CAII Flashcards
(413 cards)
1
Q
Butterfly rash on the cheeks
A
Systemic lupus erythematosus
2
Q
Scaly rash and pitted nails
A
Psoriatic arthritis
3
Q
Papules, pustules, vesicles on red bases on distal extremities
A
Gonococcal arthritis
4
Q
Erythematous patch expanding, mental status change, facial weakness, stiff neck
A
Lyme disease
5
Q
Hives
A
Serum sickness, drug reaction
6
Q
Erosings or scaling of the penis and crusted scaling papules on soles and palms. Uveitis, urethritis, arthritis
A
Reiter’s syndome
7
Q
Maculopapular rash
A
Rubella
8
Q
Clubbing of fingernails
A
COPD
9
Q
Red, burning, and itchy eyes
A
Reiter’s syndrome
10
Q
Preceding sore throat
A
Rheumatic fever or gonococcal arthritis
11
Q
Diarrhea, abdominal pain, cramping
A
Ulcerative colitis
12
Q
Urethritis
A
Reiter’s syndrome
13
Q
Hours per week of moderate-intensity exercise
A
150 minutes
14
Q
Hours per week of vigorous-intensity
A
75 minutes
15
Q
Muscle-strengthening activity involving all major muscle groups
A
2 days or more per week.
16
Q
S2-S4 midline disc or tumor and bowel or bladder dysfunction
A
Cauda equina syndrome
17
Q
Gluteal and posterior leg pain that radiates
A
Sciatica
18
Q
Leg pain that resolves with rest of lumbar flexion
A
Spinal stenosis
19
Q
What is a predictor of low back pain?
A
Depression
20
Q
Osteoporosis: risk factor prior incidence of:
A
Fraigility fracture
21
Q
Osteoporosis: risk factor for women:
A
Postmenomause
22
Q
Osteoporosis: risk factor of age
A
> 50 y/o
23
Q
Osteoporosis: risk factor of weight
A
< 70 kg or 154 lbs
24
Q
Osteoporosis: risk factor of mineral
A
Low Ca levels
25
Osteoporosis: risk factor of vitamin:
Vit D
26
Osteoporosis: risk factor for drugs
Tobacco and alcohol
27
Osteoporosis: risk factor for family
Family history of fracture in a first-degree relative
28
Osteoporosis: risk factor for medication
Corticosteroids, breast cancer meds, antiseuizure meds, immunosuppressive meds, antigonadal therapy
29
Osteoporosis: risk factor for disease
Inflammatory disease of MS, lungs, GI, or RA
30
Osteoporosis: risk factor for conditions
Thyrotoxicosis, celiac sprue, renal organ, DM, HIV, hypogonadism, myeloma, anorexia
31
Who should be screened for OP?
Women older than 65 and younger women with risk factors.
32
How can bone density be measured?
Dual Energy X-ray Absoptiometry (DXA)
33
Osteoporosis T score
<-2.5
34
Osteopenia T score
-2.5 to 1.5
35
Normal levels of 25OHD
20-50 ng/mL
36
Ages 19-50 Calcium and Vit D
1000 mg and 600 IU
37
Age 50-71 Women
1200 mg and 600 IU
38
Age 50-71 Men
1000 mg and 600 IU
39
Age >71
1200 mg and 800 IU
40
Involvement of only one joint
Trauma, septic arthritis, gout
41
Polyarticular and symmetrical
RA
42
Limited extension, normal flexion. Nodule on ring finger
Dupuyren's contracture
43
Bowleg
Genu varum
44
Knock-knees
Genu valgum
45
Effusion is associated with
Trauma
46
Subcutaneous nodules are associated with
Rheumatoid arthritis or Rheumatic fever
47
Crepitus is associated with
Inflamed joints as in osteoarthritis or inflamed tendon sheaths
48
Excess mobility of joint ligaments or ligamentous laxity is associated with what 2 things
ACL tear in knee trauma or muscle atrophy seen in RA
49
Decreased ROM is associated with what 3 things
Arthritis, inflammation of tissues around a joint/fibrosis of the joint, or bone fixation (ankylosis)
50
Bogginess or doughiness accompanied by effusion from the palpable joint fluid
Synovitis
51
Tenderness over the tendon sheath
Tendinitis
52
Increased warmth seen in 4 things
Arthritis
Tendinitis
Bursitis
Osteomyelitis
53
Diffuse tenderness and warmth suggests
Infection of arthritis
54
Focal tenderness suggests
Injury
55
Redness over a tender joint suggests three things
Septic arthritis
Gouty arthritis
RA
56
Most active joint in the body
TMJ
57
ESR/CRP
Chronic inflammatory arthritis
58
Facial asymmetry is seen in
TMJ syndrome
59
UL chronic pain with chewing, jaw clenching, teeth grinding, stress, HA
TMJ syndrome
60
Pain with chewing is also seen in
Trigeminal neuralgia
61
Swelling in TMJ may appear as a rounded bulge .5 cm from what
EAM
62
Elevation of one shoulder
Scoliosis
63
Rounded aspect of the shoulder appearance flattened
Anterior dislocation of the shoulder
64
Supraspinatus and infraspinatus atrophy
Rotator cuff tear
65
Localized tenderness near SITS muscles
Subacromial or subdeltoid bursitis, degenerative changes, calcific deposits near rotator cuff.
