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Physical Exam 2 > Written comp review > Flashcards

Written comp review Flashcards

1
Q

What sort of exam does a first-time patient in office or hospital get?

A

Comprehensive assessment

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2
Q

Which exam includes all elements of health history and complete physical exam?

A

Comprehensive assessment

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3
Q

Which exam covers base-line for future assessments?

A

Comprehensive assessment

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4
Q

What type of exam for a PT who is known-well and coming in for routine care?

A

Focal/Problem-oriented assessment

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5
Q

What type of exam for specific “urgent care” like sore throat or knee pain?

A

Focal/Problem-oriented assessment

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6
Q

Which exam is addressed to symptoms and specific body system?

A

Focal/Problem-oriented assessment

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7
Q

What is the sequence of physical exam?

A

Head to toe

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8
Q

Which side to exam PT on?

A

PT’s right side, even if lefty

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9
Q

3 goals of exam sequence?

A
  1. Maximize PT comfort
  2. Avoid unnecessary changes in position
  3. Enhance clinical efficiency
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10
Q

Normal BP for age 18-60?

A

Systolic <120

Diastolic <80

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11
Q

Prehypertensive age 18-60?

A

Systolic=120-139

Diastolic=80-89

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12
Q

Stage 1 range HTN in 18-60?

A

Systolic=140-159

Diastolic 90-99

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13
Q

Stage 2 range HTN in 18-60?

A

Systolic ≥160

Diastolic ≥100

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14
Q

4 end-organs damaged by HTN?

A
  1. Eyes
  2. Brain
  3. Heart
  4. Kidneys
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15
Q

Is home/ambulatory or office BP measurment more predictive of CV disease and end-organ damage?

A

Home/ambulatory

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16
Q

What is home/ambulatory BP measurement for HTN with automated device?

A

≤135/85

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17
Q

HTN: Office manual or automated avg how many times? Occasions?

A

Average of two separate occasions

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18
Q

HTN: Office manual or automated avg for Stage 1 HTN? (actual numbers)

A

≥140/90 (aka Stage 1 HTN)

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19
Q

Asleep/nocturnal HTN measurment?

A

> 120/70 (<10% of daytime values)

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20
Q

What is Masked HTN? What are the home and office measurments?

A

Office blood pressure <140/90, but an elevated daytime blood pressure of >135/85 on home or ambulatory testing

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21
Q

What does Masked HTN a risk for?

A

Increased risk for CV disease and end-organ damage

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22
Q

White Coat HTN measurment?

A

≥140/90

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23
Q

White Coat HTN is what type of response?

A

Anxiety response

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24
Q

White Coat HTN and risk for what?

A

Normal to slight increased CV risk

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25
Q

Does White Coat HTN require treatment?

A

No tx required

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26
Q

Cuff bladder width what % of upper arm?

A

40%

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27
Q

Cuff bladder length what % of upper arm?

A

80%. Almost long enough to encircle arm.

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28
Q

Standard cuff measurment? Good for what arm circumference?

A

12x23cm. Good for 28cm arm circumference.

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29
Q

Where should brachial artery be when assessing BP?

A

At level of heart

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30
Q

BP if brachial artery is below heart?

A

Elevated BP

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31
Q

BP if brachial artery is above heart?

A

Low BP

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32
Q

Systolic: when to stop inflating cuff and what to feel for?

A

Feel radial art until disappears. Note that number and add 30. Deflate, wait 15-30 sec, and reinflate to check systolic.

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33
Q

Systolic: What is avoided when inflating, adding 30, then reinflating?

A

Ausculatory gap

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34
Q

Which side of stethoscope over brachial artery for BP?

A

Bell

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35
Q

How many mmHg to deflate cuff in BP?

A

2-3mmHg

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36
Q

Systolic: What is heard?

A

2 consecutive beats

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37
Q

Diastolic: What is heard?

A

Disappearance point ater muffling sound

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38
Q

Diastolic: Which heart condition causes muffling to never disappear?

A

Aortic regurg

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39
Q

BP: Round to nearest what?

A

2 mmHg

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40
Q

How long to wait between taking BP?

A

2 or more minutes

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41
Q

If two BPs differ by more than ___mmHg take additional readings

A

5mmHg

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42
Q

BP: ≥10mmHg difference between arms which 3 conditions?

A
  1. Subclavian steel syndrome
  2. Supravalvular Aortic Stenosis
  3. Aortic Dissection
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43
Q

What will Coarctation of Aorta and Occlusive Aortic Disease to do BP and pulses in extremities?

A

Upper ext=Higher systolic BP

Lower ext=Lower systolic BP, delayed/diminished femoral pulses

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44
Q

Which 3 CNs are sensory only?

A

1, 2, 8

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45
Q

Which 5 CNs are motor only?

A

3, 4, 6, 11, 12

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46
Q

Which 4 CNs are both motor and sensory?

A

5, 7, 9, 10

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47
Q

How to test CN 1 Olfactory?

A

Occlude each nostril for patency. Then PT closes eyes and smells through one nostril to identify scent.

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48
Q

How to test CN 2 Optic?

A

Test visual acuity with charts. Test visual fields by controntation. Fundoscopic exam.

