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H & P > Exam 3 > Flashcards

Exam 3 Flashcards

(159 cards)

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1
Q

Thumb abduction test

A

Isolates strength of abductor pollicis brevis muscle, innervated only by the median nerve

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2
Q

Phalen test

A

Both wrists fully palmar flexed with dorsal surfaces pressed together for 1 minute

Numbness and paresthesia in median nerve distribution is positive, carpal tunnel

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3
Q

Tinel sign

A

Strike patients wrist where the median nerve passes under flexor retinaculum

Tingling sensation radiating is positive

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4
Q

Finkelstein

A

Assesses de quervain’s tenosynovitis

Patient places thumb inside fist, hand is flexed, if pain its positive

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5
Q

Neer test

A

Forward flex arm 150 degrees while depressing/stabilizing scapula

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6
Q

Hawkins test

A

Abduct shoulder to 90 degrees, flex elbow 90 degrees, then internally rotate

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7
Q

Hawkins kennedy test

A

Forward flex shoulder to 90 degrees, flex elbow to 90 degrees, internally rotate to limit

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8
Q

Jobe’s or empty the can test

A

Abduct shoulder to 90 degrees, flex shoulder forward to 30 degrees, point thumb down, provide resistance

Weakness is a supraspinatus issue

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9
Q

Drop arm test

A

Patient raise arm to 90 degrees of abduction then lower slowly, if they can’t hold it could be supraspinatus issue

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10
Q

Cross arm test

A

Forward elevation to 90 degrees and active adduction

Impingement issue if positive

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11
Q

Sulcus sign

A

Place traction on patient arm, observe sulcus or depression lateral or inferior to acromion

Instability of shoulder

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12
Q

Apprehension test for shoulder

A

Patient supine, abduction to 90 degrees, elbow flexed 90 degrees, shoulder externally rotated

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13
Q

Relocation test

A

Immediately after positive apprehension test, posterior force on proximal humerus, shoulder external rotated

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14
Q

Spurling test

A

Cervical root impingement

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15
Q

Straight leg raising test

A

Disc herniation with nerve root irritation

Patient lie supine with neck slightly flexed, passive leg raise

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16
Q

Femoral stretch test

A

Inflammation of nerve root

Patient lies prone and extends him, pain on extension is positive

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17
Q

Thomas test

A

Flexion contract urges of hip

Patient lies supine, fully extend one left flat, flex other leg with knee to chest

Lifting the extended leg off table indicated hip flexion contracture

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18
Q

Trendelenburg test

A

Weak hip abductor muscle

Balance on one foot, drop of the iliac crests is positive

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19
Q

Ballottement

A

Excess fluid or effusion test

Apply downward pressure on suprapatellar pouch

Push patella sharply downward against femur

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20
Q

Bulge sign

A

Excess fluid, milk medial aspect of knee upward then milk lateral side of the patella

Observe for bulge of returning fluid to the hollow area medial to patella

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21
Q

Mcmurray test

A

Torn medial or lateral meniscus

Thumb and fingers on either side of joint space, heel held with other hand, fully flex knee and rotate the foot and knee outward to lateral position, extend and flex

