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PA H&P2 > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are the three vertical regions of the abdomen?

A

Epigastric
Umbilical
Hypogastric or suprapubic

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2
Q

Why is the order of exam techniques different for the abdomen?

A

Auscultation needs to come before percussion and palpation because these will alter the sounds in the bowel

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3
Q

Where in the abdomen is the aortic pulsation normally visible?

A

Epigastrium

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4
Q

What does increased peristalsis signify on inspection?

A

Intestinal obstruction

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5
Q

What should be noted during auscultation of the abdomen?

A

Frequency and character of bowel sounds

Normally consists of clicks and gurgles (5-34 per minute)

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6
Q

What is borborygmi?

A

Growling of the stomach

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7
Q

What organs in the abdomen need to be auscultated for friction rubs?

A

Liver

Spleen

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8
Q

What arteries need to be auscultated for bruits in the abdominal exam?

A 
Aorta
Renal
Iliac
Femoral
Could be normal if only heard in systole
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9
Q

What is the function of percussion during the abdominal exam?

A

Assess amount and distribution of gas
Assess size of liver and spleen
Assess distribution of tympany and dullness

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10
Q

What is normal vertical span of the liver at the right midclavicular line? Midsternal line?

A

Right midclavicular: 6 to 12 centimeters

Midsternal: 4 to 8 centimeters

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11
Q

What would result in dullness to percussion over the spleen?

A

Splenomegaly

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12
Q

What is the splenic percussion sign?

A

Percuss along the anterior axillary line during a deep breath
Note should stay tympanic

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13
Q

How is the liver edge palpated?

A

Patient takes a deep breath in and you press up under the 12th rib to feel for the liver
Deep breath lowers the liver

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14
Q

In what positions is the spleen palpated?

A

Supine

Right lateral decubitus

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15
Q

When do you move to the left side of the patient during the abdominal exam?

A

Left kidney palpation

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16
Q

What should the size of the aorta be in patients over 50?

A

Less than 3 cm

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17
Q

What is the test for a ventral hernia?

A

Have patient lift head and shoulders off table

Increased intraabdominal pressure will create bulges

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18
Q

What is the test for ascites?

A

Percuss in center of abdomen for tympany and move outwards for dullness
Have patient lay on their side and see if tympany moves to side (shifting dullness)
Can also do fluid wave test

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19
Q

What are the tests for appendicitis?

A 
Palpate McBurney's Point
Cutaneous hypersensitivity
Rebound tenderness
Rovsing's sign
Psoas sign
Pectal/pelvic exam
Markle sign (heel jar test)
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20
Q

What does murphy’s sign test for?

A

Cholecystitis

Palpate deeply under right costal margin jabbing at the gallbladder for sharp pain

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21
Q

What are signs of peritoneal inflammation?

A

Abdominal pain with coughing
Abdominal pain produced by light percussion
Rebound tenderness

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22
Q

What are the three categories of abdominal pain?

A

Visceral
Parietal
Referred

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23
Q

What is visceral abdominal pain?

A

Occurs when a hollow abdominal organ such as intestine or biliary tree contract forcefully, distended, or stretched

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24
Q

How is visceral abdominal pain perceived?

A

Gnawing
Burning
Cramping
Aching

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25
Q

What is parietal abdominal pain?

A

Pain that originates from inflammation of the parietal peritoneum

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26
Q

How is parietal abdominal pain perceived?

A

Steady aching pain

Aggravated by movement or coughing

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27
Q

What is referred abdominal pain?

A

Pain felt in more distant sites which are innervated at approximately the same spine levels as the disordered structure

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28
Q

How is referred abdominal perceived?

A

Superficially or deep but usually well localized

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29
Q

What is an example of abdominal referred pain?

A

Gallbladder pain referring to the right shoulder

Stomach to back

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30
Q

What is dyspepsia?

A

Chronic or recurrent discomfort in the upper abdomen

Includes a variety of symptoms

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31
Q

What is history of heartburn?

A

Rising retrosternal burning pain or discomfort

Occurs more than once a week

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32
Q

What are the alarm symptoms with heartburn?