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49
Q

How to test CN 3 Oculomotor?

A

Pupilary reaction to light and near response. Ptosis (levator palpebrae muscle) and medial rectus muscle (convergance).

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50
Q

How to test CN 4 Trochlear?

A

Superior oblique muscle. Vertical diplopia.

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51
Q

How to test CN 6 Abducens?

A

Lateral rectus muscle. Moves eye out/lateral.

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52
Q

CNs 3, 4, and 6 control what 3 things about the pupil?

A

Pupil size, shape, reaction to light

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53
Q

How to test CN 8 Vestibularchocolear?

A

Whisper in one each while closing off opposite ear.
Rinne Test=bone conduction
Webber test=lateralization

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54
Q

How to test CN 11 Spinal Accessory?

A

Head turn against resistance to test SCM. Inspect trap muscles for fasiculations or atrophy, shoulder droop, scapula downward drop.

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55
Q

How to test CN 12 Hypoglossal?

A

Observe tongue for atrophy or fisculations. Stick tongue out and it deviates to weak side. Also word articulation problems.

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56
Q

3 questions which frame neuro exam?

A
  1. Is mental status intact?
  2. Are findings symmetric?
  3. Where is lesion?
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57
Q

What is the most sensitive indicator of brain injury?

A

Change in PTs level of mentation

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58
Q

What seen in Upper Motor Neuron Lesion? (hint: 5)

A
  1. Hypertonia
  2. Hyperreflexia
  3. No fasciculations
  4. No atrophy
    • Babinski
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59
Q

What seen in Lower Motor Neuron Lesion?

A
  1. Hypotonia
  2. Hyporeflexia
  3. Has fasciculations
  4. Has atrophy
  5. Normal plantar reflex
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60
Q

Range of reflex grading?

A

0-4

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61
Q

Reflex grade 0?

A

No response

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62
Q

Reflex grade 1+?

A

Diminished response

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63
Q

Reflex grade 2+?

A

Normal

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64
Q

Reflex grade 3+?

A

Brisk, maybe normal.

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65
Q

Reflex grade 4+?

A

Hyperactive. Brisk with clonus.

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66
Q

Which reflex grade has clonus?

A

4+

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67
Q

Can plain films rule out C-spine fx?

A

No

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68
Q

where are the most important missed injuries in the spine?

A

C1-C2 levels

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69
Q

Why measure infant head?

A

Reflects brain and cranium rate of growth

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70
Q

what is an uncle herniation?

A

brain herniation through the foramen magnum (Seen in babies when brain grows and skull doesn’t)

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71
Q

Define Proptosis

A

AKA exophthalmos.

Eye protrusion.

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72
Q

Proptosis/Exophalamos seen in which dz?

A

Graves

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73
Q

Define Hyperopia

A

Far sighted

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74
Q

Define Myopia

A

Near sighted

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75
Q

Define Presbyopia

A

Aging vision

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76
Q

Define Scomata

A

Specks in vision where can’t see

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77
Q

3 causes of diplopia?

A
  1. Brainstem
  2. Cerebellum
  3. CN problems
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78
Q

Horizontal Diplopia due to palsy of which 2 CNs?

A

3 or 6

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79
Q

Vertical Diplopia due to palsy of which 2 CNs?

A

3 or 4

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80
Q

Diplopia in one eye with other eye closed due to problem where? (hint: 2 possible places)

A
  1. Cornea

2. Lens

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81
Q

Define Coloboma

A

Defect/hole in iris

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82
Q

Define hyphema

A

Blood in anterior chamber of eye

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83
Q

Define hypopon

A

Pus in anterior chamber of eye

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84
Q

Describe near reaction

A

Pupils constrict (miosis) when look from far to near

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85
Q

Convergence due to which CN and muscle?

A

CN 3, medial rectus

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86
Q

Define miosis

A

Pupils constrict

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87
Q

Define mydriasis

A

Pupils dialate

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88
Q

Describe Marcus Gunn Pipil

A

Partial dilation of pupils when light shined into eye with optic nerve damage

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89
Q

Which condition: Partial dilation of pupils when light shined into eye with optic nerve damage

A

Marcus Gunn Pupil

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90
Q

Describe Tonic/Adie Pupil

A

Dilated large pupil. Slow to no reaction to light.

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91
Q

Which condition: Dilated large pupil. Slow to no reaction to light.

A

Tonic/Adie pupil

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93
Q

accommodation of the lens is controlled by what muscle?

A

cilliary muscle

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94
Q

Horner Syndrome 3 signs?

A
  1. Ptosis
  2. Miosis
  3. Anhydrosis
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95
Q

Describe Argyll Robertson Pupils

A

Bilateral small and irregularly shaped pupils. Do not react to light.

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96
Q

Which condition: Bilateral small and irregularly shaped pupils. Do not react to light.

A

Argyll Robertson Pupils

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97
Q

Define Anisocoria

A

Unequal pupil size

difference of >.4mm in the diameter of one pupil

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98
Q

Color, size, and light reflex arteries in eye?

A

Light red, small, bright light reflex

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99
Q

Color, size, and light reflex veins in eye?

