Yonkisms for Final Flashcards
Internal/External of shoulders/arms involves _____ muscles
rotator cuff
Distrust and suspicion is a characteristic behavior pattern of what personality?
Paranoid
Detachment from social relations with a restricted emotional range is a characteristic behavior pattern of what personality?
Schizoid
Eccentricities in behavior and cognitirve distortions along with acute discomfort in close relationships is a characteristic behavior pattern of what personality?
Schizotypal
Disregard for the law and the rights of others is a characteristic behavior pattern of what personality?
Antisocial
Instability in interpersonal relationships, self-image and affective regulation along with impulsivity is a characteristic behavior pattern of what personality?
Borderline
Emotional overreactivty, theatrical behavior, and seductiveness is a characteristic behavior pattern of what personality?
Histrionic
Persisting grandiosity, need for admiration and lack of empathy for others is a characteristic behavior pattern of what personality?
Narcissitic
Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation is a characteristic behavior pattern of what personality?
Avoidant
Sumissive and clining behavior, psychological dependence on others is a characteristic behavior pattern of what personality?
Dependent
Rigid, detail-oriented behavior, often associated with compulsions to perform tasks repetitively and unnecessarily and rigid confromtiy to rules is a characteristic behavior pattern of what personality?
Obsessive-compulsive
Injury from shoulder dislocation could affect which nerve?
Axillary nerve injury
Nerve for lateral aspect of foot
Tibial nerve
Workhorse muscle of shoulder abduction is
Supraspinatus
When performing ROM you should isolate?
the joint above
Intrinsic muscles of the hand are under what nerve control?
Ulnar nerve
Romberg test really tests
proprioception and vestibular function
Positive romberg with eyes open suggests
Cerebellar disease
Pronator drift tests for
corticospinal damage- CVA
Positive pronator drift is sensitive and specific for a stroke on the _________side
contralateral
Abdominal reflexes test nerves
T8-T12
What has a better prognosis? Decorticate posturing or decerebrate (extension of arms, flexions of wrists)
Decorticate
Rooting reflex should go away
at 4 months
Palmar grasp reflex normal until
6 months
Moro refelx normal up till
2 months
Plantar reflex abnormal after
1 year
Frontal release sigsn typically go with
frontal lobe diseases
Abnormal glabellar reflex seen in what disease?
Parkinsons (will not stop blinking)
Triad for Wernkicke-Korsakoff’s sydrome
Confusion, Opthalmoplegia, Ataxia
common in alcoholic pt, very malnourished (thiamine/B vitamin)
Give thiamine before giving glucose or you can precipiate them
In carpal tunnel there is inflammation of the
aponeurosis of median nerve
Median nerve entrapment symptoms include
pain and numbness on the VENTRAL surface of the first three digits
Phalen’s test
Flex wrist at 90 degrees and push ventral surfaces together, reproducing symptoms/ numbness in fingers. Sensitive for carpal tunnel
Tinel’s sign
Tap patients wrist right over median nerve/carpal tunnel, reproduction of paresthesias
What is Kernig’s sign?
pain in back and increased resistance to extending the knne with the hip flexed
Common initial finding of MS
Optic neuritis
Bilateral positve Kernig signs suggest
meningeal irritation
What is Brudzinski’s sign
Passively flexing neck. Pain and flexiion of knees and hips flex suggests meningitis
How do you test for peripheral neuropathy?
