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CPD Lab Spring Midterm > written > Flashcards

written Flashcards

1
Q

What are the normal variants of the epidydimis?

A

Usually a vertical ridge of soft nodule at upper testicular pole, usually lying behind the testis (~7% are anterior, a normal variant).

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2
Q

What’s the technique for palpating the inguinal ring for hernias?

A

Place the tip of your index finger at the most dependent part of the scrotum and slowly direct it up into the external inguinal ring.
Have patient strain (valsalva) and cough (away from you). Note any palpable herniating mass against your fingertip.

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3
Q

What’s the difference between direct and indirect inguinal and femoral hernias?

A

Indirect hernia
o Most common, all ages, both sexes.
o Tissue herniates through internal ring.
Direct hernia
o Less common, usually in men over 40 years of age.
o Tissue herniates behind external ring.

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4
Q

Are the testicles usually equal in position, or is one lower than the other?

A

left is lower

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5
Q

What is the normal size and shape of the testicle?

A

Solid ovoid in shape, suspended in the scrotum with the long axis aligned vertically.
5-7 cm x 2.5

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6
Q

Differentiate spermatocele, testicular cancer, hematocele, and hydrocele.

A

Hematocele
o Nontender accumulation of blood.
o Swelling resembles a hydrocele, but opaque on transillumination
Hydrocele
o Nontender accumulation of serous fluid from infection or trauma.
o Testis and epididymis are usually behind the mass.
o Mass transilluminates.
Spermatocele
o Painless, cystic mass, usually in head of epididymis.
o Translucent.
Solid tumor
o Rarely occurs.
o Opaque masses.

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7
Q

What is a varicocele? How does one confirm the diagnosis?

A

= Varicosities of the pampiniform plexus of veins of the spermatic cord.
o Forms a soft, irregular mass.
o Feels like a bag of worms.
o Most commonly on the left side due to pressure of left venous outflow.
o Collapses slowly when scrotum is elevated in supine patient.

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8
Q

What’s difference between acute orchitis and acute epididymitis?

A

Acute orchitis
o Painful, tender, swollen.
o Associated with mumps or other infectious disease.
o May be simultaneous epididymitis.
o Need to rule out testicular torsion (which may follow a rigorous workout).
Acute epididymitis
o Usually from trauma or infection.
o Painful, tender, swollen with fever and increased WBCs.

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9
Q

What is the size of a normal prostate?

A

The prostate gland is about the size of a chestnut. It lies 2 cm posterior to the symphisis pubis with the posterior surface of the gland in close contact with the rectal wall.

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10
Q

What’s the difference between BPH, prostatic cancer, and acute prostatitis on digital rectal exam (DRE)?

A

BPH - smooth, symmetrical, elastic/rubbery/firm & NT
PrCA - palpable hard, NT nodule(s),
Prostatitis - enlarged, tender, asymmetrical edema

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11
Q

What information can be derived from transilluminating a scrotal mass?

A

DDX solid vs. fluid-filled masses

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12
Q

What is Peyronie’s disease? What are the findings on PE?

A

formation of plaques on the shaft of the penis

found on palpation

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13
Q

Inguinal lymph nodes - horizontal

A

just below inguinal ligament. It drains the skin of the lower abdominal wall, external genitalia (except testis), anal canal, lower vagina, and gluteal area

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14
Q

Inguinal lymph nodes - vertical

A

located beside the upper segment of the great saphenous vein and drains that area of the leg. It is often palpable

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15
Q

Unilateral LAD

A

may indicate possible infection of scrotum, epididymis, urethritis, chancroid, or lymphogranuloma. The testes drain deep into pelvic nodes, so lymphadenopathy due to a testicular issue won’t be palpable

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16
Q

BL LAD

A

may indicate gonorrhea or syphilis

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17
Q

Mental status exam sections

A 
appearance
thought processes, content, perception
cognitive function
language and motor skills
higher intellectual functions
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18
Q

MSE: Appearance

A 
LOC
Posture and motor behavior
Personal hygiene
Facial expression
Manner/affect
Speech
Mood
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19
Q

MSE: Thought processes, content, and perception

A

Logic, relevance, organization, coherence
Thought content
Perceptions
Insight

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20
Q

MSE: Cognitive functions

A

Orientation
Attention
Memory
New learning ability

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21
Q

MSE: Language and Motor Skills

A

Comprehension
Writing
Naming/identifying

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22
Q

MSE: Higher intellectual functions

A

hobbies, job, school

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23
Q

Never OMIT

A

O - orientation x 3
M - memory: recent and remote
I - intelligence: calculating, fund of knowledge, abstract reasoning
T - talk: speech rate, quantity, fluency, articulation

