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Physical Diagnosis > PD Exam III > Flashcards

PD Exam III Flashcards

1
Q

Mini-Mental State Exam

A

30 pt questionnaire
cognitive impairment - dementia
cognitive and higher cognitive

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2
Q

What are the categories of Mental Status Exam

A 
appearance and behavior
speech and language
mood
thought processes
thought content
judgment
insight
abstract thinking
cognitive
higher cognitive
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3
Q

speech and language

A

quantity: talkative, silent
rate: fast or slow
volume: loud or soft
fluency: rate, flow, melody

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4
Q

thought process

A

flight of ideas, incoherence, confabulation, etc,

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5
Q

thought content

A

compulsions, obsessions, phobias, anxieties, delusions, unreality

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6
Q

circumstantiality

A

speech with unnecessary detail, indirection, and delay in reaching the point

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7
Q

derailment

A

shift topics that are loosely connected or unrelated

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8
Q

flight of ideas

A

continuous flow of speech but abrupt changes from one topic to next

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9
Q

neologisms

A

invented or distorted words

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10
Q

incoherence

A

incomprehensible and illogical speech w/o meaningful connections

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11
Q

blocking

A

interruption of speech mid-sentence (losing thought)

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12
Q

confabulation

A

fabrication of facts or events in response to questions; to fill in gaps from impaired memory

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13
Q

preservation

A

persistent repetition of words or ideas

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14
Q

echolalia

A

repetition of words and phrases of others

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15
Q

clanging

A

choosing words based on rhyming rather than meaning

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16
Q

judgment

A

affected by anxiety, mood, edu, income, intelligence, culture
also delirium, dementia, psychosis

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17
Q

insight

A

can have denial of impairment (memory loss/confusion)

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18
Q

cognitive function

A 
orientation
attention
remote memory
recent memory
new learning ability
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19
Q

higher cognitive function

A

information and vocab
calculating ability
abstract thinking
constructional ability

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20
Q

high cognitive functions

A

calculating
abstract thinking: concrete v abstract
information and vocabulary
constructional ability

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21
Q

concrete v abstract thinking

A

concrete: both mouse and rat have tails, sew rip before it gets bigger
abstract: both are animals, prompt attention to problem prevents trouble

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22
Q

information and vocabulary

A

name object
word comprehension
reading comprehension
writing

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23
Q

constructional ability

A

draw clock with hands pointing to specific time

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24
Q

where do the cranial nerves emerge from?

A

1, 2: cerebrum

3-12: brain stem

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25
Q

which cranial nerve relates BEYOND head and neck?

A

vagus CN10

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26
Q

Which CNs are Sensory, Motor, Both?*

A

Some say marry money but my brother says big brains matter more

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27
Q

What two muscles does CN11 (accessory) control?

A

SCM

Trap

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28
Q

What muscles do CN12 control?

A

strap muscles - infrahyoid ones

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29
Q

hyposmia v hyperosmia

A

hyposmia: partial loss of smell
hyperosmia: exaggerated sensitivity

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30
Q

dyosmia

A

distorted smell

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31
Q

anosmia

A

total loss of smell

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32
Q

phantosmia

A

olfactory hallucination

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33
Q

cacosmia

A

smelling something burned, foul, or rotten

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34
Q

what CN do irritating smells stimulate?

A

trigeminal (peppermint, NH3 –> dont use to test)

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35
Q

common olfactory disorders

A

post traumatic
post infection
olfactory hallucinations in epilepsy

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36
Q

what to do to examine olfaction?

A 
inspect for obstruction
sniff test (occlude one)
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37
Q

unilateral olfactory disturbance can be from what?

A

sub-frontal meningioma

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38
Q

rods v cones

A

rods: low light, low spatial acuity
cones: high light level, color, high spatial acuity

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39
Q

L/R VISUAL FIELDS of BOTH eyes go to which side of brain?*

A

L visual field of BOTH eyes: right brain

R: left brain

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40
Q

The image on the retina is…?

A

inverted

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41
Q

outside areas of both L/R visual fields lost, damage is at..?