A

Dark red, large, absent light reflex

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100
Q

Normal introcular pressure range?

A

10-22mmHg

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101
Q

Describe Style/hordeolum. 2 causes? Which way does it point?

A

Painful, tender, red eyelid. Points outside lid.

  1. S Aureus
  2. Blocked meibomian gland
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102
Q

Describe Chalazion. Which way does it point?

A

Painless nodules due to blocked meibomian gland. Points inside lid.

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103
Q

Describe Xanthelasma

A

Yellow cholesterol plaque on eye lid

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104
Q

Describe Corneal Arcus

A

Thin white/gray arc at edge of cornea

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105
Q

Describe Keyser Fleischer Ring. Cause?

A

Golden to red brown ring. Copper deposits.

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106
Q

Describe corneal scar

A

Opacity of lens

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107
Q

Color nuclear cataract? Need what to see?

A

Gray with flashlight

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108
Q

what is pinguecula?

A

harmless yellowish triangular nodule in the bulbar conjunctiva on either side of iris

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109
Q

Describe peripheral cataract

A

Spokelike shadows

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111
Q

what is entropion?

A

inward turning of the lid

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112
Q

what is the ectropion?

A

lower lid margin turns outward, exposing palpebral conjunctiva

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113
Q

Which wall does the breast lay against?

A

Anterior thoracic wall

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114
Q

what is nystagmus?

A

involuntary jerking movement of the eye with quick and slow components (horizontal, vertical or rotary)

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115
Q

Breast goes from which rib to which rib?

A

(Clavicle ) 2nd rb to 6th rib

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116
Q

Breast horizontal borders?

A

Sternum to midaxillary line

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117
Q

What is the male loose, wrinkled pouch?

A

Scrotum

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118
Q

Scrotum how many compartments?

A

2

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119
Q

2 compartments of the Scrotum?

A
  1. Tunica vaginalis

2. Epididymis

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120
Q

Scrotum’s Tunica vaginalis covers what? Where doesn’t it cover?

A

Covers Testis, not posteriorally

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121
Q

Scrotum’s epididymis covers what and where?

A

Posterolateral surface of testis

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122
Q

Epididymis shape?

A

Comma-like

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123
Q

Job of epididymis

A

Reservoir for storage, maturaiton, and transport of sperm

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124
Q

2 types if inguinal hernia?

A
  1. Direct

2. Indirect

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125
Q

What pokes through in inguinal hernia?

A

Loops of bowel thorugh weak areas into inguinal canal

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126
Q

Which 2 hernias are above the inguinal ligament?

A
  1. Indirect

2. Direct

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127
Q

Which is the most common inguinal hernia?

A

Indirect hernia

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128
Q

Which hernia affects men over 40 and women rarely?

A

Direct hernia

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129
Q

Which hernia is more common in women?

A

Femoral

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130
Q

Indirect Inguinal Hernia goes into where?

A

Scrotum

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131
Q

What direction Direct Inguinal Hernia bulge?

A

Anteriorally

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132
Q

Which hernia is below the inguinal ligament?

A

Femoral

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133
Q

What is a herniation of the rectum into the posterior vaginal wall?

A

Rectocele

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134
Q

What is a bulge of the upper 2/3 of ant vaginal wall?

A

Cystocele

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135
Q

What is a tight prepuce (foreskin) which cannot retract over glans penis?

A

Phimosis

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136
Q

Describe Phimosis

A

Tight prepuce (foreskin) which cannot rectract over glans penis

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137
Q

What is a tight prepuce (foreskin) which is retracted and cannot be returned

A

Paraphimosis

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138
Q

Describe paraphimosis

A

A tight prepuce (foreskin) which is retracted and cannot be returned

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139
Q

What is an inflammation of the glans penis?

A

Balanitis

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140
Q

Describe Balanitis

A

Inflammation of the glans penis

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141
Q

What is a tender and painful scrotal swelling called?

A

Epididymitis

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142
Q

Describe Epididymitis

A

Tender and painful scrotal swelling

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143
Q

What is a twist of the sermatic cord causing acutely painful, tender, and swollen scrotum?

A

Testicular torsion

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144
Q

Decribe testicular torsion

A

A twist of the sermatic cord causing acutely painful, tender, and swollen scrotum

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145
Q

Which side of stethoscope to hear high-pitch sounds of S1 and S2?

A

Diaphragm

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146
Q

Diaphragm for which pitch sounds?

A

High-pitch

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147
Q

Which side of stethoscope for mitral regurg, aortic regurg, and preicardial friction rubs

A

Diaphragm

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148
Q

Bell of stethoscope for which pitch sounds?

A

Low-pitch

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149
Q

S3 and S4 hears with which side of stethoscope?

A

Bell of stethoscope

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150
Q

S3 and S4 which pitch?

A

Low-pitch

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151
Q

Pitch of mitral stenosis? Which side of stethoscope?

A

Bell of stethoscope

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152
Q

What causes the S1 sound?

A

When mitral and tricuspid valves slam shut

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153
Q

Where is S1 loudest?

A

Apex

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154
Q

What immediately follows S1?

