Physical Exams 2: Block 1 Flashcards

1
Q

What are the two motor pathways and what do they control?

A

Corticospinal (pyramidal)- cerebral cortex connecting to spinal motor neurons to control torso and limbs

Corticobulbar- upper motor neurons of CNs to control muscles of face, head and neck and terminate in the motor neurons in the brainstem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does the L side of the brain control the R side of the body?

What happens of these motor neurons are damaged?

A

Corticospinal tracts cross the spinal cord in the medulla

Above- motor impairment on contralateral side
Below- motor impairment on ipsilateral side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Damage to an Upper Motor neuron results in ?

Damage to a Lower Motor neuron results in ?

A

UMN- increased muscle tone and exaggerated DTRs

LMN- absent muscle tone and DTRs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What neuron tract carries the impulse that inhibits muscle tone?

What is the sequence of flow for sensory pathways?

A

Corticospinal tract

Impulses from skin/muscle/tendons/viscera
Peripheral nerves/dorsal roots
Spinal cord (pain, temp, position, touch)
Spinothalamic tract/Posterior Column
Sensory cortex of brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Once sensations like pain, temp and crude touch synapse w/ secondary neurons, how to they get to the thalamus?

How are sensations like postition, vibration and fine touch perceived?

A

Cross and ascend in Spinothalamic tract

Directly into posterior columns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What type of sensation are and are not sensed in the thalamus?

How is full perception of stimuli achieved?

A

Perceives pain, cold, pleasant
No fine distinctions are made

Third group of neurons send impulses to sensory cortex and higher discrimination is made

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A lesion in the sensory cortex may impair ? but leaves ? intact

What type of PT presentation suggests Dz of posterior columns?

A

Impaired perception of pain, touch and position; leaves finer discrimination intact (person can’t tell size/shape/texture of object in hand)

Loss of position and vibration senses but other senses are preserved

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What Sxs mean transection of spinal cord

What are the 4 guiding questions of a neuro exam?

A

Loss of all sensation, paralysis and hyperactive DTRs

Does PT have Dz
Is there localization/symmetry
What is the pathophysiology of the finding
Wat is the DDx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

General assessment of a PTs mental status starts where?

How is orientation assessed?

How to assess cognitive function?

How intellectual function assessed?

A

First meeting- LOC, Appearance, Affect

ANO x 3

Long term- presidents
Short term- 3 words

Count back by 7s, spell 5 letter word

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Chart on Slide 28

A

Pg 147-171

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where do CNs 3-12 arise from?

Where do CNs 1 and 2 originate?

A

Diencephalon and brain stem

Brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What CNs control pupil constriction, opening eye lid and most EOMs?

Which ones control EOM?

A

2 and 3

3, 4, 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What CNs control swallowing, raising of palate and gag reflex

Which ones contribute to voice and speech?

A

9 and 10

5 7 9 10 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

While assessing EOMs, a loss of conjugate movements in any direction will cause ?

How are nystagmus’ names?

A

Diplopia

Direction of quick component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define 3rd nerve palsy?

Define Anisocoria

A

Ptosis- drooping of upper eye lid

Difference of >0.4mm of pupil diameters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Table 7-10,

A

Pg 277

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A lesion on ? CN causes an absent blinking reflex with the corneal reflex test?

What is the different results of a peripheral injury, like Bell’s Palsy, and a central lesion, like a stroke, on the muscles of the face?

A

Sensory 5 or Motor 7

Palsy- affects upper and lower face
Stroke- only lower face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What nerves are the motor area and pull the palate up during “aahh”?

How are both motor and sensory areas of these nerves tested?

A lesion here will cause what result to be seen?

A

9 and 10

Gag reflex

Paralysis causes pulling the uvula to unaffected side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

A lesion on ? CN will cause hoarseness or difficulty swallowing during the gag reflex?

What are the functions of CN11?

A

Unilateral lesion on 10, vagus
Unilateral absence of reflex can mean lesion on 9 or 10

Carry efferent motor fibers to innervate SCM (turn head) and Trap muscles (raise shoulders)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Trapezius muscle weakness with atrophy and fasciculations indicates ?

What type of result will be seen in the shoulder as a result of the muscle’s weakness?

A

Peripheral nerve d/o

Drooped shoulder, scapula is displaced down and laterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A unilateral cortical lesion of CN12 causes ? result?

A distal lesion of C12 will cause what tongue result?

A

Protruded tongue deviates away from side of lesion

Deviates to weak side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Sensory system carries stimuli such as pain/temp, position/vibration, light touch and discriminative sensation through which pathways?

A

Pain/temp- spinothalamic
Position/vibration- posterior column
Light tough- both paths
Discriminative sensation- cerebral cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When testing vibration and sensory sensation, what areas of the body are tested first?

Mapping out dermatomes help with an exam how?

A

Finger and toe

Localize neurological lesions to a specific level of the spine, particularly in spinal cord injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the organization that own dermatome mapping?

What are the land mark dermatome levels?

