Test 1 Flashcards

1
Q

The cardinal signs of gaze check for CNs ____

SO4LR6 All rest 3

A

3, 4, and 6

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2
Q

The rapid cover/uncover test is used to identify weakness of EOM such as strabismus (misalignment of the eyes aka they both can’t turn to the same spot) and this can be involved with ___tropia (aka lateral drift) or ____ (aka medial drift)

Due to the eyes not being aligned properly, ____ can develop leading to blindness if not corrected

A

Exotropia, Esotropia

Amblyopia (aka lazy eye)

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3
Q

____/____ is normal for the snellen test and it is used to test ___

You hold the chart ___ feet away and read at LEAST ___ lines of letters

A

20/20, visual acuity

6, 2

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4
Q

The ____ nerve innervates the superior oblique muscle, the ___ nerve innervates the lateral rectus muscle and all the other muscles are innervated by the ___ nerve

____ is the involuntary, alternating fast-slow movements or jerking of the eye

A

Trochlear, Abducens, Oculomotor

Nystagmus

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5
Q

The Caloric reflex test (aka the Vestibular Caloric Reflex) tests the vestibulo-ocular reflex and can be remembered by the mnemonic ____

So for Cold water, the fast phase of nystagmus is the the Opposite side from the cold water filled ear

^** So for example, lets say the left ear is irrigated with cold water… The eyes will move towards the left ear and quickly oscillate towards the right ear (aka nystagmus towards the Opposite ear aka the right ear)

For Warm water, the fast phase of nystagmus is to the Same side from the warm water filled ear

^** So for example, lets say the left ear is irrigated with warm water…. The eyes will move towards to right ear and quickly oscillate towards the left ear (aka nystagmus towards the Same ear aka the left ear)

** In a braindead patient, the nystagmus will be absent

A

COWS

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6
Q

Confrontation testing for peripheral vision assessment is used to asses _____s

____ fields can be tests together and ___ fields require testing each eye separately by covering one

A

Visual Fields

Temporal, Nasal

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7
Q

When conducting the fundoscopic exam, the ___ is nasal and inferior and the ___ is temporal

A

Optic disc, Macula

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8
Q

____ is a bacterial infection of the eyelid and very common in older adults (in the nursing home)

^** Presents as erythema of the eyelids and FLAKING of the eyelashes

____ is seen in patients when their bilirubin is at least 3 (so something is most likely going on with the liver)

A

Blepharitis

Scleral icterus

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9
Q

Bacterial conjunctivitis in adults is most common caused by ____ and in children it is ____

^** It is spread by direct contact and usually unilateral. Associated with a purulent discharge throughout the day and often mattes shut during sleep

Viral conjunctivitis is caused by ___virus and usually associated with a prodrome of symptoms like the flu, etc…

^** Also spread by direct contact and a GRITTY SAND feeling occurs with CLEAR discharge. Also quickly becomes bilateral and usually gets better on its own (self-limiting)

Allergic conjunctivitis is associated with an IgE response and mast cell degranulation and is different from viral due to the fact that there is bilateral redness, a WATERY discharge, and ITCHING

A

Staph Aureus, M. Catarrhalis

Adenovirus

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10
Q

So just to recap, name the conjunctivitis

1) A watery/clear discharge with patient complaining of gritty/sandy feeling in their eyes that started unilaterally but quickly became bilateral
2) A watery/clear discharge with itching that presents bilaterally
3) A purulent discharge that presents unilaterally

A

1) Viral
2) Allergic
3) Bacterial

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11
Q

An infection of the Tarsal glands of the eyelids (sometimes called the Meibomian glands) that causes an acute purulent inflammation (either sterile or from staph aureus) is associated with a tender, red bump is called a ____

Chronic inflamation from an OBSTRUCTED Tarsal gland AKA Meibomian gland that causes a non tender (painless), rubbery, nodular, and hard lesion is called a _____

____ is cholesterol deposits around the eyes that are yellow in color and often benign. Presents in patients with Hyperlipidemia

** Fluorescein stains are used to identify epithelial defects

A

Hordeolum

Chalazion

Xanthelasma

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12
Q

The ophthalmoscope is used to examine the Retina/Posterior chambers/Fundus

^** ^** Realize that the fundus is just the inner surface of the eye and contains the retina, optic disc, macula, and fovea