A

Carotid upstroke

S1->carotid upstoke->S2

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155
Q

What causes the S2 sound

A

Aortic and pulmonic valves slam shut, and blood ejected out of left ventricle

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156
Q

Where is S2 loudest?

A

At base

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157
Q

S3 normal in who?

A

Children, preggers, well-trained athelets

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158
Q

S4 represents what pathology?

A

LVH

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159
Q

5 spots for cardiac auscultation?

A
  1. Apical
  2. Pulmonic
  3. Erb’s point
  4. Tricuspid area
  5. Mitral area
160
Q

Which side of stethoscope to use with cardiac auscultation

A

Diaphragm

161
Q

Which sides of stethoscope to use for Tricuspid and Mitral area?

A

Diaphragm and bell

162
Q

What does JVP measure/reflect?

A

Pressure in right atrium

163
Q

Which vein to use for JVP?

A

Right internal jugular vein

164
Q

Where to measure for JVP?

A

Meniscus (high point) of pulsations

165
Q

JVP measures height of colums in relation to which angle?

A

Sternal angle

166
Q

How much to add to column measurement in JVP?

A

5cm

167
Q

What is normal JVP measurement?

A

≤9cm

168
Q

High JVP measurement?

A

> 9cm

169
Q

Bed at which angle for JVP? Lighting?

A

30º. Tangential lighting.

170
Q

JVP: what to do to bed if PT is hypovolemic?

A

Lower head of bed

171
Q

JVP: what to do to bed if PT is hypervolemic?

A

Raise head of bed

172
Q

What is Kussmal’s Sign?

A

JVP rises with inspiration (normally goes down)

173
Q

What called when JVP rises with inspiration?

A

Kussmal’s Sign

174
Q

In normal heart what happens to JVP waveform when pressure put on liver?

A

Transient rise

175
Q

In heart with right sided failure what happens to JVP waveform when pressure put on liver?

A

Progressive rise in CVP then JVP waveform

176
Q

Describe Hepato Jugular Reflex

A

Normal heart= increased blood volume only causes transient increase of JVP
R-sided heart impaired=progressive rise in CVP and JVP waveform

177
Q

3 types of pain

A
  1. Patietal pain
  2. Visceral pain
  3. Referred pain
178
Q

Which pain is steady aching, localized over involved structure, and worse with movement like cough or ambulance ride?

A

Patietal Pain

179
Q

Which pain in due to stretching/distentin of hollow abdominal organs and difficult to localize?

A

Visceral Pain

180
Q

Renal Colic causes which type of pain?

A

Visceral pain

181
Q

Which pain is felt in distance sites due to dermatomal innervation at same spinal level?

A

Referred pain

182
Q

What causes Pleuritic Chest Pain?

A

Irritation of parietal pleura with deep inspiration. Viral pleurisy, pericarditis, pulmonary embolism, pneumomia.

183
Q

Which pain is worse with cough or movement?

A

Parietal Pain

184
Q

Describe Murphy’s Sign

A

Sharp increase in RUQ tenderness with inspiration

185
Q

Murphy’s Sign for which condition?

A

Acute cholecystitis

186
Q

3 appendix signs?

A
  1. Rovsing
  2. Psoas
  3. Obturator
187
Q

Rovsing Sign when…?

A

RLQ pain during LLQ pressure

188
Q

Which sign is RLQ pain during LLQ pressure?

A

Rovsing Sign for appendix

189
Q

How many Psoas Signs are there?

A

TWO!

190
Q

Which sign: Pain of psoas muscle with rise thigh against hand at knee or flex leg at hip

A

Psoas Sign

191
Q

Which sign: Flex right thigh at hip, bend knee, int rotate causes right hypogastric pain

A

Obtorator Sign

192
Q

Subluxation vs dislocation: which is temporary and partial?

A

Subluxation

193
Q

Shoulder subluxation can also be called what?

A

“Shoulder joint instability”

194
Q

Should joint instability (temporary and partial dislocation) is most consistent with what type of ortho problem?

A

Subluxation

195
Q

What happens with a true shoulder dislocation?

A

Humerus comes out of socket (the glenoid)

196
Q

ROM and pain with shoulder dislocation?

A

Poor ROM. LOTS OF PAIN!

197
Q

What 2 things are the main shoulder joint stabilizers?

A
  1. Ligaments

2. Capsule complex

198
Q

Arm position in anterior shoulder dislocation?

A

Slight abduction and external rotation

199
Q

Humeral head and void in anterior shoulder dislocation?

A

In patients who are thin, the prominent humeral head can be felt anteriorly and the void can be seen posteriorly (sulcus sign) in the shoulder.

200
Q

Arm position in posterior shoulder dislocation?

A

Arm in adduction and internal rotation

201
Q

Why are posterior shoulder dislocations easy to miss?

A

PT appears to be only guarding extremity

202
Q

Which 2 radiograph views for shoulder dislocation?

A
  1. AP

2. Axillary

203
Q

Shoulder dislocation: Which view to get if axillary view cannot be obtained?

A

Y-view

204
Q

Which view required for posterior shoulder dislocation or might be missed?

A

Orthogonal view

205
Q

What is the most important treatment of an acute shoulder dislocation?