A

American Spinal Injury Association

C3- front of neck
C6- thumb
C8- ring and little finger
T4- nipples
T10- umbilicus
L1- inguinal
L4- knee
L5- anterior ankle/foot
L4,L5,S1- posterior ankle and foot
S5- perianal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
# Define Analgesia Define Hypalgesia Define Hyperalgesia
Absence of pain sensation Decreases sensitivity to pain Increased sensitivity to pain
26
Which dermatomes need to be checked bilaterally?
``` All 3 branches of trigeminal C5-T2 T4 T10 T12 L2-S1 ```
27
What part of a sensory test is often omitted if pain sensation is normal? What size of tuning fork is used to test PTs vibration sense?
Temp 128Hz
28
What tests are included in testing discriminatroy sensations?
Stereognosis- name objects held in hand Graphesthesia- numbers drawn on hand 2 point discrimination- normal <5mm on finger pads Point localization
29
# Define Asterognosis When is graphesthesis testing used?
Inability to recognize objects held in hand If stereognosis is too painful or difficult for PT
30
How do we grade motor strength
0: no contraction detected 1: barely detectable flicker 2: movement w/ gravity eliminated 3: movement against gravity only 4: movement w/ some resistance 5: movement against full resistance w/out fatigue
31
How many muscle groups represent the motor innervation by the cervical/lumbar spinal cord What muscles are not tested
10 groups Abdominal muscles, T10-11 Hamstrings- innervated by levels of other muscles
32
What nerves control areas of the upper extremity?
``` C5- elbow flexor (bicep) C6- radial; wrist extensor C7- elbow extensor (tricep) C8- median; grip and thumb opposition T1- ulnar; pinky abduction ```
33
What nerves control areas of the lower extremity?
``` L2- psoas hip flexion L3- quad, knee extension L4- tibialis anterior, ankle dorsiflexion, inversion L5- hallucis longus, great toe extension S1- gastrocnemius, plantar flexion ```
34
What neurons are innervated during DTR tests? In order for a DTR to fire, what all needs to be intact?
Afferent and Efferent Sensory, spinal cord synapse, motor fibers, neuromuscular junction, muscle fibers
35
What is the path of a signal to elicit a DTR response? How are reflexes graded?
Tapping - sensory - peripheral nerve - spinal cord - anterior horn - crosses neuromuscular junction - contraction/completion ``` 4- very brisk w/ clonus 3- brisker than average, not specifically indicative of Dz 2- normal 1- low normal 0- absent ```
36
An abnormal reflex at tricep, bicep, brachioradialis, patellar or achilles means a lesion where?
``` Bicep- C5 Brachioradialis- C6 Tricep- C7 Patellar- L4 Achilles- S1 ```
37
A cutaneous reflex on upper/lower abdomen, plantar or anal region signify what areas of the NS?
Upper abdomen- T8-10 Lower abdomen- T10-12 Plantar- L5-S1 Anal- S2-4
38
Hyperactive reflexes can indicate lesions where? How do you prove/disprove an issue?
Descending corticospinal tract Weakness, Spasticity, Pos Babinski
39
Hypo active/absent reflexes imply ? issue How do you prove/disprove these issues?
Dz in spinal nerve roots, spinal nerves, plexus or peripheral nerves Lower motor neuron findings of weakness, atrophy or fasciculations
40
What type of reinforcement can accent/increase a PTs diminished/difficult reflexes
Isometric contraction Diminished arm reflexes- clench teeth, squeeze knees together Diminished leg reflexes- lock fingers and pull against each other
41
Define the Babinski reflex
Plantar reflex- normal is toe flexion Abnormal=positive, dorsiflexion and toe fanning from CNS lesion in corticospinal area or unconscious from drug/alcohol intoxication or postictal period
42
If a reflex seems hyperactive, what is the follow on test? What part of the brain helps w/ keeping the body upright in space?
Test for ankle clonus Sustained clonus= CNS dz Cerebellum
43
Coordination of muscle movement requires what four areas of the NS to function together? What function is usually not tested in a routine neuro exam?
Motor- strength Cerebellar- rhythm/posture Vestibular- balance/coordination Sensory- position Vestibular function
44
How do you assess PTs coordination during a cerebellar exam?
Rapid alternating movements Point to point movements Gait Standing- Romberg, Pronator drift
45
# Define Dysdiadochokinesis Define Dysmetria
Cerebellar issues- one rapid movement can't be followed by follow on rapid movement Finger over shoots target when PT point nose to out stretched finger target and worsened by eyes closed
46
What PE finding suggests a PT has a loss of position sense? What do abnormal Heel-to-Shin tests mean?
Nose to finger test is over shot by PT Cerebellar Dz if heel over shoots knee and oscilates side to side down shin Lost position sense of heel lifted too high and PT tries to look
47
# Define Ataxic What type of gait test can reveal hidden ataxia?
Uncoordinated gait and can be due to cerebellar Dz, loss of position sense or intoxication Tandem walking
48
What PE test mainly tests a PTs position sense? What abnormal findings can be seen and what do the represent?