66
The most common cause of shoulder pain is
Rotator cuff injury
67
The best predictor of rotator cuff tear
1. Supraspinatus weakness on abduction
2. Infraspinatus weakness on external rotation
3. Positive impingement sign
68
Age > 60 y/o and positive drop-arm test
Degenerative rotator cuff tear
69
Swelling around the olecranon process
Olecranon bursitis
70
Lateral epicondylitis, tenderness distal to epicondyle
Tennis elbow
71
Medial epicondylitis, tenderness distal to epicondyle
Pitcher's/Golfer's elbow.
72
Preservation of active ROM helps to...
| What specific movement?
Rule out fracture
| Elbow extension
73
Full elbow extension rules out
Hemarthrosis and intra-articular effusion
74
Degenerative changes at the 1st CM joint are most common among who?
Women
75
Complaints of dropping objects, inability to twist lids off jars, aching at the wrist of forearm, numbness of first three digits.
CTS
76
Other CTS signs include
Typing, pregnancy, RA, DM, hypothyroidism, thenar atrophy
77
Impaired hand movement
Dupuytren's contracture, trigger finger, arthritis
78
Phalen's sign within how many seconds is positive
60 seconds
79
Weakness on thumb abduction
CTS because abductor pollicis is innervated by median nerve
80
De Quervains tenosynovitis
Inflammation of the abductor pollicis longus and extensor pollicis brevis tendons. CTS and this is more common in women
81
Local swelling
Ganglion
82
Diffuse swelling
Arthritis or infection
83
Heberden's nodes
DIP OA
84
Bouchard's nodes
PIP OA
85
Thenar atrophy
Median nerve compression/CTS
86
Hypothenar atrophy
Ulnar nerve compression
87
Tenderness over distal radius
Colles' fracture
88
BL tenderness
RA
89
Snuffbox tenderness
Scaphoid fracture
90
MCPs are boggy and tender in this disease but not in this disease
YES RA
| NO OA
91
DIP also involved in
Psoriatic arthritis
92
Lateral deviation and rotation of the head from SCM contraction
Torticollis
93
Level of iliac crest
L4
94
Step offs of lower lumbar area
Spondylolisthesis
95
Increase in this with age but should be a correctable structural deformity in children
Thoracic kyphosis
96
Lateral and rotatory curvature of the spine evident during adolescence
Scoliosis
97
Unequal shoulder height
Scoliosis, Sprengel's deformity of the scapula b/c extra bone between it and C7, winging from loss of innervation
98
Unequal iliac crest
Pelvic tilt, unequal length of the legs,
99
Listing of the trunk
Herniated lumbar disc
100
Birthmarks, port-win stains, hair patch, lipoma
Spina bifida and other bone defects
101
Cafe au lait, skin tag, fibrous tumor
Neurofibromatosis
102
Most serious cause of low back pain because associated with paralysis of affected limb or loss of bladder or bowel control
Cauda equina compression
103
Lumbar lordosis or muscle spasm
Ankylosing spondylitis
104
When do most hip problems appear?
During the weight bearing stage
105
Wide base
Cerebellar disturbance
106
Bulge along the ligament
Inguinal hernia or aneurysm
107
Ischiogluteal bursitis, may mimic sciatica
Weaver's bottom makes sitting painful
108
Unequal leg length
Scoliosis
109
Arthritic joint vs ligamentous sprain
Arthritic joints are painful when moved in any directions
| Ligamentous sprains produce pain when the ligament is stretched.
110
Tenderness over the 3rd and 4th MT heads, women wearing high healed shoes
Morton's neuroma
111
Housemaid's knee
Prepatellar bursitis
112
Bulge sign with tapping laterally
Minor effusion
113
Balloon sign using both hands
Major effusion
114
Ballotting the patella compress the patella again the femur
Major effusion
115
Aching pain in the lumbosacral area along L5 lateral leg and S1 posterior leg
Mechanical low back pain
116
What are the risk factors of mechanical low back pain?
Heavy lifting, poor conditioning, obesity
117
What are the causes of mechanical low back pain?
Muscle, ligament injury, Spondylolisthesis
118
When the sharp edge of a toenail digs into the lateral nail fold causing inflammation and infection. Includes a tender, reddened, overhanging nail fold usually affecting the great toe.
Ingrown toenail.
119
Hyperextension at MP joint, flexion at PIP involving 2nd toe. A corn may also be present
Hammer toe.
