Random Facts to memorize Flashcards

Question

Valgus and Varus Stress Tests

Answer 1

- test for collateral ligament disruption - For valgus stress test: push on lateral side of elbow while abducting the distal forearm away from the body (medial glid and abduction) - For Varus stress test push on medial elbow while adducting the distal forearm (lateral glide and adduction)

Answer 2

* Sharply tap over the location of the median nerve in the carpal tunnel, on the palmar surface of the wrist, using your index and middle finger, or a reflex hammer. * A positive test is noted by reproduction of the patient's pain typically a shooting pain or paresthesias in the distribution of the median nerve. * Tinel's sign is not specific for carpal tunnel syndrome. It can be used in the diagnosis of any compression neuropathy.

Answer 3

- upside down prayer test: flex both wrists at 90 degrees with dorsal aspect of the hands together. pain is positive. - can indicate carpal tunnel - more sensitive than tinel's sign

Answer 4

- dorsiflexing wrists - positive pain is indicative of carpal tunnel syndrome

Answer 5

Distal radius fracture with distal fracture fragment displace dorsally. Often due to falling on an outstretched hand.

Answer 6

Distal 5th metacarpal fracture with volar angulation. Often due to punching something like a wall

Answer 7

Put the patient’s thumb inside their fist, and then gently ulnar deviate the wrist. If pain occurs along the thumb or wrist, the test is positive for tenosynovitis of the extensor pollicis brevis and abductor pollicis longus (De Quervain’s Disease).

Answer 8

Varus/Valgus ligament stress * Stabilize the proximal bone with one hand while using the other hand to deviate the distal bone to the ulnar and radial sides checking for ligamentous instability. Thumb/Ulnar collateral ligament stress * Put stress on the upper thumb joint, by pushing the thumb away from the hand.

Answer 9

10-15 degrees; directly under epidermis * primarily used for diagnostic purpose - use small syringes (1 cc) and small gauge (27 gauge, 1/2'')

Answer 10

administred at a 45 degree angle use a variety of syringes (1-3 cc) and needle sizes (23-25 guague, 1/2 - 5/8'' needle) - allows for slow sustained absorption of medications (insulin, hormones, opiates) - done wherever there is a good layer of SQ fat (i.e. posterior upper arm)

Answer 11

administered into a well perfused muscle at 90 degree angle along with aspiration - uses a variety of syringes (3 cc) and 21-25 gauge with 1- 1.5 '' needle. - provides rapid systemic acttivation of large doses with least amount of tissue damage * injection site at deltoid * Includes vaccines such as Hep A/B, MMR,DPT Pentacel, tetanus, B12, epinephrine, opiates, promethazine.

Answer 12

**Vasovagal syncope** Skin infection Toxic rxn. to local anesthetics Hematoma formation Neuritis Rebound pain Pneumothorax or Compartment syndrome

Answer 13

**Absolute** * Local cellulitis * Septic arthritis * Acute fracture * Bacteremia * Joint prosthesis * Achilles or patella tendinopathies * History of allergy or anaphylaxis to injectable pharmaceuticals or constituents * More than 3 previous corticosteroid injections within the past year in a single joint\*. Relative * Minimal relief after 2 previous corticosteroid injections * Underlying coagulopathies * Anticoagulation therapy * Evidence of surrounding joint osteoporosis * Anatomically inaccessible joints * Uncontrolled diabetes mellitus

Answer 14

Lidocaine - 1 min onset (.5-1 hour duration) * can cause vasodilation * use in contaminated wounds * safe in figers, nose, penis, toes and ear lobes lidocaine w/ epi - 1 min onset (2-4 hours) * causes vasoconstriction * use in highly vascular areas * use in clean wounds Bupivacaine w/ epi - 5 min onset (2-4 hours) Bupivicaine - 5 min onset (3-7 hours) * longer duration - fore nerve blocks Use epi (vasoconstrictor) when have area that is extremely vascular and need to control the bleeding , it also makes the wound longer. Want to make sure wound is clean in order to use epi Do not use epi in finger, toes, penis, nose and earlobes (not vascular – could cause necrosis)