Monofilament
Stocking glove electric burning is an early sign for
peripheral neuropathy
Neuropathy can progress to involve
Orthostasis
Gastroparesis
Neurogenic bladder
cardiac arrhythmias (and sudden cardiac death)
Posterior column/ impaired vibratory sense
Sexual dysfunction
Rigidity, bradykinesia, and tremor at rest is diagnostic of
Parkinsons Disease
Parkinson’s disease pts often have a gait described as
slow, shuffling gait with loss of arm swing
Upper motor neuron signs include
Spastic weakness
Hyperactive reflexes
+ Babinski
Pronator drift (corticospinal)
Lower Motor Neuron Signs include
Flaccid weakness
Hypoactive reflexes
Muscle atrophy
Fasciculations
Extrapyramidal signs include (HD, PD)
Resting tremor, rigidity
Postural deformity
Slowed RAM
Cerebellar signs include (B1 def)
Intention tremor
Ataxia
Impaired RAM
Diplopia, eye pain, scanning speech, and paresthesias top ddx should be
MS
Guillain-Barre is mostly _____ neuron features
Lower motor neuron
white matter
axons and tracts
gray matter
cell bodies
Nerve for front and back of neck
C3
Nerve for thumb
C6
Nerve for fifth finger
C8
Nerve for nipple line
T4
Nerve for umbilicus
T10
Nerve for inguinal
L1
Nerve for anogential
S2/3
Nerve for knee
L4
Nerve for back of hand thenar space
Radial nerve
Nerve for middle three digits anterior and posterior
Median nerve
Nerve for lateral aspsect 5th digit
Ulnar nerve
Serial 7s
Assess attention, Subtract 7 from 100 multiple times
Pathway that is sensorimotor to maintain balance
Cerebellar
lesion velow corticospinal (pyramidal) tract cross causes _____ symptoms
Contralateral
lesion above corticospinal (pyramidal) tract cross causes _____ symptoms
Ipsilateral
complex motor and movement pathways in deep grey matter
Basal ganglia
Positive baninski
sign of upper motor neuron lesion (ie MS)
Decreased DTRs indicate______ lesion
lower motor neuron lesion
Guillan-Barre is an example of _________ lesion
lower motor neuron lesion
Upper motor neuron lesions likely to have _______ DTRs
increased DTRs
Ipsilater weakness likely seen in _______ neuron lesion
lower motor neuron lesion
Spinothalamic pathways cross
in the cord
Spinothalamic pathways responsible for
pain, temp, crude touch
posterior column pathways cross
in the medulla
posterior column pathways responsible for
position, vibration, fine touch
Diabetic neuropathy likely to have damage to
posterior column
hypermanesium will have _______ DTRs
decreased
DTR of Biceps is CN
5,6
DTR of Triceps is CN
6,7
DTR of brachioradialis is CN
5,6
DTR of patellar is nerve
L2,3,4
DTR of achilles is nerve
S1
Absent DTR is grade
O
Hypoactive DTR is grade
1+
Normal DTR is grade
2+
Hyperactive DTR is grade
3+
Hyperactive DTR with clonus is grade
4+
Classic cerebellar disease signs
Dysmetria (finger to nose) nystagmus (probably up and down) and intention tremor
Patting thighs is an example of
Rapid alternating movements, tests cerebellar function
finger spread tests what nerve
ulnar nerve
wrist extension tests what nerve
radial nerve
finger opposition tests what nerve
median nerve
Normal muscle strength grade is
5 out of 5
Movement against gravity but not against resistance is graded
3 out of 5
Visible muscle contraction but no joing movement is graded
1 out of 5
Movement of joing but not against gravity is graded
2 out of 5
Movement against resistance, but less than normal is
4 out of 5
Axillary nerve injury may cause shoulder____
drop, paresthesia over deltoid, weakness of abduction
proximal muscle weakness is more suggestive of
myopathy
distal muscle weakness is more selective of
polyneuropathy or disorder of peripheral nerve
Fibrous joints are
immovable
like skull
passive motion means
you as the examiner provides the motion
Expected head and neck flexion is
40 degrees, more is okay
Expected head and neck extension is
30 degrees, more is okay
Expected lateral head flexion is
30 degrees
Head and neck movement may reproduce radicular pain. This is from _____ commonly vertebrae____
spinal nerve root compression, C6 C7
Passive head rotation should probably not go past
60 degrees
Winged scapula is caused by paralysis of
Long thoracic nerve
-serratus anterior
Torticollis is
“wry neck”
lateral deviation and rotation of the head
from unilateral SCM contraction
What can cause torticollis
hematoma, muscle tear, dystonic rxn from phenothiazines (thorazine)
the TMJ is what kind of joint
condylar
What muscles open the mouth
pterygoid
Closing the mouth uses what muscles
masseter and temporalis
Chewing, fx of TMJ is with what CN
CN5
What major condition can have deferred pain to the TMJ
Giant cell arteritis
Normal convexity of cervical spine is
concave/ lordotic
Normal convexity of the thoracic spine is
convex/ kyphotic
Most mobile part of the spine is
cervical and then lumbar….