A 
Difficulty swallowing
Painful swallowing
Recurrent vomiting
GI bleeding
Anemia
Gastric cancer
Palpable mass
Jaundice
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33
Q

What is early satiety an early symptom of?

A

Pancreatic cancer

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34
Q

What is the definition of constipation?

A 
Two or more of
Fewer than 3 shits a week
25% of more shits being straining
Lumpy or hard stool
Manual facilitation needed
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35
Q

What does red stool signify?

A

Bleeding in the lower GI

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36
Q

What does black stool signify?

A

Bleeding in upper GI

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37
Q

What is stress incontinence?

A

Forceful pressure in the abdomen causes leakage

Such as coughing

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38
Q

What is urge incontinence?

A

Patient gets the urge to go and can’t control it

Has leakage

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39
Q

What is functional incontinence?

A

Patient has the urge to go but can’t functionally get to the bathroom in time

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40
Q

What is polyuria?

A

Significant increase in 24 hour urine volume

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41
Q

How is hepatitis B and C spread?

A

Blood born

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42
Q

How is hepatitis A spread?

A

Stool and oral born

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43
Q

What are the history findings for alcohol abuse?

A

History of pancreatitis
DUIs
Family history of alcoholism

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44
Q

What are the physical exam findings of alcohol abuse?

A

Hepatosplenomegaly
Ascites
Peripheral edema

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45
Q

What is alcohol abuse for men and women?

A

Men - more than 4 on occacion or 14 in a week

Woemn - more than 3 on an occasion or 7 in a week

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46
Q

How is screening done for patients of average risk for colon cancer?

A

Begins at age 50 with colonoscopy every 10 years

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47
Q

When should a patient get a colonoscopy if they have had a colorectal cancer resection?

A

Within one year of resection

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48
Q

When should a patient get a colonoscopy if they have a small polyp?
Large polyp?

A

Small polyp - 5-10 years

Large polyp - 3 years

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49
Q

When should a patient get a colonoscopy if they have a family member had colorectal cancer?

A

Age 40

!0 years before youngest age of diagnosis

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50
Q

What are the different types of joints?

A

Synovial - freely moveable
Cartilaginous - slightly moveable
Fibrous - Bones in almost direct contact, no movement

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51
Q

What are examples of spheroidal joints?

A

Ball and socket

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52
Q

What are examples of hinge joints?

A

Gliding motion in a single plane

Elbow

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53
Q

What are examples of a condylar joint?

A

TMJ
Knee
Wrist
Ankle

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54
Q

What are the signs of inflammation?

A

Swelling
Warmth
Tenderness
Redness

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55
Q

What are the different grades of muscle strength?

A

0 - no muscular contraction
1 - barely detectable flicker of contraction
2 - active movement with no gravity
3 - active movement against gravity
4 - Active movement against gravity and some resistance
5 - active movement against full resistance

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56
Q

What bony landmarks should be palpated on the shoulder?

A

Acromion
Coracoid process
Greater tubercle

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57
Q

What are the muscles in the rotator cuff?

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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58
Q

What shoulder test is used to test the AC joint?

A

Crossover test

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59
Q

What test is used to test overall shoulder rotation?

A

Apley scratch test

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60
Q

What tests are used to determine function of the rotator cuff?

A

Neer’s impingement sign

Hawkin’s impingement sign

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61
Q

What does extending wrist against resistance test?

A

Lateral epicondylitis

Tennis elbow

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62
Q

What does flexing wrist against resistance test?

A

Medial epicondylitis

Golfer’s elbow

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63
Q

What bone can be felt in the anatomical snuffbox?

A

Scaphoid

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64
Q

What is Tinel’s sign?

A

Taping the median nerve

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65
Q

What is phalen’s sign?

A

Pushing backs of hands together

Tests carpal tunnel

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66
Q

What is the finkelstein’s test?

A

Carpal tunnel test

Hurts like a bitch

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67
Q

What are the anterior bony landmarks that can be palpated on the hip?

A

Iliac crest
Iliac tubercle
ASIS
Greater trochanter

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68
Q

What are the posterior bony landmarks that can be palpated on the hip?

