PD Final Exam Review Flashcards
Dis is it boi
1
Q
Signs vs symptoms
A
Signs are objective observations made by a clinician during examination, symptoms are subjective feelings the patient reports during a history that cannot be observed by the clinician
2
Q
History and physical exam relationship
A
A good history will help alert to pertinent findings on a physical exam and type of exam to perform, whether obtained form patient themselves, chart, or family
3
Q
Indirect percussion, plexor versus pleximeter
A
Plexor is the finger doing the tapping, pleximeter is the finger receiving the tap, important to strike the same location with the same technique
4
Q
Resonance indicates ____ on the thorax. Hyperresonance indicates ____
A
normal lung, emphysematous lung
5
Q
Diaphragm is used to listen to… Bell is used to listen to….
A
…high pitched sounds….low pitched sounds
6
Q
Normal exam sequence vs abdominal exam
A
Inspection, palpation, percussion, auscultation
Inspection, auscultation, percussion, palpation
7
Q
5-6 vital signs
A
Temp BP Pulse RR BMI Pulse ox (sometimes)
8
Q
Rapid weight gain suggests….
A
….bodily fluid retention of fluid, could potentially indicate heart failure
9
Q
Weight loss with high food intake suggests…
A
…diabetes mellitus, hyperthyroidism, bulimia
10
Q
Temperature is regulated by the ____ of the brain
A
Hypothalamus
11
Q
Rapid weight loss suggests…
A
….cancer, depression, GI disease
12
Q
4 ways to measure temp
A
Oral
Axillary
Rectal (only when patient is unconscious or can’t keep mouth closed or other reasons)
Tympanic
13
Q
Normal oral temp
Rectal temp compared to oral
Axillary temp compared to oral
Tympanic temp compared to oral
A
98.6F/37C
Rectal is 1 degree F higher
Axillary is 1 degree F lower
Tympanic is 1.4 degrees F higher
14
Q
Hypothermic thermometer
A
Accurate for temperatures below which a normal thermometer is not, indicated for use when temp reading on regular thermometer falls below 94 degrees F
15
Q
Things that can cause a false temp reading (5)
A
- rigorous exercise
- mouth breathing
- smoking
- drinking fluids
- cerumen (ear wax)
16
Q
Two groups that do not always present with presence of pyrexia
A
Infants and elderly
17
Q
Pyrexia vs hyperpyrexia
A
Pyrexia is body temp above 98.6 Fand 37C but below hyperpyrexia, hyperpyrexia is temp greataer than 41.1C or 106F,
18
Q
Hypothermia
A
Body temp below 35 C or 95 F
19
Q
Noninfectious causes of pyrexia and hypothermia
A
- ovulation
- thyroid storm
- drug effects
- trauma
- exposure to cold
- hypothyroidism or hypoglycmeia
- shock
20
Q
Noninfectious causes of pyrexia and hypothermia
A
- ovulation
- thyroid storm
- drug effects
- trauma
- exposure to cold
- hypothyroidism or hypoglycmeia
- shock
21
Q
4 pulse sites and important notes about each, what other pulse sites are there?