A

Prompt reduction of the glenohumeral joint

206
Q

After determining the direction of the dislocation what is the most important next step in treatment?

A

Relaxation of the shoulder musculature

207
Q

How does one verify successful shoulder reduction?

A

Post-reduction films

208
Q

Which tx for common anterior shoulder dislocations?

A

Hippocratic Method. For common anterior dislocations, one of the oldest methods of reduction. The clinician places their foot in the patient’s axilla while gentle longitudinal traction is applied (may be utilized with or without int./ext. rotation of shoulder).

209
Q

Describe Stimson Technique technique

A

Stimson Technique—The clinician has the patient lie prone on an examining table, allowing the affected arm to hang off the bed. Again, longitudinal traction and int./ext. rotation are applied to the arm. Weights can also be added to the patient’s wrist to facilitate reduction.

210
Q

Which tx for shoulder dislocation has always worked for Orrahood?

A

Fried Maneuver—Taught to this PA by his then supervising physician, Dr. Fried, circa 2001.
Patient lies supine, and an assistant applies counter traction to the patient’s chest wall; the clinician begins maneuver with forced long axial traction of the affected extremity, followed by slow, gentle abduction to roughly 90 degrees (or until resistance encountered) and subsequent external rotation applied.

211
Q

How long to immobilize arm after post-reduction? With what?

A

Sling and swath for 1-3 weeks.

212
Q

What should be encourages while PT in sling for shoulder dislocation?

A

Elbow, wrist, and hand ROM should be encouraged.

213
Q

T or F
After diagnosing an anterior shoulder dislocation (with an associated axillary
nerve injury), the clinician should expect, and subsequently plan for,
prolonged sequelae from said nerve injury.

A

False

214
Q

Injury to the axillary nerve during shoulder dislocation has been reported to be as high as what?

A

40%

215
Q

When do perform a detailed neurovascular exam with a shoulder dislocation?

A

Before and after reduction

216
Q

When does Apprehension Sign occur?

A

Paltellar dislocation

217
Q

Which sign: Knee placed at 30 degrees flexion, and lateral pressure is applied. Medial instability results in apprehension by the patient.

A

Apprehension Sign

218
Q

4 phases of wound healing?

A
  1. Hemostasis/Coagulation phase
  2. Inflammation phase
  3. Proliferation/migratory phase
  4. Remodeling phase
219
Q

When does hemostasis/coagulation phase occur in wound healing?

A

Immediately after wound

220
Q

What is formed, constricted, and seals in Hemostasis/Coagulation Phase of wound healing?

A

Platelet plug forms. Vessels constrict. Thrombus seals wound.

221
Q

When does Inflammatory Phase occur in wound healing?

A

First 2-3 days after injury

222
Q

What do WBCs to in Inflammatory Phase of wound healing?

A

WBCs remove necrotic tissue and control infection.

223
Q

When does Proliferation/Migratory Phase occur in wound healing? How long does it last?

A

2-3 days after injury. Lasts 2-3 weeks.

224
Q

Which tissue migrates across top of wound in Proliferation Phase?

A

Granulation tissue. Forms capillaries and epithelial cells.

225
Q

What proliferate into wound during Proliferation/Migratory Phase of wound healing? What do they create?

A

Fibroblasts proliferate into wound. Create structure.

226
Q

When does Remodeling Phase occur in wound healing?

A

Days to weeks after injury

227
Q

What forms in Remodeling Phase of wound healing? What contractures?

A

Collagen forms, scar contracture.

228
Q

What is the strength of the scar in Remodeling Phase?

A

80% of original wound up to one year

229
Q

What to confirm before repairing wounds?

A

Neurovascular and sensori-motor condition

230
Q

When to update tetanus shot? (Hint: 2 cases)

A
  1. ≥10y since last

2. 5y plus wound is tetanus prone

231
Q

When is a wound considered tetanus prone? (Hint: 4)

A
  1. 6h+
  2. > 1cm deep
  3. Stellate lacerations
  4. Soiled with feces, saliva, gunshot, puncture, burn, or frostbit
232
Q

Which tetanus shot to use if between 6 weeks and 6 years old?

A

DTaP

233
Q

Which tetanus shot to use if 11 years or older?

A

Tdap

234
Q

Which animal causes most infections with bite?

A

Cats

235
Q

Motto when suturing?

A

“Approximate, don’t stangulate”

236
Q

Range of suture size?

A

00 to 10-0

237
Q

Which suture size is larger- 00 or 10-0?

A

00 is larger. 10-0 is smaller.

238
Q

Most commonly used suture sizes?

A

3-0 to 6-0

239
Q

2 non-absorbable monofilamented sutures?

A

Ethilon and Prolene

240
Q

Which suture material is absorbable for dermal and fascial closure?

A

Vicryl

241
Q

Which suture material is absorbable for mucosal and scrotal closure?

A

Vicryl

242
Q

Ways to do primary wound closure?

A

Suturing, stapling, taping, etc

243
Q

Primary wound closure and wound edges?

A

Wound edges approximated

244
Q

Timeframe for primary wound closure?