120
Hammer toe what joint is flex and hyperextended
PIP, MP
121
Painful conical thickening of skin
Corn
122
On 5th toe usually from pressure
Corn
123
Painless conical thickening
Callus
124
Thickened skin of sole, may be accompanied by what
Callus, plantar wart
125
Hyperkeratotic lesion caused b HPV on sole of foot resembling a callus
Plantar wart
126
Pain sensation is diminished or absent on pressure points of feet. Deep infect, indolent painless. Common in DM
Neuropathic ulcer
127
Tenderness over the plantar surface between 3rd and 4th MT heads of common digital nerve. Hyperesthia, numbness, aching, burning.
Morton's Neuroma
128
Lateral deviation of the great toe and enlargement of the head of the first MT on medial side forming a bunion usually in women
Hallux valgus
129
Apparent when the patient stands because the longitudinal arch flattens so that the sole touches the floor as a result of the medial side of the foot developing a convex cavity. Tenderness commonly.
Flat foot
130
Flat foot is common among who
Obese, DM, prior foot injury
131
Very painful, tender, hot, dusky, red swelling of the MP of great toe
Acute gouty arthritis
132
When gout affects the big toe
Pedagra
133
Process of fibromyalgia
Widespread MS pain and tender points, these people move well
134
Location of fibromyalgia
All over but especially in the neck, shoulders, hands, low back, and knees
135
Pattern of spread of fibromyalgia and what makes it worse
Shifts unpredictably or worsen in response to immobility, excessive use, exposure to cold
136
Onset of fibromyalgia
Variable
137
Duration of fibromyalgia
Chronic with ups and downs
138
Swelling of fibromyalgia
None
139
Redness, warmth, tenderness of fibromyalgia
Multiple trigger points that aren't recognized until an exam
140
Stiffness of fibromyalgia
Present usually in morning
141
Limitation of motion of fibromyalgia
Absent, just stiffness of movement
142
Generalized symptoms of fibromyalgia
Disturbance of sleep, morning fatigue, DEPRESSION
143
Process of polymyalgia rhematica
Unclear etiology, > 50 y/o, women
144
Location of polymyalgia rhematica
Muscles of hip shoulder girdles neck
145
Pattern of spread of polymyalgia rhematica
N/A
146
Onset of polymyalgia rhematica
Insidious, abrupt
147
Progression of polymyalgia rhematica
Chronic, but self limiting
148
Swelling of polymyalgia rhematica
Hands, wrist, feet
149
Redness, warmth, and tenderness of polymyalgia rhematica
Tender
150
Stiffness of polymyalgia rhematica
In morning
151
Limitation of motion of polymyalgia rhematica
Restricts movement especially in shoulders
152
Symptoms of polymyalgia rhematica
Malaise, depression, anorexia, weight loss, fever, not true weakness
153
Process of chronic tophaceous gout
Multiple local accumulations of sodium urate in the joints and other tissues (tophi)
154
Location of chronic tophaceous gout
Feet, ankles, wrists, fingers, elbows,
155
Spread of chronic tophaceous gout
Additive, not symmetric like RA
156
Onset of chronic tophaceous gout
Gradual dev
157
Progression of chronic tophaceous gout
Chronic symptoms with acute exacerbations
158
Swelling of chronic tophaceous gout
Present as tophi and SUBQ tissues
159
Redness, warmth, and tenderness of chronic tophaceous gout
All 3
160
Stiffness of chronic tophaceous gout
Present
161
Limitation of motion of chronic tophaceous gout
Present
162
Symptoms of of chronic tophaceous gout
Fever, renal failure, renal stones.
163
Process of acute gout
Inflammatory rxn to microcrystals of monosodium urate
164
Location of of acute gout
Base of big toe, first MP, dorsum of foot, ankles, knees, elbows
165
Spread of acute gout
Confined to one joint
166
Onset of acute gout
Sudden
167
Progression of acute gout
Isolated occasionally lasting days to 2 weeks and they may get more frequent and severe
168
Swelling of acute gout
Present with the involved joint
169
Redness, warmth, tenderness of acute gout
Exquisitely tender, hot, and red yes
170
Stiffness of acute gout
No
171
Limitations of motion of acute gout
Limited by pain
172
Symptoms of acute gout
Fever, septic arthritis must be considered
173
Process of OA
Degeneration and loss of cartilage within joints followed by the formation of new bone at the margins of the cartilage
174
Location of OA
Knees, hips, hands (PIP/DIP), cervical, lumbar, wrist first CM
175
Spread of OA
Additive, only one joint may be involved
176
Onset of OA
Insidious
177
Progression of OA
Slow progressive with temporary exacerbations after period of overuse
178
Swelling of OA
Small effusions in joint especially in knees with bony enlargement
179
Redness, warmth, tenderness of OA
Sometimes tender, seldom warm, and rarely red
180
Stiffness of OA
Frequent but brief, in morning and after inactivity
181
Limitation of motion of OA
Often
182
Symptoms of OA
Absent
183
Process of RA
Inflammation of synovial membranes with erosion of adjacent cartilage and bone
184
Location of RA
PIP and MP of Hands, MT of feet, wrists, knees, elbows ankles
185
Spread of RA
Symmetrically
186
Onset of RA
Insidious
187
Progression of RA
Remissions and exacerbations
188
Swelling of RA
SUBQ NODULES, synovial tissue swelling
189
Redness, warmth, tenderness of RA
Tender, warm, NOT RED
190
Stiffness of RA
Prominent
191
Limitation of motion of RA
Often develops
192
Symptoms of RA
Weakness, fatigue, weight loss, fever
193
Injury to the fingertip resulting in infection usually from this virus. Can be from this if vesicle are present.