A
1) radial (easiest)
2) carotid (have to listen for bruits first)
3) femoral (inguinal region, uncomfortable for patients)
4) apical (on the heart, says nothing about perfusion)
Dorsal pedal, posterior tibial, poplitial, brachial
22
Q
3 concepts to assess while taking pulse
A
1) rate
2) rhythm (if irregular need to count the full minute)
3) Correlation to systolic BP (carotid means at least 60, radial or femoral means at least 80
23
Q
Sinus tachycardia definition and a few causes
A
Rapid regular elevated heart rate above 100bpm, due to exercise, fever, dehydration, drugs
24
Q
Sinus bradycardia defintion and a few causes
A
Slow regular heart rate below 50bpm, athlete, heart disease, hypothyroidsim, abnormal electrolytes
25
Occasionally irregular beat cause and indication
Occasional premature atrial or ventricular contractions, indicate normal variation
26
Irregularly irregular beat cause and indication
Frequent premature ventricular contractions, indicate atrial fib presence
27
Regularly irregular beat cause and indication
Bigeminy or trigeminy, indicates mobitz I AV block
28
Pulsus altercans definition and cause
Alternating strong and weak pulse, indicates left ventricular heart failure
29
Pulsus bisiferens defnition and cause
Biphasic pulse, indicates aortic valve problem
30
Dicrotic pulse definition and cause
2 distinguishable palpable pulses, indicates low cardiac output
31
Pulsus parvus et tardus defnition and cause
Pulse is weak and has late carotid upstroke, caused by aortic valve stenosis
32
Pulsus paradoxus definition and cause
Typically SBP falls more than 10mm during inspiration and pulse gets weaker, caused by cardiac tamponade, asthma, COPD, etc
33
Normal respiration rate
12-18 rpm
34
Tachypnea vs hyperpnea and causes of both
Tachypnea is rapid shallow breathing often brought on in anxiety or restrictive lung disease
Hyperpnea is rapid deep breathing often brought on by exercise or infarct
35
Bradypnea vs hypopnea and causes of both
bradypnea is slow breathing often brought on by coma or respiratory depression
Hypopnea is shallow infrequent breathing often brough on by smoking or sedatives
36
Kussmaul
Fluctuating fast, slow, and normal breathing brought on by metabolic acidosis
37
Cheyne stokes
Breaths with periods of apnea, often seen in head injuries or brain tumors
38
Biot's breathing
Unpredictable irregular breathing, shallow, deep, stopping for periods, sign of respiratory depression or brain damage at medullary level
39
A too small blood pressure cuff will give a ___ reading, too large will give a ____
Falsely high, falsely low
40
Auscultory gap
Silent period present between blood pressure reading between systole and diastole, indicative of arterial stiffness
41
Pulse pressure
Diff between systolic and diastolic BP
42
Elevated vs narrow pulse pressure and causes of each
Greater than 60mmHg, indicative of heart attack or CV disease
Less than 40mmHg, indicative of shock or cardiac tamponade
43
Korotkoff sounds
Heard during BP, first indicates systolic bp, last heard sound indicates diastolic bp
44
Autonomy of patient
Ethical need of patient to have self determination
45
Beneficence of provider
Provider's need to do good
46
Non-maleficence of provider
Provider's responsibility to do no harm
47
Utilitarianism
Appropriate use of resources as a provider to complete the duty of provider to patient
48
Fairness and Justice
Balance between autonomy and competing interest of family and community
49
Deontological imperitives
Duty of providers established by tradition and cultural imperitives
50
Useful precision
The idea that the problem at hand should dictate how precise the information that is needed must be
51
6 components of all health history, both H&P and SOAP notes
1) CC
2) HPI
3) PMH (med and allergies, etc.)
4) Family history
5) Social history
6) Review of systems
52
Chief complaint
1 sentence quote from patient's own words of why they are visiting you including duration of symptoms
53
History of present illness
Needs to be complete, clear, and chronological background to patient's response to symptoms and effect it is having on their life, document peritent positives and negatives (other signs and symptoms from ROS related directly to CC)
54
LORCATES acronym
```
Location
Other associated signs and symptoms
Radiation
Character
Aggravating or alleviating factors
Timing
Environment/evolution
Severity
```
55
A HISTORY Acronym
```
Allergies
Hospitalization
Immunizations
Surgery
Trauma
(Oral) medications
Reproductive
Youth illness and disease
```
56
FLAMES acronym for social history
```
Family and Food
Lifestyle
Abuses
Marital status
Employmnt
Support systems
```
57
Review of systems order
```
General Endo Head Loves Brass, Crass and Gas to Pass Near the Mass
General
Endocrine
HEENT
Lungs
Breast
Cardiovascular
Abdominal/GI