Pain, audible or palpable click is positive

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22
Q

Anterior and posterior draw tests

A

5 mm is abnormal

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23
Q

Lachman test

A

Anterior crucial ligament integrity

Heel on table

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24
Q

Thompson’s test

A

Squeeze calf and observe for plantar flexion of achilles

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25
Inversion talar tilt test
Assesses calcaneofibular ligament and anterior talofibular ligament Greater than 10 degrees of inversion is positive
26
Version talar tilt test
Deltoid ligament Greater than 10 degrees of tilt is positive
27
Anterior drawer ankle test
Anterior talofibular ligament and calcaneofibular ligament Anterior force to heel while moving the talus anterior
28
Limb measurement
No more than 1 cm difference between length and circumference
29
Dupuytren contracture
Contracture involving the flexor hand tendons
30
Kyphosis
Rounding of the shoulder
31
Gibbous
More angulated back changes, vertebral fracture related
32
Burning
Peptic ulcer
33
Cramping
Gastroenteritis, biliary colic
34
Colicky
Appendicitis with impacted feces, renal stone
35
Aching
Appendices irritation
36
Knifelike
Pancreatitis
37
Ripping, tearing
Aortic dissection
38
Gradual. Onset
Infection
39
Sudden onset
Duodenal ulcer, acute pancreatitis, obstruction, perforation
40
Dysphagia
Trouble swallowing They can point to the location usually, constant or stable or progressing
41
Odynophagia
Pain with swallowing Sharp/burning- mucosal inflammation squeezing/cramping- muscular
42
Color cancer screening
At 50 unless they have a relative who has had colon cancer, then its 40
43
Itching without a rash
Associated with pancreatic cancer
44
Bowel sounds
Can be 5-35 per minute Clicks and gurgles
45
Increased bowel sounds
Gastroenteritis, early intestinal obstruction, borborgymi
46
Decreased bowel sounds
Peritonitis, paralytic ileum
47
Abnormal abdominal bruit
Systole and diastole! Systole is normal
48
Describe liver percussion
Start at mid clavicular line and go up until dullness Same at umbilicus
49
Dullness in spleen percussion
Splenic enlargement, left sided pleural effusion, stool filled intestine
50
Which kidney is easier to palpate?
The right kidney
51
Shifting dullness
Fluid moves the way you have shifted their body- fluid sounds dull!
52
Bowel sounds in chest wall
Suggest diaphragmatic hernia
53
Volvulus
Twisting of bowel Whirl shape! It's obstructed
54
Pyloric stenosis
Olive shaped mass RUQ!! Vomiting dramatically and projectile
55
Intussuception
Cramping, sausage mass, drawing up knees, stool is currant jelly
56
Omphalocele
Organs outside of the body
57
Appendicitis
``` Cutaneous hypersensitivity Guarding Rebound tenderness Rovsing's Psoas sign Obturator sign ```
58
Rovsing's
Appendicitis Referred pain when palpating on left side, they feel in on the left
59
Mcburney's point
1/3 of the way along the line drawn from the hip to umbilicus
60
Acute gastroenteritis causes
Mostly viral, rotavirus or norwalk virus
61
Shigellosis
Bloody mucoid stool
62
Cholera
Rice water stool
63
Campylobacter
Raw milk/raw meat Watery blood diarrhea
64
Giardiasis
Malodorous, greasy stool Copious and frothy
65
Difference between chrohn's and colitis
Cholitis is only the colon, chrohn's can be small or large intestine Skip lesions in chrohn's
66
4 clinical features of chrohn's
1. Transmural sharlply delineated inflammation 2. Non-caseating granulomas 3. Fissuring formation of fistulous tracts 4. Systemic manifestations
67
Hallmark of ulcerative colitis
Bloody diarrhea
68
Diverticulitis
Acute LLQ pain, fever, abdominal tenderness and mass
69
Ileus
Sleeping belly due to mechanical or paralytic reasons
70
Meckel's diverticulum
Most common GI congenital abnormality First 2 years of life Asymptomatic rectal bleeding
71
Bilirubin levels in jaundice
>2.5
72
Cirrhosis
Diffuse fibrosis of entire liver with nodules
73
5 F's for cholecystitis
``` Fertile Fat Forty Fair skinned Female ```
74
Cholecystits
Inflammation of gallbladder usually caused by cholelithiasis (aka obstruction from stone) RUQ/epigastric pain postprandial fatty meal
75
Ascending cholangitis
Charcot's triad: fever, RUQ pain, jaundice Complication of acute cholecystitis
76
Rectal exam positions
Knee-chest Lithotomy Left lateral with hips or knees flexed Standing with hips flexed and upper body supported by examining table
77
If there is pain during a digital rectal exam, what should you do?
Stop! Dont force it
78
Describe the digital rectal exam
Press pad of finger against anal opening. Wait until sphincter relaxes and slip the fingertip into the anal canal Palpate subQ external sphincter Palpate deep external sphincter Palpate posterior rectal wall
79
Boggy prostate
BPH
80
Hard prostate
Cancer
81
Tender prostate
Infection or abcess
82
Grade 1 prostate
1-2 cm, NORMAL
83
Grade IV prostate
>4 cm
84
Hirschsprung disease
Primary absence of parasympathetic ganglion cells in a segment of the colon, interrupting intestinal motility
85
Anal wink absence
Suggests abuse or spinal cord injury If you lightly touch the anus it should constrict
86
Pilonidal cyst
Cysts around an ingrown hair at the top of the cleft of the butt
87
Condyloma accunatima
Anal warts
88
Perianal/perirectal abscess
Fever Painful/tender Usually polymicrobial Common in chrohn's and immunosuppressive
89
Fistula
Canal between two things, can be between rectum and vagina, rectum and urethra, etc.
90
Causes of hemorrhoid
Increased pressure!
91
Prostatitis
