PDX 2 Flashcards
Articular or Extra-articular Structures
Joint Capsule
Articular Cartilage
Synovium and synovial fluid
Intra-articular ligaments
Juxta-articular bone
ARTICULAR
Articular or Extra-articular Structures
peri-articular ligaments
tendons
bursae
muscle
fascia
bone
nerve
overlying skin
Extra-articular
Articular or Extra-articular Disease
Swelling
Tenderness
Limit active and passive ROM
Articular
Articular or Extra-articular Disease
Involve selective portions of joint
Movement dependent
Extra-articular
What type of synovial joint is found in the shoulder and hip
freely movable
Spheriodal (ball and socket)
What type of synovial joint is found in the IP joints, hand and foot, elbow
freely movable
Hinge
movement in 1 plane
What type of synovial joint is found in the knee and TMJ?
freely movable
Condylar (hinges and glides)
2 articulating surfaces
Fibrous joints are immovable and are found where?
skull sutures
audible or palpable “crunching” sound
rubbing of ligament/tendon over bone or bone over bone
CREPITUS
Red Flags of Lower Back Pain
age, weight, time of day, history, present issues
> 50 yrs
History of Cancer
Unexplained weight loss
Pain at Night, worsening with rest, lasting more than one month, un-responsive to treatment
History of IV drug use
Current infection
motion by the patient vs motion by the examiner?
Active – patient
passive – physician
signs of inflammation and arthritis
SWTRP
Swelling
Warmth
Tenderness
Redness
Pain
SITS muscles of the shoulder
Supraspinatus
Infraspinatus
Teres ,inor
Subscapularis
Predictors of Rotator Cuff Tear
Supraspinatus weakness on abduction
Infraspinatus weakness on external rotation
Positive impingement sing – Neers or Hawkings sign
What test is this / what does is diagnose?
Adduct arm across chest –> PAIN
Crossover Test – AC Joint Injury
inflammation or arthritis
What test is this / diagnoses what ?
IR and raise arm while compressing scapula –> PAIN
NEER’s impingement test
= ROTATOR CUFF TEAR
What test is this / what does is diagnose?
shoulder and elbow flexed to 90 degrees and then IR arm –> PAIN
Hawkin’s Impingement Test
ROTATOR CUFF TEAR
What test is this / what does is diagnose?
abduct arm with thumb down, ask patient to resist pressure –> weakness to resist
possible rotator cuff tear
EMPTY CAN TEST
What test is this / what does is diagnose?
Abduct arm to 90 degrees and slowly lowering to side –> inability to slowly lower
DROP ARM TEST
possible rotator cuff tear
a positive VALGUS stress test indicates
push from lateral to medial –> Pain
MCL Tear
a postive VARUS stress test indicates
push from medial to lateral –> PAIN
LCL tear
What test would indicate a potential ACL tear?
Lacmans test – pull anterior with knee 15 degrees
Anterior Drawer Test
pull anterior with knee 90 degrees –> increased excursion
What test would indicate a possible PCL tear?
Posterior Drawer
push poterior with knee 90 degrees
What test could check for a meniscal injury?
MCMURRAY Test
rotate and flex/extend – click or tenderness
What test is this; weakness on thumb abduction is a positive test
CARPAL TUNNEL
Finkelstein’s Test
you are tapping lightly over the course of the median nerve in the carpal tunnel for median nerve compression … what are you testing for
TINEL SIGN
WHAT TEST IS THIS
hold hands at right angles with wrist flexed and hold for 60 seconds –> reproduces symptoms
Phalens Sign
What are the nodules on dorsal DIP called?
HERBEDEN’s Nodes
What are the nodules on dorsal PIP called?
Bouchard’s Nodes
RA = fusiform/spindle shaped swelling is most common where?