Genitourinary
Psychological
Neurological
Musculoskeletal
```
58
Koebner phenomenon
Appearance of skin lesions along the lines of trauma to the area
59
Herpatiform vs zosteriform
Herpatiform is random grouping, zosteriform is grouping according to dermatomal distribution
60
Macule
Non palpable lesion with distinc borders, less than 1cm in diameter
61
Patch
Non palpable lesion with distinct borders, greater than 1 cm in diameter
62
Papule
Palpable solid lesion less than 1 cm in diameter
63
Plaque
Palpable solid lesion greater than 1cm in diameter
64
Nodule
Palpable lesion more than 1cm in diameter taller than it is wide
65
Vesicle
Fluid containing superficial thin walled cavity <1cm
66
Bulla
Fluid containing superficial thin walled cavity >1cm
67
Erosion
A skin defect where there has been loss of epidermis only
68
Ulcer
A skin defect where there has been loss of dermis and epidermis
69
Pustule
Pus containing, superficial, thin walled cavity
70
Abscess
Pus containing, superficial, thick walled cavity
71
Scale
Desquamating layers of stratum corneum
72
Crust
Dried serum, blood, or purulent exudate
73
Lichenification
Thickening of skin resulting from crhronic rubbing, corn
74
Scar
Lesion formed as a result of dermal damage
75
Excoriation
Superficial excavations of epidermis from scratching
76
Fissure
Thin linear painful crack on skin
77
Wood's lamp
Long wavelength uv light lamp that can determine if a lesion is hypo or depigmented or to see if a fungal infection is present and fluoresces
78
Normal nail bed angle, and how do hepatic necrotic nails appear? Anemic? Hypoxic? Anxiety? Nephrotic? Hypothyrodic?
160 degrees, half and half coloration, white, clubbing, bitten, alternating white and pink bands, brittleness
79
Shoulder separation vs shoulder dislocation
Separation is known as AC separation, occurs between acromion and clavicle (clavicle protrudes upward)
Dislocation is known as glenohumoral dislocation, occurs at the glenohumoral joint
80
Bony step off
Clear unusual drop in a bone
81
If you can move a patient thru passive ROM but they cannot do active, what does this mean?
There is nothing blocking them from moving but the muscle or tendon is compromised
82
Bone spurs
Osteomites that rub on muscles such as the supraspinatus and irritate it
83
Boutennaire vs swan neck deformity
Boutennaire is due to a severing of a tendon at the PIP causing it to point flexed while swan neck is the volar plate being damaged causing an extension curve
84
Q angle
Angle formed from the vertical of the inward displacement of the thigh and legs,larger in females than males generally
85
Pain with active and passive internal rotation of the hip is associated with....
....osteoarthritis
86
Patient with trisomy 21 facial features
Flattened nose and face, upward slanting eyes
87
Patient with nephrotic syndrome facial features
Periorbital edema, puffy pale face
88
Patient with cushing syndrome facial features
Red cheeks, moon face, hirsutism, buffalo hump on back of neck
89
Patient with hypothyroidism facial features
Periorbital edema, hair coarse dry and sparse as well as eyeballs, puffy dull face
90
Patient with acromegaly facial features
Prominant jaw, soft tissues of nose, ears, and lips enlarged, prominant brow
91
Patient with parotiditis facial features
Local swelling obscuring one or both ear lobes
92
Patient with parkinson's disease facial featuers
Far off stare, slow blinking, decreased facial mobility
93
LR VI, SO IV
Latral rectus muscle controlled by abducens nerve, Superior oblique muscle controlled by trochlear nerve
94
Ipsalateral monocular vision loss
Caused by a lesion at the optic nerve creating blindness in one eye
95
Bitemporal hemianopia
Caused by a lesion at the optic chiasm causing blindness on the lateral sides of both visual fields
96
Ipsalateral nasal hemianopia
Caused by lesion at the uncrossed optic nerve fiber creating blindness on the nasal side of one visual field
97
Contralateral homonymous hemianopia
Caused by a lesion at the optic tract creating blindness in the same side of both visual fields (one nasal side one temporal side)
98
Contralateral homonymous hemianopia with macular sparing
Caused by a lesion at the optic nerve creating blindness in the same side of both visual fields (one nasal side one temporal side) while sparing the macula
99
Ipsalateral central scotoma
Caused by a lesion in the eye at a fixed point creating a blind spot in the middle of one eye
100
Ipsalateral horizontal defect
Caused by vascular occlusion
101
Presbyopia
Hyperopia occuring with age
102
Corneal light reflex
Checking for normal occular alignment thru watching how light is reflected between both eyes, indicates a lazy eyeif asymmetric
103
PERRLA acronym
Pupils equal, round, react to light, accommodate
104
Inferior oblique muscle moves the eye....
