of TD
Tdap for every pregnancy
How many doses of varicella vaccine?
Who is contraindicated?
When do you give varicella zoster shot?
2 doses of varicella unless you have chickenpox
Don’t give to pregos or immunocompromised pt
Give varicella zoster at age 60
When do you begin giving HPV vaccines?
How many doses?
When do you stop for males and females?
Begin at age 11
3 doses
Male-21
Female-26
Who do you give the pneumococcal vaccine to?
When do you give the second dose?
Age 65, smokers, living in nursing home, or kidney problems
Second dose 5 years after vaccine
Who do you give the Hep A vaccine to?
Who do you give the Hep B vaccine to?
Hep A- homosexual males or travel to area affected by hep A
Hep B- health care workers
Who do you screen for abdominal aortic aneurysm?
Age 65-74 if they ever smoked
Who do you screen for alcohol misuse?
What do you provide?
Screen >18 y/o
Provide behavioral counseling
When do you begin mammograms?
How often?
Start at age 50, then every 2 years until 75 y/o
When do you begin and stop doing pap smears?
Begin at age 21 and do every 3 years until 65
At what ages do you screen for colorectal cancer?
Age 50-75
Who do you screen for diabetes?
Age 40-70 if overweight
What age do you screen for HIV?
Age 15-65
What is the order of the physical exam for an abdominal exam?
Inspect
Auscultate
Percuss
Palpate
What are the 4 quadrants of the abdomen?
What are the 9 regions?
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
What is Grey Turners sign?
What is Cullen Sign?
Grey Turner- ecchymosis around the flank
Cullen sign- ecchymosis around the umbilicus
What do striae possibly indicate?
Cushings syndrome
What does caput medusae indicate?
Portal hypertension
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?
Normal- 5 to 34 clicks per minute Absent sounds- obstruction or ischemia Dec sounds- peritonitis Inc sounds- diarrhea High pitched- early obstruction
When ascultating the abdomen what vasculature do you listen do?
Renal, abdominal aorta, common iliac, and femoral
Tympanic percussion =
Dullness percussion =
Resonant percussion =
Hyperresonant percussion =
Tympanic- air filled
Dull- solid
Resonant- hallow organ
Hyperresonant- pneumothorax
Explain percussion of liver?
Explain percussion of the spleen?
Liver- 6-12 cm at R mid clavicular line
Spleen- left ribs 6-12 at mid axillary line
What is rebound tenderness of palpation? What does it indicate?
Pain when releasing pressure
Peritoneal inflammation
What is abdominal ridigity and what causes it?
Hard abdomen due to involuntary abdominal contraction
What is Rovsings sign? What does it indicate
RLQ pain when applying P on L side
Indicates appendicitis
Where is mcburneys point?
1/3 of way from ASIS to umbilicus and indicates where appendix is usually located
What is murphys sign of the gallbladder?
When palpating R costal margin for gallbladder it is pain or cessation of inhalation and indicates acute cholecystitis
What is Courvosiers sign of the gallbladder?
Palpate large non tender gallbladder
Indicates pancreatic cancer
What are shifting oulines for ascites?
Percuss from tympany to dullness supine then lateral recumbent and if borders change so tympany is on top then it may be ascites
What is fluid wave of ascites?
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
What is the Psoas test for abdomen? What does a positive test indicate?
Flex hip against R
If abdominal pain then appendicitis
What is the obturator test for abdomen? What does a positive test indicate?
Flex hip and knee over opposite knee
Pain may indicate appendicitis
What is lloyds punch and what does it indicate?
Apply force on posterior aspect of kidney region
Pain indicates kidney infeciton
What does a positive heel strike test indicate?
Appendicitis
What does chovsket sign indicate? What is it?
Tap facial nerve and it triggers facial muscle twitches
Indicates hypocalcemia/hypoparathyroidism
What is trousseaus sign and what does it indicate?
Inflate BP cuffs leads to muscle spasm
Indicates hypocalcemia/hypoparathyroidism
Bones, groans, and stones are complaints associated with?
Hypercalcemia/hyperparathyroidism
What are thyroid hormone levels associated with hypothryoidism vs hyperthryoidism
Hypo- elevated TSH and low T4 T3
Hyper- low TSH and high T4 and T3
What are some signs and symptoms of cushings disease?