A

6-12h

245
Q

Primary wound closure and cosmetic outcome good or bad?

A

Good!

246
Q

Which wound closure not to use is cosmetic is a concern?

A

Staples

247
Q

When does delayed primary closure occur?

A

When primary closure inappropriate

248
Q

When is primary closure inappropriate and required delayed primary closure? (hint: 2)

A
  1. Infection

2. Severely contaminated

249
Q

Delayed primary closure is a period of time when what type of healing occurs?

A

Secondary healing prior to closure

250
Q

Timeframe for delayed primary closure?

A

48-96h

251
Q

When to avoid staples for wound closure?

A

Avoid in cosmetic areas

252
Q

Staples good for which areas?

A

Scalp, torso, genital areas

253
Q

Most common type of suture knot?

A

Square knot

254
Q

Most common type of suture technique?

A

Simply interrupted

255
Q

When is horizontal mattress used? (hint: wound edges)

A

To pull wounde edges together over distance

256
Q

When is vertical mattress used? (hint: wound edges)

A

Used when wound edges tend to invert or on concave surfaces

257
Q

When to remove sutures from eyelid?

A

3 days

258
Q

When to remove sutures from cheek?

A

3-5 days

259
Q

When to remove sutures from nose, forehead, or neck?

A

5 days

260
Q

When to remove sutures from ear or scalp?

A

5-7 days

261
Q

When to remove sutures from arm, leg, hand, foot, chest, back, and abdomen?

A

7-10 days

262
Q

1% Lidocaine blocks what? What intact?

A

Blocks painful stimulant. Pressure and touch intact.

263
Q

2% Lidocaine blocks what? What intact?

A

Block all stimuli including pressure and touch. Nothing intact.

264
Q

Max dose of Lidocaine?

A

4mg/kg

265
Q

How much volume for average finger numbing?

A

No more than 5mL

266
Q

Where to avoid epi? (hint: 4 places)

A
  1. Digits
  2. Nose
  3. Ear
  4. Penis
267
Q

Goal of splinting?

A

To stabilize/immobilize until seen by ortho

268
Q

When it PT seen by ortho after splint places?

A

2-3 days (another slide says follow up w/n 3-5d after injury)

269
Q

When to splint?

A

Immediately after injury

270
Q

What direction to wrap injury?

A

Distal to proximal

271
Q

When to evaluate circulation, sensory, and motor when splinting?

A

Before and after splint placed

272
Q

Plaster splint sets in how many minutes?

A

2-8 minutes

273
Q

Plaster splint max strength in how long?

A

24h

274
Q

DIP Joint Splint must not be removed for how many weeks?

A

8 weeks

275
Q

How long is a cast on for?

A

4-6 weeks

276
Q

When to put on a cast?

A

After post-traumatic swelling resolved, 5-7d

277
Q

2 most common spots to do LP?

A
  1. L3-L4

2. L4-L5

278
Q

PT position for LP if need opening pressure?

A

Lateral recumbant (on side with knees to chest)

279
Q

LP opening pressure normal range?

A

18-20mm H2O

280
Q

CSF volume to collect?

A

4-8ml

281
Q

How many tubes for CSF collection?

A

4

282
Q

Tube 1 CSF for what?

A

Cell count and diff

283
Q

Tube 2 CSF for what?

A

Glucose and protein

284
Q

Tube 3 CSF for what?

A

Culture and gram stain

285
Q

Tube 4 CSF for what?

A

Cell count and diff

286
Q

Normal CSF protein range?

A

15-45

287
Q

Elevated CSF protein can mean?

A

Infection

288
Q

CSF WBC above 5 means what?

A

Possible infection

289
Q

Increased CSF neutrophil means what type of infection?

A

Bacterial

290
Q

Increased CSF lymphocytes means what type of infection?

A

Viral (aseptic meningitis)

291
Q

Normal CSF RBC?

A

<10

292
Q

What is a yellow color in CSF called?

A

Xanthochromia

293
Q

Xanthochromia means what?

A

Possible SAH

294
Q

Xanthochromia vs traumatic tap?

A

Traumatic tap isn’t caused by SAH while Xanthochromia can be from SAH.

295
Q

Normal CSF glucose range?

A

50-80

296
Q

Low CSF glucose can mean what?

A

Bacterial meningitis, sarcoidosis, syphillis, SAH

297
Q

Variable CSF glucose can mean what?

A

Viral

298
Q

Serum hyperglycemia can do what to CSF glucose?

A

Mask CSF hypoglycemia

299
Q

Xanthochromia is produced from lysis of what?

A

RBCs

300
Q

Xanthochromia helps to differentiate from what complication?

A

Traumatic tap

301
Q

N. Menigitidis gram and shape?

A

Gram negative diplococci

302
Q

H. Flu gram and shape?

A

Gram negative bacilli

303
Q

Staph and Strep gram and shape?

A

Gram positive cocci

304
Q

Opening pressure above 30 can mean what? (hint: 2)

A
  1. Bacterial infection

2. Pseudotumor cerebri

305
Q

When to get help for: Sudden vision loss, flash of light/floaters, any chemical to eye, and diplopia?

A

Right now. Ocular emergency!