A

chiasm`

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42
Q

Isihara’s testing

A

color vision

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43
Q

optic nerve testing

A

snellen chart
color vision
visual fields by confrontation
fundoscopic exam

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44
Q

testing CN II, CN III: PERRLA

A

pupils equal, round, react to light, accomodation

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45
Q

direct and consensual response to light

A

direct: shine light, pupil constrict
consensual: other pupil also constricts w/o direct light

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46
Q

anisocoria

A

different of 0.4mm in pupil diameter

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47
Q

testing CN3,4,6

A

Eyelid for symmetry (ptosis)
extraocular mvmts (6 cardinal directions)
convergence: look towards nose
nystagmus

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48
Q

medial/lateral canthus

A

corners of the eyes

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49
Q

sclera

A

whites of eye, covered by conjunctiva

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50
Q

limbus

A

outer edge between iris and sclera

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51
Q

two types of conjunctiva

A

bulbar: over sclera
palpebral: under eyelid

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52
Q

meibomian gland

A

produce mebium: oily substance to prevent tear evaporation

dysfunction: dry eyes

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53
Q

adie’s syndrome

A 
neurological: usually unilateral
mydriasis, 
no reaction to light, 
loss of deep tendon reflex, 
abnormal sweating
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54
Q

who can get Adie’s (tonic) pupil?

A

diabetic neuropathy

alcoholism

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55
Q

what is sustained in Adie’s pupil?

A

accommodation sustained –> complain blur vision from distant to near

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56
Q

Argyll Robertson Pupil

A

moisis
iris atrophy
cant dilate in dark

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57
Q

What causes argyl robertson pupil?

A

neurosyphilis

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58
Q

abducens palsy

A

eye mvmt disorder: lesion of CN6 –> gaze paresis
cant eye abduct
unilateral or bi- increase intracranial pressure

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59
Q

complete abducens palsy causes…?

A

convergent strabismus (looking straight, one goes in )

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60
Q

trochlear palsy

A

CN4: SO weakness

diplopia on downward gaze

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61
Q

oculomotor palsy

A

CN3 compression from tumor or post communicating a. aneurysm –> dilation (blown pupil)
complete v incomplete
30% pupil sparing

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62
Q

causes of trochlear palsy

A

myasthenia

dysthyroid eye disease: grave ophthalmology

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63
Q

cause of oculomotor palsy

A

diabetes

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64
Q

strabismus

A

eyes don’t align bilaterally: exotropia

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65
Q

complete oculomotor palsy

A

ptosis

lateral deviation, slightly downward

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66
Q

types of nystagmus (oscillation mvmt)

A

pendular: slow waveform, congenital ,MS
vestibular: peripheral (suppressed by visual fixation), central (unaffected by fixation)
gaze evoked: certain direction (Tav)
down beat: chiari malformation
convergence: dorsal midbrain
endpoint: physiological

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67
Q

CN5 Trigeminal

A

pons
facial sensations
mastication: muscles

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68
Q

damage to trigeminal during mastication

A

jaw deviate to affected side

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69
Q

4 muscles of mastication

A

masseter
temporalis
medial, lateral pterygoids

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70
Q

3 divisions of trigeminal nerve

A

ophthalmic n.
maxillary n.
mandibular n.

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71
Q

sensations of trigeminal

A

sharp-dull
hot-cold
light touch
compare side to side

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72
Q

how to test corneal reflex (trigeminal n.)

A

cotton to one eye –> blinking of both eyes

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73
Q

Facial nerve CN7

A

pons
ant 2/3 taste
facial muscle expression
parasymp: submandibular, sublingual, lacrimal glands

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74
Q

Motor function branches of facial n.*

A 
two zebras bit my clavicle:
temporal
zygomatic
buccal
mandibular
cervical
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75
Q

Bell’s palsy

A

one sided facial droop
LOWER motor neuron
facial nerve

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76
Q

difference between stroke and bell’s palsy

A

stroke: UMN, paralysis of lower face

Bell’s: LMN, paralysis of entire side

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77
Q

Types of hearing loss (vestibulocochlear n.) and how to test for it

A

conductive
sensorineural
Weber: lateralization
Rinne: conduction

78
Q

Weber Test*

A

tuning fork midline
conductive hearing loss: heard best affected ear
nerve: heard best by intact ear

79
Q

Rinne Test

A

conduction test
Normal: AC > BC
conductive loss: BC > AC
nerve: AC > BC, sound stops much earlier

80
Q

How to straighten ear canal?