Romberg Ataxia- from dorsal column dz and loos of position sense Cerebellar ataxia- PT has difficulty standing w/ feet together regardless if eyes are open or not
49
What PE test is both sensitive and specific for a corticospinal tract lesion? Other than drifting, what other finding can be indicative of an issue?
Pronator drift, signifies lesion in contralateral hemisphere Downward drift of arm w/ flexion of fingers and elbow
50
# Define Brudzinski sign Define Kernig Sign
Elevated head bends/elevates knees Extends knee from raised leg position, positive is pain in neck, back or head upon knee extension
51
# Define Articular Structures Define Extra-Articular Structures
Capsule, Articular Cartilage, Synovium/Fluid, lIgaments, Juxta-Bone Periarticular Ligaments, Tendons, Bursae, Muscle, Fascia, Bone, Nerve and Overlying sking
52
What are the 3 types of joints?
Synovial- freely moveable, bones don't touch and are covered by articular cartilage and separated by synovial cavity which is lined by membrane and secretes fluid, membrane surrounded by joint capsule Cartilage- slightly moveable, discs separate surfaces- ribs-sternum, epiphyseal plates of long bones Fibrous- immoveable, bones connected by fibrous CT, intervening layers of tissue holds bones together- sutures, distal talofibular joingt, teeth/socket
53
What are the 5 types of synovial joints? What is the most active joint in the body?
B/Socket, Condylar, Saddle, Hinge, Pivot TMJ
54
What type of joints are in between the tib/fib and along the plates of the cranium? What type are between the spinal vertebrae and the manubrium-rib?
Syndesmosis, Suture Symphisis, Synchondrosis
55
What is assessed during the General Information part of a MSK exam? What is assessed during the inspection? What is assessed in the surrounding areas?
Appearance, Proportions, Ease of movement Malalignment, deformity, fasciculation or tremors Skin changes and atrophy
56
Acute involvement of only one joint suggests ? issue What issue affects several joints symmetrically
Trauma, Septic arthritis, Gout RA
57
How do you grade muscle strength?
``` 0- no contraction detected 1- barely detectable/flicker 2- movement w/ no gravity 3- movement against gravity only 4- movement w/ some resistance 5- movement against full resistance and no fatigue ```
58
What muscle opens the jaw? What muscles close it?
External pterygoids Masseter, Temporalis and Internal pterygoids
59
# Define TMJ Syndrome What finding wold be seen 2-3wks post-rotator cuff tear?
Unilateral chronic pain w/ chewing/clenching often associated w/ stress Can have swelling/dec ROM and Trismus Atrophy of Supraspinatus and Infraspinatus
60
Lateral to medial, what are the bony land marks of the shoulder? Which landmark do the rotator cuff muscles insert?
Great tubercle, AC joint, Coracoid process Great tubercle
61
What movements are Flex, Extend, Abd, Add, Internal and External rotation movements for the shoulder?
Flex= raise arm up and over head (0-180*) Extend= raise arms behind (0-60*) Abduct- raise arms out and overhead Add= cross arms across body Internal- reach behind, touch scapula External- brush hair/arm to shoulder level, bend elbow and rotate forearm to ceiling
62
``` What does each special test assess in the shoulder? Cross over Apley scratch Neers/Hawkins Suprspinatus strength (empty can) Infraspinatus strength Drop arm Forearm supination ```
``` ACJ Overall rotation Cuff tendonitis/tear Cuff tendonitis/tear Cuff of biceps tendonitis Cuff tear Bicep tendonitis ```
63
What special test is done to assess the subscapularis Muscles? Where is the ulnar nerve in relation to the olecranon?
Lift off test Posterior between olecranon process and medial epicondyle
64
``` What do each of the following movements use for muscles? Flexion Extension Supination Pronation ```
Flex- bicep, brachialis, brachioradialis Extend- tricep Supinate- bicep, supinator Pronate- pronator teres/quadratus
65
Thenar or hyperthenar atrophy are signs of ? issue What structures make up the snuff box?
Thenar- median nerve compression Hypothenar- ulnar nerve compression Distal to radial styloid Extensor Pollicis Brevis and Abductor Pollicus Longus
66
What are the movements of the thumb?
``` Flex- move across palm to 5MCP joint Extend- across palm and away from fingers Abduct- anterior and away from palm Adduct- toward palm Opposition- touch thumb to each finger ```
67
What parts of the hand are innervated by nerves from the carpal tunnel. What tests can be done to assess for carpal tunnel?
Median Nerve-> pulp of index finger Ulnar nerve-> pulp of pinky finger Radial nerve-> dorsal web space of thumb and finger Tinel Sign- tap median nerve Phalen Sign- hold wrist flexed x 60sec and assess for numb/tingling; Pos= median nerve affected Finklesteins- fist the thumb w/ wrist ulnar deviation; Pain= de Quervian Tenosynovitis
68
What does C5 do for Motor, Reflex and Sensation
M: deltoid and bicep R: bicep S- outter upper arm
69
What does C6 do for Motor, Reflex and Sensation
M: bicep curl, wrist extendors- carpi rad longus and brevis R: forearm S: outter lower arm and thumb