306
Q

When to get help for: Ocular pain, foreign body, corneal abrasion

A

Today. Ocular urgency.

307
Q

When to get help for: Itchty eyes, painful bump on eyelip

A

This week. Ocular priority.

308
Q

When to get help for: Vision change over last few months, bump on eye, non-painful bump on lid

A

Next available appointment. Ocular routine.

309
Q

Ascites and flanks?

A

Bulging and dullness

310
Q

Ascites and fluid?

A

Fluid shift

311
Q

What does cyanosis suggest?

A

Hypoxia

312
Q

What does diaphoresis and somnolence suggest?

A

Hypercapnia and respiratory acidosis

313
Q

What does assisted ventilations do to ICP?

A

Decreases ICP

314
Q

What do assisted ventilations do to hypercarbia and acidosis?

A

Corrects hypercarbia and acidosis

315
Q

Can do blind Nasotracheal Intubation if PT is apenic?

A

CI’d due to increased risk of esophageal intubation

316
Q

Can do blind blind Nasotracheal Intubation and coagulopathy?

A

CI’d due to risk of epistaxis

317
Q

Cricothyotomy CI’d before what age?

A

8

318
Q

Airway of choice in children and PT with tracheal injury?

A

Tracheotomy

319
Q

Does a CXR rule out esophageal intubation?

A

Nope!

320
Q

Which airway used when gag reflex present?

A

Nasopharyngeal

321
Q

Which airway used when gag reflex absent?

A

Oropharyngeal

322
Q

Most common type of intubation?

A

Orotracheal

323
Q

When to ventilate prior to orotracheal intubation?

A

Hypoxic or apenic

324
Q

Orotracheal head position?

A

Sniffing position

325
Q

Miller Blade shape and where does it go?

A

Straight. Under epiglottis.

326
Q

McIntosh Blade shape and where does it go?

A

Curved blade. Anterior to epiglottis in vallecula.

327
Q

Best method to confirm placement of endotracheal tube?

A

See tube pass through cords

328
Q

When to do Rapid Sequence Intubation?

A

PT with full stomach

328
Q

RSI and preoxygenation aka?

A

Nitrogen washout

329
Q

What does preoxygenation before RSI do to O2?

A

Creates O2 reservoir. Sat 90% up to 8 minutes.

330
Q

How to do preoxygenation for RSI?

A

100% O2 with tight fitting mask. 8 deep breaths over 60 seconds.

331
Q

Preoxygenation in RSI CI’d in who?

A

PT with severe COPD or asthma

332
Q

in what diseases is nystagmus seen?

A

cerebellar disease, gait ataxia, dysarthria and vestibular disorders

333
Q

what diseases is ptosis seen in?

A

3rd nerve palsy, Horner syndrome, myasthenia gravis

334
Q

how do you test corneal reflex of CN V?

A

touch cornea with find wisp of cotton -> should see blinking

sensory -> CNV (if don’t blink then CNV lesions)

motor -> CNVII

335
Q

bells palsy is what type of CNVII injury?

A

peripheral injury that affects both upper and lower face

336
Q

central injury of CNVII affects what part of the face?

A

lower face

337
Q

what are the 6 components of the sensory portion of neuro exam?

A

(1) pain
(2) temperature
(3) position (proprioception)
(4) vibration
(5) light touch
(6) discriminative sensation (EYES CLOSED)

338
Q

how do you test for pain for sensory neuro exam?

A

sharp pin or stick of broken q-tip

use blunt and sharp end at random -> ask pt if it feels sharp or dull

339
Q

how do you test for temperature for sensory neuro exam?

A

fill 2 test tubes with hot and cold water -> ask pt if it feels hot or cold

340
Q

when is temperature test excluded from neuro exam?

A

if pain sensation is normal

341
Q

how do you test for position (proprioception) for sensory neuro exam?

A

grasp big toe and move it up and down while pts eyes are closed and ask them what position the big toe is in

if sense is impaired, move more proximal ankle joint

342
Q

how do you test vibration for sensory neuro exam?

A

use low pitched tuning forking (128 hx)

tap tuning fork and place over DIP and ask pt what they feel

343
Q

how do you test light touch for sensory neuro exam?

A

cotton wisp

344
Q

how do you test discriminative sensation?

A

stereognosis, graphesthesia, two-point discrimination, point localization, extinction

345
Q

what is stereognosis?

A

ability to identify an object by feeling it

346
Q

what is graphesthesia?

A

number identification
-do this with arthritis

draw number on pts hand and have pt identify number while drawing

347
Q

what is a normal two-point discrimination?

A

<5mm distance that can be identified from one or 2 points

348
Q

what is point localization?

A

touch a point on pts skin, ask pt to open both eyes and point to that location

349
Q

what is extinction?

A

stimulate one side or simultaneously corresponding areas on both sides of the body

350
Q

damage to upper motor neuron lesion above the cross over point causes impairment on what side?

A

impairment develops on contralateral side

351
Q

damage to upper motor neuron lesion below the cross over point causes impairment on what side?

A

motor impairment occur son the ipsilateral side

352
Q

lower motor neuron lesion causes what impairment and on what side?