A

pull ear up

81
Q

Glossopharyngeal CN9

A

medulla
swallowing throat muscles
post 1/3 taste
gag reflex

82
Q

jugular foramen syndrome

A

nasopharyngeal carcinoma compress CN9

83
Q

glossopharyngeal neuralgia

A

tumor or vascular

pain swallowing

84
Q

Vagus n. damage*

A 
deviation of uvula AWAY from affected side*
dysphagia
dysphasia
dysarthria
flattening palatal arch
85
Q

dysphagia

A

difficult swallowing

86
Q

dysphasia

A

difficult use/understand language

87
Q

Aphasia

A

cant use/comprehend words

88
Q

dysarthria

A

difficult articulating words

89
Q

assess vagus nerve by…?

A

listen tot quality of voice

ask pt to say “ahh” and observe uvula, soft palate rising

90
Q

roots of accessory n.

A

spinal root

bulbar root

91
Q

Test accessory n.

A

turn head against resistance

shoulder shrug against hand

92
Q

what nerve do surgeons nick a lot?

A

accessory n.

93
Q

hypoglossal n.

A

tongue mvmt

94
Q

test for hypoglossal n.

A

voice
tongue midline, side to side
push tongue against cheek

95
Q

hypoglossal damage: which side tongue and uvula deviates to?*

A

tongue TOWARD*

uvula: AWAY*

96
Q

Your patient tells you they have a prickly sensation on their lower left anterior thigh. What is a word to describe this?

A

Paresthesia

97
Q

What is the definition of Fasciculations?

A

Random involuntary muscle twitches

98
Q

Normal Muscle Strength would be graded as what number?

A

5/5

99
Q

Define Ataxia

A

A gait that lacks coordination and is unstable

100
Q

Considering what you know about Anatomy, Besides Balance, what else does walking on your toes and Heels test for (respectively)?

A

Plantar flexion/ dorsiflexion of ankles

101
Q

Afferent Nerve fibers travel toward the spinal cord and away from the stimulus in a deep tendon reflex

A

True

102
Q

A normal exam finding would be which of the following?

A

Patellar DTR, 2/4 bilaterally

103
Q

If you found the previous answer number 4 “Patellar DTR, 2 on the left and 4 on the right” in your patient, What might this suggest?

A

CNS lesion on the left

104
Q

You all received the “Meningitis vaccine”, what organism does that vaccine protect you from (several serogroups of this bacteria Anyway-but not all)

A

Neisseria meningitidis

105
Q

fasciculation

A

muscle twitch

106
Q

When upper motor neurons are damaged above the crossover of its tracts in the medulla, motor impairment is on?

A

opposite side of the body

107
Q

When upper motor neurons are damaged below the crossover of its tracts in the medulla, motor impairment is on?

A

same side of the body

108
Q

When do you check temperature sensation?

A

only if pain sensation (sharp or dull test) is abnormal

109
Q

Analgesia v. Hypoalgesia v. Hyperalgesia

A

Analgesia – absence of pain sensation
Hypoalgesia - DECREASED sensitivity to pain
Hyperalgesia - INCREASED sensitivity to pain

110
Q

Anesthesia v. Hypesthesia v. Hyperesthesia

A

Anesthesia – absence of touch sensation
Hypesthesia – DECREASED sensitivity to touch
Hyperesthesia - INCREASED sensitivity to touch
Paresthesia – peculiar sensation without an obvious stimulation
Dysesthesia – distorted sensation in response to stimulus

111
Q

What can loss of proprioception and vibration be causes by?

A

multiple sclerosis, B12 deficiency, posterior column disease, peripheral neuropathy

112
Q

how to test proprioception (position)

A
  1. hold sides of big toe and move it up and down (tell them which is which)
  2. pt close eyes and tell you up or down
113
Q

how to test vibration

A
  1. place tuning fork on DIP big toe

2. ask pt when vibration stops

114
Q

what if vibration test abnormal?