70
What does C7 do for Motor, Reflex and Sensation
M: tricep extension, wrist flexion, finger extension R: back of elbow S: middle finger
71
What does C8 do for Motor, Reflex and Sensation
M: interossei muscles, finger flexors R: NONE S: medial forearm and pinky/ring finger
72
What does T1 do for Motor, Reflex and Sensation
M: interossei muscles R: none S: medial elbow
73
When assessing gait, define Stance Phase When do most gait problems occur? Define the Swing Phase
Foot on ground and bears weight Weight bearing/stance phase Foot moving forward and bears no weight
74
How far wide should the gait base be ? What is the only part of the gait that does NOT have knees flexed?
2-4" Heel strike
75
Top of the iliac crest is at what lumbar level? Pubic symphsis should be at the same level of ? structure
L4 Greater trochanter
76
How is the inguinal ligament best palpated during exam? What is the sequence of structures that bisect w/ the inguinal ligament
Ipsilateral heel on opposite knee NAVEL
77
What are the 3 bursae in the hip and how are the palpated?
Psoas- below inguinal ligament on deeper plane Trochanteric- overlying greater trochanter Ischiogluteal- overlying the ischial tuberosity and NOT palpable unless inflamed
78
What muscles are involved for movements of Flex, Extend, Abd, Add, Internal and External rotation movements for the hip?
``` Flex- ilipsoas Extend- gluteaus max Abduct- max and minimus Adduct- adductors, pectineus, gracilis External- obterator, quad femoris, gemuli Internal- gluteus medius and minimus ```
79
# Define Genu Varum Define Genu Valgrum
Bow leg Knock knee
80
What does swelling over patella indicate? What does swelling over infrapatellar bursitis mean? What does swelling over medial tubercle suggest?
Prepatellar bursitis Infrapatellar bursitis Anserine bursitis
81
What movement makes palpation of the medial meniscus easier to palpate? How far above the knee is the suprapatellar pouch?
Tibia slightly internally rotated 10cm
82
What is a Baker's Cyst What's the difference signs for a minor and major effusion in the knee?
Popliteal cyst Bulge sign= minor Ballottment- major
83
What muscles are responsible for knee flexion, extension, rotation?
Flex- hamstring group Extend- quads Internal rotate- sartorius, gracilis, semitendinous, semimembranous External rotation- bicep femoris
84
What special tests can be done for a knee exam?
McMurray- click/pop along medial joint w/ valgus stress, external rotation and leg extension= posterial medial meniscus tear Valgus test- pain/gap in medial joint= MCL injury Varus test- pain/gap in lateral joint= LCL injury A/P Drawer- unequal= ACL/PCL injury Lachman- forward excursion of tibia, most sensitive for ACL
85
What muscles are used in ankle movement
Plantar flexion- gastrocoleus, plantaris, tibialis posterior and soleus Dorsiflexion- tibialis anterior, extensor digitus longus, extesnor hallicus longus Inversion- tibialis posterior and anterior Everson- peroneus longus and brevus
86
What movements does the tibiotalar joint do What movements does the subtalar joint do
dorsiflexion/plantar flexion inversion/eversion of foot
87
What movements does the transverse tarsal joint do? What movements does the MTP joints do?
Inversion/eversion of forefoot Toe flexion
88
What is the Motor, Reflex and Sensation offered by L4
M: tibialis anterior (foot inversion) R: patellar tendon S: sensation to medial arch of foot
89
What is the Motor, reflex and Sensation offered by L5
M: extensor digitorum longus R: NONE S: middle 3 toes
90
What is the Motor, Reflex and Sensation offered by S1
M: peroneus longus and brevus R: achilles S: lateral arch of foot
91
What 4 landmarks should be visible when examining the spine?
C7 and T1 Paravertebral muscles Iliac crest PSIS
92
Facet joints of the neck are protected by ? muscle Sciatic nerve is located between what 2 structures
Trapezius Greater trochanter and Ischial tuberosity
93
When assessing Pts spine, offer stabilization for movements except for ? Define Patrick's Test
Flexion Flexion Abduction External Roation- tests for SI joint problems like sacroiliitis
94
What are the 3 shafts of the penis? Size range for testes?
Two corpus cavernosum Corpus spongiosum w/ urethra forms bulb 3.5-5.5 w/ L lower than R
95
Testes produce what two things? What covers each of the testes except for ? location
Testosterone, sperm Tunic vaginalis
96
Path of sperm from testes to urethra Spermatic cord contains what structures?
Through external inguinal ring, over ureter to prostate, merges w/ seminal vesicle Vessels, nerves, Vas Deferens, muscles
97
Lymphatic from penile and scrotal surfaces drain where? Where do lymphatics from the testes drain to?
Inguinal nodes Abdomen
98
What are landmarks for hernias? External ring that allows vas deferens passage is palpable on what location? Where is the non-palpable internal ring?
ASIS, pubic tubercle and inguinal ligament in between Above and lateral to pubic tubercle 1cm above midpoint of inguinal ligament
99