``` Fever Bacterial infection Pain Dysuria Sexual dysfunction ``` If you massage the prostate it can lead to bacteremia
92
BPH type
Irritative- increased frequency and urgency, nocturia Obstructive- peak urine flow is <10/15 sec, dribbling, hesitancy, double stream
93
Prostate cancer risk factors
``` Age Lifetime risk: 20% Lifetime death risk: 40% Vasectomy African americans 1.5x > Caucasian BRCA2 ```
94
Anal cancer
Squamous cell most commonly Associated with HPV Bleeding, pain, itching, nodule, change in bowel habits
95
What tissues do not have lymph that are still supplied by the vascular system?
The brain and placenta
96
Lymph fluid
Made of protein and WBS, is cloudy, clear or milky
97
Right upper extremities are drained by...
Right subclavian vein
98
Thorax and left upper extremities are drained by...
Left subclavian vein
99
3 physical signs of lymph disorders
Lymphadenopathy Lymphangitis, red streaks in the skin Lymphedema
100
Submandibular or cervical nodes normal
Less than 1 cm
101
Inguinal nodes normal
Less than 2 cm in diameter
102
Matted nodes
Group of nodes that feel connected and seem to move as a unit
103
Shotty nodes
No clinical consequence, enlargement of nodes following a viral infection
104
Extremely hard and painless nodes
Likely malignancy
105
Increased tenderness with nodes
More likely inflammation
106
Virchow node
Supraclavicular on the left side Suggests malignancy
107
Superficial cervical nodes at...
Sternocleidomastoid
108
Posterior cervical nodes along...
Anterior trapezius
109
Cervical nodes deep to...
Sternocleidomastoid
110
Inguinal and popliteal nodes
Check when patient is supine Inguinal LAD can be a scrotal or penile infection
111
Pregnant women and lymph concerns
Exposure to cat feces or litter, think toxoplasmosis
112
Facial muscles are innervated by...
CN V and VII
113
Posterior fontanelle closes...
2 months of age
114
Anterior fontanelle closes...
12-15 months
115
Anterior triangle
In front of SCM to mid line of neck
116
Posterior triangle
Behind SCM to trapezius
117
Think migraine if...
HA then nausea Blind spots
118
If aneurysm, think...
Nausea then HA Worst HA of their life. They have to mean it
119
Hippocratic facies
Sunken appearance of eyes, cheeks, temporal areas Sharp nose Dry, rough skin
120
Myxedema facies
Dull, puffy, yellowed skin Coarse, sparse hair Temporal loss of eyebrows Periorbital edema Prominent tongue
121
Hyperthyroid facies
Fine moist skin Fine hair Prominent eyes and lid retraction
122
Bell palsy facies
Asymmetry of one side of the face and eyelid not closing completely
123
Pierre-robin sequence
Triad of micrognathia, glossoptosis, palatial clefting
124
Apert syndrome
Severe maxillary and midfacial hypoplasia
125
Crouzon syndrome
Severe maxillary and midfacial hypoplasia with low set ears
126
Vellous hair
Thin, unpigmented, peach fuzz
127
Terminal hair
Coarse, pigmented, scalp and eyebrows
128
Eccrine glands
Wide distribution, regulate temperature
129
Apocrine sweat glands
Stimulated by stress, axilla/groin, body odor
130
Sebaceous glands
Access skin through hair follicles, on all surfaces except soles of feet
131
Melanoma risk factors
Sun sensitivity, fair skin, exposure to sunlight or UV, family history, moles
132
Basal and squamous cell risk factors
``` Older age Radiation or sunlight Fair complexion Sun burning easily Trauma or irritation ``` Chronic exposure- squamous cell Intermittent- basal cell
133
Halo nevus
Sharp oval or circular Has a depigmented halo around it Benign
134
Intradermal nevus
Dome shaped, raised, pedunculated or hair bearing
135
Junction nevus
Flat or slightly elevated, dark brown
136
Compound nevus
Slightly elevated, indistinguishable border
137
Hair nevus
Present at birth usually, may cover large area, hair growth may occur after several years
138
Primary skin lesions
Occur as initial spontaneous manifestations of a pathological process
139
Secondary skin lesion
Result from later evolution of or external trauma to a primary lesion
140
Patch
Macule >10 mm
141
Nodule
Papule >10 mm
142
Plaque
Plateau like, >10 mm
143
Bulla
Vesicle >5 mm
144
Macerated
Soggy, soft, water saturdated
145
Where do you test for turgor on an infant?
Their abdomen
146
Salmon patches
Aka stork bites Flat, deep pink localized areas usually on mid forehead, eyelids, uppper lip and back of neck
147
Cutis marmorata
Mottled appearance of a baby when they are cold
148
Basal cell carcinoma appearance
Pearly or translucent Open sore
149
Squamous cell carcinoma presentation
Elevated growth with central depression Scaly red. Patch May have crusted
150
Kaposi sarcoma
Found most commonly in immunosuppressed patients Soft, vascular, bluish purple, painless lesions
151
Alopecia are at a
Sudden, rapid, patchy loss of hair usually from scalp or face
152
Scarring alopecia
Replacement of hair follicles with scar tissue Permanent hair loss
153
Traction alopecia
Hair loss from the result of prolonged, tightly pulled hairstyles
154
Hirsutism
Growth of terminal hair in women in the male distribution pattern on the face, body and pubic areas
155
Paronychia
Inflammation or infection between nail fold and nail plate, causes purulent drainage
156
Beau lines
Associated with coronary occlusion, hypercalcemia
157
White banding aka terry nails
Associated with cirrhosis, chronic congestive HF, adult onset DM and age
158
Measles
Rubeola Koplik spots on the buccal mucosa Macular rash on face and neck, maculopapular on trunks nd extremities
159
Rubella
Aka german measles Light pink to red maculopapular rash Reddish spots on soft palate

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