A

move distally, eg medial malleolus, tibial tuberosity

115
Q

How to check light touch?

A

cotton ball
pt tell you when they feel it (eyes closed)
test side to side (does it feel the same)
looking for anesthesia

116
Q

tests for discriminative sensation

A 
stereognosis
graphesthesia
two point discrimination: 1 or 2 pts
point localization
extinction: touch at same place on each side (eyes close), they to where
117
Q

What to INSPECT in motor sensory test

A

muscle bulk: side to side
muscle tone
body position
body stance

118
Q

muscle tone

A

residual tension in relaxed muscle

test through passive mvmt

119
Q

muscle bulk

A

active mvmt: I and palp for atrophy

120
Q

paratonia

A

increased resistance that decreases when pt distracted

121
Q

rigidity

A

increased resistance through mvmt

122
Q

what to watch out for in motor exam?

A

fasciculations
atrophy
abnormal movements
involuntary movements

123
Q

Myoclonus*

A

Rapid shock-like muscle jerks

124
Q

Chorea*

A

rapid, jerky twitches, similar to myoclonus but more random in location and more likely to blend into one another

125
Q

Tics*

A

abrupt, stereotyped, coordinated movements or vocalizations

126
Q

Dystonia*

A

maintenance of abnormal posture or repetitive twisting movements

127
Q

paresis v plegia

A

paresis: weakness
plegia: paralysis

128
Q

How to test Grip Strength

A

pt squeeze 2 fingers as hard as they can

test bilaterally

129
Q

Rapid alternating mvmt

A 
palm up and down, one by one
tap toes to your hand
thumb to fingers
tongue wiggle
"lalala" "papapa"
130
Q

how to test coordination and equilibrium (taxia)

A

rapid alternating mvmt

point to point mvmt: finger to nose and to finger

131
Q

how to test for gait

A

walk heel to toe (tandem walking)
walk on toes, heels
hop one foot
shallow knee bend

132
Q

Romberg Test

A

push pt side to side and have them maintain balance

133
Q

whats a positive romberg test?

A

pt can stand well w/eyes open but lose balance when they’re closed

134
Q

pronator drift

A
  1. pt close eyes
  2. have pt flex and supinate and HOLD 20-30sec
    POS: if cant hold and starts supinate
  3. tap arm downward
135
Q

what is pyramidal drift?

A

arm tapping of pronator drift

136
Q

pronator drift is positive in what condition?

A

stroke

corticospinal tract lesion contralaterally

137
Q

Normal rating in DTR

A

2/4

138
Q

What muscles does the patellar reflex stimulate?

A

quadriceps

139
Q

What is 5/4 for a DTR rating?

A

sustained clonus

140
Q

what type of lesion in a hyper reactive DTR?*

A

central (CNS/upper motor neuron) lesion

141
Q

What spinal tract is responsible for DTR and where does it cross over?

A

Corticospinal

medulla

142
Q

corticospinal tract lesion above medulla result

A

contralateral hyper reflexia

below: ipsilateral

143
Q

Where are DTRs?

A 
Biceps
Triceps
Brachioradialis
Abdominal
Patellar tendon (knee)
Achilles (ankle)
144
Q

abdominal reflex

A

stimulate ab wall –> see contraction

145
Q

Plantar (Babinski) reflex

A

stroke foot, curve medially over ball of foot –> flexion

146
Q

Babinski reflex in infants

A

fanning of toes bc incomplete myelination

147
Q

clonus

A

rhythmic oscillation response (hands, feet)

148
Q

how to check for clonus?

A

sharply dorsiflex foot and hold (passive)

feel for oscillations

149
Q

anal reflex

A

stroke outward in 4 quadrants from anus –> contraction

150
Q

meningeal signs

A

neck mobility
brudzinski’s sign
Kernig’s sign

151
Q

Kernig’s sign

A

for meningitis

pos: pain bilateral behind knee when flexed knee is extended

152
Q

Brudzinski’s sign

A

for meningitis

pos: flexion of hips and knee in response to flexing neck

153
Q

priapism

A

prolonged erection usually w/o sexual arousal

154
Q

CVA tenderness

A

pain w/percussion of costovertebral angle (over kidneys)

155
Q

What should you inspect in genitourinary exam?