Answer 15

T3 spine of scapula T7 inferior angle scapula L4 located at level of Iliac crest

Answer 16

Patella tendon reflex: L4 * middle of foot Achilles tendon reflex: S1 * lateral portion of foot \*\* note: L5-S1 is most common area of injury and source of lower back pain

Answer 17

Small Intestine T10-11 Colon and Rectum T12-L2 Bladder T12-L2 Ovaries/Testes T10-11 Uterus T12-L2 Prostate T12-L2

Answer 18

Raise leg, if reproduce leg pain radiation, lower leg just to point of no pain then dorsiflex foot. This stretches sciatic nerve so if dermatomal pain reproduced again, more likely is sciatic nerve. Most commonly positive for sciatica if pain found between 40-60 degrees of extension

Answer 19

Evaluates gluteus medius muscle Observe PSIS dimples standing on both legs Next have patient stand on one leg Gluteus medius on supported side should contract elevating pelvis on opposite side (“negative” normal test) If pelvis descends shows weakened muscle (“positive” test) Gluteus medius keeps hips stable during gait

Answer 20

Evaluates iliotibial tract (ITB syndrome) Patient lies on side opposite side being tested Flex knee to 90˚ and abduct leg at hip as far as possible Release leg in question, patient to relax leg * Normal test = leg returning to normal position * Abnormal test = leg remaining in abducted position

Answer 21

For flexion contractures of the hip due to tight Psoas (Iliopsoas) Flex hip(s) with patient supine so thigh touches abdomen Upon extending one hip should lie flat on table Positive test if hip does not fully extend

Answer 22

tests hip joint - patient lies supine - the foot of involved sie is placed on opposite knee - hip is now flexed, abducted and externally rotated - press down - pain may represent sacroiliac joint pathology

Answer 23

push up against resistance with hand placed on knee - this will also engage the quads

Answer 24

Anterior: dome swelling over patella associated with tenderness from excessive kneeling

Answer 25

Medial aspect of knee - tibial plateau - excessive running is the gcommon cause - also from valgus knee deformity

Answer 26

* Patient supine with knee extended * Compress patella against femur * Instruct patient to tighten quads. * Assess for roughness of motion, crepitus, pain * Pain associated with going up stairs or rising from chair consider Chondromalacia or patellofemoral syndrome

Answer 27

* Tests for dislocation or subluxation of patella * Attempt to manually dislocate patella laterally * Observe patient’s facial expressions

Answer 28

Anterior Cruciate Ligament: Anterior Drawer Sign: * Patient supine flex knees and hips 90˚ * Pull tibia forward to check for movement anteriorly * Compare to opposite side. Positive test = ACL tear Lachman test: only good for ACL * Knee flexed 15˚ and externally rotated if possible * Grasp femur with one hand and tibia with other * Move femur and tibia in opposite directions * Asymmetric, forward movement of tibia against femur suggests positive test = ACL tear

Answer 29

Posterior Cruciate Ligament: (post attachment) Posterior Drawer Sign: * Patient supine with hip and knee flexed to 90˚ * Push tibia posteriorly checking for movement against femur * Compare to opposite side. Positive test = PCL tear

Answer 30

- not a very specific test that tests for injury of the mmenisci of the knee * Patient supine grasp heel and fully flex the knee * Hold knee joint with other hand palpating along joint line * Rotate the lower leg internally to engage the lateral meniscus and extend the leg. Note pain; “pop” or “click” during the motion. Medial Meniscus: * Externally rotate tibia = heel points in/toward midline * Extend knee feeling for click, looking for pain Lateral Meniscus: * Internally rotate tibia = heel points out/away from midline * Extend knee feeling for click, looking for pain

Answer 31

Apley’s Compression Test: testing meniscus Patient prone with knee flexed to 90˚ Stabilize thigh with one hand while leaning onto heel compressing medial and lateral menisci. Rotate heel during compression noting any pain

Answer 32

- more sensitive meniscal test than mcmurray - with patient standing and holding on to you for balance, lift the affected leg and bend the leg standing on about five degrees. Apply internal and external rotation through the hips creating a standing grind onthe meniscus - then test the affected side.