Staphyloccocus aureus. Herpetic whitlow
194
Localized tederness, swelling, dusky red, usually requires incision and drainage of fingertip after infection. HSV common for these HC workers
Felon. Dentists
195
Infection of tendon sheath of the fascial space of the palm, index finger, thenar space are common
Acute tenosynovitis and thenar space involvement
196
Pain on extension, so finger held in flexion of tendon from distal phalanx to MP joint
Acute tenosynovitis.
197
Cystic, round, nontender swellings along tendon sheaths. Cyst contains synovial fluid and flexion of the wrist makes it more apparent
Ganglion
198
Ganglion is commonly found at
Wrist
199
Acute tenosynovitis it hurts to do what
Extend, so finger is slightly flexed
200
Median nerve disorder/CTS
Thenar atrophy
201
Hypothenar atrophy
Ulnar nerve disorder
202
Painless nodule on flexor tendon in palm near what is trigger finger
MC head
203
Nodule is too big to enter the tendon sheath during extension of the fingers from a flexed position, but with extra effort the finger extends and flexes with a palpable and audible snap as the nodule pops into the tendon sheath.
Trigger finger.
204
Thickened nodule overlying the flexor tendon finger of the ring finger limiting what
Extension, may gradually dvelop flexion contracture
205
Extension is limited because of a nodule over the flexor tendon of the ring finger
Dupuytren's contracture
206
Associated with eating meat, knobby swellings white chalklike urate discharge
Chronic Tophaceous Gout
207
Bony overgrowth of DIP
Herberden's node, OA
208
Bony overgrowth of PIP
Bouchard's node, OA, less common
209
OA usually spares what joint
MP
210
Is OA painless
No
211
Hyperextension of PIP, flexion of DIP
Swan neck deformity RA
212
Hyperextension of DIP, flexion of PIP
Boutonniere deformity, RA, less common
213
Which way to the fingers deviate in RA?
Ulnar deviation
214
Nodules
RA
215
Involvement of joints in RA is usually symmetrical or asymmetrical?
Symmetrical
216
Tennis elbow
Lateral epicondylitis, extension of wrist, repeated pronation and supination of forearm developing 1 cm distal to lateral epicondyle
217
What aggravates tennis elbow?
Extending wrist vs resistance
218
Pitcher's, Golfer's elbow
Medial epicondylitis, wrist flexion (throwing),
219
What aggravates pitcher's elbow?
Flexing wrist vs resistance.
220
Synovial inflammation, boggy, soft, fluctuant swelling,
Many causes: arthritis of elbow
221
What increases arthritis of elbow risk
Alcohol
222
SUBQ nodules at pressure points on extensor surface of ulna. Firm, nontender
Rheumatoid nodules from RA or Acute rhematic fever
223
Swelling and inflammation of the olecranon bursa form trauma, gout, or RA
Olecranon bursitis, can be 6 cm in diameter
224
From throwing or swimming causing edema, hemorrhage and inflammation involving this tendon. Pain is maximal just below acromion
Supraspinatus usually
225
Aggravation of activity causing inflammation. Report sharp catches of pain, grating, weakness when lifting arms overhead. May have bone spur
Rotator cuff tendinitis/impingement syndrome
226
Subscapularis
Internal rotation
227
Supraspinatus
Elevation/abduction
228
Infraspinatus/Teres minor
External rotation
229
Patient complains of chronic shoulder pain, at night, catching, grating when raising the arm overhead, pain starts at supraspinatus tendon and progresses posteriorly and anteriorly. Characteristic shoulder shrug of affected shoulder
Rotator cuff tearr
230
Degenerative process int he tendon associated with the depostion of calicum involving the supraspinatus tendon. Often in women over 30. Tenderness is maximal below tip of acromion and the subacromial bursa which overlies the supraspinatus tendon may be inflamed
Calcific tendinitis
231
Inflammation of the long head of the biceps tendon and tendon sheaths. May coexist with rotator cuff tendinitis
Bicepital tendinitis
232
Frozen shoulder. Fibrosis of GH joint capsule manifested by diffuse, dull aching pain in the shoulder that restricts the active and passive ROM.