What is a second route for potential hernias? How do you estimate the location?
Femoral canal below inguinal ligament Index finger on R femoral artery, next medial finger on femoral vein, third finger on canal/empty space
100
What separates the colon from the anus? How many lobes of prostate surround urethra and can be palpated? What structures are not palpable here?
Pectinate/denate line, visible w/ proctoscope only 3, two lateral are palpable against anterior rectal wall and be 2.5cm long Median lobe and seminal vesicle are NOT palpable
101
What issues are examined for in males w/ PTs standing? What 3 issues can cause irritative voiding Sxs
Hernias Varicoceles- variscosities of pampiniform plexus around spermatic cord and gravity dependent and nearly always L sided UTI, STI, BPH
102
What 3 issues can cause hematuria Define Phimosis
Nephrolithiasis, Cancer, Excessive exercise Tight prepuce that can't retract over glans
103
# Define Paraphimosis Define Smegma
Tight prepuce that can't be returned back to original position Cheese/white material that acumulates under skin
104
# Define Balanitis Define Balanoposthitis
Inflammation of glans Inflammation of glans and prepuce
105
# Define Hypospadias Define Epispadias
Congenital ventral displacement of meatus Dorsal displacement of meatus, can be associated w/ incontinence
106
What does yellow/clear discharge from penis mean? What does induration along ventral surface of the penis mean?
Non/Gonococcal urethritis Urethral stricture or carcinoma
107
# Define Pearly Penile Papules Define Peyronies Dz
Skin colored bumps that form row around glans Considered normal variant, not contagious and ASx Dec w/ age but can remain for life Palpable, non-tender plaque along dorsum of penis causing crooked/painful erections in middle age/older men
108
# Define Penis CA Define Tinea Cruris
Non-atender indurated nodule/ulcer limited to uncircumcised men Jock itch, unilateral lesions starting in crural folds Define as half-moon shaped plaque w/ scaling Take sample for KOH examination
109
# Define Erythrasma How do different skin infections appear under Wood's Lamp
Infection of major skin folds caused by bacteria Corynebacterium Minutissiumum but can be confused for Tinea Cruis C. Mint glows coral red under Wood's Lamp but negative hyphae on KOH Tinea- none
110
Poorly developed scrotum contours can be indicative of ? issue What 3 issues can cause scrotal swelling?
Cryptorchidism- atrophied L testis outside of scrotum in inguinal canal and no palpable epididymis. Even w/ Tx, huge increase for CA. Indirect hernia- intestines come through external ring and won't allow examiner's finger above it Hydrocele Edema
111
# Define Epidermoid Cyst What parts of the scrotum can be evaluated w/ tranillumination?
Benign dome shaped white/yellow papules from occluded follicles that fill w/ keratin debris Hydrocele- transilluminates Blood, tissue, testis, tumors and most hernias DONT
112
# Define Hydrocele How do male genital warts appear on exam?
Nontender fluid filled mass inside of tunica vaginalis Examiner can get finger above the mass (scrotal hernias won't allow finger above it) Condylomata Acuminata ASx/ithcy/painful papules/plaques of various shapes but can be cauliflower-like usually caused by HPV 6 or 11
113
How do Genital Herpes appear? How does Primary Syphilis appear
Scattered groups of vesicles 1-3mm 90% are HSV-2 w/ a 2-7 day incubation period; need to DDx from Zoster and Albicans Red papule, becomes chancre 2cm in diameter w/ clean/red/smooth borders; heals in 3-8wks Treponema Pallidum, spirochete, after 9-90 day incubation PT may have inguinal lymphadenopathy w/in 7 days
114
Define Chancroid
Red papule/pustule then turns into deep painful ulcer w/ ragged margins from Haemophilus ducreyi, anaerobic bacillus, after 3-7 day incubation and half w/ lymphadenopathy
115
How does Gonococcal Urethritis present How does Non-Gonococcal Urethritis present
Inflammation of urethra from G w/ yellow discharge and irritative voiding Sxs Inflammation of urethra from Chlamydia w/ clear discharge and irritative voiding Sxs
116
# Define Acute Orchitits How do tumors of the testis appear?
Unilaterally inflamed painful testes from mumps/viral infection Painless nodule
117
# Define Spermatocele Define Epididymitis
Painless, moveable cystic mass above testis that transilluminates and contains sperm Inflammed epididymis causing tender pain and swelling that can pass to scrotum, relieved w/ lifting scrotum
118
# Define Varicocele Define Prehn's Sign
Varicose veins of spermatic cord usually on L side and can be associated w/ infertility R sided= concern for vena cava obstruction by tumor Lack of relief of pain when scrotum is elevated, used to support Dx of torsion along w/ absent Cremaster reflex
119
What are the types of hernias?
Indirect- most common; exits external inguinal ring and is palpable w/ fingers but can't get finger above it Direct Femoral
120
# Define Pilonidal Cyst and Sinus How does rectal CA feel upon exam compared to polyps?
Small tuft of hair/halo of erythema marks opening of sinus Generally ASx but abscess causes swelling, pain Sessile mass w/ edges, stony consistency and irregular contours Polyps= pedunculated and are round, smooth and semi-mobile