Unequal height of iliac crests of pelvic tilt suggests
leg length discrepancy
scoliosis
hip abduction
Expected active flexion of back is
90 degrees
Expected active extension of spine is
30 degrees
Normal active lateral flexion of spine is
30 degrees
What should risk is higher in those with scoliosis
atrophy of supraspinatus and infraspinatus with rotator cuff tears
inability to abduct shoulder and ttp over bicipital grove suggests
rotator cuff tear
Localized shoulder pain is suggestive of what disorders
subacromial bursitis
subdeltoid bursitis
arthritis
Restricted ROM in shoulder is seen in what major disorders
Bursitis, adhesive capsulitis, tendonits, cuff injuries, or fx
Two sensitive indicators for radiculopathy stemming from spine issues are
straight leg raise
contralateral straight leg raise
Expected active forward flexion of shoulder/UE is
180 degrees
Expected active extension of shoulder/UE is
60 degrees
Expected active abduction of shoulder is
180 degrees
Expected external and internal rotation of should is
180 degrees
Muscles of the rotator cuff
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Palpation of step on spine is suggestive of
spondylolisthesis
Common fractured area of spine from osteoporosis is
T10-12
2 major bursa in shoulder
subacromial and subdeltoid
what muscle is responsible for the majority of abduction of the shoulder
supraspinatus
two tests for impingement syndrome is
Neers and Hawkings test
Yergason test is
With the patient’s elbow flexed at 90 degrees the examiner palpates the bicipital groove as the patient attempts forearm supination against resistance
= biceps tendonitis
What nerve transverses the elbow
ulnar
what muslces are needed for supination
biceps and supinator
tennis elbow=
lateral epicondylitis
overuse with wrist extensors
golfers elbow=
medial epicondyle
muscles responsible for flexion of the wrist
Herberden’s nodes and Bouchard’s nodes are seen in
OA
Ulnar deviation, swan neck deformity, and boutonniere deformity are seen in
Chronic RA
Expected wrist extension/flexion is
75 degrees
What joints does Heeberden’s nodes develop on
DIP
What joint does Bouchard’s nodes develop on
PIP
Positive Finkelstein test suggests
De Quervain’s Tenosynovitis
53 y/o M showing flexion contractures at PIP joints of 3rd digit. Dx=
Dupuytren’s contracture
What is Trendelenburg test?
Pt asked to stand on one hip, opposite hip (off ground) should point upward
knee deformities -> bow legged is aka
genu varum
Inward turning of knees is known as
genu valgus
When is genu varum normal?
up to 3 years old
when is genu valgus normal
3- 8
or look for skeletal dysplasia or rickets
How can you test ACL injury
Lachman test- flex knee at 20-30degrees, stabilize femur, pull tibia anteriorly. If it moves it is (+)
Anterior drawer test- knee at 90 degrees, pull tibia forward
How can you test PCL injury?
Posterior drawer rest- try to displace tibia posteriorly
How can you test meniscal injury?
McMurray test- knee flexed 90deg, gently ext/int rotate and extend knee (+) is pain or feel click
What is patellar grind test
leg fully extended, examiner places downward pressure on patella compressing it against patellofemoral groove. (+) elicits pain
MC injured collateral ligament is
MCL
When should routine digital rectal exams be done in otherwise healthy population?
Age 40
Is DRE specific for ruling out disease?
Yes but not sensitive
Purpose of digital rectal exam
evaluate symptoms prostate cancer screening colorectal cancer screening evaluation of a retroverted uterus any rectal complaints
How is prostate cancer staged
Gleeson score
-histology
+TNM scoring
MC cancer in men
Prostate Cancer
PSA guidelines determines >_____ mg/dL as associated with CA
4
When should baseline PSA be obtained?
40? from AUA
but American Cancer Society says at 50
If PSA is less than 2.5 and normal DRE they should be repeated
Every two years
What drugs on the market could effect PSA
finasteride
5 alpha reductase inhibitors
so get baseline before starting
What gene mutation is associated with prostate cancer?
BRCA2
If you feel a nodule on prostate what is the next step?
transrectal ultrasound
and biopsy
What hyperplastic process can lead to obstruction of urethra?
BPH
Normal prostate is how long
2.5cm
prostate should feel like
rubbery, nontender, symmetrical, no nodules
what is an infectious febrile condition caused by bacterial infection?
acute prostatitis
MC culprit of acute prostatitis of a man >35
GC/ chlamydia
MC culprit of acute prostatitis of man >40
GNR- enterobacteraciae
In what case is DRE contraindicated for acute prostatitis?
Immunocompromised
also, prostatic massage in any state in contraindicated
What are internal hemorrhoids associated with?