A

PSIS
Greater trochanter
Ischial tuberosity

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69
Q

What are the special tests for the knee?

A 
Bulge sign
Ballottement
Patellofemoral grind test
Patellar stability
Valgus stress
Varus stress
Drawer test
McMurray's test
Lachman's test
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70
Q

What is the bluge sign test?

A

Tap inferior to patella and watch for fluid movement

Tests for minor effusions

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71
Q

What is the ballottement test for the knee?

A

Push down on the patella to assess if it is floating

Tests for major effusions

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72
Q

What does a valgus test assess?

A

MCL stability

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73
Q

What does a varus test assess?

A

LCL stability

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74
Q

What does an anterior drawer test assess?

A

ACL

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75
Q

What does a posterior drawer test assess?

A

PCL

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76
Q

What does a McMurray’s test assess?

A

Medial meniscus and lateral meniscus

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77
Q

What does Lachman’s test assess?

A

ACL

Alternate pushing up and pulling down on opposite sides of the joint

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78
Q

What needs to palpated during an leg exam?

A 
Inguinal nodes
Femoral pulses
Popliteal pulses
Posterior tibial pulses
Dorsalils pedis pulses
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79
Q

What needs to be palpated during a foot and ankle exam?

A 
Achiles tendon
Tibiotalar joints
Metatarsophalangeal joints
Proximal toes
Distal toes
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80
Q

What are the special tests of the foot and ankle?

A

Anterior drawer test

Stability (medial and lateral)

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81
Q

What are risk factors of osteoporosis?

A 
Women
Old
Small body frame
Low calcium
Low vitamin D
Sedentary
Tobacco use
Excessive alcohol consumption
82
Q

What are the four regions of the brain?

A

Cerebrum
Diencephalon
Brainstem
Cerebellum

83
Q

What are the five segments of the spinal cord?

A 
C1 to C8
T1 to T12
L1 to L5
S1 to S5
Coccygeal
84
Q

What is the corticospinal tract of the nervous system responsible for?

A

Voluntary movement

Skilled, complicated, or delicate movements

85
Q

What is the basal ganglia system of the nervous system responsible for?

A

Control body movements

Muscle tone maintenance

86
Q

What is the cerebellar system of the nervous system responsible for?

A

Coordinates motor activity
Controls posture
Maintains equilibrium

87
Q

What are the important dermatomes to know?

A 
T4 - nipple line
T10 - umbilicus
S5 - Rectum
L5 - Great toe
S1 - Lateral foot
C6 - Thumb
C7 - Middle finger
C8 - pinky finger
88
Q

What are the deep tendon responses?

A

S1 - ankle
L2, 3, and 4 - Knee
C5, 6 - Brachioradialis and biceps
C6, C7 - Triceps

89
Q

What are the cutaneous stimulation reflexes?

A

T8, 9, and 10 - upper abdominal
T10, 11, and 12 - Lower abdominal
L5 and S1 - Plantar
S2, 3, and 4 - Anal

90
Q

What are the five categories of the neurologic exam?

A 
Mental status
Cranial nerves
Motor system
Sensory system
Reflexes
91
Q

What is the Romberg test?

A

Patient stands with feet together and eyes closed

Tests sense of positioning

92
Q

What is the pronator drift test?

A

Patient stands with eyes closed and arms straight in front

Tap down on patients hands and see if they return to normal position

93
Q

What special tests are part of the neuro exam?

A 
Romberg
Pronator drift test
Hop on one foot
Shallow knee bends
Heel to toe gait
Proprioception
94
Q

What does hopping on one foot test?

A

Cerebellar function

Position sense

95
Q

What does shallow knee bend tests assess?

A

Proximal weakness

96
Q

What is stereognosis?

A

Ability to identify an object by feeling it

97
Q

What is number identification test?

A

Patient closes their eyes and identifies a number that was drawn on their hand

98
Q

What are the special tests for meningeal signs?

A

Brudzinski’s - flex neck

Kernig - flex hip

99
Q

What is graphesthesia?

A

Ability to identify a shape or number that is drawn from touch

100
Q

What is a two point discrimination test?