....upward and inward
105
Nystagmus
Abnormal movement of the eye
106
Optic disk
Entry point into the retina for ganglion cells forming the optic nerve and small vessels entering the posterior eye, lacks any rods or cones and forms the blind spot of the eye, 3-4mm toward the nasal side of the fovea, has an optic cup central depression within
107
Fovea
Small pit of closely packed cones in the eye at the center of the macula, forming central vision
108
Tonometry
Testing of intraocular pressure, either via numbing the eye (contact) or via air puff method
109
Fluorescin eye exam
Applied via drops to most medial area of eye, use cobalt blue light to examine eyes with lights dimmed where abrasions will appear yellow
110
Anisocoria
Unequal pupil size distribution
111
Red reflex
Reddish orange reflection of the retina when observed under opthalmoscope
112
Weber tuning fork exam
Place tuning fork on top of patient's head and ask if they hear it equally in both ears or if one is louder. Conductive hearing loss has the sound heard well in the impaired ear as well as the good. Sensorineural hearing loss has the sound heard better in the good ear.
113
Normal cup to disk ratio
Less than .5
114
AV nicking
Retinovascular signs during the fundoscopic exam that is often seen in hypertension
115
Rinne tuning fork exam
Place sound through bone until they lose it, then move to ear. In normal hearing or sensorineural hearing loss, sound is heard longer thru air than bone, but in conductive hearing loss, sound is heard thru bone longer than it is thru air
116
Auditory acuity test
Have patient occlude 1 ear, finger rub while pulling away slowly
117
At what age are frontal sinuses developed?
7-8
118
Transillumination of sinuses
Placing a bright light source on the maxilla, and having the patient open their mouth and look for an orrange glow on the hard palate - decreased or absent glow indicates something other than air
119
Buccul gingival sulcus
Space where gums lining meet the inside of the cheek lining
120
The uvula deviates to which side when there is a weakness? What about the tongue?
- Uvula to the opposite side to which the lesion is (vagus nerve)
- Tongue to same side the lesion is (hypoglossal nerve)
121
Diaphgram contraction during inspiration causes it to move....
....downward
122
Directly behind the body of the sternum sits....
....The right ventricle of the heart
123
RALS system
Determines the orientation of the pulmonary arteries in the hilus of the lung, with the right lung having anterior placed 2 pulmonary arteries to the main bronchus and the left lung having superior 1 placed pulmonary artery to the main bronchus
124
The left side has ____ bronchial arteries, the right side has ___
2, 1
125
Which bronchus has a more direct path to the lung?
Right
126
Where is the carina of the bronchus located?
Directly behind the sternal angle, about the 2nd rib
127
Pectus excavatum
Caved in chest,
128
Pectus carinatum
Caved out chest
129
Decreased bilateral tactile fremitus indicates....
........obstruction, copd, pleural effusion, fibrosis, or pneumothroax
130
Vesicular breath sounds definition and where they can be heard
Normal breath sounds at a higher pitch with a longer inspiratory and shorter expiratory phase, heard throughout most of lung fields and not the sternal borders
131
Bronchial breath sounds definition and where they can be heard
Normal breath sounds at a lower pitch with a longer expiratory phase and shorter inspiratory phase, heard over large airways, between the scapulae, or on the sternum best
132
Rales breath sound definition and what it indicates (3 things)
Adventitious breath sound like a cracking pop indicating atelectasis, chronic bronchitis, or COPD
133
Rhonchi breath sound definition and what it indicates (2 things)
Adventitious breath sound like snoring rough coarse sound indicating bronchitis or COPD
134
Bronchovesicular breath sounds definition and where they can be heard
Normal breath sound at medium pitch with equal length inspiratory and expiratory phases, heard best between scapula
135
Assymetric decreased fremitus indicates...