121
How do you grade the prostate size
``` 1= 1-2cm 2= 2-3cm 3= 3-4cm 4= more than 4cm ```
122
How does BPH present upon exam? How does bacterial prostatitis present?
Symmetrically enlarged, smooth and firm/rubbery w/ possible obliteration of median sulcus Fever, UTI Sxs, low back pain Prostate can be swollen/boggy/warm Caused by E Coli, Enterococcus, and Proteus Men <35- consider N Gonorrhea and Chlamydia
123
How does chronic bacterial prostatitis present What is the most frequent non-skin CA Dx in the US?
ASx, Sxs of dysuria, mild pelvic pain w/ normal feeling gland w/out tenderness/swelling Cultures show E Coli Prostate CA, also the second leading cause of CA death in men
124
What are the Risk Factors for prostate CA
Inc w/ each decade after 50 Higher in AfAm Fam Hx Saturated fats/animal source fats
125
What are the components/sequence of a well woman exam? Define Gravida and Parity
Breast, External/Internal pelvic, Bimanual, Rectal (Sxs, +50) Microscopy/lab of pregnancies, # of deliveries
126
Preterm delivery is what weeks? Abortions occur before ? week
20-36 20
127
``` Define Polymenorrhea Define Oligo Define Menor Define Metro Define Postcoital ```
``` <21 days between menses Infrequent Excessive flow Intermenstrual bleeding Suggestscervical polyps/CA; in older PTs means atrophic vaginitis ```
128
What preparation needs to be done by female PTs prior to a well woman exam? Vaginal opening is AKA?
No douche/intercourse 24hrs prior Empty bladder Introitus
129
# Define Condyloma Latum How do genital warts appear in female PTs?
Secondary Syphilis on Female PT Shallow ulcer w/ red bases
130
Define Cystocele Define Cystourethrocele Define Retrocele
Bladder hernia into vagina Herniation of bladder neck and urethra into vagina Prolapsed wall between rectum and vagina
131
What causes Bacterial Vaginosis What are the S/Sxs of an infection
Anaerobic bacteria Gray/white malodorous coating of vaginal wall causing fishy/musty smell
132
How many degrees is the spatula rotated and what is collected? How many degrees is the cytobrush rotated and what is collected?
360 to collect cells from external os 180 to collect endocervical cells Both replaced by CytoBroom
133
How does BME of the uterus change w/ pregnancy?
12wks- palpable at pubis symphysis 16wks- midway between pubis and umbilicus 20wks- at umbilicus More than 20wks- 1cm for every week of gestation
134
When is a rectovaginal exam required? When are DREs for FOT done?
Uterus is not palpable due to retroflexion All PTs >50y/o or has any rectal complaints
135
What changes are seen in female PTs during menopause?
``` Gray/sparse pubic hair Small/flat/dry labia Gaping/constricted introitus Narrow/atrophic vagina Smaller uterus Non-palpable uterus Weaker rectal tone ```
136
What is the target site of sampling during a PAP smear? __% of HPV infections are ASx and resolve within ?yrs
Transformation zone 90, 2yrs
137
What is the most important risk factor for cervical cancer? What HPV strains cause genital warts?
Persistent infection w/ high-risk HPV sub-types (HPV 16 and 18) 6 and 11
138
Breasts extend from __ to __ Where does it extend superficially
2nd rib to 6th rib, sternum to mid-axillary line Pec major, inferior margin at serratus anterior
139
# Define Inflammatory Ridge What are the 3 types of breast tissue?
Bilateral thickening of inferior border Glandular, fibrous and fat
140
How many lobes per breast? What do these lobes drain into?
15-20 Lactiferous ducts that drain into sinuses at nipple
141
What supplies the breast with blood? What 3 things are contained w/in the areola?
Internal Mammary and Lateral thoracic artery Sebaceous, smooth muscle and occasional hair
142
Where does breast lymph drain to? Where does the upper arm and retro-areolar areas drain to?
Anterior and central nodes Arm- lateral nodes Retro-aerolar- central
143
Where does deep breast lymphatic drainage go to? How much time spent on breast exams yields the highest sensitivity?
Internal mammary nodes and supraclavicular nodes 5-10 for both
144
How do breasts change in time of menses? How does this correlate to the best time for a breast exam?
Swell and more nodular from increased estrogen 5-7 days after onset
145
When laying supine for breast exam, examiner should spend ?min/breast What type of findings suggest CA?
3 Hard, Irregular, Poorly circumsized, fixed to skin/tissue
146
What types of drugs can cause non-pregnant lactation What can cause unilateral bloody discharge from 1-2 ducts?
Dopamine agonists Intraductal pappiloma Ductal carcinoma in situ Paget's Dz of the breast
147
What is needed for PTs presenting with Serous, Green, Black, non-bloody multiductal discharges? What type of post-surgical finding can suggest recurrence?
Reassurance Masses, Nodularity, Changes in color
148
# Define Fibroadenoma Define Cysts
Benign non-tender tumor usually at 15-25y/o Round, disc-like and mobile Benign tender findings between 15-25y/o that mimic fibroadenomas