Answer 33

Medial Collateral Ligament * **Valgus Stress Test: ** (Abduction Stress Test) * Patient supine and flex knee slightly * One hand against lateral knee the other around medial ankle * Push medially against knee while laterally against ankle Lateral Collateral Ligament * **Varus Stress Test:** (Adduction Stress Test) * Position patient same as for Valgus test * Hands against medial knee and lateral ankle * Push laterally against knee while medially against ankle

Answer 34

Evaluates for DVT (deep venous thrombosis) Dorsiflex patient’s ankle with leg extended at knee. Pain in calf is a positive sign.

Answer 35

- evaluates achille's rupture Patient prone, leg bent 90 deg, squeeze calf and observe for normal passive plantar flexion. Best to determine achilles rupture if done in 48 hrs.

Answer 36

lateral ankle Anterior Talofibular and Calcaneofibular are most injured in sprains --\> cause by inversion force Ankle dorsiflex/plantar flex (Tibiotalar joint) Inversion/eversion (Talocalcaneal joint = Subtalar Joint)

Answer 37

- used to evaluate joint stability of the ankle involving the talo-fibular ligament - with patient sitting at edge of talbe, grip the calcaneus in the palm and pull the calcaneus forward while pushing tibia posterior. in normal ankle, there should be no movment

Answer 38

- patient sits with foot hanging - doc inverts the calcaneous If the talus gaps or rocks in the ankle mortise, the ATF & calcaneofibular ligs are torn and the test is positive

Answer 39

- external rotation stress test - patient sitting. stabilize leg with one hand and hold foot at 90 degrees. apply passive external rotation stress to foot and ankle pain or instability at deltoid ligament of interosseous membrane is a high ankle sprain Ottowa Rules (age \>18 yr): inability to bear weight after four steps or tenderness over posterior aspect of either malleolus

Answer 40

One or more sharply demarcated, erythematous lesion(s), sometimes with blisters. Lesions reoccur in the same (fixed) location. Lips, hands, legs, face, genitalia and oral mucosa. Drugs: sulfonamides, cyclines, dipyrone, NASIDS, barbiturates and phenolphthalein. Burning sensation.

Answer 41

Renal function test: BUN/Cr - high levels indicate kidney failure * pre-renal: BUN/Cr \> 20 * Renal and post-renal: BUN/Cr = 10-20

Answer 42

Can be caused by: A; Rheumatoid Arthritis B. Acute Myocardial Infarction C. Colon Cancer D. Tuberculosis ESR: indicates the presence of an inflammatory process - associated with AI process, infectious process, neoplastic process

Answer 43

Definition: Malignant mesecnhymal tumor in which cancerous cells produce bone matrix. Most common primary malignant tumor of the bone. Makes up 20% of all bone cancers. 75% of osteosarcomas occur in patients younger than 20 years old. Smaller second peak in elderly d/t Paget’s disease, bone infarct and prior irradiation. Associated with patients with previous retinoblastoma. - most common sites: distal femur, proximal tibia, hip and pelvis, proximal humerus, jaw 75% Classic A. Osteoblastic B. Chondroblastic C. Fibroblastic 25% Variant A. Clinical characteristics, post radiation, Paget’s disease B. Morphologic characteristics C. Location - periosteal

Answer 44

Paget's disease, Osteoblastic bone tumors, liver disease, hyperparthyroidism (excess bone growth) ALP: Enzyme that catalyzes hydrolysis of organic phosphate esters. (seen in bone growth)

Answer 45

Normal * A resting ankle-brachial index of 0.9 to 1.3 less than 0.9 is normal and suggests no significant narrowing or blockage of blood flow. Abnormal * A resting ankle-brachial index of less than 0.9 is abnormal. If the ABI is 0.41 to 0.9, there is mild to moderate peripheral arterial disease. If ABI is 0.4 or below, there is severe peripheral arterial disease.