...unilateral pleural effusion
136
Asymmetric increased tactile fremitus indicates....
...consolidated tissue thru unilateral pneumonia
137
Hyperresonance during thorax percussion indicates...
...copd and asthma
138
Diaphragm normal size measured during diaphragmatic excursion
3-5 cm
139
Wheeze breath sound definition and what it indicates (3 things)
Adventitious breath sound like high pitched squeal with musical quality indicating asthma, bronchitis, or COPD
140
Bronchophony
Amplification of sound by fluid in a certain space, heard when ascultating by having a patient say 99, it will be louder where there's consolidation
141
Egophony
Alteration of sound heard when auscultating by having a patient say eeee and you may hear aaaa if egophony is present, indicative of lung or pleural disease
142
Whispered Pectriloquy
Loudness due to consolidation tranmission of sound by having a patient whisper 99 while ausculatating, should be barely heard in healthy lungs
143
Bronchitis findings on lung exam
- Tachypnea
- rhonchi and rales
- clears up with cough
144
COPD findings on lung exam
- Increased A/P diameter
- audible wheezing
- cyanosis
- peripheral edema
- clubbing fingers and toes
- hyperresonance
- rhonchi
- wheezing
- crackles
145
Pleural effusion findings on lung exam
- Diminished respiratory movement on affected side
- Dullness on effusion, hyperresonance superior to effusion
- trachea shifted to contralateral side (unaffected side)
146
Consolidated pneumonia findings on lung exam
- Tachypnea
- Shallow breathing
- dullness to percussion
- crackles and rhonchi
- egophony, bronchophony, whispered pectriloquy
147
Pneumothorax findings lung exam
- tachypnea
- cyanosis
- tracheal deviation to contralateral unaffected side
- Decreased fremitus
- shifts mediastinal structures to opposite side (diff from tension pneumothorax)
148
Mitral valve is on the ___ side of the heart and part of the__ circulation, what is the tricuspid?
Left, systemic, right, pulmonary
149
Apex of heart location
5th intercostal space mdiclavicular line on left side
150
PMI
Point of maximal impulse, typically same as apical impulse in a healthy individual
151
2 causes of Right ventricular hypertrophy, 2 causes of left
1) pulmonic valve stenosis, pulmonary hypertension
| 2) aortic valve stensois, systemic hypertension
152
S1 heart sound
Closure of mitral and tricuspid valves at the beginning of systole
153
S2 heart sound
Closure of aortic and pulmonic valves at the end of systole indicating the beginning of diastole
154
Physiologic splitting of S2
A delayed closure of the pulmonic valve during inspiration causing S2 to split into A2 and P2, very subtle and not pathologic
155
S3 heart sound and associated pathology
Also known as an early diastolic sound heard quickly after S2, indicates heart failure, large ventricle, and ventricular dysfunction most of the time except in young people
156
S4 heart sound and associated pathology
Also known as a latae diastolic sound heard shortly before S1, indicates atria trying to push blood into a noncompliant ventricle, causes include diastolic dysfunction and LV hypertrophy
157
Aortic area cardiac exam
Right 2nd intercostal space
158
Pulmonic area cardiac exam
Left 2nnd intercostal space
159
Tricuspid area cardiac exam
4th left intercostal space
160
Mitral or apex area cardiac exam
5th left intercostal space, midclavicular line
161
Erb's point cardiac exam
Left 3rd intercostal space, left sternal border
162
Systolic vs diastolic heart murmurs
Systolic are often benign and present in 60% of people, diastolic is always pathology
163
Aortic and pulmonic regurgitation is a...
...diastolic murmur
164
Aortic and pulmonic stenosis is a....
....systolic murmur
165
Mitral and tricuspid regurgitation is a....
....systolic murmur
166
Mitral and tricuspid stenosis is a....