Moon face, buffalo hump, trunk obesity, striae
Explain mechanics of OA, AA, and typical C spine
OA- modified type 1 (main F/E)
AA- rotation only
Typical C spine- modified type II and I
What makes the anterior and posterior triangle of the neck
Ant triangle- SCM, mandible, midline
Post triangle- SCM, traps, clavicle
When palpating the thryoid
Soft indicates
Firm indicates
Tender indicates
Soft- GD
Firm- hashimotos
Tender- thyroiditis
What is ROM of C spine
Flex- 45-90
Extend- 70-90
Rotate 70-90
SB- 20-45
Explain muscle strength testing of: C1 C2-4 C5 C6 C7 C8 T1
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
Explain dermatomes from C1- T1
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
DTR spinal n.
Biceps
Brachioradialis
Triceps
Biceps- C5
Brachioradialis- C6
Triceps- C7
What is a compression neuropathy?
MSK or myofascial tissue is compressing a nerve leading to pain and paresthesia
What is the compression, distraction, and spurling test? What may it indicate?
Compression- axial load
Distraction- relieve pain
Spurlings- compress in neutral, extension, and SB/rotated
What are the boundaries of the thoracic outlet?
Manubrium, t1, and first rib
What is found within the thoracic outlet?
Brachial plexus, subclavian a/v
What are the zones of the thoracic oulet?
Scalene triangle
Costoclavicular space
Retropectoralis minor
What is the EAST test? What may it indicate
Abduct and externally rotate shoulders 90 and flex elbow 90
Then open and close fist for 3 min
Pain may indicate compressed subclavian a
What is adson test? What may it indicate?
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
What is wrights hyperabduction test? What does it indicate
Abduct shoulder fully and apply some extension while monitoring radial pulse for any change
Indicates pec minor compression of thoracic outlet
What is the costoclavicular test and what does it indicate
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
Explain nuchal ridigity
Explain brudzinskis
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
Posture evaluation
Slumped over-
Erect-
Slumped over- depression, muscle spasm, or to relieve pressure
Erect- relieve hernia or spinal stenosis
What is a spinal step off? What may it indicate
An abnormally prominent or recessed spinous process that may indicate spondylolisthesis
What is the ROM of lumbar spine
Flex- 40-90
Extend- 20-45
SB- 15-30
Rotate- 3-18
Explain muscle evaluation of: L1-3 L4 L5 S1
L1-3- hip flexion
L4- knee extension
L5- Dorsiflex/heel walk
S1- plantarflex/ toe walk
DTR
Patellar
Achilles
Patellar- L4
Achilles- S1
Explain straight leg raise and contralateral straight leg raise for lumbar spine and why you do both
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
What is hoovers sign?
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
Explain thomas test and what it indicates
While supine hold one knee to chest and let other fall over table to evaluate if it extends fully
Indicates psoas contracture
What is gaenslens test and what does it indicate?
One hip off with leg extending down and other hip and knee pulled to chest
Evaluates SI joint problems
What is stork test and what does it indicate
Standing, have patient flip one hip and knee then have them extend back for pain
Indicates pars fracture
Whiplash is a combo of what two actions in what is refered as a what type of injury
Whiplash= hyperextend and hyperflex
Inertia injury
Does hyperextension or hyperflexion in whiplash do more damage and why?
Hyperextension because the chin/chest limits hyperflexion
What is the most commonly affected muscle of whiplash?
SCM
What ligament does hyperextension/flexion in a whiplash injury affect in the vertebra?
Hyperextension- anterior longitidunal
Hyperflexion- posterior longitudinal
Torticolis-
Laterocolis-
Anterocolis-
Retrocolis-
Torticolis- rotation
Laterocolis- SB
Anterocolis- flex
Retrocolis- extend
Is congenital or adult torticolis more common?
Adult
What is scoliosis and what plane does the injury occur in?
Abnormal lateral curvature of spine in coronal plane
How do you name a scoliosis?
The side of convexity (what side the curve points to)
What form of scoliosis is most common?
Double major curvature
Idiopathic scoliosis
Infantile- ages, gender, side, when to refer
Juvenile- age and when to refer
Adolescent- age, gender, progression
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
What are some related symptoms of congenital scoliosis?
Urinary, cardiac, and spinal dysraphia (spine doesn’t close along midline and leads to club feet)
What are conditions associated with neuromuscular scoliosis?
Polio, duchenes, cerebral palsy
What are conditions associated with syndromic scoliosis?
Marfans, elhlers danlos, and neurofibromatosis
When do you generally begin screening for scoliosis?
Age 10
How do you measure cobbs angle and what is the gold standard angle for scoliosis and when to refer
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