Answer 46

Have the patient open and close the fist several times quickly, then will hold it closed tightly. Apply firm pressure over the radial and ulnar arteries. Ask the patient to open the hand slowly. Release the pressure on one of the arteries and observe the return of pink coloration of the hand. Repeat the process to test the collateral artery supply. \* determines arterial insufficiency in the hand

Answer 47

Tests for chronic peripheral arterial disease With the patient lying on their back, elevate the affected extremity for at least 1 minute If the color becomes pale, lower the extremity to watch for return of pinkness which should occur within 10 seconds Common symptoms of PAD: * Pain * Coldness * Numbness * Hair loss (Chronic) * Color change (Chronic) * Loss of pulse * 3 P’s-Pain, Pallor, Pulselessness

Answer 48

* Occlusion of the artery by embolus often a thromboembolus * Sudden onset of very severe extremity pain * Unilateral * Not aggravated by movement or position change Associated sx: Cold, weak, numb distally Physical findings: Extremity is pallid, cool and pulseless 5 P's: * pain * paresthesia * paralysis * pallor * pulseless

Answer 49

peripheral arterial disease * Chronic inadequate arterial flow * Intermittent claudication while walking, relived by rest * Associated symptoms: muscle fatigue, numbness, cold feet * Physical findings: decreased distal pulses, pallor on elevation, ulcers/gangrene * Ankle Brachial Index is the ratio of the dorsal pedis and brachial arterial pressures : An index of less than 0.9 indicates PAD.

Answer 50

With patient supine, raise one leg as high off the table to 90 degrees and let the venous blood drain from the leg Occlude the great saphenous vein with one hand in the inner thigh and then lower the leg and ask the patient to stand up Watch for normal slow venous filling of the leg veins while maintaining pressure on the great saphenous vein from above If rapid filling occurs during this time there is incompetent valves of the communicating veins. After 20 seconds release the pressure on the great saphenous vein If sudden venous distension occurs , it indicates rapid venous filling and incompetent valves of the great saphenous vein.

Answer 51

Clot formation in one of the larger veins usually the leg Virchow’s triad * Stasis * Hypercoagulability * Endothelial injury Symptoms * Often painless, but may complain of discomfort secondary to swelling * Almost always unilateral * Not aggravated by movement, may be mild relief by non-weight bearing Physical findings * Swelling * Pitting edema * Homan’s sign * Discoloration of the distal limb from venous congestion Pulmonary Embolus: major complication of DVT: large clot breaks off the leg and travels to lungs, resulting in hypoxemia and necrosis of the lung

Answer 52

* Same mechanism as deep vein thrombophlebitis but in one of the smaller veins in the leg * Pain is a much more common complaint * Physical findings: may be redness and tenderness over the affected vein, usually much less swelling than with DVT

Answer 53

* Valves in veins of lower extremities become incompetent so that blood begins to pool in veins * Early the patient has few complaints and usually seeks care for cosmetic reasons. As the disease progresses, patients show signs of chronic venous insufficiency * Physical findings: engorged lower extremity veins very often the greater saphenous Venous Disease: can be the result of DVT, Varicose veins and superficial thrombophlebitis, all causing venous valve damage from the high venous pressures

Answer 54

Venous Disease: can be the result of DVT, Varicose veins and superficial thrombophlebitis, all causing venous valve damage from the high venous pressures Risk factors * Deep vein thrombosis (DVT) * Varicose veins or a family history of varicose veins * Obesity * Pregnancy * Extended periods of standing or sitting * Age over 50 Symptoms * Diffuse ache in legs * Gradual onset over months * Aggravated by prolonged standing * Alleviated by elevation of the legs Signs * Pitting edema * Rust colored skin with chronic disease * Thickened skin hair * Moist reddened ulcers

Answer 55

* Lymph channel obstruction or damage * Gradual onset * Unilateral or bilateral depending on cause * Aggravated by pressure on lymphatics * Alleviated by elevation and pressure release * Examination: non-pitting edema, thickened skin, often no pigmentation change

Answer 56

Often palpable in children More often palpable in cervical region in children More often palpable in inguinal region in adults More often palpable in cervical region in adult smokers Characteristics to note: * Size * Tenderness * Firmness * Mobility * Borders Benign Disease: * Less than 1 cm * Tender * May be firm but not hard * Freely movable * Discreet borders Malignant Disease: * Greater than 1 cm * Non tender * Rock-hard * Fixed to surrounding tissue * Difficult to palpate borders

Answer 57

* Localized bacterial infection of lymphatics * Acute onset * Usually secondary to skin injury * Associated symptoms: pain and fever * Physical findings: Tender red streaks in the skin, tender and enlarged lymph nodes.

