Exam #4: Lower Extremity Flashcards Preview

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Flashcards in Exam #4: Lower Extremity Deck (43):
1

Outline the classification of pulses.

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

2

What are bounding pulses associated with?

Fever
Aortic insufficiency
Complete heart block
Thryotoxicosis
Systolic HTN

3

Describe a technique for locating the DP.

1) Ask the patient to extend great toe
2) DP should be between Extensor Tendon of the Great Toe & adjacent tendon

4

Where is the posterior tibial artery?

Posterior to the medial malleolus

5

Where is the popliteal pulse?

Lateral 1/2 of the popliteal fossa

6

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

3 seconds or less

7

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

vasospasm
structural changes in the large vessels

8

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

Non-pitting= acute
Pitting= chronic

9

What is the criteria for pitting edema?

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

10

What causes pitting edema?

Systemic disease leading to protein rich exudate (CHF)

11

What causes non-pitting edema?

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

12

Outline the classification scheme for pitting edema.

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

13

What is a macule?

Non-palpable skin change less than 0.5 cm

14

What is a patch?

Non-palpable skin change greater than 0.5 cm

15

What is a papule?

Palpable solid skin mass that is less than 0.5cm

16

What is a nodule?

Palpable solid skin mass that is less than 0.5cm

17

What is a plaque?

Palpable solid skin mass that is greater than 0.5cm

18

What is a vesicle?

Clear fluid filled skin less than 0.5 cm

19

What is a bulla?

Clear fluid filled skin greater than 0.5 cm

20

What is a pustule?

Cloudy pus-filled skin less than 0.5 cm

21

What is an abscess?

Cloudy pus-filled skin greater than 0.5 cm

22

What is the difference between a primary and secondary lesion?

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

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

23

What is a verruca papule?

Wart

24

What is a paronychia?

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.

25

What is onychomycosis?

Fungal infection of the toe nail

26

What is the mnemonic for thick toe nails?

TOE CLYPT

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

27

What are the causes of dry skin?

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

28

What is the classification system of muscle testing?

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

29

Describe the sensory pathway to the brain.

- Receptor
- DRG
- Posterior column or lateral spinothalamic tract

30

What are the fibers of the spinothalamic tract associated with?

Patient complains of "burning or cramping" pain
- Small fibers
- Sharp & dull pain
- Temp
- Crude touch

31

What are the fibers of the posterior column associated with?

Patient complains of "pins & needles or electric shock"
- Large fibers
- Position
- Vibration
- Fine touch

32

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

Small fiber disease-- spinothalamic tract

*Remember Spinothalamic = Small

33

What does a lack of temperature sensation suggest?

Small fiber disease--spinothalamic tract

34

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

Large fiber disease-- posterior column

35

What does a loss of proprioception indicate?

Large fiber disease-- posterior column

36

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

No, this is normal

37

How are deep tendon reflexes graded?

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

38

What spinal levels innervate the knee jerk reflex?

L2,3,4

39

What spinal levels innervate the ankle reflex?

S1 & 2

40

What is the Jendrassie maneuver?

Pulling hands apart while doing reflexes

41

What is the Babinski response a sign of?

Upper motor neuron disease

42

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

Peripheral neuropathy

43

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

Spinal lesion