A

Touch a finger pad using two ends of an opened paper clip

Find minimal distance at which patient can discriminate 2 points

101
Q

What is the distance at which a patient should be able to distinguish two points on the fingerpads?

A

Less than 5 mm

102
Q

What is point localization?

A

Touch a point on patient’s skin and ask the patient to point to where you touched

103
Q

What is extinction?

A

Simultaneously stimulate corresponding areas on both sides of the body
Ask patient where the touch was felt

104
Q

What dermatomes are stimulated in an upper abdominal superficial reflex?

A

T8
T9
T10

105
Q

What dermatomes are stimulated in an lower abdominal superficial reflex?

A

T10
T11
T12

106
Q

What dermatomes are stimulated in a cremasteric superficial reflex?

A

T12
L1
L2

107
Q

What nerves are tested during a bicep deep tendon reflex?

A

C5

C6

108
Q

What nerves are tested during a tricep deep tendon reflex?

A

C6

C7

109
Q

What nerves are tested during a brachioradialis deep tendon reflex?

A

C5

C6

110
Q

What nerves are tested during a patellar deep tendon reflex?

A

L2
L3
L4

111
Q

What nerves are tested during an Achilles deep tendon reflex?

A

S1

112
Q

What nerves are tested during a Platar/Babinski deep tendon reflex?

A

L5

S1

113
Q

What is the grading scale?

A 
4+ - very brisk
3+ - brisker than average
2+ - average
1+ - somewhat diminished
0 - no response
114
Q

What is the Brudzinski’s sign?

A

Flex neck and watch hips and knees for tension

115
Q

What is the Kernig’s sign?

A

Flex the patient’s leg at hip and knee and then straighten knee watching for pain

116
Q

What does the corticospinal (pyramidal) tract control?

A

Voluntary movement

117
Q

What does the basal ganglia system control?

A

Helps maintain muscle tone and control body movements

Mostly automatic movements

118
Q

What does the cerebellar system control?

A

Maintains equilibrium and helps control posture

119
Q

What does an upper motor neuron lesion result in?

A

Increased reflexes
Paralysis on opposite side of the lesion
Positive Babinski sign

120
Q

What are examples of upper motor neuron diseases?

A

Brain tumor
Stroke
MS

121
Q

What does a lower motor neuron lesion result in?

A 
Weakness
Atrophy
Fasciculations
Paralysis on the same side as the lesion
Decreased reflex
122
Q

What are examples of lower motor neuron diseases?

A

Gigampere

Disc herniation

123
Q

What sensations travel down the spinothalamic tract?

A

Pain
Temperature
Crude touch

124
Q

What sensations travel down the posterior column?

A

Position
Vibration
Fine touch

125
Q

What part of the brain allows you to comprehend speech?

A

Wenicke’s area

Only on left side of the brain

126
Q

What part of the brain allows you to produce speech?

A

Broca’s area

Only on left side of the brain

127
Q

What are the components of the reflex arc?

A 
Sensory nerve fibers
Spinal cord synapse
Motor nerve fibers
Neuromuscular junction
Muscle fibers
128
Q

What does a lack of an anal reflex suggest?

A

Lesion in the S2-3-4 reflex arc

Seen in cauda equine lesions

129
Q

What does a positive Babinski’s test signify?

A

CNS lesion in Corticospinal tract
Unconscious state
Postictal period

130
Q

What may cause an abdominal reflex to be absent?

A

May be present in both central and peripheral nerve disorders

131
Q

How is lumbosacral radiculopathy tested for?

A

Straight leg raise

132
Q

How is the straight leg raise test conducted?”

A

Legs are flexed at the hip and then the foot is dorsiflexed

Looking for lower back pain with pain radiating into the leg

133
Q

What is the Asterixis special test?

A

Patient is “stopping traffic” with wrists extended
Tests for metabolic encephalopathy
Positive if patient can not maintain extension for 2 minutes

134
Q

What does scapula winging show?

A

Occurs in muscular dystrophy or thoracic nerve injury

135
Q

What is the most important clue to understanding the cause of a coma?