149
# Define Fibrocystic changes What causes edema of breast skin, what is it AKA and where is it seen
Cobble stone texture w/ periodic/intermittent breast pain w/ Sxs peaking before menses Lymphatic blockage, Peau d'Orange Lower portion of breast/areola
150
When palpating male areola and breast tissue, if a nodule if found greater than ? size needs to be distinguished between what two issues?
>2cm Pseudogynecomastia- soft fatty enlargement of obesity Gynecomastia- benign firm disc of glandular enlargement that may be tender
151
What is the most common important risk factor for breast cancer? What are the modifiable risk factors?
Age ``` Breastfeeding for less than 1yr Postmenopausse obesity HRT Cigarettes/ETOH Sedentary Contraception ```
152
What are the non-modifiable risk factors for breast cancer? What are the 3 models used for assessing breast cancer risks
FamHx, Inheritence, Hx, Endogenous hormones BRCAPRO- used for high risk women to assess BRCA 1/2 Gail- PTs over 50 w/ no FamHx or one affected 1* relative and have annual mammograms Claus Model- assesses high risk females and incorporated FamHx for both female and 1*/2* relative w/ age of onset
153
What are the most common screening modalities for breast CA?
Mammogram and CBE
154
Define the Corticospinal/pyramidal tract
Mediate voluntary movement and integrate skill/movements | Carry inhibitory signals
155
Define the Basal Ganglia System
Motor pathways between the cerebral cortex, ganglia, brain stem and spinal cord to help maintain tone, movement and gross automatic movements like walking
156
Define the Cerebellar System
Receives sensory and motor input and coordinates motor activity, equilibrium and controls posture.
157
A cortical stroke lesion on the Cerebral Cortex will cause what motor, sensory, and DTR effects?
Chronic contralateral weakness/spasticity Flexion stronger than extension Hip is externally rotated Contralateral sensory loos in face. limbs and trunk on same side as motor deficits Increased DTRs
158
A brain stem stroke of acoustic neuroma on the brain stem will cause what motor, sensory and DTR effects?
Contralateral weakness and spasticity, diplopia and dysarthria No typical sensory findings Inc DTRs
159
Trauma to or a tumor on the spinal cord will cause what motor, sensory and DTR effects?
Bilatera weakness and spaticity Dermatomal sensory deficit on the trunk at level of lesion Inc DTRs
160
Parkinsonism at the subcortical gray matter/basal ganglia will cause what motor, sensory and DTR effects?
Bradykinesia, Rigidity and tremors Sensation intact Normal or decreased DTRs
161
Cerebellar stroke or brain tumor will cause what motor, sensory and DTR effects?
Hypotonis, ataxia, nystagmus and dysmetria Sensory intact Normal or dec DTRs
162
Polio, amyotrophic lateral sclerosis of the anterior horn will cause what motor, sensory and DTR effects?
Weak/atrophy in segment/focal pattern or fasciculations Sensation intact Dec DTRs
163
A herniated cervical/lumber disc affecting the spinal roots or nerves will effect motor, sensory and DTRs how?
Weak and atrophy in root-innervated pattern, sometimes w/ fasciculations Sensory deficits at dermatomes Dec DTRs
164
Trauma to a peripheral nerve/mononeuropathy will effect motor, sensory and DTRs how?
Weak and atrophy in peripheral nerve distribution; sometimes w/ fasciculations Sensory loss in nerve pattern, Dec DTRs
165
Peripheral polyneuropathy from alcohol or diabetes will lead to peripheral nerves/polyneuropathy and have what effect on motor, sensory and DTR functions?
Weak and atrophy distally, possible fasciculations Stocking/glove sensory deficit Dec DTRs
166
Myasthenia gravis causing neuromuscular junction issues will have what motor, sensory and DTR effects?
Fatigue Intact sensation Normal DTRs
167
Myscular dystrophy will have what effect on motor, sensory and DTR function?
Proximal weakness Sensation intact Normal or Dec DTRs
168
Define Anisocoria
Defected constriction/dilation of a pupil Constriction to light/near effort= PNS Dilation= SNS
169
What does it mean if Anisocoria is greater in light? What does it mean if it's greater in darkness?
Pupil can't constrict Due to trauma, open angle glaucoma, impaired PNS Pupil can't dilate Horner Syndrome
170
Define Adie Pupil
Tonic pupil Large regular unilateral pupil size w/ reduced or absent reaction to light Caused by denervation of PNS
171
What would be seen in CN3 paralysis?
Large/fixed pupil to light and near effort | Ptosis from paralysed LP msucle w/ down and lateral deviation of the eye
172
Define Horner Sydrome
Pupil is small w/ brief reflex to light but dilates slowly Tirad= miosis, ptosis and anhydrosis If hereditary, affected iris is lighter in color
173
Define Argyll Robertson Pupils
Small irregular pupils bilaterally Constrict w/ near and dilate w/ far vision but NO reaction to light Seen in neurosyphylis and rarely in diabetes
174
Why doesn't blindness cause anisocoria?
As long as SNS and PNS innervation remain normal, no changes. Blind eye will constrict w/ consensual reaction but not from direct stimulation