In order to improve visualization, one would dilate the patients pupils aka mydriasis

Once you move the light from the lateral position to midline over the iris, one should see a ____ reflex which is just the NORMAL reflection of light off the ____

A

Red, Retina

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13
Q

If one were to follow the lateral blood vessels centrally they would get to the ____

Also, ____s are brighter and smaller than _____s

When performing the funduscopic exam approach the patient at ___ degrees lateral of midline

A

Optic disc

Arterioles, venules

15

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14
Q

In order to demonstrate the examination of the orbital conjunctiva one first depresses the lower eyelid and has the patient look ____ then you raise the upper eyelid and have the patient look ____

The conjunctiva should look ____ without any foreign bodies, erythema, purulence, or pterygiums

In order to remove foreign bodies, one would ___vert the patients ____ eyelid

A

Up, down

Clear

Evert, Upper

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15
Q

The cornea, anterior chamber, and lens is normally ___ in color and the sclera is ____

The iris and pupil are normally ____ in shape and equal in size

Also bilateral pupillary contraction is normal due to the direct and consensual pupillary light reflex of the ____ and ___ nerves

A

Clear, white

Round

Optic and Oculomotor aka 2 and 3

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16
Q

If one were to see swelling of the optic disc due to increased intracranial pressure it is called a _____

_____ is often associated with Blurry vision

^** If one sees deposits called DRUSENS, it’s a ____ macular degeneration and if one sees scarring and hemorrhaging on the retina it’s a ____ macular degeneration

____ is seen when patients have a high blood pressure characterized by hemorrhage, cotton wool spots, exudates, etc….

A

Papilledema

Macular degeneration

Dry, Wet

Hypertensive retinopathy

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17
Q

NEVER perform OMT on a patient with ____

A

DVT

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18
Q

For assessment 2 and 3, you must use something OTHER than what the patient is primarily concerned about (their chief complaint)

If they have a ___, use this first

If not, you can use a _____ next

If they have neither of those, you can use ___ problems (smoker, excessive alcohol use, etc) and if all else fails, you can use ___ problems

You MUST write family history problems as ____

A

PMHx (or other active problem)

Somatic dysfunction

Social history, Family history

Family History of ____

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19
Q

Viscerosomatic reflexes

Parasympathetics:

1) ___ nerve (CN X via the OA and AA) supplies everything above and below the diaphragm PROXIMAL to the ____

^** Aka anything proximal to that point like the heart, lungs, stomach, pancreas, adrenal glands, small intestine, etc…

2) ____ nerve goes from ____-____ and supplies everything below the diaphragm DISTAL to the mid transverse colon like the rectum, bladder, kidney, genitals, etc…

A

1) Vagus nerve, Mid-transverse colon

2) Pelvic splanchnic nerve, S2-S4

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20
Q

Viscerosomatic reflexes

Sympathetics:

1) Head, neck and heart = ___-___
2) Heart and lungs = ____-____
3) Upper extremities = ____-_____
4) GI tract and Pelvis = ____-_____
5) Lower extremity = ___-____

^** The greater splanchnic nerve = ____-____, Lesser = ____-____, Least = ____-____

Greater -> ____ ganglion -> Upper GI, Liver, Duodenum, Pancreas

Lesser -> ____ ganglion -> Small intestines, right colon, adrenals, gonads, kidneys, upper ureter

Least -> ____ ganglion -> Left colon, Pelvis, Lower ureter, bladder, genitalia

A

1) T1-T4
2) T1-T6
3) T2-T8
4) T5-L2
5) T11-L2

T5-T9, T10-T11, T12-L2

Celiac

Superior mesenteric

Inferior mesenteric

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21
Q

The ____ lymphatic duct drains the right side of the head, right UE, and heart and lungs

The ___ lymphatic duct drains the rest of the body

To treat these patients, release the ____ (aka DRIVE THE BUS)

Name the areas treated

1) UEs
2) Thoracic outlet down to thoracoabdominal diaphragm
3) Head and neck
4) Abdominal diaphragm down to pelvic diaphragm
5) LEs

A

Right

Left

Thoracic inlet

1) Area 3
2) Area 1
3) Area 5
4) Area 2
5) Area 4

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22
Q

Viscerosomatic levels as it applies to:

1) Common cold
2) CHF
3) COPD
4) Asthma
5) GERD
6) UTI
7) Dysmenorrhea (Painful menstruation)

A

1) Head and neckish -> T1-T4
2) Heart and lungs -> T1-T6
3) Heart (T1-T6)
4) T1-T6
5) GI tractish T5-L2
6) T5-L2 (Upper lumbar)
7) Upper lumbar

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23
Q

Radiation is seen in Radigraphy, CTs, Fluoroscopy, and Angiography and NOT seen in ____ or ____

^** US is CHEAP and has NO radiation but can be hindered by bowel gas and lung tissue, along with adipose tissue (fat people)

Clinical contraindications include Allergy to _____, Renal patients with ____ greater than ____, female patients that could be pregnant (instead, run a BhCG test), pregnant patients (16-45 days are critical), children

____ is a medication used to increase insulin sensitivity to cells (like T2D or PCOS), but be careful because this can cause ____

^** Presents very non-specific

A

US or MRI

Contrast, Creatinine, 1.5

Metformin, Lactic Acidosis

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24
Q

Contrast is used to increase the differences in density between anatomic structures

_____ and ____ is the type of contrast used for GI

_____ is used for IV contrast

____ is used for MRI contrast

A

Barium and Gastrograffin

Iodine

Gadolinium

25
Q

Contrast reactions include:

1) Type ___ hypersensitivity reactions will have the patient present with hives, anaphylaxis, urtivcaria, pruritus, and angioedema

^** This is an ____ type of reaction aka occurs in ____ than an hour

Treat with Epi/Saline/Albuterol

2) Nausea, Vomiting, and Flushing is seen in ____ reactions as a response to contrast and is SELF LIMITING
3) Vasovagal reactions cause ____ vasovagal tone leading to ___ SA and AV node conduction aka Bradycardia and Peripheral vaso____ leading to a ____tensive component to it

A

1) 1

Immediate, less

2) Chemotoxic
3) Increased, Decreased, vasoDILATION, HYPOtensive

26
Q

___ can be used in trauma, **RUQ pain (cholelithiasis), **RLQ pain, Pelvic pain, **Cardiac concerns (valvues, integrity, ejection fraction, etc), Pregnancy, Procedures, and to **evaluate blood flow which is called a ____ like in a patient with a BRUIRY on auscultation that might have a AAA

Also use US for _____ if a patient has incurred trauma

^** Like a motor collision

A

Ultra Sound, Duplex (aka doppler)

FAST (Focused Assessment Sonography for Trauma)

27
Q

X rays are cheap, fast, and a good screening tool but drawbacks are that you only get a 2D pic, radiation, and bad soft tissue detail

Air = \_\_\_\_
Fat = \_\_\_\_
Soft tissue/fluid = \_\_\_\_
Mineral = Off white
Metal = \_\_\_\_

Good to asses chest pathology, skeletal structure (like from TRAUMA), air/fluid in abdomen, Dental

A

Black
Dark gray
Light gray
Bright white

28
Q

CTs are widely available, quick, painless but they have contrast exposure, radiation exposure, and ___ is limited

**^ Unlike CT scans, ___ are great for seeing soft tissue ******

Use ____ for Ischemia and hemorrhage of the brain, GI stuff like AAA or RUQ/LUQ pain (but remember, these would usually be started with an US)

You can also use a CT when MRI is contraindicated like if a patient has a CV device, is unstable (since it takes a while), Claustrophobic, or Fat as fuck

MRIs are good because they are safe and have no radiation but can be VERY expensive

Use MRI for _____ disease or ischemia CVA where you need to see more info than just from a CT scan

A

Soft tissue

MRI

CT scans

Demyelination

29
Q

Remember, Gadolinium is used for contrast in MRIs, but it has a lot of toxicity for the kidneys leading to ____ 24-48 hours after administration where you get ____ serum CR and ____ GFR with Oliguria (decreased urine output)

You can also get _____ due to advancing renal failure or in dialysis patients (Patients with GFR less than 30) where the patient presents with THICKENING and HARDENING of the skin****