A

Pupils
Tells if coma is caused by a metabolic or structural disorder
Light reaction stays intact in metabolic coma but not structural

136
Q

What is the order of examine when a comatose patient comes in?

A 
Airway
Breathing
Circulation
Level of consciousness
Examine patient neurologically
137
Q

What are the five levels of consciousness?

A 
Alertness
Lethargy
Obtundation
Stupor
Coma
138
Q

What is a lethargic patient?

A

Patient responds but seems drowsy

139
Q

What is an obtundant patient?

A

Have to shake patient

Patient opens eyes but seems unaware of surrounding

140
Q

What is a stupor patient?

A

Painful stimulus is applied for a response

141
Q

What is a comatose patient?

A

Patient is unresponsive despite painful stimulus

142
Q

What is the oculocephalic reflex?

A

Head is moved side to side to see if the eyes move
In normal patient the eyes stay focused on the ceiling
Normal shows intact brainstem

143
Q

What is the oculovestibular reflex?

A

Ice water is injected into ear canal
Eyes should deviate toward the ear with water injected if brain stem is intact
Done if oculocephalic reflex is absent

144
Q

What are the abnormal responses to a painful stimulus?

A

Decorticate rigidity - abnormal flexor
Decerebrate rigidity - abnormal extensor
Flaccid paralysis

145
Q

What is the main cause of stroke?

A

Ischemia

146
Q

What are the risk factors for a TIA patient to have a stroke soon?

A 
Age over 60
Blood pressure
Clinical features - focal weakness or impaired speech
Diabetes
Duration - TIA longer than 60 mins
147
Q

What are the warning signs of a stroke/TIA?

A 
Sudden numbness/weakness in face, arm, or leg
Sudden confusion
Sudden trouble walking or balance issues
Sudden trouble seeing
Sudden severe headahce
148
Q

What are the risk factors for stroke?

A 
HTN
Smoking
Dyslipidemia
Diabetes
Weight
Exercise
Alcohol
149
Q

What are general signs of a stroke?

A

Visual field cuts
Contralateral hemiparesis
Contraleteral sensory deficits

150
Q

What are signs of a left sided stroke?

A

Aphasia

151
Q

What are signs of a right sided stroke?

A

Neglect of the opposite side of the body

152
Q

What is anhedonia?

A

Little interest or pleasure in doing things

153
Q

What are the key aspects of examination for mental status?

A 
Appearance and behavior
Speech and language
Mood
Thoughts and perceptions
Cognitive function
154
Q

What is examined during the though and perceptions part of a mental exam?

A

Thought process
Thought content
Perceptions
Judgement

155
Q

What is the difference between a delusion and an illusion?

A

Delusion - fixed false personal belief

Illusion - misinterpretation of a real stimulus

156
Q

What tests are used to determine cognitive functioning?

A 
Immediate memory
Recent memory
Remote memory
Fund of knowledge
Analogies
Proverb
Calculations
157
Q

What is gynecomastia?

A

Breast enlargement in males

158
Q

What causes gynecomastia?

A

Decrease in testosterone compared to estrogen

Hypogonadism

159
Q

What does the breast area cover?

A

2nd to 6th rib

Sternum to midaxillary line

160
Q

What is ductal carcinoma in situ?

A

Cancer is within the duct of the breast

161
Q

What region of the breast is the most common for breast cancer?

A

Upper outer quadrant

162
Q

What lymph nodes are found within the breast?

A

Pectoral
Subscapular
Lateral

163
Q

What is the number one risk factor for breast cancer?

A

Age

164
Q

What is the recommended screening pattern for breast cancer?

A

Mammogram every year after 40

Clinical breast exam every 3 years from 20-39, and annually after 40

165
Q

How does a fibroadenoma present in the breast?

A 
Fine
Round
Mobile
Nontender
Patient under 25
166
Q

How does a cyst present in the breast?

A

Soft to firm
Round
Mobile
Often tender

167
Q

How does cancer present in the breast?

A

Irregular
Firm
Fixed to skin or underlying tissue
Nontender

168
Q

What are the 4 views the breast should be inspected at?