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24
Q

CN 1

A

Olfactory

sensory: smell

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25
Q

CN 2

A 
Optic 
sensory: visual acuity
Snellen/Rosenbaum
Visual fields by confrontation
Ophthalmoscopic exam - disc/cup, atrophy, papilledema, spontaneous venous pulsations
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26
Q

CN 3

A

Oculomotor
motor: pupil, eyelid, extraocular muscles (sup/med/inf rectus and inf oblique)
PERRLA
EOM

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27
Q

CN 4

A

Trochlear

motor: superior oblique muscle
- primarily downward and internal rotation of the eye

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28
Q

CN 5

A 
Trigeminal
sensory: face
motor: muscles of mastication
Light touch in ophthalmic, maxillary, and mandibular regions
Have pt clench jaw while palpating
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29
Q

CN 6

A

Abducens

motor: lateral rectus

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30
Q

CN 7

A

Facial
sensory: taste on ant 2/3 of tongue
motor: facial muscles
ask pt to raise eyebrows, frown, close eyes tightly, smile, puff out cheeks, attempt to elicit a spontaneous smile

31
Q

CN 8

A

Vestibulocochlear
sensory: hearing and balance
gross hearing test, then Weber/Rinne if necessary
Romberg for balance

32
Q

CN 9

A

Glossopharyngeal
sensory: pharynx, taste on posterior 1/3 of tongue
stimulate gag reflex with swab; response should be symmetrical

33
Q

CN 10

A

Vagus
motor: pharynx
ask pt to swallow, phonate

34
Q

CN 11

A

Spinal Accessory
motor: trapezius, SCM
ask pt to shrug against resistance
test SCM if trap is abN

35
Q

CN 12

A

Hypoglossal
motor: tongue
ask pt to protrude their tongue
in case of deficit, tongue will deviate toward side of lesion

36
Q

How do we rate muscle strength? How do we test muscle tone?

A

Tone - flaccidity, rigidity, spasticity
Strength
0/5 = no muscle contraction or mvmt
1/5 = visible contrax w/out strength to move joint
2/5 = can move joint but not overcome gravity
3/5 = can move vs gravity but not active resistance
4/5 = can move against gravity and some resistance
5/5 = normal strength, active mvmt vs resistance w/out fatigue

37
Q

Neuro Exam

A 
MSE
CN
Motor system
Coordination
Sensory system
Reflexes
38
Q

What is cogwheel rigidity?

A

jerky resistance to passive movement as muscles tense and relax
caused by Parkinsons

39
Q

What is spasticity?

A

a special form of rigidity, present only at the start of passive movement. It is rate-dependent and only elicited upon a high-speed movement
present in motor d/o, like parkinsons

40
Q

What tests check coordination?

A

Rapid, alternating movements (arms and fingers - finger tapping test)
Point-to-point testing
Forearm rolling test
Heel-to-shin test

41
Q

How do you test sensation in the spinal tracts? Which tests evaluate which tracts?

A 
LSTT (lateral spinal thalamic tract)
-- sharp v. dull
-- temp
ASTT (anterior spinothalamic tract)
-- light touch
PC (posterior column)
-- vibration using 128 Hz tuning fork
 -healthy 40 yo should perceive vibe for: 11 sec at med malleolus; 15 sec at lat malleolus, 15 sec at ulnar styloid
-- proprioception
42
Q

How are deep tendon reflexes rated? When are deep tendon reflexes abnormal?

A 
0/4 = areflexia (LMN lesion)
1/4 = reduced or weak reflex or only with Jendrassik reinforcement
2/4 = average, normal reflex
3/4 = brisk reflex, in upper half of normal range
4/4 = hyperreflexia with clonus (UMN lesion)
43
Q

How are the DTRs tested?

A 
Biceps (C5, 6)
Triceps (C6, 7)
Brachioradialis (C5, 6)
Patellar (L2, 3, 4)
Achilles (S1, 2) - slow return suggests hypothyroid
Plantar (L4, 5; S1. 2)
44
Q

What is clonus?

A

a series of involuntary, rhythmic, muscular contractions and relaxations.
mb a sign of UMN lesions involving descending motor pathways
mb accompanied by spasticity (another form of hyperexcitability)
Unlike small, spontaneous twitches known as fasciculations (usually caused by LMN pathology), clonus causes large motions that are usually initiated by a reflex

45
Q

Describe a Babinski reflex. What does a positive Babinski sign indicate in a 21-year old patient versus an 18-month old child?

A

positive (in adults) = dorsiflexion of the big toe

indicates lesion in corticospinal tract or LOC d/t drugs/alcohol/seizure

46
Q

What are the tests for meningeal irritation?