Acute = PIP
Chronic = MCP and PIP
fingers may deviate toward ulnar side
Name the deformity
hyperextended PIP
flexed DIP
SWAN NECK
name the deformity
hyperextended DIP
Flexed PIP
Boutonniere
THENAR atrophy vs HYPOTHENAR atrophy
Carpal tunnel syndrome – THENAR
Ulnar nerve compression – HYPOTHENAR
tenderness over anatomical snuffbox
increased risk of avascular necrosis of scaphoid bone
what do you suspect!
Scaphoid Fracture
What disease!
tenderness over the extensor pollicis brevis and abductor pollicis longus tendons
Finkelstein test tuck thumb inside first - ulnar wrist deviation = pain
De Quervian tenosynovitis
primary hip flexor =
iliopsoas
primary extensor of the hop =
gluteus maximus
Genu Varum vs Genu Valgum
VARUM = BOWED Legs
VALGUM = KNOCK Knees
Genu Recurvatum = Back Knee - extend past normal
How do you test acuity of central vision?
Snellen Eye chart
Rosenbaum – also tests near vision
Visual Acuity Recording
First number indicates
Second Number indicates
First # = distance from eye to chart
2nd # = distance at which normal eye can read letters
Legally Blind acuity recording =
20/200
SO4
LR6
Rest are 3
swelling of optic disc due to increased intraocular pressure (glaucoma) =
papilledema
What is the normal cup:disc ratio
0.3
When looking at a patient with hypertension using a funduscope, the arteries appear …
NARROW
Arteriovenous Nicking
Copper wiring of arterioles
Cotton Wool Spots
When looking at a patient with diabetes using a funduscope, you notice …
Neovascularitzation
Microaneurysms
Patient presents with diffusely red eye, painful, decreased vision
Ciliary injuection = dilation of deep blood vessels
Uveitis (Iritis)
patient with narrow angle glaucoma, has increased pressure in their eye due to what?
decreased drainage of aqueous humor
You suspect your patient has Marcus Gunn Pupil, you swing your flashlight into the abnormal eye and you see what?
afferent pupillary defect
Dilation of both pupils
You are conducting a flashlight test on a patient with syphillis you observe …
small irregular pupils that accommodate (constrict) but dont react to light
misalignment of the eyes =
hypertropia
unequal pupil size
anisocoria
irregular curvature of cornea/lens
blurry vision
Astigmatism
loss of lens elasticity causing decreased ability to foucs on near objects
seen with aging
Presbyopia
What clinical triad is seen with Horner’s Syndrome?
damage to reticulospinal fibers
Ptosis
Miosis
Anhidrosis
sudden onest, “thunderclap”, worst headache of my life can be indicative of …
Subarachinoid hemorrhage
lazy eye =
amblyopia
small bump in the eyeleid caused by a blockage of a ting oil gland
Chalazion
styes = hordeolum
conductive loss results from problems in what part of the ear?
External/MIddle Ear
sensorineural loss arises from problems in what part of the ear?
Innter Ear/Cochlear Nerve
When bone conduction is longer than or equal to air conduction it indicates what kind of loss
BC > AC
CONDUCTIVE loss
When air conduction is longer than bone conduction, it indicates what kind of loss?
AC > BC
Sensorineural Loss
musical ringing or a rushing or a roaring noise in one or both ears =
Tinnitus
drainage from the nose, often associated with nasal congestion, sense of stuffiness/obstruction
Rhinorrhea
Differences in hair with HYPERthyroidism vs. HYPOthyrodisim
HYPER – FINE/SILKY Hair
HYPO – coarse/sparse hair
infection of the ear canal =
pain with auricle movement
Otitis externa
infection of middle ear
erythema, distortion/bulging of TM
otitis media
What test checks conductive and what checks localization?
RINNE Test – conductive
WEBER – Localization
Where is the Wharton’s duct located?
base of the tongue, ducts of the submandibular gland
Proteinuria and Hematuria are seen in nephritic syndrome, but only what is seen in nephortic syndrome?