...diastolic murmur
167
AXVY waves jugular venous pulsation
A - atrial contraction prior to S1
X - atrial relaxation between S1 and 2
V - atrial filling
Y - Atrial emptying into ventricle
168
Murmur scale heart
1-4 diastolic, 1-6 systolic
1 very faint
2 loud enough to be obvious
3 louder than 2
4 has thrill
5 heard with stethoscope partially off chest with thrill
6 heard with stethoscope completely off chest with thrill
169
What value for JVP's measured from sternal angle is considered elevated
>3cm
170
Leaning patient forward and listening at the aortic area while they hold their breath exhaled tests for....
....aortic stenosis
171
Left lateral decibutus and listening to the mitral area tests for....
....mitral stenosis
172
5 P's of PAD
Pain, pulselessness, pallor, paralysis, parasthesia, poikilothermia (rare 6th P)
173
Virchow's triad and what it indicates
Intimal trauma
coagulopathy, hypercoagulable state
venous stasis
Indicates DVT
174
Arterial claudication
Indicative of atherosclerotic disease, pain in defined group of muscles relieved with rest
175
Neurogenic claudication
Indicative of spinal stenosis, improves leaning forward
176
Subclavian steal syndrome
Stenosis of subclavian artery between causing syncope
177
Rest pain and what it indicates
Waking up with pain, laying legs over side of bed and pain goes away, indicative of PAD
178
ABI index
Measurement of systolic blood pressure with doppler ultrasound in each arm then in dorsal pedis and posterior tibial, should get higgher ankle pressure than arm by dividing ankle/arm, .9-1.3 is normal, .410.9 is mild pvd, 0-.41 is severe pvd
179
How to record pulse
```
4- boudning
3- increased
2- brisk
1- weak
0- abscen
```
180
Males are more likely to have ____ vascular disease while females are more likely to ahve _____
arterial, venous
181
Are varicose veins a risk for DVT?
Nahhh fam
182
Arterial vs venous characteristics
Cool vs warm
Sharp vs achy
No pulse vs pulse
No edema vs edema
183
Allen's test*****
Shows interconnection between between superfical and deep palmar arch arteries still intact between radial and ulnar part of hand by occluding and then testing
184
Term for erythematous, swollen, tender lymph nodes
Lymphadenitis
185
Lymphatic return is faciliated by....
....skeletal muscle pump, respiration, one way valves
186
Cisterna chyli
Dilated lymph vessel usually located on the right of the first or second lumbar vertebra marking the beginning of the thoracic duct
187
Thoracic duct
Receives overwhelming majority of lymphatic drainage from the entire left side and bottom right side of body, travels up the left side of the abdomen and thorax to empty where the left internal jugular and left subclavian vein meet
188
Right lymphatic duct
Responsible for minimal lymphatic drainage from the body, just the right upper extremity and right side of the head, travels to empty into the junction where the right internal jugular and right subclavian vein meet
189
Horizontal inguinal lymph nodes
Travel along th einguinal canal and drain the lower abdomen and buttocks, external genitalia (minus testes or ovaries) scrotum, anal, and lower vagina
190
Vertical inguinal lymph nodes
Travel along the line of the great saphenous vein and drain portions of the leg corresponding
191
Testes and ovaries lymphatic drainage
Separate pattern from horizontal and vertical inguinal lymph nodes going to paraoritc lymph nodes following testicular arteries deep into abdomen
192
Each breast is drained by ___ lymphatically
Different sides (thoracic duct vs right lymphatic duct)
193
Infraclavicular nodes
Any palpation is abnormal and can be indicative of breast cancer or malignant lymphoma
194
Virchow's node
Left supraclavicular node if palpated indicative of stomach, intestinal, breast, lung, or lymphoma cancers
195
Right supraclavicular node
Any palpation indicates cancer of lung, mediastinum, or esophagus
196
Lymphatic drainage of the testes vs scrotum
They are different - scrotum drains to inguinal lymph nodes while testes drains paraaortically
197
Milroy's disease
Lymphatic system congenital defect where valves do not work resulting in lymphedema (hard, non pitting, thickened skin)
198
Pain in the gut is interesting because if cut open, it results in ___ but distension, results in _____
No pain, extreme pain
199
Tenesmus
Feeling of incomplete defecation
200
Right upper quadrant is associated iwth...
