Podiatric H&P Flashcards
When should you ask ROS questions?
prior to past medical history
what age group should you consider asking pregnancy questions?
women age 12-50
what should you focus on when asking ROS questions for diabetes?
type, duration, last accucheck, last HbA1C, last time checked by family physician
*must have been seen my family doc within the last 6 months
what scale is pulse rated on?
0/4- absent 1/4- weakly palpated 2/4- normal 3/4- bounding 4/4- strongest, usually associated with thrill or bruit
what are bounding pulses associated with?
wide pulse pressure (>60mm Hg)
any delay in capillary fill time can be associated with what?
vasospasm or structural changes
what are some systemic diseases causing pitting edema?
congestive heart failure (protein-rich exudate)
what are some systemic diseases that cause non-pitting edema?
liver and kidney problems (lack of protein in exudate)
what are some important characteristics for determining the nutritional condition of the skin?
- hair growth
- temp
- turgor
what is turgor vs. mobility?
mobility- the ease with which skin is moved when it is liften
turgor- the speed with which the skin returns into place
identify this lesion: palpable, solid , measures .5-1cm
nodule
identify this lesion: non-palpable, <0.5 cm
macule
identify this lesion: palpable, solid (>1cm)
tumor
identify this lesion: palpable, solid (<0.5cm)
papule
identify this lesion: palpable, solid (>0.5cm flat, elevated surface formed by coalescence of papules)
plaque
identify this lesion: clear, fluid filled (>0.5cm)
bulla
Identify this lesion: cloudy, pus filled (>0.5cm)
abscess
Identify this lesion: clear, fluid filled (<0.5cm)
vesicle
identify this lesion: cloudy, pus filled (<0.5cm)
pustule
identify this lesion: non-palpable >0.5cm
patch
Name the two non-palpable lesions, and their size ranges.
macule (0.5cm)
Name the two palpable, solid lesions, and their size ranges.
papule 1cm
plaque >0.5cm flat, elevated surface formed by a coalescence of papules
Name the clear, fluid-filled lesions
vesicle 05cm
Name the cloudy, pus-filled lesions
pustule 0.5cm
Name some examples of secondary lesions.
erosion, crust, scale, fissure, ulcer, lichenification, atrophy, excoriation, scar, keloid
what are teh 3 classification systems utilized for ulcers:
- Wagner’s- vascular surgery
- International Pressure Ulcer Advisory Panel (IPUAP)- wound care nursing
- University of Texam San Antonio (UTSA)
Describe the UTSA classification system for ulcers.
#- refers to depth of ulcer letters- refers to ischemia/infection or both
Using the UTSA classification system, grade the depth of ulcers.
0- no break in skin
1- subcutaneous break
2- wound probes to tendon
3- wound probes to bone
Using the UTSA classification syste, grade the level of ischemia/infection.
A- no infection or ischemia
B- infection
C- ischemia
D- ischemia & infection
muscle strength scale: normal strength
5/5
movement against resistance, but less than normal
4/5
movement against gravity, but not against added resistance
3/5
movement at the joint, but not against gravity
2/5
visible muscle movement, but no movement at the joint
1/5
no muscle movement
0/5
because the normal pod MSK exam occurs in the sitting position with the feet elevated (gravity eliminated), active movement of the foot and ankle against resistance implies what muscle strength?
2/5
early loss of strength will usually be seen in which muscle?
extensor digitorum brevis
*test by having patient dorsiflex the toes
more severe loss of muscular strength will be seen in what motion?
ankle dorsiflexion
MOST severe loss of muscular strength will be seen in what motion?
ankle plantar flexion
sensation proceeds along which courses in the spinal cord?
- posterior column
2. lateral spinothalamic tract
if a patient complains of “burning, cramping” pain- what tract is affected?
lateral spinothalamic tract- (aka small fiber tract)
which tract is for sharp and dull pain (nociception), temp, crude touch?
lateral spinothalamic tract
which tract is for position, vibration, and fine touch?
posterior column
if a patient complains of “pins and needles or electric shock sensation”, which tract is affected?
posterior column
what is considered a normal neurological exam with SWM?
at least 7/10 areas detected
what is the normal distance for 2-point discrimination?
5-6mm
an absent achilles reflex after what age is considered normal/
after 80 y/o
what is the spinal root level for the knee reflex?
L2,3,4
what is the spinal root level for the ankle reflex?
S1,2
what are the 5 potential areas of problems if you don’t get a reflex?
- intact sensory nerve
- a functional synapse in the spinal cord
- an intact motor nerve fiber
- NMJ
- competent muscle
true or false- deep reflex is not dependent upon higher levels of motor function in the brain and spinal cord.
true
describe the scale for scoring a deep tendon reflex.
4/4- hyperactive, clonus –> indicates UMN lesion
3/4- brisker than average, may indicate disease
2/4- average, normal
1/4- somewhat diminished
0/4- no response –> indicates LMN disease, peripheral neuropathy
what does a Babinskin response indicate?
(is a superficial reflex or plantar response, L4, L5, S1, S2) UMN disease- dorsiflexion of the great toe and fanning of the other toes
if a patient is able to stand on their tiptoes but not on their heels, what dose this suggest?
peripheral neuropathy
if a patient is able to stand on heels, but not tiptoes, suggests what?
spinal lesion
what does the ability to hop in place with each foot indicate?
intact motor system in the legs, normal cerebellar function and good position sense
what is the impression?
same as diagnosis
if a child is born in the breech position (buttocks first), what problems are more associated with this?
greater chance of LE problems, especially hip dislocation with or without metatarsus adductus
what is the APGAR score?
(very intial exam of teh infant after birth) A-appearance P-pulse G-grimace A-activity R-respirations
what is the desirable APGAR score?
> 7
when does a child develop hand preference?
age 2- a preference before then could signify a problem
when can a child lift their head?
at 3 months
when can a child control head position while sitting?
6 months
when can a child begin to crawl?
6 months
when can a child pull self to stand?
9 months
when can a child walk?
14 months
when can a child ascend staris with 2-hand support?
18 months
when can a child run forward?
2 years
when can a child pedal a tricycle?
3 years
when can a child balance or hop on one foot?
4 years
when can a child heel-toe walk?
5 years
when can a child skip one foot at a time?
6 years