Adhesive capsulitis
233
Prior direct injury to shoulder girdle with degenerative changes over AC joint tenderness
Acromionclavicular arthritis
234
Shoulder instability so that the shoulder slips out of the joint when the arm is adbducted and externally rotated causing a positive apprehension sign
Anterior dislocation of humerus
235
Adhesive capsulitis especially limits what ROM
External rotation
236
What other condition is an antecedent to adhesive capsulitis
MI, other shoulder disorder. Stretching helps though
237
Neck pain with B/L weakness and parasethesia in UE, LE with urinary frequency. Hand clumsiness palmar paresthesia, gait change
Cervical Myelopathy from cervical cord compression
237
Neck pain with B/L weakness and parasethesia in UE, LE with urinary frequency. Hand clumsiness palmar paresthesia, gait change
Cervical Myelopathy from cervical cord compression
238
Cause of cervical myelopathy
Cervical spondylosis, cervical degenerative disc disease from spurs, protrusion of ligamentum flavum,
238
Cause of cervical myelopathy
Cervical spondylosis, cervical degenerative disc disease from spurs, protrusion of ligamentum flavum,
239
Signs of cervical myelopathy
Hyperreflexia, clonus at the wrist, knee, or ankle, extensor plantar reflexes, positive Babinski sign, gait disturbance. Lhermitte's sign: neck flexion causes electrical shock radiating down the spine.
239
Signs of cervical myelopathy
Hyperreflexia, clonus at the wrist, knee, or ankle, extensor plantar reflexes, positive Babinski sign, gait disturbance. Lhermitte's sign: neck flexion causes electrical shock radiating down the spine.
240
Sharp burning or tingling pain in the neck and one arm associated paresthesia and weakness. Sensory symptoms in myotomoal pattern, deep inmuscle rather than dermatomal pattern
Cervical radiculopathy from nerve root compression
240
Sharp burning or tingling pain in the neck and one arm associated paresthesia and weakness. Sensory symptoms in myotomoal pattern, deep inmuscle rather than dermatomal pattern
Cervical radiculopathy from nerve root compression
241
Cause of cervical radiculopathy
Dysfunction of cervical spine nerve, nerve roots, or encroachment of spinal nerve, herniated cervical disc. Involving hypoxia of the nerve root, dorsal ganglion, and release of inflammatory mediators.
241
Cause of cervical radiculopathy
Dysfunction of cervical spine nerve, nerve roots, or encroachment of spinal nerve, herniated cervical disc. Involving hypoxia of the nerve root, dorsal ganglion, and release of inflammatory mediators.
242
What nerve root is affected most often in cervical radiculopathy?
C7: affecting extensors and flexors. Triceps weakness. C6 is also common with weakness in biceps, brachioradialis, wrist extensors
242
What nerve root is affected most often in cervical radiculopathy?
C7: affecting extensors and flexors. Triceps weakness. C6 is also common with weakness in biceps, brachioradialis, wrist extensors
243
Mechanical neck pain with aching paracervical pain and stiffness beginning the day after injury.
Mechanical neck pain: Whiplash
243
Mechanical neck pain with aching paracervical pain and stiffness beginning the day after injury.
Mechanical neck pain: Whiplash
244
If mechanical neck pain is prolonged and accompanied by abnormal neck posture, muscle spasm, so neck goes to one side and chin goes to the other...what should you suspect?
Torticollis
244
Associated symptoms of mechanical neck pain
Aching, occipital HA, dizziness, malaise, fatigue.
245
Chronic whiplash syndrome lasts more than how many months
6 months
246
Cause of mechanical neck pain whiplash
Hyperflexion followed by hyperextension injury to the neck causing a musculoligamentous sprain or strain. Often from rear-end collisions.
247
Signs of low back pain referred from abdomen or pelvis
Local vertebral tenderness, spinal movements are not painful and ROM is not restricted.
248
Aching pain in paracervical muscles and ligaments associated muscle spasm stiffness, tightness in upper back and shoulder lasting up to 6 weeks.
Mechanical neck pain
249
Associated symptoms of mechanical neck pain
HA, local muscle tenderness, no neurologic deficits.
| No radiation, paresthesia, weakness.
250
How is mechanical neck pain related to fibromyalgia?
Trigger points
251
If mechanical neck pain is prolonged and accompanied by abnormal neck posture, muscle spasm, so neck goes to one side and chin goes to the other...what should you suspect?
Torticollis
252
Cause of mechanical neck pain
Sustained muscle contraction associated with poor posture, stress, poor sleep, poor head position during activiies such as computer use, watching TV, and driving.
253
Deep aching pain that varies with the source but doesn't affect ROM
Pain referred from the abdomen or pelvis causing low back pain
254
Cause of low back pain referred from abdomen or pelvis
Peptic ulcer, pancreatitis, pancreatic cancer, prostatitis, endometriosis, dissecting AA, retroperitoneal tumor.
255
Signs of low back pain referred from abdomen or pelvis
Local vertebral tenderness, spinal movements are not painful and ROM is not restricted.
256
Back pain at night, is it relieved by rest?
Unrelieved by rest: noctural back pain
257
Cause of noctural back pain
Metastatic malignancy to spine from cancer of prostate, breast, lung, thyroid, kidney, multiple myeloma
258
Tumor or midline disc herniation in bowel or bladder dysfunction with leg weakness associated with lower back pain. This is emergent.
Cauda equina syndrome.
259
Signs of sciatic
Calf wasting, weak ankle dorsiflexion, absent ankle jerk, positive crossed straight leg raise (pain in affected leg when healthy leg) Negative straight leg raise makes it less likely. Ipsilateral straight leg raise.