Nephortic = proteinuria
defective articulation =
its a SPEECH disorder
dysarthria
language disorder =
dysphasia
disorder in producing or understanding LANGUAGE
aphasia
inability to perform particular purposive actions
APRAXIA
nonfluent aphasia =
BROCAS Aphasia
Broken Speech
Receptive/Fluent Aphasia =
Wernicke’s Aphasia
word salad
Patient has wernickes aphasia, the location of the lesion is …
Posterior Superior temporal lobe
Your patient has Broca’s Aphasia, where is the location of lesion
Posterior Inferior FRONTAL lobe
inability or difficulty ambulating
ATAXIA
Spasticity is increased resistance that worsens at the extremes of range.
This is seen in what type of tract diseases?
rate dependent, increasing with rapid movement
Corticospinal
rigidity is not rate dependent
Bell’s Palsy is due to a lesion in what CN?
motor loss in both upper and lower face
CN VII
Patient is unable to close eyelids, has no facial expression, facial droop, and cant raise eyelids. You suspect …
Bells Palsy
3 superficial reflexes
Abdominal, Plantar and Anal
Test for Meningitis
flex hip and knee –> NECK PAIN
Kernig Sign
Test for meningitis
Flex neck –> bending of knee
Brudzinski’s Sign
the common causes of great toe dorsiflexion weakness are due to what nerve palsy?
Peroneal nerve palsy (failing to actively extend the ankle) or an L5 radiculopathy (isolated toe problem)
abnormality of rapid alternating movements indicates ….
dysdiadochokinesis
When theres an abnormality in point to point movements …
dysmetria
brief, rapid, jerky, irregular movements
Ex: Sydenham’s
CHOREA
twisting, writhing choreiform movements
cerebral palsy
Athetosis
3D’s
delirium
depression
dementia
this system classifies newborn neurologic recovery from birth and immediate adaptation to extra uterine life
APGAR score
this scoring system estimates gestational age to within 2 weeks, even in extremely premature infants
Ballard Scoring System
ability to selectively and progressively shut out negative stimuli
repetitve sound
HABITUATION
standard to measure developmental milestones throughout infancy and childhood
Denver Developmental Screening Test
personal social, fine motor-adaptive, language, gross motor
blue discoloration of hands and feet in the cold
Acrocyanosis
fine, downy hair growth over body at birth
Languo
smooth, white, raised areas without erythema due to sebum retention in sebaceous gland opening
Milia
dark, bluish pigmentation over buttocks and lumbar region that disappears during childhood
Mongolian Spots
When do anterior and posterior fontanelles close?
Posterior = 2 mo
Anterior = 4-26 mo
Enlarged fontanelle is seen in what congenital problem?
congenital hypothyroidism
Bulging fontanelle can be seen with what pressure issue?
INC intracranial pressure
if jaundice happens within the first 24hrs of birth, it may be due to what?
Hemolytic disease
2-3 weeks after – biliary osbtruction/liver disease
newborn swelling over occipito-parietal region
crosses suture lines
resolves in 1-2 days
Caput succedaneum
newborn sub-periosteal hemorrhage
does NOT cross suture lines
resovles within 3 weeks
Cephalohematoma
pre-mature closure of cranial sutures –> abnormally shaped skull
Craniosynostosis
tiny white or yellow, rounded muscous retention cysts are locaated along the posterio midline of the hard palate
Epsteins Pearls
Test for signs of hip dysplasia
test for relocating posterior dislocated hip
baby supine – flex/abduct hip – movement of fem head back into place
ORTOLANI TEST
test for signs of hip dysplasia
tests for ability to subluxe or dislocate an intact, unstable hip
baby is supine, flex and ADDUCT hip
barlow test
until what age is a positive babinksi response normal
2 yo
decreased arterial perfusion to peripheral tissues is caused by
hair loss over LE, pain w/exertion, muscle atrophy
atherosclerosis
What test can be used in the diagnosis of DVT of the leg
Homan’s Sign
What test is used to ensure the patency of the ulnar artery before puncturing the radial artery for blood samples
ALLEN Test