Liver disease and portal HTN
Which hemorrhoid is painful?
External
What position for DRE Is best for short fingers and is more comfortable for patient
Lateral decubitus (sims position)
Mammogram should be started at
age 40 and annually
Testicular cancer screening recommendation
in teen years 15
recommended to have your pts start doing it monthly after a hot shower
Clinical breast exam should be done
start at age 20 and then q3 years
annually at age 40
self breast exams should be done
starting in 20s monthly 5-7 days after menses
screening for cervical cancer
Pap smear +HPV testing at age 21 to 65
q3 years or if after age 30 q5 if previous have been normal
total abdominal hysterectomy-don’t need one if no previous problems
which HPV strains are “bad”
6 and 11 cause most condylomas/ warts
16 and 18 are most oncogenic
(Gardasil covers these 4)
often develops in adolescents
come in with heavy feeling in scrotum
scrotum doesn’t elevate as much as normal
“bag of worms”
Varicocele
- varicosities of venus plexus in spermatic cord
- infertility unless corrected in 50%
Following trauma or spontaneously
Immediate severe pain in testicle and abdomen
Loss of cremasteric reflex
elevating testicle makes pain worse
testicular torsion
emergent US with color Doppler
EMERGENCY 6hrs to save from ischemia
fluid accumulation around test
transilluminate
Hydrocele
- benign
- but look for underlying malignancy/testicular cancer
Phren’s sign- relief with elevation of epididymis
Mild to moderate pain in testicle
Epididymitis
Cryptorchidism
testicles don’t descend
-have much higher risk of testicular cancer
gynecomastia
abnormal breast development consider: liver failure THC use Spironolactone use finasteride use
If there is galactorrhea in men you should look for:
what visual deficit might be present?
prolactinoma
visual field deficit: bitemporal hemi
also phenothiazine antipsych meds (halidol)
HCG
renal?
strawberry cervix/ punctate petechae
Trichomonas
sexually transmitted inflammatory condition of cervix that can spread and lead to ascending of infection of organs (PID)
cervicitis
Chandelier sign
palpating during bimanual exam of cervix
will jump from extreme pain
=cervical motion tenderness (CMT)
PID
Pelvic heaviness that radiates to inner thighs along with menorrhagia/ heavy periods think
uterine fibroid
- benign overgrowth of myometrium
- tx varies
Mastitis in a non-lactating woman or persistent dermatitis of the nipple you must
r/o inflammatory breast carcinoma (DEADLY)
mc staph aureus
What might you see on exam that suggests ductal breast cancer
nipple retraction, dimpling, edema (orage peel sign), unilateral bloody nipple discharge
DDx in non-lactating galactorrhea
prolactinoma
phenothiazines
hypothyroidism
mc type of breast cancer
ductal breast cancer
Post-menopausal vaginal bleeding is
endometrial cancer until proven otherwise
Pt with insulin resistance, trunkal obesity, and hirsute (male pattern hair growth) think
PCOS
poly cystic ovarian syndrome
related to insulin resistance= diabetes
acanthosis nigricans can indicate
internal malignancy
in otherwise healthy adult digital rectal exams should be performed
age 40
DRE is good at ruling_____ prostate cancer
ruling out
but not in
Prostate cancer is staged via
Gleeson score
+TNM scoring
Feeling a hard fixed nontender mass in prostate is
suspicious for CA
prostate swollen, firm, warm and VERY tender to palpation is likely
acute prostatitis
DRE is strictly contraindicated in
immunocompromised
-also no prostatic massage (anyone)
Internal hemorrhoids are often related to disease to what organ?
liver disease, portal HTN
when are mammograms performed
40 and annually
breast exams start at
age 20 q3yrs
annually at 40
Phren’s sign (relief of testicle pain with elevation) is seen in
epididymitits
an enlarged testicle that you can transillumiate
hydrocele
-look for underlying tumor
testicle with “heaviness, “bag of worms”
varicocele
infertility unless corrected in 50%
strawberry cervix
trichomons
chandelier sign
cervicitis/PID
new onset IBS symptoms in older woman
must r/o Ovarian CA
mastitis in a non-lactating woman or persistent dermatitis of the nipple
r/o inflammatory breast carcinoma
DEADLY
acanthosis nigricans consider
internal malignancy
post-menopausal vaginal bleeding is
endometrial CA until proven otherwise
hirsute, truchal obesity, insulin resistance think
PCOS