260
Signs of lumbar spinal stenosis
Posture may be flexed forward with LE weakness and hyporeflexia. Thigh pain after 30 second of lumbar extension. Straight leg raise is negative.
261
Cause of mechanical low back pain.
Muscle and ligament injuries. Intervertebral disc or facet. Herniated disc, spinal stenosis
262
Pseudoclaudication pain in the back or legs with walking that improves with rest lumbar flexion which decompresses spinal cord. Pain vague but B/L with paresthesia in one or both legs.
Lumbar spinal stenosis
263
Radicular low back pain
Sciatica
264
Shooting pain below the knee into lateral leg l5 or posterior calf s1 accompanied by low back pain. Associated paresthesia, weakeness, bending sneezing, coughing straining during bowel movements will worsen pain
Sciatica
265
Cause of sciatica
Disc herniation of intervertebral disc compressing the nerve root in people 50 y/o or older. Involving l5 or s1 disc herniation.
266
Tumor or midline disc herniation in bowel or bladder dysfunction with leg weakness associated with lower back pain
Cauda equina syndrome.
267
Signs of sciatic
Calf wasting, weak ankle dorsiflexion, absent ankle jerk, positive crossed straight leg raise (pain in affected leg when healthy leg) Negative straight leg raise makes it less likely. Ipsilateral straight leg raise.
268
Signs of mechanical low back pain
Paraspinal muscle or facet tenderness, pain with back movement, loss of normal lumbar lordosis, but no motor or sensory loss or reflex abnormalities. In OP check for thoracic kyphosis, percussion tenderness, over a spinaous process.
269
What does hepatocellular carcinoma often present with
Nodules
270
What is a palpable liver the result of?
Change in consistency from normal softness to abnormal firmness or hardness as in CIRRHOSIS
271
Downward displacement of the liver
Caused by a low diaphragm, indicating COPD
272
Normal variation in liver shape associated with what?
Lanky build causing elongation so that the right lobe is palpable as it projects downward towards the iliac crest.
273
In visceral tenderness is there muscular rigidity or rebound tenderness
No muscular rigidity or rebound tenderness.
274
Cirrhosis
Firm, nontender edge, or hemochromatosis, amyloidosis, lymphoma
275
Smooth large liver, tender
Inflammation, hep, venous congestion as in RSHF
276
Irregular large liver that is firm or hard and has an irregular edge or surface
Hepatocellular carcinoma.
277
What does hepatocellular carcinoma often present with
Nodules
278
Tenderness persists when the patient raises the head and shoulder for this type of lesion
Superficial tender area
279
Tenderness goes away when the patient raises the head and shoulders
Deep tender area because the tightened muscles protect the pain.
280
Right rectal tenderness accompanies
Acute appendicitis
281
In visceral tenderness is there muscular rigidity or rebound tenderness
No muscular rigidity or rebound tenderness.
282
Chest signs, abdominal pain and tenderness from inflammation of this?
This can mimic what when U/L?
Acute pleurisy.
| Acute cholecystitis or appendicitis.
283
Inflammation of fallopian tubes above the inguinal ligaments with rebound tenderness and rigidity. Pressing on this causes pain?
Acute salpingitis
| Pressing on the pelvis.
284
Signs in RUQ, Murphy's sign
Acute cholecystitis
285
Epigastric tenderness, rebound tenderness, abdominal wall may be soft
Acute pancreatitis
286
Right lower quadrant sign with McBurney's point, also consider the right flank
Acute appendicitis.
287
High-pitched tinkling sounds suggests
Intestinal fluid and air under tension in a dilated bowel.
288
Rushes of high-pitched sounds
Abdominal cramp indicating intestinal obstruction.
289
What is more severe peritoneal inflammation or visceral tenderness?
Peritoneal inflammation.
290
Common symptoms of peritoneal inflammation
Muscular rigidity and rebound tenderness
291
Exquisite tenderness throughout abdomen with boardlike muscular rigidity
Generalized peritonitis.
292
Increased bowel sounds
Diarrhea or early intestinal obstruction
293
Systolic bruit accompanies hepatic friction rub
Liver carcinoma
294
How long must you sit down and listen before declaring bowel sounds are absent?
2 minutes
295
High-pitched tinkling sounds suggests
INtestinal fluid and air under tension in a dilated bowel.
296
"Pelvic mass" reported by females
Pregnancy, listen for fetal heart
297
Hepatic bruits
Carcinoma of the liver or alcoholic hepatitis
298
Occlusion of renal artery
HTN
299
Arterial bruits with both systolic and siastolic components suggest occlusion of what
Aorta of large arteries
300
Grating sounds with respiratory variation, indicates inflammation of peritoneal surface of an organ. For liver...
Friction rub.
301
Systolic bruit accompanies hepatic friction rub
Liver carcinoma
302
Fluid seeking the lowest position in the abdomen producing bulging flanks that are dull to percussion. Umbilicus may protrude.