Liver, gallbladder, duodenum, head of pancreas, right kidney, right adrenal gland, portions of ascending and transverse colon
201
Left upper quadrant is associated with...
Left lobe of liver, spleen, stomach, pancreas, left adrenal gland, left kidney, portions of descending and transverse colon
202
Right lower quadrant pain is associated with...
Cecum, appendix, portion of ascending colon, right ovary, right spermatic cord and inguinal canal, right ureter, part of bladder
203
Left lower quadrant pain is associated with...
Descending and sigmoid colon, left ovary, left spermatic cord and inguinal canal, left ureter, part of bladder
204
Cullen's sign
Bruising around the umbilicus indicative of acute pancreatitis or intra-abdominal bleeding
205
Grey turner's sign
Bruising around the flanks, a sign of retroperitoneal hemorrhage
206
Caput medusa
Distension and engorging of periumbilical veins seen with late stage hepatic cirrhosis
207
Shifting dullness
Can indicate presence of freely mobile fluid by having a patient lie on back and measure where dullness begins vs on the side where dullness begins
208
CVA tenderness indicates...
....pyelonephritis
209
Abdominal wall mass test
Ask patient to raise head/shoulders to see if mass remains palpable (on the wall) or not (in the vicera) to see if abdominal wall or cavity based
210
Roysing's sign
Press deeply in LLQ, pain in RLQ with pressure in LLQ or with RLQ rebound tenderness is positive for appendicitis
211
Psoas sign
Flex right hip to test for appendicities
212
Obturator sign
Flex right thigh at hip with knee bend, internally rotate hip, positive if pain for appendicitis
213
Murphy's sign
Ask patient to exhale, place hand below costal margin on right side of midclavicular line, have patient inspire, if sharp pain then positive test for acute cholecystitis
214
Most important factor for risk of breast cancer
Age
215
Inspeection of the breast
Make sure you check for 4 views (hands at sides, hands on hips, hands overhead and leaning forward)
216
Cervical motion test/chandellier test
A test for PID during the bimanual exam involving physical manipulation of the cervix, positive if patient experiences acute pain from manipulation
217
```
Meaning of common thought process defects seen in mental status exam
Circumstantiality
derailment
flight of ideas
neologisms
incoherence
blocking
confabulation
echolalia
clanging
perseveration
```
- rambling
- shifting topics
- abrupt change in topics one to next
- Geroge W Bush
- making no sense
- losing train of thought
- fabricating
- echoing what you say
- talking in rhyme only
- repeating
218
MSE Judgement exam
"What would you do if you saw a fire while in a grocery store"
219
MSE Insight exam
What brings you here today
220
MSE abstract thinking exam
What does the proverb Rome wasn't built in a day mean to you?
221
MSE orientation exam
Tell me your name, where you are, what is the date
222
MSE attention exam
Serial 7's, spell world backward
223
MSE recent memory and remote memory exam
Recent news, name last 4 presidents
224
MSE new learning ability exam
Give 3 words and have them repeat after 5 minutes
225
MSE info and vocab exam
Name an object
226
MSE constructional ability exam
Draw a clock
227
Cranial nerves sensory, motor, or both
```
Some (I)
Say (II)
Money (III)
Matters (IV)
Some (V 1)
Say (V 2)
Brains (V 3)
My (VI
Brother (VII)
Says (VIII)
Big (IX)
Boobs (X)
Matter (XI)
Most (XII)
```
228
CN I function and test
Olfaction, do sniff test, inspect nasal cavity, test each side with smell test
229
When pointing an otoscope, point...
....straight back, not upward
230
CN II function and test
Vision, visual fields by confrontuation, manipulate to view conjunctiva, snellen chart and color vision test, fundoscopic exam
231
CN III, IV, VI function and test
Motor movement of eye and extraocular muscles, pupil size test, accommodation, direct and indirect response to light, nystagmus, lid lag,
232
Strabismus vs ambylopia
Cross eyed vs lazy eye
233
Adie's (tonic) pupil
Absence of light response in dilated pupil (cannot constrict), can be seen in diabetic neuropathy or alcoholism
234
Argyll Robertson pupil
Absence of pupillary dilation in dark, pathognomonic of neurosyphilis
235
Trochlear palsy often manifests as....