A

Brudzinki’s - flexion of supine patient’s neck causes hip/knee flexion BL
Kernig’s - with pt’s hips/knees flexed, pt resists knee extension
Neck stiffness - involuntary resistance to neck flexion

47
Q

What does “glove and stocking distribution” mean in terms of sensory testing?

A

pattern of peripheral neuropathy involving the hands and feet
often is suggestive of DM

48
Q

How are discriminative sensations tested? What part of the nervous system is responsible for sensory discrimination?

A

Depends on normal cortical function
Stereognosis = ability to recognize common objects 90% of the time in 5 sec
Graphesthesia = ability to ID numbers or letters (1 cm tall on fingertips, 6 cm tall elsewhere)
2-point discrimination = ability to distinguish 2 sharp points simultaneously applied to skin (3 cm for hand/foot and 6 mm for fingertips)

49
Q

What is a dermatome?

A

area of skin innervated by a single spinal nerve

50
Q

What is the normal ROM of the TMJ? What other findings will you encounter?

A

3 cm btw upper and lower incisors (3 fingers width)

Note any swelling, crepitus, or deviation

51
Q

What is Adson’s test? When is it positive (as discussed in class!)?

A

Check radial pulse as you ABduct, Extend, and Externally Rotate the pt’s arm. Have the pt valsalva and turn head towards the side being tested.
Positive can be:
absent/diminished pulse = compression of subclavian A
repro of peripheral neuropathy = TOS

52
Q

What is Finklestein’s test?

A

Pt makes a fist with thumb grasped by fingers, then ulnar deviates
severe pain = tenosynovitis

53
Q

What are the best exams for ruling in, or ruling out Carpal Tunnel Syndrome?

A

to rule in = Hand sx diagram and hypalgesia

to rule out = hand sx diagram and weak thumb adduction

54
Q

What are the findings in tennis elbow?

A

TTP distal to lateral epicondyle

55
Q

Know how to assess ROM for the shoulder.

A 
Abduction: 180º
Adduction: 45º
Flexion: 90º
Extension: 45º
Internal rotation: 55º
External Rotation: 40º
56
Q

Define crepitus

A

grating, crackling or popping sounds and sensations experienced under the skin and joints or a crackling sensation due to the presence of air in the subcutaneous tissue

57
Q

What are the tests for “non-organic” low back pain?

A

Flip test - pos with SLR is pos, but pt can sit up with leg extended w/out pain
Hoover’s test - hold pt’s heel off the table and ask him to raise other leg. Should feel pressure as pt uses straightened leg for leverage. If not — malingering

58
Q

What is the term for gout on the great toe?

A

podagra

59
Q

What part of the leg is affected in Osgood-Schlatter disease

A

Knee, specifically tibial tuberosity

60
Q

Which test is most sensitive for detecting a meniscal tear? Detecting an anterior cruciate ligament tear?

A 
meniscal = Thessaly at 20* flexion
ACL= Lachman's
61
Q

How does one test the knee for effusion? Where would you expect to find tenderness to palpation in a meniscal tear?

A

Ballottement

Tibial plateau

62
Q

ligamentous stability in the knee: Valgus and Varus stress

A

valgus - stresses MCL

varus - stresses LCL

63
Q

ligamentous stability in the knee: Apley’s compression/distraction

A

tests meniscus and collateral ligs

64
Q

ligamentous stability in the knee: McMurray’s test

A

assess meniscus

  • -apply valgus stress to flexed knee while slowly externally rotating the leg and extending the knee (medial meniscus)
  • -apply varus stress to flexed knee while slowly internally rotating leg and extending knee (lateral meniscus)
65
Q

ligamentous stability in the knee: Lachman’s

A

detects ACL deficiency
with knee flexed 20-30*, tibia is displaced anteriorly
soft endpoint of > 4 mm of displacement = positive

66
Q

Patrick - FABERE test

A

assess flexion, abduction, ext rotation at hip

pos = repro of pain

67
Q

Gaenslen’s Test

A

assesses hip extension, psoas tenderness, SI disease
allow leg to fall off the edge of the table
pos = repro of pain

68
Q

SLR

A

active and passive

pos = pain shooting down the leg, past the knee

69
Q

Bragard’s

A

SLR until painful, lower until pain stops, then dorsiflex the foot
pos = pain

70
Q

Tests to evaluate LBP

A

SLR
Crossed SLR
Bragard’s
Valsalva

71
Q

Findings of DJD in the hands

A

Bouchard’s and Heberden’s nodes

72
Q

Findings of RA

A

PIP involvement

swan-necking

73
Q

Hallux valgus?

A

bunion

CPD Lab Spring Midterm (1 decks)

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