A

Arms at sides
Arms above head
Arms pressed against hips
Leaning forward

169
Q

What can a darkened armpit be an early sign of?

A

Type 2 diabetes

170
Q

What equipment is needed for a vaginal exam?

A 
Good light
Gloves
Speculum
Water soluble lubricant
Equipment for Pap smear
171
Q

What position should a patient be in during a vaginal exam?

A

Lithotomy position

172
Q

Where is the Bartholin’s gland?

A

Near the inferior portion of the vagina

173
Q

What instrument is used to collect a sample of cervical tissue?

A

Cervical brush

174
Q

What are the recommended testing patterns for a Pap smear?

A

Every year 3 years 21-29
Every year 5 years 30-65
Discontinue after three consecutive negative results if over 65

175
Q

What are the risk factors for cervical cancer?

A 
Persistent infection with HPV
Failure to undergo screenings
Multiple sexual partners
Smoking
Immunosuppression
Long term use of oral contraception
Chlamydia infection
7 or more full term pregnancies
Prior cervical cancer
176
Q

What is cervical motion tenderness a test for?

A

Pelvic inflammatory disease

177
Q

What is postmenopausal bleeding a concern for?

A

Uterine cancer

178
Q

How does bacterial vaginosis present?

A

White discharge

Mild fishy odor

179
Q

What causes genital warts?

A

HPV

180
Q

What erectile tissue houses the urethra?

A

Corpus spongiosum

181
Q

What do the testes produce?

A

Testosterone

Spermatozoa

182
Q

What does the spermatic cord contain?

A

Vas deferens
Blood vessels
Nerves
Muscle fibers

183
Q

What are the two stimuli that can prompt an erection?

A

Visual, auditory, or erotic triggers from brain center to T11-L2
Physical stimulation from S2-S4

184
Q

What are common scrotal swellings?

A

Indirect inguinal hernias
Hydroceles
Scrotal edema

185
Q

What needs to be palpated in the scrotum?

A

Each testes
Epididymis
Spermatic cord

186
Q

What is a varicocele?

A

Multiple tortuous veins in the area of the spermatic cord

187
Q

What is a hydrocele?

A

Swelling of the scrotum containing serous fluid

Lights up when transilluminating

188
Q

What can be causes of painful scrotal swelling?

A

Acute epididymis
Acute orchitis
Spermatic cord torsion
Strangulated inguinal hernia

189
Q

What are the risk factors for testicular cancer?

A 
Cryptorchidism - undescended testicle
History of testicular cancer
Mumps orchitis
Inguinal hernia
Hydrocele in childhood
190
Q

What are the three types of pelvic hernias?

A

Indirect inguinal
Direct inguinal
Femoral

191
Q

If you have your pinky in the inguinal ring and feel something touch the tip of your finger when the patient coughs?

A

Indirect inguinal hernia

192
Q

If you have your pinky in the inguinal ring and feel something touch the side of your finger when the patient coughs?

A

Direct inguinal hernia

193
Q

How do you palpate for a femoral hernia?

A

Place fingers on the anterior thigh in the region of the femoral canal
Have patient strain or cough
Note tenderness or swelling

194
Q

What is a reducible hernia?

A

You can push the hernia back into place by yourself

Less concerning for complications

195
Q

What is an incaracerated hernia?

A

Tissue is stuck and can’t be pushed back in

196
Q

What is a strangulated hernia?

A

Can not be pushed back in and blood supply is compromised

197
Q

What occurs in an indirect inguinal hernia?

A

Hernia occurs through the internal inguinal ring
Occurs in young children
Pain on straining

198
Q

What occurs in a direct inguinal hernia?

A

Hernia occurs through the external inguinal ring
Occurs in older men
Usually painless

199
Q

What occurs in a femoral hernia?

A

Hernia occurs in the fossa ovalis

200
Q

What are signs of prostate cancer upon palpation?

A

Exaggerated sulcus or loss of a sulcus

201
Q

What should your finger be pointing to when entering the rectum for exam?

A

Umbilicus

202
Q

How does the prostate normally feel?

A

Rubbery
Smooth
Nontender

PA H&P2 (3 decks)

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