Ascitic fluid
303
Where is distention more pronounced when gas is involved from adynamic or paralytic ileus?
Colon rather than small bowel.
304
"Pelvic mass"
Pregnancy, listen for fetal heart
305
Large solid mass rising out of the pelvis and is dull to percussion. Displaces the bowel to the periphery.
Ovarian tumor, uterine myomata.
306
This is sometimes misdiagnosed as a tumor
Distended bladder.
307
Most common cause of a protuberant abdomen that thickens the abdominal wall, the mesentery, and omentum.
Fat.
308
How does the umbilicus appear in a fat abdomen?
Sunken.
309
Apron of fatty tissue that extends below the inguinal ligaments.
Pannus
310
Gas causes what type of percussion?
Tympanic.
311
Where is distention more pronounced when gas is involved from adynamic or paralytic ileus?
Colon rather than small bowel.
312
Localied bulge in the abdominal wall through which a tissue protudes
Ventral hernia
313
Subcutaneous tumor
Lipoma
314
Most common ventral hernia
Umbilical, incisional, epigastric
315
What makes a hernia and rectus diastasis move evident?
Patient raises head and shoulders from a supine position.
316
Protrusion through a defecive umbilical ring most common in infant
Umbilical hernia
317
Separation of the two rectus abdominis muscles through which abdominal contents form a midline ridge when the patient raises head and shoulders. Seen in pregnancies, obesity, and chronic lung disease. It has no clinical consequences
Diastasis recti
318
Protrusion through an operative scar. A small defect has a greater risk for complications than a large defect.
Incisional hernia
319
Strong detrusor contraction that overcome the normal urethral resistance. Bladder is small.
Urge incontinence
320
Common, benign fatty tumor in subcutaneous tissue almost anywhere in the body including the abdominal wall. Small or large, they are usually soft and lobulated.
Lipoma
321
When you press your finger down on the edge of a lipoma what happens to it?
The tumor slips out from under it.
322
Drugs contributing to incontinence like sedatives, tranquilizers, anticholinergics, sympathetic blockers, potent diuretics
Incontinence secondary to medications
323
Detrusor contractions are strong
Urge incontience
324
Detrusor contractions are insufficient to overcome urethral resistance and the bladder is large even after an effort to void caused by an obstruction of the bladder as in benign prostatic hyperplasia or tumor. Weakness of the detrusor muscle associated with peripheral nerve disease at the sacral level. Impaired bladder sensation that interrupts the reflex arc. DM related.
Overflow incontinence
325
Symptoms of overflow incontinence
A continuous dripping or dribbling incontinence, decreased force of urinary stream, obstruction or peripheral nerve disease hx as in DM,
326
Signs of overflow incontinence
Enlarged bladder and may be tender. Prostatic enlargement, motor signs of peripheral nerve disease, decrease in sensation, diminished absent reflexes.
327
Strong detrusor contraction that overcome the normal urethral resistance. Bladder is small.
Urge incontience
328
Bladder is small.
Urge incontinence
329
Bladder is large
Overflow incontinence
330
Detrusor contractions are weak
Overflow incontience
331
Detrusor contractions are strong
Urge incontience
332
Is there a desire to urinate is pure stress incontinence?
No.
333
Symptoms of urge incontinence
Involuntary urine loss preceded by an urge to void, urgency, frequency and nocturia with small to moderate volumes, pain on urination, pseudo stress incontinence voiding 10 to 20 seconds after stresses such as a change of position going up or down stairs and possibly coughing laughing or sneezing.
334
Signs of urge incontinence
Bladder is not detectable on abdominal exam. Cortical inhibition is decreased, mental deficits or motor signs of CNS, local pelvic problems or fecal impaction
335
The urethral sphincter is weakened so that transiet increases in intra-abdominal pressure raise the bladder pressure to levels that exceed urethral resistance. In women a pelvic floor weakness with inadequate muscular support of the bladder and proximal urethra and a change in the angle of the bladder and urethra from childbirth and surgery. Also local conditions that affect the internal urethral sphincter.
In men after prostatic surgery
Stress incontience
336
Cause of stress incontinence in men
Prostatic surgery
337
Cause of stress incontinence in women
Weakness of pelvic floor or chaange in internal urethral sphincter, postmenopausal atrophy.
338
Symptoms of stress incontinence
Momentary leakage of small amounts of urine with coughing, laughing, sneezing while person is in upright position
339
Signs of stress incontinence
Bladder is not detected, atrophic vaginitis.
340
Is there a desire to urinate is pure stress incontinence?
No.
341
Prolonged exposure of eophagus to gastric acid due to impaired esophageal motility or lower esophageal sphincter action
GERD
342
What bacterial infection is associated with GERD?
H. pylori
343
Location of GERD
Chest or epigastric
344
Quality of GERD
Burning, heartburn, regurgitation.
345
When does GERD occur?
After meals
346
What aggravates GERD?
Lying down, bending over, activity physical, alcohol, fatty meals, chocolate, calcium channel blockers
347
What relieves GERD?