A

Nephropathy, Increased, Decreased

Nephrogenic systemic fibrosis

30
Q

____ is an imaging technique that has continue emitted X-rays to allow for real time visualization

Used most for ______

Use ___ for an embolism or aneurysm

A

Fluoroscopy

Esophagrams

Angiography

31
Q

If a patient comes in with CSF rhinorrhea, otorrhoea, battle signs, racoon eyes, and neuro signs, think _____

The best imaging for this is ___

Pneumocephalus or bleeding into the paranasal sinuses might occur

A

Skull fracture

Non-contrast CT

32
Q

Herniations

1) Herniation beneath the falx cerebri is ____

The ____ artery is involved leading to Paraparesis, ____ and frontal release signs

Use ____ for imaging

2) Herniation of the supratentorial structures under the tentorium cerebelli is ____

___ nerve (Fixed dilation, Impaired occular movements) and ___ artery (Contralateral homonymous hemianopsia) is involved

Use ____ for imaging

3) Herniation of the cerebellar tonsils through the forament magnum is ___

Brainstem becomes compressed and compromises respiratory and cardiac centers in the medulla leading to loss of consciousness, flaccid paralysis, etc…

A

1) Cingulate

ACA, Urinary incontinence

CT

2) Uncal (aka Transtentorial)

Oculomotor, PCA

MRI

3) Tonsillar

33
Q

The ___ artery runs through the Foramen Spinosum and can cause a ____ hematoma often when there is a fracture of the temporal bone

Patient will present with dilated pupil on contralateral side and lucid intervals and is ____ shaped on CT

Epidural hematomas ____ (do or do not?) cross suture lines but ____ cross the falx and tentorium

In Subdural hematoms, the ___ are ruptured aka old people or alcoholics

Subdural hematomas ____ (do or do not?) cross suture lines but ____ cross the falx and tentorium

Unlike epidurals which is lens shaped, subdurals are ___ shaped

Subarachnoid hemorrhages are from an ____ of a cerebral artery “worst headache of my life”

______ hemorrhages occur often from SYSTEMIC HTN

A

MMA, Epidural

^* DO NOT CONFUSE MMA with MCA

Lens (Biconvex)

Do NOT, Do

Bridging veins

DO, Do Not

Crescent

Aneurysm

Intraparenchymal

34
Q

KNOW THE CIRCLE OF WILLIS MRI angiography

Know the CT scans for PCA, ACA, MCA, and Internal capsule (aka Lenticulo-striate)

Paralysis of contralateral face and arm, motor aphasia, and homonymous hemianopsia is ____

^** Think CHANGes

Paralysis of contralateral foot and leg, sensory loss in toes foot and leg, and urinary incontinence is ____

Homonymous hemianospai with macular sparing and occipital cortex and visual corttex problems is ____

Contralateral hemiparesis and hemiplegia (UMNs) is ____

A

Slide 36

Page 34

MCA

ACA

PCA

Lenticulo-striate artery (in the internal capsule)

35
Q

SLIDE 43

Medial medullary syndrome is from ____ and the distinguishing nerve damaged is the ipsilateral ____ causing tongue movement problems

Lateral medullar syndrome is from ____ and results in Vertigo, Nystagmus, Dysphagia/hoarseness/gag decreased, and ipsilateral horner syndrome

Lateral pontine syndrome is ___ Vomiting, nystagmus, paralaysis of the face, DEAFNESS

Locked in syndrome is ____ and wont be able to communicate aka quadriplegia although you can be conscious and blinking

A

ASA, Hypoglossal nerve

PICA

AICA

Basilar

36
Q

____ is most affected in hypoxemia states like when you drown

Patient can’t form new memories and cortical blindness or double vision

___ is an autoimmune inflammation and demyelination of the CNS disease commonly in females 20-30

^** On radiology, you will see increased ____ levels aka ____ bands and use ____ for imaging

In MS, often the ____ is lesioned so if a patient presents with Double vision, horizontal nystagmus, upon left eye abduction and weak right eye adduction with normal convergence would be a lesion to the ____

^** In other words, whichever side the eye is weak on

A

Hippocampus

MS

IgG, Oligoclonal, MRI

MLF, Right medial longitudinal Fasciculus

37
Q

Name the ADULT cancer

PAGE 61 for CT scans

1) A characteristic butterfly lesion with GFAP + astrocytes and occurs in the cerebral hemispheres
2) Occurs at the junction of gray and white matter, round in shape
3) Spindle cells concentrically arranged and psammoma bodies, occurs in the parasagittal region
4) S-100+ and occurs in the cerebellopontine angle
5) “Chicken-wire” capillary pattern and “fried-egg” cells looking
6) Slow growing commonly prolactinoma with bitemporal hemianopia seen