Answer 58

Pitting is usually fluid overload or a cardiac problem Non pitting is usually a lymphatic problem Grade 1 = 2 mm pit and resolves quickly Grade 2 = 4 mm pit and resolves in less than 1 minute Grade 3 = 6 mm pit lasts from 1-2 minutes Grade 4 = 8 mm pit and lasts from 2- 5 minutes

Answer 59

* Inflammation of the skin and/or subcutaneous tissues * Almost always a bacterial infection usually strep or staph * Acute onset * Usual presenting symptoms: pain, redness and warmth (dolor, rubor and calor) * Physical findings: well demarcated area that is exquisitely tender to palpation * Frequently accompanied by localized lymphadenopathy

Answer 60

* Inflammation of the skin of the shins, * Gradual onset over weeks and often associated various systemic infections or immune reactions, not a vascular disease * Recurrent and bilateral * No aggravating or alleviating factors * Associated symptoms: fatigue, joint pain, fever * Examination: Raised red inflammatory nodules commonly found in crops

Answer 61

Chest pain or discomfort Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, wheezing Palpitations, dizziness, syncope Cough, hemoptysis Fatigue, weakness Pain in extremities with exertion (claudication)

Answer 62

BNP Hormone secreted by myocytes in the ventricles d/t pressure overload and stretch. Works as potent diuretic, natriuretic (Na excretion), vascular smooth muscle relaxer. Sensitive marker for LV dysfunction, but not specific for a particular disease. Can be used to follow response to therapy.

Answer 63

Involuntary rapid, rhythmic movement of eye in any direction Strabismus: : Misalignment of eyes relative to each other. If untreated can cause amblyopia (visual loss) of one eye

Answer 64

- used to test for strabismus Stare at one spot Cover one eye Holding gaze, cover other eye If eye uncovered moves, some degree of strabismus exists

Answer 65

- hemmorhage in eye that stops at limbus. no pain - exopthalamos = wide eyes due to fat pad hypertrophy and hyperthryoidism

Answer 66

Weber: tests lateralization * place above head, on medial scalp * may be normal in equal bilateral hearing loss * if lateralization occurs, use Rinne to further define the problem * Rinne: compares time of air vs. bone conduction, normally air is better: AC \> BC * Conductive hearing loss: can hear bone better than air- sounds not reaching or being conducted through the middle ear bone apparatus * Sensorineural hearing loss: both bone and air conduction is poor Sensorineural- If ear that sound lateralizes to/heard better can hear AC\>BC - then it is the good ear. If ear that sound does not move to can hear AC\>BC, then it is bad ear. * Inner ear disorder involves cochlear nerve and neuronal impulse transmission to the brain. * Causes include loud noise exposure (\>85 db), inner ear infections, trauma, tumors, congenital and familial disorders, and aging Conductive loss: if the ear that the sound lateralizes to can hear BC\>AC, then it is the bad ear. If ear that can't hear it as well hears AC\>BC, then it is the good ear. * External or middle ear disorder impairs sound conduction to inner ear. * Causes include foreign body, otitis media, perforated eardrum, and otosclerosis of ossicles

Answer 67

Inspection of : * Turbinates – use otoscope or nasal speculum to view middle and inferior turbinates (not superior) * Septum * Mucosa Palpation of: * sinuses: frontal, maxillary, ethmoid

Answer 68

hearing : CN VIII olfaction: CN I Gag reflex: CN IX, X Tongue Protrusion: CN XII

Answer 69

Maxillary sinus: direct light downward from under the medial aspect of the eye. ask patient to open their mouht and observe the glow in the hard palate. ... or can direct light from inside the mouth upward on the hard palate frontal sinus: shine light upward from the medial aspect of the eyebrow, observing the glow above the eye