....diplopia on downwrd gaze
236
Oculomotor palsy symtpoms
Ptosis, dilation of pupil
237
CN V function and test
Facial sensation and motor function of the jaw, sharp dull test, corneal reflex,
238
CN VII function and test
Muscle of facial expression and taste on anterior 2/3 of tongue, facial motion test, taste test
239
Branches of facial nerve motor function (remember the pneumonic two zebras bit my clavicles)
```
Temporal
Zygomatic
Buccal
Mandibular
Cervial
```
240
CN VIII function and test
Hearing and balance, finger rub test, rinne and weber
241
CN IX function and test
Muscles of the throat, posterior 1/3 of tongue taste sensation
Swallow test, gag reflex, taste sensation test
242
CN X function and test
Esophagus contraction, ear sensation, pericardium, bronchi, stomach, uvula, say ahhh,
243
CN XI function and test
Trapezius and SCM function, test with resistance
244
CN XII function and test
Motor tongue innervation, look for deviation, cheek test
245
Hyperactive DTR's and spacticity are a sign of
Upper motor lesion
246
Hypoactive DTR's and flaccidity are a sign of
Lower motor lesion
247
Recall corticospinal, spinothalamic, and posterior column tracts
Corticospinal - voluntary movement and muscle tone
spinothalamic - pain, temp, crude touch
posterior column - position, vibration, refinded touch
248
Parasthesia
Peculiar sensation without obvious stimulation
249
Up down proprioception test
Move toe in up and down position, same with fingers
250
When doing sensory tests, always work from ___ to ____
distal to proximal
251
Vibratory sensation test
Place tuning fork distally and tell patient when senesation stops
252
Light touch test
Cotton ball when is touch felt, compare side to side
253
Stereognosis test
Hold hands out and close eyes, give object and have them know it
254
Graphesthesia test
Draw a number on a patient's hand and have them tell you what it is
255
2 point discrimination test
Have patient determine difference between 1 point or 2 on finger pads
256
Point localization test
Touch skin with patient's eyes closed, have them point to where they were touched
257
Fasciculations definition
Random involuntary muscle twitches
258
Normal strength test would be graded a ___/5
5/5
259
Babinski sign
A reflex test on infants after the sole of the foot has been firmly stroked causing fanning of the toes and movement upward being positive, normal in infants but a sign of disease in adults
260
Rapid alterrnating movements test
Cerebellar test where they tap hands alternatively
261
Point to point movements
Cerebellar teset of movement of finger to nose to finger
262
Rhomberg test
Have patient close eyes, slight push and watch for maintanance of balance
263
Pronator drift test (2 parts)
1) Place hands out and supine while eyes are closed, if unable to hold patient will start to slowly pronate hand indicative of contralateral stroke
2) push down on arms and see if they return to normal position, if not or overshoot then positive indactive of contralateral storke
264
DTR ratings
0-4 scale, 5 refers to sustained clonus
265
Hyperactive DTR suggests...
....central lesion, corticospinal tract corsses at medulla, so lesion is contralateral
266
Sequence of DTR tesets
```
Ankle
Knee
Brachioradialis
Biceps
Triceps
Abdominal
```
267
Brudzinski's sign
Flexion of hips and knees in response to neck flexion positive for meningitis
268
Kernig's sign
Pain bilaterally behind knee when flexed knee is extended, positive for meningitis
269
Preferred positoining for rectal exam
Either bend over or left lateral decuibuts
270
Direct hernia
Above the inguinal ligament, rarely in the scrotum, hernia bulges anteriorally and pushes side of finger forward
271
Indirect hernia
Above inguinal ligament, often into the scrotum, touches the fingertip
272
Anorectal junction
Region of transition for cell type as a result experiences increased risk of cancer