A

1) Glioblastoma Multiforme (aka grade 4 astrocytoma)
2) Metastasis of another cancer
3) Meningioma
4) Schwannoma
5) Oligodendroglioma
6) Pituitary adenoma

38
Q

Name the CHILD cancer

1) Rosenthal fibers, GFAP+, Posterior fossa, Well-circumscribed
2) Homer-Wright rosettes, can compress 4th ventricle causing hydrocephalus, cerebellum in location
3) Arise in 4th ventricle system, Perivascular rosettes
4) Supratentorial tumor, Calcifications and oil-like fluid, benign

A

1) Pilocytic astrocytoma
2) Medulloblastoma
3) Ependymoma
4) Craniopharyngioma

39
Q

Name the infection

1) Frontal lobe abscess, black eschar on face, DKA patients
2) Focal collections of necrosis and inflammation, MRI DWI used, headache, neck stiffness, vomiting
3) Temporal lobe, memory and behavior changes, necrotizing and hemorrhagic
4) HIV is seen with macrophages, subacute inflammation, etc and patient can develop ____ that affects the parietal/frontal lobes, etc

^** Primary CNS lymphoma can also occur in HIV patients, but will present with a large solitary lesion and a diffuse ring enhancement and periventricular location

5)

A

1) Mucor or Rhizopus spp
2) Bacterial (strep or staph)
3) Herpes simplex Type 1
4) Toxoplasmosis

40
Q

_____ is any trauma induced by alteration in mental status that may or may NOT include a loss of consciousness

Concussions are more common in _____ aged ___-___ and present with cognitive deficits and amnesia compared to females that present with drowsiness and noise sensitivity

A

Concussion

Males, 0-4

41
Q

**Pathophysiology of concussions occur in deep _____ tracts, is referred to as _____ injury and often _____ imaging is used *******

In patients that have repeated multiple injuries, they can get _____ which is a progressive degenerative disease leading to impaired attention, memory, and decreased executive functions

A

White matter, Diffuse axonal, 3d diffusion tensor

CTE (Chronic Traumatic Encephalopathy)

42
Q

A _____ must clear a young athlete to return to play in the subsequent days or weeks

You should perform a detailed Neuro exam (including mental status), Gait and balance, and cognitive function tests (SCAT2, ImPACT, ect)

^** Cognitive testing is used in order to get a baseline and then you can reassess

A

Licensed healthcare professional

43
Q

IMMEDIATELY image someone if they have:

1) Prolonged LOC (More than ___ seconds)
2) Post concussive ____
3) Major neuro deficits like MOTOR
4) Significant lethargy or rapidly progressive worsening

Best imaging is ____

The ONLY known treatment for concussions is ____ and NO ONE returns while they’re symptomatic

A

1) 60
2) Seizures

CT

REST

44
Q

For return to play, the patient must have ____ between each stage

List the steps in order

1) Full contact training only if medically cleared
2) Light aerobic exercise
3) Noncontact drills, light resistance training
4) Cognitive and physical rest UNTIL asymptomatic
5) Sport-specific aerobic exercise
6) Game play

If the concussion is very bad, take 2-3 days*******

^***** KNOW THIS

A

24

4, 2, 5, 3, 1, 6

45
Q

KNOW THE VALVE LOCATIONS

Heart murmurs are on a grade of 1-6, with grade ____-____ having a thrill being heard

Systolic murmurs are between ___-____ and diastolic are ____-____

S1 closure is TV and MV and S2 is AV and PV closure

____ sound is a dull, low pitched sound best heard with the BELL and is normal in children or healthy athletes and is ____-____-____

^** If heard in ADULTS, it’s abnormal and is a sign of HF

_____ sound is a dull, low pitched sound best heard with the BELL and is due to atrial contraction against a stiff ventricle aka ____ but would NOT be seen in a-fib or a-flutter and is ____-____-____