A

ipsilateral weakness and paralysis

353
Q

gag reflex is absent with lesions in what CNs?

A

CN IX and maybe CNX

353
Q

hyperactive reflexes mean lesions where?

A

CNS lesions of corticospinal tract

354
Q

hypoactive reflexes mean lesions where?

A

lesions of the spinal nerve roots, spinal nerves, plexuses

PNS

355
Q

what 4 conditions elevate right atrial pressure (JVP >9cm)?

A

(1) HF
(2) Tricuspid valve disease
(3) Pulmonic stenosis
(4) Pericardial disease

356
Q

what is the a wave? when does it occur?

A

atrial contraction

occurs just prior to S1 and before the carotid upstroke

357
Q

what does an increased a wave mean?

A

increased resistance to right atrial emptying

358
Q

what 4 conditions cause absent a waves?

A

(1) RV hypertrophy
(2) Pulmonary valve stenosis
(3) COPD with associated pulmonary HTN
(4) Restrictive cardiomyopathy

359
Q

what is the v wave?

A

increased atrial pressure as venous return increases after systole

occurs when tricuspid valve closes, the chamber begins to fill, and the right atrial pressure begins to rise again

360
Q

what condition causes prominent (increased) v waves?

A

severe tricuspid regurgitation

361
Q

pleuritic chest pain is persistent or not persistent?

A

persistent

362
Q

what muscle do the breasts overlie?

A

pectoralis major

363
Q

what muscle does the inferior margin of the breasts overlie?

A

the serratus anterior

364
Q

tail of breast aka

A

tail of spence

365
Q

what are the 4 views for inspection of breasts?

A

(1) arms at sides
(2) arm overhead
(3) arms pressed at hips
(4) leaning forward

366
Q

when doing inspection of breasts, pt is in what position?

A

sitting up and disrobed to waist

367
Q

what are vitreous floaters?

A

moving debris inside vitreous humor, often protein fragments

368
Q

what position is pt in when doing palpation of breasts?

A

supine with arm above head and shoulder raised on rolled towel/sheet

369
Q

what degree is the arm in palpation of the axillae?

A

pts arm shouldn’t be more than 30 degrees of abduction

370
Q

what is rectocele d/t?

A

weakness or defection the endopelvic fascia

371
Q

what is cystocele d/t?

A

weakened anterior supporting tissues

372
Q

ascites reflects increased hydrostatic pressure in what 5 conditions?

A

(1) cirrhosis
(2) HF
(3) constrictive pericarditis
(4) IVC
(5) hepatic vein obstruction

374
Q

what method of knot tying is used mostly in the ER?

A

instrument knot typing

375
Q

what are you looking for in A of ABCS of lateral c-spine film interpretation?

A

check for a smooth line at the anterior and posterior aspect of the vertebral bodies and suinolaminal line

376
Q

what are you looking for in B of ABCS of lateral c-spine film interpretation?

A

carefully check each vertebral body to ensure that the anterior and posterior heights are similar

377
Q

what are you looking for in C of ABCS of lateral c-spine film interpretation?

A

check the intervertebral joint spaces and the facet joints

378
Q

what does ABCS stand for in interpretation of the lateral c-spine film?

A

A = alignment

B = bones

C = cartilage

S = soft-tissue spaces

380
Q

what are you looking for in S of ABCS?

A

look for prevertebral swelling, esp at C2-C3 (> 5mm) and check the predental space which should be < 3mm in adults and < 5mm in children

381
Q

when are flexion-extension view of the c-spine used?

A

if ligamentous injury is suspected

those with severe neck pain and normal cervical radiographs or those with suspicious abnormal radiographs

382
Q

flexion-extension view of the c-spine should be performed only in what patients?

A

alert, cooperative patients and must be supervised by a clinician

383
Q

what are the indications for CT?

A

identify vertebral fx’s and some correctable problems such as hematomas

384
Q

what are the indications for MRI?

A

useful to evaluate injury to the spinal cord itself or rupture of the intervertebral discs

also demonstrates areas of contusion and edema within the cord, as well as areas of compression

385
Q

what is anterior cord syndrome?

A

loss of fxn in the anterior 2/3 of spinal cord

386
Q

what is lost in anterior cord syndrome?

A

loss of voluntary motor fxn, pain and temp sensation below the level of injury

387
Q

what is preserved in anterior cord syndrome?

A

posterior column fins of position and vibration

388
Q

what is needed immediately for anterior cord syndrome?

A

immediate neurosurgeon consult

389
Q

what is central cord syndrome?

A

injury to the central portion of spinal column

more UE involvement than LE

can occur +/- x or ligamentous disruption

389
Q

what is brown squared syndrome? what are findings?

A

hemisection of the spinal cord usually from penetrating trauma

contralateral sensation of pain and temp is lost

motor and posterior column fins are absent on the side of the injury

390
Q

what is spinal shock? when can extent of cord injury be determined?

A

temporary concussive like condition in which the cord reflexes and anal wink are absent

extent of cord injury can’t be determined until reflex return

390
Q

what difference b/w anterior and posterior vertebral heights indicates fx?

A

> 3mm

Physical Exam 2 (5 decks)

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