Answer 70

3: moderately loud **4: loud with palpable thrill** 5: very loud with thrill may be heart with stethoscope off chest 6: very loud with thrill

Answer 71

Reflects right atrial pressure JVP is highest point of jugular venous pulsations Best estimated from right internal jugular vein More direct anatomical channel to right atrium Measuring JVP: * highest point of oscillation. extend ruler from sternal angle vertically. Add this number to 5 cm * If JVP \> 9cm RA is abnormal Elevated JVP is because of increased RA pressure. abnormalities: * Prominent a wave-increased resistance to RA contraction * Tricuspid stenosis, 1st degree AV bock, SVT, junctional rhythms, pulm. HTN and pulm. stenosis * Absent a waves-in atrial fibrillation * Large v waves in tricuspid regurgitation

Answer 72

apply firm pressure on liver - if jugular veins in neck distend for more than 8-10 seconds - indicates problem with atria and excessive fluid in RA

Answer 73

Diaphragm High pitched sounds of S1/S2, certain murmurs Firm pressure Bell Low pitched sound of S3/S4, bruits/thrills, & certain murmurs Lightly to skin

Answer 74

Palpable vibrations transmitted through bronchopulmonary treet o chest wall when pt. speaks Abnormalities Inc. as vibration from larynx to chest in enhanced as when consolidation is present (ie. pneumonia) Dec. or absent when vibration from larynx to chest surface impeded (ie. COPD, obstruction, pleural effusion or pneumothorax)

Answer 75

Flatness: soft with high pitch, muscle (thigh) Dullness: medium pitch and intensity (liver) Resonance: Loud intensity, low pitch, long duration (normal lung) Hyperresonance: High intensity and loud (abnormal) Tympany: Loud intensity, high pitch (gastric bubble) difference between dullness and resonance indicates where diaphragm is - normally 5-6 cm: abnormally high indicates pleural effusion or high diaphragm

Answer 76

Vesicular: heard more on inspiration: soft sound, low pitch: heard over most of lungs Bronchovesicular: inspir = expir:intermediate pitch and intensity: heard over 1st/2nd ICS anterior and between scapulae Bronchial: Expiration is loudest: loud intensity and high pitch: heard over manubrium Tracheal: inspir = expir: very loud intensity, high pitch. heard over trachea * breath sounds are usually louder in lower posterior fields * Decreased breath sounds occur due to obstructive lung disease or muscle weakness * transmission is poor due to pleural effusion, pneumothorax and emphysema

Answer 77

Wheeze that is predominately or entirely in inspiration Louder in neck than chest wall Indicates partial obstruction of larynx or trachea - heard more in children

Answer 78

Discontinuous Intermittent, nonmusical, & brief Fine crackles-soft, high pitched, very brief (5-10msec) Coarse crackles-somewhat louder, lower pitched, brief (20-30 msec) ex. pneumonia, congestive heart failure, fibrosis

Answer 79

- similar to crackles - but heard in end of inspiration, beginning of expiration "creaking leather" heard when pleural surfaces are inflamed or thickened

Answer 80

musical sounds, mostly heard during expiration when airflow goes througha narrowed bronchi. All that whezes is not astham Ex. Asthma, COPD, bronchitis

Answer 81

lowered pitch; bubbly sounds heard in inspiration or expiration (due to air over fluid due to inflammation or airway secretions) ex. secretions in the large airways

Answer 82

-these three abnormalitiescan be found over a lung consolidation (pneumonia) or pleural effusion Bronchophony: normally 99 is muffled and indistinct; abnormal is when 99 is heard louder, clear voice sounds Egophony: "ee" heard as a muffled long E sound is normal. When "ee" is heard as "ay" (an E to A change) with a nasal quality it is abnormal Whispered pectoriloquy: Whispered "99" or "1-2-3" heard faintly and not at all is normal. If is it heard clear and loud, it is abnormal