Antacids,
348
Symptoms of GERD
Burning, wheezing, cough, SOB, hoarseness, choking, halitosis, sore throat.
349
GERD increases the risk of what
Barrett's esophagus/esophageal cancer.
350
Demonstrated ulcer usually in duodenum or stomach. Dyspepsia.
Peptic ulcer
351
Infection with peptic ulcer
H. pylori
352
Location of peptic ulcer
Epigastric to back
353
Quality of peptic ulcer
Gnawing, burning, boring, aching, pressing, hungerlike
354
Pain epigastric that causes patient to wake at night
Duodenal ulcer timing.
355
What relieves a peptic ulcer?
Food and antacids bring relief in duodenal ulcer
356
Symptoms of peptic ulcer
Nausea, vomiting, belching , bloating, heartburn, weight loss , dypepsia
357
Weight loss peptic ulcer
Gastric ulcer
358
Heartburn peptic ulcer
Duodenal ulcer
359
Cancer of stomach that is slowly progressive
Adenocarcinoma
360
Location of cancer of stomach
Cardia or GE junction
361
Cancer of stomach is aggravated by
Food
362
Cancer of stomach is relieved
NOT BY FOOD or ANTACIDS
363
Symptoms of cancer of stomach
Anorexia, nausea, early satiety, weight loss, bleeding
364
Progression of acute appendicitis
Periumbilical pain followed by RLQ that begins as mild and becomes more steady and severe.
365
What makes an acute appendicitis worse?
Coughing or movement.
366
What do you suspect if pain of appendix subsides temporarily
Perforation of the appendix
367
Symptoms of acute appendicitis
Anorexia, nausea, vomiting, LOW FEVER
368
Inflammation of the gallbladder from obstruction of the cystic duct by gallstone.
Acute cholecystitis
369
Acute cholecystitis
RUQ
370
Where does an acute cholecystitis radiate to?
Right scapular area.
371
Quality of acute cholecystitis
Steady, aching
372
What aggravates acute cholecystitis
Deep breathing.
373
Symptoms of acute cholecystitis
Anorexia, nausea, vomiting fever
374
Obstruction of the bowel lumen caused by adhesions or hernia (small bowel) or cancer or diverticulitis (colon)
Acute bowel obstruction
375
Biliary colic location
Epigastric or RUQ that may radiate to the right scapula and shoulder
376
Is biliary colic colicky?
No, steady and aching! NOT COLIC
377
Timing of biliary colic
Episodic
378
Symptoms of biliary colic
Anorexia, nausea, vomiting, restlessness
379
Blood supply to the bowel and mesentery blocked from thrombosis or embolus or reduced from hypoperfusion,
Mesenteric ischemica
380
Location of mesenteric ischemia
Periumbilical then diffuse
381
Symptoms of mesenteric ischemia
Cramping then steady, abrupt then persistent with vomiting diarrhea that might be bloody constipation, shock and older age.
382
Acute inflammation of a colonic diverticulum which is a saclike mucosal outpouching through the colonic muscle.
Acute diverticulitis
383
Where is the pain in acute diverticulitis?
LLQ
384
Describe acute diverticulitis pain
Cramping and then steady
385
Acute diverticulitis symptoms
Fever constipation, diarrhea
386
Location of acute bowel obstruction small bowel
Periumbilical or upper abdominal
387
Location of acute bowel obstruction colon
Lower abdominal or generalized
388
Symptoms of acute bowel obstruction small bowel
Vomiting of bile, mucus or fecal material, obstipation
389
Symptoms of acute bowel obstruction colon
Obstipation, vomiting.
390
Acute inflammation of pancreas
Acute pancreatitis
391
Fibrosis of pancreas secondary to recurrent inflammation
Chronic pancreatitis
392
Adenocarcinoma of epigastric and upper quadrants
Cancer of pancreas
393
Where does pancreatitis or cancer of pancreas radiate to?
Back
394
Where is pancreatitis or cancer of pancreas located
Epigastric and radiates to the back
395
Pancreas pain that is epigastric quality
Steady and deep
396
Symptoms of pancreatic cancer
FEVER, constipation.
397
What makes chronic pancreatitis worse?
Alcohol, heavy or fatty meals
398
What relieves acute pancreatitis?
Leaning forward with trunk flexed intractable
399
What relieves chronic pancreatitis?
Leaning forward with trunk flexed intractable
400
Symptoms of acute pancreatitis
Nausea, vomiting, abdominal distention, FEVER. Alcohol abuse, gallstone history.
401
Symptoms of chronic pancreatitis
Pancreatic enzyme insufficiency, diarrhea with fatty stools steatorrhea, DM
402
What relieves cancer of pancreatitis?
Leaning forward with trunk flexed intractable
403
Symptoms of pancreatic cancer
FEVER, constipation.
404
Decreased bladder capacity caused by bladder sensitivity to stretch from inflammation, decreased elasticity of bladder wall, decreased cortical inhibition of bladder contraction.
Frequency
405
Cause of frequency
Infection, stones, tumor
