Exam #4: Lower Extremity

Question 1

Outline the classification of pulses.

Answer 1

0/4= absent 
1/4= weakly palpated 
2/4= normal
3/4= bounding
4/4= strongest & associated with thrill or bruit

Question 2

What are bounding pulses associated with?

Answer 2

Fever 
Aortic insufficiency 
Complete heart block 
Thryotoxicosis 
Systolic HTN

Question 3

Describe a technique for locating the DP.

Answer 3

1) Ask the patient to extend great toe

2) DP should be between Extensor Tendon of the Great Toe & adjacent tendon

Question 4

Where is the posterior tibial artery?

Answer 4

Posterior to the medial malleolus

Question 5

Where is the popliteal pulse?

Answer 5

Lateral 1/2 of the popliteal fossa

Question 6

What is the normal capillary refill time in the great toe?

Answer 6

3 seconds or less

Question 7

What are the causes of delayed capillary refill time in the great toe?

Answer 7

vasospasm

structural changes in the large vessels

Question 8

What is the difference between pitting and non-pitting edema?

Answer 8

Non-pitting= acute 
Pitting= chronic

Question 9

What is the criteria for pitting edema?

Answer 9

If indentation lasts more than 5 seconds after pressing in an edematous area for 5 seconds= pitting

Question 10

What causes pitting edema?

Answer 10

Systemic disease leading to protein rich exudate (CHF)

Question 11

What causes non-pitting edema?

Answer 11

Systemic disease leading to protein deficient exudate (liver & kidney problems)

Question 12

Outline the classification scheme for pitting edema.

Answer 12

1+ = 2mm
2+ = 4mm 
3+ = 6mm
4+ = 8mm

Question 13

What is a macule?

Answer 13

Non-palpable skin change less than 0.5 cm

Question 14

What is a patch?

Answer 14

Non-palpable skin change greater than 0.5 cm

Question 15

What is a papule?

Answer 15

Palpable solid skin mass that is less than 0.5cm

Question 16

What is a nodule?

Answer 16

Palpable solid skin mass that is less than 0.5cm

Question 17

What is a plaque?

Answer 17

Palpable solid skin mass that is greater than 0.5cm

Question 18

What is a vesicle?

Answer 18

Clear fluid filled skin less than 0.5 cm

Question 19

What is a bulla?

Answer 19

Clear fluid filled skin greater than 0.5 cm

Question 20

What is a pustule?

Answer 20

Cloudy pus-filled skin less than 0.5 cm

Question 21

What is an abscess?

Answer 21

Cloudy pus-filled skin greater than 0.5 cm

Question 22

What is the difference between a primary and secondary lesion?

Answer 22

Primary= initial changes in skin brought about by disease or process

Secondary= Progressive changes in primary lesion or lesion with external cause

Question 23

What is a verruca papule?

Answer 23

Wart

Question 24

What is a paronychia?

Answer 24

A nail disease that is an often-tender bacterial or fungal infection of the hand or foot where the nail and skin meet at the side or the base of a finger or toenail.

Question 25

What is onychomycosis?

Answer 25

Fungal infection of the toe nail

Question 26

What is the mnemonic for thick toe nails?

Answer 26

TOE CLYPT

T=trauma
O= onchymycosis
E= eczema 
C= circulatory problem
L= lichen planus 
Y= yellow nail syndrome 
P= psoriasis 
T= tumor

Question 27

What are the causes of dry skin?

Answer 27

• Insufficient sweat glands
• Autonomic dysfunction (DM)
• Tinea pedis
• Psoriasis
• Eczema

Question 28

What is the classification system of muscle testing?

Answer 28

0/5= No muscle movement 
1/5= See tendon contract but no movement 
2/5= Able to perform movement when gravity is not a factor
3/5= Able to perform the movement against gravity 
4/5= Slight decrease in strength 
5/5= Normal

Question 29

Describe the sensory pathway to the brain.

Answer 29

• Receptor
• DRG
• Posterior column or lateral spinothalamic tract

Question 30

What are the fibers of the spinothalamic tract associated with?

Answer 30

Patient complains of “burning or cramping” pain

• Small fibers
• Sharp & dull pain
• Temp
• Crude touch

Question 31

What are the fibers of the posterior column associated with?

Answer 31

Patient complains of “pins & needles or electric shock”

• Large fibers
• Position
• Vibration
• Fine touch

Question 32

What is your diagnosis of a patient cannot discriminate between sharp and dull?

Answer 32

Small fiber disease– spinothalamic tract

*Remember Spinothalamic = Small

Question 33

What does a lack of temperature sensation suggest?

Answer 33

Small fiber disease–spinothalamic tract

Question 34

What does a loss of vibration in >10 seconds indicate?

Answer 34

Large fiber disease– posterior column

Question 35

What does a loss of proprioception indicate?

Answer 35

Large fiber disease– posterior column

Question 36

Is the absence of an Achilles tendon reflex after 80 years an abnormal finding?

Answer 36

No, this is normal

Question 37

How are deep tendon reflexes graded?

Answer 37

0/4= hypo-reflexive i.e. lower motor neuron disease 
2/4= normal
4/4= hyper-reflexive (upper motor neuron disease, stroke)

Question 38

What spinal levels innervate the knee jerk reflex?

Answer 38

L2,3,4

Question 39

What spinal levels innervate the ankle reflex?

Answer 39

S1 & 2

Question 40

What is the Jendrassie maneuver?

Answer 40

Pulling hands apart while doing reflexes

Question 41

What is the Babinski response a sign of?

Answer 41

Upper motor neuron disease

Question 42

What is suggested if a patient is able to stand on tiptoes but not heels?

Answer 42

Peripheral neuropathy

Question 43

What is suggested if a patient is able to stand on heels but NOT tiptoes?

Answer 43

Spinal lesion