175
When conducting MSK exam, warmth can be indicative of what four issues? What two jaw structures have a disc between them to act as a cushion?
Arthritis, Tendinitis, Bursitis, Osteomyelitis Madible condyle and temporal bone articulating surface
176
What are the 4 muscles of the rotator cuff?
SITS | Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
177
What are the painful shoulder maneuvers and findings on exam for Rotator Cuff Tendonitis
Impingement Syndrome- repetition causes inflammation of supraspinatous tendon w/ max tenderness beneath the tip of the acromion
178
What are the PE findings for rotator cuff tears
The most common clinical problem of the shoulder RC Tears- RC muscles compress humeral head into glenoid fossa Subscapularis- internal rotation Supraspinatus- elevation Infraspinatus/TM- external Trauma/chronic wear on acromion and coracoacromial ligament Shrug of shoulder and Drop arm test are Pos on PE
179
What are the PE findings of Calcific Tendinitis
Degeneration of supraspinatus tendon from Ca Salts Usually +30 women Max tenderness below tip of acromium w/ inflamed subacromial bursa
180
What are the PE findings seen in Bicipital Tendinits
Inflammation resembling/co-existing w/ rotator cuff tendinitis Max tenderness at Bicep Groove Supinate raised elbow, pain in groove or w/ resisted fwd flexion is Pos for test
181
What are the PE finding Frozen Shoulder exam
Progressive restriction of A/PROM especially w/ external rotation and localized tenderness Associated w/ MI that has decreased shoulder movement
182
What is seen on PE for acromioclavicular arthritis
Degenerative changes with most tender on AC joint | Inc pain w/ movement of scapula and arm abduction
183
What will be seen on PE with an anterior disclocation of the humerus
Anterior subluxatio/dislocaiton from fall or forced throwing Pos apprehension sign is seen Inferior, multi-directional or rarely, posterior dislocations also seen
184
What is seen in Olecranon Bursitis and how is it treated
Trauma, gout or RA causes swelling superficial to OProcess, aspirate for Dx and relief
185
How are elbow nodules in RA PTs characterized? How does arthritis present?
Non-tender and firm Can be attached to underlying periosteum Inflammation/fluid felt along process/epicondyles causing stiff/pain and dec ROM
186
How does Epicondylitis present?
Lateral Epicondylitis- tennis elbow- repetitive extension of wrist or pro/supination of elbow Pain will be 1cm distal to lateral epicondyl and inc w/ resisted wrist extension Medial Epicondylitis- Golfer elbow from repetitive wrist flexion from throwing Max tenderness lateral/distal to medial condyle and inc w/ resisted wrist flexion
187
What hand deformities are seen in chronic RA?
Swan neck- hyperextension of PIP and fixed flexion of DIP | Boutonniere- persistent flexion of PIP joint w/ hyperextension of DIP joint
188
When/where are Heberden nodules seen? How do you tell the difference between Chronic Tophi Gout and RA?
Hard/painless nodules on dorsolateral aspects of DIP joints in OA Tophi involvement is less symmetrical than RA and can ulcerate/leak white urates
189
# Define Dupuytren Contracture Define Trigger finger
Thickened band under 4th finger near distal palmar crease Painless nodule on flexor tendon in palm near MC head
190
# Define Acute Tenosynovitis Define Felon
Inflammation along tendon sheath of distal digit from Staph A, Step, Gonorrhea or C Albicans. Can spread to thenar space Finger tip injury causing infection in an enclosed fasical space of distal phalaynx pulp usually from Staph A If vesicle is present- consider Herpetic Whitlow, seen in health care workers exposed to HSV in saliva
191
Flat feet can arise from what 4 underlying issues Bunions are AKA ?
Posterior Tibial Tendon Dysfunction, Obsity, Diabetes, Prior Injury Hallux Valgus
192
Define Morton Neuroma
Tenderness in 3/4th metatarsal space that radiates w/ squeezing Sxs include hyperesthesia, numbness, aching and burning
193
# Define Hypospadias What type of scrotal changes can be seen in HF and Nephrotic Syndrome PTs?
Urethral meatus is in inferior surface of penis Pitting Edema- skin is taut
194
Since testis are usually 3.5cm or smaller, what does a size 2cm or smaller indicate? What do soft testis indicate?
Klinefelters ``` Cirrhosis Myotonic Dystrophy Estrogen Hypopituitary Post-orchitis ```
195
What is the difference between early discovery of testis lump and late finding? Primary Syphilis and Chacroids need to be distinguished from?
Late- testis feel heavier Both from Granulosum Inguinale from Klebsiella
196
Chacroid needs to be distinguished from ? 4 microbes Where are anal fissures typically found?
Primary Syphilis Genital Herpes Lymphogranuloma Venereum Granulosum Inguinale Posterior midline
197
What does rectal cancer feel like during DRE? What does peritoneal metastases cause to be found during DRE?
Firm nodule w/ rolled edges of ulcerated CA Rectal shelf If PT is female- shelf is formed in the rectouterine pouch behind cervix and uterus