A

First Aid

4-6

S1-S2, S2-S1

S3, KENT-TUCK-Y

S4, Hypertrophy, TEN-NES-SEE

46
Q

Systolic murmurs are

1) MR, TR, AS, and PS

___ murmurs are

1) AR, PR, MS, TS

^** KNOW THESE*****

A

1) Systolic

2) Diastolic

47
Q

If a systolic murmur is heard 5th ICS, MCL (aka the APEX) it’s _____

It’s a BLOWING murmur heard between ____-____ and RADIATES into the ____

If young chronic patient = ____
If old chronic patient = ____

If acute patient = ____ of papillary muscle or chordal tendineae or ____ wall MI

A

Mitral regurg

S1-S2, left axilla

MVP
MAC (Mitral Annular calcification)

Rupture, Inferior

48
Q

If a diastolic murmur is heard 5th ICS, MCL (aka at the APEX) it’s _____

Often presents with ___ syndromes, ____ on EKG, and _____ due to compression of the LRLN

____ is heard after ____ sound

A

Mitral Stenosis

Pulmonary, A-fib, Hoarseness

Openig snap, S2

49
Q

If a systolic murmur is heard 2nd ICS, RSB it’s _____ (aka best heard at the BASE)

This radiates to the CAROTIDS and this is due to aged related degenerative _____ in older patients (or if young, could be due to calcification of the ____ valve)

Symptoms = _____ and this can lead to HF

Leads to Increased pressure and LVH

A

Aortic Stenosis

Calcification, BAV (Bicuspid)

SAD (Syncope, Angina, and Dyspnea)

50
Q

If a diastolic murmur is heard 3rd ICS, LSB it’s _____

This patient will have a ___ pulse pressure, a De Musset sign aka head BOBs

Indicates aortic root dissection, BAV, endocarditis, rheumatic fever, etc.

A

Aortic Regurgitation

Wide

51
Q

Blowing systolic murmur at the LSB, 4th ICS that increases with inspiration is ____

It is associated with ____ or ____ and presents as a prominent ___ wave in the JVP

^** In other words often seen with ____

A

Tricuspid Regurgitation

Pulmonary HTN or Inferior MI, V wave

RV dilation

52
Q

If a patient has a systolic ejection murmur at the 2nd-3rd ICS, LSB that radiates to the left shoulder and increases on inspiration/RVH, think ____

A

Pulmonary Stenosis

53
Q

For a patient with DVT, you can use a Duplex R popliteal a and v

Patients with DVT have leg swelling, pain, immobilization, etc… (Surgery or trauma can also induce a DVT)

Realize you can have STROKE symptoms instead of a PE with a DVT

You can use a _____ for imaging because it is possible that the patient has a heart defect that allows the DVT embolism to bypass the heart and go straight to the brain

^** Like a Patent foramen Ovale or Atrial Septal Defect

This type of stroke is referred to as a _____

A

Transthoracic Echocardiogram with bubble study

Paradoxical embolism

54
Q

One of the complications of pericarditis (inflammation of the pericardium) is ____

Effusions can also lead to ____ due to the heat being surrounded by fluid

Cardiac tamponade patients have the BECK triad which includes ____, ____, and ____ along with INCREASED HR, low voltage QRS, and electrical ____

You can use a ____ exam with CXR to check this out

A

Effusion

Cardiac tamponade

Hypotension, Distended neck veins, Distant (aka muffled) heart sounds, alternans

FAST

55
Q

A palpable pulsatile abdominal mass, associated with smoking, age, and male would be a ____

^** 2cm is normal, 5 cm a mass becomes palpable

Perform a Abdominal Aortic Ultrasound

A

AAA

56
Q

Irregularly Irregular rhythm is ____ and this can lead to _____ events, specifically a ____

^** Often associate with HTN and CAD

Use a ____ to look at the posterior structures of the heart to asses for thrombus formation

A

A-fib, thromboembolic, stroke

TEE (Transesophageal Echocardiogram)

57
Q

STEMI (ST elevation) for a MI is

V1-V6 is seen with ____ MI and the ___ artery

Lateral MI is _____ and associated with the ___ artery

Inferior MI is _____ and associated with the _____ artery

A

Anterior, LAD

I and aVL, LCX

2/3/aVF, RCA

58
Q

REVIEW ALL OF THE SPECIAL JOINT TESTS

A

SESSION 2: Physical Diagnosis OMT Integration