A 
perineal skin
tanner staging
position of urethral meatus
compress glans for discharge
lice and eggs
156
Q

What to evaluate with inguinal canal?

A

hernia by having patient bear down

157
Q

What’s in inguinal canal?

A

spermatid cord
genital branch of genitofemoral n.
ilioinguinal n.

158
Q

What is inguinal ligament between

A

ASIS

pubic tubercle

159
Q

Sequence of inspection and palpation

A

inspect penis
palpate testes and epididymis
palpate each spermatid cord
evaluate for hernias

160
Q

What to palpate for hernias in the groin?

A

observe
pt standing and valsalva maneuver
palpate inguinal rings and femoral canal

161
Q

Which is medial: external or internal inguinal ring?

A

external

162
Q

How to tell there’s a scrotal hernia?

A

fingers cannot get above mass

163
Q

Indirect Hernia frequency, course, and origin

A

most common, often children
all sex, age
origin: above inguinal lig, midline (internal ring)
course: down into scrotum through canal

164
Q

where does your finger touch an indirect hernia?*

A

fingertip

165
Q

Direct Hernia frequency, course, and origin

A

less common
usually men >40, rare in women
origin: above inguinal lig, close to pubic tubercle (ext ring)
course: bulge ant, rare in scrotum

166
Q

where does your finger touch a direct hernia?*

A

side of finger forward

167
Q

Femoral Hernia frequency, course, and origin

A

least common
more women than men
origin: BELOW inguinal lig, more LATERAL (hard diff from nodes)
course: never into scrotum, inguinal canal empty

168
Q

condyloma accuminata

A

HPV warts
rare symptomatic, sometimes painful
HIV serology 6/11 (not same as cancer)

169
Q

Genital Herpes Simplex

A

found: penis shaft, vagina/vulva/cervix, around anus

HSV, painless; painful if blisters rupture

170
Q

chancre

A

primary syphilis, painless

171
Q

hypospadius

A

urethral opening on underside of penis

surgical correction 1st 18months life

172
Q

Peyronie’s Disease

A

fibrous plaques top above cavernosum (beneath buck’s fascia) –> painful CURVATURE
connective tissue disorder

173
Q

Carcinoma of penis

A

squamous cell
localized lesion,
may be painful, drainage can start to bleed and enlarge

174
Q

risks of carcinoma of penis

A

HIV
HPV
Warts

175
Q

Differential diagnosis of testicular mass

A 
tumor
epididymitis
hydrocele: cystic, asymp, around testis
spermatocele: cystic swelling, top of testis
varicocele: cystic, asymp
176
Q

epididymitis v. tumor

A

tumor: painless, swelling, attach to penis, solid
epididymitis: acute, painful, swelling, no fever, around testi

177
Q

epidermoid cysts

A

benign cysts

surgical removal if painful

178
Q

causes of scrotal edema

A

many: cancer, heart liver failure, lymph, vein, bladder

179
Q

risks of cryptorchidism

A

testicular cancer

reduced fertility

180
Q

most common testicular tumor

A

germ cell tumor: seminoma or nonseminoma

181
Q

cause of acute epididymitis

A

STD, UTI

182
Q

Spermatocele

A

cyst with sperm on epididymis, painless usually

183
Q

tuberculous epididymitis

A

inflam, swelling of epididymis from mycobacterium tuberculosis

184
Q

testicular torsion onset

A

rapid and severe pain

blood supply compromised

185
Q

What to look at in rectal exam

A

perianal skin: hemorrhoids, warts, lesions

digital exam: sphincter tone, prostate, rectal vault, hemoccult card

186
Q

anal fissure

A

tear in anal lining

187
Q

valve of houston

A

transverse fold into rectum

188
Q

Patient positions for genitourinary exam

A

standing

left lateral decubitus

189
Q

Ext v int hemorrhoids

A

ext: painful
int: painless

190
Q

Most common rectal cancer

A

squamous cell, linked to HPV

Physical Diagnosis (3 decks)

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